Chapter 14 Pathology (pgs. 639-665) (No Answer Document)
Match the following (1-3):
a) MCV
b) MCH
c) MCHC
1) Average content of hemoglobin per red cell in picograms.
2) Average volume of RBCs in femtoliters (fL).
3) Average concentration of hemoglobin in a given volume of packed red cells, grams
per deciliter.
4) T/F Iron in hemoglobin can be recaptured if it is lost into tissue space.
5) T/F Iron in hemoglobin can be recaptured if it is lost into the gut.
6) T/F Extravascular hemolysis can lead to organomegaly.
7) Which of the following doesn’t cause splenomegaly?
a. Extravascular hemolysis
b. Intravascular hemolysis
c. Hereditary spherocytosis
d. Sequestration crises
e. Sickle cell anemia
8) What is the function of haptoglobin?
a. Bind vitamin B12 for absorption
b. Promote iron excretion in urine
c. Bind hemoglobin and prevent it from be excreted in urine
d. Destroy red cells
e. Parvovirus mechanism for aplastic anemia
9) T/F Intravascular anemia causes hemoglobinemia and hemosiderinuria.
10) T/F Heme breakdown causes the formation of bilirubin as a product which is the main
cause of jaundice.
11) Spectrin heads bind with which of the following?
a. Other spectrin heads
b. Actin
c. Glycophorin A
d. Protein 4.1
e. Spectrin tails
12) Spectrin and band 3 bind to each other via?
a. Ankyrin and band 4.1
b. Ankyrin and band 4.2
c. Actin and protein 4.1
d. Ankyrin and protein 4.1
e. Actin and glycophorin A
13) T/F The most common cause of hereditary spherocytosis is mutations to actin, protein
4.1, and glycophorin A.
14) Spherocytes have an increased MCHC because?
a. Loss of Ca++ and H2O
b. Loss of Na+ and H2O
c. Loss of K+ and Na+
d. Loss of K+ and H2O
e. Loss of K+, Na+, and H2O
15) A patient has a blood smear done and dark nuclear remnants in his red cells appear
and you diagnose him with hereditary spherocytosis, what are those nuclear remnants
called?
a. Heinz bodies
b. Alpha chain aggregates
c. Howell Jolly bodies
d. Hemoglobin Barts
e. HBH
16) What is the correct order in glutathione metabolism from G6P to oxidant reduction?
a. G6PD to NADP to Glutathione
b. G6PD to NAD to Glutathione
c. Glutathione to NAD to G6PD
d. Glutathione to NADP to G6PD
e. NAD to G6PD to Glutathione
17) A man with excess oxidant stress secondary to an infection by pneumococcus
pneumoniae has inclusions caused by sulfhydryl cross linking of globin chains, these
are called what?
a. Heinz bodies
b. Howell Jolly bodies
c. Alpha chain aggregates
d. Hemoglobin Barts
e. HBH
18) G6PD deficiency is?
a. Autosomal recessive
b. Autosomal dominant
c. Y-linked
d. Caused by point mutations
e. X-linked
19) T/F G6PD minus has the shortest half-life.
20) T/F Fava beans are detrimental to G6PD deficient individuals.
21) A patient with heterozygous sickle cell anemia (HbA and HbS) is?
a. 30% HbA and 70% HbS
b. 70% HbA and 30% HbS
c. 60% HbA and 40% HbS
d. 40% HbA and 60% HbS
e. 50% HbA and 50% HbS
22) A patient comes in with dehydration and sickling of his red cells, you do a genetic
analysis and determine he doesn’t have the more severe HbSS but instead he has
HbSC. HbS and HbC are caused by the following amino acid exchanges respectively:
a. Valine for glutamine and lysine for glutamine
b. Valine for glutamate and lysine for glutamine
c. Valine for glutamate and lysine for glutamate
d. Arginine for glutamine and glycine for glutamate
e. Arginine for glutamate and glycine for glutamate
23) T/F Sickling occurs under oxygenated conditions.
24) After an amniocentesis and genetic analysis of a baby you determine the baby will
have sickle cell anemia that will present after around 6 months. Why did you make
this claim?
a. The baby is protected by maternal antibodies that destroy sickle cells early
b. HbC protect the baby
c. Surfactant in the infant is adequate to overcome sickling events
d. The infant has enough normal red cell progenitors that can prevent sickling
e. The infant has HbF which protective against sickling
25) T/F Sickle cells cause microvascular occlusions because of inflammation, increased
surface adhesion expression, and decreased Hb binding of NO.
26) To narrow down possible diseases you do a skull x-ray that shows a crew-cut
calvarium and prominent cheek bones, which of the following could MOST likely
cause this other than sickle cell anemia?
a. Hereditary Spherocytosis
b. G6PD deficiency
c. Aplastic anemia
d. Myelophthisic anemia
e. B-thalassemia
27) While karyotyping a patient with alpha thalassemia you look for defects for alpha
chains on which of the following?
a. Two identical genes on chromosome 16
b. One gene on chromosome 11
c. One gene on chromosome 15
d. One gene on chromosome 16
e. Two identical genes on chromosome 11
28) Beta + defects in beta-thalassemia patients is most commonly caused by:
a. Splicing mutations
b. Insertions
c. Operon mutations
d. Promoter region mutations
e. Chain terminator mutations
29) Beta thalassemia major which is homozygous was diagnosed in a newborn (beta0/beta-0 variant), which of the following insoluble aggregates are causing red cell
membrane destruction, ineffective erythropoiesis, and extramedullary hematopoiesis?
a. Beta aggregates
b. HbH
c. Hemoglobin Barts
d. Alpha aggregates
e. Gamma aggregates
30) A patient suffering from beta thalassemia was given blood transfusions and he started
forming iron deposits in his organs because of the following unknown etiologic
effect?
a. DMT1 overexpression
b. Decreased hepcidin
c. Increased hephaestin
d. Decreased ferroportin
e. Increased ceruloplasmin
31) Alpha thalassemia is less likely to cause hemolysis and ineffective erythropoiesis
because?
a. Alpha aggregates are less soluble and condense to the center of the red cell
b. Beta chains are more soluble
c. Beta chains are less soluble
d. Gamma chains create insoluble aggregates
e. Alpha chains are very soluble
32) T/F In Asians the alpha thalassemia trait is (a/a),(-/-) and they are more likely to have
thalassemia than Africans.
33) T/F HbH is a tetramer of beta chains and occurs when 1 alpha gene is defective.
34) A fetus in the third trimester is suffering from Hydrops Fetalis and you as a physician
immediately start blood transfusions and recommend a bone marrow transplant when
possible. How many genes are missing/mutated?
a. Two alpha genes
b. Three beta genes
c. Four beta genes
d. Four alpha genes
e. Three alpha genes
35) The leading cause of death in Paroxysmal Nocturnal Hemoglobinuria (PNH) is?
a. Iron overload
b. Jaundice
c. Megaloblastic anemia
d. Immune Gastritis
e. Thrombosis
36) T/F A direct Coombs antiglobulin test requires commercial red blood cells and a
patient’s blood serum.
37) Warm antibody type immunohemolytic anemia is most commonly caused by which
immunoglobulin?
a. IgA
b. IgD
c. IgE
d. IgG
e. IgM
38) Vitamin B12 deficiency causes pernicious anemia and megaloblastic anemia mainly
because of?
a. Autoimmune gastritis
b. Folate deficiency
c. Homocysteine increase
d. Methylmalonate increase
e. Gastric carcinoma
39) What is intrinsic factor used to absorb and what part of the intestinal tract is the
vitamin/mineral absorbed?
a. Folic acid/jejunum
b. Folic acid/duodenum
c. B12/ileum
d. B12/jejunum
e. B12/duodenum
40) Even though pernicious anemia occurs due to primarily T cell damage to parietal
cells, associated type III autoantibodies do what?
a. Destroy intrinsic factor
b. Destroy transcobalamin II
c. Affect the gastric proton pump
d. Inhibit the binding of B12 and intrinsic factor
e. Inhibit internalization of B12-intrinsic factor complex by enterocytes
41) A patient presents with fundic gland atrophy, intestinalization, and spinal cord
demyelination because of his poor diet which has caused a deficiency of?
a. B12
b. Folate
c. Iron
d. K+
e. Methionine synthase
42) Which of the following won’t be fixed by parenteral administration of B12 in a
deficient patient?
a. Anemia
b. Vascular disease
c. Neurological symptoms
d. Atrophic glossitis
e. Gastric atrophy
43) Folate is not involved in which of the following?
a. dTMP formation
b. Purine synthesis
c. Methylmalonate metabolism
d. Homocysteine metabolism
e. FH4 production
44) A patient comes in with neurological issues and megaloblastic anemia, which of the
following will help fix the megaloblastic anemia but not the neurological issues?
a. Iron
b. Pteroylmonoglutamic acid
c. B12
d. Cobalamin
e. Ceruloplasmin
Match the following (45-49) (some may be used once, more than once, or not at all):
a)
b)
c)
d)
e)
f)
g)
Transferrin
Ferritin
Hephaestin
DMT1
Ferroportin
Nonheme Iron
Heme Iron
45) Transports Fe3+ in the blood.
46) Allows iron to be taken into enterocytes from the lumen of the proximal duodenum.
47) Is storage form of iron.
48) Inhibited by hepcidin on not only enterocytes but also macrophages.
49) Animal Hb form of iron.
50) T/F Beta Thalassemia causes primary hemochromatosis.
51) A patient who has been drinking a lot of tea has developed microcytic hypochromic
anemia and koilonychia because of iron deficiency, you advise the patient to increase
their intake of?
a. Tannates
b. Carbonates
c. Oxalates
d. Citric acids
e. Phosphates
52) A patient with drastically depleted ferritin iron levels comes to Westmoreland
Hospital. You being the brightest intern suspect the underlying cause to most likely
be?
a) Chronic bleeding
b) Menstruation
c) Dietary insufficiency
d) Increased Hepcidin
e) High tea consumption
53) Anemia with chronic disease is most likely caused by which cytokine?
a. IL-10
b. IL-12
c. IL-7
d. IL-1
e. IL-6
54) T/F In aplastic anemia a dry tap occurs, fat/fibrotic tissue replaces marrow, and
splenomegaly is missing.
55) A patient’s blood smear shows tear drop shaped red cells, and you diagnose the
patient with?
a. Polycythemia
b. Alpha Thalassemia
c. Hereditary Spherocytosis
d. Myelophthisic anemia
e. Aplastic anemia
56) Polycythemia Vera is a?
a. Relative polycythemia associated with high erythropoietin.
b. Relative polycythemia associated with low erythropoietin.
c. Absolute polycythemia associated with high erythropoietin.
d. Absolute polycythemia associated with low erythropoietin.