EXAM 1 Flashcards by Vanessa Beltran

The process of formation and development of blood cells is termed:
a. Hematopoiesis
b. Hematemesis
c. Hematocytometry
d. Hematorrhea

a. Hematopoiesis

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During the second trimester of fetal development, the primary site of blood cell production is the:
a. Bone marrow
b. Spleen
c. Lymph nodes
d. Liver

d. Liver

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Which one of the following organs is responsible for the maturation of T lymphocytes and regulation of their expression of CD4 and CD8?
a. Spleen
b. Liver
c. Thymus
d. Bone marrow

c. Thymus

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The best source of active bone marrow from a 20 year old would be:
a. Iliac crest
b. Femur
c. Distal radius
d. Tibia

a. Iliac Crest

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Physiologic programmed cell death is termed:
a. Angiogenesis
b. Apoptosis
c. Aneurysm
d. Apohematics

b. Apoptosis

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Which organ is the site of sequestration of platelets?
a. Liver
b. Thymus
c. Spleen
d. Bone marrow

c. Spleen

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Which one of the following morphologic changes occurs during normal blood cell maturation?
a. Increase in cell diameter
b. Development of cytoplasm basophilia
c. Condensation of nuclear chromatin
d. Appearance of nucleoli

c. Condensation of nuclear chromatin

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Which one of the following cells is a product of the common lymphoid progenitor?
a. Megakaryocyte
b. T lymphocyte
c. Erythrocyte
d. Granulocyte

b. T Lymphocyte

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What growth factor is produced in the kidneys and is used to treat anemia associated with kidney disease?
a. EPO
b. TPO
c. G-CSF
d. KIT ligand

a. EPO

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Which one of the following cytokines is required very early in the differentiation of a hematopoietic stem cell?
a. IL-2
b. IL-8
c. EPO
d. FLT3 ligand

d. FLT3 ligand

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When a patient has severe anemia and the bone marrow is unable to effectively produce red blood cells to meet the increased demand, one of the body’s responses is:
a. Extramedullary hematopoiesis in the liver and spleen
b. Decreased production of erythropoietin by the kidney
c. Increased apoptosis of erythrocyte progenitor cells
d. Increased proportion of yellow marrow in the long bones

a. Extramedullary hematopoiesis in the liver and spleen

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Hematopoietic stem cells produce all lineages of blood cells in sufficient quantities over the lifetime of an individual because they:
a. Are unipotent
b. Have the ability of self-renewal by asymmetric division
c. Are present in large numbers in the bone marrow niches
d. Have a low mitotic potential in response to growth factors

b. Have the ability to self-renewal by asymmetric division

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Which of the following is an erythroid progenitor?
a. Pronormoblast
b. Reticulocyte
c. CFU-E
d. Orthochromic normoblast

c. CFU-E

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Which of the following is the most mature normoblast?
a. Orthochromic normoblast
b. Basophilic normoblast
c. Pronormoblast
d. Polychromatic normoblast

a. Orthochromic normoblast

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What erythroid precursor can be described as follows: The cell is of medium size compared with other normoblasts, with an N:C ratio of nearly 1:1. The nuclear chromatin is condensed and chunky throughout the nucleus. No nucleoli are seen. The cytoplasm is gray-blue.
a. Reticulocyte
b. Pronormoblast
c. Orthochromic normoblast
d. Polychromatic normoblast

d. Polychromatic normoblast

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At which normoblastic stage does globin production begin?
a. Orthochromic normoblast
b. Pronormoblast
c. Polychromatic normoblast
d. Basophilic normoblast

b. Pronormoblast

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Hypoxia stimulates RBC production by:
a. Inducing more pluripotent stem cells into the erythroid lineage
b. Stimulating EPO production by the kidney
c. Increasing the number of RBC mitoses
d. Stimulating the production of fibronectin by macrophages of the bone marrow

b. Stimulating EPO production by the kidney

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Erythropoietin can increase the production of RBCS by:
a. Promoting apoptosis of erythroid progenitors
b. Decreasing intravascular hemolysis
c. Increasing EPO receptor sites
d. Promoting early release of reticulocytes from bone marrow

d. Promoting early release of reticulocytes from BM

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In the bone marrow, erythroid precursors are located:
a. Surrounding macrophages in erythroid islands
b. Adjacent to megakaryocytes along the adventitial cell lining
c. Surrounding fat cells in apoptotic islands
d. In the center of the hematopoietic cords

a. Surrounding macrophages in erythroid islands

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Which of the following determines the timing of egress of RBCs from the bone marrow?
a. Stromal cells decrease production of adhesive molecules over time as RBCs mature.
b. Endothelial cells of the venous sinus form pores at specified intervals of time, allowing egress of free cells.
c. Periodic apoptosis of pronormoblasts in the marrow cords occurs.
d. Maturing normoblasts slowly lose receptors for adhesive molecules that bind them to stromal cells.

d. Maturing normoblasts slowly lose receptors for adhesive molecules that bind them to stromal cells

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What single feature of normal RBCs is most responsible for limiting their life span?
a. Loss of the nucleus
b. Increased flexibility of the cell membrane
c. Reduction of hemoglobin iron
d. Loss of mitochondria

a. Loss of nucleus

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Extravascular hemolysis occurs when:
a. RBCs are mechanically ruptured
b. RBCs extravasate from blood vessels into the tissues
c. Splenic macrophages ingest senescent RBCs
d. RBCs are trapped in blood clots outside the blood vessels

c. Splenic macrophages ingest senescent RBCs

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Which RBC process does not require energy?
a. Cytoskeletal protein deformability
b. Maintaining cytoplasm cationic electrochemical gradients
c. Oxygen transport
d. Preventing the peroxidation of proteins and lipids

c. Oxygen transport

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What pathway anaerobically generates energy in the form of ATP?
a. 2,3-BPG pathway
b. Embden-Meyerhof pathway
c. Hexose monophosphate pathway
d. Rapoport-Luebering pathway

b. Embden-Meyerhof pathway

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3. Which is true concerning 2,3-BPG? a. Enhances O2 release from hemoglobin b. Source of RBC ATP c. Source of RBC glucose d. The least abundant of RBC organophosphates

a. Enhances O2 release from hemoglobin

4. What hexose-monophosphate shunt products participate in the detoxification of peroxides? a. 2,3-BPG and pyruvic acid b. ATP and lactic acid c. NADPH and reduced glutathione d. Pyruvic and lactic acid

c. NADPH and reduced glutathione

5. Which of the following helps maintain RBC shape? a. Cytoskeletal proteins b. Glycocalyx c. GPI anchor d. Membrane phospholipids

a. Cytoskeletal proteins

6. The glycolipids of the RBC membrane: a. Attach the cytoskeleton to the lipid layer b. Carry RBC antigens c. Constitute ion channels d. Provide flexibility

b. Carry RBC antigens

7. RBC membranes block passage of most large molecules, such as proteins, but allow passage of small molecules such as the cations Na+, K+, and Ca2+. What is the term for this membrane property? a. Deformable b. Flexible c. Intangible d. Semipermeable

d. Semipermeable

8. RBC membrane phospholipids are arranged: a. In a hexagonal lattice b. In chains beneath a protein cytoskeleton c. In two layers whose composition is asymmetric d. So that hydrophobic portions are facing the plasma

c. In 2 layers whose composition is asymmetric

9. RBC membrane cholesterol is replenished from the: a. Cytoplasm b. EMB pathway c. Mitochondria d. Plasma

d. Plasma

10. Hemoglobin iron may become oxidized to Fe3+ by several pathologic mechanisms. What portion of the Embden-Meyerhof pathway reduces iron to Fe2+? a. Hexose monophosphate pathway b. Methemoglobin reductase pathway c. Rapoport-Luebering pathway d. 2,3-BPG shunt

b. Methemoglobin reductase pathway

11. Which of the following is an example of a transmembrane or integral membrane protein? a. Actin b. Ankyrin c. Glycophorin A d. Spectrin

c. Glycophorin A

12. Abnormalities in the horizontal and vertical linkages of the transmembrane and cytoskeletal RBC membrane proteins may be seen as: a. Enzyme pathway deficiencies b. Methemoglobin increase c. Reduced hemoglobin content d. Shape changes

d. Shape changes

1. A hemoglobin molecule is composed of: a. One heme molecule and four globin chains b. Ferrous iron, protoporphyrin IX, and a globin chain c. Protoporphyrin IX and four globin chains d. Four heme molecules and four globin chains

d. 4 heme molecules and 4 globin chains

2. Normal adult Hb A contains which polypeptide chains? a. α and β b. α and δ c. α and γ d. α and ε

a. alpha beta

3. A key rate-limiting step in heme synthesis is suppression of: a. Aminolevulinate synthase b. Carbonic anhydrase c. Protoporphyrin IX reductase d. Glucose-6-phosphate dehydrogenase

a. Aminolevulinate synthase ALA

4. Which of the following forms of hemoglobin molecule has the lowest affinity for oxygen? a. Tense b. Relaxed

a. Tense

5. Using the normal hemoglobin-oxygen dissociation curve in Figure 7.7 for reference, predict the position of the curve when there is a decrease in pH. a. Shifted to the right of normal with decreased oxygen affinity b. Shifted to the left of normal with increased oxygen affinity c. Shifted to the right of normal with increased oxygen affinity d. Shifted to the left of normal with decreased oxygen affinity

a. Shift to the Right --> with decreased oxygen affinity

6. The predominant hemoglobin found in a healthy newborn is: a. Gower-1 b. Gower-2 c. A d. F

d. F

7. What is the normal distribution of hemoglobins in healthy adults? a. 80% to 90% Hb A, 5% to 10% Hb A2, 1% to 5% Hb F b. 80% to 90% Hb A2, 5% to 10% Hb A, 1% to 5% Hb F c. >95% Hb A, <3.5% Hb A2, 1% to 2% Hb F d. >90% Hb A, 5% Hb F, <5% Hb A2

c. >95% Hb A, <3.5% Hb A2, 1% to 2% Hb F

8. Which of the following is a description of the structure of oxidized hemoglobin? a. Hemoglobin carrying oxygen on heme; synonymous with oxygenated hemoglobin b. Hemoglobin with iron in the ferric state (methemoglobin) and not able to carry oxygen c. Hemoglobin with iron in the ferric state so that carbon dioxide replaces oxygen in the heme structure d. Hemoglobin carrying carbon monoxide; hence oxidized refers to the single oxygen

b. Hemoglobin with iron in the ferric state (methemoglobin) and not able to carry oxygen

9. In the quaternary structure of hemoglobin, the globin chains associate into: a. α Tetramers in some cells and β tetramers in others b. A mixture of α tetramers and β tetramers c. α Dimers and β dimers d. Two αβ dimers

d. 2 alphabeta dimers

10. How are the globin chain genes arranged? a. With α genes and β genes on the same chromosome, including two α genes and two β genes b. With α genes and β genes on separate chromosomes, including two α genes on one chromosome and one β gene on a different chromosome c. With α genes and β genes on the same chromosome, including four α genes and four β genes d. With α genes and β genes on separate chromosomes, including four α genes on one chromosome and two β genes on a different chromosome

11. The nature of the interaction between 2,3-BPG and hemoglobin is that 2,3-BPG: a. Binds to the heme moiety, blocking the binding of oxygen b. Binds simultaneously with oxygen to ensure that it stays bound until it reaches the tissues, when both molecules are released from hemoglobin c. Binds to amino acids of the globin chain, contributing to a conformational change that inhibits oxygen from binding to heme d. Oxidizes hemoglobin iron, diminishing oxygen binding and promoting oxygen delivery to the tissues

1. Iron is transported in plasma via: a. Hemosiderin b. Ferritin c. Transferrin d. Hemoglobin

2. What is the major metabolically available storage form of iron in the body? a. Hemosiderin b. Ferritin c. Transferrin d. Hemoglobin

b. Ferritin

3. The total iron-binding capacity (TIBC) of the serum is an indirect measure of which iron-related protein? a. Hemosiderin b. Ferritin c. Transferrin d. Haptoglobin

c. Transferrin

4. For a patient with screening iron study values that are equivocal for iron deficiency, which of the following tests would be most helpful in determining whether iron deficiency is present or not? a. Zinc protoporphyrin b. Peripheral blood iron stain c. Soluble transferrin receptor d. Mean cell hemoglobin

c. Soluble transferrin receptor

5. What membrane-associated protein in enterocytes transports iron from the intestinal lumen into the enterocyte? a. DMT1 b. Ferroportin c. Transferrin d. Hephaestin

a. DMT1

6. Iron is transported out of macrophages, hepatocytes, and enterocytes by what membrane protein? a. Transferrin b. Ferroportin c. DMT1 d. Ferrochelatase

b. Ferroportin

7. Following are several of the many steps in the process from absorption and transport of iron to incorporation into heme. Place them in proper order. i. Transferrin picks up ferric iron. ii. Iron is transferred to the mitochondria. iii. DMT1 transports ferrous iron into the enterocyte. iv. Ferroportin transports iron from enterocyte to plasma. v. The transferrin receptor transports iron into the cell. a. v, iv, i, ii, iii b. iii, ii, iv, i, v c. ii, i, v, iii, iv d. iii, iv, i, v, ii

d. iii, iv, i, v, ii

8. What is the fate of the transferrin receptor when it has completed its role in the delivery of iron into a cell? a. It is recycled to the plasma membrane and released into the plasma. b. It is recycled to the plasma membrane, where it can bind its ligand again. c. It is catabolized and the amino acids are returned to the metabolic pool. d. It is retained in the endosome for the life span of the cell.

9. The transfer of iron from the enterocyte into the plasma is REGULATED by: a. Transferrin b. Ferroportin c. Hephaestin d. Hepcidin

13. Developing erythroblasts in the bone marrow affect the supply of body iron, both absorption and recycling, by secreting which of the following hormones? a. Erythropoietin b. Erythroferrone c. Hepcidin d. Haptoglobin

14. Which of the following cells critical to iron trafficking in the body does NOT possess ferroportin? a. Erythroblasts b. Enterocytes c. Hepatocytes d. Macrophages

15. Which of the following plays a role in iron sensing so as to adjust iron absorption and recycling? a. Hepcidin b. Transferrin receptor 2 c. Ferroportin d. Divalent metal transporter 1

1. Which of the following patients would be considered anemic with a hemoglobin value of 14.5 g/dL? Refer to reference intervals inside the front cover of this text. a. An adult man b. An adult woman c. A newborn boy d. A 10-year-old girl

c. Newborn boy

2. Anemia most commonly presents with which one of the following set of symptoms: a. Abdominal pain (from splenomegaly) b. Shortness of breath and fatigue c. Chills and fever d. Jaundice and enlarged lymph nodes

3. Which of the following are important to consider in the patient’s history when investigating the cause of an anemia? a. Diet and medications b. Occupation, hobbies, and travel c. Bleeding episodes in the patient or in his or her family members d. All of the above

d. All of the above

4. Which one of the following is reduced as an adaptation to long-standing anemia? a. Heart rate b. Respiratory rate c. Oxygen affinity of hemoglobin d. Volume of blood ejected from the heart with each contraction

c. Oxygen affinity of Hgb

5. An autoimmune reaction destroys the hematopoietic stem cells in the bone marrow of a young adult patient, and the amount of active bone marrow, including erythroid precursors, is diminished. Erythroid precursors that are present are normal in appearance, but there are too few to meet the demand for circulating red blood cells, and anemia develops. The reticulocyte count is low. The mechanism of the anemia would be described as: a. Effective erythropoiesis b. Ineffective erythropoiesis c. Insufficient erythropoiesis

c. Insufficient

6. What are the initial laboratory tests that are performed for the diagnosis of anemia? a. CBC, iron studies, and reticulocyte count b. CBC, reticulocyte count, and peripheral blood film examination c. Reticulocyte count and serum iron, vitamin B12, and folate assays d. Bone marrow study, iron studies, and peripheral blood film examination

b. CBC, RETIC, PBS examination

7. An increase in which one of the following suggests a shortened life span of RBCs and hemolytic anemia? a. Hemoglobin concentration b. Hematocrit c. Reticulocyte count d. Red cell distribution width

c. RETIC count

8. Which of the following is detectable only by examination of a peripheral blood film? a. Microcytosis b. Anisocytosis c. Hypochromia d. Poikilocytosis

d. Poikilocytosis (abnormal shape ONLY microscopically)

9. Schistocytes, ovalocytes, and acanthocytes are examples of abnormal changes in RBC: a. Volume b. Shape c. Inclusions d. Hemoglobin concentration

b. Shape

10. Refer to Figure 16.3 to determine which one of the following conditions would be included in the differential diagnosis of an anemic adult patient with an absolute reticulocyte count of 20 × 109/L and an MCV of 65 fL. a. Aplastic anemia b. Sickle cell anemia c. Iron deficiency d. Folate deficiency

c. Iron deficiency

11. Which one of the following conditions would be included in the differential diagnosis of an anemic adult patient with an MCV of 125 fL and an RDW of 20% (reference interval 11.5% to 14.5%)? Refer to Table 16.4. a. Aplastic anemia b. Sickle cell anemia c. Iron deficiency d. Vitamin B12 deficiency

d. Vit B 12 def

1. The mother of a 4-month-old infant who is being breastfed sees her physician for a routine postpartum visit. She expresses concern that she may be experiencing postpartum depression because she does not seem to have any energy. Although the physician is sympathetic to the patient’s concern, she orders a CBC and iron studies seeking an organic explanation for the patient’s symptoms. The results are as follows: CBC: all results within reference intervals except the RDW, which was 15%. Serum iron: decreased TIBC: increased % transferrin saturation: decreased Serum ferritin: decreased Correlate the patient’s laboratory and clinical findings. What can you conclude? a. The results of the iron studies reveal findings consistent with a thalassemia that was apparently previously undiagnosed. b. The patient is in stage 2 of iron deficiency, before frank anemia develops. c. The results of the iron studies are inconsistent with the CBC results, and a laboratory error should be suspected. d. There is no evidence of a hematologic explanation for the patient’s symptoms.

2. A bone marrow biopsy was performed as part of the cancer staging protocol for a patient with Hodgkin lymphoma. Although no evidence of spread of the tumor was apparent in the bone marrow, other abnormal findings were noted, including a slightly elevated myeloid-to-erythroid ratio. WBC and RBC morphology appeared normal, however. The Prussian blue stain showed abundant stainable iron in the marrow macrophages. The patient’s CBC revealed a hemoglobin of 10.8 g/dL, but RBC indices were within reference intervals. RBC morphology was unremarkable. These findings are consistent with: a. Anemia of chronic inflammation b. Sideroblastic anemia c. Thalassemia d. Iron deficiency anemia

3. Predict the iron study results for the patient with Hodgkin lymphoma described in question 2. Serum Iron Level TIBC % Transferrin Saturation Serum Ferritin Level a. Decreased Increased Decreased Decreased b. Increased Normal Increased Normal c. Increased Increased Normal Increased d. Decreased Decreased Normal Normal

5. In men and postmenopausal women whose diets are adequate, iron deficiency anemia most often results from: a. Increased need associated with aging b. Impaired absorption in the gastric mucosa c. Chronic gastrointestinal bleeding d. Diminished resistance to hookworm infections

6. Which one of the following individuals is at greatest risk for the development of iron deficiency anemia? a. A 15-year-old boy who eats mainly junk food b. A 37-year-old woman who has never been pregnant and has amenorrhea c. A 63-year-old man with reactivation of tuberculosis from his childhood d. A 40-year-old man who lost blood during surgery to repair a fractured leg

4. A 35-year-old white woman went to her physician complaining of headaches, dizziness, and nausea. The headaches had been increasing in severity over the past 6 months. This was coincident with her move into an older house built about 1900. She had been renovating the house, including stripping paint from the woodwork. Her CBC results showed a mild hypochromic, microcytic anemia, with polychromasia and basophilic stippling noted. Which of the following tests would be most useful in confirming the cause of her anemia? a. Serum lead level b. Serum iron level and TIBC c. Absolute reticulocyte count d. Prussian blue staining of the bone marrow to detect iron stores in macrophages

7. Which of the following individuals is at the greatest risk for the development of anemia of chronic inflammation? a. A 15-year-old girl with asthma b. A 40-year-old woman with type 2 diabetes mellitus c. A 65-year-old man with hypertension d. A 30-year-old man with severe rheumatoid arthritis

8. In what situation will increased levels of free erythrocyte protoporphyrin be present? a. Loss of function mutation to one of the enzymes in the heme synthesis pathway b. A mutation that prevents heme attachment to globin so that protoporphyrin remains free c. Any condition that prevents iron incorporation into protoporphyrin IX d. When red blood cells lyse, freeing their contents into the plasma

9. In the pathogenesis of the anemia of chronic inflammation, hepcidin levels: a. Decrease during inflammation and reduce iron absorption from enterocytes b. Increase during inflammation and reduce iron absorption from enterocytes c. Increase during inflammation and increase iron absorption from enterocytes d. Decrease during inflammation and increase iron absorption from enterocytes

10. Sideroblastic anemias result from: a. Sequestration of iron in hepatocytes b. Inability to incorporate heme into apohemoglobin c. Sequestration of iron in myeloblasts d. Failure to incorporate iron into protoporphyrin IX

EXAM 1 Flashcards

(78 cards)