2016 Block B Flashcards by Aldwin Arceo

Severe aplastic anemia is defined by the following features except:

a. Hemoglobin count is less than 100
b. Corrected Reticulocyte count is less than 1%
c. Absolute neutrophil count is less than 500
d. Platelet count is less than 20 000

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The following is not a prognostic variable in the International Prognostic Scoring System for Myelodysplastic syndrome:

a. Age of diagnosis
b. Bone marrow blast
c. karyotype
d. cytopenia

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The bone marrow of patients with MDS usually show the following except:

a. Dyserythropoietic changes seen as megaloblastoid and multinucleated red cell precursors
b. Small megakaryocytes showing bizarre lobulation
c. Myeloid dyspoiesis seen as hypogranularity and hypersegmentation
d. None of the above

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The Durie-Salmon Staging for Multiple Myeloma has the following number of stages:

a. 1
b. 2
c. 3
d. 4

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The stage of Non-Hodgkin’s lymphoma that involves the mediastinum and the neck nodes alone:

a. 1
b. 2
c. 3
d. 4

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This classification of Hodgkin’s lymphoma belongs to belongs to the new classification but was not included in the old classification

a. Nodular lymphocyte predominate

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This drug is useful in multiple myeloma but not in Lymphoma:

a. Prednisone
b. Rituximab
c. Thalidomide
d. Doxorubicin

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This cell is clonal in Hodgkin’s disease

d. reed-sternberg

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The clonal cell in multiple myeloma is?

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.

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The following is a “B symptoms” of lymphoma?

a. Pruritus
b. Jaundice
c. Weight Loss
d. Anorexia

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The following is associated with relatively better prognosis in Multiple Myeloma

b. Normal karyotype

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The following 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. > 30% plasma cell on bone marrow aspirate and lytic lesions on skeletal survey
d. 10% plasma cell on bone marrow aspirate and elevated serum Ig

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In Multiple Myeloma, prognosis is best correlated with?

a. CRP and B microglobulin
b. LDH and serum creatinine
c. ESR and LDH
d. serum calcium and LDH

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Lymphoma and Multiple Myeloma are disorder of what lineage? (2012, 2014)

a. Myeloid
b. Lymphoid
c. Unknown
d. Stromal Cells

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A 6 year boy comes to your clinic with a 4 year history of easy bruisability. Your physical examination shows 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.

Clinically significant bleeding would be:

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

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The parents asked you to work-up their son but their funds are limited and you can only do 1 test. What test will you order?

A. Test for von Willebrand disease

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Von willebrand Disease is:

a. X-linked recessive
b. Autosomal dominant
c. Autosomal recessive
d. X-linked dominant

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Hemophilia A is:
A. X-linked
b. Autosomal Dominant
c. Autosomal Recessive
d. Not a familial disease

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A 15 year old male comes to the emergency room with severe RLQ abdominal pain with tenderness; HR 140 bpm; BP 80/60. He remembers being told of having 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

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Initial Laboratory results reveal: Hemoglobin – 68, WBC – 9, Platelets – 260; Prothrombin time – 1.02, PTT – 248 seconds. Your primary working impression is:

a. Von Willebrand Disease
b. Platelet Function Defect
c. Acute Immune Thrombobytopenic Purpura
d. Hemophilia A

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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

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To evaluate a prolonged prothrombin time or PTT the following test is/are preformed:

A. Mixing test

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The following presents 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

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The protein involved in platelet production is:

C. Thrombopoietin

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Each megakaryocyte seen in the bone marrow gives rise to:

B. 10, 000 platelets *** (protested)

The following describes a normoreactive bone marrow in a healthy patient with thrombocytopenia secondary to drug use.

C. Decreased in megakaryocte number.

The coagulation factor that is inhibited by protein C and its cofactor Protein S is

C. Activated factor 8

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

The mechanism behind the thrombocytopenia in Immune Thrombocytopenia Purpura is:

D. Increase platelet destruction in the peripheral blood

Thrombocytopenia associated with HIV is best characterized by: a. Megakaryocytes in the bone marrow are infected. b. There is no improvement in platelet count with anti-viral drugs c. There is complement deposition in the megakaryoblasts d. ADAMTS13 levels are high

The following describes the destruction of platelet function in uremia: a. There is a marked increase in thromboxane A2 leading to a decrease in platelet aggregation b. The accumulation of hydrophenolic acids lead to increase alpha 2 beta 3 activity c. The cyclooxygenase pathway is markedly diminished d. The accumulation of guanidinosuccinate acid leads to glycoprotein 2b 3a dysfunction.

The most profound hemostatic disorder in cardiac surgery is:

a. platelet aggregation defects.

Liver disease can impair hemostasis and cause bleeding due to? a. Increase levels of intrinsic pathway inhibitor b. Dysfibrinogenemia c. Increase levels of anti-thrombin III d. Marked thrombocytosis

Hemophiliacs with recurrent bleeding who are multiply transfused with factor 8 inhibitors. Which of the following best describes this inhibitors?

c. Immunoglobulin G

36. The primary problem in thrombotic thrombocytopenic purpura is

b. The circulating large multimers of von Willebrand factor

The best way to treat a case of Disseminated Intravascular Coaguation is?

B. Treat the etiology

The most common cause of fatal transfusion reaction worldwide: a. clerical errors b. improper refrigeration c. overheated blood d. mechanical trauma

Primary site of erythropoietin production in feta life is:

a. hepatic

Rate of plasma iron turnover of blood to maintain normal hemostasis?

a. 0.38mg

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

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

Site of maximum iron absorption: a. Stomach b. Duodenum c. Distal ileum d. Colon

Micocytic type of cells with low serum iron with normal or increased bone marrow iron stores is found in:

c. anemia of chronic disease

Anemia of inflammation:

b. Increase vessel destruction from activation of host factors

Most prevalent hemoglobinopathy in southeast asia

c. Hemoglobin E

The hallmark of the common course of alpha Thalassemia:

d. Low Hemoglobin A2

Main regulator of Iron homeostasis:

a. Hepcidin

Deferoxamine and other iron chelating compounds have the following characteristics:

c. Poorly absorbed from the Gut

Definitive management may be achieved through splenectomy

a. Hereditary spherocytosis

Response following parenteral vitamin B12 administration in a deficient patient

d. Reticulocytosis in 1 week

Acquired aplastic anemia appears to be largely caused by: a. immune mediated mechanism b. loss of hematopoietic stem cells due to DNA damage c. low threshold for apoptosis d. NOTA

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

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

Infection that has been implicated I the causation of Aplastic Anemia:*** a. Tuberculosis b. Malaria c. Ebstein-Barr virus d. Coxsackie virus

An inherited bone marrow failure state that results in aplastic anemia as well as skeletal abnormalities and renal dysfunction: a. Fanconi's anemia b. Dyskeratosiscongenita c. Schwachmann-Diamond syndrome d. Diamond-Blackfan syndrome

An inherited cause of bone marrow failure with the least tendency to progress to leukemia a. Fanconi'sanemia b. Dyskeratosiscongenita c. Schwachmann-Diamond syndrome d. Diamond-Blackfan syndrome

The currently recommended immunosuppressive regimen for severe Aplastic Anemia? a. Cyclosporine b. Antithymocyte Globulin c. Cyclosporine and Antithymocyte Globulin d. Cyclophosphamide

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

The definitive diagnostic procedure for thalassemia is: a. Coomb’s test b. osmotic fragility test c. Ham’s test d. hemoglobin electrophoresis

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

This haemoglobin is markedly increased in beta thalassemia major: a. Hb A1 b. Hb A2 c. Hb H d. Hb F

The definitive diagnostic procedure for Hereditary Spherocytosis is a. Hgb electrophoresis b. Ham’s Test c. Osmotic Fragility Test d. Coomb’s Test

The aim of hypertransfusion and supertransfusion in thalassemia major is: a. to increase the patient’s Hgb level b. to increase patient’s RBC in the blood c. to increase the patients iron stores d. to suppress erythropoiesis in the marrow

The mode of inheritance of Hereditary spherocytosis is usually:

a. Autosomal dominant

A 4 year old male child has haemolytic anemia characterized by frequent transfusions every 2 months, huge splenomegaly, craniofacial changes and stunting of growth. He most commonly has: a. silent carrier b. thalassemia trait c. thalassemia intermedia d. thalassemia major

Failure to give oral folic acid to patients with haemolytic anemia may lead to:

Megaloblastic crisis

Precipitates of denatured hemoglobulin due to oxidant damage seen in the reticulocyte stain of red blood cells in G6PD Deficiency is called:

Heinz bodies

Hematologically, the neonatal stage stems from birth up to:

4 months

At birth fetal red cells contain 53 to 95% ___? a. Hb A1 b. Hb A2 c. Hb F d. Hb H

When neonates receive direct donations from first degree relatives, they are at risk for: a. Acute hemolytic reaction b. Transfusion-associated GVHD c. Febrile reaction d. Allergic reaction

Which one is not an indication for exchange transfusion in neonates? a. Rh incompatibility b. Iron Deficiency Anemia c. ABO incompatibility d. Sepsis

Choice of blood for exchange transfusion in ABO incompatibility: a. Type O Rh positive PRBC b. Type-specific Rh positive FWB c. Type O Rh positive FWB d. Type-specific positive PRBC

Additional hazards in RBC transfusion in neonates:

c. They are at risk for retrolental fibroplasias and CMV infections

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.

At ABO typing, the patient gives the following result of agglutination reactions: Patient cells + Anti-A test reagent → +4 agglutination Patient cells + Anti-B test reagent → +4 agglutination Patient serum + type A RBCs → negative Patient serum + type B RBCs→ negative What is the patient’s blood type?

a. Type AB

Crossmatching: a. Proves that the donor plasma cell is free of irregular antibodies b. Detects the most irregular antibodies on the donor’s RBC that are reactive to the patient’s serum c. Detects most errors in ABO grouping d. Ensures complete safety of the transfusion

Leukocyte reduction filters can do all of the following except:

d. Correct transfusion associated GVHD

The process whereby selected blood products are directly collected from the donor is called:

c. Apheresis

Transfused plasma constituents resulting in immediate erythema, itching and hives best signify the following transfusion reactions:

c. allergic

The following transfusion reaction may result from an anamnestic following a second exposure the donor’s RBC

b. Alloimmunization

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 with saline d. first inform the laboratory to begin an investigation

The following is/are symptoms of febrile non-hemolytic transfusion reactions

d. temperature rise of 1 °C with transfusion

Pre transfusion irradiation of all blood products from first degree relatives is done to prevent which of the following a. cytomegalovirus b. transfusion associated graft vs. host disease c. febrile non hemolytic transfusion reaction d. hemolytic transfusion reaction

The following are complications of hyperleukocytosis except: a. Pulmonary edema b. Stroke c. Metabolic acidosis d. Hypercalcemia

In Tumor Lysis Syndrome, the following metabolic imbalances are encountered except:

c. High calcium

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

Which of the following is true for the pediatric age group?

c. The frequency of ALL is approximately 4:1 compared to AML

These patients have “standard risk” ALL a. Infants <50,000/mm3 c. Positive for CNS leukemia d. Positive for Philadelphia chromosome

Which is true regarding the treatment of ALL in children

c. intrathecal chemotherapy is given to all children for CNS prophylaxis against Leukemia

The prognosis of AML depends solely on:

c. The cytogenetic abnormalities of the leukemia clone

Which food is rich in Iron? a. Fruits b. Vegetables c. Red meat d. Fish

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

``` A 36 year old female, married, housewife complains of progressive pain at the leg of 1 week duration. She had just come from a vacation in the province riding a van for 8 hours. No other symptoms. Her only medication is Oral contraceptive pills which she has taken for more than 3 years. Family history is not contributory. She does not smoke or drink alcohol. Right leg swollen at the calf, slightly tender, pain on the right calf and on dorsiflexion What is your impression? a. DVT b. Infected phlebitis c. Preipheral neuropathy d. Myositis of the calf ```

Why are pregnant women predisposed to thrombosis?

a. Because their coagulant factors are physiologically elevated

Cirrhosis can result to thrombosis because?

c. Hepatic clearance of activated coagulation factors is poor.

Elderly patients who develop deep vein thrombosis should be worked up for? a. Vasculitis b. Malignancy c. Atherosclerosis d. liver cirrhosis

Arterial thrombosis occurs when (2012) a. There is an increase in the circulatory coagulation factors b. Prolonged immobilization c. Damage to the endothelium of blood vessels d. increased synthesis of prothrombin