MRCP Part 1 Haematology, Infectious Disease & Dermatology

Question 1

A 70-year-old man has a haemoglobin of 70 g/L, MCV 120 fL, and hypersegmented neutrophils on blood film. Vitamin B12 is low. What is the most likely cause of B12 deficiency?

Accepted Answer

Pernicious anaemia

Answer

Pernicious anaemia is the most common cause of B12 deficiency in older adults in the UK. It is an autoimmune condition where anti-intrinsic factor antibodies prevent B12 absorption in the terminal ileum. Hypersegmented neutrophils and macrocytosis are classic blood film findings.

Question 2

A patient presents with petechiae, gum bleeding, and a platelet count of 8 × 10⁹/L. Blood film shows no clumping. What is the diagnosis?

Accepted Answer

Immune thrombocytopenia (ITP)

Answer

Immune thrombocytopenia (ITP) presents with isolated thrombocytopenia (normal white cells and haemoglobin), mucocutaneous bleeding (petechiae, gum bleeding), and no microangiopathic changes on blood film. It is caused by antiplatelet antibodies (anti-GPIIb/IIIa or GPIb/IX).

Question 3

Which marker is used to guide treatment decisions and monitor prognosis in non-Hodgkin's lymphoma?

Accepted Answer

Lactate dehydrogenase (LDH)

Answer

LDH is an important prognostic marker in non-Hodgkin's lymphoma, reflecting tumour bulk and cell turnover. It is incorporated into the International Prognostic Index (IPI) for DLBCL, alongside age, stage, performance status, and number of extranodal sites.

Question 4

A patient returning from sub-Saharan Africa presents with fever, rigors, and splenomegaly. Thick and thin blood films show ring forms within red blood cells. What is the treatment for falciparum malaria without complications?

Accepted Answer

Artemether-lumefantrine (Riamet)

Answer

Artemether-lumefantrine (Riamet) is the first-line treatment for uncomplicated Plasmodium falciparum malaria in the UK. Chloroquine resistance is widespread in P. falciparum. Quinine plus doxycycline/clindamycin is an alternative or second-line option.

Question 5

In disseminated intravascular coagulation (DIC), which coagulation profile would you expect?

Accepted Answer

Elevated PT, elevated APTT, reduced fibrinogen, reduced platelets

Answer

DIC is characterised by simultaneous microvascular thrombosis and consumption of clotting factors and platelets, leading to elevated PT, elevated APTT, reduced fibrinogen (consumed), reduced platelets, and elevated D-dimer (from fibrin degradation). Fragmented red cells (schistocytes) may be seen on blood film.

MRCP Part 1 Practice Test

MRCP Part 1 Practice Test

MRCP Part 1 Haematology, Infectious Disease & Dermatology