Both the aPTT and PT would be expected to be prolonged with:
A. Deficiency of factors X, V, II or I
B. Deficiency of factors X, V, II or XIII
C. Deficiency of factors XII, XI, IX, VIII, or IV
D. Deficiency of factors III or VII
E. Deficiency of HWMK (High molecular weight kininogen) or Prekallikrein
Answer
Which of the following would be increased with deficiency(ies) of factors XI, IX, or VIII:
A. aPTT (activated partial thromboplastin time)
B. PT (prothrombin time)
C. Ivey bleeding time
D. Platelet count
Answer
Both the aPTT and PT would be expected to be prolonged with:
A. Deficiency of factors X, V, II or I
B. Deficiency of factors X, V, II or XIII
C. Deficiency of factors XII, XI, IX, VIII, or IV
D. Deficiency of factors III or VII
E. Deficiency of HWMK (High molecular weight kininogen) or Prekallikrein
Answer
Which of the following would be increased with deficiency(ies) of factors XI, IX, or VIII:
A. aPTT (activated partial thromboplastin time)
B. PT (prothrombin time)
C. Ivey bleeding time
D. Platelet count
Answer
Fibrin/Fibrinogen split products may cause prolongation of the aPTT due to:
A. Inhibition of platelet aggregation
B. Inhibition of fibrin crosslinking by factors XIIIa
C. Inhibition of thrombin mediated conversion of fibrinogen to fibrin
D. Conversion of plasminogen to plasmin
Answer
Fibrin/Fibrinogen split products may cause prolongation of the aPTT due to:
A. Inhibition of platelet aggregation
B. Inhibition of fibrin crosslinking by factors XIIIa
C. Inhibition of thrombin mediated conversion of fibrinogen to fibrin
D. Conversion of plasminogen to plasmin
Answer
In the clotting process, as the hemostatic plug develops, fibrin polymerizes into monomeric threads which are held together by noncovalent bonds. Which clotting protein increases the strength of the clot by crosslinking the newly formed fibrin threads?
A. Factor XIII
B. High molecular weight kininogen (HMWK)
C. Plasminogen
D. Thrombin
E. von Willebrand Factor (vWF)
Answer
Which one of the following blood cells contains large cytoplasmic structures that exhibit metachromatic staining with toluidine or methylene blue?
a) Basophil
b) Eosinophil
c) lymphocyte
d) monocyte
e) neutrophil
Answer
Adults with sickle cell anemia most commonly experience neurological complications as which of the following:
A. Intracranial hemorrhage
B. Cerebral infarction
C. Seizures
D. Visual changes
E. Ataxia
Answer
A 35 year old man with many immature leukocytes in his peripheral blood smear spontaneously develops DIC. Which translocation might his cells expected to show?
a) t(8,14)
b) t(8,22)
c) t( 9,22)
d) t( 11, 14)
e) t( 15,17)
Answer
A 60 year old patient with pernicious anemia. the stomach would exhibit one of the following characteristicically:
A. Increased number of argentaffin cells
B. Hyperacidity
C. Mucosal atrophy
D. H. pylori infection
AnswerTags:
MCQ, Hematology, Pernicious Anemia
A non-bleeding 70 kg adult is transfused with 8 units of platelets. The pre- transfusion platelet count is 70,000/mm2. The expected post-transfusion platelet count should be about:
a. 80,000
b. 95,000
c. 115,000
d. 175,000
e. 250,000
Answer
Tags: MCQ, Hematology, Platelet Transfusion
A 54-year-old white man is admitted to the hospital because of abdominal pain and "black stools." He has not seen a doctor in years. He smokes two packs of cigarettes daily. Physical exam reveals poor dentition, normal cardiovascular exam, moderate splenomegaly with mild epigastric and left upper quadrant tenderness, and a guaiac stool test positive for occult blood.
Laboratory values reveal a hemoglobin of 9.5 g/dL, hematocrit of 29%, WBC count of 14,500/μL with a fairly normal differential, a platelet count of 540,000/μL, and a ferritin level of 4 μg/L. Serum vitamin B12 levels are elevated.
A bone marrow exam shows hypercellularity without other specific findings, and chromosomes are reported as normal. Endoscopy reveals a gastric ulcer and biopsies are negative for malignancy but positive for Helicobacter pylori infection. Appropriate management at this stage should be
A. Splenectomy
B Transfusion of two units of packed RBCs
C. Observation
D. Antibiotic treatment for the H. pylori infection and iron supplementation for the iron deficiency anemia
E. Antibiotic treatment for the H. pylori infection
AnswerTags:
MCQ, Hematology, Polycythemia
A 62-year-old woman with a platelet count of 1,350,000/μL has been diagnosed with essential thrombocytosis after an exhaustive search failed to reveal any reactive causes for the elevated platelet count. Her platelet count has been greater than 1 million for more than 6 months. The most appropriate therapy now that a diagnosis of essential thrombocytosis has been established is
A. Platelet pheresis
B. Aspirin
C. Anagrelide
D. Hydroxyurea
E. Interferon-[agr ]
AnswerTags:
MCQ, Hematology, Leukemia, Thrombocytosis
A 53-year-old woman comes to see you regarding a possible diagnosis of essential thrombocytosis. She says her gynecologist has noted a platelet count of >550,000/μL on three separate occasions over the past 2 years. Apart from two uneventful childbirths, the woman says she really has no significant medical history. She says she has never been told she was anemic. Lab values reveal a normal hemoglobin, hematocrit, and MCV. The platelet count is 580,000/μL. Your review of the peripheral smear reveals no microcytosis or hypochromia but does show RBC Howell-Jolly bodies. The platelet count on the smear appears elevated, but there are no giant platelets or platelet clumps. What is the next most appropriate step in your diagnostic work-up?
A.Perform bone marrow aspirate and biopsy.
B. Obtain a C-reactive protein and a sedimentation rate, looking for a state of chronic inflammation.
C. Obtain a ferritin level to confirm that there is no iron deficiency.
D. Go back and obtain a more thorough history and repeat the physical exam.
E. Perform chest, abdominal, and pelvic CT scans, searching for an occult malignancy.
AnswerTags:
MCQ, Hematology, Splenectomy
A 50-year-old white man comes to see you because he was told he had "high blood." Physical exam is normal except for a ruddy complexion, which he says he has had most of his adult life .He has smoked two packs of cigarettes per day since he was 16 years old. A CBC shows a normal WBC count and differential, normal platelet count, a hemoglobin of 18.4 g/dL, and a hematocrit of 57%. The next set of tests to order after the preliminary assessment would include all of the following, except
A. Serum EPO level
B. Determination of venous P50 (partial pressure of oxygen at which the hemoglobin is 50% saturated)
C. Arterial oxygen saturation determination
D. Carbon monoxide determination
E. Bone marrow aspirate and biopsy
AnswerTags:
MCQ, Hematology, Polycythemia
A 50-year-old white man comes to see you because he was told he had "high blood." Physical exam is normal except for a ruddy complexion, which he says he has had most of his adult life .He has smoked two packs of cigarettes per day since he was 16 years old. A CBC shows a normal WBC count and differential, normal platelet count, a hemoglobin of 18.4 g/dL, and a hematocrit of 57%. To work up this elevated hematocrit, what is the next most appropriate test to order?
A. Serum EPO level
B. Arterial blood gas analysis
C. RBC mass study
D. Bone marrow aspirate and biopsy
E. Pulmonary function tests
AnswerTags:
MCQ, Hematology, Polycythemia
A 25-year-old white woman presents to the emergency room with the complaint of extreme shortness of breath of acute onset. She was actually seen in the same emergency room 24 hours previously where she was diagnosed with a urinary tract infection and given prescriptions for phenazopyridine (Pyridium) and sulfamethoxazole. She is overweight and sedentary and smokes two packs of cigarettes a day. On physical exam she is markedly dyspneic and extremely cyanotic. Arterial blood gases fail to reveal any hypoxia, but a ventilation-perfusion scan is obtained anyway, which is read as low probability. What should be the next course of action?
A. Repeat the arterial blood gas to look for progression and development of hypoxia.
B. Proceed to pulmonary arteriography.
C. Begin anticoagulation.
D. Administer methylene blue.
E. Transfuse two units of packed RBCs.
AnswerTags:
MCQ, Hematology, Cyanosis, Methemoglobin
A 52-year-old black woman comes to you for another opinion regarding a history of anemia that has been unresponsive to oral iron supplementation. She sought your opinion because her other physician was recommending IV iron supplementation. She has been on nearly continuous iron supplementation therapy ever since her second child was born 23 years ago.
Over the years she says her doctors have prescribed her to take anywhere from one to three pills daily, sometimes with vitamin C concomitantly. Although she has never needed a transfusion, she says she has been told that her RBC count has never completely normalized. She is otherwise healthy and has no unusual dietary habits.
Her menstrual history reveals relatively normal menstrual periods until about 3 years ago, when she attained menopause. The patient believes that her mother was also iron deficient. Your physical exam is normal. Laboratory values show a hemoglobin of 11.6 g/dL; hematocrit, 33%; MCV, 70 fL; normal WBC with differential; normal platelet count; serum iron, 70 μg/L; iron-binding capacity, 255 μg/dL; and ferritin, 158 μg/L. At this point you should next
A. Agree with the other physician and recommend IV iron supplementation because she does not appear to be absorbing enough oral iron to totally correct her anemia.
B. Perform a hemoglobin electrophoresis.
C. Obtain a serum EPO level.
D. Discontinue iron supplementation.
E. Perform a bone marrow aspirate and biopsy.
AnswerTags:
MCQ, Thalessemias, Thalassemias, Hematology
