Module 4 Pharmacology Blood And Lymph

Question 1

You are describing basic pharmacokinetics to a student and explain that the bioavailability of a drug is determined by many factors, including the route of administration. You tell this student that the lowest drug availability is provided by a particular route of administration. Which one of the following routes of administration is it?

Answer 1

oral

Question 2

A patient presents with an adverse drug reaction that is unusual and cannot be explained based on its pharmacodynamics. The dose, frequency, and patient characteristics are all appropriate. You classify this reaction as which one of the following?

Answer 2

Idiosyncratic

Question 3

A patient of yours has terminal cancer and is receiving oral morphine for palliation of bone pain. Over a period of weeks, you have had to increase the dose of the morphine to get the same level of pain relief. Having to increase the dose is due to which one of the following characteristics of pharmacology?

Answer 3

Tolerance

Question 4

A patient of yours presents to your office one week after getting a prescription for an antibiotic, following a diagnosis of pneumonia. He complains that his cough has gotten worse and his fever has persisted. You ask him about the medication, and he tells you he has cut down from taking it three times to just once a day, as it makes him nauseated. The most likely reason for this patient’s persisting symptoms is:

Answer 4

Poor compliance

Question 5

As you prepare for your final exams, you review the varying duration of action of medications based on their application. You remember that the following administration method leads to the longest duration of action:

Answer 5

Transdermal patch

Question 6

In your hematology rotation, you see a patient with a clotting disorder. She is 14 years old and has had multiple episodes of bruising and bleeding in her joints following minor traumas. More recently, she has had excessive bleeding with her periods (menorrhagia). After you learn more about her past history, you are able to rule out Hemophilia A, based on:

Answer 6

Her gender

Question 7

You have prescribed a medication that helps prevent the reuptake of a neurotransmitter in the synaptic space, thus increasing the stimulation of the distal neuron. You consider this type of drug a(n):

Answer 7

Agonist

Question 8

A 32-year-old man presents to the ER, with a fever, malaise, weight loss, and night sweats. On examination, you identify hepatosplenomegaly and palpable lymph nodes in the axillary and supraclavicular regions. A chest X-ray reveals enlarged mediastinal lymph nodes and a biopsy of the axillary nodes reveals Reed-Sternberg cells. The most likely diagnosis in this patient is:

Answer 8

Hodgkin’s lymphoma

The Reed-Sternberg cell (a giant cell present in the lymph node) is used as a marker for dx.
Onset in adults is primarily between 20 to 40 years of age.
Begins with enlarged lymph node in neck and then enlarged lymph nodes in surrounding tissue (palpable lymph nodes in auxiliary and supraclavicular regions).

Question 9

A 7-year-old male patient presents to your office, with his mother. She is concerned that he is pale and more tired than usual. She reports that he is a picky eater and drinks a lot of cow’s milk. He will eat meat and potatoes but refuses almost all types of vegetables. Vital signs reveal a blood pressure of 87/55 mm Hg and a heart rate of 105 beats/min. On examination, you notice significant pallor, and palmar creases in his hands. As part of your workup, you get a complete blood count. Which one of the following findings on the CBC could help explain this patient’s condition?

Answer 9

Microcytic anemia

Most common cause of anemia in children. It is characterized by small red blood cells and is a type of iron deficiency anemia.

Question 10

You are asked to see a 10-year-old patient in the ER, who is continuing to bleed from his nose after falling during a basketball game at school. You take a thorough history and perform a physical examination and are concerned that the child may have a coagulopathy. In particular, you are concerned about von Willebrand disease. This disease is a problem with which one of the following?

Answer 10

An abnormality in the clotting pathway

Question 11

A 75-year-old male patient presents to your office, with his daughter. She insisted that he come in, as he has had a series of falls over the past six months. He has also complained of generalized weakness, malaise, light-headedness, and tingling in his extremities. His daughter is concerned about his memory, as he has been more forgetful than usual. Vital signs reveal a blood pressure of 97/56 mm Hg and a heart rate of 105 beats/min. On examination, you notice a thick, beefy tongue, general pallor, and decreased vibratory sensation in his lower extremities. As part of your workup, you get a complete blood count. Which one of the following findings on the CBC could help explain his condition?

Answer 11

Megaloblastic anemia

Question 12

A patient presents with a medical condition that was caused by a medication he is taking for a separate medical condition. You would classify this reaction as which of the following?

Answer 12

Iatrogenic

Question 13

You are giving a talk on anemia to a high school class. After you describe the basic types, you give them case-based quizzes to test their understanding of the information presented. The first case you describe is one that includes a pancytopenia, in which all blood cell lines are abnormally low. The type of anemia this represents is:

Answer 13

Aplastic anemia

Question 14

During anesthesia for a surgical procedure, a patient’s blood pressure drops. The anesthesiologist gives the patient an intravenous dose of an indirect-acting pressor, which brings the blood pressure back to normal. Forty-five minutes later, the patient’s blood pressure drops again, and the same dose of the pressor is repeated. This time, however, the patient’s blood pressure does not increase as much as it did previously. This is due to which one of the following characteristics of pharmacology?

Answer 14

Tachyphylaxis

Question 15

You have just diagnosed one of your patients, with chronic lymphocytic leukemia. After the initial shock, she has many questions about her blood work. She wants to start with the basics and to know what the hematocrit measures. You tell her it represents:

Answer 15

The proportion of cells in the blood

Question 16

In the ER, you are asked to see a 7-year-old boy who has a history of frequent infections. He presents this time with a high fever, but no obvious source is determined by the history or physical examination. You order blood work that reveals decreased levels of red blood cells, white blood cells, and platelets. A peripheral smear identifies multiple large lymphoblasts. The most likely diagnosis is:

Answer 16

Acute lymphocytic leukaemia

Question 17

A 62-year-old man comes into your clinic, concerned that he no longer has the energy he needs to exercise regularly. He is increasingly tired and has developed muscle and joints aches. Recently, his back has been particularly painful. When questioned, he confirms that he has been constipated for some time and is urinating more frequently than usual. After a complete history and physical examination, you obtain blood work, which reveals that the levels of red blood cells, hemoglobin, and hematocrit are all slightly below normal and that his calcium is elevated. Urinalysis reveals slight proteinuria. Which one of the following is the most likely diagnosis?

Answer 17

Multiple myeloma

Question 18

You are asked to see a 10-year-old patient in the ER, who presents with a purpuric rash on his lower extremities and part of his abdomen. After you do a careful history and physical examination, you order blood work. The blood work suggests he may have idiopathic thrombocytopenic purpura, a condition characterized by:

Answer 18

Decreased number of platelets

Question 19

While on your ICU rotation, the team you are working with is called to the bedside of a 46-year-old man with overwhelming sepsis. He is on many medications to control the infection and his blood pressure, but the most recent concern is that he has begun to bleed excessively. All his clotting tests are abnormal. The most likely diagnosis for this man’s condition is:

Answer 19

Disseminated intravascular coagulation (DIC)

Question 20

In your hematology rotation, you see a patient with a clotting disorder. He is an 8-year-old boy who smiles when he tells you that he is special because he has Christmas disease. You smile back, and recall that this condition, also called Hemophilia B, results from the deficiency of which one of the following?

Answer 20

Factor IX

Question 21

You are reviewing a karyotype of a 38-year-old female patient of yours who presented with increasing fatigue, weight loss, and night sweats. On examination, her spleen was enlarged, and blood tests revealed an elevated white blood cell count. The peripheral smear identified granulocytes in multiple stages of differentiation. The karyotype you are reviewing shows the presence of the Philadelphia chromosome, (9,22)(q34;q11). The most likely diagnosis for this patient is:

Answer 21

Chronic myelocytic leukaemia

Question 22

A patient of yours presents to your office one week after getting a prescription for an antibiotic, following a diagnosis of pneumonia. He complains that his cough has gotten worse and his fever has persisted. You ask him about the medication, and he tells you he has cut down from taking it three times to just once a day, as it makes him nauseated. You realize that the frequency of a medication is an important part of maintaining adequate blood levels. This is based on and determined by which one of the following?

Answer 22

The drug half-life

Question 23

During your neonatology rotation, you assess a newborn who has birth defects attributed to the medication his mother was taking during critical portions of the pregnancy. You would classify this condition as which one of the following?

Answer 23

Teratogenic

Question 24

You are giving a talk on anemia to a high school class. After you describe the basic types, you give them case-based quizzes to test their understanding of the information presented. The second case you describe is one that includes a microcytic, hypochromic red blood cells. The type of anemia this represents is:

Answer 24

Aplastic anemia

Question 25

You are giving a talk on anemia to a high school class. After you describe the basic types, you give them case-based quizzes to test their understanding of the information presented. The second case you describe is one that includes a microcytic, hypochromic red blood cells. The type of anemia this represents is:

Answer 25

Chronic lymphocytic anemia

Question 26

As you prepare for your final exams, you review the varying duration of action of medications based on their application. You remember that the following administration method leads to the shortest duration of action:

Answer 26

Intravenous

Question 27

During a talk to high school students about hematology, one student asks what hemoptysis means. Which one of the following should be included in your explanation?

Answer 27

Coughing up blood

Question 28

You have prescribed a medication that blocks the receptor cells on distal neurons, thus decreasing their stimulation. You consider this type of drug a(n):

Answer 28

Antagonist

Question 29

You are describing basic pharmacokinetics to a student and explain that the bioavailability of a drug is determined by many factors, including the route of administration. You tell him that the highest drug availability is provided by a certain route of administration. Of the following, which one is it?

Answer 29

Intravenous

Question 30

During a talk to high school students about hematology, one student asks what ecchymosis means. Which one of the following should be included in your explanation?

Answer 30

Large areas of bruising