0
[{"id":631338,"quiz_id":"30871","answer_id":null,"answerType_id":"0","created_at":"2018-11-29 12:17:51","updated_at":"2018-11-30 15:01:20","questionName":"Which of these is incorrect regarding Hodgkin lymphoma?","questionTimeSeconds":"0","questionTimeMinutes":"2","questionImagePath":null,"position":17,"explanation":"Diffuse large b-cell is the most common high grade\r\n\r\nHodgkin (a type of high grade)\r\n\u2022\tPeak in early 20s and peak in elderly (\u201cbimodal distribution\u201d)\r\n\u2022\tMost are cured (80% of stage 4)\r\n\u2022\tIdentified by Reed-Sternberg Cell on histology\r\n","question_score_id":null,"lang":"","questionAudioPath":null},{"id":631337,"quiz_id":"30871","answer_id":null,"answerType_id":"0","created_at":"2018-11-29 12:13:54","updated_at":"2018-11-30 15:01:20","questionName":"You see a patient in GP who has a presented with a 2 week history of a painful new lump in their neck and fevers. On examination you palpate a 1.1cm by 1.5cm lump underneath the patients jaw. What should be your next course of action?","questionTimeSeconds":"0","questionTimeMinutes":"2","questionImagePath":null,"position":16,"explanation":"This patient is presenting with a lymph node enlargement bigger than 1cm and a B symptom therefore you need to refer them.\r\n\r\nWhen to Refer:\r\n\u2022\tLymph node >1cm for >6 weeks (especially if supraclavicular)\r\no\tOr if new lump, or if B symptoms present (Weight loss >10% of body mass; Drenching night sweats (have to change bedding etc); Fever)\r\n\u2022\tGeneralised lymphadenopathy\r\no\t2+ non-contiguous areas\r\no\tCould be HIV but this is rare\r\n","question_score_id":null,"lang":"","questionAudioPath":null},{"id":631344,"quiz_id":"30871","answer_id":null,"answerType_id":"0","created_at":"2018-11-29 12:46:47","updated_at":"2018-11-30 15:01:20","questionName":"A 39-year-old man presented with a 4-week history of tiredness and weight loss. He also complained of flu like symptoms and sweats for 3 weeks. He presented to his GP with a temperature and bruising.\r\n \r\nHaemoglobin\t\t61 g\/L \t\t\t(130-180 g\/L) \r\nWBC \t\t\t103.5 x 109\/L \t\t(4.0-11.0) \r\nNeutrophil \t\t0.1 x 109\/L \t\t(1.5-7.0) \r\nBlasts \t\t\t100.9 x 109\/L \t\t(0-1)\r\nPlatelet count \t\t4 x109\/L \t\t(150-400) \r\n\r\nWhat is the most likely diagnosis?","questionTimeSeconds":"0","questionTimeMinutes":"2","questionImagePath":null,"position":23,"explanation":"Very high WCC with blasts = ACUTE LEUKAEMIA (AML) \u2013 acute promyelocytic leukemia (responsiveness to all-trans retinoic acid (ATRA; also known as tretinoin) therapy)","question_score_id":null,"lang":"","questionAudioPath":null},{"id":631347,"quiz_id":"30871","answer_id":null,"answerType_id":"0","created_at":"2018-11-29 13:00:51","updated_at":"2018-11-30 15:01:20","questionName":"52-year-old woman presented with drowsiness and confusion.\r\n \r\nHaemoglobin \t\t91 g\/L (130-180 g\/L)\r\nWBC \t\t\t5.6 x109\/L (4.0-11.0)\r\nNeutrophil \t\t3.2 x 109\/L (1.5-7.0) \r\nPlatelet count \t\t205 x 109\/L (150-400) \r\nBlood film\t\tRouleaux\r\nAdjusted calcium \t3.2 mmol\/L (2.20-2.60) \r\nUrea \t\t\t34 mmol\/L (2.5-7.0) \r\nCreatinine \t\t400 \u00b5mol\/L (60-110) \r\nTotal protein \t\t105 g\/L (61-76) \r\nAlbumin \t\t35 g\/L (37-49)\r\n\r\nWhat is the most likely diagnosis?","questionTimeSeconds":"0","questionTimeMinutes":"2","questionImagePath":null,"position":26,"explanation":"What is the most likely diagnosis?\r\n\u2022\tHigh total protein and low albumin\r\n\u2022\tHigh immunoglobulins\r\n\u2022\tCRAB \u2013 high calcium, renal failure, anaemia, lytic lesions of the bone\r\n\u2022\tSo she has cancer of plasma cells, or MULTIPLE MYELOMA \u2013 get lots of Ab produced (it\u2019s useless, but it clogs up kidneys)\r\n\u2022\tHigh risk of bone fractures (as it likes to live in the bone)\r\n\u2022\tShe has high calcium and is about to go into renal failure\r\n\r\nImmediate management.\r\n\u2022\tGive her hydration, stop any NSAIDs\r\n\u2022\tConsider steroids and bisphosphonates to bring the calcium down\r\n\u2022\tCheck paraprotein in the blood and Bence Jones proteins in the urine\r\n\u2022\tDon\u2019t transfuse (as not volume depleted, so can cause heart failure)\r\n","question_score_id":null,"lang":"","questionAudioPath":null},{"id":631342,"quiz_id":"30871","answer_id":null,"answerType_id":"0","created_at":"2018-11-29 12:37:36","updated_at":"2018-11-30 15:01:20","questionName":"You are trying to establish a diagnosis of lymphoma in a patient. You have already performed routine bloods including a monospot test and viral screen. You then performed a blood film. What would be the next best further investigation?","questionTimeSeconds":"0","questionTimeMinutes":"2","questionImagePath":null,"position":21,"explanation":"Answer = Excision node biopsy\r\n\r\n1. Tissue biopsy is required (NOT CYTOLOGY) \u2013 contact surgeons almost immediately\r\n\r\n\u2022\tFine Needle Aspiration (FNA) of cells is not adequate\r\no\tLymphoma is a change in the architecture of the tissue, rather than a change in individual cells\r\n\u2022\tBest way is excision node biopsy\r\n\u2022\tCore biopsies are possible, but don\u2019t always work \u2013 may need to repeat it, or do excision anyway\r\n\u2022\tInvolving an expert lymphoma pathologist is essential \u2013 get the right type and right treatment FAST\r\n\r\n\u2022\tCan see REED STERNBERG CELLS on histological slides (Hodgkin\u2019s)\r\no\tDiagnostic\r\no\tOwl eye nucleus\r\no\t90% of tumour is inflammatory reaction to this cell\r\n\r\n2. Immunohistochemistry\r\n\r\n\u2022\tAntigen assessment of CD20, to see how many B-cells there are\r\no\tLots = B-cell lymphoma\r\no\tCan therefore use rituximab (monoclonal antibody to CD20 cells)\r\n\r\n3. Fluorescence in situ hybridization (FISH)\r\n\u2022\tCan be diagnostic of some types of lymphoma, don\u2019t need to know what\r\n","question_score_id":null,"lang":"","questionAudioPath":null},{"id":631346,"quiz_id":"30871","answer_id":null,"answerType_id":"0","created_at":"2018-11-29 12:55:46","updated_at":"2018-11-30 15:01:20","questionName":"28-year-old woman presents with 6 month history of a dry cough, 5 kg in weight loss and itch but no rash. Clinical examination is normal. For CXR see photo. A biopsy report states that binucleate B-cells have been seen. What is the most likely diagnosis?","questionTimeSeconds":"0","questionTimeMinutes":"2","questionImagePath":"volume-1\/stage-4-csim2-blood-and-blood-disorders-quiz\/Case 14 CXR.png","position":25,"explanation":"\u2022\tCXR shows unilateral hilar lymphadenopathy\r\n\r\nWhat is the diagnosis? \r\n\u2022\tOn biopsy you see the classical REED-STERNBURG cell (binucleate B-cell) of HODGKIN\u2019S DISEASE\r\n\u2022\tShe has an 80-90% chance of being cured\r\n","question_score_id":null,"lang":"","questionAudioPath":null},{"id":631341,"quiz_id":"30871","answer_id":null,"answerType_id":"0","created_at":"2018-11-29 12:33:34","updated_at":"2018-11-30 15:01:20","questionName":"Which one of these would be an initial investigation when trying to establish a diagnosis of lymphoma?","questionTimeSeconds":"0","questionTimeMinutes":"2","questionImagePath":null,"position":20,"explanation":"Initial Investigations\r\n\u2022\tFBC, U+E, LFTs\r\no\tMay have some anaemia, but usually normal\r\n\u2022\tMonospot test (looking for EBV - reactive cause of lymphadenopathy)\r\n\u2022\tViral screen (HIV \u2013 as a risk factor or cause of generalised lymphadenopathy)","question_score_id":null,"lang":"","questionAudioPath":null},{"id":631476,"quiz_id":"30871","answer_id":null,"answerType_id":"0","created_at":"2018-11-29 16:41:12","updated_at":"2018-11-30 15:01:20","questionName":"A 23 year old vegetarian female presents to her GP with fatigue. She has 2 children aged 2 & 3 & since her last pregnancy she has suffered from very heavy menstrual bleeding. FBC revealed (see image). What is the most likely diagnosis? \r\n","questionTimeSeconds":"0","questionTimeMinutes":"2","questionImagePath":"volume-1\/stage-4-csim2-blood-and-blood-disorders-quiz\/Case 1 anaemia.png","position":27,"explanation":"","question_score_id":null,"lang":"","questionAudioPath":null},{"id":631336,"quiz_id":"30871","answer_id":null,"answerType_id":"0","created_at":"2018-11-29 11:58:58","updated_at":"2018-11-30 15:01:20","questionName":"Which is the commonest inherited bleeding disorder?","questionTimeSeconds":"0","questionTimeMinutes":"2","questionImagePath":null,"position":15,"explanation":"Von Willebrand Disease\r\n\t\r\n\u2022\tDisorder of WB factor, which\u2026\r\no\tBinds platelets to sites of vascular injury (bridging molecule) or in sites of high shear stress\r\no\tImportant in fibrin formation \u2013 binds and stabilises factor 8\r\n\r\n\u2022\tCommonest inherited bleeding disorder, but usually mild\r\n\u2022\tUsually dominant inheritance\r\n\r\nHaemophilia A \u2013 factor 8 deficiency\r\n\u2022\tX-linked (affects males only, females can be carriers)\r\n\u2022\tSeverity classified according to residual factor 8 activity \u2013 the higher the factor 8 level, the less severe the bleeding tendency (\u201cphenotype\u201d)\r\n\u2022\tThis is determined by the type of mutation\r\n\r\nHaemophilia B \u2013 factor 9 deficiency, \u201cChristmas Disease\u201d\r\n\u2022\t1\/5 as common as haemophilia A\r\n\u2022\tAlso X-linked\r\n\u2022\tSimilar presentation, clinical picture, and spectrum of severity\r\n\u2022\tTreatment is with factor 9 concentrate\r\n\r\n\u2022\tPlatelet function disorders (very rare!)\r\no\tGlanzmann thrombasthenia\r\no\tBernard-Soulier syndrome\r\n\r\n","question_score_id":null,"lang":"","questionAudioPath":null},{"id":631345,"quiz_id":"30871","answer_id":null,"answerType_id":"0","created_at":"2018-11-29 12:51:24","updated_at":"2018-11-30 15:01:20","questionName":"A 39-year-old man presented with a 4-week history of tiredness and weight loss. He also complained of flu like symptoms and sweats for 3 weeks. He presented to his GP with a temperature and bruising.\r\n \r\nHaemoglobin\t\t61 g\/L \t\t\t(130-180 g\/L) \r\nWBC \t\t\t103.5 x 109\/L \t\t(4.0-11.0) \r\nNeutrophil \t\t0.1 x 109\/L \t\t(1.5-7.0) \r\nBlasts \t\t\t100.9 x 109\/L \t\t(0-1)\r\nPlatelet count \t\t4 x109\/L \t\t(150-400) \r\n\r\nYou have a diagnosis for this patient - what should be offered to this patient before commencing treatment?","questionTimeSeconds":"0","questionTimeMinutes":"2","questionImagePath":null,"position":24,"explanation":"Patient has adult acute myeloid leukaemia.\r\n\r\nWhat treatments are available and what is the outlook for this patient?\r\n\u2022\tUse FFP and fibrinogen replacement to keep platelets over 50\r\n\u2022\tSave sperm\r\n\u2022\tChemotherapy\/bone marrow transplant\r\n\u2022\tAim to start definitive treatment within 24 hours\r\n\u2022\tIn younger patients, complete remission rates of at least 80% may be reached, with five-year overall survival about 40%.","question_score_id":null,"lang":"","questionAudioPath":null},{"id":631339,"quiz_id":"30871","answer_id":null,"answerType_id":"2","created_at":"2018-11-29 12:25:01","updated_at":"2018-11-30 15:01:20","questionName":"Match these types of lymphomas with the most appropriate description...","questionTimeSeconds":"0","questionTimeMinutes":"2","questionImagePath":null,"position":18,"explanation":"1. Follicular (most common low grade)\r\n\u2022\tCommon\r\n\u2022\tSlow growing, may be picked up incidentally\r\n\u2022\tUsually stage 4 at presentation (but still doesn\u2019t cause problems)\r\n\u2022\tOnly treat if they have symptoms (can\u2019t cure it)\r\no\tRituximab \u2013 Ab attaches to the B-cell, own immune system destroys it\r\n\r\n2. Diffuse large b-cell (most common high grade)\r\n\r\n3. Hodgkin (a type of high grade)\r\n\u2022\tPeak in early 20s and peak in elderly (\u201cbimodal distribution\u201d)\r\n\u2022\tMost are cured (80% of stage 4)\r\n\u2022\tIdentified by Reed-Sternberg Cell on histology\r\n\r\n4. Burkitt\u2019s (a type of non-Hodgkin\u2019s) \u2013 fastest growing, die within 24 hrs if you don\u2019t treat","question_score_id":null,"lang":"","questionAudioPath":null},{"id":631340,"quiz_id":"30871","answer_id":null,"answerType_id":"0","created_at":"2018-11-29 12:31:18","updated_at":"2018-11-30 15:01:20","questionName":"Which of these lymphomas is most serious and requires immediate treatment?","questionTimeSeconds":"0","questionTimeMinutes":"2","questionImagePath":null,"position":19,"explanation":"Burkitt\u2019s (a type of non-Hodgkin\u2019s) \u2013 fastest growing, die within 24 hrs if you don\u2019t treat","question_score_id":null,"lang":"","questionAudioPath":null},{"id":631343,"quiz_id":"30871","answer_id":null,"answerType_id":"0","created_at":"2018-11-29 12:41:10","updated_at":"2018-11-30 15:01:20","questionName":"A patient presents with a Hodgkin's lymphoma, they have a raise cervical lymph node and a palpable lymph node in their axilla, they also report 5kg of weight loss. Using the Ann Arbour staging, what stage of lymphoma does this patient have?","questionTimeSeconds":"0","questionTimeMinutes":"2","questionImagePath":null,"position":22,"explanation":"Ann Arbour Staging\r\no\tStage 1: one side, same side of diaphragm (1 lymph node area)\r\no\tStage 2: both sides, same side of diaphragm (2 lymph node areas)\r\no\tStage 3: crossed the diaphragm (lymph glands above and below diaphragm)\r\no\tStage 4: out of lymph node sites (e.g. affecting liver, gut, etc.)\r\n\r\no\tA: absence of B symptoms\r\no\tB: presence of fever, night sweats, weight loss\r\n","question_score_id":null,"lang":"","questionAudioPath":null},{"id":631477,"quiz_id":"30871","answer_id":null,"answerType_id":"0","created_at":"2018-11-29 16:42:59","updated_at":"2018-11-30 15:01:20","questionName":"6 month old boy presenting with lethargy and pallor and faltering growth. On examination, a new cardiac flow murmur is heard.\r\nYou take an FBC: \r\nHb- 56 (115-160)\r\nMCV - 72.1 (76-96)\r\nRed Cell Count-5.8 x 1012\/L (3.8-5.8)\r\nIncreased reticulocytes\r\n\r\nWhat is the most likely diagnosis?\r\n","questionTimeSeconds":"0","questionTimeMinutes":"2","questionImagePath":null,"position":28,"explanation":"An autosomal recessive disorder \r\nLeading to absence or dysfunction of alpha or beta globin chains.\r\n\r\nThis can lead to destruction of RBC membranes in the marrow.\r\nClinical presentation:\r\nCan present at any age (older = milder presentations)\r\nGives microcytic anaemia ( decreased Hb, MCV), increased reticulocytes, LFT derangements if severe","question_score_id":null,"lang":"","questionAudioPath":null},{"id":631479,"quiz_id":"30871","answer_id":null,"answerType_id":"0","created_at":"2018-11-29 16:46:04","updated_at":"2018-11-30 15:01:20","questionName":"32 year old man, presents to his GP with tingling in his hands and fingers. He has also been more tired than normal. \r\nAs a responsible GP you send off some blood (see image)\r\nWhat is the most likely diagnosis?","questionTimeSeconds":"0","questionTimeMinutes":"2","questionImagePath":"volume-1\/stage-4-csim2-blood-and-blood-disorders-quiz\/case 3 anaemia.png","position":29,"explanation":"Answer = B12 Deficiency\r\nPathophysiology- B12 is in meat, fish and dairy (sorry vegans) and is absorbed in the terminal ilium by IF\r\nRisks include gastrectomy, Crohn\u2019s disease, pernicious anaemia \r\nB12 def, thymidine synthesis is impaired which impairs DNA - hence decreased RBC production\r\n\r\nGives: \r\nGeneral anaemia symptoms, glossitis, angular stomatitis \r\nNeuro-psych- depression, irritability, dementia\r\nNeurological- paraesthesia, peripheral neuropathy. If severe combined degeneration of spinal cord \r\n\r\nFolate Deficiency\r\nProduces a megaloblastic macrocytic anaemia.\r\n\r\nFolate is found in green veg, nuts, yeasts and liver.\r\nAbsorbed by duodenum\/prox jejunum \r\nRisks- Malabsorption condition, Alcoholics, Medications\r\nSimilar presentation to B12 but less neurological. \r\nGive Folate 5mg OD 3 months \r\n","question_score_id":null,"lang":"","questionAudioPath":null}]