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  • Question 1 - The accumulation of eosinophils within tissues is mostly regulated by which of the...

    Correct

    • The accumulation of eosinophils within tissues is mostly regulated by which of the following cytokines?

      Your Answer: Interleukin-5

      Explanation:

      IL-5 is produced by TH2 helper cells and by mast cells. They stimulate increased secretion of immunoglobulins and stimulate B cell growth. They are the major regulators in eosinophil activation and control. They are also released from eosinophils and mast cells in asthmatic patients and are associate with a many other allergic conditions.

    • This question is part of the following fields:

      • Inflammation & Immunology
      • Pathology
      97.5
      Seconds

  • Question 2 - A young girl who presented with a clinical picture of type I hypersensitivity...

    Incorrect

    • A young girl who presented with a clinical picture of type I hypersensitivity reaction with eosinophilia is most likely to have?

      Your Answer:

      Correct Answer: Liver flukes

      Explanation:

      Usually a parasitic infection will be associated with a type I hypersensitivity reaction.

      Amyloid deposition will not cause an immune reaction.

      Organic dust will lead to a type III hypersensitivity reaction.

      Cell mediated as well as humoral immune mechanism play a part in syphilis, but they are do not specifically cause a type I reaction.

      Malaria is cause by plasmodium and is not cause of a hypersensitivity reaction.

      Atopic dermatitis will not be accompanied by eosinophilia.

    • This question is part of the following fields:

      • Inflammation & Immunology
      • Pathology
      0
      Seconds

  • Question 3 - Langhans giant cells are characteristically seen in which type of inflammation? ...

    Incorrect

    • Langhans giant cells are characteristically seen in which type of inflammation?

      Your Answer:

      Correct Answer: Granulomatous inflammation

      Explanation:

      Langhans giant cells are characteristically seen in granulomatous inflammation. They form when epithelioid cells fuse together. They usually contain a nuclei with a horseshoe-shaped pattern in the periphery of the cell.

    • This question is part of the following fields:

      • Inflammation & Immunology
      • Pathology
      0
      Seconds

  • Question 4 - A 36-year old gentleman with a history of cough for 4 weeks came...

    Incorrect

    • A 36-year old gentleman with a history of cough for 4 weeks came to the hospital. Examination revealed multiple lymphadenopathy with splenomegaly. Investigations revealed haemoglobin 11 g/dl, haematocrit 32.4%, mean corpuscular volume (MCV) 93 fl, white blood cell count 63 × 109/l, and platelet count 39 × 109/l; along with characteristic Auer rods on peripheral blood smear. What is the likely diagnosis?

      Your Answer:

      Correct Answer: Acute myelogenous leukaemia (AML)

      Explanation:

      AML, or acute myeloid leukaemia is the commonest acute leukaemia affecting adults. increasing in incidence with age. It is a malignancy of the myeloid line of white blood cells. It results in rapid proliferation of abnormal cells, which accumulate in the marrow. Interference with normal cell production leads to a drop in red blood cells, white blood cells and platelets. This causes symptoms such as tiredness, shortness of breath, tendency to bleed or bruise easily and recurrent infections. AML is known to progress quickly and can lead to death in weeks and months if not treated. Leukemic blasts of AML show presence of Auer rods. These are clumps of azurophilic granular material that form needles in the cytoplasm. Composed of fused lysosomes, these contain peroxidase, lysosomal enzymes and crystalline inclusions. Auer rods are classically present in myeloid blasts of M1, M2, M3 and M4 acute leukaemia. They also help to distinguish the preleukemia myelodysplastic syndromes.

    • This question is part of the following fields:

      • Haematology
      • Pathology
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  • Question 5 - A Monospot test in a 17-year old boy presenting with fever, multiple palpable...

    Incorrect

    • A Monospot test in a 17-year old boy presenting with fever, multiple palpable lymph nodes and mild icterus was positive. His blood investigation is likely to show which of the following?

      Your Answer:

      Correct Answer: Atypical lymphocytosis

      Explanation:

      Epstein-Barr virus is the causative agent for infectious mononucleosis leading to presence of atypical lymphocytes in blood. Usually symptomatic in older children and adults, the incubation period is 30-50 days. Symptoms include fatigue, followed by fever, adenopathy and pharyngitis. Fatigue can last for months and is maximum in first few weeks. Fever spikes in the afternoon or early evening, with temperature around 39.5 – 40.5 °C. The ‘typhoidal’ form where fatigue and fever predominate has a low onset and resolution. Pharyngitis resemble that due to streptococcus and can be severe and painful. Lymphadenopathy is bilaterally symmetrical and can involve any nodes, specially the cervical ones. Mild splenomegaly is seen in 50% cases, usually in 2-3rd week. Mild tender hepatomegaly can occur. Less common manifestations include maculopapular eruptions, jaundice, periorbital oedema and palatal enanthema. Diagnostic tests include full blood count and a heterophil antibody test. Morphologically abnormal lymphocytes account for 80% cells and are heterogenous, unlike leukaemia.

    • This question is part of the following fields:

      • Haematology
      • Pathology
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  • Question 6 - An experiment is carried out to observe engulfment and phagocytosis of microbes. Strep...

    Incorrect

    • An experiment is carried out to observe engulfment and phagocytosis of microbes. Strep pneumoniae are added to a solution of leukocytes with a substance added to enhance the process of phagocytosis. What is this substance?

      Your Answer:

      Correct Answer: Complement C3b

      Explanation:

      C3b is cleaved from C3 complement with the help of the enzyme C3- convertase. It binds to the cell surface of the offending substance and opsonizes it. This makes it easy for the phagocytes to detect and eliminate them.

      IgM does not act as an opsonin but igG does.

      Selectins aid leukocytes to bind to the endothelial surfaces.

      C5a is a chemo-attractant and histamine a vasodilator.

      NADPH oxidises offending substance after phagocytosis within the macrophage.

    • This question is part of the following fields:

      • Inflammation & Immunology
      • Pathology
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      Seconds

  • Question 7 - What is the role of ICAM-1 and VCAM-1 in the inflammatory process? ...

    Incorrect

    • What is the role of ICAM-1 and VCAM-1 in the inflammatory process?

      Your Answer:

      Correct Answer: Leukocyte adhesion

      Explanation:

      Steps involved in leukocyte arrival and function include:

      1. margination: cells migrate from the centre to the periphery of the vessel.

      2. rolling: selectins are upregulated on the vessel walls.

      3. adhesion: upregulation of the adhesion molecules ICAM and VCAM on the endothelium interact with integrins on the leukocytes. Interaction of these results in adhesion.

      4. diapedesis and chemotaxis: diapedesis is the transmigration of the leukocyte across the endothelium of the capillary and towards a chemotactic product.

      5. phagocytosis: engulfing the offending substance/cell.

    • This question is part of the following fields:

      • Inflammation & Immunology
      • Pathology
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      Seconds

  • Question 8 - Which of the following coagulation factors is responsible for the formation of a...

    Incorrect

    • Which of the following coagulation factors is responsible for the formation of a complex with tissue factor to activate factors IX and X?

      Your Answer:

      Correct Answer: Factor VII

      Explanation:

      Factor VII, also known as proconvertin or stable factor, is a vitamin K–dependent protein that plays a central role in haemostasis and coagulation. Tissue factor is a protein that is normally not exposed on the surface of intact blood vessels. Damage to the vascular lumen leads to tissue factor exposure. The exposed tissue factor binds to factor VII. This facilitates the activation of factor VII to factor VIIa.

    • This question is part of the following fields:

      • Haematology
      • Pathology
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      Seconds

  • Question 9 - A patient presented with continuous bleeding several hours after dental extraction. Which of...

    Incorrect

    • A patient presented with continuous bleeding several hours after dental extraction. Which of the following findings is most often associated with clinical bleeding?

      Your Answer:

      Correct Answer: Factor IX deficiency

      Explanation:

      Factor IX deficiency, also called Haemophilia B or Christmas disease, is a disorder caused by missing or defective clotting factor IX. Deficiency of the factor IX causes irregular bleeding that can happen spontaneously or after mild trauma, surgery and dental extractions.

    • This question is part of the following fields:

      • Haematology
      • Pathology
      0
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  • Question 10 - Which of the following cells would be increased in a patient suffering from...

    Incorrect

    • Which of the following cells would be increased in a patient suffering from a hydatid cyst in the liver?

      Your Answer:

      Correct Answer: Eosinophils

      Explanation:

      Eosinophils are granulocytes that respond to parasitic infections. They are also involved in allergy response and asthma. They contain granules which stain red with Romanowsky’s method and contain peroxidase, Rnase, Dnase, histamine, lipase and major basic proteins that are toxic to the parasite as well as the hosts tissue. They are about 1-5% of the total WBC population and persist in the blood for 6-12 hours.

    • This question is part of the following fields:

      • Inflammation & Immunology
      • Pathology
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      Seconds

  • Question 11 - A 50-year old lady presented to the clinic with chronic pain in the...

    Incorrect

    • A 50-year old lady presented to the clinic with chronic pain in the abdomen. On physical examination, she was found to be pale. Further investigations revealed a decrease in both serum iron and total iron-binding capacity, along with an increase in serum ferritin. These findings are seen in:

      Your Answer:

      Correct Answer: Anaemia of chronic disease

      Explanation:

      Anaemia of chronic disease is characterized by low serum iron, iron-binding capacity and saturation with increased ferritin (storage iron). Haemolytic anaemia is characterized by normal iron levels as the haemoglobin released from the haemolysed red blood cells is recycled. Anaemia due to chronic blood loss leads to low serum iron, low ferritin and high total iron-binding capacity (TIBC). Malabsorption, especially with duodenal involvement can also lead to iron deficiency anaemia with low ferritin and high TIBC. Megaloblastic anaemia due to vitamin B12 and folate deficiency is not associated with abnormalities in metabolism of iron.

    • This question is part of the following fields:

      • Haematology
      • Pathology
      0
      Seconds

  • Question 12 - A 50-year old gentleman who was admitted for elective surgery was found to...

    Incorrect

    • A 50-year old gentleman who was admitted for elective surgery was found to have haemoglobin 9.5 g/dl, white blood cell count of 1.4 × 109/l and a mean corpuscular volume (MCV) of 134 fl. Which of the following is the likely finding on his peripheral blood smear?

      Your Answer:

      Correct Answer: Hypersegmented neutrophils

      Explanation:

      The likely diagnosis is megaloblastic anaemia, which also shows the presence of hypersegmented neutrophils.

    • This question is part of the following fields:

      • Haematology
      • Pathology
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      Seconds

  • Question 13 - A 30 year old lawyer presented with a history of pleural effusions, pericarditis,...

    Incorrect

    • A 30 year old lawyer presented with a history of pleural effusions, pericarditis, arthralgia without joint deformity and episodes of myalgia for the past 12 months. Blood tests reveal a normocytic anaemia. Which of the following tests should be performed to investigate this condition further?

      Your Answer:

      Correct Answer: Antinuclear antibody test

      Explanation:

      These non specific findings are suggestive of autoimmune disease. Antinuclear antibody (ANA) is the first test that should be performed when autoimmune diseases are suspected and later on more specific tests should be performed. This tests aids in the diagnosis of SLE, scleroderma, Sjogren’s syndrome, Raynaud’s disease, juvenile chronic arthritis, rheumatoid arthritis and antiphospholipid antibody syndrome etc. To confirm the disease a history, physical examination along with specific tests are required.

      CPK is more specific for acute conditions.

      ESR is a non specific test for inflammation.

    • This question is part of the following fields:

      • Inflammation & Immunology
      • Pathology
      0
      Seconds

  • Question 14 - A 40 year old woman, who is under anaesthesia for an elective procedure,...

    Incorrect

    • A 40 year old woman, who is under anaesthesia for an elective procedure, received an antibiotic injection. She immediately developed a rash and her airway constricted raising the airway pressure. Which mechanism is responsible for this reaction?

      Your Answer:

      Correct Answer: Type I hypersensitivity

      Explanation:

      Type I hypersensitivity reaction is an immediate reaction that occurs due to binding of the antigen with antibodies attached to mast cells in a previously sensitized person. It has an immediate phase, which is characterised by vasodilation, leakage of plasma, smooth muscle spasm, or glandular secretions. This manifests in about 5-30 min and usually resolves within 60 mins. The delayed phase follows after 24 hours and can persist up to several days. It is due to infiltration of eosinophils, neutrophils, basophils and CD4+ cells and leads to tissue destruction. The nature of the reaction varies according to the site. It can take the form of skin allergy, hives, allergic rhinitis, conjunctivitis, bronchial asthma or food allergy.

    • This question is part of the following fields:

      • Inflammation & Immunology
      • Pathology
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      Seconds

  • Question 15 - Which of the following over-the-counter drugs can cause a prolonged bleeding time? ...

    Incorrect

    • Which of the following over-the-counter drugs can cause a prolonged bleeding time?

      Your Answer:

      Correct Answer: Acetylsalicylic acid

      Explanation:

      Acetylsalicylic acid, or aspirin, is a nonsteroidal anti-inflammatory drug that is widely used as an analgesic and antipyretic. Aspirin is as a cyclo-oxygenase inhibitor that leads to decreased prostaglandin production. Decreased platelet aggregation is another effect of this drug, achieved by long-lasting use of aspirin.

    • This question is part of the following fields:

      • Haematology
      • Pathology
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  • Question 16 - Which of the following conditions is likely to result in splenomegaly, hypochromic anaemia...

    Incorrect

    • Which of the following conditions is likely to result in splenomegaly, hypochromic anaemia and hemochromatosis in a young male?

      Your Answer:

      Correct Answer: β-Thalassaemia

      Explanation:

      Beta-thalassaemia is due to decreased production of β-polypeptide chains, with an autosomal inheritance pattern. Carrier patients (heterozygotes) are asymptomatic and have mild to moderate microcytic anaemia. This is known as thalassaemia minor. Homozygotes (β-thalassaemia major, or Cooley’s anaemia) develop severe anaemia and marrow hyperactivity. The disease presents at 1-2 years of age with severe anaemia and transfusional and absorptive iron overload. Patients also present with jaundice, leg ulcers, massive splenomegaly and cholelithiasis. The disease can also lead to splenic sequestration leading to faster destruction of transfused red blood cells. Increased marrow activity causes thickening of cranial bones. Involvement of long bones is also seen, which can cause pathological fractures and growth impairment. There is iron deposition in various organs, which can lead to heart failure or hepatic failure (leading to cirrhosis). Thalassaemias are suspected in presence of family history, or signs suggesting microcytic haemolytic anaemia. Further test and quantitative haemoglobin studies are useful. In beta-thalassaemia, there is an increase in serum bilirubin, iron and ferritin levels. There is severe anaemia, often with haemoglobin < 6 g/dl. There is an elevated red blood cell count, which are microcytic. Peripheral blood smear is diagnostic with nucleated erythroblasts, target cells, small pale red blood cells, and punctate basophilia.

    • This question is part of the following fields:

      • Haematology
      • Pathology
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      Seconds

  • Question 17 - What is the primary function of the Kupffer cells found in the liver?...

    Incorrect

    • What is the primary function of the Kupffer cells found in the liver?

      Your Answer:

      Correct Answer: Recycling of old red blood cells

      Explanation:

      Kupffer cells found in the liver are part of the monocyte-reticular system. They are specialised macrophages and primarily function to recycle old and damaged RBCs. The RBCs are phagocytosed and the haemoglobin is broken down into haem and globin. The haem is further broken down into iron that is recycled and bilirubin that is conjugated with glucuronic acid and excreted in the bile.

    • This question is part of the following fields:

      • Inflammation & Immunology; Hepatobiliary
      • Pathology
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      Seconds

  • Question 18 - A significantly elevated white cell count of 50 x 109/l with 5% blasts...

    Incorrect

    • A significantly elevated white cell count of 50 x 109/l with 5% blasts and raised leucocyte alkaline phosphatase is seen in which of the following conditions?

      Your Answer:

      Correct Answer: Leukaemoid reaction

      Explanation:

      Non-neoplastic proliferation of leucocytes causes an increase in leukocyte alkaline phosphatase (LAP). This is referred to as ‘leukemoid reaction’ because of the similarity to leukaemia with an increased white cell count (>50 × 109/l) with immature forms. Causes of leukemoid reaction includes haemorrhage, drugs (glucocorticoids, all-trans retinoic acid etc), infections such as tuberculosis and pertussis, and as a paraneoplastic phenomenon. Leukemoid reaction can also be seen in infancy as a feature of trisomy 21. This is usually a benign condition, but can be a response to a disease state. Differential diagnosis include chronic myelogenous leukaemia (CML).

    • This question is part of the following fields:

      • Haematology
      • Pathology
      0
      Seconds

  • Question 19 - An 8 year old boy presents with a history of repeated bacterial/pyogenic infections....

    Incorrect

    • An 8 year old boy presents with a history of repeated bacterial/pyogenic infections. He had a normal recovery from chickenpox and measles and shows normal antibody response. A decrease in which of the cell types can best explain this history of repeated pyogenic infections?

      Your Answer:

      Correct Answer: Neutrophils

      Explanation:

      A decrease in the number of granulocytes, particularly neutrophils is known as agranulocytosis and it increases the susceptibility of an individual towards recurrent infections. Neutropenia can be either due to decreased production or increased elimination of neutrophils.

      Ineffective agranulopoiesis is seen in: 1. myeloid stem cell suppression, 2. disease conditions associated with granulopoiesis such as megaloblastic anaemia and myelodysplastic syndromes, 3. rare genetic diseases, 4. splenic sequestration and 5. increased peripheral utilization.

    • This question is part of the following fields:

      • Inflammation & Immunology
      • Pathology
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  • Question 20 - A middle aged man presented in OPD with a low grade fever and...

    Incorrect

    • A middle aged man presented in OPD with a low grade fever and a persistent cough. His blood smear showed an increase in cells with large bi-lobed nuclei. Which of these cells represent the one seen on the smear?

      Your Answer:

      Correct Answer: Monocytes

      Explanation:

      Monocytes are white cells that protect the body against harmful pathogens. They are mobile and are produced in the bone marrow, mature there and circulate in the blood for about 1-3 days, where they enter the tissues and transform into macrophages. They are characteristically identified by their large bi-lobed nuclei.

    • This question is part of the following fields:

      • Inflammation & Immunology
      • Pathology
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  • Question 21 - A 65-year old gentleman presents to the clinic with chronic back pain and...

    Incorrect

    • A 65-year old gentleman presents to the clinic with chronic back pain and weight loss. His blood count shows a white blood cell count of 10 × 109/l, with a differential count of 66 polymorphonuclear leukocytes, 7 bands, 3 metamyelocytes, 3 myelocytes, 14 lymphocytes, 7 monocytes, and 5 nucleated red blood cells. The haemoglobin is 13 g/dl with a haematocrit of 38.1%, a mean corpuscular volume of 82 fl, and a platelet count of 126 × 109/l. What is the likely diagnosis?

      Your Answer:

      Correct Answer: Metastatic carcinoma

      Explanation:

      The peripheral blood findings suggest a leucoerythroblastic picture, the common causes of which in a 65-year old gentleman includes prostatic or lung malignancy.

    • This question is part of the following fields:

      • Haematology
      • Pathology
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  • Question 22 - Where do the cells belonging to the mononuclear phagocyte system originate? ...

    Incorrect

    • Where do the cells belonging to the mononuclear phagocyte system originate?

      Your Answer:

      Correct Answer: Bone marrow

      Explanation:

      The macrophage originates from a committed bone marrow stem cell. It is called the pluripotent hematopoietic stem cell. This differentiates into a monoblast and then into a promonocyte and finally matures into a monocyte. When called upon they leave the bone marrow and enter into the circulation. Upon entering the tissue they transform into macrophages. Tissue macrophages include: Kupffer cells (liver), alveolar macrophages (lung), osteoclasts (bone), Langerhans cells (skin), microglial cells (central nervous system), and possibly the dendritic immunocytes of the dermis, spleen and lymph nodes.

    • This question is part of the following fields:

      • Inflammation & Immunology
      • Pathology
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  • Question 23 - Blood investigations of a patient with vitamin K deficiency revealed a prolonged prothrombin...

    Incorrect

    • Blood investigations of a patient with vitamin K deficiency revealed a prolonged prothrombin time. This coagulation abnormality is most probably due to:

      Your Answer:

      Correct Answer: Factor VII deficiency

      Explanation:

      Factor VII deficiency is a bleeding disorder caused by a deficiency or reduced activity of clotting factor VII. It may be inherited or acquired at some point during life. Inherited factor VII deficiency is an autosomal recessive disorder caused by mutations of the F7 gene. Factor VII is vitamin K-dependent, as are Factors II, IX and X and therefore lack of this vitamin can cause the development of acquired factor VII deficiency. Other causes of acquired deficiency of this factor include liver disease, sepsis and warfarin therapy.

    • This question is part of the following fields:

      • Haematology
      • Pathology
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      Seconds

  • Question 24 - Coagulation in the body (in vivo) is a process in which several proteins...

    Incorrect

    • Coagulation in the body (in vivo) is a process in which several proteins known as coagulation factors are activated in a cascade effect to stop bleeding. Which of the following initiates this cascade effect?

      Your Answer:

      Correct Answer: Tissue factor

      Explanation:

      Tissue factor (TF), also known as ‘factor III’ or ‘thromboplastin’, is an anti-coagulation protein that initiates the extrinsic coagulation. TF acts as a transmembrane receptor for Factor VII/VIIa . It is expressed by endothelial cells but also certain tissues, such as the heart and brain.

    • This question is part of the following fields:

      • Haematology
      • Pathology
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  • Question 25 - Which of the following terms best describes the movement of leukocytes towards a...

    Incorrect

    • Which of the following terms best describes the movement of leukocytes towards a specific target?

      Your Answer:

      Correct Answer: Chemotaxis

      Explanation:

      The movement of leukocytes towards a chemical mediator is termed chemotaxis and the mediators likewise called chemoattractants.

      Diapedesis is the squeezing of the leukocytes from the capillary wall into the intercellular space.

      Endocytosis is engulfing of a small substance by the cells e.g. glucose, protein, fats.

      Margination is lining of the WBC along the periphery of the blood vessel.

      Adhesion is attachment with the vessel wall.

      Phagocytosis is described as engulfing the bacteria or the offending substance.

    • This question is part of the following fields:

      • Inflammation & Immunology
      • Pathology
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  • Question 26 - An enlarged lymph node which shows well-defined, prominent paracortical follicles with germinal centres...

    Incorrect

    • An enlarged lymph node which shows well-defined, prominent paracortical follicles with germinal centres is most likely from which of the following patients?

      Your Answer:

      Correct Answer: A 5-year-old boy with a sore throat and runny nose

      Explanation:

      Lymphadenopathy is common in children and is usually reactive in nature. The description fits that of a benign, reactive lymph node.

    • This question is part of the following fields:

      • Haematology
      • Pathology
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  • Question 27 - A 58-year-old woman diagnosed with deep vein thrombosis had been using warfarin for...

    Incorrect

    • A 58-year-old woman diagnosed with deep vein thrombosis had been using warfarin for 10 days. When she presented to the doctor she had haemorrhagic bullae and necrotic lesions in her lower limbs and buttocks. Deficiency of which of the following proteins may have caused the necrotic skin lesions?

      Your Answer:

      Correct Answer: Protein C

      Explanation:

      Warfarin-induced skin necrosis is a rare complication of anticoagulant therapy that requires immediate drug cessation. The most common cutaneous findings include petechiae that progress to ecchymoses and haemorrhagic bullae. Warfarin inactivates vitamin K-dependent clotting factors II, VII, IX, and X and vitamin K-dependent proteins C and S. The concentration of protein C falls more rapidly than other vitamin K-dependent factors because they have a shorter half-lives. Skin necrosis is seen mainly in patients with prior protein C deficiency.

    • This question is part of the following fields:

      • Haematology
      • Pathology
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  • Question 28 - Multiple, non-tender lymphadenopathy with biopsy showing several crowded follicles of small, monomorphic lymphocytes...

    Incorrect

    • Multiple, non-tender lymphadenopathy with biopsy showing several crowded follicles of small, monomorphic lymphocytes and the absence of Reed-Sternberg cells is seen in which of the following?

      Your Answer:

      Correct Answer: Poorly differentiated lymphocytic lymphoma

      Explanation:

      Malignant lymphoma usually causes non-tender lymphadenopathy, unlike the tender lymphadenopathy caused by infections (including infectious mononucleosis caused by Epstein-Barr virus). Also, the lymphoid hyperplasia seen in infectious mononucleosis is benign and polyclonal.

    • This question is part of the following fields:

      • Haematology
      • Pathology
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  • Question 29 - A 14 year-old girl is found to have haemophilia B. What pathological problem...

    Incorrect

    • A 14 year-old girl is found to have haemophilia B. What pathological problem does she have?

      Your Answer:

      Correct Answer: Deficiency of factor IX

      Explanation:

      Haemophilia B (also known as Christmas disease) is due to a deficiency in factor IX. Haemophilia A is due to a deficiency in factor VIII.

    • This question is part of the following fields:

      • Haematology
      • Pathology
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  • Question 30 - Which of the following is the most likely cause of massive splenomegaly in...

    Incorrect

    • Which of the following is the most likely cause of massive splenomegaly in a 35-year old gentleman?

      Your Answer:

      Correct Answer: Myelofibrosis

      Explanation:

      Causes of massive splenomegaly include chronic myelogenous leukaemia, chronic lymphocytic leukaemia, lymphoma, hairy cell leukaemia, myelofibrosis, polycythaemia vera, sarcoidosis, Gaucher’s disease and malaria.

    • This question is part of the following fields:

      • Haematology
      • Pathology
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  • Question 31 - A 63-year old lady presents with pain in multiple bones and renal failure....

    Incorrect

    • A 63-year old lady presents with pain in multiple bones and renal failure. On enquiry, there is history of recurrent pneumonia in the past. What will be the likely finding on her bone marrow biopsy?

      Your Answer:

      Correct Answer: Plasma cells

      Explanation:

      Multiple myeloma is a plasma cell malignancy that produce excessive monoclonal immunoglobulins. The disease presents with bone pains, renal dysfunction, increased calcium, anaemia and recurrent infections. Diagnosis is by demonstrating the presence of M-protein in urine or serum, lytic bone lesions, light chain proteinuria or excessive plasma cells on marrow biopsy.

    • This question is part of the following fields:

      • Haematology
      • Pathology
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  • Question 32 - Skin infiltration by neoplastic T lymphocytes is seen in: ...

    Incorrect

    • Skin infiltration by neoplastic T lymphocytes is seen in:

      Your Answer:

      Correct Answer: Mycosis fungoides

      Explanation:

      Mycosis fungoides is a chronic T-cell lymphoma that involves the skin and less commonly, the internal organs such as nodes, liver, spleen and lungs. It is usually diagnosed in patients above 50 years and the average life expectancy is 7-10 years. It is insidious in onset and presents as a chronic, itchy rash, eventually spreading to involve most of the skin. Lesions are commonly plaque-like, but can be nodular or ulcerated. Symptoms include fever, night sweats and weight loss. Skin biopsy is diagnostic. However, early cases may pose a challenge due to fewer lymphoma cells. The malignant cells are mature T cells (T4+, T11+, T12+). The epidermis shows presence of characteristic Pautrier’s micro abscesses are present in the epidermis.

    • This question is part of the following fields:

      • Haematology
      • Pathology
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  • Question 33 - Following a bee sting, a women develops a 2cm red, raised, swollen lesion...

    Incorrect

    • Following a bee sting, a women develops a 2cm red, raised, swollen lesion at the site of the sting . Which of the following findings is likely to be seen in this lesion?

      Your Answer:

      Correct Answer: Vasodilation

      Explanation:

      Inflammation is the immediate response of the body towards infections or irritations. The cardinal signs of inflammation are 1. redness/rubor, 2. tumour/swelling, 3.dolar/pain, 4.calor/heat and organ dysfunction (function laesa). Inflammation has 2 components; vascular and cellular. Blood vessels dilate upstream of the inflamed area leading to the rubor and calor and constrict downstream, increasing pressure and causing fluid to leak out of the capillary, resulting in swelling. The cellular component includes infiltration by neutrophils. Leukocyte arrival and functions include; 1. margination: cells marginated from the centre to the periphery of the vessel, 2. rolling: selectins are upregulated on the vessel walls, 3. adhesion: upregulation of the adhesion molecules ICAM and VCAM on the endothelium interact with integrins on the leukocytes resulting in adhesion, 4. diapedesis and chemotaxis: diapedesis is the transmigration of the leukocyte across the endothelium of the capillary and towards a chemotactic product and 5. phagocytosis: engulfing the offending substance/cell.

    • This question is part of the following fields:

      • Inflammation & Immunology
      • Pathology
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  • Question 34 - A 24-year-old patient with recurrent episodes of deep vein thrombosis presents again to...

    Incorrect

    • A 24-year-old patient with recurrent episodes of deep vein thrombosis presents again to the clinic. Deficiency of which of the following blood proteins is the most probable cause of this episode?

      Your Answer:

      Correct Answer: Antithrombin III

      Explanation:

      Antithrombin III (ATIII) is a blood protein that acts by inhibiting blood coagulation by neutralizing the enzymatic activity of thrombin.

      Antithrombin III deficiency is an autosomal dominant disorder that leads to an increased risk of venous and arterial thrombosis. Clinical manifestations typically appear in young adulthood.

    • This question is part of the following fields:

      • Haematology
      • Pathology
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  • Question 35 - Which of the following is the most likely cause of prolonged thrombin clotting...

    Incorrect

    • Which of the following is the most likely cause of prolonged thrombin clotting time?

      Your Answer:

      Correct Answer: Hypofibrinogenemia

      Explanation:

      Thrombin clotting time, also called thrombin time (TT), is test used for the investigation of possible bleeding or clotting disorders. TT reflects the conversion of fibrinogen to fibrin and it’s also very sensitive to the presence of the anticoagulant heparin. A prolonged thrombin time may indicate the presence of hypofibrinogenemia (decreased fibrinogen level ), dysfibrinogenaemia, disseminated intravascular coagulation (DIC), end stage liver disease or malnutrition.

    • This question is part of the following fields:

      • Haematology
      • Pathology
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  • Question 36 - Which of these is secreted by both macrophages and muscle cells? ...

    Incorrect

    • Which of these is secreted by both macrophages and muscle cells?

      Your Answer:

      Correct Answer: Interleukin-6

      Explanation:

      IL-6 is secreted by the T cells and macrophages and is a pro inflammatory cytokine. It is secreted in response to trauma e.g. burns and tissue damage that leads to inflammation. Apart from this its is also a myokine and is elevated due to muscle contraction. Other functions include: stimulate osteoclast formation when secreted by osteoblasts, mediate fever in acute phase response and are responsible for energy metabolism in muscle and fatty tissues. Inhibitors of IL-6 e.g. oestrogen are used as a treatment for postmenopausal osteoporosis.

    • This question is part of the following fields:

      • Inflammation & Immunology
      • Pathology
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  • Question 37 - Reed-Sternberg cells are characteristic of: ...

    Incorrect

    • Reed-Sternberg cells are characteristic of:

      Your Answer:

      Correct Answer: Hodgkin's lymphoma

      Explanation:

      Reed-Sternberg cells are characteristic of Hodgkin’s lymphoma.

    • This question is part of the following fields:

      • Haematology
      • Pathology
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      Seconds

  • Question 38 - Low molecular weight heparin (LMWH) has less side effects than heparin and is...

    Incorrect

    • Low molecular weight heparin (LMWH) has less side effects than heparin and is used in the prophylaxis and treatment of venous and arterial thrombotic disorders. Which of the following is LMWHs mechanism of action?

      Your Answer:

      Correct Answer: Inhibition of factor Xa

      Explanation:

      Low molecular weight heparin (LMWH) is a anticoagulant that differs from normal heparin in that it has only short chains of polysaccharide. LMWH inhibits thrombin formation by converting antithrombin from a slow to a rapid inactivator of coagulation factor Xa.

    • This question is part of the following fields:

      • Haematology
      • Pathology
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  • Question 39 - A 59-year old gentleman admitted for elective cholecystectomy was found to have a...

    Incorrect

    • A 59-year old gentleman admitted for elective cholecystectomy was found to have a haemoglobin 12.5 g/dl, haematocrit 37%, mean corpuscular volume 90 fl, platelet count 185 × 109/l, and white blood cell count 32 × 109/l; along with multiple, small mature lymphocytes on peripheral smear. The likely diagnosis is:

      Your Answer:

      Correct Answer: Chronic lymphocytic leukaemia

      Explanation:

      CLL or chronic lymphocytic leukaemia is the most common leukaemia seen in the Western world. Twice more common in men than women, the incidence of CLL increases with age. About 75% cases are seen in patients aged more than 60 years. The blood, marrow, spleen and lymph nodes all undergo infiltration, eventually leading to haematopoiesis (anaemia, neutropenia, thrombocytopenia), hepatomegaly, splenomegaly and decreased production of immunoglobulin. In 98% cases, CD+5 B cells undergo malignant transformation.

      Often diagnosed on blood tests while being evaluated for lymphadenopathy, CLL causes symptoms like fatigue, anorexia, weight loss, pallor, dyspnoea on exertion, abdominal fullness or distension. Findings include multiple lymphadenopathy with minimal-to- moderate hepatomegaly and splenomegaly. Increased susceptibility to infections is seen. Herpes Zoster is common. Diffuse or maculopapular skin infiltration can also be seen in T-cell CLL.

      Diagnosis is by examination of peripheral blood smear and marrow: hallmark being a sustained, absolute leucocytosis (>5 ×109/l) and increased lymphocytes in the marrow (>30%). Other findings can include hypogammaglobulinemia (<15% of cases) and, rarely, raised lactate dehydrogenase (LDH). Only 10% cases demonstrate moderate anaemia and/or thrombocytopenia.

    • This question is part of the following fields:

      • Haematology
      • Pathology
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  • Question 40 - For which of the following is NOT screened for in blood for transfusion?...

    Incorrect

    • For which of the following is NOT screened for in blood for transfusion?

      Your Answer:

      Correct Answer: EBV

      Explanation:

      Blood for transfusion is routinely screened for hepatitis B and C, HIV, CMV and syphilis.

    • This question is part of the following fields:

      • Haematology
      • Pathology
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  • Question 41 - Perforin are present in the granules of which cell? ...

    Incorrect

    • Perforin are present in the granules of which cell?

      Your Answer:

      Correct Answer: Natural killer cell

      Explanation:

      Perforins are characteristically found In the granules of CD8+ T cells and natural killer cells. They are cytolytic proteins that insert into the target plasma membrane forming a hole and resulting in lysis. They along with granzyme B induce apoptosis in the target cell.

    • This question is part of the following fields:

      • Inflammation & Immunology
      • Pathology
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  • Question 42 - Which of the following proteins acts as cofactor in the thrombin-induced activation of...

    Incorrect

    • Which of the following proteins acts as cofactor in the thrombin-induced activation of anticoagulant protein C?

      Your Answer:

      Correct Answer: Thrombomodulin

      Explanation:

      Thrombomodulin is a protein cofactor expressed on the surface of endothelial cells. Thrombomodulin binds with thrombin forming a complex which activates protein C, initiating the anticoagulant pathway.

    • This question is part of the following fields:

      • Haematology
      • Pathology
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  • Question 43 - A 40-year old lady presented to the hospital with fever and mental confusion...

    Incorrect

    • A 40-year old lady presented to the hospital with fever and mental confusion for 1 week. On examination, she was found to have multiple petechiae all over her skin and mucosal surfaces. Blood investigations revealed low platelet count and raised urea and creatinine. A platelet transfusion was carried out, following which she succumbed to death. Autopsy revealed pink hyaline thrombi in myocardial arteries. What is the likely diagnosis?

      Your Answer:

      Correct Answer: Thrombotic thrombocytopenic purpura

      Explanation:

      Hyaline thrombi are typically associated with thrombotic thrombocytopenic purpura (TTP), which is caused by non-immunological destruction of platelets. Platelet transfusion is contraindicated in TTP. Platelets and red blood cells also get damaged by loose strands of fibrin deposited in small vessels. Multiple organs start developing platelet-fibrin thrombi (bland thrombi with no vasculitis) typically at arteriocapillary junctions. This is known as ‘thrombotic microangiopathy’. Treatment consists of plasma exchange.

    • This question is part of the following fields:

      • Haematology
      • Pathology
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  • Question 44 - A 20-year old boy presented with low grade fever, night sweats and weakness...

    Incorrect

    • A 20-year old boy presented with low grade fever, night sweats and weakness over two months. On examination, he had multiple, non-tender, cervical, supraclavicular and axillary adenopathy. Microscopy of lymph node biopsy showed the presence of Reed-Sternberg cells. He is likely suffering from:

      Your Answer:

      Correct Answer: Hodgkin’s lymphoma

      Explanation:

      Hodgkin’s lymphoma is a disease characterized by malignant proliferation of cells of the lymphoreticular system. It can be localized or disseminated, and can involve the nodes, spleen, liver and marrow. Symptoms of the disease include non-tender lymphadenopathy, fever, night sweats, weight loss, itching and hepatosplenomegaly. Histologically, the involved nodes show the presence of Reed-Sternberg cells, which are large, binucleated cells, in a heterogenous cellular infiltrate of histiocytes, lymphocytes, monocytes, plasma cells and eosinophils.

    • This question is part of the following fields:

      • Haematology
      • Pathology
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  • Question 45 - From which of the following cells is heparin produced? ...

    Incorrect

    • From which of the following cells is heparin produced?

      Your Answer:

      Correct Answer: Mast cells

      Explanation:

      Heparin is a natural highly-sulphated glycosaminoglycan that has anticoagulant functions. It is produced by the body basophils and mast cells.

    • This question is part of the following fields:

      • Haematology
      • Pathology
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  • Question 46 - Laboratory findings in a patient with dark urine and yellowish skin revealed a...

    Incorrect

    • Laboratory findings in a patient with dark urine and yellowish skin revealed a prolonged prothrombin time. Which of the following is the most likely cause of this finding?

      Your Answer:

      Correct Answer: Liver damage

      Explanation:

      Various conditions may prolong the prothrombin time (PT), including: warfarin use, vitamin K deficiency, liver disease, disseminated intravascular coagulopathy, hypofibrinogenemia, heparin infusion, massive blood transfusion and hypothermia. Liver disease causes prolonging of PT due to diminished synthesis of clotting factors. Dark urine colour and jaundice are indicators of the presence of a liver disease in this patient.

    • This question is part of the following fields:

      • Haematology
      • Pathology
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  • Question 47 - A Jewish man was diagnosed with haemophilia C. Which of the following factors...

    Incorrect

    • A Jewish man was diagnosed with haemophilia C. Which of the following factors is deficient in this form of haemophilia?

      Your Answer:

      Correct Answer: Factor XI

      Explanation:

      Haemophilia C, also known as plasma thromboplastin antecedent (PTA) deficiency or Rosenthal syndrome, is a condition caused by the deficiency of the coagulation factor XI. The condition is rare and it is usually found in Ashkenazi Jews.

    • This question is part of the following fields:

      • Haematology
      • Pathology
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  • Question 48 - A 17-year-old boy, who had developed shortness of breath and a loss of...

    Incorrect

    • A 17-year-old boy, who had developed shortness of breath and a loss of appetite over the last month, was referred to a haematologist because he presented with easy bruising and petechiae. His prothrombin time, platelet count, partial thromboplastin and bleeding time were all normal. Which of the following would explain the presence of the petechiae and easy bruising tendency?

      Your Answer:

      Correct Answer: Scurvy

      Explanation:

      Scurvy is a condition caused by a dietary deficiency of vitamin C, also known as ascorbic acid. Humans are unable to synthesize vitamin C, therefore the quantity of it that the body needs has to come from the diet. The presence of an adequate quantity of vitamin C is required for normal collagen synthesis. In scurvy bleeding tendency is due to capillary fragility and not coagulation defects, therefore blood tests are normal.

    • This question is part of the following fields:

      • Haematology
      • Pathology
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  • Question 49 - T lymphocytes that express the MCH type II antigen are most likely to...

    Incorrect

    • T lymphocytes that express the MCH type II antigen are most likely to produce which of the following cytokines?

      Your Answer:

      Correct Answer: Gamma interferon

      Explanation:

      Interferon gamma is a soluble cytokine previously known as the macrophage activating factor. It is the only member belonging to the type II class of the interferons. It is secreted by a number of cells taking part in the immune reaction including: T-helper cells (CD-4), cells with immunological memory (CD45PA), killer cells (CD8), dendrite cells (CD23,35), natural killer cells (CD16) and B lymphocytes (CD22,CD23). It has both a defending as well as a pathological effect. It induces differentiation in the myeloid cell in the bone marrow. If macrophages are infected by parasites it activates the macrophages to destroy them. IFN-γ strengthens the anti-tumour activities of the cytotoxic lymphocytes. Together with CD4 or CD8 toxins, produced by lymphocytes, it suppresses the growth of the tumour cells. along with these functions it increases the non specific response of the natural killer cells, causing changes in the cell membrane surface to prevent adhesion and penetration of a virus. It can either increase or decrease B cell response and it activates osteoclasts which increases bone resorption.

    • This question is part of the following fields:

      • Inflammation & Immunology
      • Pathology
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  • Question 50 - Elevated mean corpuscular volume with hypersegmented neutrophils and low reticulocyte index is seen...

    Incorrect

    • Elevated mean corpuscular volume with hypersegmented neutrophils and low reticulocyte index is seen in on the blood count of a middle-aged lady about to undergo elective surgery. On enquiry, she mentions feeling tired for a few months. Which of the following investigations should be carried out in her to reach a diagnosis?

      Your Answer:

      Correct Answer: Serum vitamin B12 and folate

      Explanation:

      Elevated levels of MCV indicates megaloblastic anaemia, which are associated with hypersegmented neutrophils. Likely causes include vitamin B12 or folate deficiency. Megaloblastic anaemia results from defective synthesis of DNA. As RNA production continues, the cells enlarge with a large nucleus. The cytoplasmic maturity becomes greater than nuclear maturity. Megaloblasts are produced initially in the marrow, before blood. Dyspoiesis makes erythropoiesis ineffective, causing direct hyperbilirubinemia and hyperuricemia. As all cell lines are affected, reticulocytopenia, thrombocytopenia and leukopenia develop. Large, oval blood cells (macro-ovalocytes) are released in the circulation, along with presence of hypersegmented neutrophils.

    • This question is part of the following fields:

      • Haematology
      • Pathology
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  • Question 51 - A 30-year-old woman known with Von Willebrand disease (vWD) has to undergo surgery....

    Incorrect

    • A 30-year-old woman known with Von Willebrand disease (vWD) has to undergo surgery. Which of these complications is most unlikely in this patient?

      Your Answer:

      Correct Answer: Hemarthrosis

      Explanation:

      Von Willebrand disease (vWD) is an inherited haemorrhagic disorder characterised by the impairment of primary haemostasis. It is caused by the deficiency or dysfunction of a protein named von Willebrand factor. The most common manifestation due to the condition is abnormal bleeding. Complications include easy bruising, hematomas, epistaxis, menorrhagia, prolonged bleeding and severe haemorrhage. Hemarthrosis is a complication that is more commonly found in haemophilia.

    • This question is part of the following fields:

      • Haematology
      • Pathology
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  • Question 52 - Which of the following mediators of inflammation requires arachidonic acid for synthesis? ...

    Incorrect

    • Which of the following mediators of inflammation requires arachidonic acid for synthesis?

      Your Answer:

      Correct Answer: Prostaglandins

      Explanation:

      Arachidonic acid is normally present in the phospholipids that make up the cell membrane and is cleaved by phospholipase A2 from the phospholipid. Arachidonic acid is a precursor for the production of eicosanoids which include: 1) prostaglandins, prostacyclins and thromboxane, 2) leukotrienes and 3) anandamides. The production of these products along with their action on the body is called the arachidonic acid cascade.

    • This question is part of the following fields:

      • Inflammation & Immunology
      • Pathology
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  • Question 53 - Which cells are most commonly seen in a granulomatous lesion that suggests an...

    Incorrect

    • Which cells are most commonly seen in a granulomatous lesion that suggests an underlying chronic inflammation?

      Your Answer:

      Correct Answer: Lymphocytes

      Explanation:

      Lymphocytes and monocytes are commonly and characteristically recognised in a case of chronic inflammation.

      Eosinophils and neutrophils are seen with acute inflammation.

      Mast cells release histamine in early inflammation.

      Basophils are seen with allergies.

      Plasma cells are seen with viral infection.

      Platelets are not characteristic of any type of inflammation.

    • This question is part of the following fields:

      • Inflammation & Immunology
      • Pathology
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  • Question 54 - A week after a renal transplant the patient received antilymphocyte globulins. Shortly after...

    Incorrect

    • A week after a renal transplant the patient received antilymphocyte globulins. Shortly after she developed fever and hypotension. Which of the following mechanisms is involved in this response?

      Your Answer:

      Correct Answer: Type III hypersensitivity

      Explanation:

      Type III hypersensitivity is characterized by soluble immune complexes which are aggregations of IgG and IgM antibodies with antigens that deposit in different tissues e.g. the skin, joints, kidneys. They can then trigger an immune response by activating the complement cascade. This reaction can take hours to develop and examples include: immuno-complex glomerulonephritis, rheumatoid arthritis, SLE, subacute bacterial endocarditis, arthus reaction and serum sickness.

    • This question is part of the following fields:

      • Inflammation & Immunology
      • Pathology
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  • Question 55 - A 35-year old lady presents to her GP with vague abdominal symptoms. Examination...

    Incorrect

    • A 35-year old lady presents to her GP with vague abdominal symptoms. Examination reveals a normal size spleen. Which of the following is the likely diagnosis?

      Your Answer:

      Correct Answer: Idiopathic thrombocytopenic purpura

      Explanation:

      Idiopathic thrombocytopenic purpura (ITP) is a disease caused due to development of an antibody against a platelet antigen (autoantibody). In childhood disease, the autoantibody gets triggered by binding of viral antigen to the megakaryocytes. Presentation includes unexplained thrombocytopenia, petechiae and bleeding from mucosal surfaces. The spleen usually does not enlarge in size. However, splenomegaly can occur due to coexisting viral infection. Marrow examination reveals normal or increased number of megakaryocytes. Diagnosis is by exclusion of other thrombocytopenic disorders.

    • This question is part of the following fields:

      • Haematology
      • Pathology
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  • Question 56 - A 14 year old girl suffers from haemophilia A and chronic knee pain...

    Incorrect

    • A 14 year old girl suffers from haemophilia A and chronic knee pain with progressive swelling and deformity over the last 4 years. Test results reveal a significantly reduced factor VIII activity. Which of the following is seen in the knee joint space after an acute painful episode?

      Your Answer:

      Correct Answer: Cholesterol crystals

      Explanation:

      Due to breakdown of the red blood cell membrane in haemophilic patients, cholesterol crystals are formed by the lipids. On the other hand lipofuscin deposition does not occur in haemolysis or haemorrhage. Neutrophil accumulation suggests acute inflammation. Anthracotic pigment is an exogenous carbon pigment that deposits in the lung from dust. Russell bodies are intracellular accumulations of immunoglobins in plasma cells. Curschmann’s spirals and Charcot Leyden crystals are pathognomonic of asthma.

    • This question is part of the following fields:

      • Cell Injury & Wound Healing; Haematology
      • Pathology
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  • Question 57 - A 35 year old man presented to the surgical OPD with a lump...

    Incorrect

    • A 35 year old man presented to the surgical OPD with a lump on his right forearm which appeared 3 weeks ago and was tender on examination. He gave a history was being in a car accident with pieces of glass from the windshield piercing his forearm removed manually and on further elective surgery. Which of these cells are characteristically found during inflammation in this situation?

      Your Answer:

      Correct Answer: Giant cell

      Explanation:

      A foreign body reaction Is characteristic of giant cells. Glass being the foreign object initiates an inflammatory response in this condition.

      Mast cells are involved in allergic reactions.

      Eosinophils are characteristic of a parasitic infection and allergic inflammatory process but are not due to foreign bodies.

      Plasma cells are typical of chronic inflammation.

      Lymphocytes are involved in viral infections.

      Macrophages combine together to form giant cells.

    • This question is part of the following fields:

      • Inflammation & Immunology
      • Pathology
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  • Question 58 - Investigations in a 40-year old gentleman with splenomegaly reveal the following: haemoglobin 21.5...

    Incorrect

    • Investigations in a 40-year old gentleman with splenomegaly reveal the following: haemoglobin 21.5 g/dl, haematocrit 66%, mean corpuscular volume (MCV) 86 fl, mean cell haemoglobin concentration 34 g/dl, mean corpuscular haemoglobin 34.5 pg, platelet count 450 × 109/l, and white blood cell count 12 × 109/l, with 81% polymorphonuclear leukocytes, 4% bands, 3% monocytes, and 7% lymphocytes.

      What is the likely diagnosis?

      Your Answer:

      Correct Answer: Polycythaemia vera

      Explanation:

      The markedly increased haematocrit, along with thrombocytosis and the leucocytosis suggest a myeloproliferative disorder.

      Polycythaemia vera is the commonest myeloproliferative disorders occurring more often in males (about 1.4 to 1). The mean age at diagnosis is 60 years (range 15–90 years) with 5% of patients below 40 years at onset. It involves increased production of all cell lines, including red blood cells (independent of erythropoietin), white blood cells and platelets. If confined only to red blood cells, it is known as ‘primary erythrocytosis’. There is an increase in blood volume and hyperviscosity occurs, predisposing to thrombosis. Increased bleeding occurs due to abnormal functioning of platelets. Patients become hypermetabolic, and increased cell turnover leads to hyperuricaemia.

      Usually asymptomatic, occasionally symptoms include weakness, pruritus, headache, light-headedness, visual disturbances, fatigue and dyspnoea. Face appears red with engorged retinal veins. Lower extremities appear red and painful, along with digital ischaemia (erythromelalgia). Hepatomegaly is common and massive splenomegaly is seen in 75% patients. Thrombosis can lead to stroke, deep venous thrombosis, myocardial infarction, retinal artery or vein occlusion, splenic infarction (often with a friction rub) or Budd–Chiari syndrome. Gastrointestinal bleeding is seen in 10-20% patients. Hypermetabolism can lead to low-grade fevers and weight loss. Late features include complications of hyperuricaemia (e.g. gout, renal calculi). 1.5% to 10% cases transform to acute leukaemia.

    • This question is part of the following fields:

      • Haematology
      • Pathology
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  • Question 59 - The absence of which of the following components characterizes the grey platelet syndrome...

    Incorrect

    • The absence of which of the following components characterizes the grey platelet syndrome (GPS)?

      Your Answer:

      Correct Answer: Alpha granules

      Explanation:

      Grey platelet syndrome (GPS) is a rare inherited bleeding disorder associated with an almost total absence of α-granules and their contents. The syndrome is characterised by thrombocytopenia, enlarged platelets that have a grey appearance, myelofibrosis, and splenomegaly. Alpha granules store proteins and growth factors that promote platelet adhesiveness and wound healing. Patients with GPS develop symptoms and signs such as easy bruising, prolonged bleeding, and nose bleeds.

    • This question is part of the following fields:

      • Haematology
      • Pathology
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  • Question 60 - Leukotrienes normally function during an asthma attack and work to sustain inflammation. Which...

    Incorrect

    • Leukotrienes normally function during an asthma attack and work to sustain inflammation. Which of the following enzymes would inhibit their synthesis?

      Your Answer:

      Correct Answer: 5-lipoxygenase

      Explanation:

      Leukotrienes are produced from arachidonic acid with the help of the enzyme 5-lipoxygenase. This takes place in the eosinophils, mast cells, neutrophils, monocytes and basophils. They are eicosanoid lipid mediators and take part in allergic and asthmatic attacks. They are both autocrine as well as paracrine signalling molecules to regulate the body’s response and include: LTA4, LTB4, LTC4, LTD4, LTE4 and LTF4.

    • This question is part of the following fields:

      • Inflammation & Immunology
      • Pathology
      0
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Inflammation & Immunology (1/1) 100%
Pathology (1/1) 100%
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