Hematology

Question 1

Which of the following is a feature of Hemolytic Anemia?

a. Increased haptoglobin
b. Decreased LDH
c. Reticulocytosis
d. Low Indirect Bilirubin

Answer 1

Reticulocytosis (>2.5)

Question 2

Inheritance of thalassemia trait is through

A. X-linked recessive
B. Translocation of chromosomes
C. Chromosomal mosaicism
D. Autosomal dominant

Answer 2

Autosomal dominant
| Autosomal codominant trait

Question 3

Which of the following is not true of Thrombin?
A. Thrombin activates factor XIII to factor XIIIa
B. Multifunctional enzyme that converts soluble plasma fibrinogen to an insoluble fibrin matrix
C. Protein C is inactivated by thrombin
D. The pviotal protease of the coagulation

Answer 3

C. Protein C is inactivated by thrombin

Question 4

Pure Red Cell Aplasia is strongly associated with which viral infection?
A. Cytomegalovirus
B. Parvovirus B19
C. Infectious Mononucleosis
D. Non-A and Non-B Hepatitis

Answer 4

B. Parvovirus B19

Question 5

Which of the following is not true of heparin induced thrombocytopenia?
A. can occur after exposure to UFH but not with LMWH
B. results from antibody formation to a complex of the platelet specific protein platelet factor 4 (PF4) and heparin
C. Associated with increased risk of thrombosis and not with bleeding
D. Diagnosis is mainly clinical

Answer 5

A. can occur after exposure to UFH but not with LMWH

Question 6

An 18 yo male student was referred for prolonged bleeding after circumcision. He had prolonged bleeding when he was in elementary after dental extraction but no workup done then. FHx unremarkable. PE was unremarkable. CBC revealed WBC 11 Seg 65, Lym 35, Hgb 100, Hct .33, Plately 458 PT control 12 secs patient 13 secs/ aPTT control 35 secs patient 105 secs. What is the next step you will consider?
A. Request for platelet aggregation studies
B. Give Tranexamic acid
C. Transfuse FFP
D. Request for specific factor assay

Answer 6

C. Transfuse FFP - to elevate PT/PTT

Question 7

True of Polycythemia vera, EXCEPT
a. Elevated plasma EPO level with isolated erythrocytosis excludes PV
b. clinical features may include splenomegaly, phletora, and aquagenic pruritus
c. a clonal disorder involving a multipotent hematopoietic progenitor cell in which phenotypically normal red cells, granulocytes, and platelets accumulate in the presence of a recognizable physiologic stimulus
d. majority of patients will show mutation JAk 2

Answer 7

c. a clonal disorder involving a multipotent hematopoietic progenitor cell in which phenotypically normal red cells, granulocytes, and platelets accumulate in the presence of a recognizable physiologic stimulus

Question 8

A 25 year-old male with CBC values of: Hgb 100 mg/dL, Hct .30, MCV 79fL. MCH 30pg. WBC 7x109/L. His other siblings also have the same condition. Peripheral blood smear shows presence of target cells in significant amount. What is the most likely diagnosis of the following cases?
A. Thalassemia syndrome
B. Anemia of Chronic disease
C. Pure red cell aplasia
D. Iron deficiency anemia

Answer 8

D. Iron deficiency anemia

Question 9

Which of the following is NOT a diagnostic criterion for Myelodysplastic Syndrome?
A. more than one lineage cytopenia
B. Presence of del 5q abnormality
C. Bone marrow dysplastic features
D. Blast cells of 30%

Answer 9

D. Blast cells of 30%

Question 10

Which of the following is not true of Henoch-Schonlein Purpura?
A. Glucocorticoids may provide symptomatic relief
B. Acute inflammatory reaction with IgA and complement components in capillaries, mesangial tissues. and small arterioles, leading to increased vascular permeability and localized hemorrhage
C. Coagulation tests are abnormal
D. Manifest as purpuric rash on the extensor surfaces of the arms and legs, usually accompanied by joint pains, abdominal pain, and hematuria

Answer 10

C. Coagulation tests are abnormal

Question 11

True of Von Willebrand Disease, EXCEPT
A. all patients with low VWF levels have bleeding symptoms
B. mainstay of tx for mild type is desmopressin
C. Patients have predominantly mucosal bleeding symptoms
D. type 3 vWD are usually with no detectable VWF

Answer 11

A. all patients with low VWF levels have bleeding symptoms

Question 12

A 27 year old female with persistent low hemoglobin and a chest xray finding of widened mediastinum considering a thymoma. she has low reticulocyte count and her bone marrow shows marked decrease eythroid precursor, with intact platelet and whiteblood cell precursors. What is most likely diagnosis of the following cases?
A. Anemia of Chronic Disease
B. Pure Red Cell Aplasia
C. Thalassemia Syndrome
D. Iron deficiency Anemia

Answer 12

B. Pure Red Cell Aplasia

Question 13

A young adult female consulted for menorrhagia and easy bruising. Her platelet count is normal but the bleeding time is prolonged. Platelet aggregation studies revealed impaired response to thrombin, epinephrine and ADP, with normal response to ristocetin. What is the possible cause of the prolonged bleeding in this patient?
A. Bernard Soulier syndrome
B. Glanzmann’s thrombasthenia
C. Idiopathic Thrombocytopenic Purpur
D. von Willebrand Disease

Answer 13

B. Glanzmann’s thrombasthenia

Question 14

A 19-year-old male consulting due to hemolytic anemia and on work-up is positive for direct antiglobulin test. What is the most likely diagnosis?
A. Hereditary Spherocytosis
B. Cold Agglutinin Disease
C. Autoimmune Hemolytic Anemia
D. Paroxysmal nocturnal hemoglobinuria

Answer 14

C. Autoimmune Hemolytic Anemia

Question 15

True of Hemophilia, EXCEPT
A. Hemophilia A and Hemophilia B are clinically indistinguishable
B. autosomal dominant disease due to mutations in the F8 gene or F9
C. affected females are carrier
D. may typically show isolated prolongation of the aPTT assay

Answer 15

B. autosomal dominant disease due to mutations in the F8 gene or F9

Question 16

True of direct oral anticoagulants, EXCEPT
A. produce a non predictable level of anticoagulation
B. no routine coagulation monitoring is needed
C. more convenient to administer than warfarin
D. have half-lives that permit once- or twice-daily administration

Answer 16

A. produce a non predictable level of anticoagulation

Question 17

A 57 y/o male painter was referred for abnormal CBC on annual PE. He was asymptomatic except for occasional early satiety. Significant in the PE was the huge splenomegaly. A repeat CBC was done and revealed WBC 100,000/uL Platelet 530,000/uL Hgb 125 g/L. PBS N/N red cells, WBC increased with neutrophil’s predominance with leftward shift. Platelets are slightly increased. What test will help you confirm your suspicion and rule out other disorder similar to this case?
A. Jak 2 mutation assay
B. BCR ABL FISH
C. AML PANEL FISH
D. SERUM PROTEIN ELECTROPHORESIS

Answer 17

B. BCR ABL FISH

Question 18

Which of the following statements is not True of venous thrombosis?
A. May occur with stasis or states of hypercoagulability.
B. Can break off and embolize to pulmonary circulation.
C. Highly dependent upon the state of the vessel wall, the platelet, and factors related to blood flow.
D. Thrombi are rich in fibrin and trapped red cells and contain relatively few platelets.

Answer 18

C. Highly dependent upon the state of the vessel wall, the platelet, and factors related to blood flow.

Question 19

A 14-year-old female with CBC showing Hgb 100 mg/dL, Hct 0.30,MCV 75fL low MCH 28pg low, WBC 6x10%/L, Platelet Count 400 x 10°/L. She is asymptomatic and had her menarche at 13 y.o. Her TSAT is 9 and her Reticulocyte count is 0.5%. What is the most likely diagnosis of the following cases?
A. Iron Deficiency Anemia
B. Pure Red Cell Aplasia
C. Thalassemia Syndrome
D. Anemia of Chronic Disease

Answer 19

A. Iron Deficiency Anemia

Question 20

A 25-year-old male presenting with pancytopenia and hemoglobinuria. Bone marrow shows erythroid hyperplasia and he has a positive PIG A gene mutation. What is the most likely diagnosis?
A. Hereditary Spherocytosis
B. Paroxysmal nocturnal hemoglobinuria
C. Cold Agglutinin Disease
D. Autoimmune Hemolytic Anemia

Answer 20

B. Paroxysmal nocturnal hemoglobinuria

Question 21

A young adult female primigravid just gave birth complicated by placenta accreta. Patient still with bleeding a day after evacuation of placenta. Her CBC revealed the following Hgb 7g/di, Hct 26%, WBC 17,000 with segmenter’s predominance, Platelet count 30,000/ul. PT control 12, patient 18secs INR 3 and aPTT control 35 patient 80secs. Which of the following laboratory findings is expected of this patient?
A. absent ADAMTS 13
B. low megakaryocytes in the bone marrow
C. reduced Fibrinogen level
D. decreased D-Dimer

Answer 21

C. reduced Fibrinogen level

Question 22

A 44 y/o male has been hospitalized for 6 weeks because of various complications beginning with a bowel obstruction. The patient has had several operative procedures, one of which required transfusion of 3 units of PRBC. He has been unable to eat and has been receiving broad spectrum antibiotics almost continuously. Recently performed tests showed an isolated prolongation of PTT and bleeding time were normal. What is the most likely cause of the coagulation abnormality?
A. Disseminated Intravascular coagulopathy
B. Coagulopathy of liver disease
C. Vitamin K deficiency
D. Hemophilia A|

Answer 22

C. Vitamin K deficiency

Question 23

True of vWF
A. synthesized in the liver
B. mediates platelet binding via the GP IIb/IIa
C. plasma carrier of FVIII
D. facilitates platelet aggregation

Answer 23

C. plasma carrier of FVIII

Question 24

A 65-year-old female diagnosed with chronic lymphocytic anemia presents severe hemolytic anemia. Antibody identification shows it is predominantly IgM. What is the most likely diagnosis?
A. Autoimmune Hemolytic Anemia
B. Hereditary Spherocytosis
C. Cold Agglutinin Disease
D. Paroxysmal nocturnal hemoglobinuria

Answer 24

C. Cold Agglutinin Disease

Question 25

A 35-year-old male presenting with moderate anemia which was detected since he was 18-years-old. He has icteric sclerae, splenomegaly and his osmotic fragility test shows increased hemolysis. What is the most likely diagnosis?
A. Hereditary Spherocytosis
B. Cold Agglutinin Disease
C. Paroxysmal nocturnal hemoglobinuria
D. Autoimmune Hemolytic Anemia

Answer 25

A. Hereditary Spherocytosis