Welcome to your Gp neelima hematology and oncology 1-02-17

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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?



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?



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?



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?



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?



Which of the following statements regarding prognosis in lung cancer is true?



Which of the following does NOT explain the clinical manifestations of hereditary spherocytosis?



The most commonly associated with cancer of the uterine cervix is



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?



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?



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?



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?



All of the following are associated with neutropenia, EXCEPT



All are frequently found in Chronic Myelogenous Leukemia (CML), except



The test that distinguishes pernicious anemia from other causes of macrocytic anemia is



Which of the following statement is FALSE regarding multiple myeloma?



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



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



True statement regarding the treatment of iron deficiency anaemia is which one of the following?



A 42-year-old male has suspected superior vena cava obstruction (SVCO). Which of the following statements is correct?



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.



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?



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



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



Which of the following cytotoxic agents acts by inhibiting purine synthesis?



Burkit´s lymphoma is associated with a mutation of which of the following genes?



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?



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



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?



Drug resistance to chemotherapeutic agents is a major reason for treatment failure. All of the following are true regarding drug resistance EXCEPT



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



The most common site for development of embryonal rhabdomyosarcoma is



Hemolytic disease of the newborn usually occurs in infants born to mothers whose blood type is which of the following?



What is the treatment of choice for a two day post cholecystectomy patient with pulmonary embolism?



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?



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



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?



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?



True statement regarding sickle cell disease is which one of the following?



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?



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



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?



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?



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?



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?



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?



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



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?



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?



A patient attends for breast screening and asks you the following questions. Which statement is correct?



Lymphadenopathy is most likely to be malignant at which of the following sites of head and neck?



A 46-year-old man is diagnosed acute promyelocytic leukaemia. Which of the following chromosomal translocations is associated with this of leukaemia?



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












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



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



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



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?



Which of the following is NOT useful in the management of von Willebrand´s disease?



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



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?



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?



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?



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



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



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



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?



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?












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?



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?



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?



With respect to gastric carcinoma, which of the following statement is true?



The following are recognized features of Pancoast´s tumour except:



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?



In asbestos related disorders which of the following statements are correct?



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?



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



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?



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



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?



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?












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?



FALSE statement regarding the recently described gene associated with breast cancer, BRCA-1, is



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?



What is the most appropriate treatment for polycythemia vera?



Which of the following is NOT a part of the staging of a sarcoma?



FALSE statement regarding thrombolytics in acute myocardial infarction is



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



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?



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?



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



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



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



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



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



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



Which tumor marker is most closely associated with ovarian cancer?



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



In a woman under 40 years of age, the breast abnormality that would have the highest predictive valve for malignancy is



A 30-year-old man is starting a chemotherapy regime that includes Cisplatin. Which of the following is the mechanism of action of Cisplatin?



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?



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