Pathology EMQ template.

Name: Denise Chan

Candidate number: 00410373

Theme: Chronic Myeloid Leukaemia (and other haematological malignancies)

OPTION LIST

A	Essential thrombocythaemia	I	Hairy cell leukaemia
B	Leukaemoid reaction	J	Prolymphocytic leukaemia
C	Chronic lymphocytic leukaemia	K	Hodgkin’s disease
D	CML chronic phase	L	Non-Hodgkin’s lymphoma
E	CML accelerated phase	M
F	CML blast crisis	N
G	Chuvash polycythaemia	O
H	Polycythaemia vera	P

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 35 year old man returned from a 1 month holiday in India and presented to his GP with drenching night sweats, coughing and a fever. His neutrophil count was 11.2 x 10⁹/L. No immature neutrophil precursors were seen on the blood film.

2. At a follow-up appointment with the Haematologists, a 55 year old woman presents with severe fatigue. She is on Imatinib Mesylate. The consultant informs her that she is now refractory to treatment.

3. A 62 year old woman presents to her GP with generalised tiredness. On routine examination her GP notices an enlarged liver and spleen. Her white cell count is raised. Chromosome analysis is negative for the Philadelphia chromosome t(9:22).

4. A 42 year old man presented to his GP with recurrent headaches accompanied with blurred vision. Routine blood tests revealed a low haemoglobin, low platelet count but elevated white cell count. A bone marrow aspirate shows a hypercellular marrow. He is started on a tyrosine kinase inhibitor.

5. A 22 year old motorcyclist courier was involved in a RTA with an Ocado delivery van. He bled profusely from a leg wound. His WCC was very high. The attending house officer ordered a bone marrow aspirate. This showed a hypercellular marrow but there were no other abnormalities.

ANSWERS

1. B

2. F

3. H

4. D

5. B