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Defense Mechanisms and Hematology Flashcards

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USMLE® Step 1 flashcards
1
Q

Which of the following statements about immunity is TRUE?

Question 1 options:

A)

Lymphocytes are the primary cells involved in the immune response.

B)

T cells mature in the bone marrow.

C)

Cell-mediated immunity uses antibody formation to combat pathogens.

D)

Humoral immunity uses cytotoxic chemicals to destroy pathogens.

A

lymphocytes are the primary cells involved in immune response

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2
Q

Which of the following would directly result in decreased fibrinolysis?

Question 2 options:

A)

Increased factor X

B)

Hypercalcemia

C)

Increased plasmin secretion

D)

Decreased plasminogen secretion

A

decreased plasminogen secretion

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3
Q

When a patient receives a laceration, the clotting process that occurs is primarily mediated by the ________ pathway.

Question 3 options:

A)

extrinsic

B)

common

C)

intrinsic

D)

platelet

A

extrinsic

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4
Q

Of the following, which would be the most likely dysfunction experienced by a patient with multiple myeloma?

Question 4 options:

A)

Increased T cell production

B)

Decreased T cell production

C)

Decreased blood cell production

D)

Increased blood cell production

A

decreased blood cell production

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5
Q

A patient with hemophilia has suffered a large and deep laceration to the right forearm after cutting it on a mirror, which fell while he was hanging it. The wound is hemorrhaging a steady amount of dark red blood. Given the history of hemophilia, your immediate action on reaching the patient’s side and putting on gloves would be to:

Question 5 options:

A)

apply a tourniquet proximal to the wound.

B)

start an IV and administer a 1 L NS bolus.

C)

request that the ED have Factor VIII standing by on your arrival.

D)

apply direct pressure with a bulky dressing.

A

apply direct pressure with a bulky dressing

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6
Q

Prehospital treatment for a hemophiliac patient who is bleeding is to:

Question 6 options:

A)

control bleeding with direct pressure.

B)

contact online medical control for factor VIII infusion.

C)

administer IV colloid solutions.

D)

provide aggressive IV therapy with isotonic crystalloids.

A

control bleeding with direct pressure

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7
Q

A cat scratches a patient on the arm. Twenty-four hours later, the area is swollen and red. What additional signs or symptoms is the patient most likely to exhibit?

Question 7 options:

A)

Pain and warmth at the injury site

B)

Urticaria

C)

Loss of appetite

D)

Fever and hypotension

A

pain and warmth at the injury site

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8
Q

Patients with lymphoma are most likely to experience abnormal function of:

Question 8 options:

A)

thrombocytes.

B)

neutrophils..

C)

erythrocytes.

D)

stem cells from which malignancy arises.

A

stem cells from which malignancy arises

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9
Q

Which of the following statements about sickle cell disease is FALSE?

Question 9 options:

A)

Sickle hemoglobin has a flawed chemical structure that results in erythrocyte deformity when oxygen levels are low.

B)

Splenomegaly is a common problem of sickle cell disease.

C)

Sickled red blood cells have longer life spans than normal red blood cells.

D)

Patients with chronic sickle cell disease have chronic hemolytic anemia.

A

sickled red blood cells have longer life spans than normal red blood cells

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10
Q

Your patient is a 22-year-old male complaining of a two-day history of a sore throat. He denies difficulty breathing, nausea, vomiting, or chest pain. He has no medical history and takes no medications. HR = 72, BP = 120/78, RR = 12, SaO2 = 99%. Physical examination reveals cool, dry skin. Which of the following findings would be most likely?

Question 10 options:

A)

Swelling of the cervical lymph nodes

B)

Positive Murphy’s sign

C)

Generalized erythema

D)

Rhonchi upon auscultation of the lungs

A

swelling of the cervical lymph nodes

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11
Q

In a patient with a hematological disease resulting in production of high numbers of abnormal red blood cells, which of the following would you be most likely to find?

Question 11 options:

A)

Fever

B)

Splenomegaly

C)

Florid skin

D)

Hepatomegaly

A

splenomegaly

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12
Q

Which of the following situations would result in a right shift of the oxygen-hemoglobin dissociation curve?

Question 12 options:

A)

Increase in 2,3-BPG

B)

Sepsis

C)

Hyperventilation

D)

Hypothermia

A

increase in 2, 3-BPG

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13
Q

The more acidic the blood is, the more readily hemoglobin:

Question 13 options:

A)

binds carbon dioxide.

B)

binds oxygen.

C)

releases oxygen.

D)

releases carbon dioxide.

A

releases oxygen

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14
Q

Dehydration is most likely to result in:

Question 14 options:

A)

leukocytosis.

B)

thrombocytopenia.

C)

increased number of white blood cells and platelets.

D)

increased prothrombin time.

A

increased number of white blood cells and platelets

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15
Q

Which of the following is NOT a difference between cellular and humoral immunity?

Question 15 options:

A)

Cellular immunity concerns itself with pathogens in cells and tissue; humoral concerns itself with pathogens in the lymph.

B)

T cells mature in the thymus gland, but B cells mature in lymph tissue.

C)

Humoral immunity uses memory cells, while cell-mediated immunity does not.

D)

T cells use cytotoxins to destroy pathogens, while B cells use antibodies.

A

humoral immunity uses memory cells, while cell- mediated immunity does not

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16
Q

A smoker who also takes supplemental vitamin K would be expected to:

Question 16 options:

A)

be unable to generate active forms of clotting factors II, VII, IX, and X.

B)

have a lower risk of developing pulmonary embolism.

C)

have enhanced clotting ability.

D)

have a higher incidence of polycythemia.

A

have enhanced clotting ability

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17
Q

All of the following are components of the inflammatory process EXCEPT:

Question 17 options:

A)

vasodilation.

B)

decreased chemotaxis.

C)

increased blood flow.

D)

increased capillary permeability.

A

decreased chemotaxis

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18
Q

Your patient is a 23-year-old female who is 6 hours postpartum after a traumatic delivery resulting in a massive blood transfusion. She is to be transferred from a community hospital to a specialty hospital for further care. She is unconscious and intubated, with a number of intravenous lines. Your physical examination reveals a purpuric rash over the chest and abdomen and mottling of the fingers and toes and all of the venous access sites are oozing blood. In addition, auscultation of the lung fields reveals rales to the dependent regions. HR = 112, BP = 82/60, RR = 12 via ventilator. Which of the following best describes the patient’s condition and treatment needs, in addition to continued ventilation and fluid administration?

Question 18 options:

A)

DIC; fresh frozen plasma and platelet administration

B)

DIC; type O negative blood

C)

Idiopathic hemophilia; factor VIIa administration

D)

Idiopathic hemophilia; corticosteriods

A

DIC, fresh frozen plasma and platelet administration

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19
Q

Humoral and cell-mediated immunity differ in that cell-mediated immunity uses:

Question 19 options:

A)

T cells, which generate effector cells to combat such invaders as intracellular organisms, while humoral immunity uses B cells that reside in lymph tissue and produce antibodies to combat foreign invaders.

B)

B cells, which generate effector cells to combat such invaders as intracellular organisms, while humoral immunity uses T cells that reside in lymph tissue and produce antibodies to combat foreign invaders.

C)

T cells, which reside in lymph tissue and produce antibodies to combat foreign invaders, while humoral immunity uses B cells that generate effector cells to combat such invaders as intracellular organisms.

D)

B cells, which generate effector cells to combat such invaders as intracellular organisms, while cellular immunity uses T cells that reside in lymph tissue and produce antibodies to combat foreign invaders

A

A)

T cells, which generate effector cells to combat such invaders as intracellular organisms, while humoral immunity uses B cells that reside in lymph tissue and produce antibodies to combat foreign invaders.

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20
Q

Which of the following statements about disseminated intravascular coagulation (DIC) is TRUE?

Question 20 options:

A)

The bleeding typical of DIC is a result of an increased fibrinogen level.

B)

Causes of DIC include reduced fibrinogen levels, consumption of coagulation factors, and thrombocytopenia.

C)

Activated thrombin converts fibrinogen to fibrin in the circulating blood.

D)

DIC most commonly results from hemophilia, hypertension, and severe tissue injury.

A

activated thrombin converts fibrinogen to fibrin in the circulating blood

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21
Q

Which of the following situations would result in erythropoietin secretion?

Question 21 options:

A)

Alkalemia

B)

Hemophilia

C)

CVA

D)

Hypoxia

A

hypoxia

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22
Q

Which of the following situations would result in a more rapid response by the immune system to an infection?

Question 22 options:

A)

First-time exposure to an antigen with memory B cell activation

B)

First-time exposure to an antigen

C)

Second exposure to an antigen with memory B cell activation

D)

First-time exposure to an antigen with memory T cell activation

A

second exposure to an antigen with memory B cell activation

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23
Q

A patient has a hematocrit of 48 percent and a hemoglobin of 15 g/dl. Which of the following statements is TRUE?

Question 23 options:

A)

His hemoglobin is high, but his hematocrit is normal.

B)

Both are within the normal range for an adult male.

C)

Both are within the normal range for an adult male or female.

D)

His hematocrit and hemoglobin are both low.

A

both are within the normal range for an adult male

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24
Q

Which of the following statements about leukemia is TRUE?

Question 24 options:

A)

Infections secondary to low levels of circulating neutrophils are common.

B)

Leukemia is a disease of children and young adults, not older adults.

C)

Leukemias are cancers of erythrocytes.

D)

The pediatric mortality rate is greater than 50 percent.

A

infections secondary to low levels of circulating neutrophils are common

25
Q

In the presence of calcium, thrombin will encourage:

Question 25 options:

A)

prothrombin activation.

B)

platelet aggregation.

C)

plasminogen release.

D)

fibrin clot formation.

A

platelet aggregation

26
Q

You are pruning a rosebush and puncture the skin on your thumb with a thorn. The next day you note that the area is swollen. Which of the following best explains the swelling that has occurred?

Question 26 options:

A)

Humoral immunity activation results in localized tissue damage and edema of the tissue surrounding the injury site.

B)

Cell-mediated immunity activation results in chemotaxis and increased capillary permeability.

C)

Localized vasodilation and increased capillary permeability result in plasma leakage into the tissue surrounding the injury site.

D)

There is an infection, resulting in edema to the surrounding tissue.

A

localized vasodilation and increased capillary permeability result in plasma leakage into the tissue surrounding the injury site

27
Q

Which of the following statements about leukocytes is FALSE?

Question 27 options:

A)

Leukocytes can travel through blood vessel walls into the surrounding tissues.

B)

Leukocytes engulf and destroy foreign invaders via leukopoiesis.

C)

Leukocytes protect against foreign invaders.

D)

Leukocytes follow chemical signals to an infection site.

A

Leucocytes engulf and destroy foreign invaders via leukopoiesis

28
Q

Which of the following circumstances would result in activation of the coagulation cascade via the intrinsic pathway?

Question 28 options:

A)

Administration of warfarin

B)

Development of a plaque in a coronary artery resulting in turbulent blood flow

C)

Penetrating trauma resulting in soft-tissue damage

D)

Blunt-force trauma

A

development of a plaque in a coronary artery resulting in a turbulent blood flow

29
Q

A male will express hemophilia if he acquires ________ chromosome(s).

Question 29 options:

A)

defective X and Y

B)

one defective X

C)

two defective X

D)

one defective Y

A

one defective X

30
Q

For a patient with hemophilia B, which of the following statements is TRUE?

Question 30 options:

A)

The patient’s father had hemophilia B, and the mother was unaffected.

B)

The patient’s father had hemophilia B, and the mother was a carrier of the defective gene.

C)

The patient’s father was a carrier for the defective gene, and her mother did not carry the defective gene.

D)

The patient’s mother was a carrier for the defective gene, and her father did not carry the defective gene.

A

the patients father has hemophilia B, and the mother was a carrier of the defective gene

31
Q

Which of the following is NOT a goal of the inflammatory process?

Question 31 options:

A)

To ward off damage from microorganisms or trauma

B)

To localize the damage

C)

To facilitate repair of the tissues

D)

To produce antibodies to combat pathogens

A

to produce antibodies to combat pathogens

32
Q

Which of the following situations would NOT result in anemia?

Question 32 options:

A)

Blood loss

B)

Destruction of red blood cells

C)

Increased production of erythropoietin

D)

Iron deficiency

A

increased production of erythropoietin

33
Q

Your patient is a 26-year-old African-American male who is alert but in severe distress, complaining of pain in his hands and feet, as well as abdominal pain. The pain began this morning but has progressed from an initial rating of 5/10 to a 9/10 at the present time. The patient has a history of sickle cell anemia and denies any trauma. Physical examination reveals cool, diaphoretic skin; pain with palpation to all four abdominal quadrants; splenomegaly; and a priapism. HR = 132, BP = 140/90, RR = 16. Select the most appropriate acute diagnosis and treatment for this patient.

Question 33 options:

A)

Sickle cell disease; administer oxygen according to pulse oximetry readings, start an IV of normal saline, and administer ketorolac for pain

B)

Sickle cell vaso occlusive crisis; administer high-concentration oxygen, IV therapy with isotonic crystalloids, and narcotics for pain control

C)

Sickle cell occlusive crisis; administer oxygen by nonrebreathing mask, isotonic crystalloids, and aspirin

D)

Sickle cell trait; administer oxygen according to pulse oximetry readings, and give a 500 mL bolus of isotonic crystalloid solution

A

Sickle cell vaso occlusive crisis; administer high-concentration oxygen, IV therapy with isotonic crystalloids, and narcotics for pain control

34
Q

Your patient is suffering from end-stage liver disease. In which of the following ways would impairment of the hematologic system most likely be evident?

Question 34 options:

A)

Leukocytosis

B)

Jaundice

C)

Polycythemia resulting in a florid appearance

D)

Vaso-occlusive crisis resulting in joint pain

A

jaundice

35
Q

Your patient is taking an immunosuppressant drug to prevent rejection of a transplanted kidney. As a consequence, the patient is more prone to:

Question 35 options:

A)

prolonged blood clotting time.

B)

aplastic anemia.

C)

infection.

D)

polycythemia.

A

infection

36
Q

Your patient is undergoing chemotherapy and is complaining of bleeding from the gums and blood in his stool. Which of the following will best address the patient’s problem?

Question 36 options:

A)

Administering erythropoietin

B)

Stopping the chemotherapy

C)

Administering vitamin K

D)

Administering platelets

A

administering platelets

37
Q

In an emergency situation if you administer blood to a patient whose blood type is unknown, you should administer type ________ blood.

Question 37 options:

A)

O negative

B)

A positive

C)

A negative

D)

B positive

A

O negative

38
Q

Your patient has type A+ blood. Which of the following statements about the patient’s blood is TRUE?

Question 38 options:

A)

The blood cells lack Rh antigens.

B)

There are type A antigens on the surface of the red blood cells.

C)

The patient can only receive A+ blood if a transfusion is needed.

D)

The patient produces anti-A antibodies.

A

there are type A antigens on the surface of the red blood cells

39
Q

In which of the following situations is hemolytic disease of the newborn most likely to occur?

Question 39 options:

A)

An Rh negative mother delivers a first Rh positive newborn

B)

An Rh positive mother delivers a second Rh negative newborn

C)

An Rh negative mother delivers a second Rh positive newborn

D)

An Rh positive mother delivers a first Rh negative newborn

A

an Rh negative mother delivers a second Rh positive newborn

40
Q

Which of the following medications would be most useful in the event of a transfusion reaction?

Question 40 options:

A)

Aspirin

B)

Magnesium sulfate

C)

Diphenhydramine

D)

Furosemide

A

diphenhydramine

41
Q

Your patient has a history of pernicious anemia. If not treated, your primary concern for this patient should be:

Question 41 options:

A)

infection.

B)

hypoxia.

C)

hypovolemia.

D)

prolonged blood clotting time.

A

hypoxia

42
Q

Which of the following is TRUE concerning sickle cell anemia?

Question 42 options:

A)

It is an acquired disease in which the body cannot absorb iron.

B)

It is a hereditary disease involving abnormal hemoglobin.

C)

It is an autoimmune disease in which the body destroys its own hemoglobin.

D)

It is a hereditary disease involving lack of intrinsic factor.

A

it is a hereditary disease involving abnormal hemoglobin

43
Q

Your patient is an 18-year-old female suffering from sickle cell crisis. Which of the following is the best course of treatment for this patient?

Question 43 options:

A)

High-concentration oxygen, IV NS KVO

B)

High-concentration oxygen, IV bolus of NS, morphine sulfate

C)

High-concentration oxygen, IV bolus of NS

D)

High-concentration oxygen, IV NS KVO, diphenhydramine

A

high - concentration oxygen, IV bolus on NS, morphine sulfate

44
Q

Which of the following statements regarding polycythemia is most accurate?

Question 44 options:

A)

It decreases the ability of blood to clot.

B)

It decreases the patient’s risk of infection.

C)

It increases the patient’s risk of infection.

D)

It increases the patient’s risk of thrombosis and congestive heart failure.

A

it increases the patients risk of thrombosis and congestive heart failure

45
Q

Which of the following statements regarding hemophilia is most accurate?

Question 45 options:

A)

Hemophilia is a hereditary abnormality of the platelets.

B)

Hemophilia is a hereditary disease that causes fibrin clots to dissolve prematurely.

C)

Hemophilia is a hereditary lack of certain proteins needed in the clotting cascade.

D)

Hemophilia is a hereditary disease in which the body is unable to produce vitamin K.

A

hemophilia is a hereditary lack of certain proteins needed in the clotting cascade

46
Q

What ethnicity is most likely to suffer from sickle cell disease?

Question 46 options:

A)

Caucasian

B)

Native American

C)

African American

D)

Asian

A

African American

47
Q

You are caring for a patient with a known history of sickle cell disease. The patient has severe abdominal and back pain. The patient is tachycardic and tachypneic. The blood pressure is normal. What should be one of the paramedic’s first interventions?

Question 47 options:

A)

Administer oxygen

B)

Give oral analgesics

C)

Put the patient in a supine position

D)

Initiate an IV

A

administer oxygen

48
Q

The study of blood and blood-forming organs is called:

Question 48 options:

A)

oncology.

B)

hematology.

C)

palliative care.

D)

homeostasis.

A

hematology

49
Q

Hemophilia A is an example of a ________ disorder.

Question 49 options:

A)

intrinsically endued

B)

environmentally acquired

C)

genetically acquired

D)

extrinsically endued

A

genetically acquired

50
Q

The organ that is most responsible for producing erythropoietin is the:

Question 50 options:

A)

bone marrow.

B)

spleen.

C)

liver.

D)

kidney.

A

kidney

51
Q

A complete hemoglobin molecule can carry up to:

Question 51 options:

A)

three oxygen molecules.

B)

two oxygen molecules.

C)

six oxygen molecules.

D)

four oxygen molecules.

A

four oxygen molecules

52
Q

Causes of the inflammatory process include all of the following EXCEPT:

Question 52 options:

A)

chemical exposure.

B)

infection.

C)

trauma.

D)

psychosocial factors.

A

psychosocial factors

53
Q

Hemostasis is maintained by which three mechanisms?

Question 53 options:

A)

Von Willebrand’s factor, fibrin, platelets

B)

Fibrin, platelets, hemoglobin

C)

Factor VIII, factor VII, factor III

D)

Vascular spasm, platelet plugs, fibrin clots

A

Vascular spasm, platelet plugs, fibrin clots

54
Q

Fibrinolytics are effective against:

Question 54 options:

A)

occlusions only in the heart.

B)

any clot.

C)

clots containing fibrin.

D)

occlusions only in the brain.

A

clots containing fibrin

55
Q

You are transporting a patient to a tertiary trauma center. The patient is receiving blood and has sustained trauma the local center cannot handle. You notice that the patient has begun to develop tachycardia, hives, and a fever. You suspect:

Question 55 options:

A)

hypovolemia

B)

a normal response to a transfusion.

C)

anaphylaxis.

D)

transfusion reaction.

A

transfusion reaction

56
Q

You suspect that your patient is having a transfusion reaction. The patient’s care plan should include:

Question 56 options:

A)

dobutamine, diphenhydramine, albuterol.

B)

diphenhydramine alone.

C)

IV fluid.

D)

dopamine, diphenhydramine, IV fluid bolus.

A

dopamine, diphenhydramine, IV fluid bolus

57
Q

A patient complains of atraumatic bleeding of the gums. You suspect:

Question 57 options:

A)

a hematologic disorder.

B)

halitosis.

C)

dentalgia.

D)

gingivitis.

A

a hematologic disorder

58
Q

You are caring for a patient who is complaining of diffuse musculoskeletal pain, shortness of breath, and atraumatic priapism. You suspect:

Question 58 options:

A)

AML.

B)

sickle cell vaso occlusive crisis.

C)

sickle cell hematologic crisis.

D)

Acute lymphocytic leukemia (ALL).

A

sickle cell vaso occlusive crisis

59
Q

You respond to a patient complaining of shortness of breath. Upon your arrival, the patient tells you that she has been experiencing headaches, vertigo, and now itching. She says her doctor had called with a lab result of her latest test. Her hematocrit is reported as 60. You suspect:

Question 59 options:

A)

sickle cell disease.

B)

thrombocytopenia.

C)

congestive heart failure (CHF).

D)

polycythemia.

A

polycythemia

Medical Emergencies (19 decks)

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