Hematological and Immune Problems-
Chapter 18-Dunphy
Mrs. Jameson complains of unilateral blurry vision and partial blindness in the left
eye. On PE, you find decreased peripheral vision on her left side. Funduscopic
examination reveals cotton-wool spots. Your most likely diagnosis is
A. cryptococcosis
B. toxoplasmosis
C. cytomegalovirus infection
D. herpes simplex virus infection - C
Sickle cell anemia affects African Americans. Approximately 1 in 400 African
Americans in the United States has sickle cell disease (SCD). Advances in treatment
have been made, but life expectancy is still limited. The mean survival time for men
with the disease is approximately
A. 24 years
B. 34 years
C. 42 years
D. 52 years - C
You suspect that your new client Doug, age 28, has hepatitis C although he is
currently asymptomatic. Your suspicion is based on his medical history, which
includes which of the following factors that has been identified as a red flag for this
disease?
A. History of GERD
B. Diet high in fat and alcohol
C. A history of mononucleosis at age 17
D. Unsafe sexual behaviors - D
Your client, George, age 60, presents with pruritus and complains of
lymphadenopathy in his neck. He also complains of night sweats and has noticed a
low-grade fever. He has not lost any weight and otherwise feels well. He is widowed
and has been dating a new woman recently. On physical examination, you find
enlarged supraclavicular nodes. You suspect:
A. Lung cancer.
B. Hodgkin's lymphoma.
C. A lingering viral infection from a bout of flu he had 6 weeks ago.
D. Non-Hodgkin's lymphoma. - B
Mindy, age 6, recently was discharged from the hospital after a sickle cell crisis. You
are teaching her parents to be alert to the manifestations of splenic sequestration
and tell them to be alert to
A. vomiting and diarrhea
B. decreased mental acuity
C. abdominal pain, pallor, and tachycardia
D. abdominal pain and vomiting - C
,Your client Mrs. Young, age 64, is here to see you because she has pain in her left
breast. She reports no pain in her right breast and no noted lesions or masses on
breast self-exam, which she performs monthly. You know that
A. at her age, you do not need to worry about breast cancer
B. initial presentation of breast pain is usually not suspicious for a malignancy
C. she must be sent for a mammogram as soon as possible
D. she has no personal or family history of breast cancer; therefore, you are not
concerned - C
Samantha is being given platelets because of acute leukemia. One "pack" of
platelets should raise her count by how much?
A. 2,000 to 4,000 mm3
B. 5,000 to 8,000 mm3
C. 9,000 to 12,000 mm3
D. About 15,000 mm3 - B
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 iron and total iron binding capacity (TIBC)
B. Order a serum ferritin
C. Order a serum folate level
D. Order a serum iron, TIBC, and serum ferritin level - D
Robin has HIV and is having a problem with massive diarrhea. You suspect the
cause is
A. cryptococcosis
B. toxoplasmosis
C. cryptosporidiosis
D. cytomegalovirus - C
Julia asks how smoking increases the risk for folic acid deficiency. You respond that
smoking
A. causes small-vessel disease and constricts all vessels that transport essential
nutrients
B. decreases vitamin C absorption
C. affects the liver's ability to store folic acid
D. causes nausea, thereby inhibiting the appetite and ingestion of foods rich in folic
acid - B
Jimmy, age 6 months, is newly diagnosed with sickle cell disease. His mother brings
him to the clinic for a well-baby visit. Which of the following should you do on this
visit?
A. Tell the parents that Jimmy will not be immunized because of his diagnosis.
B. Tell the parents that Jimmy should not go to day care
C. Immunize Jimmy with diphtheria, tetanus, and pertussis; Haemophilus influenzae
type B (HIB); hepatitis B (HBV); and poliomyelitis vaccines
D. Immunize Jimmy with measles, mumps, and rubella; HIB; and HBV vaccines only
-C
, Your client, Ms. Jones, has an elevated platelet count. You suspect
A. systemic lupus erythematosus
B. infectious mononucleosis
C. disseminated intravascular coagulation (DIC)
D. splenectomy - D
When a neonate is initially protected against measles, mumps, and rubella because
the mother is immune, this is an example of which type of immunity?
A. Natural active
B. Artificial active
C. Natural passive
D. Artificial passive - C
One major approach to cancer prevention is
A. Colonoscopy
B. new drug trials
C. Pap smears for women of all ages
D. host modification - D
Allie, age 5, is being treated with radiation for cancer. Her mother asks about the
effect radiation will have on Allie's future growth. Although she knows that a
specialist will be handling Allie's care, her mother asks for your opinion. How do you
respond?
A. "Let's worry about the cancer first, then see how her growth is affected."
B. "Chemotherapy may affect her future growth, but radiation will not."
C. "She will probably have growth hormone problems, in which case she can then
begin growth hormone therapy."
D. "That's the least of your worries now; everything will turn out okay." - C
Maria, age 35, asks if being overweight predisposes her to cancer. How do you
respond?
A. "No, you have the same risk as a normal-weight individual."
B. "You have less of a risk of cancer than normal-weight individuals because you
have protein stores to combat mutant cells."
C. "Yes, you have an increased risk for hormone-dependent cancers because of
your obesity."
D. "Yes, you have an increased risk because you have many more cells in all the
organs of your body." - C
Your client Jeannie, age 64, comes to you complaining of tinnitus and
lightheadedness without loss of consciousness. On PE, you note splenomegaly. To
sort out your differential diagnosis, you order an alkaline phosphatase and vitamin
B12 level because you are ruling out a diagnosis of
A. liver cancer
B. pancreatic cancer
C. mononucleosis
D. polycythemia vera - D
When Judy tells you that she has hemophilia, you know that
A. both of her parents also have the disease
Chapter 18-Dunphy
Mrs. Jameson complains of unilateral blurry vision and partial blindness in the left
eye. On PE, you find decreased peripheral vision on her left side. Funduscopic
examination reveals cotton-wool spots. Your most likely diagnosis is
A. cryptococcosis
B. toxoplasmosis
C. cytomegalovirus infection
D. herpes simplex virus infection - C
Sickle cell anemia affects African Americans. Approximately 1 in 400 African
Americans in the United States has sickle cell disease (SCD). Advances in treatment
have been made, but life expectancy is still limited. The mean survival time for men
with the disease is approximately
A. 24 years
B. 34 years
C. 42 years
D. 52 years - C
You suspect that your new client Doug, age 28, has hepatitis C although he is
currently asymptomatic. Your suspicion is based on his medical history, which
includes which of the following factors that has been identified as a red flag for this
disease?
A. History of GERD
B. Diet high in fat and alcohol
C. A history of mononucleosis at age 17
D. Unsafe sexual behaviors - D
Your client, George, age 60, presents with pruritus and complains of
lymphadenopathy in his neck. He also complains of night sweats and has noticed a
low-grade fever. He has not lost any weight and otherwise feels well. He is widowed
and has been dating a new woman recently. On physical examination, you find
enlarged supraclavicular nodes. You suspect:
A. Lung cancer.
B. Hodgkin's lymphoma.
C. A lingering viral infection from a bout of flu he had 6 weeks ago.
D. Non-Hodgkin's lymphoma. - B
Mindy, age 6, recently was discharged from the hospital after a sickle cell crisis. You
are teaching her parents to be alert to the manifestations of splenic sequestration
and tell them to be alert to
A. vomiting and diarrhea
B. decreased mental acuity
C. abdominal pain, pallor, and tachycardia
D. abdominal pain and vomiting - C
,Your client Mrs. Young, age 64, is here to see you because she has pain in her left
breast. She reports no pain in her right breast and no noted lesions or masses on
breast self-exam, which she performs monthly. You know that
A. at her age, you do not need to worry about breast cancer
B. initial presentation of breast pain is usually not suspicious for a malignancy
C. she must be sent for a mammogram as soon as possible
D. she has no personal or family history of breast cancer; therefore, you are not
concerned - C
Samantha is being given platelets because of acute leukemia. One "pack" of
platelets should raise her count by how much?
A. 2,000 to 4,000 mm3
B. 5,000 to 8,000 mm3
C. 9,000 to 12,000 mm3
D. About 15,000 mm3 - B
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 iron and total iron binding capacity (TIBC)
B. Order a serum ferritin
C. Order a serum folate level
D. Order a serum iron, TIBC, and serum ferritin level - D
Robin has HIV and is having a problem with massive diarrhea. You suspect the
cause is
A. cryptococcosis
B. toxoplasmosis
C. cryptosporidiosis
D. cytomegalovirus - C
Julia asks how smoking increases the risk for folic acid deficiency. You respond that
smoking
A. causes small-vessel disease and constricts all vessels that transport essential
nutrients
B. decreases vitamin C absorption
C. affects the liver's ability to store folic acid
D. causes nausea, thereby inhibiting the appetite and ingestion of foods rich in folic
acid - B
Jimmy, age 6 months, is newly diagnosed with sickle cell disease. His mother brings
him to the clinic for a well-baby visit. Which of the following should you do on this
visit?
A. Tell the parents that Jimmy will not be immunized because of his diagnosis.
B. Tell the parents that Jimmy should not go to day care
C. Immunize Jimmy with diphtheria, tetanus, and pertussis; Haemophilus influenzae
type B (HIB); hepatitis B (HBV); and poliomyelitis vaccines
D. Immunize Jimmy with measles, mumps, and rubella; HIB; and HBV vaccines only
-C
, Your client, Ms. Jones, has an elevated platelet count. You suspect
A. systemic lupus erythematosus
B. infectious mononucleosis
C. disseminated intravascular coagulation (DIC)
D. splenectomy - D
When a neonate is initially protected against measles, mumps, and rubella because
the mother is immune, this is an example of which type of immunity?
A. Natural active
B. Artificial active
C. Natural passive
D. Artificial passive - C
One major approach to cancer prevention is
A. Colonoscopy
B. new drug trials
C. Pap smears for women of all ages
D. host modification - D
Allie, age 5, is being treated with radiation for cancer. Her mother asks about the
effect radiation will have on Allie's future growth. Although she knows that a
specialist will be handling Allie's care, her mother asks for your opinion. How do you
respond?
A. "Let's worry about the cancer first, then see how her growth is affected."
B. "Chemotherapy may affect her future growth, but radiation will not."
C. "She will probably have growth hormone problems, in which case she can then
begin growth hormone therapy."
D. "That's the least of your worries now; everything will turn out okay." - C
Maria, age 35, asks if being overweight predisposes her to cancer. How do you
respond?
A. "No, you have the same risk as a normal-weight individual."
B. "You have less of a risk of cancer than normal-weight individuals because you
have protein stores to combat mutant cells."
C. "Yes, you have an increased risk for hormone-dependent cancers because of
your obesity."
D. "Yes, you have an increased risk because you have many more cells in all the
organs of your body." - C
Your client Jeannie, age 64, comes to you complaining of tinnitus and
lightheadedness without loss of consciousness. On PE, you note splenomegaly. To
sort out your differential diagnosis, you order an alkaline phosphatase and vitamin
B12 level because you are ruling out a diagnosis of
A. liver cancer
B. pancreatic cancer
C. mononucleosis
D. polycythemia vera - D
When Judy tells you that she has hemophilia, you know that
A. both of her parents also have the disease
