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Quiz Hematology Oncology Part 1 of 2

Quiz Hematology Oncology Part 1 of 2

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Quiz Hematology Oncology Part 1 of 2
Quiz Hematology Oncology Part 1 of 2

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Published by: MedShare on Apr 15, 2009
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1) A diplomat plans to make a trip to Central America. However, just before leaving, his
doctor receives a CDC report of jungle log cutters that have fallen ill with jaundice,
instances of hemorrhage, and liver dysfunction. He insists that the diplomat be
immunized against this infectious agent before traveling to the area. Which of the
following is NOT a transmission means for this virus, yellow fever?
a) Haemagogus mosquitoes
b) Aedes aegypti mosquitoes
c) Human to human
d) Monkey to human
e) None of the above
2) For a summer trip, a woman visits the tropics for a short time. One week upon
returning, she shows signs of fever, headaches, and pain behind the eyes and in the back
and joints. She also notices a generalized rash forming. The doctor explains that the
illness will pass. This flavivirus, dengue fever, is transmitted by aedes aegypti
mosquitoes and replicates inside what kind of cells?
a) Neutrophils
b) Lymphocytes
c) Monocytes
d) Eosinophils
e) Basophils
3.1) Which of the following diseases is NOT matched correctly with the vector?
a) Rocky Mountain spotted fever; Rabbit
b) Rickettsialpox; Infected mite
c) Epidemic typhus; Louse
d) Endemic typhus; Flea
e) Scrub typhus; Mite
3.2) Which of the following diseases is NOT matched correctly with the reservoir?
a) Rocky Mountain spotted fever; Rodents
b) Rickettsialpox; Mice
c) Epidemic typhus; Human
d) Endemic typhus; Human
e) Scrub typhus; Rodent
4) A patient presents to your office complaining of fever, conjunctival redness, a severe
headache and a rash that he states started out on his wrists, ankles soles and palms and
later spread to his trunk. While on vacation in North Carolina/Oklahoma recently, the
patient found several ticks on his body. Rocky Mountain spotted fever (RMSF) is
suspected so a Weil-Felix test is ordered to find serum antigens from Proteus vulgaris. A
positive test would show latex beads coated with proteus antigens and agglutinate. Which
of the following is specific for Rickettsia species RMSF in this Weils reaction?
a) OX-19: Positive, OX-2: Positive, OX-K: Positive
b) OX-19: Positive, OX-2: Positive, OX-K: Negative
c) OX-19: Positive, OX-2: Negative, OX-K: Negative
d) OX-19: Negative, OX-2: Negative, OX-K: Positive
e) OX-19: Negative, OX-2: Negative, OX-K: Negative

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5) A war veteran presents with a rash spreading outward from his trunk but sparing his
palms. He says it reminds him of what he had decades ago while in a war camp. At that
time, he had “flu-like” symptoms with the rash and recovered without treatment. Brill-
Zinsser disease is suspected. What disease is this diagnosed as?
a) Rocky Mountain spotted fever
b) Rickettsialpox
c) Epidemic typhus
d) Endemic typhus
e) Scrub typhus
6.1) A man from Ethiopia presents with relapsing fever, jaundice, mental disturbances,
bleeding, and a prolonged QT interval. There are areas of rash that the man scratches.
The clinician uses extra precautions to prevent transmission to her self and other patients.
What is the likely vector for this relapsing fever?
a) Rabbit
b) Mite
c) Louse
d) Flea
e) Tick
6.2) A camper from Colorado presents with abrupt onset of relapsing fever, rigors, and
severe headache. Exam reveals a rapid pulse. Typhoid fever is ruled out. A blood test
reveals spirochetes. What is the likely vector for this relapsing fever?
a) Rabbit
b) Mite
c) Louse
d) Flea
e) Tick
6.3) A patient is being treated with antibiotics for relapsing fever. They develop
apprehension, diaphoresis, fever, tachycardia, and hypotension. A Jarisch-Herxheimer
reaction is suspected. What drug was the patient taking?
a) Tetracycline
b) Erythromycin
c) Chloramphenicol
d) Penicillin G
e) TMP-SMX
7) A hunter from Pennsylvania presents with fever and fatigue. Physical exam reveals
erythema migrans. The clinician decides to start doxycycline instead of amoxicillin. What
is the bacteria and vector responsible?
a) Borrelia burgdorferi from ticks
b) Coxiella burnetii from goats
c) Rickettsia prowazekii from flying squirrels
d) Rickettsia rickettsia from dogs/rodents
e) Borrelia recurrentis from body louse
8.1) A patient presents with flu-like symptoms. A Geimsa-stained preparation of
peripheral blood shows morulae, where bacteria have assembled into membrane enclosed
masses. Ehrlichiosis due to E. chaffeensis is diagnosed. What cell type is infected?
a) Erythrocytes

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b) Leukocytes
c) Platelets
d) CNS fluid and cells
e) Myeloid bone marrow
8.2) A patient presents with flu-like symptoms. A blood smear slows morulae and an
indirect immunofluorescence assay (IFA) is diagnostic for A. phagocytophilum
(Anaplasmosis). What cell type is infected?
a) Erythrocytes
b) Leukocytes
c) Platelets
d) CNS fluid and cells
e) Myeloid bone marrow
9.1) A man from Long Island, New York presents with high fever, shaking, and chills.
Although he has malaria-like symptoms, he denies any traveling. He says he had some
ticks removed by a friend after a hunting trip. Physical exam does not reveal erythema
migrans. A blood smear is done, shown here. The presence of ring-form inclusions and a
tetrad (Maltese cross) is noted. Which of the following is most likely?
a) Rocky Mountain spotted fever
b) Lyme disease
c) Vivax malaria
d) Falciparum malaria
e) Babesiosis
9.2) Which of the following is transmitted by
trombiculid mites ("chiggers") with the bite
site having eschar and a macular rash
following five days of illness?
a) Rickettsia typhi (Endemic typhus)
b) Rickettsia prowazekii (Epidemic typhus)
c) Rickettsia tsutsugamushi (Scrub typhus)
d) Rickettsia rickettsii (Rocky Mountain spotted fever)
e) Coxiella burnetii (Q fever)
10.1) What developmental stage of Plasmodium falciparum is shown here, noting the
“banana” shaped (”sausage”, ”boomerang”) inclusions?
a) Sporozoites
b) Liver stage
c) Merozoites
d) Asexual stage
e) Gametocytes
10.2) Symptoms associated with Plasmodium falciparum
range from fever (IL-1, TNF) to fatal renal disease and are
exclusively associated with what developmental stage?
a) Sporozoites
b) Liver stage
c) Merozoites
d) Asexual stage
e) Gametocytes

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11) A Korean War veteran presents with fever, shaking, and diaphoresis every two days.
History reveals he was successfully treated for malaria while on tour with the military. A
blood smear is performed, shown here. Schüffner dots are noted. Chloroquin treatment is
begun. What was the diagnosis?
a) Plasmodium falciparum
b) Plasmodium malariae
c) Plasmodium ovale
d) Plasmodium vivax
e) Babesia (Babesiosis)
12) Which of the following is shown in the blood smear here, noting appliqué (accolé)
positioning, multiple ring forms in an individual erythrocyte, and possible Maurer dots?
a) Plasmodium falciparum
b) Plasmodium malariae
c) Plasmodium ovale
d) Plasmodium vivax
e) Babesia (Babesiosis)
13) A student reports to his college clinic complaining of “the flu.” He explains that he
has been suffering from intermittent headaches, fevers, and muscle aches. Assuming the
flu, the physician sends the student home with acetaminophen. Now, days later, the
student returns to the clinic with chills, extreme fever, and debilitating fatigue. Physical
exam reveals yellow sclera and severe splenomegaly. CBC reveals low hematocrit and
urinalysis shows hemoglobinuria. Alarmed, the doctor questions the student about recent
travels and learns that he just returned from a visit to India and says no mosquito netting
was used while sleeping. The patient is begun on mefloquine. What was the diagnosis?
a) Plasmodium falciparum
b) Plasmodium malariae
c) Plasmodium ovale
d) Plasmodium vivax
e) Babesia (Babesiosis)
14) What is the drug of choice for dormant liver vivax malaria (hypnozoite)?
a) Chloroquin
b) Quinidine
c) Mefloquine
d) Primoquin
e) Clindamycin
15) A patient with suspected plasmodium infection undergoes a blood smear, which is
negative. Inoculation of blood samples into hamsters confirms babesia (babesiosis). What
is the drug of choice?
a) Penicillin
b) Quinidine
c) Mefloquine
d) Primoquin
e) Clindamycin
16.1) An East African man is asked to leave his job after repeatedly falling asleep. He
visits the doctor hoping to cure his somnolence as well as accompanying headache and
dizziness. During the interview, the patient explains that he had suffered recurring bouts

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of fever and enlarged lymph noted before the sleepiness started. The doctor decides to
perform a lumbar puncture and, after finding a flagellated protozoan in the CSF, plans to
start the patient on melarsoprol. What is the transmission vector involved (African
trypanosomiasis)?
a) Reduviid bug
b) Aedes aegypti mosquito
c) Haemagogus mosquito
d) Sand fly
e) Tsetse fly
16.2) A Mexican man complains to his doctor of worsening constipation and stomach
pains. On physical exam, the doctor is surprised to find an enlarged heart on auscultation
and moderate arrhythmia. An abdominal x-ray reveals megacolon. Head exam reveals
unilateral periorbital swelling (Romaña sign, chagoma). The clinician explains there is no
chronic treatment. What is the transmission vector involved (American trypanosomiasis)?
a) Reduviid bug
b) Aedes aegypti mosquito
c) Phlebotomous sand fly
d) Lutzomyia sand fly
e) Tsetse fly
17.1) A recent immigrant from a tropical country presents with weight loss and fever. A
physical exam reveals massive hepatosplenomegaly with associated edema as well as
hyperpigmented skin patches. The doctor orders a CBC and spleen biopsy. CBC reveals
thrombocytopenia, anemia, and leukopenia, while spleen biopsy shows macrophages
containing protozoa. The doctor begins the patient on an antimony compound. Which of
the following is most likely? (Leishmaniasis or “Kala-Azar”)
a) Leishmania donovani
b) Leishmania tropica
c) Leishmania braziliensis
17.2) A South American man presents with a cutaneous skin lesion that has ulcerated.
Physical exam reveals lesions of the mucous membranes and edema (oriental sores,
espunida). Occupational history reveals the man harvests chicle sap for gum in the
rainforest. Which of the following is most likely?
a) Leishmania donovani
b) Leishmania tropica
c) Leishmania braziliensis
17.3) What is the vector for cutaneous leishmaniasis (Leishmania tropica)?
a) Reduviid bug
b) Aedes aegypti mosquito
c) Phlebotomous sand fly
d) Lutzomyia sand fly
e) Tsetse fly
17.4) What is the vector for Leishmania donovani and Leishmania braziliensis?
a) Tsetse fly
b) Aedes aegypti mosquito
c) Phlebotomous sand fly
d) Lutzomyia sand fly

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18) Which of the following is an option for drug-resistant leishmaniasis?
a) Doxycycline
b) Quinidine
c) Mefloquine
d) Sodium stibogluconate
e) Immunotherapy
19.1) A patient from a tropical village has an enormously swollen scrotum and lower
extremity. The skin around the swelling has become scaly and thick. The patient
remembers feeling enlarged nodes in the groin months before the swelling began, but
because of poor health resources in the area, he never saw a physician. Samples of his
blood drawn at night show worm-like organisms under a microscope. A visiting doctor
strongly recommends that the patient and other villagers sleep with a mosquito net to
prevent more infections. What is the helminth responsible?
a) Wuchereria bancrofti
b) Brugia malayi
c) Onchocerca volvulus
d) Loa loa filariasis
19.2) A traveling physician visits a remote riverside village in a South American country
and discovers that most of the older village inhabitants are blind. On physical exam of
some of the members, she notes skin nodules and hyperpigmented rashes. One male
villager has an extremely enlarged, hanging scrotum. To prevent other village members
from becoming blind, she administers donated ivermectin to many people in the village
and urges black fly control. What is the helminth responsible?
a) Wuchereria bancrofti
b) Brugia malayi
c) Onchocerca volvulus
d) Loa loa filariasis
19.3) A patient presents with vision problems. History reveals bouts of red itchy swelling
below the skin (Calabar swelling) of the upper extremities. Further questioning reveals a
trip to West Africa about a year ago in an area with many Chrysops (deer) and mango
flies. The eye exam is abnormal, shown. What is the helminth responsible?
a) Wuchereria bancrofti
b) Brugia malayi
c) Onchocerca volvulus
d) Loa loa filariasis
19.4) What is the vector for Brugia malayi?
a) Kissing bug
b) Mosquito
c) Mango fly
d) Sand fly
e) Tsetse fly

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