1. (H1) A 17-year-old girl is involved in a motor vehicle accident and incurs blunt abdominal trauma. On arrival in the emergency department she has orthostatic hypotension and tachycardia. Which of the following peripheral blood findings is most likely to be present a week later?
A. Leukocytosis
B. Microcytosis
C. Reticulocytosis
D. Schistocytes
E. Thrombocytopenia
Answer: C: Reticulocytosis.
She has acute blood loss, and the response is increased marrow release and production of erythrocytes, including early forms, marked by polychromasia as viewed on a peripheral blood smear, and an increased reticulocyte count. These early RBCs are larger in size. Platelets and WBCs are not directly affected to a significant degree, since there are far fewer of them than red blood cells.
2. (H1) Which of the following is the best indication for ordering a manual WBC differential count on a 5-year-old child?
A. Accident with trauma
B. Failure to thrive
C. History of seizures
D. Prolonged vomiting
E. Recurrent infection
Answer: E: Recurrent infection.
White blood cells fight infections, and recurrent infections suggest that either a quantitative or qualitative leukocyte problem may be present. Looking at the morphology of the white blood cells on the peripheral blood smear gives a better indication of possible diagnoses.
3. (H4) A 69-year-old woman has had increasing dyspnea for 3 months. On examination there is dullness to percussion in lower lung fields bilaterally. A chest x-ray shows bilateral pleural effusions. A left thoracentesis is performed and 500 mL of reddish fluid is removed. Which of the following pre-existig diagnoses most suggests the need for cytopathologic examination of this fluid?
A. Breast carcinoma
B. Diabetes mellitus
C. Chronic sinusitis
D. Pulmonary emphysema
E. Systemic lupus erythematosus
Answer: A: Breast carcinoma.
Pleural fluid that appears bloody suggests a malignant effusion from pleural metastases in a patient with a previously diagnosed carcinoma. Cytopathologic examination will aid in identifying the presence of malignant cells.
4. (H5) A 19-year-old woman has had a history of deep venous thrombosis since childhood. She has had two episodes of pulmonary thromboembolism in the past 4 years. On examination she has a swollen and tender left leg. Doppler ultrasound shows left femoral vein thrombosis. Laboratory studies show Hgb 14 g/dL and WBC count 7510/microliter. Which of the following laboratory tests should be obtained on this woman?
A. Activated partial thromboplastin time
B. Platelet count
C. Factor V Leiden mutation
D. Prothrombin time
E. Von Willebrand factor assay
Answer: C: FVL mutation.
She has a coagulopathy marked by thrombosis but not bleeding. At her age and with her history, the likelihood for a congenital coagulopathy is increased. Factor V Leiden mutation is one of the most frequent findings with this history.
5. (H6) A 20-year-old East Asian woman delivers a stillbirth with severe hydrops fetalis. Which of the following abnormal hemoglobins is most likely to be identified with postmortem hemoglobin electrophoresis on blood obtained from the stillbirth?
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