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WorksheetsCh. 3 Practice Questions
Total questions: 10
Worksheet time: 5mins
A 64-year-old woman with chronic rheumatoid arthritis presents with progressive fatigue and pallor. Labs: low Hb, low MCV, low serum iron, low ferritin, high TIBC. Which mechanism best explains her anemia?
Cytokine-mediated suppression of erythropoietin production in the kidneys
Chronic gastrointestinal blood loss from NSAID-induced mucosal damage leading to iron depletion
Autoimmune destruction of red blood cells producing spherocytes on smear
Bone marrow suppression from methotrexate therapy reducing RBC precursors
A 55-year-old man presents with recurrent nosebleeds, easy bruising, and gum bleeding. Platelet count is normal; bleeding time is prolonged; aPTT is slightly elevated. Which is the most likely underlying process?
Autoantibody formation against platelet membrane glycoproteins causing immune destruction
Vitamin K deficiency impairing gamma-carboxylation of clotting factors II, VII, IX, and X
Deficiency or dysfunction of von Willebrand factor impairing platelet adhesion and stabilizing factor VIII
Factor IX deficiency impairing intrinsic pathway activation
A 48-year-old African American man with sickle cell disease presents with acute chest pain, hypoxia, and fever. Which pathophysiologic cascade most accurately explains his current crisis?
Autoimmune antibody binding to RBC membranes leading to extravascular hemolysis in the spleen
Increased bone marrow RBC production causing marrow expansion and bone pain
Polymerization of deoxygenated HbS causing RBC sickling, vaso-occlusion in pulmonary vasculature, and tissue ischemia
Reduced G6PD activity causing RBC susceptibility to oxidative stress and hemolysis
A 70-year-old man with new-onset confusion and weakness is found to have Hct 62%, elevated RBC mass, and low erythropoietin. Which is the most likely diagnosis and pathophysiology?
Secondary polycythemia from chronic hypoxia stimulating excess EPO
Polycythemia vera from a myeloproliferative neoplasm with JAK2 mutation causing uncontrolled RBC production
Relative polycythemia from dehydration concentrating RBC count
Paraneoplastic polycythemia from renal carcinoma producing excess EPO
A 28-year-old woman presents with petechiae, confusion, fever, and acute kidney injury. Labs: thrombocytopenia, schistocytes, ↑ LDH, normal PT/aPTT. Which is the most likely underlying defect?
Autoantibodies against platelet factor 4 causing immune complex-mediated thrombocytopenia
Deficiency of ADAMTS13 metalloprotease leading to accumulation of large vWF multimers and platelet aggregation
Activation of coagulation cascade from sepsis causing consumption of clotting factors
Antiphospholipid antibodies causing arterial and venous thromboses
A 35-year-old man with HIV presents with fever, night sweats, and painless cervical lymphadenopathy. Biopsy shows Reed–Sternberg cells. Which cytokine most contributes to the B-cell proliferation seen in this disease?
Tumor necrosis factor-alpha (TNF-α)
Interleukin-2 (IL-2)
Interleukin-13 (IL-13)
Interferon-gamma (IFN-γ)
A 60-year-old woman presents with bone pain, anemia, hypercalcemia, and recurrent infections. Labs: M-spike on serum protein electrophoresis; urine positive for Bence Jones proteins. Which pathophysiologic mechanism is central to her condition?
Lymphoid proliferation producing abnormal immunoglobulins that activate complement
Malignant plasma cells producing monoclonal immunoglobulins and cytokines that stimulate osteoclast activity
Malignant transformation of myeloid precursors impairing neutrophil function
Hyperactive B cells producing multiple classes of immunoglobulins
A 72-year-old man with chronic lymphocytic leukemia presents with worsening anemia and indirect hyperbilirubinemia. Peripheral smear: spherocytes; Coombs test positive. Which pathophysiologic event is occurring?
Complement-mediated intravascular RBC destruction from paroxysmal nocturnal hemoglobinuria
Autoantibody-mediated RBC destruction in the spleen leading to extravascular hemolysis
Mechanical RBC fragmentation from microangiopathic process
Oxidative injury to RBCs from G6PD deficiency
A 44-year-old man presents with fatigue, bleeding gums, and recurrent infections. CBC: pancytopenia; bone marrow biopsy is hypocellular with fatty infiltration. Which best explains the mechanism?
Autoimmune destruction of multipotent hematopoietic stem cells in the marrow
Bone marrow failure due to injury or suppression of hematopoietic stem cells from toxins, radiation, or idiopathic causes
Infiltration of bone marrow by malignant plasma cells
Chronic infection causing suppression of myeloid lineage only
A 30-year-old woman develops acute onset of widespread petechiae after a viral infection. CBC: isolated thrombocytopenia; PT and aPTT normal. Which mechanism best explains her thrombocytopenia?
Deficiency of clotting factors II, VII, IX, and X from liver dysfunction
Autoimmune antibody production against platelet membrane glycoproteins causing splenic destruction
Platelet consumption in widespread microthrombi
Decreased platelet production from megakaryocyte failure
