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HAM711S - HAEMATOLOGY 3 -2ND OPP - JULY 2022 |
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nAmlBIA UnlVERSITY
OF SCIEnCE Ano TECHnOLOGY
FACULTYOF HEALTH,APPLIEDSCIENCESAND NATURALRESOURCES
DEPARTMENTOF HEALTHSCIENCES
QUALIFICATION: BACHELOROF MEDICAL LABORATORYSCIENCES
QUALIFICATION CODE:08BMLS
LEVEL: 7
COURSECODE: HAM711S
COURSENAME: HAEMATOLOGY 3
SESSION:
JULY 2022
PAPER:
THEORY
DURATION: 3 HOURS
MARKS:
100
Supplementary/ Second Opportunity Examination
EXAMINER(S)
MODERATOR:
Dr Maurice Nyambuya
Dr Aaron Maramba
1. Answer ALL the questions.
2. Write clearly and neatly.
3. Number the answers clearly.
INSTRUCTIONS
PERMISSIBLEMATERIALS
1. Pen
2. Calculator
THIS QUESTION PAPERCONSISTSOF 6 PAGES{Including this front page)
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SECTION A (65 MARKS)
QUESTION 1
Answer all the following multiple choice questions and select the best suitable answer.
[15]
1.1 Tartrate resistant alkaline phosphatase (TRAP)positivity is seen in all of the following
(1)
conditions except
a) Gaucher disease
b) Hodgkins lymphoma
c) Osteoporosis
d) Osteoclastoma
1.2 Which of the following is true regarding mantle cell lymphoma?
(1)
a) It is a Hodgkin's lymphoma
b) Associated with t(8:14)
c) The blasts are light chain restricted and cos+
d) The blasts express FMC-7 +
e) Leukemic non nodal mantle cell lymphoma is an entity with significant
lymphadenopathy
1.3 All of the following CD markers are positive in plasma cell leukaemia except?
(1)
a) CD138
b) CD38
c) CD56
d) CD79a
1.4 The following conditions are associated with the following Karyotyping except?
(1)
J I U HIB
di ff I >
IO
Iii
i
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"
"
_:,. ,I
aiJ5
"
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a) Polycythaemia Vera
b) CLL/SLL
c) B-PLL
d) Burkitt's lymphoma
'II
Ill ar,
ii
i<
y
1.5 Most cases of acute leukaemia in children are of which type:
a) T-cell ALL
(1)
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b) Mature B-cell ALL
c) Hairy cell leukaemia
d) Pre-B-cell ALL
1.6 Acute leukaemias are often associated with which of the following?
(1)
a) Bleeding
b) Bruising
c) Tiredness
d) All of the above
1.7 The following surface marker results were obtained with lymphocytes from a 21-year- (1)
old man with a lymphocytosis of 16 x 109/L. Percentage of peripheral lymphocytes
reactive with antisera to: Kappa = 6%; Lambda= 4%; CD19 = 10%; CD11c = 0%; CD3 =
81%; CD56 = 6%. Which ONE is the most likely diagnosis?
a) Early chronic lymphocytic leukaemia
b) Sezary syndrome
c) Non-Hodgkin's lymphoma
d) Infectious mononucleosis
1.8 Chronic lymphocytic leukaemia is commonly associated with which one feature of
(1)
those listed below?
a) Invariably a rapidly demise
b) A slow but progressive course
c) Overwhelming bleeding
d) Hepatitis
1.9 The type of leukaemia most likely to have skin involvement is:
(1)
a) Sezary syndrome
b) Plasma cell leukaemia
c) Hairy cell leukaemia
d) Acute leukaemia
(1)
1.10 Bence Jones proteins are
a) Fragments of transferrin
b) Monoclonal free light chains
c) Beta 2-microglobulin
d) Polyclonal free light chains
1.11 Waldenstrom's Macroglobulinaemia patients often subsequently develop which one
(1)
of the following?
a) Non-Hodgkin's lymphoma
b) Hyperviscosity syndrome
c) Multiple myeloma
d) Duodenal ulcer
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1.12 Which of the following intitates he coagulation casacade in vivo?
(1)
a) Factor XII
b) Thrombin
c) Tissues factor
d) Prekallikrein
1.13 Which of the following anti-coagulating substances acts on factor V and VIII
(1)
a) APT
b) Protein C
c) Plasmin
d) t-PA
(1)
1.14 What does van Willebrand factor do?
a) Binds platelets to each other
b) Binds platelets to the subendothelium
c) Binds platelets to the phospholipids
d) Cleaves factor V
1.15 Which of the following is a cofactor?
(1)
a) XII
b) X
c) VIII
d) XII
QUESTION 2
[10]
A 65-year-old man was admitted to a hospital presenting with lymphadenopathy,
splenomegaly and lethargy. In addition, he appeared easily bruised. A peripheral blood smear
was req~~_stec!__ta_h.e__r?~.?..ultswere as follows:
2.1 Identify the middle cell and attempt a possible diagnosis
2.2 What would you expect the complete blood count results to be?
(1)
(3)
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2.3 What other three tests will you request to confirm this diagnosis including the expected (6)
results?
QUESTION 3
[25]
3.1 By means of a short essay explain the varying roles of thrombin during injury or
(15)
inflammation.
3.2 D-dimers are often an indication of an abnormal coagulation process. How are these
(5)
products formed in the body?
3.3 Patients suffering from acute leukaemia usually suffer from infection, fatigue, shortness (5)
of breath, bruising and bleeding. Explain why they suffer from these symptoms
QUESTION 4
[15]
A seven-year-old boy who had previously been very healthy and active was brought to his
doctor with acute sepsis and lymphadenopathy. An ultrasound revealed a large mass in his
thorax region. A peripheral blood smear showed the following cells, and a lymphoproliferative
disorder was suspected. Cytochemistry analysis and flow cytometry were requested, and the
results are below.
Peripheral bloo,.d,. s.me,.a,.r,,,,.
Cytochemistry results
Myeloperoxidase - Negative
Sudan black - Negative
Acid Phosphatase - "Polar dot" or localised positivity
Non-specific esterase - "Polar dot" or localised positivity
Flowcytometry results
10 '· 0 09%
,o'
(.)
c::
::'.::tO-~
C,
<.:•
10'
o·tfii-
tOl) ·
100
10'
102
C03-PC5
97.58
1.62%
,al
10'
.,., io~
;;ru_.:,
L'
10'
0.93%
10'
10 11
CD8-FITC
0.02%
10•
io'
10' 0 02%
10,J.
e'!,-;:, 10 2
<..>
10'
0.03%
,o" ,o~ 10 > ,o'
CDS-FITC
10 4 ~ 2.39';
(.)
10 2
Iu=. :
'E io?
0
0
10'
5
>0 1
10-='
HlA-DR-PC5
0.27%
0.26%
10 1
1 o'
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'(.
4.1 Examine the above results and suggest which of the lymphoproliferative disorders is this {10)
most likely to be. Explain your answer.
4.2 Explain the relevance of including CD19 and HLA-DRin the panel of antibodies.
(5)
SECTION B (35 MARKS)
QUESTION 5
[15]
A 21-year-old HIV+ male was seen at the clinic for routine full blood count and CD4+ count.
5.1 Which of the full blood count parameters is often raised on anti-retroviral therapy?
{l)
5.2 What other full blood count parameters are abnormal in patients with HIV?
(1)
5.3 Why do HIV+ patients have increased Erythrocyte Sedimentation Rate (ESR)?
(1)
5.4 What is the absolute CD4 count reference range of a normal adult?
(1)
5.5 At what absolute CD4 count is ARV therapy recommended?
(1)
5.6 CD4 counts are measured using flow cytometry. Discuss the principles of flowcytometry. (10)
QUESTION 6
The following questions pertain to quality management system, an integral part of good
[20]
clinical laboratory practice.
6.1 Discuss how non-conformances are handled.
(8)
6.2 Good housekeeping improves the working environment. This means better working
conditions, which encourages workers to more efficient, resulting in increased
production.
6.2.1 Name 6 benefits of ORDER
(6)
6.2.2 Name 6 signs of DISORDER
(6)
Total [100 marks]
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