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LEVEL II > IM 3 > Flashcards

IM 3 Flashcards

1
Q

Anisocytosis means a change in the

A. size of RBCs
B. shape of RBCs
C. hemoglobin content in RBCs
D. staining capacity of RBCs

A

A. size of RBCs

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2
Q

A woman being treated with multiple cycles of methotrexate for complete hydatidiform mole is at risk of developing what kind of blood disorder?

A. Anemia of chronic disease
B. Iron deficiency anemia
C. Warm AIHA
D. Megaloblastic anemia

A

D. Megaloblastic anemia

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3
Q

Proper classification of anemia is often achieved when one does the following routine clinical work-up, except what?

A. Peripheral blood smear
B. Bone marrow examination
C. Flow cytometry
D. Erythrocyte indices

A

C. Flow cytometry

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4
Q

Reticulocyte index > 2.5 with macrocytic red cell morphology

A. Myelodysplasia
B. Chronic kidney disease
C. Lead toxicity
D. G6PD deficiency with intake of antimalarials

A

D. G6PD deficiency with intake of antimalarials

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5
Q

What is the absolute reticulocyte count of an anemic male patient with a reticulocyte count of 6%, hemoglobin 7.5
g/dL and hematocrit 21%?

A. 2.0
B. 2.5
C. 3.0
D. 1.5

A

C. 3.0

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6
Q

A diabetic patient with multiple medications presented with anemia, with reticulocyte index less than 2.5, and MCV. What is the most likely cause of the anemia?

A. Intravascular hemolysis
B. Folate deficiency
C. Drug toxicity
D. Renal disease

A

D. Renal disease

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7
Q

A diabetic patient with periorbital edema, brought in lab results of Hgb 7.9 g/dL and a reticulocyte count of 2%. Red cell indices on its CBC reveal normocytic and normochromic anemia. What is the best laboratory test to order next?

A. Bone marrow aspiration
B. Peripheral blood smear
C. Serum creatinine
D. Coomb’s test

A

C. Serum creatinine

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8
Q

What human cell primarily rises in the peripheral blood involving anemias with rampant unchecked destruction of
erythrocytes?

A. Reticulocyte
B. Normoblast
C. Poikilocyte
D. Platelets

A

C. Poikilocyte

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9
Q

A 30-year-old female presents with dizziness, pallor and easy fatigability. CBC done which showed hemoglobin of 8mg/dL, MCV 85 fL, MCH of 30 pg, RPI of 2.4, which of the following is recommended?

A. Bone marrow aspiration should be prioritized
B. Coombs test must be done
C. Do serum iron studies
D. Request for serum folate and vitamin B12 levels

A

C. Do serum iron studies

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10
Q

A 65-year old male came in for consult due to worsening pallor associated with weight loss for the past 6 months. Initial test done revealed Hgb 7.2 g/dL. As the attending physician, how will you further evaluate the
patient?

A. Examine for petechiae as this strongly suggests a lymphoproliferative disorder
B. Palpate for lymphadenopathy which when present, is suggestive of platelet dysfunction
C. Auscultate for the presence of diastolic “flow” murmur that may correlate with the patient’s anemia
D. Check for lightening of the palmar creases which
may support the patient’s actual level of hemoglobin

A

D. Check for lightening of the palmar creases which
may support the patient’s actual level of hemoglobin

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11
Q

JJ, a 40/M is vegan and was found out to have anemia during routine workup in their annual physical exam. What test will tell us the amount of circulating iron bound to transferrin?

A. Red cell Protoporphyrin levels
B. Serum Ferritin
C. Serum Iron
D. Serum Transferrin

A

C. Serum Iron

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12
Q

A 25-year old female came in for consult due to worsening fatigue for about 3 months already. She also complained of occasional dizziness and SOB on exertion. No medications taken. She had her menarche at 12 years old, with menses now occurring at regular intervals, lasting for 10 days, consumes 5-6 napkin pads per day, with dysmenorrhea noted. On physical examination, she appears clinically pale, hence you requested the following tests:
CBC – WBC 6,800 per mm3
Hematocrit 28%
MCV 73 fL
Platelet count 380,000
Reticulocyte count: 1.9%
What is the patient’s corrected reticulocyte count?

A. 1.18%
B. 2.25%
C. 1.55%
D. 2.05%

A

A. 1.18%
RPI = 1.9 x (28/45) = 1.18

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13
Q

Physical examination may give clues to the mechanisms of anemia, which of the following is true?

A. Petechiae point to a coagulation disorder causing the anemia
B. Splenomegaly suggests an underlying
lymphoproliferative disease
C. Hematoma suggest hemolysis
D. Blood noted on Digital Rectal Examination indicates a bleeding ulcer

A

B. Splenomegaly suggests an underlying
lymphoproliferative disease

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14
Q

A 28-year-old female sought consult due to anemia. Her baseline hemoglobin level is 7mg/dl, hematocrit of 21%, normochromic normocytic indices. Reticulocyte count was 8%; on blood smear, no noted polychromatophilic cells. How will you compute for reticulocyte production index? (normal values for adult: hematocrit 45%

A. 8 x 21/7
B. 8 x 7/21
C. 8 x 21/45
D. 8 x 7/45

A

C. 8 x 21/45

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15
Q

This laboratory test is done for the initial classification of anemia:

A. Bone marrow aspiration
B. Serum ferritin
C. Reticulocyte count
D. Peripheral smear

A

C. Reticulocyte count

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16
Q

Anemia as defined by hemoglobin levels based on laboratory examination. Which of the following patient is anemic

A. A 25 years old female with hematocrit of 37
B. A 60 years old male with hematocrit of 40
C. A 19 years old female with a hemoglobin of 12g/dL
D. A 45 years old male with a hemoglobin of 15g/dL

A

B. A 60 years old male with hematocrit of 40

17
Q

Organ responsible for red blood cell production.

A. Erythron
B. Reticuloendothelial cells
C. Liver
D. Erythroid marrow cells

A

A. Erythron

18
Q

Majority of iron distributed in the body is found in

A. Hemoglobin
B. Myoglobin
C. Transferrin
D. Liver

A

A. Hemoglobin

19
Q

Majority of iron passing through the plasma transferrin pool comes from

A. iron stores in the liver
B. destruction of senescent RBCs
C. iron absorbed from diet
D. circulating erythrocytes

A

B. destruction of senescent RBCs

20
Q

Which of the following conditions is an acquired intracorpuscular abnormality that presents with anemia

A. Familial uremic syndrome
B. Hemogiobinopathies
C. Microangiopathic hemolytic anemia
D. Paroxysmal nocturnal hemoglobinuria (PNH)

A

D. Paroxysmal nocturnal hemoglobinuria (PNH)

21
Q

Pelita Coralles, 77 y.o. post menopausal, came into your clinic due to complaints of loss of appetite, weight loss, dizziness, pallor and SOB on exertion. She denied any history of bleeding. She was noted of pallor and other exams were unremarkable. Lab exam:
Hgb: 7
Hct: 22%
MCV: 65
MCH: 22
MCHC: 23
Serum ferritin: 15
TIBS: 400
SI: 30
Peripheral blood smear: microcystis, hopychromic RBCs, (+) anisocytosis & poikilocytosis. What is the diagnosis for this patient?

A. Anemia of Chronic Disease
B. Iron deficiency anemia
C. Iron deficient erythropoeisis
D. Negative iron balance

A

B. Iron deficiency anemia

22
Q

The most likely cause of Pelita’s iron deficiency, until proven otherwise,

A. Colonic bleeding
B. Gynecologic bleeding
C. Chronic disease
D. Malnutrition

A

A. Colonic bleeding

23
Q

A female patient name Pelita. CBC shows she has Hgb = 7.8g/L. Her weight is 60kg. You decide to give parenteral iron therapy with the goal of replenishing 500mg of her iron stores. Which of the following therapies is the most appropriate

A. Ferumoxytol 510mg injection
B. LMW dextran iron 1500mg IV slow drip
C. Ferric carboxymaltose 750mg injection
D. Sucrose iron 200mg IV slow drip

A

B. LMW dextran iron 1500mg IV slow drip

24
Q

Julia Berreta is awake and follows command but prefers to lie down due to dizziness when sitting or standing. She feels weak & looks very pale. As an ER physician, you deduce that she has lost a lot of blood. What percentage is the amount of blood does she lost?

A. 10
B. 20
C. 30
D. 40

A

C. 30

25
Q

Julia’s hgb is 80g/L. Reticulocyte count of 10. Her peripheral smear shows increase reticulocytes and presence of polychromatophilic cells.
What is her RPI

A. 2.6
B. 5.3
C. 26.6
D. 53.3

A

A. 2.6

LEVEL II (16 decks)

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