Mcq Of Pass Medicine Flashcards by drsar drsar

Each one of the following is associated with hyposplenism, except:
 1-Sickle-cell anaemia
2-Liver cirrhosis
3-Systemic lupus erythematous
4-Coeliac disease
5-Splenectomy

Liver cirrhosis

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A 30-year-old man is investigated for enlarged, painless cervical lymph nodes. A biopsy is taken and a 
diagnosis of Hodgkin's lymphoma is made. Which one of the following types of Hodgkin's 
lymphoma carries the best prognosis?
Lymphocyte predominant
Mixed cellularity
Nodular sclerosing
Hairy cell
Lymphocyte depleted

Hodgkin’s lymphoma - best prognosis = lymphocyte predominant

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Which one of the following cytotoxic agents acts by inhibiting dihydrofolate reductase and 
thymidylate synthesis?
Methotrexate
Vincristine
Bleomycin
Cyclophosphamide
Doxorubicin

Methotrexate

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A 4-year-old boy is admitted after developing a haemarthrosis in his right knee whilst playing in the 
garden. The following blood results are obtained:
Platelets 220 * 109
/l
PT 11 secs
APTT 76 secs
Factor VIIIc
activity
Normal
What is the most likely diagnosis?
Antithrombin III deficiency
Von Willebrand's disease
Antiphospholipid syndrome
Haemophilia A
Haemophilia B

Haemophilia B

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A 45-year-old woman is diagnosed with non-Hodgkin’s lymphoma. She is a recovering alcoholic and
has been left with significant alcohol-related peripheral neuropathy. Which one of the following
chemotherapy agents should be avoided if possible, given her past history?
Doxorubicin
Vincristine
Chlorambucil
Docetaxel
Cyclophosphamide

Vincristine

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A patient is investigated for leukocytosis. Cytogenetic analysis shows the presence of the following 
translocation: t(9;22)(q34;q11). Which hematological malignancy is most strongly associated with 
this translocation?
Chronic myeloid leukaemia
Acute promyelocytic leukaemia
Acute lymphoblastic leukaemia
Burkitt's lymphoma
Mantle cell lymphoma

Chronic myeloid leukaemia

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50-year-old man with a history of ulcerative colitis comes for review. Six years ago he had an
ileostomy formed which has been functioning well until now. Unfortunately he is currently suffering
significant pain around the stoma site. On examination a deep erythematous ulcer is noted with a
ragged edge. The surrounding skin is erythematous and swollen. What is the most likely diagnosis?
Munchausen’s syndrome
Irritant contact dermatitis
Pyoderma gangrenosum
Dermatitis artefacta
Stomal granuloma

Pyoderma gangrenosum is associated with inflammatory bowel disease and may be seen around the
stoma site. Treatment is usually with immunosuppressants as surgery may worsen the problem
A differential diagnosis would be malignancy and hence lesions should be referred for specialist
opinion to evaluate the need for a biopsy. Irritant contact dermatitis is common but would not be
expected to cause such a deep ulcer.

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Which one of the following is least likely to cause a warm autoimmune haemolytic anaemia?
Mycoplasma infection
Methyldopa
Chronic lymphocytic leukaemia
Lymphoma
Systemic lupus erythematous

Mycoplasma infection

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A 64-year-old man with a history of depression and lumbar spinal stenosis presents with a swollen and
painful left calf. He is seen in the DVT clinic and found to have a raised D-dimer. He therefore
undergoes a Doppler scan which shows a proximal deep vein thrombosis. The patient reports being
active and otherwise well. He has not recently had any surgery or been immobile for any prolonged
period. He is started on low-molecular weight heparin and referred to the warfarin clinic. What is the
most appropriate duration of warfarin treatment?
6 week
3 months
6 months
12 months
Lifelong

6 months

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A 33-year-old male patient with a history of recurrent nose bleeds, iron-deficiency anaemia and 
dyspnoea is found to have a pulmonary AV malformation on pulmonary angiography. What is the 
likely underlying diagnosis?
Haemophilia A
Hereditary haemorrhagic telangiectasia
Mantle cell lymphoma
Wegener's granulomatosis
Down's syndrome

Hereditary haemorrhagic telangiectasia

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blood film is reported as follows:
Howell-Jolly bodies, target cells and occasional Pappenheimer bodies are seen
What is the most likely underlying cause?
Iron-deficiency anaemia
Lead poisoning
Myelofibrosis
Sideroblastic anaemia
Post-splenectomy

Post-splenectomy

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You are asked to review a 60-year-old Greek man with known glucose-6-phosphate dehydrogenase
(G6PD) deficiency who was admitted with malaria and a chest infection. He has developed jaundice
and haemolytic anaemia after starting some medications this morning.
Which of these medications are most likely to have precipitated his crisis?
Clarithromycin
Amoxicillin
Artesunate
Primaquine
Salbutamol
.

Primaquine
is a well known cause of haemolysis in G6PD deficiency and is used in the treatment of
malaria. Artesunate is generally considered safe to use in G6PD deficiency. Penicillins and macrolides
are safe antibiotics to use in G6PD deficiency.

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42-year-old woman presented with sudden onset gait ataxia, intention tremor and nystagmus. CT
head demonstrated a 4cm left cerebellar haematoma. She is discussed with the local neurosurgical unit
and urgently transferred for intervention. She is repatriated a week later for further rehabilitation.
Routine blood tests are notable for a platelet count of 1,700 * 109
/l . Initially, you attribute this to a
post-surgical rise. However, on closer examination of her results you realise that on initial presentation
her platelet count was 1,300 * 109
/l. What gene mutation is likely to be discovered in this lady?
JAK2
HFE
CFTR
WASP
BCR-ABL

JAK2
This lady has presented with a stroke at a young age, on a background of raised platelets. This is very
suggestive of essential thrombocythaemia which is known to be a rare cause of stroke and is
associated with a mutation in the JAK2 gene.
HFE mutation is seen in haemochromatosis, CFTR in cystic fibrosis and WASP in Wiskott-Aldrich.
Mutations in BCR-ABL are associated with chronic myeloid leukaemia, and is known as the
Philadelphia translocation.

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22-year-old man with sickle cell anaemia presents with pallor, lethargy and a headache. Blood 
results are as follows
Hb 4.6 g/dl
Reticulocytes 3%
Infection with a parvovirus is suspected. What is the likely diagnosis?
Thrombotic crisis
Sequestration crisis
Transformation to myelodysplasia
Haemolytic crisis
Aplastic crisis

Aplastic crisis
The sudden fall in haemoglobin without an appropriate reticulocytosis (3% is just above the normal
range) is typical of an aplastic crisis, usually secondary to parvovirus infection

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Which one of the following factors is most associated with an increased risk of developing 
bladder cancer?
Strongyloides stercoralis infection
Beryllium salt exposure
Aniline dye exposure
Aflatoxin exposure
Long term phenytoin use

Aniline dye exposure

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Which one of the following is not a feature of paroxysmal nocturnal haemoglobinuria?
Haemolytic anaemia
Positive Ham test
Haemoglobinuria
Aplastic anaemia
Haemarthrosis

Haemarthrosis

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A 21-year-old man comes for review. He recently had an abdominal ultrasound for episodic right 
upper quadrant pain which demonstrated gallstones. A full blood count was also ordered which was 
reported as follows:
Hb 9.8 g/dl
MCV 91 fl
Plt 177 * 109
/l
WBC 5.3 * 109
/l
The patient also mentions that his father had a splenectomy at the age of 30 years. Which one of the 
following tests is most likely to be diagnostic?
Ham's test
PAS staining of erythrocytes
Glucose-6-phoshate dehydrogenase levels
Osmotic fragility test
Direct Coombs' test

Osmotic fragility test
This patient has hereditary spherocytosis as evidenced by the normocytic anaemia, gallstones and
family histor

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A 21-year-old man comes for review. He recently had an abdominal ultrasound for episodic right 
upper quadrant pain which demonstrated gallstones. A full blood count was also ordered which was 
reported as follows:
Hb 9.8 g/dl
MCV 91 fl
Plt 177 * 109
/l
WBC 5.3 * 109
/l
The patient also mentions that his father had a splenectomy at the age of 30 years. Which one of the 
following tests is most likely to be diagnostic?
Ham's test
PAS staining of erythrocytes
Glucose-6-phoshate dehydrogenase levels
Osmotic fragility test
Direct Coombs' test

Osmotic fragility test
This patient has hereditary spherocytosis as evidenced by the normocytic anaemia, gallstones and
family histor

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42-year-old female is noted to have a Hb of 17.8 g/dL. Which one of the following is least likely 
to be the cause?
Polycythaemia rubra vera
Chronic obstructive pulmonary disease
Hypernephroma
Haemochromatosis
Dehydration

Haemochromatosis
is not associated with polycythaemia. Blood tests typically reveal a raised ferritin
and iron, associated with a transferrin saturation of greater than 60% and a low total iron binding
capacit

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patient is diagnosed with acute lymphoblastic leukaemia after presenting with lethargy and easy 
bruising. Which one of the following is a marker of a bad prognosis in acute lymphoblastic 
leukaemia?
Pre-B phenotype
Presentation in childhood
Initial white cell count of 18 * 109
/l
Female sex
Philadelphia chromosome positive

Philadelphia translocation, t(9;22) - good prognosis in CML, poor prognosis in AML + ALL

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patient is diagnosed with acute lymphoblastic leukaemia after presenting with lethargy and easy 
bruising. Which one of the following is a marker of a bad prognosis in acute lymphoblastic 
leukaemia?
Pre-B phenotype
Presentation in childhood
Initial white cell count of 18 * 109
/l
Female sex
Philadelphia chromosome positive

Philadelphia translocation, t(9;22) - good prognosis in CML, poor prognosis in AML + ALL

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A 34-year-old man who is HIV positive is starting treatment for Burkitt’s lymphoma. His
chemotherapy regime includes cyclophosphamide, vincristine, methotrexate and prednisolone. Around
24 hours after starting chemotherapy he becomes confused and complains of muscle cramps in his
legs. Which one of the following is most likely to have occurred?
Prednisolone-induced psychosis
Hypercalcaemia
Methotrexate pneumonitis leading to hypoxia
Haemorrhagic cystitis leading to acute renal failure
Tumour lysis syndrome

Tumour lysis syndrome
Burkitt’s lymphoma is a common cause of tumour lysis syndrome
Tumour lysis syndrome occurs as a result of cell breakdown following chemotherapy. This releases a
large quantity of intracellular components such as potassium, phosphate and uric acid.

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Which one of the following may be used to monitor patients with colorectal cancer?
CA-125
Carcinoembryonic antigen
Alpha-fetoprotein
CA 19-9
CA 15-3

Carcinoembryonic antigen may be used to monitor for recurrence in patients post-operatively or to
assess response to treatment in patients with metastatic disease

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66-year-old woman with a history of chronic kidney disease stage disease 4 metastatic breast cancer
is admitted with a swollen right calf. Investigations confirm a deep vein thrombosis and she is started
on treatment dose dalteparin. As she has a significant degree of renal impairment it is decided to
monitor her response to dalteparin. What is the most appropriate blood test to perform?
Anti-Factor Xa levels
Antithrombin III levels
Anti-Factor VIIIa levels
Protrombin time (PT)
Activated Partial Thromboplastin Time (APTT)

Anti-Factor Xa levels

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A 52-year-old man with a history of anaemia and abdominal discomfort is diagnosed as having chronic myeloid leukaemia. What is the mechanism of action of imatinib? EGF receptor antagonist Tyrosine kinase inhibitor Anti-CD52 monoclonal antibody Anti-CD23 monoclonal antibody p53 inhibitor

Chronic myeloid leukaemia - imatinib = tyrosine kinase inhibitor Imatinib is an inhibitor of the tyrosine kinase associated with the BCR-ABL defec

``` 67-year-old man with a 10-year history of gastro-oesophageal reflux disease is investigated for dysphagia. An endoscopy shows an obstructive lesion highly suspicious of oesophageal cancer. What is the biopsy most likely to show? Squamous cell carcinoma Normal squamous epithelium Adenocarcinoma Leiomyoma Metaplastic columnar epithelium ```

Oesophageal adenocarcinoma is associated with GORD or Barrett's Metaplastic columnar epithelium would be seen with Barrett's but this is not consistent with the obstructive lesion seen on endoscopy

``` 72-year-old woman is found to have a marked lymphocytosis associated with smudge cells on the blood film. A diagnosis of chronic lymphocytic leukaemia is suspected. Which one of the following is the investigation of choice? Immunophenotyping Bone marrow aspiration Protein electrophoresis White cell scan Bone marrow trephine ```

CLL - immunophenotyping is investigation of choice

72-year-old lady develops sudden onset shortness of breath. She has a heavy smoking history and has been losing weight recently. She undergoes a CT pulmonary angiogram to exclude pulmonary embolism, but this demonstrates obstruction of the superior vena cava (SVC) secondary to a large, poorly defined mass. What is the most likely cause of her superior vena cava obstruction? Small cell lung cancer Non-small cell lung cancer Non-Hodgkin lymphoma Breast cancer Thymoma

Non-small cell lung cancer

``` A 30-year-old female presents to the Emergency Department with epistaxis, which has now terminated. Her boyfriend reports she has a recent history of mucosal bleeding and has at times been very disorientated. On examination, she has a low-grade fever and appears confused and jaundiced. There is bruising over her legs and arms. A urine pregnancy test is negative. You receive the following blood results from the laboratory: Hb 85 g/l Platelets 8 * 109 /l WBC 4.5 * 109 /l MCV 92 fl Na+ 138 mmol/l K+ 4.9 mmol/l Urea 10.2 mmol/l Creatinine 182 µmol/l Clotting studies are normal. Given the most likely diagnosis, what is the most appropriate management of this patient? Platelet transfusion Intravenous immunoglobulin Plasma exchange Intravenous methylprednisolone Intravenous argatroban ```

Plasma exchange.. the haematological emergency and be aware of the correct management. thrombocytopenia, microvascular haemolysis, fluctuating neurological signs, renal impairment and fever. rombocytopenia is immune thrombocytopenic purpura (ITP). ITP is more common than TTP however would not present with the range of symptoms seen in this scenario. a life saving intervention. Platelet transfusion in TTP is only indicated if there is an on-going life- threatening bleed. Intravenous methylprednisolone is indicated after treatment with PEX has been completed. mmunoglobulin in the routine management of TTP, however there have been reports of its successful use in PEX- and steroid-refractory case

``` A 12-year-old boy is noted to bleed excessively during an elective dental extraction. Following the procedure, examination reveals petechial skin haemorrhages. Blood results show: Hb 12.3 g/dl Plt 255 * 109 /l WBC 7.9 * 109 /l PT 13.3 secs APTT 39 secs Factor VIII activity 87% What is the most likely diagnosis? Disseminated intravascular coagulation Idiopathic thrombocytopenic purpura Von Willebrand's disease Haemophilia A Haemophilia B ```

Von Willebrand's disease

A 52-year-old woman with a history of hypothyroidism presents with lethargy and a sore tongue. Blood tests are reported as follows: Hb 10.7 g/dl MCV 121 fl Plt 177 * 109 /l WBC 5.4 * 109 /l Further tests are ordered: Vitamin B12 64 ng/l (200-900 ng/l) Folic acid 7.2 nmol/l (> 3.0 nmol/l) What is the most appropriate management? 1 mg of IM hydroxocobalamin once every 3 months 1 mg of IM hydroxocobalamin 3 times each week for 2 weeks, then once every 3 months 1 mg of IM hydroxocobalamin once every 2 months + folic acid 5mg od Give folic acid 5mg od one week then recheck bloods 1 mg of IM hydroxocobalamin 3 times each week for 2 weeks, then once every 3 months + folic acid 5mg od

1 mg of IM hydroxocobalamin 3 times each week for 2 weeks, then once every 3 months

54-year-old man is diagnosed as having acute myeloid leukaemia. What is the single most important test in determining his prognosis? Gene-expression profiling White cell count at diagnosis Immunophenotyping Lactate dehydrogenase Cytogenetics

Cytogenetics

``` 30-year-old female presents to the Emergency Department with epistaxis, which has now terminated. Her boyfriend reports she has a recent history of mucosal bleeding and has at times been very disorientated. On examination, she has a low-grade fever and appears confused and jaundiced. There is bruising over her legs and arms. A urine pregnancy test is negative. You receive the following blood results from the laboratory: Hb 85 g/l Platelets 8 * 109 /l WBC 4.5 * 109 /l MCV 92 fl Na+ 138 mmol/l K+ 4.9 mmol/l Urea 10.2 mmol/l Creatinine 182 µmol/l Clotting studies are normal. Given the most likely diagnosis, what is the most appropriate management of this patient? Platelet transfusion Intravenous immunoglobulin Plasma exchange Intravenous methylprednisolone Intravenous argatroban ```

Plasma exchang

45-year-old woman who is being treated for Hodgkin's lymphoma with ABVD chemotherapy is reviewed on the haematology ward. Six days ago she was admitted with a fever of 38.9ºC. After admission she was immediately started on piperacillin with tazobactam (Tazocin). Her blood count on arrival was as follows: Hb 10.1 g/dl Platelets 311 * 109 /l WBC 0.8 * 109 /l Neutrophils 0.35 * 109 /l Lymphocytes 0.35 * 109 /l After 48 hours she remained febrile and tachycardic, Tazocin was stopped and meropenem + vancomycin prescribed. Today, six days after being admitted she remains unwell with a temperature of 38.4ºC. Blood pressure is 102/66 mmHg and the heart rate is 96/min. Respiratory examination remains unremarkable and blood/urine cultures have failed to show any cause for the fever. What is the most appropriate next step? Add amphotericin B Add G-CSF Add gentamicin Add aciclovir Refer for a stem cell transplant

Add amphotericin B

``` patient with a history of recurrent thromboembolic events develops a deep vein thrombosis despite full anticoagulation with heparin. Which one of the following causes of thrombophilia is associated with resistance to heparin? Protein S deficiency Antithrombin III deficiency Protein C deficiency Lupus anticoagulant Activated protein C resistanc ```

Antithrombin III deficiency

A 67-year-old woman is reviewed 6 months after she had a mastectomy following a diagnosis of breast cancer. Which one of the following tumour markers is most useful in monitoring her disease? CA 125 CD 34 CA 15-3 CA 19-9 CD 117

CA 15-3

``` A 49-year-old woman is referred to the haematology clinic with easy bruising and recurrent epistaxis. She is otherwise well. Blood tests reveal the following: Hb 12.9 g/dl Platelets 19 * 109 /l WCC 6.6 * 109 /l The patient refuses consent for a bone marrow examination. What is the most appropriate initial management? Platelet transfusion Oral prednisolone No treatment ABVD chemotherapy Splenectomy ```

ITP - give oral prednisolone

A 71-year-old woman who is known to have multiple myeloma is admitted with confusion. Blood tests show the following: Corrected calcium 2.91 mmol/l Which one of the following is the most significant cause of the raised calcium level? Adverse effects of standard treatment Increased osteoclastic activation Impaired renal function Increased renal tubular calcium reabsorption Elevated PTH-rP levels

Increased osteoclastic activatio

What is the mechanism of action of DDAVP in von Willebrand's disease? Prevents renal excretion of von Willebrand's factor Induces release of factor VIII from endothelial cells Induces release of von Willebrand's factor from endothelial cells Inhibits breakdown of von Willebrand's factor Acts as substitute carrier molecule for factor VIII

Desmopressin - induces release of von Willebrand's factor from endothelial cells

Which one of the following statements regarding the aetiology of venous thromboembolism (VTE) is correct? Third generation combined oral contraceptive pills are safer than second generation ones VTE develops in around 5% of patients with Goodpasture's syndrome Female gender is a risk factor recurrent VTE The second trimester of pregnancy is associated with a greater risk than the puerperium Tamoxifen therapy increases the risk of VTE

Tamoxifen therapy increases the risk of VTE

A 7-year-old boy who recently emigrated from Nigeria was seen in emergency department with a 6 week history of progressive swelling of his jaw, fevers, night sweats and weight loss. He had no past medical history but his mother describes a sore throat in the past, which was treated with antibiotics, but unfortunately developed a rash subsequently. On examination there was a painless 4x3cm mass that was fixed and hard. The only other examination findings of note was rubbery symmetrical cervical lymphadenopathy. What translocation would most likely to found on biopsy karyotyping? T9:22 T15:17 T8:14 T14:18 T11:14

T8:14

Burkitt's lymphoma is an uncommon, very high grade non Hodgkin's lymphoma endemic to west Africa and the mosquito belt. There is a close association with contraction of Epstein Barr virus (EBV). Burkitt's lymphoma often presents with symmetrical painless lymphadenopathy, systemic B symptoms (fever, sweats and weight loss), central nervous system involvement and bone marrow infiltration. Classically in the textbooks the patient also develops a large jaw tumour. T9:22 - Chronic myeloid leukaemia - 9 ABL (oncogene - an aberrant tyrosine kinase) + 22 B cell receptor T15:17 - Acute pro-myelocytic leukaemia - 15 Promyelocytic gene + 17 Retinoid acid receptor alpha (Fusion protein binds retinoid acid receptor and promotes transcription). T8:14 - Burkitt's Lymphoma - 8 c-myc (oncogene) + 14 Ig heavy constant region T14:18 - Follicular Lymphoma - 14 Ig heavy constant region + 18 Bcl2 (anti-apoptotic gene) T11:14 - Mantle Cell Lymphoma - 11 - Cyclin D (oncogene) + 14 Ig heavy constant region

^~^

74-year-old male is admitted to the Emergency Department after routine blood tests by his GP showed the following results. The patient has a background of stable essential thrombocytosis. Na+ 139 mmol/l K+ 6.6 mmol/l Urea 4.2 mmol/l Creatinine 68 umol/l Hb 13.5 g/dl Plt 800 *109/l WBC 6.6 *109/l His ECG was normal and he was given calcium gluconate along with an insulin/dextrose infusion. Following this his potassium improved to 6.1, however over the next few days he remained persistently hyperkalaemic. What would you suspect is the cause of his high potassium given his high cell counts? Pseudohyperkalaemia Tumour lysis syndrome Hypomagnasaemia Conn's syndrome Chronic kidney disease

High cell counts and high potassium: consider pseudohyperkalaemia

``` What is the mechanism of action of cisplatin? Stabilises DNA-topoisomerase II complex Causes cross-linking in DNA Inhibits ribonucleotide reductase Inhibits purine synthesis Inhibits formation of microtubules ```

Causes cross-linking in DNA

72-year-old man is admitted with a deep vein thrombosis. He is normally fit and well but has recently lost weight. Blood tests reveal the following: IgG 889 mg/dl (range 600-1300 mg/dl) IgM 1674 mg/dl (range 50-330 mg/dl) IgA 131 mg/dl (range 60-300 mg/dl) What is the most likely diagnosis? Monoclonal gammopathy of undetermined significance Acute promyelocytic leukaemia Waldenstrom's macroglobulinaemia Antiphospholipid syndrome Multiple myeloma

IgM paraproteinaemia - ?Waldenstrom's macroglobulinaemia Waldenstrom's macroglobulinaemia is more likely than monoclonal gammopathy of undetermined significance given the weight loss and deep vein thrombosis (evidence of hyperviscosity).

``` Which of the following is most associated with thymomas? Myelodysplasia Thrombocytopenia Acute myeloid leukaemia Acute lymphoblastic leukaemia Red cell aplasia ```

Red cell aplasia

``` Which of the following is a cause of extravascular haemolysis? Hereditary spherocytosis Paroxysmal nocturnal haemoglobinuria Disseminated intravascular coagulation Mismatched blood transfusion Haemolytic uraemic syndrome ```

Hereditary spherocytosis

65-year-old woman is reviewed. She is on the waiting list for a varicose vein operation but during the preoperative assessment was noted to have a raised lymphocyte count. She reports feeling well currently and clinical examination is normal. Her bloods were as follows: Hb 11.8 g/dl Plt 184 * 109 /l WBC 21.2 * 109 /l There are no previous bloods to compare these results with. Following referral to haematology a diagnosis of chronic lymphocytic leukaemia was made. What is the most appropriate management? No treatment + cancel operation No treatment + go ahead with operation Chlorambucil + cancel operation Fludarabine + go ahead with operation but with quinolone prophylaxis Alemtuzumab + cancel operation

There is no indication for treating this patient at the current time or not going ahead with surgery

``` A 73-year-old woman is reviewed in the pre-op clinic prior to an elective hip replacement. Her past medical history includes polymyalgia rheumatica and ischaemic heart disease. Screening blood tests are ordered and the full blood count is reported as follows: Hb 12.9 g/dl Plt 158 * 109 /l WBC 19.0 * 109 /l Neuts 4.2 * 109 /l Lymphs 14.1 * 109 /l What is the most likely diagnosis? Lymphoma Nicorandil-related lymphocytosis Transient viral illness Chronic lymphocytic leukaemia Secondary to steroid use ```

Such a lymphocytosis in an elderly patient is very likely to be caused by chronic lymphocytic leukaemia. Steroids tend to cause a neutrophilia. It would be unusual for a viral illness to cause such a marked lymphocytosis in an elderly person.

``` A 67-year-old man is diagnosed with myelofibrosis. What is the most common presenting symptom of myelofibrosis? Lethargy Anorexia and weight loss Night sweats Easy bruising Splenomegaly ```

Lethargy

``` Which one of the following malignancies may be associated with HTLV-1? Adult T-cell leukaemia Colorectal cancer Burkitt's lymphoma Medullary thyroid cancer Breast cancer ```

Adult T-cell leukaemia

``` 25-year-old female presents with recurrent sinopulmonary infections. What test is most likely to confirm a primary immunodeficiency? IgG level B cell level T cell level Complement (CH50) assay IgM level ```

IgG level

A 51-year-old female is referred to the haematology clinic with a haemoglobin of 19.2 g/dl. She is a non-smoker. Her oxygen saturations on room air are 98% and she is noted to have mass in the left upper quadrant. What is the most useful test to establish whether she has polycythaemia rubra vera? Bone marrow aspiration Blood film Red cell mass Transferrin saturation JAK2 mutation screen

Jak2

``` Which one of the following translocations is associated with acute promyelocytic leukaemia? t(15;17) t(9;17) t(9;22) t(15;22) t(17;22) ```

Acute promyelocytic leukaemia - t(15;17)

A 54-year-old gentleman is diagnosed with diffuse large B-cell lymphoma and is started on chemotherapy. Two days following his first treatment, he presents to the emergency department with nausea, vomiting, and myalgia. On examination, he appears clinically dehydrated. A diagnosis of tumour lysis syndrome (TLS) is suspected. Which of the following would be in keeping with this diagnosis? Low phosphate Low uric acid Low lactate dehydrogenase (LDH) Low creatinine Low corrected calcium

Low corrected calcium

A 40-year-old male patient is admitted with recurrent pancreatitis. A CT scan reveals no pancreatic mass, but evidence of widespread lymphadenopathy. Dedicated liver imaging reveals a stricture in the common bile duct but no stones. He also has a history of parotiditis. What is the most likely diagnosis? Lymphoma IgG4 disease Pancreatic cancer Biliary malignancy Primary sclerosing cholangitis

IgG4 disease

``` Which one of the following viruses is associated with nasopharyngeal carcinoma? Adenovirus Rhinovirus Herpes simplex virus Epstein-Barr virus Picornavirus ```

Epstein-Barr virus

Which one of the following would most suggest a leukaemoid reaction rather than chronic myeloid leukaemia? Raised packed cell volume Right shift of neutrophils A low leucocyte alkaline phosphatase score Dohle bodies in the white cells Positive osmotic fragility test

Dohle bodies in the white cells

57-year-old man who has had multiple emergency department admissions for alcohol related injuries and admissions under the general medical team for alcohol withdrawal, presents acutely unwell after a twelve day drinking binge. He is icteric, confused and has hepatomegaly. There are stigmata of chronic liver disease. Admission blood work shows a thrombocytopaenia, transaminitis with hyperbilirubinemia and a severe coagulopathy. A diagnosis of severe acute alcoholic hepatitis is made. With respect to the coagulopathy associated with liver disease, which clotting factor is characteristically increased? Factor VIII Factor II Factor IX Factor VII Factor XII

Factor VIII

``` A 62-year-old man presents with lethargy. A full blood count is taken and is reported as follows: Hb 10.2 g/dl Platelets 330 * 109 /l WBC 15.2 * 109 /l Film Leucoerythroblastic picture. Tear-drop poikilocytes seen What is the most likely diagnosis? Myelodysplasia Chronic lymphocytic leukaemia Myelofibrosis Chronic myeloid leukaemia Post-splenectomy ```

Tear-drop poikilocytes = myelofibrosis | Thrombocytopenia and leucopenia are seen in progressive diseas

24-year-old nulliparous female with a history of recurrent deep vein thrombosis presents with shortness of breath. The full blood count and clotting screen reveals the following results: Hb 12.4 g/dl Plt 137 WBC 7.5 * 109 /l PT 14 secs APTT 46 secs What is the most likely underlying diagnosis?

Antiphospholipid syndrome: (paradoxically) prolonged APTT + low platelets

60-year-old woman develops a deep vein thrombosis (DVT) 10 days after having a hip replacement despite taking prophylactic dose low-molecular weight heparin (LMWH). She has no significant past medical history of note other than osteoarthritis. After being diagnosed she is started on treatment dose LMWH. What is the most appropriate anticoagulation strategy? Continue on treatment dose LMWH for 6 weeks Continue on treatment dose LMWH for 3 months Continue on treatment dose LMWH for 6 months Switch to warfarin for 3 months Switch to warfarin for 6 months

Switch to warfarin for 3 months

``` 59-year-old female patient presents with headache, lethargy, and a purpuric rash on her shins. Hb 89 g/l Platelets 68 * 109 /l WBC 2.6 * 109 /l Protein Electrophoresis paraprotein 2g/L Immunoprotein Electrophoresis monoclonal IgM C4 low limit of normal Rheumatoid Factor Elevated What is the most likely diagnosis? Hepatitis C infection Rheumatoid arthritis Sjogren syndrome Waldenstrom's macroglobulinaemia Monoclonal gammopathy of unclear significance ```

Waldenstrom's macroglobulinaemia

73-year-old man is prescribed cetuximab after being diagnosed with metastatic colorectal cancer. What target is this monoclonal antibody directed against? Vascular endothelial growth factor receptor Angiopoietin-2 receptors CD20 protein complex Epidermal growth factor receptor Fibroblast growth factor receptor

Epidermal growth factor receptor

``` A 34-year-old female presents due to the development of a purpuric rash on the back of her legs. Her only regular medication is Microgynon 30. She also reports frequent nose bleeds and menorrhagia. A full blood count is requested: Hb 11.7 g/dl Platelets 62 * 109 /l WCC 5.3 * 109 /l PT 11 secs APTT 30 secs Factor VIIIc activity Normal What is the most likely diagnosis? Drug-induced thrombocytopenia Henoch-Schonlein purpura Thrombotic thrombocytopenic purpura Idiopathic thrombocytopenic purpura Antiphospholipid syndrome ```

Idiopathic thrombocytopenic purpura

``` A 75-year-old male patient has metastatic colorectal cancer. He spends most of his day resting in bed or in his chair and requires assistance with his activities of daily living. What is his Eastern Cooperative Oncology Group (ECOG) score? 0 1 2 3 4 ```

26-year-old man with a history of hereditary haemorrhagic telangiectasia is planning to start a family. What is the mode of inheritance? Autosomal dominant with incomplete penetrance Autosomal codominant Autosomal recessive with incomplete penetrance Autosomal dominant Autosomal recessive

Hereditary haemorrhagic telangiectasia - autosomal dominant

``` A man is investigated for anaemia. A blood film is ordered and reported as follows: Ring sideroblasts Which one of the following is least likely to give this picture? Anti-tuberculosis medication Alcohol Pyridoxine Lead Myelodysplasia ```

Pyridoxine

A 54-year-old woman is reviewed in oncology clinic following debulking surgery for primary peritoneal cancer. She is known to have two liver metastases. She underwent surgery one month ago and has come in for review prior to adjuvant chemotherapy. During her chemotherapy treatment, which tumour marker would be most appropriate to monitor disease progression? CA 15-3 CA 19-9 CA 125 Human chorionic gonadotropin (hCG) S-100

CA 125

A 65-year-old man comes for review. He has a history of small cell lung cancer and ischaemic heart disease. His cancer was diagnosed five months ago and he has recently completed a course of chemotherapy. From a cardiac point of view he had a myocardial infarction two years ago following which he had primary angioplasty with stent placement. He has had no angina since. For the past week he has become increasingly short-of-breath. This is worse at night and is associated with an occasional non-productive cough. He has also noticed that his wedding ring feels tight. Clinical examination is of his chest is unremarkable. He does however have distended neck veins and periorbital oedema. What is the most likely diagnosis? Heart failure secondary to chemotherapy Tumour lysis syndrome Nephrotic syndrome secondary to chemotherapy Superior vena cava obstruction Hypercalcaemia

Superior vena cava obstruction

``` A 35-year-old woman presents with menorrhagia and a persistent sore throat. A full blood count shows the following: Hb 6.8 g/dl Platelets 45 * 109 /l WBC 1.4 * 109 /l Neutrophils 0.8 * 109 /l Which one of the following medications is most likely to account for this finding? Trimethoprim Rifampicin Olanzapine Montelukast Clomifene ```

Trimethoprim may cause pancytopenia

35-year-old female who is 34 weeks pregnant presents with a swollen, painful right calf. A deep vein thrombosis is confirmed on Doppler scan. What is the preferred anticoagulant? Clopidogrel Aspirin Intravenous heparin Warfarin Subcutaneous low molecular weight heparin

Subcutaneous low molecular weight heparin

``` A 67-year-old woman is referred to the haematology clinic. Her GP has noted that her platelet count is persistently elevated and no reactive cause can be found. Bloods taken a week before clinic are as follows: Hb 15.4 g/dl Platelets 784 * 109 /l WBC 5.3* 109 /l JAK2 kinase (V617F mutation) Positive What is the treatment of choice? Imatinib Stem-cell transplantation Hydroxycarbamide Vincristine Venesection ```

Hydroxycarbamide

A 74-year-old woman with a past history of chronic lymphocytic leukaemia presents with lethargy. The following blood results are obtained: Hb 7.9 g/dl Plt 158 * 109 /l WCC 24.0 * 109 /l Blood film: normochromic, normocytic anaemia What complication has most likely occurred? Paroxysmal nocturnal haemoglobinuria Microangiopathic haemolytic anaemia Sideroblastic anaemia Warm autoimmune haemolytic anaemia Cold autoimmune haemolytic anaemia

Warm autoimmune haemolytic anaemia

``` A 31-year-old man is referred to the acute medical unit with a painful swollen left leg. The patient reports that he has the 'Factor V Leiden mutation'. Which one of the following best describes the pathophysiology of his condition? Protein S deficiency Activated protein C excess Antithrombin deficiency Resistance to action of protein C Activated protein C deficiency ```

Resistance to action of protein C

``` Which of the following is a cause of intravascular haemolysis? Hereditary spherocytosis Sickle cell anaemia Paroxysmal nocturnal haemoglobinuria Haemolytic disease of the newborn Warm autoimmune haemolytic anaemia ```

Paroxysmal nocturnal haemoglobinuria

27-year-old male is receiving cyclophosphamide as part of his chemotherapy for non-Hodgkin' lymphoma. What is the most appropriate management to reduce the likelihood of haemorrhagic cystitis? Hydration + tranexamic acid Hydration + twice-daily bladder washouts Hydration + prophylactic antibiotics Hydration + twice-daily bladder washouts + prophylactic antibiotics Hydration + mesna

Hydration + mesn

``` A 31-year-old woman who is 25-weeks pregnant is brought to the Emergency Department by her husband. Over the past two days she has become increasingly confused. Her temperature is 37.8ºC and blood pressure is 104/62 mmHg. Blood tests show: Hb 8.3 g/dl Platelets 88 * 109 /l WBC 15.1 * 109 /l Blood film Fragmented red blood cells Sodium 139 mmol/l Potassium 5.2 mmol/l Urea 19.4 mmol/l Creatinine 296 µmol/l What is the most appropriate treatment? Rituximab Intravenous immunoglobulin Methylprednisolone Ceftriaxone + vancomycin Plasma exchange ```

Plasma exchange

A 54-year-old woman presents to the Emergency Department with a five day history of back pain. Her past medical history includes breast cancer and osteoarthritis. The back pain is located in the lower thoracic region and is made worse by coughing and sneezing. There has been no change in bowel habit or urinary symptoms. On examination there is diffuse tenderness in the lower thoracic region. Peri- anal sensation is normal and lower limb reflexes are brisk. Which one of the following is the most appropriate management plan? Organise outpatient MRI Oral paracetamol + urgent MRI Oral paracetamol + urgent thoracic/lumbar spine x-ray Oral dexamethasone + urgent thoracic/lumbar spine x-ray Oral dexamethasone + urgent MRI

Oral dexamethasone + urgent MRI

``` What is the most common inherited bleeding disorder? Haemophilia A Activated protein C resistance Haemophilia B Antithrombin III deficiency von Willebrand's disease ```

von Willebrand's disease

Mcq Of Pass Medicine Flashcards

(82 cards)