Beruflich Dokumente
Kultur Dokumente
Choose the one best answer. The answers are following the exam.
1. A 21 year old man with diffuse large B-cell non-Hodgkin’s lymphoma had Cytoxan,
Adriamycin, Vincristine and Prednisone (CHOP) chemotherapy 7 days ago. Now he has
fever, light-headedness, rigors, weakness, and decreased urine output. On work-up what
else could you find?
A- IV normal saline
B- Empiric IV antibiotics
C- Steroids such as prednisone
D- A and B
E- All of the above.
3. A 48 year old man who had squamous cell carcinoma of the lung one year ago treated
with surgery now presents to you with shortness of breath, facial swelling, headaches, and
vomiting. A chest x-ray finding that explains his symptoms would most likely show-
4. Potential problems this patient could have that would need your immediate care
include-
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5. The most sensitive way to detect asymptomatic breast cancer is-
A- Monthly self-exam
B- Yearly mammogram
C- Yearly exam by an MD that lasts longer than 5 minutes
D- Blind bilateral breast biopsies
6. A 30 year old woman is found to have an enlarged right ovary on her routine pelvic
exam. Your work-up would include-
A- CA125
B- vaginal ultrasound
C- physical exam to assess GI obstruction
D- Alpha-feto protein and b-human chorionic gonadotropin levels.
E- All of the above
8. You arranged for a lumpectomy and axillary node dissection for a pre-menopausal
woman with a 2 cm ductal carcinoma of the breast. Which of the following is true?
9. A 48 year old chain smoking day trader comes into your office for a worsening bloody
cough. He has been on albuterol inhaler for bronchitis for 4 years. Prior to day trading he
worked for the NRC cleaning up radioactive waste sites. Prior to that he worked as an
asbestos remover in older medical school buildings. Which of the following increases his
risk of lung cancer-
A- Smoking
B- family history of lung cancer
C- Sclerodema
D- A, B, and C
E- A and C
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10. A chest x-ray finds a left upper lobe 3 cm mass. A bronchoscopic biopsy shows small
cell carcinoma. The patient develops several bizarre problems. You know that several of
these are paraneoplastic syndromes due to the tumor, but which ones?
11. A 56 year old Viet Nam veteran with a long smoking history presents with a 3 cm lung
mass. The mass was resected, but 3 surrounding lymph nodes were positive for
adenocarcinoma. Work-up found no distant metastasis. What stage is the patient?
A- I
B- II
C- III
D- IV
E- V
12. You are planning this patient’s future care. The best chance at cure for this patient is
from-
A- Adjuvant chemotherapy.
B- Interferon- alpha therapy.
C- Surgical resection of the mass and surrounding lymph nodes.
D- Local intensive radiation therapy.
13. A 14 year old African-American girl comes to your clinic with a 6 month history of
weakness, light-headedness, and pallor. He hemoglobin (Hb) is low at 7.2 mg/dl, and her
mean corpuscalar volume (MCV) is high at 101. Her reticulocyte count is high at 6.5%.
You know that she could have-
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14. You find that a 78 year old Caucasian woman in a nursing home has vitamin B12
deficiency anemia. Which could you also find?
15. A 17 year old Italian high school exchange student comes into to your clinic with
jaundice, splenomegaly, and weakness. On taking a careful history you find that his only
medications are Trimethoprin-Sulfamethoxazole for a Strep pharyngitis. An initial Hb is low
at 5.4. Before the reticulocyte count comes back, what further work-up to pin down your
diagnosis do you order?
16. A 51 year old African-American attorney long time patient of yours has a history of
sickle cell anemia. He presents today with abdominal pain, shortness of breath, weakness,
and fever beginning 3 days ago when a stressful court case started. He put off coming to
you until he was doubled over with pain. This is his 5th such episode in the last 3 months.
Your thoughts are-
17. On a lonely snowing night a patient comes in to see you in the Wishard ER. She is a
39 year old homemaker finally convinced by her husband to seek medical care. She has a
vague 6 month history of early satiety, abdominal fullness, and mild nausea. Just before
you are about to dismiss her from the ER, you take a few more minutes on the abdominal
exam and find an enlarged spleen. Then you walk to the lab to see the peripheral blood
smear. Her total leukocyte count is 27,900/ul, and she has promyelocytes, myelocytes,
and bands prominent on the smear. You obtain a marrow aspirate with cytogenetics. A
week later you are told by cytogenetics that she has a t(9;22).
A- A PML-RAR fusion oncogene stimulates her marrow cells to divide without stopping
B- The only cure for this type of leukemia is an allogeneic bone marrow transplant
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C- This type of leukemia is often inherited
D- These patients often present with DIC.
E- All of the above
18. An 8 year old girl comes to your clinic with fever, weakness, petechiae, and
splenomegaly. She has a platelet count that is low at 8,000/ul, a Hb that is low at 7.4, and
a total leukocyte count that is high at 36,000/ul. A marrow aspirate could find-
19. A 28 year old Down’s patient works in a machine shop cleaning grease off lathes with
organic solvents. His boss calls him into the office for working slower and slower. In the
office the employer notices that the patient has bruises and red spots. Just then the
patient’s right pupil dilates and he has a seizure. At first the boss thinks he is faking to get
off work, but unable to arouse the patient, he becomes anxious, and calls you. Upon
hearing the situation, you immediately hypothesize that-
20. Treatment that you immediately arrange for this patient include-
A- Platelet transfusions
B- Ara-C and daunorubicin
C- 3 year maintenance chemotherapy with thiogaunine and mercaptopurine
D- local radiation
E- A and B
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21. A 52 year old male auto mechanic presents to you with urinary frequency, difficulty
starting his stream, and dribbling after urination. Upon exam you find that he has point
tenderness along his thoracic spine and nodules on his prostate during rectal exam. He
has a prostate specific antigen (PSA) that is high at 29. You ask for-
A- Acinar adenocarcinoma
B- A Gleason’s score that is less than 7 indicating aggressive disease
C- Lymphomatous involvement of the prostate
D- Ductal squamous cell carcinoma
E- All of the above
23. Multiple bone metastasis are found in this patient indicating to you that-
25. A 49 year old male comes to your clinic with back and rib pain, decreased urine
output, roaring in his ears, and a headache. Laboratory exam finds a creatinine that is high
at 6.2, Hb low at 8.9, and a total protein that is high at 11.8. Spine and rib x-rays show
multiple punched out lesions in his bones. You ask for-
A- Quanitative immunoglobulins
B- Marrow aspirate
C- Calcium level
D- Skeletal X-ray survey
E- All of the above
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26. Treatment that you plan for this patient would be-
A- Vincristine/Adriamycin/Dexamethasone (VAD)
B- Splenectomy and Prednisone
C- Autologous stem cell transplant
D- Ara-C and Daunorubicin
E- Both A and C
27. A 61 year old male living alone presents to you with a 11 cm right neck mass. He has
had this for several years, and it is slowly enlarging. On history the patient describes
weight loss, fever, and night sweats. On exam you find hepatomegaly and splenomegaly
and adenopathy in the axilla and inguinal (groin) region. Biopsy reveals low grade non-
Hodgkin’s lymphoma. You know that-
28. A 19 year old male college student complains to you that his skin itches when he has
a drink of alcohol. On taking a careful history and physical you also notice that he has
enlarged cervical and inguinal nodes . A chest x-ray finds a 5 cm mediastinal mass. A
mediastinoscopy and biopsy find Reed-Sternberg cells surrounded by many lymphocytes
on microscopic analysis. You know that-
29. A 48 year old man presents to your office with a Hb low at 8.1 and an MCV low at 62.
You find that his serum ferritin is low and his serum iron is low while his iron binding
capacity is high. You next Guiac test his stool. It is positive. From these lab tests you ask
the patient-
30. This patient develops vomiting and severe abdominal pain. He develops a fever and
leukocytosis (high white blood cell count). What do you do next?
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A- Decrease his gastrointestinal pressure by placing a rectal tube.
B- Discontinue his fluids and antibiotics
C- Call a surgeon to relieve his bowel obstruction
D- Perform a rigid sigmoidoscopy
E- All of the above
31. The patient is found to have a colonic mass. Resection of this mass takes place.
Pathology finds that the margins are clear, but that there are 3 subserosal lymph nodes
positive for tumor. Which is true?
32. In carcinoma located primarily in the rectum, which is true about treatment?
33. A 12 year old boy is brought to the ER by his friend’s parents where he was at a
sleep-over while his parents were out of town. He was injured in a pillow fight. He has a
warm, tender and enlarging swollen area around her right knee. He also has a warm,
tender knot in her right bicep. He says that he has hemophilia A.
A- The swollen knee is called a pseudotumor, and may lead to total knee replacement in
this type of hemophilia.
B- Prednisone may decrease the hemolysis
C- Factor VIII intravenously will decrease the bleeding.
D- Coumadin would help stop the bleeding into the joint.
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34. You are called to consult on a 48 year old man prior to an elective cholecystectomy
the next day. He has a history of bleeding the day after a wisdom toot extraction. His
bleeding time is long at 19 minutes, but his Von Willibrand’s antigen and activity are
normal. You check the peripheral blood smear. It shows giant hypogranular platelets.
35. A 28 year old woman presents to your clinic with a swollen, red, painful left leg.
Venogram finds a femoral vein clot. You start her on heparin. She has a history of 3
miscarriages. She had a transient ischemic attack her physician said was secondary to
oral contraceptives. You are not so sure. You find that her prothrombin (PT) time is normal,
her partial thromboplastin (PTT) time is elevated, and a bleeding time is normal. Which of
the following tests do you do to help assess this patient?
36. Her PTT did not correct with normal plasma added. You tell the patient with her
husband present that she has a positive VDRL syphilis test. This causes an angry marital
argument before you have the chance to break in and explain. A year later, after treatment,
when she successfully delivers her first born child, she sends you a 1000 shares of her
husband’s software start-up as a small token of her esteem. When that develops into a
small fortune, you endow the Robert A. Hromas, Chair in Hematology because you knew
that she had-
A- ATIII deficiency
B- Lupus anti-coagulant
C- VWF deficiency
D- Factor V Leiden
E- Protein S deficiency
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38. A 29 year old woman comes to you to check a mole on her back. She is worried that
her tanning bed use prior to a trip to Cancun has given her melanoma. Which of the
following characteristics of the mole worry you the most?
39. While you recommend removal, the patient would rather not worry about the problem,
so she does not return to you. One year later, she is brought in by her room-mate because
the mole has now ulcerated. Which is true?
40. Which tumors are immunolgically responsive and can be treated with immune
stimulators such as Interferon-α?
41. A 65 year pathologist who has been teaching you marrow histology tells you that he
has just had painless hematuria. A cystogram shows a filling defect in the bladder. Which
is true?
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42. A 28 year old pediatric nurse comes to see you for cervical adenopathy that has
persisted for several months despite multiple antibiotic courses. Her node biopsy shows
Reed-Sternberg cells. She has no other adenopathy or marrow involvement. Which is
true?
43. A 43 year old woman presents with pelvic pain and what she describes as “irregular
periods.” On pelvic exam there is a fungating mass extending from her cervix. Which is
true?
44. An impoverished 36 year old woman with 6 children comes to your free clinic because
of her insatiable desire to eat clay. Although pale and light-headed on standing, she has no
adenopathy, or hepatosplenomegaly. You are about to swear to never again volunteer in
free clinics because the problems are too difficult when you notice that her fingernails are
flat and scaling. Which is true?
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Answers
1- E 23- E
2- D 24- C
3- C 25- E
4- D 26- E
5- B 27- D
6- E 28- B
7- A 29- E
8- C 30- C
9- E 31- C
10- E 32- A
11- B 33- C
12- C 34- D
13- E 35- E
14- C 36- B
15- E 37- E
16- E 38- C
17- B 39- B
18- B 40- E
19- C 41- A
20- E 42- D
21- C 43- A
22- A 44- A
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