Haematology1. A 54-year-old woman with pneumonia has Hb 105 g/L, MCV 80 fL, ferritin 180 µg/L and CRP 96 mg/L. What is the best interpretation of the ferritin?A. Ferritin this high always excludes iron deficiencyB. Ferritin is an acute-phase protein so iron deficiency is not excludedC. She must have haemochromatosisD. MCV 80 excludes all iron problemsCheck
Haematology2. A 70-year-old has a macrocytic anaemia. B12 is low and folate is low. He has sensory ataxia. What is the most appropriate prescribing precaution?A. Cover B12 replacement when treating folate so as not to worsen subacute combined degenerationB. Replace folate alone first because it is cheaperC. Give iron onlyD. Give folic acid 5 mg and delay B12 for 3 monthsCheck
Haematology3. A 73-year-old has back pain, Hb 95 g/L, creatinine 180 µmol/L, calcium 2.85 mmol/L. What is the most appropriate GP myeloma screen?A. ESR aloneB. Serum protein electrophoresis plus serum free light chains (NICE NG35)C. CA15-3D. Watchful waiting for 6 monthsCheck
Haematology4. An 78-year-old well man has incidental lymphocytes 18 × 10^9/L, smear cells, normal Hb and platelets, no nodes or B symptoms. Haematology suggests early CLL. What is the usual initial strategy? Select TWO correct statements.Select all that apply.A. Most appropriate: Watch and wait under haematology if truly early-stage and wellB. The following is not the most appropriate next step: Immediate GP-prescribed chlorambucilC. Most appropriate: Emergency 999 transfer tonightD. Most appropriate: High-dose dexamethasone in primary careCheck
Haematology5. A 45-year-old has a 3 cm hard left supraclavicular node for 8 weeks, night sweats, and 4 kg weight loss. What is the most appropriate referral?A. Routine ENT in 6 monthsB. A course of co-amoxiclav and review in 3 monthsC. Reassure as reactive after a cold last winterD. Suspected cancer 2WW pathway for unexplained lymphadenopathy (NICE NG12)Check
Haematology6. A 69-year-old with new AF has platelets 18 × 10^9/L and wet purpura. CHA2DS2-VASc is 4. What is the most appropriate anticoagulation decision today?A. Start rivaroxaban immediately because the stroke score is highB. Do not start anticoagulation until thrombocytopenia and bleeding risk are urgently managed with haematologyC. Give intramuscular influenza vaccine then start warfarinD. Start dual antiplatelet therapy insteadCheck
Haematology7. A 22-year-old with sickle cell disease has a severe painful crisis, fever 38.8 °C and oxygen saturations 93% on air. What is the most appropriate action? Select TWO correct statements.Select all that apply.A. Most appropriate: Emergency admission: painful crisis plus fever/hypoxia may be acute chest syndrome or infectionB. The following is not the most appropriate next step: Extra codeine at home and review in 5 daysC. Most appropriate: Start community hydroxycarbamide tonightD. Most appropriate: Give IM diclofenac and dischargeCheck
Haematology8. A pregnant woman is found to have beta-thalassaemia trait at antenatal screening. The father of the baby has never been tested. What is the most appropriate GP action?A. Tell her trait is irrelevant to the babyB. Start the partner on ironC. Offer the partner a FIT testD. Arrange urgent partner haemoglobinopathy testing via the NHS SCT pathwayCheck
Haematology9. A 6-year-old develops widespread petechiae and is pale. He is otherwise playing. What is the most appropriate action? The most appropriate action is: Routine 8-week dermatologyTRUE. TrueFALSE. FalseCheck
Haematology10. Intrinsic factor antibodies are negative in a patient with low B12 and a positive family history of autoimmune thyroid disease. What is the correct interpretation?A. Negative IF antibodies exclude pernicious anaemiaB. He must have folate deficiency onlyC. He cannot have autoimmune gastritisD. Negative IF antibodies do not exclude pernicious anaemiaCheck