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MRCP questions and answers exam review
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MRCP questions and answers exam review
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MRCP questions and answers exam reviewWhat is Anagrelide? - It is used to control platelets in essential thrombocythemia.
What is Asparaginase? - it is used in the treatment of acute lymphoblastic
leukaemia.
When do you do Venesection in Polycythemia vera? - should aim to get the
haematocrit below 0.45
How long should anticoagulation be continued in pregnancy? What leg is
frequently affected in DVT? - Anticoagulation should continue until at least 6
weeks post partum in this patient. Left leg.
What are the principal features of myelodysplasia ? - 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? - Disseminated intravascular coagulation
results from excess thrombin generation arising from excessive tissue
,MRCP questions and answers exam review
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? - 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? - 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
, MRCP questions and answers exam review
caused the Coombs' test to become positive. He had developed a Jka red cell
antibody, which had not previously been detected
How do you give a definitive diagnosis of PVR? - 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? - The median survival for PRV is 10-15 years.
What is multiple myeloma? What is rouleaux cells? - 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? - The MCV is often raised as
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