1.

A newborn presents with jaundice, hepatosplenomegaly, and difficulty breathing 12 hours after
birth. The mother states that she had an uncomplicated pregnancy and says that the birth of her first
child was uncomplicated as well. After stabilizing the newborn’s condition, a clinician sends a
sample of serum taken from the mother to the laboratory. The laboratory performs a test by mixing
the mother's serum with donor red blood cells of known antigenicity and then adding an anti-IgG
antibody. Agglutination occurs.
Which of the following is the most likely conclusion that can be drawn from the results of the test?

1. The laboratory performed the test incorrectly; it should have mixed the mother’s serum
with her own RBCs rather than RBCs from another individual
2. The mother has been pregnant with an Rh-positive fetus
3. The mother is Rh positive
4. The mother’s child from her previous pregnancy is Rh negative
5. The mother’s first pregnancy was with an Rh-positive fetus, and she was most recently
pregnant with an Rh-negative fetus

2. A 25-year-old man presents to the clinic complaining of numbness and tingling in his arms and
legs for 3 days. He has a history of multiple indoor and outdoor allergies, as well as asthma as a
child. He denies any family medical history and states that he no longer takes medications, but was
once using an inhaler for his asthma. Vital signs are:
Blood pressure: 130/85 mm Hg
Heart rate: 78/min
Temperature: 37.2°C
Pulse oximetry: 100%
Which of the following findings is most likely to be seen in this individual?

1. Hepatitis B seropositivity
2. Coronary aneurysms
3. Granulomatosis with polyangiitis
4. Eosinophilia
5. Raynaud phenomenon

3. A 44-year-old woman with a history of excessive menstrual bleeding and menstrual cycles that
generally last over 7 days complains of increasing fatigue and cold extremities. Laboratory results
reveal a hemoglobin (Hb) concentration of 6 g/dL. In this patient with anemia, which of the
following would be reduced?

1. Percent O2 saturation in the arterial blood

2. Total arterial oxygen conten
3. Oxygen extraction
4. Dissolved oxygen content
5. Arterial PO2

4. A 37-year-old man presents with low exercise tolerance. Blood work shows a normal hematocrit
and Hb concentration but a decreased P50. Which would be true of his oxyhemoglobin transport
and dissociation?

1. O2 unloading is increased at the tissue level

2. O2 loading at the alveolar-capillary level is less than norma
3. O2 saturation is lower than normal at any PaO2
4. Hb’s affinity for oxygen is increased
 5. The differential diagnosis includes a point mutation resulting in increased binding of H+
to his Hb chains

5. A 65-year-old slightly cyanotic man presents to his physician complaining of pruritus and nose
bleeds. A blood test reveals a hematocrit of 62%, leading to the diagnosis of polycythemia vera.
Treatment includes aspirin to prevent thrombosis and periodic phlebotomy to reduce the hematocrit.
The reduction in hematocrit is beneficial because it does which of the following?

1. Increases arterial oxygen saturatio

2. Reduces blood velocity
3. Reduces blood viscosity
4. Increases arterial oxygen conten
5. Decreases cardiac output

6. A 26-year-old woman presents at the obstetrician’s office for her second trimester evaluation.
Which of the following values would normally be less in the fetus than in the mother?

1. Hb concentration
2. Affinity of Hb for oxyge
3. Cardiac glycogen content
4. Cardiac output/kg body weight
5. Erythrocyte binding of 2,3-bisphosphoglycerate

7. A 52-year-old man is brought to the emergency department with severe chest pain. Angiography
demonstrates a severe coronary occlusion. A thrombolytic agent is administered to reestablish
perfusion. Which of the following does the thrombolytic agent activate?

1. Plasminogen
2. Heparin
3. Kininogen
4. Prothrombin
5. Thrombi

8. A 14-year-old adolescent girl reports blood in her urine 2 weeks after she had a sore throat. She
has uremia and a blood pressure of 160/90 mm Hg with peripheral edema, suggestive of volume
expansion secondary to salt and water retention. Which of the following is the approximate
extracellular fluid volume of a normal individual?

1. 5% of body mass
2. 10% of body mass
3. 20% of body mass
4. 40% of body mass
5. 60% of body mass

9. As part of an experimental study investigating carbon dioxide transportation mechanisms, a 26-

year-old woman is participating in a simulated long-distance bike ride in a laboratory-controlled
setting. As part of the study, the researchers require the patient to consume a special glucose
solution that contains a radiolabeled carbon isotope for several days before the bike ride and during
the ride. After she has been riding the bike for 10 km, several samples are taken from the patient.
Where will the greatest concentration of the radiolabeled carbon isotope be found?

1. In urine
2. Within the plasma
3. Within a stool sample
4. Within red blood cells
5. In sweat

10. A 41-year-old man presents to the emergency department because of sudden onset of chest pain
and extreme shortness of breath. He has a history of hepatitis C and hypertension, along with deep
venous thrombosis, which occurred 3 years ago. He has smoked one pack of cigarettes daily for the
past 20 years. His temperature is 37.7°C , blood pressure is 120/60 mm Hg, heart rate is 115/min,
and respiratory rate is 28/min. An electrocardiogram (ECG) shows sinus tachycardia but no other
abnormalities. Heparin anticoagulation therapy is started immediately. In addition to monitoring the
activated partial thromboplastin time, which of the following should be monitored closely in the
first week of treatment?

1. Plasma fibrin
2. Platelet count
3. Plasma thromboxane A2
4. Absolute neutrophil count
5. Prothrombin time

11. A 36-year-old man presents to the clinic complaining of an itchy rash on his left foot. He
recently returned from a vacation in the Caribbean, where he stayed at a resort next to the beach. He
spent considerable time walking barefoot on the beach. Since returning from his vacation 2 weeks
ago, he feels like he has been losing weight and has occasional fevers. On physical examination, his
temperature is 37.8°C (100.1°F), heart rate is 82/min, blood pressure is 120/78 mm Hg, and
respiratory rate is 18/min. Laboratory results are as follows:
Hemoglobin: 15 g/dL
Leukocyte count: 13,000/mm3
Neutrophils: 56%
Eosinophils: 7%
Lymphocytes: 36%
Which of the following proteins provides specific defense against this patient’s underlying
condition?

1. Major basic protein

2. CD14
3. Histamine
4. Birbeck granules
5. Myeloperoxidase

12. A 36-year-old man presents to the emergency department after a motor vehicle accident. He
requires a blood transfusion. ABO testing on whole blood from the two uncharacterized individuals
(donor and recipient) is performed. Samples are tested against different types of antibodies (anti-A,
anti-B, anti-D) or different red blood cells (RBCs) (A type or B type). A positive antibody-antigen
interaction results in RBC agglutination. In the first experiment, anti-A antibodies were added
separately to the control, donor, and recipient whole blood samples. Each sample was then observed
for the presence of agglutination after addition of the antibodies. The next four experiments were
conducted in the same manner, testing different antibody-antigen interactions as shown in the chart.

Which of the following pairs represents the blood types for donor and recipient?

1. A-positive donor and O-negative recipient

2. AB-negative donor and A-positive recipient
3. AB-positive donor and B-negative recipient
4. B-negative donor and AB-positive recipient
5. O-negative donor and A-positive recipient

13. A 44-year-old woman presents to the clinic because of a burning sensation during urination and
increased urinary frequency. She takes warfarin (anticoagulant). She currently works as a yoga
instructor and follows a vegetarian diet. She is prescribed ciprofloxacin (antibiotic) for a presumed
urinary tract infection. 1 week later she reports resolution of her urinary symptoms, but complains
of an upset stomach and loose stools over the past day. On physical examination, her temperature is
36.9°C (98.4°F), blood pressure is 118/78 mm Hg, pulse is 82/min, and respiratory rate is 18/min.
Laboratory studies show:
Leukocyte count: 10,000/mm3
Platelet count: 300,000/mm3
Prothrombin time: 29 seconds (was 22 seconds at her last visit)
Partial thromboplastin time: 45 seconds (was 41 seconds at her last visit)
Bleeding time: 2 minutes
Which of the following is the most likely cause of the change in her laboratory values?

1. Loss of gut bacteria

2. Dietary vitamin K deficiency
3. Malabsorption syndrome
4. Overgrowth of a gram positive bacillus
5. P450 enzyme upregulation
14. A 55-year-old man presents to his primary care physician because of recent-onset chest pain and
a feeling of tightening. On physical examination, his temperature is 37.1°C (98.8°F), pulse is
82/min, blood pressure is 130/88 mm Hg, and respiratory rate is 16/min. His heart has a regular rate
and rhythm. An in-office electrocardiogram (ECG) shows no abnormalities. The physician orders
an exercise stress test, and the patient later undergoes full cardiac monitoring while on the treadmill.
In addition, serum lactate and levels of oxygen uptake are measured in intervals.
Which of the following would most likely be seen in the oxygen-hemoglobin dissociation curve
while this patient is exercising?

1. A decrease in partial pressure of carbon dioxide, causing an increase in the affinity of

hemoglobin for oxygen
2. An increase in temperature, causing a decrease in the affinity of hemoglobin for oxygen
3. An increase in 2,3-bisphosphoglycerate concentration, causing an increase in the affinity
of hemoglobin for oxygen
4. A decrease in hydrogen ions, causing a decrease in the affinity of hemoglobin for
oxygen
5. An increase in ventilation, causing a decrease in the affinity of hemoglobin for oxygen

15. A 63-year-old man comes to the emergency department because of palpitations that have been
present for the past 2 days. On physical examination, his temperature is 37.2°C (98.9° F), blood
pressure is 126/86 mm Hg, pulse is 106/min, and respiratory rate is 18/min. Auscultation of the
chest discloses an irregular heart rhythm. The patient is admitted to the hospital and started on
medical treatment with β-blocker and anticoagulant. Five days after his hospitalization, the patient
develops painful lesions on his left shoulder. Which of the following is associated with the
medication that caused the skin lesions?

1. Increased activated partial thromboplastin time

2. Effect is reversed with aminocaproic acid
3. Increased prothrombin time
4. Acts via direct inhibition of thrombin
5. Low platelet count

16. Erythrocytes content in the blood of sportsman-climber before training courses in mountains
equals to 4.5 x 10 12/l. How could you estimate the erythrocytes changes 2 weeks after their
trainings at 2000 meters above sea level?

1. Physiological norm
2. Relative erythrocytosis
3. Absolute erythrocytosis
4. Relative erythropenia
5. Absolute erythropenia

17. Erythrocytes content in patient decreased till 2х1012/l. It is accompanied by dyspnea, a faint
and noise in ears. The most probable reason for such condition is the following ...

1. All answers are correct

2. Insufficient oxygen capacity
3. Hemoglobin content decreasing
4. Hypoxia
 5. Blood respiratory function failure

18. Patient has less amount of erythropoietin. Erythropoietin’s secretion is caused by ...

1. Blood androgens concentration

2. Blood glucocorticoids concentration
3. Blood catecholamines concentration
4. The level of oxygenation in the kidneys
5. Blood estrogens concentration

19. Patient increased amount of erythropoietin. Erythropoietin’s secretion will cause...

1. The fall of level of RBC

2. The rise of level of RBC
3. The rise of level of WBC
4. Increased platelts
5. Decrease of blood estrogens concentration

20. What is true about initiation of vascular hemostasis

1. Involves release of cortisol

2. Involves release of ET (endothelin)-1
3. Involves release of serotonin
4. Involves binding of NE to alpha adrenergic receptors
5. Mediated by sympathetic release of hormones from brain, kidneys, adrenals

21. Physician suspect toxoplasmodis in 4-year old boy fnd prescribes antibodies study. Among
antibody isotypes ones of them is main antibody for 2nd response and that crosses placenta
(provides infants with passive immunity):

1. IgA
2. IgD
3. IgE
4. IgG
5. IgM

22. A 7 year old girl requiring a tonsillectomy and adenoidectomy undergoes pre-operative
laboratory testing by her surgeon revealing a prolonged activated partial thromboplastin time (PTT)
of 150 seconds (normal range 22-36 seconds). Her prothrombin time (PT) is normal. She had
previously had 2 dental extractions that were uneventful. She otherwise has no personal or family
history of bleeding. Which of the following abnormal clotting factor is most likely:

1. Factor VIII activity of 2%

2. Factor IX activity of 2%
3. Factor VII activity of 2%
4. Factor XII activity of 2%
5. Factor XI activity of 2%
23. Physian was asked to consult on a newborn on day of life 2 due to excessive bleeding after
circumcision. The PTT is prolonged and the PT is normal. You order factor assays and the results
are as follows:
Factor VIII—8%
Factor IX—12%
Factor XI—15%
Factor XII—6%
The most likely diagnosis is:

1. Factor IX deficiency
2. Factor XI deficiency
3. Factor VIII deficiency
4. Factor XII deficiency
5. All the factor levels are normal for age

24. 18-year man has finger injury, name correct sequence of platelet plug formation:

1. Contact of platelets with collagen fibres, swell and forms pseudopodes , becomes sticky,
adherance of collagen with tissue and protein Von Wilibrand factor, secretion of
thromboxane A2 and ADP, activation of nearby platelets, agglutination of platelets
forming plug
2. Contact of platelets with collagen fibres, swell and forms pseudopodei , becomes sticky ,
adherence of collagen with tissue, secretion of thromboxane A2 and ADP, activation of
nearby platelets, agglutination of platelets, forming plug
3. Secretion of of thromboxane A2 and ADP, activation of nearby platelets which will
adherence to collagen fibres, agglutination of platelets, forming plug
4. Secretion of serotonin, activation of collagen fibres, adherence to collagen fibres,
agglutination of platelets, forming plug
5. Secretion of endothelin, serotonin, activation of collagen fibres, adherence to collagen
fibres, aggregation, agglutination of platelets, forming plug

25. 3-month-old girl has with multiple bruises and hemorrhages. She had no evidence of
malabsorption, liver disease, or warfarin poisoning. She was found to have a prothrombin time of
95 seconds and a partial thromboplastin time of 305 seconds. These times corrected on mixing 1:1
with normal plasma, indicating factor deficiency rather than inhibition of coagulation. Her plasma
showed less than 3% activity of factors II, VII, IX, and X. This condicion caused by:

1. Deficiency of Ca2+
2. Combined deficiency of factors VIII and XI
3. Combined deficiency of vitamin K–dependent clotting factors
4. Deficiency of factors XI
5. Deficiency of vitamin B12

26. After blood laboratory test it was found abnormal clotting ffactors levels. If factors II, VII, IX,
and X are absent then:

1. Clotting time increases

2. Clotting time decreases
3. Bleeding time increases
4. Both remain equal
5. Bleeding time decreases
27 . Tissue trauma results in activation:

1. Extrinsic pathway
2. Intrinsic pathway
3. Complement system
4. Common pathway
5. -