424: Final Exam Book ?'s
What is the prevalence of venous thrombosis in the United States? a. 0.01 b. 1/1000 c. 10%-15% d. 500,000 cases per year
1/1000
For an erythroid precursor to be considered a ring sideroblast, the iron laden mitochondria must encircle how much of the nucleus? a. 1/4 b. 1/3 c. 2/3 d. Entire nucleus
1/3
Heterozygous HPFH is characterized by: a. 10% to 35% hemoglobin F with normal RBC morphology b. 100% hemoglobin F with slightly hypochromic, microcytic cells c. A decreased amount of hemoglobin F with normal RBC morphology d. 5% to 15% hemoglobin F with hypochromic, macrocytic cells
10% to 35% hemoglobin F with normal RBC morphology
According to the WHO classification of MDS, what % of blasts would constitute transformation to an acute leukemia? a. 5% b. 10% c. 20% d. 30%
20%
According to the WHO classification, except in leukemias with specific genetic anomalies, the minimal percentage of blasts necessary for a diagnosis of acute leukemia is: a. 10% b. 20% c. 30% d. 50%
20%
Through routine screening, prospective parents discover that they are both heterozygous for hemoglobin S. What percentage of their children potentially could have sickle cell anemia (Hgb SS)? a. 0% b. 25% c. 50% d. 100%
25%
Which of the following individuals is at greatest risk for developing iron deficiency anemia? a. A 15 year old boy who eats mainly fast food and junk food b. A 37 year old women who has never been pregnant and has amenorrhea c. A 63 year old man with reactivation of tuberculosis from his childhood d. A 40 year old man who lost blood during surgery to repair a fractured leg
A 15 year old boy who eats mainly fast food and junk food
Which of the following individuals is at the greatest risk for developing anemia of chronic inflammation? a. A 15 year old girl with asthma b. A 40 year old women with type 2 diabetes mellitus c. A 65 year old man with hypertension d. A 30 year old man with severe rheumatoid arthritis
A 30 year old man with severe rheumatoid arthritis
Which of the following patients would be considered anemic with a hemoglobin value of 14.5 g/dL. a. An adult man b. An adult women c. A newborn baby d. A 10 year old girl
A newborn baby
What is the most common acquired bleeding disorder? a. Vitamin K deficiency b. Liver disease c. ACOTS: Acute Coagulopathy of Trauma-Shock d. WVD: van Willebrand Disease
ACOTS
Signs and symptoms of cerebral infiltration with blasts are more commonly seen in: a. AML with recurrent cytogenetic abnormalities b. Therapy-related myeloid neoplasms c. AML with myelodysplasia-related changes d. ALL
ALL
Into what other hematologic disease does MDS often convert? a. Megaloblastic anemia b. Aplastic anemia c. AML d. Myeloproliferative disease
AML
A 20 year old patient has an elevated WBC count with 70% blasts, 4% neutrophils, 5% lymphocytes, and 21% monocytes in the peripheral blood. Eosinophils with dysplastic changes are seen in the bone marrow. AML with which of the following karyotypes would be most likely to be seen? a. AML with t(8;21)(q22;q22) b. AML with t(16;16)(p12;q22) c. AML with t(15;17)(q22;q12) d. AML with t(9;11)(p22;q23)
AML with t(16;16)(p12;q22)
Which of the following leukemias affects primarily children, is characterized by an increase in monoblasts and monocytes, and often is associated with gingival and skin involvement? a. Pre-B lymphoblastic leukemia b. Pure erythroid leukemia c. AML with t(9;11)(p22;q23) d. AML with t(15;17)(q22;q12)
AML with t(9;11)(p22;q23)
What is the most common heritable thrombosis risk factor in Caucasians? a. APC resistance (factor V Leiden mutation) b. Prothrombin G20210A mutation c. Antithrombin deficiency d. Protein S deficiency
APC resistance
Acanthocytes are found in associated with: a. Abetalipoproteinemia b. G6PD deficiency c. Rh deficiency syndrome d. Vitamin B12 deficiency
Abetalipoproteinemia
The thalassemia's are caused by: a. Structurally abnormal hemoglobins b. Absent or defective synthesis of a polypeptide chain in hemoglobin c. Excessive absorption of iron d. Abnormal or defective protoporphyrin synthesis
Absent or defective synthesis of a polypeptide chain in hemoglobin
A 5 year old girl was seen by her physician several days prior to this visit and was diagnosed with pneumonia. Her mother has brought her to the physician again because the girl's urine began to darken after the first visit and now is alarmingly dark. The girl has no history of anemia, and there is no family history of any hematologic disorder. The CBC shows a mind anemia, polychromasia, and a few shistocytes. This anemia could be categorized as: a. Acquired, fragmentation b. Acquired, macrophage-mediated c. Hereditary, fragmentation d. Hereditary, macrophage-mediated
Acquired, fragmentation
What therapeutic agent may occasionally cause DIC? a. Factor VIII b. Factor VIIa c. Antithrombin concentrate d. Activated prothrombin complex concentrate
Activated prothrombin complex concentrate
The most common manifestation of G6PD deficiency is: a. Chronic hemolytic anemia caused by cell shape change b. Acute hemolytic anemia caused by drug exposure or infection c. Mild compensated hemolysis caused by ATP deficiency d. Chronic hemolytic anemia caused by intravascular RBC lysis
Acute hemolytic anemia caused by drug exposure or infection
A patient with normal chromosomes has a WBC count of 3.0x10^9/L and dysplasia in all cell lines. There are 60% blasts of varying sizes. The blasts stain positive for CD61. The most likely type of leukemia is: a. Acute lymphoblastic b. Acute megakaryoblastic c. Acute monoblastic d. AML with t(15;17)
Acute megakaryoblastic
A 20 year old patient presents with fatigue, pallor, easy bruising, and swollen gums. Bone marrow examination reveals 82% cells with delicate chromatin and prominent nucleoli that are CD14+, CD4+, CD11b+, and CD36+. Which of the following acute leukemias is likely? a. Minimally differentiated leukemia b. Leukemia of ambiguous lineage c. Acute monoblastic/monocytic leukemia d. Acute megakaryoblastic leukemia
Acute monoblastic/monocytic leukemia
Trousseau syndrome, a low grade chronic DIC, is often associated with what type of disorder? a. Renal disease b. Hepatic disease c. Adenocarcinoma d. Chronic inflammation
Adenocarcinoma
Which of the following inherited leukocyte disorders might be seen in Hurler syndrome? a. Pelger-Huet anomaly b. Chediak-Higashi disease c. Alder-Reilly anomaly d. May-Hegglin anomaly
Alder-Reilly anomaly
The neutrophils in chronic granulomatous disease are incapable of producing: a. Hydrogen peroxide b. Hypochlorite c. Superoxide d. All of the above
All of the above
Which of the following are important to consider in the patient's history when investigating the cause of anemia? a. Diet and medications b. Occupation, hobbies, and travel c. Bleeding episodes in the patient or in his or her family members d. All of the above
All of the above
Immune hemolytic anemia is due to a(n): a. Structural defect in the RBC membrane b. Allo- or autoantibody against a RBC antigen c. T cell immune response against a RBC antigen d. Obstruction of blood flow by intravascular thrombi
Allo- or autoantibody against a RBC antigen
The altered shape of the spherocyte in hereditary spherocytosis is due to: a. An abnormal RBC membrane protein affecting vertical protein interactions b. Defective RNA synthesis c. An extrinsic factor in the plasma d. Abnormality in the globin composition of the hemoglobin molecule
An abnormal RBC membrane protein affecting vertical protein interactions
The immunophenotype of mycosis fungoides is: a. The normal T cell immunophenotype b. An abnormal T cells immunophenotype with expression of CD4 and loss of CD7 antigen c. A mix of CD4+ and CD8+ T cells d. An abnormal T cell immunphenotype with expression of CD8 and loss of CD7 antigen
An abnormal T cell immunophenotype with expression of CD4 and loss of CD7 antigen
A bone marrow biopsy was performed as part of the cancer staging protocol for a patient with Hodgkin lymphoma. Although no evidence of spread of the tumor was apparent in the marrow, other abnormal finding were noted, including a slightly evaluated myeloid-to-erythroid ratio. WBC and RBC morphology appeared normal. The Prussian blue stain showed abundant stainable iron in the marrow macrophages. The patient's CBC revealed a hemoglobin of 10.8 g/dL but RBC indices were within reference intervals. RBC morphology was unremarkable. These findings would be consistent with: a. Anemia of chronic inflammation b. Sideroblastic anemia c. Thalassemia d. Iron deficiency anemia
Anemia of chronic inflammation
In what situation will increased levels of free erythrocyte protoporphyrin be present? a. Gain of function mutation to one of the enzymes in the heme synthesis pathway b. A mutation that prevents heme attachment to globin so that protoporphyrin remains free c. Any condition that prevents iron incorporation into protoporphyrin IX d. When red blood cells lyse, freeing their contents into the plasma
Any condition that prevents iron incorporation into protoporphyrin IX
The screening test for hemoglobin S that uses a reducing agent, such as sodium dithionite, is based on the fact that hemoglobins that sickle: a. Are insoluble in reduced, deoxygenated form b. Form methemoglobin more readily and cause a color change c. Are unstable and precipitate as Heinz bodies d. Oxidize quickly and cause turbidity
Are insoluble in reduced, deoxygenated form
Chronic secondary cold agglutinin disease is most often associated with: a. Antibiotic therapy b. M. pneumoniae infection c. B cell malignancies d. Infectious mononucleosis
B cel malignancies
One week after returning from vacation in Rhode Island, a 60 year old man experienced fever, chills, nausea, muscles aches, and fatigue of 2 days' duration. A complete blood count showed a WBC count of 4.5x10^9/L, hemoglobin level of 10.5 g/dL, a platelet count of 134x10^9/L, and a reticulocyte count of 2.7%. The medical laboratory scientist noticed tiny ameboid ring forms in some of the RBCs and some tetrad forms in others. These findings suggest: a. Bartonellosis b. Malaria c. Babesiosis d. Clostridial sepsis
Babesiosis
Which morphologic diagnosis has to be confirmed with molecular studies demonstrating the presence of t(8;14)? a. Mantle cell lymphoma b. Burkitt lymphoma c. Follicular lymphoma d. Sezary syndrome
Burkitt lymphoma
What are the initial laboratory test that are performed for the diagnosis of anemia? a. CBC, iron studies, and reticulocyte count b. CBC, reticulocyte count, and peripheral blood film examination c. Reticulocyte count and serum iron, vitamin B12, and folate assays d. Bone marrow study, iron studies, and peripheral blood firm examination
CBC, reticulocyte count, and peripheral blood film examination
A peripheral blood film that shows increased neutrophils, basophils, eosinophils, and platelets is highly suggestive of: a. AML b. CML c. MDS d. Multiple myeloma
CML
In men and postmenopausal women whose diets are adequate, iron deficiency anemia most often results from: a. Increased need associated with aging b. Impaired absorption in the gastric mucosa c. Chronic gastrointestinal bleeding d. Diminished resistance to hookworm infections
Chronic gastrointestinal bleeding
Which of the following is not a mechanism causing anemia in P. falciparum infections? a. Inhibition of erythropoiesis b. Lysis of infected RBCs during schizogony c. Competition for vitamin B12 in the erythrocyte d. Immune destruction of non-infected RBCs in the spleen
Competition for vitamin B12 in the erythrocyte
The pathophysiology of immune hemolysis with IgM antibodies always involves: a. Complement b. Autoantibodies c. Abnormal hemoglobin molecules d. Alloantibodies
Complement
Which anemia should be suspected in a patient with refractory anemia, reticulocytopenia, hemosiderosis, and binucleated erythrocyte precursors in the bone marrow? a. Fanconic anemia b. Dyskeratosis congenita c. Acquired aplastic anemia d. Congenital dyserythropoeitic anemia
Congenital dyserythropoietic anemia
Which is not a fibrinolysis control protein? a. Thrombin-activatable fibrinolysis inhibitor b. Plasminogen activator inhibitor-1 c. alpha2-antiplasmin d. D-dimer
D-dimer
Folate and vitamin B12 work together in the production of: a. amino acids b. RNA c. Phospholipids d. DNA
DNA
In most LA profiles, what screening test is primary because it detects LA with the fewest interferences? a. Low-phospholipid PTT b. DRVVT c. KCT d. PT
DRVVT
A qualitative abnormality in hemoglobin may involve all of the following except: a. Replacement of one or more amino acids in a globin chain b. Addition of one or more amino acid in a globin chain c. Deletion of one or more amino acids in a globin chain d. Decreased production of a globin chain
Decreased production of a globin chain
Which of the following laboratory results may be seen in both traumatic cardiac hemolytic anemia and exercise induced hemoglobinuria? a. Schistocytes on the peripheral blood film b. Thrombocytopenia c. Decreased serum haptoglobin d. Hemosiderinuria
Decreased serum haptoglobin
The RBCs in hereditary elliptocytosis are abnormally shaped and have unstable cell membranes as a result of: a. Abnormal shear stresses in the circulation b. Defects in horizontal membrane protein interactions c. Mutations in ankyrin d. Lack of all Rh antigens in the RBC membrane
Defects in horizontal membrane protein interactions
Mucocutaneous hemorrhage is typical of: a. Acquired hemorrhagic disorders b. Localized hemorrhagic disorders c. Defects in primary hemostasis d. Defects in fibrinolysis
Defects in primary hemostasis
The most important finding in the diagnostic investigation of a suspected autoimmune hemolytic anemia is: a. Detection of a low hemoglobin and hematocrit b. Observation of hemoglobinemia in a specimen c. Recognition of a low reticulocyte count d. Demonstration of IgG and/or C3d on the RBC surface
Demonstration of IgG and/or C3d on the RBC surface
Marked paracortical expansion is most commonly seen in: a. Rheumatoid arthritis b. Syphilis c. Dermatopathic lymphadenopathy d. Follicular lymphoma
Dermatopathic lymphadenopathy
The pathophysiologic mechanism is acquired idiosyncratic aplastic anemia is: a. Replacement of bone marrow by abnormal cells b. Destruction of stem cells by autoimmune T cells c. Defective production of hematopoietic growth factors d. Inability of bone marrow stroma to support stem cells
Destruction of stem cells by autoimmune T cells
The test that is most useful in differentiating FA, Fanconi anemia, from other causes of pancytopenia is: a. Bone marrow biopsy b. Ham acidified serum test c. Diepoxybutane-induced chromosome breakage d. Flow cytometric analysis of CD55 and CD59 cells
Diepoxybutane-induced chromosome breakage
What leukocyte cytoplasmic inclusion is composed of ribosomal RNA? a. Primary granules b. Toxic granules c. Dohle bodies d. Howell-Jolly bodies
Dohle bodies
What is a major indication of MDS in the peripheral blood and bone marrow? a. Dyspoiesis b. Leukocytosis with left shift c. Normal bone marrow with abnormal peripheral blood features d. Thrombocytosis
Dyspoiesis
A patient has a platelet count of 700x10^9/L with abnormalities in the size, shape, and granularity of platelets; a WBC count of 12x10^9/L; and hemoglobin of 11 g/dL. The Philadelphia chromosome is not present. The most likely diagnosis is: a. PV b. ET c. CML d. Leukemoid reaction
ET, essential thrombocythemia
Which of the following laboratory finding is inconsistent with beta-thalassemia minor? a. A slightly elevated RBC count and marked microcytosis b. Target cells and basophilic stippling on the peripheral blood film c. Hemoglobin level of 10-13 g/dL d. Elevated MCHC and spherocytic RBCs
Elevated MCHC and spherocytic RBCs
A sign of hemolysis that is typically associated with both fragmentation and macrophage mediated hemolysis is: a. Hemoglobinuria b. Hemosiderinuria c. Hemoglobinemia d. Elevated urinary urobilinogen level
Elevated urinary urobilinogen level
The peripheral blood film for patients with mild hereditary elliptocytosis is characterized by: a. Elliptical RBCs b. Oval RBCs with one or two transverse ridges c. Overhydrated RBCs with oval central pallor d. Densely stained RBCs with a few irregular projections
Elliptical RBCs
The myelofibrosis associated with PMF is a result of: a. Apoptosis resistance in the fibroblasts of the bone marrow b. Impaired production of normal collagenase by the mutated cells c. Enhanced activity of fibroblasts owing to increase stimulatory cytokines d. Increased number of fibroblasts owing to cytokine stimulation of the pluripotential stem cell
Enhanced activity of fibroblasts owing to increase stimulatory cytokines
The peripheral blood in PV, polycythemia vera, typically manifests: a. Erythrocytosis only b. Erythrocytosis and thrombocytosis c. Erythrocytosis, thrombocytosis, and granulocytosis d. Anemia and thrombocytopenia
Erythrocytosis, thrombocytosis, and ganulocytosis
In the following description of a bone marrow smear, find the statement that is inconsistent with the expected picture in megaloblastic anemia. "The marrow appears hyper cellular with a myeloid-to-erythroid ratio of 1:1 due to prominent erythroid hyperplasia. Megakaryocytes appear normal in number an appearance. The WBC elements appear larger than normal, with especially large metamyelocytes, although they otherwise appear morphologically normal. The RBC precursors also appear large. There is nuclear-cytoplasmic asynchrony, with the nucleus appearing more mature than expected for the color of the cytoplasm." a. Erythroid nuclei that are more mature than cytoplasm b. Larger than normal WBC elements c. Larger than normal RBCs d. Normal appearance of megakaryocytes
Erythroid nuclei that are more mature than cytoplasm
A patient has anemia that has been worsening over the last several months. The hemoglobin level has been declining slowly, with a drop of 1.5 g/dL of hemoglobin over about 6 weeks. Polyhromasia and anisocytosis are seen on the blood film, consistent with the elevated reticulocyte count and RBC distribution width (RDW). Serum levels of total bilirubin and indirect fractions are normal. Urinary urobilinogen level also is normal. When these findings are evaluated, the conclusion is drawn that anemia does not have a hemolytic component. Based on the date given here, why was hemolysis ruled out as the cause of the anemia? a. The decline in hemoglobin is too gradual to be associated with hemolysis. b. The elevation of the reticulocyte count suggest a malignant cause. c. Evidence of increase protoporphyrin catabolism is lacking d. Elevated RDW points to an anemia of decreased production
Evidence of increase protoporphyrin catabolism is lacking
Which of the following describes a penicillin induced autoimmune hemolytic anemia? a. Extravascular hemolysis, positive DAT with IgG, gradual anemia b. Intravascular, possible renal failure, positive DA with C3d c. Rare hemolysis, positive DAT with IgG d. Intravascular hemolysis, positive DAT with IgG
Extravascular hemolysis, positive DAT with IgG, gradual anemia
A patient has a WBC count of 30x10^9/L and the following WBC differential: Segmented neutrophils = 38%, Bands = 17%, Metamyelocytes = 7%, Myelocytes = 20%, Promyelocytes = 20%, Eosinophils = 3%, Basophils = 5%. Which of the following test results would be helpful in determining whether the patient has CML? a. Nitroblue tetrazolium reduction product increased b. Myeloperoxidase increased c. Periodic acid-Schiff staining decreased d. FISH positive for BCR/ABL1 fusion
FISH positive for BCR/ABL1 fusion
What molecular test may be used to confirm APC resistance? a. Prothrombin G202010A b. MTHFR 1298 c. MTHFR 677 d. FVL
FVL
Which of the following assays is used to distinguish vitamin K deficiency from liver disease? a. PT b. Protein C assay c. Factor V assay d. Factor VII assay
Factor V assay
What factor deficiency has the speediest effect on the prothrombin time? a. Prothrombin deficiency b. Factor VII deficiency c. Factor VIII deficiency d. Factor IX deficiency
Factor VII deficiency
If a patient has anatomic soft tissue bleeding and poor wound healing, but the PT, PTT, thrombin time, platelet count, and platelet functional assay results are normal, what factor deficiency is indicated? a. Fibrinogen b. Prothrombin c. Factor XII d. Factor XIII
Factor XIII
Sideroblastic anemia results from: a. Sequestration of iron in hepatocytes b. Inability to incorporate heme into apohemoglobin c. Sequestration of iron in myeloblasts d. Failure to incorporate iron into protoporphyrin IX
Failure to incorporate iron into protoporphyrin IX
A patient experiences an episode of acute intravascular hemolysis after taking primaquine for the first time. The physician suspects that the patient may have G6PD deficiency and orders an RBC G6PD assay 2 days after the hemolytic episode begins. How will this affect the test results? a. No effect b. False increase due to reticulocytosis c. False decrease due to hemoglo binemia d. Absence of enzyme activity
False increase due to reticulocytosis
The clinical consequences of pancytopenia include: a. Pallor and thrombosis b. Kidney failure and fever c. Fatigue, infection, and bleeding d. Weakness, hemolysis, and infection
Fatigue, infection and bleeding
Which of the following laboratory tests would be best to confirm paroxysmal nocturnal hemoglobinuria? a. Acidified serum test (Ham test) b. Osmotic fragility test c. Flow cytometry for detection of eosin-5'-maleimide binding on erythrocytes d. Flow cytometry for detection of CD55, CD59, and FLAER binding on neutrophils and monocytes
Flow cytometry for detection of CD55, CD59, and FLAER binding on neutrophils and monocytes
Megaloblastic episodes in sickle cell disease can by prevented by prophylactic administration of: a. Iron b. Folic acid c. Steroids d. Erythropoietin
Folic acid
The pathophysiology of idiopathic thrombocytopenic purpura involves: a. Shiga toxin damage to endothelial cells and obstruction of small blood vessels in glomeruli b. Formation of platelet-VWF thrombi due to autoantibody inhibition of ADAMTS-13 c. Over-activation of the complement system and endothelial cell damage due to loss of regulatory function d. Activation of the coagulation and fibrinolytic systems with fibrin clots throughout the microvasculature
Formation of platelet-VWF thrombi due to autoantibody inhibition of ADAMTS-13
Hemoglobin H is composed of: a. Two alpha and two beta chains b. Two epsilon and two gamma chains c. Four beta chains d. Four gamma chains
Four beta chains
Hemoglobin Bart is composed of: a. Two alpha and two beta chains b. Two epsilon and two gamma chains c. Four beta chains d. Four gamma chains
Four gamma chains
Which of the following lysosomal storage diseases is characterized by macrophages with striated cytoplasm and storage of glucocerebroside? a. Sanfilippo syndrome b. Gauchers disease c. Fabry disease d. Niemann-Pick disease
Gauchers disease
What is the function of the germinal center? a. Generation of B cells producing immunoglobulins with the highest affinity for a particular antigen through the process of somatic mutation b. Production of plasma cells that secrete specific immunoglobulins following antigenic stimulation c. T cell maturation following T cell education in the thymus d. Generation of dendritic cells with unique antigen-processing capabilities
Generation of B cells producing immunoglobulins with the highest affinity for a particular antigen through the process of somatic mutation
In the erythropoietic porphyrias, mild anemia may be accompanied by what distinctive clinical finding? a. Gallstones b. Impaired night vision c. Unintentional nighttime leg movements d. Heightened propensity for sunburn
Heightened propensity for sunburn
Which of the following is the most definitive test for hemoglobin S? a. Hemoglobin solubility test b. Hemoglobin electrophoresis at alkaline pH c. Osmotic fragility test d. Hemoglobin electrophoresis at acid pH
Hemoglobin electrophoresis at acid pH
A 1 year old Indian patient presents with anemia, and both parents claim to have an inherited anemia but can't remember the type. The peripheral blood shows target cells, and the hemoglobin solubility is negative. Alkaline hemoglobin electrophoresis shows a single band at the Hgb C position and a small band at the Hgb F position. Acid hemoglobin electrophoresis shows two bands. The most likely diagnosis is: a. Hgb CC b. Hgb AC c. Hgb CO d. Hgb SC
Hgb CO
Which hemoglobinopathy is most common in Southeast Asian patients? a. Hgb S b. Hgb C c. Hgb O d. Hgb E
Hgb E
The predominant hemoglobin present in beta-0 thalassemia major is: a. Hgb A b. Hgb A2 c. Hgb F d. Hgb C
Hgb F
Which of the following hemoglobin S compound heterozygous exhibits the mildest symptoms? a. Hgb S-beta-thal b. Hgb SG c. Hgb S-C-Harlem d. Hgb SC
Hgb SG
Patients with sickle cell disease usually do not exhibit symptoms until 6 months of age because: a. The mother's blood has protective effect b. Hemoglobin levels are higher in infants at birth c. High levels of hemoglobin F are present d. The immune system is not fully developed
High levels of hemoglobin F are present
The expected complete blood count results for women in active labor would include: a. High total white blood cell count with increased lymphocytes b. High total WBC count with a slight shift to the left in neutrophils c. Normal WBC count with increased eosinophils d. Low WBC count with increased monocytes
High total WBC count with a slight shift to the left in neutrophils
The most common lymphoma occurring in young adults is: a. Follicular lymphoma b. DLBCL: Diffused Large B cell Lymphoma c. Hodgkin lymphoma d. Mycosis fungoides
Hodgkin lymphoma
Which of the following is the most metabolically alive form of absorbed vitamin B12? a. Transcobalamin b. Intrinsic factor-vitamin B12 complex c. Holotranscobalamin d. Haptocorrin-vitamin B12 complex
Holotranscobalamin
DNA analysis documents a patient has inherited the sickle mutation in both beta globin genes. The two terms that best describe this genotype are: a. Homozygous/trait b. Homozygous/disease c. Heterozygous/trait d. Heterozygous/disease
Homozygous/disease
Which of the following would be considered a sign of potentially favorable prognosis in children with ALL? a. Hyperdiploidy b. Presence of CD19 and 20 c. Absence of trisomy 8 d. Presence of BCR/ABL gene
Hyperdiploidy
Which of the following CBC findings is most suggestive of a megaloblastic anemia? a. MCV of 103 fL b. Hypersegmentation of neutrophils c. RDW of 16% d. Hemoglobin concentration of 9.1 g/dL
Hypersegmentation of neutrophils
Which of the following conditions causes a prolonged thrombin time? a. Antithrombin deficiency b. Prothrombin deficiency c. Hypofibrinogenemia d. Warfarin therapy
Hypofibrinogenemia
Individuals with X-linked SCID have a mutation that affects their ability to synthesis: a. Deaminase b. Oxidase c. IL-2 receptor d. Il-8 receptor
IL-2 receptor
In autoimmune hemolytic anemia, a positive DAT is evidence that an: a. IgM antibody is in the patient's serum b. IgG antibody is in the patient's serum c. IgM antibody is sensitizing the patient's red blood cells d. IgG antibody is sensitizing the patient's red blood cells
IgG antibody is sensitizing the patient's red blood cells
Which of the following is not a mechanism of drug induced hemolytic anemia? a. Drug adsorption on red blood cell membrane b. Drug-RBC membrane protein immunogenic complex c. RBC autoantibody induction d. IgM autoantibody sensitization of RBCs after exposure to the cold
IgM autoantibody sensitization of RBCs after exposure to the cold
The hemolytic anemia associated with the thalassemia's is due to: a. Imbalance of globin chain synthesis b. Microcytic, hypochromic cells c. Ineffective erythropoiesis caused by immune factors d. Structually abnormal hemoglobin
Imbalance of globin chain synthesis
The primary pathophysiologic mechanism of anemia associated with chronic kidney disease is: a. Inadequate production of erythropoietin b. Excessive hemolysis c. Hematopoietic stem cell mutation d. Toxic destruction of stem cells
Inadequate production of erythropoietin
Which of the following results are consistent with hereditary spherocytosis? a. Increased osmotic fragility, negative DAT result b. Decreased osmotic fragility, positive DAT result c. Increase osmotic fragility, positive DAT result d. Decreased osmotic fragility, negative DAT result
Increase osmotic fragility, negative DAT
In hereditary spherocytosis a characteristic abnormality in the CBC result is: a. Increased MCV b. Increased MCHC c. Decreased MCH d. Decreased platelet and WBC counts
Increased MCHC
Which of the following findings is consistent with a diagnosis of megaloblastic anemia? a. Hyposegmentation of neutrophils b. Decreased serum lactate dehydrogenase levels c. Absolute increase in reticulocytes d. Increased MCV
Increased MCV
Laboratory test results for patients with hereditary pyropoikilocytosis include all of the following except: a. RBCs that show marked thermal sensitivity at 41 C to 45C b. Marked poikilocytosis with elliptocytes, RBC fragments, and microspherocytes c. Low fluorescence when incubated with eosin-5'-maleimide d. Increased MCV and normal RDW
Increased MCV and normal RDW
The term hemolytic disorder in general refers to a disorder in which there is: a. Increased destruction of RBCs after they enter the bloodstream b. Excessive loss of RBCs from the body c. Inadequate RBC production by the bone marrow d. Increase plasma volume with unchanged red cell mass
Increased destruction of RBCs after they enter the bloodstream
Beta thalassemia minor (heterozygous) usually exhibits: a. Increased hemoglobin Constant Spring b. 50% hemoglobin F c. No hemoglobin A d. Increased hemoglobin A2
Increased hemoglobin A2
In the pathogenesis of the anemia of chronic inflammation, hepcidin levels: a. Decrease during inflammation and reduces iron absorption from enterocytes b. Increase during inflammation and reduces iron absorption from enterocytes c. Increase during inflammation and increase iron absorption from enterocytes d. Decrease during inflammation and increase iron absorption from enterocytes
Increases during inflammation and reduces iron absorption from enterocytes
Complications of ET, essential thrombocythemia, includes all of the following except: a. Thrombosis b. Hemorrhage c. Seizures d. Infection
Infection
An autoimmune reaction destroys the hematopoietic stem cells in the bone marrow of a young adult patient, and the amount of active bone marrow, including RBC precursors, is diminished. The RBC precursors that are present are normal in appearance, but there are too few to meet the demand for circulating red blood cells, and anemia develops. The reticulocyte count is low. The mechanism of the anemia would be described as: a. Effective erythropoiesis b. Ineffective erythropoiesis c. Insufficient erythropoiesis
Insufficient erythropoiesis
Which one of the following is a feature found in all microangiopathic hemolytic anemias? a. Pancytopenia b. Thrombocytosis c. Intravascular RBC fragmentation d. Prolonged prothrombin time and partial thromboplastin time
Intravascular RBC fragmentation
Which of the following conditions would be included in the differential diagnosis of an anemic adult patient with an absolute reticulocyte count of 20 x 10^9 /L and an MCV of 65 fl. a. Aplastic anemia b. Sickle cells anemia c. Iron deficiency d. Folate deficiency
Iron deficiency
A 4 month old infant of Asian heritage is seen for a well baby check. Because of pallor, the physician suspects anemia and orders a CBC. The RBC count is 4.5x10^9/L, hemoglobin concentration is 10 g/dL, and MCV is 77 fL, with microcytosis, hypochromasia, poikilocytosis, and mild polychromasia noted on the peripheral blood film. These findings should lead the physician to suspect: a. Beta-thalassemia major b. Alpha-thalassemia silent carrier state c. Iron deficiency anemia d. Homozygous alpha-thalassemia (--/--)
Iron deficiency anemia
Which of the following statements is true about delayed hemolytic transfusion reactions? a. It is usually due to an ABO incompatibility b. Hemoglobinemia and hemoglobinuria frequently occur c. It is due to an anamnestic response after repeat exposure to a blood group antigen d. The DAT yields a positive result for C3d only
It is due to an anamnestic response after repeat exposure to a blood group antigen
How does lipoprotein A cause thrombosis? a. It causes elevated factor VIII levels b. It coats the endothelial lining of arteries c. It substitutes for plasminogen or TPA in the forming clot d. It contributes additional phospholipid in vivo for formation of the Xase complex.
It substitutes for plasminogen or TPA in the forming clot
The most common mutation found in patients with primary PV, polycythemia vera, is: a. BCR/ABL b. Philadelphia chromosome c. JAK2 V617F d. t(15;17)
JAK2 V617F
SBB stains which of the following component of cells? a. Glycogen b. Lipids c. Structural proteins d. Enzymes
Lipids
Which of the following findings would be inconsistent with elevated titers of intrinsic factor blocking antibodies? a. Hypersegmentation of neutrophils b. Low levels of methylmalonic acid c. Macrocytic RBCs d. Low levels of vitamin B12
Low levels of methylmalonic acid
What acquired thrombosis risk factor is assessed in the hemostasis laboratory? a. Smoking b. Immobilization c. Body mass index d. Lupus anticoagulant
Lupus anticoagulant
Chronic myelomonocytic leukemia is classified in the WHO system as: a. A myeloproliferative neoplasm b. Myelodysplastic syndrome, unclassified c. MDS/MPN d. Acute leukemia
MDS/MPN
The most consistent peripheral blood findings in sever aplastic anemia are: a. Hairy cells, monocytopenia, and neutropenia b. Macrocytosis, thrombocytopenia, and neutropenia c. Blasts, immature granulocytes, and thrombocytopenia d. Polychromasia, nucleated RBCs, and hypersegmented neutrophils
Macrocytosis, thrombocytopenia, and neutropenia
RBC destruction that occurs when macrophages ingest and destroy RBCs is termed: a. Extracellular b. Macrophage mediated c. Intra-organ d. Extrahematopoietic
Macrophage mediated
Select the statement that is true about bilirubin metabolism. a. Indirect bilirubin is formed in the liver by the addition of two sugar molecules to direct bilirubin. b. Macrophages of the spleen liberate bilirubin during hemoglobin catabolism. c. Urobilinogen is not water soluble and is not excreted in the urine. d. Normally, the major fraction of bilirubin in the blood is direct (conjugated) form released from macrophages.
Macrophages of the spleen liberate bilirubin during hemoglobin catabolism
The t(11;14) is the defining feature of: a. Follicular lymphoma b. Hodgkin lymphoma c. CLL d. Mantle cell lymphoma
Mantle cell lymphoma
Which of the following inherited leukocyte disorder is one of a group of disorders with mutations in nonmuscle myosin heavy chain IIA? a. Pelger-Huet anomaly b. Chediak-Higashi disease c. Alder-Reilly anomaly d. May-Hegglin anomaly
May-Hegglin anomaly
Which one of the following statements characterizes the relationship among macrocytic anemia, megaloblastic anemia, and pernicious anemia? a. Macrocytic anemias are megaloblastic b. Macrocytic anemia is pernicious anemia c. Megaloblastic anemia is macrocytic d. Megaloblastic anemia is pernicious anemia
Megaloblastic anemia is macrocytic
RBC morphologic features in beta-thalassemia would most likely include: a. Microcytes, hypochromia, target cells, elliptocytes, stippled cells b. Macrocytes, acanthocytes, target cells, stippled cells c. Microcytes, sickle cells d. Macrocytes, hypochromia, target cells, stippled cells
Microcytes, hypochromia, target cells, elliptocytes, stippled cells
The cytochemical stain alpha-naphthyl butyrate is a nonspecific esterase stain that shows diffuse positivity in cells of which lineage? a. Erythroid b. Monocytic c. Granulocytic d. Lymphoid
Monocytic
Which of the following is least likely to contribute to the death of patients with MDS? a. Neutropenia b. Thrombocytopenia c. Organ failure d. Neuropathy
Neuropathy
When one alpha gene is deleted (a-/aa), a patient has: a. Normal hemoglobin levels b. Mild anemia (9-11 g/dL) c. Moderate anemia (7-9 gm/dL) d. Marked anemia requiring regular transfusions
Normal hemoglobin levels
MSDs (Myelodysplastic Syndromes) are most common in which age group? a. 2-10 years b. 15-20 c. 25-40 d. Older than 50 years
Older than 50 years
Diamond-Blackfan anemia differs from inherited aplastic in that in the former: a. Reticulocyte count is increased b. Fetal hemoglobin is decreased c. Only erythropoiesis is affected d. Congential malformation are absent
Only erythropoiesis is affected
Unstable hemoglobins show all the of the following findings except: a. Globin chains precipitate intracellularly b. Heinz body formation c. Elevated reticulocyte count d. Only homozygotes are symptomatic
Only homozygotes are symptomatic
Which one of the following is reduced as an adaptation to long-standing anemia? a. Heart rate b. Respiratory rate c. Oxygen affinity of hemoglobin d. Volume of blood ejected from the heart with each contraction
Oxygen affinity of hemoglobin
Which Plasmodium species is widespread in Malaysia, has RBCs with multiple ring forms, has band shaped early trophozoites, shows a 24 hour erythrocytic cycle, and can cause severe disease and high parasitemia? a. P. falciparum b. P. vivax c. P. knowlesi d. P. malariae
P. knowlesi
Which of the following species of Plasmodium produce hypnozoites that can remain dormant in the liver and cause a relapse months or years later? a. P. falciparum b. P. vivax c. P. knowlesi d. P. malariae
P. vivax
An elevated level of what fibrinolytic system assay is associated with arterial thrombotic risk? a. PAI-1 b. TPA c. Factor VIIa d. Factor XII
PAI-1
What test may be used to confirm the presence of LA? a. PT b. Bethesda titer c. Antinuclear antibody d. PTT using high-phospholipid reagent
PTT using high-phospolipid reagent
Which of the following inherited leukocyte disorders is caused by a mutation in the lamin B receptor? a. Pelger-Huet anomaly b. Chediak-Higashi disease c. Alder-Reilly anomaly d. May-Hegglin anomaly
Pelger-Huet anomaly
In most cases, the diagnosis of lymphoma relies on all of the following except: a. Microscopic examination of affected lymph nodes b. Immunophenotyping using immunohistochemistry or flow cytometry c. Molecular or cytogenetic analysis d. Peripheral blood examination and a complete blood count
Peripheral blood examination and a complete blood count
Which of the following groups has the highest risk for pernicious anemia? a. Malnourished infants b. Children during growth periods c. Persons older than 60 years of age d. Pregnant women
Persons older than 60 years of age
In a normal lymph node, the medulla includes predominantly: a. T cells b. B cells c. Tingible-body macrophages d. Plasma cells
Plasma cells
Which of the following is detectable only be examination of peripheral blood film? a. Microcytosis b. Anisocytosis c. Hypochromia d. Poikilocytosis
Poikilocytosis
The substitution of valine for glutamic acid at position 6 of the beta chain of hemoglobin results in hemoglobin that: a. Is unstable and precipitates as Heinz bodies b. Polymerizes to form tactoid crystals c. Crystallizes into a hexagonal shape d. Contains iron in the ferric (Fe3+) state
Polymerizes to form tactoid crystals
What is thrombophilia? a. Predisposition to thrombosis secondary to a congenital or acquired disorder b. Inappropriate triggering of the plasma coagulation system c. A condition in which clots form uncontrollably d. Inadequate fibrinolysis
Predisposition to thrombosis secondary to a congenital or acquired disorder
Mutation in genes that code for the telomerase complex may induce bone marrow failure by causing which of the following? a. Resistance of stem cells to normal apoptosis b. Autoimmune reaction against telomeres in stem cells c. Decreased production of hematopoietic growth factors d. Premature death of hematopoietic stem cells
Premature death of hematopoietic stem cells
Pure erythroid leukemia is a disorder involving: a. Pronormoblasts only b. Pronormoblasts and basophilic normoblasts c. All forms of developing RBC precursors d. Equal number of pronormoblasts and myeloblasts
Pronormoblasts and basophilic normoblasts
Which of the following tests yields results that are abnormal in DIC but are usually within the reference interval or just slightly abnormal in thrombocytopenic purpura and hemolytic uremic syndrome? a. Indirect serum bilirubin and serum haptoglobin b. Prothrombin time and partial thromboplastin time c. Lactate dehydrogenase and aspartate aminotransferase d. Serum creatinine and serum total protein
Prothrombin time and partial thromboplastin time
The most common defect or deficiency in the anaerobic glycolytic pathway that causes chronic hereditary nonspherocytic hemolytic anemia is: a. Pyruvate kinase deficiency b. Lactate dehydrogenase deficiency c. Glucose-6-phosphate dehydrogenase deficiency d. Methemoglobin reductase deficiency
Pyruvate kinase deficiency
A 63 year old man is being evaluated because of a decrease in hemoglobin of 5 gm/dL after a second cycle of fludarabine for treatment of chronic lymphocytic leukemia. The patient's DAT result is strongly positive for IgG only, and antibody testing on his serum and an eluate of his RBCs yield positive results with all panel cells and the patient's own cells. This suggests which mechanism of immune hemolysis for this patient? a. Drug-RBC membrane protein complex b. Drug adsorption c. RBC autoantibody induction d. Drug-induced non-immunologic protein adsorption
RBC autoantibody induction
The macrocytosis associated with megaloblastic anemia results from: a. Reduced number of cell divisions with normal cytoplasmic development b. Activation of a gene that is typically active only in megakaryocytes c. Reduced concentration of hemoglobin in the cells so that larger cells are needed to provide the same oxygen carrying capacity d. Increased production of reticulocytes in an attempt to compensate for the anemia
Reduced number of cell divisions with normal cytoplasmic development
An increase in which one of the following suggests a short-ended life span of RBCs and hemolytic anemia? a. Hemoglobin b. Hematocrit c. Reticulocyte count d. Red cell distribution width
Reticulocyte count
Which of the following tests provides a good indication of accelerated erythropoiesis? a. Urine urobilinogen level b. Hemosiderin level c. Reticulocyte count d. Glycated hemoglobin level
Reticulocyte count
What is the most important application of the quantitative D-dimer test? a. Diagnose primary fibrinolysis b. Diagnose liver and renal disease c. Rule out deep venous thrombosis d. Diagnose acute myocardial infarction
Rule out deep venous thrombosis
What RBC morphology is characteristically found within the first 24 hours following extensive burn injury? a. Macrocytosis and polychromatic b. Burr cells and crenated cells c. Howell-Jolly bodies and bite cells d. Schistocytes and microspherocytes
Schistocytes and microspherocytes
Typical laboratory findings in thrombocytopenia purpura and hemolytic uremic syndrome include: a. schistocytosis and thrombocytopenia b. anemia and reticulocytopenia c. Reduced levels of lactate dehydrogenase and aspartate aminotransferase d. Increased levels of free plasma hemoglobin and serum haptoglobin
Schistocytosis and thrombocytopenia
Thalassemia is more prevalent in individuals from areas along the tropics because it confers: a. Heat resistance to those heterozygous for a thalassemia gene b. Selective advantage against tuberculosis c. Selective advantage against malaria d. Resistance to mosquito bites
Selective advantage against malaria
Which of the following sets of test results is typically expected with chronic fragmentation hemolysis? a. Serum haptoglobin = Increased; Urine hemoglobin = positive; Urine sediment Prussian blue stain = Positive b. Serum haptoglobin = Decreased; Urine hemoglobin = Negative; Urine sediment Prussian blue stain = Negative c. Serum haptoglobin = Decreased; Urine hemoglobin = Positive; Urine sediment Prussian blue stain = Positive d. Serum haptoglobin = Increased; Urine hemoglobin = Positive; Urine sediment Prussian blue stain = Negative
Serum haptoglobin = Decreased; Urine hemoglobin = Positive; Urine sediment Prussian blue stain = Positive
Predict the iron study results for a patient with Hodgkin lymphoma and anemia of chronic inflammation. a. Serum iron level = Decreased; TIBC = Increased; % transferring saturation = Decreased; Serum ferritin level = Decreased b. Serum iron level = Increased; TIBC = Normal; % transferring saturation = Increased; Serum ferritin level = Normal c. Serum iron level = Increase; TIBC = Increase; % transferring saturation = Normal; Serum ferritin level = Increase d. Serum iron level = Decreased; TIBC = Decreased; % transferring saturation = Normal; Serum ferritin level = Normal
Serum iron level = Decreased; TIBC = Decreased; % transferring saturation = Normal Serum ferritin level = Normal
A 35 year old white women went to her physician complaining of headaches, dizziness, and nausea. The headaches had been increasing in severity over the past 6 months. This was coincident with her move into an older house build about 1900. She had been renovating the house, including stripping paint from the woodwork. Her CBC results showed a mild hypochromic, microcytic anemia with polychromasia and basophilic stippling noted. Which of the following test would be most useful in confirming the cause of her anemia? a. Serum lead level b. Serum iron levels and TIBC c. Absolute reticulocyte count d. Prussian blue staining of the bone marrow to detect iron stores in macrophages
Serum lead level
Schistocytes, ovalocytes, and acanthocytes are examples of abnormal changes in RBC: a. Volume b. Shape c. Inclusions d. Hemoglobin concentration
Shape
Common clinical symptoms of anemia include: a. Splenomegaly b. Shortness of breath and fatigue c. Chills and fever d. Jaundice and enlarged lymph nodes
Shortness of breath and fatigue
The condition hemoglobin S-beta0-thalassemia has a clinical cause that resembles: a. Sickle cell trait b. Sickle cell anemia c. Beta-thalassemia minor d. Beta-thalassemia major
Sickle cell anemia
Hemoglobin H inclusions in a supra vital stain preparation appear as: a. A few large, blue, round bodies in the RBCs with aggregated reticulum b. Uniformly stained blue cytoplasm in the RBC c. Small, evenly distributed, greenish-blue granules that pit the surface of the RBCs d. Uniform round bodies that adhere to the RBC membrane
Small, evenly distributed, greenish-blue granules that pit the surface of the RBCs
Which is a typical form of anatomic bleeding? a. Epistaxis b. Menorrhagia c. Hematemesis d. Soft tissue bleed
Soft tissue bleed
In which part of the world is the alpha gene mutation causing hemoglobin Bart hydrops fetalis (--/--) most common? a. Northern Africa b. Mediterranean c. Middle East d. Southeast Asia
Southeast Asia
In hemolysis mediated by IgG antibodies, which abnormal RBC morphology is typically observed on the peripheral blood film? a. Spherocytes b. Nucleated RBCs c. RBC agglutination d. Macrocytes
Spherocytes
A patient has a personal and family history of a mild hemolytic anemia. The patient has consistently elevated levels of total and indirect serum bilirubin and urinary urobilinogen. The serum haptoglobin level is consistently decreased, whereas the reticulocyte count is elevated. The latter can be seen as polychromasia on the patient's blood firm, along with spherocytes. Which of the findings reported for this patient is inconsistent with the clinical diagnosis of fragmentation hemolysis? a. Elevated total and indirect serum bilirubin b. Elevated urinary urobilinogen c. Decreased haptoglobin d. Spherocytes on the peripheral film
Spherocytes on the peripheral film
The treatment that has shown the best success rate in young patients with severe aplastic anemia is: a. Immunosuppressive therapy b. Long-term red blood cell and platelet transfusions c. Administration of hematopoietic growth factors and androgens d. Stem cell transplant with an HLA identical sibling
Stem cell transplant with an HLA identical sibling
In which of the following geographic areas is hemoglobin S most prevalent? a. India b. South Africa c. United States d. Sub-Saharan Africa
Sub-Saharan Africa
A patient presents with mild normochromic, normocytic anemia. On the peripheral blood film, there are a few target cells, rare nucleated RBCs, and hexagonal crystals within and lying outside of the RBCs. Which abnormality in the hemoglobin molecule is most likely? a. Decreased production of beta chains b. Substitution of lysine for glutamic acid at position 6 of the beta chain c. Substitution of tyrosine for the proximal histidine in the beta chain d. Double amino acid substitution in the beta chain
Substitution of lysine for glutamic acid at position 6 of the beta chain
In what subtype of VWM is the RIPA test result positive when ristocetin is used at a concentration of less than 0.5 mg/mL? a. Subtype 2A b. Subtype 2B c. Subtype 2N d. Type 3
Subtype 2B
A 60 year old women comes to the physician with fatigue and malaise. Her hemoglobin is 8 g/dL, hematocrit is 25%, RBC count is 2.00x10^12/L, platelet count is 550x10^9/L, and WBC count is 3.8x10^9/L. Her WBC differential is unremarkable. Bone marrow shows erythroid hypoplasia and hypolobulated megakaryocytes; granulopoiesis appears normal. Ring sideroblasts are rare. Chromosome analysis reveals the deletion of 5q only. Based on the classification of this disorder, what therapy would be most appropriate? a. Supportive therapy; lenalidomide if the disease progresses b. Aggressive chemotherapy c. Bone marrow transplantation d. Low-dose cytosine arabinoside, accompanied by cis-retinoci acid
Supportive therapy; lenalidomide if the disease progresses
An alert hematologist should recognize all of the following peripheral blood abnormalities as diagnostic clues in MDS except: a. Oval macrocytes b. Target cells c. Agranular neutrophils d. Circulating micromegakaryocytes
Target cells
Which of the following patterns is characteristic of the peripheral blood in patents with PMF, primary myelofibrosis? a. Teardrop-shaped erythrocytes, nucleated RBCs, immature granulocytes b. Abnormal platelets only c. Hypochromic erythrocytes, immature granulocytes, and normal platelets d. Spherocytes, immature granulocytes, and increased number of platelets
Teardrop-shaped erythrocytes, nucleated RBCs, immature granulocytes
In general, the hereditary hemochromatoses result from mutations that impair: a. The manner in which developing red cells acquire and manage iron b. The hepcidin-ferroportin iron regulatory system c. The TfR-Tf endocytic iron acquisition process for body cells other than blood cells d. The function of divalent metal transporter in enterocytes and macrophages
The hepcidin-ferroportin iron regulatory system
A group A Rh-negative mother gave birth to a Group O Rh-positive baby. The baby is at risk of hemolytic disease of the fetus and newborn if: a. This was the mother's first pregnancy b. The mother has IgG ABO antibodies c. The mother was previously immunized to the D antigen d. The mother received Rh immune globulin prior to delivery
The mother was previously immunized to the D antigen
A well mixed specimen obtained for a CBC has brown color. The patient is being treated with a sulfonamide for a bladder infection. Which of the following could explain the brown color? a. The patient has hemoglobin M b. The patient is a compound heterozygote for hemoglobin S and thalassemia c. The incorrect anticoagulant was used d. Levels of hemoglobin F are high
The patient has hemoglobin M
The mother of a 4-month old infant who is being breast fed sees her physician for a touring postpartum visit. She expresses concern that she may be experiencing postpartum depression because she does not seem to have any energy. Although the physician is sympathetic to the patient's concerns, she orders a BCB and iron studies seeking an organic explanation for the patient's symptoms. The results are as follows: CBC: all results within reference intervals except RDW = 15%, serum iron = decreased, TIBC = increased, % transferrin saturation = decreased, and serum ferritin = decreased. Correlate the patient's laboratory and clinical findings. What can you conclude? a. The result s of the iron studies reveal findings consistent with a thalassemia that was apparently previously undiagnosed b. The patient is in stage 2 of iron deficiency, before frank anemia develops c. The results of the iron studies are inconsistent with the CBC results, and a laboratory error should be expected d. There is no evidence of a hematologic explanation for the patient's symptoms
The patient is in stage 2 of iron deficiency, before frank anemia develops
MGUS (Monoclonal Gammopathy of Undetermined Significance) is best described as: a. The presence of monoclonal immunoglobulin in serum with only mild bone marrow plasmacytosis b. The presence of monoclonal serum or urine immunoglobulin with significant bone marrow plasmacytosis c. The presence of significant bone marrow plasmacytosis in a patient with only a few clinical symptoms of plasma cell myeloma d. The presence of monoclonal immunoglobulin in a patient with a solitary mass composed of plasma cells
The presence of monoclonal immunoglobulin in serum with only mild bone marrow plasmacytosis
What is the major morphologic difference between Hodgkin lymphoma and other B cell lymphomas? a. The extent of the lymph node involvement b. The presence of numerous reactive lymphocytes and only a few malignant cells in Hodgkin lymphoma c. The presence of numerous tingible-body macrophages in Hodgkin lymphoma d. The preservation of normal lymph node architecture in Hodgkin lymphoma
The presence of numerous reactive lymphocytes and only a few malignant cells in Hodgkin lymphoma
Which of the following is true of an absolute increase in lymphocytes with reactive morphology? a. The population of lymphocytes appears morphologically homogeneous b. They are usually effector B cells c. The reactive lymphocytes have increased cytoplasm with variable basophilia d. They are most commonly seen in bacterial infections
The reactive lymphocytes have increased cytoplasm with variable basophilia
A 36 year old women was brought to the emergency department by her husband because she had experienced a seizure. He reported that she had been well unit that morning, when she complained of a sudden headache and malaise. She was not taking any medication and had no history of previous surgery or pregnancy. Laboratory studies show a WBC could of 15x10^0/L, hemoglobin level of 7.8 g/dL, a platelet count of 18x10^9/L, and schistocytes and helmet cells on the peripheral blood film. Chemistry test results included markedly elevated serum lactate dehydrogenase activity and a slight increase in the level of total and indirect serum bilirubin. The urinalysis results were positive for protein and blood, but there were no RBCs in the urine sediment. Prothrombin time and partial thromboplastin time were within the reference interval. When the entire clinical and laboratory picture is considered, which of the following is most likely the diagnosis? a. Hemolytic uremic syndrome b. Hemolysis, elevated liver enzymes, low platelet count syndrome c. Thrombocytopenic purpura d. Exercise-induced hemoglobinuria
Thrombocytopenic purpura
A patient in whom CML has previously been diagnosed has circulating blasts and promyelocytes that total 30% of leukocytes. The disease is considered to be in what phase? a. Chronic stable phase b. Accelerated phase c. Transformation to acute leukemia d. Temporary remission
Transformed to acute leukemia
An oncology patient exhibiting signs and renal failure with seizures after initial chemotherapy may potentially develop: a. Hyperleukocytosis b. Tumor lysis syndrome c. Acute leukemia secondary to chemotherapy d. Myelodysplasia
Tumor lysis syndrome
What is the most prevalent form of VWD? a. Type 1 b. Type 2A c. Type 2B d. Type 3
Type 1
A patient with venous thrombosis is tested for protein S deficiency. The protein S activity, antigen, and free antigen all are less than 65%, and the C4bBP level is normal. What type of deficiency is likely? a. Type I b. Type II c. Type III d. No deficiency is indicated, because the reference range includes 65%
Type I
Idiopathic acquired aplastic anemia is due to an: a. Drug reaction b. Benzen exposure c. Inherited mutation in stem cells d. Unknown cause
Unknown cause
Painful crises in patients with sickle cell disease occur as a result of: a. Splenic sequestration b. Aplasia c. Vasoocclusion d. Anemia
Vasoocclusion
What is the aplastic anemia classification of a 15 year old female with a bone marrow cellularity of 10%, hemoglobin of 7 g/dL, absolute neutrophil count of 0.1 x 10^9 /L, and platelet count of 10 x 10^9/L? a. Non-severe b. Moderate c. Severe d. Very severe
Very severe
An absolute lymphocytosis with reactive lymphocytes suggests which of the following conditions? a. DiGeorge syndrome b. Bacterial infection c. Parasitic infection d. Viral infection
Viral infection
A patient has anemia, oval macrocytes, and hyperhsegmented neutrophils. Which of the following tests would be most efficient in differential diagnosis of the disorder? a. Serum iron and ferritin levels b. Erythropoietin level c. Vitamin B12 and folate levels d. Chromosome analysis
Vitamin B12 and folate levels
Which of the following conditions would be included in the differential diagnosis of an adult patient with a MCV of 125 fL and an RDW of 20%? a. Aplastic anemia b. Sickle cell anemia c. Iron deficiency d. Vitamin B12 deficiency
Vitamin B12 deficiency
What is the typical treatment for vitamin K deficiency when the patient is bleeding? a. Vitamin K and PCC b. Vitamin K and plasma c. Vitamin K and platelet concentration d. Vitamin K and factor VIII concentrate
Vitamin K and plasma
A patient has a clinical picture of megaloblastic anemia. The serum folate level is decreased and the serum vitamin B12 level is 600 pg/mL (RR: 200-900 pg/mL). What is the expected value for the methylmalonic acid assay? a. Increased b. Decreased c. Within the reference range
Within the reference range
An elderly white women is evaluated for worsening anemia, with a decrease of approximately 0.5 mg/dL of hemoglobin each week. The patient is pale, and her skin and eyes are slightly yellow. She complains of extreme fatigue and is unable to complete the tasks of daily living without napping in the mid-morning and mid-afternoon. She also tires with exertion, finding it difficult to climb even 5 stairs. Which of the features of this description points to a hemolytic cause of her anemia? a. Pallor b. Yellow skin and eyes c. Need for naps d. Tiredness on exertion
Yellow skin and eyes
What therapy may be used for a hemophilic boy who is bleeding and has a high titer of factor VIII inhibitor? a. rFVIIa b. Plasma c. Cryoprecipitate d. Factor VIII concentrate
rFVIIa
Disseminated intravascular coagulation is more often seen in associated with leukemia characterized by which of the following mutations? a. t(12;21)(p13;q22) b. t(9;22)(q34;q11.2) c. inv(16)(p13;q22) d. t(15;17)(q22;q12)
t(15;17)(q22;q12)
Which of the following chromosome abnormalities is associated with CML? a. t(15;17) b. t(8;14) c. t(9;22) d. Monosomy 7
t(9;22)
