Hematology

Question 1

A 68-year-old man comes to the physician complaining of fatigue for the last several weeks. He has been feeling dizzy and SOB when climbing the stairs. He has not visited a physician in years b/c he has “always felt healthy.” He has no paresthesia, cognitive impairment, joint pains, or abnormal bleeding episodes. Temp is 37, P is 96, respirations 14, and BP 144/88. Physical examination shows conjunctival pallor. The neck is non-tender, and no mass is palpated. Oropharyngeal examination reveals an enlarged, erythematous tongue; no gingival pigmentation is noted. Labs show Hgb 9.9. A stool guaiac test is positive. which of the following is the likely pathophysiology of this patient’s condition?
Overproduction of cytokines
Impaired heme synthesis due to enzyme inhibition
Destruction of myeloid stem cells
Impaired heme synthesis due to decreased substrate availability
defective globin synthesis

Answer 1

Impaired heme synthesis due to decreased substrate availability

Question 2

_____ anemia is the most common type of anemia.

Answer 2

Iron deficiency

Question 3

Serum iron levels are (increased/decreased) in iron deficiency.

Answer 3

decreased

Question 4

(Organ system losing iron) ___ is the most common cause of iron deficiency anemia in the elderly in the western world.

Answer 4

Gastrointestinal loss

Question 5

Chronic iron deficiency leads to (microcytic/macrocytic/normocytic) anemia

Answer 5

microcytic

Question 6

_____ is a manifestation of iron deficiency anemia described as spooning of the nails.

Answer 6

Koilonychia

Question 7

Variation in red blood cell size seen in iron deficiency is known as _____.

Answer 7

anisocytosis

Question 8

Variation in red blood cell shape seen in iron deficiency anemia is know as _____.

Answer 8

poikilocytosis

Question 9

TIBC is (increased/decreased) in iron deficiency anemia.

Answer 9

increased

Question 10

Serum ferritin levels are (increased/decreased) in iron deficiency anemia.

Answer 10

decreased

Question 11

Iron deficiency anemia seen in men over the age of 50yrs in the US classically raises suspicion for ____ cancer.

Answer 11

colon

Question 12

_____ is the most common cause of iron deficiency anemia worldwide.

Answer 12

Nutritional deficiency

Question 13

Iron deficiency anemia presents with (increased/decrease/normal) RCW.

Answer 13

increased

Question 14

_______ is the most common side effect of ferrous sulfate supplementation.

Answer 14

Constipation

Question 15

_____ is a form of iron deficiency anemia that presents with a triad of iron deficiency anemia, esophageal webs and dysphagia.

Answer 15

Plummer-Vinson syndrome

Question 16

Microcytosis and (hypochromia/hyperchromia) are common findings on a peripheral blood smear in iron deficiency anemia.

Answer 16

hypochromia

Question 17

The lack of iron in iron deficiency anemia decreases the synthesis of (heme/globin), thereby decreasing hgb levels.

Answer 17

Heme

Question 18

Plummer-Vinson syndrome, presenting as a triad of iron deficiency anemia, esophageal webs, and dysphagia could progress to _____ of the esophagus.

Answer 18

squamous cell carcinoma

Question 19

_____ is a manifestation of iron deficiency anemia described as the consumption of non-food substances.

Answer 19

Pica

Question 20

Hemophilia B follows a(n) _____ genetic inheritance pattern.

Answer 20

X-linked recessive

Question 21

Hemophilia A follows a(n) _____ genetic inheritance pattern.

Answer 21

X-linked recessive

Question 22

Hemophilia B is a blood clotting disorder that is due to a deficiency in a factor _____.

Answer 22

IX

Question 23

The (intrinsic/extrinsic) coagulation pathway is defective in hemophilia A.

Answer 23

intrinsic

Question 24

PTT (increases/decreases) _____in hemophilia B.

Answer 24

increases

Question 25

PT (increases/decreases/doesn't change) in hemophilia B.

Answer 25

doesn't change

Question 26

Prothrombin time (increases/decreases/doesn't change) in hemophilia A.

Answer 26

doesn't change

Question 27

_____ is the treatment for hemophilia B.

Answer 27

Factor IX concentrate

Question 28

Partial thromboplastin time (increases/decrease) in hemophilia A.

Answer 28

increases

Question 29

_____ is a macrohemorrhage that occurs in hemophilia A or B and involves bleeding into joints.

Answer 29

Hemarthrosis

Question 29

Hemophilia A is a coagulation disorder that involves a genetic deficiency of _____.

Answer 29

factor VIII

Question 30

The bleeding time is (increased/normal) in patients with vitamin K deficiency.

Answer 30

normal

Question 31

Warfarin (stimulates/inhibits) vitamin K epoxide reductase and causes vitamin K deficiency.

Answer 31

inhibits

Question 32

Partial thromboplastin time (increases/does not change) in vitamin K deficiency.

Answer 32

increases

Question 33

Vitamin K deficiency will lead to a decreased activity in factors II,II, IX, X and factors C and factor ___.

Answer 33

S

Question 34

Prothrombin time (increases/does not change) in vitamin K deficiency.

Answer 34

increases

Question 35

Vitamin K deficiency bleeding in the newborn is prevented by _____.

Answer 35

prophylactic vitamin K injection

Question 36

_____ is a condition characterized by bleeding in a newborn due to immature liver function.

Answer 36

Vitamin K deficiency bleeding (hemorrhagic disease of the newborn)

Question 37

Vitamin _____ deficiency can be caused by medications like warfarin, anticonvulsants like phenytoin, and antibiotics.

Answer 37

K

Question 38

Vitamin K deficiency causes signs and symptoms of bleeding that is related to (platelet inhibition/coagulation pathway defect), such as easy bruising.

Answer 38

coagulation pathway defect

Question 39

Serum iron is (increased/decreased/unchanged) in anemia of chronic disease.

Answer 39

decreased

Question 40

Anemia of chronic disease is associated with autoimmune disorders such as _____.

Answer 40

systemic lupus erythematosus and rheumatoid arthritis

Question 41

Chronic inflammation, as see with anemia of chronic disease, increases the levels of _____, an acute phase reactant released by the liver that binds to ferroportin, thereby inhibiting iron transport.

Answer 41

hepcidin

Question 42

_____ is a type of anemia typically associated with chronic inflammation or cancer.

Answer 42

Anemia of chronic disease

Question 43

_____ is a nonhemolytic anemia due to chronic inflammation/disease that can become microcytic in its later stages.

Answer 43

Anemia of chronic disease

Question 44

_____ can be used to treat anemia of chronic disease associated with chronic renal failure.

Answer 44

Erythropoietin

Question 45

Ferritin levels are (increased/decreased/unchanged) in anemia of chronic disease.

Answer 45

increased

Question 46

TIBC is (increased/decreased/unchanged) in anemia of chronic disease.

Answer 46

decreased

Question 47

Individuals that have the sickle cell trait have a resistance to the mosquito borne infection _____.

Answer 47

malaria

Question 48

______ syndrome is a painful vaso-occlusive crisis seen in sickle-cell disease that involves severe chest pain and shortness of breath due to occlusion of the pulmonary microcirculation.

Answer 48

Acute chest

Question 49

Glutamic acid to valine (at position 6) is an amino acid substitution seen in the ____ chain in sickle cell disease.

Answer 49

beta-globin

Question 50

Autosplenectomy is a complication of sickle-cell disease tat leads to an increased risk of infection with encapsulated organisms and the formation of _______ in red blood cells.

Answer 50

Howell-Jolly bodies

Question 51

_____ is the most common cause of death in adults with sickle-cell disease.

Answer 51

Upper respiratory tract infection

Question 52

_____ is an anti-neoplastic drug used in myeloproliferative disorders that can treat the painful attacks of sickle-cell disease by increasing hemoglobin F expression.

Answer 52

Hydroxyurea

Question 53

Patients with ______ have hemoglobin with one normal and one malformed beta-globin chain.

Answer 53

sickle-cell trait

Question 54

Sickle cell disease is diagnosed by_____.

Answer 54

hemoglobin electrophoresis

Question 55

______ and Staphylococcus aureus are the bacteria commonly associated with osteomyelitis in patients with sickle cell disease.

Answer 55

Salmonella spp.

Question 56

_____ is a complication of sickle-cell disease that leads to an increased risk of infection with encapsulated organisms and the formation of Howell-jolly blood cells.

Answer 56

Autosplenectomy

Question 57

Sickle-cell disease typically follows an _____ genetic inheritance pattern.

Answer 57

autosomal recessive

Question 58

_____ disease is a hematological cause of focal segmental glomerulosclerosis due to poor oxygenation of the glomeruli and structural weakness of red blood cells.

Answer 58

Sickle-cell

Question 59

_______ is a possible complication of sickle cell anemia that presents as a severely painful penile erection that does not become flaccid.

Answer 59

Priapism

Question 60

Aplastic crisis is a possible complication of sickle cell disease that can be triggered by _____.

Answer 60

parvovirus B19

Question 61

_____ disease causes vaso-occlusive symptoms as a result of red blood cell sickling.

Answer 61

Sickle-cell

Question 62

Newborns that have sickle-cell disease are initially asymptomatic because _____ levels are high, while hemoglobin S levels are low.

Answer 62

hemoglobin F

Question 63

_____ is a painful vaso-occlusive crisis seen in sickle-cell disease that involves painful swelling of the hands.

Answer 63

Dactylitis

Question 64

Erythrocytes have an affinity for each of the following except mitochondria oxygen carbon dioxide glucose

Answer 64

mitochondria

Question 65

Common causes of anemia include each of the following except severe bleeding low erythropoietin level hemolysis polycythemia

Answer 65

polycythemia

Question 66

A patient has chronic anemia associated with chronic renal failure. What substance does the healthcare professional tell the patient is needed to treat this anemia?

Answer 66

Erythropoietin

Question 67

A patient has microcytic and hypochromic erythrocytes. What is the expected diagnosis?

Answer 67

Iron Deficiency Anemia

Question 68

A patient presents with paresthesia of hands and feel fatigue and pallor. The CBC reveals reduced number of erythrocytes, low hemoglobin and low hematocrit. The MCV is high. What is most likely causing the symptoms?

Answer 68

Pernicious Anemia

Question 69

Which of the following is most likely to trigger a sickle cell crisis? snow skiing in the Rocky Mountains Drinking 6-8 glasses of water each day cruise ship vacation Daily folic acid supplements

Answer 69

snow skiing in the Rocky Mountains

Question 70

What is needed to absorb B12?

Answer 70

Intrinsic Factor

Question 71

What is hemoglobin?

Answer 71

A protein composed of iron and globin capable of oxygen and carbon dioxide transport.

Question 72

For the patient with pernicious anemia, which of the following is least likely to be observed? Stomatitis Microcytic erythrocytes Parathesis of extremities History of gastric bypass bariatric surgery

Answer 72

Microcytic erythrocytes