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    Prof. of Hepatology & Gastroenterology, Cairo University.

    Consultant of Hepatology,Gastroenterology and Endoscopy

    Management Positions: •

    Chief of Hepatology unit El Manial University Hospital (1994-1998).

    • Chief of Gastroentero ICU in Cairo university hospital (1997-2000)

    • President of the board of AlfaScope GI Specialized center (2004-2014).

    • Head of Endoscopy Unit in Cairo University Hospitals (2005-2010).       

     

     .Read more

     

    استاذ الكبد و الجهاز الهضمى بكلية الطب جامعة القاهرة

    استشارى الكبد و الجهاز الهضمى و المناظير

    دكتوراه امراض الكبد و الجهاز الهضمى من كلية الطب جامعة القاهرة

    الرئيس السابق لقسم الامراض الباطنية بكلية الطب جامعة ٦ اكتوبر

    الرئيس السابق لوحدة مناظير الجهاز الهضمى و مركز الكبد و الرعاية المركزة بقصر العينى

     

    إقرأ المزيد

     

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Monday, Nov 20th

Last update10:09:06 AM

        

Blood

Blood

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Blood Diseases

 

Enumerate:

1. Causes of microcytic hypochromic anemia.

2. Causes of normocytic normochromic anemia.

3. Causes of iron deficiency anemia.

4. Causes of megaloblastic anemia.

5. Causes of aplastic anemia.

6. Causes of pancytopenia.

7. Causes of agranulocytosis (granulocytopenia, neutropenia).

8. Causes of sore throat.

9. Causes of neutrophil leucocytosis.

10. Causes of lymphocytosis.

11. Causes of eosinophilia.

12. Causes of purpura.

13. Causes of thrombocytopenic purpura.

14. Causes of non-thrombocytopenic purpura.

15. Causes of hypoprothrombinemia.

16. Causes of vitamin K deficiency.

17. Causes of leucocytosis.

18. Causes of bone marrow failure.

19. Causes of Folate deficiency.

20. Causes of Autoimmune hemolytic anemia.

21. Causes of Polymorphneuclear leucocytosis.

22. Causes of Thrombophilia.

23. Causes of Hereditary blood diseases.

24. 5 infections that can be transmitted by blood transfusion
Outline:

1. Clinical features of anemia.

2. Clinical features of iron deficiency anemia.

3. Investigations for iron deficiency anemia.

4. Treatment of iron deficiency anemia.

5. Clinical features of megaloblastic anemia.

6. Investigations for megaloblastic anemia.

7. Clinical features of aplastic anemia.

8. Investigations & treatment of aplastic anemia.

9. Clinical & hematological picture of acute leukemia.

10. Clinical & hematological picture of CML.

11. Investigations for bleeding tendency.

12. Clinical features & investigations of purpura.

13. Idiopathic thrombocytopenic purpura.                  

14. Diagnosis of hemophilia.

15. Factors predisposing to deep venous thrombosis.

16. Clinical picture & investigations of DVT.

17. Complications & fate of DVT.

18. Blood transfusion adverse effects.

19. Heparin therapy.

20. Oral anticoagulants.

21. Clinical picture of idiopathic thrombocytopenic purpura.

22. Clinical picture and treatment of pernicious anemia.

23. Diagnosis of a case of hemolytic anemia.

24. Etiology and treatment of acute purpura.

25. Diagnosis of acute leukemia.

26. Treatment of thrombocytopenic purpura, enumerate the complications of the drugs used.

27. Treatment of one disease causing purpura.

28. Causes, clinical picture & diagnosis, of malignant mediastinal lymphadenopathy.

29. Hematological findings (peripheral blood & BM), in the following:

          - Idiopathic thrombocytopenic purpura.

          - Pernicious anemia.

          - Thalassemia.

          - Acute leukemia.

30. Clinical picture, investigations & treatment of chronic lymphatic leukemia.

 

 

Case 1:

A male patient aged 18 years presented with bilateral cervical lymph nodes. One right inguinal node was palpable. Biopsy of this node revealed Reed Sternberg cells.

1. What is the diagnosis?

2. What further investigations you would ask for?

3. What are the lines of treatment of this condition?

 

Case 2:

A young adult presented with severe pallor. On examination he was ill, feverish, and had a palpable spleen with cervical small lymph nodes. His blood film showed a total leucocytic count of 30000 cell/cmm. Myeloblasts were abundant.

1. What is the likely diagnosis?

2. What other investigations you would do?

3. What are the lines of treatment in short?

 

Case 3:

A 33 year old man presents to his GP complaining of painless lump on the right side of the neck. This has been present for about 2 months, and seems to be enlarging. He has no recent throat infections. He has been feeling generally unwell and has lost about 5 kg in weight. The patient has also developed drenching night sweats. He has had no significant past medical history. He is an accountant, married with three children.

On examination, his temperature is 37.8 C. There is a smooth, firm, 3x4 cm palpable mass in the right supra-clavicular fossa. There are also lymph nodes 1-2 cm in diameter palpable in both axillae and inguinal areas. His oro-pharynx appears normal. His pulse rate is 100/m, regular and BP 110/65. Examination of his cardiovascular and respiratory systems is normal. On abdominal examination there is a mass palpable 3 cm below the left costal margin. The mass is dull to percussion and it is impossible to palpate its upper edge. Neurological examination is normal.

Laboratory investigations revealed hemoglobin 12.6 gm/dl, WBCs 12,200/cmm, ESR 74 mm in the first hour. Sodium, potassium, calcium, phosphate, albumin, SGOT, SGPT, and urine analysis all were normal.

1. What is the likely diagnosis?

2. Mention 4 other differential diagnosis.

3. How are you going to investigate this patient?

 


 

Case 4:

The following patients developed moderate microcytic hypochromic anemia.

- A 28 years old female with dysfunctional uterine bleeding of 2 y duration

- A 45 years old female patient with pharyngeal dysphagia of 6 m duration.

1. What would be the cause of anemia in each of these patients?

2. Describe the clinical picture that you should expect in one of them

3. Describe your plan of management in that particular patient.

 

Case 5:

A 26 year old multiparous female presented with pallor and easy fatiguability. Her Hb was 7 gm/dl, serum iron was 30 mcg/dl and serum ferritin was 40 ng/ml. Red blood cells were microcytic.

1. What is the likely diagnosis? And why?

2. Mention 2 possible causes for her anemia.

3. How would you treat her?

4. Mention 2 other causes of microcytic anemia.

 

Case 6:

A male patient aged 60 year presented with cervical lymphadenopathy. On examination he had a firm spleen and the liver was palpable 3 fingers below the costal margin in the mid clavicular line. Lymph nodes were detected in the groins and axillae. Blood picture showed normocytic anemia and a white cell count of 120000 composed mainly of lymphocytes.

1. What is the likely diagnosis?

2. What are the investigations you would order?

3. How would you treat such condition?

 

Case 7:

A 40 year-old mother of five, presents with generalized weakness and dizziness of several months duration, together with difficulty in swallowing of one month duration. She reports that her menstrual flow has increased in volume for the past year. Physical examination reveals:

- Pallor of the face.

- Abnormalities in the nails and mouth.

- Pulse: 120/m, regular and strong.

- BP: 140/60.

- Prominent pulsations in the neck.

- Accentuated S1.

- Systolic murmur, grade 2/6 over the heart base.

- Galloping heart.


 

Her CBC shows the following:

- RBCs: 3,500,000 /cmm.

- Hemoglobin: 9 gm/dl.

- MCH: 25 pg.

- MCHC: 30 gm/dl.

- MCD: 5µ.

- MCV: 75 fl.

- WBCs: 8,000/cmm.

- Platelets: 250,000/cmm.

1. What is your diagnosis?

2. Explain each of the physical signs?

3. What are the causes of such a blood picture? Discuss the etiology of the commonest cause.

4. How to investigate a patient with such a blood picture?

5. How would you treat this patient?

 

Case 8:

A 25 year-old man came to you complaining of non-tender swellings in the neck. He had fever of 38º C, for several days one week previously, but this subsided spontaneously. He had twice noted pain in the neck after drinking alcoholic beverages during the past month.

Physical examination showed that cervical lymph nodes were firm, movable, discrete, non-tender, and up to three centimeters in diameter. A few pea-sized axillary and inguinal lymph nodes were also palpated. The liver was 2 cm below the right costal margin. The spleen tip was palpable. There was a mild normocytic anemia with eosinophilia. Chest X-ray showed bilateral, enlarged hilar nodes.

1. Enumerate causes of lymphadenopathy.

2. What is the most likely diagnosis of this case?

3. What is the most diagnostic investigation in this case?

4. What are the pathological types & classification of this disease?

 

Case 9:

A 44 year-old woman was referred to the hospital because her physician, during routine examination, discovered marked splenomegaly. She is otherwise asymptomatic. A thorough physical examination shows no other abnormalities.

 

1. Enumerate causes of marked splenomegaly.

2. Outline diagnostic features of each cause.

 

CBC of the patient shows the following results:

- Hemoglobin 11.9 gm/dl.

- Red blood count: 3,950.000/cmm.

- MCH: 30 pg, MCHC: 34 gm/dl.

- MCD: 7 µ, MCV: 90 fl.

- White blood count 60,000

- 50% segmented.

- 14% band.

- 10% metamyelocytes.

- 9% myelocytes.

- 6% promyelocytes.

- 3% myeloblasts.

- 1% eosinophils.

- 1% lymphocytes.

- Platelets 250,000.

 

3. What is the type of anemia in this patient?

4. Enumerate other causes of this type of anemia.

5. What is the most likely diagnosis of this patient?

6. What is the investigation you need to confirm your diagnosis?

7. What is the chromosomal abnormality you expect to find here?

 

While under treatment, patient felt severely exhausted and he began to complain of repeated sore throats and bleedings from the gums and nose.

Examination revealed marked pallor and congestion of the throat.

 

8. What are the 2 most likely possibilities of this new event?

9. Enumerate causes of repeated sore throats.

 

CBC of the patient showed the following:

- RBCs: 2,000,000/cmm

- Hb: 6 gm/dl

- MCHC: 34 gm/dl.

- MCV: 90 fl.

-WBCs: 3,000/cmm:

          - Neutrophils: 50%.

          - Lymphocytes: 50%.

- Platelets: 60,000/cmm.

 

10. What is your diagnosis according to CBC?

11. What is the cause of this event?

12. What is the expected bone marrow picture at this point?

13. What type of lymphocytosis in this CBC?

14. What is the type of anemia in this CBC?

15. What is the expected reticulocytic count in this patient?

 

The condition was managed properly and the patient recovered. Two years later the patient came to the hospital in coma. Examination revealed coma (score 3 Glasgow scale) with lateralization, marked pallor of skin & mucus membranes and petechiae & ecchymosis in the skin.

CBC showed the following:

- RBCs: 2,000,000/cmm.

- Hb: 6 gm/dl.

- WBCs: 70,000/cmm:

          - 3% segmented.

          - 5% staff.

          - 8% metamyelocytes.

          - 7% myelocytes.

          - 7% promyelocytes.

          - 60% myeloblasts.

          - 10% lymphocytes.

- Platelets: 15,000.

 

16. What are the possible causes coma in this patient?

17. What is the significance of this CBC?

 

Case 10:

A 2 year-old male entered the hospital because of a six month history of repeated episodes of large scattered ecchymosis following slight trauma. His uncle is known to be similarly affected. Physical examination showed no additional abnormality. Tourniquet test and clot retraction were good. Fibrinogen and calcium were found to be normal.

1. What is the most likely diagnosis?

2. What is the specific abnormality in this disease is?

3. Outline investigations & treatment of this case.

 

The patient’s parents took the child to the hospital because he became very pale and tired, and they noticed that his stool becomes loose, black with offensive odor.

 

4. How would you manage this patient?

5. What would be the type of anemia at that point?

6. What would be the reticulocytic count at that point? 

 

Case 11:

A 57 year-old man with a history of chronic alcohol ingestion is admitted to the hospital with acute alcoholic intoxication and chest infection.

Physical examination reveals pallor, a large liver & palpable spleen.

CBC was done, and showed the following:

- Hb: 7 gm/dl.

- RBCs: 1,800,000/cmm

- MCH: 37 pg.

- MCHC: 35 gm/dl.

- MCD: 9 µ.

- MCV: 99 fl.

- WBCs: 3,500/cmm.

          - Segmented: 33%.

          - Staff: 2%.

          - Eosinophils: 2%.

          - Lymphocytes: 60%.

          - Monocytes: 3%.

- Platelets: 85,000/cmm.

- There is marked anisocytosis & poikilocytosis.

- There are many hyper-segmented neutrophils.

 

1. What is the diagnosis of the case?

2. What are the causes that lead to this blood picture?

3. Outline investigations & treatment for this blood disorder.

 

Neurological examination of the patient revealed:

- Diminished sensations in the distal parts of the limbs.

- Diminished ankle reflex and increased knee reflex.  

 

4. What are the lesions that led to these neurological findings?

5. What other neurological findings you will look for?

 


 

Case 12:

A 55 year-old man comes to you because of headaches, dizziness, weakness, ringing in his ears, and several episodes of transitory dimness of his vision.

Physical examination revealed the following findings:

- The face appears somewhat red.

- The fingers and toes are cyanotic.

- The liver and spleen are palpable.

- There is no abnormality of heart or lungs.

Investigations reveal the following results:

- Chest x-ray is normal.

- Urinalysis is normal.

- Hemoglobin is 20 gm/dl.

- Red blood count is 7,500,000.

- White blood count is 16,500.

- Platelet count is 800,000.

- Erythrocyte sedimentation rate was 2 mm in one hour.

 

1. What is the diagnosis?

2. What is the expected bone marrow picture?

3. What are the complications that can occur to this patient?

 

Case 13:

A 21year-old male is treated for an acute urinary tract infection with Ofloxacin. Three days later his hematocrite, which had been normal, is recorded at 22%, a reticulocyte count is 7.4%. Examination of a peripheral blood smear shows essentially normal erythrocyte morphology.

 

1. The following is most likely to confirm the diagnosis?

a. Hemoglobin electrophoresis.

b. Assays of glucose-6-phosphate dehydrogenase.

c. Serum iron concentration & total iron-binding capacity.

d. Sickle cell preparation.

e. Blood cultures.

2. Other drugs implicated in this condition include all of the following except:

          a. Quinine.

          b. Sulphonylurea.

          c. Salazopyrin.

          d. Penicillin.

          e. Vitamin K.

3. What types of cells may be detected in such a condition?

 


 

Case 14:

A 12 year-old male, is found to have a hypochromic microcytic anemia of 10 gm/dl. In addition there is a fair degree of targeting on smear. TLC is 9500, platelet count is 240,000 and reticulocyte count is 7%. The spleen is palpated 10 cm below the left costal margin, but the liver is not palpable. There is no history of hematemesis, melena or bleeding from other sites and no signs of liver diseases.

 

1. Enumerate the causes that may lead to this reticulocytic count.

2. What are the causes of targeting of red cells?

3. Which of the following is the most likely diagnosis?

a. Sickle cell trait.

b. Alpha thalassaemia major.

c. Beta thalassaemia major.

d. Iron deficiency anemia.

e. Hereditary spherocytosis.

4. Which would be the most diagnostic in this case?

a. Coomb’s test.

b. Osmotic fragility test.

c. Ham’s test.

d. Hemoglobin electrophoresis.

e. Serum iron determination.

5. What are the investigations to prove or exclude iron deficiency?

6. What is the significance of haptoglobin level in a case of anemia?

 

Case 15:

A 25 year old male went to the doctor complaining of petechiae in his skin. CBC was done for the patient and it was found to be normal.

 

1. Enumerate the possible causes of this case.

2. Outline investigations for this case.

 

Few days later the patient developed abdominal pain, painful swelling of the joints and slight puffiness in the face. Urine examination revealed excess red cells together with other red casts.

 

3. What is the most probable diagnosis of the case?

 


 

MCQs (Part I)

Case1:

A 60 year old black male presents with bone pain, specifically in his back and his ribs.. On physical examination, he is found to be pale and have bone tenderness. Laboratory tests are done, including a CBC with differential His hematocrit is 30. Rouleaux is seen. He has an elevated sedimentation rate. Protein electrophoresis shows a monoclonal spike in the beta region. He has a white blood count of 10,000/ cu mm and no abnormalities are seen with white blood cells. On peripheral smear, no Auer rods are visualized. He is negative for Philadelphia chromosome. Which of the following is most likely?

a) multiple myeloma

b) acute myelogenous leukemia

c) chronic lymphoblastic leukemia

d) chronic myelogenous leukemia

e) hairy cell leukemia

Case2:

A 25 year old male presents with an enlarged, painless swelling in his neck. His doctor suspects Hodgkin\'s disease. What finding would be pathognomic for Hodgkin\'s disease?

a) smudge cell

b) Philadelphia chromosome

c) Sezary cell

d) Bence Jones protein

e) Reed Sternberg cell


 

Case 3:

A 15-year-old boy from Ghana has the acute onset of right upper quadrant abdominal pain. Abdominal ultrasound reveals a dilated gallbladder with thickened wall and filled with calculi. A laparoscopic cholecystectomy is performed. The pathologist assistant opens the gallbladder to reveal ten multifaceted 0.5 to 1 cm diameter dark, greenish-black gallstones. Which of the following underlying conditions does this boy most likely have?

A Sickle cell anemia

B Crohn disease

C Hypercholesterolemia

D Hyperparathyroidism

E Schistosomiasis

Case 4:

A 19-year-old previously healthy woman has had a mild pharyngitis followed by a high fever over the past 24 hours. When seen in the emergency room, her skin now shows extensive areas of purpura. Vital signs include T 39 C, P 102/minute, RR 21/minute, and BP 80/55 mm Hg. Laboratory studies show a serum sodium of 115 mmol/L, potassium 5.3 mmol/L, glucose 42 mg/dL, and creatinine 1.1 mg/dL. Which of the following is the most likely diagnosis?

A Idiopathic thrombocytopenic purpura.

B Disseminated tuberculosis

C Reactive systemic amyloidosis

D Sheehan syndrome

E Acute adrenal insufficiency

Case 5:

A 33-year-old woman has experienced low grade fevers, night sweats, and generalized malaise for the past 2 months. On physical examination she has non-tender cervical and supraclavicular lymphadenopathy. A cervical lymph node biopsy is performed. On microscopic examination at high magnification there are occasional Reed-Sternberg cells along with large and small lymphocytes and bands of fibrosis. Which of the following is the most likely diagnosis?

A Burkitt lymphoma

B Hodgkin lymphoma

C Cat scratch disease

D Mycosis fungoides

E Multiple myeloma

Case 6:

A 17-year-old adolescent has had malaise for the past 3 weeks. He has a mild pharyngitis on physical examination, as well as tender axillary and inguinal lymphadenopathy. A CBC shows Hgb 14.0 g/dL, Hct 42.2%, MCV 90 fL, platelet count 301,300/microliter, and WBC count 8120/microliter with "atypical lymphocytes" on the peripheral blood smear. His illness is most likely to be acquired via which of the following mechanisms?

A From a genetic abnormality

B Droplet infection

C As a result of an insect bite

D Through an environmental exposure at work

E Without any known etiology

 Case 7:

A 30-year-old man gives a history of a sore throat with fever followed by 6 weeks of malaise. On physical examination he has mildly tender generalized lymphadenopathy. A cervical lymph node biopsy is performed and on microscopic examination shows prominent germinal centers in follicles with a diffuse polyclonal hyperplasia composed of lymphocytes, plasma cells, and macrophages. Which of the following is the most likely diagnosis?

A Lymphocytic lymphoma

B Hodgkin lymphoma

C Infectious mononucleosis

D Human immunodeficiency virus infection

E Brucellosis

Case 8:

A 30-year-old man has had a progressively worsening productive cough for one month. On physical examination, a few small non-tender lymph nodes are palpable in the axillae, and the tip of the spleen is palpable. Laboratory studies show Hgb 10.2 g/dl, Hct 31.1%, MCV 90 fL, WBC count 67,000/microliter, and platelet count 36,000/microliter. Microscopic examination of his peripheral blood smear shows many blasts with Auer rods. Which of the following is the most likely diagnosis?

A Leukemoid reaction

B Acute myelogenous leukemia

C Chronic lymphocytic leukemia

D Acute lymphoblastic leukemia

E Leukoerythroblastosis

Case 9:

A 45-year-old man has had increasing abdominal discomfort with abdominal enlargement for the past two years. On physical examination, the spleen can be felt below the left costal margin. There is no fluid wave. An abdominal CT scan reveals massive (estimated 3000 gm size) splenomegaly. Which of the following underlying conditions is he most likely to have?

A Myelofibrosis

B Sickle cell anemia

C Chronic lymphatic leukemia

D Infectious mononucleosis

E Hemochromatosis

Case 10:

For the past 4 months, a 62-year-old man has noted increasing fatigue and shortness of breath with minimal exercise. He has noted some abdominal discomfort over the past month. He has been healthy all his life. On physical examination he has non-tender cervical lymphadenopathy. The liver span is 10 cm in the right mid-clavicular line; the edge is smooth and palpable just below right costal margin. The spleen is palpated 3 cm below left costal margin on inspiration. A CBC shows WBC count 23,100/microliter with 16 segs, 2 bands, 78 lymphs, and 4 monos, Hgb 11.9 g/dL, Hct 36%, MCV 90, and platelet count 277,300/microliter. Which of the following is the most likely diagnosis?

A Leukemoid reaction

B Chronic myelogenous leukemia

C Acute myelogenous leukemia

D Acute lymphocytic leukemia

E Chronic lymphocytic leukemia


 

Case 11:

A 16-year-old boy has had a low energy level for as long as he can remember. On physical examination he has a palpable spleen tip. A CBC shows Hgb of 8.8 g/dL, Hct 24.1%, MCV 65 fL, platelet count 187,000/microliter, and WBC count 7400/microliter. His serum ferritin is 3740 ng/mL. A bone marrow biopsy is performed and on microscopic examination reveals a myeloid:erythroid ratio of 1:4, and there is 4+ stainable iron. Which of the following is the most likely diagnosis?

A G6PD deficiency

B Beta-thalassemia

C Sickle cell anemia

D Hereditary spherocytosis

E Malaria

Case 12:

A 48-year-old man has experienced increasing malaise and difficulty concentrating at work for the past 6 months. On physical examination he has splenomegaly but no lymphadenopathy. He is afebrile. Laboratory studies show Hgb 12.0 g/dL, Hct 35.8%, MCV 92 fL, platelet count 390,000/uL, and WBC count 190,000/uL with differential count 73 segs, 12 bands, 6 metamyelocytes, 2 myelocytes, 2 myeloblasts, and 5 lymphs. The leukocyte alkaline phosphatase (LAP) score is only 8. A bone marrow biopsy is performed. Which of the following microscopic findings is most likely to be found in this biopsy?

A Sheets of plasma cells

B Atypical cytokeratin positive glands

C Numerous mature and immature myeloid cells

D A decrease in all cell lines

E Granulomas that have many acid fast bacilli

Case 13:

A 35-year-old man has had fatigue, fever, and episodes of epistaxis for the past 3 months. On physical examination his temperature is 37.4 C. Laboratory studies show Hgb 12.5 g/dL, Hct 37.6%, MCV 89 fL, platelet count 170,000/microliter, and WBC count 52,000/microliter. Examination of his peripheral blood smear shows large blasts with Auer rods. Which of the following is the most likely diagnosis?

A Chronic myelogenous leukemia

B Infectious mononucleosis

C Plasma cell leukemia

D Chronic lymphocytic leukemia

E Acute myelogenous leukemia

Case 14:

Top of Form

A 25-year-old African-American man is given anti-malarial prophylaxis for a trip to West Africa. Over the next week he develops increasing fatigue. On physical examination there are no abnormal findings. Laboratory studies show a hematocrit of 30%. Examination of his peripheral blood smear shows red blood cells with numerous Heinz bodies. There is a family history of this disorder, with males, but not females, affected. Which of the following is the most likely diagnosis?

A Beta-thalassemia

B Sickle cell anemia

C Alpha-thalassemia

D Hereditary spherocytosis

E G6PD deficiency

Case 15:

A 38-year-old woman has become increasingly fatigued for the past 3 months. During the past week she has noted purple blotches on her skin. On physical examination there are purpuric areas of skin on her trunk and extremities. She has no hepatosplenomegaly and no lymphadenopathy. Laboratory studies show Hgb 6.8 g/dL, Hct 20.7%, MCV 91 fL, platelet count 28,760/microliter, and WBC count 1940/microliter. Which of the following is the most likely diagnosis?

A Aplastic anemia

B Chronic myelogenous leukemia

C Infectious mononucleosis

D Large B cell lymphoma

E Hereditary spherocytosis


 

Answers

Case 1:

ANSWER: A

Bottom of Form

In multiple myeloma ; patients typically present with anemia and bone pain. There will be a monoclonal spike on serum electrophoresis.

In acute myelogenous leukemia there would be numerous blast cells in the peripheral smear and marrow.

In chronic lymphocytic leukemia there would be a lymphocytosis with mature looking cells. CLL occurs in older people.

The laboratory findings in chronic myelogenous leukemia would show an elevated granulocytic count. The Philadelphia chromosome is positive in the vast majority (90-95%) of patients with chronic myelogenous leukemia.

Hairy cell leukemia has distinctive cells present in the peripheral blood smear, called 'hairy cells'.

 

Case 2:

ANSWER: E

Bottom of Form

The Reed-Sternberg cell is pathognemonic for Hodgkin\'s disease. The Reed-Sternberg cell has a multi-lobed nucleus with is a large \'owl eye\' nucleoli.

Smudge cells are cells that have been destroyed during the slide preparation. They are seen in acute leukemias.

The Philadelphia chromosome is a translocation between chromosomes 22 and 9, is positive in the vast majority (90-95%) of patients with chronic myelogenous leukemia.

Sezary cell is an atypical lymphoid cells seen in Sezary syndrome and mycosis fungoides both are forms of cutaneous T cell lymphoma (CTCL).

Bence Jones protein is light chains seen with multiple myeloma.


Case 3:

(A) CORRECT.

Darkly pigmented gallstones usually contain bilirubin. Hyperbilirubinemia is a consequence of hemolysis. Patients with sickle cell anemia have chronic hemolysis.

 

Case 4:

 (E) CORRECT.

This is acute adrenal insufficiency marked by hyponatremia, hyperkalemia, and hypoglycemia ( the Waterhouse-Friderischsen syndrome)


 

Case 5:

(B) CORRECT.

Reed-Sternberg cells are multinucleated with large nucleoli. Variants of them called lacunar cells are also seen with some forms of Hodgkin lymphoma.

Case 6:

 (B) CORRECT.

Infectious mononucleosis with Epstein-Barr virus (EBV) infection is typically acquired with close personal contact.

 

Case 7:

 (C) CORRECT.

This is a typical history for infectious mononucleosis. The peripheral blood usually demonstrates atypical lymphocytosis. Liver involvement may lead to mild icterus.

Case 8:

 (B) CORRECT.

The high WBC count with the blasts and Auer rods are very characteristic for an acute myelogenous leukemia.

Case 9:

(A) CORRECT.

Myeloproliferative disorders, and myelofibrosis in particular, are known to cause massive splenomegaly.

Case 10:

(E) CORRECT.

Most of the circulating cells are small, mature lymphocytes with CLL. Most persons with CLL are older adults.


 

Case 11:

B) CORRECT.

Reduced beta-globin chain synthesis from beta-thalassemia leads to RBC microcytosis, hypochromia, ineffective erythropoiesis, and excessive iron absorption.

Case 12:

(C) CORRECT.

He has chronic myelogenous leukemia (CML) which is a form of myeloproliferative process in which one or more cell lines (myeloid, erythroid, megakaryocytic) becomes increased. Unlike acute myelogenous leukemia, blasts are uncommon in CML

Case 13:

(E) CORRECT.

Auer rods are formed of the cytoplasmic granules of the myeloid blasts of AML and are a typical finding with AML.

Case 14:

(E) CORRECT.

He has glucose-6-phosphate dehydrogenase (G6PD) deficiency, which can result in a hemolytic anemia on exposure to oxidizing agents such as certain drugs such as antimalarials. This is an X-linked disorder. The Heinz bodies within the RBCs are formed from denatured hemoglobin.

Case 15:

(A) CORRECT.

There is evidence from the peripheral cytopenias for marked hypocellularity of the bone marrow with aplastic anemia. The spleen is of normal size.

 


 

MCQs (Part II)

 

1) All of the following are seen in intravascular hemolysis except:

  1. High urinary urobilinogen
  2. Reticulocytosis
  3. High plasma stercobilinogen
  4. High urinary hemosiderin
  5. ↑ LDH

 

2) Commonest cause of jaundice in thalassemia is:

  1. Viral hepatitis C
  2. Iron deposition in liver
  3. Viral hepatitis B
  4. Hemolysis
  5. Gall stones

 

3) Which of the following anemias is associated with splenomegaly:

  1. Chronic renal failure
  2. Aplastic anemia
  3. Hereditary spherocytosis
  4. Sickle-cell anemia
  5. Sideroplastic anemia

 

4) All of the following may cause pain abdomen in thalassemia major except:

  1. Vasculitis
  2. Splenic infarction
  3. Dragging pain due to huge splenomegaly
  4. Pigment stone-induced biliary colic
  5. Hemolytic crisis

 

5) Which of the following has does not have target cells in peripheral blood:

  1. Lymphoma
  2. Cholestatic jaundice
  3. Thalassemia
  4. Iron deficiency anemia
  5. Hyposplenism

 


 

6) Virchow's node receives lymphatics from all except:

  1. Testes
  2. Stomach
  3. Prostate
  4. Breast
  5. Kidney

 

7) All of the following produce microcytic anaemia except:

  1. Sideroblastic anemia
  2. Thalassemia
  3. Pernicious anemia
  4. Lead poisoning
  5. Iron deficiency anemia

 

8) All of the following may produce agranulocytosis except:

  1. Methyldopa
  2. Interferon
  3. Gold salts
  4. Chloramphenicol
  5. Carbimazole

 

9) Basophilic stippling is classically seen in:

  1. Chronic myeloid leukemia
  2. Myelosclerosis
  3. Chronic lead poisoning
  4. Iron deficiency anemia
  5. Basophilic leukemia

 

10) Which of the following is not a myeloproliferative disorder:

  1. Chronic myeloid leukemia
  2. Polycythemia vera
  3. Essential thrombocytopenia
  4. Myeloid metaplasia
  5. Myelofibrosis

 

11) Gum bleeding is characteristic of all except:

  1. Chronic phenytoin therapy
  2. Aplastic anaemia
  3. Scurvy
  4. Haemophilia
  5. Monocytic leukemia

 

12) Which is not associated with hypersplenism:

  1. Splenomegaly
  2. Hypocellular bone marrow
  3. Pancytopenia
  4. Reversibility by splenectomy
  5. Short RBCs survival

 

13) Splenectomy is virtually curative in:

  1. G6PD deficiency
  2. Iron deficiency
  3. Thalassaemia
  4. Hereditary spherocytosis
  5. Sickle cell anemia

 

14) Red cell osmotic fragility is increased in:

  1. Thalassaemia major
  2. Hereditary spherocytosis
  3. Hb C disease
  4. Iron deficiency anaemia
  5. Paroxysmal nocturnal hemoglobinuria

 

15) Plummer-Vinson syndrome is not associated with:

  1. Angular stomatitis
  2. Splenomegaly
  3. Clubbing
  4. Post-cricoid web
  5. Pica

 

16) The outstanding feature of ITP is:

  1. Fever
  2. Gum bleeding
  3. Moderate splenomegaly
  4. Presence of sternal tenderness
  5. Fatigue.

 

17) Plasmapheresis may be done in all except:

  1. Cryoglobulinaemia
  2. Goodpasture's disease
  3. Hypoplastic anaemia
  4. Myasthenia gravis
  5. Guillain-Barre syndrome

 

18) Circulating anticoagulants are found in:

  1. Hairy cell leukaemia
  2. SLE
  3. Multiple myeloma
  4. Dermatomyositis
  5. HELLP syndrome

 

19) Which of the following is false in haemophilia:

  1. Normal prothrombin time
  2. von Willebrand antigens level is grossly diminished
  3. Increased partial thromboplastin time
  4. Absent factor VIII coagulant activity
  5. Prolonged bleeding time

 

20) Incorrect statement in pernicious anaemia is:

  1. Hyperchlorhydria
  2. Premature greying of hair
  3. Anti-intrinsic factor antibody in 60% patients
  4. Gastric polyp may develop
  5. Macrocytosis

 

21) Which is not true in polycythaemia vera:

  1. Increased RBC mass
  2. Markedly hypercellular marrow
  3. Thrombocytopenia
  4. Basophilia
  5. Hyperucaemia

 

22) Disseminated intravascular coagulation may be seen in all except:

  1. Amniotic fluid embolism
  2. Rocky Mountain spotted fever
  3. Giant haemangioma
  4. Diabetes mellitus
  5. Hemorrhagic pancreatitis

 

23) Thalassaemia major may be associated with all except:

  1. Cardiac arrhythmia
  2. Cardiac tamponade
  3. Congestive cardiac failure
  4. Cardiomegaly
  5. Hypersplenism

 

24) Hess' capillary fragility test is positive in:

  1. Cushing's syndrome
  2. Idiopathic thrombocytopenic purpura
  3. Paraproteinaemias
  4. Vasculitis
  5. Scurvy

 

25) Hepatospenomegaly with lymphadenopathy is found in all except:

  1. Acute lymphatic leukaemia
  2. Lymphoma
  3. Chronic myeloid leukaemia
  4. Disseminated tuberculosis
  5. Infectious mononucleosis

 

26) Iron transport protein is:

  1. Transcobalamin II
  2. Ferritin
  3. Haptoglobin
  4. Transferrin
  5. Ferroprotien

 

27) Most effective treatment of polycythaemia vera is:

  1. Fresh frozen plasma
  2. Splenectomy
  3. Phlebotomy
  4. Exchange transfusion
  5. Cyclophosphamide

 

28) Which is not a vitamin K-dependent factor:

  1. Factor VIII
  2. Factor VII
  3. Factor X
  4. Factor II
  5. Factor IX

 

29) Eosinophilia is a feature of:

  1. Non-Hodgkin's lymphoma
  2. Sickle-cell anaemia
  3. Hodgkin's disease
  4. Haemophilia
  5. Cushing’s syndrome

 

30) ¯iron and ¯iron-binding capacity are seen in:

  1. Recurrent GI tract haemorrhage
  2. Intestinal resection
  3. Chronic infections
  4. Menorrhagia
  5. Iron deficiency anemia

 

31) Carcino-embryonic antigen is the tumour marker of:

  1. Medullary carcinoma of thyroid
  2. Hepatocellular carcinoma
  3. Bronchogenic carcinoma
  4. Colorectal carcinoma
  5. Thymoma

 

32) Which is not true in relation to multiple myeloma:

  1. Hyperviscosity syndrome
  2. Renal failure
  3. Moderate splenomegaly
  4. Response to melphalan
  5. Hypocalcaemia

 

33) Autoimmune haemolytic anaemia is associated with:

  1. ALL
  2. CLL
  3. AML
  4. CML
  5. PNH

 

34) Multiple myeloma does not feature:

  1. ­Calcium
  2. ­Uric acid
  3. Hyperglobulinaemia
  4. ­Phosphate
  5. Anemia

 

35) Half-life of platelet is:

  1. 1-2 days
  2. 3-4 days
  3. 5-6 days
  4. 7-8 days
  5. 10 days

 

36) Pancytopenia may develop from all except

  1. Haemosiderosis
  2. Paroxysmal nocturnal haemoglobinuria (PNH)
  3. Acute myeloid leukaemia (AMI)
  4. Chloramphenicol.
  5. Hypersplenism

 

37) Peripheral blood picture is the most useful diagnostic aid in:

  1. A Non-Hodgkin'slymphoma
  2. Multiple myeloma
  3.  Myelodysplastic syndrome
  4. Chronic myeloid leukaemia
  5. Iron deficiency anemia

 

38) Which is false in polycythaemia vera

  1. High erythropoietin level
  2. Massive splenomegaly
  3. Hyperviscosity
  4. Normal arterial saturation
  5. Low ESR

 

39) Splenectomy is contraindicated in:

  1. Pyruvate kinase deficiency
  2. Immune thrombocytopenic purpura
  3. Marrow failure
  4. Spherocytosis
  5. Thalassaemia


 

Answer key:

  1. C
  2. D
  3. C
  4. A
  5. A
  6. C
  7. C
  8. A
  9. C
  10. C
  11. A
  12. B
  13. D
  14. B
  15. C
  16. B
  17. C
  18. B
  19. B
  20. A
  21. C
  22. D
  23. B
  24. B
  25. C
  26. D
  27. C
  28. A
  29. C
  30. C
  31. D
  32. C
  33. B
  34. D
  35. B
  36. A
  37. D
  38. A
  39. C

 

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  • عنوان: 98 شارع التحرير , ميدان الدقي, القاهرة , مصر
     
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