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B Falciparum malaria C Trypanosomiasis D Loa loa

E Schistosomiasis

Question 13

Clinical scenario

A 24-year-old woman presents with purpura (Fig. 56).

Investigation reveals haemoglobin 12.1 g/dL (normal range 11.5 –16), mean corpuscular volume 81 fL

(normal range 80 –100), platelets 147× 10⁹/L (normal range 150 – 400), white cell count 10× 10⁹/L (normal range 4 –11), prothrombin time 14 seconds (normal range 12–16), activated partial thromboplastin time 32 seconds (normal range 30 – 46) and fibrinogen 4.1 g/L (normal range 2– 4). She had similar appearances of purpura on her other leg and on the flexor aspects of her forearms.

Question

What is the most likely diagnosis?

Answers

A Henoch–Schönlein purpura B Acute leukaemia

C Factitious purpura

D Idiopathic thrombocytopenia E Thrombotic thrombocytopenia

Question 14

Clinical scenario

A 70-year-old man was admitted for a prostatectomy. His haemoglobin was 12.9 g/dL (normal range 12–16.5), mean corpuscular volume 85 fL (normal range 80 –100),

Fig. 54 Question 11.

Fig. 55 Question 12. Fig. 56 Question 13.

platelets 367× 10⁹/L (normal range 150 – 400) and white cell count 9× 10⁹/L (normal range 4 –11).

The blood film is shown in Fig. 57.

Question

What is the diagnosis from the blood film?

Answers

A Hereditary spherocytosis B Hereditary elliptocytosis C Folate deficiency D Iron deficiency

E Coombs’ positive haemolysis

Question 15

Clinical scenario

A 31-year-old woman was admitted to the Emergency Department having been found unconscious at home. Her relatives said that she had recently had ’flu-like symptoms and been confused. She had a fever of 38.7°C. Laboratory investigations revealed haemoglobin 9.7 g/dL (normal range 11.5 –16), platelets 16× 10⁹/L (normal range 150 – 400), white cell count 15× 10⁹/L (normal range 4 –11) with neutrophils 11× 10⁹/L (normal range 2–7),

prothrombin time 14 seconds (normal range 12–16), activated partial thromboplastin time 37 seconds (normal range 30 – 46) and fibrinogen 4.1 g/L (normal range 2 – 4). The blood film is shown in Fig. 58.

Question

What is the diagnosis?

Answers

A Idiopathic thrombocytopenia B Acute myeloid leukaemia C Thrombotic thrombocytopenic

purpura

D Viral marrow suppression E Disseminated intravascular

coagulation

Question 16

Clinical scenario

A 72-year-old man is admitted for hernia repair. Investigation reveals haemoglobin 14.2 g/dL (normal range 12–16.5), white cell count 25× 10⁹/L (normal range 4 –11) and platelets 374× 10⁹/L (normal range 150 – 400). His blood film is shown in Fig. 59.

Question

What is the diagnosis?

Answers

A Acute myeloid leukaemia B Chronic myeloid leukaemia C Chronic lymphatic leukaemia D Myeloma

E Non-Hodgkin’s lymphoma

Question 17

Clinical scenario

A 64-year-old woman has non-Hodgkin’s lymphoma, for which she has received chemotherapy, and has also had multiple blood transfusions for anaemia. She is also receiving tamoxifen for breast cancer. She has become sensitive to sunlight and developed a rash on her hands (Fig. 60).

Fig. 57 Question 14.

Fig. 58 Question 15.

Question

What is the diagnosis?

Answers

A Mycosis fungoides B Drug reaction C Metastatic cancer D Porphyria cutanea tarda E Psoriasis

Question 18

Clinical scenario

A 50-year-old man has isolated lymphocytosis on his FBC (25× 10⁹/L; normal range 1–3× 10⁹/L).

Immunophenotyping is performed

and confirms a diagnosis of chronic lymphatic leukaemia (CLL). He is well and his examination is normal.

Question

Which are the two most accurate statements?

Answers

A It is important to perform a bone-marrow aspirate and trephine B This is stage A disease

C Due to the high white cell count, this is stage B disease

D Treatment should be initiated as soon as he is investigated fully E His blood count should be

monitored weekly

F CLL cannot be confirmed on immunophenotyping

G There is no indication to treat at this stage

H He should have a CT of his chest and abdomen

I The median survival in such patients is 3 years

J Women have a worse prognosis than men

Question 19

Clinical scenario

A 60-year-old man with a high-grade lymphoma has commenced on chemotherapy.

Blood tests are taken 2 hours after commencing and you are asked to review these to exclude tumour lysis syndrome.

Question

Which result would not suggest the development of tumour lysis syndrome?

Answers

A Hyperuricaemia B Hypocalcaemia C Hyperkalaemia D Hypophosphataemia E Hyperphosphataemia

Question 20

Clinical scenario

A 72-year-old man, who is known to have myeloma, is brought to the Emergency Department because he is generally ‘unwell’.

Question

Which of the following is not a usual feature of hypercalcaemia?

Answers

A Impaired renal function B Constipation

C Confusion D Dehydration E Diarrhoea

Fig. 59 Question 16.

Fig. 60 Question 17.

Question 21

Clinical scenario

A 57-year-old man is found to have polycythaemia vera, with a haemoglobin of 20 g/dL (normal range 12–16.5) and a haematocrit of 0.48 (normal range 0.38 – 0.50). He is asymptomatic.

Question

Which is the single best treatment option?

Answers

A Observation alone

B Hydroxycarbamide oral therapy C Venesection

D Aspirin

E Subcutaneous interferon injections

Question 22

Clinical scenario

A 38-year-old man has had two deep venous thromboses in the absence of any recognised precipitating events. You ask the haematology laboratory to screen for causes of a thrombophilic state.

Question

Which one of the following conditions will they not look for?

Answers

A Protein C deficiency B Protein S deficiency C Antithrombin III deficiency D Factor VIII deficiency E Lupus anticoagulant

Question 23

Clinical scenario

A 55-year-old woman presents with tiredness. She had been given a diagnosis of rheumatoid arthritis at the age of 35 years, but has been fit and well for many years, without any joint

problems. Her FBC is as follows:

haemoglobin 9.3 g/dL (normal range 11.5 –16), mean corpuscular volume 85 fL (normal range 80 –100), mean corpuscular haemoglobin 28 pg (normal range 27–32), white blood cell count normal and platelet count normal.

Question

Which one of the following statements is correct?

Answers

A Sideroblastic anaemia is a likely diagnosis

B Felty’s syndrome is a likely diagnosis

C Acute blood loss is likely D Anaemia of chronic disorders is

the most likely diagnosis E A normal ferritin excludes iron

deficiency as a cause of her anaemia

Question 24

Clinical scenario

A tall, thin 18-year-old man with sickle cell disease presents to the Emergency Department with a 36-hour history of cough, fever, breathlessness and pleuritic chest pain.

Question

The most likely diagnosis is:

Answers

A Pulmonary embolism B Myocardial infarction C Pneumococcal pneumonia D Pneumothorax

E Acute chest syndrome

Question 25

Clinical scenario

A 49-year-old man presents with malaena of 1 week’s duration. On investigation his platelet count is found to be elevated.

Question

Which of the following is the most likely cause of the thrombocytosis?

Answers

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