KFP – Haematological presentations

George Holbrook, aged 72, presents for review following a recent hospital admission for anaemia and fatigue. He reports increasing lethargy over the last two months and was found to have a haemoglobin of 78 g/L at the time of admission. He required a transfusion of two units of packed red cells. He denies any overt bleeding but notes darker stools, reduced appetite, and a 3 kg weight loss over the past three months.

Medications: perindopril 5 mg daily, aspirin 100 mg daily

Allergies: Nil known

Past history: Hypertension, osteoarthritis, previous peptic ulcer disease (10 years ago)

Family history: Mother died of colorectal cancer aged 68

Social history: Retired builder, lives with wife, non-smoker, drinks 2-3 standard drinks on weekends

Examination findings: Pale conjunctivae, mild epigastric tenderness, no lymphadenopathy or hepatosplenomegaly

Investigations:

What are the most appropriate next steps in the management of George’s presentation? Select three (3) from the following list:

Imogen Darley, aged 27, presents with progressive fatigue and shortness of breath on exertion for the past month. She has also noticed increased bruising and occasional gum bleeding. She is a vegan and denies alcohol or drug use. She has no regular medications, is not sexually active, and her last menstrual period was five weeks ago. She reports no significant family history of blood disorders.

Past history: Nil significant

Examination findings: Pale, with scattered petechiae on the lower limbs, and mild gum hypertrophy. No hepatosplenomegaly or lymphadenopathy.

Investigations:

What are the most appropriate next steps in Imogen’s care? Select three (3) from the following list:

Thomas Ward, aged 64, presents with night sweats, unintentional weight loss (5 kg over two months), and persistent fatigue. He describes a sensation of fullness in the left upper abdomen and has recently noticed that his shirt collars feel tight due to a ‘puffy’ neck. He denies pain, fever, or cough. His appetite is normal. There is no history of travel, recent infections, or known malignancy.

Past history: Hypertension, hypercholesterolaemia

Medications: amlodipine 5 mg daily, atorvastatin 20 mg daily

Examination findings: Palpable cervical and axillary lymphadenopathy, splenomegaly, no hepatomegaly

Investigations:

What are the most appropriate next steps in the management of Thomas’ presentation? Select three (3) from the following list:

Sophie Blanchard, aged 33, presents with heavy menstrual bleeding for the past six months and increasing fatigue. She describes prolonged periods lasting 7–9 days with clots and recent intermenstrual spotting. She has no significant past medical history and takes no regular medications. She denies pelvic pain, dyspareunia, or abnormal cervical screening history. She works as a teacher and is planning to start trying for a pregnancy in the next six months.

Past history: Nil significant

Family history: Her sister had ‘problems with bleeding’ and was diagnosed with von Willebrand disease (VWD).

Examination findings: Pale conjunctivae. Abdomen soft, non-tender. Pelvic examination normal. No bruising or petechiae.

Investigations:

What are the most appropriate next steps in the management of Sophie’s presentation? Select three (3) from the following list:

Michael Tseng, aged 41, presents with increasing fatigue, headaches, and occasional blurred vision. He reports recent episodes of dizziness and itching after hot showers. He also describes a sensation of fullness in his upper abdomen. He does not smoke, drinks occasionally, and has no significant past medical history.

Medications: Nil

Family history: Father had a myocardial infarction at 52, otherwise unremarkable

Examination findings: Plethoric face, splenomegaly, blood pressure 148/88 mmHg, no lymphadenopathy or bruising

Investigations:

What are the most appropriate next steps in Michael’s management? Select three (3) from the following list:

Lena Moss, aged 56, presents with complaints of bone pain in her lower back and ribs, increasing fatigue, and recurrent respiratory infections over the past four months. She reports unintentional weight loss of 4 kg and night sweats. She is otherwise fit and active and has no prior significant medical history. She takes no regular medications.

Family history: Nil malignancy

Social history: Former smoker, 10-pack-year history, quit 6 years ago. Drinks 2–3 glasses of wine per week.

Examination findings: Mild pallor, localised tenderness over thoracic spine, no lymphadenopathy or hepatosplenomegaly

Investigations:

What are the most appropriate next steps in the management of Lena’s presentation? Select three (3) from the following list:

Bilal Al-Karim, aged 25, presents with a two-week history of jaundice, dark urine, fatigue, and mild abdominal discomfort. He recently returned from a backpacking trip in Southeast Asia. He has no significant past medical history. He denies alcohol or drug use. There is no family history of liver disease or haemolytic disorders.

Medications: Recently took trimethoprim-sulfamethoxazole for a skin infection overseas

Examination findings: Scleral icterus, mild splenomegaly, no lymphadenopathy or hepatomegaly. No stigmata of chronic liver disease.

Investigations:

What are the most appropriate next steps in the management of Bilal’s presentation? Select three (3) from the following list:

Emily Lawson, aged 16, presents with persistent fatigue, low mood, and easy bruising over the past six weeks. She has also noticed frequent nosebleeds and heavy menstrual periods since menarche began at age 13. Her diet is limited due to food aversions and she has lost 2 kg in the past two months. She has no chronic illnesses, and her immunisations are up to date.

Past history: Nil significant

Family history: Mother has hypothyroidism; no known bleeding disorders

Social history: Lives with both parents, Year 11 student, non-smoker

Examination findings: Pale, scattered ecchymoses on upper limbs, mild tachycardia. No hepatosplenomegaly or lymphadenopathy

Investigations:

What are the most appropriate next steps in the management of Emily’s presentation? Select three (3) from the following list:

Andrew Riley, aged 47, presents with recurrent episodes of left calf pain and swelling over the past year. He reports that each episode lasts several days and resolves slowly. He works as a long-haul truck driver and recently returned from a 30-hour interstate trip. Today he presents with a swollen, tender left calf. He denies chest pain or dyspnoea. He smokes occasionally and drinks 1–2 beers per week. His BMI is 32.

Past history: Appendicectomy as a teenager

Family history: His sister had a pulmonary embolism in her 30s; mother had ‘clots in the legs’

Examination findings: Swollen, tender left calf with a difference of 4.5 cm in circumference compared to the right. No pitting oedema, lungs clear, cardiovascular exam unremarkable

Investigations:

What are the most appropriate next steps in the management of Andrew’s presentation? Select three (3) from the following list:

Leila Mohammadi, aged 68, presents with fatigue, anorexia, and a sensation of fullness in her upper abdomen. She has also noted easy bruising and a recent episode of epistaxis. She denies weight loss or night sweats. On questioning, she mentions that she’s had several upper respiratory infections over the past year that were slow to resolve.

Past history: Type 2 diabetes mellitus, osteoarthritis

Medications: Metformin 1000 mg BD, paracetamol PRN

Family history: Her brother died of ‘blood cancer’ at age 60

Examination findings: Mild pallor, petechiae on arms and legs, splenomegaly. No lymphadenopathy

Investigations:

What are the most appropriate next steps in Leila’s management? Select three (3) from the following list:

Samuel Novak, aged 5, is brought in by his parents due to persistent pallor, reduced activity, and bruising over the past month. They report that he has been more lethargic than usual, avoids playing, and has several unexplained bruises on his arms and legs. He has had intermittent low-grade fevers and one episode of a nosebleed. There is no history of trauma or recent infections.

Past history: Unremarkable, immunisations up to date

Family history: Non-contributory

Social history: Attends preschool, lives with both parents, no recent travel

Examination findings: Pale, multiple ecchymoses on limbs, mild hepatosplenomegaly, no lymphadenopathy

Investigations:

What are the most appropriate next steps in the management of Samuel’s presentation? Select three (3) from the following list:

Karen Ellison, aged 39, presents with a 3-month history of fatigue and tingling in her hands and feet. She also reports occasional difficulty with balance and concentration. Her appetite is good and she follows a strict vegan diet. She denies alcohol use. There is no history of gastrointestinal disease or surgery.

Medications: Nil

Examination findings: Pale, mildly ataxic gait, decreased vibration sense in the lower limbs, mild glossitis

Investigations:

What are the most appropriate next steps in the management of Karen’s presentation? Select three (3) from the following list:

Nguyen Tran, aged 62, presents for review of fatigue, pruritus, and a recent diagnosis of portal hypertension. He was previously treated for chronic hepatitis C and achieved sustained virological response. He reports early satiety and has lost 4 kg over the past two months. He also notes intermittent left upper quadrant discomfort. There is no history of alcohol use or recent infections.

Past history: Chronic hepatitis C (treated), hypertension

Medications: Ramipril 5 mg daily

Examination findings: Pale, mild scleral icterus, splenomegaly, no ascites, no peripheral oedema

Investigations:

What are the most appropriate next steps in the management of Nguyen’s presentation? Select three (3) from the following list:

Adrian Wallace, aged 54, presents for review following routine blood tests that showed persistent thrombocytosis over three months. He reports occasional headaches and a burning sensation in his hands and feet. He denies bleeding or bruising. He has no significant past medical history, takes no regular medications, and does not smoke. There is no recent infection, inflammation, or trauma.

Past history: Nil

Family history: Non-contributory

Examination findings: Mild facial erythema, no hepatosplenomegaly, cardiovascular and neurological exams normal

Investigations:

What are the most appropriate next steps in the management of Adrian’s presentation? Select three (3) from the following list:

Fatima Hussein, aged 28, presents with fatigue, shortness of breath on exertion, and dark urine in the mornings. She has no significant past medical history. She reports several urinary tract infections in the past but is otherwise well. She is not taking any regular medications and does not smoke. There is no known family history of anaemia or kidney disease.

Examination findings: Pale conjunctivae, mild jaundice, no lymphadenopathy or hepatosplenomegaly

Investigations:

What are the most appropriate next steps in the management of Fatima’s presentation? Select three (3) from the following list:

Jacob Williams, aged 72, presents with worsening fatigue and easy bruising over several months. He also reports frequent nosebleeds and mild gum bleeding. He has no recent infections or medication changes. He denies alcohol use. His appetite is unchanged, and he has not had any recent weight loss.

Past history: Hypertension, controlled with amlodipine

Medications: Amlodipine 5 mg daily

Family history: Nil significant

Examination findings: Pale, petechiae on lower limbs, mild hepatomegaly, no lymphadenopathy

Investigations:

What are the most appropriate next steps in Jacob’s management? Select three (3) from the following list:

Alisha Singh, aged 22, presents with persistent fatigue and lightheadedness, particularly around her menstrual cycle. She describes heavy periods lasting 6–7 days with clots and has recently become vegetarian. She also reports occasional pica, craving ice and clay. There is no history of gastrointestinal symptoms or chronic illness.

Past history: Nil significant

Medications: Nil

Family history: Nil known bleeding disorders or haematological conditions

Examination findings: Pale, conjunctival pallor, no bruising, no organomegaly, vital signs normal

Investigations:

What are the most appropriate next steps in Alisha’s management? Select three (3) from the following list:

David Kerr, aged 66, presents with increasing fatigue, recent onset of back pain, and unintentional weight loss of 6 kg over two months. He also reports nocturia and persistent thirst. He is a retired accountant with no significant past medical history and takes no medications. He does not smoke and drinks alcohol occasionally.

Examination findings: Mild pallor, no lymphadenopathy or hepatosplenomegaly. Spinal tenderness in the lower thoracic region.

Investigations:

What are the most appropriate next steps in David’s management? Select three (3) from the following list:

Aisha Rahman, aged 31, presents with a 2-week history of increasing fatigue, mild jaundice, and dark urine. She returned from a work trip to Nigeria four weeks ago. She had a brief febrile illness upon return which resolved without treatment. She denies recent medication use and has no known chronic illness.

Past history: Nil significant

Medications: Nil

Family history: Her father was diagnosed with ‘a blood condition’ but she is unsure of the specifics

Examination findings: Scleral icterus, mild splenomegaly, no hepatomegaly or lymphadenopathy. Afebrile.

Investigations:

What are the most appropriate next steps in Aisha’s management? Select three (3) from the following list:

Tom Ellis, aged 60, presents for follow-up after routine blood tests showed isolated lymphocytosis. He reports feeling well with no recent infections, weight loss, or systemic symptoms. He has no history of night sweats, recurrent infections, or bleeding. He is a retired bus driver and has no significant medical history.

Past history: Nil

Medications: Nil

Family history: Non-contributory

Examination findings: No lymphadenopathy or hepatosplenomegaly. Vitals normal.

Investigations (repeat FBC):

What are the most appropriate next steps in the management of Tom’s presentation? Select three (3) from the following list:

Layla Demir, aged 45, presents with sudden onset of bruising on her arms and legs and gum bleeding. She reports no trauma and feels otherwise well. She is not taking any medications, including over-the-counter or herbal supplements. She denies any recent infection, illness, or travel.

Past history: Nil significant

Family history: Nil known bleeding disorders

Examination findings: Multiple ecchymoses on upper and lower limbs, no hepatosplenomegaly or lymphadenopathy

Investigations:

What are the most appropriate next steps in the management of Layla’s presentation? Select three (3) from the following list:

Hassan Noor, aged 36, presents with fatigue, jaundice, and dark urine for the past week. He has a known diagnosis of hereditary spherocytosis but has been largely asymptomatic in adulthood. He recently had an upper respiratory tract infection and has not taken any new medications. He is not anaemic on previous records and reports no family members requiring splenectomy.

Past history: Diagnosed with hereditary spherocytosis as a child

Medications: Nil

Family history: Positive for hereditary spherocytosis in father

Examination findings: Scleral icterus, mild splenomegaly, pale conjunctivae, no lymphadenopathy

Investigations:

What are the most appropriate next steps in the management of Hassan’s presentation? Select three (3) from the following list:

Jordan West, aged 70, presents with new-onset generalised lymphadenopathy noticed over the past month. He reports mild fatigue but no fevers, weight loss, or night sweats. He has no pain or localising symptoms. His appetite is normal, and he is a non-smoker. He has no recent infections or travel.

Past history: Hypercholesterolaemia, managed with atorvastatin

Medications: Atorvastatin 20 mg daily

Examination findings: Non-tender cervical, axillary, and inguinal lymphadenopathy. No hepatosplenomegaly.

Investigations:

Blood film: Small mature lymphocytes, smudge cells present

What are the most appropriate next steps in Jordan’s management? Select three (3) from the following list:

Meera Patel, aged 48, presents with a 3-month history of progressive fatigue, bleeding gums, and heavy menstrual periods. She has also noticed increased bruising without trauma. She has no history of significant illnesses and takes no medications. She has not had recent infections or travel.

Past history: Nil significant

Family history: Mother had menorrhagia; no known haematological disorders

Examination findings: Pale, scattered petechiae on lower limbs, mild gum bleeding. No lymphadenopathy or hepatosplenomegaly.

Investigations:

What are the most appropriate next steps in Meera’s management? Select three (3) from the following list:

Owen Zhang, aged 52, presents with persistent fatigue, exertional breathlessness, and chest discomfort. He also reports occasional episodes of headaches and dizziness. He works as a mine site supervisor in regional WA. He has a 20 pack-year smoking history and lives at high altitude during rostered shifts. No recent travel or infections.

Past history: Hypertension, managed with ramipril

Medications: Ramipril 10 mg daily

Family history: Non-contributory

Examination findings: Ruddy complexion, BP 142/88 mmHg, mild splenomegaly. No clubbing or cyanosis.

Investigations:

What are the most appropriate next steps in the management of Owen’s presentation? Select three (3) from the following list:

Amelia Browne, aged 29, presents with fatigue, pallor, and new bruising on her legs. She has also noticed mild gum bleeding when brushing her teeth. She returned from a trip to South-East Asia two weeks ago where she had a self-limited febrile illness. She is not on any medications and has no significant past history.

Past history: Nil significant

Family history: Nil of note

Examination findings: Pale, petechiae on lower limbs, no hepatosplenomegaly or lymphadenopathy. Afebrile.

Investigations:

What are the most appropriate next steps in the management of Amelia’s presentation? Select three (3) from the following list:

Daniel Russo, aged 34, presents with a 2-week history of low-grade fevers, night sweats, and a painless lump in his neck. He also reports recent fatigue and a 3 kg unintentional weight loss. He works in IT, does not smoke, and drinks occasionally. There is no recent travel, and he is not on any regular medications.

Past history: Nil significant

Family history: Father has hypertension; no malignancies

Examination findings: Non-tender, firm cervical lymphadenopathy (2.5 cm), no hepatosplenomegaly. Vitals stable.

Investigations:

What are the most appropriate next steps in Daniel’s management? Select three (3) from the following list:

Sarah Tomlin, aged 40, presents with persistent fatigue and has noticed her skin appears more pale and yellowish than usual. She denies bleeding, bruising, weight loss, or night sweats. She follows a vegan diet and has done so for over 10 years. She drinks alcohol occasionally and denies smoking or drug use.

Past history: Nil significant

Family history: Nil of note

Examination findings: Pale, mild scleral icterus, smooth tongue, decreased vibration sense in feet

Investigations:

What are the most appropriate next steps in Sarah’s management? Select three (3) from the following list:

Benjamin Lee, aged 59, presents with intermittent headaches, visual disturbances, and a recent episode of epistaxis. He also reports pruritus after warm showers. He has no recent infections or medication changes. He is a non-smoker and drinks socially. On examination, he has a ruddy complexion and mild splenomegaly.

Past history: Hypertension and hyperlipidaemia

Medications: Amlodipine 5 mg daily, atorvastatin 20 mg daily

Family history: Father died of stroke at 70

Investigations:

What are the most appropriate next steps in Benjamin’s management? Select three (3) from the following list:

Emily Grant, aged 32, presents with a 4-month history of heavy menstrual bleeding and fatigue. She reports flow lasting 7–9 days with clots and a need to change sanitary products hourly on heavy days. She has also noticed increased bruising and occasional bleeding gums. There is no personal or family history of known bleeding disorders. She is not on hormonal contraception or anticoagulants and is otherwise well.

Past history: Nil significant

Family history: Nil bleeding disorders

Examination findings: Pale, scattered bruising over forearms and thighs, no lymphadenopathy or hepatosplenomegaly

Investigations:

What are the most appropriate next steps in Emily’s management? Select three (3) from the following list:

Clive Jenkins, aged 75, presents with increasing fatigue, pallor, and weight loss over the past two months. He has also had several recent infections requiring antibiotics. He denies bleeding or bruising. He is a retired farmer with no smoking or alcohol history.

Past history: Type 2 diabetes, osteoarthritis

Medications: Metformin 1000 mg BD, paracetamol PRN

Family history: Nil of note

Examination findings: Pale, mild gum pallor, no lymphadenopathy or hepatosplenomegaly

Investigations:

What are the most appropriate next steps in Clive’s management? Select three (3) from the following list:

Farrah Youssef, aged 36, presents with fatigue, pallor, and a recent history of jaundice and dark urine following treatment with trimethoprim for a urinary tract infection. She reports no prior history of anaemia and is otherwise healthy. She migrated from Egypt as a child.

Past history: Nil significant

Medications: Recently completed a 5-day course of trimethoprim

Family history: Father had ‘a blood issue’ but details unknown

Examination findings: Pale, mild scleral icterus, no hepatosplenomegaly or lymphadenopathy

Investigations:

What are the most appropriate next steps in Farrah’s management? Select three (3) from the following list:

Rita Kowalski, aged 68, presents with progressive fatigue, mild jaundice, and abdominal fullness. She also reports early satiety and unintentional weight loss of 5 kg over 3 months. She denies bleeding, bruising, or infections. She is a non-smoker and does not drink alcohol.

Past history: Hypertension and osteoarthritis

Medications: Perindopril 5 mg daily, paracetamol PRN

Family history: Father died of ‘a blood cancer’ in his 70s

Examination findings: Pallor, massive splenomegaly, no lymphadenopathy or hepatomegaly

Investigations:

What are the most appropriate next steps in Rita’s management? Select three (3) from the following list:

Liam Carter, aged 45, presents with recurrent episodes of leg swelling and tenderness over the past year, each time managed as presumed deep vein thrombosis (DVT), though imaging has only confirmed one episode. He is otherwise well, non-smoker, and not on any long-term medications. There is no personal or family history of cancer. He has no recent travel or immobilisation.

Past history: One confirmed DVT, two prior episodes treated empirically

Medications: Nil currently

Family history: Brother had a pulmonary embolism at age 38

Examination findings: Mild left calf swelling, no varicosities or skin changes. Vitals normal.

Investigations:

What are the most appropriate next steps in Liam’s management? Select three (3) from the following list:

Monique Delaney, aged 57, presents with new fatigue and shortness of breath on exertion. She mentions she has felt increasingly tired over the past 2 months and has experienced two minor nosebleeds in the last week. She also reports mild lower back pain. She denies any fever, recent illness, bruising or weight loss.

Past history: Type 2 diabetes (well controlled), hysterectomy at 45 for fibroids

Medications: Metformin 500 mg BD

Family history: Sister has rheumatoid arthritis

Examination findings: Pale, no lymphadenopathy, no hepatosplenomegaly

Investigations:

What are the most appropriate next steps in Monique’s management? Select three (3) from the following list:

Sofia Nguyen, aged 24, presents with easy bruising, heavy menstrual periods, and prolonged bleeding after dental work. These symptoms have been present since childhood but have become more noticeable over the past year. She is otherwise well and takes no regular medications. There is no history of recent infection or trauma.

Past history: Nil significant

Family history: Maternal uncle with a bleeding disorder, details unknown

Examination findings: Multiple small bruises on arms and thighs, no hepatosplenomegaly or lymphadenopathy

Investigations:

What are the most appropriate next steps in Sofia’s management? Select three (3) from the following list:

Michael Fraser, aged 62, presents with generalised fatigue and pruritus, especially after a hot shower. He has also had two episodes of spontaneous nosebleeds and a recent history of gout. He has no history of travel, infection, or recent medication changes.

Past history: Hypertension, gout

Medications: Allopurinol 100 mg daily, amlodipine 5 mg daily

Family history: Nil significant

Examination findings: Ruddy complexion, palpable splenomegaly. No lymphadenopathy.

Investigations:

What are the most appropriate next steps in Michael’s management? Select three (3) from the following list:

Arjun Singh, aged 33, presents with worsening fatigue, shortness of breath, and pale skin. He recently migrated from India and has been following a vegetarian diet. He denies alcohol use and has not had any recent infections or weight loss.

Past history: Nil known

Medications: Nil

Family history: Cousin diagnosed with thalassaemia in India

Examination findings: Pale conjunctivae, mild splenomegaly, no jaundice or lymphadenopathy

Investigations:

What are the most appropriate next steps in Arjun’s management? Select three (3) from the following list:

Isabella Moore, aged 63, presents with a 3-month history of easy bruising and fatigue. She reports bleeding gums and a recent episode of prolonged bleeding after a minor cut. There is no fever, weight loss, or night sweats. She has no previous history of bleeding issues and takes no regular medications.

Past history: Nil significant

Family history: Nil of note

Examination findings: Pale, multiple bruises on upper limbs, no hepatosplenomegaly or lymphadenopathy

Investigations:

What are the most appropriate next steps in Isabella’s management? Select three (3) from the following list:

Ahmed Suleiman, aged 47, presents with ongoing fatigue, mild jaundice, and dark urine. He has a history of hereditary spherocytosis diagnosed in childhood but has not required treatment since. He reports a recent mild viral illness and now feels increasingly tired. He is not on any medications.

Past history: Hereditary spherocytosis (not splenectomised)

Family history: Father had the same condition

Examination findings: Scleral icterus, mild splenomegaly, pale conjunctivae

Investigations:

What are the most appropriate next steps in Ahmed’s management? Select three (3) from the following list:

Natalie Baxter, aged 26, presents with a 3-month history of fatigue and increasing shortness of breath when climbing stairs. She also reports a craving for ice and chewing pencils. She follows a vegetarian diet and has heavy periods lasting 7–8 days. She denies gastrointestinal symptoms, weight loss, or changes in appetite.

Past history: Nil significant

Medications: Nil

Family history: Nil of note

Examination findings: Pale conjunctivae, brittle nails, no lymphadenopathy or hepatosplenomegaly

Investigations:

What are the most appropriate next steps in Natalie’s management? Select three (3) from the following list:

Samuel McKenzie, aged 50, presents with sudden onset of widespread bruising and gum bleeding. He has no history of trauma, liver disease, or alcohol use. He takes no medications other than paracetamol. He had a flu-like illness about three weeks ago but has since recovered.

Past history: Nil significant

Family history: Nil known bleeding disorders

Examination findings: Multiple large ecchymoses, scattered petechiae, no hepatosplenomegaly or lymphadenopathy

Investigations:

What are the most appropriate next steps in Samuel’s management? Select three (3) from the following list:

Fatima Almasi, aged 39, presents with persistent fatigue, lower back pain, and occasional nosebleeds over the past month. She also notes increased thirst and recent constipation. She denies any infections, trauma, or recent travel. Her diet is balanced and she does not take supplements.

Past history: Nil significant

Family history: Nil malignancy or bleeding disorders

Examination findings: Pale, mild tenderness over the lower spine, no lymphadenopathy or hepatosplenomegaly

Investigations:

What are the most appropriate next steps in Fatima’s management? Select three (3) from the following list:

Thomas Reilly, aged 72, presents with fatigue, early satiety, and increasing abdominal discomfort over the past two months. He also reports unintentional weight loss of 6 kg. There is no bleeding, bruising, or recent infections. He is a retired engineer with no recent travel or known exposures.

Past history: Hypertension, controlled

Medications: Perindopril 5 mg daily

Family history: Non-contributory

Examination findings: Pale, massive splenomegaly, no lymphadenopathy

Investigations:

What are the most appropriate next steps in Thomas’s management? Select three (3) from the following list:

Emily Novak, aged 46, presents with easy bruising and gum bleeding over the past two weeks. She also reports fatigue and low-grade fevers. She has no history of travel, no medication use, and no family history of bleeding disorders. She works as a primary school teacher.

Past history: Nil significant

Examination findings: Pale, scattered petechiae and ecchymoses, mild gingival bleeding, no hepatosplenomegaly or lymphadenopathy

Investigations:

What are the most appropriate next steps in Emily’s management? Select three (3) from the following list:

Leo Zhang, aged 35, presents with mild jaundice, dark urine, and fatigue. He reports that symptoms worsened after a recent course of nitrofurantoin for a urinary tract infection. He has no significant past medical history but recalls his brother being told he had a ‘red cell issue’. Leo follows a balanced diet and does not drink alcohol.

Past history: Nil known

Medications: Recently completed nitrofurantoin course

Family history: Brother with haemolytic anaemia of uncertain type

Examination findings: Mild scleral icterus, no hepatosplenomegaly, no lymphadenopathy

Investigations:

What are the most appropriate next steps in Leo’s management? Select three (3) from the following list:

Jonathan Hughes, aged 67, presents with progressive fatigue, weight loss, and early satiety. He also reports night sweats and occasional fevers over the past 2 months. He denies recent infections or travel. He is a retired accountant and lifelong non-smoker.

Past history: Hypertension, well controlled

Medications: Amlodipine 5 mg daily

Family history: Nil of note

Examination findings: Pale, firm non-tender cervical and axillary lymphadenopathy (up to 3 cm), moderate splenomegaly

Investigations:

What are the most appropriate next steps in Jonathan’s management? Select three (3) from the following list:

Olivia Taylor, aged 55, presents with persistent fatigue, frequent headaches, and facial redness. She also reports recent episodes of blurred vision and pruritus, particularly after hot showers. She is a non-smoker and drinks occasionally. Her blood pressure today is 148/86 mmHg.

Past history: Migraine (in remission)

Medications: Nil regular

Family history: Father had a ‘blood condition’ treated with venesection

Examination findings: Ruddy complexion, no lymphadenopathy, mild splenomegaly

Investigations:

What are the most appropriate next steps in Olivia’s management? Select three (3) from the following list:

Clara Mendes, aged 28, presents with easy bruising and menorrhagia since her teenage years. She has recently been diagnosed with iron deficiency anaemia and reports increased bruising over her legs and arms after minimal trauma. She is otherwise well and takes no medications.

Past history: Heavy menstrual bleeding since menarche

Medications: Nil

Family history: Mother had a ‘bleeding tendency’ but was never formally diagnosed

Examination findings: Multiple ecchymoses on shins and forearms, no hepatosplenomegaly, no lymphadenopathy

Investigations:

What are the most appropriate next steps in Clara’s management? Select three (3) from the following list:

James O’Donnell, aged 70, presents with fatigue, night sweats, and a feeling of fullness in the left upper abdomen. He has also noticed some unintentional weight loss over the past three months. He denies recent infections or travel and has no personal or family history of malignancy.

Past history: Type 2 diabetes, hypertension

Medications: Metformin 1 g BD, amlodipine 5 mg daily

Examination findings: Mild pallor, palpable spleen extending 5 cm below costal margin, no lymphadenopathy

Investigations:

What are the most appropriate next steps in James’s management? Select three (3) from the following list: