Hematologic and Select Immunological Disorders

Match each definition with the correct term. A. RBCs of unequal size B. Variation in RBC shape C. Increase in the production of immature RBCs D. Abnormal decrease in the production of immature RBCs A. Poikilocytosis B. Anisocytosis C. Reticulocytosis D. Reticulocytopenia

A + B B + A C + C D + D

One of the earliest laboratory markers in evolving macrocytic or microcytic anemia is: A. an increase in RBC distribution width (RDW). B. a reduction in measurable hemoglobin. C. a low MCH level. D. an increased platelet count.

A. an increase in RBC distribution width (RDW) Size of cells is changing from old to new

A 46-year-old woman complains of a 2-month history of tiredness as well as progressive worsening of short-term memory and coordination. Her hemogram is as follows: Hbg = 10 g/dL Hct = 30% RBC = 3.7 million mm3 MCV =118 fL MCH = 32 pg RDW = 19.4% A. cobalamin B. ferritin C. thyrotropin (TSH) D. head computed tomography (CT)

A. cobalamin

A 66-year-old man is recently diagnosed with advanced colon cancer. A hemogram reveals the following: Hgb = 9.7 g/dL Hct = 30% RBC = 2.7 million mm3 MCV = 69 fL MCHC = 27.2 g/dL RDW = 18.4% Next step testing for this patient should be serum: A. ferritin B. folate C. cobalamin D. homocysteine

A. ferritin

Two months into therapy for pernicious anemia, you wish to check the efficacy of the intervention. The best laboratory test to order at this point is a(n): A. Schilling test B. Hbg measurement C. reticulocyte count D. serum cobalamin

B. Hbg measurement

Most of the body's iron is obtained from: A. animal-based food sources. B. recycled iron content from aged red blood cells (RBCs). C. endoplasmic reticulum production. D. vegetable-based food sources.

B. Recycled iron content from RBCs

You examine a 47-year-old man who presents with difficulty initiating and maintaining sleep and chronic pharyngeal erythema with the following results on hemogram: Hemoglobin (Hgb) = 15 g Hct = 45% RBC = 4.2 million mm3 MCV = 108 fL MCHC=33.2 g/dL These values are most consistent with: A. pernicious anemia. B. alcohol abuse. C. thalassemia minor. D. Fanconi disease.

B. alcohol abuse

A 40-year old woman with pyelonephritis is taking two medications: ciprofloxacin and ferrous sulfate (for IDA). She asks about taking both medications. You advise that: A. she should take the medications with a large glass of water B. an inactive drug compound is potentially formed if the two medications are taken together C. she can take the medications together to enhance adherence to therapy D. the ferrous sulfate potentially slows GI motility and results in enhanced ciprofloxacin absorption

B. an inactive drug compound is potentially formed if the two medications are taken together

You examine a 57-year-old woman with rheumatoid arthritis who is on disease-modifying antirheumatic disease but continues to have poor disease control and find the following results on hemogram: Hgb = 10.5 g Hct = 33% RBC = 3.1 million mm3 MCV = 88 fL MCHC=32.8 g/dL RDW= 12.2% Reticulocytes = 0.8% The laboratory findings are most consistent with: A. pernicious anemia. B. anemia of chronic disease. C. beta-thalassemia minor. D. folate-deficiency anemia.

B. anemia of chronic disease

Risk factors for folate-deficiency anemia include: A. menorrhagia B. chronic ingestion of overcooked foods C. use of NSAIDs D. gastric atrophy

B. chronic ingestion of overcooked foods

You see a 36-year-old man with a history of depression. He states that he drinks about a six-pack of beer every night and eats from fast-food restaurants. His diet consists of very little consumption of fruits and vegetables. His hemogram is as follows: Hgb = 10.4 g/dL Hct = 31% RBC = 3.8 million mm3 MCV = 116 fL MCHC = 33.1 g/dL RDW = 17.6% Next step testing for this patient should include: A. ferritin B. folate C. Hgb electrophoresis D. no further testing

B. folate

When counseling a patient about the neurological alterations often associated with vitamin B12 deficiency, the NP advises that: A. these usually resolve within days with appropriate therapy B. if present for longer than 6 months, these changes are occasionally permanent C. the use of parenteral vitamin B12 therapy is needed to ensure symptom resolution D. cognitive changes associated with vitamin B12 deficiency are seldom reversible even with appropriate therapy

B. if present for longer than 6 months, these changes are occasionally permanent

Pernicious anemia is usually caused by: A. dietary deficiency of vitamin B12 B. lack of production of intrinsic factor by the gastric mucosa C. RBC enzyme deficiency D. a combination of micronutrient deficiencies caused by malabsorption

B. lack of production of intrinsic factor by the gastric mucosa

Which of the following is most consistent with Iron deficiency anemia? A. low MCV, normal MCH B. low MCV, low MCH C. low MCV, elevated MCH D. normal MCV, normal MCH

B. low MCV, low MCH Microcytic, hypochromic

A 68-year-old man who is usually healthy presents with new onset of "huffing and puffing" with exercise for the past 3 weeks. Physical examination reveals conjunctiva pallor and hemic murmur. Hemogram results are as follows: Hgb = 7.6 g/dL Hct = 20.5% RBC = 2.1 million mm3 MCV = 76 fL MCHC = 28 g/dL RDW = 18.4% Reticulocytes = 1.8% The most likely cause of these findings is: A. poor nutrition B. occult blood loss C. malabsorption D. chronic inflammation

B. occult blood loss

Which of the following conditions in unlikely to result in ACD? A. rheumatoid arthritis B. peripheral vascular disease C. chronic renal insufficiency D. osteomyelitis

B. peripheral vascular disease

Common physical examination findings in patients with pernicious anemia include: A. hypoactive bowel sounds B. stocking glove neuropathy C. thin spoon-shaped nails C. retinal hemorrhage

B. stocking glove neuropathy

When prescribing erythropoietin supplementation, the nurse practitioner (NP) considers that: A. the adrenal glands are its endogenous source B. the addition of micronutrient supplementation needed for erythropoiesis is advisable C. its use is as an adjunct in treating thrombocytopenia D. with its use, the RBC life span is prolonged

B. the addition of micronutrient supplementation needed for erythropoiesis is advisable

Which of the following is the best advice on taking ferrous sulfate to enhance iron absorption? A. "Take with other medications" B. "Take on a full stomach" C. "Take on an empty stomach" D. "Do not take with Vitamin C"

C. "Take on an empty stomach"

In health, the ratio of Hgb to Hct is usually: A. 1:1 B. 1:2 C. 1:3 D. 1:4

C. 1:3

Which of the following is not consistent with ACD? A. normal limit RDW B. normal limit MCHC C. Hct less than 24% D. normal limit to slightly elevated serum ferritin

C. Hct less than 24%

You examine a 22-year-old woman of Asian ancestry. She has no presenting complaint. Hemogram results are as follows: Hgb = 9.1 g (normal 12 to 14 g) Hct = 28% (normal 36% to 42%) RBC = 5 million mm3 (normal 3.2 to 4.3 million mm3) MCV = 68 fL (normal 80 to 96 fL) MCHC=33.2 g/dL (normal 32-36 d/dL) RBC distribution width (RDW) = 13% (normal ≤15%). Reticulocytes = 1.5% This is most consistent with the laboratory assessment of: A. iron-deficiency anemia. B. Cooley anemia. C. alpha-thalassemia minor. D. hemoglobin Barts.

C. alpha-thalassemia minor

A woman who is planning a pregnancy should increase her intake of which of the following to minimize the risk of neural tube defect in the fetus? A. iron B. niacin C. folic acid D. vitamin C

C. folic acid

In the first week of anemia therapy with parenteral vitamin B12 in a a 68-year-old woman with hypertension who is taking a thiazide diuretic the patient should be carefully monitored for: A. hypernatremia B. dehydration C. hypokalemia D. acidemia

C. hypokalemia

When the cause of a macrocytic anemia is uncertain, the most commonly recommended additional testing includes which of the following? A. haptoglobin and reticulocyte count. B. Schilling test and gastric biopsy. C. methylmalonic acid and homocysteine. D. transferrin and prealbumin.

C. methylmalonic acid and homocysteine.

A 48-year old woman developed IDA after excessive perimenopausal vaginal bleeding, successfully treated by endometrial ablation. Her Hct level is 25%, and she is taking iron therapy. At 5 days into therapy, one possible observed change in laboratory parameters would include: A. a correction of mean cell volume B. an 8% increase in Hct level C. reticulocytosis D. a correction in ferritin level

C. reticulocytosis New cells being produced with micronutrient available

A healthy 34-year-old man asks whether he should take an iron supplement. You respond that: A. this is a prudent measure to ensure health B. IDA is a common problem in men of his age C. use of an iron supplement in the absence of a documented deficiency can led to to iatrogenic iron overload D. excess iron is easily excreted

C. use of an iron supplement in the absence of a documented deficiency can led to to iatrogenic iron overload

Prolonged use of PPIs can lead to which micronutrient deficiency that can contribute to anemia? A. vitamin D B. folate C. vitamin B12 D. potassium

C. vitamin B12

Worldwide, which of the following is the most common type of anemia? A. Pernicious anemia B. Folate-deficiency anemia C. Anemia of chronic disease D. Iron deficiency anemia

D. Iron deficiency anemia

Folate-deficiency anemia causes which of the following changes in the RBC indices? A. microcytic, normochromic B. normocytic, normochromic C. microcytic, hypochromic D. macrocytic, normochromic

D. macrocytic, normochromic

Pernicious anemia causes which of the following changes in the RBC indices? A. microcytic, normochromic B. normocytic, normochromic C. microcytic, hypochromic D. macrocytic, normochromic

D. macrocytic, normochromic

You examine a 27-year-old woman with menorrhagia who is otherwise well and note the following results on hemogram: Hgb = 10.1 g Hct = 32% RBC = 2.9 million mm 3 MCV = 72 fL MCHC=28.2 g/dL RDW = 18.9% Physical examination is likely to include: A. conjunctiva pallor. B. hemic murmur. C. tachycardia. D. no specific anemia-related findings.

D. no specific anemia-related findings.

True or False The body's normative response to anemia is reticulocytopenia.

False

True or False Anemia in children is potentially associated with poorer school performance.

True

True or False Approximately 90% of the body's erythropoietin is produced by the kidney.

True

True or False During pregnancy, folic acid requirements increase two-to-four fold.

True

True or False The RBC content is approximately 90% Hgb.

True