Clin Chem A Quiz 3

NADPH oxidase deficiency cause which of the following condition ? A ) Chronic granulomatous disease B ) Leukocyte adhesion defect C) Job syndrome d) Bruton's agammaglobulinemia

A ) Chronic granulomatous disease

A 20 - year old man requires an extraction of an impacted wisdom tooth. He is not taking any over - the - counter or prescription drugs. He has no previous history of surgery. He stated that he bleed into his knee joint as a child during soccer games. He also said there is history of bleeding problems in his mother 's family ( brothers/ uncles) but he is not sure which individuals has the problems. Shortly after the tooth extraction, he rinses his mouth out with lukewarm water and develops severe bleeding from the tooth that cannot be controlled. Which of the following is the most likely diagnosis of this patient ? A. Hemophilia B. Von Willi brand disease C. Thrombotic thrombocytopenic purpura (TTP) D. Idiopathic Thrombocytopenic Purpura(IPT)

A. Hemophilia

1. Mr. Frank, a 20 -year-old male presents to the clinic with complains of extreme fatigue and sore throat. Physical examination reveals an exudative tonsilitis and palatal petechiae. There is generalized painful lymphadenopathy and tender hepatosplenomegaly. The hemoglobin and platelet count are normal. CBC/ serum chemistry shows elevated serum transaminases, and total bilirubin is normal. peripheral blood smear shows atypical lymphocytes. Which of the following test is most indicated and diagnostic for this patient condition ? A. Bone marrow Aspirate B. Heterophile antibody test C. Lymph node biopsy D. Marker studies for CALLA antigen E. Reticulocyte count

B. Heterophile antibody test

A 25 years old female present to the clinic with history of menorrhagia ( heavy menstrual bleeding) since menarche at age 12. She has been diagnosed with anovulatory dysfunctional uterine bleeding. Additional complaints are easy bruisability, excessive bleeding from superficial cuts from shaving her legs and frequent nosebleeds. She has a family history of epistaxis in her father and brothers. Her bleeding problems improves significantly when she takes oral contraceptive pills( containing estrogen) and recur to the same level of severity when she discontinues the medication. CBC, show normal PT , and prolonged PTT. Which of the following is the most likely diagnosis of this patient A. Hemophilia B. Von Willi brand disease C. Thrombotic thrombocytopenic purpura (TTP) D. Idiopathic Thrombocytopenic Purpura( IPT)

B. Von Willi brand disease

1. Mr. John a 60 year -old man presents to the clinic with sudden onset of bloody diarrhea followed by abdominal pain and vomiting . over the past few months he has had problems with recurrent headaches, blurry vision, and generalized pruritus after bathing . He had a bout of gouty arthritis involving his right big toe approximately 1 month ago. The blood pressure is 90/72 mmHg and the pulse is 160 beats/minute. The abdomen is distended and abdomen bowel sounds are absent . Hepatosplenomegaly is present. The CBC shows a Hb of 20g/dL, WBC count of 25, 000/mm3 with left shift and toxic granulation, and a platelet count of 625, 000/mm3. Which of the following groups of laboratory test results are expected A B C D

C

Kate a 28 year-old female presents with fever, headaches and recurrent nosebleeds. Physical examination reveals retinal hemorrhages, widespread petechiae and ecchymoses, and a positive stool for occult blood. There is no lymphadenopathy or hepatosplenomegaly. Mental status examination is abnormal. The CBC shows a decreased hemoglobin and a normal WBC count and mean corpuscular volume (MCV). The corrected reticulocyte count is 10%. The peripheral blood shows numerous fragmented RBCs, polychromasia, and platelet abnormality. There is a positive urine dipstick for blood . Renal tubular cell cast are present. The serum blood urea nitrogen is 60mg/dL and the serum creatinine is 6mg/dL. The platelet count is decreased, bleeding time is increased, PT and PTT is normal. Which of the following is the most likely diagnosis of this patient A. Hemophilia B. Von Willi brand disease C. Thrombotic thrombocytopenic purpura (TTP) D. Idiopathic Thrombocytopenic Purpura(IPT)

C. Thrombotic thrombocytopenic purpura (TTP)

A 11 year -old boy has minimal change disease. In addition to generalized edema and ascites, he has moon-shaped face and truncal obesity with purple stretch marks. Which of the following leukocyte alterations would most likely be present? A B C D E

D

In evaluation of a patient for G6PD deficiency which of the following test results would indicate a deficiency of the enzyme a) Increased formation of Heinz bodies b) Lack of fluorescence in the fluorescent spot test C) Failure to reduce methemoglobin in the presences of methylene blue D) All of the above

D) All of the above

A 12 yea-old boy presents with a nosebleed that is unresponsive to pinching of the nose and packing of the anterior nares. He is not taking any prescription or over- the -counter mediations. Physical examination reveals scattered petechiae and ecchymoses over the anterior and posterior trunk and in the area where the blood pressure cuff was located. There is no lymphadenopathy or hepatosplenomegaly. A stool for occult blood is negative . A CBC shows normal hemoglobin and WBC count. An abnormality is noted in the peripheral blood smear . The bleeding time is prolonged , PT and PTT is normal. Which of the following is the most likely diagnosis of this patient ? A. Hemophilia B. Von Willi brand disease C. Thrombotic thrombocytopenic purpura (TTP) D. Idiopathic Thrombocytopenic Purpura(IPT)

D. Idiopathic Thrombocytopenic Purpura(IPT)

A patient present to the clinic with fatigue and positive fecal stool test. He has history of celiac disease . which of the following vitamin deficiency is associated with his bleeding ? A . Vitamin A B. Vitamin B c. Vitamin D D. Vitamin E E. Vitamin K

E. Vitamin K

TTP presents with a pentad of symptoms which does not include : A. Fever B. Anemia C. Thrombocytopenia D. Renal failure E. Neurological disorder F. Liver failure

F. Liver failure

The direct antiglobulin test is used to differentiate ____________ : a) Inherited from acquired spherocytosis b) Intravascular from extravascular c) Heterozygous from homozygous thalassemia d) Sickle trait from sickle disease

a) Inherited from acquired spherocytosis

Anemia chronic infection is characterized by : a) Decrease iron stores in the reticuloendothelial system b) Decreased serum iron level c) Macrocytic erythrocytes d) Increased serum Iron binding capacity

b) Decreased serum iron level

What are the causes of red cell defect in paroxysmal nocturnal hemoglobinuria ( PNH) ? a) Lack of GPI - anchored protein on the erythrocyte membrane b) Excessive amount of complement components c) Excessive amounts of complement components C5 and C9 d) Glucose -6- phosphate dehydrogenase enzyme deficiency

a) Lack of GPI - anchored protein on the erythrocyte membrane

Which of the following is a correct description of the Sugar water test ( sucrose hemolysis test) ? a) PNH cells are lysed by complement after exposure to low- ionic strength sugar water b) PNH cells are lysed by antibody and complement after heating to 56oC in sugar water solution ( 5 %) c) Patient's serum is acidified to enhance complement binding and lysis of patient cell d) Patient's serum is heated -inactivated and treated with HCl; complement is added: patient cell lysis occurs

a) PNH cells are lysed by complement after exposure to low- ionic strength sugar water

What is the most common glycolytic enzyme deficiency associated with the Embden - Meyerhof pathway a) Pyruvate Kinase (PK) deficiency b) G6PD c) Hexokinase Deficiency d) Hexokinase deficiency e) Glutathione reductase deficiency

a) Pyruvate Kinase (PK) deficiency

Which of these test is used to diagnose PNH ? select all the applies a) Sugar water test b) Ham's test c) Flow cytometric analysis for CD55 and CD 59 d) Schilling test

a) Sugar water test b) Ham's test c) Flow cytometric analysis for CD55 and CD 59

Which statement best describes paroxysmal nocturnal hemoglobinuria ? a) Acquired hemolytic anemia associated with cellular membrane abnormalities b) Congenital hemolytic anemias associated with the inflammatory response c) A premalignant condition that almost always results in development of acute leukemia

a) Acquired hemolytic anemia associated with cellular membrane abnormalities

1. A 5 year -old boy presents to the clinic with fever, fatigue, epistaxis, and pain over the sternum, physical examination reveals generalized, nontender lymphadenopathy , hepatosplenomegaly , sternal tenderness to percursion, and widespread petechiae, and echymoses. The CBC report shows a Hb of 6g/dL, WBC count of 46, 000/mm3, and platelet count of 30,000/mm3. A bone marrow aspirate reveals sheets of Cells similar to those that are present in the peripheral blood . The blast count > 20 % . What kind of leukemia is best described in the patient above ? a) Acute lymphoblastic leukemia b) Acute promyelocytic leukemia ( M3) c) Adult -T cell Leukemia d) Chronic Lymphocytic Leukemia e) Chronic myelogenous Leukemia (CML) f) Hairy Cell Leukemia

a) Acute lymphoblastic leukemia

Which of these are clinical manifestation of both B12 and folate deficiency ? a) Anemia and Jaundice b) Thrombocytosis c) Hemoglobinemia d) Hemoglobinuria

a) Anemia and Jaundice

Which of the following is a cause of Vitamin B 12 deficiency ? a) Atrophic gastritis b) Total gastrectomy c) Blind loop syndrome d) Chronic glossitis

a) Atrophic gastritis b) Total gastrectomy c) Blind loop syndrome

What test are useful in the classification of the cause of anemia of red Cell hemolysis ? a) Coombs test b) Hemoglobin level and electrophoresis c) Reticulocyte count d) Red cell enzyme studies and iron -binding capacity

a) Coombs test

A patient develops unexpected bleeding and the following test results were obtained: What is the most probable cause of patient bleeding and the result above? a) Disseminated intravascular coagulation ( DIC) b) Idiopathic thrombocytopenic purpura c) Primary Fibrinolysis d) Liver disease e) Thrombotic thrombocytopenic purpura

a) Disseminated intravascular coagulation ( DIC)

What is the most common cause congenital disorder associated with aplastic anemia ? a) Fanconi's anemia b) Thrombocytopenia - absent radius ( TAR) syndrome c) Congenital dyserythropoitiec anemia type1 d) Diamond -blackfan anemia

a) Fanconi's anemia

A 30 years female complains of fatigue and chronic diarrhea with greasy stools. Physical examination reveals pale conjunctivae, glossitis and normal neurologic examination. A CBC shows macrocytic anemia with neutropenia and thrombocytopenia. The peripheral smear reveals macro-ovalocytes and few hypersegmented neutrophils. A stool for occult blood is negative. Serum Antigliadin antibodies are present. What is this patient most likely diagnosis? a) Folate deficiency b) Anemia of chronic disease c) Aplastic anemia d) Vitamin B12 deficiency e) G6PD deficiency

a) Folate deficiency

The platelet disorder in which the abnormality is due to defect in platelet aggregation is: a) Glanzmann thrombasthenia b) Von Willebrand Disease c) Storage pool disease D) Bernard - Soulier Syndrome

a) Glanzmann thrombasthenia

What is the appearance of bone marrow in aplastic anemia ? a) Hypocellular b) Normocellular c) Hypercellular d) Fibrotic

a) Hypocellular

Which of the following laboratory findings coincide with megaloblastic anemia a) Increased serum iron and serum bilirubin b) Decreased serum iron and serum bilirubin c) Decreased serum muramidase d) Increased haptoglobin

a) Increased serum iron and serum bilirubin

1. A 20 year-old man presents with ecchymoses, petechia, generalized nontender lymphadenopathy, and painful hepatosplenomegaly. A CBC reveals a hemoglobin (Hb) of 7 g/ dL, normal mean corpuscular volume ( MCV) , a total WBC count of 38,000/mm3, and a platelet count of 35,000/mm3. Abnormal cells . The prothrombin time (PT) and partial thromboplastin time ( pTT) are both prolonged, serum fibrinogen level is decreased, and the D -dimers test is positive . The peripheral blood is shown below : What kind of leukemia is best described in the patient above ? a) Acute lymphoblastic leukemia b) Acute promyelocytic leukemia ( M3) c) Adult -T cell Leukemia d) Chronic Lymphocytic Leukemia e) Chronic myelogenous Leukemia (CML) f) Hairy Cell Leukemia

b) Acute promyelocytic leukemia ( M3)

A 24 year-old female with sickle cell anemia whose usual hemoglobin concentration is 8 g/dL( 80/L )develops fever, increased weakness and malaise. The hemoglobin concentration is 4 g/ dL ( 40g/L) and the reticulocyte count is 0.1%. The most likely explanation for her clinical picture at this time is : a) Increase hemolysis due hypersplenism b) Aplastic crisis c) Thrombotic crisis d) Occult blood loss

b) Aplastic crisis

What factors contribute to the sickling of RBCs a) Increase in PH and oxygenation b) Decrease in pH and oxygenation and dehydration c) Increase in pH and decrease in oxygenation d) Decrease in dehydration and increase in pH and oxygenation

b) Decrease in pH and oxygenation and dehydration

what is the pathophysiology of megaloblastic anemia ? a) Defective RNA synthesis and abnormal Cytoplasm maturation b) Defective DNA synthesis and abnormal nuclear maturation c) Defective RNA synthesis and abnormal nuclear maturation d) Defective DNA synthesis and abnormal cytoplasm maturation

b) Defective DNA synthesis and abnormal nuclear maturation

What is the most common glycolytic enzymes deficiency associated with the pentose phosphate pathway ( aerobic pathway) a) Pyruvate Kinase (PK) deficiency b) G6PD deficiency c) Hexokinase deficiency d) Glutathione reductase deficiency

b) G6PD deficiency

Factors commonly involved in producing anemia in patients with chronic renal disease include; a) Marrow hypoplasia b) Inadequate erythropoiesis c) Vitamin B12 deficiency d) Increased Erythropoietin production

b) Inadequate erythropoiesis

Macrocytosis associated with acute blood loss is characterized by : a) Decrease reticulocyte count b) Increase reticulocyte count c) Pancytopenia d) Macro-ovalocytes

b) Increase reticulocyte count

Which of the following has not been associated with an acquired type of aplastic anemias ? a) Ionizing radiation b) Increased chromosomal breakage c) Chemical agents d) Drugs

b) Increased chromosomal breakage

Which of the following is not seen in the peripheral smear of blood of patient with aplastic anemias ? a) Normochromic, normocytic, anemias b) Increased reticulocyte count c) Relative lymphocytosis d) Decrease neutrophils

b) Increased reticulocyte count

Megaloblastic anemia is associated with: a) Ineffective erythropoiesis and increased reticulocytes b) Ineffective erythropoiesis and decreased reticulocytes c) Ineffective erythropoiesis and decreased and decreased LDH d) Ineffective erythropoiesis and decreased erythropoietin

b) Ineffective erythropoiesis and decreased reticulocytes

The primary leukocyte alteration in chronic inflammation like rheumatoid arthritis is : a) Neutrophil b) Monocyte c) Eosinophil d) Lymphocyte e) Basophil

b) Monocyte

Which of the following schilling test results corresponds to a diagnosis of pernicious anemia ? a) Part I abnormal (decrease/ no excretion labelled cobalamin urine) , part II( cobalamin + intrinsic factor) not corrected b) Part I abnormal (decrease/ no excretion of labelled cobalamin urine), part II ( labelled cobalamin + intrinsic factor) corrected c) Part I abnormal (decrease/ no excretion of labelled cobalamin urine) , part II (labelled cobalamin + intrinsic factor) abnormal d) Part I normal (decrease/ no excretion of labelled cobalamin urine) , part II ( Labelled cobalamin + intrinsic factor) corrected

b) Part I abnormal (decrease/ no excretion of labelled cobalamin urine), part II ( labelled cobalamin + intrinsic factor) corrected

Which of the following red cell membrane protein deficiencies does not cause hereditary spherocytosis ? a) Ankyrin b) Protein 4.1 c) Protein 4.2 d) Band 3

b) Protein 4.1

A 22 year old male with chronic cholecystitis has a family history of anemia. Physical examination reveals splenomegaly . CBC shows a normocytic anemia with an increased corrected reticulocyte count . Peripheral blood shows acanthocytes/ thorny RBCs. What is the most likely diagnosis : a) G6PD ( Glucose -6-phosphate dehydrogenase deficiency) b) Pyruvate Kinase (PK) deficiency c) PNH (Paroxysmal nocturnal hemoglobinuria) d) Hereditary spherocytosis

b) Pyruvate Kinase (PK) deficiency

Which of the following characteristics are common to hereditary spherocytosis, hereditary elliptocytosis, hereditary stomatocytosis, and paroxysmal nocturnal hemoglobinuria ? a) Autosomal dominant inheritance b) Red cell membrane defect c) Positive direct antiglobulin test d) Measured platelet count

b) Red cell membrane defect

ADAMTS13 deficiency is responsible for thrombocytopenia found in : a) ITP b) TTP c) DIC d) HUS

b) TTP

The life span of platelet is : a) 5 days b. 10days C. 20 days d. 30 days

b. 10days

Anemic patient investigated for hemolytic state has the following laboratory findings : Hbg 8g/dL, Hct, 23%, reticulocyte count 8 %, polymorphs on peripheral smear . What is the reticulocyte production index ( RPI) : a) 8 b) 4 c) 2 d) 1

c) 2

In TTP, a deficiency of ADAMTS13 causes clotting because of : a. Increased vW factor b. Inability to cleave Ultra light von Willi brand Multimer ( UL VWM) c. Increase production of thrombin d. Inability to produce antibodies to prevent platelet aggregation

b. Inability to cleave Ultra light von Willi brand Multimer ( UL VWM)

The protein that transfers cobalamin ( Vit B12 ) in blood to it designated tissue or organ ( liver) is : a) Albumin b. Transcobalamin II c. Haptoglobulin d. Intrinsic factor

b. Transcobalamin II

1. A 40 - year- old Japanese man presents with epistaxis, a generalized eczematous type of skin rash, generalized nontender lymphadenopathy, and hepatosplenomegaly. A complete blood count (CBC) reveals a Hb of 7.2g/dL, a total WBC count of 37, 000/mm3, and a platelet count of 48,000/mm3.occassional blast cells are present in the peripheral blood smear and on bone marrow examination. Lytic bone lesions are noted on a routine chest radiograph. What kind of leukemia is best described in the patient above ? a) Acute lymphoblastic leukemia b) Acute promyelocytic leukemia ( M3) c) Adult -T cell Leukemia d) Chronic Lymphocytic Leukemia e) Chronic myelogenous Leukemia (CML) f) Hairy Cell Leukemia

c) Adult -T cell Leukemia

The basis of flow cytometric test for diagnosis of PNH is which of the following ? a) PNH will have increased amount of complement detected on the cell surface b) PNH Cells are easily lysed and will show decreased number when analyzed c) An affected patient will show decreased levels of CD55 and CD59 binding in a subset of cells d) All of the patient cells will show decreased levels of GPI - anchored proteins on the erythrocyte membrane

c) An affected patient will show decreased levels of CD55 and CD59 binding in a subset of cells

Which of the following drug is not associated with the development of aplastic anemia ? a) Chloramphenicol b) Phenylbutazone c) Aspirin d) Chemotherapeutic agents

c) Aspirin

What is the treatment of choice for severe aplastic anemia in patient who are younger than age 50 ? a) Multiple transfusion b) Androgens c) Bone marrow transplantation d) Erythropoietin therapy

c) Bone marrow transplantation

Which of the following laboratory tests would not be typical of hereditary spherocytosis ? a) Increase osmotic fragility b) Spherocytes on peripheral smear c) Decreased MCHC d) Increased RPI

c) Decreased MCHC

A 28 year old male who raises hogs has a habit of eating raw bacon. He complains of muscle tenderness, particularly in the deltoid muscle. Elevation of which of the following white blood cell will aid in diagnosing the causative pathogen ? a) Neutrophil b) Monocyte c) Eosinophil d) Lymphocyte e) Basophil

c) Eosinophil

Which finding would be most useful in establishing a diagnosis of HbSC disease ? a) Target cells and sickle cells on peripheral blood smear b) Severe anemia: increased reticulocyte count c) Hemoglobin electrophoresis at Alkaline pH d) RBC indices

c) Hemoglobin electrophoresis at Alkaline pH

What is the definition of pure red cell aplasia? a) Lack of hematopoietic precursors in the bone marrow b) Abnormal, giant normoblast in the bone marrow c) Lack of erythroid precursors with normal white blood cells and megakaryocytic precursors d) Dysplastic red cells precursors with normal white cells and megakaryocytic precursors

c) Lack of erythroid precursors with normal white blood cells and megakaryocytic precursors

According to the classification anemias, megaloblastic anemias is a : a) Macrocytic , hypochromic anemia b) Macrocytic, hyperchromic anemia c) Macrocytic, normochromic anemia d) Normocytic, normochromic anemias

c) Macrocytic, normochromic anemia

1. A 3 year old boy with blond hair has recurrent staphylococcus infections. The CBC shows an absolute neutrophilic leukocytosis. The leukocyte abnormality is shown in the peripheral blood smear. The chemiluminescence test is normal. What is the pathogenesis of his disorder a) Adhesion molecule defect b) Enzyme defect c) Membrane fusion defect d) Opsonization defect e) Respiratory burst defect

c) Membrane fusion defect

Which hemoglobin deficiency causes hemoglobin to be oxidized from ferrous to the ferric state a) G6PD b) PK deficiency c) NADH- methemoglobin reductase deficiency d) Lactate dehydrogenase deficiency

c) NADH- methemoglobin reductase deficiency

What is the correct description of the Ham's test ( acidified serum lysis test)? a) PNH cells are lysed by complement after exposure to low- ionic strength sugar water b) PNH cells are lysed by antibody and complement after heating to 56o C in sugar water solution ( 5 %) c) Patient's serum is acidified to enhance complement binding and lysis of patient cell d) Patient's serum is heated -inactivated and treated with HCl; complement is added: patient cell lysis occurs

c) Patient's serum is acidified to enhance complement binding and lysis of patient cell

Which of the following are not seen on the peripheral smear of a patient with megaloblstic anemias ? a. Macro-ovalocytes b. Hypersegmented neutrophils c. Hyposegmented neutrophils d. Howell -jolly bodies

c. Hyposegmented neutrophils

In HELLP syndrome patient present with : a) Normal liver enzyme b. elevated platelet count c. high blood pressure d. Low blood pressure

c. high blood pressure

Which of the following is a cause of methemoglobinemia ? a) HbM variant b) NADH- diaphorase deficiency c) Toxic substances d) All above

d) All above

Ionizing radiation causes aplastic anemia by which of the following mechanisms? a) Dose - dependent destruction of the bone marrow stem cells b) An idiosyncratic delayed development of bone marrow aplasia c) Disruption of chemical bonds to form free radicals that damage the bone marrow cells d) All of the Above ( select which one applies)

d) All of the Above ( select which one applies)

What are therapeutic strategies or goals in the management of sickle cell anemia ? a) Decrease microvascular entrapment of sickled cells or change the volume or RBCs b) Modify oxygenation affinity or solubility of sickle hemoglobin c) Increase production of fetal hemoglobin d) All of the above

d) All of the above

Which of the following are crises associated with sickle cell anemia ? a) Aplastic crisis with low reticulocyte count and infection b) Hemolytic crisis with splenic sequestration, decrease hemoglobin and hematocrit, increased reticulocyte count, jaundice c) Vaso-occlusive or painful crises with severe pain, tissue damage and necrosis d) All of the above

d) All of the above

Which of the following is most closely associated with chronic myelogenous leukemia? a) Ringed sideroblasts b) Disseminated intravascular coagulation c) Micromegakaryocytes d) BCR/ABL fusion gene

d) BCR/ABL fusion gene

Hemolysis in paroxysmal nocturnal hemoglobinuria ( PNH) is : a) Temperature -dependent b) Complement -independent c) Antibody -mediated d) Caused be a red cell membrane defect

d) Caused be a red cell membrane defect

Jane a 69 year - old female presents with fatigue, generalized, nontender lymphadenopathy, hepatosplenomegaly, and scattered petechiae and ecchymoses over the anterior chest. A CBC report shows a Hb of 9.5g/dL, WBC count of 92,000/mm3, and a platelet count 73, 000/mm3. Total serum protein concentration is 4.5g/dL What kind of leukemia is best described in the patient above ? a) Acute lymphoblastic leukemia b) Acute promyelocytic leukemia ( M3) c) Adult -T cell Leukemia d) Chronic Lymphocytic Leukemia e) Chronic myelogenous Leukemia (CML) f) Hairy Cell Leukemia

d) Chronic Lymphocytic Leukemia

Von Wille brand factor sere as a stabilizer for : a) Platelet b) Factor IX c) Ristocetin d) Factor VIII

d) Factor VIII

Oxidative denaturation of hemoglobin results in formation of small particles that are visualized with supravital staining, What is the term for these particles : a) Basophilic stippling b) Howell - Jolly bodies C) . Pappenheimer -bodies d) Heinze bodies

d) Heinze bodies

Which of the following are characteristics findings of the bone marrow in a patient with megaloblastic anemia ? a) Hypocellular with low M:E ratio b) Hypercellular with high M:E ratio c) Hypocellular with high M:E ratio d) Hypercellular with low M: E ratio

d) Hypercellular with low M: E ratio

Which of the following is associated with pernicious anemia and not macrocytic anemia due to liver disease ? a) Increase LDH b) Increase bilirubin c) Increase MCV d) Hypersegmented neutrophils

d) Hypersegmented neutrophils

The glycoprotein necessary for the intestinal absorption of vitamin B12 is : a) Albumin b) Transcobalamin II c) Haptoglobulin d) Intrinsic factor

d) Intrinsic factor

The characteristics erythrocyte found in pernicious anemia is : a) Microcytic b) Spherocytic c) Hypochromic d) Macrocytic

d) Macrocytic

Which of the following tests is not used to determine increased red cell destruction ? a) Unconjugated (indirect) bilirubin b) Serum haptoglobin c) Schumm's test d) Reticulocyte count

d) Reticulocyte count

Which of the following represent the most complete list of etiologies causing aplastic anemia ? a) Secondary and congenital b) Idiopathic and congenital c) Secondary and idiopathic d) Secondary, idiopathic, and congenital

d) Secondary, idiopathic, and congenital

A 65 years old female complains of fatigue and chronic diarrhea. Physical examination reveals a beefy red tongue with fissuring along the lateral edges. Vibratory sensation is absent in both lower extremities and there is loss of balance when standing up with her eyes closed that is corrected when the eyes are open . A CBC shows pancytopenia and MCV of 125 um3 . Peripheral smear shows hypersegmented neutrophils What is the most likely diagnosis of this patient ? a) Folate deficiency b) Anemia of chronic disease c) Aplastic anemia d) Vitamin B12 deficiency e) G6PD deficiency

d) Vitamin B12 deficiency

Which of the following genetic alteration is associated with favorable prognosis in pre- B -ALL? a) t( 1:19) b) t(4: 11) c) t(9: 22) d) t(12: 21)

d) t(12: 21)

1. A 50 year-old male presents with fever weight loss, petechiae, generalized nontender lymphadenopathy, massive hepatosplenomegaly. A CBC exhibits a Hb of 7.1 g/dL, MCV of 105um3, WBC count of 111,000cells/ mm3, and a platelet count of 600,000/mm3. The leukocyte alkaline phosphatase score is very low . A special chromosome study is pending What kind of leukemia is best described in the patient above ? a) Acute lymphoblastic leukemia b) Acute promyelocytic leukemia ( M3) c) Adult -T cell Leukemia d) Chronic Lymphocytic Leukemia e) Chronic myelogenous Leukemia (CML) f) Hairy Cell Leukemia

e) Chronic myelogenous Leukemia (CML)

1. Mr. James a 58 year-old present to the clinic with complains of painful joints fullness in the right upper quadrant, and rash . Physical examination reveals palpable purpura and hepatosplenomegaly . There is no evidence of lymphadenopathy. His CBC shows a Hb of 8/dL, platelet count of 75,000/mm3, and a WBC count of 3500/mm3. Abnormal cells are present in the peripheral blood . A bone marrow biopsy reveals a monomorphic infiltrate of cells with abundant cytoplasm. The patient is scheduled for splenectomy What kind of leukemia is best described in the patient above ? a) Acute lymphoblastic leukemia b) Acute promyelocytic leukemia ( M3) c) Adult -T cell Leukemia d) Chronic Lymphocytic Leukemia e) Chronic myelogenous Leukemia (CML) f) Hairy Cell Leukemia

f) Hairy Cell Leukemia