Gp neelima hematology and oncology 31-01-17 Welcome to your Gp neelima hematology and oncology 31-01-17 Name Business Email Phone Number Which of the following is the mode of action of Imatinib? Angiogenesis inhibitor Epidermal growth factor inhibitor Interferon Proteosome inhibitor Signal transductase inhibitor Hint 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? Colchicine Thalidomide Interferon alpha Methotrexate Simvastatin Hint 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? Carcinoid syndrome Hypothyroidism Lymphoma Insulinoma Pheochromocytoma Hint 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? Prophylactic mastectomy Repeat mammogram in 6 months Excisional biopsy Repeat mammogram in 1 year Ultrasound Hint Hemoglobin A1C assays are inaccurate in patients having which of the following? Secondary hypertension Morbid obesity Cor pulmonate Sickle cell disease Hypothyroidism Hint All are factors which contribute at the development of squamous cell cancers of the head and neck, except Cigarette smoking Alcohol ingestion Aging Solar irradiation Exposure to particular emission from diesel engines Hint Mutations of the p53 gene frequently occur in: Huntington´s Disease Bronchial carcinoma Type 2 Diabetes Mellitus Cystic fibrosis Colonic polyps Hint 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? Small cell (oat cell) carcinoma Adenocarcinoma Benign bronchial adenoma Bronchoalveolar cell carcinoma (BAC) Squamous cell carcinoma Hint 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 Steroids Narcotics Anticoagulants Antibiotics Hint Out of the following, which one should be considered in elderly patients when a long airline flight is planned? Hypoxia with desaturations Temporal disorientation Barotitis Deep venous thrombophlebitis Dehydration Hint 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? Change the chemotherapy regimen Administer a bisphosphonate drug intravenously Give normal saline solution and a diuretic together Give normal saline solution Give dextrose 5% in water solution Hint Which of the following statement is FALSE regarding hemophilia? It is the result of factor VIII deficiency Spontaneous bleeding occurs when the level of factor VIII in the plasma is less than 50 percent. ten to fifteen percent of hemophiliacs will develop circulating inhibitors to factor VIII. Hemophilia can cause hemarthroses which may lead to joint destruction. A hemophiliac with a factor VIII level of 5 percent is at high risk of bleeding after surgery or trauma, but will rarely bleed spontaneously. Hint 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 Giant early red-cell precursors Hypercellularity with megaloblasts and giant metamyelocytes Hypocellularity with a decrease in all cells, predominance of fat cells, and marrow stroma. RINGED sideroblasts on Prussian blue stain Sheets of abnormal plasma cells Hint 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? Colloid (mucinous) Invasive ductal Invasive lobular Medullary Metastatic bronchogenic Hint 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? Cancer Infection Pregnancy Systemic lupus erythematosus Polycythemia Hint 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? Bone marrow aplasia IgG directed against red blood cells IgM directed against red blood cells Renal failure Spleen sequestration Hint 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? Autoimmune hemolysis Disseminated intravascular coagulation (DIC) Functional asplenia Hereditary spherocytosis Mechanical mitral valve replacement Hint 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? Estrogen receptor positive. Aneuploid DNA on flow cytometry studies. neu oncogene expression. Expression of epidermal growth factor. High levels of cathepsin D. Hint What is the principle therapeutic component of the management of acute lymphocytic leukemia? Supportive care. Antibiotics. Chemotherapy. Radiotherapy. Surgery. Hint 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 Vitamin B12 deficient anemia Folate deficient anemia Iron deficient anemia Sickle cell anemia Glucose 6 phosphate dehydrogenase deficiency. Hint 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? Antiplatelet antibodies Detective platelet aggregation Hypersplenism Ineffective megakaryopoiesis Proteinuria Hint The patients with Hodgkin´s disease that have the worse prognosis include which one of the following? 25 year old man with inguinal lymphadenopathy 25 year old woman with mediastinal and inguinal lymphadenopathy 25 year old woman with mediastinal and inguinal lymphadenopathy and night sweats 25 year old man with mediastinal and inguinal lymphadenopathy and pruitis 25 year old man with cervical and mediastinal lymphadenopathy Hint 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? Antiphospholipid antibodies Homocystine concentration Platelet function test Protein C concentration. Indium-labelled white cell scan. Hint 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? Papillary carcinoma Anaplastic carcinoma Grave´s disease Medullary carcinoma Subacute thyroiditis Hint 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? Topoisomerase inhibitor Alkylating agent DNA antimetabolites Inhibition of protein synthesis Interferes with microtubule function Hint A 55-year-old man presents with ataxia and bilateral gynecomastia. Which of the following is the most likely diagnosis? Hypereosinophilic syndrome Klinefelter´s syndrome Long term treatment with Cyclophosphamide for wegener´s granulomatosis Bronchial carcinoma Long term treatment with oral steroids for chronic asthma Hint 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? Pathological grade (Gleason score) Age Urinary obstructive symptoms Positive family history Adenosquamous histology 6 Hint 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? CBC and differential Serum electrolytes & creatinine Fibrin split products PT & PTT (includes INR) Hint 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? Heparin Allopurinol Coumarin Vitamin E Vitamin K Hint 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 Hypocalcemia. Infections. Plasma cells. Rib fracture. Cast Nephropathy. Hint 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 Aphthous ulcer Candidiasis Herpes simplex virus I- mediated ulcer Herpes simplex virus II- mediated ulcer Pyogenic granuloma Hint 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? M1 M2 M3 M5 M7 Hint In porphyria cutanea tarda, which of the following is FALSE regarding uroporphyrinogen decarboxylase? Hepatic uroporphyrinogen decarboxylase is deficient in all forms. In type I, uroporphyrinogen decarboxylase is normal in erythrocytes. In type III, uroporphyrinogen decarboxylase is deficient only in the liver. In type II, there is a 50% deficiency of uroporphyrinogen decarboxylase in nonhepatic tissues. In type I, uroporphyrinogen decarboxylase is deficient in erythrocytes. Hint 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 Factor II Factor VI Factor VII Factor IX Factor X Hint Chronic clinical manifestation of sickle disease does NOT result from which of the following? "Fishmouth" vertebrae are produced by bone infarction. Systolic ejection murmurs are caused by a hyperdynamic circulation. Papillary infarcts produce prolonged painless hematuria. Renal medullary infarcts cause isosthenuria, with a subsequent risk of overhydration. Hyperbilirubinemia causes formation of gallstones. Hint 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? Thyrotoxicosis. Multiple myeloma. Hyperparathyroidism. Chronic renal failure. Metastatic breast cancer. Hint 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? Hepatitis B. Transfusion reaction. Cytomegalovirus exposure. Iron overload resulting in hemochromatosis. Pulmonary leukoagglutinin reaction. Hint Tumor that is often curable by chemotherapy is which one of the following? Acute lymphocytic leukemia Kaposi´s sarcoma Prostate cancer Astrocytoma Melanoma Hint 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 Lymphoma Multiple myeloma Acute lymphocytic leukemia Endocarditis Chronic fatigue syndrome Hint Condition that is associated with over-expression of bcl-2 is which one of the following? Acute lymphoblastic leukemia Burkitt lymphoma Follicular lymphoma Multiple myeloma Small lymphocytic lymphoma Hint 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? Change to hirudin Change to low molecular weight heparin Change to warfarin Danaparoid No change in treatment and observe Hint 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 Anterior spinal artery occlusion Dorsal meningioma Multiple sclerosis Subacute combined degeneration of the cord Tabes dorsalis Hint Which of the following statements is correct concerning the relationship between Type 2 Diabetes and colonic cancer? The increased risk of colorectal cancer in diabetes is related to BMI The increased risk of colorectal cancer in diabetes is related to total cholesterol Insulin treatment increases recurrence-free survival after treatment of colonic cancer Low concentrations of C-peptide indicate low colorectal cancer risk Type 1 diabetes has similar risks of colonic cancer as does type 2 diabetes Hint Which one of the following statements is true of B cell CLL? Diffuse infiltration of bone marrow indicates good prognosis Late transformation to all occur in the majority of patients Autoimmune thrombocytopenia is uncommon Reduced immunoglobulins a risk of recurrent viral infections Stage A disease should be treated with chemotherapy Hint 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? Sinus histiocytosis Hodgkin´s disease Sarcoidosis Metastatic carcinoma Angiosarcoma Hint Interferon alpha immunotherapy is used as treatment of which for the following condition? Acute lymphoblastic leukemia Hairy cell leukemia Acute myeloid leukemia Burkitt´s lymphoma Myelodysplastic syndrome Hint Batson´s plexus is considered responsible for some of the bony spread of Breast cancer. Lung cancer. Prostate cancer. Ovarian cancer. Seminoma. Hint Which one of the following therapeutic drugs is LEAST likely to be administered to treat stage IV Hodgkin´s disease? Adriamycin Dacarbazine Vincristine Cyclophosphamide Bleomycin. Hint 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? Galactose Glucosylceramide Glycogen Homocysteine Mineralocorticoids Hint 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? Adult T-cell leukemia Cutaneous and mucous membrane plaque like violaceous lesions Genital warts Maligant soft tissue mass of the jaw Liver cirrhosis Hint Which of the following is NOT susceptible to degradation by stromelysin? Type IX collagen. Fibronectin. Elastin. Type IV collagen. Heparan sulfate. Hint All of the following are risk factors for pulmonary emboli, EXCEPT Hip fracture History of deep venous thrombosis History of pulmonary emboli Hypertension Cigarette smoking Hint 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 Mechlorethamine Vincristine Prednisone Procarbazine Effects due to the severity of the Hodgkin´s disease Hint 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? Radiotherapy. Chemotherapy. Combined radiotherapy and chemotherapy. Surgical resection. Palliative surgical procedures only. Hint All of the following are precipitating factors for attacks in acute intermittent porphyria, EXCEPT Low calorie diets Infections Surgery Sulfonamides Aspirin Hint A leukemic patient who develops DIC is diagnosed with acute promyelocytic leukemia. The translocation that is associated with the development of this disorder is t (4; 11) t (6; 9) (8J4) t (8; 21) t (15; 17) Hint 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 Aplastic anaemia Autoimmune haemolytic anaemia Dietary folate deficiency Pernicious anaemia Sideroblastic anaemia Hint 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 FFP Factor VII Oral vitamin K 1mg Prothrombin complex concentrate Stop warfarin only Hint 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 Amegakaryocytic thrombocytopenia Disseminated intravascular coagulation Drug-induced thrombocytopenia Immune thrombocytopenia Thrombotic thrombocytopenic purpura Hint 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? Bernard-Soulier syndrome Chédiak-Higashi syndrome May-Hegglin anomaly Thrombasthenia Von Willebrand disease Hint 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 Folate/B12 deficiency Lymphoma/leukemia Factor VIII deficiency SLE Hint 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? Bronchioloalveolar carcinoma Large cell carcinoma Adenocarcinoma Small cell carcinoma Carcinoid of Lung Hint The most appropriate treatment for hairy cell leukemia is Alpha interferon. Beta interferon. Gamma interferon. Interleukin-2 There is no appropriate treatment for hairy cell leukemia Hint 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 Amyloidosis Monoclonal gammopathy of uncertain significance Multiple myeloma Plasmacytoma Prostate carcinoma Hint Which one of the following statement is correct regarding B cell CLL? Thrombocytopenia often autoimmune Reduced immunoglobulins are a risk for recurrent bacterial infections Stage A disease should be treated with chemotherapy Late transformation to ALL occur in the majority of patients Diffuse infiltration of bone marrow indicates good prognosis Hint 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? 24 hour urinary protein estimation Measurement of anti-glomerular basement membrane (anti-GBM) Measurement of anti-neutrophil cytoplasmic antibodies (ANCA) Plasma protein electrophoresis Renal angiography Hint 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 Addison´s disease Anti-phospholipid syndrome Autoimmune polyendocrine Syndrome (Schmidt´s disease) Protein S deficiency Pituitary infarction Hint 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? Carbamazepine Scurvy Lead poisoning Phenytoin Sodium valproate Hint 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? Acute lymphocytic leukemia Acute myeloid leukemia Aplastic anaemia Henoch-Schonlein purpura Hodgkin´s lymphoma Hint Which of the following lung cancers has the best prognosis? Squamous cell carcinoma. Small cell lung carcinoma. Adenocarcinoma, bronchoalveolar variant type. Large cell carcinoma. Adenocarcinoma. Hint 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 Preferential activation of plasminogen in the fibrin domain. Relative clot selectivity. Induction of systemic lysis. More frequent coronary artery recanalization. More rapid coronary artery recanalization. Hint 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 Multiple myeloma Waldenstrom´s macroglobulinemia Solitary plasmacytoma of bone Chronic lymphocytic leukemia Hyperviscocity syndrome Hint 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 Acute lymphocytic leukemia Acute myelogenous leukemia Chronic lymphocytic leukemia Hairy cell leukemia Multiple myeloma Hint 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? L1 L2 M1 M2 M3 Hint 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? Haemoglobinuria Low mean cell volume Positive direct antiglobulin test Reduced reticulocyte count Spherocytes present on blood film Hint 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? BCR-ABL gene fusion only Deletion chromosome 13 Deletion 11q13 Normal chromosomal analysis Translocation 9;22 Hint 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 Anagrelide Hydroxycarbamide Low dose aspirin Observation Plateletpheresis Hint 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 Up to six months Up to one year Up to five years Five to 10 years More than 10 years Hint 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 Addison´s disease Anti-phospholipid syndrome Autoimmune polyendocrine Syndrome (Schmidt´s disease) Protein S deficiency Pituitary infarction Hint 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 Cancel the patient´s operation Chlorambucil Fludarabine Observation Prednisolone Hint 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 Amiodarone Ezetimibe Metformin Nicotinic acid Sodium valproate Hint 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 Acute Myeloid Leukaemia Autoimmune haemolytic anaemia Haemoglobin H disease Hereditary spherocytosis Paroxysmal cold haemoglobinuria Hint 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? Celiac disease Giardia lamblia infection Small Intestinal bacterial overgrowth Pancreatic carcinoma Whipple´s disease Hint 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? Fine-needle biopsy is contraindicated His overall prognosis is very poor The testicular mass is likely a secondary tumour A needle aspiration of the tumour is indicated He will likely require chemotherapy Hint 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 Multiple myeloma Sarcoidosis Primary hyperparathyroidism Laboratory error Paraneoplastic syndrome Hint 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 EKG Repeat the BMP Calcium gluconate Insulin Hint What is the appropriate initial management of deep venous thrombosis? Heparin Warfarin IVC filter Pneumatic/compression stockings Hint 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? Clubbing Forced expiratory volume (FEV)1 of 0.75 L His age of 76 years Syndrome of Inappropriate ADH Pleural effusion Hint 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 Performance of a rectal examination Performance of prostate massage Performance of Cystoscopy A diagnosis of urinary tract infection A diagnosis of urinary retention Hint A 64 year old man who is a cigar and pipe smoker develops a circular lesion on the lower lip. See picture: Squamous cell carcinoma Basal cell carcinoma Actinic keratosis Malignant melanoma Hint All of the following are true statements regarding chronic myelogenous leukemia except: The classic disease is associated with the Philadelphia 1 chromosome on cytogenetic analysis. Busulfan, hydroxyurea, and interferon have been used to treat this disease. "Blast" crises can result in a profound elevation of the WBC, anemia, thrombocytopenia, and an increase in the spleen size. The serum uric acid level is usually elevated. The bone marrow is hypocellular with marked myeloid hypoplasia and with a erythroid: myeloid ratio of 15:1. Hint 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? Bone marrow biopsy. Serum electrophoresis Skeletal radiographic survey. LIGHT chains in the urine (Bencejones protein). Gallium scan of the lungs. Hint 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? Cytoskeratin Desmin Glial fibrillary acidic proteins Neurofilaments Vimentin Hint 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 Beta Thalassemia minor Chloramphenicol toxicity Chronic autoimmune Rheumatoid Uterine leiomyomas Hint 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 Burkitt lymphoma Mantle cell lymphoma Multiple myeloma Small cell lymphoma Small cleaved cell lymphoma Hint A seminoma of the testes and a germinoma involving the ovary differ most significantly by which of the following? Most common age presentation Number of mitoses Potential to contain foci of more aggressive tumors Radiosensitivity Ultrastructural appearance Hint 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? Burkitt lymphoma Mixed cellularity Hodgkin disease Nodular sclerosing Hodgkin disease Normal lymph node Predominately small cleaved cell lymphoma Hint 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? Hemoglobin crystals Iron-containing granules Nuclear remnants Ribosomal precipitates Denatured hemoglobin Hint 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? Stage IA Stage IB Stage IIA Stage IIB Stage IIIB Hint Which cancer does NOT has an increased risk with high fat diet? Breast. Colorectal Lung. Renal. 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.
