Internal-Medicine
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110 5: Hematology<br />
59. A 28-year-old man, originally from West Africa,<br />
is found on routine examination to have<br />
splenomegaly. His hemoglobin is 9.5 g/dL, and<br />
blood film examination reveals target cells.<br />
Which of the following is the most likely abnormal<br />
hemoglobin in this man?<br />
(A)<br />
(B)<br />
(C)<br />
(D)<br />
(E)<br />
HbM<br />
HbS<br />
Hb Zurich<br />
HbC<br />
Hb Barts<br />
DIRECTIONS (Questions 60 through 73): Each set<br />
of matching questions in this section consists of a<br />
list of lettered options followed by several numbered<br />
items. For each numbered item, select the<br />
appropriate lettered option(s). Each lettered<br />
option may be selected once, more than once, or<br />
not at all. EACH ITEM WILL STATE THE NUM-<br />
BER OF OPTIONS TO SELECT. CHOOSE<br />
EXACTLY THIS NUMBER.<br />
Questions 60 through 64<br />
(A)<br />
(B)<br />
(C)<br />
(D)<br />
iron deficiency anemia<br />
beta-thalassemia trait<br />
anemia of chronic disease<br />
sideroblastic anemia<br />
For each patient with a hypochromic microcytic<br />
anemia, select the most likely diagnosis.<br />
60. A 42-year-old man is feeling chronically<br />
fatigued. His hemoglobin is 11.5 g/dL, and the<br />
blood film is hypochromic and microcytic. The<br />
serum iron is increased, total iron-binding<br />
capacity (TIBC) is normal, ferritin is increased,<br />
and HbA2 is decreased. (SELECT ONE)<br />
61. An 18-year-old woman is feeling chronically<br />
fatigued. Her hemoglobin is 11.5 g/dL, RBC<br />
count 5,900,000/mL, and the blood film is<br />
hypochromic and microcytic. The serum iron is<br />
normal, TIBC is normal, ferritin is normal, and<br />
HbA2 is elevated. (SELECT ONE)<br />
film shows hypochromic microcytic cells. His<br />
serum iron is decreased, TIBC is increased, ferritin<br />
is decreased, and HbA2 is normal.<br />
(SELECT ONE)<br />
63. A 43-year-old man, in hospital for 2 weeks with<br />
pancreatitis, is anemic with hemoglobin of<br />
9.7 g/dL and MCV 79 fL. The blood film shows<br />
slightly microcytic hypochromic red cells, and<br />
the reticulocyte count is 0.5 %. The serum is iron<br />
decreased, TIBC is decreased, serum ferritin is<br />
increased, and HbA2 normal. (SELECT ONE)<br />
64. A 52-year-old man is complaining of fatigue.<br />
His physical examination is normal, but his<br />
hemoglobin is low at 8.9 mg/dL. The reticulocyte<br />
count is 0.5 %, serum iron and TIBC are<br />
normal, and ferritin is elevated. A bone marrow<br />
aspirate reveals erythroid precursors that have<br />
accumulated abnormal amounts of mitochondrial<br />
iron. (SELECT ONE)<br />
Questions 65 through 69<br />
(A)<br />
(B)<br />
(C)<br />
(D)<br />
(E)<br />
(F)<br />
spherocytes<br />
schistocytes<br />
sickle cells<br />
burr cells<br />
agglutinated cells<br />
Heinz bodies<br />
For each of the following conditions, select the<br />
most likely RBC morphology.<br />
65. Found in severe liver disease. (SELECT ONE)<br />
66. Represent precipitated Hb. (SELECT ONE)<br />
67. Caused by loss of red cell membrane. (SELECT<br />
ONE)<br />
68. Caused by polymerization of an abnormal Hb.<br />
(SELECT ONE)<br />
69. Caused by trauma to red cell membranes.<br />
(SELECT ONE)<br />
62. A 67-year-old man presents with fatigue due to<br />
a low hemoglobin value of 9.2 g/dL. The blood
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