heme Flashcards
(38 cards)
A 55-year-old non-smoking male presents with a hemoglobin of 18.5 g/dl and a hematocrit of 56%. Which of the following physical examination findings is the most likely to be noted with this patient?
Splenomegaly
An 8-year-old presents with splenomegaly. CBC results reveal the following: WBC- 6,300/microliter, Hgb- 10.5 g/dl, Hct- 31%, MCV- 87 fL, MCHC- 39 g/dl, MCH- 28 pg, and platelets- 317,000/mL. Examination of the RBC morphology reveals 80% spherocytes. Which of the following would be most helpful in confirming the diagnosis?
Osmotic fragility
A 60-year-old presents with fatigue and splenomegaly. CBC reveals the following: WBC- 24,000/microliter, Hgb- 13.5 g/dl, Hct- 40%, MCV- 87 fL, MCHC- 34 g/dl, MCH- 28 pg, and platelets- 380,000/mL. The differential reveals neutrophils- 11%, lymphocytes- 80%, monocytes- 8%, and basophils- 1%. What is the most likely diagnosis?
Chronic lymphocytic leukemia
A patient with multiple myeloma should be immunized against which of the following organisms?
Streptococcus pneumoniae
It is essential to advise a patient with infectious mononucleosis to
avoid contact sports
A 32-year-old man with a history of easy bruising and joint swelling is being prepped for an appendectomy. During the physical examination, the patient states that he had surgery to correct a heart defect when he was 4, and during the procedure, he was bleeding uncontrollably. Since then he has been diagnosed with a bleeding disorder and must be treated prophylactically prior to any surgical procedure. He adds that his maternal grandfather and 2 of his grandfather’s brothers also had the same disorder. Which of the following is the best primary perioperative treatment to prevent uncontrollable bleeding?
Replacement therapy of factor VIII
Pernicious anemia is due to deficiency in which of the following?
Intrinsic factor
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?
Bleeding time and platelet aggregometry
Which of the following physical findings suggest pernicious anemia?
Loss of position and vibratory sensation
Which of the following therapies is recommended for a 13 month-old child with sickle cell disease?
Folic acid and penicillin V
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?
Splenectomy
A defect in which of the following physiologic processes can lead to the development of a microcytic, hypochromic anemia?
Hemoglobin production
Which of the following leukemias is most closely associated with the Philadelphia chromosome?
chronic myelocytic
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 Which of the following is the best treatment option for this patient?
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?
avoid dehydration
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?
disseminated intravascular coagulation
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?
lymph node biopsy
Absorption of vitamin B12 requires intrinsic factor that is secreted by which of the following?
parietal cells
A 56 year-old male is noted to have a recent diagnosis of polycythemia vera. His current hemoglobin is 21 gms/dl. What treatment should be instituted for this patient at this time?
Phlebotomy
A positive osmotic fragility test is seen in which of the following?
Hereditiary spherocytosis
An adult patient who has undergone a splenectomy secondary to idiopathic thrombocytopenic purpura should receive which prophylactic agent?
Pneumococcal vaccine IM one time only
A 48 year-old male complains of weakness and general malaise for about 2 months. Patient denies any recent illness and does not take any medications. Physical examination reveals a pale looking male in no acute distress. His heart rate is 110 beats/minute without a murmur and his abdominal examination reveals hepatosplenomegaly. A CBC reveals the WBC to be 62,000/microliter, Hgb is 8.3 gms/dl, Hct is 24.6%. A differential reveals a predominance of monoblasts and promyelocytes with Auer rods present. What is the most likely diagnosis?
Acute myelogenous leukemia
A patient with a history of multiple trauma has received a combination of 12 units of packed red blood cells and whole blood while in the emergency department. Later that night it is noted that the patient is beginning to ooze blood from sites of injury and needle punctures. Which of the following is the most appropriate intervention?
Fresh frozen plasma
A positive direct Coombs’ test may be seen in which of the following conditions?
Autoimmune hemolytic anemia
