2011 module exam Flashcards
Which of the following protects vitamin B12 from denaturation in the stomach?
a. Transferrin
b. Haptocorrin
c. Transcobalamin 2
d. Hepcidin
b. Haptocorrin (aka Transcobalamin 1)
What binds vitamin B12 in the duodenum?
a. Gastric intrinsic factor
b. Transcobalamin 1
c. Transcobalamin 2
a. Gastric intrinsic factor
The immune destruction of which of the following results in pernicious anemia?
a. Duodenal cells
b. Jejunal cells
c. Parietal cells
d. Ileal cells
c. Parietal cells
Which of the following is an iron storage form found in all cells?
a. ferritin
b. ferroportin
c. transferrin
d. hepcidin
a. ferritin
An iron storage complex stained with Prussian blue
a. serum ferritin
b. hemosiderin
b. hemosiderin
What binds to the transmembrane protein that controls the release of iron from the intestinal epithelium?
a. ferritin
b. ferroportin
c. transferrin
d. hepcidin
d. hepcidin
it may be B sinch hepcidin isn’t intracellular
How can lead cause anemia?
a. By inhibiting aminolevulinic acid synthase
b. By inhibiting aminolevulinic acid dehydrase
c. b. By inhibiting aminolevulinic acid dehydrogenase
b. By inhibiting aminolevulinic acid dehydrase
Which of the following represents the Bohr effect?
a. Positive effectors of O2
b. Binding of H+ to the globin
b. Binding of H+ to the globin
Bohr effect= decrease in the oxygen affinity
What causes the shift of the hemoglobin saturation curve from left to right?
a- Acidification
b- Biconcave shape of RBCs
a- Acidification
What is methemoglobin?
a. The reduced heme is combined with carbon monoxide
b. Heme contains iron in the reduced form (Fe2+)
c. Hemoglobin with Fe³⁺ in the heme
c. Hemoglobin with Fe³⁺ in the heme
A southern Chinese boy was found to have a tumor in his nasopharynx. What is the likely causative agent?
a) HIV
b) Hepatitis C
c) EBV
d) HTLV-1
e) CMV
c) EBV
What would be increased in a patient who developed megaloblastic anemia after a gastrectomy?
a. Methylmalonic acid
b. Methemoglobin
a. Methylmalonic acid
What will be the neutrophil response in the presence of cells opsonized with activated complement fragments?
Release of enzymes that mediate tissue damage
Cytotoxic T-cells recognize viral antigens in association with which of the following molecules?
a. MHC class I
b. MHC class II
a. MHC class I
Which of the following is involved in type II hypersensitivity?
a. Complement
b. Fc receptors
c. Defensins
a. Complement
What is the correct sequence of hematopoiesis in the fetus?
a. Yolk sac, liver, placenta, bone marrow
b. Bone marrow, liver, spleen, yolk sac
c. Yolk sac, spleen and lymphatic organ, bone marrow
c. Yolk sac, spleen and lymphatic organ, bone marrow
The order is: yolk sac, liver, spleen, lymph nodes, bone marrow. The placenta is not involved in hematopoiesis
A patient has a nervous system degenerative disorder. It was diagnosed as tropical spastic paraperisis. What is the causative agent?
a) HIV
b) Hepatitis C
c) EBV
d) HTLV-1
e) CMV
d) HTLV-1
What is the cause of 25-50% of heterophile negative infectious mononucleosis cases?
a) HIV
b) Hepatitis C
c) EBV
d) HTLV-1
e) CMV
e) CMV
heterophile positive= EBV
A 17-year old boy presents with fever, sore throat, difficulty swallowing, and generalized malaise. Examination reveals a whitish membrane covering his pharynx. A blood smear reveals the presence of atypical mononuclear cells. What is the causative agent?
a) HIV
b) Hepatitis C
c) EBV
d) HTLV-1
e) CMV
c) EBV
(Corynebacterium diphtheriae-> causes white, thick covering in the back of the throat. It can lead to difficulty breathing)
Which hemoglobin would you find in a newborn that would decrease soon after birth? a- HbF b- HbA2 c- Hb Gower 1 d- Hb Bart
a- HbF
A patient has Beta thalassemia major. What would you detect?
a. Absence of Hemoglobin A
b. Presence of Hemoglobin barts
(Both were in the choices, we don’t know which is correct)
A 20-year old male was in a car accident. He has a lacerated liver and multiple fractures. He lost a lot of blood and his Hb was 50g/L. He was given 20 units of packed cells. What complication would most commonly occur in this patient?
a. Hyperkalemia
b. Incompatible transfusion reaction
a. Hyperkalemia
An 18-year old girl is complaining of a microcytic anemia and splenomegaly. What is the most likely diagnosis?
a. Thalassemia minor
b. Thalassemia major
b. Thalassemia major
Which of the following is an initial test in the workup of a patient with a suspected case of hemolytic anemia?
a. Osmotic fragility test
b. G6PD enzyme levels
c. Hemoglobin electrophoresis
d. Reticulocyte count
d. Reticulocyte count
Which of the following will result in agglutination in a cross-matching reaction?
a. Mixing the donor’s RBCs with the recepient’s serum
b. Mixing the donor’s serum with the recipient’s RBCs
a. Mixing the donor’s RBCs with the recepient’s serum
What would you give a patient who suffers from hepatic encephalopathy with prolonged PT and APTT?
a. Platelets
b. Fresh frozen plasma
c. PRBC
d. cryoprecipitate
b. Fresh frozen plasma
A 45-year old female who has been on chemotherapy for 2 days developed nose bleeds. What would you give her?
a. Platelets
b. Fresh frozen plasma
c. PRBC
d. cryoprecipitate
a. Platelets
A 25-year old male has been in a road-traffic accident. He lost a significant amount of blood. What would you give him?
a. Platelets
b. Fresh frozen plasma
c. PRBC
d. cryoprecipitate
c. PRBC
Which of the following is an intravascular hemolytic anemia?
a. Hereditary elliptocytosis
b. Beta-thalassemia major
c. Autoimmune hemolytic anemia
d. Thrombotic thrombocytopenic purpura
e. Hereditary spherocytosis
d. Thrombotic thrombocytopenic purpura
A 15-year old female suffers from long standing anemia. Her peripheral blood smear shows Howell-jolly bodies. What is the most likely diagnosis?
a. thalassemia minor
b. thalassemia major
c. sickle cell anemia
c. sickle cell anemia
note: Howell- jolly bodies result from spleen dysfunction
What hemoglobin might you detect in a newborn expected with alpha-thalassemia trait?
a. Hb bart’s
b. HBA2
a. Hb bart’s
What results from the inactivation of the pentose phosphate pathway?
a. methemoglobin build up
b. oxidative damage
c. GSH build up
b. oxidative damage
Which molecule links glucose metabolism with hemoglobin’s affinity for oxygen?
a. methemoglobin
b. GSH
c. 2,3-bisphosphoglycerate
c. 2,3-bisphosphoglycerate
Which drug is characterized by low compliance and bioavailability?
A) deferasirox
B) deferoxamine
C) deferiprone
B) deferoxamine
What is given with deferoxamine to enhance the excretion of iron?
a. Calcium
b. Vitamin C
b. Vitamin C
A transfusion dependent MDS patient is on regular blood transfusions. He presents with symptoms of heart failure. Upon examination, his serum ferritin was found to be 4500 #g/L. What would be administered to treat him?
A) deferasirox
B) deferoxamine
C) deferiprone
B) deferoxamine
a 12-year old boy presents with a 2-day history of dark urine. His PBS shows spherocytes and the direct antiglobulin test is negative. What is the diagnosis?
a. Beta-thalassemia major
b. Autoimmune hemolytic anemia
c. Thrombotic thrombocytopenic purpura
d. Hereditary elliptocytosis
e. Hereditary spherocytosis
e. Hereditary spherocytosis
A 28-year old female presents with fatigue, dyspnea, and shortness of breath. Her CBC shows increased reticulocytes and low Hb. PBS shows spherocytic morphology. The direct antiglobulin test is positive. What is the most likely diagnosis?
a. thalassemia minor
b. spherocytosis
c. Immune-mediated hemolysis
c. Immune-mediated hemolysis (auto-immune hemolytic anemia)
What is the most important thing for the RBC to withstand the mechanical sheer force of moving thru small blood vessels?
a- G6PD enzyme present in RBC
b- Integral membrane protein attachment to the cytoskeleton
c- hemoglobin distributed evenly across the cell
b- Integral membrane protein attachment to the cytoskeleton
A patient with a long-standing anemia and diabetes mellitus. He had a splenectomy 2 years ago. What is the diagnosis?
a. Thalassemia major
b. Autoimmune hemolytic anemia
c. Thrombotic thrombocytopenic purpura
d. Hereditary elliptocytosis
a. Thalassemia major
What are lipid rafts?
a) Indication of cell death
b) Regions of low lipid fluidity
c) lipid interactions with membrane proteins
d) Lipid clusters with covalent bonds
b) Regions of low lipid fluidity
What is the causative defect in sickle cell anemia?
a. inversion in chromosome 7
b. Point mutation in the alpha globin gene
c. Point mutation in the beta globin gene
c. Point mutation in the beta globin gene
What causes the abnormal migration of HbS in sickle cell? a. Increase charge
b. Decrease charge
c. Lower volume
b. Decrease charge
What level of factor VIII would you expect to find in a person with severe hemophilia A?
a. More than 30%
b. Less than 1%
b. Less than 1%
A 56-year old female presented with a sudden onset of acute dyspnea. Shortly after that, she went into cardiac arrest. The autopsy shows a saddle thromboembolism. Which of the following conditions is the most likely cause?
a. Heterozygous Factor V Leiden mutation
b. Protein C deficiency
c. Thrombocytopenia
a. Heterozygous Factor V Leiden mutation
(both this and the next choice could lead to thrombus formation, as they are thrombophilias. However. Factor V Leiden is the most common thrombophilia so it is most likely)
A 23-year old male patient in the intensive care unit has easy bruising and bleeding from venipuncture sites. He has low platelets and fibrinogen. What is this condition?
a) vWF deficiency
b) DIC
c) vitamin k deficiency
d) antiphoshphilipid syndrome
b) DIC
Which of the following drugs activates both circulating and bound plasminogen?
a) Otamixaban
b) Aspirin
c) Streptokinase
d) Leuvocorin
c) Streptokinase
Aspirin is given in low doses to prevent thrombosis. What is the mechanism of action of aspirin?
a. Inhibits platelets cyclooxygenase
b. Accelerates the action of anti-thrombin III
a. Inhibits platelets cyclooxygenase
Which drug inhibits platelets irreversibly?
a) Otamixaban
b) Aspirin
c) Streptokinase
d) Leuvocorin
b) Aspirin
How does heparin work?
a. Inhibits platelets cyclooxygenase
b. Accelerates the action of anti-thrombin III
b. Accelerates the action of anti-thrombin III
Which protease starts the common pathway?
a. Xa
b. IXa
c. VIIa
a. Xa
A 16-year-old girl suffers from recurrent easy bruising. She has hyper extensible skin and joints. What might be responsible for her condition?
a. Blood vessel disorder (note: ehler danlos syndrome)
Which molecules are responsible for platelet aggregation? a. plasmin
b. ADP and TBXA2
c. serotonin
b. ADP and TBXA2
A 31-year old female was admitted to the hospital with a gram negative bacterial infection. Upon examination, she was found to be septic. She has petechial rashes and easy bruising. CBC shows anemia and low platelets. PBS shows RBC fragments. Her D-dimer is elevated. What is the most likely diagnosis?
a) vWF deficiency
b) DIC
c) vitamin k deficiency
d) antiphoshphilipid syndrome
b) DIC
What would be the consequence of a mutation in the 3’UTR of the prothrombin gene?
a. increase activity of factor V leiden
b. Stabilization of Prothrombin mRNA
c. Protein C becomes inactive
d. DNA of antithrombin becomes more active
b. Stabilization of Prothrombin mRNA
What is the consequence of rearrangement of the hemophilia A gene? A) gene deactivation, severe hemophilia B) gene duplication, mild hemophilia C) gene mutation, severe hemophilia D) gene deletion, mild hemophilia
A) gene deactivation, severe hemophilia
A 35-year old woman developed a pulmonary thromboembolism. She has a history of a still-birth at 6 months. Her PT and APTT are normal and she is positive for lupus anticoagulant. What is the most likely diagnosis?
A) Antiphospholipid syndrome
B) DIC
C) TTP
A) antiphospholipid syndrome
A 19-year old was brought by her mother to the hospital for a bleeding disorder. What would indicate that her bleeding is due to a platelet problem and not a coagulation problem?
a. Excessive menstrual bleeding
b. Having received fresh frozen plasma in the past joint swelling
c. Bleeding several hours after a tooth extraction
a. Excessive menstrual bleeding
A patient with a history of thromboembolism with prolonged APTT not corrected with normal plasma. What is the diagnosis?
a. Factor V deficiency
b. Lupus anticoagulant
b. Lupus anticoagulant
Why is vitamin K important?
Carboxylates glutamate
What causes thrombophilia in a patient with factor V Leiden mutation?
a. It becomes resistant to protein C
b. It becomes more sensitive protein C
a. It becomes resistant to protein C
A premature neonate presents with prolonged bleeding from his umbilical stump. He has prolonged PT and APTT. What is the most likely cause?
a) vWF deficiency
b) DIC
c) Vitamin k deficiency
c) Vitamin k deficiency
A patient presents with a petechial rash and fatigue. CBC reveals reduced platelets and Hb. PBS reveals fragmented cells. His coagulation profile is normal. What is the most likely diagnosis?
A) antiphospholipid syndrome
B) DIC
C) TTP
C) TTP
A person is complaining of a severe asthmatic attack. His WBCs are elevated. What would you expect to be elevated in the differential count?
a. neutrophils
b. blasts
c. eosinophils
d. promyelocyte
c. eosinophils
Which of the following is an antibacterial substance found in neutrophilic granules?
Lactoferrin
Which of the following is an antibacterial substance found in eosinophilic granules?
a. Major basic protein
b. Cationic protein
a. Major basic protein
Which of the following is responsible for mast cell degranulation?
a. IgA
b. IgE
c. IgM
b. IgE
Which of the following cells is phagocytic but is independent of phagocytosis in its immune function?
a. Promyelocytes
b. Neutrophils
c. Blasts
d. Eosinophils
d. Eosinophils
What is the function of the ETO/AML1 fusion protein?
a) transcription factor
b) TNF
c) tyrosine Kinase inhibitor
a) transcription factor
What is given to patients to recover from drug-induced suppression of myelopoietic activity?
a. CSF
b. Interferon
a. CSF
What is the best sample used for the detection of the Philadelphia chromosome?
a. Peripheral cells
b. Bone marrow aspirate
b. Bone marrow aspirate
What is the first morphologically recognizable cell of the myeloid series?
a. Myeloblast
b. Neutrophils
c. Blasts
d. Eosinophils
a. Myeloblast
What is the most common abnormality found in MDS?
a. necrotic bone marrow and ineffective hematopoiesis
b. fibrotic bone marrow and bone marrow infiltration
c. hypercellular bone marrow and reduced cell counts
c. hypercellular bone marrow and reduced cell counts
A 45-year old male presents with epistaxis and fatigue. His CBC shows pancytopenia. The PBS shows circulating immature cells. What is the pathogenesis of this condition?
a. Acute leukemic infiltration
b. Aplastic anemia
c. CML
a. Acute leukemic infiltration
A patient presents with fever, petechial, shortness of breath, and fatigue. He has splenomegaly. His PBS shows circulating immature cells with intracytoplasmic rods. What is the most likely diagnosis?
a. CML
b. AML
c. MDS
b. AML
A patient presented with thrombosis in the deep veins of his right leg following a long flight. His CBC reveals grossly elevated platelets (1350) with normal Hb and WBC count. What would you expect to find in the bone marrow of this patient?
Megakaryocytic hyperplasia
A patient with prostate cancer suffers from anemia and epistaxis. His CBC shows pancytopenia. What is the cause of his condition?
a. Bone marrow hypoplasia
b. Bone marrow hyperplasia
a. Bone marrow hypoplasia
What is the consequence of the BCR-ABL translocation?
a. Makes the cell less sensitive to growth factors
b. Makes the cell more sensitive to growth factors
b. Makes the cell more sensitive to growth factors
A patient has a transfusion dependent anemia. His CBC showed pancytopenia. His PBS showed macrocytes and hypolobated neutrophils. What is the diagnosis?
a. CML
b. AML
c. MDS
c. MDS
A patient was found to have elevated leukocyte count and basophilia in his CBC. His PBS showed granulocytic leukocytosis with circulating myelocytes and mature neutrophils. What is the pathogenic mechanism of this condition?
a. inactivation of tyrosine kinase
b. Activation of tyrosine kinase
b. Activation of tyrosine kinase
What results in the progression of chronic myelogenous leukemia to the acute blast phase?
Trisomies
A patient showed leukocytosis and basophilia. What is this condition?
a. CML
b. AML
c. MDS
a. CML
A patient presents with fever, easy bruising, and hepatosplenomegaly. CBC shows low WBCs, platelets, and Hb. PBS shows immature cells. What is the diagnosis?
Acute leukmemia
What is used by granulocytes to opsonize bacteria? A) Complement fragments B) Immunoglobulins D) Fc receptors E) Defensins
D) Fc receptors
Which is an anti-bacterial peptide released by neutrophils? A) Complement fragments B) Immunoglobulins D) Fc receptors E) Defensins
E) Defensins
A Patient came to the hospital complaining of recurrent chest infections, epistaxis, fatigue, and shortness of breath. His CBC shows low Hb, thrombocytopenia, and leukocytosis. His peripheral blood smear shows mature lymphocytes and spherocytic red blood cell morphology. What is the reason for his recurrent infections?
a. neutrophil dysfunction
b. hypogammaglobulinemia
b. hypogammaglobulinemia
Where does tolerance for the deletion of self-reactive B-cells occur?
a. Spleen
b. Liver
c. Bone marrow
c. Bone marrow
What is the function of the white pulp of the spleen?
The production of lymphocytes
A patient complains of fever and unexplained weight loss. He also has lymphadenopathy. Lymph node biopsy shows a follicular pattern. Which test would you use to diagnose this condition?
a. fluorescence in-situ hybridization
b. cytochemical staining
c. peripheral blood smear
a. fluorescence in-situ hybridization
A Patient came to the hospital complaining of recurrent chest infections, epistaxis, fatigue, and shortness of breath. His CBC shows low Hb, thrombocytopenia, and leukocytosis. His peripheral blood smear shows mature lymphocytes and spherocytic red blood cell morphology. What is the mechanism of anemia?
Auto-immune hemolysis
A 60 year old male complains of weight loss. Examination reveals lymphadenopathy. A biopsy of the lymph node shows a nodular pattern with bi-nucleated cells. What is the causative agent?
a. EBV
b. Ionizing radiation
a. EBV
EBV can cause hodgkin’s lymphoma, which is the diagnosis of this case
A 65-year old female complains of fever and night sweats. Imaging reveals the presence of mediastinal lymph node enlargement. A biopsy reveals the presence of bi-nucleated cells with prominent nucleoli that are CD15 and CD30 positive. What is the most likely diagnosis?
a. Non Hodgkin’s lymphoma
b. Hodgkin’s lymphoma
c. MDS
b. Hodgkin’s lymphoma
Which is a prodrug that causes hemorrhagic cystitis?
a. Imatinib
b. Methotrexate
c. Cyclophosphamide
c. Cyclophosphamide
Which of the following is a tyrosine kinase inhibitor?
a. Imatinib
b. Methotrexate
c. Cyclophosphamide
a. Imatinib
What is a characteristic of alkylating antineoplastic drugs used in the treatment of hematological malignancies?
a. Disrupt protein folding
b. Act on proliferating and non-proliferating cells
c. Act on proliferating cells only
b. Act on proliferating and non-proliferating cells
Which of the following is a dihydrofolate reductase inhibitor?
a. Imatinib
b. Methotrexate
c. Cyclophosphamide
b. Methotrexate
Which of the following confirms the diagnosis of multiple myeloma?
a. Reduced bone density
b. low calcium levels
c. polyclonal increase in gamma globulins
d. Increased serum protein concentration
e. Bence-jones protein in the urine
e. Bence-jones protein in the urine
remember: it is lytic bone lesions on an x-ray. Reduced bone density doesn”t necessarily indicate multiple myeloma
A patient presented with unexplained weight loss and lymphadenopathy. He was found to have the t(14,18) translocation. What is the diagnosis?
Follicular lymphoma
Which of the following is true regarding MGUS?
a. It is a benign condition
b. It is not associated with clinical symptoms
c. Plasma cells are found at a concentration of more than 10% in the bone marrow
d. 50% progress to plasma cell myeloma
b. It is not associated with clinical symptoms
A patient with splenomegaly. PBS shows increased mature lymphocytes and smudge cells. What is the diagnosis?
a. AML
b. CML
c. MDS
b. CML
Compared to high grade lymphoma, what is a characteristic of indolent (low grade) lymphoma?
a. rapid progeression and usually terminal
b. slowly progressing but more difficult to cure
b. slowly progressing but more difficult to cure
