Hematology 1

A 67-year-old man has a 2 week history of increasing facial swelling with onset of facial cyanosis. Examination shows elevated jugular venous pressure and dilation of the veins of the anterior chest and both arms. Cardiac examination is normal. Which of the following is the most likely underlying cause?

Primaquine therapy is initiated in a 21-year-old African American soldier for anti-malarial prophylaxis. One week later the patient has dark brown urine, jaundice, and anemia. Which of the following is the most likely diagnosis?

Which of the following laboratory tests assesses the extrinsic coagulation pathway?

A 30-year-old female who has been on an unsupplemented vegan diet for many years presents to you with anemia. Which of the following test results is she most likely to have?

The term “left shift” in hematology refers to which of the following in the peripheral blood?

A 70-year-old patient presents with fatigue, left upper quardrant abdominal discomfort, early satiety, and malaise. The patient is noted to have an enlarged spleen on examination). Results of the CBC with differential are as follows:
WBC: 120,000
Hgb: 10 g/dL
HCT: 30%
MCV: 90
Plt: 700,000
Differential: 49% segs, 4% bands, 20% lymphocytes,
6% metamyelocytes, 6% myelocytes, 2% promyelocytes,
6% eosinophils, 6% basophils, 1% blasts
Subsequent cytogenetic analysis of bone marrow aspirate reveals the presence of Philadelphia chromosome. Based on this information, what is the most likely diagnosis?

A 25-year-old woman is seen for evaluation of “excessive gum bleeding” noted during a recent dental procedure. Upon further questioning, the patient admits intermittent nosebleeds and heavy menstrual bleeding. She reports feeling otherwise well and denies recent acute illness, fever, infections, or other chronic medical concerns. The results of her initial lab tests are as follows:
WBC: 5200 BUN: 10.0
Hgb: 13.0 Creat: 0.8
HCT: 38%
MCV: 84
Plt: 164,000
Differential: normal
PT/INR: 12.6 sec/1.0 (normal)
PTT: 38 sec (elevated)
Based on this information, what is the most likely diagnosis for this patient?

Which of the following laboratory findings would be suggestive of a diagnosis of advanced liver disease?

All of the following statements pertaining to polycythemia vera (PV) are true except:

All of the following statements pertaining to acute leukemia are true except:

While evaluating test results for a patient recently found to have lymphocytosis in the peripheral blood and associated peripheral lymphadenopathy on examination, which of the following clinical findings would support a diagnosis of chronic lymphocytic leukemia (CLL) for the patient?

When evaluating the peripheral blood smear of a patient with microcytic anemia, basophilic stippling and many target cells are noted to be present. Based on this information, which of the following diagnostic studies should be included in the evaluation of this patient?

While evaluating a 62-year-old male patient who presents with a complaint of significant back pain, it is noted that a recent CBC revealed a normocytic anemia accompanied by renal insufficiency, both of which had not previously been present on routine lab work 8 months ago. Plain films of the patient’s spine reveal multiple lytic lesions. Based on this information, you are concerned that the patient may have a diagnosis of multiple myeloma. All of the following tests would be helpful in establishing this diagnosis except:

All of the following clinical findings would support a diagnosis of thrombotic thrombocytopenia purpura (TTP) except:

All of the following clotting factors are vitamin K dependent except:

Which of the following malignant disorders is a malignancy of plasma cells?

Individuals who are diagnosed with G6PD deficiency are susceptible to which of the following types of anemia?

Which of the following is the proper intervention when individuals with immune thrombocytopenic purpura are unresponsive to treatments?

A 46-year-old female comes to the office complaining of fatigue, dizziness, cognitive problems, and cold hands and feet. Her skin is pale. Her vital signs are normal, except that she is slightly tachycardic with a pulse of 100. On further questioning, she tells you she has been having heavy menstrual bleeding for the past six months, possibly related to perimenopause. You suspect she has iron-deficiency anemia. Which of the following most likely reflects her hematocrit and hemoglobin values?

An African-American mother brings her 3-month-old infant to the clinic. The baby has edema of the hands and feet, jaundice, and cries often, sometimes loudly, as if he is in pain. He has only gained 4 ounces from his birth weight. His temperature is 101.4 degrees F. What condition does this infant likely have?

Which of the following individuals is most at-risk for developing multiple myeloma?

A complete blood count (CBC) for a 27-year-old female suffering from fatigue and headaches resulting from microcytic anemia reveals a mean corpuscular volume (MCV) of less than 80 fL. The woman has no family history of thalassemia. Which of the following is most likely the cause of her anemia?

Which of the following is the predominant presenting feature of acute thrombocytopenia?

Which of the following individuals would be most likely to be at risk of ά-Thalassemia?

A 25-year-old female presents with pale skin, fatigue, and numbness in her hands and feet. She reports that she exercises three times a week and eats a healthy vegan diet, though she does not take vitamin supplements. You suspect that her diet is depriving her of essential nutrients, which is causing mild megaloblastic anemia and possible nerve damage. Which nutrient is most likely missing from this patient’s diet?

A 58-year-old man comes to the office due to several months of fatigue. He also complains of occasional headaches and shortness of breath on exertion. The patient has no chest pain, vomiting, or diarrhea. Blood pressure is 132/80 mm Hg and pulse is 95/min. Conjunctivae are pale. The abdomen is soft and non-tender without palpable masses. There are no rashes or peripheral edema. Laboratory results are as follows:
Hemoglobin 7.9 g/dL
Mean corpuscular volume 71 µm3
Platelets 192,000/mm3
Leukocytes 8,500/mm3
Ferritin, serum 8 ng/mL
Which of the following is the best next step in the evaluation of this patient’s anemia?

A 7-month-old girl is brought to the office for evaluation of irritability and pallor. Serum laboratory studies are as follows:
Hemoglobin 6.8 g/dL
Mean corpuscular hemoglobin concentration 24%
Mean corpuscular volume 67 μm3
Red cell distribution width 21% (normal: 11.5-14.5%)
Reticulocytes 0.7%
Iron 39 µg/dL
Total iron binding capacity 471 µg/dL (normal: 300-350 µg/dL)
Transferrin saturation 8.3% (normal: 15-50 %)
Total bilirubin 0.8 mg/dL
Which of the following is the most likely cause of this patient’s anemia?

A 29-year-old, HIV-negative man comes to the office for evaluation of a neck mass that he discovered 3 weeks ago. The patient has no other associated symptoms. Physical examination shows enlarged, firm, non-tender, mobile, and right-sided anterior cervical lymph nodes. The remainder of the examination is unremarkable. Complete blood count, comprehensive metabolic panel, and chest x-ray are within normal limits. Cervical lymph node biopsy is consistent with classic Hodgkin lymphoma. Which of the following is the best next step in managing this patient?

A 49-year-old man comes to the hospital due to epistaxis. Over the past 3 months, he has had several episodes of epistaxis that resolved within a few minutes with nose pinching. He also reports shortness of breath on exertion and fatigue. The patient was previously hospitalized for severe alcoholic hepatitis and he continues to drink 1 or 2 pints of hard liquor most days. Examination reveals mucosal pallor. There is no jaundice or lymphadenopathy. Cardiopulmonary and neurological examinations are normal. Mild hepatomegaly is present, but there is no splenomegaly. Laboratory results are as follows:
Complete blood count
Hemoglobin 6.7 g/dL
Mean corpuscular volume 123 µm3
Reticulocytes 0.1%
Platelets 48,000/mm3
Leukocytes 3,100/mm3
Coagulation studies
Prothrombin time 13 sec
Which of the following is the most likely cause of this patient’s current condition?

A 67-year-old man with Glioblastoma Multiforme undergoing radiation is brought to the hospital due to worsening chest pain and dyspnea over the last 24 hours. Temperature is 36.8 C, blood pressure is 109/67 mm Hg, pulse is 119/min, and respirations are 24/min. Pulse oximetry shows 89% on room air. A CT pulmonary angiogram reveals a right-sided pulmonary embolism, and he is started on a continuous unfractionated heparin infusion. Several hours later, he begins to experience severe headache and quickly becomes unconscious. A CT scan of the head reveals bleeding into the tumor. After stopping the heparin infusion, administration of which of the following is indicated for immediate anticoagulant reversal?