Internal-Medicine

Questions: 17–27 103
22. A 23-year-old woman has symptoms of fatigue
and not feeling well. She appears well and the
physical examination is normal, but her hemoglobin
is low at 9.8 g/dL with a mean corpuscular
volume (MVC) of 76 fL. Her family
history is positive for thalassemia. She also
mentions a history of heavy menses in the past
year. Which of the following would be most
helpful in distinguishing thalassemia from one
of pure iron deficiency anemia?
(A)
(B)
(C)
(D)
(E)
peripheral blood smear
osmotic fragility test
Ham’s test
Hb electrophoresis on paper
serum ferritin determination
23. A 21-year-old woman is suspected of having
mycoplasma pneumonia based on symptoms
of a dry cough, fever, normal lung examination
but abnormal chest x-ray with bilateral
infiltrates. She is also anemic with hemoglobin
of 10.5 g/dL, reticulocyte count 7%, and WBC
12,000/mL. Hemolytic anemia from cold
agglutinins is suspected as the cause. Which
of the following tests will confirm autoimmune
causation as the cause of the anemia?
(A)
(B)
(C)
(D)
(E)
positive antinuclear antibody (ANA)
positive rheumatoid factor
polyclonal gammopathy
presence of Heinz bodies
positive Coombs’ test
24. A 59-year-old man presents to the emergency
room with left face and arm weakness that lasts
for 3 hours. He reports no other symptoms of
palpitations, chest pain, or headache. Neurologic
examination is now normal. A computerized
tomography (CT) head, electrocardiogram
(ECG), and laboratory workup are normal. He
is started on clopidogrel, and referred for further
evaluation as an outpatient. Which of the
following is the most likely mechanism of action
on platelet function from this medication?
(C)
(D)
(E)
adenosine diphosphate (ADP) receptor
blockade
GPIIB-IIIA blocker
cyclooxygenase-2 inhibition
25. A 23-year-old woman has symptoms of leg
swelling and discomfort, but no chest pain or
shortness of breath. She has no risk factors for
a blood clot. On examination, the left leg is
swollen when compared to the right. Leg
Doppler ultrasound is positive for deep vein
thrombosis, and further investigations reveal
decreased plasma antithrombin III (AT-III)
levels. Which of the following is the most likely
clinical effect from the low AT-III levels?
(A)
(B)
(C)
(D)
(E)
aspirin sensitivity
heparin resistance
warfarin (Coumadin) resistance
platelet dysfunction
disseminated intravascular coagulation
26. A 4-month-old infant is anemic with a hemoglobin
level of 9.5 g/dL and MCV 77 fL. The
baby looks well, the height and weight growth
parameters are normal, and she is breastfeeding
well. Which of the following is the
most likely cause for her anemia?
(A)
(B)
(C)
(D)
(E)
inadequate dietary iron
hemolysis
late clamping of cord
iron malabsorption
folate deficiency
27. Which of the following is the most likely effect
of increased levels of red blood cell 2,3 diphosphoglycerate
(2,3-DPG)?
(A)
(B)
(C)
(D)
(E)
hemolytic anemia due to sulfa drugs
increased oxygen affinity
decreased oxygen affinity
loss of red cell energy
multiple congenital abnormalities
(A)
(B)
cyclooxygenase-1 inhibition
modulation of cyclic adenosine
monophosphate (cAMP) levels