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Haematology

Haematological Examination

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CANDIDATE INSTRUCTIONS

You are a foundation doctor working in general practice. Patricia Jones, a 45-year-old patient has come in complaining of fever, pallor and persistent fatigue. As part of your work up, perform a full haematological examination on the patient. You are not required to take a history.

  1. Perform a haematological examination and report your findings.

  2. At 8 minutes, the examiner will ask further questions.

2 Minutes Reading Time

10 Minutes Station Time

Total 12 Minutes

EXAMINER INSTRUCTIONS

Timing Instructions: At 8 minutes, stop the candidate and ask the following questions:

Question 1: What are your differential diagnoses based on your physical findings?

Answer 1: 

  • Leukaemia

  • Non-Hodgkin's lymphoma

  • Lymphoma

  • Infection (Viral Hepatitis, Ebstein-Barr Virus infection, Cytomegalovirus infection)

  • Chronic Liver Disease with portal hypertension

  • Sarcoidosis

Question 2: What is the most likely diagnosis? 

Answer 2: Leukaemia

Question 3: What is the most important investigation to order as part of confirming your diagnosis?

Answer 3: Very urgent Full Blood Count (within 48 hours)

Question 4: What would you expect to see in the Full Blood Count of this patient?

Answer 4:

  • Anaemia

  • Leucopaenia

  • Thrombocytopaenia

  • Leukaemia

PATIENT INSTRUCTIONS

  • Patient details:

    Name: Patricia Jones

    Age: 55 Years Old

    Date of Birth: 3 October 1979

    Location: General Practice

    Occupation: Secretary

  • Heart rate: 80 bpm

    Blood Pressure 145/75 mmHg

    Respiratory rate: 14

    Oxygen saturations: 100% on Room air

    Temperature: 38.4 degrees Celsius

    • General Inspection: Pallor; bruises and petechiae noted on upper and lower limbs

    • Face inspection: pallor in the conjunctiva of the eyes, swollen gums in the mouth

    • Axillary examination: palpable enlarged axillary lymph nodes bilaterally, rubbery and hard in nature

    • Neck examination: palpable enlarged cervical lymph nodes in the submandibular and supraclavicular regions, rubbery and hard in nature

    • Abdominal examination: Palpable enlarged lymph nodes in the inguinal region, rubbery and hard in nature. Liver and spleen enlarged on palpation. Liver span 20cm.

MARK SCHEME

Introduction

General Inspection

Hand Inspection

Axillary Examination

Face Inspection

Mouth Inspection

Neck Examination

Abdominal Examination

Leg Inspection

Leg Examination

Endpieces

Questions

Patient Scores

Enter Your Score Here: /36

SCORE GUIDE

High Pass: > 29

Pass: > 22

Borderline Pass: 18 – 22

Fail: < 18

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