Chapter 29: Alterations of Leukocyte, Lymphoid, and Hemostatic Function MULT!L" CH#C"
1. What change is observed in leukocytes leuko cytes during an allergic disorder (type I hypersensitivity)
often caused by asthma, hay fever, and drug reactions? a. Neutrophilia c. osinophilia b. !asophilia d. "onocytosis #N$% &
osinophilia is an absolute increase (more than '*+) in the total numbers of circulating eosinophils. #llergic #llergic disorders (type I h ypersensitivity) associated -ith asthma, hay fever, and drug reactions, as -ell as parasitic infections (particularly -ith metaoal parasites), are often cited as causes. /his change is not identified b y any of other options. 0/$% 1
2% 0ages 113111
4. In infectious mononucleosis (I"), -hat does the "onospot test detect? a. Immunoglobulin (Ig) c. Immunoglobulin 5 (Ig5) b. Immunoglobulin " (Ig") d. Immunoglobulin # (Ig#) #N$% !
6eterophile antibodies are a heterogeneous group of Ig" antibodies that are agglutinins against nonhuman red blood cells (e.g., sheep, horse) and are detected by 7ualitative (monospot) or 7uantitative (heterophile antibody) test methods. /his statement is not true of the other options. 0/$% 1
2% 0ages 1143118
8. Which description is consistent -ith acute lymphocytic leukemia (#)? a. # is a progressive neoplasm defined by the presence of greater than 89
lymphoblasts in the bone marro- or blood. b. eukocytosis and a predominance of blast cells characterie the bone marro- and peripheral blood. #s the the immature blasts increase, they replace normal myelocytic cells, megakaryocytes, and erythrocytes. c. ! cells fail to mature into plasma cells that synthesie immunoglobulins. d. /he translocation of genetic material from genes : and 44 create an abnormal, fused gene identified as BCR-ABL. as BCR-ABL. #N$% #
# is a progressive neoplasm defined by the presence of grea ter than 89 lymphoblasts in the bone marro- or blood. None of the other options provide an accurate description of #. 0/$% 1
2% 0age 11;
'. Which description is consistent -ith chronic myelogenous leukemia (&")? a.
gene encoding a cell3cycle regulatory protein. b. eukocytosis and a predominance of blast cells characterie the bone marro- and peripheral blood. #s the the immature blasts increase, they replace normal myelocytic
cells, megakaryocytes, and erythrocytes. c. ! cells fail to mature into plasma cells that synthesie immunoglobulins. d. /he translocation of genetic material from genes : and 44 creates an abno abnormal, rmal, fused protein identified as BCR-ABL1 as BCR-ABL1.. #N$% <
/he 0hiladelphia chromosome is present in more than :9 of those -ith &", and the presence of the BCR-ABL1 the BCR-ABL1 protein protein is responsible for the initiation of &". /he other options do not accurately describe &". 0/$% 1
2% 0ages 11'311 > 0age 141
. Which description is consistent -ith chronic lymphocytic leukemia (&)? a.
gene encoding a cell3cycle regulatory protein. b. eukocytosis and a predominance of blast cells characterie the bone marro- and
peripheral blood. #s the the immature blasts increase, they replace normal myelocytic cells, megakaryocytes, and erythrocytes. c. ! cells fail to mature into plasma cells that synthesie immunoglobulins. d. /he translocation of genetic material from genes : and 44 creates an abno abnormal, rmal, fused protein identified as BCR-ABL as BCR-ABL.. #N$% &
& is derived from transformation of a partially mature ! cell that has not yet encoun tered antigen. /he other options do not accurately describe &. 0/$% 1
2% 0ages 143141
;. Which electrolyte imbalance accompanies multiple myeloma ("")? a. 6yperkalemia c. 6yperphosphatemia b. 6ypercalcemia d. 6ypernatremia #N$% !
levated levels of calcium in the blood (hypercalcemia) characterie the common presentation of "". /he other options do not accompany acco mpany "". 0/$% 1
2% 0age 184
. eed3$ternberg ($) cells represent malignant transformation and proliferation of -hich of
the follo-ing? a. Interleukin (I)@1, I34, I3, and I3; b. /umor necrosis factor@beta c. ! cells d. / cells #N$% &
#lthough the molecular events that cause malignant transformation remain controversial, $ cells are apparently from !3cell lineage. /he other options are not relevant to this process. 0/$% 1
2% 0ages 14'314
A. ocal signs and symptoms of 6odgkin disease@related lymphadenopa thy are a result of -hich
of the follo-ing? a. 0ressure and ischemia b. 0ressure and obstruction
c. Inflammation and ischemia d. Inflammation and pressure
#N$% !
ocal symptoms caused by pressure and obstruction ob struction of the lymph nodes are the result of lymphadenopathy. /he other options do not contribute to the lymphadenopathy associated -ith 6odgkin disease. 0/$% 1
2% 0age 14
:. Which virus is associated -ith !urkitt lymphoma in #frican children? a. &ytomegalovirus c. 6uman papillomavirus b. #denovirus d. pstein3!arr virus #N$% <
pstein3!arr virus, found in nasopharyngeal secretions, is associated -ith !urkitt lymphoma in #frican children. /he other options are not associated -ith this malignancy. malignanc y. 0/$% 1
2% 0age 14:
1. Which term is used to describe a red3purple discoloration cau sed by diffuse hemorrhage into
the skin tissue? a. 0etechiae b. 6ematoma
c. cchymosis d. 0urpura
#N$% <
2% 0age 18
11. Which statement best describes heparin3induced thrombocytopenia (6I/)? a. Immunoglobulin 5 immune@mediated adverse drug reaction that reduces
circulating platelets b. 6ematologic reaction to heparin in -hich the bone marro- is unable to produce sufficient platelets to meet the bod yBs needs c. Immunoglobulin @mediated allergic drug reaction that reduces circulating platelets d. &ell3mediated drug reaction in -hich macrophages process the heparin and platelet comple=es that are then destroyed by b y activated cytoto=ic / cells. #N$% #
6eparin is a common cause of drug3induced thrombocytopenia. 6I/ is an immune3mediated, adverse drug reaction caused by b y immunoglobulin 5 antibodies that leads to increased platelet consumption and a decrease in platelet counts. None of the other options accurately describe 6I/. 0/$% 1
2% 0age 18A
14. Immune thrombocytopenia (I/0) is a(n) CCCCC condition in adults and a(n) CCCCC condition in
children. a. #cuteD acute b. &hronicD chronic
c. #cuteD chronic d. &hronicD acute
#N$% <
I/0 may be acute or chronic. /he acute form is fre7uen tly observed in children. &hronic I/0 is more commonly observed in adults, -ith the highest prevalence in -omen bet-een 4 and ' years of age. 0/$% 1
2% 0ages 18A318:
18. Eitamin CCCCC is re7uired for normal clotting factor synthesis by the CCCCC. a. FD kidneys c. FD liver b.
Eitamin Eitamin F, a fat3soluble vitamin, is necessary for the synthesis and regulation of prothrombin, procoagulant factors (EII, IG, G), and anticoagulant regulators (proteins & and $) in in the liver. 0/$% 1
2% 0ages 1'431'8
1'. What is the most common cause of vitamin F deficiency? a. #dministration of -arfarin (&oumadin) b. /otal /otal parenteral nutrition -ith antibiotic therapy therap y c. #n immunoglobulin 5@mediated autoimmune disorder d. iver failure #N$% !
/he most common cause of vitamin F deficiency is parenteral nutrition in combination -ith broad3spectrum antibiotics that destroy normal gut flora. flora. None of the other options are commonly associated -ith vitamin F deficiency. 0/$% 1
2% 0age 1'8
1. Which disorder is described as an unregulated release of thrombin -ith subse7uent fibrin
formation and accelerated fibrinolysis? a.
2% 0age 1'8
1;. In disseminated intravascular coagulation (
alpha (/N23α)
b. /hrombo=ane #, causing platelets to aggregate and consume clotting factors c. /issue factor (/2) located in the endothelial layer of blood vessels and
subcutaneous tissue d. ndoto=ins from gram3negative and gram3positive bacteria circulating in the bloodstream #N$% &
2% 0ages 1'831''
1. Which proinflammatory cytokines are responsible for the development and maintenance of
disseminated intravascular coagulation (
ndoto=in, in particular, triggers the release of multiple cytokines that play a significant role in the development and maintenance of
2% 0age 1''
1A. In disseminated intravascular coagulation (
thrombosis? a. educed amplitude in peripheral pulses b. $ymmetric cyanosis of fingers and toes c. Numbness and tingling in fingers and toes d. !ilateral pallor and edema of fingers and toes #N$% !
$everal organ systems are susceptible to microvascular thrombosis that affects their function. Indicators of multisystem failure include changes in the level of consciousness, behav ior, and mentationD confusionD seiure activityD oliguriaD hematuriaD hypo=iaD hypotensionD hemoptysisD chest painD and tachycardia. $ymmetric $ ymmetric cyanosis of the fingers and toes (i.e., Jblue finger*toe syndromeK) and, in some instances, of the nose and breasts may be present. /he other options are not recognied indicators of microvascular thrombosis. 0/$% 1
2% 0age 1';
1:. What is the most reliable and specific test for diagnosing disseminated intravascular
coagulation (
a. b. c. d.
0rothrombin time (0/) #ctivated partial thromboplastin time (a0//) 2ibrin degradation products (2<0) <3dimer
#N$% <
<3dimer testing measures a specific
2% 0age 1'
4. What term is used to identify thrombi that occlude arterioles and capillaries and are made up
of platelets -ith minimal fibrin and erythrocytes? a. ssential (primary) thrombocythemia (/) b. #cute idiopathic thrombotic thrombocytopenic purpura c. /hrombotic thrombocytopenic purpura (//0) d. Immune thrombocytopenic purpura (I/0) #N$% &
Lf the available options, only //0 is characteried by thrombotic microangiopathy in -hich platelets aggregate and cause occlusion of arterioles and capillaries in the microcirculation. 0/$% 1
2% 0age 1'
41. Which of the follo-ing is characteried by -hat is referred to as pathognomonic as pathognomonic pnta! of of
symptoms? a. #cute idiopathic thrombotic thrombocytopenic purpura b. ssential (primary) thrombocythemia (/) c. Immune thrombocytopenic purpura (I/0) d. /hrombotic thrombocytopenic purpura (//0) #N$% #
#cute idiopathic thrombotic thrombocytopenic purpura is characteried by a pathognomonic pentad of symptoms that includes e=treme thrombocytopenia (fe-er than 4, platelets*mm8), intravascular hemolytic anemia, ischemic signs and symptoms most often involving the central nervous system (appro=imately ;9 e=hibit memory disturbances, behavioral irregularities, headaches, or coma), kidney failure (affecting (affecting appro=imately ;9 of individuals), and fever (present in appro=imately 889 of individuals /he o ther options do not demonstrate these symptoms. 0/$% 1
2% 0age 1'
44. Which statement relates to immune thrombocytopenic purpura (I/0)? a. I/0 is formed in conditions of lo- flo- and is made up of mostly of mostly red cells -ith
larger amounts of fibrin and fe- platelets. b. #n alteration of multipotent stem cells, resulting in an e=cess production of platelets, causes I/0. I/0. c. "ononuclear phagocytes in the spleen remove antibody3coated platelets from circulation. d. #rterial clots are made up of mostly of mostly platelet aggregates held together by fibrin strands.
#N$% &
I/0 involves the antigen usually forming immune comple=es -ith circulating antibodies, and it is thought that the immune comple=es bind to 2c receptors on platelets, leading to their destruction in the spleen. None of the other options are accurately related to I/0. 0/$% 1
2% 0ages 18A318:
48. When the demand for mature neutrophils e=ceeds e=ce eds the supply, immature neutrophils are
released indicating% a. # shift to the right b. # shift to the left
c. eukocytosis d. eukemia
#N$% !
When the demand for circulating mature neutrophils e=c eeds the supply, the marro- begins to release immature neutrophils (and other leukocytes) into the blood. 0remature release of the immature -hite cells is responsible for the phenomenon kno-n as a shi"t a shi"t to th #"t or #"t or #u$moi! raction. raction. None of the remaining options op tions -ould be used to identify the process described. 0/$% 1
2% 0age 1:
4'. 6odgkin disease is characteried by the presence of -hich of the follo-ing? a. 0hiladelphia chromosome c. "icrovascular thrombi b. Eircho- triad d. eed3$ternberg ($) cells #N$% <
6odgkin disease is characteried by its progression from one g roup of lymph nodes to another, the development of systemic symptoms, and the presence of $ cells (see 2igure 4:3 A), but not the involvement of the 0hiladelphia chromosome. Eircho- triad is a symptom related to thrombus formation.
2% 0age 14'
MULT!L" $"%!#&%"
4. Which classic clinical manifestations are symptoms o f I"? %&#ct a## that app#'.( ap p#'.( a. ymph ymph node enlargement b. 6epatitis c. 0haryngitis d. dema in the area of the eyes e. 2ever #N$% #, &, &,
#t the time of diagnosis, the individual usually has the classic triad of symptoms% fever, pharyngitis, and lymphadenopathy of the cervical lymph nodes. /he triad does not include hepatitis or orbital edema. 0/$% 1
2% 0age 114
4;. arly detection of acute leukemia -ould include -hich of the follo-ing symptoms? %&#ct
a## that app#'.( a pp#'.( a.
$igns and symptoms related to bone marro- depression de pression include fatigue caused by anemia, bleeding resulting from thrombocytopenia (reduced numbers of circulating platelets), platelets), and fever caused by infection. #nore=ia can occur in all va rieties of acute leukemia and is associated -ith -eight loss. 0ain in the bones a nd Hoints is thought to result from leukemia infiltration -ith secondary stretching of the periosteum. /he other options are not generally associated -ith acute leukemia. 0/$% 1
2% 0age 11 > 0age 11:
4. What are the most significant risk factors for the development of thrombus formation as
referred to by the EirchoEircho- triad? %&#ct a## that app#'.( a. ndothelial inHury to blood vessels b. /urbulent arterial blood floc. apid coagulation of the blood d. $tagnant venous blood floe. 6istory of obesity #N$% #N$% #, !, !, &, &, <
/he risk for developing spontaneous thrombi is related to several factors, referred to as the EirchoEircho- triad% (1) inHury to the blood vessel endothelium, (4) abnormalities of blood flo-, and (8) hypercoagulability of the blood. Lbesity is not associated -ith the triad. 0/$% 1
2% 0ages 1'A31':
4A. Which statements are tru are tru regarding regarding leukemias? %&#ct a## that app#'.( a. # single progenitor cell undergoes a malignant change. b. eukemia is a result of uncontrolled cellular proliferation. c. !one marro- becomes overcro-ded. d. eukocytes are under produced. e. 6ematopoietic cell production is decreased. #N$% #N$% #, !, !, &, &,
In the leukemias, a single progenitor cell und ergoes malignant transformation. /he common feature of all forms of leukemia is an uncontrolled proliferation of malignant leukocytes, causing an overcro-ding of bone marro- and decreased production and function of normal hematopoietic cells. 0/$% 1
2% 0age 11
4:. /he t-o maHor forms of leukemia, acute and chronic, are classified by -hich criteria? %&#ct
a## that app#'.( a pp#'.( a. 0redominant cell type
b. c. d. e.
ate of progression #ge of individual -hen cells differentiation occurs $tage of cell development -hen malignancy first occurs $erum level of leukocytes
#N$% #, !
/he current classification of leukemia is based on (1) the predominant cell of origin (either myeloid or lymphoid) and (4) the rate of o f progression, -hich usually reflects the degree at -hich cell differentiation -as arrested -hen the cell became malignant (acute or chronic) (see 2igure 4:34). /he remaining options are inaccurate statements regarding the classification criteria. 0/$% 1
2% 0age 118
8. What are the clinical manifestations of advanced no n3#frican !urkitt lymphoma? %&#ct a##
that app#'.( a. #bdominal s-elling b. Night s-eats c. 2ever d. Weight gain e.
In non3#frican !urkitt lymphoma, the most common presentation is abdominal s-elling. "ore advanced disease may e=hibit e=h ibit night s-eats, fever, and -eight loss.
2% 0age 14:
MATCH&'
)atch th causs or !iagnostic tsts *ith th hmato#ogic !isor!rs. !isor!rs. CCCCCC #. pstein3!arr pstein3!arr virus CCCCCC !. !ence Mones protein CCCCCC &.
Infectious mononucleosis &hronic myelogenous leukemia "ultiple myeloma 6odgkin lymphoma
81. #N$% # 0/$% 1 2% 0age 111 "$&% /he most common common etiologic agent agent is pstein3!arr pstein3!arr virus, a ubi7uitous, ubi7uitous, lymphotrophic, lymphotrophic, gamma3 gamma3 group herpesvirus. 84. #N$% < 0/$% 1 2% 0ages 11'311 "$&% /he 0hiladelphia 0hiladelphia chromosome is is present in more more than :9 of of patients -ith -ith chronic myelogenous leukemia. 88. #N$% ! 0/$% 1 2% 0age 184 "$&% /he myeloma may produce produce free immunoglobulin immunoglobulin light chain (!ence Mones protein) that is present in the blood and and urine in appro=imately appro=imately A9 of patients.
8'. #N$% & 0/$% 1 2% 0age 14' "$&% 6odgkin lymphoma lymphoma is characteried characteried by its progression progression from one one group of lymph lymph nodes to another, the development of systemic symptoms, and the presence of eed3$ternberg cells
