Question 1

All of the following are normal peripheral blood RBC findings at birth in a full-term infant except&#10;A)nucleated RBCs&#10;B)Mean cell volume (MCV) less than 90 fL&#10;C)reticulocytosis of 5%&#10;D)hemoglobin of 20.2 g/dL

Accepted Answer

An MCV of 90 fL in a newborn is abnormal and cause for a thalassemia/iron deficiency work-up.The mean MCV in a full-term newborn is 109 fL;an MCV less than 94 fL is cause for evaluation for a-thalassemia or iron deficiency.All the other results given are normal for a full-term newborn.

Question 2

Which of the following is true concerning age-related changes of hemostasis in older adults?&#10;A)decreased factor VIII&#10;B)decreased platelet activity&#10;C)increased fibrinogen&#10;D)increased fibrinolysis

Accepted Answer

Fibrinogen levels,factor VIII,and platelet activity all increase during aging.Plasminogen activator inhibitor,the major inhibitor of fibrinolysis,increases with aging,so fibrinolysis of clots decreases.

Question 3

Why is there a relative lymphocytosis in a 2-year-old?&#10;A)An absolute neutropenia occurs.&#10;B)The absolute number of lymphocytes is increased as the immune system develops.&#10;C)A greater proportion of neutrophils are marginated.&#10;D)Fewer lymphocytes are marginated.

Accepted Answer

An absolute increase in lymphocytes occurs,presumably because the immune system is developing as more antigens are encountered;this increases the absolute number of lymphocytes,as well as the relative percent.The number of marginated neutrophils is not increased;lymphocytes do not marginate.

Question 4

A Complete blood count (CBC)is requested on a full-term newborn girl,and the following results are obtained:

What conclusion can be made regarding these data for this infant?

A)All results are normal.
B)The white count is elevated.
C)Hemoglobin, hematocrit, and MCV are all decreased.
D)Red cell count, hemoglobin, and hematocrit are all normal, but MCV is decreased.

Accepted Answer

The hemoglobin,hematocrit,and MCV are all low for a full-term newborn (the red count is actually in the reference range).Because the red count is relatively high for the hematocrit and hemoglobin,with the low MCV,thalassemia should be suspected.

Question 5

What is the normal bone marrow cellularity in the population older than 65 years?&#10;A)90%&#10;B)70%&#10;C)50%&#10;D)30%

Accepted Answer

Bone marrow cellularity decreases in the older population and is approximately 30%.That of a young adult is 50%.This change may be caused by an increase in the volume of spongy tissue in the bone,as well as an increase in fat,rather than an actual decrease in hematopoietic tissue.

Question 6

An 85-year-old woman has a hemoglobin of 10.5 g/dL.This is&#10;A)high for a woman of this age.&#10;B)normal for this age regardless of sex (i.e., for both male and female patients).&#10;C)a sign of an underlying disease and requires further evaluation.&#10;D)most likely a myelophthisic anemia.

Accepted Answer

The majority of geriatric individuals maintain a normal hemoglobin for their sex so that this hemoglobin of 10.5 g/dL in an 85-year-old woman is low and a sign of an underlying disease.This requires further work-up.Most anemias in older adults are iron deficiency or the anemia of chronic inflammation (disease).Myelophthisic anemia,in which the bone marrow is invaded by something foreign,such as metastatic malignant cells,certainly occurs but is not the most common cause of anemia in older adults.

Question 7

At what age is it normal for bone marrow cellularity to be 80% to 90% (i.e.,has very little fat)?&#10;A)at birth&#10;B)in an 8-year-old&#10;C)in a 20 to 40-year-old&#10;D)in those older than 70 years

Accepted Answer

At the time of birth,the bone marrow is fully active and extremely cellular with very little fat.It contains all hematopoietic cell lineages.

Question 8

What is the most likely reason that the red blood cell (RBC)count remains elevated in a newborn for the first 2 weeks of life?&#10;A)A relative loss of plasma occurs during the birth process.&#10;B)A significantly longer RBC life span increases the number of red cells in circulation.&#10;C)Partial anoxia exists in utero, and erythropoietin increases.&#10;D)The switch from fetal to adult hemoglobin causes the number of red cells to increase.

Accepted Answer

Partial anoxia occurs in utero,which causes the normal physiologic response to increase erythropoietin,which stimulates erythropoiesis.About 2 weeks after birth,as the infant makes the transition from its placenta-dependent oxygenation to the increased tissue oxygenation of the lungs,erythropoietin decreases,and the red cell count begins to decrease.

Question 9

Which of the following is more likely to result from poor absorption than from inadequate nutritional intake in older adults?&#10;A)folic acid deficiency&#10;B)iron deficiency&#10;C)vitamin B12 deficiency&#10;D)lead deficiency

Accepted Answer

Vitamin B₁₂ deficiency is most likely to develop from inadequate intestinal absorption,rather than an inadequate vitamin intake.This can progressively lead to the development of pernicious anemia.

Question 10

A normal 3-month-old boy has a hemoglobin of 11.2 g/dL.Which of the following is true about his hemoglobin? It is&#10;A)higher than that of a normal full-term newborn.&#10;B)lower than that of an adult of the same age.&#10;C)higher than that of a 14 year old of the same sex.&#10;D)the same as that of an adult of the same sex.

Accepted Answer

Hemoglobin is lower in a 3 month old than in an adult of the same sex.It is normally higher at birth but quickly begins to decrease so that by 3 months old this would be a normal hemoglobin (abnormal at birth).It is lower than that of both a 14 year old and an adult of the same sex.

Question 11

Why is the white count in a normal full-term newborn elevated shortly after birth?&#10;A)A relative loss of plasma occurs.&#10;B)An absolute increase in neutrophils occurs.&#10;C)An absolute increase in lymphocytes occurs.&#10;D)An absolute increase in both neutrophils and lymphocytes occurs.

Accepted Answer

The answer of Why is the white count in a...

Question 12

Which of the following age groups normally has the lowest mean red cell values (red cell count,hemoglobin,hematocrit)?&#10;A)preterm premature&#10;B)full-term newborn&#10;C)normal 2-year-old child&#10;D)normal 30-year-old woman

Accepted Answer

The answer of Which of the following age groups normally...

Question 13

Which of the following is most commonly seen in the population older than70 years?&#10;A)chronic lymphocytic leukemia&#10;B)chronic myelogenous leukemia&#10;C)essential thrombocytosis&#10;D)acute lymphocytic leukemia

Accepted Answer

The answer of Which of the following is most commonly...

Question 14

Iron deficiency anemia in older adults is most often a result of&#10;A)poor nutritional intake of iron.&#10;B)malabsorption of iron.&#10;C)decreased ability to transport iron because of a decrease in transferrin.&#10;D)bleeding in the gastrointestinal tract.

Accepted Answer

The answer of Iron deficiency anemia in older adults is...

Deck 45: Pediatric and Geriatric Hematology and Hemostasis