Hematology 2

An 82-year-old woman is to undergo a major orthopedic surgical procedure. Which of the following is an advantage of low molecular weight heparin over unfractionated heparin?

Your patient presents to the clinic with what you believe to be von Willebrand disease. What examination finding would be expected?

Which of the following is the primary pathophysiological abnormality in the patient who has hereditary hemochromatosis?

One of your patients brings his 30-year-old nephew who is visiting from Greece to see you because of fatigue. On exam, he has conjunctival and nail bed pallor. His hemoglobin is 11 gm/dL, MCV is 60 fL and his peripheral blood smear shows hypochromia, microcytosis, and target cells. Which of the following tests is most likely to establish this patient’s diagnosis?

Hairy leukoplakia of the tongue is most likely in a patient who has which of the following diseases?

The presence of which of the following differentiates polycythemia rubra vera from secondary polycythemia caused by chronic bronchitis?

Which of the following statements pertaining to sickle cell anemia is true?

Which of the following test results would support a diagnosis of polycythemia vera (PV)?

In a patient with advanced liver disease who is currently experiencing significant bleeding symptoms due to hepatic coagulopathy, which of the following interventions is most helpful for the short-term management of this patient?

A 32-year-old female patient is noted to have significant microcytic anemia on routine CBC done during a recent physical examination. The patient is new to your office, and is a rather poor historian. She is unable to tell you her family medical history, and states that she is not aware of a previous diagnosis of anemia. Her CBC results are as follows (abnormal results are in bold type):
WBC: 6,300
Hgb: 10.5 g/dL
HCT: 32%
MCV: 60
Plts: 210,000

Each of the following diagnostic tests would be appropriate in determining the underlying cause of the patient’s microcytic anemia EXCEPT:

A 48-year-old male presents complaining of a painless lump on his neck for the past several months. On physical examination, there is nontender, fixed adenopathy in the right posterior cervical region. Which of the following interventions is the next most appropriate step in the evaluation of this patient?

While evaluating a patient who is being treated for Gram-negative sepsis in the intensive care unit, you note that the patient has developed significant bleeding at venipuncture sites and IV insertion sites. The patient was noted to have a decreased platelet count on CBC. All of the following additional laboratory findings would support a diagnosis of disseminated intravascular coagulation (DIC) except:

Which of the following statements pertaining to non-Hodgkin’s lymphoma (NHL) is true?

A 62-year-old patient presents complaining of fatigue and a “skin infection” and states that he has also noticed recent increased bruising. On examination, you note that the patient has significant periorbital cellulitis. There are also multiple areas of ecchymoses in varying stages of resolution, as well as petechiae, noted over the trunk and extremities. There is no lymphadenopathy, hepatomegaly, or splenomegaly noted. A stat CBC with differential is ordered, and the results are as follows:
WBC: 80,000
Hgb: 9.0 g/dL
HCT: 27%
MCV: 90
Plt: 60,000
Differential: 20% segs, 2% bands, 36% lymphocytes,
4% monocytes, 3% eosinophils, 1% basophils, and 34% blasts
Peripheral smear: blast cells with Auer rods noted
Based on this information, which of the following conditions is the most likely diagnosis for this patient?

Which of the following peripheral blood smear findings would support a diagnosis of megaloblastic anemia due to folate deficiency?

A 42-year-old male patient presents complaining of colicky abdominal pain and headache. He was noted to have microcytic anemia on a recent CBC. Upon examination, a dark line is noted along the gum line. The peripheral smear reveals significant basophilic stippling of the RBCs. Based on this information, which of the following tests would be the most helpful in establishing a definitive diagnosis for this patient?

Which of the following medical treatments is appropriate for maintenance therapy of pernicious anemia?

Which of the following types of anemia is clinically diagnosed by the presence of greater than 60% hemoglobin S in red blood cells?

A 24-year-old female with a history of thrombocytopenia presents with petechiae on the skin and mucous membranes. She also complains of abnormal bleeding in the gums. Blood work reveals a decreased platelet count of 40,000 platelets/mcL. This patient has been prescribed a steroid regimen to treat her thrombocytopenia, which has failed. Which of the following options would offer a definitive treatment for her disorder?

A 42-year-old male presents with abnormal bleeding in the nasal sinus and GI mucous membranes. Blood work reveals normal PT and a mildly prolonged PTT. The blood work also reveals a reduced level of factor VIII antigen, which is characteristic of von Willebrand disease. Which of the following medications would you prescribe for treatment of this disorder?

A 26-year-old female presents to the Intensive Care Unit after developing hemorrhaging during child- birth. Bloodwork reveals an extremely elevated d-dimer level, prolonged PT and very low fibrinogen levels. You diagnose this patient with disseminated intravascular coagulopathy. Which of the following substances is most important for treatment of this disorder?

Which of the following types of anemia is classically diagnosed by an elevated reticulocyte count, LDH and decreasing haptoglobin occurring simultaneously with falling hematocrit levels?

A 61-year-old female presents with bleeding from the gums, epistaxis, menorrhagia, lethargy, and shortness of breath. Lab work reveals decreased white cells, decreased red cells, and 22% blasts. Urinalysis reveals hyperuricemia. Based on the patient’s presentation and lab results, which of the following is the most likely diagnosis?

A 20-year-old female with a history of systemic lupus erythematosus presents with petechiae on the skin and mucous membranes. She also complains of abnormal bleeding in the gums. Bloodwork reveals a decreased platelet count of 44,000 platelets/mcL. You diagnose this patient with thrombocytopenia. Which of the following medications would you prescribe for treatment of this disorder?

A 55-year-old male presents with headache, dizziness, weakness, fatigue, and blurred vision. Physical examination reveals systolic hypertension, engorged retinal veins, and splenomegaly. Bloodwork reveals hematocrit of 57%, elevated red cell mass, neutrophilic leukocytosis, increased basophils and eosinophils, and increased numbers of large, bizarre platelets. Based on the patient’s presentation, physical examination, and lab results, which of the following is the most appropriate diagnosis?

An 8-year-old boy with sickle cell disease is brought to the emergency department with worsening shortness of breath, weakness, and fatigue over the past 3 days. The patient has no fever, cough, or chest pain. He has had many hospitalizations for acute pain crises and acute chest syndrome. Temperature is 36.7 C (98.1 F). Pulse oximetry is 98% on room air. Physical examination shows a pallor in the nail beds and conjunctiva, cardiopulmonary examination unremarkable, abdomen soft without hepatosplenomegaly. Laboratory studies reveal markedly reduced hemoglobin level and reticulocyte count of only 0.1%; leukocytes and platelets are normal. Which of the following is the most likely cause of this patient’s symptoms?

A 28-year-old man comes to the emergency department due to a day of worsening pain and swelling in his right leg. The patient was hospitalized 3 weeks ago for left lower extremity deep vein thrombosis after a minor sports injury; he was discharged on warfarin and at the time, his INR was 2.3 (goal: 2-3). The patient has been taking warfarin daily; however, his dietary intake has been variable and last week he missed his clinic appointment for anticoagulation monitoring. Today, his INR is 1.4. Examination shows mild pretibial edema in the right leg. Platelet count, creatinine, and liver function tests are normal. Venous Doppler ultrasound shows worsening of the RLE DVT. Which of the following is the best next step in management of this patient?

A 5-year-old boy with G6PD deficiency is brought to the office due to a day of dysuria and lower abdominal pain. Despite being toilet-trained, he had an episode of urinary incontinence last night. Physical examination shows mild suprapubic tenderness. Urinalysis is positive for nitrites and leukocyte esterase. Which of the following antibiotics should be avoided in this patient?

A 19-year-old college student is brought to the emergency department due to one day of fever, headache, and neck pain. Temperature is 38.7 C (101.7 F), blood pressure is 98/62 mm Hg, pulse is 112/min, and respirations are 26/min. There is neck stiffness and a petechial rash on the trunk. Cerebrospinal fluid (CSF) analysis reveals the following:
Glucose 30 mg/dL
Protein 180 mg/dL
Leukocytes 1,500/mm3
Neutrophils 70%
CSF gram stain shows gram-negative diplococci. In the emergency department, the patient’s hemodynamic status deteriorates rapidly. Blood pressure drops to 80/50 mm Hg, and the venous access sites are oozing blood. Which of the following findings is most likely to be seen on this patient’s peripheral smear?

A 68-year-old man comes to the emergency department due to severe left leg pain and is found to have an acute thrombotic occlusion of the left popliteal artery. The patient is admitted and intravenous unfractionated heparin is initiated. The following morning, he undergoes surgical revascularization of the left leg. On postoperative day 5, his platelet count decreases from 240,000/mm3 on admission to 65,000/mm3. Vital signs are stable. The surgical wound is healing well. There are no rashes or pitting edema. In addition to stopping the unfractionated heparin, which of the following is the best next step in management?