Título em Hematologia e Hemoterapia Practice Questions - Título de Especialista em Hematologia e Hemoterapia (ABHH AMB) Exam - Título em Hematologia e Hemoterapia Practice Questions - Título de Especialista em Hematologia e Hemoterapia (ABHH AMB) Exam

Question 1

A 34-year-old female presents with persistent fatigue, pica (pagophagia), and brittle spoon-shaped nails (koilonychia). Laboratory workup reveals: Hemoglobin 8.4 g/dL, MCV 68 fL, MCH 22 pg, Serum Iron 24 mcg/dL, Total Iron-Binding Capacity (TIBC) 450 mcg/dL, Transferrin Saturation 5.3%, and Serum Ferritin 6 ng/mL. Which laboratory finding most definitively confirms iron deficiency anemia (anemia ferropriva) over anemia of chronic disease / inflammation?

Severely decreased serum ferritin (< 15 ng/mL) combined with elevated TIBC. Elevated serum ferritin with normal transferrin saturation. Marked elevation of soluble transferrin receptor (sTfR) with a normal transferrin level. Decreased hemoglobin with an elevated reticulocyte production index (> 3.0).

Correct Answer:

Severely decreased serum ferritin (< 15 ng/mL) combined with elevated TIBC.

Question 2

A 58-year-old male with a history of chronic autoimmune gastritis presents with progressive paresthesias in a stocking-glove distribution, loss of proprioception and vibratory sense, and memory lapses. Laboratory studies reveal: Hb 7.2 g/dL, MCV 118 fL, Platelets 95 x 10^9/L, Leukocytes 3.2 x 10^9/L, LDH 1,850 U/L, Indirect Bilirubin 2.1 mg/dL, and hypersegmented neutrophils on peripheral blood smear. Which diagnostic metabolite profile is most specific for cobalamin (Vitamin B12) deficiency over folate deficiency?

Elevated serum methylmalonic acid (MMA) and elevated serum homocysteine. Elevated serum homocysteine with normal serum methylmalonic acid (MMA). Normal serum methylmalonic acid (MMA) with low erythrocyte folate. Suppressed serum methylmalonic acid (MMA) and elevated serum cobalamin.

Correct Answer:

Elevated serum methylmalonic acid (MMA) and elevated serum homocysteine.

Question 3

A 22-year-old male with known Sickle Cell Disease (Anemia Falciforme - HbSS) is admitted with fever (38.8°C), acute pleuritic chest pain, tachypnea (RR 28/min), and an oxygen saturation of 88% on ambient air. Chest radiography reveals a new alveolar consolidation in the right lower lobe. In accordance with Brazilian Clinical Protocols (PCDT da Doença Falciforme), which emergency therapeutic approach is indicated?

Empiric broad-spectrum intravenous antibiotics (including macrolide coverage), aggressive fluid hydration, supplemental oxygen, and prompt red blood cell transfusion (simple or exchange) targeting Hb ~10 g/dL. High-dose corticosteroids alone, strict fluid restriction, and immediate prophylactic anticoagulation with full-dose warfarin. Routine therapeutic phlebotomy to reduce blood viscosity followed by high-dose aspirin. Immediate emergency splenectomy to prevent recurrent splenic sequestration crisis.

Correct Answer:

Question 4

A 4-year-old child with homozygous sickle cell disease (HbSS) undergoes routine primary stroke screening with Transcranial Doppler (Doppler Transcraniano - DTC). The examination reveals a time-averaged maximum mean velocity (TAMV) of 215 cm/s in the right middle cerebral artery, confirmed on repeat testing 2 weeks later. According to established guidelines (STOP trial and PCDT MS), what is the appropriate clinical intervention?

Initiation of a chronic red blood cell transfusion program (transfusão crônica regular) targeting HbS < 30%. Observation with repeat Transcranial Doppler in 12 months without therapeutic intervention. Immediate initiation of aspirin 100 mg daily as monotherapy without transfusion. Immediate surgical revascularization (encephaloduroarteriosynangiosis) prior to medical therapy.

Correct Answer:

Initiation of a chronic red blood cell transfusion program (transfusão crônica regular) targeting HbS < 30%.

Question 5

Hydroxyurea (hidroxiureia) is the cornerstone disease-modifying pharmacotherapy for patients with Sickle Cell Disease (Doença Falciforme). What is the primary molecular and cellular mechanism through which hydroxyurea exerts its main therapeutic benefit in HbSS patients?

Induction of fetal hemoglobin (HbF / Hemoglobina Fetal) synthesis, which inhibits intracellular deoxy-HbS polymerization. Direct covalent binding to the beta-globin chain preventing sickle erythrocyte dehydration. Competitive inhibition of splenic macrophages to prolong red blood cell lifespan. Direct enzymatic cleavage of abnormal alpha-globin tetramers.

Correct Answer:

Induction of fetal hemoglobin (HbF / Hemoglobina Fetal) synthesis, which inhibits intracellular deoxy-HbS polymerization.

Question 1

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Prepare with the Título em Hematologia e Hemoterapia Practice Questions - Título de Especialista em Hematologia e Hemoterapia (ABHH AMB) Exam practice quiz. This question bank includes 100 questions covering year-old, male, blood, presents, and reveals. Use it to review important concepts, identify knowledge gaps, and build confidence for the related exam, course, or assessment.

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Título em Hematologia e Hemoterapia Practice Questions - Título de Especialista em Hematologia e Hemoterapia (ABHH AMB) Exam

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Título em Hematologia e Hemoterapia Practice Questions - Título de Especialista em Hematologia e Hemoterapia (ABHH AMB) Exam

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