Block 10 Pathology RBC Labs

12 Questions | By Chachelly | Last updated: Mar 18, 2022 | Total Attempts: 422

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1.

A 54-year-old woman with a long history of iron deficiency anemia now presents with progressive dysphagia (difficulty swallowing) primarily with solid foods. On examination, she has swollen, painful, smooth appearing tongue (glossitis) and spooning of her nails (koilonychia). Endoscopy reveals she has a large esophageal web, which has been obstructing her food passage. Her most likely diagnosis is
- A.
  
  Fanconi anemia
- B.
  
  Lead poisoning
- C.
  
  Esophageal cancer
- D.
  
  Plummer-Vinson syndrome
- E.
  
  Thalassemia
2.

Which of the following is most likely to show microcytic, hypochromic red cells and a low MCV?
- A.
  
  Pernicious anemia
- B.
  
  Gastro-intestinal blood loss
- C.
  
  Folate deficiency
- D.
  
  Warm auto-immune hemolytic anemia
3.

Which of the following is most likely to show microcytic, hypochromic red cells and a low MCV?
- A.
  
  A habitual alcoholic with acute withdrawal symptoms
- B.
  
  A patient with chronic gastric ulcer
- C.
  
  A patient who has taken methotrexate
- D.
  
  A patient with SLE and reticulocytosis
4.

A 55-yr-old man visits his physician for a routine physical examination. Other than occasional fatigue, he reports feeling well. CBC shows low hemoglobin values and microcytic hypochromic red cells. Which of the following serum values would suggest that the physician should next take a stool sample for analysis?
- A.
  
  ↑ MCV and hyper-segmented neutrophils
- B.
  
  ↑ reticulocyte count and abnormal hemoglobin EP
- C.
  
  ↑ Serum ferritin
- D.
  
  ↑TIBC and low MCV
5.

A 13-yr-old boy is brought to the emergency department because of a fall from the skateboard. An x-ray of the skull is shown here. Which of the following hematological conditions is the most likely cause of these findings?
- A.
  
  Acute lymphoblastic leukemia (ALL)
- B.
  
  Megaloblastic anemia
- C.
  
  Iron deficiency anemia
- D.
  
  Sickle cell anemia
- E.
  
  Multiple myeloma
6.

A 25-year-old black male sickle cell patient was brought to the ER because of fever and chest pains for the past 24 hours. His anemia was unchanged. His reticulocyte count was 10%. The most likely cause of his acute problem is
- A.
  
  Aplastic crisis
- B.
  
  Vaso-occlusive crisis
- C.
  
  Sequestration crisis
- D.
  
  Severe iron deficiency
- E.
  
  Vitamin B12 deficiency
7.

A 2-yr-old boy is brought to the emergency department because of shortness of breath and left-sided abdominal pain for 3 hrs. He appears pale. Physical examination shows hypotension and tachycardia. There is splenomegaly with the spleen tip palpated 8 cm below the costal margin. Lab studies show Hb - 5.1 g/dL (N: 12.1-14.9) Hematocrit - 16% (N: 37-44.4%) Leukocyte count- 4500/cmm (N: 4000-11,500) Platelet count - 87,000/cmm (N: 150,000-400,000) A photomicrograph of a Wright-stained peripheral blood smear is shown. Which of the following is the most likely cause of this patient’s current condition?
- A.
  
  Aplastic crisis
- B.
  
  Splenic sequestration
- C.
  
  Congestive heart failure
- D.
  
  Auto-immune hemolysis
- E.
  
  Salmonella sepsis
8.

A 30-year-old woman complains of constant fatigue. Physical examination reveals pallor and a palpable spleen tip. PBS shows spherocytes. Osmotic fragility is increased. An inherited abnormality in which of the following best accounts for these findings?
- A.
  
  Alpha-globin chain
- B.
  
  Beta-globin chain
- C.
  
  Membrane skeletal protein
- D.
  
  G6PD
- E.
  
  Synthesis of heme
9.

A 31-year-old woman has a low-grade fever for the past one week. Physical examination reveals pallor. She has a history of chronic anemia. PBS shows spherocytosis. Her reticulocyte count is very low. Which of the following events is most likely to have occurred in this patient?
- A.
  
  DIC
- B.
  
  Reduced erythropoiesis from parvovirus B19 infection
- C.
  
  Accelerated extravascular hemolysis in the spleen
- D.
  
  Development of anti-RBC antibodies
10.

A 56-yr-old man presents to his primary care physician and reports having a blood problem, mentioning a recent diagnosis of myelophthisic anemia. He does not seem to understand his diagnosis and wants to know what causes this disorder. His physician immediately orders labs and explains that his condition is usually caused by a problem located in the
- A.
  
  Bone marrow
- B.
  
  Kidneys
- C.
  
  Liver
- D.
  
  Pancreas
- E.
  
  Spleen
11.

A 23-year old woman presents to her family physician with fatigue. She also states that her urine looks “cola-colored” when she first goes to the bathroom in the morning. Blood work-up shows a pancytopenia. The patient’s RBCs are mixed with acidified normal serum and compared to normal RBCs at room temperature and at 37C. Both temperatures cause the patient’s, but not the normal, RBCs to lyse. Based on the clinical information provided and the laboratory tests, which of the following is the most likely diagnosis?
- A.
  
  Aplastic anemia
- B.
  
  Megaloblastic anemia
- C.
  
  Myelodysplastic syndrome (MDS)
- D.
  
  Paroxysmal nocturnal hemoglobinuria (PNH)
- E.
  
  Fanconi anemia
12.

A 32-yr-old female comes to the physician because of a sore throat, worsening fatigue, and shortness of breath for the past 3 days. She has a history of migraines for many years. Her temperature is 38.6°F (101.5°F) and her pulse is 100/minute. A CBC shows hemoglobin of 10 g/dL, hematocrit of 30%, and 1,500 WBC/cmm. Platelet count is 50,000/cmm. The corrected reticulocyte count is <1%. Which of the following is the most likely diagnosis?
- A.
  
  Iron deficiency anemia
- B.
  
  Megaloblastic anemia
- C.
  
  Aplastic anemia
- D.
  
  Sideroblastic anemia