Blood and Lymph Test I. Of the following white cells which of the following are the most numerous in...

Blood and Lymph Test IBlood and Lymph Test I

Of the following white cells which of the followingOf the following white cells which of the following

are the most numerous in the blood?are the most numerous in the blood?

a. lymphocytesa. lymphocytes

b. monocytesb. monocytes

c. Neutrophilsc. Neutrophils

d. eosinophilsd. eosinophils

e. basophilse. basophils

c. neutrophilsc. neutrophils

Which of the following white cells has as their primary Which of the following white cells has as their primary function the phagocytosis of antigen antibody complexes and function the phagocytosis of antigen antibody complexes and destruction of parasites?destruction of parasites?

a.a. lymphocyteslymphocytesb.b. monocytesmonocytesc.c. neutrophilsneutrophilsd.d. eosinophilseosinophilse.e. basophilsbasophils

d. eosinophilsd. eosinophils

In hematopoiesis, all of the following cells may undergo In hematopoiesis, all of the following cells may undergo mitosis EXCEPT:mitosis EXCEPT:

a.a. basophilic erythroblastsbasophilic erythroblastsb.b. promyelocytespromyelocytesc.c. orthochromatophilic erythroblastsorthochromatophilic erythroblastsd.d. progenitor cellsprogenitor cellse.e. neutrophilic myelocytesneutrophilic myelocytes

c. orthochromatophilic erythroblastsc. orthochromatophilic erythroblasts

All of the following statements concerning the development of All of the following statements concerning the development of

mature elements of blood are correct EXCEPT:mature elements of blood are correct EXCEPT:

a.a. megakaryocytes give rise to plateletsmegakaryocytes give rise to platelets

b.b. CFU-NM (CFU-GM) gives rise to neutrophils and monocytesCFU-NM (CFU-GM) gives rise to neutrophils and monocytes

c.c. The ribosomes in basophilic erythroblasts manufactures hemoglobinThe ribosomes in basophilic erythroblasts manufactures hemoglobin

d.d. development of erythrocytes in the bone marrow occurs in close development of erythrocytes in the bone marrow occurs in close association with macrophagesassociation with macrophages

e.e. promyelocytes are described as containing azurophilic, specific, and promyelocytes are described as containing azurophilic, specific, and tertiary granules.tertiary granules.

e. promyelocytes are described as containing e. promyelocytes are described as containing

azurophilic, specific, and tertiary granules.azurophilic, specific, and tertiary granules.

All of the following types of tissue contain lymph All of the following types of tissue contain lymph nodules EXCEPT:nodules EXCEPT:

a.a. spleenspleenb.b. thymusthymusc.c. GALT (gut associated lymphoid tissue)GALT (gut associated lymphoid tissue)d.d. palatine tonsilpalatine tonsile.e. lymph noduleslymph nodules

b. thymusb. thymus

In the spleen the cells surrounding the central In the spleen the cells surrounding the central

arterioles consist primarily ofarterioles consist primarily of

a.a. macrophagesmacrophages

b.b. erythrocyteserythrocytes

c.c. T-lymphocytesT-lymphocytes

d.d. B-lymphocytesB-lymphocytes

e.e. splenic cordssplenic cords

c. T lymphocytesc. T lymphocytes

Recirculating lymphocytes primarily leave theRecirculating lymphocytes primarily leave theblood vascular system and enter lymph nodes via:blood vascular system and enter lymph nodes via:

a.a. high endothelial post-capillary venules in the paracortexhigh endothelial post-capillary venules in the paracortexb.b. afferent lymphatic vesselsafferent lymphatic vesselsc.c. capillaries in the cortexcapillaries in the cortexd.d. high endothelial post-capillary venules in the medullahigh endothelial post-capillary venules in the medullae.e. capillaries in the medullacapillaries in the medulla

A. high endothelial post-capillary venules in the paracortexA. high endothelial post-capillary venules in the paracortex

All of the following statements that refer to a All of the following statements that refer to a specific lymphoid organ are correct except:specific lymphoid organ are correct except:

a.a. M cells and Peyer’s patches – small intestineM cells and Peyer’s patches – small intestineb.b. Hassell’s corpuscles – thymusHassell’s corpuscles – thymusc.c. subcapsular sinus – lymph nodesubcapsular sinus – lymph noded.d. afferent lymphatic vessels – thymusafferent lymphatic vessels – thymuse.e. deep crypts and stratified squamous epithelium – deep crypts and stratified squamous epithelium –

palatine tonsilpalatine tonsil

d. afferent lymphatic vessels - thymusd. afferent lymphatic vessels - thymus

The cell shown is:The cell shown is:

a.a. lymphocytelymphocyte

b.b. basophilbasophil

c.c. monocytemonocyte

d.d. neutrophilneutrophil

e.e. eosinophileosinophil

c. monocytec. monocyte

The white cell shown is:The white cell shown is:

a.a. basophilic erythroblast (early normoblast)basophilic erythroblast (early normoblast)

b.b. neutrophilic myelocyteneutrophilic myelocyte

c.c. neutrophilic metamyelocyte (stab cell)neutrophilic metamyelocyte (stab cell)

d.d. orthochromatophilic erythroblast (late normoblast)orthochromatophilic erythroblast (late normoblast)

e.e. promyelocytepromyelocyte

d. orthochromatophilic erythroblast (lated. orthochromatophilic erythroblast (late

normoblast)normoblast)

The white cell shown is:The white cell shown is:

a.a. eosinophileosinophil

b.b. promyelocytepromyelocyte

c.c. neutrophilic metamyelocyte (stab cell)neutrophilic metamyelocyte (stab cell)

d.d. eosinophilic metamyelocyteeosinophilic metamyelocyte

e.e. mature neutrophilmature neutrophil

c. neutrophilic metamyelocyte (stab cell)c. neutrophilic metamyelocyte (stab cell)

This is a photomicrograph of:This is a photomicrograph of:

a.a. spleenspleen

b.b. palatine tonsilpalatine tonsil

c.c. GALTGALT

d.d. lymph nodelymph node

e.e. thymusthymus

d. lymph noded. lymph node

This is a photomicrograph of:This is a photomicrograph of:

a.a. spleenspleen

b.b. palatine tonsilpalatine tonsil

c.c. GALTGALT

d.d. lymph nodelymph node

e.e. thymusthymus

e. thymuse. thymus

In this figure, the most numerous cells located at the end of In this figure, the most numerous cells located at the end of

the THICKEST arrow are:the THICKEST arrow are:

a.a. neutrophilsneutrophils

b.b. eosinophilseosinophils

c.c. T cellsT cells

d.d. B cellsB cells

e.e. macrophagesmacrophages

C. T cellsC. T cells

A 19 y/o comes into the ER very short of breath. On physical A 19 y/o comes into the ER very short of breath. On physical examination you note that her eyes are jaundiced and her examination you note that her eyes are jaundiced and her conjunctiva is very pale. The remainder of the physical exam conjunctiva is very pale. The remainder of the physical exam reveals only an enlarged spleen. Her CBC includes a reveals only an enlarged spleen. Her CBC includes a hematocrit = 22% (normal 38-44%), MCV = 98 hematocrit = 22% (normal 38-44%), MCV = 98 μμ³, ³, platelets=200,000 cell/mm³, (normal 150,000-300,000 platelets=200,000 cell/mm³, (normal 150,000-300,000 cells/mm³), and WBC=7500 cells/mm³ (normal 4-8000 cells/mm³), and WBC=7500 cells/mm³ (normal 4-8000 cells/mm³). The reticulocyte count was 18%. Which of the cells/mm³). The reticulocyte count was 18%. Which of the following is NOT a likely scenario?following is NOT a likely scenario?

a.a. The patient has hereditary spherocytosisThe patient has hereditary spherocytosisb.b. The patient has autoimmune hemolytic anemiaThe patient has autoimmune hemolytic anemiac.c. The patient has sickle cell diseaseThe patient has sickle cell diseased.d. The patient has a production defect in bone marrowThe patient has a production defect in bone marrowe.e. The patient has increased RBC destructionThe patient has increased RBC destruction

d. d. The patient has a production defect in bone marrowThe patient has a production defect in bone marrow

You are in your basement pharmacy concocting the world’s You are in your basement pharmacy concocting the world’s best iron preparation to be used in patients who have had a best iron preparation to be used in patients who have had a gastrectomy. The properties of your concoction should gastrectomy. The properties of your concoction should include all of the follow except:include all of the follow except:

a. a low pH to keep iron subtlea. a low pH to keep iron subtleb. a reductant like ascorbic acid to keep iron in the b. a reductant like ascorbic acid to keep iron in the ferrous formferrous formc. a strong oxidant because ferric (Fe³c. a strong oxidant because ferric (Fe³++) is more potent than ) is more potent than ferrous iron (Feferrous iron (Fe2+2+).).d. chelators that might facilitate iron absorption in the distald. chelators that might facilitate iron absorption in the distal duodenum and upper jejunumduodenum and upper jejunum

c.c. a strong oxidant because ferric (Fe³a strong oxidant because ferric (Fe³++) is more ) is more potent than ferrous iron (Fepotent than ferrous iron (Fe2+2+).).

In order for iron to be taken up by erythroid precursor cells in the In order for iron to be taken up by erythroid precursor cells in the bone marrow all of the following needs to happen except:bone marrow all of the following needs to happen except:

a. transferrin needs to bind to the transferrin receptora. transferrin needs to bind to the transferrin receptorb. the transferrin receptor needs to be internalized byb. the transferrin receptor needs to be internalized by receptor mediated endocytosisreceptor mediated endocytosisc. the pH of the endosomes needs to increase to at least pH = 8.0c. the pH of the endosomes needs to increase to at least pH = 8.0d. transferrin needs to bind either one or two ironsd. transferrin needs to bind either one or two ironse. the kidney needs to synthesize erythropoietin to allow for e. the kidney needs to synthesize erythropoietin to allow for erythroid differentiation past the BFU-E.erythroid differentiation past the BFU-E.

c.c. the pH of the endosomes needs to increase to at least the pH of the endosomes needs to increase to at least pH = 8.0 pH = 8.0

In a patient with hemochromatosis, you might expect all of the In a patient with hemochromatosis, you might expect all of the following to occur EXCEPT:following to occur EXCEPT:

a. the liver would develop iron overloada. the liver would develop iron overloadb. iron absorption would be increasedb. iron absorption would be increasedc. the patient would be resistant to developing diabetesc. the patient would be resistant to developing diabetesd. the patients TIBC would be saturated with irond. the patients TIBC would be saturated with irone. the patient’s ferritin would be highe. the patient’s ferritin would be high

c. the patient would be resistant to developing diabetesc. the patient would be resistant to developing diabetes

During the process of erythropoiesis which of the following During the process of erythropoiesis which of the following does notdoes not

occur?occur?

a.a. in iron deficiency, erythroid precursors leave the bone marrow early in iron deficiency, erythroid precursors leave the bone marrow early and hence circulate as macrocytesand hence circulate as macrocytes

b.b. folic acid is used for DNA synthesisfolic acid is used for DNA synthesis

c.c. erythroid cells get progressively smaller with each cell divisionerythroid cells get progressively smaller with each cell division

d.d. heme synthesis in erythroid cells accounts for the chromicity of the heme synthesis in erythroid cells accounts for the chromicity of the resulting red blood cellsresulting red blood cells

e.e. erythropoietin binds to receptors on erythroid precursor cellserythropoietin binds to receptors on erythroid precursor cells

a.a. in iron deficiency, erythroid precursors leave in iron deficiency, erythroid precursors leave the bone marrow early and hence circulate as the bone marrow early and hence circulate as macrocytesmacrocytes

A 36 year old develops active rheumatoid arthritis with inflammation of the 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 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 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 the following might be involved in the development of the anemia exceptexcept which:which:

a. cytokines generated in the inflamed synovium in the joints will a. cytokines generated in the inflamed synovium in the joints will

interfere with erythropoiesis.interfere with erythropoiesis.

b. cytokines will antagonize the action of erythropoietinb. cytokines will antagonize the action of erythropoietin

c. cytokines will affect the synthesis of ferritin in macrophages causing thec. cytokines will affect the synthesis of ferritin in macrophages causing the

macrophages to hold onto iron.macrophages to hold onto iron.

d. cytokines will stimulate receptor mediated endocytosis allowing for more d. cytokines will stimulate receptor mediated endocytosis allowing for more

iron to get into erythroid precursor cellsiron to get into erythroid precursor cells

e. the cellularity of the bone marrow may be affectede. the cellularity of the bone marrow may be affected

d. cytokines will stimulate receptor mediated endocytosisd. cytokines will stimulate receptor mediated endocytosis

allowing for more iron to get into erythroid precursorallowing for more iron to get into erythroid precursor

cellscells

The structure of the product of the committed, rate limiting The structure of the product of the committed, rate limiting step in heme synthesisstep in heme synthesis

A B C D E

A. ALAA. ALA

The structure of a compound which inhibits the committed, The structure of a compound which inhibits the committed, rate controlling step in heme synthesisrate controlling step in heme synthesis

A B C D E

D. HemeD. Heme

The structure of a compound NOT formed in NORMAL The structure of a compound NOT formed in NORMAL porphyrin biosynthesis, but which IS formed in porphyrin porphyrin biosynthesis, but which IS formed in porphyrin biosynthesis in the absence of uroporphyrinogen (UPG) III biosynthesis in the absence of uroporphyrinogen (UPG) III co-synthase.co-synthase.

A B C D E

C. Uroporphyrinogen IC. Uroporphyrinogen I

The structure of a NORMAL intermediate of porphyrin The structure of a NORMAL intermediate of porphyrin biosynthesis which is synthesized by a cytoplasmic enzyme.biosynthesis which is synthesized by a cytoplasmic enzyme.

A B C D E

B. Porphobilinogen (PBG)B. Porphobilinogen (PBG)

Which of the following statements is NOT correct?Which of the following statements is NOT correct?

a.a. Carbon monoxide is produced when a macrophage enzyme Carbon monoxide is produced when a macrophage enzyme acts on hemeacts on heme

b.b. Conjugated bilirubin is converted to biliverdin in premature Conjugated bilirubin is converted to biliverdin in premature infants by fluorescent light.infants by fluorescent light.

c.c. ““Direct bilirubin” is a measure of conjugated bilirubinDirect bilirubin” is a measure of conjugated bilirubin

d.d. In order to obtain “indirect bilirubin,” an organic solvent must In order to obtain “indirect bilirubin,” an organic solvent must first be added to serumfirst be added to serum

e.e. bilirubin glucuronidation enhances excretion of heme bilirubin glucuronidation enhances excretion of heme catabolism products.catabolism products.

b. Conjugated bilirubin is converted to biliverdin in b. Conjugated bilirubin is converted to biliverdin in

premature infants by fluorescent light.premature infants by fluorescent light.

The substance deposited in the CNS of individuals with The substance deposited in the CNS of individuals with “kernicterus” is:“kernicterus” is:

a.a. biliverdinbiliverdin

b.b. only “direct bilirubin”only “direct bilirubin”

c.c. unconjugated bilirubinunconjugated bilirubin

d.d. both conjugated and unconjugated bilirubinboth conjugated and unconjugated bilirubin

e.e. inactive UDP glucoronyl transferaseinactive UDP glucoronyl transferase

c. unconjugated bilirubinc. unconjugated bilirubin

The amino acid which provides most of the 1-carbon units in The amino acid which provides most of the 1-carbon units in animal metabolism isanimal metabolism is

a. methioninea. methionine

b. homocysteineb. homocysteine

c. glycinec. glycine

d. histidined. histidine

e. serinee. serine

e. serinee. serine

1-carbon-carrying folate derivatives are readily interconverted enzymatically 1-carbon-carrying folate derivatives are readily interconverted enzymatically exceptexcept for for

a. Na. N55-methyl-THF-methyl-THF

b. Nb. N55-N-N1010-methylene-THF-methylene-THF

c. Nc. N55-N-N1010-methenyl-THF-methenyl-THF

d. Nd. N55-formimino-THF-formimino-THF

e. Ne. N1010-formyl-THF-formyl-THF

a. Na. N55-methyl-THF-methyl-THF

Which of the following statements regarding cobalamin (Vitamin B12) is Which of the following statements regarding cobalamin (Vitamin B12) is incorrect?incorrect?

a. cobalamin is transported in blood bound to intrinsic factora. cobalamin is transported in blood bound to intrinsic factorb. cobalamin is required for the synthesis of methionine in humansb. cobalamin is required for the synthesis of methionine in humansc. deoxyadenosyl-cobalamin is the coenzyme involved in the c. deoxyadenosyl-cobalamin is the coenzyme involved in the conversion of L-methylmalonyl-CoA to succinyl-CoAconversion of L-methylmalonyl-CoA to succinyl-CoAd. cobalamin stores in the body can last for decadesd. cobalamin stores in the body can last for decadese. cobalamin deficiency is rare in teenagerse. cobalamin deficiency is rare in teenagers

a. cobalamin is transported in blood bound to a. cobalamin is transported in blood bound to

intrinsic factorintrinsic factor

oror

d. cobalamin stores in the body can last for decadesd. cobalamin stores in the body can last for decades

Which one, if any, of the following statements regarding the primaryWhich one, if any, of the following statements regarding the primary

hemostatic process is hemostatic process is incorrectincorrect::

a.a. platelets adhere to exposed subendothelial collagen through platelets adhere to exposed subendothelial collagen through

GpIa-IIa receptorsGpIa-IIa receptors

b.b. platelets secrete prostacyclin, which prevents excessive platelet platelets secrete prostacyclin, which prevents excessive platelet aggregationaggregation

c.c. fibrinogen enhances platelet aggregation through GpIIb-IIIa receptorsfibrinogen enhances platelet aggregation through GpIIb-IIIa receptors

d.d. Von-Willebrand factor allows adhered platelets to resist turbulence and Von-Willebrand factor allows adhered platelets to resist turbulence and shear forces in injured small vesselsshear forces in injured small vessels

e.e. none of the above statements is correctnone of the above statements is correct

b. platelets secrete prostacyclin, which prevents excessiveb. platelets secrete prostacyclin, which prevents excessive

platelet aggregationplatelet aggregation

When coagulation factor VIIa interacts with tissue factor:When coagulation factor VIIa interacts with tissue factor:

a.a. Factor XI is activated, thus involving the “intrinsic pathway” of Factor XI is activated, thus involving the “intrinsic pathway” of coagulationcoagulation

b.b. Factor X binds to the VIIa-tissue factor complex in a Ca2+ Factor X binds to the VIIa-tissue factor complex in a Ca2+ dependent reactiondependent reaction

c.c. Factor IXa is rapidly inactivated by TFPI, along with factor XaFactor IXa is rapidly inactivated by TFPI, along with factor Xa

d.d. Tissue Factor is released from a phospholipid membraneTissue Factor is released from a phospholipid membrane

e.e. Factor IX must be released from a phospholipid membrane before Factor IX must be released from a phospholipid membrane before it can be activatedit can be activated

b. Factor X binds to the VIIa-tissue factor complex in a b. Factor X binds to the VIIa-tissue factor complex in a

Ca2+ dependent reactionCa2+ dependent reaction

Which one of the following substances is used as an Which one of the following substances is used as an anticoagulant both in vivo and in vitro?anticoagulant both in vivo and in vitro?

a. heparina. heparin

b. sodium citrateb. sodium citrate

c. warfarinc. warfarin

d. EDTAd. EDTA

e. sodium oxalatee. sodium oxalate

a. heparina. heparin

When Coumadin therapy initially begins to lengthen PT, the When Coumadin therapy initially begins to lengthen PT, the coagulation factor which is most likely to be decreased in the coagulation factor which is most likely to be decreased in the patient’s blood is:patient’s blood is:

a. Prothrombina. Prothrombin

b. Factor Xb. Factor X

c. Factor VIIc. Factor VII

d. Factor IXd. Factor IX

e. Factor Ve. Factor V

Which of the coagulation factors listed below catalyzes the Which of the coagulation factors listed below catalyzes the formation of amide bonds?formation of amide bonds?

a. Factor XIIaa. Factor XIIa

b. Thrombinb. Thrombin

c. Factor XIIIac. Factor XIIIa

d. Factor VIIIad. Factor VIIIa

e. Factor Vae. Factor Va

c. Factor XIIIac. Factor XIIIa

Which one, if any, of the following statements regarding Which one, if any, of the following statements regarding fibrinolysis is fibrinolysis is incorrectincorrect??

a.a. plasminogen activator inhibitor, PAI, stimulates plasminogen activator inhibitor, PAI, stimulates fibrinolysisfibrinolysis

b.b. D-dimers are products of fibrinolysis found in plasmaD-dimers are products of fibrinolysis found in plasma

c.c. both plasminogen and tPA bind to fibrin in a thrombusboth plasminogen and tPA bind to fibrin in a thrombus

d.d. plasmin bound to fibrin is resistant to plasmin bound to fibrin is resistant to αα2 plasmin 2 plasmin inhibitor actioninhibitor action

e.e. none of the above statements is falsenone of the above statements is false

a.a. plasminogen activator inhibitor, PAI, stimulates plasminogen activator inhibitor, PAI, stimulates fibrinolysisfibrinolysis

An 18 year old woman with delayed onset of menses is An 18 year old woman with delayed onset of menses is sent to your office with a history of bone pain, severe sent to your office with a history of bone pain, severe enough to cause visits to the ER, a hematocrit of 25% enough to cause visits to the ER, a hematocrit of 25% (normal 36-48%), and a reticulocyte count of 12% (normal 36-48%), and a reticulocyte count of 12% (normal 0.5-1.5). Her peripheral blood smear appeared (normal 0.5-1.5). Her peripheral blood smear appeared as below.as below.

Most likely diagnosis is:Most likely diagnosis is:

a.a. iron deficiencyiron deficiency

b.b. anemia of chronic diseaseanemia of chronic disease

c.c. iron excessiron excess

d.d. sickle cell anemiasickle cell anemia

e.e. lead intoxicationlead intoxication

d. sickle cell anemiad. sickle cell anemia

Which of the following is NOT seen in patients with Which of the following is NOT seen in patients with accelerated red cell destruction due to hemolytic accelerated red cell destruction due to hemolytic anemias?anemias?

a.a. increased serum unconjugated bilirubinincreased serum unconjugated bilirubin

b.b. decreased serum haptoglobindecreased serum haptoglobin

c.c. increased serum lactate dehydrogenase activityincreased serum lactate dehydrogenase activity

d.d. decreased red cell countdecreased red cell count

e.e. decreased reticulocyte countdecreased reticulocyte count

e. decreased reticulocyte counte. decreased reticulocyte count

A 25 year old is noted to be intermittently jaundice and A 25 year old is noted to be intermittently jaundice and to have a hematocrit of 25% (normal 36-52%). The to have a hematocrit of 25% (normal 36-52%). The patient has a family history of cholecystectomies before patient has a family history of cholecystectomies before 30 years of age in the father and 2 siblings. Peripheral 30 years of age in the father and 2 siblings. Peripheral blood smear appears as below. blood smear appears as below.

After reviewing the peripheral blood smear, you After reviewing the peripheral blood smear, you postulate the primary defect resides in:postulate the primary defect resides in:

a.a. the ability to absorb ironthe ability to absorb iron

b.b. the cytoskeleton of red blood cellsthe cytoskeleton of red blood cells

c.c. a congenital absence of the spleena congenital absence of the spleen

d.d. the lipid composition of the red blood cellsthe lipid composition of the red blood cells

e.e. hairy cell leukemiahairy cell leukemia

b. b. the cytoskeleton of red blood cellsthe cytoskeleton of red blood cells

Which one is NOT a nutritional anemia?Which one is NOT a nutritional anemia?

a.a. refractory anemiarefractory anemia

b.b. iron deficient anemiairon deficient anemia

c.c. vitamin B12 deficient anemiavitamin B12 deficient anemia

d.d. starvation anemiastarvation anemia

e.e. KwashiorkorKwashiorkor

a.a. refractory anemiarefractory anemia

All of the causes listed below are responsible for All of the causes listed below are responsible for iron deficiency anemia EXCEPT:iron deficiency anemia EXCEPT:

a.a. chronic blood losschronic blood loss

b.b. hookworm infestationhookworm infestation

c.c. severe malabsorptionsevere malabsorption

d.d. Vitamin C deficiencyVitamin C deficiency

e.e. Excessive mensesExcessive menses

d. Vitamin C deficiencyd. Vitamin C deficiency

Iron store depletion occurs in all EXCEPT:Iron store depletion occurs in all EXCEPT:

a.a. inadequate dietinadequate diet

b.b. ThalassemiaThalassemia

c.c. rapid growth in infancy and adolescencerapid growth in infancy and adolescence

d.d. blood donationblood donation

e.e. normal mensesnormal menses

b. Thalassemiab. Thalassemia

Which of the following conditions is most likely to Which of the following conditions is most likely to be cured with combination of chemotherapy?be cured with combination of chemotherapy?

a.a. disseminated non-small cell lung cancerdisseminated non-small cell lung cancer

b.b. disseminated breast cancerdisseminated breast cancer

c.c. intermediate grade lymphomaintermediate grade lymphoma

d.d. low grade lymphomalow grade lymphoma

e.e. multiple myelomamultiple myeloma

c. intermediate grade lymphomac. intermediate grade lymphoma

Which one of the following lab abnormalities is least likely to Which one of the following lab abnormalities is least likely to occur in multiple myeloma?occur in multiple myeloma?

a.a. decreased hemoglobindecreased hemoglobinb.b. increased serum creatinineincreased serum creatininec.c. increased alkaline phosphataseincreased alkaline phosphatased.d. increased serum total proteinsincreased serum total proteinse.e. increased serum calciumincreased serum calcium

c. increased alkaline phosphatasec. increased alkaline phosphatase

Which one of the following statements is true about Which one of the following statements is true about

lymphoma?lymphoma?

a.a. staging is more likely to determine the treatment in staging is more likely to determine the treatment in a patient with Non-Hodgkin’s Lymphoma than in a patient with Non-Hodgkin’s Lymphoma than in one with Hodgkin’s diseaseone with Hodgkin’s disease

b.b. Elevated serum LDH does not correlate with Elevated serum LDH does not correlate with disease activity in non-Hodgkin’s Lymphomadisease activity in non-Hodgkin’s Lymphoma

c.c. Hodgkin’s disease is unlikely to be cured with Hodgkin’s disease is unlikely to be cured with combination chemotherapycombination chemotherapy

d.d. Non-Hodgkin’s lymphoma is frequently Non-Hodgkin’s lymphoma is frequently disseminated at the time of presentationdisseminated at the time of presentation

d. Non-Hodgkin’s lymphoma is frequently disseminated at d. Non-Hodgkin’s lymphoma is frequently disseminated at

the time of presentationthe time of presentation

A 65 year old patient comes to see you for evaluation of an abnormal 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 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 (with no symptoms) and a CBC was noted to be abnormal. His physical

exam is normal.exam is normal.

WBC = 20,000 (normal 4500-12,000)WBC = 20,000 (normal 4500-12,000)

Hb normalHb normal

Platelet count normalPlatelet count normal

Peripheral smear belowPeripheral smear below

Your diagnosis is?Your diagnosis is?

a.a. Chronic Myeloid LeukemiaChronic Myeloid Leukemia

b.b. Chronic Lymphocytic LeukemiaChronic Lymphocytic Leukemia

c.c. Acute Myeloblastic LeukemiaAcute Myeloblastic Leukemia

d.d. Acute Lymphoblastic LeukemiaAcute Lymphoblastic Leukemia

e.e. No hematological DiseaseNo hematological Disease

b. b. Chronic Lymphocytic LeukemiaChronic Lymphocytic Leukemia

Appropriate therapy for this patient is?Appropriate therapy for this patient is?

a.a. bone marrow transplant from an unrelated donorbone marrow transplant from an unrelated donor

b.b. high dose chemotherapy short of transplant doseshigh dose chemotherapy short of transplant doses

c.c. Chlorambucil or Prednisone chemotherapyChlorambucil or Prednisone chemotherapy

d.d. no treatment indicated at this timeno treatment indicated at this time

e.e. prophylactic immunoglobulin therapy to prevent prophylactic immunoglobulin therapy to prevent infectioninfection

d. no treatment indicated at this timed. no treatment indicated at this time

A 25 year old medical student is sent to you for the evaluation of fatigue. Fatigue has become 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 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. brushing his teeth. Your exam shows an enlarged spleen and extensive petechiae and bruises.

Lab Exam:Lab Exam:

Hb of 7gm% (nl >14)Hb of 7gm% (nl >14) Platelets = 15,000 (nl 150-350,000)Platelets = 15,000 (nl 150-350,000)

WBC = 3000 (nl 4500-12,000)WBC = 3000 (nl 4500-12,000) PT – 26 sec (nl < 13 sec)PT – 26 sec (nl < 13 sec)

APTT = 60 sec (nl < 30 sec)APTT = 60 sec (nl < 30 sec) Fibrinogen = 50mg% (nl > 200 mg%)Fibrinogen = 50mg% (nl > 200 mg%)

Bone marrow below:Bone marrow below:

Molecular analysis of the cells shows a 15:17 translocation. Molecular analysis of the cells shows a 15:17 translocation.

in counseling this patient you tell him which of the following?in counseling this patient you tell him which of the following?

a.a. you have an incurable disease and should be sent to hospiceyou have an incurable disease and should be sent to hospice

b.b. You need an emergent bone marrow transplantYou need an emergent bone marrow transplant

c.c. Standard therapy with All Trans retinoic acid Standard therapy with All Trans retinoic acid

and chemotherapy has a chance of curing your leukemiaand chemotherapy has a chance of curing your leukemia

a.a. the bleeding problem is not related to the leukemiathe bleeding problem is not related to the leukemia

b.b. you have chronic myeloid leukemia and need Gleevec treatmentyou have chronic myeloid leukemia and need Gleevec treatment

c. Standard therapy with All Trans retinoic acid c. Standard therapy with All Trans retinoic acid and chemotherapy has a chance of curing your and chemotherapy has a chance of curing your

leukemialeukemia

Note: This is acute promyelocytic leukemia and Note: This is acute promyelocytic leukemia and requires requires All-trans retinoic acid because according to All-trans retinoic acid because according to the the NEJM.NEJM.

All-trans-retinoic acid induces complete All-trans-retinoic acid induces complete remission in remission in acute promyelocytic leukemia. However, it is acute promyelocytic leukemia. However, it is not not clear whether induction therapy with all-trans-clear whether induction therapy with all-trans-retinoic retinoic acid is superior to chemotherapy alone or acid is superior to chemotherapy alone or whether whether maintenance treatment with all-trans-retinoic maintenance treatment with all-trans-retinoic acid acid improves outcome improves outcome

Which of the following is a co-factor for Which of the following is a co-factor for activation of coagulation proteins?activation of coagulation proteins?

a.a. Factor XFactor X

b.b. Factor VIIFactor VII

c.c. Factor VFactor V

d.d. Factor IXFactor IX

c. Factor Vc. Factor V

Which of these proteins is stored in endothelial cells?Which of these proteins is stored in endothelial cells?

a.a. tissue factortissue factor

b.b. Factor VIIFactor VII

c.c. von Willbrand’s factorvon Willbrand’s factor

d.d. Factor IXFactor IX

c. von Willbrand’s factorc. von Willbrand’s factor

Prolongation of activated partial thromboplastin time is caused by the Prolongation of activated partial thromboplastin time is caused by the

following following except:except:

a.a. deficiency of Factor VIIdeficiency of Factor VII

b.b. deficiency of Factor VIIIdeficiency of Factor VIII

c.c. deficiency of Factor IXdeficiency of Factor IX

d.d. deficiency of Factor XIdeficiency of Factor XI

a.a. deficiency of Factor VIIdeficiency of Factor VII

Which of the following statements regarding hemophilia A is Which of the following statements regarding hemophilia A is

incorrect?incorrect?

a.a. it is an X-linked disorderit is an X-linked disorder

b.b. bleeding in the joints is characteristicbleeding in the joints is characteristic

c.c. hemophilia is more common in black maleshemophilia is more common in black males

d.d. caused by deficiency in factor VIIIcaused by deficiency in factor VIII

c. hemophilia is more common in black malesc. hemophilia is more common in black males

Which of the following statements regarding factor IX is Which of the following statements regarding factor IX is accurate?accurate?

a.a. it is a co-factor for factor VIIIit is a co-factor for factor VIII

b.b. Deficiency of factor IX is transmitted as autosomal recessive Deficiency of factor IX is transmitted as autosomal recessive disorderdisorder

c.c. Bleeding in the joints is rare in patients severely deficient in Bleeding in the joints is rare in patients severely deficient in factor IXfactor IX

d.d. The gene encoding factor IX is located on the X-chromosomeThe gene encoding factor IX is located on the X-chromosome

d. The gene encoding factor IX is located on the X-d. The gene encoding factor IX is located on the X-

chromosomechromosome

Venous thrombosis can result from all of the following Venous thrombosis can result from all of the following except:except:

a.a. Proteins S deficiencyProteins S deficiency

b.b. impaired fibrinolysisimpaired fibrinolysis

c.c. increase in factor VIIincrease in factor VII

d.d. a point mutation at site 506 in the factor Va point mutation at site 506 in the factor V

a.a. Proteins S deficiencyProteins S deficiency

Which of the following best characterizes immune Which of the following best characterizes immune thrombocytopenia purpura (ITP)?thrombocytopenia purpura (ITP)?

a.a. it is transmitted as autosomal recessive traitit is transmitted as autosomal recessive trait

b.b. the destruction of platelets is commonly caused by the destruction of platelets is commonly caused by antibodies against GPIIantibodies against GPIIbb|III|IIIaa

c.c. Severe neutropenia is common with ITPSevere neutropenia is common with ITP

d.d. ITP is a rare cause of thrombocytopeniaITP is a rare cause of thrombocytopenia

b. the destruction of platelets is commonly caused by b. the destruction of platelets is commonly caused by

antibodies against GPIIantibodies against GPIIbb|III|IIIaa

All of the following can be found in a patient with All of the following can be found in a patient with thrombotic thrombocytopenic purpura except:thrombotic thrombocytopenic purpura except:

a.a. severe headachesevere headache

b.b. prolonged activated partial thromboplastin timeprolonged activated partial thromboplastin time

c.c. fragmented red blood cellsfragmented red blood cells

d.d. anemiaanemia

b. prolonged activated partial thromboplastin timeb. prolonged activated partial thromboplastin time

Which of the following possess both specific and Which of the following possess both specific and azurophilic granules?azurophilic granules?

a. Erthrocytea. Erthrocyte

b. Lymphocyteb. Lymphocyte

c. Plateletc. Platelet

d. Neutrophild. Neutrophil

e. Monocytee. Monocyte

Which of the following is derived from reticulocytes?Which of the following is derived from reticulocytes?

a. Erythrocytesa. Erythrocytes

b. Lymphocytesb. Lymphocytes

c. Plateletc. Platelet


e. Monocytee. Monocyte

a. Erythrocytesa. Erythrocytes

Which of the following is a characteristic of monocytes?Which of the following is a characteristic of monocytes?

a. They contain a multilobed nucleusa. They contain a multilobed nucleus

b. They are the most numerous of the white cellsb. They are the most numerous of the white cells

c. Their cytoplasm is packed with ribosomesc. Their cytoplasm is packed with ribosomes

d. They become active macrophages while circulating in d. They become active macrophages while circulating in the bloodthe blood

e. They become active macrophages after entering the e. They become active macrophages after entering the tissuestissues

e. They become active macrophages after entering e. They become active macrophages after entering the the

tissuestissues

After their maturation in the thymus and release into the After their maturation in the thymus and release into the circulation, T lymphocytes migrate preferentially to which circulation, T lymphocytes migrate preferentially to which of the following sites?of the following sites?

a. Paracortex (deep cortex) of lymph nodesa. Paracortex (deep cortex) of lymph nodes

b. Cortical lypmhoid nodules of lymph nodesb. Cortical lypmhoid nodules of lymph nodes

c. Hilus of lymph nodesc. Hilus of lymph nodes

d. Lymphoid nodules of the tonsilsd. Lymphoid nodules of the tonsils

e. Lymphoid nodules of the spleene. Lymphoid nodules of the spleen

a. Paracortex (deep cortex) of lymph a. Paracortex (deep cortex) of lymph nodesnodes

The region of a lymph node where reticulating lymphocytes The region of a lymph node where reticulating lymphocytes normally leave the blood via postcapillary high endothelial normally leave the blood via postcapillary high endothelial venules is the:venules is the:

a. Subcapsular sinusa. Subcapsular sinus

b. Cortexb. Cortex

c. Paracortex (deep cortex)c. Paracortex (deep cortex)

d. Medullary cordsd. Medullary cords

e. Medullary sinusese. Medullary sinuses

c. Paracortex (deep cortex)c. Paracortex (deep cortex)

Which of the following is a Which of the following is a uniqueunique characteristic of the characteristic of the palantine tonsils?palantine tonsils?

a. It is completely surrounded by a connective tissue capsulea. It is completely surrounded by a connective tissue capsuleb. It contains deep crypts lined by stratified squamous b. It contains deep crypts lined by stratified squamous epitheliumepitheliumc. Its surface is covered by pseudostratified ciliated columnar c. Its surface is covered by pseudostratified ciliated columnar

epitheliumepitheliumd. Its pits are washed out by mucus secretions from glands d. Its pits are washed out by mucus secretions from glands located located

near the base of the pitsnear the base of the pitse. Many of the arterioles in the gland are surrounded by e. Many of the arterioles in the gland are surrounded by lymph lymph

nodules and are called central arterioles nodules and are called central arterioles

b. It contains deep crypts lined by stratified squamous b. It contains deep crypts lined by stratified squamous epitheliumepithelium

The genetically defined developmental The genetically defined developmental programs which regulate proliferation and programs which regulate proliferation and maturation of hematopoeitic stem cells (HSCs) maturation of hematopoeitic stem cells (HSCs) are driven by external signals that include:are driven by external signals that include:

a. Interleukin 3a. Interleukin 3b. Erythropoietinb. Erythropoietinc. 2,3-bisphosphoglycerate (2,3-BPG)c. 2,3-bisphosphoglycerate (2,3-BPG)d. A, B, and Cd. A, B, and Ce. A and B onlye. A and B only

e. A and B onlye. A and B only

The oxygen saturation curve (O2 fractional saturation vs. O2 The oxygen saturation curve (O2 fractional saturation vs. O2 partial pressure) of a pH 7.4 buffered solution of normal adult partial pressure) of a pH 7.4 buffered solution of normal adult hemoglobin (HbA) containing 0.0 mM 2,3-BPG exhibits: hemoglobin (HbA) containing 0.0 mM 2,3-BPG exhibits:

a. A shift to the right, relative to HbA in the same solution, a. A shift to the right, relative to HbA in the same solution, but but

containing 5 mM 2,3-BPGcontaining 5 mM 2,3-BPG

b. A high degree of cooperativity with respect to O2 bindingb. A high degree of cooperativity with respect to O2 binding

c. Almost no cooperativity with respect to O2 bindingc. Almost no cooperativity with respect to O2 binding

d. An exaggerated Bohr effectd. An exaggerated Bohr effect

e. A, B, and De. A, B, and D

c. Almost no cooperativity with respect to O2 c. Almost no cooperativity with respect to O2 bindingbinding

The relatively simple metabolic system of normal, The relatively simple metabolic system of normal, mature RBCsmature RBCs

a. Requires a source of lactatea. Requires a source of lactate

b. Is unable to produce NADPHb. Is unable to produce NADPH

c. Is incapable of oxidative phosphorylationc. Is incapable of oxidative phosphorylation

d. Is incapable of reducing methemoglobin d. Is incapable of reducing methemoglobin

e. Produces ATP anaerobically e. Produces ATP anaerobically

c. Is incapable of oxidative c. Is incapable of oxidative phosphorylationphosphorylation

Which of the following statements about heme synthesis in Which of the following statements about heme synthesis in bone marrow erythrocyte precursor cells is NOT correct?bone marrow erythrocyte precursor cells is NOT correct?

a. ALA synthase is the rate-limiting enzymea. ALA synthase is the rate-limiting enzyme

b. PBG synthase (ALA dehydratase) is a cytoplasmic b. PBG synthase (ALA dehydratase) is a cytoplasmic enzyme enzyme

c. Ferrochelatase is a mitochondrial enzymec. Ferrochelatase is a mitochondrial enzyme

d. Elevated heme prevents mitochondrial PBG transport d. Elevated heme prevents mitochondrial PBG transport

e. UPG I is not a normal intermediate e. UPG I is not a normal intermediate

d. Elevated heme prevents mitochondrial PBG d. Elevated heme prevents mitochondrial PBG transport transport

The enzymatic steps in heme synthesis that are sensitive to The enzymatic steps in heme synthesis that are sensitive to inhibition by Pb2+ in RBC precursor cells areinhibition by Pb2+ in RBC precursor cells are

a. Ferrochelatase and PBG synthase (ALA dehydratase)a. Ferrochelatase and PBG synthase (ALA dehydratase)

b. UPG synthase and ferrochelataseb. UPG synthase and ferrochelatase

c. UPG synthase and PBG synthasec. UPG synthase and PBG synthase

d. ALA synthase and ferrochelatased. ALA synthase and ferrochelatase

e. ALA synthase and CPG oxidasee. ALA synthase and CPG oxidase

a. Ferrochelatase and PBG synthase (ALA a. Ferrochelatase and PBG synthase (ALA dehydratase)dehydratase)

Which of the following statements regarding porphyrias are NOT Which of the following statements regarding porphyrias are NOT correct?correct?

a. Patients with porphyria cutanea tarda are photosensitivea. Patients with porphyria cutanea tarda are photosensitiveb. Patients who have inherited defects of enzymes which catalyze b. Patients who have inherited defects of enzymes which catalyze

reactions in the early reactions in heme synthesis usually have reactions in the early reactions in heme synthesis usually have neurologic symptomsneurologic symptoms

c. Spontaneous oxidation of porphyrinogens to porphyrins does not c. Spontaneous oxidation of porphyrinogens to porphyrins does not occur occur

in porphyriain porphyriad. Phenobarbital and similar drugs can precipitate acute attacks of d. Phenobarbital and similar drugs can precipitate acute attacks of certain certain

porphpyrias porphpyrias e. The ability to produce cytochrome P450 enzymes is affected in e. The ability to produce cytochrome P450 enzymes is affected in certain certain

porphyries. porphyries.

c. Spontaneous oxidation of porphyrinogens to porphyrins c. Spontaneous oxidation of porphyrinogens to porphyrins does not occur in porphyriadoes not occur in porphyria

Metabolic Metabolic products products of the first three enzymatic of the first three enzymatic reactions in heme degradation includereactions in heme degradation include

a. NADP+, biliverdin, and Fe3+a. NADP+, biliverdin, and Fe3+

b. NADPH, biliverdin, and COb. NADPH, biliverdin, and CO

c. NAD+, bilirubin, and UDPc. NAD+, bilirubin, and UDP

d. NADH, bilirubin, and UDP-glucoronated. NADH, bilirubin, and UDP-glucoronate

e. FAD, Fe2+, and UTPe. FAD, Fe2+, and UTP

c. NAD+, bilirubin, and UDPc. NAD+, bilirubin, and UDP

In the heme oxygenase reaction of heme degradation In the heme oxygenase reaction of heme degradation the methene (=C-) group of the porphyrin ring which the methene (=C-) group of the porphyrin ring which is oxidized to CO is between the pyrrol rings is oxidized to CO is between the pyrrol rings designated. designated.

a. A and Ba. A and B

b. B and Cb. B and C

c. C and Dc. C and D

d. D and Ad. D and A

a. A and Ba. A and B

The addition of both diazotized sulfanilic acid The addition of both diazotized sulfanilic acid (Ehrlich’s reagent) (Ehrlich’s reagent) and and methyl alcohol to methyl alcohol to plasma results in a colored product which plasma results in a colored product which representsrepresents

a. Direct bilirubina. Direct bilirubin

b. Indirect bilirubinb. Indirect bilirubin

c. Total bilirubinc. Total bilirubin

d. Albumin-bound bilirub9in onlyd. Albumin-bound bilirub9in only

e. Bilirubin diglucuronide onlye. Bilirubin diglucuronide only

c. Total bilirubinc. Total bilirubin

You are asked to see a 24-year old white female medical resident who has just You are asked to see a 24-year old white female medical resident who has just done her done her

own complete blood count (CBC) because of symptoms of progressive fatigue. The 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 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 progressing over the past 6 to 12 months. She is a serious runner, running over 50

miles miles each week. Because of the accompanying aches and pains she takes NSAIDS daily. each week. Because of the accompanying aches and pains she takes NSAIDS daily.

Her Her periods are irregular and last 8 to 9 days with heavy flow on the first 2 days. She periods are irregular and last 8 to 9 days with heavy flow on the first 2 days. She

avoids avoids eating meat. On physical examination the patient is a pale but otherwise healthy, eating meat. On physical examination the patient is a pale but otherwise healthy, muscular, young woman. muscular, young woman.

Laboratory includes:Laboratory includes:White Blood Cells White Blood Cells = 7,500 cells/mm3 (normal 3-8,000)= 7,500 cells/mm3 (normal 3-8,000)HemoglobinHemoglobin = 6.0 gm/dl (normal 12,15 gm/dl)= 6.0 gm/dl (normal 12,15 gm/dl)Mean Corpuscular VolumeMean Corpuscular Volume = 72 u3 (normal 81 – 95)= 72 u3 (normal 81 – 95)PlateletsPlatelets = 305,000 cells/mm3= 305,000 cells/mm3

The peripheral smear is to be shown:The peripheral smear is to be shown:

The cause of her anemia can be attributed to all of the following EXCEPT whichThe cause of her anemia can be attributed to all of the following EXCEPT which

a. Menstrual blood lossa. Menstrual blood lossb. Gastric irritation from her NSAID agentsb. Gastric irritation from her NSAID agentsc. Malabsorption of vitamin B12c. Malabsorption of vitamin B12d. March hemoglobinuria with loss of hemoglobin in the urined. March hemoglobinuria with loss of hemoglobin in the urinee. A diet in which iron is too low to compensate for increased losse. A diet in which iron is too low to compensate for increased loss

c. Malabsorption of vitamin B12c. Malabsorption of vitamin B12

In a patient with iron deficiency with a microcytic In a patient with iron deficiency with a microcytic hypochromic morphology of red blood cells and a MCV < 70 hypochromic morphology of red blood cells and a MCV < 70 fl (normal 80-90 fl) all of the following might be present fl (normal 80-90 fl) all of the following might be present EXCEPT:EXCEPT:

a. Hemoglobin of 5 gm/dla. Hemoglobin of 5 gm/dl

b. Hemoglobin of 6 gm/dlb. Hemoglobin of 6 gm/dl

c. Ferritin < 5 mg/dl (normal 15-200 mg/dl)c. Ferritin < 5 mg/dl (normal 15-200 mg/dl)

d. Hemoglobin 12 gm/dld. Hemoglobin 12 gm/dl

e. TIBC saturation < 10%e. TIBC saturation < 10%

d. Hemoglobin 12 gm/dld. Hemoglobin 12 gm/dl

The absorption of iron in the intestine is regulated The absorption of iron in the intestine is regulated

a. By renal tubular excretiona. By renal tubular excretion

b. By increased sloughing of the skinb. By increased sloughing of the skin

c. By absorption in the terminal duodenum and proximal c. By absorption in the terminal duodenum and proximal jejunumjejunum

d. In the terminal ileumd. In the terminal ileum

e. By having sufficient folic acid in the diete. By having sufficient folic acid in the diet

b. By increased sloughing of the skinb. By increased sloughing of the skin

A patient present with Hemoglobin = 7 gm/dl (normal 12 – A patient present with Hemoglobin = 7 gm/dl (normal 12 – 15 gm/dl) and a reticulocyte count of < 1%. Which of the 15 gm/dl) and a reticulocyte count of < 1%. Which of the following is probably NOT a cause for the anemia?following is probably NOT a cause for the anemia?

a. Metastatic cancer infiltrating the bone marrowa. Metastatic cancer infiltrating the bone marrow

b. Exposure to benzene with development of aplastic b. Exposure to benzene with development of aplastic anemiaanemia

c. High doses of radiation from a reactor accidentc. High doses of radiation from a reactor accident

d. 24 hours of bleeding from a gastric ulcerd. 24 hours of bleeding from a gastric ulcer

e. Acute myelogenous leukemiae. Acute myelogenous leukemia

d. 24 hours of bleeding from a gastric d. 24 hours of bleeding from a gastric ulcerulcer

A patient with a Hemoglobin + 7 gm/dl (normal 12 -15 A patient with a Hemoglobin + 7 gm/dl (normal 12 -15 gm/d.), total bilirubin 2.2 mg (normal < 1.2 mg), indirect gm/d.), total bilirubin 2.2 mg (normal < 1.2 mg), indirect bilirubin = 2.0 mg (normal 0.2 mg), reticulocyte = 10%, bilirubin = 2.0 mg (normal 0.2 mg), reticulocyte = 10%, LDH = 1500 units/dl (normal < 600 units/dl) and a LDH = 1500 units/dl (normal < 600 units/dl) and a prolong protime could have all of the following EXCEPT prolong protime could have all of the following EXCEPT which:which:

a. Antibodies directed to a red blood cell surface antigena. Antibodies directed to a red blood cell surface antigen

b. A positive Coombs testb. A positive Coombs test

c. Disseminate intravascular coagulationc. Disseminate intravascular coagulation

d. A bone marrow infiltrated with metastatic cancerd. A bone marrow infiltrated with metastatic cancer

e. A defect in the red blood cell cytoskeletone. A defect in the red blood cell cytoskeleton

d. A bone marrow infiltrated with metastatic cancerd. A bone marrow infiltrated with metastatic cancer

Therapeutic use of it can reverse the megaloblastic Therapeutic use of it can reverse the megaloblastic anemia associated with cobalamin deficiency:anemia associated with cobalamin deficiency:

a. Erythropoietina. Erythropoietin

b. Folic acid or related folatesb. Folic acid or related folates

c. Vitamin B-12 (cobalamin)c. Vitamin B-12 (cobalamin)

d. A and Cd. A and C

e. B and Ce. B and C

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






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






Reversal of megaloblastic hematopoiesis as a consequence Reversal of megaloblastic hematopoiesis as a consequence of vitamin B-12 replacement occurs after initiation of of vitamin B-12 replacement occurs after initiation of therapy at:therapy at:

a. 2-3 days and peaks by 508 daysa. 2-3 days and peaks by 508 days

b. 12-48 hoursb. 12-48 hours

c. 1 weekc. 1 week

d. 2 monthsd. 2 months

e. Never occurs unless the patient receives folic acid e. Never occurs unless the patient receives folic acid

simultaneouslysimultaneously

b. 12-48 hoursb. 12-48 hours

Surgical removal of the terminal ileum because of Surgical removal of the terminal ileum because of trauma might be expected to result in which of the trauma might be expected to result in which of the following:following:

a. Folic acid depletion within 30-60 daysa. Folic acid depletion within 30-60 days

b. Folic acid depletion within one yearb. Folic acid depletion within one year

c. Folic acid depletion within three yearsc. Folic acid depletion within three years

d. Vitamin B-12 deficiencyd. Vitamin B-12 deficiency

e. Achlorhydriae. Achlorhydria

d. Vitamin B-12 deficiencyd. Vitamin B-12 deficiency

A patient presents with a Hemoglobin of 7 gm/dl. The A patient presents with a Hemoglobin of 7 gm/dl. The blood smear shows both macrocytic red cells and blood smear shows both macrocytic red cells and hypersegmented neutrophils. Which of the following hypersegmented neutrophils. Which of the following is the patient most likely to have:is the patient most likely to have:

a. Decreased methylmalonic acid 2-100 x normala. Decreased methylmalonic acid 2-100 x normal

b. Increased methylmalonic acid 2-100 x normal b. Increased methylmalonic acid 2-100 x normal

c. Decreased serum homocysteine 2-20 x normalc. Decreased serum homocysteine 2-20 x normal

d. High total iron binding capacity (TIBC)d. High total iron binding capacity (TIBC)

b. Increased methylmalonic acid 2-100 x b. Increased methylmalonic acid 2-100 x normal normal

The complex consisting of tissue factor and activated The complex consisting of tissue factor and activated factor VII (TF/VIIa) activates which of the following factor VII (TF/VIIa) activates which of the following proteins:proteins:

a. Factors VIII and IXa. Factors VIII and IX

b. Proteins C and Sb. Proteins C and S

c. Factors X and IXc. Factors X and IX

d. Factor XII and XIIId. Factor XII and XIII

c. Factors X and IXc. Factors X and IX

Which of the following is not a vitamin K dependent Which of the following is not a vitamin K dependent factor:factor:

a. Factor IXa. Factor IX

b. Protein Sb. Protein S


d. Factor VIIId. Factor VIII

d. Factor VIIId. Factor VIII

Excessive bleeding can be a manifestation of Excessive bleeding can be a manifestation of deficiency of all the following EXCEPT:deficiency of all the following EXCEPT:

a. Factor VII deficiencya. Factor VII deficiency

b. Factor V deficiencyb. Factor V deficiency

c. Protein C deficiencyc. Protein C deficiency

d. Factor IX deficiencyd. Factor IX deficiency

c. Protein C deficiencyc. Protein C deficiency

Which of these proteins is inactivated by activated Which of these proteins is inactivated by activated protein C:protein C:

a. Activated factor IXa. Activated factor IX

b. Activated factor VIIb. Activated factor VII

c. Protein Sc. Protein S

d. Activated factor Vd. Activated factor V

d. Activated factor Vd. Activated factor V

Which of these proteins is not synthesized in the Which of these proteins is not synthesized in the endothelial cell:endothelial cell:

a. Von Willebrand’s factora. Von Willebrand’s factor

b. Factor XIIb. Factor XII

c. Thrombomodulinc. Thrombomodulin

The sons of a hemophilia B carrier woman married to a The sons of a hemophilia B carrier woman married to a healthy man are expected to be:healthy man are expected to be:

a. All healthya. All healthy

b. Hal healthy and half carriersb. Hal healthy and half carriers

c. Half affected and half carriersc. Half affected and half carriers

d. Half affected and half healthyd. Half affected and half healthy

d. Half affected and half healthyd. Half affected and half healthy

Which of the following is not considered a hereditary Which of the following is not considered a hereditary condition predisposing to hypercoagulability:condition predisposing to hypercoagulability:

a. Activated protein C resistance a. Activated protein C resistance

b. Protein S deficiencyb. Protein S deficiency

c. Factor V deficiencyc. Factor V deficiency

d. Antithrombin II deficiency d. Antithrombin II deficiency

c. Factor V deficiencyc. Factor V deficiency

Which of the following findings is a Which of the following findings is a characteristic of thrombotic thrombocytopenic characteristic of thrombotic thrombocytopenic purpura:purpura:

a. Autoimmune hemolysis and a. Autoimmune hemolysis and thrombocytopeniathrombocytopenia

b. Intravascular hemolysis and high D-dimerb. Intravascular hemolysis and high D-dimer

c. Intravascular hemolysis and thrombocytosisc. Intravascular hemolysis and thrombocytosis

d. Intravascular hemolysis and d. Intravascular hemolysis and thrombocytopeniathrombocytopenia

d. Intravascular hemolysis and d. Intravascular hemolysis and thrombocytopeniathrombocytopenia

A 62 year old woman was admitted to the hospital because of high A 62 year old woman was admitted to the hospital because of high fever, chills and confusion. Physical exam showed a non-alert woman fever, chills and confusion. Physical exam showed a non-alert woman with a temperature of 103.2, pulse 108/min, and blood pressure of 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 100/55. There was an ecchymotic rash on the chest wall and no organomegaly or lymphadenopathy. Complete blood count revealed organomegaly or lymphadenopathy. Complete blood count revealed a hematocrit of 31% (normal 38 – 45%), WBC 12,300 (normal 3-a hematocrit of 31% (normal 38 – 45%), WBC 12,300 (normal 3-10,000) with 82% segmented neutrophils and platelet count of 64,000 10,000) with 82% segmented neutrophils and platelet count of 64,000 (normal 150,000 – 300,000). Review of the blood smear showed (normal 150,000 – 300,000). Review of the blood smear showed schistocytes, mild polychromatophilia and confirmed the presence of schistocytes, mild polychromatophilia and confirmed the presence of low platelets. Blood cultures were positive from gram negative rods low platelets. Blood cultures were positive from gram negative rods in 3 out of 3 bottles. Fibrinogen was 105 mg/dl (normal >150), D-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 dimer was 14 ug/ml (normal <2) and prolonged activated partial thromboplastin time (APTT). Liver and renal function were within the thromboplastin time (APTT). Liver and renal function were within the normal limits. The most likely diagnosis in this case is:normal limits. The most likely diagnosis in this case is:

a. Thrombotic Thrombocytopenic Purpura (TTP)a. Thrombotic Thrombocytopenic Purpura (TTP)b. Immune Thrombocytopeniab. Immune Thrombocytopeniac. Disseminated Intravascular Coagulation (DIC)c. Disseminated Intravascular Coagulation (DIC)d. Factor VIII Deficiencyd. Factor VIII Deficiency

b. Immune Thrombocytopeniab. Immune Thrombocytopenia

To distinguish an acute lymphocytic leukemia To distinguish an acute lymphocytic leukemia from an acute myeloid leukemia the presence from an acute myeloid leukemia the presence of WHICH of the following cellular structures of WHICH of the following cellular structures would be most helpful:would be most helpful:

a. Nucleusa. Nucleus

b. Barr bodyb. Barr body

c. Auer Rodc. Auer Rod

d. Smudge Celld. Smudge Cell

e. Normal granulese. Normal granules

c. Auer Rodc. Auer Rod

In treating acute Myeloid Leukemia which of the following is In treating acute Myeloid Leukemia which of the following is CORRECT:CORRECT:

a. The only curative therapy is bone marrow transplantation a. The only curative therapy is bone marrow transplantation

undertaken at the time of diagnosisundertaken at the time of diagnosis

b. Low dose non-toxic chemotherapy should be usedb. Low dose non-toxic chemotherapy should be used

c. Induction therapy consists of high doses of chemotherapy c. Induction therapy consists of high doses of chemotherapy to to

eliminate all the abnormal blasts is given and then eliminate all the abnormal blasts is given and then supportive supportive

care to allow the normal marrow to repopulatecare to allow the normal marrow to repopulate

d. No treatment is of any valued. No treatment is of any value

c. Induction therapy consists of high doses of c. Induction therapy consists of high doses of chemotherapy to chemotherapy to

eliminate all the abnormal blasts is given and then eliminate all the abnormal blasts is given and then supportive supportive

care to allow the normal marrow to repopulatecare to allow the normal marrow to repopulate

Characteristics of Chronic Lymphocytic Leukemia (CLL) Characteristics of Chronic Lymphocytic Leukemia (CLL) include all of the following EXCEPT:include all of the following EXCEPT:

a. CLL is usually characterized by an overproduction of T-a. CLL is usually characterized by an overproduction of T-cellscells

b. CLL is staged 0-4 with 0 being the best prognostic stageb. CLL is staged 0-4 with 0 being the best prognostic stage

c. Smudge cells are seen on the peripheral blood smearc. Smudge cells are seen on the peripheral blood smear

d. There is no curative therapy only palliative therapyd. There is no curative therapy only palliative therapy

e. Infections and autoimmune disorders may occure. Infections and autoimmune disorders may occur

d. There is no curative therapy only palliative d. There is no curative therapy only palliative therapytherapy

Which of the following platelet (thrombocyte) surface Which of the following platelet (thrombocyte) surface receptor(s) is/are correctly matched with its/their receptor(s) is/are correctly matched with its/their ligand(s)?ligand(s)?

a. GpIa, collagena. GpIa, collagen

b. GpIbIX, fibrinogenb. GpIbIX, fibrinogen

c. GpIbIIIa, von Willebrand factorc. GpIbIIIa, von Willebrand factor

d. A and Bd. A and B


a. GpIa, collagena. GpIa, collagen

Which of the following blood coagulation factors below Which of the following blood coagulation factors below is NOT involved in physiological (in vivo) blood is NOT involved in physiological (in vivo) blood coagulation?coagulation?

a. Factor XIa. Factor XI


c. Factor XIIIc. Factor XIII

d. Factor IXd. Factor IX

e. Factor IIe. Factor II

Which of the anticoagulants listed below prevent Which of the anticoagulants listed below prevent clotting of blood in vitro by binding Ca2+?clotting of blood in vitro by binding Ca2+?

a. Heparina. Heparin

b. Coumadinb. Coumadin

c. Citratec. Citrate



c. Citratec. Citrate

Which of the pairs of blood coagulation factors below Which of the pairs of blood coagulation factors below are both activated by thrombin?are both activated by thrombin?

a. Factor XIII and Factor Xa. Factor XIII and Factor X

b. Factor IX and Factor XIIb. Factor IX and Factor XII

c. Factor V and Factor VIIIc. Factor V and Factor VIII



c. Factor V and Factor VIIIc. Factor V and Factor VIII

Which of the following statements regarding in vivo Which of the following statements regarding in vivo enzymatic covalent crosslinking of fibrin is/are NOT correct?enzymatic covalent crosslinking of fibrin is/are NOT correct?

a. The reaction involves the addition of NH4+ to fibrina. The reaction involves the addition of NH4+ to fibrin

b. Glutamine and lysine residues in fibrin are substratesb. Glutamine and lysine residues in fibrin are substrates

c. Fibrin crosslinking is normally an intermolecular reactionc. Fibrin crosslinking is normally an intermolecular reaction


e. B and C e. B and C

a. The reaction involves the addition of NH4+ a. The reaction involves the addition of NH4+ to fibrinto fibrin

Which of the following complexes involved in blood coagulation Which of the following complexes involved in blood coagulation contain a substrate for activated protein C?contain a substrate for activated protein C?

a. Tissue factor –VIIaa. Tissue factor –VIIa

b. “Tenase”b. “Tenase”

c. “Prothrombinase”c. “Prothrombinase”



You see a 65-year old male who is mildly short of breath but 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 in no major distress. He reports that he has been getting weak and tiered in the last 6 months. Physical exam shows weak and tiered in the last 6 months. Physical exam shows mild tachycardia and a massively enlarged spleen. His CBC mild tachycardia and a massively enlarged spleen. His CBC shows moderate anemia with WBC = 12,400, and a platelet shows moderate anemia with WBC = 12,400, and a platelet count = 120,000. The blood film shows many RBCs with count = 120,000. The blood film shows many RBCs with tear drop morphology, nucleated red cells, and some white tear drop morphology, nucleated red cells, and some white cell precursors with no blast forms. Cytogenetics are cell precursors with no blast forms. Cytogenetics are normal. Which of the following is the MOST likely diagnosis:normal. Which of the following is the MOST likely diagnosis:

a. Chronic myelogenous leukemia in blast crisisa. Chronic myelogenous leukemia in blast crisisb. Polycythemia verab. Polycythemia verac. Myeloid metaplasia with myelofibrosisc. Myeloid metaplasia with myelofibrosisd. End stage liver diseased. End stage liver disease

c. Myeloid metaplasia with c. Myeloid metaplasia with myelofibrosismyelofibrosis

A 48-year old female has been feeling very tiered in the last 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 few weeks and has noticed that she a lot a night sweats frequently causing her to change her night gown and pillow frequently causing her to change her night gown and pillow case. On examination, you find that she has a large spleen. case. On examination, you find that she has a large spleen. The Hgb = 13 gm and the WBC is 86,200 cells/nm3 with The Hgb = 13 gm and the WBC is 86,200 cells/nm3 with immature myeloid forms and occasional myeloblasts. The immature myeloid forms and occasional myeloblasts. The platelet count is 650,000 mm3. A cytogenic examination of platelet count is 650,000 mm3. A cytogenic examination of the blood cells shows the presence of Philadelphia the blood cells shows the presence of Philadelphia chromosome. What is the diagnosis of this patient?chromosome. What is the diagnosis of this patient?

a. Polycythemia veraa. Polycythemia verab. Myelofibrosisb. Myelofibrosisc. Essential thrombocythemiac. Essential thrombocythemiad. Chronic myelogenous leukemiad. Chronic myelogenous leukemiae. Leukemoid reactione. Leukemoid reaction

d. Chronic myelogenous leukemiad. Chronic myelogenous leukemia

A 51 year old male has just been diagnosed with CML by his primary 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 physician and is referred to you for treatment. The patient is asymptomatic but has mild splenomegaly. The patient has a white 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 blood count of 45,500 cells/mm3. He has one older brother who is in good health. What is your initial treatment?good health. What is your initial treatment?

a. Observe the patient until he becomes symptomatica. Observe the patient until he becomes symptomatic

b. Allogeneic bone marrow transplantation immediately because of b. Allogeneic bone marrow transplantation immediately because of his agehis age

c. Treatment with a-interferonc. Treatment with a-interferon

d. Treatment with the signal transduction inhibitor Gleevec with d. Treatment with the signal transduction inhibitor Gleevec with periodic periodic

assessment of response by measuring percentage of cells assessment of response by measuring percentage of cells expressing expressing

BCR-ABL.BCR-ABL.

d. Treatment with the signal transduction inhibitor d. Treatment with the signal transduction inhibitor Gleevec with periodic assessment of response by Gleevec with periodic assessment of response by measuring percentage of cells expressing BCR-ABL.measuring percentage of cells expressing BCR-ABL.

A 33-year old female has had night sweats for 3 weeks but no 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 fever or weight loss. She is short of breath when she walks. A Chest X-ray shows an enlarged mediastinum. At physical Chest X-ray shows an enlarged mediastinum. At physical examination, an enlarged lymph node is palpated in the right examination, an enlarged lymph node is palpated in the right supraclavicular area. A biopsy is obtained and show supraclavicular area. A biopsy is obtained and show Hodgkin’s Hodgkin’s disease with nodular sclerosis. disease with nodular sclerosis. A bone marrow biopsy is A bone marrow biopsy is negative and a CT scan shows mediastinal nodes and no negative and a CT scan shows mediastinal nodes and no enlargement of abdominal lymph nodes or spleen.enlargement of abdominal lymph nodes or spleen.

What is her clinical stage?What is her clinical stage?

a. I Aa. I Ab. IV Bb. IV Bc. Staging is incomplete, patient should first undergo laparotomyc. Staging is incomplete, patient should first undergo laparotomyd. II Bd. II Be. III Ae. III A

d. II Bd. II B

Mantle cell lymphoma is associated with Mantle cell lymphoma is associated with

a. T(9:22) (t = translocation)a. T(9:22) (t = translocation)

b. Helicobacter pylori infectionb. Helicobacter pylori infection

c. T(11:14)c. T(11:14)

d. Cure by a triple antibiotic regimen in >90% of d. Cure by a triple antibiotic regimen in >90% of casescases

e. HTLV – 1 infection e. HTLV – 1 infection

c. T(11:14)c. T(11:14)

Multiple myeloma is frequently associated with each of the Multiple myeloma is frequently associated with each of the following EXCEPT which:following EXCEPT which:

a. Multiple bone lesionsa. Multiple bone lesions

b. Rouleaux formation on the peripheral smearb. Rouleaux formation on the peripheral smear

c. Amyloidosisc. Amyloidosis

d. A precursor T-cell phenotype according to the W.H.O. d. A precursor T-cell phenotype according to the W.H.O.

classificationclassification

e. Infectionse. Infections

d. A precursor T-cell phenotype according to the d. A precursor T-cell phenotype according to the W.H.O. W.H.O.

classificationclassification

Which product is correctly matched to the storage parameters:Which product is correctly matched to the storage parameters:

a. Packed Red Blood Cells a. Packed Red Blood Cells 5 days shelf life stored at 20 5 days shelf life stored at 20 – –

24 degrees Celsius24 degrees Celsius

b. Fresh Frozen Plasmab. Fresh Frozen Plasma 35-42 day shelf life, stored at 35-42 day shelf life, stored at 1-6 degrees Celsius1-6 degrees Celsius

c. Pheresis Plateletc. Pheresis Platelet 24 hr. shelf life, stored at 1-6 24 hr. shelf life, stored at 1-6 degrees Celsiusdegrees Celsius

d. Washed Red Blood Cellsd. Washed Red Blood Cells 1 yr. shelf life, stored at < or 1 yr. shelf life, stored at < or = =

-18 degrees Celsius-18 degrees Celsius

e. Pooled Plateletse. Pooled Platelets 4 hr. shelf life, stored at 20-4 hr. shelf life, stored at 20-24 24 degrees Celsiusdegrees Celsius

e. Pooled Plateletse. Pooled Platelets 4 hr. shelf life, stored at 20-4 hr. shelf life, stored at 20-24 24 degrees Celsiusdegrees Celsius

Leukoreduction of cellular products (red blood cells and Leukoreduction of cellular products (red blood cells and platelets) to less than 5 x 10(6) leukocytes/product (“3 log platelets) to less than 5 x 10(6) leukocytes/product (“3 log leukoreduction”) is an accepted indication for prevention or leukoreduction”) is an accepted indication for prevention or reduction of _____:reduction of _____:

a. Immunization to HLA antigens, Cytomegalovirus (CMV) a. Immunization to HLA antigens, Cytomegalovirus (CMV) transmission, and Febrile transfusion reactionstransmission, and Febrile transfusion reactions

b. HIV transmission, Hepatitis C transmission, and Hepatitis b. HIV transmission, Hepatitis C transmission, and Hepatitis B B

transmissiontransmissionc. Creutzfelt Jacob Disease (CJD) and West Nile Virus c. Creutzfelt Jacob Disease (CJD) and West Nile Virus

transmissiontransmissiond. Bacterial infectiond. Bacterial infection

a. Immunization to HLA antigens, Cytomegalovirus a. Immunization to HLA antigens, Cytomegalovirus (CMV) (CMV)

transmission, and Febrile transfusion reactionstransmission, and Febrile transfusion reactions

Your patient has a hemoglobin of 8.5 g/dl. You are asked to decide 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 whether the patient requires a transfusion of packed red blood cells (PRBCS). Your decision is:(PRBCS). Your decision is:

a. A patient definitely requires blood transfusion at a hemoglobin of a. A patient definitely requires blood transfusion at a hemoglobin of

8.5 g/dl.8.5 g/dl.

b. The patient’s clinical condition such as underlying cardiac b. The patient’s clinical condition such as underlying cardiac disease and disease and

current vital signs should be considered with the hemoglobin to current vital signs should be considered with the hemoglobin to

determine the need for transfusiondetermine the need for transfusion

c. A patient never requires blood transfusion at a hemoglobin of 8.5 c. A patient never requires blood transfusion at a hemoglobin of 8.5 g/dl.g/dl.

d. Call the blood bank and ask them whether to transfuse the d. Call the blood bank and ask them whether to transfuse the patientpatient

b. The patient’s clinical condition such as underlying cardiac b. The patient’s clinical condition such as underlying cardiac disease and current vital signs should be considered with disease and current vital signs should be considered with the hemoglobin to the hemoglobin to

determine the need for transfusiondetermine the need for transfusion

You decide to transfuse the patient on slide 107. The You decide to transfuse the patient on slide 107. The patient says his friend got HIV from a transfusion in 1980. patient says his friend got HIV from a transfusion in 1980. You tell him that the risk of HIV is:You tell him that the risk of HIV is:

a. The same as in 1980a. The same as in 1980

b. No risk at allb. No risk at all

c. With the current testing a small risk exists; the c. With the current testing a small risk exists; the estimated risk per estimated risk per

unit is about 1/50,000unit is about 1/50,000

d. With the current testing a small risk exists; the d. With the current testing a small risk exists; the estimated risk estimated risk

per unit is one in a million or lessper unit is one in a million or less

d. With the current testing a small risk exists; the estimated d. With the current testing a small risk exists; the estimated risk per unit is one in a million or lessrisk per unit is one in a million or less

The trauma team sends you a tube for testing with an The trauma team sends you a tube for testing with an emergency request to the blood bank for “as much blood as emergency request to the blood bank for “as much blood as you can provide” for a 27 year old female stabbing victim. you can provide” for a 27 year old female stabbing victim. The blood bank computer records say that this patient is The blood bank computer records say that this patient is type A, Rh(D) negative. The technologist’s first action is:type A, Rh(D) negative. The technologist’s first action is:

a. Tell the trauma team they will have to wait 20 minutes a. Tell the trauma team they will have to wait 20 minutes for the for the

type and crossmatchtype and crossmatch

b. Immediately release several A, Rh-negative unitsb. Immediately release several A, Rh-negative units

c. Immediately release several O, Rh-negative unitsc. Immediately release several O, Rh-negative units

d. Immediately release several O, Rh-positive unitsd. Immediately release several O, Rh-positive units

c. Immediately release several O, Rh-negative c. Immediately release several O, Rh-negative unitsunits

The patient from slide 111 types as A, Rh(D)-negative with NO The patient from slide 111 types as A, Rh(D)-negative with NO unexpected antibodies. She is still bleeding, but not profusely. The ER 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 calls for 2 more units. There is no A, Rh(D)-negative blood in the blood bank. What is the next step?bank. What is the next step?

a. Release O, Rh-negative blood to avoid an acute hemolytic anemiaa. Release O, Rh-negative blood to avoid an acute hemolytic anemia

b. Release A, Rh-positive blood; if anti-D forms, it does not matterb. 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-c. Ask the trauma team if they can hold the transfusion, because type-

specific blood is unavailablespecific blood is unavailable

d. Release O, Rh-negative blood because she is a woman of child-d. Release O, Rh-negative blood because she is a woman of child-bearing bearing

age; if anti-D forms, it might cause severe hemolytic disease of the age; if anti-D forms, it might cause severe hemolytic disease of the

newborn if she later becomes pregnant. newborn if she later becomes pregnant.

d. Release O, Rh-negative blood because she is a d. Release O, Rh-negative blood because she is a woman of child-bearing age; if anti-D forms, it might woman of child-bearing age; if anti-D forms, it might cause severe hemolytic disease of the newborn if she cause severe hemolytic disease of the newborn if she later becomes pregnant. later becomes pregnant.

The cell marked identify is a:The cell marked identify is a:

A.A. PromyelocytePromyelocyte

B.B. Neutrophilic myelocyteNeutrophilic myelocyte

C.C. Neutrophilic metamyelocyteNeutrophilic metamyelocyte

D.D. Mature neutrophilMature neutrophil

E.E. MonocyteMonocyte

Identify

C.C. Neutrophilic metamyelocyteNeutrophilic metamyelocyte

This cell is a:This cell is a:

A.A. BasophilBasophil

B.B. NeutrophilNeutrophil

C.C. EosinophilEosinophil

D.D. LymphocyteLymphocyte

E.E. MononcyteMononcyte

C.C. EosinophilEosinophil

The tissue featured here is:The tissue featured here is:

A.A. Lymph nodeLymph node

B.B. Palatine tonsilPalatine tonsil

C.C. Pharyngeal tonsilPharyngeal tonsil

D.D. ThymusThymus

E.E. SpleenSpleen

D. D. ThymusThymus

If Figure 4 the tissue is:If Figure 4 the tissue is:

A.A. Lymph nodeLymph node

B.B. Palatine tonsilPalatine tonsil

C.C. Pharyngeal tonsilPharyngeal tonsil

D.D. ThymusThymus

E.E. SpleenSpleen

B. B. Palatine tonsilPalatine tonsil

Reticulocytes become which of the following?Reticulocytes become which of the following?

A.A. PlateletsPlatelets

B.B. MonocytesMonocytes

C.C. NeutrophilsNeutrophils

D.D. ErythrocytesErythrocytes

D. D. ErythrocytesErythrocytes

Which of the following white cells are the most numerous in blood?Which of the following white cells are the most numerous in blood?

A.A. BasophilsBasophils

B.B. EosinophilsEosinophils

C.C. MonocytesMonocytes

D.D. LymphocytesLymphocytes

E.E. NeutrophilsNeutrophils

E. E. NeutrophilsNeutrophils

Hematocrit is defines as:Hematocrit is defines as:

A.A. The volume of packed leukocytes per unit volume of blood The volume of packed leukocytes per unit volume of blood expressed as a %.expressed as a %.

B.B. The volume of packed erythrocytes per unit volume of blood The volume of packed erythrocytes per unit volume of blood expressed as a %expressed as a %

C.C. The volume of hemoglobin per unit volume of blood The volume of hemoglobin per unit volume of blood expressed as a %expressed as a %

D.D. The number of red blood cells per milliliter of bloodThe number of red blood cells per milliliter of blood

E.E. The number of granulocytes per unit volume of bloodThe number of granulocytes per unit volume of blood

B.B. The volume of packed erythrocytes per unit volume of blood The volume of packed erythrocytes per unit volume of blood expressed as a %expressed as a %

Which of the following stem cells give rise to all types of blood Which of the following stem cells give rise to all types of blood cells?cells?

A.A. Multipotential stem cellsMultipotential stem cells

B.B. Colony-forming-unit-spleen stem cells (CFU-S)Colony-forming-unit-spleen stem cells (CFU-S)

C.C. Pluripotential hemopoietic stem cells (PHSCs)Pluripotential hemopoietic stem cells (PHSCs)

D.D. Unipotential (progenitor) cellsUnipotential (progenitor) cells

E.E. Precursor cellsPrecursor cells

C.C. Pluripotential hemopoietic stem cells (PHSCs)Pluripotential hemopoietic stem cells (PHSCs)

After their maturation in the thymus and release into the After their maturation in the thymus and release into the circulation, T circulation, T

lymphocytes migrate preferentially to which of the following sites?lymphocytes migrate preferentially to which of the following sites?

A.A. Lymph nodules of the spleenLymph nodules of the spleen

B.B. Periarterial lymphatic sheaths of the spleen (PALS)Periarterial lymphatic sheaths of the spleen (PALS)

C.C. Cortical lymph nodules of lymph nodesCortical lymph nodules of lymph nodes

D.D. Lymph nodules of tonsilsLymph nodules of tonsils

E.E. Lymph nodules in Peyer’s patchesLymph nodules in Peyer’s patches

B. B. Periarterial lymphatic sheaths of the spleen Periarterial lymphatic sheaths of the spleen (PALS)(PALS)

Recirculating lymphocytes primarily leave the blood vascular Recirculating lymphocytes primarily leave the blood vascular system and system and

enter lymph nodes via:enter lymph nodes via:

A.A. Venules in the medullaVenules in the medulla

B.B. Efferent lymphatic vesselsEfferent lymphatic vessels

C.C. High endothelial post-capillary venules in the cortexHigh endothelial post-capillary venules in the cortex

D.D. High endothelial post-capillary venules in the paracortexHigh endothelial post-capillary venules in the paracortex

E.E. Afferent lymphatic vesselsAfferent lymphatic vessels

D.D. High endothelial post-capillary venules in the High endothelial post-capillary venules in the paracortexparacortex

All of the following cells in the erythroid lineage synthesize All of the following cells in the erythroid lineage synthesize hemoglobin hemoglobin

EXCEPT:EXCEPT:

A.A. Red blood cellsRed blood cells

B.B. ReticulocytesReticulocytes

C.C. Orthochromic erythroblastsOrthochromic erythroblasts

D.D. Polychromic erythroblastsPolychromic erythroblasts

E.E. Basophilic erythroblastsBasophilic erythroblasts

A.A. Red blood cellsRed blood cells

Which of the following statements regarding globin chain Which of the following statements regarding globin chain expression is/are expression is/are

correct?correct?

A.A. Transcription of both Transcription of both ζζ and and αα globin occurs on the same globin occurs on the same chromosome.chromosome.

B.B. In gestation, In gestation, εε globin expression decreases as globin expression decreases as γγ globin globin expression increases.expression increases.

C.C. The total number of different globin chains expressed during The total number of different globin chains expressed during human development is fivehuman development is five

D.D. A, B, and C are all correctA, B, and C are all correct

E.E. Only A and B are correct.Only A and B are correct.

E. E. Only A and B are correct.Only A and B are correct.

Hereditary spherocytosis is most often caused by a defect in, or Hereditary spherocytosis is most often caused by a defect in, or deficiency deficiency

of RBC:of RBC:

A.A. Membrane cholesterolMembrane cholesterol

B.B. Membrane anion transporter, band 3Membrane anion transporter, band 3

C.C. Cytoskeletal spectrinCytoskeletal spectrin


E.E. Only B and C are correct.Only B and C are correct.

C. C. Cytoskeletal spectrinCytoskeletal spectrin

The enzyme which catalyzes the rate-limiting step in heme The enzyme which catalyzes the rate-limiting step in heme biosynthesis:biosynthesis:

A.A. Uses a TCA cycle intermediate as a substrate.Uses a TCA cycle intermediate as a substrate.

B.B. Is synthesized in the cytoplasm of the cell.Is synthesized in the cytoplasm of the cell.

C.C. Is inhibited by elevated cellular levels of lead.Is inhibited by elevated cellular levels of lead.


E.E. Only A and B are correctOnly A and B are correct

E. E. Only A and B are correctOnly A and B are correct

Which of the following statements is/are true regarding normal Which of the following statements is/are true regarding normal heme heme

biosynthesis?biosynthesis?

A.A. It is increased in bone marrow, but not in liver, by It is increased in bone marrow, but not in liver, by barbiturates and certain other drugs.barbiturates and certain other drugs.

B.B. The enzyme of the last reaction in step is regulated by direct The enzyme of the last reaction in step is regulated by direct product inhibition.product inhibition.

C.C. The first three steps occur in the mitochondriaThe first three steps occur in the mitochondria

D.D. All of the above statements are trueAll of the above statements are true

E.E. All of the above statements are falseAll of the above statements are false

E. E. All of the above statements are falseAll of the above statements are false

The color of each of the first three compound involved in heme The color of each of the first three compound involved in heme degradation degradation

in the order in which they occur (left to right) is:in the order in which they occur (left to right) is:

A.A. Yellow, purple, greenYellow, purple, green

B.B. Yellow, green, purpleYellow, green, purple

C.C. Purple, yellow, greenPurple, yellow, green

D.D. Purple, green, yellowPurple, green, yellow

E.E. Green, purple, yellowGreen, purple, yellow

D. D. Purple, green, yellowPurple, green, yellow

The heme degradation product secreted by spleen macrophages is The heme degradation product secreted by spleen macrophages is carried carried

to the liver:to the liver:

A.A. Bound to haptoglobinBound to haptoglobin

B.B. Bound to albuminBound to albumin

C.C. As a glucoronideAs a glucoronide

D.D. Bound to hemopexinBound to hemopexin

E.E. As polar, water-soluble compoundAs polar, water-soluble compound

B.B. Bound to albuminBound to albumin

The order which the numbered heme degradation products listed The order which the numbered heme degradation products listed below below

occur in the body before being excreted in occur in the body before being excreted in urineurine is: is:

1.1. UroblinUroblin

2.2. BilirubinBilirubin

3.3. UrobilinogenUrobilinogen

4.4. Bilirubin glucoronideBilirubin glucoronide

A.A. 2, 3, 1, 42, 3, 1, 4

B.B. 4, 2, 3, 14, 2, 3, 1

C.C. 3, 4, 2, 13, 4, 2, 1

D.D. 1, 4, 3, 21, 4, 3, 2

E.E. 4, 2, 1, 34, 2, 1, 3

B. B. 4, 2, 3, 14, 2, 3, 1

Which of the following is NOT involved in the primary hemostatic Which of the following is NOT involved in the primary hemostatic processes, processes,

platelet adhesion and aggregation on injured endothelium?platelet adhesion and aggregation on injured endothelium?

A.A. CollagenCollagen

B.B. FibrinogenFibrinogen

C.C. Von Willebrand factorVon Willebrand factor

D.D. Factor VIIIFactor VIII

E.E. Integrin GpIIbIIIaIntegrin GpIIbIIIa

D.D. Factor VIIIFactor VIII

Blood coagulation factor Va Leiden:Blood coagulation factor Va Leiden:

A.A. Is rapidly inactivated by activated protein C.Is rapidly inactivated by activated protein C.

B.B. Is the result of polymorphism in the factor V gene 3’-UTR.Is the result of polymorphism in the factor V gene 3’-UTR.

C.C. Is the cause of most common human bleeding disorder.Is the cause of most common human bleeding disorder.

D.D. Is correctly described by both A and B.Is correctly described by both A and B.

E.E. Is correctly described by none of the above.Is correctly described by none of the above.

E.E. Is correctly described by none of the Is correctly described by none of the above.above.

Factor XIIa:Factor XIIa:

A.A. Can activate Factor XI.Can activate Factor XI.

B.B. Is activated when blood is drawn into a glass tube without Is activated when blood is drawn into a glass tube without anticoagulantanticoagulant

C.C. Is not essential for physiological blood coagulation.Is not essential for physiological blood coagulation.

D.D. Is properly described by all of the above.Is properly described by all of the above.

E.E. Is properly described only by A and B. Is properly described only by A and B.

D. D. Is properly described by all of the above.Is properly described by all of the above.

Endongenous tissue plasminogen activator:Endongenous tissue plasminogen activator:

A.A. Is stimulated by binding to thrombinIs stimulated by binding to thrombin

B.B. Binds to fibrin containing thrombi (clots)Binds to fibrin containing thrombi (clots)

C.C. Is the major physiological anticoagulantIs the major physiological anticoagulant

D.D. Is correctly described only by A and B.Is correctly described only by A and B.

E.E. Is correctly described only by B and C.Is correctly described only by B and C.

B.B. Binds to fibrin containing thrombi Binds to fibrin containing thrombi (clots)(clots)

Plasma proteins that are vitamin K-dependent are:Plasma proteins that are vitamin K-dependent are:

A.A. Prothrombin, protein C and tissue factorProthrombin, protein C and tissue factor

B.B. Factor X, factor IX, and protein S.Factor X, factor IX, and protein S.

C.C. Factor V, factor XII and factor VII.Factor V, factor XII and factor VII.

D.D. All of the proteins listed in A, B, and C.All of the proteins listed in A, B, and C.

E.E. Those proteins listed in A and B onlyThose proteins listed in A and B only

B. B. Factor X, factor IX, and protein S.Factor X, factor IX, and protein S.

Thrombotic disorders are frequently characterized by:Thrombotic disorders are frequently characterized by:

A.A. A tendency to form clots in the large, deep veins of the legs.A tendency to form clots in the large, deep veins of the legs.

B.B. Genetically transmitted deficiency of von Willebrand factor.Genetically transmitted deficiency of von Willebrand factor.

C.C. Abnormally low plasma concentration of prothrombinAbnormally low plasma concentration of prothrombin

D.D. None of the above are characteristics of thrombotic disorders.None of the above are characteristics of thrombotic disorders.

E.E. Statements A and C onlyStatements A and C only

A.A. A tendency to form clots in the large, deep veins of the legs.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 A 54yo male was diagnosed with CML and was referred to you for

treatment. The patient reports some fatigue but is fully employed treatment. The patient reports some fatigue but is fully employed as an as an

office manager. He has six siblings. Two of his siblings have office manager. He has six siblings. Two of his siblings have identical HLA identical HLA

match with him.match with him.

What is your initial treatment?What is your initial treatment?

A.A. Wait and watch until the patient becomes more symptomatic Wait and watch until the patient becomes more symptomatic and then initiate treatment.and then initiate treatment.

B.B. Bone marrow or peripheral stem cell transplantation from his Bone marrow or peripheral stem cell transplantation from his sibling because of his relatively young age.sibling because of his relatively young age.

C.C. Treat with hydroxyurea to maintain his WBC and platelet Treat with hydroxyurea to maintain his WBC and platelet count in the normal rangecount in the normal range

D.D. Treat with signal transduction inhibitor drug (Gleevec) and Treat with signal transduction inhibitor drug (Gleevec) and periodic determination of BCR-ABL.periodic determination of BCR-ABL.

D.D. Treat with signal transduction inhibitor drug (Gleevec) and Treat with signal transduction inhibitor drug (Gleevec) and periodic determination of BCR-ABL.periodic determination of BCR-ABL.

A 62yo white male was referred to you because of splenomegaly A 62yo white male was referred to you because of splenomegaly and and

anemia. The patient reports to you that he has had early satiety, anemia. The patient reports to you that he has had early satiety, some some

vague abdominal pain, and has gradually more difficulty catching vague abdominal pain, and has gradually more difficulty catching his breath. his breath.

Your examination shows massive splenomegaly associated with Your examination shows massive splenomegaly associated with tachycardia, tachycardia,

tachypnea, and dilated neck veins. The blood picture shows tachypnea, and dilated neck veins. The blood picture shows moderate moderate

anemia, WBC of 18, 200 with young forms and platelet count of anemia, WBC of 18, 200 with young forms and platelet count of 680,000. 680,000.

There is 10% nucleated red cells on the blood smear.There is 10% nucleated red cells on the blood smear.

What is the likely initial diagnosis?What is the likely initial diagnosis?

A.A. Congestive heart failureCongestive heart failure

B.B. Chronic myelogenous leukemiaChronic myelogenous leukemia

C.C. Myelofibrosis with congestive heart failureMyelofibrosis with congestive heart failure

D.D. Acute myelogenous leukemiaAcute myelogenous leukemia

C. C. Myelofibrosis with congestive heart failureMyelofibrosis with congestive heart failure

A 55yo male has been feeling ill for a long time but because of lack A 55yo male has been feeling ill for a long time but because of lack of of

health insurance, has not seen a physician. He reports that he has health insurance, has not seen a physician. He reports that he has had poor had poor

appetite and 20lbs of weight loss. He has had intermittent fever appetite and 20lbs of weight loss. He has had intermittent fever and night and night

sweats and fullness in his abdomen. On physical exam, the major sweats and fullness in his abdomen. On physical exam, the major findings findings

are massive splenomegaly with some enlargement of the liver. His are massive splenomegaly with some enlargement of the liver. His blood blood

picture shows WBC of 48,300 with myelocytes and premyelocytes, picture shows WBC of 48,300 with myelocytes and premyelocytes, mild mild

anemia and thrombocytosis of 543,000. You suspect CML and you anemia and thrombocytosis of 543,000. You suspect CML and you take take

blood for Philadelphia chromosome determination, which turns out blood for Philadelphia chromosome determination, which turns out to be to be

negative.negative.

What other tests can you do to reach the diagnosis? What other tests can you do to reach the diagnosis?

A.A. Repeat Philadelphia chromosome determinationRepeat Philadelphia chromosome determination

B.B. Bone marrow aspirationBone marrow aspiration

C.C. Red cell mass determination.Red cell mass determination.

D.D. BCR-ABL determinationBCR-ABL determination

D. D. BCR-ABL determinationBCR-ABL determination

All of the following statements about ABO antibodies are true All of the following statements about ABO antibodies are true EXCEPT:EXCEPT:

A.A. ABO antibodies are IgG antibodiesABO antibodies are IgG antibodies

B.B. ABO antibodies are reactive at body temperatureABO antibodies are reactive at body temperature

C.C. ABO antibodies bind complement efficiently.ABO antibodies bind complement efficiently.

D.D. Associated transfusion reactions can lead to massive Associated transfusion reactions can lead to massive intravascular hemolysis.intravascular hemolysis.

E.E. ABO incompatible transfusion can lead to renal failure and ABO incompatible transfusion can lead to renal failure and death.death.

A.A. ABO antibodies are IgG antibodiesABO antibodies are IgG antibodies

All of the following about Type and Screen are true EXCEPT:All of the following about Type and Screen are true EXCEPT:

A.A. Consists of ABO and RhD typing and an antibody screen.Consists of ABO and RhD typing and an antibody screen.

B.B. If the antibody screen is negative, blood is not crossmatched If the antibody screen is negative, blood is not crossmatched unless transfusion is necessary.unless transfusion is necessary.

C.C. Blood can be provided in minutes if needed.Blood can be provided in minutes if needed.

D.D. If an unexpected antibody is present, the workup is If an unexpected antibody is present, the workup is completed and 2 units set aside even though the need for completed and 2 units set aside even though the need for blood may be remote.blood may be remote.

E.E. A Type and Screen is appropriate for procedures where the A Type and Screen is appropriate for procedures where the likelihood of transfusion is high.likelihood of transfusion is high.

E.E. A Type and Screen is appropriate for procedures where the A Type and Screen is appropriate for procedures where the likelihood of transfusion is high.likelihood of transfusion is high.

All of the following statements regarding transfusion are true All of the following statements regarding transfusion are true EXCEPT:EXCEPT:

A.A. Transfusion of one unit of packed red blood cells to an adult Transfusion of one unit of packed red blood cells to an adult will raise the hemoglobin by 1g/dL.will raise the hemoglobin by 1g/dL.

B.B. Only isotonic saline may be added to red blood cellsOnly isotonic saline may be added to red blood cells

C.C. Transfusion of platelets is indicated in all patients with Transfusion of platelets is indicated in all patients with decreased platelet counts.decreased platelet counts.

D.D. One dose of platelets is usually provided by a pheresis One dose of platelets is usually provided by a pheresis platelet unit.platelet unit.

E.E. Indications for transfusion coagulation factor deficiencies and Indications for transfusion coagulation factor deficiencies and massive transfusionmassive transfusion

C.C. Transfusion of platelets is indicated in all patients with Transfusion of platelets is indicated in all patients with decreased platelet counts.decreased platelet counts.

All of the following statements regarding transfusion reactions are All of the following statements regarding transfusion reactions are true true

EXCEPT:EXCEPT:

A.A. ABO incompatibility is the most common cause of an acute ABO incompatibility is the most common cause of an acute hemolytic transfusion reaction.hemolytic transfusion reaction.

B.B. Transfusion of ABO incompatible blood is usually due to Transfusion of ABO incompatible blood is usually due to technical errors in the blood bank.technical errors in the blood bank.

C.C. Delayed hemolytic transfusion reactions usually occur days to Delayed hemolytic transfusion reactions usually occur days to weeks after transfusion and may be recognized due to a fall weeks after transfusion and may be recognized due to a fall in hematocrit.in hematocrit.

D.D. Febrile nonhemolytic reactions may be caused by cytokines Febrile nonhemolytic reactions may be caused by cytokines released from donor leukocytes and recipient antibodies to released from donor leukocytes and recipient antibodies to donor leukocytesdonor leukocytes

E.E. Anaphylactic reactions occur in patients with IgA deficiency Anaphylactic reactions occur in patients with IgA deficiency that make anti-IgA.that make anti-IgA.

B.B. Transfusion of ABO incompatible blood is usually due to Transfusion of ABO incompatible blood is usually due to technical errors in the blood bank.technical errors in the blood bank.

Patients at risk for GVHD should receivePatients at risk for GVHD should receive

A.A. Washed red blood cellsWashed red blood cells

B.B. Leukoreduced red blood cellsLeukoreduced red blood cells

C.C. Whole bloodWhole blood

D.D. Frozen red blood cellsFrozen red blood cells

E.E. Irradiated packed red blood cell unitsIrradiated packed red blood cell units

E.E. Irradiated packed red blood cell unitsIrradiated packed red blood cell units

All of the following statements regarding donor testing and All of the following statements regarding donor testing and transfusion transfusion

transmitted infections are true EXCEPT:transmitted infections are true EXCEPT:

A.A. Donor blood testing includes NAT testing for HIV and HCV. Donor blood testing includes NAT testing for HIV and HCV.

B.B. NAT testing stand for Nucleic Acid TestingNAT testing stand for Nucleic Acid Testing

C.C. NAT testing is done by PCR to detect RNANAT testing is done by PCR to detect RNA

D.D. NAT testing has reduced the window period for HIV to NAT testing has reduced the window period for HIV to approximately two months.approximately two months.

E.E. The current risk for contracting HIV as a result of transfusion The current risk for contracting HIV as a result of transfusion is 1:1.9 million.is 1:1.9 million.

D. D. NAT testing has reduced the window period for HIV to NAT testing has reduced the window period for HIV to approximately two months.approximately two months.

Nutritional anemia is a decreased concentration of hemoglobin due Nutritional anemia is a decreased concentration of hemoglobin due to:to:

A.A. Increased destruction of red blood cellsIncreased destruction of red blood cells

B.B. Mutations that influence the function of red blood cell Mutations that influence the function of red blood cell proteinsproteins

C.C. Excess of unstable hemoglobinExcess of unstable hemoglobin

D.D. Lack of nutrients contained in foodLack of nutrients contained in food

D.D. Lack of nutrients contained in foodLack of nutrients contained in food

Microcytic hypocromic morphology of red blood cells and MCV <70 Microcytic hypocromic morphology of red blood cells and MCV <70 are are

present in iron deficiency anemia when hemoglobin level is:present in iron deficiency anemia when hemoglobin level is:

A.A. 5 g/dL5 g/dL

B.B. Normal Normal

C.C. 11 g/dL11 g/dL

D.D. 7 g/dL7 g/dL

a. 5 g/dLa. 5 g/dL

Reversion of megaloblastic hematopoiesis as a consequence of Reversion of megaloblastic hematopoiesis as a consequence of vitB12 vitB12

replacement occurs after initiation of therapy:replacement occurs after initiation of therapy:

A.A. 2-3 days and peaks by 5-8 days2-3 days and peaks by 5-8 days

B.B. 12-48 hours12-48 hours

C.C. 1 week 1 week

D.D. 2 months2 months

B.B. 12-48 hours12-48 hours

A 55yo female has night sweats for 3 weeks, no fever or weight A 55yo female has night sweats for 3 weeks, no fever or weight loss and is loss and is

short of breath when she walks. A chest X ray shows an enlarged short of breath when she walks. A chest X ray shows an enlarged

mediastinum. At physical examination, an enlarged lymph node is mediastinum. At physical examination, an enlarged lymph node is palpated palpated

in the right supraclavicular area. A biopsy is obtained and shows in the right supraclavicular area. A biopsy is obtained and shows

Diffuse Large Cell Lymphoma (B-lineage, high grade). A bone Diffuse Large Cell Lymphoma (B-lineage, high grade). A bone marrow marrow

biopsy is negative and a CT of the abdomen shows an enlarged biopsy is negative and a CT of the abdomen shows an enlarged spleen and spleen and

borderline pelvic lymph nodes and normal liver and pancreas.borderline pelvic lymph nodes and normal liver and pancreas.

What is her clinical stage?What is her clinical stage?

A.A. I AI A

B.B. IV BIV B

C.C. Staging is incomplete, patient should first undergo Staging is incomplete, patient should first undergo laparotomy or PET imaginglaparotomy or PET imaging

D.D. II BII B

E.E. III BIII B

E.E. III BIII B

Mantle cell lymphoma is associated with:Mantle cell lymphoma is associated with:

A.A. t(9;22)t(9;22)

B.B. Helicobacter pyloriHelicobacter pylori

C.C. Older age, advanced stageOlder age, advanced stage

D.D. Cure by a triple antibiotic regimen in >90% of casesCure by a triple antibiotic regimen in >90% of cases

E.E. HTLV-1HTLV-1

E. E. HTLV-1HTLV-1

Multiple myeloma is frequently associated with:Multiple myeloma is frequently associated with:

A.A. Multiple bone lesionsMultiple bone lesions

B.B. Rouleaux formationRouleaux formation

C.C. AmyloidosisAmyloidosis

D.D. A precursor B, T or NK cell phenotype according to the W.H.O. A precursor B, T or NK cell phenotype according to the W.H.O. classificationclassification

E.E. Monoclonal proteins (paraprotein or M-protein)Monoclonal proteins (paraprotein or M-protein)

D.D. A precursor B, T or NK cell phenotype according to the W.H.O. A precursor B, T or NK cell phenotype according to the W.H.O. classificationclassification

The primary cause of deficiency of which of the following is chronic The primary cause of deficiency of which of the following is chronic kidney kidney

disease?disease?

A.A. ErythropoietinErythropoietin

B.B. Folic acid or related folatesFolic acid or related folates

C.C. Vitamin b-12 (cobalamin)Vitamin b-12 (cobalamin)

D.D. A and CA and C

E.E. B and CB and C

A. ErythropoietinA. Erythropoietin

Therapy with which of the following will reverse the megaloblastic Therapy with which of the following will reverse the megaloblastic anemia anemia

associated with cobalamin deficiency?associated with cobalamin deficiency?

A.A. Vitamin B12Vitamin B12

B.B. Folic acidFolic acid

C.C. IronIron

D.D. A and BA and B

E.E. B and CB and C

A. Vitamin B12A. Vitamin B12

Which of the following are usually administered by parenteral Which of the following are usually administered by parenteral routes to treat routes to treat

a deficiency-related anemia?a deficiency-related anemia?

A.A. Vitamin B12Vitamin B12

B.B. IronIron

C.C. ErythropoietinErythropoietin

D.D. B and CB and C

E.E. A and CA and C

E.E. A and CA and C

A 21 year old college student is admitted to the hospital with A 21 year old college student is admitted to the hospital with sudden onset sudden onset

of shortness of breath, fever and chest pain. His oxygen saturation of shortness of breath, fever and chest pain. His oxygen saturation is low is low

and on chest x ray there is an infiltrate consistent with pneumonia. and on chest x ray there is an infiltrate consistent with pneumonia. You are You are

asked to see the patient because of an anemia. You look at his asked to see the patient because of an anemia. You look at his blood blood

smear. On the basis of this smear you suggest that all of the smear. On the basis of this smear you suggest that all of the following following

EXCEPT would be a useful diagnostic or therapeutic maneuver:EXCEPT would be a useful diagnostic or therapeutic maneuver:

A.A. High doses of a diureticHigh doses of a diuretic

B.B. Supplemental oxygenSupplemental oxygen

C.C. Hemoglobin electrophoresisHemoglobin electrophoresis

D.D. Treating the patient with antibioticsTreating the patient with antibiotics

E.E. RBC exchange transfusionsRBC exchange transfusions

A. High doses of a diureticA. High doses of a diuretic

A young woman has had progressive fatigue. Her exercise tolerance is quite low and A young woman has had progressive fatigue. Her exercise tolerance is quite low and she notes she notes

difficulty in minding her 3 young children because she gets short of breath. During difficulty in minding her 3 young children because she gets short of breath. During her her

pregnancies she did take her folic acid but could not take her iron pills because of pregnancies she did take her folic acid but could not take her iron pills because of constipation. constipation.

Her periods are irregular and last 8 to 9 days with heavy flow on the first 2 days. Her Her periods are irregular and last 8 to 9 days with heavy flow on the first 2 days. Her diet diet

consists primarily of fruits and vegetables and she tends to avoid eating meat. ON consists primarily of fruits and vegetables and she tends to avoid eating meat. ON physical physical

examination the patient is pale but otherwise healthy, muscular, young woman.examination the patient is pale but otherwise healthy, muscular, young woman.

Laboratory includes:Laboratory includes:WBC = 6,500 cells/mm3 (normal 3-8,000)WBC = 6,500 cells/mm3 (normal 3-8,000)Hemoglobin (Hgb) = 6.0 gm/dL (normal 12-15 gm/dL)Hemoglobin (Hgb) = 6.0 gm/dL (normal 12-15 gm/dL)Mean corpusclar volume (MCV) = 72 u3 (normal 81-95)Mean corpusclar volume (MCV) = 72 u3 (normal 81-95)Platelets = 305,000 cell/mm3Platelets = 305,000 cell/mm3

The peripheral smear is shown in figure to the right.The peripheral smear is shown in figure to the right.

All of the following laboratory tests would be consistent with her underlying All of the following laboratory tests would be consistent with her underlying hematologic problem hematologic problem

problem EXCEPT:problem EXCEPT:

A.A. Low ferritinLow ferritinB.B. Low serum ironLow serum ironC.C. Elevated serum transferrin (TIBC)Elevated serum transferrin (TIBC)D.D. Markedly increased MCVMarkedly increased MCVE.E. Markedly decreased MCVMarkedly decreased MCV

D.D. Markedly increased MCVMarkedly increased MCV

A teenager is sent to you because of jaundice and a palpable A teenager is sent to you because of jaundice and a palpable spleen. The spleen. The

patient is here from Greece and you do not have a translator. You patient is here from Greece and you do not have a translator. You are able are able

to get a peripheral smear which is shown below.to get a peripheral smear which is shown below.

On the basis of the history, physical examination, and blood On the basis of the history, physical examination, and blood smear, which of smear, which of

the following would NOT be correct:the following would NOT be correct:

A.A. Mean corpuscular volume (MCV) = 62 u3 (normal 81-95)Mean corpuscular volume (MCV) = 62 u3 (normal 81-95)

B.B. Serum ferritin levels might be elevatedSerum ferritin levels might be elevated

C.C. Reticulocyte count would be increasedReticulocyte count would be increased

D.D. Alpha globin chains would be synthesized in excess of beta Alpha globin chains would be synthesized in excess of beta globin chainsglobin chains

E.E. Both of the parents’ blood smears would be absolutely Both of the parents’ blood smears would be absolutely normalnormal

E. Both of the parents’ blood smears would be absolutely E. Both of the parents’ blood smears would be absolutely normalnormal

You have just removed the gall bladders of several members of the same You have just removed the gall bladders of several members of the same family family

because of gall stones. A 25 year old member of the same family arrives in because of gall stones. A 25 year old member of the same family arrives in your your

office with jaundice and splenomegaly complaining of right upper quadrant office with jaundice and splenomegaly complaining of right upper quadrant pain.pain.

Laboratory data include:Laboratory data include:WBC = 7,500 cells/mm3 (normal 3-8,000)WBC = 7,500 cells/mm3 (normal 3-8,000)Hgb = 11.0 gm/dL (normal 12-15 gm/dL)Hgb = 11.0 gm/dL (normal 12-15 gm/dL)MCV = 89u3 (normal 81-95)MCV = 89u3 (normal 81-95)Platelets = 305,00 cells/mm3Platelets = 305,00 cells/mm3Reticulocyte count = 6% (normal 0-2%)Reticulocyte count = 6% (normal 0-2%)

The peripheral smear is shown here.The peripheral smear is shown here.

On the basis of this information all of the following are possible EXCEPT:On the basis of this information all of the following are possible EXCEPT:A.A. The patient has a mutation in a gene coding for a cytoskeletal The patient has a mutation in a gene coding for a cytoskeletal

protein.protein.B.B. The patient has a mutation in a gene coding for The patient has a mutation in a gene coding for αα globin chains globin chainsC.C. The hemolysis in this patient takes place primarily in the spleen.The hemolysis in this patient takes place primarily in the spleen.D.D. The patient’s sibs had bilirubin in their gall stones.The patient’s sibs had bilirubin in their gall stones.E.E. The patient’s RBCs will have lost surface area in excess of volume.The patient’s RBCs will have lost surface area in excess of volume.

B. B. The patient has a mutation in a gene coding for The patient has a mutation in a gene coding for αα globin globin chainschains

A long-lost cousin who works at a nuclear reactor appears in your office A long-lost cousin who works at a nuclear reactor appears in your office complaining complaining

of fevers and weakness. She was exposed to a disaster at the nuclear of fevers and weakness. She was exposed to a disaster at the nuclear reactor several reactor several

years previously. She has a high fever and petechia. Her lab tests include:years previously. She has a high fever and petechia. Her lab tests include:

WBC = 900 cells/mm3 (normal 3-8,000)WBC = 900 cells/mm3 (normal 3-8,000)Hgb = 5.6 gm/dL (normal 12-15 gm/dL)Hgb = 5.6 gm/dL (normal 12-15 gm/dL)MCV = 87 u3 (normal 81-95)MCV = 87 u3 (normal 81-95)Platelets = 6,000 cells/mm3Platelets = 6,000 cells/mm3Reticulocyte count = 0% (normal 0-2%)Reticulocyte count = 0% (normal 0-2%)

Bone marrow aspiration reveals no cell and the bone marrow biopsy is Bone marrow aspiration reveals no cell and the bone marrow biopsy is shown. On shown. On

the basis of this information all of the following are reasonable EXCEPT:the basis of this information all of the following are reasonable EXCEPT:

A.A. The patient needs to be on oral antibiotics and given a return The patient needs to be on oral antibiotics and given a return appointment in one month.appointment in one month.

B.B. The patient’s sibs need to be HLA typed to see if they are a match for The patient’s sibs need to be HLA typed to see if they are a match for a possible bone marrow transplantation.a possible bone marrow transplantation.

C.C. The patient needs to be on broad spectrum antibiotics coverage after The patient needs to be on broad spectrum antibiotics coverage after the blood cultures are drawn.the blood cultures are drawn.

D.D. Radiation exposure might be a cause for the patient’s problemsRadiation exposure might be a cause for the patient’s problemsE.E. Platelet transfusions should be used if the patient starts bleedingPlatelet transfusions should be used if the patient starts bleeding

a. The patient needs to be on oral antibiotics and given a return a. The patient needs to be on oral antibiotics and given a return appointment in one month.appointment in one month.

In a patient with iron deficiency anemia secondary to bleeding In a patient with iron deficiency anemia secondary to bleeding from a from a

colonic polyp you might expect all of the following except:colonic polyp you might expect all of the following except:

A.A. That intestinal iron uptake would increaseThat intestinal iron uptake would increase

B.B. The patient might have a low MCVThe patient might have a low MCV

C.C. That serum ferritin would be increasedThat serum ferritin would be increased

D.D. That transferrin receptors would increaseThat transferrin receptors would increase

E.E. That in response to the anemia that iron transporters in the That in response to the anemia that iron transporters in the intestine might have increased expressionintestine might have increased expression

C.C. That serum ferritin would be increasedThat serum ferritin would be increased

Iron absorption in the intestine would be affected by all of the Iron absorption in the intestine would be affected by all of the following following

except WHICH.except WHICH.

A.A. Absent gastric acid productionAbsent gastric acid production

B.B. The dietary form of ironThe dietary form of iron

C.C. Removing the duodenum and proximal jejunumRemoving the duodenum and proximal jejunum

D.D. Removing the terminal ileumRemoving the terminal ileum

E.E. Adding ascorbic acid to the dietAdding ascorbic acid to the diet

D. D. Removing the terminal ileumRemoving the terminal ileum

Iron absorption may be affected by all of the following EXCEPT:Iron absorption may be affected by all of the following EXCEPT:

A.A. Inherited abnormalities in the iron uptake pathwayInherited abnormalities in the iron uptake pathway

B.B. Inflammatory diseasesInflammatory diseases

C.C. Hemolytic anemiasHemolytic anemias

D.D. Digoxin levels between 0.5 and 1.0 mg/dLDigoxin levels between 0.5 and 1.0 mg/dL

E.E. Levels of hepcidinLevels of hepcidin

D.D. Digoxin levels between 0.5 and 1.0 mg/dLDigoxin levels between 0.5 and 1.0 mg/dL

A patient with a Hemoglobin = 7 gm% (normal 12-15gm%), total A patient with a Hemoglobin = 7 gm% (normal 12-15gm%), total bilirubin bilirubin

2.2 mg% (normal <1.2mg%), indirect bilirubin = 2.0 mg% (normal 2.2 mg% (normal <1.2mg%), indirect bilirubin = 2.0 mg% (normal <0.2 <0.2

mg%), reticulocyte = 10%, and a LDH =1500 units/dL (normal mg%), reticulocyte = 10%, and a LDH =1500 units/dL (normal

<600units/dL) could have all of the following except WHICH:<600units/dL) could have all of the following except WHICH:

A.A. Antibodies directed to a red blood cell surface antigenAntibodies directed to a red blood cell surface antigen

B.B. A positive coomb’s testA positive coomb’s test

C.C. Disseminated intravascular coagulopathyDisseminated intravascular coagulopathy

D.D. A bone marrow infiltrated with metastatic cancerA bone marrow infiltrated with metastatic cancer

E.E. A defect in the red blood cell cytoskeletonA defect in the red blood cell cytoskeleton

D.D. A bone marrow infiltrated with metastatic A bone marrow infiltrated with metastatic cancercancer

A patient is seen in your office for a routine physical examination. He is A patient is seen in your office for a routine physical examination. He is 59yo and is 59yo and is

in excellent health. His entire physical examination is normal for his age. in excellent health. His entire physical examination is normal for his age. Routine CBC Routine CBC

shows the following:shows the following:

Hgb = 14.5 gm%Hgb = 14.5 gm%

Hematocrit = 47% (normal 40 to 52%)Hematocrit = 47% (normal 40 to 52%)

Platelets = 25,000 (normal 150 to 450,000)Platelets = 25,000 (normal 150 to 450,000)

WBC = 45,000 (normal 5 to 12,000)WBC = 45,000 (normal 5 to 12,000)

The peripheral blood smear is shown here.The peripheral blood smear is shown here.

Which of the following is correct?Which of the following is correct?

A.A. He has acute Myeloid Leukemia and needs aggressive chemotherapyHe has acute Myeloid Leukemia and needs aggressive chemotherapy

B.B. He needs a bone marrow transplant.He needs a bone marrow transplant.

C.C. He has chronic lymphocytic leukemia stage III and needs He has chronic lymphocytic leukemia stage III and needs chemotherapychemotherapy

D.D. He has chronic lymphocytic leukemia stage 0 and needs observation He has chronic lymphocytic leukemia stage 0 and needs observation only with no therapy at this time.only with no therapy at this time.

E.E. He has chronic myeloid leukemia and need Gleevac treatment.He has chronic myeloid leukemia and need Gleevac treatment.

D.D. He has chronic lymphocytic leukemia stage 0 and needs He has chronic lymphocytic leukemia stage 0 and needs observation only with no therapy at this time.observation only with no therapy at this time.

A patient presented to the ER with bleeding gums and also has petechiae A patient presented to the ER with bleeding gums and also has petechiae and and

purpura. CBC shows the following:purpura. CBC shows the following:

Hgb = 9 gm% (normal 13.5-15.5)Hgb = 9 gm% (normal 13.5-15.5)

Hematocrit = 27% (normal 40-52%)Hematocrit = 27% (normal 40-52%)

Platelets = 25,000 (normal 150-450,000)Platelets = 25,000 (normal 150-450,000)

WBC = 45,000 (normal 5 to 12,000)WBC = 45,000 (normal 5 to 12,000)

The smear show is in figure here.The smear show is in figure here.

Which of the following is correct?Which of the following is correct?

A.A. He has acute Myeloid Leukemia with Auer Rods, and needs He has acute Myeloid Leukemia with Auer Rods, and needs aggressive chemotherapy.aggressive chemotherapy.

B.B. He has Chronic lymphocytic leukemia stage III and needs He has Chronic lymphocytic leukemia stage III and needs chemotherapychemotherapy

C.C. He has chronic lymphocytic leukemia stage 0 and needs observation He has chronic lymphocytic leukemia stage 0 and needs observation only with no therapy at this time.only with no therapy at this time.

D.D. He has chronic myeloid leukemia and needs gleevec treatmentHe has chronic myeloid leukemia and needs gleevec treatment

E.E. The blood cells are normal.The blood cells are normal.

A.A. He has Acute Myeloid Leukemia with Auer Rods, and needs He has Acute Myeloid Leukemia with Auer Rods, and needs aggressive chemotherapy.aggressive chemotherapy.

You are asked to see a 25yo woman with a history of easy bruising You are asked to see a 25yo woman with a history of easy bruising and and

heavy menstrual bleeding. She has never been ill, takes no heavy menstrual bleeding. She has never been ill, takes no medicines medicines

(even over the counter meds) and had a tonsillectomy as a child-(even over the counter meds) and had a tonsillectomy as a child-she she

““almost had to have a transfusion” secondary to bleeding. Family almost had to have a transfusion” secondary to bleeding. Family history is history is

positive on her mother’s side of the family for several aunts/uncles positive on her mother’s side of the family for several aunts/uncles who are who are

““free bleeders” as well as some cousins. You order the following free bleeders” as well as some cousins. You order the following tests:tests:

PT= 12 (normal 11 to 13)PT= 12 (normal 11 to 13)

aPTT = 45 (normal 27 to 35)aPTT = 45 (normal 27 to 35)

Bleeding Time = 10 minutes (normal 3 to 5 minutes)Bleeding Time = 10 minutes (normal 3 to 5 minutes)

CBC is normalCBC is normal

Your diagnosis is?Your diagnosis is?

A.A. HemophiliaHemophilia

B.B. No significant problemNo significant problem

C.C. Von Willebrands diseaseVon Willebrands disease

D.D. Factor VII deficiencyFactor VII deficiency

E.E. Factor II deficiencyFactor II deficiency

C.C. Von Willebrands diseaseVon Willebrands disease

A patient is seen by you in the ER. She is a 75yo woman from the A patient is seen by you in the ER. She is a 75yo woman from the nursing nursing

home. She is confined to bed and has Alzheimer’s dementia. She home. She is confined to bed and has Alzheimer’s dementia. She was was

brought in by her family as she seems less responsive and they brought in by her family as she seems less responsive and they noted a noted a

fever. Her temperature is 104 degrees. She has purpura and is fever. Her temperature is 104 degrees. She has purpura and is bleeding bleeding

from the gums. The family relates she has never had a bleeding from the gums. The family relates she has never had a bleeding problem problem

before. Her regular lab shows a urinary tract infection with gram-before. Her regular lab shows a urinary tract infection with gram-negative negative

rods seen in the urine. Her coagulation testing shows the rods seen in the urine. Her coagulation testing shows the following.following.

PT= 22 (normal 11 to 13)PT= 22 (normal 11 to 13)aPTT= 45 (normal 27 to 35)aPTT= 45 (normal 27 to 35)Platelet count is 50,000 (normal>150,000 and <400,000)Platelet count is 50,000 (normal>150,000 and <400,000)Fibrinogen 100 mg% (normal >200)Fibrinogen 100 mg% (normal >200)

Your diagnosis of the hematologic problem is?Your diagnosis of the hematologic problem is?

A.A. ITP (Immune thrombocytopenia)ITP (Immune thrombocytopenia)B.B. DIC (Disseminated Intravascular Coagulation)DIC (Disseminated Intravascular Coagulation)C.C. TTP (Thrombotic Thrombocytopenic Purpura)TTP (Thrombotic Thrombocytopenic Purpura)D.D. HemophiliaHemophiliaE.E. Von Willebrands diseaseVon Willebrands disease

B.B. DIC (Disseminated Intravascular Coagulation)DIC (Disseminated Intravascular Coagulation)

All of the following are associated with a hypercoaguable state All of the following are associated with a hypercoaguable state

(Thrombophilia) except?(Thrombophilia) except?

A.A. Factor V LeidenFactor V Leiden

B.B. ATII deficiencyATII deficiency

C.C. Protein C deficiencyProtein C deficiency


E.E. Protein S deficiencyProtein S deficiency

D. D. Factor VII deficiencyFactor VII deficiency

Which of the following would be abnormal in hemophilia?Which of the following would be abnormal in hemophilia?

A.A. Bleeding TimeBleeding Time

B.B. aPTTaPTT

C.C. PTPT

D.D. Thrombin TimeThrombin Time

E.E. 1 to 1 mix of the aPTT1 to 1 mix of the aPTT

B. aPTTB. aPTT

If a 1 to 1 mix is done on an abnormal aPTT and it does not correct, If a 1 to 1 mix is done on an abnormal aPTT and it does not correct, which which

of the following has been eliminated as a possibility?of the following has been eliminated as a possibility?

A.A. Von Willebrands DiseaseVon Willebrands Disease

B.B. Lupus AnticoagulantLupus Anticoagulant

C.C. Hemophilia with inhibitorHemophilia with inhibitor

D.D. Heparin contamination of the sampleHeparin contamination of the sample

A.A. Von Willebrands DiseaseVon Willebrands Disease

The treatment of ITP usually starts with which of the following The treatment of ITP usually starts with which of the following treatments?treatments?

A.A. SplenectomySplenectomy

B.B. PrednisonePrednisone

C.C. Immunosuppressive drugs such as cyclophosphamideImmunosuppressive drugs such as cyclophosphamide

D.D. Immunoglobulin therapy (IVIG)Immunoglobulin therapy (IVIG)

B. B. PrednisonePrednisone

Abnormal platelet function is seen is all of the following except?Abnormal platelet function is seen is all of the following except?

A.A. Von Willibrands DiseaseVon Willibrands Disease

B.B. Aspirin UseAspirin Use

C.C. Factor X DeficiencyFactor X Deficiency


E.E. Heparin contaminationHeparin contamination

If a patient has a both an abnormal PT and an abnormal PTT then If a patient has a both an abnormal PT and an abnormal PTT then which of which of

the following is not possible?the following is not possible?

A.A. Factor X deficiencyFactor X deficiency

B.B. Abnormal fibrinogenAbnormal fibrinogen

C.C. Factor V deficiencyFactor V deficiency

D.D. Factor XI deficiencyFactor XI deficiency

E.E. Vitamin K deficiencyVitamin K deficiency

D.D. Factor XI deficiencyFactor XI deficiency

A patient with liver disease might be expected to have low values A patient with liver disease might be expected to have low values of all the of all the

following clotting factors except?following clotting factors except?

a.a. II II

b.b. VIIVII

c.c. Protein CProtein C

d.d. VIII-VWFVIII-VWF

e.e. FibrinogenFibrinogen

D.D. VIII-VWFVIII-VWF

Blood and Lymph Test I. Of the following white cells which of the following are the most numerous in...

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