Module 10: Alterations of Hematologic Function

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Which of the following proteins is not a normal component of plasma?

A) Albumin
B) Clotting factors
C) Collagen
D) Globulins

C) Collagen

Which of the following is a characteristic of mature erythrocytes (red blood cells)?

A) Have a spherical shape
B) Produced in the spleen
C) Contain the protein transferrin
D) Have no nucleus

D) Have no nucleus

What is the average life span of an erythrocyte?

A) 10 days
B) 40 days
C) 120 days
D) 365 days

C) 120 days

Which of the following is a secondary lymphoid organ capable of releasing up to 200 mL of blood into the circulation to restore blood volume in the case of hemorrhage?

A) Liver
B) Bone marrow
C) Pancreas
D) Spleen

D) Spleen

In adults, erythropoiesis occurs in the bone marrow of all of the following bones, except the:

A) vertebrae.
B) shaft of the femur.
C) ribs.
D) pelvic bones.

B) shaft of the femur.

Which of the following minerals is required for erythropoiesis?

A) Iron
B) Calcium
C) Magnesium
D) Selenium

A) Iron

Iron is stored in the tissues as:

A) myoglobin.
B) ferritin.
C) hemosiderin.
D) all of the above.

D) all of the above.

What is the role of folate in erythropoiesis?

A) Forms a component of hemoglobin
B) Required for DNA and RNA synthesis
C) Stimulates vitamin B12 absorption
D) All of the above

B) Required for DNA and RNA synthesis

Erythropoietin, the hormone that regulates erythropoiesis, is released by the:

A) red blood cells.
B) bone marrow.
C) spleen.
D) kidneys.

D) kidneys.

The developing erythrocyte is released from the bone marrow as a:

A) proerythroblast.
B) megaloblast.
C) reticulocyte.
D) megakaryocyte.

C) reticulocyte.

Where does the sequestration and destruction of aged erythrocytes normally take place?

A) Liver
B) Spleen
C) Bone marrow
D) Kidneys

B) Spleen

Red blood cell lysis yields which of the following products?

A) Bilirubin
B) Vitamin B12
C) Hematopoietic growth factors
D) Fibrin

A) Bilirubin

Which of the following white blood cells does not circulate in the plasma?

A) Mast cell
B) Monocyte
C) Neutrophil
D) Basophil

A) Mast cell

Granulocytes contain:

A) hemoglobin for transporting oxygen.
B) enzymes capable of killing microorganisms.
C) plasma proteins for binding with plasma lipids.
D) antibodies for mounting an immune response.

B) enzymes capable of killing microorganisms.

Which cell is the first phagocyte to arrive after bacterial invasion or tissue injury?

A) Macrophage
B) Basophil
C) Neutrophil
D) Eosinophil

C) Neutrophil

The circulating monocyte becomes a __________ after it has entered the tissue at a site where an inflammatory response is occurring.

A) macrophage
B) basophil
C) neutrophil
D) mast cell

A) macrophage

Under normal conditions, which type of white blood cell accounts for the highest percentage in the total white blood cell count?

A) Basophils
B) Eosinophils
C) Neutrophils
D) Lymphocytes

C) Neutrophils

Why do lymph nodes enlarge and become tender during an infection?

A) Edema is accumulating.
B) Blood flow is decreasing.
C) Macrophages are proliferating.
D) Microorganisms are colonizing.

C) Macrophages are proliferating.

In adults, hematopoiesis occurs in the bone marrow of all of the following bones except the:

A) vertebrae.
B) radius and ulna.
C) sternum.
D) pelvic bones.

B) radius and ulna.

Which of the following blood components is required for coagulation and control of bleeding?

A) Neutrophils
B) Mast cells
C) Basophils
D) Platelets

D) Platelets

Which of the following molecules forms a meshwork to stabilize a blood clot during hemostasis?

A) Fibrin
B) Collagen
C) Thrombin
D) Fibrinogen

A) Fibrin

When plasmin degrades fibrin during the fibrinolytic process, what are the by-products called?

A) Clotting factors
B) Thrombopoietins
C) Fibrin degradation products
D) Tissue thromboplastins

C) Fibrin degradation products

Which of the following statements provides the best general definition of anemia?

A) Decreased amount of circulating plasma volume
B) Decreased oxygen-carrying capacity of the blood cells
C) Presence of tissue hypoxia
D) Bone marrow failure

B) Decreased oxygen-carrying capacity of the blood cells

Which of the following blood tests measures the percentage of erythrocytes in a given volume of blood?

A) Hemoglobin
B) Hematocrit
C) Mean cell volume (MCV)
D) Red blood cell count

B) Hematocrit

Which of the following blood tests allows the clinician to visualize structural changes in the erythrocytes such as sickle cells or schistocytes?

A) Blood smear
B) MCV
C) Mean corpuscular hemoglobin (MCH)
D) Hematocrit

A) Blood smear

In anemia, which of the following is a physiologic response to hypoxia?

A) Low blood pressure
B) Splenomegaly
C) Increased respiratory rate
D) Clot formation

C) Increased respiratory rate

In anemia, what factor stimulates the production of erythropoietin?

A) Low blood viscosity
B) Tissue hypoxia
C) Inflammation
D) Release of stress hormones

B) Tissue hypoxia

General causes of the decreased number of erythrocytes in anemia include all of the following except:

A) hemorrhage.
B) hemolysis.
C) dehydration.
D) decreased erythropoiesis.

C) dehydration.

An increase in which of the following laboratory values would indicate the presence of a hemorrhagic or hemolytic anemia?

A) Hematocrit
B) MCV
C) Reticulocyte count
D) All of the above

C) Reticulocyte count

Pernicious anemia is caused by:

A) iron deficiency.
B) bone marrow failure.
C) folate deficiency.
D) vitamin B12 deficiency.

D) vitamin B12 deficiency.

Vitamin B12 or folate deficiency anemia usually exhibits a red blood cell morphology that is:

A) microcytic and hypochromic.
B) macrocytic and normochromic.
C) normocytic and normochromic.
D) macrocytic and hypochromic.

B) macrocytic and normochromic.

Which of the following explanations describes why a folate or vitamin B12 deficiency causes anemia?

A) Stem cells are unable to differentiate into mature erythrocytes.
B) Decreased hemoglobin formation in the red blood cell.
C) Structural hemoglobin defects limit oxygen transport.
D) Red blood cells are fragile and have a shorter life span.

D) Red blood cells are fragile and have a shorter life span.

Why is gastric bypass surgery for morbid obesity a risk factor for the development of pernicious (vitamin B12 deficiency) anemia?

A) Vitamin B12 is absorbed in the stomach.
B) Intrinsic factor production by the gastric epithelium is reduced.
C) Postoperative antibodies to vitamin B12 are produced.
D) Vitamin B12 stores are in the adipose tissue.

B) Intrinsic factor production by the gastric epithelium is reduced.

Clinical manifestations unique to vitamin B12 anemia (i.e., usually absent in other types of anemia) include:

A) fatigue, dyspnea on exertion, and pale skin.
B) palpitations, chest pain, and signs of heart failure.
C) dizziness, headaches, and nausea.
D) paresthesias, muscle weakness, and ataxia.

D) paresthesias, muscle weakness, and ataxia.

Which of the following population groups are at the highest risk for developing a folate deficiency anemia?

A) Children born with a congenital intrinsic factor deficiency
B) Alcoholics
C) Menstruating women
D) Vegetarians

B) Alcoholics

Iron deficiency anemia usually exhibits a red blood cell morphology that is:

A) microcytic and hypochromic.
B) macrocytic and normochromic.
C) normocytic and normochromic.
D) macrocytic and hypochromic.

A) microcytic and hypochromic.

Which of the following problems is not a known cause of iron deficiency?

A) Blood loss
B) Inadequate dietary iron
C) Severe diarrhea
D) Disorders of iron metabolism

C) Severe diarrhea

Iron-deficiency anemia among adult populations in the United States is most commonly caused by:

A) chronic inflammatory and autoimmune diseases.
B) inadequate dietary iron.
C) chronic gastrointestinal bleeding.
D) renal disease.

C) chronic gastrointestinal bleeding.

In evaluating for iron deficiency, which of the following lab tests provides the most accurate assessment of iron stores in the tissues?

A) Hemoglobin
B) Serum iron
C) MCV
D) Serum ferritin

D) Serum ferritin

Clinical manifestations of iron deficiency include all of the following except:

A) diarrhea.
B) fatigue and weakness.
C) brittle, concave nails.
D) a red, sore tongue.

A) diarrhea.

The reticulocyte count in iron deficiency, vitamin B12, and folate deficiency is:

A) increased.
B) decreased.
C) absent.
D) impossible to measure.

B) decreased.

Which microcytic anemia is associated with a genetic defect in the globin (protein) subunits of hemoglobin and is most prevalent in Asian, Mediterranean, and black populations?

A) Sideroblastic anemia
B) Iron-deficiency anemia
C) Thalassemia
D) Aplastic anemia

C) Thalassemia

What is the underlying pathophysiological cause of sideroblastic anemia?

A) Available iron is not incorporated into the developing erythrocyte.
B) Iron transport from the tissues to the bone marrow is impaired.
C) Iron deficiency leads to inadequate hemoglobin formation.
D) Excess hemoglobin causes erythrocyte deformation.

A) Available iron is not incorporated into the developing erythrocyte.

Which of the following problems is usually present in sideroblastic anemia?

A) Central nervous system demyelination
B) Increased serum iron and iron toxicity
C) Gastric atrophy
D) Immunosuppression

B) Increased serum iron and iron toxicity

What is the general cause of aplastic anemia?

A) Hemolysis in the spleen
B) Severe nutritional deficiencies
C) Autoimmune destruction of mature red blood cells
D) Bone marrow failure

D) Bone marrow failure

Toxic causes of aplastic anemia include which of the following?

A) Drugs
B) Industrial toxins
C) Radiation exposure
D) All of the above

D) All of the above

In addition to a low serum hemoglobin and hematocrit, which of the following problems also manifest with aplastic anemia?

A) Elevated bilirubin levels
B) Formation of deep vein thromboses
C) Increased risk of acquiring serious infections
D) All of the above

C) Increased risk of acquiring serious infections

Anemia from recent blood loss (acute blood loss) usually exhibits a red blood cell morphology that is:

A) macrocytic and normochromic.
B) microcytic and hypochromic.
C) macrocytic and hypochromic.
D) normocytic and normochromic.

D) normocytic and normochromic.

Immediate, life-threatening consequences of a massive hemorrhage are primarily related to:

A) loss of platelets.
B) low blood pressure.
C) activation of the immune response.
D) loss of hemoglobin.

B) low blood pressure.

The most common cause of acquired hemolytic anemia is:

A) viral infection of erythrocytes.
B) autoimmune destruction of erythrocytes.
C) severe nutritional deficiencies.
D) alcoholism.

B) autoimmune destruction of erythrocytes.

A unique manifestation of hemolytic anemia (i.e., generally absent in other forms) is:

A) jaundice.
B) paralysis.
C) cerebral edema.
D) cyanosis.

A) jaundice.

Which of the following are characteristics of a cold agglutination immunohemolytic anemia?

A) Associated with infectious disorders
B) Associated with drug-induced hemolytic anemias
C) Mediated by IgG
D) All of the above

A) Associated with infectious disorders

All of the following are reasons why chronic infections (HIV disease, hepatitis), rheumatological diseases, and malignancies result in anemia of chronic inflammation (anemia of chronic disease), except:

A) decreased erythropoiesis.
B) disordered iron utilization by developing erythrocytes.
C) decreased erythrocyte survival.
D) all of the above.

D) all of the above.

A 28-year-old woman with a history of rheumatoid arthritis is seen in a prenatal clinic for the first time late in her second trimester of pregnancy. She reports severe fatigue and experiences shortness of breath when going up stairs. Laboratory evaluation reveals low hematocrit and hemoglobin levels. Which of the following is a (are) potential cause(s) of her anemia?

A) Anemia of chronic inflammation
B) Iron deficiency
C) Folate deficiency
D) All of the above

D) All of the above

Which of the following descriptions is characteristic of sickle cell disease?

A) Malformed, sickle-shaped platelets lead to thrombocytopenia and bleeding.
B) Hemoglobin reacts to deoxygenation or dehydration by sickling the erythrocytes.
C) Sickled erythroblasts are unable to form adequate amounts of hemoglobin.
D) Production of antibodies that attach to erythrocytes, causing sickling.

B) Hemoglobin reacts to deoxygenation or dehydration by sickling the erythrocytes.

Vaso-occlusive crisis in sickle cell disease manifests with which of the following symptoms?

A) Pain
B) Pancytopenia
C) Splenomegaly
D) Hypotension

A) Pain

In the United States, sickle cell disease is most common among _________ populations.

A) Hispanic/Latino
B) Asian
C) Black
D) Caucasian

C) Black

What is the pattern of inheritance of the gene for sickle cell disease?

A) Autosomal dominant
B) Nondisjunction
C) X-linked recessive
D) Autosomal recessive

A) Autosomal dominant

Secondary polycythemia caused by hypoxemia at high altitude manifests with which of the following problems?

A) Severe anemia
B) Increased erythrocyte production
C) Thrombocytopenia
D) Neutrophilia

B) Increased erythrocyte production

Pathophysiological consequences of polycythemia vera include:

A) hypercoagulability, leading to organ infarction.
B) decreased oxygen-carrying capacity of erythrocytes, leading to tissue hypoxia.
C) malformed platelets, leading to spontaneous bleeding.
D) production of deformed erythrocytes that lyse prematurely.

A) hypercoagulability, leading to organ infarction.

Symptoms such as pica and pagophagia are most commonly associated with:

A) iron deficiency.
B) folate deficiency.
C) thalassemia.
D) sideroblastic anemia.

A) iron deficiency.

The term used to describe a leukocyte count that is higher than normal is:

A) leukocytosis.
B) leukemia.
C) leukopenia.
D) hemostasis.

A) leukocytosis.

An increase in the production of neutrophils in response to infection is called:

A) neutropenia.
B) pancytopenia.
C) right shift.
D) neutrophilia.

D) neutrophilia.

Which of the following conditions is commonly associated with eosinophilia?

A) Allergic reactions
B) Tuberculosis
C) Parasitic infections
D) All of the above

D) All of the above

Agranulocytosis increases a person's risk of:

A) cancer.
B) infection.
C) allergic reactions.
D) a left shift.

B) infection.

Lymphocytosis commonly occurs in response to:

A) viral infection.
B) fungal infection.
C) drug overdose.
D) bone marrow failure.

A) viral infection.

Mononucleosis is caused by infection of the B lymphocytes by which of the following microorganisms?

A) Influenza virus
B) Human immunodeficiency virus
C) Epstein-Barr virus
D) Staphylococcus aureus

C) Epstein-Barr virus

How long is the incubation period for infectious mononucleosis?

A) 24 hours
B) 3-5 days
C) 2-3 weeks
D) 4-8 weeks

D) 4-8 weeks

What is the primary transmission route of the virus that causes infectious mononucleosis?

A) Skin to skin contact
B) Transfer of saliva through close personal contact
C) Contamination of public drinking water
D) Aerosol transmission

B) Transfer of saliva through close personal contact

Which of the following are clinical manifestations of infectious mononucleosis?

A) Fever and sore throat
B) Headache and joint aches
C) Fatigue and enlarged cervical lymph nodes
D) All of the above

D) All of the above

Leukemia is classified as:

A) differentiated or undifferentiated.
B) benign or malignant.
C) proliferative or nonproliferative.
D) acute or chronic.

D) acute or chronic.

Which of the following descriptions is not a characteristic of leukemia?

A) Leukemic cells crowd out the other cells in the bone marrow.
B) There is an inherited susceptibility to leukemia-causing mutagens.
C) Differentiation of the leukemic cell is blocked and it becomes immortal.
D) Leukemic cells function as normal white blood cells.

D) Leukemic cells function as normal white blood cells.

Acute lymphocytic leukemia most commonly occurs in:

A) children.
B) women between the ages of 20 and 40 years.
C) males between the ages of 40 and 60 years.
D) adults over age 65.

A) children.

Symptoms that individuals with acute myelogenous leukemia (AML) may present with include all of the following except:

A) ecchymosis and petechiae.
B) fatigue and weakness.
C) hypertension and myocardial hypertrophy.
D) recurrent infections.

C) hypertension and myocardial hypertrophy.

Which of the following describes an important difference between acute and chronic leukemias?

A) Chronic leukemia develops more rapidly than acute leukemia.
B) Acute leukemias are cancerous, while chronic leukemias are benign.
C) Acute leukemia originates in the bone marrow and chronic leukemia originates in the spleen and lymph nodes.
D) In chronic leukemia the cancerous cells are more differentiated than in acute leukemia.

D) In chronic leukemia the cancerous cells are more differentiated than in acute leukemia.

Multiple myeloma is the proliferation of malignant plasma cells that aggregate into tumor masses that are distributed in the:

A) lung.
B) brain.
C) bones.
D) liver.

C) bones.

In multiple myeloma, immunoglobulin fragments called Bence Jones proteins cause injury to which of the following organs?

A) Liver
B) Kidneys
C) Pancreas
D) Spleen

B) Kidneys

One of the first clinical manifestations to arise in Hodgkin lymphoma is the presence of:

A) bone pain.
B) an abdominal mass.
C) lymphadenopathy.
D) dyspnea.

C) lymphadenopathy.

Other symptoms that often present with Hodgkin lymphoma include:

A) headache, visual changes, and hearing loss.
B) night sweats, low-grade fevers, and weight loss.
C) hypertension, tachycardia, and chest pain.
D) hematuria, flank pain, and ascites.

B) night sweats, low-grade fevers, and weight loss.

Which of the following are known causes of non-Hodgkin lymphoma (NHL)?

A) Immunosuppression following organ transplantation
B) Viral infection
C) Chemical exposure
D) All of the above

D) All of the above

Which of the following is a characteristic of non-Hodgkin lymphoma (NHL)?

A) NHL will often spread to the nasopharynx, gastrointestinal tract, and bone.
B) NHL remains localized in one set of lymph nodes.
C) NHL usually only involves the T cells.
D) NHL is diagnosed on the basis of the presence of Reed-Sternberg cells in the blood.

A) NHL will often spread to the nasopharynx, gastrointestinal tract, and bone.

Which lymphoma is associated with Epstein-Barr virus infection and most commonly occurs in Africa?

A) Hodgkin lymphoma
B) Low-grade non-Hodgkin lymphoma
C) High-grade non-Hodgkin lymphoma
D) Burkitt lymphoma

D) Burkitt lymphoma

Following a splenectomy (removal of the spleen), a person has a higher risk of:

A) bleeding.
B) developing lymphoma.
C) acquiring infections.
D) developing blood clots.

C) acquiring infections.

Which of the following diseases can cause sequestration of blood components in the spleen, which leads to hypersplenism?

A) Leukemia
B) Lymphoma
C) Liver disease
D) All of the above

D) All of the above

Heparin-induced thrombocytopenia (HIT) occurs in 5% to 15% of all individuals receiving heparin therapy. In these individuals, the administration of heparin induces:

A) platelet aggregation and thrombus formation.
B) the antibody-mediated destruction of platelets.
C) lysis of megakaryocytes in the bone marrow.
D) release of deformed platelets that are unable to form clots.

A) platelet aggregation and thrombus formation.

Idiopathic thrombocytopenic purpura (ITP) is caused by:

A) a vaccine-induced hypersensitivity reaction against platelets.
B) viral-induced hyperproliferation of platelets.
C) antibody destruction of platelets in the spleen.
D) drug-induced platelet toxicity.

C) antibody destruction of platelets in the spleen.

Which of the following group of symptoms would lead you to suspect your pediatric patient has idiopathic thrombocytopenic purpura (ITP)?

A) Multiple infections and erythematous rash
B) Epitaxis, gum bleeding, and petechiae
C) Lower extremity that is warm to touch, edematous, and painful
D) Fatigue, weakness, and pale skin

B) Epitaxis, gum bleeding, and petechiae

The pathophysiology of thrombotic thrombocytopenic purpura (TTP) involves:

A) antibody destruction of platelets.
B) pathological activation of the clotting cascade.
C) platelet aggregation from autoimmune stimulation.
D) autoimmune destruction of the megakaryocytes.

C) platelet aggregation from autoimmune stimulation.

In addition to a reduced platelet count, what other problem arises in thrombotic thrombocytopenic purpura (TTP)?

A) Leukopenia
B) Tissue hypoxia
C) Hepatomegaly
D) Pneumonia

B) Tissue hypoxia

Thrombocythemia is characterized by:

A) platelet count below 15,000 per cubic millimeter.
B) platelet count above 600,000 per cubic millimeter.
C) excessive clotting despite having a normal platelet count.
D) direct autoimmune activation of the clotting cascade.

B) platelet count above 600,000 per cubic millimeter.

Hemophilia is caused by:

A) autoimmune platelet lysis.
B) an inherited clotting factor deficiency.
C) proliferation of megakaryocytes in the bone marrow.
D) stem cell defect in platelet production.

B) an inherited clotting factor deficiency.

Which of the following conditions are associated with the development of disseminated intravascular coagulation (DIC)?

A) Sepsis
B) Major trauma
C) Obstetrical accidents
D) All of the above

D) All of the above

An elevation in the serum level of which molecule is consistently observed in disseminated intravascular coagulation (DIC)?

A) Platelets
B) Fibrin degradation products
C) Clotting factors
D) Activated protein C

B) Fibrin degradation products

A deficiency in which vitamin will lead to decreased clotting capabilities and increased risk of bleeding?

A) C
B) E
C) A
D) K

D) K

Factors associated with the development of thrombi in the veins, as described by the Virchow triad, include all of the following except:

A) venous stasis.
B) endothelial injury.
C) increased heparin levels.
D) hypercoagulability.

C) increased heparin levels.

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