11. An acute leukemia causing. 12. An adult patient presents with acute. 13. Anemia due to renal failure may be

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1 Hematology Study online at 1. A 23 year old white female has weakness, fatigue and has developed a habit of chewing ice. What are the expected findings in regard to TIBC and Ferritin? 2. A 25 year old white female had prolonged bleeding after a dental procedure, bruises easily and has heavy periods. What is the most likely bleeding disorder? 3. A 31 year old Mediterranean female has a hemoglobin of 10.3 gm/dl, MCV of 54, TIBC and Ferritin are normal. What is the most likely etiology of her 4. A 36 year old black male s/p gastric bypass surgery has peripheral neuropathy. Oral B12 has not improved his symptoms. What is the next step? 5. A 42 year-old black female with SLE has an increased bilirubin and a mild anemia. Which test is most definitive to evaluate this patient's 6. A 73 year old male presents with back pain and high protein with an increased albumin/globulin ratio. Which laboratory tests would be appropriate to order next? 7. A 74 year old white male with a history of chronic ETOH abuse has an MCV of 102. Physical exam finds no neurological deficit. What is the most likely diagnosis? 8. A 76 year old female develops a post op DVT after an ORIF if her hip. She has a platelet count of 72,000. What medication is the likely cause of her condition? 9. An 82 year old male has recurrent infections, lymphadenopathy and lymphocytosis. What is the most likely type of leukemia the patient suffers from? 10. Acute chest syndrome occurs during the acute phase of which Increased TIBC and decreased Ferritin in patient with iron deficiency anemia Von Willebrand Disease Thalassemia minor Sublingual or IM B12 Direct coombs in patient with autoimmune anemia Serum protein electrophoresis + immunofixation and urine for Bence Jones protein in patient with suspected multiple myeloma Folate deficiency Heparin or low molecular weight heparin in patient with Heparin Induced Thrombocytopenia (HIT) Chronic lymphocytic leukemia (CLL) Hemolytic sickle cell crisis 11. An acute leukemia causing lymphadenopathy, bone pain, bleeding and fever in a child is most likely which type of leukemia? 12. An adult patient presents with acute thrombocytopenia, fever, multiorgan thrombosis, and hemolytic anemia. What is the best treatment for this patient? 13. Anemia due to renal failure may be confirmed by which test? 14. Anemia of renal failure is defined by decreased levels of which hormone? Acute Lymphoblastic Leukemia (ALL) Plasmapheresis for thrombotic thrombocytopenia purpura (TTP) Decreased Serum erythropoietin levels Erythropoietin 15. Auer rods? Acute myeloblastic leukemia (AML) 16. Autoimmune bleeding disorder in which patients develop antibodies against their own platelets? Idiopathic Thrombocytopenia Purpura (ITP) 17. Basophilic stippling of RBCs? Lead poisoning (May also occur in thalassemia and chronic EtOH abuse) Lead poisoning (May also occur in thalassemia and chronic EtOH abuse) 18. Can oral B12 be used as an initial treatment in a B12 deficient patient? 19. Christmas disease is another name for deficiency of which clotting factor? 20. Chronic thrombocytopenia with an otherwise negative work up is most likely what disorder? 21. The complications of multiple myeloma can be described by CRABI. List these 5 complications. 22. Decreased Ferritin and Increased TIBC? Yes - Oral B12 is considered initial therapy - Other routes if oral fails or pernicious anemia is diagnosed Decreased Factor IX (AKA Hemophilia B) Idiopathic thrombocytopenia purpura (ITP) 23. Deficient factor in hemophilia A? Factor VIII 24. Deficient factor in hemophilia B? Factor IX C: hypercalcemia - R: Renal failure - A: Anemia - B: lytic Bone lesions - I: Infections C: hypercalcemia - R: Renal failure - A: Anemia - B: lytic Bone lesions - I: Infections

2 25. A dialysis patient has been on darbepoetin alfa for 3 months. His most recent hemoglobin is 11.3 gm/dl. Should he continue to use this medication? 26. Does AML primarily occur in adults or children? 27. Erythropoietin analogs should be suspended once the hemoglobin is >? 28. Erythropoietin analogs should only be initiated if the hemoglobin is <? 29. Heavy menstrual cycle gum bleeding with teeth brushing? 30. How is factor V Leiden disorder confirmed? No. erythropoetin analogs must be stopped when the hemoglobin is greater than 11 gm/dl Adults 11 mg/dl 10 mg/dl Von Willebrand deficiency Activated protein C resistance assay - Genetic testing definitive 31. How is hemophilia inherited? X-linked recessive 32. How would you expect TIBC and ferritin to present in anemia of chronic disease? 33. In addition to Factor VIII replacement, what medication may be used in the treatment of Von 34. Increased MCV with smooth tongue, loss of proprioception and vibratory sense is likely which type of 35. Increased serum protein with a decreased albumin/globulin ratio? 36. Is the onset of idiopathic thrombocytopenia purpura (ITP) usually faster or slower than TTP? 37. List 5 common causes of folate deficiency. 38. List the four direct thrombin inhibitors which may be used in HIT. 39. List the four lab findings which support a diagnosis of DIC. 40. List the three tests to confirm an DX of antiphospholipid syndrome in a hypercoagulable patient? Decreased TIBC - Normal/increased Ferritin DDAVP (desmopressin) = increased release of vwf B12 deficiency Multiple myeloma ITP has a slow onset whereas TTP is usually an acute onset EtOH abuse - Advancing age - Gastric bypass - Pregnancy - Methotrexate Lepirudin - Bivalirudin - Argatroban - Fondaparinux Decreased Fibrinogen - Thrombocytopenia - Increased D-Dimer - Increased PT and PTT Lupus anticoagulant - Anticardiolipin antibody ELISA - Anti-beta2- glycoprotein-i ELISA 41. List three medications which may cause aplastic anemia. 42. List three medications which may trigger autoimmune anemia. 43. List three medications which may trigger hemolysis in a patient with G6PD deficiency. 44. List three ways to describe the genetic abnormality in CML? 45. List two conditions which predispose a patient to antiphospholipid syndrome. 46. Measurement of which laboratory value is the best indicator of whether or not a sickle cell crisis is resolving? 47. Monoclonal proteinuria (Bence Jones proteins) are found in which disorder? 48. Name 2 things which can cause aplastic anemia other than medications. 49. Painless lymphadenopathy indicative of which malignant disorder? 50. A patient has a leukemia with high uric acid levels and a WBC of 109,000. What chromosome abnormality would you expect to find upon further testing? 51. A patient presents 2 months after initiating warfarin with necrotic skin lesions. What underlying hypercoagulable state is most likely? 52. A patient who recently started lisinopril has a hemoglobin 7.4, WBC 1.1, platelets 55. What is the most likely disorder? 53. A patient with SLE is admitted with a with new onset DVT. What antibodies should be ordered to aid in the diagnosis of the patients hypercoagulable state? ACE inhibitors - Sulfonamides - Phenytoin Cephalosporins - Penicillins - NSAIDs Antimalarials - Sulfa drugs - Aspirin BCR-ABL gene - chromosome Systemic Lupus Erythematosus - Women with recurrent abortions Reticulocyte count - Decreasing reticulocyte counts are the best indicator that a crisis is resolving Multiple myeloma Chemotherapy and radiation Hodgkin lymphoma chromosome in patient with chronic myeloid leukemia (CML) Protein C deficiency Aplastic Anemia Anti-phospholipid antibodies 54. (Ph) chromosome? Chronic myeloid leukemia (CML) 55. Pica is a specific symptom of which type of (philadelphia "cream" cheese)

3 56. Priapism may occur in which acute Sickle cell crisis 57. Reed Sternberg cells? Hodgkins lymphoma 58. Slowly decreasing MCV in an elderly patient? 59. Translocation of chromosomes 9 and 22 or 922 suggests which disorder? 60. TTP symptom Mnemonic: FAT-RN. What dose FAT-RN stand for? 61. Type of anemia in which serum iron is decreased and TIBC is increased? 62. WBC > and hyperuricemia are most likely associated with which disorder? 63. What anemia should be suspected in a 3 year old black male with anemia and priapism? 64. What antibody test would confirm a diagnosis of pernicious 65. What are some common oxidative events which may trigger hemolysis in G6PD deficiency? 66. What are the organ systems which may be involved in Thrombotic thrombocytopenia purpura (TTP)? 67. What are the two medications available for treatment of anemia due to renal failure? 68. What are the two medications available for treatment of anemia due to renal failure? 69. What assay is definitive for Von 70. What conditions other than trauma can lead to disseminated intravascular coagulation (DIC)? 71. What disorder is a hemoglobin electrophoresis result of "SA" indicative of? 72. What disorder is a hemoglobin electrophoresis result of "SS" indicative of? 73. What disorder is usually diagnosed early in childhood and has hemarthrosis bruising and bleeding? Occult GI blood loss CML (This describes the chromosome) Fever - Anemia - Thrombocytopenia - Renal failure - Neurologic involvement CML Sickle cell anemia Intrinsic factor and parietal cell antibodies Antimalarials - Sulfa drugs - Aspirin - Febrile Illness - Acidosis - Fava beans Renal - Neuro - Cardiac Hemolysis or blood loss epoetin alfa and darbepoetin alfa Ristocetin cofactor assay Sepsis and malignancy Sickle cell trait Sickle cell disease Hemophilia 74. What disorder should be considered for a patient on warfarin who develops diffuse necrotic skin lesions? 75. What do an increased LDH, decreased Haptoglobin and an increased indirect Bilirubin represent? 76. What does a > 50% reduction in platelet count within 7-10 days of exposure to heparin define? 77. What does the presence of Heinz bodies indicate? 78. What factor is produced in the stomach and required for Vitamin B12 absorption? 79. What factors are affected in Von 80. What gene mutation is associated with polycythemia vera? 81. What hematological malignancy has a bimodal incidence by age of years old or >60 years old? 82. What heritage is associated with an increased chance of thalassemia? 83. What is first line treatment for Idiopathic thrombocytopenia purpura? 84. What is the acute treatment of Von 85. What is the best test to determine whether a patient as a hemolytic 86. What is the chronic treatment of Von 87. What is the difference between Von Willebrand disease and hemophilia in regards to platelet function? 88. What is the Dx? 75 year old male with adenopathy WBC 150K (90% lymphocytes). 89. What is the Dx? Child with fever bleeding bone pain and adenopathy? 90. What is the Dx? Low MCV, low RBC, high RDW, low serum iron, high TIBC. Protein C deficiency Hemolysis Heparin Induced Thrombocytopenia (HIT) syndrome G6PD deficiency (May also be found in thalassemia) Intrinsic factor Von Willebrand factor and factor VIII are both decreased JAK2 mutation Hodgkin lymphoma Mediterranean descent Steroids Acute/initial treatment: DDAVP Reticulocyte count and haptoglobin Chronic treatment: Factor VIII replacement Platelet function is normal in hemophilia and impaired in Von Willebrand disease CLL ALL

4 91. What is the Dx? Microcytic hypochromic anemia, low serum iron and low TIBC. Unresponsive to iron therapy. 92. What is the Dx? Teenage African American with severe bone and joint pain severe anemia. 93. What is the Dx? Very low MCV, normal/high RBC, normal RDW and high/normal serum iron normal TIBC. Anemia of chronic disease Sickle cell disease Thalassemia 94. What is the etiology of pernicious Antibodies to gastric parietal cells and intrinsic factor 95. What is the most common autoimmune disorder associated with hemolytic 96. What is the most common genetic hypercoagulable state? 97. What is the most common hypercoagulable state? 98. What is the most common malignancy associated with autoimmune hemolytic 99. What is the most common type of kids leukemia? 100. What is the most likely lymphoma to occur in a 31 year old male with HIV who presented to the ER after suffering focal neurological deficit? 101. What is the result of homozygous alpha thalassemia (Alpha major) genetics? 102. What leukemia would lymphoblast be 103. What leukemia would myeloblasts be 104. What medication is commonly used for CML? 105. What medications related to travel can be an oxidative trigger for a patient with G6PD? 106. What organism associated with ground meat is often responsible for hemolytic uremic syndrome? 107. What organism is likely responsible for Renal failure microangiopathic hemolytic anemia and thrombocytopenia? 108. What organ systems can be affected in thrombotic thrombocytopenia purpura (TTP)? Systemic lupus erythematosus (SLE) Factor V Leiden Factor V Leiden Mutation CLL Acute lymphocytic leukemia (ALL) Non-Hodgkin Lymphoma Fetal death ALL (Blasts = Acute) AML (Blasts = Acute) Imatinib Anti-malarial medications E. Coli 0157 E. Coli 0157 Renal, neuro and cardiac 109. What surgery can induce B12 deficiency? 110. What symptom differentiates B12 from folate deficiency? 111. What test confirms the diagnosis of pernicious 112. What test is diagnostic for sickle cell disease? 113. What tests are used to confirm monoclonal gammaglobulinopathy? 114. What tests other than a Schilling test are used to diagnose pernicious 115. What tests will confirm your diagnosis of multiple myeloma? 116. What two types of anemia have macroovalocytes? 117. What type of anemia are cephalosporins PCN NSAIDS methyldopa 118. What type of anemia can occur in hypothyroidism? 119. What type of anemia does a + direct coombs indicate? 120. What type of anemia does a + osmotic fragility test indicate? 121. What type of leukemia is most commonly seen in older men? 122. What type of megaloblastic anemia causes neurologic deficits? 123. Which anemia has a decreased MCV, decreased MCH (hypochromic) yet normal TIBC and ferritin? 124. Which anemia has all 3 cells lines affected: Anemia leukopenia and thrombocytopenia? 125. Which anemia is associated with bilirubin cholelithiasis? 126. Which anemia is most commonly associated with EtOH abuse? Gastric bypass Neuropathy occurs with B12 deficiency but not with folate deficiency Schilling test or + antibodies to intrinsic factor and parietal cells Hemoglobin electrophoresis Protein electrophoresis + immunofixation (Monoclonal spike IgG or IgA - multiple myeloma) Increased Methylmalonic acid levels - + Intrinsic factor and parietal cell antibodies Serum: Protein electrophoresis may show monoclonal proteins - Urine: Bence Jones proteins B12 and folate deficiency What type of anemia are cephalosporins PCN NSAIDS methyldopa Macrocytic nonmegaloblastic anemia Autoimmune hemolytic anemia Hereditary Spherocytosis Chronic lymphocytic leukemia (CLL) Vitamin B12 deficiency Thalassemia Aplastic anemia Hereditary spherocytosis Folate deficiency

5 127. Which antibody is positive in HIT syndrome? + platelet factor 4 (PF4) antibody 128. Which food is known to trigger hemolysis in a patient with G6PD deficiency? Fava beans 129. Which groups are most likely to be affected by G6PD deficiency? Black or Mediterranean males 130. Which is the only lymphoma that is bimodal in age of onset, painless lymphadenopathy and has Reed-Sternberg cells on pathology? 131. Which leukemia is more common in adults and on laboratory review has Auer rods with increased myeloblasts? 132. Which malignancy has a peak incidence of years old and can be associated with HIV? Hodgkin Lymphoma Acute Myeloid Leukemia (AML) Non-Hodgkin Lymphoma 133. Which route is best for administering B12 to a deficient patient? Sublingual IM or deep subcutaneous 134. Which test is more sensitive than B12 levels for B12 deficiency in early disease? Increased Methylmalonic acid levels occur in early B12 loss and may precede decreased serum B12 levels 135. Which test is most specific for hemolysis? Haptoglobin is decreased in both extra and intravascular hemolysis 136. Which type of anemia is most likely with associated leukopenia and thrombocytopenia? Aplastic anemia