Haematology Module 6

A 32-year-old woman presents to the clinic with complaints of fatigue and jaundice. Laboratory findings reveal a hemoglobin level of 85 mmol/L, reticulocytosis, and an elevated indirect bilirubin.

A peripheral blood smear shows anisocytosis and polychromasia without evidence of spherocytes. The patient’s family history is notable for her brother having similar symptoms.

Which of the following is the most likely diagnosis for her condition?

Pyruvate kinase deficiency

Correct Incorrect Correct answer

Autoimmune hemolytic anemia

Correct Incorrect Correct answer

Glucose-6-phosphate dehydrogenase (G6PD) deficiency

Correct Incorrect Correct answer

Hereditary spherocytosis

Correct Incorrect Correct answer

Paroxysmal nocturnal hemoglobinuria

Correct Incorrect Correct answer

A 72-year-old man is referred to haematology with a raised haemoglobin. A diagnosis of polycythaemia rubra vera is suspected. What other blood abnormality would be most consistent with this diagnosis?

Raised haematocrit

Correct Incorrect Correct answer

Raised alanine transferase

Correct Incorrect Correct answer

Hypokalaemia

Correct Incorrect Correct answer

Thrombocytopaenia

Correct Incorrect Correct answer

Raised ferritin level

Correct Incorrect Correct answer

Which one of the following therapeutic option is least recognized in the treatment of aplastic anaemia?

Interferon-gamma

Correct Incorrect Correct answer

Allogeneic hematopoietic cell transplantation

Correct Incorrect Correct answer

Eltrombopag

Correct Incorrect Correct answer

Anti-thymocyte globulin

Correct Incorrect Correct answer

Platelet transfusion

Correct Incorrect Correct answer

Which one of the following haematological malignancies is most commonly associated with the t(11;14) translocation?

Mantle cell lymphoma

Correct Incorrect Correct answer

Acute promyelocytic leukaemia

Correct Incorrect Correct answer

Burkitt's lymphoma

Correct Incorrect Correct answer

Acute lymphoblastic leukaemia

Correct Incorrect Correct answer

Chronic myeloid leukaemia

Correct Incorrect Correct answer

Which one of the following is not a recognized treatment for idiopathic thrombocytopenic purpura?

Plasma exchange

Correct Incorrect Correct answer

Splenectomy

Correct Incorrect Correct answer

IV immunoglobulin

Correct Incorrect Correct answer

Eltrombopag

Correct Incorrect Correct answer

Oral prednisone

Correct Incorrect Correct answer

Which of the following drug is known to cause a rapid onset of drug induced immune thrombocytopenia?

Tirofiban

Correct Incorrect Correct answer

Quinine

Correct Incorrect Correct answer

Phenytoin

Correct Incorrect Correct answer

Haloperidol

Correct Incorrect Correct answer

Naproxen

Correct Incorrect Correct answer

An 80-year-old man is reviewed in the haematology clinic. He has been referred due to weight loss, lethargy and a significantly elevated IgM level. Recent bloods show the following:

Hb	138 g/L
Platelets	127 x 10⁹/l
IgM	2150 mg/dl (range 50-330 mg/dl)
ESR	45 mm/hr

Given the likely diagnosis, which one of the following complications is he most likely to develop?

Hyperviscosity syndrome

Correct Incorrect Correct answer

Renal failure

Correct Incorrect Correct answer

Chronic lymphocytic leukaemia

Correct Incorrect Correct answer

Anaemia

Correct Incorrect Correct answer

Hypercalcemia

Correct Incorrect Correct answer

A 28-year-old man is investigated for cervical lymphadenopathy. A biopsy shows nodular sclerosing Hodgkin’s lymphoma. Which one of the following factors is associated with a poor prognosis?

Night sweats

Correct Incorrect Correct answer

History of Epstein Barr virus infection

Correct Incorrect Correct answer

Mediastinal involvement

Correct Incorrect Correct answer

Male gender

Correct Incorrect Correct answer

Lymphocytes 20% of total white blood cells

Correct Incorrect Correct answer

In immune thrombocytopenic purpura, what are the autoantibodies most commonly directed at?

Glycoprotein IIb/IIIa complex

Correct Incorrect Correct answer

Platelet activating factor

Correct Incorrect Correct answer

ATP receptor

Correct Incorrect Correct answer

Anti-thrombin III receptor

Correct Incorrect Correct answer

ADP receptor

Correct Incorrect Correct answer

A 34-year-old man who is known to have type 1 von Willebrand’s disease asks for advice. He is due to have a tooth extracted at the dentist next week. Which one of the following is the most appropriate management to reduce the risk of bleeding?

Desmopressin

Correct Incorrect Correct answer

Mefanamic acid

Correct Incorrect Correct answer

Vitamin K

Correct Incorrect Correct answer

Factor VIII concentrate

Correct Incorrect Correct answer

Factor VII concentrate

Correct Incorrect Correct answer

A 66-year-old woman is referred by her GP with anaemia. She has been feeling generally unwell for the past 3 weeks. Bloods on admission show:

Hb	87 g/L
MCV	87 fl
Plt	198 x 10⁹/l
WBC	5.3 x 10⁹/l

Further tests were then ordered:

Reticulocytes	5.2%
Direct antiglobulin test	Positive, IgG only
Film	Marked red cell agglutination at room temperature

Which one of the following is the most likely underlying cause?

Non-Hodgkin's lymphoma

Correct Incorrect Correct answer

Mycoplasma pneumonia

Correct Incorrect Correct answer

Chronic myeloid leukaemia

Correct Incorrect Correct answer

Acute myeloid leukaemia subtype M3

Correct Incorrect Correct answer

Cytomegalovirus infection

Correct Incorrect Correct answer

A 17-year-old man is investigated after he bled excessively following a tooth extraction. The following results are obtained:

Plt	173 x 10⁹/l
PT	12.9 secs
APTT	84 secs

The most likely clotting factor deficiency in this case is?

Factor VIII

Correct Incorrect Correct answer

Factor VI

Correct Incorrect Correct answer

Factor VII

Correct Incorrect Correct answer

Factor IX

Correct Incorrect Correct answer

Factor X

Correct Incorrect Correct answer

Which of the following is the best diagnostic test for paroxysmal nocturnal haemoglobinuria?

Flow cytometry for CD59 and CD55

Correct Incorrect Correct answer

Osmotic fragility test

Correct Incorrect Correct answer

FMC-7 staining

Correct Incorrect Correct answer

PAS staining of erythrocytes

Correct Incorrect Correct answer

Immunophenotyping for CD19 and CD20

Correct Incorrect Correct answer

A 25-year-old woman with primary antiphospholipid syndrome is reviewed. She has just had a booking ultrasound at 11 weeks gestation which confirms a viable pregnancy. This is her first pregnancy and she is otherwise fit and well.

Which one of the following is the recommend treatment?

Aspirin + low-molecular weight heparin

Correct Incorrect Correct answer

Aspirin + prednisone

Correct Incorrect Correct answer

Low-molecular weight heparin

Correct Incorrect Correct answer

Prednisone + low-molecular weight heparin

Correct Incorrect Correct answer

Aspirin

Correct Incorrect Correct answer

Transmission of which type of infection is most likely to occur following a platelet transfusion?

Bacterial

Correct Incorrect Correct answer

Syphilis

Correct Incorrect Correct answer

Malaria

Correct Incorrect Correct answer

Hepatitis B

Correct Incorrect Correct answer

HIV

Correct Incorrect Correct answer

Patients with Sjogren’s syndrome are at an increased risk of which one of the following malignancies?

Non-Hodgkin's lymphoma

Correct Incorrect Correct answer

Myeloma

Correct Incorrect Correct answer

Oesophageal cancer

Correct Incorrect Correct answer

Intraocular melanoma

Correct Incorrect Correct answer

Squamous cell skin cancer

Correct Incorrect Correct answer

A 14-year-old girl with sickle cell anaemia presents with abdominal pain. On examination she is noted to have splenomegaly and is clinically anaemic. What is the most likely diagnosis?

Sequestration crisis

Correct Incorrect Correct answer

Liver cirrhosis

Correct Incorrect Correct answer

Parvovirus infection

Correct Incorrect Correct answer

Salmonella infection

Correct Incorrect Correct answer

Thrombotic crisis

Correct Incorrect Correct answer

Which one of the following statements regarding heparin-induced thrombocytopaenia (HIT) is correct?

HIT is a prothrombotic condition

Correct Incorrect Correct answer

A fall in the platelet count of greater than 15% is diagnostic

Correct Incorrect Correct answer

Tranexamic acid is the treatment of choice

Correct Incorrect Correct answer

HIT usually develops with 2-3 days of starting treatment

Correct Incorrect Correct answer

HIT is more common with low-molecular weight heparin than with unfractionated heparin

Correct Incorrect Correct answer

Which of the following feature is not commonly associated with Waldenstrom’s macroglobulinaemia?

Bone pain

Correct Incorrect Correct answer

Cryoglobulinaemia

Correct Incorrect Correct answer

Retinal vein thrombosis

Correct Incorrect Correct answer

Hepatosplenomegaly

Correct Incorrect Correct answer

Monoclonal IgM paraproteinaemia

Correct Incorrect Correct answer

Cladribine is a recognised treatment for which haematological disorder?

Hairy cell leukaemia

Correct Incorrect Correct answer

Acute lymphoblastic leukaemia

Correct Incorrect Correct answer

Myelofibrosis

Correct Incorrect Correct answer

Burkitt's lymphoma

Correct Incorrect Correct answer

Acute myeloid leukaemia

Correct Incorrect Correct answer

A 17-year-old male is diagnosed with alpha-thalassaemia.

What chromosome is the alpha-globulin genes located on?

Chromosome 16

Correct Incorrect Correct answer

Chromosome 4

Correct Incorrect Correct answer

Chromosome 8

Correct Incorrect Correct answer

Chromosome 12

Correct Incorrect Correct answer

Chromosome 20

Correct Incorrect Correct answer

A 72-year-old woman is admitted with confusion and pallor. Her daughter reports that she has been getting more confused are tired for the past three months. Blood tests are reported as follows:

Hb	89 g/L
MCV	125 fl
Plt	148 x 10⁹/l
WBC	4.4 x 10⁹/l

In light of the macrocytic anaemia some further tests are ordered:

Intrinsic factor antibodies	Negative
Vitamin B12	94 ng/l (200-900 ng/l)
Folic acid	1.1 nmol/l (> 3.0 nmol/l)

What is the most appropriate management?

Intramuscular vitamin B12 + start oral folic acid when vitamin B12 levels are normal

Correct Incorrect Correct answer

Oral folic acid + blood transfusion

Correct Incorrect Correct answer

Oral folic acid + start Intramuscular vitamin B12 when folic acid levels are normal

Correct Incorrect Correct answer

Blood transfusion

Correct Incorrect Correct answer

Oral prednisone

Correct Incorrect Correct answer

Which of the following condition is associated with a high leucocyte alkaline phosphatase score?

Myelofibrosis

Correct Incorrect Correct answer

Pernicious anaemia

Correct Incorrect Correct answer

Infectious mononucleosis

Correct Incorrect Correct answer

Paroxysmal nocturnal haemoglobinuria

Correct Incorrect Correct answer

Chronic myeloid leukaemia

Correct Incorrect Correct answer

Which one of the following statements regarding warfarin is correct?

Warfarin can be used when breast-feeding

Correct Incorrect Correct answer

Hypothyroidism may develop in a small minority of patients

Correct Incorrect Correct answer

Aortic prosthetic valves generally require a higher INR than mitral valves

Correct Incorrect Correct answer

The target INR following a pulmonary embolism is 3.5

Correct Incorrect Correct answer

All patients with an INR of greater than 6.0 should be given vitamin K

Correct Incorrect Correct answer

Which one of the following feature confirms the presence of CML?

Detection of t(9: 22) the Philadephia chromosome

Correct Incorrect Correct answer

Presence of leukocytosis

Correct Incorrect Correct answer

Presence of splenomegaly

Correct Incorrect Correct answer

Presence of hypermetabolic symptoms

Correct Incorrect Correct answer

Presence of a blast crisis.

Correct Incorrect Correct answer

A 72-year-old woman is found to have a marked lymphocytosis associated with smudge cells on the blood film. A diagnosis of chronic lymphocytic leukaemia is suspected. Which one of the following is the investigation of choice?

Immunophenotyping

Correct Incorrect Correct answer

Bone marrow aspiration

Correct Incorrect Correct answer

Protein electrophoresis

Correct Incorrect Correct answer

White cell scan

Correct Incorrect Correct answer

Bone marrow trephine

Correct Incorrect Correct answer

Haematology Module 6

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