A 39 year old man presents with a three month history of lethargy, fatigue and night sweats. On examination you note enlarged, painless cervical lymph nodes and splenomegaly. Blood tests show Hb 103 g/l (normal 135-180g/l), WCC 12.0 (normal 3.4-11), ESR 70 (<12). Histologically multinucleated giant cells (Reed-Sternberg cells) are noted. What is the most likely cause of this patient’s symptoms?
A Burkitt’s Lymphoma
B Hodgkin’s Lymphoma
C Chronic Myeloid Leukemia
D Non-Hodgkin’s Lymphoma
E Tuberculosis
A 58 year old man has been admitted to the general medical ward with abdominal pain and fluctuating consciousness. On examination he has shifting dullness and is scleral icterus. A social history has been taken and he has been started on a reducing regime of chlordiazepoxide. Blood tests have been undertaken, which show: Hb 92 g/l (normal 135-180), MCV 130fl (80-102fl), platelet count 145 (140-450). What is the most likely cause for this patient’s anaemia?
A Autoimmune pernicious anaemia
B Malabsorption causing folate deficiency
C Iron deficiency anaemia
D Anaemia of chronic disease
E Chronic excess alcohol
A 4 year old boy came to clinic to have bloods taken for a check-up following a recent stay in hospital with a chest infection. However, following venepuncture, his mother has noticed that he bled for quite some time. On examination you also notice multiple petechiae on his legs, without any history of significant trauma, other than the usual bumps one would associate with a child. Mum remembers that her brother had the same problem when he was young, but she hasn’t seen him for a long time. Blood tests show PT 12 seconds (normal 11-14), APTT 55 seconds (normal 29-39) & fibrinogen 2.2g/l (normal 1.9-4.3). Von Willebrand factor is normal. Factor VIII assay is reduced, whilst factor IX is normal. What is the most likely cause of the above presentation?
A Non Accidental Injury
B Ehlers-Danlos syndrome
C Von Willebrand Disease
D Haemophilia A
E Haemophilia B
A 22 year old female has presented with persistent fatigue. She is frustrated as her GP ‘keeps putting this down to depression’. She has not lost any weight and has not had any feverish symptoms. She remembers having a sore throat that wouldn’t go away a few months ago, but nothing since. On examination, you note cervical lymphadenopathy and mild splenomegaly. Her full blood count comes back as: Hb 120g/l (normal 115-165g/l), WCC 6.0 (normal 3.9-5.6), platelet count 310 (normal 140-450). What is the most appropriate next investigation to undertake?
A Monospot test
B LFTs
C Peripheral blood smear
D Bone marrow aspiration
E CMV IgG
A 25 year old male presents with progressive fatigue and splenomegaly. His WCC is 110 (normal 3.4-11.0). Bone marrow aspiration and biopsy diagnoses Chronic Myeloid leukaemia. Cytogenetic treatment is being considered. Which of the following investigations would be most useful in determining likely susceptibility to treatment?
A Leukocyte alkaline phosphatase test
B Lactate dehydrogenase
D FISH studies
E HLA typing for patient and family members
A 68 year old man has presented with progressive shortness of breath, fatigue and worsening pain in his left leg and back. He has lost 2 stone of weight in the past year. On his last appointment it was noted that his renal function was deranged. Routine bloods show Hb 104g/l (normal 135-180), MCV 93fl (normal 80-102fl), WCC 2.8 (normal 3.4-11.0). Which of the following investigations would be most useful initially in finding the source of his symptoms?
A Abdominal ultrasound
B Lumbar spine X ray
C Blood film
D Urine electrophoresis (Bence Jones protein)
E DEXA
A 7 year old girl has presented with petechiae on her knees and shins and frequent nosebleeds. She had a viral infection 2 weeks ago from which she apparently recovered. She appears clinically well in herself, with no temperatures. She has no joint pain. PT, APTT, vW factor, factor VIII and factor IX are all normal. Her platelets are 100 (140-450). What is the most likely cause of these findings?
A Meningococcal septicaemia
B Henoch-Schonlein purpura
C Idiopathic thrombocytopenic purpura
D Von Willebrand’s disease
E Non Accidental Injury
A four year old boy presents to the GP surgery with his mother. He has been feeling unwell for the past 3 weeks, with fevers, headaches and tiredness. His mother is concerned that he has been getting worse over time instead of better. He looks very pale and has many bruises and petechiae on his arms and legs, which have appeared spontaneously over the past week. Abdominal examination reveals an enlarged liver and spleen. An urgent full blood count shows: haemoglobin 68g/L (normal 120-180), platelets 25 (normal 150-450), white cell count 83 (normal 3.4-11.0). What is the most likely diagnosis in this child?
A. Acute lymphoblastic leukaemia
B. Aplastic anaemia
C. Epstein-Barr virus
D. Idiopathic thrombocytopenic purpura
E. Lymphoma
