haem

Question 1

blood test results in VWD:
- bleeding time:
- platelet count:
- prolonged APTT:

Answer 1

• bleeding time: increased
• platelet count: normal
• prolonged APTT: increased

Question 2

____________ 1st line imaging in suspected multiple myeloma

Answer 2

Whole body MRI

Question 3

B thalassaemia: ____ reticulocytes and ____ bilirubin

Answer 3

raised, raised

bilirubin is normal in iron deficient anaemia

Question 4

Bleeding on dabigatran? Can use _______ to reverse

Answer 4

idarucizumab

Question 5

_________is used for the reversal of apixaban or rivaroxaban

Answer 5

Andexanet alfa

Question 6

The blood tests show a __________________________, characteristic of DIC. The condition is associated with ___________ on blood film.

Answer 6

depletion of platelets and coagulation factors
schistocytes

Question 7

weight loss, pallor, thrombocytosis, raised neutrophils, low/normal other WBCs, anaemia ‘sense of fullness’ –>

Answer 7

CML
splenomegaly

Question 8

___________ is usually picked up as an incidental finding of lymphocytosis, as it has no symptoms

Answer 8

Chronic lymphocytic leukaemia (CLL)

Question 9

how to diagnose a haem malognancy?

Answer 9

Step given by my lecturer (simple yet helpful)
1. Look at lymphocytes
2. Look at WBC
3. Others hint (blast cell/ bands)

Example
1.Low Lymphocytes -> the answer should be AML or CML
2. WBC > 100 -> Chronic causes so Consider CML (rule out AML)
3. Presence of bands cell -> confirm CML

*blast -> Acute
*bands -> Chronic

Question 10

Deranged coagulation in sepsis ->

Answer 10

DIC

Question 11

DIC bloods (coag screen)

Answer 11

low platelets, increased clotting time and raised fibrin degradation products (FDPs), schistocytes

Question 12

Heparin-induced thrombocytopenia usually happens ________ post-heparin exposure

Answer 12

5-14 days

Question 13

Answer 13

Question 14

B-thalassemia major - when does it present, blood tests, Tx

Answer 14

when: within first year of life
blood tests: HBA2 and HbF raised, HbA absent

Mx: repeated transfusion (risk: iron overload)

Question 15

Blood films: what are the conditions associated with:
1. Target cells:
2. Tear-drop cells:
3. Spherocytes:
4. Basophilic stippling:
5. Howel-Jolly bodies:
6. Heinz bodies:
7. Schistocytes (helmet cells):
8. Burr cells:
9. hypersegmented neutrophils:

Answer 15

1. Target cells: sickle-cell, thalassaemia, iron deficiency, hyposplenism, liver disease
2. Tear-drop cells: myelofibrosis
3. Spherocytes: spherocytosis, AIHA
4. Basophilic stippling: sideroblastic, thalassaemia, lead-poinsoning, myelodysplasia
5. Howel-Jolly bodies: hyposplenism
6. Heinz bodies: G6PD deficiency, A-thalassaemia
7. Schistocytes (helmet cells): haemolysis, mechanical heart valve, DIC
8. Burr cells: uraemia
9. hypersegmented neutrophils: megaloblastic anaemia

Question 16

complications of blood transfusion

Answer 16

1. immunological - acute haemolytic, non-haemolytic febrile, allergic, anaphylaxis
2. infective
3. TRALI
4. TACO
5. HyperK
6. HyperFe
7. clotting

Question 17

key investigation for CLL (other than bone marrow biopsy)

Answer 17

immunotyping

Question 18

________ is marked in CML

Answer 18

splenomegaly

Question 19

difference in inheritance between two haemolytic anaemias, G6PD and hereditary spherocytosis

Answer 19

G6PD: X-linked recessive
spherocytosis: AD

Question 20

Haematological malignancies: infections

Hodgkin’s and Burkitt’s lymphoma, nasopharyngeal carcinoma:

High-grade B-cell lymphoma:

gastric lymphoma (MALT):

Burkitt’s lymphoma:

Answer 20

Hodgkin’s and Burkitt’s lymphoma, nasopharyngeal carcinoma: EBV

High-grade B-cell lymphoma: HIV

gastric lymphoma (MALT): H.Pylori

Burkitt’s lymphoma: Malaria

Question 21

what is increased in haemophilia?

Answer 21

APTT

Question 22

lacunar cells are found in

Answer 22

nodular sclerosing Hodgkin’s lymphoma

Question 23

New system of staging Hodgkin’s Lymphoma?

Answer 23

Lugano classification

Question 24

ITP - 1st line Tx? Ix result?

Answer 24

Isolated thrombocytopenia
Tx: 1st line is predinosolone
2nd line: IVIG

Question 25

what is Evans syndrome

Answer 25

ITP in association with AIHA

Question 26

AOCD vs Iron deficient anaemia - serum iron, ferritin, TIBC and transferrin results?

Answer 26

Fe-deficient: iron and ferritin low, transferrin low, TIBC high AOCD: iron low, ferritin high, transferrin low, TIBC low

Question 27

Drainage of the ovaries, uterus and cervix

Answer 27

The ovaries drain to the para-aortic lymphatics. Uterus: iliac lymph nodes Cervix: internal and external iliac lymph nodes

Question 28

polycthaemia vera Mx

Answer 28

aspirin: reduce risk of thrombotic events venesection

Question 29

_________________ should be suspected in any patient presenting with an acute kidney injury in the presence of a high phosphate and high uric acid level.

Answer 29

tumour lysis syndrome

Question 30

vWD pattern of inheritence

Answer 30

AD (except type 3 which is AR)

Question 31

Tx for vWD

Answer 31

tranexamic acid, desmopressin, factor Vlll concentrate

Question 32

mainstay Tx for Pts undergoing sickle cell vaso-occlusive crisis? what do you add depending on infection/low Hb?

Answer 32

oxygen with IV analgesia and IV fluids. IV abx, blood transfusion

Question 33

Polycythaemia vera blood results

Answer 33

isolated increase in Hb low ESR JAK2 mutation

Question 34

Hodgkin's lymphoma - most common type =

Answer 34

nodular sclerosing

Question 35

tricuspid regurg would cause what murmur

Answer 35

It would cause a pan-systolic murmur, as, during systole, the blood is ejected from the ventricles which are contracting

Question 36

Poor prognostic factors of ALL

Answer 36

- presenting <2 years or >10 years - having B or T cell surface markers - having a WCC > 20 * 10^9/l at diagnosis - male sex

Question 37

Steroids tend to cause a neutrophilia

Question 38

Anaphylaxis - serum tryptase levels _____following an acute episode

Answer 38

rise

Question 39

ALL is the most common childhood leukaemia and presents with

Answer 39

anaemia, neutropaenia and thrombocytopaenia

Question 40

Acute chest syndrome is defined as

Answer 40

new pulmonary infiltrates on chest x-ray along with dyspnoea, chest pain, cough or hypoxia.

Question 41

Burkitt's lymphoma - ______gene translocation

Answer 41

c-myc

Question 42

_______________can present with bone marrow failure, due to ineffective haematopoeisis. Furthermore, bone marrow biopsy may show ring sideroblasts, as described in this patient

Answer 42

myelodysplasia

Question 43

Failure to fully recover from abx with swinging fever

Answer 43

empyema

Question 44

vast majority of erythema multiforme are due to?

Answer 44

herpes simplex virus

Question 45

________________can give a falsely high HbA1c level due to the increased lifespan of RBCs

Answer 45

Splenectomy

Question 46

Ix of choice for Non-Hodgkin's lymphoma?

Answer 46

Excisional node biopsy

Question 47

Platelet thresholds for transfusion________________________ for patients with severe bleeding, or bleeding at critical sites, such as the CNS

Answer 47

are higher (maximum < 100 x 10 9)

Question 48

which drugs can trigger G6PD?

Answer 48

sulph- drugs: sulphonamides, sulphasalazine and sulfonylureas can trigger haemolysis, ciprofloxacin too

Question 49

Platelet transfusion threshold:

Answer 49

30 x 109 for patients not bleeding or having an invasive procedure- except where CI or alternative treatments for their condition

Question 50

Platelet transfusion threshold for Pt with severe bleeding?

Answer 50

<100 x 10^9