The Quizzes about Hematology diseases – Part 3 (26 test)

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The Quizzes about Hematology diseases – Part 3 (26 test)
5 (100%) 2 votes

Select the ONE answer that is BEST in each case.

A 22-year-old medical student donates his blood as part of a clinical study. He is discovered to have persistent HbF (fetal hemoglobin) levels. He feels well, and his clinical examination is normal. Which of the following features about this condition is most likely true?

HbF is evenly distributed among red cells, unlike the increased F in other conditions. It is a heterogeneous condition, and can be classified into deletion and nondeletion forms.

 

See all quizzes of  the Hematology diseases at here:

Part 1Part 2 | Part 3 |

 

48. A 22-year-old medical student donates his blood as part of a clinical study. He is discovered to have persistent HbF (fetal hemoglobin) levels. He feels well, and his clinical examination is normal. Which of the following features about this condition is most likely true?

(A) cause of sickling red cells

(B) disease of infants only

(C) variant of thalassemia major

(D) anemia exacerbated by fava beans

(E) benign genetic abnormality

49. A 19-year-old man had his spleen removed a year ago after a motorcycle accident. Which of the following findings on the blood film are most consistent with a previous history of splenectomy? (See Fig. 5–6.)

(A) increase in macrophages

(B) leukopenia

(C) polycythemia

(D) increased reticulocytes

(E) red cells with nuclear fragments

50. A 49-year-old man is involved in a motor vehicle accident, resulting in large amounts of blood loss and hypotension. He is initially given normal saline at the accident site, and on arrival at the hospital, the trauma team orders an emergent blood transfusion with type O “universal donor” packed red cells. Which of the following is a possible complication of unmatched type O blood?

(A) type O donors have a higher incidence of hepatitis C virus

(B) type O donors have a shorter survival time when transfused than do other cell types

(C) at times type B blood may be mistyped as type O

(D) type O donors may have high titers of anti-A and anti-B in their plasma

(E) conversion of the recipient to type O blood

51. A 9-year-old boy presents with fever, feeling unwell, and easy bruising on his legs. On examination he is pale, blood pressure 100/60 mm Hg, pulse 100/min, and temperature 37.8C. His lungs are clear, abdomen is soft with a palpable spleen, and there are petechiae and bruises on his legs. His CBC reveals a hemoglobin of 8.5 g/dL, WBC of 17,000/mL, and platelets of 30,000/mL. A blood film reveals neutropenia and leukemic lymphoblasts. Which of the following is the most appropriate initial diagnostic test to confirm the diagnosis?

(A) monospot test

(B) bone marrow aspirate and biopsy

(C) CT scan abdomen

(D) chest x-ray

(E) lumbar puncture and cerebrospinal fluid (CSF) fluid for cytology

52. A 50-year-old White woman presents with a 3-week history of tiredness and pallor. A family member has noted some yellowness of her eyes, but she denies darkening of the urine. Physical examination reveals only slight jaundice. Laboratory data include hemoglobin of 9 g/dL, reticulocyte count of 8%, a bilirubin in the serum of 2 mg/dL (indirect reacting), and some microspherocytes on peripheral smear. The direct antiglobulin test (Coombs’) is positive. Which of the following is the most likely cause for her anemia?

(A) blood loss externally

(B) decreased red cell production

(C) ineffective erythropoiesis

(D) intravascular hemolysis

(E) extravascular hemolysis

53. A 24-year-old man is suspected of having mycoplasma pneumonia based on his symptoms of dry cough and chest x-ray findings. He is also anemic with hemoglobin of 10.5 g/dL, and hemolytic anemia from cold agglutinins is suspected. Which of the following is consistent with hemolytic anemia?

(A) increased haptoglobin level

(B) increased bilirubin in the urine

(C) increased reticulocyte count

(D) increased myoglobin in the blood

(E) increased hemopexin in the blood

54. A 57-year-old man, with a history of chronic alcohol ingestion, is admitted to the hospital with acute alcoholic intoxication and lobar pneumonia. Physical examination reveals pallor; a large, tender liver; and consolidation of the right lower lobe. Laboratory data include hemoglobin of 7 g/dL, WBC of 4000/mL, and platelet count of 85,000/mL.Which of the following is the most likely factor for the anemia?

(A) hemolysis

(B) hemobilia

(C) vitamin B 12 deficiency

(D) toxic marrow suppression

(E) hemoglobinopathy

55. A 82-year-old woman is brought to the hospital because of functional decline at home and an inability to care for herself. She has a prior history of hypertension and dyslipidemia, and her medications include hydrochlorothiazide and atorvastatin. She looks disheveled, pale, and has muscle wasting; her heart and lungs are clear and there are no focal neurologic findings. Her hemoglobin is 9 g/dL, MCV 105 fL, WBC 4500/mL, and platelets 100,000/mL. The blood film shows macrocytic RBCs and hypersegmented neutrophils. Which of the following vitamin deficiencies is most likely responsible for her pancytopenia?

(A) B 12 (cyanocobalamin)

(B) folate

(C) pyridoxine

(D) thiamine

(E) riboflavin

56. A 39-year-old man with chronic alcoholism is brought to the hospital after a fall, while intoxicated. He has completely recovered except for a bruise on his shoulder. His only abnormality is low hemoglobin of 9.6 g/dL, the platelets and WBC are normal. Additional tests including ferritin, vitamins B 12, and folate are normal. Which of the following findings is most likely to be seen on his peripheral blood film?

(A) macrocytosis

(B) basophilia

(C) red cell fragments

(D) increased platelet adhesiveness

(E) atypical lymphocytes

57. A 56-year-old woman presents with feeling light-headed when standing up and 3 days of passing dark black stools. She has past history of chronic viral hepatitis B, and has developed cirrhosis. On examination she is alert, blood pressure is 90/60 mm Hg supine and 76/60 mm Hg standing. Her abdomen is distended with signs of ascites, nontender, and there are multiple bruises on the legs. Her hemoglobin is 9.0 g/dL, platelets 90,000/mL, albumin 3 g/dL, bilirubin 1.3 mg/dL, and international normalized ratio (INR) 2.5 (prothrombin time [PT] 25 seconds). Which of the following coagulation factors are most likely deficient in this patient?

(A) V and VIII

(B) VIII, IX, XI, and XII

(C) XIII

(D) II, V, VII, IX, X, and XI

(E) II, VII, IX, and X

58. A 18-year-old man, of Italian extraction, is found to have a hypochromic microcytic anemia of 10 g/dL. In addition, there is a fair degree of anisocytosis, poikilocytosis, and targeting on the blood film. The WBC is 9500/mL, the platelet count is 240,000/mL, and the reticulocyte count is 7%. The spleen is palpated 5 cm below the left costal margin. Which of the following is the most likely diagnosis?

(A) sickle cell trait

(B) thalassemia minor

(C) HbS-C disease

(D) sideroblastic anemia

(E) hereditary spherocytosis

59. A 28-year-old man, originally from West Africa, is found on routine examination to have splenomegaly. His hemoglobin is 9.5 g/dL, and blood film examination reveals target cells. Which of the following is the most likely abnormal hemoglobin in this man?

(A) HbM

(B) HbS

(C) Hb Zurich

(D) HbC

(E) Hb Barts

60. A 42-year-old man is feeling chronically fatigued. His hemoglobin is 11.5 g/dL, and the blood film is hypochromic and microcytic. The serum iron is increased, total iron-binding capacity (TIBC) is normal, ferritin is increased, and HbA2 is decreased. (SELECT ONE)

(A) iron deficiency anemia

(B) beta-thalassemia trait

(C) anemia of chronic disease

(D) sideroblastic anemia

61. An 18-year-old woman is feeling chronically fatigued. Her hemoglobin is 11.5 g/dL, RBC count 5,900,000/mL, and the blood film is hypochromic and microcytic. The serum iron is normal, TIBC is normal, ferritin is normal, and HbA2 is elevated. (SELECT ONE)

(A) iron deficiency anemia

(B) beta-thalassemia trait

(C) anemia of chronic disease

(D) sideroblastic anemia

62. A 67-year-old man presents with fatigue due to a low hemoglobin value of 9.2 g/dL. The blood film shows hypochromic microcytic cells. His serum iron is decreased, TIBC is increased, ferritin is decreased, and HbA2 is normal. (SELECT ONE)

(A) iron deficiency anemia

(B) beta-thalassemia trait

(C) anemia of chronic disease

(D) sideroblastic anemia

63. A 43-year-old man, in hospital for 2 weeks with pancreatitis, is anemic with hemoglobin of 9.7 g/dL and MCV 79 fL. The blood film shows slightly microcytic hypochromic red cells, and the reticulocyte count is 0.5 %. The serum is iron decreased, TIBC is decreased, serum ferritin is increased, and HbA2 normal. (SELECT ONE)

(A) iron deficiency anemia

(B) beta-thalassemia trait

(C) anemia of chronic disease

(D) sideroblastic anemia

64. A 52-year-old man is complaining of fatigue. His physical examination is normal, but his hemoglobin is low at 8.9 mg/dL. The reticulocyte count is 0.5 %, serum iron and TIBC are normal, and ferritin is elevated. A bone marrow aspirate reveals erythroid precursors that have accumulated abnormal amounts of mitochondrial iron. (SELECT ONE)

(A) iron deficiency anemia

(B) beta-thalassemia trait

(C) anemia of chronic disease

(D) sideroblastic anemia

65. Found in severe liver disease. (SELECT ONE)

(A) spherocytes

(B) schistocytes

(C) sickle cells

(D) burr cells

(E) agglutinated cells

(F) Heinz bodies

66. Represent precipitated Hb. (SELECT ONE)

(A) spherocytes

(B) schistocytes

(C) sickle cells

(D) burr cells

(E) agglutinated cells

(F) Heinz bodies

67. Caused by loss of red cell membrane. (SELECT ONE)

(A) spherocytes

(B) schistocytes

(C) sickle cells

(D) burr cells

(E) agglutinated cells

(F) Heinz bodies

68. Caused by polymerization of an abnormal Hb. (SELECT ONE)

(A) spherocytes

(B) schistocytes

(C) sickle cells

(D) burr cells

(E) agglutinated cells

(F) Heinz bodies

69. Caused by trauma to red cell membranes. (SELECT ONE)

(A) spherocytes

(B) schistocytes

(C) sickle cells

(D) burr cells

(E) agglutinated cells

(F) Heinz bodies

70. A 23-year-old man presents with prolonged nose bleeds. He has always noted easy bruising, and ongoing bleeding after minor cuts. There is no prior history of surgery or dental procedures. His hemoglobin is 14.5 g/dL, platelets 200,000/mL, and PT/PPT is normal. Further testing reveals that the bleeding time is elevated; the factor VIII level is reduced, as is the ristocetin cofactor assay. (SELECT ONE)

(A) von Willebrand’s disease

(B) hemophilia A

(C) hemophilia B

(D) thrombotic thrombocytopenic purpura (TTP)

71. An 18-year-old man develops excessive bleeding 2 hours after wisdom tooth extraction. He has a history of easy bruising after playing sports, and of minor cuts that rebleed. His examination is normal, except for the tooth extraction site, which is still oozing blood. His hemoglobin is 14.8 g/dL, platelets 230,000 mL, PT is normal, and partial thromboplastin time (PTT) is elevated. A bleeding time is normal, factor VIII level is reduced, factor IX is normal, and ristocetin cofactor assay is normal. (SELECT ONE)

(A) von Willebrand’s disease

(B) hemophilia A

(C) hemophilia B

(D) thrombotic thrombocytopenic purpura (TTP)

72. A 19-year-old man is brought to the hospital after injuring his knee playing football. The knee is swollen and painful to move. He has no prior history of bleeding disorders. Arthrocentesis of the knee reveals 20 cc of blood. Further investigations show that his platelets are 170,000/mL, PT is normal, PTT is elevated, bleeding time is normal, factor VIII is normal, factor IX is reduced, and the ristocetin cofactor assay is normal. (SELECT ONE)

(A) von Willebrand’s disease

(B) hemophilia A

(C) hemophilia B

(D) thrombotic thrombocytopenic purpura (TTP)

73. A 27-year-old woman presents with nose bleeds, rash on her feet, and fevers. She looks unwell, pale, jaundiced, and there are multiple petechiae on her feet. The lungs are clear, heart sounds normal, and abdomen is soft with no palpable spleen or liver. Her bilirubin is 2 mg/dL (mostly indirect), aspartate amino transferase (AST), alanine amino transferase (ALT), alkaline phosphatase (ALP) are normal. The hemoglobin is 8.7 g/dL, platelets 24,000/mL, PT/PTT normal, and bleeding time is elevated. The blood film reveals anemia, thrombocytopenia, and red cell fragments. (SELECT ONE)

(A) von Willebrand’s disease

(B) hemophilia A

(C) hemophilia B

(D) thrombotic thrombocytopenic purpura (TTP)

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