Peripheral Blood Film in MRCP(3)

Peripheral Blood Film in MRCP (3)

OK,sorry for the long inactivity and quietness of this blog.

Today, we are going to learn a few more important blood films that are frequently asked in MRCP.

4) Megaloblastic anaemia

During your MRCP examination, they will always show a film with hypersegmented neutrophils. Remember that a normal neutrophil usually has 3-4 segments instead of 8 lobes as shown above!

5) Rouleaux Formation

I was always asked by my lecturer during my second year medical school the question about the abnormality you can detect in blood film for a patient with multiple myeloma. You notice that the RBC's here have stacked together in long chains. Learn more about Multiple myeloma because it is popular in your MRCP.

6) Filariasis

You can detect this only in thick blood film. Although it is almost extinct in UK, you can find this is tropics and subtropics. I always remember it as one of the causes of unilateral leg swelling during my medical school.

Unilateral leg swelling

MRCP Question Bank

MRCP Question Bank

Just relax, today we are going to try a few MRCP questions and I hope that you would try to answer all the questions first before looking at the answers at the end of this post.

1)
45 year old female presents with abdominal pain,depression, constipation, polyuria and thirst. Over the last 4 months she has become increasingly aware of tiredness and arthralgia since being diagnosed with hypertension and has been treated with ramipril 2.5 mg daily. Physical examination proves to be entirely normal except for a blood pressure of 162/94 mmHg. Her investigations are as follows:
Haemoglobin 14 g/dl
White cell count 7 x 109/l
Platelets 200 x 109/l
Sodium 148 mmol/l
Potassium 4 mmol/l
Chloride 105 mmol/l
Bicarbonate 28 mmol/l
Urea 8 mmol/l (NR 2-8)
Creatinine 105 umol/l (NR 50-100)
Calcium corrected 3.14 mmol/l (NR 2.2-2.6)
Parathyroid hormone 17 pmol/l (normal range 0.9-5.4)
Bilirubin 16 umol/l (NR 0-18)
ALT 10 IU/l (NR 10-40)
AST 17 IU/l (NR 10-40)
Alkaline phosphatase 130 IU/l (NR 50-100)
What is the diagnosis?
1) Depresseion
2) Primary hyperparathyroidism
3) Chronic renal failure
4) Secondary hyperparathyroidism
5) Bone metastasis due to underlying tumour

2)
A 55 year old male with a 12 year history of diabetes mellitus presents for annual review. He is currently receiving gliclazide at a dose of 80 mg twice daily. Examination reveals a pulse of 76 beats per minute regular and a blood pressure of 152/90 mmHg. Fundal examination reveals bilateral hard exudates. He has loss of vibration sensation in to the ankles but all pulses are palpable.
Investigations reveal the following:
Urine microalbumin = present
Plasma sodium138 mmol/l
Potassium3.8 mmol/l
Urea10.2 mmol/l
Creatinine160 µmol/l
Glucose12.1 mmol/l
HbA1c9.5%
Cholesterol5.5 mmol/l
Triglycerides2.8 mmol/l

Which of the following measures would you adopt to improve this patient's prognosis is?
1 ) ACE inhibitor
2 )Beta-blocker
3 )Increased dose of gliclazide
4 )Add insulin
5 )Aspirin

3)
A 22 year old female presents in the 21th week of pregnancy with profound tiredness and anxiety. Examiantion reveals a tremor, a pulse of 100 beats per minute and a soft bruit heard over the thyroid gland.
Thyroid function tests show a free T4 of 32.9 pmol/l (NR 9.8 - 23.1) and a TSH of 0.04 mu/l (NR 0.5 - 4).
Which of the following treatments would you select for this patient?
1 )Radioactive iodine therapy
2 )Carbimazole
3 )Lithium
4 )Propanolol
5 )Wait and see and repeat her thyroid function test again

4)
A 23 year old female presents with weight gain and a 4 month history of amenorrhoea. Examination reveals a BMI of 33 and mild hirsuitism. Relevant investigations reveal an oestradiol concentration of 1200 pmol/l (NR 130 - 800 pmol/l), a testosterone concentration of 2.8 nmol/l (NR less than 3 nmol/l), a prolactin concentration of 1500 mU/l (NR 50 - 450 mU/l),an LH of 1.2 u/l (NR 1.2 - 8 u/l) and a FSH of 1.5 u/l (NR 1.5 - 8 u/l).
What is the most likely diagnosis:
1) Prolactinoma
2) Polycystic ovaraian syndrome
3) Adrenal tumour
4) Pregnancy
5) Cushing syndrome


ANSWERS: 1) 2 , 2) 1 , 3) 2 , 4) 4