Haematology Flashcards
An immunologic reaction which leads to the formation of blood clots and a rapid 50% drop in platelet count.
- A ) Antithrombin III deficiency
- B ) APS
- C ) Factor V Leiden
- D ) Heparin-induced thrombocytopenia
- E ) Protein C and S deficiency
= D ) Heparin-induced thrombocytopenia
Considering the following case which blood film correctly matches this patient?
An 82-year-old male presents to your clinic with dementia. He has a past history of tingling, numbness, pins-and-needles sensation, coldness (especially in the lower extremities). He also has spinal ataxia and positive Romberg’s test
Which one of the following blood films correctly describes this man’s problem?
Answer: Option E is correct
- Subacute combined degeneration of spinal cord due to Vitamin B12 deficiency. The blood film shows megaloblastic anaemia with hypersegmented neutrophils
- Subacute combined degeneration of spinal cord - symmetrical manifestations:
- Loss of vibratory sensation, tactile discrimination, and proprioception
- Spastic paresis
- Gait abnormalities (spinal ataxia, positive Romberg’s test)
- A ) Atypical lymphocytes
- B ) Bence Jones protein
- C ) Rouleaux formations
- D ) Schistocytes
- E ) Target cells
= C ) Rouleaux formations
Multiple myeloma is a malignancy of monoclonal plasma cells that arises in the bone marrow and produces large amounts of immunoglobulin (IgG or IgA). Multiple myeloma is the most common primary bone tumor in patients above the age of 50. Clinical features of multiple myeloma can be remembered with the mnemonic “CRAB”: hyperCalcemia, Renal involvement, Anemia, and Bone lytic lesions/Back pain. In multiple myeloma, immunoglobulins coat the red blood cells and neutralize the ionic charge that normally repels them from one another, allows the red blood cells to stack together (Rouleaux formation).
Illustration shows a rouleaux formation, characteristic of multiple myeloma. A Rouleaux formation refers to the appearance of red blood cells stacked like poker chips on a peripheral blood smear
NOTE: Bence Jones protein is a monoclonal globulin protein or immunoglobulin light chain found in the urine.
Which immunoglobulin is produced in Waldenstrom’s macroglobulinemia?
- A ) IgA
- B ) IgD
- C ) IgE
- D ) IgG
- E ) IgM
Answer: IgM
Waldenstrom macroglobulinemia is a B-cell lymphoma with monoclonal IgM production.
Which histopathology stain is used to detect the presence of iron in biopsy specimens?
- A ) Congo red
- B ) Eosin
- C ) Masson’s trichrome
- D ) Prussian blue
- E ) Romanowsky
= D ) Prussian blue
A rouleaux formation on blood film is indicative of which pathology?
- A ) Follicular lymphoma
- B ) Hodgkin lymphoma
- C ) Monoclonal gammopathy of uncertain significance
- D ) Multiple myeloma
- E ) Polycythemia vera
Answer: Multiple myeloma
Rouleaux formations are chains of erythrocytes which stick together due to the high concentration of immunoglobulins, which reduce the cell surface charge. (Underwood’s Pathology, 6th edition).
Proliferation and differentiation of red blood cell precursors is stimulated by _________, a hormone produced by renal _______________.
A ) erythropoietin, glomerulus podocytes
B ) erythropoietin, interstitial peritubular cells
C ) erythropoietin, loop of Henle thin segment cells
D ) IL-3, collecting duct principal cells
E ) stem cell factor, collecting duct principal cells
= B)
Proliferation and differentiation of red blood cell precursors is stimulated by erythropoietin, a hormone produced by renal interstitial peritubular cells.
Some forms of anaemia can be treated with exogenous recombinant erythropoietin.
Which type of anaemia is caused by vitamin B6 deficiency, alcoholism, or lead poisoning?
- A ) Anaemia of pregnancy
- B ) Haemolytic anaemia
- C ) Iron deficiency anaemia
- D ) Sideroblastic anaemia
- E ) Vitamin B12 deficiency
= D ) Sideroblastic anaemia
A 68-year-old presents to his GP with complaints of general malaise, weight loss, and a change in his bowel habits. He claims to have lost seven kilos over the past three months. He undergoes a work up, and it is discovered that he has an anaemia. What would be the most common type of anaemia in this patient?
- A ) Macrocytic anaemia
- B ) Microcytic anaemia due to iron deficiency
- C ) Microcytic anaemia due to sideroblastic anaemia
- D ) Normocytic normochromic anaemia
- E ) Relative normocytic anaemia from fluid retention and hypervolaemia
= B ) Microcytic anaemia due to iron deficiency
This patient’s story is typical of a patient with bowel cancer, which commonly results in an iron-deficiency anaemia.
Considering the following blood film, what is the likely diagnosis?
- A ) Anaemia caused by thalassemia
- B ) Anaemia of chronic disease
- C ) Aplastic anemia
- D ) Iron deficiency anaemia
- E ) Pernicious anaemia
- F ) Sideroblastic anaemia
= E ) Pernicious anaemia
A hypersegmented neutrophil that is present with megaloblastic anaemias. There are 8 lobes instead of the usual 3 or 4. Such anaemias can be due to folate or B12 deficiency. The size of the RBC’s is also increased.
Considering the following blood film, what is the likely diagnosis?
- A ) Anaemia caused by thalassemia
- B ) Anaemia of chronic disease
- C ) Aplastic anemia
- D ) Iron deficiency anaemia
- E ) Pernicious anaemia
- F ) Sideroblastic anaemia
= E ) Pernicious anaemia
Where does iron absorption take place?
- A ) Duodenum
- B ) Ileum
- C ) Jejunum
- D ) Large intestine
- E ) Liver
= A ) Duodenum
- A ) Bone marrow biopsy
- B ) Peripheral blood smear
- C ) Radiograph of the lumbar spine
- D ) Urine protein levels
- E ) Urine, blood, and cerebrospinal fluid cultures
= A ) Bone marrow biopsy
Where does folate absorption mostly take place?
- A ) Duodenum
- B ) Ileum
- C ) Jejunum
- D ) Large intestine
- E ) Liver
= C ) Jejunum
Considering the following blood film, what is the most common diagnosis?
- A ) Anaemia caused by thalassemia
- B ) Anaemia of chronic disease
- C ) Iron deficiency anaemia
- D ) Megaloblastic disease
- E ) Pernicious anaemia
- F ) Sideroblastic anemia
= C ) Iron deficiency anaemia
The most common cause for a hypochromic microcytic anaemia is iron deficiency.
Which coagulation factor is the final part in the clotting cascade and acts to stabilise the fibrin clot by cross-linking fibrin polymers?
- A ) IX
- B ) Prothrombin
- C ) VIII
- D ) X
- E ) XIII
= E ) XIII
All of the following are seen in Plummer–Vinson syndrome except:
- A ) Anemia
- B ) Angular stomatitis
- C ) Glossitis
- D ) Koilonychia
- E ) Oesophageal web
- F ) Splenomegaly
= F ) Splenomegaly
Plummer–Vinson syndrome is a rare disease characterised by difficulty in swallowing, iron-deficiency anemia, glossitis, angular stomatitis and esophageal webs
Complete this sentence: Iron deficiency anaemia ____.
- A ) in childhood is associated with chronic blood loss in most cases
- B ) is associated with pica
- C ) is characterized by low serum iron and low TIBCB
- D ) is prevented by the early introduction of cow’s milk
- E ) never requires treatment under the age of 6 months
= B ) is associated with pica
Which anaemia is due to defective protoporphyrin synthesis?
- A ) Anaemia of chronic disease
- B ) Hereditary spherocytosis
- C ) Iron deficiency anaemia
- D ) Paroxysmal nocturnal haemoglobinuria
- E ) Sideroblastic anaemia
= E ) Sideroblastic anaemia
Sideroblastic anaemia can be congenital or acquired. Congenital sideroblastic anaemia most often involves aminolevulinic acid synthetase, a rate-limiting enzyme involved in protoporphyrin synthesis. Acquired causes include alcoholism, lead poisoning, and vitamin B6 deficiency. (Pathoma, 2018)
Which blood film shows inherited defect of RBC cytoskeleton-membrane tethering proteins. Diagnosis made by osmotic fragility test.
Answer: Option B is correct
Hereditary spherocytosis is a condition that affects red blood cells. People with this condition typically experience anemia, jaundice, and splenomegaly.
A patient with hypochromic microcytic anemia would also be expected to have which of the following?
- A ) Iron deficiency anaemia
- B ) Folic acid deficiency
- C ) Hypothyroidism
- D ) Subacute combined degeneration of the cord
- E ) Vitamin B12 deficiency
= A ) Iron deficiency anaemia
Hypercalcaemia causes which of the following signs/symptoms?
- A ) Chvostek’s sign
- B ) Constipation
- C ) Laryngospasm
- D ) Prolonged QT interval
- E ) Seizures
= B ) Constipation
In a typical case of iron deficiency, which of the following molecular forms increases in the patient’s serum?
- A ) Ferritin
- B ) Haemoglobin
- C ) Haemosiderin
- D ) Myoglobin
- E ) Transferrin
= E ) Transferrin
Considering the following blood film, what is the likely diagnosis?
- A ) Anaemia caused by thalassemia
- B ) Anaemia of chronic disease
- C ) Hereditary spherocytosis
- D ) Iron deficiency anaemia
- E ) Megaloblastic disease
- F ) Pernicious anaemia
- G ) Sideroblastic anemia
= C ) Hereditary spherocytosis
The size of many of these RBC’s is quite small, with lack of the central zone of pallor. These RBC’s are spherocytes. In hereditary spherocytosis, there is a lack of spectrin, a key RBC cytoskeletal membrane protein. This produces membrane instability that forces the cell to the smallest volume - a sphere. In the laboratory, this is shown by increased osmotic fragility. The spherocytes do not survive as long as normal RBC’s.
_____ would cause a macrocytic anaemia with an MCV greater than ______ micrometers3.
- A ) Anaemia of chronic disease, >60
- B ) Aplastic anaemia, >100
- C ) Folate deficiency, >100
- D ) Immune haemolytic anaemia, 80-100
- E ) Thalassaemia, >150
= C ) Folate deficiency, would cause a macrocytic anaemia with an MCV greater than >100 micrometers3.
Macrocytic anaemias are most commonly due to folate or vitamin B12 deficiencies, but can also be caused by alcoholism, liver disease and some drugs. Lack of folate or vitamin B12 impairs synthesis of DNA precursors. This results in cells with arrested nuclear maturation but with normal cytoplasmic development; this is known as nucleocytoplasmic asynchrony. Proliferating cells exhibit megaloblastosis and impaired division of granulocytic precursors leads to hypersegmented neutrophils.
Which condition can sometimes progress to multiple myeloma?
- A ) Hairy cell leukaemia
- B ) Histiocytosis
- C ) Monoclonal gammopathy of uncertain signficance
- D ) Myeloid stem cell dysplasia
- E ) Polycythemia vera
= C ) Monoclonal gammopathy of uncertain signficance
People with monoclonal gammopathy of uncertain significance (MGUS) have a stable paraprotein without the other features of multiple myeloma. (Underwood’s Pathology, 6th edition)
Considering the following blood film, what is the likely diagnosis?
- A ) Anaemia caused by thalassemia
- B ) Anaemia of chronic disease
- C ) Iron deficiency anaemia
- D ) Megaloblastic disease
- E ) Pernicious anaemia
- F ) Sideroblastic anemia
= A ) Anaemia caused by thalassemia
Smear shows microcytic, hypochromic RBCs with target cells and nucleated red blood cells.
A 50-year-old male walks into ED presenting with insidious onset of shortness of breath, fatigue, and dizziness. He has bilateral numbness and tingling in his fingers. He appears pale and sallow. On examination, his heart rate is 132. His sclerae and nailbeds are pale, and he has dependent oedema of his ankles. CXR demonstrates cardiomegaly. Laboratory findings include a negative Coombs’ test and a hemoglobin of 40 g/L (130–180g/L). The likely diagnosis is:
- A ) Autoimmune anaemia
- B ) Blood loss
- C ) Iron-deficiency anaemia
- D ) Pernicious anaemia
- E ) Traumatic hemolytic anaemia
= D ) Pernicious anaemia
Which of the following causes of anaemia is associated with microcytosis?
- A ) Alcohol
- B ) Folic acid deficiency
- C ) Hypothyroidism
- D ) Thalassemia
- E ) Therapy with methotrexate
= D ) Thalassemia
Considering the following case and blood film, what is the likely diagnosis?
A 56-year-old man presents to his annual physical exam with weight loss, fatigue, and weakness. He is a long-term smoker and also recently immigrated from Southeast Asia. He complains of a chronic cough for the past year with occasional bloody mucus. He agrees to undergo imaging for lung lesions and a blood test for tuberculosis. Iron studies reveal decreased serum iron, increased ferritin, and decreased TIBC.
- A ) Anaemia caused by thalassemia
- B ) Anaemia of chronic disease
- C ) Iron deficiency anaemia
- D ) Megaloblastic disease
- E ) Pernicious anaemia
- F ) Sideroblastic anaemia
= B ) Anaemia of chronic disease
This is normochromic, normocytic anaemia. Anaemia of chronic disease is the most common anaemia in hospitalised persons.
Deficiency of which one of the following causes this clinical feature?
- A ) Iron
- B ) Magnesium
- C ) Thiamine
- D ) Vitamin B6
- E ) Vitamin D
= A ) Iron
Angular stomatitis resulting from iron deficiency
Choose the correct option:
This deficiency is often associated with SLE and RA. It predisposes to both arterial and venous thrombi formation and spontaneous abortion.
- A ) Antithrombin III deficiency
- B ) APS
- C ) Factor V Leiden
- D ) Heparin-induced thrombocytopenia
- E ) Protein C and S deficiency
= B ) APS
Mycosis fungoides is a type of ___________ that involves the neoplastic proliferation of _________ that infiltrate the skin, producing localised skin rash, plaques, and nodules.
- A ) acute leukemia, C84+ T cells
- B ) chronic leukaemia, CD4+ T cells
- C ) lymphoma, B cells
- D ) lymphoma, CD4+ T cells
- E ) myeloproliferative disorder, mature myeloid cells
= D ) Mycosis fungoides is a type of lymphoma that involves the neoplastic proliferation of CD4+ T cells that infiltrate the skin, producing localised skin rash, plaques, and nodules.
What is the likely cause of diagnosis based on this blood film?
- A ) Blood loss
- B ) Hodgkin lymphoma
- C ) Iron deficiency
- D ) Multiple myeloma
- E ) Vitamin B12 deficiency
= D ) Multiple myeloma
Rouleaux formation is apparent in this low power view of a peripheral blood smear from a patient with multiple myeloma.
In multiple myeloma, neoplastic plasma cells produce a monoclonal immunogloblulin known as M-protein, or paraprotein. What is the most common immunoglobulin synthesised?
- A ) IgA
- B ) IgD
- C ) IgE
- D ) IgG
- E ) IgM
= D ) IgG
Multple myeloma plasma cells most commonly produces IgG (60% of cases). IgA may also be produced, and/or immunoglobulin light chains (kappa and lambda) may also be seen. IgD and IgE types are unusual, while IgM types are more typical of Waldenstrom’s macroglobulinaemia; a lymphoma. (Underwood’s Pathology, 6th edition)
Which blood film is seen after a splenectomy in a patient with hereditary spherocytosis?
= Answer: Option C is correct
Treatment of hereditary spherocytosis is splenectomy; anemia resolves, but spherocytes persist and Howell-Jolly bodies (fragments of nuclear material in RBCs) emerge on blood smear.
A 27-year-old man with a history of alcoholism and chronic liver disease was admitted for anaemia (hemoglobin 4.8 g/dL) and thrombocytopenia with normal white blood cell count, mean corpuscular volume 110.2 fL. The blood smear demonstrated macrocytes. Which blood film matches these clinical features in this patient?
= Answer: Option G is correct
Nonmegaloblastic Macrocytic Anemia
- Increase in RBC without megaloblasts present in the bone marrow
- Associated with accelerated erythropoiesis
- Caused by liver disease alcoholism, reticulocytosis, hypothyroidism and myelodysplasia
Which oncogenic virus is associated with adult T-cell leukemia/lymphoma?
- A ) EBV
- B ) HBV
- C ) HHV-8
- D ) HPV 16, 18, 31 and 33
- E ) HTLV-1
= E ) HTLV-1
During haematopoeisis which cell is generated from a CFU-GM?
- A ) B-cell
- B ) Eosinophil
- C ) Erythrocyte
- D ) Megakaryoblast
- E ) Thymocyte
= B ) Eosinophil
- A ) Analgesic nephropathy
- B ) ANCA-associated granulomatous vasculitis
- C ) Membranous nephropathy
- D ) Multiple myeloma
- E ) Systemic lupus erythematosus
- F ) Type 2 diabetes mellitus
= D ) Multiple myeloma
Goodpasture’s syndrome is caused by autoantibodies against:
- A ) Type I collagen
- B ) Type II collagen
- C ) Type III collagen
- D ) Type IV collagen
- E ) Type V collagen
= D ) Type IV collagen
Tissue plasminogen activator works by converting plasminogen to plasmin. What does plasmin then do?
- A ) Augments antithrombin III
- B ) Blocks platelet aggregation and activates protein C
- C ) Cleaves fibrin and serum fibrinogen, destroys coagulation factors and blocks platelet aggregation
- D ) Inactivates coagulation factors only
- E ) Ridrects thrombin to activate protein C
= C ) Cleaves fibrin and serum fibrinogen, destroys coagulation factors and blocks platelet aggregation
tPAs, such as alteplase, are a class of thrombolytic drugs sometimes indicated in treatment of acute MI, thrombotic stroke, and PE.
What is the most common form of non-Hodgkin Lymphoma?
- A ) Burkitt lymphoma
- B ) Diffuse large B-cell lymphoma
- C ) Follicular lymphoma
- D ) Mantle cell lymphoma
- E ) Waldenstrom macroglobulinaemia
= B ) Diffuse large B-cell lymphoma
- A ) Abdominal x-ray and colonoscopy
- B ) CT scan of the abdomen and upper GI endoscopy
- C ) Sigmoidoscopy and upper GI endoscopy
- D ) Ultrasound scan of abdomen and colonoscopy
- E ) Upper GI endoscopy and colonoscopy
= E ) Upper GI endoscopy and colonoscopy
As an infant grows, the site of foetal erythropoiesis changes. Which option correctly describes this order from birth to adulthood?
- A ) Yolk sac, liver, spleen and skull
- B ) Yolk sac, liver and spleen
- C ) Yolk sac, liver, skull and bone marrow
- D ) Yolk sac, liver, spleen and bone marrow
- E ) Yolk sac, spleen, liver and bone marrow
= D ) Yolk sac, liver, spleen and bone marrow
The prothrombin time (PT) measures the clotting time that takes to produce fibrin polymers after adding ____ and calcium.
- A ) Factor 1
- B ) Factor III
- C ) Factor IX
- D ) Factor VII
- E ) Factor X
= B ) The prothrombin time (PT) measures the clotting time that takes to produce fibrin polymers after adding Factor III and calcium.
Which is the most common inherited coagulation disorder?
- A ) Bernard Soulier syndrome
- B ) Glanzmann thrombasthenia
- C ) Haemophilia A
- D ) Haemophilia B (Christmas disease)
- E ) Von Willebrand disease
= E ) Von Willebrand disease
Von Willebrand factor binds exposed subendothelial collagen. Von Willebrand disease therefore results in impaired platelet adhesion. There are multiple different subtypes the disease. It typically presents with mild mucosal and skin bleeding.
Which blood film matches the clinical features seen in this x-ray?
Answer: Option F is correct
Which vitamin K–dependent factor is activated in the presence of thrombin to cleave activated factors V and VIII?
- A ) Antithrombin III (ATIII)
- B ) Plasminogen
- C ) Prekallikrein
- D ) Protein C
- E ) Protein S
= D ) Protein C
Which of the following causes of anaemia is associated with microcytosis?
- A ) Alcohol
- B ) Folic acid deficiency
- C ) Hypothyroidism
- D ) Thalassemia
- E ) Therapy with zidovudine (AZT)
= D ) Thalassemia
In multiple myeloma, free light chains can cross the glomerular filter and enter the urine. These are known as:
- A ) Bence Jones proteins
- B ) Burkitt proteins
- C ) JAK2
- D ) Reed-Steinberg proteins
- E ) Rouleaux formations
= A ) Bence Jones proteins
Which blood film matches the clinical features seen in this picture?
Note; the registrar tells you that HbS is negative for this patient.
Answer: Option F is correct
Which of the following is a microcytic anaemia?
- A ) Hereditary spherocytosis
- B ) Intravascular haemolysis
- C ) Sickle-cell anaemia
- D ) Sideroblastic anaemia
- E ) Vitamin B12 deficiency
= D ) Sideroblastic anaemia
Which cytokine perpetuates the malignant proliferation of plasma cells in multiple myeloma?
- A ) GM-CSF
- B ) IL-2
- C ) IL-6
- D ) IL-8
- E ) TGF-beta
= C ) IL-6
IL-6 is produced by fibroblasts and macrophages in the bone marrow stroma. In multiple myeloma, it stimulates the neoplastic proliferation of plasma cells (myeloma cells). (Robbins Basic Pathology, 8th edition)
Which is a factor capable of inhibiting the serine protease factors II, IX, X, XI, and XII?
- A ) Antithrombin III (ATIII)
- B ) Plasminogen
- C ) Prekallikrein
- D ) Protein C
- E ) Protein S
= A ) Antithrombin III (ATIII)
Which pathology is this histology image characteristic of?
- A ) Chronic lymphocytic leukemia
- B ) Chronic myeloid leukemia
- C ) Diffuse large B cell lymphoma
- D ) Hodgkin’s lymphoma
- E ) Mantle cell lymphoma
= D ) Hodgkin’s lymphoma
Hodgkin’s lymphoma is a neoplastic proliferation of Reed-Sternberg cells. These are large B cells with multiolbed nuclei and prominent nucleoli (‘owl-eyed’ nuclei). They are typically positive for CD15 and CD30. (Pathoma, 2018)
Which neoplastic cell type is pathognomonic for Hodgkin’s lymphoma?
- A ) Auer rods
- B ) Pelger-Huet cells
- C ) Reed-Sternberg cells
- D ) Ringed sideroblasts
- E ) Rouleaux formation
= C ) Reed-Sternberg cells
“Microscopically, affected lymph nodes show partial or complete effacement of normal features, replaced by a mixed infiltrate including lymphocytes, macrophages, plasma cells and eosinophils, as well as neoplastic cells typical of cHL; these are large cells, heterogeneous in appearance, which may be mononuclear (Hodgkin cells) or bi- or multinucleated (Reed–Sternberg cells).” (Underwood Pathology, 6th edition)
Answer: Option D is correct
Which condition is caused by the production of IgG autoantibodies against platelet antigens?
- A ) Bernard-Soulier syndrome
- B ) Haemophilia B (Christmas disease)
- C ) Immune thrombocytopenic purpura
- D ) Microangiopathic hemolytic anaemia
- E ) Von Willebrand disease
= C ) Immune thrombocytopenic purpura
Immune thrombocytic purpura (ITP) is the most common cause of thrombocytopenia in children and adults. IgG autoantibodies against platelets are produced by plasma cells in the spleen; the antibody-bound platelets are then phagocytosed by splenic macrophages, which results in the thrombocytopenia. There are acute forms (usually in children post-viral infection) and chronic forms (usually in adults). Both forms respond to corticosteroids, but in adults there is often a relapse.
A 22-year-old man comes to the emergency room of the hospital because he has a diffuse, erythematous rash involving nearly all of his body. His total WBC count is greater than 100,000 cells/mm3. He also complains of bone pain, severe irritability, weakness, fatigue, nausea and vomiting, constipation, photophobia, and polyuria. His electrocardiogram (ECG) shows shortening of the QT interval, prolongation of the PR interval, and nonspecific T-wave changes. The most likely cause of his symptoms is:
- A ) Hypercalcemia
- B ) Hyperkalemia
- C ) Hyperphosphatemia
- D ) Hypocalcemia
- E ) Hypophosphatemia
= A ) Hypercalcemia
On which factor does the low molecular weight heparin (LMW Heparin) exerts its effect?
- A ) Antithrombin III
- B ) II
- C ) II, VII, IX and X
- D ) VII
- E ) X
= E ) X
If heparin or LMWH is present in the patient plasma, it will bind to antithrombin and form a complex with factor X, inhibiting it from becoming factor Xa
A 55-year-old woman with a history of sarcoidosis and Graves’ disease who is taking corticosteroids and antithyroid medication is hospitalised because of hemoptysis. Results of initial laboratory measurements show a serum calcium level of 10.9 mg/dL (normal, 8.8–10.2 mg/dL); further testing reveals an intact parathyroid hormone level of 85 pg/mL (normal, 10–65 pg/mL).
Which of the following is the most likely cause of hypercalcemia in this patient?
A ) Hyperthyroidism
B ) Lung cancer
C ) Medications
D ) Primary hyperparathyroidism
E ) Secondary hyperparathyroidism
= D ) Primary hyperparathyroidism
Compared with this patient’s high serum calcium level, her intact parathyroid hormone level (PTH intact) is inappropriately high. Primary hyperparathyroidism presents with hypercalcemia and a high PTH intact level. Hyperthyroidism, lung cancer, medications, and sarcoidosis all are associated with low or suppressed PTH intact levels.
If an Rh-negative mother is exposed to the Rh antigen in the first pregnancy, she will produce anti-Rh antibodies of which class in the second pregnancy?
- A ) IgA
- B ) IgD
- C ) IgE
- D ) IgG
- E ) IgM
= D ) IgG
What is the infection status of a patient with the following serology report?
HBsAg - negative
anti-HBs - positive
anti-HBc - negative
- A ) Acutely infected
- B ) Chronic infection
- C ) Natural immunity
- D ) Susceptible
- E ) Vaccinated
= E ) Vaccinated
Which leukocyte secretes heparin?
- A ) Basophils
- B ) Eosinophils
- C ) Lymphocytes
- D ) Monocytes
- E ) Neutrophils
= A ) Basophils
- A ) Chronic lymphocytic leukaemia
- B ) IgM monoclonal gammopathy of undetermined significance (MGUS)
- C ) Multiple myeloma
- D ) Non-Hodgkin’s lymphoma
- E ) Waldenstrom’s macroglobulinemia
= E ) Waldenstrom’s macroglobulinemia
- A ) Factor IX
- B ) Factor VII
- C ) Factor VIII
- D ) Factor X
- E ) Factor XII
= E ) Factor XII
What is the infection status of a patient with the following serology report?
HBsAg - negative
anti-HBs - negative
anti-HBc - negative
- A ) Acutely infected
- B ) Chronic infection
- C ) Resolved infection
- D ) Susceptible
- E ) Vaccinated
= D ) Susceptible
A 57-year-old woman with a history of hypertension presents to her physician with severe mid-back pain. She reports that the pain is sharp and began when she was reaching to retrieve a plate from a cabinet in her kitchen. She denies any major trauma to the back or any history of lifting heavy objects. On exam, she has spinal tenderness over the site, which is not warm or erythematous. On laboratory evaluation, she is found to have a creatinine of 5.6 mg/dL and a calcium of 16 mg/dL. Which of the following bone marrow biopsy findings is most likely to be found in this patient?
Answer: Figure A
This patient’s clinical presentation is consistent with multiple myeloma (MM). Bone marrow biopsy in this condition shows plasma cell overgrowth.
MM is a plasma cell neoplasm characterised by overproduction of plasma cells that results in increased levels of IgG or IgA. It typically presents with bone pain, hypercalcemia, and renal failure, and is often found after a non-traumatic fracture in middle-aged patients. Definitive diagnosis requires a bone marrow biopsy, however, serum protein electrophoresis showing a monoclonal immunoglobulin “M-spike” is highly suggestive of MM.
Figure A shows a bone marrow biopsy with plasma cell overgrowth that is typical of MM, with notable “fried-egg” appearance.
Choose the correct type of anaemia for the following clinical presentation:
- Glossitis
- Normal methylmalonic acid
- ↑ Serum homocysteine
- A ) Folate deficiency
- B ) Heamolytic anemia
- C ) Non-megaloblastic anaemia
- D ) Sideroblastic anaemia
- E ) Vitamin B12 deficiency
= A ) Folate deficiency
___ makes up about 2%-3% of Hb; has two alpha (α) and two delta (δ) protein chains
- A ) Hb delta
- B ) HbA
- C ) HbA1c
- D ) HbA2
- E ) HbF
= D ) HbA2 makes up about 2%-3% of Hb; has two alpha (α) and two delta (δ) protein chains
A 70-year-old woman with no significant medical history presents with severe back pain. Radiography of her spine and pelvis shows diffusely decreased bone mass, and general laboratory measurements reveal a low calcium level. Which of the following is the most likely cause of this patient’s hypocalcemia?
- A ) Multiple myeloma
- B ) Osteoporosis
- C ) Primary hyperparathyroidism
- D ) Renal failure
- E ) Vitamin D deficiency
E ) Vitamin D deficiency
As the elderly population increases, vitamin D deficiency is becoming more and more common and is usually related to poor nutrition combined with limited exposure to sunlight; the 2 sources of vitamin D are the diet and cutaneous synthesis after ultraviolet irradiation. Although the patient’s back pain could be explained by any of the suggested diagnoses, osteoporosis is not usually accompanied by calcium abnormalities. Multiple myeloma and primary hyperparathyroidism more frequently present with hypercalcemia; renal failure should have manifested other signs, apart from the hypocalcemia.
What is the infection status of a patient with the following serology report?
HBsAg - negative
anti-HBs - positive
- anti-HBc - positive
- A ) Acutely infected
- B ) Chronic infection
- C ) Immune due to natural infection
- D ) Susceptible
- E ) Vaccinated
= C ) Immune due to natural infection
A 76-year-old male presents to his primary care physician for symptoms of fatigue. As part of the workup, a serum protein electrophoresis (SPEP) is ordered, which finds an elevated M protein. Which of the following tests would be the LEAST useful in distinguishing between the two conditions associated with this laboratory abnormality?
- A ) Bone marrow biopsy
- B ) Serum calcium
- C ) Serum creatinine
- D ) Serum TSH
- E ) Skull radiograph
= D ) Serum TSH
What organ is the largest source of ferritin storage?
- A ) Bone marrow
- B ) Brain
- C ) Intestinal tract
- D ) Liver
- E ) Muscle
= D ) Liver
A 68-year-old male presents to his GP with complaints of fatigue and pain in his upper arms and lower back for the past 2 months. Physical examination reveals pallor, hepatosplenomegaly, and focal bony tenderness to palpation over the lumbar vertebrae, bilateral humeri, and skull. Laboratory evaluation reveals low haemoglobin, high serum calcium low albumin, and rouleaux formation on the peripheral blood smear. Serum protein electrophoresis reveals an elevated spike of a monoclonal IgG protein, with an M-protein serum concentration of 50 g/L.
Which of the following radiographs would most likely be associated with this patient’s condition?
Answer: Figure A
___ makes up to 2% of Hb found in adults; has two alpha (α) and two gamma (γ) protein chains; the primary haemoglobin produced by the foetus during pregnancy; its production usually falls to a low level shortly after birth
- A ) Hb delta
- B ) HbA
- C ) HbA1c
- D ) HbA2
- E ) HbF
= E ) HbF makes up to 2% of Hb found in adults; has two alpha (α) and two gamma (γ) protein chains; the primary haemoglobin produced by the foetus during pregnancy; its production usually falls to a low level shortly after birth
________ activates protein C when it is bound to ________.
A ) Fibrin : fibrinomodulin
B ) Fibrin : plasmin
C ) Plasmin : fibrin
D ) Thrombin : fibrin
E ) Thrombin : thrombomodulin
= E ) Thrombin activates protein C when it is bound to thrombomodulin.
A 67-year-old woman presents to her oncologist for a follow-up appointment. She was diagnosed and treated for breast cancer 1 year ago, and had recent blood work that she wants to follow up. The patient has a past medical history of breast cancer, osteoporosis, and bulimia nervosa. She recently broke her ankle when she fell down a flight of stairs. She is currently taking fluoxetine (antidepressant of the selective serotonin reuptake inhibitor class. ). Her temperature is 37.5°C , blood pressure is 127/68 mmHg, pulse is 85/min, respirations are 17/min, and oxygen saturation is 98% on room air. Physical exam reveals a lean woman in no acute distress with an ankle brace. Her exam is non-remarkable. Laboratory values are as seen below and in Figure A.
- - Hemoglobin: 90 (120 – 160 g /L)
- - Hematocrit: 31% (36 to 48%)
- - Leukocyte count: 7.5 x 109/L (4.5 to 11.0 x 109/L)
- - Platelet count: 197 x 109/L (150-400 x 109/L)
What is the likely diagnosis?
- A ) Clinically free of malignancy
- B ) Metastatic breast cancer
- C ) Monoclonal gammopathy of undetermined significance
- D ) Multiple myeloma
- E ) Waldenstrom macroglobulinemia
= C ) Monoclonal gammopathy of undetermined significance
In vitamin B12 deficiency, an excess of which substance results in subacute combined degeneration of the spinal cord?
- A ) Folate
- B ) Homocysteine
- C ) Methylmalonic acid
- D ) Protoporphyrin
- E ) Succinyl CoA
= C ) Methylmalonic acid
What diagnosis can be drawn for Patient 2 from the following haemoglobin electrophoresis?
- A ) Normal patient specimens - HbA is over 98% with a small amount of HbA2 visible
- B ) Alpha thalassemia - no HbA or A2 is present, HbF is 100%
- C ) Thalassemia intermedia - HbA is 8.5%, HbA2 is 3.5% and HbF is 88%
- D ) Thalassemia major - no HbA or A2 is present, HbF is 100%
- E ) Thalassemia minor - HbA is decreased to 94%, HbA2 is increased at 5%, and HbF is 1%
Answer: Thalassemia major - no HbA or A2 is present, HbF is 100%
The activation of thrombin by the extrinsic pathway is initiated by the ________.
- A ) activation of factor XIII
- B ) release of factor III from damaged tissue to complex with factor VII
- C ) release of tissue factor from damaged tissue to directly activate factor X
- D ) subendothelial activation of factor X
- E ) subendothelial activation of factor XII
Answer: release of factor III from damaged tissue to complex with factor VII
Which one of the following anaemias causes subacute combined degeneration of the spinal cord?
- A ) Folate deficiency
- B ) Heamolytic anemia
- C ) Non-megaloblastic anaemia
- D ) Sideroblastic anaemia
- E ) Vitamin B12 deficiency
Answer: Vitamin B12 deficiency
- Vitamin Bl2 is a cofactor for the conversion of the methylmalonic acid to succinyl CoA (important in fatty acid metabolism).
- Vitamin Bl2 deficiency results in increased levels of methylmalonic acid, which impairs spinal cord myelinisation.
- Damage results in poor proprioception and vibratory sensation (posterior column) and spastic paresis (lateral corticospinal tract).
- A ) Calcium
- B ) IgA and IgG
- C ) IgM
- D ) Natural killer cells
- E ) T-cells
= C ) IgM
A 65-year-old man presents to his primary care physician with concern over recent weight loss. He reports losing 15 pounds in the past 3 months, despite no changes in his diet. The patient also reports experiencing night sweats and fatigue. Laboratory studies show an albumin/globulin ratio of 0.5, and serum protein electrophoresis (SPEP) shows an M-spike. All of the following will help differentiate multiple myeloma from Waldenstrom’s macroglobulinemia in this patient, EXCEPT:
- A ) Identification of gammopathy as IgA-predominant
- B ) Identification of gammopathy as IgG-predominant
- C ) Identification of gammopathy as IgM-predominant
- D ) Splenomegaly
- E ) The presence of engorged retinal veins
= D ) Splenomegaly
What is the most common sub-type of Hodgkin lymphoma?
- A ) Lymphocyte-depleted
- B ) Lymphocyte-rich
- C ) Mixed cellularity
- D ) Nodular sclerosing
- E ) Waldenstrom macroglobulinaemia
= D ) Nodular sclerosing
Nodular sclerosing is the most common subtype of HL, accounting for around 70% of all cases.
A 62-year-old man presents to his primary care physician for back pain. He states that the pain started yesterday and has been steadily worsening. The patient was lifting boxes when it happened. Review of systems reveals fatigue and an 8 kg weight loss over the past 3 weeks. The patient’s past medical history is notable for hypertension. Physical exam reveals tenderness in multiple areas in the thoracic and lumbar spine. Range of motion of the spine is not tested due to patient discomfort.
What is the most likely diagnosis?
- A ) Degeneration of intervertebral discs
- B ) Low calcium in diet and absence of weight bearing activities
- C ) Multiple myeloma
- D ) Musculoskeletal strain
- E ) Positive straight leg test
Answer: Multiple myeloma
In healthy endothelial cells, arachidonic acid is converted to ________, which ________ formation of blood clots.
- A ) histamine : stimulates
- B ) nitric oxide : inhibits
- C ) prostacyclin : inhibits
- D ) prostacyclin : stimulates
- E ) thromboxane A2 : inhibits
= C ) In healthy endothelial cells, arachidonic acid is converted to prostacyclin, which inhibits formation of blood clots.
Choose the correct type of anaemia for the following clinical presentation:
- Glossitis
- ↑ Methylmalonic acid
- ↑ Serum homocysteine
- A ) Folate deficiency
- B ) Heamolytic anemia
- C ) Non-megaloblastic anaemia
- D ) Sideroblastic anaemia
- E ) Vitamin B12 deficiency
= E ) Vitamin B12 deficiency
Which element is defective of the coagulation cascade in people with haemophilia A?
- A ) Factor II
- B ) Factor IX
- C ) Factor VIII
- D ) Factor X
- E ) Protein C and S
= C ) Factor VIII
What is the infection status of a patient with the following serological report?
HBsAg - positive
anti-HBs - negative
anti-HBc - positive
IgM anti-HBc - positive
- A ) Acutely infected
- B ) Chronic infection
- C ) Natural immunity
- D ) Susceptible
- E ) Vaccinated
= A ) Acutely infected
What is the infection status of a patient with the following serology:
HBsAg - positive
anti-HBc - positive
anti-HBs - negative
IgM anti-HBc - negative
- A ) Acutely infected
- B ) Chronic infection
- C ) Natural immunity
- D ) Susceptible
- E ) Vaccinated
= B ) Chronic infection
The activation of thrombin by the intrinsic pathway is initiated by the ________.
- A ) activation of factor XIII
- B ) release of factor III from damaged tissue to activate factor VII
- C ) release of tissue factor from damaged tissue to directly activate factor X
- D ) subendothelial activation of factor X
- E ) subendothelial activation of factor XII
Answer: subendothelial activation of factor XII
Which interleukin is mainly responsible for neutrophil chemotaxis?
- A ) IL1
- B ) IL3
- C ) IL4
- D ) IL6
- E ) IL8
= E ) IL8
