PANRE Hematology 1 — Questions and Answers
Question 1: A 28-year-old woman presents with fatigue, pallor, and pica. Labs show Hgb 9.2 g/dL, MCV 72 fL, low ferritin, and low serum iron with elevated TIBC. What is the most appropriate initial treatment?
- Ferrous sulfate 325 mg orally three times daily (Correct answer)
- IV iron dextran infusion
- Folate supplementation 1 mg daily
- Erythropoietin injections
Correct answer: Ferrous sulfate 325 mg orally three times daily
Oral ferrous sulfate is the first-line treatment for iron deficiency anemia in a patient who can tolerate oral therapy, with IV iron reserved for those who cannot absorb or tolerate oral iron.
Question 2: A 65-year-old male presents with peripheral neuropathy, glossitis, and megaloblastic anemia. Serum B12 is 98 pg/mL. Anti-intrinsic factor antibodies are positive. What is the most likely diagnosis?
- Folate deficiency anemia
- Pernicious anemia (Correct answer)
- Celiac disease
- Alcoholic liver disease
Correct answer: Pernicious anemia
Pernicious anemia is caused by autoimmune destruction of gastric parietal cells leading to intrinsic factor deficiency and B12 malabsorption, confirmed by positive anti-intrinsic factor antibodies.
Question 3: A 22-year-old Black male with sickle cell disease presents with severe bone pain in his legs and back for 12 hours. Temperature is 37.2°C, SpO2 is 97%. What is the most appropriate immediate management?
- Urgent exchange transfusion
- IV morphine and IV fluids (Correct answer)
- Hydroxyurea administration
- Emergent bone marrow biopsy
Correct answer: IV morphine and IV fluids
A vaso-occlusive pain crisis is managed with adequate analgesia (IV opioids) and IV hydration to reduce sickling and improve microvascular flow.
Question 4: A patient on warfarin for atrial fibrillation has an INR of 9.2 with active major bleeding. Which intervention is most appropriate?
- Hold warfarin and recheck INR in 24 hours
- Administer vitamin K 10 mg orally
- Administer 4-factor prothrombin complex concentrate (PCC) and IV vitamin K (Correct answer)
- Fresh frozen plasma alone
Correct answer: Administer 4-factor prothrombin complex concentrate (PCC) and IV vitamin K
Life-threatening warfarin-associated bleeding requires 4-factor PCC for rapid reversal combined with IV vitamin K for sustained effect; PCC works faster than FFP alone.
Question 5: A 35-year-old woman has recurrent mucosal bleeding, easy bruising, and prolonged bleeding after dental extraction. PTT is mildly prolonged, PT is normal, platelet count is 210,000/μL. What is the most likely diagnosis?
- Hemophilia A
- Von Willebrand disease (Correct answer)
- Immune thrombocytopenic purpura
- Bernard-Soulier syndrome
Correct answer: Von Willebrand disease
Von Willebrand disease is the most common inherited bleeding disorder, presenting with mucosal and skin bleeding, a normal platelet count, and a mildly prolonged PTT due to VWF's role in stabilizing factor VIII.
Question 6: A 45-year-old patient with immune thrombocytopenic purpura (ITP) has a platelet count of 8,000/μL and is actively bleeding from the gums. Which is the most appropriate initial management?
- Splenectomy
- IV immunoglobulin (IVIG) and high-dose corticosteroids (Correct answer)
- Rituximab infusion
- Platelet transfusion alone
Correct answer: IV immunoglobulin (IVIG) and high-dose corticosteroids
For acute severe ITP with bleeding, IVIG combined with high-dose corticosteroids provides the fastest platelet count rise and is the preferred initial treatment.
Question 7: A 58-year-old man is diagnosed with a proximal DVT after knee replacement surgery. He has normal renal function and no active cancer. What is the preferred anticoagulation therapy?
- Warfarin with a target INR of 2-3
- Rivaroxaban 15 mg twice daily for 21 days, then 20 mg daily (Correct answer)
- Aspirin 81 mg daily
- Unfractionated heparin infusion for 3 months
Correct answer: Rivaroxaban 15 mg twice daily for 21 days, then 20 mg daily
Direct oral anticoagulants such as rivaroxaban are preferred over warfarin for DVT treatment in patients without cancer or severe renal impairment due to their predictable dosing and no need for monitoring.
PANRE Hematology 1
A 28-year-old woman presents with fatigue, pallor, and pica.
Labs show Hgb 9.2 g/dL, MCV 72 fL, low ferritin, and low serum iron with elevated TIBC.
What is the most appropriate initial treatment?