8 All of the following statements concerning the development of mature elements of blood are correct EXCEPT:megakaryocytes give rise to plateletsCFU-NM (CFU-GM) gives rise to neutrophils and monocytesThe ribosomes in basophilic erythroblasts manufactures hemoglobindevelopment of erythrocytes in the bone marrow occurs in close association with macrophagespromyelocytes are described as containing azurophilic, specific, and tertiary granules.
9 e. promyelocytes are described as containing azurophilic, specific, and tertiary granules.
10 All of the following types of tissue contain lymph nodules EXCEPT:spleenthymusGALT (gut associated lymphoid tissue)palatine tonsillymph nodules
14 Recirculating lymphocytes primarily leave the blood vascular system and enter lymph nodes via:high endothelial post-capillary venules in the paracortexafferent lymphatic vesselscapillaries in the cortexhigh endothelial post-capillary venules in the medullacapillaries in the medulla
15 A. high endothelial post-capillary venules in the paracortex
16 All of the following statements that refer to a specific lymphoid organ are correct except:M cells and Peyer’s patches – small intestineHassell’s corpuscles – thymussubcapsular sinus – lymph nodeafferent lymphatic vessels – thymusdeep crypts and stratified squamous epithelium – palatine tonsil
30 A 19 y/o comes into the ER very short of breath 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 cells/mm³), and WBC=7500 cells/mm³ (normal cells/mm³). The reticulocyte count was 18%. Which of the following is NOT a likely scenario?The patient has hereditary spherocytosisThe patient has autoimmune hemolytic anemiaThe patient has sickle cell diseaseThe patient has a production defect in bone marrowThe patient has increased RBC destruction
31 d. The patient has a production defect in bone marrow
32 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 subtleb. a reductant like ascorbic acid to keep iron in theferrous formc. a strong oxidant because ferric (Fe³+) is more potent thanferrous iron (Fe2+).d. chelators that might facilitate iron absorption in the distalduodenum and upper jejunum
33 a strong oxidant because ferric (Fe³+) is more potent than ferrous iron (Fe2+).
34 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 receptorb. the transferrin receptor needs to be internalized byreceptor mediated endocytosisc. the pH of the endosomes needs to increase to at least pH = 8.0d. transferrin needs to bind either one or two ironse. the kidney needs to synthesize erythropoietin to allow forerythroid differentiation past the BFU-E.
35 the pH of the endosomes needs to increase to at least pH = 8.0
36 In a patient with hemochromatosis, you might expect all of the following to occur EXCEPT: a. the liver would develop iron overloadb. iron absorption would be increasedc. the patient would be resistant to developing diabetesd. the patients TIBC would be saturated with irone. the patient’s ferritin would be high
37 c. the patient would be resistant to developing diabetes
38 During the process of erythropoiesis which of the following does not occur?in iron deficiency, erythroid precursors leave the bone marrow early and hence circulate as macrocytesfolic acid is used for DNA synthesiserythroid cells get progressively smaller with each cell divisionheme synthesis in erythroid cells accounts for the chromicity of the resulting red blood cellserythropoietin binds to receptors on erythroid precursor cells
39 in iron deficiency, erythroid precursors leave the bone marrow early and hence circulate as macrocytes
40 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 willinterfere with erythropoiesis.b. cytokines will antagonize the action of erythropoietinc. cytokines will affect the synthesis of ferritin in macrophages causing themacrophages to hold onto iron.d. cytokines will stimulate receptor mediated endocytosis allowing for moreiron to get into erythroid precursor cellse. the cellularity of the bone marrow may be affected
41 d. cytokines will stimulate receptor mediated endocytosis allowing for more iron to get into erythroid precursorcells
42 The structure of the product of the committed, rate limiting step in heme synthesis A B C D E
50 Which of the following statements is NOT correct? Carbon monoxide is produced when a macrophage enzyme acts on hemeConjugated bilirubin is converted to biliverdin in premature infants by fluorescent light.“Direct bilirubin” is a measure of conjugated bilirubinIn order to obtain “indirect bilirubin,” an organic solvent must first be added to serumbilirubin glucuronidation enhances excretion of heme catabolism products.
51 b. Conjugated bilirubin is converted to biliverdin in premature infants by fluorescent light.
52 The substance deposited in the CNS of individuals with “kernicterus” is: biliverdinonly “direct bilirubin”unconjugated bilirubinboth conjugated and unconjugated bilirubininactive UDP glucoronyl transferase
58 Which of the following statements regarding cobalamin (Vitamin B12) is incorrect? a. cobalamin is transported in blood bound to intrinsic factorb. cobalamin is required for the synthesis of methionine in humansc. deoxyadenosyl-cobalamin is the coenzyme involved in theconversion of L-methylmalonyl-CoA to succinyl-CoAd. cobalamin stores in the body can last for decadese. cobalamin deficiency is rare in teenagers
59 a. cobalamin is transported in blood bound to intrinsic factorord. cobalamin stores in the body can last for decades
60 Which one, if any, of the following statements regarding the primary hemostatic process is incorrect:platelets adhere to exposed subendothelial collagen throughGpIa-IIa receptorsplatelets secrete prostacyclin, which prevents excessive platelet aggregationfibrinogen enhances platelet aggregation through GpIIb-IIIa receptorsVon-Willebrand factor allows adhered platelets to resist turbulence and shear forces in injured small vesselsnone of the above statements is correct
61 b. platelets secrete prostacyclin, which prevents excessive platelet aggregation
62 When coagulation factor VIIa interacts with tissue factor: Factor XI is activated, thus involving the “intrinsic pathway” of coagulationFactor X binds to the VIIa-tissue factor complex in a Ca2+ dependent reactionFactor IXa is rapidly inactivated by TFPI, along with factor XaTissue Factor is released from a phospholipid membraneFactor IX must be released from a phospholipid membrane before it can be activated
63 b. Factor X binds to the VIIa-tissue factor complex in a Ca2+ dependent reaction
64 Which one of the following substances is used as an anticoagulant both in vivo and in vitro? a. heparinb. sodium citratec. warfarind. EDTAe. sodium oxalate
66 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. Prothrombinb. Factor Xc. Factor VIId. Factor IXe. Factor V
70 Which one, if any, of the following statements regarding fibrinolysis is incorrect? plasminogen activator inhibitor, PAI, stimulates fibrinolysisD-dimers are products of fibrinolysis found in plasmaboth plasminogen and tPA bind to fibrin in a thrombusplasmin bound to fibrin is resistant to α2 plasmin inhibitor actionnone of the above statements is false
72 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 ). Her peripheral blood smear appeared as below.Most likely diagnosis is:iron deficiencyanemia of chronic diseaseiron excesssickle cell anemialead intoxication
74 Which of the following is NOT seen in patients with accelerated red cell destruction due to hemolytic anemias?increased serum unconjugated bilirubindecreased serum haptoglobinincreased serum lactate dehydrogenase activitydecreased red cell countdecreased reticulocyte count
76 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:the ability to absorb ironthe cytoskeleton of red blood cellsa congenital absence of the spleenthe lipid composition of the red blood cellshairy cell leukemia
84 Which of the following conditions is most likely to be cured with combination of chemotherapy? disseminated non-small cell lung cancerdisseminated breast cancerintermediate grade lymphomalow grade lymphomamultiple myeloma
86 Which one of the following lab abnormalities is least likely to occur in multiple myeloma?decreased hemoglobinincreased serum creatinineincreased alkaline phosphataseincreased serum total proteinsincreased serum calcium
88 Which one of the following statements is true about lymphoma?staging is more likely to determine the treatment in a patient with Non-Hodgkin’s Lymphoma than in one with Hodgkin’s diseaseElevated serum LDH does not correlate with disease activity in non-Hodgkin’s LymphomaHodgkin’s disease is unlikely to be cured with combination chemotherapyNon-Hodgkin’s lymphoma is frequently disseminated at the time of presentation
89 d. Non-Hodgkin’s lymphoma is frequently disseminated at the time of presentation
90 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 physicalexam is normal.WBC = 20,000 (normal ,000)Hb normalPlatelet count normalPeripheral smear belowYour diagnosis is?Chronic Myeloid LeukemiaChronic Lymphocytic LeukemiaAcute Myeloblastic LeukemiaAcute Lymphoblastic LeukemiaNo hematological Disease
92 Appropriate therapy for this patient is? bone marrow transplant from an unrelated donorhigh dose chemotherapy short of transplant dosesChlorambucil or Prednisone chemotherapyno treatment indicated at this timeprophylactic immunoglobulin therapy to prevent infection
94 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 afterbrushing his teeth. Your exam shows an enlarged spleen and extensive petechiae and bruises.Lab Exam:Hb of 7gm% (nl >14) Platelets = 15,000 (nl ,000)WBC = 3000 (nl ,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?you have an incurable disease and should be sent to hospiceYou need an emergent bone marrow transplantStandard therapy with All Trans retinoic acidand chemotherapy has a chance of curing your leukemiathe bleeding problem is not related to the leukemiayou have chronic myeloid leukemia and need Gleevec treatment
95 c. Standard therapy with All Trans retinoic acid and chemotherapy has a chance of curing your leukemiaNote: This is acute promyelocytic leukemia and requiresAll-trans retinoic acid because according to theNEJM.All-trans-retinoic acid induces complete remission inacute promyelocytic leukemia. However, it is notclear whether induction therapy with all-trans-retinoicacid is superior to chemotherapy alone or whethermaintenance treatment with all-trans-retinoic acidimproves outcome
96 Which of the following is a co-factor for activation of coagulation proteins? Factor XFactor VIIFactor VFactor IX
102 Which of the following statements regarding hemophilia A is incorrect?it is an X-linked disorderbleeding in the joints is characteristichemophilia is more common in black malescaused by deficiency in factor VIII
104 Which of the following statements regarding factor IX is accurate? it is a co-factor for factor VIIIDeficiency of factor IX is transmitted as autosomal recessive disorderBleeding in the joints is rare in patients severely deficient in factor IXThe gene encoding factor IX is located on the X-chromosome
105 d. The gene encoding factor IX is located on the X- chromosome
106 Venous thrombosis can result from all of the following except: Proteins S deficiencyimpaired fibrinolysisincrease in factor VIIa point mutation at site 506 in the factor V
108 Which of the following best characterizes immune thrombocytopenia purpura (ITP)? it is transmitted as autosomal recessive traitthe destruction of platelets is commonly caused by antibodies against GPIIb|IIIaSevere neutropenia is common with ITPITP is a rare cause of thrombocytopenia
109 b. the destruction of platelets is commonly caused by antibodies against GPIIb|IIIa
110 All of the following can be found in a patient with thrombotic thrombocytopenic purpura except: severe headacheprolonged activated partial thromboplastin timefragmented red blood cellsanemia
111 b. prolonged activated partial thromboplastin time
112 Which of the following possess both specific and azurophilic granules? a. Erthrocyteb. Lymphocytec. Plateletd. Neutrophile. Monocyte
116 Which of the following is a characteristic of monocytes? a. They contain a multilobed nucleusb. They are the most numerous of the white cellsc. Their cytoplasm is packed with ribosomesd. They become active macrophages while circulating in the bloode. They become active macrophages after entering the tissues
117 e. They become active macrophages after entering the tissues
118 After their maturation in the thymus and release into the circulation, T lymphocytes migrate preferentially to which of the following sites?a. Paracortex (deep cortex) of lymph nodesb. Cortical lypmhoid nodules of lymph nodesc. Hilus of lymph nodesd. Lymphoid nodules of the tonsilse. Lymphoid nodules of the spleen
120 The region of a lymph node where reticulating lymphocytes normally leave the blood via postcapillary high endothelial venules is the:a. Subcapsular sinusb. Cortexc. Paracortex (deep cortex)d. Medullary cordse. Medullary sinuses
122 Which of the following is a unique characteristic of the palantine tonsils? a. It is completely surrounded by a connective tissue capsuleb. It contains deep crypts lined by stratified squamous epitheliumc. Its surface is covered by pseudostratified ciliated columnarepitheliumd. Its pits are washed out by mucus secretions from glands locatednear the base of the pitse. Many of the arterioles in the gland are surrounded by lymphnodules and are called central arterioles
123 b. It contains deep crypts lined by stratified squamous epithelium
124 The genetically defined developmental programs which regulate proliferation and maturation of hematopoeitic stem cells (HSCs) are driven by external signals that include:a. Interleukin 3b. Erythropoietinc. 2,3-bisphosphoglycerate (2,3-BPG)d. A, B, and Ce. A and B only
126 The oxygen saturation curve (O2 fractional saturation vs 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, butcontaining 5 mM 2,3-BPGb. A high degree of cooperativity with respect to O2 bindingc. Almost no cooperativity with respect to O2 bindingd. An exaggerated Bohr effecte. A, B, and D
127 c. Almost no cooperativity with respect to O2 binding
128 The relatively simple metabolic system of normal, mature RBCs a. Requires a source of lactateb. Is unable to produce NADPHc. Is incapable of oxidative phosphorylationd. Is incapable of reducing methemoglobine. Produces ATP anaerobically
130 Which of the following statements about heme synthesis in bone marrow erythrocyte precursor cells is NOT correct?a. ALA synthase is the rate-limiting enzymeb. PBG synthase (ALA dehydratase) is a cytoplasmic enzymec. Ferrochelatase is a mitochondrial enzymed. Elevated heme prevents mitochondrial PBG transporte. UPG I is not a normal intermediate
131 d. Elevated heme prevents mitochondrial PBG transport
132 The enzymatic steps in heme synthesis that are sensitive to inhibition by Pb2+ in RBC precursor cells area. Ferrochelatase and PBG synthase (ALA dehydratase)b. UPG synthase and ferrochelatasec. UPG synthase and PBG synthased. ALA synthase and ferrochelatasee. ALA synthase and CPG oxidase
133 a. Ferrochelatase and PBG synthase (ALA dehydratase)
134 Which of the following statements regarding porphyrias are NOT correct? a. Patients with porphyria cutanea tarda are photosensitiveb. Patients who have inherited defects of enzymes which catalyzereactions in the early reactions in heme synthesis usually haveneurologic symptomsc. Spontaneous oxidation of porphyrinogens to porphyrins does not occurin porphyriad. Phenobarbital and similar drugs can precipitate acute attacks of certainporphpyriase. The ability to produce cytochrome P450 enzymes is affected in certainporphyries.
135 c. Spontaneous oxidation of porphyrinogens to porphyrins does not occur in porphyria
136 Metabolic products of the first three enzymatic reactions in heme degradation include a. NADP+, biliverdin, and Fe3+b. NADPH, biliverdin, and COc. NAD+, bilirubin, and UDPd. NADH, bilirubin, and UDP-glucoronatee. FAD, Fe2+, and UTP
138 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. A and Bb. B and Cc. C and Dd. D and A
140 The addition of both diazotized sulfanilic acid (Ehrlich’s reagent) and methyl alcohol to plasma results in a colored product which representsa. Direct bilirubinb. Indirect bilirubinc. Total bilirubind. Albumin-bound bilirub9in onlye. Bilirubin diglucuronide only
142 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. Thefeeling of fatigue and reduced exercise tolerance is quite recent and has beenprogressing over the past 6 to 12 months. She is a serious runner, running over 50 mileseach week. Because of the accompanying aches and pains she takes NSAIDS daily. Herperiods are irregular and last 8 to 9 days with heavy flow on the first 2 days. She avoidseating meat. On physical examination the patient is a pale but otherwise healthy,muscular, young woman.Laboratory includes:White Blood Cells = 7,500 cells/mm3 (normal 3-8,000)Hemoglobin = 6.0 gm/dl (normal 12,15 gm/dl)Mean Corpuscular Volume = 72 u3 (normal 81 – 95)Platelets = 305,000 cells/mm3The peripheral smear is to be shown:The cause of her anemia can be attributed to all of the following EXCEPT whicha. Menstrual blood lossb. Gastric irritation from her NSAID agentsc. Malabsorption of vitamin B12d. March hemoglobinuria with loss of hemoglobin in the urinee. A diet in which iron is too low to compensate for increased loss
144 In a patient with iron deficiency with a microcytic hypochromic morphology of red blood cells and a MCV < 70 fl (normal fl) all of the following might be present EXCEPT:a. Hemoglobin of 5 gm/dlb. Hemoglobin of 6 gm/dlc. Ferritin < 5 mg/dl (normal mg/dl)d. Hemoglobin 12 gm/dle. TIBC saturation < 10%
146 The absorption of iron in the intestine is regulated a. By renal tubular excretionb. By increased sloughing of the skinc. By absorption in the terminal duodenum and proximal jejunumd. In the terminal ileume. By having sufficient folic acid in the diet
148 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. Metastatic cancer infiltrating the bone marrowb. Exposure to benzene with development of aplastic anemiac. High doses of radiation from a reactor accidentd. 24 hours of bleeding from a gastric ulcere. Acute myelogenous leukemia
150 A patient with a Hemoglobin + 7 gm/dl (normal 12 -15 gm/d A patient with a Hemoglobin + 7 gm/dl (normal 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. Antibodies directed to a red blood cell surface antigenb. A positive Coombs testc. Disseminate intravascular coagulationd. A bone marrow infiltrated with metastatic cancere. A defect in the red blood cell cytoskeleton
151 d. A bone marrow infiltrated with metastatic cancer
152 Therapeutic use of it can reverse the megaloblastic anemia associated with cobalamin deficiency: a. Erythropoietinb. Folic acid or related folatesc. Vitamin B-12 (cobalamin)d. A and Ce. B and C
158 Reversal of megaloblastic hematopoiesis as a consequence of vitamin B-12 replacement occurs after initiation of therapy at:a days and peaks by 508 daysb hoursc. 1 weekd. 2 monthse. Never occurs unless the patient receives folic acidsimultaneously
160 Surgical removal of the terminal ileum because of trauma might be expected to result in which of the following:a. Folic acid depletion within daysb. Folic acid depletion within one yearc. Folic acid depletion within three yearsd. Vitamin B-12 deficiencye. Achlorhydria
162 A patient presents with a Hemoglobin of 7 gm/dl 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. Decreased methylmalonic acid x normalb. Increased methylmalonic acid x normalc. Decreased serum homocysteine 2-20 x normald. High total iron binding capacity (TIBC)
163 b. Increased methylmalonic acid 2-100 x normal
164 The complex consisting of tissue factor and activated factor VII (TF/VIIa) activates which of the following proteins:a. Factors VIII and IXb. Proteins C and Sc. Factors X and IXd. Factor XII and XIII
174 The sons of a hemophilia B carrier woman married to a healthy man are expected to be: a. All healthyb. Hal healthy and half carriersc. Half affected and half carriersd. Half affected and half healthy
176 Which of the following is not considered a hereditary condition predisposing to hypercoagulability: a. Activated protein C resistanceb. Protein S deficiencyc. Factor V deficiencyd. Antithrombin II deficiency
178 Which of the following findings is a characteristic of thrombotic thrombocytopenic purpura: a. Autoimmune hemolysis and thrombocytopeniab. Intravascular hemolysis and high D-dimerc. Intravascular hemolysis and thrombocytosisd. Intravascular hemolysis and thrombocytopenia
179 d. Intravascular hemolysis and thrombocytopenia
180 a. Thrombotic Thrombocytopenic Purpura (TTP) 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. Thrombotic Thrombocytopenic Purpura (TTP)b. Immune Thrombocytopeniac. Disseminated Intravascular Coagulation (DIC)d. Factor VIII Deficiency
182 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. Nucleusb. Barr bodyc. Auer Rodd. Smudge Celle. Normal granules
184 In treating acute Myeloid Leukemia which of the following is CORRECT: a. The only curative therapy is bone marrow transplantationundertaken at the time of diagnosisb. Low dose non-toxic chemotherapy should be usedc. Induction therapy consists of high doses of chemotherapy toeliminate all the abnormal blasts is given and then supportivecare to allow the normal marrow to repopulated. No treatment is of any value
185 c. Induction therapy consists of high doses of chemotherapy to eliminate all the abnormal blasts is given and then supportivecare to allow the normal marrow to repopulate
186 Characteristics of Chronic Lymphocytic Leukemia (CLL) include all of the following EXCEPT: a. CLL is usually characterized by an overproduction of T-cellsb. CLL is staged 0-4 with 0 being the best prognostic stagec. Smudge cells are seen on the peripheral blood smeard. There is no curative therapy only palliative therapye. Infections and autoimmune disorders may occur
187 d. There is no curative therapy only palliative therapy
188 Which of the following platelet (thrombocyte) surface receptor(s) is/are correctly matched with its/their ligand(s)?a. GpIa, collagenb. GpIbIX, fibrinogenc. GpIbIIIa, von Willebrand factord. A and Be. B and C
196 Which of the following statements regarding in vivo enzymatic covalent crosslinking of fibrin is/are NOT correct?a. The reaction involves the addition of NH4+ to fibrinb. Glutamine and lysine residues in fibrin are substratesc. Fibrin crosslinking is normally an intermolecular reactiond. A and Be. B and C
197 a. The reaction involves the addition of NH4+ to fibrin
198 Which of the following complexes involved in blood coagulation contain a substrate for activated protein C?a. Tissue factor –VIIab. “Tenase”c. “Prothrombinase”d. A and Be. B and C
200 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. Chronic myelogenous leukemia in blast crisisb. Polycythemia verac. Myeloid metaplasia with myelofibrosisd. End stage liver disease
202 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. Polycythemia verab. Myelofibrosisc. Essential thrombocythemiad. Chronic myelogenous leukemiae. Leukemoid reaction
204 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. Observe the patient until he becomes symptomaticb. Allogeneic bone marrow transplantation immediately because of his agec. Treatment with a-interferond. Treatment with the signal transduction inhibitor Gleevec with periodicassessment of response by measuring percentage of cells expressingBCR-ABL.
205 d. Treatment with the signal transduction inhibitor Gleevec with periodic assessment of response by measuring percentage of cells expressing BCR-ABL.
206 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. I Ab. IV Bc. Staging is incomplete, patient should first undergo laparotomyd. II Be. III A
210 Multiple myeloma is frequently associated with each of the following EXCEPT which: a. Multiple bone lesionsb. Rouleaux formation on the peripheral smearc. Amyloidosisd. A precursor T-cell phenotype according to the W.H.O.classificatione. Infections
211 d. A precursor T-cell phenotype according to the W.H.O. classification
212 Which product is correctly matched to the storage parameters: a. Packed Red Blood Cells 5 days shelf life stored at 20 –24 degrees Celsiusb. Fresh Frozen Plasma day shelf life, stored at1-6 degrees Celsiusc. Pheresis Platelet 24 hr. shelf life, stored at degrees Celsiusd. Washed Red Blood Cells 1 yr. shelf life, stored at < or =-18 degrees Celsiuse. Pooled Platelets 4 hr. shelf life, stored at degrees Celsius
213 e. Pooled Platelets 4 hr. shelf life, stored at 20-24 degrees Celsius
214 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 reactionsb. HIV transmission, Hepatitis C transmission, and Hepatitis Btransmissionc. Creutzfelt Jacob Disease (CJD) and West Nile Virusd. Bacterial infection
215 a. Immunization to HLA antigens, Cytomegalovirus (CMV) transmission, and Febrile transfusion reactions
216 Your patient has a hemoglobin of 8. 5 g/dl 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 of8.5 g/dl.b. The patient’s clinical condition such as underlying cardiac disease andcurrent vital signs should be considered with the hemoglobin todetermine the need for transfusionc. 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
217 b. The patient’s clinical condition such as underlying cardiac disease and current vital signs should be considered with the hemoglobin todetermine the need for transfusion
218 You decide to transfuse the patient on slide 107 You decide to transfuse the patient on slide The patient says his friend got HIV from a transfusion in You tell him that the risk of HIV is:a. The same as in 1980b. No risk at allc. With the current testing a small risk exists; the estimated risk perunit is about 1/50,000d. With the current testing a small risk exists; the estimated riskper unit is one in a million or less
219 d. With the current testing a small risk exists; the estimated risk per unit is one in a million or less
220 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 thetype and crossmatchb. Immediately release several A, Rh-negative unitsc. Immediately release several O, Rh-negative unitsd. Immediately release several O, Rh-positive units
221 c. Immediately release several O, Rh-negative units
222 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 anemiab. Release A, Rh-positive blood; if anti-D forms, it does not matterc. Ask the trauma team if they can hold the transfusion, because type-specific blood is unavailabled. Release O, Rh-negative blood because she is a woman of child-bearingage; if anti-D forms, it might cause severe hemolytic disease of thenewborn if she later becomes pregnant.
223 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.
224 The cell marked identify is a: PromyelocyteNeutrophilic myelocyteNeutrophilic metamyelocyteMature neutrophilMonocyteIdentify
236 Hematocrit is defines as: 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 bloodThe number of granulocytes per unit volume of blood
237 B. The volume of packed erythrocytes per unit volume of blood expressed as a %
238 Which of the following stem cells give rise to all types of blood cells? Multipotential stem cellsColony-forming-unit-spleen stem cells (CFU-S)Pluripotential hemopoietic stem cells (PHSCs)Unipotential (progenitor) cellsPrecursor cells
239 C. Pluripotential hemopoietic stem cells (PHSCs)
240 After their maturation in the thymus and release into the circulation, T lymphocytes migrate preferentially to which of the following sites?Lymph nodules of the spleenPeriarterial lymphatic sheaths of the spleen (PALS)Cortical lymph nodules of lymph nodesLymph nodules of tonsilsLymph nodules in Peyer’s patches
241 B. Periarterial lymphatic sheaths of the spleen (PALS)
242 Recirculating lymphocytes primarily leave the blood vascular system and enter lymph nodes via:Venules in the medullaEfferent lymphatic vesselsHigh endothelial post-capillary venules in the cortexHigh endothelial post-capillary venules in the paracortexAfferent lymphatic vessels
243 D. High endothelial post-capillary venules in the paracortex
244 All of the following cells in the erythroid lineage synthesize hemoglobin EXCEPT:Red blood cellsReticulocytesOrthochromic erythroblastsPolychromic erythroblastsBasophilic erythroblasts
246 Which of the following statements regarding globin chain expression is/are correct?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 fiveA, B, and C are all correctOnly A and B are correct.
248 Hereditary spherocytosis is most often caused by a defect in, or deficiency of RBC:Membrane cholesterolMembrane anion transporter, band 3Cytoskeletal spectrinA, B, and C are all correctOnly B and C are correct.
250 The enzyme which catalyzes the rate-limiting step in heme biosynthesis: 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 correctOnly A and B are correct
252 Which of the following statements is/are true regarding normal heme biosynthesis?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 mitochondriaAll of the above statements are trueAll of the above statements are false
254 The color of each of the first three compound involved in heme degradation in the order in which they occur (left to right) is:Yellow, purple, greenYellow, green, purplePurple, yellow, greenPurple, green, yellowGreen, purple, yellow
258 The order which the numbered heme degradation products listed below occur in the body before being excreted in urine is:UroblinBilirubinUrobilinogenBilirubin glucoronide2, 3, 1, 44, 2, 3, 13, 4, 2, 11, 4, 3, 24, 2, 1, 3
260 Which of the following is NOT involved in the primary hemostatic processes, platelet adhesion and aggregation on injured endothelium?CollagenFibrinogenVon Willebrand factorFactor VIIIIntegrin GpIIbIIIa
262 Blood coagulation factor Va Leiden: Is rapidly inactivated by activated protein C.Is the result of polymorphism in the factor V gene 3’-UTR.Is the cause of most common human bleeding disorder.Is correctly described by both A and B.Is correctly described by none of the above.
263 E. Is correctly described by none of the above.
264 Factor XIIa:Can activate Factor XI.Is activated when blood is drawn into a glass tube without anticoagulantIs not essential for physiological blood coagulation.Is properly described by all of the above.Is properly described only by A and B.
266 Endongenous tissue plasminogen activator: Is stimulated by binding to thrombinBinds to fibrin containing thrombi (clots)Is the major physiological anticoagulantIs correctly described only by A and B.Is correctly described only by B and C.
268 Plasma proteins that are vitamin K-dependent are: Prothrombin, protein C and tissue factorFactor 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
270 Thrombotic disorders are frequently characterized by: 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 prothrombinNone of the above are characteristics of thrombotic disorders.Statements A and C only
271 A tendency to form clots in the large, deep veins of the legs.
272 A 54yo male was diagnosed with CML and was referred to you for treatment. The patient reports some fatigue but is fully employed as anoffice manager. He has six siblings. Two of his siblings have identical HLAmatch with him.What is your initial treatment?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 rangeTreat with signal transduction inhibitor drug (Gleevec) and periodic determination of BCR-ABL.
273 D. Treat with signal transduction inhibitor drug (Gleevec) and periodic determination of BCR-ABL.
274 A 62yo white male was referred to you because of splenomegaly and anemia. The patient reports to you that he has had early satiety, somevague 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 moderateanemia, 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?Congestive heart failureChronic myelogenous leukemiaMyelofibrosis with congestive heart failureAcute myelogenous leukemia
275 C. Myelofibrosis with congestive heart failure
276 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 poorappetite and 20lbs of weight loss. He has had intermittent fever and nightsweats and fullness in his abdomen. On physical exam, the major findingsare massive splenomegaly with some enlargement of the liver. His bloodpicture shows WBC of 48,300 with myelocytes and premyelocytes, mildanemia and thrombocytosis of 543,000. You suspect CML and you takeblood for Philadelphia chromosome determination, which turns out to benegative.What other tests can you do to reach the diagnosis?Repeat Philadelphia chromosome determinationBone marrow aspirationRed cell mass determination.BCR-ABL determination
278 All of the following statements about ABO antibodies are true EXCEPT: ABO antibodies are IgG antibodiesABO antibodies are reactive at body temperatureABO antibodies bind complement efficiently.Associated transfusion reactions can lead to massive intravascular hemolysis.ABO incompatible transfusion can lead to renal failure and death.
280 All of the following about Type and Screen are true EXCEPT: 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.
281 E. A Type and Screen is appropriate for procedures where the likelihood of transfusion is high.
282 All of the following statements regarding transfusion are true EXCEPT: 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 cellsTransfusion 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
283 C. Transfusion of platelets is indicated in all patients with decreased platelet counts.
284 All of the following statements regarding transfusion reactions are true EXCEPT: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 leukocytesAnaphylactic reactions occur in patients with IgA deficiency that make anti-IgA.
285 B. Transfusion of ABO incompatible blood is usually due to technical errors in the blood bank.
286 Patients at risk for GVHD should receive Washed red blood cellsLeukoreduced red blood cellsWhole bloodFrozen red blood cellsIrradiated packed red blood cell units
288 All of the following statements regarding donor testing and transfusion transmitted infections are true EXCEPT:Donor blood testing includes NAT testing for HIV and HCV.NAT testing stand for Nucleic Acid TestingNAT testing is done by PCR to detect RNANAT 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.
289 D. NAT testing has reduced the window period for HIV to approximately two months.
290 Nutritional anemia is a decreased concentration of hemoglobin due to: Increased destruction of red blood cellsMutations that influence the function of red blood cell proteinsExcess of unstable hemoglobinLack of nutrients contained in food
296 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 enlargedmediastinum. At physical examination, an enlarged lymph node is palpatedin the right supraclavicular area. A biopsy is obtained and showsDiffuse Large Cell Lymphoma (B-lineage, high grade). A bone marrowbiopsy is negative and a CT of the abdomen shows an enlarged spleen andborderline pelvic lymph nodes and normal liver and pancreas.What is her clinical stage?I AIV BStaging is incomplete, patient should first undergo laparotomy or PET imagingII BIII B
300 Multiple myeloma is frequently associated with: Multiple bone lesionsRouleaux formationAmyloidosisA precursor B, T or NK cell phenotype according to the W.H.O. classificationMonoclonal proteins (paraprotein or M-protein)
301 D. A precursor B, T or NK cell phenotype according to the W. H. O D. A precursor B, T or NK cell phenotype according to the W.H.O. classification
302 The primary cause of deficiency of which of the following is chronic kidney disease?ErythropoietinFolic acid or related folatesVitamin b-12 (cobalamin)A and CB and C
308 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 lowand on chest x ray there is an infiltrate consistent with pneumonia. You areasked to see the patient because of an anemia. You look at his bloodsmear. On the basis of this smear you suggest that all of the followingEXCEPT would be a useful diagnostic or therapeutic maneuver:High doses of a diureticSupplemental oxygenHemoglobin electrophoresisTreating the patient with antibioticsRBC exchange transfusions
310 A young woman has had progressive fatigue A young woman has had progressive fatigue. Her exercise tolerance is quite low and she notesdifficulty in minding her 3 young children because she gets short of breath. During herpregnancies 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 dietconsists primarily of fruits and vegetables and she tends to avoid eating meat. ON physicalexamination 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 gm/dL)Mean corpusclar volume (MCV) = 72 u3 (normal 81-95)Platelets = 305,000 cell/mm3The peripheral smear is shown in figure to the right.All of the following laboratory tests would be consistent with her underlying hematologic problemproblem EXCEPT:Low ferritinLow serum ironElevated serum transferrin (TIBC)Markedly increased MCVMarkedly decreased MCV
312 A teenager is sent to you because of jaundice and a palpable spleen A teenager is sent to you because of jaundice and a palpable spleen. Thepatient is here from Greece and you do not have a translator. You are ableto get a peripheral smear which is shown below.On the basis of the history, physical examination, and blood smear, which ofthe following would NOT be correct:Mean corpuscular volume (MCV) = 62 u3 (normal 81-95)Serum ferritin levels might be elevatedReticulocyte count would be increasedAlpha globin chains would be synthesized in excess of beta globin chainsBoth of the parents’ blood smears would be absolutely normal
313 E. Both of the parents’ blood smears would be absolutely normal
314 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 youroffice 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 gm/dL)MCV = 89u3 (normal 81-95)Platelets = 305,00 cells/mm3Reticulocyte count = 6% (normal 0-2%)The peripheral smear is shown here.On the basis of this information all of the following are possible EXCEPT:The patient has a mutation in a gene coding for a cytoskeletal protein.The patient has a mutation in a gene coding for α globin chainsThe hemolysis in this patient takes place primarily in the spleen.The patient’s sibs had bilirubin in their gall stones.The patient’s RBCs will have lost surface area in excess of volume.
315 B. The patient has a mutation in a gene coding for α globin chains
316 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 severalyears 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 gm/dL)MCV = 87 u3 (normal 81-95)Platelets = 6,000 cells/mm3Reticulocyte count = 0% (normal 0-2%)Bone marrow aspiration reveals no cell and the bone marrow biopsy is shown. Onthe basis of this information all of the following are reasonable EXCEPT: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 problemsPlatelet transfusions should be used if the patient starts bleeding
317 a. The patient needs to be on oral antibiotics and given a return appointment in one month.
318 In a patient with iron deficiency anemia secondary to bleeding from a colonic polyp you might expect all of the following except:That intestinal iron uptake would increaseThe patient might have a low MCVThat serum ferritin would be increasedThat transferrin receptors would increaseThat in response to the anemia that iron transporters in the intestine might have increased expression
320 Iron absorption in the intestine would be affected by all of the following except WHICH.Absent gastric acid productionThe dietary form of ironRemoving the duodenum and proximal jejunumRemoving the terminal ileumAdding ascorbic acid to the diet
322 Iron absorption may be affected by all of the following EXCEPT: Inherited abnormalities in the iron uptake pathwayInflammatory diseasesHemolytic anemiasDigoxin levels between 0.5 and 1.0 mg/dLLevels of hepcidin
324 A patient with a Hemoglobin = 7 gm% (normal 12-15gm%), total bilirubin 2.2 mg% (normal <1.2mg%), indirect bilirubin = 2.0 mg% (normal <0.2mg%), reticulocyte = 10%, and a LDH =1500 units/dL (normal<600units/dL) could have all of the following except WHICH:Antibodies directed to a red blood cell surface antigenA positive coomb’s testDisseminated intravascular coagulopathyA bone marrow infiltrated with metastatic cancerA defect in the red blood cell cytoskeleton
325 D. A bone marrow infiltrated with metastatic cancer
326 A patient is seen in your office for a routine physical examination A patient is seen in your office for a routine physical examination. He is 59yo and isin excellent health. His entire physical examination is normal for his age. Routine CBCshows 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?He has acute Myeloid Leukemia and needs aggressive chemotherapyHe needs a bone marrow transplant.He has chronic lymphocytic leukemia stage III and needs chemotherapyHe 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.
327 D. He has chronic lymphocytic leukemia stage 0 and needs observation only with no therapy at this time.
328 A patient presented to the ER with bleeding gums and also has petechiae and purpura. CBC shows the following:Hgb = 9 gm% (normal )Hematocrit = 27% (normal 40-52%)Platelets = 25,000 (normal ,000)WBC = 45,000 (normal 5 to 12,000)The smear show is in figure here.Which of the following is correct?He has acute Myeloid Leukemia with Auer Rods, and needs aggressive chemotherapy.He has Chronic lymphocytic leukemia stage III and needs chemotherapyHe has chronic lymphocytic leukemia stage 0 and needs observation only with no therapy at this time.He has chronic myeloid leukemia and needs gleevec treatmentThe blood cells are normal.
329 He has Acute Myeloid Leukemia with Auer Rods, and needs aggressive chemotherapy.
330 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 ispositive 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 normalYour diagnosis is?HemophiliaNo significant problemVon Willebrands diseaseFactor VII deficiencyFactor II deficiency
332 A patient is seen by you in the ER A patient is seen by you in the ER. She is a 75yo woman from the nursinghome. She is confined to bed and has Alzheimer’s dementia. She wasbrought in by her family as she seems less responsive and they noted afever. Her temperature is 104 degrees. She has purpura and is bleedingfrom the gums. The family relates she has never had a bleeding problembefore. Her regular lab shows a urinary tract infection with gram-negativerods 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?ITP (Immune thrombocytopenia)DIC (Disseminated Intravascular Coagulation)TTP (Thrombotic Thrombocytopenic Purpura)HemophiliaVon Willebrands disease
333 B. DIC (Disseminated Intravascular Coagulation)
334 All of the following are associated with a hypercoaguable state (Thrombophilia) except?Factor V LeidenATII deficiencyProtein C deficiencyFactor VII deficiencyProtein S deficiency
338 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?Von Willebrands DiseaseLupus AnticoagulantHemophilia with inhibitorHeparin contamination of the sample
344 If a patient has a both an abnormal PT and an abnormal PTT then which of the following is not possible?Factor X deficiencyAbnormal fibrinogenFactor V deficiencyFactor XI deficiencyVitamin K deficiency