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REVIEW TEST
Time: 20 mins
Note: This test consists of 4 parts. You can get 1 point for each right answer, but you lose a
half of point for each wrong one.
PART A: Choose the best answer (A, B, C or D) to fill in the blank (5 points)
Question 1. ____________ provides important information about defects in red cell production
and variations in anisocytosis and poikilocytosis, which can reinforce the findings in other tests
and guide us to the diagnosis of some diseases such as thalassemia and megaloblastic anemia. It is
carried out with a multiple-step process which includes the Wright-Giemsa stain.
A. Complete Blood Count. C. Blood Culture.
B. Peripheral Blood Smear. D. Marrow Examination.
Question 2. _____________ is the newly released cell from the medulla which can help us in the
classification of anemia.
A. Polychromatophil erythroblast. C. Reticulocyte.
B. Pluripotential hematopoietic stem cell. D. Orthochromatic erythroblast.
Question 3. In the pulmonary capillaries, occurs the exchange of oxygen and dioxyde carbon
through the respiratory membrane. The process of binding four oxygen molecules to one
hemoglobin molecule in the RBCs is called____________.
A. oxygenation. B. oxidation. C. reduction. D. conjugation.
Question 4. Partial or complete gastroectomy can lead to _________ anemia.
A. pernicious. B. aplastic. C. hemolytic. D. microcytic.
Question 5. ________________ is the condition in which Rh-positive RBCs in the fetus are
attacked by antibodies from an Rh-negative mother.
A. Sickle cell anemia. C. Hereditary spherocytosis.
B. Megaloblastic anemia. D. Erythroblastosis fetalis.
USMLE Sub B, 1st Semester, 2017
PART B: Read the following passages and answer the questions (15 points)
Passage 1
Passage 2
Line 1 According to World Health Organization criteria, anemia is defined as
blood hemoglobin (Hb) concentration <130 g/L (<13 g/dL) or hematocrit (Hct)
<39% in adult males; Hb <120 g/L (<12 g/dL) or Hct <37% in adult females.
Signs and symptoms of anemia are varied, depending on the level of
Line 5 anemia and the time course over which it developed. Acute anemia is nearly
always due to blood loss or hemolysis. In acute blood loss, hypovolemia
dominates the clinical picture; hypotension and decreased organ perfusion are the
main issues. Symptoms associated with more chronic onset vary with the age of
the pt and the adequacy of blood supply to critical organs. Moderate anemia is
Line 10 associated with fatigue, loss of stamina, breathlessness, and tachycardia. The pt’s
skin and mucous membranes may appear pale. If the palmar creases are lighter in
color than the surrounding skin with fingers extended, Hb level is often <80 g/L
(8 g/dL). In pts with coronary artery disease, anginal episodes may appear or
increase in frequency and severity. In pts with carotid artery disease,
Line 15 lightheadedness or dizziness may develop.
A physiologic approach to anemia diagnosis is based on the understanding
that a decrease in circulating red blood cells (RBCs) can be related to either
inadequate production of RBCs or increased RBCs destruction or loss. Within the
category of inadequate production, erythropoiesis can be either ineffective, due to
Line 20 an erythrocyte maturation defect (which usually results in RBCs that are too small
or too large), or hypoproliferative (which usually results in RBCs of normal size,
but too few of them).
Basic evaluations include (1) reticulocyte index (RI), and (2) review of
blood smear and RBC indices [chiefly mean corpuscular volume].
Line 25 The RI is a measure of RBC production. The reticulocyte count is
corrected for the Hct level and for early release of marrow reticulocytes into the
circulation, which leads to an increase in the lifespan of the circulating
reticulocyte beyond the usual 1 day. Thus, RI = (% reticulocyte x pt Hct/45%) x
(1/shift correction factor). The shift correction factor varies with the Hct: 1.5 for
Line 30 Hct = 35%, 2 for Hct = 25%, 2.5 for Hct = 15%. RI < 2-2.5% implies inadequate
RBC production for the particular level of anemia; RI > 2.5% implies excessive
RBC destruction or loss.
If the anemia is associated with a low RI, RBC morphology helps
distinguish a maturation disorder from hypoproliferative marrow states.
Line 35 Cytoplasmic maturation defects such as iron deficiency or Hb synthesis problems
produce smaller RBCs, MCV < 80; nuclear maturation defects such as B12 and
folate deficiency and drug effects produce larger RBCs, MCV >100. In
hypoproliferative marrow states, RBCs are generally normal in morphology but
too few are produced. Bone marrow examination is often helpful in the evaluation
Line 40 of anemia but is done most frequently to diagnose hypoproliferative marrow states.
Other laboratory tests indicated to evaluate particular forms of anemia
depend on the initial classification based on the pathophysiology of the defect.
USMLE Sub B, 1st Semester, 2017
Question 6. Which is true about the diagnosis criteria of anemia according to WHO?
A. Hematocrit is lower than 39%.
B. The diagnosis of anemia is only based on the hemoglobin level.
C. It is necessary to consider the sex of the patient when diagnosing anemia.
D. Hemoglobin level is lower than 12 g/L.
Question 7. What can be inferred from the second passage?
A. Patients presented with acute anemia need to be monitored closely in order to prevent shock.
B. The clinical scenarios of acute and chronic anemia are quite similar.
C. Patients in different ages have the same symptoms of chronic anemia.
D. Light palmar skin does not have value in predicting the hemoglobin level.
Question 8. Which of the following words has the closest meaning to the word “lightheadedness”
in line 15?
A. headache. B. vertigo. C. faint. D. coma.
Question 9. According to the passage, which of the following parameters is the most important in
evaluating causes of anemia?
A. MCH. B. MCHC. C. RDW. D. MCV.
Question 10. Excessive RBC destruction or loss can lead to which of the following phenomenon?
A. Polycythemia. C. Hemolytic anemia.
B. Erythrocytopenia. D. None of the above.
Question 11. All of the followings are correct, EXCEPT:
A. The causes of anemia can be classified into two main groups.
B. Reticulocyte count can be used directly to distinguish between these two groups of causes.
C. The abnormal maturation can leave the size of red blood cells unaffected.
D. Blood smear test is necessary in evaluating anemia.
Question 12. Which of the following words has the closest meaning to the word “defect” in line
20?
A. disease B. flaw C. disorder D. mutation
Question 13. What can be inferred from the passage about RI?
A. The lower Hct is, the lower shift correction factor is.
B. RI does not help us differentiate erythropoietic causes from destructive causes.
C. RI and hematocrit level do not have any correlation.
D. If RI is lower than 2.5%, a blood smear can be useful for further diagnosis.
Question 14. Which of the followings is NOT correct?
A. An abnormality in hemoglobin synthesis results in a decrease of MCV.
USMLE Sub B, 1st Semester, 2017
PART D: Use the list elements to build medical words. You can use more than once. (5 points)
Combining Forms Suffixes Prefixes
KEY
PART A:
1. B 3. A 5. D
2. C 4. A
PART B:
1.Two units of packed red blood cells
2.The patient was anemic as a result of sickle cell anemia.
3.Medical-surgical bed, oxygen, IV fluids, morphine
4.Ileus in small bowel, dilated small bowel loops, and abnormal enhancement pattern in the
kidney.
5. To follow up on the renal abnormality.
6. C 10. B 14. C
7. A 11. B 15. D
8. B 12. C
9. D 13. D
PART C:
1. Single 6. To 11. Another
2. Called 7. Erythrocytes 12. Instance/example
3. From 8. Abbreviation 13. Low
4. Like 9. Likewise 14. Infectious
5. Although 10. Controlled 15. That/which
PART D:
1. Lymphangioma 6. Thymectomy 11. Hemolysis
2. Sideropenia 7. Hypochromic 12. Nucleic
3. Splenomegaly 8. Microcytic 13. Adenoid
4. Thrombosis 9. Lymphadenopathy 14. Agranular
5. Morphology 10. Erythroblast 15. Hemopoiesis