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Haematology week 3

Total questions: 84

Worksheet time: 3hrs 37mins

Name
Class
Date
1.

What type of anaemia is shown on the left?

a)

Haemolytic anaemia

b)

megaloblastic anaemia (folate deficiency)

c)

iron deficiency anaemia

d)

pernicious anaemia

e)

aplastic anaemia

2.

which bone marrow cell is this?

a)

stem cell

b)

myeloblast

c)

lymphoblast

d)

megakaryocyte

e)

macrophage

3.

What type of rash is this?

a)

maculopapular drug eruption

b)

shingles

c)

uriticaria

d)

petechiae/purpura

e)

erythema nodosum

4.

This blood film shows what?

a)

malarial parasites

b)

Heinz bodies

c)

Howell-Jolly bodies

d)

target cells

e)

Trypanosomes

5.

Hyposplenism does not cause increased risk of?

a)

meningococcus

b)

pneumococcus

c)

haemophilus

d)

E coli

e)

malaria

6.

A 21 year old female medical student presents to A & E with a 24 hour history of fever. She is febrile (40oC), drowsy and has a purpuric rash and nuchal rigidity.

Her coagulation screen shows: PT and APTT prolonged, fibrinogen and platelet reduced

What term is used to describe her coagulopathy?

a)

von willebrands disease

b)

toxic shock syndrome

c)

thrombotic thrombocytopenic purpura

d)

meningococcal meningitis

e)

disseminated intravascular coagulation

7.

10 yr old boy presents to A&E. Minor trauma. Painful swollen L knee

Coagulation shows PTT prolonged, PT normal

Platelets and Fibrinogen normal

Likely diagnosis?

a)

Von Willibrand's disease

b)

Haemophilia

c)

acute lymphoblastic leukaemia

d)

immune thrombocytopenia

e)

factor VII deficiency

8.

A 41 year old man presents with tiredness and a rash

FBC: Hb 101g/l, WCC 27.1x109/L, Plt 9x109/L

Coagulation; DIC

Bone marrow cytogenetics subsequently show t(15;17)

The blood film is shown here.

a)

acute lymphoblastic leukaemia

b)

chronic myeloid leukaemia

c)

acute promyelocytic leukaemia

d)

acute myeloid leukaemia

e)

chronic lymphocytic anaemia

9.

A 33 year old woman presents to her GP with left upper quadrant pain and anorexia.

On examination her spleen is 12 cm below the costal margin.

The GP performs a full blood count:

Hb 115g/L

WCC 103x109/L

Plt 740x109/L

Blood film: There is marked neutrophilia with prominent left shift and frequent myelocytes and metamyelocytes. There is a basophilia and eosinophilia. Platelets are increased. Features are suggestive of……

a)

Chronic myeloid leukaemia

b)

essential thrombocytosis

c)

acute myeloid leukaemia

d)

myelofibrosis

e)

non hodgkin's lymphoma

10.

A 25 year old female presents to A & E with sudden onset facial swelling and redness. She has noticed some swelling in her neck for last 6 weeks. What is the diagnosis?

a)

Primary mediastinal B cell lymphoma

b)

Hodgkin's lymphoma

c)

acute T cell lymphoblastic lymphoma/leukaemia

d)

diffuse large B cell lymphoma

e)

none of these

11.

The patient has B cell ALL. He is entered into the UKALL14 trial.

Cytogenetics show that he has a p190 BCR-ABL translocation (Ph+ ALL)

He will receive imatinib (Glivec) with his chemotherapy

Following his remission induction therapy he requires a stem cell transplant

As part of his remission induction chemotherapy, he requires intrathecal chemotherapy….

Which of the following drugs should NEVER be given intrathecally?

a)

Methotrexate

b)

Vincristine

c)

Cytosine arabinoside

d)

all of these are safe

e)

none of these are safe

12.

What is this called?

a)

Hickman Line

b)

Portocath

c)

dialysis line

d)

apheresis line

e)

temporary central line

13.

Which of the following statements related to the coagulation cascade is true?

a)

Tissue factor released by damaged tissue ignited the extrinsic pathway

b)

thrombin converts plasminogen to plasmin

c)

heparin inhibits the activation of factor 8

d)

the intrinsic pathway is the main pathway in coagulation

e)

the activation of factor 8 is the point when the intrinsic and the extrinsic pathways meet

14.

A 21 year old female medical student presents with an acute purpuric rash on her hands and legs. She is otherwise well but had some ‘viral symptoms’ 1 week before


Full Blood Count

White count 6.0 x109/l (NR 4.0-10.0) (normal WBC differential)

Haemoglobin 130 g/l

Platelets 05 x 109/l (NR 150-450)


Blood film shows only thrombocytopenia


Coagulation Screen

PTT Normal

PT Normal

Fibrinogen Normal

Platelets 05


What is the likely diagnosis?

a)

immune thrombocytopenic purpura

b)

Disseminated intravascular coagulation

c)

Haemolytic uraemic syndrome

d)

von-willebrand's disease

e)

Over anticoagualtion

15.

a 42 year old patient is actively bleeding and is in circulatory shock. He requires blood immediately. which is the best option?

a)

fully crossmatched blood

b)

blood of the same ABO group as the patient

c)

blood of the same RhD group as the patient

d)

O RhD negative blood

e)

fresh frozen plasma

16.

A 22 year old woman with sickle cell disease requires multiple blood transfusions. She is planning to have a baby in the near future. Which one of the following is the best option for transfusion?

a)

same ABO and RhD group as patient

b)

same ABO and RhD group as patient which is c-negative and Kell-negative

c)

RhD negative blood

d)

same ABO and RhD group as the patient which is Duffy negative

e)

same ABO and RhD group as patient without IgA

17.

HbA1c is an indicator of blood glucose levels for

a)

7 days

b)

30 days

c)

60 days

d)

120 days

e)

6 weeks

18.

In the normal adult, haemopoiesis

a)

is present in the marrow of every bone

b)

partially occurs in the liver

c)

occurs in the spleen

d)

is confined to the central skeleton and the proximal ends of the long bones

e)

occurs in the lymph nodes, central skeleton and proximal ends of the long bones, spleen and liver

19.

A 52 year old farmer in india presents with generalised weakness. Haematocrit is 0.20 and MCV is 72 . on examination he has koilonychia. What is the diagnosis?

a)

Sickle cell disease

b)

thalassaemia major

c)

iron deficiency anaemia

d)

sideroblastic anaemia

e)

polycythaemia vera

20.

A 28 year old Greek waiter complains of fatigue. Haematocrit is 0.32. On examination he has bone deformities. What is the diagnosis?

a)

sickle cell disease

b)

thalassaemia major

c)

iron deficiency anaemia

d)

sideroblastic anaemia

e)

Polycythaemia vera

21.

A 28 year old sudanese medical registrar complains of fatigue. Haematocrit is 0.28. On examination he has leg ulcers. What is the diagnosis?

a)

sickle cell disease

b)

thalassaemia major

c)

iron deficiency anaemia

d)

sideroblastic anaemia

e)

polycythaemia vera

22.

A 22 year old presents with shortness of breath. Haematocrit is 0.27. Serum bilirubin is raised. What is the diagnosis?

a)

thalassaemia major

b)

iron deficiency anaemia

c)

polycythaemia vera

d)

haemolytic anaemia

e)

spurious polycythaemia

23.

A 7 year old boy attends the GP with a limp and his blood work shows a low platelet count. What is the most likely explanation?

a)

CML

b)

ALL

c)

AML

d)

CLL

e)

Lymphoma

24.

A 83 year old man attends his GP with fatigue. On his blood film there are auer rods. What is the most likely diagnosis?

a)

CML

b)

ALL

c)

AML

d)

CLL

e)

Lymphoma

25.

Which diseases is associated with the philadelphia chromosome?

a)

AML

b)

ALL

c)

CLL

d)

CML

e)

Lymphoma

26.

What is measured by the PT (prothrombin time)?

a)

extrinsic pathway

b)

intrinsic pathway

c)

common pathway

27.

What is measured by the aPPT (activated partial prothrombin time)?

a)

Intrinsic pathway

b)

extrinsic pathway

c)

common pathway

28.

which type of leukaemia has symptoms that develop from accumulation of cells?

a)

chronic leukaemia

b)

acute leukaemia

29.

which type of leukaemia causes symptoms from marrow failure?

a)

chronic leukaemia

b)

acute leukaemia

30.

What is the definition of a major haemorrhage?

4 lines
31.

what does trauma to the spleen cause?

4 lines
32.

name the 2 classes of fibrinolytic drugs.

4 lines
33.

name some kinases

4 lines
34.

name some tPAs

4 lines
35.

48y female - pyrexia + rigors ? acute abdomen - paracolic abscess at laparotomy - Post-op  -> ICU

Haematology Result = Hb  94 g/l 

PT  21s  (NR 11-15)

WBC 16.0 x109/l 

APTT  41s  (NR 26-37)

Platelets  78 x109/l 

D-dimer  4200  (NR <500)

Few RBC fragments on blood film

What is the diagnosis?

4 lines
36.

What do you do when someone has bleeding complications from warfarin?

4 lines
37.

35 year old female with a history of PE - no FH of thrombosis

prolonged APTT and APTT 50:50 dilution - what is the diagnosis and what is causing this?

4 lines
38.

What factor is deficient in haemophilia A?

a)

factor IIa

b)

Factor X

c)

Factor VII

d)

Factor VIII

e)

Factor XI

39.

25y female - Referred to haematology from gynaecology clinic

–Heavy menstrual bleeding since menarche

–Frequent epistaxis; had cautery twice

–Easy bruising but no petechiae

- prolonged APTT

- Low Hb

- Low MCV

- factor VIII low

- VWF:RCo low

- VWF:Ag low

what is the diagnosis?

4 lines
40.

what do we need for normal red cell production?

4 lines
41.

what does B12/folate deficiency cause and why?

4 lines
42.

What is the basic definition of thalassaemia?

4 lines
43.

what is the clinical significance if someone with alpha thallasaemia is missing 1 gene?

4 lines
44.

what is the clinical significance of a patient with alpha thalassaemia missing 2 genes?

4 lines
45.

what is the clinical significance of a patient with alpha thallasaemia who is missing 3 genes?

4 lines
46.

what is the clinical significance of alpha thalassaemia with 4 missing genes?

4 lines
47.

what is beta thalassaemia major?

4 lines
48.

what genetic mutation leads to sickle cell disease?

4 lines
49.

what is the clinical result of sickle cell disease?

4 lines
50.

what hormone does hereditary haemochromatosis result in?

4 lines
51.

what does hepcidin do?

4 lines
52.

what does low serum ferritin levels show?

4 lines
53.

Male 70yr; tired, pale, no meds, no GI upset

  HB   90g/l          (130-170)

  MCV 60fl     (80-100)

  MCH 20pg    (27-32)

     WBCs, platelets

blood film report - microcytic hypochromic RBCs

what is the likely diagnosis? what test would you do to confirm this? what is the likely underlying cause?

4 lines
54.

what is anaemia of chronic disease?

4 lines
55.

what happens to serum ferritin in anaemia of chronic disease?

4 lines
56.

what causes haemolytic anaemia?

4 lines
57.

What are the different types of acquired haemolytic anaemias?

4 lines
58.

which autoantibody does cold autoimmune haemolytic anaemia involve?

a)

IgG

b)

IgM

c)

IgE

d)

IgA

59.

which autoantibody does warm autoimmune haemolytic anaemia involve?

a)

IgM

b)

IgG

c)

IgA

d)

IgE

60.

What is the purpose of the direct coombs test?

4 lines
61.

what does it mean if a direct coombs test is positive?

4 lines
62.

what is the purpose of the indirect coombs test?

4 lines
63.

what is the treatment for cold autoimmune haemolytic anaemia?

4 lines
64.

what is the treatment for warm autoimmune haemolytic anaemia?

4 lines
65.

what is the definition of myeloproliferative disorders?

4 lines
66.

list some classic myeloproliferative disorders

4 lines
67.

what do all myeloproliferative disorders have the capacity to transform into?

4 lines
68.

what type of stem cell transplant uses the patients own blood stem cells?

a)

allogeneic

b)

syngeneic

c)

haplotype identical

d)

autologous

e)

volunteer unrelated

69.

what type of stem cell transplant uses stem cells from a donor?

a)

allogeneic

b)

syngeneic

c)

autologous

d)

haplotype identical

e)

volunteer unrelated

70.

which type of transplant is between identical twins?

a)

allogeneic

b)

syngeneic

c)

autologous

d)

haplotype identical

e)

volunteer unrelated

71.

which of the following describes a transplant with a half matched family member (usually a parent or half-matched sibling)?

a)

allogeneic

b)

syngeneic

c)

autologous

d)

haplotype identical

e)

volunteer unrelated

72.

what is lymphoma?

4 lines
73.

how do patients with lymphoma present?

4 lines
74.

how do we investigate patients with lymphoma?

4 lines
75.

describe the ann-arbor classification and its uses?

4 lines
76.

what type of lymphoma is Burkitt's lymphoma?

4 lines
77.

what type of lymphoma is diffuse large B cell lymphoma?

4 lines
78.

what type of lymphoma is follicular lymphoma?

4 lines
79.

what is the treatment for diffuse large B cell lymphoma?

4 lines
80.

what are some features of classic hodgkin lymphoma?

4 lines
81.

how do we treat hodgkin lymphoma?

4 lines
82.

What is the definition of leukaemia?

4 lines
83.

which is the most common leukaemia to be seen in adults?

a)

AML

b)

ALL

c)

CML

d)

CLL

e)

myeloma

84.

Which leukaemia is most commonly seen in children?

a)

AML

b)

ALL

c)

CML

d)

CLL

e)

myeloma

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