Transcript No Slide Title

Blood and Lymph Test I
Of the following white cells which of the following
are the most numerous in the blood?
a.
b.
c.
d.
e.
lymphocytes
monocytes
Neutrophils
eosinophils
basophils
c. neutrophils
Which of the following white cells has as their primary
function the phagocytosis of antigen antibody complexes and
destruction of parasites?
a.
b.
c.
d.
e.
lymphocytes
monocytes
neutrophils
eosinophils
basophils
d. eosinophils
In hematopoiesis, all of the following cells may undergo
mitosis EXCEPT:
a.
b.
c.
d.
e.
basophilic erythroblasts
promyelocytes
orthochromatophilic erythroblasts
progenitor cells
neutrophilic myelocytes
c. orthochromatophilic erythroblasts
All of the following statements concerning the development of
mature elements of blood are correct EXCEPT:
a.
b.
c.
d.
e.
megakaryocytes give rise to platelets
CFU-NM (CFU-GM) gives rise to neutrophils and monocytes
The ribosomes in basophilic erythroblasts manufactures hemoglobin
development of erythrocytes in the bone marrow occurs in close
association with macrophages
promyelocytes are described as containing azurophilic, specific, and
tertiary granules.
e. promyelocytes are described as containing
azurophilic, specific, and tertiary granules.
All of the following types of tissue contain lymph
nodules EXCEPT:
a.
b.
c.
d.
e.
spleen
thymus
GALT (gut associated lymphoid tissue)
palatine tonsil
lymph nodules
b. thymus
In the spleen the cells surrounding the central
arterioles consist primarily of
a.
b.
c.
d.
e.
macrophages
erythrocytes
T-lymphocytes
B-lymphocytes
splenic cords
c. T lymphocytes
Recirculating lymphocytes primarily leave the
blood vascular system and enter lymph nodes via:
a.
b.
c.
d.
e.
high endothelial post-capillary venules in the paracortex
afferent lymphatic vessels
capillaries in the cortex
high endothelial post-capillary venules in the medulla
capillaries in the medulla
A. high endothelial post-capillary venules in the paracortex
All of the following statements that refer to a
specific lymphoid organ are correct except:
a.
b.
c.
d.
e.
M cells and Peyer’s patches – small intestine
Hassell’s corpuscles – thymus
subcapsular sinus – lymph node
afferent lymphatic vessels – thymus
deep crypts and stratified squamous epithelium –
palatine tonsil
d. afferent lymphatic vessels - thymus
The cell shown is:
a.
lymphocyte
b.
basophil
c.
monocyte
d.
neutrophil
e.
eosinophil
c. monocyte
The white cell shown is:
a.
basophilic erythroblast (early normoblast)
b.
neutrophilic myelocyte
c.
neutrophilic metamyelocyte (stab cell)
d.
orthochromatophilic erythroblast (late normoblast)
e.
promyelocyte
d. orthochromatophilic erythroblast (late
normoblast)
The white cell shown is:
a.
eosinophil
b.
promyelocyte
c.
neutrophilic metamyelocyte (stab cell)
d.
eosinophilic metamyelocyte
e.
mature neutrophil
c. neutrophilic metamyelocyte (stab cell)
This is a photomicrograph of:
a.
spleen
b.
palatine tonsil
c.
GALT
d.
lymph node
e.
thymus
d. lymph node
This is a photomicrograph of:
a.
spleen
b.
palatine tonsil
c.
GALT
d.
lymph node
e.
thymus
e. thymus
In this figure, the most numerous cells located at the end of
the THICKEST arrow are:
a.
b.
c.
d.
e.
neutrophils
eosinophils
T cells
B cells
macrophages
C. T cells
A 19 y/o comes into the ER very short of breath. On physical
examination you note that her eyes are jaundiced and her
conjunctiva is very pale. The remainder of the physical exam
reveals only an enlarged spleen. Her CBC includes a
hematocrit = 22% (normal 38-44%), MCV = 98 μ³,
platelets=200,000 cell/mm³, (normal 150,000-300,000
cells/mm³), and WBC=7500 cells/mm³ (normal 4-8000
cells/mm³). The reticulocyte count was 18%. Which of the
following is NOT a likely scenario?
a.
b.
c.
d.
e.
The patient has hereditary spherocytosis
The patient has autoimmune hemolytic anemia
The patient has sickle cell disease
The patient has a production defect in bone marrow
The patient has increased RBC destruction
d. The patient has a production defect in bone marrow
You are in your basement pharmacy concocting the world’s
best iron preparation to be used in patients who have had a
gastrectomy. The properties of your concoction should
include all of the follow except:
a. a low pH to keep iron subtle
b. a reductant like ascorbic acid to keep iron in the
ferrous form
c. a strong oxidant because ferric (Fe³+) is more potent than
ferrous iron (Fe2+).
d. chelators that might facilitate iron absorption in the distal
duodenum and upper jejunum
c.
a strong oxidant because ferric (Fe³+) is more
potent than ferrous iron (Fe2+).
In order for iron to be taken up by erythroid precursor cells in the
bone marrow all of the following needs to happen except:
a. transferrin needs to bind to the transferrin receptor
b. the transferrin receptor needs to be internalized by
receptor mediated endocytosis
c. the pH of the endosomes needs to increase to at least pH = 8.0
d. transferrin needs to bind either one or two irons
e. the kidney needs to synthesize erythropoietin to allow for
erythroid differentiation past the BFU-E.
c.
the pH of the endosomes needs to increase to at least
pH = 8.0
In a patient with hemochromatosis, you might expect all of the
following to occur EXCEPT:
a.
b.
c.
d.
e.
the liver would develop iron overload
iron absorption would be increased
the patient would be resistant to developing diabetes
the patients TIBC would be saturated with iron
the patient’s ferritin would be high
c. the patient would be resistant to developing diabetes
During the process of erythropoiesis which of the following does not
occur?
a.
b.
c.
d.
e.
in iron deficiency, erythroid precursors leave the bone marrow early and
hence circulate as macrocytes
folic acid is used for DNA synthesis
erythroid cells get progressively smaller with each cell division
heme synthesis in erythroid cells accounts for the chromicity of the
resulting red blood cells
erythropoietin binds to receptors on erythroid precursor cells
a.
in iron deficiency, erythroid precursors leave the
bone marrow early and hence circulate as
macrocytes
A 36 year old develops active rheumatoid arthritis with inflammation of the
joints of the wrist and hands and knees. The patient’s hemoglobin had
been normal and with the onset of the arthritis has now decreased. All of
the following might be involved in the development of the anemia except
which:
a. cytokines generated in the inflamed synovium in the joints will
interfere with erythropoiesis.
b. cytokines will antagonize the action of erythropoietin
c. cytokines will affect the synthesis of ferritin in macrophages causing the
macrophages to hold onto iron.
d. cytokines will stimulate receptor mediated endocytosis allowing for more
iron to get into erythroid precursor cells
e. the cellularity of the bone marrow may be affected
d. cytokines will stimulate receptor mediated endocytosis
allowing for more iron to get into erythroid precursor
cells
The structure of the product of the committed, rate limiting
step in heme synthesis
A
B
C
D
E
A. ALA
The structure of a compound which inhibits the committed,
rate controlling step in heme synthesis
A
B
C
D
E
D. Heme
The structure of a compound NOT formed in NORMAL
porphyrin biosynthesis, but which IS formed in porphyrin
biosynthesis in the absence of uroporphyrinogen (UPG) III cosynthase.
A
B
C
D
E
C. Uroporphyrinogen I
The structure of a NORMAL intermediate of porphyrin
biosynthesis which is synthesized by a cytoplasmic enzyme.
A
B
C
D
E
B. Porphobilinogen (PBG)
Which of the following statements is NOT correct?
a.
b.
c.
d.
e.
Carbon monoxide is produced when a macrophage enzyme
acts on heme
Conjugated bilirubin is converted to biliverdin in premature
infants by fluorescent light.
“Direct bilirubin” is a measure of conjugated bilirubin
In order to obtain “indirect bilirubin,” an organic solvent must
first be added to serum
bilirubin glucuronidation enhances excretion of heme
catabolism products.
b. Conjugated bilirubin is converted to biliverdin in
premature infants by fluorescent light.
The substance deposited in the CNS of individuals with
“kernicterus” is:
a.
b.
c.
d.
e.
biliverdin
only “direct bilirubin”
unconjugated bilirubin
both conjugated and unconjugated bilirubin
inactive UDP glucoronyl transferase
c. unconjugated bilirubin
The amino acid which provides most of the 1-carbon units in
animal metabolism is
a.
b.
c.
d.
e.
methionine
homocysteine
glycine
histidine
serine
e. serine
1-carbon-carrying folate derivatives are readily interconverted enzymatically
except for
a. N5-methyl-THF
b. N5-N10-methylene-THF
c. N5-N10-methenyl-THF
d. N5-formimino-THF
e. N10-formyl-THF
a. N5-methyl-THF
Which of the following statements regarding cobalamin (Vitamin B12) is
incorrect?
a. cobalamin is transported in blood bound to intrinsic factor
b. cobalamin is required for the synthesis of methionine in humans
c. deoxyadenosyl-cobalamin is the coenzyme involved in the
conversion of L-methylmalonyl-CoA to succinyl-CoA
d. cobalamin stores in the body can last for decades
e. cobalamin deficiency is rare in teenagers
a. cobalamin is transported in blood bound to
intrinsic factor
or
d. cobalamin stores in the body can last for decades
Which one, if any, of the following statements regarding the primary
hemostatic process is incorrect:
a.
b.
c.
d.
e.
platelets adhere to exposed subendothelial collagen through
GpIa-IIa receptors
platelets secrete prostacyclin, which prevents excessive platelet
aggregation
fibrinogen enhances platelet aggregation through GpIIb-IIIa receptors
Von-Willebrand factor allows adhered platelets to resist turbulence and
shear forces in injured small vessels
none of the above statements is correct
b. platelets secrete prostacyclin, which prevents excessive
platelet aggregation
When coagulation factor VIIa interacts with tissue factor:
a.
b.
c.
d.
e.
Factor XI is activated, thus involving the “intrinsic pathway” of
coagulation
Factor X binds to the VIIa-tissue factor complex in a Ca2+
dependent reaction
Factor IXa is rapidly inactivated by TFPI, along with factor Xa
Tissue Factor is released from a phospholipid membrane
Factor IX must be released from a phospholipid membrane before it
can be activated
b. Factor X binds to the VIIa-tissue factor complex in a
Ca2+ dependent reaction
Which one of the following substances is used as an
anticoagulant both in vivo and in vitro?
a. heparin
b. sodium citrate
c. warfarin
d. EDTA
e. sodium oxalate
a. heparin
When Coumadin therapy initially begins to lengthen PT, the
coagulation factor which is most likely to be decreased in the
patient’s blood is:
a.
b.
c.
d.
e.
Prothrombin
Factor X
Factor VII
Factor IX
Factor V
c. Factor VII
Which of the coagulation factors listed below catalyzes the
formation of amide bonds?
a. Factor XIIa
b. Thrombin
c. Factor XIIIa
d. Factor VIIIa
e. Factor Va
c. Factor XIIIa
Which one, if any, of the following statements regarding
fibrinolysis is incorrect?
a.
b.
c.
d.
e.
plasminogen activator inhibitor, PAI, stimulates
fibrinolysis
D-dimers are products of fibrinolysis found in plasma
both plasminogen and tPA bind to fibrin in a thrombus
plasmin bound to fibrin is resistant to α2 plasmin
inhibitor action
none of the above statements is false
a.
plasminogen activator inhibitor, PAI, stimulates
fibrinolysis
An 18 year old woman with delayed onset of menses is
sent to your office with a history of bone pain, severe
enough to cause visits to the ER, a hematocrit of 25%
(normal 36-48%), and a reticulocyte count of 12%
(normal 0.5-1.5). Her peripheral blood smear appeared
as below.
Most likely diagnosis is:
a.
iron deficiency
b.
anemia of chronic disease
c.
iron excess
d.
sickle cell anemia
e.
lead intoxication
d. sickle cell anemia
Which of the following is NOT seen in patients with
accelerated red cell destruction due to hemolytic
anemias?
a.
b.
c.
d.
e.
increased serum unconjugated bilirubin
decreased serum haptoglobin
increased serum lactate dehydrogenase activity
decreased red cell count
decreased reticulocyte count
e. decreased reticulocyte count
A 25 year old is noted to be intermittently jaundice and
to have a hematocrit of 25% (normal 36-52%). The
patient has a family history of cholecystectomies before
30 years of age in the father and 2 siblings. Peripheral
blood smear appears as below.
After reviewing the peripheral blood smear, you
postulate the primary defect resides in:
a.
b.
c.
d.
e.
the ability to absorb iron
the cytoskeleton of red blood cells
a congenital absence of the spleen
the lipid composition of the red blood cells
hairy cell leukemia
b. the cytoskeleton of red blood cells
Which one is NOT a nutritional anemia?
a.
b.
c.
d.
e.
refractory anemia
iron deficient anemia
vitamin B12 deficient anemia
starvation anemia
Kwashiorkor
a.
refractory anemia
All of the causes listed below are responsible for
iron deficiency anemia EXCEPT:
a.
b.
c.
d.
e.
chronic blood loss
hookworm infestation
severe malabsorption
Vitamin C deficiency
Excessive menses
d. Vitamin C deficiency
Iron store depletion occurs in all EXCEPT:
a.
b.
c.
d.
e.
inadequate diet
Thalassemia
rapid growth in infancy and adolescence
blood donation
normal menses
b. Thalassemia
Which of the following conditions is most likely to
be cured with combination of chemotherapy?
a.
b.
c.
d.
e.
disseminated non-small cell lung cancer
disseminated breast cancer
intermediate grade lymphoma
low grade lymphoma
multiple myeloma
c. intermediate grade lymphoma
Which one of the following lab abnormalities is least likely to
occur in multiple myeloma?
a.
b.
c.
d.
e.
decreased hemoglobin
increased serum creatinine
increased alkaline phosphatase
increased serum total proteins
increased serum calcium
c. increased alkaline phosphatase
Which one of the following statements is true about
lymphoma?
a.
b.
c.
d.
staging is more likely to determine the treatment in
a patient with Non-Hodgkin’s Lymphoma than in
one with Hodgkin’s disease
Elevated serum LDH does not correlate with
disease activity in non-Hodgkin’s Lymphoma
Hodgkin’s disease is unlikely to be cured with
combination chemotherapy
Non-Hodgkin’s lymphoma is frequently
disseminated at the time of presentation
d. Non-Hodgkin’s lymphoma is frequently disseminated at
the time of presentation
A 65 year old patient comes to see you for evaluation of an abnormal
CBC. He was in to see his primary care physician for an annual checkup
(with no symptoms) and a CBC was noted to be abnormal. His physical
exam is normal.
WBC = 20,000 (normal 4500-12,000)
Hb normal
Platelet count normal
Peripheral smear below
Your diagnosis is?
a.
Chronic Myeloid Leukemia
b.
Chronic Lymphocytic Leukemia
c.
Acute Myeloblastic Leukemia
d.
Acute Lymphoblastic Leukemia
e.
No hematological Disease
b. Chronic Lymphocytic Leukemia
Appropriate therapy for this patient is?
a.
b.
c.
d.
e.
bone marrow transplant from an unrelated donor
high dose chemotherapy short of transplant doses
Chlorambucil or Prednisone chemotherapy
no treatment indicated at this time
prophylactic immunoglobulin therapy to prevent
infection
d. no treatment indicated at this time
A 25 year old medical student is sent to you for the evaluation of fatigue. Fatigue has become
severe enough to interfere with studying. He also notes easy bruising and gum bleeding after
brushing his teeth. Your exam shows an enlarged spleen and extensive petechiae and bruises.
Lab Exam:
Hb of 7gm% (nl >14)
Platelets = 15,000 (nl 150-350,000)
WBC = 3000 (nl 4500-12,000)
PT – 26 sec (nl < 13 sec)
APTT = 60 sec (nl < 30 sec)
Fibrinogen = 50mg% (nl > 200 mg%)
Bone marrow below:
Molecular analysis of the cells shows a 15:17 translocation.
in counseling this patient you tell him which of the following?
a.
b.
c.
a.
b.
you have an incurable disease and should be sent to hospice
You need an emergent bone marrow transplant
Standard therapy with All Trans retinoic acid
and chemotherapy has a chance of curing your leukemia
the bleeding problem is not related to the leukemia
you have chronic myeloid leukemia and need Gleevec treatment
c. Standard therapy with All Trans retinoic acid
and chemotherapy has a chance of curing your
leukemia
Note: This is acute promyelocytic leukemia and requires
All-trans retinoic acid because according to the
NEJM.
All-trans-retinoic acid induces complete remission in
acute promyelocytic leukemia. However, it is not
clear whether induction therapy with all-trans-retinoic
acid is superior to chemotherapy alone or whether
maintenance treatment with all-trans-retinoic acid
improves outcome
Which of the following is a co-factor for
activation of coagulation proteins?
a.
b.
c.
d.
Factor X
Factor VII
Factor V
Factor IX
c. Factor V
Which of these proteins is stored in endothelial cells?
a.
b.
c.
d.
tissue factor
Factor VII
von Willbrand’s factor
Factor IX
c. von Willbrand’s factor
Prolongation of activated partial thromboplastin time is caused by the
following except:
a.
b.
c.
d.
deficiency of Factor VII
deficiency of Factor VIII
deficiency of Factor IX
deficiency of Factor XI
a.
deficiency of Factor VII
Which of the following statements regarding hemophilia A is
incorrect?
a.
b.
c.
d.
it is an X-linked disorder
bleeding in the joints is characteristic
hemophilia is more common in black males
caused by deficiency in factor VIII
c. hemophilia is more common in black males
Which of the following statements regarding factor IX is
accurate?
a.
b.
c.
d.
it is a co-factor for factor VIII
Deficiency of factor IX is transmitted as autosomal recessive
disorder
Bleeding in the joints is rare in patients severely deficient in
factor IX
The gene encoding factor IX is located on the X-chromosome
d. The gene encoding factor IX is located on the Xchromosome
Venous thrombosis can result from all of the following except:
a.
b.
c.
d.
Proteins S deficiency
impaired fibrinolysis
increase in factor VII
a point mutation at site 506 in the factor V
a.
Proteins S deficiency
Which of the following best characterizes immune
thrombocytopenia purpura (ITP)?
a.
b.
c.
d.
it is transmitted as autosomal recessive trait
the destruction of platelets is commonly caused by
antibodies against GPIIb|IIIa
Severe neutropenia is common with ITP
ITP is a rare cause of thrombocytopenia
b. the destruction of platelets is commonly caused by
antibodies against GPIIb|IIIa
All of the following can be found in a patient with
thrombotic thrombocytopenic purpura except:
a.
b.
c.
d.
severe headache
prolonged activated partial thromboplastin time
fragmented red blood cells
anemia
b. prolonged activated partial thromboplastin time
Which of the following possess both specific and azurophilic
granules?
a.
b.
c.
d.
e.
Erthrocyte
Lymphocyte
Platelet
Neutrophil
Monocyte
d. Neutrophil
Which of the following is derived from reticulocytes?
a.
b.
c.
d.
e.
Erythrocytes
Lymphocytes
Platelet
Neutrophil
Monocyte
a. Erythrocytes
Which of the following is a characteristic of monocytes?
a.
b.
c.
d.
e.
They contain a multilobed nucleus
They are the most numerous of the white cells
Their cytoplasm is packed with ribosomes
They become active macrophages while circulating in the blood
They become active macrophages after entering the tissues
e. They become active macrophages after entering the
tissues
After their maturation in the thymus and release into the circulation,
T lymphocytes migrate preferentially to which of the following sites?
a.
b.
c.
d.
e.
Paracortex (deep cortex) of lymph nodes
Cortical lypmhoid nodules of lymph nodes
Hilus of lymph nodes
Lymphoid nodules of the tonsils
Lymphoid nodules of the spleen
a. Paracortex (deep cortex) of lymph nodes
The region of a lymph node where reticulating lymphocytes
normally leave the blood via postcapillary high endothelial venules is
the:
a.
b.
c.
d.
e.
Subcapsular sinus
Cortex
Paracortex (deep cortex)
Medullary cords
Medullary sinuses
c. Paracortex (deep cortex)
Which of the following is a unique characteristic of the palantine
tonsils?
a. It is completely surrounded by a connective tissue capsule
b. It contains deep crypts lined by stratified squamous epithelium
c. Its surface is covered by pseudostratified ciliated columnar
epithelium
d. Its pits are washed out by mucus secretions from glands located
near the base of the pits
e. Many of the arterioles in the gland are surrounded by lymph
nodules and are called central arterioles
b. It contains deep crypts lined by stratified squamous epithelium
The genetically defined developmental programs
which regulate proliferation and maturation of
hematopoeitic stem cells (HSCs) are driven by external
signals that include:
a.
b.
c.
d.
e.
Interleukin 3
Erythropoietin
2,3-bisphosphoglycerate (2,3-BPG)
A, B, and C
A and B only
e. A and B only
The oxygen saturation curve (O2 fractional saturation vs. O2 partial
pressure) of a pH 7.4 buffered solution of normal adult hemoglobin
(HbA) containing 0.0 mM 2,3-BPG exhibits:
a. A shift to the right, relative to HbA in the same solution, but
containing 5 mM 2,3-BPG
b. A high degree of cooperativity with respect to O2 binding
c. Almost no cooperativity with respect to O2 binding
d. An exaggerated Bohr effect
e. A, B, and D
c. Almost no cooperativity with respect to O2 binding
The relatively simple metabolic system of normal, mature
RBCs
a.
b.
c.
d.
e.
Requires a source of lactate
Is unable to produce NADPH
Is incapable of oxidative phosphorylation
Is incapable of reducing methemoglobin
Produces ATP anaerobically
c. Is incapable of oxidative phosphorylation
Which of the following statements about heme synthesis in bone
marrow erythrocyte precursor cells is NOT correct?
a.
b.
c.
d.
e.
ALA synthase is the rate-limiting enzyme
PBG synthase (ALA dehydratase) is a cytoplasmic enzyme
Ferrochelatase is a mitochondrial enzyme
Elevated heme prevents mitochondrial PBG transport
UPG I is not a normal intermediate
d. Elevated heme prevents mitochondrial PBG transport
The enzymatic steps in heme synthesis that are sensitive to
inhibition by Pb2+ in RBC precursor cells are
a.
b.
c.
d.
e.
Ferrochelatase and PBG synthase (ALA dehydratase)
UPG synthase and ferrochelatase
UPG synthase and PBG synthase
ALA synthase and ferrochelatase
ALA synthase and CPG oxidase
a. Ferrochelatase and PBG synthase (ALA dehydratase)
Which of the following statements regarding porphyrias are NOT correct?
a. Patients with porphyria cutanea tarda are photosensitive
b. Patients who have inherited defects of enzymes which catalyze
reactions in the early reactions in heme synthesis usually have
neurologic symptoms
c. Spontaneous oxidation of porphyrinogens to porphyrins does not occur
in porphyria
d. Phenobarbital and similar drugs can precipitate acute attacks of certain
porphpyrias
e. The ability to produce cytochrome P450 enzymes is affected in certain
porphyries.
c. Spontaneous oxidation of porphyrinogens to porphyrins does not
occur in porphyria
Metabolic products of the first three enzymatic reactions in
heme degradation include
a.
b.
c.
d.
e.
NADP+, biliverdin, and Fe3+
NADPH, biliverdin, and CO
NAD+, bilirubin, and UDP
NADH, bilirubin, and UDP-glucoronate
FAD, Fe2+, and UTP
c. NAD+, bilirubin, and UDP
In the heme oxygenase reaction of heme degradation the
methene (=C-) group of the porphyrin ring which is oxidized
to CO is between the pyrrol rings designated.
a.
b.
c.
d.
A and B
B and C
C and D
D and A
a. A and B
The addition of both diazotized sulfanilic acid (Ehrlich’s
reagent) and methyl alcohol to plasma results in a
colored product which represents
a.
b.
c.
d.
e.
Direct bilirubin
Indirect bilirubin
Total bilirubin
Albumin-bound bilirub9in only
Bilirubin diglucuronide only
c. Total bilirubin
You are asked to see a 24-year old white female medical resident who has just done her
own complete blood count (CBC) because of symptoms of progressive fatigue. The
feeling of fatigue and reduced exercise tolerance is quite recent and has been
progressing over the past 6 to 12 months. She is a serious runner, running over 50 miles
each week. Because of the accompanying aches and pains she takes NSAIDS daily. Her
periods are irregular and last 8 to 9 days with heavy flow on the first 2 days. She avoids
eating meat. On physical examination the patient is a pale but otherwise healthy,
muscular, young woman.
Laboratory includes:
White Blood Cells
Hemoglobin
Mean Corpuscular Volume
Platelets
= 7,500 cells/mm3 (normal 3-8,000)
= 6.0 gm/dl (normal 12,15 gm/dl)
= 72 u3 (normal 81 – 95)
= 305,000 cells/mm3
The peripheral smear is to be shown:
The cause of her anemia can be attributed to all of the following EXCEPT which
a. Menstrual blood loss
b. Gastric irritation from her NSAID agents
c. Malabsorption of vitamin B12
d. March hemoglobinuria with loss of hemoglobin in the urine
e. A diet in which iron is too low to compensate for increased loss
c. Malabsorption of vitamin B12
In a patient with iron deficiency with a microcytic hypochromic
morphology of red blood cells and a MCV < 70 fl (normal 80-90 fl)
all of the following might be present EXCEPT:
a.
b.
c.
d.
e.
Hemoglobin of 5 gm/dl
Hemoglobin of 6 gm/dl
Ferritin < 5 mg/dl (normal 15-200 mg/dl)
Hemoglobin 12 gm/dl
TIBC saturation < 10%
d. Hemoglobin 12 gm/dl
The absorption of iron in the intestine is regulated
a.
b.
c.
d.
e.
By renal tubular excretion
By increased sloughing of the skin
By absorption in the terminal duodenum and proximal jejunum
In the terminal ileum
By having sufficient folic acid in the diet
b. By increased sloughing of the skin
A patient present with Hemoglobin = 7 gm/dl (normal 12 – 15
gm/dl) and a reticulocyte count of < 1%. Which of the following is
probably NOT a cause for the anemia?
a.
b.
c.
d.
e.
Metastatic cancer infiltrating the bone marrow
Exposure to benzene with development of aplastic anemia
High doses of radiation from a reactor accident
24 hours of bleeding from a gastric ulcer
Acute myelogenous leukemia
d. 24 hours of bleeding from a gastric ulcer
A patient with a Hemoglobin + 7 gm/dl (normal 12 -15
gm/d.), total bilirubin 2.2 mg (normal < 1.2 mg), indirect
bilirubin = 2.0 mg (normal 0.2 mg), reticulocyte = 10%, LDH
= 1500 units/dl (normal < 600 units/dl) and a prolong
protime could have all of the following EXCEPT which:
a.
b.
c.
d.
e.
Antibodies directed to a red blood cell surface antigen
A positive Coombs test
Disseminate intravascular coagulation
A bone marrow infiltrated with metastatic cancer
A defect in the red blood cell cytoskeleton
d. A bone marrow infiltrated with metastatic cancer
Therapeutic use of it can reverse the megaloblastic anemia
associated with cobalamin deficiency:
a.
b.
c.
d.
e.
Erythropoietin
Folic acid or related folates
Vitamin B-12 (cobalamin)
A and C
B and C
e. B and C
Is administered therapeutically in an oral form in almost all
cases:
a.
b.
c.
d.
e.
Erythropoietin
Folic acid or related folates
Vitamin B-12 (cobalamin)
A and C
B and C
b. Folic acid or related folates
The primary cause of deficiency of it is chronic kidney
disease:
a.
b.
c.
d.
e.
Erythropoietin
Folic acid or related folates
Vitamin B-12 (cobalamin)
A and C
B and C
a. Erythropoietin
Reversal of megaloblastic hematopoiesis as a consequence of
vitamin B-12 replacement occurs after initiation of therapy at:
a.
b.
c.
d.
e.
2-3 days and peaks by 508 days
12-48 hours
1 week
2 months
Never occurs unless the patient receives folic acid
simultaneously
b. 12-48 hours
Surgical removal of the terminal ileum because of trauma
might be expected to result in which of the following:
a.
b.
c.
d.
e.
Folic acid depletion within 30-60 days
Folic acid depletion within one year
Folic acid depletion within three years
Vitamin B-12 deficiency
Achlorhydria
d. Vitamin B-12 deficiency
A patient presents with a Hemoglobin of 7 gm/dl. The
blood smear shows both macrocytic red cells and
hypersegmented neutrophils. Which of the following
is the patient most likely to have:
a.
b.
c.
d.
Decreased methylmalonic acid 2-100 x normal
Increased methylmalonic acid 2-100 x normal
Decreased serum homocysteine 2-20 x normal
High total iron binding capacity (TIBC)
b. Increased methylmalonic acid 2-100 x normal
The complex consisting of tissue factor and activated factor
VII (TF/VIIa) activates which of the following proteins:
a.
b.
c.
d.
Factors VIII and IX
Proteins C and S
Factors X and IX
Factor XII and XIII
c. Factors X and IX
Which of the following is not a vitamin K dependent factor:
a.
b.
c.
d.
Factor IX
Protein S
Factor VII
Factor VIII
d. Factor VIII
Excessive bleeding can be a manifestation of deficiency of all
the following EXCEPT:
a.
b.
c.
d.
Factor VII deficiency
Factor V deficiency
Protein C deficiency
Factor IX deficiency
c. Protein C deficiency
Which of these proteins is inactivated by activated protein C:
a.
b.
c.
d.
Activated factor IX
Activated factor VII
Protein S
Activated factor V
d. Activated factor V
Which of these proteins is not synthesized in the endothelial
cell:
a. Von Willebrand’s factor
b. Factor XII
c. Thrombomodulin
b. Factor XII
The sons of a hemophilia B carrier woman married to a
healthy man are expected to be:
a.
b.
c.
d.
All healthy
Hal healthy and half carriers
Half affected and half carriers
Half affected and half healthy
d. Half affected and half healthy
Which of the following is not considered a hereditary
condition predisposing to hypercoagulability:
a.
b.
c.
d.
Activated protein C resistance
Protein S deficiency
Factor V deficiency
Antithrombin II deficiency
c. Factor V deficiency
Which of the following findings is a characteristic of
thrombotic thrombocytopenic purpura:
a.
b.
c.
d.
Autoimmune hemolysis and thrombocytopenia
Intravascular hemolysis and high D-dimer
Intravascular hemolysis and thrombocytosis
Intravascular hemolysis and thrombocytopenia
d. Intravascular hemolysis and thrombocytopenia
A 62 year old woman was admitted to the hospital because of high fever,
chills and confusion. Physical exam showed a non-alert woman with a
temperature of 103.2, pulse 108/min, and blood pressure of 100/55.
There was an ecchymotic rash on the chest wall and no organomegaly or
lymphadenopathy. Complete blood count revealed a hematocrit of 31%
(normal 38 – 45%), WBC 12,300 (normal 3-10,000) with 82% segmented
neutrophils and platelet count of 64,000 (normal 150,000 – 300,000).
Review of the blood smear showed schistocytes, mild polychromatophilia
and confirmed the presence of low platelets. Blood cultures were positive
from gram negative rods in 3 out of 3 bottles. Fibrinogen was 105 mg/dl
(normal >150), D-dimer was 14 ug/ml (normal <2) and prolonged
activated partial thromboplastin time (APTT). Liver and renal function
were within the normal limits. The most likely diagnosis in this case is:
a.
b.
c.
d.
Thrombotic Thrombocytopenic Purpura (TTP)
Immune Thrombocytopenia
Disseminated Intravascular Coagulation (DIC)
Factor VIII Deficiency
b. Immune Thrombocytopenia
To distinguish an acute lymphocytic leukemia from an
acute myeloid leukemia the presence of WHICH of the
following cellular structures would be most helpful:
a.
b.
c.
d.
e.
Nucleus
Barr body
Auer Rod
Smudge Cell
Normal granules
c. Auer Rod
In treating acute Myeloid Leukemia which of the following is
CORRECT:
a. The only curative therapy is bone marrow transplantation
undertaken at the time of diagnosis
b. Low dose non-toxic chemotherapy should be used
c. Induction therapy consists of high doses of chemotherapy to
eliminate all the abnormal blasts is given and then supportive
care to allow the normal marrow to repopulate
d. No treatment is of any value
c. Induction therapy consists of high doses of chemotherapy to
eliminate all the abnormal blasts is given and then supportive
care to allow the normal marrow to repopulate
Characteristics of Chronic Lymphocytic Leukemia (CLL) include all of
the following EXCEPT:
a.
b.
c.
d.
e.
CLL is usually characterized by an overproduction of T-cells
CLL is staged 0-4 with 0 being the best prognostic stage
Smudge cells are seen on the peripheral blood smear
There is no curative therapy only palliative therapy
Infections and autoimmune disorders may occur
d. There is no curative therapy only palliative therapy
Which of the following platelet (thrombocyte) surface
receptor(s) is/are correctly matched with its/their ligand(s)?
a.
b.
c.
d.
e.
GpIa, collagen
GpIbIX, fibrinogen
GpIbIIIa, von Willebrand factor
A and B
B and C
a. GpIa, collagen
Which of the following blood coagulation factors below is NOT
involved in physiological (in vivo) blood coagulation?
a.
b.
c.
d.
e.
Factor XI
Factor XII
Factor XIII
Factor IX
Factor II
b. Factor XII
Which of the anticoagulants listed below prevent clotting of
blood in vitro by binding Ca2+?
a.
b.
c.
d.
e.
Heparin
Coumadin
Citrate
A and B
B and C
c. Citrate
Which of the pairs of blood coagulation factors below are both
activated by thrombin?
a.
b.
c.
d.
e.
Factor XIII and Factor X
Factor IX and Factor XII
Factor V and Factor VIII
A and B
B and C
c. Factor V and Factor VIII
Which of the following statements regarding in vivo enzymatic
covalent crosslinking of fibrin is/are NOT correct?
a.
b.
c.
d.
e.
The reaction involves the addition of NH4+ to fibrin
Glutamine and lysine residues in fibrin are substrates
Fibrin crosslinking is normally an intermolecular reaction
A and B
B and C
a. The reaction involves the addition of NH4+ to fibrin
Which of the following complexes involved in blood coagulation contain a
substrate for activated protein C?
a.
b.
c.
d.
e.
Tissue factor –VIIa
“Tenase”
“Prothrombinase”
A and B
B and C
e. B and C
You see a 65-year old male who is mildly short of breath but in no
major distress. He reports that he has been getting weak and tiered
in the last 6 months. Physical exam shows mild tachycardia and a
massively enlarged spleen. His CBC shows moderate anemia with
WBC = 12,400, and a platelet count = 120,000. The blood film
shows many RBCs with tear drop morphology, nucleated red cells,
and some white cell precursors with no blast forms. Cytogenetics
are normal. Which of the following is the MOST likely diagnosis:
a.
b.
c.
d.
Chronic myelogenous leukemia in blast crisis
Polycythemia vera
Myeloid metaplasia with myelofibrosis
End stage liver disease
c. Myeloid metaplasia with myelofibrosis
A 48-year old female has been feeling very tiered in the last few
weeks and has noticed that she a lot a night sweats frequently
causing her to change her night gown and pillow case. On
examination, you find that she has a large spleen. The Hgb = 13
gm and the WBC is 86,200 cells/nm3 with immature myeloid forms
and occasional myeloblasts. The platelet count is 650,000 mm3. A
cytogenic examination of the blood cells shows the presence of
Philadelphia chromosome. What is the diagnosis of this patient?
a.
b.
c.
d.
e.
Polycythemia vera
Myelofibrosis
Essential thrombocythemia
Chronic myelogenous leukemia
Leukemoid reaction
d. Chronic myelogenous leukemia
A 51 year old male has just been diagnosed with CML by his primary
physician and is referred to you for treatment. The patient is asymptomatic
but has mild splenomegaly. The patient has a white blood count of 45,500
cells/mm3. He has one older brother who is in good health. What is your
initial treatment?
a.
b.
c.
d.
Observe the patient until he becomes symptomatic
Allogeneic bone marrow transplantation immediately because of his age
Treatment with a-interferon
Treatment with the signal transduction inhibitor Gleevec with periodic
assessment of response by measuring percentage of cells expressing
BCR-ABL.
d. Treatment with the signal transduction inhibitor Gleevec with
periodic assessment of response by measuring percentage of
cells expressing BCR-ABL.
A 33-year old female has had night sweats for 3 weeks but no fever or
weight loss. She is short of breath when she walks. A Chest X-ray shows
an enlarged mediastinum. At physical examination, an enlarged lymph
node is palpated in the right supraclavicular area. A biopsy is obtained and
show Hodgkin’s disease with nodular sclerosis. A bone marrow
biopsy is negative and a CT scan shows mediastinal nodes and no
enlargement of abdominal lymph nodes or spleen.
What is her clinical stage?
a.
b.
c.
d.
e.
IA
IV B
Staging is incomplete, patient should first undergo laparotomy
II B
III A
d. II B
Mantle cell lymphoma is associated with
a.
b.
c.
d.
e.
T(9:22) (t = translocation)
Helicobacter pylori infection
T(11:14)
Cure by a triple antibiotic regimen in >90% of cases
HTLV – 1 infection
c. T(11:14)
Multiple myeloma is frequently associated with each of the following
EXCEPT which:
a.
b.
c.
d.
Multiple bone lesions
Rouleaux formation on the peripheral smear
Amyloidosis
A precursor T-cell phenotype according to the W.H.O.
classification
e. Infections
d. A precursor T-cell phenotype according to the W.H.O.
classification
Which product is correctly matched to the storage parameters:
a. Packed Red Blood Cells
5 days shelf life stored at 20 –
24 degrees Celsius
b. Fresh Frozen Plasma
35-42 day shelf life, stored at
1-6 degrees Celsius
c. Pheresis Platelet
24 hr. shelf life, stored at 1-6
degrees Celsius
d. Washed Red Blood Cells
1 yr. shelf life, stored at < or =
-18 degrees Celsius
e. Pooled Platelets
4 hr. shelf life, stored at 20-24
degrees Celsius
e. Pooled Platelets
4 hr. shelf life, stored at 20-24
degrees Celsius
Leukoreduction of cellular products (red blood cells and platelets) to
less than 5 x 10(6) leukocytes/product (“3 log leukoreduction”) is an
accepted indication for prevention or reduction of _____:
a. Immunization to HLA antigens, Cytomegalovirus (CMV)
transmission, and Febrile transfusion reactions
b. HIV transmission, Hepatitis C transmission, and Hepatitis B
transmission
c. Creutzfelt Jacob Disease (CJD) and West Nile Virus
transmission
d. Bacterial infection
a. Immunization to HLA antigens, Cytomegalovirus (CMV)
transmission, and Febrile transfusion reactions
Your patient has a hemoglobin of 8.5 g/dl. You are asked to decide
whether the patient requires a transfusion of packed red blood cells
(PRBCS). Your decision is:
a. A patient definitely requires blood transfusion at a hemoglobin of
8.5 g/dl.
b. The patient’s clinical condition such as underlying cardiac disease and
current vital signs should be considered with the hemoglobin to
determine the need for transfusion
c. A patient never requires blood transfusion at a hemoglobin of 8.5 g/dl.
d. Call the blood bank and ask them whether to transfuse the patient
b. The patient’s clinical condition such as underlying cardiac disease
and current vital signs should be considered with the hemoglobin to
determine the need for transfusion
You decide to transfuse the patient on slide 107. The patient says
his friend got HIV from a transfusion in 1980. You tell him that the
risk of HIV is:
a. The same as in 1980
b. No risk at all
c. With the current testing a small risk exists; the estimated risk per
unit is about 1/50,000
d. With the current testing a small risk exists; the estimated risk
per unit is one in a million or less
d. With the current testing a small risk exists; the estimated risk per
unit is one in a million or less
The trauma team sends you a tube for testing with an emergency
request to the blood bank for “as much blood as you can provide”
for a 27 year old female stabbing victim. The blood bank computer
records say that this patient is type A, Rh(D) negative. The
technologist’s first action is:
a. Tell the trauma team they will have to wait 20 minutes for the
type and crossmatch
b. Immediately release several A, Rh-negative units
c. Immediately release several O, Rh-negative units
d. Immediately release several O, Rh-positive units
c. Immediately release several O, Rh-negative units
The patient from slide 111 types as A, Rh(D)-negative with NO unexpected
antibodies. She is still bleeding, but not profusely. The ER calls for 2 more
units. There is no A, Rh(D)-negative blood in the blood bank. What is the
next step?
a. Release O, Rh-negative blood to avoid an acute hemolytic anemia
b. Release A, Rh-positive blood; if anti-D forms, it does not matter
c. Ask the trauma team if they can hold the transfusion, because typespecific blood is unavailable
d. Release O, Rh-negative blood because she is a woman of child-bearing
age; if anti-D forms, it might cause severe hemolytic disease of the
newborn if she later becomes pregnant.
d. Release O, Rh-negative blood because she is a woman of
child-bearing age; if anti-D forms, it might cause severe
hemolytic disease of the newborn if she later becomes
pregnant.
The cell marked identify is a:
A.
B.
C.
D.
E.
Promyelocyte
Neutrophilic myelocyte
Neutrophilic metamyelocyte
Mature neutrophil
Monocyte
Identify
C.
Neutrophilic metamyelocyte
This cell is a:
A.
B.
C.
D.
E.
Basophil
Neutrophil
Eosinophil
Lymphocyte
Mononcyte
C.
Eosinophil
The tissue featured here is:
A.
B.
C.
D.
E.
Lymph node
Palatine tonsil
Pharyngeal tonsil
Thymus
Spleen
D.
Thymus
If Figure 4 the tissue is:
A.
B.
C.
D.
E.
Lymph node
Palatine tonsil
Pharyngeal tonsil
Thymus
Spleen
B.
Palatine tonsil
Reticulocytes become which of the following?
A.
B.
C.
D.
Platelets
Monocytes
Neutrophils
Erythrocytes
D.
Erythrocytes
Which of the following white cells are the most numerous in blood?
A.
B.
C.
D.
E.
Basophils
Eosinophils
Monocytes
Lymphocytes
Neutrophils
E.
Neutrophils
Hematocrit is defines as:
A.
B.
C.
D.
E.
The volume of packed leukocytes per unit volume of blood expressed
as a %.
The volume of packed erythrocytes per unit volume of blood
expressed as a %
The volume of hemoglobin per unit volume of blood expressed as a %
The number of red blood cells per milliliter of blood
The number of granulocytes per unit volume of blood
B.
The volume of packed erythrocytes per unit volume of blood
expressed as a %
Which of the following stem cells give rise to all types of blood cells?
A.
B.
C.
D.
E.
Multipotential stem cells
Colony-forming-unit-spleen stem cells (CFU-S)
Pluripotential hemopoietic stem cells (PHSCs)
Unipotential (progenitor) cells
Precursor cells
C.
Pluripotential hemopoietic stem cells (PHSCs)
After their maturation in the thymus and release into the circulation, T
lymphocytes migrate preferentially to which of the following sites?
A.
B.
C.
D.
E.
Lymph nodules of the spleen
Periarterial lymphatic sheaths of the spleen (PALS)
Cortical lymph nodules of lymph nodes
Lymph nodules of tonsils
Lymph nodules in Peyer’s patches
B.
Periarterial lymphatic sheaths of the spleen (PALS)
Recirculating lymphocytes primarily leave the blood vascular system and
enter lymph nodes via:
A.
B.
C.
D.
E.
Venules in the medulla
Efferent lymphatic vessels
High endothelial post-capillary venules in the cortex
High endothelial post-capillary venules in the paracortex
Afferent lymphatic vessels
D. High endothelial post-capillary venules in the paracortex
All of the following cells in the erythroid lineage synthesize hemoglobin
EXCEPT:
A.
B.
C.
D.
E.
Red blood cells
Reticulocytes
Orthochromic erythroblasts
Polychromic erythroblasts
Basophilic erythroblasts
A.
Red blood cells
Which of the following statements regarding globin chain expression is/are
correct?
A.
B.
C.
D.
E.
Transcription of both ζ and α globin occurs on the same chromosome.
In gestation, ε globin expression decreases as γ globin expression
increases.
The total number of different globin chains expressed during human
development is five
A, B, and C are all correct
Only A and B are correct.
E.
Only A and B are correct.
Hereditary spherocytosis is most often caused by a defect in, or deficiency
of RBC:
A.
B.
C.
D.
E.
Membrane cholesterol
Membrane anion transporter, band 3
Cytoskeletal spectrin
A, B, and C are all correct
Only B and C are correct.
C.
Cytoskeletal spectrin
The enzyme which catalyzes the rate-limiting step in heme biosynthesis:
A.
B.
C.
D.
E.
Uses a TCA cycle intermediate as a substrate.
Is synthesized in the cytoplasm of the cell.
Is inhibited by elevated cellular levels of lead.
A, B, and C are all correct
Only A and B are correct
E.
Only A and B are correct
Which of the following statements is/are true regarding normal heme
biosynthesis?
A.
B.
C.
D.
E.
It is increased in bone marrow, but not in liver, by barbiturates and
certain other drugs.
The enzyme of the last reaction in step is regulated by direct product
inhibition.
The first three steps occur in the mitochondria
All of the above statements are true
All of the above statements are false
E.
All of the above statements are false
The color of each of the first three compound involved in heme degradation
in the order in which they occur (left to right) is:
A.
B.
C.
D.
E.
Yellow, purple, green
Yellow, green, purple
Purple, yellow, green
Purple, green, yellow
Green, purple, yellow
D.
Purple, green, yellow
The heme degradation product secreted by spleen macrophages is carried
to the liver:
A.
B.
C.
D.
E.
Bound to haptoglobin
Bound to albumin
As a glucoronide
Bound to hemopexin
As polar, water-soluble compound
B.
Bound to albumin
The order which the numbered heme degradation products listed below
occur in the body before being excreted in urine is:
1.
2.
3.
4.
A.
B.
C.
D.
E.
Uroblin
Bilirubin
Urobilinogen
Bilirubin glucoronide
2,
4,
3,
1,
4,
3,
2,
4,
4,
2,
1,
3,
2,
3,
1,
4
1
1
2
3
B.
4, 2, 3, 1
Which of the following is NOT involved in the primary hemostatic processes,
platelet adhesion and aggregation on injured endothelium?
A.
B.
C.
D.
E.
Collagen
Fibrinogen
Von Willebrand factor
Factor VIII
Integrin GpIIbIIIa
D.
Factor VIII
Blood coagulation factor Va Leiden:
A.
B.
C.
D.
E.
Is
Is
Is
Is
Is
rapidly inactivated by activated protein C.
the result of polymorphism in the factor V gene 3’-UTR.
the cause of most common human bleeding disorder.
correctly described by both A and B.
correctly described by none of the above.
E.
Is correctly described by none of the above.
Factor XIIa:
A.
B.
C.
D.
E.
Can activate Factor XI.
Is activated when blood is drawn into a glass tube without
anticoagulant
Is not essential for physiological blood coagulation.
Is properly described by all of the above.
Is properly described only by A and B.
D.
Is properly described by all of the above.
Endongenous tissue plasminogen activator:
A.
B.
C.
D.
E.
Is stimulated by binding to thrombin
Binds to fibrin containing thrombi (clots)
Is the major physiological anticoagulant
Is correctly described only by A and B.
Is correctly described only by B and C.
B.
Binds to fibrin containing thrombi (clots)
Plasma proteins that are vitamin K-dependent are:
A.
B.
C.
D.
E.
Prothrombin, protein C and tissue factor
Factor X, factor IX, and protein S.
Factor V, factor XII and factor VII.
All of the proteins listed in A, B, and C.
Those proteins listed in A and B only
B.
Factor X, factor IX, and protein S.
Thrombotic disorders are frequently characterized by:
A.
B.
C.
D.
E.
A tendency to form clots in the large, deep veins of the legs.
Genetically transmitted deficiency of von Willebrand factor.
Abnormally low plasma concentration of prothrombin
None of the above are characteristics of thrombotic disorders.
Statements A and C only
A.
A tendency to form clots in the large, deep veins of the legs.
A 54yo male was diagnosed with CML and was referred to you for
treatment. The patient reports some fatigue but is fully employed as an
office manager. He has six siblings. Two of his siblings have identical HLA
match with him.
What is your initial treatment?
A.
B.
C.
D.
Wait and watch until the patient becomes more symptomatic and then
initiate treatment.
Bone marrow or peripheral stem cell transplantation from his sibling
because of his relatively young age.
Treat with hydroxyurea to maintain his WBC and platelet count in the
normal range
Treat with signal transduction inhibitor drug (Gleevec) and periodic
determination of BCR-ABL.
D.
Treat with signal transduction inhibitor drug (Gleevec) and periodic
determination of BCR-ABL.
A 62yo white male was referred to you because of splenomegaly and
anemia. The patient reports to you that he has had early satiety, some
vague abdominal pain, and has gradually more difficulty catching his breath.
Your examination shows massive splenomegaly associated with tachycardia,
tachypnea, and dilated neck veins. The blood picture shows moderate
anemia, WBC of 18, 200 with young forms and platelet count of 680,000.
There is 10% nucleated red cells on the blood smear.
What is the likely initial diagnosis?
A.
B.
C.
D.
Congestive heart failure
Chronic myelogenous leukemia
Myelofibrosis with congestive heart failure
Acute myelogenous leukemia
C.
Myelofibrosis with congestive heart failure
A 55yo male has been feeling ill for a long time but because of lack of
health insurance, has not seen a physician. He reports that he has had poor
appetite and 20lbs of weight loss. He has had intermittent fever and night
sweats and fullness in his abdomen. On physical exam, the major findings
are massive splenomegaly with some enlargement of the liver. His blood
picture shows WBC of 48,300 with myelocytes and premyelocytes, mild
anemia and thrombocytosis of 543,000. You suspect CML and you take
blood for Philadelphia chromosome determination, which turns out to be
negative.
What other tests can you do to reach the diagnosis?
A.
B.
C.
D.
Repeat Philadelphia chromosome determination
Bone marrow aspiration
Red cell mass determination.
BCR-ABL determination
D.
BCR-ABL determination
All of the following statements about ABO antibodies are true EXCEPT:
A.
B.
C.
D.
E.
ABO antibodies are IgG antibodies
ABO antibodies are reactive at body temperature
ABO antibodies bind complement efficiently.
Associated transfusion reactions can lead to massive intravascular
hemolysis.
ABO incompatible transfusion can lead to renal failure and death.
A.
ABO antibodies are IgG antibodies
All of the following about Type and Screen are true EXCEPT:
A.
B.
C.
D.
E.
Consists of ABO and RhD typing and an antibody screen.
If the antibody screen is negative, blood is not crossmatched unless
transfusion is necessary.
Blood can be provided in minutes if needed.
If an unexpected antibody is present, the workup is completed and 2
units set aside even though the need for blood may be remote.
A Type and Screen is appropriate for procedures where the likelihood
of transfusion is high.
E.
A Type and Screen is appropriate for procedures where the likelihood
of transfusion is high.
All of the following statements regarding transfusion are true EXCEPT:
A.
B.
C.
D.
E.
Transfusion of one unit of packed red blood cells to an adult will raise
the hemoglobin by 1g/dL.
Only isotonic saline may be added to red blood cells
Transfusion of platelets is indicated in all patients with decreased
platelet counts.
One dose of platelets is usually provided by a pheresis platelet unit.
Indications for transfusion coagulation factor deficiencies and massive
transfusion
C.
Transfusion of platelets is indicated in all patients with decreased
platelet counts.
All of the following statements regarding transfusion reactions are true
EXCEPT:
A.
B.
C.
D.
E.
ABO incompatibility is the most common cause of an acute hemolytic
transfusion reaction.
Transfusion of ABO incompatible blood is usually due to technical
errors in the blood bank.
Delayed hemolytic transfusion reactions usually occur days to weeks
after transfusion and may be recognized due to a fall in hematocrit.
Febrile nonhemolytic reactions may be caused by cytokines released
from donor leukocytes and recipient antibodies to donor leukocytes
Anaphylactic reactions occur in patients with IgA deficiency that make
anti-IgA.
B.
Transfusion of ABO incompatible blood is usually due to technical
errors in the blood bank.
Patients at risk for GVHD should receive
A.
B.
C.
D.
E.
Washed red blood cells
Leukoreduced red blood cells
Whole blood
Frozen red blood cells
Irradiated packed red blood cell units
E.
Irradiated packed red blood cell units
All of the following statements regarding donor testing and transfusion
transmitted infections are true EXCEPT:
A.
B.
C.
D.
E.
Donor blood testing includes NAT testing for HIV and HCV.
NAT testing stand for Nucleic Acid Testing
NAT testing is done by PCR to detect RNA
NAT testing has reduced the window period for HIV to approximately
two months.
The current risk for contracting HIV as a result of transfusion is 1:1.9
million.
D.
NAT testing has reduced the window period for HIV to approximately
two months.
Nutritional anemia is a decreased concentration of hemoglobin due to:
A.
B.
C.
D.
Increased destruction of red blood cells
Mutations that influence the function of red blood cell proteins
Excess of unstable hemoglobin
Lack of nutrients contained in food
D.
Lack of nutrients contained in food
Microcytic hypocromic morphology of red blood cells and MCV <70 are
present in iron deficiency anemia when hemoglobin level is:
A.
B.
C.
D.
5 g/dL
Normal
11 g/dL
7 g/dL
a. 5 g/dL
Reversion of megaloblastic hematopoiesis as a consequence of vitB12
replacement occurs after initiation of therapy:
A.
B.
C.
D.
2-3 days and peaks by 5-8 days
12-48 hours
1 week
2 months
B.
12-48 hours
A 55yo female has night sweats for 3 weeks, no fever or weight loss and is
short of breath when she walks. A chest X ray shows an enlarged
mediastinum. At physical examination, an enlarged lymph node is palpated
in the right supraclavicular area. A biopsy is obtained and shows
Diffuse Large Cell Lymphoma (B-lineage, high grade). A bone marrow
biopsy is negative and a CT of the abdomen shows an enlarged spleen and
borderline pelvic lymph nodes and normal liver and pancreas.
What is her clinical stage?
A.
B.
C.
D.
E.
IA
IV B
Staging is incomplete, patient should first undergo laparotomy or PET
imaging
II B
III B
E.
III B
Mantle cell lymphoma is associated with:
A.
B.
C.
D.
E.
t(9;22)
Helicobacter pylori
Older age, advanced stage
Cure by a triple antibiotic regimen in >90% of cases
HTLV-1
E.
HTLV-1
Multiple myeloma is frequently associated with:
A.
B.
C.
D.
E.
Multiple bone lesions
Rouleaux formation
Amyloidosis
A precursor B, T or NK cell phenotype according to the W.H.O.
classification
Monoclonal proteins (paraprotein or M-protein)
D.
A precursor B, T or NK cell phenotype according to the W.H.O.
classification
The primary cause of deficiency of which of the following is chronic kidney
disease?
A.
B.
C.
D.
E.
Erythropoietin
Folic acid or related folates
Vitamin b-12 (cobalamin)
A and C
B and C
A. Erythropoietin
Therapy with which of the following will reverse the megaloblastic anemia
associated with cobalamin deficiency?
A.
B.
C.
D.
E.
Vitamin B12
Folic acid
Iron
A and B
B and C
A. Vitamin B12
Which of the following are usually administered by parenteral routes to treat
a deficiency-related anemia?
A.
B.
C.
D.
E.
Vitamin B12
Iron
Erythropoietin
B and C
A and C
E.
A and C
A 21 year old college student is admitted to the hospital with sudden onset
of shortness of breath, fever and chest pain. His oxygen saturation is low
and on chest x ray there is an infiltrate consistent with pneumonia. You are
asked to see the patient because of an anemia. You look at his blood
smear. On the basis of this smear you suggest that all of the following
EXCEPT would be a useful diagnostic or therapeutic maneuver:
A.
B.
C.
D.
E.
High doses of a diuretic
Supplemental oxygen
Hemoglobin electrophoresis
Treating the patient with antibiotics
RBC exchange transfusions
A. High doses of a diuretic
A young woman has had progressive fatigue. Her exercise tolerance is quite low and she notes
difficulty in minding her 3 young children because she gets short of breath. During her
pregnancies she did take her folic acid but could not take her iron pills because of constipation.
Her periods are irregular and last 8 to 9 days with heavy flow on the first 2 days. Her diet
consists primarily of fruits and vegetables and she tends to avoid eating meat. ON physical
examination the patient is pale but otherwise healthy, muscular, young woman.
Laboratory includes:
WBC = 6,500 cells/mm3 (normal 3-8,000)
Hemoglobin (Hgb) = 6.0 gm/dL (normal 12-15 gm/dL)
Mean corpusclar volume (MCV) = 72 u3 (normal 81-95)
Platelets = 305,000 cell/mm3
The peripheral smear is shown in figure to the right.
All of the following laboratory tests would be consistent with her underlying hematologic problem
problem EXCEPT:
A.
B.
C.
D.
E.
Low ferritin
Low serum iron
Elevated serum transferrin (TIBC)
Markedly increased MCV
Markedly decreased MCV
D.
Markedly increased MCV
A teenager is sent to you because of jaundice and a palpable spleen. The
patient is here from Greece and you do not have a translator. You are able
to get a peripheral smear which is shown below.
On the basis of the history, physical examination, and blood smear, which of
the following would NOT be correct:
A.
B.
C.
D.
E.
Mean corpuscular volume (MCV) = 62 u3 (normal 81-95)
Serum ferritin levels might be elevated
Reticulocyte count would be increased
Alpha globin chains would be synthesized in excess of beta globin
chains
Both of the parents’ blood smears would be absolutely normal
E. Both of the parents’ blood smears would be absolutely normal
You have just removed the gall bladders of several members of the same family
because of gall stones. A 25 year old member of the same family arrives in your
office with jaundice and splenomegaly complaining of right upper quadrant pain.
Laboratory data include:
WBC = 7,500 cells/mm3 (normal 3-8,000)
Hgb = 11.0 gm/dL (normal 12-15 gm/dL)
MCV = 89u3 (normal 81-95)
Platelets = 305,00 cells/mm3
Reticulocyte count = 6% (normal 0-2%)
The peripheral smear is shown here.
On the basis of this information all of the following are possible EXCEPT:
A.
The patient has a mutation in a gene coding for a cytoskeletal protein.
B.
The patient has a mutation in a gene coding for α globin chains
C.
The hemolysis in this patient takes place primarily in the spleen.
D.
The patient’s sibs had bilirubin in their gall stones.
E.
The patient’s RBCs will have lost surface area in excess of volume.
B.
The patient has a mutation in a gene coding for α globin chains
A long-lost cousin who works at a nuclear reactor appears in your office complaining
of fevers and weakness. She was exposed to a disaster at the nuclear reactor several
years previously. She has a high fever and petechia. Her lab tests include:
WBC = 900 cells/mm3 (normal 3-8,000)
Hgb = 5.6 gm/dL (normal 12-15 gm/dL)
MCV = 87 u3 (normal 81-95)
Platelets = 6,000 cells/mm3
Reticulocyte count = 0% (normal 0-2%)
Bone marrow aspiration reveals no cell and the bone marrow biopsy is shown. On
the basis of this information all of the following are reasonable EXCEPT:
A.
B.
C.
D.
E.
The patient needs to be on oral antibiotics and given a return appointment in
one month.
The patient’s sibs need to be HLA typed to see if they are a match for a
possible bone marrow transplantation.
The patient needs to be on broad spectrum antibiotics coverage after the blood
cultures are drawn.
Radiation exposure might be a cause for the patient’s problems
Platelet transfusions should be used if the patient starts bleeding
a.
The patient needs to be on oral antibiotics and given a return
appointment in one month.
In a patient with iron deficiency anemia secondary to bleeding from a
colonic polyp you might expect all of the following except:
A.
B.
C.
D.
E.
That intestinal iron uptake would increase
The patient might have a low MCV
That serum ferritin would be increased
That transferrin receptors would increase
That in response to the anemia that iron transporters in the intestine
might have increased expression
C.
That serum ferritin would be increased
Iron absorption in the intestine would be affected by all of the following
except WHICH.
A.
B.
C.
D.
E.
Absent gastric acid production
The dietary form of iron
Removing the duodenum and proximal jejunum
Removing the terminal ileum
Adding ascorbic acid to the diet
D.
Removing the terminal ileum
Iron absorption may be affected by all of the following EXCEPT:
A.
B.
C.
D.
E.
Inherited abnormalities in the iron uptake pathway
Inflammatory diseases
Hemolytic anemias
Digoxin levels between 0.5 and 1.0 mg/dL
Levels of hepcidin
D.
Digoxin levels between 0.5 and 1.0 mg/dL
A patient with a Hemoglobin = 7 gm% (normal 12-15gm%), total bilirubin
2.2 mg% (normal <1.2mg%), indirect bilirubin = 2.0 mg% (normal <0.2
mg%), reticulocyte = 10%, and a LDH =1500 units/dL (normal
<600units/dL) could have all of the following except WHICH:
A.
B.
C.
D.
E.
Antibodies directed to a red blood cell surface antigen
A positive coomb’s test
Disseminated intravascular coagulopathy
A bone marrow infiltrated with metastatic cancer
A defect in the red blood cell cytoskeleton
D.
A bone marrow infiltrated with metastatic cancer
A patient is seen in your office for a routine physical examination. He is 59yo and is
in excellent health. His entire physical examination is normal for his age. Routine CBC
shows the following:
Hgb = 14.5 gm%
Hematocrit = 47% (normal 40 to 52%)
Platelets = 25,000 (normal 150 to 450,000)
WBC = 45,000 (normal 5 to 12,000)
The peripheral blood smear is shown here.
Which of the following is correct?
A.
B.
C.
D.
E.
He has acute Myeloid Leukemia and needs aggressive chemotherapy
He needs a bone marrow transplant.
He has chronic lymphocytic leukemia stage III and needs chemotherapy
He has chronic lymphocytic leukemia stage 0 and needs observation only with
no therapy at this time.
He has chronic myeloid leukemia and need Gleevac treatment.
D.
He has chronic lymphocytic leukemia stage 0 and needs observation
only with no therapy at this time.
A patient presented to the ER with bleeding gums and also has petechiae and
purpura. CBC shows the following:
Hgb = 9 gm% (normal 13.5-15.5)
Hematocrit = 27% (normal 40-52%)
Platelets = 25,000 (normal 150-450,000)
WBC = 45,000 (normal 5 to 12,000)
The smear show is in figure here.
Which of the following is correct?
A.
B.
C.
D.
E.
He has acute Myeloid Leukemia with Auer Rods, and needs aggressive
chemotherapy.
He has Chronic lymphocytic leukemia stage III and needs chemotherapy
He has chronic lymphocytic leukemia stage 0 and needs observation only with
no therapy at this time.
He has chronic myeloid leukemia and needs gleevec treatment
The blood cells are normal.
A.
He has Acute Myeloid Leukemia with Auer Rods, and needs aggressive
chemotherapy.
You are asked to see a 25yo woman with a history of easy bruising and
heavy menstrual bleeding. She has never been ill, takes no medicines
(even over the counter meds) and had a tonsillectomy as a child-she
“almost had to have a transfusion” secondary to bleeding. Family history is
positive on her mother’s side of the family for several aunts/uncles who are
“free bleeders” as well as some cousins. You order the following tests:
PT= 12 (normal 11 to 13)
aPTT = 45 (normal 27 to 35)
Bleeding Time = 10 minutes (normal 3 to 5 minutes)
CBC is normal
Your diagnosis is?
A.
B.
C.
D.
E.
Hemophilia
No significant problem
Von Willebrands disease
Factor VII deficiency
Factor II deficiency
C.
Von Willebrands disease
A patient is seen by you in the ER. She is a 75yo woman from the nursing
home. She is confined to bed and has Alzheimer’s dementia. She was
brought in by her family as she seems less responsive and they noted a
fever. Her temperature is 104 degrees. She has purpura and is bleeding
from the gums. The family relates she has never had a bleeding problem
before. Her regular lab shows a urinary tract infection with gram-negative
rods seen in the urine. Her coagulation testing shows the following.
PT= 22 (normal 11 to 13)
aPTT= 45 (normal 27 to 35)
Platelet count is 50,000 (normal>150,000 and <400,000)
Fibrinogen 100 mg% (normal >200)
Your diagnosis of the hematologic problem is?
A.
B.
C.
D.
E.
ITP (Immune thrombocytopenia)
DIC (Disseminated Intravascular Coagulation)
TTP (Thrombotic Thrombocytopenic Purpura)
Hemophilia
Von Willebrands disease
B.
DIC (Disseminated Intravascular Coagulation)
All of the following are associated with a hypercoaguable state
(Thrombophilia) except?
A.
B.
C.
D.
E.
Factor V Leiden
ATII deficiency
Protein C deficiency
Factor VII deficiency
Protein S deficiency
D.
Factor VII deficiency
Which of the following would be abnormal in hemophilia?
A.
B.
C.
D.
E.
Bleeding Time
aPTT
PT
Thrombin Time
1 to 1 mix of the aPTT
B. aPTT
If a 1 to 1 mix is done on an abnormal aPTT and it does not correct, which
of the following has been eliminated as a possibility?
A.
B.
C.
D.
Von Willebrands Disease
Lupus Anticoagulant
Hemophilia with inhibitor
Heparin contamination of the sample
A.
Von Willebrands Disease
The treatment of ITP usually starts with which of the following treatments?
A.
B.
C.
D.
Splenectomy
Prednisone
Immunosuppressive drugs such as cyclophosphamide
Immunoglobulin therapy (IVIG)
B.
Prednisone
Abnormal platelet function is seen is all of the following except?
A.
B.
C.
D.
E.
Von Willibrands Disease
Aspirin Use
Factor X Deficiency
Factor VII deficiency
Heparin contamination
D.
Factor VII deficiency
If a patient has a both an abnormal PT and an abnormal PTT then which of
the following is not possible?
A.
B.
C.
D.
E.
Factor X deficiency
Abnormal fibrinogen
Factor V deficiency
Factor XI deficiency
Vitamin K deficiency
D.
Factor XI deficiency
A patient with liver disease might be expected to have low values of all the
following clotting factors except?
a.
b.
c.
d.
e.
II
VII
Protein C
VIII-VWF
Fibrinogen
D.
VIII-VWF