Q's I got wrong

Question 1

In the management of B12 and Folate deficiency, which should be replaced treated first and why?

Answer 1

B12
- To avoid subacute degeneration of the spinal cord.

Question 2

What is Paroxysmal Nocturnal Haemoglobinuria?

Answer 2

A rare type of haemolytic anaemia associated with aplastic anaemia in which the Complement system targets and destroys RBC’s.

Question 3

What types of signs would a patient with Paroxysmal Nocturnal Haemoglobinuria displpay?

Answer 3

Patients complain of Dark urine (especially in morning due to higher concentration of urine in morning)
- Symptoms of anaemia
- Erectile dysfunction
- Dysphagia

Question 4

What type of mutation causes Paroxysmal Nocturnal Haemoglobinuria?

Answer 4

A mutation in the PIG-A gene of Haematopoietic stem cells leading to a deficiency of Glycosyl-Phospatidylinositol anchor proteins.

Question 5

What are Auer rods common in?

Answer 5

AML

Question 6

What would VWD show on APTT and PT?

Answer 6

Decreased factor VIII leads to prolonged APTT and but normal PT.

Question 7

What drug can cause heamolytic crisis in G6PD?

Answer 7

Nitrofurantoin.

Question 8

What is Aplastic Anaemia?

Answer 8

A type of Anaemia characterisedby a deficiency of all types of blood cells due to failure of the bone marrow to produce them. (pancytopenia on blood film)

Question 9

What are some causes of Aplastic Anaemia?

Answer 9

Radiation, Chemotherapy, Certain medications, Autoimmune disorders.

Question 10

What would Anaemia of Chronic disease do to serum Iron and Serum Ferritin?

Answer 10

Cause a Low Serum Iron and Normal / High serum ferritin.

Question 11

What are Non-Hodgkins lymphomas?

Answer 11

A group of malignancies that affect the lymphoid system.

Question 12

How are Non-hodgkins lymphomas distinguishable from other lymphomas?

Answer 12

The Absence of Reed-Seternberg cells in Non-Hodgkins.

Question 13

How do Non-hodgkins Lymphomas usually present?

Answer 13

Painless, Symmetrical Lymphadenopathy associated with B symptoms (fever, Night sweats, and weight loss)

Question 14

What blood tests are important in a non-hodgkins lymphoma?

Answer 14

LDH is the most important - an elevated LDH is a poor prognostic indicator.
(reflects greater red cell turnover)
- Blood tests
- Blood film

Question 15

Increased marrow involvement and turnover in particularly high-grade cancers Blood films may show characteristic left shift, what does this mean?

Answer 15

Left shift refers to the presence of early white blood cell precursors (not yet fully matured neutrophils and such)

Question 16

What test is required to define the subtype of non-hodgkins lymphoma?

Answer 16

Biopsy

Question 17

what is a smear blood test?

Answer 17

A laboratory technique used to examine blood cells under a microscope which involves spreading a drop of blood thinly on a glass slide, fixing it, staining it then viewing it.

Question 18

What are smear cells and when are they seen?

Answer 18

Smear cells, also known as smudge cells or basket cells, are a type of abnormal finding observed on a peripheral blood smear. These cells appear as fragmented or ruptured lymphocytes or monocytes that have been disrupted during the preparation of the blood smear.
- commonly seen in CLL as the delicate lymphocytes are damaged.

Question 19

In which Haematological Malignancy is Splenomegaly most common?

Answer 19

CML

Question 20

What drugs are used in anti-parasitic therapy? (of Taeniasis / tapeworm)

Answer 20

Praziquantel and Niclosamide.

Question 21

How is Tapeworm contracted?

Answer 21

By eating uncooked pork or beef as the eggs are laid in meat.

Question 22

What should you think when a patient described “grapefruit seeds” in their stool?

Answer 22

These are Proglottids - Tape worm segments

Question 23

What is a Wells score used to calculate the risk of?

Answer 23

DVT

Question 24

What is the range of a wells score and at what score is DVT likely?

Answer 24

-2 to 10
DVT likely with a score of 2 or more.

Question 25

What should be done first in a suspected DVT with a wells score of 2, US doppler or Anticoagulation?

Answer 25

A Score of ≥ 2 means DVT is likely.
NICE recommends a proximal vein US should be carried out within 4 hrs of a suspected lower limb DVT and Wells score of ≥ 2.
Anticoagulation should only be done if there is a delay of > 4 hrs for D/Dimer / US Doppler.

Question 26

What should be done US Doppler or D-Dimer in a patient with suspected Lower limb DVT and Well’s score of 1 or less?

Answer 26

D Dimer within 4 hours.
If there is going to be a delay of > 4 hrs for this then Anticoagulation should be commenced.

Question 27

What anticoagulation should be started in Patients with suspected DVT if its indicated?

Answer 27

DOACs are generally preferred.
(Apixaban)

Question 28

In a Patient with a Disproportionally low MCV to Hb Microcytic anaemia, what would be the likely cause?

Answer 28

Thalassaemia
- Beta thalassaemia trait and alpha thalassaemia minor may present with a normal/low Hb with a disproportionately low MCV

Question 29

What is Cold Autoimmune Haemolytic Anaemia (AIHA)?

Answer 29

An IgM-Mediated autoimmune condition characterised by the production of autoantibodies against erythrocytes that bind at temperatures colder than body temperature.

Question 30

What are some common causes of Cold AIHA?

Answer 30

Infection, Malignancy or Idiopathic.
SLE is more commonly assoc w Warm AIHA.

Question 31

What is Warm AHIA?

Answer 31

A condition characterised by the production of IgG autoantibodies against erythrocytes.
Presents as a Normocytic anaemia and patient may have certain risk factors… e.g. SLE or Lymphoma.
In warm AIHA Haemolysis occurs at body temperature.

Question 32

What should be given to a patient with an INR of 3.4 (2.0-3.0) before emergency surgery which cannot be delayed for 6-12 hrs?

Answer 32

IV vitamin K and Prothrombin complex concentrate!

Question 33

What should be given to a patient with an INR of 3.4 (2.0-3.0) before emergency surgery which can be delayed for 6-12 hrs?

Answer 33

IV Vitamin K and recheck INR in 6-12 hrs.

Question 34

What INR value is usually considered safe for surgery?

Answer 34

<1.5

Question 35

What medication can reduce the frequency and severity of vaso-occlusive crises in sickle cell disease?

Answer 35

Hydroxyurea aka (hydroxycarbamide)
- Increased Foetal Hb (which is resistant to sickling)

Question 36

What are some indications to commence a patient on Hydroxyurea (aka Hydroxycarbamide)?

Answer 36

If a patient has three or more painful crises in one year.
If a patient has pain which interferes with daily activities or affects their QoL.

Question 37

What type of medication is Desferrioxamine?

Answer 37

An Iron Chelator which can be used to Tx iron overload, for e.g. due to repeated blood transfusions in pateints with beta thalassaemia.

Question 38

Which marker measures the extrinsic pathway in haemostasis?

Answer 38

Prothrombin Time. (and the INR which is derived from the PT)

Question 39

Which marker measures the intrinsic clotting pathway in haemostasis?

Answer 39

Activated partial Thromboplastin Time (APTT)

Question 40

When is the intrinsic pathway of Haemostasis initiated?

Answer 40

When blood comes into contact with collagen on the injured vessel wall.

Question 41

When is the Extrinsic pathway of Haemostasis initiated?

Answer 41

When blood comes into contact with the products of damaged tissue (tissue factor)

Question 42

What is the target action of Rituximab?

Answer 42

CD20
- Rituximab is a monoclonal antibody targeting CD20, which is important in the maturation of B cells into plasma cells.

Question 43

What is vWF produced by?

Answer 43

The endothelium and Megakaryocytes.

Question 44

What is the main function of vWF?

Answer 44

It Functions by binding to platelets to promote agglutination.