OME - Day 9

Question 1

Macrocytic anemia, what is the next step?

Answer 1

Blood smear (not B12 and Folate)

Question 2

Megaloblastic anemia, differential?

Answer 2

B12 deficiency and Folate deficiency.

Question 3

Normocytic anemia, decreased reticulocyte count, differential?

Answer 3

Cancer and CKD

Question 4

Normocytic anemia, elevated reticulocyte count, differential?

Answer 4

Hemorrhage and Hemolysis

Question 5

Pallor, tachycardia, dyspnea on exertion, diagnosis?

Answer 5

Anemia

Question 6

Two tests you should look at with every anemia

Answer 6

MCV and Retic Count

Question 7

What are 4 causes of Microcytic anemia?

Answer 7

Iron Deficiency, Anemia of Chronic Inflammatory Disease, Thalassemia, and Sideroblastic

Question 8

Diagnose Pernicious anemia, what’s the best test?

Answer 8

EGD with biopsy showing atrophy of gastric mucosa

Question 9

Diagnose Pernicious anemia, what’s the first step?

Answer 9

Anti-IF and Anti-parietal cell antibodies

Question 10

Tea and toast diet, diagnosis?

Answer 10

Folate deficiency

Question 11

What leads to a non-megaloblastic anemia?

Answer 11

Lead, Toxins, Cirrhosis

Question 12

What separates B12 from folate deficiency?

Answer 12

Neurologic symptoms (irreversible)

Question 13

What test can you get if the B12 and Folate are equivocal?

Answer 13

Methylmalonic Acid (B12 def elevated, Folate def not elevated)

Question 14

A picture of a red blood cell with a circle of darkly pigmented iron, what’s the diagnosis?

Answer 14

Sideroblastic anemia (ringed sideroblasts)

Question 15

Decreased Ferritin, increased TIBC, decreased iron, diagnosis?

Answer 15

Iron deficiency anemia

Question 16

Elevated ferritin, decreased TIBC, decreased iron, diagnosis?

Answer 16

Anemia of chronic inflammatory disease

Question 17

How do you diagnose thalassemia?

Answer 17

Hemoglobin electrophoresis

Question 18

How do you treat iron overload from blood transfusions?

Answer 18

Deferoxamine, Deferasirox (not phlebotomy)

Question 19

Hydrops Fetalis, diagnosis?

Answer 19

4 alpha genes deleted, incompatible with life

Question 20

Iron deficiency anemia in an old man, what’s the diagnosis and next step?

Answer 20

Colon cancer, get a c-scope

Question 21

Normal iron studies in an Asian, diagnosis?

Answer 21

Thalassemia

Question 22

Thalassemia Major, diagnosis and next step?

Answer 22

Monthly transfusions to support life, iron overload

Question 23

Thalassemia Minor, diagnosis and next step?

Answer 23

Has mild anemia, does not need treatment

Question 24

What one test do you get to separate microcytic anemias?

Answer 24

Ferritin

Question 25

African American man, anemia, jaundice, joint pain, bone pain, how would you treat?

Answer 25

O2, IVF, Pain Control

Question 26

African American man, anemia, jaundice, joint pain, bone pain, priapism, how would you treat?

Answer 26

Exchange transfusion (priapism)

Question 27

Aplastic anemia in a sickle cell patient - causative organism?

Answer 27

Parvovirus B19

Question 28

Bite Cells shows what?

Answer 28

G6PD Deficiency

Question 29

CD55 Negative?

Answer 29

Paroxysmal Nocturnal Hemoglobinuria

Question 30

Heinz Bodies shows what?

Answer 30

G6PD Deficiency

Question 31

How do you diagnose hereditary spherocytosis?

Answer 31

Osmotic Fragility test (spherocytes on smear is wrong)

Question 32

How do you diagnose Sickle cell Disease?

Answer 32

Hgb Electrophoresis (first time), Sickled Cells on smear (for crisis)

Question 33

How do you test for Paroxysmal Nocturn Hemoglobinuria?

Answer 33

Flow Cytometry (Decreased CD55 and CD59)

Question 34

How do you test for warm autoimmune hemolytic anemia?

Answer 34

Coomb's test

Question 35

Mediterranean man, salads, and HIV drugs, diagnosis?

Answer 35

G6PD Deficiency

Question 36

Sickle Cell patient with chest pain and fluffy infiltrates on chest-x-ray, diagnosis and next step?

Answer 36

Acute chest, exchange transfusion

Question 37

Smear for sickle cell anemia shows what?

Answer 37

Sickled Cells

Question 38

What is the best test for Hereditary Spherocytosis?

Answer 38

Osmotic Fragility

Question 39

What test for Autoimmune Hemolytic Anemia?

Answer 39

Coomb's test

Question 40

What's the best test for sickle cell anemia?

Answer 40

Hgb Electrophoresis

Question 41

What's the treatment for a pain crisis in sickle cell?

Answer 41

IVF, O2, Pain Control

Question 42

What's the treatment for hereditary spherocytosis?

Answer 42

Splenectomy (fixes anemia, not spherocytes)

Question 43

What's the treatment for Sickle Cell chronically, reduce attacks?

Answer 43

Hydroxyurea