(MCQS 301-303) :A 14 year immunocompromised boy develops a severe anemia. A bone marrow aspirate is performed

Correct Answer: H
Methyldopa is the drug most commonly used to treat hypertension during pregnancy and is the standard against which other agents are compared. It lowers blood pressure by stimulation of central alpha2 -receptors via alpha-methylnorepinephrine, which is the active form of alpha-methyldopa. PIH is defined as an elevated blood pressure which begins after 20 weeks gestation. PIH is the main manifestation of preeclampsia ( a systemic disease involving maternal endothelial cell dysfunction ) and is primarily seen in the last 16 weeks of gestation. PIH occurs in 1 - 5% of all pregnancies and is 2 - 3 times more prevalent in black women. Chronic hypertensive women are 2 - 7 times more likely to develop PIH. Unfortunately there is as high as a 10% perinatal mortality rate associated with preeclampsia. Since both PIH and chronic hypertension are related to third trimester fetal death, diagnosis and treatment are very important. Misdiagnosis is an easily made mistake due to the fluctuating blood pressures in the normal physiology of pregnancy. During the first trimester there is a drop in blood pressure followed by a rise back up to pre-pregnancy levels by the 3rd trimester. This process could easily be misdiagnosed as preeclampsia. Treatment should first involve non-pharmacological means (counseling, restricted activity, nutritional diet, etc.). If that approach fails, then drug therapy may be necessary. The most commonly used drugs to treat hypertension in pregnancy are the beta-blockers, calcium channel blockers, methyldopa, and hydralazine. Methyldopa is the golden standard of treatment. It has been extensively studied and is proven safe to the fetus. However, it is not tolerated as well as beta-blockers or calcium channel blockers. Methyldopa is not as efficient at lowering blood pressure as the newer agents. ACE inhibitors and diuretics should not be used during pregnancy. ACE inhibitors can cause renal failure and death to the fetus. Diuretics should not be used because they can cause depletion of fluid volume and electrolyte deficiencies which can be harmful to the fetus.

Correct Answer: F
This pattern, while not specific, is quite typical of Burkitt's lymphoma/leukemia or small noncleaved cell lymphoma. CD 19, 20, and 21 are usually positive on the blasts of Burkitt's, whereas CD 34 is absent. CD 10 expression is common (positive in up to 3/4 of cases). Burkitt's lymphoma is usually seen in children, young adults, and immune-compromised patients There is frequent extranodal involvement and also frequent bone marrow involvement. Diffuse lymph node involvement is a typical feature with monotonous morphology with cells of uniform size and shape. The cytoplasm is scanty, the nucleus is round or slightly irregular with slightly coarse chromatin and several nucleoli. There are frequent mitotic figures and the presence of a starry sky appearance, imparted by scattered macrophages with phagoctyes cell debris. The 'Starry sky' pattern is not pathognomonic for Burkitt's lymphoma and may be observed in other highly proliferative lymphomas. There is typically expression of B-Cell associated antigens CD19, CD20, CD22 and expression of CD10 and HLA-DR

Correct Answer: I
A disorder involving chronic inflammation of the cheeks, nose, chin, forehead, or eyelids; it may cause redness, vascularity (increased prominence of the blood vessels), swelling or hyperplasia (increase in size of the tissue), or skin eruptions similar to acne. The cause of rosacea is unknown. The disorder involves enlargement of the blood vessels just under the skin. It occurs most often in fair skinned people, particularly those who blush easily. Women are more commonly affected, but men are usually more severely affected. Symptoms usually begin between ages 30 to 50, and the disorder is most often seen in middle-aged or older people. Rosacea may be associated with a migraine headache, other skin disorders (acne vulgaris , seborrhea), or eye disorders (blepharitis, keratitis).


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