Blood and Lymph Test I.

Blood and Lymph Test I

Of the following white cells which of the following
are the most numerous in the blood? a. lymphocytes b. monocytes c. Neutrophils d. eosinophils e. basophils

c. neutrophils

Which of the following white cells has as their primary
function the phagocytosis of antigen antibody complexes and destruction of parasites? lymphocytes monocytes neutrophils eosinophils basophils

d. eosinophils

In hematopoiesis, all of the following cells may undergo
mitosis EXCEPT: 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: 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: 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 macrophages erythrocytes T-lymphocytes B-lymphocytes splenic cords

c. T lymphocytes

Recirculating lymphocytes primarily leave the
blood vascular system and enter lymph nodes via: 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: 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: lymphocyte basophil monocyte neutrophil eosinophil

c. monocyte

The white cell shown is:
basophilic erythroblast (early normoblast) neutrophilic myelocyte neutrophilic metamyelocyte (stab cell) orthochromatophilic erythroblast (late normoblast) promyelocyte

d. orthochromatophilic erythroblast (late normoblast)

The white cell shown is:
eosinophil promyelocyte neutrophilic metamyelocyte (stab cell) eosinophilic metamyelocyte mature neutrophil

c. neutrophilic metamyelocyte (stab cell)

This is a photomicrograph of:
spleen palatine tonsil GALT lymph node thymus

d. lymph node

This is a photomicrograph of:
spleen palatine tonsil GALT lymph node thymus

e. thymus

In this figure, the most numerous cells located at the end of
the THICKEST arrow are: neutrophils eosinophils T cells B cells macrophages

C. T cells

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 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

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.

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. the liver would develop iron overload b. iron absorption would be increased c. the patient would be resistant to developing diabetes d. the patients TIBC would be saturated with iron e. 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? 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

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 co-synthase. 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?
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:
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. methionine b. homocysteine c. glycine d. histidine e. 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: 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:
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. Prothrombin b. Factor X c. Factor VII d. Factor IX e. 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?
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

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 ). Her peripheral blood smear appeared as below. Most likely diagnosis is: iron deficiency anemia of chronic disease iron excess sickle cell anemia lead intoxication

d. sickle cell anemia

Which of the following is NOT seen in patients with accelerated red cell destruction due to hemolytic anemias? 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: 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?
refractory anemia iron deficient anemia vitamin B12 deficient anemia starvation anemia Kwashiorkor

refractory anemia

All of the causes listed below are responsible for iron deficiency anemia EXCEPT:
chronic blood loss hookworm infestation severe malabsorption Vitamin C deficiency Excessive menses

d. Vitamin C deficiency

Iron store depletion occurs in all EXCEPT:
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?
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? 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? 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 ,000) Hb normal Platelet count normal Peripheral smear below Your diagnosis is? Chronic Myeloid Leukemia Chronic Lymphocytic Leukemia Acute Myeloblastic Leukemia Acute Lymphoblastic Leukemia No hematological Disease

b. Chronic Lymphocytic Leukemia

Appropriate therapy for this patient is?
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 ,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 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?
Factor X Factor VII Factor V Factor IX

c. Factor V

Which of these proteins is stored in endothelial cells?
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: deficiency of Factor VII deficiency of Factor VIII deficiency of Factor IX deficiency of Factor XI

deficiency of Factor VII

Which of the following statements regarding hemophilia A is
incorrect? 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?
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 X- chromosome

Venous thrombosis can result from all of the following except:
Proteins S deficiency impaired fibrinolysis increase in factor VII a point mutation at site 506 in the factor V

Proteins S deficiency

Which of the following best characterizes immune thrombocytopenia purpura (ITP)?
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:
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. Erthrocyte b. Lymphocyte c. Platelet d. Neutrophil e. Monocyte

d. Neutrophil

Which of the following is derived from reticulocytes?
a. Erythrocytes b. Lymphocytes c. Platelet d. Neutrophil e. Monocyte

a. Erythrocytes

Which of the following is a characteristic of monocytes?
a. They contain a multilobed nucleus b. They are the most numerous of the white cells c. Their cytoplasm is packed with ribosomes d. They become active macrophages while circulating in the blood e. 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. Paracortex (deep cortex) of lymph nodes b. Cortical lypmhoid nodules of lymph nodes c. Hilus of lymph nodes d. Lymphoid nodules of the tonsils e. 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. Subcapsular sinus b. Cortex c. Paracortex (deep cortex) d. Medullary cords e. 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. Interleukin 3 b. Erythropoietin c. 2,3-bisphosphoglycerate (2,3-BPG) d. A, B, and C e. A and B only

e. A and B only

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, 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. Requires a source of lactate b. Is unable to produce NADPH c. Is incapable of oxidative phosphorylation d. Is incapable of reducing methemoglobin e. 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. ALA synthase is the rate-limiting enzyme b. PBG synthase (ALA dehydratase) is a cytoplasmic enzyme c. Ferrochelatase is a mitochondrial enzyme d. Elevated heme prevents mitochondrial PBG transport e. 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. Ferrochelatase and PBG synthase (ALA dehydratase) b. UPG synthase and ferrochelatase c. UPG synthase and PBG synthase d. ALA synthase and ferrochelatase e. 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. NADP+, biliverdin, and Fe3+ b. NADPH, biliverdin, and CO c. NAD+, bilirubin, and UDP d. NADH, bilirubin, and UDP-glucoronate e. 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. A and B b. B and C c. C and D 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. Direct bilirubin b. Indirect bilirubin c. Total bilirubin d. Albumin-bound bilirub9in only e. 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 = 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/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 fl) all of the following might be present EXCEPT: a. Hemoglobin of 5 gm/dl b. Hemoglobin of 6 gm/dl c. Ferritin < 5 mg/dl (normal mg/dl) d. Hemoglobin 12 gm/dl e. TIBC saturation < 10%

d. Hemoglobin 12 gm/dl

The absorption of iron in the intestine is regulated
a. By renal tubular excretion b. By increased sloughing of the skin c. By absorption in the terminal duodenum and proximal jejunum d. In the terminal ileum e. 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. Metastatic cancer infiltrating the bone marrow b. Exposure to benzene with development of aplastic anemia c. High doses of radiation from a reactor accident d. 24 hours of bleeding from a gastric ulcer e. 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
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 antigen b. A positive Coombs test c. Disseminate intravascular coagulation d. A bone marrow infiltrated with metastatic cancer e. 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. Erythropoietin b. Folic acid or related folates c. Vitamin B-12 (cobalamin) d. A and C e. B and C

e. B and C

Is administered therapeutically in an oral form in almost all cases:

b. Folic acid or related folates

The primary cause of deficiency of it is chronic kidney disease:

a. Erythropoietin

Reversal of megaloblastic hematopoiesis as a consequence of vitamin B-12 replacement occurs after initiation of therapy at: a days and peaks by 508 days b hours c. 1 week d. 2 months e. Never occurs unless the patient receives folic acid simultaneously

b hours

Surgical removal of the terminal ileum because of trauma might be expected to result in which of the following: a. Folic acid depletion within days b. Folic acid depletion within one year c. Folic acid depletion within three years d. Vitamin B-12 deficiency e. Achlorhydria

d. Vitamin B-12 deficiency

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 normal b. Increased methylmalonic acid x normal c. Decreased serum homocysteine 2-20 x normal d. 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. Factors VIII and IX b. Proteins C and S c. Factors X and IX d. Factor XII and XIII

c. Factors X and IX

Which of the following is not a vitamin K dependent factor:
a. Factor IX b. Protein S c. Factor VII d. Factor VIII

d. Factor VIII

Excessive bleeding can be a manifestation of deficiency of all the following EXCEPT:
a. Factor VII deficiency b. Factor V deficiency c. Protein C deficiency d. Factor IX deficiency

c. Protein C deficiency

Which of these proteins is inactivated by activated protein C:
a. Activated factor IX b. Activated factor VII c. Protein S d. 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. All healthy b. Hal healthy and half carriers c. Half affected and half carriers d. 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. Activated protein C resistance b. Protein S deficiency c. Factor V deficiency d. Antithrombin II deficiency

c. Factor V deficiency

Which of the following findings is a characteristic of thrombotic thrombocytopenic purpura:
a. Autoimmune hemolysis and thrombocytopenia b. Intravascular hemolysis and high D-dimer c. Intravascular hemolysis and thrombocytosis d. Intravascular hemolysis and thrombocytopenia

d. Intravascular hemolysis and thrombocytopenia

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 Thrombocytopenia c. Disseminated Intravascular Coagulation (DIC) d. 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. Nucleus b. Barr body c. Auer Rod d. Smudge Cell e. 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. CLL is usually characterized by an overproduction of T-cells b. CLL is staged 0-4 with 0 being the best prognostic stage c. Smudge cells are seen on the peripheral blood smear d. There is no curative therapy only palliative therapy e. 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. GpIa, collagen b. GpIbIX, fibrinogen c. GpIbIIIa, von Willebrand factor d. A and B e. B and C

a. GpIa, collagen

Which of the following blood coagulation factors below is NOT involved in physiological (in vivo) blood coagulation? a. Factor XI b. Factor XII c. Factor XIII d. Factor IX e. Factor II

b. Factor XII

Which of the anticoagulants listed below prevent clotting of blood in vitro by binding Ca2+?
a. Heparin b. Coumadin c. Citrate d. A and B e. B and C

c. Citrate

Which of the pairs of blood coagulation factors below are both activated by thrombin?
a. Factor XIII and Factor X b. Factor IX and Factor XII c. Factor V and Factor VIII d. A and B e. 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. The reaction involves the addition of NH4+ to fibrin b. Glutamine and lysine residues in fibrin are substrates c. Fibrin crosslinking is normally an intermolecular reaction d. A and B e. 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. Tissue factor –VIIa b. “Tenase” c. “Prothrombinase” d. A and B e. 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. Chronic myelogenous leukemia in blast crisis b. Polycythemia vera c. Myeloid metaplasia with myelofibrosis d. 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. Polycythemia vera b. Myelofibrosis c. Essential thrombocythemia d. Chronic myelogenous leukemia e. 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. Observe the patient until he becomes symptomatic b. Allogeneic bone marrow transplantation immediately because of his age c. Treatment with a-interferon d. 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. I A b. IV B c. Staging is incomplete, patient should first undergo laparotomy d. II B e. III A

d. II B

Mantle cell lymphoma is associated with
a. T(9:22) (t = translocation) b. Helicobacter pylori infection c. T(11:14) d. Cure by a triple antibiotic regimen in >90% of cases e. HTLV – 1 infection

c. T(11:14)

Multiple myeloma is frequently associated with each of the following EXCEPT which:
a. Multiple bone lesions b. Rouleaux formation on the peripheral smear c. Amyloidosis d. 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 day shelf life, stored at 1-6 degrees Celsius c. Pheresis Platelet 24 hr. shelf life, stored at 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 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 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
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
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 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 type- specific 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:
Promyelocyte Neutrophilic myelocyte Neutrophilic metamyelocyte Mature neutrophil Monocyte Identify

C. Neutrophilic metamyelocyte

This cell is a: Basophil Neutrophil Eosinophil Lymphocyte Mononcyte

C. Eosinophil

The tissue featured here is:
Lymph node Palatine tonsil Pharyngeal tonsil Thymus Spleen

D. Thymus

If Figure 4 the tissue is:
Lymph node Palatine tonsil Pharyngeal tonsil Thymus Spleen

B. Palatine tonsil

Reticulocytes become which of the following?
Platelets Monocytes Neutrophils Erythrocytes

D. Erythrocytes

Which of the following white cells are the most numerous in blood?
Basophils Eosinophils Monocytes Lymphocytes Neutrophils

E. Neutrophils

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 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?
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? 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: 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: Red blood cells Reticulocytes Orthochromic erythroblasts Polychromic erythroblasts Basophilic erythroblasts

Red blood cells

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 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: 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:
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? 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: 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: 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: Uroblin Bilirubin Urobilinogen Bilirubin glucoronide 2, 3, 1, 4 4, 2, 3, 1 3, 4, 2, 1 1, 4, 3, 2 4, 2, 1, 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? Collagen Fibrinogen Von Willebrand factor Factor VIII Integrin GpIIbIIIa

D. Factor VIII

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.

E. Is correctly described by none of the above.

Factor XIIa: 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:
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:
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 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 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? 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? 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? 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:
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.

ABO antibodies are IgG antibodies

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.

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:
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: 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
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: 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:
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: 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: 2-3 days and peaks by 5-8 days 12-48 hours 1 week 2 months

B 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? I A 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:
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:
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
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? 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? 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? 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: 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
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 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: 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
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: 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 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: 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 chains The 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.

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 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: 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: 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. 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:
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: 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
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? 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 ) 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 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.

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? 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
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? 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? 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?
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? Von Willebrands Disease Lupus Anticoagulant Hemophilia with inhibitor Heparin contamination of the sample

Von Willebrands Disease

The treatment of ITP usually starts with which of the following treatments?
Splenectomy Prednisone Immunosuppressive drugs such as cyclophosphamide Immunoglobulin therapy (IVIG)

B. Prednisone

Abnormal platelet function is seen is all of the following except?
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? 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? II VII Protein C VIII-VWF Fibrinogen

D. VIII-VWF

Blood and Lymph Test I.

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