MMS Clinical Integration Exam I: Blood Disorders: Student Questions

A 50 year-old woman presents with increased fatigue and headaches. Her lab work shows she has developed anemia with a mild increase in spherocytes in circulation. Which of the following is most likely the direct cause of her anemia?

deficiency in folate

3 multiple choice options

A patient presents to their physician with a case of anemia. After ordering a CBC, it’s determined that the patient has a MCV of 68 (normal values: 80-100 fL) and MCHC of 29 (normal: 32-37 g/L). Which of the following is a possible cause of the patient’s anemia?

Deficiency of iron

3 multiple choice options

Which of the following statements best describes the metabolism of mature erythrocytes?

Erythrocytes generate ATP exclusively through glycolysis and use it for ion transport and membrane maintenance.

3 multiple choice options

A patient presents with a rare metabolic disorder affecting heme production. Laboratory tests reveal decreased activity of δ-aminolevulinic acid (δ-ALA) synthase. Which of the following statements about heme synthesis is correct?

Heme is synthesized from glycine and succinyl-CoA, and iron is added at the final step.

3 multiple choice options

A four-year-old male child presents to the clinic with failure to thrive and recurrent infections. Genetic testing shows a mutation in the y-chain of the interleukin 2 receptor. Laboratory testing shows the absence of mature T lymphocytes and inactive B lymphocytes. Which of the following describes the best direct mechanism that can be causing this child's condition?

Inability to activate JAK3

3 multiple choice options

Both the HbS and HbC mutations occur at the exact same amino acid position. Why does HbC homozygosity (HbC/HbC) lead to only a mild anemia, while HbS homozygosity (HbS/HbS) is devastating?

The HbS mutation causes globin polymerization and critical cell deformation (sickling), while the HbC mutation causes hemoglobin precipitation and water loss without this severe cell deformation.

3 multiple choice options

After approximately 120 days an aged red blood cell is phagocytosed by reticuloendothelial cells. During normal heme degradation, which of the following correctly matches the product of heme breakdown with its immediate fate?

Heme → oxidized and cleaved to produce biliverdin and carbon monoxide

3 multiple choice options

Red blood cells must be deformable in the human body to pass through many organs as they circulate the body. These cells rely on membrane proteins in order to change their shape and a certain organ to determine their viability. Identify the major red blood cell membrane protein that allows for its deformability and the main organ that detects its viability, respectively.

Spectrin, spleen

3 multiple choice options

A 25-year-old professional skier reports to the emergency department complaining of fatigue, dyspnea, and pale skin following a fall she had two hours prior. It is determined that the patient’s fall caused internal bleeding and the patient has become anemic due to acute blood loss. What predictable changes are expected in regard to the patient’s anemia?

Mobilization of granulocytes

3 multiple choice options

A 35-year-old male presents to the hospital after returning from a trip to Liberia, Africa. He was initially diagnosed with typhoid fever and treated with antibiotics. The following day, he develops shortness of breath, dark urine, fatigue, and yellow discoloration of the eyes. Physical examination reveals bilateral scleral icterus, no evident splenomegaly, and a soft, non-tender abdomen. Laboratory tests show hemoglobinemia and hemoglobinuria.

G6PD Deficiency

3 multiple choice options

A 3-year-old female with sickle cell anemia presents pale, lethargic, and tachycardic. Exam shows marked splenomegaly. Patient needs urgent transfusion. Which of the following best describes this crisis?

Sequestration Crisis

3 multiple choice options

A 7-year-old boy presents with fatigue and pale skin. Laboratory studies show a microcytic, hypochromic anemia with target cells on smear. Hemoglobin electrophoresis reveals increased HbF and increased HbA2. He has hepatosplenomegaly, and skull imaging shows bone expansion from increased marrow activity. Which of the following best explains the cause of his anemia?

Decreased production of β-globin chains causing ineffective red blood cell formation

3 multiple choice options

A 47 y.o woman presents with fatigue, diarrhea, and loss of appetite. She recalls having eaten undercooked fish while on vacation abroad four months ago. Blood testing reveals Vitamin B-12 deficiency. Which of the following is most likely observed in a peripheral blood smear?

Hypersegmented neutrophils

3 multiple choice options

A 52-year-old man presents to the ED with progressive fatigue and pallor. Laboratory results attached below. Bone marrow Biopsy shows adequate iron stores but decreased iron in erythroid precursor cells. A liver biopsy shows increased production of an acute phase reactant that inhibits ferroportin-mediated iron export from enterocytes. Which of the following underlying conditions most likely explain the patient’s laboratory findings.

- Hemoglobin: 9.2 g/dL

- MCV: 75 fL

- Serum iron: ↓

- Hepcidin ↑

- Ferritin: ↑

Chronic inflammatory disease such as rheumatoid arthritis

3 multiple choice options

An 8-year-old girl is brought to the Emergency room by her mother after a sudden onset of chills, fever and difficulty breathing. The mother mentions that the child has β Thalassemia Minor but has never had any major issues due to this. The mother also mentions that two days ago the child had red, rosy cheeks. After a CBC is run, the physician notes the patient has low reticulocyte and RBC count. Which of the following could have caused a sudden onset of these symptoms?

Parvovirus B19

3 multiple choice options

A 54-year-old male presents to his primary care physician with headaches, dizziness, and facial redness. He reports that his skin becomes itchy after taking hot showers. Upon physical examination, his blood pressure is elevated and he appears flushed. His CBC shows elevated hemoglobin and hematocrit. His erythropoietin level is also decreased. Which of the following best explains the underlying mechanism of this patient’s condition?

Erythropoietin-independent proliferation of red cell progenitors

3 multiple choice options

A 45-year-old man is found to have macrocytic anemia. His doctor prescribes folic acid supplementation, and his hemoglobin level rises within a week. However, one month later, he reports numbness and tingling in his hands and feet and difficulty walking. Further testing shows low vitamin B₁₂ and high methylmalonic acid levels. Which of the following best explains why vitamin B₁₂ deficiency must be excluded before starting folic acid therapy?

Folate corrects hematologic findings but can mask and worsen neurologic damage in vitamin B₁₂ deficiency

3 multiple choice options

A 12-year-old patient presents with fatigue, mild jaundice, and intermittent episodes of anemia. Physical examination reveals splenomegaly. Laboratory testing shows that the patient’s red blood cells demonstrate increased osmotic sensitivity when incubated in hypotonic salt solutions and numerous small, round red blood cells lacking membrane stability. The patient’s father has a history of similar symptoms requiring splenectomy during adolescence. Which of the following molecular abnormalities most likely accounts for this patient’s condition?

Mutations involving ankyrin, band 3, or spectrin proteins

3 multiple choice options

A 16-year-old male presents with mild anemia, jaundice, and moderate splenomegaly. His peripheral smear shows small, dark-staining red cells lacking a central zone of pallor and several Howell-Jolly bodies. Another patient develops anemia and dark urine two days after taking antimalarial medication. His smear shows red cells with “bite-like” defects. Which of the following best explains the cause of the abnormal red cell morphology in each patient?

The first patient’s red cells have lost membrane surface area due to a membrane skeletal defect, while the second patient’s red blood cells have membrane damage from oxidant injury caused by deficient NADPH production.

3 multiple choice options

A pregnant woman undergoes an ultrasound that reveals severe pallor, massive hepatosplenomegaly, and generalized edema which is consistent with Hydrops Fetalis. This condition is associated with which abnormal form of globin chains in thalassemia, and during which trimester of pregnancy is it typically present?

Deletion of all four alpha-globin gene: third trimester

3 multiple choice options

An 8-month-old infant is brought to the pediatric clinic with complaints of persistent weakness, pallor, and poor growth. Lab reports show a hemoglobin concentration of 3–6 g/dL and an elevated reticulocyte count. Peripheral smear shows microcytic, hypochromic red cells with target cells. Imaging studies reveal evidence of extramedullary hematopoiesis. Physical examination also shows hepatosplenomegaly and Iron chelators have been used to treat the condition. Which of the following is the most likely diagnosis and associated hemoglobin pattern in this patient?

β-thalassemia major — elevated HbF levels

3 multiple choice options

A 50-year-old postmenopausal woman presents to the clinic with fatigue and pallor. Laboratory results show:

· Hemoglobin: 9.2 g/dl (low)

· MCV: 70 fL (low)

· Serum ferritin: 8 ug/L (low)

· Transferrin saturation: 10% (low)

· Total iron-binding capacity: increased

A peripheral smear shows hypochromic, microcytic red cells with pencil forms. What is the most appropriate next diagnostic step?

Colonoscopy to evaluate for occult gastrointestinal bleeding

3 multiple choice options

A 28-year-old woman with no previous significant medical history has developed hemoglobinuria along with fatigue in the morning. Laboratory testing shows high lactate dehydrogenase, normocytic anemia, and low haptoglobin. Flow cytometry reveals an absence of CD59 and CD55 on the red blood cells. Based on these findings, which of the following physiologic mechanisms best explains her condition?

Deficiency of GPI-anchored protective proteins causing complement-mediated intravascular hemolysis

3 multiple choice options

A patient with β-thalassemia is noted to have severe chronic hemolytic anemia but is not transfusion-dependent. This patient is at high risk of developing iron overload, even without receiving transfusions. Which of the following best explains the genetic basis and pathophysiology of this specific presentation?

The patient has β-thalassemia intermedia, leading to ineffective erythropoiesis and chronic iron hyperabsorption

3 multiple choice options

A 29-year-old woman comes to the clinic with fatigue and reports heavy menstrual periods. Her CBC shows a microcytic, hypochromic anemia with pencil-shaped RBCs. Which of the following laboratory findings is most consistent with iron deficiency anemia?

Increased TIBC

3 multiple choice options

A 30-year-old female presents to her primary care physician with jaundice after taking penicillin for an infection. The physician orders a Coombs test, blood smear, and reticulocyte count. The Coombs test is positive, and the blood smear shows spherocytes. What is the first therapeutic approach to mitigate her hemolytic episode?

Prednisone

3 multiple choice options

A 58-year-old patient presents with fatigue, pallor, and a smooth, sore tongue. Laboratory findings indicate loss of intrinsic factor due to autoimmune destruction of gastric parietal cells. Which of the following conditions is the most common cause of this patient's vitamin B12 (cobalamin) deficiency?

Pernicious anemia

3 multiple choice options

A 65-year-old man with long-standing rheumatoid arthritis presents with fatigue and pallor. His laboratory results show a normocytic, normochromic anemia. Iron studies reveal decreased serum iron, decreased total iron-binding capacity (TIBC), and normal to increased ferritin. Which of the following mechanisms best explains the anemia seen in this patient?

Iron sequestration within macrophages mediated by increased hepcidin levels

3 multiple choice options

A 70-year-old man with a history of vitamin B12 and folate deficiency presents with a sudden onset of fatigue, weakness, and palpitations. Laboratory studies reveal anemia with a low reticulocyte count and elevated mean corpuscular volume (MCV). Which of the following additional findings would most likely be seen on his peripheral blood smear?

Hypersegmented neutrophils

3 multiple choice options

A 10-year-old boy returns 48 hours after a scraped knee. The area is mildly red and warm. A smear from the wound shows neutrophils and rising mononuclear cells. Which factor most directly drives circulating monocytes to mature into tissue macrophages?

M-CSF

3 multiple choice options

A 49-year-old man experiences ischemic injury, and his lab levels show low levels of RBCs, WBCs, and platelets. The first step to restore blood population is for hematopoietic stem cells to give rise to ________.

Progenitor stem cells

3 multiple choice options

A PhD student and her advisor are studying a bone marrow smear containing cells in different stages of granulopoiesis under a microscope. The student asks her advisor about the identity of a cell with a kidney bean-shaped nucleus and granules. The advisor informs her that the granules of this cell are lineage-specific, making it possible to distinguish neutrophilic, eosinophilic, and basophilic precursors. Which cell type are they most likely looking at?

Metamyelocyte

3 multiple choice options

A 67-year-old male presents with fatigue, sore throat, and enlarged cervical lymph nodes. Laboratory tests were ordered and results showed normal H&H, normal Platelet Count, however it showed an increased Lymphocyte count. Which type of Lymphocytes only recognize antigens bound to MHC 1 molecules?

Cytotoxic CD8+ T Lymphocytes

3 multiple choice options

A 2-year-old child presents his pediatrician with pain and swelling in his hands and feet, along with fatigue and pallor. His parents relay that the child has been increasingly tired over the past few weeks and less energetic than usual. Lab results reveal hemoglobin of 9.0 g/dL (normal pediatric Hgb: 11-14 g/dL), and a peripheral blood smear shows multiple crescent and sickle shaped red blood cells. Which of the following best explains the underlying molecular defect in this patient's condition?

Point mutation in the β-globin gene resulting in substitution of valine for glutamic acid at position 6

3 multiple choice options

A 5-year-old male child is brought in by his parents due to long-standing, unexplained fatigue and a recent finding of mild jaundice following a common cold. His parents report that he has a history of splenomegaly noted during routine check-ups. Lab evaluation indicates a chronic, compensated hemolytic anemia with many small, dense red blood cells spherocytes on the peripheral blood smear. These findings are consistent with a diagnosis of Hereditary Spherocytosis, which is caused by a membrane defect leading to the erythrocyte plasma membrane detaching and peeling off. Which protein complex is defective?

Ankyrin Protein Complex

3 multiple choice options

A 26-year-old is brought to the emergency department after accidentally cutting his forearm while cooking. Bleeding is quickly controlled with pressure, and a clot begins to form at the site of injury. During platelet activation and degranulation, several vasoactive substances are released to aid in homeostasis. One of these substances is serotonin. What is the correct function of serotonin in vascular homeostasis?

Local vasoconstrictor

3 multiple choice options

A patient presents with signs of an allergic reaction, including swelling and redness at the site of a mosquito bite. Laboratory analysis shows an increase in a specific type of granulocyte that releases histamine from secretory granules, contributing to vascular permeability and smooth muscle contraction. Which type of leukocyte is most likely responsible for these findings?

Basophil

3 multiple choice options

A patient presents with cyanosis after ingesting large quantities of nitrites. Which of the following describes the biochemical abnormality?

Increased oxidation of ferrous iron (Fe²⁺) to ferric iron (Fe³⁺)

3 multiple choice options

During heme biosynthesis, two molecules of δ-aminolevulinic acid (δ-ALA) condense to form porphobilinogen in a reaction catalyzed by δ-ALA dehydratase. Later in the pathway, iron in its ferrous (Fe²⁺) form is inserted into protoporphyrin IX to generate heme, an essential component of hemoglobin and cytochromes.

Which of the following enzymes catalyzes this final, iron-incorporating step of heme formation?

Ferrochelatase

3 multiple choice options

A patient is diagnosed with acute porphyria, an inherited disorder caused by a deficiency in an enzyme in the heme biosynthesis pathway. The patient is experiencing severe neuropsychiatric symptoms, including anxiety, confusion, and potential hallucinations. Which of the following best explains the mechanism leading to the patient's neurological symptoms?

Toxic effects of accumulated δ-aminolevulinic acid and Porphobilinogen on the nervous system

3 multiple choice options

A 47-year-old man presents with fatigue, early satiety, and splenomegaly. Laboratory studies reveal a markedly elevated white blood cell count, characterized by a left shift and increased basophils. Bone marrow biopsy reveals hypercellularity with granulocytic proliferation. Cytogenetic analysis reveals a reciprocal translocation between the long arms of chromosomes 9 and 22, resulting in a fusion gene that encodes a constitutively active tyrosine kinase.

Which of the following best describes the molecular mechanism underlying this patient’s condition?

Reciprocal translocation resulting in a fusion gene with loss of regulatory control

3 multiple choice options

A 4 year old boy presenting with recurrent infections and failure to thrive. Lab studies indicate an absence of circulating mature T lymphocytes and nonfunctional B lymphocytes. Genetic testing shows a mutation in the gene encoding the γ-chain of the interleukin 2 receptor.

Which of the following molecular events is most directly impaired in this patient's cells?

Dimerization and nuclear translocation of STAT proteins

3 multiple choice options

A 25 year old woman undergoes routine prenatal screening. Her CBC reveals mild microcytosis, and slight hypochromia, but she is otherwise asymptomatic. She also demonstrates normal proportions of HbA (Adult hemoglobin) and HbF (Fetal hemoglobin). She mentions that several family members have been told they have “small red blood cells” but no one has ever been diagnosed with anemia or required treatment.

This patient most likely has which of the following genetic abnormalities?

Deletion of two α-globin genes

3 multiple choice options

A 32-year-old female is found to be microcytic and mildly anemic. Her hematocrit and MCV are abnormal. Her genetic testing shows deletion of two α-globin chains. Which of the following best describes her condition?

α-thalassemia trait

3 multiple choice options

Which feature of a normal red blood cell allows it to pass easily through small capillaries?

Biconcave disc shape

3 multiple choice options

A 29 y/o female who is severely anemic and presents with yellowish skin was admitted to the hospital. She reports having symptoms of weakness and fatigue that have gotten worse over the past couple of months. The patient also states she is on a vegan diet for the past six years. The physician orders labs and suspects the patient of having megaloblastic anemia. What deficiency might the patients have to support the physician’s suspicion?

Cobalamin (vitamin B12)

3 multiple choice options

A 29-year-old man treated with high-dose penicillin for endocarditis develops fatigue, jaundice, and dark urine. Labs show anemia and a positive direct Coombs test. His roommate with G6PD deficiency develops similar symptoms but has a negative Coombs test and bite cells on smear. Which best explains the difference in their mechanisms of anemia?

Penicillin binds to red blood cell membranes as a hapten, causing IgG-mediated hemolysis, while G6PD deficiency causes oxidative injury from reduced NADPH.

3 multiple choice options

A patient presents the office with complaints of fatigue, dyspnea, palpations. She also mentions a decrease in exercise tolerance. Additionally, she states previous exposure to lead poisoning. A lab was conducted and showed a mean corpuscular volume (MCV) of 43 femtoliters per cell. Based on these findings, what is the patient's diagnosis?

Microcytic anemia

3 multiple choice options

A 27-year-old male presents to his PCP with concern over frequent fatigue and weakness. A Coombs test is performed, revealing the presence of IgG on his erythrocytes, therefore confirming him with Classic Autoimmune Hemolytic Anemia. Which of the following treatments would be most effective for this patient?

Corticosteroids

3 multiple choice options

A 25-year-old man of Mediterranean descent develops fatigue, jaundice, and dark urine two days after eating fava beans. His peripheral smear shows bite cells and Heinz bodies. Another patient with sickle cell disease also develops anemia after an infection, but his smear shows sickle-shaped cells.

Which of the following best explains the difference between these two conditions?

G6PD deficiency causes oxidative damage to hemoglobin, while sickle cell disease causes hemoglobin polymerization when deoxygenated.

3 multiple choice options

A 45-year-old man presents to his physician complaining of swelling around his ankles that worsens throughout the day. Physical examination reveals pitting edema in both lower extremities. Laboratory studies show normal renal function but decreased plasma protein levels. Further analysis reveals a significant decrease in serum albumin concentration.

Which of the following best explains the pathophysiologic mechanism responsible for this patient's symptoms?

Decreased colloid osmotic pressure within blood vessels

3 multiple choice options

A 24 year old male presents to the clinic with fatigue and shortness of breath. A peripheral blood smear reveals red blood cells with variable shapes, many appearing spherical rather than bi-concave. Laboratory findings reveal anemia with indirect-billirubin above normal ranges. Additional testing reveals defects in proteins responsible for anchoring the cytoskeletal network to the cell membrane. Which of the following proteins is most likely defective in this patient?

Ankyrin

3 multiple choice options

A 34 year old woman with a history of leukemia presents to the clinic after she accidentally cut her hand while cooking. Despite the injury being days old, the bleeding has not stopped. Her doctors order a CBC with a differential and decide to lower her dose of chemotherapeutic medications. What is the most likely cause of her complaint?

Thrombocytopenia

3 multiple choice options

Which of the following processes directly involves the production of reactive oxygen

intermediates (ROIs) via respiratory burst in neutrophils, utilizing enzymes stored in azurophilic

granules during phagocytosis?

Microbial killing inside phagolysosomes

3 multiple choice options

A 22 year old man is found to have abnormal blood work after a routine visit with his primary care physician. The doctor follows up by ordering a bone marrow smear due to a suspected bone marrow disorder. Which cell type would most likely be the first point of visible morphological differentiation between eosinophilic and neutrophilic cells undergoing granulopoiesis?

Myelocyte

3 multiple choice options

A college student presented to the clinic with a fever, dry cough, and sore throat and was diagnosed with Influenza A. Which lymphocyte is the primary effector in cell mediated immunity, and what is its role in the immune response?

Cytotoxic CD8+ T cell will bind the antigen-MHC 1 complex on infected cells and secrete lymphokines and perforins that will lead to cell lysis.

3 multiple choice options

A 40 year old man came into the emergency room with fatigue, pale skin, as well as shortness of breath. The doctor later diagnosed the pt with aplastic anemia. It was shown that a major contribution to his condition was the inability to stimulate differentiation of developing progenitor cells into red blood cells. What key cell play a major role in this differentiation process?

Adventitial cells which secretes several cytokines CSF, IL5, IL7

3 multiple choice options

Which of the following is least likely to be a cause of secondary polycythemia?

Mutation in hemocytoblast cells

3 multiple choice options

A hematopoietic growth factor is administered to a patient that stimulates the proliferation of pluripotent stem cells, leading to regeneration of multiple blood cell lineages. Which of the following factors has a role in supporting the growth and reproduction of all different types of stem cells?

Interleukin-3

3 multiple choice options

The remarkable efficiency of CO2 transport in the blood is largely dependent on the presence of a specific enzyme within the red blood cells (RBCs). This enzyme's action results in the transport of CO2 primarily in what chemical form?

Carbonic anhydrase; bicarbonate ion (HCO3−).

3 multiple choice options

A 65-year-old female presents to her primary care physician with fatigue, shortness of breath on exertion. CBC shows macrocytic anemia, and peripheral smear demonstrates large, fragile erythrocytes. The patient recently reports long-standing “heartburn” for which she has been taking over-the-counter medications for years. Lab studies reveal decreased hemoglobin and MCV. Additional evaluation suggests the patient is developing neurologic symptoms and her gastric mucosa is atrophic and that she is unable to efficiently absorb a key nutrient necessary for proper red blood cell maturation.

Intrinsic factor antibody levels

3 multiple choice options

A patient arrives at the hospital showing symptoms of weakness, fatigue, headaches. Records indicate that the patient donated one of his kidneys in the past. Which of the following most likely explain the symptoms of the patient:

Severe anemia

3 multiple choice options

Which of the following most likely represents the function of the cytoplasmic enzymes of the RBC?

Maintain the pliability of the cell membrane

3 multiple choice options

Hemochromatosis is a condition where a person’s body is not able to regulate the absorption of iron, leading to an excess absorption and buildup of iron in the body. In a healthy individual, which of the following regulates total body iron?

Altering rate of absorption

3 multiple choice options

A 21-year-old male presents to the clinic with swelling in both of his ankles when he woke up in the morning. The doctor orders a serum plasma protein test to identify this specific plasma protein that is responsible for maintaining the colloid osmotic pressure of blood and tissue volume.

Albumin

3 multiple choice options

A patient presents with a history of hereditary spherocytosis, a condition caused by several autosomal dominant mutations. As a result, the patient's RBCs cannot anchor the erythrocyte plasma membrane to the cytoskeleton properly. Which protein is affected, and what is its function?

Ankyrin protein complex; interacts with band 3 and other integral membrane proteins

3 multiple choice options

A 68-year-old male with a history of prostate cancer treated with chemotherapy presents for evaluation of persistent fatigue and pallor. His CBC shows pancytopenia (low RBCs, WBCs, and platelets). A bone marrow biopsy is performed from the posterior iliac crest. Histologic examination reveals extensive replacement of hematopoietic tissue by adipose cells, with few erythroblastic islets and markedly decreased cellularity.

Which of the following best describes this finding?

Hypocellular bone marrow consistent with aplastic anemia

3 multiple choice options

A 36-year-old male returns from a rural area with abdominal pain, diarrhea, and marked eosinophilia. Stool examination reveals helminthic ova.

Which of the following mechanisms best explains the ability of his eosinophils to kill the parasitic organisms?

Secretion of major basic protein, eosinophil peroxidase, and eosinophil cationic protein that are toxic to parasites

3 multiple choice options

In the bone marrow, hematopoietic stem cells (HSCs) differentiate into various blood cell lineages under the influence of specific molecular regulators. Which of the following types of molecules primarily determine the fate of these hematopoietic stem cells?

Transcription factors

3 multiple choice options

A 32-year-old woman with chronic kidney disease presents with fatigue and pallor. A peripheral blood smear shows decreased numbers of mature erythrocytes. Bone marrow examination reveals numerous immature erythroid precursor cells with basophilic cytoplasm, a large central nucleus with several nucleoli, and no hemoglobin present. Which of the following best identifies the cell type described?

Proerythroblast

3 multiple choice options

A 45-year-old man presents with fatigue and shortness of breath on exertion. Examination reveals pallor of the skin and conjunctiva. The patient notes recent changes in their diet, with reduced consumption of meat and leafy greens. The physician suspects anemia due to nutritional deficiency and orders an initial lab test. Which of the following tests would best evaluate the quantity and characteristics of his red blood cells?

Complete blood count (CBC)

3 multiple choice options

A 28-year-old woman with a history of recurrent jaundice and gallstones presents with pallor and mild splenomegaly. Her labs show:

Hemoglobin: 10.2 g/dL

Reticulocyte count: 7%

Indirect bilirubin: elevated

Haptoglobin: decreased

Peripheral smear: spherocytes

Which of the following best explains the underlying mechanism of her condition?

Extravascular hemolysis due to macrophage destruction of deformed red cells

3 multiple choice options

A 56-year-old male presents to the emergency room with fatigue, dyspnea, and dark colored urine. The physician diagnosed him with acute hemolytic anemia. During the patient's history, the patient reveals that he has eaten fava beans in the past 3 days. Which event is most likely causing his symptoms?

A shortage of NADPH

3 multiple choice options

A 6- month-old male infant is brought to the emergency department with fever and painful swelling of his hands and feet. Lab results show normocytic anemia with an increased reticulocyte count. A peripheral blood smear reveals target cells and several irreversibly sickled erythrocytes. Which of the following factors would most help reduce the likelihood of additional vaso-occlusive crises in this patient?

Increased fetal hemoglobin (HbF) expression

3 multiple choice options

A 25-year-old woman of Southeast Asian descent presents for routine evaluation. She reports no symptoms. Laboratory studies show a mild microcytic anemia with normal hemoglobin A₂ levels. Her red blood cell count is slightly elevated, and her peripheral smear shows small, pale red cells but no abnormal physical findings are noted. Her husband, also of Asian ancestry, has a history of severe anemia requiring regular blood transfusions since childhood. Which of the following genotypes best describes this patient's condition?

−/α −/α

3 multiple choice options

A patient presents to the clinic with severe abdominal pain, heartburn, and vomiting. Blood serum levels were obtained and found to contain deficient vitamin B12. Which of the following choices are most directly causing these conditions?

Decreased folic acid in erythroid precursor cells

3 multiple choice options

A patient is prescribed oral iron supplements by her primary care physician for iron-deficiency anemia. After several weeks of consistent use, lab values confirm that serum ferritin and total body iron stores have increased. Which of the following compensatory changes is mostly likely to occur in response to this rise in iron stores?

Increased hepatic production of hepcidin to reduce further absorption

3 multiple choice options

A six year old patient presents with hypoplastic thumbs, short stature, and fatigue. Lab results reveal pancytopenia and a low reticulocyte count. The physician diagnoses the patient with a rare autosomal recessive disorder of aplastic anemia. What mechanism is responsible for this disorder?

Defects in a multiprotein complex

3 multiple choice options

A 45-year-old woman has been diagnosed with a disorder resulting in excess iron circulating in the blood. Which location is primarily responsible for depositing and storing the excess iron?

Hepatocytes in the liver

3 multiple choice options

A pathologist examines a segment of bone marrow from the sternum and notices developing erythroid cells that have a mix of basophilic and eosinophilic properties (grayish cytoplasm). This property corresponds to the stage of erythropoiesis when hemoglobin synthesis first appears. Which phase of erythropoiesis is the pathologist observing?

Polychromatophil Erythroblast

3 multiple choice options

During an experiment, a researcher is interested in investigating the effect of a newly discovered inhibitor molecule on transport of oxygen throughout the body. The researcher finds that the inhibitor molecule competitively binds to hemoglobin, leading to a subsequent decrease in the quantity of oxygen transported to tissues. Which of the following choices would be considered an immediate compensatory physiological response to this molecule’s effects on the body?

An increase in rate of red blood cell production by erythropoietin

3 multiple choice options

A 27-year-old female presents to the ER with fatigue and shortness of breath on exertion. She reports being vegan and adhering strictly to a plant-based diet for the past 6 years. Laboratory results show macrocytosis and decreased serum vitamin B12 levels. Bone marrow biopsy reveals megaloblastic changes and asynchronous nuclear-cytoplasmic maturation. Which of the following best describes the pathophysiologic mechanism of her anemia?

Decreased thymidine synthesis resulting in defective DNA replication

3 multiple choice options

A 57-year-old male patient presents with chronic hypoxia due to COPD. CBC differential showed elevated red blood cells (6.7 1012/L) and elevated hemoglobin (19g/dL) indicative of polycythemia. Which of the following best explains how hemoglobin’s structure facilitates oxygen transport in this condition?

Oxygen binds reversibly to the coordination bonds of the iron atom in heme

3 multiple choice options

A first-year medical student is learning about the different types of anemia that can be present in patients. They are given a case of a patient who is unable to absorb vitamin B12 and has recently undergone a total gastrectomy. Which type of anemia is being presented to the student?

Megaloblastic anemia

3 multiple choice options

A hematologist evaluates a patient who recently moved to a high-altitude region (15,000 feet above sea level) and observes a hematocrit of 65% with an RBC count of 6.8 million/mm³. The bone marrow biopsy reveals increased erythroid cell activity without genetic abnormalities. Which of the following best explains this patient’s findings?

Physiological (secondary) polycythemia

3 multiple choice options