de hematologia para discussao com a respectiva divisao.Atualizacao: Gabarito esta no PDF abaixo. Visualize ou baixe clicando aqui.Caso 1 (FELIPE E BRENA)A 46-year-old female with a history of rheumatoid arthritis presents to you with complaints of heavy menses and fatigue. In the past 18 months, her periods have become increasingly heavy for 35 days, requiring changing a maxi pad every 12 h. She also complains of increasing pain and swelling of her hands and wrists for the past 6 weeks.On physical exam, there is mild tenderness of the MCP joints, pelvic examination is normal, and she appears pale. Laboratory studies are significant for WBC = 5.2, Hgb = 9.0 g/dL, platelets = 290K, MCV = 76 fL, and RDW = 14. Her erythrocyte sedimentation rate is 32 mm/h. Ferritin is 42.Which of the following would be the next best diagnostic test in elucidating the primary mechanism of her anemia?(A) Serum c-reactive protein(B) Serum iron(C) Soluble transferrin receptor(D) Bone marrow iron stores(E) Reticulocyte countCaso 2 (SAMUEL E LEANDRO)A 73-year-old Caucasian male reports for a routine physical examination. Past medical history is significant for hypertension and osteoarthritis, and he is taking metoprolol, naproxen, and a multivitamin. CBC shows a normal WBC and platelets, but hemoglobin 11.8 g/dL and MCV of 106. B12 level is normal.Which one of the following is the most likely cause of the anemia?(A) Anemia of chronic disease(B) Folate deficiency(C) Renal disease(D) Alcohol use(E) Thalassemia traitCaso 3 (LUCAS E NATHALIA)A 65-year-old male presents to establish medical care after recently moving to your area. He has not been seen by a physician in 5 years. He states that he takes no prescription medications and is generally healthy. He has never smoked. Exam is normal other than obesity. CBC shows a normal WBC and platelets, but hemoglobin is 18.8 g/dL. Repeat hemoglobin 4 weeks later is the same.What would you recommend as the most appropriate next step in evaluation of his polycythemia?(A) Erythropoietin levels(B) Overnight oximetry(C) CT abdomen(D) Arterial blood gas(E) Testosterone levelCaso 4 (IURY, LEONARDO E YUKA)A 71-year-old female was found to have lymphocytosis on routine CBC. Further workup with flow cytometry revealed stage 0 chronic lymphocytic leukemia. After consultation with the hematologist, she returns to your office and shares that she does not require CLL treatment at this time. All of the following are true regarding this patients condition EXCEPT?(A) There is a higher risk of autoimmune cytopenias.(B) All patients should be up to date with influenza, pneumoccal, and tetanus vaccines.(C) There is a higher risk of non-hematological cancers compared to the general population.(D) There is a higher risk of diffuse large B-cell lymphoma.(E) Prophylactic IVIG should be started due to the higher risk of infection.Caso 5 (SAMUEL E IARA)A 34-year-old man is hospitalized after a motorcycle accident. He suffered multiple traumatic injuries, including splenic laceration requiring splenectomy and pneumothorax requiring chest tube placement. Today is post-operative day 7, he is clinically improving, and hopes to be discharged today. Todays CBC shows the following: WBC = 10.5, hemoglobin = 12.5 g/dL, and platelets = 832 K. Platelet count was normal on