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4th Year Haematology > Haematology passmed flashcards > Flashcards

Haematology passmed flashcards

1
Q

A 34 year old female presents due to the development of a purpuric rash on the back of her legs. Her only regular medication is Microgyon 30. She also reports frequent nose bleeds and menorrhagia. A full blood count is requested:

Hb 117g/L

Platelets 62 x 109/L

WCC 5.3 x 109/L

What is the likely diagnosis?

A

Idiopathic thrombocytopenic purpura

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2
Q

First line treatment for idiopathic thrombocytopenic purpura

A

Oral prednisolone

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3
Q

Ovarian / testicular cancer

In which lymph nodes would you most likely find regional metastasis?

A

Para-aortic

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4
Q

Breast cancers

In which lymph nodes would you most likely find regional metastasis?

A

Axillary nodes

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5
Q

Colon cancer

In which lymph nodes would you most likely find regional metastasis?

A

Mesenteric nodes

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6
Q

Vulval, penile and anal cancers

In which lymph nodes would you most likely find regional metastasis?

A

Inguinal nodes

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7
Q

Thoracic, breast and gastric cancers

In which lymph nodes would you most likely find regional metastasis?

A

Supraclavicuar nodes

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8
Q

A 32 year old woman who had a positive pregnancy test 5 days ago attends a direct access antenatal clinic appointment. A foetal heart is seen on s ultrasound with a heart rate of 120 beats/minute.

Her past medical history includes recurrent miscarriages, pulmonary embolisms and deep vein thromboses.

What is the likely diagnosis?

What blood results would you expect to see?

What treatment would you offer this woman?

A

Antiphospholipid syndrome

Prolonged APTT and a moderately elevated anticardiolipin antibody level.

Aspirin and LMWH (eg enoxaparin)

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9
Q

A 28 year old man in investigated for cervical lymphadenopathy. A biopsy shows nodular sclerosis Hodkin’s lymphoma.

The presence of B symptoms are associated with a worse prognosis. Name some B symptoms.

A
  • Weight loss >10% in the last 6 months
  • Fever >38 degrees
  • Night sweats
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10
Q

A 76 year old gentleman presents with a 1 month history of fatigue and 2kg of weight loss. He also complains of a full stomach and he has noticed that he sometimes bleeds from his gums, which he’s never had before.

A blood film demonstrates tear drop cells.

What is the likely diagnosis?

What other diagnosis could cause tear drop cells?

A

Myelofibrosis

Other causes of tear drop cells: thalassaemia and megaloblastic anaemia

Tear drop cells + constitutional symptoms (fatigue and weight los) + splenomegaly (indicated by the stomach fullness) + easy bleeding points towards myelofibrosis. This reduces the ability of the bone marrow to produce normal cells, thus causing thrombocytopenia, anaemia and extramedullary haematopoiesis in the spleen.

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11
Q

A 12 year old boy, recently immigrated from Africa is referred to the hospital after presenting to his GP with a growth of the jaw. A number of investigations are performed, including a test for the Epstein-Barr virus which comes back positive. A biopsy is taken, which demonstrates a starry sky appearance.

What is the most likely diagnosis?

Which translocation is most likely implicated?

A

Burkitt’s lymphoma

t(8:14)

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12
Q

A 22 year old man with sickle cell anaemia presents with pallor, lethargy and a headache. Blood results are as follows:

Hb 46g/L

Reticulocytes 3%

A

Aplastic crisis

The sudden fall in Hb without an appropriate reticulocytosis (3% is just above the normal range) is typical of an aplastic crisis, usually secondary to parovirus infection.

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13
Q

A 58 year old man presents to his GP with an 8 month history of progressive fatigue and abdominal distension. He also reports fevers and night sweats. He has not travelled outside the UK in the past year.

On examination, there is conjunctival pallor and a massively enlarged spleen. There is no cervical lymphadenopathy. Blood results are awaited.

What is the most likely diagnosis?

A

Chronic myeloid leukaemia

B symptoms are characteristic of haematological malignancy. Massive splenomegaly is particularly characteristic of CML. Cervical lymphadenopathy is typically absent and is more commonly seen with chronic lymphoid leukaemia (CLL - Cervical Lyphadenopathy, Chronic Lymphoid Leukaemia)

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14
Q

Which translocation is seen in chronic myeloid leukaemia?

A

The Philidelphia chromosome is present in more than 95% of patients with chronic myeloid leukaemia.

t(9:22)

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15
Q

FBC results in chronic myeloid leukaemia

A
  • Leukocytosis
  • Granulocytosis
  • Anaemia with a reduced reticulocyte count
  • Reduced leukocyte ALP may be seen
  • Thrombocytosis is found in 30% of patients
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16
Q

First line managment in chronic myeloid leukaemia

A

Tyrosine kinase inhibitor: imatinib

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17
Q

What is meant by a blast crisis in Chronic myeloid leukaemia?

A

Undergoes conversion to acute leukaemia (AML in 80%, ALL in 20%)

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18
Q

A 35 year old lady presented with gradual onset weakness and loss of sensation in her right arm. She has felt fatigued for several months following a severe sore throat.

A large lesion is found in her right axilla and exised. Low power microscopy shows a starry sky appearance of densely packed basophils city cells interspersed with white areas containing cellular debris.

What is the most likely diagnosis?

A

Burkitt lymphoma

19
Q

A 23 year old woman is recovering of the haematology ward following a stem cell transplant for acute myeloid leukaemia. On reviewing her blood results, the FY1 doctor notes that her haemoglobin in low, at 64g/L. The doctor orders her a unit of irradiated packed red cells.

What is being prevented by ordering irradiated blood products in this patient?

A

Graft versus host disease

20
Q

You are the on call doctor covering a general surgical ward. You are bleeped and asked to assess a deteriorating patient that began receiving a blood transfusion 1 hour ago. His observations are as follows:

  • Temperature: 38 degrees
  • Oxygen saturation: 88%
  • Heart rate: 110/min
  • Respiratory rate: 24/min
  • Blood pressure: 80/65 mmHg

On examination of the chest, you hear crackles at the lung bases.

You request an urgent chest X-ray and phone your senior for help. They ask you what you think is the most likely diagnosis?

A

Transfusion related acute lung injury

(Hypotension vs hypertension in TACO (transfusion associated circulatory overload); also respiratory distress and pyrexia indicated TRALI)

21
Q

Managment of transfusion related acute lung injury

A

Stop the transfuion.

Oxygen and supportive care.

22
Q

An 8 year old boy presents with increasing jaundice over the past week. He was recently treated with nitrofurantoin for a simple urinary tract infection. On examination he is obviously jaundiced and is looking pale and breathless. Investigation results are as follows:

  • Hb: 58g/L
  • Platelets: 250 x 109/L
  • WBC: 6.5 x 109/L

What is the likely diagnosis?

A

Glucose 6 phosphate dehydrogenase deficiency

23
Q

Triggers of G6PD deficiency crisis

A
  • Recent infection
  • Certain medications eg nitrofurantoin
  • Broad (fava) beans
24
Q

You’re the doctor in the emergency department and you’re part of the team called to see a trauma patient following a road traffic accident. You and the team find that he has lost a lot of blood from several penetrating injuries. The major haemorrhage protocol is activated in order to quickl get blood products for the patient.

Whilst waiting for the blood products you look on the computer system to find out more about the patient’s history. Recent blood tests are available from the GP’s records and are shown below:

IgA very low

What transfusion related compication is this patient at an increased risk of?

A

Anaphylactic reaction

25
Q

A 30 year old Afro-Caribbean lady with known systemic lupus erythematosus presents complaining of fatigue and shortness of breath, which started 2 months ago, and has worsened since then. Her friends have also commented that her skin appear a little yellow. She denies vomiting or diarrhoea, and has no other medical history. She currently only takes hydroxychloroquine, as NSAIDs were not effective and so she stopped taking them.

On examination she looks mildly jaundiced and has pale conjunctiva. There are no signs of bleeding or petechia, and her neurological examination is normal. Blood tests reveal a low haemoglobin, a raised LDH, and raised bilirubin. A blood film shows spherocytes, and a direct Coombs tests is positive.

A

Autoimmune haemolytic anaemia

SLE is a cause of autoimmune haemolytic anaemia.

The presence of spherocytes indicated Extravascular anaemia.

The positive Coombs test confirms the diagnosis.

26
Q

A 73 year old female patient is admitted with symptomatic anaemia. She is cross matched for a transfuion of 2 units of packed red cells. A few minutes after the transfusion is commenced, she begins to feel very unwell, complaining of chills and breathlessness. Visible rigours are noted. Blood pressure is 83/47 mmHg.

What is the diagnosis?

A

Acute haemolytic transfusion reactions

27
Q

Acute haemolytic transfusion reaction Managment

A
  • Stop transfusion
  • Confirm diagnosis
    • check the identity of patient / name of blood product
    • send blood for direct Coombs test, repeat typing and cross matching
  • Supportive care
    • fluid resuscitation
28
Q

A 13 year old girl presents to her GP with a 1 week history of fever and fatigue. She has a past medical history of Down syndrome.

On examination you note conjunctival pallor and a generalised petechial rash on her abdomen.

What is the most likely diagnosis?

A

Acute lymphocytic leukaemia

29
Q

A 17 year old man is investigated after he bled excessively following a tooth extraction.

Plt 173 x 109/L (normal)

PT 12.9 sec (normal)

APTT 84 seconds (prolonged)

What is the most likely diagnosis?

A

Haemophilia A

Prolonged APTT; bleeding time, thrombin time, prothrombin time normal

30
Q

Haemophilia A and B are due to deficiency in which clotting factors?

A

A: factor VIII

B: factor IX

31
Q

A 7 year old boy is admitted to your ward after being hit by a car.

He as sustained a mid diaphysis spiral fracture of his left femur and is currently waiting to go to theatre for open reduction and internal fixation of the fracture. Unfortunately the patient also has type 1 Von Willebrand disease.

Which agent should be given to reduce bleeding while awaiting theatre?

A

Desmopressin

32
Q

Smudge cells / smear cells are seen in:

A

Chronic lymphocytic leukaemia

33
Q

Auer rods are seen in:

A

Acute myeloid leukaemia

34
Q

Target cells are seen in:

A
  • Iron deficiency anaemia
  • Sickle cell anaemia
  • Thalassaemia
  • Liver disease
  • Hyposplenism
35
Q

Heinz bodies are seen in:

A
  • G6PD deficiency
  • Thalassaemia
36
Q

Tear drop cells are seen in:

A

Myelofibrosis

37
Q

Spherocytes are seen in:

A
  • Autoimmune haemolytic anaemia
  • Hereditary spherocytosis
38
Q

Howell-Jolly bodies are seen in:

A

Hyposplenism

39
Q

Shistocytes are seen in:

A
  • Intravascular haemolysis
  • Mechanical heart valve
  • Disseminated intravascular coagulation
40
Q

Basophilic stippling is seen in:

A
  • Lead poisoning
  • Thalassamia
  • Sideroblastic anaemia
  • Myelodysplasia
41
Q

Pencil poikilocytes are seen in:

A

Iron deficiency anaemia

42
Q

Causes of macrocytic normoblastic anaemia

A
  • Hypothyroidism
  • Myelodysplasia
43
Q

Causes of macrocytic megaloblastic anaemia

A
  • Vitamin B12 deficiency
  • Folate deficiency
44
Q

History of neonatal jaundice. Erythematosus cheeks. Splenomegaly.

Diagnosis?

A

Hereditary spherocytosis

4th Year Haematology (7 decks)

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