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  • Question 1 - A 68-year-old woman presents with lethargy and poor exercise tolerance. She also mentions...

    Incorrect

    • A 68-year-old woman presents with lethargy and poor exercise tolerance. She also mentions that, over the last month, she has had excessive thirst and polyuria.
      Initial investigations show:
      Investigation Result Normal value
      Haemoglobin (Hb) 78 g/l 115–155 g/l
      Erythrocyte sedimentation rate (ESR) 109 mm/h 0–10mm in the first hour
      Sodium (Na+) 134 mmol/l 135–145 mmol/l
      Potassium (K+) 5.8 mmol/l 3.5–5.0 mmol/l
      Urea 26.5 mmol/l 2.5–6.5 mmol/l
      Creatinine 268 µmol/l 50–120 μmol/l
      Corrected calcium (Ca2+) 3.02 mmol/l 2.20–2.60 mmol/l
      Glucose 5.2 mmol/l 3.5–5.5 mmol/l
      Which of the following tests is the most appropriate to confirm the underlying diagnosis?

      Your Answer: Oral glucose tolerance test

      Correct Answer: Serum and urine electrophoresis

      Explanation:

      Diagnostic Tests and Differential Diagnosis for a Patient with Multiple Derangements

      The patient in question presents with several abnormalities in their blood tests, including anaemia, hypercalcaemia, electrolyte imbalances, and a significantly elevated ESR. These findings, along with the patient’s symptoms, suggest a diagnosis of malignancy, specifically multiple myeloma.

      Multiple myeloma is characterized by the malignant proliferation of plasma cells, leading to bone marrow infiltration, pancytopenia, osteolytic lesions, hypercalcaemia, and renal failure. The ESR is typically elevated in this condition. To confirm a diagnosis of multiple myeloma, serum and urine electrophoresis can be performed to identify the presence of monoclonal antibodies and Bence Jones proteins, respectively. Bone marrow examination can also reveal an increased number of abnormal plasma cells.

      Treatment for multiple myeloma typically involves a combination of chemotherapy and bisphosphonate therapy, with radiation therapy as an option as well. This condition is more common in men, particularly those in their sixth or seventh decade of life.

      Other diagnostic tests that may be considered include an oral glucose tolerance test (to rule out diabetes as a cause of polydipsia and polyuria), a chest X-ray (to evaluate for a possible small cell carcinoma of the lung), and an abdominal CT scan (to assess the extent of disease and the presence of metastasis). A serum PTH level may also be useful in ruling out primary hyperparathyroidism as a cause of hypercalcaemia, although the patient’s symptoms and blood test results make malignancy a more likely diagnosis.

      Diagnostic Tests and Differential Diagnosis for a Patient with Multiple Derangements

    • This question is part of the following fields:

      • Haematology
      48.6
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  • Question 2 - A 28-year-old woman on vacation complained of a swollen left calf. She mentioned...

    Incorrect

    • A 28-year-old woman on vacation complained of a swollen left calf. She mentioned having the 'factor V Leiden mutation'. Can you explain the pathophysiology of this mutation?

      Your Answer: Prothrombin mutation

      Correct Answer: Activated protein C resistance

      Explanation:

      Factor V Leiden: A Genetic Condition Affecting Blood Clotting

      Factor V is a protein that acts as a cofactor to allow the generation of an enzyme called thrombin, which is responsible for cleaving fibrinogen to fibrin. This process leads to the formation of a dense meshwork that makes up the majority of a clot. Activated protein C (aPC) is a natural anticoagulant that limits clotting by degrading factor V. However, in individuals with Factor V Leiden, a genetic condition that is inherited in an autosomal dominant manner, the coagulation factor cannot be destroyed by aPC.

      Factor V Leiden is caused by a single nucleotide substitution of adenine for guanine in the gene encoding factor V. This mutation changes the protein’s 506th amino acid from arginine to glutamine, which prevents efficient inactivation of factor V. As a result, factor V remains active, leading to overproduction of thrombin and excess fibrin generation, which in turn causes excess clotting.

      In summary, Factor V Leiden is a genetic condition that affects blood clotting by preventing the efficient inactivation of factor V. This leads to excess clotting, which can increase the risk of developing blood clots and related complications.

    • This question is part of the following fields:

      • Haematology
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  • Question 3 - A 45-year-old patient presents with the following full blood count (FBC) result: Hb...

    Incorrect

    • A 45-year-old patient presents with the following full blood count (FBC) result: Hb 105 g/L (130-180), RBC 4.5 Ă—1012/L, Hct 0.353 (0.4-0.52), MCV 75 fL (80-96), MCH 32.5 pg (28-32), Platelets 325 Ă—109/L (150-400), WBC 7.91 Ă—109/L (4-11), Neutrophils 6.15 Ă—109/L (1.5-7.0), Lymphocytes 1.54 Ă—109/L (1.5-4.0), Monocytes 0.33 Ă—109/L (0-0.8), Eosinophils 0.16 Ă—109/L (0.04-0.4), Basophils 0.08 Ă—109/L (0-0.1), Others 0.14 Ă—109/L. What would be the most appropriate initial investigation for this FBC result?

      Your Answer: Endoscopy

      Correct Answer: Ferritin concentration

      Explanation:

      Interpretation of FBC Results

      When analyzing a full blood count (FBC), a microcytosis with low mean corpuscular volume (MCV) and anaemia (low Hb) is indicative of iron deficiency anaemia. To confirm this, a ferritin test should be requested, followed by an investigation into the source of blood loss if iron deficiency is confirmed. If faecal occult blood is positive, an endoscopy may be necessary. On the other hand, macrocytic anaemia with elevated MCV is caused by folate and B12 deficiency, while hypothyroidism is associated with elevated MCV. While a bone marrow biopsy can also show iron deficiency, it is an invasive procedure and is not necessary in a primary care setting. Therefore, interpreting FBC results requires a thorough of the different types of anaemia and their associated causes.

    • This question is part of the following fields:

      • Haematology
      305.8
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  • Question 4 - A patient on the ward receiving a blood transfusion after knee replacement surgery...

    Correct

    • A patient on the ward receiving a blood transfusion after knee replacement surgery is noted to have rigors.

      On examination, their temperature is 39°C (baseline 36.5°C). They also complain of abdominal pain and their blood pressure is 90/55 mmHg (baseline 126/84 mmHg).

      What is the next step in managing this patient?

      Your Answer: Stop the transfusion immediately and commence IV fluids

      Explanation:

      Management of Acute Haemolytic Transfusion Reaction

      When a patient experiences a temperature rise of more than 2°C, abdominal pain, and hypotension after a blood transfusion, an acute haemolytic transfusion reaction should be suspected. In such cases, the transfusion must be stopped immediately, and the set should be taken down. Saline infusion should be initiated to maintain the patient’s blood pressure.

      The blood bank should be notified of the suspected reaction, and a sample may need to be collected for further investigation. However, the priority is to manage the patient’s symptoms and prevent further complications. If the reaction is severe, the transfusion should not be continued.

      In summary, prompt recognition and management of acute haemolytic transfusion reactions are crucial to prevent serious complications. Healthcare providers should be vigilant in monitoring patients who receive blood transfusions and act quickly if any adverse reactions occur.

    • This question is part of the following fields:

      • Haematology
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  • Question 5 - These results were obtained on a 65-year-old male:
    Hb 110 g/L (120-170)
    RBC 4.8 Ă—1012/L...

    Correct

    • These results were obtained on a 65-year-old male:
      Hb 110 g/L (120-170)
      RBC 4.8 Ă—1012/L (4.2-5.8)
      Hct 0.365 (0.37-0.49)
      MCV 75 fL (82-98)
      MCH 33.2 pg (28-33)
      Platelets 310 Ă—109/L (140-450)
      WBC 8.21 Ă—109/L (4.5-11)
      Neutrophils 6.45 Ă—109/L (1.8-7.5)
      Lymphocytes 1.23 Ă—109/L (1.0-4.5)
      Monocytes 0.28 Ă—109/L (0-0.8)
      Eosinophils 0.18 Ă—109/L (0.02-0.5)
      Basophils 0.09 Ă—109/L (0-0.1)
      Others 0.18 Ă—109/L -

      What could be the possible reason for these FBC results in a 65-year-old male?

      Your Answer: Gastrointestinal blood loss

      Explanation:

      Microcytic Anaemia in a 63-Year-Old Female

      A Full Blood Count (FBC) analysis has revealed that a 63-year-old female is suffering from microcytic anaemia, which is characterized by low mean corpuscular volume (MCV) and low haemoglobin (Hb) levels. This type of anaemia is typically caused by iron deficiency, which is often the result of blood loss. However, in this case, menorrhagia can be ruled out as the patient is postmenopausal. Therefore, the most likely cause of the microcytic anaemia is peptic ulceration. It is important to note that pernicious anaemia or folate deficiency can cause macrocytosis, which is characterized by elevated MCV levels. Proper diagnosis and treatment are necessary to address the underlying cause of the microcytic anaemia and prevent further complications.

    • This question is part of the following fields:

      • Haematology
      128.1
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  • Question 6 - A 25-year-old female presents with severe anaemia and a skull x-ray shows a...

    Correct

    • A 25-year-old female presents with severe anaemia and a skull x-ray shows a 'hair on end' appearance. Where is this appearance most commonly observed on a skull x-ray?

      Your Answer: Thalassaemia

      Explanation:

      Skeletal Abnormalities in Thalassaemia Major

      Patients with thalassaemia major often exhibit skeletal abnormalities, which can be observed in various parts of the body. One of the most notable changes is an expanded bone marrow space, which leads to the thinning of the bone cortex. This can be particularly striking in the skull, where it can cause a hair on end appearance. While this phenomenon can also occur in sickle cell disease, it is much less common.

      In addition to changes in the skull, bone abnormalities can also be seen in the long bones, vertebrae, and pelvis. These changes can have a significant impact on a patient’s quality of life, as they can cause pain, deformities, and other complications. As such, it is important for healthcare providers to be aware of these skeletal abnormalities and to monitor patients for any signs of progression or deterioration. With proper management and treatment, many of these complications can be mitigated or prevented, allowing patients with thalassaemia major to lead healthy and fulfilling lives.

    • This question is part of the following fields:

      • Haematology
      24.3
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  • Question 7 - A 70-year-old man presents with melaena and an INR of 8. He is...

    Incorrect

    • A 70-year-old man presents with melaena and an INR of 8. He is currently taking warfarin for atrial fibrillation, as well as antihypertensive medication and cholesterol-lowering agents. He recently received antibiotics from his GP for a cough. Which medication is the likely culprit for his elevated INR?

      Your Answer: cephalexin

      Correct Answer: Erythromycin

      Explanation:

      Medications that Interfere with Warfarin and Increase INR

      Certain medications can affect the duration of warfarin’s effects in the body by interfering with the cytochrome P450 enzyme system in the liver. This can cause the INR to increase or decrease rapidly, making patients who are on a stable warfarin regimen vulnerable. To remember the drugs that inhibit cytochrome P450 and increase the effects of warfarin, the mnemonic O-DEVICES can be helpful.

      Omeprazole, disulfiram, erythromycin, valproate, isoniazide, cimetidine and ciprofloxacin, ethanol (acutely), and sulphonamides are the drugs that can interfere with warfarin’s effects. These drugs can increase the INR, which can lead to bleeding complications. Therefore, it is important for healthcare providers to monitor patients who are taking warfarin and any of these medications closely to ensure that their INR remains within the therapeutic range. Patients should also inform their healthcare providers of any new medications they are taking to avoid potential interactions with warfarin.

    • This question is part of the following fields:

      • Haematology
      36.8
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  • Question 8 - A middle-aged patient is newly diagnosed with a bleeding disorder after complaining of...

    Correct

    • A middle-aged patient is newly diagnosed with a bleeding disorder after complaining of heavy periods. She presents with a prolonged APTT and bleeding time, but normal indices. The patient reports a family history of bleeding disorders on her mother's side. She denies any prior history of bleeding or bruising after minor surgical procedures. What is the most likely bleeding disorder in this patient?

      Your Answer: von Willebrand’s disease

      Explanation:

      The diagnosis in this scenario is von Willebrand’s disease, which is the most common hereditary bleeding disorder caused by a defective von Willebrand factor. This protein plays a crucial role in haemostasis by assisting in platelet adhesion and stabilising coagulation factor VIII. A deficiency in von Willebrand factor prolongs bleeding time and APTT, but does not affect platelet counts or PT. It is more pronounced in women and may present with menorrhagia. Treatment involves administration of recombinant von Willebrand factor. Haemophilia A, Bernard-Soulier syndrome, Glanzmann’s thrombasthenia, and vitamin K deficiency are other bleeding disorders with different causes and blood test results.

    • This question is part of the following fields:

      • Haematology
      28.1
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  • Question 9 - Which autoantibody is correctly matched with its associated disease in the following list?...

    Correct

    • Which autoantibody is correctly matched with its associated disease in the following list?

      Your Answer: Pernicious anaemia and anti-intrinsic factor antibodies

      Explanation:

      Autoimmune Disorders and Associated Antibodies

      Autoimmune disorders occur when the immune system mistakenly attacks healthy cells and tissues in the body. These disorders are often associated with the presence of specific antibodies that can help diagnose and monitor the disease. Here are some examples:

      Pernicious Anaemia and Anti-Intrinsic Factor Antibodies
      Pernicious anaemia is a type of anaemia caused by a deficiency in vitamin B12. It is associated with the presence of anti-intrinsic factor antibodies, which bind to intrinsic factor and prevent the absorption of vitamin B12 in the gut.

      Primary Biliary Cholangitis and Anti-Jo-1 Antibodies
      Primary biliary cholangitis is an autoimmune disorder that affects the liver. It is associated with the presence of anti-mitochondrial antibodies, but not anti-Jo-1 antibodies, which are associated with other autoimmune disorders like polymyositis and dermatomyositis.

      Myasthenia Gravis and Voltage-Gated Calcium Channel Antibodies
      Myasthenia gravis is a neuromuscular disorder that causes muscle weakness and fatigue. It is associated with the presence of anti-acetylcholine receptor antibodies, but not anti-striated muscle antibodies, which are found in other autoimmune disorders.

      Granulomatosis with Polyangiitis (GPA) and Anti-Myeloperoxidase (p-ANCA) Antibody
      GPA is a type of vasculitis that affects small and medium-sized blood vessels. It is associated with the presence of cytoplasmic antineutrophil cytoplasmic antibodies (c-ANCA), but not p-ANCA, which are found in other types of vasculitis.

      Hashimoto’s Thyroiditis and Thyroid-Stimulating Antibodies
      Hashimoto’s thyroiditis is an autoimmune disorder that affects the thyroid gland. It is associated with the presence of anti-thyroglobulin and anti-thyroperoxidase antibodies, which attack the thyroid gland and cause inflammation.

    • This question is part of the following fields:

      • Haematology
      12.3
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  • Question 10 - A 14-year-old girl presents with a history of easy bruising and excessive bleeding...

    Correct

    • A 14-year-old girl presents with a history of easy bruising and excessive bleeding after a dental procedure. She is diagnosed with von Willebrand's disease and is scheduled for additional dental extractions. The physician prescribes DDAVP. What is the mechanism of action of DDAVP in treating von Willebrand's disease?

      Your Answer: Stimulates release of von Willebrand's factor from endothelial cells

      Explanation:

      DDAVP for Increasing von Willebrand Factor

      DDAVP is a medication that can be administered to increase the amount of von Willebrand factor in the body, which is necessary for surgical or dental procedures. This medication can increase plasma von Willebrand factor and factor VIII concentrations by two to five times. The mechanism of action involves the induction of cyclic adenosine monophosphate (cAMP)-mediated vWF secretion through a direct effect on endothelial cells. Overall, DDAVP is a useful tool for increasing von Willebrand factor levels in the body, allowing for safer and more successful surgical and dental procedures.

    • This question is part of the following fields:

      • Haematology
      18.4
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SESSION STATS - PERFORMANCE PER SPECIALTY

Haematology (6/10) 60%
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