FEU BLOOD Flashcards
Q4: Which of the following is a chimeric monoclonal antibody against TNF?
A. Etanercept
B. Golimumab
C. Infliximab
D. Certolizumab
C. Infliximab
Rationale: Infliximab is a chimeric (human-mouse) monoclonal antibody targeting TNF-α, used for autoimmune diseases like rheumatoid arthritis, Crohn’s disease, and psoriasis.
Q8: What is the most frequent extracutaneous manifestation in systemic sclerosis?
A. Pulmonary arterial hypertension
B. Raynaud’s phenomenon
C. Myopathy
D. Calcinosis cutis
A. Pulmonary arterial hypertension
Rationale: Pulmonary arterial hypertension (PAH) is a leading cause of mortality in systemic sclerosis, often progressing despite treatment.
Q10: An 18-year-old man presents for his first annual physical. His CBC shows hemoglobin 10.2 and MCV of 68. He has a family history of anemia but feels well. What is the best next test?
A. Erythropoietin level
B. Bone marrow biopsy
C. Hemoglobin electrophoresis
D. Total bilirubin
C. Hemoglobin electrophoresis
Rationale: Microcytic anemia (MCV 68) with a family history suggests thalassemia, which is best diagnosed with hemoglobin electrophoresis to detect abnormal hemoglobin variants (e.g., HbA2 in β-thalassemia).
Q15: The term that refers to variation in red cell size is:
A. Poikilocytosis
B. Anisochromasia
C. Anisocytosis
D. Polychromasia
C. Anisocytosis
Rationale: Anisocytosis refers to variation in RBC size, seen in iron deficiency anemia, thalassemia, and megaloblastic anemia. Poikilocytosis refers to abnormal RBC shapes.
Q21: A 36-year-old female presents with six-month fatigue and menorrhagia. Her labs show Hb 10.2 g/dL, MCV 72, ferritin 7.5 ng/mL, and low reticulocyte count (0.3%). You start her on iron supplements and schedule a follow-up in a month. What lab result would confirm iron deficiency as the cause?
A. Increased hemoglobin
B. Low reticulocyte count
C. High ferritin
D. Decreased MCV
A. Increased hemoglobin
Rationale: Iron supplementation improves hemoglobin levels first, followed by MCV normalization later. Ferritin remains low until iron stores are replenished. Reticulocyte count should increase after treatment, not remain low.
Q26: A leukoerythroblastic smear may include the following EXCEPT:
A. Teardrop-shaped RBCs
B. Target cells
C. Immature myeloid cells
D. Nucleated red blood cells
B. Target cells
Rationale: Leukoerythroblastic smears show nucleated RBCs, immature myeloid cells, and teardrop cells, commonly seen in myelofibrosis or bone marrow infiltration. Target cells are seen in thalassemia and liver disease.
Q27: Clinical features of aplastic anemia, EXCEPT:
A. Restriction of symptoms to the hematologic system
B. Bleeding is the most common early symptom
C. Lymphadenopathy and splenomegaly are common
D. Symptoms of anemia are frequent
C. Lymphadenopathy and splenomegaly are common
Rationale: Aplastic anemia does NOT cause lymphadenopathy or splenomegaly. It presents with pancytopenia, bleeding (due to thrombocytopenia), and symptoms of anemia. Enlarged lymph nodes suggest alternative diagnoses like leukemia.
Q31: A healthy 24-year-old woman with no symptoms or signs of excessive bleeding is noted to have a platelet count of 60,000/μL on routine examination. What is the next step in evaluation?
A. Measurement of Von Willebrand factor antigen
B. Bleeding time
C. Examination of the peripheral blood smear
D. Bone marrow aspiration
C. Examination of the peripheral blood smear
Rationale: A peripheral blood smear helps assess for platelet clumping, thrombocytopenia causes (immune thrombocytopenia, leukemia, or microangiopathies) before proceeding with invasive tests. Von Willebrand disease and bleeding time are not first-line tests for asymptomatic thrombocytopenia.
Q32: Iron regulatory hormone that is increased in inflammation and acts to suppress iron absorption and iron release from storage sites:
A. Hepcidin
B. IL-1
C. Hephaestin
D. TNF
A. Hepcidin
Rationale: Hepcidin is a key iron regulatory hormone produced by the liver. It inhibits ferroportin, decreasing iron absorption from the intestines and iron release from macrophages, contributing to anemia of chronic disease.
Q36: Which of the following factors can activate Factors I, V, VII, VIII, XI, XIII, protein C, and platelets?
A. Factor IX
B. Factor XII
C. Factor III
D. Factor II
D. Factor II (Thrombin)
Rationale: Thrombin (Factor IIa) is a key coagulation enzyme that activates multiple clotting factors (I, V, VIII, XI, XIII) and promotes platelet aggregation.
Q38: A 35-year-old man with HIV presents with weakness, shortness of breath, dark urine, and fever. His CBC shows hemoglobin 5.9 g/dL. Which of the following results would be most consistent with a diagnosis of Thrombotic Thrombocytopenic Purpura (TTP)?
A. Schistocytes on peripheral smear
B. Positive Coombs’ Direct Antibody Test
C. Low to absent haptoglobin
D. Prolonged PT and PTT
A. Schistocytes on peripheral smear
Rationale: TTP is a thrombotic microangiopathy characterized by microangiopathic hemolytic anemia (schistocytes), thrombocytopenia, fever, renal dysfunction, and neurologic symptoms. PT and PTT are typically normal.
Q39: A 59-year-old man is diagnosed with polycythemia vera. Which ONE of the following findings is NOT a feature of this disease?
A. High serum erythropoietin
B. Elevated uric acid
C. Splenomegaly
D. Thrombocytosis
A. High serum erythropoietin
Rationale: Polycythemia vera is a myeloproliferative disorder with low erythropoietin (EPO) levels. High EPO suggests secondary polycythemia (e.g., hypoxia-driven EPO production).
Q41: A 75-year-old female presents with fatigue and tingling in her fingers and toes. Her CBC shows hemoglobin 10 g/dL with an MCV of 115. Which set of lab findings is most consistent with vitamin B12 deficiency?
A. Low WBC and platelets, B12 level 400 pg/mL, homocysteine elevated, methylmalonic acid elevated
B. Normal WBC and platelets, B12 level 100 pg/mL, homocysteine decreased, methylmalonic acid elevated
C. Low WBC and platelets, B12 level 100 pg/mL, homocysteine elevated, methylmalonic acid elevated
D. Normal WBC and platelets, B12 level 100 pg/mL, homocysteine decreased, methylmalonic acid normal
C. Low WBC and platelets, B12 level 100 pg/mL, homocysteine elevated, methylmalonic acid elevated
Rationale: Vitamin B12 deficiency causes macrocytic anemia, low WBC/platelets (bone marrow suppression), elevated methylmalonic acid, and homocysteine levels. A B12 level <200 pg/mL is diagnostic.
Q47: Which of the following tests measures the extrinsic and common pathways of secondary coagulation?
A. Clotting time
B. Prothrombin time (PT)
C. Bleeding time
D. Activated partial thromboplastin time (aPTT)
B. Prothrombin time (PT)
Rationale: PT measures the extrinsic and common coagulation pathways, specifically assessing Factors I, II, V, VII, and X. aPTT evaluates the intrinsic pathway.
Q55: A 55-year-old male presents to the ER with severe hematemesis (vomiting blood). He cannot provide his medical or surgical history. Lab results: PT 50 sec, APTT 70 sec. What is the most likely etiology?
A. Antiphospholipid antibody
B. Liver disease
C. Factor VIII deficiency
D. Von Willebrand disease
B. Liver disease
Rationale: Liver disease leads to impaired synthesis of clotting factors, causing prolonged PT and APTT. Factor VIII deficiency (hemophilia A) and von Willebrand disease primarily affect APTT.
Q56: A 38-year-old man presents with bleeding gums, gingival hypertrophy, and oral purpura. CBC shows numerous immature blasts. What is the most likely diagnosis?
A. AML (monoblastic subtype)
B. APL
C. ALL
D. Therapy-related AML
A. AML (monoblastic subtype)
Rationale: Acute Monoblastic Leukemia (AML M5) often presents with gum hypertrophy and excessive bleeding due to leukemic infiltration of the gingiva.
Q57: A common feature of this disorder is a defect in DNA synthesis that affects rapidly dividing cells in the bone marrow.
A. Myelophthisic anemia
B. Megaloblastic anemia
C. Aplastic anemia
D. Pure red cell aplasia
B. Megaloblastic anemia & D. Pure red cell aplasia
Rationale: Megaloblastic anemia is due to defective DNA synthesis (B12 or folate deficiency). Pure red cell aplasia is a selective bone marrow failure affecting erythroid precursors.
Q65: A 68-year-old man presents with fever, night sweats, and weight loss. Immunologic studies show mature lymphocytes that are CD5 and CD23 positive but negative for cyclin D1. What is the most likely diagnosis?
A. Mantle cell lymphoma
B. B-cell acute lymphocytic leukemia
C. Diffuse large B-cell NHL
D. Chronic lymphocytic leukemia (CLL)
D. Chronic lymphocytic leukemia (CLL)
Rationale: CLL is characterized by CD5+ and CD23+ mature lymphocytes. Mantle cell lymphoma is also CD5+ but cyclin D1 positive.
Q67: Spherocytes in the blood film are a feature of:
A. Thalassemia major
B. Iron deficiency anemia
C. Autoimmune hemolysis
D. Aplastic anemia
C. Autoimmune hemolysis
Rationale: Spherocytes are seen in autoimmune hemolytic anemia (AIHA) and hereditary spherocytosis. They result from membrane loss due to complement or splenic destruction.
Q68: A 23-year-old male presents with headache, stiff neck, fever, and a rash. He has neck stiffness, petechiae, and ecchymoses. Labs: WBC 20,000/μL, platelets 90,000/μL, decreased fibrinogen, PT 17 s, PTT 50 s. Blood culture: gram-negative diplococci. What is the most likely diagnosis?
A. Factor VIII deficiency
B. Thrombotic thrombocytopenic purpura
C. Hemolytic uremic syndrome
D. Disseminated intravascular coagulation (DIC)
D. Disseminated intravascular coagulation (DIC)
Rationale: DIC is a life-threatening coagulopathy with prolonged PT/PTT, thrombocytopenia, decreased fibrinogen, and fibrin degradation products. It is a complication of meningococcal sepsis.
Q69: Which of the following best describes leukodepletion/leukoreduction of packed RBCs?
A. Using leukoreduction to prevent transfusion-related immunosuppression is unclear.
B. Bacterial infection prevention is proven ineffective with leukodepletion of blood components.
C. Leukoreduction reduces leukocyte count to less than 5 billion in a packed RBC unit.
D. Acute hemolytic transfusion reactions have been largely prevented with leukoreduction of blood components.
C. Leukoreduction reduces leukocyte count to less than 5 billion in a packed RBC unit.
Rationale: Leukoreduction removes white blood cells to reduce febrile non-hemolytic transfusion reactions, CMV transmission, and alloimmunization.
Q74: Laboratory features of anemia of chronic disease, EXCEPT:
A. Increased red cell protoporphyrin
B. Decreased serum ferritin
C. Low serum iron
D. Hypoproliferative marrow
B. Decreased serum ferritin
Rationale: Serum ferritin is usually normal or increased in anemia of chronic disease (ACD) due to iron sequestration. The condition is characterized by low serum iron, decreased transferrin saturation, and hypoproliferative marrow.
Q79: What is the most convenient laboratory test to estimate iron stores?
A. Serum Ferritin
B. Serum Iron
C. Transferrin Saturation
D. Bone Marrow Iron Stores Evaluation
A. Serum Ferritin
Rationale: Serum ferritin is the best non-invasive marker of total body iron stores. Bone marrow iron evaluation is invasive and rarely needed.
Q81: WHO defines anemia in women as a hemoglobin level of:
A. Less than 130 g/L
B. Less than 100 g/L
C. Less than 120 g/L
D. Less than 110 g/L
C. Less than 120 g/L
Rationale: The WHO defines anemia in non-pregnant women as Hb <120 g/L (12 g/dL) and in pregnant women as Hb <110 g/L (11 g/dL).
