Haematology

Question 1

How does polycythaemia vera present?

Answer 1

Itchyness, increased HB, and platelets, splenomegaly and HTN

Question 2

What does liver failure show in terms of coagulation study bloods?

Answer 2

Prolonged PT/APTT. All the clotting factors are low apart from Factor 8 which will be super high!

Question 3

Rouleaux formation is seen in which condition?

Answer 3

Myeloma

Question 4

What is the classical presentation for hereditary spherocytosis?

Answer 4

Neonatal jaundice, splenomegaly, failure to thrive

Question 5

Hereditary spherocytosis - what are the biochemical findings?

Answer 5

Haemolytic anaemia, increase unconjugated bilirubin, increased LDH, increased reticulocytes. raised mean haemoglobin concentration MCHC.

Question 6

What is the reference range for MCV ?

Answer 6

82-100

Question 7

Thalaessmia presents in childhood how? What are the biochemical findings?

Answer 7

Beta thalaessmia MAJOR- Anaemia, failure to thrive, frontal bossing of head
Microcytic anaemia with good iron stores.

Question 8

How does haemophilia present?

Answer 8

Bleeding
Early in life
Haemarthorses - bleeding into joints !

Question 9

What are the bloods for haemophilia?

Answer 9

Raised APTT (isolated)
Low factor 8/9 assay

Question 10

What are the INR ranges for stopping/ continuing warfarin in the context of no bleeding?

Answer 10

If over 8 and no bleeding- stop and give vit k
If 5-8 and no bleeding- withhold a couple of doses.

Question 11

Auer rods indicate?

Answer 11

Acute myeloid leukaemia

Question 12

How does acute lymphoblastic leukaemia present (biochemically)

Answer 12

Anaemia, Thromboyctopaenia, neutropenia. PANCYTOPAENIA

Question 13

Features of ALL

Answer 13

Most common malignancy in children
Hepatosplenomegaly
Fever
Recurrent infections

Question 14

Antiphospholid syndrome- what is seen on bloods and what is the biochemical picture?

Answer 14

Recurrent miscarriage
Anticardiolipin
Levido reticularis

On bloods
Thrombocytopenia
Prolonged APTT

First line management is Aspirin

Question 15

Smear cells are seen in?

Answer 15

CLL

Question 16

Myelofibrosis has which characteristic cell?

Answer 16

Tear drop cell

Question 17

Philadelphia chromosome is associated with which condition?

Answer 17

CML

Question 18

Reed stenberg cells are a/w which condition?

Answer 18

Hodgkins lymphoma

Question 19

What are the features of G6PD deficiency?

Answer 19

Precipitated by drugs/ fava beans
Intravascular haemolysis
Males
Mediterranean descent

Question 20

What is seen on a blood film for G6PD deficiency?

Answer 20

Heinz bodies

Question 21

Howell Jolley bodies are seen in?

Answer 21

Post splenectomy
Coeliac disease.

Question 22

Causes of a microcytic anaemia?

Answer 22

Iron deficiency
Thalasseamia

Question 23

B12 deficiency present with ?

Answer 23

Macrocytic (megaloblastic) anaemia and peripheral neuropathy

Question 24

How does Idiopathic Thomboyctopenia purpura commonly present?

Answer 24

Children
Purpuric/ petechial rash following a viral illness
Epistaxis!
Low platelets is the only blood abnormality

Question 25

Is Haemophilia more common in males or females?

Answer 25

Males because X linked recessive

Question 26

Haemophilia A is reduction in which clotting factor?

Answer 26

Factor 8

Question 27

What are the features of aplastic anaemia?

Answer 27

Normocytic anaemia Pancytopenia (leukopenia and thrombocytopenia) Hypoplastic bone marrow.

Question 28

What is found during biopsy when diagnosing amyloidosis?

Answer 28

apple green birefringence when using the Congo red stain.

Question 29

DVT management- what are the provoking factors?

Answer 29

Surgery, trauma, pregnancy. HRT AND COCP are considered provoking factors!

Question 30

Management of confirmed DVT in a patient with antiphopholipid syndrome?

Answer 30

LMWH and WARFARIN for 5 days then just warfarin

Question 31

Ann Arbour staging used for?

Answer 31

Hodgkins and Non- Hodgkins lymphoma

Question 32

What is the management of Hodgkins lymphoma?

Answer 32

Chemotherapy (ABVD) and Radiotherapy in combination

Question 33

What does PT (prothrombin time) look at?

Answer 33

As you Play Tennis outside Extrinsic Overall clotting factor synthesis and consumption

Question 34

What does APTT look at?

Answer 34

As you Play Table Tennis inside Intrinsic pathway

Question 35

When switching from warfarin to DOAC what INR can you start the DOAC?

Answer 35

Start the DOAC when the INR is less 2.5. Apixiban start when the INR is less than 2.

Question 36

What factors potentiate Warfarin?

Answer 36

Orlistat NSAIDS Inhbitors of the PY40 enzyme system (Ciprofloxacin) Cranberry Juice Liver disease

Question 37

Management of sickle cell crisis (principles) ?

Answer 37

Analgesia Strong opioid if moderate or severe pain (Also add in NSAIDS/ paracetamol)

Question 38

Non Hodgkins lymphoma is treated with?

Answer 38

RCHOP regime of chemotherapy for AGGRESSIVE disease R-CHOP = Rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone

Question 39

What sort of anaemia do you get with Beta Thalessemia?

Answer 39

Microcytic anaemia

Question 40

How would beta thalassemia major present?

Answer 40

Microcytic anaemia Heptasplenomegaly Recurrent infections

Question 41

CML - Which age group? - Which chromosome - First line treatment?

Answer 41

Age group: 60s Philadelphia chromosome First Line: Imatinib

Question 42

CLL management?

Answer 42

Chemotherapy with FCR Fludarabine, cyclophosphamide and rituximab (FCR) Curative: allogenic stem cell transplant

Question 43

What type of anaemia does sickle cell give you?

Answer 43

Normocytic anaemia

Question 44

Infection with a parasite increases which white blood cell?

Answer 44

Eosionphils

Question 45

How does thrombotic thromboyctopenia purpura present?

Answer 45

haemolytic anaemia, thrombocytopenia and neurological symptoms. Non blanching petechial rash Fever Renal failure

Question 46

How does acute haemolytic reaction present (following blood transfusion)?

Answer 46

Fever, abdominal pain, hypotension Anaphyaxis is a differential but would have wheeze/angiooedema

Question 47

What are some examples of myeloproliferative disorders?

Answer 47

Primary myelofibrosis PCV (Polycythaemia Rubera) Essential thrombocytopenia

Question 48

How does essential thrombocytopenia present?

Answer 48

High platelets JAK 2 Burning in hands

Question 49

Inheritance of sickle cell?

Answer 49

Autosomal recessive

Question 50

Most common crisis in sickle cell?

Answer 50

Vasocculsive- presents with pain and ischaemia. eg strokes, acute limb ischaemia.

Question 51

Reed Sternberg Cells indicate...

Answer 51

HODGKINS lymphoma

Question 52

Von willebrand- what do the clotting studies show?

Answer 52

Prolonged APTT PT Normal *Most common inherited bleeding disorder**

Question 53

Hodgkins lymphoma- management?

Answer 53

Chemo + Radiotherapy!

Question 54

Non Hodgkins lymphoma- management

Answer 54

Wide spectrum of disease Follicular (mild form)- local radiotherapy Aggressive disease= RCHOP or Bone marrow transplant

Question 55

What is the triad for paroxysmal nocturnal haemoglobinuria? And classic presentation?

Answer 55

Aplastic anaemia Haemolytic anaemia (Raised LDH and Reduced Hb) Thrombosis Man presents with dark urine in the morning that clears by afternoon

Question 56

Sickle cell presents how? and what is seen on bloods?

Answer 56

Normocytic anaemia Jaundice Low ESR Might present with their first crises eg pain

Question 57

Congenital spherocytosis presents how?

Answer 57

Anaemia, failure to thrive Autosomal dominant Splenomegaly

Question 58

What are some of the causes of a unprovoked DVT/PE

Answer 58

Active ca. Thrombophillia EG: Risk factors that are not easily modifiable! 6 months anticoagulation

Question 59

What disorders increase your risk of thrombosis?

Answer 59

Factor V leiden Antiphospholipid

Question 60

Haemochromotosis - what are the features and which are reversible?

Answer 60

Problem with Iron Features: Bronze diabetes Skin pigmentation (reversible) Cardiomyopathy (reversible) Cirrhosis DM Erectile dysfunction Treatment is venesection

Question 61

What is a complication of CML?

Answer 61

Blast crisis! Acute illness- ++progenitor cells/ blast cells. Present with fever/ splenomegaly

Question 62

Target cells are seen in which pathological conditions?

Answer 62

B Thalasemia IDA Hyposplenism Liver disease

Question 63

Heinz bodies are seen in?

Answer 63

G6DPH defiency

Question 64

Features of ALL

Answer 64

Children A/W Downs syndrome Neutropenia Thrombocytopenia Anaemia, bleeding and infections

Question 65

Major bleeding in the context of warfarin?

Answer 65

Stop warfarin/ Vit K and OCTAPLEX if INR >8 and bleeding!

Question 66

Characteristic features of PCV (Polycythaemia vera )

Answer 66

Tingling INCREASED HB! Itching after a hot bath JAK 2

Question 67

What is seen on clotting studies of haemophilia?

Answer 67

PROLONGED APTT