Hematology Exam #5 – Flashcards

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Normally the production of autoantibodies is kept in check by:
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T suppressor lymphocytes
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Which of the following is true regarding the mechanism of warm-reactive autoimmune hemolytic anemia (WAHA)?
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IgG autoantibodies cause extravascular hemolysis
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A patient's blood smear shows a moderate number of spherocytes and polychromasia. Select the best test to distinguish warm autoimmune hemolytic anemia (WAHA) from hereditary spherocytosis.
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direct antiglobulin test (DAT)
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Secondary cold-reactive autoimmune hemolytic anemia is found most often in patients with:
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Mycoplasma pneumoniae or infectious mononucleosis
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Red cell agglutination is found on a blood smear. Select the best course of action.
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Warm the blood and rerun it though the automated cell counter
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Monospecific Coombs sera indicates that a patient's red cells have complement coating them. Which of the following red cell morphology would be more likely?
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agglutination
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All of the following have been linked to excess erythrocyte destruction except:
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IgE alloantibodies
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Which of the following causes of alloimmune hemolytic anemia accounts for the largest number of deaths?
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ABO blood type errors from patient misidentification
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Which of the following is most often the result of human error?
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immediate hemolytic transfusion reaction
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A type A Rh-negative infant has spherocytes on his blood smear and a weakly positive direct antiglobulin test (DAT). What antibody will most likely be found on the baby's red cells?
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IgG anti-A
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An Rh-negative woman is pregnant with her third child. She received little or no prenatal care during the first two pregnancies. Her anti-D titer is 1:512 at 30 weeks of gestation. What is the likely outcome for the baby?
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Rh hemolytic disease of the newborn (HDN)
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A warm-reactive autoimmune hemolytic anemia is found in combination with thrombocytopenia in a patient. This is called:
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Evans syndrome
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The Donath-Landsteiner antibody:
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is found in serum and causes lysis of donor red blood cells, which have first been incubated at 4C and then warmed to 37C
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The qualitative hemoglobinopathies cause disease by producing hemoglobin that are:
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structurally altered.
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Which of the following hemoglobinopathies is most common?
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sickle cell diseases
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What clinical feature of sickle cell disease accounts for the highest number of hospital admissions?
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vaso-occlusion
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Sickle cell disease (SCD) is found in individuals descended from ancestors from all of the following places except:
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Scandinavia
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What percentage of African Americans have heterozygous sickle cell trait?
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8%
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Which of the following would be an unusual finding in the blood smear of an adult with sickle cell disease (SCD) crisis?
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Heinz bodies
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What is the probably etiologic association between malaria and sickle cell trait?
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Sickle gene offers some protection against malaria
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Which of the following would be unexpected homozygous hemoglobn S?
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hemoglobin A
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A patient has target cells and a positive tube solubility test. This patient probaby:
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has either sickle cell anemia or trait
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Select the best test to confirm the diagnosis of the patient in Question 9.
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hemoglobin electrophoresis
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A patient has two bands on alkaline hemoglobin electrophoresis. One lines up with hemoglobin A and the other is the S position. Select the best course of action.
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confirm sickle gene with tube solubility
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All of the following improve the clinical outcome of sickle cell anemia (hemoglobin SS) except which of the following?
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keeping the oxygen saturation low
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A patient has 45% hemoglobin S, 55% hemoglobin A, and a positive tube solubility. Which of the following would likely be found?
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normal blood smear and no disease
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Moderate to marked target cells are found on a blood smear. Which of the following can most likely be eliminated?
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hereditary spherocytosis
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Which of the following would be an unexpected finding for patients with hemoglobin SC disease or S.B0-thalassemia?
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normal tube solubility test
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Which of the following is a typical finding in patients with hemoglobin M?
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elevated methemoglobin
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Heinz bodies are found when hemoglobin:
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precipitates
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What is the correct relationship between red cells' affinity for oxygen and red cell production?
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When affinity is high, less oxygen is released and the body compensates by increasing erythropoietin and making more red cells
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What is a point mutation?
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replacement of one nucleotide in the normal gene with a different nucleotide
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Cellulose acetate is performed on a patient with known homozygous hemoglobin S who has received red cell transfusions in the past week. What hemoglobins would be expected to be found?
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S, A, F, and A2
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An adult female patient from Southeast Asia has no anemia, but her CBC shows an MCV of 68 fL and marked target cell are observed on her blood film. Cellulose acetate alkaline electrophoresis shows two large bands: approximately 55% migrating with hemoglobin A and 40% migrating with hemoglobin C. What is the patient's most likely genotype?
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hemoglobins A and E
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What is the basic hemoglobin defect in the thalassemias?
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A structurally normal globin chain is absent or produced at lower levels.
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Which of the following is the normal approximate percentage of hemoglobins in adults?
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a2b2 96% a2d2 2% a2y2 2%
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Why are infants with beta-thalassemia major not ill until approximately 6 months of age?
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Infants are protected by their high concentration of fetal hemoglobin.
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Which of the following is the primary mechanism for anemia in the thalassemias?
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an imbalance in the rate of globin chain synthesis
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Which of the following is true regarding the clinical features of thalassemias?
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vary from benign forms to those incompatible with life
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Which of the following is/are expected findings in beta-thalassemia minor?
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basophilic stippling
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All of the following can distinguish beta-thalassemia minor from major except:
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presence of microcytosis, hypochromasia, and target cells
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Which of the following would e an unexpected finding in homozygous beta0-thalassemia?
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normal fetal hemoglobin
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A patient has 30% hemoglobin F. Which of the following an be eliminated?
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four missing genes for alpha chain production
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What finding is present in all types of alpha-thalassemias?
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Barts hemoglobin present at birth
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Which of the following is true of patients with hemoglobin H disease?
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have two missing genes for alpha chain productions
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Homozygous alpha-thalassemia (--/--) has what clinical outcome?
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incompatible with life
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Which of the following can help distinguish the combination Hb S-beta0-thalassemia from sickle cell anemia?
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MCV
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Which of the following is least useful in diagnosing and differentiating the thalassemias from each other?
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osmotic fragility
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Which of the following is useful in helping to distinguish mild asymptomatic iron deficiency from thalassemia?
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mild anemia
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Hemoglobin Barts is composed of:
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y (gamma)
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A patient with beta+-thalassemia has, from that gene locus:
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variable but decreased beta globin chain synthesis
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Iron overload in severe beta-thalassemia (beta-thalassemia major) patients is primarily a consequence of:
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accumulation of iron from massive red blood cell transfusion therapy
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Patients who are heterozygous or hemoglobin Lepore have a clinical course:
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similar to that of beta-thalassemia minor
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Hemoglobin E is primarily found in individuals of which ethnic origin?
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Southeast Asian
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Hemoglobins A2 and F can quantified by:
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performing high-performance liquid chromatography (HPLC)
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A chemotherapy patient's WBC is 1.0 x 10^9/L. There are 60% segmented neutrophils, 38% lymphocytes, and 2% monocytes. What is the correct interpretation of the relative differential?
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normal
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What is the absolute neutrophil count for the patient in Question 1?
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0.6 x 19^9/L
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What is the correct interpretation of the absolute neutrophil count in the chemotherapy patient in Question 1?
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neutropenia
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A patient has a white count of 15.0 x 10^9/L. What is the correct interpretation?
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normal for an infant, leukocytosis for an adult
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What is the best test to determine the reason for the 15.0 x 10^9/L leukocyte count in Question 4?
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white cell differential
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Neutrophilia accompanied by immature granulocytes and nucleated red cells is what kind of reaction?
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leukoerythroblastic
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Neutrophilia and a left shift are most often found in patients with:
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acute bacterial infection
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Which of the following is the poorest prognostic sign for a patient with a bacterial infection?
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low white count with immature neutrophils and toxic changes
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A patient has 20% eosinophils. Which of the following can probably be eliminated?
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pertussis
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A patient has a white count of 8.3 x 10^9/L and 65% lymphocytes. What is the correct interpretation?
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depends on the patient's age
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Why is the absolute neutrophil count (ANC) monitored closely in patients receiving chemotherapy?
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Bacterial infection becomes a possibility when the ANC is <1.0 c 10^9/L
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Nonmalignant disorders of leukocytes are:
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acquired or inherited, and range from benign to life threatening
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Nuclear hyposegmentation and denser-than-normal chromatin clumping are features of:
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Pelger-Huet anomaly
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What is the concern in Pelger-Huet anomaly is not recognized?
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The cells could be misclassified as immature neutrophils, indicating that the patient has a bacterial infection when he or she does not
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The abnormal granules seen in Alder-Reilly anomaly could be confused for:
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toxic granulation
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What are the abnormal cytoplasmic inclusions in Chediak-Higashi?
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fused granules that inhibit bactericidal functions
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What abnormal findings are found in May-Hegglin anomaly?
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Dohle body like cytoplasmic inclusions and thrombocytopenia
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Toxic granulation, Dohle bodies, and vacuolization in neutrophils are often found together in:
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bacteria infection
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The nitroblue tetrazolim (NBT) test is used to diagnose:
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chronic granulomatous disease
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Deficient enzymes that allow various lipids to accumulate in macrophages and monocytes describe:
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storage cell disease
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Gaucher cells and Niemann-Pick cells are found in:
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bone marrow and spleen
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A college student seeks medical care of extreme fatigue and swollen lymph nodes in the neck. The white blood cell (WBC) count is 11.3 x 10^9/L. The differential shows a relative and absolute lymphocytosis. Many of the lymphocytes are larger than normal with a basophilic cytoplasm indented by the RBCs. The nuclei are less clumped than normal and some have nucleoli. The rest of the complete blood count (CBC) is normal. What is the most likely diagnosis?
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Infectious monoucleosis
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The lymphocytes in the student in Question 22 are most likely:
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differentiated T cells
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A clinical laboratory scientist sees unusual darkly stained cytoplasmic inclusions in leukocytes that she has no seen before. She should:
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have a supervisor or pathologist look at the cells
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The Epstein-Barr virus (EBV) is causative agent of:
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infectious mononucleosis
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The diagnosis of infectious mononucleosis is most often made by which of the following findings?
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demonstration of the presence of the heterophil antibody
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What laboratory tests are used to diagnose and classify leukemia?
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all of the above
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Which of the following can be determined from examining the blood smear?
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presence and percentage of blasts
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Which of the following malignancies has the greatest chance for long-term survival or cure?
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chronic myelocytic leukemia
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What are the most common life-threatening complications after chemotherapy?
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bacterial infection and bleeding
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What is the major drawback to chemotherapy?
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suppression of the bone marrow
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How do chemotherapy drugs work to kill or inhibit tumor cells?
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variety of mechanisms can damage DNA or interfere with the cell cycle
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What is the greatest drawback to autologous over allogeneic stem cell transplant (SCT) for leukemia?
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malignant cells more likely to return
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Most malignancies of the hematopoietic system are an:
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acquired genetic disease
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A proto-oncogene codes for a protein involved in cell:
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cycle regulation
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What cell process is normally responsible for removal of redundant, damaged, aged, or defective cells?
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apoptosis
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Viruses have been found as an etiologic agent for which of the following hematologic malignancies?
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Burkitt lymphoma
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Which of the following is true concerning the use of the chemotherapeutic dugs?
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dosage limited by the impact on normal bone marrow cells
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Graft-versus-host disease (GVHD) develops when:
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donor T cells attack patient tissue(s)
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Hematopoietic stem cells can be harvested from all of the following tissues except:
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umbilical cord blood
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Imatinib mesylate is an example of:
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targeted therapy
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