QCHP Haematology & Oncology exam questions

6 worked Haematology & Oncology practice questions

Original exam-style questions from the bank, spread across the blueprint domains. They are not real or recalled exam questions. Try each one, then open the answer for the rationale and reference. None of them appear in the free mock exam, so reading them will not spoil it.

1. Question 1 · Haemoglobinopathies and Transfusion Medicine

   Two hours after receiving 3 units of red cells, an 82-year-old with heart failure becomes breathless with crackles, raised jugular venous pressure and blood pressure of 175/95 mmHg. Breathing improves after intravenous furosemide. What is the most likely diagnosis?

   1. ATransfusion-related acute lung injury
   2. BTransfusion-associated circulatory overload
   3. CAnaphylactic transfusion reaction
   4. DBacterial contamination of the unit
   Show answer and explanation

   Correct answer: B. Transfusion-associated circulatory overload

   Hypertension, raised venous pressure, positive fluid balance and response to diuretics in an older patient with heart failure point to transfusion-associated circulatory overload. TRALI is non-cardiogenic oedema, often with hypotension and fever, and does not respond to diuretics. Risk assessment and slower transfusion help prevent TACO.

   Reference: BSH Guideline on the investigation and management of acute transfusion reactions, 2023

2. Question 2 · Haemostasis and Thrombosis

   A young woman with lifelong heavy periods and nosebleeds is diagnosed with type 1 von Willebrand disease. She needs a dental extraction. Which treatment is most often used to prevent bleeding in type 1 disease?

   1. ARecombinant factor IX
   2. BDesmopressin
   3. CPlatelet transfusion
   4. DVitamin K
   Show answer and explanation

   Correct answer: B. Desmopressin

   Desmopressin releases stored von Willebrand factor and factor VIII from endothelial cells and is effective in most patients with type 1 disease, ideally after a test dose shows a response. Tranexamic acid is useful for mucosal bleeding. Factor IX is for haemophilia B.

   Reference: James et al., ASH ISTH NHF WFH 2021 guidelines on the management of von Willebrand disease, Blood Adv 2021

3. Question 3 · Lymphoid Malignancies and Plasma Cell Disorders

   A lymph node biopsy from a 22-year-old with cervical lymphadenopathy shows large binucleate cells with prominent nucleoli in a mixed inflammatory background. Which immunophenotype is typical of these cells in classical Hodgkin lymphoma?

   1. ACD20 and CD45 strongly positive
   2. BCD5 and CD23 positive
   3. CCD10 and BCL6 positive
   4. DCD15 and CD30 positive
   Show answer and explanation

   Correct answer: D. CD15 and CD30 positive

   Reed-Sternberg cells in classical Hodgkin lymphoma are typically CD30 and CD15 positive and usually CD45 negative. CD5 and CD23 co-expression is typical of chronic lymphocytic leukaemia. CD10 and BCL6 indicate a germinal centre B-cell phenotype.

   Reference: WHO Classification of Haematolymphoid Tumours, 5th ed.

4. Question 4 · Lymphoid Malignancies and Plasma Cell Disorders

   A 62-year-old has an IgG paraprotein of 25 g/L, no anaemia, normal calcium and creatinine, and no lytic lesions. Which finding alone would establish multiple myeloma requiring treatment?

   1. ABone marrow clonal plasma cells of 15%
   2. BInvolved to uninvolved light chain ratio of 20
   3. CBone marrow clonal plasma cells of 65%
   4. DA single 3 mm focal lesion on MRI
   Show answer and explanation

   Correct answer: C. Bone marrow clonal plasma cells of 65%

   The IMWG criteria include myeloma-defining biomarkers: clonal marrow plasma cells of 60% or more, an involved to uninvolved free light chain ratio of 100 or more, or more than one focal lesion of at least 5 mm on MRI. Fifteen percent plasma cells without CRAB features or biomarkers is smouldering myeloma. A ratio of 20 does not meet the threshold.

   Reference: Rajkumar et al., IMWG updated criteria for the diagnosis of multiple myeloma, Lancet Oncol 2014

5. Question 5 · Oncological Emergencies

   A man with bulky Burkitt lymphoma at high risk of tumour lysis syndrome is about to start chemotherapy. He has known G6PD deficiency. What is the best approach to uric acid control?

   1. ARasburicase at the standard dose
   2. BRasburicase at half the usual dose
   3. CIntravenous hydration with allopurinol
   4. DUrinary alkalinisation with bicarbonate alone
   Show answer and explanation

   Correct answer: C. Intravenous hydration with allopurinol

   Rasburicase is contraindicated in G6PD deficiency because the hydrogen peroxide it generates can cause severe haemolysis and methaemoglobinaemia. Aggressive hydration with allopurinol, close monitoring of electrolytes and renal function, and early access to dialysis are used instead. Urinary alkalinisation is no longer recommended.

   Reference: Jones et al., BSH Guidelines for the management of tumour lysis syndrome in adults and children, Br J Haematol 2015

6. Question 6 · Red Cell Disorders and Anaemias

   A 32-year-old has haemolytic anaemia with a negative direct antiglobulin test, dark morning urine and a recent hepatic vein thrombosis. Which test confirms the most likely diagnosis?

   1. AOsmotic fragility test on red cells
   2. BHaemoglobin electrophoresis by HPLC
   3. CG6PD enzyme assay after recovery
   4. DFlow cytometry for GPI-anchored proteins
   Show answer and explanation

   Correct answer: D. Flow cytometry for GPI-anchored proteins

   Coombs-negative haemolysis, haemoglobinuria and thrombosis at an unusual site suggest paroxysmal nocturnal haemoglobinuria. Flow cytometry shows loss of GPI-anchored proteins such as CD55 and CD59 or FLAER binding on red cells and granulocytes. Osmotic fragility is used for hereditary spherocytosis.

   Reference: Borowitz et al., Guidelines for the diagnosis and monitoring of PNH by flow cytometry, Cytometry B Clin Cytom 2010