hematology/oncology

HEMATOLOGY /ONCOLOGY you have prescribed oral iron replacement for a 46 yo female with iron deficiency anemia related to heavy menses. she wants to be sure that the iron she takes will be absorbed well. Which one of the following would you suggest for improving iron absorption? - vitamin C a mother brings her 6yo son to your office for evaluation b/c she found a lump in his neck below the jaw on the right side. She first noted it a week ago, about a week after he had recovered from an upper respiratory infection. She reports that her son feels well and is back to full, unrestricted activity. When you examine the child you find an enlarged lymph node in the right anterior cervical nodes. It measures 2 cm in diameter and is somewhat firm, mobile, and contender. The remainder of the examination is normal. which one of the following would be most appropriate at this point? - f/u examination in 1 month A gynecologist requests a preoperative consultation on your patient, a 38 yo white G2 P0 A2 whom you referred for a total abdominal hysterectomy for adenomatous endometrial hyperplasia. The patient has been hospitalized twice for DVT in the past 2 years and had spontaneous second-trimester abortions at the ages of 34 and 36. Routine prep-op blood screening reveals : platelet- 189,000 PTT-12.0 sec INR- 1.1 Activated-partial thromboplastin- 42 sec (prolonged) There is no family hx of bleeding disorders and the evaluation is otherwise normal. A repeat activated partial activated thromboplastin time with a 1:1 mix of normal plasma does not correct to normal. The most likely diagnosis is - antiphospholipid antibody syndrome A 75 yo female presents with a compliant of paresthesias in her feet. On examination she has mild erythema of her tongue and decreased vibratory sensation in her feet. A CBC reveals a hemoglobin level of 11.1 and a mean corpuscular volume of 105. The patient takes the following OTC drugs: aspirin ranitidine acetaminophen which of the following prescription medications the patient takes is most likely causing her problem? - omeprazole (prilosec) Which of the following is a classic finding in multiple myeloma? - bone pain activated protein C resistance (factor V leiden) is most commonly found in patients with - venous thrombotic disease A 23 yo healthy male is sexually active with the men and does not use condoms. He is interested in reducing his risk of contracting HIV by using a daily oral antiretroviral medication. Which one of the following lab tests should be done no more than 7 days before initially prescribing pre-exposure prophylaxis with emtricitabine/tenofivir disoproxil (truvada)? - antibody testing for HIV A 30 yo female sees you because of increasing fatigue. She has no chronic medical problems and reports no recent acute illnesses. She recalls being told that she was mildly anemic after the birth of her daughter 3 years ago. The anemia resolved after 3 months of oral iron supplementation. The t's menstrual periods are regular and last approximately 6 days, with heavy bleeding for the first 3 days then moderate to mild flow for approximately 3 days. She denies epistaxis, black stools, or other signs of bleeding. On examination her temp is 36.7 C, pulse 93, RR-16 and BP 116/58. the remainder of her physical examination is unremarkable. A CBC is notable for a hemoglobin level of 10.9 and a mean corpuscular volume of 70. Which one of the following serum levels would be most appropriate for further evaluating her microcytic anemia at this point? - ferritin A 29 yo female presents with 1 wk hx of a rash on her legs. A full ROS is significant only for regular borderline-heavy periods that lasted for 7 days during her last 2 menstrual cycles. She has not had any recent illness or hospitalization, and takes no meds. Her examination shows non blanching purple macule on her upper legs. A comprehensive metabolic panel reveals normal renal function and liver enzyme tests, and a urine pregnancy test is negative. A CBC reveals a platelet count of 27,000 but is otherwise normal. which of the following is the most most likely cause of the rash? - ITP A 43 yo female complains of easy bruising. She is otherwise asymptomatic. A CBC reveals a platelet count of 23,000. A peripheral smear reveals giant platelets. A workup is negative for autoimmune causes , including Graves disease, HIV, EBV, CMV, varicella zoster, hep C and H.pylori. She is on no prescription or OTC meds and denies alcohol or drug use. Which one would be the most appropriate initial management? - corticosteroids which of the following is most appropriate for patients with asplenia? - antibiotics for any episode of fever Which one of the following is associated with vitamin B12 deficiency? - metformin (glucophage) A 78 yo asymptomatic male is found to have a platelet count of 90,000 and a slightly decreased WBC count. Which one of the following would be most consistent with a diagnosis of myelodysplastic syndrome? - macrocytic anemia which one of the following medications used to treat psychiatric disorders is associated with an increased risk of agranulocytosis? - carbamazepine 57 yo female with a past medical history significant for well controlled type 2 DM, HTN, and hyperthyroidism presents to your office with a chief complaint of a sore throat and a fever to 101.5 at home. She has had chills and night sweats but has not had a cough, CP, or abdominal pain. Physical Findings General- ill appearing HEENT........ diffuse tender anterior cervical adenopathy; thyroid contender; oropharynx erythematous with some purulence on her tonsils cardiovascular- tachycardia with murmur Lungs- clear to auscultation bilaterally Skin- Mild jaundice laboratory findings- rapid strep test-negative total WBC- 3000 absolute neutrophils-0 total bilirubin- 5 (high) alkaline phosphatase-151 (high) Which one of the following medications is most likely to cause these lab abnormalities - methimazole a 67 yo male with moderate macrocytosis complains of paresthesias of his feet. If the patient has a borderline low vitamin B12 level, elevated levels of which one of the following would suggest vitamin B12 deficiency? - methymalonic acid 26 yo african-american male presents with diffuse abdominal and back pain 5 days after being diagnosed with strep pharyngitis. He appears mildly ill, with slight scleral icterus. Lab findings: -unconjugated bilirubin 3.2 (high) -hemoglobin 9.6 (low) -hematocrit 29.4% (low) - peripheral blood smear: keratocytes, blister cells, and polychromatic macrocytes which is the most likely diagnosis? - G6PD deficiency A 25 yo male presents to your office after recently being diagnosed with HIV infection at the health department. you obtain blood work and note that his CD4 count is 180 cells/mm3. This patient should receive prophylaxis against which one of the following opportunistic infections - Pneumocystis A 43 yo asymptomatic male is found to have slightly elevated ALT and SAT levels on lab work prior to donating blood. He feels well and is otherwise healthy. which one should be ordered to evaluate the patient for hereditary hemochromatosis - A serum iron panel, including a serum ferritin level and transferrin saturation A 23 yo female nonsmoker has a history of an unusually high number of sinus infections and episodes of bronchitis. She has not required hospitalization, and the infections have not been due to a fungus or MRSA. Her growth as a child was normal, and she has BMI of 24 kg/m2. Which one of the following lab findings would be most likely? - decreased serum levels of IgG, IgM, and IgA A mother brings her 5 yo daughter to see you bc she found a mass in the child's neck. The mass appeared over the past week and was preceded by a sore throat. Her pharyngitis is now resolved but she still has a fever, although it is not as high. the mother is most concerned bc the mass developed over a short span of time, and it is warm, red, and tender. When asked, she says that her daughter has and no recent exposure to cats. when you examine the child you note that her temperature is 38 C. You also find shotty adenopathy in both anterior cervical lymph node chains, and a 2.5 cm warm, firm, moderately tender lymph node in the right anterior cervical chain. the overlying skin is also erythematous. Which one of the following would be the most appropriate management at this time? - Empiric antibiotic therapy with observation for 4 weeks A 56-year-old man presents to his physician complaining of severe fatigue. He began to feel increasingly tired about 6 months ago, but believes that his fatigue has been worsening over the past 3 weeks. He also notes he has had a nonproductive cough for about 2 weeks and has experienced several episodes of drenching night sweats. On examination he has several large bruises on his extremities but recalls no injuries. Abdominal examination reveals massive enlargement of both the liver and the spleen, without any lymphadenopathy. Laboratory studies show: WBC count: 1200/mm3 Neutrophils: 58% Eosinophils: 7% Lymphocytes: 30% Monocytes: 0% Basophils: 5% RBC count: 3.0/mm3 Hemoglobin: 7.5 mg/dL Platelet count: 18,000/mm3 Peripheral blood smear reveals irregular nuclei and cell membranes, as well as cytoplasmic projections. Which of the following is the most