Practice questions Anemia VII
Practice questions
Anemia VII
© Jun Wang, MD, PhD
Abbreviations:
|
Hb: hemoglobin |
HCT: hematocrit |
|
MCV: Mean Corpuscular Volume |
MCH: Mean Corpuscular Hemoglobin |
|
RDW: Red Cell Distribution Width |
TIBC: total iron binding capacity |
1. Use this case for the next four questions. A 45-year-old woman presents to the clinic with fatigue, dyspnea, dark-colored urine and jaundice for the past month. She has a history of Hashimoto thyroiditis for 10 years. She was diagnosed with depression three years ago is current taking Prozac. Physical examination reveals pallor and splenomegaly. Laboratory tests show the following:
MCV: 85 fL (80-100 fL)
Reticulocyte count: 7% (0.5-2.5%)
Total bilirubin: 3.2 mg/dL (0.3-1.2 mg/dL)
Direct Coombs test: positive for IgG and C3
Her white cell and platelet count, and TSH are within normal range. An image of her peripheral blood smear is shown. What is the cause of her symptoms?
(Image credit: E. Uthman, MD, CC BY-SA 2.0 <https://creativecommons.org/licenses/by-sa/2.0>, via Wikimedia Commons)
B. Depression
C. Hypothyroidism
D. Liver disease
E. Side effects of Prozac
2. A 45-year-old woman presents to the clinic with fatigue, dyspnea, dark-colored urine and jaundice for the past month. She has a history of Hashimoto thyroiditis for 10 years. She was diagnosed with depression three years ago is current taking Prozac. Physical examination reveals pallor and splenomegaly. Laboratory tests show the following:
MCV: 85 fL (80-100 fL)
Reticulocyte count: 7% (0.5-2.5%)
Total bilirubin: 3.2 mg/dL (0.3-1.2 mg/dL)
Direct Coombs test: positive for IgG and C3
Her white cell and platelet count, and TSH are within normal range. An image of her peripheral blood smear is shown. What is most likely the cause of her morphological changes of RBC?
(Image credit: E. Uthman, MD, CC BY-SA 2.0 <https://creativecommons.org/licenses/by-sa/2.0>, via Wikimedia Commons)
B. Hemoglobinopathy
C. Red cell cytoskeletal defects
D. Serum M-proteins
E. Warm auto-immune antibodies
3. A 45-year-old woman presents to the clinic with fatigue, dyspnea, dark-colored urine and jaundice for the past month. She has a history of Hashimoto thyroiditis for 10 years. She was diagnosed with depression three years ago is current taking Prozac. Physical examination reveals pallor and splenomegaly. Laboratory tests show the following:
MCV: 85 fL (80-100 fL)
Reticulocyte count: 7% (0.5-2.5%)
Total bilirubin: 3.2 mg/dL (0.3-1.2 mg/dL)
Direct Coombs test: positive for IgG and C3
Her white cell and platelet count, and TSH are within normal range. An image of her peripheral blood smear is shown. What is most likely the cause of elevated bilirubin?
(Image credit: E. Uthman, MD, CC BY-SA 2.0 <https://creativecommons.org/licenses/by-sa/2.0>, via Wikimedia Commons)
B. Drug effect
C. Hemolysis
D. Liver injury
E. Splenic tumor
4. A 45-year-old woman presents to the clinic with fatigue, dyspnea, dark-colored urine and jaundice for the past month. She has a history of Hashimoto thyroiditis for 10 years. She was diagnosed with depression three years ago is current taking Prozac. Physical examination reveals pallor and splenomegaly. Laboratory tests show the following:
MCV: 85 fL (80-100 fL)
Reticulocyte count: 7% (0.5-2.5%)
Total bilirubin: 3.2 mg/dL (0.3-1.2 mg/dL)
Direct Coombs test: positive for IgG and C3
Her white cell and platelet count, and TSH are within normal range. An image of her peripheral blood smear is shown. What is most likely the diagnosis?
(Image credit: E. Uthman, MD, CC BY-SA 2.0 <https://creativecommons.org/licenses/by-sa/2.0>, via Wikimedia Commons)
B. G-6-PD deficiency
C. Hereditary spherocytosis
D. Paroxysmal nocturnal hemoglobinuria
E. Pyruvate kinase deficiency
F. Warm antibody autoimmune hemolytic anemia
5. Use this case for the next five questions. A 60-year-old woman presents to the clinic with fatigue, jaundice, and dark-colored urine over the past two weeks. She has had similar symptoms that tend to worsen in cold weather. Physical examination reveals pale skin. Mild icteric sclera is noted. Her fingers and toes appear to be bluish and gray. Laboratory results are as follows:
MCV: 85 fL (80-100 fL)
Reticulocyte count: 6% (0.5-2.5%)
Indirect bilirubin: 1.2 mg/dL (0.2-0.8 mg/dL)
Direct Coombs test: positive for complement C3d
An image of her peripheral blood smear at room temperature is shown. What is the most likely associated with her RBC findings?
(Image credit: Spicy, CC BY-SA 4.0 <https://creativecommons.org/licenses/by-sa/4.0>, via Wikimedia Commons)
B. Complements
C. Hemoglobinopathy
D. RBC cytoskeletal defects
E. Reduced RBC NADPH
6. A 60-year-old woman presents to the clinic with fatigue, jaundice, and dark-colored urine over the past two weeks. She has had similar symptoms that tend to worsen in cold weather. Physical examination reveals pale skin. Mild icteric sclera is noted. Her fingers and toes appear to be bluish and gray. Laboratory results are as follows:
MCV: 85 fL (80-100 fL)
Reticulocyte count: 6% (0.5-2.5%)
Indirect bilirubin: 1.2 mg/dL (0.2-0.8 mg/dL)
Direct Coombs test: positive for complement C3d
An image of her peripheral blood smear at room temperature is shown. Additional studies confirmed the presence of auto-immune antibodies against his RBC. What type of antibodies are most likely identified?
(Image credit: Spicy, CC BY-SA 4.0 <https://creativecommons.org/licenses/by-sa/4.0>, via Wikimedia Commons)
B. IgD
C. IgE
D. IgG
E. IgM
F. λ light chain
7. A 60-year-old woman presents to the clinic with fatigue, jaundice, and dark-colored urine over the past two weeks. She has had similar symptoms that tend to worsen in cold weather. Physical examination reveals pale skin. Mild icteric sclera is noted. Her fingers and toes appear to be bluish and gray. Laboratory results are as follows:
MCV: 85 fL (80-100 fL)
Reticulocyte count: 6% (0.5-2.5%)
Indirect bilirubin: 1.2 mg/dL (0.2-0.8 mg/dL)
Direct Coombs test: positive for complement C3d
An image of her peripheral blood smear at room temperature is shown. Additional studies confirmed the presence of auto-immune antibodies against his RBC. What is most likely the cause of his digit discoloration?
(Image credit: Spicy, CC BY-SA 4.0 <https://creativecommons.org/licenses/by-sa/4.0>, via Wikimedia Commons)
B. Loss of RBC elasticity due to hemoglobinopathy
C. Platelet activation by injured endothelium
D. RBC aggregate due to lower temperature
E. Over activation of coagulative factors
8. A 60-year-old woman presents to the clinic with fatigue, jaundice, and dark-colored urine over the past two weeks. She has had similar symptoms that tend to worsen in cold weather. Physical examination reveals pale skin. Mild icteric sclera is noted. Her fingers and toes appear to be bluish and gray. Laboratory results are as follows:
MCV: 85 fL (80-100 fL)
Reticulocyte count: 6% (0.5-2.5%)
Indirect bilirubin: 1.2 mg/dL (0.2-0.8 mg/dL)
Direct Coombs test: positive for complement C3d
An image of her peripheral blood smear at room temperature is shown. Additional studies confirmed the presence of auto-immune antibodies against his RBC. What is most likely the target for these auto-immune antibodies?
(Image credit: Spicy, CC BY-SA 4.0 <https://creativecommons.org/licenses/by-sa/4.0>, via Wikimedia Commons)
B. Duffy
C. I
D. Kidd
E. RhD
9. A 60-year-old woman presents to the clinic with fatigue, jaundice, and dark-colored urine over the past two weeks. She has had similar symptoms that tend to worsen in cold weather. Physical examination reveals pale skin. Mild icteric sclera is noted. Her fingers and toes appear to be bluish and gray. Laboratory results are as follows:
MCV: 85 fL (80-100 fL)
Reticulocyte count: 6% (0.5-2.5%)
Indirect bilirubin: 1.2 mg/dL (0.2-0.8 mg/dL)
Direct Coombs test: positive for complement C3d
An image of her peripheral blood smear at room temperature is shown. Additional studies confirmed the presence of auto-immune antibodies against his RBC. What is the diagnosis?
(Image credit: Spicy, CC BY-SA 4.0 <https://creativecommons.org/licenses/by-sa/4.0>, via Wikimedia Commons)
B. G-6-PD deficiency
C. Hereditary spherocytosis
D. Paroxysmal nocturnal hemoglobinuria
E. Sickle cell anemia
F. Warm antibody autoimmune hemolytic anemia
10. Use this case for the next five questions. A 35-year-old man with a history of chronic kidney disease is undergoing a blood transfusion for severe anemia. Thirty minutes into the transfusion, he begins to experience fever, chills and chest pain. His temperature raised 3 degrees to 100 °F, and his blood pressure dropped from 110/75 mm Hg to 85/45 mm Hg. What should be done immediately?
B. Broad spectrum antibiotics
C. IV fluid
D. Stop transfusion
11. A 35-year-old man with a history of
chronic kidney disease is undergoing a blood transfusion for severe anemia.
Thirty minutes into the transfusion, he begins to experience fever, chills and
chest pain. His temperature raised 3 degrees to 100 °F, and his blood pressure dropped from
110/75 mm Hg to 85/45 mm Hg.
Hemoglobin: 7.0 g/dL (14-18 g/dL)
Reticulocyte count: 10% (0.5-2.5%)
Indirect bilirubin: 3.8 mg/dL (0.1-1.0 mg/dL)
Haptoglobin: undetectable
What additional blood test result is likely to be positive?
B. Direct antiglobulin test
C. Enzymatic activity of G6PD
D. Eosin-5-maleimide (EMA) binding assay
E. PCR for parvovirus B19
F. Smear for RBC parasites
12. A 35-year-old man with a history of
chronic kidney disease is undergoing a blood transfusion for severe anemia.
Thirty minutes into the transfusion, he begins to experience fever, chills and
chest pain. His temperature raised 3 degrees to 100 °F, and his blood pressure dropped from
110/75 mm Hg to 85/45 mm Hg.
The transfusion is immediately stopped. Laboratory tests show:
Reticulocyte count: 10% (0.5-2.5%)
Indirect bilirubin: 3.8 mg/dL (0.1-1.0 mg/dL)
Haptoglobin: undetectable
Direct Coombs test is positive. What is most likely the cause of his low hemoglobin level?
B. Immune-mediated hemolysis
C. Oxidative stress
D. RBC membrane instability
E. Reduced erythropoietin production
13. A 35-year-old man with a history of
chronic kidney disease is undergoing a blood transfusion for severe anemia.
Thirty minutes into the transfusion, he begins to experience fever, chills and
chest pain. His temperature raised 3 degrees to 100 °F, and his blood pressure dropped from
110/75 mm Hg to 85/45 mm Hg.
The transfusion is immediately stopped. Laboratory tests show:
Reticulocyte count: 10% (0.5-2.5%)
Indirect bilirubin: 3.8 mg/dL (0.1-1.0 mg/dL)
Haptoglobin: undetectable
B. Allergic reaction
C. Bacterial contamination of donor blood
D. Oxidative stress
E. RBC membrane instability
14. A 35-year-old man with a history of
chronic kidney disease is undergoing a blood transfusion for severe anemia.
Thirty minutes into the transfusion, he begins to experience fever, chills and
chest pain. His temperature raised 3 degrees to 100 °F, and his blood pressure dropped from
110/75 mm Hg to 85/45 mm Hg.
The transfusion is immediately stopped. Laboratory tests show:
Reticulocyte count: 10% (0.5-2.5%)
Indirect bilirubin: 3.8 mg/dL (0.1-1.0 mg/dL)
Haptoglobin: undetectable
Direct Coombs test is positive. What is the diagnosis?
B. Delayed hemolytic transfusion reaction
C. G-6-PD deficiency
D. Paroxysmal nocturnal hemoglobinuria
E. Transient pure red cell aplasia
F. Warm antibody autoimmune hemolytic anemia
15. Use this case for the next three questions. A 21-year-old G2P1 woman presents to the obstetrics clinic at 28 weeks of gestation for a routine prenatal visit. Her first pregnancy was uncomplicated, and she delivered a healthy baby boy. She has no significant medical history. Routine prenatal blood tests reveal that she is blood type O negative. Her husband is blood type A positive. Further testing shows that her indirect Coombs test is positive. An ultrasound of the fetus shows mild ascites and an enlarged liver. What is most likely causing these changes in the fetus?
B. Fetal IgM against maternal RBC
C. Maternal IgG against fetal RBC
D. Maternal IgM against fetal RBC
16. A 21-year-old G2P1 woman presents to the obstetrics clinic at 28 weeks of gestation for a routine prenatal visit. Her first pregnancy was uncomplicated, and she delivered a healthy baby boy. She has no significant medical history. Routine prenatal blood tests reveal that she is blood type O negative. Her husband is blood type A positive. Further testing shows that her indirect Coombs test is positive. An ultrasound of the fetus shows mild ascites and an enlarged liver. What is the most likely diagnosis?
B. Deletion of 4 a globin gene of fetus
C. Fetal congenital hematopoietic stem cell defect
D. Fetal Parvovirus B19 infection
E. Rhesus (Rh) Incompatibility
17. A 21-year-old G2P1 woman presents to the obstetrics clinic at 28 weeks of gestation for a routine prenatal visit. Her first pregnancy was uncomplicated, and she delivered a healthy baby boy. She has no significant medical history. Routine prenatal blood tests reveal that she is blood type O negative. Her husband is blood type A positive. Further testing shows that her indirect Coombs test is positive. An ultrasound of the fetus shows mild ascites and an enlarged liver. What is the most likely cause of these fetal changes?
B. Fetal anti-A IgM
C. Fetal anti-D IgG
D. Maternal anti-A IgG
E. Maternal anti-A IgM
F. Maternal anti-D IgG
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