PHARMACOLOGY OF NURSING Hematology and Oncology PANCE/PANRE Exam Questions and Answers

Auer rods on peripheral smear indicate...? - acute myeloblastic leukemia (AML) 60 year old male with severe anemia, decreased neutrophil count, and small, abnormal B lymphocytes in the bone marrow (>30%) with levels at 90,000 per cubic millimeter. Has painless cervical lymphadenopathy and hepatosplenomegaly. Likely diagnosis? - Chronic lymphocytic leukemia (CLL) Bone marrow aspiration and biopsy reveals the presence of the Philadelphia (Ph) chromosome in dividing marrow cells. Likely diagnosis? - Chromic myeloblastic leukemia (CML) Follicular, cleaved cell, lymphocytic, histolytic - Hodgkins Lymphoma Reed Sternberg cell - Hodgkin's lymphoma Plasma cells, monoclonal protein - Multiple myeloma What disease is characterized by abnormal monoclonal protein, anemia, and lytic bone lesions? - Multiple myeloma 30 year old white male with 3 month history of painless enlargement of bilateral cervical lymph nodes, fever, and night sweats. Likely diagnosis? - Hodgkin's disease What hematologic measurement is abnormal in chronic heavy alcohol use? - Mean corpuscular volume Most frequent cause of B12 deficiency in patients with classic pernicious anemia - Lack of intrinsic factor In thalassemia anemia, what causes the anemia? - Shortened lifespan of RBCs Teenage African American female presents with severe bone and joint pain. CBC shows severe anemia and elevate leukocyte and platelet counts. Most likely diagnosis? - Sickle cell disease What 2 tests are used to confirm the diagnosis of homozygous sickle cell disease? - Peripheral smear and hemoglobin electrophoresis The most helpful test to distinguish megaloblastic from nonmegaloblastic macrocytic anemia - Peripheral smear What is the most common initial presentation of sickle cell disease? - Failure to thrive in a child at risk 4 year old with fever, bleeding, bone pain, generalized lymphadenopathy, splenomegaly, hepatomegaly. CBC shows anemia, leukocytosis (100,000 immature WBC) and thrombocytopenia. Prognosis is good. Likely diagnosis? - Acute lymphocytic leukemia Type of anemia characterized by small red blood cells, MCV <76 - Microcytic anemia Name the classic types of microcytic anemia - Iron deficiency anemia, thalassemia, sideroblastic anemia, anemia of chronic disease, lead poisoning Type of anemia characterized by large red blood cells, MCV >100 - Macrocytic anemia Causes of megaloblastic anemia - B12 (cobalamine) deficiency, folate deficiency, and drugs. May be idiopathic. Type of anemia in which serum iron is decreased and TIBC is increased - Iron deficiency anemia Basophilic stippling of RBCs is noted. Likely dx? - Lead poisoning Classify the 2 types of macrocytic anemia - Megaloblastic and nonmegaloblastic RBC with low hemoglobin and an enlarged area of central pallor - Hypochromic RBC with a loss of central pallor, stains more densely, and is often microcytic. - Spherocyte RBC that is hypochromic with a central darkening of hemoglobin. Seen in liver disease, thalassemia. - Target cell Fragmented helmet or triangular-shaped RBC - Schistocyte Elongated RBC with pointed ends - Sickle cell Type microcytic hypochromic anemia that demonstrates low serum iron and low TIBC. Unresponsive to iron therapy. - Anemia of chronic disease/inflammation 3 possible etiologies of normocytic normochromic anemia - Blood loss, hemolysis, decreased production In a patient presenting with normochromic normocytic anemia, what is the next test to classify the anemia according to marrow response? - Reticulocyte count Low MCV, low RBC, high RDW, low serum Fe, high/nml TIBC - Iron deficiency anemia Low MCV, normal/high RBC, normal RDW, high/norm serum Fe, normal TIBC - Thalassemia Normal/low MCV, normal RBC, low serum Fe, low TIBC - Anemia of chronic disease