10-07-2008, 05:52 PM
An 18-year-old man comes to clinic complaining of
fatigue and pallor. He states that he has suffered from
episodic anemia for as long as he can remember, and
now that he can make his own medical decisions he
would like to have it treated before he leaves for college.
Aside from this recurrent anemia, he has had no major
illnesses. The only medication he takes is a daily multivitamin.
Physical examination confirms a mild pallor
and marked splenomegaly. Laboratory studies are
remarkable for a reduced hematocrit with an elevated
mean corpuscular hemoglobin concentration (MCHC)
and elevated red cell distribution width (RDW). A
review of the blood smear shows numerous small,
dense, hyperchromatic erythrocytes that lack central
pallor. A review of the patient™s previous laboratory
studies reveals a positive osmotic fragility test, a low
haptoglobin level, and an elevated lactate dehydrogenase
level.Which of the following is the most appropriate
treatment for this patient™s anemia?
(A) Corticosteroids
(B) Erythropoietin
© No treatment
(D) Splenectomy
(E) Stem cell transplant
A 32-year-old woman comes to the clinic complaining of
malaise, severe pallor, and generalized weakness.
Approximately 2 months ago, while working at a rural
health clinic in the war-torn Congo, she became extremely
ill with a severe gastroenteritis. She was given antibiotics,
though she is not sure which ones, and quickly
recovered. Since returning to the United States approximately
6 weeks ago, however, she has felt progressively
more ill. She has never been sick in the past, takes no medications,
and knows of no diseases that run in her family.
A review of symptoms, aside from reduced exercise tolerance
and a mild decrease in appetite, is unremarkable. She
has suffered no recent fevers, chills, nausea, or diarrhea,
and denies any weight loss or night sweats.Vital signs are:
temperature 37.0 C (98.6 F), blood pressure 118/70 mm
Hg, pulse 103/min, and respirations 20/min. Examination
reveals a young, pale woman in no apparent distress.
Cardiac auscultation reveals a 2/6 midsystolic murmur
heard best at the right upper sternal border that does not
radiate. Lungs are clear to auscultation bilaterally, and
abdominal examination is benign, without evidence of
hepatosplenomegaly. There are no signs and stigmata of
liver disease or endocarditis. Laboratory studies show:
Hematologic
Hematocrit 17%
Hemoglobin 6.0 g/dL
Leukocytes 3000/mm3 (67% neutrophils,
25% lymphocytes,
7% monocytes)
Platelets 12,500/mm3
Reticulocytes 0.6%
The rest of the patient™s laboratory studies, including a
set of chemistries and liver function tests, are unremarkable.
Which of the following is the next most
appropriate diagnostic study?
(A) Blood and stool cultures
(B) Bone marrow biopsy
© CT scan of abdomen
(D) Echocardiogram
(E) Erythropoietin level
fatigue and pallor. He states that he has suffered from
episodic anemia for as long as he can remember, and
now that he can make his own medical decisions he
would like to have it treated before he leaves for college.
Aside from this recurrent anemia, he has had no major
illnesses. The only medication he takes is a daily multivitamin.
Physical examination confirms a mild pallor
and marked splenomegaly. Laboratory studies are
remarkable for a reduced hematocrit with an elevated
mean corpuscular hemoglobin concentration (MCHC)
and elevated red cell distribution width (RDW). A
review of the blood smear shows numerous small,
dense, hyperchromatic erythrocytes that lack central
pallor. A review of the patient™s previous laboratory
studies reveals a positive osmotic fragility test, a low
haptoglobin level, and an elevated lactate dehydrogenase
level.Which of the following is the most appropriate
treatment for this patient™s anemia?
(A) Corticosteroids
(B) Erythropoietin
© No treatment
(D) Splenectomy
(E) Stem cell transplant
A 32-year-old woman comes to the clinic complaining of
malaise, severe pallor, and generalized weakness.
Approximately 2 months ago, while working at a rural
health clinic in the war-torn Congo, she became extremely
ill with a severe gastroenteritis. She was given antibiotics,
though she is not sure which ones, and quickly
recovered. Since returning to the United States approximately
6 weeks ago, however, she has felt progressively
more ill. She has never been sick in the past, takes no medications,
and knows of no diseases that run in her family.
A review of symptoms, aside from reduced exercise tolerance
and a mild decrease in appetite, is unremarkable. She
has suffered no recent fevers, chills, nausea, or diarrhea,
and denies any weight loss or night sweats.Vital signs are:
temperature 37.0 C (98.6 F), blood pressure 118/70 mm
Hg, pulse 103/min, and respirations 20/min. Examination
reveals a young, pale woman in no apparent distress.
Cardiac auscultation reveals a 2/6 midsystolic murmur
heard best at the right upper sternal border that does not
radiate. Lungs are clear to auscultation bilaterally, and
abdominal examination is benign, without evidence of
hepatosplenomegaly. There are no signs and stigmata of
liver disease or endocarditis. Laboratory studies show:
Hematologic
Hematocrit 17%
Hemoglobin 6.0 g/dL
Leukocytes 3000/mm3 (67% neutrophils,
25% lymphocytes,
7% monocytes)
Platelets 12,500/mm3
Reticulocytes 0.6%
The rest of the patient™s laboratory studies, including a
set of chemistries and liver function tests, are unremarkable.
Which of the following is the next most
appropriate diagnostic study?
(A) Blood and stool cultures
(B) Bone marrow biopsy
© CT scan of abdomen
(D) Echocardiogram
(E) Erythropoietin level