1.

During the second trimester of pregnancy, where is the predominant site of red blood cell

production?

A) Yolk sac

B) Bone marrow

C) Lymph nodes

D) Liver

2. Following a blood donation, red cell production begins to increase in

A) 30 minutes

B) 24 hours

C) 2 days

D) 5 days

E) 2 weeks

Questions 3–6

Which points in the following graph most closely define the following conditions? Normal
erythropoietin

(EPO) levels are approximately 10.

3. Olympic marathoner

4. Aplastic anemia

5. End-stage renal disease

6. Polycythemia vera

7. A 62-year-old female arrives for her annual physical. She complains of itching in her hands along

with headaches and vertigo. A routine complete blood count (CBC) shows red blood cells (RBCs) of
8.2

million/μl, white blood cells (WBCs) 37,000/μl, and platelets 640,000/μl. Her erythropoietin levels
are

lower than normal. The primary diagnosis would be

A) thrombocytopenia

B) relative polycythemia

C) secondary polycythemia

D) polycythemia vera

E) myeloid leukemia

8
Hemoglobin 11 gm/dl Leukocyte count 22,000/μl

Reticulocyte count 25%

What is the diagnosis of this patient?

A) Acute blood loss

B) Sickle cell anemia

C) Anemia of chronic disease

D) End-stage renal disease

12. A 62-year-old man complains of headaches, visual difficulties, and chest pains. His examination

shows a red complexion and a large spleen. His complete blood count follows: hematocrit, 58%,
WBC

13,300/μl, and platelets 600,000/μl. His arterial oxygen saturation is 97% on room air. Which of the

following would you recommend as a treatment?

A) Chemotherapy

B) Phlebotomy

C) Iron supplement

D) Inhaled oxygen therapy

13. A 45-year-old woman developed fatigue in July and had blood counts that were reported to be

normal. She was hospitalized because of a very severe headache in December, and was found to
have a

blood pressure of 175/90. Her laboratory values were as follows: hemoglobin (8.3 g/dL), RBC count

(2.2 × 10

/μl), Hct (23%), MCV (89 fL), WBCs (5100/μl), platelets (262 × 10

/μl), and reticulocyte

count 0.8%. What is the diagnosis for this patient?

A) Folic acid deficiency

B) Iron deficiency

C) Hemolytic anemia

D) End-stage renal disease

14. A 38-year-old healthy female comes to you for a routine visit. She has spent the last 2 months
hiking

through the Himalayas and climbed to the base camp of Mount Everest. Which of the following
would you

expect to see on her CBC (complete blood count)?

15. A patient presents to your office complaining of extreme fatigue and shortness of breath on
exertion

that has gradually worsened over the past 2 weeks. On physical examination, you observe a
wellnourished woman who appears comfortable but somewhat short of breath. Her vital signs
include a pulse

of 120, respiratory rate of 20, and blood pressure of 120/70. When she stands up her pulse increases
to

150 and her blood pressure falls to 80/50. Her hematologic values are Hgb 7 g/dL, Hct 20%, RBC
count

2 × 10

/μl, platelet count of 400,000/μl. On a peripheral smear, her RBCs are microcytic and

hypochromic. What would be your diagnosis of this patient?

A) Aplastic anemia

B) Renal failure

C) Iron deficiency anemia

D) Sickle cell anemia

E) Megaloblastic anemia

16. After a person is placed in an atmosphere with low oxygen, how long does it take before there
are

increased numbers of reticulocytes?

A) 6 hours

B) 12 hours

C) 3 days

D) 5 days

E) 2 weeks

17. Over the past 12 weeks, a 75-year-old man with a moderate aortic stenosis has developed
shortness

of breath and chest pains during exertion. He appears pale. Test of his stool for blood is positive.
Laboratory studies show the following: hemoglobin 7.2 g/dL, and mean corpuscular volume 75. A
blood

smear shows microcytic, hypochromic erythrocytes. Which of the following is the most likely
diagnosis?

A) Vitamin B12 deficiency

B) Autoimmune hemolytic anemia

C) Folate deficiency anemia

D) Iron deficiency anemia

18. A 24-year-old man came into the ER with a broken leg. A blood test was ordered and his WBC

count was 22 × 10

/μl. Five hours later, a second blood test resulted in values of 7 × 10

/μl. What is the

cause of the increased WBC count with the first test?

A) Increased production of WBC by the bone marrow

B) Shift of WBCs from the marginated pool to the circulating pool

C) Decreased destruction of WBCs

D) Increased production of selectins

19. Adhesion of white blood cells to the endothelium is

A) due to a decrease in selectins

B) dependent on activation of integrins

C) due to the inhibition of histamine release

D) greater on the arterial than venous side of the circulation

20. During an inflammatory response, which is the correct order for cellular events?

A) Filtration of monocytes from blood, increased production of neutrophils, activation of tissue

macrophages, infiltration of neutrophils from the blood

B) Activation of tissue macrophages, infiltration of neutrophils from the blood, infiltration of

monocytes from blood, increased production of neutrophils

C) Increased production of neutrophils, activation of tissue macrophages, infiltration of neutrophils

from the blood, infiltration of monocytes from blood

D) Infiltration of neutrophils from the blood, activation of tissue macrophages, infiltration of

monocytes from blood, increased production of neutrophils

21. In a normal healthy person, which of the following blood components has the shortest life span?

A) Macrophages

B) Memory T cells

C) Erythrocytes

D) Memory B lymphocytes

22. A 45-year-old man presents to the emergency room with a 2-week history of diarrhea that has
gotten

progressively worse over the last several days. He has minimal urine output and is admitted to the

hospital for dehydration. His stool specimen is positive for parasitic eggs. Which type of WBCs would

have an elevated number?

A) Eosinophils

B) Neutrophils

C) T lymphocytes

D) B lymphocytes

E) Monocytes

23. An 8-year-old male is frequently coming to the clinic for persistent skin infections that do not
heal

within a normal time frame. He had a normal recovery from the measles. Checking his antibodies

following immunizations yielded normal antibody responses. A defect in which of the following cells

would most like be the cause of the continual infections?

A) B lymphocytes

B) Plasma cells

C) Neutrophils

D) Macrophages

E) CD4 T lymphocytes

24. Where does the transmigration of WBCs occur in response to infectious agents?

A) Arterioles

B) Lymphatic ducts

C) Venules

D) Inflamed arteries
25. A 65-year-old alcoholic developed chest pain and cough with an expectoration of sputum. A
blood

sample revealed that his white blood cell count was 42,000/μl. What is the origin of these WBCs?

A) Pulmonary alveoli

B) Bronchioles

C) Bronchi

D) Trachea

E) Bone marrow

26. A 26-year-old man received a paper cut. What substance is the major cause of pain of this acute

inflammatory response?

A) Platelet-activating factor (PAF)

B) Bradykinin

C) Interleukin-1

D) Tumor necrosis factor (TNF)

27. A patient visits his dentist, who notices a sore on the patient’s lip. The sore was unusual in that

there was no pain or drainage from the sore. The patient was subsequently admitted to the hospital
with a

violent shaking chill. His lab values were Hct 30%, platelets 400,000/μl, WBC 4200/μl, 68%

lymphocytes, and 20% neutrophils. What is the diagnosis of this patient?

A) A mild, nontreatable, infection

B) Agranulocytosis

C) Aplastic anemia

D) Acute leukemia

28. What occurs following activation of basophils?

A) Decreased diapedesis of neutrophils

B) Decreased ameboid motion

C) Contraction of blood vessels

D) Increased capillary permeability

29. Fluid exudation into the tissue in the acute inflammatory reaction is due to

A) decreased blood pressure

B) decreased protein in the interstitium

C) obstruction of the lymph vessels

D) increased clotting factors

E) increased vascular permeability

30. Which of the following applies to AIDS patients?

A) Able to generate a normal antibody response

B) Increased helper T cells

C) Increased secretion of interleukins

D) Decrease in helper T cells

31. Presentation of antigen on MHC-I by a cell will result in

A) generation of antibodies

B) activation of cytotoxic T cells

C) increase in phagocytosis

D) release of histamine by mast cells

32. What is the term for adhesion of an invading microbe with IgG and complement to facilitate

recognition?

A) Chemokinesis

B) Opsonization

C) Phagolysosome fusion

D) Signal transduction

33. Interleukin-2 (IL-2) is an important molecule in the immune response. What is the function of IL-
2?

A) Binds to and presents antigen

B) Stimulates proliferation of cytotoxic T cells

C) Kills virus-infected cells

D) Is required for replication of helper T cells

34. CD4 is a marker of

A) B cells

B) Cytotoxic T cells

C) Helper T cells

D) An activated macrophage

E) A neutrophil precursor

35. What will occur following presentation of antigen by a macrophage?

A) Direct generation of antibodies

B) Activation of cytotoxic T cells

C) Increase in phagocytosis

D) Activation of helper T cells

36. Activation of the complement system results in which of the following actions?

A) Binding of the invading microbe with IgG

B) Inactivation of eosinophils

C) Decreased tissue levels of complement

D) Generation of chemotaxic substances

37. A 9-year-old female has nasal discharge and itching of the eyes in the spring every year. An

allergist performs a skin test using a mixture of grass pollens. Within a few minutes she develops a
focal

redness and a swelling at the test site. This response is most likely due to

A) antigen–antibody complexes being formed in blood vessels in the skin

B) activation of neutrophils due to injected antigens

C) activation of CD4 helper cells and the resultant generation of specific antibodies

D) activation of cytotoxic T lymphocytes to destroy antigens

38. Which of the following applies to cytotoxic T cells?

A) Cytotoxic T cells require the presence of a competent B-lymphocyte system

B) Cytotoxic T cells require the presence of a competent suppressor T-lymphocyte system

C) Cytotoxic T cells are activated by the presentation of antigen by an infected cell

D) Cytotoxic T cells destroy bacteria by initiating macrophage phagocytosis

39. Helper T cells

A) are activated by the presentation of antigen by an infected cell

B) require the presence of a competent B-cell system

C) destroy bacteria by phagocytosis

D) are activated by the presentation of antigen by macrophage or dendritic cells

40. Which of the following transfusions will result in an immediate transfusion reaction?

A) O Rh− whole blood to an O Rh+ patient

B) A Rh− whole blood to a B Rh− patient

C) AB Rh− whole blood to an AB Rh+ patient

D) B Rh− whole blood to an B Rh− patient

41. Which of the following is a TRUE statement?

A) In a transfusion reaction, there is agglutination of the recipient blood

B) Shutdown of the kidneys following a transfusion reaction occurs slowly

C) Blood transfusion of Rh+ blood into any Rh− recipient will result in an immediate transfusion

reaction

D) A person with type AB blood is considered to be a universal recipient

42. Which blood type is depicted in the following figure?

A) A

B) B

C) O

D) AB

43. A couple requests blood typing of their 2-year-old child (father AB, Rh-negative; mother B,
Rhnegative). Results of hemagglutination assays of the child’s blood are shown in the next figure.
Which of

the following conclusions concerning the child’s parentage is valid?

A) The child could be the natural offspring of this couple

B) The mother could be the natural mother, but the father could not be the natural father

C) The father could be the natural father, but the mother could not be the natural mother

D) Neither the father nor the mother could be the natural parents

44. A 21-year-old female, blood type B, is undergoing surgery. Her platelet count is 75,000/μl. She

will need platelet infusions before and during surgery. Which of the following blood types would be
used

to collect platelets that are compatible with the patient?

A) Type A only

B) Type B only

C) Type O only

D) Types B and O

E) Types A and B

F) Types A and B only

G) Types A, B, and AB only

45. Which of the following is TRUE concerning erythroblastosis fetalis (hemolytic disease of the
newborn, HDN)?

A) This occurs when a Rh+ mother has an Rh− child

B) This is prevented by giving the mother a blood transfusion

C) A complete blood transfusion after the first birth will prevent HDN

D) The father of the child has to be Rh+

46. Which of the following will result in a transfusion reaction? Assume that the patient has never
had a

transfusion.

A) Type O Rh− packed cells to an AB Rh+ patient

B) Type A Rh+ packed cells to an A Rh− patient

C) Type AB Rh+ packed cells to an AB Rh+ patient

D) Type A Rh+ packed cells to an O Rh+ patient

47. A mother of blood type A+ who has always been perfectly healthy just delivered her second
child.

The father is of blood group O−. Knowing that the child is of blood group O− (O, Rh−), what would
you

expect to find in this child?

A) The child will suffer from erythroblastosis fetalis due to rhesus incompatibility

B) The child will suffer from erythroblastosis fetalis due to ABO blood group incompatibility

C) The child will suffer from both A and B

D) The child has no chance of developing HDN

48. Which of the following blood units carries the least risks for inducing an immediate transfusion

reaction into a B+ (B, rhesus positive) recipient?

A) Whole blood A+

B) Whole blood O+

C) Whole blood AB+

D) Packed red cells O+

E) Packed red cells AB−

49. A pregnant woman comes in for a visit. She is AB Rh− and her husband is A Rh+. This is her first

child. What should be done at this time?

A) Nothing

B) Administer anti-D immunoglobulin to the mother at this time

C) Administer anti-D immunoglobulin to the mother after delivery

D) Administer anti-D immunoglobulin to the child after delivery

E) Administer anti-D immunoglobulin to the child if the child is Rh+

50. What is the proper pathway for the extrinsic clotting pathway?

A) Contact of blood with collagen, formation of prothrombin activator, conversion of prothrombin

into thrombin, conversion of fibrinogen into fibrin threads

B) Tissue trauma, formation of prothrombin activator, conversion of prothrombin into thrombin,

conversion of fibrinogen into fibrin threads

C) Activation of platelets, formation of prothrombin activator, conversion of prothrombin into

thrombin, conversion of fibrinogen into fibrin threads

D) Trauma to the blood, formation of prothrombin activator, conversion of prothrombin into

thrombin, conversion of fibrinogen into fibrin threads

51. What condition leads to a deficiency in factor IX that can be corrected by an intravenous
injection of

vitamin K?

A) Classic hemophilia

B) Hepatitis B

C) Bile duct obstruction

D) Genetic deficiency in antithrombin III

52. A patient suffers from a congenital deficiency in factor XIII (fibrin-stabilizing factor). What would

analysis of his blood reveal?

A) Prolonged prothrombin time

B) Prolonged whole blood clotting time

C) Prolonged partial thromboplastin time

D) Easily breakable clot

53. A 2-year-old boy bruises easily and has previously had bleeding gums. The maternal grandfather

has a bleeding disorder. His physical examination shows several small bruises on the legs. Of which

coagulation factor would you suspect this patient to be deficient?

A) Prothrombin activator

B) Factor II

C) Factor VIII
D) Factor X

54. An 11-year-old premenstrual female presents with a painful knee after mild trauma. Upon
further

evaluation you observe soft tissue bruises. The child is an orphan and there is no family history. The

foster mother reports no other problems. The aPTT is prolonged and the PT is normal. A complete

hematologic workup would yield

A) decreased plasma Ca

2+

B) elevated plasmin

C) lack of factor VIII

D) decreased platelet number

55. The coagulation pathway that begins with tissue thromboplastin is

A) extrinsic pathway

B) intrinsic pathway

C) common pathway

D) fibrin stabilization

56. A 63-year-old woman returned to work following a vacation in New Zealand. Several days after

returning home, she awoke with swelling and pain in her right leg and her leg was blue. She went

immediately to the emergency room where an examination showed an extensive deep vein
thrombosis

involving the femoral and iliac veins on the right side. Following resolution of the clot, this patient
will

require which treatment in the future?

A) Continual heparin infusion

B) Warfarin

C) Aspirin

D) Vitamin K

57. Which of the following would most likely be used for prophylaxis of transient ischemic heart

attack?

A) Heparin

B) Warfarin

C) Aspirin
D) Streptokinase

58. Which of the following would be appropriate therapy for massive pulmonary embolism?

A) Heparin

B) Warfarin

C) Aspirin

D) Tissue plasminogen activator

59. Which of the following would best explain a prolonged bleeding time test?

A) Hemophiliac A

B) Hemophilia B

C) Thrombocytopenia

D) Coumarin use

60. Why do some malnourished patients bleed excessively when injured?

A) Vitamin K deficiency

B) Platelet sequestration by fatty liver

C) Serum bilirubin raises neutralizing thrombin

D) Low serum-protein levels cause factor XIII problems

61. A teenaged boy with numerous nosebleeds was referred to a physician for evaluation prior to a

minor surgery. His prothrombin time (PT) was 11 sec (11–15 sec normal), partial thromboplastin
time

(PTT) was 58 sec (25–40 sec normal), and bleeding time was 6.5 min (2–7 min normal). Which of the

following is most likely abnormal in this young man?

A) Decreased platelet number

B) Defective platelets

C) Intrinsic pathway

D) Extrinsic pathway

E) Production of clotting factors by the liver