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  • Question 1 - Regarding acute lymphoblastic leukaemia (ALL), which of the following statements is CORRECT: ...

    Correct

    • Regarding acute lymphoblastic leukaemia (ALL), which of the following statements is CORRECT:

      Your Answer: 75% of cases occur before the age of 6 years.

      Explanation:

      Acute lymphoblastic leukaemia (ALL) is caused by an accumulation of lymphoblasts in the bone marrow and is the most common malignancy of childhood. The incidence of ALL is highest at 3 – 7 years, with 75% of cases occurring before the age of 6. 85% of cases are of B-cell lineage. Haematological investigations reveal a normochromic normocytic anaemia with thrombocytopenia in most cases. There is great variation in the chance of individual patients achieving a long-term cure based on a number of biological variables. Approximately 25% of children relapse after first-line therapy and need further treatment but overall 90% of children can expect to be cured. The cure rate in adults drops significantly to less than 5% over the age of 70 years.

    • This question is part of the following fields:

      • Haematology
      • Pathology
      8
      Seconds

  • Question 2 - The blood test reports of a 56-year-old female are sent for your review....

    Correct

    • The blood test reports of a 56-year-old female are sent for your review. She seems acutely sick and has had multiple infections over the past few months. Her complete blood count report shows neutropenia.

      Which one of the following options is true with regards to neutropenia?

      Your Answer: It can be caused by both radiotherapy and chemotherapy

      Explanation:

      A total neutrophil count of less than 2 x 109/L is defined as neutropenia. It can be caused by the following:
      1. viral infections
      2. SLE
      3. RA
      4. hypersplenism
      5. chemo- and radiotherapy
      6. vitamin B12 and folate deficiency
      7. drug reactions

    • This question is part of the following fields:

      • Haematology
      • Pathology
      18.2
      Seconds

  • Question 3 - Haemophilia B results from a deficiency in: ...

    Correct

    • Haemophilia B results from a deficiency in:

      Your Answer: Factor IX

      Explanation:

      Haemophilia B is a bleeding disorder caused by a deficiency of clotting factor IX. It is the second commonest form of haemophilia, and is rarer than haemophilia A. Haemophilia B tends to be similar to haemophilia A but less severe. The two disorders can only be distinguished by specific coagulation factor assays.

      The incidence is one-fifth of that of haemophilia A. Laboratory findings demonstrate prolonged APTT, normal PT and low factor IX.
      Haemophilia B inherited in an X-linked recessive fashion, affecting males born to carrier mothers.
      There is also a variation called Leyden, in which factor IX levels are below 1% until puberty, when they rise, potentially reaching as high as 40-60% of normal. This is thought to be due to the effects of testosterone at puberty.

    • This question is part of the following fields:

      • Haematology
      • Pathology
      3.2
      Seconds

  • Question 4 - The most common type of adult leukaemia is chronic lymphocytic leukaemia (CLL). It...

    Incorrect

    • The most common type of adult leukaemia is chronic lymphocytic leukaemia (CLL). It develops as a result of lymphocyte clonal proliferation. Which of the following statements about CLL is CORRECT?

      Your Answer: A predominance of immature lymphocytes are seen on the blood film

      Correct Answer: It is most commonly discovered as an incidental finding

      Explanation:

      CLL (chronic lymphocytic leukaemia) is the most common type of chronic lymphoid leukaemia, with a peak incidence between the ages of 60 and 80. It is the most common type of leukaemia in Europe and the United States, but it is less common elsewhere.

      The CLL tumour cell is a mature B-cell with low immunoglobulin surface expression (IgM or IgD). The average age at diagnosis is 72 years, with only 15% of cases occurring before the age of 50.

      The male-to-female ratio is about 2:1. Over 80% of cases are identified by the results of a routine blood test, which is usually performed for another reason.

      Lymphocytic anaemia, thrombocytopenia, and normochromic normocytic anaemia are common laboratory findings. Aspiration of bone marrow reveals up to 95% lymphocytic replacement of normal marrow elements.

    • This question is part of the following fields:

      • Haematology
      • Pathology
      10.1
      Seconds

  • Question 5 - A 66-year-old female presents to the Emergency Department with a nose bleed. She...

    Incorrect

    • A 66-year-old female presents to the Emergency Department with a nose bleed. She says that she has been having frequent episodes of nose bleeds over the past four months, along with increasing fatigue and some weight loss. On examination, she has a diffuse petechial rash and hypertrophy of the gingiva.

      Which one of the following conditions is this patient most likely to have?

      Your Answer: Chronic lymphocytic leukaemia (CLL)

      Correct Answer: Acute myeloid leukaemia (AML)

      Explanation:

      The history of nosebleeds and fatigue, and gingival hyperplasia presents a typical picture of acute myeloid leukaemia. Leukemic infiltrates within the gingiva cause hypertrophy and distinguish this condition from other types of leukaemia. The fatigue is secondary to anaemia, while the nosebleeds are caused by thrombocytopenia secondary to leukemic infiltration of bone marrow. Patients may also report frequent infections secondary to neutropenia and hepatosplenomegaly.

    • This question is part of the following fields:

      • Haematology
      • Pathology
      11.3
      Seconds

  • Question 6 - Which of the following is NOT a heritable risk factor for venous thrombosis:...

    Correct

    • Which of the following is NOT a heritable risk factor for venous thrombosis:

      Your Answer: Von Willebrand disease

      Explanation:

      Approximately one-third of patients who suffer DVT or PE have an identifiable heritable risk factor, although additional risk factors are usually present when they develop the thrombosis. The history of a spontaneous DVT in a close relative increases an individual’s risk of DVT even if no known genetic predisposition can be identified.

    • This question is part of the following fields:

      • Haematology
      • Pathology
      5.6
      Seconds

  • Question 7 - The most common cause of anaemia worldwide is which of the following? ...

    Correct

    • The most common cause of anaemia worldwide is which of the following?

      Your Answer: Iron deficiency anaemia

      Explanation:

      The most common cause of microcytic anaemia and of any anaemia worldwide is iron deficiency anaemia.

    • This question is part of the following fields:

      • Haematology
      • Pathology
      2.1
      Seconds

  • Question 8 - How does abciximab mediate its antiplatelet effect: ...

    Correct

    • How does abciximab mediate its antiplatelet effect:

      Your Answer: It is a GPIIb/IIIa inhibitor.

      Explanation:

      Abciximab, eptifibatide and tirofiban are GPIIb/IIIa inhibitors, inhibiting platelet aggregation by preventing the binding of fibrinogen, von Willebrand factor and other adhesive molecules.

    • This question is part of the following fields:

      • Haematology
      • Pathology
      1.8
      Seconds

  • Question 9 - A 23-year-old male is referred to your haematology clinic after an acute attack...

    Correct

    • A 23-year-old male is referred to your haematology clinic after an acute attack of haemolytic anaemia. He was diagnosed with glucose-6-phosphate dehydrogenase deficiency ten years ago.

      Which ONE of the following options is FALSE with regards to this disorder?

      Your Answer: Acute haemolysis can be triggered by cephalosporin antibiotics

      Explanation:

      Glucose-6-phosphate dehydrogenase deficiency is an X-linked recessive disorder in which there is a deficiency of the enzyme G6PD. This causes instability of red blood cell membranes under oxidative stress leading to haemolysis.

      Triggers include:
      1) Fava beans
      2) Sulphonamides
      3) Primaquine
      4) Anti-TB drugs
      5) Infections

      Most individuals will be asymptomatic until exposed to one of the triggers listed above. It is the commonest human enzyme defect and affects males more than females because of the X-linked inheritance pattern. The use of penicillins and cephalosporins is generally safe.

    • This question is part of the following fields:

      • Haematology
      • Pathology
      6.5
      Seconds

  • Question 10 - A 78-year-old man complains of lumps in his neck. Several large, non-tender cervical...

    Correct

    • A 78-year-old man complains of lumps in his neck. Several large, non-tender cervical lymph nodes are discovered during your examination.

      You arrange for some blood tests, and the results reveal that he has lymphocytosis with a count of 16 x 10 9 /l.

      In this case, what is the most likely diagnosis?

      Your Answer: Chronic lymphocytic leukaemia

      Explanation:

      The most common type of adult leukaemia is chronic lymphocytic leukaemia (CLL). It develops as a result of relatively mature lymphocytes clonally proliferating. The B-cell lineage accounts for approximately 95% of cases. CLL is primarily a disease of adult men, with men over the age of 50 accounting for more than 75% of CLL patients.

      It is the most indolent form of chronic leukaemia, and it is frequently discovered by chance when blood counts are taken for other reasons, such as ‘well man’ screening tests. The patient may develop lymphadenopathy, hepatosplenomegaly, anaemia, and infections as the disease progresses.

      The following are examples of CLL laboratory findings:
      Clonal B cell lymphocytosis (diagnosed at greater than 5 x 109/l, but can reach 300 x 109/l)
      In advanced disease, normocytic, normochromic anaemia is present.

      Patients with autoimmune-related haemolytic anaemias have a positive direct antiglobulin test (DAT).

      Although bone marrow aspiration is not always required, it can aid in the diagnosis of CLL. If there has been rapid lymph node enlargement, a lymph node biopsy is required to rule out Richter’s syndrome. This is the transition from low-grade lymphoma to high-grade lymphoma, which is characterised by fever, weight loss, and pain.

      Although there is no cure for CLL, it can be managed with chemotherapy regimens that help patients live longer. Early treatment has no benefit, and the standard treatment for early disease is to watch and wait, with examinations and blood counts every 3 to 12 months. Chemotherapy is usually reserved for patients who have a disease that is active and causing symptoms.

      The following is the overall prognosis for CLL:
      1/3 will not require treatment and will live a long time.
      1/3 will go through an indolent phase before the disease progresses.
      1/3 of patients will have an aggressive disease that requires immediate treatment.

    • This question is part of the following fields:

      • Haematology
      • Pathology
      10.3
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Haematology (8/10) 80%
Pathology (8/10) 80%
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