Haematology paper 1 Past Papers — Past Paper OmpathStudy

Haematology Paper 1 — Examination Collection Complete transcription of six examination papers (24 questions) from all 13 source pages. The source contains no answer key, so answers have not been invented. Tuesday 20 March 2018 1. General Haematology You are asked by a surgical colleague for your opinion on a 23yr old lady who has been admitted with abdominal pain, but was noted to have Haemoglobin 90g/L, elevated LDH of 600U/L and low haptoglobin. a) Write a differential diagnosis as a list. Outline your investigation plan with justification for each test that you suggest. (12.5 marks) b) A diagnosis of Paroxysmal Nocturnal Haemoglobinuria (PNH) is established - outline your management plan of this lady. (12.5 marks) 2. Transfusion Medicine A 33 year old woman is admitted with symptoms of abdominal pain and confusion. Full blood count shows Haemoglobin 90g/L, white blood cell count 11 x 109/L and platelet count 6 x 109/L. Red cell fragments are noted on blood film. Lactate Dehydrogenase (LDH) is 1200U/L. Blood group is A RhD negative. A provisional diagnosis of Thrombotic Thrombocytopenic Purpura (TTP) is made and the patient is referred for plasma exchange following placement of central line. a) Discuss the management of blood product support for this patient. (12.5 marks) b) Prepare an information leaflet for patients requiring plasma exchange (12.5 marks) …/questions continue over 3. Haematological Oncology A 60 year old man presents with drowsiness, nosebleeds, headaches and blurred vision. On examination he has retinal haemorrhages, 4 fingerbreadths of splenomegaly and extensive 1-2 cm lymphadenopathy. Blood count shows Haemoglobin 78 g/L, platelets 76 x109/L, and white blood cell count 1.5 x 109/L. His serum total protein is elevated, and total IgM is raised at 28 g/L with a paraprotein demonstrated on serum electrophoresis. A bone marrow trephine biopsy reveals dense infiltration with lymphoplasmacytoid lymphocytes. a) What is the diagnosis? What further investigations are required to identify the cause of his presenting symptoms and clarify the underlying problem? Indicate the appropriate initial management of the patient (7 marks) b) With appropriate initial management, his symptoms improve significantly. What options for systemic anti-cancer treatment would you offer him to treat the underlying condition? Describe what aims of treatment and potential adverse effects you would discuss with the patient in order to gain written informed consent for the proposed treatment (9 marks) c) He responds well to first line chemotherapy and achieves a remission. 12 months later he represents with renewed nosebleeds and a significant rise in the IgM paraprotein. What is the appropriate management at this stage? Are there any molecular genetic tests that might guide your choice of therapy? (9 marks) 4. Haemostasis and Thrombosis You are asked for advice on a 70 year old woman with a platelet count of 45 x 109/L who had undergone coronary artery bypass graft surgery 6 days previously. Full blood count and coagulation screen (prothrombin time and activated partial thromboplastin time) are otherwise normal. The blood film confirms the thrombocytopenia is genuine with no other abnormalities seen and review indicates that the preoperative platelet count was normal. a) Discuss the differential diagnosis and any further history you will obtain to help establish the diagnosis (7 marks) b) Outline the pathophysiological basis of heparin induced thrombocytopenia (HIT). Discuss the laboratory tests used to investigate suspected cases of HIT and how the findings of these may be interpreted in its diagnosis (12 marks) c) Outline the anticoagulation options available for the treatment of HIT including the duration of treatment and describe any factors that may influence your choice of treatment. (6 marks) Haematology First Paper Tuesday 26th September 2017 1. Haemostasis and thrombosis A 28 year old woman presents for the first time to antenatal clinic at approximately 34 weeks gestation. Her haemoglobin, white cell count, and differential are normal but platelet count is 58 x 109/l. The blood film confirms genuine thrombocytopenia. You are asked to see her by the obstetrics team. a) Detail the history, examination and investigation you would perform to establish the differential diagnosis. b) Outline the differential diagnosis in an otherwise completely well patient c) Outline the management of the mother and baby for a diagnosis in this case of ITP 2. Haemato-oncology A 64 year old man describes 6 months of fatigue, loss of appetite, sweating and weight loss. On examination he has 3 finger breadths of splenomegaly and palpable liver edge. His FBC is: Haemoglobin 110 g/L, white cell count 20 X 109/L (neutrophils 15.3 basophils 0.3), platelets 110 x 109/L. Blood film examination reveals a leucoerythroblastic picture with numerous tear drop poikilocytes. Blasts account for <1% of circulating white blood cells and there are gia