HEMATOLOGY /ONCOLOGY
you have prescribed oral iron replacement for a 46 yo female with iron deficiency anemia related to
heavy menses. she wants to be sure that the iron she takes will be absorbed well. Which one of the
following would you suggest for improving iron absorption? - vitamin C
a mother brings her 6yo son to your office for evaluation b/c she found a lump in his neck below the
jaw on the right side. She first noted it a week ago, about a week after he had recovered from an upper
respiratory infection. She reports that her son feels well and is back to full, unrestricted activity. When
you examine the child you find an enlarged lymph node in the right anterior cervical nodes. It measures
2 cm in diameter and is somewhat firm, mobile, and contender. The remainder of the examination is
normal. which one of the following would be most appropriate at this point? - f/u examination in 1
month
A gynecologist requests a preoperative consultation on your patient, a 38 yo white G2 P0 A2 whom you
referred for a total abdominal hysterectomy for adenomatous endometrial hyperplasia. The patient has
been hospitalized twice for DVT in the past 2 years and had spontaneous second-trimester abortions at
the ages of 34 and 36. Routine prep-op blood screening reveals :
platelet- 189,000
PTT-12.0 sec
INR- 1.1
Activated-partial thromboplastin- 42 sec (prolonged)
There is no family hx of bleeding disorders and the evaluation is otherwise normal. A repeat activated
partial activated thromboplastin time with a 1:1 mix of normal plasma does not correct to normal. The
most likely diagnosis is - antiphospholipid antibody syndrome
A 75 yo female presents with a compliant of paresthesias in her feet. On examination she has mild
erythema of her tongue and decreased vibratory sensation in her feet. A CBC reveals a hemoglobin level
of 11.1 and a mean corpuscular volume of 105. The patient takes the following OTC drugs:
,aspirin
ranitidine
acetaminophen
which of the following prescription medications the patient takes is most likely causing her problem? -
omeprazole (prilosec)
Which of the following is a classic finding in multiple myeloma? - bone pain
activated protein C resistance (factor V leiden) is most commonly found in patients with - venous
thrombotic disease
A 23 yo healthy male is sexually active with the men and does not use condoms. He is interested in
reducing his risk of contracting HIV by using a daily oral antiretroviral medication. Which one of the
following lab tests should be done no more than 7 days before initially prescribing pre-exposure
prophylaxis with emtricitabine/tenofivir disoproxil (truvada)? - antibody testing for HIV
A 30 yo female sees you because of increasing fatigue. She has no chronic medical problems and
reports no recent acute illnesses. She recalls being told that she was mildly anemic after the birth of her
daughter 3 years ago. The anemia resolved after 3 months of oral iron supplementation. The t's
menstrual periods are regular and last approximately 6 days, with heavy bleeding for the first 3 days
then moderate to mild flow for approximately 3 days. She denies epistaxis, black stools, or other signs of
bleeding. On examination her temp is 36.7 C, pulse 93, RR-16 and BP 116/58. the remainder of her
physical examination is unremarkable. A CBC is notable for a hemoglobin level of 10.9 and a mean
corpuscular volume of 70. Which one of the following serum levels would be most appropriate for
further evaluating her microcytic anemia at this point? - ferritin
A 29 yo female presents with 1 wk hx of a rash on her legs. A full ROS is significant only for regular
borderline-heavy periods that lasted for 7 days during her last 2 menstrual cycles. She has not had any
recent illness or hospitalization, and takes no meds. Her examination shows non blanching purple
macule on her upper legs. A comprehensive metabolic panel reveals normal renal function and liver
enzyme tests, and a urine pregnancy test is negative. A CBC reveals a platelet count of 27,000 but is
otherwise normal. which of the following is the most most likely cause of the rash? - ITP
, A 43 yo female complains of easy bruising. She is otherwise asymptomatic. A CBC reveals a platelet
count of 23,000. A peripheral smear reveals giant platelets. A workup is negative for autoimmune causes
, including Graves disease, HIV, EBV, CMV, varicella zoster, hep C and H.pylori. She is on no prescription
or OTC meds and denies alcohol or drug use. Which one would be the most appropriate initial
management? - corticosteroids
which of the following is most appropriate for patients with asplenia? - antibiotics for any episode of
fever
Which one of the following is associated with vitamin B12 deficiency? - metformin (glucophage)
A 78 yo asymptomatic male is found to have a platelet count of 90,000 and a slightly decreased WBC
count. Which one of the following would be most consistent with a diagnosis of myelodysplastic
syndrome? - macrocytic anemia
which one of the following medications used to treat psychiatric disorders is associated with an
increased risk of agranulocytosis? - carbamazepine
57 yo female with a past medical history significant for well controlled type 2 DM, HTN, and
hyperthyroidism presents to your office with a chief complaint of a sore throat and a fever to 101.5 at
home. She has had chills and night sweats but has not had a cough, CP, or abdominal pain. Physical
Findings
General- ill appearing
HEENT........ diffuse tender anterior cervical adenopathy; thyroid contender; oropharynx erythematous
with some purulence on her tonsils
cardiovascular- tachycardia with murmur
Lungs- clear to auscultation bilaterally
Skin- Mild jaundice
, laboratory findings- rapid strep test-negative
total WBC- 3000
absolute neutrophils-0
total bilirubin- 5 (high)
alkaline phosphatase-151 (high)
Which one of the following medications is most likely to cause these lab abnormalities - methimazole
a 67 yo male with moderate macrocytosis complains of paresthesias of his feet. If the patient has a
borderline low vitamin B12 level, elevated levels of which one of the following would suggest vitamin
B12 deficiency? - methymalonic acid
26 yo african-american male presents with diffuse abdominal and back pain 5 days after being
diagnosed with strep pharyngitis. He appears mildly ill, with slight scleral icterus.
Lab findings:
-unconjugated bilirubin 3.2 (high)
-hemoglobin 9.6 (low)
-hematocrit 29.4% (low)
- peripheral blood smear: keratocytes, blister cells, and polychromatic macrocytes
which is the most likely diagnosis? - G6PD deficiency
A 25 yo male presents to your office after recently being diagnosed with HIV infection at the health
department. you obtain blood work and note that his CD4 count is 180 cells/mm3. This patient should
receive prophylaxis against which one of the following opportunistic infections - Pneumocystis
A 43 yo asymptomatic male is found to have slightly elevated ALT and SAT levels on lab work prior to
donating blood. He feels well and is otherwise healthy. which one should be ordered to evaluate the
patient for hereditary hemochromatosis - A serum iron panel, including a serum ferritin level and
transferrin saturation
you have prescribed oral iron replacement for a 46 yo female with iron deficiency anemia related to
heavy menses. she wants to be sure that the iron she takes will be absorbed well. Which one of the
following would you suggest for improving iron absorption? - vitamin C
a mother brings her 6yo son to your office for evaluation b/c she found a lump in his neck below the
jaw on the right side. She first noted it a week ago, about a week after he had recovered from an upper
respiratory infection. She reports that her son feels well and is back to full, unrestricted activity. When
you examine the child you find an enlarged lymph node in the right anterior cervical nodes. It measures
2 cm in diameter and is somewhat firm, mobile, and contender. The remainder of the examination is
normal. which one of the following would be most appropriate at this point? - f/u examination in 1
month
A gynecologist requests a preoperative consultation on your patient, a 38 yo white G2 P0 A2 whom you
referred for a total abdominal hysterectomy for adenomatous endometrial hyperplasia. The patient has
been hospitalized twice for DVT in the past 2 years and had spontaneous second-trimester abortions at
the ages of 34 and 36. Routine prep-op blood screening reveals :
platelet- 189,000
PTT-12.0 sec
INR- 1.1
Activated-partial thromboplastin- 42 sec (prolonged)
There is no family hx of bleeding disorders and the evaluation is otherwise normal. A repeat activated
partial activated thromboplastin time with a 1:1 mix of normal plasma does not correct to normal. The
most likely diagnosis is - antiphospholipid antibody syndrome
A 75 yo female presents with a compliant of paresthesias in her feet. On examination she has mild
erythema of her tongue and decreased vibratory sensation in her feet. A CBC reveals a hemoglobin level
of 11.1 and a mean corpuscular volume of 105. The patient takes the following OTC drugs:
,aspirin
ranitidine
acetaminophen
which of the following prescription medications the patient takes is most likely causing her problem? -
omeprazole (prilosec)
Which of the following is a classic finding in multiple myeloma? - bone pain
activated protein C resistance (factor V leiden) is most commonly found in patients with - venous
thrombotic disease
A 23 yo healthy male is sexually active with the men and does not use condoms. He is interested in
reducing his risk of contracting HIV by using a daily oral antiretroviral medication. Which one of the
following lab tests should be done no more than 7 days before initially prescribing pre-exposure
prophylaxis with emtricitabine/tenofivir disoproxil (truvada)? - antibody testing for HIV
A 30 yo female sees you because of increasing fatigue. She has no chronic medical problems and
reports no recent acute illnesses. She recalls being told that she was mildly anemic after the birth of her
daughter 3 years ago. The anemia resolved after 3 months of oral iron supplementation. The t's
menstrual periods are regular and last approximately 6 days, with heavy bleeding for the first 3 days
then moderate to mild flow for approximately 3 days. She denies epistaxis, black stools, or other signs of
bleeding. On examination her temp is 36.7 C, pulse 93, RR-16 and BP 116/58. the remainder of her
physical examination is unremarkable. A CBC is notable for a hemoglobin level of 10.9 and a mean
corpuscular volume of 70. Which one of the following serum levels would be most appropriate for
further evaluating her microcytic anemia at this point? - ferritin
A 29 yo female presents with 1 wk hx of a rash on her legs. A full ROS is significant only for regular
borderline-heavy periods that lasted for 7 days during her last 2 menstrual cycles. She has not had any
recent illness or hospitalization, and takes no meds. Her examination shows non blanching purple
macule on her upper legs. A comprehensive metabolic panel reveals normal renal function and liver
enzyme tests, and a urine pregnancy test is negative. A CBC reveals a platelet count of 27,000 but is
otherwise normal. which of the following is the most most likely cause of the rash? - ITP
, A 43 yo female complains of easy bruising. She is otherwise asymptomatic. A CBC reveals a platelet
count of 23,000. A peripheral smear reveals giant platelets. A workup is negative for autoimmune causes
, including Graves disease, HIV, EBV, CMV, varicella zoster, hep C and H.pylori. She is on no prescription
or OTC meds and denies alcohol or drug use. Which one would be the most appropriate initial
management? - corticosteroids
which of the following is most appropriate for patients with asplenia? - antibiotics for any episode of
fever
Which one of the following is associated with vitamin B12 deficiency? - metformin (glucophage)
A 78 yo asymptomatic male is found to have a platelet count of 90,000 and a slightly decreased WBC
count. Which one of the following would be most consistent with a diagnosis of myelodysplastic
syndrome? - macrocytic anemia
which one of the following medications used to treat psychiatric disorders is associated with an
increased risk of agranulocytosis? - carbamazepine
57 yo female with a past medical history significant for well controlled type 2 DM, HTN, and
hyperthyroidism presents to your office with a chief complaint of a sore throat and a fever to 101.5 at
home. She has had chills and night sweats but has not had a cough, CP, or abdominal pain. Physical
Findings
General- ill appearing
HEENT........ diffuse tender anterior cervical adenopathy; thyroid contender; oropharynx erythematous
with some purulence on her tonsils
cardiovascular- tachycardia with murmur
Lungs- clear to auscultation bilaterally
Skin- Mild jaundice
, laboratory findings- rapid strep test-negative
total WBC- 3000
absolute neutrophils-0
total bilirubin- 5 (high)
alkaline phosphatase-151 (high)
Which one of the following medications is most likely to cause these lab abnormalities - methimazole
a 67 yo male with moderate macrocytosis complains of paresthesias of his feet. If the patient has a
borderline low vitamin B12 level, elevated levels of which one of the following would suggest vitamin
B12 deficiency? - methymalonic acid
26 yo african-american male presents with diffuse abdominal and back pain 5 days after being
diagnosed with strep pharyngitis. He appears mildly ill, with slight scleral icterus.
Lab findings:
-unconjugated bilirubin 3.2 (high)
-hemoglobin 9.6 (low)
-hematocrit 29.4% (low)
- peripheral blood smear: keratocytes, blister cells, and polychromatic macrocytes
which is the most likely diagnosis? - G6PD deficiency
A 25 yo male presents to your office after recently being diagnosed with HIV infection at the health
department. you obtain blood work and note that his CD4 count is 180 cells/mm3. This patient should
receive prophylaxis against which one of the following opportunistic infections - Pneumocystis
A 43 yo asymptomatic male is found to have slightly elevated ALT and SAT levels on lab work prior to
donating blood. He feels well and is otherwise healthy. which one should be ordered to evaluate the
patient for hereditary hemochromatosis - A serum iron panel, including a serum ferritin level and
transferrin saturation
