HEMA MODLE QUIZ COMPILATIONS Flashcards
Which of the following statements is NOT true about erythropoiesis?
a. Erythroid precursors undergo apoptosis before reaching blood circulation without EPO
b. In the bone marrow, the polychromatic normoblast is the first morphologically recognizable erythroid precursor
c. EPO activates a signaling cascade that results in differentiation, survival, and proliferation of the erythroid cell
d. EPO is synthesized mainly in the kidney and is released into the bloodstream in response to hypoxia
b. In the bone marrow, the polychromatic normoblast is the first morphologically recognizable erythroid precursor
Which of the following is NOT true about EPO regulation and production?
a. It is produced by the peritubular capillary lining cells within the kidney
b. It is produced by hepatocytes
c. During hypoxemia, the hypoxia-inducible factor (HIF-a) is hydroxylated and degraded leading to the upregulation of the EPO gene.
d. The fundamental stimulus for EPO production is the availability of the oxygen for tissue metabolic needs
c. During hypoxemia, the hypoxia-inducible factor (HIF-a) is hydroxylated and degraded leading to the upregulation of the EPO gene.
What is the primary key that regulates EPO expression?
a. HIF-1a
b. GATA-1
c. FOG-1
d. GMC-SF
a. HIF-1a
Which of the following organs produces the principal iron regulatory hormone, hepcidin?
a. Pancreas
b. Spleen
c. Liver
d. Kidney
c. Liver
Which among the following results is distinctive of anemia of acute or chronic inflammation?
a. High TIBC
b. High serum ferritin
c. Normal transferrin saturation
d. Normal serum iron
b. High serum ferritin
Which of the following is true about hemolytic anemia?
a. Hemolysis is associated with red cell production indices of ≥ 2 times normal
b. Marrow examination is indicated if reticulocyte production index is increased
c. Stimulated erythropoiesis is reflected in blood smear by the appearance of increased number of polychromatophilic macrocytes
d. The red cell indices is typically microcytic or slightly macrocytic reflected by the increased number of
reticulocyte
c. Stimulated erythropoiesis is reflected in blood smear by the appearance of increased number of polychromatophilic macrocytes
What condition would result in cytoplasmic maturation defects?
a. Iron deficiency
b. Folic acid deficiency
c. Thalassemia
d. Drugs
c. Thalassemia
Which of the following is TRUE regarding Acute Blood Loss?
a. Acute blood loss is not associated with an increased Reticulocyte Production Index
b. Acute blood loss may be associated with modest reticulocytosis
c. Anemia from chronic blood loss presents more often as iron deficiency anemia
d. The confirmation of a recovering state may require observations over a period of time which the hemoglobin concentration will rise and the reticulocyte production index falls
a. Acute blood loss is not associated with an increased Reticulocyte Production Index
Grace, 25/F, went for consultation at the OPD clinic because of dizziness associated with easy fatigability. She denies fever, vomiting and LBM. No known comorbidities. Patient is not in distress. She works as a bank teller and denied any vices. Vital signs are normal.
Pertinent PE: pale palpebral conjunctiva,
CBC:
WBC 5100mm3
HCT 27% (NV: 34-46 % in menstruating females)
MCV 75 (NV: 80 - 100 fL; Harrison: 82 - 98 fL)
Platelet 210 000 mm3
Neutrophil 60%.
What laboratory test to request next based on the algorithm?
a. Peripheral blood smear
b. Bone marrow
c. Reticulocyte count
d. Serum ferritin
c. Reticulocyte count
Louise, a 25-year old female, came into the clinic due to easy fatigability. Which of the following does not test for anemia?
a. Press Luoise’s nail bed until it turns white and measure the time it takes for the color to return on her nail bed
b. Ask Louise to look up while you depress both of her eyelids with your thumbs and check her palpebral conjunctiva for color
c. Check her radial pulse and take note of the quality of the pulse
d. Inspect her palms and check the color of the creases
a. Press Luoise’s nail bed until it turns white and measure the time it takes for the color to return on her nail bed
Which of the following statements is true about CBC values?
a. MHC is the least helpful of the rbc indices
b. A person living in high altitude may also have high-normal hemoglobin value
c. MCHC reflects defects of the hemoglobin synthesis
d. All above is true
d. All above is true
Which of the following statements are NOT TRUE about Iron Deficiency Anemia
a. Koilonychia occurs due to the upward deformation of lateral and distal portions of pliable iron deficient nail plates under mechanical pressure
b. Unusual eating habits should be monitored
c. Alcohol affects overall absorption of Iron deficiency
d. All of the above
c. Alcohol affects overall absorption of Iron deficiency
Which physiologic factors affect cbc parameters?
a. Age, sex, pregnancy, smoking, higher altitude
b. Drug toxicity
c. Previous blood transfusion
d. ABO compatibility
a. Age, sex, pregnancy, smoking, higher altitude
____ is the test that gives information that detects abnormalities in red cell production. It also compliments red cell indices, and detects variations in size (anisocytosis) and shape (poikilocytosis).
a. CBC and PLT
b. Reticulocyte count
c. Bone marrow smear
d. Peripheral blood smear
d. Peripheral blood smear
A person with normocytic anemia with hypoproliferative iron stores is indicated with?
a. Bleeding parameters
b. Coomb’s test
c. Bone marrow aspirate
d. TIBC
c. Bone marrow aspirate
Which of the following tests represents the amount of circulating iron bound to transferrin?
a. Serum iron
b. Serum ferritin
c. Red cell protoporphyrin levels
d. Serum TRP
a. Serum iron
Which of the following tests is a better indicator of iron overload?
a. Serum iron
b. Serum ferritin
c. Transferrin saturation
d. Bone marrow iron stain
c. Transferrin saturation
Which test shows an effective delivery of iron to the developing erythroblast?
a. Serum iron
b. Serum ferritin
c. Transferrin saturation
d. Bone marrow iron stain
d. Bone marrow iron stain
Which of the ff results is indicative of absent iron stores in the body?
a. Transferrin saturation of >50%
b. Serum ferritin at 12 ug/L
c. TIBC at 315 ug/L
d. Serum iron at 50 ug/L
b. Serum ferritin at 12 ug/L
What happens when the level of protoporphyrin is 100ug/L?
a. Not enough for heme synthesis
b. Iron supply is inadequate for Hgb synthesis
c. Indicative of iron overload
d. Suggestive of megaloblastic anemia
b. Iron supply is inadequate for Hgb synthesis
A 60 yo man with dizziness and pallor has a BP of 90/60mmhg, HR 110. He has a history of melena of 2 episodes 2 days ago, though it is not present at that time. CBC revealed hgb of 7.0. What is the best treatment for his condition?
a. Oral iron therapy
b. Parenteral iron therapy
c. Recombinant EPO
d. Transfuse with pack red cells
b. Parenteral iron therapy
Elizabeth, 20/F is a Highschool student who was diagnosed with IDA due to Intestinal parasites, she was prescribed 3 tabs FeS04 for a week, she has been constipated. What is the most likely cause?
a. Passage of worms during defecation
b. Result of iron deficiency
c. Side effect of iron supplements
d. All of the above
c. Side effect of iron supplements
Deaths occur as a consequence of malnutrition worldwide prevalent in?
a. Africa
b. North America
c. South America
d. Central Asia
a. Africa
What is the TIBC level in a person expected to have deficient iron erythropoiesis?
a. 310 ug/L
b. 370 ug/L
c. 390 ug/L
d. 410 ug/L
c. 390 ug/L
Upon examination of the patient’s peripheral blood smear there appears to be hyperproliferative bone marrow, this patient is expected to be having?
a. Normal reaction to an acute blood loss
b. Mild anemia
c. Moderate anemia
d. Severe anemia
c. Moderate anemia
The marrow iron stores become completely deficient when serum ferritin level is at
a. <50 ug/dL
b. <30 ug/dL
c. <20 ug/dL
d. <15 ug/dL
d. <15 ug/dL
Which of the following statements regarding iron deficiency evolution is NOT correct?
a. Impairment of hemoglobin synthesis occurs when transferrin saturation decreases to <20%.
b. Microcytic cells are evident in PBS during period of iron deficiency erythropoiesis
c. In a pregnant patient, TIBC is normal, while red cell protoporphyrin is decreased
d. Red cell indices remain normal in the first stage of Iron deficiency
b. Microcytic cells are evident in PBS during period of iron deficiency erythropoiesis
What is the normal value of marrow sideroblasts?
a. 10%
b. 20%
c. 40%
d. 60%
b. 20%
Before large doses of folic acid are given in a patient with megaloblastic anemia, cobalamin deficiency must be excluded and, if present, corrected because there is a risk for the development of which of the following conditions?
a. Bone marrow failure
b. Cardiomyopathy
c. Neuropathy
d. Liver failure
c. Neuropathy
Serum homocysteine is raised in which of the following situations?
a. Pregnancy
b. Mutation of the gene TCN1
c. Oral contraceptive
d. Early cobalamin deficiency
d. Early cobalamin deficiency
Who will be deficient in vitamin b12 due to inadequate intake?
a. Pregnant woman
b. Vegan
c. ESRD patient
d. Alcoholics
b. Vegan
In the treatment of megaloblastic anemia occasionally, an excessive rise of platelets occurs after 1-2 weeks of transfusion therapy. This drug should be considered if the platelet count rises to >800 x 10^9/L
a. Enoxaparin
b. Warfarin
c. Aspirin
d. Streptokinase
c. Aspirin
In oral treatment of folate deficiency time therapy depends on the underlying disease. It is customary to continue therapy for how many months?
a. 1 week
b. 1 month
c. 2 months
d. 4 months
d. 4 months
It is a reduced form of folate. It is given orally or parenterally to overcome the toxic effects of methotrexate.
a. Ascorbic acid
b. Folinic Acid
c. TFN
d. None of the Above
b. Folinic Acid
A glycoprotein secreted by the parietal cells of the fundic mucosa that is required for vitamin B12 absorption.
a. Pepsin
b. Haptocorrin
c. Intrinsic factor
d. Transcobalamin II
c. Intrinsic factor
Which of the following drugs may cause folate deficiency?
a. Phenytoin
b. Clindamycin
c. Valproic acid
d. Sulfamethoxazole
a. Phenytoin
This organ has the largest store of folic acid in the body.
a. Pancreas
b. Liver
c. Duodenum
d. Ileum
b. Liver
Which of the following statements regarding Vitamin B12 metabolism is TRUE?
a. Vitamin B12 is freed from binding proteins in food through the action of pepsin in the stomach and binds to a salivary protein called haptocorrin.
b. In the Ileum, bound vitamin B12 is released from haptocorrin by the action of pancreatic proteases and it associates with intrinsic factor.
c. Transcobalamin I deliver vitamin B12 to the liver and other cells of the body
d. Absorption of vitamin B12 requires intrinsic factor, which is secreted by the chief cells of the fundic mucosa
a. Vitamin B12 is freed from binding proteins in food
through the action of pepsin in the stomach and binds to a salivary protein called haptocorrin.
Which of the following general tissue effects due to cobalamin and folate deficiencies is TRUE?
a. The gonads are rarely unaffected, and infertility is uncommon in both men and women with severe deficiency of either vitamin.
b. The cells of epithelial surface show microcytosis, with decreased numbers of multinucleated and dying cells.
c. Children with serum homocystinuria (blood levels > 100 umol/L) have vascular disease as teenagers or in young adulthood.
d. There is a clear simple relationship between maternal folate status and incidence of fetal abnormalities such as cleft
palate and harelip.
c. Children with serum homocystinuria (blood levels > 100 umol/L) have vascular disease as teenagers or in young adulthood.
A 52 year old patient comes in for consultation due to lightheadedness and easy fatigability. No bleeding, or shortness of breath noted. Initial lab test shows low hemoglobin of 10.2 g/dL, and MCV of 110 fL. 3 months prior, blood transfusion was done during partial gastrectomy secondary to malignancy. Which of the following diagnostic features is related?
a. Many patients are detected during elevated MCV in routine blood test
b. Thrombocytopenia can predispose bleeding and be exacerbated by vitamin C deficiency
c. Elevated WBC count predisposes to infection
d. Folic Acid deficiency associated with defective bactericidal phagocytosis and with osteoporosis
a. Many patients are detected during elevated MCV in routine blood test
All of the following are mechanisms involved in chronic kidney disease, EXCEPT:
a. Decrease erythropoietin production in peritubular capillary lining cells within the kidney
b. Increase renal clearance of hepcidin
c. Enhanced hepcidin release leading to decrease in erythropoiesis
d. Uremic-induced decrease in erythropoiesis
d. Uremic-induced decrease in erythropoiesis
Anemia in CKD is typically
a. Normocytic, normochromic, hypoproliferative
b. Macrocytic, hypochromic, maturation disorder
c. Macrocytic, hypochromic, hypoproliferative
d. Microcytic, hypochromic maturation disorder
a. Normocytic, normochromic, hypoproliferative
Erythroid precursor takes how many days to mature?
a. 2.5
b. 3.5
c. 4.5
d. 5.5
c. 4.5
A patient suffers from significant blood loss as a result of a motor vehicular accident. Paramedics stopped the bleeding at the accident site and transported him to the emergency room 2 hours after the accident occurred. Which of the following statements is true?
a. With an estimated blood loss of 5-10% of the patient’s total blood volume, signs of vascular instability may appear
b. Hemoglobin and hematocrit are expected to be significantly low upon arrival at the emergency room.
c. If the volume of blood loss is >2 liters, change in sensorium and low blood pressure may ensue.
d. All of the above.
c. If the volume of blood loss is >2 liters, change in sensorium and low blood pressure may ensue.
What is the corrected reticulocyte count?
Hg: 9.5 Retic: 8.1 Hct: 32
a. 2
b. 2.5
c. 3
d. 4
b. 2.5
What is the expected M:E ratio for patients with pure red cell aplasia?
a. 1:01
b. 2:01
c. 2-4:1
d. >5:1
d. >5:1
True of bone marrow aspirate
a. Marrow smear can be stained for the presence of iron stores
b. Done to examine the bone marrow architecture and cellularity
c. Preferred site for sacrum
d. Routinely done in the work-up of hypoproliferative anemia
a. Marrow smear can be stained for the presence of
iron stores
Most elevated reticulocyte index is seen in patients with?
a. Thalassemia
b. Sickle cell disease
c. Myelofibrosis
d. Chronic inflammation
b. Sickle cell disease
Acute ITP is common in:
a. Children
b. Adults
c. Elderly
d. All of the above
a. Children
Which of the following is a correct statement about thrombocytopenia?
a. Heavy alcohol use causes low platelet production
b. Benzene production results to platelet destruction
c. An autoimmune disease can cause low platelet production
d. Chemical drugs result to platelet destruction
a. Heavy alcohol use causes low platelet production
True of pseudothrombocytopenia, except?
a. Is an in vitro clumping of platelets
b. Often seen in blood films from specimen collected in heparinized tubes
c. Visualized as platelet clumping and large platelet size in peripheral blood smear
d. Caused by antibodies that bind platelets only in the presence of a chelating agent
b. Often seen in blood films from specimen collected in heparinized tubes
Heavy alcohol intake can cause thrombocytopenia by:
a. Decreased bone marrow production
b. Indirectly by sequestration
c. Increased platelet destruction
d. AOTA
d. AOTA
Thrombocytopenia that increase platelet destruction:
a. Evan’s syndrome
b. Myelodysplasia
c. Portal vein thrombosis
d. Megaloblastic anemia
a. Evan’s syndrome
Most surgical procedure may be done with the platelet count of
a. <50,000/uL
b. <80,000/uL
c. <100,000/uL
d. <150,000/uL
b. <80,000/uL
A 32 yr old male, sought consultation because of recurrent epistaxis. With a platelet count of <25,000/uL. You suspected ITP.Which of the following will be part of your diagnostic workup?
a. Anti-HCV
b. Bone marrow aspirate
c. Anti-GPIIb-IIIa assay
d. All of the above
a. Anti-HCV
What is the preferred treatment for the patient above?
a. Observation and manage as OPD
b. Start Prednisone and manage as OPD
c. Admit and observe
d. Admit and start Prednisone
b. Start Prednisone and manage as OPD
Which of the following correctly associates bleeding with thrombocytopenia
a. Hemarthrosis is a common manifestation
b. Platelet <20,000/ul is associated as non traumatic bleeding
c. Laboratory tests show prolonged BT, PT, aPTT
d. Commonly seen in major arteries and veins
b. Platelet <20,000/ul is associated as non traumatic bleeding
There are different treatments in the management of ITP, which of the ff is correctly matched?
a. Anti-RhD Ig - decreases platelet destruction and phagocytosis
b. Romiplostim - inhibits antibody-mediated destruction of
platelets
c. Fostamatinib- reduces antiplatelet antibody production
d. Corticosteroid- increase platelet production
a. Anti-RhD Ig - decreases platelet destruction and phagocytosis
The most common non iatrogenic cause of thrombocytopenia?
a. DIC Answer
b. Bone marrow failure
c. Viral & bacterial infection
d. Drugs
c. Viral & bacterial infection
Which of the following is true regarding the mechanism of HIT?
a. Increase platelet destruction
b. Bone marrow depression
c. Increase platelet aggregation
d. Destruction of platelet adhesion
c. Increase platelet aggregation
A Vitamin K dependent factor produced in liver
a. Factor VII
b. Factor VIII
c. Protein D
d. Hageman factor
a. Factor VII
Hallmark of moderate to severe with factor VIII & IX bleeding
a. Heavy menstrual bleeding
b. Spontaneous hemarthrosis
c. CNS bleeding
d. Post hemorrhage bleeding
b. Spontaneous hemarthrosis
Platelets:
a. Lifespan 10-15 days
b. 2/3 sequestered in spleen
c. Release of ADP after activation
d. Adhesion mediated by VWF and GPIIb/IIIa receptors
c. Release of ADP after activation
During primary hemostasis
a. Initial vasoconstriction does not require platelet activation
b. Thromboxane A2 causes platelet adhesion
c. Fibrinogen is converted to fibrin
d. Activation of lipoxygenase is a vital step
a. Initial vasoconstriction does not require platelet activation
Which pathway of coagulation cascade does heparin act on?
I. Intrinsic pathway
II. Extrinsic pathway
III. Common pathway
I. Intrinsic pathway
III. Common pathway
Are pinpoint, nonblanching hemorrhages and are usually a sign of decreased platelet number
Petechiae
Which of the ff statements regarding HMB (Heavy Menstrual Bleeding) is true?
a. Is defined quantitatively as a loss of >80 mL of blood per cycle
b. Passage of clots <1 inch in diameter is one of its predictors
c. Women with HMB beginning at menarche are much more likely to have underlying bleeding disorders
d. Changing of pad or tampon for a minimum of 2 hours
a. Is defined quantitatively as a loss of >80 mL of blood per cycle
A 62 yr old female went on a routine check up and complained of easy bruising for the past month.
No comorbidities, no medications taken.
WBC 7.8
Hgb 12.8
Neutrophils 45%
Lymphocytes 38
Platelets 80,000
What should you do next?
a. Peripheral blood smear
b. Coomb’s Test
c. Clotting Time
d. Bone Marrow Exam
d. Bone Marrow Exam
Which of the following statements of the approach to patients with bleeding is NOT TRUE?
a. Mucosal bleeding symptoms are more suggestive of disorders of primary hemostasis
b. Spontaneous hemarthrosis is a hallmark of Factor VIII and IX deficiency
c. Low Bleeding Assessment Tool score and a normal aPTT excludes VWD in 99.6% cases
d. Bleeding with eruption of primary teeth is common in children with mild bleeding
d. Bleeding with eruption of primary teeth is common in children with mild bleeding
58/M came in for consultation. He has a diabetic right foot, gangrenous. Doctor suggested amputation. Platelet count is 85,000/uL. What is the best thing to do to the patient?
a. Start Prednisone
b. IVIG
c. Prepare platelet concentrate and standby for surgery
c. Prepare platelet concentrate and standby for surgery
Which of the following drugs do not impair primary hemostasis?
a. Clopidogrel
b. Celecoxib
c. Aspirin
d. Ibuprofen
b. Celecoxib
In a 45 year old male patient presenting with chronic easy bruising which of the following would support primary bleeding disorder?
a. A history of bleeding 1 week post tonsillectomy
b. Epistaxis cause from trauma that resolved with nasal packing
c. Chronic alcohol consumption since 25 years old
d. All of the above
a. A history of bleeding 1 week post tonsillectomy
Rain, a 24yo medical student on her last day of vacation in Panama, recently started experiencing epistaxis that resolves spontaneously. She has no history of trauma and bleeding tendencies and has no other associated symptoms. As a medical student, she knows that
a. Her epistaxis is most likely due to her nasal membrane becoming dry and cracked because of the climate and isn’t a cause for concern
b. It’s probably better to consult an ENT specialist as soon as possible because her epistaxis might probably due to friable nasal polyp
c. She needs to run down a CBC and peripheral smear when she gets home to rule out blood disorders
d. She has to do bone marrow biopsy because epistaxis rarely occurs in the absence of hemophilia
a. Her epistaxis is most likely due to her nasal membrane becoming dry and cracked because of the climate and isn’t a cause for concern
Harvey, a 23yo personal trainer, consulted for the first time with a chief complaint of 2 episodes of black tarry stool. He has no history of gastric ulcer. Upon PE, you note bruising on both his biceps. He explains that it’s an injury he got at the gym yesterday. No other significant findings. What is his bleeding score based on the ISTH bleeding assessment tool?
2
How can most infections cause thrombocytopenia?
a. Decreased platelet production
b. Sequestration
c. Increased platelet destruction
a. Decreased platelet production
c. Increased platelet destruction
Which of these statements do not describe Immune Thrombocytopenic Purpura?
a. Spontaneous remission in adults is expected in days to weeks after establishment of diagnosis
b. Markedly low platelet count in the presence of normal peripheral blood smear
c. Presentation of ecchymosis with incidental finding of thrombocytopenia suggests ITP
a. Spontaneous remission in adults is expected in days to
weeks after establishment of diagnosis
What is the expected morphologic feature of the spleen in patients with ITP?
a. Elevated levels of thrombopoietin causes the presence of megakaryocytes within the sinusoids
b. Congestion of sinusoids and enlargement of splenic follicles leads to the enlargement of splenic size
c. There is increased of thrombocytes in the marrow
d. Presence of megakaryocytes in
the peripheral blood smear accelerated thrombopoiesis
b. Congestion of sinusoids and enlargement of splenic follicles leads to the enlargement of splenic size
A previously diagnosed ITP patient underwent splenectomy after relapsing following steroid treatment. Patient went into remission. A few months after splenectomy, the patient sought consult for unusual and unexplained bruising. There was also evidence of petechial rash on his extremities. Which of these treatments is more effective to address patient ITP and can induce a longer remission.
Intravenous gamma globulin
There is high specificity and low sensitivity in serologic tests for ITP.
FALSE
There may be a concurrent Iron Deficiency Anemia with ITP.
TRUE
Coomb’s test is done to rule out Evan’s syndrome
TRUE
TP is termed ______ if it is associated with an underlying disease; autoimmune disorders, particularly SLE, and infections
Secondary
The principal changes of thrombocytopenic purpura are found in the
Spleen, bone marrow, and blood
In considering ITP in a patient, which of the following is applied?
a. Laboratory testing for antibodies (serologic testing) is usually helpful due to high specificity and sensitivity of current tests
b. Bone marrow examination can be done in most patients with bleeding episodes
c. Laboratory testing should be performed to evaluate secondary causes of ITP and should include testing for HIV infections and hepatitis C
d. The peripheral blood smear shows fragmented platelets with otherwise normal sizes
c. Laboratory testing should be performed to evaluate secondary causes of ITP and should include testing for HIV infections and hepatitis C
These principal changes in ITP match with the organ involved
a. Spleen- there is congestion in the sinusoids and enlargement of follicles, often associated with prominent reactive germinal centers
b. Bone-scattered megakaryocytes are found within the sinuses, possibly representing mild extramedullary
hematopoiesis driven by elevated levels of thrombopoietin
c. Spleen - there is a modest increase in the number of megakaryocytes. Some are apparently immature with large, non lobulated, single nuclei
d. Bone marrow- there is abnormally large platelets (megathrombocytes) in the peripheral vasculature
a. Spleen- there is congestion in the sinusoids and enlargement of follicles, often associated with
prominent reactive germinal centers
Which of the following statements about HIT is true
a. The thrombocytopenia is usually severe
b. Platelet count rarely reach at <40,000/uL
c. Cases presents with bleeding
d. There is increased risk of thrombosis
d. There is increased risk of thrombosis
Which of the following is true of HIT?
a. Can occur upon exposure to low molecular weight heparin(LMWH)
b. Unusual in patients with unfractionated heparin (UFH)
c. May occur after 21 days ofnexposure to heparin
d. Thrombosis occurs before thrombocytopenia
a. Can occur upon exposure to low molecular weight heparin(LMWH)
Which of the following is used in the treatment of HIT?
a. Platelet transfusion
b. Administration of direct thrombin inhibitor
c. Plasma exchange
d. Stop heparin
d. Stop heparin
Which of the following is presently used as an anticoagulant therapy for HIT?
a. Danaparoid
b. Argatroban
c. Bivalirudin
d. Fondaparinux
b. Argatroban
In patients with thrombosis among HIT patients. Which is recommended in treatment of warfarin
A. 1-2 mos
B. 2-3 mos
C. 4-5 mos
D. 3-6 mos
D. 3-6 mos
In patients receiving heparin therapy, which of the following diagnostics tests should you order to monitor treatment response?
APTT
Which of the following is not included in the 4Ts diagnostic algorithm for HIT?
a. Thrombocytosis
b. Timing of platelet count drop
c. Thrombosis
d. Other cause of thrombocytopenia
a. Thrombocytosis
Leo, 45/M has recently had heart attack and has been on anticoagulant therapy with Aspirin + Heparin. He had taken CBC and showed a platelet count of <30000. You suspected that he had HIT. What laboratory test detects antibodies with higher specificity?
Serotonin Release assay
Danaparoid, a mixture of glycosaminoglycans with anti-Xa activity, has been used extensively for the treatment of HITT. Which coagulation cascade does it affect
Common
Leo was subsequently switched from heparin therapy to warfarin therapy. Which of the following diagnostic tests will you use to monitor treatment response to warfarin?
PT
Which of the following drugs causes definite or probable isolated thrombocytopenia?
a. Metoprolol
b. Salbutamol
c. Simvastatin
d. Acetaminophen
d. Acetaminophen
Which among the following is true regarding Drug-Induced Thrombocytopenia?
a. A predictable decrease in platelet count occurs after treatment with many chemotherapeutic drugs due to increased platelet survival.
b. The thrombocytopenia typically occurs after a period of initial exposure (median length 21 days), or upon re- exposure, and usually resolves in 5-10 days after drug withdrawal.
c. Classic drug-dependent antibodies are antibodies that react with specific platelet surface antigens and result in
thrombocytopenia only when the drug is present.
d. The thrombocytopenia caused by the platelet Gp IIb/IIIa inhibitor drugs, such as abciximab, differs in that it may occur within 48h of initial exposure
c. Classic drug-dependent antibodies are antibodies that
react with specific platelet surface antigens and result in
thrombocytopenia only when the drug is present.
Drugs for ITP treatment
1. Increase platelet production
2. Increase reticuloendothelial uptake of antibody-bound platelet
3. Decrease antibody production
4. Decrease sequestration of spleen
- Increase platelet production
- Decrease antibody production
The patient is supine. Percussion begins at the lowest intercostal space in the anterior axillary line and produces a resonant note if the spleen is normal in size
Castell
Percussion begins at the lower level of pulmonary resonance in the posterior axillary line and proceeds diagonally along a perpendicular line toward the lower mid anterior costal margin. The patient is placed on the right side so that the spleen lies above the colon and stomach.
Nixon
Percussion begins at the lower level of pulmonary resonance in the posterior axillary line and proceeds diagonally along a perpendicular line toward the lower mid anterior costal margin. The patient is placed on the right side so that the spleen lies above the colon and stomach.
Barkun
BCL2 Translocation
Pro-survival mutation
MYC Translocation
Pro-growth
MLL Translocation
for self renewa
Erythropoietin stimulates the following intermediates of hematopoiesis?
a. Reticulocytes
b. Proerythroblast
c. Basophilic erythroblast
d. CFU-erythroid
d. CFU-erythroid
A 45 yrs old male who underwent bone marrow biopsy after several months of thrombocytopenia refractory treatment. Biopsy shows significant decrease of certain hematopoietic lineage. Which of the following cells, when decreased in bone marrow, contribute to the patient’s illness?
a. Large multilobed cells with numerous granules
b. Small, lobed with basophilic granules
c. Cell have thin rim cytoplasm with red granules
d. Cell with kidney shaped nucleus with very fine cytoplasmic granule
a. Large multilobed cells with numerous granules
What is the common precursor cell for both monocytes and neutrophils?
a. G-CSF
b. CFU-GM
c. GM-CSF
d. CFU-GEMM
b. CFU-GM
Which disease condition associated with splenomegaly results in passive congestion due to a decreased blood flow from the spleen?
a. Felty’s syndrome
b. Budd-Chiari syndrome
c. Gaucher’s disease
d. Metastatic cancer
b. Budd-Chiari syndrome
Which of the following statements is true about spleen?
a. It weighs <350 grams
b. It increases in size with age
c. Inspection may reveal fullness in the left upper quadrant that descends on inspiration
d. Palpable spleen always equate the presence of
disease
c. Inspection may reveal fullness in the left upper
quadrant that descends on inspiration
Condition associated with infiltration of the spleen
a. Amyloidosis
b. Infectious mononucleosis
c. Subacute bacterial endocarditis
d. Cirrhosis
a. Amyloidosis
A 68 year old female has hypertension and hypothyroidism, she presented with thrombocytopenia with a platelet count of 60,000, hgb 13.4 and wbc of 4300. During physical examination Splenomegaly was also noted. She was considered to have ITP. What is the type of mechanism responsible for organ enlargement?
a. Passive congestion due to decreased blood flow from the spleen
b. Infiltrative disease of the spleen
c. Hyperplasia & Hypertrophy related to a particular splenic function
d. Obstructive occlusion
c. Hyperplasia & Hypertrophy related to a particular splenic function
Patients with AML recurrent genetic abnormality
Inv (16)
Myeloid leukemia primarily affects
a. Bone
b. Lymph Node
c. Lungs
d. Skeletal Muscle
b. Lymph Node
Which of the following hematologic findings is the most consistent in diagnosis of AML?
a. Decreased reticulocyte count
b. Microcytic, normochromic anemia
c. Leukocytosis with lymphocytic predominance
d. None of the above
a. Decreased reticulocyte count
Germline mutation which causes the increased risk for myeloid neoplasm.
a. BBF23
b. DFX21
c. ABC1
d. GATA2
d. GATA2
he diagnosis of AML is based on the presence of
a. Red cell nuclear chromatin
b. Azurophilic lobulated granules
c. At least 20 % myeloid blasts in bone marrow
d. Multilobular, multinucleated
cells
c. At least 20 % myeloid blasts in bone marrow
A 45 year old patient with hepatosplenomegaly, blurred vision, fatigue, exertional dyspnea.
CBC result shows: WBC 5000, Hgb 7, Hct 25, Platelets 100,000.Bone marrow: Different infiltrates of blasts with cellularity of 80-85%. There is presence of hematologic suppression. With these, what is the consistent finding of AML that shows distinctive needle-like azurophilic granules?
a. Histiocytes
b. Monocytes
c. Erythroid precursor
d. Auer rods
d. Auer rods
In the treatment of AML, what is the target hemoglobin in the absence of DIC, bleeding, or congestive heart failure?
a. 7 g/dL
b. 8 g/dL
c. 9 g/dL
d. 10 g/dL
b. 8 g/dL
Which of the following is TRUE for the treatment for patients with AML?
a. If diagnosis is confirmed, consolidation and induction therapy should be started immediately in the absence of DIC, active bleeding and
congestive heart failure
b. Elevation of uric acid is part of disease process; patients should be given allopurinol from diagnosis
c. Consolidation therapy should be given if no remission is achieved in induction therapy
d. Molecular markers should be assessed before
treatment for its prognostic significance
d. Molecular markers should be assessed before
treatment for its prognostic significance
A 45-year-old male patient went to the ER due to fever for 2 weeks and melena, associated with
body malaise and lightheadedness. After thorough investigation he was diagnosed with AML and was
advised with chemotherapy. Which of the following is recommended?
a. Allogeneic hematopoietic cell
b. 7-day continuous induction of cytarabine
and 3-day course daunorubicin followed with
therapy if CR is achieved
c. Patient may be started with TKI such as imatinib, nilotinib, dasatinib
d. Oral lenalidomide and PI3 kinase inhibitor idelalisib for FL.
b. 7-day continuous induction of cytarabine
and 3-day course daunorubicin followed with
therapy if CR is achieved
Which of the following cytogenetic changes is expected in CML, in its chronic phase?
a. Inv(16)
b. t(8,21)
c. t(9,22)
c. t(9,22)
What is the bone marrow picture of patients with CML?
a. Normal bone marrow picture Answer
b. Hypocellular
c. Presence of Auer rods
d. Hypercellular
d. Hypercellular
Which BCR-ABL KTI is usually associated with the development of pleural and pericardial
effusions?
a. Dasatinib
b. Imatinib
c. Nilotinib
d. Bosutinib
a. Dasatinib
A 35 yo woman was diagnosed with CML and is currently on Nilotinib 300 mg orally twice daily and
shifted to Imatinib. However noted no improvement in symptoms despite the medications. What BCR ABL TKI can be used in this kind of even when suspecting a mutation?
a. Dasatinib
b. Nilotinib
c. Ponatinib
d. Bosutinib
c. Ponatinib
Which of the following is the most common genetic abnormality in CLL
a. Trisomy 12
b. Deletion of 11q
c. Somatic hypermutation
d. Chromosomal translocation
a. Trisomy 12
Which of the following statements is true regarding chronic lymphocytic leukemia?
a. Lymph nodes are diffusely effaced by an infiltrate of predominantly large lymphocytes
b. It is more common in Japan and other Asian countries
c. Patients are often symptomatic at diagnosis
Patients often asymptomatic at dianosis
d. Chromosomal translocation are rare
d. Chromosomal translocation are rare
Which of the following is a worse outcome of CLL?
a. Lymphocytosis
b. Expression of ZAP 70
c. Presence of somatic mutation
d. Absence of deletion of chromosome (11;17p)
b. Expression of ZAP 70
Which of the following is the most common childhood leukemia?
a. Acute lymphoblastic leukemia of B cell type
b. Burkitt’s leukemia
c. Acute promyelocytic leukemia
d. Acute erythroid leukemia
a. Acute lymphoblastic leukemia of B cell type
Secondary AML may arise from which of the following:
a. Hematologic disease like aplastic anemia
b. Myelodysplastic disease
c. Hemolytic Anemia
d. Myeloproliferative disorders
b. Myelodysplastic disease
In which age group does ALL occur with the highest frequency?
a. 1-15 years old
b. 20-35 years old
c. 45-60 years old
d. Elderly
a. 1-15 years old
A 7 year old boy presenting with 100,000 wbc count/mm3 on his cbc and a new diagnosis of ALL, which of the following findings would place him on a high risk protocol?
a. Bone marrow is in remission on day 10
b. His age
c. His WBC count
d. L1 morphology
c. His WBC count
Which of the following is associated with mediastinal mass presentation, high incidence of CNS relapse, and shorter disease-free interval?
a. T-cell ALL
b. precursor B-cell ALL
c. B-cell ALL
d. None of the above
a. T-cell ALL
Acute promyelocytic leukemia is characterized by which genetic abnormality?
a. t(8,21)
b. Inv (16)
c. t(15,17)
d. 11q23
c. t(15,17)
Which of the following cytogenetic abnormalities is seen in ALL offers the worst prognosis?
a. Hyperploidy with more than 50 chromosomes
b. Presence of a Philadelphia chromosome
c. Translocation with breakpoints involving the T cell receptor gene
d. Hypoploidy with loss of chromosome 20
b. Presence of a Philadelphia chromosome
Which of the following antineoplastic drugs is correctly matched to its mechanism of action?
a. 5 Fluorouracil - Inhibit thymidylate phosphorylase
b. Hydroxyurea - Forms adducts with DNA
c. L-Asparaginase - Inhibit purine ring synthesis
d. Permetrexed - Inhibit dihydrofolate reductase
d. Permetrexed - Inhibit dihydrofolate reductase
Which of the following has the highest cancer cytotoxicity in S phase?
a. Doxorubicin
b. Irinotecan
c. Temozolomide
d. Vincristine
b. Irinotecan
Which of the the following dose limited toxicity is common to most alkylating agents?
a. Alopecia
b. GI toxicity
c. Marrow suppression
d. Neurotoxicity
c. Marrow suppression
Which of the following drugs is mainly excreted through the kidney?
a. 5-fluorouracil
b. Cyclophosphamide
c. Doxorubicin
d. Methotrexate
d. Methotrexate
What is the maximum IV dose of vincristine that can be given weekly chemotherapy?
a. 2mg/m2
b. 3mg/m2
c. 4mg/m2
d. 5mg/m2
a. 2mg/m2
Which of the ff is a side effect of docetaxel that can’t be found in taxanes?
a. Fluid Retention
b. Neutropenia
c. Hypersensitivity
d. Peripheral Neuropathy
a. Fluid Retention
Which of the following exhibits selective destruction of the adrenocortical cells and is primarily used in the treatment of adrenal cancer?
a. Melphalan
b. Mitoxantrone
c. Mitomycin
d. Mitotane
d. Mitotane
Hydroxyurea inhibits which enzyme in the biosynthesis of DNA?
a. Adenosine deaminase
b. Cytosine methyltransferase
c. Ribonucleotide reductase
d. Thymidylate synthase
c. Ribonucleotide reductase
Which of the following crises in sickle cell anemia is proven to be fatal among children?
a. Vaso-occlusive
b. Sequestration
c. Aplastic
d. Pain
a. Vaso-occlusive
What laboratory parameter is not depressed in severe beta-thalassemia major?
Serum Iron
How does a physician prove or confirm the diagnosis of Cooley’s anemia?
Hemoglobin electrophoresis
Which of the most important GPI-linked proteins is deficient in erythrocytes and is crippled by paroxysmal nocturnal hemoglobinuria?
CD59
Which of the following is the best treatment for PNH?
a. Immunosuppressive drugs
b. Bone marrow transplant
c. Splenectomy
d. Hydroxyurea administration
a. Immunosuppressive drugs
Well-made blood smears offer insights as to the underlying cause of anemia, and as for
microangiopathic anemia, what red cell is most readily found?
a. Bite cell
b. Schistocyte
c. Stomatocyte
d. Microcyte
b. Schistocyte
Severe anemia may ensue in patients with red cell aplasia. If the attending physician discovers the
underlying tumor on CT scan, what would it be?
a. Teratoma
b. Granular cell tumor
c. Thymoma
d. Endolymphatic sac tumor
c. Thymoma
Splenectomy is often carried out to cure or alleviate some forms of anemia, thus reducing or eliminating the need for multiple blood transfusion. Nevertheless, this decision poses an imminent risk of what?
a. Priapism
b. Hematopoietic tumors
c. Bacterial sepsis
d. Zollinger-Ellison syndrome
c. Bacterial sepsis
Which of the given factors is less likely to trigger a sickling episode in sickle cell anemia?
a. Infection
b. Medication
c. Dehydration
d. None of the above
b. Medication
In erythropoiesis, the process of full maturation takes up to five days. Which of the following would
have the full complement hemoglobin?
a. Normoblast
b. Proerythroblast
c. Red blood cell
d. Orthochromatic-proerythroblast
d. Orthochromatic-proerythroblast
True of erythrocyte except
a. Contains enzyme of carbonic anhydrase
b. Metabolize glucose CO2 and H2O
c. Responsible for blood viscosity
d. Swelling and bursting if suspended to isotonic saline
d. Swelling and bursting if suspended to isotonic saline
The biconcave shape of the RBC is beneficial to
a. Increase intercellular exchange
b. Inhibit diapedesis
c. Increase cell surface ratio
d. Increase flexibility to pass through narrow blood vessels
d. Increase flexibility to pass through narrow blood
vessels
Paroxysmal nocturnal hemoglobinuria
a. Intravascular
b. Extravascular
c. Both
c. Both
HDFN
a. Intravascular
b. Extravascular
c. Both
b. Extravascular
Which of the following clinical manifestations differentiates hemolytic anemia from other types of anemia?
a. Easy fatigability
b. Jaundice
c. Bleeding
d. Pallor
b. Jaundice
Which of the following is the telltale sign of intravascular hemolysis?
a. Hemoglobinuria
b. Increased urobilinogen
c. Jaundice
d. Increased unconjugated bilirubin
a. Hemoglobinuria
Which of the following signs is seen in extravascular hemolysis?
a. Clostridial sepsis
b. Hereditary spherocytosis
c. Bongo drumming
d. Transfusion reaction
b. Hereditary spherocytosis
Hereditary related causes of disease that is intracorpuscular and inherited EXCEPT
a. PNH
b. Familial uremic syndrome
c. Membrane-cytoskeletal defects
d. Enzymopathies
a. PNH
b. Familial uremic syndrome
A marathon runner presents with splenomegaly and jaundice. Hemolytic anemia is considered.
What is the mechanism of injury?
a. RBC membrane abnormality
b. Abnormal globin
c. Cardiac traumatic hemolysis
d. Repetitive physical trauma
d. Repetitive physical trauma
For the above patient, under which of the following hemolytic anemia does the patient belong?
a. Intracorpuscular Answer
b. Intravascular
c. Very severe
d. Inherited
b. Intravascular
Which of the following are in CAD?
a. IgG
b. IgM
c. IgG & IgM
b. IgM
Which of the following AIHA is associated with mycoplasma infection?
a. Paroxysmal Cold hemoglobinuria
b. Warm antibody AIHA
c. Cold agglutinin disease
d. Alloimmune hemolytic anemia
a. Paroxysmal Cold hemoglobinuria
Extravascular hemolysis occurs mostly in what type of AIHA?
a. Paroxysmal cold hemoglobinuria
b. Warm antibody AIHA
c. Cold agglutinin disease
d. Paroxysmal nocturnal hemoglobinuria
b. Warm antibody AIHA
What is/are the effect/s of chronic extravascular hemolysis on iron metabolism?
a. There will be iron loss, needing replacement
b. Iron overload is possible causing hemochromatosis
c. There is no significant effect on iron stores since iron will be efficiently recycled by the body
d. All the statements are true
b. Iron overload is possible causing hemochromatosis
diagnostic results support AIHA?
Positive direct agglutination
test, elevated LDH, bilirubin
& reticulocytes
True of PNH
a. Lysis of red cells optimally at 4 degree celsius
b. Hemolysis occurs intravascularly resulting to hemoglobinuria
c. This type of autoimmune HA is associated with malignancy
d. It is a drug dependent autoimmune HA
b. Hemolysis occurs intravascularly resulting to
hemoglobinuria
Which of the following is the most common mechanism of hemolysis in warm type antibody AIHA?
a. The Fc portion of the antibody will be
recognized by the Fc receptor of macrophages, and this will trigger erythrophagocytosis
b. Antigen-antibody complex activate complement forming membrane attack complex and the red cells are destroyed directly
c. Antigen has anti-P specificity and binds to red cells only at a low temperature (optimally at 4°C), but when the temperature is shifted to 37°C, lysis of red cells takes place in the presence of complement
d. The antigen usually has an anti-I specificity
a. The Fc portion of the antibody will be
recognized by the Fc receptor of macrophages, and this will trigger erythrophagocytosis
Which of the following pathophysiologic processes is common to all HA?
a. Increase red cell turnover
b. Short lifespan of RBC of transfused blood
c. Decrease hemoglobin level
d. Increase production of RBC by bone marrow
a. Increase red cell turnover
A 32 year old female was admitted due to signs of anemia, including fatigue, dizziness, light
headedness, associated with jaundice and dark urine. Hemolytic anemia was suspected, diagnostic test revealed positive for DAT, with noted elevated bilirubin, LDH, and retic count of 8.1%. Baseline hemoglobin upon admission was 7.1 g/dL. Which of the following is recommended?
a. Splenectomy can be done to terminate the hemolysis
b. Blood transfusion is not advisable since patient has no gross active bleeding
c. Allogeneic hematopoietic stem cell transplantation is preferable during this time
d. She may be started with corticosteroid and monitor response
d. She may be started with corticosteroid and monitor response
This form of hematologic disease usually affects elders and has special clinical and pathological features. This is characterized as chronic condition
a. PCH
b. CAD
c. Periodic cold hemoglobinuria
d. March hemoglobinuria
b. CAD
What is the gold standard for proving the lifespan of red cells are reduced?
a. HbA1C
b. Non-radioactive isotope 15N
c. Radioactive iodine test
d. Peripheral blood smear
b. Non-radioactive isotope 15N
Considered the de facto first-line treatment of cold agglutinin disease
a. Cyclophosphamide
b. Prednisone
c. Rituximab
d. Splenomegaly
c. Rituximab
A patient with cold agglutinin disease is caused by autoantibodies that react to temperature at 4 degrees celsius to 37 degrees celsius. Half of them are caused by idiopathic, half of them are caused by lymphoproliferative disorders such as
a. SLE
b. Use of cephalosporin
c. HIV
d. Mycoplasma pneumonia
d. Mycoplasma pneumonia
Direct coombs test is used for AIHA for the presence of autoantibodies. A positive reaction of which of the following suggests warm antibody hemolytic anemia
C3 bound to RBCs
Autoimmune hemolytic anemia is a type ____ hypersensitivity reaction
II
A 37yo woman diagnosed with warm AIHA several months ago presents for a follow up visit. She responded to prednisone therapy but she cannot weaned off steroid therapy because her hemolysis flares at dose 20mg/day. She developed diabetes and had flares of chronic hepatitis B when introduced to high dose steroids. What is the next most reasonable option for therapy?
a. Cyclophosphamide
b. Rituximab
c. Splenectomy
d. Danazol
b. Rituximab
A patient with jaundice suspected with hemolytic anemia is caused by
a. Lack of oxygen within cells
b. Buildup of carbon dioxide due to RBC destruction
c. Bilirubin, a yellowish pigment, is a byproduct of hemoglobin breakdown
d. Spleen digestive enzymes
causes the yellow color
c. Bilirubin, a yellowish pigment, is a byproduct of hemoglobin breakdown
Which of these participates as a cofactor in reactions that neutralize substances such as H2O2 and provide protection from oxidative stress?
a. NADP
b. NADPH
c. GSH
d. GSGG
c. GSH
Which is true about G6PD deficiency?
a. G6PD deficiency usually presents as NNJ or low grade hemolytic anemia in
the absence of infections
b. Episodic hemolysis of G6PD deficiency is caused by exposures that generate oxidant stress
c. Bite cells seen as dark
inclusions within red cells which are membrane bound precipitates in G6PD deficiency
b. Episodic hemolysis of G6PD deficiency is caused by exposures that generate oxidant stress
Three triggering factors of G6PD:
fava beans, drugs, & infection
Which of the following is a peripheral blood finding of hemolysis in G6PD deficiency?
a. Heinz bodies
b. Bite cells
c. Schistocyte
d. All of the above
d. All of the above
Which of the drugs carry definite risk in clinical hemolysis in G6PD deficient patients?
a. Sulfafiazine
b. Sulfisoxazole
c. Sulfamethoxazole
c. Sulfamethoxazole
Which of the following is FALSE about acute hemolytic anemia due to G6PD deficiency?
a. Hemoglobinemia
b. Hemoglobinuria
c. Raised plasma haptoglobin
c. Raised plasma haptoglobin
Conditions associated with hemolysis and negative DAT result includes all except
a. Hemoglobinopathies
b. SLE
c. Microangiopathic hemolytic anemia
d. Disseminated intravascular
coagulation
b. SLE
What is the antibody involved in paroxysmal cold hemoglobinuria?
Donath Landsteiner Antibody
Cold agglutinin disease is related to
a. Cold urticaria Answer
b. Chronic lymphocytic leukemia
c. Waldenstrom’s macroglobulinemia
c. Waldenstrom’s macroglobulinemia
