cardio and hema super samplex

Cardio. Hema (Definitive) 1st sem 2013

Dr. Payawal Midterm Exam Sept. 3, 2013

1. Sinus Bradycardia

Regularly occurring PQRST Rate < 60 / min

2. Atrial Flutter

Atrial rate = 220-300/min ( P as flutter waves ) Variable degree of AV block ( irregular RR interval )

3. Premature Atrial Contraction

Prematurely occurring PQRTS complex

P wave different in configuration from the sinus beat

PR interval often long QRS narrow

4. Normal ECG

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

5. Premature Junction Contraction

Prematurely occurring PQRST. Inverted P wave that may precede,

be incorporated within, or may follow the QRS complex.

QRS narrow.


6. Mobitz I

Progressive lengthening of PR interval w/ intermittent drop beats .

7. Atrial Fibrillation

No discernible P waves Irregular RR interval

8. Asystole

hmmmm

9. Ventricular tachycardia, monomorphic

At least 3 consecutive PVC’s Rapid, bizarre, wide QRS

complexes (> 0.10 sec) No P wave (ventricular impulse origin)

10. Mobitz II

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 atrio-ventricular 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 .


11. Torsades de pointes

12. First 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.e. > 0.21 sec )

13. Premature Ventricular complex

Prematurely occurring complex. Wide, bizarre looking QRS

complex. Usually no preceding P wave. T wave opposite in deflection to

the QRS complex. Complete compensatory pause

following every premature beat.

14. Third degree heart block

No recognizable consistent or meaningful relationship between atrial and ventricular activity

QRS complexes often abnormal in shape, 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)


15. Sinus Tachycardia

Regularly occurring PQRST Rate > 100 / min

16. Lateral walllead I NOTE: Lateral wall – Lead I, AVL, V5, V6 Inferior wall – Lead II & 3, AVF Anterior wall – V3, V4 Anterior septal wall – V1, V2 No specific view – AVR

17. 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. The cell membrane is impermeable to entry of sodium ions during which phase of the action potential?

phase 4 (a.k.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. to flow in K cont. to flow out Phase 3 – Rapid repolarization Large amt. of K diffuse out as the K channels open Inactivation of Ca channels

19. ? A 35 y/o F, came in at the ER complaining of

progressive SOB and DOB for the past month. She is non diabetic and non smoker, non alcoholic. On PE she had a BP of 130/95, HR 110/min and RR of 30/min. Her apex beat is displaced at 6th ICS LAAL with a loud S3, no murmurs were appreciated. She had crackles mid to base in both lung fields with a +1 bipedal edema. Her ECG showed:

(sorry no images but PE correlates well with DCMP & Heart Failure) Basis: S3 (indicative of fluid overload)

Crackles, peripheral edema, displaced apex beat point to DCMP

20. The electrical axis on her 12 lead ECG is

A. Right Axis Deviation B. Left Axis Deviation (?) C. Normal D. Extreme right axis deviation

NOTE: Lead I (+), AVF (-) = left axis deviation Lead I (-), AVF (+) = right axis deviation Lead I (-), AVF (-) = right axis deviation 21. Her 12 ECG shows

A. Right BBB B. Right Ventricular hypertrophy C. Left Ventricular hypertrophy (?) D. Left posterior hemiblock E. None of the above

21. Her clinical findings are compatible with a diagnosis of?

A. dilated cardiomyopathy B. rheumatic mitral stenosis C. inferior wall myocardial infarction D. TOF E. Atrial septal defect

22. To confirm your clinical impression you will request: A. TPCK MB B. ASO TITER C. Serum cholesterol D. ECG E. ABG

23. Management would consist of the following except A. Streptokinase B. Captopril C. PTCA (?) D. Digoxin E. A and C F.

24. You would advise the patient to: A. Avoid excessive salt intake B. Undergo open mitral commissurotomy C. Undergo patch closure D. Undergo PTCA E. NOTA

25. What is the prognosis for this type of heart disease?


A. 75% mortality in 5 years B. No improvement if PMC is not done C. Coronary artery bypass grafting should be

performed to prolong life D. Patch closure cannot be done because of

Eisenmenger syndrome E. NOTA

26. What are the expected chest x-ray findings in this patient?

A. normal sided heart B. Interstitial edema C. Boot shaped heart D. Cut off sign of the pulmonary artery

27. ECG monitoring shows

A. Ventricular fibrillation B. Fragments of shivering C. Atrial fibrillation D. Ventricular tachycardia

28. 29. A 60 y/o male, bus driver, hypertensive, 45 pack years of smoking complained of left caudal pain after walking. ANS: clopidogrel + B blocker + stop smoking 30. What antiarrhythmic agent would you give if the patient is successfully resuscitated with BP of 120/90 mmHg?

A. Verapamil B. Nifedipine C. Diltiazem D. Metoprolol

31: Most common location of PAD: A. Abd. aorta and iliac arteries B. Femoral and Popliteal Arteries C. Tibial and Peroneal D. Radial and Brachial

32. Case: 57 year old female, hypertensive, with diabetes, felt claudication with walking of a distance of >200m, relieved with rest. Based on history alone, what is the probable location?

A. Abd. aorta and iliac arteries B. Femoral and Popliteal Arteries C. Tibial and Peroneal D. Radial and Brachial

33. ABI result: Right Tibial 1.4

Right Dorsalis Pedis = 1.3 Left Tibial = 1.1 Left Dorsalis Pedis = 1.0

Interpretation: ANS = Incompressible right lower Ext & Normal Left Lower Ext

NOTE: ABI Classification system >1.3 – incompressible 1.0 – 1.3 – normal 0.90 – 0.99 – equivocal/borderline 0.51 – 0.89 – mild to mod 0.41 – 0.50 – mod to severe <0.40 – severe


Dra. Deduyo Prelims

1. Best antihypertensive with 30 year old patient with asthmatic and heart rate of 110-120 bpm

a. ND CCB c. B Blocker

b. D CCB d.ACEi

2. Female hypertensive, bilateral kidney palpable, abdominal bruit

a. Renal artery stenosis c.Hyperaldosteronism

b. Polycystic kidney disease d.Pheocromocytoma

3. The patient had ECG and Cardiac Bio Markers what other test the patient need immediately to detect CAD?

a. 2D echo c. CXR

b. Coronary angiography d. ----

4. A 28 year old female is hypertensive with a bp of 140/100-160/100. The hypertension had been diagnosed since 4 years ago. which antihypertensive drug is best for a 28 year old fertile female?

a. CCB c. ACEi

b. B blocker d. ARBs

6. 36 y/o, male, non HPN, 5cm ST elevation at I, VL, (sorry dkomaalalamsyado.) troponin of 150 ug/L

a. Stable angina c. NSTEMI

b. Unstable angina d. STEMI

8. -----A 62y/o male was admitted due to severe progressive chest pain. He is hypertensive with COPD because of chronic smoking. BP is 160/90 to 166/100. ECG revealed sinus tachycardia with Tall & Peaked T wave. Troponin T is Negative.

a. Chronic stable angina pectoris c. NSTEMI

b. Unstable angina pectoris d. STEMI

9. A 60 y/o patient complained of severe progressive chest pain. Bp is 180/110mmhg. ECG revealed LBBB, (+) Troponin T

a. Chronic stable angina c. NSTEMI


10. 70 y/o, male, (+) DM and HPN, continuous(?) severe chest pain, ST depression at II, III, V3, V4, V5 , VL(?), positive troponin after 6 hours

a. Stable Angina c. NSTEMI


13. Which is a contraindication for a trhombolytic therapy in ACS?

a. CVA hemorrhage c. ST elevation….

b. 180/100 d. ST elevation……

15.This is the common cause of death in acute coronary syndrome.

a.Heart failure c. Ventricular fibrillation

b. Pneumonia d. Sinus tachycardia

16. A 40 year old male, athletic, hypertensive but can do regular gym activities without any cardiac symptoms

a. Stage A c. Stage C

b. Stage B d. Stage D

20. 61 y/o male with orthopnea, fatigue and dyspnea - diabetic with insulin treatment. With dilated ischemic Cardiomyopathy

a. Stage A c. Stage C

b. Stage B d. Stage D


1. Endocarditis prophylaxis is indicated in the ff: A. prosthetic heart valves B. previous infective endocarditis C. VSD D. HOCM E. all of the above

2. Most common site of metastasis in the heart a. pericardium (ans) b. myocardium c. endocardium

3. Tx of Choice for ACS – CABG

Dr. Bartolome Prelims B1 2) Most common site of cardiac metastasis a. Pericardium 3.) DM in CVS a. CAD leading cause of death in DM b. MI tend to be larger c. abnormal pain response to MI d. all e.b& c 5.) A holosystolic murmur in left sternal border radiating to the right. a. Tricuspid regurgitation b. VSD c. both d. neither

7.) 68 y/o male patient was noted to have systolic murmur at the apex of the heart which radiates to the carotids. Which of the following is unusual in severe aortic stenosis? A. Dyspnea B. Exertional syncope C. Angina D. Hypertension 8.) 28 year old female; bp of 140/40 (kulang ata itong given sa Q) a. pulsus parvus et tardus b. head bobbing 9.) 35 year old, female, with dyspnea and orthopnea, RV heave, diastolic rumbling murmur at 5th ICS MCL A. Tricuspid Stenosis B. Mitral Stenosis C. Aortic regurgitation D. Pulmonary Stenosis

23. Gold standard for the diagnosis of heart failure?

a. ECG c. 2D echo Doppler

b. CXR d. pro BNP

26. NC 30y/o, call center agent, with no previous medical illness complained of daily bilateral leg heaviness while at work. Elevating the legs or walking would temporarily relieve the symptoms. While playing basketball, he tripped and fell landing on his left leg. He was brought to the hospital for treatment. The leg x-ray is negative for fracture. He was sent home with NSAIDS. 3days later the patient noticed the entire left leg is swollen. He was brought to ER for evaluation and treatment. On measurement the right ankle is 21cm, calf is 38cm and thigh is 50cm. On the left lower ex, the ankle measures 25cm, calf is 44cm, thigh is 54cm. Wells score is 4. Your working impression is DVT. What initial test will you do next?

a. Venograph c. Venous duplex scan of LE

b. D-dimer d. CT scan of LE e. MRA

28. Non invasive procedure to rule in pulmonary embolism: ANS VQ scan

29. Confirmed pulmonary embolism on left lung, what is the best tx. of choice

a. Direct catheter thrombolytics c. -----

b. Systemic thrombolytics d. LMW and Dabigatran

Cardio. Hema.Gastro (Definitive) 1st sem 2013

10) Graham Steell murmur high pitch decrescendo diastolic blowing murmur noted @ Left upper sternal border due to: a. Aortic Regurgitation b. Aortic Stenosis c. Pulmonic Stenosis d. Pulmonic Regurgitation 14) Definition of pulsus paradoxus is a. inspiratory decline in systolic arterial pressure b. patch of dullness above the left scapular space c. delayed carotid upstroke 15.) A 45 y/o female patient was brought to the ER due to dyspnea. She is known to be diagnosed with breast malignancy. Cardiac Tamponade is suspected. Which is not a manifestation of Cardiac Tamponade? A. Increased arterial pressure B. Neck vein engorgement C. Faint heart sounds D. Pulsus paradoxus 18.) PDA except? A. Loud S1 & S2 B. Differential Cyanosis C. Machinery Murmur D. AOTA 19.) A 35 year old male - pleuritic chest pain radiating to the trapezius ridge on auscultation, grating sound. What is the ECG finding? A. Widespread ST elevation with concavity B. (something about sa QRS) C. (something about sa Q wave) 21.) A 53 year old male in the ER presented with neck vein distention, ascites, bipedal edema. No S3 no murmur with Kussmaul's sign. The patient most likely has: a. cardiac tamponade b. acute pericarditis c. constrictive pericarditis d. tricuspid regurgitation 23) Radiologic finding of mitral stenosis (MS)? A. water bottle shaped (pericardial effusion) B. "3 sign" (COA) C. boot shaped, normal sized heart (TOF)

D. Dilated left atrium, normal sized ventricle 26.) What is the most common location of syphilitic aneurysm? ANS: ascending aorta

1. Most common site of acute aortic dissection A. ascending aorta B. aortic arch C. infra abdominal aorta D. descending aorta E. supra abdominal aorta 5. Clinical criteria Takayasu arteritis A. age < 40 B. systolic BP? >40 C. Brachial artery... D. Carotid pulse.... 8. Dynamic maneuver to make MVP murmur click sound earlier? A. Standing (early) B. Squatting (late) C. Isometric (late) D. Valsalva's (late) 9. Valvular murmur that increases during inspiration? A. Standing (early) B. Squatting (late) C. Isometric (late) D. Valsalva's (late) 15. Routine antimicrobial prophylaxis needed, EXCEPT A. AR B. MVP C. PDA D. VSD 18. True of PDA A. murmur s1 to after s2 upper sternal border B. machinery like murmur C. differential cyanosis may be present D. AOTA E. B&C ECG in acute pericarditis widespread ST-segment elevation 20. Radiologic finding in mitral stenosis A. water bottle


B. “3” sign C. boot shaped D. Large atrium and normal ventricle 26. 45 yo F, hx of breast ca w/ cardiac tamponade. Features of cardiac tamponade EXCEPT: A. Increased arterial pressure B. Neck vein distention C. Faint heart sounds D. Pulsus paradoxus 30. Relationship of DM and cardiovascular disease A. Most common cause of death in DM is coronary artery disease B. In DM, MI is larger in size C. Abnormal pain response to myocardial ischemia D. All of the above 1.Most common site of acute aortic dissection a. ascending aorta b. aortic arch c. infra abdominal aorta d. descending aorta e. supra abdominal aorta 2. Clinical criteria Takayasu arteritis a. age <40 b. systolic BP ?>40 c. Brachial artery… d. Carotid pulse.... 3. Dynamic maneuver to make MVP murmur click sound earlier? A. Standing (early) b. Squatting (late) C. Isometric (late) D. Valsalva's (late) 4. Valvular murmur that increases during inspiration? A. Standing (early) B. Squatting (late) C. Isometric (late) D. Valsalva's (late) 5. Routine antimicrobial prophylaxis needed, except A. AR B. MVP C. PDA D. VSD

7. ECG in acute pericarditis ANS widespread ST segment elevation 11. Loud S1, diastolic rumbling: A. AS B. MS C. MR D. AR 12. Systolic murmur radiating to axilla: A. AS B. MS C. MR D. AR 13. Normal LV, dilated LA: A. AS B. MS C. MR D. AR 14. Most common organism found in the blood culture after dental procedure A. S. viridans B. S. pneumonia C. Chlamydia D. S. aureus 15. Common sign to LV diastolic dysfunction a. Dyspnea on exertion b. Chest pain on exertion c. Easy fatigability d. Palpitation

1. Key in the classification of anemia a. Coomb’s test c.Reticulocyte count b. BMA d.all 2. Principal site of hematopoiesis at birth a. yolk sac (embryo) b. liver (embryo) c. spleen (fetus) d. bone marrow (at birth) 3. Most common infection preceding aplastic anemia


a. Infectious mononucleosis b. Hepatitis c. Parvovirus B19 d. EBV 4. Characterized by anemia, reticulocytopenia and absent or rare erythro precursor cells in the bone marrow a. pure red cell aplasia b. aplastic anemia c. myelodysplastic syndrome d. megaloblastic anemia 5. A clonal hematopoietic stem cell disorder characterized by cytopenia associated with dysmorphic usually cellular bone marrow and ineffective erythropoiesis a. pure red cell aplasia b. aplastic anemia c. myelodysplastic syndrome d. paroxysmal nocturnal hemoglobinuria 6. The presence of the ff. cells is suggestive of leukoerythroblastic anemia EXEPT a. nucleated red cell c. target cells b. tear drop shaped cell d. immature white cell 7. Earliest least developed stem cells a. Pluripotent stem cell b. multipotent stem cell c. erythroid progenitor cell d. granulocyte progenitor cell 8. Earliest precursor of RBC that is recognizable morphologically a. promegakaryoblast b. proerythroblast a.k.ka. pronormoblast c. promyelocyte d. myeloblast (earliest for granulocyte) 9. Treatment for anemia of endocrine disorder a. bone marrow transplant b. glucocorticoid c. androgen

d. correction of underlying endocrine disorder 10. Pancytopenia with hypocellular bone marrow a. pure red cell aplasia b. aplastic anemia c. myelodysplastic syndrome d. megaloblastic anemia 11. Anucleated hematopoietic stem cell a. RBC c. both b. platelet d. neither 12. Red cell morphology of anemia of renal origin a. Normocytic, normochromic b. microcytic, hypochromic c. macrocytic, hypochromic d. normocytic, hyperchromic 13. Treatment of choice for anemia of renal origin a. Erythropoietin c. androgen b. Glucocorticoids d. G-CSF 14. Cell membrane defect in PNH (Paroxysmal Nocturnal Hemoglobinuria) a. depletion of CD 55 c. both b. depletion of CD 59 d. neither 15. Major physiologic regulator of RBC production a. erythropoietin c. granulopoietin b. thrombopoietin d. all 16. RBC morphology of severe iron deficiency anemia a. normocytic, normochromic b. microcytic, hypochromic c. macrocytic, hypochromic d. normocytic, hyperchromic 17. Most common cause of cobalamin deficiency caused by absence of intrinsic factor from autoimmune dysfunction a. post gastrectomy b. pernicious anemia c. hypothyroidism d. alcoholism


18. Main site for folate absorption a. duodenum c. jejunum b. ileum d. cecum 19. Main site for iron absorption a. duodenum c. jejunum b. ileum d. cecum remember: IFB DJI (I’m on Facebook, Do Join It) I – iron D – duodenum F – folate J – jejunum B – B12 and bile acids I – ileum 20. Main iron transport protein a. transferrin c. both b. ferritin d. neither 21. Major source of iron utilized for erythropoiesis a. senescent RBC c. both b. iron from fat d. neither 22. The following conditions may result to increased iron loss a. Phlebotomy as treatment for polycythemia vera b. pregnancy c. infancy d. chronic inflammation 23. Definitive treatment for aplastic anemia a. bone marrow transplant b. splenectomy c. chemotherapy d. radiation therapy 24. The major convenient lab test to estimate iron storage a. serum iron c. iron stains b. serum ferritin d. TIBC 25. A reticulocyte index of < 2.5 indicates a. hemolytic anemia b. anemia from acute bloos loss c. hypoproliferative anemia

d. all 26. Microcytosis is reflected by a a. lower MCV c. lower RDW b. lower MCHC d. lower MCH 27. Most common form of hypoproliferative anemia a. anemia of renal disease b. anemia of acute and chronic inflammation c. anemia of endocrine disorder d. aplastic anemia 28. Presence of significant MACROcytosis is suggestive of: a. iron deficiency anemia b.. b thalassemia c. MEGAloblastic anemia d. all 29. A cell directed carrier protein for cobalamin a. transferrin b. intrinsic factor c. ferritin d. ceruloplasmin 30. Deficiency of this vitamin is almost always due to malabsorption a. cobalamin c. iron b. folate d. all

1. Diagnosis of AML is established by the presence of: a. >10% myeloblast in the bone marrow b. >20% myeloblast in the bone marrow c. >5% myeloblast in the bone marrow d. <5% myeloblast in the bone marrow 2. FAB classification of erythroleukemia a. M3 c. M5 b. M4 d. M6 3. Leukemia with the high risk to develop DIC


a. AML M2 c. AML M4 b. AML M3 d. AML M5 4. Immunophenotypic feature of AML cells a. expression of CD 13 and 33 b. expression of CD 3 c. CD 19 and 20 d. CD 7 & CD 10 5. Treatment of AML M3 a. Hydroxyurea b. 7+3 chemotherapy c. ATRA d. high dose cytarabine 6. Cytochemical stain that favors AML and ALL a. (+) myeloperoxidase b. (-) myeloperoxidase c. (+) Periodic Acid Schiff (PAS) d. (-) Periodic Acid Schiff (PAS) 7. Immunophenotypic feature of AML 7 a. expression of CD 13 b. expression of CD 41 c. expression of CD 19 d. expression of CD 7 8. Earliest precursor of granulocyte recognizable by light microscopy a. promyelocyte c. myelocyte b. myeloblast d. proerythrocyte 9. Treatment of choice for relapse cases of AML a. Doxorubicin & cytarabine c. Splenectomy b. Glucocorticoids d. stem cell transplant 10. NOT a feature of retinoic acid syndrome a. occur during the first three weeks of treatment b. (+) fever, dyspnea, chest pain c. related to adhesion of differentiated neoplastic cell to pulmonary vasculature d. glucocorticoids not usually effective 11. Causes of absolute lymphocytosis, EXCEPT: a. COPD

b. Polycythemia vera c. diuretic use (a relative cause, not absolute) d. hepatoma 12. Treatment of essential thrombocytopenia that is selective to platelet and platelet precursor a. Anagrelide c. Salicylates b. Hydroxyurea d. Interferon 13. Erythropoietin level of patient with Polycythemia vera a. high c. normal b. low d. all 14. Neoplastic expansion of hematopoietic cell in blood and bone marrow. a. lymphoma c. sarcoma b. leukemia d. hemangioma 15. Most common presenting sign of Polycythemia vera a. splenomegaly c. digital gangrene b. vertigo d. pallor 16. NOT a criteria of clinical diagnosis of essential thrombocytosis a. platelet count <500,000/uL b. (-) Ph chromosome c. (-) myelofibrosis d. (-) known cause of selective thrombocytosis 17. Philadelphia chromosome (+) a. ALL c. both b. CML d. neither 18. Cytogenic hallmark of CML a. 15:17 c. 16 b. 9:22 d. Ba:22 19. NOT a hematologic finding onf CML a. elevated WBC leftward shift b. Low Lap score c. Neutropenia d. normal to elevated platelet count


20. Tyrosine kinase inhibitor that induce cytogenic remission in CML patients a. Hydroxyurea c. Busulfan b. Imatinib mesylate d. Anagrelide 21. Origin of majority of lymphoid leukemia and lymphoma a. T-cell c. NK cell b. B-cell d. plasma cell 22. FAB class of ALL with small uniform lymphoblast a. L1 c. L3 b. L2 d. all NOTE: L1 small uniform lymphoblast L2 lymphoblast size varies L3 uniform large lymphoblast with vacuolation 23. Causes of anemia and thrombocytopenia in CLL a. progression marrow infiltration b. autoimmune phenomenon c. hypersplenism d. all 24. A potentially cardiotoxic chemotherapeutic agent to acute leukemia a. Anthracycline (Doxorubicin) b. Prednisone c. Imatinib d. Vincristine 25. Recognition of diagnosis of Reed-Strenberg (RS) cells is diagnostic of a. Non-hodgkins c. Myeloma b. Hodgkin’s d. Leukemia 26.Indication of CLL therapy a. Thrombocytosis b. Asymptomatic lymphositosis c. Richter transformation d. Autoimmune hemolytic anemia 27. NOT an indication for CLL therapy a. Thrombocytopenia

b. Asymptomatic lymphocytosis c. Richter transformation d. 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. Neoplastic proliferation of mature lymphocytes in blood, marrow, and lymphoid tissue a. ALL (if immature) c. AML b. CML d. CLL (mature) 29. Solid tumor of the immune system a. Leukemia b. Sarcoma (solid tumor of soft tissues) c. Lymphoma (solid tumor of immune system) d. Hemangioma 30. Most common malignancy of pediatric population ALL (Acute Lymphoblastic Leukemia)

1. Factor VIII deficiency: a. Hemophilia A b. Hemophilia B (factor 9 def.) c. Hemophilia C (factor 11 def.) d. all 2. Vit. K deficiency, EXCEPT: a. Factor II c. Factor XII c. Protein C & S d. Factor XI NOTE: Vitamin K dependent clotting factors are:


II, VII, IX, and X; protein C and S Vit.K dependents are also the ones affected by WARfarin (9,10,7, and 2 1972; there was WAR in 1972) whereas heparin and related compounds increase the action of antithrombin on thrombin and factor Xa 3. Vitamin K antagonist a. Heparin c. Streptokinase b. Warfarin d. Aspirin 4. Enzyme cyclooxygenase resulting to thromboxane A2 inhibit synthesis a. NSAID c. Ticlopedine b. Aspirin d. Heparin 5. Plasma protein derivative that inactivates factor V and VIII a. Antithrombin III (AT III) b. Plasmin c. Protein C d. Heparin 6. Safest replacement therapy for bleeding patients with liver disease a. cryoprecipitate b. cryosupernate c. platelet concentrate d. FFP (fresh Frozen Plasma) 7. Critical events necessary for effective primary hemostasis a. platelet adhesion b. granule release and secretion c. platelet aggregation d. all 8. Most common cause of isolate thrombocytopenia that results from action of anti-platelet antibody coating the platelet a. Megakaryocytic thrombocytopenic purpura b. ITP (Idiopathic Thrombocytopenic Purpura c. TTP

d. Vascular purpura 9. Test to distinguish Hemophilia A from Hemophilia B: a. Bleeding time b. Urea clot lysis test (is a screening test for factor 13, if positive, it is diagnostic for factor 13 deficiency) c. Mixing test (performed if screening test is prolonged) d. Specific factor assay (distinguishes Factor 8 from F9) 10. Treatment with curative intent in CML a. Hydroxyurea b. Interferon c. Allogenic SCT (Stem Cell Transplant) d. Prednisone 11. A non-alkylating, myelosuppresive chemotherapeutic drug a. Anagrelide c. ASH b. Hydroxyurea d. Interferon 12. Clinical manifestation of Pancytopenia, EXCEPT: a. pallor c. sepsis b. bleeding d. thrombosis

Additional: 1.MCV 120 Macrocytic 2. Reticulocyte index of 4 means bone marrow is responding to anemia 3. Low/absent iron stores Iron Deficiency Anemia 4. End product of Secondary hemostasis fibrin clot formation 5. Factor II aka Prothrombin 6. Definitive treatment for Chronic ITP splenectomy


7. General signs and symptoms of anemia is due to low affinity of hemoglobin to O2 8. Main treatment of choice for Anemia of Chronic Renal disease/insufficiency Erythropoietin (EPO)

1. Laboratory finding seen in anemia in chronic disease, EXCEPT: a. low serum protein b. inc. red cell protophorpyrin c. hypocellular marrow d. dec. serum ferritin 2. Café au lait spot, short stature, thumb abnormality Fanconi Syndrome 3. First line treatment of AIHA: a. Rituximab b. Splenectomy c. transfusion of RBC d.corticosteroids 4. Hereditary spherocytosis, EXCEPT: a.jaundice b. splenomegaly c. gallstones d. pancreatitis 5. Hereditary spherocytosis, EXCEPT: a.jaundice b. splenomegaly c. gallstones d. hemoglobinuria 6. True about hemolyticanemia,except: Low reticulocyte index 7. Red blood cell index/indices for red cell size a. MCV b. MCH c. MCHC d. RDW NOTE: MCV – average red blood cell size MCH – amount of hemoglobin per RBC

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. A 40 year old male complained of anemia with a history of 5 year post-gastrectomy due to BPUD. What is the most likely cause of his anemia: a. iron deficiency b. folate deficiency c. Vit.b12 deficiency/Megaloblastic anemia d. anemia of chronic disease 9. True regarding Hemolytic anemia except: a. premature destruction of RBC b. Detected by decrease reticulocyte count c. increase red cell production d. usually presented with pallor or jaundice

Hematology Recalls Midterm Exam Dr. Samson-Cruz Sept. 3, 2013 1. 60 y/o male with leukocytosis. WBS is marked.... A. melphalan 3. Ascites, svc obstruction, EXCEPT

a. Bulging flanks b. – c. Everted umbilicus d. Pulsatile liver e. Venous hum

A,c,d,e are correct 4. Few weeks onset of easy bruising, pale, hepatosplenomegaly,ecchymosis, PBS normochromic,normocytic RBC, dec WBC predominantly myeloblast, dec platelet

A. AML B. ALL C. CML D. CLL


5. 60 years old, low back pain, cough, pale conjunctiva, CXR- infiltrates

A. AA B. BMA & Biopsy C. SPEP D. Serum B2 macroglobulin

6. The most common sign of Myeloproliferative dse: ANS: Splenomegaly 8. Cytogenic hallmark of CML Chromosome t(9:22)

A. Chromosome t(17:22) B. Chromosome t(22:9)

9. Polycythemia vera

A. erythrocytosis B. leukocytosis C. BMA mandatory D. red cell mass to differentiate absolute

versus relative 10. Intrathecal CNS treatment:

A. ALL B. AML C. CML D. CLL

11. MC hepatotoxic drug

A. prescription B. environmental toxin C. metabolites of Cyp450 D. metabolites of glucuronidation

12. WHO cutoff for blast count for AML

A. 20% B. 40% C. 30% D. 50%

13. Stain that do not react with lymphoblasts except

A. Myeloperoxidase B. Sudan Black C. Non-specific esterase

D. PAS 14. Treatment of asymptomatic essential thrombocytosis

A. Aga B. Aspirin C. Hydroxylurea D. None

15. true of chronic idiopathic myelofibrosis except:

1. clonal disorder of multipotent hematopoietic progenitor cell of unknown etiology characterized by marrow fibrosis, myeloid metaplasia, with extramedullary hematopoiesis and splenomegaly

2. same manifestation with PV and CML 3. Hydroxyurea is the only treatment for

children 16. True of PV except:

A. Clonal disorder involving a multipotent hematopoietic progenitor cell in which there is accumulation of phenotypically normal red cells, granulocytes, and platelets in the presence of a recognizable physiologic stimulus

17. 53 y/o F CML for 3 years. Imatinib. Platelet count 80,00 & BM Blast 12%:

A. MDS B. CML Chronic C. CML Accelerated D. CML Blast

18. absolute erythrocytosis except:

A. hepatoma B. dehydration C. R-L shunt D. splenomegaly

19. Retinoic Syndrome except:

A. occur during the first three weeks of treatment

B. (+) fever, dyspnea, chest pain


C. related to adhesion of differentiated neoplastic cell to pulmonary vasculature

D. none 20. True about ALL except:

A. a standard remission induction requirement 7,3 regimen

B. continuous treatment given for 2-3 years C. Intrathecal chemoprophylaxis is mandatory D. Higher centers command

21. Hema: test to differentiate primary to secondary polycythemia

A. red cell mass determination B. epo level C. bma D. pa score

22. Aim of Post Remission therapy except:

A. induce complete remission quickly B. eliminate residual cells C. prolong relapse D. prolong survival

23. B Cell ALL marker:

A. CD 13, 33 B. CD 3, CD 4 C. CD 19, CD 20 D. CD 41, CD 61

24. Prognostic single factor for survival of multiple myeloma:

A. LDH B. Crea Level C. SPEP D. Serum B2 microglobulin

25. Best regimen for highly agressive HL- B. ABVD 26. Indication for chemotherapy in CML

A. Anemia B. Thrombocytopenia C. Richter formation D. All

27. Most common sign of myeloma A. Renal failure B. Susceptibilty to bacterial infections C. Bone pains D. Hyperviscocity problems

28. aa 29. A ribonucleotide reductase inhibitor, non selective myelosupression is mechanism of what chemotherapeutic agent?

A. Anagrelide B. Anthracycline C. Imatinib D. Hydroxyrurea

30. Lab features of CML except:

A. LAP score is zero B. Normal platelet count C. Decreased WBC D. ABR


1. Levels of narrowing

Upper esophageal sphincter

Aortic arch

Left mainstem bronchi

Diaphragm

Lower esophageal sphincter

2. MC type of TEF EA with distal TEF 3.

Anomaly Age at presentation

EA with distal TEF Isolated EA

New born

Isolated TEF (H-type TEF)

Infants to adult

4. Hypopharyngeal web + iron def. anemia + dysphagia = PLUMMER VINSON or PATTERSON KELLY SYNDROME 5. Diagnosis for Hypertensive motor disorder “cork screw esophagus” on barium swallow 6. Adenocarcinoma – MC upper GI Ca 7. Most common site affected in Squamous cell Ca lower third (55%) ~least affected is the upper third 8.

Diffuse type Intestinal type

No cell cohesion No mass formed Leather bottle appearance Affects whole stomach (antrum and cardia) Younger patients Hereditary Poorer prognosis

Cohesion present Tumor formed Ulcerative Distalstomach affected

9. Gastric Ca MC metastasis to LIVER 10. Most common type of gastric lymphoma non-Hodgkin’s (B-cell in origin) 11. Treatment for primary gastric lymphoma subtotal gastrectomy followed by combination chemotherapy (R-CHOP)

12. 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; unable to carry on normal activity or do active work

Ann Arbor stage III or IV

>1 site of extranodal involvement 13. GIST non-epithelial (mesenchymal) tumors that arise from the gastrointestinal pacemaker calls called interstitial cells of Cajal (ICC) 14. 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, the most numerous and distinct gastric glands secretes acid, pepsinogen, intrinsic factor, & the bulk of gastric enzymes 16. Pyloric glands at the antrum and pylorus of the stomach composed of endocrine, mucous and gastrin (G) cells 17. Ketoprofen most harmful NSAID 18. H. Pylori treatment- 10 to 14 days of antibiotic therapy 19. Gastric ulcer 6 to 8 weeks treatment 20. Duodenal ulcer 4 to 6 weeks treatment 21. Regulation of gastric acid secretion

Stimulants of gastric acid secretion

Inhibitors of gastric acid secretion

Histamine (ECL cells)

Gastrin (G cells)

Acetylcholine (Vagus)

Somatostatin (D cell)

Secretin/Cholecystokinin (Hormonal)

Neural (CNS/PNS)

22. Duodenal vs Gastric Ulcers


Duodenal Gastric

Malignant DUs are extremely rare

most often in the first portion of duodenum (>95%), with ~90% located within 3 cm of the pylorus.

can represent malignancy

most often found distal to the junction between the antrum and the acid secretory mucosa (body)

23. Most sensitive/specific INVASIVE test to detect H. pylori infection rapid urease test 24. Most sensitive/specific NON-INVASIVE test to detect H. pylori infection urea breath test 25. 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. Naproxen safest NSAID 27. Classified according to predominant site of involvement Type A - Body predominant form (autoimmune) Type B - Antral predominant form (H. pylori-related) AB gastritis - mixed antral and body 28. ZOLLINGER-ELLISON SYNDROME (ZES) - Gastric acid hypersecretion from Gastrinoma tumor - associated with Multiple Endocrine Neoplasia (MEN) type 1 syndrome - Mostly malignant (>60%) - MC tumor distribution: at duodenum (most common non-pancreatic lesion) - Peptic ulcer – MC manifestation of ZES - Diarrhea – 2nd MC manifestation of ZES 29. Sensitivity of imaging in ZES

Primary gastrinoma Metastatic gastrinoma

Most - EUS (80-100%) Least - UTZ

Most – Ostreoscan Least - UTZ

30. Lymphocytic gastritis

also called varioliform gastritis

primarily in the body of the stomach

presence of lymphocytes

have thickened folds 31. Eosinophilic gastritis

primarily in the antrum

edematous folds

presence of eosinophils

can lead to outlet obstruction 33. Ménétrier's Disease

large, tortuous gastric mucosal folds mostly in the fundus and body

34. Granulomatous gastritis

not associated with folds

GASTROENTEROLOGY 1st SEM 2013-2014 PRELIMS – Dr. Lopez 12. Anemia, palpitation and weakness are signs and symptoms of colorectal cancer found in: A. cecum B. transverse colon C. descending colon D. rectum NOTE: obstruction of a tumor at the right side (cecum) manifests as bleeding it will cause anemia 18. Least common cause of mechanical S.I obstruction a. neoplastic –common for Large intestine b. adhesions c. hernia d. volvulus 16. Which is a purely diagnostic alone? A. Colonoscopy b. Barium enema c. CT cholangiography D. Enteroclysis


21, sign of ruptured appendicitis except: a. mass b. abdominal rigidity c. absent bowel sound d. (+) Rovsing’s sign 27. True regarding C. Difficile Infection a. community acquired than hospital b. An invasive organism c. Secrete toxin leading to Pseudomembranous Enterocolitis d. An aerobic organism 28. Best acceptable risk factor for irritable bowel syndrome a. psychosis b. genetic predisposition c. old age d. previous campylobacter infection 29. Mesenteric angiography. (not so sure of the exact question) A. Superior mesenteric artery B. non-occlusive Mesenteric ischemia C. Superior mesenteric artery embolus D. Mesenteric venous thrombosis 30. Treatment for IBS-D a. Lactulose b. SSRI c. Desipranozasine d. Bisacodyl Additional Recalls: Severe mucosal invasion - shigella, others EIEC, E.histolytica Ciprofloxacin except rotavirus IBD- tgf-b and il-10 GI TB- distal ileum and cecum Aminoglycoside - least/never used in pseudomembranous colitis Sigmoid - most common diverticula location

MIDTERMS – Dra. Payawal 1. unlikely cause of isolated hyperbilirubinemia: A. Ca bilirubinate

B. ?? C. ?? D. ?? 2. Hepatotoxic: A. Prescription drugs B. environmental toxin C. metabolites of P450 D. metabolites of glucoridation 3. true of viral hepatitis: A. Hepa A is dsDNA B. Hepa B is ssDNA C. Hepa D is dsDNA D. Hepa C is ssRNA NOTE: Hepa B – dsDNA The rest are ssRNA 4. Parameters in differentiating Jaundice from hyperbilirubinemia of other cause except A. greenish discoloration of skin B. nasolabial fold involvement C. sparing of sclera D. predominant involvement of palms and forehead E. sparing of the non exposed skin to sun 5. Sequel of chronic HBV infection except: A. HCC with or without cirrhosis B. Polyarthritis Nodosa C. GN D. Lichen Planus 6. Bilirubin Metabolic process that most likely causing bilirubinuria: A. conjugation of bilirubin to glucoronic acid B. Conversion of biliverdin to bilirubin C. Transfer of unconjugated bilirubin D. Transfer of conjugated bilirubin 7. Complication of Hepatitis C except: A. Cryoglobinemia dermatitis B. Lymph sialadenitis C. B cell lymphoma D. T cell lymphoma 8. Low Risk immunocompromised booster after primary given


A. every year B. every 5-7 years C. every 10-15 years D. not needed 9. Superior vena cava obstruction A. bulging flanks B. collateral venous C. pulsatile liver D. venous hum 10. (+) HbsAg, no need for therapy: A. 35, female, alt 150, HbeAg (+), HBV DNA (+) B. 35, female, alt 50, HBV DNA (+), HbeAg (-) C. 35, female, alt 150, HBV DNA (-), HbeAg (-) D. 35, female, Anti-HbSag (+), with liver cirrhosis 11. Basolateral iron transporter A. Ferroportin B. Transferrin C. Ferritin D. DMTI 12. Viral Hepatitis which causes a risk fatality among the pregnant A. Hepa B B. Hepa C C. Hepa D D. Hepa E E. Hepa A 14. Which of the conditions does hepatic venous pressure do not correlate with actual portal pressure? A. Budd Chiari B. Alcohol induced cirrhosis C. Venoocclusive disease D. Portal vein thrombosis 15. True of Alcoholic liver injury: A. increases peripheral transport of fatty acids B. convert NAD to NADH C. bridging fibrosis D. microvesicular injury 16. Best marker for liver injury: A. Serum albumin B. bilirubin C. Factors 2, 7, 9, 10 D. EPO

17. Risk factor for development of drug induced liver injury except: A. AA B. aa C. dd D. DD NOTE: The risk factors are: Toxic potential of drugs: Reactive Metabolite, Acylglucoronide, Mitochondrial Effects Genetic Factors: Drug metabolism, Detoxification, Transport Environmental Factors: Age, Sex, Underlying Disease 18. Fulminant: acetaminophen 19. OCP hepatotoxic effects: A. macrovesicular steatosis B. hepatic vein thrombosis C. Hepatic adenoma D. intrahepatic cholestasis 20. Cholestasis except: A. Elevated serum bilirubin B. elevated AP C. can be caused by lymphoma 21. Pathophysiology of liver cirrhosis except: A. irreversible liver damage 22. True about alcoholic liver disease except: A. PPAR can induce FPA and transport genes B. PPAR can induce synthesizing FPA C. Down regulation of PPAR D. Down regulation of SREB 23. Causes of liver cirrhosis except: A. Wilsons disease B. Glycogen Storage Dse C. TB D. Schistosomiasis 24. Fibrolamellar HCC: A. children, adult and elderly B. common in OCP users C. frequent in males D. worse prognosis than other HCC E. AOTA


25. True of chronic hepatitis EXCEPT: A. Caused by DNA virus B. Caused by RNA virus C. Caused by?? 26. For patient with HBsAg who does not need treatment: A. ALT 150, HBeAG (+)/ HBV DNA (+) B. ALT 250 HBeAG (-)/ HBV DNA (+) C. ALT 20 HBeAG (-)/ HBV DNA (-) D. Anti-HbsAG 27. True of protocol for liver cancer screening except: A. alpha feto protein measurement every 6 months B. -- C. CEA for high risk individuals D. due to reactivation of chronic or acute hepatitis 28. Fulminant Hepatitis includes all of the following except: A. collapsed reticulin network B. hepatic failure in 6 months C. presence of massive necrosis with only portal tract visible D. may be due to reactivation of chronic or acute hepatitis

FINALS – Dr. Lapuz 1. 73 y/o male underwent surgery due to intestinal ischemia and gangrene, later on develop malabsorption. Why? A. bacterial overgrowth B. short bowel syndrome C. destruction of intestinal mucosal function and structure D. intestinal obstruction 2. Bird beak appearance on esophagogram: A. scleroderma B. esophageal ring C. achalasia D. hypertensive motor disorder 3. Oxyntic cells: Fundus and Body 20. H. Pylori seg??? – MALT 25. Duodenal ulcer tx: Omeprazole 20mg BID + Clarithromycin 500g BID + Amoxicillin 1g BID or Metronidazole 500 mg BID for 10-14 days

49. Pathophysiology of liver cirrhosis, except A. Irreversible chronic injury of hepatic parenchyma B. Extensive fibrosis C. Regenerating nodule D. Histopathological diagnosis 50. True of Hepa C virus except: - caused by DNA

Gastric adenocarcinoma- linitis plastics or leather bottle appearance

Esophageal cancer-chronic gastric reflux (barretts esophagitis)

Gastric cancer-mc adenocarcinoma (85%)

Esophageal cancer- post radiation therapy

Non-hodgkins lymphoma-mc type of gastric lymphoma;b cell in origin

Primary gastric lymphoma- B symptoms: -unexplained weight loss of >10% body weight -recurrent fever -night sweats

Gastric adenocarcinoma- mc route of spread is hematogenous

GIST- arises from GU pacemaker cells

Breast-mc metastatic site of stomach cancer

Fundus&body- oxyntic cells are located

Duodenal ulcers- malignancy is rare

Somatostatin-inhibitor of gastric acid secretion

Duodenal ulcers- antral predominant gastritis

Gastric ulcer-6 to 8 weeks of treatment

Advanced age-established risk factor for pud

Ketoprofen- most harmful Ibuprofen-least harmful

H. Pylori treatment- 10 to 14 days of antibiotic therapy

Eradication of H. Pylori may result in complete regression of tumor

Traditional NSAID + PPI if GI risk warrants gastric protection

Other causes of elevated gastrin: H. Pylori infection and used of anti secretory agents for ulcers

Esophageal atresia with TEF distal - most common

Crohn disease- not included in folded type of gastritis


Congenital anomalies arises from Vertebral, anal, cardiac, tracheal, esophageal, renal, limb system

Endoscopic Ultrasound (EUS) - most commonly used in primary gastrinoma

Scleroderma- decreases LES pressure

Achalasia- bird beak appearance

Bernstein test/ acid perfusion test- least effective in diagnosing GERD

CREST syndrome - esophageal dysfunction

cardio and hema super samplex

Documents