Haem / Onco

Question 1

4 causes of microcytic anaemia

Answer 1

TICS

• Thalassaemia
• Iron deficiency
• anaemia of Chronic disease
• Sideroblastic anaemia

Question 2

An elderly man with hypochromic, microcytic anaemia is asymptomatic. Diagnostic tests?

Answer 2

Faecal occult blood test & sigmoidoscopy

Suspect colorectal cancer

Question 3

Precipitants of haemolytic crisis in patients with G6PD deficiency

Answer 3

Sulphonamides, antimalarial drugs, fava beans

Question 4

The most common inherited cause of hypercoagulability

Answer 4

Factor 5 Leiden mutation

Question 5

The most common inherited haemolytic anaemia

Answer 5

Hereditary spherocytosis

Question 6

Diagnostic test for hereditary spherocytosis

Answer 6

Osmotic fragility test

Question 7

Pure RBC aplasia. Diagnosis?

Answer 7

Diamond-Blackfan anaemia

Question 8

Anaemia associated with absent radii and thumbs, diffuse hyperpigmentation, cafe au lait spots, microcephaly & pancytopenia

Answer 8

Fanconi anaemia

Question 9

Medications and viruses that lead to aplastic anaemia

Answer 9

Chloramphenicol, sulphonamides, chemo, radiation

HIV, hepatitis, parvovirus B19, EBV

Question 10

How to distinguish polycythemia Vera from secondary polycythemia

Answer 10

Both have raised Hct & RBC mass BUT

PV should have normal oxygen sats and low Epo

Question 11

Thrombotic thrombocytopenic purpura (TTP) pentad

Answer 11

FAT RN

• Fever
• Anaemia
• Thrombocytopenia
• Renal dysfunction
• Neurological abnormalities

Question 12

Haemolytic uraemic syndrome (HUS) triad

Answer 12

Anaemia
Thrombocytopenia
Acute renal failure

Question 13

Treatment for TTP

Answer 13

Emergency large volume plasmapheresis, corticosteroids, anti platelet drugs

Platelet transfusion is CONTRAINDICATED

Question 14

Treatment for idiopathic thrombocytopenic purpura (ITP) in kids

Answer 14

Usually resolves spontaneously

May require IVIG and/or corticosteroids

Question 15

Patten of fibrin split products, D-dimer, fibrinogen, platelets and Hct in DIC

Answer 15

Raised: FSP & D-dimer

Low: plts, fibrinogen & Hct

Question 16

8yo boy presents with hemarthrosis and high PTT with normal PT and bleeding time.
Diagnosis?
Treatment?

Answer 16

Haemophilia A or B

Desmopressin (haemophilia A) OR factor 8 or 9 supplements

Question 17

14yo girl presents with prolonged bleeding after dental surgery and with menses, normal PT, normal or raised APTT, and raised bleeding time

Answer 17

VWD

Tx: desmopressin, FFP or cryoprecipitate

Question 18

60 yo African American man presents with bone pain.

Work up for multiple myeloma?

Answer 18

Monoclonal gammopathy
Bence-Jones proteinuria
Punched out lesions on radiographs of skull and long bones

Question 19

Reed-Sternberg cells

Answer 19

Hodgkin’s lymphoma

Question 20

10yo boy presents with fever, weight loss, night sweats. O/E anterior mediastinal mass

Answer 20

Non-Hodgkin lymphoma

Question 21

Microcytic anaemia with low serum Fe, low TIBC, normal/high ferritin

Answer 21

Anaemia of chronic disease

Question 22

Microcytic anaemia with low serum Fe, low ferritin and high TIBC

Answer 22

Fe deficiency anaemia

Question 23

80yo man presents with fatigue, lymphadenopathy, splenomegaly, and isolated lymphocytosis

Answer 23

CLL

Question 24

Patient with fatigue is found to have a low Hb and raised MCV

Answer 24

B12 deficiency

• pernicious anaemia
• vegetarian diet
• Crohns/GI disorder

Folate
- alcoholics

Question 25

Late, life-threatening complication of CML

Answer 25

Blast crisis (fever, bone pain, splenomegaly, pancytopenia)

Question 26

Auer rods on blood smear

Answer 26

AML

Question 27

AML subtype associated with DIC. Tx?

Answer 27

M3 Tx: retinoic acid

Question 28

Electrolyte changes in tumour lysis syndrome

Answer 28

Low Ca | High K, Pi, uric acid

Question 29

50yo man presents with early satiety, splenomegaly and bleeding. Cytogenetics show t(9,22). Dx?

Answer 29

CML

Question 30

A patient on the chemotherapy service with an absolute neutrophil count (ANC) of 1000 is noted to have a fever of 38.8 (102.1). Next best step?

Answer 30

Neutropenic sepsis is a medical emergency Start broad-spec Abx

Question 31

Virus associated with aplastic anaemia in patients with sickle cell anaemia

Answer 31

Parvovirus B19

Question 32

A 25yo African American man with sickle cell anaemia has sudden onset of bone pain. Management?

Answer 32

Oxygen, analgesia, hydration, Transfusion (severe)

Question 33

A significant cause of morbidity in thalassaemia patients. Tx:

Answer 33

Iron overload use desferrioxime