2014 module exam Flashcards by Survive Medical School

A drug used to relieve the symptoms of acute porphyria. What is the mechanism of the drug?
A) inhibits delta-ALA dehydratase 
B) inhibits hydroxymethylbilane synthase 
C) inhibits delta-ALA synthase 
D) inhibits feedback of ala synthase

C) inhibits delta-ALA synthase 

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Which enzyme is inhibited by lead toxicity?
A) ALA synthase
B) hydroxymethylbilane synthase
C) ALA dehydratase

C) ALA dehydratase

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What is the most important thing for the RBC to withstand the mechanical sheer force of moving through small blood vessels?
A) binding of cytoskeleton to hemoglobin
B) covalent linking of rafts to spectrin
C) covalent linking between membrane lipids to integral proteins
D) Non-covalent bonds between integral membrane proteins and cytoskeleton

D) Non-covalent bonds between integral membrane proteins and cytoskeleton

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What is the correct sequence of hematopoiesis in a fetus? 
A) Placenta, yolk sac, liver, bone marrow
B) Yolk sac, liver, placenta, bone marrow
C) Yolk sac, spleen, lymphoid organs, bone marrow
D) Bone marrow, liver, spleen, yolk sac

B or C

both are wrong so the question was canceled

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Blood islands are formed at which stage?
A) Bone marrow phase
B) Hepatic phase
C) Yolk sac phase

C) Yolk sac phase

first stage of hematopoiesis in the embryo

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What are rafts of lipid in red blood cells?
A) Indication of cell death
B) Areas of low lipid fluidity
C) Lipid interactions with membrane proteins
D) Lipid clusters with covalent bonds
E) Area with excessive linking to carbohydrates

B) Areas of low lipid fluidity

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Which of the following indicates that the cell is old or damaged when it is expressed?
A) Sphingomyelin
B) Phosphatidylethanolamine 
C) Phosphatidylserine
D) Phosphatidylcholine

C) Phosphatidylserine

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Pernicious anemia is due to the production of antibodies that lead to the immune destruction of which of the following?
A) parietal cells
B) haptocorin
C) cobulin

A) parietal cells

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Which of the following is the reason for the transport of oxygen from the maternal circulation to into the fetal circulation
A) because HbF doesn’t bind to 2,3BPG
B) gamma chains bind oxygen more tightly than beta chains in acidic environment

A) because HbF doesn’t bind to 2,3BPG

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A 29-year-old female who suffers from easy fatigability and can't perform her daily tasks visited a clinic. Upon examination, her Hemoglobin level was found to be 50g/L and a hookworm infestation was positive in her stool. What is the best treatment method assuming we gave her the needed medication for her helminthic (parasitic) infection?  
A) Two units of packed cells  
B) intensive iron therapy  
C) vitamin b12 therapy
 D) vitamin k therapy

B) intensive iron therapy  

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What causes the shift of the hemoglobin curve to the left and to the right?

a. Oxidation of Fe2+ to Fe3+ shifts it to the left, Reduction of hemin to heme shifts it to the right
b. Low H+ shifts it to the left, Addition of 2,3BPG shifts it to the right
c. Binding of CO shifts it to the left, Dissociation of CO shifts it to the right
d. Increase in BPG shifts it to the left, Decrease in CO2 shifts it to the right

b. Low H+ shifts it to the left, Addition of 2,3BPG shifts it to the right

(this is a picture question!)

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What can cause a hypersensitivity reaction toward a RBC?

Drugs absorbed onto cell membrane

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Which of these is most likely to lead to hemolytic disease of the newborn?
A) Rh+ mother, Rh- father
B) Rh+ mother, Rh+ father
C) Rh- mother, Rh+ father

C) Rh- mother, Rh+ father

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A person with renal failure will suffer from a deficiency in which group of cells?
A) Leukocytes
B) Proerythroblast
C) Platelets
D) Myeloblast

B) Proerythroblast

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A 16-year-old girl was brought to the hospital by her mother saying that she daughter is suffering from fatigue and tiredness. Upon asking her the doctor discovered that the girl has been experiencing irregular periods and menorrhagia. What is the cause of her problem?
A) sickle cell
B) thalssemia minor
C) thallasemia major
D) iron deficiency anemia

A) iron deficiency anemia

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What is the importance of the presence of NADH generated from glycolysis in erythrocytes?
A) Reduction of methemoglobin
B) To produce ATP through oxidative phosphorylation

A) Reduction of methemoglobin

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A 5-year-old with sickle cell anemia develops a fever, arthritis, rash, fatigue, and pallor. PCR demonstrated the presence of viral DNA in a blood sample. What is the causative organism?
A) Adenovirus 40
B) Parvovirus B19
C) Epstein barr virus

B) Parvovirus B19

+ an indication of aplastic crisis in the question

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What cell expresses CD34+ on their surfaces?
A) T lymphocytes
B) Multipotent stem cells
C) Pluripotent stem cells

C) Pluripotent stem cells

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A patient came to your presenting with bilateral lymphadenopathy in the neck, upon biopsy of the Lymph node binucleated cells were present surrounded by a polycellular environment, what organism most likely caused this disorder? 
A) HIV 
B) Hepatitis C 
C) EBV 
D) HTLV-1

C) EBV

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A 23-year-old male presented with sore throat, fever, and atypical lymphocytes. What’s the organism causing this condition? 
A) HIV 
B) Hepatitis C 
C) EBV 
D) HTLV-1
E) CMV

C) EBV

atypical lymphocytes= mononucleosis

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Tropical spastic paraparesis is caused by? 
A) HIV 
B) Hepatitis C 
C) EBV 
D) HTLV-1

D) HTLV-1

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An elderly patient with lymphoma (lymphadenopathy), cytogenetic tests found a translocation t(8:14). What is most likely the causative agent? 
A) HIV 
B) Hepatitis A 
C) EBV 
D) HTLV-1

C) EBV

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What cause trilineage suppression in TB? 
A) Transforming growth factor 
B) Tumor necrosis factor 
C) Interferon gamma 
D) Colony Stimulating factor

B) Tumor necrosis factor

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A Chinese baby with nasopharyngeal carcinoma? 
A) EBV
B) Hepatitis C 
C) HIV
D) CMV

A) EBV

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``` What point mutation leads to sickle cell anemia?   A) Glu6Val  B) Glu26Val  C) Glu26lys  D) Glu6lys ```

A) Glu6Val 

``` What would you expect to see in a female with sickle cell anemia suffering from a vaso-occlusive crisis?  A) schistocytes  B) howell jolly bodies  C) helmet cells  D) blister cells  E) spherocytes ```

 B) howell jolly bodies 

``` Which of the following is stored in room temperature with constant agitation? A) Plasma B) Packed cells C) Platelets D) Factor 8 ```

C) Platelets

Presence of this in low concentrations helps in the protection against malaria/limiting malaria effect. A) NAD+ B) G6PD C) NADPH

C) NADPH

A 45-year-old developed fever and cough. His WBC count was 70x10^9. Blood smear shows neutrophilia with toxic granulation. What is the diagnosis? A) Acute myeloid leukemia B) Reactive granulocytic leukocytosis C) CML

B) Reactive granulocytic leukocytosis

What is a characteristic of beta-thalassemia major? A) Low reticulocytes B) Gallstones C) Hypocellular bone marrow

B) Gallstones

A high demand of these compounds the reason behind hemolytic crisis in patients with G6PD deficiency, when facing great oxidative stress? A) Low amounts of GSH and NADPH B) RBC cytoplasm destruction C) Hemoglobin build-up

A) Low amounts of GSH and NADPH

Which of the following iron chelator is not taken orally with short half-life and low compliance? A) deferasirox B) deferoxamine C) deferiprone

B) deferoxamine

``` A dimerized molecule mainly responsible for cytoskeleton formation? A) Ankyrin B) Spectrin C) Actin D) AE1 E) GLUT-1 ```

B) Spectrin

``` Which of the following is an integral membrane protein that is responsible for linking the membrane with cytoskeleton? A) AE1 B) Spectrin C) Actin D) Junctional complex E) Phosphatidylserine F) Phosphatidylethanolamine G) Ankyrin ```

A) AE1

``` Defective resulting from point mutation in beta and when present in beta-thalassemia it increases its severity A) HbE B) HbF C) Hb bart’s D) HbE/beta E) HbS F) HbS/Beta G) HbH ```

A) HbE

``` Which abnormal hemoglobin is present in half of the severe cases of beta-thalassemia? A) HbE B) HbF C) Hb bart’s D) HbE/beta E) HbS F) HbS/Beta G) HbH ```

D) HbE/beta

``` Which is composed of 4 gamma homotetramer? A) HbE B) HbF C) Hb bart’s D) HbE/beta E) HbS F) HbS/Beta G) HbH ```

C) Hb bart’s

A woman had a car accident in which she lost lots of blood she was then carried/taken by an ambulance to the hospital. What is the best test to find out which blood is compatible for her (or to avoid cross matching errors or to prevent blood transfusing reactions)? A) DAT B) Kleihauer’s test C) Ab screening

C) Ab screening

``` Which disorder involves the impairment in conversion/switch of γ-globin to β-globin? A) β-thalassemia B) HbE/β thalassemia C) α-thalassemia D) HPFH ```

D) HPFH (hereditary persistence of fetal hemoglobin)

Which of the following is found in lipid rafts? A) phosphatidylserine B) phosphatidylcholine C) sphingomyelin

C) sphingomyelin

Which of the following orally active iron chelator is approved to treat iron overload in patients 2 years of age and older? A) deferasirox B) deferoxamine C) deferiprone

A) deferasirox

A patient went to Africa and was given antimalarial prophylaxis. What problem would you expect in this patient? A) RBC enzyme deficiency B) sickle cell C) alpha thalassemia

A) RBC enzyme deficiency

``` Which of the following factors is delocalized from the procoagulant membrane when activated? A) Factor X B) Factor VII C) Factor IX D) Prothrombin ```

D) Prothrombin

``` A 25-year-old female admitted to hospital with joint pain and swollen leg, rash, and renal failure. Upon testing her APTT was prolonged. What is the most likely cause? A) vWF deficiency B) DIC C) Vitamin k deficiency D) Antiphospholipid syndrome E) Hemophilia A ```

D) Antiphospholipid syndrome (Lupus anticoagulant)  | joint pain-> chronic arthritis

``` A patient was given an oral anticoagulant and had bleeding that was not stopped by the administration of protamine sulfate or vitamin k supplements, which drug was administered?   A) Rivaroxaban  B) Warfarin  C) Heparin  D) Enoxaparin E) Otamixaban ```

A) Rivaroxaban 

``` Which of the following conditions is associated with normal spleen?  A) Hereditary Eliptocytosis  B) immune thrombocytopenia C) Primary myelofibrosis D) Thrombotic thrombocytopenic purpura E) Sickle cell anemia ```

 B) immune thrombocytopenia

A 2-year-old boy, previously healthy, presented with epistaxis and purpura after receiving his viral vaccination. What is the reason behind his condition? CBC shows anemia and thrombocytopenia with normal WBC count A) Immune thrombocytopenia  B) hemophilia A C) Acute myeloid leukemia D) Aplastic anemia

A) Immune thrombocytopenia

``` What is the mechanism of action of heparin? A) Inhibits ADP dependent pathway B) Direct IIa inhibitor C) Deactivates factor X D) Activates factor V E) Activates antithrombin III ```

E) Activates antithrombin III

A 20-year-old female presents with a bleeding disorder. Which of the following would suggest a bleeding problem due to platelets and not due to coagulation?   A) A massive joint swelling  B) the fact that she received fresh frozen plasma supplement in the past  C) her mother has the same problem  D) excessive menstrual bleeding E) bleeding for several hours after tooth extraction

D) excessive menstrual bleeding

``` A 35-year-old woman has a sudden onset of severe dyspnea and goes into cardiac arrest from which she cannot be resuscitated. Autopsy: saddle pulmonary embolism. This is most likely a consequence of?  a) Factor 5 deficiency   b) protein C deficiency   c) vWD  d) thrombocytopenia   e) heterozygous F5 Leiden mutation ```

e) heterozygous F5 Leiden mutation

An abnormality of which of the following is present in 5% of normal people? A) Protein C B) antithrombin III C) Factor V

C) Factor V

What is the role of bradykinin? a) Release of PAI b) Stimulates the release of tPA from endothelial cells c) Degradation of fibrin and fibrinogen

b) Stimulates the release of tPA from endothelial cells

What substances are secreted from platelets to enhance aggregation? A) Thromboxane A2 and ADP B) von willbrand factor

A) Thromboxane A2 and ADP

A child presented with bleeding in his joint, what would you give him as a treatment?

Concentrated factor VIII

Which of the following act as a direct inhibitor of thrombin? A) otaxixaban B) dabigatran C) fondapirux

B) dabigatran

Which of the following works as an inhibitor of factor V and VIII? A) Antithrombin III B) Protein C C) Heparin

B) Protein C

Which inhibits ADP dependent pathway of platelet aggregation? A) Otamixaban B) Dabigatran C) Clopidigrol

C) Clopidigrol

``` Which mutant factor is the commonest cause of thrombophilia? A) Factor V B) Factor VII C) Factor VIII D) Factor X ```

A) Factor V

Which of the following is direct factor Xa inhibitor? A) Otamixaban B) Dabigatran

A) Otamixaban

A 35-year-old woman developed pulmonary thromboembolism. She has a history of stillbirth at 6 months (repeated abortions). After testing her she proved to be positive for lupus anticoagulant. What is the most likely diagnosis?

A) Antiphospholipid syndrome

What is the result of a mutation in 3'UTR of prothrombin?

A) Stabilization of prothrombin mRNA

``` A 48 years old male with deep vein thrombosis in his right lower limb, BM shows pancytosis. Found to have JAK2 mutation. What is the cause?   A) primary myelofibrosis   B) chronic myeloid leukemia   C) polycythemia vera  D) essential thrombocythemia ```

C) polycythemia vera 

A 56-year old asymptomatic male splenomegaly, CBC pancytopenia, PBS teardrop RBCs and nucleated RBCs. What is the diagnosis? A) Essential thrombocythemia B) Primary myeloid fibrosis C) Polycythemia Vera

B) Primary myeloid fibrosis

``` Which of the following antibacterial substance is found in neutrophils granules? A) Lysozymes  B) Granzymes  C) Perforin D) major basic protein ```

A) Lysozymes 

``` What is the function of ABL gene?  A) tumor suppressor gene   B) protooncogene   C) oncogene  D) oncosuppressor gene ```

B) protooncogene  

``` A man presented to the emergency department with a severe asthmatic attack. He was afebrile and fine prior to that. CBC showed leukocytosis. Which type of cell is increased?  A) Neutrophils  B) monocytes  C) eosinophils  D) lymphocytes ```

C) eosinophils 

``` What is a characteristic of chronic lymphocytic leukemia?  A) Monoclonal b lymphocytosis  B) Monoclonal immunoglobulins   C) Plasma cell infiltration D) polyclonal immunoglobulin production ```

A) Monoclonal b lymphocytosis 

Retinoic acid is given to acute promyelocytic leukemia patients, what is the molecular function of retinoic acid?  A) Activates PML-RARA B) Degrades PML-RARA  C) Stabilizes PML-RARA mRNA

B) Degrades PML-RARA 

What is a characteristic of Myelodysplastic syndrome?  A) Fibrous BM and pancytosis B) Peripheral pancytosis and hypercelluar bone marrow C) Peripheral pancytopenia and hypercellular Bone marrow 

C) Peripheral pancytopenia and hypercellular Bone marrow 

Which of the following substances is present in the granules of eosinophils? A) Lysozyme B) Major basic protein C) Defensins

B) Major basic protein

A patient complaining from Gum swelling and bleeding. The CBC shows Anemia and thrombocytopenia. Hemoglobin 79 g/L platelets 15x10^9 and WBC 7x10^9 PBS shows immature cells in peripheral blood, what is the most investigative tool to know the possible cause? A) Morphology of bone marrow aspiration B) Immunophenotyping of circulation neutrophils C) Tissue biopsy of the swollen gum D) Cytogenetics analysis of lymphocytes E) Reticulocyte count

A) Morphology of bone marrow aspiration

A patient presents with fatigue, bleeding, and recurrent infections. CBC shows high WBCs, low hemoglobin, and low platelets. Peripheral blood smear shows intracytoplasmic occlusions and immature blast cells. What is the diagnosis? a- megaloblastic leukemia b- acute myeloid leukemia c- chronic myeloid leukemia

b- acute myeloid leukemia

What would you give as a treatment to a person undergoing chemotherapy because of cancer? A) G –CSF B) TNF C) IL

A) G-CSF | treat Drug Induced-Myelosuppression

What is the protein that results from the translocation of chromosomes (9:22) and mostly associated with CML? A) P210 B) P190 C) P200

A) P210

A patient presented with redness and burning sensation in the hands. His CBC findings showed elevation in hemoglobin, WBC, platelets count. What is the pathophysiology of his condition?

panmyelosis | why not ET?

``` A patient presented with pallor, dizziness, fatigue, and bleeding. The CBC indicated decreased number of RBCs and platelets (they gave us CBC numbers). Bone marrow examination showed mononuclear megakaryocytes and nuclear budding in erythroblast. What is the possible diagnosis? a- aplastic anemia b-hyperthyroidism c-megaloblastic anemia d-MDS ```

d-MDS

A patient presented with fatigue, bleeding and recurrent infections. The immunophenotyping was positive for CD33, which lineage is affected?

myeloid

What is the pathogenicity of BCR-ABL fusion protein? A) Tyrosine kinase activation B) G6PD C) CML

A) Tyrosine kinase activation

``` A patient presented with splenomegaly, his PBS showed leukocytosis and basophilia. What is his condition? A) primary myelofibrosis   B) chronic myeloid leukemia   C) polycythemia vera  D) essential thrombocythemia ```

B) chronic myeloid leukemia  

Which of the following is a feature of hematopoietic stem cells? A) infrequent in (adult) bone marrow B) do not undergo apoptosis C) divides symmetrically

A) infrequent in (adult) bone marrow

``` Where does the maturation of T-cell lymphocytes occur?  A) Bone marrow  B) Thymus C) Spleen D) Lymph nodes ```

B) Thymus

A 4-year-old boy complaining of bone pain in his left leg. He had thrombocytopenia and anemia. His bone marrow expressed 80% blast cells. what is the origin of these cell?  A) Myeloblast B) Monoblast  C) B lymphoblast 

C) B lymphoblast 

What is the structural unit of the bone marrow?  A) Trabeculae B) Capillary Venus sinus C) Extracellular matrix

B) Capillary Venus sinus

What is a general characteristic of alkylating antineoplastic drug?   A) Crosslink DNA   B) Does not cause secondary cancer  C) Does not cause bone marrow suppression   D) Cell cycle-specific

A) Crosslink DNA  

A 33-old female has night sweats and lymphadenopathy. Blood smear shows large binucleated cells  A) follicular lymphoma  B) hodgkin’s lymphoma  C) plasma cell myeloma

B) hodgkin’s lymphoma 

What is meant by “hematopoietic stem cells homing”? A) Migrating to the niche microenvironment B) Apoptosis of stem cells C) Differentiation of stem cells

A) Migrating to the niche microenvironment

``` Which of the following is a professional cell with MHC II and antigen presentation? A) Neutrophils B) Macrophages C) T helper cell D) T cytotoxic cell ```

B) Macrophages

``` Which drug has decreased activity when given with allopurinol? a- Imatinib b- Cyclophosphamide c- Doxorubicin d- 6-Mercaptopurine ```

d- 6-Mercaptopurine

``` Which drug may lead to hemorrhagic cystitis? a- Imatinib b- Cyclophosphamide c- Doxorubicin d- Mercaptopurine ```

b- Cyclophosphamide

``` Which of the following cells has abundant rough ER and a dense chromatin? A) Plasma cell B) Erythrocyte C) B lymphocytes D) T lymphocytes E) Kuppfer cells ```

A) Plasma cell

``` By which process are the T lymphocytes that bind to self-MHC eliminated? A) Positive selection B) Negative selection C) T cell differentiation D) T cell suppression E) T cell activation ```

B) Negative selection

``` A 25 years old female with a mediastinal lymph node. A biopsy was done to the lymph node showing binucleated large cells, immunophenotyping showed positive CD15 and CD30, What is this condition? A) Follicular lymphoma B) Hodgkin’s lymphoma C) Chronic lymphocytic leukemia D) Acute lymphocytic leukemia ```

B) Hodgkin’s lymphoma

``` A patient presented with unexplained weight loss and lymphadenopathy. He was found to have the t(14:18) translocation. What’s the diagnosis? A) Hodgkin’s lymphoma B) Follicular lymphoma C) Chronic lymphocytic leukemia D) Acute lymphocytic leukemia ```

B) Follicular lymphoma

How is low grade lymphoma different from high grade lymphoma? A) Low grade lymphoma progresses slowly and is more difficult to cure/treat B) Low grade lymphoma progresses slowly and is easier to cure/treat C) Low grade lymphoma progresses faster and is easier to cure/treat D) High grade lymphoma progresses faster and is more difficult to cure/treat

A) Low grade lymphoma progresses slowly and is more difficult to cure/treat

Which cell type is deficient in HIV? A) B-lymphocytes B) T cytotoxic cells C) T helper cells

C) T helper cells

``` Which of the following expresses CD3 and either CD4 or CD 8? A) T-Cytotoxic Lymphocytes B) T-helper Lymphocytes C) T-Lymphocytes D) B-Lymphocytes ```

C) T-Lymphocytes

Which of the following is a feature of ALL? A) >20% blast cells B) <20% blast cells

A) >20% blast cells

``` A patient with splenomegaly. PBS shows increased mature lymphocytes and smudge cells. What is the diagnosis? A) primary myelofibrosis   B) chronic myeloid leukemia   C) polycythemia vera  D) essential thrombocythemia ```

B) chronic myeloid leukemia  

A patient presented with renal failure, his blood and urine were tested for monoclonal antibodies, Urine dipstick test Protein precipitation and no glucose, Urine protein electrophoresis, Monoclonal spike. What is the abnormal cell lineage that might be causing this condition? A) Plasma cell B) Erythrocyte C) B lymphocytes

A) Plasma cell

2014 module exam Flashcards

(99 cards)