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Flashcards in 2015 Block B Deck (100)
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1

A 6 year old boy comes to your clinic with a 4 year history of easy bruisability. Your physical examination reveals multiple purpuras over both shins and forearms. Rest of physical exam is unremarkable. You think this is just the normal bruising of childhood. But the parents are worried.

Clinically significant bleeding would be
a. bruise out of proportion to degree of trauma
b. bleeding from a cut lasting 30 seconds
c. hematomas after immunizations
d. a and c

D

2

Von Willebrand Disease is
a. X-linked
b. autosomal dominant
c. autosomal recessive
d. not a familial disease

B

3

A 15 year old male comes to the Emergency Room for severe right lower quadrant abdominal pain and tenderness. He is unable to extend his right hip. He is pale, with a heart rate of 120/min and BP of 80/60. He remembers being told of two uncles who had bleeding disorders and who died at a young age.

Your differential diagnosis would include the following except:
a. acute appendicitis
b. urinary tract infection
c. iliopsoas bleed
d. acute peptic ulcer disease

D

4

The following statement is true about hemophilia
a. clinical presentation of hemophilia A and hemophilia B are indisinguishable
b. hemophilia often presents with gum and nose bleeds
c. mild hemophiliacs (factor VIII level of 5-25%) usually presents with spontaneous hemorrhages
d. there is no such thing as a female with hemophilia

A

5

To evaluate aa prolonged PT or PTT, the following test(s) is/are performed next
a. mixing studies
b. FXII, FXI, FIX and FVIII assays
c. platelet function analyzer
d. urea clot lysis assay

A

6

The protein involved in platelet production is
a. prostacyclin
b. thromboxane A1
c. thrombopoietin
d. thromboxane A2

C

7

the following statement describes a normal reactive bone marrow in a healthy patient presenting wiht thrombocytopenia secondary to drugs
a. decreased in megakaryocyte numbers
b. many megakaryocytes are vacuolated
c. increase in megakaryocyte numbers
d. there is relative lymphocytosis

C

8

The coagulation factor that is inhibited by Protein C and its co-factor Protein S is
a. Factor VII
b. activated factor VIII
c. factor V
d. activated factor IX

B

9

The following is consistent with a platelet type of bleeding
a. local measures are effective to stop the bleeding
b. bleeding may last for days
c. bleeding within the muscle is often
d. hemarthosis is common

A

10

The mechanism behind the thrombocytopenia in immune thrombocytopenic purpura
a. decreased megakaryocyte production in the bone marrow
b. increased platelet destruction in the peripheral blood
c. decreased megakaryocyte monocyte precursors in the bone marrow
d. increased thrombopoietin production

B

11

Thrombocytopenia associated with HIV infection is best characterized by
a. megakaryocytes in the bone marrow are infected
b. there is no improvement in platelet count with anti-viral drugs
c. there is complement deposition in the megakaryoblasts
d. ADAMTS13 levels are high

A

12

The following describes the disruption of platelet funtions in uremia
a. there is a marked increase in thromboxane A2 leading to a decrease in platelet aggregation
b. the accumulation of hydrophenolic acids lead to increase alpha 2 beta 3 activity
c. the cyclooxygenase pathway is markedly diminished
d. the accumulation of guanidinosuccinic acid leads to glycoprotein IIB/ IIIA dysfunction

D

13

The most profound hemostatic disorder due to cardiac surgery
a. platelet aggregation defects
b. anti-coagulant effect
c. platelet adhesion defects
d. anesthesia effect of the vitamin K dependent clotting proteins

A

14

Liver disease can impair hemostasis and cause bleeding due to
a. increased levels of intrinsic pathway inhibitor
b. dysfibrinogenemia
c. increased levels of anti-thrombin III
d. marked thrombocytosis

B

15

Hemophiliacs with recurrent bleeding who are multiply transfused will invariably develop factor VIII inhibitors. Which of the following best characterizes these inhibitors?
a. complement mediated
b. hepatitis related
c. immunoglobulin G
d. serum sickness

C

16

The primary problem in thrombotic thrombocytopenic purpura is
a. neurologic deficits
b. circulating large multimers of von Willebrand factors
c. immune mediated
d. platelet dysfunction

B

17

reason to temporarily defer a blood donor from donating blood
a. ear piercing within 6-12 months
b. major surgery 5 years ago
c. chemotherapy for non hodgkin's lymphomaa 5 years ago, patient in remission
d. history of treated venereal disease

A

18

Indication to irradiate blood
a. third degree relative blood donor
b. history of frequent allergic reactions to blood transfusion
c. history of febrile non hemolytic transfusion reactions
d. blood donor with history of asthma

A

19

These tests may be most informative in diagnosing paroxysmal nocturnal hemoglobinuria:
a. ham's and sucrose lysis test
b. immunophenotyping and FISH
c. erythropoietin assay and Coomb's test
d. chromosomal analysis

A

20

Mechanism of action of cyclosporine in aplastic anemia
a. reduces cytotoxic T cells
b. inhibits IL 2 production by T lymphocytes
c. modulates adverse reactions to ATG
d. stimulate production of erythropoietin

B

21

Most common cause of fatal transfusion reaction worldwide:
a. clerical error
b. transfusion related acute lung injury
c. congestive heart failure secondary to volume overload
d. febrile non hemolytic transfusion reaction

A

22

A 60 year old female who complains of easy fatigue and weakness is found to be moderately anemic with hemoglobin level of 90g/dl and ferritin at 8 ng/dl. How should the patient be best managed?
a. start IV iron dextran and overlap with oral ferrous sulfate for 4 months to replace iron stores
b. advise patient to refrain from alcoholic beverages and maintain healthy lifestyle through proper diet and adequate exercise
c. do bone marrow aspiration with biopsy to document iron deficiency and look for bone marrow infiltration
d. request for fecal occult blood test

D

23

Site of maximum iron absorption:
a. stomach
b. duodenum
c. distal ileum
d. colon

B

24

Microcytic, hypochromic cells with low serum iron and normal or increased bone marrow iron stores may be found in
a. thalassemia
b. iron deficiency anemia
c. anemia of chronic disease
d. chronic lead poisoning

C

25

Anemia of inflammation
a. increased serum ferritin, low transferrin, high serum iron
b. increased red cell destruction from activation of host factors
c. decreased TNF alpha
d. decreased absolute reticulocyte count

B

26

Most prevalent hemoglobinopathy in Southeast Asia:
a. Hb C
b. Hb D
c. Hb E
d. Hb S

C

27

Hallmark of the common forms of alpha thalassemia:
a. elevated Hgb A
b. elevated Hgb A2
c. elevated HgbF
d. low Hgb A2

B

28

Definitive management may be achieved through splenectomy:
a. hereditary spherocytosis
b. G6PD deficiency
c. thalassemia
d. sickle cell hemoglobinopathy

A

29

Response following parenteral vitamin B12 administration to a deficient patient:
a. increased plasma iron turn over
b. normal hemoglobin within 2 weeks
c. marrow begins to normalize within 72 hours
d. reticulocytosis within 1 week

D

30

The following drug is useful in multiple myeloma but not in lymphomas
a. prednisone
b. rituximab
c. thalidomide
d. doxorubicin

C

31

the following cell is clonal in Hodgkin's disease
a. B cell
b. T cell
c. natural killer cell
d. Reed Sternberg cell

D

32

The clonal cell in multiple myeloma is
a. bilobed nucleus with prominent eosinophilic nucleoli
b. large mononuclear cell, fine chromatin material with minimal cytoplasm
c. round cell with round indented nucleus and perinuclear clearing
d. small round cell with clumped chromatin material and minimal to moderate cytoplasm

C

33

The "B symptoms" of lymphomas include
a. pruritus
b. jaundice
c. weight loss
d. anorexia

C

34

the following is associated with relatively better prognosis in multiple myeloma:
a. monosomy 13
b. 13q
c. 11q
d. normal karyotype

C

35

In multiple myeloma, prognosis is best correlated with
a. CRP and B microglobulin
b. LDH and serum creatinine
c. ESR and LDH
d. serum calcium and LDDH

A

36

lymphomas and multiple myeloma are disorders of the following lineage
a. myeloid
b. lymphoid
c. unknown
d. stromal cells

B

37

acquired aplastic anemia appears to be caused largely by:
a. stem cell defect
b. stromal defect
c. immune-mediated
d. decrease in hematopoietic growth factors

C

38

The peripheral blood smear of patients with aplastic anemia shows
a. normocytosis
b. microcytosis
c. monocytosis
d. all of the above

A

39

The diagnosis of aplastic anemia should be questioned in the presence of
a. splenomegaly
b. increased mast cells in the marrow
c. normal marrow reticulin
d. macrocytosis

A

40

infection that has been implicated in the causation of aplastic anemia
a. tuberculosis
b. malaria
c. Ebstein-Barr virus
d. Coxsackie virus

C

41

Transfusion in aplastic anemia should be limited to prevent
a. sensitization to transplantation antigens
b. sensitization to blood antigens
c. CMV seroconversion
d. all of the above

D

42

The treatment of choice for sever aplastic anemia in a 25 year old patient is
a. supportive therapy
b. immunosuppressive therapy
c. massive blood transfusion
d. bone marrow / stem cell transplant

D

43

An inherited bone marrow failure state that results in aplastic anemia as well as skeletal abnormalities and renal dysfunction is
a. Fanconi's anemia
b. dyskeratosis congenita
c. Schwachmann-Diamond syndrome
d. Diamond-Blackfan syndrome

A

44

An inherited cause of bone marrow failure with the least tendency to progress to leukemia
a. Fanconi's anemia
b. dyskeratosis congenita
c. Schwachmann-Diamond syndrome
d. Diamond-Blackfan syndrome

B

45

Because of the possibility of gallstones, this procedure should be performed prior to splenectomy in a child with hemolytic anemia:
a. hepatitis profile
b. 2-D echocardiogram
c. bone marrow aspiration
d. hepatobiliary tree ultrasound

D

46

The currently recommended immunosuppressive regimen for sever aplastic anemia
a. cyclosporine
b. antithymocyte globulin
c. cyclosporine and antithymocyte globulin
d. cyclophosphamide

C

47

The finding of this cytogenetic abnormality may herald the clonal evolution in aplastic anemia
a. trisomy 7
b. monosomy 7
c. monosomy 8
d. inversion 16

B

48

Splenectomy offers a clinical cure in:
a. autoimmune hemolytic anemia
b. hereditary spherocytosis
c. thalassemia major
d. G6PD deficiency

B

49

The definitive diagnostic procedure for thalassemia is:
a. Coombs' test
b. osmotic fragility test
c. hemoglobin electrophoresis
d. Ham's test

C

50

In the presence of prolonged neonatal jaundice with exposure to naphthalene balls, one should consider:
a. G6PD deficiency
b. autoimmune hemolytic anemia
c. thalassemia major
d. neonatal hepatitis syndrome

A

51

this hemoglobin is markedly increased in beta thalassemia major:
a. Hb A1
b. Hb A2
c. Hb H
d. Hb F

D

52

The definitive diagnostic procedure for hereditary spherocytosis is:
a. Coombs' test
b. osmotic fragility test
c. Ham's test
d. hemoglobin electrophoresis

B

53

The aim of hypertransfusion and supertransfusion in thalassemia major is:
a. to increase the patient's iron stores
b. to increase the patient's serum iron
c. to improve the patient's anemia
d. to suppress erythropoiesis in the marrow

D

54

The mode of ineritance of hereditary spherocytosis is usually:
a. autosomal dominant
b. autosomal recessive
c. de novo mutation
d. x-linked

A

55

The mode of inheritance of beta thalassemia major is:
a. autosomal dominant
b. autosomal recessive
c. de novo mutation
d. x-linked

B

56

A 4 year old male child has a hemolytic anemia characterized by frequent transfusions every 2 months, huge hepatosplenomegaly, craniofacial changes, stunting of growth. He most probably has:
a. silent carrier
b. thalassemia trait
c. thalassemia intermedia
d. thalassemia major

D

57

Failure to give oral folic acid to patients with hemolytic anemia may lead to:
a. aplastic crisis
b. hemolytic crisis
c. megaloblastic crisis
d. gallstones

C

58

A possible cure for thalasseia major may be achieved by:
a. supertransfusion
b. iron chelation
c. stem cell transplantation
d. splenectomy

C

59

The 4 allele deletion in alpha thalassemia that is incompatible with life is:
a. silent carrier
b. thalassemia trait
c. hemoglobin H disease
d. hydrops fetalis

D

60

Precipitates of denatured hemoglobin due to oxidant damage seen in the reticulocyte stain of red cells in G6PD deficiency are called:
a. Howell-Jolly bodies
b. Heinz bodies
d. Golf ball inclusons
d. Pappenheimer bodies

D

61

At birth, fetal red cells contain 53 to 95% what:
a. Hb A1
b. Hb A2
c. Hb H
d. Hb F

D

62

The only indication for fresh whole blood is:
a. hemodialysis
b. hypovolemic shock
c. exchange transfusion
d. uremia

C

63

Neonates who receive directed blood donation from first degree relatives are at risk for developing
a. acute hemolytic reaction
b. transfusion-associated GVHD
c. febrile reaction
d. allergic reaction

B

64

The following is not an indication for exchange transfusion in neonates
a. Rh incompatibility
b. iron deficiency anemia
c. ABO incompatibility
d. sepsis

B

65

Choice of blood for exchange transfusion in ABO incompatibility:
a. type O Rh positive fresh whole blood
b. type-specific Rh positive fresh whole blood
c. type O Rh positive PRBC
d. type-specific Rh positive PRBC

A

66

An ABO type on a patient gives the following agglutination reactions:
patient cells reacted with: anti-A 4+, anti-B 4+
patient serum reacted with: A cells (-), B cells (-)
What is the patient's blood type?
a. O
b. A
c. B
d. AB

D

67

Leukocyte-reduction filters can do all of the following except
a. reduce the risk of CMV infection
b. prevent or reduce the risk of HLA alloimmunization
c. prevent febrile, nonhemolytic transfusion reactions
d. prevent transfusion associated graft versus host disease (TA-GVHD)

D

68

A 26 year old type B Rh-negative female patient requires a transfusion. No group B Rh-negative donor units are available. Which should be chosen for transfusion?
a. Group B Rh-positive RBCs
b. Group O Rh-negative RBCs
c. Group AB Rh-negative RBCs
d. Group A Rh-negative RBCs

B

69

Apheresis can be used to collect all of the following except:
a. leukocytes
b. macrophages
c. hematopoietic progenitor cells
d. platelets

B

70

Transfused plasma resulting in immediate erythema, itching, and hives best typify the following transfusion reaction
a. immediate hemolytic transfusion reaction (IHTR)
b. delayed hemolytic transfusion reaction (DHTR)
c. allergic reaction
d. anaphylactoid reaction

C

71

When a suspected hemolytic reaction occurs, the first thing to do is:
a. slow the transfusion rate and call the physician
b. administer medication to stop the reaction
c. stop the transfusion but keep the intravenous line open
d. first inform the laboratory to begin an investigation

C

72

Pre-transfusion irradiation of all blood products from 1st degree relatives is done to prevent
a. febrile non-hemolytic transfusion reaction (FNHTR)
b. transfusion associated graft versus host disease (TA-GVHD)
c. hemolytic transfusion reaction (HTR)
d. anaphylactic reaction

B

73

The following are complications of hyperleukocytosis except:
a. pulmonary edema
b. stroke
c. metabolic acidosis
d. hypercalcemia

D

74

The peak age for ALL is
a. 2 to 5 years of age
b. 0 to 1 year
c. 10 to 14 years of age
d. 7 to 10 years of age

A

75

Which of the following is true in the pediatric age group:
a. the frequency of chronic and acute leukemias in children are equal
b. the frequency of AML is approximately 4:1 compared to ALL
c. the frequency of ALL is approximately 4:1 compared to AML
d. JMML is te most frequent leukemia in children

C

76

The following are predisposing factors for ALL except:
a. Down syndrome
b. epilepsy
c. Wiskott Aldrich syndrome
d. ionizing radiation

B

77

The following is true regarding the treatment of ALL in children
a. bone marrow transplant is recommended for all patients in first remission
b. remission is defined as

C

78

The prognosis of AML depends strongly on
a. age of the patient at presentation
b. presence of CNS involvement
c. cytogenetic abnormalities of the leukemia clone
d. white blood cell count at presentation

C

79

Parenteral iron is given in the following condition
a. rapid increase in hemoglobin is desired
b. malabsorption syndrome exists
c. the patient requests for it
d. rapid utilization of iron by the body

B

80

when a male adult develops iron deficiency anemia, blood loss should always be suspected because
a. iron loss is very minimal in males
b. cancer is frequenyt in males
c. iron utilization becomes deficient as age progresses
d. bowel disturbances are common

A

81

A donor who has ingested aspirin on the day of donation is temporarily deffered because
a. he has fever
b. he is infected
c. aspirin alters the quality of platelets
d. aspirin causes a hypercoagulable state

C

82

this is a cause for permanent deferral of a blood donor
a. upper respiratory infection
b. hepatitis B
c. fever
d. ingestion of contraceptive pill

B

83

What is the purpose of doing a crossmatch before transfusion?
a. to detect autoantibodies present in the recipient
b. to prevent alloimmunization
c. to detect alloantibodies in the recipient
d. to avoid sensitization of the recipient

C

84

What is the reason why an Rh negative recipient should not receive an Rh positive blood?
a. presence of incompatibility
b. prevention of alloimmunization to D antigen
c. prevention of immediate post transfusion reaction
d. preventon of infection

B

85

The most frequent cause of a febrile non-hemolytic transfusion reaction is
a. IgG protein in the transfused blood
b. ABO incompatibility
c. presence of WBC and cytokines in the transfused blood
d. presence of malarial parasite in the transfused blood

C

86

the "window period" in the testing for HIV in blood donors represents
a. the time from the infection of the donor up to the time that the antibody is detected
b. the duration of the HIV laboratory test
c. the incubation period of the reagents
d. the time when the HIV symptoms became manifest

A

87

Thawed fresh frozen plasma (FFP) cannot be refrozen because
a. it is potentially infected
b. it has lost the activity of most of the coagulation factors
c. the plastic bag is already brittle
d. cytokines are released in the process of thawing

B

88

Cirrhosis of the liver can result in thrombosis because
a. the liver releases large amounts of coagulation factors
b. the liver cannot synthesize coagulation factors
c. hepatic clearance of activated coagulation factors is poor
d. toxic substances not metabolized by the liver cause damage in blood vessles

C

89

Elderly patients who develop deep vein thrombosis should be worked up for
a. vasculitis
b. malignancy
c. atherosclerosis
d. liver cirrhosis

B

90

The most serious complicaton of deep vein thrombosis is
a. myocardial infarction
b. cerebrovascular thrombosis
c. peripheral vascular disease
d. pulmonary embolism

D

91

The initiating event in the formation of arterial thrombus is
a. activation of factor X
b. adherence of platelets to damaged blood vessels promoting aggregation
c. activation of anti-thrombin III
d. increased synthesis of prothrombin

B

92

Important "sanctuary" sites for acute lypmhoblastic leukemia are
a. liver and spleen
b. lymph nodes and CNS
c. testes and CNS
d. lymph nodes and liver

C

93

Rouleaux formation is seen in:
a. afibrinogenemia
b. paraproteinemia
c. sickle cell anemia
d. autoimmune hemolytic anemia

B

94

Microcytosis is best defined as:
a. high RDW
b. low MCV
c. high MCH
d. low MCHC

B

95

A neoplasm of immunosecreting terminally differentiated B-lymphocytes is:
a. B-cell chronic lymphocytic leukemia
b. B-cell acute lymphocytic leukemia
c. multiple myeloma
d. chronic myelogenous leukemia

C

96

The most common cytogenetic abnormality in myelodysplastic syndrome (MDS) involves chromosome #:
a. 5
b. 7
c. 8
d. 20

A

97

A more favorable prognosis is associated with
a. therapy-related MDS
b. 5q syndrome
c. MDS with fibrosis
d. hypoplastic MDS

B

98

The key organ in the pathophysiology of chronic ITP is:
a. bone marrow
b. liver
c. spleen
d. kidneys

C

99

The most common type of leukemia associated with disseminated intravascular coagulation is:
a. acute promyelocytic leukemia
b. acute monocytic leukemia
c. erythroleukemia
d. acute megakaryocytic leukemia

A

100

During the first week of treatment with oral iron, which laboratory parameter should be taken?
a. hemoglobin
b. hematocrit
c. reticulocyte count
d. red cell indices

C