Çıkmış Dahiliye Flashcards by Lala 🤩

After diagnosis of medullary (parafollicular) thyroid cancer, what is the best next step?

Screen for RET proto-oncogene
Screen for plasma fractionated metanephrines
Perform CT of the abdomen and pelvis to evaluate for
pheochromocytoma
Prescribe levothyroxine
Contact family members about a genetic syndrome

Screen for RET proto-oncogene

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Which of the following mutation results Type 1 Bartter Syndrome?

AE1
NCC
ROMK
NHE3
NKCC2

NKCC2

…

Tip 1: NKCC2 gen mutasyonu.
Tip 2: ROMK gen mutasyonu.
Tip 3: CLCNKB gen mutasyonu.
Tip 4: BSND veya CLCNKA/CLCNKB gen mutasyonları (sensorinöral işitme kaybı ile birlikte).
Tip 5: MAGED2 gen mutasyonu (geçici neonatal form).

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An 82-year-old woman, who has previously been diagnosed with breast cancer, arrives at the clinic reporting persistent headaches over the last two weeks. She explains that these headaches occur behind her eyes on a daily basis and intensify in the morning. She also experiences intense nausea and vomiting. A brain MRI indicates the presence of several metastatic lesions. Which of the following is the most appropriate initial management for this patient?

Surgical resection
Biopsy the lesions
Dexamethasone
0.9% saline bolus
Repeat MRI in 6 months

Dexamethasone

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Which of the following is the most potent intracellular buffer system?

Carbonic acid-bicarbonate buffer
Hemoglobin buffer
Phosphate buffer
Albumin buffer
Aminoacid buffer

Phosphate buffer

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A 67-year-old man comes to the physician because of abdominal discomfort and weight loss. Physical examination shows splenomegaly. Laboratory studies show neutrophilic leukocytosis and thrombocytosis. Cytogenetic analysis shows a BCR- ABL fusion gene. Which option expresses the appropriate diagnosis and drug mechanisms?

Chronic myeloid leukemia-Tyrosine kinase inhibitor
Acute myeloid leukemia-Topoisomerase inhibitor
Chronic myeloid leukemia-CD20 antibody
Acute myeloid leukemia-Monoclonal anti-EGFR antibody
Acute myeloid leukemia-Ribonucleotide reductase inhibitor

Chronic myeloid leukemia-Tyrosine kinase inhibitor

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Which of the following disease causes a significant enlargement of the spleen?

Alpha-1 antitrypsin deficiency
PSC (primary sclerosing cholangitis)
CML (chronic myeloblastic leukemia)
ALL (acute lymphoblastic leukemia)
Chagas disease

CML (chronic myeloblastic leukemia)

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A 45-year-old man has had pruritis for the past 8 months. On physical examination
he has a ruddy complexion. His spleen tip is palpable. Laboratory studies show Hgb
22.3 g/dL, Hct 65.7%, MCV 89 fL, MCHC 33.9 pg/mL, MCH 34.2, platelet count
445,000/microliter, and WBC count 12,500/microliter with 80% segs, 5% bands, 3% monos, and 7% lymphs. A urinalysis shows no remarkable findings. What is the most appropriate next investigation to undertake?

Eritropoetin, jak2 v617f mutation
TSH
Protein electrophoresis
t(9;22)
Batın CT

Eritropoetin, jak2 v617f mutation

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Where do porto-systemic shunts occur in portal hypertension that develops in liver
cirrhosis?

Between the spinal veins and the hepatic veins
Between the superior mesenteric vein and the subclavian vein
system
Between the esophageal veins and the hemorrhoidal veins
Between the pericardial veins and the gastric veins
Between the left renal vein and splenic vein

Between the left renal vein and splenic vein

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Which of the following statements is false about common variable immune
deficiency (CVID)?

Otoimmune diseases are commonly seen in CVID.
It is the most common immundeficiency seen in adults.
Granulamatous lesions and malignancies can been seen in CVID.
Recurrent pneumonia and brochectasis are frequently
encountered findings in CVID.
Intravenous or subcutaneous immunglobulin replacement is the
main treatment.

It is the most common immundeficiency seen in adults. IS FALSE therefore the correct answer

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Which of the following does result in pre-renal acute kidney injury?

Heart failure
Renal calculi
Acute interstitial nephritis
Small-vessel vasculitis
Acute tubular necrosis

Heart failure

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Which of the following is the most common electrolyte imbalance?

Hypocalcemia
Hyperkalemia
Hypernatremia
Hypokalemia
Hyponatremia

Hyponatremia

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Which of the following is wrong about syndrome of inappropriate antidiuretic
hormone secretion (SIADH)?

Thirst is not adequately suppressed so fluid intake continues.
Vasopressin limits the excretion of water in the urine.
Hyperosmolality and hypernatremia occur.
The pathophysiology of SIADH begins with uncontrolled secretion
of vasopressin.
The most specific treatment for SIADH is to block the V2 receptors
in the kidney (conivaptan, tolvaptan).

Hyperosmolality and hypernatremia occur.
This is the correct answer which is a wrong statement.

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Antibody against antiphosphalipase A2 receptor is used in the diagnosis of which
disease?

Focal segmental glomerulosclerosis
Systemic Lupus Erythematosis
Membranous glomerulonephritis
Membranoproliferative glomerulonephritis
IgA nephropathy

Membranous glomerulonephritis

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A 27-year-old man experiences excessive bleeding after tooth extraction. His mother has frequent nosebleeds and his sister has a history of menorrhagia. His PT, PTT and platelet count is normal. Which of the following is the most likely diagnosis?

Antiphospholipid syndrome
Protein C deficiency
Hemophilia B
Vitamin K deficiency
von Willebrand disease

von Willebrand disease

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A 22-year-old woman presents with a 6 hour history of a raised, very itchy and
distressing red rash all over the body. Besides, she has swelling around her eyes,
around her lips and on her right hand with a burning sensation. Previous medical
history was of atopic dermatitis as a child and mild hay fever. On examination, she
had red, raised weals all over her body, periorbital swelling, and swelling of the lips.
What could be the most likely diagnosis?

Hereditary angio-oedema
Contact dermatitis
Acute urticaria
Acute urticaria with angio-oedema

Acute urticaria with angio-oedema

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A 70-year-old man has had progressive fatigue for the past year. He notes easy
bruisability. He has had a series of upper respiratory tract infections. On physical
examination he has splenomegaly but no lymphadenopathy. A CBC shows a Hgb of
10.6 g/dL, Hct 29.8%, MCV 92 fL, platelet count 25,000/uL, and WBC count
2,900/uL. The WBC differential count shows 67 segs, 4 bands, 2 metamyelocytes,
22 lymphs, 5 monos, and 2 nucleated RBC’s per 100 WBC’s. There are occasional
tear drop cells on examination of his peripheral blood smear. Which of the following is the most likely diagnosis?

Parvovirus infection
Disseminated intravascular coagulation (DIC)
Myelofibrosis
Hereditary spherocytosis
Previous splenectomy

Myelofibrosis

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A 63 years old man was diagnosed adenocarcinoma of the lung with
bronchoscopic biopsy. 18 FDGT PET CT scan showed multipl liver and bone metastases. Molecular tests showed EGFR exon 21 L858R mutation. Which agent can not be recommended for the treatment of stage IV lung carcinoma?

Afatinib
Lapatinib
Osimertinib
Genitinib
Erlotinib

Lapatinib

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Which of the following is not an example of a type 4 allergic reaction?

Behcet disease
Chronic Asthma
Type I Diabetes
Goodpasture Syndrome
Tuberculin reaction

Goodpasture Syndrome

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Which of the following doesnt induce SIADH syndrome?

Desmopressin
Lithium
Carbamazapine
SSRI
Tricyclic antidepressants

Lithium

ıt causes DI

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Romatoid artrit için en spesifik test nedir?

c-ANCA
anti-CCP
p-ANCA
ANA
ds-DNA

Anti CCP

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Which of the following is a criterion for acute kidney injury according to KDIGO?

> 1.0 mg/dL Creatinine rise within 7 days
50% Creatinine rise within 2 days
Urine output < 0.3 mL/kg/h for more than 12 hours
Urine output < 0.5 mL/kg/h for more than 6 hours
0.5 mg/dL Creatinine rise within 48 hours

Urine output < 0.5 mL/kg/h for more than 6 hours

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You are asked to evaluate a 64-year-old women admitted with acute confusion.
The serum level of calcium is elevated at 13,4 mg/dL (8,5-10,2 mg/dL). Confusion
reportedly developed over the preceding 24 hours.
Which test supports the diagnosis of hypercalcemia of malignancy?

Undetectable PTH-related peptide (PTHrp)
Parathyroid hormone (PTH) level <1 pmol/L
25-Hydroxyvitamin D >40 ng/mL
1,25-Dihydroxyvitamin D >70 pg/mL
Serum level of calcium >12 mg/dL

Parathyroid hormone (PTH) level <1 pmol/L

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Which of the following is not involved in the etiology of the complications of diabetes?

Increased fructase-6-phosphatase levels
Increased advanced glycation end products
Protein kinase inactivation
Increased sorbitol
Increased diacyl glycerol

Protein kinase inactivation

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A 53-year-old man presents with bilateral conductive deafness,
palpable purpura on the lower extremities, and bloody discharge from sputum.
A radiograph of the chest shows a thin- walled cavity in the left lower zone.
Investigations reveal red cell casts in the
urine and an elevated serum creatinine level (2.7 mg/dL).
Which laboratory test is most likely to be positive?

anti-Good pasture antibody
HLA-B51
anti-CCP
c-ANCA
anti-Ro52

c-ANCA

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A 23-year-old male presents to the emergency room with a two-week history of night sweats, 20 kg weight loss, severe bone pain, and fatigue. CT imaging shows mild hepatosplenomegaly. Bone marrow aspirate and biopsy reveal complete replacement of the marrow with large, (%95) monomorphic lymphoid cells. Lab tests: hemoglobin 5,5 g/dL (12-16), leukocyte 6 x109/L (4,5-10,5), platelet 60 x109/L (150-450), LDH 5500 (125-220), uric acid 12 (3-7) Mantle cell lymphoma Burkitt lymphoma/leukemia Hodgkin lymphoma Chronic myeloid leukemia Acute myeloid leukemia

Burkitt lymphoma/leukemia

Which of these is the rheumatoid factor of our daily practice? IgA antibody for IgG IgG antibody for IgA IgA antibody for IgM IgM antibody for IgG IgG antibody for IgM

IgM antibody for IgG

Which of the following is not one of the diabetic ketoacidosis criteria? Ketonemia>3 mmol/L Blood pH < 7.30 Hyperosmolarity Plasma glucose level > 300 mg/dL (in pregnancy >250) Serum bicarbonate < 15 mEq/L

Hyperosmolarity

Which of the following is a tissue immune system cell and mediator that plays the primary and main role in the immune system's response to allergic reactions? Basophil PAF,serotonin Basophil , leukotrienes, serotonin Mast cell, histamine, serotonin Mast cell , histamine and bradykinin Mast cell, histamine, prostoglandins

Mast cell, histamine, serotonin

Which of the following is the immunoglobulin, tissue immune system cell and mediator that plays a primary and main role in the immune system response to allergic reactions? lg G, basophil, bradykinin lg E , basophil, serotonin lg G, mast cell, histamine lg E, mast cell, serotonin lg E, mast cell, histamine

lg E, mast cell, histamine

What is the approximate daily production of non-volatile acid in an adult? 4 mEq/kg/day 1 mEq/kg/day 3 mEq/kg/day 0,25 mEq/kg/day 2 mEq/kg/day

1 mEq/kg/day

A 77-year-old man has had progressive fatigue for the past year. On physical examination he has splenomegaly but no lymphadenopathy. CBC shows an Hgb 7.4 g/dL, MCV 85 fL, platelet count 45000/uL, and WBC count 3,900/uL. The WBC di erential count shows 70 neutrophils, 4 metamyelocytes, 21 lymphs, 2 monos, and 3 nucleated RBCs per 100 WBC's and occasional tear drop cells are seen on his peripheral blood smear. Coagulation tests are normal. Which of the following is the most likely diagnosis? Aplastic anemia Primary myelobrosis (PMF) Chronic myeloid leukemia (CML) Disseminated intravascular coagulation Essential thrombocythemia

Primary myelobrosis (PMF)

A 76-year-old male patient presented for a routine check-up. He complains of occasional, movement-related left shoulder pain. He uses paracetamol irregularly. Routine tests revealed the following: CRP 10 mg/L, creatinine 1.3 mg/dL, uric acid 7.9 mg/dL, Hb 10.3 g/dL, Hct 32%, MCV 71, Platelets: 561,000/mm3, ESR 64 mm/h, Albumin 3.7 g/dL, and globulin 3.7 g/dL. Which test would you order first? Upper gastrointestinal system endoscopy PSA and vertebral radiographs Whole abdomen CT Whole-body FDG-PET scan Lower gastrointestinal system endoscopy

Lower gastrointestinal system endoscopy

43 years old male; presented to emergency service with fever and new diagnosed epilepsy. Lab tests show hematuria, hemoglobin 7 g/dL, thrombocyte 23000/mm3, LDH 800 u/L. Blood smear reveals %5 schistocytosis. What is the most appropriate treatment for this patient? Platelet transfusion Erythrocyte transfusion Antibiotherapy Plasmapheresis Antiepileptic medication

Plasmapheresis Hastada TTP var.

Which one is not one of clinical features of Addison disease? Nausea Hyponatremia Hypoglycemia Hypertension Hyperpigmentation

Hypertension Hypotension özelliği. Hyper değil.

Which of the following is not an effect of insulin? Provides glucose entry into cells Reduces fat and protein breakdown Increases hepatic glucose output Increases visceral and subcutaneous fat Increases glycogen storage

Increases hepatic glucose output

Which of the following is not seen in patients with classic von Willebrand disease? Easy bruising Prolonged bleeding time Prolonged prothrombin time Decreased platelet aggregation with ristocetin Prolonged closure time in PFA test

Prolonged prothrombin time

An 81-year-old female patient has been referred to your emergency department from another medical center due to acute upper gastrointestinal bleeding. She has a history of coronary artery disease and underwent stent placement 3 years ago, and is currently taking 100 mg aspirin daily. The patient is hemodynamically stable. Laboratory results are as follows: Hb: 10 g%, Hct: 31%, PLT: 315,000/mm3 , MCV 90%, Creatinine 1.5 mg/dL, Serum Albumin 3.5 g/dL, and serum Globulin 3.1 g/dL. How would you plan to manage this patient? I would stop aspirin, administer IV pantoprazole, and schedule an elective upper GI endoscopy. I would stop aspirin, secure IV access, admit the patient for observation, order 3 units of blood, and schedule an elective upper GI endoscopy. I would stop aspirin, administer IV famotidine, and schedule an urgent upper GI endoscopy. I would stop aspirin, secure IV access, admit the patient for observation, and order 3 units of blood.

I would stop aspirin, secure IV access, admit the patient for observation, and order 3 units of blood.

Which of the following is a cause of Odynophagia Achalasia Sliding type hiatal hernia Helicobacter pylori esophagitis Pill induced esophagitis Left atrial enlargement

Pill induced esophagitis

A 27-year-old man presents to the emergency department with his family because of abdominal pain, excessive urination, and drowsiness for the past day. He has had type 1 diabetes mellitus for 2 years. He ran out of insulin 2 days ago. His vital signs at admission include a temperature of 36.8°C , blood pressure of 102/69 mmHg, and pulse of 121/min. On physical examination, he is lethargic and his breathing is rapid and deep. There is mild generalized abdominal tenderness without rebound tenderness or guarding. His serum glucose is 480 mg/dL. The patient's arterial blood gas and electrolyte panel will most likely show which of the following? ↑ pH, normal bicarbonate and ↓ pCO2 ↑ pH, ↑ bicarbonate, and normal pCO2 ↓ pH, normal bicarbonate and ↑ pCO2 ↓ pH, ↓ bicarbonate and normal anion gap ↓ pH, ↓ bicarbonate and ↑ anion gap

↓ pH, ↓ bicarbonate and ↑ anion gap

A 50-year-old man presents to the emergency department for evaluation of a pulsatile headache, palpitations, chest pain, and anxiety. His vital signs include a heart rate of 90/min, blood pressure of 211/161 mm Hg and respiratory rate of 18/min. His fundoscopic exam is remarkable for papilledema. A urinalysis reveals increased protein and red blood cells (RBCs). Further evaluation reveals elevated plasma metanephrines. What is the first step in the treatment of this patient’s underlying disorder? Alpha-blockers Emergent surgery ACE inhibitors Calcium channel blockers Hydralazine

Alpha-blockers Hastada pheochromocytoma var, bunun için alfa bloker verdik.

A 56-year-old male patient was brought to the emergency department immediately from his home across the hospital with complaints of hematemesis and melena. The history revealed that he frequently experienced epigastric pain and controlled his complaints with antacids and short-term lansoprazole use. He had undergone coronary angiography the previous year and was using aspirin 100 mg/day. A few hours ago, he had one episode of black stool, followed by hematemesis, and was immediately brought to the hospital by his family. BP: 125/85 mmHg, Pulse: 96/min regular. On physical examination, the abdomen was participating in respiration, there was no rebound or defense, and epigastric tenderness and hepatomegaly extending 3 cm below the costal margin were detected. Emergency laboratory tests showed PLT: 302,000/mm3. Hb: 14 g % and Htc: 42%. How would you initially approach this patient? I would stop aspirin, prescribe oral pantoprazole, and send him home to return tomorrow for endoscopy. I would prescribe oral famotidine and send him home to return tomorrow for endoscopy. I would prescribe oral lansoprazole and send him home to return tomorrow for endoscopy. I would admit the patient to the hospital I would administer IV omeprazole and tell him to return if the pain does not subside.

I would admit the patient to the hospital

Extralymphatic involvement is uncommon in Hodgkin lymphoma. Bu ifade doğru mduur?

Evet, doğru.

Which of the following pharmacologic agent is a hedgehog pathway inhibitor used to treat patients with locally advanced or metastatic basal cell carcinoma? Nivolumab Bevacizumab Vismodegib Alpelisib Erlotinib

Vismodegib

Which of the following does not define Hepatorenal Syndrome? Proteinuria > 1 g/day No improvement despite 2 days diuretic withdrawal and volume expansion Absence of nephrotoxic drug use Cirrhosis with ascites Absence of shock

Proteinuria > 1 g/day

A 24-year-old man is brought to the physician because of a 1-month history of generalized fatigue, and bone pain. Examination shows cervical and axillary lymphadenopathy. His liver is palpated 4 cm below the right costal margin and the spleen is palpated 3 cm below the left costal margin. His hemoglobin concentration is 9.2 g/dL, leukocyte count is 60,500/mm3, and platelet count is 20,000/mm3. A bone marrow aspirate predominantly shows immature cells that stain positive for CD10, CD19, and TdT. Which of the following is the most likely diagnosis? Leukemoid reaction Aplastic anemia Acute lymphoblastic leukemia Hodgkin lymphoma Acute myeloid leukemia

Acute lymphoblastic leukemia

Which of the following causes euvolemic hyponatremia? Heart failure Hypothyroidism Renal salt wasting Nephrotic syndrome Pancreatitis

Hypothyroidism

A 45-year male with a 20-year history of rheumatoid arthritis presents to the office after being hospitalized for septic shock secondary to streptococcus. During the hospitalization, he was found to be severely neutropenic with an absolute neutrophil count below 2,000/microL. Workup of the neutropenia demonstrated splenomegaly on ultrasound. Which of the following is the diagnosis regarding his cause of neutropenia? Caplan Syndrome Felty Syndome Heerfordt Syndrome Rokitansky--Küster-Hauser-Mayer Syndrome Harada Disease

Felty Syndome The patient's complaints are suitable for Rheumatoid arthritis and Felty disease is a splenic complication of RA

A 59-year-old man has experienced fevers and progressive weight loss of 6 kg over the past 7 months. On physical examination his temperature is 37.6 C. His spleen tip is palpable. There are enlarged non-tender right inguinal lymph nodes. An abdominal CT scan shows splenomegaly and para-aortic lymphadenopathy. An inguinal lymph node biopsy is performed and on microscopic examination there are small lymphocytes, plasma cells, eosinophils, neutrophils, macrophages, and multinucleated cells. The multinucleated cell mark with an immunohistochemical stain for CD15. Which of the following is the most likely diagnosis? Hodgkin lymphoma Disseminated tuberculosis Langerhans cell histiocytosis Mycosis fungoides Sarcoidosis

Hodgkin lymphoma CD15 + --> AML, KML, MDS, HL

Which of the following disease causes a “significant” enlargement of the spleen? Chagas disease Gaucher disease AML (acute myeloblastic leukemia) Alpha-1 antitrypsin deficiency ALL (acute lymphoblastic leukemia)

Gaucher disease

A 24-year-old man is admitted to the emergency service with 2-week history of fever and right knee arthritis. On taking further history he also complained of acute onset rashes over his toes for the past 4 days. He gave a history of frequent intravenous drug abuse for the past 2 years. On examination his pulse rate was 136/min; his blood pressure was 90/56 mmHg. He had a petechial rash over his toes bilaterally and his joint examination revealed a warm and reddish right knee with effusion. Initial blood investigation showed a leukocytosis with a shift to the left. Blood cultures and joint aspiration were done and reports are awaited. What is the most probable diagnosis? Haemophilic arthritis Reactive arthritis Viral arthritis Septic arthritis Gouty arthritis

Septic arthritis

Which is not right for nivolumab? It targets PD1 It inhibits immune evasion of tumor cells. It targets T cells. It is a monoclonal antibody. It enters into tumor cell and binds to DNA; shows antiproliferative effect.

It enters into tumor cell and binds to DNA; shows antiproliferative effect.

A 28-year-old male patient is evaluated for a mass behind the right knee. Biopsy of the mass yields a diagnosis of “giant cell tumor of bone”. Which of the following systemic therapies should be recommended to the patient who refuses surgery? Vorinostat Palbociclib Nirogacestat Denosumab Cabozantinib

Denosumab

Which of the following is among the primary treatments used in the medical treatment of anaphylaxis? Diphenhydramine Cetirizine Albuterol Famotidine Methylprednisolone

Albuterol

A sixty-�ve-year-old male patient presents with complaints of fatigue, weight loss, and recurrent fever that have been going on for 6 months. The patient's history includes short-term bleeding of the nose 3 months ago; In the last 2 months, he has had cough, hemoptysis and darkening of his urine several times, lasting for 2-3 days. In laboratory examinations, the erythrocyte sedimentation rate was found to be 80 mm/hour. Which of the following is the most speci�c autoantibody that can be used for the diagnosis of this patient? ANA anti-dsDNA Anti-cardiolipin antibody c-ANCA (Anti-PR3) P-ANCA (Anti-MPO)

c-ANCA (Anti-PR3)

A 64-year-old female is hospitalized for severe joint pain and swelling. The patient has a known history of gout but has not been taking her urate lowering medications. She has chronic kidney disease with a creatinine of 3.2 mg/dL and uncontrolled diabetes with a hemoglobin A1C of 9.2. On exam, she has multiple joint involvement including metacarpophalangeal joints (MCPs), wrists, knees and ankles. She appears very uncomfortable. Arthrocentesis is performed and shows uric acid crystals with a white blood cell count of 23,000. Oral glucocorticoids are given with only minimal bene�t and her sugars are becoming di�cult to control. Which of the following options can rapidly relieve her joint symptoms? IL-17 inhibition IL-1 inhibition Intra-articular injections Colchicine Allopurinol

IL-1 inhibition The patient cannot use other prescriptions except the IL-1 inhibitors, Anakinra, rilonacept, or canakinumab Gut atağı tedavisi sorusu

Bence jones proteinleri hangi hastalıkta görülür?

Bence Jones proteinleri, immünoglobulin hafif zincirlerinin (genellikle kappa veya lambda) monomerik veya dimerik formlarında idrarla atılan küçük moleküllerdir. Başlıca monoklonal gamopati ile ilişkili hastalıklarda görülür: 1. Multipl Miyelom (En Sık Nedeni) Plazma hücre malignitesi ile karakterizedir. Hastaların %50-80'inde idrarda Bence Jones proteini (+) (serumda M proteini ile birlikte veya tek başına) MGUS ve Waldenströmde de görülür!

A 62-year old woman has a routine health check-up. On physical examination there are no abnormal �ndings. Laboratory studies show Hgb 13.4 g/dL, Hct 40.2%, MCV 89 fL, platelet count 219,700/microliter, and WBC count 4890/ microliter. Her total serum protein is 7.2 g/dL, and albumin 4.1 g/dL. A serum protein electrophoresis show a 2.7 g monoclonal spike. Urinalysis reveals no Bence Jones proteinuria. A bone marrow biopsy is performed and on microscopic examination shows normal cellularity with maturing hematopoiesis and 5% plasma cells. A bone scan is normal. Which of the following is the most likely diagnosis? Waldenström macroglobulinemia Monoclonal gammopathy of undetermined signi�cance Multiple myeloma Heavy-chain disease Lymphoplasmacytic lymphoma

MGUS

An investigator is studying the role of different factors in inflammation and hemostasis. Alpha-granules from activated platelets are isolated and applied to a medium containing inactive platelets. When ristocetin is applied, the granules bind to GpIb receptors, inducing a conformational change in the platelets. Binding of the active component of these granules to GpIb receptors is most likely responsible for which of the following steps of hemostasis? Local vasoconstriction Platelet aggregation Platelet activation Clotting factor activation Platelet adhesion

Platelet adhesion

Which of the following statements about urticaria and angioedema is incorrect? Glucocorticoids are recommended as �rst-line therapy in the treatment of acute urticaria. The most important criterion that distinguishes urticarial vasculitis from urticaria is that the duration of urticaria symptoms does not exceed 24 hours and is painless. Icatibant treatment, a bradykinin B2 receptor antagonist, can be used in recurrent idiopathic angioedema and hereditary angioedema. Bradykinin-related etiology constitutes one of the underlying mechanisms of angioedema.

Glucocorticoids are recommended as �rst-line therapy in the treatment of acute urticaria. This is incorrect, therefore the correct asnwer. The main criterion that distinguishes chronic urticaria from acute urticaria is that chronic urticaria symptoms persist for more than 6 weeks.

A 48-year old woman undergoses a carotid Doppler study for a carotid bruit detected on physical examination. The study shows a 0.8 cm nodule in the right lobe of the thyroid gland. She is otherwise asymptomatic and says she does not have dysphagia or dyspnea. She has no history of thyroid disease and no history of external radiation treatment to the head or neck as a child. There is no family history of thyroid disease. Examination �ndings are unremarkable. No thyroid nodule is palpable. TSH is 1.2 mIU/L (normal). What is the next step in the management of this patient Perform a �ne-needle aspiration (FNA) of the thyroid nodule under ultrasonographic guidance Advise surgical removal of the nodule Arrenge for a follow-up visit in 6 months to 1 year Begin levothyroxine therapy at a dose that suppresses TSH, and repeat the neck examination in 6 months Perform a thyroid scan

Arrenge for a follow-up visit in 6 months to 1 year

A 49-year-old woman with chronic renal insu�ciency is hospitalized with chest pain and diagnosed with non–ST-segment elevation myocardial infarction. This illness has been managed with simvastatin, lisinopril, metoprolol, and unfractionated heparin. Her platelet count on admission is 387,000 per mm3 (reference range, 150,000–350,000). Six days later, her platelet count falls to 43,000 per mm3 . She also develops new swelling in her lower left extremity. There are no signs of bleeding. Ultrasound examination of the lower extremities con�rms deep-vein thrombosis. What is the patient's most likely diagnosis? Idiopathic thrombocytopenic purpura (ITP) Thrombotic thrombocytopenic purpura (TTP) Heparin-induced thrombocytopenia (HIT) Antiphospholipid syndrome Protein S de�ciency

Heparin-induced thrombocytopenia (HIT) Heparin-induced thrombocytopenia (HIT) is a hypercoagulable state and requires immediate discontinuation of all heparin therapy and initiation of an alternative anticoagulant, such as the direct thrombin inhibitor argatroban. Testing for heparin/platelet factor 4 antibodies, often called heparin-induced platelet antibodies, can be helpful in diagnosing HIT

A 40-year-old female patient applied to her primary care physician with complaints of constant fatigue, dizziness and weight loss for the last 4 months. On physical examination, diffuse hyperpigmentation is seen, more prominent in the skin, oral mucosa and palmar wrinkles. What is the preliminary diagnosis for the patient? CRH insufficiency Increased iron deposition Hypopituitarism Primary adrenal insufficiency Prolonged corticosteroid therapy

Primary adrenal insufficiency

A 45-year-old patient with a �fteen-year history of Raynaud's phenomenon has shortness of breath for the last month. Physical examination reveals thickening, tightness and depressed scars on the �ngers, back of the hand, forearms and skin, and on the �ngertips. In laboratory examinations, ANA is positive with a titer of 1/320 and anticentromere antibody (+). Which of the following should be considered to be causing the shortness of breath in this patient? Pulmonary hypertension Interstitial �brosis Pulmonary thromboembolism Bronchial asthma Pulmonary vasculitis

Pulmonary hypertension

In which type of allergic reaction is the complement and antibody duo primarily involved? Type 4a Type II Type 4b Type III Type I

Type III

A 35-year-old female presents to the hospital for workup of persistent fevers and elevated white blood cell count. The patient was in her usual state of health until 4 months ago when she began having fevers daily, as well as a feeling of malaise and fatigue during the episodes. She notes a few of these episodes have been accompanied by a sore throat sensation. She has been diagnosed with pharyngitis twice and received antibiotics without any relief of symptoms. She has undergone imaging, which has noted mild splenomegaly and borderline lymphadenopathy in the chest and abdomen. Lymph node biopsy was pursued, demonstrating reactive changes without evidence of infection or malignancy. The fevers occur nightly, and feels well the next day. She also develops a subtle erythematous rash throughout her body when she has the fever. Her husband pointed out when he saw it at the base of her neck. The rash resolves when the fever resolves. An infectious disease specialist evaluated the patient and found no evidence of underlying infection. Labs are as follows: * WBC: 15,000/mL with >80% neutrophils * AST/ALT are both 3 x the upper limit of normal * Ferritin: 3,000 mcg/L (normal range: 10-300 mcg/L) Autoimmune serologies are negative. What is the most likely diagnosis? IgG4-related disease B-cell lymphoma Adult-onset Still's Rheumatoid arthritis Macrophage activation syndrome

Adult-onset Still's

A twenty-seven-year-old male patient presents with a complaint of low back pain that has been ongoing for 5 years. He states that the pain is especially evident later at night, that he feels stiffness in the waist and hips in the morning, and that the feeling of stiffness partially decreases in the afternoon. He has been complaining of occasional redness, burning, stinging and pain in the right eye for the last 2 years. Which of the following should be considered first for ocular involvement in this patient? Scleritis Keratoconjunctivitis Anterior uveitis Retinal vasculitis Vitritis

Anterior uveitis

A 38-year-old nurse from Mardin presents with 2 months history of low-grade fever, severe fatigue and progressive polyarthritis predominantly a�ecting large joints of lower limbs, with no signi�cant early morning sti�ness. She also gave a history of acute onset swelling of the right 2nd and left 4th toes for the past 2 weeks, associated with pain. There was no history of any high-risk sexual behavior or contact with tuberculosis in the past. On examination, she was febrile, with two 1x1 cm-sized cervical nodes. She had 3 raised nodules over the right shin, which were tender. A joint examination showed dactylitis over toes, with active arthritis over the right knee and bilateral ankles. Abdominal examination revealed a mild hepatomegaly – 4cm below the right costal margin. Other systemic examinations were normal. Initial blood investigations showed a normal blood count and ESR. CRP was 128 mg/L (normal < 6). What other investigations would be ordered? ASO titers Echocardiogram Radiograph of both feet Joint fluid aspiration Blood culture Chest radiograph

Chest radiograph

1. Which of the following is wrong about diabetes insipidus disease? A) Diagnosis is made by dehydration test. B) Hyponatremia is a common clinical feature. C) Caused by decreased vasopressin synthesis or end-organ resistance. D) Craniopharyngioma is the most common solid tumor causing it. E) Polyuria (>3 L/day) is typical.

B) Hyponatremia is a common clinical feature. HYPERnatremia

Indication for autologous stem cell transplant in lymphoma? A) First-line treatment for Hodgkin lymphoma B) Salvage therapy for relapsed/refractory lymphoma C) Maintenance after complete remission D) Palliative care for advanced lymphoma

Answer: B (Nüks/refrakter lenfomada kurtarma tedavisi).

32-year-old woman with easy bruising, platelet 25,000/µL, normal PT/aPTT. Diagnosis? A) ITP B) von Willebrand disease C) Hemophilia A

Answer: A (ITP: Trombositopeni + diğer pıhtılaşma testleri normal).

Most common feature in primary myelofibrosis (PMF)? A) Splenomegaly with fibrosis B) Lymphadenopathy C) Erythrocytosis

A) Splenomegaly with fibrosis

Hypokalemia + dark skin in Cushing’s syndrome suggest (en sık hangisinde görülür bu semptomlar?): A) Ectopic ACTH B) Adrenal adenoma

Answer: A (Ektopik ACTH'de ACTH çok yüksek → hiperpigmentasyon + hipokalemi).

Daily urine volume defining oliguria? A) <100 mL/day B) <400 mL/day C) < 200 mL/day

Answer: B (Oligüri: <400 mL/gün).

Which does not cause nephrotic syndrome? A) Minimal lesion disease B) Membranous GN C) Focal segmental glomerulosclerosis D) Diabetes mellitus E) IgA nephropathy

Answer: E (IgA nefropatisi genelde nefritik sendrom yapar).

Which is not a typical clinical picture for familial Mediterranean fever (FMF)? A) A 14-year-old male with fever and abdominal pain (post-appendectomy) B) A 43-year-old male with diarrhea, nausea, vomiting, and jaundice C) A 13-year-old male with swollen, red, painful ankle (father on hemodialysis) D) A 34-year-old female with peritoneal adhesions and MEFV mutation E) A 15-year-old female with recurrent pleuritic chest pain

Answer: B (Diarrhea + jaundice → FMF dışı; kolanjit/malignite düşündürür). Açıklama: FMF'de karın ağrısı, ateş, artrit tipik; sarılık ve kusma atipik.

Most common leukemia in older adults? A) CLL B) AML C) CML D) ALL

Answer: A (Kronik lenfositik lösemi >60 yaş sık)

Feature distinguishing chronic myeloproliferative disorders (MPDs) from other hematologic conditions? A) Pancytopenia with hypocellular marrow B) Clonal myeloid proliferation with preserved maturation C) Lymphoid cell predominance

Answer: B (MPD'lerde myeloid seri klonal çoğalma + olgunlaşma korunur).

25-week pregnant woman with family history of DM2. Best test for GDM? A) Fasting glucose B) HbA1c C) Oral glucose tolerance test (OGTT)

Answer: C (GDM tanısı için 75/100 gr OGTT altın standart).

Serum osmolality calculation for Na⁺:118 mEq/L, glucose:180 mg/dL, urea:84 mg/dL? 260 269 276 285 292

260

45-year-old woman with purple fingers in cold + distal skin sclerosis. Likely antibody? A) Anti-centromere (Limited scleroderma) B) Anti-Scl70 (Diffuse scleroderma)

Answer: A (Raynaud + distal skleroz → CREST sendromu/anti-sentromer).

Which of the following is the most common type of primary immunodeficiency? A) X-linked agammaglobulinemia B) Selective IgA deficiency C) Severe combined immunodeficiency (SCID) D) Wiskott-Aldrich syndrome E) DiGeorge syndrome

Answer: B (Selective IgA deficiency - 1:500 prevalence). Açıklama: IgA eksikliği en sık primer immün yetmezliktir; çoğu asemptomatik.

EGFR+ lung adenocarcinoma patient. Which drug is NOT appropriate? A) Osimertinib B) Alectinib C) Erlotinib

Answer: B (Alectinib ALK inhibitörü; EGFR'de etkisiz)

Not expected in non-classical congenital adrenal hyperplasia? A) Ambiguous genitalia B) Hirsutism C) Early puberty

Answer: A (Ambigu genital sadece klasik formda görülür).

71-year-old with upper GI bleed + aspirin use. Management? A) Stop aspirin, admit, transfuse B) Continue aspirin, urgent endoscopy

Answer: B continue aspirin, urgent endoscopy, NOT EMERGENCY

Doxorubicin cardiotoxicity mechanism and prevention? A) Oxidative stress → dexrazoxane B) Calcium channel blockage--> CCBs

Answer: A (Doksorubisin serbest radikal hasarı yapar; dekstrazoksan korur).

Anti-VEGF monoclonal antibody which can be used for metastatic CRC? A) Bevacizumab B) Pembrolizumab C) Durvalumab D) Atezolizumab E) Nivolumab

Answer: A (Bevasizumab VEGF'i bloke eder).

Which statement about subacute thyroiditis is true? A) The thyroid gland is painless B) Thyroid is soft and palpable C) Ultrasound shows a well-defined hyperechoic nodule D) Radioactive iodine uptake is low E) The sedimentation rate is low

Answer: D (Radioactive iodine uptake is low) Açıklama: Subakut tiroiditte (de Quervain) tiroid sintigrafisinde düşük uptake görülür (destrüktif tiptir). Ağrı, hassasiyet ve yüksek sedimentasyon tipiktir.

Which statement is correct? A) Trypanosoma cruzi causes achalasia B) Esophageal cancers are mostly adenocarcinomas C) Eosinophilic esophagitis affects mid-esophagus D) Barrett's esophagus involves squamous metaplasia E) Zenker's diverticulum is in the colon

Answer: C (Eosinophilic esophagitis is more pronounced in the middle esophagus) Açıklama: Eozinofilik özofajit proksimalden distale tüm özofagusta görülebilir, ancak orta özofagusta daha belirgindir.

Which drug should be stopped if angioedema develops? A) Beta-blockers B) ACE inhibitors C) Calcium channel blockers D) ARBs

Answer: B (ACE inhibitors) Açıklama: ACE inhibitörleri bradikinin birikimine bağlı anjiyoödem yapabilir. ARB'lerde bu risk daha düşüktür.

Which is NOT in Child-Pugh classification? A) Calcium B) Bilirubin C) Encephalopathy D) Ascites E) Prothrombin time Answer: A (Calcium)

Açıklama: Child-Pugh skorlamasında bilirubin, albumin, PT, assit, ensefalopati kullanılır. Kalsiyum dahil değildir.

A 70-year-old man with fatigue, back pain, recurrent infections, and lab findings: Hb 9.2 g/dL, Ca 12.2 mg/dL, creatinine 2.1 mg/dL, total protein 9.8 g/dL. Cause of infections? A) Hypogammaglobulinemia due to decreased polyclonal immunoglobulins B) Hypercalcemia C) Anemia D) Neutropenia secondary to bone marrow suppression E) Elevated total protein

Answer: A (Hypogammaglobulinemia due to decreased polyclonal immunoglobulins) Açıklama: Multipl myelomda monoklonal protein artışı normal immünglobulinleri baskılar (immun paresis), enfeksiyon riskini artırır. Hiperkalsemi ve renal yetmezlik de eşlik edebilir.

A 29-year-old African male with acute ankle/shin pain + tender erythematous nodules. Chest X-ray finding? A) Apical interstitial changes B) Bilateral hilar adenopathy C) Focal consolidation D) Normal

Answer: B (Bilateral hilar adenopathy) Açıklama: Eritema nodozum + hiler lenfadenopati sarkoidoz düşündürür. Afrika kökenli hastalarda daha sık görülür.

Which is NOT a characteristic of IgE-mediated hypersensitivity? A) Immediate allergic response B) Mast cell degranulation C) Primarily involves T cells D) Requires prior allergen exposure

Answer: C (Primarily involves T cells) Açıklama: Tip I hipersensitivite mast hücreleri ve IgE aracılıdır. T hücreleri Tip IV'te rol oynar.

. Which dynamic test evaluates cortisol and GH axes simultaneously? A) CRH stimulation test B) L-Dopa test C) ACTH stimulation test D) Insulin tolerance test (ITT)

Answer: D (Insulin tolerance test) Açıklama: İnsülin ile hipoglisemi oluşturularak CRH ve GHRH salınımı uyarılır. Kontrendikasyon: Kardiyak hastalık/epilepsi.

. A 76-year-old male with shoulder pain, Hb 10.3 g/dL (MCV 70), platelets 561,000/mm³, ESR 64 mm/h. Next step? A) Colonoscopy B) Whole-body PET scan C) Shoulder radiograph

Answer: A (Colonoscopy) Açıklama: Mikrositer anemi + trombositoz + yüksek ESR kolon kanseri ile uyumlu. Kolonoskopi ile GI kaynak araştırılmalı.

Correct anion gap (AG) formula? A) [Na⁺] - ([HCO₃⁻] + [Cl⁻]) B) [Na⁺] - [HCO₃⁻] - [Cl⁻] C) [Na⁺] + [K⁺] - [HCO₃⁻]

Answer: B (AG = [Na⁺] - [HCO₃⁻] - [Cl⁻]) Açıklama: Normal AG: 8-12 mEq/L. Yüksek AG metabolik asidozda (örn. ketoasidoz) görülür.

Which is NOT a cause of acute pancreatitis? A) Hypercalcemia B) Hyperacidemia C) Hypertriglyceridemia

Answer: B (Hyperacidemia) Açıklama: Pankreatit nedenleri: Safra taşı, alkol, hipertrigliseridemi, hiperkalsemi. Hiperasidite (örn. gastrinoma) pankreatit yapmaz.

Best approach for thyroid nodules >1 cm on USG? A) Biopsy if "cold" on scintigraphy B) Biopsy if "hot" on scintigraphy

Answer: A (Biopsy if "cold" on scintigraphy) Açıklama: Soğuk nodüller malignite riski taşır, ince iğne aspirasyonu (FNA) gerekir. Sıcak nodüller genelde benign izlenir.

Soru: Akut lösemi ile ilgili doğru ifadeleri seçiniz. AML'nin insidansı yaşla birlikte artar. Akut lösemide kemik iliği veya periferik kanda malign hücre oranı %20'den fazladır. ALL, normal organlara AML'den daha sık infiltrasyon yapar. Lösemik hücreler farklılaşamaz ancak kontrolsüz şekilde çoğalır (osteoblastlar gibi). Lösemik hücreler farklılaşamaz ancak kontrolsüz şekilde çoğalır (osteoblastlar gibi).

Açıklama: AML yaşla birlikte artar. Akut lösemide malign hücre oranı %20'nin üzerindedir. ALL normal organlara daha sık yayılır. Lösemik hücreler farklılaşamaz ve kontrolsüz çoğalır.

Cancer cells use important enzymatic tools known as _______ like swords to cut through the extracellular matrix (surrounding tumor region) in order to achieve migration and metastatic growth. Which of the following fills in the blank? proteases matrix metalloproteases extracellular lipases exonucleases glycolipases

matrix metalloproteases

Which of the following biochemical parameters is the gold standard for the diagnosis of CAD caused by 21-OH deficiency? Measurement of cholesterol level Measurement of dehydroepiandosterone sulfate level Measurement of free testosterone level Measurement of 17-OH progesterone level Measurement of 18-OH corticosterone level

Measurement of 17-OH progesterone level

What is the most important cause of increased mortality in nephrotic syndrome? Kidney failure Heart failure Increased risk of coagulation Increased risk of cancer Arrhythmia

Increased risk of coagulation

Which part of the nephron is responsible for the reabsorption of the most of the bicarbonate? Thin descending loop of Henle Thick ascending loop of Henle Proximal tubule Collecting tubule Distal tubule

Proximal tubule

Which of the following primary malignant bone tumor is more common among older adults? Lymphoma of bone Giant cell tumor Osteosarcoma Chondrosarcoma Adamantinoma

Chondrosarcoma

A 35-year-old man comes to his physician due to progressive weight gain and fatigue over the last 3 months. Past medical history is noncontributory. His temperature is 37.0°C, pulse is 80/min, and blood pressure is 160/90 mmHg. Physical examination reveals scattered ecchymoses. There is symmetric proximal muscle weakness of the upper and lower extremities. 24-hour urine free-cortisol concentration is markedly elevated, and ACTH level is reduced. Abdominal CT shows a tumor in the right adrenal gland. Which of the following sections in the contralateral adrenal gland is most likely to show the greatest atrophy? Zona Glomerulosa Medulla of Adrenal Gland Zona Faciculata Zona Reticularis

Zona Faciculata

A 62-year old woman has a routine health check-up. On physical examination there are no abnormal findings. Laboratory studies show Hgb 13.4 g/dL, Hct 40.2%, MCV 89 fL, platelet count 219,700/microliter, and WBC count 4890/microliter. Her total serum protein is 7.2 g/dL, and albumin 4.1 g/dL. A serum protein electrophoresis show a 2.7 gm monoclonal spike. Urinalysis reveals no Bence Jones proteinuria. A bone marrow biopsy is performed and on microscopic examination shows normal cellularity with maturing hematopoiesis and 5% plasma cells. A bone scan is normal. Which of the following is the most likely diagnosis? Multiple myeloma Heavy-chain disease Lymphoplasmacytic lymphoma Waldenström macroglobulinemia Monoclonal gammopathy of undetermined significance

Monoclonal gammopathy of undetermined significance

A patient is being investigated for pyrexia of unknown origin by an infectious diseases unit. After a 1-week inpatient stay, extensive investigations have not revealed any evidence of infection. A rheumatology consult is requested. Which one of the following investigations would most support a diagnosis of Adult Onset Still's Disease (AOSD)? Elevated IL-2 level Ferritin > 12000 ng/mL High titre anti-nuclear antibody Positive rheumatoid factor Glycosylated ferritin fraction > 20%

Ferritin > 12000 ng/mL

Which of the followings is not a feature of Bartter syndrome? Nephrocalcinosis Hypermagnesemia Hypokalemic metabolic alkalosis Hypercalciuria Hyperaldosteronism

Hypermagnesemia

Which of the following scenarios is suggestive of an inflammatory joint disease? A 27-year-old female with oral ulceration, alopecia, leukopenia presenting with arthralgia. A 27-year-old pregnant female with bilateral burning hand pain and numbness especially when waking up at night and in the morning. A 27-year-old female with irritable bowel syndrome presenting with fatigue, insomnia and arthralgia. A 27-year-old overweight female presenting with pain in the knees, especially when climbing or descending stairs.

A 27-year-old female with oral ulceration, alopecia, leukopenia presenting with arthralgia. BEHÇET

Which of the following is not a characteristic of urticaria? Urticarial lesions are usually accompanied by pain and the regression of the lesions takes more than 24 hours. Its lifetime prevalence is around 20% worldwide. A typical urticarial lesion consists of intensely pruritic, erythematous plaque and itchy blisters. Urticaria may sometimes be accompanied by angioedema. In its treatment, 2nd generation H1 blocker treatments are primarily used

Urticarial lesions are usually accompanied by pain and the regression of the lesions takes more than 24 hours. NOT a characteristic, therefore the correct asnwer.

Which of the following is not a sign of Cushing syndrome? Hypokalemia Hypocalcemia Obesity Psychosis Hirsutism

Hypocalcemia

A 54-years old female was diagnosed with metastatic adenocarcioma of the lung. Her molecular tests showed EGFR exon 19 deletion positivity. Which is not an alternative systemic treatment choice for that patient? Erlotinib Osimertinib Dacomitinib Afatinib Alectinib

Alectinib

Which of the following is true regarding drug allergies? Drug allergies are classified according to the way the drug is administered, its type, and the time the reaction occurs. In a person who has a drug reaction to penicillin, beta-lactam group antibiotics should be chosen instead of penicillin group. Patch test, one of the diagnostic tests, is used to detect delayed drug reactions. The risk of developing drug allergy to IV treatments is higher.

Patch test, one of the diagnostic tests, is used to detect delayed drug reactions.

A 40-year-old male presents with fatigue, headaches, and weight loss. The symptoms began insidiously several months ago but have worsened to the point where his headaches awaken him from sleep. The patient also has vision changes and often “sees double.” Past medical history is noncontributory, and he does'nt take any medications. Vital signs are within normal limits, and physical exam is notable for bitemporal loss of vision. A brain MRI is obtained, and a macroadenoma is reported. Which of the following laboratory findings is most reflective of this patient’s clinical presentation? CRH ↑, ACTH ↑, Cortisol ↑ CRH ↓, ACTH ↓, Cortisol ↓ CRH ↓, ACTH ↓, Cortisol ↑ CRH ↑, ACTH ↓, Cortisol ↓

CRH ↑, ACTH ↓, Cortisol ↓

A 45-year-old man has complained of headache and dizziness for the past 2 weeks. Physical examination reveals a palpable spleen tip but no lymphadenopathy; his complexion appears plethoric. A bone marrow biopsy is performed and on microscopic examination shows 98% hypercellularity with myeloid, erythroid, and megakaryocytic cell lines increased in number. Which of the following sets of peripheral blood findings is most likely to be present in this man? CBC with Hgb 20 g/dL, Hct 61%, and MCV 92 fL Total lymphocyte count of 200 per microliter WBC differential count: 59 segs, 3 bands, 18 lymphs, 5 monos, 15 eosinophils CBC with Hgb 10 g/dL, Hct 30%, MCV 85 fL, platelet count 3,000/microliter WBC differential count: 80 lymphs, 14 segs , 5 mono, 1 eosinophil

CBC with Hgb 20 g/dL, Hct 61%, and MCV 92 fL Polisitemia vera (PV) veya primer myeloproliferatif neoplazi. Artmış eritropoez (kırmızı küre üretimi) nedeniyle plethorik görünüm ve yüksek hemoglobin/hematokrit. Dalak büyümesi (splenomegali) ve kemik iliğinde tüm serilerde artış tipik bulgular. Anahtar Kelimeler: Plethora, splenomegali, hipercellülarite → Polisitemia vera. Myeloid, eritroid, megakaryositik artış → Myeloproliferatif neoplazi. Ek Not: PV'de JAK2 V617F mutasyonu sık görülür. Tedavide flebotomi (kan alma) ve aspirin kullanılır.

In a newly diagnosed hemophilia patient with no family history, which test among the options is important in distinguishing whether the disease is acquired or congenital? Activated partial thromboplastin time Prothrombin time Mixing test Platelet function analyze Factor VIII activity

Mixing test

Which of the following dynamic tests evaluates the cortisol and growth hormone axis simultaneously? Insulin tolerance test L-Dopa test Metyrapone test ACTH stimulation test CRH test

Insulin tolerance test

Which of the following clinical signs is not associated with a patient speaking as follows: “I wake up in the morning with hip pain and have difficulty putting my socks on. I have difficulty stepping on the soles of my feet. However, as I move throughout the day, I feel relief from my pain.” Acute anterior uveitis IgA nephropathy Psoriasis Diarrhoea Episcleritis

Episcleritis IgA nephropathy is also a clinical presentation of SpA

A 47 year old man presents with recurrent epigastric pain and diarrhea. He has had these symptoms for the last year and has been to the clinics several times with similiar complaints. His current dosage of famotidine has been steadily increasing to combat his symptoms. The pain seems to be related with food intake. He describes his diarrhea as watery and unrelated to his meals. Vital findings are normal. He denies tobacco or alcohol use. He does not take any medications apart from famotidine. An upper endoscopy reveals thickened gastric folds with 3 ulcers in the first part of the duodenum, which are negative for Helicobacter pylori. Which of the following is the best next step in this patient's management? Serum calcium levels Secretin stimulation test Computed tomography scan of the abdomen Endoscopic ultrasound Fasting serum gastrin levels

Fasting serum gastrin levels Patients complaints and clinical findings are suggestive of gastrinoma - Zollinger Ellison Syndrome. The very first laboratory investigation is fasting serum gastrin level

Which clinical feature suggests primary cortisol deficiency rather than secondary cortisol deficiency? Hyperpigmentation of skin Moon facies Palmar erythema Livid striae Malar rash

Hyperpigmentation of skin

A 75-year-old man came to the physician because of a 1-week history of increased tiredness and diffuse petechiae. He has multiple large lymph nodes. Hemoglobin concentration is 6 g/dL, leukocyte count is 100,000/mm3 with high lymphocytosis and platelet count is 19,000/mm3. Bone marrow aspiration shows numerous immature cells that stain positive for CD10, CD19, and terminal deoxynucleotidyl transferase (TdT). Which of the following diagnoses is most probable? Acute myeloblastic leukemia (AML) Chronic myelocytic leukemia (CML) T-cell acute lymphoblastic leukemia (T-ALL) B-cell acute lymphoblastic leukemia (B-ALL) Chronic lymphocytic leukemia (CLL)

B-cell acute lymphoblastic leukemia (B-ALL)

Which is not used in hyponatremia /inappropriate ADH syndrome? Tolvaptan Fluoxetine NaCl tablet Furosemide EMphagliflosin

Fluoxetine

Which of the following about isolated idiopathic (immune) thrombocytopenia (ITP) is correct? IVIG (IV immune globulins) may use for severe life-threatening bleeding. A decrease in megakaryocytes in the bone marrow is typical. Two major hallmarks are thrombocytopenia and microangiopathic hemolytic anemia. Usually major changes in the other cell series are seen on complete blood counts. Coagulation disorders are often accompanies with ITP.

IVIG (IV immune globulins) may use for severe life-threatening bleeding.

Which of the treatment methods are not used in the management of hypercalcemia in oncologic patients? Loop diuretics Thiazide diuretics Hydration with normal saline Calcitonin Intravenous bisphosphonate

Thiazide diuretics

Which of the statements is incorrect about plasma cell dyscariasis? 3-5% of myeloma patients has no detectable M proteins. Smoldering multiple myeloma (SMM) is an asymptomatic clonal plasma cell disorder. In multiple myeloma, lower amounts of serum albumin may indicate a poorer prognosis. In MGUS, the M protein level is typically less than 3 g/dL. Multiple myeloma is the most common hematologic malignancy.

Multiple myeloma is the most common hematologic malignancy.

Which of the following is an aromatase inhibitor used in the treatment of breast cancer? Larotrectinib Fulvestrant Ribociclib Tamoxifen Letrozole

Letrozole

Question: A patient on ipilimumab shows initial tumor growth, then regression. What is this called? Options: A) Classical Objective Response B) Classical Disease Progression C) Pseudoprogression D) Spontaneous Recovery E) Delayed Relapse

C) Pseudoprogression ✓

Which statements are correct? (Select all that apply) A) Cyclophosphamide – Hemorrhagic cystitis B) Bleomycin – Lung fibrosis C) Cisplatin – Nephropathy D) Vincristine – Neuropathy E) Vincristine – Severe bone marrow suppression

A) Cyclophosphamide – Hemorrhagic cystitis ✓ B) Bleomycin – Lung fibrosis ✓ C) Cisplatin – Nephropathy ✓ D) Vincristine – Neuropathy ✓ Incorrect: E) Vincristine – Severe bone marrow suppression ✗

Which is incorrect about MASCC? A) Identifies low-risk febrile neutropenia B) Max score = 26 C) Outpatient fever = low-risk criterion D) Score <21 = low-risk E) Predicts hypotension

D) Score <21 = low-risk