General

Question 1

Constituents of the blood

Answer 1

Plasma
RBCs
Platelets
WBCs

Question 2

What % of blood is plasma

Answer 2

55%

Question 3

What % of the blood is RBCs, Platelets or WBCs

Answer 3

45%

Question 4

Where are RBCs produced

Answer 4

Bone marrow

Question 5

Describe appearance of RBC

Answer 5

Biconcave

Anucleated

Question 6

Lifespan of RBC

Answer 6

120 days

Question 7

Where does eryptosis occur

Answer 7

Old RBCs are destroyed by spleen, liver and bone marrow

Question 8

Types of WBCs

Answer 8

Granulocytes
Lymphocytes
Monocytes

Question 9

Types of Granulocytes

Answer 9

Neutrophils
Basophils
Eosinophils

Question 10

Features of neutrophil (appearance etc)

Answer 10

Multi-lobular nucleus

Phagocytic and play a role in inflammation, infection and myeloid leukemia

Question 11

Features of eosinophil (appearance etc)

Answer 11

Bi-lobular or tri-lobular nuclei
Show diurnal variation, being more common in morning
Number raised in parasitic infections

Question 12

Features of basophil (appearance etc)

Answer 12

Associated with hypersensitivity reactions

Similar role to mast cells - secrete histamine when stimulated

Question 13

Types of lymphocytes

Answer 13

T cells - mediators in cellular immunity

B-cells - mediators in humoral immunity e.g. antibody mediated responses

Question 14

Types of T-cells

Answer 14

Cytotoxic (CD8+)

T-helper (CD4+)

Question 15

Features of lymphocytes

Answer 15

Numbers increase in viral infection, inflammation and leukaemia
Numbers decrease in HIV and chemotherapy

Question 16

Features of monocytes

Answer 16

Immature cells that differentiate once they leave the bloodstream
Many monocytes form macrophages

Question 17

Where are platelets derived from

Answer 17

Megakaryocytes in bone marrow

Question 18

Functions of platelets

Answer 18

Major role in clotting:

Platelet plug and Coagulation cascade (cascade helps to strengthen the platelet plug, ultimately producing fibrin)

Question 19

Functions of thrombin

Answer 19

Converts fibrinogen to fibrin
Activates factor XIII to XIIIa
Positive feedback effect on further thrombin production

Question 20

What factors in coagulation cascade are inhibited by warfarin/vitamin K deficiency

Answer 20

2 (pro-thrombin), 7, 9, 10

Question 21

What factor in coagulation cascade is inhibited by Heparin or NOACs

Answer 21

Xa

Question 22

What is function of plasmin

Answer 22

Cuts fibrin into fragments

Prevents blood clots from growing and becoming problematic

Question 23

Important of liver to clotting

Answer 23

Liver synthesises many coagulation factors

Liver produces BILE sals needed for Vitamin K absorption

Question 24

Examples of Haematological investigations

Answer 24

FBC
Reticulocyte count
Serum ferritin (measure iron levels in body)
Blood film

Question 25

What can a FBC show you

Answer 25

``` Red blood cell volume WBC volume Platelet volume Hb conc Mean corpuscular volume etc ```

Question 26

Purpose of Reticulocyte count

Answer 26

Allows you to see how quickly the bone marrow is producing new RBCs

Question 27

What is implied by a low reticulocyte count

Answer 27

indicative that something is preventing RBCs from being produced e.g. a haematinic deficiency

Question 28

What is implied by a high reticulocyte count

Answer 28

Indicate that RBCs are being lost or destroyed (e.g. bleeding / haemolytic anaemia). New RBC production is increased to act as a compensatory mechanism

Question 29

When can serum ferritin be falsely high?

Answer 29

Inflammation | Malignancy

Question 30

Describe process of blood film

Answer 30

Smears of blood are placed onto slides and then examined under a microscope.

Question 31

Types of Blood film

Answer 31

Thick | Thin

Question 32

What can you examine with thick blood film

Answer 32

examination of a large amount of blood for the presence of parasites

Question 33

What can you observe with thin blood film

Answer 33

Observation of RBC morphology, inclusion and Intra/Extra-cellular parasites

Question 34

Normal function of Hb

Answer 34

To carry and deliver oxygen to tissues

Question 35

``` What is the characteristic genetic abnormality in Chronic Myeloid Leukaemia? t(15;17) ATRA gene t(9;22) Philadelphia chromosome t(8;21) AML/ETO gene t(8;14) cMYC oncogene ```

Answer 35

t(9;22) Philadelphia chromosome | Resulting in 210-kDa fusion protein –activated tyrosine kinase

Question 36

Chronic myeloid leukamia: | Describe investigations and their results

Answer 36

FBC - high WCC | Film - Left shift + basophilia

Question 37

Treatment of Chronic Myeloid Leukaemia and how it works

Answer 37

Imatinib: Blocks abnormal tyrosine kinase activity Can result in molecular remission BCR -ABL mutations may result in resistance

Question 38

What class of drug best describes Rituximab?

Answer 38

Monoclonal antibody

Question 39

How does Rituximab work

Answer 39

Monoclonal antibody that targets CD20 expressed on cell surface of B-cells Chimeric mouse/human protein Infusional side-effects Widely used

Question 40

Which age group is characteristically affected by Hodgkin’s lymphoma?

Answer 40

Teenagers and young adults

Question 41

How is myeloma bone disease usually assessed?

Answer 41

Plain X-ray | Lytic lesions seen

Question 42

How do lytic lesions result from myeloma bone disease

Answer 42

Production of Osteoclast-activating factors OAFs include RANKL, IL-3 and TNF-α

Question 43

Examples of Osteoclast-activating factors

Answer 43

RANKL, IL-3 and TNF-alpha

Question 44

``` What is the correct mechanism of action for the anti-emetic drug Ondansetron? Peripheral D2 antagonist Central D2 antagonist Anti-cholinergic 5HT3 antagonist ```

Answer 44

5HT3 antagonist | For chemo induced

Question 45

Anti-emetic for gastostasis

Answer 45

Pro-kinetics

Question 46

In sickle cell anaemia what would you expect to see the reticulocyte count?

Answer 46

Raised

Question 47

How many RBCs are lost per hour in body

Answer 47

9 billion

Question 48

``` Bacterial infection usually causes? Low lymphocytes Low neutrophils High lymphocytes High neutrophils ```

Answer 48

High neutrophil count

Question 49

Which best outlines the approach to the management of a patient with suspected febrile neutropaenia? Encourage fluids and paracetamol Perform cultures and wait for results before starting antibiotics Perform cultures and start oral antibiotics Perform cultures and start broad spectrum iv antibiotics

Answer 49

Perform cultures and start broad spectrum iv antibiotics

Question 50

Treatment of Febrile Neutropaenia

Answer 50

``` Haematologic emergency ABC Perform cultures Broad spectrum iv Abs with 1 hour E.g. Tazosin and Gentamicin ```

Question 51

Malignant spinal cord compression usually presents with: Back pain, ataxia and sensory neuropathy Back pain, spastic paresis and a sensory level Perianal numbness and urinary incontinence Weak legs impaired joint position sense

Answer 51

Back pain, spastic paresis and a sensory level

Question 52

*Treatment of malignant spinal cord compression

Answer 52

``` Emergency Urgent MRI Bed rest + pressure area care Steroids Analgesia Chemo or Radiotherapy ```

Question 53

How does Aspirin exert its antiplatelet effect?

Answer 53

Inhibition of Cyclooxygenase enzyme

Question 54

How does Tirofiban exert its antiplatelet effect

Answer 54

Inhibition of Glycoprotein IIb-IIIa

Question 55

How does Clopidogrel exert its antiplatelet effect

Answer 55

Inhibition of P2Y12

Question 56

Describe platelet function

Answer 56

P2Y12 and Glycoprotein IIbIIIa help make ARACHIODONIC ACID ->PGH2: with COX1 -> TXA2 or with COX2 -> PGI1