Multiple Choice Questions for Haematology and Core Medical Trainees E-Book

Barbara J. Bain

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Sprache: Englisch

Seitenzahl: 251

Veröffentlichungsjahr: 2016

Beschreibung

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 70 SBA multiple choice questions appropriate for haematology specialist trainees but also useful to core medical trainees * Includes 30 EMQs 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.

Leseprobe

Contents

Cover

Title Page

Copyright

Preface

Normal Ranges and Abbreviations

Section 1: Single Best Answers Questions 1–50

SBA 1

SBA 2

SBA 3

SBA 4

SBA 5

SBA 6

SBA 7

SBA 8

SBA 9

SBA 10

SBA 11

SBA 12

SBA 13

SBA 14

SBA 15

SBA 16

SBA 17

SBA 18

SBA 19

SBA 20

SBA 21

SBA 22

SBA 23

SBA 24

SBA 25

SBA 26

SBA 27

SBA 28

SBA 29

SBA 30

SBA 31

SBA 32

SBA 33

SBA 34

SBA 35

SBA 36

SBA 37

SBA 38

SBA 39

SBA 40

SBA 41

SBA 42

SBA 43

SBA 44

SBA 45

SBA 46

SBA 47

SBA 48

SBA 49

SBA 50

Section 2: Single Best Answers Questions 51–120

SBA 51

SBA 52

SBA 53

SBA 54

SBA 55

SBA 56

SBA 57

SBA 58

SBA 59

SBA 60

SBA 61

SBA 62

SBA 63

SBA 64

SBA 65

SBA 66

SBA 67

SBA 68

SBA 69

SBA 70

SBA 71

SBA 72

SBA 73

SBA 74

SBA 75

SBA 76

SBA 77

SBA 78

SBA 79

SBA 80

SBA 81

SBA 82

SBA 83

SBA 84

SBA 85

SBA 86

SBA 87

SBA 88

SBA 89

SBA 90

SBA 91

SBA 92

SBA 93

SBA 94

SBA 95

SBA 96

SBA 97

SBA 98

SBA 99

SBA 100

SBA 101

SBA 102

SBA 103

SBA 104

SBA 105

SBA 106

SBA 107

SBA 108

SBA 109

SBA 110

SBA 111

SBA 112

SBA 113

SBA 114

SBA 115

SBA 116

SBA 117

SBA 118

SBA 119

SBA 120

Section 3: Extended Matching Questions 1–30

EMQ 1

EMQ 2

EMQ 3

EMQ 4

EMQ 5

EMQ 6

EMQ 7

EMQ 8

EMQ 9

EMQ 10

EMQ 11

EMQ 12

EMQ 13

EMQ 14

EMQ 15

EMQ 16

EMQ 17

EMQ 18

EMQ 19

EMQ 20

EMQ 21

EMQ 22

EMQ 23

EMQ 24

EMQ 25

EMQ 26

EMQ 27

EMQ 28

EMQ 29

EMQ 30

Section 4: Single Best Answers Answers to Questions 1–120 with Feedback

SBA 1 b Chronic Lymphocytic Leukaemia.

SBA 2 c JC Virus.

SBA 3 b 70 g/l.

SBA 4 c Haematological Features of Anorexia Nervosa.

SBA 5 c Anaemia of Chronic Disease Plus Iron Deficiency.

SBA 6 a Lead Poisoning.

SBA 7 d Plegmasia Caerulea Dolens.

SBA 8 e Ig (Immunoglobulin) A Anti-Tissue Transglutaminase Antibodies.

SBA 9 e Human Immunodeficiency Virus.

SBA 10 b Hepatitis B.

SBA 11 d Hereditary Haemorrhagic Telangiectasia.

SBA 12 e Streptococcus Pneumonia.

SBA 13 e Sinusoidal Obstruction Syndrome.

SBA 14 b Acute Myeloid Leukaemia, Breast Cancer, Hypothyroidism and Coronary Artery Disease.

SBA 15 c She should Take Supplementary Folic Acid.

SBA 16 a Anaemia.

SBA 17 d Wilson's Disease.

SBA 18 e Pure Red Cell Aplasia.

SBA 19 d Henoch–Schönlein Purpura.

SBA 20 b ESR Greater than 40 mm in 1 h.

SBA 21 e Lupus Anticoagulant.

SBA 22 e Vitamin B12 Deficiency.

SBA 23 b β Thalassaemia.

SBA 24 e The Haemoglobin A1c is Likely to be Misleadingly Reduced.

SBA 25 e Vitamin K Malabsorption.

SBA 26 a An Apparently Healthy 70-Year-Old Woman.

SBA 27 b Dengue Fever.

SBA 28 d Schistosomiasis.

SBA 29 d Malaria.

SBA 30 c Anaemia of Chronic Disease.

SBA 31 b Acute Myeloid Leukaemia.

SBA 32 b Intrinsic Factor Antibodies.

SBA 33 c Hypoparathyroidism.

SBA 34 e Primary Myelofibrosis.

SBA 35 d Sickle Cell-Related Intrahepatic Cholestasis.

SBA 36 a Atypical Haemolytic Uraemic Syndrome (aHUS).

SBA 37 d Rasburicase.

SBA 38 a Measure D Dimer.

SBA 39 c Cholesterol Embolisation.

SBA 40 b Fluid Restriction.

SBA 41 b Intravenous Fluids 3 l/m2/d Plus Allopurinol.

SBA 42 e Temporal Artery Biopsy Followed by Prednisolone in a Dose of 40–60 mg Daily.

SBA 43 d Molecular Analysis for JAK2 Mutation.

SBA 44 b Computed Tomography Pulmonary Angiogram.

SBA 45 c Serum Tryptase.

SBA 46 e Warfarin or Non-Vitamin K Antagonist Oral Anticoagulant.

SBA 47 d Rivaroxaban is Relevant and She is Likely to be Fully Anticoagulated.

SBA 48 b Four-Factor Prothrombin Complex Plus Vitamin K.

SBA 49 d Factor XI Deficiency

SBA 50 b No Specific Treatment

SBA 51 d Sézary Syndrome.

SBA 52 b Imatinib 200–300 mg Daily.

SBA 53 b Combination Chemotherapy Followed by Involved Field Radiotherapy.

SBA 54 e Molecular Analysis for a JAK2 Exon 12 Mutation.

SBA 55 a Acquired von Willebrand Disease.

SBA 56 e The Eculizumab Therapy is Unmasking C3 Binding to Red Cells.

SBA 57 d Transfusion of Blood Intended for Another Patient.

SBA 58 a Arrange Molecular Analysis for a CALR Mutation and BCR-ABL1.

SBA 59 d Top-Up Transfusion to Achieve an Hb of 100 g/l.

SBA 60 d Ruxolitinib.

SBA 61 c Juvenile Myelomonocytic Leukaemia.

SBA 62 d Horse Antithymocyte Globulin Plus Ciclosporin.

SBA 63 a Autoimmune Lymphoproliferative Syndrome.

SBA 64 a Blastic Plasmacytoid Dendritic Cell Neoplasm

SBA 65 a Adult T-Cell Leukaemia/Lymphoma.

SBA 66 e Von Willebrand Factor-Containing Plasma-Derived Concentrate.

SBA 67 a B-Cell Lymphoma, Unclassifiable, with Features Intermediate between Diffuse Large B-Cell Lymphoma and Burkitt Lymphoma.

SBA 68 d Rituximab.

SBA 69 c Doxycycline.

SBA 70 a Clusters of CD34-Positive Cells in Biopsy Sections

SBA 71 e Therapy-Related Myeloid Neoplasm.

SBA 72 e Recombinant Factor VIIa OR Activated Prothrombin Complex, Followed by Cyclophosphamide and Corticosteroids.

SBA 73 c Plasma Exchange Followed by Eculizumab.

SBA 74 e Withholding the Second Dose of Desmopressin and no Encouragement of Fluid Intake.

SBA 75 b Chronic Eosinophilic Leukaemia with PDGFRB Rearrangement.

SBA 76 b Ibrutinib.

SBA 77 b Acute Promyelocytic Leukaemia

SBA 78 a Arrange Magnetic Resonance Imaging

SBA 79 a Continuation of Allopurinol.

SBA 80 e Solvent Detergent-Treated Fresh Frozen Plasma.

SBA 81 d Reduced-Intensity Treatment.

SBA 82 b Aspirin Plus Low Molecular Weight Heparin.

SBA 83 c Clostridium Perfringens Sepsis.

SBA 84 d A Normal Thrombin Time.

SBA 85 e Rearrangement of MYC.

SBA 86 e Oral Corticosteroids.

SBA 87 b CD1a

SBA 88 e Iron-Refractory Iron Deficiency Anaemia.

SBA 89 c Phlebotomy to Normalise Iron Stores.

SBA 90 a Cautious Paracentesis and Defibrotide.

SBA 91 e Is Increased Leading to Impaired Release of Iron from Macrophages and Reduced Delivery of Iron into the Plasma by Enterocytes.

SBA 92 b High Dose Methotrexate Followed by Dose-Intensive Consolidation Chemotherapy

SBA 93 b Chromogenic Assay for Anti-Thrombin Activity.

SBA 94 a Copper Deficiency.

SBA 95 d Heterozygosity for Either β Thalassaemia or Haemoglobin S.

SBA 96 b Haemopoietic Stem Cell Transplantation.

SBA 97 b Danazol.

SBA 98 b DNA Analysis for α0 Thalassaemia.

SBA 99 c β Thalassaemia Heterozygosity.

SBA 100 a Intrinsic Factor Antibodies.

SBA 101 c Less than 5 Days Old, CMV-Negative, Taken into Citrate-Phosphate-Dextrose (CPD), Irradiated.

SBA 102 d POEMS Syndrome.

SBA 103 b Aspirin, Venesection and Hydroxycarbamide.

SBA 104 c Observation.

SBA 105 b Normal for Age.

SBA 106 c Intravenous Methylene Blue.

SBA 107 c Commencement of Argatroban and Administration of Vitamin K.

SBA 108 a Compound Heterozygosity for β0 Thalassaemia and δβ Thalassaemia.

SBA 109 c Continue Warfarin at the Same Dose as Long as the INR is in the Therapeutic Range.

SBA 110 b Herpes Zoster.

SBA 111 d Haemoglobin D-Punjab Trait.

SBA 112 e Ruxolitinib.

SBA 113 e Rituximab in a Dose of 375 mg/m2 Weekly for 4 Weeks.

SBA 114 c Hyperdiploidy.

SBA 115 e Hereditary Xerocytosis.

SBA 116 a BCR-ABL1.

SBA 117 e Intensive Combination Chemotherapy Plus Rituximab Plus HAART.

SBA 118 d This Variant Haemoglobin can Interact Adversely with Haemoglobin S and β Thalassaemia.

SBA 119 e Neutrophilic Leukaemoid Reaction.

SBA 120 d Persistent Polyclonal B Lymphocytosis.

Section 5: Extended Matching Questions Answers and Feedback

EMQ 1

EMQ 2

EMQ 3

EMQ 4

EMQ 5

EMQ 6

EMQ 7

EMQ 8

EMQ 9

EMQ 10

EMQ 11

EMQ 12

EMQ 13

EMQ 14

EMQ 15

EMQ 16

EMQ 17

EMQ 18

EMQ 19

EMQ 20

EMQ 21

EMQ 22

EMQ 23

EMQ 24

EMQ 25

EMQ 26

EMQ 27

EMQ 28

EMQ 29

EMQ 30

Index

End User License Agreement

Guide

Cover

Table of Contents

Begin Reading

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Multiple Choice Questions for Haematology and Core Medical Trainees

Barbara J. Bain

MB BS, FRACP, FRCPathProfessor in Diagnostic Haematology,Imperial College London and Honorary Consultant Haematologist,St Mary's Hospital, Praed Street, London.

This edition first published 2016 © 2016 by John Wiley & Sons Ltd.

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The contents of this work are intended to further general scientific research, understanding, and discussion only and are not intended and should not be relied upon as recommending or promoting a specific method, diagnosis, or treatment by health science practitioners for any particular patient. The publisher and the author make no representations or warranties with respect to the accuracy or completeness of the contents of this work and specifically disclaim all warranties, including without limitation any implied warranties of fitness for a particular purpose. In view of ongoing research, equipment modifications, changes in governmental regulations, and the constant flow of information relating to the use of medicines, equipment, and devices, the reader is urged to review and evaluate the information provided in the package insert or instructions for each medicine, equipment, or device for, among other things, any changes in the instructions or indication of usage and for added warnings and precautions. Readers should consult with a specialist where appropriate. The fact that an organization or Website is referred to in this work as a citation and/or a potential source of further information does not mean that the author or the publisher endorses the information the organization or Website may provide or recommendations it may make. Further, readers should be aware that Internet Websites listed in this work may have changed or disappeared between when this work was written and when it is read. No warranty may be created or extended by any promotional statements for this work. Neither the publisher nor the author shall be liable for any damages arising herefrom.

Library of Congress Cataloging-in-Publication Data

Names: Bain, Barbara J., author.

Title: Multiple choice questions for haematology and core medical trainees / Barbara J. Bain.

Other titles: Multiple choice questions and extending matching questions for haematology and core medical trainees

Description: Chichester, West Sussex, UK ; Ames, Iowa : John Wiley & Sons, Inc., [2016] | Includes bibliographical references and index.

Identifiers: LCCN 2015044915 (print) | LCCN 2015047076 (ebook) | ISBN 9781119210528 (pbk.) | ISBN 9781119210559 (pdf) | ISBN 9781119210535 (epub)

Subjects: | MESH: Hematologic Diseases—Examination Questions. | Blood Physiological Phenomena—Examination Questions.

Classification: LCC RC633 (print) | LCC RC633 (ebook) | NLM WH 18.2 | DDC 616.1/50076—dc23LC record available at http://lccn.loc.gov/2015044915

A catalogue record for this book is available from the British Library.

Wiley also publishes its books in a variety of electronic formats. Some content that appears in print may not be available in electronic books.

Set in 9/11.5pt MeridienLTStd-Roman by Thomson Digital, Noida, India

1 2016

This title is also available as an e-book. For more details, please seewww.wiley.com/buy/9781119210528or scan this QR code:

Preface

This book has been written to help haematology trainees preparing for the part 1 examination of the Royal College of Pathologists. It 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. There is a considerable paediatric content so the book will also be useful to those preparing for examination of the Royal College of Paediatrics and Child Health. The two formats that are most used by these Royal Colleges have been used, Single Best Answer and Extended Matching Question. 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 preferred. Because of the detailed feedback and because some of the questions are quite searching, the book is an educational tool as well as a way to prepare for examinations. It will thus be of value also to advanced trainees including those preparing for the part 2 RCPath examination. Since the book incorporates much recent knowledge it may well also be of use to consultant haematologists wanting to update themselves as well as to those who are involved in training and examining.

Barbara J. Bain, 2016

Normal Ranges and Abbreviations

Core abbreviations and normal ranges

Standard abbreviations (not defined in text) and normal ranges for the full blood count (FBC) in Caucasian adults are shown in this table. Normal ranges for children and for other tests are given in relation to the individual cases when necessary.

Males

Females

Units

White blood cell count (WBC)

3.7–7.9

3.9–11.1

× 10

9

/l

Red blood cell count (RBC)

4.32–5.66

3.88–4.99

× 10

12

/l

Haemoglobin concentration (Hb)

133–167

118–148

g/l

Haematocrit (Hct)

0.39–0.50

0.36–0.44

l/l

Mean cell volume (MCV)

82–98

fl

Mean cell haemoglobin (MCH)

27.3–32.6

pg

Mean cell haemoglobin concentration (MCHC)

316–349

g/l

Neutrophils

1.7–6.1

1.7–7.5

× 10

9

/l

Lymphocytes

1.0–3.2

× 10

9

/l

Monocytes

0.2–0.6

× 10

9

/l

Eosinophils

0.03–0.06

× 10

9

/l

Basophils

0.02–0.29

× 10

9

/l

Platelets

143–332

169–358

× 10

9

/l

Other abbreviations

aHUS

atypical haemolytic uraemic syndrome

ABVD

doxorubicin, bleomycin, vinblastine, dacarbazine

ADAMTS13

a disintegrin and metalloproteinase with a thrombospondin type 1 motif, member 13

AIDS

acquired immune deficiency syndrome

ALL

acute lymphoblastic leukaemia

AML

acute myeloid leukaemia

APTT

activated partial thromboplastin time

ATLL

adult T-cell leukaemia/lymphoma

BEACOPP

bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, prednisone

C

complement

CD

cluster of differentiation

CHOP

cyclophosphamide, doxorubicin, vincristine, prednisolone

CLL

chronic lymphocytic leukaemia

CT

computed tomography

DNA

deoxyribonucleic acid

DVT

deep vein thrombosis

ESR

erythrocyte sedimentation rate

G6PD

glucose-6-phosphate dehydrogenase

HIT

heparin-induced thrombocytopenia

HIV

human immunodeficiency virus

HPLC

high performance liquid chromatography

Ig

immunoglobulin

INR

international normalised ratio

LDH

lactate dehydrogenase

MALT

mucosa-associated lymphoid tissue

MRI

magnetic resonance imaging

NK

natural killer

NRBC

nucleated red blood cells

PET

positron emission tomography

PNH

paroxysmal nocturnal haemoglobinuria

PT

prothrombin time

R-CHOP

rituximab + CHOP

RDW

red cell distribution width

RiCoF

ristocetin co-factor

RNA

ribonucleic acid

SLE

systemic lupus erythematosus

TdT

terminal deoxynucleotidyl transferase

TTP

thrombotic thrombocytopenic purpura

VWF

von Willebrand factor

Section 1Single 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:

Adult T-cell leukaemia/lymphoma

Chronic lymphocytic leukaemia

Follicular lymphoma in leukaemic phase

Mantle cell lymphoma

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:

BK virus

Herpes simplex

JC virus

Treponema pallidum

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:

60 g/l

70 g/l

80 g/l

90 g/l

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:

Aplastic anaemia

Folic acid deficiency

Haematological features of anorexia nervosa

Hepatic steatosis

Vitamin B

12

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:

α

thalassaemia trait

Anaemia of chronic disease

Anaemia of chronic disease plus iron deficiency

β

thalassaemia trait

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:

Lead poisoning

Myelodysplastic syndrome (refractory anaemia)

Myelodysplastic syndrome (refractory anaemia with ring sideroblasts)

Pyrimidine 5

´

nucleotidase deficiency

Zinc deficiency

SBA 7

A 57-year-old man with a history of hypercholesterolaemia, heart failure and atrial fibrillation is on warfarin with a satisfactory international normalised ratio (INR). He presents with the sudden onset of marked swelling of the left leg and thigh with pain in his foot and calf. Within a short period of time, the distal foot become purplish blue and cold with no palpable pulses in the leg.

The most likely diagnosis is:

Embolisation from the left atrium

Femoral artery thrombosis

Plegmasia alba dolens

Plegmasia caerulea dolens

Worsening heart failure

SBA 8

A 32-year-old woman with a history of irritable bowel syndrome is found to have iron deficiency anaemia and a serum folate of 1 µg/l (2–11). Her serum vitamin B12 is normal. Her diet is assessed as nutritionally adequate, although she says she has to ‘watch what she eats'.

The test you would do next is:

Antibodies to deamidated gliadin peptide

Antiendomysial antibodies

Antiendomysial antibodies, making sure that the patient is first on a gluten-free diet

Duodenal biopsy

Ig (immunoglobulin) A anti-tissue transglutaminase antibodies

SBA 9

A 23-year-old African man who presents with an epileptiform convulsion and fever is found to have a microangiopathic haemolytic anaemia, thrombocytopenia and acute kidney injury.

The micro-organism you would test for is:

Escherichia coli

O104:H4

Escherichia coli

O157:H7

Hepatitis B

Human herpesvirus 8

Human immunodeficiency virus

SBA 10

An 18-year-old medical student is permitted to perform an unsupervised venepuncture on a febrile Indian patient and suffers a needle prick injury. He is anxious that he may have contracted human immunodeficiency virus (HIV) infection.

Assuming that the patient is infected, transmission is most likely for:

Dengue fever

Hepatitis B

Hepatitis C

Human immunodeficiency virus (HIV)

Leishmaniasis

SBA 11

A 39-year-old woman presents with haemoptysis and is found to have a pulmonary arteriovenous malformation. She is also noted to be pale and to have telangiectasia of the lips and tongue. There are no other abnormal physical findings. A full blood count shows WBC 7.2 × 109/l, RBC 3.10 × 1012/l, Hb 70 g/l, Hct 0.23 l/l, MCV 75.6 fl, MCH 23.8 pg, MCHC 315 g/l and platelet count 221 × 109/l.

The most likely underlying diagnosis is:

Acquired von Willebrand disease

Advanced liver disease

CREST variant of scleroderma (calcinosis, Raynaud phenomenon, (o)esophageal dysmotility, sclerodactyly, telangiectasia)

Hereditary haemorrhagic telangiectasia

Heyde syndrome

SBA 12

A 29-year-old man suffered a road traffic accident in West Africa and required a splenectomy. A few weeks after his return to the UK he presents with chills, fever, myalgia and vomiting. He is found to be hypotensive with no localising signs. His FBC shows WBC 18 × 109/l, Hb 177 g/l, platelet count 98 × 109/l, neutrophils 17.2 × 109/l and lymphocytes 0.6 × 109/l. His blood film shows toxic granulation and left shift. No malaria parasites are seen on thick film examination. A coagulation screen shows a prolonged activated partial thromboplastin time (APTT) and increased D dimers.

The lost likely cause of the fever is infection by:

Capnocytophaga canimorsus

Haemophilus influenza

type b

Neisseria meningitidis

Plasmodium falciparum

Streptococcus pneumonia

SBA 13

A 52-year-old man with poor prognosis acute myeloid leukaemia achieves a complete remission with daunorubicin and cytarabine. He then receives an allogeneic haemopoietic stem cell transplant from a matched unrelated donor after conditioning with busulphan and cyclophosphamide. He receives methotrexate and tacrolimus for graft-versus-host disease prophylaxis. A week after transplantation he complains of abdominal pain and is found to have a tender liver, weight gain, oedema and ascites. His bilirubin has risen to 35 µmol/l (<17) and alanine aminotransferase is twice the upper limit of normal. Creatinine has risen to 132 µmol/l (60–125).

The most likely diagnosis is:

Graft-versus-host disease

Hepatorenal syndrome

Inferior vena cava thrombosis

Methotrexate toxicity

Sinusoidal obstruction syndrome

SBA 14

A 30-year-old woman is referred to medical outpatients with suspected hypothyroidism. On reviewing her clinical history it is found that she was treated abroad for Hodgkin lymphoma at the age of 16 years with mantle radiotherapy and combination chemotherapy (doxorubicin, bleomycin, vinblastine and dacarbazine).

The long term morbidity of the treatment administered to this patient includes a significantly increased rate of:

Acute lymphoblastic and acute myeloid leukaemia

Acute myeloid leukaemia, breast cancer, hypothyroidism and coronary artery disease

Bladder cancer

Breast and ovarian cancer

Hypothyroidism

SBA 15

A 29-year-old Caucasian woman who is seen in outpatients for review of the management of her coeliac disease mentions that she has been trying to get pregnant for some time. She has previously been deficient in both folic acid and iron but her blood count is now normal

You advise her that when trying to get pregnant:

She does not need any dietary supplements

She should take supplementary ferrous sulphate

She should take supplementary folic acid

She should take supplementary pyridoxine

She should take supplementary vitamin B

12

SBA 16

A 43-year-old woman presents with sudden onset of blurred vision in both eyes. She is tired and has suffered from recurrent aphthous ulcers. Ophthalmological examination shows multiple bilateral retinal haemorrhages without exudates; optic discs appeared normal. Visual acuity is reduced. FBC shows Hb 48 g/l, MCV 119 fl, WBC 6.1 × 109/l and platelet count 86 × 109/l. The blood film showed macrocytes, oval macrocytes and hypersegmented neutrophils.

The most likely cause of the retinal haemorrhages is:

Anaemia

Impaired platelet function

Raised intracranial pressure

Malignant hypertension

Thrombocytopenia

SBA 17

A 31-year-old Caucasian woman had been known to have elevated transaminases for several years but this had not been followed up. She is teetotal. She presents in liver failure and is found to have an Hb of 74 g/l and a reticulocyte count of 270 × 109/l (50–100). A blood film shows irregularly contracted cells, polychromasia and nucleated red blood cells. A Heinz body preparation is positive.

The most likely diagnosis is:

Autoimmune haemolytic anaemia

Exposure to an exogenous oxidant

Glucose-6-phosphate dehydrogenase (G6PD) deficiency

Wilson's disease

Zieve's syndrome

SBA 18

A 23-year-old Afro-Caribbean woman presents with symptoms of anaemia. She has also suffered from swollen painful joints. Her FBC shows WBC 4.5 × 109/l, Hb 53 g/l, MCV 93 fl, reticulocyte count 5 × 109