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USMLE Sub B, 1st Semester, 2017

Time: 20 mins
Note: This test consists of 4 parts. You can get 1 point for each right answer, but you lose a
half of point for each wrong one.
PART A: Choose the best answer (A, B, C or D) to fill in the blank (5 points)
Question 1. ____________ provides important information about defects in red cell production
and variations in anisocytosis and poikilocytosis, which can reinforce the findings in other tests
and guide us to the diagnosis of some diseases such as thalassemia and megaloblastic anemia. It is
carried out with a multiple-step process which includes the Wright-Giemsa stain.
A. Complete Blood Count. C. Blood Culture.
B. Peripheral Blood Smear. D. Marrow Examination.
Question 2. _____________ is the newly released cell from the medulla which can help us in the
classification of anemia.
A. Polychromatophil erythroblast. C. Reticulocyte.
B. Pluripotential hematopoietic stem cell. D. Orthochromatic erythroblast.
Question 3. In the pulmonary capillaries, occurs the exchange of oxygen and dioxyde carbon
through the respiratory membrane. The process of binding four oxygen molecules to one
hemoglobin molecule in the RBCs is called____________.
A. oxygenation. B. oxidation. C. reduction. D. conjugation.
Question 4. Partial or complete gastroectomy can lead to _________ anemia.
A. pernicious. B. aplastic. C. hemolytic. D. microcytic.
Question 5. ________________ is the condition in which Rh-positive RBCs in the fetus are
attacked by antibodies from an Rh-negative mother.
A. Sickle cell anemia. C. Hereditary spherocytosis.
B. Megaloblastic anemia. D. Erythroblastosis fetalis.
USMLE Sub B, 1st Semester, 2017

PART B: Read the following passages and answer the questions (15 points)
Passage 1

Question 1. What blood product was administered to the patient?

USMLE Sub B, 1st Semester, 2017

Question 2. Why was this blood product given to the patient?

Question 3. How was the patient treated with his first problem?
Question 4. What were the three findings of the CT scan?
Question 5. Why should the patient see his regular doctor?
USMLE Sub B, 1st Semester, 2017

Passage 2
Line 1 According to World Health Organization criteria, anemia is defined as
blood hemoglobin (Hb) concentration <130 g/L (<13 g/dL) or hematocrit (Hct)
<39% in adult males; Hb <120 g/L (<12 g/dL) or Hct <37% in adult females.
Signs and symptoms of anemia are varied, depending on the level of
Line 5 anemia and the time course over which it developed. Acute anemia is nearly
always due to blood loss or hemolysis. In acute blood loss, hypovolemia
dominates the clinical picture; hypotension and decreased organ perfusion are the
main issues. Symptoms associated with more chronic onset vary with the age of
the pt and the adequacy of blood supply to critical organs. Moderate anemia is
Line 10 associated with fatigue, loss of stamina, breathlessness, and tachycardia. The pt’s
skin and mucous membranes may appear pale. If the palmar creases are lighter in
color than the surrounding skin with fingers extended, Hb level is often <80 g/L
(8 g/dL). In pts with coronary artery disease, anginal episodes may appear or
increase in frequency and severity. In pts with carotid artery disease,
Line 15 lightheadedness or dizziness may develop.
A physiologic approach to anemia diagnosis is based on the understanding
that a decrease in circulating red blood cells (RBCs) can be related to either
inadequate production of RBCs or increased RBCs destruction or loss. Within the
category of inadequate production, erythropoiesis can be either ineffective, due to
Line 20 an erythrocyte maturation defect (which usually results in RBCs that are too small
or too large), or hypoproliferative (which usually results in RBCs of normal size,
but too few of them).
Basic evaluations include (1) reticulocyte index (RI), and (2) review of
blood smear and RBC indices [chiefly mean corpuscular volume].
Line 25 The RI is a measure of RBC production. The reticulocyte count is
corrected for the Hct level and for early release of marrow reticulocytes into the
circulation, which leads to an increase in the lifespan of the circulating
reticulocyte beyond the usual 1 day. Thus, RI = (% reticulocyte x pt Hct/45%) x
(1/shift correction factor). The shift correction factor varies with the Hct: 1.5 for
Line 30 Hct = 35%, 2 for Hct = 25%, 2.5 for Hct = 15%. RI < 2-2.5% implies inadequate
RBC production for the particular level of anemia; RI > 2.5% implies excessive
RBC destruction or loss.
If the anemia is associated with a low RI, RBC morphology helps
distinguish a maturation disorder from hypoproliferative marrow states.
Line 35 Cytoplasmic maturation defects such as iron deficiency or Hb synthesis problems
produce smaller RBCs, MCV < 80; nuclear maturation defects such as B12 and
folate deficiency and drug effects produce larger RBCs, MCV >100. In
hypoproliferative marrow states, RBCs are generally normal in morphology but
too few are produced. Bone marrow examination is often helpful in the evaluation
Line 40 of anemia but is done most frequently to diagnose hypoproliferative marrow states.
Other laboratory tests indicated to evaluate particular forms of anemia
depend on the initial classification based on the pathophysiology of the defect.
USMLE Sub B, 1st Semester, 2017

Question 6. Which is true about the diagnosis criteria of anemia according to WHO?
A. Hematocrit is lower than 39%.
B. The diagnosis of anemia is only based on the hemoglobin level.
C. It is necessary to consider the sex of the patient when diagnosing anemia.
D. Hemoglobin level is lower than 12 g/L.
Question 7. What can be inferred from the second passage?
A. Patients presented with acute anemia need to be monitored closely in order to prevent shock.
B. The clinical scenarios of acute and chronic anemia are quite similar.
C. Patients in different ages have the same symptoms of chronic anemia.
D. Light palmar skin does not have value in predicting the hemoglobin level.
Question 8. Which of the following words has the closest meaning to the word “lightheadedness”
in line 15?
A. headache. B. vertigo. C. faint. D. coma.
Question 9. According to the passage, which of the following parameters is the most important in
evaluating causes of anemia?
Question 10. Excessive RBC destruction or loss can lead to which of the following phenomenon?
A. Polycythemia. C. Hemolytic anemia.
B. Erythrocytopenia. D. None of the above.
Question 11. All of the followings are correct, EXCEPT:
A. The causes of anemia can be classified into two main groups.
B. Reticulocyte count can be used directly to distinguish between these two groups of causes.
C. The abnormal maturation can leave the size of red blood cells unaffected.
D. Blood smear test is necessary in evaluating anemia.
Question 12. Which of the following words has the closest meaning to the word “defect” in line
A. disease B. flaw C. disorder D. mutation
Question 13. What can be inferred from the passage about RI?
A. The lower Hct is, the lower shift correction factor is.
B. RI does not help us differentiate erythropoietic causes from destructive causes.
C. RI and hematocrit level do not have any correlation.
D. If RI is lower than 2.5%, a blood smear can be useful for further diagnosis.
Question 14. Which of the followings is NOT correct?
A. An abnormality in hemoglobin synthesis results in a decrease of MCV.
USMLE Sub B, 1st Semester, 2017

B. Some drugs can have an effect on the maturation of the nucleus.

C. It is common to examine the bone marrow to diagnose the cause of anemia.
D. Anemia can be a result of malnutrition.
Question 15. What can be the suitable title for the passage?
A. Anemia: Epidermiology and Clinical presentation.
B. Definition and Laboratory tests in Anemia.
C. Two main groups of causes resulting in anemia.
D. Approach to a patient with anemia.
PART C: Fill in the blank with ONE suitable word (15 points)
The blood cells begin their lives in the bone marrow from a ……………. (1) type of cell
……………… (2) the pluripotential hematopoietic stem cell, …………… (3) which all the cells
of the circulating blood are eventually derived. As these cells reproduce, a small portion of them
remains exactly …………… (4) the original pluripotential cells and is retained in the bone marrow
to maintain a supply of these, ………………… (5) their numbers diminish with age. Most of the
reproduced cells, however, differentiate to form the other cell types. The intermediate-stage cells
are very much like the pluripotential stem cells, even though they have already become committed
…………… (6) a particular line of cells and are called committed stem cells.
The different committed stem cells, when grown in culture, will produce colonies of
specific types of blood cells. A committed stem cell that produces …………………… (7) is called
a colony-forming unit-erythrocyte, and the …………………… (8) CFU-E is used to designate
this type of stem cell. ……………… (9), colony-forming units that form granulocytes and
monocytes have the designation CFU-GM and so forth.
Growth and reproduction of the different stem cells are ………………… (10) by multiple
proteins called growth inducer. The growth inducers promote growth but not differentiation of the
cells, which is the function of ……………… (11) set of proteins called differentiation inducers.
Formation of the growth inducers and differentiation inducers is controlled by factors outside the
bone marrow. For ……………… (12), in the case of RBCs, exposure of the blood to ……………
(13) oxygen for a long time causes growth induction, differentiation, and production of greatly
increased numbers of RBCs. In the case of some of the white blood cells, ……………… (14)
diseases cause growth, differentiation, and eventual formation of specific types of white blood
cells ………… (15) are needed to combat each infection.
USMLE Sub B, 1st Semester, 2017

PART D: Use the list elements to build medical words. You can use more than once. (5 points)
Combining Forms Suffixes Prefixes

aden/o lymphagi/o -ar -oid a-

chrom/o morph/o -blast -oma hypo-
cyt/o nucle/o -ectomy -osis micro-
erythr/o sider/o -ic -pathy
granul/o splen/o -logy -penia
hem/o thromb/o -lysis -poiesis
lymphaden/o thym/o -megaly

Question 1. Tumor of a lymph vessel _______________________________________________

Question 2. Decrease in iron ______________________________________________________
Question 3. Enlargement of the spleen ______________________________________________
Question 4. Abnormal condition of a blood clot _______________________________________
Question 5. Study of shapes (of cells) _______________________________________________
Question 6. Excision of the thymus _________________________________________________
Question 7. Pertaining to deficient color (of red blood cells) _____________________________
Question 8. Pertaining to small (red blood) cells _______________________________________
Question 9. Disease of a lymph gland _______________________________________________
Question 10. Embryonic red blood cell ______________________________________________
Question 11. Destruction of blood __________________________________________________
Question 12. Pertaining to a nucleus ________________________________________________
Question 13. Resembling a gland __________________________________________________
Question 14. Pertaining to without granules __________________________________________
Question 15. Formation (production) of blood ________________________________________
USMLE Sub B, 1st Semester, 2017

1. B 3. A 5. D
2. C 4. A
1.Two units of packed red blood cells
2.The patient was anemic as a result of sickle cell anemia.
3.Medical-surgical bed, oxygen, IV fluids, morphine
4.Ileus in small bowel, dilated small bowel loops, and abnormal enhancement pattern in the
5. To follow up on the renal abnormality.
6. C 10. B 14. C
7. A 11. B 15. D
8. B 12. C
9. D 13. D
1. Single 6. To 11. Another
2. Called 7. Erythrocytes 12. Instance/example
3. From 8. Abbreviation 13. Low
4. Like 9. Likewise 14. Infectious
5. Although 10. Controlled 15. That/which
1. Lymphangioma 6. Thymectomy 11. Hemolysis
2. Sideropenia 7. Hypochromic 12. Nucleic
3. Splenomegaly 8. Microcytic 13. Adenoid
4. Thrombosis 9. Lymphadenopathy 14. Agranular
5. Morphology 10. Erythroblast 15. Hemopoiesis