Hematology packrat Flashcards
What is the most common hypercoagulable state? A. Factor V Leiden B. Protein C deficiency C. Protein S deficiency D. Antithrombin III Deficiency
(c) A. Factor V Leiden is the most common inherited hypercoagulable states with about 2-5% of the population affected.
A patient presents complaining of new onset of repeated mottled and numb fingers when exposed to previously tolerated cold weather. The patient denies color changes or itching. ANA is negative. CBC reveals a mild anemia and rouleaux. Which of the following is the most likely diagnosis? A. Cold agglutinin disease B. Raynaud’s phenomena C. Chilblains D. Frostbite
(c) A. Cold agglutinin disease presents with mottled and numb fingers after repeated cold exposure. CBC reveals a mild anemia and rouleaux.
A patient presents to the office for routine examination. Initial labs reveal a Hgb of 8.5 mg/dL and Hct of 26%, MCV 66 fL, and RDW 12.1. Peripheral blood smear shows numerous target cells. Based upon these findings what would be the next laboratory test to order? A. Hemoglobin electrophoresis B. Serum ferritin C. Serum vitamin B12 D. Serum lead level
(c) A. The findings of target cells on the peripheral blood smear indicate that a hemoglobinopathy exists. To confirm what type of hemoglobinopathy exists an electrophoresis should be done.
(u) B. Iron deficiency anemia does not present with target cells.
(u) C. Vitamin B12 deficiency anemia presents with an elevated MCV.
(u) D. Anemia secondary to lead poisoning presents with basophilic stippling.
When palpating a patient’s abdomen at the level of the left costal margin, the physician assistant feels the edge of the spleen. To confirm findings, which of the following is appropriate?
A. Roll the patient onto the right side and palpate for the spleen edge.
B. Roll the patient onto the left side and palpate for the spleen edge.
C. Have the patient get into the knee-chest position
D. Have the patient sit upright and palpate in the left costal vertebral angle.
(c) A. By rolling the patient onto the right side, gravity may bring the spleen forward and medial so that it is in a palpable location.
Which of the following is the treatment of choice for polycythemia vera?
A. Oral steroids
B. Phlebotomy
C. Antiplatelet agents D. Iron supplementation
(c) B. The treatment of choice is phlebotomy, removing one unit of blood weekly until the Hct is less than 45%.
A patient presents with a macrocytic anemia and paresthesia of the lower extremities. The treatment of choice is
A. phenytoin. B. gabapentin. C. cobalamin. D. folate.
(c) C. The patient presents with laboratory findings and symptoms of Vitamin B12 deficiency. The treatment of choice is cobalamin.
A 6 year-old male presents with hemarthrosis of the left knee. Coagulation studies reveal the following results: PT 12.5 seconds (normal range 12-14 seconds), INR 1.0, aPTT 58 seconds (normal range 18-28 seconds), platelet count 430,000/microliter (normal range 150,000-450,000/microliter), and bleeding time 4 minutes (normal range 2-12 minutes). Which of the following is the best treatment option for this patient? A. Desmopressin acetate B. Corticosteroids C. Vitamin K D. Cryoprecipitate or Factor VIII
(c) D.Hemophilia A presents with a prolonged aPTT and normal platelet count and function. Hemophilia A is treated with factor VIII concentrate or cryoprecipitate.
An 18 year-old woman presents to the clinic complaining of fatigue. She reports a past history of lifelong frequent nosebleeds and bleeding gums. She also has menorrhagia. Her mother and maternal grandfather have a similar bleeding history. Initial lab results are as follows: WBC 9,500/mm3, Hgb 10.9 g/dL, HCT 33%, MCV 69 fL, MCHC 26 pg and platelets 284,000/mm3. Which of the following tests should be ordered to evaluate this patient’s diagnosis?
A. Hemoglobin electrophoresis
B. Bleeding time and platelet aggregometry
C. Bone marrow aspiration
D. PT and aPTT
(c) B. The patient’s presentation is consistent with a congential qualitative platelet disorder, most likely von
Willebrand’s Disease, necessitating a bleeding time and evaluation of platelet function.
Which of the following physical findings suggest pernicious anemia?
A. Splenomegaly and hepatomegaly
B. Petechiae and ecchymosis
C. Loss of position and vibratory sensation
D. Cheilosis and koilonychia
(c) C. Loss of position and vibratory sensation are common neurologic findings in pernicious anemia.
A 60 year-old male presents with a normochromic, normocytic anemia and splenomegaly. His past history reveals several episodes of bacterial pneumonia in the past year. The WBC count is 43,000 mm3 with 25% segmented neutrophils, 3% blasts, 70% mature lymphocytes, 1% basophils, and 1% eosinophils. This most likely represents
A. myelodysplastic syndrome.
B. acute lymphocytic leukemia.
C. chronic lymphocytic leukemia. D. chronic myelogenous leukemia.
(c) C. Chronic lymphocytic leukemia usually occurs after the age of 50 presenting with lymphocytosis > 20,000 mm3 and lymphocytes that appear mature.
Which of the following therapies is recommended for a 13 month-old child with sickle cell disease?
A. Folic acid and penicillin V
B. Ferrous sulfate and penicillin V
C. Folic acid and ferrous sulfate
D. Folic acid, ferrous sulfate and penicillin V
(c) A. Patients with sickle cell disease should receive prophylactic penicillin V starting at 2 months of age and folic acid starting at 1 year of age. Ferrous sulfate is not globally recommended for patients with sickle cell disease.
A 29 year-old patient with idiopathic thrombocytopenia purpura (ITP) is treated with prednisone therapy. Despite therapy, platelet counts remain consistently below 20,000/microliter over the course of 6 weeks. Which of the following is the most appropriate intervention for this patient? A. Aspirin B. Intravenous immunoglobulin C. Danazol (Danocrine) D. Splenectomy
(c) D. Persistently low platelet counts (< 20,000) require effective long-term treatment, and splenectomy is the
treatment of choice.
A defect in which of the following physiologic processes can lead to the development of a microcytic, hypochromic anemia? A. Hemoglobin production B. IgG antibody formation C. Red blood cell nuclear maturation D. Red blood cell membrane defects
(c) A. A deficiency in substances required for hemoglobin synthesis result in RBCs with a deficient mean corpuscular hemoglobin concentration and usually microcytosis.
Which of the following leukemias is most closely associated with the Philadelphia chromosome?
A. hairy cell
B. acute lymphocytic C. acute myelocytic D. chronic myelocytic
(c) D. Philadelphia chromosome is noted most commonly in patients with chronic myelogenous leukemia.
A 35 year-old female presents with fatigue. CBC results reveal the following: WBC: 6,300/microliter Hgb: 9.5 g/dl Hct: 28% MCV: 75 fL MCHC: 32 g/dl MCH: 24 pg Platelets: 550,000/mL 46 Which of the following is the best treatment option for this patient? A. folic acid B. vitamin B12 C. prednisone D. ferrous sulfate
(c) D. Iron deficiency anemia is a microcytic, hypochromic anemia and is treated with ferrous sulfate.
A 13 year-old male with sickle cell trait is interested in playing football for his school. Which of the following considerations should be reviewed with the patient and his parents? A. avoid dehydration B. avoid all contact sports C. begin daily use of aspirin D. begin hydroxyurea supplements
(c) A. No restriction of sports activity is required of patients with sickle cell trait. Hydration is required in all sports activities
A 26 year-old female required 12 units packed red blood cells during a trauma resuscitation and surgical repair of liver and splenic lacerations. The patient is now 6 hours postoperative and has blood oozing from the suture line and IV sites. There is bloody urine in the Foley bag. Laboratory evaluation demonstrates a platelet count of 10,000/microliter, prolonged prothrombin level, and the presence of fibrin split products. Which of the following is the most likely diagnosis?
A. acute ABO incompatibility reaction
B. disseminated intravascular coagulation
C. exacerbation of idiopathic thrombocytopenia
D. inadequate repair of the liver lacerations
(c) B. Disseminated intravascular coagulation is characterized by bleeding from many sites as all coagulation factors are consumed and then broken down, leading to decreased fibrinogen level and platelet count, prolonged PT and PTT, and presence of fibrin split products.
A 26 year-old male presents with a four week history of fatigue, night sweats, and a painless mass in his neck. Physical examination confirms the presence of an enlarged right posterior cervical lymph node. What is the next best step in the evaluation of this patient? A. bone marrow biopsy and aspiration B. lymph node biopsy C. chest CT scan D. reexamine in 2-4 weeks
(c) B. This patient presents with possible lymphoma. Diagnosis is made by lymph node biopsy. Bone marrow biopsy and CT scan of the chest are used for staging of the disease.
Absorption of vitamin B12 requires intrinsic factor that is secreted by which of the following? A. parietal cells B. chief cells C. mucous cells D. enteroendocrine cells
(c) A. Parietal cells are responsible for acid secretion and intrinsic factor.
