Medicine 5th LE Feedback 2013A

Medicine 5th LE Feedback (Respi & Hema) 1. what is a sign of advanced tissue iron deficiency? a. pallor b. cheilosis c. reduced exercise capacity d. chest pain 2. What is true regarding myelodysplastic syndrome(MDS)? a. Fever and weight loss point to a myelodysplastic syndrome b. The total WBC count is high except in chronic myelodysplastic leukemia c. MDS is caused by environmental exposures such as radiation and benzene d. The therapy of MDS is generally unsatisfactory 3. What feature distinguishes AML from ALL? a. Absence of clefting characteristic of monocytoid cells b. Uniformly fine or lacelike nuclear chromatin c. Positive myeloperoxidase stain d. Cytogenetic and molecular mechanisms 4. What is the common manifestation of paroxysmal nocturnal hemoglobinuria? a. Venous thrombosis b. Extravascular hemolysis c. Thrombocytosis d. Thrombocytopenia 5. What is the most feared haemophilia? a. Hematuria b. Oropharyngeal bleeding c. Hemarthrosis d. GI bleeding

complication

of

6. What is the most convenient laboratory test to estimate iron stores? a. Serum iron b. Serum ferritin c. Total iron binding capacity d. Marrow iron stores 7. What is the usual pattern of anemia of chronic disease? a. Hypochromic, microcytic b. Normochromic, hypochromic c. Normochromic, normochromic d. Microcytic, normochromic 8. What is the cytogenetic hallmark of CML? a. P53 mutation b. Monosomy 7 c. Trisomy 8 d. t(9,22) 9. What is the most common preceding infection associated with aplastic anemia? a. Ebstein Barr virus b. Hepatitis infection c. Parvovirus B infection d. CMV virus

10. Which are true of hemoglobins during embryonic, fetal and adult life? a. The major adult haemoglobin is Hba which is a structure of 2 alpha and 2 gamma b. According to the Bohr effect, haemoglobin has a higher oxygen affinity at low pH facilitating delivery to tissues c. Fetuses and newborns require alpha globin but not beta globin for normal gestation d. All of the above 11. Which is true of CML? a. There is clonal expansion of stem cells that contain a reciprocal translocation between chromosomes 8 and 14 leading to the formation of the BCR/ABL fusion gene b. Disease acceleration is defined as blood or bone marrow blasts >20% c. Laboratory evaluation reveals elevated WBC associated with high leukocyte alkaline phosphatase d. Early satiety with left upper quadrant pain are almost always appreciated in patients with splenomegaly 12. regarding the clinical course of patients with AML a. patients most often present with nonspecific symptoms that begin gradually or abruptly b. significant intracranial, gastrointestinal and pulmonary hemorrhage occur most often in myelomonocytic leukemia c. usually, patients may present with a mass lesion, a tumor of leukemic cells called a granulocytic sarcoma or chloroma d. functional abnormalities in the WBC maybe manifested as abnormal lobulation and deficient granulation. 13. multiple myeloma represents a malignant proliferation of plasma cells derived from a single clone. Which of the following is true? a. bone pain is usually often worse at night and usually involves the back and the ribs b. pallor is the most common symptom of patients, affecting nearly 70% c. bony lesions are osteoblastic in nature; therefore, radioisotope bone scanning is less useful than plain radiography in diagnosis. d. renal involvement is usually secondary to hypercalcemia. 14. true regarding adverse reactions to blood transfusion: a. allergic reactions occur when the recipient has preformed antibodies that lyse donor erythrocytes b. a delayed hemolytic transfusion reaction occurs 1224 hours post transfusion c. febrile nonhemolytic transfusion reactions are the most common frequent reactions with blood transfusion d. platelet concentrates are acellular preparations and do not transmit intracellular infections 15. hemophilia maybe a deficiency in Factor VIII or IX. Which of the following is true?

a. factor IX is synthesized in the liver while Factor VII is not. b. hemarthosis is extremely painful but is not associated with joint destruction once bleeding stops c. patients may receive aspirin to relieve pain. d. inhibitors of factor VIII maybe formed with repeated transfusions 16. the most common structural hemoglobinopathy a. hemoglobin SC b. sickle cell disease c. beta thalassemia d. alpha thalassemia

18. what is true regarding disseminated intravascular coagulation? a. DIC is most frequently associated with obstetric catastrophes and bacterial sepsis b. the most sensitive test is the determination of platelet count c. heparin therapy should be started once DIC is recognized d. blood transfusions should be avoided 19. true of immune thrombocytic purpura: a. acute ITP is common in adults while chronic type is more commonly seen in children b. patients with chronic ITP who fail to maintain a normal platelet count after a course of prednisone are eligible for elective splenectomy c. patients who present with acute ITP should be started immediately with corticosteroids d. patients with ITP usually show a good incremental response with platelet concentrate transfusion 20. the most commonly encountered anemia in the congenital nonspherocytic hemolytic anemias is caused by a deficiency of: a. pyruvate kinase b. metheglobin reductase c. G6PD d. glucose phosphate isomerase 21. in moderate exercise, the O2-dissociation curve is shifted to the: a. right b. left c. mid-position d. variable, dependent on exercise level 22. response to oxygen is poor if hypoxemia is due to: a. hypoventilation b. V/Q mismatch c. shunt d. diffusion defect pulmonary

24. a post-bronchodilator improvement of this spirometric parameter indicates a reversible obstructive airways defect: a. FVC b. FEV1/FVC c. FEV1 D. FEF 25-75% 25. the reduction of this parameter indicated the presence of restrictive lung defect: a. FVC b. FEV1 c. FEV1/FVC ratio d. FEF 25-75%

17. smudge cells are commonly seen in a. ALL b. CLL c. AML d. CML

23. the low-permeability exemplified by:

a. ARDS b. LV failure c. pneumonia d. toxic gas inhalation

edema

is

26. on chest xray, an obscured costophrenic sulcus with a meniscus sign is suggestive of: a. consolidation b. pleural fluid c. atelectasis d. pneumothorax 27. on chest xray, a homogenous opacification on the right apical area with displacement of the minor fissure upwards is indicative of: a. pleural fluid b. consolidation c. pneumothorax d. atelectasis 28. to reduce V/Q mismatch and lessen hypoxemia, a patient with consolidated left lung from pneumonia is best lying in which position? a. supine b. right lat decubitus c. prone d. left lat decubitus 29. a 65 year old male, 20pack years current smoker complains of progressive difficulty of breathing with occasional dry cough. On PE, breath sounds were distant and there were persistent bilateral expiratory wheeze. The chest xray showed hyperaerated lung fields. The PFT show FEV1/FVC post-BD = 60%; FEV1 baseline 1.2L, post-BD 1.5L. the most likely diagnosis is: a. asthma b. simple bronchitis c. emphysema d. chronic bronchitis for questions 30-32, refer to the following case: a 60 year old ex-heavy smoker is seen at the ER because of progressive worsening over 3 weeks of chronic cough associated with cough and thick muco-purulent secretions. He was drowsy with RR=26 BP=150/90 and widespread coarse and fine crackles with persistent expiratory wheezing. The ABGs at room air showed pH=7.32, pO2=40, pCO2=65, HCO3=30

30. the ABGs is best described as hypoxemia with: a. acute respiratory acidosis b. acute metabolic acidosis c. chronic respiratory acidosis d. chronic metabolic acidosis 31. he was given O2 at 1L/min and the ABGs showed pH=7.12, pO2=75, pCO2=75, HCO3=30. The mechanism responsible for the hypoxemia is: a. hypoventilation plus V/Q mismatch b. hypoventilation plus diffusion defect c. hypoventilation plus shunt d. hypoventilation alone 32. the worsening hypoxemia is due to depression of the: a. central respiratory drive b. peripheral hypoxic drive c. apneustic center d. lateral dorsal center 33. a 28 year old female with a 10pack year smoking history complained of sudden onset of difficulty of breathing after coming in from a flight from the USA. She was tachypneic at 26bpm but the rest of examination is unremarkable. The chest xray is normal. The best test to establish the diagnosis is: a. cardiac enzymes b. ECG c. CT angiography d. spirometry 34. a 70 year old male, heavy smoker consulted because of progressive difficulty of breathing. He has had productive cough for the most days of the past 3 years and recently had increase volume of mucopurulent sputum associated with moderate grade fever. He has widespread wheezing and coarse crackles. The chest xray showed prominent basal bronchovascular markings and a homogenous density with air bronchogram obscuring the left hemi-diaphragm. He most likely developed: a. pneumonia b. lung cancer c. pulmonary hemorrhage d. pulmonary edema 35. a 60 year old female 15 pack years smoker, with uncontrolled hypertension is seen at the ER because of severe difficulty of breathing that woke her up from sleep, associated with coughing of pinking frothy sputum. BP is 180/110, neck veins distended, widespread fine crackles from mid to base of thorax and occasional wheezing. Chest xray showed caardiomegaly and redistribution of blood flow to the upper lung zones. She most likely is suffering from: a. chronic bronchitis b. idiopathic pulmonary fibrosis c. congestive failure d. bronchiectasis 36. a 50 year old male farmer 20 pack year smoker, complains of progressive difficulty of breathing of 2 months duration, later associated with occasional dry

cough. He had no fever, RR=28bpm, there is a lag of the left hemithorax, absent breath sounds, dullness on the same side. The PMI is displaced to the right. The chest xray showed almost complete opacification of the left hemithorax and the mediastinum is displaced into the right side. He most likely has a left-sided massive: a. consolidation b. atelectasis c. effusion d. tumor 37. a 60 year old male laborer, 30 pack year smoker, complains of progressive difficulty of breathing of 4 months duration, later associated with occasional blood-streaked sputum and 10 lbs weight loss. He has no fever. RR is 26 bpm, there is a lag of the left hemithorax, no breath sounds and dullness on the same side. PMI is normally located. Chest xray showed almost complete opacification of the left hemi-thorax but the mediastinum is midline. He most likely has a left-sided: a. effusion b. atelectasis d. tumor d. AOTA 38. a 60 year old male 30 pack year smoker complains of progressive difficulty of breathing over the past 2 years, lately associated with occasional dry cough. His chest is hyperresonant with distant breath sounds. Chest xray showed bilateral hyperlucent lung fields, flattened diaphragm and a narrowed vertical heart shadow. He most likely has: a. emphysema b. chronic bronchitis c. asthma d. pneumothorax 39. a 68 year old COPD male complains of progressive increase in cough and phlegm production without fever for the past 3 months. There are occasional bilateral wheezing and decreased breath sounds and dullness over the right lower lung. Chest xray showed a homogenous density with no air-bronchogram on the right lower lung field not seen in a film 2 years earlier. He most likely has developed: a. pneumonia b. PTB c. lung cancer d. pleural effusion 40. a 50 year old smoker, jeepney driver consulted at the OPD complaining of one month history of cough with scanty to moderate phlegm associated with poor appetite and 2 lbs weight loss. His temperature was 37.8C, RR=20. There were fine crackles over both apices. The best test to establish diagnosis is: a. chest xray b. sputum examination c. spirometry d. chest CT scan. 41. a 56 year old previously healthy surrent smoker developed community-acquired pneumonia. She was assessed to have a low risk for complicated course. Antibiotic therapy should include coverage for:

a. H. influenza b. S. aureus c. L. pneumophilia d. drug-resistant S. pneumonia 42. which of the following is a risk factor for pneumonia due to Enterobacteriaceae? a. IV drug use b. preceding viral infection c. recent luxury ship cruise d. presence of co-morbidities 43. physical findings of decreased breath sounds with dullness on percussion in a patient suspected of having pneumonia suggests the presence of a. bronchospasm b. pleural effusion c. pneumatocoeles d. consolidation with open airway 44. a 70 year old male consults because of fever. He is oriented and alert with temperature of 39C, HR=93, RR=20, BP=104/70. Chest xray shows hazy density on the right lower lung. Serum creatinine is normal. The CURB65 score is a. 1 b. 2 c. 3 d. 4 45. a 40 year old current smoker consulted because of 4 days of cough with yellow phlegm, dyspnea and low grade fever. PE revealed bibasal crackles. CBC showed mild leukocytosis and chest xray showed clear lung fields. The diagnosis is: a. pneumonia b. lung abscess c. bronchial infection d. pulmonary tuberculosis

49. a 56 year old female was admitted at the general ward (non-ICU) because of CAP. She has no risk factors for anaerobic infection. Which of the following combination therapy is appropriate? a. coamoxiclav and cefuroxime b. clindamycin and levofloxacin c. ceftriaxine and azithromycin d. moxifloxacin and clarithromycin 50. which of the following is a risk factor for multidrug resistant pathogens in hospital acquired pneumonia (HAP)? a. comatose state b. immunosuppressive therapy c. preceding viral upper respiratory infection d. previous history of pneumonia 6 months ago 51. cancer chemotherapy increases the risk of developing pulmonary tuberculosis by interfering with a. innate immunity b. humoral immunity c. cell mediated immunity d. delayed tissue hypersensitivity 52. in patients with adequate nonimmunologic defenses, exposure to suspended particles containing TB bacilli would most likely result in a. no infection b. infection with late progression c. infection with early progression d. infection with continued containment throughout the person’s lifetime 53. engulfment of the TB bacilli by a nonactivated macrophage results in a. killing the bacilli b. containment of the bacilli c. activation of that macrophage d. multiplication of the bacilli inside the macrophage

46. in the treatment of CAP, which of the following is the strongest indication for ICU admission? a. confusion b. age 70 years or over c. need for mechanical ventilation d. systolic BP