623 Adult Hema/Immune chapter 17 - Dunphy, Winland-Brown, Porter & Thomas (Questions and Answers)

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b. withhold one or more days of anticoagulant therapy pg 907 - ANSWER If the international normalized ratio (INR) result is above the therapeutic range in a patient with atrial fibrillation on warfari... n, what might the clinician do? a. stop the warfarin for 1 week, and then repeat the INR. b. withhold one or more days of anticoagulant therapy. c. restart therapy at a lower dose immediately. d. the prothrombin time (PT) and INR should be reevaluated within 1 month of the dosage adjustments. a hematoma pg 907 - ANSWER which is larger? a hematoma or bruise pancreatitis, UTIs, and intracranial pathology pg 908 - ANSWER fevers in excess of 104F (40C) tend to be associated with URIs and some acute viral syndromes pg 908 - ANSWER fevers between 101.3F (38.5C) and 104F (40C) tend to be associated with hepatitis, some acute viral infections, and TB pg 908 - ANSWER fevers less than 101.3 (38.5C) are characteristic of a fever greater than 101.3F (38.5C) that occurs on at least three occasions in a 3-week period pg 908 - ANSWER a fever of unknown origin (FUO) in an ambulatory pt is an unexplainable fever that persists for one week pg 908 - ANSWER a fever of unknown origin (FUO) in a hospitalized pt is 3 or more extrainguinal lymphadenopathies pg 908 - ANSWER an example of systemic lymphadenopathy is human immunodeficiency virus infection, in which there may be iron deficiency pg 910 - ANSWER what is one of the most common causes of microcytic anemias in the world? every 4-6 months pg 915 - ANSWER how often should someone with mild iron deficiency be followed up? 1. iron deficiency 2. anemia of chronic disease (ACD) 3. thalassemia 4. siderblastic anemia pg 910 - ANSWER what are the four causes of microcytic anemia? serum ferritin, a value less than 30mg/L is considered pathological pg 913 - ANSWER what is a reliable test of low iron stores in a pt who does not have advanced liver disease? variable RBC size pg 913 - ANSWER what is anisocytosis? variable RBC shape pg 913 - ANSWER what is poikilocytosis? a CBC and Hgb electrophoresis pg 913 - ANSWER what tests are required to determine thalassemia? by a Prussian blue stain of a bone marrow aspirate pg 913 - ANSWER how is sideroblastic anemia dx? 1. vitamin B12 deficiency 2. folate deficiency 3. antimetabolite drugs such as methotrexate 4. miscellanceous etiologies pg 919 - ANSWER what are the four general categories of cause of macrocytic anemia? vitamin B12 deficiency alone pg 921 - ANSWER peripheral neuropathy is part of the differential among subjective symptoms for d. Not enough intrinsic factor 624 quiz - ANSWER Pernicious anemia is a result of? a. Not enough vitamin D. b. Not enough iron. c. Not enough folic acid. d. Not enough intrinsic factor. b. Smoking. 624 quiz - ANSWER Caroline, an older adult, is homeless and has iron-deficiency anemia. She smokes and drinks when she can and has an ulcer. Which of the following is not one of the risk factors of iron-deficiency anemia? a. Poverty. b. Smoking. c. Age older than 60. d. Ulcer disease. a. Ferritin. 624 quiz - ANSWER Which is the best test to perform to spot an iron-deficiency anemia early before it progresses to full-blown anemia? a. Ferritin. b. Reticulocytes. c. Hematocrit. d. Hemoglobin. a. Acute blood loss 624 quiz - ANSWER Under which of the following circumstances is the reticulocyte count elevated? a. Acute blood loss. b. Aplastic anemia. c. Iron-deficiency anemia. d. Poisonings. c. iron-deficiency anemia pg 910 - ANSWER what is the most common cause of microcytic anemia? a. anemia of chronic disease b. sideroblastic anemia c. iron-deficiency anemia d. thalassemia c. A deficiency of folic acid. - ANSWER Macrocytic normochromic anemias are caused by: a. A nutritional deficiency of iron. b. An infection or tumor. c. A deficiency of folic acid. d. Acute blood loss. b. Order a serum iron, TIBC, and serum ferritin level 624 quiz - ANSWER Sherri's blood work returns with a decreased mean cell volume (MCV) and a decreased mean cellular hemoglobin concentration (MCHC). What should you do next? a. Order a serum ferritin. b. Order a serum iron, TIBC, and serum ferritin level. c. Order a serum folate level. d. Order a serum iron and total iron binding capacity (TIBC). microcytic or normocytic anemia pg 911 - ANSWER anemia of chronic disease may cause ibuprofen, aspirin pgs 911-912 - ANSWER what medications can cause occult blood in the stool? deletions or severe mutations in both beta-globin genes result in beta-thalassemia major resulting in a severe, transfusion-dependent, lifelong anemia with skeletal abnormalities pg 912 - ANSWER what is Cooley's anemia? a reduced number of RBCs form from ring sideroblast precursors found in the bone marrow pg 912 - ANSWER what is a diagnostic hallmark of sideroblast anemia? chronic alcoholism pg 912 - ANSWER what is one of the most common causes of acquired sideroblastic anemia? lead poisoning pg 912 - ANSWER besides chronic alcoholism, what is another common cause of acquired sideroblastic anemia? yes, as long as the pt does not have advanced liver disease pg 913 - ANSWER is serum ferritin a reliable test of low stores of iron? d. Pica pg 913 - ANSWER which of the following is identified as an eating disorder of craving for food substitutes such as clay, ice chips, and cotton and is considered an OBJECTIVE finding associated with severe iron deficiency? a. ferritin b. Porter's syndrome c. hypochromasia d. Pica b. three pg 909 - ANSWER as a general rule of thumb, the estimated level of hct is how many times the value of hgb? a. two b. three c. four d. five a. severe pg 913 - ANSWER how severe is the anemia in patients with beta-thalassemia major? a. severe b. mild c. moderate d. not at all HIV, AIDS, or chronic renal failure pg 914 - ANSWER what are typical causes of anemia of chronic disease? Darbepoetin (Aranesp), weekly initially, than adjusted to every 2 week dosing Erythropoietin (Epogen, Procrit) is given 3xweekly, then adjusted pg 914 - ANSWER what medication can be given for anemia of chronic disease and how often? when there is documented failure of therapy with oral iron supplements pg 914 - ANSWER when is supplemental iron by parental route indicated? every 4-6 months pg 915 - ANSWER how often should you followup with a patient with mild iron-deficiency? colonoscopy to r/o GI cancer pg 915 - ANSWER any pt over the age of 50 with heme-positive stools or evidence of iron-deficiency should be referred for a if the patient requires erythropoietin-alpha injections, then every 30 days for the next six months pg 915 - ANSWER how often should you followup with a patient with anemia chronic disease? MCV=81-99 fL pg 915 - ANSWER normocytic anemia is defined as anemia associated with normally sized RBCs, what is the MCV? should raise suspicion that the dx may be paroxysmal nocturnalhemoglobinuria (PNH) pg 917 - ANSWER what does dark red urine first thing in the morning indicate? equal or greater than 100 fL. - ANSWER macrocytic anemia is defined as having an MCV autosomal-recessive disorder pg 923 - ANSWER sickle cell anemia is an usually within the first year of life for those born with sickle cell anemia pg 923 - ANSWER when do the first symptoms of sickle cell anemia occur? 40-50 years pg 923 - ANSWER the average lifespan for someone who is homozygous for the hemoglobin S gene is a. pain pg 925 - ANSWER the cardinal subjective symptom of sickle cell crisis is what? a. pain b. nausea c. light-headedness d. palpitations a. excruciating pg 925 - ANSWER patients undergoing a sickle cell crisis describe the pain as: a. excruciating b. tolerable c. moderate d. minor d. 12,000 or greater pg 925 - ANSWER in a patient during or after a sickle cell crisis, clinicians should expect the WBC to be elevated to a. 9,000 b. 10,000 c. 11,000 d. 12,000 or greater b. twice a year pg 926 - ANSWER every patient with sickle cell anemia should be evaluated by a hematologist at least: a. once a year b. twice a year c. every four months d. every three months d. syngeneic pg 936 - ANSWER what type of bone marrow transplant is obtained from an identical twin? 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