Haematology

Question 1

A 20 month old boy attends accident and emergency with his father
The child has refused to walk for the past 2 days having been walking unsupported for 4 months
The right knee is slightly swollen and feels warm to touch
Blood is aspirated from the knee

Which of following is likely diagnosis? 
Acute lymphoblastic leukaemia
Osteomyelitis
Von Willebrand Disease
Haemophilia A

Answer 1

haemophilia a

Question 2

How do you differentiate between haemophilia A and haemophilia B?

Answer 2

Measure factor VIII and IX levels

Question 3

How is haemophilia A inherited?

Autosomal Recessive
X-linked
Y-linked
Autosomal Dominant

Answer 3

X-linked

Question 4

The mother tells you that her father also has haemophilia A and wants to know the chances of haemophilia in any further children born to her
What is the chance of any further child having haemophilia A?

1 in 2
Can’t say because it depends on the mothers status
1 in 4
Random chance – not quantifiable

Answer 4

The chance is 1 in 4 as the mother is an obligate carrier of haemophilia

Question 5

Having established the diagnosis of severe haemophilia A with a joint bleed, what optimal treatment should you give?

Fresh frozen plasma
Plasma derived Factor VIII
DDAVP and tranexamic acid
Recombinant factor VIII

Answer 5

Recombinant factor VIII

Question 6

The father is concerned about the boy receiving factor VIII because of infections in his father –in-law related to factor VIII treatment
Which of these is not a complication of plasma derived factor VIII treatment?

Hepatitis B
HIV
Hepatitis C
Hepatitis A

Answer 6

Hepatitis A is not transmitted by concentrate

Question 7

What is the other main complication of treatment of severe haemophilia A with factor VIII concentrates?

Allergic reactions
Increased risk of thrombosis
Development of inhibitory antibodies
Addiction to factor VIII

Answer 7

development of inhibitory antibodies

Question 8

Which of the following is not a cause of thrombocytopenia

A. Acute myeloid leukaemia
B. Vitamin K deficiency
C. Aplastic anaemia
D. ITP

Answer 8

Vit K deficiency

Question 9

This patient with Thrombocytopenia has spontaneous bruising and petechiae formation which platelet count is most likely?

30
10
50
100

Answer 9

10

Question 10

Which underlying illness is not associated with ITP?

A. HIV infection
B. Vitamin C deficiency
C. SLE
D. Glandular fever

Answer 10

Vitamin C deficiency

Question 11

A 70 year old man has excessive bleeding after a colectomy for cancer

He has bleeding from his abdominal wound but not from his drain or his indwelling line

He has had surgery in the past but had no abnormal bleeding
Which is the most likely cause of this?

A. Severe haemophilia A
B. Von Willebrand Disease
C. LMWH prophylaxis
D. Surgical

Answer 11

surgical bleeding

Question 12

A 65 year old man takes aspirin because of a previous history of TIA. How does aspirin work?

It inhibits thrombin
It reduces platelet aggregation
Inhibits coagulation factor production
Inhibits vitamin D

Answer 12

Aspirin inhibits platelet function by inhibiting COX-1

Question 13

A 21-year old medical student uses the combined oral contraceptive. She is clinically well

Which of the following is true?
A. She has an increased risk of stroke
B. She has a reduced risk of pulmonary embolism
C. She may bleed more easily from injuries
D. She has a family history of her mother and sisters suffering from pulmonary embolus

Answer 13

She has an increased risk of stroke and VTE

Question 14

Which of the following could be present and contribute further to her VTE risk?

A. Hypercholesterolaemia
B. Factor V Leiden
C. Von Willebrand factor deficiency
D. Diabetes Mellitus

Answer 14

Factor V Leiden