Cardio.Hema (Definitive) 1st sem 2013 Dr. Payawal Midterm Exam Sept. 3, 2013 1. Sinus Bradycardia 2. Atrial Flutter 3. Premature Atrial Contraction 4. Normal ECG 5. Premature Junction Contraction Regularly occurring PQRST Rate < 60 / min Atrial rate = 220-300/min ( P as flutter waves ) Variable degree of AV block ( irregular RR interval ) Prematurely occurring PQRTS complex P wave different in configuration from the sinus beat PR interval often long QRS narrow Look at the p waves: rate is 60-100/min cycle length does not vary by 10% PR interval is 0.12 sec. or more Prematurely occurring PQRST. Inverted P wave that may precede, be incorporated within, or may follow the QRS complex. QRS narrow. Cardio. Hema (Definitive) 1st sem 2013 Progressive lengthening of PR interval w/ intermittent drop beats . 7. Atrial Fibrillation No discernible P waves Irregular RR interval 8. Asystole hmmmm At least 3 consecutive PVC’s Rapid, bizarre, wide QRS complexes (> 0.10 sec) No P wave (ventricular impulse origin) Within period of observation, one P wave is not followed by a QRS complex. No change in P-R interval before the transient failure of atrioventricular conduction. “n” P waves to “(n-1)” QRS complexes for each example of transient type II block. (“n” will be 3 or more*) Fixed PR interval w/ intermittent drop beats . 6. Mobitz I 9. Ventricular tachycardia, monomorphic 10. Mobitz II Hema (Definitive) 1st sem 2013 11. No recognizable consistent or meaningful relationship between atrial and ventricular activity QRS complexes often abnormal in shape. Usually no preceding P wave. duration and axis (occasionally normal) QRS morphology constant QRS rate constant ( 15-60 beats/min ) Any form of atrial activity seen (most commonly sinus initiated) .Cardio.e. > 0.21 sec ) Prematurely occurring complex. T wave opposite in deflection to the QRS complex. Complete compensatory pause following every premature beat. Torsades de pointes 12. Third degree heart block P waves present QRS complexes present P waves morphology and axis usual for the subject QRS complexes morphology and axis usual for the subject One P wave to each QRS complex P-R interval constant P-R interval must be prolonged ( i. bizarre looking QRS complex. First degree heart block 13. Wide. Premature Ventricular complex 14. Hema (Definitive) 1st sem 2013 15.Cardio. Sinus Tachycardia Regularly occurring PQRST Rate > 100 / min . no murmurs were appreciated. The cell membrane is impermeable to entry of sodium ions during which phase of the action potential? phase 4 (a. of K diffuse out as the K channels open Inactivation of Ca channels 19. Management would consist of the following except A. RMP) phase 0 phase 2 phase 1 NOTE: Phase 0 – aka Rapid depolarization Na moves rapidly into the cell Ca moves slowly into the cell Phase 1 – Early repolarization Na channels close Transient K efflux Phase 2 – Plateau phase Ca cont. non alcoholic. Normal D. Her clinical findings are compatible with a diagnosis of? A. Her 12 ECG shows A. peripheral edema. None of the above 21. Captopril C. ASO TITER C. Undergo open mitral commissurotomy C. V5. ECG E.16. TOF E. Avoid excessive salt intake B. You would advise the patient to: A. Extreme right axis deviation NOTE: Lead I (+). AVF (+) = right axis deviation Lead I (-). AVF (-) = right axis deviation 21. Digoxin E. HR 110/min and RR of 30/min. Atrial septal defect 22. ABG 23. AVF (-) = left axis deviation Lead I (-). PTCA (?) D. Lateral walllead I NOTE: Lateral wall – Lead I. Placement of V5 5th ICS anterior axillary line NOTE: V1 – 4th ICS right sternal margin V2 – 4th ICS left sternal margin V3 – midway between V2 & V4 V4 – 5th ICS MCL V5 – 5th ICS AAL V6 – 5th ICS midaxillary line (MAL) 18.k. Her apex beat is displaced at 6th ICS LAAL with a loud S3. Right BBB B. TPCK MB B. to flow in K cont. Left posterior hemiblock E. On PE she had a BP of 130/95. Serum cholesterol D. AVL. To confirm your clinical impression you will request: A. She is non diabetic and non smoker. Right Ventricular hypertrophy C. V4 Anterior septal wall – V1. V6 Inferior wall – Lead II & 3. A and C F. Undergo patch closure D.a. AVF Anterior wall – V3. to flow out Phase 3 – Rapid repolarization Large amt. NOTA 25. Her ECG showed: (sorry no images but PE correlates well with DCMP & Heart Failure) Basis: S3 (indicative of fluid overload) Crackles. The electrical axis on her 12 lead ECG is A. Left Axis Deviation (?) C. rheumatic mitral stenosis C. Undergo PTCA E. 24. displaced apex beat point to DCMP 20. She had crackles mid to base in both lung fields with a +1 bipedal edema. inferior wall myocardial infarction D. came in at the ER complaining of progressive SOB and DOB for the past month. Streptokinase B. ? A 35 y/o F. Right Axis Deviation B. V2 No specific view – AVR 17. What is the prognosis for this type of heart disease? . Left Ventricular hypertrophy (?) D. dilated cardiomyopathy B. Radial and Brachial 33. hypertensive.51 – 0. ABI result: Right Tibial 1. ANS: clopidogrel + B blocker + stop smoking 30. B. What are the expected chest x-ray findings in this patient? A. Patch closure cannot be done because of Eisenmenger syndrome E. D. B. D.89 – mild to mod 0.1 Left Dorsalis Pedis = 1. 45 pack years of smoking complained of left caudal pain after walking.40 – severe . aorta and iliac arteries B. C. Verapamil Nifedipine Diltiazem Metoprolol >1. Tibial and Peroneal D. D.90 – 0.50 – mod to severe <0.4 Right Dorsalis Pedis = 1. C. Case: 57 year old female. Femoral and Popliteal Arteries C. Ventricular fibrillation Fragments of shivering Atrial fibrillation Ventricular tachycardia 28. B. 75% mortality in 5 years B. Based on history alone. felt claudication with walking of a distance of >200m. normal sided heart Interstitial edema Boot shaped heart Cut off sign of the pulmonary artery 27.3 – normal 0. No improvement if PMC is not done C. NOTA 26. aorta and iliac arteries B. Hema (Definitive) 1st sem 2013 A. Abd. 29.41 – 0. ECG monitoring shows 31: Most common location of PAD: A.Cardio. Radial and Brachial 32. Tibial and Peroneal D. Coronary artery bypass grafting should be performed to prolong life D. what is the probable location? A. relieved with rest. C. A 60 y/o male. What antiarrhythmic agent would you give if the patient is successfully resuscitated with BP of 120/90 mmHg? A. with diabetes.99 – equivocal/borderline 0. Femoral and Popliteal Arteries C.3 – incompressible 1. bus driver.0 Interpretation: ANS = Incompressible right lower Ext & Normal Left Lower Ext NOTE: ABI Classification system A.3 Left Tibial = 1. Abd. hypertensive.0 – 1. a. Troponin T is Negative. Renal artery stenosis c.diabetic with insulin treatment. The patient had ECG and Cardiac Bio Markers what other test the patient need immediately to detect CAD? a. Unstable angina pectoris d. a. ST elevation…… 15. NSTEMI b. VL(?). ECG revealed sinus tachycardia with Tall & Peaked T wave. Coronary angiography d. Polycystic kidney disease d. STEMI 13. III.Hyperaldosteronism b. male. 2D echo c. CCB c. B blocker d. Unstable angina d. Stage B d. V4. continuous(?) severe chest pain. Stage C b. Chronic stable angina pectoris c. which antihypertensive drug is best for a 28 year old fertile female? a. athletic. Pneumonia d.) troponin of 150 ug/L a. Chronic stable angina c. Stage C b. BP is 160/90 to 166/100. Which is a contraindication for a trhombolytic therapy in ACS? a. Sinus tachycardia 16. Deduyo Prelims 1. bilateral kidney palpable.Cardio. 70 y/o. Hema (Definitive) 1st sem 2013 Dra. ST elevation…. ARBs 6. Stage D 20.Pheocromocytoma 3. 180/100 d. VL. Ventricular fibrillation b. ST depression at II. STEMI 8. -----A 62y/o male was admitted due to severe progressive chest pain. A 28 year old female is hypertensive with a bp of 140/100-160/100. Bp is 180/110mmhg. A 60 y/o patient complained of severe progressive chest pain. ND CCB c. V5 . Stage B d. ---4. (+) Troponin T a. ECG revealed LBBB. (+) DM and HPN. abdominal bruit a.ACEi 2. male. V3. Stage D . NSTEMI b. STEMI 9. Stable angina c. Stage A c. STEMI 10. Best antihypertensive with 30 year old patient with asthmatic and heart rate of 110-120 bpm a.Heart failure c. 36 y/o. Female hypertensive. With dilated ischemic Cardiomyopathy a. The hypertension had been diagnosed since 4 years ago. 61 y/o male with orthopnea. 5cm ST elevation at I. CXR b. CVA hemorrhage c. B Blocker b. (sorry dkomaalalamsyado. NSTEMI b. He is hypertensive with COPD because of chronic smoking.This is the common cause of death in acute coronary syndrome. b. ACEi b. Unstable angina d. Unstable angina d. hypertensive but can do regular gym activities without any cardiac symptoms a. NSTEMI b. Stable Angina c. fatigue and dyspnea . Stage A c. D CCB d. positive troponin after 6 hours a. non HPN. A 40 year old male. bp of 140/40 (kulang ata itong given sa Q) a. Non invasive procedure to rule in pulmonary embolism: ANS VQ scan 29. all of the above Dr. Most common site of metastasis in the heart a. While playing basketball. calf is 38cm and thigh is 50cm. RV heave. myocardium c. what is the best tx. Venous duplex scan of LE b. Dyspnea B. On measurement the right ankle is 21cm. LMW and Dabigatran 1. He was brought to ER for evaluation and treatment. CXR d. Pericardium 3. ----b. Tricuspid regurgitation b. MRA 28. call center agent. neither 2. He was sent home with NSAIDS. Hema (Definitive) 1st sem 2013 23. Venograph c. diastolic rumbling murmur at 5th ICS MCL A. VSD c. Aortic regurgitation D. ECG c. Endocarditis prophylaxis is indicated in the ff: A. NC 30y/o. Which of the following is unusual in severe aortic stenosis? A. Direct catheter thrombolytics c. all e. both d.) DM in CVS a. Hypertension 8. endocardium 3. the ankle measures 25cm.) 68 y/o male patient was noted to have systolic murmur at the apex of the heart which radiates to the carotids. abnormal pain response to MI d. MI tend to be larger c. thigh is 54cm. with no previous medical illness complained of daily bilateral leg heaviness while at work. Tricuspid Stenosis B.) 28 year old female. Mitral Stenosis C. Bartolome Prelims B1 2) Most common site of cardiac metastasis a. Elevating the legs or walking would temporarily relieve the symptoms. Wells score is 4. Exertional syncope C. He was brought to the hospital for treatment.) 35 year old. a. Tx of Choice for ACS – CABG 7. D-dimer d. with dyspnea and orthopnea. he tripped and fell landing on his left leg. prosthetic heart valves B. HOCM E. Pulmonary Stenosis . The leg x-ray is negative for fracture.b& c 5. pro BNP 26. Your working impression is DVT.) A holosystolic murmur in left sternal border radiating to the right. On the left lower ex.Cardio. CT scan of LE e. VSD D. 2D echo Doppler b. head bobbing 9. 3days later the patient noticed the entire left leg is swollen. Gold standard for the diagnosis of heart failure? a. pulsus parvus et tardus b. Systemic thrombolytics d. pericardium (ans) b. What initial test will you do next? a. previous infective endocarditis C. CAD leading cause of death in DM b. calf is 44cm. Angina D. female. of choice a. Confirmed pulmonary embolism on left lung. EXCEPT A. inspiratory decline in systolic arterial pressure b. Valsalva's (late) 15. Squatting (late) C.) A 53 year old male in the ER presented with neck vein distention. bipedal edema. murmur s1 to after s2 upper sternal border B. Isometric (late) D. Increased arterial pressure B. Which is not a manifestation of Cardiac Tamponade? A. Loud S1 & S2 B. Standing (early) B. differential cyanosis may be present D. Pulmonic Regurgitation 14) Definition of pulsus paradoxus is a. Hema. cardiac tamponade b. Valsalva's (late) 9. Squatting (late) C. B&C ECG in acute pericarditis widespread ST-segment elevation 20.) What is the most common location of syphilitic aneurysm? ANS: ascending aorta 1. She is known to be diagnosed with breast malignancy. grating sound. "3 sign" (COA) C. patch of dullness above the left scapular space c.. Dilated left atrium. Aortic Stenosis c. Isometric (late) D. Dynamic maneuver to make MVP murmur click sound earlier? A. aortic arch C.) A 45 y/o female patient was brought to the ER due to dyspnea. Carotid pulse. normal sized heart (TOF) 26. Clinical criteria Takayasu arteritis A. Valvular murmur that increases during inspiration? A. delayed carotid upstroke 15. Faint heart sounds D. supra abdominal aorta 5. descending aorta E. tricuspid regurgitation 23) Radiologic finding of mitral stenosis (MS)? A. No S3 no murmur with Kussmaul's sign. Pulmonic Stenosis d. age < 40 B. Brachial artery. water bottle . AR B. D. Differential Cyanosis C. acute pericarditis c. systolic BP? >40 C. Routine antimicrobial prophylaxis needed. water bottle shaped (pericardial effusion) B.. ascending aorta B. The patient most likely has: a. infra abdominal aorta D..Gastro (Definitive) 1st sem 2013 D.. MVP C. ascites. (something about sa QRS) C.) PDA except? A. VSD 18. Most common site of acute aortic dissection A. Neck vein engorgement C. AOTA E. normal sized ventricle 10) Graham Steell murmur high pitch decrescendo diastolic blowing murmur noted @ Left upper sternal border due to: a. True of PDA A. (something about sa Q wave) 21.pleuritic chest pain radiating to the trapezius ridge on auscultation. machinery like murmur C. Pulsus paradoxus 18. AOTA 19. PDA D. 8. boot shaped. Cardiac Tamponade is suspected. What is the ECG finding? A. Aortic Regurgitation b. Widespread ST elevation with concavity B. Machinery Murmur D.. Standing (early) B.Cardio.) A 35 year old male . constrictive pericarditis d. Radiologic finding in mitral stenosis A. Increased arterial pressure B. ascending aorta b. Valsalva's (late) 5. Key in the classification of anemia a. MS C. MR D. Most common organism found in the blood culture after dental procedure A. diastolic rumbling: A. Coomb’s test c. viridans B. MR D. MS C. Faint heart sounds D. Principal site of hematopoiesis at birth a. age <40 b. hx of breast ca w/ cardiac tamponade. boot shaped D. Brachial artery… d. Squatting (late) C. Clinical criteria Takayasu arteritis a. S. ECG in acute pericarditis ANS widespread ST segment elevation 11. Valvular murmur that increases during inspiration? A. Chlamydia D. Common sign to LV diastolic dysfunction a. Hema. spleen (fetus) d.. S. PDA D. dilated LA: A. Standing (early) B.Gastro (Definitive) 1st sem 2013 B. Features of cardiac tamponade EXCEPT: A. aureus 15. Dyspnea on exertion b. Most common infection preceding aplastic anemia . pneumonia C. AS B.Most common site of acute aortic dissection a. Standing (early) b. bone marrow (at birth) 3.. Large atrium and normal ventricle 26. except A. AR 12. Palpitation 1. Valsalva's (late) 4.all 2. Isometric (late) D. Most common cause of death in DM is coronary artery disease B. Easy fatigability d. Systolic murmur radiating to axilla: A. Carotid pulse.Cardio. supra abdominal aorta 2. Neck vein distention C. AR 14. MVP C. S. Relationship of DM and cardiovascular disease A. Chest pain on exertion c. “3” sign C. VSD 7. systolic BP ?>40 c. Pulsus paradoxus 30. In DM. yolk sac (embryo) b. Isometric (late) D. 45 yo F. MR D. Loud S1. Squatting (late) C.. BMA d. liver (embryo) c. infra abdominal aorta d.Reticulocyte count b. AS B. MI is larger in size C. aortic arch c. 3. Normal LV. AS B. AR 13. All of the above 1. Routine antimicrobial prophylaxis needed. MS C. Abnormal pain response to myocardial ischemia D. AR B. descending aorta e. Dynamic maneuver to make MVP murmur click sound earlier? A. myelodysplastic syndrome d. Glucocorticoids d. pronormoblast c. normochromic b. androgen d. reticulocytopenia and absent or rare erythro precursor cells in the bone marrow a. Pancytopenia with hypocellular bone marrow a. hypochromic c. pernicious anemia c. bone marrow transplant b. Parvovirus B19 d. hypochromic d. correction of underlying endocrine disorder 10. microcytic. post gastrectomy b. normocytic. platelet d. Cell membrane defect in PNH (Paroxysmal Nocturnal Hemoglobinuria) a. Treatment for anemia of endocrine disorder a. hyperchromic 13.k. promyelocyte d. paroxysmal nocturnal hemoglobinuria 6. nucleated red cell c. androgen b. normochromic b.Gastro (Definitive) 1st sem 2013 a.ka. The presence of the ff. both b. aplastic anemia c. erythroid progenitor cell d. neither 12. aplastic anemia c. tear drop shaped cell d. alcoholism . pure red cell aplasia b. megaloblastic anemia 5. depletion of CD 59 d. Normocytic. hypothyroidism d. Pluripotent stem cell b. Earliest precursor of RBC that is recognizable morphologically a. normocytic. hypochromic c. RBC c. depletion of CD 55 c. hyperchromic 17. myelodysplastic syndrome d. G-CSF 14. Infectious mononucleosis b. promegakaryoblast b. Hepatitis c. Treatment of choice for anemia of renal origin a. A clonal hematopoietic stem cell disorder characterized by cytopenia associated with dysmorphic usually cellular bone marrow and ineffective erythropoiesis a. erythropoietin c. Major physiologic regulator of RBC production a. microcytic. Characterized by anemia. granulopoietin b. Erythropoietin c. megaloblastic anemia 11. immature white cell 7. granulocyte progenitor cell 8. hypochromic d. all 16.Cardio. cells is suggestive of leukoerythroblastic anemia EXEPT a. aplastic anemia c. proerythroblast a. Hema. both b. pure red cell aplasia b. Earliest least developed stem cells a. normocytic. macrocytic. RBC morphology of severe iron deficiency anemia a. Most common cause of cobalamin deficiency caused by absence of intrinsic factor from autoimmune dysfunction a. Red cell morphology of anemia of renal origin a. multipotent stem cell c. pure red cell aplasia b. neither 15. thrombopoietin d. target cells b. macrocytic. glucocorticoid c. EBV 4. myelodysplastic syndrome d. Anucleated hematopoietic stem cell a. myeloblast (earliest for granulocyte) 9. <5% myeloblast in the bone marrow 2. all 29. anemia of renal disease b. >20% myeloblast in the bone marrow c. bone marrow transplant b. >5% myeloblast in the bone marrow d. M4 d. M6 3. Main site for folate absorption a. A reticulocyte index of < 2. Presence of significant MACROcytosis is suggestive of: a. lower MCH 27. both b. aplastic anemia 28. serum iron c. anemia from acute bloos loss c. transferrin c. The following conditions may result to increased iron loss a. Deficiency of this vitamin is almost always due to malabsorption a. hypoproliferative anemia 26. Leukemia with the high risk to develop DIC . cobalamin c. transferrin b. folate d. The major convenient lab test to estimate iron storage a. ileum d. Hema. all 1.Cardio. jejunum b. b thalassemia c. radiation therapy 24. infancy d. serum ferritin d. intrinsic factor c. anemia of acute and chronic inflammation c. Definitive treatment for aplastic anemia a. Main iron transport protein a. splenectomy c. iron from fat d. iron stains b. ceruloplasmin 30. jejunum b. lower RDW b. Diagnosis of AML is established by the presence of: a.Gastro (Definitive) 1st sem 2013 d. neither 21. neither 22. iron deficiency anemia b. chemotherapy d. all 18. cecum remember: IFB DJI (I’m on Facebook. M5 b.. M3 c. Do Join It) I – iron D – duodenum F – folate J – jejunum B – B12 and bile acids I – ileum 20. A cell directed carrier protein for cobalamin a. anemia of endocrine disorder d. Microcytosis is reflected by a a. both b. Main site for iron absorption a. lower MCV c.5 indicates a. senescent RBC c. hemolytic anemia b. ferritin d. MEGAloblastic anemia d. ileum d. Major source of iron utilized for erythropoiesis a. duodenum c. ferritin d. duodenum c. Phlebotomy as treatment for polycythemia vera b. lower MCHC d. iron b. FAB classification of erythroleukemia a. Most common form of hypoproliferative anemia a. chronic inflammation 23. >10% myeloblast in the bone marrow b. pregnancy c. cecum 19. TIBC 25. neither 18. lymphoma c.000/uL b. Cytochemical stain that favors AML and ALL a. normal to elevated platelet count . CML d. platelet count <500. NOT a hematologic finding onf CML a. AML M5 4. Low Lap score c. normal b. proerythrocyte 9. splenomegaly c. ATRA d. not absolute) d. leukemia d. Salicylates b. expression of CD 19 d. hemangioma 15. elevated WBC leftward shift b. Ba:22 19. Polycythemia vera c. Treatment of choice for relapse cases of AML a. hepatoma 12. Hydroxyurea b. low d. Treatment of AML M3 a. vertigo d. Anagrelide c. NOT a criteria of clinical diagnosis of essential thrombocytosis a. expression of CD 41 c. Treatment of essential thrombocytopenia that is selective to platelet and platelet precursor a. dyspnea. Doxorubicin & cytarabine c. chest pain c. (-) myelofibrosis d. expression of CD 13 and 33 b. CD 7 & CD 10 5. Immunophenotypic feature of AML 7 a. 7+3 chemotherapy c. expression of CD 7 8. NOT a feature of retinoic acid syndrome a. 15:17 c. 16 b. Erythropoietin level of patient with Polycythemia vera a. (-) Ph chromosome c. a. glucocorticoids not usually effective 11. related to adhesion of differentiated neoplastic cell to pulmonary vasculature d.Gastro (Definitive) 1st sem 2013 a. Cytogenic hallmark of CML a. AML M2 b. sarcoma b. Neoplastic expansion of hematopoietic cell in blood and bone marrow. Hema. all 14. EXCEPT: a. CD 19 and 20 d. digital gangrene b. AML M4 d. (-) Periodic Acid Schiff (PAS) 7. pallor 16. expression of CD 13 b.Cardio. (-) myeloperoxidase c. Glucocorticoids d. AML M3 c. Interferon 13. COPD b. Neutropenia d. expression of CD 3 c. 9:22 d. Splenectomy b. stem cell transplant 10. myelocyte b. Causes of absolute lymphocytosis. promyelocyte c. high dose cytarabine 6. diuretic use (a relative cause. myeloblast d. Philadelphia chromosome (+) a. ALL c. Earliest precursor of granulocyte recognizable by light microscopy a. Most common presenting sign of Polycythemia vera a. both b. Immunophenotypic feature of AML cells a. occur during the first three weeks of treatment b. Hydroxyurea d. (-) known cause of selective thrombocytosis 17. (+) fever. (+) myeloperoxidase b. high c. (+) Periodic Acid Schiff (PAS) d. Non-hodgkins c. Lymphoma (solid tumor of immune system) d. Hemophilia A b. all NOTE: L1 small uniform lymphoblast L2 lymphoblast size varies L3 uniform large lymphoblast with vacuolation 23. T-cell c. Busulfan b. ALL (if immature) c. Hemangioma 30. Thrombocytosis b. Factor II c. L3 b. Factor XII c. Vit. Recognition of diagnosis of Reed-Strenberg (RS) cells is diagnostic of a. Leukemia 26. Anagrelide 21. CLL (mature) 29. Hema. Hemophilia B (factor 9 def. marrow.) d. NK cell b. Tyrosine kinase inhibitor that induce cytogenic remission in CML patients a. Richter transformation d. EXCEPT: a. hypersplenism d. FAB class of ALL with small uniform lymphoblast a. Most common malignancy of pediatric population ALL (Acute Lymphoblastic Leukemia) 1. autoimmune phenomenon c. Richter transformation d. L2 d.Gastro (Definitive) 1st sem 2013 20. Thrombocytopenia b. Protein C & S d. all 24. Causes of anemia and thrombocytopenia in CLL a. Hydroxyurea c. K deficiency.Cardio. Hemophilia C (factor 11 def. Asymptomatic lymphocytosis c. plasma cell 22. A potentially cardiotoxic chemotherapeutic agent to acute leukemia a. L1 c. CML d. and lymphoid tissue a. B-cell d. AML b. Factor VIII deficiency: a.) c. NOT an indication for CLL therapy a. progression marrow infiltration b.Indication of CLL therapy a. Imatinib d. Asymptomatic lymphositosis c. all 2. Prednisone c. Factor XI NOTE: Vitamin K dependent clotting factors are: . Autoimmune hemolytic anemia 27. Sarcoma (solid tumor of soft tissues) c. Prolymphocytic transformation NOTE: List of Indication for CLL treatment Anemia Thrombocytopenia Disease related symptoms Markedly enlarged or painful spleen Symptomatic lymphadenopathy/lymphocytosis Blood lymphocyte count doubling time <6 months Prolymphocytic transformation Richter transformation 28. Solid tumor of the immune system a. Leukemia b. Hodgkin’s d. Origin of majority of lymphoid leukemia and lymphoma a. Anthracycline (Doxorubicin) b. Vincristine 25. Neoplastic proliferation of mature lymphocytes in blood. Myeloma b. Imatinib mesylate d. VII. Prednisone 11. Protein C d. cryoprecipitate b. Aspirin 4. Warfarin d. Vitamin K antagonist a. Critical events necessary for effective primary hemostasis a. A non-alkylating.MCV 120 Macrocytic 2. myelosuppresive chemotherapeutic drug a.7. it is diagnostic for factor 13 deficiency) c. Interferon 12. ITP (Idiopathic Thrombocytopenic Purpura c. Plasmin c. Heparin 6. thrombosis Additional: 1. End product of Secondary hemostasis fibrin clot formation 5. Megakaryocytic thrombocytopenic purpura b. platelet concentrate d. Safest replacement therapy for bleeding patients with liver disease a. Hema. Test to distinguish Hemophilia A from Hemophilia B: a. Low/absent iron stores Iron Deficiency Anemia 4. Enzyme cyclooxygenase resulting to thromboxane A2 inhibit synthesis a.Cardio.K dependents are also the ones affected by WARfarin (9. and X. Hydroxyurea b. Most common cause of isolate thrombocytopenia that results from action of antiplatelet antibody coating the platelet a. Bleeding time b. bleeding d. Vascular purpura 9. Streptokinase b. platelet adhesion b. Allogenic SCT (Stem Cell Transplant) d. pallor c. granule release and secretion c. Anagrelide c. Interferon c.Gastro (Definitive) 1st sem 2013 II. NSAID c. Specific factor assay (distinguishes Factor 8 from F9) 10. FFP (fresh Frozen Plasma) 7. and 2 1972. platelet aggregation d.10. Aspirin d. Hydroxyurea d. EXCEPT: a. if positive. Heparin 5. Factor II aka Prothrombin 6. ASH b. sepsis b. there was WAR in 1972) whereas heparin and related compounds increase the action of antithrombin on thrombin and factor Xa 3. TTP d. all 8. IX. Plasma protein derivative that inactivates factor V and VIII a. Reticulocyte index of 4 means bone marrow is responding to anemia 3. protein C and S Vit. Heparin c. Antithrombin III (AT III) b. Ticlopedine b. Treatment with curative intent in CML a. cryosupernate c. Mixing test (performed if screening test is prolonged) d. Definitive treatment for Chronic ITP splenectomy . Urea clot lysis test (is a screening test for factor 13. Clinical manifestation of Pancytopenia. d. hepatosplenomegaly.normocytic RBC. PBS normochromic. Detected by decrease reticulocyte count c. 3. Everted umbilicus d. MCV b. Pulsatile liver e. hemoglobinuria 6. Few weeks onset of easy bruising. Hereditary spherocytosis. iron deficiency b. CML D.Gastro (Definitive) 1st sem 2013 7. anemia of chronic disease 9. pancreatitis 5.jaundice c. First line treatment of AIHA: a. Laboratory finding seen in anemia in chronic disease. pale. dec. A 40 year old male complained of anemia with a history of 5 year post-gastrectomy due to BPUD.e are correct 4. inc. Café au lait spot. General signs and symptoms of anemia is due to low affinity of hemoglobin to O2 8. True about hemolyticanemia. Venous hum A. Rituximab b. EXCEPT a. Vit. Red blood cell index/indices for red cell size a. MCHC d. hypocellular marrow d. gallstones b. EXCEPT: a. transfusion of RBC d. dec platelet A. folate deficiency c. ALL C. short stature. Main treatment of choice for Anemia of Chronic Renal disease/insufficiency Erythropoietin (EPO) 1. WBS is marked. EXCEPT: a. – c. Ascites. splenomegaly d.Cardio. CLL . melphalan 3. True regarding Hemolytic anemia except: a. Samson-Cruz Sept. Hema. serum ferritin 2.jaundice c. low serum protein b. MCH c.. Hereditary spherocytosis.b12 deficiency/Megaloblastic anemia d. What is the most likely cause of his anemia: a. splenomegaly d.ecchymosis.corticosteroids MCHC – amount of hemoglobin relative to the size of the cell RDW – measures variation in red blood cell size or red blood cell volume 8. premature destruction of RBC b. gallstones b. A. 2013 4. usually presented with pallor or jaundice Hematology Recalls Midterm Exam Dr. 60 y/o male with leukocytosis. AML B.except: Low reticulocyte index 7... Splenectomy c. RDW NOTE: MCV – average red blood cell size MCH – amount of hemoglobin per RBC 1. Bulging flanks b. red cell protophorpyrin c. thumb abnormality Fanconi Syndrome 3. increase red cell production d. svc obstruction. dec WBC predominantly myeloblast. EXCEPT: a.c. 00 & BM Blast 12%: A. Polycythemia vera A. leukocytosis C. SPEP D. Hydroxyurea is the only treatment for children 16. None 15. ALL B. MC hepatotoxic drug A. absolute erythrocytosis except: A. Chromosome t(17:22) B.infiltrates A. Cytogenic hallmark of CML Chromosome t(9:22) A. AA B. CML D. CML Chronic C.Cardio. 20% B. R-L shunt D. environmental toxin C. CML Accelerated D. PAS 14. MDS B. Aga B. pale conjunctiva. splenomegaly 13. AML C. CLL D. Stain that do not react with lymphoblasts except A. granulocytes. metabolites of Cyp450 D. Imatinib. Non-specific esterase 19. with extramedullary hematopoiesis and splenomegaly 2. clonal disorder of multipotent hematopoietic progenitor cell of unknown etiology characterized by marrow fibrosis. metabolites of glucuronidation 17. Treatment of asymptomatic essential thrombocytosis A. Aspirin C. chest pain . WHO cutoff for blast count for AML A. low back pain. dyspnea. True of PV except: A. 30% D. 40% C. Retinoic Syndrome except: A. occur during the first three weeks of treatment B. CML Blast 12. BMA mandatory D. hepatoma B.Gastro (Definitive) 1st sem 2013 5. Intrathecal CNS treatment: A. Hema. 53 y/o F CML for 3 years. Clonal disorder involving a multipotent hematopoietic progenitor cell in which there is accumulation of phenotypically normal red cells. myeloid metaplasia. true of chronic idiopathic myelofibrosis except: 1. same manifestation with PV and CML 3. red cell mass to differentiate absolute versus relative 10. 50% 18. 60 years old. (+) fever. prescription B. Chromosome t(22:9) 9. CXR. Serum B2 macroglobulin 6. and platelets in the presence of a recognizable physiologic stimulus 11. erythrocytosis B. cough. Hydroxylurea D. The most common sign of Myeloproliferative dse: ANS: Splenomegaly 8. BMA & Biopsy C. dehydration C. Sudan Black C. Myeloperoxidase B. Platelet count 80. ABVD 26.Gastro (Definitive) 1st sem 2013 C. Lab features of CML except: A.B. induce complete remission quickly B. prolong survival 23. Hema: test to differentiate primary to secondary polycythemia A. Serum B2 microglobulin 25. red cell mass determination B. CD 3. continuous treatment given for 2-3 years C. Anemia B. CD 13. aa 29.3 regimen B. epo level C. pa score 22. Aim of Post Remission therapy except: A. bma D. Crea Level C. Prognostic single factor for survival of multiple myeloma: A. non selective myelosupression is mechanism of what chemotherapeutic agent? A. Anagrelide B. eliminate residual cells C. A ribonucleotide reductase inhibitor. Susceptibilty to bacterial infections C. CD 41. Normal platelet count C. Richter formation D. Intrathecal chemoprophylaxis is mandatory D. B Cell ALL marker: A. CD 4 C. related to adhesion of differentiated neoplastic cell to pulmonary vasculature D. CD 19. Bone pains D. All 27. True about ALL except: A. Higher centers command 21. Most common sign of myeloma A. none 20. Indication for chemotherapy in CML A. 33 B. CD 20 D. Hydroxyrurea 30. Hema. SPEP D. Best regimen for highly agressive HL. LDH B. ABR . Anthracycline C. Hyperviscocity problems 28. Imatinib D. a standard remission induction requirement 7. LAP score is zero B. prolong relapse D. Decreased WBC D. Renal failure B. Thrombocytopenia C. CD 61 24.Cardio. Diffuse type No cell cohesion No mass formed Leather bottle appearance Affects whole stomach (antrum and cardia) Younger patients Hereditary Poorer prognosis Intestinal type Cohesion present Tumor formed Ulcerative Distalstomach affected 9. Hypopharyngeal web + iron def. anemia + dysphagia = PLUMMER VINSON or PATTERSON KELLY SYNDROME 5. Most common site affected in Squamous cell Ca lower third (55%) ~least affected is the upper third 8. Diagnosis for Hypertensive motor disorder “cork screw esophagus” on barium swallow 6. Adenocarcinoma – MC upper GI Ca 7.Gastro (Definitive) 1st sem 2013 1. Treatment for primary gastric lymphoma subtotal gastrectomy followed by combination chemotherapy (R-CHOP) 12. H. pepsinogen. Pyloric glands at the antrum and pylorus of the stomach composed of endocrine. Duodenal vs Gastric Ulcers . International Prognostic Index for NHL Five clinical risk factors: Age 60 yo Serum lactate dehydrogenase (LHD) levels elevated Performance status 2 (ECOG) or 70 (Karnofsky) = cares for self. Ketoprofen most harmful NSAID 18. the most numerous and distinct gastric glands secretes acid. MC type of TEF EA with distal TEF 3. unable to carry on normal activity or do active work Ann Arbor stage III or IV >1 site of extranodal involvement 13. Duodenal ulcer 4 to 6 weeks treatment 21. intrinsic factor. Anomaly Age at presentation EA with distal TEF New born Isolated EA Isolated TEF (H-type Infants to adult TEF) 4. & the bulk of gastric enzymes 16. Gastric Ca MC metastasis to LIVER 10. Levels of narrowing Upper esophageal sphincter Aortic arch Left mainstem bronchi Diaphragm Lower esophageal sphincter 2. Regulation of gastric acid secretion Stimulants of gastric Inhibitors of gastric acid acid secretion secretion Histamine (ECL Somatostatin (D cell) cells) Secretin/Cholecystokinin Gastrin (G cells) (Hormonal) Acetylcholine Neural (CNS/PNS) (Vagus) 22. Hema. Metastasis of stomach MC arise from primary breast Ca 15. Oxyntic glands at the fundus and body of the stomach located in a gastric pit. Pylori treatment. Gastric ulcer 6 to 8 weeks treatment 20. mucous and gastrin (G) cells 17. GIST non-epithelial (mesenchymal) tumors that arise from the gastrointestinal pacemaker calls called interstitial cells of Cajal (ICC) 14.Cardio.10 to 14 days of antibiotic therapy 19. Most common type of gastric lymphoma nonHodgkin’s (B-cell in origin) 11. Granulomatous gastritis not associated with folds GASTROENTEROLOGY 1st SEM 2013-2014 PRELIMS – Dr. pylori-related) AB gastritis .Body predominant form (autoimmune) Type B .Antral predominant form (H. cecum B. Anemia. palpitation and weakness are signs and symptoms of colorectal cancer found in: A. Lopez 12. CT cholangiography D.Mostly malignant (>60%) . pylori infection rapid urease test 24. pylori infection urea breath test 25. Least common cause of mechanical S. Naproxen safest NSAID 27. with mucosa (body) ~90% located within 3 cm of the pylorus. Hema. Guide to NSAID therapy in CV setting No CV risk no aspirin With C risk consider giving aspirin DO NOT give COX 2 inhibitor for patients with CV risk 26.Diarrhea – 2nd MC manifestation of ZES 29. Ménétrier's Disease large.Gastric acid hypersecretion from Gastrinoma tumor .UTZ 30. Enteroclysis . Colonoscopy b. Eosinophilic gastritis primarily in the antrum edematous folds presence of eosinophils can lead to outlet obstruction 33. Classified according to predominant site of involvement Type A .I obstruction a.Cardio. Sensitivity of imaging in ZES Primary gastrinoma Metastatic gastrinoma Most . ZOLLINGER-ELLISON SYNDROME (ZES) .associated with Multiple Endocrine Neoplasia (MEN) type 1 syndrome . descending colon D. hernia d. transverse colon C.mixed antral and body 28. Barium enema c. Most sensitive/specific NON-INVASIVE test to detect H.Peptic ulcer – MC manifestation of ZES . rectum NOTE: obstruction of a tumor at the right side (cecum) manifests as bleeding it will cause anemia 18. volvulus 16. Which is a purely diagnostic alone? A.Gastro (Definitive) 1st sem 2013 Duodenal Gastric Malignant DUs can represent are extremely malignancy rare most often found most often in distal to the the first junction between portion of the antrum and duodenum the acid secretory (>95%).MC tumor distribution: at duodenum (most common non-pancreatic lesion) . Most sensitive/specific INVASIVE test to detect H. 23.EUS (80-100%) Least . tortuous gastric mucosal folds mostly in the fundus and body 34.UTZ Most – Ostreoscan Least . adhesions c. Lymphocytic gastritis also called varioliform gastritis primarily in the body of the stomach presence of lymphocytes have thickened folds 31. neoplastic –common for Large intestine b. E. community acquired than hospital b. Hepatotoxic: A.most common diverticula location 6.histolytica Ciprofloxacin except rotavirus IBD. Lichen Planus Additional Recalls: Severe mucosal invasion . An aerobic organism 28. absent bowel sound d. Hepa C is ssRNA NOTE: Hepa B – dsDNA The rest are ssRNA 4.Gastro (Definitive) 1st sem 2013 21. predominant involvement of palms and forehead E. (not so sure of the exact question) A. psychosis b.tgf-b and il-10 GI TB. environmental toxin C.Cardio. Transfer of unconjugated bilirubin D. Lactulose b. Mesenteric angiography. mass b. nasolabial fold involvement C. true of viral hepatitis: A. Hepa D is dsDNA D. Transfer of conjugated bilirubin MIDTERMS – Dra. Lymph sialadenitis C. Secrete toxin leading to Pseudomembranous Enterocolitis d.distal ileum and cecum Aminoglycoside . Hema. Best acceptable risk factor for irritable bowel syndrome a. sign of ruptured appendicitis except: a. Parameters in differentiating Jaundice from hyperbilirubinemia of other cause except A.least/never used in pseudomembranous colitis Sigmoid . T cell lymphoma 1. metabolites of P450 D. Mesenteric venous thrombosis 30. genetic predisposition c. Low Risk immunocompromised booster after primary given . Superior mesenteric artery embolus D. Hepa A is dsDNA B. GN D. sparing of the non exposed skin to sun 5. Polyarthritis Nodosa C. An invasive organism c. Bisacodyl B. non-occlusive Mesenteric ischemia C. Ca bilirubinate 8. ?? 2. Complication of Hepatitis C except: A. Sequel of chronic HBV infection except: A. Difficile Infection a. Treatment for IBS-D a. Cryoglobinemia dermatitis B. ?? C. previous campylobacter infection 29. Bilirubin Metabolic process that most likely causing bilirubinuria: A. True regarding C. old age d. metabolites of glucoridation 3. ?? D. others EIEC. HCC with or without cirrhosis B.shigella. SSRI c. unlikely cause of isolated hyperbilirubinemia: A. sparing of sclera D. Superior mesenteric artery B. abdominal rigidity c. greenish discoloration of skin B. Hepa B is ssDNA C. (+) Rovsing’s sign 27. Desipranozasine d. conjugation of bilirubin to glucoronic acid B. Conversion of biliverdin to bilirubin C. Prescription drugs B. B cell lymphoma D. Payawal 7. dd D. OCP hepatotoxic effects: A. collateral venous C. Hepa D D. female. Hepatic adenoma D. adult and elderly B. Superior vena cava obstruction A. Basolateral iron transporter A. bridging fibrosis D. Elevated serum bilirubin B. HBV DNA (+). 35. Acylglucoronide. Detoxification. Venoocclusive disease D. HbeAg (+). Hepa B B. every 5-7 years C.Cardio. AA B. Hepa E E. 10 D. Schistosomiasis 16. Anti-HbSag (+). Down regulation of PPAR D. Ferritin D. Viral Hepatitis which causes a risk fatality among the pregnant A. Fulminant: acetaminophen 19. bulging flanks B. 35. Underlying Disease 18. 9. PPAR can induce FPA and transport genes B. Down regulation of SREB 15. 7. Budd Chiari B. alt 50. frequent in males D. Best marker for liver injury: A. bilirubin C. common in OCP users C. Transport Environmental Factors: Age. not needed 9. pulsatile liver D. DMTI 12. female. HbeAg (-) C. HBV DNA (+) B. with liver cirrhosis 11. EPO 24. Mitochondrial Effects Genetic Factors: Drug metabolism. no need for therapy: A. Pathophysiology of liver cirrhosis except: A. PPAR can induce synthesizing FPA C. hepatic vein thrombosis C. Glycogen Storage Dse C. macrovesicular steatosis B. intrahepatic cholestasis 20. alt 150. HBV DNA (-). 35. Risk factor for development of drug induced liver injury except: A. Hema. HbeAg (-) D. Ferroportin B. every year B.Gastro (Definitive) 1st sem 2013 A. elevated AP C. Serum albumin B. aa C. Portal vein thrombosis 22. Alcohol induced cirrhosis C. 35. True about alcoholic liver disease except: A. Cholestasis except: A. irreversible liver damage 14. worse prognosis than other HCC E. Transferrin C. venous hum 10. convert NAD to NADH C. True of Alcoholic liver injury: A. children. can be caused by lymphoma 21. Causes of liver cirrhosis except: A. Hepa C C. (+) HbsAg. every 10-15 years D. TB D. DD NOTE: The risk factors are: Toxic potential of drugs: Reactive Metabolite. Fibrolamellar HCC: A. Wilsons disease B. microvesicular injury 23. alt 150. Sex. Hepa A 17. female. AOTA . Which of the conditions does hepatic venous pressure do not correlate with actual portal pressure? A. Factors 2. increases peripheral transport of fatty acids B. female. -C. H. scleroderma B. collapsed reticulin network B.caused by DNA Gastric adenocarcinoma.antral predominant gastritis Gastric ulcer-6 to 8 weeks of treatment Advanced age-established risk factor for pud Ketoprofen. Oxyntic cells: Fundus and Body 20. Hema. short bowel syndrome C. may be due to reactivation of chronic or acute hepatitis FINALS – Dr.linitis plastics or leather bottle appearance Esophageal cancer-chronic gastric reflux (barretts esophagitis) Gastric cancer-mc adenocarcinoma (85%) Esophageal cancer.B symptoms: unexplained weight loss of >10% body weight recurrent fever -night sweats Gastric adenocarcinoma. Why? A. except A. Pylori may result in complete regression of tumor Traditional NSAID + PPI if GI risk warrants gastric protection Other causes of elevated gastrin: H. Histopathological diagnosis 50. esophageal ring C. True of Hepa C virus except: .arises from GU pacemaker cells Breast-mc metastatic site of stomach cancer Fundus&body. CEA for high risk individuals D. Caused by DNA virus B. Regenerating nodule D. hypertensive motor disorder 3.b cell in origin Primary gastric lymphoma. Anti-HbsAG 27. Duodenal ulcer tx: Omeprazole 20mg BID + Clarithromycin 500g BID + Amoxicillin 1g BID or Metronidazole 500 mg BID for 10-14 days 49. Pylori infection and used of anti secretory agents for ulcers Esophageal atresia with TEF distal . ALT 250 HBeAG (-)/ HBV DNA (+) C. True of protocol for liver cancer screening except: A. ALT 150. presence of massive necrosis with only portal tract visible D. Caused by?? 26.not included in folded type of gastritis . due to reactivation of chronic or acute hepatitis 28. Lapuz 1.malignancy is rare Somatostatin-inhibitor of gastric acid secretion Duodenal ulcers.most common Crohn disease. Bird beak appearance on esophagogram: A. For patient with HBsAg who does not need treatment: A. destruction of intestinal mucosal function and structure D. Extensive fibrosis C. Pylori seg??? – MALT 25. Irreversible chronic injury of hepatic parenchyma B. Pathophysiology of liver cirrhosis.Gastro (Definitive) 1st sem 2013 25.Cardio. alpha feto protein measurement every 6 months B. Pylori treatment. hepatic failure in 6 months C. 73 y/o male underwent surgery due to intestinal ischemia and gangrene.most harmful Ibuprofen-least harmful H. achalasia D. True of chronic hepatitis EXCEPT: A. later on develop malabsorption.oxyntic cells are located Duodenal ulcers. HBeAG (+)/ HBV DNA (+) B.post radiation therapy Non-hodgkins lymphoma-mc type of gastric lymphoma. intestinal obstruction 2. bacterial overgrowth B.10 to 14 days of antibiotic therapy Eradication of H.mc route of spread is hematogenous GIST. Fulminant Hepatitis includes all of the following except: A. ALT 20 HBeAG (-)/ HBV DNA (-) D. Caused by RNA virus C. Gastro (Definitive) 1st sem 2013 Congenital anomalies arises from Vertebral. renal.most commonly used in primary gastrinoma Scleroderma.esophageal dysfunction .decreases LES pressure Achalasia. limb system Endoscopic Ultrasound (EUS) .Cardio. anal.bird beak appearance Bernstein test/ acid perfusion test. cardiac. esophageal. Hema. tracheal.least effective in diagnosing GERD CREST syndrome .