Haematology RACP MCQs Flashcards
RACP 2021b Q121.
What is the diagnostic test in AHUS?
A. ADAMTS13
B. C3
C. LDH
D. DAT
Answer C LDH
RACP 2021 Q122. What is the major protein extraction in a normal serum protein electrophoresis?
A. Albumin
B. Alpha anti trypsin
C. Beta lipoprotein
D. Immunoglobulin G
Answer A Albumin
RACP 2021 Q133. Which organ system is predominantly affected by the differentiation syndrome associated with ATRA and
arsenic treatment for APML?
A. Blood
B. Brain
C. Lung
D. Liver
Answer C Lung
RACP 2021 Q162. Which protein is cleaved by ADAMTs13?
A. Fibrinogen
B. Plasminogen
C. Thrombin
D. Von Willebrand factor
Answer D Von Willebrand factor
RACP 2021 Q10. A 46 year old female presents with new diagnosis of acute pulmonary embolism. Her HR is 94 and her blood pressure is 110/64. Her TTE shows right heart dilatation. Which of the following treatments had been shown to have the greatest improve improvement in mortality?
A. Anticoagulation
B. IVC filter placement
C. Surgical pulmonary embolectomy
D. Systemic thrombolysis
Answer A Anticoagulation
RACP 2021 Q12. What is the minimum percentage of bone marrow plasma cells required for a diagnosis of suspected
myeloma?
A. 5%
B. 10%
C. 15%
D. 20%
Answer B 10%
RACP 2021 Q21. What is the mutated haemoglobin in sickle cell anaemia?
A. Alpha
B. Beta
C. Zeta
D. Epsilon
Answer B Beta
RACP 2021 Q37. A man presents to ED after an accident, and his group and screen is taken as part of trauma workup. What is
his blood type?
The real exam included a photograph of an agglutination test with test tubes represented and labelled as above.
A. A positive
B. A negative
C. B positive
D. B negative
Answer B positive
RACP 2021 Q114. Agonist activation of which receptor has been shown to be effective in the treatment of aplastic anaemia?
A. Cluster differentiation 34 (CD34)
B. Erythropoeitin
C. GCSF
D. Thrombopoeitin
Answer A CD 34 (i.e. stem cell transplant)
RACP 2021o
25. What is the most common side effect of ticagrelor that leads to it needing to
be ceased?
a. Diarrhea
b. Nausea
c. Dyspnea
d. Dizziness
Answer C Dysnpoea
RACP 2021o
31. One way to prognosticate covid is to review the D- Dimer elevation. The d
dimer is from the breakdown of which product
a. Thrombin
b. Plasmin
c. Fibrin
d. Rhubarb
Answer C Fibrin
RACP 2021o
36. Which cell is most responsible for the production of erythropoietin?
a. Renal cell
b. Liver cell
c. Blood cell
d. Bone marrow cell
Answer A Renal cell
RACP 2021o
49. What does plasma exchange remove in TTP
a. Adamts13
b. antigen antibody complex
c. fibrin
d. red cell fragments
Answer B Antigen Ab complex
RACP 2021o
52. Which factors does DOAC work on
a. 2 and 10
b. 8 and 10
c. 2 and 8
d. 5 and 8
Answer A
RACP 2021 87. Young woman Bleeding, aptt raised, PT normal, mixing study not
corrected. What is the diagnosis?
a. Von Willebrand disease
b. factor VIII inhibitor
c. Haemophilia
Answer B
RACP 20210
103. What is the benefit of blood transfusion with irradiated RBCs?
a. Prevention of febrile non haemolytic blood reaction
b. prevention of GVHD
c. prevention of anaphylaxis
d. Prevention of infection
Answer B
RACP 2021o
105. The side effect of ATRA treatment for APML includes Cytokine release
(differentiation) syndrome. which organ is most affected? (Repeat question from
feb. 2021)
a. skin
b. blood
c. lungs
d. liver
Answer C
RACP 2021
106. What gene is used in monitoring recurrence in AML?
a. DTNM3-A
b. NPM-1
A DTNM3-A
RACP 2020a 13. A 54 male is post op D1 lap resection and Hartmann’s Procedure for fecal peritonitis. Loss of 500ml blood, now in septic shock. On prophylactic clexane.
Bloods as follows:
WCC 5.4
Hb 76
Plt 46
PT 27
APTT 76
Fibrinogen 1.2
A) Dilutional coagulopathy
B) DIC
C) HITS
D) Vitamin K deficiency
Answer B
RACP 2020a
- 98M post fall and Hb 78. A decrease in which of the following is most consistent with a diagnosis of haemolytic anaemia?
A) Haptoglobin
B) LDH
C) Platelets
D) Reticulocytes
Answer A
RACP 2020 52. EMQ Which genetic mutation would you give this treatment for: allogenic transplant at first disease remission ?
A) FLT3-ITD
B) NPM2
C) DNMT3A
D) t(15;17) PML:RARA
E) t(8; 21)
F)RUNX1
G) Inv (16)
Answer F: RUNX1
RACP 2020
53. EMQ Which genetic mutation would you give this treatment for: ATRA + Arsenic
A) FLT3-ITD
B) NPM2
C) DNMT3A
D) t(15;17) PML:RARA
E) t(8; 21)
F) RUNX1
G) Inv (16)
Answer D: PML: RARA
RACP 2020
16. What is prescribed in haemolytic anaemia to prevent aplastic crisis?
A) B12
B) Folate
C) Vitamin C
Folate
In haemolytic anaemia, there is an increased turnover of red blood cells (RBCs), which can lead to higher demand for folate (vitamin B9). Folate is essential for the production of new red blood cells, and in patients with chronic haemolysis, folate stores can be rapidly depleted, increasing the risk of megaloblastic anaemia.
- Vitamin B12 is important for red blood cell production but is not typically depleted in haemolytic anaemia as quickly as folate.
- Vitamin C does not play a direct role in preventing aplastic crisis in this context.
RACP 2020
25. Patient with chronic bony pain. Splenomegaly on examination. Knee x-ray showing an Erlenmeyer flask deformity (radiological finding given in stem). Marrow aspirate slide shown with an arrow labelling the “Abnormal cell”
A. Fabry’s Disease
B. Glycogen Storage Disorder
C. Gaucher’s Disease
D. Haemophagocytic lymphohistiocytosis
RACP 2020
- A 48 year old man (smoker) developed a right distal below knee DVT and bilateral PE after a long haul flight - What is the minimum duration of anticoagulation?
A) 6 weeks
B) 3 months
C) 12 months
D) Lifelong
RACP 2020
- Best way to prevent transfusion related GVHD
A Irradiation
B Leukodepletion
C Washing
A
RACP 2020
- What does TXA bind to?
A) Fibrin
B) Factor 10
C) Plasminogen
D) Thrombin
- Normally plasminogen + plasminogen activator (tPA) bind together = form plasmin
- Plasmin binds to fibrin and causes it to breakdown
The mechanism by which tranexamic acid exerts its antifibrinolytic activity is by binding to plasminogen and preventing it from becoming plasmin; a molecule responsible for the degradation of fibrin.
RACP 2019a
Question 13
A 37 year old female presents with a DVT following a cholecystectomy. There is RV dilatation on echocardiogram. She is hemodynamically stable. What is the appropriate duration for anticoagulation?
A. 6 weeks
B. 3 months
C. 12 months
D. Indefinitely
According to the Therapeutic Guidelines and The Australian and New Zealand Society of Thrombosis and Haemostasis (ANZTH), the standard duration of anticoagulation for a provoked deep vein thrombosis (DVT), such as one following surgery (in this case, after a cholecystectomy), is typically 3 months.
Reasoning:
Provoked DVT: This is classified as a surgically-provoked DVT, which falls under the category of transient risk factors for venous thromboembolism (VTE).
Echocardiographic finding of RV dilatation: The presence of right ventricular (RV) dilatation on echocardiogram suggests possible pulmonary embolism (PE) and adds severity to the case, but the patient remains hemodynamically stable. Even in cases of provoked VTE with right heart strain, the recommended duration of anticoagulation remains 3 months, provided the patient stabilizes and no ongoing risk factors remain.
Longer durations of anticoagulation (e.g., 12 months or indefinitely) are typically reserved for unprovoked DVTs or those with ongoing risk factors like cancer or recurrent thrombosis.
RACP 2019a Question 22
Patient with non-Hodgkin’s lymphoma receiving R-CHOP. Which agent carries the highest risk of peripheral neuropathy?
A. Rituximab
B. Cyclophosphamide
C. Doxorubicin
D. Vincristine
D. Vincristine.
Vincristine is a vinca alkaloid that disrupts microtubule formation in cells. It is well known to cause peripheral neuropathy as a side effect, primarily due to its effect on axonal transport in neurons. Neuropathy typically manifests as sensory disturbances, numbness, tingling, and sometimes motor weakness.
Rituximab (A), Cyclophosphamide (B), and Doxorubicin (C) have different side effect profiles, with less risk of causing peripheral neuropathy compared to vincristine:
Rituximab: This is a monoclonal antibody targeting CD20 and is not commonly associated with peripheral neuropathy.
Cyclophosphamide: An alkylating agent, cyclophosphamide is more often associated with bone marrow suppression and hemorrhagic cystitis, not peripheral neuropathy.
Doxorubicin: An anthracycline, doxorubicin is primarily associated with cardiotoxicity rather than neuropathy.
RACP 2019a Question 83
What is the mechanism of action of rasburicase in tumour lysis syndrome?
A. Inhibits xanthine oxidase
B. Decreases tubular reabsorption of urate
C. Increases tubular secretion of urate
D. Increases the oxidation of uric acid to allantoin
Answer D
RACP 2019b Question 10
Haptoglobin levels decline in haemolysis. What is the reason for this?
A. Haemoglobin and haptoglobin are cleared by the liver
B. Haemoglobin and haptoglobin are cleared by the kidney
C. Bilirubin and haptoglobin are cleared by the liver
D. Bilirubin and haptoglobin are cleared by the kidney
A. Haemoglobin and haptoglobin are cleared by the liver.
Explanation:
In haemolysis, free haemoglobin is released into the bloodstream from the destruction of red blood cells. Haptoglobin, a plasma protein, binds to free haemoglobin to form a haptoglobin-haemoglobin complex. This complex is then rapidly cleared from circulation by the reticuloendothelial system (mainly the liver).
Haptoglobin levels decline during haemolysis because haptoglobin is used up in binding to free haemoglobin, and the resulting complexes are cleared from the bloodstream by the liver.
The decline in haptoglobin serves as a diagnostic marker for haemolysis, as a reduced level indicates that haemoglobin is being released and bound to haptoglobin, leading to its clearance.
The kidneys play a lesser role in clearing haemoglobin-haptoglobin complexes, but they may become involved if haemolysis is severe and overwhelms the binding capacity of haptoglobin, leading to haemoglobinuria. However, the primary clearance mechanism is through the liver.
RACP 2019b Question 16
What gives PCR its specificity in detection? For example, detection of the BCR-ABL in chronic myeloid leukaemia.
A. Epigenetic diversity
B. Oligonucleotide polymer design
C. Heat stable DNA polymerase
D. Amplification of target sequence
B. Oligonucleotide polymer design.
Explanation:
Oligonucleotide primers are short, single-stranded sequences of DNA designed to bind (or anneal) to specific regions of the target DNA sequence, such as the BCR-ABL fusion gene in chronic myeloid leukemia.
The specificity of PCR comes from the primers being designed to match the unique sequence of the target region. Only the complementary DNA sequences that match the primers are amplified, making it a highly specific process.
Other options:
* Epigenetic diversity (A) does not play a direct role in PCR specificity.
* Heat-stable DNA polymerase (C), such as Taq polymerase, allows PCR to withstand high temperatures during the denaturation step but does not contribute to specificity.
* Amplification of target sequence (D) refers to the PCR process itself but does not explain the specificity, which is determined by the primers.