Platelets, petechiae, oncology

Question 1

A 6-year old otherwise well boy presents with petechiae around the ankles and buttocks. You suspect Henoch-Schonlein purpura. What is the cause of petechiae in this condition?

Question 1Select one:

a.
Liver synthetic deficiency

b.
Capillary fragility

c.
Thrombocytopaenia

d.
Fibrinogen deficiency

Answer 1

Capillary fragility

Question 2

A 9-month-old infant is referred by the after hours GP because of pallor and mild jaundice. The baby is breast fed as well has taking some solids. You note her to be very pale and she appears mildly icteric. You note a 3cm spleen. She is otherwise well and is thriving. You arrange a blood count with the following results: Hb 80 g/L MCV 98 fL WBC 10x10^9/L Platelets 300x10^9/L Bilirubin 70 mcmol/L.

Which ONE of the following is the MOST likely explanation for her current problem?

Question 2Select one:

a.
Nutritional anaemia

b.
Acute blood loss

c.
Acute hepatitis

d.
Haemolytic anaemia

Answer 2

Haemolytic anaemia

Haemolysis, large spleen confirms it

Question 3

Danny is 1 month old and has been diagnosed with Trisomy 21. You are explaining to his parents some of the later health risks that will need monitoring and vigil. There is an increased risk for WHICH ONE of the following malignancies in Trisomy 21?

Question 3Select one:

a.
Wilms tumour

b.
Leukaemia

c.
Astrocytoma

d.
Neuroblastoma

Answer 3

Leukaemia (interestingly enough, downs have less chance of solid tumour).

Question 4

A 6 year old girl, Cheryl, comes to the surgery with a rash on the lower limbs. It is a non-blanching rash on the lower limbs, consisting of small petechiae, most dense around the ankles and buttocks. There is no bruising. Cheryl is otherwise well.

WHICH ONE of the following is the MOST LIKELY diagnosis?

Question 4Select one:

a.
Idiopathic thrombocytopaenia

b.
Meningococcal septicaemia

c.
Acute lymphoblastic leukaemia (ALL)

d.
Henoch-Schonlein purpura

Answer 4

Henoch-Schonlein purpura

Question 5

A 6 year old girl, Cheryl, comes to the surgery with a rash on the lower limbs. It is a non-blanching rash on the lower limbs consisting of small petechiae, most dense around the ankles and buttocks. There is no bruising. She has some joint swelling and pain in the right wrist and both ankles. Cheryl is otherwise well.

WHICH ONE of the following IS NOT a characteristic feature of this condition?

Question 5Select one:

a.
Painless haematuria

b.
Acute abdominal pain

c.
Aortic regurgitation

d.
Urticarial skin lesions

Answer 5

Aortic regurgitation

nothing to do with capillaries

Question 6

A 16 month old presents two weeks after his MMR vaccine with extensive petechiae and bruising of the skin, and bleeding from the gums. His coagulation screen shows normal PT, APPT and fibrinogen. FBC shows Hb 115, WCC 6.3 and platelets 8. The MOST LIKELY diagnosis is:

Question 6Select one:

a.
Immune thrombocytopenic purpura

b.
Thrombus in blood collecting tube

c.
Congenital thrombocytopenia

d.
Acute lymphoblastic leukaemia

Answer 6

Immune thrombocytopenic purpura

triggered by vaccine

Question 7

A 3-year-old boy has had a sore throat for 3 weeks and has become pale and lethargic. You are worried about acute lymphoblastic leukaemia.

WHICH ONE of the following examination findings would be most CONCERNING regarding this diagnosis?

Question 7Select one:

a.
Clinically anaemic with petechiae

b.
Liver edge 1 cm below the costal margin

c.
Large tender tonsillar lymph nodes

d.
Clubbing of the fingernails and toenails

Answer 7

Clinically anaemic with petechiae

Question 8

A 3-year-old boy presents with a short history of limping. A full blood count shows the following:

Haemoglobin 105 g/L
White cell count 2.3 x 10^9/L
Neutrophils 1.3 x 10^9/L
Lymphocytes 1.0 x 10^9/L
Platelets 103 X 10^9/L
What diagnostic investigation does he need at this point?

Question 8Select one:

a.
Ultrasound hips

b.
Bone marrow

c.
ESR and CRP

d.
X-ray knees

Answer 8

Bone marrow

4x blood lines low

Question 9

WHICH ONE of the following is a common presentation of nephroblastoma (Wilms tumour) in children?

Question 9Select one:

a.
Polyuria, polydipsia, anorexia

b.
School-age onset of enuresis

c.
Incidental abdominal mass

d.
Pathological fracture of tibia

Answer 9

Incidental abdominal mass

Question 10

WHICH ONE of the following is not a typical presentation of acute lymphoblastic anaemia?

Question 10Select one:

a.
Cranial nerve palsy

b.
Pallor and bruising

c.
Diabetic ketoacidosis

d.
A new-onset limp

Answer 10

Diabetic ketoacidosis