MCQ haem/ immuneology/ allergy

Question 1

risk of replacing folate before b12?

Answer 1

subacute combined degeneration

Question 2

most common inherited bleeding disorer?

Answer 2

VWD: deficiency of abnormal function of VWF (responsible for platelet plug forming and factor 8)

Question 3

nose bleeds, menhorragia, raised APTT, blood group O woman. tx?

Answer 3

VWD. test family.
Ix: VWF antigen assay detects quantitative deficiency. there is also qualitative
TX: desmopressin (temporarily increases factor 8/ vwf)(intranasal/ parerntal), TXa

Question 4

drugs that cause low platelets?

Answer 4

Alcohol.
Cephalosporins, nitrofurantoin, penicillins, sulfonamides.
Carbamazepine and valproic acid.
Quinine.
Propranolol.
Thiazide diuretics.

Question 5

Standard for detecting malaria?
fever pattern?
most serious cx?

Answer 5

thick and thin blood films, gram stain.
diurnal variation of fever
serious/ splenic rupture: P. falciparum

Question 6

APTT measured?

Answer 6

intrinsic pathway - factors 12, 11, 9, 8,, 5, 2, 1, VWF. and the common pathway (factor 10 to 2 to fibrinogen to fibrin)

Question 7

PT measures?

Answer 7

extrinsic pathway and common pathway, 1, 2, 5 ,7 10 and warfarin.

Question 8

how do likely due to coagulation factor defects normally present?sm

Answer 8

large bruises, small bleed from cut, haematuria, bleeding after a day of truama/ surgery/ dental extraction, haemoarthrosis (in severe cases of haemophilia)

Question 9

How are platelet/ vWF deficiencies liekly to present?

Answer 9

small bruises, lot sof bleeding form cuts, immediately bleeding post surgery/ dental work, nosebleeds and gI bleeds common

Question 10

post transfusion: fever, chills, burnign at site of transfusion, red urine, pain, restless, chest tightness. cx?

Answer 10

acute haemolytic reaciton (ABO incompatibility/ direct antibodies in recipients blood)

Question 11

post transfusion: 2 hrs after/ SOB, fever, chills, malaise

Answer 11

non haemolytic (due to cytokine production from leukocytes. delayed reaction could be days/ weeks later.

Question 12

post transfusion: high fever, shock, no clear cx for infection?

Answer 12

bacterial contamination

Question 13

TRALI is?

Answer 13

antibodies in donor’s blood attacking recipient, recipient releases mediators that cause pulmonary oedema

Question 14

G6PD?

Answer 14

x linked causes haemolyitc crisis after exposure to fava beans, quinine, sulfa drugs, infections, heinz bodies, normocytic normochromic anaemia

Question 15

pruritus, ehadache, sweating, ruddy complexion, splenomegaly, turning red in hot bath. HTN
dx criteria?

Answer 15

myeloproliferative neoplasm: Polycythaemia vera AF: dysfunction of JAK 1 and 2,
Dx: 2 major+1 minor or 2 minor and 1st major
major: HB 185+men/165+women / JAK2/ haematocrit 0.6+men/ 0.56 women
minor: EPO <normal, bone marrow changes
risk: vTE/ tx: control cardio rf

Question 16

Down’s syndrom associated conditions?

Answer 16

hypothyroid, AD, duodenal atresia, t1dm, hirschprungs, acute leukaemia, LD, endocardial cusion defects, seizures

Question 17

apparent polycythaemia?

Answer 17

increased haemtrocrit, normal red cell mass caused by reduced plasma volume. obese men, stress, diuretics, smoking, HTN, alchjol dehydration

Question 18

secondary PCV?

Answer 18

caused by EPO production due to chronic hypoxia eg copd, CLD. renal disorders - inappropraite EPO, sleep apnoea, obesity,

Question 19

microcytic cx?

Answer 19

TAILS (thallassaemia, anaemia of chronic disease, iron (ferritin <15, lead, sideroblastic).
thalassaemia - common in ethnic, MCV more reduced

Question 20

Riskiest blood product?

Answer 20

platelets (@stored at room temp)

Question 21

cough, sob, hypoxia, pulmonary infiltrates new on CXR.
B/G: anaemia, jaundice, vaso-occlusive crisis?

Answer 21

sickle cell crisis

Question 22

cryoprecipitate contains?

Answer 22

factor 8, 13, vwf, fibrinogen,

Question 23

VTE in cancer patients tx?

Answer 23

6 monts

Question 24

coag disorder older women?
young boy?

Answer 24

VWF

Haemophilia A (x linked)

Question 25

LN pain after drinking alcohol?

Answer 25

Hodgkins L

Question 26

Hodgkins Lymphoma?

Answer 26

Reed sternberg cells
RF: EBV, SLE, RA,
ann arbour staging
bimodal age distribution

Question 27

23 YO bowel obstruction, interssuseption, haematochezia, pigmented lesions on buccal mucosa with FH, GI polyps

Answer 27

peutz-jegher’s

Question 28

Multiple myeloma fact file?

avoid prescribing?

ix?

Answer 28

plasma cells, 2nd most common (after NHL). AF: black men, maori, fH,
SX: unexplained back pain
risks: hyperviscosity, fractures, spinal comrpession, renal, infections, anaemia, bleeding

risk renal: avoid nsaids/ aminioglycosides

Ix: ESR high, Ca high, normochromic normocytic anaemia, serum electrophoresis, light chain, bence jones

Question 29

MGUS dx?

Answer 29

Monocloncal protein <30 blood or <500 in urine (24 hrs), <10% plasma cells in bone marrow and no end organ damage

Question 30

Waldenstorm’s macroglobulinaemia presentation?

Answer 30

diffuse large B cell lymphoma. old white men fatigue, anorexia, finding of monoclonal IGM or rapid growing large mass. bone lesions not a feature of this but can present like MM (hyperviscosity etc)

Question 31

Non hodgkins Lymphoma?

Answer 31

burkitt’s - EBV/ HIV
Waldenstorms - large b cell, rapid mass old men
MALT - stomach , h.pylori

Question 32

CML fact file?
what happens when known CML is acutely unwell with blast cells (progeniter cell) increased?

Answer 32

myeloprliferative disorder - granulocyte. philadelphia chromosome. 3 phases - chronic (normal), accelerated (unstable), blast stage (progenitor cells 20%+) is fatal.
tx: bone marrow transplant/ imatinab

sx: finding of raised WCC, tired WL, splenomegaly