Hematology block 2 (Q46-73)

[wcb22]

Question 46





A 38 year old female has a history of rheumatoid arthritis, and she is currently receiving immunosuppressive therapy including corticosteroids. She has a CBC that shows Hgb 10.1 g/dL, Hct 30.4%, MCV 88 fL, WBC count 6500/microliter, and platelet count 137,000/microliter. Her reticulocyte count is 1.5%. She has a serum iron of 20 microgm/dl and iron binding capacity (TIBC) of 200 microgm/dl. Her serum ferritin is 420 ng/mL. Which of the following explanations for these findings is most likely:
A Chronic blood losss
B Beta-thalassemia
C Anemia of chronic disease
D Autoimmune hemolytic anemia
E Corticosteroid therapy
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Question 47 An enlarged cervical lymph node is biopsied. The node demonstrates prominent, well-defined paracortical follicles with germinal centers. This is most consistent with origin from:
A A 62-year-old female with infiltrating ductal carcinoma of breast and widespread metastases
B A 40-year-old male with a peripheral basophilia noted on a peripheral blood smear
C A 5-year-old boy with a sore throat and runny nose
D A 35-year-old female scratched by her cat when she pours cheap cat food into the cat's dish
E A 58-year-old male with Bence-Jones proteins in the urine
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Question 48 A 30-year-old male noticed a progressive cough for one month. On physical examination, a few small lymph nodes were palpable in the axillae, and the tip of the spleen was palpable. A CBC showed: Hgb 10.2 g/dL, Hct 31.1%, MCV 90 fL, WBC count 67,000/microliter, and platelet count 36,000/microliter. If blasts with Auer rods are seen in the peripheral blood smear, then the most likely diagnosis is:
A Acute myelogenous leukemia
B Plasma cell leukemia
C Chronic lymphocytic leukemia
D Acute lymphoblastic leukemia
E Leukoerythroblastosis
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Question 49 A peripheral blood smear was made when a CBC was ordered on a 64-year-old female scheduled to undergo a hernia repair. Many small, mature lymphocytes were seen. A CBC shows a total WBC count of 26,000/microliter, Hgb 11.2 g/dL, Hct 33.3%, MCV 90 fL, and platelet count 163,000/microliter. She reports increasing tiredness over the past year, which he attributed to job-related stress. She has no lymphadenopathy and no hepatosplenomegaly on physical examination. Which of the following conditions is she most likely to have:
A Leukemoid reaction
B Acute lymphocytic leukemia
C Infectious mononucleosis
D Cytomegalovirus infection
E Chronic lymphocytic leukemia
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Question 50 A 51-year-old female has been feeling tired for months. She is found to have decreased sensation over the lower extremities on physical examination. A CBC demonstrates the following findings: Hgb 9.5 g/dL, Hct 29.1%, and MCV 124 fL. The reticulocyte index is low. Hypersegmented PMN's are seen on the peripheral blood smear. Which of the following tests should be ordered next:
A Serum B12 and folate
B Bone marrow biopsy
C Serum ferritin
D Hemoglobin electrophoresis
E HIV antibody test
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Question 51 Biopsy of an enlarged supraclavicular lymph node from a 25 year old female reveals bands of fibrosis, lacunar cells (Reed-Sternberg variants), and focal necrosis. Which of the following features is NOT characteristic of the disease present in the lymph node:
A The prognosis is good with treatment.
B The patient is a young adult male.
C A bone marrow biopsy should be performed.
D Other lymph nodes may be involved.
E An immunoglobulin spike is present.
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Question 52 The most characteristic peripheral blood finding in a 19-year-old male with pharyngitis for several weeks accompanied by fever, lymphadenopathy, mild scleral icterus, and a positive monospot test is:
A Eosinophilia
B Atypical lymphocytosis
C Normocytic anemia
D Mild thrombocytopenia
E Increased band neutrophils
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Question 53 A 69 year old male has had chronic back pain for several months. He has lost some weight. He is not febrile. A CBC is performed and shows a WBC count of 9800/microliter with differential count of 63 segs, 7 bands, 2 metamyelocytes, 2 myelocytes 18 lymphs 8 monos, and 4 nucleated RBC's. The Hgb is 12.2 g/dL with Hct of 37.1%, MCV of 84 fL, and platelet count of 124,000/microliter. The most likely explanation for these findings is:
A Hemolytic anemia
B Chronic lymphocytic leukemia
C Staphylococcus aureus osteomyelitis
D Previous splenectomy
E Metastatic carcinoma
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Question 54 A 70 year old male has a CBC showing a Hgb of 10.6 g/dL, Hct 29.8%, MCV 92 fL, platelet count 95,000/uL, and WBC count 4,900/uL. The WBC differential count shows 67 segs, 4 bands, 2 metamyelocytes, 22 lymphs, 5 monos, and 2 nucleated RBC's per 100 WBC's. There are occasional tear drop cells on the peripheral blood smear. The most likely diagnosis is:
A Disseminated intravascular coagulation (DIC)
B Parvovirus infection
C Hereditary spherocytosis
D Previous splenectomy
E Myelofibrosis
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Question 55 A 45-year-old male is found to have the following findings on a CBC: Hgb 22.3 g/dL, Hct 65.7%, MCV 89 fL, MCHC 33.9 pg/mL, MCH 34.2, platelet count 445,000/microliter, and WBC count 12,500/microliter with 80% segs, 5% bands, 3% monos, and 7% lymphs. On physical exam he has a palpable spleen tip. Which of the following conditions is the most probable diagnosis:
A Chronic myelogenous leukemia
B Polycythemia vera
C Miliary tuberculosis
D Epstein-Barr virus infection
E Dehydration
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Question 56 A 30 year old female is found to have a peripheral blood WBC count of 10,500/microliter with differential count 61 segs, 3 bands, 15 lymphs, 8 monos, and 13 eos. These findings can be generally be associated with each of the following EXCEPT:
A Infection with Ascaris lumbricoides
B Hypersensitivity pneumonitis
C Extrinsic asthma
D Corticosteroid therapy
E Chronic myelogenous leukemia
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Question 57 A 62 year old male has decreasing renal function, and a urinalysis reveals increased protein. A serum protein electrophoresis reveals a large 4 gm monoclonal gamma spike. This is consistent with the appearance of all of the following additional laboratory findings EXCEPT:
A Elevated BUN and creatinine
B Increased sedimentation rate
C Chromosomal translocation
D Hypercalcemia
E Normocytic anemia
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Question 58 An Internal Medicine resident in Seattle noted the appearance of sickled erythrocytes on a peripheral blood smear when reviewing the smear with the pathhologist. This is most indicative of which of the following clinical situations:
A A 20 year old African-American male with severe abdominal pain and cramping
B A premature Caucasian neonate who is noted to be jaundiced
C A 45 year old Caucasian female has recently had parvovirus B19 infection
D A 72 year old Asian male with chronic atrophic gastritis
E A 25 year old Indian female with Wilson's disease and marked ascites
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Question 59 A 41 year old male has a Hgb of 11.5 g/dL, Hct 34.2%, MCV 90 fL, WBC count 13,400/microliter, and platelet count 37,000/microliter. The appearance of a "helmet cell" (a type of schistocyte) on examination of the peripheral blood smear is most consistent with origin from a patient who has:
A A diagnosis of beta-thalassemia
B Adenocarcinoma of the colon
C Septicemia with E. coli
D Hereditary spherocytosis
E Massive splenomegaly
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Question 60 A 45 year old plethoric male presents with headache and dizziness. Physical examination reveals no lymphadenopathy. A bone marrow biopsy demonstrates hypercellularity with all cell lines increased in number. Which set of findings is most likely to be present:
A WBC differential count: 80 segs, 14 bands, 4 lymphs, 1 mono, 1 eosinophil
B CBC with Hgb 20 gm/dl, Hct 61%, and MCV 92 fL
C Total lymphocyte count of 200 per microliter
D CBC with Hgb 10 gm/dl, Hct 30%, MCV 85 fL, Platelet count 3,000 per microliter
E WBC differential count: 59 segs, 3 bands, 18 lymphs, 5 monos, 15 eosinophils
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Questions 61 and 62: Click on the checkbox first, then the lettered item. (61) A 13 year old male has a chronic anemia. A Hgb electrophoresis shows 95% Hgb S, 4% Hgb F, and 1% Hgb A2.
(62) A 30 year old female is anemic, with Hgb 11.1 g/dL, Hct 28.8%, and MCV 77 fL. The WBC count is normal, and she has mild reticulocytosis. RBC morphology shows small cells that lack central pallor. Physical examination reveals a palpable spleen tip..
A Autosomal dominant, European ancestry
B Autosomal recessive, Asian ancestry
C X-linked recessive, Middle Eastern ancestry
D Autosomal recessive, West African ancestry
E Sporadic occurrence
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Questions 63 and 64: Click on the checkbox first, then the lettered item. (63) A 9 year old previously healthy boy is noted by his teacher to be lethargic. He has not participated in games at recess for many weeks. The boy says he always feels tired. A workup is done that includes a CBC which shows a Hgb of 9.8 g/dL, Hct 28.2%, MCV 95 fL, platelet count 74,000/uL, and WBC count 2300 with differential count of 23 segs, 15 bands, 12 monos, 44 lymphs, 5 eos, and 1 baso. Physical examination reveals no lymphadenopathy and no organomegaly..
(64) A 32 year old female presents with fever and headache. She develops purpuric hemorrhages on her skin. Her serum fibrinogen is 55 mg/dL. A CBC shows Hgb 13.3 g/dL, Hct 40.2%, MCV 93 fL, WBC count 34,000/microliter, and platelet count 11,500/microliter. A WBC differential count shows 38 segs, 8 bands, 5 metamyelocytes, 1 myelocyte, 41 promyelocytes, 5 lymphs, and 2 monos.
A Disseminated intravascular coagulation
B Numerous Auer rods
C Philadelphia chromosome
D Polycythemia
E Terminal deoxynucleotydyl transferase (TDT)
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Questions 65 and 66: Click on the checkbox first, then the lettered item. (65) A 29 year old female with a history of systemic lupus erythematosus has a feeling of dizziness with fatigue. Physical examination reveals no lymphadenopathy, but she has a palpable spleen tip. She has a CBC that shows Hgb 8.9 g/dL, Hct 27.8%, MCV 105 fL, RDW 22, WBC count 8650/microliter, and platelet count 222,000/microliter.
(66) A 22 year old female delivers a 3100 gm baby at 35 weeks gestation. The baby is hydropic. The baby is noted to have a bilirubin of 10.5 mg/dL with Hgb 8.3 g/dL.
A Positive indirect Coombs test
B Hypochromic microcytic RBC's
C Positive direct Coombs test
D Decreased reticulocyte count
E Increased osmotic fragility
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Questions 67 and 68: Click on the checkbox first, then the lettered item. (67) The genetic distribution of sickle cell anemia is based upon the presence of this infectious agent.
(68) Autoimmune hemolytic anemia can appear in persons infected with this agent.
A Mycoplasma
B Parvovirus
C Plasmodium
D Hepatitis virus
E Babesia
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Questions 69 and 70: Click on the checkbox first, then the lettered item. (69) A 54-year-old male is dehydrated following a marathon race run on the big island of Hawaii.
(70) A 61-year-old male smoker has a hilar lung mass and bone metastases. He has developed easy bruisability, moon facies, and truncal obesity despite an overall weight loss.
A Eosinophilia
B Neutrophilia
C Monocytosis
D Lymphopenia
E Polycythemia
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Question 71 and 72: Click on the checkbox first, then the lettered item. (71) A 40-year-old male states that he would like to cut down on his alcohol consumption.
(72) A 25-year-old female who has a poor diet is in the third trimester of pregnancy.
A MCV of 145
B MCV of 105
C MCV of 85
D MCV of 75
E MCV of 55
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Question 73 A 51 year old male returns to the clinic several weeks after being placed on anti-hypertensive medications. He still has the substernal burning epigastric pain that initially brought him to see a physician. His doctor notes that the CBC drawn on his first visit revealed a WBC count of 6600/microliter with WBC differential count of 62 segs, 4 bands, 22 lymphs, 9 monos, 2 eos, and 1 baso. His Hgb is 11.3 g/dL, Hct 32.1%, MCV 75 fL, and platelet count 168,000/microliter. The most cost-effective test to perform at this point is a(an):
A Hemoglobin electrophoresis coagulation (DIC)
B Serum haptoglobin
C Antibody screen
D Stool guaiac
E Urinalysis
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[nimithomas]

what do you think is a decent score to get on these practice questions?

[wcb22]

from my limited experience, i've noticed they are close the the qbank scores, but i guess it just depends.

i think passing (75/182) is in the low low 60s%, average is around 70% (85-88/210-217), and 74-75% average would be lower 90s/(222-227) on boards, 80% here would put you into mid-upper 90s (235+) on boards.

but then again, this is only one subject, but a very important one.