Neoplasia and Blood Disorders

Questions

DIRECTIONS: Each item below contains a question or incomplete statement followed by suggested responses. Select the one best response to each question.

91. A 48-year-old white woman has what she believes is a suspicious lump in her breast, but a mammogram does not reveal any suspicious lesions. Truthful statements concerning potential pitfalls in management and diagnosis include a. Assuming that mammography is "diagnostic"

b. Assuming that a radiographic lesion seen on mammography is the same as a palpable lesion c. Letting a negative or nonsuspicious mammogram influence the judgment of whether a palpable mass needs to be biopsied d. Assuming that a benign aspiration cytology is definitive

92. A 55-year-old man has lung cancer in the right middle lobe. Which paraneoplastic syndrome is associated with GHRH secretion and lung cancer?

a. Hypocalcemia b. Hypocortisolemia c. Hypophosphatemia d. Acromegaly e. Gynecomastia

93. A 30-year-old man has pain in the left scrotum. What is currently valid concerning types of tumor?

a. Alpha fetoprotein (AFP) is only elevated in seminomas.

c. Lactate dehydrogenase (LDH) is an important marker to follow tumor progression or regression.

d. Human chorionic gonadotropin-P subunit (P-hCG) is only elevated in semi-noma.

94. In a patient with multiple enlarged lymph nodes, which should be biopsied?

a. Groin nodes b. Nodes in the axilla c. Superficial cervical nodes d. Periaortic lymph node with CT guidance

95. The etiology of chronic lymphocytic leukemia (CLL) is a. Due to radiation b. Due to a retrovirus c. A familial disease d. Unknown

96. Which of the following is not a major example of inherited susceptibility to cancer?

a. Li-Fraumeni syndrome b. Familial polyposis coli c. Familial retinoblastosis d. Peutz-Jeghers syndrome

97. A 22-year-old man comes to the emergency room of your hospital because he has a diffuse, erythematous rash involving nearly all of his body His total WBC count is greater than 100,000 cells/mm3. He also complains of bone pain, severe irritability, weakness, fatigue, nausea and vomiting, constipation, photophobia, and polyuria. His electrocardiogram (ECG) shows shortening of the QT interval, prolongation of the PR interval, and nonspecific T wave changes. The most likely cause of his symptoms is a. Hypercalcemia b. Hypocalcemia c. Hypophosphatemia d. Hyperkalemia

98. A 45-year-old white man with a limited small cell lung cancer presents to the emergency room of a local hospital and exhibits agitation and confusion, ataxia, nystagmus, peripheral sensory loss, and generalized weakness. The most likely etiology of this disorder is a. Hypercalcemia b. Paraneoplastic syndrome c. Cerebral vascular accident d. Myasthenia gravis

99. A 52-year-old white woman with breast cancer receiving adjuvant therapy presents with back pain that intensifies on movement and pain over the L1 vertebral body when she coughs and that radiates down her left lower extremity to her leg and foot. The most likely etiology of this disorder is a. Paraneoplastic disorder b. Trauma to the lumbar disk c. Muscular spasm of the intercostal muscles d. Possible spinal cord compression

100. In the aforementioned patient, the most effective initial treatment is a. Intravenous Decadron (dexamethasone)

b. Orthopedic consultation c. Physical therapy techniques d. Intravenous narcotics

101. A 66-year-old white woman with a known history of small cell lung cancer comes to your office because of engorgement of her neck veins on the right side and over her chest wall. She also has cyanosis of the extremities, facial edema, and difficulty with her mentation. Her diagnosis is most likely a. Congestive heart failure b. Lymphatic obstruction of the upper body c. Superior vena cava syndrome d. Deep venous thrombosis

102. The multistep theory of carcinogenesis can be applied to what form of cancer?

a. Head and neck cancer b. Breast cancer c. Lung cancer d. Colorectal cancer

103. Platelet production (thrombopoiesis) is affected by more than one cytokine. Which of the following sets seems to be the most important in platelet development?

a. IL-3, granulocyte colony-stimulating factor (G-CSF), and granulocytemacro-phage colony-stimulating factor (GM-CSF)

b. IL-4, IL-6, and thrombopoietin c. Erythropoietin, thrombopoietin, and IL-6

104. Which of the following factors complexes with factor VIII, which is activated to factor VIIIa when released from the complex?

a. Factor XIII

b. High molecular weight kininogen c. Von Willebrand factor (vWF)

d. Thromboplastin e. Plasminogen

105. Which of the following factors depends on platelets for synthesis?

a. Factor II (prothrombin)

b. Factor VII (proconvertin)

c. Protein S

d. Factor XIII (fibrin-stabilizing factor)

e. Factor X (Stuart-Prower factor)

106. Which of the following causes of anemia is associated with micro-cytosis?

a. Folic acid deficiency b. Therapy with zidovudine (AZT)

c. Hypothyroidism d. Alcohol e. Thalassemia

107. Which of the following causes of an elevated hemoglobin concentration in the blood is characterized by a LOW level of erythropoietin in the blood?

a. Chronic tobacco smoking b. Dwelling at high altitudes, such as in the Andes c. Erythrocytosis associated with renal tumors d. Primary polycythemia (polycythemia vera)

e. Erythrocytosis secondary to chronic pulmonary insufficiency

108. Which of the following causes a leukocytosis without an increase in the number of circulating polymorphonuclear neutrophil leukocytes?

a. Acute infection b. Release of epinephrine c. Tissue necrosis d. Myelocytic leukemia e. Collagen vascular disease

109. In a typical case of iron deficiency, which of the following molecular forms that contains or can bind to iron increases in the patient's serum?

a. Hemoglobin b. Ferritin c. Hemosiderin d. Myoglobin e. Transferrin

110. Which of the following disorders is associated with thrombocytosis?

a. Disseminated intravascular coagulation b. A plastic anemia c. Postsplenectomy d. Hypersplenism e. Prosthetic valves

111. A 47-year-old man walks into the emergency room because of feeling very weak, tired, short of breath, and dizzy. He has numbness and tingling of his fingers. He appears pale and sallow. On examination, his heart rate is 132. His sclerae and nailbeds are pale. His heart is enlarged and he has dependent edema of his ankles. Laboratory findings include a negative Coombs' test and a hemoglobin of 4 g/dL. The likely diagnosis is a. Traumatic hemolytic anemia b. Autoimmune anemia c. Blood loss d. Pernicious anemia e. Iron-deficiency anemia

112. Most drugs induce thrombocytopenia by which mechanism?

a. Marrow-depressing effect b. Directly cytotoxic of platelets c. Depress megakaryoctye production d. Immune response in which the platelet is damaged by complement activation e. Impair megakaryoctye production

113. Which of the following statements related to circulating erythrocytes (red cells) is untrue?

a. The nuclei of the precursor cells to erythrocytes are extruded from their cells shortly before the red cells leave the bone marrow. Consequently, the presence of nucleated red cells in the peripheral blood should be regarded as abnormal and may indicate an underlying disease state.

b. In a thin blood smear stained with Romanowsky's stain (such as Wright's stain), the youngest cells (reticulocytes) can be recognized by a blue coloration (baso-philia) as different from most of the red cells present.

c. The average diameter of erythrocytes is about 8 |J,m; consequently, they cannot flow through the smaller capillaries that have a diameter of 2 to 4 |J,m.

d. The protein of hemoglobin, which is the principal constituent of the red cell contents, is in tetrameric form, with two a and two P subunits.

e. The iron atom of the hemoglobin molecule, which is essential to its function of carrying oxygen, is an intrinsic part of the heme complex attached to each subunit of protein.

114. Which of the following statements concerning the relationship of the neutrophil polymorphonuclear leukocyte (PMN) to infection with bacterial pathogens is incorrect?

a. The principal functions of the PMN are expressed in the tissues and not usually in the bloodstream, which is simply the transport path of the cells to their required site of action.

b. The cytoplasmic granules of PMN are essentially inert, but metabolically have only a vegetative role in maintaining cell viability.

c. When the cell numbers of PMN are reduced significantly, the probability of severe bacterial infection can be greatly increased.

d. The average duration of the period of circulation of PMN after entering the bloodstream is about 6 to 8 h.

e. An increasing need for PMN produced by infection is met in part by large numbers of immature cells (especially band cells) being released from the marrow pool into the bloodstream.

115. Which pathologic cells in a stained blood film have appearances very similar to those of normal mature white cells or their precursors?

a. Chronic lymphocytic leukemia (B cell type)

b. Chronic myelocytic leukemia c. Lymphoblastic leukemia d. Hodgkin's disease e. Non-Hodgkin's disease

116. On karyotyping, a well-defined chromosomal abnormality is patho-gnomonic of which condition?

a. Chronic lymphocytic leukemia (B cell type)

b. Chronic myelocytic leukemia c. Lymphoblastic leukemia d. Hodgkin's disease e. Non-Hodgkin's disease

117. Which condition customarily terminates by transition to a blast cell phase with similarities to acute leukemia?

a. Chronic lymphocytic leukemia (B cell type)

b. Chronic myelocytic leukemia c. Lymphoblastic leukemia d. Hodgkin's disease e. Non-Hodgkin's disease

118. The principal complication of which condition is susceptibility to infection?

a. Chronic lymphocytic leukemia (B cell type)

b. Chronic myelocytic leukemia c. Lymphoblastic leukemia d. Hodgkin's disease e. Non-Hodgkin's disease

119. Which disorder presents mainly as a localized new mass or group of superficial lymph nodes?

a. Chronic lymphocytic leukemia (B cell type)

b. Chronic myelocytic leukemia c. Lymphoblastic leukemia d. Hodgkin's disease e. Non-Hodgkin's disease

120. Which mechanism is responsible for thrombocytopenia in vitamin B12 deficiency?

a. Decreased production b. Maldistribution c. Accelerated destruction d. Decreased survival e. Inherited

121. Which mechanism is responsible for thrombocytopenia in disseminated intravascular coagulation (DIC)?

a. Decreased production b. Maldistribution c. Accelerated destruction d. Decreased survival e. Inherited

122. Which mechanism is responsible for thrombocytopenia in immune (idiopathic) thrombocytopenic purpura (ITP)?

a. Decreased production b. Maldistribution c. Accelerated destruction d. Decreased survival e. Inherited

123. Which mechanism is responsible for thrombocytopenia in any increase in spleen size?

a. Decreased production b. Maldistribution c. Accelerated destruction d. Decreased survival e. Inherited

124. Which mechanism is responsible for thrombocytopenia in throm-botic thrombocytopenic purpura (TTP)?

a. Decreased production b. Maldistribution c. Accelerated destruction d. Decreased survival e. Inherited

125. Which mechanism is responsible for thrombocytopenia in von Willebrand's syndrome?

a. Decreased production b. Maldistribution c. Accelerated destruction d. Decreased survival e. Inherited

126. Which is a protein cofactor that exposes the inactivation site of activated coagulation factor V, which can then be cleaved by a protease?

a. Protein C

b. Protein S

c. Antithrombin III (ATIII)

d. Plasminogen e. Prekallikrein

127. Which is a factor capable of inhibiting the serine protease factors II, IX, X, XI, and XII, a process accelerated by heparin or similar molecules.

a. Protein C

b. Protein S

c. Antithrombin III (ATIII)

d. Plasminogen e. Prekallikrein

128. Which is a vitamin K-dependent factor, activated in the presence of thrombin to cleave activated factors V and VIII.

a. Protein C

b. Protein S

c. Antithrombin III (ATIII)

d. Plasminogen e. Prekallikrein

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