Bbc: Practice Questions 2

Front 1

A neonate is subjected to hemoglobin electrophoresis, wherein high levels of hemoglobin F are found along with hemoglobin S. What types of cells can eventually be expected on blood smear of this child?

A. Target cells
B. Downey cells
C. Helmet cells
D. Drepanocytes
E. Smudge cells

Back 1

Another name for sickle cells are Drepanocytes. D.

Front 2

Diseases that are associated with this are those with significantly decreased iron (so there is little iron, despite lots of membrane): Hemoglobin C disease, asplenia (having no spleen), thalassemia, and severe iron deficiency....what cell shape would be present here?

Back 2

target cells or bullseye center due ti excess cell membrane and dec iron

Front 3

What are Downey cells and where are they found?

Back 3

Downey cells are also known as Atypical Lymphocytes;
- excessively large with random-sized and -shaped nuclei
- basophilic (blue appearing).
- associated with EBV infection and CMV infections

Front 4

What cell is seen in hemolytic anemias?

Back 4

Helmet cells are also known as burr cells, bite cells, echinocytes, or schistocytes; they are red blood cells that have fragments or pieces missing from them, yielding irregularly shaped, jagged-edged, red blood cells.

Front 5

What is a smudge cell and where is it seen?

Back 5

Smudge cells are fragile B cells that break or smear (“smudge”) when smeared onto a glass slide; they can be indicative of possible chronic lymphocytic anemia.

Front 6

A 52-year old obese female with newly diagnosed atrial fibrillation is prescribed coumadin. She comes for a follow exam on the third day of her therapy wherein red, sharp-bordered lesions with multiple petechiae are appreciated on her breasts bilaterally. What could have prevented this?

A. Ibuprofen
B. Tissue-type plasminogen activator
C. Vitamin K
D. Low-molecular weight heparin administration at onset of coumadin therapy
E. Aspirin

Back 6

D. This woman has developed warfarin-induced skin necrosis. Coumadin is warfarin. Coumadin is an anticoagulant, working to inhibit the maturation of the vitamin K-dependent clotting factors in the liver. However, it also inhibits the formation of vitamin K-dependent pro-coagulants like proteins C and S. Since proteins C and S have a very short half-life, any inhibition to the production of functional new protein C and S molecules has effects within the first 24 hours

Front 7

A 54-year old male inpatient status post bowel resection 1 day ago is undergoing therapy with high-dose cephalosporins for an ongoing infection. During the surgery, he had two units of packed red blood cells. He has no specific complaints other than pain at the surgical site, but no more than what would be expected. Physical exam is unremarkable, and the surgical site looks good, except for a little more than expected bloody oozing. Today’s labs demonstrate a prolonged PTT, an elevated d-dimer, but a normal bleeding time and platelet count. What could be a cause for his laboratory findings?

A. Disseminated intravascular coagulation
B. Clotting factor dilution due to transfusions
C. Vitamin K deficiency
D. AHA generated by the cephalosporins
E. Pulmonary embolus

Back 7

A. This patient had two units of packed red blood cells. While dilution of clotting factors is certainly possible with transfusions, it is only possible with massive transfusions. This is not a massive transfusion. Vitamin K deficiency can result from use of high dose antibiotics, or even (rarely) bowel resection. The main source for vitamin K in the human body is actually that which is made by gut microbes. Anyone on long-term or high-dose antibiotics reduces the number of bowel normal flora, yielding decreased availability of vitamin K. Thus, this patient’s high-dose cephalosporins could cause a vitamin K deficiency; likewise, the bowel resection could have an effect. However, the effects would not be immediate, as the vitamin K deficiency would only affect clotting factors made AFTER the deficiency was in place. Hence, effects will not be seen for about 2-3 days, and that will be represented first by a prolonged PT. Eventually, the PTT will also become prolonged. Thus, it is too soon to see a prolonged PTT if the vitamin K deficiency is due to the high-dose antibiotics or bowel resection. AHA (autoimmune hemolytic anemia) generated by the cephalosporins is possible, in the form of warm antibody disease. However, that affects red blood cells, and not the clotting cascade.

Front 8

A patient was recently started on high-dose penicillin therapy, and now demonstrates evidence of sudden onset severe hemolytic anemia. What test would be best to specifically identify the suspected diagnosis?

A. Direct Coombs’ test
B. Ham’s test
C. Haptoglobin levels
D. Indirect Coombs’ test
E. TIBC

Back 8

A. The sudden onset following the initiation of high-dose penicillin suggests that this might be a form of autoimmune hemolytic anemia, most probably warm antibody disease. All autoimmune hemolytic anemias share one common theme: they feature anti-RBC antibodies. A direct Coombs’ test (also known as a direct antiglobulin test, or a DAT) tests for whether there is an antibody bound DIRECTLY to RBCs. This is the most specific test to identify and diagnose autoimmune hemolytic anemia. The indirect Coombs may be positive, too, since it determines if there are anti-RBC antibodies free in the serum (e.g., not directly bound, hence indirect). However, it does not prove that the antibodies are the cause of the hemolytic anemia.

Front 9

A patient presents with fatigue. Labs demonstrate decreased hemoglobin and hematocrit, and increased MCHC. Blood smear demonstrates sphere-shaped erythrocytes. What is the molecular event responsible for this disorder?

A. Spectrin deficiency
B. Ankyrin deficiency
C. Heme synthesis defect
D. Glucose-6-phosphate dehydrogenase deficiency
E. Antibody attack of red blood cells

Back 9

A. This patient has hereditary spherocytosis, a disorder in which the patient produces exclusively sphere-shaped RBCs (erythrocytes) known as spherocytes. Because the spleen removes such unusually shaped red blood cells from circulation, there is also a decreased number of red blood cells, yielding an anemia in concert with decreased hemoglobin and hematocrit. MCHC (mean corpuscular hemoglobin concentration) is elevated because whatever erythrocytes survive the hemolytic process (done by the spleen, in this case) tend to be smaller (due to fragments of cytoplasm and cytoplasm missing) but contain the same amount of hemoglobin as before (so the concentration of hemoglobin in the cell is higher than normal). Since elevated MCHC indicates that cells have been sheared, it is an indication for the presence of a hemolytic anemia. Hence, the combination of fatigue, low hemoglobin, low hematocrit, along with increased MCHC clearly indicates that this is a type of hemolytic anemia; the presence of the spherocytes allows us to identify which type of hemolytic anemia it is: hereditary spherocytosis.

Front 10

What type of arteriosclerosis affects primarily the radial and ulnar arteries of elderly persons and involves the development of calcific "pipestem" arteries?

A. atherosclerosis
B. hyperplastic arteriolosclerosis
C. hyaline arteriolosclerosis
D. benign nephrosclerosis
E. Monckeberg arteriosclerosis

Back 10

E. Correct Answer=E. This is Monckeberg arteriosclerosis: > 50 years old (usually elderly), affects primarily ulnar and radial arteries, involves benign calcium deposition on media of arteries (forming ring-like calcifications that do not obstruct blood flow but that do yield stiff, calcific arteries that are termed, colloquially, "pipestem arteries")

Front 11

A 55-year-old male is evaluated via colonoscopy. A large, sessile, velvety polyp with multiple finger-like villi is identified. What would be a true statement regarding this man's lesion?

A. it is adenomatous
B. it is a neoplastic adenoma
C. it is a neoplastic adenomatous polyp that is a villous adenoma
D. it is a neoplastic adenomatous polyp that is a villous adenoma and that, therefore, has the lowest potential for malignancy of all adenomatous polyps
E. it is a non-neoplastic polyp

Back 11

C. Correct Answer=C. Villous adenomas are large, sessile (broad-based), & velvety; all are adenomatous polyps. All adenomatous polyps are adenomas and all are neoplastic rather than simply benign proliferations of normal tissue; there are 3 types: tubular adenomas (most common, small, pedunculated (on a stem), lowest malignant potential), tubulovillous adenomas (pedunculated with finger-like villi), & villous adenomas (large, sessile, velvety with finger-like projections, highest malignant potential, associated with great GI K loss).

Front 12

A 24-year-old female presents with complaints of fatigue for one month. Physical examination is unremarkable. Labs demonstrate 3.0 million RBCs/uL (normal=4-5.5 million/uL), 4000 WBCs/uL (normal=4500-11000/uL), and 100,000 platelets/uL (normal=150,000-400,000/uL). Myeloblasts are identified. What marker would you expect to find?

A. M protein
B. TRAP
C. Smudge cells
D. Philadelphia chromosome
E. Auer rods

Back 12

E. Correct Answer=E. This is AML (acute myelogenous leukemia). Auer rods are red-staining peroxidase (+) needle-like crystals found in the myeloblasts and are evidence of myeloid proliferation of AML.

Front 13

What protein is seen in electrophoresis and is associated with multiple myeloma and Waldenstrom's macroglobulinemia?

Back 13

M protein

Front 14

The neoplastic B cells of Hairy Cell Leukemia stain positive for what?

Back 14

tartrate-resistant acid phosphatase (TRAP)

Front 15

Smudge cells, cells easily mechanically disrupted, are associated with what?

Back 15

chronic lymphocytic leukemia (CLL).

Front 16

Philadelphia Chromosome this is most closely associated with what?

Back 16

chronic myelogenous leukemia (CML).

Front 17

A young female who recently returned from vacation in Mexico now presents with severe, bloody diarrhea. Colonoscopy with biopsy reveals flask-shaped ulcers in the colon. What is the etiologic agent?

A. Clostridium difficile
B. Vibrio cholerae
C. Entamoeba histolytica
D. Tropheryma whippelii
E. Staphylococcus aureus

Back 17

C. This is amebiasis: bloody diarrhea, fecal-oral transmission, flask-shaped (tear-drop shaped) colonic ulcers, often associated with travel to third world nations. It's caused by Entamoeba histolytica.

Front 18

This causes pseudomembranous colitis: diarrhea with or without blood, often associated with antibiotic use, grayish/greenish mucosal exudate with necrotic, sloughing mucosal debris (pseudomembranes) as seen on colonoscopy

Back 18

Clostridium difficile

Front 19

This causes cholera: very watery diarrhea with no blood, normal mucosa on colonoscopy.

Back 19

Vibrio cholerae

Front 20

This causes Whipple disease, a malabsorptive disease with PAS-positive macrophages in small intestine mucosa

Back 20

Tropheryma whippelii

Front 21

The toxin from this causes vomiting + non-bloody, non-watery diarrhea without colonic lesions.

Back 21

Staphylococcus aureus

Front 22

A 25-year-old male presents with pruritic blistering vesicles on his knees and elbows. He has had it before. He also relates a multi-year history of recurrent bouts of diarrhea, especially after eating pizza, cereal, or pasta. What dermatologic condition does this probably represent?

A. Erythema multiforme
B. Psoriasis
C. Pemphigus vulgaris
D. Dermatitis herpetiformis
E. Chickenpox

Back 22

D. . Dermatitis herpetiformis is a cutaneous manifestation of Celiac Disease (malabsorption, recurrent diarrhea, sensitivity to wheat, rye, oats, & barley) and is characterized by recurrent vesicles that blister over such areas as the extensor surfaces of the elbows, knees, scalp, & sacral area.

Front 23

An 80-year-old male is evaluated for memory loss that has progressively worsened over the past 5 years. CT scan demonstrates generalized cerebral atrophy. If a post-mortem biopsy of the brain is later conducted, what finding would be expected?

A. Hirano bodies
B. Enlarged mamillary bodies
C. Pick bodies
D. Lewy bodies
E. Negri bodies

Back 23

A. This is Alzheimer's disease: usually > 60 years old; generalized cerebral atrophy; cognitive decline with memory loss (recent memory loss occurs before long-term memory loss), then motor decline; Hirano bodies (intracytoplasmic eosinophilic actinic inclusions in neuronal dendrites); A-beta40 amyloid; neurofibrillary tangles & senile plaques.

Front 24

You are studying cells that have long dendritic processes. They are antigen-presenting cells found in lymph nodes. What type of human leukocyte antigens are on the surface of these cells?

A. class I
B. class II
C. HLA-DP, -DQ, and -DR
D. classes I and II
E. HLA-A, -B, and -C

Back 24

D. These are dendritic cells, one of many types of antigen-presenting cells (APCs). All APCs. have human leukocyte antigen (HLA) class II on their cell surface. All nucleated cells, including APCs, have HLA class I on their cell surface.

Front 25

A 1-year-old boy is diagnosed with a yolk sac tumor. Where is the tumor and what tumor marker may be used to monitor it?

A. liver; CEA
B. testicle; CEA
C. bone; alkaline phosphatase
D. liver; AFP
E. testicle; AFP

Back 25

E. . A yolk sac tumor (endodermal sinus tumor) is, in males, a testicular tumor of infants and toddlers. Its tumor marker is alpha fetoprotein (AFP).

Front 26

A 40-year-old female presents with a large palpable, spongy superficial tumor just under the skin of the medial thigh. Biopsy demonstrates mature adipose tissue. What is the diagnosis?

A. liposarcoma
B. obesity
C. lipoma
D. rhabdomyosarcoma
E. fibrosarcoma

Back 26

C. a lipoma, the most common soft tissue tumor. It is benign

Front 27

A 1-year-old child is found to have hepatosplenomegaly, anemia, CNS deficits, and a cherry red spot on the macula. What enzyme deficiency exists?

A. hexosaminidase A
B. sphingomyelinase
C. glucose-6-phosphatase
D. glucocerebrosidase
E. L-iduronosulfate sulfatase

Back 27

B. is Niemann-Pick disease: hepatosplenomegaly, anemia, CNS deterioration, & cherry spot on macula. Sphingomyelinase is deficient, causing an accumulation of sphingomyelin.

Front 28

This is the enzyme deficiency for Tay-Sachs disease (CNS deterioration, mental retardation, macular cherry red spot, no hepatosplenomegaly).

Back 28

hexosaminidase A

Front 29

This is the enzyme deficiency for von Gierke disease (hepatomegaly, hypoglycemia).

Back 29

glucose-6-phosphatase

Front 30

This is the enzyme deficiency for Gaucher disease (hepatosplenomegaly, femoral head erosion, anemia (& CNS deterioration in many cases, as well).

Back 30

glucocerebrosidase

Front 31

This is the enzyme deficiency for Hunter syndrome (hepatosplenomegaly, retinal degeneration, mental retardation).

Back 31

L-iduronosulfate sulfatase

Front 32

What molecules facilitate leukocyte transmigration?

A. PECAM-1
B. IL-1
C. C5a
D. E-selectins
E. ICAM-1

Back 32

A. This is platelet endothelial cell adhesion molecule 1 which is on leukocytes and endothelium; it mediates transmigration, the movement of white blood cells across endothelium into soft tissues.

Front 33

An immigrant from Indonesia develops nasopharyngeal carcinoma. What is the likely etiology?

A. smoking
B. consumption of salty food
C. EBV
D. Helicobacter pylori
E. anti-neutrophil cytoplasmic antibody

Back 33

C. Nasopharyngeal carcinoma is most common to Southeast Asia & East Africa, and is caused by Epstein-Barr virus (EBV).

Front 34

A patient's kidney biopsy demonstrates thickening of the glomerular basement membrane with nodular accumulations of mesangium. What is the probable etiology?

A. SLE
B. Alport syndrome
C. Multiple myeloma
D. Diabetes mellitus
E. Goodpasture's disease

Back 34

D. Diabetes causes benign nephrosclerosis (hyaline arteriolosclerosis of renal vessels) and increased mesangial matrix - if diffusely increased, it is diffuse glomerulosclerosis; if the increase is nodular, it is nodular glomerulosclerosis (Kimmelstiel-Wilson nodule).

Front 35

A 22-year-old female presents with complaints of vulvar pruritis. Physical examination reveals an erythematous vulva, satellite lesions, and a white, bready-smelling, curd-like vaginal discharge. What drug should be administered?

A. fluconazole
B. metronidazole
C. ceftriaxone
D. doxycycline
E. miconazole

Back 35

E. is vaginal candidiasis (vulvar excoriations are also commonly appreciated). The drug of choice is miconazole. If the patient refuses this topical treatment, a single dose of oral fluconazole can be administered instead.

Front 36

A 40-year-old patient presents with complaints of itchy patches of skin on his face and dorsum of the hands. He has had multiple recurrent episodes of diarrhea. His girlfriend also states that he has been getting "weirdly" forgetful. What is the likely cause?

A. Alcoholism
B. Vitamin B3 deficiency
C. Cobalamin deficiency
D. Ascorbic acid deficiency
E. Vitamin B2 deficiency

Back 36

B. This is pellagra: diarrhea, dementia, dermatitis. It is due to niacin (vitamin B3) deficiency.

Front 37

This causes vitamin B1 (thiamine) deficiency; the acute onset form is called Wernicke's encephalopathy (confusion, ataxia, ophthalmoplegia). The slow onset form is beriberi (dry beriberi yields peripheral neuropathy and wet beriberi yields high-output cardiac failure). What is this?

Back 37

Alcoholism

Front 38

Ascorbic acid deficiency: what is this associated with?

Back 38

This is vitamin C deficiency (scurvy): bleeding gums, loose teeth, impaired wound healing, bone pain

Front 39

A patient presents with cold, blue hands, feet, and ears, plus low hemoglobin, high MCHC, and a positive direct Coombs test. What is the diagnosis?

A. Cold antibody disease
B. Raynaud's syndrome
C. TTP
D. Isoimmunization
E. Warm autoimmune hemolytic disease

Back 39

A. This is cold antibody disease: acrocyanosis (bluish coloration of hands, feet, scrotum, ears, &/or nose), Raynaud's syndrome, & anemia (resulting in lo hemoglobin). There's hemolysis due to anti-RBC antibodies. Because some cells are only sheared, MCHC (mean corpuscular hemoglobin concentration) is hi. The anti-RBC antibodies are detected via the direct Coombs test, a test that allows for ID anti-RBC antibodies directly bound to RBCs.

Front 40

What is the inheritance pattern for albinism?

A. autosomal dominant
B. autosomal recessive
C. X-linked recessive
D. X-linked dominant
E. mitochondrial inheritance

Back 40

B. autosomal recessive

Front 41

A patient has bilateral 1st MCP joint pain that lasts for 2 hours after awakening each day. No other complaints or findings are evident. What diagnostic measure would aid in confirming your suspected diagnosis?

A. MRI
B. X-Ray
C. CT scan
D. PET scan
E. More than one diagnostic test would have to be performed to confirm the diagnosis

Back 41

B. This is probably rheumatoid arthritis. Four of possibly 7 diagnostic criteria must be met in order to make the definitive diagnosis. Those 7 criteria include: am stiffness > 1 hour, arthritis in > 3 joints simultaneously, arthritis in hand joints, rheumatoid nodules, positive serum rheumatoid factor, symmetrical arthritis, bony erosions or decalcification as seen on X-ray.

Front 42

A male patient inherits a disease from his father. His father got it from the patient's great-grandmother (the father's grandmother). None of the father's aunts or uncles and neither of the father's parents have the disease. What is the likely means by which this disease is inherited?

A. mitochondrial inheritance
B. X-linked recessive
C. X-linked dominant
D. autosomal dominant
E. autosomal recessive

Back 42

E.

Front 43

An IV drug abuser develops sudden onset chills with high fever. A new onset murmur is appreciated. Blood cultures are positive. What is the likely disorder?

A. Pneumococcal pneumonia
B. Sepsis
C. Acute infective endocarditis
D. Subacute infective endocarditis
E. NBTE

Back 43

C. This is most likely acute infective endocarditis. Endocarditis is marked by a new onset murmur. Infective endocarditis (except for those caused by HACEK organisms) yield (+) blood cultures. IV drug users are most likely to develop acute infective endocarditis (which manifests with chills & high fever).