I have dated when I wrote questions, to help you gauge if particular answers may be obsolete.

Malignant Qu 1 (2019)

You SHO phones you for advice. They have been asked to review a 35 year old man who started his steroid pre-phase for ALL yesterday. The patient complained of palpitations and an ECG shows some T wave abnormalities.

  1. What do you suspect and how will you proceed?

  2. What are the diagnostic criteria for TLS?

  3. Can you give me any examples of risk factors for TLS?

  4. Can you tell me how rasburicase works?

  5. What is the dose in prophylaxis?

 

Malignant Qu 2 (2019)

A GP refers a 57 year old man to you with a Hb 170, Hct 0.53, plt 320, WBC 6.0. How would you approach the investigation of this patient?

  1. The patient is positive for the JAK2 V617F mutation. Can you tell me about any diagnostic criteria for PV?

  2. How will you manage this patient?

  3. Would you not start cytoreduction?

  4. Three years later patient is still venesection dependent as he did not tolerate hydroxycarbamide and he is now experiencing early satiety and LUQ discomfort. Would you give him ruxolitinib?

Malignant Qu 3 (2023)

You are reviewing a 40 year man with a new diagnosis of acute myeloid leukaemia. He has two young children and three siblings. He asks you if his cancer could be heritable.

  1. What further medical history would you ask of this patient?

  2. You receive the results of his myeloid gene panel, can you give me any examples of genes associated with a germline predisposition to leukaemia?

  3. This patient is found to have two somatic DDX41 mutations, one with a variant allele frequency of 50% and a second at 18%. What relevance does the variant allele frequency have to the assessment of this case?

  4. What further testing would offer this patient?

  5. What are the potential implications of identifying a germline mutation in this patient?

 

Coag Qu 1 (2019)

Tell me the principle of preforming an activated partial thromboplastin time

  1. Tell me about the method or analyser your lab uses for this

  2. What is Quality Assurance and how does your lab ensure that is provides its service users with quality APTT results?

  3. Your lab manager phones you and tells you that your most recent NEQAS submission has been returned as outwith consensus. You reported an APTT of 36 seconds, compared to the method median of other labs which reported 43 seconds. What would your initial actions be?

 

Transfusion Qu 1 (2019)

A 26 year old patient, post 2nd cycle of intensive chemotherapy for acute myeloid leukaemia, is an inpatient for treatment of a neutropenic fever and for the third consecutive morning bloods have shown a platelet count <10 x10e9/l despite a one unit platelet transfusion during each of the previous days.

  1. What is the differential diagnosis for the patient’s thrombocytopenia?

  2. How would you assess the response to platelet transfusion?

  3. You suspect an alloimmune cause for the thrombocytopenia, how can this be investigated?

  4. How will you manage the patient in the meantime?

Transfusion Qu 2 (2020)

You are called by the acute medicine registrar about a 50 year old man having acute upper gastrointestinal bleeding. The patient is hypotensive and tachycardic and has received 4 units of red cells in the emergency department. The team are calling you now because the patient’s Hb is 55g/l on the most recent venous blood gas.

  1. What advice would you give with regard to this patient’s blood resuscitation?

  2. What definitions are there for massive blood loss? 

  3. Would you give this patient tranexamic acid? Are you aware of any relevant trial data to support your decision?

  4. If you were asked to review your hospital’s major haemorrhage protocol who would you involve in that process?