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Question 1

Question 1. A 33 yo F comes to the office with fatigue and heavy menstrual cycle. Her H&H is 10.2 /27 and RDW 18.5. A pregnancy test is negative and she is otherwise healthy. What do you recommend? Colonoscopy Blood Transfusion Trial of ferrous sulfate Schilling Test

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Question 1

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  1. Question 1 A 33 yo F comes to the office with fatigue and heavy menstrual cycle. Her H&H is 10.2/27 and RDW 18.5. A pregnancy test is negative and she is otherwise healthy. What do you recommend? • Colonoscopy • Blood Transfusion • Trial of ferrous sulfate • Schilling Test • Bone Marrow Biopsy

  2. Question 2 A Greek woman brings her 10 yo son to your office complaining that he tires too easily on the soccer field and the iron pills from a different doctor aren’t helping. On PE you note he has puffy cheeks. You do an electrophoresis of his hemoglobin and are most likely to see which of the following? • HbA2 • HbF • HbS • HbC • HbM • HbH

  3. Question 3 A 32 yo F has heavy menstrual bleeding, easy bruising, gingival bleeding when she brushes her teeth, and nose bleeds. She required a blood transfusion when she gave birth. Labs: Hb 10.8, MCV 78.1, WBC 4.3, Platelet 275 BT 14 (high), PT 11 (normal), PTT 40 (high) What is the most likely diagnosis? a) Hemophilia A b) Hemophilia B c) vonWillebrand’s disease d) Disseminated Intravascular Coagulation e) Hemolytic Uremic Syndrome

  4. Question 4 A 72 yo F comes has increasing memory problems and weakness over the last 7 months but can take care of her ADLs. She has a PMH of HTN. Labs: Hb 8.2 LDH 450 B12 324 (normal) Hct 22 Tbili 4.8 Folate 12 (normal) WBC 3.9 Dbili 0.3 Homocysteine 20 (high) MCV 110 Platelet 234 Methylmalo 400 (high) What is the most likely diagnosis? a) Autoimmune hemolytic anemia • Folate deficiency • Myelodysplasia • Vitamin B12 deficiency • Gilbert Syndrome

  5. Question 5 A family new to the area reports the strange behavior of their 2 yo girl and her constant belly aches. Her blood smear is shown. What is the best treatment? • Succimer and EDTA • N-acetylcysteine • Naloxone • Glucagon • Protamine sulfate • Atropine • Thiosulfate

  6. Question 6 A 59-yo who takes warfarin for a mechanical heart valve is brought to the hospital after a car accident. What would you give to help stop his bleeding? • Protamine sulfate • 2 units of packed RBCs • Fresh Frozen Plasma • Multiple doses of Vit K • Isolated factor VIII • DDVAP

  7. Question 7 A 31yo F comes in with blistering lesions all over the skin after a weekend escape to the beach. She also reports tea colored urine. What enzyme is likely defective? a) d-aminolevulinic acid synthase • d-aminolevulinic acid dehydratase c) Porphobilinogendeaminase • Uroporphyrinogendecarboxylase • Ferrochetalase

  8. Question 8 A previously healthy 9 yo M is currently being treated for a UTI that began 5 days ago. He returns with his Mom, who is scared that her son’s urine is now dark in color and he has excessive fatigue. What are you likely to see on his blood smear? • Bite cells • Schistocytes • Spur cells • Elliptocytes • Howell Jolly bodies • Target cells

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