Examkin

Question

Difficulty: MediumHematology and Oncology

Match the following clinical and laboratory descriptions with the most likely underlying hematologic disorder.

  • Massive splenomegaly, 'dry tap' on bone marrow aspiration, and teardrop cells on peripheral smearPrimary Myelofibrosis
  • Episodic epistaxis, heavy menses, normal PT and aPTT, but prolonged bleeding timevon Willebrand Disease
  • Recurrent deep vein thromboses, normal PT and aPTT, and lack of aPTT prolongation upon addition of activated protein CFactor V Leiden
  • Bone pain, renal insufficiency, hypercalcemia, and peripheral smear demonstrating erythrocytes stacked like coinsMultiple Myeloma
  • Petechiae, mucosal bleeding, isolated severe thrombocytopenia, and normal PT and aPTTImmune Thrombocytopenic Purpura

Answer

1 matches Primary Myelofibrosis, 2 matches von Willebrand Disease, 3 matches Factor V Leiden, 4 matches Multiple Myeloma, 5 matches Immune Thrombocytopenic Purpura
The matching correctly pairs distinct clinical vignettes and pathognomonic laboratory or peripheral smear findings with their definitive underlying hematologic diagnoses based on established pathophysiology.

Step-by-Step Solution

1
Analyze the hematologic features associated with bone marrow fibrosis.
Identify that teardrop cells and a dry tap indicate Primary Myelofibrosis.
Fibrotic marrow forces red blood cells to squeeze out, forming teardrop shapes (dacrocytes).
2
Evaluate the bleeding disorder characterized by mucosal bleeding and prolonged bleeding time with normal coagulation times.
Match these symptoms with von Willebrand Disease.
Deficiency in von Willebrand factor impairs platelet adhesion, prolonging bleeding time without necessarily affecting PT or aPTT.
3
Examine the hypercoagulable state resistant to activated protein C.
Identify this as Factor V Leiden.
A genetic mutation in Factor V makes it resistant to cleavage by activated protein C, leading to thrombosis.
4
Review the triad of bone pain, hypercalcemia, and rouleaux formation.
Correlate these findings with Multiple Myeloma.
Excess monoclonal proteins cause RBCs to stack (rouleaux), while plasma cell proliferation causes lytic bone lesions and hypercalcemia.
5
Assess the presentation of isolated thrombocytopenia with normal coagulation studies.
Diagnose Immune Thrombocytopenic Purpura.
Autoantibody destruction of platelets leads to thrombocytopenia without affecting the coagulation cascade.

Key Concept

Clinical and laboratory diagnosis of common hematologic and oncologic disorders.
Estimated Time:2m 0s
Rate this question

Topics

Hematology and Oncology

More questions from this topic