Gp neelima hemaphology and onkolgy Welcome to your Gp neelima hematology and oncology 27-01-17 Name Business Email Phone Number A 15-year-old girl presents with bilateral cervical lymphadenopathy. Her lymph node biopsy reveals a nodular sclerosing Hodgkin´s disease (HD). Which one of the following features indicates a poorer prognosis? Fatigue Mass of >10 cm Dry skin Pruritis Recent Epstein-Barr virus (EBV) infection Hint A 70-year-old man with one-month old dyspnea and 3kg weight loss has a large left pleural effusion confirmed on chest X-ray. Pleural fluid analysis reveals a Protein of 39 g/L with a few lymphocytes and red blood cells. Which one of the following investigations should be considered next? Bronchoscopy Repeat pleural aspiration with biopsy CT scan pleural aspiration with biopsy Thoracoscopic pleural biopsy Tuberculin test Hint A 25-year-old man with a teratoma of the testis attended for review following chemotherapy. Which one of the following serum tumour markers is of most value in monitoring the clinical progression of his disease? Carbohydrate antigen CA 15-3 Carbohydrate antigen CA 19-9 Alpha-fetoprotein Carbohydrate antigen CA 125 Carcinoembryonic antigen Hint A 39-year-old presents with a two week history of recurrent hemoptysis which he has noted over the last 17 months. Having no chest pain, he is a smoker of 5 cigarettes daily. CXR reveals collapse of the left lower lobe. What is the most likely diagnosis? Bronchial Carcinoid Bronchial carcinoma Bronchiectasis Inhaled foreign body Pulmonary embolism Hint In which of the following cases of lung cancer would surgical resection of the tumor be a reasonable therapeutic option? A 57-year-old woman with an adenocarcinoma of the right lung. CT scan shows enlarged lymph nodes in the right and left hilum. PFTs show an FEV1 of 2.25 L. (55% predicted). A 71-year-old man with a 3 cm tumor obstructing the right lower lobe bronchus. Lung function tests show an FEV1 of 2.1 L. (60% predicted). A 58-year-old man is found at bronchoscopy to have a tumor in the right mainstem bronchus extending to within 1 cm of the carina. Pulmonary function tests (PFTs) show an FEV1 of 2.1 liters (65% of predicted normal. A 61-year-old lady with a small peripheral mass who has elevated liver enzymes and a COMPUTEDtomography (CT) scan showing probable metastatic deposits in the liver Lung function tests dhow an FEV1 of 3.5 liters (80% of predicted normal) A 70-year-old man with a right lower lobe tumor 2 cm in diameter with no evidence of regional adenopathy or distant spread of disease lung function studies show an FEV1 of 0.8 liters (28% predicted). Hint The most characteristic lab finding in a patient with hemolytic anemia is Increased haptoglobin Reticulocytosis MCV < 80 Abnormal Hb electrophoresis Hint Epithelial ovarian cancer is characterized by all of the following EXCEPT The normal function of the p53 gene may be lost. Oncogenes can encode growth factors or their receptors. It is a polyclonal disease, arising from a multiple cells. Surface epithelial cells may express transforming growth factor alpha and its epidermal receptor. Cytokines stimulate its growth. Hint A patient on total parenteral nutrition develops pancytopenia. What is the most likely deficiency? Magnesium Selenium Zinc Copper Chromium Hint A 27 year old female presented to her physician with symptoms of a fever of 103°, enlarged axillary lymph nodes, weight loss, and night sweats for the duration of one month. Her PPD test was negative. Bone-marrow biopsy revealed Reed-Sternberg cells. The most appropriate diagnosis is Systemic lupus erythematosus. Pulmonary tuberculosis Crohn´s disease Hodgkin´s disease Sarcoidosis Hint A 44 year old female with acute promyelocytic leukemia suddenly presents with acute gastrointestinal bleeding, epistaxis, and evidence of hemolysis. She is diagnosed with disseminated intravascular coagulation (DIC). Which of the following statement is FALSE regarding DIC? Most cases of DIC are associated with malignant neoplasms, Gram-negative sepsis, liver disease, and obstetric complications. Infusions of cryoprecipitate or fresh-frozen plasma may be given if bleeding is the major complication. Thrombocytopenia, hyperfibrinogenemia, and low levels of fibrin degradation products are all associated with disseminated intravascular coagulation. DIC is the consequence of intravascular activation of both the coagulation and fibrinolytic systems. DIC can be chronic or acute and can present with either bleeding or microvascular thrombosis. Hint Abnormalities in the p53 protein usually Cause polyploidy. Enhance necrosis. Increase enzyme synthesis. Suppress apoptosis. Decrease synthesis of Rb protein. Hint A 27 year old man presents with weakness, anemia, and left sided abdominal pain. He was found to have massive splenomegaly on examination. Which of the following is NOT a cause of massive splenomegaly? Gaucher´s disease. Hodgkin´s disease. Chronic myelogenous leukemia. Sickle cell anemia. Malaria. Hint A patient has long-standing hemolytic anemia characterized by hypochromic cells. Electrophoresis studies demonstrate a near complete absence of beta by DealXplorer" href="http://www.interface.edu.pk/medical-exams/test.php?u=33509&t=196865&Page=13#4213016">CHAINS. Several years later, the patient develops pulmonary edema, ascites, and peripheral edema, and complains that he feels weak all the time. The most likely contributing factor is the intracardiac deposit of which of the following? Amyloid deposition Calcium Fibrous tissue Iron Sodium Hint A 32 year old man presents with history of fevers and night sweats. CT scan reveals masses involving the mediastinal nodes, abdominal nodes, and liver. Biopsy of one of the nodes demonstrates a nodular lymphoma with nodular areas composed predominately of small (6-12 micrometer) lymphocytes with scant cytoplasm and irregular, twisted, and indented nuclei. This lymphoma is most closely linked to a translocation involving Immunoglobulin heavy CHAIN and bcl-1 Immunoglobulin heavy chain and bcl-2 Immunoglobulin heavy chain and myc Kappa Immunoglobulin LIGHT chain and myc Lambda Immunoglobulin light chain and myc Hint A 4th year medical student is evaluating a patient with red blood cell disorder. The student is asked to follow up on admission testing. She is considering sickle cell anemia and thalassemia major in her differential. The manifestations common to both disorders is Autosplenectomy Bone marrow expansion in the calvarium Ineffective erythropoiesis Predisposition to Hemophilus influenzae infections Sickling of erythrocytes Hint A severely ill hospitalized patient develops a coagulopathy characterized by prolongation of the prothrombin time (PT) and partial thromboplastin time (PT) with a reduced platelet count. Acute anuria and uremia develop several hours later. The patient´s blood pressure is initially high normal, but then later falls as he is dying. The major finding seen at autopsy would be Chronic cortical inflammation with tubular atrophy and interstitial fibrosis Diffuse cortical necrosis Patchy papillary necrosis Small uric acid stones in the renal pelvis Staghorn calculi Hint A 5 year old boy is brought to the emergency department when he develops severe extremity pain after playing in the snow. The emergency room physician notes that the child has two fingers that are shorter than expected, and orders a peripheral blood smear. Sickle shaped cells are present in the smear. This child most likely has which of the following red blood cell abnormalities? Absent alpha-globin CHAIN Absent beta-globin chain Spectrin deficiency Hexose monophosphate shunt enzyme defect Beta-globin point mutation Hint Which of the following is true regarding deoxygenation induced polymerization? Sickle fibers consist of a helical polymer with 141 strands. The rate at which polymerization occurs is dependent on the extracellular concentration of hemoglobin S. Hemoglobin F inhibits the polymerization of hemoglobin S. Alkalosis promotes intracellular polymerization. Hemoglobin F participates more readily than hemoglobin A in copolymerization with hemoglobin S. Hint A 64 year old woman is brought to the emergency department after falling on an icy sidewalk. She fractured her hip and is found to have a low bone density, thought to be due to a malignant tumor. She also has a history of recurrent pneumonia over the last 6 months. Investigations reveal a normal WBC count, but decreased platelets and serum albumin with an elevated ESR. Serum electrophoresis indicates an M protein spike band of IgG kappa. The urine will show the presence of Bence Jones protein composed of Kappa light chains Kappa and lambda light chains of a 60:40 ratio IgG heavy CHAINS Lambda light chains Monomer IgG Hint A 14 year old child has a skull X-ray film taken after a fall from a skateboard. The X-ray film does not show any fractures, however, it does show the changes illustrated in the accompanying image. The hematologic process that would most likely produce these changes is Acute lymphoblastic leukemia Hodgkin disease Iron deficiency anemia Multiple myeloma Sickle cell anemia Hint Transfusion reactions are most common in which of the following individuals? AB+ individuals. Individuals who have received many transfusions. Children. The elderly. Immunocompromised hosts. Hint Which of the following does NOT characterize methemoglobinemia? Heme iron, in the Fe3+ state, is incapable of binding oxygen. It may result from a deficiency of cytochrome b5 reductase. It causes a shift to the left of the oxyhemoglobin dissociation curve. Nitrite produces it by direct oxidation of heme iron When caused by M hemoglobins, it is rapidly fatal in infancy. Hint A 66 year old woman has a history of recurrent DVT. She is started on intravenous heparin prior to cardiac bypass for ischemic heart disease. She seems to require very high doses of heparin to achieve adequate anticoagulation especially during surgery. What condition would explain her thrombophilia and her heparin resistance? Activated protein C resistance Antithrombin III deficiency Lupus anticoagulant Protein C deficiency Protein S deficiency Hint A 74 year old male with tiredness and lethargy is found to have an enlarged right supraclavicular mass. He had developed acrocyanosis six months ago and two months ago had been admitted with a chest infection for which he was treated with co-amoxiclav. Blood film shows red cell auto-agglutination, direct antiglobin and cold agglutinin tests are positive. The most likely diagnosis is Bronchial carcinoma Drug-induced haemolysis Mycoplasma pneumoniae infection Non-Hodgkin´s lymphoma (NHL) Paroxysmal cold haemoglobinuria (PCH) Hint A 28 year old pregnant female develops swollen painful left leg at 12 weeks gestation. Doppler ultrasound showed a left popliteal vein thrombosis. The treatment that is associated with the greatest risk to the fetus is Aspirin Intravenous unfractionated Heparin Subcutaneous low molecular weight Heparin Subcutaneous unfractionated Heparin Warfarin Hint A girl aged 17 years with von Willebrand´s disease is scheduled for dental extraction. Previous extraction resulted in bleeding that had required two unit transfusion. The most appropriate treatment prior to dental surgery is Cryoprecipitate DDAVP Fresh frozen plasma High purity factor VIII concentrate Recombinant factor VIII concentrate Hint A 25 year old man presents after developing a bluish discolouration of the body, lips and nails. He has no relevant past history. Exam reveals central cyanosis and a grey complexion. His haemoglobin is 17.0 g/dL, PaO2 is 13.0 kPa (11.3-12.6) and SaO2 (using an oximeter) is 85% (>95). The likely diagnosis is Argyria Cyanotic congenital heart disease Haemochromatosis Methaemoglobinaemia Methylene blue poisoning Hint A male aged 80 years presents with tiredness and weakness. Diagnosis of Myelodysplastic syndrome is suspected. Which statement regarding myelodysplastic syndrome is correct? Absence of RING sideroblasts on the blood film excludes Myelodysplasia as a diagnosis Cytotoxic chemotherapy is likely to be part of his treatment He is more likely to die from an infection than from leukaemic transformation If blast cells constitute 1% of the total white cells, this signifies leukaemic transformation. On a blood film, neutrophils typically show toxic granulation Hint A woman aged 40 years presents with a swollen right calf. She has a history mental health problem and is on a number of medications. Which medication increases the risk of thromboembolism? Antipsychotics Benzodiazepines Monoamine oxidase inhibitors Selective serotonin reuptake inhibitors Tricyclic antidepressants Hint Lab results of a 43 year old male under investigation for diabetes and impotence show ALT level of 30 U/l (5-35), AST of 22 U/l (1-31), fasting plasma glucose of 7.4 mmol/l (3.0-6.0) and ferritin of 500 µg/1 (15-300). The next appropriate investigation would be Bone marrow smear and iron stain Liver biopsy Red cell protoporphyrins Serum transferrin receptors Transferrin saturation Hint A 61-year-old man is found to have squamous cell carcinoma of the lung after being investigated for hemoptysis. Which one of the following would be a contraindication to surgical resection? Superior vena cava obstruction Finger clubbing Hypercalcemia Hypertrophic pulmonary osteoarthropathy Pleural effusion Hint A 59-year-old chronic smoker presents with weight loss and hemoptysis. Examination reveals that he is clubbed and has clinical evidence of right pleural effusion. His serum calcium is 12.8 mg/dL. A bone scan is normal. Which of the following type of lung cancer is he most likely to suffer from? Adenocarcinoma Squamous cell carcinoma Large cell carcinoma Mesothelioma Small cell carcinoma Hint A 40-year-old male is receiving Cisplatin based chemotherapy as adjuvant therapy for lymphoma. Which of the following is a typical side effect of Cisplatin? Acoustic Nerve damage Cerebellar ataxia Hemorrhagic cystitis Cardiotoxicity Rhabdomyolysis Hint Which ONE of the following statements regarding colon cancer is correct: In non-familial cases, gene mutations in the cancer cells are unusual In familial cases the inheritance pattern is typically autosomal recessive The rectum and sigmoid colon are the commonest sites It is a characteristic feature of the Peutz-Jegher´s syndrome Peutz-Jegher´s syndrome, the almost all polyps tend to be malignant. Hint Labs of a 60-year-old man who presented with back pain show: WBC count 3.7 x 109, Hb 10.3g/dL, MCV 85fL, platelets 110 x 109, serum total protein 85g/L and albumin 41g/L. CXR shows several leucencies in vertebral bodies. Sternal bone marrow aspirate is dark red jelly-like material. Which cell type is likely to be present on aspirate smear? Plasma cells Fibroblasts Giant cells Metastatic renal cell carcinoma cells Osteoblasts Hint A 66 year old male present with low back pain. His lab results show anemia and hypercalcemia. You suspect multiple myeloma. The most appropriate test to confirm the diagnosis is Bone marrow aspiration WBC count Platelets count X-rays Hint True statement about PSA is which of the following? Every man past the age of 50 should have an annual PSA test as a primary screen for prostate cancer PSA is best used to follow disease progression or recurrence post-operatively PSA is a useless test Increased complex PSA to total PSA ratio favors BPH over prostate cancer Hint An 82 year old man is talking warfarin because of a history of atrial fibrillation. He is found to have an INR of 7.2 on routine blood workup. He reports no bleeding. The best immediate management of this problem is Vitamin K 1 mg orally Hold the warfarin for 3 days Vitamin K 10 mg intravenously Fresh frozen plasma intravenously Desmopressin (DDAVP) Hint Which of the following types of thyroid cancer in a 47 year old woman has the worst prognosis following optimal treatment? Anaplastic cancer in a long standing goiter Papillary cancer with cervical lymph node metastases Follicular cancer with bone metastases Medullary cancer as part of the MEN type II syndrome Thyroid lymphoma Hint A 74-year-old male smoker presents with hemoptysis of three weeks duration. Examination reveals left supraclavicular lymphadenopathy. A chest radiograph reveals a left sided hilar mass. Which of the following would be an appropriate next step in the investigation of this patient? Bronchoscopy CT guided biopsy Lymph node Biopsy PET scanning Sputum cytology Hint Carcinoid tumours of the lung (bronchial adenomas) originate from which of the following cell types? Ciliated cell Clara cell Mucus (goblet) cell Kulchitsky (K) cell Type 2 alveolar cell Hint A 50 year old man presents with symptoms consistent with hypercalcemia, which is confirmed with a high blood calcium measurement. A diagnosis of Wermer´s syndrome (MEN-I) is made with the help of imaging studies. Which one of the following is not indicated in this patient? Parathyroidectomy Neurosurgery of pituitary Pancreatic surgery Thyroidectomy Prolactinoma removal Hint Positron emission tomography (PET) scans used to detect cancer most commonly use radioactive tracer tagged to a molecule that is an analogue of which of the following? oxygen Glucose Hemoglobin Nitrate Phosphate Hint A child develops easy bruising and excessive bleeding from small skin cuts. Tests show bleeding time is increased and a deficiency of von Willebrand´s factor. The most appropriate treatment is Factor 8 Factor 9 Platelet transfusion DDAVP Hint In the ward, a repeat calcium is 15.6 mg/dL, the previous result four hours earlier was 12.8. The patient has a disseminated malignancy with an unknown primary. Which of the following statements is most correct when considering the hypercalcemia of malignancy? A prolonged QT interval is associated with hypercalcemia Bisphosphonates inhibit osteoblast function thereby lowering calcium Calcitonin is of greater benefit than bisphosphonates in the treatment of hypercalcemia of malignancy NSAIDs are indicated for bone pain in this patient On neurological examination, hyporeflexia may be exhibited Hint The most appropriate treatment for chronic myelocytic leukemia is Hydroxyurea plus phlebotomy Cisplatin plus etoposide. Cisplatin plus fluorouracil. Hydroxyurea plus alpha interferon. Chlorambucil plus prednisone. Hint The best way to screen men for prostate cancer is Prostate specific antigen (PSA) assays every year beginning at puberty. Digital rectal exam every year beginning at puberty Annual ultrasonography of the prostate in all men over 50. PSA in all men over 50. PSA and digital rectal exam in all men over 50. Hint A 48-year-old female has headache, fever, confusion and jaundice for 1 week. Vitals: T 102°F, R/R 20/min, pulse 98/min and BP 140/90 mmHg. Exam shows jaundiced sclerae and skin, purpura on trunk and bleeding gums. Platelet count is 25000/mm3 and creatinine is 4.9mg/dL. LDH and indirect bilirubin are elevated. Bleeding time is increased and Coombs test is negative. Peripheral film shows shistocytes, helmet shaped cells and cell with triangular shape. Likely diagnosis is: Autoimmune hemolytic anemia Disseminated intravascular coagulation (DIC) Hemolytic-uremic Idiopathic thrombocytopenic Thrombotic thrombocytopenic purpura (TTP) Hint A patient presents with cervical lymphadenopathy. Biopsy of the lesion demonstrates a nodular lymphoma with follicle formation. This lesion would most likely be associated with which of the following? t (9, 22) t (8, 14) c-myc activation bcr-2 activation bcr-c-abl Hint Which one of the following is a major laboratory manifestation of disseminated intravascular coagulation? Thrombocytosis. Bacteremia. Reduced fibrinogen levels. Reduced fibrin split products. Leucopenia. Hint A 61-year-old has vertigo and blurred vision and itching after showering. White blood cell count is 15,000/ml, hematocrit is 62% with normal erythrocyte morphology, and platelet counts >1 million/mL. Arterial oxygen saturation is normal. Diagnose the problem! Polycythemia Vera Essential thrombocytosis Myelofibrosis Chronic myeloid leukemia Chronic lymphocytic leukemia Hint Which of the following is NOT true about the ability of red blood cells to transport oxygen from the lungs to tissues? The sigmoid shape of the oxygen dissociation curve results in an efficient oxygen unloading in tissues. Increasing the concentration of 2, 3-diphosphoglycerate (2,3- DPG) shifts the oxyhemoglobin dissociation curve to the right. Acidosis shifts the oxyhemoglobin dissociation curve to the right. Hemoglobin F has higher oxygen affinity than hemoglobin A in vivo. Methemoglobin, containing ferric iron, binds oxygen avidly. Hint A 42 year old woman from the Peruvian region presents with a large pulsating mass in her left neck. After appropriate evaluation a tumor is removed. The tumor was attached to the bifurcation of left common carotid artery and displayed histologic features of a paraganglioma. The predominant secretory product of the cells that give rise to this tumor is Acetyicholine Catecholamines Histamine Serotonin Substance P Hint A 22 year old female presents with a fibroadenoma of the left breast in the lower medial quadrant. Which of the following could not be a possible option for her? Ultrasound Fine needle aspiration Observe for a few cycles Mammography Hint What is effective in the treatment of severe drug induced or idiopathic thrombocytopenia? Aspirin Platelet transfusions Plasmapheresis Heparin Corticosteroids Hint A 53 year old man who is taking ACE inhibitor for hypertension and quinine for nocturnal leg cramps presents with symptoms of petechiae and excessive gum bleeding. There is no fever or chills. The most likely cause for his symptoms is Allergic reaction to ACE inhibitors Idiopathic thrombocytopenic purpura Quinine induced thrombocytopenia Hypertensive crisis V Leukemia Hint A 55 year old man complains of fatigue. Examination shows marked splenomegaly, but the liver is not enlarged. Blood analysis demonstrates pancytopenia and stain positive with tartrate resistant acid phosphatase (TRAP) and CD22. The most likely diagnosis is Waldenstrom´s macroglobulinemia Multiple myeloma Hairy cell leukemia Non-Hodgkin´s lymphoma Hodgkin´s disease Hint Laboratory value that should be periodically followed in patients who are being treated with subcutaneous low molecular weight heparin (Lovenox) is which one of the following? Prothrombin time (PT) PTT PTT and PT INR Platelet count Hint A 10 year old girl presents with malaise, pallor, low grade fever, and weight loss. She has had several nose bleeds recently. FBC shows a markedly elevated white cell count. Bone marrow aspirate shows 35% myeloblasts and 55% erythroblasts. Which acute myelogenous leukemia she has according to FAB classification? M2 M3 M4 M5 M6 Hint A 67 year old male presents with fatigue and night sweats. Examination is remarkable for generalized lymphadenopathy and hepatosplenomegaly. Blood study shows anemia, thrombocytopenia, and neutropenia. Peripheral blood smear shows numerous small lymphocytes, some of which appear to have been disrupted during the process of making the smear. Which marker(s) is/are most likely present on the abnormal cells and could specifically identify such cells in a flow cytometric analyzer? CD3 CD8 CD14 CD 16 and CD 56 CD 19 and CD 20 Hint A previously healthy 74year old woman presents with tiredness and a mildly raised lymphocyte count on her full blood count. Smudge cells are seen on the blood film. If she is known to have chronic lymphocytic leukaemia, then what is the appropriate next investigation to confirm this lady´s diagnosis? Bone marrow aspirate Bone marrow trephine Immunophenotyping Serum immunoglobulins Ultrasound scan Hint A 25 year old lady with a history of type 1 von willebrand´s disease needs to undergo a cervical cone biopsy and the admitted teams are concerned about her clotting. She has a past history menorrhagia and has had two dental extractions as an adolescent that were uncomplicated. The useful test to assess her bleeding tendency is which one of the following? Activated partial thromboplastin Bleeding time Plasma factor VIII activity Platelet aggregation Prothrombin time Hint A 21 year old student has bloody diarrhea that started after one day eating steak from the local butcher, and was associated with nausea and malaise, and mild swelling of the lower limbs. She is pale, with petechiae over her legs. Her face is puffy. BP is 160/95 and has tachycardia and crackles on inspiration at both lung bases. Her Hb and platelets are low and WBCs are elevated with neutrophilia. PT and APTT are normal. Urea and creatinine are also elevated and urine dipstick shows blood ++ and protein +. The single next test to make the diagnosis is ASO titres Renal tract ultrasound Stool culture Transthoracic echocardiogram Urine microscopy Hint A 74 year old woman receives 2 units of packed red cells following hip replacement. 1 week later her haemoglobin concentration had fallen by 4 g/L. What would be most likely to indicate a delayed transfusion reaction? Conjugated hyperbilirubinaemia Elevated D-dimer concentration Haemoglobinuria Haemosiderinuria Positive direct antiglobulin test Hint A 77-year-old woman has had Paget´s disease of bone for at least 16 years. She has developed a destructive mass in the bony pelvis and a diagnosis of primary tumour is considered. What is the most likely primary tumour? Chondrosarcoma Osteosarcoma Exostosis Multiple myeloma Osteoma Hint A sickle cell patient presents with abdominal pain and fever. He is given narcotics for pain and IV fluids. Blood cultures are obtained. The appropriate next step in his management is Antibiotics Hydroxyurea Transfusion Folic acid Hint A 66-year-old has locally advanced pancreatic cancer and has been paying privately for treatment with Erlotinib (Tarceva) for the past 9 months. It has worked effectively for that period but a recent CT scan showed further growth in the tumor. Which of the following mechanism best explains this resistance to treatment with Erlotinib? Mutated IGF-1 receptor Development of antibodies to Erlotinib Lack of autophosphorylation at binding site Malabsorption Reduced expression of EGFR Hint A 45-year-old male is hospitalized for DVT treatment. His platelet count on admission was 250,000/mm3. He was started on heparin and warfarin. He showed clinical improvement and planned for discharge. Before discharge his platelet count is 45,000/mm3. PT and PTT are normal. Most appropriate management is: Stop the heparin but continue the warfarin Stop the warfarin but continue the heparin Stop the heparin and warfarin and substitute a low-molecular-weight heparin Discharge the patient, as clinical improvement has occurred Stop the heparin and warfarin and start a non-heparin anticoagulant Hint The best test to confirm the diagnosis of hereditary spherocytosis is Coombs test Bone marrow aspiration Red blood cell enzyme studies Osmotic fragility studies Human leukocyte antigens (HLA) studies Hint A 61-year-old male presents with a thyroid nodule. He has a history of radiation exposure when he was employed as an X-ray technologist. Invasive carcinoma is diagnosed. Management should now consist of Palliative radiation. Propylthiouracil chemotherapy Total thyroidectomy and post-op 131I treatment. Total thyroidectomy Partial thyroidectomy Hint A 51-year-old obese white male, with a long history of smoking and hypertension, presents with extreme fatigue and chronic headaches. His physician finds generalized plethora and elevated blood pressure. Lab data reveal hematocrit of 60%. What is the most likely diagnosis? Gaisbock´s syndrome Polycythemia Vera Von Hippel-Lindau disease Essential thrombocytosis Renal cell carcinoma Hint Which of the following is NOT true of hemochromatosis? It is produced by excessive intestinal absorption of iron. It results from a mutant gene linked to the HLA on chromosome 6. It occurs in iron-loading anemias, such as thalassemia. It is rare following excessive oral iron ingestion. Routine treatment involves chelating agent (Deferoxamine) administration. Hint Hyperviscosity syndrome is most characteristic of which of the following? Wegener´s granulomatosis. Familial Mediterranean fever. Syphilis. Systemic lupus erythematosus. Waldenstrom´s macroglobulinemia. Hint A 46 year old man is noted to have plethoric features with a slight cyanotic tinge to his nose, ears, and lips. His spleen is palpable to 3 cm below the costal margin. No history of smoking or pulmonary disease is present. Hematologic studies demonstrates is normal, and leukocyte alkaline phosphate is increased. This patient´s condition is most closely related to which of the following other hematologic diseases? Chronic myeloid leukemia Multiple myeloma Sickle cell anemia Vitamin B12 deficiency Warm antibody autoimmune anemia Hint A 74 year old man presents to a physician because of fatigue, recurrent infections, and easy bruising. Marked hepatosplenomegaly is present on physical examination. Blood studies reveal anemia, neutropenia, thrombocytopenia, and the presence of unusual lymphocytes with elongated cytoplasmic projections seen on peripheral blood smear. The blood smear is stained with a special stain, yielding the results seen in the image below. Which one of the following special stain was most likely used? Anti Epstein Barr virus Chromium-51 Myeloperoxidase stain Nitroblue tetrazolium Tartrate resistant acid phosphatase Hint A 55 year old female presents with fatigue, early satiety, and a 30 lb weight loss over the past 2 months. Routine blood studies show leukocytosis and thrombocytosis. A peripheral smear is performed and is shown below. There are large numbers of neutrophils and elevated numbers of normal appearing eosinophils and basophils. No blast forms are seen. The cytogenetic abnormality that is associated with this condition is bcl-2 activation c-myc activation t (8, 14) t (9, 22) t (14, 18) Hint Which of the following is NOT a feature of thalassemia? In beta thalassemia, beta CHAINS are produced in reduced or even undetectable quantities. In beta thalassemia, the structure of the beta chain is normal. In alpha thalassemia, a silent carrier state occurs when one gene from each parent has been deleted. In alpha thalassemia, the production of the globulin chain is decreased. In alpha thalassemia, clinical manifestations correlate with the number of gene deletions. Hint FALSE statement regarding Rh immune system is which one of the following? Rho (D) is the most immunogenic alloantigen. Rh-negative blood lacks the D antigen. A single unit of Rh positive blood cells transfused into an Rh negative individual result in anti-D antibodies in 70-80% of persons. To avoid hemolytic disease of the newborn, a nonimmunized premenopausal Rh negative woman must not receive Rh- positive blood products. Rh antigens C and E are more immunogenic than D. Hint A 62 year old male has bone pain in his spine and arms. Radiograph shows multiple, punched out lesions of bone. Biopsy shows sheets of plasma cells. The molecule that is most likely to be found in the patient´s urine is VaCa VoCo VECE VyCy VKCK Hint An Asian female aged 34 years has tiredness and lethargy. Her Hb is 10.3 g/dL, platelet count is 320 x109/L, WBC count is 10.6 x109/L, MCV is 68 fL, and HbA2 is 5.2% (2-3). The most likely diagnosis is which one of the following? Acute myeloid leukaemia Beta-thalassaemia major Beta-thalassaemia trait Hereditary spherocytosis Sickle cell disease Hint A boy aged 19 years with glucose-6-phosphate dehydrogenase deficiency wishes travel to Africa. He should be advised to avoid which one of the following? Primaquine Loperamide Mefloquine Ibuprofen Yellow fever vaccine Hint Which of the following is least likely to precipitate an acute attack in porphyria? Aspirin Menstruation Phenytoin Starvation Hint A male aged 21 years old with non-Hodgkins lymphoma and haemolytic anemia is assessed for splenectomy. When should Pneumococcal vaccine be administered? One month before surgery One week before surgery One week after surgery One month after surgery Perioperatively Hint An 83 year old man has a 6 month history of fatigue and increasing exertional dyspnoea. Labs show Hb of 7.5 g/dL, MCV of 112 fL, WBC count of 3.12 x109L with neutrophils 34%, blasts 1% and platelet count is 12 x109/L. Bone marrow aspirate stained with perl´s showed by DealXplorer" href="http://s.igmhb.com/click?v=SU46MTMwMDUxOjIxOTIyOnJpbmc6YjI3ODg0ZDVlOThjMjkzMjgyZDJhYmI0ZjVmNDg4MjA6ei0yMzAxLTUwMDMzMDYwOnd3dy5pbnRlcmZhY2UuZWR1LnBrOjM3OTU5ODowOjBjZmNmYTViZjI5NjRlNTM5MDU5NjU2YTFkZWMwNmRhOjA6ZGF0YV9zcyw3Mjh4MTM2NjtkYXRhX3JjLDE7ZGF0YV9mYixubzs6NDUxMzczOTo6OjAuMDE&subid=g-50033060-f17243f2588542c193b1df5f6711e92c-&data_ss=728x1366&data_rc=1&data_fb=no&data_tagname=A&data_ct=link_only&data_clickel=link&data_sid=1d4fab98e406f9752be6deae8f77ec68" target="a652c_1485815021_wwwinterfaceedupk_379598">RING sideroblasts. The diagnosis is Aplastic anaemia Chronic myeloid leukaemia Metastatic bone marrow infiltration Myelodysplastic syndrome Myelofibrosis Hint A 50 year old man has a history of lethargy and epistaxis over the last one month. Exam reveals numerous bruises over arms and legs, splenomegaly and retinal haemorrhages. His Hb is 7 g/dL, WBC count is 14 x109/L and platelet count is 20x109/L. Blood film showss white cells predominantly myeloblasts and promyelocytes. Investigation that would be of most prognostic value is Bone marrow aspiration Bone marrow trephine biopsy Cerebrospinal fluid examination Cytogenetic karyotype Immunophenotyping Hint A 26-year-old woman for the past 2 weeks has had small, red, non-blanching, non-pruritic spots on her arms and legs. Additionally, she now has easy bruising and occasional nose bleeds. She takes no medications aside. Labs show: Hb: 12.5 g/dL Leukocyte count: 6000/mm Platelets: 20000/mm PTT: 24 seconds PT: 10 seconds Peripheral blood smear, basic chemistries and electrolytes, and tests of liver function are unremarkable. Based on this woman´s presentation, which of the following is the most likely diagnosis? Disseminated intravascular coagulation Idiopathic thrombocytopenic purpura Scurvy Thrombotic thrombocytopenic purpura Vitamin K deficiency Hint A 65-year-old man has terminal cancer with hepatic metastases. He is treated with oral morphine solution for pain relief. Which is the most by DealXplorer" href="http://www.interface.edu.pk/medical-exams/test.php?u=33509&t=197368&Page=4#38310003">IMPORTANT pharmacodynamic factor in determining the appropriate timing between doses? Plasma half-life Bioavailability First pass metabolism Morphine-6-glucuronide formation Renal clearance Hint A 77 year old man develops prostate cancer and is also found to have metastasis. Which of the following is not an appropriate treatment? Androgen blockade Castration Prostatectomy WATCHFUL waiting Hint Which of the following malignancies is associated with HTLV-1 infection? Burkitt´s lymphoma Chronic lymphocytic leukaemia Pancreatic cancer Adult T-cell leukemia Extranodal NK/T-cell lymphoma Hint A 57-year-old is recently diagnosed with small cell carcinoma of the lung. Which of the following non-metastatic manifestations is she most likely to develop?f Myasthenia gravis Ectopic PTH-related peptide secretion erythema gyratum repens Eaton-Lambert syndrome hypertrophic pulmonary osteoarthropathy (HPOA) Hint Schistocytes on blood film examination are unlikely to be seen in Thalassemia Thrombotic thrombocytopenia purpura (TTP) Vasculitis Disseminated intravascular coagulation (DIC) Glomerulonephritis Hint A complication NOT associated with blood transfusion is Malaria Fever Hemolysis Siderosis Hypovolemia Hint What is the most common form of cancer in American women? Cervical cancer. Colon cancer. Breast cancer. Lung cancer. Uterine cancer. Hint A 37 year old woman presents with complaints of several months of fatigue and malaise. Blood studies performed during her evaluation demonstrates acute myelogenous leukemia. She develops hemorrhage and clotting phenomena and a diagnosis of disseminated intravascular coagulation (DIC) is made. The most likely subtype of acute myelogenous leukemia in this woman is M3 M1 M5 M6 M7 Hint An elderly man comes to medical attention because of anemia and multiple infections. Splenomegaly is demonstrated on physical examination. A complete blood count demonstrates pancytopenia. Peripheral blood smear of the patient is shown below. The characteristic that would likely be associated with these cells is Birbeck granules Elevated leukocyte alkaline phosphatase Philadelphia chromosome Positive tartrate resistant acid phosphatase Production of Bence-Jones proteins Hint An 81 year old man complains to his physician of focal pain on his back. On examination several localized areas of tenderness are observed in his vertebrae. Radiographic studies of the spine demonstrate focal lytic areas in the vertebrae, one of which has undergone pathologic fracture. Image below shows the results of bone marrow biopsy. The numerous round clear areas in the cytoplasm of the cells would most likely contain which of the following? Complement Hemoglobin Immunoglobulin Lipofuscin Melanin Hint A 30 year old man presents with acute mental status changes, severe anemia, and petechial rash all over his body. He has elevated serum LDH levels and schistocytes were found on the peripheral smear. He was diagnosed with a microangiopathic hemolytic anemia. His renal function was also abnormal. The definitive diagnosis in this patient is which of the following? Thrombotic thrombocytopenic purpura. Disseminated intravascular coagulation. Tonic water-induced reaction. Paroxysmal cold hemoglobinuria. None of the above. Hint A 27 year old woman is diagnosed with anemia. She has a reduced mean corpuscular volume, red cell count, and serum iron level. ESR is normal, while total iron binding capacities are increased. The reticulocyte count in the bone marrow is increased, but hemoglobin A2 levels appear low. The most likely diagnosis is Iron deficiency anemia Thalassemia trait Anemia of chronic disease Sideroblastic anemia Hemolytic anemia Hint A 52 year old man presents with fatigue, weight loss, and abdominal pain. Exam showed splenomegaly, mild hepatomegaly, and pallor. Lab data showed neutropenia, anemia, and thrombocytopenia. The peripheral smear and bone marrow revealed a lymphocytosis, composed of cells having cytoplasmic projections. The cells exhibit a strong acid phosphatase reaction. The most likely diagnosis is Chronic lymphocytic leukemia Hairy cell leukemia Chronic myelogenous leukemia Acute lymphocytic leukemia Infectious mononucleosis Hint A girl aged 17 years who had completed treatment for acute lymphoblastic leukaemia 6 months ago presents with a by DealXplorer" href="http://www.interface.edu.pk/medical-exams/test.php?u=33509&t=197368&Page=24#54787853">SHORT history of marked, right hip pain and associated limp. The most likely diagnosis is Avascular necrosis of the femoral head Gout Osteoarthritis Pseudogout Septic arthritis Hint Time's up Submit a Comment Cancel replyYour email address will not be published. Required fields are marked *Comment * Name * Email * Website Save my name, email, and website in this browser for the next time I comment.
