2012 Block A Flashcards
Splenectomy offers a clinical cure in:
a. Autoimmune Hemolytic Anemia
b. Hereditary Spherocystosis
c. Thalassemia Major
d. G6PD Deficiency
B
The definitive diagnostic procedure for Thalassemia is:
a. Coomb’s Test
b. Osmotic Fragility Test
c. Hemoglobin Electrophoresis
d. Ham’s Test
C
In the presence of prolonged neonatal jaundice, with exposure to naphthalene balls, one should consider:
a. G6PD Deficiency
b. Autoimmune Hemolytic Anemia
c. Thalassemia Major
d. Neonatal Hepatitis Syndrome
A
This hemoglobin is markedly increased in Beta Thalassemia Major:
a. HbA1
b. HbA2
c. HbH
d. HbF
B & D
The definitive diagnostic procedure for Hereditary Spherocytosis is:
a. Coomb’s Test
b. Osmotic Fragility Test
c. Ham’s Test
d. Hemoglobin Electrophoresis
B
The aim of hypertransfusion and supertransfusion in Thalassemia Major is:
a. To increase the patient’s iron stores
b. To increase the patient’s serum iron
c. To improve the patient’s anemia
d. To suppress erythropoiesis in the marrow
D
Patient with hemolysis, cranio facial changes, with frequent blood transfusions and stunted growth:
a. Is a silent carrier
b. Has a thalassemia trait
c. Has thalassemia intermedia
d. Has thalassemia major
D
Why is crossmatching done before transfusion?
a. To detect alloantibodies present in the recipient
b. To prevent alloimmunization
c. To detect alloantibodies in the recipient
d. To prevent sensitization of the patient
B
The 4 allele deletion in Alpha Thalassemia that is incompatible with life is:
a. Silent Carrier
b. Thalassemia Trait
c. Hemoglobin H Disease
d. Hydrops Fetalis
D
At birth fetal red cells contain 53 to 95%:
a. HbA1
b. HbA2
c. HbH
d. HbF
D
What risk do neonates have when they receive directed donations from first degree relatives:
a. Acute hemolytic reaction
b. Transfusion-associated GVHD
c. Febrile reaction
d. Allergic reaction
B
Which one is not an indication for exchange transfusion in neonates?
a. Rh incompatibility
b. Iron Deficiency Anemia
c. ABO incompatibility
d. Sepsis
B
Which statement is not true regarding transfusion in neonates?
a. The antibody-producing mechanisms and cellular immune system of neonates are mature.
b. Hypothermia in the newborn causes adverse metabolic effects.
c. Transfusion in neonates is different and unique.
d. The newborn does not compensate for hypovolemia as well as an adult.
A
Most common cause of fatal transfusion reactions worldwide:
a. Clerical error
b. Transfusion related acute lung injury
c. Congestive heart failure secondary to overload
d. Febrile non-hemolytic transfusion reaction
A
Reason/s to temporarily defer a blood donor from donating blood:
a. Ear piercing within 6-12 months
b. Major surgery 5 years ago
c. Chemotherapy for Hodgkin’s Lymphoma 5 years ago, patient in remission
d. History of treated venereal disease
A & D
Indication to irradiate blood:
a. Third degree relative blood donor
b. History of frequent allergic reactions to blood transfusion
c. History of febrile non-hemolytic transfusion reactions
d. Blood donor with history of asthma
A
These tests may be most informative in diagnosing Paroxysmal Nocturnal Hemoglobinuria:
a. Ham’s Test and Sucrose Lysis Test
b. Immunophenotyping and FISH
c. Erythropoietin Assay and Coomb’s Test
d. Chromosomal Analysis
A
Mechanism of action of Cyclosporine in Aplastic Anemia:
a. Reduces cytotoxic T cells
b. Inhibits interleukin 2 production by T lymphocytes
c. Modulates adverse reactions to ATG
d. Stimulate production of erythropoietin
D
Site of maximum iron absorption:
a. Stomach
b. Duodenum
c. Distal ileum
d. Colon
B
A 6 year old child with 4 year history of easy bruisability is brought to PGH with multiple purpuras on both shins and forearms. The rest of the PE is unremarkable. You think it is normal bruising of childhood, but the parents are concerned. If bleeding is spontaneous, what would you expect to see?
a. Bruise out of proportion to degree of trauma
b. Bleeding from a cut lasting 30 seconds
c. Hematomas after immunizations
d. A and C
D
You decide to order screening tests. Which one will you order?
a. CBC, Platelets, Clotting Time, Bleeding Time, Clot Retraction Time
b. CBC, Platelets, Prothrombin Time, Partial Thromboplastin Time
c. CBC, Platelets, Bleeding Time
d. CBC, Platelets
B
Hemophilia A is:
a. X-Linked
b. Autosomal Dominant
c. Autosomal Recessive
d. Not a familial disease
A
15 year old boy with LLQ pain; HR 120 bpm; BP 80/60. Family history includes 2 uncles who died of a bleeding disorder. Your differential diagnosis would include the following except:
a. Acute appendicitis
b. Urinary Tract Infection
c. Iliopsoas Bleed
d. Acute Peptic Ulcer Disease
D
Your primary working impression is:
a. Von Willebrand Disease
b. Platelet Function Defect
c. Acute Immune Thrombobytopenic Purpura
d. Hemophilia A
D
Management would include the following except:
a. FWB transfusion
b. Cryoprecipitate
c. Platelet concentrate transfusion
d. Pain medication
D
Which of the following is true about hemophilia?
a. Clinical features of Hemophilia A and B are indistinguishable
b. Mild hemophilia would present with spontaneous bleeding
c. Gum bleeds and epistaxis occur in hemophilia
d. There is no such thing as a female hemophilia
A
Which of the following will present with a decreased Platelet, prolonged Prothrombin Time, prolonged Partial Thromboplastin Time?
a. Acute Immnue Thrombocytopenic Purpura
b. Disseminated Intravascular Coagulation
c. Hemophilia
d. Vitamin K Deficiency
B
Which among the following is consistent with a platelet type of bleeding?
a. Local measures are effective to stop the bleeding
b. Bleeding may last for days
c. Bleeding within the muscles is often
d. Hemarthrosis is common
A
Liver disease can impair hemostasis and cause bleeding by which of the following mechanism?
a. Increase levels of intrinsic pathway inhibitor
b. Dysfibrinogenemia
c. Increase levels of anti-thrombin III
d. Marked thrombocytosis
B
Which characterizes bone marrow with AITP?
a. Presence of marked reticulin formation
b. Megakaryoctes increased
c. Cellularity of bone marrow decreases
d. Presence of atypical non-hematologic cell
B
The following are complications of hyperleukocytosis except:
a. Pulmonary edema
b. Stroke
c. Metabolic acidosis
d. Hypercalcemia
D
In tumor lysis syndrome, the following metabolic imbalances are encountered except:
a. High Potassium
b. High Phosphate
c. High Calcium
d. High Uric Acid
C
The peak age for ALL is:
a. 2 to 5 years of age
b. 0 to 1 year
c. 10 to 14 years of age
d. 7 to 10 years of age
A
The most frequent subtype of ALL in children:
a. T cell ALL
b. L1
c. L2
d. B precursor ALL
e. Mature B cell ALL
D
These patients have “standard risk” ALL
a. Infants <50,000/mm3
c. Positive for CNS leukemia
d. Positive for Philadelphia chromosome
NA
The following is an adverse prognosis factors in ALL
a. DNA index > 1.16 or hyperdiploidy
b. Age 1-9 years at diagnosis
c. Rapid early response
d. Age > 10 years at diagnosis
A
Thawed fresh frozen plasma cannot be refrozen because
a. It is potentially infected
b. It has lost the activity of most of the coagulation factors
c. The plastic bag is already brittle
d. Cytokines are released in the process
B
Which of the following is true of AML?
a. All patients should have HLA matched sibling BMT once in remission for cure
b. Patients with good prognosis have favorable cytogenetics such as inv (16) and t(15;17)
c. The cure rate in the US is 80% similar to ALL
d. The total duration of chemotherapy is 2 to 3 years
e. Age is a strong prognostic factor
B
Disseminated Intravascular Coagulation is a common presentation of:
a. ALL
b. JMML
c. AML M3
d. AML M6
C
Acquired Aplastic Anemia appears to be caused largely by:
a. Stem cell defect
b. Stromal defect
c. Immune-mediated
d. Decreased in hematopoietic growth factors
B
Hematopoiesis in patients with Aplastic Anemia is reflected by:
a. Increased number of CD34+ cells
b. Decreased levels of IFN gamma
c. Decreased hematopoietic colony formation
d. Decreased levels of TNF
C
The diagnosis of Aplastic Anemia should be questioned in the presence of:
a. Splenomegaly
b. Increased mast cells in the marrow
c. Normal marrow reticulin
d. Macrocytosis
A
Infection that has been implicated I the causation of Aplastic Anemia:
a. Tuberculosis
b. Malaria
c. Ebstein-Barr virus
d. Coxsackie virus
C
An inherited bone marrow failure state that results in Aplastic Anemia as well as skeletal abnormalities and renal dysfunction is:
a. Fanconi Anemia
b. Dyskeratosis Congenita
c. Schwachmann-Diamond Syndrome
d. Diamond-Blackfan Syndrome
NA
What is the currently recommended immunosuppressive regimen for severe Aplastic Anemia?
a. Cyclosporine
b. Antithymocyte Globulin
c. Cyclosporine and Antithymocyte Globulin
d. Cyclophosphamide
C
The finding of this cytogenetic abnormality may herald the clonal evolution in Aplastic Anemia:
a. Trisomy 7
b. Monosomy 7
c. Monosomy 8
d. Inversion 16
B
The most common cytogenetic abnormality in Myelodysplastic Syndrome (MDS) involves chromosome #:
a. 5
b. 7
c. 8
d. 20
NA
The best way to distinguish between Aplastic Anemia and MDS is:
a. Cellularity of the bone marrow
b. Severity of pancytopenia
c. Abnormal karyotype
d. All of the above
A
The following are the most important variables in the disease outcome of MDS except
a. Number of blast in peripheral blood
b. Number of blast in bone marrow
c. Cytogenetic abnormality
d. Severity of cytopenia
A
Anemia of chronic renal failure:
a. Usually microcytic, normochromic
b. Erythropoietin deficiency is usually seen when creatinine is >2 mg/dl
c. Supplemental iron should be avoided as much as possible
d. Erythropoietin alpha dose of 50-75 U/kgbw per week is usually required
B
Anemia of chronic disease:
a. Reticulocyte count is usually normal or increased
b. Iron level is normal
c. Iron-binding capacity is increased
d. Ferritin value is elevated
In anemia of chronic disease:
Inc ferittin, dec reticulocyte count, iron levels and total iron binding capacity (Bone marrow failure trans)
D
The proposed mechanism for anemia of chronic inflammatory condition include:
a. Increased red cell survival
b. Decreased responsiveness to erythropoietin
c. Decreased levels of erythropoietin
d. All of the above
B
Which drug is useful in Multiple Myeloma but not in Lymphomas?
a. Prednisone
b. Rituximab
c. Thalidomide
d. Doxorubicin
A
Which cell is clonal in Hodgkin’s disease?
a. B cell
b. T cell
c. NK cell
d. Reed Sternberg cell
D
What describes the clonal cell in Multiple Myeloma?
a. Bilobed nucleus with prominent eosinophilic nucleoli
b. Large mononuclear cell fine chromatin material with minimal cytoplasm
c. Round cell with round indented nucleus and perinuclear clearing
d. Small round cell with clumped chromatin material and minimal to moderate cytoplasm
C
What is included in the “B symptoms” of Lymphomas?
a. Pruritus
b. Jaundice
c. Weight loss
d. Anorexia
C
Which anemic patient with high creatinine likely has multiple myeloma?
a. Normal serum calcium and high uric acid
b. High serum calcium and lytic lesions on bone scan
c. >3% plasma cell on bone marrow aspirate and lytic lesion on skeletal survey
d. 10% plasma cells on bone marrow aspirate and elevated serum Ig
C
In Multiple Myeloma, prognosis is best correlated with:
a. CRP and Beta microglobulin
b. LDH and Serum creatinine
c. ESR and LDH
d. Serum calcium and LDH
A
Lymphomas and Multiple Myeloma are disorders of which lineage?
a. Myeloid
b. Lymphoid
c. Unknown
d. Stromal cells
B
The process whereby selected blood components are directly collected from a donor is:
a. Compatibility testing
b. Apharesis
c. Leukoreduction
d. Phlebotomy
NA
When a suspected hemolytic reaction occurs, the first thing to do is:
a. Slow the transfusion rate and call the physician
b. Administer medication to stop the reaction
c. Stop the transfusion but keep the intravenous line open
d. First inform the laboratory to begin an investigation
C
The best specimen for diagnosis of Aplastic Anemia is:
a. Peripheral blood
b. Bone marrow aspirate
c. Bone marrow core biopsy
d. Bone marrow clot section
C
Sever Iron Deficiency Anemia would manifest with:
a. Normochromic, normocytic red cells
b. Hypochromic, normocytic red cells
c. Normochromic, microcytic red cells
d. Hypochromic, microcytic red cells
D
Rouleaux formation is seen in conditions like:
a. Iron Deficiency Anemia
b. Lymphoma
c. Sickle Cell Anemia
d. Multiple Myeloma
D
Schistocytes are commonly associated with:
a. A blood-borne helminth
b. Aplastic Anemia
c. Polycythemia
d. Disseminated Intravascular Coagulopathy
NA
On a peripheral blood smear, red cells will normally have a central pallor that occupies:
a. 1/3 of its diameter
b. ½ of its diameter
c. 2/3 of its diameter
d. ¾ of its diameter
A
The presence of Auer rod is definite evidence that the cell is:
a. Leukemic
b. Immature
c. Myeloid
d. Differentiated
C
According to the WHO classification, the diagnosis of Acute Myelogenous Leukemia requires the presence of _____ blasts in the marrow:
a. > 10%
b. > 20%
c. > 30%
d. > 40%
B
Anemia in Multiple Myeloma is largely due to:
a. Intravascular hemolysis
b. Myeloid stem cell defect
c. Marrow replacement by neoplastic cells
d. Depletion of iron stores
NA
Bone marrow involvement by chronic lymphocytic leukemia will manifest as:
a. Loss of myeloid and lymphoid precursors
b. Hypercellular marrow with lymphoblasts
c. Ineffective hematopoiesis
d. Lymphoid aggregates
NA
Pregnant women should routinely be given iron because:
a. The fetus needs iron
b. The mother has lost iron from her previous monthly menses
c. She will lose blood when she delivers
d. All of the above
A
The gold standard in the diagnosis of Iron Deficiency Anemia is:
a. Bone marrow aspiration/ bone marrow iron store
During the first week of treatment with oral iron which laboratory parameter should be taken?
a. Hemoglobin
b. Hematocrit
c. Reticulocyte count
d. Red cells indices
C
The duration of treatment with iron is usually six (6) months because:
a. The body’s iron stores have to be replenished
b. This will cover the future occurrence of bleeding
c. This will facilitate more absorption of iron
d. All of the above
A
Parenteral iron is given if:
a. Rapid increase in hemoglobin (Hb) is desired
b. Malabsorption syndrome exists
c. The patient requests for it
d. Rapid utilization of iron by the body
B
Oral iron is given for 6 months to:
a. Replenish iron stores
b. Increase chance of absorption
c. Sdress possible future blood loss
d. All of the above
A
A donor who has ingested aspirin on the day of donation is temporarily deferred because:
a. He has fever
b. He is infected
c. Aspirin alters the quality of platelets
d. Aspirin causes a hypercoagulable state
C
This is a case for permanent deferral of a blood donor:
a. Upper respiratory infection
b. Hepatitis B
c. Fever
d. Ingestion of contraceptive pill
B
Why is type O considered a universal donor?
a. It does not contain agglutinogens A and B
b. It does not contain anti A and B antibodies
c. It is the most common blood type
d. It is easy to procure
A
What s the purpose of doing a crossmatch before transfusion?
a. To detect autoantibodies present in the recipient
b. To prevent alloimmunization
c. To detect alloantibodies in the recipient
d. To avoid sensitization of the recipient
B
Why should you not give Rh (+) to a Rh (-) patient?
a. To prevent incompatibility
b. To prevent alloimunization to D antigens
c. To prevent immediate post transfusion reactions
d. To prevent infection
B
Thawed fresh frozen plasma (FFP) cannot be refrozen because:
a. It is potentially infected
b. It has lost the activity of most of the coagulation factors
c. The plastic bag is already brittle
d. Cytokines are released in the process of thawing
B
Elderly patients who develop deep vein thrombosis should be worked up for:
a. Vasculitis
b. Malignancy
c. Atherosclerosis
d. Liver cirrhosis
B
The most serious complication of deep vein thrombosis is:
a. Myocardial infarction
b. Cerebrovascular thrombosis
c. Peripheral vascular disease
d. Pulmonary embolism
D
Arterial thrombosis occurs when:
a. There is an increase in the circulatory coagulation factors
b. Prolonged immobilization
c. Damage to the endothelium of blood vessel
d. AOTA
C
The initiating event in the formation of arterial thrombosis is:
a. Activation of Factor X
b. Adherence of platelets to damaged blood vessels promoting aggregation
c. Activation of anti-thrombin III
d. Increased synthesis of prothrombin
B
Important “sanctuary” sites for acute lymphoblastic leukemia are:
a. Liver and spleen
b. Lymph nodes and CNS
c. Testes and CNS
d. Lymph nodes and liver
C
The key organ in the pathophysiology of Chronic Immune Thrombocytopenic Purpura (ITP) is:
a. Bone marrow
b. Liver
c. Spleen
d. Kidneys
C
(+) Anti A testing reagent
(-) Anti B testing reagent
Blood Type?
Type A
(-) Anti A testing reagent
(+) Anti B testing reagent
Blood Type?
Type B
(-) Anti A testing reagent
(-) Anti B testing reagent
Blood Type?
Type O
(+) Anti A testing reagent
(+) Anti B testing reagent
Blood Type?
Type AB
