29 Mei 2010

Soal hematolimfopoetik yang lain

1. Bayi laki2 4,5 th, dibawa ke UGD dengan kel perdarahan yang sulit berhenti di bekas

suntikan im hep B. Pada PF: KU baik, perdarahan merembes di paha kiri bekas suntikan,

perdarahan tempat lain tidak ada, anemi(-), ikterik (-), hepatomegali (-), splenomegali(-),

limfadenopati (-). Lab darah : Hb 11, Leu 8500, trom 170rb, PT PTTK meningkat. Dx?

a.ITP,

b. Hemofili A

c. Hemofili B

d. Def vit K

e. DIC


 

2. manakah dari dibawah ini yang paling mungkin mndasari anemi pada kasus diatas?

a.ggg prod

b.destruksi

c.perdarahan kronis

d.--------"------- akut

e.kongenital


 

3. Seorang laki-laki 17 tahun diantar ke Puskesmas karena KLL, patah tulang terbuka

kedua tungkai, darah mengallir deras. Di Puskesmas penderita tenang, tertidur dan

mengeluarkan suara mendengkur seperti berkumur-kumur. Nadi a. radialis cepat dan

lemah, ujung jari-jari dingin. Tindakan apa yang harus dilakukan pertama kali ?

A. membebaskan jalan nafas dan mengatur posisi kepala

B. memberi nafas buatan dari mulut ke mulut

C. mengangkat kedua tungkai, badan diberi alas papan keras

D. pasang infuse line cairan koloid dan vasopresor

E. pasang bidai pada kedua tungkai


 

4. Platelet production (thrombopoiesis) is affected by more than one

cytokine. Which of the following sets seems to be the most important in

platelet development?

a.IL-3, granulocyte colony-stimulating factor (G-CSF), and granulocytemacro-

phage colony-stimulating factor (GM-CSF)

b.IL-4, IL-6, and thrombopoietin

c.Erythropoietin, thrombopoietin, and IL-6

d.IL-6 and thrombopoietin

e.IL-3, IL-4, and IL-6


 

5. Which of the following factors complexes with factor VIII, which is

activated to factor VIIIa when released from the complex?

a.Factor XIII

b.High molecular weight kininogen

c.Von Willebrand factor (vWF)

d.Thromboplastin

e.Plasminogen


 

6. Which of the following factors depends on platelets for synthesis?

a.Factor II (prothrombin)

b.Factor VII (proconvertin)

c.Protein S

d.Factor XIII (fibrin-stabilizing factor)

e.Factor X (Stuart-Prower factor)


 

7. Which of the following causes of anemia is associated with micro-

cytosis?

a.Folic acid deficiency

b.Therapy with zidovudine (AZT)

c.Hypothyroidism

d.Alcohol

e.Thalassemia


 

8. Which of the following causes of an elevated hemoglobin concentra-

tion in the blood is characterized by a LOW level of erythropoietin in the

blood?

a.Chronic tobacco smoking

b.Dwelling at high altitudes, such as in the Andes

c.Erythrocytosis associated with renal tumors

d.Primary polycythemia (polycythemia vera)

e.Erythrocytosis secondary to chronic pulmonary insufficiency


 

9. Which of the following causes a leukocytosis without an increase in

the number of circulating polymorphonuclear neutrophil leukocytes?

a.Acute infection

b.Release of epinephrine

c.Tissue necrosis

d.Myelocytic leukemia

e.Collagen vascular disease


 

10. In a typical case of iron deficiency, which of the following molecular

forms that contains or can bind to iron increases in the patient's serum?

a.Hemoglobin

b.Ferritin

c.Hemosiderin

d.Myoglobin

e.Transferrin


 

11. Which of the following disorders is associated with thrombocytosis?

a.Disseminated intravascular coagulation

b.A plastic anemia

c.Postsplenectomy

d.Hypersplenism

e.Prosthetic valves


 

12. A 47-year-old man walks into the emergency room because of feeling

very weak, tired, short of breath, and dizzy. He has numbness and tingling

of his fingers. He appears pale and sallow. On examination, his heart rate is

132. His sclerae and nailbeds are pale. His heart is enlarged and he has

dependent edema of his ankles. Laboratory findings include a negative

Coombs' test and a hemoglobin of 4 g/dL. The likely diagnosis is

a.Traumatic hemolytic anemia

b.Autoimmune anemia

c.Blood loss

d.Pernicious anemia

e.Iron-deficiency anemia


 

13. Most drugs induce thrombocytopenia by which mechanism?

a.Marrow-depressing effect

b.Directly cytotoxic of platelets

c.Depress megakaryoctye production

d.Immune response in which the platelet is damaged by complement activation

e.Impair megakaryoctye production


 

14. Which of the following statements related to circulating erythrocytes

(red cells) is untrue?

a.The nuclei of the precursor cells to erythrocytes are extruded from their cells

shortly before the red cells leave the bone marrow. Consequently, the presence

of nucleated red cells in the peripheral blood should be regarded as abnormal

and may indicate an underlying disease state.

b.In a thin blood smear stained with Romanowsky's stain (such as Wright's stain),

the youngest cells (reticulocytes) can be recognized by a blue coloration (baso-

philia) as different from most of the red cells present.

c.The average diameter of erythrocytes is about 8 µm; consequently, they cannot

flow through the smaller capillaries that have a diameter of 2 to 4 µm.

d.The protein of hemoglobin, which is the principal constituent of the red cell

contents, is in tetrameric form, with two a and two ß subunits.

e.The iron atom of the hemoglobin molecule, which is essential to its function of

carrying oxygen, is an intrinsic part of the heme complex attached to each sub-

unit of protein.


 

15. Which of the following statements concerning the relationship of the

neutrophil polymorphonuclear leukocyte (PMN) to infection with bacter-

ial pathogens is incorrect?

a.The principal functions of the PMN are expressed in the tissues and not usually

in the bloodstream, which is simply the transport path of the cells to their

required site of action.

b.The cytoplasmic granules of PMN are essentially inert, but metabolically have

only a vegetative role in maintaining cell viability.

c.When the cell numbers of PMN are reduced significantly, the probability of

severe bacterial infection can be greatly increased.

d.The average duration of the period of circulation of PMN after entering the

bloodstream is about 6 to 8 h.

e.An increasing need for PMN produced by infection is met in part by large num-

bers of immature cells (especially band cells) being released from the marrow

pool into the bloodstream.


 

16. Which pathologic cells in a stained blood film have appearances very

similar to those of normal mature white cells or their precursors?

a.Chronic lymphocytic leukemia (B cell type)

b.Chronic myelocytic leukemia

c.Lymphoblastic leukemia

d.Hodgkin's disease

e.Non-Hodgkin's disease


 

17. On karyotyping, a well-defined chromosomal abnormality is patho-

gnomonic of which condition?

a.Chronic lymphocytic leukemia (B cell type)

b.Chronic myelocytic leukemia

c.Lymphoblastic leukemia

d.Hodgkin's disease

e.Non-Hodgkin's disease


 

18. Which condition customarily terminates by transition to a blast cell

phase with similarities to acute leukemia?

a.Chronic lymphocytic leukemia (B cell type)

b.Chronic myelocytic leukemia

c.Lymphoblastic leukemia

d.Hodgkin's disease

e.Non-Hodgkin's disease


 

19. The principal complication of which condition is susceptibility to

infection?

a.Chronic lymphocytic leukemia (B cell type)

b.Chronic myelocytic leukemia

c.Lymphoblastic leukemia

d.Hodgkin's disease

e.Non-Hodgkin's disease


 

20. Which disorder presents mainly as a localized new mass or group of

superficial lymph nodes?

a.Chronic lymphocytic leukemia (B cell type)

b.Chronic myelocytic leukemia

c.Lymphoblastic leukemia

d.Hodgkin's disease

e.Non-Hodgkin's disease


 

21. Which mechanism is responsible for thrombocytopenia in vitamin

B12 deficiency?

a.Decreased production

b.Maldistribution

c.Accelerated destruction

d.Decreased survival

e.Inherited


 

22. Which mechanism is responsible for thrombocytopenia in dissemi-

nated intravascular coagulation (DIC)?

a.Decreased production

b.Maldistribution

c.Accelerated destruction

d.Decreased survival

e.Inherited


 

23. Which mechanism is responsible for thrombocytopenia in immune

(idiopathic) thrombocytopenic purpura (ITP)?

a.Decreased production

b.Maldistribution

c.Accelerated destruction

d.Decreased survival

e.Inherited


 

24. Which mechanism is responsible for thrombocytopenia in any

increase in spleen size?

a.Decreased production

b.Maldistribution

c.Accelerated destruction

d.Decreased survival

e.Inherited


 

25. Which mechanism is responsible for thrombocytopenia in throm-

botic thrombocytopenic purpura (TTP)?

a.Decreased production

b.Maldistribution

c.Accelerated destruction

d.Decreased survival

e.Inherited


 

26. Which mechanism is responsible for thrombocytopenia in von

Willebrand's syndrome?

a.Decreased production

b.Maldistribution

c.Accelerated destruction

d.Decreased survival

e.Inherited


 

27. Which is a protein cofactor that exposes the inactivation site of acti-

vated coagulation factor V, which can then be cleaved by a protease?

a.Protein C

b.Protein S

c.Antithrombin III (ATIII)

d.Plasminogen

e.Prekallikrein


 

28. Which is a factor capable of inhibiting the serine protease factors II,

IX, X, XI, and XII, a process accelerated by heparin or similar molecules.

a.Protein C

b.Protein S

c.Antithrombin III (ATIII)

d.Plasminogen

e.Prekallikrein


 

29. Which is a vitamin K–dependent factor, activated in the presence of

thrombin to cleave activated factors V and VIII.

a.Protein C

b.Protein S

c.Antithrombin III (ATIII)

d.Plasminogen

e.Prekallikrein

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