RACP- Haematology

Question 1

Venous thromboembolism (VTE) is often recurrent. Which of the following is the strongest risk factor for recurrent VTE?
a) Female sex
b) Heterozygosity for Factor V Leiden mutation
c) First presentation of VTE with Pulmonary Embolism
d) Unprovoked VTE
e) Residual thrombus on ultrasound

Answer 1

D- Unprovoked VTE

Question 1

A 74-year-old man is on medication for prevention of stroke due to a past medical history of atrial fibrillation. He presents to hospital with malaena. He is unable to recall the name of the medication.
Blood tests demonstrate the following

What is the most likely medication he is taking?
a) Apixaban
b) Dabigatran
c) Rivaroxaban
d) Warfarin
e) Tirofiban

Answer 1

Dabigatran

Note:
*Apixaban and Rivaroxoban prolong PT and APTT
*Warfarin prolongs PT +/- APTT
*Tirofiban is an anti-platelet and does not affect these factors

Question 2

What is the pathophysiology of TTP (Thrombotic thrombocytopenic purpura)
A. ADAMTS13 deficiency
B. GP IIb/ IIIA inhibition
C. Complement deficiency
D. Von willebrand factor deficiency
E. Antibody mediated destruction of platelets

Answer 2

A- ADAMTS13 deficiency

Question 3

A 48 year old man presents to pre-admissions clinic for an elective thyroidectomy with elevated APTT level that does no correct with 1:1 plasma mixing of normal patient plasma. Normal INR and fibrinogen level. No previous history of bleed. What is the most likely diagnosis?

A. Hereditary factor VIII deficiency
B. Acquired factor VIII deficiency
C. Acquired factor VII deficiency
D. Lupus anticoagulant
E. Hypofibrinogenemia

Answer 3

D- lupus anticoagulant

could be B but would usually expect bleeding

Question 4

68yo man is receiving unfractionated heparin after an hip arthroplasty. On day 5 he is noted to be thrombocytopenic (Plt 20). There is no evidence of bleeding or thrombosis.

Whilst awaiting confirmatory laboratory testing, what is the best option?

A. Fondaparinux
B. Low-dose aspirin
C. Low molecular weight heparin
D. Platelet transfusion
E. Rivaroxaban

Answer 4

A. Fondaparinux

Question 5

Hepcidin mediates its affect by inhibiting the action of which of the following proteins?

A) Metal divalent protein
B) Ferritin
C) Ferroportin
D) Transferrin receptor
E) Hephafastin

Answer 5

C) Ferroportin

Question 6

32. A 48 year old man (smoker) developed a right distal below knee DVT and bilateral PE after a long haul flight - What is the minimum duration of anticoagulation?
    A) 6 weeks
    B) 3 months
    C) 12 months
    D) Lifelong

Answer 6

B) 3 months

Proximal DVT or PE caused by major surgery –> 3 months
Proximal DVT or PE that is unprovoked or transient risk factor –> 3-6 months
Proximal DVT or PE that is recurrent + provoked –> lifelong
Distal DVT and major risk factor –> 6 weeks

Question 7

3. Choose the appropriate marker for peripheral blood stem cell precursor
   A) CD19
   B) CD20
   C) CD34
   D) CD38

Answer 7

C) CD34

Question 8

Q12. What is the minimum percentage of bone marrow plasma cells required for a diagnosis of suspected
myeloma?
A. 5%
B. 10%
C. 15%
D. 20%

Answer 8

B. 10%

Question 9

Answer 9

B positive

Forward typing
Anti-A: No agglutination → Absence of A antigen.
Anti-B: Agglutination → Presence of B antigen.
Anti-D: Agglutination → Presence of D antigen (Rh-positive).
Control (Albumin): No agglutination → Confirms the validity of the test (no nonspecific agglutination).

Reverse Typing:
Plasma A: Agglutination → Presence of anti-A antibodies in plasma (consistent with group B blood).
Plasma B: No agglutination → Absence of anti-B antibodies in plasma.