hema + onco internal Flashcards
Which alteration associates frequently with congenital spherocytosis A) arteriosclerosis obliterans B) immunodeficiency C) gallstone disease D) hypertension E) diarrhoea F) constipation
C) gallstone disease
bco hemolysis..
Which means Hodgin III/A Ann Arbor stage
A) pathologic lymphnodes both sides of the neck, axillary without fever and weight loss
B) pathological lymphnodes at the neck and inguinal region with fever and weight loss
C) pathological lymphnodes at the neck and inguinal region without fever and weight loss
D) pathologic lymph node at the neck and supraclavicular region with fever and weight loss
C) pathological lymphnodes at the neck and inguinal region without fever and weight loss
EXPLANATIONAnn Arbor stage III/A is described under C.
Please identify a non-Hodgkin's lymphoma in which lymphadenopathy is not charateristic finding. A) hairy cell leukemia B) Waldenström-macroglobulinaemia C) Burkitt-lymphoma D) multiple myeloma E) mantle-cell lymphoma
D) multiple myeloma
EXPLANATION
Correct is D, multiple myeloma, in which lymphadenopathy or splenomegaly occurs in less than 10%, myeloma cells are mainly occupying bone marrow. All the other listed entities are characterised by diffent degree of enlarged lymph nodes or spleen.
Which hermolytic disorder is associated with pancytopenia? A) spherocytosis B) immunhemolytic anemia C) sickle cell trait D) paroxysmal nocturnal hemoglobinuria E) thalassaemia minor
D) paroxysmal nocturnal hemoglobinuria
EXPLANATION
D is correct, the only hemolytic condition is paroxysmal nocturnal hemoglobinuria, which is a clonal hemopetic disorder affecting all cell lines.
Complement system mediated destruction of all blood components. (PIGA mutation)
In chilhood acute ITP prognosis:
A) If thrombocytopenia severe, spontaneous improvement is uncommon.
B) Spontaneous recovery is the most common.
C) Improvement might be achieved only with 1-2 mg/kg prednisone.
B) Spontaneous recovery is the most common.
EXPLANATION
The correct selection is B, as childhood acute ITP spontaneously and quickly cures in vast majoritiy of cases, without any intervention.
In chronic ITP (non post infectious event) the prognosis
A) Spontaneous remissions are the rule
B) Spontaneous remissions are uncommon, but after a short course of 1 mg/kg Prednisolon 80% achieves durable remissions
C) In chronic ITP spontaneous remissions are uncommon, first line 1 mg/kg Prednisolon achieves durable remissions in 10-15%
D) Any kind of remisssion needs combined immusuppressive therapy
C) In chronic ITP spontaneous remissions are uncommon, first line 1 mg/kg Prednisolon achieves durable remissions in 10-15%
EXPLANATION
C is correct, as in adultory ITP sponatenous cure is extremely rare. Point B is incorrect, as steroid therapy much less rarely results in longstanding remission in chronic ITP. Selection D is clearly incorrect, you do not neeed combined immunsuppression in ITP, as steroids, high dose invenous immunoglobulins, or is some cases Anti D sera might achieve remission, even if short duration.
Megaloblastic (pernicious) anemia characteristics
1) Weak gastric acid output, only after pentagstrin stimulation.
2) Pentagastrin refractory achlorhydria in manifest anemia cases.
3) Normoblast accumulation in bone marrow.
4) Presence of giant metamyelocytes in the marrow and blood.
A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) only 4th answer is correct
E) all of the answers are correct
C) 2nd and 4th answers are correct
EXPLANATION
In megaloblastic (pernicious) anemia refractory achlorhydria is the rule. Nucleated erythroid precursors are large, so called megaloblastic cells, not normal sized normoblasts. So answer 1 and 3 are wrong. Giant metamyelocytes are frequently seen.
What is/are diagnostic criterium of chronic lymphocytic leukemia?
1) Fever, painful lymphadenopathy, elevated CRP
2) Leukocytosis with left shift
3) Monoclonal gammopathy
4) CD5/CD19 coexpression cell count exceeds 5 G/L in peripheral blood
A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) only 4th answer is correct
E) all of the answers are correct
D) only 4th answer is correct
Therapies which are able to prolong multiple myeloma survival:
1) per os melphalan plus prednisolon
2) bortezomib, proteasome inhibitors
3) vincristine
4) dexamethasone
5) high dose melphalan with autologous stem cell transplantation
6) thalidomide, revlimide
7) antracyclines
8) methotrexate
A) 2nd, 5th and 6th answers are correct
B) 3rd, 6th and 8th answers are correct
C) 2nd, 4th and 7th answers are correct
A) 2nd, 5th and 6th answers are correct
EXPLANATION
Only autologous transplatation, proteasome inhibitors (bortezomib) and imids are able prolong substantialy survival in myeloam, all the other agents listed are not. So A is the good response
Which statements are correct in diffuse large B cell lymphoma?
1) indolent lymphoma
2) aggressive lymphoma
3) antiCD20 based immunochemotherapy achieves definitive cure in substantial part of patients
4) antiCD20 based immunochemotherapy should be applied, but it never achieves final cure
5) In refractory/relapsed cases high dose chemotherapy/autologous transplant should be performed
6) Diffuse large B cell lymphoma is CD20 negative, so anti CD20 therapy is not applicable
A) 2nd, 3th and 5th answers are correct
B) 3rd and 5th answers are correct
C) 4th and 5th answers are correct
D) 2nd and 6th answers are correct
A) 2nd, 3th and 5th answers are correct
DLBCL = prototype of aggressive lymphomas. Never final cure.
Important viruses in aplastic anemia etiopathogenesis:
1) Epstein–Barr-virus
2) cytomegalovirus
3) parvovirus
4) hepatitis A virus
5) HIV virus
6) hepatitis B, C virus
7) mumps virus
A) 1st, 2nd and 4th answers are correct
B) 2nd, 4th and 7th answers are correct
C) 3rd, 5th and 6th answers are correct
C) 3rd, 5th and 6th answers are correct
Correct statements in mantle cell lymphoma:
1) Dense CD 20+ lymphoma so anti CD20 based intensive immunochemotherapy should be applied
2) CD20 negative, so anti CD 20 therapy is not necessary
3) Autologous transplant should be performed in first remission
4) Indolent course is frequent in which watch and wait approach is enough
5) indolent lymphoma
6) Aggressive course is typical in vast majority
A) 1st, 3rd and 6th answers are correct
B) 2nd, 4th and 5th answers are correct
A) 1st, 3rd and 6th answers are correct
Which are the most useful disease specific diagnostic tools
A 16 years old girl admitted to your ward, looks really sick. History: no meaningful previous event, she had regular sport activity, but 8 days ago she had transient mild fever and diarrhoea for 2 days. Last day she had fever again, headache, dizziness, mild confusion, she could not even recognise her sister. Small petechiae and suffusiones appeared. You observe somnolence, mild jaundice. No meningeal signs. Liver, spleen, lymphnodes are normal sized. Platelet count 10 G/L, WBC 15 G/L, urea 11 mmol/l, hemostasis screening tests are normal.
1) Bone marrrow myeloblast flow cytometry
2) t15,17 translocation, suggesting acute promyelocytic leukemia, to indicate retinooid therapy
3) Durable increment of platelet counts after platelet transfusion, a sin ITP foreign platelets are not affected by antibodies
4) test if patient plasma provokes platelet aggregation in control specimen
5) verotoxin ELISA
6) ADAM TS13 activity or complementactivation measurement
7) TFPI measurement (tissue Factor inhibitor)
A) 1st and 7th answers are correct
B) 5th and 6th answers are correct
C) 3rd and 7th answers are correct
D) 4th and 5th answers are correct
E) all of the answers are correct
B) 5th and 6th answers are correct
Which therapeutic approach is the most appropriate
A 16 years old girl admitted to your ward, looks really sick. History: no meaningful previous event, she had regular sport activity, but 8 days ago she had transient mild fever and diarrhoea for 2 days. Last day she had fever again, headache, dizziness, mild confusion, she could not even recognise her sister. Small petechiae and suffusiones appeared. You observe somnolence, mild jaundice. No meningeal signs. Liver, spleen, lymphnodes are normal sized. Platelet count 10 G/L, WBC 15 G/L, urea 11 mmol/l, hemostasis screening tests are normal.
A) AML induction chemoterapy
B) ALL induction chemotherapy
C) retinoic acid administration
D) Antibiotics
E) high dose plasma administration/plasmaapheresis
F) aspirin
E) high dose plasma administration/plasmaapheresis
Which more recent therapy can also be helpful
A 16 years old girl admitted to your ward, looks really sick. History: no meaningful previous event, she had regular sport activity, but 8 days ago she had transient mild fever and diarrhoea for 2 days. Last day she had fever again, headache, dizziness, mild confusion, she could not even recognise her sister. Small petechiae and suffusiones appeared. You observe somnolence, mild jaundice. No meningeal signs. Liver, spleen, lymphnodes are normal sized. Platelet count 10 G/L, WBC 15 G/L, urea 11 mmol/l, hemostasis screening tests are normal.
A) heparin
B) autologous bone marrow transplantation
C) allogeneous bone marrow transplantation
D) iv. anti cd20 monoclonal antibody
E) high dose interferon
D) iv. anti cd20 monoclonal antibody
Dominant pathogentic factor in this disease A 16 years old girl admitted to your ward, looks really sick. History: no meaningful previous event, she had regular sport activity, but 8 days ago she had transient mild fever and diarrhoea for 2 days. Last day she had fever again, headache, dizziness, mild confusion, she could not even recognise her sister. Small petechiae and suffusiones appeared. You observe somnolence, mild jaundice. No meningeal signs. Liver, spleen, lymphnodes are normal sized. Platelet count 10 G/L, WBC 15 G/L, urea 11 mmol/l, hemostasis screening tests are normal. A) retinoin receptor anomaly B) previous alkylator therapy C) previous irradiation D) hypertension E) ADAMTS13 or complement alteration F) multidrug-resistane
E) ADAMTS13 or complement alteration
ADAMTS13 blocking antibody or deficiency is most common background of TTP/HUS. Correct E, all other options are irreleveant
DO NOT TRANSFUSE PLTs
What are the most helpful diagnostic tools in this case
You see a 62 years old male, with cherry sized neck, axillary, inguinal painless lymphadenopathy. Moderate weakness and weightloss. He had some mild fever and upper airway infections recently. Spleen enlarged by 6 cm. White Blood cell count 23 G/L, 76% small matured lymphocyte, other forms are normal. Hemoglobin 105 g/l, platelet count normal. Reduced IgG.
1) lymph node biopsy
2) Gumprecht shadows in peripheral blood smears
3) Bone marrow examination
4) citogenetics screening for Philadelphia-chromosome
5) peripheral blood flowcytometry. CD5/CD19 coexpressed cell count measurement
A) 1st and 3rd answers are correct
B) 2nd and 4th answers are correct
C) 2nd and 5th answers are correct
D) 4th and 5th answers are correct
E) all of the answers are correct
C) 2nd and 5th answers are correct
also want to do peripheral blood FISH analysis.
Which alteration carries important prognostic relevance
You see a 62 years old male, with cherry sized neck, axillary, inguinal painless lymphadenopathy. Moderate weakness and weightloss. He had some mild fever and upper airway infections recently. Spleen enlarged by 6 cm. White Blood cell count 23 G/L, 76% small matured lymphocyte, other forms are normal. Hemoglobin 105 g/l, platelet count normal. Reduced IgG.
1) histological subtype, as lymphoid depletion cases run poor prognosis
2) In ALL Philadelphia chromosome means very bad prognosis
3) lymphocyte doubling time shorter than 6 month
4) anemia, thrombocytopenia, medullary infiltration
5) male sex in itself has worse prognosis in Hodgkin
6) In chronic lymphocytic leukemia FISH p53 positivity especaillay bad prognosis
A) 1st and 3rd answers are correct
B) 3rd and 6th answers are correct
C) 4th and 6th answers are correct
B) 3rd and 6th answers are correct
Follow up:
leukocyte doubling time, extent of lymphadenomegali, progression of FISH alterations.
So the most common thrombophilia was proved. What prophylactic guideline is recommended in her case?
A 26-year-old pregnant lady in 16 weeks of pregnancy arrives to your office. Progressive swelling and pain developed in he right femoral region, four days ago. Pregnancy goes on normally otherwise. Doppler ultrasound reveals newly developed deep vein thrombosis in right femoral vein and popliteal vein. The patient’s mother and sister also had thrombotic episodes.
A) all cases whoi had once DVT lifelong anticoagulant prophylactic approach recommended.
B) All cases with previous DVT should receive couple of years anticoagulant prophylaxis, after some years may go for cautious dose reduction
C) In all such cases a 6 mont prophylaxis is enough
D) As all prophylactic efforts are ineffective, their use is not recommended
B) All cases with previous DVT should receive couple of years anticoagulant prophylaxis, after some years may go for cautious dose reduction
At cellular level tumor growth does not depend on the following:
A) Time of cell cycle
B) Growth fraction (proliferating tumor cell ratio)
C) cell death rate inside the tumor
D) Time of duplication of tumor volume
E) apoptosis
E) apoptosis
EXPLANATION
Tumor growth depends on four factors: time of cell cycle, growth fraction (proliferating tumor cell ratio), time to duplicate tumor volume, and tumor cell loss (cell death rate). With these variations, the different behavior of various histologic and primary and metastatic histopathological tumors can be well described.
