Professional Documents
Culture Documents
Problems
Dr Kiran P Sathe.
General Tips for Entrance Exams
• Identify the commonly asked theory topics
• Objective way of understanding and reading
• Try to remember the “most common”
aspects for any disease
• Grouping helps to remember better
• Group discussion helps to remember better
HEMATOLOGY- ONCOLOGY
Anemia
• Normal physiological polycythemia at birth
• Physiological anemia of infancy
• Deficiency, hemolysis, hemorrhage, marrow
• Age of onset, specific h/o, ethnicity, family
h/o
• Growth, cong anomalies, petechia, L,S,LN,
jaundice
Marrow
deficiency Hemolysis hemorrhage
disease
Mostly chronic, Acute- manifest Acute,
onset chronic
rarely acute Chronic- occult Rare- chronic
Mostly-
occurence acquired
congenital
acquired acquired
-( aplasia)
L/S - + -
+( leukemia)
N
↓ B12 def
Plt ↑Fe def
↓ ↑ ↓
hypersplenism
↑ Aplasia-↓
WBC N
(normoblasts)
N
Leukemia-↑
MCV, RDW
MCV
low Normal High
RDW- N RDW- RDW- N
↑ RDW-↑
Thal RDW- ↑
Chr disease, Mixed def, RDW- N
trait, Fe def, B12,
sherocytosis, Sideroblas Aplasia
Chronic Thal Folate def
disease major hemorrhage tic
Bleeding Disorder
• Platelet disorder- superficial
bleed, purpura, spontaneous
• Coagulation defect-Deep
bleed- hematoma/
hemarthrosis, provoked
Screening test
Platelet PT PTT Disease
Stem
10,5,2 1, 13
• Prolonged PT- Extrinsic
• PTT- Intrinsic
• Both- 10, 5, 2 def or DIC
• Only PTT prolonged-
• 12( never clinically manifests), 11, 9, 8
• PTT corrected by plasma- factor 8 def,
• adsorbed serum- Factor 9 def
• Prolonged BT- platelet functional defect
• TT- fibrinogen deficiency (factor 1)
• Urea stability test- Factor 13 def
• VW disease:
• Easy bruising and epistaxis from early childhood,
menorrhagia
• Prolonged PFA-100, or BT
• Reduced activity / abormal structure of VWF
• DIC- underlying trigger
• Consumptive coagulopathy
• Prolonged PT, PTT, TT, ↑FDP, ↓fibrinogen or
platelets.
• HSP- anaphylactoid / vascular purpura
• Palpable purpuric rash, migratory joint
affection, intermittent abdominal pain,
nephritis.
MCQs
1. Regarding fanconi anemia false is?
a. AD inheritance
b. Chrosmosomal instability
c. Increased HBF
d. Decreased survival
2. A 9-year-old girl has bleeding diathesis with
prolonged aPTT but normal PT and normal
platelet count. What is the most probable
diagnosis?
a. Hemophilia A
b. Hemophilia B
c. vonWillebrand’s disease
d. Factor V mutation
3. A newborn baby presented with
profuse bleeding from umbilical stump
after birth. Most likely diagnosis is
a. Factor XIII deficiency
b. VWF deficiency
c. Factor XII deficiency
d. Glanzmann thrombasthenia
4. A 5-year-old boy comes with overnight
petechial spots. Two weeks back he had history
of abdominal pain and no hepatosplenomegaly.
Most likely diagnosis nof this patient is
a. Acute lymphatic leukemia
b. Aplastic anemia
c. Idiopathic thrombocytopenic purpura
d. Acute viral infection
5. Primary site of hematopoiesis in
the fetus before mid pregnancy is
a. Bone
b. Liver
c. Spleen
d. Lung
6. Which of the following is not
true of thalassemia major?
a. Splenomegaly
b. Target cells on peripheral smear
c. Microcytic hypochromic anemia
d. Increased osmotic fragility
7. A 15-year-old female presented to the emergency department
with history of recurrent epistaxis, hematuria and hematochezia.
There was a history of profuse bleeding from the umbilicus
stump at birth. Previous investigations revealed normal
prothrombin time, activated partial thromboplastin time,
thrombin time and fibrinogen levels. Her platelet counts as well
as platelet function tests were normal but urea clot lysis test was
positive. Deficiency of which of the following clotting factor is
responsible for this?
a. Factor X
b. Factor XI
c. Factor XII
d. Factor XIII
8. The earliest indicator of response
after starting iron in a 6-year-old girl
with iron deficiency is
a. Increased reticulocyte count
b. Increased hemoglobin
c. Increased ferritin
d. Increased serum iron
9. At what gestation does the switch over
from fetal to adult hemoglobin synthesis
begin?
a. 30 weeks
b. 36 weeks
c. 7 days postnatal
d. 3 weeks postnatal
10. Which of the following is not feature of
idiopathic thrombocytopenic purpura
(ITP)?
a. More common in females
b. Petechiae, ecchymosis and bleeding
c. Palpable splenomegaly
d. Increased megakaryocytes in bone
marrow
ALL
• MC pediatric malignancy (2-10 yrs)
• Down syndrome
• BMA/ biopsy- >25% lymphoblasts
• Pallor, petechia, purpura(50%),
• bone pain (25%) HSmegaly(60%),LN (50%)
• Single or multiple cytopenias(99%)
• Leucopenia (15%), leucocytosis(50%) with
lymphoblasts on PBS
AML
• BM >20% leukemic blasts
• Fatigue bleeding, infection
• Adenopathy, HSmegaly,skin nodules,(M4, M5)
• Cytopenias:neutropenia(69%),anemia(44%),
• thrombocytopenia(33%)
• Syndromes and chromosomal breakage
associated- FA, DBS,NF, Down,WAS,Kostmann
AML
• M2-chloroma
• M3-DIC, retinoic acid therapy
• M4-gum skin, CNS
• M6-erythroleukemia
• M7-down syndrome
Myeloproliferative diseases
• CML- >3 yrs, Ph+
• TMD- <3 mo, Trisomy 21
• JMML- <2 yrs eczematous
rash, bleeding, HbF+
Brain tumours
• MC solid pediatric tumour
• NF, TS
• 2 yrs- infratentorial tumour (post
fossa)
• >2 yrs- supratentorial tumour
HD
• Painless cervical (70-80%) or
supraclavicular ( 25%) adenopathy,
mediastinal mass (50%)
• Fatigue, anorexia, wt loss, fever,
night sweats, pruritus, cough
• Autoimmune HA, ITP associated
NHL
• Cough, dyspnoea, orthopnoea, swelling of
face, LN, mediastinal mass, pleural effusion
• Abd pain, abd distention, vomiting,
constipation, abd mass, ascites, HS megaly
• Adenopathy, fever, neurodeficit, skin lesions
• Association- immune deficiency-WAS, SCID,
XLPD, HIV, immunosuppression post organ
transplantation
Neuroblastoma
• Bone pain, abd pain, anorexia, wt loss, fatigue,
fever, irritability
• Abd mass (65%)- crosses midline, adenopathy,
proptosis, periorbital ecchymosis, skull masses,
subcutaneous nodules, racoon eyes hepatomegaly,
spinal cord compression
• Small round blue cell tumours
• Horner synd, heterochromia, opsomyoclonus
Wilms tumour (Nephroblastoma)
• Asymptomatic abdominal mass or
swelling (83%)
• Fever( 23%), hematuria (21%)
• Hypertn( 25%), GU anomalies (6%),
aniridia, hemihypertrophy
LCH
• Seborrheic skin rashes
• Diaper rash
• Draining ears
• Bone pain
• Diabetes insipidus
• Punched out skull lesions
MCQs
1.All of the following are true about neuroblastoma
except
a. It is the most common extracranial solid tumor in
children
b. More than 50% of patients presents with
metastasis at the time of presentation
c. Lung metastasis common
d. Involve aorta and branches at early stage
2.Which one of the followings is the
postchemotherapy based staging system in
Wilm’s tumor for prognosis?
a. National Wilm Tumor Study Group (NWTSG)
staging system
b. AJCC TNM
c. Chadwick
d. International Society of Pediatric Oncology
(SIOP)
3.Which of the followings is NOT correct
about Cerebellar astrocytoma?
a. Common in first two decades of life
b. More Common in females than males
c. Low grade tumor
d. Good prognosis
4.MC inherited malignant tumor
in childhood is
a. Leukemia
b. Retinoblastoma
c. Neuroblastoma
d. Wilm’s tumor
5. Which of the following syndromes
is not associated with AML?
a. Down’s syndrome
b. Klinefelter’s syndrome
c. Patau syndrome
d. Turner’s syndrome
6. Of the following malignant tumor of
childhood most commonly
metastasize to bones?
a. Wilms’ tumor
b. Neuroblastoma
c. Adrenal gland tumors
d. Granulose cell tumor of ovary
7. A 2-year-old child comes with ear discharge,
seborrheic dermatitis, polyuria and
hepatosplenomegaly. Most probable
diagnosis is
a. Leukemia
b. Lymphoma
c. Langerhans’ cell histiocytosis
d. Germ cell tumor
Immunodeficiency, ( rule out local anatomic causes, FB,
secondary causes)
Primary ID
Combined T & B AB (B) defect
lymphocyte defect
Phagocyte Complement
>3-6 mo age defect
<6 mo age defect
Encapsulated
Recurrent diarrhea, bacteria, Early onset neisseria
herpes, Candida,,
opportunistic, Giardia, polio Skin, oral cavity meningitis
bacteria Malabsorption infection autoimmune
GVHD
Autoimmunity Suppuration SLE, etc
Disseminated BCG
Lymphoreticular
Absent Thymus malignancy Cold abscess
Genetic syndromes- Bloom,TCA2,Trisomy
21, Turner, chediak higashi, Griscelli,
Netherton, cartilage hair hypoplasia
Combined Ab def Phagocyte Complement
• SCID • Agama • Neutropenia • Factor def
• WAS • Hypogama • CGD • C1 esterase
• Di George • CVID • LAD I, II
• AT
• PNH
• IgA def • G6PD def
• HyperIgM • HyperIgM • MPO def
• INF-ϒ &
• IL-12 def
• Which of the following is not a
characteristics of Ataxia
telangiectasia?
a. Chronic sinopulmonary disease
b. Decreased level of a-fetoprotein
c. Chromosomal breakage
d. IgA deficiency
Rheumatology
• JIA (6-12 wks duration of arthritis)
1. Systemic( still) 10-15%
2. Polyarticular RF -/+ 35% >= 4 jts ( anti-CCP)
3. Oligoarticular/ pauciarticular 50% <=4 jts
• Asymptomatic uveitis ( 30%), ANA +
persistent/ extended
4.Enthesitis related arthritis
5. Psoriatic arthritis
6. Undifferentiated
SLE- multisystem autoimmune inflammatory affection of Jt,
skin, kidney, serosa, blood, CNS
ANA, Anti-dSDNA, Anti- Sm, histone, Ro, La
Type 2
•NIDDM, adult onset
• Chromosoal-trisomy 21, klinefelter, Turner
• Metabolic-CF, GSD 1,hyperlipoprotenemia
Secondary • CNS disease- AT, Fredreich ataxia
• Obesity- laurence moon Biedle, Pradar Willi
MCQs
1.A 5-year-old male presented with enlarged phallus
and increased pigmentation of the genitalia and
developed pubic hair; his height is 104 cm. Which
of the following estimation can help to reach the
diagnosis?
a. 11-deoxy cortisol
b. Deoxycorticosterone
c. 17-hydroxy progesterone
d. Aldosterone
2. A 10-month-old baby previously normal suddenly
died in his crib in intensive care unit. On physical
examination hyperpigmentation present and genitalia
were normal. On laboratory examination findings,
blood glucose was 30 mg%. What is the most probable
diagnosis?
a. 21-Hydroxylase deficiency
b. Hyperinsulinemia
c. Familial glucocorticoid deficiency
d. Cushing’s syndrome
3.Which of the following occurs first
during puberty in females?
a. Thelarche
b. Pubarche
c. Menarche
d. Growth spurt
4. Most common cause of delayed
puberty in males is
a. Constitutional delay
b. Klinefelter’s syndrome
c. Noonan syndrome
6.Commonest cause of short
stature is
a. Constitutional
b. Systemic diseases
c. Hypothyroidism
d. Growth hormone deficiency
7. A child is below the third percentile for
height. His growth velocity is normal, but
chronologic age is more than skeletal age.
Which of the following is probable diagnosis?
a. Constitutional delay in growth
b. Genetic short stature
c. Primordial dwarfism
d. Hypopituitarism
8. Earliest manifestation of Cushing’s
syndrome is
a. Loss of diurnal variation
b. Increased ACTH
c. Increased plasma cortisol
d. Increased urinary metabolites of
cortisol