Your Name: Puja Mehta

Theme: Myeloproliferative Disorders

OPTION LIST

A	Chronic Myeloid Leukaemia	I	Idiopathic Myelofibrosis
B	Polycythaemia vera	J	Venesection
C	Imitanib	K	Erythropoietin
D	Essential Thrombocythaemia	L	Haematocrit
E	Acute myeloid Leukaemia	M	Tear drop poikilocytes
F	Splenomegaly	N	Hydroxycarbamide
G	Microcytosis	O	Chlorambucil
H	Pseudopolycythaemia	P	Melphalan

For each scenario below, choose the most appropriate answer from the list above. Each option may be used once, more than once or not at all.

1. A 64 year old man complains of headaches, fatigue and itchy skin, particularly evident after a hot bath. He has a long-standing history of alcohol abuse and drug history reveals that he taking thiazide diuretics. On examination, you note that he is thin with sunken eyes.

2. A 55 year old female has a past medical history of deep vein thrombosis. She also complains of easy bruising. Her platelet count is 770 x10⁹/L, CRP is 4mg/L. You prescribe aspirin.

3. A 53 year old man goes to see his doctor about an embarrassing problem. It seems that his friends have nicknamed him ‘Rudolph’. You seem quite confused, but all becomes apparent when he points to his nose, which appears red. After further questioning, he describes a ‘burning’ sensation on his nose, hands and feet and visual disturbances. You send him for ‘blood tests’. What do you expect to be raised?

4. A consultant grills you on a ward round: there is a patient with a WBC of 140 x10⁹/L, Hb 12 g/dL, Platelet count 320 x10⁹/L. She complains of tiredness, night sweats, fever and abdominal pain. Her spleen is markedly enlarged. Blood film shows blasts, neutrophils, basophils. How would you treat her?

5. You are asked to see a 76 year old man on the wards, who presented with fatigue, dyspnoea, bleeding gums and nightsweats. His abdomen is massively enlarged. You read his notes and find ‘bone marrow aspirate: ‘dry tap’. What would you expect to see on the blood film?

ANSWERS

1. H

2. D

3. L

4. C

5. M