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You are treating a patient with localized osteosarcoma of the distal femur with methotrexate, doxorubicin, and cisplatin (MAP) chemotherapy. At week 10 of treatment, the patient undergoes complete resection of the tumor. Pathology demonstrates 40% necrosis. Which of the following represents the most appropriate further therapy?
- A. Ifosfamide and etoposide (IE)
- B. MAP plus ifosfamide and etoposide (MAPIE)
- C. Gemcitabine docetaxel
- D. MAP
Correct Answer: D
Rationale: Rationale: The correct answer is D, continuing with MAP chemotherapy. The 40% necrosis rate indicates a good response to the current regimen. Continuing MAP ensures completion of the planned therapy and maximizes the benefit of the initial treatment's response. Choice A (Ifosfamide and etoposide) and B (MAPIE) are not indicated as the response to MAP was favorable. Choice C (Gemcitabine docetaxel) is not the standard of care for osteosarcoma. Continuing with MAP is the most appropriate option for this patient.
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In microcytic hypochromic anaemia
- A. Red cells are larger with normal staining
- B. Red blood cell count is increased
- C. Haemtocrit and mean corpuscular haemoglobin are normal
- D. Red cells are smaller with a pale large central pallor
Correct Answer: D
Rationale: In microcytic hypochromic anemia, the correct answer is D because red cells are smaller (microcytic) and have a pale large central pallor (hypochromic). This is due to decreased hemoglobin content and iron deficiency. Choice A is incorrect as red cells are smaller, not larger. Choice B is incorrect as the red blood cell count is typically decreased in this type of anemia. Choice C is incorrect as both hematocrit and mean corpuscular hemoglobin are decreased in microcytic hypochromic anemia, not normal. Therefore, the correct answer is D based on the characteristic features of microcytic hypochromic anemia.
A 17-year-old female presents with cervical adenopathy and a history of daily fevers and drenching night sweats. A biopsy is performed and reveals classic Hodgkin lymphoma. Which of the following is least appropriate as part of the staging workup?
- A. Chest x-ray
- B. CT scan of chest, abdomen, and pelvis
- C. Functional imaging (PET scan)
- D. Lumbar puncture and cerebrospinal fluid (CSF) analysis
Correct Answer: D
Rationale: The correct answer is D, Lumbar puncture and cerebrospinal fluid (CSF) analysis. In Hodgkin lymphoma, central nervous system involvement is rare at presentation, making routine CSF analysis unnecessary. Staging workup typically includes imaging studies (A, B, C) to assess disease extent and involvement of distant organs. CSF analysis is reserved for cases with neurological symptoms or signs suggestive of CNS involvement. Therefore, in this case, the least appropriate option for staging workup is D.
A 30 year old patient had presented with fever and posterior cervical lymphadenopathy over the past two years. Which is the most probably causative organism?
- A. Trypanosoma cruzi
- B. Trypanosoma brucei rhodesiense
- C. Trypanosoma brucei gambiense
- D. Leishmania donovani
Correct Answer: C
Rationale: The correct answer is C: Trypanosoma brucei gambiense. This is the most likely causative organism because the patient's presentation of fever and posterior cervical lymphadenopathy is consistent with African trypanosomiasis, also known as sleeping sickness, which is caused by T. brucei gambiense. This parasite is transmitted by the tsetse fly in sub-Saharan Africa. The other choices (A, B, D) are not the correct causative organism for African trypanosomiasis and do not match the clinical presentation described in the question. Trypanosoma cruzi causes Chagas disease, Trypanosoma brucei rhodesiense causes a more acute form of African trypanosomiasis, and Leishmania donovani causes visceral leishmaniasis, which typically presents with splenomegaly and hepatomegaly rather than posterior cervical lymphadenopathy.
All produce microcytic anemia except:
- A. sideroblastic an.
- B. thalassemia
- C. pernicious anemia
- D. lead poisoning
Correct Answer: C
Rationale: The correct answer is C, pernicious anemia. Pernicious anemia is a macrocytic anemia caused by vitamin B12 deficiency affecting red blood cell production. Sideroblastic anemia (A), thalassemia (B), and lead poisoning (D) can all lead to microcytic anemia due to different mechanisms such as impaired hemoglobin synthesis or red blood cell destruction. Pernicious anemia, on the other hand, is not associated with microcytosis.
Outstanding feature of ITP:
- A. fever
- B. gum bleeding
- C. moderate splenomegaly
- D. stema tenderness
Correct Answer: B
Rationale: The correct answer is B: gum bleeding. In immune thrombocytopenic purpura (ITP), the hallmark feature is low platelet count leading to easy bruising and bleeding, including gum bleeding. Fever (choice A) is not a typical feature of ITP. Moderate splenomegaly (choice C) is less common in ITP. Stema tenderness (choice D) is not a recognized feature of ITP. Therefore, gum bleeding is the outstanding feature of ITP due to the primary underlying mechanism of platelet destruction.