Haematology – Oncology Question Bank

 

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#1. A 5-month-old infant has severe pallor since birth. Examination demonstrates triphalangeal thumbs. Investigations: Hb 5.2 g/dL, Reticulocyte count very low, WCC normal, Platelets normal. What is the most likely diagnosis?

#2. A 5-year-old boy presents with recurrent diarrhoea, poor growth and repeated bacterial infections. Investigations reveal neutropenia. Pancreatic elastase is markedly reduced. What is the most likely diagnosis?

#3. A 13-year-old boy presents with progressive pain around the distal femur for two months. The pain is worse at night. Radiography demonstrates a sunburst periosteal reaction. What is the most likely diagnosis?

#4. A 2-year-old boy presents with abdominal distension. Examination reveals a firm abdominal mass that crosses the midline. He has periorbital bruising and hypertension. Urinary VMA levels are elevated. What is the most likely diagnosis?

#5. A 4-year-old boy has recurrent bacterial infections, eczema and persistent neutropenia. Bone marrow examination is normal. Neutrophil count increases following administration of G-CSF. What is the most appropriate long-term management?

#6. A 3-year-old boy presents with fever, irritability and refusal to walk. Examination demonstrates marked hepatosplenomegaly and generalized lymphadenopathy. Investigations: Hb 7.1 g/dL, WCC 2.8 x10^9/L, Platelets 42 x10^9/L. Peripheral blood film shows no circulating blasts. What is the next best investigation?

#7. A 7-year-old boy with beta-thalassaemia major attends clinic for routine review. He has received monthly blood transfusions since infancy. His serum ferritin is 2,800 ug/L. What is the most appropriate long-term management?

#8. A 12-year-old boy with relapsed acute lymphoblastic leukaemia is being evaluated for curative treatment. Which treatment offers the greatest chance of long-term cure?

#9. A 3-year-old boy presents with progressive abdominal distension and weight loss. Examination reveals a large right-sided abdominal mass that does not cross the midline. Urinalysis demonstrates microscopic haematuria. What is the most likely diagnosis?

#10. A 10-year-old boy with sickle cell disease develops sudden pallor and lethargy after a viral illness. Investigations: Hb has fallen from 8.7 g/dL to 3.9 g/dL, Reticulocyte count is markedly reduced. What is the most likely cause?

#11. A 10-year-old girl develops progressive fatigue and recurrent bacterial, fungal and HPV infections. Bone marrow examination demonstrates monocytopenia. Which inherited disorder is most likely?

#12. A 6-year-old child presents with fever, thrombocytopenia and acute kidney injury after a bloody diarrhoeal illness. Blood film demonstrates fragmented red blood cells. Which diagnosis is most likely?

#13. A 5-year-old boy develops fever, lethargy and rapidly enlarging cervical lymph nodes. Chest radiograph demonstrates a large anterior mediastinal mass. What is the most important initial concern?

#14. A 13-year-old boy presents with persistent pain involving the pelvis. Radiography demonstrates an onion-skin periosteal reaction. What is the most likely diagnosis?

#15. A 6-year-old child develops fever, bone pain and gingival swelling. Investigations: Hb 6.8 g/dL, Platelets 34 x10^9/L, WCC 62 x10^9/L. Peripheral smear demonstrates myeloblasts with Auer rods. What is the most likely diagnosis?

#16. A 9-year-old boy develops severe back pain and progressive weakness of both legs. MRI demonstrates an epidural tumour compressing the thoracic spinal cord. What is the best immediate management?

#17. A 7-year-old boy with acute myeloid leukaemia develops bleeding from venepuncture sites. Investigations: Platelets 18 x10^9/L, PT prolonged, aPTT prolonged, Fibrinogen low, D-dimer markedly elevated. What complication has occurred?

#18. A 4-year-old boy with acute lymphoblastic leukaemia suddenly develops severe headache, vomiting and confusion. CT brain demonstrates an intracranial haemorrhage. His platelet count is 6 x10^9/L. What is the most urgent treatment?

#19. A 4-year-old child with acute lymphoblastic leukaemia develops persistent headache and repeated vomiting during maintenance chemotherapy. Neurological examination reveals bilateral papilloedema. What is the most appropriate next investigation?

#20. A 2-year-old child presents with an enlarging abdominal mass. Ultrasound demonstrates a renal tumour confined to one kidney. Which diagnosis is most likely?

#21. A 7-month-old infant has recurrent skin abscesses and pneumonia since birth. Investigations: ANC 0.1 x10^9/L. Bone marrow examination demonstrates maturation arrest of neutrophil precursors. What is the most likely diagnosis?

#22. A 15-year-old girl presents with fatigue, bruising and recurrent infections. Investigations: Hb 6.4 g/dL, WCC 1.4 x10^9/L, Platelets 18 x10^9/L. Bone marrow biopsy demonstrates a markedly hypocellular marrow without malignant infiltration. What is the most likely diagnosis?

#23. A 5-year-old boy presents with severe anaemia after eating fava beans. Peripheral blood film demonstrates bite cells. Which enzyme deficiency is responsible?

#24. A 7-year-old boy has recurrent epistaxis, fatigue and easy bruising. He has short stature, cafe-au-lait pigmentation and absent thumbs. Investigations show pancytopenia. Which inherited disorder is the most likely diagnosis?

#25. A 6-year-old girl presents with fever, petechiae and recurrent infections. Bone marrow demonstrates hypocellularity. Chromosomal breakage studies are normal. Which diagnosis is most likely?

#26. A 9-year-old child receiving chemotherapy develops severe mucositis and persistent fever despite broad-spectrum antibiotics. Blood cultures grow Candida albicans. What is the most appropriate treatment?

#27. A 2-month-old infant presents with profound anaemia requiring repeated transfusions. Examination demonstrates craniofacial abnormalities and triphalangeal thumbs. Which gene abnormality is most commonly associated with this condition?

#28. A 3-year-old boy presents with pallor and recurrent infections. Bone marrow examination demonstrates ring sideroblasts and vacuolated erythroid precursors. Which diagnosis is most likely?

#29. A 5-year-old boy develops persistent neutropenia, extensive viral warts and recurrent bacterial infections. Bone marrow examination demonstrates neutropenia without maturation arrest. Which inherited syndrome is most likely?

#30. A 10-year-old girl presents with fever, pallor and diffuse bone pain. Investigations: Hb 6.4 g/dL, Platelets 24 x10^9/L, WCC 78 x10^9/L. Flow cytometry demonstrates CD10-positive lymphoblasts. What is the most likely diagnosis?

#31. A previously healthy 4-year-old boy is brought to the emergency department because of increasing fatigue over 3 weeks. His mother reports intermittent fever, refusal to walk because of leg pain, and bruises appearing after minimal trauma. On examination he is pale with petechiae, cervical lymphadenopathy and hepatosplenomegaly. Investigations: Hb 5.8 g/dL, WCC 38 x10^9/L, Platelets 18 x10^9/L. What is the most likely diagnosis?

#32. A 9-year-old boy with newly diagnosed Burkitt lymphoma develops vomiting and muscle cramps 12 hours after chemotherapy. Investigations: Potassium 6.9 mmol/L, Phosphate elevated, Calcium low, Creatinine rising. What is the most likely diagnosis?

#33. A 6-year-old girl presents with fatigue and jaundice. Examination demonstrates splenomegaly. Investigations: Hb 8.4 g/dL, MCHC elevated, Blood film shows numerous spherocytes, Direct Coombs test negative. What is the most likely diagnosis?

#34. A 3-year-old boy develops jaundice and cola-coloured urine one day after receiving trimethoprim-sulfamethoxazole. Blood film demonstrates bite cells and Heinz bodies. What is the most likely diagnosis?

#35. A 12-year-old boy presents with fever, pallor and bleeding gums. Investigations: Hb 5.9 g/dL, Platelets 16 x10^9/L, WCC 118 x10^9/L. Bone marrow demonstrates greater than 25% lymphoblasts. Which diagnosis is most likely?

#36. A previously healthy 5-year-old girl develops widespread petechiae one week after recovering from influenza. She is otherwise well. Investigations: Hb normal, WCC normal, Platelets 7 x10^9/L. What is the most likely diagnosis?

#37. A 14-year-old girl presents with recurrent epistaxis and heavy menstrual bleeding. Examination is otherwise normal. Investigations: Hb 11.9 g/dL, WCC 6.8 x10^9/L, Platelets 9 x10^9/L. Blood film shows isolated thrombocytopenia with large platelets. What is the most likely diagnosis?

#38. A 9-year-old girl receiving chemotherapy develops facial swelling, distended neck veins and increasing respiratory distress. What is the most likely oncological emergency?

#39. A 15-year-old boy presents with fever, bruising and gingival hypertrophy. Peripheral blood demonstrates circulating blasts. Which feature most strongly suggests acute myeloid leukaemia rather than acute lymphoblastic leukaemia?

#40. A 6-year-old girl is receiving induction chemotherapy for acute lymphoblastic leukaemia. She develops a temperature of 39.3C. She is alert and haemodynamically stable. Investigations: ANC 0.1 x10^9/L, Hb 8.4 g/dL, Platelets 76 x10^9/L. What is the best initial management?

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