Haematology

Question 1

AML poor prognostic factors (2)

Answer 1

> 60yo
20% blasts after first chemo

Question 2

Translocation 15;17
Average age 25yo
Auer rods
Presents with thrombocytopenia/ DIC
=

Answer 2

Acute promyelocytic leukaemia

Question 3

Antiphospholipid syndrome
Features (3)

Could be secondary to which condition?

Answer 3

Predisposition to:
1. Venous and arterial thrombus
2. Recurrent fetal aloss
3. Thrombocytopenia

SLE

Question 4

Antiphospholipid syndrome
In pregnancy which complications may occur? (6)

Answer 4

Recurrent miscarriage
IUGR
PET
Abruption
Pre-term labour
VTE

Question 5

Mx antiphospholipid syndrome in pregnancy (3)

Answer 5

Low dose aspirin once pregnancy confirmed
LMWH once FHR on US
Discontinue at K34

Question 6

1. Pancytopenia
2. Hypoplastic bone marrow
3. Could be the presenting feature of AML/ALL
4. Normochromic, normocytic anaemia
5. Lekopenia with lymphocytes spared

30yo

Answer 6

aplastic anaemia

Question 7

Auto immune haemolytic anaemia classification
Which is more common?
Which antibody?
Extra/intravascular?

Answer 7

Warm - most common, IgG, extravascular e.g spleen

Cold - less common, IgM, intravascular
Features Raynaud’s, acrocyanosis

Question 8

Causes of warm (3) and cold autoimmune haemolytic anaemia (2)

Which one response well to steroids?

Answer 8

Warm - underlying autoimmune condition e.g SLE, lymphoma, CLL
Steroids

Cold - lymphoma, EBV

Question 9

Beta thalassemia trait
What type of anaemia?
What may be raised?

Answer 9

Hypochromic, microcytic anaemia
HbA2 raised

Question 10

‘starry sky’ appearance: lymphocyte sheets interspersed with macrophages containing dead apoptotic tumour cells

Classification (2)

Answer 10

Burkitt’s lymphoma
1. Endemic (African) form - involves maxilla or mandible
2. Sporadic (most common) - common in pts with HIV

Question 11

What is strongly implicated in the development of the endemic Burkitt’s lymphoma?

Answer 11

EBV

Question 12

Tumour lysis syndrome signs (5)

Answer 12

AKI
Low calcium
High potassium, phosphate, uric acid

Question 13

CLL complications (3)

Answer 13

Hypogammaglobulinaemia leading to recurrent infections
Warm autoimmune haemolytic anaemia
High grade lymphoma

Question 14

What is Richter’s transformation?

Features (5)

Answer 14

Leukaemia turning into high grade Hodgkin’s lymphoma

1. Lymph node swelling
2. Fever without infection
3. Weight loss
4. Night sweats
5. AP

Question 15

CLL
Blood film
What will you seen on FBC?

Answer 15

Smudge cells
Anaemia
Lymphocytosis

Question 16

Raynaud’s
Ulceration
Arthralgia
Glomerulonephritis
=
Can be caused by? (3)

C4 high or low
ESR high or low

Answer 16

Cryoglobulinaemia
HIV/ hep C/ lymphoma

C4 low
High ESR

Question 17

Where would you see Howell Jolly bodies?

Answer 17

Asplenia

Question 18

How to diagnose DVT

Answer 18

Wells score
If =>2 US within 4 hours

If +ve - DOAC
If -ve do a d-dimer

If scan -ve but d-dimer +ve stop DOAC and repeat scan in 1 week

If <2
D-dimer within 4 hours
If negative then likely alternative diagnosis
If positive then US within 4 hours

Question 19

DVT length of anticoag

Answer 19

Provoked 3 months
Unprovoked 6 months total

Question 20

Three DOACs direct factor Xa inhibitor
x1 direct thrombin inhibitor
Reversal drugs

Answer 20

Rivarox
Apix
Edox
Reversal: Andexanet

Dabigatran
Reversal: Idarucizumab

Question 21

What is Fanconi anaemia? (5)

Answer 21

Aplastic anaemia
Increased risk of AML
Pancytopenia
Short stature
Cafe au lai spots

Question 22

G6PD deficiency is most common in which patient group?
Inheritance?

Answer 22

X linked recessive
Mediterranean & AFrica

Question 23

Features G6PD deficiency (4)
Blood film (2)

Answer 23

Neonatal jaundice
Intravascular haemolysis
Gall stones
Splenomegaly

Heinz bodies
Bite and blister cells

Question 24

G6PD deficiency
Diagnosis

Answer 24

G6PD enzyme assay three months after an acute episode of haemolysis

Question 25

Which drugs can precipitate haemolysis in G6PD defiency?

Answer 25

Primarquine Cipro Sulphonamides

Question 26

Hereditary spherocytosis Inheritance Patient group Features that make it different from G6PD deficiency(1)

Answer 26

AD Northern European Extravascular haemolysis

Question 27

Primary immunodeficiency Recurrent bacterial infections Eczema Thrombocytopenia Low IgM levels X linked recessive

Answer 27

Wiskott-Aldrich syndrome

Question 28

Weight loss Visual disturbance Hepatosplenomegaly Lymphadenopathy Cryoglobulinameia e.g Raynaud's

Answer 28

Waldenstrom's macroglobulinaemia

Question 29

Most common inherited bleeding disorder Inheritance Features (2)

Answer 29

Von Willebrand's disease AD Epistaxis Menorrhagia

Question 30

Von Willebrand's Ix (2) Mx (3)

Answer 30

APTT prolonged Factor VIII reduced TXA Desmopressin Factor VIII concentrate

Question 31

Rx essential thrombocytopenia (3)

Answer 31

Hydroxyurea Interferon a Low dose aspirin

Question 32

Essential thrombocytosis features (3)

Answer 32

Burning sensation in the hands Thrombosis and haemorrhage Platelet count >600

Question 33

Causes of splenomegaly (4)

Answer 33

Myelofibrosis CML Malaria Visceral leishmaniasis

Question 34

How often should sickle cell patients receive the pneumococcal vaccine?

Answer 34

Every 5 years

Question 34

Secondary causes of polycythaemia (4)

Answer 34

COPD Altitude Obstructive sleep anoea Excessive EPO

Question 34

Secondary causes of polycythaemia (4)

Answer 34

COPD Altitude Obstructive sleep anoea Excessive EPO

Question 35

What is polycythaemia? Mutation of what gene?

Answer 35

Overproduction of red blood cells JAK2

Question 36

Fatigue Dizziness Increased sweating Redness in the face Blurred vision Itchiness after a hot shower =

Answer 36

Polycythaemia rubra vera

Question 36

Polycythaemia features (7)

Answer 36

Hyperviscosity Pruritus Splenomegaly Haemorrhage Plethoric appearance HTN Low ESR

Question 37

Polycythaemia Age Mx (3)

Answer 37

60yo Aspirin, venesection, chemo (hydroxyurea)

Question 38

Polycythaemia can go on to develop which two diseases?

Answer 38

Myleofibrosis Acute leukaemia

Question 39

Haemophillia Inheritance A deficiency in factor? B deficiency in factor? Ix

Answer 39

X linked recessive A - factor 8 B factor 9 deficiency Prolonged APTT, all the rest normal

Question 40

Reed-Steenberg cell = Age?

Answer 40

Hodgkin's lymphoma 30yo and 70yo

Question 41

Hodgkin's lymphoma features (5)

Answer 41

Lymphadenopathy Weight loss Alcohol pain Eosinophilia LDH raised

Question 42

Mx immune thrombocytopenia

Answer 42

PO prednisolone IVIG

Question 43

What is Evan's syndrome?

Answer 43

ITP in association with autoimmune haemolytic anaemia

Question 44

In IDA a High TIBC/ transferrin =

Answer 44

Low iron stores

Question 45

abdominal pain peripheral neuropathy (mainly motor) neuropsychiatric features fatigue constipation blue lines on gum margin (only 20% of adult patients, very rare in children) =

Answer 45

Lead poisoning

Question 46

Lead poisoning investigations (3) Blood film (2)

Answer 46

Lead levels >10 Microcytic anaemia Raised serum and urine levels of aminolaevulinic acid Blood film: basophillic stippling, clover leaf morphology

Question 47

Mx lead poisoning (2)

Answer 47

Dimercaptosuccinic acid (DMSA) D penicillamine

Question 47

Causes of megaloblastic macrocytic anaemia (2)

Answer 47

B12 and folate

Question 48

usually asymptomatic no bone pain or increased risk of infections around 10-30% of patients have a demyelinating neuropathy paraprotinaemia normal immune function =

Answer 48

Monoclonal gammopathy of undetermined significance

Question 49

Myeloma features (5) Ix (3)

Answer 49

Bone pain Hypercalcaemia Renal failure Lethargy Infection Monoclonal antibodies (bence jones proteins) Whole body MR XR rain drop skull

Question 50

What is paroxysmal nocturnal haemoglobinuria? Features (4)

Answer 50

Acquired disorder leading to haemolysis More prone to venous thrombosis Haemolytic anaemia Pancytopenia Haemoglobinuria (dark coloured urine in the morning) Thrombosis (Budd Chiari syndrome)