Chapter 9 - Hematologic Toxicology Flashcards
All of the following are true regarding hematopoiesis except….
A. In children, it is confined to the yellow or fatty marrow
B. In adults it is confined to the axial skeleton and proximal humerus and femur
C. Under extreme conditions embryonic patterns may occur
D. The bone marrow is the only blood cell producing organ at birth
A. In children, it is confined to the yellow or fatty marrow
All of the following could be features of megaloblastic anemia except…
A. Low serum B12 or folate
B. Microcystosis (decreased MCV)
C. Pancytopenia
D. Hypersegmented neutrophils
B. Microcystosis (decreased MCV)
All of the following are asso w/ megaloblasice anemia except…
A. Phenytoin
B. ethanol
C. Aspirin
D. Methotrexate
C. Aspirin
All of the following are characteristics of aplastic anemia except…
A. Causation by radiation exposure
B. Peripheral blood pancytopenia
C. Bone marrow hypoplasia
D. Reticulocytosis
D. Reticulocytosis
All of the following have been asso w/ aplastic anemia except…
A. Gold
B. chloramphenicol
C. Acetone
D. Felbamate
D. Felbamate
A defect in the synthesis of the porphyrin ring of heme can produce…
A. Iron precipitation within mitochondria
B. Sideroblastic anemia
C. Accumulation of iron in the bone marrow
D. All of the above
D. All of the above
All of the following are true of carboxyhemaglobin except…
A. Low conc can be cytoprotective during inflammatory stress…
B. Symptoms appear at levels of 3%
C. The oxygen-disassociation curve is shifted to the left
D. Smoking during pregnancy could produce levels in the fetus that decrease tissue oxygenation
B. Symptoms appear at levels of 3%
Methemoglobin can reversibly bind all of the following ions except…
A. Calcium
B. Azide
C. Sulfide
D. Cyanide
A. Calcium
Infectious diseases causing direct hemolysis of red blood cells include all of the following except…
A. Malaria
B. Babesiosis
C. Chlamydial urethritis
D. Bartonellosis
C. Chlamydial urethritis
During oxidative hemolysis of red blood cells, the ferric iron in heme can react with chloride to form a complex called…
A. Heinz bodies
B. Hemin
C. Hemosiderin
D. Beta-2-macroglobulin
B. Hemin
The major enzymes that protect against oxidative injury in red blood cells include all of the following except…
A. Aldehyde reductase
B. superoxide dismutase
C. Glutathione peroxidase
D. NADH-diaphorase
A. Aldehyde reductase
All of the following have been asso w/ ox stress in RBCs except…
A. Primaquine
B. ethanol
C. Dapsone
D. Nitrofurantoin
B. ethanol
Snake venom produces…
A. Oxidative hemolytic anemia
B. Nonoxidative chemical-induced hemolytic anemia
C. Immune hemolytic anemia
D. All of the above
B. Nonoxidative chemical-induced hemolytic anemia
All of the following are mechanisms for drug-induced immune hemolytic anemia except..
A. Hapten
B. Conformational change in erythrocyte membrane
C. Schistocyte formation
D. Drug-induced autoantibody
C. Schistocyte formation
An enzyme that markedly increases in the serum after hemolysis is…
A. Alkaline phosphatase
B. creatine phosphokinase
C. Acid phosphatase
D. Lactate dehydrogenase
D. Lactate dehydrogenase
Eosinophilia is seen in all of the following conditions except…
A. Toxic oil syndrome
B. Contaminated tryptophan preparations
C. Megoblastic anemia
D. Drug allergic reactions
C. Megoblastic anemia
All of the following are true of neutrophils except…
A. A ‘shift to the right’ occurs during major infection
B. serious infections can occur when counts fall below 500/ul
C. G-CSF regulates both PMN production and release from bone marrow
D. Bands and metamyelocytes are immature forms that can appear in the peripheral blood during infection
A. A ‘shift to the right’ occurs during major infection
An inhibition of CXR-chemokine ligand CXCR4 will be expected to…
A. Mobilize stem cells from the bone marrow
B. Mobilize mature neutrophils from BM
C. Treat the myelotoxicity of cancer chemo
D. All of the above.
D. All of the above.
Which of the following is most likely to cause neutropenia?
A. Lithium carbonate
B. Lindane
C. Dexamethasone
D. Hydrocortisone
B. Lindane
All of the following inhibit phagocytosis except…
A. Glucocorticoids
B. Ethanol
C. Iohexol
D. Calcium ion
D. Calcium ion
All of the following are true regarding idiosyncratic toxic neutropenia except…
A. It may or may not be dose related
B. toxicants that do not affect uncommitted stem cells are asso w/ better outcome
C. It usually persists for months after drug withdrawal
D. The immunologic form is more common in women and the elderly
C. It usually persists for months after drug withdrawal
All of the following agents affect stem cells except…
A. Aminopyrine
B. gold
C. Chloramphenicol
D. Phenylbutazone
A. Aminopyrine
Which of the following is true for clozapine-induced agranulocytosis?
A. The incidence, even with frequent monitoring is 6%
B. A genetic predisposition has been established
C. Olanzapine causes agranulocytosis by the same mechanism
D. All of the above
B. A genetic predisposition has been established
All of the following are true of immune neutropenia except…
A. The incidence is considerably higher than immune hemolytic anemia
B. direct antigeanulocyte antibodies are difficult to measure
C. Antigen-antibody reactions can lead to the destruction of peripheral WBCs
D. Propylthiouracil causes neutropenia by this mechanism
A. The incidence is considerably higher than immune hemolytic anemia
Deletions in chromosomes 5 and 7 occur at a low frequency in…
A. AML secondary to alkalating agents
B. AML secondary to benzine
C. AML secondary to topoII inhibitors
D. Non-toxicant and non-chemotherapy-related AML
D. Non-toxicant and non-chemotherapy-related AML
The two conditions most frequently asso w/ drug or chemical exposure is…
A. AML and CLL
B. AML and ALL
C. AML and MDS
D. AML and CML
C. AML and MDS
Current theories on the origin of AML suggest…
A. Its a multievent progression
B. It is caused by an infectious RNA virus
C. In utero exposure to a toxicant is necessary for development
D. None of the above
A. Its a multievent progression
For which of the following drugs is causation data for AML inconclusive?
A. Cyclophosphamide
B. busilfan
C. Chlorambucil
D. None of the above
D. None of the above
There is evidence that xylene causes…
A. CLL
B. CML
C. ALL
D. None of the above
D. None of the above
All of the following are asso w/ heparin-induced thrombocytopenia except…
A. Formation of an immune complex that binds to platelets
B. retroperitoneal hematomas
C. Arterial thrombosis
D. Venous thrombosis
B. retroperitoneal hematomas
Thrombotic thrombocytopenic purpura (TTP) has been asso w/ all of the following except…
A. Cocaine
B. hydrochlorothiazide
C. Ticlopidine
D. Clopidogrel
B. hydrochlorothiazide
All of the following are asso w/ an increased risk of bleeding except…
A. Asprin
B. ibuprofen
C. Vit B6
D. N-methylthiotetrazole ceohalosporins
C. Vit B6
All of the following will decrease bleeding except…
A. Nadolol
B. Aprotinin
C. Aminocaproic acid
D. Transexamic acid
A. Nadolol
All of the following are true of lupus anticoagulates except…
A. They are antibodies that interfere with coag rxns
B. they potentiate procoagulant mechanisms
C. They cause severe bleeding
D. They can be induced by procainamide and hydralazine
C. They cause severe bleeding
All of the following are true of heparin except…
A. Unfractionated heparin causes a higher incidence of thrombocytopenia
B. it causes osteoporosis
C. It crosses the placenta
D. It causes transaminase elevations
C. It crosses the placenta
To detect one adverse event in a clinical trial that occurs at a frequency of 1% at a 95% confidence level, how many test subjects need to be exposed?
A. 100
B. 300
C. 500
D. 1000
B. 300
A hematologic problem detected through postmarketing surveillance was…
A. Bleeding and urokinase
B. acute allergy and streptokinase
C. Aplastic anemia and felbamate
D. Leukopenia and transexamic acid
C. Aplastic anemia and felbamate
A grading system for hematologic toxicity was established in 1979 by…
A. WHO
B. FDA
C. EPA
D. OSHA
A. WHO
Serial blood and bone marrow sampling is best done in…
A. Hamster
B. rat
C. Dog
D. Mouse
C. Dog
All of the following are advantages of in vitro bone marrow assays except…
A. Can examine effects on myeloid, erythroid and platelet precursors
B. can predict pharmacokinetics in humans
C. Can examine combinations of chemicals
D. Can make interspecies comparisons
B. can predict pharmacokinetics in humans
A chemical causing nonoxidative chemical-induced hemolysis of red blood cells is…
A. Hydrogen sulfide
B. arsine
C. Ozone
D. Xylene
B. arsine
Drug-induced immunohemolytic anemia is asso w/ all of the following except…
A. Alpha-methyldopa
B. Warfarin
C. Penicillin
D. Quinidine
B. Warfarin
The hemolytic uremic syndrome has been linked to…
A. Endotoxin-producing P. aeruginosa
B. Tetrodotoxin
C. Emetic toxins from B. cerus
D. Verocytotoxin from E. coli
D. Verocytotoxin from E. coli
Acetominophen overdose would affect the clotting factor with the shortest half-life, which would be…
A. II
B. VII
C. IX
D. X
B. VII
All of the following are asso w/ warfarin except…
A. Hepatitis
B. congenital abnormalities
C. Bone demineralization
D. Skin necrosis
A. Hepatitis
All of the following are true of methemoglobin except…
A. Methylene Blue is not an effective antidote in G6PD deficiency
B. the predominant detoxication pathway involves methemoglobin reductase and NADPH
C. Most patients tolerate low levels of methemoglobin without clinical symptoms
D. Aniline dyes are causative agents
B. the predominant detoxication pathway involves methemoglobin reductase and NADPH
The hemoglobin-oxygen dissociation curve is shifted to the left by…
A. Fever
B. Acidosis
C. Hypophosphatemia
D. 2,3-BPG
C. Hypophosphatemia
The presence of schistocytes on a perpherial blood smear is indicative of…
A. Iron deficiency
B. lead poisoning
C. Malaria
D. Microangiopathic hemolytic anemia
D. Microangiopathic hemolytic anemia
Oxidative injury to red blood cells is most severe in humans with a deficiency of…
A. Glucose-6-phosphate dehydrogenase
B. Cytochrome P450 2E1
C. Aspartate transaminase
D. Creatine phospokinase
A. Glucose-6-phosphate dehydrogenase
In the human fetus, hematopoiesis can occur in all of the following organs except…
A. Liver
B. Lung
C. Spleen
D. Thymus
B. Lung
An imbalance in the production of alpha and beta globulin chains is the basis for…
A. Iron deficiency anemias
B. Congenital thalassemia
C. Sideroblastic anemias
D. Megaloblastic anemia
B. Congenital thalassemia
Ringed sideroblasts are characteristic of anemias caused by…
A. Alpha methyldopa
B. Phenytoin
C. Lead
D. Folate deficiency
C. Lead
Pure red cell aplasia is caused by all of the following except…
A. Isoniazid
B. acetaminophen
C. Phenytoin
D. Azathioprine
B. acetaminophen
