DI

Question 1

What are common causes of pancytopenia?

Answer 1

Aplastic anaemia 
BM infiltration 
Hypersplenism 
Sepsis 
SLE

Question 2

Blood film abnormalities:

Hypochromic cells

Answer 2

Hypochromic cells - iron deficiency anaemia

Question 3

Blood film abnormalities:

Spherocytes

Answer 3

Hereditary spherocytosis
Haemolytic anaemia
Burns

Question 4

Blood film abnormalities:

Target cells

Answer 4

Thalassaemia
Iron deficiency
Post-splenectomy
Liver disease

Question 5

Blood film abnormalities:

Fragmented cells

Answer 5

Microangiopathic haemolytic anaemia
Haemolytic uraemic syndrome
TTP
Mechanical heart valves

Question 6

Blood film abnormalities:

Howell-Jolly bodies

Answer 6

Hyposplenism

Post-splenectomy

Question 7

What test is the most commonly used clinically to assess the function of the liver?

Answer 7

Prothrombin time

Question 8

What test is commonly done to assess heparin use?

Answer 8

Activated partial thromboplastin time APTT

Question 9

Give some causes of a raised PT

Answer 9

Warfarin treatment
Liver disease
DIC

Question 10

Give some causes of a raised APTT

Answer 10

Heparin treatment
Haemophilia A/B
Liver disease
DIC

Question 11

What test is done to distinguish between the various causes of B12 deficiency?

Answer 11

Schilling test

Question 12

What can cause a high opening pressure of CSF?

Answer 12

Meningitis
Tumour
High ICP
Idiopathic intracranial HTN

Question 13

What can causes an elevated WCC in the CSF?

Answer 13

Cerebral infection - meningitis/encephalitis
Inflammatory diseases
Malignancy

Question 14

What cells would the CSF contain predominantly in…

a) bacterial meningitis
b) other infective causes

Answer 14

a) bacterial meningitis = neutrophils

b) other infective causes = lymphocytes

Question 15

What can causes raised protein in the CSF?

Answer 15

Meningitis, brain abscess, intracerebral haemorrhage, neoplastic disease, GBS, MS

Question 16

Give examples of neurophysiological investigations

Answer 16

• Nerve conduction studies
• Electromyography
• Visually evoked responses
• Electroencephalopathy

Question 17

Give an example of when a nerve conduction study would be used?

Answer 17

Carpal tunnel syndrome - median nerve

Question 18

When might electromyography be used?

Answer 18

MG

- Fatiguability following repetitive stimulation

Question 19

When might visually evoked responses be used?

Answer 19

MS

- delayed P100 latencies without amplitude loss

Question 20

Give other causes of oligoclonal bands in the CSF, other then MS?

Answer 20

GBS
Neurosyphilis
Lyme disease
Neurosarcoidosis

Question 21

What is the lights criteria?

Answer 21

It is used to distinguish with greater certainty between transudate and exudate effusions

1) Pleural fluid proteins
2) Serum fluid proteins
3) Lactate dehydrogenase levels

Question 22

What are the common parameters measured in pleural fluid and what can they be used for?

Answer 22

Total protein (lights) 
Lactate dehydrogenase (lights)  
Microscopy, cell count, gram stain & culture 
pH (low in empyema) 
Cytology (malignancy)

Question 23

What are the causes of a transudate pleural effusion?

Answer 23

(Proteins stopped - not enough to pass) 
Failures... 
Cardiac 
Liver (cirrhosis) 
Renal (nephrotic syndrome) 
Thyroid (hypo) 
Nutritional (low albumin)

Question 24

What are the causes of exudate pleural effusion?

Answer 24

(Proteins exciting - pumped out - local problem) 
Cancer 
Pneumonia 
PE/infarction 
TB 
Connective tissue disease (RA) 
Pancreatitis

Question 25

What is the most common cause of ascites?

Answer 25

Portal HTN secondary to liver cirrhosis

Question 26

What are the causes of transudate ascites?

Answer 26

Cirrhosis/liver failure
Cardiac failure
Hypoalbuminaemia
Nephrotic syndrome

Question 27

When classifying ascites - what can be measured other than proteins to improve the accuracy?

Answer 27

The serum-ascites-albumin gradient

Question 28

What are the parameters measured in ascitic fluid and what can they show?

Answer 28

WCC
Total protein and albumin (SAAG + Trans/exudate) 
Microscopy + culture + gram staining 
Glucose (low in malignancy) 
Cytology (malignancy) 
Amylase (high in pancreatitis)

Question 29

What Abs?

AI haemolytic anaemia

Answer 29

RBC autoantibodies

Question 30

What Abs?

AI hepatitis

Answer 30

Anti-nuclear
Anti-smooth muscle
Anti- liver/kidney microsomal 1
pANCA

Question 31

What Abs?

Addisons

Answer 31

Anti-21 hydroxylase

Question 32

What Abs?

Anti-phospholipid syndrome

Answer 32

Anti-cardiolipin

Lupus anti-coagulant abs

Question 33

What Abs?

a) diffuse cutaneous scleroderma
b) limited cutaneous scleroderma

Answer 33

a) Diffuse = Anti-ScL 70 + RF + ANA

b) Cutaneous = Anti-centromere

Question 34

What Abs?

Good pastures

Answer 34

Anti-glomerular basement membrane

Question 35

What Abs?

Pernicious anaemia

Answer 35

Anti-parietal cell

Anti-intrinsic factor

Question 36

What Abs?

Primary biliary cirrhosis

Answer 36

Anti-mitochondrial

Question 37

What Abs?

Sjogren syndrome

Answer 37

RF + ANA

Anti Ro + Anti La

Question 38

What Abs?

Wegener

Answer 38

cANCA

cytoplasmic anti-nuclear cytoplasmic antibody

Question 39

What can raise amylase?

Answer 39

Raised in:

• Pancreas - pancreatitis, pancreatic ca, DKA
• Salivary gland - mumps, salivary gland tumours
• Bowel - acute cholecystitis, bowel obstruction, perforated peptic ulcer, ruptured ectopic
• Kidney - renal disease

Question 40

Give causes of raised CK

Answer 40

• Muscle disease: rhabdomyolysis, muscular dystrophy
• Vigorous exercise
• Drugs: statins & AP
• Hypothyroidism

Question 41

When is lactate dehydrogenase a useful serum marker?

Answer 41

To look for haemolysis - RBC contain high amounts of this enzyme

Question 42

What is M protein a hallmark feature of?

Answer 42

Multiple Myeloma

Question 43

What 2 conditions cause a raised ESR but normal CRP?

Answer 43

SLE

MM