Multiple Choice Questions for Haematology and Core Medical Trainees

Barbara J. Bain

• Publisher: Wiley-Blackwell
• Year: 2016
• ISBN:
  9781119210535
• Edition: 1
• Topic: Medicina
• Subtopic: Hematología

Written to help haematology and general medical trainees evaluate their own knowledge, and particularly useful for those preparing for the Part 1 examination of the Royal College of Pathologists. This exam-centered book will also be of use to core medical trainees preparing for the examinations of the Royal College of Physicians and the Royal Australasian College of Physicians and to haematology and general medicine trainees in other countries where methods of examination are similar.

The 150 questions are presented in two formats, Single Best Answer and Extended Matching Question, and comes complete with detailed feedback and, when appropriate, relevant references are given for each question so that those who select the wrong answer will understand why another answer is better.

• Quick reference question book, ideal for examination preparation
• Includes 50 SBA questions, ideal for the Part 1 and Part 2 MRCP examinations, which although having a general medical slant, are also appropriate for haematology specialist trainees
• Includes 70SBA multiple choice questions appropriate for haematology specialist trainees but also useful to core medical trainees
• Includes 30EMQs suitable for those taking Part 1 of the FRCPath examination
• Questions come complete with fully referenced answers and discussion points

This book provides an educational tool for training as well as an ideal way to prepare for examinations and is also of value to those who examine in haematology and haematopathology.

Section 1
Single Best Answers Questions 1–50

This section comprises 50 Single Best Answer (SBA) questions. They are divided into questions 1–31, which are more relevant to the part 1 MRCP examination and questions 32–50, which are more relevant to the part 2 MRCP examination. Although having a general medical slant, these questions are also appropriate for haematology specialist trainees. Normal ranges are given in parentheses. Answers and feedback will be found on pages 101–123.

MRCP part 1 level

SBA 1

A 69-year-old Afro-Caribbean woman is referred to rheumatology outpatients because of painful joints and morning stiffness. She is found to have a minor degree of lymphadenopathy and her spleen is tipped on inspiration. An FBC shows WBC 98 × 10⁹/l, Hb 83 g/l, platelet count 221 × 10⁹/l, neutrophils 7.2 × 10⁹/l and lymphocytes 91 × 10⁹/l. Her blood film shows mature small lymphocytes with scanty cytoplasm, round nuclei and coarsely clumped chromatin. Smear cells are present. Rheumatoid factor is detected and her erythrocyte sedimentation rate (ESR) is 54 mm in 1 h (<20).

The most likely diagnosis is:

1. Adult T-cell leukaemia/lymphoma
2. Chronic lymphocytic leukaemia
3. Follicular lymphoma in leukaemic phase
4. Mantle cell lymphoma
5. Reactive lymphocytosis

SBA 2

A 69-year-old man who has received repeated courses of chemotherapy and chemo-immunotherapy for refractory mantle cell lymphoma presents with the gradual onset of cognitive impairment, dysphasia and dyspraxia. On lumbar puncture, pressure is normal, there is a slight increase in protein concentration, cell count is not increased and glucose is normal. Magnetic resonance imaging (MRI) of the brain shows multiple high intensity signals on T2-weighted and FLAIR sequences affecting mainly the white matter.

The most likely organism implicated is:

1. BK virus
2. Herpes simplex
3. JC virus
4. Treponema pallidum
5. Varicella-zoster virus

SBA 3

A 49-year-old woman is admitted to the intensive care ward with septic shock. Her FBC shows WBC 18 × 10⁹/l, Hb 83 g/l, platelet count 150 × 10⁹/l, neutrophils 17.2 × 10⁹/l and lymphocytes 0.5 × 10⁹/l. Her blood film shows toxic granulation and left shift.

The appropriate haemoglobin threshold for blood transfusion in this patient would be:

1. 60 g/l
2. 70 g/l
3. 80 g/l
4. 90 g/l
5. 100 g/l

SBA 4

A 23-year-old woman is hospitalised with severe anorexia nervosa. Her FBC shows WBC 3.5 × 10⁹/l, neutrophil count 1.1 × 10⁹/l, Hb 100 g/l, MCV 104 fl and platelet count 70 × 10⁹/l. Blood film shows occasional acanthocytes. Neutrophils show normal segmentation. Her prothrombin time (PT) is slightly increased.

The most likely diagnosis is:

1. Aplastic anaemia
2. Folic acid deficiency
3. Haematological features of anorexia nervosa
4. Hepatic steatosis
5. Vitamin B₁₂ deficiency

SBA 5

A 60-year-old Cypriot woman is referred back to rheumatology outpatients as she has suffered a flare of her rheumatoid arthritis. Her FBC shows WBC 12.0 × 10⁹/l, RBC 3.62 × 10¹²/l, Hb 83 g/l, Hct 0.27 l/l, MCV 74 fl, MCHC 310 g/l, platelet count 441 × 10⁹/l and neutrophils 9.2 × 10⁹/l. Her blood film shows increased rouleaux formation and the ESR is 65 mm in 1 h (<20). Serum ferritin is 47 µg/l (14–200), serum iron is 6 µmol/l (11–28) and total iron binding capacity 65 µmol/l (45–75).

The most likely explanation of the microcytic anaemia is:

1. α thalassaemia trait
2. Anaemia of chronic disease
3. Anaemia of chronic disease plus iron deficiency
4. β thalassaemia trait
5. Iron deficiency

SBA 6

A 60-year-old Caucasian man presents with a history of fatigue, nausea, abdominal discomfort, altered bowel function, insomnia, anxiety and altered taste. He is a self-employed painter and decorator with a past history of a coronary artery bypass and is taking atorvastatin. His FBC shows WBC 7.8 × 10⁹/l, Hb 105 g/l, Hct 0.30 l/l, MCV 79 fl, MCH 27.6 pg, MCHC 350 g/l, red cell distribution width (RDW) 15% (9.5–15.5), platelet count 403 × 10⁹/l and reticulocyte count 120 × 10⁹/l. His blood film shows anisocytosis, polychromasia, basophilic stippling and occasional nucleated red blood cells and myelocytes. A bone marrow aspirate shows dyserythropoiesis with abnormal sideroblasts including 3% ring sideroblasts.

The most likely diagnosis is:

1. Lead poisoning
2. Myelodysplastic syndrome (refractory anaemia)
3. Myelodysplastic syndrome (refractory anaemia with ring side...