A
It is essential to advise a patient with infectious mononucleosis to
Answers
A. avoid contact sports.
B. continue to rest as much as possible.
C. gargle with salt water for relief of throat pain.
D. rest voice to prevent hoarseness.
A. PATIENTS WITH ACUTE INFECTIOUS MONONUCLEOSIS OFTEN HAVE ENLARGEMENT OF THE SPLEEN. CONTACT SPORTS INCREASE THE RISK FOR SPLENIC RUPTURE AFTER CONTACT.
What examination finding would be expected in a patient with von Willebrand disease?
A. Gingival bleeding
B. Splenomegaly
C. Muscle weakness
D. Hemarthrosis
A. A PATIENT WITH VON WILLEBRAND DISEASE MOST COMMONLY PRESENTS WITH MUCOSAL BLEEDING SEEN IN EPISTAXIS, GINGIVAL BLEEDING, AND MENORRHAGIA.
Adult patients with a compromised immune system should not receive which of the following immunizations?
A. Hepatitis A
B. Pneumococcal
C. Influenza
D. Varicella
D. VARICELLA VACCINE IS A LIVE VACCINE AND IS CONTRAINDICATED IN THOSE INDIVIDUALS WITH A COMPROMISED IMMUNE SYSTEM. HEPATITIS A, PNEUMOCOCCAL AND INFLUENZA ARE RECOMMENDED FOR PATIENTS WITH A COMPROMISED IMMUNE SYSTEM.
A positive osmotic fragility test is seen in which of the following?
A. G6PD deficiency
B. Sickle cell anemia
C. Hereditary spherocytosis
D. Autoimmune hemolytic anemia
C. HEREDITARY SPHEROCYTOSIS WILL HAVE A POSITIVE OSMOTIC FRAGILITY TEST SECONDARY TO A DEFECTIVE RED BLOOD CELL MEMBRANE.
Pernicious anemia is due to deficiency in which of the following?
Answers
A. Cobalamin-binding proteins B. Pancreatic enzymes
C. Spectrin
D. Intrinsic factor
D. Pernicious anemia is caused by lack of intrinsic factor.
Absorption of vitamin B12 requires intrinsic factor that is secreted by which of the following?
A. parietal cells
B. chief cells
C. mucous cells
D. enteroendocrine cells
A. Parietal cells are responsible for acid secretion and intrinsic factor.
An adult patient who has undergone a splenectomy secondary to idiopathic thrombocytopenic purpura should receive which prophylactic agent?
A. Bicillin 1.2 million units IM every month
B. Pneumococcal vaccine IM one time only
C. Gamma globulin IM every month
D. Hepatitis B vaccine IM series
B. PNEUMOCOCCAL VACCINE SHOULD ROUTINELY BE GIVEN TO ALL PATIENTS WHO UNDERGO SPLENECTOMY FOR PROPHYLAXIS TO STREPTOCOCCAL PNEUMONIAE.
A 26 year-old male presents with a four week history of fatigue, night sweats, and a painless mass in his neck. Physical examination confirms the presence of an enlarged right posterior cervical lymph node. What is the next best step in the evaluation of this patient?
A. bone marrow biopsy and aspiration
B. lymph node biopsy
C. chest CT scan
D. reexamine in 2-4 weeks
B. THIS PATIENT PRESENTS WITH POSSIBLE LYMPHOMA. DIAGNOSIS IS MADE BY LYMPH NODE BIOPSY. BONE MARROW BIOPSY AND CT SCAN OF THE CHEST ARE USED FOR STAGING OF THE DISEASE.
A positive direct Coombs' test may be seen in which of the following conditions?
A. G6PD deficiency
B. Sickle cell anemia
C. Hereditary spherocytosis
D. Autoimmune hemolytic anemia
D. A positive direct Coombs' test indicates that antibody has attached to an antigen on the RBC which causes agglutination. Autoimmune hemolytic anemia results when the patient has antibodies against their own RBCs. G6PD deficiency does result from an antibody antigen reaction. Sickle cell anemia is caused by a defective hemoglobin which detected by hemoglobin electrophoresis. Hereditary spherocytosis is detected utilizing the osmotic fragility test.
A 13 year-old male with sickle cell trait is interested in playing football for his school. Which of the following considerations should be reviewed with the patient and his parents?
A. avoid dehydration
B. avoid all contact sports
C. begin daily use of aspirin
D. begin hydroxyurea supplements
A. NO RESTRICTION OF SPORTS ACTIVITY IS REQUIRED OF PATIENTS WITH SICKLE CELL TRAIT. HYDRATION IS REQUIRED IN ALL SPORTS ACTIVITIES.
A 26 year-old female required 12 units packed red blood cells during a trauma resuscitation and surgical repair of liver and splenic lacerations. The patient is now 6 hours postoperative and has blood oozing from the suture line and IV sites. There is bloody urine in the Foley bag. Laboratory evaluation demonstrates a platelet count of 10,000/microliter, prolonged prothrombin level, and the presence of fibrin split products. Which of the following is the most likely diagnosis?
A. acute ABO incompatibility reaction
B. disseminated intravascular coagulation
C. exacerbation of idiopathic thrombocytopenia
D. inadequate repair of the liver lacerations
B. DISSEMINATED INTRAVASCULAR COAGULATION IS CHARACTERIZED BY BLEEDING FROM MANY SITES AS ALL COAGULATION FACTORS ARE CONSUMED AND THEN BROKEN DOWN, LEADING TO DECREASED FIBRINOGEN LEVEL AND PLATELET COUNT, PROLONGED PT AND PTT, AND PRESENCE OF FIBRIN SPLIT PRODUCTS.
Which of the following leukemias is most closely associated with the Philadelphia chromosome?
A. hairy cell
B. acute lymphocytic
C. acute myelocytic
D. chronic myelocytic
D. PHILADELPHIA CHROMOSOME IS NOTED MOST COMMONLY IN PATIENTS WITH CHRONIC MYELOGENOUS LEUKEMIA.
A defect in which of the following physiologic processes can lead to the development of a microcytic, hypochromic anemia?
A. Hemoglobin production
B. IgG antibody formation
C. Red blood cell nuclear maturation
D. Red blood cell membrane defects
A. A deficiency in substances required for hemoglobin synthesis result in RBCs with a deficient mean corpuscular hemoglobin concentration and usually microcytosis.
A defect in which of the following physiologic processes can lead to the development of a microcytic, hypochromic anemia?
A. Hemoglobin production
B. IgG antibody formation
C. Red blood cell nuclear maturation
D. Red blood cell membrane defects
A. A DEFICIENCY IN SUBSTANCES REQUIRED FOR HEMOGLOBIN SYNTHESIS RESULT IN RBCS WITH A DEFICIENT MEAN CORPUSCULAR HEMOGLOBIN CONCENTRATION AND USUALLY MICROCYTOSIS.
A mean corpuscular volume (MCV) of less than 80 cubic microns is a manifestation of which of the following diagnoses?
A. Iron deficiency
B. Vitamin B12 deficiency
C. Folate deficiency
D. G6PD deficiency
A. Iron deficiency is associated with microcytic anemia.
A 55-year-old non-smoking male presents with a hemoglobin of 18.5 g/dl and a hematocrit of 56%. Which of the following physical examination findings is the most likely to be noted with this patient?
A. Splenomegaly
B. Cheilosis
C. Purpura
D. Decreased vibratory sense
A. PATIENTS WITH POLYCYTHEMIA VERA PRESENT WITH ELEVATED HEMOGLOBIN AND HEMATOCRIT. ON PHYSICAL EXAMINATION PLETHORA, ENGORGED RETINAL VEINS, AND SPLENOMEGALY ARE COMMON.
Which of the following therapies is recommended for a 13 month-old child with sickle cell disease?
A. Folic acid and penicillin V
B. Ferrous sulfate and penicillin V
C. Folic acid and ferrous sulfate
D. Folic acid, ferrous sulfate and penicillin V
A. PATIENTS WITH SICKLE CELL DISEASE SHOULD RECEIVE PROPHYLACTIC PENICILLIN V STARTING AT 2 MONTHS OF AGE AND FOLIC ACID STARTING AT 1 YEAR OF AGE. FERROUS SULFATE IS NOT GLOBALLY RECOMMENDED FOR PATIENTS WITH SICKLE CELL DISEASE.
A 29 year-old patient with idiopathic thrombocytopenia purpura (ITP) is treated with prednisone therapy. Despite therapy, platelet counts remain consistently below 20,000/microliter over the course of 6 weeks. Which of the following is the most appropriate intervention for this patient?
A. Aspirin
B. Intravenous immunoglobulin
C. Danazol (Danocrine)
D. Splenectomy
D. PERSISTENTLY LOW PLATELET COUNTS (< 20,000) REQUIRE EFFECTIVE LONG-TERM TREATMENT, AND SPLENECTOMY IS THE TREATMENT OF CHOICE.
A 60 year-old male presents with a normochromic, normocytic anemia and splenomegaly. His past history reveals several episodes of bacterial pneumonia in the past year. The WBC count is 43,000 mm3 with 25% segmented neutrophils, 3% blasts, 70% mature lymphocytes, 1% basophils, and 1% eosinophils. This most likely represents
A. myelodysplastic syndrome.
B. acute lymphocytic leukemia.
C. chronic lymphocytic leukemia.
D. chronic myelogenous leukemia.
C. CHRONIC LYMPHOCYTIC LEUKEMIA USUALLY OCCURS AFTER THE AGE OF 50 PRESENTING WITH LYMPHOCYTOSIS > 20,000 MM3
AND LYMPHOCYTES THAT APPEAR MATURE.
Which of the following physical findings suggest pernicious anemia?
A. Splenomegaly and hepatomegaly
B. Petechiae and ecchymosis
C. Loss of position and vibratory sensation
D. Cheilosis and koilonychia
C. LOSS OF POSITION AND VIBRATORY SENSATION ARE COMMON NEUROLOGIC FINDINGS IN PERNICIOUS ANEMIA.
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. Paresthesia of the hands and feet
B. Hepatosplenomegaly
C. Tachycardia
D. Jaundice
A. Neurological manifestation is the earliest type most commonly seen with megaloblastic anemia most commonly from vitamin B12 deficiency.
Normal hemoglobin A is made of what combination of heme and globin chains?
A. 2-alphas and 2-betas
B. 4-gammas
C. 2-alphas and 2-gammas
D. 4-betas
A. Hemoglobin A1 is composed of two alpha and two beta chains.
A 6 year-old male presents with hemarthrosis of the left knee. Coagulation studies reveal the following results: PT- 12.5 seconds with an INR: 1.0, aPTT:58 seconds, platelet count:
430,000/microliter, and bleeding time:4 minutes. Which of the following is the best treatment option for this patient?
A. Desmopressin acetate
B. Corticosteroids
C. Vitamin K
D. Cryoprecipitate
D. HEMOPHILIA A PRESENTS WITH A PROLONGED APTT AND NORMAL PLATELET COUNT AND FUNCTION. HEMOPHILIA A IS TREATED WITH FACTOR VIII CONCENTRATE OR CRYOPRECIPITATE.
An 18 year-old woman presents to the clinic complaining of fatigue. She reports a past history of lifelong frequent nosebleeds and bleeding gums. She also has menorrhagia. Her mother and maternal grandfather have a similar bleeding history. Initial lab results are as follows: WBC 9,500/mm3, Hgb 10.9 g/dL, HCT 33%, MCV 69 fL, MCHC 26 pg and platelets 284,000/mm3. Which of the following tests should be ordered to evaluate this patient's diagnosis?
A. Hemoglobin electrophoresis
B. Bleeding time and platelet aggregometry
C. Bone marrow aspiration
D. PT and aPTT
B. THE PATIENT'S PRESENTATION IS CONSISTENT WITH A CONGENTIAL QUALITATIVE PLATELET DISORDER, MOST LIKELY VON
WILLEBRAND'S DISEASE, NECESSITATING A BLEEDING TIME AND EVALUATION OF PLATELET FUNCTION.
A 35 year-old female presents with fatigue. CBC results reveal the following:
WBC: 6,300/microliter Hgb: 9.5 g/dl
Hct: 28%
MCV: 75 fL
MCHC: 32 g/dl
MCH: 24 pg Platelets: 550,000/mL
Which of the following is the best treatment option for this patient?
A. folic acid
B. vitamin B12
C. prednisone
D. ferrous sulfate
D. Iron deficiency anemia is a microcytic, hypochromic anemia and is treated with ferrous sulfate.