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MRCP EXAM QUESTIONS AND ANSWERS
What is Anagrelide? - answer-It is used to control platelets in essential thrombocythemia.
What is Asparaginase? - answer-it is used in the treatment of acute lymphoblastic leukaemia.
When do you do Venesection in Polycythemia vera? - answer-should aim to get the haematocrit
below 0.45
How long should anticoagulation be continued in pregnancy? What leg is frequently affected in
DVT? - answer-Anticoagulation should continue until at least 6 weeks post partum in this
patient. Left leg.
What are the principal features of myelodysplasia ? - answer-B12 and folate levels must be
normal to establish the diagnosis. Blasts can be a feature of evolving myelodysplasia
A 25-year-old man was shot in the thigh at a local restaurant and was moribund when brought in
to A&E. He received 20 units of blood to maintain normovolaemia. His coagulation parameters
were PT 23 seconds, APTT 56 seconds and thrmobin time 25 seconds. His fibrinogen level was
0.6g/L. Which of the following results can be predicted? - answer-Disseminated intravascular
coagulation results from excess thrombin generation arising from excessive tissue
thromboplastin activation of coagulation. This occurs in presence of reduced fibrinolysis, leading
to bleeding diathesis. There are low levels of platelets (and hence a prolonged bleeding time),
protein C/S, antithrombin, factor VIII, factor VII and other coagulation factors due to ongoing
consumption and reduced synthesis. PAI type 1 levels, D-Dimers are increased.
A 63-year-old man was admitted with fever and dyspnoea. He had been previously well.
Investigation revealed haemoglobin was 9.2 g/dL (normal range 12-16.5), mean corpuscular
volume 113 fL (normal range 80-100), white cell count 14 x 109/L (normal range 4-11) and
platelets 23 x 109/L (normal range 150-400). His blood film is shown in the image above. What
is the most likely diagnosis? - answer-Note the clumping of red cells on the film caused by cold
agglutinins, which are a feature of Mycoplasma pneumonia
A 76-year-old man had been treated with fludarabine for Waldenström's macroglobulinaemia 5
years ago. His IgM band had fallen from 36 g/l to a plateau of 5 g/l. He was stable for 5 years but
suddenly presented with Hb 6.7 gm/dl, platelets 79, creatinine 130 micromol/l, plasma viscosity
2.5 mPa/sec. During blood transfusion, he developed a tachycardia and chest pain and was
transferred to CCU. The next day results showed Hb 7 g/dl, Coombs' test positive, creatinine 377
micromol/l. What is the most likely diagnosis? - answer-Most Waldenström's and myeloma
patients relapse with a rise in their paraprotein; this man's IgM had risen to 29 g/l when tested
and the anaemia was a feature of active disease. He developed chest pain due to an acute
haemolytic transfusion reaction, and this caused the Coombs' test to become positive. He had
developed a Jka red cell antibody, which had not previously been detected
[Type here]
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How do you give a definitive diagnosis of PVR? - answer-PRV is confirmed by a red cell mass
of greater than 125% of predicted. Treatment is aimed at reducing the haematocrit to less than
45% by either venesection or drugs (such as hydroxyurea or busulphan). Risk of transformation
to acute leukaemia is very low.
What is the median survival in PVR? - answer-The median survival for PRV is 10-15 years.
What is multiple myeloma? What is rouleaux cells? - answer-Multiple myeloma is a malignant
proliferation of clonal plasma cells in the bone marrow. Presentation is often non-specific with
bone pain, symptoms of anaemia or symptoms due to renal failure. The ESR is most often raised
and a characteristic finding on the blood film is rouleaux (coin-like stacking up of red cells).
A 76-year-old man has had refractory anaemia for 3 years. He has required blood transfusion
every 6 weeks. His white cell count (WCC) normally runs at 3 x 109/l, platelets at 88 x 109/l and
mean corpuscular volume (MCV) 110 fl. He is admitted as an emergency with a chest infection
and his full blood count reveals Hb 10.2 g/dl, MCV 116 fl, platelets 22 x 109/l, WCC 77 x 109/l
(neuts 1.3 x 109/l). There is no obvious blood loss. What is the most likely cause? - answer-The
MCV is often raised as a feature of myelodysplasia and has not changed significantly here. The
sudden collapse in platelets and rise in WCC signifies progression of the disease. The neutrophil
count is low, so the other white cells are probably leukaemic. Although a pneumonia could in
exceptional circumstances cause a WCC of 77 x 109/l, the neutrophil count would be much
higher. About 40% of patient with myelodysplasia will transform into leukaemia.
When does relative polycythemia occur? - answer-Occurs mainly in overweight middle aged
men. This may be exacerbated by diuretics. True polycythaemia is often associated with changes
in platelts and WCC
Does myeloproliferative disorders cause polycythemia? - answer-May all cause splenomegaly.
More common in a man of this age is leukaemia, which also may cause splenomegaly.
What prophylaxis should doctor give to sickle cell disease pt? - answer-Consequently penicillin
prophylaxis and vaccinations (pneumococcus, meningococcus and HIB) are recommended to
reduce the risk of infection with encapsulated organisms
Do Sickle cell disease and ITP cause splenomegaly? - answer-NO!
What are the common side effects of Thalidomide? - answer-Thalidomide has a number of
common side effects including somnolence, rash, peripheral neuropathy and constipation
What are the laboratory features for chronic myeloid leukemia? - answer-Chronic myeloid
leukaemia and none of the classical signs of large hepatosplenomegaly. The picture shows an
elevated white count with no increase in blast cells and there are myelocytes and metamyelocytes
[Type here]
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MRCP EXAM QUESTIONS AND ANSWERS
What is Anagrelide? - answer-It is used to control platelets in essential thrombocythemia.
What is Asparaginase? - answer-it is used in the treatment of acute lymphoblastic leukaemia.
When do you do Venesection in Polycythemia vera? - answer-should aim to get the haematocrit
below 0.45
How long should anticoagulation be continued in pregnancy? What leg is frequently affected in
DVT? - answer-Anticoagulation should continue until at least 6 weeks post partum in this
patient. Left leg.
What are the principal features of myelodysplasia ? - answer-B12 and folate levels must be
normal to establish the diagnosis. Blasts can be a feature of evolving myelodysplasia
A 25-year-old man was shot in the thigh at a local restaurant and was moribund when brought in
to A&E. He received 20 units of blood to maintain normovolaemia. His coagulation parameters
were PT 23 seconds, APTT 56 seconds and thrmobin time 25 seconds. His fibrinogen level was
0.6g/L. Which of the following results can be predicted? - answer-Disseminated intravascular
coagulation results from excess thrombin generation arising from excessive tissue
thromboplastin activation of coagulation. This occurs in presence of reduced fibrinolysis, leading
to bleeding diathesis. There are low levels of platelets (and hence a prolonged bleeding time),
protein C/S, antithrombin, factor VIII, factor VII and other coagulation factors due to ongoing
consumption and reduced synthesis. PAI type 1 levels, D-Dimers are increased.
A 63-year-old man was admitted with fever and dyspnoea. He had been previously well.
Investigation revealed haemoglobin was 9.2 g/dL (normal range 12-16.5), mean corpuscular
volume 113 fL (normal range 80-100), white cell count 14 x 109/L (normal range 4-11) and
platelets 23 x 109/L (normal range 150-400). His blood film is shown in the image above. What
is the most likely diagnosis? - answer-Note the clumping of red cells on the film caused by cold
agglutinins, which are a feature of Mycoplasma pneumonia
A 76-year-old man had been treated with fludarabine for Waldenström's macroglobulinaemia 5
years ago. His IgM band had fallen from 36 g/l to a plateau of 5 g/l. He was stable for 5 years but
suddenly presented with Hb 6.7 gm/dl, platelets 79, creatinine 130 micromol/l, plasma viscosity
2.5 mPa/sec. During blood transfusion, he developed a tachycardia and chest pain and was
transferred to CCU. The next day results showed Hb 7 g/dl, Coombs' test positive, creatinine 377
micromol/l. What is the most likely diagnosis? - answer-Most Waldenström's and myeloma
patients relapse with a rise in their paraprotein; this man's IgM had risen to 29 g/l when tested
and the anaemia was a feature of active disease. He developed chest pain due to an acute
haemolytic transfusion reaction, and this caused the Coombs' test to become positive. He had
developed a Jka red cell antibody, which had not previously been detected
[Type here]
, 1
1
How do you give a definitive diagnosis of PVR? - answer-PRV is confirmed by a red cell mass
of greater than 125% of predicted. Treatment is aimed at reducing the haematocrit to less than
45% by either venesection or drugs (such as hydroxyurea or busulphan). Risk of transformation
to acute leukaemia is very low.
What is the median survival in PVR? - answer-The median survival for PRV is 10-15 years.
What is multiple myeloma? What is rouleaux cells? - answer-Multiple myeloma is a malignant
proliferation of clonal plasma cells in the bone marrow. Presentation is often non-specific with
bone pain, symptoms of anaemia or symptoms due to renal failure. The ESR is most often raised
and a characteristic finding on the blood film is rouleaux (coin-like stacking up of red cells).
A 76-year-old man has had refractory anaemia for 3 years. He has required blood transfusion
every 6 weeks. His white cell count (WCC) normally runs at 3 x 109/l, platelets at 88 x 109/l and
mean corpuscular volume (MCV) 110 fl. He is admitted as an emergency with a chest infection
and his full blood count reveals Hb 10.2 g/dl, MCV 116 fl, platelets 22 x 109/l, WCC 77 x 109/l
(neuts 1.3 x 109/l). There is no obvious blood loss. What is the most likely cause? - answer-The
MCV is often raised as a feature of myelodysplasia and has not changed significantly here. The
sudden collapse in platelets and rise in WCC signifies progression of the disease. The neutrophil
count is low, so the other white cells are probably leukaemic. Although a pneumonia could in
exceptional circumstances cause a WCC of 77 x 109/l, the neutrophil count would be much
higher. About 40% of patient with myelodysplasia will transform into leukaemia.
When does relative polycythemia occur? - answer-Occurs mainly in overweight middle aged
men. This may be exacerbated by diuretics. True polycythaemia is often associated with changes
in platelts and WCC
Does myeloproliferative disorders cause polycythemia? - answer-May all cause splenomegaly.
More common in a man of this age is leukaemia, which also may cause splenomegaly.
What prophylaxis should doctor give to sickle cell disease pt? - answer-Consequently penicillin
prophylaxis and vaccinations (pneumococcus, meningococcus and HIB) are recommended to
reduce the risk of infection with encapsulated organisms
Do Sickle cell disease and ITP cause splenomegaly? - answer-NO!
What are the common side effects of Thalidomide? - answer-Thalidomide has a number of
common side effects including somnolence, rash, peripheral neuropathy and constipation
What are the laboratory features for chronic myeloid leukemia? - answer-Chronic myeloid
leukaemia and none of the classical signs of large hepatosplenomegaly. The picture shows an
elevated white count with no increase in blast cells and there are myelocytes and metamyelocytes
[Type here]
