Heme/Onc Questions Flashcards
Which of the following is true about sickle cell anemia? (A) It often leaves women infertile (B) Splenic infarct may occur, especially later in life (C) Those heterozygous for the disease have a typical life span of 10 years less than those without the gene (D) Those homozygous are often undiagnosed until the second decade of life (E) An elevated MCV may be noted, caused by folic acid deficiency
(E) Patients may become folate deficient because of the increased production of erythrocytes. Hemoglobin S disease is an autosomal dominant hemoglobinopathy. The homozygous form (SS), sickle cell anemia, results in sickling of erythrocytes, occurring when the oxygen levels decrease at the tissue level. Hemolysis often accompanies these abnormal erythrocytes.
Which of the following is true of iron deficiency? (A) It is commonly due to acute blood loss (B) Does not frequently occur form the typical American diet (C) It often occurs in pregnancy due to increased RBC destruction (D) It should be confirmed by nine marrow aspiration (E) It requires treatment with long-term iron replacement
(B) Iron deficiency anemia is most commonly due to chronic blood loss. In the USA, dietary deficiency is uncommon (except during pregnancy) and should not be presumed unless potential sources of blood loss have been excluded. However, dietary deficiency often occurs during pregnancy due to increased production of erythrocytes.
All the following are consistent with lead poisoning EXCEPT…. (A) Profound anemia (B) Vague complaints of mild to persistent muscle weakness (C) Difficulty concentrating, progressively worsening (D) Basophilic strippling (E) Lead level > 40 ucg/dL
(A) Lead poisoning is a common occurrence, usually resulting in a mild anemia. Patients often have vague complaints including fatigue, abdominal pain, difficulties with concentration, and muscle weakness. Always check lead levels in patients that present with these complaints and/or you suspect possible lead poisoning.
Causes of mircolytic anemia may include all the following EXCEPT…. (A) Lead poisoning (B) Thalassemia (C) Iron deficiency (D) Anemia f chronic disease (E) Sickle cell anemia
(E) Anemia may be the result of a wide variety of causes. Once a patient is found to be anemic, the next step is determining the underlying etiology. Anemia may be divided into microcytic, normocytic, and microcytic based on the MCV of the erythrocytes. Once this has been determined, the differential diagnosis may be narrowed and appropriate adjuvant tests can be ordered.
Which of the following is true of macrocytic anemias? (A) It causes include poor absorption of Vit B12 in the stomach due to prior gastrectomy (B) Schilling’s test is used to diagnose folate deficiency (C) Folate supplementation should be started empirically to prevent worsening anemia, while further studies are being performed (D) When associated with the loss of taste and atrophy of the tongue mucosa, it suggest Vit B12 deficiency (E) Strict vegetarians are at risk of folate deficiency and may need chronic supplementation
(D) Vit B12 and folate deficiencies are the common forms of macrocytic anemia. Vitamin B12 is found in animal products and is richly found in typical American diets.
One day, while covering the internal medicine floor, you evaluate a patient who was admitted last night for pneumonia. Upon reviewing the routine laboratory studies ordered for that day, you note that the patient has developed an anemia. The chemistry profile reveals a total bilirubin of 2.6 with an elevated LDH. Potential causes of the anemia and hyperbilirubinemia may include all the following EXCEPT…. (A) Malaria (B) Drug use (C) Folate deficiency (D) Blood transfusions (E) Disseminated intravascular coagulopathy
(C) Anemia associated with hyperbilirubinemia and elevated LDH suggests hemolytic anemia. Folate deficiency does not result in hemolysis and therefore elevated bilirubin and LDH would NOT be expected.
All of the following are true regarding disseminated intravascular coagulopathy (DIC), EXCEPT…. (A) DIC may be referred to as a consumptive coagulopathy (B) DIC may result in life threatening bleeding (C) DIC frequently causes micro- or macro thrombosis (D) Heparin is contraindicated (E) Use of fresh frozen plasma (FFP) platelets is controversial
(D) DIC is a systemic disorder resulting from abnormal and excessive activation of the clotting cascade. This results in both excessive bleeding and clotting, often resulting in organ damage such as renal impairment. Heparin is sometimes used but is HIGHLY controversial.
Common precipitators of DIC include all of the following, EXCEPT…. (A) Abruptio placenta (B) MI (C) Closed head injury (D) Gram - bacteremia (E) Prostate cancer
(B) Common precipitators for DIC include infection, closed head trauma, crush injuries, and burns, and obstetric accidents. MI does not typically cause DIC.
Causes of hemolytic anemia include all of the following EXCEPT…. (A) Blood transfusion reaction (B) Lead poisoning (C) TTP (D) Sickle cell anemia (E) DIC
(B) Hemolysis may occur in a variety of settings and is associated with both acute and chronic illness. Distinguishing intravascular and extravascular hemolysis will assist in determining the underlying cause. Lead poisoning results in inhibition of heme synthesis and injury to red cell membranes, resulting in a mild to moderate microcytic anemia. It is not typically associated with hemolysis.
Which of the following is true of idiopathic thrombocytopenic purpura (ITP)? (A) ITP is typically chronic in onset (B) ITP is commonly precipitated by severe bleeding (C) The primary treatment involves transfusion of platelets until bleeding is controlled (D) ITP may be associated with lupus (E) ITP rarely occurs in children
(D) ITP is a disorder of the immune complexes binding to platelets and resulting in severe thrombocytopenia. The diagnosis of ITP is often made in patents when no other etiology can be established. Patients typically present with new onset of abnormal bleeding. The disorder may be seen in patients with other underlying immune disorders such as SLE. Corticosteroids are the primary treatment for these patients.
A 33-year-old engineer with a recent history of prolonged analgesic use (Daypro, a non-steroidal anti-inflammatory) passes out at the gym. His wife states he had been feeling OK, but had recently experienced come gingival bleeding while brushing his teeth. No PMH. Previously healthy young man. On exam, he is slightly pale; otherwise the exam is normal. His blood counts area s follows: H/H = 5.2/15.6, MCV = 90, Platelets = 20,000 and WBC = 1.3 w/ normal diff. What is the mostly likely diagnosis? (A) Hodgkin’s disease (B) Aplastic anemia (C) Chronic lymphocytic leukemia (CLL) (D) Brain tumor (E) Idiopathic thrombocytopenic purpura (ITL)
(B) Aplastic anemia is the most likely diagnosis, Profound pancytopenia, with a normocytic anemia and few signs and symptoms (except for bleeding), is characteristic for aplastic anemia. A bone marrow aspiration and biopsy MUST be done to confirm - it will be hypocellular.T In this case, the anemia is caused by the use of Daypro and can be treated by discontinuing the drug use, provide supportive care (transfusions, rapid treatment of any infection), observe closely and see if the marrow recovers spontaneously.
Acute leukemia frequently presents with…. (A) Infection (B) Neutropenia (C) Joint pain (D) Bleeding (E) All of the above
(E) Acute leukemias may present with any of these symptoms or signs, any combo or not at all. Fatigue is the most common initial complaint, but nonspecific.
“B-symptoms” are: (A) fever + chills + pruritus (B) fatigue + chills + pruritus (C) weight loss + fatigue + headache (D) night sweats + pruritus + headache (E) night sweats + fever + weight loss
(E) B symptoms include fever, weight loss and drenching night sweats (requiring pajama or sheet changing). These are presumed to be a result of hyperproliferation of lymphocytes, especially B-lymphocytes. Pruritus and headache are not typically symptoms.
A 52-year-old man presents complaining of early satiety and mild fatigue for the last 5 months. He has no other complaints and no significant PMH, other than a tonsillectomy at age 6 and well controlled HTN. On exam, there is no lymphadenopathy or hepatomegaly, but his spleen is palpable. A blood smear shows: H/H = 13.9/42, Platelets = 380, 000 and WBC = 85,000 w/ some immature cells but only 1% blasts. A bone marrow done the next day shows a hypercellular sample with essentially a normal differential, and again only 1% blasts. Chromosome analysis shows presence of the Philadelphia chromosome (t(9;22)). What is the most likely diagnosis? (A) ALL (B) AML (C) CML (D) CLL (E) Burkitt’s lymphoma
(C) The myeloproliferative divorced CML is the most likely diagnosis here. Early satiety is a common manifestation of splenomegaly; fatigue is a general complaint with a single cause often never found.
A 33-year-old woman presents complaining of profound fatigue for the past 6 weeks. She has quit her job because of her fatigue. She looks pale and is tachycardic at 110 bpm, but otherwise her exam is normal. A blood smear shows: H/H = 4.5/13/4, Platelets = 19,000 and WBC = 3.1 w/ 21% blasts that have Auer rods. The most likely diagnosis is: (A) Hodgkin’s disease (B) Non-hodgkin’s lymphoma (C) CML (D) Acute leukemia (E) Hemolytic anemia
(D) Auer rods are pathognomonic of acute leukemia, especially AML. This presentation is typical for AML.
