Test 2 Flashcards
What is the most common reason cited for lack of response to iron supplementation?
a. Patient adherence issues
b. malabsorption
c. excessive elimination
Patient adherence issues
Which symptom is NOT associated with iron deficiency?
a. Diarrhea
b. fatigue
c. decreased cognitive ability
d. pagophagia
Diarrhea
(T or F) One form of pica, the urge to eat ice is associated with iron deficiency and resolves with correction of the deficiency.
T
In which ways is iron balance maintained in the body.
a. Epidermal cell sloughing
b. Blood loss through menstruation
c. Gastrointestinal absorption
d. all of the above
all of the above
Which for of iron is most readily absorbed?
a. plant based iron
b. Ferrous gluconate
c. Ferrous sulfate
d. Heme iron
Heme iron
Which of the following foods have the ability to block iron absorption?
a. Animal meat
b. Citrus fruit
c. green tea
d. Milk
c. green tea
d. Milk
(T or F) Iron is more readily absorbed on an empty stomach but can cause irritation.
T
New research is demonstrating improved methods for dosing iron to increase its absorption. According to the research, which dosing method is preferred?
a. Dose to bowel tolerance
b. Low doses times a day
c. The maximum RDA every day
d. Moderate doses every other day
Moderate doses every other day
Which of the following tests is the most sensitive for detecting early (uncomplicated) iron deficiency?
a. Serum iron
b. CBC
c. Ferritin
d. Methylmalonic acid
Ferritin
Which testing can be used to determine response to iron supplementation in an iron deficiency individual?
a. Reticulocyte index
b. Hemoglobin
c. Each of these can be helpful at different time intervals.
d. Ferritin
Reticulocyte index
Hemoglobin
Ferritin
Your patient has increase serum homocysteine and normal serum methylmalonic acid leading you to suspect she has
a. B12 deficiency
b. Copper deficiency
c. Folate deficiency
d. Iron deficiency
Folate deficiency
(T or F) B12 deficiency can lead to folate deficiency.
T
_____________ is the most common cause of B12 deficiency
a. SIBO
b. Iron deficiency anemia
c. IBS
d. Pernicious anemia
Pernicious anemia
At what B12 level is a methylmalonic acid assay recommended?
a. <150 ng/L
b. 150-300 ng/L
c. >300 ng/L
d. MMA is not helpful in the workup for B12 deficiency
150-300 ng/L
In what way is the schilling test useful?
a. It provides information about the source of the B12 deficiency
b. It provides information about the source of homocysteine deficiency
c. It provides kidney function status through the use of radiolabeled B12
d. It’s a quick, easy test to determine a B12 deficiency
It provides information about the source of the B12 deficiency
Which conditions affect the intestinal absorption of B12?
a. IBD
b. PCOS
c. Tapeworm infections
d. SIBO
IBD
Tapeworm infections
SIBO
What form must B12 leave the stomach in order to be absorbed?
a. Intrinsic factor bound B12
b. R factor bound B12
c. Pepsin bound B12
d. Lipid bound B12
R factor bound B12
hich conditions or states negatively affect the oral phase of B12 absorption?
a. Sympathetic state
b. Sjogren’s syndrome
c. Parasympathetic state
d. Dental caries
Sympathetic state
Sjogren’s syndrome
Which of the following are signs/symptoms of B12 deficiency?
a. Macrocytic anemia
b. Numbness and paresthesia in the extremities
c. Gastrointestinal disturbances such as anorexia and diarrhea
d. Hyperreflexia
a. Macrocytic anemia
b. Numbness and paresthesia in the extremities
c. Gastrointestinal disturbances such as anorexia and diarrhea
(T or F) Folate deficiency leads to neurologic deficits.
F
Select the conditions/populations associated with increased risk of folate deficiency?
a. Tropical sprue
b. Malabsorption syndromes
c. Pregnancy
d. Alcohol abuse
a. Tropical sprue
b. Malabsorption syndromes
c. Pregnancy
d. Alcohol abuse
What is the suggested supplementation ratio of zinc to copper?
a. 30mg zinc to 20mg copper
b. 15mg zinc to 15mg copper
c. 30mg zinc to 10mg copper
d. 15mg zinc to 1 mg copper
15mg zinc to 1 mg copper
Which of the following minerals is essential for mobilization of iron from both enterocytes and ferritin?
a. Copper
b. Zinc
c. Chromium
d. Manganese
Copper
Which of the following impairs copper absorption?
a. High protein intake
b. High iron intake
c. High vitamin C intake
d. High zinc intake
High zinc intake
High iron intake
Which of the following dietary factors inhibit zinc absorption?
a. High non-heme iron intake
b. Phytates
c. iron deficiency
d. Animal based heme iron
a. High non-heme iron intake
b. Phytates
X-linked sideroblastic anemia can be treated by high doses of
a. B12
b. Vitamin C
c. B6
d. Iron
. B6
(T or F) Iron rich foods and ascorbic acid may be harmful to those with sickle cell anemia.
T
(T or F) Zinc should be avoided by those with sickle cell anemia
F
Reduction of hemolytic events associated with G6PD has been demonstrated with supplementation of with of the following?
a. Vitamin E
b. Selenium
c. Magnesium
d. Vitamin C
a. Vitamin E
b. Selenium
Which of the following minerals competes with zinc absorption and may become depleted with long-term zinc supplementation?
a. Potassium
b. Chromium
c. Manganese
d. Copper
copper
Which of the following foods may be harmful to to individuals with hemochromatosis due to their effect on the liver?
a. Coffee
b. Alcohol
c. Raw Oysters
d. Dark leafy greens
b. Alcohol
c. Raw Oysters
Which of the following is the primary treatment for hemochromatosis?
a. There is no treatment for hemochromatosis
b. Vitamin C supplementation
c. Regular phlebotomy to remove excess iron
d. Iron supplementation
Regular phlebotomy to remove excess iron
(T or F) Individuals homozygous for hemochromatosis have a shorted life expectancy unless they donate blood regularly
T
(T or F) Zinc supplementation may be harmful to those with hemochromatosis.
T
Which of the following minerals competes with iron for transferrin binding and has been shown to be beneficial for those with hemochromatosis?
a. Chromium
b. Calcium
c. Zinc
d. Vitamin C
Chromium
Platelets stay in circulation for
a. ~120 days
b. 7-10 days
c. ~50 days
d. 6 hours
7-10 days
What are critical values?
a. Values a person must have in order to survive
b. Another name for normal values
c. Values determined to be so low/high they constitute a medical emergency
d. Values determined to be so low/high they warrant follow up
Values determined to be so low/high they constitute a medical emergency
The major risk associated with thrombocytopenia is
a. Increased thrombus formation
b. Anemia
c. Cancer
d. Spontaneous hemorrhage
Spontaneous hemorrhage
(T or F) Thrombocytopenia is associated with a wide variety of conditions.
T
Which of the following is NOT an interfering factor for platelet counts?
a. Estrogen
b. Drug intake
c. Tobacco use
d. High altitude
Tobacco use
A screening CBC is performed on a healthy individual. The report findings are positive for low platelets. Your next step is to
a. Review the peripheral smear for satellite formation or platelet clumping
b. Order a comprehensive metabolic panel for liver and kidney function
c. Disregard the results
d. Refer the patient for a bone marrow biopsy
Review the peripheral smear for satellite formation or platelet clumping
Which of the following conditions is associated with a decreased MPV?
a. Valvular heart disease
b. B12 deficiency
c. Aplastic anemia
d. Sepsis
Aplastic anemia
What is the final outcome of healthy hemostasis
a. Platelet activation
b. Formation of a primary hemostatic plug
c. Coagulation pathway activation
d. Formation of a stable hemostatic plug
Formation of a stable hemostatic plug
Which of the following steps are included in primary hemostasis?
a. Recruitment of RBCs to the area of injury
b. Formation of a white thrombus
c. Reflexive vasoconstriction
d. Formation of a stable clot
b. Formation of a white thrombus
c. Reflexive vasoconstriction
In primary hemostasis, the bleeding initially stops with
a. Activation of von Willebrand factor (vWB)
b. RBCs getting stuck in the vascular tear
c. Formation of a fibrin-platelet mesh
d. Platelet adherence to subendothelial collagen fibers
Platelet adherence to subendothelial collagen fibers
What triggers platelet morphophonology to change?
a. Exposure to fibrinogen
b. Activation by von Willebrand factor (vWB)
c. They don’t change shape
d. Activation by nitrogen gas exposure
Activation by von Willebrand factor (vWB)
(T or F) The two steps of hemostasis (primary and secondary) happen independently of one another and in succession.
F
Which best describes aggregation in primary hemostasis?
a. Platelet to platelet attachments
b. Platelet to collagen attachments
c. Platelet to WBC attachments
d. Platelet to RBC attachments
Platelet to platelet attachments
Which of the following trigger amplification of aggregation into a large platelet mass?
a. Exposure of platelets to fibrinogen
b. Continued activation of platelets to exposed collagen
c. Release of serotonin by platelets
d. Release of large quantities of ADP with thromboxane A2 (TXA2)
Release of large quantities of ADP with thromboxane A2 (TXA2)
Why must a platelet plug be reinforced with secondary hemostasis?
a. It produces serotonin
b. It is stable
c. It is fragile
d. It can easily be dislodged from the vessel wall
c. It is fragile
d. It can easily be dislodged from the vessel wall
Which of the following is the most frequently inherited primary bleeding disorder?
a. Gray platelet syndrome
b. Bernard Soulier disease
c. Von Willebrand disease
d. Storage pool disease
Von Willebrand disease
Which presenation are associated with von Willebrand disease?
a. All of these are correct
b. increased clotting with DVT formation
c. Heavy menstrual bleeding
d. Mucosal bleeding
c. Heavy menstrual bleeding
d. Mucosal bleeding
What is the mechanism of action of aspirin?
a. Inhibition of fibrinogen
b. Inhibition of thromboxane
c. Inhibition of von Willebrand factor
d. Inhibition of ADP
Inhibition of thromboxane
The aspirin effect lasts for
a. 2 hours
b. 7 days
c. 10+ days
d. 24 hours
7 days
Bleeding time testing gives information about
a. Heparin therapy evaluation
b. How a body responds to trauma
c. platelet function
d. Platelet number or count
platelet function
What lab has largely replaced bleeding time testing?
a. Thrombin time
b. Mean platelet volume
c. Platelet function screen
d. Peripheral smear
Platelet function screen
A zymogen is
a. A foreign body found is circulation
b. An active substance which is deactivated by an enzyme
c. A protein acting as a cofactor for an enzymatic reaction
d. An inactive substance which can be converted into an enzyme when activated by another enzyme
An inactive substance which can be converted into an enzyme when activated by another enzyme
(T or F) The roman numerals assigned to clotting factors are named in the order of discovery not the order of activation in the clotting cascade.
T
Which clotting factor initiates the extrinsic pathway (tissue factor pathway).
a. Factor II (Prothrombin)
b. Factor X (Stuart–Prower factor)
c. Factor I (Fibronogin)
d. Factor III (Tissue Factor)
Factor III (Tissue Factor)
Which factor does factor III (tissue factor) activate in the clotting cascade?
a. Factor VII
b. Factor II
c. Fibrinogen
d. Factor X
Factor VII
In the clotting cascade, throbin has this action.
a. Activates protein C
b. Converts factor VII to factor VIIa
c. Converts factor XII to factor XIIa
d. Converts fibrinogen to fibrin
Activates protein C
Converts fibrinogen to fibrin
The intrinsic pathway is initiated by which factor?
a. Factor XII
b. Factor VII
c. Factor X
d. Factor II
Factor XII
Which factor has the greatest ability to bioregulate hemostasis (upregulate or downregulate the clotting cascade)?
a. Fibrin
b. Prothrombin
c. Tissue factor (Factor III)
d. Thrombin
Thrombin
Which factor creates crosslinks of fibrin mesh during clot formation?
a. Factor XIII
b. Fibrinogen
c. Thrombin
d. Factor VII
Factor XIII
In which organ are the majority of clotting factors produced?
a. Bone Marrow
b. Endothelium
c. Liver
d. Spleen
Liver
Which clotting factors are vitamin K dependent?
a. X
b. VII
c. IX
d. II
e. XIII
a. X
b. VII
c. IX
d. II
Prothrombin time (PT) evaluates the
a. Extrinsic pathway
b. Intrinsic pathway
Extrinsic pathway
(T or F) Delayed bleeding is characteristic of secondary hemostatic disorders.
T
Which of the following can lead to a prolonged prothrombin time (PT)?
a. Vitamin K deficiency
b. Malignancy
c. Vitamin C deficiency
d. Polycythemia
Vitamin K deficiency
Activated partial thromboplastin time (aPTT) evaluates the
a. Intrinsic system
b. Extrinsic system
Intrinsic system
Hemophilia A is a deficiency of this factor.
a. Factor VIII
b. Factor XI
c. Factor IX
d. Fibrin
Factor VIII
Which of the following is the most common type of hemophilia?
a. Hemophilia C
b. Hemophilia B
c. Hemophilia A
d. Each hemophilia subtype occurs with the same frequency
Hemophilia A
(T or F) Elongation of aPTT occurs with Von Willebrand disease.
T
Which of the following are sources of vitamin K?
a. Green leafy vegetables
b. Synthesized by intestinal flora
c. Sunlight
d. Animal protein
a. Green leafy vegetables
b. Synthesized by intestinal flora
Which enzyme is responsible for degrading fibrin during fibrinolysis?
a. Plasminogen
b. Protease
c. Fibrinogen
d. Anti-plasmin
Plasminogen
Under what circumstances do protein C and protein S become activated?
a. In the presence of excess fibrin
b. In the presence of excess thrombin
c. In the presence of excess fibrinogen
d. In the absence of fibrin
In the presence of excess thrombin
(T or F) Factors C and S are vitamin K dependant.
T
Factor V Leiden mutation results in what?
a. Hypocoagulability
b. Hypercoagulability
Hypercoagulability
Which of the following is contraindicated for individuals with Factor V Leiden disease?
a. Warfarin
b. Oral birth control pills
c. Heparin
d. Vitamin K supplementation
Oral birth control pills
An elevation in aPTT suggests
a. A deficit of functional factors in the intrinsic pathway
b. A deficit of functional factors in the extrinsic pathway
A deficit of functional factors in the intrinsic pathway
Disseminated Intravascular coagulation is typically initiated through
a. Reduction in factor XIII preventing the conversion from a soft clot to a hard clot
b. Reduction of protein C in the plasma
c. Excessive Tissue Factor is the plasma
d. Hemorrhage from vascular injury
Excessive Tissue Factor is the plasma
The morbidity associated with DIC is
a. Hemorrhage due to lack of functional clotting factor
b. Tissue necrosis secondary to infection
c. Embolism due to large clot formation
d. Hemorrhage due to vascular fragility
Hemorrhage due to lack of functional clotting factor
Acute DIC can be treated as a stand-alone diagnosis
a. No, DIC is associated with an underlying condition that required treatment
b. Yes, it is a treatable condition as is
No, DIC is associated with an underlying condition that required treatment
The most common trigger for DIC is
a. Infection
b. Trauma
c. Obstetric complications
d. Malignancy
Infection
Low-grade DIC is
a. Associated with purpura fulminans
b. An incidental finding
c. Enhanced by the coexistence of liver disease
d. A leading cause of death in the United States
e. Often asymptomatic
b. An incidental finding
c. Enhanced by the coexistence of liver disease
e. Often asymptomatic
Laboratory findings in acute DIC include
a. Reduced PT, reduced aPTT
b. Prolonged PT, prolonged aPTT
c. Reduced PT, prolonged aPTT
d. Prolonged PT, reduced aPTT
Prolonged PT, prolonged aPTT
Which of the following tests is the most helpful in the workup of chronic DIC?
a. Decreased platelet count
b. Presence of fibrin degradation products (FDP)
c. CBC demonstrating anemia
d. Prolonged aPTT
Presence of fibrin degradation products (FDP)
What is the role of ADAMTS13?
a. Cleaves von Willebrand factor and prevents overactivity of platelet aggregation
b. Cleaves clotting factors
c. Inhibits formation of a hard clot from a soft clot
d. Increases production of proteins C and S
Cleaves von Willebrand factor and prevents overactivity of platelet aggregation
Deficiency of ADAMST13 is associated with which disease?
a. Immune thrombocytopenia (ITP)
b. Thrombotic thrombocytopenic purpura (TTP)
c. Disseminated intravascular coagulation (DIC)
d. Hemolytic uremic syndrome (HUS)
Thrombotic thrombocytopenic purpura (TTP)
Primary idiopathic TTP has a higher incidence in which population
a. Males
b. Obese
c. Diabetic
d. Females
e. Asian Americans
f. African Americans
b. Obese
d. Females
f. African Americans
The prognosis associated with TTP has been greatly improved with the utilization of
a. Phlebotomy
b. Warfarin
c. Plasmapheresis
d. Blood transfusions
Plasmapheresis
Select the features that are included in the “classic pentad” of TTP.
a. Thrombocytosis
b. Liver failure
c. Fatigue
d. Fever
e. Thrombocytopenia
f. Diffuse ecchymosis
g. Anemia
h. Renal failure
i. Neurologic findings
d. Fever
e. Thrombocytopenia
g. Anemia
h. Renal failure
i. Neurologic findings
Which of the following findings on a peripheral smear is highly suspicious for TTP?
a. Reticulocytes
b. Absence of platelets
c. Platelets clumps
d. Schistocytes
Schistocytes
Absence of platelets
Which of the following bones are an appropriate choice to access marrow for a biopsy?
a. Short (carpals, tarsals)
b. Irregular (vertebrae)
c. Sesamoid (patella)
d. Flat (sternum, illium)
Flat (sternum, illium)
Which of the following cells are considered agranulocytes? Basophils Monocytes Lymphocytes Neutrophils
Monocytes
Lymphocytes
(T or F) Monocytes are immature macrophages who have yet to migrate from the blood into tissue.
T
Thrombocytopenia in ITP is due to
a. Excessive clotting
b. Kidney failure
c. Removal of platelets by the spleen
d. Decreased production of thrombopoietin
Removal of platelets by the spleen
Which of the following is true concerning the presentation of ITP?
a. It is generally seen in a geriatric population
b. It can occur at any age and presents the same regardless of age group
c. It is generally a pediatric condition
d. It can present at any age and presents differently in children and adults
It can present at any age and presents differently in children and adults
The correct order according to size of bruising from largest to smallest is
a. Petechiae > hematoma > purpura
b. Petechiae > purpura > Hematoma
c. Purpura > hematoma > petechiae
d. Hematoma > purpura > petechiae
Hematoma > purpura > petechiae
ITP is diagnosed by
a. Positive direct coombs test
b. Presence of antibodies to platelets found in blood
c. It is a diagnosis of exclusion
d. Thrombocytopenia with splenomegaly
It is a diagnosis of exclusion
What percentage of children have ITP that self-resolves
a. 0-1%
b. 30%
c. 50%
d. 80%
80%
Which condition is the most common cause of acute renal injury in children?
a. DIC
b. ITP
c. TTP
d. HUS
HUS
HUS differs from ITP in that
a. HUS relies on a positive coombs test for diagnosis whereas ITP does not
b. HUS is not associated with renal complications
c. The platelet destruction is toxin mediated in HUS rather that autoimmune mediated
d. HUS presents with thrombocytopenia whereas ITP does not
The platelet destruction is toxin mediated in HUS rather that autoimmune mediated
Which conditions are considered thrombotic microangiopathies (TMAs)?
a. HUS and ITP
b. TTP and ITP
c. DIC and TTP
d. HUS and TTP
HUS and TTP
Atypical HUS
a. Represents >90% of cases
b. Is secondary to bacterial toxins
c. Is more likely than typical HUS to result in end-stage renal disease
d. Has a positive prognosis
Is more likely than typical HUS to result in end-stage renal disease
E. coli is generally transmitted to humans through
a. Vertical transmission
b. Ingestion of contaminated foods
c. Fecal-oral human to human transmission
d. Blood-borne pathogen
Ingestion of contaminated foods
Why are kidneys particularly susceptible to injury from HUS
a. Shiga toxin decreases TNF release from the kidneys, hampering the kidney’s ability to fight the infection
b. Gb3 , the binding site for shiga toxin, exists in high quantities on renal cells
c. The Gb3 receptor promotes E.coli replication and is found exclusively on the kidneys
d. The kidneys are the initial site E.coli travels to in the body
Gb3 , the binding site for shiga toxin, exists in high quantities on renal cells
Which of the following is NOT true concerning the differences between HUS and TTP?
a. ADAMTS13 deficiency is seen in TTP but will be sufficient in HUS
b. HUS typically involves greater damage to the endothelium
c. HUS does not typically present with the widespread symptoms associated with TTP
d. TTP etiology involves the clotting cascade, HUS does not
TTP etiology involves the clotting cascade, HUS does not
50-70% of patients with diarrhea associated HUS require
a. Plasmapheresis
b. RBC transfusions
c. IV fluids
d. Dialysis therapy
Dialysis therapy
Which of the following best describes the pathophysiology of atypical HUS?
a. Autoimmune or genetic mutation reducing complement cascade inhibitors
b. Infectious agent overstimulating the alternative pathway of the complement system
c. Infectious agent triggering destruction of clotting cascade inhibitors
d. A genetic mutation causing abnormally high levels of vWF
Autoimmune or genetic mutation reducing complement cascade inhibitors
Most variations in the leukocyte count are due to increases or decreases in the number of ______________ since by percentage they are more numerous.
a. Neutrophils
b. Basophils
c. Eosinophils
d. Monocytes
Neutrophils
Eosinophils stain ___________ with Wright’s stain due to the stain’s affinity for the ___________ pH of their granules.
a. Bluish-black; acidic
b. greenish-blue; basic
c. Orange-red; basic
d. Pinkish-purple; neutral
Orange-red; basic
What color do basophil granules stain with Wright stain?
a. Blue
b. Purple
c. Orange
d. Pink
Blue
Which of the following conditions are associated with lymphocytosis?
a. Some bacterial infections
b. Some viral infections
c. AIDS
d. Radiation therapy
Some viral infections
Some bacterial infections
(T or F) WBC counts on a CBC give an accurate and complete representation of WBCs throughout the body.
F
What is the relative number (%) of lymphocytes observed on WBC differential count in a healthy adult?
a. 6%
b. 3%
c. 30%
d. 60%
30%
Toxic granulation of neutrophils can be a result of what?
a. B12 or folate deficiency
b. Significant infection
c. Severe inflammatory state
d. Chemotherapy
Severe inflammatory state
Significant infection
Which of the following leads to a neutrophil left shift?
a. Chemotherapy
b. Bone marrow depression
c. Bacterial infection
d. B12 or folate deficiency
Bacterial infection
(T of F) Basophils are immature mast cells who have yet to leave the blood and migrate into tissue.
F
Which conditions are associated with eosinophilia (5%)?
a. Allergic infections
b. Parasitic infections
c. Cushing syndrome
d. Severe infection
Allergic infections
Parasitic infections
What conditions are associated with basophilia?
a. Prolonged steroid therapies
b. Hyperthyroidism
c. Myeloproliferative disease
d. Stress reactions
Myeloproliferative disease
What causes hypersegmented neutrophils?
a. Trauma
b. Infection
c. B12 or folate deficiency
d. Myeloproliferative disease
B12 or folate deficiency
Which of the following is the correct criteria for neutrophil hypersegmentation?
a. More than 5 cells with 6 lobes or one with 7
b. More than 3 cells with 7 lobes or one with 8
c. More than 3 cells with 3 lobes or one with 5
d. More than 3 cells with 5 lobes or one with 6 lobes
More than 3 cells with 5 lobes or one with 6 lobes
Which of the following cells have a nucleus classically shaped like a horse shoe?
a. Lymphocyte
b. Monocyte
c. Neutrophil
d. Eosinophil
Monocyte
T cells, B cells and natural killer cells are all this cell type.
a. Eosinophils
b. Monocytes
c. Mast cells
d. Lymphocytes
Lymphocytes
(T or F) LAP stain is low in leukemoid reactions
F
Which of the following describes a leukemoid reaction?
a. A non-leukemic WBC reaction with no more than 5% metamyelocytes or earlier
b. A leukemic reaction with less than 20% blasts
c. A non-leukemic WBC reaction with greater than 5% metamyelocytes or earlier cells
d. A leukemic reaction with more than 20% blasts
A non-leukemic WBC reaction with no more than 5% metamyelocytes or earlier
Myeloproliferative disorders can lead to enlargement of which organ?
a. Bone
b. Kidney
c. Spleen
d. Heart
spleen
What is the role of JAK2 in polycythemia vera?
a. A mutation of JAK2 leads to the binding of erythropoietin binding to cells in the bone marrow for a longer period of time
b. A mutation causing and absence of JAK2 stimulates production of excess erythropoietin
c. A mutation of JAK2 leads to stimulation of new RBCs in the absence of erythropoietin
d. A mutation causing an increase in JAK2 leading to over-sensitization of cells to erythropoietin
A mutation of JAK2 leads to stimulation of new RBCs in the absence of erythropoietin
Polycythemia and myelofibrosis and both examples of
a. Myelodysplastic syndromes
b. Myeloproliferative disorders
c. Leukemias
d. Lymphomas
Myeloproliferative disorders
Erythropoietin levels in secondary polycythemia (reactive) are
a. Within normal limits
b. Elevated
c. Decreased
Decreased
Which of the following is a common symptom in polycythemia vera?
a. Easy bruising
b. Lower leg edema
c. Alopecia
d. Pruritus
Pruritus
Myelofibrosis, a condition in which bone marrow becomes fibrotic, can cause
a. Changes in vision
b. Osteosclerosis
c. Osteoporosis
d. Displacement of hematopoiesis to extramedullary tissue
e. Hepatosplenomegaly
f. Pancytopenia
Displacement of hematopoiesis to extramedullary tissue
Hepatosplenomegaly
Osteosclerosis
Pancytopenia
Myelofibrosis is diagnosed
a. with a platelet count <100,000
b. WIth a biopsy demonstrating fibrosis
c. As a diagnosis of exclusion
d. After a finding of dacrocytes on peripheral smear
WIth a biopsy demonstrating fibrosis
Which finding on peripheral smear is particularly indicative of myelofibrosis?
a. Reticulocytes
b. Dacrocytes
c. Elliptocytes
d. Microcytes
Dacrocytes
IN what way do myelodysplastic syndromes differ from myeloproliferative disorders?
a. The cells in Myelodysplastic syndromes are mature and functioning. In MPD they are dysfunctional.
b. The cells in Myeloproliferative disorders and mature and functioning. In MDS they are dysfunctional
c. Myelodysplastic syndromes typically result in an increase in circulating cells. In MPD there are fewer circulating cells.
d. Myeloproliferative disorders typically result in an increase in circulating cells. In MDS there are fewer circulating cells.
Myeloproliferative disorders typically result in an increase in circulating cells. In MDS there are fewer circulating cells.
The cells in Myeloproliferative disorders and mature and functioning. In MDS they are dysfunctional
Leukemia results from cells losing their ability to control
a. Passion for dancing
b. Response to antigen
c. Replication and apoptosis
d. Apoptosis and mitochondrial function
Replication and apoptosis
Which of the following are established risk factors for leukemia?
a. Excessive sunlight exposure
b. Maternal exposure to pesticides/herbicides
c. Age (younger than 20)
d. Age (older than 60)
e. Lead poisoning
f. HIV
g. Down syndrome
h. EBV
Down syndrome Age (older than 60) EBV HIV Maternal exposure to pesticides/herbicides
Which is the most common malignancy in children
a. Chronic myelocytic leukemia (CML)
b. Acute lymphoblastic leukemia (ALL)
c. Acute myeloblastic leukemia (AML)
d. Chronic lymphocytic leukemia (CLL)
Acute lymphoblastic leukemia
What differentiates acute from chronic leukemia?
a. Presence of >20% blasts on peripheral smear
b. A bone marrow biopsy with <20% blasts
c. The patient has presenting symptoms for <2 years
d. A bone marrow biopsy with >20% blasts
A bone marrow biopsy with >20% blasts
Auer rods are pathognomonic for
a. CML
b. CLL
c. ALL
d. AML
AML
Philadelphia chromosome abnormalities are found in individuals with
a. AML
b. ALL
c. CML
d. CLL
CML
Which of the following is NOT true concerning smudge cells?
a. They are pathognomonic for leukemia
b. They are generally immature lymphocytes
c. They indicate increased cell fragility
d. They may be a result of operator (user) error
They are pathognomonic for leukemia
(T or F) Leukemia is a rare cancer, affecting older individuals.
False
(T or F) Individuals with chronic myeloid leukemia can develop an acute myeloid leukemia.
T
What age group(s) is/are commonly affected by Hodgkin’s lymphoma?
a. Age 50 and older
b. Age 36-57
c. Ages 15-34 and greater than 60
d. Children younger than 18
Ages 15-34 and greater than 60
Reed-Sternberg cells are pathognomonic for which lymphoma?
a. Hodgkin’s lymphoma
b. Nonspecific bone cancer
c. Burkitt’s lymphoma
d. Non-hodgkin’s lymphoma
Hodgkin’s lymphoma
The clinical history of pain in a lymph node following alcohol consumption is highly suspicious for
a. Non-specific bone cancer
b. Hodgkin’s lymphoma
c. Non-hodgkin’s lymphoma
d. Burkitt’s lymphoma
Hodgkin’s lymphoma
What environmental exposure is a known risk factor for Non-hodgkin’s lymphoma?
a. Asbestos
b. Endocrine disruptors like flame retardants
c. Benzene herbicides like glyphosate
d. Lead
Benzene herbicides like glyphosate
The diagnosis of Non-hodgkin’s lymphoma is made via
a. CBC
b. Bone marrow aspirate
c. Lymph node biopsy
d. DEXA scan
Lymph node biopsy
The age at diagnosis for Non-hodgkin’s lymphoma is typically
a. Less than 18
b. 67 and older
c. 18-34
d. 34-65
67 and older
Which virus is associated with Burkitt’s lymphoma?
a. EBV
b. HIV
c. CMV
d. RSV
EBV
Which geographical location is Burkitt’s lymphoma associated with?
a. Eastern Europe
b. North America
c. Central Africa
d. South America
Central Africa
“Starry sky” presentation of cell on a peripheral smear is associated with which type of lymphoma?
a. Hodgkin’s lymphoma
b. Nonspecific finding of all lymphoma types
c. Burkitt’s lymphoma
d. Non-Hodgkin’s lymphoma
Burkitt’s lymphoma
(T or F) Hodgkin’s lymphoma is more common than Non-hodgkin’s lymphoma.
F
Plasma cell dyscrasias (PCDs) are defined as
a. Proliferation of one clone of plasma cells
b. Proliferation of multiple clones of plasma cells
c. Senescence of multiple plasma cell lines
d. Senescence of one line of plasma cells
Proliferation of one clone of plasma cells
In which condition are Bence Jones proteins found in the urine?
a. HIV
b. Multiple myeloma
c. Polycythemia vera
d. Erythromelalgia
Multiple myeloma
What does the “C” in the CRAB mnemonic used for multiple myeloma stand for?
a. CRAB isn’t a mnemonic used for anything
b. Ascorbic acid
c. Hypercalcemia
d. Hypocalcemia
Hypercalcemia
What type of anemia is associated with multiple myeloma?
a. Normocytic Normochromic
b. Macrocytic normochromic
c. Microcytic hypochromic
Normocytic Normochromic
What is typically found with ESR in multiple myeloma?
a. ESR generally isn’t measured with this condition
b. ESR is often markedly depressed
c. ESR is often markedly elevated
d. ESR with usually WNL
ESR is often markedly elevated
Which antibodies are typically associated with multiple myeloma?
a. IgM
b. IgG
c. IgE
d. IgA
IgG
Which antibody is produced in Waldenstrom’s macroglobulinemia?
a. IgE
b. IgG
c. IgM
d. IgA
IgM
What condition is strongly associated with Waldenstrom’s macroglobulinemia?
a. Polycythemia vera
b. Raynaud’s phenomenon
c. HIV
d. Soft tissue tumor
Raynaud’s phenomenon
(T or F) Waldenstrom’s macroglobulinemia can be diagnosed in an asymptomatic individual.
T
