Block 10 RBC MCQ's

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Block 10 RBC MCQ

Questions and Answers
  • 1. 

    An 18 year old Swedish girl presents with jaundice and anemia. Laboratory studies are significant for a decreased mean cell volume (MCV), an increased mean corpuscular hemoglobin concentration (MCHC), and an increase in osmotic fragility of the red blood cells. Red blood cells on peripheral blood smear (PBS) are most likely to be

    • A.

      Schistocytes

    • B.

      Polkiolocytes

    • C.

      Spherocytes

    • D.

      Hypochromic microcytic red blood cells

    Correct Answer
    C. Spherocytes
    Explanation
    The laboratory findings of decreased MCV, increased MCHC, and increased osmotic fragility of red blood cells are characteristic of hereditary spherocytosis. In this condition, the red blood cells are spherical in shape instead of the usual biconcave disc shape. This abnormal shape leads to increased fragility and destruction of the red blood cells, resulting in anemia. Therefore, the most likely appearance of the red blood cells on peripheral blood smear would be spherocytes.

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  • 2. 

    A 52-year-old woman suffers from an acute onset of normocytic, normochromic anemia, hemoglobinuria, hemosiderinuria, and jaundice accompanied by a decreased serum haptoglobin. What is the most likely cause of this patient's findings?

    • A.

      Hemolysis

    • B.

      Iron deficiency

    • C.

      Inadequate production of red blood cells

    • D.

      Hemorrhage.

    Correct Answer
    A. Hemolysis
    Explanation
    The patient's presentation of acute onset normocytic, normochromic anemia, hemoglobinuria, hemosiderinuria, jaundice, and decreased serum haptoglobin is indicative of hemolysis. Hemolysis refers to the breakdown of red blood cells, leading to the release of hemoglobin into the bloodstream. This can result from various causes such as autoimmune disorders, infections, certain medications, or genetic conditions. The presence of hemoglobinuria and hemosiderinuria suggests intravascular hemolysis, where red blood cells are destroyed within the blood vessels. The decreased serum haptoglobin levels further support the diagnosis of hemolysis as haptoglobin binds to free hemoglobin to prevent its loss in the urine.

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  • 3. 

    A 17-year-old black male has a history of severe lifelong anemia requiring many blood transfusions. He has non-healing leg ulcers and recurrent episodes of abdominal and chest pain. These signs and symptoms are most likely associated with which one of the following laboratory abnormalities?

    • A.

      Positive RBC sucrose hemolysis test

    • B.

      Positive RBC osmotic fragility test

    • C.

      Positive direct Coombs test

    • D.

      Increased hemoglobin S on electrophoresis

    Correct Answer
    D. Increased hemoglobin S on electrophoresis
    Explanation
    The signs and symptoms described in the question, including severe lifelong anemia, non-healing leg ulcers, and recurrent episodes of abdominal and chest pain, are most likely associated with sickle cell disease. Increased hemoglobin S on electrophoresis is characteristic of sickle cell disease, which is a genetic disorder that causes red blood cells to become misshapen and leads to various complications, including anemia and tissue damage.

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  • 4. 

    A 33-year-old woman was admitted to the hospital for a hysterectomy to control excessive uterine bleeding. Her Hgb was 7.4 gmjdL, hematocrit was 23% and red blood cell count was 2 millionjmm3. The most likely cause of her anemia is

    • A.

      Bone marrow failure

    • B.

      Chronic blood loss and iron deficiency anemia

    • C.

      Acute blood loss and iron deficiency

    • D.

      Hemolysis and irc:m deficiency

    Correct Answer
    B. Chronic blood loss and iron deficiency anemia
    Explanation
    The most likely cause of the woman's anemia is chronic blood loss and iron deficiency anemia. This can be inferred from the information provided, such as the excessive uterine bleeding and the low levels of hemoglobin, hematocrit, and red blood cell count. Chronic blood loss can lead to a decrease in iron stores in the body, resulting in iron deficiency anemia.

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  • 5. 

    In a 34-year-old patient with a hemoglobin of 5.2 gjdL, a smooth and sore tongue, and spooning of the fingernails, the most likely red blood cell ind ices would be

    • A.

      Macrocytic indices

    • B.

      Normocytic indices with reticulocytosis

    • C.

      Microcytic and hypochromic indices

    • D.

      Normocytic indices without reticulocytosis

    Correct Answer
    C. Microcytic and hypochromic indices
    Explanation
    The patient's symptoms of a smooth and sore tongue, along with spooning of the fingernails, are consistent with iron deficiency anemia. In iron deficiency anemia, the red blood cells are typically smaller (microcytic) and have a decreased color (hypochromic) due to insufficient iron for hemoglobin production. Therefore, the most likely red blood cell indices would be microcytic and hypochromic.

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  • 6. 

    A 30 year old man with Hodgkin's Lymphoma is hospitalized with a fever and infection . Physical exam reveals a pale thin man with lymphadenopathy and spenolmegaly. His laboratory data show a low serum iron, low serum iron binding capacity, low mean corpuscular hemoglobin concentration and low mean cell volume. What is the most likely diagnosis?

    • A.

      Myelophthisic anemia

    • B.

      Anemia of chronic disease

    • C.

      Megaloblastic anemia

    • D.

      Iron deficiency anemia

    • E.

      Thalessemia

    Correct Answer
    B. Anemia of chronic disease
    Explanation
    The patient's presentation of fever, infection, lymphadenopathy, and splenomegaly, along with the laboratory findings of low serum iron, low serum iron binding capacity, low mean corpuscular hemoglobin concentration, and low mean cell volume, are consistent with the diagnosis of anemia of chronic disease. Anemia of chronic disease is characterized by a chronic inflammatory condition, such as Hodgkin's Lymphoma, which leads to decreased iron availability and impaired erythropoiesis. This type of anemia is typically normocytic and normochromic, as seen in this patient.

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  • 7. 

    A 65-year-old man with vague symptoms, fatigue and weight loss has a Hb=8 and Hct=24. His PBS shows hypochromic microcytic RBCS. His reticulocyte count is low. Which of the following would be most helpful in establishing a diagnosis?

    • A.

      Direct Coombs test

    • B.

      Indirect Coombs test

    • C.

      Hemoglobin electrophoresis

    • D.

      Schilling test

    • E.

      Digital rectal exam and stool guaiac test

    Correct Answer
    E. Digital rectal exam and stool guaiac test
  • 8. 

    A 54-year-old woman who was being treated for hypertension with alpha methyldopa presented with malaise and generalized weakness. Her Hb=8 and Hct=24. Her corrected reticulocyte count and RDW are both increased. Spherocytes is seen on peripheral smear. Which of the following is the best test to order to help confirm the diagnosis?

    • A.

      Indirect Coombs test

    • B.

      Direct Coomb's test

    • C.

      Bone marrow examination

    • D.

      Osmotic fragility

    • E.

      Protein electrophoresis

    Correct Answer
    B. Direct Coomb's test
    Explanation
    The Direct Coomb's test is the best test to order in this case because the patient's presentation is consistent with autoimmune hemolytic anemia (AIHA), which is characterized by the destruction of red blood cells by autoantibodies. The Direct Coomb's test detects the presence of antibodies bound to the patient's red blood cells, confirming the diagnosis of AIHA. The other options are not specific for AIHA and would not provide the same level of diagnostic information.

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  • 9. 

    A 24-year-old woman presents with epistaxis.' Her physical exam reveals moderate splenomegaly. Her platelet count is significantly decreased, but her red and white blood cells are within normal limits. What is the next best step that should be done in the evaluation of this patient?

    • A.

      Bleeding time

    • B.

      Bone marrow biopsy

    • C.

      Complete blood count

    • D.

      Ristocetin test

    • E.

      Osmotic Fragility test

    Correct Answer
    B. Bone marrow biopsy
    Explanation
    The next best step in the evaluation of this patient is a bone marrow biopsy. This is because the patient presents with epistaxis and moderate splenomegaly, which could indicate a hematologic disorder such as aplastic anemia or myelodysplastic syndrome. A bone marrow biopsy can help determine the cause of the decreased platelet count and provide further information for diagnosis and treatment. The other options, such as bleeding time, complete blood count, Ristocetin test, and osmotic fragility test, may not provide enough information to identify the underlying condition.

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  • 10. 

    A coagulation consult is requested for an asymptomatic patient who has had a surgery six days previously and a prolonged hospital course requiring intravenous antibiotics. Her PT & PTT are both prolonged. Mixing studies with normal plasma show that both PT and PTT are completely corrected. Which of the following coagulation factors is most likely to be decreased?

    • A.

      Factor VIII

    • B.

      Factor X

    • C.

      Factor VII

    • D.

      Factor XI

    • E.

      Factor IX

    Correct Answer
    B. Factor X
    Explanation
    The correct answer is factor X. This is because the mixing studies show that both the PT and PTT are completely corrected, indicating that the patient's prolonged clotting times are due to a deficiency in a coagulation factor rather than an inhibitor. Among the options given, factor X is the most likely factor to be decreased as it plays a crucial role in the common pathway of the coagulation cascade.

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  • 11. 

    Which of the following conditions is associated with the most severe serum haptoglobin depletion?

    • A.

      Intravascular hemolysis

    • B.

      Chronic blood loss

    • C.

      Extravascular hemolysis

    • D.

      Acute blood loss

    Correct Answer
    A. Intravascular hemolysis
    Explanation
    Intravascular hemolysis is associated with the most severe serum haptoglobin depletion. Intravascular hemolysis refers to the breakdown of red blood cells within the blood vessels, leading to the release of hemoglobin. Haptoglobin is a protein that binds to free hemoglobin in the bloodstream, preventing its loss through urine and protecting against oxidative damage. In cases of intravascular hemolysis, there is a significant release of hemoglobin, leading to a rapid depletion of haptoglobin levels. This is in contrast to extravascular hemolysis, where red blood cells are broken down outside of the blood vessels, and haptoglobin is not as severely depleted. Chronic blood loss and acute blood loss do not directly involve the breakdown of red blood cells and are not associated with significant haptoglobin depletion.

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  • 12. 

    In a patient w ith normocytic normochromic anemia, which of the following is the earl iest laboratory sign indicating iron deficiency?

    • A.

      Decreased serum iron and increased serum tranferrin

    • B.

      Decreased serum transferrin and increased transferrin saturation

    • C.

      Increased serum transferrin and decreased transferrin saturation

    • D.

      Decreased serum ferritin and depletion of bone marrow iron store

    Correct Answer
    D. Decreased serum ferritin and depletion of bone marrow iron store
    Explanation
    The correct answer is "Decreased serum ferritin and depletion of bone marrow iron store." Serum ferritin is a marker of iron stores in the body, and a decrease in serum ferritin levels indicates a depletion of iron stores. This is an early laboratory sign of iron deficiency anemia. Additionally, the depletion of iron stores in the bone marrow further supports the diagnosis of iron deficiency.

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  • 13. 

    In patients with heparin-induced thrombocytopenia, which of the following is the most dangerous complication?

    • A.

      Gastrointestinal bleeding and bleeding after tooth extraction

    • B.

      Cerebral hemorrhage and hemarthrosis

    • C.

      Bleeding from a postoperative wound and multiple bruises

    • D.

      Pulmonary thromboembolism and cerebral sinus thrombosis

    Correct Answer
    D. Pulmonary thromboembolism and cerebral sinus thrombosis
    Explanation
    Pulmonary thromboembolism and cerebral sinus thrombosis are the most dangerous complications in patients with heparin-induced thrombocytopenia. Pulmonary thromboembolism refers to a blockage in the pulmonary artery, which can lead to severe respiratory distress and even death. Cerebral sinus thrombosis is the formation of a blood clot in the veins that drain blood from the brain, which can cause stroke-like symptoms and potentially be fatal. Both of these complications are life-threatening and require immediate medical attention.

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  • 14. 

    Which microorganism is associated with development of cold immunohemolytic anemia?

    • A.

      Strepococcus pleumoniae and Salmonella typhi

    • B.

      Ebstein-Barr virus and Mycoplasma pneumoniae

    • C.

      E.coli 0157: H7 and Shigella dysenteriae

    • D.

      Chlamydiae trachomatis and parvovirus B19

    Correct Answer
    B. Ebstein-Barr virus and Mycoplasma pneumoniae
  • 15. 

    Which of the following best describes the iron panel seen in patients with anemia of chronic diseases?

    • A.

      Increased ferritin, decreased serum iron, decreased TIBC, decreased % saturation

    • B.

      Decreased ferritin, decreased serum iron, increased TIBC, decreased % saturation

    • C.

      Increased ferritin, increased serum iron, decreased TIBC, increased % saturation

    • D.

      Normal ferritin, normal serum iron, normal TIBC, normal % saturation

    Correct Answer
    A. Increased ferritin, decreased serum iron, decreased TIBC, decreased % saturation
    Explanation
    Patients with anemia of chronic diseases typically have increased ferritin levels due to inflammation and increased iron storage. However, their serum iron levels are decreased as iron is sequestered within macrophages. Additionally, the total iron-binding capacity (TIBC) is decreased because the body's iron stores are already saturated. As a result, the percentage saturation of transferrin, which represents the amount of iron bound to transferrin, is also decreased.

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  • 16. 

    Which of the following are the diagnostic signs that distinguish between B12-and folate-deficiency megaloblastic anemia?

    • A.

      Pallor and fatigue

    • B.

      Paresthesias in hands and feet

    • C.

      Cheilosis/cheilitis and atrophic glossitis

    • D.

      Macroovalocytes and hypersegmented neutrophils in peripheral blood

    Correct Answer
    B. Paresthesias in hands and feet
    Explanation
    Paresthesias in hands and feet are diagnostic signs that distinguish between B12 and folate-deficiency megaloblastic anemia. This symptom refers to abnormal sensations such as tingling, numbness, or a "pins and needles" feeling in the hands and feet. This is a specific manifestation of B12 deficiency and is not typically seen in folate deficiency. Other symptoms like pallor and fatigue, cheilosis/cheilitis, atrophic glossitis, and macroovalocytes and hypersegmented neutrophils in peripheral blood can be present in both B12 and folate deficiency, but paresthesias in hands and feet are more specific to B12 deficiency.

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  • 17. 

    A 32-year-old Swedish woman presents to her obstetrician for a prenatal examination in her 8th  month of gestation. She complains of severe fatigue. Physical examination reveals a pale woman with tachypnea and tachycardia. Her laboratory data is significant for a decreased red blood cell and corrected reticulocyte count and a decrease in MCV and MCHC. What is the most likely diagnosis?

    • A.

      Acute blood loss

    • B.

      Hereditary spherocytosis

    • C.

      Iron deficiency

    • D.

      Sickle cell anemia

    • E.

      G6PD Deficiency

    Correct Answer
    C. Iron deficiency
    Explanation
    The most likely diagnosis for this patient is iron deficiency. Iron deficiency is a common cause of anemia in pregnancy, and the patient's symptoms and laboratory findings are consistent with this diagnosis. The decreased red blood cell count, corrected reticulocyte count, MCV, and MCHC are all indicative of iron deficiency anemia. Additionally, the patient's complaint of severe fatigue is a common symptom of iron deficiency.

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  • 18. 

    The bone marrow shown below was most likely taken from a patient with:

    • A.

      Pancytopenia and low reticulocyte count

    • B.

      Erythrocytopenia and low reticulocyte count

    • C.

      Pancytopenia and high reticulocyte count

    • D.

      Erythopenia and high reticulocyte count

    Correct Answer
    A. Pancytopenia and low reticulocyte count
    Explanation
    The bone marrow shown is most likely taken from a patient with pancytopenia and low reticulocyte count. Pancytopenia refers to a decrease in all three blood cell types (red blood cells, white blood cells, and platelets) and low reticulocyte count indicates decreased production of red blood cells. This suggests a bone marrow disorder or failure, leading to a decrease in all blood cell types.

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  • 19. 

    A 21 year old Italian girl comes to your office with severe shortness of breath. Her past medical history is significant for frequent red blood cell transfusions. Physical examination reveals a jaundiced woman in respiratory distress with pallor of the conjunctiva and oral mucosa, tachypnea and tachycardia. Laboratory tests are significant for decreased hemoglobin, hematocrit, red blood cell count, MCV, and MCHC. What is the most likely diagnosis?

    • A.

      B-Thalassemia Major (Cooley's Anemia)

    • B.

      B-Thalassemia Minor

    • C.

      A-Thalassemia Major

    • D.

      A-Thalassemia Minor

    Correct Answer
    A. B-Thalassemia Major (Cooley's Anemia)
    Explanation
    The most likely diagnosis for this patient is B-Thalassemia Major (Cooley's Anemia). The patient's symptoms and laboratory findings are consistent with severe anemia, which is a characteristic feature of B-Thalassemia Major. The frequent red blood cell transfusions in the past medical history suggest a chronic condition that requires regular transfusions to maintain hemoglobin levels. The jaundice, pallor, and respiratory distress are also common manifestations of severe anemia. The decreased hemoglobin, hematocrit, red blood cell count, MCV, and MCHC are all consistent with B-Thalassemia Major, as these parameters are typically decreased in this condition.

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  • 20. 

    The following picture was taken of a peripheral blood smea r from an automobile accident victim who was brought to the ER with a blood pressure of 60 mm Hg (palpable) and a weak but rapid pulse (115 bpm). Physical exam revealed a cool , diaphoretic young man with no visible signs of bleeding. Laboratory data would most likely show a/an:

    • A.

      Decreased hemoglobin and hematocrit with a normal MCV and MCHC

    • B.

      Decreased hemoglobin, hematocrit, MCV and MCHC

    • C.

      Decreased hemoglobin and hematocrit with an increassed MCV and MCHC

    • D.

      Increased hemoglobin and hematocrit with a normal MCV and MCHC

    Correct Answer
    A. Decreased hemoglobin and hematocrit with a normal MCV and MCHC
    Explanation
    The description of the patient's condition, including low blood pressure and weak but rapid pulse, suggests that the patient is in a state of shock. In cases of shock, the body tries to compensate by constricting blood vessels and increasing heart rate, which can lead to decreased blood volume. This decrease in blood volume would result in a decreased hemoglobin and hematocrit level. The normal MCV (mean corpuscular volume) and MCHC (mean corpuscular hemoglobin concentration) suggest that the size and color of the red blood cells are within normal range, indicating that there is no significant abnormality in the red blood cell morphology.

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  • 21. 

    During your internal medicine rotation, you are asked to take an history and perform a physical examination on a 55-year-old man with AIDS. Your findings include a history of headaches, confusion, fever, bleeding from his nose and gums with petechiae and purpura found on his trunk and extremities. The patient's partner also reported that he has had some episodes of bizarre behavior. Wh ich of the following laboratory results would be most helpful in confirming your diagnosis?

    • A.

      Normal PT & PTT, increased bleeding time, and decreased platelet count

    • B.

      Increased PT, PTT, bleeding time, and platelet count

    • C.

      Decreased PT, PTT, bleeding time and platelet count

    • D.

      Normal PT, PTT, bleeding time and platelet count

    Correct Answer
    A. Normal PT & PTT, increased bleeding time, and decreased platelet count
    Explanation
    The given laboratory results would be most helpful in confirming the diagnosis of thrombocytopenia, which is a condition characterized by a decreased platelet count. The normal PT (prothrombin time) and PTT (partial thromboplastin time) indicate that the patient's coagulation factors are functioning properly. However, the increased bleeding time suggests impaired platelet function, while the decreased platelet count confirms the diagnosis of thrombocytopenia. This combination of findings is consistent with the patient's symptoms of bleeding from the nose and gums with petechiae and purpura.

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  • 22. 

    You are asked to examine the peripheral blood smears (image) from a 2 year old Swedish girl. Her mother reports that her little girl does not seem her usual energetic self and has no appetite. She also noticed the whites of her daughter's eyes had turned yellow. Physical exam reveals a listless pale girl with icteric sclera and splenomegaly. Her complete blood count shows a decrease in red blood cells, hemoglobin, and hematocrit. Which of the following test would be most beneficial in confirming your diagnosis?

    • A.

      Hemoglobin electrophoresis

    • B.

      Osmotic fragility test

    • C.

      Direct Coombs test

    • D.

      Indirect Coombs test

    • E.

      Total bilirubin

    Correct Answer
    B. Osmotic fragility test
    Explanation
    The most beneficial test in confirming the diagnosis in this case would be the osmotic fragility test. This test is used to evaluate the fragility of red blood cells and can help diagnose conditions such as hereditary spherocytosis, which is characterized by decreased red blood cell survival and increased osmotic fragility. Given the patient's symptoms of anemia, jaundice, and splenomegaly, hereditary spherocytosis is a likely diagnosis. The osmotic fragility test would help confirm this by demonstrating increased fragility of the red blood cells.

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