Haematology Flashcards
1
Q
Female aged 39 treated for breast cancer 4 years previously. Recent onset jaundice and hepatomegaly GP bloods: -Hb 87g/l -Reticulocyte 15 x 10^9/L (20-92) -Bilirubin 50 micromol/l conjugated -DAT negative -Nucleated RBCs on blood film What is the most likely explanation for this anaemia? A. Iron deficiency anaemia B. Anaemia of chronic disease C. Bone marrow matastases from breast cancer D. MAHA E. Autoimmune haemolytic anaemia
A
C. Bone marrow metastases from breast cancer.
2
Q
45 year old male. 3 weeks history of sore throat Recent episode of shingles EBV igG serology positive FBC: -Lymphocytes raised -Neutrophils normal -Film: reactive lymphocytes no abnormal cells -Monoclonal, kappa only Most likely diagnosis? A. B cell acute lymphoblastic leaukaemia B. Mature B cell lymphoproliferative disorder e.g. CLL C. Infectious mononucleosis D. T cell acute leukaemia lymphoma
A
B. Mature B cell lymphoproliferative disorder e.g. CLL
3
Q
Which one of the following about MDS is true?
A. Myelodysplasia has a bi-modal age distribution
B. The primary modality of treatment of MDS is by intensive chemo
C. One third of MDS patients can be expected to die from leukaemic transformation
D. There is no good correlation between the severity of the cytopenias and the overall life expectancy
E. White cell function is frequently well preserved in MDS
A
C. One third of MDS patients can be expected to die from leukaemic transformation
4
Q
Regarding aplastic anaemia- which one is true?
A. Immunosuppressive therapy is only used to treat a minority of patients with AA
B. If treated with immunosuppression, then relapse of AA occurs in less than 15% of cases
C. The cure rate of AA treated by sibling related allogeneic SCT in a patient under 40 years old is >70 %
D. Severe AA is differentiated from non-severe AA on the basis of the acquired cytogentic abnormalities in the BM
E. Leucodepletion of cellular blood products is only exceptionally undertaken for patients with AA
A
C. The cure rate of AA treated by sibling related allogeneic SCT in a patient under 40 years old is >70 %
5
Q
Which one of the following is true?
A. Telomeric shortening is a feature of both idiopathic AA and dyskeratosis congenita.
B. Development of malignancy is an uncommon complication of Fanconi anaemia
C. Single genetic defect has been identified as the underlying cause for Fanconi anaemia
D. Fanconi anaemia is usually inherited in an autosomal dominant fashion.
E. Telomeric function is considered to be unimportant in the pathophysiology of Dyskeratosis Congenita
A
A. Telomeric shortening is a feature of both idiopathic AA and dyskeratosis congenita.
6
Q
Chronic HTLV-1 is associated with an increased risk of which type of lymphoma?
A
Adult T cell leukaemia lymphoma
7
Q
Chronic HIV infection is associated with an increased risk of which type of lymphoma?
A
High grade B cell non Hodgkin Lymphoma
8
Q
H. pylori is associated with an increased risk of which type of lymphoma?
A
Gastric MALT lymphoma (marginal cell lymphoma)
9
Q
If a Blood group O RhD positive patient was transfused A RhD negative red cells, what sort of transfusion reaction would occur?
A
Acute haemolytic transfusion reaction
10
Q
What is the probability of finding an HLA donor if the patient has 2 siblings?
A
44%
11
Q
The role of conditioning in an allogeneic transplant is to: A. Eradicate the malignancy B. Suppress the patient C. To make space for the incoming cells D. All of the above E. None of the above
A
D. All of the above
12
Q
Which of these is a risk factor to develop Graft vs Host disease?
A. Degree of HLA disparity
B. Recipient age
C. Gender combination of recipient and donor
D. Stem cell source
E. All of the above
A
E. All of the above
13
Q
Newborn babies, in contrast to adults have: A. A higher Hb B. A lower WBC C. Smaller red blood cells D. The same percentage of HbF
A
A. A higher Hb
14
Q
Complications of sickle cell anaemia that are more common in adults than children include: A. Hand-foot syndrome B. Hyposplenism C. Red cell aplasia D. Splenic sequestration E. Stroke
A
B. Hyposplenism
15
Q
Siblings with sickle cell anaemia present simultaneously with severe anaemia and a low reticulocyte count - likely diagnosis? A. Splenic sequestration B. Parvovirus B19 infection C. Folic acid deficiency D. Haemolytic crisis E. Vitamin B12 deficiency
A
B. Parvovirus B19 infection
16
Q
A 6 year old Afro Caribbean boy presents with chest and abdominal pain; Hb is 63g/l, MCV 85fl and blood film shows sickle cells- likely diagnosis?
A. Sickle cell trait
B. Sickle cell anaemia
C. Sickle cell/beta thalassaemia
A
B. Sickle cell anaemia
17
Q
A 1 year old boy present with joint bleeding, Hb, WBC and platelet count are normal, aPTT is prolonged, PT is normal, bleeding time normal-most likely diagnosis? A. Haemophilia A B. Haemophila B C. Von Willebrand disease D. TTP E. Taken his mothers warfarin tablets
A
A. Haemophilia A
18
Q
A 5 year old boy of Indian ethnic origin presented with lymphadenopathy and a mediastinal mass on chest radiology.
WBC 180
Hb 93
Platelet 43
1. What is the most likely diagnosis?
2. What is the mediastinal mass?
3. What is the best technique to confirm the diagnosis?
A
- ALL
- The mediastinal mass is the thymus, which is infiltrated by T lymphoblasts
- Immunophenotyping
N.B very high white blood count in a child = leukaemia
19
Q
The risk of thrombosis is increased by: A. Reduced prothrombin B. Thrombocytopenia C. Reduced Protein C D. Elevated antithrombin E. Increased fibrinolysis
A
C. Reduced protein C
20
Q
Which factor confers the highest risk of thrombosis? A. Factor V Leiden B. Antithrombin deficiency C. Family history of thrombosis D. Reduced Factor VIII level E. 3 hour plane flight
A
B. Antithrombin deficiency
21
Q
Which agent has a delayed anti-coagulant effect? A. Vitamin K B. Unfractionated heparin C. Warfarin D. LMWH E. Aspirin
A
C. Warfarin
22
Q
How does warfarin achieve its anticoagulant effect?
A. Reduction of plasma protein C and Protein S
B. Blocks phospholipid synthesis
C. Reduction of plasma procoagulant factors
D. Acts as a cofactor for antithrombin
E. Inhibits Factors II, VII, IX and X
A
C. Reduction of plasma procoagulant factors
23
Q
Which patient is most likely to benefit from long term anticoagulation after their DVT?
A. 57 year old man after flying to Moscow
B. 27 year old woman during pregnancy
C. 33 year old woman on OCP
D. 77 year old man after hip replacement
E. 30 year old man after a long walk
A
E. 30 year old man after a long walk
24
Q
A 32 year old woman developed a DVT after removal of ovarian cyst. Her father and brother had DVTs in the past. What is the next most appropriate step?
A. Test for antithrombin deficiency
B. Recommend HRT
C. Start on long term anticoagulation
A
A. Test for antithrombin deficiency
25
A 29 year old man collapsed at work following a PE. No family history. What is the most appropriate next step?
A. Testing for factor V leiden
B. Daily aspirin
C. Continue long term anticoagulation
D. Heparin injections for long haul flights
C. Continue long term anticoagulation
26
```
A 38 year old woman had a previous DVT when taking the COCP. She then had a 2nd DVT during her 2nd pregnancy. What is the next most appropriate step?
A. Testing for factor V leiden
B. HRT
C. Continue long term anticoagulation
D. Fixed low dose warfarin
```
A. Testing for factor V Leiden
27
A 67 year old man present with DVT and weight loss. He is started on LMWH. What is the next most appropriate step?
A. Adbo-pelvic CT scan
B. Switch to DOAC
C. Switch to Warfarin
A. Abdo-pelvic CT scan
28
```
The most important cell in the initiation of normal haemostats is:
A. Thromboxane A2
B. Erythrocyte
C. Cycloxygenase
D. t-PA
E. Protein C
F. Fibrin
G. Platelet
H. Endothelial Cell
I. Antithrombin III
J. Megakaryocyte
K. Plasmin
L. Fibrinogen
M. a2 macroglobulin
```
H. Endothelial cell
29
```
The main component involved in stabilising the primary haemostatic plug is:
A. Thromboxane A2
B. Erythrocyte
C. Cycloxygenase
D. t-PA
E. Protein C
F. Fibrin
G. Platelet
H. Endothelial Cell
I. Antithrombin III
J. Megakaryocyte
K. Plasmin
L. Fibrinogen
M. a2 macroglobulin
```
F. Fibrin
30
```
A serine protease which assists in the breakdown of blood clots by binding to the clot and localising agents which break it down is:
A. Thromboxane A2
B. Erythrocyte
C. Cycloxygenase
D. t-PA
E. Protein C
F. Fibrin
G. Platelet
H. Endothelial Cell
I. Antithrombin III
J. Megakaryocyte
K. Plasmin
L. Fibrinogen
M. a2 macroglobulin
```
D. t-PA
31
```
A potent inhibitor of plasmin in the blood is:
A. Thromboxane A2
B. Erythrocyte
C. Cycloxygenase
D. t-PA
E. Protein C
F. Fibrin
G. Platelet
H. Endothelial Cell
I. Antithrombin III
J. Megakaryocyte
K. Plasmin
L. Fibrinogen
M. a2 macroglobulin
```
M. a2 macroglobulin
32
```
A single chain glycoprotein, synthesised by the liver and endothelium, which has strongly anticoagulant action and is important in the mode of action of heparin is:
A. Thromboxane A2
B. Erythrocyte
C. Cycloxygenase
D. t-PA
E. Protein C
F. Fibrin
G. Platelet
H. Endothelial Cell
I. Antithrombin III
J. Megakaryocyte
K. Plasmin
L. Fibrinogen
M. a2 macroglobulin
```
I. Antithrombin III
33
```
This product of the cyclic endoperoxides induces platelet aggregation:
A. Megakaryocytes
B. Sensitised platelets
C. Christmas disease
D. Thromboxane A2
E. Ehler-Danlos syndrome
F. Vitamin K deficiency
G. Haemophilia
H. Marfan disease
I. Autoimmune thrombocytopenia purpura
J. Prostacylcin PGI2
K. Factor VIII deficiency
L. Factor XII deficiency
M. Von willebran deficiency
```
D. Thromboxane A2
34
```
A 6 foot 7 inch rower presents to his GP complaining of easy skin bruising. On further examination he is found to have pectus excavatum, lax joints and a high-arched palate.
A. Megakaryocytes
B. Sensitised platelets
C. Christmas disease
D. Thromboxane A2
E. Ehler-Danlos syndrome
F. Vitamin K deficiency
G. Haemophilia
H. Marfan disease
I. Autoimmune thrombocytopenia purpura
J. Prostacylcin PGI2
K. Factor VIII deficiency
L. Factor XII deficiency
M. Von willebran deficiency
```
E. Ehlers Danlos Syndrome
35
```
A 62 year old overweight woman presents to the Emergency Department following a Road Traffic Accident. A full set of investigations is carried out – which shows an increased Activated Partial Thromboplastin Time (APTT) and Prothrombin Time (PT)
A. Megakaryocytes
B. Sensitised platelets
C. Christmas disease
D. Thromboxane A2
E. Ehler-Danlos syndrome
F. Vitamin K deficiency
G. Haemophilia
H. Marfan disease
I. Autoimmune thrombocytopenia purpura
J. Prostacylcin PGI2
K. Factor VIII deficiency
L. Factor XII deficiency
M. Von willebran deficiency
```
F. Vitamin K deficiency
36
```
A 25 year old man presents to the Emergency Department a day after attending his dentist for a routine check-up. After treatment at the dentists the previous day, his gums had not stopped bleeding. On investigation, his APTT and bleeding time are prolonged but a normal PT.
A. Megakaryocytes
B. Sensitised platelets
C. Christmas disease
D. Thromboxane A2
E. Ehler-Danlos syndrome
F. Vitamin K deficiency
G. Haemophilia
H. Marfan disease
I. Autoimmune thrombocytopenia purpura
J. Prostacylcin PGI2
K. Factor VIII deficiency
L. Factor XII deficiency
M. Von willebran deficiency
```
M. Von willebrand deficiency
37
```
A 16 year old girl presents to the Haematology Outpatients clinic describing a fluctuating history of easy bruising, epistaxis and menorrhagia. On investigation there is a thrombocytopaenia with increased megakaryocytes on BM examination.
A. Megakaryocytes
B. Sensitised platelets
C. Christmas disease
D. Thromboxane A2
E. Ehler-Danlos syndrome
F. Vitamin K deficiency
G. Haemophilia
H. Marfan disease
I. Autoimmune thrombocytopenia purpura
J. Prostacylcin PGI2
K. Factor VIII deficiency
L. Factor XII deficiency
M. Von willebran deficiency
```
I. Autoimmune thrombocytopenia purpura
38
```
Which protein, important in haemostasis, is vitamin K dependent but is not a serine protease?
A. Tissue factor
B. Thrombin
C. Arichidonic acid
D. Protein S
E. Activated factor X
F. Protein C
G. Vascular subendothelium
H. Factor VII
I. Vascular endothelium
J. Tissue factor pathway inhibitor
K. Platelets
L. Cyclooxygenase
```
D. Protein S
39
```
Which option is required as a cofactor for protein C activity?
A. Tissue factor
B. Thrombin
C. Arichidonic acid
D. Protein S
E. Activated factor X
F. Protein C
G. Vascular subendothelium
H. Factor VII
I. Vascular endothelium
J. Tissue factor pathway inhibitor
K. Platelets
L. Cyclooxygenase
```
D. Protein S
40
```
Which option synthesises tissue factor, vWF, prostacyclin, plasminogen activator, antithrombin III and thrombomodulin?
A. Tissue factor
B. Thrombin
C. Arichidonic acid
D. Protein S
E. Activated factor X
F. Protein C
G. Vascular subendothelium
H. Factor VII
I. Vascular endothelium
J. Tissue factor pathway inhibitor
K. Platelets
L. Cyclooxygenase
```
I. Vascular endothelium
41
```
Which enzyme, important for platelet aggregation, is irreversibly inhibited by aspirin?
A. Tissue factor
B. Thrombin
C. Arichidonic acid
D. Protein S
E. Activated factor X
F. Protein C
G. Vascular subendothelium
H. Factor VII
I. Vascular endothelium
J. Tissue factor pathway inhibitor
K. Platelets
L. Cyclooxygenase
```
L. Cyclooxygenase
42
```
Which key clotting factor activates both factors V and VIII, and also activates protein C?
A. Tissue factor
B. Thrombin
C. Arichidonic acid
D. Protein S
E. Activated factor X
F. Protein C
G. Vascular subendothelium
H. Factor VII
I. Vascular endothelium
J. Tissue factor pathway inhibitor
K. Platelets
L. Cyclooxygenase
```
B. Thrombin
43
```
A 37 year old mother of 4 children, presents to her GP because of recurrent nose bleeds and feeling tired all the time and heavy periods.
A. Antiphospholipid antibody syndrome
B. Haemophilia A
C. Disseminated intravascular coagulation
D. Factor V Leiden
E. Christmas Disease
F. B-Thalassaemia
G. Bile acid malabsorption
H. Warfarin overdose
I. Henoch – Schönlein Purpura
J. Vitamin K Deficiency
K. Malignancy
L. Osler-Weber-Rendu Syndrome
M. Sickle cell anaemia
N. Von Willebrand disease
```
L. Osler-Weber-Rendu (Hereditary haemorrhage telangiectasia)
44
```
A 3 year old boy is brought to see his GP by his mother. A fortnight ago he had been brought along because of cold-like symptoms, unsurprising since it was the middle of winter and he attends nursery. He was therefore sent home with some Calpol, and as expected his symptoms soon resolved. However this morning his mother noticed a rash on his bottom, and he said his tummy ached.
A. Antiphospholipid antibody syndrome
B. Haemophilia A
C. Disseminated intravascular coagulation
D. Factor V Leiden
E. Christmas Disease
F. B-Thalassaemia
G. Bile acid malabsorption
H. Warfarin overdose
I. Henoch – Schönlein Purpura
J. Vitamin K Deficiency
K. Malignancy
L. Osler-Weber-Rendu Syndrome
M. Sickle cell anaemia
N. Von Willebrand disease
```
I. Henoch Schonlein purpura
45
```
22 year old Saharawi refugee presents with anaemia, weight loss, loose stools and blood tests reveal an increased PT and slightly increased APTT, with normal thrombin time and platelet count.
A. Antiphospholipid antibody syndrome
B. Haemophilia A
C. Disseminated intravascular coagulation
D. Factor V Leiden
E. Christmas Disease
F. B-Thalassaemia
G. Bile acid malabsorption
H. Warfarin overdose
I. Henoch – Schönlein Purpura
J. Vitamin K Deficiency
K. Malignancy
L. Osler-Weber-Rendu Syndrome
M. Sickle cell anaemia
N. Von Willebrand disease
```
J. Vitamin K deficiency
46
```
A 5 year old boy has the following blood results: normal PT, increased APTT, normal platelet count, decreased VIII:C and decreased vWF.
A. Antiphospholipid antibody syndrome
B. Haemophilia A
C. Disseminated intravascular coagulation
D. Factor V Leiden
E. Christmas Disease
F. B-Thalassaemia
G. Bile acid malabsorption
H. Warfarin overdose
I. Henoch – Schönlein Purpura
J. Vitamin K Deficiency
K. Malignancy
L. Osler-Weber-Rendu Syndrome
M. Sickle cell anaemia
N. Von Willebrand disease
```
N. Von Willebrand disease
47
```
A 32 week pregnant lady who has gestational diabetes and is epileptic has a caesarean section while on holiday in rural China. Her newborn baby is suffering from bleeding from the umbilical stump, as well as nose and gums. What is wrong with the baby?
A. Antiphospholipid antibody syndrome
B. Haemophilia A
C. Disseminated intravascular coagulation
D. Factor V Leiden
E. Christmas Disease
F. B-Thalassaemia
G. Bile acid malabsorption
H. Warfarin overdose
I. Henoch – Schönlein Purpura
J. Vitamin K Deficiency
K. Malignancy
L. Osler-Weber-Rendu Syndrome
M. Sickle cell anaemia
N. Von Willebrand disease
```
J. Vitamin K deficiency
48
```
A fit 48-year-old investment banker presents to A&E with a painful R arm that was present when he woke up that morning. He is otherwise well and there is no history of trauma or abnormalities of any system. On examination there is marked tenderness and mild erythema along the anterolateral aspect of the forearm and cubital fossa, with no abnormality of the upper arm or axilla.
A. Varicose veins
B. Postphlebitic syndrome
C. Inferior vena caval obstruction
D. DIC
E. Superior vena caval obstruction
F. Pulmonary embolism
G. Deep vein thrombosis
H. Superficial venous thrombosis
I. Axillary vein thrombosis
J. Thrombophlebitis
```
H. Superficial venous thrombosis
49
```
A 45-year-old lady, known heavy smoker with chronic respiratory problems, presents to her GP with increasing dyspnoea and swelling of her R arm and face. On examination of her chest there is no asymmetry or tracheal deviation, but there are added sounds over the R upper lobe and on bending forward her face becomes congested.
A. Varicose veins
B. Postphlebitic syndrome
C. Inferior vena caval obstruction
D. DIC
E. Superior vena caval obstruction
F. Pulmonary embolism
G. Deep vein thrombosis
H. Superficial venous thrombosis
I. Axillary vein thrombosis
J. Thrombophlebitis
```
E. Superior vena cava obstruction
50
```
A 56-year-old woman returns to the Vascular Clinic with recurrence of her L leg ulcer after the area has been knocked by a shopping trolley. On examination the ulcer is situated above the medial malleolus, its dimensions being 6cm x 5cm. The base is filled with yellowish slough and the surrounding area is erythematous, with prominent oedema.
A. Varicose veins
B. Postphlebitic syndrome
C. Inferior vena caval obstruction
D. DIC
E. Superior vena caval obstruction
F. Pulmonary embolism
G. Deep vein thrombosis
H. Superficial venous thrombosis
I. Axillary vein thrombosis
J. Thrombophlebitis
```
B. Postphelbotic syndrome
51
```
A 48-year-old man develops R-sided pleuritic chest pain and coughs up a trace of bloodstained sputum 8 days after a R hemicolectomy. He has mild dyspnoea but chest examination and chest radiography are normal.
A. Varicose veins
B. Postphlebitic syndrome
C. Inferior vena caval obstruction
D. DIC
E. Superior vena caval obstruction
F. Pulmonary embolism
G. Deep vein thrombosis
H. Superficial venous thrombosis
I. Axillary vein thrombosis
J. Thrombophlebitis
```
F. Pulmonary embolism
52
```
A 32-year-old lady develops acute swelling of her L leg 2 days post-partum. She had bilateral leg swelling during the pregnancy but the delivery was normal. On examination there is tense swelling of the leg and thigh and some deep tenderness over the calf and medial aspect of the thigh.
A. Varicose veins
B. Postphlebitic syndrome
C. Inferior vena caval obstruction
D. DIC
E. Superior vena caval obstruction
F. Pulmonary embolism
G. Deep vein thrombosis
H. Superficial venous thrombosis
I. Axillary vein thrombosis
J. Thrombophlebitis
```
G. Deep vein thrombosis
53
```
A drug that is administered intravenously and has a rapid effect by potentiating the action of antithrombin. Action can be reversed quickly which is of relevance in myocardial infarction patients who may require early invasive treatment (ie PTCA).
A. 5mg, 5mg, 5mg, 5mg, measure on 5th day, 8th day and then every 4 days
B. LMWH and aspirin
C. Pentapolysaccharide
D. Streptokinase
E. Clopidogrel
F. 10mg, 10mg, 5mg, measure on 4th day then every 2 days
G. Unfractionated heparin (UFH)
H. Thrombin time (TT)
I. Calciparone
J. Prothrombin time (PT)
K. Dalteparin (LMWH)
L. Clopidogrel and aspirin
M. Aspirin
N. Dipyridamole modified release (MR) and aspirin
O. Warfarin
P. APTT
```
G. Unfractionated heparin (UFH)
54
```
Potentiates antithrombin III. Usually given subcutaneously. Can cause osteoporosis and hyperkalaemia.
A. 5mg, 5mg, 5mg, 5mg, measure on 5th day, 8th day and then every 4 days
B. LMWH and aspirin
C. Pentapolysaccharide
D. Streptokinase
E. Clopidogrel
F. 10mg, 10mg, 5mg, measure on 4th day then every 2 days
G. Unfractionated heparin (UFH)
H. Thrombin time (TT)
I. Calciparone
J. Prothrombin time (PT)
K. Dalteparin (LMWH)
L. Clopidogrel and aspirin
M. Aspirin
N. Dipyridamole modified release (MR) and aspirin
O. Warfarin
P. APTT
```
K. Dalteparin (LMWH)
55
```
Used to monitor patients undergoing warfarin therapy.
A. 5mg, 5mg, 5mg, 5mg, measure on 5th day, 8th day and then every 4 days
B. LMWH and aspirin
C. Pentapolysaccharide
D. Streptokinase
E. Clopidogrel
F. 10mg, 10mg, 5mg, measure on 4th day then every 2 days
G. Unfractionated heparin (UFH)
H. Thrombin time (TT)
I. Calciparone
J. Prothrombin time (PT)
K. Dalteparin (LMWH)
L. Clopidogrel and aspirin
M. Aspirin
N. Dipyridamole modified release (MR) and aspirin
O. Warfarin
P. APTT
```
J. Prothrombin time (PT)
56
```
Used to monitor patients undergoing unfractionated heparin therapy.
A. 5mg, 5mg, 5mg, 5mg, measure on 5th day, 8th day and then every 4 days
B. LMWH and aspirin
C. Pentapolysaccharide
D. Streptokinase
E. Clopidogrel
F. 10mg, 10mg, 5mg, measure on 4th day then every 2 days
G. Unfractionated heparin (UFH)
H. Thrombin time (TT)
I. Calciparone
J. Prothrombin time (PT)
K. Dalteparin (LMWH)
L. Clopidogrel and aspirin
M. Aspirin
N. Dipyridamole modified release (MR) and aspirin
O. Warfarin
P. APTT
```
P. APTT
57
```
This anticoagulant drug is directly contraindicated in pregnancy, especially the first 16 and last 4 weeks of a 40 week gestation.
A. 5mg, 5mg, 5mg, 5mg, measure on 5th day, 8th day and then every 4 days
B. LMWH and aspirin
C. Pentapolysaccharide
D. Streptokinase
E. Clopidogrel
F. 10mg, 10mg, 5mg, measure on 4th day then every 2 days
G. Unfractionated heparin (UFH)
H. Thrombin time (TT)
I. Calciparone
J. Prothrombin time (PT)
K. Dalteparin (LMWH)
L. Clopidogrel and aspirin
M. Aspirin
N. Dipyridamole modified release (MR) and aspirin
O. Warfarin
P. APTT
```
O. Warfarin
58
```
Reflects the amount and activity of fibrinogen.
A. 5mg, 5mg, 5mg, 5mg, measure on 5th day, 8th day and then every 4 days
B. LMWH and aspirin
C. Pentapolysaccharide
D. Streptokinase
E. Clopidogrel
F. 10mg, 10mg, 5mg, measure on 4th day then every 2 days
G. Unfractionated heparin (UFH)
H. Thrombin time (TT)
I. Calciparone
J. Prothrombin time (PT)
K. Dalteparin (LMWH)
L. Clopidogrel and aspirin
M. Aspirin
N. Dipyridamole modified release (MR) and aspirin
O. Warfarin
P. APTT
```
H. Thrombin time (TT)
59
```
Antiplatelet action. Indicated for primary prophylaxis of stroke in a patient experiencing recurrent retinal TIAs (amaurosis fugax). Ineffective for DVT prophylaxis.
A. 5mg, 5mg, 5mg, 5mg, measure on 5th day, 8th day and then every 4 days
B. LMWH and aspirin
C. Pentapolysaccharide
D. Streptokinase
E. Clopidogrel
F. 10mg, 10mg, 5mg, measure on 4th day then every 2 days
G. Unfractionated heparin (UFH)
H. Thrombin time (TT)
I. Calciparone
J. Prothrombin time (PT)
K. Dalteparin (LMWH)
L. Clopidogrel and aspirin
M. Aspirin
N. Dipyridamole modified release (MR) and aspirin
O. Warfarin
P. APTT
```
M. Aspirin
60
```
Antiplatelet action. Licensed for secondary prophylaxis of stroke. More effective than aspirin alone. Cheap.
A. 5mg, 5mg, 5mg, 5mg, measure on 5th day, 8th day and then every 4 days
B. LMWH and aspirin
C. Pentapolysaccharide
D. Streptokinase
E. Clopidogrel
F. 10mg, 10mg, 5mg, measure on 4th day then every 2 days
G. Unfractionated heparin (UFH)
H. Thrombin time (TT)
I. Calciparone
J. Prothrombin time (PT)
K. Dalteparin (LMWH)
L. Clopidogrel and aspirin
M. Aspirin
N. Dipyridamole modified release (MR) and aspirin
O. Warfarin
P. APTT
```
N. Dipyridamole modified release (MR) and aspirin
61
```
Antiplatelet action. Licensed for primary prevention of stroke in aspirin allergic patients, secondary prevention of stroke (but expensive) and in acute myocardial infarction in addition to aspirin.
A. 5mg, 5mg, 5mg, 5mg, measure on 5th day, 8th day and then every 4 days
B. LMWH and aspirin
C. Pentapolysaccharide
D. Streptokinase
E. Clopidogrel
F. 10mg, 10mg, 5mg, measure on 4th day then every 2 days
G. Unfractionated heparin (UFH)
H. Thrombin time (TT)
I. Calciparone
J. Prothrombin time (PT)
K. Dalteparin (LMWH)
L. Clopidogrel and aspirin
M. Aspirin
N. Dipyridamole modified release (MR) and aspirin
O. Warfarin
P. APTT
```
E. Clopidogrel
62
```
Dangerous combination with no added efficacy and increased GI bleed.
A. 5mg, 5mg, 5mg, 5mg, measure on 5th day, 8th day and then every 4 days
B. LMWH and aspirin
C. Pentapolysaccharide
D. Streptokinase
E. Clopidogrel
F. 10mg, 10mg, 5mg, measure on 4th day then every 2 days
G. Unfractionated heparin (UFH)
H. Thrombin time (TT)
I. Calciparone
J. Prothrombin time (PT)
K. Dalteparin (LMWH)
L. Clopidogrel and aspirin
M. Aspirin
N. Dipyridamole modified release (MR) and aspirin
O. Warfarin
P. APTT
```
L. Clopidogrel and aspirin
63
```
Old model of starting warfarin
A. 5mg, 5mg, 5mg, 5mg, measure on 5th day, 8th day and then every 4 days
B. LMWH and aspirin
C. Pentapolysaccharide
D. Streptokinase
E. Clopidogrel
F. 10mg, 10mg, 5mg, measure on 4th day then every 2 days
G. Unfractionated heparin (UFH)
H. Thrombin time (TT)
I. Calciparone
J. Prothrombin time (PT)
K. Dalteparin (LMWH)
L. Clopidogrel and aspirin
M. Aspirin
N. Dipyridamole modified release (MR) and aspirin
O. Warfarin
P. APTT
```
F. 10mg, 10mg, 5mg, measure on the 4th day then every 2 days
64
```
New (recommended, Tait) model of starting warfarin
A. 5mg, 5mg, 5mg, 5mg, measure on 5th day, 8th day and then every 4 days
B. LMWH and aspirin
C. Pentapolysaccharide
D. Streptokinase
E. Clopidogrel
F. 10mg, 10mg, 5mg, measure on 4th day then every 2 days
G. Unfractionated heparin (UFH)
H. Thrombin time (TT)
I. Calciparone
J. Prothrombin time (PT)
K. Dalteparin (LMWH)
L. Clopidogrel and aspirin
M. Aspirin
N. Dipyridamole modified release (MR) and aspirin
O. Warfarin
P. APTT
```
A. 5mg, 5mg, 5mg, 5mg, measure on the 5th day, 8th day and then every 4 days
65
```
In patients with metallic heart valves, this drug is the most effective anticoagulant
A. 5mg, 5mg, 5mg, 5mg, measure on 5th day, 8th day and then every 4 days
B. LMWH and aspirin
C. Pentapolysaccharide
D. Streptokinase
E. Clopidogrel
F. 10mg, 10mg, 5mg, measure on 4th day then every 2 days
G. Unfractionated heparin (UFH)
H. Thrombin time (TT)
I. Calciparone
J. Prothrombin time (PT)
K. Dalteparin (LMWH)
L. Clopidogrel and aspirin
M. Aspirin
N. Dipyridamole modified release (MR) and aspirin
O. Warfarin
P. APTT
```
O. Warfarin
66
```
In patients with cancer and acute venous thromboembolism, the most effective drug at reducing the risk of recurrent VTE is __?
A. 5mg, 5mg, 5mg, 5mg, measure on 5th day, 8th day and then every 4 days
B. LMWH and aspirin
C. Pentapolysaccharide
D. Streptokinase
E. Clopidogrel
F. 10mg, 10mg, 5mg, measure on 4th day then every 2 days
G. Unfractionated heparin (UFH)
H. Thrombin time (TT)
I. Calciparone
J. Prothrombin time (PT)
K. Dalteparin (LMWH)
L. Clopidogrel and aspirin
M. Aspirin
N. Dipyridamole modified release (MR) and aspirin
O. Warfarin
P. APTT
```
K. Dalteparin (LMWH)
67
```
This drug when given alone initially increases the clotting risk
A. 5mg, 5mg, 5mg, 5mg, measure on 5th day, 8th day and then every 4 days
B. LMWH and aspirin
C. Pentapolysaccharide
D. Streptokinase
E. Clopidogrel
F. 10mg, 10mg, 5mg, measure on 4th day then every 2 days
G. Unfractionated heparin (UFH)
H. Thrombin time (TT)
I. Calciparone
J. Prothrombin time (PT)
K. Dalteparin (LMWH)
L. Clopidogrel and aspirin
M. Aspirin
N. Dipyridamole modified release (MR) and aspirin
O. Warfarin
P. APTT
```
O. Warfarin
68
```
Side effects include cutaneous necrosis
A. 5mg, 5mg, 5mg, 5mg, measure on 5th day, 8th day and then every 4 days
B. LMWH and aspirin
C. Pentapolysaccharide
D. Streptokinase
E. Clopidogrel
F. 10mg, 10mg, 5mg, measure on 4th day then every 2 days
G. Unfractionated heparin (UFH)
H. Thrombin time (TT)
I. Calciparone
J. Prothrombin time (PT)
K. Dalteparin (LMWH)
L. Clopidogrel and aspirin
M. Aspirin
N. Dipyridamole modified release (MR) and aspirin
O. Warfarin
P. APTT
```
O. Warfarin
69
```
The drug most likely to cause thrombocytopaenia with paradoxical thrombosis
A. 5mg, 5mg, 5mg, 5mg, measure on 5th day, 8th day and then every 4 days
B. LMWH and aspirin
C. Pentapolysaccharide
D. Streptokinase
E. Clopidogrel
F. 10mg, 10mg, 5mg, measure on 4th day then every 2 days
G. Unfractionated heparin (UFH)
H. Thrombin time (TT)
I. Calciparone
J. Prothrombin time (PT)
K. Dalteparin (LMWH)
L. Clopidogrel and aspirin
M. Aspirin
N. Dipyridamole modified release (MR) and aspirin
O. Warfarin
P. APTT
```
G. Unfractionated heparin (UFH)
70
```
Indicated as thrombotic prophylaxis in DIC
A. 5mg, 5mg, 5mg, 5mg, measure on 5th day, 8th day and then every 4 days
B. LMWH and aspirin
C. Pentapolysaccharide
D. Streptokinase
E. Clopidogrel
F. 10mg, 10mg, 5mg, measure on 4th day then every 2 days
G. Unfractionated heparin (UFH)
H. Thrombin time (TT)
I. Calciparone
J. Prothrombin time (PT)
K. Dalteparin (LMWH)
L. Clopidogrel and aspirin
M. Aspirin
N. Dipyridamole modified release (MR) and aspirin
O. Warfarin
P. APTT
```
K. Dalteparin (LMWH)
71
```
Contra-indicated if recent sore throat, if ever used before, or in the presence of proliferative retinopathy.
A. 5mg, 5mg, 5mg, 5mg, measure on 5th day, 8th day and then every 4 days
B. LMWH and aspirin
C. Pentapolysaccharide
D. Streptokinase
E. Clopidogrel
F. 10mg, 10mg, 5mg, measure on 4th day then every 2 days
G. Unfractionated heparin (UFH)
H. Thrombin time (TT)
I. Calciparone
J. Prothrombin time (PT)
K. Dalteparin (LMWH)
L. Clopidogrel and aspirin
M. Aspirin
N. Dipyridamole modified release (MR) and aspirin
O. Warfarin
P. APTT
```
D. Streptokinase
72
A 65 year old patient presents with hepatosplenomegaly. He is mildly anaemic and thrombocytompenic. A blood monocyte count of 1.2 x 109/l is observed. Bone marrow aspirate reveals ring sideroblasts at 15% of total blasts. Auer rods are observed.
A. Refractory anaemia
B. Refractory Anaemia with excess of Blasts I
C. Myelodysplastic syndrome,unclassifiable
D. Aplastic Anaemia
E. Refractory Anaemia with Ring Sideroblasts
F. Refractory Cytopaenia with Multilineage Dysplasia
G. Myelodysplastic syndrome associated with isolated del(5q) chromosome abnormality (5q syndrome)
H. Refractory Anaemia with excess of Blasts II
I. Secondary Sideroblastic Anaemia
J. Chronic Myelomonocytic Anaemia
K. Acute Myeloid Leukaemia
J. Chronic myelomonocytic anaemia
CMML and JMML. In addition to the 7 MDS subtypes above, chronic myelomonocytic leukemia (CMML) and juvenile myelomonocytic leukemia (JMML) are types of blood cancers that the WHO classifies as “mixed myelodysplastic/myeloproliferative diseases.” Unlike other types of MDS in which blood counts are low, white blood cell counts are higher in these subtypes. Both CMML and JMML begin after a change, or mutation, happens in a type of blood cell called a monocyte. CMML generally occurs in people ages 65 to 75. JMML is most common in children younger than 6. Treatment is similar to MDS and can include chemotherapy and/or stem cell transplantation
73
An alcoholic presents to your clinic with anaemia. Sideroblasts are observed on morphological examination.
A. Refractory anaemia
B. Refractory Anaemia with excess of Blasts I
C. Myelodysplastic syndrome,unclassifiable
D. Aplastic Anaemia
E. Refractory Anaemia with Ring Sideroblasts
F. Refractory Cytopaenia with Multilineage Dysplasia
G. Myelodysplastic syndrome associated with isolated del(5q) chromosome abnormality (5q syndrome)
H. Refractory Anaemia with excess of Blasts II
I. Secondary Sideroblastic Anaemia
J. Chronic Myelomonocytic Anaemia
K. Acute Myeloid Leukaemia
I. Secondary sideroblastic anemia
74
A 58 year old lady complains of lethargy and “easy bruising”. She presents with purpura. Her FBC reveals Hb 10.5g/dl; WBCs 2.3x109/l and platelets 8x109/l. Blood film reveals <1% Blasts, and marrow aspirate shows 20% dysplasia in erythroid lineage, 60% dysplasia in platelet lineage, 5% dysplasia in granulocyte lineage, and less than 5% blasts.
A. Refractory anaemia
B. Refractory Anaemia with excess of Blasts I
C. Myelodysplastic syndrome,unclassifiable
D. Aplastic Anaemia
E. Refractory Anaemia with Ring Sideroblasts
F. Refractory Cytopaenia with Multilineage Dysplasia
G. Myelodysplastic syndrome associated with isolated del(5q) chromosome abnormality (5q syndrome)
H. Refractory Anaemia with excess of Blasts II
I. Secondary Sideroblastic Anaemia
J. Chronic Myelomonocytic Anaemia
K. Acute Myeloid Leukaemia
F. Refractory cytopaenia with multilineage dysplasia Refractory cytopenia with multilineage dysplasia (RCMD). In this subtype, people have less than 5% blasts and less than 15% ringed sideroblasts in the bone marrow. The other bone marrow cells look abnormal when viewed under the microscope. At least 2 of the blood cell counts are low. RCMD may eventually turn into AML.
75
A 78 year old male patient with recurring infections of the face and maxillary sinuses associated with neutropenia. His bloods are: Hb 9.8 g/dl; WBC 1.3x109/l; Neutrophils 0.3x109/l; platelets 38x109/l.The lab informs you that there are Blasts approximately compromise 17% of bone marrow aspirate.
A. Refractory anaemia
B. Refractory Anaemia with excess of Blasts I
C. Myelodysplastic syndrome,unclassifiable
D. Aplastic Anaemia
E. Refractory Anaemia with Ring Sideroblasts
F. Refractory Cytopaenia with Multilineage Dysplasia
G. Myelodysplastic syndrome associated with isolated del(5q) chromosome abnormality (5q syndrome)
H. Refractory Anaemia with excess of Blasts II
I. Secondary Sideroblastic Anaemia
J. Chronic Myelomonocytic Anaemia
K. Acute Myeloid Leukaemia
H. Refractory anaemia with excess of blasts II
Refractory anemia (RA). The primary sign of RA is anemia. White blood cell counts and platelet counts are healthy. There are less than 5% blasts found in the bone marrow. This subtype of MDS does not often turn into AML.
Refractory anemia with ringed sideroblasts (RARS). People with this subtype of MDS have anemia, similar to those with RA, except more than 15% of the red blood cells are sideroblasts. A sideroblast is a red blood cell in which the iron in the cell appears to be in a ring around the center of the cell where the genes are found, called the nucleus. The white blood cell and platelet counts are usually healthy. People diagnosed with RARS have a low risk of developing AML.
Refractory cytopenia with multilineage dysplasia (RCMD). In this subtype, people have less than 5% blasts and less than 15% ringed sideroblasts in the bone marrow. The other bone marrow cells look abnormal when viewed under the microscope. At least 2 of the blood cell counts are low. RCMD may eventually turn into AML.
Refractory anemia with excess blasts (RAEB). People with RAEB can have decreases in all or some of their blood cell counts. There are less than 5% blast cells in the blood and 5% to 20% blasts in the bone marrow. People with more than 20% blasts in the bone marrow are diagnosed with AML. People with RAEB may also have lower white blood cell and platelet counts. About 40% of people diagnosed with RAEB eventually develop AML.
Myelodysplastic syndrome, unclassified (MDS-U). People diagnosed with this subtype have decreased numbers of white blood cells, red blood cells, or platelets, but do not have the specific signs of the other MDS subtypes.
MDS associated with isolated del(5q). People with this subtype have anemia and fewer than 5% blasts, and genetic material is missing from chromosome 5.
76
You are called to A&E to see a 65 year old man. He is complaining of fever, shortness of breath, and has lost 5Kg in the last few months. His notes say he was previously diagnosed with “Refractory Anaemia with excess Blasts in Transformation” (RAEB-t). His blast cell count is approximately 30% of all nucleated cells.
A. Refractory anaemia
B. Refractory Anaemia with excess of Blasts I
C. Myelodysplastic syndrome,unclassifiable
D. Aplastic Anaemia
E. Refractory Anaemia with Ring Sideroblasts
F. Refractory Cytopaenia with Multilineage Dysplasia
G. Myelodysplastic syndrome associated with isolated del(5q) chromosome abnormality (5q syndrome)
H. Refractory Anaemia with excess of Blasts II
I. Secondary Sideroblastic Anaemia
J. Chronic Myelomonocytic Anaemia
K. Acute Myeloid Leukaemia
K. Acute myeloid leukaemia
77
A 34 year old man with peripheral cytopenia suffers from bleeding gums. Peripheral blood shows 5% blast cells and bone marrow 42% blast cells.
A. Myelofibrosis
B. 5q syndrome
C. Refractory anaemia with an excess of blasts
D. Inherited aplastic anaemia
E. Refractory cytopenia with multilineage dysplasia
F. Refractory anaemia
G. Secondary aplastic anaemia
H. Idiopathic aplastic anaemia
I. Acute myeloid leukaemia
J. Juvenile myelomonocytic leukaemia
I. Acute myeloid leukaemia
78
A 74 year old woman with high-normal platelet count. Bone marrow aspirate shows hyperplasia of hypolobulated micromegakaryocytes. Responds well to lenalidomide.
A. Myelofibrosis
B. 5q syndrome
C. Refractory anaemia with an excess of blasts
D. Inherited aplastic anaemia
E. Refractory cytopenia with multilineage dysplasia
F. Refractory anaemia
G. Secondary aplastic anaemia
H. Idiopathic aplastic anaemia
I. Acute myeloid leukaemia
J. Juvenile myelomonocytic leukaemia
B. 5q syndrome
MDS associated with isolated del(5q). People with this subtype have anemia and fewer than 5% blasts, and genetic material is missing from chromosome 5.
79
A 20 year old man with hepatitis C complains of fatigue and breathlessness and bruises very easily.
A. Myelofibrosis
B. 5q syndrome
C. Refractory anaemia with an excess of blasts
D. Inherited aplastic anaemia
E. Refractory cytopenia with multilineage dysplasia
F. Refractory anaemia
G. Secondary aplastic anaemia
H. Idiopathic aplastic anaemia
I. Acute myeloid leukaemia
J. Juvenile myelomonocytic leukaemia
G. Secondary aplastic anaemia
80
This patients blood film shows classic Pelger-Huet neutrophils and bone marrow blasts make up 15% of cells.
```
A. Myelofibrosis
B. 5q syndrome
C. Refractory anaemia with an excess of blasts
D. Inherited aplastic anaemia
E. Refractory cytopenia with multilineage dysplasia
F. Refractory anaemia
G. Secondary aplastic anaemia
H. Idiopathic aplastic anaemia
I. Acute myeloid leukaemia
J. Juvenile myelomonocytic leukaemia
```
C. Refractory anaemia with an excess of blasts
81
In this case haemoglobin is normal but there is a reduction in platelets and neutrophils
A. Myelofibrosis
B. 5q syndrome
C. Refractory anaemia with an excess of blasts
D. Inherited aplastic anaemia
E. Refractory cytopenia with multilineage dysplasia
F. Refractory anaemia
G. Secondary aplastic anaemia
H. Idiopathic aplastic anaemia
I. Acute myeloid leukaemia
J. Juvenile myelomonocytic leukaemia
E. Refractory cytopenia with multilineage dysplasia
82
```
A 64 year old man complains of headaches, fatigue and itchy skin, particularly evident after a hot bath. He has a long-standing history of alcohol abuse and drug history reveals that he taking thiazide diuretics. On examination, you note that he is thin with sunken eyes.
A. Venesection
B. Pseudopolycythaemia
C. Acute myeloid leukaemia
D. Erythropoeitin
E. Tear drop poikilocytes
F. Idiopathic myelofibrosis
G. Melphalan
H. Imitanib
I. Haematocrit
J. Splenomegaly
K. Microcytosis
L. Hydroxycarbamide
M. Essential thrombocythaemia
N. Chronic myeloid leukaemia
O. Chlorambucil
P. Polycythaemia vera
```
B. Pseudopolycythaemia
83
```
A 55 year old female has a past medical history of deep vein thrombosis. She also complains of easy bruising. Her platelet count is 770 x109/L, CRP is 4mg/L. You prescribe aspirin.
A. Venesection
B. Pseudopolycythaemia
C. Acute myeloid leukaemia
D. Erythropoeitin
E. Tear drop poikilocytes
F. Idiopathic myelofibrosis
G. Melphalan
H. Imitanib
I. Haematocrit
J. Splenomegaly
K. Microcytosis
L. Hydroxycarbamide
M. Essential thrombocythaemia
N. Chronic myeloid leukaemia
O. Chlorambucil
P. Polycythaemia vera
```
M. Essential thrombocythaemia
84
```
A 53 year old man goes to see his doctor about an embarrassing problem. It seems that his friends have nicknamed him ‘Rudolph’. You seem quite confused, but all becomes apparent when he points to his nose, which appears red. After further questioning, he describes a ‘burning’ sensation on his nose, hands and feet and visual disturbances. You send him for ‘blood tests’. What do you expect to be raised?
A. Venesection
B. Pseudopolycythaemia
C. Acute myeloid leukaemia
D. Erythropoeitin
E. Tear drop poikilocytes
F. Idiopathic myelofibrosis
G. Melphalan
H. Imitanib
I. Haematocrit
J. Splenomegaly
K. Microcytosis
L. Hydroxycarbamide
M. Essential thrombocythaemia
N. Chronic myeloid leukaemia
O. Chlorambucil
P. Polycythaemia vera
```
I Haematocrit
85
```
A consultant grills you on a ward round: there is a patient with a WBC of 140 x109/L, Hb 12 g/dL, Platelet count 320 x109/L. She complains of tiredness, night sweats, fever and abdominal pain. Her spleen is markedly enlarged. Blood film shows blasts, neutrophils, basophils. How would you treat her?
A. Venesection
B. Pseudopolycythaemia
C. Acute myeloid leukaemia
D. Erythropoeitin
E. Tear drop poikilocytes
F. Idiopathic myelofibrosis
G. Melphalan
H. Imitanib
I. Haematocrit
J. Splenomegaly
K. Microcytosis
L. Hydroxycarbamide
M. Essential thrombocythaemia
N. Chronic myeloid leukaemia
O. Chlorambucil
P. Polycythaemia vera
```
H. Imatanib
86
```
You are asked to see a 76 year old man on the wards, who presented with fatigue, dyspnoea, bleeding gums and nightsweats. His abdomen is massively enlarged. You read his notes and find ‘bone marrow aspirate: ‘dry tap’. What would you expect to see on the blood film?
A. Venesection
B. Pseudopolycythaemia
C. Acute myeloid leukaemia
D. Erythropoeitin
E. Tear drop poikilocytes
F. Idiopathic myelofibrosis
G. Melphalan
H. Imitanib
I. Haematocrit
J. Splenomegaly
K. Microcytosis
L. Hydroxycarbamide
M. Essential thrombocythaemia
N. Chronic myeloid leukaemia
O. Chlorambucil
P. Polycythaemia vera
```
E. Tear drop poikilocytes
87
```
A 64-year old woman receiving long-term chemotherapy for lymphoma presents with worsening bone pain, recurrent fever and night sweats. Blood film shows blast cells with Auer rods.
A. Chronic lymphocytic leukaemia
B. Acute myeloid leukaemia
C. Lung fibrosis
D. DIC
E. Bronchial carcinoma
F. Septicaemia
G. Chronic myeloid leukaemia
H. Acute lymphoblastic leukaemia
I. Tumour-lysis syndrome
J. Hairy cell leukaemia
K. Hypothyroidism
L. Acute promyelocytic leukaemia
M. Richter's syndrome
N. Vincristine poisoning
```
B. Acute myeloid leukaemia
88
```
A 61-year-old man with CLL presents with recurrent pneumonia and haemoptysis. On fibreoptic bronchoscopy, the patient is found to have an endobronchial mass. The biopsy shows anaplastic, large cell lymphoma.
A. Chronic lymphocytic leukaemia
B. Acute myeloid leukaemia
C. Lung fibrosis
D. DIC
E. Bronchial carcinoma
F. Septicaemia
G. Chronic myeloid leukaemia
H. Acute lymphoblastic leukaemia
I. Tumour-lysis syndrome
J. Hairy cell leukaemia
K. Hypothyroidism
L. Acute promyelocytic leukaemia
M. Richter's syndrome
N. Vincristine poisoning
```
M. Richter's syndrome
Richter's syndrome (RS), also known as Richter's transformation, is a transformation of B cell chronic lymphocytic leukemia (CLL) or hairy cell leukemia into a fast-growing diffuse large B cell lymphoma.
89
```
A newly diagnosed ALL patient complains of tiredness, polyuria, polydipsia, abdominal pain and vomiting on receiving chemotherapy. On examination, BP: 160/100mmHg, temp: 39ºC, and ECG shows tented T waves. Blood test shows serum K+: 6.9mmol/L and phosphate: 7.1 mmol/L. The patient later dies of cardiac arrest.
A. Chronic lymphocytic leukaemia
B. Acute myeloid leukaemia
C. Lung fibrosis
D. DIC
E. Bronchial carcinoma
F. Septicaemia
G. Chronic myeloid leukaemia
H. Acute lymphoblastic leukaemia
I. Tumour-lysis syndrome
J. Hairy cell leukaemia
K. Hypothyroidism
L. Acute promyelocytic leukaemia
M. Richter's syndrome
N. Vincristine poisoning
```
I. Tumour lysis syndrome
90
```
A routine medical of 33-year-old footballer reveals: Hb = 9.9g/dl and WCC = 130 x 109/L. His blood film shows whole spectrum of myeloid precursors, including a few blast cells. He admits to having frequent night sweats and blurred vision. There is a presence of Ph chromosome t(9;22) on cytogenetic analysis.
A. Chronic lymphocytic leukaemia
B. Acute myeloid leukaemia
C. Lung fibrosis
D. DIC
E. Bronchial carcinoma
F. Septicaemia
G. Chronic myeloid leukaemia
H. Acute lymphoblastic leukaemia
I. Tumour-lysis syndrome
J. Hairy cell leukaemia
K. Hypothyroidism
L. Acute promyelocytic leukaemia
M. Richter's syndrome
N. Vincristine poisoning
```
G. Chronic myeloid leukaemia
91
```
A 5-year-old girl presents with failure to thrive, recurrent fever and bruising. Immunotyping reveals the presence of CD10.
A. Chronic lymphocytic leukaemia
B. Acute myeloid leukaemia
C. Lung fibrosis
D. DIC
E. Bronchial carcinoma
F. Septicaemia
G. Chronic myeloid leukaemia
H. Acute lymphoblastic leukaemia
I. Tumour-lysis syndrome
J. Hairy cell leukaemia
K. Hypothyroidism
L. Acute promyelocytic leukaemia
M. Richter's syndrome
N. Vincristine poisoning
```
H. Acute lymphoblastic leukaemia
92
```
A 6-year-old boy presents with bone pain. On examination you notice he looks pale and has many bruises. What is his diagnosis?
A. Acute lymphocytic leukaemia
B. Marfan’s syndrome
C. Chronic lymphocytic leukaemia
D. Chronic myeloid leukaemia
E. Neutrophils
F. Blast cells
G. Down’s syndrome
H. Sickle cell disease
I. Magnesium exposure
J. Thalassaemia
K. Ionising radiation
L. Acute myeloid leukaemia
M. Lymphocytes
```
A. Acute lymphocytic leukaemia
93
```
A patient has acute lymphoblastic leukaemia. A bone marrow biopsy will show infiltration by which cells?
A. Acute lymphocytic leukaemia
B. Marfan’s syndrome
C. Chronic lymphocytic leukaemia
D. Chronic myeloid leukaemia
E. Neutrophils
F. Blast cells
G. Down’s syndrome
H. Sickle cell disease
I. Magnesium exposure
J. Thalassaemia
K. Ionising radiation
L. Acute myeloid leukaemia
M. Lymphocytes
```
F. Blast cells
94
```
Patients with this inherited disorder have an increased risk of developing acute leukaemia.
A. Acute lymphocytic leukaemia
B. Marfan’s syndrome
C. Chronic lymphocytic leukaemia
D. Chronic myeloid leukaemia
E. Neutrophils
F. Blast cells
G. Down’s syndrome
H. Sickle cell disease
I. Magnesium exposure
J. Thalassaemia
K. Ionising radiation
L. Acute myeloid leukaemia
M. Lymphocytes
```
G. Down's syndrome
95
```
An environmental factor associated with acute leukaemia.
A. Acute lymphocytic leukaemia
B. Marfan’s syndrome
C. Chronic lymphocytic leukaemia
D. Chronic myeloid leukaemia
E. Neutrophils
F. Blast cells
G. Down’s syndrome
H. Sickle cell disease
I. Magnesium exposure
J. Thalassaemia
K. Ionising radiation
L. Acute myeloid leukaemia
M. Lymphocytes
```
K. Ionising radiation
96
```
The commonest adult leukaemia.
A. Acute lymphocytic leukaemia
B. Marfan’s syndrome
C. Chronic lymphocytic leukaemia
D. Chronic myeloid leukaemia
E. Neutrophils
F. Blast cells
G. Down’s syndrome
H. Sickle cell disease
I. Magnesium exposure
J. Thalassaemia
K. Ionising radiation
L. Acute myeloid leukaemia
M. Lymphocytes
```
C. Chronic lymphocytic leukaemia
97
```
A 50yr old man presents to his GP complaining of weight loss, tiredness, easy bruising and a painful big toe. On examination his spleen is massively enlarged. Investigation shows a raised serum urate. The peripheral blood film is abnormal, showing proliferation of which type of cell?
A. Spherocytes
B. Auer rods
C. Reticulocytes
D. Neutrophils
E. Blast cells
F. Chromosome 11q23 deletion
G. Eosinophils
H. Pelger-Huet cells
I. Clonal B lymphocytes
J. Platelets
K. Chromosome 9;22 translocation
```
D. Neutrophils
98
```
A 65yr old lady is seen in the haematology clinic where she has been treated for 7 years with Imantinib for chronic myeloid leukaemia. Having been previously well, she is now complaining of shortness of breath and general weakness. Examination reveals splenomegally. Her peripheral blood film has changed from previous appointments and reflects the progression of her disease. Which type of cell is now proliferating?
A. Spherocytes
B. Auer rods
C. Reticulocytes
D. Neutrophils
E. Blast cells
F. Chromosome 11q23 deletion
G. Eosinophils
H. Pelger-Huet cells
I. Clonal B lymphocytes
J. Platelets
K. Chromosome 9;22 translocation
```
E. Blast cells
99
```
A 70yr old man complains of a year’s history of fatigue, weight loss and recurrent sinusitis. His white cell count is raised with a lymphocytosis of 283x109 /L. Blood film shows features of haemolysis and Coomb’s test is positive. Further investigation show the bone marrow, blood and lymph nodes are infiltrated with which cell population?
A. Spherocytes
B. Auer rods
C. Reticulocytes
D. Neutrophils
E. Blast cells
F. Chromosome 11q23 deletion
G. Eosinophils
H. Pelger-Huet cells
I. Clonal B lymphocytes
J. Platelets
K. Chromosome 9;22 translocation
```
I. Clonal B lymphocytes
100
```
A routine full blood count on a 62yr old gardener reveals a high white cell count of 154x109 /L, and the differential shows this to be a neutrophilia. The haemoglobin and platelet count are normal. Biopsy shows a hypercellular “packed” bone marrow, and cells show the presence of which chromosomal abnormality?
A. Spherocytes
B. Auer rods
C. Reticulocytes
D. Neutrophils
E. Blast cells
F. Chromosome 11q23 deletion
G. Eosinophils
H. Pelger-Huet cells
I. Clonal B lymphocytes
J. Platelets
K. Chromosome 9;22 translocation
```
K. Chromosome 9;22 translocation
101
```
A 10 year old boy presenting with tan-to-grey hyperpigmented patches on his upper trunk, neck and face, nail ridges and leukoplakia.
A. Hepatitis C infection
B. Drug-induced
C. Systemic lupus erythematosus
D. Myelofibrosis
E. Fanconi anaemia
F. Acute myeloid leukaemia
G. Dyskeratosis congenita
H. Aplastic anaemia
I. Parvovirus B19 infection
J. Radiation-induced
```
G. Dyskeratosis congenita
102
```
A 60 year old female patient with the following blood results: neutrophils 0.4 x 109/l, platelets 19 x 109/l and reticulocytes 50 x109/l.
A. Hepatitis C infection
B. Drug-induced
C. Systemic lupus erythematosus
D. Myelofibrosis
E. Fanconi anaemia
F. Acute myeloid leukaemia
G. Dyskeratosis congenita
H. Aplastic anaemia
I. Parvovirus B19 infection
J. Radiation-induced
```
H. Aplastic anaemia
103
```
A 76 year old man presents to his GP with increasing tiredness, weakness and a long-standing cold. The blood results ordered by the GP showed that the gentleman was anaemic and that increased blast cells were present.
A. Hepatitis C infection
B. Drug-induced
C. Systemic lupus erythematosus
D. Myelofibrosis
E. Fanconi anaemia
F. Acute myeloid leukaemia
G. Dyskeratosis congenita
H. Aplastic anaemia
I. Parvovirus B19 infection
J. Radiation-induced
```
F. AML
104
```
An 83 year old woman presents to the A&E Departments with severe weakness and shortness of breath on minimal exertion. On examination, masses are felt in both left and right upper quadrants of the abdomen. Blood film show leukoerythroblastic cells and teardrop poikilocytes.
A. Hepatitis C infection
B. Drug-induced
C. Systemic lupus erythematosus
D. Myelofibrosis
E. Fanconi anaemia
F. Acute myeloid leukaemia
G. Dyskeratosis congenita
H. Aplastic anaemia
I. Parvovirus B19 infection
J. Radiation-induced
```
D. Myelofibrosis
105
```
A 30 year old woman with a photosensitive rash across her cheeks presents with easy bruising.
A. Hepatitis C infection
B. Drug-induced
C. Systemic lupus erythematosus
D. Myelofibrosis
E. Fanconi anaemia
F. Acute myeloid leukaemia
G. Dyskeratosis congenita
H. Aplastic anaemia
I. Parvovirus B19 infection
J. Radiation-induced
```
C. SLE
106
```
A 35 year old women complains of abdominal pain. There is associated pancytopenia, and a Ham’s test is positive.
A. Paroxysmal nocturnal haemoglobinuria
B. Hereditary spherocytosis
C. Sepsis
D. Sickle-cell disease
E. Drug-induced immune haemolysis
F. Spur cell anaemia
G. Cardiac haemolysis
H. Autoimmune haemolytic anaemia
I. Gaucher's disease (glucosylceramide lipidosis)
J. Haemolytic uraemic syndrome
K. Hereditary elliptocytosis
L. Pyruvate kinase deficiency
```
A. Paroxysmal nocturnal haemoglobinuria
107
```
A 62 year old male lorry driver has a blood film that shows polychromasia and macrocytosis. It emerges during consultation with one of your colleges that he had a prosthetic aortic valve fitted 5 years previously.
A. Paroxysmal nocturnal haemoglobinuria
B. Hereditary spherocytosis
C. Sepsis
D. Sickle-cell disease
E. Drug-induced immune haemolysis
F. Spur cell anaemia
G. Cardiac haemolysis
H. Autoimmune haemolytic anaemia
I. Gaucher's disease (glucosylceramide lipidosis)
J. Haemolytic uraemic syndrome
K. Hereditary elliptocytosis
L. Pyruvate kinase deficiency
```
G. Cardiac haemolysis
108
```
A 20 year old male develops intravascular haemolysis while undergoing treatment for syphilis (T. pallidum), which he contracted while visiting the Far East.
A. Paroxysmal nocturnal haemoglobinuria
B. Hereditary spherocytosis
C. Sepsis
D. Sickle-cell disease
E. Drug-induced immune haemolysis
F. Spur cell anaemia
G. Cardiac haemolysis
H. Autoimmune haemolytic anaemia
I. Gaucher's disease (glucosylceramide lipidosis)
J. Haemolytic uraemic syndrome
K. Hereditary elliptocytosis
L. Pyruvate kinase deficiency
```
E. Drug-induced immune haemolysis
109
```
A 19 year old Jewish male presenting with multiple pathological fractures and hypersplenism.
A. Paroxysmal nocturnal haemoglobinuria
B. Hereditary spherocytosis
C. Sepsis
D. Sickle-cell disease
E. Drug-induced immune haemolysis
F. Spur cell anaemia
G. Cardiac haemolysis
H. Autoimmune haemolytic anaemia
I. Gaucher's disease (glucosylceramide lipidosis)
J. Haemolytic uraemic syndrome
K. Hereditary elliptocytosis
L. Pyruvate kinase deficiency
```
I. Gaucher's disease (glucosylceramide lipidosis)
110
```
A 26 year old primary school teacher presents with chronic anaemia. She has an increased (unconguated) bilirubin, and has had well controlled systemic lupus erythematosus for 7 years.
A. Paroxysmal nocturnal haemoglobinuria
B. Hereditary spherocytosis
C. Sepsis
D. Sickle-cell disease
E. Drug-induced immune haemolysis
F. Spur cell anaemia
G. Cardiac haemolysis
H. Autoimmune haemolytic anaemia
I. Gaucher's disease (glucosylceramide lipidosis)
J. Haemolytic uraemic syndrome
K. Hereditary elliptocytosis
L. Pyruvate kinase deficiency
```
H. Autoimmune haemolytic anaemia
111
A woman aged 69 with no past medical history except osteoarthritis suffered acute haemolysis after her right hip was replaced. There was no evidence of splenomegaly or lymphadenopathy and both warm and cold antibody tests were negative. When she had the left hip replaced 2 years later she again developed haemolysis soon after the anaesthetic. She was tested for IgG and IgE antibodies to the anaesthetic. Seven months later she had a revision arthroplasty and haemolysed again. Which condition might she have?
A. Paroxysmal cold haemoglobinuria
B. Autoimmune haemolytic anaemia due to infectious mononucleosis
C. Disseminated intravascular coagulation
D. Hereditary elliptocytosis
E. Primary autoimmune haemolytic anaemia
F. G6PD deficiency
G. Sepsis
H. Cephalosporin-induced haemolytic anaemia
I. Paroxysmal nocturnal haemoglobinuria
J. Hereditary spherocytosis
K. Sickle cell anaemia
H. Cephalosporin-induced haemolytic anaemia
112
In which condition might the sucrose and Ham acid haemolysis tests be positive?
A. Paroxysmal cold haemoglobinuria
B. Autoimmune haemolytic anaemia due to infectious mononucleosis
C. Disseminated intravascular coagulation
D. Hereditary elliptocytosis
E. Primary autoimmune haemolytic anaemia
F. G6PD deficiency
G. Sepsis
H. Cephalosporin-induced haemolytic anaemia
I. Paroxysmal nocturnal haemoglobinuria
J. Hereditary spherocytosis
K. Sickle cell anaemia
I. Paroxysmal nocturnal haemoglobinuria
113
Mr RX came to Fulham from Thailand last year. He has inflammatory bowel disease and is taking dapsone for his dermatitis herpetiformis. Which of the above conditions would be likely and clinically relevant?
A. Paroxysmal cold haemoglobinuria
B. Autoimmune haemolytic anaemia due to infectious mononucleosis
C. Disseminated intravascular coagulation
D. Hereditary elliptocytosis
E. Primary autoimmune haemolytic anaemia
F. G6PD deficiency
G. Sepsis
H. Cephalosporin-induced haemolytic anaemia
I. Paroxysmal nocturnal haemoglobinuria
J. Hereditary spherocytosis
K. Sickle cell anaemia
F. G6PD deficiency
114
A 29 year old man noticed he had yellow eyes and dark urine. He was always tired, and could not take part in sports as he easily became short of breath. There was no itching, fever or bleeding, and he was not taking any drugs. On examination he was anaemic, jaundiced, afebrile and had no palpable lymphadenopathy, hepatosplenomegaly or rash. His blood tests showed Hb 5.4g/Dl and raised WCC (40 x 109/L), bilirubin (47 µmol/l), aspartate transaminase (90iu/L) and lactate dehydrogenase (5721iu/l). The blood film showed polychromic nucleated red cells and spherocytes and the reticulocyte count was 9%. Direct Coombs' test revealed IgG and C3 on the red cell surfaces. The serum contained a warm non-specific autoantibody (i.e. it reacted with all the red cells in the test panel). Antinuclear antibodies and rheumatoid factor tests were negative and immunoglobulin levels were normal; there were no paraprotein bands in his serum. He failed to respond to high-dose corticosteroids and had a splenectomy three weeks later.
A. Paroxysmal cold haemoglobinuria
B. Autoimmune haemolytic anaemia due to infectious mononucleosis
C. Disseminated intravascular coagulation
D. Hereditary elliptocytosis
E. Primary autoimmune haemolytic anaemia
F. G6PD deficiency
G. Sepsis
H. Cephalosporin-induced haemolytic anaemia
I. Paroxysmal nocturnal haemoglobinuria
J. Hereditary spherocytosis
K. Sickle cell anaemia
E. Primary autoimmune haemolytic anaemia
115
In which condition might a Donath-Landsteiner be positive?
A. Paroxysmal cold haemoglobinuria
B. Autoimmune haemolytic anaemia due to infectious mononucleosis
C. Disseminated intravascular coagulation
D. Hereditary elliptocytosis
E. Primary autoimmune haemolytic anaemia
F. G6PD deficiency
G. Sepsis
H. Cephalosporin-induced haemolytic anaemia
I. Paroxysmal nocturnal haemoglobinuria
J. Hereditary spherocytosis
K. Sickle cell anaemia
A. Paroxysmal cold haemoglobinuria
116
A 49 year old female complains of abdominal pain and vomiting a few minutes after the start of transfusion. O.E she is tachycardic and has facial flushing. Urinalysis reveals haemoglobinuria.
A. Viral contamination
B. Graft versus host disease
C. Bacterial contamination
D. Delayed haemolytic transfusion reaction.
E. Anaphylactic reaction
F. Iron overload
G. TRALI
H. Immediate haemolytic transfusion reaction
I. Febrile non haemolytic transfusion reaction
J. Allergic reaction
K. Fluid overload
H. Immediate haemolytic transfusion reaction
117
A 28 year old female presents with fever < 40 C and rigors approx. 1 ½ hours after transfusion. She has two children and previously had a blood transfusion 7 years ago.
A. Viral contamination
B. Graft versus host disease
C. Bacterial contamination
D. Delayed haemolytic transfusion reaction.
E. Anaphylactic reaction
F. Iron overload
G. TRALI
H. Immediate haemolytic transfusion reaction
I. Febrile non haemolytic transfusion reaction
J. Allergic reaction
K. Fluid overload
I. Febrile non haemolytic transfusion reaction
118
A 44 year old male develops a pyrexia of >40 C and marked hypotension very shortly after receiving a blood transfusion. He has never had a transfusion before and there is no evidence of ABO blood group / rhesus incompatibility.
A. Viral contamination
B. Graft versus host disease
C. Bacterial contamination
D. Delayed haemolytic transfusion reaction.
E. Anaphylactic reaction
F. Iron overload
G. TRALI
H. Immediate haemolytic transfusion reaction
I. Febrile non haemolytic transfusion reaction
J. Allergic reaction
K. Fluid overload
C. Bacterial contamination
119
A 78 year old man is found collapsed in his bathroom at home. Tests reveal that he is anaemic and has raised urea and creatinine levels. Over the next 24 hours he receives 3 litres of fluid and a blood transfusion. He then becomes dyspnoeic. Examination reveals a raised JVP, basal crepitations and ankle oedema
A. Viral contamination
B. Graft versus host disease
C. Bacterial contamination
D. Delayed haemolytic transfusion reaction.
E. Anaphylactic reaction
F. Iron overload
G. TRALI
H. Immediate haemolytic transfusion reaction
I. Febrile non haemolytic transfusion reaction
J. Allergic reaction
K. Fluid overload
K. Fluid overload
120
An 18 year old boy with sickle cell anaemia is observed to have short stature. Further tests reveal poor cardiac function
A. Viral contamination
B. Graft versus host disease
C. Bacterial contamination
D. Delayed haemolytic transfusion reaction.
E. Anaphylactic reaction
F. Iron overload
G. TRALI
H. Immediate haemolytic transfusion reaction
I. Febrile non haemolytic transfusion reaction
J. Allergic reaction
K. Fluid overload
F. Iron overload
121
```
An 18 year old African girl known to suffer from sickle cell anaemia develops a fever, sudden lethargy, pallor and arthralgia two months post-transfusion. Investigations reveal bone marrow red cell aplasia and a positive Paul-Bunnell test.
A. Reaction to massive transfusion
B. Air embolism
C. Post-transfusion purpura (PTP)
D. Allergic reaction to transfusion
E. Non-haemolytic reaction
F. B19 parvovirus infection
G. Delayed haemolytic transfusion reaction (DHTR)
H. CMV infection
I. Iron overload
J. Immunological haemolytic reaction
K. Transfusion-related fluid overload
L. Graft vs. Host disease (GvHD)
M. Transfusion-related acute lung injury (TRALI)
```
F. B19 parvovirus infection
122
```
A 32 year old Irish man was noted to have a temperature of 36.9ºC and blood electrolyte results of: urea = 5.2 mmol/L, sodium = 144 mmol/L, potassium = 5.5 mmol/L, calcium = 2.5 mmol/L after receiving 10 units of blood over a 24 hour period.
A. Reaction to massive transfusion
B. Air embolism
C. Post-transfusion purpura (PTP)
D. Allergic reaction to transfusion
E. Non-haemolytic reaction
F. B19 parvovirus infection
G. Delayed haemolytic transfusion reaction (DHTR)
H. CMV infection
I. Iron overload
J. Immunological haemolytic reaction
K. Transfusion-related fluid overload
L. Graft vs. Host disease (GvHD)
M. Transfusion-related acute lung injury (TRALI)
```
A. Reaction to massive transfusion
123
```
A 55 year old British female developed an itchy, diffuse erythematous rash on both arms fifteen minutes after receiving a blood transfusion. This rash responded well to acrivastine.
A. Reaction to massive transfusion
B. Air embolism
C. Post-transfusion purpura (PTP)
D. Allergic reaction to transfusion
E. Non-haemolytic reaction
F. B19 parvovirus infection
G. Delayed haemolytic transfusion reaction (DHTR)
H. CMV infection
I. Iron overload
J. Immunological haemolytic reaction
K. Transfusion-related fluid overload
L. Graft vs. Host disease (GvHD)
M. Transfusion-related acute lung injury (TRALI)
```
D. Allergic reaction to transfusion
124
```
A 36 year old Italian gentleman presented with severe bruising across the dorsal aspect of his left arm one week post-transfusion. FBC results included: Hb = 15g/dL, platelets = 8x109/L and WBC = 5.5x109/L.
A. Reaction to massive transfusion
B. Air embolism
C. Post-transfusion purpura (PTP)
D. Allergic reaction to transfusion
E. Non-haemolytic reaction
F. B19 parvovirus infection
G. Delayed haemolytic transfusion reaction (DHTR)
H. CMV infection
I. Iron overload
J. Immunological haemolytic reaction
K. Transfusion-related fluid overload
L. Graft vs. Host disease (GvHD)
M. Transfusion-related acute lung injury (TRALI)
```
C. Post-transfusion purpura (PTP)
125
```
A 72 year old Australian man developed a fever and jaundice five days post-transfusion. FBC revealed Hb = 9g/dL and MCV = 105fL with haemoglobinuria noted on urine dipstick testing.
A. Reaction to massive transfusion
B. Air embolism
C. Post-transfusion purpura (PTP)
D. Allergic reaction to transfusion
E. Non-haemolytic reaction
F. B19 parvovirus infection
G. Delayed haemolytic transfusion reaction (DHTR)
H. CMV infection
I. Iron overload
J. Immunological haemolytic reaction
K. Transfusion-related fluid overload
L. Graft vs. Host disease (GvHD)
M. Transfusion-related acute lung injury (TRALI)
```
G. Delayed haemolytic transfusion reaction (DHTR)
126
Patient develops increasing restlessness and chest pain during blood transfusion. Haemoglobinuria is also present.
A. FNHTR – Febrile non-haemolytic transfusion reaction
B. ABO incompatible
C. Bacterial infection
D. TRALI – Transfusion related acute lung injury
E. DHTR – Delayed Haemolytic transfusion reaction
F. IgA deficiency
G. TA-GVHD – Transfusion associated graft versus host disease
H. Urticarial rash
I. Iron overload
B. ABO incompatible
127
Patient develops shortness of breath, dry cough and chills. Donors blood was found to contain anti-leucocyte antibodies with similar specificity to the patient’s white blood cell antigens.
A. FNHTR – Febrile non-haemolytic transfusion reaction
B. ABO incompatible
C. Bacterial infection
D. TRALI – Transfusion related acute lung injury
E. DHTR – Delayed Haemolytic transfusion reaction
F. IgA deficiency
G. TA-GVHD – Transfusion associated graft versus host disease
H. Urticarial rash
I. Iron overload
D. TRALI – Transfusion related acute lung injury
128
Seven days after a blood transfusion, a patient presents to A&E with jaundice and fever. They are found to have a lowered haemoglobin level.
A. FNHTR – Febrile non-haemolytic transfusion reaction
B. ABO incompatible
C. Bacterial infection
D. TRALI – Transfusion related acute lung injury
E. DHTR – Delayed Haemolytic transfusion reaction
F. IgA deficiency
G. TA-GVHD – Transfusion associated graft versus host disease
H. Urticarial rash
I. Iron overload
E. DHTR – Delayed Haemolytic transfusion reaction
129
Patient has a severe anaphylactic reaction soon after transfusion. Signs and symptoms include wheeze, raised pulse, low blood pressure and laryngeal oedema.
A. FNHTR – Febrile non-haemolytic transfusion reaction
B. ABO incompatible
C. Bacterial infection
D. TRALI – Transfusion related acute lung injury
E. DHTR – Delayed Haemolytic transfusion reaction
F. IgA deficiency
G. TA-GVHD – Transfusion associated graft versus host disease
H. Urticarial rash
I. Iron overload
F. IgA deficiency
130
Patient develops mild symptoms of fever and rigors a few days after transfusion, with a rise pulse rate.
A. FNHTR – Febrile non-haemolytic transfusion reaction
B. ABO incompatible
C. Bacterial infection
D. TRALI – Transfusion related acute lung injury
E. DHTR – Delayed Haemolytic transfusion reaction
F. IgA deficiency
G. TA-GVHD – Transfusion associated graft versus host disease
H. Urticarial rash
I. Iron overload
A. FNHTR – Febrile non-haemolytic transfusion reaction
131
```
A 21 year old male patient develops a diffuse, erythematous rash on both arms shortly after receiving a blood transfusion. The rash responded well to chlorphenamine.
A. Air embolism
B. Urticarial rash
C. Transfursion related acute lung injury
D. CMV infection
E. Febrile non-haemolytic transfusion reaction
F. Iron overload
G. Post-transfusion purpura
H. Bacterial infection
I. Graft vs host disease
J. ABO incompatible
K. Delayed transfusion reaction
L. Anaphylaxis due to IgA deficiency
```
B. Urticarial rash
132
```
A 28 year old female patient presents to A&E with jaundice and fever. The history revealed she had received a blood transfusion whilst giving birth seven days previously. Blood tests revealed her haemoglobin to be 9g/dL.
A. Air embolism
B. Urticarial rash
C. Transfursion related acute lung injury
D. CMV infection
E. Febrile non-haemolytic transfusion reaction
F. Iron overload
G. Post-transfusion purpura
H. Bacterial infection
I. Graft vs host disease
J. ABO incompatible
K. Delayed transfusion reaction
L. Anaphylaxis due to IgA deficiency
```
K. Delayed transfusion reaction
133
```
A 30 year old female patient develops red/purple spots on both legs after receiving a blood transfusion during a Caesarean section several days previously.
A. Air embolism
B. Urticarial rash
C. Transfursion related acute lung injury
D. CMV infection
E. Febrile non-haemolytic transfusion reaction
F. Iron overload
G. Post-transfusion purpura
H. Bacterial infection
I. Graft vs host disease
J. ABO incompatible
K. Delayed transfusion reaction
L. Anaphylaxis due to IgA deficiency
```
G. Post-transfusion purpura
134
```
A 40 year old male patient with known Sickle-Cell anaemia develops mild symptoms of fever and rigors 3 to 4 days after a transfusion.
A. Air embolism
B. Urticarial rash
C. Transfursion related acute lung injury
D. CMV infection
E. Febrile non-haemolytic transfusion reaction
F. Iron overload
G. Post-transfusion purpura
H. Bacterial infection
I. Graft vs host disease
J. ABO incompatible
K. Delayed transfusion reaction
L. Anaphylaxis due to IgA deficiency
```
E. Febrile non-haemolytic transfusion reaction
135
```
A 36 year old male patient develops severe shortness of breath, laryngeal oedema and hypotension shortly after receiving a blood transfusion.
A. Air embolism
B. Urticarial rash
C. Transfursion related acute lung injury
D. CMV infection
E. Febrile non-haemolytic transfusion reaction
F. Iron overload
G. Post-transfusion purpura
H. Bacterial infection
I. Graft vs host disease
J. ABO incompatible
K. Delayed transfusion reaction
L. Anaphylaxis due to IgA deficiency
```
L. Anaphylaxis due to IgA deficiency
136
A 24 year old male who was diagnosed with thalassaemia major at 13 months presents to outpatients clinic complaining of malaise and erectile dysfunction.
A. Transfusion-related acute lung injury (TRALI)
B. Bacterial contamination of transfusion
C. Transfusion haemosiderosis
D. Guthrie test
E. Delayed haemolytic transfusion reaction (DHTR)
F. Pulmonary embolism
G. Kleihauer test
H. Viral contamination of transfusion
I. Allergic reaction to forein protein in donor blood
J. Immediate haemolytic transfusion reaction
C. Transfusion haemosiderosis
137
a 54 year old male smoker is 7 days post-op for the repair of an abdominal aortic aneurysm, He presents with fever and jaundice and bloods show a falling Hb.
A. Transfusion-related acute lung injury (TRALI)
B. Bacterial contamination of transfusion
C. Transfusion haemosiderosis
D. Guthrie test
E. Delayed haemolytic transfusion reaction (DHTR)
F. Pulmonary embolism
G. Kleihauer test
H. Viral contamination of transfusion
I. Allergic reaction to forein protein in donor blood
J. Immediate haemolytic transfusion reaction
E. Delayed haemolytic transfusion reaction (DHTR)
138
A 33 year old male was brought in from a serious RTA. He was given a donor transfusion on the ward. He later developed a fever and complained of suffereing from a 'dry cough'. The patient became increasingly breathless.
A. Transfusion-related acute lung injury (TRALI)
B. Bacterial contamination of transfusion
C. Transfusion haemosiderosis
D. Guthrie test
E. Delayed haemolytic transfusion reaction (DHTR)
F. Pulmonary embolism
G. Kleihauer test
H. Viral contamination of transfusion
I. Allergic reaction to forein protein in donor blood
J. Immediate haemolytic transfusion reaction
A. Transfusion-related acute lung injury (TRALI)
139
A 22 year old female with sickle cell anaemia presented 15 minutes after a donor blood transfusion with a diffuse, itchy, erythematous rash on both forearms. This responded well to ceftirizine.
A. Transfusion-related acute lung injury (TRALI)
B. Bacterial contamination of transfusion
C. Transfusion haemosiderosis
D. Guthrie test
E. Delayed haemolytic transfusion reaction (DHTR)
F. Pulmonary embolism
G. Kleihauer test
H. Viral contamination of transfusion
I. Allergic reaction to forein protein in donor blood
J. Immediate haemolytic transfusion reaction
I. Allergic reaction to forein protein in donor blood
140
A 33 year old patient has just given birth to her second child. The baby is jaundiced and placed under a UV lamp. What investigation would you perform to test for foetal haemoglobin-containing red cells?
A. Transfusion-related acute lung injury (TRALI)
B. Bacterial contamination of transfusion
C. Transfusion haemosiderosis
D. Guthrie test
E. Delayed haemolytic transfusion reaction (DHTR)
F. Pulmonary embolism
G. Kleihauer test
H. Viral contamination of transfusion
I. Allergic reaction to forein protein in donor blood
J. Immediate haemolytic transfusion reaction
G. Kleihauer test
141
A 25 year old man vomits and becomes restless on receiving a blood transfusion, he also complains of chest and abdominal pain.
A. Viral infection
B. Air Embolism
C. Anaphylaxis
D. Pulmonary Embolism
E. TRALI
F. Iatrogenic Iron overload
G. Massive transfusion reaction
H. Delayed haemolytic transfusion reaction
I. Transfusion-associated graft versus host disease
J. Fungal infection
K. Post-transfusion purpura
L. Allergic reaction
M. Febrile non-haemolytic transfusion reaction
N. Immediate haemolytic transfusion reaction
O. Bacterial infection
N. Immediate haemolytic transfusion reaction
142
A 60 year old women on a surgical ward develops dyspnoea while receiving a blood transfusion. You notice a red, swollen leg
A. Viral infection
B. Air Embolism
C. Anaphylaxis
D. Pulmonary Embolism
E. TRALI
F. Iatrogenic Iron overload
G. Massive transfusion reaction
H. Delayed haemolytic transfusion reaction
I. Transfusion-associated graft versus host disease
J. Fungal infection
K. Post-transfusion purpura
L. Allergic reaction
M. Febrile non-haemolytic transfusion reaction
N. Immediate haemolytic transfusion reaction
O. Bacterial infection
D. Pulmonary Embolism
143
A 23 year old Middle Eastern man with beta thalassaemia major complains of a bronze skin discolouration.
A. Viral infection
B. Air Embolism
C. Anaphylaxis
D. Pulmonary Embolism
E. TRALI
F. Iatrogenic Iron overload
G. Massive transfusion reaction
H. Delayed haemolytic transfusion reaction
I. Transfusion-associated graft versus host disease
J. Fungal infection
K. Post-transfusion purpura
L. Allergic reaction
M. Febrile non-haemolytic transfusion reaction
N. Immediate haemolytic transfusion reaction
O. Bacterial infection
F. Iatrogenic Iron overload
144
A 60 year old man who has been given a blood transfusion has noticed an itchy rash on his arms and legs.
A. Viral infection
B. Air Embolism
C. Anaphylaxis
D. Pulmonary Embolism
E. TRALI
F. Iatrogenic Iron overload
G. Massive transfusion reaction
H. Delayed haemolytic transfusion reaction
I. Transfusion-associated graft versus host disease
J. Fungal infection
K. Post-transfusion purpura
L. Allergic reaction
M. Febrile non-haemolytic transfusion reaction
N. Immediate haemolytic transfusion reaction
O. Bacterial infection
L. Allergic reaction
145
A 65 year old women presents with jaundice 5 days following an aortic aneurysm repair. FBC shows a low Hb.
A. Viral infection
B. Air Embolism
C. Anaphylaxis
D. Pulmonary Embolism
E. TRALI
F. Iatrogenic Iron overload
G. Massive transfusion reaction
H. Delayed haemolytic transfusion reaction
I. Transfusion-associated graft versus host disease
J. Fungal infection
K. Post-transfusion purpura
L. Allergic reaction
M. Febrile non-haemolytic transfusion reaction
N. Immediate haemolytic transfusion reaction
O. Bacterial infection
H. Delayed haemolytic transfusion reaction
146
```
Free light chains produced by abnormal plasma cells that are small enough to pass into the urine.
A. Osteoblasts
B. Paraprotein
C. Amyloid
D. Barry-Jane proteins
E. Osteoclasts
F. Extramedullary tumour deposits
G. Bence-Jones proteins
H. Inflammation
```
G. Bence-Jones proteins
147
```
Found in patients with Myeloma with low serum albumin and oedema.
A. Osteoblasts
B. Paraprotein
C. Amyloid
D. Barry-Jane proteins
E. Osteoclasts
F. Extramedullary tumour deposits
G. Bence-Jones proteins
H. Inflammation
```
C. Amyloid
148
```
A reactive increase in number of plasma cells in the marrow and polyclonal increase in Ig
A. Osteoblasts
B. Paraprotein
C. Amyloid
D. Barry-Jane proteins
E. Osteoclasts
F. Extramedullary tumour deposits
G. Bence-Jones proteins
H. Inflammation.
```
H. Inflammation.
149
```
A monoclonal immunoglobulin which appears as a dense narrow band (M band) on electrophoresis.
A. Osteoblasts
B. Paraprotein
C. Amyloid
D. Barry-Jane proteins
E. Osteoclasts
F. Extramedullary tumour deposits
G. Bence-Jones proteins
H. Inflammation.
```
B. Paraprotein
150
```
Stimulated by IL-6 secreted by cells in the vicinity of the myeloma cells. Produces radiological changes resembling those of generalized osteoporosis.
A. Osteoblasts
B. Paraprotein
C. Amyloid
D. Barry-Jane proteins
E. Osteoclasts
F. Extramedullary tumour deposits
G. Bence-Jones proteins
H. Inflammation.
```
E. Osteoclasts
151
```
Misfolded protein deposited in myeloma-associated amyloidosis
A. AA amyloid
B. Rituximab
C. Melphalan + prednisolone
D. IgM
E. Lenalidomide + low dose dexamethasone
F. Bortezomib
G. Multiple myeloma
H. Monoclonal gammopathy of undetermined significance (MGUS)
I. AL amyloid
J. Thalidomide + high dose dexamethasone
K. Aβ amyloid
L. Anaemia & renal failure
M. Waldenstrom’s macroglobinaemia
N. Interferon α + ibuprofen
O. Infliximab + budesonide
```
I. AL amyloid
152
```
A condition involving a low level of paraprotein in the blood in usually asymptomatic elderly patients
A. AA amyloid
B. Rituximab
C. Melphalan + prednisolone
D. IgM
E. Lenalidomide + low dose dexamethasone
F. Bortezomib
G. Multiple myeloma
H. Monoclonal gammopathy of undetermined significance (MGUS)
I. AL amyloid
J. Thalidomide + high dose dexamethasone
K. Aβ amyloid
L. Anaemia & renal failure
M. Waldenstrom’s macroglobinaemia
N. Interferon α + ibuprofen
O. Infliximab + budesonide
```
H. Monoclonal gammopathy of undetermined significance (MGUS)
153
```
Induction chemotherapy regimen with the best evidence pre autologous stem cell transplant in multiple myeloma
A. AA amyloid
B. Rituximab
C. Melphalan + prednisolone
D. IgM
E. Lenalidomide + low dose dexamethasone
F. Bortezomib
G. Multiple myeloma
H. Monoclonal gammopathy of undetermined significance (MGUS)
I. AL amyloid
J. Thalidomide + high dose dexamethasone
K. Aβ amyloid
L. Anaemia & renal failure
M. Waldenstrom’s macroglobinaemia
N. Interferon α + ibuprofen
O. Infliximab + budesonide
```
E. Lenalidomide + low dose dexamethasone
154
```
Monoclonal immunoglobulin raised in macroglobinaemia
A. AA amyloid
B. Rituximab
C. Melphalan + prednisolone
D. IgM
E. Lenalidomide + low dose dexamethasone
F. Bortezomib
G. Multiple myeloma
H. Monoclonal gammopathy of undetermined significance (MGUS)
I. AL amyloid
J. Thalidomide + high dose dexamethasone
K. Aβ amyloid
L. Anaemia & renal failure
M. Waldenstrom’s macroglobinaemia
N. Interferon α + ibuprofen
O. Infliximab + budesonide
```
D. IgM
155
```
Factor(s) associated with a very poor prognosis in multiple myeloma
A. AA amyloid
B. Rituximab
C. Melphalan + prednisolone
D. IgM
E. Lenalidomide + low dose dexamethasone
F. Bortezomib
G. Multiple myeloma
H. Monoclonal gammopathy of undetermined significance (MGUS)
I. AL amyloid
J. Thalidomide + high dose dexamethasone
K. Aβ amyloid
L. Anaemia & renal failure
M. Waldenstrom’s macroglobinaemia
N. Interferon α + ibuprofen
O. Infliximab + budesonide
```
L. Anaemia & renal failure
156
```
Proteasome inhibitor active in myeloma
A. AA amyloid
B. Rituximab
C. Melphalan + prednisolone
D. IgM
E. Lenalidomide + low dose dexamethasone
F. Bortezomib
G. Multiple myeloma
H. Monoclonal gammopathy of undetermined significance (MGUS)
I. AL amyloid
J. Thalidomide + high dose dexamethasone
K. Aβ amyloid
L. Anaemia & renal failure
M. Waldenstrom’s macroglobinaemia
N. Interferon α + ibuprofen
O. Infliximab + budesonide
```
F. Bortezomib
157
```
Asymptomatic, serum monoclonal protein 25g/L, marrow plasma cells 5%, serum Ca 2.3 mmol/L, estimated GFR 100mL/min, Hb 12.5 g/dL, skeletal survey normal
A. Solitary plasmacytoma of bone (SPB)
B. Smouldering multiple myeloma
C. Primary hyperparathyroidism
D. CLL
E. Multiple myeloma
F. Waldenstrom's macroglobulinaemia
G. Sarcoidosis
H. Primary amyloidosis
I. MGUS
J. Secondary hyperparathyroidism
K. Metastatic breast cancer
```
I. MGUS
158
```
Asymptomatic, serum monoclonal protein 30g/L, marrow plasma cells 10%, serum Ca 2.3 mmol/L, estimated GFR 100mL/min, Hb 12.5 g/dL, skeletal survey normal
A. Solitary plasmacytoma of bone (SPB)
B. Smouldering multiple myeloma
C. Primary hyperparathyroidism
D. CLL
E. Multiple myeloma
F. Waldenstrom's macroglobulinaemia
G. Sarcoidosis
H. Primary amyloidosis
I. MGUS
J. Secondary hyperparathyroidism
K. Metastatic breast cancer
```
B. Smouldering multiple myeloma
159
```
Asymptomatic, serum monoclonal protein 10g/L, marrow plasma cells 15%, serum Ca 2.3 mmol/L, estimated GFR 30 mL/min, Hb 8 g/dL, lytic vertebral lesions
A. Solitary plasmacytoma of bone (SPB)
B. Smouldering multiple myeloma
C. Primary hyperparathyroidism
D. CLL
E. Multiple myeloma
F. Waldenstrom's macroglobulinaemia
G. Sarcoidosis
H. Primary amyloidosis
I. MGUS
J. Secondary hyperparathyroidism
K. Metastatic breast cancer
```
E. Multiple myeloma
160
```
Abdo pain, serum monoclonal protein 10g/L, marrow plasma cells >10%, serum Ca 2.6 mmol/L, estimated GFR 30 mL/min, Hb 8 g/dL, lytic vertebral lesions
A. Solitary plasmacytoma of bone (SPB)
B. Smouldering multiple myeloma
C. Primary hyperparathyroidism
D. CLL
E. Multiple myeloma
F. Waldenstrom's macroglobulinaemia
G. Sarcoidosis
H. Primary amyloidosis
I. MGUS
J. Secondary hyperparathyroidism
K. Metastatic breast cancer
```
E. Multiple myeloma
161
```
Previously fit 35yo Afro Carribean female, sudden onset back pain, no history of trauma, 1 month history polyuria, urine specific gravity raised but dipstick negative for protein (and normal in all other respects), estimated GFR 70mL/min, vertebral fracture and bilateral femoral neck fractures on radiograph.
A. Solitary plasmacytoma of bone (SPB)
B. Smouldering multiple myeloma
C. Primary hyperparathyroidism
D. CLL
E. Multiple myeloma
F. Waldenstrom's macroglobulinaemia
G. Sarcoidosis
H. Primary amyloidosis
I. MGUS
J. Secondary hyperparathyroidism
K. Metastatic breast cancer
```
E. Multiple myeloma
162
```
Which paraprotein is most commonly raised in patients with multiple myeloma?
A. IL-6
B. IgD
C. IgM
D. Monoclonal gammopathy of undetermined significance (MGUS)
E. Waldenstrom's macroglobuliaemia
F. Amyloid AA
G. IgA
H. Bence-Jones protein
I. IL-8
J. IgG
K. Amyloid AB
L. Beta2 microglobulin
M. Amyloid AL
```
J. IgG
163
```
Which cytokine is an important growth factor in the development of myeloma?
A. IL-6
B. IgD
C. IgM
D. Monoclonal gammopathy of undetermined significance (MGUS)
E. Waldenstrom's macroglobuliaemia
F. Amyloid AA
G. IgA
H. Bence-Jones protein
I. IL-8
J. IgG
K. Amyloid AB
L. Beta2 microglobulin
M. Amyloid AL
```
A. IL-6
164
```
Free light chains that are small enough to pass into the urine.
A. IL-6
B. IgD
C. IgM
D. Monoclonal gammopathy of undetermined significance (MGUS)
E. Waldenstrom's macroglobuliaemia
F. Amyloid AA
G. IgA
H. Bence-Jones protein
I. IL-8
J. IgG
K. Amyloid AB
L. Beta2 microglobulin
M. Amyloid AL
```
H. Bence-Jones protein
165
```
Elevated levels imply a poor prognosis in myeloma patients.
A. IL-6
B. IgD
C. IgM
D. Monoclonal gammopathy of undetermined significance (MGUS)
E. Waldenstrom's macroglobuliaemia
F. Amyloid AA
G. IgA
H. Bence-Jones protein
I. IL-8
J. IgG
K. Amyloid AB
L. Beta2 microglobulin
M. Amyloid AL
```
L. Beta2 microglobulin
166
```
Condition usually in asymptomatic elderly patients with a low level of paraprotein in the blood.
A. IL-6
B. IgD
C. IgM
D. Monoclonal gammopathy of undetermined significance (MGUS)
E. Waldenstrom's macroglobuliaemia
F. Amyloid AA
G. IgA
H. Bence-Jones protein
I. IL-8
J. IgG
K. Amyloid AB
L. Beta2 microglobulin
M. Amyloid AL
```
D. Monoclonal gammopathy of undetermined significance (MGUS)
167
```
A 52 yr old woman who has a 5 yr history of rheumatoid arthritis and has recently been found to have proteinuria. Further examination revealed hepatosplenomegaly. A rectal biopsy stained with Congo Red showed apple green birefringence in polarised light.
A. Primary amyloidosis
B. Monoclonal gammopathy of undetermined significance
C. Waldenstrom's macroglobulinaemia
D. Multiple myeloma
E. Chronic lymphocytic leukaemia
F. Secondary amyloidosis
G. Metastatic carcinoma
```
F. Secondary amyloidosis
168
```
A 60 yr old woman presents to her GP with fatigue and bone pain. Examination of her bone marrow demonstrated >10 % plasma cells, and a monoclonal protein in the serum. Further investigations showed a hypercalcaemia.
A. Primary amyloidosis
B. Monoclonal gammopathy of undetermined significance
C. Waldenstrom's macroglobulinaemia
D. Multiple myeloma
E. Chronic lymphocytic leukaemia
F. Secondary amyloidosis
G. Metastatic carcinoma
```
D. Multiple myeloma
169
```
A 65 yr old man presents to his GP with general malaise, weight loss and visual disturbances that he likens to looking through a watery car windscreen. On examination he has peripheral lymph node enlargement. Protein electrophoresis shows an IgM paraprotein
A. Primary amyloidosis
B. Monoclonal gammopathy of undetermined significance
C. Waldenstrom's macroglobulinaemia
D. Multiple myeloma
E. Chronic lymphocytic leukaemia
F. Secondary amyloidosis
G. Metastatic carcinoma.
```
C. Waldenstrom's macroglobulinaemia
170
```
A 73 yr old man is shown to have paraprotein in blood <2g/L. Further investigations reveal no renal impairment or bone destruction.
A. Primary amyloidosis
B. Monoclonal gammopathy of undetermined significance
C. Waldenstrom's macroglobulinaemia
D. Multiple myeloma
E. Chronic lymphocytic leukaemia
F. Secondary amyloidosis
G. Metastatic carcinoma.
```
B. Monoclonal gammopathy of undetermined significance
171
```
A 60 yr old woman presents to her GP with shortness of breath and ankle oedema. When examined the patient has bilateral weakness and paraesthesia of her hands. Investigations revealed a monoclonal proliferation of plasma cells and the presence of Bence Jones proteins.
A. Primary amyloidosis
B. Monoclonal gammopathy of undetermined significance
C. Waldenstrom's macroglobulinaemia
D. Multiple myeloma
E. Chronic lymphocytic leukaemia
F. Secondary amyloidosis
G. Metastatic carcinoma.
```
A. Primary amyloidosis
172
```
A 49-year-old woman presented with a 6-month history of vague aches and pains in her chest. On examination, she was overweight but had no abnormal physical signs. Protein electrophoresis showed a small paraprotein band in the gamma region; this band was an IgG of lambda type. A bone marrow biopsy showed only 12% plasma cells. There was no protein in her urine.
A. Multiple myeloma
B. Non-Hodgkin's lymphoma
C. Acute leukaemia
D. Hodgkin's lymphoma
E. Sezary syndrome
F. Bone metastasis
G. Hairy cell leukaemia
H. Fractured vertebrae
I. Sarcoidosis
J. Benign paraproteinaemia
```
J. Benign paraproteinaemia
173
```
A 71-year-old man presented with sharp, constant, low back pain, dating from a fall from a ladder 6 weeks earlier. He admitted to vague malaise for over 8 months. He had a raised serum calcium level (3.2mmol/l) but a normal alkaline phosphatase. X-rays of his back showed a small, punched-out lesion in the second lumbar vertebra and a Bone marrow biopsy showed an increased number of atypical plasma cells; these constituted 45% of the nucleated cells found on the film.
A. Multiple myeloma
B. Non-Hodgkin's lymphoma
C. Acute leukaemia
D. Hodgkin's lymphoma
E. Sezary syndrome
F. Bone metastasis
G. Hairy cell leukaemia
H. Fractured vertebrae
I. Sarcoidosis
J. Benign paraproteinaemia
```
A. Multiple myeloma
174
```
A 43 year old man presents to his GP with concerns over a tender lump on the left side of his abdomen. Investigation showed a normal haemoglobin but a mildly raised white-cell count (13.2 x 109/l). On the blood film these cells were mainly small mononuclear cells resembling lymphocytes. These cells stained positively for tartrate-resistant acid phosphatase.
A. Multiple myeloma
B. Non-Hodgkin's lymphoma
C. Acute leukaemia
D. Hodgkin's lymphoma
E. Sezary syndrome
F. Bone metastasis
G. Hairy cell leukaemia
H. Fractured vertebrae
I. Sarcoidosis
J. Benign paraproteinaemia
```
G. Hairy cell leukaemia
175
```
A 78 year old man is admitted to hospital after experiencing problems urinating and defecating. He also noticed numbness in some areas of his abdomen. Blood levels of calcium and ALP were raised. A bone scan confirms the diagnosis.
A. Multiple myeloma
B. Non-Hodgkin's lymphoma
C. Acute leukaemia
D. Hodgkin's lymphoma
E. Sezary syndrome
F. Bone metastasis
G. Hairy cell leukaemia
H. Fractured vertebrae
I. Sarcoidosis
J. Benign paraproteinaemia
```
F. Bone metastasis
176
```
A 69 year old man presents with a complaint of right elbow pain. Radiography shows a lytic lesion in the area of the right proximal radius. Biopsy of the lesion reveals a mono-clonal population of plasma cells consistent with a plasmacytoma. A radiographic skeletal bone survey shows other similar lesions.
A. Multiple myeloma
B. Non-Hodgkin's lymphoma
C. Acute leukaemia
D. Hodgkin's lymphoma
E. Sezary syndrome
F. Bone metastasis
G. Hairy cell leukaemia
H. Fractured vertebrae
I. Sarcoidosis
J. Benign paraproteinaemia
```
A. Multiple myeloma
177
```
Myeloma:
A. Variable T cell
B. Aggressive B cell
C. Aggressive T cell
D. Variable B cell
E. Indolent T cell
F. Indolent B cell
```
D. Variable B cell
178
```
Burkitts Lymphoma
A. Variable T cell
B. Aggressive B cell
C. Aggressive T cell
D. Variable B cell
E. Indolent T cell
F. Indolent B cell
```
B. Aggressive B cell
179
```
ATLL
A. Variable T cell
B. Aggressive B cell
C. Aggressive T cell
D. Variable B cell
E. Indolent T cell
F. Indolent B cell
```
C. Aggressive T cell
180
```
Most easily curable B cell neoplasm
A. Variable T cell
B. Aggressive B cell
C. Aggressive T cell
D. Variable B cell
E. Indolent T cell
F. Indolent B cell
```
B. Aggressive B cell
181
```
Follicular lymphoma
A. Variable T cell
B. Aggressive B cell
C. Aggressive T cell
D. Variable B cell
E. Indolent T cell
F. Indolent B cell
```
F. Indolent B cell
182
```
A 25 year old man presents with a single enlarged painless cervical lymph node and complains of drenching night sweats. Histology shows the presence of Reed-Sternberg cells.
A. Hodgkins Stage IIA
B. ABVD combination chemotherapy + radiotherapy if required
C. Polycythaemia Rubra Vera
D. Acute Myeloid Leukaemia
E. Primary Amyloidosis
F. Radiation Therapy Alone
G. Hodgkins Disease Stage IB
H. Aplastic Anaemia
I. Combination Chemotherapy
J. Multiple Myeloma
K. Hairy Cell Leukaemia
L. Burkitts Lymphoma
M. Myelodysplasia
N. Chronic Lymphocytic Leukaemia
```
G. Hodgkins Disease Stage IB
183
```
An elderly lady is found to suffer from Epstein-Barr virus. She is late noted to have splenic enlargement
A. Hodgkins Stage IIA
B. ABVD combination chemotherapy + radiotherapy if required
C. Polycythaemia Rubra Vera
D. Acute Myeloid Leukaemia
E. Primary Amyloidosis
F. Radiation Therapy Alone
G. Hodgkins Disease Stage IB
H. Aplastic Anaemia
I. Combination Chemotherapy
J. Multiple Myeloma
K. Hairy Cell Leukaemia
L. Burkitts Lymphoma
M. Myelodysplasia
N. Chronic Lymphocytic Leukaemia
```
L. Burkitts Lymphoma
184
```
During an insurance medical a 32 year old IT consultant was found to have hilar lymphadenopathy on his chest x-ray. He also complains of a painless lump under his right arm
A. Hodgkins Stage IIA
B. ABVD combination chemotherapy + radiotherapy if required
C. Polycythaemia Rubra Vera
D. Acute Myeloid Leukaemia
E. Primary Amyloidosis
F. Radiation Therapy Alone
G. Hodgkins Disease Stage IB
H. Aplastic Anaemia
I. Combination Chemotherapy
J. Multiple Myeloma
K. Hairy Cell Leukaemia
L. Burkitts Lymphoma
M. Myelodysplasia
N. Chronic Lymphocytic Leukaemia
```
A. Hodgkins Stage IIA
185
```
Advanced Hodgkins disease should be treated with…..
A. Hodgkins Stage IIA
B. ABVD combination chemotherapy + radiotherapy if required
C. Polycythaemia Rubra Vera
D. Acute Myeloid Leukaemia
E. Primary Amyloidosis
F. Radiation Therapy Alone
G. Hodgkins Disease Stage IB
H. Aplastic Anaemia
I. Combination Chemotherapy
J. Multiple Myeloma
K. Hairy Cell Leukaemia
L. Burkitts Lymphoma
M. Myelodysplasia
N. Chronic Lymphocytic Leukaemia
```
I. Combination Chemotherapy
186
```
Pathological stage IA or IIA disease may be treated with.....
A. Hodgkins Stage IIA
B. ABVD combination chemotherapy + radiotherapy if required
C. Polycythaemia Rubra Vera
D. Acute Myeloid Leukaemia
E. Primary Amyloidosis
F. Radiation Therapy Alone
G. Hodgkins Disease Stage IB
H. Aplastic Anaemia
I. Combination Chemotherapy
J. Multiple Myeloma
K. Hairy Cell Leukaemia
L. Burkitts Lymphoma
M. Myelodysplasia
N. Chronic Lymphocytic Leukaemia
```
B. ABVD combination chemotherapy + radiotherapy if required
187
```
A subtype of Non-Hodgkin lymphoma associated with very aggressive disease.
A. Very aggressive
B. Indolent
C. Non-Hodgkin lymphoma
D. Diffuse large B cell lymphoma
E. Aggressive
F. Pruritis
G. Stage IIA
H. Hodgkin lymphoma
I. Epstein-Barr virus
J. Follicular lymphoma
K. Burkitt's lymphoma
L. Stage IIIB
M. Night sweats
N. Pel-Ebstein fever
```
K. Burkitt's lymphoma
188
```
A classical but rare constitutional symptom of Hodgkin lymphoma
A. Very aggressive
B. Indolent
C. Non-Hodgkin lymphoma
D. Diffuse large B cell lymphoma
E. Aggressive
F. Pruritis
G. Stage IIA
H. Hodgkin lymphoma
I. Epstein-Barr virus
J. Follicular lymphoma
K. Burkitt's lymphoma
L. Stage IIIB
M. Night sweats
N. Pel-Ebstein fever
```
N. Pel-Ebstein fever
189
```
The stage characterised by multiple lymph node involvement on the same side of the diaphragm but without constitutional symptoms
A. Very aggressive
B. Indolent
C. Non-Hodgkin lymphoma
D. Diffuse large B cell lymphoma
E. Aggressive
F. Pruritis
G. Stage IIA
H. Hodgkin lymphoma
I. Epstein-Barr virus
J. Follicular lymphoma
K. Burkitt's lymphoma
L. Stage IIIB
M. Night sweats
N. Pel-Ebstein fever
```
G. Stage IIA
190
```
The grade of the Follicular lymphoma NHL subtype.
A. Very aggressive
B. Indolent
C. Non-Hodgkin lymphoma
D. Diffuse large B cell lymphoma
E. Aggressive
F. Pruritis
G. Stage IIA
H. Hodgkin lymphoma
I. Epstein-Barr virus
J. Follicular lymphoma
K. Burkitt's lymphoma
L. Stage IIIB
M. Night sweats
N. Pel-Ebstein fever
```
B. Indolent
191
```
A patient presents with a lump in his groin and complains of night sweats and an itchy rash. A biopsy is taken and on inspection is shown to include Reed-Sternberg cells.
A. Very aggressive
B. Indolent
C. Non-Hodgkin lymphoma
D. Diffuse large B cell lymphoma
E. Aggressive
F. Pruritis
G. Stage IIA
H. Hodgkin lymphoma
I. Epstein-Barr virus
J. Follicular lymphoma
K. Burkitt's lymphoma
L. Stage IIIB
M. Night sweats
N. Pel-Ebstein fever
```
H. Hodgkin lymphoma
192
```
A 61 year old lady complains to her GP of morning stiffness and aching in her hips. She also suffers from anorexia, fatigue and occasional night sweats. She is found to have a raised ESR. Of note she has had giant cell arterititis in the past. What is the most likely diagnosis from the list above.
A. Microangiopathic haemolytic anaemia
B. Neutrophils
C. Eosinophils
D. Leucoerythroblastic anaemia
E. Monocytes
F. Systemic lupus erythematosis
G. Anaemia of chronic disease
H. Iron deficiency anaemia
I. Diverticular disease
J. Rheumatoid arthritis
K. Polymyalgia rheumatica
```
K. Polymyalgia rheumatica
193
```
An 81 year old man with known prostatic carcinoma presents to his GP with severe bone pain. Blood tests reveal a mild anaemia and peripheral blood film shows nucleated red blood cells and immature myeloid cells. What are these haematological features collectively known as?
A. Microangiopathic haemolytic anaemia
B. Neutrophils
C. Eosinophils
D. Leucoerythroblastic anaemia
E. Monocytes
F. Systemic lupus erythematosis
G. Anaemia of chronic disease
H. Iron deficiency anaemia
I. Diverticular disease
J. Rheumatoid arthritis
K. Polymyalgia rheumatica
```
D. Leucoerythroblastic anaemia
194
```
A 51 year old man is having work up for palliative surgery due to gastric adenocarcinoma. He is found to be anaemic, with high a reticulocyte count and fragmented red blood cells on blood smear. What is this anaemia known as?
A. Microangiopathic haemolytic anaemia
B. Neutrophils
C. Eosinophils
D. Leucoerythroblastic anaemia
E. Monocytes
F. Systemic lupus erythematosis
G. Anaemia of chronic disease
H. Iron deficiency anaemia
I. Diverticular disease
J. Rheumatoid arthritis
K. Polymyalgia rheumatica
```
A. Microangiopathic haemolytic anaemia
195
```
A 21 year old student recently returning from India complains to his GP of cough, headache and diarrhoea. He is febrile and rose spots are present on his chest. Blood culture reveals salmonella typhi. Which immune cells out of the list are most likely to be raised?
A. Microangiopathic haemolytic anaemia
B. Neutrophils
C. Eosinophils
D. Leucoerythroblastic anaemia
E. Monocytes
F. Systemic lupus erythematosis
G. Anaemia of chronic disease
H. Iron deficiency anaemia
I. Diverticular disease
J. Rheumatoid arthritis
K. Polymyalgia rheumatica
```
E. Monocytes
196
```
Anaemia and neutropenia are more common in which of the above autoimmune disease?
A. Microangiopathic haemolytic anaemia
B. Neutrophils
C. Eosinophils
D. Leucoerythroblastic anaemia
E. Monocytes
F. Systemic lupus erythematosis
G. Anaemia of chronic disease
H. Iron deficiency anaemia
I. Diverticular disease
J. Rheumatoid arthritis
K. Polymyalgia rheumatica
```
F. Systemic lupus erythematosis
197
```
A peripheral blood smear of a thrombocytopenic patient raised Lactate dehydrogenase and unconjugated bilirubin shows fragmented Red blood cells.
A. Microangiopathic haemolytic anaemia
B. Type 1 hypersensitivity reaction
C. Acute fungal infection
D. Parasitic infestation
E. Polycythaemia vera
F. Leucoerythroblastic anaemia
G. Autoimmune haemolytic anaemia
H. Secondary true polycythaemia
I. Rheumatoid arthritis
J. Brucella infection
```
A. Microangiopathic haemolytic anaemia
198
```
A markedly raised haemoglobin in a patient with renal cell carcinoma.
A. Microangiopathic haemolytic anaemia
B. Type 1 hypersensitivity reaction
C. Acute fungal infection
D. Parasitic infestation
E. Polycythaemia vera
F. Leucoerythroblastic anaemia
G. Autoimmune haemolytic anaemia
H. Secondary true polycythaemia
I. Rheumatoid arthritis
J. Brucella infection
```
H. Secondary true polycythaemia
199
```
Monocytosis but with a normal neutrophil count.
A. Microangiopathic haemolytic anaemia
B. Type 1 hypersensitivity reaction
C. Acute fungal infection
D. Parasitic infestation
E. Polycythaemia vera
F. Leucoerythroblastic anaemia
G. Autoimmune haemolytic anaemia
H. Secondary true polycythaemia
I. Rheumatoid arthritis
J. Brucella infection
```
J. Brucella infection
200
```
A markedly raised haemoglobin in a patient with splenomegaly
A. Microangiopathic haemolytic anaemia
B. Type 1 hypersensitivity reaction
C. Acute fungal infection
D. Parasitic infestation
E. Polycythaemia vera
F. Leucoerythroblastic anaemia
G. Autoimmune haemolytic anaemia
H. Secondary true polycythaemia
I. Rheumatoid arthritis
J. Brucella infection
```
E. Polycythaemia vera
201
```
Neutrophilia with visible toxic granulation and vacuoles on the blood film. The monocyte count is normal.
A. Microangiopathic haemolytic anaemia
B. Type 1 hypersensitivity reaction
C. Acute fungal infection
D. Parasitic infestation
E. Polycythaemia vera
F. Leucoerythroblastic anaemia
G. Autoimmune haemolytic anaemia
H. Secondary true polycythaemia
I. Rheumatoid arthritis
J. Brucella infection
```
C. Acute fungal infection
202
```
A patient with a positive coombs test and a blood film showing spherocytes.
A. Microangiopathic haemolytic anaemia
B. Type 1 hypersensitivity reaction
C. Acute fungal infection
D. Parasitic infestation
E. Polycythaemia vera
F. Leucoerythroblastic anaemia
G. Autoimmune haemolytic anaemia
H. Secondary true polycythaemia
I. Rheumatoid arthritis
J. Brucella infection
```
G. Autoimmune haemolytic anaemia
203
```
A 30 year old female presents to her GP complaining of aches and pains in her joints and a rash on her face after returning from a holiday in Spain. Her blood tests show a normocytic anaemia, an elevated ESR and a positive Anti-Nuclear Antibodies test.
A. Osteoarthritis
B. Type I diabetes mellitus
C. C1 inhibitor deficiency
D. Anaphylaxis
E. Rheumatoid arthritis
F. Scleroderma
G. SLE
H. Impaired glucose tolerance
I. Sjorgens syndrome
J. Type II diabetes mellitus
K. Vasculitis
L. Cushings syndrome
```
G. SLE
204
```
A 60 year old male of Indian origin presents to his GP with increasing thirst over the past 6 months. He also admits to increased urinary frequency. He has a random plasma glucose of 11.2mmol/l and a fasting glucose of 7.8mmol/l.
A. Osteoarthritis
B. Type I diabetes mellitus
C. C1 inhibitor deficiency
D. Anaphylaxis
E. Rheumatoid arthritis
F. Scleroderma
G. SLE
H. Impaired glucose tolerance
I. Sjorgens syndrome
J. Type II diabetes mellitus
K. Vasculitis
L. Cushings syndrome
```
J. Type II diabetes mellitus
205
```
A 38 year old male presents to his GP complaining of general malaise and joint stiffness which is particularly bad in the morning. His blood tests show a normocytic anaemia and are positive for Rheumatoid factor.
A. Osteoarthritis
B. Type I diabetes mellitus
C. C1 inhibitor deficiency
D. Anaphylaxis
E. Rheumatoid arthritis
F. Scleroderma
G. SLE
H. Impaired glucose tolerance
I. Sjorgens syndrome
J. Type II diabetes mellitus
K. Vasculitis
L. Cushings syndrome
```
E. Rheumatoid arthritis
206
```
A 22 year old female who has recently undergone surgery presents with difficulties breathing and swelling of the face, hands and feet. She also complains of severe abdominal pains. She has experienced similar problems in the past.
A. Osteoarthritis
B. Type I diabetes mellitus
C. C1 inhibitor deficiency
D. Anaphylaxis
E. Rheumatoid arthritis
F. Scleroderma
G. SLE
H. Impaired glucose tolerance
I. Sjorgens syndrome
J. Type II diabetes mellitus
K. Vasculitis
L. Cushings syndrome
```
C. C1 inhibitor deficiency
207
```
A 16 year old male is rushed into A+E with severe shortness of breath and wheezing. He is also noted to have urticaria and he is tachycardic and hypotensive with decreasing consciousness.
A. Osteoarthritis
B. Type I diabetes mellitus
C. C1 inhibitor deficiency
D. Anaphylaxis
E. Rheumatoid arthritis
F. Scleroderma
G. SLE
H. Impaired glucose tolerance
I. Sjorgens syndrome
J. Type II diabetes mellitus
K. Vasculitis
L. Cushings syndrome
```
D. Anaphylaxis
208
```
A female infant presents to A&E with symptoms of hypoxia. It is noted that she has dactylitis.
A. Sickle Cell Disease
B. Autoimmune Haemolytic Anaemia
C. Autoimmune Thrombocytopenic Purpura
D. Haemophilia A
E. Acute Lymphoblastic Leukaemia
F. Iron Deficiency Anaemia
G. Parvovirus B19 Infection
H. Normal Neonate
I. Vitamin K Deficiency
J. Haemolytic Uraemic Syndrome
```
A. Sickle Cell Disease
209
```
A 4 year old male presents to A&E with pallor, bruising and bone pain. O/E: hepatosplenomegaly is noted. Blood analysis reveals a reduced Hb and a raised WCC. Blast cells are noted on the blood film
A. Sickle Cell Disease
B. Autoimmune Haemolytic Anaemia
C. Autoimmune Thrombocytopenic Purpura
D. Haemophilia A
E. Acute Lymphoblastic Leukaemia
F. Iron Deficiency Anaemia
G. Parvovirus B19 Infection
H. Normal Neonate
I. Vitamin K Deficiency
J. Haemolytic Uraemic Syndrome
```
E. Acute Lymphoblastic Leukaemia
210
```
A child is known to have a blood disorder and seems to have suffered from a stroke. What is the blood disorder that this child is most likely to have?
A. Sickle Cell Disease
B. Autoimmune Haemolytic Anaemia
C. Autoimmune Thrombocytopenic Purpura
D. Haemophilia A
E. Acute Lymphoblastic Leukaemia
F. Iron Deficiency Anaemia
G. Parvovirus B19 Infection
H. Normal Neonate
I. Vitamin K Deficiency
J. Haemolytic Uraemic Syndrome
```
A. Sickle Cell Disease
211
```
A routine blood sample is taken from an asymptomatic neonate. Results reveal a raised Hb, a raised WCC and a raised MCV. Both Hb A and F are present.
A. Sickle Cell Disease
B. Autoimmune Haemolytic Anaemia
C. Autoimmune Thrombocytopenic Purpura
D. Haemophilia A
E. Acute Lymphoblastic Leukaemia
F. Iron Deficiency Anaemia
G. Parvovirus B19 Infection
H. Normal Neonate
I. Vitamin K Deficiency
J. Haemolytic Uraemic Syndrome
```
H. Normal Neonate
212
```
A male infant is admitted to hospital for a routine circumcision. During the operation haemostasis seems to be impaired. His mother failed to mention in the family history that her father had some sort of blood disorder.
A. Sickle Cell Disease
B. Autoimmune Haemolytic Anaemia
C. Autoimmune Thrombocytopenic Purpura
D. Haemophilia A
E. Acute Lymphoblastic Leukaemia
F. Iron Deficiency Anaemia
G. Parvovirus B19 Infection
H. Normal Neonate
I. Vitamin K Deficiency
J. Haemolytic Uraemic Syndrome
```
D. Haemophilia A
213
```
A 3 month old boy, of Greek origin is brought to A&E by his mother straight from his christening. On examination, he is crying and appears jaundiced. Mild splenomegaly is felt in his abdomen. His mother says he has a fever and she notes that his urine was very dark when she changed his nappy. Investigation of his blood film reveals polychromatic macrocytes and irregularly shaped red blood cells. You also note his “special christening clothes” that his mother proudly tells you have been in the family for generations, they smell strongly of moth balls. Assay for G6PD reveals a normal level.
A. Hereditary Eliptocytosis
B. Sickle Cell Anaemia
C. Sickle Cell Trait
D. Thalassaemia Major
E. Haemophilia A
F. Thalassaemia Minor
G. Transient Abnormal Myelopoiesis
H. Haemophillia B
I. G6PD deficiency
J. Von Willebrand’s Disease
K. Haemolytic Disease of the Newborn
L. Hereditary Spherocytosis
M. Haemolytic Uraemic Syndrome
```
I. G6PD deficiency
214
```
A 6 month old girl is brought to her GP by her Greek Cypriot parents. They complain that she looks small compared to their neighbour’s baby of the same age. They also think her face looks funny. On examination, you note pallor and jaundice, the baby’s skull appears bossed and there is maxillary prominence. There is also marked hepatosplenomegaly. Her blood film shows a microcytosis and haemoglobin analysis shows high levels of HbF and HbA2.
A. Hereditary Eliptocytosis
B. Sickle Cell Anaemia
C. Sickle Cell Trait
D. Thalassaemia Major
E. Haemophilia A
F. Thalassaemia Minor
G. Transient Abnormal Myelopoiesis
H. Haemophillia B
I. G6PD deficiency
J. Von Willebrand’s Disease
K. Haemolytic Disease of the Newborn
L. Hereditary Spherocytosis
M. Haemolytic Uraemic Syndrome
```
D. Thalassaemia Major
215
```
A young boy is referred to you because of prolonged bleeding following circumcision. You also note some bleeding of the gums. Coagulation tests reveal a normal PT but a raised APTT and an increased Bleeding Time. Analysis of clotting factors reveals a low Factor VIII.
A. Hereditary Eliptocytosis
B. Sickle Cell Anaemia
C. Sickle Cell Trait
D. Thalassaemia Major
E. Haemophilia A
F. Thalassaemia Minor
G. Transient Abnormal Myelopoiesis
H. Haemophillia B
I. G6PD deficiency
J. Von Willebrand’s Disease
K. Haemolytic Disease of the Newborn
L. Hereditary Spherocytosis
M. Haemolytic Uraemic Syndrome
```
J. Von Willebrand’s Disease
N.B
Haemophilia = prolonged APTT but normal PT and bleeding time
VWD = prolonged APTT and bleeding time and low levels of vwf (factor 8 may also be low as it is the carrier protein)
216
```
A baby is noted to be jaundiced a few days after birth, with marked anaemia. Examination reveals an enlarged spleen. The blood film shows numerous spherocytes. On questioning the parents, the father says his mother told him he was a “bit yellow” as a child.
A. Hereditary Eliptocytosis
B. Sickle Cell Anaemia
C. Sickle Cell Trait
D. Thalassaemia Major
E. Haemophilia A
F. Thalassaemia Minor
G. Transient Abnormal Myelopoiesis
H. Haemophillia B
I. G6PD deficiency
J. Von Willebrand’s Disease
K. Haemolytic Disease of the Newborn
L. Hereditary Spherocytosis
M. Haemolytic Uraemic Syndrome
```
L. Hereditary Spherocytosis
217
```
A baby with Down’s syndrome is noted, on routine blood testing, to have large numbers of circulating megakaryocyte blast cells and nucleated red blood cells. A repeat blood film 2 months later is normal.
A. Hereditary Eliptocytosis
B. Sickle Cell Anaemia
C. Sickle Cell Trait
D. Thalassaemia Major
E. Haemophilia A
F. Thalassaemia Minor
G. Transient Abnormal Myelopoiesis
H. Haemophillia B
I. G6PD deficiency
J. Von Willebrand’s Disease
K. Haemolytic Disease of the Newborn
L. Hereditary Spherocytosis
M. Haemolytic Uraemic Syndrome
```
G. Transient Abnormal Myelopoiesis
218
```
A 6 year old boy from Greece presents to paediatric outpatients with severe anaemia. On examination he is anaemic and has enlarged maxilla and prominent frontal and parietal bones and hepatosplenomegaly. A skull X-ray reveals expansion of the medullary cavity giving rise to a ‘hair on end’ appearance. What is the likely diagnosis?
A. Gaucher's disease
B. Acute myeloid leukaemia
C. Burkitt's lymphoma
D. Beta thalassaemia
E. Haemophilia A
F. Von Willebrand's disease
G. Alpha thalassaemia
H. Malaria
I. Haemophilia B
J. Acute lymphoblastic leukaemia
K. Langerhans' cell histiocytosis
L. Autoimmune thrombocytopenia
M. Infectious mononucleosis
N. Glucose-6-phosphate dehydrogenase deficiency
O. Sickle cell anaemia
P. Haemolytic uraemic syndrome
```
D. Beta thalassaemia
219
```
You are asked to see a neonate who while being treated for a urinary tract infection with Nitrofurantoin has developed jaundice. The blood film shows Heinz bodies, “bite cells” and polychromasia. What is the likely diagnosis?
A. Gaucher's disease
B. Acute myeloid leukaemia
C. Burkitt's lymphoma
D. Beta thalassaemia
E. Haemophilia A
F. Von Willebrand's disease
G. Alpha thalassaemia
H. Malaria
I. Haemophilia B
J. Acute lymphoblastic leukaemia
K. Langerhans' cell histiocytosis
L. Autoimmune thrombocytopenia
M. Infectious mononucleosis
N. Glucose-6-phosphate dehydrogenase deficiency
O. Sickle cell anaemia
P. Haemolytic uraemic syndrome
```
N. Glucose-6-phosphate dehydrogenase deficiency
220
```
A 4 year old Afro-Caribbean girl presents to A&E with severe bony pain in her hands and feet and shortness of breath. Her oxygenation is 85% on air. On investigation her Hb is found to be very low at 6.3g/dl. What is the likely diagnosis?
A. Gaucher's disease
B. Acute myeloid leukaemia
C. Burkitt's lymphoma
D. Beta thalassaemia
E. Haemophilia A
F. Von Willebrand's disease
G. Alpha thalassaemia
H. Malaria
I. Haemophilia B
J. Acute lymphoblastic leukaemia
K. Langerhans' cell histiocytosis
L. Autoimmune thrombocytopenia
M. Infectious mononucleosis
N. Glucose-6-phosphate dehydrogenase deficiency
O. Sickle cell anaemia
P. Haemolytic uraemic syndrome
```
O. Sickle cell anaemia
221
```
A 2 year old girl presents to his GP following a viral illness with purpuric rash, ecchymoses and epistaxis. Normal haemoglobin and white cell count and platelets 19x109/L. Bone marrow show increased numbers of megakaryocytes. What is the likely diagnosis?
A. Gaucher's disease
B. Acute myeloid leukaemia
C. Burkitt's lymphoma
D. Beta thalassaemia
E. Haemophilia A
F. Von Willebrand's disease
G. Alpha thalassaemia
H. Malaria
I. Haemophilia B
J. Acute lymphoblastic leukaemia
K. Langerhans' cell histiocytosis
L. Autoimmune thrombocytopenia
M. Infectious mononucleosis
N. Glucose-6-phosphate dehydrogenase deficiency
O. Sickle cell anaemia
P. Haemolytic uraemic syndrome
```
L. Autoimmune thrombocytopenia
222
```
A 9 month old boy presents to A&E with excessive bleeding following circumcision. Laboratory investigations reveal a prolonged activated partial thromblastin time (APTT), normal prothrombin time (PT) and a factor VIII level which is 10% of normal. Bleeding time is normal. What is the likely diagnosis?
A. Gaucher's disease
B. Acute myeloid leukaemia
C. Burkitt's lymphoma
D. Beta thalassaemia
E. Haemophilia A
F. Von Willebrand's disease
G. Alpha thalassaemia
H. Malaria
I. Haemophilia B
J. Acute lymphoblastic leukaemia
K. Langerhans' cell histiocytosis
L. Autoimmune thrombocytopenia
M. Infectious mononucleosis
N. Glucose-6-phosphate dehydrogenase deficiency
O. Sickle cell anaemia
P. Haemolytic uraemic syndrome
```
E. Haemophilia A
223
Iron overload in beta thalassaemia major can lead to: (More than one is correct)
A. Cardiac failure
B. Diabetes mellitus
C. Hepatic fibrosis and cirrhosis
D. Increased iron utilisation and lower transfusion requirement
E. Reduced pituitary function
A, B, C and E
Iron overload cannot lead to increased iron utilisation in thalassaemia major. All the other answers are true, with cardiac failure being an important cause of death
224
```
Target cells can be a feature of: (More than one is correct)
A. Beta thalssaemia heterozygosity
B. Liver disease
C. Obstructive jaundice
D. Hypersplenism
E. Megaloblastic anaemia
```
A, B and C
They are a usual feature of obstructive jaundice and, to a lesser extent, liver disease. They are also often seen in beta thalassaemia heterozygosity. They are a feature of hyposplenism not hypersplenism and are not a feature of megaloblastic anaemia
225
```
A patient with CLL who has not required treatment for 6 months develops worsening anaemia. He is found to have spherocytes, polychromatic and a positive direct anti globulin (Coombs) test.
A. Autoimmune haemolysis
B. Bone marrow infiltration
C. Hereditary spherocytosis
D. Late effect of chemotherapy
E. Pooling of red cells in the spleen
```
A.
226
A full blood count and blood film is reviewed in the haematology lab. The sample is from a child who recently had a respiratory infection and has been noted to be pale. There is anaemia with a raised reticulocyte count. The WBC and platelet count is normal. The blood film shows marked red cell agglutination and polychromasia. A first direct antiglobulin (Coombs) test (DAT) is performed and is positive:
A. Cold (IgM mediated) autoimmune haemolytic anaemia
B. Hereditary spherocytosis
C. Sickle cell anaemia
D. Thalassaemia
E. Warm (IgG mediated) autoimmune haemolytic anaemia
A.
Hereditory spherocytosis, thalassaemia, sickle cell would all be DAT negative. In warm AIHA the DAT would be positive but the main feature on the blood film would be spherocytosis with polychromasia.
227
Features expected in an adult with sickle cell anaemia include:
A. Increased incidence of gallstones
B. Increased reticulocyte count
C. Increased susceptibility to infection
D. Red cell lifespan reduced to about a sixth of normal
E. Hypersplenism
A, B, C and D
228
A full blood count and blood film is reviewed in haematology lab. The patient has anaemia with a raised reticulocyte count. The WBC and platelet count are normal. The blood film shows spherocytes and polychromasia. DAT is negative:
A. Cold (IgM mediated) autoimmune haemolytic anaemia
B. Haemolytic disease of the newborn
C. Hereditary spherocytosis
D. Recent transfusion of incompatible red cells
E. Warm (IgG mediated) autoimmune haemolytic anaemia
C
229
```
A 73 year old man in under investigation by his haematologist for suspected auto-immune haemolytic anaemia. The following blood tests are commonly abnormal in patients with haemolysis:
A. Bilirubin
B. Creatinine
C. Haptoglobin
D. Lactate dehydrogenase
E. Phosphate
```
A, C and D
Typical pattern in haemolytic anaemia: anaemia, raised bilirubin (unconjugated), raised LDH, raised reticulocyte count and low haptoglobin
230
```
The reticulocyte count would be expected to increase with anaemia secondary to:
A. Acute leukaemia
B. Autoimmune haemolytic anaemia
C. Chemotherapy
D. Post partum haemorrhage
E. Elective total hip replacement
```
B, D and E
231
```
What would be the expected lab findings in a patient with active autoimmune haemolytic anaemia?
A. Raised bilirubin
B. Raised Alkaline phosphatase
C. Raised LDH
D. Prolonged prothrombin time
E. Low reticulocyte count
```
A and C
232
What kind of anaemia do you see in beta thalassaemia?
A. Microcytic
B. Macrocytic
C. Normocytic
A. Microcytic
233
```
Which haemoglobin is most common in adults?
A. HbA
B. HbA2
C. HbF
D. HbB2
```
A. HbA
90% of adult Hb is HbA (made up of two beta and two alpha chains)
HbA2 = 2 alpha and 2 delta chains
HbF = 2 alpha and 2 gamma chains
234
```
Compared to an adult, a child has:
A. Fewer lymphocytes
B. Higher MCV
C. Lower Hb
D. There is no difference
```
C. Lower Hb
Children have: a higher number of lymphocytes, a lower MCV and lower Hb
235
```
Compared to an adult, a neonate has:
A. Smaller red cells
B. A lower % of HbF
C. Higher WBC
D. Fewer neutrophils
```
C. Higher WBC
Neonates have: higher WBC, higher neutrophils and lymphocytes, higher Hb, large red cells, higher % of HbF
Remember: neonates have MORE of everything!
236
How does sickle cell differ in adults and children?
1. red marrow is more widely distributed in children and is susceptible to infarction = hand/foot syndrome
2. Splenic sequestration in children which causes a large spleen. Compared to adults who have had recurrent infarctions and the spleen is small and fibrotic.
3. Infants have an immature immune system so they are more susceptible to parvovirus and pneumococcus infections.
4. Infants are rapidly growing so require folic acid
N.B. sickle cell is only manifest when game chain synthesis decreases. It is only diagnosed at birth due to Guthrie spot
237
```
What is the lifespan of a sickle cell?
A. 80 days
B. 50 days
C. 20 days
D. 10 days
E. 2 days
```
D. 10 days
238
```
In sickle cell anaemia there is a problem with:
A. The alpha chains
B. The beta chains
C. The delta chains
D. The gamma chains
```
B. The beta chains
| Same as thalassemia, except thalassemia there is a reduction/no synthesis of the beta gene rather than a mutation
239
Which one of the following would you give a blood transfusion?
A. Major blood loss of 10% blood volume
B. Before an operation when the patients Hb is 60g/L
C. After chemotherapy if the patients Hb is 95g/L
D. Major blood loss of 15% blood volume
B. Before an operation when the patients Hb is 60g/L
Indications:
- Major blood loss >30% blood volume
- Peri op <70g/L
- Post chemo <80g/L
240
When is platelet transfusion contraindicated?
TTP and heparin induced thrombocytopenia purpura
241
What causes a febrile non haemolytic transfusion reaction?
A. Allergy to plasma protein in donor blood
B. Bacterial contamination of the donor blood
C. White cells release cytokines during the blood storage
D. Wrong blood is given (ABO incompatible)
C. White cells release cytokines during the blood storage.
The patient will get chills/rigors. Transfusion must be slowed or stopped and paracetamol given
242
Acute haemolytic reaction is:
A. IgG mediated
B. IgM mediated
C. IgE mediated
B. IgM mediated
Rhesus incompatibility is IgG mediated and happens >24 hours (i.e. delayed reaction). IgG can cross the placenta = haemolytic disease of the newborn
Anaphylaxis is IgE mediated
243
JVP will be raised in:
A. Transfusion associated circulatory overload (TACO)
B. Transfusion related acute lung injury (TRALI)
C. Both
A. Transfusion associated circulatory overload
244
Transfusion associated graft vs. host disease is:
A. An immediate reaction
B. A delayed reaction
B. A delayed reaction
245
```
A 22-year-old motorcyclist is involved in a road traffic accident, and is trans- fused two units of blood. Four hours later he develops acute shortness of breath and hypoxia, and despite attempts at ventilation deteriorates rapidly and goes into respiratory arrest. An autopsy shows evidence of massive pulmonary oede- ma with granulocyte aggregation within the pulmonary microvasculature. The most likely diagnosis is:
A Anaphylaxis
B ABO incompatible blood transfusion
C Fluid overload
D Transfusion related acute lung injury
E Air embolism
```
D Transfusion related acute lung injury
246
```
A 43-year-old woman is transfused three units of blood as an emergency fol- lowing prolonged haematemesis. A few minutes later she becomes restless, and complains of chest pain. On examination she is pyrexial and tachycardic with a blood pressure of 95/60. There is bleeding at the site where her cannula is inserted, and urinalysis reveals haemoglobinuria. The most likely diagnosis is:
A Anaphylaxis
B ABO incompatible blood transfusion
C Myocardial infarction
D Graft versus host disease
E Bacterial contamination
```
B ABO incompatible blood transfusion
247
An 83-year-old woman with myelodysplasia is found to have a haemoglobin of 6.2 on admission. She is transfused two units of blood, and is discharged 2 days later. Six days after her admission her carer calls the GP with concerns that she is feverish and her skin looks slightly yellow. She is readmitted to hospital where blood tests reveal the following: bilirubin 35, ALT 15 (N 5–35), ALP 82
(N 20–140), Hb 7.3g/dL, platelets 264×109/L. The most likely diagnosis is:
A Febrile haemolytic transfusion reaction
B Hepatitis B
C Graft versus host disease
D Post-transfusion purpura
E Delayed haemolytic transfusion reaction
E Delayed haemolytic transfusion reaction
248
```
An 8-year-old boy is brought to his GP by his father, who reports that he has been feeling progressively more tired over the past few months. On examination the GP notices a slight yellowing of his sclera, and the presence of splenomegaly. His father recollects that he himself was told he had a problem with his blood cells as a child, but has never been affected by it. A peripheral blood film shows a raised reticulocyte count and spherocytes. He is likely to have a positive:
A Coombs test
B Osmotic fragility test
C G6PD test
D Sickle cell screen
E Schilling test
```
B Osmotic fragility test
249
```
A 33-year-old Turkish man presents with extreme tiredness and shortness of breath after being started on a course of anti-malarial tablets. A full blood count reveals an Hb of 6.8. His Coombs test is negative. The cell type most likely to be found on his blood film is:
A Heinz bodies
B Pencil cells
C Target cells
D Spherocytes
E Sickle cells
```
A Heinz bodies
250
```
A 25-year-old student is treated for infectious mononucleosis following a posi- tive Paul Bunnell test. A blood film reveals target cells, Howell–Jolly bodies and atypical lymphocytes. Together, these suggest that he has features of:
A Bone marrow suppression
B Hyposplenism
C Disseminated intravascular coagulation
D Haemolytic anaemia
E Liver failure
```
B Hyposplenism
251
```
A 4-year-old Afro-Caribbean boy has chest and abdominal pain. His blood tests reveal an Hb of 6.1g/dL, with an MCV of 65. A blood film shows the presence of sickle cells. The most likely diagnosis is:
A Sickle cell trait
B Sickle cell anaemia
C Sickle cell/ -thalassaemia
D Sickle cell/haemoglobin C
-Thalassaemia
```
B Sickle cell anaemia
252
```
A 7-year-old child has known sickle cell disease. He presents with a 5-day his- tory of fever, shortness of breath and extreme fatigue. His mother reports that his younger brother, who also has sickle cell disease, has been feeling unwell too recently. A blood test for the patient reveals a severe anaemia and low reticulo- cyte count. He has most likely developed:
A Splenic sequestration
B Pneumococcal infection
C Vaso-occlusive crisis
D Folic acid deficiency
E Parvovirus B19 infection
```
E Parvovirus B19 infection
253
```
A 26-year-old pregnant woman is found to have an Hb of 9.5g/dL on a rou- tine blood test, with an MCV of 70. Serum electrophoresis reveals an Hb A2 of 3.9 per cent and Hb A of 96.1 per cent. Her ferritin levels are normal. The most likely diagnosis is:
A Iron deficiency anaemia
B Cooley’s anaemia
C Beta-Thalassaemia intermedia
D beta -Thalassaemia minor
E alpha-Thalassaemia
```
D beta-Thalassaemia minor
254
```
A 24-year-old unemployed man presents to his GP with a 4-week history of flu-like symptoms and a persistent dry cough. On examination he has a maculo- papular rash. A blood film reveals a haemolytic anaemia, and he is positive for cold agglutinins. The most likely organism implicated is:
A Streptococcus pneumoniae
B Mycoplasma pneumoniae
C Legionella pneumophilia
D Chlamydophila psittaci
E Borrelia burgdorferi
```
B Mycoplasma pneumoniae
255
```
A 7-year-old boy is taken ill from school on a cold December day, with a pre- sumed viral infection. On returning home that day, he beings to feel even more unwell with a very high fever, headache and abdominal pain. His father begins to worry that his skin has taken on a yellow tinge, and the boy says his urine is now a dark reddy-brown colour. He is taken to the GP and after several tests the presence of ‘Donath–Landsteiner antibodies’ is reported. This child is suffering from:
A Paroxysmal cold haemoglobinuria
B Paroxysmal nocturnal haemoglobinuria
C Sickle cell disease
D Acute intermittent porphyria
E Epstein–Barr virus
```
A Paroxysmal cold haemoglobinuria
Paroxysmal cold haemoglobinuria (A) is a rare form of autoimmune haemolytic anaemia. It usually affects children in the acute setting after an infection, and the key in this case is the presence of sudden haemo- globinuria and jaundice after exposure to a cold temperatures. IgG autoantibodies usually form after an infection, and bind to red blood cell surface antigens, inducing variable degrees of intravascular haemolysis in the cold. The antibodies are known as ‘Donath–Landsteiner antibodies’.
256
```
A 21-year-old student has recently been diagnosed with coeliac disease. She presents to her GP complaining of increased tiredness and shortness of breath on climbing stairs. Which of the following are most likely to be raised in this patient?
A Serum iron
B Haematocrit
C Transferrin
D Ferritin
E Mean cell haemoglobin
```
C Transferrin
This patient is suffering from iron deficiency anaemia, a common complication in coeliac disease.
257
A 34-year-old woman with known Addison’s disease is brought to the GP by her husband, as he is concerned that she keeps falling over at night. On examination the GP notes that she has conjunctival pallor. A thorough neurological examination reveals absent knee jerks, absent ankle jerks and extensor plantars bilaterally. Which of the following is the most sensitive test for the condition she has developed?
A Anti-intrinsic factor antibodies
B Anti-endomysial cell antibodies
C Anti-smooth muscle antibodies
D Anti-parietal cell antibodies
E Anti-voltage gated calcium channel antibodies
D Anti-parietal cell antibodies
This woman has developed pernicious anaemia leading to vitamin B12 deficiency.
258
```
A 58-year-old woman is referred to a haematology clinic following repeated chest infections and epistaxis. On examination the doctor notes that she hasconjunctival pallor and some petechial rashes on her forearms, but no organo- megaly. Her blood tests reveal a pancytopenia, and an MCV of 112. Her drug history includes omeprazole, carbamazepine, gliclazide, metformin, paracetamol, and simvastatin. A bone marrow biopsy reveals a hypocellular marrow. The most likely diagnosis is:
A Aplastic anaemia
B Myelodysplasia
C Hypothyroidism
D Chronic myeloid leukaemia
E Myeloma
```
A Aplastic anaemia
This woman is suffering from aplastic anaemia (A), where the bone marrow stops producing cells leading to a pancytopenia. Bone marrow examination is needed to confirm the diagnosis, and shows a hypocellu- lar bone marrow. Causes of aplastic anaemia can be primary or secondary. Primary causes can be congenital (e.g. Fanconi’s anaemia) or idiopathic acquired aplastic anaemia. Secondary causes include drugs (all the Cs – cytotoxics, carbamazepine, chloramphenicol, anticonvulsants uch as phenytoin), ionizing radiation and viruses (e.g. hepatitis, EBV). This woman’s aplastic anaemia is secondary to long-term carbamazepine therapy for hypothyroidism.
259
```
A 50-year-old diabetic man sees his GP complaining of generalized tiredness and a painful right knee. He is found on examination to have five finger breadths of hepatomegaly. An X-ray of his right knee is reported as showing chondrocalci- nosis. His blood tests are likely to reveal:
A Raised MCV
B Raised total iron binding capacity
C Reduced serum ferritin
D Reduced iron level
E Raised transferrin saturation
```
E Raised transferrin saturation
This man has hereditary haemachromatosis, an inherited disorder of iron metabolism. Blood tests can show deranged LFTs as in this case, as well as a raised serum ferritin, raised serum iron, reduced or normal total iron binding capacity and raised transferrin saturation
260
A 64-year-old woman is seen in the haematology clinic with generalized bone pain and recurrent infections. Following a set of blood tests, a skeletal survey reveals multiple lytic lesions and a bone marrow biopsy reports the presence of >10 per cent plasma cells. Her blood tests are most likely to have shown:
A Raised calcium, normal alkaline phosphatase, raised ESR
B Normal calcium, raised alkaline phosphatase, normal ESR
C Raised calcium, raised alkaline phosphatase, raised ESR
D Raised calcium, normal alkaline phosphatase, raised CRP
E Normal calcium, normal alkaline phosphatase, raised CRP
A Raised calcium, normal alkaline phosphatase, raised ESR
This woman has multiple myeloma, a cancer of plasma cells. The diagnostic criteria for symptomatic myeloma are as follows:
Clonal plasma cells >10 per cent on bone marrow biopsy
A paraprotein in the serum or urine –most commonly IgG
Evidence of end-organ damage related to the plasma cell disorder
(commonly referred to by the acronym ‘CRAB’):
Calcium – high
Renal insufficiency
Anaemia
Bone lesions (e.g. lytic lesions, or osteoporosis with compression factors)
261
A 67-year-old woman presented with polyuria and polydipsia on a background of ongoing bone pain. Her blood tests revealed a high calcium, and a serum electrophoresis was sent. Her serum paraprotein was 25g/L and a bone marrow biopsy revealed 6 per cent clonal plasma cells. The most likely diagnosis is:
A Plasma cell dyscrasia
B Monoclonal gammopathy of undetermined significance
C Smouldering myeloma
D Multiple myeloma
E Hypercalcaemia with no evidence of underlying malignancy
D Multiple myeloma
262
```
A 39-year-old motorcyclist is admitted following a road traffic accident com- plicated by severe burns. Several days later he is due to go home, when ooz- ing is noted from his cannula site and he has several nose bleeds. Repeat blood tests reveal an Hb of 12.2g/dL, WCC of 11.2×109/L, and platelets of 28×109/L. A coagulation screen shows a prolonged APTT and PT. He also has a reduced fibrinogen and raised D-dimers. The most likely diagnosis is:
A Liver failure
B Disseminated intravascular coagulation
C Thrombotic thrombocytopenic purpura
D Aplastic anaemia
E Heparin induced thrombocytopenia
```
B Disseminated intravascular coagulation
263
A 46-year-old woman is brought to accident and emergency by her daughter, who reports that she had been feeling unwell for a few days with a fever and is now hallucinating. On examination she has a temperature of 38.9°C, is noted to be pale and has widespread purpura over both arms. Blood tests reveal an Hb of 9.1g/dL, platelet count of 60×109/L, creatinine of 226 and urea 16.7. A blood film is reported as showing the presence of shistocytes. The most likely diagnosis is:
A. Weil’s disease
B. Glandular fever
C. Idiopathic thrombocytopenic purpura D. Thrombotic thombocytopenic purpura
E. Haemolytic uraemic syndrome
D. Thrombotic thombocytopenic purpura
This woman has thrombotic thrombocytopenic purpura (TTP) (D), a rare but potentially fatal haematological emergency. It consists of six key features:
1 MAHA
2 A fever
3 Renal failure
4 Fluctuating CNS signs, e.g. seizures, hallucinations, hemiparesis, decreased consciousness
5 Haematuria/proteinuria
6 Low platelet count
264
A 28-year-old woman in her 29th week of pregnancy comes to accident and emergency with epigastric pain, nausea and vomiting. She also complains that her hands and feet have been swelling up. On examination her blood pressure
is 165/96, HR 125bpm, and she is apyrexial. She is noted to have yellowing of her sclera and right upper quadrant tenderness. Blood tests reveal an Hb of 10.1, platelets 96, WCC 11.3, LDH 820 (N 70–250), AST 115 (N 5–35), and ALT 102 (N 5–35). Her coagulation screen is normal and a blood film is reported as showing the presence of schistocytes. The most likely diagnosis is:
A Hepatitis
B Thrombotic thrombocytopenic purpura
C Pre-eclampsia
D Acute fatty liver of pregnancy
E HELLP syndrome
E HELLP syndrome
265
```
Hereditary Spherocytosis is inherited:
A. Autosomal dominant
B. Autosomal recessive
C. X-lined
D. Mitochondrial
```
A. Autosomal dominant
266
```
G6PD is inherited:
A. Autosomal dominant
B. Autosomal recessive
C. X-lined
D. Mitochondrial
```
C. X linked
267
```
The comitta criteria is used to diagnose what?
A. Severity of myelofibrosis
B. Severity of aplastic anaemia
C. Severity of myelodysplastic syndrome
D. Severity of hereditary spherocytosis
```
B. Severity of aplastic anaemia
2 out of 3:
- Reticulocytes <1%
- Neutrophils <0.5 x10^9
- Platelets <20
- BM <25% cellularity
268
```
Which of the following is not a treatment option for multiple myeloma?
A. Steroids
B. Proteosome inhibitors
C. Thalidomide
D. Radiotherapy
E. Cytostatic drugs e.g. Melphalan
```
D. Radiotherapy
269
```
A 56-year-old woman with known cirrhosis presents with falls. On examination she is clinically jaundiced and rectal examination reveals malaena. Blood tests reveal an INR of 2.2. She is diagnosed with decompensated chronic liver disease. Which of the following is not a vitamin K dependent clotting factor?
A Thrombin
B Factor VII
C Factor VIII
D Protein C
E Factor X
```
C Factor VIII
The vitamin K dependent clotting factors include II, VII, IX and X. Vitamin K is also required for the production for protein C, protein S and protein Z, although these are strictly not clotting factors, rather anticoagulant factors.
270
```
A 46-year-old man presents with pain and swelling in the right calf 2 weeks after being fitted with a plaster cast to his leg after a fall. The calf is tender, erythematous and swollen. He is also a heavy smoker and slightly overweight. His admitting physician suspects a deep vein thrombosis (DVT) and books an ultrasound of the calf. A deep vein thrombosis is confirmed and 5mg warfarin is started the next day. Two days later, the same patient develops pain and swelling in the other calf, an ultrasound confirms a further deep vein thrombosis in the contralateral leg. What factor is least likely to contribute to the development of the second DVT?
A Smoking
B Warfarin
C Previous DVT
D Being slightly overweight
E Plaster cast
```
D Being slightly overweight
All of the factors except being slightly overweight probably directly contributed to this patient developing a second deep vein thrombosis. The risk factors for developing venous thrombosis may be categorized to mechanisms affecting the blood vessel wall, the blood flow and the blood itself, i.e. Virchow’s triad.
271
A 54-year-old man presents with haematemesis. He has known varices and is currently vomiting large amounts of bright red blood. The admitting doctor takes some blood for fast analysis and confirms a haemoglobin of 4g/dL. The patient’s haematemesis continues and he is transfused a total of 20 units of blood and eight units of fresh frozen plasma in the next 24 hours. The patient underwent gastroscopy which revealed bleeding oesophageal varices which were successful- ly treated by endoscopic banding. His post-transfusion bloods are the following:
Hb 9.2g/dL
White cells 8.0×109/L
Platelets 57×109/L
Prothrombin time normal
Activated partial thromboplastin time normal Fibrinogen >1.0g/L
What is the most likely cause of his thrombocytopenia?
A Disseminated intravascular coagulopathy
B Alcohol excess
C Massive blood transfusion
D Megaloblastic anaemia
E Hypersplenism
C Massive blood transfusion
Although all of the given options are causes of thrombocytopenia, the most likely cause in this patient is massive blood transfusion without replacement of platelets (C).
272
```
Which of the following is not often associated with a very high (>100mm/hour) erythrocyte sedimentation rate (ESR)?
A Myeloma
B Anaemia
C Leukaemia
D Aortic aneurysm
E Malignant prostatic cancer
```
B Anaemia
273
```
A 62-year-old man presents with shortness of breath. This has been gradually getting worse for the last few years and is associated with chronic productive cough. He is a heavy smoker. His chest X-ray reveals a hyperexpanded chest with no other abnormalities. His bloods tests are normal except for a raised hae- moglobin and raised haematocrit. What is the most likely cause for this?
A Polycythaemia rubra vera
B Idiopathic erythrocytosis
C Secondary polycythaemia
D Gaisbock’s disease
E Combined polycythaemia
```
E Combined polycythaemia
Combined polycythaemia (E), also known as smoker’s polycythaemia,
274
```
von Willebrand’s disease is characterized by abnormal platelet aggregation when they are exposed to:
A Streptomycin
B Aspirin
C Fibrinogen
D Collagen
E Ristocetin
```
E Ristocetin
von Willebrand’s disease (vWD) is characterized by a quantitive or qualititative defect in von Willebrand factor (vWF). Ristocetin, an anti- biotic no longer used clinically, causes vWF to bind the platelet receptor glycoprotein Ib (GlpIb) through an unknown mechanism. If ristoce-
tin is added to platelets with defective vWF or defective GlpIb (called Bernard–Soulier syndrome) then platelet aggregation does not occur.
275
```
An 18-month-old child with Down syndrome presents with recurrent infections and petechial bleeding. A blood film was analyzed showing a particular distinc- tive feature of haematological malignancy. What is the most likely diagnostically helpful finding seen in this patient?
A Smudge cell
B Reed Sternberg cell
C Auer rod
D Pelger Huet anomaly
E Hairy cell
```
C Auer rod
The Auer rod (C) is pathognomonic of acute myeloblastic leukaemia (AML). Children with Down syndrome are at higher risk of this dis-
ease due to chromosome 21 duplication where a ‘dosage’ effect is theorized to increase the expression of proto-oncogenes.
276
A 25-year-old black man develops jaundice and dark red urine 2 days after starting primaquine, an anti-malarial. His blood tests reveal a macrocytic anae- mia with raised bilirubin and urine dipstick is positive for blood. A peripheral blood film reveals ‘bite cells’ and Heinz bodies. The most likely diagnosis is:
```
A Hereditary spherocytosis
B Glucose-6-phosphate dehydrogenase deficiency
C Paroxysmal nocturnal haemoglobinuria
D Microangiopathic haemolytic anaemia
E Autoimmune haemolytic anaemia
```
B Glucose-6-phosphate dehydrogenase deficiency
277
What are the likely laboratory findings for a patient with renal cell carcinoma with secondary polycythaemia who is not dehydrated?
A Normal red cell count, normal red cell mass, increased erythropoietin con- centration
B Increased red cell count, increased red cell mass, increased erythropoietin concentration
C Decreased red cell count, decreased red cell mass, normal erythropoietin concentration
D Increased red cell count, decreased red cell mass, increased erythropoietin concentration
E Decreased red cell count, increased red cell mass, decreased erythropoietin concentration
B Increased red cell count, increased red cell mass, increased erythropoietin concentration
278
```
An 8-year-old African boy presents with a large jaw mass which has been grow- ing rapidly over the last few weeks. A histological sample was taken and a clas- sical ‘starry sky’ appearance was observed. The most likely diagnosis is:
A Follicular lymphoma
B Marginal zone lymphoma
C Burkitt’s lymphoma
D Diffuse large B cell lymphoma
E Mantle cell lymphoma
```
C Burkitt’s lymphoma
279
Which factors do Protein S and C inactivate?
Factor V and VIII
280
Which two proteins have to be present to activate protein C?
Protein S and thrombomodulin
281
```
A 35-year-old Afro-American man presents with painless lymphadenopathy which he noticed after shaving. He denies any recent infections, fevers, weight loss or night sweats. A biopsy is performed which shows lymphocytic and his- tiocytic cells. A haematologist calls to confirm the diagnosis of non-classical Hodgkin’s lymphoma. Which subtype is this?
A Nodular sclerosis
B Mixed cellularity
C Nodular lymphocytic
D Lymphocytic rich
E Lymphocytic depleted
```
C Nodular lymphocytic
282
```
A 17-year-old boy with glucose-6-phosphate dehydrogenase (G6PD) deficiency presents with tiredness and is noticed to be jaundiced. These features have devel- oped since he was diagnosed with a chest infection 1 week ago. What is the most likely haematological finding?
A Positive direct antiglobulin test
B Low mean cell volume
C Reduced reticulocyte count
D Haemoglobinuria
E Increased haptoglobin concentration
```
D Haemoglobinuria
283
A 35-year-old Asian woman presents with tiredness. The full blood count shows:
Haemoglobin: 10.1g/dL (11.5–16.5) Platelet count: 160×109 (150–400×109) White cell count: 6.6×109 (4–11×109) Mean cell volume: 62fL (80–96fL)
Hb A2: 6.3 per cent (2–3 per cent)
Which of the following is the most likely diagnosis?
A Sickle cell disease
B Acute myeloid leukaemia
C beta-Thalassaemia major
D beta-Thalassaemia trait
E Hereditary spherocytosis
D beta-Thalassaemia trait
This woman presents with microcytic anaemia, the most common cause of which is iron deficiency. However, the mean cell volume is dispropor- tionally reduced compared with the degree of anaemia indicating there might be a haemoglobinopathy present. The presence of increased Hb A2 confirms the diagnosis of -thalassaemia trait.
284
```
A 62-year-old man presents with bruising and tiredness. Examination reveals moderate splenomegly and his a reveal a normocytic anaemia with blood tests platelet count of 900×109/L, neutrophilia, basophilia, numerous myelocytes and 4 per cent myeloblasts. The neutrophils have low leukocyte alkaline phosphatase levels. Which of the following is likely to be present in this patient?
A t(9;22)
B t (8;14)
C BCR-Abl fusion gene only
D V617F point mutation in JAK2
E 5q-Syndrome
```
A t(9;22)
This patient exhibits features of chronic myeloid leukaemia as evidenced by raised myeloid lineage cells including neutrophils, myelocytes and basophils. The neutrophils are morphologically normal but cytochemically different – a laboratory test sometimes used to differentiate between reactive or leukaemoid neutrophilia and CML is the leukocyte alkaline phosphatase. It is normal or high in the former, but characteristically low in CML. Absolute basophilia is a universal finding in CML, with absolute eosinophilia found in 90 per cent of cases. A raised platelet count is also common in CML
285
Which of the following patients has the worse prognosis?
A 25-year-old man with inguinal lymphadenopathy
B 25-year-old woman with mediastinal and inguinal lymphadenopathy
C 25-year-old woman with mediastinal and inguinal lymphadenopathy and
night sweats
D 25-year-old woman with mediastinal and inguinal lymphadenopathy with
5 per cent weight loss in last 6 months
E 25-year-old man with cervical and mediastinal lymphadenopathy
C 25-year-old woman with mediastinal and inguinal lymphadenopathy and
night sweats
286
```
A patient presents with acute promyelocytic leukaemia. What is the most likely mechanism of underlying leukaemogenesis?
A Telomere shortening
B Aberrant fusion of two genes
C Impaired protein degredation
D Over-expression of cellular oncogene
E Post-translational modification
```
B Aberrant fusion of two genes
t(15;17)
287
A 64-year-old man presents with lethargy, weight loss and abdominal fullness. He is found to have chronic myeloid leukaemia. He is started on imatinib as part of the initial treatment to control his disease. What is the mechanism of action of imatinib?
A Proteosome inhibitor
B Tyrosine kinase inhibitor
C IL-6 inhibitor
D p53 inhibitor
E Human epidermal growth factor receptor 2 protein inhibitor
B Tyrosine kinase inhibitor
288
```
A 16-year-old girl with mild von Willebrand’s disease is scheduled for a dental extraction. She has had one previously where she required two units of blood transfused. What is the most appropriate treatment for this patient prior to surgery?
A Cryoprecipitate
B Desmopressin
C Fresh frozen plasma
D Vitamin K
E Recombinant factor VIII concentrate
```
B Desmopressin
This woman has mild von Willebrand’s disease (vWD) which can be treated with desmopressin (B). There are three types of vWD – type I is a quantitative deficiency of von Willebrand Factor (vWF), type II is a qualitative defect in vWF whereas type III results in profound deficiency in vWF.
289
An 80-year-old man presents with tiredness and lethargy. After initial work-up, a diagnosis of myelodysplastic syndrome is suspected. Which of the following is true about this condition?
A A blood film will typically show neutrophil toxic granulation
B If there are 1 per cent blasts of the total white cell count, this represents
leukaemic transformation
C Cytotoxic chemotherapy is first line treatment
D Mortality is more likely to be from infection than leukaemic transformation
E Absence of the short arm of chromosome 5 is a subtype
D Mortality is more likely to be from infection than leukaemic transformation
290
```
A middle-aged woman comes to the dermatology clinic with a suspicious mole on her back. You decide excision is required and during the history she says ‘I have Factor V Leiden’. Which of the following best describes the pathophysiol- ogy of Factor V Leiden mutation?
A Prothrombin mutation
B Activated protein C resistance
C Antithrombin III deficiency
D Protein C deficiency
E Protein S deficiency
```
B Activated protein C resistance
291
A 35-year-old man presents to his GP with a 1-month history of increased tiredness. The patient also admits to diarrhoea and minor abdominal pain during this period. His blood tests reveal the following:
Hb 9.5 (13–18g/dL)
MCV 64 (76–96fL)
Fe 12.2 (14–31μmol/L) TIBC 74 (45–66μmol/L) Ferritin 9.2 (12–200μg/L)
```
A Iron deficiency anaemia
B. beta-Thalassaemia
C Anaemia of chronic disease
D Blood loss
E Alcohol
F Vitamin B12 deficiency
G Renal failure
H Aplastic anaemia
I Lead poisoning
```
A Iron deficiency anaemia
292
```
A 56-year-old vagrant man presents to the accident and emergency depart- ment with weakness in his legs. The patient has a history of poorly controlled Crohn’s disease. His blood tests demonstrate Hb 9.4 (13–18 g/dL) and MCV 121 (76–96 fL). A blood film reveals the presence of hypersegmented neutrophils.
A Iron deficiency anaemia
B. beta-Thalassaemia
C Anaemia of chronic disease
D Blood loss
E Alcohol
F Vitamin B12 deficiency
G Renal failure
H Aplastic anaemia
I Lead poisoning
```
F Vitamin B12 deficiency
293
```
A 65-year-old man is referred to the haematology department by his GP after initially presenting with tiredness, palpitations, petechiae and recent pneu- monia. His blood tests reveal Hb 9.8 (13–18 g/dL), MCV 128 (76–96 fL), reticu- locyte count 18 (25–100 × 109/L), 1.2 (2–7.5 × 109/L) and platelet count 125 (150–400 × 109/L).
A Iron deficiency anaemia
B. beta-Thalassaemia
C Anaemia of chronic disease
D Blood loss
E Alcohol
F Vitamin B12 deficiency
G Renal failure
H Aplastic anaemia
I Lead poisoning
```
H Aplastic anaemia
294
A 56-year-old woman presents to her GP with increased tiredness in the past few weeks. A past medical history of rheumatoid arthritis is noted. Her blood tests demonstrate the following:
Hb 8.6 (11.5–16g/dL) MCV 62 (76–96fL)
Fe 10.2 (11–30μmol/L) TIBC 38 (45–66μmol/L) Ferritin 220 (12–200μg/L)
```
A Iron deficiency anaemia
B. beta-Thalassaemia
C Anaemia of chronic disease
D Blood loss
E Alcohol
F Vitamin B12 deficiency
G Renal failure
H Aplastic anaemia
I Lead poisoning
```
C Anaemia of chronic disease
295
```
A 12-year-old Mediterranean boy presents to his GP with increased tiredness over the past few weeks which is affecting his ability to concentrate at school. Examination is normal. Blood tests demonstrate the following:
Hb 9.5 (13–18g/dL)
MCV 69 (76–96fL)
Fe 18.2 (14–31μmol/L) TIBC 54 (45–66μmol/L) Ferritin 124 (12–200μg/L)
A Iron deficiency anaemia
B. beta-Thalassaemia
C Anaemia of chronic disease
D Blood loss
E Alcohol
F Vitamin B12 deficiency
G Renal failure
H Aplastic anaemia
I Lead poisoning
```
B. beta-Thalassaemia
296
```
A 48-year-old woman diagnosed with chronic lymphocytic leukaemia devel- ops jaundice and on examination is found to have conjunctival pallor. Direct antiglobulin test is found to be positive at 37°C.
A Hereditary sherocytosis
B Sickle cell anaemia
C beta -Thalassaemia
D Glucose-6-phosphate
dehydrogenase deficiency
E Pyruvate kinase deficiency
F Autoimmune haemolytic anaemia
G Haemolytic disease of the newborn
H Paroxysmal nocturnal haemoglobinuria
I Microangiopathic haemolytic anaemia
```
F Autoimmune haemolytic anaemia
297
```
An 18-year-old man presents to accident and emergency after eating a meal containing Fava beans. He is evidently jaundiced and has signs sug- gestive of anaemia. The patient’s blood film reveals the presence of Heinz bodies.
A Hereditary sherocytosis
B Sickle cell anaemia
C beta -Thalassaemia
D Glucose-6-phosphate
dehydrogenase deficiency
E Pyruvate kinase deficiency
F Autoimmune haemolytic anaemia
G Haemolytic disease of the newborn
H Paroxysmal nocturnal haemoglobinuria
I Microangiopathic haemolytic anaemia
```
D Glucose-6-phosphate
| dehydrogenase deficiency
298
```
A 10-year-old girl presents to accident and emergency with jaundice. Blood tests reveal uraemia and thrombocytopenia. A peripheral blood film demon- strates the presence of schistocytes.
A Hereditary sherocytosis
B Sickle cell anaemia
C beta -Thalassaemia
D Glucose-6-phosphate
dehydrogenase deficiency
E Pyruvate kinase deficiency
F Autoimmune haemolytic anaemia
G Haemolytic disease of the newborn
H Paroxysmal nocturnal haemoglobinuria
I Microangiopathic haemolytic anaemia
```
I Microangiopathic haemolytic anaemia
299
```
A 9-year-old boy from sub-Saharan Africa presents to accident and emergency with abdominal pain. On examination the child is found to have dactylitis. Blood haemoglobin is found to be 6.2 g/dL and electrophoresis reveals the diagnosis.
A Hereditary sherocytosis
B Sickle cell anaemia
C beta -Thalassaemia
D Glucose-6-phosphate
dehydrogenase deficiency
E Pyruvate kinase deficiency
F Autoimmune haemolytic anaemia
G Haemolytic disease of the newborn
H Paroxysmal nocturnal haemoglobinuria
I Microangiopathic haemolytic anaemia
```
B Sickle cell anaemia
300
```
A 1-day old baby has developed severe jaundice on the neonatal ward. The mother is rhesus negative and has had one previous pregnancy. Due to having her first baby abroad, she was not administered prophylactic anti-D.
A Hereditary sherocytosis
B Sickle cell anaemia
C beta -Thalassaemia
D Glucose-6-phosphate
dehydrogenase deficiency
E Pyruvate kinase deficiency
F Autoimmune haemolytic anaemia
G Haemolytic disease of the newborn
H Paroxysmal nocturnal haemoglobinuria
I Microangiopathic haemolytic anaemia
```
G Haemolytic disease of the newborn
301
```
A 34-year-old man, who has a past medical history of splenectomy following splenic trauma, presents to his GP with malaise 2 weeks after returning from abroad. Routine blood results are found to be normal but a blood film demon- strates inclusions within erythrocytes.
A Anisocytosis
B Howell–Jolly bodies
C Heinz bodies
D Rouleaux formation
E Spherocytes
F Target cells
G Cabot rings
H Pappenheimer bodies
I Tear-drop cells
```
B Howell–Jolly bodies
302
```
A 66-year-old man has a gastroscopy and colonoscopy following a blood test which demonstrated a microcytic anaemia. The patient had complained of tired- ness and significant weight loss over a 1-month period.
A Anisocytosis
B Howell–Jolly bodies
C Heinz bodies
D Rouleaux formation
E Spherocytes
F Target cells
G Cabot rings
H Pappenheimer bodies
I Tear-drop cells
```
A Anisocytosis
303
```
A 36-year-old woman presents to her GP after a 1-month history of tiredness and recurrent chest infections. Blood tests reveal a pancytopenia and a subse- quent bone marrow aspirate reveals a dry tap.
A Anisocytosis
B Howell–Jolly bodies
C Heinz bodies
D Rouleaux formation
E Spherocytes
F Target cells
G Cabot rings
H Pappenheimer bodies
I Tear-drop cells
```
I Tear-drop cells
304
```
A 3-week-old neonate is found to have prolonged jaundice with serious risk of kernicterus. Blood film demonstrates the presence of ‘bite cells’ as well as inclusions within erythrocytes.
A Anisocytosis
B Howell–Jolly bodies
C Heinz bodies
D Rouleaux formation
E Spherocytes
F Target cells
G Cabot rings
H Pappenheimer bodies
I Tear-drop cells
```
C Heinz bodies
305
```
A 45-year-old woman with known Graves’ diseases presents to her GP with increased tiredness. She is found to have a megaloblastic anaemia.
A Anisocytosis
B Howell–Jolly bodies
C Heinz bodies
D Rouleaux formation
E Spherocytes
F Target cells
G Cabot rings
H Pappenheimer bodies
I Tear-drop cells
```
G Cabot rings
Cabot rings (G) are looped structures found within erythrocytes which may be caused by megaloblastic anaemia
306
```
A 4-year-old girl is seen by her GP due to recent onset petechiae on her feet and bleeding of her gums when she brushes her teeth. The child’s platelet count is found to be 12 500 per μL. The GP prescribes prednisolone and reassures the child’s mother that the bleeding will resolve.
A Immune thrombocytopenic purpura
B Idiopathic thrombotic thrombocytopenic purpura
C Disseminated intravascular
coagulation
D Glanzmann’s thrombasthenia
E Von Willebrand disease
F Haemophilia A
G Haemophilia B
H Hereditary haemorrhagic
telangiectasia
I Bernard–Soulier syndrome
```
A Immune thrombocytopenic purpura
307
```
A 28-year-old man attends the haematology outpatient clinic regarding a long- standing condition he has suffered from. His disorder is related to a deficiency in factor 8 and therefore requires regular transfusions to replace this clotting factor.
A Immune thrombocytopenic purpura
B Idiopathic thrombotic thrombocytopenic purpura
C Disseminated intravascular
coagulation
D Glanzmann’s thrombasthenia
E Von Willebrand disease
F Haemophilia A
G Haemophilia B
H Hereditary haemorrhagic
telangiectasia
I Bernard–Soulier syndrome
```
F Haemophilia A
308
```
A 34-year-old man is taken to the local accident and emergency after suffering an episode of jaundice, fever and worsening headache. Blood tests reveal a low platelet count and blood film is suggestive of a microangiopathic haemolytic anaemia picture.
A Immune thrombocytopenic purpura
B Idiopathic thrombotic thrombocytopenic purpura
C Disseminated intravascular
coagulation
D Glanzmann’s thrombasthenia
E Von Willebrand disease
F Haemophilia A
G Haemophilia B
H Hereditary haemorrhagic
telangiectasia
I Bernard–Soulier syndrome
```
B Idiopathic thrombotic thrombocytopenic purpura
309
```
A 68-year-old man on the Care of the Elderly ward is confirmed to have Gram- negative sepsis. The patient is bleeding from his mouth and is in shock. Initial blood tests reveal a reduced platelet count, anaemia and renal failure.
A Immune thrombocytopenic purpura
B Idiopathic thrombotic thrombocytopenic purpura
C Disseminated intravascular
coagulation
D Glanzmann’s thrombasthenia
E Von Willebrand disease
F Haemophilia A
G Haemophilia B
H Hereditary haemorrhagic
telangiectasia
I Bernard–Soulier syndrome
```
C Disseminated intravascular
| coagulation
310
```
A 2-year-old boy is taken to see the GP due to his mother noticing bruising on his arms and legs after playing in the park. The parent mentions that she has also noticed several recent nose bleeds in her son but thought he would ‘grow out of it’. Investigations reveal a low APTT, low factor 8 levels and low Ristocetein cofactor activity.
A Immune thrombocytopenic purpura
B Idiopathic thrombotic thrombocytopenic purpura
C Disseminated intravascular
coagulation
D Glanzmann’s thrombasthenia
E Von Willebrand disease
F Haemophilia A
G Haemophilia B
H Hereditary haemorrhagic
telangiectasia
I Bernard–Soulier syndrome
```
E Von Willebrand disease
311
```
A 35-year-old Caucasian man presents to accident and emergency with deep pain and swelling in his left calf. His past medical history reveals history of recurrent DVTs. The patient’s notes reveal a letter from his haematologist who had diagnosed a condition caused by a substitution mutation.
A Factor V Leiden
B Antiphospholipid syndrome
C Malignancy
D Protein S deficiency
E Antithrombin deficiency
F Prothrombin G20210A mutation
G Oral contraceptive pill
H Buerger’s disease
I Chronic liver disease
```
F Prothrombin G20210A mutation
312
```
A 38-year-old woman presents to accident and emergency with abdomi-
nal pain as well as passing blood and tissue per vagina. Ectopic pregnancy
is diagnosed after ultrasound. The patient’s past medical history includes a haematological condition in which a clotting factor is unable to be degraded by activated protein C.
A Factor V Leiden
B Antiphospholipid syndrome
C Malignancy
D Protein S deficiency
E Antithrombin deficiency
F Prothrombin G20210A mutation
G Oral contraceptive pill
H Buerger’s disease
I Chronic liver disease
```
A Factor V Leiden
313
```
A 32-year-old woman is seen by her rheumatologist to follow up her long- standing systemic lupus erythematosus (SLE). The patient has a history of recurrent miscarriages. The woman is positive for anti-cardiolipin antibodies and lupus anticoagulant.
A Factor V Leiden
B Antiphospholipid syndrome
C Malignancy
D Protein S deficiency
E Antithrombin deficiency
F Prothrombin G20210A mutation
G Oral contraceptive pill
H Buerger’s disease
I Chronic liver disease
```
B Antiphospholipid syndrome
314
```
A 45-year-old man, who has a 50 pack/year history of smoking, is referred to the vascular outpatient clinic by his GP after suffering intermittent claudica- tion. A diagnostic angiogram reveals a corkscrew appearance of his lower limb arteries.
A Factor V Leiden
B Antiphospholipid syndrome
C Malignancy
D Protein S deficiency
E Antithrombin deficiency
F Prothrombin G20210A mutation
G Oral contraceptive pill
H Buerger’s disease
I Chronic liver disease
```
H Buerger’s disease
315
```
A 37-year-old man presents to accident and emergency with shortness of breath and severe pleuritic chest pain. A CTPA reveals the diagnosis of pulmo- nary embolism. The patient’s haematological records state the patient has a condition that leads to the persistence of factors 5a and 8a causing increased risk of venous thrombosis.
A Factor V Leiden
B Antiphospholipid syndrome
C Malignancy
D Protein S deficiency
E Antithrombin deficiency
F Prothrombin G20210A mutation
G Oral contraceptive pill
H Buerger’s disease
I Chronic liver disease
```
D Protein S deficiency
316
```
An 82-year-old man has just received a blood transfusion following a low hae- moglobin level on the Care of the Elderly ward. He is now short of breath and is coughing up pink frothy sputum.
A Immediate haemolytic transfu- sion reaction
B Febrile non-haemolytic reaction
C Iron overload
D IgA deficiency
E Transfusion related lung injury
F Bacterial infection
G Delayed haemolytic transfusion
reaction
H Fluid overload
I Graft versus host disease
```
H Fluid overload
317
```
A 34-year-old HIV-positive man receives a regular blood transfusion as part of his beta-thalassaemia major treatment regimen. He soon develops diarrhoea and a maculopapular rash on his limbs.
A Immediate haemolytic transfu- sion reaction
B Febrile non-haemolytic reaction
C Iron overload
D IgA deficiency
E Transfusion related lung injury
F Bacterial infection
G Delayed haemolytic transfusion
reaction
H Fluid overload
I Graft versus host disease
```
I Graft versus host disease
318
```
A 34-year-old man requires a blood transfusion following a road traffic acci- dent. However, soon after the transfusion, the patient is dyspnoeic and hypo- tensive. Investigation into the patient’s past medical history reveals a history of recurrent chest and gastrointestinal infections.
A Immediate haemolytic transfu- sion reaction
B Febrile non-haemolytic reaction
C Iron overload
D IgA deficiency
E Transfusion related lung injury
F Bacterial infection
G Delayed haemolytic transfusion
reaction
H Fluid overload
I Graft versus host disease
```
D IgA deficiency
319
```
A 56-year-old man is given a blood transfusion following severe blood loss after a hip replacement operation. Three hours after the transfusion, the patient develops shortness of breath, a dry cough and a fever of 39°C.
A Immediate haemolytic transfu- sion reaction
B Febrile non-haemolytic reaction
C Iron overload
D IgA deficiency
E Transfusion related lung injury
F Bacterial infection
G Delayed haemolytic transfusion
reaction
H Fluid overload
I Graft versus host disease
```
E Transfusion related lung injury
320
```
A 29-year-old woman requires an immediate blood transfusion after suffering a post-partum haemorrhage. However, 30 minutes after her transfusion she develops abdominal pain, facial flushing and vomiting. Analysis of the woman’s urine reveals the presence of haemoglobin.
A Immediate haemolytic transfusion reaction
B Febrile non-haemolytic reaction
C Iron overload
D IgA deficiency
E Transfusion related lung injury
F Bacterial infection
G Delayed haemolytic transfusion
reaction
H Fluid overload
I Graft versus host disease
```
A Immediate haemolytic transfusion reaction
321
```
A 62-year-old woman is seen by a GP due to a recent chest infection that has been troubling her. Initial blood tests show an elevated white cell count with specifically raised granulocytes. Following referral to a haematologist, a bone marrow biopsy reveals a hypercellular bone marrow and cytogenetic screening suggests a translocation between chromosomes 9 and 22.
A Acute lymphoblastic leukaemia
B Acute promyelocytic leukaemia
C Chronic myeloid leukaemia
D Chronic lymphocytic leukaemia
E Hairy cell leukaemia
F T-cell prolymphocytic leukaemia G Large granular lymphocytic
leukaemia
H Adult T-cell leukaemia
I Acute myeloid leukaemia
```
C Chronic myeloid leukaemia
322
A 41-year-old man is referred to a haematologist by his general practitioner after several recent chest infections and tiredness. On examination, bruises
are seen on his lower limbs as well as splenomegaly. Initial blood tests reveal a pancytopenia. Further testing demonstrates the presence of tumour cells that express tartrate-resistant acid phosphatase.
A Acute lymphoblastic leukaemia
B Acute promyelocytic leukaemia
C Chronic myeloid leukaemia
D Chronic lymphocytic leukaemia
E Hairy cell leukaemia
F T-cell prolymphocytic leukaemia G Large granular lymphocytic
leukaemia
H Adult T-cell leukaemia
I Acute myeloid leukaemia
E Hairy cell leukaemia
Adult T-cell leukaemia (adult T-cell lymphoma; ATL; H) is a rare haema- tological malignancy with poor prognosis. It is caused by human T-cell leukaemia virus type 1 (HTLV-1), endemic in Japan and the Caribbean. Tumour cells express the cell surface protein CD4 and will contain the HTLV-1 virus within; the nuclei of ATL cells have a characteristic clo- verleaf appearance. Clinical features include lymphadenopathy, hepatos- plenomegaly, skin lesions and hypercalcaemia.
323
A 60-year-old man presents to his GP with fever, malaise and cough. On exami- nation, the man is found to have petechiae on his legs as well as gum hypertro- phy. Blood tests reveal anaemia, leukocytopenia and thrombocytopenia. A blood film demonstrates the presence of Auer rods within blast cells.
```
A Acute lymphoblastic leukaemia
B Acute promyelocytic leukaemia
C Chronic myeloid leukaemia
D Chronic lymphocytic leukaemia
E Hairy cell leukaemia
F T-cell prolymphocytic leukaemia G Large granular lymphocytic
leukaemia
H Adult T-cell leukaemia
I Acute myeloid leukaemia
```
I Acute myeloid leukaemia
324
A 42-year-old Japanese migrant presents to his GP with generalized lymphad- enopathy and nodules on his arms. On examination the patient has hepatosple- nomegaly. Blood tests reveal lymphocytosis and a raised calcium level.
```
A Acute lymphoblastic leukaemia
B Acute promyelocytic leukaemia
C Chronic myeloid leukaemia
D Chronic lymphocytic leukaemia
E Hairy cell leukaemia
F T-cell prolymphocytic leukaemia G Large granular lymphocytic
leukaemia
H Adult T-cell leukaemia
I Acute myeloid leukaemia
```
H Adult T-cell leukaemia
325
```
A 70-year-old man is reviewed by his GP after having felt tired and experienced weight loss over a 2-month period. The patient has lymphadenopathy on examination. Blood tests demonstrates a lymphocytosis of 4500 cells per micro- litre and smudge cells can be visualized on a peripheral blood film.
A Acute lymphoblastic leukaemia
B Acute promyelocytic leukaemia
C Chronic myeloid leukaemia
D Chronic lymphocytic leukaemia
E Hairy cell leukaemia
F T-cell prolymphocytic leukaemia G Large granular lymphocytic
leukaemia
H Adult T-cell leukaemia
I Acute myeloid leukaemia
```
D Chronic lymphocytic leukaemia
326
```
A 70-year-old man is reviewed by his GP after having felt tired and experienced weight loss over a 2-month period. The patient has lymphadenopathy on examination. Blood tests demonstrates a lymphocytosis of 4500 cells per micro- litre and smudge cells can be visualized on a peripheral blood film.
A Acute lymphoblastic leukaemia
B Acute promyelocytic leukaemia
C Chronic myeloid leukaemia
D Chronic lymphocytic leukaemia
E Hairy cell leukaemia
F T-cell prolymphocytic leukaemia G Large granular lymphocytic
leukaemia
H Adult T-cell leukaemia
I Acute myeloid leukaemia
```
D Chronic lymphocytic leukaemia
327
```
A 5-year-old boy is seen by a volunteer doctor at an Ethiopian refugee camp. On examination the child has a prominent swelling on the left side of his jaw. A tissue sample of the mass demonstrates a ‘starry sky’ appearance on light microscopy.
A Diffuse large B-cell lymphoma
B Burkitt lymphoma
C Follicular lymphoma
D Small lymphocytic leukaemia
E Mantle cell lymphoma
F Peripheral T-cell lymphoma G Mycosis fungoides
H Angiocentric lymphoma
I Hodgkin’s lymphoma
```
B Burkitt lymphoma
328
```
A 52-year-old man presents to his GP with painless lymphadenopathy which he describes as having fluctuated in size over the past month, as well as experienc- ing night sweats and weight loss. He also mentions the lumps become painful when he drinks alcohol. Further biopsy of the lumps reveals the presence of Reed–Sternberg cells.
A Diffuse large B-cell lymphoma
B Burkitt lymphoma
C Follicular lymphoma
D Small lymphocytic leukaemia
E Mantle cell lymphoma
F Peripheral T-cell lymphoma G Mycosis fungoides
H Angiocentric lymphoma
I Hodgkin’s lymphoma
```
I Hodgkin’s lymphoma
329
```
A 60-year-old man presents to his GP with malaise, night sweats and weight loss. On examination the patient is found to have generalized lymphadenopathy and hepatomegaly. Cytogenetic investigation a few weeks later by a haematologist reveals a translocation between chromosomes 11 and 14, which has caused overexpression of the BCL-2 protein.
A Diffuse large B-cell lymphoma
B Burkitt lymphoma
C Follicular lymphoma
D Small lymphocytic leukaemia
E Mantle cell lymphoma
F Peripheral T-cell lymphoma G Mycosis fungoides
H Angiocentric lymphoma
I Hodgkin’s lymphoma
```
E Mantle cell lymphoma
Mantle cell lymphoma is an aggressive B-cell lymphoma primarily affecting elderly men. The most common cause is a translocation between chromosomes 11 and 14, involving the BCL-1 locus and Ig heavy chain locus, therefore leading to over-expression of cyclin D1.
330
```
A 40-year-old woman is referred to a haematologist after she is found to have generalized, painless lymphadenopathy. A report on tumour cell morphology states the presence of both centrocytes and centroblasts.
A Diffuse large B-cell lymphoma
B Burkitt lymphoma
C Follicular lymphoma
D Small lymphocytic leukaemia
E Mantle cell lymphoma
F Peripheral T-cell lymphoma G Mycosis fungoides
H Angiocentric lymphoma
I Hodgkin’s lymphoma
```
C Follicular lymphoma
Follicular lymphoma (C) is caused most commonly by a translocation between chromosomes 14 and 18, leading to over-expression of the BCL-2 protein. Over-expression of BCL-2 causes inhibition of apopto- sis, promoting the survival of tumour cells. Tumour cells in follicular lymphoma are characterized by centrocytes (small B cells with irregular nuclei and reduced cytoplasm) and centroblasts (larger B cells with multiple nuclei).
331
```
A 62-year-old HIV-positive man presents to a haematologist with a 3-month history of weight loss and tiredness. On examination, the patient has a mass on his neck which the patient states has been rapidly growing. Staining of biopsy tissue demonstrates the present of large B cells which are positive for EBV.
A Diffuse large B-cell lymphoma
B Burkitt lymphoma
C Follicular lymphoma
D Small lymphocytic leukaemia
E Mantle cell lymphoma
F Peripheral T-cell lymphoma G Mycosis fungoides
H Angiocentric lymphoma
I Hodgkin’s lymphoma
```
A Diffuse large B-cell lymphoma
332
```
A 40-year-old man is referred to a haematologist after suffering an episode of petechiae on his legs followed by a burning sensation in his fingers and deep vein thrombosis a few weeks later. Blood tests reveal a platelet count of 850 × 109/L.
A Essential thrombocythaemia
B Myelofibrosis
C Chronic myelo-monocytic
leukaemia
D Refractory anaemia with excess
blasts
E Polycythaemia rubravera
F Refractory anaemia with ringed
sideroblasts
G Refractory anaemia H 5q-Syndrome
I Multiple myeloma
```
A Essential thrombocythaemia
333
```
A 52-year-old woman presents to her GP due to increased tiredness. The patient also reports easy bruising and numerous bouts of pneumonia which have occurred over the past 6 months. On examination, the patient has splenomegaly. Blood tests reveal a low white cell and platelet count. Blood film reveals the pres- ence of tear drop cells and on bone marrow aspiration there is a ‘dry’ tap.
A Essential thrombocythaemia
B Myelofibrosis
C Chronic myelo-monocytic
leukaemia
D Refractory anaemia with excess
blasts
E Polycythaemia rubravera
F Refractory anaemia with ringed
sideroblasts
G Refractory anaemia H 5q-Syndrome
I Multiple myeloma
```
B Myelofibrosis
334
```
A 60-year-old man is referred to a haematologist after complaining of back pain and tiredness as well as recent onset low mood. Urine tests reveal the pres- ence of Bence–Jones proteins. An X-ray of the patient’s spine shows the pres- ence of lytic lesions.
A Essential thrombocythaemia
B Myelofibrosis
C Chronic myelo-monocytic
leukaemia
D Refractory anaemia with excess
blasts
E Polycythaemia rubravera
F Refractory anaemia with ringed
sideroblasts
G Refractory anaemia H 5q-Syndrome
I Multiple myeloma
```
I Multiple myeloma
335
```
A 72-year-old man presents with a 1-month history of fever, night sweats and weight loss. Blood tests reveal a monocyte count of 1400/mm3 in the peripheral blood and a bone marrow biopsy demonstrates that myeloblasts constitute 16 per cent of his bone marrow.
A Essential thrombocythaemia
B Myelofibrosis
C Chronic myelo-monocytic
leukaemia
D Refractory anaemia with excess
blasts
E Polycythaemia rubravera
F Refractory anaemia with ringed
sideroblasts
G Refractory anaemia H 5q-Syndrome
I Multiple myeloma
```
C Chronic myelo-monocytic
leukaemia
Chronic myelo-monocytic leukaemia is a myelodysplastic/ myeloproliferative disease which most commonly affects the elderly population, defined by a monocytosis of >1000/mm3 and increased number of monocytes in the bone marrow. Myeloblasts make up <5
per cent of the peripheral blood and <20 per cent of the bone marrow.
336
```
A 43-year-old woman presents to her general practitioner with headaches, epi- sodes of dizziness and a strange itching sensation after she comes out of the bath. On examination a plethoric appearance is noted. Blood tests reveal a hae- moglobin of 19 g/dL and erythropoietin levels are suppressed.
A Essential thrombocythaemia
B Myelofibrosis
C Chronic myelo-monocytic
leukaemia
D Refractory anaemia with excess
blasts
E Polycythaemia rubravera
F Refractory anaemia with ringed
sideroblasts
G Refractory anaemia H 5q-Syndrome
I Multiple myeloma
```
E Polycythaemia rubravera
337
```
A 56-year-old woman visits her GP for a regular check-up for a chronic con- dition she suffers from. On examination, she has signs of long-term steroid therapy. There is ulnar deviation at her metacarpophalangeal joints. Blood tests reveal a microcytic hypochromic anaemia, low iron and total iron binding capacity, but a raised ferritin level.
A Temporal arteritis
B Renal cell carcinoma
C Colorectal cancer
D Rheumatoid arthritis
E Miliary tuberculosis
F Acute pancreatitis
G Schistosomiasis
H Sarcoidosis
I Epstein–Barr infection
```
D Rheumatoid arthritis
338
```
A 45-year-old man presents to accident and emergency with an excruciating headache. Blood tests show an erythrocyte sedimentation rate of 110 mm/hour.
A Temporal arteritis
B Renal cell carcinoma
C Colorectal cancer
D Rheumatoid arthritis
E Miliary tuberculosis
F Acute pancreatitis
G Schistosomiasis
H Sarcoidosis
I Epstein–Barr infection
```
A Temporal arteritis
339
```
A 38-year-old man from Nigeria presents to his GP with progressive short- ness of breath, cough and painful rashes on his lower legs. Blood tests reveal a monocytosis. Chest X-ray demonstrates bihilar lymphadenopathy.
A Temporal arteritis
B Renal cell carcinoma
C Colorectal cancer
D Rheumatoid arthritis
E Miliary tuberculosis
F Acute pancreatitis
G Schistosomiasis
H Sarcoidosis
I Epstein–Barr infection
```
H Sarcoidosis
340
```
A 66-year-old presents to his GP with severe weight loss over 1 month as well as tiredness. Blood tests reveal an increased erythrocyte, haemoglobin and erythropoietin count.
A Temporal arteritis
B Renal cell carcinoma
C Colorectal cancer
D Rheumatoid arthritis
E Miliary tuberculosis
F Acute pancreatitis
G Schistosomiasis
H Sarcoidosis
I Epstein–Barr infection
```
B Renal cell carcinoma
341
```
A 24-year-old man has recently returned from a trip to Kenya. He presents to his GP with abdominal pain, fever and on examination has hepatosplenomegaly. Blood tests reveal a marked eosinophilia.
A Temporal arteritis
B Renal cell carcinoma
C Colorectal cancer
D Rheumatoid arthritis
E Miliary tuberculosis
F Acute pancreatitis
G Schistosomiasis
H Sarcoidosis
I Epstein–Barr infection
```
G Schistosomiasis
