Cps Exam 4: Blood Disorders/wbcs

Front 1

T/F
the patients mother who had a history of anemia, stomach adenocarcinoma, and Alzheimers disease did not have pernicious anemia because her hematologic abnormalities corrected to normal with folate and iron

Back 1

False
PA was likely, folate will correct hematologic abnormalities but not the neurological defects in B12 deficiency

Front 2

The patients sister with a history of fatigue and memory loss should be checked for B12 deficiency.

Back 2

True
PA is an autoimmune disease and autoimmune diseases run in families

Front 3

The patient has hypocalcemia related to hypoalbuminemia secondary to malabsorption and reduced liver synthesis of albumin

Back 3

False
the calcium is low after correcting the hypoalbuminemia
She has vitamin D deficiency from her malabsorption related to B12 deficiency and atrophy of the small bowel mucosa

Front 4

Factors unique to PA in this patient are not found in other causes of B12 deficiency include stomach cancer, atrophy of the papillae of the tongue, optic nerve neuropathy, and antibodies against parietal cells and intrinsic factor

Back 4

False
Atrophic glossitis/optic atrophy are not unique to PA, the other disorders listed are unique to PA

Front 5

T/F
If the patient was place on B12 therapy, the Schilling's test would be normal after administration of radioactive B12 alone.

Back 5

False
The patient still lacks IF so the test would only be normal if IF was added along with radioactive B12

Front 6

T/F
Physical findings that are present in a lung consolidation without an effusion that are not present in pleural effusion include increased tactile fremitus, positive e to A sign, and dullness to percussion.

Back 6

False
Pleural effusions also have dullness to percussion

Front 7

T/F
the patients pleuritic pain was most likely secondary to metastatic cancer

Back 7

True

Front 8

T/F
The patient had a wide pulse pressure, palpitations, and bounding pulses due to vasodilation of the peripheral resistance arterioles secondary to primary hypothyroidism.

Back 8

False
the findings were due to the low viscosity of the blood from her anemia which led to a reduction in the total peripheral resistance - recall Poiseulle's law

Front 9

T/F
the patient had prerenal azotemia secondary to hypovolemia related to her anemia

Back 9

False
the patient did not have signs of hypovolemia
the elevated BUN was due to blood in her GI tract; blood handled like any other protein, it is digested and the increased ammonia coming from its metabolism in the gut is metabolized in the liver into urea

Front 10

T/F
the patient had hypokalemia and a normal anion gap metabolic acidosis related to the loss of bicarbonate in the stool

Back 10

True
recall the patient had 4-5 loose stools per day

Front 11

T/F
Krukenburg tumors of the ovaries are examples of seeding from a primary cancer located in the stomach

Back 11

False
it is an example of a hematogenous spread of tumor, if seeding was the cause the omental fat would have been involved

Front 12

T/F
Normally the driving force for the formation of pleural fluid is the greater increase in hydrostatic pressure in the parietal pleura capillaries versus the hydrostatic pressure in the visceral pleural capillaries

Back 12

True

Front 13

T/F
the patient had a mixed ABG disorder consisting of primary respiratory alkalosis from pleural disease and primary metabolic acidosis from her diarrhea

Back 13

true

Front 14

T/F
There is no relationship of the patients thyroid disease or vitiligo with PA

Back 14

False
Hashimotos thyroiditis/vitiligo like PA are autoimmune diseases, hence there is a connection between them all and in the family as well

Front 15

T/F
Romberg's test in this patient indicates that she has cerebellar disease related to her PA

Back 15

False
the positive Romberg's test indicates that she has posterior column disease and diminished proprioception

Front 16

T/F
The patient's reduced sense of taste and smell related to her neurologic disease

Back 16

False
related to atrophy of her papillae on her tongue

Front 17

T/F
the patients muscle weakness in her upper and lower extremities and the elevated serum CK are most likely secondary to her primary hypothyroidsim

Back 17

True

Front 18

T/F
The pigmented skin lesions in this patient are seborrheic keratoses, their sudden appearance is called the Leser-Trelat sign, a paraneoplastic syndrome indicating the presence of gastric adenocarcinoma

Back 18

True

Front 19

T/F
Pancytopenia in this patient is due to inability to stimulate marrow stem cells to produce granulocytes, platelets, and RBCs

Back 19

False
the patient has massive ineffective erythropoiesis with macrophage destruction of megaloblastic cells in the extrasinusoidal part of the bone marrow

Front 20

T/F
The increase in total bilirubin, LDH, and AST are due to macrophage destruction of the patients RBCs in the bone marrow

Back 20

True

Front 21

T/F
The increase in urobilinogen in the patients urine is due to increased metabolism of UCB in the patients liver.

Back 21

True

Front 22

T/F
The dark yellow urine in this patient was secondary to hyperbilirubinuria

Back 22

False
UCB is lipid soluble and cannot enter the urine
the increase yellow color is from an increase in urine urobilinogen, which oxidizes into the yellow pigment called urobilin, the same pigment that causes the brown color of stool

Front 23

T/F
the increased A-a gradient in this patient relates to compression atelectasis from the pleural effusion and possible lymphangitic spread of stomach cancer in her lungs

Back 23

True

Front 24

T/F
The left supraclavicular nodes drain the abdominal cavity hence their involvement as a site of metastasis in this patient

Back 24

True

Front 25

T/F
Virchow's nodes refer to metastasis to the right supraclavicular lymph nodes

Back 25

False
Left supraclavicular

Front 26

T/F
the elevated serum alkaline phosphatase and GGT in this patient indicate liver disease, most likely HCV from previous blood transfusion 26 years ago

Back 26

False
the ar most likely due to liver metastasis

Front 27

T/F
Hypovitaminism D results in hypocalcemia and hypophosphatemia the later leading to a reduction in ATP synthesis as well as reduced mineralization of bone.

Back 27

True

Front 28

T/F
the patients cachexia is due to production of TNF-a and is reversible with total perenteral nutrition

Back 28

False
Cachexia is irreversible

Front 29

T/F
Ovaries are normally palpable in elderly women

Back 29

False
ovaries normally undergo atrophy hence the palpable ovary requires investigation

Front 30

T/F
the yellowish appearance of the patient is most likely due to an increase in b-carotenes secondary to her primary hypothyroidism

Back 30

True
thyroid hormone normally converts b-carotene into retinoic acid in the intestinal epithelium, hence a deficiency of thyroid hormone leads to increase in carotenes, which stain the skin but not the sclear

Front 31

t/F
the yellowish appearance of the patient is most likely due to an increase in b-carotenes secondarily to her primary hypothyroidism

Back 31

True
thyroid hormone normally converts b-carotenes into retinoic acid in the intestinal epithelium, hence the deficiency of thyroid hormone leads to an incresae in carotenes which stain the skin but not the sclera

Front 32

T/F
A deficiency of B12 and folate will lead to an increase in both plasma homocysteine levels and methylmalonic acid

Back 32

False
only an increase in homocysteine levels damage vessels endothelium leading to an increased risk of thrombosis
Folate deficiency is the most common cause of an increase in plasma homocysteine

Front 33

T/F
Achlorydia is the primary cause of gastric adenocarcinoma in patients with PA

Back 33

True
autoantibodies destroy parietal cells leading to a loss of acid production as well as IF for reabsorption of B12

Front 34

T/F
Factors unique to B12 deficiency that are not seen in folate deficiency include an increase in serum/urine methylmalonic acid, an abnormal Schilling's test and neurolgical disoder.

Back 34

True

Front 35

Iron and folate supplementation must be given when intially treating a patient with B12 deficiency owing to an increase in RBC synthesis

Back 35

True

Front 36

what are the signs that are indicative of coagulation disorders rather than a platelet disorder?

Back 36

Late rebleeding and hemarthroses

Front 37

Why is menorrhagia worsened in a patient with classical VWD when taking ASA/NSAID?

Back 37

if further decreases the formation of temporary platelet plug
- reduce the synthesis of TXA2 thus enhancing the overal functional platelet defect in these patients

Front 38

The most common cause of menorrhagia in a patient from menarche to 20 years of age is:

Back 38

anvolulatory dysfunction uterine bleeding
- increased estrogen without enough progesterone causes endometrial gland hyperplasia leading to sloughing of the mucosa

Front 39

the most common cause of primary and secondary dysmenorrhea, respectively are:

Back 39

increased prostaglandin F2-a
Endometriosis

Front 40

the common cause of menorrhagia in the patients in this age bracket would be:

Back 40

endometrial polyp
dysfunctional uterine bleeding
submucosal leiomyoma
- endometrial carcinoma is a postmenpausal patients

Front 41

Birth control pills, estrogen, and desmopressin are useful in treating VWD because they all:

Back 41

increase release of all of the factor VIIII complex from storage sites

Front 42

The most common cause of hematochezia in descending order are:

Back 42

Diverticulosis
Angiodysplasia

Front 43

Hematochezia?

Back 43

bright red blood in the stool

Front 44

A pure vegan on no vitamin supplements would MOST likely develop:

Back 44

macrocytic anemia (B12 deficiency)

Front 45

an infant who is breast feeding from a mother who is a pure vegan develops anemia at 6 months of age. the most likely cause of the anemia is:

Back 45

B12 deficiency

Front 46

the main reason why the ejection click and murmur in mitral valve prolapse comes closer to the S1 when the patient is anxious or standing up is?

Back 46

decreased venous return to the heart

Front 47

prolongation of the PTT and normal PT would most likely be a secondary to deficiency factor?

Back 47

Playing odds: VIII
factor VIII deficiency is more common than any other deficiency in the intrinsic pathway; however this would have to be documented by ordering co-factor assays

Front 48

Von Willebrand's factor is synthesized in the ?

Back 48

endothelial cells and megakaryocytes

Front 49

antiphospholipids antibodies cause spontaneous abortions by:

Back 49

causing thrombosis in placental vessels

Front 50

transferrin synthesis in the liver is directly related to:

Back 50

Ferritin stores in the bone marrow

Front 51

Microcytic anemias all have

Back 51

reduction in HB synthesis

Front 52

The most common location of angiodysplasia in the elderly is the?

Back 52

cecum

Front 53

T/F
Black tarry stools indicated that a bleed is below the ligament of Treitz

Back 53

False
- above the ligament of Treitz
- the black color indicates acid conversion in Hb into hematin, which is a black pigment

Front 54

T/F
Melenemesis refers to the vomitting of coffee ground material which implies acid conversion of Hb into hematin most likely from peptic ulcer disease

Back 54

true

Front 55

T/F
Blood coating the stool is most commonly due to external hemorrhoids.

Back 55

False
internal hemorrhoids bleed, external hemorrhoids thrombose

Front 56

T/F
Patient receiving iron or taking Pepto-Bismol will have black stools

Back 56

True
Pepto-Bismol contains bismuth, which causes the stools to turn black. Iron medication also turns the stool black

Front 57

T/F
VWD may be associated with MVP and or angiodysplasia.

Back 57

True

Front 58

T/F
the bleeding time and aPTT are the most sensitive test for diagnosing VWD

Back 58

False
risotectin cofactor assay is most sensitive

Front 59

T/F
the patient had control of her heavy bleeding when she was placed on OCP, because the pills increased the release of all components of the factor VIII complex from storage sites

Back 59

True

Front 60

T/F
The click and murmur of MVP occurs closer to S2 if the patient squats or has sustained hand grip

Back 60

True
both maneuvers increase systemic arterial pressure and would be expected to cause the click and murmur to come closer to S2

Front 61

T/F
Valsalva maneuver increases systemic arterial pressure and would be expected to cause the click and murmur to come closer to S2

Back 61

False
- it decreases preload in the LV, hence causing the click and murmur to move closer to S2

Front 62

T/F
All patients with MVP should be placed on prophylactic antibiotics to prevent infective endocarditis

Back 62

False
only those that have signficant components of mitral regurgitation

Front 63

T/F
Recurrent fetal wastage may be associated with antiphospholipid antibodies like the lupus anticoagulant or anti-cardiolipin antibodies as well as parvovirus infections

Back 63

True

Front 64

VWD protects against atherosclerosis since platelets are not able to stick to endothelium

Back 64

True

Front 65

Desmopressin is a Category C for pregnancy and should be used with extreme caution in treating VWd

Back 65

False
Category B and can be used safely

Front 66

VWF complexes with VIII:c in the peripheral blood and prevents its degradation

Back 66

TRUE