Pathology Flashcards
What does this blood gas show?
pH 6.9 H+ 126nmol/L pCO2 3.0kPa pO2 24.0kPa HCO3 6mmol/L
A) Normal B) Metabolic acidosis C) Metabolic alkalosis D) Acute respiratory acidosis E) Chronic respiratory acidosis F) Respiratory alkalosis G) Mixed metabolic and respiratory acidosis H) Mixed metabolic and respiratory alkalosis
B - Compensated metabolic acidosis
Could be due to:
Increased H+ production (DKA, lactic acidosis)
Decreased H+ excretion (renal failure)
Loss of bicarbonate (fistula)
What does this blood gas show?
pH 7.55 H+ 28nmol/L pCO2 8.2kPa pO2 10.0kPa HCO3 51mmol/L
A) Normal B) Metabolic acidosis C) Metabolic alkalosis D) Acute respiratory acidosis E) Chronic respiratory acidosis F) Respiratory alkalosis G) Mixed metabolic and respiratory acidosis H) Mixed metabolic and respiratory alkalosis
C - Compensated metabolic alkalosis
Could be due to:
Hypokalaemia (e.g. vomiting)
H+ loss (e.g. pyloric stenosis)
Ingestion of bicarbonate
What does this blood gas show?
pH 7.55 H+ 28nmol/L pCO2 3.0kPa pO2 14.4kPa HCO3 20mmol/L
A) Normal B) Metabolic acidosis C) Metabolic alkalosis D) Acute respiratory acidosis E) Chronic respiratory acidosis F) Respiratory alkalosis G) Mixed metabolic and respiratory acidosis H) Mixed metabolic and respiratory alkalosis
F - Acute respiratory alkalosis
What does this blood gas show?
pH 7.41 H+ 39nmol/L pCO2 10.4kPa pO2 7.8kPa HCO3 47mmol/L
A) Normal B) Metabolic acidosis C) Metabolic alkalosis D) Acute respiratory acidosis E) Chronic respiratory acidosis F) Respiratory alkalosis G) Mixed metabolic and respiratory acidosis H) Mixed metabolic and respiratory alkalosis
E - Chronic respiratory acidosis (e.g. COPD)
OR
C - Metabolic alkalosis (e.g. hypokalaemia)
Need clinical picture to tell difference.
During acute porphyrias, what is the most useful sample to send?
A) Blood B) CSF C) Urine D) Muscle biopsy E) Stool F) Skin biopsy
C
Urine PBG should be sent to confirm porphyria. Then further enzymes studies can be done.
A 22-year-old female presents with tonic-clinic seizures, blurred vision, and flashing lights. This started on returning to the UK from a holiday during which she reports drinking heavily. Other symptoms include abdominal pain, nausea and vomiting, and paranoia. You suspect a porphyria. Which is the most likely cause?
A) Porphyria cutanea tarda
B) Acute intermittent porphyria
C) Erythropoetic protoporphyria
D) X-linked sideroblastic anaemia
B
A porphyria with erythema, no blistering or bullae, is most likely:
A) Porphyria cutanea tarda B) Acute intermittent porphyria C) Erythropoetic protoporphyria D) X-linked sideroblastic anaemia E) CEP
C
TSH <0.01U/L
Free T3 15.6pmol/L
Free T4 38.0pmol/L
A) Clinical primary hypothyroidism
B) Euthyroid status in a patient complaining of tiredness
C) Pituitary driven thyrotoxicosis
D) Secondary or pituitary hypothyroidism
E) Subclinical hypothyroidism with risk of later clinical hypothyroidism
F) Thyrotoxicosis
G) To screen for medullary thyroid carcinoma
H) To screen for recurrence of differentiated thyroid carcinoma
F
TSH 8.4U/L
Free T4 11.7pmol/L
Thyroid peroxidase antibodies positive
A) Clinical primary hypothyroidism
B) Euthyroid status in a patient complaining of tiredness
C) Pituitary driven thyrotoxicosis
D) Secondary or pituitary hypothyroidism
E) Subclinical hypothyroidism with risk of later clinical hypothyroidism
F) Thyrotoxicosis
G) To screen for medullary thyroid carcinoma
H) To screen for recurrence of differentiated thyroid carcinoma
E
TSH 1.4U/L
Free T4 12.1pmol/L
A) Clinical primary hypothyroidism
B) Euthyroid status in a patient complaining of tiredness
C) Pituitary driven thyrotoxicosis
D) Secondary or pituitary hypothyroidism
E) Subclinical hypothyroidism with risk of later clinical hypothyroidism
F) Thyrotoxicosis
G) To screen for medullary thyroid carcinoma
H) To screen for recurrence of differentiated thyroid carcinoma
B
TSH 22.4U/L
Free T4 6.3pmol/L
A) Clinical primary hypothyroidism
B) Euthyroid status in a patient complaining of tiredness
C) Pituitary driven thyrotoxicosis
D) Secondary or pituitary hypothyroidism
E) Subclinical hypothyroidism with risk of later clinical hypothyroidism
F) Thyrotoxicosis
G) To screen for medullary thyroid carcinoma
H) To screen for recurrence of differentiated thyroid carcinoma
A
Thyroglobulin 254ug/L
A) Clinical primary hypothyroidism
B) Euthyroid status in a patient complaining of tiredness
C) Pituitary driven thyrotoxicosis
D) Secondary or pituitary hypothyroidism
E) Subclinical hypothyroidism with risk of later clinical hypothyroidism
F) Thyrotoxicosis
G) To screen for medullary thyroid carcinoma
H) To screen for recurrence of differentiated thyroid carcinoma
H
Medullary thyroid carcinoma would be screened for using calcitonin or CEA.
Which has the lowest calcium?
A) Primary hyperparathyroidism B) Secondary hyperparathyroidism C) Osteoporosis D) Paget's disease of bone E) Breast cancer
B
Newborn babies, in contrast to adults, have:
A) A higher haemoglobin
B) A lower white cell count
C) Smaller red blood cells
D) The same percentage of haemoglobin F
A
Newborn babies, in contrast to adults, have:
A) A higher haemoglobin
B) A lower white cell count
C) Smaller red blood cells
D) The same percentage of haemoglobin F
A
Newborn babies, in contrast to adults, have:
A) A higher haemoglobin B) A lower white cell count C) Smaller red blood cells D) The same percentage of haemoglobin F E) All of the above
A
Complications of sickle cell anaemia that are more common in adults than children include:
A) Hand-foot syndrome B) Hyposplenism C) Red cell aplasia D) Splenic sequestration E) Stroke F) All of the above
B
Siblings with sickle cell anaemia present simultaneously with severe anaemia and a low reticulocyte count - likely diagnosis?
A) Splenic sequestration B) Parvovirus B19 infection C) Folic acid deficiency D) Haemolytic crisis E) Vitamin B12 deficiency
B
A 6-year-old Afro-Caribbean boy presents with chest and abdominal pain; Hb is 63g/DL, MCV 85fL, and blood film shows sickle cells. The most likely diagnosis is:
A) Sickle cell trait
B) Sickle cell anaemia
C) Sickle cell/beta thalassaemia
B
A 7-year-old Afro-Caribbean boy has abdominal pain and urinary tract symptoms and was given an anti-emetic by his GP. Three days later he had yellow eyes, and was brought to the hospital.
WCC 10.9x10^9/L
Hb 58g/L
MCV 100fL
Platelets 275x10^9/L
His blood film shows irregularly contracted cells and reticulocytes.
What is the likely diagnosis?
A) Hepatitis A B) Hepatitis B C) Hereditary spherocytosis D) Sickle cell anaemia E) G6PD deficiency
E
Complications of sickle cell anaemia that are more common in adults than children include:
A) Hand-foot syndrome B) Hyposplenism C) Red cell aplasia D) Splenic sequestration E) Stroke F) All of the above
B
Siblings with sickle cell anaemia present simultaneously with severe anaemia and a low reticulocyte count - likely diagnosis?
A) Splenic sequestration B) Parvovirus B19 infection C) Folic acid deficiency D) Haemolytic crisis E) Vitamin B12 deficiency
B
A 6-year-old Afro-Caribbean boy presents with chest and abdominal pain; Hb is 63g/DL, MCV 85fL, and blood film shows sickle cells. The most likely diagnosis is:
A) Sickle cell trait
B) Sickle cell anaemia
C) Sickle cell/beta thalassaemia
B
A 7-year-old Afro-Caribbean boy has abdominal pain and urinary tract symptoms and was given an anti-emetic by his GP. Three days later he had yellow eyes, and was brought to the hospital.
WCC 10.9x10^9/L
Hb 58g/L
MCV 100fL
Platelets 275x10^9/L
His blood film shows irregularly contracted cells and reticulocytes.
What is the likely diagnosis?
A) Hepatitis A B) Hepatitis B C) Hereditary spherocytosis D) Sickle cell anaemia E) G6PD deficiency
E
A 1-year-old boy presents with joint bleeding. Hb, WCC, and platelets are normal. aPTT is prolonged, PT is prolonged, and bleeding time is normal. What’s the most likely diagnosis?
A) Haemophilia A B) Haemophilia B C) Von Willebrand disease D) Thrombotic thrombocytopenic purpura E) Has taken mother’s warfarin tablets
A
Haemophilia A is more likely than B.
TTP would show decreased platelets.
A 39-year-old female presents with recent onset jaundice and hepatomegaly. She was treated for breast cancer 4 years previously.
Hb 87g/L
Reticulocyte 15x10^9/L
Bilirubin (conjugated) 50umol/L
Her bloods are DAT negative, and her blood film shows nucleated red blood cells.
What is the most likely cause of her anaemia?
A) Iron deficiency anaemia B) Anaemia of chronic disease C) Bone marrow metastases from breast cancer D) Microangiopathic haemolytic anaemia E) Autoimmune haemolytic disease
C
A 45-year-old male presents with a 3-week history of sore throat. He has had a recent episode of shingles, and his EBV IgG serology is positive.
Lymphocytes: 12x10^9/L
Neutrophils: 7x10^9/L
His blood film shows reactive lymphocytes with no abnormal cells. Flow cytometry shows 82% kappa expressing B-cells with 0% lambda.
What is the likely diagnosis?
A) B cell acute lymphoblastic leukaemia
B) Mature B cell lymphoproliferative disorder
C) Infectious mononucleosis
D) T cell acute leukaemia lymphoma
B
Not acute because no abnormal cells found. Not glandular fever because would expect polyclonal B cells (combination of kappa and lambda chains). IgG positive just means he has had EBV in the past.
A 22-year-old female presents with drenching night sweats and a mediastinal mass. Biopsy shows Hodgkin’s lymphoma.
CT shows mediastinal and cervical node involvements.
What stage is she?
A) IA B) IB C) IIA D) IIB E) IIIA F) IIIB G) IVA H) IVB
D
The risk of thrombosis is increased by:
A) Reduced prothrombin B) Thrombocytopenia C) Reduced protein C D) Elevated antithrombin E) Increased fibrinolysis
C
The highest risk of thrombosis is conferred by:
A) Factor V Leiden B) Antithrombin deficiency C) Family history of thrombosis D) Reduced Factor VII level E) 3-hour plane flight
B
How does warfarin achieve its antithrombotic effect?
A) Reduction in plasma proteins C and S B) Blocks phospholipid synthesis C) Reduction in plasma procoagulant factors D) Acts as a cofactor for antithrombin E) Inhibits factors II, VII, IX, and X
C
Which patient is most likely to benefit from long-term anticoagulation after developing a DVT?
A) A 57-year-old man after flying from Berlin
B) A 27-year-old woman during pregnancy
C) A 33-year-old woman on the combined oral contraceptive pill
D) A 77-year-old man after a hip replacement
E) A 30-year-old man after a long walk
E
Long-term anticoagulation is unlikely to benefit those in high risk situations (e.g. pregnancy, flying, post-surgery) as each of these situations is short term only, and the risk will decrease as the situation passes.
The man who developed a DVT after a long walk despite being so young has had an idiopathic thrombosis, and is more prone to have recurrent thrombosis.
A 53-year-old man presents with weight loss and abdominal discomfort. On examination, he has hepatosplenomegaly.
Hb 98g/L
WCC 20x10^9/L
Platelets 60x10^9/L
BCR/ABL transcripts were not detected. JAK2 V617F is positive. BM aspirate gave a dry tap, and a leucoerythroblastic picture.
What is the likely diagnosis?
A) CML chronic phase
B) Bone marrow metastases from prostate cancer
C) Primary myelofibrosis
D) CML blast crisis
C
A 22-year-old male with cyanotic congenital heart disease presents. He has no splenomegaly. His haemoglobin is 210g/L and haematocrit is 60%.
What are likely results of JAK2 V617F and serum erythropoietin?
A) JAK negative, EPO low
B) JAK positive, EPO high
C) JAK negative, EPO high
D) JAK positive, EPO low
C
A 35-year-old woman with CML presents on treatment with imatinib. Her blood results at diagnosis, 12m in, and now (24m) are shown.
Hb (g/L): 16 13 9
WCC (x10^9/L: 300 8.5 35
Platelets (x10^9/L): 800 320 24
%Blasts: 2 0 25
BCR-ABL: 100 0.01 10
What phase of disease is she currently in?
A) Chronic phase
B) Accelerated phase
C) Blast crisis
C
Blast % of over 20% is a diagnosis of acute leukaemia, so this is blast crisis.
Which of the following statements concerning myelodysplastic syndromes is true?
A) Myelodysplasia has a bimodal age distribution
B) The primary modality of treatment is intensive chemotherapy
C) 1/3 of patients can be expected to die from leukaemia transformation
D) There is no good correlation between severity of cytopenia and overall life expectancy
E) White cell function is frequently well-preserved
C
Which of the following statements concerning aplastic anaemia is true?
A) Immunosuppressive therapy is only used to treat a minority of patients with aplastic anaemia
B) If treated with immunosuppression, then relapse of aplastic anaemia occurs in less than 15% of cases
C) The cure rate of AA treated by sibling-related allogeneic stem cell transplantation in a patient under 40 years is >70%
D) Severe aplastic anaemia is differentiated from non-severe aplastic anaemia on the basis of the acquired cytogenetic abnormalities in the bone marrow
E) Leucodepletion of cellular blood products is only exceptionally undertaken for patients with aplastic anaemia
C
Which of the following is true?
A) Telomeric shortening is a feature of both idiopathic aplastic anaemia and dyskeratosis congenita
B) Development of malignancy is an uncommon complication of Fanconi’s anaemia
C) A single genetic defect has been identified as the underlying cause of Fanconi’s anaemia
D) Fanconi’s anaemia is usually inherited in an autosomal dominant fashion
E) Telomeric function is considered to be unimportant in the pathophysiology of dyskeratosis congenita
A
During normal pregnancy…
A) Less iron is required
B) There is an increase in haemoglobin concentration
C) The platelet count falls
D) The neutrophil count falls
C
Coagulation changes in pregnancy…
A) Increase the likelihood of bleeding
B) Result in a hyperfibrinolytic state
C) Are mediated by BHCG hormone
D) Result in a leading cause of maternal mortality
D
The leading cause is VTE.
VTE during pregnancy…
A) Has a higher incidence than during postnatal period
B) Is more common in women with high BMI
C) Is more likely to occur following vaginal delivery than elective C Section
D) Usually affects right leg
B
Which of the following statements is correct?
A) In gestational thrombocytopenia the baby’s platelet count is usually affected
B) Thrombocytopenia is rarely round in association with pre-eclampsia
C) Thrombotic thrombocytopenic purport remits spontaneously following delivery
D) The platelet count may fall following deliver in babies born to mothers with ITP
D
A reduction in pregnancy-associated thrombosis mortality rate can be attributed to…
A) Lower obesity rates
B) Improved targeted thromboprophylaxis
C) Rising maternal age
D) Increase in prevalence of gestational thrombocytopenia
B
Which of the following statements is correct?
A) Decision to use antithrombotic therapy in pregnant women with history of recurrent pregnancy loss should be based on results of thrombophilia testing
B) Aspirin and heparin have been shown to improve live birth rate in women with recurrent pregnancy loss and antiphospholipid antibodies
B
