Haematology RACP MCQs Flashcards
(81 cards)
1
Q
RACP 2021b Q121.
What is the diagnostic test in AHUS?
A. ADAMTS13
B. C3
C. LDH
D. DAT
A
Answer: None of the above
Loss of function of complement regulatory factor H
2
Q
RACP 2021 Q122. What is the major protein extraction in a normal serum protein electrophoresis?
A. Albumin
B. Alpha anti trypsin
C. Beta lipoprotein
D. Immunoglobulin G
A
Answer A: Albumin
3
Q
RACP 2021 Q133. Which organ system is predominantly affected by the differentiation syndrome associated with ATRA and
arsenic treatment for APML?
A. Blood
B. Brain
C. Lung
D. Liver
A
Answer C Lung
4
Q
RACP 2021 Q162. Which protein is cleaved by ADAMTs13?
A. Fibrinogen
B. Plasminogen
C. Thrombin
D. Von Willebrand factor
A
Answer D Von Willebrand factor
5
Q
RACP 2021 Q10. A 46 year old female presents with new diagnosis of acute pulmonary embolism. Her HR is 94 and her blood pressure is 110/64. Her TTE shows right heart dilatation. Which of the following treatments had been shown to have the greatest improve improvement in mortality?
A. Anticoagulation
B. IVC filter placement
C. Surgical pulmonary embolectomy
D. Systemic thrombolysis
A
Answer A Anticoagulation
6
Q
RACP 2021 Q12. What is the minimum percentage of bone marrow plasma cells required for a diagnosis of suspected
myeloma?
A. 5%
B. 10%
C. 15%
D. 20%
A
Answer B 10%
7
Q
RACP 2021 Q21. What is the mutated haemoglobin in sickle cell anaemia?
A. Alpha
B. Beta
C. Zeta
D. Epsilon
A
Answer B Beta
8
Q
RACP 2021 Q37. A man presents to ED after an accident, and his group and screen is taken as part of trauma workup. What is
his blood type?
The real exam included a photograph of an agglutination test with test tubes represented and labelled as above.
A. A positive
B. A negative
C. B positive
D. B negative
A
Answer B positive
9
Q
RACP 2021 Q114. Agonist activation of which receptor has been shown to be effective in the treatment of aplastic anaemia?
A. Cluster differentiation 34 (CD34)
B. Erythropoeitin
C. GCSF
D. Thrombopoeitin
A
Answer A CD 34 (i.e. stem cell transplant)
10
Q
RACP 2021o
25. What is the most common side effect of ticagrelor that leads to it needing to
be ceased?
a. Diarrhea
b. Nausea
c. Dyspnea
d. Dizziness
A
Answer C Dysnpoea
11
Q
RACP 2021o
31. One way to prognosticate covid is to review the D- Dimer elevation. The d
dimer is from the breakdown of which product
a. Thrombin
b. Plasmin
c. Fibrin
d. Rhubarb
A
Answer C Fibrin
12
Q
RACP 2021o
36. Which cell is most responsible for the production of erythropoietin?
a. Renal cell
b. Liver cell
c. Blood cell
d. Bone marrow cell
A
Answer A Renal cell
13
Q
RACP 2021o
49. What does plasma exchange remove in TTP
a. Adamts13
b. antigen antibody complex
c. fibrin
d. red cell fragments
A
Answer B Antigen Ab complex
14
Q
RACP 2021o
52. Which factors does DOAC work on
a. 2 and 10
b. 8 and 10
c. 2 and 8
d. 5 and 8
A
Answer A
15
Q
RACP 2021 87. Young woman Bleeding, aptt raised, PT normal, mixing study not
corrected. What is the diagnosis?
a. Von Willebrand disease
b. factor VIII inhibitor
c. Haemophilia
A
Answer B
16
Q
RACP 20210
103. What is the benefit of blood transfusion with irradiated RBCs?
a. Prevention of febrile non haemolytic blood reaction
b. prevention of GVHD
c. prevention of anaphylaxis
d. Prevention of infection
A
Answer B
17
Q
RACP 2021o
105. The side effect of ATRA treatment for APML includes Cytokine release
(differentiation) syndrome. which organ is most affected? (Repeat question from
feb. 2021)
a. skin
b. blood
c. lungs
d. liver
A
Answer C
18
Q
RACP 2021
106. What gene is used in monitoring recurrence in AML?
a. DTNM3-A
b. NPM-1
A
A DTNM3-A
19
Q
RACP 2020a 13. A 54 male is post op D1 lap resection and Hartmann’s Procedure for fecal peritonitis. Loss of 500ml blood, now in septic shock. On prophylactic clexane.
Bloods as follows:
WCC 5.4
Hb 76
Plt 46
PT 27
APTT 76
Fibrinogen 1.2
A) Dilutional coagulopathy
B) DIC
C) HITS
D) Vitamin K deficiency
A
Answer B
20
Q
RACP 2020a
- 98M post fall and Hb 78. A decrease in which of the following is most consistent with a diagnosis of haemolytic anaemia?
A) Haptoglobin
B) LDH
C) Platelets
D) Reticulocytes
A
Answer A
21
Q
RACP 2020 52. EMQ Which genetic mutation would you give this treatment for: allogenic transplant at first disease remission ?
A) FLT3-ITD
B) NPM2
C) DNMT3A
D) t(15;17) PML:RARA
E) t(8; 21)
F)RUNX1
G) Inv (16)
A
Answer F: RUNX1
22
Q
RACP 2020
53. EMQ Which genetic mutation would you give this treatment for: ATRA + Arsenic
A) FLT3-ITD
B) NPM2
C) DNMT3A
D) t(15;17) PML:RARA
E) t(8; 21)
F) RUNX1
G) Inv (16)
A
Answer D: PML: RARA
23
Q
RACP 2020
16. What is prescribed in haemolytic anaemia to prevent aplastic crisis?
A) B12
B) Folate
C) Vitamin C
A
Folate
In haemolytic anaemia, there is an increased turnover of red blood cells (RBCs), which can lead to higher demand for folate (vitamin B9). Folate is essential for the production of new red blood cells, and in patients with chronic haemolysis, folate stores can be rapidly depleted, increasing the risk of megaloblastic anaemia.
- Vitamin B12 is important for red blood cell production but is not typically depleted in haemolytic anaemia as quickly as folate.
- Vitamin C does not play a direct role in preventing aplastic crisis in this context.
24
Q
RACP 2020
25. Patient with chronic bony pain. Splenomegaly on examination. Knee x-ray showing an Erlenmeyer flask deformity (radiological finding given in stem). Marrow aspirate slide shown with an arrow labelling the “Abnormal cell”
A. Fabry’s Disease
B. Glycogen Storage Disorder
C. Gaucher’s Disease
D. Haemophagocytic lymphohistiocytosis
A
25
RACP 2020
32. A 48 year old man (smoker) developed a right distal below knee DVT and bilateral PE after a long haul flight - What is the minimum duration of anticoagulation?
A) 6 weeks
B) 3 months
C) 12 months
D) Lifelong
26
RACP 2020
46. Best way to prevent transfusion related GVHD
A Irradiation
B Leukodepletion
C Washing
A
27
RACP 2020
48. What does TXA bind to?
A) Fibrin
B) Factor 10
C) Plasminogen
D) Thrombin
* Normally plasminogen + plasminogen activator (tPA) bind together = form plasmin
* Plasmin binds to fibrin and causes it to breakdown
The mechanism by which tranexamic acid exerts its antifibrinolytic activity is by binding to **plasminogen** and preventing it from becoming plasmin; a molecule responsible for the degradation of fibrin.
28
RACP 2019a
Question 13
A 37 year old female presents with a DVT following a cholecystectomy. There is RV dilatation on echocardiogram. She is hemodynamically stable. What is the appropriate duration for anticoagulation?
A. 6 weeks
B. 3 months
C. 12 months
D. Indefinitely
According to the Therapeutic Guidelines and The Australian and New Zealand Society of Thrombosis and Haemostasis (ANZTH), the standard duration of anticoagulation for a provoked deep vein thrombosis (DVT), such as one following surgery (in this case, after a cholecystectomy), is typically **3 months.**
Reasoning:
Provoked DVT: This is classified as a surgically-provoked DVT, which falls under the category of transient risk factors for venous thromboembolism (VTE).
Echocardiographic finding of RV dilatation: The presence of right ventricular (RV) dilatation on echocardiogram suggests possible pulmonary embolism (PE) and adds severity to the case, but the patient remains hemodynamically stable. Even in cases of provoked VTE with right heart strain, the recommended duration of anticoagulation remains 3 months, provided the patient stabilizes and no ongoing risk factors remain.
Longer durations of anticoagulation (e.g., 12 months or indefinitely) are typically reserved for unprovoked DVTs or those with ongoing risk factors like cancer or recurrent thrombosis.
29
RACP 2019a Question 22
Patient with non-Hodgkin’s lymphoma receiving R-CHOP. Which agent carries the highest risk of peripheral neuropathy?
A. Rituximab
B. Cyclophosphamide
C. Doxorubicin
D. Vincristine
D. Vincristine.
Vincristine is a vinca alkaloid that disrupts microtubule formation in cells. It is well known to cause peripheral neuropathy as a side effect, primarily due to its effect on axonal transport in neurons. Neuropathy typically manifests as sensory disturbances, numbness, tingling, and sometimes motor weakness.
Rituximab (A), Cyclophosphamide (B), and Doxorubicin (C) have different side effect profiles, with less risk of causing peripheral neuropathy compared to vincristine:
Rituximab: This is a monoclonal antibody targeting CD20 and is not commonly associated with peripheral neuropathy.
Cyclophosphamide: An alkylating agent, cyclophosphamide is more often associated with bone marrow suppression and hemorrhagic cystitis, not peripheral neuropathy.
Doxorubicin: An anthracycline, doxorubicin is primarily associated with cardiotoxicity rather than neuropathy.
30
RACP 2019a Question 83
What is the mechanism of action of rasburicase in tumour lysis syndrome?
A. Inhibits xanthine oxidase
B. Decreases tubular reabsorption of urate
C. Increases tubular secretion of urate
D. Increases the oxidation of uric acid to allantoin
Answer D
31
RACP 2019b Question 10
Haptoglobin levels decline in haemolysis. What is the reason for this?
A. Haemoglobin and haptoglobin are cleared by the liver
B. Haemoglobin and haptoglobin are cleared by the kidney
C. Bilirubin and haptoglobin are cleared by the liver
D. Bilirubin and haptoglobin are cleared by the kidney
A. Haemoglobin and haptoglobin are cleared by the liver.
Explanation:
In haemolysis, free haemoglobin is released into the bloodstream from the destruction of red blood cells. Haptoglobin, a plasma protein, binds to free haemoglobin to form a haptoglobin-haemoglobin complex. This complex is then rapidly cleared from circulation by the reticuloendothelial system (mainly the liver).
Haptoglobin levels decline during haemolysis because haptoglobin is used up in binding to free haemoglobin, and the resulting complexes are cleared from the bloodstream by the liver.
The decline in haptoglobin serves as a diagnostic marker for haemolysis, as a reduced level indicates that haemoglobin is being released and bound to haptoglobin, leading to its clearance.
The kidneys play a lesser role in clearing haemoglobin-haptoglobin complexes, but they may become involved if haemolysis is severe and overwhelms the binding capacity of haptoglobin, leading to haemoglobinuria. However, the primary clearance mechanism is through the liver.
32
RACP 2019b Question 16
What gives PCR its specificity in detection? For example, detection of the BCR-ABL in chronic myeloid leukaemia.
A. Epigenetic diversity
B. Oligonucleotide polymer design
C. Heat stable DNA polymerase
D. Amplification of target sequence
B. Oligonucleotide polymer design.
Explanation:
Oligonucleotide primers are short, single-stranded sequences of DNA designed to bind (or anneal) to specific regions of the target DNA sequence, such as the BCR-ABL fusion gene in chronic myeloid leukemia.
The specificity of PCR comes from the primers being designed to match the unique sequence of the target region. Only the complementary DNA sequences that match the primers are amplified, making it a highly specific process.
Other options:
* Epigenetic diversity (A) does not play a direct role in PCR specificity.
* Heat-stable DNA polymerase (C), such as Taq polymerase, allows PCR to withstand high temperatures during the denaturation step but does not contribute to specificity.
* Amplification of target sequence (D) refers to the PCR process itself but does not explain the specificity, which is determined by the primers.
33
RACP 2019b
Question 27
What is the best product to use to replace fibrinogen in a massive transfusion protocol?
A. Cryoprecipitate
B. Fresh frozen plasma
C. Prothrombinex
D. Recombinant factor VIII
Answer A Cryoprecipitate
34
RACP 2019b Question 39
In the context of allograft transplantation, which process may be triggered by donor APCs displaying donor antigens to recipient T Cells?
A. Acute cellular rejection
B. Humoral rejection
C. Graft-versus-host disease
D. T cell anergy
A. Acute cellular rejection.
Explanation:
Acute cellular rejection occurs when donor antigen-presenting cells (APCs) present donor antigens to the recipient’s T cells. This process activates the recipient's cytotoxic T cells, leading to an immune response against the transplanted organ. This type of rejection is primarily mediated by the cellular immune system and typically occurs days to weeks after transplantation.
Humoral rejection (B): Involves the recipient’s production of antibodies against donor antigens (usually against donor HLA molecules), but this is mediated by B cells and antibodies, not by donor APCs presenting antigens to recipient T cells.
Graft-versus-host disease (C): This occurs when donor T cells attack the recipient's tissues, which is typically seen in bone marrow or stem cell transplants, not solid organ transplants.
T cell anergy (D): Refers to a state where T cells become non-responsive to antigens, typically in the context of tolerance or immunosuppressive therapies, and does not lead to rejection.
35
RACP 2019bQuestion 63
In allogeneic stem cell transplant for acute myeloid leukemia, anti-thymocyte antibodies (ATG) are routinely administered as part of the conditioning regime. What is the benefit of ATG?
A. Prevent graft versus host disease
B. Enhance graft versus leukemia effect
C. Bone marrow recovery
D. Prevention of infection
Prevent graft-versus-host disease (GVHD).
Explanation:
ATG is an immunosuppressive agent used to deplete T cells in the recipient, thereby reducing the likelihood of graft-versus-host disease (GVHD). GVHD occurs when the donor immune cells (particularly T cells) recognize the recipient's tissues as foreign and launch an immune attack. By reducing the number of T cells, ATG helps to prevent this complication.
36
RACP 2022 18.What is reduced by dose escalation during commencement of venetoclax
a. Haematopoietic toxicity
b. Differentiation syndrome
c. Tumour lysis
C
37
RACP 2022 33.64 year old male with polycythemia Rubra vera, jak2 positive, HCT 0.55, Hb
185. What do you start in addition to venesection?
a. Aspirin
b. Hydroxyurea
c. Aspirin and hydroxyurea
d. Ruxolitinib + aspirin
C (high risk as age > 60 yo)
38
RACP 2022
69. A couple is wanting to become pregnant and seeking genetic advice. Man is alpha thalassaemia carrier, woman is beta thalassaemia carrier. If their child
inherits both of their affected genes, what is the most likely clinical outcome?
a. Healthy carrier
b. Hydrops fetalis
c. Beta thalassaemia trait
d. HbH disease
39
RACP 2022
83.EMQ: Thalassemia - What will four alpha chain deletions produce?
a. Haemoglobin Barts
b. HbH
c. HbS
d. Congenital persistance of HbF
e. Beta major thalassemia
A
40
RACP 2022
84.EMQ: Thalassemia - What will be protective against sickle cell disease?
a. Haemoglobin Barts
b. HbH
c. HbS
d. Congenital persistance of HbF
e. Beta major thalassemia
Congenital persistence of HbF refers to the continued production of fetal hemoglobin (HbF) into adulthood. HbF does not sickle under low oxygen conditions, which provides a protective effect against the complications associated with sickle cell disease (HbS). Patients with higher levels of HbF often experience milder forms of sickle cell disease or may have less severe symptoms.
Why the Other Options Are Not Protective:
a. Haemoglobin Barts: This is a form of hemoglobin associated with alpha thalassemia, not directly protective against sickling.
b. HbH: This is another hemoglobin type related to alpha thalassemia and does not provide protection against sickle cell disease.
c. HbS: This is the abnormal hemoglobin found in sickle cell disease; therefore, it does not confer protection.
e. Beta major thalassemia: This condition leads to severe anemia and does not protect against sickle cell disease.
41
RACP 2022
10. How does hydroxyurea help in sickle cell disease?
A. Alters gene expresnsion of locus of beta globin chain
B. Cell cycle arrest
C. Enhanced nitric oxide
B
42
RACP 2022
18. Red blood cells have mechanisms of protecting itself from oxidative damage. In
G6PD, what does the cell try to produce to protect from oxidative damage?
A. Glutathione
B. Superoxide dismutase
C. Nicotinamide adenine dinucleotide phosphate
D. Falvicin
43
RACP 2018b 115.Which investigation is most specific for confirming a diagnosis of complement-mediated
haemolysis?
A. Direct antiglobulin (Coombs).
B. Free haemoglobin.
C. Haptoglobin.
D. Lactate dehydrogenase.
E. Reticulocytes.
44
RACP 2018b 123.The circles represent blood groups. The arrows represent the direction of donor to recipient.
Which diagram is correct for transfusion of plasma products (for example, fresh frozen
plasma)?
B
45
RACP 2018a 9. A 28-year-old otherwise healthy woman who is 36/40 pregnant presents with dyspnoea for
1 week and left lower limb swelling for 2 days. Temperature is 37.4 °C, blood pressure is
136/86 mmHg, heart rate 98 beats per minute, oxygen saturations 98% on room air. Her left calf
diameter measures 2 cm greater than the right. An ECG and chest radiograph are normal.
Which is the next most appropriate investigation?
A. CT pulmonary angiogram.
B. D-dimer.
C. Echocardiogram.
D. Lower limb Doppler ultrasound.
E. Ventilation/perfusion scan.
D
46
RACP 2018a 16. In patients with essential thrombocytosis without the JAK2 mutation, what is the next most commonly mutated gene?
A. Bcl2.
B. Calreticulin.
C. Dnmt3a.
D. Mpl.
E. p53.
B
47
RACP 2018a 37. A 60-year-old asymptomatic man on routine annual full blood examination (FBE) has the
following results:
Haemoglobin 125 g/L [130–170]
White cell count 35 × 10^9/L [4–10]
Platelets 168 × 10^9 /L [150–400]
Differential includes:
Neutrophils 2.1 X 10 ^9/L [2.0–7.0]
Lymphocytes 31 × 10^9/L [1.0–3.0]
He has palpable, maximal 2 cm bilateral cervical lymphadenopathy, but no
hepatosplenomegaly. Peripheral blood flow cytometry of lymphocytes confirms chronic
lymphocytic leukaemia.
What is the most appropriate management decision?
A. Bone marrow biopsy.
B. Chlorambucil.
C. CT scan of chest and abdomen.
D. Prednisolone.
E. Serial monitoring of FBE.
E
48
RACP 2018a 38. A 58-year-old lady taking 20 mg rivaroxaban daily, presents with haematemesis. In addition to
resuscitation and commencing a proton pump inhibitor, what is the next most appropriate
therapeutic intervention to arrest the bleeding?
A. Angiographic embolisation.
B. Fresh frozen plasma.
C. Gastroscopy.
D. Idarucizumab.
E. Octreotide infusion.
C
49
RACP 2018a 85. Disseminated intravascular coagulopathy is most commonly associated with which acute
leukaemia?
A. Eosinophilic.
B. Lymphoid.
C. Monocytic.
D. Myeloid.
E. Promyelocytic.
Answer E
50
RACP 2018a 87. Which plasma component decreases during tumour lysis?
A. Calcium.
B. Magnesium.
C. Phosphate.
D. Potassium.
E. Uric acid.
Answer A Calcium
Calcium precipitates with phosphate to form calcium phosphate crystals.
51
RACP 2018a Q88
88. The therapeutic benefit of hydroxyurea in sickle cell disease is achieved by increased synthesis
of which haemoglobin subtype?
A. HbA.
B. HbB.
C. HbE.
D. HbF.
E. HbS.
52
RACP 2018b Q111
111.BCL-2 inhibitors have recently shown to have therapeutic efficacy in blood cancers.
What is the function of BCL-2 protein?
A. Activates cell death receptors.
B. Activates cell survival proteins.
C. Activates effector caspases.
D. Inhibits cell apoptotic proteins.
E. Inhibits cell survival proteins.
Answer D Inhibits cell apoptotic proteins
53
RACP 2018b 115.Which investigation is most specific for confirming a diagnosis of complement-mediated
haemolysis?
A. Direct antiglobulin (Coombs).
B. Free haemoglobin.
C. Haptoglobin.
D. Lactate dehydrogenase.
E. Reticulocytes.
54
RACP 2018b 123.The circles represent blood groups. The arrows represent the direction of donor to recipient.
Which diagram is correct for transfusion of plasma products (for example, fresh frozen
plasma)?
B
55
RACP 2017 a Q5
Which of the following serum electrolyte levels typically decreases in tumour lysis syndrome?
a) Sodium
b) Potassium
c) Calcium
d) Phosphate
e) Magnesium
C
56
RACP 2017a Q7
Venous thromboembolism (VTE) is often recurrent. Which of the following is the strongest risk
factor for recurrent VTE?
a) Female sex
b) Heterozygosity for Factor V Leiden mutation
c) First presentation of VTE with Pulmonary Embolism
d) Unprovoked VTE
e) Residual thrombus on ultrasound
D
57
RACP 2017a Q10
A 74-year-old man is on medication for prevention of stroke due to a past medical history of atrial
fibrillation. He presents to hospital with malaena. He is unable to recall the name of the medication.
Blood tests demonstrate the following:
PT 12 (11-13)
APTT 39 (28-38)
TT 300 (<30)
What is the most likely medication he is taking?
a) Apixaban
b) Dabigatran
c) Rivaroxaban
d) Warfarin
e) Tirofiban
B
58
RACP 2017a Q23
A couple are known to have both been diagnosed with α-thalassaemia trait. They come to you to seek counsel with regards to the outcome for having a child. Given their genetic profile, which of the following could their child suffer from?
a) Hb F disease
b) Hb H disease
c) Sickle Cell anaemia
d) β-Thalassaemia
e) Hb E disease
59
RACP 2017a Q36
Which is the following if co-administered with Dabigatran will likely to lead to a rise in the serum
concentrations of Dabigatran?
a) Itraconazole
b) Adenosine
c) Verapamil
d) Metoprolol
e) Paroxetine
A. Itraconazole.
Explanation:
Itraconazole is a potent CYP3A4 inhibitor and can also inhibit the P-glycoprotein (P-gp) transporter. Dabigatran is primarily eliminated by the kidneys, and its absorption and distribution are significantly affected by P-glycoprotein. When Itraconazole is administered alongside Dabigatran, it can inhibit P-gp, leading to increased absorption and serum levels of Dabigatran, which may elevate the risk of bleeding.
Other Options:
b) Adenosine: Does not significantly interact with Dabigatran.
c) Verapamil: This is also a P-gp inhibitor, but its effect on Dabigatran concentrations is not as pronounced as that of Itraconazole.
d) Metoprolol: Primarily affects heart rate and blood pressure, with minimal effect on Dabigatran levels.
e) Paroxetine: While it is a CYP2D6 inhibitor, its impact on Dabigatran is less relevant than that of a strong P-gp inhibitor like Itraconazole.
60
RACP 2017a Q61
A 72-year-old patient with multiple myeloma is on treatment with bortezomib, cyclophosphamide
and dexamethasone. She presents with acute back pain, bilateral leg weakness difficulty passing
urine.
What is the next immediate step in management after administering analgesia?
a) Bisphosphonate
b) High dose steroids
c) Radiotherapy
d) Surgery
e) Urgent chemotherapy
B
61
RACP 2017a Q84
Which of the following is the most common clinical presentation of AA Amyloidosis?
a) Gastroparesis
b) Macroglossia
c) Peripheral Neuropathy
d) Restrictive Cardiomyopathy
e) Nephrotic Syndrome
E
62
RACP 2017a Q92
A 30-year-old lady is being treated for an unprovoked below knee DVT with Warfarin for the last 2
months. She has no past medical history and no history of bleeding. Her routine INR measurement
today is 10. She is otherwise well. What is the best immediate management?
a) Vitamin K (route of administration was not specified)
b) Repeat INR in 12 hours
c) Prothrombin complex concentrate
d) Fresh Frozen Plasma
e) Idarucizumab
Answer A: Vit K
63
RACP 2017b Question 37
Which of the following tests is best for monitoring the activity of low molecular weight heparin?
a) Activated Partial Thromboplastic Time
b) Prothrombin Time
c) Anti-Factor Xa level
d) Thrombin Clotting Time
e) Prothrombin fragments 1 and 2
Answer C : Anti Xa level
64
RACP 2016a Question 1
What is the pathophysiology of TTP (Thrombotic thrombocytopenic purpura)
A. ADAMTS13 deficiency
B. GP IIb/ IIIA inhibition
C. Complement deficiency
D. Von willebrand factor deficiency
E. Antibody mediated destruction of platelets
Answer A: ADAMST13 deficiency
65
RACP 2016a Question 16
A 48 year old man presents to pre-admissions clinic for an elective thyroidectomy with elevated APTT level that does no correct with 1:1 plasma mixing of normal patient plasma. Normal INR and fibrinogen level. No
previous history of bleed. What is the most likely diagnosis?
A. Hereditary factor VIII deficiency
B. Acquired factor VIII deficiency
C. Acquired factor VII deficiency
D. Lupus anticoagulant
E. Hypofibrinogenemia
Answer D: Lupus anticoagulant
66
RACP 2016a Question 70
Which of the following is the most sensitive test of rivaroxaban activity?
A) APTT
B) PT
C) Prothrombinase complex
D) Prothrombin products
E) INR
Answer B: PT
67
RACP 2016a Question 81
A 60year old presents febrile and neutropenic post induction chemotherapy for AML. A CT chest is concerning
for fungal infection and bronchoscopy culture demonstrates Aspergillus fumigatus.
What is the most appropriate treatment?
A. Posaconazole
B. Fluconazole
C. Itraconazole
D. Carbimazole
E. Voriconazole
E: Voriconazole
68
RACP 2016a Question 82.
A 72 year old patient with multiple myeloma is on treatment with bortezomib, cyclophosphamide and
dexamethasone. She presents with bilateral leg weakness with decreasing sensation travelling up her legs.
What is the next immediate step in management after analgesia?
A) Bisphosphanate
B) High dose steroids
C) Radiotherapy
D) Surgery
E) Rituximab
Answer B vs C:
Dexamethasone vs Radiotherapy
Possibly has cauda equina or spinal cord compression from metastatic vertebral disease and needs emergency radiotherapy which will be the more definitive management - but you would give dexamethasone STAT as well.
69
RACP 2016b Question 8
On which receptor(s) does Aprepitant work?
A. Serotonin
B. Dopamine-2 receptors
C. Dopamine-4 receptors
D. NK-1
E. Serotonin and dopamine receptors
Answer D: NK-1
70
RACP 2016b Question 46
A 68 year old man with who has a mitral valve repair in situ for 15 years ago presents with symptomatic
anaemia and congestive cardiac failure. You suspect intravascular hemolysis. Which of the following tests
would be most helpful in confirming this suspicion?
A) LDH
B) Direct antiglobulin test
C) Urinary haemosiderin
D) Haptoglobin
E) Reticulocytes
Answer C: Urine haemosiderin
Urine haemosiderin is present in intravascular haemolysis but not in extravascular haemolysis.
Haptoglobin is reduced in both intra and extravascular haemolysis but reduced much more in intravascular haemolysis.
Haptoglobin is a protein that binds to free hemoglobin released into the bloodstream during hemolysis. In cases of intravascular hemolysis, haptoglobin levels decrease as the protein is consumed while binding to the free hemoglobin. A low haptoglobin level is a hallmark of intravascular hemolysis.
LDH is an enzyme that is elevated in many conditions, including hemolysis, but its elevation is not specific to intravascular hemolysis.
Urinary haemosiderin can indicate hemolysis but is typically only positive after prolonged or severe hemolysis.
Direct antiglobulin test (B) (DAT or Coombs test) is used to detect immune-mediated hemolysis, not mechanical or intravascular hemolysis, such as that caused by a prosthetic valve.
Reticulocyte count (E) is useful for assessing the bone marrow response to anemia but is not specific for confirming hemolysis.
71
RACP 2016b Question 57
Haemolytic Uraemic Syndrome and bloody diarrhoea can occur as a consequence of EHEC. The pathogenesis
involves the production of which of the following?
A) Shiga toxin
B) Heat stable endotoxin
C) Intimin
D) Cytotoxin
E) Adherin
Answer A: Shiga toxin
72
RCAP 2016 b Question 58
Tranexamic acid is an analogue that blocks interactions between which two factors?
A) Factor V and Factor X
B) Factor XIII and fibrinogen
C) Plasmin and fibrin-containing clot
D) Thrombin and anti-thrombin
E) Tissue factor and factor VII
Answer C : Plasmin and fibrin containing clot
73
RACP 2016b Question 64
Hepcidin mediates its affect by inhibiting the action of which of the following proteins?
A) Metal divalent protein
B) Ferritin
C) Ferroportin
D) Transferrin receptor
E) Hephafastin
Answer C: Ferroportin
74
RACP 2015a Question 12
Which of the following has the greatest effect on the Well’s Criteria for Pulmonary
Embolism?
A. Likely diagnosis is PE or alternative diagnosis is less likely
B. Immobilisation
C. Malignancy
D. Previous DVT/PE
E. Haemoptysis
Answer A
75
RACP 2015a Question 33
The reason for having less febrile non haemolytic transfusion reactions in more recent times
is?
A. Leukoreduction at the bedside
B. Premedication with steroids
C. Premedication with Paracetamol
D. HLA matching accuracy
E. Leukoreduction pre storage
Answer E: Leukodepletion/reduction pre storage
76
RACP 2015a Question 87
76 year old man with AF, CHADS 5. On dabigatran 150mg bd, last took dose 26 hours ago.
Presents after a fall with a SDH requiring surgical intervention.
Bloods
Hb 100
Plts 150
aPTT 37 (<38)
TT 30 (<20)
Dabigatran level 30 (Trough >90)
What do you do to minimise his risk of bleeding?
A. Haemodialysis
B. Factor eight inhibitor bypass activity
C. Fresh frozen plasma
D. Nothing
E. Rhubarb
Answer: None of the above or C
Ideally would give idarizumab + FFP
77
RACP 2015a Question 90
44 year old male with varicose veins has a proximal iliac DVT. Apart from appropriate
anticoagulation, what is the best approach to minimise his risk of post thrombotic syndrome?
A. Bed rest
B. Exercises
C. Sequential compression devices
D. Compression stocking
E. Varicose vein stripping
Answer D: Compression stockings
78
RACP 2015b Question 19
The commonest cause of acute haemolytic transfusion reaction after red cell transfusion is:
A. Not giving anti-D to a sensitised Rh negative patient
B. Lab misidentifying recipient's ABO status
C. Lab misidentifying recipient's Rhesus status
D. Mislabelled blood products
E. Incorrect patient identification
Answer B: Lab mislabelling ABO status
79
RACP 2015b Question 44
A 25 year old female presents following a major multi trauma, in need of an urgent blood
transfusion. There is no time to cross match or rhesus test.
Which of the following red cell types could be used?
A. A positive
B. AB negative
C. B negative
D. O negative
E. O positive
Answer: D - O negative
80
RACP 2015 Question
What is the main role of factor VII in coagulation?
A. Amplification
B. Propagation
C. Initiation
D. Rhubarb
E. Rhubarb
Answer C: Initiation
81
