Free QCHP Haematology & Oncology mock test

Haematology & Oncology sample questions with answers

4 more original exam-style Haematology & Oncology questions, worked in full. They are not real or recalled exam questions, and none of them is in the diagnostic above, so sit that first if you have not.

1. Question 1 · Haemostasis and Thrombosis

   A 6-year-old boy has painful swollen knees after minor falls. PT and platelet count are normal, APTT is prolonged and corrects fully with a 50:50 normal plasma mix. Which deficiency is most likely?

   1. AFactor VII deficiency
   2. BFactor VIII deficiency
   3. CLupus anticoagulant
   4. DFibrinogen deficiency
   Show answer and explanation

   Correct answer: B. Factor VIII deficiency

   An isolated prolonged APTT that corrects on mixing indicates a factor deficiency in the intrinsic pathway, and haemarthroses in a boy suggest haemophilia A (factor VIII) or B (factor IX). Factor VII deficiency prolongs the PT. A lupus anticoagulant typically fails to correct on mixing and causes thrombosis rather than bleeding.

   Reference: Srivastava et al., WFH Guidelines for the Management of Hemophilia, 3rd ed., Haemophilia 2020

2. Question 2 · Haemostasis and Thrombosis

   A 40-year-old woman has an unprovoked DVT and is persistently positive for lupus anticoagulant, anticardiolipin and anti-beta2-glycoprotein I antibodies. Which long-term anticoagulant is preferred?

   1. ARivaroxaban at standard dose
   2. BApixaban at standard dose
   3. CWarfarin, target INR 2 to 3
   4. DAspirin 75 mg daily alone
   Show answer and explanation

   Correct answer: C. Warfarin, target INR 2 to 3

   In triple-positive antiphospholipid syndrome, direct oral anticoagulants were associated with more thrombotic events than warfarin, so warfarin with a target INR of 2 to 3 is preferred. Aspirin alone is inadequate after venous thrombosis. Long-term anticoagulation is usually needed.

   Reference: Tektonidou et al., EULAR recommendations for the management of antiphospholipid syndrome in adults, Ann Rheum Dis 2019

3. Question 3 · Haemostasis and Thrombosis

   A 35-year-old has confusion, haemoglobin 78 g/L with fragmented red cells, platelets 12 x 10^9/L, raised LDH and normal clotting. ADAMTS13 activity is pending. What is the most urgent treatment?

   1. APlatelet transfusion
   2. BTherapeutic plasma exchange
   3. CIntravenous heparin
   4. DObservation until ADAMTS13 returns
   Show answer and explanation

   Correct answer: B. Therapeutic plasma exchange

   Microangiopathic haemolysis with severe thrombocytopenia and neurological features suggests thrombotic thrombocytopenic purpura, which is fatal without urgent plasma exchange. Treatment with steroids, plus caplacizumab and rituximab as appropriate, should begin before ADAMTS13 results return. Platelet transfusion is avoided unless there is life-threatening bleeding.

   Reference: Zheng et al., ISTH guidelines for treatment of thrombotic thrombocytopenic purpura, J Thromb Haemost 2020

4. Question 4 · Lymphoid Malignancies and Plasma Cell Disorders

   A 20-year-old has a rapidly growing abdominal mass. Biopsy shows medium-sized B cells with a starry-sky pattern and Ki-67 near 100%. Which genetic finding is characteristic?

   1. At(14;18) BCL2 rearrangement
   2. Bt(11;14) CCND1 rearrangement
   3. Ct(9;22) BCR-ABL1 fusion
   4. Dt(8;14) MYC rearrangement
   Show answer and explanation

   Correct answer: D. t(8;14) MYC rearrangement

   Burkitt lymphoma is characterised by MYC translocation, most often t(8;14), with a very high proliferation rate and starry-sky appearance. t(14;18) is typical of follicular lymphoma and t(11;14) of mantle cell lymphoma. Burkitt lymphoma carries a high risk of tumour lysis syndrome at treatment start.

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