Internal-Medicine

Questions: 4–16 101
(F)
(G)
(H)
(I)
(J)
Bence Jones proteinuria
increased osmotic fragility
type III cryoglobulin
marrow hyperplasia
increased plasma cells in bone marrow
For each patient with anemia, select the corresponding
clinical and laboratory findings.
10. A 19-year-old woman is found to be anemic
with hemoglobin of 10.0 g/dL. She has target
cells on the blood film, and is homozygous for
HbC. She has no other clinical symptoms.
(SELECT THREE)
11. A 74-year-old woman is anemic with hemoglobin
of 10.5 g/dL. She has symptoms of tingling
in her feet and back discomfort. X-rays of
her spine reveal osteopenia and multiple lytic
lesions. She has an immunoglobulin G (IgG)
spike on serum protein electrophoresis.
(SELECT THREE)
Questions 12 through 14
(A)
(B)
(C)
(D)
(E)
(F)
(G)
(H)
(I)
(J)
(K)
(L)
decreased red cell survival
thalassemia
postsplenectomy
increased numbers of reticulocytes
thiamine deficiency
acute hemorrhage
low fecal urobilinogen
pyridoxine deficiency
immediate postoperative period
acute lymphocytic leukemia
iron deficiency
increased urine urobilinogen
For each patient with a blood count anomaly, select
the corresponding clinical situation and/or laboratory
finding.
12. A 49-year-old woman feels unwell because of
fatigue and shortness of breath on exertion. Her
hemoglobin is 9.0 g/dL, the direct antiglobulin
test (Coombs’) is positive, and she is suspected of
having a hemolytic anemia. (SELECT THREE)
13. A 69-year-old man presents with increasing
symptoms of chest pain on exertion, but never
at rest. He has a history of chronic stable coronary
artery disease. Repeat evaluation now
reveals a hypochromic microcytic anemia as
the cause for his increased chest pain symptoms.
(SELECT THREE)
14. A 72-year-old woman is admitted to the hospital
with an acute illness. Her platelet count is
incidentally noted to be 800,000/mL. (SELECT
THREE)
DIRECTIONS (Questions 15 through 31): Each of
the numbered items in this section is followed by
answers. Select the ONE lettered answer that is
BEST in each case.
15. A 7-year-old boy has severe microcytic anemia
due to beta-thalassemia major (homozygous).
He requires frequent blood transfusions (once
every 6 weeks) to prevent the skeletal and
developmental complications of thalassemia.
Which of the following medications is also
indicated in the treatment of patients requiring
frequent blood transfusions?
(A)
(B)
(C)
(D)
(E)
oral calcium supplements
fresh frozen plasma
desferrioxamine
penicillamine
cryoprecipitate
16. A 45-year-old woman develops symptoms of
shortness of breath on exertion, easy fatigue,
and jaundice. On examination she is pale,
and there is a palpable spleen, but no lymphadenopathy.
Her hemoglobin is 9.0 g/dL,
the reticulocyte count 9%, and the direct antibody
test (Coombs’) is positive. Which of the
following bone marrow findings is most likely
to be seen in this patient?
(A)
(B)
(C)
(D)
(E)
megaloblastic changes
giant metamyelocytes
increased erythroid-to-myeloid ratio
increased lymphocytes
shift to left of the myeloid series