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[h] Hematology & Oncology System Flashcards

[i] Master EL Husseiny’s Essentials of Hematology & Oncology System in just 2 hours.

[q] What is the most likely diagnosis?

15 years old child presenting with epistaxis and Petechiae & Purpura + laboratory findings include: ↓ platelet count with prolonged bleeding time: often < 50,000 platelets per microliter (mcL), Normal PT/PTT, ↑ megakaryocytes on bone marrow biopsy. Symptoms respond well to corticosteroids.

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IEltbXVuZSB0aHJvbWJvY3l0b3BlbmljIHB1cnB1cmEgKElUUCkuIElUUCBpcyBjaGFyYWN0ZXJpemVkIGJ5IHRoZSBhdXRvaW1tdW5lIGRlc3RydWN0aW9uIG9mIHBsYXRlbGV0cyBieSBhbnRpLXBsYXRlbGV0IGFudGlib2RpZXMsIGxpa2VseSBJZ0cgYXV0b2FudGlib2RpZXMgYWdhaW5zdCB0aGUgcGxhdGVsZXQgbWVtYnJhbmUgZ2x5Y29wcm90ZWlucyBHUElJYi9sbGxhLg==[Qq]

[q] What is the most likely diagnosis?

10 years old child presenting with hematuria and Petechiae & Purpura, fever + Laboratory findings include: Thrombocytopenia with ↑ bleeding time, Normal PT/PTT, Anemia with schistocytes, ↑ Megakaryocytes on bone marrow biopsy, decreased hemoglobin and haptoglobin levels as well as increased serum lactate dehydrogenase and unconjugated bilirubin levels, elevated BUN and creatinine + the child has history of bloody diarrhea one week ago after eating undercooked beef.

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IEhlbW9seXRpYyB1cmVtaWMgc3luZHJvbWUgKEhVUykuIENsYXNzaWNhbGx5IHNlZW4gaW4gY2hpbGRyZW4gd2l0aCBFIGNvbGkgTzE1NzpINyBkeXNlbnRlcnksIHdoaWNoIHJlc3VsdHMgZnJvbSBleHBvc3VyZSB0byB1bmRlcmNvb2tlZCBiZWVmLiBFIGNvbGkgdmVyb3RveGluIGRhbWFnZXMgZW5kb3RoZWxpYWwgY2VsbHMgcmVzdWx0aW5nIGluIHBsYXRlbGV0IG1pY3JvdGhyb21iaS4=

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[q] What is the most likely diagnosis?

30 years old MALE presenting with confusion, disorientation, hematuria and Petechiae & Purpura, fever + Laboratory findings include: Thrombocytopenia with ↑ bleeding time, Normal PT/PTT, Anemia with schistocytes, ↑ Megakaryocytes on bone marrow biopsy, decreased hemoglobin and haptoglobin levels as well as increased serum lactate dehydrogenase and unconjugated bilirubin levels.

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IFRocm9tYm90aWMgdGhyb21ib2N5dG9wZW5pYyBwdXJwdXJhIChUVFApLiBUVFAgaXMgZHVlIHRvIGRlY3JlYXNlZCBBREFNVFMxMyAodldGIG1ldGFsbG9wcm90ZWFzZSksIGFuIGVuenltZSB0aGF0IG5vcm1hbGx5IGNsZWF2ZXMgVndGIG11bHRpbWVycyBpbnRvIHNtYWxsZXIgbW9ub21lcnMuIExhcmdlLCB1bmNsZWF2ZWQgbXVsdGltZXJzIGxlYWQgdG8gYWJub3JtYWwgcGxhdGVsZXQgYWRoZXNpb24sIHJlc3VsdGluZyBpbiBtaWNyb3Rocm9tYmku

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Jm5ic3A7

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[Qq]

[q] …… is due to a genetic GP1b deficiency —> platelet adhesion is impaired, but …… is due to a genetic GIIb/llla deficiency —> platelet aggregation is impaired.

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IEJlcm5hcmQtU291bGllciBzeW5kcm9tZSwgR2xhbnptYW5uIHRocm9tYmFzdGhlbmlhLg==

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Cg==[Qq]

[q] What is the most likely diagnosis?

8 years old male presenting with deep joint bleeding (hemarthrosis) in the right knee + Laboratory findings include: ↑ PTT; normal PT. ↓ FVIII. Normal platelet count and bleeding time.

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IEhlbW9waGlsaWEgQS4gR2VuZXRpYyBmYWN0b3IgVklJSSAoRlZJSUkpIGRlZmljaWVuY3kgZHVlIHRvIFgtbGlua2VkIHJlY2Vzc2l2ZSBtdXRhdGlvbiAocHJlZG9taW5hbnRseSBhZmZlY3RzIG1hbGVzKS4=[Qq]

[q] Hemophilia A and B are indistinguishable clinically, as both demonstrate similar symptoms, similar inheritance patterns, and isolated prolongation of the PTT except …….?

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IEZJWCBsZXZlbHMgYXJlIGRlY3JlYXNlZCBpbnN0ZWFkIG9mIEZWSUlJLg==

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Cg==[Qq]

[q] The vitamin K-dependent coagulation factors (II, VII IX, X) are initially produced by the liver in an inactive form, and are then activated by vitamin K-dependent carboxylation. Defect in vitamin K-dependent coagulation factors may be due to clotting factors deficiency (liver dysfunction) or vitamin k deficiency. Thus, failure of a prolonged PT to correct with vitamin K supplementation indicates ……?

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IGxpdmVyIGR5c2Z1bmN0aW9uLg==

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[q] Why PT is the first to be prolonged in liver diseases that affect the synthetic function of the liver to produce the clotting factors?

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IEJlY2F1c2UgRmFjdG9yIFZJSSwgcGFydCBvZiB0aGUgZXh0cmluc2ljIHBhdGh3YXksIGhhcyB0aGUgc2hvcnRlc3QgaGFsZi1saWZlLg==[Qq]

[q] Why vitamin K injection is given prophylactically to all newborns at birth?

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IFRvIHByZXZlbnQgaGVtb3JyaGFnaWMgZGlzZWFzZSBvZiB0aGUgbmV3Ym9ybi4gTmV3Ym9ybnMgbGFjayBHSSBjb2xvbml6YXRpb24gYnkgYmFjdGVyaWEgdGhhdCBub3JtYWxseSBzeW50aGVzaXplIHZpdGFtaW4gSyBhbmQgYnJlYXN0ZmVkIG1pbGsgaXMgcG9vciBpbiB2aXRhbWluIEsu[Qq]

[q] What is the most likely diagnosis?

13 years old male presenting with mild mucosal and skin bleeding and re-bleeding after surgical procedures (wisdom tooth extraction) + Laboratory findings include: ↑ bleeding time. ↑ PTT, normal PT. Decreased FVIII half-life + Abnormal ristocetin test + patient has a family history of similar condition?

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IFZvbiB3aWxsYnJhbmQgZGlzZWFzZS4=[Qq]

[q] Factor VIII is synthesized by the liver and stored in endothelial cells. Desmopressin acetate (DDAVP) is a synthetic vasopressin analog that releases von Willebrand factor and factor VIII from the endothelium. It is used for the treatment of  ……?

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IEhlbW9waGlsaWEgQSBhbmQgVm9uIHdpbGxicmFuZCBkaXNlYXNlLg==[Qq]

[q] What is the most likely diagnosis?

Patient admitted in ICU due to meningococcemia presenting with bleeding from IV puncture sites and body orifices + Laboratory findings include:↓ platelet count and prolonged bleeding time, ↑ PT/PTT, ↓ fibrinogen, Microangiopathic hemolytic anemia, Elevated fibrin split products, particularly D-dimer.

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IERpc3NlbWluYXRlZCBpbnRyYXZhc2N1bGFyIGNvYWd1bGF0aW9uIChESUMpLg==

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[q] What is the most likely diagnosis?

Patient presenting with diffuse skin necrosis after taking warfarin as anticoagulant for DVT?

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IFdhcmZhcmluIGluZHVjZWQgc2tpbiBuZWNyb3NpcyBkdWUgdG8gcHJvdGVpbiBDIGRlZmljaWVuY3ku[Qq]

[q] What is the most likely diagnosis?

25 years old Patient presenting with history of recurrent DVT and pulmonary embolism. Patient’s father died from Pulmonary Embolism in age of 40?

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IEZhY3RvciBWIExlaWRlbi4gSXQgaXMgYSBtdXRhdGVkIGZvcm0gb2YgZmFjdG9yIFYgdGhhdCBsYWNrcyB0aGUgY2xlYXZhZ2Ugc2l0ZSBmb3IgZGVhY3RpdmF0aW9uIGJ5IHByb3RlaW5zIEMgYW5kIFMuIE1vc3QgY29tbW9uIGluaGVyaXRlZCBjYXVzZSBvZiBoeXBlcmNvYWd1bGFibGUgc3RhdGUu[Qq]

[q] What is the most likely diagnosis?

Patient presenting with hypercoagulable state and history of recurrent DVT + PTT does not rise with standard heparin dosing?

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IEluaGVyaXRlZCBBbnRpdGhyb21iaW4gZGVmaWNpZW5jeS4gQ2FuIGFsc28gYmUgYWNxdWlyZWQgKHJlbmFsIGZhaWx1cmUvbmVwaHJvdGljIHN5bmRyb21lKSDihpIgYW50aXRocm9tYmluIGxvc3MgaW4gdXJpbmUg4oaSIOKGkyBpbmhpYml0aW9uIG9mIGZhY3RvcnMgSUlhIGFuZCBYYS4=[Qq]

[q] What is the most likely diagnosis?

60 years old patient presenting with Weakness, fatigue, and dyspnea, Pale conjunctiva and skin, Spoon nails (koilonychia) + Laboratory findings include: Hb: 9.2 g/dL, MCV: 75  with ↑ red cell distribution width (RDW),  ↓ ferritin; ↑ TIBC, ↓ Serum iron; ↓ % saturation,↑ Free erythrocyte protoporphyrin (FEP) + Fecal occult blood test is positive.

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IElyb24gZGVmaWNpZW5jeSBhbmVtaWEu

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[q] …….. is a Triad of iron deficiency anemia, esophageal webs, and glossitis. Presenting with anemia, dysphagia, and beefy-red tongue.

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IFBsdW1tZXItVmluc29uIHN5bmRyb21lLg==[Qq]

[q] What is the most likely diagnosis?

20 years old patient presenting with Weakness, fatigue, and dyspnea + Laboratory findings include: Hb: 9.2 g/dL, MCV: 75, ↑ ferritin, ↓ TIBC, ↑ serum iron, and ↑ % saturation (iron-overloaded state). Ringed sideroblasts (with iron-laden, Prussian blue-stained mitochondria) seen in bone marrow?

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IFNpZGVyb2JsYXN0aWMgYW5lbWlhLiBBbmVtaWEgZHVlIHRvIGRlZmVjdGl2ZSBwcm90b3BvcnBoeXJpbiBzeW50aGVzaXMu

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SXJvbiBpcyB0cmFuc2ZlcnJlZCB0byBlcnl0aHJvaWQgcHJlY3Vyc29ycyBhbmQgZW50ZXJzIHRoZSBtaXRvY2hvbmRyaWEgdG8gZm9ybSBoZW1lLiBJZiBwcm90b3BvcnBoeXJpbiBpcyBkZWZpY2llbnQsIGlyb24gcmVtYWlucyB0cmFwcGVkIGluIG1pdG9jaG9uZHJpYS4=

[Qq]

Iron-laden mitochondria form a ring around the nucleus of erythroid precursors; these cells are called ringed sideroblasts (hence, the term sideroblastic anemia).

[q] What is the most likely diagnosis?

1 years old child presenting with Weakness, fatigue, and dyspnea, Encephalopathy (cognitive impairment), Abdominal colic and constipation + History of moving recently to old house +  Laboratory findings include: Hb: 9.2 g/dL, MCV: 75. Peripheral blood smear is coarse basophilic stippling on a background of hypochromic microcytic anemia?

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IExlYWQgcG9pc29uaW5nLiBMZWFkIGluaGliaXRzIEFMQSBkZWh5ZHJhdGFzZSBhbmQgZmVycm9jaGVsYXRhc2UgJiM4MjExOyZndDsg4oaTIGhlbWUgc3ludGhlc2lzLg==

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QmFzb3BoaWxpYyBzdGlwcGxpbmcgcmVzdWx0cyBmcm9tIHRoZSBhYm5vcm1hbCBhZ2dyZWdhdGlvbiBvZiByaWJvc29tZXMgKGxlYWQgaW5oaWJpdHMgclJOQSBkZWdyYWRhdGlvbiku

[Qq]

Diagnosis is made by measuring the patient’s blood lead level.

Dimercaprol and EDTA are 1st line of treatment. Succimer used for chelation for kids (It “sucks” to be a kid who eats lead).

[q] α-Thalassemia is usually due to gene deletion; normally, 4 alpha genes are present on chromosome 16. How many genes is deleted in the following cases?

1. Type of  α-Thalassemia which is usually asymptomatic?

2. Type of  α-Thalassemia which is presented with mild anemia with ↑ RBC count; can be due to Cis or trans deletion?

3. Type of  α-Thalassemia which is presented with severe anemia; β chains form tetramers (HbH) that damage RBCs; HbH is seen on electrophoresis?

4. Type of  α-Thalassemia which is lethal in utero (hydrops fetalis); γ chains form tetramers (Hb Barts) that damage RBCs; Hb Barts is seen on electrophoresis?

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]

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MS4gT25lIGdlbmUgZGVsZXRlZC4=

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Mi4gVHdvIGdlbmVzIGRlbGV0ZWQ=

[Qq]

3. Three genes deleted

4. Four genes deleted.

 

[q] What is the most likely diagnosis?

2 years old child presenting with severe anemia that started 6 months after birth with prominent facial bones that looks like chipmunk facies and skull x-rays show ‘crewcut’ appearance + Laboratory findings include: Hb: 9.2 g/dL, MCV: 75 + Blood Smear shows microcytic, hypochromic RBCs with target cells and nucleated red blood cells + Electrophoresis shows little or no HbA1 with increased HbA2, and HbF.

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IFRoYWxhc3NlbWlhIG1ham9yICjOsjDOsjApLg==

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SXQgaXMgdGhlIG1vc3Qgc2V2ZXJlIGZvcm0gb2YgZGlzZWFzZSBhbmQgcHJlc2VudHMgd2l0aCBzZXZlcmUgYW5lbWlhIGEgZmV3IG1vbnRocyBhZnRlciBiaXJ0aDsgaGlnaCBIYkYgKM6xMs6zMikgYXQgYmlydGggaXMgdGVtcG9yYXJpbHkgcHJvdGVjdGl2ZSAoc3ltcHRvbWF0aWMgb25seSBhZnRlciA2IG1vbnRocywgd2hlbiBmZXRhbCBoZW1vZ2xvYmluIGRlY2xpbmVzKS4=

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[Qq]

α Tetramers aggregate and damage RBCs, resulting in ineffective erythropoiesis and extravascular hemolysis (removal of circulating RBCs by the spleen).

 

[q] Target cells form when erythrocytes have …….. or ……

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IHJlZHVjZWQgY2VsbCB2b2x1bWUgKHRoYWxhc3NlbWlhLCBpcm9uIGRlZmljaWVuY3kpLCBleGNlc3NpdmUgbWVtYnJhbmUgKG9ic3RydWN0aXZlIGxpdmVyIGRpc2Vhc2UsIHBvc3RzcGxlbmVjdG9teSku[Qq]

[q] What is the most likely diagnosis?

36 years old patient with a long history of alcohol use presenting with Weakness, fatigue, and dyspnea + laboratory findings include: Macrocytic RBCs and hypersegmented neutrophils (> 5 lobes), ↓ serum folate, ↑ serum homocysteine, Normal methylmalonic acid.

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IEZvbGF0ZSBkZWZpY2llbmN5Lg==[Qq]

[q] What is the most likely diagnosis?

36 years old patient with a long history of crohns disease presenting with Weakness, fatigue, dyspnea, ataxia and parathesia + laboratory findings include: Macrocytic RBCs with hypersegmented neutrophils, ↑ serum homocysteine (similar to folate deficiency), ↑ methylmalonic acid (unlike folate deficiency).

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IFZpdGFtaW4gQjEyIGRlZmljaWVuY3ku[Qq]

[q] ….. is a megaloblastic anemia that is refractory to folate and B12 supplementation.

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IE9yb3RpYyBhY2lkdXJpYS4gVXJpZGluZSBtb25vcGhvc3BoYXRlIHRvIGJ5cGFzcyBtdXRhdGVkIGVuenltZS4=[Qq]

[q] What is the most likely diagnosis?

6 months child presenting with Rapid-onset anemia,↑ % HbF, craniofacial abnormalities, and triphalangeal thumbs.

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IERpYW1vbmQtQmxhY2tmYW4gYW5lbWlhLg==[Qq]

[q] What is the most likely diagnosis?

16 years old patient presenting with Weakness, fatigue, dyspnea, and Splenomegaly, laboratory findings include: Spherocytes with loss of central pallor, ↑ mean corpuscular hemoglobin concentration (MCHC). Jaundice with unconjugated bilirubin,  + osmotic fragility test, which reveals increased spherocyte fragility in hypotonic solution.

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IEhlcmVkaXRhcnkgc3BoZXJvY3l0b3Npcy4gSW5oZXJpdGVkIGRlZmVjdCBvZiBSQkMgY3l0b3NrZWxldG9uLW1lbWJyYW5lIHRldGhlcmluZyBwcm90ZWlucy4=[Qq]

[q] What is the most likely diagnosis?

22 years old African American presenting with Weakness, fatigue, dyspnea, with prominent facial bones that looks like chipmunk facies and skull x-rays show ‘crewcut’ appearance + he has multiple painful foci, hematuria + ultrasound shows Shrunken, fibrotic spleen + Laboratory findings: HB: 9.2, MCV: 85 + Blood smear is shown below + Hb electrophoresis: 90% HbS, 8% HbF, 2% HbA2 (no HbA1).

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IFNpY2tsZSBjZWxsIGFuZW1pYS4gQXV0b3NvbWFsIHJlY2Vzc2l2ZSBtdXRhdGlvbiBpbiDOsiBjaGFpbiBvZiBoZW1vZ2xvYmluOyBhIHNpbmdsZSBhbWlubyBhY2lkIGNoYW5nZSByZXBsYWNlcyBub3JtYWwgZ2x1dGFtaWMgYWNpZCAoaHlkcm9waGlsaWMpIHdpdGggdmFsaW5lIChoeWRyb3Bob2JpYyku

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[q] What is the most likely diagnosis?

35 years old patient presenting with Weakness, fatigue, dyspnea, Hemoglobinuria, Hemosiderinuria, with Decreased serum haptoglobin. Symptoms often occurs episodically, often at night during sleep. CBC shows Pancytopenia. Patient has a previous history of ischemic stroke 2 years ago.

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IFBhcm94eXNtYWwgbm9jdHVybmFsIGhlbW9nbG9iaW51cmlhLiBBY3F1aXJlZCBkZWZlY3QgaW4gbXllbG9pZCBzdGVtIGNlbGxzIHJlc3VsdGluZyBpbiBhYnNlbnQgZ2x5Y29zeWwgcGhvc3BoYXRpZHlsIGlub3NpdG9sIChHUEkpOyBhIGdseWNvbGlwaWQgbmVjZXNzYXJ5IGZvciB0aGUgYXR0YWNobWVudCBvZiBzZXZlcmFsIGNlbGwtc3VyZmFjZSBwcm90ZWlucywgaW5jbHVkaW5nIENENTUgKGRlY2F5LWFjY2VsZXJhdGluZyBmYWN0b3IpIGFuZCBDRDU5IChNQUMgaW5oaWJpdG9yeSBwcm90ZWluKS4=

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[Qq]Suspect PNH in patients with hemolytic anemia, a hypercoagulable state, and pancytopenia.

Complications include iron deficiency anemia (due to chronic loss of hemoglobin in the urine) and acute myeloid leukemia (AML), which develops in 10% of patients.

[q] What is the most likely diagnosis?

African American male presenting with hemoglobinuria and back pain hours after taking sulfa for urinary tract infection + Peripheral blood smear shows Heinz bodies and Bite cells.

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IEdsdWNvc2UgNiBwaG9zcGhhdGUgZGVoeWRyb2dlbmFzZSBkZWZpY2llbmN5LiAmIzgyMTE7IOKGkyBHNlBEICYjODIxMTsmZ3Q7IOKGkyBOQURQSCAmIzgyMTE7Jmd0OyDihpMgcmVkdWNlZCBnbHV0YXRoaW9uZSAmIzgyMTE7Jmd0OyBveGlkYXRpdmUgaW5qdXJ5IGJ5IEgyTzIgJiM4MjEyOy0mZ3Q7IGludHJhdmFzY3VsYXIgaGVtb2x5c2lzLg==[Qq]

 

[q] What is the most likely diagnosis?

30 years old female with history of SLE presenting with normocytic anemia + positive direct coombs test?

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IEltbXVub2hlbW9seXRpYyBhbmVtaWEgKElnRy1tZWRpYXRlZCBkaXNlYXNlKS4=

Cg==

Cg==[Qq]

[q] What is the most likely diagnosis?

60 years old patient with long history of  Aortic stenosis presenting with mild microcytic anemia + Peripheral blood smear shows Schistocytes.

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IE1hY3JvYW5naW9wYXRoaWMgaGVtb2x5dGljIGFuZW1pYS4=[Qq]

[q] What is the most likely diagnosis?

40 years old female with long history of rheumatoid arthritis presenting with Weakness, fatigue, dyspnea, pale conjunctiva and skin + laboratory findings include: HB: 8.5, MCV: 83, low corrected reticulocyte count, ↑ ferritin, ↓ TIBC, ↓ serum iron, and ↓ % saturation,↑ Free erythrocyte protoporphyrin (FEP).

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IEFuZW1pYSBvZiBjaHJvbmljIGRpc2Vhc2UuIENocm9uaWMgZGlzZWFzZSByZXN1bHRzIGluIHByb2R1Y3Rpb24gb2YgYWN1dGUgcGhhc2UgcmVhY3RhbnRzIGZyb20gdGhlIGxpdmVyLCBpbmNsdWRpbmcgaGVwY2lkaW4u

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Cg==[Qq]

[q] What is the most likely diagnosis?

43 years old patient presenting with fatigue, malaise, pallor, purpura, mucosal bleeding, petechiae, increases susceptibility to infections + laboratory findings include: pancytopenia (anemia, thrombocytopenia, and leukopenia) with low reticulocyte count, ↑ EPO + Bone marrow aspiration is usually “dry” and histopathology shows marrow replacement with fat cells and fibrous stroma.

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IEFwbGFzdGljIGFuZW1pYS4=[Qq]

[q] …. is a rare form of marrow failure characterized by severe hypoplasia of marrow erythroid elements in the setting of normal granulopoiesis and thrombopoiesis.

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IFB1cmUgcmVkIGNlbGwgYXBsYXNpYSAoUFJDQSku

Cg==

UFJDQSBjYW4gYWxzbyByZXN1bHQgZnJvbSBwYXJ2b3ZpcnVzIEIxOSBpbmZlY3Rpb24uIFRoaXMgdmlydXMgcHJlZmVyZW50aWFsbHkgYXR0YWNrcyBhbmQgZGVzdHJveXMgcHJvZXJ5dGhyb2JsYXN0cy4gUmVjZW50IHBhcnZvdmlydXMgaW5mZWN0aW9uIGNhbiBiZSBjb25maXJtZWQgdmlhIHRoZSBkZXRlY3Rpb24gb2YgYW50aS1CMTkgSWdNIGFudGlib2RpZXMgaW4gdGhlIHNlcnVtLg==

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[Qq]

When a thymoma is present, removal can occasionally cure PRCA. Thus, all patients with PRCA should undergo a chest CT scan.

[q] What is the most likely diagnosis?

22 years old patient with long history of alcohol use presenting with abdominal pain, Polyneuropathy, Psychological disturbances, Port wine-stained urine.

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IEFjdXRlIGludGVybWl0dGVudCBwb3JwaHlyaWEu

Cg==

Cg==

RW56eW1lIGRlZmljaWVuY3k6IFBvcnBob2JpbGlub2dlbiBkZWFtaW5hc2UsIHByZXZpb3VzbHkgY2FsbGVkIHVyb3BvcnBoeXJpbm9nZW4gSSBzeW50aGFzZSAoYXV0b3NvbWFsIGRvbWluYW50IG11dGF0aW9uKS4=

[Qq]

Acculamted substrate: Porphobilinogen, ALA.

[q] ALA synthase is upregulated by ….. and downregulated by …..

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IENZUDQ1MCBpbmR1Y2VycyAobW9zdCBhbnRpZXBpbGVwdGljcywgZ3Jpc2VvZnVsdmluLCByaWZhbXBpbiksIGhlbWUgYW5kIGdsdWNvc2Uu[Qq]

[q] What is the most likely diagnosis?

32 years old patient with history of hepatitis C presenting with Blistering cutaneous photosensitivity and hyperpigmentation Exacerbated with alcohol consumption.

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IFBvcnBoeXJpYSBjdXRhbmVhIHRhcmRhLg==

Cg==

Cg==[Qq]

[q] What is the most likely diagnosis?

3 years old child presenting with Nausea, vomiting, gastric bleeding, lethargy after taking his mother’s tablet that looks like candy.

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IEFjdXRlIGlyb24gcG9pc29uaW5nLg==

Cg==

VHJlYXRtZW50IGlzIENoZWxhdGlvbiAoSVYgZGVmZXJveGFtaW5lLCBvcmFsIGRlZmVyYXNpcm94KSBhbmQgZ2FzdHJpYyBsYXZhZ2Uu[Qq]

[q] What is the most likely diagnosis?

8 years old child presenting with acute presentation of anemia (fatigue), thrombocytopenia (bleeding), or neutropenia (infection) + Bone marrow shows > 20% blasts in the bone marrow, blasts cells show positive nuclear staining for TdT (DNA polymerase) that express CD10, CD19, and CD20 + cytogenic analysis shows  t(12;21).

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IFByZWN1cnNvciBCLSBBY3V0ZSBseW1waG9ibGFzdGljIGxldWtlbWlhLg==

Cg==

Cg==[Qq]

[q] What is the most likely diagnosis?

18 years old patient presenting with acute presentation of anemia (fatigue), thrombocytopenia (bleeding), or neutropenia (infection) + Bone marrow shows > 20% blasts in the bone marrow, blasts cells show positive nuclear staining for TdT (DNA polymerase) that express markers ranging from CD2 to CD8 (CD3, CD4, CD7) + symptoms of facial plethora, facial edema and swelling, dysphagia, dyspnea and stridor.

 

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]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

Cg==

Cg==[Qq]

[q] What is the most likely diagnosis?

60 years old patient presenting with acute presentation of anemia (fatigue), thrombocytopenia (bleeding), or neutropenia (infection) + Bone marrow shows > 20% blasts in the bone marrow, blasts cells show positive cytoplasmic staining for myeloperoxidase (MPO) with Crystal aggregates + cytogenic analysis shows  t (15;17).

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IEFjdXRlIHByb215ZWxvY3l0aWMgbGV1a2VtaWEgKEFQTCku

Cg==

Cg==

JiM4MjExOyBDaGFyYWN0ZXJpemVkIGJ5IHQgKDE1OzE3KSwgd2hpY2ggaW52b2x2ZXMgdHJhbnNsb2NhdGlvbiBvZiB0aGUgcmV0aW5vaWMgYWNpZCByZWNlcHRvciAoUkFSKSBvbiBjaHJvbW9zb21lIDE3IHRvIGNocm9tb3NvbWUgMTU7IFJBUiBkaXNydXB0aW9uIGJsb2NrcyBtYXR1cmF0aW9uIGFuZCBwcm9teWVsb2N5dGVzIChibGFzdHMpIGFjY3VtdWxhdGUu

[Qq]

– Abnormal promyelocytes contain numerous primary granules (Auer rods) that increase the risk for DIC.

– Treatment is with all-trans-retinoic acid (ATRA, a vitamin A derivative), which binds the altered receptor and causes the blasts to mature and eventually die.

[q] What is the most likely diagnosis?

8 years old child presenting with acute presentation of anemia (fatigue), thrombocytopenia (bleeding), or neutropenia (infection) + Bone marrow shows < 20% blasts in the bone marrow.

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IE15ZWxvZHlzcGxhc3RpYyBzeW5kcm9tZS4=

Cg==

Cg==

TW9zdCBwYXRpZW50cyBkaWUgZnJvbSBpbmZlY3Rpb24gb3IgYmxlZWRpbmcsIHRob3VnaCBzb21lIHByb2dyZXNzIHRvIGFjdXRlIGxldWtlbWlhLg==[Qq]

[q] What is the most likely diagnosis?

65 years old male presenting with history of recurrent infection, generalized lymphadenopathy, neutrophils > 18000, peripheral smear shows smudge cells.

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IENocm9uaWMgbHltcGhvY3l0aWMgbGV1a2VtaWEvU21hbGwgbHltcGhvY3l0aWMgbHltcGhvbWEu[Qq]

 

[q] …… is the the most common cause of death in CLL.

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IEluZmVjdGlvbiBkdWUgdG8gSHlwb2dhbW1hZ2xvYmluZW1pYS4=[Qq]

[q] What is the most likely diagnosis?

55 years old male presenting with splenomegaly, Bone marrow aspirate shows dry tap and Cells are positive for tartrate-resistant acid phosphatase, B cells have filamentous, hair-like projections (fuzzy appearing on LM).

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IEhhaXJ5IGNlbGwgbGV1a2VtaWEu[Qq]

[q] What is the most likely diagnosis?

55 years old male presenting with splenomegaly, high granulocyte counts especially basophils, cytologic analysis shows t(9;22).

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IENocm9uaWMgbXllbG9pZCBsZXVrZW1pYSAoQ01MKS4gRHJpdmVuIGJ5IHQoOTsyMikgKFBoaWxhZGVscGhpYSBjaHJvbW9zb21lKSB3aGljaCBnZW5lcmF0ZXMgYSBCQ1ItQUJMIGZ1c2lvbiBwcm90ZWluIHdpdGggaW5jcmVhc2VkIHR5cm9zaW5lIGtpbmFzZSBhY3Rpdml0eS4=

Cg==

Cg==

Rmlyc3QgbGluZSB0cmVhdG1lbnQgaXMgaW1hdGluaWIsIHdoaWNoIGJsb2NrcyB0eXJvc2luZSBraW5hc2UgYWN0aXZpdHku[Qq]

 

[q] Myeloproliferative disorders is associated with a mutation in ….., a non-receptor tyrosine kinase except CML  is associated with ……

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IEphbnVzIGtpbmFzZSAyIChKQUsyKSwgUGhpbGFkZWxwaGlhIGNocm9tb3NvbWUu[Qq]

[q] What is the most likely diagnosis?

54 years old male presenting with facial flushing, Itching, especially after bathing, severe, burning pain and red-blue coloration of extremities, Blurry vision and headache + HB: 19 g/dl, Hematocrit: 59.

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IFBvbHljeXRoZW1pYSBWZXJhLg==

Cg==

SW4gcG9seWN5dGhlbWlhIHZlcmEsIG11dGF0aW9ucyBpbiBKQUsyIGNhdXNlIGNvbnN0aXR1dGl2ZSBraW5hc2UgYWN0aXZhdGlvbiwgcmVuZGVyaW5nIGhlbWF0b3BvaWV0aWMgY2VsbHMgbW9yZSBzZW5zaXRpdmUgdG8gZ3Jvd3RoIGZhY3RvcnMgc3VjaCBhcyBlcnl0aHJvcG9pZXRpbiBhbmQgdGhyb21ib3BvaWV0aW4u[Qq]

[q] In PV, erythropoietin (EPO) levels are …. , and Sao2 is …..

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IGRlY3JlYXNlZCwgbm9ybWFsLg==

Cg==

Cg==[Qq]

[q] In reactive polycythemia due to high altitude or lung disease, Sao2 is…., and EPO is ……

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IGxvdywgaW5jcmVhc2VkLg==

Cg==

Cg==[Qq]

[q] In reactive polycythemia due to ectopic EPO production from renal cell carcinoma, EPO is …., and Sao2 is …..

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IGhpZ2gsIG5vcm1hbC4=

Cg==

Cg==[Qq]

[q] What is the most likely diagnosis?

40 years old patient presenting with recurrent infection, anemia, thrombocytopenia, splenomegaly, peripheral smear shows teardrop RBC’s, Bone marrow aspirate shows dry tap, + JAK2 Kinase mutation.

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IE15ZWxvZmlicm9zaXMu

Cg==

Cg==[Qq]

[q] What is the most likely diagnosis?

45 years old female presenting with fever, chills, and night sweats, painless cervical lymphadenopathy + lymph node biopsy shows large B cells with binucleate or bilobed with the 2 halves as mirror images and prominent nucleoli; classically positive for CD15 and CD30, Lymph node is divided by bands of sclerosis; RS cells are present in lake-like spaces (lacunar cells)?

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IEhvZGdraW4gbHltcGhvbWEgKE5vZHVsYXIgc2NsZXJvc2lzIHN1YnR5cGUpLg==[Qq]

[q] …… has the best prognosis of all types of Hodgkin lymphoma, but …..  is the most aggressive at all types; usually seen in the elderly and HIV-positive individuals.

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IEx5bXBob2N5dGUtcmljaCwgTHltcGhvY3l0ZS1kZXBsZXRlZC4=[Qq]

[q] Benign lymph node enlargement in response to antigenic stimulation is associated with a …… proliferation of lymphocytes. But malignant lymph node enlargement is associated with a….. proliferation of lymphocytes.

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IHBvbHljbG9uYWwsIG1vbm9jbG9uYWwu[Qq]

[q] What is the most likely diagnosis?

55 years old male presenting with generalized lymphadenopathy, low-grade fever, night sweats with indolent course + lymph node biopsy shows Disruption of normal lymph node architecture that form follicle-like nodules with Bcl2 overexpression in follicles + cytogenic analysis shows by t(14,18).

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IEZvbGxpY3VsYXIgbHltcGhvbWEuIEJDTDIgb24gY2hyb21vc29tZSAxOCB0cmFuc2xvY2F0ZXMgdG8gdGhlIElnIGhlYXZ5IGNoYWluIGxvY3VzIG9uIGNocm9tb3NvbWUgMTQg4oaSIFJlc3VsdHMgaW4gb3ZlcmV4cHJlc3Npb24gb2YgQmNsMiwgd2hpY2ggaW5oaWJpdHMgYXBvcHRvc2lzICYjODIxMTsmZ3Q7IGZvbGxpY3VsYXIgbHltcGhvbWEu[Qq]

[q] What is the most likely diagnosis?

45 years old male presenting with generalized lymphadenopathy, low-grade fever, night sweats + lymph node biopsy shows Neoplastic proliferation of small B cells (CD20) that expands to the mantle zone + cytogenic analysis shows by t(11;14).

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IE1hbnRsZSBjZWxsIGx5bXBob21hLg==

Cg==

Q3ljbGluIEQxIGdlbmUgb24gY2hyb21vc29tZSAxMSB0cmFuc2xvY2F0ZXMgdG8gSWcgaGVhdnkgY2hhaW4gbG9jdXMgb24gY2hyb21vc29tZSAxNC4=

Cg==

[Qq]

Overexpression of cyclin D1 promotes G1/S transition in the cell cycle, facilitating neoplastic proliferation.

[q] What is the most likely diagnosis?

45 years old female presenting with long history of Hashimotos thyroiditis but she noticed sudden enlargement of the neck  +  Thyroid biopsy shows Neoplastic proliferation of small B cells (CD20) that expands to the marginal zone + cytogenic analysis shows by t(11;18).

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IE1hcmdpbmFsIHpvbmUgbHltcGhvbWEu

Cg==

Cg==[Qq]

[q] What is the most likely diagnosis?

African American child presenting with jaw mass + Biopsy shows Neoplastic proliferation of intermediate-sized B cells (CD20+) with – Overexpression of c-myc,  high mitotic index and high cell death rate are typically seen. Benign macrophages that phagocytize the resulting cellular debris (“tingible body macrophages”) are diffusely distributed throughout the malignant tissue. The clear spaces that surround these macrophages create “starry sky” appearance?

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IEJ1cmtpdHQgbHltcGhvbWEu

Cg==

Cg==

JiM4MjExOyB0KDg7MTQpIGlzIG1vc3QgY29tbW9uLCByZXN1bHRpbmcgaW4gdHJhbnNsb2NhdGlvbiBvZiBjLW15YyBvbiBjaHJvbW9zb21lIDggdG8gdGhlIElnIGhlYXZ5IGNoYWluIGxvY3VzIG9uIGNocm9tb3NvbWUgMTQgKEJ1cmsgOCku

[Qq]

– Overexpression of c-myc oncogene promotes cell growth.

– Almost all cases of endemic Burkitt lymphoma are associated with Epstein-Barr virus (EBV) infection.

[q] What is the most likely diagnosis?

HIV positive patient with  CD4< 50  presenting with confusion, memory loss, seizures + MRI shows Solitary mass in his brain, Histology shows Neoplastic proliferation of B cells lymphocytes?

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IFByaW1hcnkgY2VudHJhbCBuZXJ2b3VzIHN5c3RlbSBseW1waG9tYS4=[Qq]

[q] What is the most likely diagnosis?

45 years old Asian male presenting with generalized lymphadenopathy with hepatosplenomegaly, low-grade fever, night sweats, Skin rash, and lytic (punched-out) bone lesions with hypercalcemia + lymph node biopsy shows Neoplastic proliferation of mature CD4 T cells.

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IEFkdWx0IFQtY2VsbCBsZXVrZW1pYS9seW1waG9tYS4=[Qq]

[q] What is the most likely diagnosis?

45 years old Asian male presenting with generalized lymphadenopathy with hepatosplenomegaly, low-grade fever, night sweats, Skin rash+ lymph node biopsy shows Neoplastic proliferation of mature CD4 T cells + Peripheral smear shows lymphocytes with cerebriform nuclei (Sezary cells).

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IE15Y29zaXMgZnVuZ29pZGVzLg==[Qq]

[q] t(8;14) is associated with ……?

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IEJ1cmtpdHQgKEJ1cmstOCkgbHltcGhvbWEgKGMtbXljIGFjdGl2YXRpb24pLg==

Cg==

[Qq]

[q] t(11;14) is associated with ……?

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IE1hbnRsZSBjZWxsIGx5bXBob21hIChjeWNsaW4gRDEgYWN0aXZhdGlvbiku

Cg==

Cg==[Qq]

[q] t(11;18) is associated with ……?

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IE1hcmdpbmFsIHpvbmUgbHltcGhvbWEu

Cg==

Cg==[Qq]

[q] t(15;17) is associated with ……?

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IEFQTCAoTTMgdHlwZSBvZiBBTUw7IHJlc3BvbmRzIHRvIGFsbC10cmFucw==
CnJldGlub2ljIGFjaWQpLg==

Cg==

[Qq]

[q] t(9;22) (Philadelphia chromosome) is associated with ……?

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IENNTCAoQkNSLUFCTCBoeWJyaWQpLCBBTEwgKGxlc3MgY29tbW9uLCBwb29yIHByb2dub3N0aWMgZmFjdG9yKTsgUGhpbGFkZWxwaGlhIENyZWFNTCBjaGVlc2Uu

Cg==

Cg==[Qq]

[q] What is the most likely diagnosis?

32 years old male presenting with vertebrae (Back pain), hypercalcemia with increased susceptibility to infections + x-ray shows: o Lytic, ‘punched-out’ in the vertebrae + Serum protein electrophoresis (SPEP) shows Monoclonal M protein spike of IgG + peripheral blood smear shows Rouleaux formation of RBCs + dipstick of urinalysis shows Proteinuria.

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==

Cg==

[Qq]

[f]IE11bHRpcGxlIG15ZWxvbWEu

Cg==

Cg==

JiM4MjExOyBUaGluayBDUkFCOg==
[Qq] HyperCalcemia.
Renal involvement.
Anemia.
Bone lytic lesions/Back pain.

[q] ……. is a patient with increased serum protein with M spike on SPEP; but other features of multiple myeloma are absent (no lytic bone lesions, hypercalcemia, AL amyloid, or Bence jones proteinuria).

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IE1vbm9jbG9uYWwgZ2FtbW9wYXRoeSBvZiB1bmRldGVybWluZWQgc2lnbmlmaWNhbmNlIChNR1VTKS4=[Qq]

[q] What is the most likely diagnosis?

43 years old male with painless generalized lymphadenopathy with Visual and neurologic deficits, Serum protein electrophoresis (SPEP) shows Monoclonal M protein spike of IgM.

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IFdhbGRlbnN0b3JtIG1hY3JvZ2xvYnVsaW5lbWlhLg==[Qq]

[q] What is the most likely diagnosis?

5 years old child presenting with lytic bone lesions in his skull and skin rash + Histology shows Cells that express S-100 (mesodermal origin) and CD1a, Birbeck granules (“tennis rackets” or rod shaped on EM).

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IExhbmdlcmhhbnMgY2VsbCBoaXN0aW9jeXRvc2lzLg==[Qq]

[q] What is the most likely diagnosis?

9 years old child presenting with fever, pancytopenia, hepatosplenomegaly, ↑↑↑ serum ferritin levels + Bone marrow biopsy shows macrophages phagocytosing marrow elements.

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IEhlbW9waGFnb2N5dGljIGx5bXBob2hpc3Rpb2N5dG9zaXMuIFN5c3RlbWljIG92ZXJhY3RpdmF0aW9uIG9mIG1hY3JvcGhhZ2VzIGFuZCBjeXRvdG94aWMgVCBjZWxscyDihpIgZmV2ZXIsIHBhbmN5dG9wZW5pYSwgaGVwYXRvc3BsZW5vbWVnYWx5LCDihpHihpHihpEgc2VydW0gZmVycml0aW4gbGV2ZWxzLg==[Qq]

[q] What is the most likely diagnosis?

59 years old patient presenting with abnormal venous dilation of his legs, skin discoloration, lipodermatosclerosis, skin ulceration on the medial aspect of the lower leg, and pain, swelling that is typically worse in the evening or following prolonged standing and improves after walking or leg elevation.

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IENocm9uaWMgdmVub3VzIGluc3VmZmljaWVuY3kgKENWSSku[Qq]

[q] Chronic venous insufficiency is most commonly caused by ……  leading to venous hypertension in the deep venous system of the legs.

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IGluY29tcGV0ZW5jZSBvZiB2ZW5vdXMgdmFsdmVzLg==[Qq]

[q] Patients who receive the equivalent of more than one body blood volume (5-6 liters) of whole blood transfusions or packed red blood cells over a period of 24 hours may develop paresthesias due to hypocalcemia, why?

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IENpdHJhdGUgY2hlbGF0ZXMgY2FsY2l1bSBhbmQgbWFnbmVzaXVtIGFuZCBtYXkgcmVkdWNlIHRoZWlyIHBsYXNtYSBsZXZlbHMsIGNhdXNpbmcgcGFyZXN0aGVzaWFzIGR1ZSB0byBoeXBvY2FsY2VtaWEu[Qq]

[q] …… inhibits epoxide reductase which interferes with γ-carboxylation of vitamin K-dependent clotting factors II, VII, IX, and X, and proteins C and S.

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IFdhcmZhcmluLg==[Qq]

[q] – The target INR for therapeutic warfarin anticoagulation is ….

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IDItMy4=[Qq]

[q] What is the most likely diagnosis?

45 years old patient on warfarin as anticoagulant for treatment of DVT presenting with intracranial hemorrhage, he was using omeprazole for treatment of GERD for along time.

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IERydWctZHJ1ZyBpbnRlcmFjdGlvbiBiZXR3ZWVuIHdhcmZhcmluIGFuZCBvbWVwcmF6b2xlIChDWVAgNDUwIGluaGliaXRvciku

Cg==

Cg==[Qq]

 

[q] For reversal of warfarin, we give ……..

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IHZpdGFtaW4gSyBhbmQgRm9yIHJhcGlkIHJldmVyc2FsLCB3ZSBnaXZlIGZyZXNoIGZyb3plbiBwbGFzbWEgdW50aWwgdml0YW1pbiBrIHN0YXJ0IHRvIHdvcmtzLg==[Qq]

[q] ……. enhances the activity of antithrombin → Lowers the activity of thrombin and factor Xa.

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IEhlcGFyaW4u[Qq]

[q] …….. has equal activity against Factor Xa and thrombin, while ….. has greater activity against Factor Xa than thrombin.

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IFVuZnJhY3Rpb25hdGVkIGhlcGFyaW4sIExNV0gu

Cg==

Cg==

JiM4MjExOyBPbmx5IHVuZnJhY3Rpb25hdGVkIGhlcGFyaW4gKG5vdCBMTVdIKSBoYXMgYSBwZW50YXNhY2NoYXJpZGUgY2hhaW4gbG9uZyBlbm91Z2ggKCZndDsxOCBzYWNjaGFyaWRlIHVuaXRzKSB0byBiaW5kIHRvIGJvdGggYW50aXRocm9tYmluIGFuZCB0aHJvbWJpbi4gQXMgYSByZXN1bHQsIHVuZnJhY3Rpb25hdGVkIGhlcGFyaW4gaGFzIGVxdWFsIGFjdGl2aXR5IGFnYWluc3QgRmFjdG9yIFhhIGFuZCB0aHJvbWJpbiwgd2hpbGUgTE1XSCBoYXMgZ3JlYXRlciBhY3Rpdml0eSBhZ2FpbnN0IEZhY3RvciBYYSB0aGFuIHRocm9tYmluLg==

[Qq]

[q] What is the most likely diagnosis?

Patient who was on heparin as anticoagulant for long time present with thrombosis although low platelet count?

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IEhlcGFyaW4taW5kdWNlZCB0aHJvbWJvY3l0b3BlbmlhIChISVQpLg==

Cg==

RGV2ZWxvcG1lbnQgb2YgSWdHIGFudGlib2RpZXMgYWdhaW5zdCBoZXBhcmluLWJvdW5kIHBsYXRlbGV0IGZhY3RvciA0IChQRjQpLiBBbnRpYm9keS1oZXBhcmluLVBGNCBjb21wbGV4IGFjdGl2YXRlcyBwbGF0ZWxldHMgJiM4MjExOyZndDsgdGhyb21ib3NpcyBhbmQgdGhyb21ib2N5dG9wZW5pYS4=

Cg==

[Qq]

[q] Antidote of heparin is ……?

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IFByb3RhbWluZSBzdWxmYXRlIGlzIGEgcGVwdGlkZSB0aGF0IGJpbmRzIHRvIGhlcGFyaW4gZm9ybWluZyBhIGNvbXBsZXggdGhhdCBoYXMgbm8gYW50aWNvYWd1bGFudCBhY3Rpdml0eSAoY2hlbWljYWwgaW5hY3RpdmF0aW9uKS4=

Cg==

Cg==[Qq]

[q] ….. is a form of low molecular weight heparin that, like heparin, functions by binding and activating antithrombin III.

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IEVub3hhcGFyaW4sIGRhbHRlcGFyaW4u[Qq]

[q] Low molecular weight heparin is more widely used than unfractionated heparin. Why?

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]

Cg==

TE1XSCBoYXZlIGJldHRlciBiaW9hdmFpbGFiaWxpdHksIGFuZCAyLTQgdGltZXMgbG9uZ2VyIGhhbGYtbGlmZTsgY2FuIGJlIGFkbWluaXN0ZXJlZCBzdWJjdXRhbmVvdXNseSBhbmQgd2l0aG91dCBsYWJvcmF0b3J5IG1vbml0b3Jpbmcu

Cg==

74KnIE9jY3VycmVuY2Ugb2YgaGVwYXJpbi0gaW5kdWNlZCB0aHJvbWJvY3l0b3BlbmlhIChISVQpIGlzIG11Y2ggbW9yZSBjb21tb24gd2l0aCB0aGUgdXNlIG9mIHVuZnJhY3Rpb25hdGVkIGhlcGFyaW4gY29tcGFyZWQgdG8gbG93IG1vbGVjdWxhciB3ZWlnaHQgaGVwYXJpbi4=

[Qq]

Enoxaparin has been shown to cause a statistically significant reduction in death and recurrent myocardial infarction when used in the acute treatment of myocardial infarction as compared with unfractionated heparin (ESSENCE, TIMM 1 trials).

[q] Upon clinical suspicion of HIT, the most important initial step in treatment is to stop ……. and give ……?

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IHN0b3AgYWxsIGZvcm1zIG9mIGhlcGFyaW4sIERpcmVjdCB0aHJvbWJpbiBpbmhpYml0b3JzIChoaXJ1ZGluLCBsZXBpcnVkaW4gYW5kIGFyZ2F0cm9iYW4sIGRhYmlnYXRyYW4pIGRvIG5vdCByZXF1aXJlIGFudGl0aHJvbWJpbi1sbGwgZm9yIHRoZWlyIGFjdGlvbiBhbmQgYXJlIGRydWdzIG9mIGNob2ljZSBpbiB0aGUgdHJlYXRtZW50IG9mIEhJVC4=[Qq]

[q] The mainstay of DVT treatment in pregnancy is ….?

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IGhlcGFyaW4gKENvdW1hZGluIGlzIG5vdCB1c2VkIGJlY2F1c2UgaXQgaXMgdGVyYXRvZ2VuaWMpLg==[Qq]

[q] …… directly or indirectly aid conversion of plasminogen to plasmin, which cleaves thrombin and fibrin clots. ↑ PT, ↑ PTT, no change in platelet count.

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IFRocm9tYm9seXRpY3MgKEFsdGVwbGFzZSAodFBBKSwgcmV0ZXBsYXNlIChyUEEpLCB0ZW5lY3RlcGxhc2UgKFROSy10UEEpLCBzdHJlcHRva2luYXNlKS4=[Qq]

[q] We treat Thrombolytics toxicity with ……?

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IGFtaW5vY2Fwcm9pYyBhY2lkIGFuZCB0cmFuZXhlbWljIGFjaWQgKGFudGktZmlicmlub2x5dGljcyku

Cg==

Cg==[Qq]

[q] ….. inhibit platelet aggregation by blocking P2Y12 receptors → Prevent expression of glycoproteins IIb/IIIa on platelet surface?

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IEFEUCByZWNlcHRvciBpbmhpYml0b3JzLiBDbG9waWRvZ3JlbCwgcHJhc3VncmVsLCB0aWNhZ3JlbG9yIChyZXZlcnNpYmxlKSwgdGljbG9waWRpbmUgKGlycmV2ZXJzaWJsZSku[Qq]

[q] In patients with an aspirin allergy, aspirin can cause bronchoconstriction with shortness of breath and wheezing. In such patients, the best alternative antiplatelet agent is ……?

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IENsb3BpZG9ncmVsLg==[Qq]

[q] – Ticlopidine is rarely used due to the occurrence of serious side effects. ……. is seen in about 1 percent of patients on ticlopidine and typically presents with fever and mouth ulcers

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IE5ldXRyb3BlbmlhLiBUaG91Z2ggdGhpcyBpcyByYXJlLCBpdCBpcyBhIHNlcmlvdXMgY29tcGxpY2F0aW9uIGFuZCBjb21wbGV0ZSBibG9vZCBjb3VudCBzaG91bGQgYmUgbW9uaXRvcmVkIGJpd2Vla2x5IGZvciB0aGUgZmlyc3QgdGhyZWUgbW9udGhzLg==[Qq]

[q] ……. bind to the glycoprotein receptor IIb/IIIa (fibrinogen receptor) on activated platelets, preventing aggregation.

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IEdseWNvcHJvdGVpbiBJSWIvSUlJYSBpbmhpYml0b3JzIChBYmNpeGltYWIsIGVwdGlmaWJhdGlkZSwgdGlyb2ZpYmFuKS4=[Qq]

[q] …….. is a Phosphodiesterase III inhibitor → ↑ cAMP in platelets → resulting in inhibition of platelet aggregation; vasodilators.

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IENpbG9zdGF6b2wsIGRpcHlyaWRhbW9sZS4=[Qq]

[q] ……. is a folic acid analog that competitively inhibits dihydrofolate reductase –> ↓ dTMP –> ↓ DNA synthesis.

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IE1ldGhvdHJleGF0ZS4=

Cg==

Cg==[Qq]

[q] What is the chemotherapeutic drug that cause these side effects?

– Myelosuppression, which is reversible with leucovorin “rescue”.

– Toxic to 2L (Lung, Liver) → Pulmonary fibrosis, Hepatotoxicity.

– Mucositis (mouth ulcers).

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IE1ldGhvdHJleGF0ZS4=[Qq]

[q] Pyrimidine analog bioactivated to 5-FdUMP, which covalently complexes folic acid. This complex inhibits thymidylate synthase –> ↓ dTMP –> ↓ DNA synthesis.

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IEZsdW9yb3VyYWNpbC4=

Cg==

Cg==[Qq]

[q] What is the chemotherapeutic drug that cause these side effects?

Myelosuppression, worsened with the addition of leucovorin (folinic acid).

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IDUtZmx1b3JvdXJhY2lsLg==[Qq]

[q] …… is a Purine (thiol) analogs —> ↓ de novo purine synthesis. Activated by HGPRT.

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IEF6YXRoaW9wcmluZSwgNi1tZXJjYXB0b3B1cmluZS4=

Cg==

Cg==[Qq]

[q] …….. is the drug of choice for hairy cell leukemia.

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IENsYWRyaWJpbmUu[Qq]

[q] …… is an alkylating agent that cause pulmonary fibrosis as a side effect.

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IFB1bG1vbmFyeSBmaWJyb3Npcy4=

Cg==

Cg==[Qq]

[q] …… is an alkylating agent that cause hemorrhagic cystitis as a side effect that can prevented with …… or …….?

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IEN5Y2xvcGhvc3BoYW1pZGUsIHByZXZlbnRlZCB3aXRoIG1lc25hICh0aGlvbCBncm91cCBvZiBtZXNuYSBiaW5kcyB0b3hpYyBtZXRhYm9saXRlcykgb3IgTi1hY2V0eWxjeXN0ZWluZS4=

Cg==

Cg==[Qq]

[q] …… is an alkylating agent that can Cross blood-brain barrier –>  CNS + used in Brain tumors (including glioblastoma multiforme) + and cause CNS toxicity (convulsions, dizziness, ataxia) as a side effect?

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IE5pdHJvc291cmVhcyAoQ2FybXVzdGluZSwgbG9tdXN0aW5lLCBzZW11c3RpbmUsIHN0cmVwdG96b2Npbiku[Qq]

[q] ……. is a chemotherapeutic drug that induces free radical formation —> breaks in DNA strands and cause pulmonary fibrosis as a side effect.

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IEJsZW9teWNpbi4=

Cg==

Cg==[Qq]

[q] …….. is a chemotherapeutic drug that causes Cardiotoxicity (dilated cardiomyopathy) as a side effect.

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IERveG9ydWJpY2luLg==

Cg==

Cg==[Qq]

[q] The most effective method of preventing doxorubicin cardiomyopathy is ……..?

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IERleHJhem94YW5lLiBJdCBpcyBhbiBpcm9uLWNoZWxhdGluZyBhZ2VudCB0aGF0IGRlY3JlYXNlcyBmb3JtYXRpb24gb2Ygb3h5Z2VuIGZyZWUgcmFkaWNhbHMgYnkgZG94b3J1YmljaW4gYW5kIG90aGVyIGFudGhyYWN5Y2xpbmVzLg==[Qq]

[q] ……. is a microtubule inhibitors that bind β-tubulin and inhibit its polymerization into microtubules —> prevent mitotic spindle formation (M-phase arrest)?

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IFZpbmNyaXN0aW5lLCB2aW5ibGFzdGluZS4=[Qq]

[q] …….. is a vinca alkaloid that causes neurotoxicity (areflexia, peripheral neuritis).

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IFZpbmNyaXN0aW5lLg==

Cg==

Cg==[Qq]

[q] ….. is a microtubule inhibitors that hyperstabilize polymerized microtubules in M phase so that mitotic spindle cannot break down (anaphase cannot occur).

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IFBhY2xpdGF4ZWwu[Qq]

[q] …… is a platinum-containing compound that cause – Nephrotoxicity as a side effect that can prevented with …… and …….?

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IENpc3BsYXRpbi4gUHJldmVudCBuZXBocm90b3hpY2l0eSB3aXRoIGFtaWZvc3RpbmUgKGZyZWUgcmFkaWNhbCBzY2F2ZW5nZXIpIGFuZCBjaGxvcmlkZSAoc2FsaW5lKSBkaXVyZXNpcy4=

Cg==

Cg==[Qq]

[q] ……. is a chemotherapeutic drug that inhibits topoisomerase II.

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IEV0b3Bvc2lkZS4=[Qq]

[q] ……. is a chemotherapeutic drug that – Inhibits ribonucleotide reductase →↓ DNA Synthesis (S-phase specific) and (↑ HbF).

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IEh5ZHJveHl1cmVhLg==[Qq]

[q] …… is a Monoclonal antibody against VEGF.

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IEJlVmFjaXp1bWFiLiAoQmVWYWNpenVtYWIgaW5oaWJpdHMgQmxvb2QgVmVzc2VsKS4=[Qq]

[q] ……. is a monoclonal antibody against EGFR.

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IENldHV4aW1hYi4=[Qq]

[q] ……. is a EGFR tyrosine kinase inhibitor.

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IEVybG90aW5pYi4=[Qq]

[q] ……. is a tyrosine kinase inhibitor of BCR-ABL (Philadelphia chromosome fusion gene in CML) and c-kit (common in GI stromal tumors).

[c]IFNob3fCoCBtZS B0aGUgYW5zd2Vy[Qq]

[f]IEltYXRpbmliLg==[Qq]

[q]  …….. is a monoclonal antibody against CD20, which is found on most B-cell neoplasms.

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IFJpdHV4aW1hYi4=[Qq]

[q] ….. is a small molecule inhibitor of BRAF oncogene ⊕ melanoma.

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IFZlbXVyYWZlbmliLg==[Qq]

[x][restart]

[/qwiz]