TABLE 1-149 Physiologic Characteristics of the Various Forms of Shock 6 page

B. Cyclophosphamide, daunorubicin, vinblastine, and prednisone

C. Rituximab

D. Tretinoin

E. Whole-body irradiation

III-84. The patient in question III-83 is started on the appropriate induction regimen. Two weeks after initiation of treatment, the patient develops acute onset of shortness of breath, fever, and chest pain. Her chest radiograph shows bilateral alveolar infiltrates and moderate bilateral pleural effusions. Her leukocyte count is now 22,300/μL, and she has a neutrophil count of 78%, bands of 15%, and lymphocytes 7%. She undergoes bronchoscopy with lavage that shows no bacterial, fungal, or viral organisms. What is the most likely diagnosis in this patient?

A. Arsenic poisoning

B. Bacterial pneumonia

C. Cytomegalovirus pneumonia

D. Radiation pneumonitis

E. Retinoic acid syndrome

III-85. A 76-year-old man is admitted to the hospital with complaints of fatigue for 4 months and fever for the past 1 week. His temperature has been as high as 38.3°C at home. During this time, he intermittently has had a 5.5-kg weight loss, severe bruising with minimal trauma, and an aching sensation in his bones. He last saw his primary care physician 2 months ago and was diagnosed with anemia of unclear etiology at that time. He has a history of a previous left middle cerebral artery cerebrovascular accident, which has left him with decreased functional status. At baseline, he is able to ambulate in his home with the use of a walker and is dependent on a caregiver for assistance with his activities of daily living. His vital signs are blood pressure of 158/86 mm Hg, heart rate of 98 beats/min, respiratory rate of 18 breaths/min, SaO₂ 95%, and temperature of 38°C. He appears cachectic with temporal muscle

wasting. He has petechiae on his hard palate. He has no lymph node enlargement. On cardiovascular examination, there is a II/VI systolic ejection murmur present. His lungs are clear. The liver is enlarged and palpable 6 cm below the right costal margin. In addition, the spleen is also enlarged, with a palpable spleen tip felt about 4 cm below the left costal margin. There are multiple hematomas and petechiae present in the extremities. Laboratory examination reveals the following: hemoglobin, 5.1 g/dL; hematocrit, 15%; platelets, 12,000/μL; and white blood cell (WBC) count, 168,000/μL with 45% blast forms, 30% neutrophils, 20% lymphocytes, and 5% monocytes. Review of the peripheral blood smear confirms acute myeloid leukemia (M1 subtype, myeloblastic leukemia without maturation) with complex chromosomal abnormalities on cytogenetics. All of the following confer a poor prognosis for this patient EXCEPT:

A. Advanced age

B. Complex chromosomal abnormalities on cytogenetics

C. Hemoglobin below 7 g/dL

D. Prolonged interval between symptom onset and diagnosis

E. WBC count above 100,000/μL

III-86. The evaluation in a newly diagnosed case of acute lymphoid leukemia should routinely include all of the following EXCEPT:

A. Bone marrow biopsy

B. Cell-surface phenotyping

C. Cytogenetic testing

D. Lumbar puncture

E. Plasma viscosity

III-87. All of the following infectious agents have been associated with development of a lymphoid malignancy EXCEPT:

A. Helicobacter pylori

B. Hepatitis B

C. Hepatitis C

D. HIV

E. Human herpes virus 8 (HHV8)

III-88. A 64-year-old man with chronic lymphoid leukemia and chronic hepatitis C presents for his yearly follow-up. His white blood cell count is stable at 83,000/μL, but his hematocrit has dropped from 35% to 26%, and his platelet count also dropped from 178,000/μL to 69,000/μL. His initial evaluation should include all of the following EXCEPT:

A. AST, ALT, and prothrombin time

B. Bone marrow biopsy

C. Coombs test

D. Peripheral blood smear

E. Physical examination

III-89. During a routine visit, a 68-year-old woman complains of 3 months of fatigue, abdominal fullness, and bilateral axillary adenopathy. On physical examination, vital signs are normal, and she has bilateral palpable axillary and cervical adenopathy and an enlarged spleen. A complete blood count is notable for a white cell count of 88,000 with 99% lymphocytes. A peripheral smear is shown in Figure III-89. Which of the following is the most likely diagnosis?

D. Hairy cell leukemia

E. Mononucleosis

III-90. Which of the following carries the best disease prognosis with appropriate treatment?

A. Burkitt’s lymphoma

B. Diffuse large B-cell lymphoma

C. Follicular lymphoma

D. Mantle cell lymphoma

E. Nodular sclerosing Hodgkin’s disease

III-91. A 27-year-old man seeks medical attention for enlarging nodules in his neck. He reports they are non-tender and have been growing for more than 1 month. At first he thought they were caused by a sore throat, but over the past 3 weeks he has felt well with no fever, chills, throat pain, or other associated symptoms. He notes a slightly diminished appetite but no weight loss. He works as a video game developer, does not smoke or use illicit drugs, and is sexually active with numerous female partners. He has never been tested for HIV. A lymph node biopsy is performed and is shown in Figure III-91. Which of the following is the most likely diagnosis?

FIGURE III-91 (see Color Atlas)

A. Burkitt’s lymphoma

B. Cat scratch disease

C. CMV infection

D. Hodgkin’s disease

E. Non-Hodgkin’s lymphoma

III-92. Which of the following is the most likely finding in a patient with a “dry” bone marrow aspiration?

A. Chronic myeloid leukemia

B. Hairy cell leukemia

C. Metastatic carcinoma infiltration

D. Myelofibrosis

E. Normal bone marrow

III-93. All of the following statements are true regarding the criteria to diagnose hypereosinophilic syndrome EXCEPT:

A. Increased bone marrow eosinophils must be demonstrated.

B. It is not necessary to have increased circulating eosinophils.

C. Primary myeloid leukemia must be excluded.

D. Reactive eosinophilia (e.g., parasitic infection, allergy, collagen vascular disease) must be
excluded.

E. There must be less than 20% myeloblasts in blood or bone marrow.

III-94. All of the following statements regarding mastocytosis are true EXCEPT:

A. Elevated serum tryptase suggests aggressive disease.

B. Eosinophilia is common.

C. It is often associated with myeloid neoplasm.

D. More than 90% of cases are confined to the skin.

E. Urticaria pigmentosa is the most common clinical manifestation.

III-95. A 58-year-old man is evaluated in the emergency department for sudden onset cough with yellow sputum production and dyspnea. Aside from systemic hypertension, he is otherwise healthy. His only medication is amlodipine. Chest radiograph shows a right upper lobe alveolar infiltrate, and laboratory test results are notable for a blood urea nitrogen of 53 mg/dL, creatinine of 2.8 mg/dL, calcium of 12.3 mg/dL, total protein of 9 g/dL, and albumin of 3.1 g/dL. Sputum culture grows Streptococcus pneumonia. Which of the following tests will confirm the underlying condition predisposing him to pneumococcal pneumonia?

A. Bone marrow biopsy

B. Computed tomography of the chest, abdomen, and pelvis with contrast

C. HIV antibody

D. Sweat chloride testing

E. Videoscopic swallow study

III-96. A 64-year-old African American man is evaluated in the hospital for congestive heart failure, renal failure, and polyneuropathy. Physical examination on admission was notable for these findings and raised waxy papules in the axilla and inguinal region. Admission laboratories showed a blood urea nitrogen of 90 mg/dL and a creatinine of 6.3 mg/dL. Total protein was 9.0 g/dL with an albumin of 3.2 g/dL. Hematocrit was 24%, and white blood cell and platelet counts were normal. Urinalysis was remarkable for 3+ proteinuria but no cellular casts. Further evaluation included an echocardiogram with a thickened left ventricle and preserved systolic function. Which of the following tests is most likely to diagnose the underlying condition?

A. Bone marrow biopsy

B. Electromyogram (EMG) with nerve conduction studies

C. Fat pad biopsy

D. Right heart catheterization

E. Renal ultrasonography

III-97. A 75-year-old man is hospitalized for treatment of a deep venous thrombosis. He had recently been discharged from the hospital about 2 months ago. At that time, he had been treated for community-acquired pneumonia complicated by acute respiratory failure requiring mechanical ventilation. He was hospitalized for 21 days at that time and had discharged from a rehabilitation 2 weeks ago. On the day before admission, he developed painful swelling of his left lower extremity. Lower extremity Doppler ultrasonography confirmed an occlusive thrombus of his deep femoral vein. After an initial bolus, he is started on a continuous infusion of unfractionated heparin at 1600 U/hr because he has end-stage renal disease on hemodialysis. His activated partial thromboplastin time is maintained in the therapeutic range. On day 5, it is noted that his platelets have fallen from 150,000/μL to 88,000/μL. What is the most appropriate action at this time?

A. Continue heparin infusion at the current dose and assess for anti-heparin/platelet factor 4
antibodies.

B. Stop all anticoagulation while awaiting results of anti-heparin/platelet factor 4 antibodies.

C. Stop heparin infusion and initiate argatroban.

D. Stop heparin infusion and initiate enoxaparin.

E. Stop heparin infusion and initiate lepirudin.

III-98. A 48-year-old woman is evaluated by her primary care physician for a complaint of gingival bleeding and easy bruising. She has noted the problem for about 2 months. Initially, she attributed it to aspirin that she was taking intermittently for headaches, but she stopped all aspirin and nonsteroidal anti-inflammatory drug use 6 weeks ago. Her only medical history is an automobile accident 12 years previously that caused a liver laceration. It required surgical repair, and she did receive several transfusions of red blood cells and platelets at that time. She currently takes no prescribed medications and otherwise feels well. On physical examination, she appears well and healthy. She has no jaundice or scleral icterus. Her cardiac and pulmonary examination results are normal. The abdominal examination shows a liver span of 12 cm to percussion, and the edge is palpable 1.5 cm below the right costal margin. The spleen tip is not palpable. There are petechiae present on her extremities and hard palate with a few small ecchy-moses on her extremities. A complete blood count shows a hemoglobin of 12.5 g/dL, hematocrit of 37.6%, white blood cell count of 8400/μL with a normal differential, and a platelet count of 7500/μL. What tests are indicated for the workup of this patient’s thrombocytopenia?

A. Antiplatelet antibodies

B. Bone marrow biopsy

C. Hepatitis C antibody

D. Human immunodeficiency antibody

E. C and D

F. All of the above

III-99. A 54-year-old woman presents acutely with alterations in mental status and fever. She was well until 4 days previously when she began to develop complaints of myalgia and fever. Her symptoms progressed rapidly, and today her husband noted her to be lethargic and unresponsive when he awakened. She has recently felt well otherwise. Her only current medication is atenolol 25 mg daily for

hypertension. On physical examination, she is responsive only to sternal rub and does not vocalize. Her vital signs are blood pressure of 165/92 mm Hg, heart rate of 114 beats/min, temperature of 38.7°C (101.7°F), respiratory rate of 26 breaths/min, and oxygen saturation of 92% on room air. Her cardiac examination shows a regular tachycardia. Her lungs have bibasilar crackles. The abdominal examination is unremarkable. No hepatosplenomegaly is present. There are petechiae on the lower extremities. Her complete blood count has a hemoglobin of 8.8 g/dL, hematocrit of 26.4%, white blood cell count of 10.2/μL (89% polymorphonuclear cells, 10% lymphocytes, 1% monocytes), and a platelet count of 54,000/μL. A peripheral blood smear is shown in Figure III-99. Her basic metabolic panel has a sodium of 137 meq/L, potassium of 5.4 meq/L, chloride of 98 meq/L, bicarbonate of 18 meq/L, BUN of 89 mg/dL, and creatinine of 2.9 mg/dL. Which statement most correctly describes the pathogenesis of the patient’s condition?

FIGURE III-99 (see Color Atlas)

A. Development of autoantibodies to a metalloproteinase that cleaves von Willebrand factor

B. Development of autoantibodies to the heparin-platelet factor 4 complex

C. Direct endothelial toxicity initiated by an infectious agent

D. Inherited disorder of platelet granule formation

E. Inherited disorder of von Willebrand factor that precludes binding with factor VIII

III-100. What is the best initial treatment for this patient?

A. Acyclovir 10 mg/kg intravenously every 8 hours

B. Ceftriaxone 2 g intravenously daily plus vancomycin 1 g intravenously twice daily

C. Hemodialysis

D. Methylprednisolone 1 g intravenously

E. Plasma exchange

III-101. Which of the following statements regarding hemophilia A and B is TRUE?

A. Individuals with factor VIII deficiency have a more severe clinical course than those with factor IX deficiency.

B. Levels of factor VIII or IX need to be measured before administration of replacement therapy in
patients presenting with acute bleeding to calculate the appropriate dose of factor.

C. Primary prophylaxis against bleeding is never indicated.

D. The goal level of factor VIII or IX is greater than 50% in the setting of large-volume bleeding
episodes.

E. The life expectancy of individuals with hemophilia is about 50 years.

III-102. A 24-year-old man is admitted to the hospital with circulatory collapse in the setting of disseminated meningococcemia. He is currently intubated, sedated, and on mechanical ventilation. He has received over 6 L of intravenous saline in the past 6 hours but remains hypotensive, requiring treatment with norepinephrine and vasopressin at maximum doses. He is making less than 20 mL of urine each hour. Blood is noted to be oozing from all of IV sites. His endotracheal secretions are blood tinged. His laboratory studies show a white blood cell count of 24,300/μL (82% neutrophils, 15% bands, 3% lymphocytes), hemoglobin of 8.7 g/dL, hematocrit of 26.1%, and platelets of 19,000/μL. The international normalized ratio is 3.6, the activated partial thromboplastin time is 75 seconds, and fibrinogen is 42 mg/dL. The lactate dehydrogenase level is 580 U/L, and the haptoglobin is less than 10 mg/dL. The peripheral smear shows thrombocytopenia and schistocytes. All of the following treatments are indicated in this patient EXCEPT:

A. Ceftriaxone 2 g intravenously twice daily

B. Cryoprecipitate

C. Fresh-frozen plasma

D. Heparin

E. Platelets

III-103. All the following are vitamin K–dependent coagulation factors EXCEPT:

A. Factor X

B. Factor VII

C. Protein C

D. Protein S

E. Factor VIII

III-104. A 31-year-old man with hemophilia A is admitted with persistent gross hematuria. He denies recent trauma and any history of genitourinary pathology. The examination is unremarkable. Hematocrit is 28%. All the following are treatments for hemophilia A EXCEPT:

A. Desmopressin (DDAVP)

B. Fresh-frozen plasma

C. Cryoprecipitate

D. Recombinant factor VIII

E. Plasmapheresis

III-105. All of the following statements regarding the lupus anticoagulant (LA) are true EXCEPT: A. LAs typically prolong the activated partial thromboplastin time.

B. A 1:1 mixing study will not correct in the presence of LAs.

C. Bleeding episodes in patients with LAs may be severe and life threatening.

D. Female patients may experience recurrent midtrimester abortions.

E. LAs may occur in the absence of other signs of systemic lupus erythematosus.

III-106. All the following cause prolongation of the activated partial thromboplastin time that does not correct with a 1:1 mixture with pooled plasma EXCEPT:

A. Lupus anticoagulant

B. Factor VIII inhibitor

C. Heparin

D. Factor VII inhibitor

E. Factor IX inhibitor

III-107. You are evaluating a 45-year-old man with an acute upper gastrointestinal (GI) bleed in the emergency department. He reports increasing abdominal girth over the past 3 months associated with fatigue and anorexia. He has not noticed any lower extremity edema. His medical history is significant for hemophilia A diagnosed as a child with recurrent elbow hemarthroses in the past. He has been receiving infusions of factor VIII for most of his life and received his last injection earlier that day. His blood pressure is 85/45 mm Hg with a heart rate of 115 beats/min. His abdominal examination is tense with a positive fluid wave. Hematocrit is 21%. Renal function and urinalysis are normal. His activated partial thromboplastin time is minimally prolonged, his international normalized ratio is 2.7, and platelets are normal. Which of the following is most likely to yield a diagnosis for the cause of his GI bleeding?

A. Factor VIII activity level

B. Helicobacter pylori antibody test

C. Hepatitis B surface antigen

D. Hepatitis C RNA

E. Mesenteric angiogram

III-108. You are managing a patient with suspected disseminated intravascular coagulopathy (DIC). The patient has end-stage liver disease awaiting liver transplantation and was recently in the intensive care unit with Escherichia coli bacterial peritonitis. Yo u suspect DIC based on a new upper gastrointestinal bleed in the setting of oozing from venipuncture sites. Platelet count is 43,000/μL, international normalized ratio is 2.5, hemoglobin is 6 mg/dL, and D-dimer is elevated to 4.5. What is the best way to distinguish between new-onset DIC and chronic liver disease?

A. Blood culture

B. Elevated fibrinogen degradation products

C. Prolonged aPTT

D. Reduced platelet count

E. Serial laboratory analysis

III-109. All of the following genetic mutations are associated with an increased risk of deep venous thrombosis EXCEPT:

A. Factor V Leiden mutation

B. Glycoprotein 1b platelet receptor

C. Heterozygous protein C deficiency

D. Prothrombin 20210G

E. Tissue plasminogen activator

III-110. A 76-year-old man presents to an urgent care clinic with pain in his left leg for 4 days. He also describes swelling in his left ankle, which has made it difficult for him to ambulate. He is an active smoker and has a medical history remarkable for gastroesophageal reflux disease, deep venous thrombosis (DVT) 9 months ago that resolved, and well-controlled hypertension. Physical examination is revealing for 2+ edema in his left ankle. A D-dimer is ordered and is elevated. Which of the following makes D-dimer less predictive of DVT in this patient?

A. Age older than 70 years

B. History of active tobacco use

C. Lack of suggestive clinical symptoms

D. Negative Homan’s sign on examination

E. Previous DVT in the past year

III-111. A 22-year-old woman comes to the emergency department complaining of 12 hours of shortness of breath. The symptoms began toward the end of a long car ride home from college. She has no medical history, and her only medication is an oral contraceptive. She smokes occasionally, but the frequency has increased recently because of examinations. On physical examination, she is afebrile with respiratory rate of 22 breaths/min, blood pressure of 120/80 mm Hg, heart rate of 110 beats/min, and oxygen saturation on room air of 92%. The rest of her physical examination findings are normal. A chest radiograph and complete blood count are normal. Her serum pregnancy test result is negative. Which of the following is the indicated management strategy?

A. Check D-dimer and, if normal, discharge with non-steroidal anti-inflammatory therapy.

B. Check D-dimer and, if normal, obtain lower extremity ultrasound.

C. Check D-dimer and, if abnormal, treat for deep venous thrombosis/pulmonary embolism.

D. Check D-dimer and, if abnormal, obtain a contrast multislice computed tomography scan of the
chest.

E. Obtain a contrast multislice computed tomography scan of the chest.

III-112. All of the anticoagulant or antiplatelet drugs listed are correctly matched with their mechanisms of action EXCEPT:

A. Abciximab—Glycoprotein IIb/IIIa receptor inhibitor

B. Clopidogrel—Adenosine diphosphate receptor blockade

C. Enoxaparin—Direct thrombin inhibition

D. Rivaroxaban—Factor Xa inhibition

E. Warfarin—Inhibition of production of the vitamin K–dependent clotting factors

III-113. A 66-year-old woman is prescribed clopidogrel and aspirin after implantation of a bare metal

stent in her right coronary artery. Two weeks after the procedure, the woman presents to the emergency department with acute-onset chest pain and electrocardiographic changes consistent with an acute inferior myocardial infarction. Emergent cardiac catheterization confirms in-stent restenosis. The patient insists she has been adherent to her prescribed therapy. Which of the following statements most correctly described the most likely cause of the patient’s restenosis despite her current therapy?

A. She likely has aspirin resistance and should be treated with higher doses of aspirin to prevent a
recurrence.

B. She likely has clopidogrel resistance caused by a genetic polymorphism of the CYP pathway.

C. She should have been treated with low-molecular-weight heparin to prevent this complication.

D. She should have been treated with warfarin to prevent this complication.

E. Because she has demonstrated resistance to clopidogrel, switching to prasugrel would not be
useful to prevent further complications.

III-114. A 48-year-old woman is diagnosed with a deep venous thrombosis of her left lower extremity. When considering initial anticoagulant therapy, all of the following are advantages of low-molecular-weight heparins over heparin EXCEPT:

A. Better bioavailability

B. Dose-dependent clearance

C. Longer half-life after subcutaneous injection

D. Lower risk of heparin-induced thrombocytopenia

E. Predictable anticoagulant effect

ANSWER

III-1. The answers are 1—C, 2—E, 3—D, 4—A, and 5—B. (Chap. e17) Patients with homozygous sickle cell disease have red blood cells (RBCs) that are less pliable and more “sticky” than normal RBCs. Vaso-occlusive crisis is often precipitated by infection, fever, excessive exercise, anxiety, abrupt changes in temperature, hypoxia, or hypertonic dyes. Peripheral blood smear will show the typical elongated, crescent-shaped RBCs. There is also a nucleated RBC at the bottom of the figure, which may occur attributable to increased bone marrow production. Howell-Jolly bodies, small nuclear remnants normally removed by the intact spleen, are seen in RBCs in patients after splenectomy and with maturation or dysplastic disorders characterized by excess production. Acanthocytes are contracted dense RBCs with irregular membrane projections that vary in width and length. They are seen in patients with severe liver disease and abetalipoproteinemia and in rare patients with McLeod blood group. Iron deficiency, often caused by chronic stool blood loss in patients with colonic polyps or adenocarcinoma, causes a hypochromic microcytic anemia characterized by small, pale RBCs (a small lymphocyte is present on the smear to assess RBC size). RBCs are never hyperchromic; if more than the normal amount of hemoglobin is made, the cells get larger, not darker. Fragmented red cells, or schistocytes, are helmet-shaped cells that reflect microangiopathic hemolytic anemia (e.g., thrombotic thrombocytopenic purpura, disseminated intravascular coagulation, hemolytic uremic syndrome, scleroderma crisis) or shear damage from a prosthetic heart valve.

III-2. The answer is A. (Chap. 57) This patient with anemia demonstrates a low mean cell volume, low mean cell hemoglobin, and low mean cell hemoglobin concentration. The peripheral smear demonstrates microcytic and hypochromic cells, which would be expected given these laboratory findings. In addition, there is marked variation in size (anisocytosis) and shape (poikilocytosis). These findings are consistent with severe iron-deficiency anemia, and serum ferritin would be expected to be less than 10 to 15 μg/L. A low haptoglobin level would be seen in cases of hemolysis, which can be intravascular or extravascular in origin. In intravascular hemolysis, the peripheral smear would be expected to show poikilocytosis with the presence of schistocytes (fragmented red blood cells [RBCs]). In extravascular hemolysis, the peripheral smear would typically shows spherocytes. Hemoglobin electrophoresis is used to determine the presence of abnormal hemoglobin variants. Sickle cell anemia is the most common form and demonstrates sickled RBCs. Thalassemias are also common inherited hemoglobinopathies. The peripheral smear in thalassemia often shows target cells. Glucose-6-phosphate dehydrogenase deficiency leads to oxidant-induced hemolysis with presence of bite cells or blister cells. Vitamin B₁₂ deficiency leads to macrocytosis, which is not consistent with this case.

III-3. The answer is C. (Chap. 57) The reticulocyte index and reticulocyte production index are useful in the evaluation of anemia to determine the adequacy of bone marrow response to the anemia. A normal reticulocyte count is 1% to 2%, and in the presence of anemia, this would be expected to rise to more than two to three times the normal value (the reticulocyte index). The reticulocyte index is calculated as Reticulocyte count × (Patient’s hemoglobin/Normal hemoglobin). In this case, the reticulocyte index would be 5.4%. A second correction is further necessary in this patient given the presence of polychromatophilic macrocytes on peripheral smear. This finding indicates premature release of reticulocytes from the bone marrow (“shift cells”), and thus these cells have a longer life

span. It is recommended to further divide the reticulocyte index by a factor of 2, which is known as the reticulocyte production index. In this case, the value would be 2.7%.

III-4. The answer is C. (Chap. 57) This blood smear shows fragmented red blood cells (RBCs) of varying size and shape. In the presence of a foreign body within the circulation (prosthetic heart valve, vascular graft), RBCs can become destroyed. Such intravascular hemolysis will also cause serum lactate dehydrogenase to be elevated and hemoglobinuria. In isolated extravascular hemolysis, there is no hemoglobin or hemosiderin released into the urine. The characteristic peripheral blood smear in splenomegaly is the presence of Howell-Jolly bodies (nuclear remnants within red blood cells). Certain diseases are associated with extramedullary hematopoiesis (e.g., chronic hemolytic anemias), which can be detected by an enlarged spleen, thickened calvarium, myelofibrosis, or hepatomegaly. The peripheral blood smear may show teardrop cells or nucleated RBCs. Hypothyroidism is associated with macrocytosis, which is not demonstrated here. Chronic gastrointestinal blood loss will cause microcytosis, not schistocytes.

III-5. The answer is A. (Chap. 81) Although cigarette smoking is the greatest modifiable risk factor for the development of cancer, the most significant risk factor for cancer in general is age. Two-thirds of all cancers are diagnosed in individuals older than 65 years, and the risk of developing cancer between the ages of 60 and 79 years is one in three in men and one in five in women. In contrast, the risk of cancer between birth and age 49 years is one in 70 for boys and men and one in 48 for girls and women. Overall, men have a slightly greater risk of developing cancer than women (44% vs. 38% lifetime risk).

III-6. The answer is A. (Chap. 81) The cause of cancer death differs across the life span. In women who are younger than 20 years of age, the largest cause of cancer death is leukemia. Between the ages of 20 and 59 years, breast cancer becomes the leading cause of cancer death. However, lung cancer is the leading cause of cancer death after the age of 60 years and is overall the number one cause of cancer death in women.

Date: 2016-04-22; view: 757