Multiple Choice Questions (MCQ)

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Category: Medicine--->Hematology and Oncology
Page: 7

Question 31# Print Question

A 26-year-old man complains of heaviness in the left testicle. There has been no recent trauma. Physical examination reveals a 3-cm painless firm mass that clearly arises from the testicle. The physical examination is otherwise unremarkable. Abdominal CT scan shows matted periaortic lymphadenopathy, with the largest node approximately 3.5 cm in size. CT of the chest shows no abnormalities.

In addition to urological referral, what should be the next diagnostic study?

A. Needle aspiration biopsy of the retroperitoneal mass
B. Needle aspiration of the testicular mass
C. Measurement of α-fetoprotein, β-hCG, and lactate dehydrogenase (LDH)
D. Positron emission tomography (PET) scan
E. Measurement of carcinoembryonic antigen (CEA) and α fetoprotein

Question 32# Print Question

A 50-year-old man presents with 3 days of fever, diffuse bone pain, and extreme weakness. He denies any sick contacts. On examination, there is conjunctival pallor, dried blood on the nasal mucosa, and ecchymoses on both lower extremities. There is no lymphadenopathy or hepatosplenomegaly. Urinalysis and chest x-ray are normal. The peripheral blood smear is shown.

What is the most likely diagnosis? 

A. Multiple myeloma
B. Myelofibrosis
C. Acute myeloid leukemia (AML)
D. Chronic myelogenous leukemia (CML)
E. Acute lymphocytic leukemia (ALL)

Question 33# Print Question

A 70-year-old intensive care unit patient complains of fever and shaking chills. The patient develops hypotension, and blood cultures are positive for gram-negative bacilli. The patient begins bleeding from venipuncture sites and around his Foley catheter. Laboratory studies are as follows:

  • Hct: 38%
  • WBC: 15,000/µL
  • Platelet count: 40,000/µL (normal 150,000-400,000)
  • Peripheral blood smear: fragmented RBCs
  • PT: elevated
  • PTT: elevated
  • Plasma fibrinogen: 70 mg/dL (normal 200-400)

Which of the following is the best course of therapy in this patient?

A. Begin heparin
B. Treat underlying disease
C. Begin plasmapheresis
D. Give vitamin K
E. Begin red blood cell transfusion

Question 34# Print Question

A 30-year-old woman with Graves disease has been started on pro-pylthiouracil. She complains of low-grade fever, chills, and sore throat.

Which of the following is the most important initial step in evaluating this patient’s fever? 

A. Serum TSH
B. Serum T3 by RIA
D. Chest x-ray
E. Blood cultures

Question 35# Print Question

A 62-year-old woman has noted fever to 38.3°C (101°F) every evening for the past 3 weeks, associated with night sweats and a 15-lb weight loss. Physical examination reveals matted supraclavicular lymph nodes on the right; the largest node is 3.5 cm in diameter. She also has firm rubbery right axillary and bilateral inguinal nodes. Excisional biopsy of one of the nodes shows diffuse replacement of the nodal architecture with large neo-plastic cells which stain positively for B-cell markers. No Reed-Sternberg cells are seen.

Which statement most accurately reflects her prognosis?

A. This is an indolent process which will respond to corticosteroids
B. This is an aggressive neoplasm which responds poorly to chemotherapy and will likely be fatal in 6 months or less
C. This is an aggressive neoplasm, but it may be cured with chemotherapy in up to 60% of the cases
D. The neoplasm often responds to chemotherapy but almost always relapses
E. Radiation therapy is curative

Category: Medicine--->Hematology and Oncology
Page: 7 of 8