Question 1

You are treating and monitoring a patient for whom you have prescribed heparin therapy.You check the latest partial thromboplastin time (PTT)measurement and write an order for "no change." Which result most likely indicates this patient's PTT reading?

Accepted Answer

The therapeutic range for partial thromboplastin time (PTT) when a patient is on heparin therapy is typically 1.5 to 2.5 times the normal value. Normal PTT values are usually between 25 to 35 seconds, so a PTT reading of 46 to 70 seconds indicates effective anticoagulation without excessive risk of bleeding, which would justify a decision of "no change" in the heparin therapy.

Question 2

You are a physician assistant student on your internal medicine rotation when you are asked how you would order heparin to treat a patient with deep vein thrombosis (DVT)and possible pulmonary embolism (PE).Which response would be most appropriate?

Accepted Answer

The most appropriate response for initiating heparin therapy in a patient with DVT and possible PE is to give an initial bolus of 80 units/kg IV followed by a continuous infusion of 18 units/kg/hour. This regimen is aimed at quickly achieving therapeutic anticoagulation.

Question 3

Concomitant ingestion of iron and which vitamin will enhance the absorption of iron?

Accepted Answer

Concomitant ingestion of iron and vitamin C enhances the absorption of iron. Vitamin C reduces the ferric form of iron to ferrous form, which is more readily absorbed. Therefore 500 mg vitamin C is the best choice. The other options do not enhance the absorption of iron.

Question 4

You are treating a patient who has been recently diagnosed with pernicious anemia.What is the preferred method of supplementation?

Accepted Answer

The answer of You are treating a patient who has...

Question 5

You are treating a 25-year-old female who you have determined has iron deficiency anemia.She also has a history of gastroesophageal reflux disease for which you have prescribed a proton-pump inhibitor (PPI).In what way will this patient's history affect your treatment of her anemia?

Accepted Answer

PPIs can decrease the absorption of iron from the digestive system, so it is recommended that the patient take the iron supplement at a different time than the PPI to optimize iron absorption. Taking them at the same time may decrease the effectiveness of the iron supplementation. The patient does not need to discontinue their PPI while on iron supplementation, but timing the supplements differently is important.

Question 6

The appropriate therapeutic dose of oral ferrous sulphate for treating a patient with iron deficiency is:

Accepted Answer

The appropriate therapeutic dose of oral ferrous sulphate for treating iron deficiency is 325 mg 2 to 4 times daily. This dosage ensures adequate iron intake to correct the deficiency.

Question 7

You are caring for a patient in chronic renal failure.The internist in your office wants to begin erythropoietin.Which lab is most important to obtain prior to beginning this type of treatment?

Accepted Answer

Erythropoietin treatment requires adequate iron stores to be effective, so checking serum iron levels is crucial to ensure the patient can respond to the therapy.

Question 8

You have just begun treating a patient with iron deficiency anemia.Your instructions to the patient include advising her on the length of time she will be taking iron supplements.What is the usual duration?

Accepted Answer

The usual duration for taking iron supplements for iron deficiency anemia is three to six months. This allows for the depletion of iron stores to be replenished and for normal hemoglobin levels to be restored. However, the length of time may vary depending on the severity of the anemia and the patient's response to treatment. It is important for the patient to continue taking the supplements as prescribed by their healthcare provider even after symptoms improve to ensure that iron stores remain adequate.

Question 9

Which of the following is the most common etiology of B₁₂ deficiency in pernicious anemia?

Accepted Answer

The answer of Which of the following is the most...

Question 10

Which form of iron supplementation is typically used only for patients on hemodialysis?

Accepted Answer

Iron sucrose is typically used for patients on hemodialysis due to its safety profile and effectiveness in this specific patient population.

Question 11

What is the primary difference between unfractionated heparin and low-molecular-weight heparin (LMWH)?

Accepted Answer

The primary difference between unfractionated heparin and low-molecular-weight heparin (LMWH) is that LMWH binds only to factor Xa, while unfractionated heparin binds to both factor Xa and thrombin (factor II).

Question 12

You have just examined a 62-year-old male who complains of fatigue and lethargy.His complete blood count (CBC)reveals microcytic,hypochromic anemia.What should be the next step in treating this patient?

Accepted Answer

Given the patient's age and presentation with microcytic, hypochromic anemia, the next step should be to schedule a colonoscopy within 2 weeks. This is to rule out gastrointestinal bleeding as a potential cause, which is a common and serious concern in older adults presenting with these symptoms.

Question 13

Which test is the gold standard for diagnosing iron deficiency anemia?

Accepted Answer

The answer of Which test is the gold standard for...

Question 14

Erythropoietin is typically used for treatment of chronic renal failure,human immunodeficiency virus (HIV)in patients being treated with zidovudine,and which other disorder?

Accepted Answer

Erythropoietin is commonly used for anemia associated with cancer chemotherapy, but not for iron deficiency anemia, acute blood loss anemia, pernicious anemia, or acute folate deficiency.

Question 15

LMWHs carry which black box warning?

Accepted Answer

LMWHs carry a black box warning to never use them in patients with a spinal or epidural catheter, as it increases the risk of bleeding and spinal hematoma. This warning is included in the prescribing information for all LMWHs.

Question 16

You have just completed a history on a patient newly admitted to the internal medicine service at your hospital with an admitting diagnosis of DVT,r/o PE.The patient admits to taking an antihypertensive for blood pressure and ginseng,ginger,and gingko for memory improvement.How will this information affect his discharge orders?

Accepted Answer

Ginseng, ginger, and gingko all have anticoagulant properties, which can increase the risk of bleeding, especially in a patient with a history of DVT and potential PE. Discontinuing these supplements is important to avoid potential interactions with prescribed anticoagulant therapy.

Question 17

You are treating a patient with suspected iron deficiency anemia.Which laboratory test would you order for its accuracy in rendering this diagnosis?

Accepted Answer

Serum ferritin level is the best laboratory test to order for accuracy in rendering a diagnosis of iron deficiency anemia. Ferritin is a protein that stores iron, and its level decreases when the body is low in iron. A low level of serum ferritin is the most specific marker for diagnosing iron-deficiency anemia. Serum iron level and vitamin B12 and B6 levels are not specific markers for diagnosing iron-deficiency anemia.

Question 18

When monitoring a patient with vitamin B₁₂ deficiency,which of the following labs would show the effects of supplementation first?

Accepted Answer

Reticulocyte count would show the effects of vitamin B12 supplementation first because vitamin B12 plays a role in erythropoiesis, the process of creating red blood cells. As reticulocytes are immature red blood cells, an increase in their count would indicate improved erythropoiesis and thus, the effects of vitamin B12 supplementation. Hematocrit and hemoglobin levels would also eventually improve with vitamin B12 supplementation, but this would take longer than the increase in reticulocyte count. Folate level, iron level, and ferritin level are not directly related to vitamin B12 deficiency or supplementation.

Question 19

A 31-year-old female's labs reveal microcytic,hypochromic anemia.The patient has no previous medical or surgical history.What should be your recommended first line of treatment for this patient?

Accepted Answer

Microcytic, hypochromic anemia is typically caused by iron deficiency. Oral ferrous sulphate is the first line of treatment for this type of anemia. Erythropoietin is used in patients with chronic kidney disease to stimulate red blood cell production. Folic acid and vitamin B12 are used in megaloblastic anemias, which are not indicated in this patient's presentation.

Question 20

The most common side effects of oral iron supplementation are GI related.The most effective way to overcome these effects are to:

Accepted Answer

Instructing the patient to take the lowest possible dose and slowly titrate the dose to a full dose over several days can help reduce GI related side effects. This allows the patient's body to adjust to the iron supplementation and minimize discomfort. Instructing the patient to disregard the discomfort or discontinuing iron supplementation may lead to non-compliance, which can negatively impact treatment outcomes. Taking Tums prior to taking iron may interfere with iron absorption, so it is not recommended.

Quiz 9: Drugs Used in the Treatment of Blood Disorders

You are treating and monitoring a patient for whom you have prescribed heparin therapy.You check the latest partial thromboplastin time (PTT) measurement and write an order for "no change." Which result most likely indicates this patient's PTT reading?

You are a physician assistant student on your internal medicine rotation when you are asked how you would order heparin to treat a patient with deep vein thrombosis (DVT) and possible pulmonary embolism (PE) .Which response would be most appropriate?

Concomitant ingestion of iron and which vitamin will enhance the absorption of iron?

You are treating a patient who has been recently diagnosed with pernicious anemia.What is the preferred method of supplementation?

You are treating a 25-year-old female who you have determined has iron deficiency anemia.She also has a history of gastroesophageal reflux disease for which you have prescribed a proton-pump inhibitor (PPI) .In what way will this patient's history affect your treatment of her anemia?

The appropriate therapeutic dose of oral ferrous sulphate for treating a patient with iron deficiency is:

You are caring for a patient in chronic renal failure.The internist in your office wants to begin erythropoietin.Which lab is most important to obtain prior to beginning this type of treatment?

You have just begun treating a patient with iron deficiency anemia.Your instructions to the patient include advising her on the length of time she will be taking iron supplements.What is the usual duration?

Which of the following is the most common etiology of B₁₂ deficiency in pernicious anemia?

Which form of iron supplementation is typically used only for patients on hemodialysis?

What is the primary difference between unfractionated heparin and low-molecular-weight heparin (LMWH) ?

You have just examined a 62-year-old male who complains of fatigue and lethargy.His complete blood count (CBC) reveals microcytic,hypochromic anemia.What should be the next step in treating this patient?

Which test is the gold standard for diagnosing iron deficiency anemia?

Erythropoietin is typically used for treatment of chronic renal failure,human immunodeficiency virus (HIV) in patients being treated with zidovudine,and which other disorder?

LMWHs carry which black box warning?

You are treating a patient with suspected iron deficiency anemia.Which laboratory test would you order for its accuracy in rendering this diagnosis?

When monitoring a patient with vitamin B₁₂ deficiency,which of the following labs would show the effects of supplementation first?

A 31-year-old female's labs reveal microcytic,hypochromic anemia.The patient has no previous medical or surgical history.What should be your recommended first line of treatment for this patient?

The most common side effects of oral iron supplementation are GI related.The most effective way to overcome these effects are to:

Quiz 9: Drugs Used in the Treatment of Blood Disorders

You are treating and monitoring a patient for whom you have prescribed heparin therapy.You check the latest partial thromboplastin time (PTT) measurement and write an order for "no change." Which result most likely indicates this patient's PTT reading?

You are a physician assistant student on your internal medicine rotation when you are asked how you would order heparin to treat a patient with deep vein thrombosis (DVT) and possible pulmonary embolism (PE) .Which response would be most appropriate?

Concomitant ingestion of iron and which vitamin will enhance the absorption of iron?

You are treating a patient who has been recently diagnosed with pernicious anemia.What is the preferred method of supplementation?

You are treating a 25-year-old female who you have determined has iron deficiency anemia.She also has a history of gastroesophageal reflux disease for which you have prescribed a proton-pump inhibitor (PPI) .In what way will this patient's history affect your treatment of her anemia?

The appropriate therapeutic dose of oral ferrous sulphate for treating a patient with iron deficiency is:

You are caring for a patient in chronic renal failure.The internist in your office wants to begin erythropoietin.Which lab is most important to obtain prior to beginning this type of treatment?

You have just begun treating a patient with iron deficiency anemia.Your instructions to the patient include advising her on the length of time she will be taking iron supplements.What is the usual duration?

Which of the following is the most common etiology of B12 deficiency in pernicious anemia?

Which form of iron supplementation is typically used only for patients on hemodialysis?

What is the primary difference between unfractionated heparin and low-molecular-weight heparin (LMWH) ?

You have just examined a 62-year-old male who complains of fatigue and lethargy.His complete blood count (CBC) reveals microcytic,hypochromic anemia.What should be the next step in treating this patient?

Which test is the gold standard for diagnosing iron deficiency anemia?

Erythropoietin is typically used for treatment of chronic renal failure,human immunodeficiency virus (HIV) in patients being treated with zidovudine,and which other disorder?

LMWHs carry which black box warning?

You are treating a patient with suspected iron deficiency anemia.Which laboratory test would you order for its accuracy in rendering this diagnosis?

When monitoring a patient with vitamin B12 deficiency,which of the following labs would show the effects of supplementation first?

A 31-year-old female's labs reveal microcytic,hypochromic anemia.The patient has no previous medical or surgical history.What should be your recommended first line of treatment for this patient?

The most common side effects of oral iron supplementation are GI related.The most effective way to overcome these effects are to:

Which of the following is the most common etiology of B₁₂ deficiency in pernicious anemia?

When monitoring a patient with vitamin B₁₂ deficiency,which of the following labs would show the effects of supplementation first?