Answer to Q9/1, Q9/2, Q on 4/9/08

Answer to Q9/1: D

Bleeding piles, bleeding diverticulae and carcinoma of the large bowel can all cause sufficient bleeding to result in an iron deficiency anaemia which would give a hypochromic microcytic pattern on microscopic examination of the blood.
Normocytic normochromic anaemia is more likely to be caused by chronic disease such as chronic renal failure. It could also result from marrow suppression due to drugs or myelofibrosis or combined Fe/B12 deficiency.

Answer to Q9/2: A


DVT and pulmonary embolism are associated with an underlying diagnosis of cancer, particularly cancer of visceral organs such as the pancreas. Recurrent DVT is associated even more strongly with metastatic disease. There is no strong association between the other conditions listed and recurrent DVT, although smoking in combination with the oral contraceptive pill is a risk factor for DVT.

Answer for the question posted on sept 4 (consent of immunisation) is B

Consent is legally valid if all of the following have been fulfilled. The:
person giving consent has the legal and intellectual capacity to do so
consent is given voluntarily
consent is given after explanation of the benefits and risks of the relevant vaccine(s)
person giving consent has had suitable opportunity to find out further relevant information
A child's parent or legal guardian usually has the authority to provide vaccination consent. In this instance, a person is a child if they are under 18 years of age in all Australian states or territories except:
New South Wales where a person under 14 years of age is defined as a child
South Australia and the Northern Territory where a person under 16 years of age is defined as a child
Children of particular maturity and age may be able to consent to vaccination. State and territory immunisation service provider guidelines should be consulted for information on consent from children. Children who refuse vaccinations consented to by their parent/legal guardian should have their wishes respected and the parent/guardian informed.
Consent needs to be documented in the person's medical records. When a vaccination program is explained and consented to at a visit and agreed to vaccinations are provided at other visits, explicit verbal consent is required before each vaccination at the subsequent visits irrespective of whether the original consent was verbal or written.

On pneumococcal vaccine,
The correct response is (a).
Provided they are well, babies born preterm should be immunised according to the standard schedule, beginning at birth, and without correction for prematurity. Preterm babies have adequate antibody responses to most vaccines and are at increased risk for vaccine-preventable diseases. So babies still in hospital at 2 months after birth should be given DTPa, hepatitis B, Haemophilus influenzae type b (Hib), IPV, pneumococcal conjugate, and rotavirus vaccines.
Preterm babies may not respond optimally to hepatitis B, Hib and pneumococcal vaccination. Babies born before 28 weeks gestation (and some other babies) require an extra dose of PRP-OMP and pnemococcal vaccines. It is recommended that babies born before 32 weeks gestation (and those weighing less than 2000 g at birth) receive hepatitis B vaccine at 0, 2, 4 and 6 months and then a booster at 12 months. The 12-month booster can be left out if the anti-HBs response is measured at 7 months and found to be 10 mIU/mL or greater.
Preterm babies who continue to experience health issues at 6 months should receive influenza vaccination - especially if the problems are cardiac, neurological or respiratory.
Up to the age of 2 months, babies born before 37 weeks should be vaccinated using the same needle gauges and insertion angles as full-term babies but a 16 mm length needle should be used rather than 25 mm. Routine vaccinations in preterm babies in hospital can cause increased apnoea. Routine vaccinations are not associated with increased apnoea in babies at home and are not associated with increased Sudden Infant Death Syndrome (SIDS) risk.