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Haematology SBAs
- 1. SBAs
- 2. 1. A 22-year-old man presents with fever, sweating, particularly at night, pruritus and weight loss. O/E: palpable, painless cervical lymph nodes and no skin manifestations. The most appropriate investigation would be:- a) FBC b) Lymph Node Biopsy c) Chest Radiograph d) CT scan of the neck and mediastinum e) Mantoux Test
- 3. 1. A 22-year-old man presents with fever, sweating, particularly at night, pruritus and weight loss. O/E: palpable, painless cervical lymph nodes and no skin manifestations. The most appropriate investigation would be:- a) FBC b) Lymph Node Biopsy c) Chest Radiograph d) CT scan of the neck and mediastinum e) Mantoux Test
- 4. 2. 20 year old woman presents with recurrent epistaxis. She has a past history of heavy periods. Her BP is 90/60 and pulse 100. There are bruises of different ages over her extremities but not splenomegaly. Test results are as follows: WCC: 83 x 10 9 / L Hb: 11.5 g/dL(11.5 – 16) Platelets: 129 x 10 9 / L (150-400) Prolonged Bleeding Time ANA -ve a) HIV b) SLE c) ITP d) TTP e) Sickle Cell Disease
- 5. 2. 20 year old woman presents with recurrent epistaxis. She has a past history of heavy periods. Her BP is 90/60 and pulse 100. There are bruises of different ages over her extremities but not splenomegaly. Test results are as follows: WCC: 83 x 10 9 / L Hb: 11.5 g/dL Platelets: 149 x 10 9 / L Prolonged Bleeding Time ANA -ve a) HIV b) SLE c) ITP d) TTP e) Sickle Cell Disease
- 6. 3. 25-year-old woman presents with a single, non-tender, enlarged cervical lymph node. She also complains of fever and night sweats. Lymph node biopsy reveals infiltration with histiocytes and lymphocytes and presence of cells with bilobed mirror-image nuclei. The most likely diagnosis is:- a) Non-Hodgkin’s lymphoma b) Hodkin’s lymphoma c) Sarcoidosis d) Acute Lymphoblastic Leukemia (ALL) e) TB
- 7. 3. 25-year-old woman presents with a single, non-tender, enlarged cervical lymph node. She also complains of fever and night sweats. Lymph node biopsy reveals infiltration with histiocytes and lymphocytes and presence of cells with bilobed mirror-image nuclei. The most likely diagnosis is:- a) Non-Hodgkin’s lymphoma b) Hodkin’s lymphoma c) Sarcoidosis d) Acute Lymphoblastic Leukemia (ALL) e) TB
- 9. 4. 60-year-old man postgastrectomy presents with macrocytic anaemia. Drinks alcohol regularly. Most like cause for his anaemia is:- a) Coeliac Disease b) Pernicious Anaemia c) Iron Deficiency d) Vit B12 Deficiency e) Thalassaemia
- 10. 4. 60-year-old man postgastrectomy presents with macrocytic anaemia. Drinks alcohol regularly. Most like cause for his anaemia is:- a) Coeliac Disease b) Pernicious Anaemia c) Iron Deficiency d) Vit B12 Deficiency e) Thalassaemia
- 11. 5. A 30-year-old man gives a history of a sore throat with fever followed by 6 weeks of malaise. On physical examination he has mildly tender generalized lymphadenopathy. A cervical lymph node biopsy is performed and on microscopic examination shows prominent germinal centers in follicles with a diffuse polyclonal hyperplasia composed of lymphocytes, plasma cells, and macrophages. Which of the following is the most likely diagnosis? a) Lymphocytic Lymphoma b) Hodgkins Lymphoma c) Infectious Mononucleosis d) HIV Infection e) Brucellosis
- 12. 5. A 30-year-old man gives a history of a sore throat with fever followed by 6 weeks of malaise. On physical examination he has mildly tender generalized lymphadenopathy. A cervical lymph node biopsy is performed and on microscopic examination shows prominent germinal centers in follicles with a diffuse polyclonal hyperplasia composed of lymphocytes, plasma cells, and macrophages. Which of the following is the most likely diagnosis? a) Lymphocytic Lymphoma b) Hodgkins Lymphoma c) Infectious Mononucleosis d) HIV Infection e) Brucellosis
- 14. 6. 30-year-old man has had a progressively worsening productive cough for one month. On physical examination, a few small non- tender lymph nodes are palpable in the axillae, and the tip of the spleen is palpable. Hb 10.2 g/dl, Hct 31.1% MCV 90 fL, WBC count 67 x 10 9 / L Platelet count 36 x 10 9 / L. Microscopic examination of his peripheral blood smear shows many blasts with Auer rods. Which of the following is the most likely diagnosis? A) Leukemoid reaction B) Acute myelogenous leukemia C) Chronic lymphocytic leukemia D) Acute lymphoblastic leukemia E) Leukoerythroblastosis
- 15. 6. 30-year-old man has had a progressively worsening productive cough for one month. On physical examination, a few small non-tender lymph nodes are palpable in the axillae, and the tip of the spleen is palpable. Hb 10.2 g/dl, Hct 31.1% MCV 90 fL, WBC count 67 x 10 9 / L Platelet count 36 x 10 9 / L. Microscopic examination of his peripheral blood smear shows many blasts with Auer rods. Which of the following is the most likely diagnosis? A) Leukemoid reaction B) Acute myelogenous leukemia C) Chronic lymphocytic leukemia D) Acute lymphoblastic leukemia E) Leukoerythroblastosis
- 17. A B Describe?
- 18. Questions?
Notas del editor
- Recurrent Bleeding = Platelet disorder? Vascular Disorder? Clotting Disorder. Platelet and Vascular: Easy bruising and purpura. Clotting: Delayed bleeding into joints and muscle. Vascular: Congenital: Ehlers Danlos Acquired: Steroid Use, Infection (meningococcus, measles, dengue fever), Henoch Schonlein Purpura Platelet: Decreased marrow production: aplastic anaemia Increased destruction: ITP – causes: idiopathic, SLE, heparin - - - - NO SPLENOMEGALY ITP runs a 2 week course in children. Self limiting. Can be recurrent in adults. If platelets less than 20 / L. Prednislone can be used If this fails - Splenectomy can help in upto 80% of cases. Why not platelet transfusion?? Auto-antibodies will destroy them too. Coagulation: Haemophilias….Factor VIII deficiency in Haemophilia A. (X-linked recessive) 1 in 10000 Crippling arthropathy haemotomas in muscle INCREASED APTT ( Intrinsic System) Desmopressin Treatment. Also: Vit K malabsorption and Liver disease. TTP is a sextet of symptoms: Fever, Fluctuating CNS Signs (seizures, decreased consciousness), MicroAngiopathic Haemolytic Anaemia (intravascular haemolysis due to fibrin deposition -> schistocyte formation and anaemia) with jaundice, Decreased Platelets, Kidney Failure, Haematuria/Proteinuria. Causes are often unknown: some drugs: clopidegrel, ciclosporin, pregnancy, HIV, SLE. Acquired or Genetic defect of cleaving multimers of vWF. Large vWF molecules causes platelet aggregation and firbin deposition. inhibition of the enzyme ADAMTS13, (prothrombin time = PT = Extrinsic System) = INR. VII deficiency and Vit K deficiency work up.
- The WBC's seen here are "atypical" lymphocytes. They are atypical because they are larger (more cytoplasm) and have nucleoli in their nuclei. The cytoplasm tends to be indented by surrounding RBC's. Such atypical lymphocytes are often associated with infectious mononucleosis. Also leukemia, lymphoma and viral diseases:L CMV Toxo.
- Though a pronounced left shift can be seen with a leukemoid reaction, blasts should not be seen. The high WBC count with the blasts and Auer rods are very characteristic for an acute myelogenous leukemia. CLL is a disease of older adults, and the leukemic cells resemble small mature lymphocytes. ALL is typically a disease of young children, and the lymphoblasts do not have Auer rods or cytoplasmic granules positive for myeloperoxidase. Leukoerythroblastosis - There is a left shift and nucleated RBCs with leukoerythroblastosis, but not blasts.
- Though a pronounced left shift can be seen with a leukemoid reaction, blasts should not be seen. The high WBC count with the blasts and Auer rods are very characteristic for an acute myelogenous leukemia. CLL is a disease of older adults, and the leukemic cells resemble small mature lymphocytes. ALL is typically a disease of young children, and the lymphoblasts do not have Auer rods or cytoplasmic granules positive for myeloperoxidase. Leukoerythroblastosis - There is a left shift and nucleated RBCs with leukoerythroblastosis, but not blasts.
- Auer Rod
- AHematopoietic elements in this bone marrow biopsy are markedly reduced. This is a case of aplastic anemia. Of course, besides, RBC's the platelets and granulocytes will often be diminished. Sometimes a drug or toxin is the cause and sometimes infection. When no known cause can be found, it is termed idiopathic aplastic anemia OCHM: most cases are autoimmune: caused by drugsm irradition and viruses (parvovirus B19!) Fanconi’s Anaemia is the hereditary version. Gold, penicillamine, chloramphenicol. B: In contrast to aplastic anemia, leukemia results in a highly cellular marrow. The marrow between the pink bone trabeculae seen here is nearly 100% cellular, and it consists of leukemic cells of acute lymphocytic leukemia (ALL) that have virtually replaced or suppressed normal hematopoiesis. Thus, though the marrow is quite cellular, there can be peripheral cytopenias. This explains the complications of infection (lack of normal leukocytes), hemorrhage (lack of platelets), and anemia (lack of red blood cells) that often appear with leukemia.