Heme/ Endocrine Flashcards
A patient is noted to have prolonged bleeding after an intravenous needle is removed. A
subsequent laboratory test reveals a prolonged activated partial thromboplastin (aPTT) time
with a normal prothrombin time (PT). Based on this result, the provider may suspect alteration
in function of which factor?
a. Factor V
b. Factor VII
c. Factor VIII
d. Factor X
ANS: C
Factor VIII is part of the intrinsic system, which aPTT measures. The other factors are part of
the extrinsic system, which is measured by PT.
A male patient has a history of recurrent epistaxis. Prior to a scheduled surgery, the provider
asks about a family history of bleeding disorders. The patient reports no female relatives who
had excessive bleeding episodes, but states that a maternal uncle and his maternal grandfather
both had postsurgical complications related to bleeding. Based on this history, which
diagnosis is possible?
a. Hemophilia
b. Thrombocytopenia
c. Thrombophilia
d. Von Willebrand disease
ANS: A
Hemophilia is an X-linked recessive disorder affecting only males and carried by females. A
family history of maternal males with bleeding disorders should clue the provider that this
disorder is likely. Thrombocytopenia is usually an acquired disorder. Thrombophilia causes
clots and thrombi, not bleeding. Von Willebrand disease is an autosomal genetic disorder
affecting both males and females.
A patient has type 1 Von Willebrand disease (vWD). What treatment is generally effective to
prevent and treat bleeding episodes in this patient?
a. Coagulation factor
b. Desmopressin
c. Heparin
d. Vitamin K
ANS: B
Desmopressin may be useful in patients with type 1 vWD. Coagulation factor is used in most
patients with hemophilia. Heparin is an anticoagulant. Vitamin K is used to counter warfarin
overdose.
A child has a recent history of leg pain, unexplained bruising, and nosebleeds. The provider
notes petechiae and diffuse lymphadenopathy. A complete blood count reveals a white blood
cell (WBC) of 30,000 cells/mm3 and near normal red blood cell (RBC) and platelet counts.
What will the provider do next to manage this patient?
a. Order coagulation studies to evaluate for coagulopathies
b. Perform biochemical studies to look for hyperuricemia
c. Refer to a specialist for a bone marrow aspirate and biopsy
d. Repeat the complete blood count in 2 weeks
ANS: C
Patients with acute lymphocytic leukemia (ALL) may have normal blood counts even when
the marrow has been replaced with leukemic cells, so a bone marrow aspirate and biopsy is
required for the definitive diagnosis. Coagulation and biochemical studies may be performed
after the diagnosis is known to evaluate for complications. Waiting and repeating the CBC in
2 weeks is not recommended since the definitive diagnosis is made by bone marrow biopsy.
A patient is suspected of having leukemia and the provider orders biochemical studies and a
bone marrow aspirate and biopsy. The results include white blood cells (WBCs) greater than
200,000 cells/mm3 normal red blood cells (RBCs), hyperplastic myeloid cells, and the absence
of serum leukocyte alkaline phosphatase. Which test will the provider order to confirm a
diagnosis in this patient?
a. Chest radiograph
b. Coagulation studies
c. Philadelphia chromosome test
d. Serum protein electrophoresis
ANS: C
The findings from the complete blood count (CBC) and bone marrow biopsy, along with a
positive Philadelphia chromosome test, confirm the diagnosis of chronic myelogenous
leukemia. A chest radiograph and serum protein electrophoresis may be performed to evaluate
for associated symptoms. Coagulation studies are usually performed as part of the diagnostic
workup for acute lymphocytic leukemia (ALL).
A patient with acute myelogenous leukemia (AML) who has a high white blood cell count and
diffuse lymphadenopathy is hospitalized during the induction phase of chemotherapy. What
monitoring and interventions are critical to assess for complications during this phase of care
for this patient? (Select all that apply.)
a. Administration of sodium bicarbonate and allopurinol
b. Assessment for bruising and petechiae
c. Close monitoring of absolute neutrophil counts
d. Daily renal function and chemistry values
e. Meticulous assessment of hydration status
a. Administration of sodium bicarbonate and allopurinol
d. Daily renal function and chemistry values
e. Meticulous assessment of hydration status
This patient has a high WBC load and diffuse lymphadenopathy, so is at increased risk for
acute tumor lysis syndrome (ATLS). Close monitoring of renal function, serum renal
chemistry values, and hydration status is essential. Adding sodium bicarbonate and allopurinol
help to minimize risk. Thrombocytopenia causing bruising and petechiae, along with
neutropenia, are common complications of chemotherapy but these symptoms generally occur
7 to 10 days after initiation of therapy
A patient reports a neck mass that has been present intermittently for 5 or 6 weeks which
varies in size. The provider palpates a lymph node measuring 1.25 cm. Which test will
provide proper histologic diagnosis for this patient?
a. Bone marrow aspirate
b. Computed tomography (CT) scan with intravenous (IV) contrast
c. Lymph node biopsy
d. Positron emission tomography (PET) scan
ANS: C
The lymph node biopsy is used to provide proper histologic diagnosis and precise
classification. Bone marrow aspirate identifies the presence of dysplastic cells. PET and CT
scans will identify the presence of other lesions.
A patient diagnosed with myelodysplastic syndrome (MDS) and presenting with severe
neutropenia and anemia is given erythropoietin (EPO) with improvement in hemoglobin.
Which intervention has been shown to prevent infection in patients with MDS who have
severe neutropenia?
a. Anti-thymocyte globulin and cyclosporine
b. Granulocyte-macrophage colony-stimulating factor (GM-CSF)
c. Intravenous immunoglobulin infusions
d. Prophylactic treatment with fluoroquinolones
ANS: D
Prophylactic antibiotic therapy with fluoroquinolones in neutropenic patients has been shown
in a large meta-analysis to decrease the incidence of serious infections and reduce all-cause
mortality. Anti-thymocyte globulin and cyclosporine is immune suppression treatment used to
reduce the need for transfusions. GM-CSF is given when there is active infection but does not
decrease the actual number of infections. IVIG is not used for these patients and is not a
prophylactic measure.
A patient has new-onset hypertension with a systolic blood pressure of 180 mm Hg. Which
test will the provider order to diagnose this patient?
a. ACTH suppression testing
b. Adrenal antibody tests
c. Cortisol excretion studies
d. Fractionated metanephrine levels
ANS: D
Patients with pheochromocytoma may present with new-onset hypertension with systolic
pressure >170 mm Hg. Fractionated metanephrine will be elevated when the diagnosis is
confirmed. ACTH suppression testing and cortisol excretion studies are performed to
diagnose Cushing’s syndrome. Adrenal antibody tests are performed as part of the evaluation
for Addison’s disease.
A patient has rapid weight gain, amenorrhea without pregnancy, and mild hypertension. Once
confirmatory tests are performed, what is a possible treatment for this patient?
a. Antihypertensive therapy
b. Mineralocorticoid replacement
c. Oral hydrocortisone
d. Pituitary tumor resection
ANS: D
This patient has symptoms of Cushing’s syndrome. When indicated, pituitary tumor resection
is performed as the first choice. Antihypertensive therapy is initiated in patients with
pheochromocytoma. Mineralocorticoids and glucocorticoids are given to patients with
Addison’s disease
A patient has unexplained weight loss and the provider notes increased skin pigmentation on light-exposed skin folds along with darkened palmar creases. Which laboratory tests will the provider order? (Select all that apply.) a. Serum ACTH b. Serum cortisol c. Serum electrolytes d. TB skin testing e. Urine cortisol
ANS: A, C, D
This patient has symptoms of Addison’s disease. Serum ACTH will be elevated in patients
with Addison’s disease. Hyponatremia and hyperkalemia may occur and are sometimes the
initial finding. TB skin testing is done to exclude tuberculosis. Serum and urine cortisol levels
are evaluated with Cushing’s syndrome is suspected.
An obese adolescent female patient reports irregular periods and excessive acne. The provider
notes an increased amount of hair on her upper back, shoulders, and upper abdomen. What
will the provider do, based on these findings?
a. Consider treatment with oral contraceptive pills (OCPs)
b. Counsel her about diet, exercise, and weight loss
c. Recommend cosmetic laser hair removal
d. Refer to an endocrinologist for evaluation
ANS: D
All patients with suspected hirsutism should be referred to a specialist to determine the cause.
OCPs, lifestyle changes, and cosmetic treatments may be part of the treatment, but the
underlying causes must be determined first to ensure that a life-threatening condition is not
present.
A young adult woman is unable to conceive after trying to get pregnant for over 6 months.
The woman reports having had irregular periods since the onset of menarche. The provider
notes that the woman is overweight, has acanthosis nigricans, and an excess hair distribution.
What does the provider suspect as the most likely primary cause of these symptoms?
a. Congenital adrenal hyperplasia
b. Cushing’s syndrome
c. Polycystic ovary syndrome (PCOS)
d. Type 2 diabetes
ANS: C
PCOS is the most likely cause of oligo- or amenorrhea, so this is the most likely cause. The
other conditions are possible, but less likely.
A woman who has hirsutism with acne, and oligomenorrhea will most likely be treated with
which medication to control these symptoms?
a. Finasteride
b. Levonorgestrel
c. Norgestimate
d. Spironolactone
ANS: C
Norgestimate is a progestin with low androgenic activity and is used to suppress testosterone
and control symptoms. Finasteride, which decreases the peripheral conversion of testosterone
to dihydrotestosterone (DHT), is not approved for this use. Levonorgestrel is an androgenic
oral contraceptive pill (OCP) and should be avoided. Spironolactone is a second-line
medication approved for this purpose.
A patient is in the emergency department with confusion and fatigue and a corrected serum
calcium concentration is 10.8 mg/dL. What is the initial treatment for this patient prior to
admission to the inpatient unit?
a. Administration of furosemide
b. Correction of potassium and magnesium levels
c. Parenteral salmon calcitonin
d. Rapid administration of intravenous normal saline
ANS: D
To help the kidneys excrete calcium, intravenous normal saline should be given initially.
Furosemide may not be effective as once thought and is used less often today. Correction of
other electrolytes may be done when these imbalances are assessed. Parenteral salmon
calcitonin may be used later to enhance calcium losses.
