Haematology quiz

Question 1

20 year old African, acute abdomen, low Hb, raised WCC

Answer 1

Sickle cell anaemia

Question 2

12 year old girl, splenomegaly, jaundice, low Hb
Raised reticulocytes, spherocytes
- diagnosis
- inheritance

Answer 2

Spherocytosis

AD

Question 3

Haemolytic anaemia: differentials

a) Membrane
b) Hb
c) Enzyme
d) Acquired immune - will have a positive…?
e) Acquired mechanical

Answer 3

a) Spherocytosis
b) SCD
c) G6PD
d) Coombs’
e) DIC, intravascular haemolysis

Question 4

Polycythaemia

a) Congenital causes
b) Acquired/reactive causes

Answer 4

a) Polycythaemia rubra vera, congenital heart disease

b) Smoking, decreased plasma volume (relative polycythaemia)

Question 5

Macrocytic pancytopenia
- main causes (which in turn is often caused by…?) - investigations?

• other causes of macrocytosis

Answer 5

B12/ folate deficiency (needed for RNA/DNA synthesis) - may be caused by pernicious anaemia or terminal ileal disease (Crohn’s, TB, lymphoma, Coeliac). Investigate with Intrinsic factor antibodies.

• liver disease, hypothyroidism, alcoholism

Question 6

58 year old man: back pain

a) Differentials
b) Ix

Answer 6

a) MSK ( ), malignancy (myeloma, bony mets)

b) Myeloma (serum and urine electrophoresis, skeletal survey, bone marrow plasma cell excess), prostate (Alk Phos, PSA)

Question 7

Leukocytosis and neutropenia

a) Likely what pathogen type
b) Differentials

Answer 7

a) Viral

b) EBV, HIV

Question 8

65 year old woman, routine FBC:

Hb normal, raised WCC (lymphocytosis) - DD?

Answer 8

a) CLL (proliferation of mature lymphocytes)

Question 9

35 year old woman, gross splenomegaly

a) Hb normal, raised WCC, raised neutrophils
b) Chromosomal defect

Answer 9

a) CML, (DD for large spleen: myelofibrosis)

b) Philadelphia BCR: ABL (9 and 22)

Question 10

Clotting cascade

a) APTT tests the _____ pathway - raised time: DD?
b) PT tests the ______ pathway - raised time: DD?

Answer 10

a) Intrinsic - haemophilia A or B (XLR) - young boys, haemarthrosis (joint pain/swelling); vWD, heparin > warfarin, liver disease, DIC
b) Extrinsic - warfarin > heparin (WEPT), liver disease, DIC

Question 11

Artificial heart valve, unconscious, INR 8.5

• likely diagnosis
• Ix?
• Rx?

Answer 11

a) Intracranial bleed
b) CT head
c) Stop warfarin, use Vitamin K and prothrombin complex

Question 12

23 year old girl, SOB, stridor, CXR mediastinal mass

a) DD?

Answer 12

a) Hodgkin’s lymphoma (Reed-Sternberg cells, alcohol-induced lymph node pain)

Question 13

65 year old woman, abdo pain, rigors, hypotension

• Low Hb, high WCC, low platelets, long PT and APTT, raised D-Dimer, low fibrinogen
• Management?

Answer 13

a) DIC (sepsis, obstetric emergencies, malignancy)