[PHYSIO] Blood (2023) Flashcards
What is the last nucleated stage of RBC?
A. Proerythroblast
B. Basophilic erythroblast
C. Polychromatophilic erythroblast
D. Orthochromatic erythroblast
E. Reticulocyte
D. Orthochromatic erythroblast
Rationalization: The orthochromatic erythroblast (also known as normoblast) is the last stage in erythropoiesis where the nucleus is still present. After this stage, the cell loses its nucleus to become a reticulocyte, which then matures into an erythrocyte (RBC).
Bone marrow starts to form blood cells at what age?
A. 3rd week of fetal development
B. 4th week of fetal development
C. 3rd month of fetal development
D. 4th month of fetal development
E. At birth
D. 4th month of fetal development
Rationalization: Hematopoiesis in the bone marrow begins around the 4th month of fetal development. Before this period, blood cells are mainly produced in the yolk sac, liver, and spleen.
During the embryonic period, blood is synthesized by the
A. Yolk sac
B. Liver
C. Bone marrow
D. Lymph nodes
A. Yolk sac
Rationalization: During the early weeks of embryonic life, the yolk sac is responsible for the production of primitive nucleated red blood cells. Later, the liver and then the bone marrow take over this function.
Earliest stage of RBC that can be seen in non-neoplastic blood is:
A. Reticulocyte
B. Polychromatophilic erythroblast
C. Basophilic erythroblast
D. Proerythroblast
A. Reticulocyte
Rationalization: Reticulocytes are immature red blood cells that are normally present in small amounts in the circulation. They indicate ongoing erythropoiesis. Other earlier stages like proerythroblasts and erythroblasts are typically confined to the bone marrow.
During the hepatic period of hematopoiesis, which is the predominant form of hemoglobin?
A. Hgb A
B. Hgb A2
C. HgbF
D. High gower
C. Hgb F
Rationalization: Hemoglobin F (fetal hemoglobin) is the predominant form of hemoglobin during the hepatic period of fetal development. It is gradually replaced by adult hemoglobin types (Hgb A and Hgb A2) after birth.
Fetal form of hemoglobin:
A. Alpha 2, gamma 2
B. Alpha 2, delta 2
C. Alpha 2, beta 2
D. Alpha 2, epsilon 2
A. Alpha 2, gamma 2
Rationalization: The fetal form of hemoglobin, known as Hemoglobin F (Hgb F), consists of two alpha and two gamma chains (α2γ2).
What is the main trigger for the intercalated cells in the peritubular capillaries to secrete EPO?
A. Anemia
B. Low Hgb
C. Low Hct
D. Hypocarbia
E. Hypoxia
E. Hypoxia
Rationalization: Hypoxia (low oxygen levels) is the primary stimulus for the production of erythropoietin (EPO) by the renal interstitial cells. EPO then stimulates the production of red blood cells to increase oxygen delivery to tissues.
This condition is least likely to stimulate Red cell production:
A. Pulmonary disease
B. Cardiac failure
C. End-stage renal disease
D. Hemorrhagic disease
C. End-stage renal disease
Rationalization: In end-stage renal disease, the kidneys are severely damaged and produce little to no erythropoietin, leading to a decrease in red blood cell production despite other possible stimulants.
The following are stimulators of erythropoietin except:
A. Living in high altitude
B. Renal Failure
C. Decreased 2,3-DPG
D. Androgens
B. Renal Failure
Rationalization: Renal failure leads to a decrease in erythropoietin production. In contrast, living at high altitude, decreased 2,3-DPG, and androgens can stimulate erythropoietin production.
All of the following are true except:
A. Heme molecule is made up of protoporphyrin and iron
B. Protoporphyrin is made up of 4 pyrrole rings
C. Each hemoglobin chain contains 1 atom of iron
D. 4 molecules of heme combine with 1 globin chain.
D. 4 molecules of heme combine with 1 globin chain.
Rationalization: Each hemoglobin molecule is composed of four globin chains (two alpha and two beta chains in Hgb A) and each globin chain binds one heme molecule. Therefore, one hemoglobin molecule binds four heme molecules, not the other way around.
RBCs in deoxygenated systemic venous circulation will have which of the following characteristics?
A. Has less H+ bound to hemoglobin
B. The major form of transport of CO2 is via binding to Hgb to form carbaminohemoglobin
C. HCO3- enters the RBC to recombine with H+ to form H2CO3 which dissociates into CO2 and H2O
D. Has increased intracellular levels of Cl-
E. AOTA
D. Has increased intracellular levels of Cl-
Rationalization: In unoxygenated blood, hemoglobin is not bound to oxygen and can bind CO2 to form carbaminohemoglobin. However, the major form of CO2 transport is as bicarbonate (HCO3-). In systemic venous blood, CO2 is converted to HCO3- in RBCs, and HCO3- exits the RBCs in exchange for Cl- (chloride shift), increasing intracellular Cl- levels.
An unknown solution that agglutinates by adding antisera A and antisera B has blood type:
A. O
B. A
C. B
D. AB
D. AB
Rationalization: If an unknown blood sample agglutinates with both anti-A and anti-B sera, it means the blood has both A and B antigens, indicating blood type AB.
What blood type will show no agglutination to ANTI-A and ANTI-B sera?
A. A
B. B
C. AB
D. O
D. O
Rationalization: Blood type O lacks A and B antigens on the surface of RBCs, so it will not agglutinate with either anti-A or anti-B sera.
Mother is blood type A and Father is blood type B. Their children will not possibly have blood type?
A. B
B. A
C. AB
D. O
E. NOTA
E. NOTA
Rationalization: A mother with type A blood (genotype AO or AA) and a father with type B blood (genotype BO or BB) can have children with blood types A, B, AB, or O, depending on the combination of alleles inherited.
True of Rh hemolytic disease of the newborn.
A. First pregnancy is the most severely affected
B. Mother is Rh positive, while fetus is Rh negative
C. After an erythroblastic child is born, future children are certainly with disease
D. Preformed maternal antibodies cross the placenta to react with fetal Rh+ cells
E. Subsequent pregnancies are protected from maternal antibodies
D. Preformed maternal antibodies cross the placenta to react with fetal Rh+ cells
Rationalization: Rh hemolytic disease occurs when an Rh- mother has formed antibodies against Rh+ blood cells, typically from a previous pregnancy with an Rh+ baby. These antibodies can cross the placenta in subsequent pregnancies and attack the Rh+ fetal RBCs.
True of Rh blood type.
A. Plasma with D antigen is Rh+
B. Incidence of Rh- among Asians is high
C. Anti-Rh antibodies are formed at birth
D. Rh- individuals can be repeatedly transfused with Rh+ blood
B. Incidence of Rh – among Asians is High
True of extravascular hemolysis EXCEPT:
A. Old RBCs are phagocytosed by reticuloendothelial cells
B. Iron is recycled
C. Hemoglobin is broken down to alpha-beta dimers
D. Globin is broken down into amino acids
C. Hemoglobin is broken down to alpha-beta dimers
Rationalization: In extravascular hemolysis, hemoglobin is broken down into heme (which is further broken down into iron and bilirubin) and globin (which is broken down into amino acids).
Which of these platelet/coagulation studies results are most consistent with von Willebrand’s disease?
A. Normal bleeding time, platelet count, and PTT
B. Normal bleeding time, platelet count; Prolonged PTT
C. Prolonged bleeding time, normal platelet count and PT; Prolonged PTT
D. Prolonged bleeding time, low platelet count; Prolonged PT and PTT
C. Prolonged bleeding time, normal platelet count and PT; Prolonged PTT
Rationalization: Von Willebrand’s disease typically presents with a prolonged bleeding time (due to defective platelet adhesion), normal platelet count, normal PT (as it does not affect the extrinsic pathway), and prolonged PTT (as vWF stabilizes factor VIII in the intrinsic pathway).
Which of the following conditions could potentially lead to a coagulation defect in both extrinsic and intrinsic pathways?
A. A heritable defect involving von Willebrand’s factor
B. A mutation in the genes coding for platelet GpIIb/IIIa receptor
C. A mutation in genes coding for platelet GpIb/IX
D. A blockage in bile flow
E. An X-linked disorder leading to factor VIII deficiency
D. A blockage in bile flow
Rationalization: Blockage in bile flow can lead to decreased absorption of vitamin K, which is necessary for the synthesis of several clotting factors (II, VII, IX, X), affecting both the extrinsic and intrinsic pathways.
The extrinsic mechanism for initiating the formation of prothrombin activator begins with a traumatized vascular wall or extravascular tissue and occurs according to the following steps except:
A. Release of tissue factor
B. Activation of Factor X
C. Activation of Factor XI
D. Effect of activated Factor X to form prothrombin activator
C. Activation of Factor XI
Rationalization: The extrinsic pathway involves the release of tissue factor, activation of Factor X, and formation of prothrombin activator. Activation of Factor XI is part of the intrinsic pathway.
The intrinsic and extrinsic pathways of the coagulation cascade act at which of the following clotting factors?
A. Labile factor
B. Stable factor
C. Stuart factor
D. Tissue factor
E. Hageman factor
C. Stuart factor
Rationalization: The Stuart factor, also known as Factor X, is the point at which both the intrinsic and extrinsic pathways converge in the coagulation cascade to form the common pathway.
True of the intrinsic pathway for initiating clotting:
A. Begins with a traumatized vascular wall
B. Begins with extravascular tissues that come into contact with blood
C. Begins with trauma to the blood
D. B & C
E. AOTA
C. Begins with trauma to the blood
Rationalization: The intrinsic pathway is initiated by trauma to the blood itself, leading to the exposure of blood to subendothelial collagen and other components.
The deficiency in FXIII in the serum will lead to which of the following?
A. Prolonged PTT
B. Prolonged PT
C. Increased clotting time
D. Decreased clot stability
E. NOTA
D. Decrease clot stability
Rationalization: Factor XIII (Fibrin Stabilizing Factor) cross-links fibrin to stabilize the clot. Deficiency in FXIII results in unstable clots.
All of these statements are correct except:
A. The intrinsic pathway is triggered by thrombin formed by the extrinsic pathway
B. Intrinsic pathway begins with exposure of blood to collagen from traumatized tissue
C. Prothrombin time measures the intrinsic to common pathway
D. Hemophiliacs have a defect in the intrinsic pathway
C. Prothrombin time measures the intrinsic to common pathway
Rationalization: Prothrombin time (PT) measures the extrinsic and common pathways. Partial thromboplastin time (PTT) measures the intrinsic and common pathways.
Vitamin K deficiency results in a decrease in the following except:
A. Factor II
B. Factor VII
C. Factor I
D. Factor X
C. Factor I
Rationalization: Vitamin K is essential for the synthesis of Factors II, VII, IX, and X, and proteins C and S. Factor I (Fibrinogen) is not dependent on Vitamin K.
The lifespan of platelets is __ days:
A. 7-9
B. 11-12
C. 13-14
D. 3-5 days
E. 21 days
A. 7-9
Rationalization: Platelets have a lifespan of about 7-9 days in circulation.
Upon exposure of collagen with tissue injury, which platelet glycoprotein initially attaches to it?
A. GP Ia
B. GP Ib
C. GP IIb/IIIa
D. Fibrin
A. GP Ia
Rationalization: GP Ia/IIa (integrin α2β1) is one of the initial glycoproteins on the platelet surface that binds to collagen.
This is lineage-specific growth factor for megakaryocytes:
A. G-CSF
B. GM-CSF
C. TPO
D. EPO
C. TPO
Rationalization: Thrombopoietin (TPO) is the primary growth factor for the production of megakaryocytes, the precursor cells for platelets.
What is clotting factor IV?
A. Labile factor
B. Conversion factor
C. Calcium
D. Hageman factor
C. Calcium
Rationalization: Factor IV refers to calcium ions, which are essential for various steps in the coagulation cascade.
A. Labile factor = 5
B. Conversion factor = 7
C. Calcium = 4
D. Hageman factor = 12
Which of the following factors is common in both intrinsic and extrinsic pathways?
A. IV
B. VII
C. VIII
D. IX
E. X
E. X
Rationalization: Factor X is where the intrinsic and extrinsic pathways converge in the coagulation cascade, leading to the common pathway.
Which phase of hemostasis results in the gradual dissolution of the clot?
A. Primary hemostasis
B. Secondary hemostasis
C. Tertiary hemostasis
D. Quaternary hemostasis
C. Tertiary hemostasis
Rationalization: Tertiary hemostasis involves fibrinolysis, the process that gradually dissolves the clot after the tissue has been repaired.
Which of these components of the complement system is chemotactic to WBCs?
A. C3b
B. C3a
C. C4a
D. C5a
E. C5b-9
D. C5a
Rationalization: C5a is a potent chemotactic factor for WBCs, particularly neutrophils, attracting them to sites of infection or inflammation.
Complement components that are anaphylatoxins EXCEPT:
A. C2a
B. C3a
C. C4a
D. C5a
A. C2a
Rationalization: C3a, C4a, and C5a are anaphylatoxins that can trigger inflammation and allergic responses. C2a is not considered an anaphylatoxin.
The least of granulocytes but very important in immediate hypersensitivity reactions because it releases histamine:
A. Basophil
B. Eosinophil
C. Neutrophil
D. NK cells
E. Lymphocytes
A. Basophil
Rationalization: Basophils, along with mast cells, release histamine and other mediators during allergic reactions and immediate hypersensitivity responses.
All nucleated cells have which molecule on their surface?
A. MHC I
B. MHC II
C. CD4
D. CD8
A. MHC I
Rationalization: All nucleated cells express MHC class I molecules on their surface, which present endogenous antigens to cytotoxic T cells.
The only antibody that could attack the Rh complexes on fetal red blood cells is:
A. IgA
B. IgD
C. IgE
D. IgG
E. IgM
D. IgG
Rationalization: IgG is the only antibody class that can cross the placenta and attack Rh antigens on fetal red blood cells, potentially leading to hemolytic disease of the newborn.
