Internal-Medicine

Questions: 36–48 107
Which of the following is the most appropriate
initial test to determine her risk for hemolytic
disease of the newborn (erythroblastosis fetalis)
due to Rh incompatibility?
(A)
(B)
(C)
(D)
(D)
(E)
anti-Rh(D) antibody in maternal serum
direct Coombs’ test of maternal serum
anti-Rh
antibody in baby’s serum
ABO testing of the husband
direct Coombs’ test of neonate serum
after birth
45. A 63-year-old man presents with fatigue, shortness
of breath on exertion, and easy bruising.
He has no prior history of bleeding disorders,
and is not taking any medications. On examination,
his conjunctivae are pale, he has palpable
spleen, and there are multiple bruises and
petechiae on his legs. A CBC reveals a hemoglobin
of 8.3 g/dL, WBC of 2300/mL, and
platelets of 30,000/mL. A blood film also shows
multiple lymphocytes with prominent cytoplasmic
projections. A bone marrow biopsy
also shows similar cells in the marrow and
marrow fibrosis. Which of the following is the
most likely diagnosis? (See Fig. 5–5.)
(A)
(B)
(C)
(D)
(E)
lymphoma
myeloma
myelofibrosis and myeloid metaplasia
hairy cell leukemia
chronic myelogenous leukemia
46. A 22-year-old long-distance runner is found to
be mildly anemic. He is asymptomatic; his stool
is negative for occult blood, and the ferritin
level is 200 ng/mL. Which intervention is most
likely to result in return of the hemoglobin to
normal?
(A)
(B)
(C)
(D)
(E)
using more supportive footwear
iron replacement
folate replacement
altering his exercise program
investigating and treating gastrointestinal
(GI) pathology
47. A 49-year-old man presents with jaundice,
nausea, and vomiting. He has a history of
chronic alcoholism, and is currently drinking
over one bottle of red wine a day. On physical
examination, he is jaundiced and pale with a
large tender liver. Laboratory data include
hemoglobin of 9 g/dL, WBC of 4200/mL, and
platelet count of 80,000/mL. His liver enzymes
and bilirubin are also elevated. Ultrasound of
the abdomen reveals liver enlargement with
no bile duct obstruction, a normal size spleen,
and no ascites. Which of the following is the
most likely toxic effect of alcohol on the bone
marrow?
(A)
(B)
(C)
(D)
(E)
developing erythrocytes and myelocytes
mature polymorphonuclear leukocytes
mature red cells
mature platelets
eosinophils
48. A 22-year-old medical student donates his
blood as part of a clinical study. He is discovered
to have persistent HbF (fetal hemoglobin)
levels. He feels well, and his clinical examination
is normal. Which of the following features
about this condition is most likely true?
(A)
(B)
(C)
(D)
(E)
cause of sickling red cells
disease of infants only
variant of thalassemia major
anemia exacerbated by fava beans
benign genetic abnormality
Figure 5–5.
(Reproduced, with permission, from Lichtman MA, et al. Williams
Hematology, 7th ed. New York: McGraw-Hill, 2006:Plate XXI-7)