HAEMATOLOGY

Question 1

hypersegemented neutrophils

Answer 1

macrocytic anaemia - vitB12 or folate deficiency

Question 2

management of vitB12 def anaemia

Answer 2

1g IM hydroxycobalamin 3 times a week for 2 weeks
then every 3 months

if dietary can give oral oxocobalamin daily

Question 3

management for folate def anaemia

Answer 3

oral folic acid daily for 4 months

Question 4

anaemia symptoms
neuro symptoms
lemon tinge/mild jaundice

typically middle-old age female

Answer 4

pernicious anaemia

Question 5

pancytopenia 
normocytic normochromic anaemia 
thrombocytopenia 
leukopenia
(anaemia symptoms, infections and bleeding)

Answer 5

aplastic anaemia

Question 6

definitive investigation for aplastic anaemia

Answer 6

biopsy - empty marrow or dry tap

Question 7

management of aplastic anemia

Answer 7

remove any toxinx/meds/cause
if under 50 = stem cell transplant
if over 50 = immunosuppression with cyclosporine and glucocorticoids
severe cases = blood transfusion and GCS factor

Question 8

anaemia - pallor/ fatigue/ weakness
jaundice
splenomegaly

Answer 8

haemolytic anaemia

Question 9

investigation for haemolytic anaemia

Answer 9

coombs test - positive

normocytic anaemia on bloods

schistocytes and reticulocytes on blood film

IgM = cold HA
IgG = warm HA

Question 10

management of haemolytic anaemia

Answer 10

first line = steroids (+/- rituximab)

Question 11

neonatal jaundice
splenomegaly
gallstones are common
anaemia

Answer 11

G6PD deficiency

Question 12

Investigations of G6PD def anaemia

Answer 12

diagnostic = G6PD enzyme assay

also heinz bodies and bite/blister cells on blood film

Question 13

management of G6PD def anaemia

Answer 13

avoid triggers

crisis = rehydrate and blood transfusion

Question 14

25yrs 
anaemia 
neutropenia
thrombocytopenia 
splenomegaly 
bone pain

Answer 14

AML

Question 15

management for AML

Answer 15

chemotherapy

Question 16

philadelphia chromosome
60-70yrs 
marked splenomegaly = abdo pain 
B symptoms 
and WBC at different stages of maturation

Answer 16

CML

Question 17

management of CML

Answer 17

imatinib

(hydroxyurea, a-interferon and allogenic BM transplant)§

Question 18

male child
anaemia 
thrombocytopenia = brusing, bleeding or petechiae
bone pain 
hepatosplenomegaly

Answer 18

ALL

Question 19

management of ALL

Answer 19

chemotherapy +/- immunotherapy

Question 20

adult with marked lymphadenopathy, B symptoms, bleeding and infections, anaemia

Answer 20

CLL

Question 21

investigations for CLL

Answer 21

Immunophenotyping

smudge/smear cells on blood film

Question 22

management of CLL

Answer 22

watchful waiting if caught early

immunochemotherapy

Question 23

usually after injection/infection
can be in older females
bleeding
petechiae/purpura

Answer 23

ITP

Question 24

management of ITP

Answer 24

prednisolone and IVIG

sometimes splenectomy

Question 25

adult female fever flutuating neuro signs renal failure

Answer 25

TTP

Question 26

Investigations for TTP

Answer 26

ADAMTS13 IgG

Question 27

management of TTP

Answer 27

plasma exchange corticosteroids rituximab

Question 28

hypercalcemia, renal stones, anaemia, lytic lesions (on MRI)/ bence jones proteins (urine electrophoresis)

Answer 28

Multiple myeloma

Question 29

management of multiple myeloma

Answer 29

Option 1 autologous SCT + bortezomib + dexamethasone Option 2 no SCT + thalomide + alkylating agent + dexamethasone monitor every 3 months - urine electrophoresis + blood tests acute relapses = bortezomib

Question 30

associated with EBV or c-myc translocation either presents with jaw swelling/pain OR abdo pain, distension or ascites

Answer 30

burkitt's lymphoma

Question 31

investigations for burkitt's lymphoma

Answer 31

starry sky appearance - apoptotic cells in macrophages

Question 32

management of burkitt's lymphoma

Answer 32

chemotherapy

Question 33

``` painless lymphadenopathy B symptoms alcohol consumption pain pruritus normocytic anaemia ```

Answer 33

hodgkin's lymphoma

Question 34

reed sternberg/owl shaped/multinucleate

Answer 34

hodgkin's lymphoma

Question 35

management of hodgkin's lymphoma

Answer 35

immunochemotherapy

Question 36

diagnostic Ix for hodgkin's lymphoma

Answer 36

biopsy | reed sternbery cells

Question 37

``` prolonged bleeding time lowered factor 8 epistaxis menorrhagia prolonged PT/APTT ```

Answer 37

von willebrand's disease

Question 38

management of VWD

Answer 38

mild bleeding = tranexamic acid desmopressin factor 8

Question 39

hemophilia A

Answer 39

factor 8 deficiency

Question 40

hemophilia B

Answer 40

factor 9 deficiency

Question 41

haemophilia C

Answer 41

factor 11 deficiency

Question 42

haemarthrosis haematomas prolonged bleeding after surgery or trauma

Answer 42

haemophilia

Question 43

management of haemophilia

Answer 43

IV infusion of desmopressin | and blood transfusion/correct coagulation factor deficiency

Question 44

failure to thrive in first year of life hepatoplenomegaly - swollen abdomen microcytic anaemia jaundice

Answer 44

thalassemia

Question 45

target cells on blood film | high iron/ferritin/TIBC

Answer 45

thalassemia

Question 46

management of thalassemia

Answer 46

repeated transfusion | SC infusion of deferoxamine

Question 47

management of thrombocytopenia

Answer 47

stop anticoagulation with heparin | only transfuse if pt is haemorrhaging

Question 48

``` hyperviscosity pruritus, typically after a hot bath splenomegaly haemorrhage (secondary to abnormal platelet function) plethoric appearance hypertension in a third of patients associated with JAK mutation ```

Answer 48

polycythemia vera

Question 49

management of polycythemia vera

Answer 49

venesection first line aspirin chemotherapy - hydroxyurea