Haematology Flashcards
1
Q
- Blood group
A woman with BO positive blood and her partner with AB positive blood have a
child together. Which of the following cannot be the child’s blood type?
A. AB positive
B. BB positive
C. AO positive
D. AA positive
E. BB negative
A
D
2
Q
- Blood transfusion
A 24-year-old man is involved in a road traffic accident and rushed to accident and
emergency accompanied by his mother who was unharmed. An examination shows
severe abdominal injuries, peripheral cyanosis and cold extremities. The doctor on
call decides a blood transfusion is necessary. The mother thinks the patient is blood
group B negative but is unsure. The most appropriate blood group to give the
patient is?
A. Group O positive blood
B. Group B positive blood
C. Group B negative blood
D. Group O negative blood
E. Group A negative blood
A
D
3
Q
- Epistaxis
A 16-year-old boy presents to his GP complaining of nosebleeds and bleeding after
brushing his teeth. He is unsure of how long this has been occurring but decided to
seek advice after having to continually excuse himself from lessons. On examination
you notice he has some skin bruises. A blood test shows a prolonged bleeding time
and activated partial thromboplastin time (APTT), while platelet count and
prothrombin times are all normal. The most likely diagnosis is:
A. Von Willebrand disease
B. Liver disease
C. Disseminated intravascular coagulation
D. Congenital afibrinogenaemia
E. Glanzmann’s thrombasthenia
A
A
4
Q
- Painful leg
A 22-year-old Caucasian woman presents with a 1-day history of a painful right
leg which is erythematous on appearance and tender on palpation. She states that
she has had this problem many times in the last few years and her family has also
suffered from similar problems. Her grandmother died of a pulmonary embolism.
The most likely diagnosis is:
A. Antithrombin deficiency
B. Factor V Leiden mutation
C. Protein S deficiency
D. Lupus anticoagulant
E. Protein C deficiency
A
B
5
Q
- Shortness of breath
A 44-year-old Asian female presents with a two-month history of shortness of
breath and lethargy. She denies any intolerance to the cold or any changes in her
weight and on examination appears slightly pale. She states that she has recently
become a vegetarian. A blood film shows the presence of elliptocytes and blood
results show the following:
Haemoglobin 9.9 g/dL
Mean cell volume (MCV) 75 fL
Ferritin Low
The most likely diagnosis is:
A. Iron deficiency anaemia
B. Sideroblastic anaemia
C. Anaemia of chronic disease
D. Thalassaemia trait
E. Hereditary elliptocytosis
A
A
6
Q
- Malaise (1)
A 47-year-old teacher complains of difficulty maintaining her concentration at
work teaching secondary school children. She states that over the last four months
she has become increasingly tired and easily fatigued. She has noticed it has
become more difficult for her to lift books, rise from her chair and she has also
noticed a tingling sensation in her fingers. Examination shows a positive babinski
sign and absent reflexes. A blood test reveals the following:
Haemoglobin 10 g/dL
MCV 103 fL
The most likely diagnosis is:
A. Hypothyroidism
B. Vitamin B12 deficiency
C. Folic acid deficiency
D. Liver disease
E. Alcohol toxicity
A
B
7
Q
- Malaise (2)
A 55-year-old man complains of a 4-week history of general malaise and fatigue,
he has also noticed his trousers have become more loose fitting. A blood test shows
the following results:
Haemoglobin 12 g/dL
MCV 90 fL
Platelet count 250 × 109/L
WBC 10 × 109/L
Serum iron 10 μmol/L
Total iron-binding capacity 40 μmol/L
Serum ferritin 160 μg/L
The most likely diagnosis is:
A. Thalassaemia
B. Iron deficiency anaemia
C. Anaemia of chronic disease
D. Macrocytic anaemia
E. Aplastic anaemia
A
C
8
Q
- Fatigue
A 43-year-old woman suffers from Crohn’s disease. A blood test shows the
following results:
Haemoglobin 10.5 g/dL
MCV 120 fL
Platelet count 300× 109/L
The most likely diagnosis is:
A. Vitamin B12 deficiency
B. Iron deficiency
C. Hypothyroidism
D. Folic acid deficiency
E. Anaemia of chronic disease
A
A
9
Q
- Collapse
A 45-year-old man collapses at home and is brought to accident and emergency. He
has a fever at 39.5°C and blood pressure is 90/60 mmHg, although he is in a lucid
state. Bruises can be seen on his skin which he remembers being present before he
fell. Blood tests show the patient to have a normocytic anaemia with a low platelet
count and increased fibrin split products. The most likely diagnosis is:
A. Warm autoimmune haemolytic anaemia
B. Cold autoimmune haemolytic anaemia
C. Paroxysmal nocturnal haemoglobinuria
D. Disseminated intravascular coagulation
E. Thalassaemia minor
A
D
10
Q
- Microcytic anaemia
A 23-year-old Asian man presents to his GP complaining of shortness of breath
following exercise. He has always been a little unfit and decided to start going to
the gym but noticed that even after 4 weeks he is still quite short of breath. He
denies any coughing or wheezing and on examination you notice mild pallor but
the patient says he has always been slightly pale in colour. Investigation results are
given below:
Haemoglobin 12 g/dL
MCV 70 fL
Serum iron 14 umol/L
Ferritin 60 ug/L
Transferrin saturation 35 per cent
Mean cell haemoglobin 22 pg
Haemoglobin electrophoresis HbA2 increased
The most likely diagnosis is:
A. α thalassaemia trait
B. Anaemia of chronic disease
C. β thalassaemia trait
D. Haemoglobin H disease
E. Iron deficiency anaemia
A
C
11
Q
- Iron store
A 29-year-old woman complains of a 1-week history of weakness and malaise, she
has recently become a vegetarian and eats mostly green vegetables and drinks lots
of tea during the day. She is apyrexial and has a C-reactive protein (CRP) <5. You
suspect an abnormality of the patient’s iron stores. What is the most appropriate
investigation to determine iron store levels?
A. Bone marrow biopsy
B. Serum ferritin
C. Serum transferrin
D. Total iron binding capacity
E. Serum iron
A
B
12
Q
- Peripheral blood smear
A 60-year-old man presents with abdominal pain and a cupful of haematemesis.
On examination he is noted to have ascites, hepatomegaly and a very enlarged
spleen extending to the right iliac fossa. His initial blood tests reveal a
leukoerythroblastic picture with a haemoglobin of 8, white cell count (WCC) of 3
and platelets of 120. A diagnosis of myelofibrosis is made. What is most likely to
be seen on the peripheral blood smear?
A. Schistocytosis
B. Sickle cells
C. Spherocytes
D. Dacrocytes
E. Target cells
A
D
13
Q
- Blood transfusion complications
A 65-year-old woman suffers significant bleeding during a difficult bowel resection
and is prescribed three units of blood after the operation is completed. It is the first
time she has required a blood transfusion and her details are checked carefully.
Approximately 4 hours after the transfusion the patient feels acutely unwell and
complains of fever, chills and a dry cough. Blood pressure is 110/80 mmHg,
temperature 38°C and oxygen saturation is 94 per cent. The most likely diagnosis is:
A. Immediate haemolytic transfusion reaction
B. Febrile non-haemolytic transfusion reaction
C. Delayed haemolytic transfusion reaction
D. IgA deficiency
E. Transfusion-related lung injury
A
E
14
Q
- Limb numbness
A 52-year-old woman presents complaining of a two-month history of increasing
fatigue and numbness in both of her arms and legs. She lives at home with her
husband and has found it difficult coping with the daily activities of living. She
suffers from hypothyroidism which is well controlled with thyroid replacement
medication. A peripheral blood smear shows hypersegmented neutrophils. A blood
test reveals the following:
Haemoglobin 10 g/dL
Mean corpuscular volume 110 fL
Platelets 150 × 109/L
Liver function tests:
ALT 25 IU/L
AST 27 IU/L
GGT 22 IU/L
ALP 100 IU/L
Urea 5 mmol/L
Creatinine 100 μmol/L
The most likely diagnosis is:
A. Thrombotic thrombocytopenic purpura
B. Iron deficiency
C. Folic acid deficiency
D. Liver disease
E. Pernicious anaemia
A
E
15
Q
- Bleeding abnormality
During a busy ward round you are asked to visit a patient the consultant has not
had an opportunity to see. The only details you are given are that the patient is
female and was admitted the previous day with bleeding abnormalities, you are
given the results of her blood investigations:
Prothrombin time Unaffected
Partial thromboplastin time Prolonged
Bleeding time Prolonged
Platelet count Unaffected
What is the most likely diagnosis?
A. Factor V deficiency
B. Warfarin therapy
C. Glanzmann’s thrombasthenia
D. Bernard Soulier syndrome
E. Von Willbrand disease
A
E
16
Q
- Fever
A 14-year-old girl is brought to clinic by her parents who have been worried about a
fever the patient has had for the last week. The patient looks pale and unwell. Blood
tests reveal a neutropenia with normal red blood counts (RBCs) and platelets. A bone
marrow exam reveals no abnormalities. The patient has been otherwise fit and well.
There is no organomegaly or lymphadenopathy. The most likely diagnosis is:
A. Acute myeloid leukaemia
B. Aplastic anaemia
C. Acute lymphoblastic leukaemia
D. Bacterial infection
E. Thrombotic thrombocytopenic purpura
A
D
17
Q
- Pruritus
A 65-year-old man presents with a chronic history of headaches and occasional
dizziness. He hesitantly mentions that he experiences severe pruritus, especially
after hot showers and baths. Blood pressure is 160/85 mmHg. A full blood count
(FBC) reveals a haemoglobin of 20 g/dL, MCV of 94 fL, platelet count of 470 × 109/L
and WBC count of 7.8 × 109/L
The most likely diagnosis is:
A. Polycythemia vera
B. Idiopathic erythrocytosis
C. Essential thrombocythaemia
D. Myelofibrosis
E. Chronic myeloid leukaemia
A
A
18
Q
- Auer rods
A 29-year-old woman complains of tiredness, especially during activity. On
examination the patient appears pale. Auer rods and schistocytes can be seen on
peripheral blood smear. The patient is referred for a bone marrow biopsy and the
extracted cells are sent for cytogenetic analysis. The most likely results are:
A. t(8:21)
B. t(15;17)
C. t(9:22)
D. t(14;18)
E. t(8;14)
A
B
19
Q
- Auer rods
A 29-year-old woman complains of tiredness, especially during activity. On
examination the patient appears pale. Auer rods and schistocytes can be seen on
peripheral blood smear. The patient is referred for a bone marrow biopsy and the
extracted cells are sent for cytogenetic analysis. The most likely results are:
A. t(8:21)
B. t(15;17)
C. t(9:22)
D. t(14;18)
E. t(8;14)
A
A
20
Q
- Glucose-6-phosphate dehydrogenase deficiency
A 27-year-old man presents with increasing tiredness and shortness of breath. A
macrocytic anaemia with reticulocytes is discovered on blood tests and smear.
Genetic analysis reveals the patient has glucose-6-phosphate dehydrogenase
deficiency. What cell type is most likely to have been seen on the blood smear?
A. Target cells
B. Pencil cells
C. Spherocytes
D. Elliptocytes
E. Schistocytes
A
E
21
Q
- Heinz bodies
A 33-year-old man travels to South Africa to take part in a safari. On arriving, the
patient takes his antimalarial tablets. A few days into his course he becomes ill
complaining of shortness of breath, pallor and bloody urine. Blood tests reveal
anaemia and reduced haematocrit, while a blood smear shows the presence of
Heinz bodies. The most likely diagnosis is:
A. Hereditary elliptocytosis
B. Glucose-6-phosphate dehydrogenase deficiency
C. Hereditary spherocytosis
D. Autoimmune haemolytic anaemia
E. Microangiopathic haemolytic anaemia
A
B
22
Q
- Sickle cell anaemia
An 18-year-old African man presents with worries about his general health stating
that hypertension and sickle cell anaemia are present in his family history. The patient
denies any shortness of breath, chest pain, digit or limb changes. Blood pressure is
124/77 mmHg. What test would be appropriate to investigate sickle cell anaemia?
A. Ham’s test
B. Coombs’ test
C. Schilling test
D. Metabisulfite test
E. Osmotic fragility test
A
D
23
Q
- AML and ALL differentiation
A young patient presents with features of anaemia, neutropenia and
thrombocytopenia. A large number of blasts are present on bone marrow biopsy.
Which investigation would help differentiate between acute myeloid leukaemia
(AML) and acute lymphoblastic leukaemia (ALL)?
A. Myeloperoxidase stain
B. Sudan black B
C. Tartrate-resistant acid phosphatase stain
D. Leukocyte alkaline phosphatase
E. Auramine O stain
A
C
24
Q
- Polycythaemia rubra vera
A 47-year-old woman presents complaining of dark stools and painful fingers on
both hands. She appears plethoric and complains of severe itching, often when she
is washing. A large liver and spleen is palpable. You suspect features of
polycythaemia rubra vera and measure red cell mass and erythropoietin levels
among other tests. Which of the following is likely to be most accurate in this
patient?
A. Low erythropoietin and low red cell mass
B. Normal erythropoietin and normal red cell mass
C. Raised erythropoietin and low red cell mass
D. Raised erythropoietin and raised red cell mass
E. Low erythropoietin and raised red cell mass
A
E
25
Q
- Vegetarian patient
A 29-year-old woman presents complaining of shortness of breath, especially when
walking up stairs. She is starting to struggle with yoga classes, which were never a
problem before. She does not suffer from any medical conditions and takes no
regular medication. On examination there is pallor, heart rate is 90 and blood
pressure 119/79 mmHg. The patient mentions that she has recently become a
vegetarian and in the morning only has time for tea before heading to work. Which
of the following would you expect to be increased in this patient?
A. Myoglobin
B. Ferritin
C. Haemoglobin
D. Serum iron
E. Transferrin
A
E
26
Q
- Anaemia
A 65-year-old man presents with a chronic history of malaise, shortness of breath
and paraesthesia in his hands. He appears tired and pale while speaking and on
examination his heart rate is 115, respiratory rate 16. A Schillings test is positive
while blood tests reveal a macrocytic anaemia and a Coombs test is negative. The
most likely diagnosis is:
A. Iron deficiency anaemia
B. Haemorrhage
C. Anaemia of chronic disease
D. Pernicious anaemia
E. Autoimmune haemolytic anaemia
A
D
27
Q
- Macrocytic anaemia
A 47-year-old woman presents to clinic concerned about her recent ill health. She
has noticed over the last three months that she has been suffering from headaches,
fatigue and recurrent infections. She notes she has rarely been to the doctor before
and otherwise leads a healthy lifestyle. She decided to see a doctor when she noticed
petechial rashes appearing on her arms. On examination there is no organomegaly
and blood tests reveal an MCV of 105, a pancytopenia with the bone marrow
appearing hypocellular on biopsy.
A. Chronic myeloid leukaemia
B. Myeloproliferative disorder
C. Aplastic anaemia
D. Iron deficiency anaemia
E. Acute lymphoblastic anaemia
A
C
28
Q
- Auer rods
A 65-year-old man presents to you reporting he has become increasingly worried
about his lack of energy in the last 2 weeks. He mentions he has been increasingly
tired, sleeping for long periods and has suffered from fevers unresponsive to
paracetamol. He became increasingly worried when he noticed bleeding orginating
from his gums. A blood film shows auer rods, hypogranular neutrophils and stains
with Sudan black B. The most likely diagnosis is:
A. Acute lymphoblastic leukaemia
B. DiGeorge syndrome
C. Disseminated intravascular coagulation
D. Acute myeloid leukaemia
E. Afibrinogenaemia
A
D
29
Q
- Chronic myeloid leukaemia
A 70-year-old woman complains of tiredness, fatigue and weight loss. Blood tests
reveal an elevated WCC and on examination splenomegaly is palpated. Cytogenetics
are positive for the Philadelphia chromosome and the patient is diagnosed with
chronic myeloid leukaemia. The most appropriate treatment is:
A. Hydroxycarbamide
B. Imatinib
C. Venesection
D. Stem cell transplant
E. Dasatinib
A
B
30
Q
- Warfarin therapy
A 27-year-old woman who suffers from rheumatic mitral stenosis develops atrial
fibrillation. She is placed on warfarin therapy. What is the most appropriate target
international normalized raio (INR) range?
A. <1.0
B. 1.0–2.0
C. 2.0–3.0
D. 3.0–4.0
E. >5.0
A
C
31
Q
- Multiple myeloma
A 70-year-old woman complains of a dull pain in her lower back, especially when
bending forwards to lift things. She presents after a severe episode in the last 2
days. An x-ray reveals a lumbar compression fracture. Blood tests show a
normocytic anaemia and urine electrophoresis reveals a monoclonal gammopathy.
A diagnosis of multiple myeloma is made. Which of the following is not a recognized
cause of multiple myeloma?
A. High-dose radiation
B. Human herpes virus-8 (HHV-8)
C. HIV
D. Herbecides and insecticides
E. Hereditary
A
E
32
Q
- Hypersplenism investigation
A 44-year-old woman presents with recurrent fever, pallor, malaise and shortness
of breath. She has noticed a petechial rash on her skin and small bruises on her
arms. A blood test reveals a pancytopenia. During examination, you palpate a large
spleen. Which investigation would differentiate between hypersplenism and aplastic
anaemia?
A. Reticulocyte test
B. Direct Coombs test
C. Metabisulfite test
D. Ham’s test
E. Osmotic fragility test
A
A
33
Q
- Pernicious anaemia
A 66-year-old man presents complaining of a three-month history of weakness,
tingling in the limbs and a sore tongue. The patient notes an undesired 5 kg weight
loss over 2 weeks. A peripheral blood smear shows a macrocytic anaemia, a
Schilling test shows impaired vitamin B12 absorption and a diagnosis of pernicious
anaemia is made. Which of the following antibodies is most closely associated with
pernicious anaemia?
A. Anti-mitochondrial antibodies
B. Anti-intrinsic factor antibodies
C. Anti-gliadin antibodies
D. Anti-centromere antibodies
E. Anti-smooth muscle antibodies
A
B
34
Q
- Leukaemia investigation
A 5-year-old girl presents with her parents who have become concerned about the
small petechiae and ecchymoses on her skin. An abdominal examination reveals
hepatosplenomegaly. You suspect an acute leukaemia. The most appropriate initial
investigation for diagnosis is:
A. Chromosomal analysis of bone marrow cells
B. Cytochemical analysis of bone marrow cells
C. Direct microscopy of bone marrow cells
D. Electron microscopy
E. Flow cytometry
A
C
35
Q
- Bence–Jones protein
A 51-year-old man complains of severe, diffuse back pain. An x-ray finds several
lytic lesions in the vertebra alongside hypercalcaemia. Bence–Jones protein is
detected in the urine. What is a Bence–Jones protein?
A. IgG antibody
B. IgA antibody
C. IgE antibody
D. Light chain
E. IgM antibody
A
D
