Investigations

Question 1

What is a clinical sign for G6PD deficiency?

Answer 1

Heinz bodies on a blood film

Question 2

What is a blood marker for hyposplenism?

What are they?

Answer 2

High level of Howell-Jolly bodies, which are DNA remnants, found in the blood

Question 3

Name 2 blood cell parameters and discuss how each of them would be described when they are high and low.

Answer 3

MCV: Mean corpuscular volume: high - macrocytic, low - microcytic.

MCH: Mean corpuscular haemoglobin: high - hyperchromic (high Hb, dense), low - hypochromic (low Hb, pale)

Question 4

What are the 3 main categories of blood after it has been centrifuged?

Answer 4

Plasma

Buffer

Haematocrit

Question 5

What happens to the 3 amounts of the 3 main categories of blood, after it has been centrifuged, in polycythaemia.

Answer 5

Plasma levels reduce (substantially)

Buffer levels stay the same

Haematocrit levels increase (substantially)

Question 6

What is the medical terminology for RBCs that are irregular in size?

What investigation marker will be increased?

Name 2 conditions where this marker will be increased?

Answer 6

Anisocytosis.

Red cell distribution width (RDW)

Iron deficiency anaemia and after blood transfusions

Question 7

Name an anaemia that will have low MCH

Answer 7

Iron deficiency anaemia

Question 8

Name an anaemia with a high reticulocyte count.

Answer 8

Haemolytic anaemia

Question 9

What is the initial and later blood signs seen in myelofibrosis (a type of myeloproliferative neoplasm that leads to fibrosis of bone marrow)?

Answer 9

Initial:
All blood cell types are high

Later:
Pancytopenia (platelet, WBC and RBC are all low)

Question 10

Describe the principal behind the HBA1c test.

just have a rough idea, don’t need to say all the points in the Answer to get 5

Answer 10

As a persons blood becomes hyperglycaemic, their haemoglobin becomes more glycosylated and the glucose remains on the haemoglobin until the RBC dies (120 days) so this test measures the amount if glucose on the Hb - which is an indirect measure of the glucose concentration in the blood

Question 11

What are metanephrines are how can you test their levels?

Answer 11

Metanephrines are breakdown products of catecholamines (noradrenaline and adrenaline) and their body levels can be found in the urine.

(If metanephrine levels are high… catecholamine levels are also high)

Question 12

What enzyme is found to be deficient in a form of Galactosemia that has less severe symptoms.

In this condition, only galactose accumulates in blood and tissue.

Answer 12

Galactokinase

Question 13

Which enzyme is likely to be deficient in Type 1 Galactosemia?

What 2 sugar compounds are found to be at high concentrations in tissues?

This type of Galactosemia is more common and has the most severe side effects due to the build up of 2 sugar compounds.

Answer 13

Galactose-1-phosphate uridylyltransferase.

Galactose and galactose-1-phosphate are found at high levels in tissues.

Question 14

High levels of plasma alkaline phosphatase indicates what?

Answer 14

Increased bone turnover.

Question 15

What is the normal range of vitamin D (include units)

Answer 15

25-50 ng/mL (but should preferably be closer to 50)

Question 16

1. If a 30 year old woman complains of night time joint pain, has a vitamin D level of 30 ng/mL what OTC drug should you advise her to buy?
2. If after the treatment in 1 does not work, and she still has aches and pains, what could she have?

Answer 16

1000 UI (low) Vitamin D (she doesn’t need a quick boost in her vitamin D, so she can start with the low dose and her vitamin D levels will increase over the months)

2. Inflammatory arthritis (many types, e.g. RA) (so refer to rheumatologist)

Question 17

What is the recommended daily calcium intake?

Include units

Answer 17

700 mg

Question 18

If a patient’s urea and/or sodium is high, what will be tour first conservative treatment for the pt?

Answer 18

Are they drinking enough water? If not, drink more.