MCQ on Case of Medical Industries

A 42 year old man who has industrial exposure to benzene, complains of fatigue, abdominal fullness and night sweats. Finally, because his wife insists, he sees his doctor. On physical examination, he is found to have a low grade fever and dramatic splenomegaly. His doctor comments that he has never seen such splenomegaly. Laboratory tests are done, including a CBC with differential. His white blood count is 150,000/cu mm. His blood smear shows mature granulocytes, a few immature granulocytes and basophilia. No Auer rods are visualized. He is positive for Philadelphia chromosome. Which of the following is most likely?

a) acute lymphoblastic leukemia
b) acute myelogenous leukemia
c) chronic lymphoblastic leukemia
d) chronic myelogenous leukemia
e) hairy cell leukemia

The correct answer is D

Explanation
This patient is the average age for the onset of CML. Exposure to benzene is a known risk factor. Fatigue, night sweats, low grade fever and abdominal fullness secondary to splenomegaly are all symptoms that can be associated with CML The splenomegaly in CML can be marked. The laboratory findings in chronic myelogenous leukemia will show an elevated granulocytic counts, as in this scenario. Basophilia can also be seen with CML. The Philadelphia chromosome, a translocation between chromosome 22 and 9, is positive in the vast majority (90-95%) of patients with chronic myelogenous leukemia.In acute lymphoblastic leukemia (choice a) there would be numerous blast cells in the peripheral smear. ALL tends to occur in children with an average age of 4 (however, it can occur in adults).In acute myelogenous leukemia (choice b) there would be numerous blast cells in the peripheral smear. AML tends to strike adults. The presence of Auer rods indicates AML.In chronic lymphocytic leukemia (choice c) there would be a lymphocytosis with mature looking cells. CLL occurs in older people.Hairy cell leukemia (choice e) has distinctive cells present in the peripheral blood smear, called 'hairy cells'

Davidson’s Principles & Practice of Medicine

The latest 20th Edition of Davidson’s Principles & Practice of Medicine won the award for a New Edition of an Edited Textbook at the Royal Society of Medicine and Society of Authors 2007 Medical Book Awards. The award citation described the book as “Beautifully constructed with superb clarity of style – Davidson’s continues to provide for students, doctors and other health professionals a sound basis for the practice of medicine.”

This internationally famous and best-selling textbook of general (or internal) medicine is renowned for providing a rational and easily understood basis for the practice of clinical medicine. Since it was first published this comprehensive text has met the requirements of several generations of medical students preparing for their examinations, while serving as a valuable reference for doctors in training. Rather than page after page of dense text, this reference makes finding information a snap by featuring lavish, colorful visual information. Extensive tables, crib boxes, MRI images, and x-ray films accompany each chapter’s succinct discussions. The book’s clear organization and color-coded chapters make it simple to find just the information you need, when you need it.

* Readers have full online access to the whole book, along with 750 new self-testing questions whose answers are linked to the online text
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* A practical, problem-based clinical approach is described in the ‘Presenting Problems’ sections, to complement the detailed descriptions of each disease
* Over 150 evidence-based medicine boxes summarise the results of systematic reviews and randomised controlled trials in key therapeutic areas
* ‘In Old Age’ boxes highlight important spects of medical practice in the older population

* Covers ethics and communication skills as well as the role of complementary and alternative therapies in medicine.
* Contains a new chapter on ‘Molecular and genetic mechanisms of disease’ which reviews the basics of genetics, molecular biology, and cellular biology.
* Splits Infectious diseases chapter into four shorter and more focused chapters: “Principles of Infectious disease’” covering principles of infection, prevention and management; “Infectious Diseases and Tropical Medicine”; “HIV/AIDS”; and “Sexually transmitted diseases“.

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Anatomy of ear drum as seen on examination

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Lamellar Keratoplasty (LK)

Most corneal transplants performed in the U.S. involve replacing the entire thickness of the diseased cornea with a healthy donor cornea (called penetrating keratoplasty or PK). In partial-thickness corneal transplants (LK), only the anterior (surface) layers of the cornea are removed. The donor cornea is then attached to the host corneal bed, containing only posterior (deeper) layers. LK is less risky, but tends to result in somewhat inferior vision vs. PK and cannot be performed if the disease process (e.g. scar) involves the deeper layers of the cornea.

Alopecia Totalis PIC

Alopecia Totalis (AT): AT is an auto-immune disorder which results in the total loss of hair, but only on the scalp. It is somewhat of an intermediary condition between Alopecia Areata which is patchy scalp hair loss, and Alopecia Universalis which extends to total body hair loss. AT usually appears in two types: One being a fairly sudden and complete loss of all head hair. The other being a slower form which originates as Alopecia Areata (patchy loss) and advances to complete scalp hair loss. In this sense it is sometimes tied to Alopecia Areata (patchy loss), but not all the time.Patients with alopecia areata lose hair on their scalp in smooth round patches typically causing bald spots about an inch (2cm) across.

Most sufferers are children and young adults under the age of 40, though it can affect people of all ages. It can also affect the the nails, giving them a ridged, pitted or brittle appearance. According to statistics, 2% of men and 1% of women in western society suffer from some form of Alopecia Areata. About 2% of those have Totalis or Universalis. This means that about 1 in every 125,000 men and 1 in every 250,000 women have Alopecia Totalis or Universalis.


The main treatment for Alopecia Totalis are therapies which focus on immunomodulation, such as glucocorticoid injections, anthralin, or glucocorticoids taken orally. We have heard reports from some that years of steroid therapy can put the condition into remission. Years of steroid therapy is not always enjoyable however, as there are side effects. It is important to comment that Rogaine (Minoxidil) is not effective for those with Alopecia Totalis. Some treatments which have been considered include Methotrexate, a treatment for autoimmune disorders, and corticosteroids have been proposed as treatments.

Several genes have been studied and quite a bit of research has focused on the human leukocyte antigen. Two studies demonstrated that human leukocyte antigen DQ3 (DQB1*03) was found in more than 80% of patients with Alopecia Areata, which suggests that it can be a marker for general susceptibility to Alopecia Areata. The studies also found that HLA DQ7 (DQB1*0301) and human leukocyte antigen DR4 (DRB1*0401) were found quite a bit more often in patients with Alopecia Totalis (AT) and Alopecia Universalis (AU).

NOTE THAT:
1-alopecia totalis is not a painful disease and does not make people feel sick.
2-It is not contagious, and people who have the disease are usually otherwise
healthy.
3-It has no effect on life expectancy, and will not interfere with your ability to
pursue a normal lifestyle.
4-Returning to your faith can play a major role in understanding what is going on.

The Confusion Assessment Model (CAM)

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Clinical Anatomy: Applied Anatomy for Students and Junior Doctors 11th ed.

456 pages
Publisher: Wiley-Blackwell; 11 edition (November 17, 2006)
Language: English
ISBN-10: 1405138041
ISBN-13: 978-1405138048


Clinical Anatomy has remained the word of the same author for nearly half a century. Initially written for clinical medical students on the wards, clinics and revising for Finals, since then it has sold all over the world in hundreds of thousands and in several languages. Its success has been its constant revision to ensure it covers the student's needs. Today, it also covers the bulk of the anatomy required in the MRCS Part I, II, III and provides an excellent revision text for these candidates and medical students in a concise form with clear, easily reproduced diagrams.

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