Welcome to your Gp neelima hematology and oncology 31-01-17

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Which of the following is the mode of action of Imatinib?



A 70-year-old male is diagnosed with multiple myeloma and is treated with melphalan and prednisolone. Which of the following when added to this chemotherapeutic regimen would be expected to improve survival?



A 46-year-old woman has 1 year old weight gain and intermittent sweating and complains of blurred vision when she exercises. What is the most likely diagnosis?



A 58 year old woman presents to her family physician with a 3 cm palpable, well circumscribed, non-tender breast mass. She first noticed it several months ago and believes it has increased in size since then. She has a family history of breast cancer. No abnormalities are found on mammogram. Which appropriate step you should take next?



Hemoglobin A1C assays are inaccurate in patients having which of the following?



All are factors which contribute at the development of squamous cell cancers of the head and neck, except



Mutations of the p53 gene frequently occur in:



A 49-year-old has Cushingoid facies and hyperpigmentation of face and chest. She has smoked 20 cigarettes per day for 31 years. With no gross abnormalities, CXR shows a 2 cm irregularly shaped mass in the right upper lobe, in proximity to the mediastinum. Biopsy will show what histology?



A 56 year old man develops pain and swelling in his right lower leg and ankle since yesterday. Some discoloration is present on the ankle. He states that he accidently banged his ankle also. The most appropriate treatment is



Out of the following, which one should be considered in elderly patients when a long airline flight is planned?



A 49 year old woman receiving chemotherapy for widespread metastatic breast cancer is admitted to hospital with increasing drowsiness, confusion and constipation. Following investigations she is found to be hypercalcemic. Which treatment strategy represents the best initial management of her hypercalcemia?



Which of the following statement is FALSE regarding hemophilia?



A 33 year old woman has a history of sore throat, increasing fatigue, and by DealXplorer" href="http://www.interface.edu.pk/medical-exams/test.php?u=33509&t=197518&Page=17#86085431">SHORTNESS of breath for the past 3 days. On physical examination, her temperature is 38.6°C (101 .5°F) her pulse is 100/min, and no murmurs are auscultated. A complete blood count with reticulocyte count shows 1,500 white blood cells/mm^3. The platelet count is 12,000/mm^3. The corrected reticulocyte count is less than 1%. The most likely finding on bone marrow biopsy would be



A 53 year old woman had noticed a lump in her left breast 3 months ago, and after extensive workup she elects to undergo surgery. A surgical specimen is sent pathologist. The pathologist´s report states "small glandular structures lined by poorly differentiated cells." Which one of the following carcinoma does this patient most likely have based on history, report and incidence of various types of breast cancers?



A patient presents with ill defined complaints of malaise. Erythrocyte sedimentation rate ordered by the physician yields a value lower than normal. A decreased erythrocyte sedimentation rate would most likely to be produced by which one of the following?



A 34 year old woman with systemic lupus erythematosus (SLE) and chronic renal failure develops rapidly progressive weakness. She appears pale and has slightly yellow sclerae and an enlarged spleen on physical examination. Blood studies reveal severe anemia and mild, mostly unconjugated hyperbilirubinemia. Coombs test is positive at 37°C but negative at 0-4° C. What is the most likely reason for development of anemia in this patient?



A 43 year old African American man suffers severe injuries in an automobile accident and is admitted to the intensive care unit with severe injuries to multiple ribs, a femoral fracture, and head trauma. On 3rd day of admission, peripheral blood smear reveals helmet shaped red cells schistocytes, and decreased platelets. These findings most strongly suggest which one of the following?



A43 year old woman is diagnosed with non nodal breast cancer. Which of the following factor is NOT associated with an increased risk of recurrence of the breast cancer after resection?



What is the principle therapeutic component of the management of acute lymphocytic leukemia?



A 27 year old vegetarian woman complains of fatigue. She has significant menstrual blood loss. On examination she has tachycardia and tachypnea on exertion. Ferritin levels are 10 mg/L on serum analysis. The most likely diagnosis is



A 22 year old college hockey player presents for a routine checkup. Her systemic review is significant for menorrhagia. Several trauma related nonpalpable ecchymoses on both legs, and mucosal petechiae are found on physical examination. Her platelet count is 31000/mm^3. Peripheral blood smear shows normal cell morphology. What is association with this condition?



The patients with Hodgkin´s disease that have the worse prognosis include which one of the following?



A 30-year-old woman presented with a deep vein thrombosis. Her previous history included investigation for infertility. Investigations revealed:


















Haemoglobin 12.8 g/dL (11.5-16.5)
White cell count 3.6 x109/L (4-11x109)
Platelet count 35 x109/L (150-400x109)

Select one of the following investigations that is most likely to be abnormal?



A 30-year-old female presents with a discrete thyroid swelling. An isotope scan reveals it to be a "cold nodule". She has scattered local cervical lymphadenopathy. What is the likely diagnosis?



A 64-year-old female is receiving treatment for colon cancer with a combination chemotherapy regimen that includes Irinotecan. Which of the following best describes the action of Irinotecan?



A 55-year-old man presents with ataxia and bilateral gynecomastia. Which of the following is the most likely diagnosis?



A 65 year old man is found to have a nodular prostate on digital rectal examination. Subsequent biopsy confirms cancer of the prostate; which one of the following would have the most prognostic value?



A 26 year old female presents with complains of easy bruising over the past month. She is not as concerned about her rash like skin bruising as she is about her gums bleeding with brushing the teeth over the past three days. What investigations are not necessary to order?



A 33 year old man is seen in the Emergency Department after attempting suicide by taking an overdose of warfarin. Which is used as a treatemnt for this situation?



A 53-year-old white male has been diagnosed with multiple myeloma for four years. All of the following are associated with multiple myeloma EXCEPT



A 20 year old homosexual man visits doctor with complaints of painful oral ulcers. According to him these ulcers on and off for years, usually lasting about a week. He has had several sexual partners, and on occasion has not used barrier devices. On examination there is a 7 mm lesion of the anterior aspect of the tongue. It has a thin erythematous border surrounding a shallow ulcerated lesion. The man also states that his sister also complains of similar lesions. The most appropriate diagnosis is



A patient´s blood smear, diagnosed with acute myeloblastic leukemia, contains many promonocytes that stain positively for non specific esterase. According to the French American British (FAB) classification this leukemia would be best classified as which of the following?



In porphyria cutanea tarda, which of the following is FALSE regarding uroporphyrinogen decarboxylase?



A 44 year old man, who is taking broad spectrum antibiotics, is diagnosed with a vitamin K deficiency. The coagulation factor that would NOT be jeopardized by the vitamin deficiency is



Chronic clinical manifestation of sickle disease does NOT result from which of the following?



A 37 year old woman presents with severe lower back pain and bilateral anterior rib pain. Lumbar spine X-ray showed compression fracture and evidence of osteopenia. The serum calcium level was 13.7 mg/dl. Which of the following does NOT cause osteopenia and hypercalcemia?



 A 36 year old female is brought to the emergency room because of a bleeding gastric ulcer. She is anemic and loosing blood continuously. She is immediately transfused four units of packed red blood cells. Which of the following complication is NOT associated with transfusing the four units of blood?



Tumor that is often curable by chemotherapy is which one of the following?



A 37 years old man presents with complaints of excess fatigue. He is anemic with an elevated ESR and calcium level. His ribs were tender on palpation. Peripheral smear revealed a rouloux pattern of the red blood cells. The most likely diagnosis is



Condition that is associated with over-expression of bcl-2 is which one of the following?



A 27 year old pregnant lady is being treated for a deep vein thrombosis with unfractionated heparin. She has Hb of 9.8 g/dL, WBC count of 9.5 x109/L and platelet count of 35 x109/L. What would be the best course of action for her?



An 81 year old woman has a 3 month history of progressive numbness and unsteadiness of her gait. On exam, there is a mild spastic paraparesis, with brisk knee reflexes, extensor planters, sensory loss in the legs with a sensory level at T10, impaired joint position sense in the toes, and loss of vibration sense below the iliac crests. Her Hb is 12.2 g/dL and MCV is 95 fL. The likely diagnosis is



Which of the following statements is correct concerning the relationship between Type 2 Diabetes and colonic cancer?



Which one of the following statements is true of B cell CLL?



A 60 year old woman has an enlarged axillary lymph node removal. Microscope examination reveals that the nodal architecture is effaced by anaplastic gland-forming cells. Special tissue studies confirm the presence of estrogen and progesterone receptor proteins. Which one of the following is the most likely diagnosis?



Interferon alpha immunotherapy is used as treatment of which for the following condition?



Batson´s plexus is considered responsible for some of the bony spread of



Which one of the following therapeutic drugs is LEAST likely to be administered to treat stage IV Hodgkin´s disease?



A 26 year old woman presents with complaints easy bruising excessive bleeding. Hepatosplenomegaly is seen on physical examination. A blood smear reveals pancytopenia, and a bone marrow biopsy demonstrates markedly enlarged cells containing a fine fibrillar material that resembles tissue paper. Leukocyte studies demonstrate a deficiency of beta-D-glucosidase activity. Out of the following, which substance is most likely to accumulate in the bone marrow cells?



A patient complains of difficulty breathing through his nose and of bony pain in his cheeks, near his nose. Physical examination and CT of the head reveal mass lesions involving the nose, pharynx, and sinuses. CT guided biopsy demonstrates a nonkeratinizing squamous cell carcinoma. The oncogenic virus that is the likely cause of this patient´s cancer is also associated with which one of the following?



Which of the following is NOT susceptible to degradation by stromelysin?



All of the following are risk factors for pulmonary emboli, EXCEPT



A 20 year old boy is under treatment for stage III Hodgkin´s disease with the MOPP regimen (mechlorethamine, vincristine, prednisone, and procarbazine). He develops autonomic neuropathy that is manifested as severe constipation. The most likely medication that is the cause of this peripheral neuropathy is



A patient is diagnosed as having Hodgkin´s disease. Staging reveals involvement of a single lymph node. Treatment should consist of which one of the following?



All of the following are precipitating factors for attacks in acute intermittent porphyria, EXCEPT



A leukemic patient who develops DIC is diagnosed with acute promyelocytic leukemia. The translocation that is associated with the development of this disorder is



A woman aged 70 years has a 3 month history of exertional dyspnoea and chest pain. She has vague abdominal pains and lost 7kg in weight. Exam reveals pallor, patches of vitiligo on her arms and trunk, ankle oedema and a palpable spleen. Her Hb is low (5g/dL) with raised MCV. WBC and platelet count are also low. Bilirubin, AST, ALT and LDH are elevated. The likely diagnosis is



A 37 year old female is on warfarin after suffering a DVT. Her INR is 8.2 (NR <1.4) and has conjunctival haemorrhage. Her BP is 125/55 mmHg, pulse is 65/min and ECG reveals a normal sinus rhythm. The appropriate treatment is



A 42 year old man has bleeding gums and ease of bruising. He is taking Omeprazole for dyspepsia. Labs show Hb of 12.5 g/dL, MCV of 90 fL, platelet count of 20 x109/L and PT of 13.5s (11.5-15.5). Blood film shows occasional giant platelets. The most likely diagnosis is



A 14 year-old girl (child of consanguineous marriage) had a severe nosebleed. When a blood sample was, the clot that formed failed to retract. Peripheral blood smear showed normal-sized platelets that were individual, without clumping. Her platelet´s failed to aggregate with any physiologic aggregating agent, including a high concentration of exogenous ADP. Which of the following is the most likely diagnosis?



A 24 year old female arrives at her family physician´s office complaining of easy bruising over the past month. She is not as concerned about her "rash-like" skin bruising as she is about her gums bleeding with brushing her teeth over the past three days. The only abnormality detected is a platelet count of 70,000/mm. The least likely cause is



A 60-year-old chronic smoker has hyponatremia and hyperosmolar urine. Increased levels of anti-diuretic hormone are detected. Which one of the following is most likely type of lung cancer in this patient?



The most appropriate treatment for hairy cell leukemia is



A68 year old man is brought to the emergency department after fracturing his humerus when reaching for the telephone. His past medical history is significant for three episodes of pneumonia during the past year. Laboratory results indicate a normal white blood cell count, decreased platelets; an erythrocyte sedimentation rate (ESR) of 65 mm, elevated C-reactive protein, and prostate-specific antigen (PSA) of 2.5 ng/ml. Urinalysis reveals proteinuria. X-rays reveal a large lytic bone lesion. The most likely diagnosis is



Which one of the following statement is correct regarding B cell CLL?



A 71 year old woman has fatigue and weight loss. Her Hb is 9.0 g/dL, WBC count is 2.0 x109/L, platelet count is 250 x109/L, total protein is 74 g/L (61-76) and albumin is 28 g/L (37-49). Urea and creatinine are elevated. Urine dipstick is positive for protein and blood. Renal ultrasound is normal. Which investigation would be most appropriate for this patient?



A 56 year old man has anorexia and weight loss for 12 months. He had two DVTs whilst his INR was 2 (<1.4). He remained on long term warfarin therapy with an INR above 2.6. On exam he is pigmented and has a postural drop in his BP of 15 mmHg. by DealXplorer" href="http://www.interface.edu.pk/medical-exams/test.php?u=33509&t=197644&Page=27#43452618">SHORT synacthen test reveals a baseline cortisol concentration at time 0 of 120 nmol/L which rises to 155nmol/L after 30 minutes (Normal response >550 nmol/L). The likely diagnosis is



An 18 year old Asian girl is noted to have gingival hypertrophy by her dentist. Which one of the following is most likely responsible for her presentation?



A 23-year-old otherwise being well has a petechial rash on the lower legs and conjunctival pallor. He takes no medication and denies any illicit drug use. All investigations are normal except that Hemoglobin = 4.1 g/dL, WBC count =1 x103//L and Platelets = 20 x103/L .Which of the following is the likely diagnosis?



Which of the following lung cancers has the best prognosis?



When compare "first by DealXplorer" href="http://www.interface.edu.pk/medical-exams/test.php?u=33509&t=197684&Page=10#81256394">GENERATION" fibrinolytics with the "second-generation" drugs, second generation drugs are characterized by all of the following EXCEPT



A 62 year old man complains of weakness, fatigue, and bleeding from the oronasal area. He also has blurred vision, dyspnea, and pallor. Examination reveals lymphadenopathy, hepatosplenomegaly, and sensorimotor peripheral neuropathy. Hypercellular infiltration with lymphoid cells and plasma cells were revealed on bone marrow aspiration. Serum electrophoresis showed a large number of highmolecular-weight monoclonal IgM proteins (greater than 3 gm/dl). The most likely diagnosis is



A 68 year old man has 15 pounds weight loss, fatigue and night sweats for 2 months. He has noticed "lumps" in his neck that come and go. Examination shows multiple, palpable, painless cervical and axillary lymph nodes, as well as splenomegaly. FBC reveals lymphocytosis and hemoglobin is 10.8 g/dL. His peripheral smear is shown below. The most likely diagnosis is



A 5 year old child has chronic fatigue, malaise, and an 8 pound weight loss. Examination shows a pale child with many small bruises on her forearms and shine. Investigations show anemia, thrombocytopenia, and a normal WBC count. Blast forms are seen in the peripheral smear. Bone marrow aspirate and biopsy demonstrate partial replacement of the marrow by small blasts with uniform, round nuclei, and scant cytoplasm. Immunohistochemical studies show marking of these blast cell with antibodies directed against B cell antigens. Her disease should be classified as which type of acute leukemia according to the French-American-British classification?



A boy aged 17 years with G6PD deficiency has tiredness and is noticed to be jaundiced. These features have developed since he developed a mild chest infection one week ago. Which one is the most likely haematological finding?



A male aged 60 years has bruising and tiredness. Exam reveals splenomegaly and labs show hemoglobin of 11 g/dL, WBC count of 100 x109/L and platelet count of 900 x109/L. Blood film reveals a neutrophilia, basophilia, numerous myelocytes and 4% myeloblasts. What is likely to be present in him?



A 54 year old, asymptomatic woman with mild splenomegaly was found have a platelet count of 650 x109/L on blood investigation. White blood cells and haemoglobin are within normal range. The next step in management is



A 17 year old girl with non-Hodgkin´s lymphoma underwent splenectomy. She has an enhanced risk of developing pneumococcal sepsis and wishes to know how long this risk would persist. The duration of the risk is



A 56 year old man has anorexia and weight loss for 12 months. He had two DVTs whilst his INR was 2 (550 nmol/L). The likely diagnosis is



A 55 year old male was admitted for a total hip replacement. Physical exam was normal. Routine pre-operative blood study showed Hb of 11 g/dL and WBC count of 25 x109/L with lymphocyte count of 19 x109/L (1.5-4 x109). Blood film shows mature lymphocytes. The most appropriate initial management is



A female aged 70 years is on multiple medications for various conditions. She is found to have a macrocytic anaemia with a low serum B12. Medication that is a possible cause of the B12 deficiency is



A 33 year old man was prescribed an oral antibiotic for a UTI. Two days later he noticed that his urine was increasingly dark in colour. His Hb is 8.5g/dL and Reticulocyte count is 147x109/L (25-85 x109). Peripheral film shows marked anisopoikilocytosis and bite cells. The likely diagnosis is



A 66-year-old male with a four month old diarrhea, pale stool and weight loss has Serum Calcium=7.2 mg/dL and Alkaline phosphatase=355 U/L. What is the most likely diagnosis?



A 28 year old male presents with painless swelling in the testicle. A testicular ultrasound confirms the diagnosis of testicular tumour, and an abdominal CT reveals normal retroperitoneal nodes. Which statement is correct with respect to this case?



A 62 year old male with easy fatigue was found to have hypercalcemia, decreased parathyroid hormone level, normal blood urea nitrogen (BUN) and creatinine, and increased urinary excretion of calcium. CXR reveals an irregular density in the right upper lobe of the lung. The most appropriate diagnosis is



A patient admitted to the hospital has a basic metabolic panel (BMP) drawn and sent to the lab. The serum sodium, calcium, and bicarbonate are all normal except the serum potassium was 7.4. The patient is asymptomatic. The most appropriate next step is



What is the appropriate initial management of deep venous thrombosis?



A 76-year-old man with squamous cell carcinoma is thought to have resectable disease. Which of the following would be a contraindication to surgery?



A 55 year old black male presents to you 2 days after evaluation in the emergency department for acute difficulty urinating. His acute symptoms have improved. He requests screening for prostate cancer. You are concerned that his visit to the emergency department may affect the results of prostate cancer screening, and you decide to obtain more information. The possible occurrence 2 days earlier would NOT preclude prostate specific antigen (PSA) screening is



A 64 year old man who is a cigar and pipe smoker develops a circular lesion on the lower lip. See picture:



All of the following are true statements regarding chronic myelogenous leukemia except:



A 44 year old man presents with weakness, dyspnea on exertion, and mid-thoracic back pain. On examination, he was found to have vertebral tenderness on palpation and pallor. Investigations revealed hypercalcemia, anemia, ESR elevation and an elevated creatinine level. A bone marrow test reveals plasma cells predominantly. Multiple myeloma is suspected. Which investigation could not help in diagnosis?



A 6 year old boy is undergoing evaluation for a soft tissue mass in his neck. The lesion is sent for pathological evaluation after resection. In order to determine treatment, the cell of origin needs to be determined. Unfortunately, the tumor is poorly differentiated with no characteristic histologic markers for cell of origin. It is suspected that the lesion is a rhadomyosarcoma. Which structure´s immunohistochemical staining would most likely confirm the diagnosis?



The results of lab investigations for a patient are shown below.






























Hemoglobin 9g/dL
Erythrocyte count 3x 106/mm3
Mean corpuscular volume 65 µm3
Plasma iron Decreased
Serum ferritin Decreased
Transferrin Increased

The most appropriate diagnosis is



A 16 year old Asian boy has a history of fever and increased abdominal girth. Radiographic examination reveals an ileocecal mass, which is identified as a lymph node. Molecular studies on an abdominal lymph node containing lymphoma demonstrate t(2;8)(p12;q24) translocation. The most likely diagnosis is



A seminoma of the testes and a germinoma involving the ovary differ most significantly by which of the following?



A 53 year old man presents with fevers, night sweats, and a recent 17 lb weight loss. Mediastinal lymph nodes are prominent and visible on routine chest X-ray. Lymph node biopsy shows prominent nodules and fibrosing bands separating the nodules. The biopsy also shows unusual cells with multilobulated nuclei and abundant, pale cytoplasm producing an empty space. They are surrounded by lymphocytes, plasma cells, and histiocytes. Above mentioned findings are most consistent with which of the following diseases?












A 16 year old boy presents because of hematuria. He recently had a sinus infection and got treated with sulfonamide antibiotic. Serum haptoglobin is decreased, and serum bilirubin and LDH are increased. Urine red cell count is1.2 million/mm3. A peripheral blood smear shows normocytic red cells. Numerous red blood cells with inclusions are seen on peripheral smear (shown below). The inclusions seen in this patient are best described by which one of the following?



A 34 year old man presents to his physician for a routine physical examination. The man admits to recent loss of 30 pounds (20% of bodyweight) and occasional fatigue but ascribes these to increase in his workload. A 2-3 cm firm, freely moveable, nontender mass in his neck on the right side is found on physical examination. Biopsy of the neck mass reveals large binucleate cells with prominent nucleoli in a mixed inflammatory infiltrate. CT scan shows marked enlargement of mediastinal nodes and the presence of several very large lymph nodes along the abdominal aorta. How should his disease be staged?



Which cancer does NOT has an increased risk with high fat diet?



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