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Haem Flashcards

1
Q

Smear cells

A

CLL

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2
Q

Philadelphia chromosome

A

9:22
BCR-ABL
CML (but can be associated with AML/ALL)
Imatinib (TK inhibitor)

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3
Q

Auer rods

A

AML

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4
Q

Tear drop poikilocytes and JAK2

A

Myelofibrosis

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5
Q

pruritis and raised haemoglobin after shower (aquagenic pruritis)

A

Polycythaemia (Rubra) Vera

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6
Q

Acute promyelocytic leukemia (APML)

  • translocation and its name
  • common presentation
A

t(15:17)
PML-RARA translocation
Still has Auer rods like AML

Presents with bleeds (DIC common)

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7
Q

61yo with CLL
Presents with pneumonia, haemoptysis, endobronchial mass, anaplastic large cell lymphoma
What is this change called?

A

Richter’s transformation
Diffuse B cell Lymphoma (DBCL)

Sheets of large lymphoid cells

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8
Q

Clumsiness, progressive weakness, personality change after chemo

A

Progressive multifocal leukencephalopathy (JC virus)

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9
Q

Massive splenomegaly (classically which leukemia? which other haem condition?)

A

CML, Myelofibrosis

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10
Q

High calcium, CLOVER LEAF nuclei, LNs

A

Adult T cell Lymphoma

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11
Q

HTLV-1 association

A

Adult T cell Lymphoma

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12
Q

Paraprotein IgM & visual disturbances

A

Waldenstroms macroglobulinaemia

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13
Q

Paraprotein IgG

A

Multiple Myeloma (or MGUS or Smouldering depending on blasts and symptoms)

<30g/dl IgG and <10% blasts for MGUS
>30g/dl IgG and >10% blasts for SM or MM

Only MM is CRAB Sxs

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14
Q

AA vs AL amyloidosis

A

AA = Chronic illness e.g. RA, IBD

AL = Multiple Myeloma

Amyloidosis is a paraproteinaemia!! Can see raised paraproteins (often less than 30)

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15
Q

Post transplant - EBV-caused disease

A

PTLD (Post transplant lymphoproliferative disease)

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16
Q

Anaplastic lymphom

A

Alk 1

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17
Q

Past histort of DVT, easy bruising, LOADS of platelets

A

ET (essential thrombocythaemia)

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18
Q

Pregnant woman with low platelets, schistocytes, neuro sxs (headache and seizures), but LOW BP

A

TTP

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19
Q

Pregnant patient with slightly low platelets in 3rd trimester (asymptomatic)

A

Gestational thrombocytopenia (not same as physiological but it is benign and no tx is needed. It is the most common cause of low platelets in pregnancy. If platelets <70 think HELLP or ITP)

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20
Q

Can’t breathe and DIC in pregnancy

A

Amniotic fluid embolism

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21
Q

Normal heam values in preg for

  • Hb
  • MCV
  • WCC
  • Platelets
  • Plasma volume
A

Normal heam values in preg for

  • Hb low
  • MCV normal or high (macrocytosis)
  • WCC high
  • Platelets low
  • Plasma volume high
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22
Q

Prolonged APTT, normal PT, prolonged bleeding time

A

vWD

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23
Q

Prolonged APTT, normal PT, normal bleeding time

A

Haemophilia

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24
Q

INR Targets

  • AF/cardioversion
  • MI!!
  • Single DVT
  • Recurrent DVTs
  • Prosthetic valve
A

INR Targets

  • AF/cardiov 2.5
  • MI 2.5
  • Single DVT 2.5
  • Recurrent DVTs 3.5
  • Prosthetic valve 3.5

Lower = more clots
INR within 0.5 of target is satisfactory

Rule of thumb - everything except recurrent DVTs/PEs and some prosthetic valves is 2.5 target!

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25
Q

Is heparin intrinsic/extrinsic pathway and APTT or PT

A

intrinsic pathway and APTT

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26
Q

Is warfarin intrinsic/extrinsic pathway and APTT or PT

A

Extrinsic and PT

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27
Q

Anaemic with frontal bossing and XR: hairs on end

A

Thalassaemia

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28
Q

Test of choice for hereditary spherocytosis

A

Eosin-5-maleimide test

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29
Q

Membrane defect RBCs

A

Spectrin deficiency –> hereditary sphero/elliptocytosis

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30
Q

Heinz bodies

A

G6PD

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31
Q

Warm haemolytic anaemias

  1. antibody type
  2. blood film
  3. causes
A
  1. IgG
  2. Spherocytes
  3. CLL, SLE, methyldopa
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32
Q

Cold Agglutinin disease (Cold HA)

  1. antibody type
  2. Associated with
  3. causes
A
  1. IgM
  2. Raynaud’s
  3. Mycoplasma, EBV
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33
Q

Donath-Landsteiner antibodies

A

Paroxysmal cold haemoglobinuria (PCH)

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34
Q

Ham’s test or immunophenotype

A

Paroxysmal nocturnal haematuria

complement mediated, morning haematuria

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35
Q

Hypercellular BM

A

CML (but maybe other leukemias too)

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36
Q

Prognostic factors in CLL

A

Good: hypermutated Ig gene, 13q14 deletion
Bad: CD38+ve, 11q23, 17p, LDH raised

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37
Q

Owl eyed cells

  • Virus
  • Cancer
A

Cytomegalovirus

Reed Sternberg - Hodgkin’s lymphoma

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38
Q

What would you give these patients (transfusion)?

  1. triple AAA surgery
  2. Elective Caesarean section
  3. Past transfusion, allergy to plasma proteins
A
  1. Cross-match
  2. Group and save
  3. Washed red cells
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39
Q

Transfusion

Acute SOB, dry cough, hypoxia

A

Transfusion Related Acute Lung Injury

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40
Q

Transfusion

Febrile with collapse

A

Bacterial infection

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41
Q

Transfusion

Jaundice and anaemia a few days later

A

Delayed haemolytic reaction

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42
Q

Thalaessaemia pt with tan and diabetes

A

Haemosiderosis (focal iron overload)

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43
Q

Sickle cell anaemia pt with short stature and poor cardiac function

A

Iron overload

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44
Q

Old lady gets 4 units of blood and feels unwell + basal creps+ankle oedema

A

Fluid overload - TACO

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45
Q

Seizures and schistocytes

A

TTP

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46
Q

Pelger Huet cells, hyposegmented neutrophils

A

Myelodysplastic syndromes

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47
Q

> 20% blasts

A

leukemia

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48
Q

haemolysis after antimalarials

A

Glucose-6-Phosphate Dehydrogenase Deficiency

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49
Q

6 features of myelofibrosis

A
  1. pancytopenia
  2. leucoerythroblastic picture
  3. Massive splenomegaly
  4. dry tap
  5. tear drop (poikilocytes/dacrocytes)
  6. Some are JAK2+
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50
Q

Cabot rings

A

Megaloblastic anaemia

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51
Q

Factor V Leiden pathogenesis

A

Impaired degradation of factor V by protein C

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52
Q

Buerger disease

A

Vasculitis in smokers (corkscrew arteries)

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53
Q

Dry cough, dyspnoea and fever post transfusion

A

TRALI

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54
Q

Tartrate resistance acid phosphatase (TRAP) associated with which condition?

A

Hairy cell leukemia

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55
Q

Clover leaf appearance of cells and high calcium

A

Adult T cell lymphoma

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56
Q

Smudge/smear cells

A

CLL

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57
Q

Bleeding and thrombosis with high platelets

A

Essential

Thrombocythaemia

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58
Q

Essential Thrombocythaemia treatment

A

Hydroxyurea + anagrelide

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59
Q

Macrocytic anaemia and stomatitis

A

B12 deficiency

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60
Q

Pregnant greek patient with father who is on warfarin and sister had a DVT

A

Antithrombin III deficiency

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61
Q

Transfusion in past with allergy plasma proteins

A

Washed red cells

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62
Q

Splenectomy is useful in

The PIIES - what does the acronym stand for?

A

Thalessaemia

Pyruvate kinase deficiency
ITP
Immune HA
Elliptocytosis
Spherocytosis
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63
Q

Cold AI HA causes

A

IgM
Cold LID

Lymphoproliferative disease (lymphomas and leukaemias)

Infections (mycoplasma/EBV)

Don’t know (idiopathic)

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64
Q

Paroxysmal Nocturnal Haematuria signs

A

PNH is also the acronym

Pancytopenia
New thrombus
Haemolytic anaemia

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65
Q

Basophilic stripping

A

ß-thal and lead poisoning

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66
Q

Acanthocytes

  1. another name
  2. when do you see?
A
  1. Spur cells

2. Hyposplenism

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67
Q

Anisopoikilocytosis

  1. meaning
  2. conditions associated
A
  1. different size and shapes (respectively)
  2. anaemias e.g:
    - IDA
    - ß thalassaemia
    - hereditary spherocytosis
    - B12 deficiency
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68
Q

Target cells seen in which 3 conditions?

A

3 Hs

Hepatic pathology
Hyposplenism
Haemoglobinopathies

69
Q

Paroxysmal cold haemoglobinuria

A

Children, acute onset haemolysis in cold temperatures

70
Q

Aplastic anaemia causing drugs (4)

A

4 C’s

Carbamazepine
Chloramphenicol
Cytotoxics
anti-Convulsants (e.g. phenytoin)

71
Q

ALP in MM

A

NORMAL despite bone lesions (but raised calcium)

MM activates osteoclasts but shuts off ALP producing osteoblasts hence just destruction and no rebuilding which would cause the raised ALP

72
Q

TTP signs and symptoms

A

MARCH Low platelets

MAHA
A fever
Renal failure
CNS signs --> seizures etc.
Haematuria/proteinuria
73
Q

Massive transfusion with low platelets after

A

Happens if you don’t replace platelets too

74
Q

Smoker with COPD, high Hb and low plasma volume

A

Reactive polycythaemia

low plasma volume AND high Hb

75
Q

Polycythaemia and not dehydrated, what happens to RBC mass?

76
Q

ßthal minor presentation

A

35 year old with tiredness

77
Q

Mild vWD - which drug can they take before seeing the dentist?

A

Desmopressin (releases intracellular store of vWF)

78
Q

How to differentiate between acute haemolytic transfusions & febrile non-haemolytic transfusion reactions? (In exams!)

Which is more common?

A

Acute haemolytic - BP changes due to RBCs being broken down

Febrile non-haemolytic - no BP changes as RBCs not being broken down

Febrile non-haemolytic more common

79
Q

Transfusion reactions timelines:

  • Anaphylaxis
  • Acute haemolytic
  • Febrile non-haemolytic
  • Transfusion related lung injury
  • Delay haemolytic
  • Secs to mins
  • Mins to 1hr
  • 1-6hrs
  • 2-10 days
A

Anaphylaxis
- Secs to mins

Acute haemolytic
- Mins to 1hr

Febrile non-haemolytic
- 1-6hrs

TRALI
- 1-6hrs

Delayed haemolytic
2-10 days

80
Q

Itchiness of the skin is likely to be a feature of one of the following?

a. Hepatitis
b. Intravascular haemolysis
c. Polycythaemia vera
d. Gallstones

A

a. Hepatitis

81
Q

The wall of vessels expresses anti-thrombotic factors why is this?

a. Because it secretes Tissue factor
b. Because it secrete Thrombomodulin
c. Because it secretes Von Willebrand factor

A

b. Because it secretes Thrombomodulin

82
Q

Which feature is characteristic of acute lymphoblastic anaemia (ALL)

a. anaemia and thrombocytopenia
b. neutropenia
c. macrocytosis
d. raised lymphocytes
e. eosinophilia

A

b. neutropenia

Patients with ALL can have high, normal, or low whitebloodcell (lymphocyte) count (WBC), but will usually exhibit neutropenia.

Extra info: If this question had asked about CLL instead, it is commonly associated with granulocytopenia and smudge cells.

83
Q

Which clotting factor falls most rapidly after administering warfarin?

A

Factor VII

Plasma half-life of vitamin K-dependent factors 
II = 72h
VII = 4-6h
IX = 48 hours
Protein C = 6-7 hours
84
Q

A patient has a massive splenomegaly, and JAK2 V617F mutation with a leucoerythroblastic picture and tear-drop poikilocytes. What do they have?

A

Myelofibrosis (also known as osteomyelofibrosis)

JAK2 mutation occurs in 97% of Polycythaemia Vera, 50-60% of primary myelofibrosis [1].
Raised levels of Poikilocytes (also known as da-cro-cytes (Remember they are the ‘da-cry-cells’)), which are tear drop shaped, – are characteristically found in Beta Thalassemia major and myelofibrosis – resulting in splenomegaly. Therefore the only diagnosis that matches the question is Myelofibrosis (Pathophysiology = Myelo-fibr-osis = Bone marrow-fibrin-formation, or (read backwards) process of formation of fibrin in bone marrow).

85
Q

An African man, with Burkitt’s lymphoma is given Rasburicase. He develops haematuria with irregularly contracted cells. What is the cause?

A

Glucose-6-phosphate dehydrogenase deficiency

86
Q

A patient required an aortic valve replaced 3 months ago. They have now come back a few weeks later with jaundice, Hb-urea (haemoglobinuria), and raised reticulocytes. What is the cause?

A

Mechanical Haemolytic Anaemia

87
Q

Transfusion reactions

●	Allergic reaction
●	TRALI
●	Delayed transfusion reaction
●	Transfusion-related haemosiderosis
●	ABO incompatibility
  • A man requires a 6 unit transfusion after a traffic collision, and two hours later becomes breathless, feverish, and tachycardic
  • A thalassemia patient presents with malaise and erectile dysfunction
  • Loin pain and blood in urine 10 mins after transfusion
  • Man feels itchy after transfusion, calms down with cetirizine
  • A lady with myelodysplastic syndrome requires regular monthly blood transfusions. 10 minutes after her latest transfusion she becomes tachycardic, has transfusion site pain, and is hypotensive
  • Man gets haemolysis 7 days after transfusion
A
  • A man requires a 6 unit transfusion after a traffic collision, and two hours later becomes breathless, feverish, and tachycardic - TRALI
  • A thalassemia patient presents with malaise and erectile dysfunction Transfusion-related haemosiderosis
  • Loin pain and blood in urine 10 mins after transfusion - ABO incompatibility
  • Man feels itchy after transfusion, calms down with cetirizine - Allergic reaction to proteins in donor blood
  • A lady with myelodysplastic syndrome requires regular monthly blood transfusions. 10 minutes after her latest transfusion she becomes tachycardic, has transfusion site pain, and is hypotensive - ABO incompatibility
  • Man gets haemolysis 7 days after transfusion- Delayed transfusion reaction
88
Q
  • 2 with reduced platelets:
    • one in first trimester (24 x10^9/L)
    • one in third (94 x 10^9/L)
  • One whose cousin had antithrombin deficiency and wanted to get checked. Everything normal except Protein S which was mildly decreased.
  • One woman with swollen leg in first trimester of pregnancy
  • One woman after placental abruption and surgery has low fibrinogen, prolonged APTT, PT and low fibrinogen
A

-

- ITP
- Gestational thrombocytopaenia - Normal in pregnancy - DVT - DIC
89
Q

Prolactinoma vs non-functioning adenoma vs TSHoma

  • Woman comes in with bitemporal hemianopia, 2cm mass, and a raised prolactin 1400?
  • Woman comes in with no visual change, 4mm mass, and raised prolactin 1400?
  • Raised prolactin, normal TSH, raised T4
  • High TSH low T4
A
  • Non-functional macroadenoma
  • Prolactinoma (would be certain if prolactin >6000)
  • TSHoma
  • Hypothyroidism
90
Q
  • HIV patient
  • Girl receiving chemotherapy for leukaemia ‘Halo’ sign on CXR
  • Lower lobe pneumonia in a 22 year old, Gram-positive diplococci
  • Upper lobe cavitation + alcoholic
  • Smoker back from holiday in Spain, also hyponatraemic and confused
A
  • Pneumocystic jirovecii pneumonia
  • Aspergillus fumigatus
  • Streptococcus pneumoniae
  • Klebsiella pneumoniae
  • Legionella pneumophila
91
Q
  • AIDS person with meningitis
  • Water polo player with itchy scaly rash on lateral toe then moved along lateral side of foot
  • Pityriasis versicolor
  • Lady came back from visiting her sister in Arizona with systemic sx - fever etc
  • Man in his 60s with poorly controlled diabetes presents with rapidly progressing periorbital swelling, sinus pain, confusion and sinusitis
A
  • Cryptococcus neoformans
  • Trichophytum rubrum
  • Malassezia furfur
  • Coccidioides spp.
  • Rhizopus spp. causing mucomycosis
92
Q
  • Which test is used to detect beta thalassaemia?
  • How to monitor therapy in someone with polycythaemia vera?
  • Test for autoimmune haemolytic anaemia?
A
  • High performance liquid chromatography
  • Haematocrit & haemoglobin
  • Direct antiglobulin test
93
Q

What is done to blood donations to reduce GvHD in immunosuppressed patients?

A

Irradiation/leukodepletion

94
Q

VTE recurrence risk, how does being male affect it

A

Increase x3

95
Q

Smear cells on blood film. Diagnosis?

A

Chronic lymphocytic leukaemia

96
Q

Woman on a DOAC wants advice for pregnancy, has never had problems. What should she do?

A

Change to low-molecular weight heparin

97
Q

Patient on low-molecular weight heparin, what could you measure to monitor this?

A

Anti-Xa assay

98
Q

Rank the following in order of highest to lowest reticulocyte count

a. Anaemia secondary to low dose myelosuppressive chemotherapy
b. Hereditary spherocytosis
c. ITP
d. Occult GI blood loss
e. Severe aplastic anaemia

A

b. Hereditary spherocytosis
d. Occult GI blood loss
c. ITP
a. Anaemia secondary to low dose myelosuppressive
e. Severe aplastic anaemia

99
Q

62 y/o woman attends GP with tachycardia and fatigue. FBC chows macrocytic anaemia, thrombocytopenia, and neutropenia. The blood film shows neutrophils have reduced granularity and lobation, and there is no polychromasia. Rank the following in likelihood of being the diagnosis:

a. Aplastic anaemia
b. Autoimmune thrombocytopenic purpura
c. B12 deficiency
d. Chronic lymphocytic leukaemia
e. Myelodysplastic syndrome

A

e. Myelodysplastic syndrome
a. Aplastic anaemia
d. Chronic lymphocytic leukaemia
b. Autoimmune thrombocytopenic purpura
c. B12 deficiency

100
Q

45 y/o man attends GP with fatigue and easy bruising. He has recently returned from India where he had a self-resolving episode of jaundice and malaise. Blood tests show a pancytopenia with low reticulocytes. What is the most likely diagnosis?

A

Aplastic anaemia

101
Q

A patient with fatigue and mild jaundice is found to have spherocytes on a blood film and a positive DAT test (Coombs test). What is the most likely diagnosis?

A

Autoimmune haemolytic anaemia

102
Q

At what temperature can platelets be stored for transfusion for 7 days?

A

20 - 24 °C

103
Q

A 25 y/o requires anticoagulation during the first trimester of pregnancy. Which anticoagulant should be used?

A

Enoxaparin

104
Q

What is Imatinib used to treat?

A

Chronic myeloid leukaemia

105
Q

25 y/o woman presents with chest pain and difficulty breathing. She has sustained swelling of the face and neck and a large supraclavicular mass which is biopsied. Biopsy reveals malignant cells with reactive fibrosis and eosinophilia.

A

Hodgkin’s lymphoma

106
Q

What naturally occurring antibody will be in the serum of an A negative person?

A

Anti-B IgM

107
Q

35 y/o becomes acutely unwell after being given Misoprostol to induce labour. She is shivering, clammy, and vomiting. She is tachycardic and hypotensive. Her INR is 1.8, aPTT is prolonged, fibrinogen is low, and D-dimer is elevated. What is the most likely diagnosis?

A

Disseminated intravascular coagulation

108
Q

An O negative pregnant woman undergoes amniocentesis. What intervention does this indicate?

A

Anti-D immunoglobulin

109
Q

Venetoclax is a BCL2 inhibitor used for B-cell CLL. Which cellular process does this act on?

110
Q

A 55 year old man attends his GP with severe fatigue and back pain. Investigations:

Creatinine 635 (high)
IgG 3.5 (low)
IgM 0.3 (low)
Serum protein electrophoresis – no paraprotein
Kappa light chains 0.9 (low)
Lambda light chain 1970 (very high)
K/L ratio 0.0005 (low)
What is the cause of the renal failure?
A

B-cell leukaemia

111
Q

Which coagulation factor falls fastest after Warfarin initiation?

112
Q

Why is sickle cell anaemia not symptomatic for the first 3 months of life?

A

Foetal haemoglobin doesn’t contain beta haemoglobin chains

113
Q

Middle aged man with recent GP attendance for pruritis has a stroke. His haemoglobin is high and he has an acquired JAK V617F mutation. What is the most likely diagnosis?

A

Polycythaemia rubra vera

114
Q

72 y/o man with cervical lymphadenopathy and lymphocytosis. Blood film shows small mature lymphocytes and some smear cells. Cells are CD5 and CD19 positive. What is the most likely diagnosis?

A

Chronic lymphocytic leukaemia

115
Q

Which stage of pregnancy has the highest risk of VTE?

a. 1st trimester
b. Post-amniocentesis
c. 2nd trimester
d. 3rd trimester
e. Post-partum

A

e. Post-partum

116
Q

Which of the following is not usually found in multiple myeloma?

a. Anaemia
b. Humoral immune dysfunction
c. Osteolytic bone lesions
d. Renal impairment
e. Splenomegaly

A

e. Splenomegaly

117
Q

What cell type mediates acute graft vs. host disease in allogeneic stem cell transplant?

a. Donor B cells
b. Donor T cells
c. Recipient B cells
d. Recipient NK cells
e. Recipient T cells

A

b. Donor T cells

118
Q

What is the first-line treatment for chronic phase CML?

a. Ibrutinib (Bruton tyrosine kinase inhibitor)
b. Imatinib (ABL 1 tyrosine kinase inhibitor)
c. Rituximab (Anti-CD20 antibody)
d. Thalidomide (Anti-angiogenic)
e. Toilizumab (Anti-IL6 antibody)

A

b. Imatinib (ABL 1 tyrosine kinase inhibitor)

119
Q

55 y/o starts Rivaroxoban, what monitoring is required?

a. Anti-Xa assay
b. aPTT
c. INR
d. No monitoring
e. Platelet count

A

d. No monitoring (do not monitor DOACs)

120
Q

A PET scan of a Hodgkin lymphoma patient shows involvement of nodes in the supraclavicular fossa, mediastinum, inguinal region, and of the spleen. What stage disease is this?

a. Stage 0
b. Stage 1
c. Stage 2
d. Stage 3
e. Stage 4

A

d. Stage 3

121
Q

Which of the following describes the pathophysiology of beta thalassaemia major?

a. Decreased alpha globin chain production
b. Decreased beta globin chain production
c. Decreased gamma globin chain production
d. Increased alpha globin chain production
e. Increased beta globin chain production

A

b. Decreased beta globin chain production

122
Q

73 y/o woman presents to GP with fever and productive cough. Auscultation reveals a pleural rub. Her WCC is elevated at 15 and there is neutrophilia. Her haemoglobin is slightly low at 110, CRP is elevated at 98, and platelets are 210. The blood film shows left-shift and toxic granulation. What is the most likely diagnosis?

a. Acute myeloid leukaemia
b. Aplastic anaemia
c. Chronic myeloid leukaemia
d. Infectious mononucleosis
e. Reactive neutrophilia

A

e. Reactive neutrophilia

123
Q

A bleeding patient has a prolonged aPTT and PT, but normal platelets and fibrinogen. Which blood component should they be given?

a. Albumin
b. Anti-D
c. Cryoprecipitate
d. Fresh frozen plasma
e. Platelets

A

d. Fresh frozen plasma (contains clotting factors)

124
Q

A 75 y/o woman develops neutropenic sepsis secondary to myelodysplasia. Her FBC is significantly worse than 6 weeks prior, with marked pancytopenia. Blood film shows numerous large cells of primitive appearance. What is the most likely diagnosis?

a. Development of aplastic anaemia
b. Development of iron deficiency
c. Progression to acute myeloid leukaemia
d. Progression to chronic myeloid leukaemia
e. Progression to myelofibrosis

A

c. Progression to acute myeloid leukaemia

125
Q

Which of the following decreases during pregnancy?

a. Factor 8
b. Fibrinogen
c. Plasminogen activator inhibitor 1
d. Protein S
e. Von Willebrand factor

A

d. Protein S

126
Q

4 y/o girl is brought to GP because of pains in her legs and general misery for past few weeks. She is pale, has several bruises, and has generalised lymphadenopathy with large nodes. Investigations:

Hb 90 (low)
MCV 80 (normal)
WCC 25 (high)
Platelets 50 (low)
Blood film shows 80% blast cells
What is the most likely diagnosis?
a.	Acute lymphoblastic leukaemia
b.	Acute myeloid leukaemia
c.	Chronic lymphocytic leukaemia
d.	Chronic myeloid leukaemia
e.	Infectious mononucleosis
A

a. Acute lymphoblastic leukaemia

127
Q

55 y/o male smoker on furosemide has the following test results:

Hb 178 (high)
Hct 51% (high
Red cell mass 25 (low end of normal)
Plasma volume 26 (low)
What is the most likely diagnosis?
a.	High affinity haemoglobinipathy
b.	Polycythaemia vera
c.	Primary polycythaemia
d.	Relative polycythaemia
e.	Secondary polycythaemia
A

d. Relative polycythaemia
(the consequence of abnormally lowered fluid intake or of marked loss of body fluid, such as occurs in persistent vomiting, severe diarrhea, or copious sweating or when water is caused to shift from the circulation into the tissue.) Furosemide causes relative polcythemia in this case

128
Q

A 25 y/o woman with acute leukaemia needs an allogeneic stem cell transplant. She is of mixed Afro-Caribbean and European heritage with one sibling – what is the chance of that sibling being HLA identical?

a. 1:1
b. 1:1000
c. 1:2
d. 1:4
e. 1:100

129
Q

A palpable lymph node in the left supraclavicular fossa in a gastric cancer patient is known as:

a. Blumer shelf
b. Cushing’s node
c. Krukenberg tumour
d. Sister Mary Joseph node
e. Virchow node

A

e. Virchow node

130
Q

Myeloma Complications

●	Bisphosphonates                                            
●	Plasmapheresis
●	Haemodialysis
●	Radiotherapy
●	Leukapheresis

How would you manage each of the following complications?
A. Renal failure
B. Spinal cord compression
C. Prevention of pathological bone fractures
D. Hyperviscosity
E. Hypercalcemia

A 
A.	Haemodialysis
B.	Radiotherapy
C.	Bisphosphonates
D.	Plasmapheresis
E.	Bisphosphonates
131
Q

Blood Monitoring

●	None needed
●	aPTT
●	PT
●	INR 2-3
●	INR 3-4

A. Patient with AF
B. Pt with prosthetic valve and AF
C. Someone having continuous unfractionated heparin
D. Someone having low molecular weight heparin prophylaxis before surgery
E. Old lady who had cancer having aspirin and clopidogrel

A 
A.	INR 2-3
B.	INR 3-4
C.	aPTT
D.	None needed
E.	None needed
132
Q

Anaemia:

  • Thalassemia Major
  • Thalassemia Minor
  • Sickle cell trait
  • Sickle cell anaemia
  • G6PD deficiency
  • Hereditary spherocytosis
  • Folate deficiency
  • Pernicious anaemia

A. An African lady’s doctor requests a sickle cell solubility test, after blood tests show low Hb and normal MCV. The test comes back positive with some clouding of the tested blood. What is the diagnosis?
B. An African child is found to be anaemic with a low Hb and normal MCV. The doctor in the hospital has the child’s blood tested by electrophoresis to confirm the suspected diagnosis. Results show very high HbS and low HbF. What is the diagnosis
C. Haemolysis after antimalarials / malaria treatment
D. A man has spherocytes, polychromasia and reticulocytosis on blood film
E. Girl with recent diagnosis of coeliac disease, refuses to stick with a gluten free diet and now has macrocytosis

A 
A. Sickle cell trait
B. Sickle cell anaemia
C. G6PD deficiency
D. Hereditary spherocytosis
E. Folate deficiency
133
Q

Multiple Myeloma:

  • Multiple myeloma
  • Monoclonal gammopathy of undetermined significance
  • Chronic idiopathic neutropenia
  • Acute myeloid leukaemia
  • Agammaglobulinaemia
  • Lymphoplasmacytic lymphoma

A. Patient with high IgG paraprotein – (32 or 40) g/dl, back pain and loss of sensation in legs
B. Patient with IgM paraprotein and visual disturbances
C. A German lady who is asymptomatic, has low neutrophils, but no abnormal cells on film
D. A man is injured playing sports. He is found to have pancytopenia and immature myeloid cells on blood film
E. An overweight individual with diabetes has longstanding bone/back pain. They are found to have paraprotein IgA ~8g/dl, and GFR 55mls/min/1.73m^2. FBC normal and albumin normal

A

A. Multiple myeloma
B. Lymphoplasmacytic lymphoma (Waldenstrom’s macroglobulinaemia)
C. Chronic idiopathic neutropaenia
D. Acute myeloid leukaemia
E. Monoclonal gammopathy of undetermined significance

134
Q

Platelets:

  • ABO incompatibility
  • Maternal idiopathic thrombocytopenia purpura
  • Gestational thrombocytopenia
  • Increased fibrinolysis
  • Amniotic fluid embolism
  • Low Plasma Volume
  • Neutropenia
  • MAHA
  • Iron deficiency anaemia
  • Complement C7 deficiency

A. What is the most common cause of thrombocytopenia/low platelets in Pregnancy
B. Which of these options causes DIC (in pregnancy)
C. HELLP Syndrome sign
D. Normal change in pregnancy
E. Cause of Neonatal thrombocytopenia

A

A. Gestational thrombocytopaenia (70% of thrombocytopaenia in pregnancy); Pre-eclampsia (21%); Maternal idiopathic thrombocytopaenia purpura (3%)
B. Amniotic fluid embolism
C. MAHA
D. Gestational thrombocytopaenia
E. Maternal idiopathic thrombocytopaenia purpura

135
Q

56 y/o lady with SLE, has spherocytes, low Hb, raised bilirubin how do you test for diagnosis?

A

Direct antiglobulin test because has autoimmune haemolytic anaemia due to SLE

136
Q

What additional virus apart from HIV & HBV are screened for in platelet donations to pregnant women?

A

Cytomegalovirus

137
Q

Chimeric antigen receptor T-cell therapy against CD19: what type of haematological malignancy does it target?

A

B cell lymphoma/leukaemia

138
Q

Patient with low WCC and platelets, and teardrop cells on film?

A

Myelofibrosis (or another bone marrow infiltrating disease)

139
Q

HTLV1 virus is associated with which cancer?

A

Adult T cell lymphoma

140
Q

What would be the most important investigation to carry out in a 65 year old man with iron-deficient anaemia?

A

A colonoscopy/ OGD

141
Q

What is generally the minimum amount of time to treat a VTE?

142
Q

Lady with Multiple myeloma and restrictive cardiomyopathy. What will you see on heart biopsy?

A

Amyloid depositions

143
Q

Which type of cell does Rituximab target?

144
Q

Person who had a DVT many years ago (or recurrent DVTs), presents with recurrent dark bruising, and swelling over the course of 5 years, and now had pain in their leg. What is the possible cause?

A

Post-thrombotic syndrome

145
Q

Person who had negative direct coombs test but who has anaemia (low Hb), and jaundice

146
Q

Bortezomib is a proteasome inhibitor, how does this work?

A

Inhibits intracellular protein degradation, build-up and amino acid shortage kills cell

147
Q

What is the first-line treatment for CML?

A

Imatinib (BCR-ABL tyrosine kinase inhibitor)

148
Q

Vitamin deficiency that causes megaloblastic anaemia & neural tube defects?

149
Q

Transfusion threshold for platelets after trauma necessitating massive transfusion?

150
Q

Man with cyanotic heart disease has a haematocrit of 54% (high) and is found to be negative for JAK2 mutation, what is the cause of the high haematocrit?

A

Secondary polycythaemia

151
Q

Treatment for CLL with p53 mutation. What is the first line treatment?

A

Ibrutinib BTK inhibitor

152
Q

What is in urine of a multiple myeloma patient?

A

Bence-Jones protein

153
Q

Lady has newborn baby. Dat +ve, spherocytes seen. Baby jaundiced. Lady is Group A Rhesus negative, Baby is Group O Rhesus positive. Why is baby jaundiced?

a. Hereditary spherocytosis
b. G6PD
c. ABO incompatibility
d. Rhesus disease

A

d. Rhesus disease

154
Q

Acquired MAHA. What do you see?

a. Dat +ve spherocytes
b. Dat +ve fragments
c. Dat -ve spherocytes
d. Dat -ve fragments
e. Dat +ve smear cells

A

d. Dat -ve fragments

155
Q

Red cell lysis, what ion is raised:

a. Potassium
b. Sodium
c. Calcium
d. Bicarbonate

A

a. Potassium

156
Q

Sickle cell patient, spleen not felt. Low reticulocytes, very anaemic.

a. Parvovirus B19
b. Splenic sequestration
c. Normal for SCD
d. Sickle cell crisis

A

a. Parvovirus B19

157
Q

Which of the following is low during pregnancy?

a. Fibrinogen
b. Factor 7
c. Protein S
d. Plasminogen activator inhibitor 1
e. Von Willebrand’s factor

A

c. Protein S

158
Q

Person with low platelets & bruising, fever, confused. What’s going on?

a. TTP
b. HUS
c. ITP
d. APML
e. Sepsis

159
Q

Which/What cancer can the Bruton Tyrosine kinase inhibitor ibrutinib be used in?

a. Chronic myeloid leukaemia (CML)
b. Acute myeloid leukaemia (AML)
c. Acute lymphoblastic leukaemia (ALL)
d. Chronic lymphoblastic leukaemia (CLL)

A

d. Chronic lymphoblastic leukaemia (CLL)

160
Q

What is targeted in Graft vs Host disease?

a. HLA
b. pre-existing antibodies in the recipient
c. mast cell degranulation
d. ischaemia of the donated organ

161
Q

There are 5 special drug treatments. Which drug can be used to treat some malignancies and affects T cell activity?

a. Infliximab
b. Pembrolizumab
c. Rituximab

A

b. Pembrolizumab (anti PD-1 on lymphocytes)

162
Q

10 year old Nigerian boy with a neck swelling. You use a rudimentary staining kit. Stained with H and E. Starry Sky. Diagnosis?

A

Burkitt’s lymphoma

163
Q

Which of the following is expressed by vessel walls in their resting state and is anti-thrombotic?

a. Tissue factor
b. Thrombomodulin
c. Von Willebrand factor

A

b. Thrombomodulin

164
Q

Person has a blood reaction: A pregnant woman who needs anti-coagulation.

a. LMW heparin
b. Frozen Fresh Plasma

A

a. LMW heparin

165
Q

A pregnant lady is in her first trimester, and is found to have a High MCV, and a low Hb. She informs you that she hasn’t started taking any multivitamins, or supplements, since finding out she is pregnant.

A

Folate deficiency

166
Q

Which feature is most characteristic of acute lymphoblastic anaemia (ALL)

a. Anaemia and thrombocytopenia
b. Neutrophilia
c. Macrocytosis
d. Raised lymphocytes

A

d. Raised lymphocytes

167
Q

In a range of scenarios and medical conditions, the platelet count may be abnormal. Rank these conditions on the likely platelet count. Rank in the order; (1) highest platelet count to (5) lowest platelet count.

A. Rheumatoid arthritis
B. Normal pregnancy
C. Auto-immune thrombocytopenic purpura
D. Essential thrombocythaemia
E. B Thalassemia trait
A 
D. Essential thrombocythaemia
A. Rheumatoid arthritis
E. B Thalassemia trait
B. Normal pregnancy
C. Auto-immune thrombocytopenic purpura
168
Q

Cancers of the lymphatic system have highly variable natural histories. In the absence of treatment which may alter the cinical course, rank the following lymphoid cancers by their median survival. Rank in the order (1) shortest survival to (5) longest survival.
A. Chronic Lymphocytic Leukaemia (CLL) IgH variable gene mutated
B. Mantle Cell Lymphoma (MCL)
C. Diffuse Large B Cell Lymphoma (DLBCL)
D. Burkitt Lymphoma (BL)
E. Chronic Lymphocytic Leukaemia (CLL) IgH variable gene unmutated

A

B. Mantle Cell Lymphoma (MCL)
C. Diffuse Large B Cell Lymphoma (DLBCL)
E. Chronic Lymphocytic Leukaemia (CLL) IgH variable gene unmutated
A. Chronic Lymphocytic Leukaemia (CLL) IgH variable gene mutated
D. Burkitt Lymphoma (BL)

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