Hematology Flashcards
1
Q
Disproportionate Microcytic hypochromic anaemia = Hb=slightly less(110) + MCV = a lot lesser ( 60s) + Fatigue/Asymptomatic+ Raised HbA2 + basophilic stipling and target cells.Dx:
A
B thalasemia Trait.
2
Q
B thalasemia Trait.
A
Disproportionate Microcytic hypochromic anaemia = Hb=slightly less(110) + MCV = a lot lesser ( 60s) + Fatigue/Asymptomatic.
Basophilic stippling with occasional target cells
3
Q
Electrophoresis result in B thalasemia trait ?
A
Raised HBA2.
4
Q
Blood film/ type of cells in B thalasemia trait ?
A
Basophilic stipling and occasional target cells.
5
Q
Diagnostic test of B thalasemia trait ?
A
Haemoglobin electrophoresis = Raised HBA2.
6
Q
Which mutation in Polycythemia Rudra Vera ?
A
JAK 2 Mutation.
7
Q
Pruritis after bath + epistaxis + recurrent infection + splenomegaly+
Stroke history
JAK 2 mutation + all 3 : hb , tlc, platelet: all increased. Think :
A
Polycythemia Rubra Vera.
8
Q
Polycythemia rubra Vera can lead to which condition :
A
AML and Myelofibrosis.
9
Q
C/o SOB+ Lethargy+ night sweats+ Bone pain + H/o Polycythemia Rubra Vera. Which cancer most likely /
A
Acute Myeloid leukemia.
10
Q
Marked spherocytosis + DAT= negative. Dx:
A
Hereditary Spherocytosis.
11
Q
Marked spherocytosis + DAT=Positive. Dx:
A
Autoimmune Hemolytic Anaemia.
( AIHA)
12
Q
Diagnostic test in Hereditary Spherocytosis :
A
EMA binding test.
13
Q
H/O Hereditary Spherocytosis + Now : viral infection—Presents with weakness and lethargy.
A
Hemolytic crisis secondary to hereditary Spherocytosis.
Rx: Folic acid + - Fluids, Supportive Rx
14
Q
Rx for Hemolytic crisis secondary to H.Spherocytosis : Rx:
A
Folic acid.
15
Q
What genotype is associated with a milder form of sickle cell ?
A
HBSc.
16
Q
Which UTI meds can lead to pancytopenia ?
A
Trimoethoprim.
17
Q
Most common symptom of Myelofibrosis :
A
Fatigue.
18
Q
What type of cells in Myelofibrosis :
A
Tear drop cells.
19
Q
What is increased in Myelofibrosis, indicating high turnover ?
A
Urea and LDH.
20
Q
What is increased in early stage of Myelofibrosis ?
A
High WBC and High Platelet count.
21
Q
What indicates Dry tap in Myelofibrosis ?
A
Unable to take bone marrow sample.
22
Q
Elderly + Basophilia + Massive splenomegaly. Dx:
A
Chronic Myeloid Leukemia.
23
Q
Mutation In CML ?
A
BCR- ABL ( Tyrosine Kinase pathway)
24
Q
Rx in CML ?
A
Tyrosine Kinase Inhibitor ( Imatinib)
25
Poor prognosis in CLL :
Deletion of 17p13 region.
26
K/C/O Sickle cell + Throbbing pain in leg. Dx and Investigation to diagnose :
Dx: Vaso occlusive crisis.
Ix: No Ix required. Dx is clinical.
27
Transfusion—SOB+ Decrease in BP. Dx and Rx?
Transfusion related acute lung injury. ( TRALI)
Rx: IV fluids + oxygen + escalation of care.
28
20-30 year old + low in IgA, IgG, IgM+ Recurrent chest infection. Dx:
Common variable immunodeficiency syndrome.
29
Lethargy + Splenomegaly +JAK 2 + High Urea and LDH + WBC and Platelets : slightly Raised. Dx and blood film :
Myelofibrosis
Tear drop cells
30
Dapsone + Dyspnoea =
Methhaemoglobinaemia.
31
Neutropenic sepsis is caused by :
Staphylococcus epidermidis.
32
Staphylococcus epidermidis is gram ?
Gram Positive , coagulase negative.
33
mechanism of action of DDAVP in von Willebrand's disease?
Induces release of von Willebrand's factor from endothelial cells
34
Antibiotic which causes hemolysis in G6PD?
Ciprofloxacin, sulphamethaxole, co trimoxazole.
35
Acute myeloid leukaemia - poor prognosis:
Deletion of chromosome 5 or 7
36
TTP features and Rx:
Terrible Pentad : Fever + Neuro. + Anaemia+ Decrease in Platelets + AKI= Increase in Urea and Creat.
Rx: Plasma Exchange.
37
TTP deficiency of what:
Inhibition or deficiency of ADAM TS 13 = leads to failure to cleave VWF multimers.
38
In TTP, The deficiency of ADAM TS 13 leads to what :
Leads to failure to cleave VWF multimers.
39
Wiscot Aldrich syndrome, features and mnemonic :
WATER:
WA:Wiscot Aldrich, WASP gene mutation.
T: Thrombocytopenia: Decrease in platelets
E: Eczema
R: Recurrent pyogenic infection.
40
Both B and T cell deficiency :
Wash your B and Ts:
Wiscot
Ataxia Telangiectasia
SCID
Hyper IgM syndrome.
41
B cell deficiency :
ABC:
A: IgA deificiency
B : Brutons
C: Common variable immunodeficiency
42
Recurrent bruising + Recurrent infection + eczema + low platelet + anaemia
Wiscot Aldrich syndrome.
43
Most common type of lung cancer in non smokers:
Lung Adenocarcinoma.
44
Rabiscurase MOA:
Converts uric acid to allantoin.
45
Most common symptom of Superior vena cava obstruction :
Dyspnoea.
46
Hodkin’s Lymphoma poor prognosis
Fever
Weight loss
Night sweats
47
The universal donor of fresh frozen plasma is :
AB RhD negative blood
48
Myelofibrosis: High or Low LAP ?
High LAP score.
49
Haemophilia A , which factor ?
Factor 8 ( Aight)
50
Haemophiila B , which factor ?
Factor 9
51
Haemophilia clinical features ?
Haemarthroses.
Haematomas.
Prolonged Bleeding after surgery.
52
Anaphylactic reaction to bee sting, First line Ix:
Radio allergosorbent assay. ( RAST)
53
In Acute myeloid leukaemia. What is the single most important test in determining his prognosis?
Cytogenetics.
Cytogenetics detects chromosomal abnormalities—which has biggest effect on AML prognosis.
54
Cytogenetics detects what ?
C=C= Chromosomal Abnormalities.
55
Neutropenic sepsis Rx?
Filgrastim.
56
K/c/O cancer= Hodkins + Recent chemo+ C/o : Fever+ Neutrophils= < 0.5 10^9. Dx:
Neutropenic Sepsis.
57
Aetio of Neutropenic Sepsis:
Staph epidermidis.
Gm + cocci, Coagulase Negative.
58
In Hemolysis, Haptoglobin: Increase or Decrease ?
Haptoglobin decreases.
As Haptoglobin binds to free haemoglobin.
59
1 adrenaline
2 adrenaline
>2 adrenaline . Admit for how many hours ?
1 Adrenaline= Admit for 2 hours.
2 Adrenaline= Admit for 6 Hours.
>2 Adrenaline = Admit for 12 hours.
60
Aprepitant MOA:
Antiemetic which Binds to NK1 receptor( Chef wearing Apron , Nikon Camera)
61
Which products are used to avoid transfusion-associated graft versus host disease?
Irradiated Blood products.
61
Acute myeloid leukaemia - good prognosis:
good prognosis: t(15;17)
62
Woman with bone metastases- most likely to originate in the :
Breast
63
Isolated neutropenia in which ethnicity ?
Black Afro Caribbean.
64
Gallstones is common in which blood disorder ?
Hereditary Spherocytosis.
65
Philadelphia chromosome good or bad prognosis in ALL ?
Bad prognosis
66
VIT B12 absorption ?
Active transport in terminal ileum
67
Taxanes MOA:
Prevents micro tubules polymerisation.
68
T(9:22)
Philadelphia chromosome in CML.
69
Transmission of which type of infection is most likely to occur following a platelet transfusion?
Bacterial.
70
What is the single most important factor in determining whether cryoprecipitate should be given?
Low fibrinogen.
71
Pt on warfarin—Trauma—#ge—blood transfusion—which blood product to give additionally?
Prothrombin complex concentrate.
72
Best Prognosis in Hodkins:
Lymphocyte Rich ( Rich ppl have better bank accounts)
73
Worst Prognosis in Hodkins :
Lymphocyte Depleted ( Poor ppl have depleted bank accounts )
74
The oncologist recommends starting a medication which can specifically target this type of breast cancer in post-menopausal women only
Aromatase inhibitor- Azoles.
75
CKD is the most common cause of Which clotting factor deficiency ?
Anti thrombin 3.
76
Anterior mediastinal mass + symptoms of myasthenia = Dx and Ix of choice:
Thymoma.
Ix of choice : CT scan of chest.
77
Thymoma clinical features.:
Anterior mediastinal mass + symptoms of myasthenia = thymoma
78
Prostrate cancer—new onset back pain+ Peri anal numbness + leg weakness. Dx and Rx:
Neoplastic spinal cord compression.
Rx: high dose dexamethasone orally immediately.
79
Painless neck lump + B symptoms. Dx and Translocation:
Follicular Lymphoma.
Translocation: t( 14, 18)
80
Transfusion + now—fever chills rigors. Dx and Cause:
Dx: Transfusion related infection
Cause: platelets
81
Screening for Hereditary angioedema?
C4 levels
82
What is not involved in patho of hereditary angioedema?
Histamine.
83
Isolated thrombocytopenia +Increase in bleeding time. Easy bruising + Epistaxis. Dx and Rx?
ITP
Rx: oral prednisolone.
84
ITP Rx:
Oral prednisolone.
85
In ITP antibodies are against :
Glycoprotein 2b/3a complex.
86
Cells seen in DIC:
Schistocyte.
87
DIC mnemonic and features:
Damn I am clotting.
Decreased Fibrinogen + Increased D dimer.
88
Decreased Fibrinogen + Increased D dimer. Dx?
DIC
89
CML , LAP score , high or low ?
Low.
90
Family H/o + Abd pain + Neuro symptoms- hallucinations , agitation , change of mood + reduced sensation of foot +
Acute intermittent porphyria.
91
Dx of Acute intermittent porphyria :
Porphobilinogen.
92
Rx for Acute intermittent porphyria :
Heme.
93
Bombesin is a tumour marker in
Small cell lung cancer
94
Small cell lung cancer tumour marker:
Bombesin.
95
Tumour lysis syndrome. Rx:
Rasburicase + IV Fluids.
96
Tumour lysis syndrome mnemonic and electrolytes :
UKPc: Increase in urea, creat, phosphate,
Decrease in calcium.
97
H/o Breast cancer + Osteosarcoma. Most likely Dx:
Li Fraumeni syndrome.
98
Tumour marker in Li Fraumeni :
P53.
99
Difference bw TRALI and TACO:
No Hypotension in TRALI.
100
Post splenectomy which types of cells are seen ?
Howel Jolly bodies.
101
Which diabetic drugs causes hemolysis in G6PD?
Sulphonamides- Glimepiride.
Biguinide- Metformin.
102
Which bodies are seen in Leukamoid reaction:
Dohle bodies.
103
Leukamoid reaction features:
High LAP score
Dohle Bodies
Left shift of neutrophils.
104
which direction of shift of neutroohils in Leukamoid reaction ?
Left direction shift.
105
Heparin binds which clotting factor ?
Antithrombin 3.
106
Which one of the following causes of thrombophilia is associated with resistance to heparin?
Antithrombin 3 deficiency.
107
Which urine test in lead poisoning ?
Increase in urinary coproporphyrin.
108
Blood picture in lead poisoning
Microcytic anaemia plus basophilic stipling.
109
Pt started on warfarin+ Now develops necrotic skin condition : Dx
Protein c deficiency.
Protein c deficiency= Hypercoaguable state + warfarin= blood thinner= this imbalance leads to necrotic skin condition.
110
Thymoma assn :
Myasthenia gravis
Red cell aplasia.
Dermatomyositis
SIADH
111
Food allergy test:
Skin prick test.
112
JAK 2 + isolated increase in platelets. Dx:
Essential Thrombocytosis.
Rx: Hydroxyurea ( Hydroxycarbamide)
113
Essential thrombocytosis. Rx
Hydroxycarbamide.
114
Coeliacs causes which type of spleen issues ? And causes which type of cells to appear /
Hyposplenism.
Howell jolly bodies.
115
Diagnostic test in anaphylaxis
Serum tryptase.
116
Cyclophosphamide Adverse and its prevention :
Haemorhagic cystitis
Prevention: MESNA
117
H/o Sickle cell disease. Hb, WBC, Platelet : all three decreased. C/o fever cough myalgia. Dx:
Aplastic crisis
118
Raynauds + waldernstrom. Dx: which type ?
Type 1 cryoglobulinaemia.
119
Hepatitis c + Waldenstriom, which type ?
Type 3 cryoglobulinaemia.
120
_____is the empirical antibiotic of choice for neutropenic sepsis
Piperacillin with tazobactam (Tazocin)
121
Dyspnoea + Normal PO2+ Decreased SPO2. Dx:
Methhaemoglobinaemia.
Rx:IV methylthioninium chloride (methylene blue) if acquired
122
Rx of Methhaemoglobinaemia.
IV methylthioninium chloride (methylene blue) if acquired
123
PE+ Recurrent DVT- unprovoked. DX:
Activated protein c resistance( Factor 5 Leiden)
124
Which antibiotics causes Methhaemoglobinaemia ?
Sulphamethaxzole—Co-trimoxazole.
125
Which infection ass with MALT= gastric lymphoma
H.Pylori.
126
Cisplatin MOA:
Cross linking in DNA.
127
Methaemoglobinaemia Patho :
oxidation of Fe2+ in haemoglobin to Fe3+
128
Intravascular hemolysis mnemonic :
MRCGP
Mismatch blood transfusion
Red cell fragmentation- heart valves,TTP
G6PD
Paroxysmal nocturnal haemoglobinaemia.
129
Paroxysmal nocturnal haemoglobinaemia diagnostic investigation :
Cytometry- To detect low levels of CD55 and CD59.
130
Most common type of Hodkins lymphoma :
Nodular Sclerosing.
131
Acute intermittent porphyria is deficiency due to :
Porphobilinogen deaminase
132
Anaphylaxis - serum tryptase reach peak at :
Serum tryptase reach peak at one hour.
133
SVC obstruction Rx:
Dexamethasone.
134
Hodkins lymphoma- spread to other organs. Which stage ?
Stage 4
135
Which mutation is associated with prostate cancer in men?
BRACA 2
136
BRAC-2 in men mnemonic :
BP2:
Breast
Prostrate
Pancreas.
137
Hodkins = both sides of diaphragm , which stage ?
Stage 3
138
Abd pain + red coloured urine+ rapid weakness in legs. Dx :
Acute intermittent porphyria.
139
Sickle cell patients should be started____ to reduce the incidence of complications and acute crises
started on long term hydroxycarbamide/hydroxyurea.
140
most common primary tumour that metastasises to the bone in men :
Prostrate cancer.
141
Patients starting rituximab should be screened for__
Hepatitis B before starting treatment
142
Hereditary angioedema is caused by deficiency of___
C1 esterase inhibitor
143
Baseline haemoglobin of 110g/L: sudden drop of Hb—H/o Sickle cell. Dx:
Aplastic Crisis.
144
Sideroblastic anaemia causes and mnemonic :
MALT:
Myelodysplasia.
Alcohol.
Lead
Anti TB drugs.
145
Anti TB drugs causes which type of anaemia ?
Sideroblastic anaemia.
146
Which stain in Sideroblastic anaemia ?
Pearl’s stain.
147
Rx of Sideroblastic anaemia :
Pyridoxine.
148
Burkits lymphoma Translocation:
T(8,14)
149
Which gene in Burkits lymphoma?
C-Myc.
150
Which virus in Burkits lymphoma ?
Epstein Barr virus.
151
Biopsy findings in Burkits lymphoma ?
Starry sky appearance.
152
Growth in Jaw + Starry sky appearance. Dx:
Burkits lymphoma.
153
ESR value in polycythemia Rubra Vera :
Low
154
Rx for hairy cell leukemia:
Interferon alpha.
155
H/o h.spherocytosis + Episodic upper abdomen pain. Dx:
Billiary colic.
156
How is capecitabine Administered ?
Orally.
157
Which sex is a good prognosis in CLL ?
Female sex.
158
most common inherited bleeding disorder:
Von WIllebrand disease.
159
most useful marker of prognosis in myeloma?
B2 Microglobulin.
160
Which is not a treatment modality in ITP ?
Plasma exchange.
161
Alpha thalasemia on which chromosome ?
Chromosome 16.
162
Olanzapine, an atypical antipsychotic Ass with increased risk of :
VTE.
163
primary immunodeficiency is due to a defect in neutrophil function?
Chronic Granulomatous disease.
164
Common variable immunodeficiency Is due to defect in which primary immunodeficiency ?
B cell function.
Mnemonic- ABC
A- IgA deficiency
B- Brutons agammaglobulinaemia
C- common variable immunodeficiency anaemia
165
Ovarian cancer tumour marker :
CA 125.
166
Peritoneal cancer tumour marker :
CA 125.
167
Pancreatic cancer tumour marker
CA 19 9
168
Breast cancer tumour marker :
CA 15 3
169
H/o Polycythemia rubra + petechia + gingival bleeding+ DIC picture. Dx:
Acute Promyelocytic leukemia
170
Which of the following chemotherapy agents is most likelcy responsible for hypomagnesemia ?
cisplatin.
171
Aromatase inhibitors common side effects in post menopausal women ?
Osteoporosis
172
The presence of haemolysis with blister cells on the blood film is highly suggestive of____
G6PD deficiency
173
Blood smear of G6PD:
Heinz bodies
Bite cells
Blister cells.
174
Anti malarials causes hemolysis in :
G6PD
175
Translocation of Acute promyelocytic leukaemia :
t(15;17)
176
T(15;17)
Acute Promyelocytic leukaemia.
177
irinotecan MOA:
Inhibition of topoisomerase 1.
178
Methhaemoglobinaemia. Po2 and spo2 level :
Normal PO2 and low Spo2( low oxygen saturation)
179
Recurrent pancreatitis + Recurrent parotitis. Dx:
IgG4 disease.
180
which gene proliferation in follicular lymphoma ?
Increases BCL2 transcription
181
Hereditary angioedema mode of inheritance ?
Autosomal Dominant.
182
Doxorubicin Adverse:
Cardiomyopathy
183
Vincristine Adverse :
Peripheral neuropathy.
184
Imatinib MOA:
Tyrosine kinase inhibitors
185
Ototoxicity is caused by which Anti cancer drugs ?
Cisplatin.
186
Cisplatin adverse :
Hypomagnesemia
Ototoxicity
Peripheral neuropathy
187
Acute Promyelocytic leukemia Rx:
All-trans retinoic acid (ATRA)
188
Abdomen pain, diarrhoea and progressive weakness and pain in the limbs. She looks low in mood and tearful at times. You ask for a urine sample and leaves it standing near the window. 20 minutes later, you notice that the urine has become darker.
Acute intermittent porphyria
189
M protein > 30 g/l + monoclonal plasma cell infiltrate.
▪︎No CRAB features. Dx and Rx:
Smouldering Multiple Myeloma.
Rx: Observe and Monitor.
190
Cyclophosphamide - MOA:
Causes cross-linking in DNA
191
HTLV1 association :
Adult T cell leukemia
192
Do fungal infection cause eosinophilia ?
No
193
IgG paraprotein level in MGUS?
<30 g/L
194
4 year old + Splenomegaly + clinically anaemic+ H/o Sickle Cell :
Sequestration crisis.
195
IV drug user + hep C + Rheumatoid arthritis +Purpuric Rash + low C4. Dx:
Cryoglobulinaemia.
196
Megaloblastic Anaemia Rx
Intramuscular vitamin B12 + start oral folic acid when vitamin B12 levels are normal
197
Congenital cause of Methhaemoglobinaemia :
NADH methaemoglobin reductase deficiency
198
H/o H Spherocytosis—C/o- Lethargy. Hb low , Retic=low. Dx:
Parvo virus infection.
In Hemolytic anaemia, retic count is high. It’s Low here.
199
Most useful follow-up investigation(s) to detect disease recurrence in testicular cancer.
Alpha-fetoprotein + beta-HCG.
200
weight loss, anaemia, splenomegaly, + Leucocyte with all stage of maturation. Dx:
CML
201
T(11,14):
Mantle Cell Lymphoma.
202
What chemical mediator is mainly responsible for the tissue oedema seen in patients in hereditary angioedema?
Bradykinin.
203
Does penicillin cause G6PD?
No.
204
Treatment of hereditary angioedema?
Anabolic steroids.
205
Is dermatomyositis ass with Thymoma ?
yes
206
Is motor neuron disease ass with Thymoma ?
No.
207
Which two anaemias are seen in PNH ?
hemolytic anaemia and aplastic anaemia.
208
Which test is positive in PNH ?
Positive Ham test.
209
Is hemearthosis a feature of PNH ?
No. its seen in haemophilias.
210
Lead poisoning mnemonic and features:
LEADS
L- lead lines on gingival
E- encephalopathy
A- Abdomen colic
D- wrist drop- peripheral neuropathy.
211
Type of cell seen in lead poisoning:
Microcytic Anaemia + basophilic stipling.
(Iron deposition around mitochondria)
212
Mode of inheritance in Wiscot :
X linked recessive( water down)
213
SVC obstruction is caused by primary malignancy or metastatic malignancy ?
Primary malignancy.
214
Stoke + isolated increase in platelets. Dx and Mutation :
Dx: Essential thrombocytosis.
Mutation : JAK 2 mutation and CALR mutation
215
Mutations seen in essential thrombocytosis:
JAK 2 mutation and CALR
216
Which toxin leads to hepatocellular cancer ?
Aflatoxin
217
Elderly + Increase in Lymphocytes + which cancer ?
Chronic Lyphocytic Leukemia.
218
Investigation of choice in CLL :
Flow Cytometry/Immunophenotyping - detects Antibodies on the surface
219
Deletion of which chromosome in
Deletion of Long arm chromosome 13.
220
Unusual taste in mouth is a classical feature of :
LEAD poisoning.
221
Abdominal pain, constipation, neuropsychiatric features, basophilic stippling
Lead poisoning.
222
itchiness in her mouth and at the back of her throat after consuming peaches on several occasions with some mild swelling which settles down over time + Seasonal Variation:
Oral allergy syndrome.
223
Which of the following has a role in monitoring disease activity in colorectal cancer?
CEA
224
Difference between H. Angioedema and anaphylaxis :
H.angioedema has painful macular rash.
Skin manifestation in anaphylaxis is : urticaria.
225
Methotrexate MOA:
inhibits dihydrofolate reductase and thymidylate synthesis
226
Urinary findings in Acute Intermittent Porphyria.
Increased urinary porphobilinogen between acute attacks
227
Imp Adverse of SERM:
DVT
228
DVT in pregnancy. Rx:
Low molecular Weight Heparin.
(Heparin helps in pregnancy )
229
Rituximab acts against :
CD 20 and B cells
230
What to screen before giving Rituximab?
Patients starting rituximab should be screened for hepatitis B before starting treatment
231
Is Haemochromatosis ass with Polycythemia?
No.
232
Is dehydration ass with Polycythemia ?
Yes
233
Common causes of polycythemia ?
Polycythemia Rubra Vera.
COPD.
Stress/ Dehydration.
Fibroids.
Hypernephroma.
234
If allergy to latex, then allergy to which food ?
Banana
235
Hypodiploidy : Good or Bad prognosis In ALL ?
Bad prognosis
236
Epistaxis + Bleeding Gum+ Bilobed large nuclear cells. Dx:
Acute myeloid leukemia.
237
K/C/O Sickle + Fever + Dyspnoea + low spo2 + CXR= opacification.
Dx: Acute chest syndrome
Rx: Oxygen, IV FLuids, Incentive spirometry.
238
CLL - treatment:
Fludarabine, Cyclophosphamide and Rituximab (FCR)
239
MGUS+ Organomegaly + No bone lesions. think :
Waldenstorm
240
Headache+ epistaxis + hepatospleomegaly + Pancytopenia + IgM peak. Dx:
Waldernsotrm.
241
Which peak in waldenstorm ?
IgM Peak
242
Blood picture in Waldensorm :
Pancytopenia
243
What type of blood cells in Waldenstorm ?
B lymphocytes + Plasma cells
244
DVT plus IgM peak. Dx?
Waldenstorm.
DVT= Hyperviscocity syndrome
245
CLL is due to :
Monoclonal Proliferation of B lymphocytes.
246
Complications developed in Waldenstorm :
Hyperviscocity complications ( Headache, DVT)
247
Cancer patients with VTE Rx:
Continue DOAC for 6 months.
248
Provoked VTE Rx:
DOAC for 3 Months
249
Unprovoked VTE Rx:
DOAC for 6 Months
250
Elderly + Absolute Lymphocytosis. Dx:
CLL
251
Type of cells in CLL :
Smudge cells.
252
Diagnostic test for CLL.
Flow Cytometry/ Immunophenotyping : to detect antibodies.
253
Warm autoimmune Hemolytic anaemia is ass with Ig?
IgG
It’s warm in G=Ghana( Outside Uk)
254
Cold autoimmune Hemolytic anaemia is ass with ig?
IgM
It’s miserable in Manchester.
255
Coombs test ( DAT test) in warm autoimmune Hemolytic ?
Coombs or DAAT : Positive.
256
Recurrent infection in CLL is due to :
hypogammaglobulinaemia
257
Which type of anaemia occurs in CLL as complication:
Warm autoimmune haemolytic anaemia
258
Common complication in warm autoimmune Hemolytic anaemia ?
Lymphoma.
259
Raynauds+ Spherocytosis. Dx and First line Ix?
Next line Ix: Direct antiglobulin test (DAT)
Dx: Autoimmune Hemolytic anaemia.
260
Mutation in Hereditary Spherocytosis :
Mutation in Spectrin and Ankyrin
261
Sickle cell mutation occurs where ?
Valine substitution for glutamic acid at 6th position of B chain.
262
EPO level in Polycythemia Rubra Vera ?
Low EPO level
263
Long term Complications of Splenectomy :
Infections.
Therefore all splenectomy patients are vaccinated
264
Best time to give vaccine for a splenectomy Patients :
One month before surgery
265
Painless cervical Lymph nodes. Most appropriate Ix to do :
Excision Biopsy of lymph node.
A full lymph node biopsy is required to to determine the exact subtype of lymphoma/
266
Risk factor for Lead poisoning :
Old house with poor maintenance
267
H/o chemotherapy and radiotherapy + Now : Anaemia + recurrent infection taking longer to heal + Frequent Nose bleeds. Dx:
Secondary AML.
268
Secondary AML.
H/o chemotherapy and radiotherapy + Now : Anaemia + recurrent infection taking longer to heal + Frequent Nose bleeds.
269
Recent Transplant + Now : Right Quadrant pain + Abnormal LFT + Jaundice. Dx:
Veno Occlusive Disease.
270
Veno occlusive disease secondary to Recent transplant :
Recent Transplant + Now : Right Quadrant pain + Abnormal LFT + Jaundice.
271
Imatinib common side effect :
Nausea
272
Biopsy —Reduction in Hematopoeitic cells and Fatty bone marrow.
Aplastic anaemia
273
Aplastic Anaemic Bone marrow biopsy ;
Reduction in Hematopoeitic cells and Fatty bone marrow.
274
Young + fatigue+ Bruising + Gum Bleeding + Frequent nose bleeds +
Blood Picture—DIC
Acute promyelocytic leukaemias
275
Acute promelyocytic Leukemia Blood picture :
DIc picture/ thrombocytopenia
+ Auer Rods + Promyelocytes
276
Extensive bruising + Petechiae on Limbs + Bleeding Gums+ Suffers severe PR bleed.
Hb—Low, Platetlets- very low
Severe ITP
Rx: IV immunoglobulins
Mild ITP Rx : Oral Prednisolone
277
Recent chemo—Now feeling very tired. Hb- low, platelet-low. Dx
Symptomatic anaemia
Rx: transfuse with packed red cells
278
Primary function of Heparin :
Blocks anti thrombin 3 —which further blocks Factor 2(broken 2 tooth) and factor 10 (broken tennis racket)
279
Bleeding time in Haemophilia :
Bleeding time in Haemophilia is normal.
Bleeding time depends on platelet function.
In haemophilia platelets are normal. Problem is in clotting factors—factor 8 and factor 9. Therefore clotting factor is increased ( Increase in aPTT)
280
Bleeding time in VBD :
Bleeding time is prolonged
APTT —prolonged.
PT—normal.
Bleeding time depends on platelet function. In VBD , problem is in platelet adhesion.
281
Alcoholic + enlarged spleen + Bruises + on going nosebleed. Which vitamin deficiency ?
Vitamin K deficiency
Enlarged spleen is due to ALD
282
Pregnant + Mild knock at elbow + Now bruises + blood is normal + Platelets—Low
No intervention required.
Platelet is normally low in pregnancy.
Physiological thrombocytopenia.
283
17 year old + Asymptomatic + Painless cervical lymph nodes + B/L mediastinal lymph nodes
Hodkin’s Lymphoma—typical symptoms
Mantle and Non Hodkin’s—Very rare presentation in young age group
Sarcoidosis—other symptoms are present.
284
Quinine—Now bruises and low platelet :
Drug induced Thrombocytopenia
285
Rx for Paroxysmal nocturnal Haemoglobin anemia :
Eculizumab.
286
Diabetes Insipidus is associated with which hemat condition ?
Sickle cell
287
MAHA is associated with :
TTP
HUS
SLE
HELPP
288
Feve, weight loss, anorexia + Macrocytic anaemia + Thrombocytopenia + Blood film—Dimorphic red cells + papenheimmer bodies + basophilic stippling. Dx:
Myelodysplasia.
289
Protamine sulphate is used for reversal of :
Heparin
290
Prothrombin complex concentrate is used for reversal of :
Warfarin
291
Which drug to use for reversal of action of Altepase ?
Traneximic acid
292
Traneximic acid is used for reversal of which drug ?
Altepase
293
Which drug to use for reversal of warfarin ? :
Prothrombin complex concentrate.
294
Which drug to use for reversal of heparin ?
Protamine Sulphate.
295
Best test to detect protein C deficiency ?
Copperhead snake venom assay.
296
Lower back pain + tired + Hypercalcemia + Plasma viscosity raised + ALP raised. Best test to assess prognosis :
Dx: multiple myeloma.
For prognosis : serum B2 microglobulin.
297
Plasma viscosity in Multile myeloma:
Raised , due to excess immunoglobulins.
298
Age group in non Hodkin’s and Hodkin’s :
Hodkin’s—55
No Hodkins—80
299
Lymph node involvement in Non Hodkin’s and Hodkin’s :
Hodkins: Cervical lymph node
Non Hodkins : supraclavicular lymph node
300
which test is positive in Non Hodkin’s :
Cold agglutinin test.
301
Which blood work is raised in Non Hodkin’s and not in Hodkin’s ?
LDH and white cell count is only raised in Non Hodkin’s
302
Blood picture in AML ?
Pancytopenia
303
Blood film in AML ?
Auer Rods
Bilobed nuclei.
304
70 year + fatigue + bleeding gums + pancytopenia + splenomegaly. Dx?
AML
Pancytopenia —feature of AML
305
Which level can be raised in Hodkins?
Raised ESR
306
Factor 5 Leiden is resistant or deficiency of protein c
resistant to protein c
307
Most common symptom in waldenstorm :
generalised muscle weakness, Not raynauds
308
Best test to diagnose methhaemoglobinaemia :
Co-oximetry—it can directly measure methhaemoglobin level.
309
most serious side efffects in waldenstorm is caused by :
Hyperviscocity syndrome
310
How to differentiate between primary and secondary polycythemia ?
Do JAK 2 mutation , as this mutation is present in 95 % of primary polycythemia.
311
Prophylactic Rx of VWD for an upcoming surgery :
Desmopressin and Tranexemic acid
312
Increase in Thrombin Time
Normal Reptilase time
Heparin in sample
313
Heparin in sample, Blood picture :
Increase in thrombin time
Normal Reptilase time.
314
Protein c activates :
Factor Va and V111a
Va—X (common pathway)
V111a—1X (Intrinsic pathway)
315
Most common pathogen transmitted via platelet transfusion ?
Staphylococcus
316
Bone marrow biopsy of myelofibrosis :
Bone marrow aspirate: dry tap
Bone marrow biopsy : Patchy reticular fibrosis with small areas of haemopoeitic cells.
317
Does sickle cell cause hyposplenism ?
Yes.
318
Sickle cell has risk of which infection ?
Encapsulated organism :
Streptococcus pneumoniae + Neisserria + Haemophilus influenza.
319
Which medication to give in Sickle cell as preventive ?
Give lifelong penicillin plus prophylactic antibiotics.
320
Recent transplantation + Fever vomitting + diarrhoea + skin rash. Dx?
Graft vs Host disease.
321
Graft vs Host disease.
Recent transplantation + Fever vomitting + diarrhoea + skin rash.
322
differentiate Graft vs Host disease and acute graft rejection
Acute graft rejection—24 hrs following transplant: ongoing pancytopenia.
Graft vs Host disease :
Recent transplantation + Fever vomitting + diarrhoea + skin rash.
323
18 year old + tiredness and easy bruising. Auer rods. Dx and most important test to do here ?
Acute myeloid leukemia
Most imp test to do : Clotting screen to rule out DIC
324
Upper GI bleed symptoms :
Melena
Haematemesis
325
Lower GI bleed Symptoms :
Haematochazia
326
Diagnosis of Upper GI bleed ?
upper GI endoscopy
327
Diagnosis of lower GI bleed ?
Colonoscopy
328
Osmotic Fragility in Hereditary spherocytosis ?
Increased osmotic fragility
329
screen what ? During the blood transfusion in pregnant woman ?
Screen for Cytomegalovirus
330
Vitamin B12 is absorbed in :
Terminal ileum
331
Blood picture in Myelofibrosis?
Leukoerythorblastic picture with tear drop cells
332
two causes of spenomegaly in Hemat :
Myelofibrosis and CML
333
Differentiate Polycythemia Vera and secondary polycythemia ?
Polycythemia Vera: Decreased EPO
Secondary polycythemia : Increased EPO
334
Majority of Non Hodkin’s Lymphoma is of which type ?
B Lymphocyte type of Non Hodkin’s
335
Abdominal symptoms in which lymphoma ?
Non Hodkins
336
Which drug causes increased risk of catching opportunistic infection ?
Purine analogue ( Fludarabine)
337
Pt on fludarabine ( Purine analogue ) —Now , pt has progressive SOB + low spo2 + shadow at both Hila; Dx?
Purine analogue causes increased risk of opportunistic infections such as Pneumocystis jirovecii.
Transfusion related graft vs host disease. Because patients with fludarabine are T cell depleted.
338
Diagnosis of waldenstorm :
Serum Protein electrophoresis
339
B symptoms + Massive hepatosplenomegaly + Leucoerythroblastic picture + Raised LDH
Myelofibrosis.
340
When to give IV immunoglobulins in ITP ?
When platelet count < 30 * 10^9
341
What is globulin fraction ?
Total protein - Albumin.
When globulin fraction is significant—its paraprotein
342
greek man : Microcytic anaemia+ Low MCV and MCH. Serum ferittin is normal. Dx?
Greek + Serum ferittin is normal, so patient is not iron deficient.
Suspect Thallasemia.
343
Slight spike in temperature while transfusion + normal vitals. What to do next ?
Continue transfusion and give PCM
344
Which Ig peak in multiple myeloma?
IgG peak.
345
Which Ig peak in waldenstorm ?
IgM peak.
Plus Hyperviscocity syndrome.
346
Several supraclavicular lymph nodes. When to perform biopsy ?
Immediately
347
African + Hypercalcemia + Lymphadenopathy + Skin lesions. Dx ?
Adult T cell Leukemia
Ass with HTLCV1( human T cell lymphotropic virus 1)
348
Advantage of irradiated red cells :
Inactivates donor lymphocytes
349
Felty syndrome :
Rheumatoid arthritis + splenomegaly + Neutropenia.
350
Rheumatoid arthritis + splenomegaly + Neutropenia.
Felty syndrome
351
Most frequent complications which causes death in CLL ?
Infections.
352
Which anaemia is seen in coeliacs ?
Macrocytic anaemia.
353
Peripheral Blood of thallasemia :
Nucleated red cells
354
Worst prognosis in AML ?
Chromosome 7
355
Severe aplastic anaemia Rx ?
Haematopoetic stem cell transplantation.
356
Microcytic hypo chromic anaemia + Increased iron in stores
Increased iron in stores—Ring Sideroblasts
Dx: Sideroblastic Anaemia.
357
HRT on Bone and PE ?
Increased risk of PE ( Oestrogen is Thrommbotic )
Protects bone ( Prevents osteoclast activity )
358
Patient with Von Willebrand disease awaiting a dental procedure. Which prophylaxis to be done ?
Give DDVAP.
359
Pregnant woman : drop in Hb and Increase in MCV in couple of months. Which deficiency?
Megaloblastic Anaemia—due to : Folic acid deficiency.
Increased demand of folic acid during pregnancy.
Why not b12: it takes years to become b12 deficient.
360
Why does recurrent infection occur in CLL ?
Due to immunoglobulin deficiency
361
Role of DDVAP in Haemophilia ?
Releases pre formed Von willebrand factor—which complexes with factor 8—Prolongs factor 8 survival.
362
ITP + Autoimmune haemolytic anaemia :
Evans Syndrome.
363
Evans Syndrome.
ITP + Autoimmune haemolytic anaemia
364
Which type of anaemia in Multiple Myeloma ?
Normocytic Normochromic Anaemia.
365
What is characteristically raised in Multiple Myeloma ?
Raised ESR.
366
Stroke + DVT symptoms. Diagnosis and Diagnostic Test:
Dx: Patent foramen ovale.
Ix : Echocardiography.
367
Lyric lesions in vertebrae + back pain + Raised viscosity + Normocytic normochromic Anaemia.
Multiple Myeloma.
368
Is bleeding a complication of Polycythemia rubra vera ?
Yes—Due to low platelets.
369
Most common side effect of Heparin Induced Thrombocytopenia ?
Deep vein thrombosis.
Low platelet counts, but these are hyperactive and causes paradoxical thrombosis leading to DVT
370
Feature of hypothyroidism related anaemia :
Macrocytic anaemia without megaloblastic change in bone marrow.
371
Fat embolism causes which skin manifestation ?
Multiple petechiae in axilla and armpits.
372
Elderly + Tiredness + Neutrophilia + anaemia+ Splenomegaly
CML
373
In DIC , which blood product replacement ?
If prolonged PT and aPTT and bleeding—Fresh frozen plasma.
If fibrinogen is low : cryoprecipitate.
If platelet is low : Platelet transfusion
If significant anaemia : Packed red cells
374
Warfarin OD blood picture :
Warfarin inhibits vitamin K dependant clotting factors.
Which leads to : Affecting extrinsic pathway:
PT—Prolonged.
INR —Prolonged
APTT— normal or slightly increased(as its intrinsic pathway)
Fibrinogen—Normal
Platelet—Normal.
375
Recurrent DVT + Hb and platelet are low + Hemosiderin in urine analysis. Dx:
PNH
Dx by : cytometry or Immunophenotyping
376
PT in APLA ?
Normal
377
APTT in APLA ?
Prolonged.
378
Post op bleed—Low Hb + very low platelet + raised INR + presence of promyelocytes.
Acute promyelocytic Leukemias leading to coagulopathy as evidenced by low platelets and raised INR.
Give Platelets infusion as the first line.
Fresh frozen plasma—Not first line.
Give if ongoing bleed even after platelet infusion.
379
Admitted for PE , now developed DVT. Why ?
Developed DVT due to Heparin induced thrombocytopenia.
380
Which antibodies are responsible for developing HIT ?
Anti PF4 antibodies.
381
CLL is associate with which condition ?
Autoimmune haemolytic anaemia.
AIHA—Hemolytic anaemia + Raised Bilirubin and LDH
382
K/C/O CLL + Anaemia + raised bilirubin
C/0 Breathlessness + fatigue + Splenomegaly.
Which test to do find the cause of anaemia ?
Do Direct Globulin test ( Coomb’s test).
CLL is associated with Autoimmune haemolytic anaemia.
AIHA—Hemolytic anaemia + Raised Bilirubin and LDH
383
Target for immunotherapy in lymphoma ?
CD 20
384
Patient on fludarabine is at what risk?
Graft vs host disease—as those patients with fludarabine lack T cells.
Opportunistic infection.
385
How to know if it’s secondary APLA ?
Presence of SLE ( Raised ESR)
386
A 25-year-old pregnant woman with a history of postpartum hemorrhage has a prolonged APTT that normalizes with 50:50 mixing and a low Factor VIII level (12%). Her bleeding time is normal.
Haemophilia A Carrier
💡 Explanation:
Low Factor VIII (12%) suggests Haemophilia A.
APTT normalizes with mixing, meaning it’s a factor deficiency (not an inhibitor)—acquired haemophilia has inhibitors—which prevents normalisation
.
Normal bleeding time rules out Von Willebrand Disease.
Carriers of Haemophilia A can have mild bleeding symptoms, such as postpartum hemorrhage.
387
A 22-year-old woman from the USA, with a history of splenectomy and taking 20 mg prednisolone, presents with purpuric rash, headache, and neck pain. What is the most likely indication for her prior splenectomy?
A) Beta-thalassemia trait
B) Gaucher’s disease
C) Hodgkin’s disease
D) Immune thrombocytopenic purpura
E) Sickle cell disease
D - Immune Thrombocytopenic Purpura (ITP) → Splenectomy used when steroids fail—increases risk of infection.
❌ A - Beta-thalassemia trait → No splenectomy needed.
❌ B - Gaucher’s disease → Splenectomy rare.
❌ C - Hodgkin’s disease → Not a primary indication.
❌ E - Sickle cell disease → Causes auto-splenectomy, not surgical.
388
DVT with score > 2: Rx:
Apixaban
389
A 38-year-old woman with Crohn’s disease presents with anemia. Labs show:
Hb: 83 g/L
MCV: 101 fL
Bilirubin: 39 µmol/L
Low B12 and folate levels
What is the most likely cause of her anemia?
A) NSAID-induced gastritis
B) Anemia of chronic disease
C) Pernicious anemia
D) Iron deficiency anemia
E) Terminal ileal disease
E) Terminal ileal disease – Crohn’s affects the terminal ileum, causing B12 malabsorption.
❌ A) NSAID-induced gastritis – Can cause blood loss but does not explain low B12/folate.
❌ B) Anemia of chronic disease – Would not cause low B12/folate.
❌ C) Pernicious anemia – Due to intrinsic factor loss, not Crohn’s.
❌ D) Iron deficiency anemia – Typically microcytic, not macrocytic.
390
An 80-year-old woman with chronic lymphocytic leukemia (CLL) ( STABLE since many years, no medication) presents with increasing fatigue. She is clinically anemic and mildly jaundiced, with a 2 cm splenomegaly. Blood tests show:
Hb: 63 g/L
MCV: 106 fL
Reticulocytes: 205 × 10⁹/L
WCC: 85 × 10⁹/L (lymphocytes 65.5 × 10⁹/L)
Platelets: 110 × 10⁹/L
What is the most likely cause of her anemia?
✅ Autoimmune Hemolytic Anemia (AIHA)
Macrocytic anemia (MCV 106 fL) with raised reticulocytes suggests active red cell destruction or blood loss.
Mild jaundice indicates hemolysis.
CLL is associated with AIHA, as well as autoimmune thrombocytopenia.
Reticulocytosis confirms appropriate bone marrow response.
CLL progression – No worsening lymphadenopathy or cytopenias.
❌ C. Iron deficiency – No microcytosis, no GI bleed history.
❌ D. Richter’s transformation – No B symptoms, no high-grade lymphoma signs.
❌ E. Acute folate deficiency – Folate deficiency doesn’t cause reticulocytosis.
391
Which type of anaemia in warm autoantibody Hemolytic anaemia ?
Macrocytic anaemia
392
A 28-year-old woman with von Willebrand’s disease (type 1) needs a tooth extraction. She has a history of menorrhagia and prolonged bleeding after a previous dental procedure.
How should her bleeding risk be managed?
Give desmopressin (DDAVP) a short time before the procedure
393
A 17-year-old girl from Nigeria recently immigrated to England and was referred for anemia. Examination reveals frontal bossing of the skull and chronic leg ulcers. Her Hb is 70 g/L and Howell–Jolly bodies are seen on the blood film.
What is the most likely diagnosis?
: Sickle Cell Disease
Common in African populations due to high prevalence of HbS mutation.
Frontal bossing occurs due to erythroid hyperplasia from chronic hemolysis.
Howell–Jolly bodies indicate functional asplenia/autosplenectomy, common in sickle cell disease due to repeated splenic infarctions.
Chronic leg ulcers result from poor microvascular circulation and ischemia.
394
Which blood thinner is safe in pregnancy ?
Low molecular weight heparin
395
Why anaemia in kidney disease ?
Less production of erythropoietin
396
Role of all transretinoic acid in APML :
differentiation of APML cells into Mature granulocyte and apoptosis of these cells.
397
: Why should NSAIDs be approved by a hematologist before use in a patient with von Willebrand’s disease (vWD)?
NSAIDs impair platelet function by inhibiting thromboxane A2, worsening the bleeding tendency in vWD.
vWD already causes defective platelet adhesion, so NSAIDs can further increase bleeding risk.
Alternative pain management (e.g., paracetamol, opioids) should be considered.
Hematologist approval is required before prescribing NSAIDs in vWD patients.
398
Known APLA + 2 DVT attacks. What treatment ?
Lifelong warfarin
399
A 63-year-old woman presents with biventricular failure, bilateral retinal hemorrhages (eye bleed), and macrocytic anemia (Hb: 55 g/L, MCV: 118 fL). What is the most appropriate next step in management?
Options:
A) Blood transfusion
B) Bone marrow aspirate examination
C) Intramuscular B12 administration
D) Intramuscular B12 with oral folate supplements
E) Observation
A) Blood transfusion (✅ Correct) → Needed for severe symptomatic anemia (Hb 55 g/L), especially with heart failure & retinal hemorrhages.
B) Bone marrow aspirate (❌ Incorrect) → Only considered if blood tests don't reveal a cause; unnecessary at this stage.
C) Intramuscular B12 (❌ Incorrect) → B12 should only be started after confirming deficiency; urgent transfusion takes priority.
D) IM B12 + Folate (❌ Incorrect) → Same reason as C; hematinic deficiency needs confirmation first.
E) Observation (❌ Incorrect) → Not appropriate in a critically symptomatic patient with severe anemia.
400
A 38-year-old man presents with worsening tiredness, night sweats, cough, and pruritus. His full blood count shows eosinophilia of 1800/µL (40–400 per µL). Six months ago, his eosinophil count was 1500/µL. He has no known allergies, and multiple stool samples showed no evidence of parasites. What is the most appropriate treatment?
Options:
A) Ampicillin
B) Corticosteroids
C) Cyclophosphamide
D) Interferon-alpha
E) Methotrexate
Corticosteroids
The patient has persistent eosinophilia without a clear reactive cause (e.g., infection, allergy, or parasite).
He may have idiopathic hypereosinophilic syndrome, which requires immunosuppression with corticosteroids as first-line treatment.
A) Ampicillin: No evidence of infection.
C) Cyclophosphamide: Not first-line; steroids are preferred.
D) Interferon-alpha: Not a treatment for hypereosinophilic syndrome.
E) Methotrexate: Not relevant for eosinophilic syndromes.
401
Most likely test to detect invasive aspergillus :
Galactomanan test.
402
2 weeks postpartum — a painful, swollen left leg.
O/E — pale, cold, swollen to mid-thigh + no pulses below femoral artery + ↓ power below knee + ↓ fine touch sensation.
Bloods — ↑ lactate, ↓ bicarbonate.
Most likely diagnosis?
A) Arterial embolism
B) Left leg DVT
C) Pathological fracture of the left femur
D) Post-partum lymphoedema
E) Ruptured popliteal cyst
✅ A) Arterial embolism – The leg is pale, pulseless, painful, and has neurological deficits. Raised lactate suggests ischemia.
Rule Outs:
❌ B) Left leg DVT – Would not explain pulselessness or significant motor/sensory loss.
❌ C) Pathological fracture of the left femur – No history of trauma or malignancy, and does not explain absent pulses.
❌ D) Post-partum lymphoedema – Would cause swelling but not pulselessness or ischemia.
❌ E) Ruptured popliteal cyst – Causes swelling but does not explain lack of pulses or systemic acidosis.
403
19M, thalassaemia major—multiple transfusions. SOB, ↓ exercise tolerance, bilateral oedema. BP 105/80, HR 85. JVP↑, pitting oedema. Pericardial rub O/E. Ferritin 562 µg/L (N: 20–250).
Dx: pericarditis secondary to iron overload.
Rx: Chelation using desferrioxamine.
404
A 22-year-old woman presents with menorrhagia. Her mother and sister have similar issues, and her brother had prolonged bleeding after a tooth extraction. Her PTT is prolonged (42.3s), while PT and platelet count are normal. What is the most likely diagnosis?
VWD
Sometime PT is normal in VWD.
Haemophilia—only male suffer. Woman are carrier.
405
Rx for factor v leiden :
Oral anticoagulant.
406
WBC and platelets in Secondary polycythemia :
WBC and Platelets: Normal.
Only Hb increases.
EPO only stimulates Hb, not wbc and platelets.
407
Iron deficiency anaemia + Howell jolly bodies. Which diagnostic test?
IDA + Hyposplenism—think Coeliacs.
Diagnostic test: Anti TTG antibody.
408
Cause of TRALI :
Donor antibodies.
409
Splenomegaly + lymphocytosis/pancytopenia + larger than normal lymphocytes + Abdundant pale cytoplasm + hairy cell like projections
Hairy Cell Leukemia.
410
Describe Hairy cell in Hairy cell leukemia :
Larger than normal lymphocytes + Abundant cytoplasm + Hairy vell like projections.
411
X ray findings of multiple myeloma :
Multiple lytic lesions on X ray.
412
An 18-year-old woman presents with severe menorrhagia, microcytic anemia, and reactive thrombocytosis. No structural or hormonal cause is found. Her prothrombin time (PT) is normal. What is the most likely underlying disorder, and which investigation will confirm the diagnosis?
VWB Disease.
Ix for Dx: VW factor.
Rule Out Other Options:
Factor VIII:C level: Not the most reliable; hemophilia primarily affects males.
Bone marrow aspirate: Too invasive and unnecessary for diagnosing a coagulation disorder.
Serum ferritin: Only confirms iron deficiency, not the underlying bleeding disorder.
Activated partial thromboplastin time (APTT): Can be normal or elevated but is not diagnostic.
413
A 25-year-old, 33-week pregnant woman presents with hypertension, proteinuria, epigastric pain, bruising, and petechiae. BP: 145/90 mmHg, pulse: 85 bpm.
Abnormal Investigations:
Hb: 101 g/L (Low)
Platelets: 40 × 10⁹/L (Low)
ALT: 180 IU/L (High)
LDH: 780 IU/L (High)
Initial Management?
A) FFP transfusion
B) Liver ultrasound
C) Platelet transfusion
D) Red cell transfusion
E) Immediate caesarean
Likely HELLP syndrome (Hemolysis, Elevated Liver enzymes, Low Platelets) with severe thrombocytopenia, requiring platelet transfusion before urgent C-section.
FFP (A): For coagulopathy, not needed here.
Liver ultrasound (B): Delays treatment.
Red cell transfusion (D): Not needed (mild anemia).
Immediate caesarean (E): Needs platelet support first.
414
RET protoncogene cause which thyroid cancer ?
Medullary thyroid cancer
415
Rx of Hodkins stage 2a :
Chemotherapy followed by radiotherapy
416
Mycosis fungoides is :
T cell lymphoma.
Biopsy : Atypical CD4 + T cells infiltrating epidermis.
417
Target INR for APLA :
INR 2-3 lifelong
418
Haemophilia A and B Rx
Mild haemophilia A Rx: DDVAP.
Haemophilia B Rx: IV factor 9 concentrate.
419
H/o renal transplant + fever of unknown origin + Epstein Barr virus antibody positive + enlarged axillary lymph nodes+ Raised ESR + Anaemia:
Post transplant lymphoma
CMV occurs within few months.
It presents with fever and pneumonia and graft rejection.
420
Girl undergoes thrombophilia screen within one week Of stopping warfarin. Next step ?
Undergo thrombophilia screen 3 weeks later.
421
which thrombotic disease is associated with Nephrotic ?
Protein S deficiency
422
Non-Hodkin’s is associated with which chronic disease ?
HIV
423
which factor improves neutrophil count ?
G CSF( granulocyte - colony stimulating Factor)
424
Most common cause of aplastic crisis in G6PD ?
Parvo virus infection
425
426
Which heparin has higher incidence of HIT ?
Unfractionated heparin.
427
G6PD causes hemolysis due to :
Reduced levels of NADPH
428
