Corrections

Question 1

Is eosinophilia more commonly associated with non-HL or HL?

Answer 1

HL

Question 2

What happens in myelofibrosis?

Answer 2

Bone marrow gets replaced with connective tissue (fibrosis).

Question 3

What is the JAK2 mutation associated with?

Answer 3

Myeloproliferative disorders, such as:

1) polycythemia vera

2) essential thrombocythemia

3) primary myelofibrosis

Question 4

What is the most suitable mx option for epistaxis where the bleed site is difficult to localise?

Answer 4

Anterior packing (followed by referral to ENT for posterior packing)

Question 5

Cause of a severe drop in Hb and reticulocyte suppression in sickle cell?

Answer 5

Parvovirus infection —> causes aplastic crisis (temporary arrest of red cell production in bone marrow, hence low reticulocytes)

Question 6

What is a typical cause of thrombocytopenia after surgery?

Answer 6

Heparin induced thrombocytopaenia

Question 7

Post-splenectomy patients are often given prophylactic penicillin V.

What organism does this protect them against?

What organism does it not protect them against?

Answer 7

Protects them against Strep. pneumoniae

Does not protect them against Hib (due to the production of beta-lactamases by the organism)

Question 8

Well’s score results for PE vs DVT?

Answer 8

PE: ≥4.5 (likely)

DVT: ≥2 (likely)

Question 9

As a first line investigation, what should all people with iron deficiency anaemia be screened for?

Answer 9

Coeliac disease

Question 10

DVT investigation: if proximal leg US is negative but D-dimer is positive?

Answer 10

Stop anticoagulation and repeat scan in 1 week (as still as risk of developing a clot)

Question 11

Mx of gastric MALT lymphoma?

Answer 11

H. pylori eradication

Question 12

What is the Richter’s transformation?

Answer 12

CLL can transform to high-grade lymphoma (Richter’s transformation), making patients suddenly unwell.

Question 13

What type of leukaemia is the Richter’s transformation seen in?

Answer 13

CLL

Question 14

What are some contraindications for a platelet transfusion?

Answer 14

1) Chronic bone marrow failure

2) Autoimmune thrombocytopenia

3) HIT

4) TTP

Question 15

What is used in the mx of CML?

Answer 15

Tyrosine kinase inhibitors e.g. imatinib

Question 16

Haptoglobin levels in intravascular haemolysis?

Answer 16

Reduced

Question 17

What is given to patients with polycythaemia vera to reduce the risk of thrombotic events?

Answer 17

Aspirin

Question 18

What finding is most likely on a blood film in multiple myeloma?

Answer 18

Rouleaux formation (appear as stacks of RBCs)

Question 19

What medication can be used in sickle cell to prevent further crises?

Answer 19

Hydroxyurea

Question 20

What condition does APS most commonly occur 2ary to?

Answer 20

SLE

Question 21

1ary vs 2ary prevention of clots in APS?

Answer 21

1ary –> low dose aspirin

2ary –> warfarin (ie. APS patients have lifelong warfarin post DVT/PE instead of DOAC)

Question 22

What mutation is present in sickle cell?

Answer 22

Single point mutation in beta globin gene on chromosome 11.

Results in amino acid replacement from glutamic acid to valine (HbS).

Question 23

What hypersensitivity reaction is seen in ITP?

Answer 23

Type II

Question 24

What is free Hb in the plasma bound by?

Answer 24

Haptoglobin (hence why haptoglobin levels are low in haemolysis)

Question 25

What is aplastic crisis in sickle cell?

Answer 25

Temporary cessation of erythropoesis, resulting in severe anaemia.

Pts may present with high output HF 2ary to anaemia.

Question 26

What investigation is required for diagnosis of sickle cell?

Answer 26

Hb electrophoresis

Question 27

Normally no treatment is required in ITP.

What are some cases where treatment may be required?

Answer 27

1) pt is actively bleeding

2) severe thrombocytopenia (<10)

Question 28

What is hair on end skull a sign of?

Answer 28

Chronic haemolysis (so expansion of medullary cavities)

Question 29

What type of gallstones are seen in sickle cell?

Answer 29

Pigmented (as a result of raised unconjugated bilirubin from RBC breakdown)

Question 30

What may be seen on a peripheral blood smear in sickle cell?

Answer 30

Howell Jolly bodies –> basophilic nuclear remnants of RBCs

Question 31

What shoold be monitored in HSP?

Answer 31

BP & urinalysis (for renal involvement)

Question 32

What 4 bacteria are those with sickle cell particularly susceptible to?

Answer 32

1) Neisseria meningitidis

2) Strep. pneumoniae

3) Hib

4) Salmonella

Question 33

What 4 bacteria are those with sickle cell particularly susceptible to?

Answer 33

Hair on end appearance

Question 34

Where does extramedullary haematopoesis most commonly occur in sickle cell?

Answer 34

In the liver

Question 35

Mx of acute chest syndrome in sickle cell?

Answer 35

Same as vaso-occlusive crisis i.e. analgesia & O2

PLUS antibiotics & transfusion

Question 36

When is hydroxyurea given in sickle cell?

Answer 36

from 9 months of age (except in pregnancy)

Question 37

In beta-thalassaemia major, what is required alongside repeated transfusions?

Answer 37

Desferrioxamine (to prevent complications of iron overload)

Question 38

How does SLE affect neutrophils?

Answer 38

Commonly causes neutropenia

Question 39

For a patient undergoing an elective splenectomy, when is the optimal time to give the pneumococcal vaccine?

Answer 39

2 weeks before the surgery

This timing allows for optimal antibody response to develop before the patient becomes functionally asplenic.

Question 40

Does the COCP form part of the Wells score?

Answer 40

No