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Question 1
Incorrect
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A 15-year-old boy is brought to the clinic with fever, cough, sore throat and bleeding gums. He has also noticed a rash on his legs. The coryzal symptoms started 3 weeks ago before which he was fit and well. He is currently not taking any medication and denies smoking, alcohol and using other illicit drugs. Examination reveals a pale child with bilateral subconjunctival haemorrhages, erythematous throat and some petechiae on his legs. there are no sign of lymphadenopathy or hepatosplenomegaly. investigations are as follows: Hb8.9 g/dlMCV: 110 flWBC: 2 x 109/lNeutrophils: 0.3 x 109/lLymphocytes:1.5 x 109/lPLT: 13 x 109/lReticulocytes: 30 x 109/l (normal range 20-100 x 109/l)Coagulation screen: normal. Bone marrow: hypoplastic. A urine dipstick reveals trace of blood in the urine. What is the patient most likely suffering from?
Your Answer: Meningococcal septicaemia
Correct Answer: Aplastic anaemia
Explanation:Aplastic anaemia causes a deficiency of all blood cell types: red blood cells, white blood cells, and platelets. It is more frequent in people in their teens and twenties, but is also common among the elderly. It can be caused by heredity, immune disease, or exposure to chemicals, drugs, or radiation. However, in about one-half of cases, the cause is unknown.The definitive diagnosis is by bone marrow biopsy| normal bone marrow has 30–70% blood stem cells, but in aplastic anaemia, these cells are mostly gone and replaced by fat.First-line treatment for aplastic anaemia consists of immunosuppressive drugs, typically either anti-lymphocyte globulin or anti-thymocyte globulin, combined with corticosteroids, chemotherapy and ciclosporin. Hematopoietic stem cell transplantation is also used, especially for patients under 30 years of age with a related matched marrow donor.
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This question is part of the following fields:
- Haematology And Oncology
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Question 2
Correct
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A 15-year-old male presents complaining of gradually increasing fatigue. He says that he turned vegan a year ago. He explains that he takes vitamin B12 supplements every day. Considering iron deficiency anaemia as a possible cause, you order some blood tests to confirm. Which of the following would increase the ability of the body to absorb dietary iron?
Your Answer: Consuming iron in its ferrous (Fe2+) form
Explanation:Consuming iron in its Fe2+ (ferrous form) form can improve the ability to absorb dietary iron in patients with iron deficiency anaemia (IDA). Clinical features of IDA include:- Koilonychia- Atrophic glossitis- Post-cricoid webs- Angular stomatitisThe peripheral blood smear shows the following abnormal RBC morphologies:- Target cells- Pencil poikilocytes- Microcytic-hypochromic cells
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This question is part of the following fields:
- Haematology And Oncology
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Question 3
Incorrect
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An 8-year-old boy who recently migrated from Nigeria was seen in A&E department with a six-week history of progressive swelling of his jaw, fever, night sweats, and weight loss. His mother reported an episode of sore throat in the past which was treated with antibiotics, but he developed a rash subsequently. Other than that, there was no other significant past medical history. On examination, a painless, nontender 4x3cm mass was found that was fixed and hard. The only other examination finding of note was rubbery symmetrical cervical lymphadenopathy.Which of the following translocation would most likely be found on biopsy karyotyping?
Your Answer: t(14|18)
Correct Answer: t(8|14)
Explanation:Burkitt lymphoma is associated with the c-myc gene translocation, usually t(8|14). Burkitt lymphoma is a rare high-grade non-Hodgkin lymphoma endemic to west Africa and the mosquito belt. It has a close association with the contraction of Epstein-Barr virus (EBV). Burkitt lymphoma often presents with symmetrical painless lymphadenopathy, systemic B symptoms (fever, sweats, and weight loss), central nervous system involvement, and bone marrow infiltration. Classically in the textbooks, the patient also develops a large jaw tumour.Other aforementioned options are ruled out because:1. t(9|22)—Chronic myeloid leukaemia2. t(15|17)—Acute promyelocytic leukaemia3. t(14|18)—Follicular Lymphoma4. t(11|14)—Mantle Cell Lymphoma
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This question is part of the following fields:
- Haematology And Oncology
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Question 4
Correct
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A 4 year old boy presented with bruises on bilateral buttocks and thighs. His mother denied any history of trauma. The boy had a sore throat a few weeks ago. What is the most appropriate management of this patient?
Your Answer: Coagulation profile
Explanation:This history is suggestive of Henoch-Schönlein Purpura following a respiratory infection. A typical rash involving thighs and buttocks is often seen in this age group. Coagulation profile is the suitable answer from the given answers.
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This question is part of the following fields:
- Haematology And Oncology
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Question 5
Incorrect
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A 6 month old infant has developed jaundice from breast milk. He is otherwise healthy with no signs of dehydration. His LFTs will most likely show which of the following pattern?
Your Answer: Total bilirubin: 500, conjugated bilirubin >85%
Correct Answer:
Explanation:Breast milk jaundice is a type of jaundice associated with breast-feeding. It typically occurs one week after birth. The condition can sometimes last up to 12 weeks, but it rarely causes complications in healthy, breast-fed infants. The exact cause of breast milk jaundice isn’t known. However, it may be linked to a substance in the breast milk that prevents certain proteins in the infant’s liver from breaking down bilirubin. The condition may also run in families. Breast milk jaundice is rare, affecting less than 3 percent of infants. When it does occur, it usually doesn’t cause any problems and eventually goes away on its own. It’s safe to continue breast-feeding.
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This question is part of the following fields:
- Haematology And Oncology
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Question 6
Incorrect
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A child with jaundice and pale stools would most likely be evaluated by which of the following tests?
Your Answer:
Correct Answer: US
Explanation:Blood tests do not help in the diagnosis of jaundice except of course by telling the level of jaundice (bilirubin) and providing some corroborative evidence such as autoantibodies, tumour markers or viral titres in the case of hepatitis. Classifying causes of jaundice on the basis of ultrasound provides a quick and easy schema for diagnosing jaundice which is applicable in primary care as well as hospital based practice.
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This question is part of the following fields:
- Haematology And Oncology
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Question 7
Incorrect
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A 11-year-old boy is referred to you following his seventh course of antibiotics in the last six years for lower respiratory tract infections. He also has a history of eczema for which he is currently on a topical steroid cream. His full blood count (FBC) report shows:Hb: 13.9 g/dLPlts: 65 x 10^9/LWCC: 12.3 x 10^9/LWhich of the following genes should you expect an abnormality in?
Your Answer:
Correct Answer: WASP
Explanation:The combination of frequent infections, eczema, and thrombocytopaenia are characteristic of Wiskott-Aldrich syndrome, which is due to an abnormality in the WASP gene. It is an X-linked recessive disorder that causes primary immunodeficiency owing to a combined B- and T-cell dysfunction.The other listed options are:1. PKD1: polycystic kidney disease2. CFTR: cystic fibrosis3. HFE1: haemochromatosis4. RET: multiple endocrine neoplasia, Hirschsprung’s disease
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This question is part of the following fields:
- Haematology And Oncology
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Question 8
Incorrect
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A 6 year old child underwent an emergency splenectomy following trauma. After full recovery he is dismissed from the hospital and returns home. On re-examination, eight weeks later, the GP performs a full blood count with a film. What would you expect to see?
Your Answer:
Correct Answer: Howell-Jolly bodies
Explanation:Howell-Jolly bodies are often seen in post-splenectomy cases, together with Pappenheimer bodies, target cells and irregular contracted red blood cells. The loss of splenic tissue results in the inability to readily remove immature or abnormal red blood cells from the circulation.
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This question is part of the following fields:
- Haematology And Oncology
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Question 9
Incorrect
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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.
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This question is part of the following fields:
- Haematology And Oncology
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Question 10
Incorrect
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What is the average lifespan of an erythrocyte once it has entered the bloodstream?
Your Answer:
Correct Answer: 120 days
Explanation:Red blood cells (RBC) have a life span of 120 days in humans.Aging of RBC includes changes in many properties: decreased metabolic activity, morphological alterations, including decreased cell volume and changes in cell shape, and quantitative and qualitative modulations of the surface.
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This question is part of the following fields:
- Haematology And Oncology
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SESSION STATS - PERFORMANCE PER SPECIALTY
