00
Correct
00
Incorrect
00 : 00 : 00
Session Time
00 : 00
Average Question Time ( Mins)
  • Question 1 - A 55-year-old man is hospitalized after experiencing haematemesis. Upon examination, his prothrombin time...

    Incorrect

    • A 55-year-old man is hospitalized after experiencing haematemesis. Upon examination, his prothrombin time is found to be elevated. What could be a possible reason for this anomaly?

      Your Answer: Aspirin therapy

      Correct Answer: Chronic liver disease

      Explanation:

      The inheritance of Haemophilia A and B is crucial in identifying individuals who are at risk of developing the condition. Haemophilia A and B are genetic disorders that are inherited in an X-linked recessive manner. Haemophilia A is caused by a deficiency in clotting factor VIII, while haemophilia B is caused by a deficiency in clotting factor IX.

      On the other hand, haemophilia C, which is caused by a deficiency in clotting factor XI, is primarily inherited in an autosomal recessive manner. In X-linked recessive conditions like haemophilia B, males are more likely to be affected than females. This is because males only need one abnormal copy of the gene, which is carried on the X chromosome, to be affected.

      Females, on the other hand, can be carriers of the condition if they carry one normal and one abnormal copy of the gene. While carriers can have clotting abnormalities, these are usually milder than those seen in affected individuals. Men cannot pass the condition to their sons, but they will pass on the abnormal X chromosome to all their daughters, who will be carriers.

      Female carriers can pass on the condition to around half their sons, and half their daughters will be carriers. Females can only be affected if they are the offspring of an affected male and a carrier female. In summary, the inheritance of haemophilia A and B is crucial in identifying individuals who are at risk of developing the condition. It also helps in providing appropriate genetic counseling and management for affected individuals and their families.

    • This question is part of the following fields:

      • Haematology And Oncology
      49.1
      Seconds
  • Question 2 - What is the lymphatic drainage of the ovaries? ...

    Correct

    • What is the lymphatic drainage of the ovaries?

      Your Answer: Para-aortic nodes

      Explanation:

      The para-aortic nodes receive lymphatic drainage from the ovary through the gonadal vessels.

      Lymphatic Drainage of Female Reproductive Organs

      The lymphatic drainage of the female reproductive organs is a complex system that involves multiple nodal stations. The ovaries drain to the para-aortic lymphatics via the gonadal vessels. The uterine fundus has a lymphatic drainage that runs with the ovarian vessels and may thus drain to the para-aortic nodes. Some drainage may also pass along the round ligament to the inguinal nodes. The body of the uterus drains through lymphatics contained within the broad ligament to the iliac lymph nodes. The cervix drains into three potential nodal stations; laterally through the broad ligament to the external iliac nodes, along the lymphatics of the uterosacral fold to the presacral nodes and posterolaterally along lymphatics lying alongside the uterine vessels to the internal iliac nodes. Understanding the lymphatic drainage of the female reproductive organs is important for the diagnosis and treatment of gynecological cancers.

    • This question is part of the following fields:

      • Haematology And Oncology
      3.6
      Seconds
  • Question 3 - A 10-year-old boy has been admitted to the hospital due to a swollen...

    Incorrect

    • A 10-year-old boy has been admitted to the hospital due to a swollen and painful right knee. His mother reports that he has always had large bruises after minor injuries. About six months ago, he had bleeding that lasted for ten days after biting his tongue, which required a blood transfusion. The patient has not taken any medication except for Paracetamol for knee pain two hours ago. In the family history, the patient's uncle required a blood transfusion after tonsillectomy and had bleeding after a dental extraction, while their grandfather had severe bleeding after a routine knee operation. Which of the following test results would be expected? The tests are BT (bleeding time), APTT (activated partial thromboplastin time), PT (prothrombin time), and TT (thrombin time).

      Your Answer: BT - Abnormal; APTT - Normal; PT - Abnormal; TT - Normal

      Correct Answer: BT - Normal; APTT - Abnormal; PT - Normal; TT - Normal

      Explanation:

      Haemophilia and its Laboratory Findings

      Haemophilia is a genetic disorder that affects males in the family. It can either be haemophilia A or B, which are both sex-linked recessive disorders. Haemophilia A is caused by a deficiency of factor VIII, while haemophilia B is caused by a deficiency of factor IX. Females are carriers of the gene, but only males express the disease. The hallmark symptoms of haemophilia include haemorrhage into the joints, bleeding with tooth extraction, and skin bruising.

      Laboratory findings in haemophilia include normal prothrombin time and bleeding time, as well as normal fibrinogen levels. However, there is a prolongation of the partial thromboplastin time. It is important to differentiate haemophilia from other bleeding disorders, such as Von Willebrand’s disease. While the bleeding phenotype in Von Willebrand’s disease is generally less severe, the family history is more in keeping with haemophilia. Coagulation tests in Von Willebrand’s disease are often normal.

      In summary, haemophilia is a genetic disorder that affects males in the family and can either be haemophilia A or B. The hallmark symptoms include haemorrhage into the joints, bleeding with tooth extraction, and skin bruising. Laboratory findings in haemophilia include normal prothrombin time and bleeding time, normal fibrinogen levels, and a prolongation of the partial thromboplastin time. It is important to differentiate haemophilia from other bleeding disorders, such as Von Willebrand’s disease, which has different coagulation test results.

    • This question is part of the following fields:

      • Haematology And Oncology
      97.9
      Seconds
  • Question 4 - During your placement in paediatrics, you evaluate a 6-year-old patient who has recently...

    Correct

    • During your placement in paediatrics, you evaluate a 6-year-old patient who has recently undergone chemotherapy. Can you identify the most prevalent types of cancer in children between the ages of 0 and 15?

      Your Answer: Leukaemia

      Explanation:

      Understanding Acute Lymphoblastic Leukaemia

      Acute lymphoblastic leukaemia (ALL) is a type of cancer that commonly affects children, accounting for 80% of childhood leukaemias. It is most prevalent in children aged 2-5 years, with boys being slightly more affected than girls. Symptoms of ALL can be divided into those caused by bone marrow failure, such as anaemia, neutropaenia, and thrombocytopenia, and other features like bone pain, splenomegaly, hepatomegaly, fever, and testicular swelling.

      There are three types of ALL: common ALL, T-cell ALL, and B-cell ALL. Common ALL is the most common type, accounting for 75% of cases, and is characterized by the presence of CD10 and pre-B phenotype. T-cell ALL accounts for 20% of cases, while B-cell ALL accounts for only 5%.

      Certain factors can affect the prognosis of ALL, including age, white blood cell count at diagnosis, T or B cell surface markers, race, and sex. Children under 2 years or over 10 years of age, those with a WBC count over 20 * 109/l at diagnosis, and those with T or B cell surface markers, non-Caucasian, and male sex have a poorer prognosis.

      Understanding the different types and prognostic factors of ALL can help in the early detection and management of this cancer. It is important to seek medical attention if any of the symptoms mentioned above are present.

    • This question is part of the following fields:

      • Haematology And Oncology
      12.7
      Seconds
  • Question 5 - A 75-year-old man experiences an urgent amputation due to severe sepsis and gangrene...

    Incorrect

    • A 75-year-old man experiences an urgent amputation due to severe sepsis and gangrene in his lower limbs. Following the surgery, he develops disseminated intravascular coagulation. Which clotting factor will be depleted the fastest during this process?

      Your Answer: Factor III and VII

      Correct Answer: Factor V and VIII

      Explanation:

      D-I-S-S-E-M-I-N-A-T-E-D

      R-Rewritten
      E-Explanations
      W-Widespread
      R-Reporting
      I-Information
      T-Transmission
      E-Exposure

      M-Multiple sources
      E-Extensive dissemination
      D-Distribution

      Rewriting and disseminating information can help to ensure that it is widely understood and accessible. This can be especially important in cases where there are multiple sources of information or when the information needs to be widely distributed. In some cases, such as with DIC, disseminating information can be critical for understanding and treating the condition.

      Disseminated Intravascular Coagulation: A Condition of Simultaneous Coagulation and Haemorrhage

      Disseminated intravascular coagulation (DIC) is a medical condition characterized by simultaneous coagulation and haemorrhage. It is caused by the initial formation of thrombi that consume clotting factors and platelets, ultimately leading to bleeding. DIC can be caused by various factors such as infection, malignancy, trauma, liver disease, and obstetric complications.

      Clinically, bleeding is usually the dominant feature of DIC, accompanied by bruising, ischaemia, and organ failure. Blood tests can reveal prolonged clotting times, thrombocytopenia, decreased fibrinogen, and increased fibrinogen degradation products. The treatment of DIC involves addressing the underlying cause and providing supportive management.

      In summary, DIC is a serious medical condition that requires prompt diagnosis and management. It is important to identify the underlying cause and provide appropriate treatment to prevent further complications. With proper care and management, patients with DIC can recover and regain their health.

    • This question is part of the following fields:

      • Haematology And Oncology
      35.5
      Seconds
  • Question 6 - Which one of the following statements in relation to the p53 tumour suppressor...

    Incorrect

    • Which one of the following statements in relation to the p53 tumour suppressor protein is not true?

      Your Answer: It can induce DNA repair

      Correct Answer: It may induce necrosis of cells with non repairable DNA damage

      Explanation:

      If DNA cannot be repaired, it triggers cellular apoptosis instead of necrosis.

      Genetic Conditions and Their Association with Surgical Diseases

      Li-Fraumeni Syndrome is an autosomal dominant genetic condition caused by mutations in the p53 tumour suppressor gene. Individuals with this syndrome have a high incidence of malignancies, particularly sarcomas and leukaemias. The diagnosis is made when an individual develops sarcoma under the age of 45 or when a first-degree relative is diagnosed with any cancer below the age of 45 and another family member develops malignancy under the age of 45 or sarcoma at any age.

      BRCA 1 and 2 are genetic conditions carried on chromosome 17 and chromosome 13, respectively. These conditions are linked to developing breast cancer with a 60% risk and an associated risk of developing ovarian cancer with a 55% risk for BRCA 1 and 25% risk for BRCA 2. BRCA2 mutation is also associated with prostate cancer in men.

      Lynch Syndrome is another autosomal dominant genetic condition that causes individuals to develop colonic cancer and endometrial cancer at a young age. 80% of affected individuals will get colonic and/or endometrial cancer. High-risk individuals may be identified using the Amsterdam criteria, which include three or more family members with a confirmed diagnosis of colorectal cancer, two successive affected generations, and one or more colon cancers diagnosed under the age of 50 years.

      Gardners syndrome is an autosomal dominant familial colorectal polyposis that causes multiple colonic polyps. Extra colonic diseases include skull osteoma, thyroid cancer, and epidermoid cysts. Desmoid tumours are seen in 15% of individuals with this syndrome. Due to colonic polyps, most patients will undergo colectomy to reduce the risk of colorectal cancer. It is now considered a variant of familial adenomatous polyposis coli.

      Overall, these genetic conditions have a significant association with surgical diseases, and early identification and management can help reduce the risk of malignancies and other associated conditions.

    • This question is part of the following fields:

      • Haematology And Oncology
      20.7
      Seconds
  • Question 7 - A 27-year-old female patient is being treated by a haematologist after experiencing a...

    Incorrect

    • A 27-year-old female patient is being treated by a haematologist after experiencing a venous thromboembolism. Her mother has a history of multiple venous thromboembolic events. The patient has no significant medical history, no comorbidities, and is a non-smoker with a body mass index of 20 kg/m2. Her blood clotting tests show normal APTT and PT. The haematologist suspects an inherited thrombophilia. What is the most common diagnosis in a patient with this clinical presentation?

      Your Answer: Antiphospholipid syndrome

      Correct Answer: Activated protein C resistance (Factor V Leiden)

      Explanation:

      Factor V Leiden is the most prevalent inherited thrombophilia, causing activated protein C resistance. This mutation leads to increased clotting as Factor V is less susceptible to degradation by protein C. The APTT and PT typically remain normal. Protein S deficiency is a rare thrombophilia, where the lack of protein S results in the inability to activate protein C and degrade factor V and factor VIII. Antithrombin III deficiency is another rare disorder where the absence of antithrombin III leads to unregulated thrombin. The prothrombin gene mutation is the second most common inherited thrombophilia.

      Thrombophilia is a condition that causes an increased risk of blood clots. It can be inherited or acquired. Inherited thrombophilia is caused by genetic mutations that affect the body’s natural ability to prevent blood clots. The most common cause of inherited thrombophilia is a gain of function polymorphism called factor V Leiden, which affects the protein that helps regulate blood clotting. Other genetic mutations that can cause thrombophilia include deficiencies of naturally occurring anticoagulants such as antithrombin III, protein C, and protein S. The prevalence and relative risk of venous thromboembolism (VTE) vary depending on the specific genetic mutation.

      Acquired thrombophilia can be caused by conditions such as antiphospholipid syndrome or the use of certain medications, such as the combined oral contraceptive pill. These conditions can affect the body’s natural ability to prevent blood clots and increase the risk of VTE. It is important to identify and manage thrombophilia to prevent serious complications such as deep vein thrombosis and pulmonary embolism.

    • This question is part of the following fields:

      • Haematology And Oncology
      50
      Seconds
  • Question 8 - A 76-year-old male is undergoing treatment for pancytopenia with an unknown cause. His...

    Correct

    • A 76-year-old male is undergoing treatment for pancytopenia with an unknown cause. His recent blood test revealed a decreased platelet count.

      What are the typical factors that stimulate the production of platelets?

      Your Answer: Thrombopoietin

      Explanation:

      Platelets, also known as thrombocytes, are derived from myeloid stem cells, similar to red blood cells. The process involves the development of a megakaryocyte from a common myeloid progenitor cell. Megakaryocytes are large cells with multilobulated nuclei that grow to become massive before breaking up to form platelets.

      The primary signal responsible for megakaryocyte and platelet production is thrombopoietin.

      Erythropoietin initiates the signal for red blood cell production, while granulocyte-colony stimulating factor stimulates the bone marrow to produce granulocytes. Interleukin-5 is a cytokine that stimulates the proliferation and activation of eosinophils.

      Haematopoiesis: The Generation of Immune Cells

      Haematopoiesis is the process by which immune cells are produced from haematopoietic stem cells in the bone marrow. These stem cells give rise to two main types of progenitor cells: myeloid and lymphoid progenitor cells. All immune cells are derived from these progenitor cells.

      The myeloid progenitor cells generate cells such as macrophages/monocytes, dendritic cells, neutrophils, eosinophils, basophils, and mast cells. On the other hand, lymphoid progenitor cells give rise to T cells, NK cells, B cells, and dendritic cells.

      This process is essential for the proper functioning of the immune system. Without haematopoiesis, the body would not be able to produce the necessary immune cells to fight off infections and diseases. Understanding haematopoiesis is crucial in developing treatments for diseases that affect the immune system.

    • This question is part of the following fields:

      • Haematology And Oncology
      57.9
      Seconds
  • Question 9 - A sickle cell anaemia patient arrived at the emergency department after taking aspirin....

    Correct

    • A sickle cell anaemia patient arrived at the emergency department after taking aspirin. The peripheral blood film revealed bite cells and fragmented red blood cells, while the serum free haemoglobin levels were elevated. Which blood protein would the serum-free haemoglobin bind to?

      Your Answer: Haptoglobin

      Explanation:

      Free haemoglobin is bound by haptoglobin.

      Copper is bound by ceruloplasmin.

      Stored iron in the body is in the form of ferritin.

      Free heme molecules are bound by hemopexin.

      Laboratory Findings in Haematological Disease

      Haptoglobin is a laboratory test that measures the level of a protein that binds to free haemoglobin. A decrease in haptoglobin levels is often associated with intravascular haemolysis, a condition where red blood cells are destroyed within blood vessels. On the other hand, an increase in mean corpuscular haemoglobin concentration (MCHC) is commonly seen in hereditary spherocytosis and autoimmune haemolytic anemia. In contrast, a decrease in MCHC is often observed in microcytic anaemia, which is commonly caused by iron deficiency. It is important to note that autoimmune haemolytic anemia is often associated with spherocytosis. These laboratory findings are commonly tested in haematological disease exams.

    • This question is part of the following fields:

      • Haematology And Oncology
      9.8
      Seconds
  • Question 10 - A 75-year-old man has recently been diagnosed with chronic myeloid leukaemia and is...

    Correct

    • A 75-year-old man has recently been diagnosed with chronic myeloid leukaemia and is undergoing chemotherapy. Following the start of treatment, he experiences acute renal failure and a significant increase in uric acid levels. What other electrolyte abnormality is likely to be present?

      Your Answer: Hyperphosphataemia

      Explanation:

      The individual has been diagnosed with tumour lysis syndrome, which is a dangerous complication that can arise when commencing chemotherapy for cancer, particularly for lymphoma and leukaemia. Tumour lysis syndrome encompasses a range of metabolic imbalances, such as elevated levels of potassium, phosphates, and uric acid, as well as reduced levels of calcium. These imbalances can result in severe complications, including acute kidney failure, irregular heartbeats, and seizures.

      Understanding Tumour Lysis Syndrome

      Tumour lysis syndrome (TLS) is a life-threatening condition that can occur during the treatment of high-grade lymphomas and leukaemias. It is caused by the breakdown of tumour cells and the release of chemicals into the bloodstream. While it can occur without chemotherapy, it is usually triggered by the introduction of combination chemotherapy. Patients at high risk of TLS should be given prophylactic medication such as IV allopurinol or IV rasburicase to prevent the potentially deadly effects of tumour cell lysis.

      TLS leads to a high potassium and high phosphate level in the presence of a low calcium. It should be suspected in any patient presenting with an acute kidney injury in the presence of a high phosphate and high uric acid level. From 2004, TLS has been graded using the Cairo-Bishop scoring system, which takes into account laboratory and clinical factors.

      It is important to be aware of TLS and take preventative measures to avoid its potentially fatal consequences. By understanding the causes and symptoms of TLS, healthcare professionals can provide appropriate treatment and improve patient outcomes.

    • This question is part of the following fields:

      • Haematology And Oncology
      39.3
      Seconds
  • Question 11 - An asymptomatic 75-year-old patient is scheduled for an elective laparoscopic cholecystectomy and undergoes...

    Incorrect

    • An asymptomatic 75-year-old patient is scheduled for an elective laparoscopic cholecystectomy and undergoes routine pre-operative blood tests. The results show a white cell count of 25 ×109/ml, with lymphocytes at 22 ×109/ml. What would be an unfavorable prognostic indicator for this patient?

      Your Answer: His age

      Correct Answer: Trisomy 12

      Explanation:

      Chronic Lymphocytic Leukaemia (CLL) Prognostic Indicators

      Chronic lymphocytic leukaemia (CLL) is a type of cancer that affects the blood and bone marrow. Patients with CLL often have genetic mutations, with trisomy 12 being a bad prognostic indicator. ZAP-70, a tyrosine kinase involved in cell signalling, is also measured in CLL patients, and high expression is associated with a poor prognosis. On the other hand, lactate dehydrogenase (LDH) is a marker of tumour burden, and a normal level suggests less tumour bulk, which is a good prognostic marker.

      Many patients with CLL may not require treatment and may die with the disease rather than from it. It is often diagnosed in asymptomatic patients who undergo blood tests for other reasons. Treating the disease too early may actually lead to a worse outcome than monitoring the patient initially. Therefore, patients who do not need to start treatment immediately have a more favourable outlook.

      B cells in secondary lymphoid tissue undergo somatic hypermutation when they recognise an antigen. This process fine-tunes antibody specificity, and cells that have undergone somatic hypermutation are more mature. If CLL arises from one of these cells, it is associated with a more favourable prognosis. these prognostic indicators can help healthcare professionals determine the best course of treatment for patients with CLL.

    • This question is part of the following fields:

      • Haematology And Oncology
      58.8
      Seconds
  • Question 12 - A 70-year-old male has been experiencing recurrent chest infections that are becoming more...

    Correct

    • A 70-year-old male has been experiencing recurrent chest infections that are becoming more frequent. Upon examination of a blood film, it was discovered that he has small mature lymphocytes with a dense nucleus, leading to a diagnosis of chronic lymphocytic leukaemia. Which immune cells, derived from lymphoid progenitors, are typically found in higher numbers in this condition?

      Your Answer: B cells

      Explanation:

      Dendritic cells are derived from both myeloid and lymphoid lineages.

      Haematopoiesis: The Generation of Immune Cells

      Haematopoiesis is the process by which immune cells are produced from haematopoietic stem cells in the bone marrow. These stem cells give rise to two main types of progenitor cells: myeloid and lymphoid progenitor cells. All immune cells are derived from these progenitor cells.

      The myeloid progenitor cells generate cells such as macrophages/monocytes, dendritic cells, neutrophils, eosinophils, basophils, and mast cells. On the other hand, lymphoid progenitor cells give rise to T cells, NK cells, B cells, and dendritic cells.

      This process is essential for the proper functioning of the immune system. Without haematopoiesis, the body would not be able to produce the necessary immune cells to fight off infections and diseases. Understanding haematopoiesis is crucial in developing treatments for diseases that affect the immune system.

    • This question is part of the following fields:

      • Haematology And Oncology
      51
      Seconds
  • Question 13 - An 81-year-old male visits his primary care physician with concerns about his medication....

    Incorrect

    • An 81-year-old male visits his primary care physician with concerns about his medication. He has been diagnosed with Hodgkin's lymphoma and his oncologist has recommended a trial of chemotherapy with doxorubicin.

      What is the mechanism of action of doxorubicin?

      Your Answer: Pyrimidine antagonist

      Correct Answer: Inhibits the formation of microtubules

      Explanation:

      Vincristine inhibits the formation of microtubules, which are essential for separating chromosomes during cell division. This mechanism is also shared by paclitaxel, a member of the taxane family. Alkylating agents, such as cyclophosphamide, disrupt the double helix of DNA by adding an alkyl group to guanine bases. Methotrexate inhibits dihydrofolate reductase, an enzyme that supports folate in DNA synthesis. Pyrimidine antagonists, like cytarabine, prevent the use of pyrimidines in DNA synthesis.

      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 potential 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 and anthracyclines, degrade preformed DNA and stabilize DNA-topoisomerase II complex, respectively. However, they can also cause lung fibrosis and cardiomyopathy. Antimetabolites, such as methotrexate and fluorouracil, inhibit dihydrofolate reductase and thymidylate synthesis, respectively. However, they can also cause myelosuppression, mucositis, and liver or lung fibrosis. Drugs that act on microtubules, like vincristine and docetaxel, inhibit the formation of microtubules and prevent microtubule depolymerisation & disassembly, respectively. However, they can also cause peripheral neuropathy, myelosuppression, and paralytic ileus. Topoisomerase inhibitors, like irinotecan, inhibit topoisomerase I, which prevents relaxation of supercoiled DNA. However, they can also cause myelosuppression. Other cytotoxic drugs, such as cisplatin and hydroxyurea, cause cross-linking in DNA and inhibit ribonucleotide reductase, respectively. However, they can also cause ototoxicity, peripheral neuropathy, hypomagnesaemia, and myelosuppression.

    • This question is part of the following fields:

      • Haematology And Oncology
      9.8
      Seconds
  • Question 14 - A 30-year-old pregnant woman (28 weeks gestation) presents with severe abdominal pain and...

    Correct

    • A 30-year-old pregnant woman (28 weeks gestation) presents with severe abdominal pain and per-vaginal (PV) bleeding. Upon examination, it is suspected that she is experiencing placental abruption. While attempting to establish IV access, the patient suddenly develops epistaxis, bruising on her arms, and bleeding from the cannulation site. Blood test results reveal thrombocytopenia and low fibrinogen levels, and her prothrombin time (PT), activated partial thromboplastin time (APTT), and D-dimer results are all elevated. What is the most likely explanation for these complications?

      Your Answer: Disseminated intravascular coagulopathy (DIC)

      Explanation:

      DIC is often associated with pregnancy complications such as placental abruption and shock, as well as bleeding from multiple sites and abnormal blood test results. Placenta praevia is characterized by painless vaginal bleeding, but when combined with other haematological results and occurring in a pregnant woman, it may indicate DIC rather than ITP. TTP typically presents with jaundice, low platelets, fever, renal complications, and CNS signs, which are not evident in this case, and clotting test results do not support this diagnosis. While von Willebrand’s disease can cause spontaneous bleeding, the platelet count is usually normal.

      Disseminated Intravascular Coagulation: A Condition of Simultaneous Coagulation and Haemorrhage

      Disseminated intravascular coagulation (DIC) is a medical condition characterized by simultaneous coagulation and haemorrhage. It is caused by the initial formation of thrombi that consume clotting factors and platelets, ultimately leading to bleeding. DIC can be caused by various factors such as infection, malignancy, trauma, liver disease, and obstetric complications.

      Clinically, bleeding is usually the dominant feature of DIC, accompanied by bruising, ischaemia, and organ failure. Blood tests can reveal prolonged clotting times, thrombocytopenia, decreased fibrinogen, and increased fibrinogen degradation products. The treatment of DIC involves addressing the underlying cause and providing supportive management.

      In summary, DIC is a serious medical condition that requires prompt diagnosis and management. It is important to identify the underlying cause and provide appropriate treatment to prevent further complications. With proper care and management, patients with DIC can recover and regain their health.

    • This question is part of the following fields:

      • Haematology And Oncology
      30.5
      Seconds
  • Question 15 - A toddler has been admitted following a prolonged chest infection. Recurrent chest and...

    Incorrect

    • A toddler has been admitted following a prolonged chest infection. Recurrent chest and gastrointestinal infections have plagued the child in their first two years of life. Blood antibody titres have revealed reduced levels of IgA, IgG, and IgE, while IgM is three times higher than normal. The patient is currently awaiting gene sequencing results to confirm the suspected diagnosis.

      Which gene mutations are responsible for the probable diagnosis?

      Your Answer: MHC class 2

      Correct Answer: CD40

      Explanation:

      Hyper IgM syndrome is caused by mutations in the CD40 gene, which affects the ability of B cells to produce immunoglobulin A, G, and E. While the production of IgM is still possible, the process of switching to other antibodies is impaired due to a lack of activated T-cells. This results in increased susceptibility to infections during early childhood. Treatment options include regular immunoglobulin, antibiotics, and granulocyte-colony stimulating factor (GCS-F).

      Overview of Primary Immunodeficiency Disorders

      Primary immunodeficiency disorders are conditions that affect the immune system’s ability to fight off infections and diseases. These disorders can be classified based on which component of the immune system is affected. Neutrophil disorders, for example, are caused by a lack of NADPH oxidase, which reduces the ability of phagocytes to produce reactive oxygen species. This leads to recurrent pneumonias and abscesses, particularly due to catalase-positive bacteria and fungi. B-cell disorders, on the other hand, are caused by defects in B cell development, resulting in low antibody levels and recurrent infections. T-cell disorders are caused by defects in T cell development, leading to recurrent viral and fungal diseases. Finally, combined B- and T-cell disorders are caused by defects in both B and T cell development, resulting in recurrent infections and an increased risk of malignancy. Understanding the underlying defects and symptoms of these disorders is crucial for proper diagnosis and treatment.

    • This question is part of the following fields:

      • Haematology And Oncology
      38.1
      Seconds
  • Question 16 - A 50-year-old patient has discovered a lump in her neck and another one...

    Incorrect

    • A 50-year-old patient has discovered a lump in her neck and another one in her groin. She has been experiencing feverish symptoms for several months and has had to change her bedclothes twice in the last week. Upon examination, smooth, firm, enlarged lymph nodes are noted at both sites. The patient's GP is concerned about the possibility of an underlying lymphoma and has referred her to secondary care for further investigations. A CT scan has not revealed any other lymph nodes. What is the most appropriate diagnosis and staging for this patient?

      Your Answer: The diagnosis could be confirmed by looking at her blood film

      Correct Answer: On biopsy the malignant lymphoid cells would be likely to have many of the characteristics of their parent cells

      Explanation:

      Lymphomas and their Staging

      Malignancies that arise from lymphocytes can spread to different lymph node groups due to their ability to retain adhesion and signalling receptors. Lymphomas can present at various sites, including bone marrow, gut, and spleen, as normal trafficking of lymphoid cells occurs through these places. Interestingly, higher-grade lymphomas are easier to cure than lower grade lymphomas, despite initially being associated with a higher mortality rate. On the other hand, low-grade lymphomas may not require immediate treatment, but the disease progresses over time, leading to a poorer prognosis.

      To diagnose lymphoma, a biopsy of the affected area, such as a lymph node or bone marrow, is necessary. The Ann Arbor staging system is used to stage lymphomas, with Stage I indicating disease in a single lymph node group and Stage IV indicating extra-nodal involvement other than the spleen. The addition of a ‘B’ signifies the presence of ‘B’ symptoms, which are associated with a poorer prognosis for each disease stage.

      From the examination findings, it is evident that the disease is present on both sides of the diaphragm, indicating at least Stage III lymphoma. the staging of lymphomas is crucial in determining the appropriate treatment plan and predicting the patient’s prognosis.

    • This question is part of the following fields:

      • Haematology And Oncology
      119.9
      Seconds
  • Question 17 - A 20-year-old man presents to the emergency department with complaints of shortness of...

    Incorrect

    • A 20-year-old man presents to the emergency department with complaints of shortness of breath for several hours. He is in good health and not taking any regular medications. He recently had an ear infection and was prescribed ear drops, but started taking oral ciprofloxacin this morning. He believes his symptoms started after taking the first dose of the antibiotic. He has no known drug allergies, but avoids certain foods like fava beans due to feeling unwell afterwards. He mentions that male members of his family in Turkey have a history of similar episodes.

      During the examination, the patient is found to have splenomegaly and diffuse pain in the right upper quadrant of his abdomen. An abdominal ultrasound shows smooth splenomegaly and gallstones. Blood tests including a blood film and G6PD enzyme assay are ordered. The results show elevated bilirubin, ALP, and γGT levels, and the presence of Heinz bodies on the blood film.

      What is the underlying pathophysiology of the likely diagnosis?

      Your Answer: Low G6PD causing low glutathione, decreasing red cell production

      Correct Answer: Low G6PD causing low glutathione, increasing susceptibility of red cells to oxidative stress

      Explanation:

      G6PD deficiency is a genetic disorder that affects the production of glucose-6-phosphate dehydrogenase, which is necessary for the production of NADPH. NADPH is essential for maintaining glutathione, which helps prevent oxidative damage by neutralizing free radicals. Patients with G6PD deficiency have low levels of glutathione, making them more susceptible to oxidative stress and resulting in the destruction of red blood cells. This destruction leads to an enlarged spleen and jaundice, as bilirubin is released during the breakdown of hemoglobin. The patient’s Mediterranean descent and family history of the disease suggest G6PD deficiency, which was confirmed by a G6PD enzyme assay. The presence of Heinz bodies on blood film is also characteristic of the disease. The suggestion of an autosomal dominant defect of red cells is incorrect, as this is the pathophysiology for hereditary spherocytosis, which has different clinical features and would be seen on blood film.

      Understanding G6PD Deficiency

      G6PD deficiency is a common red blood cell enzyme defect that is inherited in an X-linked recessive fashion and is more prevalent in people from the Mediterranean and Africa. The deficiency can be triggered by many drugs, infections, and broad (fava) beans, leading to a crisis. G6PD is the first step in the pentose phosphate pathway, which converts glucose-6-phosphate to 6-phosphogluconolactone and results in the production of nicotinamide adenine dinucleotide phosphate (NADPH). NADPH is essential for converting oxidized glutathione back to its reduced form, which protects red blood cells from oxidative damage by oxidants such as superoxide anion (O2-) and hydrogen peroxide. Reduced G6PD activity leads to decreased reduced glutathione and increased red cell susceptibility to oxidative stress, resulting in neonatal jaundice, intravascular hemolysis, gallstones, splenomegaly, and the presence of Heinz bodies on blood films. Diagnosis is made by using a G6PD enzyme assay, and some drugs are known to cause hemolysis, while others are considered safe.

      Compared to hereditary spherocytosis, G6PD deficiency is more common in males of African and Mediterranean descent and is characterized by neonatal jaundice, infection/drug-induced hemolysis, and gallstones. On the other hand, hereditary spherocytosis affects both males and females of Northern European descent and is associated with chronic symptoms, spherocytes on blood films, and the presence of erythrocyte membrane protein band 4.2 (EMA) binding.

    • This question is part of the following fields:

      • Haematology And Oncology
      85.6
      Seconds
  • Question 18 - A 55-year-old, ex-smoker, of 25 pack years arrives at the emergency department with...

    Correct

    • A 55-year-old, ex-smoker, of 25 pack years arrives at the emergency department with central crushing chest pain that spreads down his left arm. His ECG reveals ST elevation in leads V1, V2 and V3. He has a medical history of asthma, chronic obstructive pulmonary disease (COPD) and type II diabetes. The patient's complete blood count indicates a haemoglobin level of 17.1 g/dL. What is the probable cause of this patient's elevated haemoglobin level?

      Your Answer: Chronic obstructive pulmonary disease

      Explanation:

      Chronic hypoxia caused by COPD is a secondary factor leading to polycythaemia in this patient. While an anterior ST elevation MI is likely the acute issue, it would not explain the polycythaemia. Asthma is not a cause of polycythaemia and would not be responsible for the ECG changes. An inferior MI would not be associated with polycythaemia and would only cause ST elevation in leads II, III, and aVF.

      Polycythaemia is a condition that can be classified as relative, primary (polycythaemia rubra vera), or secondary. Relative polycythaemia can be caused by dehydration or stress, such as in Gaisbock syndrome. Primary polycythaemia rubra vera is a rare blood disorder that causes the bone marrow to produce too many red blood cells. Secondary polycythaemia can be caused by conditions such as COPD, altitude, obstructive sleep apnoea, or excessive erythropoietin production due to certain tumors or growths. To distinguish between true polycythaemia and relative polycythaemia, red cell mass studies may be used. In true polycythaemia, the total red cell mass in males is greater than 35 ml/kg and in women is greater than 32 ml/kg. Uterine fibroids may also cause polycythaemia indirectly by causing menorrhagia, but this is rarely a clinical problem.

    • This question is part of the following fields:

      • Haematology And Oncology
      61.4
      Seconds
  • Question 19 - A 63-year-old man presents with a 5-month history of non-specific back pain, fatigue...

    Incorrect

    • A 63-year-old man presents with a 5-month history of non-specific back pain, fatigue and loss of appetite. He has a medical history of type 2 diabetes mellitus controlled with diet, chronic obstructive pulmonary disease, and seasonal affective disorder. He has a 30 pack-year smoking history. On examination, his vital signs are within normal limits except for saturations of 94% on room air. A chest x-ray shows hyperinflated lung fields bilaterally, unchanged from a previous x-ray. Blood tests and urine analysis reveal a positive urinary Bence-Jones protein. Based on these findings, what is the most likely diagnosis?

      Your Answer: Chronic myeloid leukaemia

      Correct Answer: Multiple myeloma

      Explanation:

      The diagnosis of multiple myeloma can be supported by the presence of Bence-Jones protein on urinary analysis, although it is not always necessary. This haematological malignancy of plasma cells is characterized by bone pain and lytic bone lesions. Hypercalcaemia can also indicate the presence of multiple myeloma.

      Ankylosing spondylitis is a chronic inflammatory arthritis that typically affects young men and is associated with HLA-B27. Symptoms include early-morning back pain that improves with exercise, and an elevated ESR may be observed.

      Chronic myeloid leukaemia (CML) is a haematological malignancy that is linked to genetic translocation on chromosome 9 (Philadelphia chromosome). It is characterized by high white cell count, splenomegaly, and blast cells seen on marrow biopsy.

      Gastric and pancreatic cancer may present with non-specific symptoms such as fatigue, weight loss, loss of appetite, and abdominal fullness or pain. Biochemistry may be normal or show raised inflammatory markers, and diagnosis is confirmed through biopsy following imaging.

      Understanding Multiple Myeloma: Features and Investigations

      Multiple myeloma is a type of cancer that affects the plasma cells in the bone marrow. It is most commonly found in patients aged 60-70 years. The disease is characterized by a range of symptoms, which can be remembered using the mnemonic CRABBI. These include hypercalcemia, renal damage, anemia, bleeding, bone lesions, and increased susceptibility to infection. Other features of multiple myeloma include amyloidosis, carpal tunnel syndrome, neuropathy, and hyperviscosity.

      To diagnose multiple myeloma, a range of investigations are required. Blood tests can reveal anemia, renal failure, and hypercalcemia. Protein electrophoresis can detect raised levels of monoclonal IgA/IgG proteins in the serum, while bone marrow aspiration can confirm the diagnosis if the number of plasma cells is significantly raised. Imaging studies, such as whole-body MRI or X-rays, can be used to detect osteolytic lesions.

      The diagnostic criteria for multiple myeloma require one major and one minor criteria or three minor criteria in an individual who has signs or symptoms of the disease. Major criteria include the presence of plasmacytoma, 30% plasma cells in a bone marrow sample, or elevated levels of M protein in the blood or urine. Minor criteria include 10% to 30% plasma cells in a bone marrow sample, minor elevations in the level of M protein in the blood or urine, osteolytic lesions, or low levels of antibodies in the blood. Understanding the features and investigations of multiple myeloma is crucial for early detection and effective treatment.

    • This question is part of the following fields:

      • Haematology And Oncology
      8.4
      Seconds
  • Question 20 - A 65-year-old man, who has a history of non-Hodgkin's lymphoma, is scheduled to...

    Incorrect

    • A 65-year-old man, who has a history of non-Hodgkin's lymphoma, is scheduled to start chemotherapy treatment. During his consultation with the oncologist, he expressed concern about the potential side effects of his chemotherapy drugs. Specifically, he is worried about the side effects associated with vincristine.

      What side effect is commonly linked to the use of vincristine in chemotherapy treatment?

      Your Answer: Cardiomyopathy

      Correct Answer: Peripheral neuropathy

      Explanation:

      Vincristine is a medication that belongs to the vinca alkaloid class and works by inhibiting microtubule formation, which prevents the cell cycle from progressing beyond the metaphase stage. However, it is commonly associated with peripheral neuropathy as a side effect.

      Anthracyclines, such as doxorubicin, are known to cause cardiomyopathy. These medications stabilize topoisomerase II, which prevents DNA replication by inhibiting the coiling of DNA.

      5-fluorouracil is a thymidylate synthase inhibitor that is associated with dermatitis. It works by preventing the formation of the thymidine nucleotide, which is essential for DNA replication. Palmar-plantar erythrodysesthesia is a severe form of dermatitis that can occur as a blistering rash on the hands and feet of patients taking this medication.

      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 potential 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 and anthracyclines, degrade preformed DNA and stabilize DNA-topoisomerase II complex, respectively. However, they can also cause lung fibrosis and cardiomyopathy. Antimetabolites, such as methotrexate and fluorouracil, inhibit dihydrofolate reductase and thymidylate synthesis, respectively. However, they can also cause myelosuppression, mucositis, and liver or lung fibrosis. Drugs that act on microtubules, like vincristine and docetaxel, inhibit the formation of microtubules and prevent microtubule depolymerisation & disassembly, respectively. However, they can also cause peripheral neuropathy, myelosuppression, and paralytic ileus. Topoisomerase inhibitors, like irinotecan, inhibit topoisomerase I, which prevents relaxation of supercoiled DNA. However, they can also cause myelosuppression. Other cytotoxic drugs, such as cisplatin and hydroxyurea, cause cross-linking in DNA and inhibit ribonucleotide reductase, respectively. However, they can also cause ototoxicity, peripheral neuropathy, hypomagnesaemia, and myelosuppression.

    • This question is part of the following fields:

      • Haematology And Oncology
      28.3
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Haematology And Oncology (8/20) 40%
Passmed