Hematology 5

A positive direct Coombs’ test may be seen in which of the following conditions?

A female patient presents with weakness and fatigue for the past three months. A CBC was ordered and revealed the following values:
RBC 3.8 X 10(6)mcL (4.7-6.1 x 10(6)mcL)
HCT 27% (35-45%)
Hgb 9.2 gms/dL (12-15.5 gms/dL)
MCV 120 fL (80-100 fL)
MCH 35 pg (26-34 pg)
On physical examination which of the following would be a consistent finding for this type of anemia?

A 69 year-old female presents to the clinic complaining of fatigue. Physical examination reveals lymphadenopathy, splenomegaly and pale conjunctiva. The remainder of the examination is unremarkable. CBC reveals a normochromic normocytic anemia. White blood cell count is 45,000/mm3, with a differential of 77% mature lymphocytes, 3% eosinophils, 18% segmented neutrophils and 1% basophils and monocytes. Platelets appear adequate in number. What is the most likely diagnosis?

Adult patients with a compromised immune system should not receive which of the following immunizations?

A patient receiving heparin therapy for 6 days for deep vein thrombosis develops thrombosis at the IV site. The INR is 1.2. The aPTT is 67 seconds and the platelet count is 43,000 down from 151,000 on admission. Which of the following is the most appropriate treatment?

Which of the following conditions is caused by a disorder in the red blood cell membrane?

A 12-year-old African American boy is brought to the emergency department with back pain, abdominal pain, and dark urine that began earlier this morning. The patient has never had these symptoms before. Two days ago, he developed fever, runny nose, and cough. Temperature is 37 C (98.6 F), blood pressure is 110/60 mm Hg, and pulse is 100/min. The patient appears tired and has scleral icterus. Abdominal examination reveals mild, diffuse tenderness with palpation, but there is no rebound tenderness or rigidity. Hemoglobin is 8.2 g/dL. Peripheral blood smear reveals bite cells and Heinz bodies. Which of the following is the most likely cause of this patient’s condition?

A 61-year-old man is evaluated for by surgery for a bowel perforation. The patient has chronic atrial fibrillation and takes warfarin. Temperature is 38.6 C (101.5 F), blood pressure is 98/60 mm Hg, and pulse is 105/min and irregular. Hemoglobin is 9.5 g/dL, platelets are 108,000/mm3, and INR is 2.4. Nasogastric tube is in place with suction, intravenous fluids, and antibiotics are initiated. Which of the following is the best next step in management of this patient?

A 8-year-old boy is brought to the ER due to fatigue. One week ago, he developed abdominal pain, vomiting, and diarrhea. A few days later, he had significant blood in his stool, which has since resolved. The patient had been feeling better until today, when he had significant fatigue. Despite drinking a normal amount of fluids, the patient has not urinated in 24 hours. Multiple family members had similar initial gastrointestinal symptoms after attending a family cookout last week, but they have all recovered. On physical examination, there is scleral icterus and 2+ pedal edema. Which of the following laboratory abnormalities is most likely associated with this patient’s current condition?

A 68-year-old man comes to the office with a cough productive of green sputum for the last week. The patient has had no fevers or chills. He was treated for a viral upper respiratory infection 2 weeks ago, and was prescribed a cough suppressant that is not working. Temperature is 37.1 C (98.7 F). Physical examination shows mild mucosal pallor. There are several palpable, nontender lymph nodes in the cervical chain and axilla. There is a slightly prominent spleen tip with deep exhalation. Laboratory results are as follows:
Hemoglobin 9.4 g/dL
Mean corpuscular volume 87 µm3
Platelets 128,000/mm3
Leukocytes 37,100/mm3
Neutrophils 7%
Lymphocytes 93% (lymphocytes are fully mature on peripheral blood smear)

Which of the following is most likely to be seen on a peripheral blood smear?

What is the typical inheritance pattern of G6PD deficiency?

A 12 year old Irish female presents to your office with complaints of fatigue and shortness of breath on exertion. Initial laboratory studies show hemoglobin 9.2g/dL, MCV 88 fL, normal white blood cell and platelet counts. Additional testing reveals an elevated LDH level and decreased serum haptoglobin. Peripheral blood smear shows the presence of spherocytes. Which of the following would be the best test to diagnose the underlying condition?

Which of the following lab values most likely represent a hemolytic anemia?

A 64 year old female with multiple medical problems presents for evaluation of anemia. Review of her lab values finds a hemoglobin of 9.4, an MCV of 84, an MCH of 28 pg, a TIBC of 205 mcg/dL and a ferritin of 310 ng/mL. Which of the following is the most likely etiology of her anemia?

A 57-year-old man has a macrocytic megaloblastic anemia. Which of the following is most likely to be noted in his past medical history?

A 77-year-old woman has early signs of dementia manifest by memory loss and poor arithmetic calculations. A nutritional deficiency of which of the following may be the underlying cause?

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

Genetic testing in a 32-year-old woman shows the presence of mutations in the tumor suppressor genes, breast cancer type 1 and type 2 susceptibility genes (BRCA-1 and BRCA-2). The patient should be counseled that she is at increased risk of having which of the following conditions?

A 77-year-old man takes dabigatran in therapy of non-valvular atrial fibrillation. Which of the following is the mechanism of action of dabigatran?

A 66-year-old man who is receiving unfractionated heparin for 6 days now has diffuse petechiae. Platelet count is 22,000/microL. Which of the following is the most likely mechanism causing the thrombocytopenia?

A 34-year-old woman has iron deficiency anemia caused by menorrhagia. She is most likely to have which of the following symptoms related to the iron deficiency?

The presence of which of the following differentiates chronic myelogenous leukemia from chronic lymphocytic leukemia?

The presence of which of the following differentiates Gilbert’s syndrome from hemolytic anemia?

A reticulocyte count is an indicator of which of the following?

A 22-year-old woman has a 1 week history of drenching night sweats and fatigue. Examination shows generalized lymphadenopathy, splenomegaly, but no scleral icterus. Which of the following is the most likely diagnosis?

An 8-year-old boy has painful crises caused by sickle cell disease. Which of the following is the preferred treatment in order to reduce the frequency of the crises?

A 6-year-old boy who lives in a Mediterranean country eats fava beans. Six hours later he has headache, nausea, and dark red-brown urine. Which of the following is the most likely diagnosis?

A concerned mother brings her four-year-old son for evaluation of his complaints of pain in his legs and limping for the last four weeks. On exam you find him to have scattered petechiae and a mild pallor. Laboratory evaluation shows an elevated white count with a predominance of lymphoblasts and anemia. The patient is noted at the time of exam have a temperature of 101°F. Which of the following is the most likely diagnosis?

A nine-year-old boy presents complaining of painful swelling of both hands and feet. His mother reports similar episodes on numerous occasions which is sometimes associated abdominal and back pain and occurs in his knees as well. His history is also positive for one episode of priapism which occurred at age 5. Which of the following would most likely confirm his diagnosis?

A two-year-old male presents to the emergency room brought by his mother with pain and swelling to his right knee. The mother is concerned as she states the patient suffered only a gentle fall onto a carpeted floor. Hemarthrosis is suspected. Which of the following is the most likely diagnosis?