Tuesday 13 November 2012

Oncology and Hematology multiple choice questions 2


Q 1 . All the following are associated with pure red cell
aplasia except
A. anterior mediastinal masses
B. connective tissue disorders
C. giant pronormoblasts
D. low erythropoietin levels
E. parvovirus B19 infection


Answer     D


Q 2 . A 73-year-old man is admitted to the hospital with 3
weeks of malaise and fevers. His past medical history is
notable only for hypertension controlled with a thiazide
diuretic. He smokes one pack of cigarettes per day and
works as an attorney. His physical examination is notable
only for a new systolic heart murmur heard best in the
mitral region. His laboratory examination is notable for
mild anemia, an elevated white blood cell count, and occasional
red blood cells on clean catch urine. Blood cultures
grow Streptococcus bovis and echocardiogram shows
a <1-cm vegetation on the mitral valve. What additional
evaluation is indicated for this patient?
A. Colonoscopy
B. Head CT scan
C. Pulmonary embolism protocol CT scan
D. Renal biopsy
E. Toxicology screen



Answer    A



Q 3 . A 58-year-old woman presents to the emergency
room complaining of jaundice. She first noticed a yellowish
discoloration of her skin about 3 days ago. It has become
progressively worse since that time. In association with the
development of jaundice, she also has noticed clay-colored
stools and pruritus. There has been no associated abdominal
pain, fever, chills, or night sweats. She has a past medical
history of alcohol abuse, but has been abstinent for the
past 10 years. She has no known history of cirrhosis. On
physical examination, she is afebrile with normal vital
signs. She is jaundiced. The bowel sounds are normal. The
abdomen is soft and nontender. There is no distention. The
liver span is 12 cm to percussion and is palpable at the right
costal margin. The spleen tip is not palpable. Liver function
testing reveals an AST of 122 IU/L, ALT of 168 IU/L, alkaline
phosphatase of 483 U/L, total bilirubin of 22.1 mg/dL,
and direct bilirubin of 19.2 mg/dL. On right upper quadrant
ultrasound, the gallbladder cannot be visualized, and
there is dilatation of the intrahepatic bile ducts but not the
common bile duct. What is the most likely diagnosis?
A. Cholangiocarcinoma
B. Cholecystitis
C. Gallbladder cancer
D. Hepatocellular carcinoma
E. Pancreatic cancer



Answer   A


Q 4 . An 81-year-old male is admitted to the hospital for
altered mental status. He was found at home, confused
and lethargic, by his son. His past medical history is significant
for metastatic prostate cancer. The patient’s medications
include periodic intramuscular goserelin injections.
On examination he is afebrile. Blood pressure is 110/50
mmHg, and the pulse rate is 110 beats/min. He is lethargic
and minimally responsive to sternal rub. He has bitemporal
wasting, and his mucous membranes are dry. On neurologic
examination he is obtunded. The patient has an
intact gag reflex and withdraws to pain in all four extremities.
Rectal tone is normal. Laboratory values are significant
for a creatinine of 4.2 mg/dL, a calcium level of 12.4
meq/L, and an albumin of 2.6 g/dL. All the following are
appropriate initial management steps except
A. normal saline
B. pamidronate
C. furosemide when the patient is euvolemic
D. calcitonin
E. dexamethasone


Answer   E


Q 5 . Which of the following statements describes the relationship
between testicular tumors and serum markers?
A. Pure seminomas produce α fetoprotein (AFP) or
beta human chorionic gonadotropin ( β-hCG) in
more than 90% of cases.
B. More than 40% of nonseminomatous germ cell tumors
produce no cell markers.
C. Both β-hCG and AFP should be measured in following
the progress of a tumor.
D. Measurement of tumor markers the day after surgery
for localized disease is useful in determining
completeness of the resection.
E. β-hCG is limited in its usefulness as a marker because
it is identical to human luteinizing hormone.



Answer   C


Q 6 . A woman with advanced breast cancer being treated
with tamoxifen presents to the emergency department
with nausea and vomiting. She has been tolerating her
treatment well but in the last 3 days noticed nausea, vomiting,
and abdominal pain. Her symptoms are not related
to food intake, and she is having normal bowel movements.
She has no fevers or rashes. Her medications include
tamoxifen, alendronate, megestrol acetate, and a
multivitamin. Abdominal examination reveals very mild
tenderness diffusely, and there is no rebound tenderness.
Bowel sounds are normal. Plain radiographs and a CT
scan of the abdomen are unremarkable. Laboratory analysis
reveals a normal white blood cell count. Sodium is
130 meq/L, potassium 4.9 meq/L, chloride 99 meq/L, bicarbonate
29 meq/L, BUN 15 mg/dL, creatinine 0.7 mg/
dL. What is the next most appropriate step in this patient’s
management?
A. Antiemetics prn
B. Laparoscopy
C. Serum cortisol
D. Small-bowel follow through
E. Upper endoscopy



Answer    C



Q 7 . A healthy 62-year-old woman returns to your clinic
after undergoing routine colonoscopy. Findings included
two 1.3-cm sessile (flat-based), villous adenomas in her
ascending colon that were removed during the procedure.
What is the next step in management?
A. Colonoscopy in 3 months
B. Colonoscopy in 3 years
C. Colonoscopy in 10 years
D. CT scan of the abdomen
E. Partial colectomy
F. Reassurance


Answer    B


Q 8 . Which of the following statements regarding polycythemia
vera is correct?
A. An elevated plasma erythropoietin level excludes the
diagnosis.
B. Transformation to acute leukemia is common.
C. Thrombocytosis correlates strongly with thrombotic
risk.
D. Aspirin should be prescribed to all these patients to
reduce thrombotic risk.
E. Phlebotomy is used only after hydroxyurea and interferon
have been tried.


Answer   A


Q 9 . A 52-year-old female is evaluated for abdominal
swelling with a computed tomogram that shows ascites
and likely peritoneal studding of tumor but no other abnormality.
Paracentesis shows adenocarcinoma but cannot
be further differentiated by the pathologist. A
thorough physical examination, including breast and pelvic
examination, shows no abnormality. CA-125 levels
are elevated. Pelvic ultrasound and mammography are
normal. Which of the following statements is true?
A. Compared with other women with known ovarian
cancer at a similar stage, this patient can be expected
to have a less than average survival.
B. Debulking surgery is indicated.
C. Surgical debulking plus cisplatin and paclitaxel is indicated.
D. Bilateral mastectomy and bilateral oophorectomy
will improve survival.
E. Fewer than 1% of patients with this disorder will remain
disease-free 2 years after treatment.



Answer      C



Q 10 .A 34-year-old female with a past medical history of
sickle cell anemia presents with a 5-day history of fatigue,
lethargy, and shortness of breath. She denies chest pain or
bone pain. She has had no recent travel. Of note, the patient’s
4-year-old daughter had a “cold” 2 weeks before
the presentation. On examination she has pale conjunctiva,
is anicteric, and is mildly tachycardic. Abdominal
examination is unremarkable. Laboratories show a
hemoglobin of 3 g/dL; her baseline is 8 g/dL. The white
blood cell count and platelets are normal. Reticulocyte
count is undetectable. Total bilirubin is 1.4 mg/dL. Lactic
dehydrogenase is at the upper limits of the normal range.
Peripheral blood smear shows a few sickled cells but a total
absence of reticulocytes. The patient is given a transfusion
of 2 units of packed red blood cells and admitted to
the hospital. A bone marrow biopsy shows a normal myeloid
series but an absence of erythroid precursors. Cytogenetics
are normal. What is the most appropriate next
management step?
A. Make arrangements for exchange transfusion.
B. Tissue type her siblings for a possible bone marrow
transplant.
C. Check parvovirus titers.
D. Start prednisone and cyclosporine.
E. Start broad-spectrum antibiotics.



Answer     C

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