Case 2 Flashcards
(95 cards)
1
Q
Which of the following hematologic diseases is Pica most likely seen?
a. G6PD deficiency
b. Thalassemia
c. Megaloblastic anemia
d. Iron deficiency anemia
A
D
2
Q
All of the following statements about acute myelocytic leukemia are true EXCEPT.
a. It is more common in adults.
b. It has worse prognosis than chronic myeloid leukemia.
c. The bone marrow examination is essential.
d. The presence of Philadelphia positive chromosome
A
D
3
Q
Target of immune mediated mechanism in dengue fatal disease involves which of the following.
a. Spleen
b. Liver
c. Kidney
d. Bone marrow
A
B
4
Q
All of the following are common findings in acute lymphocytic leukemia EXCEPT.
a. Epistaxis
b. Fever
c. Gum hypertrophy
d. None of the options
A
D
5
Q
Which of the following hemoglobin levels as criterion pregnant women indicating physiological
anemia based on WHO?
a. <130 g/L
b. <120 g/L
c. <110 g/L (1st trimester)
d. <100 g/L
A
C
6
Q
Which of the following primary causes of anemia have occurrence of postural hypotension and
tachycardia usually seen?
a. Acute blood loss
b. Hemolysis
c. Iron deficiency
d. Vitamin B12 deficiency
A
C
7
Q
Target cells are seen in which of the following.
a. Thalassemia
b. Iron deficiency anemia
c. Folate deficiency anemia
d. Vit. B12 deficiency anemia
A
A
8
Q
All of the following are included in the differential diagnosis for microcytic, hypochromic anemia.
Which one is the exception?
a. Sideroblastic anemia
b. Anemia of chronic disease
c. Thalassemia
d. Pernicious anemia- macrocytic
A
D
9
Q
The neoplastic proliferation of which of the following cells in Multiple myeloma is.
a. Lymphocytes
b. Granulocytes
c. Plasma cells
d. Monocytes
A
C
10
Q
Which of these non- invasive procedures is most likely employed for determination of the body’s
iron storage?
a. Iron stain of bone marrow aspirate
b. Iron tolerance test
c. Red cell protoporphyrin levels
d. Serum ferritin determination
A
D
11
Q
Neurological symptoms are seen often in which of the following.
a. Iron deficiency anemia
b. Vitamin B12 deficiency
c. Folate deficiency
d. Any of the options
A
D
12
Q
Which of the following about folic acid deficiency anemia is correct?
a. The folate is synthesized in the human.
b. The ingestion of alcohol interferes with the absorption of folate.
c. The folic acid deficiency anemia results in neurologic manifestations.
d. The supplementation with 1ug daily will replenish folate stores.
A
B OR C
13
Q
Which of the following is the type of anemia for Iron Deficiency?
a. Normocytic, normochromic
b. Microcytic, hypochromic
c. Macrocytic
d. Hemolytic
A
B
14
Q
All of the following clinical findings may increase the risk of mortality EXCEPT.
a. History of previous dengue
b. Hypotension on admission
c. Narrow pulse pressure on admission
d. None of the options
A
D
15
Q
Which of the following cells usually seen in patients with severe anemia in peripheral blood smear?
a. Target cells
b. Poikilocytes
c. Microcytic cells
d. All of the options
A
B
16
Q
Which of the following complications is most likely to
occur during oral iron therapy?
a. Erythrocytosis
b. Neurologic symptoms
c. Gastrointestinal discomfort
d. Polycythemia vera
A
C
17
Q
What type of ADR is managed with IV Epinephrine or Hydrocortisone during medical emergency?
a. Type I
b. Type II
c. Type III
d. Type IV
A
A
18
Q
All of the following are associated with Sickle Cell Anemia. Which one is the EXCEPTION?
a. Bleeding disease
b. Vasoocclusive crisis
c. Aplastic crisis
d. Chest syndrome
A
A
19
Q
Which of the following laboratory evaluation is considered the cornerstone for diagnosis of anemia?
a. Bone marrow aspiration with biopsy
b. Complete blood count
c. Hematocrit level determination
d. Red blood corpuscle indices
A
B
20
Q
Which of the following laboratory tests is the most useful test to document iron deficiency?
a. Complete blood count
b. Serum ferritin
c. Serum transferrin
d. Serum iron
A
A
21
Q
All of the following are pathogenesis of leukocytosis in peripheral blood leukocyte count. Which one is the exception?
a. The size of myeloid and lymphoid precursor and storage cell pools in the bone marrow, thymus circulation and peripheral tissues.
b. The size of myeloid and lymphoid precursor and storage cell pools in the bone marrow, thymus and circulation.
c. The rate of release of cells from the storage pools into the circulation.
d. The proportion of cells that are adherent to blood vessel walls at any time.
A
A
22
Q
Which of the following statements about the serum iron level is correct?
a. The serum iron level is an indirect measure of circulating transferrin.
b. The serum iron level is a measure of transferrin saturation.
c. The serum iron level is a measure of free
d. The serum iron level is the amount of circulating iron bound to transferrin.
A
D
23
Q
Which of the following is the rich source of cryoprecipitate?
a. Factor X
b. Factor VII
c. Factor VIII
d. Thromboplastin
A
C
24
Q
Which part of the GI tract is the site of iron absorption?
a. Stomach
b. Duodenum
c. Jejunum
d. Ileum
A
B
25
Heinz bodies are seen often in which of the following hematologic diseases.
a. G6PD deficiency
b. Hereditary spherocytosis
c. Sickle cell anemia
d. Hereditary elliptocytosis
A
26
Which of the following is the most common form of leukemia in children?
a. Acute lymphoblastic leukemia
b. Chronic lymphocytic leukemia
c. Acute myeloid leukemia
d. Chronic myeloid leukemia
A
27
Which of the following statements about pernicious anemia is correct?
a. The corticosteroid therapy may reverse the pathologic findings in pernicious anemia.
b. The complete vitamin B12 deficiency develops abruptly after total achiorhydria and with loss of intrinsic factor
c. . The pathologic specimens from gastric mucosa shows infiltrating antibody- producing T-cells.
d. The initial event in the pathogenetic cascade leading to pernicious anemia Begins in the ileum where vitamin B12 is.
D
28
The primary site of folate absorption is mostly located in which of the following
a. Proximal jejunum
b. Duodenum
c. Ileum
d. Cecum
A
29
According to CPG on dengue in children, the presence of the following symptom/s should be admitted.
a. Abdominal pain
b. Vomiting
c. Saddleback pattern of fever
d. Any of the options
D
30
Which of the following types of anemia is most likely associated with leukemia?
a. Normocytic, normochromic
b. Microcytic, hypochromic
c. Normocytic, hypochromic
d. Microcytic, normochromic
A
31
Grey baby syndrome occurs in which of the following drugs?
a. Doxycycline
b. Penicillin
c. Clarithromycin
d. Chloramphenicol
D
32
Which of the following is/ are the usual CBC values for G6PD deficiency anemia EXCEPT?
a. Low MCV and MCHC > microcytic, hypochromic
b. High RDW
c. Normal WBC and platelet
d. None of the options
A
33
Which of these laboratory values is most likely diagnostic for iron deficiency anemia?
a. Abnormal peripheral blood smear
b. Low Mean corpuscle volume
c. Increased reticulocyte count
d. Low serum ferritin level
D
34
A 6-year old girl accidentally tripped and fell on the ground. This caused some minor cuts on her palms and arms. Which of the following is the primary hemostatic reaction of her body to the injury?
a. Clot formation
b. Complement activation of the alternative pathway
c. Platelet adhesion
d. Platelet plug
e. Vasoconstriction
E
35
Gum infiltration is usually seen in which of the following types of leukemia?
a. Acute erythroleukemia
b. Acute monocytic leukemia
c. Acute myelomonocytic leukemia
d. Acute promyelocytic leukemia
B
36
Which of the following drugs inhibits the topoisomerase II that leads to DNA breakage?
a. Daunorubicin
b. Cisplatin
c. Bleomycin
d. Cytarabine
A
37
All of the following are myeloproliferative neoplasms. Which one is the exception?
a. Acute myelogenous leukemia
b. Polycythemia vera
c. Primary myelofibrosis
d. Essential thrombocytopenia
D
38
Which of the following best describes the proposed mechanism of action of antimalarials?
a. It bind TNF-alpha
b. It inhibits B cell proliferation
c. It inhibits lymphotoxin-alpha
d. It suppresses T-lymphocyte response
D
39
Which of the following is the next appropriate step to do in a 60-year-old man patient with relapse of AML therapy with the intention to reduce the relapse to 30%?
a. Retreatment with the similar drug regiment in the intensive phase
b. Retreatment with the similar drug regimen with different dosing schedule in post-remission
c. Start a new treatment with toxin conjugated antibody
d. Start a new treatment with tyrosine kinase inhibitor
C
40
Which of the following about folic acid deficiency anemia is correct?
a. The folate is synthesized in the human body
b. The ingestion of alcohol interferes with the absorption of folate
c. The folic acid deficiency anemia results in neurologic manifestations
d. The supplementation with 1 ug daily will replenish folate stores
B OR C
41
AB, 50 y/o M, bank executive, consulted because of pallor and easy fatigability. He takes losartan for his hypertension. A year ago, he underwent ileal resection. Which of the following is most likely the etiology of his anemia?
A. Iron deficiency
B. Cobalamin deficiency
C. Folate deficiency
D. Pyridoxine deficiency
B
42
All the following are underlying causes of cobalamin deficiency. Which one is the exception?
A. Intrinsic factor deficiency
B. Vegetarianism
C. Diphyllobothrium latum infestation
D. Anti-convulsant drugs
D
43
Which of the following cells is usually seen in patients with severe anemia in peripheral blood smear?
A. Target cells
B. Poikilocytes
C. Monocytic cells
D. Any of the options
B
44
Which of the ff best describes the pathogenesis of this form of AML, known as Di Guglielmo syndrome ?
a. The myeloproliferation of megakaryoblastic precursor
b. The myeloproliferation of erythroblastic precursor
c. The myeloproliferation of monoblastic precursor
d. AOTA
B
45
Which of these diagnostic tests with high sensitivity is a gold standard in the diagnosis of leukemia?
a. Bone marrow
b. CBC
c. Peripheral blood smear
d. Immunophenotype
A
46
All of the ff are characteristics of myelodysplastic syndrome. Which one is the exception?
a. Increased proliferation of erythrocyte
b. Increased proliferation of leukocytes
c. Increased proliferation of megakaryocytes
d. Increased proliferation of monocytes
D
47
A 55-year-old who presented in OPD clinic with painless, body malaise, and neck pain. His PE revealed cervical lymphadenopathy, peripheral cyanosis, and moderate hepatosplenomegaly. Peripheral blood smear reveals predominance of myeloblasts and early promyelocytes. Which of the ff is most likely diagnosis?
a. Acute myeloid leukemia
b. Acute leukocyte leukemia
c. Chronic myeloid leukemia
d. Chronic leukocyte leukemia
A
48
A peripheral WBC count ranges from 10 000 to 100 000 cells/ mm3 with majority of cells are lymphoblasts and is most likely seen in which of the ff.
a. AML
b. ALL
c. CML
d. CLL
B
49
All the ff are clinical features of myelodysplastic syndrome. Which one is the exception?
a. It occurs between 50-80 years old of both sexes
b. Severe pancytopenia is commonly seen as complication
c. It progresses to AML in more than 30% of cases.
d. Cytopenia and hypercellular bone marrow usually seen
D
50
According to FAB classification of AML, a myeloblastic leukemia with maturation is classified
a. M0
b. M1
c. M2
d. M3
C
51
Which subtype of acute leukemia with disseminated intravascular coagulopathy is most likely seen in patients with the following leukemia?
a. Acute myeloblastic leukemia with minimum maturation (M1)
b. Acute myeloblastic leukemia with maturation (M2)
c. Acute promyelocytic leukemia (M3)
d. Acute myelomonocytic leukemia (M4)
C
The most common abnormality is disseminated intravascular coagulation (DIC), which results in an elevated prothrombin time, a decreasing fibrinogen level, and the presence of fibrin split products. Acute promyelocytic leukemia (APL), also known as M3, is the most common subtype of AML associated with DIC.
52
Which type of acute leukemia is most likely associated with bizarre, multinucleated erythroblasts and myeloblasts present?
a. Acute megakaryocytic
b. Acute erythroleukemia
c. Acute monocytic
d. Acute myelomonocytic
B. ACUTE ERYTHROLEUKEMIA
Acute erythroid leukemia
The red blood cell (RBC) precursors have significant dysplastic features, such as multinucleation, megaloblastoid asynchrony, and vacuolization.
53
Which of the following new class agents for post-remission therapy AML does imatinib belong?
a. Demethylating agent
b. Tyrosine kinase inhibitor
c. Cell cycle inhibitor
d. Nucleosides analogues
B. TYROSINE KINASE INHIBITOR
Imatinib mesylate, originally named “sti 571” (signal transduction inhibitor 571), was the first protein kinase inhibitor designed to target a driver mutation in a cancer and to receive FDA approval. Imatinib targets the BCR-ABL tyrosine kinase fusion protein that drives CML. Imatinib-resistant ABL mutations were uncovered in 2002 and led to the development of next-generation inhibitors dasatinib and nilotinib, which overcome the resistance.
54
Which of the following statements of myelodysplastic syndrome (MDS) is correct?
a. It occurs in women between 50 and 80 years old
b. Severe pancytopenia is not commonly seen with MDS
c. It will progress to AML in less than 30% of cases of MDS
d. MSD characteristically have cytopenia and hypercellular bone marrows
D. MSD characteristically have cytopenia and hypercellular bone marrows
[1] Anemia is present in most cases, either alone or as part of`bi- or pancytopenia; isolated neutropenia or thrombocytopenia is more unusual.
[2] The bone marrow is usually normal or hypercellular, but in about 20% of cases it is sufficiently hypocellular to lead to confusion with aplastic anemia
55
Which of these laboratory values is most likely diagnostic for iron deficiency anemia?
a. Abnormal peripheral blood smear
b. Low mean corpuscle volume
c. Increased reticulocyte count
d. Low serum ferritin level
D. Low serum ferritin level
Measurement of the serum ferritin level is the most accurate test to diagnose iron deficiency anemia
56
Which of the following is/are the usual CBC values for G6PD deficiency anemia EXCEPT?
a. Low MCV and MCHC
b. High RDW
c. Normal WBC and platelet
d. None of the options
C. Normal WBC and platelet
● Low MCV and MCHC (Anemia)
● Morphology is normal except in hemolytic episodes in which the degree of change in morphology also varies. In some patients with severe variants, marked anisocytosis, poikilocytosis, spherocytosis, and schistocytosis may occur (High RDW)
● WBC is moderately elevated and platelet varies
● Usually normochromic and normocytic
57
Which of the following types of leukemia when splinter-shaped to rod-shaped structure in the cytosol of myeloblasts and fused azurophilic granules present in PBS?
a. AML
b. CML
c. ALL
d. CLL
a. AML
| ● Abnormal rod-shaped granules called Auer rods are not uniformly present but when they are, AML is virtually certain.
58
Which of the following are good prognostic factors of complete remission in AML with the exception of?
a. Neutrophil count >1000/uL
b. Platelet count >100,000/uL
c. Hemoglobin count >10g/L
d. Reverse transcriptase polymerase chain reaction presence AML-associated molecular abnormalities
c. Hemoglobin count >10g/L
| ● Hemoglobin is not considered in determining CR.
59
Which of the following is not part of the clinical triad for Autoimmune Hemolytic Anemia?
a. Hemoglobin level drop (within days) as low as 4g/fl
b. Jaundice
c. Splenomegaly
d. Bleeding
D
60
Patient MD, 34 y.o. male, single, presents to the clinic complaining of easy fatigability and was diagnosed with anemia. (+Hx of RHD and has undergone valve replacement surgery) Laboratory shows: Absolute reticulocyte count of: 9% Hct: 35% Hgb: 11.66g/DL. What could be the most likely cause of his anemia?
a. Autoimmune Hemolytic disease
b. Microangiopathic Hemolytic anemia
c. PNH
d. Hypoproliferative Anemia
e. None of the Above
B
61
A pathophysiological mechanism in AIHA where antigen-antibody complex on the surface of red cells is able to activate complement where as a result, a large amount of membrane attack complex will form, and the red cells may be destroyed directly.
a. Phacocytosis
b. Cytotoxicity
c. Intravascular Hemolysis
d. Extravascular Hemolysis
C
62
Tell-tale sign of Intravascular Hemolysis
a. Very low Hemoglobin
b. Presence of Schistocytes
c. Bite cells in the PBS
d. Hemoglobinuria
e. Fragmented RBCs
D
63
A patient comes in to the clinic complaining of abrupt onset of dramatic anemia and presents with jaundice, Hgb levels of 4g/dL, pain and a palpable mass over the left upper quadrant of his abdomen. What is the first line of treatment for his probable condition?
a. azathioprine or cyclosporine
b. Immediate BT
c. Splenectomy
d. Rituximab
e. prednisone, 1 mg/kg per day
E
64
An elderly patient who had just recently been working in an ice factory, have suddenly suffered from anemia. He was diagnosed with some kind of AIHA, the Ab involved was IgM. The involvement of IgM makes this disease related to which of the following conditions?
a. Cold Agglutinin Disease
b. Paroxysmal Cold Hemoglobinuria
c. AIHA
d. Rh Incompatibility
e. Waldenström macroglobulinemia
A
65
PNH hemolysis is due to which of the following protein deficiency in the red cell membrane?
a. CD54
b. CD59
c. CD49
d. CD45
B
66
This is considered as the most common cancer in children.
a. Acute lymphoblastic leukemia
b. Acute myeloid leukemia
c. Small lymphocytic lymphoma
d. Burkitt lymphoma
A
67
Which of the following does not describe B-ALL?
a. About 85% of ALL’s
b. Boys are more prone than girls
c. Peaks during adolescence
d. Peaks at age 3
C
68
Which of the following is not true?
a. Childhood ALL occurs more often in lower socioeconomic subgroups
b. Childhood ALL occurs more often in children with trisomy 21
c. Childhood ALL occurs more often in high energy radiation
A
69
Which of the following percent is NOT a normal value?
a. Hemtocrit percent 37-48%?
b. Hemoglobin Concentration 11.7-13.8 g/dL
c. MCV 84=99 fl
d. MCHC 31-35%
e. Vit B12 500=1100pg/mL
E Vit B 12 should be 250 to 1100pg/mL
70
What is the difference between Petechia/Purpura and Ecchymosis?
a. Ecchymosis is variable, Purpura is not
b. Purpura has no effect from pressure while ecchymosis is an effect from pressure
c. Purpura is a deep reddish purple, fading away over time measuring 1-3mm and Ecchymosis is >3mm
d. Both Blood outside the vessel suggest bleeding
C
71
It is the widely-cited hypothesis for the pathogenesis of severe dengue
a. antibody-dependent enhancement
b. antibody-dependent attachment
c. antibody-independent enhancement
d. antibody-independent attachment
A
72
The following are confirmatory tests for a suspect or probable dengue case with positive of the following, except:
a. viral culture
b. dengue NS1 antigen test
c. polymerase chain reaction
d. nucleic acid amplification test-loop mediated amplification assay (NAAT-LAMP)
e. plaque reduction neutralization test (PRNT)
B
73
Dengue warning signs include the following, except:
a. persistent vomiting
b. diarrhea
c. abdominal pain or tenderness
d. liver enlargement
B
```
warning signs:
abdominal pain or tenderness
persistent vomiting
clinical signs of fluid accumulation (ascites)
mucosal bleeding
lethargy or restlessness
liver enlargement
increase in hematocrit and/or decreasing platelet count
```
74
Mild hemorrhagic manifestations like petechiae and mucosal membrane bleeding (nose and gums) manifest in what phase of dengue infection
a. febrile
b. critical
c. defervescence
d. recovery
A
75
Patients may have the classical rash of "isles of white in the sea of red" in what phase of dengue infection
a. febrile
b. critical
c. defervescence
d. recovery
D
76
Fever drops to almost normal (between 37.5-38C)
a. febrile
b. critical
c. defervescence
d. recovery
C
77
It is used to detect dengue virus antigen during early phase of acute dengue infection
a. Dengue NS1 RDT
b. Dengue IgM/IgG
c. PCR
d. PNRT
e. NAAT-LAMP
A
78
It is the gold standard to characterize and quantify circulating level of anti-DENV neutralizing antibody (NAb)
a. Dengue NS1 RDT
b. Dengue IgM/IgG
c. PCR
d. PRNT
e. NAAT-LAMP
D
79
A novel molecular-based confirmatory test to detect dengue virus which works just like PCR nut is cheaper and simpler in nature
a. Dengue NS1 RDT
b. Dengue IgM/IgG
c. PCR
d. PNRT
e. NAAT-LAMP
E
80
The following are Dengue patients that may be sent home, except:
a. Tolerate adequate volumes of IV fluids
b. Pass urine every 6 hours
c. Do not have any of the warning signs particularly when the fever subsides
d. Have stable hematocrit
A
81
The following are patients who should be referred for in-hospital management, except:
a. patients with warning signs
b. patients who are pregnant
c. patients who are living alone
d. patients with stable hematocrit
D
82
It is found in the salivary glands of female mosquitoes, and is also called the infectious stage in malaria
a. gametocytes
b. sporozoite
c. schizont
d. merozoites
B
83
It is a manifestation of severe falciparum malaria characterized by macroscopic black, brown, or red urine, not associated with effects of oxidant drugs and red blood cell enzyme defects
a. hemaglobinuria
b. extreme weakness
c. hyperparasitemia
d. jaundice
A
84
It is where the malarial parasites multiply
a. blood stream
b. liver cells
c. red cells
d. spleen
B
85
In the exoerythrocytic stage which is also an asymptomatic stage, and infection of the liver happens, which of the following develops?
a. gametocytes
b. sporozoite
c. schizont
d. merozoites
D
86
It is the second stage of growth of parasites in a membrane-bound digestive vacuole (erythrocytic stage within red cells) that has multiple chromatin masses and each develops into a merozoite
a. gametocytes
b. sporozoite
c. schizont
d. merozoites
C
first stage: trophozoite, presence of single chromatin mass
87
First symptoms of malaria are nonspecific such as fever, headache, myalgia, and etc. Other prominent symptoms include the following, except:
a. chest pain
b. cough
c. fatigue
d. arthralgia
e. diarrhea
C
```
first symptoms, nonspecific:
lack of sense of well-being
headache
fatigue
abdominal discomfort
myalgia
fever
```
***a, b, d, & e are prominent symptoms
88
The following are laboratory findings in acute malaria, which is the exception?
a. normochromic, normocytic anemia is usual
b. platelet count us usually reduced
c. leukocyte count is generally elevated, especially in very severe infections
d. erythrocyte sedimentation rate, plasma viscosity, and levels of C-reactive protein and other acute-phase proteins are elevated
C
leukocyte count is generally normal, it may be raised in very severe infections
89
It is recommended by the WHO as the first-line treatment for P. knowleski infections and is also highly effective against other malarias
a. artemisinin-based combination therapy
b. chloroquine treatment
c. mefloquine treatment
d. primaquine radical treatment
A
90
It is the drug of choice for all patients with severe malaria
a. artemether
b. artesunate
c. parenteral quinidine
c. chloroquine
A
91
The following are the first 5 artemisinin-based combinations (ACT) recommended by the WHO, which is the exception?
a. artemether-lumefantrine
b. artesunate-mefloquine
c. dihydroartemisinin-piperaquine
d. artemether-piperaquine
e. artesunate-sulfadoxine-pyrimethamine
f. artesunate-amodiaquine
D
92
A single dose is added to ACT as a P. falciparum gametocytocide to reduce transmissibility of the infection
a. mefloquine
b. quinidine
c. primaquine
d. quinine
C
93
It is associated with increased rates of vomiting and dizziness
a. mefloquine
b. quinidine
c. primaquine
d. quinine
A
94
It is used to eradicate persistent liver stages and prevent relapse however it should not be given to pregnant women with vivax or ovale malaria
a. mefloquine
b. quinidine
c. primaquine
d. quinine
C
95
It produces cinchonism (tinnitus, high-tone deafnessm N&V, dysphoria)
a. mefloquine
b. quinidine
c. primaquine
d. quinine
D
