MCQS 238-240:A bone marrow aspiration consisting of 50% lymphoblasts is most indicative of

For each of the following types of surgery choose the most likely agent that may cause post-operative infection.
endoscopic retrograde cholangiopancreatography with improper disinfection of the scopes
a) Proteus
b) E.coli
c) bacteroides fragilis
d) Staphylococcus aureus
e) Staphylococcus epidermis
f) C.perfringens
g) Pseudomonas aeruginosa
h) streptococcus fecalis
i) streptococcus pneumonia
j) brucella melitensis

A bone marrow aspiration consisting of 50% lymphoblasts is most indicative of
a) Acute Lymphoblastic Leukemia
b) Juvenile rheumatoid arthritis
c) Infectious mononucleosis
d) Idiopathic thrombocytopenic purpura
e) systemic lupus erythematosus
f) Aplastic anemia
g) Neuroblastoma
h) Retinoblastoma
i) Rhabdomyosarcoma
j) Burkitt's lymphoma

A middle aged man with a history of angina develops severe central chest-pain at rest. AN ECG shows a new-onset ST Elevation and Bundle-Branch Block. The following treatment should be considered:
a) streptokinase
b) methadone
c) propanolol
d) diazepam
e) accelerated tissue plasminogen activator (t-PA)
f) warfarin
g) zopiclone
h) risperidone
i) amitryptilline
j) heparin

Correct Answer: G
infection after endoscopic retrograde cholangiopancreatography is associated with problems in the disinfection of the scopes. Careful disinfection of the endoscopes and other endoscopic devices is mandatory to avoid an unacceptably high rate of P. aeruginosa infection.<br>The most commonly isolated bacteria from blood and bile cultures after endoscopic retrograde cholangiopancreatography are Pseudomonas aeruginosa and Escherichia coli. P. aeruginosa is observed mainly in patients referred from other centers after previous diagnostic ERCP, and is unusual in patients without previous ERCP. Septicemia after ERCP is related to incomplete bile duct drainage, and in some cases, to bilio-pancreatic infected collections. The incidence of septicemia is significantly higher in cases of malignant obstruction than in benign obstruction due mainly to the problems of drainage associated with tumoral infiltration

Correct Answer: A
To definitively establish the diagnosis of leukemia, a bone marrow aspirate is necessary. Although leukemia cells may be present in the peripheral blood at diagnosis, attempts to establish the diagnosis on the basis of morphologic assessment of these cells alone may be misleading. Under most circumstances, a bone marrow aspirate provides sufficient material to establish the diagnosis. Occasionally, bone marrow biopsy may be required. Although more than 5% lymphoblasts in the bone marrow indicates leukemia, most centers require a minimum of 25% blast cells before the diagnosis is confirmed. Usually, most cells in the marrow aspirate are leukemic lymphoblasts

Correct Answer: E
This man is likely to be suffering from unstable angina. Angina is characterized as a deep, poorly localized chest or arm discomfort that is reproducibly associated with physical exertion or emotional stress and relieved promptly by rest or sublingual GTN. Patients with unstable angina may have all the qualities of typical angina except that episodes are more severe and prolonged and may occur at rest with an unknown relationship to exertion or stress. Features suggesting a diagnosis of not angina include: • Pleuritic pain; i.e., sharp or knife-like pain brought on by respiratory movements or cough. • Primary or sole location of discomfort in the middle or lower abdominal region. • Pain localized with one finger. • Pain reproduced by movement or palpation of chest wall or arms. • Constant pain lasting for days. • Very brief episodes of pain lasting a few seconds or less. • Pain radiating into the lower extremities. Careful examination of the ECG is crucial in the diagnosis of unstable angina. A recording made during an episode of the patient's presenting symptoms is particularly valuable, although an asymptomatic recording can be quite informative as well. Importantly, transient ST- or T-wave changes that develop during a symptomatic episode at rest and resolve when the patient becomes asymptomatic strongly suggest unstable angina and a very high likelihood of underlying severe CAD ST-segment elevation of more than 1 mm in two or more contiguous leads strongly suggests the diagnosis of acute MI and possible candidacy for reperfusion therapy. ST-segment depression typically signifies ischemia or non-Q-wave infarction. Acute reperfusion therapy is usually not indicated for patients with this finding. Marked symmetrical precordial T-wave inversion strongly suggests acute ischemia, particularly that due to a proximal LAD stenosis. Patients presenting within 12 hours of symptom onset and with ST elevation or bundle-branch block on the electrocardiogram (ECG) have a 25% reduction in early mortality with thrombolytic therapy. For these patients, a key goal is rapid restoration of normal coronary flow. Accelerated tissue plasminogen activator (t-PA) is more successful at both establishing early coronary artery patency and improving survival compared with streptokinase. Direct angioplasty appears promising for establishing early patency and improving survival relative to thrombolytic therapy.6-8 However, it is not yet known whether these trial results are generalizable to the typical hospital with the capability to perform acute angioplasty.


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