PRACTICE QNS Haematology Flashcards by Kalaryn Fisher

Commonest anemia in clinical practice is Megaloblastic anemia

True

False

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Pancytopenia is typically seen in Iron Deficiency Anemia

True

False

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Pernicious anemia is anemia seen in Atrophic gastritis patients.

True

False

True

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Hepcidin is increased in Anemia of chronic disorder.

True

False

True

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IFN blocks iron transfer from macrophages to erythroblasts in anemia of chronic disease.

True

False

True

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Megaloblasts are the large oval macrocytic RBC seen in megaloblastic anemia.

True

False

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Hemoglobinuria is a typical feature in Extravascular Hemolysis

True

False

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Absent Haptoglobins is typically seen in Intravascular hemlysis

True

False

True

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Quiz 1
3 of 3
Commonest type of Hemolytic anemia is

Acute Blood loss anemia

Chronic Blood loss anemia

Immune hemolytic anemia

Spherocytic anemia

Thalassemia

Iron deficiency anemia

Immune hemolytic anemia

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Spherocytes are commonly seen in Cold Antibody Hemolytic anemia (IgM)

True

False

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Direct Comb’s test detects RBC antibodies in the patient serum.

True

False

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Schistocytes are typically seen in MAHA.

True

False

True

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Acute Chest Syndrome is a typical feature seen in Hereditary Spherocytosis.

True

False

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Spherocytes & Sickle cells are stiff or rigid RBC’s.

True

False

True

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during “Aplastic crisis” bone marrow stops functioning.

True

False

True

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What clinical situation would prompt iron IV infusion as definitive first line
therapy in a patient with iron deficiency?
a) Following gastric bypass surgery
b) Patient <10 years
c) Low ferritin with normal Hb
d) Pregnancy
e) Hb 68 with new onset exertional SOB and ankle oedema

Following gastric bypass surgery

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A 62yo male presents for review of his type 2 diabetes. As part of his
review, an FBC is completed which revealed a macrocytic anaemia. He
reports a vegetarian diet. He has a history of irritable bowel syndrome and
hypothyroidism. On examination his BP is 125/85 and his BMI is 31.
Pt is on metformin, aspirin, pantoprazole, ramipril and thyroxine. His HbA1c is
7.2% and his T4 and TSH levels are within normal limits.
What further clinical feature would suggest anaemia due to a nutrient
deficiency as a cause of the patient’s fatigue?
a) Ankle swelling
b) Bronze-tinged skin
c) Glossitis
d) Jaundice
e) Peripheral cyanosis
f) Splenomegaly

Glossitis

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A 62-year-old male presents for review of his type 2 diabetes. As part of his review, an FBC is completed which revealed a macrocytic anaemia. He
reports a vegetarian diet. He has a history of irritable bowel syndrome and hypothyroidism. On examination his BP is 125/85 and his BMI is 31.
Pt is on metformin, aspirin, pantoprazole, ramipril and thyroxine. His HbA1c is
7.2% and his T4 and TSH levels are within normal limits.
06. The patient does not have any of these clinical features. A FBC reveals amacrocytic anaemia and the blood film shown. What red cell abnormality can
be seen on the blood film?
a) Toxic granulation
b) Megaloblasts
c) Oval macrocytes
d) Pencil cells
e) Polychromasia

Oval macrocytes

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A 62-year-old male presents for review of his type 2 diabetes. As part of his review, an FBC is completed which revealed a macrocytic anaemia. He reports a vegetarian diet. He has a history of irritable bowel syndrome and hypothyroidism. On examination his BP is 125/85 and his BMI is 31.
Pt is on metformin, aspirin, pantoprazole, ramipril and thyroxine. His HbA1c is 7.2% and his T4 and TSH levels are within normal limits.
07. Given the patient’s macrocytic anaemia and blood film, what pieces of information in the history and examination increase the likelihood of B12 deficiency as the cause?

metformin hx - needs b12 to work
autoimmunity - IBD, coeliac
PPI hx

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A 62-year-old male presents for review of his type 2 diabetes. As part of his review, an FBC is completed which revealed a macrocytic anaemia. Hereports a vegetarian diet. He has a history of irritable bowel syndrome and hypothyroidism. On examination his BP is 125/85 and his BMI is 31. Pt is on metformin, aspirin, pantoprazole, ramipril and thyroxine. His HbA1c is 7.2% and his T4 and TSH levels are within normal limits.
08. What further information in the history would put the patient at risk of folate deficiency?
a) Chronic pancreatitis
b) Colorectal cancer awaiting treatment
c) NSAIDs
d) Gastric bypass surgery
e) Alcohol consumption ~15-20 SD weekly

d) Gastric bypass surgery

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A 62-year-old male presents for review of his type 2 diabetes. As part of hisreview, an FBC is completed which revealed a macrocytic anaemia. He reports a vegetarian diet. He has a history of irritable bowel syndrome and hypothyroidism. On examination his BP is 125/85 and his BMI is 31.
Pt is on metformin, aspirin, pantoprazole, ramipril and thyroxine. His HbA1c is 7.2% and his T4 and TSH levels are within normal limits.
09. He has no further significant history. His B12 level is decreased with normal folate. What investigation is most useful to diagnose pernicious
anaemia as the cause of the B12 deficiency?
a) Anti-mitochondrial antibody (AMA)
b) Anti-nuclear factor antibody (ANA)
c) Anti-tissue transglutaminase (Anti-TTG)
d) Intrinsic factor antibody (IF Ab)
e) Anti-thyroperoxidase (TPO Ab)

Intrinsic factor antibody (IF Ab)

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A 62-year-old male presents for review of his type 2 diabetes. As part of his review, an FBC is completed which revealed a macrocytic anaemia. He reports a vegetarian diet. He has a history of irritable bowel syndrome and
hypothyroidism. On examination his BP is 125/85 and his BMI is 31.
Pt is on metformin, aspirin, pantoprazole, ramipril and thyroxine. His HbA1c is 7.2% and his T4 and TSH levels are within normal limits.
10. What factor is most influential in causing the decreased Hb level in this
patient?
a) Breakdown of RBCs within blood vessels
b) Decreased production of globin chains
c) Increased size of red cells
d) Lack of recognition by lab machine
e) Reduced number of red cells

Reduced number of red cells

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A 63-year-old male presents with a 3-month history of vague upper abdominal discomfort which is no longer responsive to PPIs. A full blood count is ordered (pending) but you can’t wait and decide to look under the microscope yourself! Your very well prepared film is shown below. What finding is most likely to be seen on the FBC? a) Macrocytic anaemia b) Microcytic anaemia c) Normal values d) Normocytic anaemia e) Pancytopaenia

Microcytic anaemia

A 63-year-old male presents with a 3-month history of vague upper abdominal discomfort which is no longer responsive to PPIs. A full blood count is ordered (pending) but the film is shown below. 02. The FBC confirms this finding. What further investigation is required to confirm the most likely underlying diagnosis causing the patient’s symptoms? a) Bone marrow biopsy b) CT abdomen c) H pylori serology d) Iron studies e) Upper endoscopy +/- biopsy

Upper endoscopy +/- biopsy

11. A 34-year-old female presents to rheumatology clinic for review of her rheumatoid arthritis. She is on weekly methotrexate, which is not currently controlling her symptoms. She describes increasing fatigue over the last 4 months. A haematological examination is normal. Testing reveals anaemia. TABLE TALK What types/causes of anaemia does the patient have risk factors for?

Other autoimmune conditions IBD immune haemolytic anaemia

A 34-year-old female presents to rheumatology clinic for review of her rheumatoid arthritis. She is on weekly methotrexate, which is not currently controlling her symptoms. She describes increasing fatigue over the last 4 months. A haematological examination is normal. Testing reveals anaemia. 12. Additional testing further reveals an elevated bilirubin. What further testing will determine if the patient’s anaemia is immune-mediated? a) Direct antiglobulin test (DAT) b) Haptoglobin c) Indirect Coombs d) Mean corpuscular volume (MCV) e) Reticulocyte count

Direct antiglobulin test (DAT)

A 34-year-old female presents to rheumatology clinic for review of her rheumatoid arthritis. She is on weekly methotrexate, which is not currently controlling her symptoms. She describes increasing fatigue over the last 4 months. A haematological examination is normal. Testing reveals anaemia. Additional testing further reveals an elevated bilirubin. 13. This test is positive. What red cell abnormality would be most likely to be seen on the blood film? a) Ovalocytes b) Nucleated RBCs c) Schistocytes d) Spherocytes e) Target cells

Spherocytes

A 34-year-old female presents to rheumatology clinic for review of her rheumatoid arthritis. She is on weekly methotrexate, which is not currently controlling her symptoms. She describes increasing fatigue over the last 4 months. A haematological examination is normal. Testing reveals anaemia. Additional testing further reveals an elevated bilirubin. This test is positive. 14. What type of auto-immune haemolytic anaemia does the patient have? a) IgG mediated (warm) b) IgM mediated (cold)

IgG mediated (warm)

A 34-year-old female presents to rheumatology clinic for review of her rheumatoid arthritis. She is on weekly methotrexate, which is not currently controlling her symptoms. She describes increasing fatigue over the last 4 months. A haematological examination is normal. Testing reveals anaemia. 15. The patient is treated and the haemolysis ceases. 6 months later, follow up testing reveals an improved, but still normocytic anaemia with normal reticulocyte count. What is the most likely pathogenesis of her anaemia now? a) Decreased erythropoietin b) Defective iron transfer c) Increased cell division d) Increased RBC breakdown e) Reduced hepcidin

Defective iron transfer

A 36-year-old male presents with 1 week of jaundice on background of 1 month of fatigue and SOB on exertion. He has had multiple similar episodes in the past since childhood which self-resolved. On examination, he has normal vitals but obvious jaundice. His abdomen is soft with splenomegaly. An FBC is done which showed a normocytic anaemia. The blood film is shown. What two abnormalities can be seen on the film? a) Erythroblasts b) Hypochromia c) Poikilocytes d) Polychromasia e) Schistocytes f) Spherocytes

Polychromasia (larger) Spherocytes

A 36-year-old male presents with 1 week of jaundice on background of 1 month of fatigue and SOB on exertion. He has had multiple similar episodes in the past since childhood which self-resolved. On examination, he has normal vitals but obvious jaundice. His abdomen is soft with splenomegaly. An FBC is done which showed a normocytic anaemia. 17. Further testing reveals a reticulocytosis and elevated unconjugated bilirubin. What is the most likely cause of this patient’s symptoms? a) Autoimmune haemolytic anaemia b) B12 deficiency c) Hereditary spherocytosis d) Sickle cell disease e) Thalassaemia minor

Hereditary spherocytosis

A 36-year-old male presents with 1 week of jaundice on background of 1 month of fatigue and SOB on exertion. He has had multiple similar episodes in the past since childhood which self-resolved. On examination, he has normal vitals but obvious jaundice. His abdomen is soft with splenomegaly. An FBC is done which showed a normocytic anaemia. Further testing reveals a reticulocytosis and elevated unconjugated bilirubin. Has hereditary spherocytosis TABLE TALK 18. What complications is the patient at risk of?

hypersplenism - trauma can rupture heart failure gallstones and related pathologies AKI

A 45-year-old presents with 5 months of increasing fatigue and shortness of breath on exertion. A finger prick Hb is performed which shows anaemia. What additional finding would suggest aplastic anaemia as the cause of the anaemia? a) Angular stomatitis b) Jaundice c) Low platelets d) Reticulocytes e) Splenomegaly

Low platelets

A 45-year-old presents with 5 months of increasing fatigue and shortness of breath on exertion. A finger prick Hb is performed which shows anaemia. 20. This additional finding is confirmed in this patient. The patient reports no recent medications (incl over the counter) and a viral hepatitis screen is unremarkable. What further testing is indicated to confirm aplastic anaemia? a) Blood film b) Bone marrow biopsy c) Genetic testing d) PET scan e) No further testing required

Low platelets

A 45-year-old male presents to the ED with chest pain and has a FBC done which shows a mildly decreased Hb, significant microcytosis and the blood film shown below. He states he has no symptoms of anaemia, has no known medical conditions and does not take any medication. Examination is unremarkable. He says he has been told of these changes before and his sister has been told the same. What is the most likely cause of the patient’s FBC abnormalities? a) G6PD deficiency b) Hereditary spherocytosis c) Iron deficiency anaemia d) Polycythaemia rubra vera e) Thalassaemia minor

Thalassaemia minor

A 43-year-old presents with 2 months of increased pallor shortness of breath and jaundice. They have been otherwise well. They have no past medical history, except for intermittent Raynaud phenomenon, and don’t take any medication. FBC reveals and macrocytic anaemia and the blood film shown. What is the most likely cause of the anaemia? a) Anaemia of chronic disease b) Aplastic anaemia c) IgG (warm) AIHA d) IgM (cold) AIHA e) Megaloblastic anaemia

IgM (cold) AIHA

Normal WBC count is ____x10^9/L Normal WBC count is ____x10^9/L 400-11,000 0.4 - 1.1 4-11 40-400 2-8

4-11

Normal absolute Neutrophil count is --___--x10^9/L Normal absolute Neutrophil count is --___--x10^9/L 1-4 4-11 0.2 - 0.8 2-8 0.1 - 1.0

2-8

Important chemical mediator for production of Eosinophils is, IL-1 IL-7 E-CSF IL-5 GM-CSF

IL-5

In neutrophilia, "Shift to left" denotes presence of, In neutrophilia, "Shift to left" denotes presence of, Toxic granules Vacuoles Dohle bodies Immature forms Bacterial infection

Immature forms

Presence of plenty of Blasts and immature cells in the blood smear is suggestive of, Agranulocytosis Leukemoid reaction Leukemia Leukocytosis Leukoerythroblastic reaction

Leukemia Presence of plenty of blasts and or early immature cells with few mature cells is suggestive of leukemia. in a leukemoid reaction mature cells will be much more than immature cells.

marked lymphocytosis is normal in a new born infant. True False

True

peripheral Blood smear report from a 52y man reads markedly high WBC count with many immature granulocytes, promyelocytes, myelocytes and occasional blasts seen with 3.2% basophils. What is the most likely diagnosis? AML ALL CML CLL Myelofibrosis (MPD)

CLL

Prominenet Lymphadenopathy in a case of acute leukmeia is typical of AML ALL Both AML & ALL Neither

ALL

Gum Hypertropy is typical of AML ALL both AML & ALL Neither

AML

Blast cells in blood film with plenty of cytoplasmic granules & Auer rods is typical of Acute Lymphoblastic leukemia Acute Myeloid Leukemia Both ALL & AML Neither

Acute Myeloid Leukemia

52y male, blood film Image is showing marked leucocytosis with increased immature myeloid cells, basophils, eosinophils & platelets. No blasts are seen. What is the most likely diagnosis? AML CML CLL ALL

CML

CML is a type of Myeloproliferative disorder True False

small lymphocytic lymphoma and Chronic Lymphocytic leukemia are pathologically similar disorders. True False

14y boy presents with fever, rash & sore throat since 3wks. There is cervical lymphadenopathy & tender Splenomegaly. Blood film showed lymphocytosis with irregular large lymphocytes with clear cytoplasm indented by surrounding RBCs. What is the most likely diagnosis? Acute lymphocytic Leuk. Chronic Lymphocytic Leuk Septicemia Infectious mononucleosis Chronic myeloid leukemia

Infectious mononucleosis

Common pathogenesis of Lymphoid neoplasms is over expression of antiapoptotic gene resulting in neoplasia of B lymphocytes. True False

True

Common infection implicated in development of Lymphoid neoplasm is, HIV EBV HBV HCV HAV

EBV

Common cell of origin of lymphoid neoplasm is, Precursor B lymphocytes Lymphooid stem cell Plasma cell Peripheral B lymphocyte Peripheral T lymphocyte Germinal centre B Cell.

Germinal centre B Cell.

Hypercellular bone marrow is typical of both Myeloproliferative disorders & Myelodysplastic syndromes. True False

Peripheral pancytopenia is typical of MPD. True False

Serum erythropoietin is markedly increased in Polycthemia Vera. True False

Myelofibrosis is due to neoplastic proliferation of marrow fibroblasts. True False

common cytogeneic abnormality in MPD is, BCR-ABL JAK2 5q Deletion PDGF

JAK2

Transformation to AML is common in MDS than MPD. True False

Pancytopenia is typical of Myelodysplastic syndrome. True False

Commonest type of Hodgkins lymphoma in elderly patients is, Nodular Lymphocyte predominat Nodular Sclerosis Lymphocyte rich Lymphocyte depletion Mixed Cellularity

Mixed Cellularity

Common etiology of Hodgkins lymphoma is, Unknown Socioeconomic factors Poor Hygiene EBV infection Random mutations.

EBV infection

Eosinophilia in Hodgkins lymphoma is because of this chemical mediator secreted by RS cells. GM-CSF IL-10 IL-13R IL-5 IL-4

IL-5

Commonest type of Non Hodgkins lymphoma in elderly patients is, Nodular Sclerosis Mixed Cellularity Diffule Large B Cell Lymphoma Plasma cell neoplasm Chronic Lymphocytic Leukemia

Diffule Large B Cell Lymphoma

Popcorn Cells, a type of RS cell is typically seen in, Nodular Sclerosis Mixed Cellularity Lymphocyte rich Lymphocyte depletion Nodular Lymphocytic Predominant

Nodular Lymphocytic Predominan

Dense fibrosis seen in nodular sclerosis type Hodgkins is due to this chemical mediator. IL-1 IL-10 GM-CSF IL-13 TGF-Beta

TGF-Beta

Normal Platelet count is to heal normal wear and tear of capillary endothelium. True False

True

Haemophilia B is due to deficiency of, Factor VIII Factor IX Platelet Factor 4 VWF Vitamin K

Factor IX

All the following are clinically common cause of vitamin K deficiency EXCEPT poor Diet Warfarin Liver disease Kidney disease

kidney disease

Von Willebrand Factor is produced in the body by Liver Endothelium Vitamin K Warfarin Hepatin

endothelium

Bleeding tendency in viral hemorrhagic fever is due to endothelial damage by virus. True False

Endothelial damage by virus & anti viral antibodies – vasculitis.  platelet activation  thrombocytopenia  bleeding

01. A 32-year-old presents with a 3-day history of a quickly progressing painful erythematous area on their left leg after a small scratch. He has otherwise been well lately. He has a known history of Grave’s hyperthyroidism which is currently well controlled with carbimazole. A FBC reveals a decreased WCC with neutropenia 0.4 (RR 2-8)?; Hb and platelets are normal. What is the most likely cause of the abnormal neutrophil count in this patient? a)Acute myeloid leukaemia b)Chronic myeloid leukaemia c)Bacterial infection d)Hyperthyroidism e)Medication adverse event f)Viral infection

e- medication adverse reaction

So weird… another 32-year-old patient presents with a 3-day history of a quickly progressively painful erythematous area on their left leg after a small scratch. They have hypothyroidism for which they take thyroxine. An FBC reveals an elevated WCC –the blood film is shown. What is the most likely cause of the abnormal neutrophil count in this patient? a) Acute myeloid leukaemia b) Chronic myeloid leukaemia c) Bacterial infection d) Hypothyroidism e) Medication adverse event f) Viral infection

Bacterial infection - increased neutrophils - band form neutrophils (immature) - toxic changes - dark granules and clear vacuoles

A 62-year-old presents to ED with 10 minutes of central crushing chest pain on exertion. He has not had any fevers or infective symptoms. He has a known history of IHD which presented similarly to this, and he is on the usual CV medications. An FBC is done which showed a WCC of 42x109/L What is the most likely cause of the abnormal white cell count in this patient? a)Acute myeloid leukaemia b)Chronic myeloid leukaemia c)Bacterial infection d)Coronary heart disease e)Medication adverse event f)Viral infection

- CML 1. neutrophilia 2. severe left shift 3. no toxic changes 4. immature myeloid cels and blast cells.

A 62-year-old presents to ED with 10 minutes of central crushing chest pain on exertion. He has not had any fevers or infective symptoms. He has a known history of IHD which presented similarly to this, and he is on the usual CV medications. An FBC is done which showed a WCC on 42. 04. What further information in the full blood count would further suggest this diagnosis? a)Basophilia b)Eosinophilia c)Lymphocytosis d)Lymphopaenia e)Pancytopaenia

basophilia think MPD

A- CLL B- ALL C- all myelocytes - no neutrophils AML D - CML (neutrophils and myelocytes)

A 62-year-old presents to ED with 10 minutes of central crushing chest pain on exertion. He has not had any fevers or infective symptoms. He has a known history of IHD which presented similarly to this, and he is on the usual CV medications. An FBC is done which showed a WCC on 42. 06. Given that blood film finding, what mutation is most likely to have caused this patient’s increased WCC? a)BCL2 b)BCR-ABL c)JAK2 d)RARA e)MYC

BCR-ABL - CML t9,22 chromosome a - ALL c- MPD d- PML e - burrits lymphoma -ebv

A 62-year-old presents to ED with 10 minutes of central crushing chest pain on exertion. He has not had any fevers or infective symptoms. He has a known history of IHD which presented similarly to this, and he is on the usual CV medications. An FBC is done which showed a WCC on 42. 6 months later with patient presents with easy bruising and fatigue. A FBC shows pancytopaenia. The film is shown below. 7. What is the most likely cause of the patient’s current presentation? a)Acute myeloid leukaemia b)Acute lymphocytic leukaemia c)Aplastic anaemia d)Myelodysplastic syndrome e)Severe haemolytic anaemia

acute myeloid leukemia - all are blasts - prominent nucleus and granules - small cell on R is erythroblast

A 62-year-old presents to ED with 10 minutes of central crushing chest pain on exertion. He has not had any fevers or infective symptoms. He has a known history of IHD which presented similarly to this, and he is on the usual CV medications. An FBC is done which showed an WCC on 42. 6 months later with patient presents with easy bruising and fatigue. An FBC shows pancytopenia. 08. What further testing is required in this patient? a)Cytogenetic testing on peripheral blood b)Bone marrow biopsy c)Lymph node excision d)PET scan

bone marrow biopsy

09. 63yo female presents with 4 weeks of swelling in her neck. She reports a history of repeated URTIs over the past 6 months. She has otherwise been well with no fatigue or bleeding. She has no known medical history. On examination, she does not have any pallor or rashes. She has palpable lymphadenopathy in the cervical, epitrochlear and inguinal region. TABLE TALK What are 3 most likely causes for this patient’s lymphadenopathy?

lymphoma - any type CLL metastatic lymphadenopathy - primarily unclear inflammatory condition - sarcoidosis

A 63yo female presents with 4 weeks of swelling in her neck. She reports a history of repeated URTIs over the past 6 months. She has otherwise been well with no fatigue or bleeding. She has no known medical history. On examination, she does not have any pallor or rashes. She has palpable lymphadenopathy in the cervical, epitrochlear and inguinal region. 10. If on further history lymphoma was the most likely diagnosis, what investigation in indicated to confirm this? a)Bone marrow biopsy b)CT neck, chest, abdo, pelvis c)Lymph node biopsy d)FBC e)Lymph node FNA

Lymph node biopsy

A 63yo female presents with 4 weeks of swelling in her neck. She reports a history of repeated URTIs over the past 6 months. She has otherwise been well with no fatigue or bleeding. She has no known medical history. On examination, she does not have any pallor or rashes. She has palpable lymphadenopathy in the cervical, epitrochlear and inguinal region. 11. This is performed and the result is shown below. What is the most likely diagnosis? a) Small cell lymphoma b) Follicular lymphoma c) Hodgkin’s lymphoma d) Large B cell lymphoma e) Multiple myeloma

multiple follicles - lymphoma FOLLICULAR LYMPHOMA

63yo female presents with 4 weeks of swelling in her neck. She reports a history of repeated URTIs over the past 6 months. She has otherwise been well with no fatigue or bleeding. She has no known medical history. On examination, she does not have any pallor or rashes. She has palpable lymphadenopathy in the cervical, epitrochlear and inguinal region. 12. What is the abnormal cell of origin in this case? a) Blast cell in bone marrow b) T cell in thymus c) B cell in germinal centre d) Plasma cell in bone marrow

B cells in the germinal centre

A 63yo female presents with 4 weeks of swelling in her neck. She reports a history of repeated URTIs over the past 6 months. She has otherwise been well with no fatigue or bleeding. She has no known medical history. On examination, she does not have any pallor or rashes. She has palpable lymphadenopathy in the cervical, epitrochlear and inguinal region. 13. If the patient’s biopsy result was the result shown below, what would the most likely diagnosis be? a) Small cell lymphoma b) Follicular lymphoma c) Hodgkin’s lymphoma d) Diffuse large B cell lymphoma e) Multiple myeloma

nuclear have big cytoplasm diffuce large b cell lymphoma

14. A 44-year-old male presents with a 5-week history of fevers. He works FIFO in the mines in PNG. He also complains of fatigue, night sweats and multiple swellings in his neck over the same time frame. A full blood count performed shows a lymphocytosis. The histology of the patient’s palpable lymph node is shown below. What is the most likely cause of the patient’s symptoms? a) Acute lymphoblastic leukaemia b) Chronic lymphocytic leukaemia c) Hodgkin’s lymphoma d) Non-Hodgkin’s lymphoma e) Tuberculosis

15. A different 44-year-old male also presents with a 5-week history of cyclical fevers. He also works FIFO in the mines in PNG. He also complains of fatigue, night sweats and multiple swellings in his neck over the same time frame. A full blood count performed shows an eosinophilia. The patient’s CXR is shown below. What is the most likely cause of the patient’s symptoms? What is the most likely diagnosis? a) Acute lymphoblastic leukaemia b) Chronic lymphocytic leukaemia c) Hodgkin’s lymphoma d) Non-Hodgkin’s lymphoma e) Tuberculosis

Hodgkins lymphoma - cyclic fever

jcu.edu.au A 44-year-old male presents with 5-week history of cyclical fevers. He works FIFO in the mines in PNG. She also complains of fatigue and night sweats over the same time frame. A full blood count performed is normal. The patient’s CXR is shown below. 16. Which of the following lymph node excision biopsies would be most consistent with this patient’s diagnosis

a- hodgkins (ANSWER) b- non-hodgkins SLL c- non-hodgkins DLBCL

17. An 18-year-old female presents to a clinic in PNG with a 1-week history of fevers and a sore throat. She was previously well with no known medical conditions. On examination, her throat is reddened and she has tender palpable lymphadenopathy in the cervical region. She has no other palpable lymph nodes and her lungs are clear on auscultation. A blood film is all that is available and is shown below. What is the most likely diagnosis? a) Acute lymphocytic leukaemia b) Chronic lymphocytic leukaemia c) Infectious mononucleosis d) Sarcoidosis e) Tuberculosis

EBV- infects b lymphocytes

18. A 76-year-old male is seen in ED with acute back pain, confirmed to be due to a vertebral fracture. An FBC is performed which shows a normocytic anaemia. A FBC performed 6 months ago was normal. What is the most likely underlying diagnosis in this patient? a) Acute lymphocytic leukaemia b) Aplastic anaemia c) Chronic myeloid leukaemia d) Multiple myeloma e) Non-Hodgkin’s lymphoma

multiple myeloma

A 76-year-old male is seen in ED with acute back pain, confirmed to be due to a vertebral fracture. An FBC is performed which shows a normocytic anaemia. A FBC performed 6 months ago was normal. 19. What additional abnormality would be expected in this patient on further testing? a)Elevated creatinine b)Hypocalcaemia c)Hypernatraemia d)Reticulocytosis e)Positive DAT

multiple myeloma - CRAB - elevated creatine

20. A 7-year-old male presents with 4 weeks of worsening lethargy and bleeding gums. On examination, he has obvious conjunctival pallor, petechiae and hepatosplenomegaly. His blood film is shown below. What is the most likely diagnosis? a)Acute lymphoblastic leukaemia b)Acute myeloid leukaemia c)Chronic lymphocytic leukaemia d)Chronic myeloid leukaemia e)Hodgkin’s lymphoma f)Non-Hodgkin’s lymphoma

Acute lymphoblastic leukemia (4 weeks, worsening bleeding)

21. A 61-year-old female presents for some reason. She has a history of a BCC on the arm, excised 2 years ago. On examination, the patient is not jaundiced and does not have any palpable lymphadenopathy. On abdominal examination, the liver is palpable and enlarged and a mass is palpated in the left upper quadrant. What feature of palpation would indicate the mass to be the spleen? a)Ballotable b)Deep mass c)No movement with respiration d)Cannot get finger between mass and ribs e)Smooth regular border

cannot get finger between mass and ribs

A 61-year-old female presents for some reason. She has a history of a BCC on the arm, excised 2 years ago. On examination, the patient is not jaundiced and does not have any palpable lymphadenopathy. On abdominal examination, the liver is palpable and enlarged and a mass is palpated in the left upper quadrant. 22. This finding is confirmed. What is the most likely cause of the abdominal examination findings? a)Cirrhosis b)Chronic myeloid leukaemia c)Metastatic melanoma d)Non-Hodgkin’s lymphoma e)Systemic lupus erythematosus

CML

23. A 36yo patient with systemic lupus erythematosus develops a functional hyposplenia. Which of the following organisms are they at increased risk of as a consequence of this? a)Bordetella pertussis b)Herpes zoster c)Mycobacterium tuberculosis d)Staphylococcus aureus e)Streptococcus pneumoniae

strep pneumoniae

All hemostatic tests will be abnormal in a classic case of DIC True False

True

Like FDP, D-dimer is also a breakdown product of fibrin following fibrinolysis. True False

True

Unlike DIC Both TTP & HUS have significantly decreased coagulation factors. True False

False

Neurological deficits are characteristic feature of TTP. True False

True

All the following are natural anticoagulants EXCEPT Protein C Protein S Heparin Warfarin Anti Thrombin III

Warfarin

Clinical features of Hypercoagulability include all the following EXCEPT Abortions DVT Myocardial Infarction Purpura Stroke

Purpura

Antiphospholipid Antibody syndrome typically produces clinical hypercoagulability and prolonged PTT result. True False

True

Antibodies in AAS typically react with, Thromibin Factor VIIIa Factor Xa Platelet Phospholipid Platelet surface glycoprotein

Platelet Phospholipid

Blood for coagulation studies are sent in sky blue cap tube with preservative EDTA Calcium Sodium Citrate Sodium fluoride no preservative

Sodium Citrate

International Normalised Ratio (INR) is used to standardise PTT values. True False

False

Thromboelastogram measures Extrinsic Pathway Intrinsic Pathway Common Pathway Fibrinolysis all of the above.

all of the above.

A patient's prolonged PTT value got corrected by adding 50% of normal plasma to patient plasma. This proves that patient has a factor deficiency and not a factor inhibitor. True False

true

Shelf life of platelet concentrate is, 5 days 10 days 35 days 6 months 1 year

5 days

RBC's have HLA antigens on their cell membrane. True False

False

Genes and corresponding antigens of Rh blood group system are, Rh Positive & Negative O+, O-, A+, A-, etc. CDE/cde D+ve & D-ve

CDE/cde

antigen/s inO blood group are? A & B Only OA or OB No H, A or B Only O. Only H

Only H

Steps in the investigation of a suspected major transfusion reaction Stop transfusion Check patient ID Check Blood product ID Check cross match details. Send blood bag and patient blood sample to blood bank, All of the above

All of the above

"Lookback" program is to double check patient records following blood transfusion. True False

Naturally occuring antibodies to blood groups are typically IgM type. True False

False

Naturally occuring antibodies to blood groups are typically IgM type. True False

True

A 32-year-old female presents with a 2-week history of a rash on her legs and arms, as shown in the picture below. The rash does not blanch when pressure is applied. What is the best description of this finding? a) Ecchymoses b) Macular rash c) Maculopapular rash d) Petechiae e) Purpura

Petechiae

A 32-year-old female presents with a 2-week history of a rash on her legs and arms, as shown in the picture below. TABLE TALK 02. Give 5 differential diagnoses for this patient’s finding, for each finding give a feature in the history that would rule in/suggest this diagnosis.

vasculitis - autoimmune vasculitis - infections (meningicoccal - HSP Thrombocytopenia - ITP - TTP - HUS - Liver disease - - acute leukemia (pancytopenia) Disorders of palatelet functions - aspirin - VWD

A 32-year-old female presents with a 2-week history of a rash on her legs and arms, as shown in the picture below. 03. On further questioning, she also reports a 3-month history of increasingly heavy menstrual bleeding and fatigue. She does not report any recent infections or weight changes and has no prior history of bleeding tendency. She gets stress-related headaches for which she takes paracetamol. On examination, her vitals are within normal limits and her skin is as shown. What is the most likely cause of her symptoms? a) B12 deficiency b) Hypothyroidism c) ITP d) TTP e) Von Willebrand disease

ITP

A 32-year-old female presents with a 2-week history of a rash on her legs and arms, as shown in the picture below. On further questioning, she also reports a 3-month history of increasingly heavy menstrual bleeding and fatigue. She does not report any recent infections or weight changes and has no prior history of bleeding tendency. She gets stress-related headaches for which she takes paracetamol. On examination, her vitals are within normal limits and her skin is as shown. ITP was the diagnosis 04. If this was the diagnosis, which of the following platelet levels would be expected to be found in this patient (reference range 150-450)? a) 30 b) 70 c) 120 d) 210 e) 530

ITP was the diagnosis so - a) 30. - 150 normal - <50 excess bleeding from trauma therefore no bleeding - has to be less than 50.

A 32-year-old female presents with a 2-week history of a rash on her legs and arms, as shown in the picture below. On further questioning, she also reports a 3-month history of increasingly heavy menstrual bleeding and fatigue. She does not report any recent infections or weight changes and has no prior history of bleeding tendency. She gets stress-related headaches for which she takes paracetamol. On examination, her vitals are within normal limits and her skin is as shown. 05. A FBC is performed which shows a (normocytic) pancytopenia and the blood film is shown below. What is the most likely cause of the pancytopenia? a) Aplastic anaemia b) ITP c) Myelodysplastic syndrome d) Severe haemolytic anaemia e) Von Willebrand disease

aplastic anaemia very abnormal and irregular RBCs

6. A 75-year-old female presents with a 30-minute history of left sided crushing chest pain. An ECG shows ST depression in leads I, II and aVF and her troponin level is elevated. What information if found in her history would increase her risk of arterial thrombus but not venous thrombosis? a) Anti-phospholipid syndrome b) Diabetes mellitus c) Family history of Factor V Leiden d) Menopausal hormone therapy e) Previous history of DVT

Diabetes melitis all others are risk factors for venous thrombus

A 75-year-old female presents with a 30-minute history of left sided crushing chest pain. An ECG shows ST depression leads I, II and aVF and her troponin level is elevated. 07. An FBC is performed which is shown below. What is the most likely cause of the patient’s FBC abnormalities? a) Anti-phospholipid syndrome b) Essential thrombocythemia c) Haemolytic uremic syndrome d) Polycythemia rubra vera e) Severe COPD

MPD ( polycythemia rubra vera)

A 22-year-old male is noted to have excessive bleeding during an appendicectomy. He reports a history of nose bleeds as a child but had not noted any excessive bleeding before. Coagulation studies are performed and showed a prolonged APTT time only. What is the most likely cause of the patient’s prolonged bleeding? a) DIC b) Haemophilia c) Immune thrombocytopenic purpura d) Bernard Soulier syndrome e) Von Willebrand disease

VWD bleeding in VWD is because of defective platelet adhesion.

A 22-year-old male is noted to have excessive bleeding during an appendicectomy. He reports a history of nose bleeds as a child but had not noted any excessive bleeding before. Coagulation studies are performed and showed elevated APTT time. 09. The diagnosis is confirmed on further testing. If this condition was known about prior to surgery, what management in indicated to prevent excessive bleeding? a) DDAVP b) FFP transfusion c) Low-molecular weight heparin d) Platelet transfusion e) Red cell transfusion

DDAVP desmopression, relaease VWF from endothelial cells - only for minor form of VWD and haemophilia A

A 22-year-old male is noted to have excessive bleeding during an appendicectomy. He reports a history of nose bleeds as a child but had not noted any excessive bleeding before. Coagulation studies are performed and showed elevated APTT time. 10. His partner is currently pregnant. She has no known bleeding issues herself or in her family. What is the chance their child will have this condition? a) 0% b) 25% c) 50% d) 100% e) Depends on the sex of the child

50% autosomal dominant

A 36-year-old female presents to ED with a 4-day history of significant diarrhoea and fevers. On examination, she looks sick with a temperature of 39.2ºC, BP 86/50 and HR 121. Her abdomen is generally tender and petechiae and purpura are seen over her legs, arms and abdomen. Coagulation studies are performed and shown below. What is the most likely cause of the abnormal coagulation studies? a) Cirrhosis b) Dengue fever c) DIC d) HUS e) TTP

Acute history - presenting with bleeding. DIC HUS would have only platelets low

A 34-year-old presents to the GP with a 2-day history of left lower limb pain and swelling. She has no chest pain or SOB. She has a history of SLE but no personal or family history of clots, is not on any hormonal therapy and has not had any recent immobility. A lower limb doppler USS confirms a deep vein thrombosis in the posterior tibial vein. What investigation is indicated in this patient? a) Coagulation studies b) CTPA c) D-dimer d) dsDNA and ANA e) LFT

Coagulation studies.

A 34-year-old presents to the GP with a 2-day history of left lower limb pain and swelling. She has no chest pain or SOB. She has a history of SLE but no personal or family history of clots, is not on any hormonal therapy and has not had any recent immobility. A lower limb doppler USS confirms a deep vein thrombosis in the posterior tibial vein. 13. What abnormality on coagulation studies is expected? a) Abnormal APTT and PT b) Decreased APTT c) Decreased PT d) Increased APTT e) Increased PT

increased aptt

A 34-year-old presents to the GP with a 2-day history of left lower limb pain and swelling. She has no chest pain or SOB. She has a history of SLE but no personal or family history of clots, is not on any hormonal therapy and has not had any recent immobility. A lower limb doppler USS confirms a deep vein thrombosis in the posterior tibial vein. 14. She is started on rivaroxaban. What part of the coagulation cascade does this medication inhibit? a) Vitamin K b) Thrombin c) Xa d) IX a e) Protein C

15. A 22-year-old female presents to ED with an episode of syncope after 1 week of SOB and pleuritic chest pain. She is on oral combined contraceptive pill. Her brother recently had a DVT, she has no other significant family history. A CTPA confirms a PE. Further testing confirms a cause for her thrombosis. What is the most likely diagnosis in this patient? a) Anti-phospholipid syndrome b) Anti-thrombin III deficiency c) Factor 5 Leiden d) Protein S deficiency e) Von Willebrand disease

factor 5 leiden

6. A 73-year-old woman is bought in to ED with 12 hours of haemoptysis. She has atrial fibrillation and mitral stenosis and is on warfarin. She states she increased her dose 4 weeks ago but has not been able to get repeat testing done. On examination, her vitals are within normal limits, with no postural drop in BP. What abnormalities in testing would be expected in this patient? a) Abnormal APTT and PT b) Decreased PT c) Increased APTT d) Increased INR e) Pancytopenia

increased INR

Vitamin K fresh frozen plasma group and cross match FBC - to check Hb IV fluids to maintainblood pressure

A 73-year-old woman is bought in to ED with 12 hours of haemoptysis. She has atrial fibrillation and mitral stenosis and is on warfarin. She states she increased her dose 4 weeks ago but has not been able to get repeat testing done. On examination, her vitals are within normal limits, with no postural drop in BP. This test comes back extremely abnormal. 18. Which of the following statements best describes cross matching? a) Patient’s plasma is tested to determine the ABO type b) Patient’s plasma is tested to determine the RhD type c) Patient’s RBCs tested against antiglobulin sera d) Testing to confirm compatibility of donor red cells with patient plasma

Testing to confirm compatibility of donor red cells with patient plasma

30 minutes after a transfusion of 4 units of packed red blood cells a patient develops a fever, chills & rigors. The compatibility form and the recipient details are verified. On examination, HR 90, BP 110/70, T38.6, RR 20, SpO2 98% RA. The lungs are clear, JVP is 3cm and heart sounds are dual. What transfusion-related adverse effect is most likely to have occurred in this patient? a) ABO incompatibility b) Bacterial contamination of unit c) Febrile non-haemolytic transfusion reaction d) Severe allergic reaction

Febrile non-haemolytic transfusion reaction

Four hours following a transfusion, a patient develops SOB and chest tightness. On examination, his HR 120, BP 90/60, T 37.6, RR 30, SpO2 94%RA. He has bilateral chest crepitations, JVP 2 cm heart sounds normal. CXR shows Kerley B lines and nodular infiltrates. ECG shows sinus tachycardia. What is the most likely cause of his current symptoms? a) Circulatory overload b) Myocardial infarction c) Pulmonary embolism d) Septicemia e) Transfusion-associated acute lung injury

Transfusion-associated acute lung injury Transfusion Reactions: * Allergic reactions – plasma proteins. * Febrile reaction – Ab to leucocytes/Infection * Hemolytic reactions – immune/ mismatch. * TRALI: Acute Lung injury (ARDS) * Transfusion transmitted infections. * GVHD: Graft vs. Host Disease – Rare