Haematology Module 5

Which one of the following features is least recognised in thrombotic thrombocytopenic purpura?

Livedo reticularis

Correct Incorrect Correct answer

Fever

Correct Incorrect Correct answer

Microangiopathic haemolytic anaemia

Correct Incorrect Correct answer

Renal failure

Correct Incorrect Correct answer

Thrombocytopenia

Correct Incorrect Correct answer

Which one of the following would most likely suggest a leukaemoid reaction rather than chronic myeloid leukaemia?

Dohle bodies in the white cells

Correct Incorrect Correct answer

Raised packed cell volume

Correct Incorrect Correct answer

Right shift of neutrophils

Correct Incorrect Correct answer

A low leucocyte alkaline phosphatase score

Correct Incorrect Correct answer

Positive osmotic fragility test

Correct Incorrect Correct answer

A 62-year-old man presents with lethargy. A full blood count is taken and is reported as follows:

Hb	102 g/l
Platelets	330 x 10⁹/l
WBC	15.2 x 10⁹/l
Film	Leucoerythroblastic picture. Tear-drop poikilocytes seen

What is the most likely diagnosis?

Myelofibrosis

Correct Incorrect Correct answer

Myelodysplasia

Correct Incorrect Correct answer

Chronic lymphocytic leukaemia

Correct Incorrect Correct answer

Chronic lymphocytic leukaemia

Correct Incorrect Correct answer

Post-splenectomy

Correct Incorrect Correct answer

A 24-year-old nulliparous female with a history of recurrent deep vein thrombosis presents with shortness of breath. The full blood count and clotting screen reveals the following results:

Hb	124 g/l
Plt	137 x 10⁹/l
WBC	7.5 x 10⁹/l
PT	14 secs
APTT	46 secs

What is the most likely underlying diagnosis?

Antiphospholipid syndrome

Correct Incorrect Correct answer

Third generation oral contraceptive pill use

Correct Incorrect Correct answer

Protein C deficiency

Correct Incorrect Correct answer

Antithrombin III deficiency

Correct Incorrect Correct answer

Activated protein C resistance

Correct Incorrect Correct answer

A 34-year-old female develops a purpuric rash on the back of her legs. Her only regular medication is Microgynon 30. She also reports frequent nose bleeds and menorrhagia. A full blood count is requested:

Hb	117 g/l
Platelets	62 x 10⁹/l
WCC	5.3 x 10⁹/l
PT	11 secs
APTT	30 secs
Factor VIIIc activity	Normal

What is the most likely diagnosis?

Immune thrombocytopenic purpura

Correct Incorrect Correct answer

Drug-induced thrombocytopenia

Correct Incorrect Correct answer

Henoch-Schonlein purpura

Correct Incorrect Correct answer

Thrombotic thrombocytopenic purpura

Correct Incorrect Correct answer

Antiphospholipid syndrome

Correct Incorrect Correct answer

A 26-year-old man with a history of hereditary haemorrhagic telangiectasia is planning to start a family. What is the mode of inheritance of this condition?

Autosomal dominant

Correct Incorrect Correct answer

Autosomal dominant with incomplete penetrance

Correct Incorrect Correct answer

Autosomal codominant

Correct Incorrect Correct answer

Autosomal recessive with incomplete penetrance

Correct Incorrect Correct answer

Autosomal recessive

Correct Incorrect Correct answer

A man is investigated for anaemia. His blood film shows ring sideroblasts.

Which one of the following is less likely to give this picture?

Vitamin B12 deficiency

Correct Incorrect Correct answer

Anti-tuberculosis medication

Correct Incorrect Correct answer

Vitamin B6 deficiency

Correct Incorrect Correct answer

Lead poisoning

Correct Incorrect Correct answer

Myelodysplasia

Correct Incorrect Correct answer

A 32-year-old woman presents with menorrhagia and a persistent sore throat. Her current medications include Olanzapine for bipolar disorder and Montelukast for exercise induced asthma. She also takes oral clomiphene to help regulate her ovulation.

She was also recently commenced on oral trimethoprim for a urinary tract infection. A ful blood count shows the following:

Hb	68 g/l
Platelets	45 x 10⁹/l
WBC	1.4 x 10⁹/l
Neutrophils	0.8 x 10⁹/l

Which medication may have caused this?

Trimethoprim

Correct Incorrect Correct answer

Olanzapine

Correct Incorrect Correct answer

Montelukast

Correct Incorrect Correct answer

Clomifene

Correct Incorrect Correct answer

A 35-year-old female who is 34 weeks pregnant presents with a swollen, painful right calf. A deep vein thrombosis is confirmed on Doppler scan. What is the preferred anticoagulant?

Low molecular weight heparin (LMWH)

Correct Incorrect Correct answer

Apixaban

Correct Incorrect Correct answer

Low dose Rivaroxaban

Correct Incorrect Correct answer

Intravenous Heparin

Correct Incorrect Correct answer

Warfarin

Correct Incorrect Correct answer

A 67-year-old woman is referred to the haematology clinic. Her GP has noted that her platelet count is persistently elevated and no reactive cause can be found. Bloods taken a week before clinic are as follows:

Hb	154 g/l
Platelets	784 x 10⁹/l
WBC	5.3 x 10⁹/l
JAK2 kinase (V617F mutation)	Positive

What is the treatment of choice?

Hydroxyurea

Correct Incorrect Correct answer

No specific therapy required.

Correct Incorrect Correct answer

Ruxolitinib

Correct Incorrect Correct answer

Prednisone

Correct Incorrect Correct answer

Venesection

Correct Incorrect Correct answer

A 74-year-old woman with a past history of chronic lymphocytic leukaemia presents with lethargy. The following blood results are obtained:

Hb	79 g/l
Platelets	158 x 10⁹/l
WBC	24.0 x 10⁹/l
Blood film:	normochromic, normocytic anaemia

Which complication most likely occurred?

Warm autoimmune haemolytic anaemia

Correct Incorrect Correct answer

Paroxysmal nocturnal haemoglobinuria

Correct Incorrect Correct answer

Microangiopathic haemolytic anaemia

Correct Incorrect Correct answer

Sideroblastic anaemia

Correct Incorrect Correct answer

Cold autoimmune haemolytic anaemia

Correct Incorrect Correct answer

A 31-year-old man is referred to the acute medical unit with a painful swollen left leg. The patient reports that he has the ‘Factor V Leiden mutation’. Which one of the following best describes the pathophysiology of his condition?

Resistance to action of protein C

Correct Incorrect Correct answer

Protein S deficiency

Correct Incorrect Correct answer

Activated protein C excess

Correct Incorrect Correct answer

Antithrombin deficiency

Correct Incorrect Correct answer

Activated protein C deficiency

Correct Incorrect Correct answer

A 31-year-old woman who is 25-weeks pregnant is brought to the Emergency Department by her husband. Over the past two days she has become increasingly confused. Her temperature is 37.8ºC and blood pressure is 104/62 mmHg. Blood tests show:

Hb	83 g/l
Platelets	88 x 10⁹/l
WBC	15.1 x 10⁹/l
Blood film	Fragmented red blood cells
Sodium	139 mmol/l
Potassium	5.2 mmol/l
Urea	19.4 mmol/l
Creatinine	296 μmol/l

What is the most appropriate treatment?

Plasma exchange

Correct Incorrect Correct answer

Rituximab

Correct Incorrect Correct answer

Intravenous immunoglobulin

Correct Incorrect Correct answer

Methylprednisolone

Correct Incorrect Correct answer

Ceftriaxone + vancomycin

Correct Incorrect Correct answer

What is the most common inherited bleeding disorder?

von Willebrand's disease

Correct Incorrect Correct answer

Haemophilia A

Correct Incorrect Correct answer

Activated protein C resistance

Correct Incorrect Correct answer

Haemophilia B

Correct Incorrect Correct answer

Antithrombin III deficiency

Correct Incorrect Correct answer

Which one of the following is the most common type of Hodgkin’s lymphoma?

Nodular sclerosis

Correct Incorrect Correct answer

Lymphocyte predominant

Correct Incorrect Correct answer

Lymphocyte depleted

Correct Incorrect Correct answer

Mixed cellularity

Correct Incorrect Correct answer

Hairy cell

Correct Incorrect Correct answer

A 45-year-old man known to have haemochromatosis attends for blood test to assess when he next needs venesection.

Which of the following blood test is commonly used to assess the adequacy of venesection?

Ferritin

Correct Incorrect Correct answer

Serum iron

Correct Incorrect Correct answer

Haemoglobin

Correct Incorrect Correct answer

Total iron binding capacity

Correct Incorrect Correct answer

Haematocrit

Correct Incorrect Correct answer

A 64-year-old man is reviewed in the haematology clinic. Which one of the following features would suggest that a diagnosis monoclonal gammopathy of undetermined significance is more likely than myeloma?

IgG paraprotein band = 18g/

Correct Incorrect Correct answer

Bone pain

Correct Incorrect Correct answer

Creatinine = 160 μmol/l

Correct Incorrect Correct answer

Raised beta-2 microglobulin

Correct Incorrect Correct answer

Lytic lesions on x-ray

Correct Incorrect Correct answer

Based on the Ann-Arbor classification of Hodgkin’s lymphoma, which one of the following would be staged as IIIB?

Nodes on both sides of diaphragm with night sweats

Correct Incorrect Correct answer

Nodes on both sides of diaphragm with pruritus

Correct Incorrect Correct answer

Two or more lymph nodes on the same side of the diaphragm with pruritus

Correct Incorrect Correct answer

Two or more lymph nodes on the same side of the diaphragm with night sweats

Correct Incorrect Correct answer

Two or more lymph nodes on the same side of the diaphragm with no systemic symptoms

Correct Incorrect Correct answer

What are the most common types of transformations seen in patients with polycythaemia rubra vera?

Myelofibrosis + acute myeloid leukaemia

Correct Incorrect Correct answer

Myelodysplasia + chronic myeloid leukaemia

Correct Incorrect Correct answer

Myelofibrosis + chronic myeloid leukaemia

Correct Incorrect Correct answer

Myelodysplasia + myelofibrosis

Correct Incorrect Correct answer

Myelodysplasia + acute myeloid leukaemia

Correct Incorrect Correct answer

Each one of the following is associated with iron-deficiency anaemia, except:

Onycholysis

Correct Incorrect Correct answer

Atrophic glossitis

Correct Incorrect Correct answer

Post-cricoid webs

Correct Incorrect Correct answer

Koilonychia

Correct Incorrect Correct answer

Angular stomatitis

Correct Incorrect Correct answer

Burkitt’s lymphoma is associated with a mutation in which one of the following genes?

MYC gene

Correct Incorrect Correct answer

Cyclin D1 gene

Correct Incorrect Correct answer

PML gene

Correct Incorrect Correct answer

BCR-ABL gene

Correct Incorrect Correct answer

RAR-alpha gene

Correct Incorrect Correct answer

A 18-year-old man who is known to have hereditary spherocytosis is admitted to hospital with lethargy. Admission bloods show the following:

Hb	47 g/L
Reticulocytes	0.3%

What is the most likely explanation for these findings?

Parvovirus infection

Correct Incorrect Correct answer

Haemolytic crisis

Correct Incorrect Correct answer

Recent ciprofloxacin therapy

Correct Incorrect Correct answer

Sequestration crises

Correct Incorrect Correct answer

Angiodysplastic bowel lesions

Correct Incorrect Correct answer

A 23-year-old woman presents with lethargy. There is no history of bleeding. The following blood results are obtained:

Hb	104 g/L
Plt	278 x 10⁹/l
WCC	6.3 x 10⁹/l
MCV	68 fl
Blood film	Microcytic hypochromic RBCs, marked anisocytosis and basophilic stippling noted
HbA2	3.9%

What is the most likely diagnosis?

Beta-thalassaemia minor

Correct Incorrect Correct answer

Lead poisoning

Correct Incorrect Correct answer

Sickle cell anaemia

Correct Incorrect Correct answer

Hereditary spherocytosis

Correct Incorrect Correct answer

Sideroblastic anaemia

Correct Incorrect Correct answer

A 30-year-old man enquires about screening for haemochromatosis as his brother was diagnosed with the condition 2 years ago. The patient is currently well with no features suggestive of haemochromatosis. What is the most appropriate investigation?

HFE gene analysis

Correct Incorrect Correct answer

Serum total iron-binding capacity

Correct Incorrect Correct answer

Serum transferrin saturation

Correct Incorrect Correct answer

Serum ferritin

Correct Incorrect Correct answer

Serum iron

Correct Incorrect Correct answer

You review a 61-year-old woman with end stage kidney failure. Four months ago she developed a deep vein thrombosis and was warfarinised with a target INR of 2.5.

She now presents with a swollen, tender left calf and Doppler scan confirms a further deep vein thrombosis. Her INR has been above 2.0 for the past three months.

What should happen in regards to her anti-coagulation?

Continue on warfarin but increase INR target to 3.5

Correct Incorrect Correct answer

Switch to treatment dose low-molecular weight heparin

Correct Incorrect Correct answer

Continue on warfarin, continue with INR target of 2.5

Correct Incorrect Correct answer

Add aspirin 75 mg od

Correct Incorrect Correct answer

Switch to oral dabigatran.

Correct Incorrect Correct answer

Which one of the following condition is least associated with thrombocytopenia?

Rheumatoid arthritis

Correct Incorrect Correct answer

Heparin therapy

Correct Incorrect Correct answer

Infectious mononucleosis

Correct Incorrect Correct answer

Liver disease

Correct Incorrect Correct answer

Pregnancy

Correct Incorrect Correct answer

Each one of the following is associated with hyposplenism, except:

Cardiac failure

Correct Incorrect Correct answer

Hereditary spherocytosis

Correct Incorrect Correct answer

Systemic lupus erythematous

Correct Incorrect Correct answer

Coeliac disease

Correct Incorrect Correct answer

Splenectomy

Correct Incorrect Correct answer

The following intervention is useful in the management of diffuse large B-cell lymphoma except?

Prophylactic intrathecal chemotherapy

Correct Incorrect Correct answer

R-CHOP chemotherapy

Correct Incorrect Correct answer

Rituximab combined with doxorubicin, cyclophosphamide, vindesine, bleomycin, and prednisone (R-ACVBP)

Correct Incorrect Correct answer

Autologous stem cell transplantation

Correct Incorrect Correct answer

Rituximab with dexamethasone, high-dose cytarabine, and cisplatin [R-DHAP]

Correct Incorrect Correct answer

Haematology Module 5

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