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

Vitamin B12 deficiency anemia

Answer

Anemia of chronic disease

Answer

Thalassemia trait

Question 2

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

Accepted Answer

Low serum ferritin

Answer

Low hemoglobin

Answer

Elevated serum ferritin with low TIBC

Answer

Elevated reticulocyte count

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

Bone marrow biopsy

Answer

Iron studies

Answer

Peripheral blood smear for malaria

Question 4

Pernicious anemia results from which underlying mechanism?

Accepted Answer

Autoimmune destruction of parietal cells leading to intrinsic factor deficiency

Answer

Dietary iron deficiency

Answer

Folate malabsorption in the terminal ileum

Answer

Chronic gastrointestinal blood loss

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

Exchange transfusion

Answer

Initiation of hydroxyurea

Answer

Urgent bone marrow transplant evaluation

Question 6

Hereditary spherocytosis is caused by a defect in which cellular component?

Accepted Answer

Spectrin or ankyrin proteins in the RBC membrane

Answer

Hemoglobin beta-globin chains

Answer

Pyruvate kinase enzyme

Answer

Glucose-6-phosphate dehydrogenase

Question 7

A patient with G6PD deficiency develops acute hemolytic anemia after starting primaquine. What is the underlying mechanism?

Accepted Answer

Oxidative stress causing Heinz body formation and hemolysis

Answer

Immune-mediated destruction of RBCs via antibodies

Answer

Mechanical destruction of RBCs in small vessels

Answer

Complement-mediated intravascular lysis