Internal Medicine Exam Hematology

Question 1

A 45-year-old woman presents with fatigue and pallor. Labs show Hgb 8.2 g/dL, MCV 72 fL, and low serum ferritin. What is the most likely diagnosis?

Accepted Answer

Iron deficiency anemia

Answer

Iron deficiency anemia classically presents with microcytic anemia (low MCV) and low serum ferritin, which is the most specific marker of depleted iron stores.

Question 2

Which lab finding best distinguishes iron deficiency anemia from anemia of chronic disease?

Accepted Answer

Low serum ferritin

Answer

A low serum ferritin is highly specific for iron deficiency anemia; in anemia of chronic disease, ferritin is normal or elevated because it is an acute-phase reactant.

Question 3

A 65-year-old man presents with Hgb 7.5 g/dL, MCV 110 fL, and hypersegmented neutrophils on peripheral smear. What is the most appropriate next step?

Accepted Answer

Serum B12 and folate levels

Answer

Macrocytic anemia with hypersegmented neutrophils strongly suggests megaloblastic anemia due to B12 or folate deficiency, which should be confirmed with serum levels.

Question 4

Pernicious anemia results from which underlying mechanism?

Accepted Answer

Autoimmune destruction of parietal cells leading to intrinsic factor deficiency

Answer

Pernicious anemia is caused by autoimmune destruction of gastric parietal cells, leading to loss of intrinsic factor, which is required for terminal ileum absorption of vitamin B12.

Question 5

A patient with sickle cell disease presents with an acute vaso-occlusive pain crisis. What is the MOST important initial management step?

Accepted Answer

IV fluids and adequate analgesia

Answer

Acute vaso-occlusive pain crisis is managed with IV hydration to improve blood flow and adequate analgesia (NSAIDs, opioids) to control pain.

Internal Medicine Exam Practice Test

Internal Medicine Exam Practice Test

Internal Medicine Exam Hematology