Mock Exam 2

Haematology
& Oncology
Part One MRCPCH
Educational Materials from MRCPCH2009 for Part 1

Number of questions: 20
Score: 100 marks
Time: 30 Minutes

MRCPCH2009 SITE
ELBABA M.A.
Mock Exam Series # 2 MRCPCH2009 Site
Hematology & Oncology Test 1 ELBABA M.A.
____________________________________________________________________________

EXTENDED MATCHING QUESTIONS

Q. 1 (20 Marks)
This is a list of certain diagnosis:
A. Acute post-infectious glomerulonephritis
B. Hemolytic uremic syndrome
C. Systemic Lupus erythmatoses
D. Beta Thalassemia major
E. Sickle cell anemia
F. Sickle B Thalassemia
G. Spherocytosis
H. G6PD deficiency
I. Vitamin B12 deficiency
J. Autoimmune hemolytic anemia
K. Acute leukemia
L. Non Hodgkin Lymphoma
M. Acquired aplastic anemia
N. Autoimmune hepatitis
O. Malaria
P. Brucellosis
Q. Lyme disease
R. Schistosomiasis

Choose the most likely diagnosis for each of the following scenarios:

SELECT ONE ANSWER ONLY FOR EACH QUESTION

Note: Each answer may be used more than once

1. 3 year old girl presented with dark urine and pallor. Urine dipsticks showed
positive blood +++. Microscopic exam of urine showed RBC of 2 only. There
is history of febrile illness of unknown focus one week ago. The child is off
color and has no family history and other parts of history are insignificant
rather than recent travel to Sudan.
2. 3 year old girl presented with dark urine and pallor. Urine dipsticks showed
positive blood +++. Microscopic exam of urine showed RBC of 2 only. The
child has insignificant family history. There is history of febrile illness with
polymorphic rash one week ago. Specific disease has been suspected.
Treatment started only yesterday after confirming coronary aneurysm by
echocardiogarm.

__________________________________________________________________________
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Mock Exam Series # 2 MRCPCH2009 Site
Hematology & Oncology Test 1 ELBABA M.A.
____________________________________________________________________________
3. 3 year old girl presented with dark urine and pallor. Urine dipsticks showed
positive blood +++. Microscopic exam of urine showed RBC of 2 only. The
child has insignificant family history. There is history of low grade fever for 2
days. No focus for that fever has been detected. Investigations showed very
low hemoglobin, and high LDH, Bilirubin & positive Coombs test.
4. 13 year old girl presented with dark urine and pallor. Urine dipsticks showed
positive blood and protein +++. Microscopic exam of urine showed RBC of
60. The child has insignificant family history. There is history of fever for 2
weeks. No focus for that fever has been detected but BP shown high
readings several times. There is undefined few rash over the fingers.
Investigations showed pancytopenia, low C3 & C4, and positive ANA.

Q. 2 (15 Marks)
This is a list of diagnosis:
A. Vitamin K deficiency
B. Bernard-Soulier syndrome
C. Acute glomerulonephritis
D. Hemolytic uremic syndrome
E. Systemic lupus erythmatosis
F. Acute cortical necrosis
G. Renal vein thrombosis
H. Immune thrombocytopenic purpura
I. Acute leukemia
J. Hemophilia B
K. Kasabach-Merritt syndrome
L. Schwashman Diamond syndrome
M. Disseminated intravascular coagulopathy
N. Thrombotic thrombocytopenic purpura
O. Shigellosis
P. Protein C deficiency

Choose the most likely diagnosis for each of the following:

SELECT ONE ANSWER ONLY FOR EACH QUESTION

Note: Each answer may be used more than once

1. 3 years severely ill child admitted recently to PICU with picture of septic
shock secondary to staph pneumonia. Underlying immunodeficiency has
been suspected. After stabilization, some rectal bleeding and melena was
observed. Oozing blood from puncture sites and from NGT has been
reported as well. CBC showed Hb. 4.5, WBC 3.7 & Plat. of 30. Urea was 3
and creat 25. Her aPTT & PT are very high.

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Mock Exam Series # 2 MRCPCH2009 Site
Hematology & Oncology Test 1 ELBABA M.A.
____________________________________________________________________________
2. 3 years old girl has admitted to PICU recently very ill with severe
hypertension. She has bloody stool and diarrhea last week. Dehydration was
only mild to moderate. Yesterday, she complained of headache and visual
disturbance. CBC showed Hb. 8, WBC 4.2 and plat. 40. Urea was 25 and
creat 210. The laboratory reported that many RBCs are abnormal and
showed schizocytes and fragmentation. Her aPTT & PT are within normal.
3. 3 months old girl has admitted to PICU recently very ill with mild
hypertension. She has gastroenteritis last week. Dehydration was severe
and required to stay 2 days on IVF in a private hospital. Yesterday, she
complained of gross hematuria and abdominal left flank swelling. CBC
showed Hb. 7, WBC 4.2 and plat. 80. Urea was 8 and creat 30. The
laboratory reported that many RBCs are abnormal and showed schizocytes
and fragmentation. Her aPTT & PT are slightly elevated.

Q. 3 (15 Marks)
These are the results of Hemoglobin electrophoreses:

A. HbA 98%, HbA2 2%

B. HbA 30%, HbA2 2%, HbF 68%
C. HbA 0%, HbA2 5%, HbF 95%
D. HbA 20%, HbA2 5%, HbF 75%
E. HbA 90%, HbA2 4%, HbF 6%
F. HbA 92%, HbA2 6%, HbF 2%
G. HbA 0%, HbA2 3%, HbF 7%, HbS 90%
H. HbA 53%, HbA2 2%, HbF 0%, HbS 45%
I. HbA 0%, HbA2 3%, HbF 15%, HbS 82%
J. HbA 10%, HbA2 3%, HbF 15%, HbS 72%
K. HbA 0%, HbA2 0%, HbF 0%, HbS 55%, HbC 45%

Choose the expected result for each of the following scenarios:

SELECT ONE ANSWER ONLY FOR EACH QUESTION

Note: Each answer may be used more than once

1. A 5 year old boy has hepatosplenomegaly with low Hb 7 gm/dl & microcytic
hypochromic blood film. Serum Iron and Ferritin are high. The child requires
blood transfusion every 3-6 months. Parents are carriers of abnormal
hemoglobin.
2. 5 year old boy presented with easy fatigability. Basic investigations showed
microcytic hypochromic anemia with Hb of 9 gm/ dl. Serum Iron, TIBC and
Ferritin are all within normal. One of the Parents has abnormal hemoglobin
pattern.
3. 5 years old boy has abnormal sickling test. His Hb is 9 gm/ dl. The blood film
showed mild microcytic and hypochromic cells. The child has only once
painful crisis. Moderate splenomegaly has been reported as well. Parents
have abnormal hemoglobin pattern.
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Mock Exam Series # 2 MRCPCH2009 Site
Hematology & Oncology Test 1 ELBABA M.A.
____________________________________________________________________________

BEST OF FIVE QUESTIONS

(5 Marks each)

1. In Sickle cell disease, exchange transfusion is required in all of the

following EXCEPT :
A. Hepatic crisis
B. Splenic crisis
C. Acute chest infection
D. Established hemiplegia
E. Intractable Priapism

2. Worldwide the most common precipitating factor of hemolysis in G6PD

deficiency is : SELECT ONE
A. Cereals specially Fava beans
B. Drugs specially NSAID
C. Infection specially viral illness
D. Gastroentritis specially with dehydration
E. Septic newborn specially preterm

3. An infant presented with aniridia. Abdominal ultrasound had done to

look for associated tumor which is confirmed and detected accidently.
The parents asked Is it usually presented like this?. You answered
NO the commonest presentation is : SELECT ONE
A. Hypertension
B. Abdominal mass
C. Hematuria
D. Abdominal pain
E. Renal Impairment

4. Atypical presentations of Acute Leukemia can include all of the

following EXCEPT:
A. Antalgic gait
B. Scrotal swelling
C. Facial asymmetry
D. Bony swelling
E. Stridor

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Mock Exam Series # 2 MRCPCH2009 Site
Hematology & Oncology Test 1 ELBABA M.A.
____________________________________________________________________________

5. These findings can be seen in blood film post-splenectomy: EXCEPT:

A. Spherocytosis
B. Acanthocytosis
C. Target cells
D. Heinz bodies
E. Howell-Jolly bodies

MULTIPLE TRUE/FALSE QUESTIONS

(5 Marks each)

1. Regarding complications of chemotherapeutic agents in malignancy :

A. Nausea and vomiting are easily controlled by Ondansetron
B. Stepping gait is well recognized problem in children on Vincristine
C. MSNA can be used with Cyclophosphamide as an adjuvant therapy
D. Staphylococci aureus is the commonest infection with portaCath.
E. Co-trimoxazole is recommended for prevention of P. Jiroveci infection

2. In Iron deficiency anemia :

A. IV Iron is advised if no improvement with oral therapy after one month.
B. Blood transfusion is required if Hb. dropped less than 4 gm/dl
C. Normal serum Ferritin excludes iron deficiency anemia
D. Advised be treated if serum Ferritin is low even if Hb is normal
E. The earliest effect of Iron therapy is rising of Retic. count after a week

3. In UK, Brain tumor :

A. is the most common solid malignancy in childhood
B. is the second most common malignancy in children
C. It is supratentorial in most of the case
D. MRI spectroscopy may help in differentiation of malignant tissue
E. Papilloedema is the earliest alarm of increased intracranial tension.

4. Tumor markers and or genetic study can confirm the diagnosis in :

A. Hepatoblastoma
B. Neuroblastoma
C. Myeloblastic leukemia
D. Wilms tumor
E. Retinoblastoma

__________________________________________________________________________
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Mock Exam Series # 2 MRCPCH2009 Site
Hematology & Oncology Test 1 ELBABA M.A.
____________________________________________________________________________
5. All of the following are true in Hemophilia A:
A. Desmopressin is advised if the enzyme activity is more than 5
B. Hemoarthrosis doesnt leave long term joint disability in most cases
C. Prophylactic use of Recombinant Factor 8 is not advised; Expensive.
D. Before major surgery, it is advised to raise factor 8 up to 100%
E. Factor VIIa is used in case of Ab. resistance to factor 8 therapy

End of material
ELBABA 2011
2011

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