Pance Hematology - Final Test Review (Qns & Ans) - 2025, Exams of Nursing

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Hematology

Final Test Review

(Questions & Solutions)

1. A 30-year-old woman presents with fatigue and pallor. Laboratory tests reveal a positive direct antiglobulin (Coombs) test and spherocytes on the peripheral smear. Which is the most likely diagnosis? A) Hereditary spherocytosis B) Autoimmune hemolytic anemia C) Iron deficiency anemia D) Thalassemia minor Correct ANS: B Rationale: A positive Coombs test indicates immune-mediated hemolysis, consistent with autoimmune hemolytic anemia.
2. Which of the following autoantibodies is most specifically associated with systemic lupus erythematosus (SLE)? A) Anti-centromere antibody B) Anti-dsDNA antibody C) Anti-Ro/SSA antibody D) Anti-smooth muscle antibody Correct ANS: B Rationale: Anti-dsDNA antibodies are highly specific for SLE.
3. Warm antibody autoimmune hemolytic anemia is primarily mediated by which immunoglobulin class? A) IgD B) IgE C) IgG D) IgM Correct ANS: C Rationale: IgG autoantibodies are implicated in warm AIHA.
4. Which of the following is NOT a typical laboratory finding in autoimmune hemolytic anemia? A) Elevated LDH B) Elevated haptoglobin C) Spherocytes on blood smear

factor? A) Factor VIII B) Factor VII C) Factor IX D) Factor V Correct ANS: C Rationale: Hemophilia B is caused by factor IX deficiency.

9. Which genetic mutation underlies factor V Leiden thrombophilia? A) Missense mutation in the factor V gene B) Frameshift mutation in the factor VIII gene C) Deletion in the factor IX gene D) Splice site mutation in the protein S gene Correct ANS: A Rationale: A point mutation (Arg506Gln) in the factor V gene causes resistance to activated protein C.
10. The antidote for heparin overdose is: A) Warfarin B) Vitamin K C) Protamine sulfate D) Fresh frozen plasma Correct ANS: C Rationale: Protamine sulfate directly neutralizes heparin. Cytopenias
11. Aplastic anemia is characterized by: A) Hypercellular bone marrow B) Pancytopenia with hypocellular marrow C) Only neutropenia D) Eosinophilia Correct ANS: B Rationale: Aplastic anemia involves pancytopenia due to marrow failure and hypocellularity.

12. The most common cause of neutropenia in hospitalized patients is: A) Congenital disorders B) Chemotherapy C) Viral infections D) Autoimmune destruction Correct ANS: B Rationale: Chemotherapy is the leading cause in this population.
13. Pure red cell aplasia typically spares which cell lines? A) Neutrophilic cells B) Platelets C) Megakaryocytes D) All of the above Correct ANS: D Rationale: Pure red cell aplasia is selective for erythroid precursors.
14. The main etiologic agent in parvovirus B19-induced anemia in a sickle cell disease patient is: A) Aplastic crisis B) Iron deficiency C) Hyperhemolysis D) Autoimmune hemolysis Correct ANS: A Rationale: Parvovirus B19 causes transient aplastic crisis by infecting erythroid progenitors.
15. Which laboratory finding differentiates megaloblastic anemia from aplastic anemia? A) Low reticulocyte count B) Hypersegmented neutrophils C) Low platelet count D) Low neutrophil count Correct ANS: B Rationale: Hypersegmented neutrophils are indicative of megaloblastic anemia due to impaired DNA synthesis.

D) High white blood cell count Correct ANS: B Rationale: Hypoxemia stimulates erythropoietin production, increasing RBC mass.

20. The hallmark bone marrow finding in chronic myelogenous leukemia (CML) is: A) Lymphocytic infiltrate B) Erythroid hyperplasia C) Marked granulocytic hyperplasia D) Megakaryocytic hyperplasia Correct ANS: C Rationale: CML is characterized by uncontrolled proliferation of granulocytes. Hereditary Disorders
21. G6PD deficiency confers resistance to which infection? A) HIV B) Plasmodium falciparum malaria C) Hepatitis B D) Escherichia coli Correct ANS: B Rationale: G6PD deficiency offers protection against severe malaria.
22. The inheritance pattern of sickle cell disease is: A) X-linked recessive B) Autosomal recessive C) Autosomal dominant D) Mitochondrial Correct ANS: B Rationale: Sickle cell disease is inherited in an autosomal recessive manner.
23. Hereditary spherocytosis is caused by a defect in which red cell membrane protein?

A) Ankyrin B) Ceruloplasmin C) Albumin D) Ferritin Correct ANS: A Rationale: Mutations in ankyrin (and/or spectrin) disrupt membrane stability.

24. Patients with hemophilia A are at increased risk for which complication with repeated factor VIII infusions? A) Development of inhibitors (antibodies) B) Iron overload C) Neutropenia D) Autoimmune hemolysis Correct ANS: A Rationale: Some patients develop inhibitory alloantibodies to administered factor VIII.
25. Which thalassemia state is typically most severe and transfusion- dependent? A) Thalassemia minor B) Thalassemia intermedia C) Thalassemia major D) Silent carrier Correct ANS: C Rationale: Thalassemia major is severe and requires regular transfusions for survival. Immunologic Disorders
26. Common variable immunodeficiency (CVID) is BEST characterized by: A) Isolated IgA deficiency B) Decreased T cell number C) Hypogammaglobulinemia D) Hyperactive B-cell response Correct ANS: C

Correct ANS: C Rationale: C3 is critical in opsonization and immune defense against encapsulated bacteria. Neoplasms, Premalignancy, and Malignancy

31. Which genetic abnormality is pathognomonic for chronic myelogenous leukemia (CML)? A) t(9;22) BCR-ABL fusion gene B) t(14;18) BCL-2 gene translocation C) t(8;14) c-MYC gene D) t(15;17) PML-RARA fusion Correct ANS: A Rationale: t(9;22) Philadelphia chromosome is diagnostic of CML.
32. Auer rods on peripheral blood smear are characteristic of: A) Acute lymphoblastic leukemia B) Chronic lymphocytic leukemia C) Acute myeloid leukemia D) Multiple myeloma Correct ANS: C Rationale: Auer rods are crystalline structures seen in myeloid blasts.
33. Which clinical feature best distinguishes Hodgkin lymphoma from non-Hodgkin lymphoma? A) Generalized lymphadenopathy B) Extranodal involvement C) Contiguous spread D) Presence of B symptoms Correct ANS: C Rationale: Hodgkin lymphoma tends to spread contiguously from one node group to another.
34. The cell of origin for follicular lymphoma is: A) Naïve T cell B) Germinal center B cell

C) Monocyte D) Plasma cell Correct ANS: B Rationale: Follicular lymphoma arises from germinal center B cells.

35. Multiple myeloma is typically associated with: A) Leukocytosis B) Hypercalcemia C) Polycythemia D) Hypogammaglobulinemia Correct ANS: B Rationale: Bone destruction releases calcium, causing hypercalcemia in multiple myeloma.
36. Reed-Sternberg cells are characteristic of: A) Burkitt lymphoma B) Diffuse large B-cell lymphoma C) Hodgkin lymphoma D) Follicular lymphoma Correct ANS: C Rationale: Reed-Sternberg cells are a hallmark of Hodgkin lymphoma.
37. Chronic lymphocytic leukemia (CLL) most often presents with: A) Blasts in peripheral blood B) Lymphocytosis with smudge cells C) Pancytopenia only D) Large solid tumor masses Correct ANS: B Rationale: Smudge cells and lymphocytosis are classic for CLL.
38. The most common inherited predisposition to venous thrombosis is: A) Protein C deficiency B) Factor V Leiden mutation C) Antithrombin III deficiency D) Prothrombin 20210A mutation

2. A 50-year-old man develops hemolysis (↑ LDH, ↓ haptoglobin) and warm IgG autoantibodies. First‐line therapy? A) Glucocorticoids B) Splenectomy C) IVIG D) Rituximab ANS: A Rationale: Warm autoimmune hemolytic anemia initially treated with corticosteroids to reduce antibody production.
3. A patient with systemic lupus erythematosus has recurrent thromboses despite warfarin. Lupus anticoagulant is positive. Next step? A) Switch to heparin or DOAC B) Continue warfarin C) High‐dose aspirin only D) Add clopidogrel ANS: A Rationale: In antiphospholipid syndrome, unprovoked thrombosis on warfarin warrants LMWH or DOAC switching.
4. A 60-year-old with rheumatoid arthritis on gold therapy develops pancytopenia. Marrow is hypocellular. Management? A) Discontinue gold and supportive care B) Increase immunosuppression C) Bone marrow transplant D) IVIG ANS: A Rationale: Drug‐induced aplastic anemia requires withdrawal of offending agent and supportive care.
5. A 45-year-old with cold‐agglutinin AIHA has acrocyanosis in cold weather and DAT positive for C3. Treatment of choice? A) Keep warm and rituximab B) Prednisone

C) Splenectomy D) IVIG ANS: A Rationale: Cold AIHA responds poorly to steroids; avoid cold exposure and rituximab targets B‐cells. COAGULATION DISORDERS (5 questions)

6. A 25-year-old with severe hemarthroses has factor VIII activity <1%. X‐ linked pattern. Diagnosis? A) Hemophilia A B) Hemophilia B C) Von Willebrand disease D) DIC ANS: A Rationale: Severe X‐linked hemophilia A presents with low factor VIII and bleeding into joints.
7. A 35-year-old woman with menorrhagia has prolonged PTT corrects with mixing, low vWF antigen, and low ristocetin cofactor. Diagnosis? A) von Willebrand disease type 1 B) Hemophilia A carrier C) Factor V deficiency D) ITP ANS: A Rationale: vWD type 1 shows proportional decreases in vWF antigen and activity with PTT prolongation.
8. A sepsis patient has prolonged PT/PTT, low fibrinogen, elevated D‐ dimer, and schistocytes. Diagnosis? A) DIC B) TTP C) HUS D) HIT ANS: A

12. A 30-year-old with fatigue and macrocytic anemia has low reticulocytes, hypercellular marrow with megaloblasts. Next test? A) Serum B12 and folate levels B) Iron studies C) Coombs test D) Hemoglobin electrophoresis ANS: A Rationale: Macrocytosis with megaloblastic marrow suggests B12/folate deficiency.
13. A 6-year-old with easy bruising and platelet count 20 × 10^9/L, normal marrow, and anti‐platelet antibodies. First‐line therapy? A) IVIG B) Platelet transfusion C) Splenectomy D) Steroids ANS: D Rationale: ITP in children often responds to corticosteroids; IVIG if severe bleeding.
14. A patient with warm AIHA has Hb 6 g/dL and retic count 10%. Peripheral smear shows spherocytes. Diagnosis? A) Hemolytic anemia B) Aplastic anemia C) Iron deficiency D) Megaloblastic anemia ANS: A Rationale: Elevated retics with spherocytes indicate hemolysis.
15. A 25-year-old with pancytopenia, fatty marrow on biopsy. Best next step? A) Hematopoietic stem cell transplant B) Splenectomy C) Steroids D) Erythropoietin

ANS: A

Rationale: Aplastic anemia often requires stem cell transplant in young patients. CYTOSES (5 questions)

16. A 60-year-old with hemoglobin 18 g/dL, hematocrit 55%, low EPO, JAK2 mutation positive. Diagnosis? A) Polycythemia vera B) Secondary polycythemia C) Iron deficiency D) Essential thrombocythemia ANS: A Rationale: PV shows elevated RBC mass, low EPO, and JAK2.
17. A 50-year-old with platelets 850 × 10^9/L, JAK2 positive, mild splenomegaly. Asymptomatic. Next step? A) Hydroxyurea B) Aspirin alone C) Plateletpheresis D) Observation ANS: B Rationale: ET with low‐risk features is treated with low‐dose aspirin.
18. A 40-year-old with WBC 150 × 10^9/L, basophilia, splenomegaly, BCR- ABL+. Diagnosis? A) CML B) AML C) ALL D) CLL ANS: A Rationale: CML presents with leukocytosis, basophilia, splenomegaly, and BCR-ABL.
19. A neonate with WBC > 100 × 10^9/L, blasts on peripheral smear,

ANS: A

Rationale: Elevated HbA₂ with microcytosis indicates β-thalassemia trait.

23. A 20-year-old with sickle cell disease presents with acute dactylitis. Pathophysiology? A) Capillary vaso-occlusion by sickled cells B) Autoimmune destruction C) Infection D) Primary osteoporosis ANS: A Rationale: Vaso‐occlusion in small bones causes painful infarcts (dactylitis).
24. A child with family history of hemolysis and negative Coombs has spherocytes and positive osmotic fragility. Diagnosis? A) Hereditary spherocytosis B) Warm AIHA C) G6PD D) Sickle cell ANS: A Rationale: HS features intrinsic RBC membrane defects causing spherocytes and positive fragility.
25. A patient with thalassemia major requires frequent transfusions and has elevated ferritin. Next step? A) Deferoxamine chelation B) IV iron C) Phlebotomy D) Splenectomy ANS: A Rationale: Transfusion‐induced iron overload in thalassemia major is managed with chelation. IMMUNOLOGIC DISORDERS (5 questions)

26. A 3-month-old boy with chronic diarrhea, thrush, and absent thymic shadow. T and B cells both low. Diagnosis? A) SCID B) DiGeorge C) HIV D) CVID ANS: A Rationale: SCID presents early with T/B cell deficiency, fungal infections, and absent thymus.
27. A 15-year-old with recurrent encapsulated bacterial infections and low IgG and IgA but normal B-cell numbers. Diagnosis? A) Common variable immunodeficiency B) Bruton's agammaglobulinemia C) Hyper IgM syndrome D) Chediak-Higashi ANS: A Rationale: CVID features low immunoglobulins with normal B-cell counts and recurrent infections.
28. A male infant with pneumonia, enterovirus, and undetectable B cells. Diagnosis? A) X-linked agammaglobulinemia (Bruton) B) CVID C) SCID D) Hyper IgE syndrome ANS: A Rationale: Bruton's has absent B cells, low all immunoglobulins, and recurrent infections in males.
29. A child with albinism, neuropathy, and recurrent pyogenic infections with giant granules in neutrophils. Diagnosis? A) Chediak-Higashi syndrome B) CGD C) Wiskott-Aldrich