HEME - ROSH Pance UPDATED ACTUAL Questions and CORRECT Answers
1. A 5-year-old boy is brought by his parents to the clinic ALL
for a limp. He has been having fever and bone pain for
2 weeks. For the past few days, the parents noted that
he was having difficulty walking. Physical exam re-
veals multiple inguinal nodes that are nontender, firm,
rubbery, and 20 mm in diameter. There is no evidence
of point tenderness on palpation. Laboratory testing
shows anemia, thrombocytopenia, and neutropenia.
There are lymphoblasts on peripheral smear. Which of
the following is the most likely diagnosis?
2. What is the most common presentation or finding of Lymphadenopathy.
acute lymphocytic leukemia (ALL)?
3. A 34-year-old woman with a history of seizures pre- Folic acid
sents to the office reporting symptoms of progressive
fatigue for the past 6 months. She is taking pheny-
toin and has not had any seizures in over a year. Her
temperature is 98.7°F, blood pressure is 118/82 mm
Hg, heart rate is 92 bpm, oxygen saturation is 98% on
room air, and respiratory rate is 20/min. She has some
skin pallor and mild gingival hyperplasia on physical
exam. Laboratory studies reveal a hemoglobin of 10.0
g/dL and a mean corpuscular volume of 118 fL. Sup-
plementation with which of the following could have
prevented this condition?
4. What are the clinical features of Wernicke-Korsakoff Confusion, decreased vi-
syndrome? sion, hypothermia, hy-
potension, ataxia, amne-
sia, tremor, and coma.
,5. A 24-year-old woman presents to the office reporting Thalsemmia
progressive fatigue for the past several months. She
is otherwise healthy and not on any medications. Her
menstrual cycles are regular, lasting between 3 and 5
days, and she uses about five or six regular tampons
per day. Her temperature is 98.6°F, blood pressure is
112/75 mm Hg, heart rate is 85 bpm, oxygen satura-
tion is 98% on room air, and respiratory rate is 22/min.
A physical exam is unremarkable. Her CBC reveals
a hemoglobin of 10.2 g/dL and a mean corpuscular
volume of 72 fL. The patient is prescribed daily oral
ferrous sulfate and returns for a follow-up in 6 weeks.
A repeat CBC is unchanged. Which of the following is
the most likely diagnosis?
6. What treatment is required to prevent organ dam- Oral or parenteral iron
age from iron overload in patients with regular blood chelation therapy.
transfusions?
7. A patient suffers from recurrent deep vein throm- Factor V Leiden
boses. Which of the following is the most likely diag-
nosis?
8. What are four other inherited hypercoagulable disor- Prothrombin muta-
ders? tion, hyperhomocysteine-
mia, protein C and S defi-
ciencies.
9. A patient is being managed for schizophrenia with a CBC
medication regimen that includes clozapine. In addi-
tion to monitoring for weight gain and hyperglycemia,
which
,10. Which class of antipsychotics is more likely to cause Typical antipsychotics
extrapyramidal side effects such as akathisia and tar- have a higher risk of caus-
dive dyskinesia? ing extrapyramidal side ef-
fects than atypical an-
tipsychotics.
11. A 52-year-old man presents with two weeks of wors- AML
ening fatigue and generalized weakness. Over the
past week his gums have been bleeding when he
brushes his teeth. Laboratory studies show a normo-
cytic, normochromic anemia with Auer rods on pe-
ripheral smear. Platelets count is 63 x 109/L. What is
the most likely diagnosis?
12. What is the 5 year survival rate of acute myeloid Approximately 25%
leukemia (AML)?
13. A 31-year-old woman is diagnosed with her sixth Antiphospholipid anti-
spontaneous abortion. Which of the following is the body syndrome
most likely underlying diagnosis?
14. What is the most common inherited hypercoagulable Factor V Leiden mutation.
state?
15. Which of the following physical exam findings is most wet pupura
consistent with thrombocytopenia?
16. What does HELLP syndrome stand for? Hemolysis, elevated liv-
er enzymes, low platelet
count.
17. An 8-year-old boy with short stature presents to the Fanconi anemia
pediatrician's office with bruising. He denies fevers,
, chills, or changes in weight. His physical exam is no-
table for several café-au-lait spots over his trunk. The
pediatrician obtains a CBC, which is notable for ane-
mia and thrombocytopenia. Further lab testing re-
veals an elevated alpha-fetoprotein. Which of the fol-
lowing is the most likely diagnosis?
18. What is the most common inheritance pattern of Fan- Autosomal recessive
coni anemia?
19. An 18-year-old African-American man presents with hydroxyurea
questions about his diagnosis of sickle cell anemia. He
has been managing his condition since childhood by
treating his symptoms and having occasional blood
transfusions. Now he is experiencing more frequent
painful episodes and wants to know if there are other
treatment options. Which of the following is the most
appropriate pharmacologic treatment?
20. How is sickle cell disease diagnosed? Hemoglobin elec-
trophoresis.
21. A 62-year-old man with a history of cigarette smoking Phlebotomy
presents to the emergency department following a
resolved episode of painless and complete vision loss
in his right eye. The episode lasted 5 minutes and
completely resolved 8 hours ago. The patient reports
that he did not experience any numbness, weakness,
dysarthria, or facial droop. Vital signs include a HR of
80 bpm, BP of 125/88 mm Hg, RR of 20/min, oxygen
saturation of 98% on room air, and T of 98.6°F. Physi-
cal examination findings include facial erythema and
swelling. The conjunctivae are not injected, there is no
1. A 5-year-old boy is brought by his parents to the clinic ALL
for a limp. He has been having fever and bone pain for
2 weeks. For the past few days, the parents noted that
he was having difficulty walking. Physical exam re-
veals multiple inguinal nodes that are nontender, firm,
rubbery, and 20 mm in diameter. There is no evidence
of point tenderness on palpation. Laboratory testing
shows anemia, thrombocytopenia, and neutropenia.
There are lymphoblasts on peripheral smear. Which of
the following is the most likely diagnosis?
2. What is the most common presentation or finding of Lymphadenopathy.
acute lymphocytic leukemia (ALL)?
3. A 34-year-old woman with a history of seizures pre- Folic acid
sents to the office reporting symptoms of progressive
fatigue for the past 6 months. She is taking pheny-
toin and has not had any seizures in over a year. Her
temperature is 98.7°F, blood pressure is 118/82 mm
Hg, heart rate is 92 bpm, oxygen saturation is 98% on
room air, and respiratory rate is 20/min. She has some
skin pallor and mild gingival hyperplasia on physical
exam. Laboratory studies reveal a hemoglobin of 10.0
g/dL and a mean corpuscular volume of 118 fL. Sup-
plementation with which of the following could have
prevented this condition?
4. What are the clinical features of Wernicke-Korsakoff Confusion, decreased vi-
syndrome? sion, hypothermia, hy-
potension, ataxia, amne-
sia, tremor, and coma.
,5. A 24-year-old woman presents to the office reporting Thalsemmia
progressive fatigue for the past several months. She
is otherwise healthy and not on any medications. Her
menstrual cycles are regular, lasting between 3 and 5
days, and she uses about five or six regular tampons
per day. Her temperature is 98.6°F, blood pressure is
112/75 mm Hg, heart rate is 85 bpm, oxygen satura-
tion is 98% on room air, and respiratory rate is 22/min.
A physical exam is unremarkable. Her CBC reveals
a hemoglobin of 10.2 g/dL and a mean corpuscular
volume of 72 fL. The patient is prescribed daily oral
ferrous sulfate and returns for a follow-up in 6 weeks.
A repeat CBC is unchanged. Which of the following is
the most likely diagnosis?
6. What treatment is required to prevent organ dam- Oral or parenteral iron
age from iron overload in patients with regular blood chelation therapy.
transfusions?
7. A patient suffers from recurrent deep vein throm- Factor V Leiden
boses. Which of the following is the most likely diag-
nosis?
8. What are four other inherited hypercoagulable disor- Prothrombin muta-
ders? tion, hyperhomocysteine-
mia, protein C and S defi-
ciencies.
9. A patient is being managed for schizophrenia with a CBC
medication regimen that includes clozapine. In addi-
tion to monitoring for weight gain and hyperglycemia,
which
,10. Which class of antipsychotics is more likely to cause Typical antipsychotics
extrapyramidal side effects such as akathisia and tar- have a higher risk of caus-
dive dyskinesia? ing extrapyramidal side ef-
fects than atypical an-
tipsychotics.
11. A 52-year-old man presents with two weeks of wors- AML
ening fatigue and generalized weakness. Over the
past week his gums have been bleeding when he
brushes his teeth. Laboratory studies show a normo-
cytic, normochromic anemia with Auer rods on pe-
ripheral smear. Platelets count is 63 x 109/L. What is
the most likely diagnosis?
12. What is the 5 year survival rate of acute myeloid Approximately 25%
leukemia (AML)?
13. A 31-year-old woman is diagnosed with her sixth Antiphospholipid anti-
spontaneous abortion. Which of the following is the body syndrome
most likely underlying diagnosis?
14. What is the most common inherited hypercoagulable Factor V Leiden mutation.
state?
15. Which of the following physical exam findings is most wet pupura
consistent with thrombocytopenia?
16. What does HELLP syndrome stand for? Hemolysis, elevated liv-
er enzymes, low platelet
count.
17. An 8-year-old boy with short stature presents to the Fanconi anemia
pediatrician's office with bruising. He denies fevers,
, chills, or changes in weight. His physical exam is no-
table for several café-au-lait spots over his trunk. The
pediatrician obtains a CBC, which is notable for ane-
mia and thrombocytopenia. Further lab testing re-
veals an elevated alpha-fetoprotein. Which of the fol-
lowing is the most likely diagnosis?
18. What is the most common inheritance pattern of Fan- Autosomal recessive
coni anemia?
19. An 18-year-old African-American man presents with hydroxyurea
questions about his diagnosis of sickle cell anemia. He
has been managing his condition since childhood by
treating his symptoms and having occasional blood
transfusions. Now he is experiencing more frequent
painful episodes and wants to know if there are other
treatment options. Which of the following is the most
appropriate pharmacologic treatment?
20. How is sickle cell disease diagnosed? Hemoglobin elec-
trophoresis.
21. A 62-year-old man with a history of cigarette smoking Phlebotomy
presents to the emergency department following a
resolved episode of painless and complete vision loss
in his right eye. The episode lasted 5 minutes and
completely resolved 8 hours ago. The patient reports
that he did not experience any numbness, weakness,
dysarthria, or facial droop. Vital signs include a HR of
80 bpm, BP of 125/88 mm Hg, RR of 20/min, oxygen
saturation of 98% on room air, and T of 98.6°F. Physi-
cal examination findings include facial erythema and
swelling. The conjunctivae are not injected, there is no
