HEME - ROSH Pance Exam Questions With Complete
Solutions
17-year-old boy presents to the ED with a painless mass on the
left side of his neck, which he first noticed three months ago,
that is now increasing in size. The patient also reports a 10-
pound weight loss and night sweats. On exam, you note a 5 cm
rubbery, firm, and mobile mass located in the anterior cervical
triangle. The overlying skin is intact, with no redness, streaking,
or drainage. What is the most likely diagnosis? Correct Answers
Hodgkin lymphoma
3-year-old boy presents to your clinic due to his mother's
concerns about the patient having intermittent fevers, fatigue,
bruising without injury and a pale appearance. Physical exam
reveals a palpable liver and spleen, and pale conjunctiva. Initial
laboratory testing reveals elevated white blood cell count and
lymphoblasts on the peripheral smear. Which of the following is
used to confirm the diagnosis? Correct Answers Bone marrow
aspiration and biopsy
A 10-year-old boy presents to the clinic with easy bruising and
frequent prolonged epistaxis. He has a family history of a
bleeding disorder. Vital signs include a HR of 90 bpm, BP of
100/60 mm Hg, RR of 20/min, oxygen saturation of 98% on
room air, and T of 98.6°F. Physical examination findings
include a regular rate and rhythm, lungs clear to auscultation
bilaterally, and several bruises on the skin. Laboratory
evaluation reveals a von Willebrand factor antigen and activity
level of 20 IU/dL. Which of the following additional laboratory
findings would be most consistent with the suspected diagnosis?
,Correct Answers Normal platelets, normal prothrombin time,
and normal activated partial thromboplastin time
A 12-month-old girl is in the clinic for a well-child check. She
can walk and is eating more table foods. The parents have given
her goat's milk for two months. Physical examination is normal.
Laboratory screening obtained shows hemoglobin of 10 g/dL,
mean corpuscular volume 77 fL and elevated red cell
distribution width. Which of the following is the most likely
diagnosis? Correct Answers Iron deficiency anemia
A 12-year-old girl presents for her annual well child check. She
had menarche eight months prior, and has had menses every
month. Each cycle lasts two weeks. The patient uses at least six
pads on most days of the cycle. On exam, she is pale but
otherwise well appearing. Her heart rate is 80 beats per minute,
blood pressure 110/65, and respiratory rate 14. The remainder of
her exam is within normal limits. Which of the following are the
most likely laboratory findings? Correct Answers Hemoglobin
6 g/dL, mean corpuscular volume 60, RDW 18
A 14-month-old boy presents to the emergency department with
his adoptive parent, who reports that he has had increased
irritability with episodes of inconsolable crying for the past 3
hours with no history of injury. He has had a recent upper
respiratory tract infection with a runny nose and cough for the
past week. His parent notices that he cries more when he is
walking and that he is easily fatigued. His parent adopted him
about 6 months ago and does not have a record of his medical
history. His temperature is 98.7°F, blood pressure is 105/64 mm
Hg, heart rate is 106 bpm, oxygen saturation is 98% on room air,
,and respiratory rate is 25/min. On a physical exam, the patient is
ill-appearing, irritable, and crying inconsolably. He has evidence
of scleral icterus and has swelling to both hands and both feet
with tenderness to palpation to the dorsal surfaces. His
hemoglobin is 8.2 g/dL. Which of the following tests w Correct
Answers Hemoglobin electrophoresis
A 14-year-old boy is brought by his grandparents to the
Emergency Department due to difficulty breathing. His
grandmother notes that the boy was eating his snack of salted
peanuts and an apple when he started to complain of generalized
itchiness especially around his mouth, face, and extremities, and
swelling around his eyes. Physical examination reveals an
irritable child in respiratory distress with periorbital edema,
tonsillopharyngeal congestion, poor air entry on lung
auscultation, and multiple erythematous and raised wheals on
the trunk and extremities. Which of the following is the most
important medication in treating this child? Correct Answers
Epinephrine
A 15-year-old girl is in your clinic with her mother for a sports
physical examination. She denies any symptoms and is doing
well in school. There is no family history of sudden death or
heart disease. She has been a vegan for the past year and takes
food supplements. She has regular menstrual periods. Physical
examination is normal. You perform a screening complete blood
count (CBC) that reveals hemoglobin of 10 g/dL, mean
corpuscular volume (MCV) of 68, with ferritin of 11 ng/mL
(normal for females 12-150 ng/mL). Which of the following is
the next best step in management? Correct Answers Trial
treatment with oral iron supplements
, A 16-year-old boy presents with a marked hemarthrosis of his
knee after tripping and striking it against the edge of a step. This
has happened in the past. His activated partial thromboplastin
time is prolonged and his prothrombin time and thrombin time
are normal. What is the most likely diagnosis? Correct Answers
Hemophilia B
A 16-year-old girl is in the clinic for a follow-up for a fever. She
has been having prolonged fever accompanied by fatigue, night
sweats, and loss of appetite. On physical examination, she has a
temperature of 38°C with an enlarged cervical lymph node on
the right that is painless, rubbery, and firm. There is no
hepatosplenomegaly. She is then referred for excisional biopsy
of the enlarged lymph node that shows Reed-Sternberg cells.
Which of the following is the most likely diagnosis? Correct
Answers Hodgkin lymphoma
A 16-year-old girl presents with her mother for a sports physical
examination. She plays volleyball and reports no chest pain,
difficulty of breathing, or family history of heart disease. She
has been vegan since the age of 13. She is a straight-A student.
Physical exam is normal. You obtain a complete blood count,
which reveals hemoglobin of 10 g/dL and mean corpuscular
volume of 110 fL. Which of the following is the most likely
diagnosis? Correct Answers Vitamin B12 deficiency
A 18-year-old man with sickle cell disease presents with chest
pain, cough, and fever. His vitals are HR 132 bpm, RR 28/min,
BP 110/65 mm Hg, and T 101.1°F. His chest X-ray shows a
right lower lobe infiltrate. Hemoglobin is 8.0 g/dL. Which of the
Solutions
17-year-old boy presents to the ED with a painless mass on the
left side of his neck, which he first noticed three months ago,
that is now increasing in size. The patient also reports a 10-
pound weight loss and night sweats. On exam, you note a 5 cm
rubbery, firm, and mobile mass located in the anterior cervical
triangle. The overlying skin is intact, with no redness, streaking,
or drainage. What is the most likely diagnosis? Correct Answers
Hodgkin lymphoma
3-year-old boy presents to your clinic due to his mother's
concerns about the patient having intermittent fevers, fatigue,
bruising without injury and a pale appearance. Physical exam
reveals a palpable liver and spleen, and pale conjunctiva. Initial
laboratory testing reveals elevated white blood cell count and
lymphoblasts on the peripheral smear. Which of the following is
used to confirm the diagnosis? Correct Answers Bone marrow
aspiration and biopsy
A 10-year-old boy presents to the clinic with easy bruising and
frequent prolonged epistaxis. He has a family history of a
bleeding disorder. Vital signs include a HR of 90 bpm, BP of
100/60 mm Hg, RR of 20/min, oxygen saturation of 98% on
room air, and T of 98.6°F. Physical examination findings
include a regular rate and rhythm, lungs clear to auscultation
bilaterally, and several bruises on the skin. Laboratory
evaluation reveals a von Willebrand factor antigen and activity
level of 20 IU/dL. Which of the following additional laboratory
findings would be most consistent with the suspected diagnosis?
,Correct Answers Normal platelets, normal prothrombin time,
and normal activated partial thromboplastin time
A 12-month-old girl is in the clinic for a well-child check. She
can walk and is eating more table foods. The parents have given
her goat's milk for two months. Physical examination is normal.
Laboratory screening obtained shows hemoglobin of 10 g/dL,
mean corpuscular volume 77 fL and elevated red cell
distribution width. Which of the following is the most likely
diagnosis? Correct Answers Iron deficiency anemia
A 12-year-old girl presents for her annual well child check. She
had menarche eight months prior, and has had menses every
month. Each cycle lasts two weeks. The patient uses at least six
pads on most days of the cycle. On exam, she is pale but
otherwise well appearing. Her heart rate is 80 beats per minute,
blood pressure 110/65, and respiratory rate 14. The remainder of
her exam is within normal limits. Which of the following are the
most likely laboratory findings? Correct Answers Hemoglobin
6 g/dL, mean corpuscular volume 60, RDW 18
A 14-month-old boy presents to the emergency department with
his adoptive parent, who reports that he has had increased
irritability with episodes of inconsolable crying for the past 3
hours with no history of injury. He has had a recent upper
respiratory tract infection with a runny nose and cough for the
past week. His parent notices that he cries more when he is
walking and that he is easily fatigued. His parent adopted him
about 6 months ago and does not have a record of his medical
history. His temperature is 98.7°F, blood pressure is 105/64 mm
Hg, heart rate is 106 bpm, oxygen saturation is 98% on room air,
,and respiratory rate is 25/min. On a physical exam, the patient is
ill-appearing, irritable, and crying inconsolably. He has evidence
of scleral icterus and has swelling to both hands and both feet
with tenderness to palpation to the dorsal surfaces. His
hemoglobin is 8.2 g/dL. Which of the following tests w Correct
Answers Hemoglobin electrophoresis
A 14-year-old boy is brought by his grandparents to the
Emergency Department due to difficulty breathing. His
grandmother notes that the boy was eating his snack of salted
peanuts and an apple when he started to complain of generalized
itchiness especially around his mouth, face, and extremities, and
swelling around his eyes. Physical examination reveals an
irritable child in respiratory distress with periorbital edema,
tonsillopharyngeal congestion, poor air entry on lung
auscultation, and multiple erythematous and raised wheals on
the trunk and extremities. Which of the following is the most
important medication in treating this child? Correct Answers
Epinephrine
A 15-year-old girl is in your clinic with her mother for a sports
physical examination. She denies any symptoms and is doing
well in school. There is no family history of sudden death or
heart disease. She has been a vegan for the past year and takes
food supplements. She has regular menstrual periods. Physical
examination is normal. You perform a screening complete blood
count (CBC) that reveals hemoglobin of 10 g/dL, mean
corpuscular volume (MCV) of 68, with ferritin of 11 ng/mL
(normal for females 12-150 ng/mL). Which of the following is
the next best step in management? Correct Answers Trial
treatment with oral iron supplements
, A 16-year-old boy presents with a marked hemarthrosis of his
knee after tripping and striking it against the edge of a step. This
has happened in the past. His activated partial thromboplastin
time is prolonged and his prothrombin time and thrombin time
are normal. What is the most likely diagnosis? Correct Answers
Hemophilia B
A 16-year-old girl is in the clinic for a follow-up for a fever. She
has been having prolonged fever accompanied by fatigue, night
sweats, and loss of appetite. On physical examination, she has a
temperature of 38°C with an enlarged cervical lymph node on
the right that is painless, rubbery, and firm. There is no
hepatosplenomegaly. She is then referred for excisional biopsy
of the enlarged lymph node that shows Reed-Sternberg cells.
Which of the following is the most likely diagnosis? Correct
Answers Hodgkin lymphoma
A 16-year-old girl presents with her mother for a sports physical
examination. She plays volleyball and reports no chest pain,
difficulty of breathing, or family history of heart disease. She
has been vegan since the age of 13. She is a straight-A student.
Physical exam is normal. You obtain a complete blood count,
which reveals hemoglobin of 10 g/dL and mean corpuscular
volume of 110 fL. Which of the following is the most likely
diagnosis? Correct Answers Vitamin B12 deficiency
A 18-year-old man with sickle cell disease presents with chest
pain, cough, and fever. His vitals are HR 132 bpm, RR 28/min,
BP 110/65 mm Hg, and T 101.1°F. His chest X-ray shows a
right lower lobe infiltrate. Hemoglobin is 8.0 g/dL. Which of the
