CMS I Cummulative: Hematology

What do we monitor with Coumadin?

PT, INR

(Target range: 2-3)

Microangiopathic hemolytic anemia (MAHA) & neurologic system abnormalities are classic signs of which disease?

a. ITP
b. HIT
c. TTP

TTP

A 32-year-old woman presents to her primary care physician with complaints of fatigue, weakness, and shortness of breath on exertion for the past few months. She reports heavy menstrual periods. Physical examination reveals pallor of the conjunctiva and nail beds. Laboratory studies show a hemoglobin level of 9.8 g/dL (normal range: 12-16 g/dL), a mean corpuscular volume (MCV) of 68 fL, and a ferritin level of 10 ng/mL (normal range: 12-150 ng/mL). The rest of the complete blood count and peripheral blood smear are unremarkable.
What is the most likely diagnosis for this patient's anemia?
a. Vitamin B12 deficiency anemia
b. Folate deficiency anemia
c. Iron deficiency anemia
d. Anemia of chronic disease

c. Iron deficiency anemia

Which of the following findings on the peripheral blood smear is characteristic of iron deficiency anemia?
a. Macrocytosis
b. Microcytosis
c. Spherocytes
d. Schistocytes

b. Microcytosis

A 32-year-old woman presents to her primary care physician with complaints of fatigue, weakness, and shortness of breath on exertion for the past few months. She reports heavy menstrual periods. Physical examination reveals pallor of the conjunctiva and nail beds. Laboratory studies show a hemoglobin level of 9.8 g/dL (normal range: 12-16 g/dL), a mean corpuscular volume (MCV) of 68 fL, and a ferritin level of 10 ng/mL (normal range: 12-150 ng/mL). The rest of the complete blood count and peripheral blood smear are unremarkable.
What is the first-line treatment for the patient's condition?
a. Oral ferrous sulfate
b. Intramuscular vitamin B12 injections
c. Folate supplementation
d. Blood transfusion

a. Oral ferrous sulfate

If the patient's anemia is due to chronic blood loss, what additional investigation would be most helpful in identifying the source?
a. Upper endoscopy
b. Colonoscopy
c. Bone marrow biopsy
d. Thyroid function tests

b. Colonoscopy

What is the main storage form of iron in the body?
a. Transferrin
b. Ferritin
c. Hemoglobin
d. Hemosiderin

b. Ferritin

A 45-year-old woman presents with fatigue and pallor. Laboratory studies reveal a hemoglobin level of 10.5 g/dL (normal range: 12-16 g/dL), a mean corpuscular volume (MCV) of 62 fL (normal range: 80-100 fL), and a serum iron level of 30 mcg/dL (normal range: 50-150 mcg/dL). Which of the following findings would be consistent with iron deficiency anemia?
a. High total iron-binding capacity (TIBC)
b. Low TIBC
c. Elevated serum ferritin
d. Normal serum transferrin saturation

a. High total iron-binding capacity (TIBC)

A patient diagnosed with iron deficiency anemia is advised to increase dietary iron absorption. Which of the following dietary recommendations is appropriate to enhance iron absorption?
a. Avoid vitamin C-rich foods
b. Consume dairy products with iron-rich meals
c. Drink tea or coffee with iron supplements
d. Include vitamin C-rich foods with iron-rich meals

d. Include vitamin C-rich foods with iron-rich meals

What is the most common cause of anemia worldwide?
a. Vitamin B12 deficiency anemia
b. Folate deficiency anemia
c. Iron deficiency anemia
d. Hemolytic anemia

c. Iron deficiency anemia

A 16-year-old adolescent of Southeast Asian descent presents with jaundice, splenomegaly, and bone deformities. Hemoglobin electrophoresis shows elevated levels of hemoglobin F and A2. Which type of thalassemia is most likely present?
a. Alpha-thalassemia
b. Beta-thalassemia major
c. Beta-thalassemia intermedia
d. Delta-beta-thalassemia

b. Beta-thalassemia major

A 40-year-old man with known beta-thalassemia trait (minor) presents for routine follow-up. He is asymptomatic. What laboratory finding is most likely to be observed in his complete blood count (CBC)?
a. Microcytic, hypochromic anemia
b. Macrocytic anemia
c. Normocytic, normochromic anemia
d. Hemolytic anemia

a. Microcytic, hypochromic anemia

A person with one deleted alpha-globin gene is most likely to be:
a. Diagnosed with thalassemia major
b. A silent carrier
c. Diagnosed with thalassemia minor
d. Manifesting symptoms of Hemoglobin H disease

b. A silent carrier

A patient with two deleted beta-globin genes is at risk for:
a. Silent carrier status
b. Thalassemia major (hydrops fetalis)
c. Thalassemia minor
d. Hemoglobin H disease

b. Thalassemia major (hydrops fetalis)

A patient with two deleted alpha-globin genes is at risk for:
a. Silent carrier status
b. Thalassemia major (hydrops fetalis)
c. Thalassemia minor
d. Hemoglobin H disease

c. Thalassemia minor

A child presents with microcytic anemia. Hemoglobin electrophoresis reveals elevated levels of Hemoglobin H. How many gene deletions are likely responsible for this condition?
a. One
b. Two
c. Three
d. Four

c. Three

A 20-year-old individual presents with marked hemolysis, profound anemia, and a dependence on regular blood transfusions. Physical examination reveals hepatosplenomegaly and jaundice. Which type of thalassemia is most likely present?
a. Thalassemia major
b. Thalassemia trait
c. Iron deficiency anemia
d. Sickle cell anemia

a. Thalassemia major

A 25-year-old patient presents with microcytosis that is out of proportion to the degree of anemia. Laboratory findings include hypochromia, stippled cells, target cells, and elliptical cells. The patient has undergone iron therapy without improvement. What is the most appropriate next step in the diagnostic workup?
a. Repeat iron studies
b. Perform a bone marrow biopsy
c. Order Hemoglobin electrophoresis
d. Administer a trial of vitamin B12 supplementation

c. Order Hemoglobin electrophoresis

A 30-year-old patient is currently experiencing severe anemia, marked hemolysis, and complications associated with iron overload. Which of the following is not a possible treatment?
a. Oral ferrous sulfate
b. Chronic transfusions
c. Splenectomy
d. Iron chelation

a. Oral ferrous sulfate

A patient with "microcytosis out of proportion to the degree of anemia" is advised to make dietary modifications. Which lifestyle recommendations are appropriate?
a. Increase tea and coffee intake to decrease iron absorption
b. Avoid tea and coffee consumption to reduce iron absorption
c. Supplement with vitamin C, E, and folic acid
d. Supplement with vitamin C

a. Increase tea and coffee intake to decrease iron absorption

c. Supplement with vitamin C, E, and folic acid

A 7-year-old child presents with abdominal pain, constipation, and irritability. Laboratory tests reveal microcytic anemia with basophilic stippling on peripheral blood smear. What is the most likely cause of the anemia?
a. Iron deficiency anemia
b. Vitamin B12 deficiency anemia
c. Lead poisoning-induced anemia
d. Sickle cell anemia

c. Lead poisoning-induced anemia

A 8-year-old child with lead poisoning-induced anemia has a blood lead level of 55 mcg/dl. What is the appropriate treatment strategy for managing the anemia associated with lead poisoning?
a. Begin iron supplementation
b. Administer vitamin B12 injections
c. Implement chelation therapy
d. Encourage a diet rich in folic acid

c. Implement chelation therapy

Chronic Blood loss vs. Acute Blood loss
A) Chronic is microcytic, Acute is normocytic
B) Chronic is normoctic, Acute is microcytic
C) Chronic is macrocytic, Acute is normocytic
D) Chronic is normocytic, Acute is macrocytic

A) Chronic is microcytic, Acute is normocytic

A 35-year-old patient presents with fatigue, jaundice, and dark urine. Laboratory findings reveal an MCV of 87, increased bilirubin, elevated LDH, decreased haptoglobin, and a markedly elevated reticulocyte count. What is the most likely mechanism responsible for the anemia in this patient?
a. Iron deficiency anemia
b. Intravascular hemolysis
c. Aplastic anemia
d. Thalassemia major

b. Intravascular hemolysis

A 40-year-old male with G6PD deficiency is asymptomatic under normal conditions but experiences hemolysis during episodes of oxidative stress. Which of the following factors is most likely to trigger hemolysis in this individual?
a. Routine physical activity
b. High dietary iron intake
c. Fava bean consumption
d. Alkaline pH

c. Fava bean consumption

(GFPD = illness, fava beans, primaquine, dapsone)

If a peripheral blood smear reveals the presence of "Bite cells" and Heinz Bodies, what is the probable diagnosis?
a. Iron deficiency anemia
b. G6PD deficiency
c. Aplastic anemia
d. Thalassemia

b. G6PD deficiency

A patient with G6PD deficiency experiences hemolysis triggered by certain medications and foods. What is the primary approach to managing G6PD deficiency?
a. Initiating iron supplementation
b. Administering high-dose vitamin C
c. Avoiding triggers and supportive care
d. Reducing dietary folate intake

c. Avoiding triggers and supportive care

A 45-year-old patient presents with fatigue, jaundice, and dark urine. Laboratory findings reveal an MCV of 89, an elevated reticulocyte count, an elevated LDH, and increased indirect bilirubin. Direct antiglobulin test (Coombs test) is positive for IgG antibodies on the surface of red blood cells. What is the most likely diagnosis?
a. Iron deficiency anemia
b. Cold autoimmune hemolytic anemia (CAIHA)
c. Warm autoimmune hemolytic anemia (WAIHA)
d. Sickle cell anemia

c. Warm autoimmune hemolytic anemia (WAIHA)

A 30-year-old female presents with fatigue, pallor, and jaundice. Laboratory tests show normocytic anemia, an elevated reticulocyte count, and a positive direct antiglobulin test (Coombs test) for complement (C3d) on the surface of red blood cells. Which of the following conditions and immunoglobulin is most likely responsible?
a. Cold autoimmune hemolytic anemia (CAIHA), IgG
b. Cold autoimmune hemolytic anemia (CAIHA), IgM
c. Warm autoimmune hemolytic anemia (WAIHA), IgM
d. Warm autoimmune hemolytic anemia (WAIHA), IgG

b. Cold autoimmune hemolytic anemia (CAIHA), IgM

A 40-year-old patient presents with a normocytic anemia, an elevated reticulocyte count, and a positive direct antiglobulin test (Coombs test) for IgG antibodies. What is the first-line treatment for this condition?
a. Splenectomy
b. High-dose corticosteroids
c. Intravenous immunoglobulin (IVIG)
d. EPO supplementation

b. High-dose corticosteroids

A 40-year-old patient presents with a normocytic anemia, an elevated reticulocyte count, and a positive direct antiglobulin test (Coombs test) for IgG antibodies. What is the second-line treatment for this condition?
a. Splenectomy
b. High-dose corticosteroids
c. Intravenous immunoglobulin (IVIG)
d. EPO supplementation

c. Intravenous immunoglobulin (IVIG)

A 40-year-old patient presents with a normocytic anemia, an elevated reticulocyte count, and a positive direct antiglobulin test (Coombs test) for IgG antibodies. What is the treatment for this condition when it is severe? (2)
a. Splenectomy
b. High-dose corticosteroids
c. Intravenous immunoglobulin (IVIG)
d. Rutuximab

a. Splenectomy
d. Rutuximab

A 60-year-old patient with a history of rheumatoid arthritis presents with fatigue, weakness, and mild jaundice. Laboratory tests reveal an MCV of 92, low serum iron, low transferrin saturation, and elevated ferritin levels, and low EPO. What is the most likely cause of the anemia in this patient?
a. Iron-deficiency anemia
b. Autoimmune Hemolytic Anemia (AIHA)
c. Thalassemia major
d. Anemia of chronic disease (ACD)

d. Anemia of chronic disease (ACD)

A patient's laboratory tests reveal an MCV of 86, low serum iron, low transferrin saturation, and elevated ferritin levels, and low EPO. What is the primary treatment approach for anemia in this patient?
a. Iron supplementation
b. Blood transfusions
c. Erythropoietin injections
d. Immunosuppressive therapy

c. Erythropoietin injections

A 25-year-old patient presents with fatigue, pallor, and frequent infections. Laboratory tests reveal pancytopenia, and a bone marrow biopsy shows hypocellular bone marrow with reduced hematopoietic stem cells. What is the most likely diagnosis?
a. Iron-deficiency anemia
b. Hemolytic anemia
c. Aplastic anemia
d. Myelodysplastic anemia

c. Aplastic anemia

A patient presents with fatigue, pallor, and frequent infections. What term is commonly used to describe the condition characterized by bone marrow failure, leading to reduced production of blood cells?
a. Myeloproliferative disorder
b. Aplastic anemia
c. Hemolytic anemia
d. Thrombocytosis

b. Aplastic anemia

A patient has a condition characterized by pancytopenia and a marked reduction in hematopoietic stem cells. Which is the likely treatment?
a. Blood transfusions
b. Immunosuppression
c. Allogeneic stem cell transplant
d. All of the above

d. All of the above

Immunosupression includes
→ anti-thymocyte globulin (ATG)
→ cyclosporine
→ steroids

A 60-year-old patient presents with splenomegaly, fatigue, and night sweats. Laboratory tests show pancytopenia with immature RBCs and WBCs on smear and bone marrow biopsy revealing fibrosis. What is the most likely diagnosis?
a. Chronic myeloid leukemia (CML)
b. Polycythemia vera (PV)
c. Essential thrombocythemia (ET)
d. Myelofibrosis

d. Myelofibrosis

A 60-year-old patient presents with splenomegaly, fatigue, and night sweats. Laboratory tests show pancytopenia with immature RBCs and WBCs on smear and bone marrow biopsy revealing fibrosis. What is the most likely treatment? (2)
a. JAK2 inhibition
b. Argatroban IV
c. IVIG
d. Allogeneic stem cell transplant

a. JAK2 inhibition
d. Allogeneic stem cell transplant

A 55-year-old patient presents with fatigue, weakness, and tingling sensations in the extremities. Physical examination reveals glossitis and decreased vibration and position sense. Laboratory tests show an MCV of 102 with hypersegmented neutrophils. What is the most likely cause of the anemia in this patient?
a. Iron-deficiency anemia
b. Vitamin B12 deficiency
c. Folate deficiency
d. Hemolytic anemia

b. Vitamin B12 deficiency

A patient presents with fatigue, weakness, and neurologic symptoms. Laboratory tests reveal macrocytic anemia with hypersegmented neutrophils. What is the most appropriate diagnostic test to confirm vitamin B12 deficiency?
a. Serum vitamin B12 level
b. Serum folate level
c. Complete blood count (CBC)
d. Methylmalonic acid (MMA) level

d. Methylmalonic acid (MMA) level

A patient is diagnosed with vitamin B12 deficiency due to lack of intrinsic factor. What is the most appropriate treatment approach for this patient?
a. Oral vitamin B12 supplementation
b. Intramuscular vitamin B12 injections
c. Folate supplementation
d. Iron supplementation

b. Intramuscular vitamin B12 injections

-Malabsorption →

Parental (IM/IV) repletion Cyanocobalamin (B12)

A patient is diagnosed with vitamin B12 deficiency due to inadequate intake. What is the most appropriate treatment approach for this patient?
a. Oral vitamin B12 supplementation
b. Intramuscular vitamin B12 injections
c. Folate supplementation
d. Iron supplementation

a. Oral vitamin B12 supplementation

-Dietary deficiency→

Oral repletion Cyanocobalamin (B12)

A patient presents with an MCV of 105, increased WBCs, increased LDH, decreased reticulocytes, decreased platelets, increased homocysteine, and increased MMA levels. You want to determine if he will respond to oral B12, what is the preferred diagnostic test?
a. HFE1 Gene Testing
b. ELISA
c. Anti-intrinsic factor antibodies
d. Schilling's test

c. Anti-intrinsic factor antibodies

A patient presents with fatigue, weakness, and pallor. Laboratory tests reveal MCV of 110 with hypersegmented neutrophils. The patient reports a diet low in green leafy vegetables and has a history of alcohol abuse. What is the most likely cause of the anemia?
a. Iron-deficiency anemia
b. Folate deficiency anemia
c. Vitamin B12 deficiency anemia
d. Hemolytic anemia

b. Folate deficiency anemia

A pregnant woman presents with fatigue, shortness of breath, and a pale complexion. Laboratory tests reveal macrocytic anemia with hypersegmented neutrophils. What is the most significant concern regarding folate deficiency during pregnancy?
a. Increased risk of neural tube defects in the fetus
b. Development of preeclampsia
c. Maternal hypertension
d. Increased risk of gestational diabetes

a. Increased risk of neural tube defects in the fetus

In the treatment of folate deficiency and B12 deficiency, which is a potential side effect?
A) Hypokalemia
B) Hyperkalemia
C) Hyponatremia
D) Hypercalcemia

A) Hypokalemia

Which of the following anemias has the potential complication of progressing to acute myeloid leukemia (AML)?
A) Sideroblastic anemia
B) Hemolytic anemia
C) Myelodysplastic syndrome (MDS)
D) Aplastic anemia

C) Myelodysplastic syndrome (MDS)

A 65-year-old patient presents with fatigue and easy bruising. Laboratory tests reveal pancytopenia, macrocytic anemia, and Pelger-Huet neutrophils. What is the required test for the diagnosis?
A) Anti-Intrinsic Factor
B) Quantitative enzyme assays
C) Bone Marrow Biopsy
D) Coombs test

C) Bone Marrow Biopsy

A 65-year-old patient presents with fatigue and easy bruising. Laboratory tests reveal pancytopenia, macrocytic anemia, and Pelger-Huet neutrophils. What is the only curative treatment?
A) Allogeneic stem cell transplant
B) Chronic transfusions
C) Bone Marrow Biopsy
D) Hydroxyurea

A) Allogeneic stem cell transplant

Which medication has been shown to reduce the frequency of vaso-occlusive crises, increase fetal hemoglobin production, and decrease the incidence of acute chest syndrome?
A) Pyroxidine (vitamin B6)
B) Hydroxyurea
C) Oral B12
D) Hemin

B) Hydroxyurea

In individuals with the formation of Hemoglobin S (HbS), which is a potential curative treatment?
A) Pyroxidine (Vitamin B6)
B) Hydroxyurea
C) Allogeneic stem cell transplant
D) Epoetin alfa administration

C) Allogeneic stem cell transplant

Acute chest syndrome is a medical emergency that requires exchange transfusion. With which condition is this syndrome most commonly associated?
A) Myelodysplastic anemia
B) Sideroblastic anemia
C) Sickle cell disease
D) Aplastic anemia

C) Sickle cell disease

A patient's bone marrow shows ringed sideroblasts. What is the primary abnormality in this type of anemia?
A) Deficient iron absorption
B) Excessive iron storage
C) Impaired heme synthesis
D) Increased red blood cell destruction

C) Impaired heme synthesis

A patient's bone marrow shows ringed sideroblasts. What is a potential therapeutic approach for managing this anemia?
A) Iron supplementation
B) Vitamin B12 injections
C) Erythropoietin administration
D) Pyridoxine (vitamin B6) supplementation

D) Pyridoxine (vitamin B6) supplementation

A patient's bone marrow shows ringed sideroblasts. For those who don't respond to pyridoxine (vitamin B6), what becomes the mainstay treatment?
A) Hemin
B) Blood transfusion
C) Erythropoietin administration
D) Allogeneic stem cell transplant

B) Blood transfusion

A 57 year old patient presents with acute abdominal pain, neurologic symptoms, and "red-wine" urine after brief exposure to sunlight. Which type of porphyria is most likely associated with these symptoms?
A) Acute intermittent porphyria (AIP)
B) Porphyria cutanea tarda (PCT)
C) Erythropoietic protoporphyria (EPP)
D) Variegate porphyria

A) Acute intermittent porphyria (AIP)

A 67 year old patient presents with bullous skin lesions, hyperpigmentation, and fragility of the skin, especially on sun-exposed areas. The patient states that she has always loved to tan and has spent countless hours at the beach over the course of her life. Laboratory testing reveals elevated levels of porphyria precursors in the urine. What type of porphyria is most common in adults and is the most likely diagnosis?
A) Acute intermittent porphyria (AIP)
B) Porphyria cutanea tarda (PCT)
C) Erythropoietic protoporphyria (EPP)
D) Variegate porphyria

B) Porphyria cutanea tarda (PCT)

Which type of porphyria is most commonly observed in children, presenting with symptoms of burning pain and swelling on sun exposure without significant cutaneous manifestations like bullae or scarring?
A) Acute intermittent porphyria (AIP)
B) Porphyria cutanea tarda (PCT)
C) Erythropoietic protoporphyria (EPP)
D) Variegate porphyria

C) Erythropoietic protoporphyria (EPP)

What is a common approach in the management of various types of porphyria?
A) Iron chelation therapy
B) Sun avoidance and protection measures
C) High-dose corticosteroids
D) Folate supplementation

B) Sun avoidance and protection measures

Which of the following should be avoided in patients with porphyrias to prevent exacerbation of symptoms?
A) B-carotene
B) lead poisoning
C) Alcohol consumption
D) High-dose vitamin D supplementation

C) Alcohol consumption

Patient presents with anemia, abdominal pain, and neurologic symptoms. Laboratory tests show elevated levels of free erythrocyte protoporphyrin (FEP) and basophilic stippling in the peripheral blood smear. Which condition is more likely responsible for these findings?
A) Erythropoietic porphyria (EPP)
B) Iron deficiency anemia
C) Lead poisoning
D) Sickle cell anemia

C) Lead poisoning

A patient presents with an acute porphyria attack, manifesting with severe abdominal pain and neurological symptoms. What is the mainstay of treatment to rapidly alleviate symptoms and prevent complications?
A) Intravenous hemin
B) Broad-spectrum sunscreen application
C) Topical analgesic cream
D) Beta-carotene supplementation

A) Intravenous hemin

In organ transplantation, what is considered the most important factor for successful donor-recipient matching?
A) Blood type compatibility
B) Age similarity
C) Human Leukocyte Antigen compatibility
D) Geographic proximity

C) Human Leukocyte Antigen compatibility

What is the primary source of stem cells in autologous transplantation?
A) Identical twin
B) Unrelated donor
C) Patient's own cells
D) Sibling match

C) Patient's own cells

When there is an HLA (Human Leukocyte Antigen) mismatch in allogeneic stem cell transplantation, what is the primary risk?
A) Von Willebrand's Disease
B) Graft-versus-host disease (GVHD)
C) Hemochromatosis
D) Hemophilia A

B) Graft-versus-host disease (GVHD)

What is a common treatment approach for graft-versus-host disease (GVHD) after allogeneic stem cell transplantation?
A) High dose steroids
B) Blood transfusions
C) High-dose chemotherapy
D) Splenectomy

A) High dose steroids

--> immunosuppression options

- High dose steroids (methylprednisolone)

- Calcineurin inhibitors ( tacrolimus, cyclosporine)

- Rituxan

What enzyme is responsible for converting fibrinogen into fibrin during secondary hemostasis?
a. Thrombin
b. Plasmin
c. Factor XIII
d. Tissue factor

a. Thrombin

What is the platelet count for "thrombocytopenia" and what is the critical platelet count at which spontaneous bleeding is most likely to occur?
a. < 20,000mm³, < 100,000/mm³
b. < 100,000mm³,< 20,000/mm³
c. < 10,000mm³,< 100,000/mm³
d. < 100,000mm³,< 10,000/mm³

d. < 100,000mm³,< 10,000/mm³

A 35-year-old woman is incidentally found to have a platelet count of 25,000/mm³ with no apparent symptoms. She reports no recent infections or medication use, and her physical examination is unremarkable. You believe she has Immune Thrombocytopenia (ITP). How can you confirm this diagnosis?
A) Schilling's Test
B) HFE1 Gene Testing
C) JAK2 mutation
D) Diagnosis of exclusion

D) Diagnosis of exclusion

A 35-year-old woman is incidentally found to have a platelet count of 25,000/mm³ with no apparent symptoms. She reports no recent infections or medication use, and her physical examination is unremarkable. You believe she has Immune Thrombocytopenia (ITP). What is your first-line treatment if a fast response is necessary?
A) Intravenous Immunoglobulin (IVIG)
B) Rituximab
C) Corticosteroids (e.g., Prednisone)
D) Splenectomy

A) Intravenous Immunoglobulin (IVIG)

A 35-year-old woman is incidentally found to have a platelet count of 25,000/mm³ with no apparent symptoms. She reports no recent infections or medication use, and her physical examination is unremarkable. You believe she has Immune Thrombocytopenia (ITP). What is your first-line treatment if a slow response is necessary?
A) Intravenous Immunoglobulin (IVIG)
B) Rituximab
C) Corticosteroids (e.g., Prednisone)
D) Splenectomy

C) Corticosteroids (e.g., Prednisone)

A patient who appears healthy presents with thrombocytopenia, and autoantibodies against their own platelets are detected. What is the most likely diagnosis?
A) Hemophilia A
B) Disseminated Intravascular Coagulation (DIC)
C) Immune Thrombocytopenia (ITP)
D) Thrombotic Thrombocytopenic Purpura (TTP)

C) Immune Thrombocytopenia (ITP)

In the pathogenesis of Heparin-Induced Thrombocytopenia (HIT), what happens to activated platelets?
A) They are destroyed by the spleen
B) They render the patient hypocoagulable
C) They have no effect on the coagulation system
D) They render the patient hypercoagulable, leading to venous or arterial thrombosis

D) They render the patient hypercoagulable, leading to venous or arterial thrombosis

Which of the following is a potential complication of Heparin-Induced Thrombocytopenia (HIT)?
A) Decreased platelet production
B) Increased risk of bleeding
C) Venous or arterial thrombosis
D) Secondary hemostasis dysfunction

C) Venous or arterial thrombosis

In a patient who experiences auto-abs cross-reactivity with platelets when they receive heparin, which anticoagulant is often used as an alternative?
A) Warfarin
B) Clopidogrel
C) Rivaroxaban
D) Argatroban

D) Argatroban

What should patients with Heparin-Induced Thrombocytopenia (HIT) avoid to prevent worsening of the condition?
A) Platelet infusions
B) Vitamin C supplements
C) Coffee and tea
D) Iron rich foods

A) Platelet infusions

A 45-year-old woman presents with petechiae, purpura, and neurological symptoms. Laboratory tests reveal thrombocytopenia, microangiopathic hemolytic anemia, and elevated lactate dehydrogenase (LDH). What is the most likely diagnosis?
A) Immune Thrombocytopenia (ITP)
B) Hemolytic Uremic Syndrome (HUS)
C) Thrombotic Thrombocytic Purpura (TTP)
D) Disseminated Intravascular Coagulation (DIC)

C) Thrombotic Thrombocytic Purpura (TTP)

A 32-year-old man with known HIV presents with petechiae, hematuria, and altered mental status. Laboratory tests show thrombocytopenia, microangiopathic hemolytic anemia, and elevated LDH. Schistocytes are also seen on peripheral blood smear. What is the most likely cause of his presentation?
A) Immune Thrombocytopenia (ITP)
B) Thrombotic Thrombocytic Purpura (TTP)
C) Hemolytic Uremic Syndrome (HUS)
D) Disseminated Intravascular Coagulation (DIC)

B) Thrombotic Thrombocytic Purpura (TTP)

Which of the following conditions is characterized by inhibitory antibodies blocking ADAMts13 activity, leading to excessive clot formation?
A) Thrombotic Thrombocytic Purpura (TTP)
B) Immune Thrombocytopenia (ITP)
C) Hemolytic Uremic Syndrome (HUS)
D) Disseminated Intravascular Coagulation (DIC)

A) Thrombotic Thrombocytic Purpura (TTP)

"Not enough Adam around, Willie is out of control"

A 32-year-old man with known HIV presents with petechiae, hematuria, and altered mental status. Laboratory tests show thrombocytopenia, microangiopathic hemolytic anemia, and elevated LDH. Schistocytes are also seen on peripheral blood smear. Which of the following is the primary treatment?
A) High-dose corticosteroids
B) Intravenous immunoglobulin (IVIG)
C) Plasma exchange
D) Platelet transfusions

C) Plasma exchange

Giving platelets will make thrombocytopenia worse!

A 50-year-old woman presents with easy bruising and occasional headaches. Laboratory tests reveal a platelet count of 700,000/mm³. There is no history of recent infections or medication use. What is the most likely diagnosis?
A) Immune Thrombocytopenia (ITP)
B) Thrombotic Thrombocytopenic Purpura (TTP)
C) Essential Thrombocythemia (ET)
D) Heparin-Induced Thrombocytopenia (HIT)

C) Essential Thrombocythemia (ET)

A 60-year-old man with a history of chronic inflammatory conditions presents with fatigue and occasional bleeding. Laboratory tests show a platelet count of 800,000/mm³. What is the most likely cause of his elevated platelet count?
A) Essential Thrombocythemia (ET)
B) Polycythemia
C) Chronic myeloid leukemia (CML)
D) Secondary thrombocytosis due to chronic inflammation

D) Secondary thrombocytosis due to chronic inflammation

A possible reason for secondary thrombocytosis is:
A) Essential Thrombocythemia (ET)
B) Iron-deficiency anemia
C) Myeloproliferative disorder (MPD)
D) Hemolytic anemia

B) Iron-deficiency anemia

Which genetic mutation is commonly associated with polycythemia vera?
a. Arg506Gln
b. JAK2
c. MPL
d. ADAMts13

b. JAK2

A 45-year-old male presents with symptoms of headaches, dizziness, and blurred vision. Laboratory tests reveal elevated hemoglobin, hematocrit, and platelet counts. The JAK2 mutation is also present. The manifestations of this usually asymptomatic condition are primarily due to:
a. Excessive oxygen delivery to tissues from hypoviscocity
b. Impaired oxygen delivery to tissues from blood hyperviscosity
c. Excessive platelet aggregation
d. Elevated white blood cell count

b. Impaired oxygen delivery to tissues from blood hyperviscosity

A 45-year-old male presents with symptoms of headaches, dizziness, and blurred vision. Laboratory tests reveal elevated hemoglobin, hematocrit, and platelet counts. The JAK2 mutation is also present. What therapeutic management can be done for this condition?
a. Phlebotomy
b. Plasma exchange
c. Iron supplementation
d. Anagrelide

a. Phlebotomy

In a patient with suspected primary polycythemia vera, which laboratory finding is most indicative of this condition?
a. Low WBC count
b. Low erythropoietin (EPO) levels
c. Normal platelet count
d. High erythropoietin (EPO) levels

b. Low erythropoietin (EPO) levels

In a patient with suspected of polycythemia vera, which laboratory finding is most indicative of secondary polycythemia vera?
a. Low WBC count
b. Low erythropoietin (EPO) levels
c. Normal platelet count
d. High erythropoietin (EPO) levels

d. High erythropoietin (EPO) levels

What is the primary cause of essential thrombocythemia (ET)?
a. Hemorrhage
b. Infection
c. Myeloproliferative neoplasm with abnormal platelets
d. Malignancy

c. Myeloproliferative neoplasm with abnormal platelets

--> the rest are secondary

Which laboratory finding is characteristic of essential thrombocythemia?
a. Low platelet count
b. Elevated white blood cell count
c. Thrombocytopenia
d. Thrombocytosis

d. Thrombocytosis

A patient with essential thrombocythemia presents with fatigue, headaches, and early satiety. On physical examination, there is splenomegaly. What is the likely cause of splenomegaly in this condition?
a. Portal hypertension
b. Infection
c. Extramedullary hematopoiesis
d. Autoimmune reaction

c. Extramedullary hematopoiesis

Which is the most common inherited liver disease characterized by severe iron overload?
a. Hemophilia A
b. Hemochromatosis
c. Von Willebrand's Disease
d. Hemolytic Uremic Syndrome

b. Hemochromatosis

A patient presents with a condition of severe iron overload characterized by darkened skin described as "bronze" and hepatomegaly which is your initial test of choice?
a. Urine Analysis
b. Electrophoresis
c. Bone marrow biopsy
d. Transferrin saturation

d. Transferrin saturation

A patient presents with a condition of severe iron overload characterized by darkened skin described as "bronze" and hepatomegaly which is your most important diagnostic test?
a. HFE1 gene testing
b. Anti-Intrinsic Factor Antibody
c. Bone marrow biopsy
d. Methylmalonic Acid levels

a. HFE1 gene testing

A patient presents with a condition of severe iron overload characterized by darkened skin described as "bronze" and hepatomegaly. What is the mainstay treatment?
a. Phlebotomy
b. Iron supplementation
c. Blood transfusion
d. Vitamin C administration

a. Phlebotomy

--> need to iron unload!!

A patient presents with recurrent episodes of joint bleeding and easy bruising. You suspect Hemophilia A. Which factor deficiency, diagnostic test, and mixed study result best aligns with this diagnosis?
a. Factor VIII deficiency, prolonged PT, clot time does not correct
b. Factor VIII deficiency, prolonged aPTT, clot time corrects
c. Factor IX deficiency, prolonged PT, clot time corrects
d. Factor IX deficiency, prolonged aPTT, clot time does not correct

b. Factor VIII deficiency, prolonged aPTT, clot time corrects

A patient presents with recurrent episodes of joint bleeding and easy bruising. You suspect Hemophilia B. Which factor deficiency, diagnostic test, and mixed study result best aligns with this diagnosis?
a. Factor VIII deficiency, prolonged PT, clot time does not correct
b. Factor VIII deficiency, prolonged aPTT, clot time corrects
c. Factor IX deficiency, prolonged aPTT, clot time corrects
d. Factor IX deficiency, prolonged aPTT, clot time does not correct

c. Factor IX deficiency, prolonged aPTT, clot time corrects

What is the main cause of acquired factor deficiency?
A) factor IX deficiency
B) factor VIII deficiency
C) factor IX inhibitors
D) factor VIII inhibitors

D) factor VIII inhibitors

In acquired factor deficiencies due to factor VIII inhibitors what is the diagnostic test and mixing study result?
a. prolonged PT, clot time does not correct
b. prolonged PT, clot time corrects
c. prolonged aPTT, clot time corrects
d. prolonged aPTT, clot time does not correct

d. prolonged aPTT, clot time does not correct