GI/Hematology

Question 1

Answer 1

All three

1 - px can be taking NSAIDs to treat pain

2 - H.pylori is possible

3. Steroids can cause ulcers

Question 2

Patient takes 800mg Ibuprofen daily. Which of the following is true:

1. By inhibiting cyclooxegenase, NSAIDs can increase the risk of gastric ulcers
2. He should stop ibuprofen
3. He should begin a proton pump inhibitor

Answer 2

1 , 2, 3

Question 3

Answer 3

none are correct

Question 4

Inflammatory bowel disease vs Irritable bowel syndrome

Answer 4

Question 5

Answer 5

VITAMINS ARE PRIMARILY ABSORBED IN SMALL INTESTINE

B

C

(Not ulcerative colitis- inflammation only in colon)

Question 6

Answer 6

A

Question 7

Answer 7

D

Question 8

Answer 8

C , D

Question 9

Bilateral episcleritis with ulcerative colitis

Answer 9

Question 10

Erythropoiesis (Red blood cell life cycle)

Answer 10

Question 11

CBC (complete blood count)

Answer 11

Question 12

Complete blood count

Hemoglobin/hematocrit

Answer 12

Hemoglobin (HGB)

• Concentration of hemoglobin (oxygen carrying molecule) in a concentration of whole blood (g/dl)
• Low O₂ = hypochromic (pink colour)
• Normal O₂ = normochromic (red)
• High O₂ = Hyperchromic (dark red)
• Small size = microcytic
• Normal = normocytic
• Large = macrocytic

Hematocrit

• Packed spun volume of blood that contains intact RBCs (%)
• Measured followind centrifugation

Low= anemia

High = polycythemia

Question 13

Bone marrow dyscrasia (disorder) - RBC

Answer 13

Question 14

Answer 14

D

(Can have normal iron levels in Anemia- only used to classify anemia)

Question 15

Answer 15

A

Question 16

Healthy 30 year old woman is found to have anemia. Well nurished, unremarkable medical history. Iron most likely deficient.

Select most appropriate next step in evaluation:

1. Evaluation to rule out colon cancer
2. Testing of B12 levels to rule out B12 as cause of anemia
3. Treat with iron to see is blood count responds
4. Work up to exclude sickle cell disease

Answer 16

3

(1 probable in older individual)

Question 17

Answer 17

A , B

Question 18

Answer 18

Abnormal white blood cells

Large red blood cells (high MCV)

Question 19

30 year old female presents with anemia

Answer 19

A

Question 20

30year old female.

Answer 20

A, B, E

Question 21

30 year old female

Answer 21

A, B, C

Question 22

Other measures of iron

Transferrin/total iron binding capacity (TIBC)

Ferritin

Answer 22

Question 23

Answer 23

A

(C- first check for colon cancer)

Question 24

Answer 24

C

Question 25

Answer 25

E - all

Question 26

Proliferative Sickle Retinopathy

Answer 26

Question 27

Answer 27

A, C (b- increases production of RBC in marrow) (Reticulocytes - immature RBC)

Question 28

Answer 28

D (B12 causes macrocytic anemia, pernicious anemia)

Question 29

Answer 29

All options

Question 30

Leukocytes - WBC

Answer 30

Question 31

Leukocyte disorders

Answer 31

Question 32

Leukemia

Answer 32

Question 33

Lymphoma

Answer 33

Reed-sternberg cells only in Hodgkins lymphoma Only in lymphoid line

Question 34

Leukemia or lymphoma Are cancer cells circulating

Answer 34

Question 35

Eye findings in leukemia and lymphoma

Answer 35

Question 36

Answer 36

A, B, D

Question 37

Answer 37

B

Question 38

Answer 38

D- all

Question 39

26 male with no significant medical history, has reduced vision in OS for a month Saw ER 3 weeks ago with complaint of easy bruising-"could be explained by mild trauma", ER did not check CBC Returned to ER 2 weeks later with same complaint in addition to blurry vision OS In eye clinic patiets admitted to fatigue/malaise; eye dr noticed pale skin

Answer 39

Retinopathy in blood dyscrasia * Retinal hemorrhaging is related to anemia, thrombocytopenia and increased venous pressure( in hypercoagulable states) * Hemes more common with anemia AND thrombocytopenia than either alone (Hgb \<8 , PLT\<50) * Tyoically need Hct \<= 50% of normal to get CWS/bleeding due to anemia alone You need SEVERE or VERY SEVERE anemia to have retinal findings(worse if concurrent thrombocytopenia) * Cotton wool spots are signs of retinal ischemia * Obstruction of axoplasmic transport = formation of "cytoid bodies" on histology * RNFL is thickest around the nerve - often see CWS here * Roth spots are nonspecific white-centered hemorrhages * Clasiccaly described in leukemia + endocarditis * Ischemic RNFL vs fibrin/PLT vs infectious material vs neoplastic cells

Question 40

Answer 40

A Reed-sternberg cells only in Hodgkins

Question 41

Answer 41

All of the above

Question 42

Leukocyte disorders - Immunoglobulin disorders

Answer 42

Question 43

Retinopathy in hyperviscosity and clotting disorders

Answer 43

Question 44

Answer 44

A, B, C

Question 45

Answer 45

A, B, C

Question 46

Answer 46

Question 47

Definition of thrombocytopenia

Answer 47

Decreased platelets, Less clotting, more bleeding Causes: bone marrow failure, Ab-mediated destruction, drugs * Thrombotic thrombocytopenic purpura * Idiopathic thrombocytopenic purpura ("-penia" - blood cell deficiency)

Question 48

Thrombocytosis

Answer 48

Too much platelets, increased chance of clotting Causes: Inflammation (physiologic) ("-cytosis" or "-philia" - blood cell excess)

Question 49

Does aspirin cause reversible or irreversible inhibition of platelets?

Answer 49

Irreversible | (NSAIDs are reversible)

Question 50

Coagulation disorders Protein C deficiency

Answer 50

Congenital/acquired condition that leads to increased risk for thrombosis Causes of aquired deficiency include: * Acute thrombosis * Warfarin therapy * Liver disease * Vitamin K deficiency * Sepsis * Disseminated intravascular coagulation * Certain chemotherapeutics * Uremia

Question 51

Coagulation disorders Factor V Leiden Mutation

Answer 51

Caused by mutaions in F5 gene

Question 52

Hemochromatosis

Answer 52

Genetic predisposition to abnormal iron absorption = plebotomy necessary Risk for organ damage

Question 53

Coagulation disorders

Answer 53

Question 54

Answer 54

Only A (B- irreversably inhibits) (C-genetic imparement|)

Question 55

Answer 55

B, D | (von willebrands causes more bleeding)

Question 56

Answer 56

A, B, D px has hemochromatosis

Question 57

Answer 57

B, D

Question 58

Irritable bowel disease

Answer 58

Question 59

60 yo white female Noticed blurry vision for 2months since hitting her head. Right eye gradually improved, left remains poor Hypertension (lisinopril) BCVA with correction * OD: 20/125 * OS: 20/40 IOP: OD: 13 ; OS: 14 SLE: anterior segment unremarkable, 1+ NS OU; no AC cells; no vitreous cells BP 129/66 A1c: 5.8 WBC 354 (leukocytosis) (normal: 3.7-10.5) RBC 2.37 (normal:4-5.2) Hb 7.3 (normal: 11.9-15) hct: 22 (normal:35-45) (anemia) Plt: 81 (normal:150-400) (Thrombocytopenia)

Answer 59

Diagnosis: Leukemia