Christie pt A

Question 1

1. Thecoagulation pathway can begin with activation of factor X.
   a. Extrinsic
   b. Intrinsic
   c. Common

Answer 1

c. Common

Question 2

2. The extrinsic coagulation pathway includes which one of the following factors?
   a. Factor VII
   b. Factor XI
   c. Factor I
   d. Factor VIII

Answer 2

a. Factor VII

Question 3

3. Which of the following converts fibrinogen to fibrin?
   a. Plasmin
   b. Thrombin
   c. Factor Xa
   d. Tissue factor

Answer 3

B. Thrombin

Question 4

4. What replacement factor should be used for hemophilia A?
   a. Factor VI
   b. Factor VII
   c. Factor VIII
   d. Factor IX

Answer 4

c. Factor VIII

Question 5

5. Hemophilia is typically a disorder of:
   a. The common coagulation pathway
   b. The extrinsic coagulation pathway
   c. The intrinsic coagulation pathway
   d. Anticoagulation pathways

Answer 5

C

Question 6

6. Exposure to collagen will activate which one of the following?
   a. Factor X
   b. Factor XII
   c. Factor VII
   d. Factor I

Answer 6

B

Question 7

7. The results of which test are used to calculate the INR?
   a. PTT.
   b. PT.
   c. Thrombin time.
   d. d-dimer assay.
   e. Platelet count.

Answer 7

B

Question 8

8. DIC consists of which of the following processes?
   a. thrombosis.
   b. hemorrhage.
   c. both thrombosis and hemorrhage.
   d. neither thrombosis nor hemorrhage.?

Answer 8

C

Question 9

9. Which of the following statement(s) about TTP is/are true?
   a. Renal failure is prominent.
   b. CNS manifestations are prominent.
   c. Antibodies against ADAMST13 are present.
   d. both a and b are true.
   e. both b and c are true.

Answer 9

E

Question 10

10. At which level of platelet count is there an increased chance of spontaneous hemorrhage into the brain?
    a. <10- 20K/uLl
    b. 20-50K/uL
    c. < 150,000/uL.
    d. >150,00/μL.

Answer 10

A

Question 11

11. A superficial puncture wound from a needle stick injury leads to a small amount of bleeding in a healthy person. Seconds after this injury occurs, the bleeding stops. Which of the following is most likely the principal mechanism to immediately stop the blood loss from this injury?
    a. Fibrin polymerization
    b. Neutrophil chemotaxis
    c. Platelet aggregation
    d. Protein C activation
    e. Vasoconstriction

Answer 11

E

Question 12

12. A 26-year-old woman has a history of frequent nosebleeds and increased menstrual blood flow. On physical examination, petechiae and purpura are present on the skin of her extremities. Laboratory studies show near normal partial thromboplastin time (PTT), prothrombin time (PT), and platelet count, but decreased von Willebrand factor activity. This patient most likely has a derangement in which of the following steps in hemostasis?

a Fibrin polymerization

b. Platelet adhesion
c. Platelet aggregation
d. Thrombin generation
e. Vasoconstriction

Answer 12

B

Question 13

13. A 12-year-old boy has a 10-year history of multiple soft tissue hemorrhages and acute upper airway obstruction from hematoma formation in the neck. On physical examination, he has decreased range of motion of the large joints, particularly the knees and ankles. He has no petechiae or purpura of the skin. Laboratory studies show normal prothrombin time, elevated partial thromboplastin time (PTT), normal platelet count, and markedly decreased Factor VIII activity. Which of the following mechanisms best describes the underlying basis of his disease?
    a. Decrease in production of thrombin
    b. Antiphospholipid antibodies
    c. Failure of platelet aggregation
    d. Failure of fibrin polymerization
    e. Inability to neutralize antithrombin III

Answer 13

A

Question 14

14. A 77-year-old woman notices that small, pinpoint-to-blotchy areas of superficial hemorrhage have appeared on her gums and on the skin of her arms and legs over the past 3 weeks. On physical examination, she is afebrile and has no organomegaly. Laboratory studies show a normal prothrombin time and partial thromboplastin time. CBC shows hemoglobin of 12.7 g/dL, hematocrit of 37.2%, MCV of 80 μm3, platelet count of 276,000/mm3, and WBC count of 5600/mm3. Platelet function studies and fibrinogen level are normal, and no fibrin split products are detectable. Which of the following conditions best explains these findings?
    a. Chronic renal failure.
    b. Macronodular cirrhosis.
    c. Meningococcemia.
    d. Metastatic carcinoma.
    e. Vitamin C deficiency.

Answer 14

E

Question 15

15. Which of the following is not a manifestation of Plummer-Vinson syndrome?

a. Splenomegaly.
b. Esophageal web.
c. Achlorhydria.
d. Glossitis.
e. Koilonychia.

Answer 15

A

Question 16

16. A 55-year-old lady presents with signs and symptoms of anemia. Her CBC is most remarkable for Hgb = 8 g/mL (N = 12 – 15 g/dL) and MCV = 70 fL (normal = 80 – 100 fL). She most likely has:
    a. Sideroblastic anemia.
    b. Relative anemia of pregnancy.
    c. Iron deficiency anemia.
    d. Thalassemia minor.
    e. Anemia of chronic inflammation.

Answer 16

C

Question 17

Answer 17

E

Question 18

Answer 18

A

Question 19

19. A gentleman whose parents emigrated from Greece presents with a hypochromic, microcytic anemia. His RBC count is high for his degree of anemia. His RDW is normal and there are occasional target cells and basophilic stippling of RBCs seen on his peripheral smear. What is the most likely cause of his anemia?
    a. Iron-deficiency anemia.
    b. Sideroblastic anemia.
    c. Anemia of chronic inflammation.
    d. Thalassemia minor.
    e. Relative anemia due to overhydration.

Answer 19

D

Question 20

20. You are at a party and are cornered by the wife of one of your friends who is in her second trimester of pregnancy. She has good prenatal care but she has seen a copy of her laboratory results and has noted that her hemoglobin is low and is concerned that the physician has not mentioned any problem to her. What do you think is going on?
    a. Undiagnosed iron deficiency anemia.
    b. Thalassemia minor.
    c. Relative anemia of pregnancy.
    d. Macrocytic anemia secondary to alcohol ingestion.
    e. Anemia of chronic inflammation.

Answer 20

C

Question 21

Answer 21

B

Question 22

22. While the anemia of acute blood loss is initially normochromic, normocytic, what happens to the peripheral smear as the bone marrow responds to the blood loss.?
    a. Microcytosis alone.
    b. Macrocytosis alone.
    c. Microcytosis and polychromatophilia.
    d. Macrocytosis and polychromatophilia.
    e. No change.

Answer 22

D

Question 23

23. In the anemia of chronic inflammation, which of the following changes occur?
    a. Increased erythropoietin and increased hepcidin.
    b. Decreased erythropoietin and increased hepcidin.
    c. Decreased erythropoietin and decreased hepcidin.
    d. Increased erythropoietin and decreased hepcidin.
    e. Increased erythropoietin and no change in hepcidin.

Answer 23

B

Question 24

24. Which of the following statements about aplastic anemia is false?
    a. The most common cause of secondary aplastic anemia is myelotoxic drugs or chemicals.
    b. Whole-body irradiation is a cause of aplastic anemia.
    c. Infections are a cause of aplastic anemia.
    d. Inherited diseases do not cause aplastic anemia.
    e. We do not know the cause for the majority of cases of aplastic anemia.

Answer 24

D

Question 25

25. A 35-year-old man presents with a normochromic, normocytic anemia. The peripheral blood smear shows spherocytosis. The circulating RBCs show an increased osmotic fragility. An inherited abnormality in which of the following RBC components best accounts for these findings?
    a. Glucose-6-phosphate dehydrogenase.
    b. Membrane cytoskeletal protein.
    c. β-globin chain.
    d. α-globin chain.
    e. Heme.

Answer 25

B

Question 26

Answer 26

E

Question 27

Answer 27

A

Question 28

Answer 28

D

Question 29

29. What is the MCV in a patient with macrocytic anemia?
    a. 80 – 100 fL.
    b. <80 fL.
    c. <60 fL.
    d. >90 fL.
    e. >100 fL.

Answer 29

E

Question 30

30. A 74 year-old gentleman is seen for a routine wellness visit. His CBC is remarkable for an increased RBC count without any other abnormalities. The nurse remembers filling the tube for the CBC right to the very top. What is the cause of this gentleman’s polycythemia?
    a. Polycythemia vera.
    b. Spurious polycythemia.
    c. Living at a high altitude.
    d. Smoking.
    e. an erythropoietin-secreting tumor.

Answer 30

B

Question 31

Answer 31

B

Question 32

32. Which of the following is not seen in B12 but not in folate deficiency?
    a. MCV >100fL.
    b. Neurological disease.
    c. Macro-ovalocytes.
    d. Hypersegmented PMNs.

Answer 32

B

Question 33

33. A 35-year-old woman has a normochromic normocytic anemia. The peripheral smear is remarkable for spherocytes and the direct and tests for autoantibodies are positive at 37 degrees C but not at 4 degrees C. What is the underlying disease that is most likely present in this lady?
    a. Systemic lupus erythematosus.
    b. Infectious mononucleosis.
    c. Mycoplasma pneumoniae infection.
    d. Hereditary spherocytosis.
    e. Escherichia coli septicemia

Answer 33

A

Question 34

34. A 67-year-old lady has had headache, dizziness, and fatigue for the past 3 months. Her friends have been commenting about her increasingly ruddy complexion. She also has experienced generalized, severe pruritus, particularly when showering. She notes that her stools are dark. CBC is remarkable for an elevated hemoglobin. The serum erythropoietin level is very low. What is the most likely diagnosis?
    a. Myelodysplastic syndrome
    b. Polycythemia vera.
    c. Essential thrombocytosis
    d. Chronic myelogenous leukemia
    e. Erythroleukemia.

Answer 34

B

Question 35

35. A 30 year-old lady who is a strict vegan becomes pregnant. At her 6th month of pregnancy, she goes to the doctor as she is feeling very faint. Her CBC is remarkable for anemia with a MCV = 120 fL, leukopenia, and thrombocytopenia. What do you think is going on?
    a. Undiagnosed iron deficiency anemia.
    b. Macrocytic anemia due to alcoholism.
    c. Megaloblastic anemia due to inadequate B12 in her diet.
    d. Pernicious anemia.
    e. Uterine bleeding.

Answer 35

C

Question 36

36. A healthy 19-year-old woman experienced blunt abdominal trauma in a motor vehicle accident. On admission to the hospital, her initial hematocrit was 33% (36%–46%), but over the next hour, it decreased to 28%. She was taken to surgery, where a liver laceration was repaired, and 1 L of bloody fluid was removed from the peritoneal cavity. She remained stable. A complete blood count (CBC) performed 7 days later is most likely to show which of the following morphologic findings in the peripheral blood?
    a. Basophilic stippling of red cells
    b. Hypochromic red cells
    c. Leukoerythroblastosis
    d. Reticulocytosis
    e. Schistocytosis

Answer 36

D

Question 37

37. A 65-year-old man has a 5-month history of worsening fatigue. On physical examination, he is afebrile and has a pulse of 91 beats/min, respirations of 18 breaths/min, and blood pressure of 105/60 mm Hg. There is no organomegaly. A stool sample is positive for occult blood. Laboratory findings include hemoglobin of 5.9 g/dL (13.5–17.5), hematocrit of 18.3%, MCV (mean corpuscular volume) of 72 µm3(80–100 µm3), platelet count of 250,000/mm3(150,000–400,000/mm3), and white blood cell (WBC) count of 7,800/mm3(4,500–11,000/mm3). The reticulocyte concentration is 2.0% (0.5–1.5%). A bone marrow biopsy specimen shows mild erythroid hyperplasia. Laboratory testing will most likely reveal which of the following?
    a. Elevated serum ferritin
    b. Low serum iron
    c. Elevated serum hepcidin
    d. Increased HbA2
    e. Low serum transferrin

Answer 37

B

Question 38

38. A 28-year-old woman has had easy fatigability since childhood. On physical examination, she is afebrile and has a pulse of 80 beats/min, respirations of 15 breaths/min, and blood pressure of 110/70 mm Hg. The spleen tip is palpable, but there is no abdominal pain or tenderness. Laboratory studies show hemoglobin of 11.7 g/dL (12.0–16.0 g/dL), platelet count of 159,000/mm3 (150,000–400,000/mm3), and WBC count of 5,390/mm3 (4,500–11,000/mm3). The peripheral blood smear shows a predominant population of round red cells that lack a zone of central pallor mixed with a smaller but readily noticeable population of larger red cells with a bluish tinge. An inherited abnormality in which of the following red blood cell (RBC) components best accounts for these findings?

A. α-Globin chain

b. β-Globin chain
c. Glucose-6-phosphate dehydrogenase
d. Heme porphyrin ring
e. Spectrin

Answer 38

E

Question 39

Answer 39

C

Question 40

40. A 28-year-old woman with a history of low-grade fever, rash, and arthralgias for the past week presents with pallor and lethargy. She has a history of chronic anemia, and spherocytes are observed on a peripheral blood smear. Her hematocrit, which normally ranges from 35% to 38%, is now 24%, and the reticulocyte count is very low. The serum bilirubin level is 1.9 mg/dL (0.1–1.0 mg/dL). Which of the following events is most likely to have occurred in this patient?
    a. Accelerated extravascular hemolysis in the spleen
    b. Development of anti-RBC antibodies
    c. Disseminated intravascular coagulation
    d. Parvovirus B19 infection of erythroblasts
    e. Superimposed dietary iron deficiency

Answer 40

D

Question 41

41. A 3-year-old boy has a poor appetite and is underweight for his age and height. Physical examination shows hepatosplenomegaly. The hemoglobin concentration is 6 g/dL (10.5–13.5 g/dL), and the peripheral blood smear shows severely hypochromic and microcytic RBCs. The total serum iron level is normal, and the reticulocyte count is 5% (0.5–1.5 %). A radiograph of the skull shows maxillofacial deformities and expanded marrow spaces. Which of the following is the most likely cause of this child’s illness?
    a. Imbalance in α-globin and β-globin chain production
    b. Increased susceptibility to oxidative stress
    c. Reduced synthesis of hemoglobin F
    d. Relative deficiency of vitamin B12
    e. Impaired utilization of iron by erythroblasts

Answer 41

A

Question 42

42. A 13-year-old boy has experienced multiple episodes of pneumonia and meningitis since infancy. Two of the episodes of infection were accompanied by sepsis. Causative organisms include Streptococcus pneumoniae and Haemophilus influenzae. On physical examination, the child has no organomegaly, but the cheekbones are prominent. Laboratory studies show hemoglobin of 9.2 g/dL (12.0–16.0 g/dL), hematocrit of 27.8% (36%–50%), platelet count of 372,000/mm3 (150,000–400,000/mm3), and WBC count of 10,300/mm3 (3,200–9,800/mm3). A hemoglobin electrophoresis shows 2% hemoglobin A2 (1.5%–3.1%), and 92% hemoglobin S. Which of the following is the most likely cause of the repeated infections in this patient?
    a. Reduced endothelial cell expression of adhesion molecules
    b. Diminished hepatic synthesis of complement proteins
    c. Impaired neutrophil production
    d. Impaired splenic function
    e. Reduced synthesis of immunoglobulins

Answer 42

D

Question 43

43. A 25-year-old woman has a 3-year history of arthralgias. Physical examination shows no joint deformity, but she appears slightly pale. Laboratory studies show total RBC count of 4.7 million/mm3 (3.5–5.5 million/mm3), hemoglobin of 12.5 g/dL (12.0–16.0 g/dL), hematocrit of 37.1% (36%–46%), platelet count of 217,000/mm3 (150,000–400,000/ mm3), and WBC count of 5890/mm3 (4,500–11,000/mm3). The peripheral blood smear shows hypochromic and microcytic RBCs. Total serum iron and ferritin levels are normal. Hemoglobin electrophoresis shows 93% hemoglobin A1 with elevated hemoglobin A2 level of 5.8% and hemoglobin F level of 1.2%. Which of the following is the most likely diagnosis?
    a. Anemia of chronic disease
    b. Autoimmune hemolytic anemia
    c. β-Thalassemia minor
    d. Infection with Plasmodium vivax
    e. Iron deficiency anemia

Answer 43

C

Question 44

44. A 23-year-old man passes dark, reddish brown urine 3 days after recovery from a viral pneumonia. On physical examination, he is afebrile, and there are no remarkable findings. Complete blood count (CBC) shows a mild normocytic anemia, but the peripheral blood smear shows precipitates of denatured globin (Heinz bodies) with supravital staining and scattered “bite cells” in the population of RBCs. Serum haptoglobin level is reduced. Which of the following is the most likely mechanism of anemia?
    a. RBC injury by unpaired beta-globin chains
    b. Oxidant injury to RBCs
    c. RBC sensitivity to complement due to lack of complement regulatory proteins
    d. Appearance of anti-RBC antibodies in the setting of viral infection
    e. Relative folate deficiency caused by viral infection

Answer 44

B

Question 45

45. A 34-year-old woman reports becoming increasingly tired for the past 5 months. On physical examination, she is afebrile and has mild splenomegaly. Laboratory studies show a hemoglobin concentration of 10.7 g/dL (12.0–16.0 g/dL) and hematocrit of 32.3% (36%–46%). The peripheral blood smear shows spherocytes and rare nucleated RBCs. Direct Coombs test results are positive. Which of the following underlying diseases is most likely to be diagnosed in this patient?
    a. Escherichia coli septicemia
    b. Hereditary spherocytosis
    c. Infectious mononucleosis
    d. Mycoplasma pneumoniae infection
    e. Systemic lupus erythematosus

Answer 45

E

Question 46

46. An infant is born at 34 weeks’ gestation to a 28-year-old woman, G3, P2. At birth, the infant is markedly hydropic and icteric. A cord blood sample is taken, and the direct Coombs test on the infant’s RBCs is positive. Which of the following is the most likely mechanism for the findings in this infant?
    a. Hemolysis of antibody-coated cells
    b. Hematopoietic stem cell defect
    c. Impaired globin synthesis
    d. Mechanical fragmentation of RBCs
    e. Oxidative injury to hemoglobin

Answer 46

A

Question 47

Answer 47

C

Question 48

48. A 59-year-old man has experienced chronic fatigue and weight loss for the past 3 months. There are no remarkable findings on physical examination. Laboratory studies show hemoglobin, 10.0 g/dL (13.5–17.5. g/dL); hematocrit, 30.3%; MCV, 81 µm3 (80–100 µm3); platelet count, 240,000/mm3 (150,000–400,000/mm3); WBC count, 7,550/mm3 (4,500–11,000/mm3); serum iron 20 µg/dL (30–60 µg/dL) ; total iron-binding capacity (transferrin level), 145 µg/dL (240–450 µg/dL); and serum ferritin, 565 ng/mL (12–150 ng/mL). Serum erythropoietin levels are low for the level of hemoglobin. Which of the following is the most likely mechanism of anemia?
    a. Increased synthesis of hepcidin in the liver
    b. Chronic blood loss
    c. Decrease in intake of heme iron
    d. An increase in the level of ferroportin
    e. Reduced synthesis of IL-6 in the liver

Answer 48

A

Question 49

Answer 49

A

Question 50

50. A 37-year-old woman has experienced abdominal pain and intermittent low-volume diarrhea for the past 3 months. On physical examination, she is afebrile. A stool sample is positive for occult blood. A colonoscopy is performed, and biopsy specimens from the terminal ileum and colon show microscopic findings consistent with Crohn disease. She does not respond to medical therapy, and part of the colon and terminal ileum are removed. She is transfused with 2 units of packed RBCs during surgery. Three months later, she appears healthy, but states that she is easily fatigued. On investigation, CBC findings show hemoglobin of 10.6 g/dL (12.0–16.0 g/dL), hematocrit of 31.6% (36%–46%), RBC count of 2.69 million/ mm3 (3.5–5.5 million/mm3), MCV of 118 µm3 (80–100 µm3); platelet count of 178,000/mm3 (150,000–400,000/mm3), and WBC count of 4,800/mm3 (4,500–11,000/mm3). Hypersegmented neutrophils were seen in the blood smear. The reticulocyte count is 0.3% (0.5%–1.5%). Which of the following is most likely to produce these hematologic findings?
    a. Anemia of chronic disease
    b. Chronic blood loss
    c. Hemolytic anemia
    d. Aplastic anemia
    e. Vitamin B12 deficiency

Answer 50

E

Question 51

51. A 28-year-old previously healthy man has noted increasing fatigue for the past 6 months and bruising after minimal trauma. Over the past 2 days, he has developed a cough. On physical examination, his temperature is 38.9° C, and he has diffuse rales in both lungs. He has neither hepatosplenomegaly nor lymphadenopathy. Laboratory findings include a sputum culture positive for Streptococcus pneumoniae, hemoglobin of 7.2 g/dL (13.5–17.5. g/dL), hematocrit of 21.7% (41%–53%), platelet count of 23,400/mm3 (150,000–400,000/mm3), WBC count of 1,310/mm3 (4,500–11,000/mm3) prothrombin time of 13 seconds (11–15 seconds), partial thromboplastin time of 28 seconds (25–40 seconds), and total bilirubin of 1 mg/dL (0.1–1.0 mg/dL). The ANA test result is negative. Which of following mechanisms is most likely to give rise to this clinical picture?
    a. Defect in hematopoietic stem cells
    b. Hemolysis of antibody-coated cells
    c. Granulomatous disease
    d. Metastatic adenocarcinoma to bone marrow
    e. Hypersplenism

Answer 51

A