-
Question 1
Incorrect
-
A 27-year-old man with a medical history of sickle cell disease presents with intense pain in his left hip. He mentions having received antibiotics from his general practitioner for a chest infection. How would you categorize this sickle cell crisis?
Your Answer: Sequestration crises
Correct Answer: Thrombotic crises
Explanation:Sickle cell patients may experience thrombotic crises due to factors such as infection, dehydration, or deoxygenation. In this case, the patient’s severe pain and recent infection suggest a thrombotic crisis. Other types of crises, such as sequestration crises that present with acute chest syndrome, aplastic crises caused by parvovirus infection, or haemolytic crises with increased haemolysis, may have different symptoms. A thyrotoxic crisis would not be related to sickle cell disease.
Sickle cell anaemia is a condition that involves periods of good health with intermittent crises. There are several types of crises that can occur, including thrombotic or painful crises, sequestration, acute chest syndrome, aplastic, and haemolytic. Thrombotic crises, also known as painful crises or vaso-occlusive crises, are triggered by factors such as infection, dehydration, and deoxygenation. These crises are diagnosed clinically and can result in infarcts in various organs, including the bones, lungs, spleen, and brain.
Sequestration crises occur when sickling occurs within organs such as the spleen or lungs, leading to pooling of blood and worsening of anaemia. This type of crisis is associated with an increased reticulocyte count. Acute chest syndrome is caused by vaso-occlusion within the pulmonary microvasculature, resulting in infarction in the lung parenchyma. Symptoms include dyspnoea, chest pain, pulmonary infiltrates on chest x-ray, and low pO2. Management involves pain relief, respiratory support, antibiotics, and transfusion.
Aplastic crises are caused by infection with parvovirus and result in a sudden fall in haemoglobin. Bone marrow suppression leads to a reduced reticulocyte count. Haemolytic crises are rare and involve a fall in haemoglobin due to an increased rate of haemolysis. It is important to recognise and manage these crises promptly, as they can lead to serious complications and even death.
-
This question is part of the following fields:
- Haematology/Oncology
-
-
Question 2
Correct
-
A 43-year-old man is being evaluated for anemia by his primary care physician. He has been experiencing mild shortness of breath for the past 3 months. His medical history is significant for a previous diagnosis of polymyalgia rheumatica.
The results of his recent blood tests are as follows:
- Hemoglobin (Hb): 98 g/L (Male: 135-180, Female: 115-160)
- Mean Corpuscular Volume (MCV): 77 fl (76-95 fl)
- Ferritin: 195 ng/mL (20-230)
- Total Iron Binding Capacity: 610 µg/dL (250-450)
What is the most probable diagnosis?Your Answer: Iron deficient anaemia
Explanation:The patient’s anaemia is complex and could have multiple causes. The anaemia is microcytic/normocytic and is accompanied by normal ferritin levels and elevated TIBC. However, the patient also has polymyalgia rheumatica, an inflammatory disorder that can affect ferritin levels. Ferritin is an acute-phase reactant and can be elevated in inflammation, making it an unreliable measurement.
Iron-deficient anaemia typically presents as microcytic with high TIBC levels. The high TIBC is due to the body’s ability to transport iron despite low iron levels. Iron-deficient anaemia also has low ferritin levels, but this may not be the case in this patient due to their chronic inflammatory condition. Therefore, iron-deficient anaemia is the most likely diagnosis due to the high TIBC levels.
Anaemia of chronic disease is also normocytic but typically has low or normal TIBC levels. This is because iron is trapped in inflammatory tissue and not available for use, reducing the body’s ability to transport free iron.
B12 deficiency results in macrocytic anaemia, which is not the case in this patient. Haemolytic anaemia is a rare form of anaemia that results in normocytic anaemia and does not explain the abnormalities in iron studies seen in this patient.
Iron Studies: Understanding the Different Tests
Iron studies are a group of laboratory tests that help evaluate a person’s iron status. These tests include serum iron, total iron binding capacity (TIBC), transferrin, transferrin saturation, and ferritin. Serum iron measures the amount of iron in the blood, while TIBC measures the amount of iron that can bind to transferrin, a protein that transports iron in the blood. Transferrin saturation is calculated by dividing serum iron by TIBC, and it reflects the percentage of transferrin that is saturated with iron. Ferritin, on the other hand, is a protein that stores iron in the body, and its level in the blood can indicate the amount of iron stored in the body.
In iron deficiency anaemia (IDA), the levels of serum iron and transferrin saturation are low, while TIBC and transferrin are high. Ferritin levels are also low in IDA. However, in pregnancy and in the presence of oestrogen, transferrin levels may be elevated. Inflammatory disorders, on the other hand, can cause an increase in ferritin levels.
Other rarer tests that may be used to evaluate iron status include transferrin receptors, which are increased in IDA, and tests for anaemia of chronic disease, which is a normochromic/hypochromic, normocytic anaemia characterized by reduced serum and TIBC levels and normal or raised ferritin levels. Understanding these different tests can help healthcare providers diagnose and manage iron-related disorders.
-
This question is part of the following fields:
- Haematology/Oncology
-
-
Question 3
Correct
-
A 67-year-old woman presents to the breast clinic with a complaint of a palpable mass in her left breast. The diagnostic mammogram shows a spiculated mass measuring 2.1 cm. Ultrasound detects a hypoechoic mass measuring 2.1 cm x 1.3 cm x 1.1 cm. Biopsy reveals a well-differentiated mucinous carcinoma which is negative for ER and HER2. The recommended course of treatment to prevent recurrence in this patient is:
Your Answer: Whole breast radiotherapy
Explanation:Breast cancer management varies depending on the stage of the cancer, type of tumor, and patient’s medical history. Treatment options may include surgery, radiotherapy, hormone therapy, biological therapy, and chemotherapy. Surgery is typically the first option for most patients, except for elderly patients with metastatic disease who may benefit more from hormonal therapy. Prior to surgery, an axillary ultrasound is recommended for patients without palpable axillary lymphadenopathy, while those with clinically palpable lymphadenopathy require axillary node clearance. The type of surgery offered depends on various factors, such as tumor size, location, and type. Breast reconstruction is also an option for patients who have undergone a mastectomy.
Radiotherapy is recommended after a wide-local excision to reduce the risk of recurrence, while mastectomy patients may receive radiotherapy for T3-T4 tumors or those with four or more positive axillary nodes. Hormonal therapy is offered if tumors are positive for hormone receptors, with tamoxifen being used in pre- and peri-menopausal women and aromatase inhibitors like anastrozole in post-menopausal women. Tamoxifen may increase the risk of endometrial cancer, venous thromboembolism, and menopausal symptoms. Biological therapy, such as trastuzumab, is used for HER2-positive tumors but cannot be used in patients with a history of heart disorders. Chemotherapy may be used before or after surgery, depending on the stage of the tumor and the presence of axillary node disease. FEC-D is commonly used in the latter case.
-
This question is part of the following fields:
- Haematology/Oncology
-
-
Question 4
Correct
-
A 32-year-old female presents with a purpuric rash on the back of her legs, frequent nose bleeds, and menorrhagia. She is currently taking Microgynon 30. A full blood count reveals Hb of 11.7 g/dl, platelets of 62 * 109/l, and WCC of 5.3 * 109/l. What is the probable diagnosis?
Your Answer: Idiopathic thrombocytopenic purpura
Explanation:A diagnosis of ITP is suggested by the presence of isolated thrombocytopenia in a healthy patient. Blood dyscrasias are not typically caused by the use of combined oral contraceptive pills.
Understanding Immune Thrombocytopenia (ITP) in Adults
Immune thrombocytopenia (ITP) is a condition where the immune system attacks and reduces the number of platelets in the blood. This is caused by antibodies targeting the glycoprotein IIb/IIIa or Ib-V-IX complex. While children with ITP usually experience acute thrombocytopenia after an infection or vaccination, adults tend to have a more chronic form of the condition. ITP is more common in older females and may be detected incidentally during routine blood tests. Symptoms may include petechiae, purpura, and bleeding, but catastrophic bleeding is not a common presentation.
To diagnose ITP, a full blood count and blood film are typically performed. While a bone marrow examination is no longer routinely used, antiplatelet antibody testing may be done, although it has poor sensitivity and does not affect clinical management. The first-line treatment for ITP is oral prednisolone, but pooled normal human immunoglobulin (IVIG) may also be used if active bleeding or an urgent invasive procedure is required. Splenectomy is now less commonly used as a treatment option.
In some cases, ITP may be associated with autoimmune haemolytic anaemia (AIHA), which is known as Evan’s syndrome. It is important for individuals with ITP to work closely with their healthcare provider to manage their condition and prevent complications.
-
This question is part of the following fields:
- Haematology/Oncology
-
-
Question 5
Incorrect
-
A 56-year-old man has been experiencing fatigue and bone pain, prompting his regular GP to conduct investigations. Blood tests revealed an elevated paraprotein level, leading to further investigations to rule out multiple myeloma as the primary differential. What other potential cause could result in a raised paraprotein level?
Your Answer: Polycythaemia
Correct Answer: MGUS (Monoclonal gammopathy of undetermined significance)
Explanation:MGUS is a possible differential diagnosis for elevated paraproteins in the blood.
Thrombocytopenia is a characteristic feature of haemolytic uraemic syndrome.
The presence of paraproteins in the blood is an abnormal finding and not a normal variant.
While a viral infection may cause neutropenia, it would not typically result in the presence of paraproteins in the blood.
Paraproteinaemia is a medical condition characterized by the presence of abnormal proteins in the blood. There are various causes of paraproteinaemia, including myeloma, monoclonal gammopathy of uncertain significance (MGUS), benign monoclonal gammopathy, Waldenstrom’s macroglobulinaemia, amyloidosis, CLL, lymphoma, heavy chain disease, and POEMS. Benign monoclonal gammopathy can also cause paraproteinaemia, as well as non-lymphoid malignancy (such as colon or breast cancer), infections (such as CMV or hepatitis), and autoimmune disorders (such as RA or SLE).
Paraproteinaemia is a medical condition that is characterized by the presence of abnormal proteins in the blood. This condition can be caused by various factors, including myeloma, MGUS, benign monoclonal gammopathy, Waldenstrom’s macroglobulinaemia, amyloidosis, CLL, lymphoma, heavy chain disease, and POEMS. Additionally, benign monoclonal gammopathy, non-lymphoid malignancy (such as colon or breast cancer), infections (such as CMV or hepatitis), and autoimmune disorders (such as RA or SLE) can also cause paraproteinaemia. It is important to identify the underlying cause of paraproteinaemia in order to determine the appropriate treatment plan.
-
This question is part of the following fields:
- Haematology/Oncology
-
-
Question 6
Incorrect
-
Among the following groups of malignant tumours, which one is known for frequently metastasizing to bone?
Your Answer:
Correct Answer: Breast, prostate, kidney, lung, thyroid
Explanation:Metastasis Patterns of Common Tumours
Metastasis, the spread of cancer cells from the primary tumour to other parts of the body, is a major factor in cancer progression and treatment. Different types of cancer have different patterns of metastasis. Here are some common tumours and their predilection for dissemination to specific organs:
– Breast, prostate, kidney, lung, thyroid: These tumours have a predilection for dissemination to bone.
– Kidney, sarcoma, lung, thyroid: Sarcoma most commonly metastasises to the lungs.
– Breast, prostate, kidney, lymphoma: Tumours that commonly metastasise to the brain include those of the breast, lung, prostate, kidney and thyroid.
– Lung, breast, prostate, thyroid, brain: Primary brain tumours rarely metastasise to other parts of the body.
– Thyroid, brain, lung, liver, breast: Primary liver tumours most commonly metastasise to the lung, portal vein and portal nodes.Understanding the metastasis patterns of different tumours can help in early detection and targeted treatment.
-
This question is part of the following fields:
- Haematology/Oncology
-
-
Question 7
Incorrect
-
A 25-year-old man visited his GP after he discovered a solid lump in his left testis.
What is the most probable diagnosis?
Your Answer:
Correct Answer: Teratoma
Explanation:Common Scrotal Conditions: Understanding Testicular Lumps and Swellings
Testicular lumps and swellings can be a cause for concern, but not all of them are cancerous. In fact, most scrotal conditions are benign and can be easily treated. Here are some common scrotal conditions and their characteristics:
Teratoma: This solid testicular lump is suggestive of a tumour and typically presents in young soldiers aged 20-30 years.
Seminoma: This tumour usually presents in more senior soldiers aged 35-45 years.
Epididymal cyst: This benign, fluid-filled lump is usually found at the head of the epididymis and is separate from the testis.
Hydrocele: This painless, cystic, scrotal swelling lies below and anterior to the testes and will normally transilluminate.
Varicocele: This painless swelling of the testes on the left side (rarely on the right) is described as a bag of worms within the spermatic cord above the testis. It tends to occur in those aged 12+ years and is associated with infertility in approximately a quarter of men with abnormal semen parameters.
If you notice any changes in your scrotum, it is important to seek medical attention. Your healthcare provider can help determine the cause of the lump or swelling and recommend appropriate treatment.
-
This question is part of the following fields:
- Haematology/Oncology
-
-
Question 8
Incorrect
-
A 63-year-old woman with metastatic breast cancer complains of worsening dyspnea. She is undergoing chemotherapy treatment. During the physical examination, a third heart sound is heard and the apex beat is displaced to the anterior axillary line in the 6th intercostal space. Which chemotherapy drug is most likely causing these symptoms?
Your Answer:
Correct Answer: Doxorubicin
Explanation:Cardiomyopathy can be caused by anthracyclines such as doxorubicin.
Cytotoxic agents are drugs that are used to kill cancer cells. There are several types of cytotoxic agents, each with their own mechanism of action and adverse effects. Alkylating agents, such as cyclophosphamide, work by causing cross-linking in DNA. However, they can also cause haemorrhagic cystitis, myelosuppression, and transitional cell carcinoma. Cytotoxic antibiotics, like bleomycin, degrade preformed DNA and can lead to lung fibrosis. Anthracyclines, such as doxorubicin, stabilize the DNA-topoisomerase II complex and inhibit DNA and RNA synthesis, but can also cause cardiomyopathy. Antimetabolites, like methotrexate, inhibit dihydrofolate reductase and thymidylate synthesis, leading to myelosuppression, mucositis, liver fibrosis, and lung fibrosis. Fluorouracil (5-FU) is a pyrimidine analogue that induces cell cycle arrest and apoptosis by blocking thymidylate synthase, but can also cause myelosuppression, mucositis, and dermatitis. Cytarabine is a pyrimidine antagonist that interferes with DNA synthesis specifically at the S-phase of the cell cycle and inhibits DNA polymerase, but can also cause myelosuppression and ataxia. Drugs that act on microtubules, like vincristine and vinblastine, inhibit the formation of microtubules and can cause peripheral neuropathy, paralytic ileus, and myelosuppression. Docetaxel prevents microtubule depolymerisation and disassembly, decreasing free tubulin, but can also cause neutropaenia. Topoisomerase inhibitors, like irinotecan, inhibit topoisomerase I which prevents relaxation of supercoiled DNA, but can also cause myelosuppression. Other cytotoxic drugs, such as cisplatin, cause cross-linking in DNA and can lead to ototoxicity, peripheral neuropathy, and hypomagnesaemia. Hydroxyurea (hydroxycarbamide) inhibits ribonucleotide reductase, decreasing DNA synthesis, but can also cause myelosuppression.
-
This question is part of the following fields:
- Haematology/Oncology
-
-
Question 9
Incorrect
-
A 72-year-old man presents to the Haematology Clinic with symptoms of bone pain and anaemia. The medical team suspects multiple myeloma (MM) and orders a set of blood tests, including a full blood count, urea, serum creatinine and electrolytes, serum calcium, albumin, serum protein electrophoresis, serum-free light-chain assay, and serum beta-2 microglobulin. The team also plans to perform an imaging investigation to look for osteolytic lesions. What initial scan should be ordered?
Your Answer:
Correct Answer: Whole-body low-dose CT (WBLD-CT)
Explanation:When investigating suspected multiple myeloma (MM), it is crucial to use whole-body low-dose CT (WBLD-CT) imaging. This method is more effective than traditional radiology in detecting lytic lesions and should be the first option if available. Lesions with a diameter of 5mm or more are considered positive. If WBLD-CT and MRI fail to show lesions with a strong clinical indication, an FDG-PET or FDG-PET-CT can be used to detect bone lesions. During treatment follow-up, an FDG-PET-CT can detect active lesions and provide prognostic information. While a skeletal survey (X-ray) is less sensitive than WBLD-CT, it can still be useful. If suspicion remains high for MM despite negative WBLD-CT or skeletal survey results, a whole-body MRI should be performed. This method can detect focal lesions and bone marrow infiltration and may also be of prognostic value in asymptomatic patients. The presence of focal lesions is a strong predictor of progression to symptomatic MM.
-
This question is part of the following fields:
- Haematology/Oncology
-
-
Question 10
Incorrect
-
A 78-year-old woman presents to her general practitioner with a painless lump in her groin that she noticed 2 weeks ago. The lump has grown slightly since she first noticed it. On examination, a hard lump is palpable on her left labia majora and she has left inguinal lymphadenopathy. She has no significant past medical history and no known allergies.
What is the most probable diagnosis?Your Answer:
Correct Answer: Vulval carcinoma
Explanation:A possible diagnosis for an older woman with a labial lump and inguinal lymphadenopathy is vulval carcinoma, especially if the lump is firm and has grown rapidly over a short period of time. Risk factors for this condition include advanced age, smoking, and HPV infection. Bartholin’s cyst, condylomata lata, lipoma, and sebaceous cyst are less likely diagnoses, as they do not typically present with the same symptoms or risk factors as vulval carcinoma.
Understanding Vulval Carcinoma
Vulval carcinoma is a type of cancer that affects the vulva, which is the external female genitalia. It is a relatively rare condition, with only around 1,200 cases diagnosed in the UK each year. The majority of cases occur in women over the age of 65 years, and around 80% of cases are squamous cell carcinomas.
There are several risk factors associated with vulval carcinoma, including human papilloma virus (HPV) infection, vulval intraepithelial neoplasia (VIN), immunosuppression, and lichen sclerosus. Symptoms of vulval carcinoma may include a lump or ulcer on the labia majora, inguinal lymphadenopathy, and itching or irritation.
It is important for women to be aware of the risk factors and symptoms of vulval carcinoma, and to seek medical attention if they experience any concerning symptoms. Early detection and treatment can improve outcomes and increase the chances of a full recovery.
-
This question is part of the following fields:
- Haematology/Oncology
-
00
Correct
00
Incorrect
00
:
00
:
0
00
Session Time
00
:
00
Average Question Time (
Mins)