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L Test results  Hgb 77 g/L  MCV 66  f/L  RBC 3.2 x10 12 /L  WBC 5.6 x10 6 /L  Plat 525 x10 9 /L l Blood film This is a 55 year old woman who has.

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Presentation on theme: "L Test results  Hgb 77 g/L  MCV 66  f/L  RBC 3.2 x10 12 /L  WBC 5.6 x10 6 /L  Plat 525 x10 9 /L l Blood film This is a 55 year old woman who has."— Presentation transcript:

1 l Test results  Hgb 77 g/L  MCV 66  f/L  RBC 3.2 x10 12 /L  WBC 5.6 x10 6 /L  Plat 525 x10 9 /L l Blood film This is a 55 year old woman who has fatigue. Her only other symptom is a craving for chewing ice cubes. Apart from being pale her examination is normal.

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3 Which one of the following tests would best define the type of anemia she has ? A. Hgb electropheresis B. Serum iron and iron-binding capacity C. Serum ferritin D. Serum transferrin E. Bone marrow iron

4 l Test results  Hgb 77 g/L  MCV 66  fL  RBC 3.2 x10 12 /L  WBC 5.6 x10 6 /L  Plat 525 x10 9 /L l Blood film  microcytosis  hypochromia  ovals  pencil  thrombocytosis This is a 55 year old woman who has fatigue. Her only other symptom is a craving for chewing ice cubes. Apart from being pale her examination is normal.

5 l Test results  Hgb 135 g/L  MCV 65 fL   RBC 5.4 x10 12 /L  WBC 6.5 x10 6 /L  Plat 355 x10 9 /L l Blood film A 44 year old executive is sent to you for an insurance examination. He is fit, but on examination he has mild hypertension.

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7 Which test is likely to give a diagnosis in this case ? A. Serum ferritin B. Serum transferrin C. Sickle Cell screen D. Hgb electropheresis E. Liver function tests

8 l Test results  Hgb 135 g/L  MCV 65  fL  RBC 5.4 x10 12 /L  WBC 6.5 x10 6 /L  Plat 355 x10 9 /L l Blood film  microcytosis  hypochromia  target  teardrop  basophilic stippling A 44 year old executive is sent to you for an insurance examination. He is fit, but on examination he has mild hypertension.

9 What would you tell this executive ? A. You have Beta thalassemia minor B. You have alpha thalasemia minor C. You have Sickle cell trait D. You have hemoglobin C trait E. More tests are needed

10 l Test results - Hgb 99 g/L - MCV 100 fL - RBC 3.7 x10 12 /L - WBC 3.4 x10 6 /L - Plat 117 x10 9 /L  bili 35  mol/L - blood film This is an 18 year old boy who you are investigating for Jaundice. He has this intermittently for some time. His family are Christian Scientists. Physical exam shows jaundice and splenomegaly

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12 Which of the following would be most helpful in identifying this young man’s problem ? A. Reticulocyte count B. Osmotic fragility test C. DAT (Coomb’s test) D. Bone marrow test E. Family studies

13 l Test results - Hgb 99 g/L - MCV 100 fL - RBC 3.7 x10 12 /L - WBC 3.4 x10 6 /L - Plat 117 x10 9 /L  bili 35  mol/L - blood film - polychromasia - spherocytes This is an 18 year old boy who you are investigating for Jaundice. He has this intermittently for some time. His family are Christian Scientists. Physical exam shows jaundice and splenomegaly

14 l Test results  Hgb 142 g/L  MCV 105 fL  RBC 4.9 x10 12 /L  WBC 6.7 x10 6 /L  Plat 105 x10 9 /L l Blood Film A 46 year old diplomat is referred to you because of abnormal blood results. On review of these you suspect the cause and order appropriate blood tests.

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16 What tests would you order on receiving these results ? A. Serum B 12 and folate B. Bone marrow aspirate C. Serum lipid studies D. Liver function tests E. Thyroid function tests

17 l Test results  Hgb 142 g/L  MCV 105 fL  RBC 4.9 x10 12 /L  WBC 6.7 x10 6 /L  Plat 105 x10 9 /L l Blood Film Macrocytosis Target cells stomatocytes A 46 year old diplomat is referred to you because of abnormal blood results. On review of these you suspect the cause and order appropriate blood tests.

18 l Test results  Hgb 85 g/L  MCV 110  fL  RBC 3.9 x10 12 /L  WBC 2.4 x10 6 /L  Plat 89 x10 9 /L l Blood Film A 65 year old woman is referred to you because of memory loss. Her family physician had received tests which included bilirubin of 28  mol/L and an LDH of 1560 U/L. He was puzzled by these results.

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20 Which one of the following tests is most appropriate ? A. Liver function B. Thyroid function C. RBC folate D. Serum B 12 E. Bone marrow aspirate

21 l Test results  Hgb 85 g/L  MCV 110  fL  RBC 3.9 x10 12 /L  WBC 2.4 x10 6 /L  Plat 89 x10 9 /L l Blood Film Macrocytosis oval macroytes hypersegmented neutrophils A 65 year old woman is referred to you because of memory loss. Her family physician had received tests which included bilirubin of 28  mol/L and an LDH of 1560 U/L. He was puzzled by these results.

22 l Test results  Hgb 103 g/L  MCV 99 fL  RBC 3.8 x10 12 /L  WBC 3.4 x10 6 /L  Plat 125 x10 9 /L Blood Film A 65 year old woman complains of back pain. Her X-rays show diffuse osteoporosis. She also complains of increased thirst and drowsiness.

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24 Which one of these tests would most likely lead to the diagnosis ? A. Serum osmolarity B. Serum viscosity C. Serum protein electrophersis D. Serum TSH E. Serum PTH

25 l Test results  Hgb 103 g/L  MCV 99 fL  RBC 3.8 x10 12 /L  WBC 3.4 x10 6 /L  Plat 125 x10 9 /L Blood Film rouleaux background staining A 65 year old woman complains of back pain. Her X-rays show diffuse osteoporosis. She also complains of increased thirst and drowsiness.

26 l Test results  Hgb 115 g/L  MCV 115  fL  RBC 2.2 x10 12 /L  WBC 8.4 x10 6 /L  Plat 246 x10 9 /L l Blood Film You admit a 36 year old woman with pneumonia. She has fever, shortness of breath and requires oxygen. She is also noted to be anemic.

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28 These test results would help you choose which one of these antibiotics ? A. Cephalexin B. Penicillin G C. Erythromycin D. Sulfamethoxazole E. Ciprofloxacin

29 l Test results  Hgb 115 g/L  MCV 115  fL  RBC 2.2 x10 12 /L  WBC 8.4 x10 6 /L  Plat 246 x10 9 /L l Blood Film RBC agglutination You admit a 36 year old woman with pneumonia. She has fever, shortness of breath and requires oxygen. She is also noted to be anemic.

30 l Test results  Hgb 75 g/L  MCV 107  fL  RBC 2.8 x10 12 /L  WBC 8.9 x10 6 /L  Plat 377 x10 9 /L Blood Film An 18 year old woman has symptoms of cystitis. After urine cultures are taken she is given Sulfamethoxazole. Her urinary symptoms improve but she becomes short of breath. A week later on follow-up her investigation shows.

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32 What type of anemia is causing this problem ? A. An idiosyncratic drug reaction B. An allergic drug reaction C. Marrow suppressive effect D. Immune hemolysis E. Oxidative hemolysis

33 l Test results  Hgb 75 g/L  MCV 107  fL  RBC 2.8 x10 12 /L  WBC 8.9 x10 6 /L  Plat 377 x10 9 /L Blood Film ploychromasia blister bite cells An 18 year old woman has symptoms of cystitis. After urine cultures are taken she is given Sulfamethoxazole. Her urinary symptoms improve but she becomes short of breath. A week later on follow-up her investigation shows.

34 l Test results  Hgb 115 g/L  MCV 91 fL  RBC 4.1 x10 12 /L  WBC 14.5 x10 6 /L  Plat 52 x10 9 /L l Blood Film You are called to see this 29 year old primip in the case room. The obstetrician is concerned about her platelet count. She is well but a bit hypertensive.

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36 What diagnosis is most likely ? A. ITP ( immune thrombocytopenia ) B. TTP ( thrombotic thrombocytopenic purpura) C. PIH (pre-eclampsia) D. Benign thrombocytopenia of pregnancy E. DIC (disseminated intravascular coagopathy)

37 l Test results  Hgb 115 g/L  MCV 91 fL  RBC 4.1 x10 12 /L  WBC 14.5 x10 6 /L  Plat 52 x10 9 /L l Blood Film polychromasia rbc fragments thrombocytopenia You are called to see this 29 year old primip in the case room. The obstetrician is concerned about her platelet count. She is well but a bit hypertensive.

38 l Test results  Hgb 115 g/L  MCV 105 fL  RBC 3.8 x10 12 /L  WBC 9.2 x10 6 /L  Plat 420 x10 9 /L l Blood Film This 35 year old man is sent to you because of unusual blood results. His complaints are of fatigue and an episodic itchy rash.

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40 What condition do you think is responsible for these results ? A. Pernicious anemia B. Sickle cell anemia C. Hyposplenism D. Leaky prosthetic valve E. Liver cirrhosis

41 l Test results  Hgb 115 g/L  MCV 105 fL  RBC 3.8 x10 12 /L  WBC 9.2 x10 6 /L  Plat 420 x10 9 /L l Blood Film targets acanthocytes fragments howell jolly bodies This 35 year old man is sent to you because of unusual blood results. His complaints are of fatigue and an episodic itchy rash.

42 What is the most likely cause ? A. Blind loop syndrome B. Coeliac disease C. Ulcerative colitis D. Crohn’s disease E. Wilson’s disease

43 l Test results  Hgb 99 g/L  MCV 96 fl  RBC 3.4 x10 12 /L  WBC 3.65 x10 6 /L  Plat 560 x10 9 /L l Blood Film You are asked to asses a 72 year old woman for anemia and splenomegaly. She has been losing weight for 1 year. She has had 2 episodes of gout.

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45 What test would give a definitive diagnosis ? A. LAP score B. Osmotic fragility C. Hgb electropheresis D. Bone scan E. Bone marrow biopsy

46 l Test results  Hgb 99 g/L  MCV 96 fl  RBC 3.4 x10 12 /L  WBC 3.65 x10 6 /L  Plat 560 x10 9 /L l Blood Film thromboytosis tear drop cells leukoerythroblstic You are asked to asses a 72 year old woman for anemia and splenomegaly. She has been losing weight for 1 year. She has had 2 episodes of gout.

47 l Test results  Hgb 136 g/L  MCV 88 fL  RBC 4.9 x10 12 /L  WBC 17.3 x10 6 /L  Plat 110 x10 9 /L l Blood Film This 24 year old man has acute abdominal pain. He has not been feeling well for 5 days. After a baseball game he had acute upper abdominal pain and was quite tender in the upper abdomen. The surgeon asks you to see the patient.

48 What is the disorder most likely responsible for his condition ? A. Acute leukemia B. Pancreatitis C. Malaria D. Infectious mononucleosis E. Liver abcess

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50 l Test results  Hgb 136 g/L  MCV 88 fL  RBC 4.9 x10 12 /L  WBC 17.3 x10 6 /L  Plat 110 x10 9 /L l Blood Film variant lymphocytes atypical reactive This 24 year old man has acute abdominal pain. He has not been feeling well for 5 days. After a baseball game he had acute upper abdominal pain and was quite tender in the upper abdomen. The surgeon asks you to see the patient.

51 l Test results  Hgb 139 g/L  MCV 93 fL  RBC 5.1 x10 12 /L  WBC 29 x10 6 /L  Plat 178 x10 9 /L l Blood Film This 55 year old man is referred for unexplained elevated White cell count. He feels well. Examination is normal.

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53 What test would confirm your diagnosis ? A. Mono spot test B. LAP score C. Bone marrow biopsy D. Immunophenotyping E. Skeletal survey

54 l Test results  Hgb 139 g/L  MCV 93 fL  RBC 5.1 x10 12 /L  WBC 29 x10 6 /L  Plat 178 x10 9 /L l Blood Film Lymphocytosis Smudge cells This 55 year old man is referred for unexplained elevated White cell count. He feels well. Examination is normal.

55 l Test results  Hgb 92 g/L  MCV 81 fL  RBC 3.4 x10 12 /L  WBC 5.2 x10 6 /L  Plat 13 x10 9 /L l Blood Film This 36 year old man is admitted to hospital with generalized bruising and bleeding. He is febrile. There are many bruises and petichia present.

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57 What disease is most responsible for his condition ? A. Septicemia B. Drug reaction C. Infectious mononucleosis D. Chronic leukemia E. Acute leukemia

58 l Test results  Hgb 92 g/L  MCV 81 fL  RBC 3.4 x10 12 /L  WBC 5.2 x10 6 /L  Plat 13 x10 9 /L l Blood Film Cytopenias Blasts This 36 year old man is admitted to hospital with generalized bruising and bleeding. He is febrile. There are many bruises and petichia present.

59 This is a 65 year old male who at retirement has his last regular work medical checkup. He is a bit fatigued but otherwise well. l Test Results Ä Hgb 11.0 g/L Ä MCV 92 fL Ä RBC 4.3x10 12 /L Ä WBC 5.2x10 6 /L Ä Plat 565x10 9 /L l Blood film

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61 What test would best establish the diagnosis ? A. Serum iron and iron binding capacity B. Serum B 12 C. Urine hemosiderin D. Bone marrow aspirate E. Serum transferrin

62 This is a 65 year old male who at retirement has his last regular work medical checkup. He is a bit fatigued but otherwise well. l Test Results Ä Hgb 11.0 g/L Ä MCV 92 fL Ä RBC 4.3x10 12 /L Ä WBC 5.2x10 6 /L Ä Plat 565x10 9 /L l Blood film Ä Normocytic Ä Normochromic Ä Microcytic Ä Hypochromic Ä Dimorphic population

63 This is a 35 year old male who is found to have persistent leukocytosis. His family physician wants you to rule out a Chronic leukemia. l Test Results Ä HGB 146 g/L Ä MCV 92 fL Ä RBC 5.5x10 12 /L Ä WBC 25X10 6 /L Ä Plat 465x10 9 /L l Blood Film

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65 What test would be most cost effective in helping to establish a diagnosis ? A. Immunophenotyping B. Leukocyte alkaline phosphatase C. Bone marrow aspirate D. Cytogenetics E. Blood cultures

66 This is a 35 year old male who is found to have persistent leukocytosis. His family physician wants you to rule out a Chronic leukemia. l Test Results Ä HGB 146 g/L Ä MCV 92 fL Ä RBC 5.5x10 12 /L Ä WBC 25X10 6 /L Ä Plat 465x10 9 /L l Blood Film  Normocytic  Normochromic  Neutrophilia  Metamyelocyte

67 A 75 year old woman is admitted to hospital because of pneumonia. She has not been feeling well for some months. l Test Results Ä HGB 96 g/L Ä MCV 103 fL Ä RBC 3.8x10 12 /L Ä WBC 2.4x10 6 /L Ä Plat 74x10 9 /L l Blood Film

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69 A 75 year old woman is admitted to hospital because of pneumonia. She has not been feeling well for some months. l Test Results Ä HGB 96 g/L Ä MCV 103 fL Ä RBC 3.8x10 12 /L Ä WBC 2.4x10 6 /L Ä Plat 74x10 9 /L l Blood Film  Macrocytes  Mild pancytopenia

70 Which test would you do next ? A. Reticulocyte count B. Serum B 12 and Folate C. Thyroid function tests D. Liver function tests E. Bone marrow aspirate and biopsy

71 Which do you think is the most likely ? A. RA - Refractory anemia B. RARS - Refractory anemia, ring sideroblasts C. RAEB - Refractory anemia excess blasts D. RAEBt - RAEB in transformation to Acute

72 A 25 year old female university student is found to have a very low hemoglobin. She in fact feels fairly well. Physical exam shows pallor only. l Test Results Ä HGB 7.1 g/L Ä MCV 80 fL Ä RBC 2.7x10 12 /L Ä WBC 6.3x10 6 /L Ä Plat 345x10 9 /L l Blood Film

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74 Which test do you think will give the diagnosis ? A. Iron studies B. Reticulocyte count C. Endocrine studies D. Liver function E. Renal function

75 A 25 year old female university student is found to have a very low hemoglobin. She in fact feels fairly well. Physical exam shows pallor only. l Test Results Ä HGB 7.1 g/L Ä MCV 80 fL Ä RBC 2.7x10 12 /L Ä WBC 6.3x10 6 /L Ä Plat 345x10 9 /L l Blood Film  Irreg contracted  Burr cells


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