Internal-Medicine

102 5: Hematology
17. A 23-year-old woman of Italian extraction is
found to have a hypochromic microcytic
anemia of 10 g/dL. In addition, there is a fair
degree of anisocytosis, poikilocytosis, and targeting
on the blood film. The WBC is 9500/mL,
the platelet count is 240,000/mL, and the reticulocyte
count is 7%. The spleen is palpated
5 cm below the left costal margin. Which of
the following is the most appropriate treatment
for her condition?
(A)
(B)
(C)
(D)
(E)
splenectomy
removal of the abnormal Hb pigment
purely supportive
plasmapheresis
intramuscular iron
18. A 67-year-old man is complaining of fatigue.
A routine complete blood count (CBC) reveals
a platelet count of 850,000/mL, and the hemoglobin
and WBC counts are normal. He reports
no other symptoms, and his clinical examination
is normal. Which of the following characteristics
is most likely to be helpful in
differentiating essential (primary) from reactive
(secondary) thrombocytosis?
(A)
(B)
(C)
(D)
(E)
increased megakaryocyte number
increased total platelet mass
increased platelet turnover
normal platelet survival
thromboembolism and hemorrhage
chills after the transfusion was started. Repeat
cross-matching and testing at the time ruled
out an acute hemolytic transfusion reaction.
The next transfusion is ordered through a
“filter” to prevent or minimize the febrile reaction.
Which of the following mechanisms is
most likely to explain the effect of the filter?
(A)
(B)
(C)
(D)
(E)
reducing bacterial transmission
reducing viral transmission
reducing parasite transmission
reducing leukocyte transfusion
reducing reticulocyte transfusion
21. A 19-year-old man is found to have low hemoglobin
on routine screening. He feels well at the
present time, but in the past he has had two
presentations to the hospital for severe abdominal
and back pain that resolved on its own with
no specific diagnosis. His blood film is shown in
Fig. 5–2; the hemoglobin is 10 mg/dL, mean
corpuscular volume (MCV) 80 fL, and reticulocyte
count 0.04 (4%). Which of the following is
the most likely explanation for his previous
episodes of abdominal pain? (See Fig. 5–2.)
(A)
(B)
(C)
(D)
(E)
aplastic crisis
sequestration crisis
vaso-occlusive crisis
hemolytic crisis
adrenal crisis
19. A 19-year-old man is found to have a decreased
eosinophil count. Which of the following is the
most likely cause?
(A)
(B)
(C)
(D)
(E)
asthma
contact dermatitis
yeast infection
mycobacterial infection
prednisone administration
20. A 68-year-old man with aplastic anemia is due
for another blood transfusion. He has had multiple
blood transfusions in the past, but with
the last transfusion, he developed fever and
Figure 5–2.
(Reproduced, with permission, from Kasper DL, et al. Harrison’s
Principles of Internal Medicine, 16th ed. New York: McGraw-Hill,
2005:596)