FRCPath Haem Part 1 Exam EMQs-Haemostasis 82 and 83

Options

A. Acute portal vein thrombosis

B. Chronic portal vein thrombosis with portal cavernoma

C. Budd–Chiari syndrome

D. Acute mesenteric vein thrombosis

E. Splenic vein thrombosis

F. Myeloproliferative neoplasm-associated SVT

G. Paroxysmal nocturnal haemoglobinuria (PNH)

H. Cirrhosis-associated portal vein thrombosis

I. Antiphospholipid syndrome-associated SVT

J. Intestinal infarction secondary to SVT

K. JAK2 V617F mutation-associated SVT

L. Factor V Leiden-associated SVT

M. DOAC-associated management strategy

N. LMWH preferred strategy

O. Indefinite anticoagulation indicated

Questions

Question 1

A 42-year-old woman presents with progressive abdominal distension, right upper quadrant pain and tender hepatomegaly. She recently started the oral contraceptive pill. Examination reveals ascites and mild jaundice. Doppler ultrasound demonstrates absent hepatic venous flow. Liver biopsy shows centrilobular congestion.

Which is the SINGLE BEST diagnosis?

Question 2

A 61-year-old man with longstanding alcohol-related cirrhosis undergoes surveillance ultrasound which demonstrates partial thrombosis of the portal vein. He has large oesophageal varices on endoscopy and platelet count is 48 ×109/L. He has no abdominal pain.

Which is the MOST appropriate anticoagulation strategy initially?

Question 3

A 36-year-old man presents with severe central abdominal pain out of proportion to examination findings. CT abdomen demonstrates thrombosis of the superior mesenteric vein with bowel wall oedema and early pneumatosis intestinalis.

What is the MOST likely complication developing?

Question 4

A 29-year-old woman presents with acute abdominal pain two weeks postpartum. Imaging confirms portal vein thrombosis extending into the splenic vein. Blood counts show Hb 175 g/L, WBC 14 ×109/L and platelets 620 ×109/L. JAK2 V617F mutation is positive.

What is the MOST likely underlying prothrombotic disorder?

Question 5

A 48-year-old man with haemolytic anaemia develops hepatic vein thrombosis. Flow cytometry demonstrates absence of CD55 and CD59 on granulocytes.

What is the MOST likely underlying diagnosis?

Question 6

A 55-year-old woman presents with upper gastrointestinal bleeding due to gastric varices. CT imaging reveals isolated thrombosis of the splenic vein secondary to chronic pancreatitis.

Which is the SINGLE BEST diagnosis?

Question 7

A 40-year-old woman with no liver disease develops acute portal vein thrombosis after abdominal sepsis. She is treated with LMWH followed by warfarin. Repeat imaging at 9 months demonstrates complete recanalisation and no persistent risk factor is identified.

What is the MOST appropriate duration of anticoagulation?

Question 8

A 63-year-old man with non-cirrhotic portal vein thrombosis is found to carry antiphospholipid antibodies and has a prior history of lower limb DVT. He has no active bleeding and renal function is normal.

What is the MOST appropriate long-term management strategy?

Question 9

A 58-year-old man with Child-Pugh C cirrhosis develops symptomatic portal vein thrombosis. He has thrombocytopenia and previous variceal bleeding.

Which anticoagulant approach is considered SAFEST according to practical guideline-based management?

Question 10

A 34-year-old woman presents with chronic abdominal discomfort and splenomegaly. Imaging demonstrates cavernous transformation of the portal vein with extensive periportal collateral vessels.

Which is the SINGLE BEST diagnosis?