Leukopenia

Question 2

What ANC value defines agranulocytosis?

Answer 2

Absolute neutrophil count (ANC) < 500/µL.

Mnemonic: “A-GRAN = Almost Gone Neutrophils.”

Question 3

What is the most common cause of agranulocytosis?

Answer 3

• Drug-induced (especially antithyroid drugs)
• Clozapine
• Sulfonamides
• Carbamazepine
• Chemotherapy

Mnemonic: “Clozapine Crushes Counts.”

Question 4

What lab finding confirms agranulocytosis?

Answer 4

CBC with differential — shows severe neutropenia (ANC <500/µL).

Mnemonic: “CBC Confirms Crisis.”

Question 5

What is seen on a peripheral smear in agranulocytosis?

Answer 5

Absence of granulocytes.

Mnemonic: “Smear = Smooth (no grans).”

Question 6

What is the classic clinical triad for agranulocytosis?

Answer 6

• Fever
• Sore throat
• Oral ulcers

Mnemonic: “3 signs = Fever, Throat, Ulcers.”

Question 7

What bone marrow biopsy finding indicates drug-induced agranulocytosis?

Answer 7

Hypocellular marrow.

Mnemonic: “Drug Damage = Deserted Marrow.”

Question 8

What is the gold-standard diagnostic test for agranulocytosis?

Answer 8

CBC with differential.

Mnemonic: “CBC is the Crown test.”

Question 9

What complication makes agranulocytosis life-threatening?

Answer 9

Sepsis (due to loss of neutrophil defense).

Mnemonic: “No Neutrophils → No Defense.”

Question 10

What infection type is most common in agranulocytosis?

Answer 10

• Bacterial infections
• Fungal infections (esp. Candida, Aspergillus)

Mnemonic: “Fungi Follow Failure.”

Question 11

What PANCE pearl is associated with agranulocytosis?

Answer 11

No pus formation despite severe infection.

Mnemonic: “No Neutrophils = No Pus.”

Question 12

What triad characterizes hypersplenism?

Answer 12

• Splenomegaly
• Cytopenias
• Normal/Hypercellular marrow

Mnemonic: “Big Spleen, Low Cells, Busy Marrow.”

Question 13

What is the most common cause of secondary hypersplenism?

Answer 13

Portal hypertension from chronic liver disease.

Mnemonic: “Portal Pressure Pops the Spleen.”

Question 14

What lab pattern supports hypersplenism?

Answer 14

Cytopenias (↓ WBCs, RBCs, PLTs) with normocytic anemia.

Mnemonic: “Hyper = Hides Blood Cells.”

Question 15

What imaging is first-line to evaluate the spleen?

Answer 15

Ultrasound.

Mnemonic: “Ultrasound = Useful Start.”

Question 16

What is the gold standard imaging for hypersplenism?

Answer 16

CT abdomen — measures spleen size, portal hypertension.

Mnemonic: “CT = Clearer Truth.”

Question 17

What bone marrow pattern is seen in hypersplenism?

Answer 17

Hypercellular marrow.

Mnemonic: “Spleen hoards, marrow works harder.”

Question 18

What is a critical pre-splenectomy precaution?

Answer 18

Vaccinate against encapsulated organisms (S. pneumo, H. flu, N. meningitidis).

Mnemonic: “Spleen Out? Shield Up!”

Question 19

What PANCE tip distinguishes hypersplenism from aplastic anemia?

Answer 19

Hypercellular marrow (not marrow failure).

Mnemonic: “Aplastic = Absent cells, Hyper = Hidden cells.”

Question 20

What does leukopenia indicate in sepsis?

Answer 20

Bone marrow exhaustion → poor prognosis.

Mnemonic: “Low WBC = Low Chance.”

Question 21

What are the hallmark vital signs of sepsis?

Answer 21

• Fever/hypothermia
• Tachycardia
• Hypotension
• Tachypnea

Mnemonic: “FAST = Fever, Altered, Shock, Tachy.”

Question 22

What is the gold standard test for identifying the infectious agent in sepsis?

Answer 22

Blood cultures.

Mnemonic: “Culture Confirms Culprit.”

Question 23

What lab marker indicates tissue hypoperfusion in sepsis?

Answer 23

Lactate > 2 mmol/L.

Mnemonic: “Lactic = Lethal.”

Question 24

What lab pattern can sepsis show on CBC?

Answer 24

Leukocytosis or leukopenia (<4,000).

Mnemonic: “High or Low — both bad.”

Question 25

What PANCE note about **leukopenia** and prognosis in sepsis is crucial?

Answer 25

Leukopenia = poor prognostic sign. ## Footnote Mnemonic: “No WBC = No Win.”

Question 26

What are the most common **drug classes** causing leukopenia?

Answer 26

* Chemotherapy * Sulfa drugs ## Footnote Mnemonic: “Chemo + Sulfa = Cell Slayers.”

Question 27

What lab confirms **drug-induced leukopenia**?

Answer 27

CBC showing low WBCs, often isolated. ## Footnote Mnemonic: “Low Count = Drug Downer.”

Question 28

What bone marrow finding supports a **toxic cause**?

Answer 28

Hypocellular marrow. ## Footnote Mnemonic: “Toxin → Thin Marrow.”

Question 29

What is the PANCE takeaway phrase for **drug-induced leukopenia**?

Answer 29

Know that chemotherapy and sulfa drugs cause it. ## Footnote Mnemonic: “Sulfa = Suppression.”

Question 30

What is the defining **CD4 count** for AIDS?

Answer 30

CD4 < 200 cells/µL. ## Footnote Mnemonic: “200 = AIDS Alert.”

Question 31

What screening test starts the **HIV workup**?

Answer 31

HIV-1/2 Ag/Ab combo immunoassay. ## Footnote Mnemonic: “Combo = Catch Early.”

Question 32

What confirmatory test follows a **reactive screen**?

Answer 32

HIV-1/2 differentiation immunoassay. ## Footnote Mnemonic: “Differentiate = Define Type.”

Question 33

What test confirms **acute HIV infection**?

Answer 33

HIV-1 RNA (NAT). ## Footnote Mnemonic: “RNA Reveals New Infection.”

Question 34

What lab abnormality is characteristic of **HIV/AIDS**?

Answer 34

Lymphopenia with ↓ CD4+ T cells. ## Footnote Mnemonic: “Low Lymphs = Lost Immunity.”

Question 35

What is the CDC rule for **window period** in HIV testing?

Answer 35

Up to 45 days for Ag/Ab, shorter with RNA. ## Footnote Mnemonic: “RNA = Rapid Notice.”

Question 36

What is the obsolete **HIV test** no longer recommended?

Answer 36

Western blot. ## Footnote Mnemonic: “Old West is Closed.”

Question 37

What opportunistic infection prophylaxis is started at **CD4 <200**?

Answer 37

TMP-SMX for PCP pneumonia. ## Footnote Mnemonic: “200 = Two Pills (TMP-SMX).”

Question 38

What is the mechanism of **leukopenia** in viral infections?

Answer 38

Viral suppression of bone marrow + immune destruction + WBC migration into tissues. ## Footnote Mnemonic: “VIRAL = Vanishing Immune Response And Leukocytes.”

Question 39

What is the typical course of **viral-induced leukopenia**?

Answer 39

Transient and self-limited (1–3 weeks). ## Footnote Mnemonic: “Viral = Vanishes Quickly.”

Question 40

What are common **viral causes** of leukopenia?

Answer 40

* EBV * CMV * Hepatitis * HIV ## Footnote Mnemonic: “Every Common Malicious Virus.”

Question 41

What is the hallmark **lab finding**?

Answer 41

Low WBC, especially neutropenia or lymphopenia. ## Footnote Mnemonic: “Virus = Vanishing WBCs.”

Question 42

What PANCE pearl about **treatment** should be remembered?

Answer 42

Supportive care; G-CSF only for prolonged or severe cases. ## Footnote Mnemonic: “G-CSF = Give if Grave.”