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[OS 216] Hema - Immuno > Hema > Flashcards

Hema Flashcards

1
Q 
1) The following conditions will present with decreased platelets, prolonged prothrombin time and prolonged thromboplastin time
A. Acute immune thrombocytopenic purpura
B. Disseminated intravascular purpura
C. Hemophilia
D. Vitamin K deficiency
A

B

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2
Q

2) The protein involved in platelet production is A. Prostacyclin
B. Thromboxane A1
C. Thrombopoeitin
D. Thromboxane A2

A

C

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3
Q

3) The following describes a normal reactive bone marrow in a healthy patient presenting with thrombocytopenia secondary to drugs
A. Decrease in megakaryocyte numbers
B. Many megakaryocytes are vacuolated
C. Increase in megakaryocyte numbers D. There is relative lymphocytosis

A

C

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4
Q

4) The coagulation factor that is inhibited by Protein C and its co-factor Protein S is A. Factor VII
B. Activated factor VIII
C. Factor V
D. Activated factor IX

A

B

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5
Q

5) The following is consistent with a platelet type of bleeding A. Local measures are effective to stop the bleeding
B. Bleeding may last for days
C. Bleeding within the muscles is often
D. Hemarthrosis is common

A

A

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6
Q

6) The mechanism behind the thrombocytopenia in Immune Thrombocytopenic Purpura A. Decreased megakaryocyte production in the bone marrow
B. Increased platelet destruction in the peripheral blood
C. Decreased megakaryocyte/monocyte precursors in the bone marrow
D. Increased thrombopoietin production

A

B

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7
Q

7) Thrombocytopenia associated with Human Immunodeficiency Virus infection is best characterized by A. Megakaryocytes in the bone marrow are infected
B. There is no improvement in platelet count with anti-viral drugs
C. There is complement deposition in the megakaryoblasts
D. ADAMTS13 levels are high Answer: A

A

A

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8
Q

8) The following describes the disruption of platelet function/s in uremia
A. There is a marked increase in thromboxane A2 leading to a decrease in platelet aggregation B. The accumulation of hydrophenolic acids lead to increase alpha-2 beta-3 activity
C. The cyclooxygenase pathway is markedly diminished
D. The accumulation of guanidinosuccinic acid leads to glycoprotein IIB/IIIA dysfunction

A

D

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9
Q

9) The most profound hemostatic disorder due to cardiac surgery A. Platelet aggregation defects
B. Anti-coagulant effect
C. Platelet adhesion defects
D. Anesthesia effect of the vitamin K dependent clotting proteins

A

A

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10
Q

10) Liver disease can impair hemostasis and cause bleeding due to A. Increased levels of intrinsic pathway inhibitor
B. Dysfibrinogemia
C. Increased levels of anti-thrombin III
D. Marked thrombocytosis

A

B

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11
Q

11) Hemophiliacs with recurrent bleeding who are multiply transfused will invariably develop factor VIII inhibitors. Which of the following best characterizes these inhibitors?
A. Complement mediated
B. Hepatitis related
C. Immunoglobulin G D. Serum sickness

A

C

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12
Q

12) The primary problem in thrombotic thrombocytopenic purpura is A. Neurological deficits
B. Circulating large multimers of von Willebrand Factors
C. Immune mediated
D. Platelet dysfunction

A

B

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13
Q

Most common cause of fatal transfusion reaction worldwide A. Clerical error
B. Transfusion related acute lung injury
C. Congestive heart failure secondary to overload
Cheers OS 216 A Hematology 2
D. Febrile non-hemolytic transfusion reaction

A

A

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14
Q

14) Storage temperature of single donor platelet (SDP) A. 31-36 degrees centigrade
B. 36-39 degrees centigrade
C. 21-24 degrees centigrade
D. 25-28 degrees centigrade

A

C

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15
Q

15) Reason/s to temporarily defer a blood donor from donating blood
A. Ear piercing within 6-12 months
B. Major surgery 5 years ago
C. Chemotherapy for Non-Hodgkin’s Lymphoma 5 years ago, patient in remission
D. History of treated venereal disease

A

A

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16
Q

16) Primary site of erythropoietin production during fetal life A. Hepatic
B. Yolk sac
C. Bone marrow
D. Renal

A

A

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17
Q

17) These tests may be most informative in diagnosing PNH A. Hams and sucrose lysis test
B. Immunophenotyping and FISH
C. Erythropoeitin assay and Coomb’s test
D. Chromosomal analysis

A

A

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18
Q

18) Mechanism of action of cyclosporine in aplastic anemia A. Reduces cytotoxic T cells
B. Inhibits IL 2 production by T lymphocytes
C. Modulates adverse reactions to ATG
D. Stimulate production of erythropoietin

A

B

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19
Q

19) Site of maximum iron absorption A. Stomach
B. Duodenum
C. Distal ileum
D. Colon

A

B

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20
Q

20) Microcytic hypochromic cells with low serum iron and normal or increased bone marrow iron stores may be found in the following situations
A. Thalassemia
B. Iron deficiency anemia
C. Anemia of chronic disease D. Chronic lead poisoning

A

A

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21
Q

21) Anemia of inflammation
A. Increased serum ferritin, low transferrin, high serum iron
B. Increased red cell destruction from activation of host factors C. Increased TNF alpha
D. Decreased absolute reticulocyte count

A

B

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22
Q

22) Most prevalent hemoglobinopathy in Southeast Asia A. Hb C
B. Hb D
C. Hb E
D. Hb S

A

C

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23
Q

23) Hallmark of the common forms of Alpha Thalassemia A. Elevated HgB A
B. Elevated HgB A2
C. Elevated HgbF
D. Low HgbA2

A

B

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24
Q

24) Main regulator of iron homeostasis A. Hepcidin
B. Apo TfR
C. Transferrin
D. FE gene

A

A

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25
Q

25) Deferrioxamine, a naturally occurring iron-chelating compound has the following characteristic A. Orally active chelating agent
B. Bidentate, three molecules bind one iron atom
C. May be more effective in removing iron from the heart than deferiprone
D. Poorly absorbed from the gastrointestinal tract

A

D

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26
Q

26) Definitive management may be achieved thru splenectomy A. Hereditary spherocytosis
B. G6PD deficiency
C. Thalassemia
D. Sickle Cell hemoglobinopathy

A

A

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27
Q

27) Response following parenteral vitamin B12 administration to a deficient patient A. Increased plasma iron turn over
B. Normal hemoglobin within 2 weeks
C. Marrow begins to normalize within 72 hours
D. Reticulocytosis within 1 week

A

D

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28
Q

28) The “B symptoms” of lymphomas includes A. Pruritus
B. Jaundice
C. Weight loss
D. Anorexia

A

C

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29
Q

29) The following is associated with relatively better prognosis in multiple myeloma A. Monosomy 13
B. 13q-
C. 11q
D. Normal karyotype

A

C

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30
Q

30) This anemic patient with high creatinine likely has multiple myeloma
A. Normal serum calcium and high uric acid
B. High serum calcium and lytic lesion on bone scan
C. >30% plasma cell on bone marrow aspirate and lytic lesions on skeletal survey D. 10% plasma cell on bone marrow aspirate and elevated serum immunoglobulin

A

Answer: C (HPIM 16th Ed. p. 734)
The classic triad of myeloma is marrow plasmacytosis (>10%), lytic bone lesions, and a serum and/or urine M component. There are two important variants of myeloma, solitary bone plasmacytoma and extramedullary plasmacytoma. These lesions are associated with an M component in fewer than 30% of the cases, they may affect younger individuals, and both are associated with median survivals of 10 or more years. Solitary bone plasmacytoma is a single lytic bone lesion without marrow plasmacytosis. Extramedullary plasmacytomas usually involve the submucosal lymphoid tissue of the nasopharynx or paranasal sinuses without marrow plasmacytosis. Both tumors are highly responsive to local radiation therapy.

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31
Q 
31) In multiple myeloma, prognosis is best correlated with
A. CRP and B microglobulin
B. LDH and serum creatinine
C. ESR and LDH
D. Serum calcium and LDH
A

Answer: A
Serum ß2-microglobulin is the single most powerful predictor of survival and can substitute for staging. Patients with ß2-microglobulin levels 0.004 g/L only 12 months. It is also felt that once the diagnosis of myeloma is firm, histologic
Cheers OS 216 A Hematology 5
features of atypia may also exert an influence on prognosis. Other factors that may influence prognosis are the number of cytogenetic abnormalities, chromosome 13q deletion, % plasma cells in the marrow, circulating plasma cells, performance status, and serum levels of IL1-6, soluble IL-6 receptors, C-reactive protein, hepatocyte growth factor, C-terminal cross-linked telopeptide of collagen I, TGF-ß, and syndecan- 1.
(HPIM 16th Ed. p. 734)

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32
Q

32) Hematopoiesis in patients with aplastic anemia is reflected by A. Increased number of CD34 positive cells
B. Decreased levels of IFN gamma
C. Decreased hematopoietic colony formation
D. Decreased levels of TNF

A

C

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33
Q

33) The diagnosis of aplastic anemia should be questioned in the presence of A. Splenomegaly
B. Increased mast ells in the marrow
C. Normal marrow reticulin
D. Macrocytosis

A

A

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34
Q

34) Infection that has been implicated in the causation of aplastic anemia A. Tuberculosis
B. Malaria
C. Ebstein-Barr virus
D. Coxsackie virus

A

C

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35
Q

35) Transfusion in aplastic anemia should be limited to prevent A. Sensitization to transplantation antigens
B. Sensitization to blood antigens
C. CMV seroconversion
D. AOTA

A

D

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36
Q 
36) An inherited bone marrow failure condition characterized by a triad of reticulated pigmentation, dystrophic nails, and leukoplakia
A. Fanconi anemia
B. Dyskeratosis congenita
C. Schwachmann-Diamond syndrome 
D. Diamond-Blackfan syndrome
A

Answer; B
A. Fanconi’s anemia - a disease passed down through families (inherited) that mainly affects the bone marrow. It results in decreased production of all types of blood cells. Persons with Fanconi’s anemia are more likely to develop several types of blood disorders and cancers, including leukemia, myelodysplastic syndrome, and cancer of the head, neck, or urinary system.
B. Dyskeratosiscongenita-
also known as Zinsser-Engman-Cole syndrome, is a rare, progressive bone
marrow failure syndrome characterized by the triad of reticulated skin hyperpigmentation, nail dystrophy,
and oral leukoplakiA
C. Schwahmann-Diamond syndrome - rare autosomal recessive disorder characterized by exocrine
pancreatic insufficiency, bone marrow dysfunction, leukemia predisposition, and skeletal abnormalities.
D.
Diamond-Blackfan syndrome
- a rare congenital disorder evident in the first 3 months of life,
characterized by severe anemia and a very low reticulocyte count but normal numbers of platelets and
white cells. It is caused by a deficiency of erythrocyte precursors

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37
Q

37) An inherited bone marrow failure state that results in aplastic anemia as well as skeletal abnormalities and renal dysfunction is
A. Fanconi anemia
B. Dyskeratosis congenita
C. Schwachmann-Diamond syndrome D. Diamond-Blackfan syndrome

A

c

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38
Q

38) An inherited bone marrow failure with the least tendency to progress to leukemia A. Fanconi anemia
B. Dyskeratosis congenita
C. Schwachmann-Diamond syndrome
D. Diamond-Blackfan syndrome

A

B

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39
Q

39) The currently recommended immunosuppressive regimen for severe aplastic anemia
A. Cyclosporine
B. Antithymocyte globulin
C. Cyclosporine and antithymocyte globulin
D. Cyclophosphamide

A

C

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40
Q

40) The finding of this cytogenetic abnormality may herald the clonal evolution in aplastic anemia A. Trisomy 7
B. Monosomy 7
C. Monosomy 8
D. Inversion 16

A

B

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41
Q

41) The definitive diagnostic procedure for thalassemia is A. Coomb’s test
B. Osmotic fragility test
C. Hemoglobin electrophoresis
D. Ham’s test

A

C

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42
Q 
42) In the presence of prolonged neonatal jaundice, with exposure to naphthalene balls, one should consider
A. G6PD deficiency
B. Autoimmune hemolytic anemia
C. Thalassemia major
D. Neonatal hepatitis syndrome
A

A. A. G6PD deficiency is an X-linked dominant disorder that increases the susceptibility of the patient to oxidant damage of RBC’s and hemolysis. It is trigerred by drugs (sulfonamides, antibiotics, antimalarials), chemicals (benzene, naphthalene, phenylhydrazine, toludine blue, TNT), and infections. (CHA Trans p4)

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43
Q

43) This hemoglobin is markedly increased in Beta thalassemia major A. HB A1
B. HB A2
C. Hb H
D. Hb F

A

D. Severity is highly variable. Known modulating factors are those that ameliorate the burden of unpaired a- globin inclusions. Alleles associated with milder synthetic defects and coinheritance of a-thalassemia trait reduce clinical severity by reducing accumulation of excess a globin. HbF persists to various degrees in ß thalassemias. ?-Globin gene chains can substitute for ß chains, simultaneously generating more hemoglobin and reducing the burden of a-globin inclusions. The diagnosis of ß-thalassemia major is readily made during childhood on the basis of severe anemia accompanied by the characteristic signs of massive ineffective erythropoiesis: hepatosplenomegaly, profound microcytosis, a characteristic blood smear (Fig. 91-5), and elevated levels of HbF, HbA2, or both.

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44
Q 
44) The definitive diagnostic procedure for Hereditary Spherocytosis is
A. Coombs’ test
B. Osmotic fragility test
C. Ham’s test
D. Hemoglobin electrophoresis
A

B

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45
Q

45) The aim of hypertransfusion and supertransfusion in thalassemia major is A. to increase the patient’s iron stores
B. to increase the patient’s serum iron
C. to improve the patient’s anemia
D. to suppress erythropoiesis in the marrow

A

D

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46
Q

46) The mode of inheritance of Beta thalassemia major is A. autosomal dominant
B. autosomal recessive
C. de novo mutation
D. x-linked

A

B

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47
Q

47) Failure to give oral folic acid to patients with hemolytic anemia may lead to A. Aplastic crisis
B. Hemolytic crisis
C. Megaloblastic crisis
D. Gallstones

A

C

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48
Q

48) At birth fetal red cells contain 53 to 95%

A. Hb A1 B. Hb A2 C. Hb H D. Hb F

A

Answer: C
After the first 10 to 12 weeks of development, the fetus’ primary form of hemoglobin switches from embryonic hemoglobin to fetal hemoglobin. At birth, fetal hemoglobin comprises 50-95% of the child’s hemoglobin. These levels decline after six months as adult hemoglobin synthesis is activated while fetal hemoglobin synthesis is deactivated. Soon after, adult hemoglobin (hemoglobin A in particular) takes over as the predominant form of hemoglobin in normal children. (Wikipedia)

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49
Q 
49) Neonates have this risk when they receive directed donations from first degree relatives
A. Acute hemolytic reaction
B. Transfusion-associated GVHD
C. Febrile reaction
D. Allergic reaction
A

Answer: B – There is a higher probability of graft vs. host from a direct relative because they share the same Hla A. This may react with the baby’s immune system. (Transfusion in Neonates Trans)

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50
Q

50) The following is not an indication for exchange transfusion in neonates A. Rh incompatibility
B. Iron deficiency anemia
C. ABO incompatibility
D. Sepsis

A

B

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51
Q

51) Choice of blood for exchange transfusion in ABO incomptability A. Type O Rh positive fresh whole blood
B. Type-specific Rh positive fresh whole blood
C. Type O Rh positive PRBC
D. Type-specific Rh positive PRBC

A

A

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52
Q

52) Leukocyte-reduction filters can do all of the following except
A. Reduce the risk of CMV infection
B. Prevent or reduce the risk of HLA Alloimmunization
C. Prevent febrile, nonhemolytic transfusion reactions
D. Prevent Transfusion Associated Graft versus Host Disease (TA-GVHD)
Answer: D

A

D

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53
Q

53) A 26-year old Type B Rh-negative female patient requires a transfusion. No Group B Rh-negative donor units are available. Which should be chosen for transfusion?
A. Group B Rh-positive RBCs
B. Group O Rh-negative RBCs C. Group AB Rh-negative RBCs D. Group A Rh-negative RBCs

A

B

54
Q

54) Apheresis can be used to collect all of the following EXCEPT
Cheers OS 216 A Hematology 9
A. Leukocytes
B. Macrophages
C. Hematopoietic progenitor cells D. Platelets

A

Answer: B
The types of apheresis are (from the Block A Blood Transfusion trans, p. 3, column 2)
§ Plasmapheresis – removal of plasma from blood
§ Plateletpheresis – equivalent to 6-10 random units
§ Erythrocytapheresis – removal of RBCs from blood
§ Leukapheresis – contain a minimum of 1.0 x 1010/L
§ Hematopoietic progenitor cell removal and collection of hematopoietic progenitor cells from the
peripheral blood
§ Therapeutic pheresis
o Therapeutic cytapheresis i.e. Thrombocytopheresis o Therapeutic plasmapheresis (Plasma Exchange)

55
Q

55) Transfused plasma resulting in immediate erythema, itching, and hives best typify the following transfusion reaction
A. Immediate Hemolytic Transfusion Reaction (IHTR)
B. Delayed Hemolytic Transfusion Reaction (DHTR)
C. Allergic reaction
D. Anaphylactoid Reaction

A

C

56
Q

56) When a suspected hemolytic reaction occurs, the first thing to do is A. Slow the transfusion rate and call the physician
B. Administer medication to stop the reaction
C. Stop the transfusion but keep the intravenous line open
D. First inform the laboratory to begin an investigation

A

C

57
Q

57) Pre-transfusion irradiation of all blood products from 1st degree relatives is done to prevent A. Febrile Non-Hemolytic Transfusion Reaction (FNHTR)
B. Transfusion Associated Graft versus Host Disease (TA-GVHD)
C. Hemolytic Transfusion Reaction (HTR)
D. Anaphylactic Reaction

A

B

58
Q

58) The following are complications of hyperleukocytosis EXCEPT A. Pulmonary edema
B. Stroke
C. Metabolic acidosis
D. Hypercalcemia

A

D

59
Q

59) In tumor lysis syndrome, the following metabolic imbalances are encountered EXCEPT A. High potassium
B. High phosphate
C. High calcium
D. HIGH URIC ACID

A

C.
Tumor lysis syndrome refers to the constellation of metabolic disturbances that may be seen after initiation of cancer treatment. It usually occurs in patients with bulky, rapidly proliferating, treatment- responsive tumors. Clinically, the syndrome is characterized by rapid development of hyperuricemia, hyperkalemia, hyperphosphatemia, hypocalcemia, and acute renal failure.

60
Q

60) The peak age for ALL is A. 2 to 5 years of age
B. 0 to 1 year
C. 10 to 14 years of age
D. 7 to 10 years of age

A

A

61
Q

61) The following is true in the pediatric age group
A. The frequency of chronic and acute leukemias in children are equal B. The frequency of AML is approximately 4:1 compared to ALL
C. The frequency of ALL is approximately 4:1 compared to AML
D. JMML is the most frequent leukemia in children

A

C

62
Q

62) The prognosis of AML depends strongly on
A. Age of the patient at presentation
B. Presence of CNS involvement
C. Cytogenetic abnormalities of the leukemia clone D. White blood cell count at presentation

A

C

63
Q

63) During the first week of treatment with oral iron, this laboratory parameter should be done A. Hemoglobin
B. Hematocrit
C. Reticulocyte count
D. Red cell indices

A

Answer: C - The response to iron therapy varies depending on the erythropoietin stimulus and the rate of absorption. Typically, the reticulocyte count should begin to increase within 4-7 days after initiation of therapy and peak at 1 1⁄2 weeks

64
Q

64) Parenteral iron is given in the following condition
A. Rapid increase in hemoglobin (HB) is desired B. Malabsorption syndrome exists
C. The patient requests it
D. Rapid utilization of iron by the body

A 
Answer: B
Parenteral iron therapy is indicated for those who:
• Cannot tolerate oral iron
• Has an acute iron need
• Needs iron on an on going basis
• GIT disorders
65
Q

65) When a male adult develops iron deficiency anemia, blood loss should always be suspected because A. iron loss is very minimal in males
B. cancer is frequent in males
C. iron utilization becomes deficient as age progresses
D. bowel disturbances are common

A

A

66
Q

66) A donor who has ingested aspirin on the day of donation is temporarily deferred because A. he has fever
B. he is infected
C. aspirin alters the quality of platelets
D. aspirin causes a hypercoagulable state

A

C

67
Q

67) This is a cause for permanent deferral of a blood donor A. Upper respiratory infection
B. Hepatitis B
C. Fever
D. Ingestion of contraceptive pill

A

Answer: B

The effects of A, C, and D are all transient

68
Q

68) The purpose of doing a crossmatch before transfusion A. to detect autoantibodies present in the recipient
B. to prevent alloimmunization
C. to detect alloantibodies in the recipient
D. to avoid sensitization of the recipient

A

Answer: C - Cross-matching is ordered when there is a high probability that the patient will require a packed RBC (PRBC) transfusion. Blood selected for cross-matching must be ABO compatible and lack antigens for which the patient has alloantibodies. Non-reactive cross-matching confirms the absence of any major incompatibility and reserves that unit for the patient. (HPIM 16th ed, p. 663)

69
Q

69) The reason why an Rh-negative recipient should not receive an Rh positive blood A. Presence of incompatibility
B. Prevention of alloimmunization to D antigen
C. Prevention of immediate post transfusion reaction
D. Prevention of infection

A

Answer: B
An Rh negative patient who lacks anti-D may receive transfusions of Rh-positive blood in urgent situations where Rh-negative blood is unavailable. No immediate danger results from such a practice, but the patient may become alloimmunized to the D antigen and risk problems with pregnancy or transfusion in the future.

70
Q

70) The most frequent cause of a febrile non-hemolytic transfusion reaction is
A. IgG protein in the transfused blood
B. ABO incompatibility
C. Presence of WBC and cytokines in the transfused blood
D. Presence of malarial parasite in the transfused blood

A

Answer: A (FNHTR is caused by the leukocyte antibodies present in the patient’s plasma, which are commonly directed against the antigens present on monocytes, granulocytes, or lymphocytes.)

71
Q

71) The “window period” in the testing for HIV in donor represents
A. the time from the infection of the donor up to the time that the antibody is detected B. the duration of the HIV laboratory test
C. the incubation period of the reagents
D. the time when the HIV symptoms become manifest

A

Answer: A - The window period is the time from infection until a test can detect any change. The average window period with antibody tests is 22 days. Antigen testing cuts the window period to approximately 16 days and NAT (Nucleic Acid Testing) further reduces this period to 12 days.

72
Q

72) Thawed fresh frozen plasma (FPP) cannot be refrozen because A. it is potentially infected
B. it has lost the activity of most of the coagulation factors
C. the plastic bag is already brittle
D. cytokines are released in the process of thawing

A

B

73
Q

73) Pregnant women are predisposed to develop thrombosis because A. their coagulant factors are physiologically elevated
B. their blood volume is increased
C. they have defective platelets
D. their fibrinolytic system is overactive

A

A

74
Q

74) Cirrhosis of the liver can result in thrombosis because
A. the liver releases large amounts of coagulation factors
B. the liver cannot synthesize coagulation factors
C. hepatic clearance of activated coagulation factors is poor
D. toxic substances not metabolized by the liver damage the blood vessels

A

C

75
Q

75) Elderly patients who develop deep vein thrombosis should be worked up for A. vasculitis
B. malignancy
C. atherosclerosis
D. liver cirrhosis

A

Answer: B 2010 smiley says atherosclerosis. 2011 beta feedback says malignancy. Journals say malignancy. Stick with malignancy. DVT may signal undiagnosed malignancy.

76
Q 
76) The most serious complication of deep vein thrombosis is
A. myocardial infarction
B. cerebrovascular thrombosis
C. peripheral vascular disease
D. pulmonary embolism
A

Answer: D (HPIM 16th ed. P.1491): The most important consequence of this DVT is pulmonary embolism and the syndrome of chronic venous insufficiency. Besides, alam mo na ‘to from cardio!

77
Q

77) In the presence of Factor V Leiden, thrombosis occurs because
A. it cannot be inactivated by Protein C
B. Protein S is non-functional
C. prothrombin production is deficient D. thrombomodulin is defective

A

?

78
Q

78) The initiating event in the formation of arterial thrombus is
A. activation of Factor X
B. adherence of platelets to damaged blood vessels promoting aggregation C. activation of anti-thrombin III
D. increase synthesis of prothrombin

A

Answer: B
Robbins, p.132: Arterial or cardiac thrombi usually begins at the site of endothelial injury (e.g. atherosclerotic plaque) or turbulence (vessel bifurcation)…p.133: The thrombus is usually superimposed on an atherosclerotic plaque, although forms of vascular injury (vasculitis, trauma) may be involved

79
Q

9) Important “sanctuary” sites for acute lymphoblastic leukemia are A. liver and spleen
B. lymph nodes and CNS
C. testes and CNS
D. lymph nodes and liver

A 
Answer: C
Manifestations of extramedullary invasion of acute leukemia - CNS
- testicular mass
- enlarged kidneys
- GI mass
- bone and joint
- skin
- rarely, heart and lung
80
Q

80) Rouleaux formation is seen in A. afibrinogenemia
B. paraproteinemia
C. sickle cell anemia
D. autoimmune hemolytic anemia

A

Answer: B - Hemopathology Microscopy trans: Rouleaux formation, the linear alignment of at least 4 RBCs in a thin area of a blood smear resembling a stack of coins, is caused by changes in the surface charge of the erythrocyte membrane when this membrane is coated with excessive amounts of protein such as globulins and fibrinogen. The most common cause of Rouleaux formation, however, is paraproteinemia due to a monoclonal gammopathy.

81
Q

81) On a peripheral blood smear, red cells will normally have a central pallor that occupies A. 1/3 of its diameter
B. 1⁄2 of its diameter
C. 2/3 of its diameter
D. 3⁄4 of its diameter

A

Answer A - Hemopathology Microscopy trans: The peripheral blood smear of a normal individual contains normochromic, normocytic, RBCs with central pallor occupying only 1/3 of the cell diameter.

82
Q 
82) A neoplasm of immunosecreting terminally differentiated B-lymphocytes is A. B-cell chronic lymphocytic leukemia
B. B-cell acute lymphoblastic leukemia
Cheers OS 216 A Hematology 14
C. multiple myeloma
D. chronic myelogenous leukemia
A

Answer: A - Hemopathology Microscopy trans: neoplasm of terminally differentiated or mature B lymphoid cells is chronic lymphocytic leukemia showing lymphoid aggregates or infiltrates

83
Q

83) The most common cytogenetic abnormality in myelodysplastic syndrome (MDS) involves chromosome #
A. 5
B. 7
C. 8 D. 20

A

Answer: A
Myelodysplastic syndrome involves a group of disorders typified by peripheral cytopenia, dysplastic hematopoietic progenitors, a hypercellular bone marrow, and a high risk of conversion to acute myelocytic leukemia (AML). Symptoms are referable to the specific cell line most affected and may include fatigue, weakness, pallor (secondary to anemia), increased infections and fever (secondary to neutropenia), and increased bleeding and bruising (secondary to thrombocytopenia). Diagnosis is by blood count, peripheral smear, and bone marrow aspiration. Treatment with 5-azacytidine may help; if AML supervenes, it is treated per the usual protocols.
(www.merck.com)

84
Q

84) A more favorable prognosis is associated with A. therapy related MDS
B. 5q syndrome
C. MDS with fibrosis
D. Hypoplastic MDS

A

??

85
Q

85) The key organ in the pathophysiology of chronic ITP is A. bone marrow
B. liver
C. spleen
D. kidneys

A

Answer: C - In Chronic ITP, there is production of antibodies to platelets (specifically directed to Gp IIb/IIIa). The antibody-coated platelets attach to Fc receptors in macrophages in the spleen , and are subsequently phagocytosed. A splenectomy is performed isf te patient is unresponsive to steroids, in order to remove the site of antiplatelet antibody production and platelet destruction

86
Q

86) A chronic ITP patient failed to respond to splenectomy. The presence of an accessory spleen is suspected by the presence of this abnormal red cell in the peripheral blood smear
A. Howell-Jolly bodies
B. Target cells
C. Tear-drop cells D. Schistocytes

A

Answer: A
Howell-Jolly bodies, seen through Wright’s stain, are nuclear inclusions. Target Cells are seen in obstructive jaundice, post-splenectomy state, thalassemia and hemoglobin c disease. Tear drop cells are seen in myelofibrosis. Histiocytosis is seen in certain inflammatory disorders and malignancies

87
Q

87) The most common type of leukemia associated with disseminated intravascular coagulation is A. acute promyelocytic leukemia
B. acute monocytic leukemia
C. erythroleukemia
D. acute megakaryocytic leukemia

A

A

88
Q

88) Severe aplastic anemia is defined by the following features EXCEPT A. hemoglobin level of

A

D, Dra. Dominguez: Because the reticulocyte value in aplastic anemia is 0.5-1.5%

89
Q 
89) The following is NOT a prognostic variable in the International Prognostic Scoring System for Myelodysplastic Syndrome (MDS)
A. Age at diagnosis
B. Bone marrow blasts (%)
C. Karyotype
D. Cytopenia (lineages affected)
A

A

90
Q

90) The bone marrow of patients with MDS usually show the following EXCEPT
A. Dyserythropoietic changes seen as megaloblastoid and multinucleated red cell precursors B. Small megakaryocytes and megakaryocytes showing bizarre lobulations
C. Myeloid dyspoiesis seen as hypogranularity and hyposegmentation
D. NOTA

A

Answer: D
Bone marrow of patients with MDS presents with: Dysplastic features of the erythroid (becomes bi- or tri- nucleated), myeloid/neutrophils (becomes hypersegmented [5] or hyposegmented [2] separated by a very thin line [Pelger-Huet anomaly] or hypogranular/hypergranular), and megakaryocytic (becomes micromegakaryocytes and hypolobated) cell lines

91
Q

91) This drug is useful in multiple myeloma but not in lymphomas A. Prednisone
B. Rituximab
C. Thalidomide
D. Doxorubicin

A

A

92
Q

92) This cell is clonal in Hodgkin’s disease A. B cell
B. T cell
C. NK cell
D. Reed Sternberg cell

A

D. According to Medscape: In classical Hodgkin lymphoma, the neoplastic cells is the Reed-Sternberg cell, which comprise only 1-2% of the total tumor mass. The remainder is composed of a variety of reactive, mixed inflammatory cells consisting of lymphocytes, plasma cells, neutrophils, eosinophils, and histiocytes. Most Reed-Sternberg cells are of B-cell origin, derived from lymph node germinal centers but no longer able to produce antibodies.

93
Q

93) To evaluate a prolonged PT or PTT, the following test(s) is/are performed next A. Mixing studies
B. F XII, F XI, and F VIII assays
C. Platelet function analyzer
D. Urea clot lysis assay

A

A

94
Q

94) Universal recipient A. Blood type O
B. Blood type AB
C. Blood type A
D. Blood type B

A

B

95
Q

95) Acquired aplastic anemia appears to be caused largely by A. Stem cell defect
B. Stromal defect
C. Immune-mediated mechanism
D. Decrease in hematopoietic growth factors

A

A OR C
A. Aplastic anemia trans: acquired idiopathic AA is due to immune mediated destruction of marrow cells or via primary stem cell defects. In previous years, the question was stated thus:
Acquired aplastic anemia in contrast to inherited form of bone marrow failure appears to be caused largely by (2012, 2014)
a. immune mediated destruction of marrow cells
b. loss of hematopoietic stem cells due to DNA damage
c. low threshold for apoptosis
d. NOTA

96
Q

96) Hematologically, the neonatal period extends from birth up to A. 1 month
B. 2 months
C. 3 months
D. 4 months

A

D

97
Q 
97) An ABO type on a patient who gives the following agglutination reactions
Patient Cells with 
Anti-A 4+ 
Anti-B 4+
Patient serum with 
A cells Neg
B cells Neg
What is the patient’s blood type?
A. O 
B. A 
C. B 
D. AB
A

Answer: D

98
Q

98) What type of blood should be given in an emergency transfusion when there is no time to type the patient’s sample?
A. Group O Rh-negative whole blood
B. Group O Rh-positive whole blood
C. Group O Rh-negative packed cells D. Group O Rh-positive packed cells

A

B

99
Q

9) Immediate hemolytic transfusion reactions resulting from ABO-incompatible transfused RBCs are usually associated with the following findings
A. Intact RBCs in the urine
B. Increase in serum haptoglobins
C. Hemoglobinuria D. Jaundice

A

???

100
Q

100) A transfusion reaction that usually appears rapidly during the transfusion, termed “warm,” and may result in fever, shock, or death
A. Immediate Hemolytic Transfusion Reaction (IHTR)
B. Bacterial contamination
C. Allergic reaction
D. Febrile Non-hemolytic Transfusion Reaction (FNHTR)

A

Answer: A
IHTR is a life-threatening transfusion reaction event which occurs soon after transfusion (1-2 h) of incompatible RBCs. Signs and symptoms, which include fever, chills, anemia, jaundice, and decreased haptoglobulins, occur within minutes of transfusion. Prompt diagnosis and treatment is essential

101
Q

Decrease in affinity of O2 to Hemoglobin

a. Decreased Body temp
b. Decreased pH
c. Increased pH
d. Decreased 2,3 BPG

A

B

102
Q
  1. Which of the following increases absorption of Iron?
    a. Vitamin C
    b. Vitamin B12
    c. Phosphates
    d. Pyrates
A

A

103
Q

Almost always results to a positive Coombs test

A

Autoimmune Hemolytic Anemia

104
Q

Protein involved in Platelet production

A

Thrombopoietin

105
Q

Hemophiliacs with recurrent bleeding which are transfused multiply will develop inhibitors. Which of the following best characterized these inhibitors?

a. Complement mediated
b. Hepatitis related
c. IgG
d. Serum sickness

A

c

106
Q

Associated with a relatively better prognosis in multiple myeloma

a. Monosomy 13
b. 13q
c. 11q
d. Normal karyotype

A

d

107
Q

This anemic patient with high creatinine likely
has multiple myeloma
a. Normal [Ca], High uric acid
b. Increased [Ca] and lytic lesions on bone
scan
c. > 31% plasma cells on Bone marrow
aspirate and lytic lesions on
d. 10% plasma cell in Bone Marrow Aspirate
and Increased serum Ig

A

???

108
Q
  1. In multiple myeloma, prognosis is least correlated with
    a. CRP and Beta microglobulin
    b. LDH and Serum Creatinine c. ESR and LDH
    d. Serum Calcium and LDH
A

a

109
Q

emophilia A and B inherited by a. Autosomal recessive

b. Autosomal dominant
c. X-linked recessive
d. X-linked dominant

A

c

110
Q

Blood component requiring constant agitation a. Packed RBC

b. Platelet concentrate
c. Cryoprecipitate d. Cryosupernate

A

b

111
Q
  1. Fresh Frozen Plasma is stored at a. Room temp

b. 6 degrees C c. 0 degrees C d. -20 degrees C

A

d

112
Q

advantage of cross matching

A

detection of alloantibodies

113
Q
  1. Why is there a need to test for Rh Antigen? a. Presence of infection
    b. Prevention of alloimmunization of D
    antigen
    c. Prevention of immediate post transfusion reaction
    d. Prevention of infection
A

b

114
Q

Most common cause of febrile non-hemolytic transfusion reactions
a. Presence of IgG proteins in transfused
blood
b. ABO incompatibility
c. Presence of WBC and Cytokinesin
transfused blood
d. Presence of malarial parasites in transfused
blood

A

a

115
Q
  1. Thawed fresh frozen plasma cannot be refrozen because
    a. It is potentially infected
    b. It has lost the activity of the most of the coagulation factors
    c. The plastic bag is already brittle
    d. Cytokines are released in the process of thawing
A

b

116
Q

What do you not screen in the blood

a. Hemoglobin determination
b. Hep A
c. Hep B
d. Hep C

A

b

117
Q

esticular mass in a boy with ALL indicates

a. Lymphoid invasion
b. Bone marrow involvement
c. Extramedullary invasion
d. Good prognosis

A

c

118
Q

Example of a neoplasm involving more than one cell line is

a. Aplasic Anemia
b. Multiple Myeloma
c. ALL
d. CML

A

d

119
Q

. Bone marrow involvement by CLL manifests as

a. Loss of myeloid and lymphoid precursors
b. Hypercellular marrow with lymphoblasts
c. Ineffective erythro precursors
d. Lymphoid aggregates

A

d

120
Q

What is the most common cytogenic abnormality in myelodysplastic syndrome, chromosome number?

a. 5
b. 7
c. 8
d. 20

A

a

121
Q

The most significant prognostic factor in children with ALL is

a. Presence of CNS involvement
b. Extent of hepatomegaly
c. Age of diagnosis
d. Initial white blood count at diagnosis

A

d

122
Q

This disease condition can coexist with aplastic anemia

A

PNH

123
Q

Hematopoetic stem cell transplantation is
a. The only available treatment for ALL
b. Replacement with healthy precursor cells
c. Utilize HSC derived from fetal liver cells
d. Is associated by less risk than conventional
chemotherapy

A

b

124
Q

mmunophenotyping

a. Involves characterization of blast cells and identifying cell surface antigens
b. Is less sensitive and specific compared to immunohistochemical staining
c. Need not be performed when blast phenotyoing is definitive
d. Can be performed on bone marrow sample only

A

a

125
Q

Microcytosis is best defined as

a. High RDW
b. Low MCV
c. High MCH
d. Low MCHC

A

b

126
Q

Anemia of chronic renal failure
a. Microcytic normochromic
b. EPO deficiency usually seen when Crea >
2mg/dL
c. Supplemental Fe should be avoided as much as possible
d. EPO dose of 50 – 75 U/kg body weight per week is usually required

A

b

127
Q

The link between a platelet receptor site in Gp1B/IX and collagen fibrils is accomplished by

a. Fibrinogen
b. Fibronectin
c. Von Willebran Factor
d. Calcium

A

c

128
Q 
The key organ in the pathophysiology of chronic ITP is
more favorable prognosis
a. Bone marrow
b. Liver
c. Spleen
d. Kidneys
A

c

129
Q

Mode of inheritance of VWD is usually

a. AR
b. AD
c. X-linked
d. De novo

A

b

130
Q

At birth, fetal RBCs contain 53% to 95% of what hemoglobin?

A

HbF

131
Q

Prolonged PT, PTT, next test is:

a. Mixing studies
b. Factor 8, 7, 9
c. Platelet
d. –

A

a

[OS 216] Hema - Immuno (1 decks)

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