Christie pt B

Question 1

Answer 1

E

Question 2

2. A 26-year-old man has a 10-week history of fever with nonproductive cough. On examination, his temperature is 37.4° C. A chest radiograph shows a 4-cm left upper lobe nodule. CBC shows hemoglobin, 13.3 g/dL (13.5–17.5. g/dL); hematocrit, 40.5% (41%–53%); platelet count, 281,000/mm3 (150,000–400,000/mm3); and WBC count, 13,760/mm3 (4,500–11,000/mm3) with 38% segmented neutrophils, 2% bands, 45% lymphocytes, and 15% monocytes. What is the most likely diagnosis?
   a. Acute lymphoblastic leukemia
   b. Chronic lymphocytic leukemia
   c. Mycobacterium tuberculosis infection
   d. Myelodysplastic syndrome
   e. Staphylococcus aureus abscess

Answer 2

C

Question 3

Answer 3

D

Question 4

4. How do you distinguish a leukemoid reaction of white blood cells from a leukemia?
   a. The presence of blasts in the leukemoid reaction.
   b. The leukemia will have many more white blood cells than the leukemoid reaction.
   d. The leukemoid reaction will always have normal RBC and platelet counts.
   d. The leukemoid reaction will have an elevated leukocyte alkaline phosphatase score.

Answer 4

D

Question 5

Answer 5

B

Question 6

Answer 6

A

Question 7

Answer 7

D

Question 8

9. What do you have to see in the peripheral blood or bone marrow to diagnose an acute leukemia?
   a. Blasts.
   b. Neoplastic plasma cells.
   c. Neoplastic Red blood cells.
   d. Neoplastic platelets.
   e. Bacteria.

Answer 8

A

Question 9

10. Which neoplasms of white blood cells is most common in children?
    a. Acute lymphoblastic leukemia.
    b. Acute myelogenous leukemia.
    c. Chronic myelogenous leukemia.
    d. Chronic lymphocytic leukemia.
    e. Multiple myeloma.

Answer 9

A

Question 10

11. A 14-year-old boy has had chest discomfort that has worsened over the past 5 days. On physical examination, he has generalized lymphadenopathy. A chest radiograph shows clear lung fields, but there is widening of the mediastinum. A chest CT scan shows a 10-cm mass in the anterior mediastinum. A biopsy specimen of the mass is obtained and microscopically shows sheets of immature lymphoid cells. The cells express markers for T-cells. What is the most likely clinical course of tumors of this type?
    a. Most cases are cured by chemotherapy
    b. Median survival is less than one year with chemotherapy
    c. It has an indolent course
    d. Treatment with drugs that kill HTLV-1 virus is curative
    e. Skin is preferentially involved in untreated cases

Answer 10

A

Question 11

Answer 11

B

Question 12

Answer 12

B

Question 13

14. Which of the following statements about non-Hodgkins lymphoma is false?
    a. Frequent involvement of multiple peripheral lymph nodes.
    b. Contiguous spread.
    c. Extra-nodal presentation is common.
    d. Waldeyer ring and mesenteric lymph nodes are commonly involved.

Answer 13

B

Question 14

15. Which of these is a Hodgkins lymphoma?
    a. Multiple myeloma.
    b. MALT lymphoma.
    c. Nodular sclerosis lymphoma.
    d. Burkitt lymphoma.
    e. Langerhans cell histiocytosis.

Answer 14

C

Question 15

16. What is the characteristic cytogenetic abnormality found in chronic myelogenous leukemia?
    a. RET proto-oncogene.
    b. keratin 6a or keratin 6b.
    c. Patched (PTCH) gene.
    d. Ras.
    e. BCR-ABL gene.

Answer 15

E

Question 16

Answer 16

B

Question 17

18. Infection with which of the following is most likely to be causally related to the development of Burkitt lymphoma?
    a. Cytomegalovirus.
    b. Hepatitis B virus.
    c. HIV.
    d. Human papillomavirus.
    e. Epstein-Barr virus.

Answer 17

E

Question 18

Answer 18

A

Question 19

20. A 55 year-old lady presents with multiple nodules over her entire body. Biopsy reveals these nodules to be composed of neoplastic T lymphocytes which have cerebriform nuclei. This lady most likely has which one of the following?
    a. Multiple myeloma.
    b. Burkitt lymphoma.
    c. Mycosis fungoides.
    d. Langerhans cell histiocytosis.
    e. Nodular sclerosis lymphoma.

Answer 19

C

Question 20

Answer 20

B

Question 21

22. MALT lymphomas in the head and neck primarily affect which structure?
    a. Parotid gland.
    b. Thyroid gland.
    c. Submaxillary gland.
    d. Tongue.
    e. Tonsils.

Answer 21

A

Question 22

23. In the endemic form of Burkett lymphoma found in Africa, in which anatomic structure is the neoplasm most often found initially?
    a. The GI tract.
    b. The jaws.
    c. The tonsils.
    d. The genitourinary tract.
    e. The thyroid.

Answer 22

B

Question 23

24. What are the two most common non-Hodgkin lymphomas found in adults?
    a. Follicular lymphoma and Burkitt lymphoma.
    b. Diffuse large B-cell lymphoma and Burkett lymphoma.
    c. Burkett lymphoma and mantle cell lymphoma.
    d. Follicular lymphoma and diffuse large B-cell lymphoma.

Answer 23

D

Question 24

Answer 24

C

Question 25

26. A 54-year-old woman has a 7-month history of nausea with vomiting and early satiety. On physical examination, she is afebrile and has no lymphadenopathy or hepatosplenomegaly. CBC shows hemoglobin, 12.9 g/dL (12.0–16.0 g/dL); hematocrit, 41.9% (36%–46%); platelet count, 263,000/mm3 (150,000–400,000/mm3); and WBC count, 8,430/mm3 (4,500–11,000/mm3). An upper gastrointestinal endoscopy shows loss of the rugal folds of the stomach over a 4 × 8 cm area of the fundus. Gastric biopsy specimens reveal the presence of Helicobacter pylori organisms in the mucus overlying superficial epithelial cells. There are extensive mucosal and submucosal mono-morphous infiltrates of small lymphocytes with B-cell markers. After treatment of the H. pylori infection, her condition improves. Which of the following effects of H. pylori is most likely involved in proliferation of B cells in such a case?
    a. Inactivation of RB by H. pylori-encoded proteins
    b. Inactivation of p53 function by H. pylori-encoded proteins
    c. Inflammatory cytokines secreted by H. pylori-specific T cells
    d. Mutagenic effect of H. pylori on helper T cells
    e. Accelerated telomere shortening by H. pylori infection

Answer 25

C

Question 26

27. A 60-year-old woman has had headaches and dizziness for the past 5 weeks. She has been taking omeprazole for ulcers. On physical examination, she is afebrile and normotensive, and her face has a plethoric to cyanotic appearance. There is mild splenomegaly, but no other abnormal findings. Laboratory studies show hemoglobin, 17.7 g/dL (12.0–16.0 g/dL); hematocrit, 59% (36%–46%); platelet count, 495,000/mm3 (150,000–450,000/mm3; and WBC count, 14,000/mm3 (4,500–11,000/mm3) with 85% polymorphonuclear leukocytes, 10% lymphocytes, and 5% monocytes. The peripheral blood smear shows abnormally large platelets and slightly increased basophils. Which of the following is most characteristic of the natural history of this patient’s disease?
    a. Development of mucosa-associated lymphoid tumor (MALToma)
    b. Transformation to a monoclonal gammopathy
    c. Marrow fibrosis with extramedullary hematopoiesis
    d. Spontaneous remissions and relapses without treatment
    e. Transformation into acute B-lymphoblastic leukemia

Answer 26

C

Question 27

29. Which immunoglobulin can cross the placenta?
    a. IgM.
    b. IgD.
    c. IgE.
    d. IgA.
    e. IgG.

Answer 27

E

Question 28

30. Which antibody develops first in a primary immune response?
    a. IgM.
    b. IgD.
    c. IgE.
    d. IgA.
    e. IgG.

Answer 28

A

Question 29

31. How many antigen-binding sites does a molecule of IGM possess?
    a. 2.
    b. 3.

C. 5.

d. 10.
e. 12.

Answer 29

D

Question 30

32. Which is not a characteristic of a naturally-occuring antibody encountered in transfusion medicine?
    a. Found in the serum of individuals never previously exposed to RBC antigens.
    b. Most are IgG.
    c. May be hemolytic when active at 37 degrees C.
    d. Cold agglutinins – react best at
    e. Activate complement.

Answer 30

B

Question 31

33. A patient’s type and screen indicates that he is type AB. What antibodies are present in his serum?
    a. anti-A.
    b. anti-B.
    c. both anti-A and anti-B.
    d. No antibodies directed against A or B.

Answer 31

D

Question 32

34. A patient who has type AB blood can receive blood containing which ABO blood types.
    a. A.
    b. B.
    c. AB.
    d. O.
    e. a, b, c, and d.

Answer 32

E

Question 33

Answer 33

B

Question 34

36. What percentage of the US population is Rh positive?
    a. 90%.
    b. 85%.
    c. 80%
    d. 75%.
    e. 50%.

Answer 34

B

Question 35

37. What antigen is found on the red blood cells of an individual who is O-positive, Rh-negative?
    a. d.
    b. D.
    c. A.
    d. H.
    e. B.

Answer 35

D

Question 36

38. True or false. All ABO antibodies can cause hemolytic disease of the newborn.
    a. True.
    b. False

Answer 36

B

Question 37

39. True or false. The gene for the d antigen is found on chromosome 1.
    a. True.
    b. False.

Answer 37

B

Question 38

40. What is the method used in the Transfusion Medicine Laboratory for determination of antigen-antibody reactions?
    a. hemagglutination.
    b. hemolysis.
    c. RBC lysis.
    d. complement activation

Answer 38

A

Question 39

41. A 16-year-old girl is receiving chemotherapy for ALL (acute lymphoblastic leukemia). She needs

transfusion support with red blood cells and platelets and red blood cells. All units are irradiated

in the blood bank before being sent to the floor. Why are these units irradiated?

a. The physician wanted it done.
b. CMV is inactivated by irradiation.
c. To warm the blood, it was in a refrigerator.
d. To inactivate the DNA in the white blood cells.
e. To activate the cells so they work properly.

Answer 39

D

Question 40

42. How much should 1 unit of packed RBCs increase the hemoglobin in a 70 kg patient?
    a. 0.5 g of hemoglobin/dL.
    b. 1.0 g of hemoglobin/dL.
    c. 1.5 g of hemoglobin/dL.
    d. 2.0 g of hemoglobin/dL.
    e. 2.5 g of hemoglobin/dL.

Answer 40

B

Question 41

44. A patient is receiving a blood transfusion and during the transfusion has a 2 degree C increase in temperature. What is the proper step to take with this patient?
    a. Give antipyretics and continue the transfusion.
    b. Stop the transfusion and throw away the unit and the lines associated with it.
    c. Stop the transfusion, notify the Transfusion Medicine laboratory and the physician on call for the Transfusion Medicine service.
    d. Call the Transfusion Medicine service and curse out the technologists for sending a unit of “bad blood”.

Answer 41

C

Question 42

45. Which type of blood product is most likely to cause sepsis?
    a. Packed RBCs.
    b. Cryoprecipitate.
    c. Fresh frozen plasma.
    d. Factor VIII concentrate.
    e. Platelets.

Answer 42

E

Question 43

46. What is the primary goal of the crossmatch procedure performed in the Transfusion Medicine laboratory?
    a. Identify the patient’s blood type.
    b. Identify antibodies against A, B, and Rh antigens.
    c. Prove that the patient’s serum and donor red blood cells are compatible.
    d. Identify antibodies against alloantigens.
    e. Make money for the hospital.

Answer 43

C

Question 44

47. What is the last check performed to make sure that the patient is receiving the proper blood product?
    a. type and screen.
    b. confirmation by two individuals that the identification on the product is the same as that of the patient.
    c. type and crossmatch.

Answer 44

B

Question 45

48. What is the most common transfusion reaction?
    a. acute hemolytic
    b. febrile non-hemolytic.
    c. delayed hemolytic transfusion reaction.
    d. urticarial.
    e. TACO.

Answer 45

B

Question 46

49. Un which of these transfusion reactions, cn you re-start the transfusion.?
    a. acute hemolytic
    b. febrile non-hemolytic.
    c. delayed hemolytic transfusion reaction.
    d. urticarial.
    e. TACO.

Answer 46

D

Question 47

7. A 36-year-old woman has a 1-week history of cough and fever. On physical examination, her temperature is 38.3° C. She has diffuse crackles in all lung fields. A chest radiograph shows extensive bilateral infiltrates. CBC shows hemoglobin, 13.9 g/dL (12.0–16.0 g/dL); hematocrit, 42% (36%–46%); MCV, 89 µm3 (80–100 µm3); platelet count, 350,000/mm3 (150,000–400,000/mm3); and WBC count, 56,000/mm3(4,500–11,000/mm3), with 63% segmented neutrophils, 16% bands, 7% metamyelocytes, 3% myelocytes, 1% blasts, 8% lymphocytes, and 2% monocytes. A bone marrow biopsy is obtained and shows increased numbers of myeloid cells that is remarkable for a left-shift, but normal, maturation. Karyotype performed on the bone marrow aspirate shows a normal female karyotype (46,XX). Which of the following is the most likely diagnosis?
   a. Chronic myeloid leukemia
   b. Polycythemia vera
   c. Hodgkin lymphoma, lymphocyte depletion type
   d. Leukemoid reaction
   e. Myelodysplastic syndrome

Answer 47

D

Question 48

43. What is the infectious risk for HIV transmission in blood products?
    a. 1 in 2 million.
    b. 1 in 200,000.
    c. 1 in 20,000.
    d. 1 in 2,000.
    e. 1 in 200.

Answer 48

A

Question 49

28. A 2-year-old boy has developed a fever over the past 15 days. He has been diagnosed and treated for otitis media multiple times in the past year. On physical examination, he has mild lymphadenopathy, hepatomegaly, and splenomegaly. There are extensive crusted papules on his skin. A CT scan of his head shows a 4-cm osteolytic mass in the mastoid bone. The tumor cells are CD1a positive. Which of the following is the most likely diagnosis?

A. Acute lymphoblastic leukemia

b. Disseminated tuberculosis
c. Acute myeloid leukemia
d. Langerhans cell histiocytosis
e. Multiple myeloma

Answer 49

D