Gp neelima hematology and oncology 2-01-17 Welcome to your Gp neelima hematology and oncology 1-02-17 Name Business Email Phone Number A 58-year-old man, admitted with epigastric pain after drinking heavily, has a temperature of 36.9°C, a pulse of 98/min, a blood pressure of 86/61 mmHg, and a respiratory rate of 33/min. Investigations reveal elevated WBC count. Which of the following is the diagnosis? Leaking aortic aneurysm Multi-organ dysfunction syndrome (MODS) Pancreatitis Systemic inflammatory response syndrome (SIRS) Septic shock Hint A 71-year-old man presents with weight loss and dyspnea and is diagnosed with small cell lung cancer. Which of the following is an adverse prognostic feature? Cavitation on X ray Decreased alkaline phosphatase Finger clubbing Hyponatremia Hypertrophic pulmonary osteoarthropathy Hint A 65-year-old man presents with hematuria. Cystoscopy discovers a transitional cell carcinoma of the bladder. Occupational exposure to which of the following is a recognized risk factor for bladder cancer? Aflatoxin Beryllium Chimney sweeps Aniline dye Strongyloides Stercoralis Hint A 46-year-old man presents with facial swelling and breathlessness. His chest X-ray reveals paratracheal lymphadenopathy. Which of the following statements is most accurate regarding the superior vena caval obstruction? The most common cause is squamous cell carcinoma It is associated with Kussmaul´s sign It may be associated with Pupillary dialation It may be associated with Pupillary dialation The commonest symptom cough and chest pain Hint A 66-year-old woman has a month old left leg pain and weight loss. Examination shows a left flank mass associated with a DVT and further investigations confirm a renal cell carcinoma with lung metastases. Being treated for her DVT with LMWH followed by warfarin, what is the most appropriate treatment for her renal carcinoma? Platinum based chemotherapy Nephrectomy Palliative therapy alone Interleukin 2 Radiotherapy Hint Which of the following statements regarding prognosis in lung cancer is true? Combined modality therapy (chemotherapy, radiation therapy and surgery) has improved overall lung cancer survival to 40% at five years. Patients undergoing radiation therapy have a five year survival of 40%. Patients who qualify for surgery have a 50% five year survival. With chemotherapy, overall survival in small cell (oat cell) carcinomas has risen to 60% at five years. Overall lung cancer survival is less than 15% at five years Hint Which of the following does NOT explain the clinical manifestations of hereditary spherocytosis? Aplastic crises are usually caused by parvovirus B19. Megaloblastic crises result from deficiencies of folic acid. Hyperbilirubinemia produces gallstone. Hemolytic crises result from splenic infraction. Paravertebral masses may result from extramedullary erythropoiesis. Hint The most commonly associated with cancer of the uterine cervix is Polycystic kidney disease Genital papillomavirus infection Family history Gonorrhea Chlamydia Hint An oncology clinic in Cleveland, OH gathers data for long range studies on patients with leukemias and lymphomas. In the month of September, 5 new cases are evaluated by flow cytometry for the presence of surface markers and other identifying features. The results are shown below: Marker Case 1 Case 2 Case 3 Case 4 Case 5 Tdt negative negative positive positive negative CD34 positive positive positive positive positive Cytoplasmic mu by DealXplorer" href="http://www.interface.edu.pk/medical-exams/test.php?u=33509&t=197767&Page=16#98761372">CHAINS positive negative negative positive negative Surface lgG negative positive negative negative negative CD40 negative positive negative negative positive B7 negative positive negative negative positive Tdt = terminal deoxvnucleotidvl transferase Based on above mentioned findings which malignancy is comprised of the most primitive cells? Case 1 Case 2 Case 3 Case 4 Case 5 Hint A 56 year old man presents to his physician because of a large non tender lump in his neck that he noticed while shaving. Biopsy shows multiple large, round, malignant cells with a high nuclear/cytoplasmic ratio in a background of mixed inflammatory cells. The diagnosis of Hodgkin disease is considered, and special stains are ordered. Assuming the diagnosis of Hodgkin disease, the large malignant cells would likely be positive for which marker? CD4 CD8 CD20 CD30 CD43 Hint Examination of a peripheral smear from a patient with a hematocrit of 30% demonstrates large numbers of target cells. Further work up of this patient would most likely reveal which of the following? Abnormal hemoglobin synthesis Abnormal red cell cytoskeleton Cells that sickle when exposed to low oxygen tension Mineral deficiency Vitamin deficiency Hint An 11 year old child develops a testicular mass and undergoes orchiectomy. The mass shows a variety of appearances and colors on the cut by DealXplorer" href="http://www.interface.edu.pk/medical-exams/test.php?u=33509&t=197767&Page=22#13787749">SECTION. Histologically, many different tissues are seen, including cartilage, thyroid, and neural tissue. A small focus of clear cut squamous cell carcinoma is seen. Which of the following is the most appropriate classification for this tumor? Dermoid cyst Embryonal carcinoma Immature teratoma Solid mature teratoma Teratoma with malignant transformation Hint All of the following are associated with neutropenia, EXCEPT Systemic lupus erythematosus Multiple myeloma Methotrexate Exfoliative dermatitis Hint All are frequently found in Chronic Myelogenous Leukemia (CML), except Elevated WBCs Elevated vitamin B12 level Elevated LDH Increased uric acid level Translocation between chromosomes 9 and 14 Hint The test that distinguishes pernicious anemia from other causes of macrocytic anemia is Abnormal Schilling test Low serum B12 level Bone marrow aspirate Correction of abnormal Schilling test by administration of intrinsic factor Upper gastrointestinal endoscopy. Hint Which of the following statement is FALSE regarding multiple myeloma? It commonly presents as a fracture of the neck of the femur IgG paraproteins are the most commonly elevated isotype. Differentiation between multiple myeloma and monoclonal gammopathy is required. Amyloidosis may occur. Serum protein electrophoresis of paraproteins is typically negative. Hint A 46 year old man presents with recurrent nausea and abdominal distress. Gastric biopsy shows atrophy of the mucosa in the fundus and body, with marked lymphocytic infiltration. Blood studies show severe anemia with a mean corpuscular volume of 110 µm^3. The most likely pathogenetic mechanism of this patient´s anemia is Autoantibodies Chronic blood loss Deficient iron absorption Helicobacter pylori infection Immune mediated hemolysis Hint A woman aged 35 years with a history of two previous lower limb deep vein thromboses presents with a further DVT. Thrombophilia screen shows the presence of lupus anticoagulant. The best course of action is Aspirin Aspirin and warfarin Long term low molecular weight heparin Warfarin for six months Warfarin lifelong Hint True statement regarding the treatment of iron deficiency anaemia is which one of the following? Iron is absorbed in the distal jejunum Absorption of iron is increased by ascorbic acid Sustained release iron is a useful way of given larger doses Ferrous sulphate 200 mg has less elemental iron than the same dose of ferrous gluconate Parenteral iron is indicated when the anaemia responds slowly to oral iron Hint A 42-year-old male has suspected superior vena cava obstruction (SVCO). Which of the following statements is correct? IV dexamethasone is of no benefit Loss of pulsation in the venous system of the neck is of clinical use in the diagnosis of SVCO Mediastinal radiotherapy relieves symptoms in only 27% of patients Palliative treatment alone is indicated Small cell cancer may cause it Hint A 56-year-old man from Eastern China presents has painful right upper quadrant mass. He reported that he had been diagnosed with viral hepatitis several years previously. Hepatitis A virus Hepatitis B virus Hepatitis C virus Hepatitis D virus Hepatitis E virus Hint A 77-year-old man has persistent abck pain unrelated to physical activity and 12 kg weight loss. Labs show: Hb 11.2 g/dL, WBCs 6.7 x 109/L, platelets 89 x 109/L, urea 14 mmol/L and creatinine 90 µmol/L. Scattered 0.4-1.2 cm bright lesions in the vertebral bodies are visualized on spine CT scan. Which additional finding would be present on lab test? Blood culture positive for Neisseria gonorrheae Parathyroid hormone, intact, of 100 pg/ mL (normal < 65) Positive serology for Borrelia burgdorferi Serum calcium of 1.4 mmol/ L Serum prostate specific antigen of 35 microgram/L Hint A 32 year old female presents to her physician´s office for an increase in fatigue over last 2 months. On physical examination, the physician notes delayed capillary by DealXplorer" href="http://www.interface.edu.pk/medical-exams/test.php?u=33509&t=197880&Page=5#75482553">REFILL in the nailbeds and a pale appearance of the inner lining of the eyelids. A peripheral smear reveals hypochromic erythrocytes. The most useful test in confirming the probable diagnosis is Serum ferritin and total iron-binding capacity (TIBC) Schilling´s test Glucose 6-phosohate dehydrogenase assay Hemoglobin electrophoresis Serum folate and cobalamin (vitamin B12) Hint An elderly female is on Tamoxifen therapy for advanced breast cancer with bone metastases. She develops increased thirst, increased urination, disorientation, nausea, vomiting, confusion and agitation. The most likely cause is Tamoxifen side effect Hypercalcemia Brain metastasis SIADH Hint Which of the following cytotoxic agents acts by inhibiting purine synthesis? Bleomycin Cisplatin Daunorubicin Methotrexate Vinblastine Hint Burkit´s lymphoma is associated with a mutation of which of the following genes? Diverse rearrangements involving IgH BCR-ABL gene Cyclin D1 gene c-MYC gene No specific chromosomal abnormality Hint A 60-year-old female smoker is diagnosed with oat cell carcinoma of the bronchus. Which of the following relating to this diagnosis is true? The tumor is likely to be radiosensitive Is associated with the elaboration of Ectopic ADH secretion Predominantly affects smokers Has a five year survival greater than 20% Is typically associated with ectopic Parathormone secretion. Hint A 67 year old woman with aortic sclerosis is admitted with chest pain. An infarct is ruled out by cardiac enzymes, but the patient has recurrent symptoms when weaned off heparin. On 2nd day of hospitalization, she has right arm pain, absent brachial pulse on the right, and a cold distal right arm. Her hematocrit is 34%, and platelets are 30,000/mm3. Her partial thromboplastin time is 64 sec. The most likely cause of this patient´s absent brachial pulse is Heparin-induced thrombocytopenia Embolization from aortic sclerosis Paradoxical embolus Hypercoagulable state from immobilization Vasospasm of the brachial artery Hint A 40 year old presents with a self detected hard breast mass. The procedure of choice for confirming the diagnosis is which of the following? Mammography Thermography Incisional biopsy histology Ultrasonography Aspiration cytology Hint Drug resistance to chemotherapeutic agents is a major reason for treatment failure. All of the following are true regarding drug resistance EXCEPT Multidrug resistance (due to P-glycoprotein overexpression) to one class of chemotherapeutic agents generally implies cross resistance to other classes of chemotherapeutic classes, even those which are functionally and structurally-disparate. Overexpression of P- glycoprotein decreases intracellular concentrations of antineoplastic agents by actively extruding them across the cell membrane. Inherent multidrug resistance occurs in tumors developing from normal tissues that express the mdrl gene, which codes for P-glycoprotein Multidrug resistance involving topoisomerase II can be observed with all classes of antineoplastics. Apoptosis, an active form of cellular suicide, may be IMPORTANT in the development of multidrug resistance. Hint All of the following have been associated with an increased risk of breast cancer, thus supporting the importance of endocrinologic factors in its development, EXCEPT Early age of menarche. Nulliparity. Late age at first pregnancy Late onset of menopause. Estrogen replacement therapy for five years. Hint The most common site for development of embryonal rhabdomyosarcoma is Gastrointestinal tract Head and neck Kidneys Liver Lungs Hint Hemolytic disease of the newborn usually occurs in infants born to mothers whose blood type is which of the following? A. B. O. AB. Lea. Hint What is the treatment of choice for a two day post cholecystectomy patient with pulmonary embolism? Heparin intravenously. Heparin subcutaneously. Inferior vena cava filter placement. Coumadin. Thrombolytic therapy. Hint A 52 year old female develops acute hemolysis after receiving a four unit blood transfusion during open heart surgery. Antibodies to the major blood groups have been ruled out as etiologic agents. Which is most likely to be responsible for reaction in this patient? Cytomegalovirus Hepatitis B Anti Lewis antibodies Antimitochondrial antibodies Anti-Ro antibodies Hint A 41 year old woman has headache, dizziness, tinnitus, fatigue, and generalized pruritis, especially after a warm shower. She also has frequent epistaxis. Splenomegaly and engorged retinal veins, along with skin plethora is noted on examination. Her hematocrit is 55% and she is a non-smoker. The most common complication and major cause of morbidity and death in this disorder is Leukemia Thrombosis Sepsis Splenic rupture and hemorrhage Liver failure Hint A 56-year-old has a ventilation-perfusion defect in the right lung and a positive D-dimer assay. Lower-extremity ultrasound studies demonstrate a thrombus on the right side. She is given oxygen and warfarin loading dose. Heparin is not utilized due to a history of "heparin allergy." Four days later, the respiratory status improves and tenderness in her right leg decreases, but she develops pain and redness in her left breast. The breast has erythema and tenderness of the left breast and right thigh with a central area of scar formation. Microscopic examination reveals extensive thrombosis with microvascular injury and fibrin deposits in the postcapillary venules and small veins. Loss of function of which of the following most likely underlies this patient´s new complaint? Factor VII Factor IX Platelets Protein C Von Willebrand factor Hint A 56 year old female has weakness. Full blood count reveals Hb concentration of 10.5 g/dL (11.5-16.5) and mean cell volume of 104 fL (80-96), but no other abnormality. This may be due to which one of the following? Hormone replacement therapy Thyrotoxicosis Ulcerative colitis Zollinger-Ellison syndrome Scurvy Hint True statement regarding sickle cell disease is which one of the following? A painful shoulder joint will respond to intra-articular corticosteroid injection Symptoms of anaemia are usually limiting when Hb equals 8 g/dL There is often an inability to concentrate urine The spleen is frequently enlarged Steroids would be useful in treatment Hint A 16 year old boy is found to have von Willebrand´s disease. He is due to have dental extraction and DDAVP is prescribed. What is the mechanism of action of DDAVP in von willebrand´s disease? Acts as a substitute carrier for Factor VIII Prevents renal excretion of von willebrand´s factor Stimulates release of von willebrand´s factor from endothelial cells Turns on the gene associated with von willebrand´s factor production Hint A 60 year old male presented with a flu-like illness which has subsided but FBC revealed a platelet count of 800 x109/L which has remained persistently elevated but with no other abnormality on the FBC. He is otherwise asymptomatic and no abnormalities are noted on exam. The most appropriate treatment for him is Anagrelide Aspirin Hydroxycarbamide Observation Plateletpheresis Hint A 70 year old chronic smoker and drinker male presents with a tender left calf and has past history of headaches, tiredness and dizziness. On exam he has a BP of 186/102 mmHg and has a swollen, hot tender and erythematous left calf. Dopplers confirms DVT. His Hb is 19 g/dL, haematocrit is 0.58 (0.40-0.52) and WBC count is 12.5 x109/L and platelet count is 500 x109/L. Which one is the most appropriate investigation to establish the diagnosis? Abdominal ultrasound scan Arterial blood gases Bone marrow trephine Leucocyte alkaline phosphatase score Red blood cell mass Hint A 30-year-old woman presents with jaundice and her investigations reveal: Haemoglobin 9.0 g/dL (11.5-16.5) Reticulocyte count 180 x109/L (25-85x109) Serum bilirubin 50µmol/L (1-22) Her blood film reveals the presence of spehrocytes Which of the following is the next most useful investigation? abdominal ultrasound scan direct antiglobulin test glucose-6-phosphate dehydrogenase activity haemoglobin electrophoresis red cell osmotic fragility Hint A 71-year-old male presents with hemoptysis. Bronchoscopy reveals a tumour in the proximal right main bronchus. Which of the following is a contraindication to radical radiotherapy? Adenocarcinoma Involvement of the pulmonary artery FEV1 of 30% predicted Ischemic heart disease Superior vena caval obstruction 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=197895&Page=2#70324233">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 new chemotherapeutic agent is said to decrease the five year mortality rate to 60% which was 80% without treatment. Which of the following represents the absolute risk reduction using this treatment? 15% 20% 30% 33% 45% Hint A male with history of his father dying of prostate cancer comes to see you to discuss the guidelines for prostate screening. You tell him that for him it is appropriate to Screen every 5 years Screen every year Screen 10 years No screening recommended Hint A 36 year old black woman returned home from a vacation in Hawaii. She comes to you with a swollen left lower extremity. She has no previous history of similar problems. Homan´s sign is positive, and ultrasonography reveals a noncompressible vein in the left popliteal fossa extending distally. True statement regarding situation is which of the following? Monotherapy with an initial 10-mg loading dose of warfarin (Coumadin) would be appropriate Enoxaparin (Lovenox) should be administered at a dosage of 1mg/k subcutaneously twice a day The incidence of thrombocytopenia is the same with low molecular weight heparin The dosage of warfarin should be adjusted to maintain the INR at 2.5-3.5 Anticoagulant therapy should be started as soon as possible and maintained for 1 year to prevent deep vein thrombosis (DVT) recurrence Hint A 62 year old male has an ulcerating carcinoma of the lateral side of the tongue. Which feature has the most important effect upon his management? He smokes 30 cigarettes daily He has a hard cervical lymph node 1.5 cm in diameter The tumor measures 2 cm in diameter The tumor is a squamous cell carcinoma He has severe dental caries Hint A patient attends for breast screening and asks you the following questions. Which statement is correct? p53 mutation is a commonly identified in subjects with a strong family history of breast cancer Early diagnosis does not change the rate of death from breast cancer Mammographic screening is offered to all women aged 20-75 years Mammographic screening is more sensitive in patient groups with less dense breast tissue In young patients with a BRCA mutation, Mammographic screening has a high sensitivity for detecting tumors Hint Lymphadenopathy is most likely to be malignant at which of the following sites of head and neck? Anterior cervical Supraclavicular Posterior cervical Preauricular Submandibular Hint A 46-year-old man is diagnosed acute promyelocytic leukaemia. Which of the following chromosomal translocations is associated with this of leukaemia? t (15; 17) t (8; 9) t (14; 18) t (9; 22) t (1; 14) Hint A physician palpates an ovarian mass in a patient on pelvic examination. Resection of the mass demonstrates a lymphoma composed of small lymphocytes with interspersed macrophages surrounded by clear spaces. This lesion would be most likely to be associated with abl-bcr hybrid bcl-2 activation c-myc activation t (9, 22) t (14, 18) Hint A 24 year old man presents with a 4 cm supraclavicular mass. CXR demonstrates marked mediastinal widening. Excisional biopsy of the mass demonstrates areas with the appearance shown in the photomicrograph below. The most likely finding in the cell marked with the arrow is Down-regulation of NF-KB Epstein-Barr virus genome in episome from Mummification Production of CD20 Somatic hypermutation Hint A 21 year old woman presents with painless cervical lymphadenopathy, night sweat, and generalized pruritus. An enlarged cervical lymph node is removed for diagnosis. Its cut surface shows broads bands of fibrosis. Histologically, the lymph node contains a mixture of cells, including lymphocytes, histiocytes, eosinophils, plasma cells, and scattered large cells with prominent nucleoli. The most likely diagnosis is Reactive non-specific lymphadenitis Non-Hodgkin lymphoma Infectious mononucleosis Hodgkin disease Cat-scratch disease Hint On a routine pap smear, it is found that a 39-year-old woman has cervical carcinoma. All of the following factors more likely put this woman at risk for the development of the condition EXCEPT Post-kidney transplant recipient taking prednisone and cyclosporine. Low socioeconomic status. 20-pack-ten year history of smoking. Multiple sexual partners. Late menopause. Hint A severely anemic patient´s peripheral blood smear reveals oval macrocytes, hypersegmented neutrophils, and decreased platelets. Which of the following is the most likely cause of the anemia? Vitamin B12 or folate deficiency A red cell membrane protein defect An amino acid substitution in the globin CHAIN Marrow hypoplasia Iron deficiency Hint Which of the following is NOT useful in the management of von Willebrand´s disease? Cryoprecipitate. Normal plasma. Desmopressin Aspirin. Hormonal suppression. Hint A 56 year old man presents with fatigue. Examination shows hepatosplenomegaly. Blood analysis shows normal hematocrit level and normal platelet count and teardrop shaped cells. WBCs are also normal. The most likely diagnosis is Polycythemia vera Essential thrombocytosis Myelofibrosis Chronic myeloid leukemia Acute myelogenous leukemia Hint In a 68 year old male the tumor marker beta 2-microglobulin was elevated. He is most likely suffering from which one of the following cancer? Trophoblastic tumor Germ cell neoplasm Pancreatic carcinoma Renal cell carcinoma Multiple myeloma Hint A 15 year old girl with globin gene mutation is admitted to the hospital with complaints of diffuse bone pain and respiratory distress. She thinks she "caught a cold" from her younger brother. She is aggressively treated, including hydration and pain control, with good results. As part of continued patient care vaccination against which disease should be specifically offered if it has not already been given? Influenza Mumps Measles Pneumococcus Rubella Hint A 75 year old woman with multiple myeloma is being treated with high doses of doxorubicin (Adriamycin). She also received cyclophosphamide and prednisone recently. During exam physician should check the patient for which finding? Abdominal tenderness Bladder distention Limitation of movement Papilledema Pulmonary rales Hint A girl aged 16 years with sickle cell disease presented with malaise and rapidly increasing dyspnoea. A full blood count showed Hb of 5.1 g/dL and reticulocyte count of 5.5 x109/L (25-85 x109). The most likely cause is Epstein-Barr virus Hepatitis E virus Human immunodeficiency virus Parvovirus B19 Hint A 30 year old woman is noted to have some bruising on her limbs with a palpable spleen on abdominal examination. She is anemic with WBC count of 110 x109/L with neutrophils 60 x109/L (1.5-7 x109), myelocytes of 40 x109/L and myeloblasts of 4 x109/L. Platelet count is 900 x109/L. The most likely diagnosis is Acute myeloid leukaemia Acute promyelocytic leukaemia Chronic myeloid leukaemia Essential Thrombocythaemia Hint A 77 year old woman who is on warfarin for atrial fibrillation presents with melaena. Her blood pressure is 90/60 mmHg and the heart rate is 100/min. Her Hb is 9g/dL (12-16), MCV is 87 fl (83-95) and INR is 7.2 (<1.4). PR exam confirms melaena. The best option for correcting the coagulopathy is FFP IV Vitamin K Stop warfarin and give IV vitamin K Stop warfarin and give Vitamin and Prothrombin complex concentrate Stop warfarin Hint Blood report of a woman aged 48 years with a history of epilepsy and ischaemic heart disease show haemoglobin of 7.4 g/dL, MCV of 105 fL, WBC count of 2.5 x 109/L and platelet count of 130 x 109/L. Medication that is the most likely cause is which one of the following? Carbamazepine Clopidogrel Furosemide Phenytoin Hint A 61 year old lady with bruising is has the haemoglobin of 13 g/dL, WBC count of 6.3 x109/L and platelet count of 15x109/L. She refuses to give consent to a bone marrow biopsy. The most appropriate management plan is which one of the following? Intravenous immunoglobulin No treatment Oral prednisolone Splenectomy Hint A 33-year-old woman has chronic fatigue, by DealXplorer" href="http://www.interface.edu.pk/medical-exams/test.php?u=33509&t=197895&Page=30#70248151">SHORTNESS of breath during exercise and pallor. No other relevant history exists. Heart rate is 90 beats/min. She has pale mucous membranes. A 2/6 early systolic murmur is appreciated. No clubbing or cyanosis is found. Laboratory data are: WBC: 6,700/mm Hematocrit: 29% Platelets: 225000/mm Blood smear: microcytosis, target red blood cells. Which of the following is the most appropriate diagnostic test? Colonoscopy Hemoglobin electrophoresis Reticulocyte count Serum ferritin Hint A 64-year-old smoker has chronic cough, hemoptysis and weight loss. His chest x-ray shows a cavitating lesion. What is the likely diagnosis? Adenocarcinoma Squamous cell carcinoma alveolar cell carcinoma large cell carcinoma small cell carcinoma Hint A 61-year-old male undergoes surgery for cecal carcinoma. Which of the following tumour markers is most appropriate for the continued surveillance of this patient? Carcinoembryonic antigen α-fetoprotein CA 19-9 CA 125 CA 27-29 Hint With respect to gastric carcinoma, which of the following statement is true? Aspirin use is a risk factor for gastric carcinoma Early diagnosis of gastric carcinoma results in a five year survival rate of 20% Helicobacter pylori infection is not associated with gastric carcinoma Incidence of distal stomach tumours is decreasing CT is superior to conventional Endoscopic ultrasonography for local tumor staging Hint The following are recognized features of Pancoast´s tumour except: Ipsilateral Miosis and Ptosis Wasting of the dorsal interossei Pain in the arm radiating to the fourth and fifth fingers Erosion of the first rib Weakness of abduction at the shoulder Hint A 63-year-old man with non-small cell lung cancer is being considered for surgical resection. Which of the following would best be regarded as a contraindication to surgery? FEV1 1.19 L FEV1 1.75 L FEV1 2.05 L FEV1 2.55 L Previous history of Myocardial Infarction Hint In asbestos related disorders which of the following statements are correct? Basal fibrotic shadowing on CXR suggests coincidental idiopathic fibrosing alveolitis Pleural effusion develops more than 20 years after causative asbestos exposure Pleural plaques are recognized precursors of Mesothelioma Increased incidence of primary lung cancer The risk of malignant mesothelioma is greatly increased in smokers compared with non-smokers Hint A 55 year old woman with a three-month history of weight loss and recurring chest infections is found to have a left hilar mass on chest x-ray. Bronchoscopy and biopsy reveal small cell carcinoma. All staging investigations are normal. Which one of the following treatment strategies is most appropriate? Left pneumonectomy Pre-operative radiation therapy followed by pneumonectomy Radiation therapy to the chest, Chemotherapy followed by left pneumonectomy Chemotherapy and radiation therapy to the chest Hint A 64 year old male with back pain, nephrotic syndrome and anemia present to the ER. Ultrasound shows normal kidney size. His creatinine is 500. The most likely diagnosis is Polycystic kidney disease Chronic glomerulonephritis Multiple myeloma Diabetic nephropathy Analgesic abuse Hint A 48 year old female complains of increasing fatigue. She has always had heavy menstrual periods. Her hemoglobin (Hb) is 85 g/L (Normal Hb 123-157 g/L), mean corpuscular volume (MCV) is 75 fL (Normal 80-100), her ferritin is 10 µmol/L (Normal 23-862 µmol/L). The most appropriate next step in the investigation of this patient is to do which one of the following? Prescribe ferrous gluconate and monitor response Pelvic ultrasound Bone marrow Colonoscopy Take a detailed dietary history Hint A 51-year-old with a history of breast cancer and known bony metastases presents with anorexia, muscle weakness, and cardiac conduction abnormalities. Laboratory tests reveal hypercalcemia and dehydration. The first step in management should be Replete intravascular volume. Diuretics. Glucocorticoids. Mithramycin. Hint A 29 year old female presents with tender cervical lymphadenopathy. She has had low-grade fever on and off a few weeks. Examination reveals two 1.5-cm anterior cervical nodes that are tender to palpation and freely moveable. A biopsy reveals multiple large round germinal centers with distinct dark and by DealXplorer" href="http://www.interface.edu.pk/medical-exams/test.php?u=33509&t=197957&Page=12#22494755">LIGHT zones. Many macrophages containing debris and frequent mitotic figures are present. She is most likely suffering from? Benign reactive lymphadenitis Hodgkin disease Malignant histiocytosis Non-Hodgkin lymphoma Sezary syndrome Hint A 56 year old male presents with increased fatigue and exertional dyspnea. He is diagnosed with leukemia. He undergoes genetic testing, which reveals a t (9; 22) translocation. Which of the following would a complete blood count most likely show? Increased lymphocyte Increased neutrophil count Numerous lymphoblasts Numerous myeloblasts Pancytopenia Hint A 68 year old woman presents to a physician because she has been having chronic fatigue. Hematocrit screening in the physician´s office shows a hematocrit of 29%. The patient has a very limited diet, and her physician suspects that she has a vitamin deficiency. The peripheral blood smear is illustrated below. Which of the following would most likely be reported on a blood sample from this patient? MCV 60 micrometers^3, MCH 20.2 pg/cell, MCHC 35% MCV 60 micrometers^3, MCH 40.7 pg/cell, MCH C 25% MCV 90 micrometers^3, MCH 25.6 pg/cell, MCHC 20% MCV 130 micrometers^3, MCH 40.3 pg/cell, MCHC 35% Hint FALSE statement regarding the recently described gene associated with breast cancer, BRCA-1, is It is associated with familial breast cancer in some families. It is a good population screening TOOL for breast cancer. It is not found only in women with breast cancer. It is found in individuals with other types of cancer. It is not an X-linked recessive. Hint A 36 year old woman with headache, weakness, fatigue, and gingival bleeding is suspected to have disseminated intravascular coagulation Hematological malignancy associated with DIC is which of the following? Acute lymphocytic leukemia Chronic myelogenous leukemia Multiple myeloma Acute promyelocytic leukemia Chronic lymphocytic leukemia Hint What is the most appropriate treatment for polycythemia vera? Hydroxyurea plus phlebotomy Cisplatin plus etoposide. Cisplatin plus nuorouracil. Hydroxyurea plus alpha interferon. Chlorambucil plus prednisone. Hint Which of the following is NOT a part of the staging of a sarcoma? Chest X-ray Bone scan. MRI of the lesion. MRI of the brain. CT of the chest. Hint FALSE statement regarding thrombolytics in acute myocardial infarction is Clinical success is increased if the thrombolytic is given as early as possible in the episodes. Streptokinase is less costly than tissue plasminogen activator (tPA). Streptokinase causes more allergic reactions than tissue plasminogen activator (tPA). d) Recent stroke is a contraindication to administering thrombolytics. Recent stroke is a contraindication to administering thrombolytics. Age >65 is a contraindication to administering thrombolytics. Hint A blood smear from one blood sample drawn from a patient shows a reduced number of normochromic, normocytic erythrocytes, with numerous schistocytes. This blood sample has been probably drawn from the patient with Acute blood loss Chronic autoimmune gastritis Disseminated intravascular coagulation Immune-mediated hemolysis Iron deficiency Hint A 21 year old student returns from Ghana with a spiking temperature and nocturnal sweats. She has 0.5% of red blood cells infected with Plasmodium falciparum. For quinine therapy in this case, what is the correct statement? Quinine contraindicated in those taking mefloquine prophylactically Quinine must always be given parenterally initially Pregnancy is a contraindication for quinine Glucose level should be monitored in those on treatment with quinine Dose of quinine should be reduced in liver impairment Hint A Chinese male aged 45 years is found incidentally to have a severely hypochromic and microcytic blood picture, with Hb11.2g/dl. He is asymptomatic. The most discriminatory investigation is which one of the following? Barium enema Gastroscopy Haemoglobin electrophoresis Bone marrow biopsy Ham test Hint A previously healthy 31 year old man has a two months history of weight loss, tiredness and nausea. Full blood count is normal. Serum sodium is low, potassium is increased. Urea is 3.0 mmol/L, creatinine is 78µmol/L, total T4 55 nmol/L (50-150) and TSH is 8 mU/L. The next useful diagnostic test is Anti-thyroid peroxidase antibody titre Insulin tolerance test SHORT synacthen test TRH test Hint A 14 year old boy has excessive bleeding from a tooth cavity following an extraction at the dentist. His Hb is 13.2 g/dL, platelet count is 260 x109/L, WBC count is 8 x109/L, PT is 14 s (11.5-15.5), Activated partial thromboplastin time is 45 sec (30-40) and factor VIII is 45 U/dL (50-150). The most likely diagnosis is Disseminated intravascular coagulation Haemophilia A Haemophilia B Idiopathic thrombocytopaenic purpura von Willebrand´s disease Hint A 73 year old man has a five day history of cough, dyspnoea and fever. CXR shows a left basal consolidation. His Hb is 11 g/dL, WBC count is 30 x109/L with neutrophils 10 x109/L (1.5-7 x109), lymphocytes 20 x109/L (1.5-4 x109), monocytes 1 x109/L (0-0.8 x109), eosinophils 0.4 x109/L (0.04-0.4 x109) and basophils 0.1 x109/L. The most appropriate test to establish the diagnosis is Bone marrow aspirate Bone marrow cytogenetics CT abdomen Immunophenotyping of white cells Sputum cytology and AFB Hint A male aged 30 years has sudden deterioration and haematuria 15 minutes after starting blood transfusion. His pulse rate is 120 beats per minute and blood pressure is 70/40 mmHg. The most likely cause is ABO incompatibility Anaphylaxis to anaesthetic agents Disseminated intravascular coagulation Graft versus host disease Rhesus incompatibility Hint An 83 year old woman has tiredness. On exam she is anaemic but has no palpable spleen. Her haemoglobin is 9.7 g/dL. She is started on oral iron therapy for one month and her Hb remained unchanged. Further report shows MCV of 102 fL with normal serum ferritin, vitamin B12 and red cell folate. Blood film show marked anisopoikilocytosis. The most likely diagnosis is Aplastic anaemia Anaemia due to renal disease Hypothyroidism Iron deficiency anaemia Sideroblastic anaemia Hint A 15 year old black female presents for a routine physical checkup. On examination, you note a well-defined, nontender rubbery breast mass approximately 2 cm in diameter. No history of skin changes, breast tenderness or nipple discharge is present. The most likely diagnosis is Fibrocystic breast disease Benign breast cyst Cystosarcoma phyllodes Fibroadenoma Intraductal papilloma Hint Which tumor marker is most closely associated with ovarian cancer? Carcinoembryonic antigen CA-125 CA 19-9 CD25 Alpha-fetoprotein Hint A 77 year old woman presents with back pain of several months duration, which is worsened by movement. Her examination is unremarkable except for mild pallor. She takes furosemide (Lasix) for hypertension. Laboratory Findings Hemoglobin..............10.0 g/dL (N 12.0-16.0) Serum creatinine........2.0 mg/dL (N 0.6-1.5) BUN.....................40 mg/dL (N 8.5-25) Serum uric acid.........8.0 mg/dL (N 3.0-7.0) Serum calcium...........12.0 mg/dL (N 8.5-10.5) Total serum protein.....9.8 g/dL (N 6.0-8.4) Globulin................6.1 g/dL (N 2.3-3.5) Albumin.................3.7 g/dL (N 3.5-5.0) Serum IgG...............3700 mg/dL (N 639-1349) Urine...................positive for Bence-Jones protein The most appropriate at this point is Repeat the physical examination and laboratory evaluation every 6 months Take the patient off the diuretic and repeat the laboratory evaluation in 1 month Obtain a bone scan Obtain a bone marrow examination Begin therapy with tamoxifen, 20 mg daily Hint In a woman under 40 years of age, the breast abnormality that would have the highest predictive valve for malignancy is Painful, moveable mass Painless, moveable mass Blood nipple discharge Clear nipple discharge Breast skin edema with dimpling Hint A 30-year-old man is starting a chemotherapy regime that includes Cisplatin. Which of the following is the mechanism of action of Cisplatin? Causes crosslinking in DNA Degrades preformed DNA Inhibits de novo purine synthesis Interferes with microtubule function, resulting in impaired mitosis Stabilizes DNA-topoisomerase II complex Hint A 66-year-old female presents with a three week history of malaise and blood in her sputum. Bronchoscopy reveals a mass in the right main bronchus, and history demonstrates it to be a small cell carcinoma. Further investigation fails to show any metastases. What is the most appropriate step in management? Chemotherapy Endobronchial laser therapy Palliative therapy Radiotherapy Surgery 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.
