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Q1: Diagnosis & Classification (3 min)
- A 70-year-old asymptomatic man has WBC 35×10⁹/L, 80 percent mature lymphocytes, smudge cells. What is the diagnosis and what three flow-cytometry findings confirm it?
- How would you distinguish this from mantle-cell lymphoma on the leukaemic phase? (CD23 vs cyclin D1, t(11;14)).
- A 50-year-old man has WBC 180×10⁹/L with myelocyte-to-neutrophil spectrum, basophilia, low LAP score, splenomegaly. What is the diagnosis and the defining molecular abnormality?
Q2: Pathophysiology (3 min)
- Explain why CLL is "slow" (BCL2 over-expression, miR-15a/16-1 deletion at 13q14, failed apoptosis vs proliferation).
- Reproduce the Döhner cytogenetic FISH hierarchy and the prognostic implications (del 17p/TP53 worst, del 13q best).
- Describe the molecular consequence of t(9;22) and how imatinib blocks it.
Q3: Staging & Treatment Indications (3 min)
- Reproduce the modified Rai and Binet staging systems with thresholds.
- List the iwCLL 2018 active-disease criteria (any one triggers treatment).
- Why is watch-and-wait correct for Binet A CLL?
Q4: Treatment (3 min)
- First-line regimen for a fit, TP53-wildtype, IGHV-mutated patient — name the components, doses and cycles (FCR).
- First-line for a TP53-mutated/del(17p) patient (ibrutinib or venetoclax-obinutuzumab — never chemo).
- First-line TKI for chronic-phase CML and the molecular response milestones at 3, 6 and 12 months.
- How would you manage a CML patient found to have the T315I mutation?
Q5: Complications & Prognosis (2 min)
- What is Richter transformation and how do you recognise it?
- TKI-specific toxicities: name one each for dasatinib, nilotinib and ponatinib.
- What is treatment-free remission and what are the eligibility criteria?