Download pathology written and practical exam 1

PATHOLOGY WRITTEN EXAM IV
1. A skin biopsy on a patient with Henoch-Schonlein purpura will have which of the following
diagnoses?
A. cholesterol embolism
B. leukocytoclastic vascutitis
C. erythema muldfornie
D. thrombotic thrombacytopenic purpura
E. cryogiobullnemla
2. A 77-year-old man is being transfused with a unit of Red Blood Cells. Following transfusion
of approximately 50mL, he develops an elevation of 1°C in his temperature. Based on this
symptom alone, which of the following types of transfusion reactions could be excluded?
A. Allergic
B. Bacterial sepsis
C. Acute hemolytic
D. Transfusion-related acute lung injury
E. Febrile nonhemolytic
3. The body attempts to compensate for decreased red blood cell mess by which of the followJng
adaptations?
A. Shifting blood flow to the kidneys
B. Decreasing production of 2,3-diphosphoglyoerate
C. Decreasing the binding affinity between hemoglobin and oxygen
D. Decreasing the systemic arterial pressure
E. None of the above
4. Which statement regarding soft tissue tumor's is TRUE?
A. Large areas of hemorrhage and necrosis we characteristic of lelomyomas
S. Prior irradiation predisposes to the development of angiosarcoma
C. Fibromatoses frequently metastasize to the lungs
D. Cavemous hemanglomas regress spontaneously during infancy
E. Lipomas most frequently arise in the retroperitoneum.
5. A blue nodule on the back of art adult is MOST LIKELY a:
A. Spitz nevus
B. blue nevus
C. dysplastic nevus
D. nevus araneus
E. Mo clan spot
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6. A 5-year-old boy has fatigue and easy bruising, and work-up leads to a diagnosis of leukemia.
Which of the following types of leukemia is this patent MOST LIKELY to have?
A. Acute myelogenous leukemia
B. Chronic myelogenous leukemia
C. Chronic lymphocytic leukemia
D. Hairy cell leukemia
E. Acute lymphoblastic leukemia
7. A 50 year old woman is diagnosed with hepatitis C infection. Liver biopsy exhibits hepatitis,
but no cirrhosis. Upon questioning you, her physician, regarding her prognosis, you inform her
that which ONE of the following is MOST LIKELY?
A. this form of hepatitis almost never recurs, with a clinical course similar to hepatitis A
B. there is no carrier state associated with this form of hepatitis
C. a very high rate of chronicity (80-10(r/6) is the usual course for patients with hepatitis
C
D. development of hepatocellular carcinoma is seen in less than 11% of patients with
hepatitis C
E. she will most likely develop submissive necrosis within the next year with near certain
mortality.
8. Transplantation of which type of tissue has the greatest association with acute cutaneous graftvs.-host disease?
A. heart
B: kidney
C. bone marrow
D. lung
E. liver
9. A Group AB Negative father and a Group B Positive mother can have children of each of the
following types, EXCEPT:
A. O Positive
B. A Positive
C. B Negative
D. B Positive
E. AB Negative
10. In a case of severe, ongoing hemolysis, which of the following is characteristically
decreased?
A. Serum haptoglobin
B. Stool uroboilnogen
C. Reticulocyte count
D. Mean corpuscular volume
E. Serum bilirubin
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11. Which ONE of the following statements is TRUE?
A. Achondroplasia is characterized by inadequate mineralization of long bones
B. Osteogenesis imperfecta Is caused by deficiencies in Type II collagen
C. Patients with Paget's disease of bone have disordered bone remodeling
D. Osteoporosis is characterized by a proportional decrease in cartilage and bone
formation
E. Osteoporosis is an heredity disease of bone due to osteoblast dysfunction
12. An obese diabetic man with multiple pedunculated, skin-colored papules in the axilia has:
A. acrochordons
B. dermatofibromas
C. neurofibromes
D. pyogenic granulomas
E. acanthosis nigricans
13. A 10-year-old boy develops respiratory distress and is found to have a large pleural effusion.
Chest x-ray shows a large mediastinal mass, and a biopsy of the mass shows sheets of large
lymphoid cells which by immunophenotype are T cell. Which of the following types of
lymphoid malignancy Is MOST LIKELY in the patient?
A. Diffuse small Iymphocytic tymphoma
B. Lymphoblastic lymphoma
C. Mycosis fungoldea
D. Follicular small cleaved cell lymphoma
E. Burkitt's lymphoma
14. A 4B year old woman presents to your office with complaints of intense pruritis. She is
Jaundiced, has elevation of liver function studies, and has a particularly high alkaline
phosphatase level. She gives no history of alcohol abuse, hepatitis, or rashes. Physical
examination also shows no rashes, but icterus is present. Ultrasound of the liver fails to
show masses, but is suggestive of early cirrhosis. Antimitochondrial antibodies are
confirmed to be of high titer. The MOST LIKELY diagnosis is.
A. hepatitis B
B. hepatitis G
C. hernochromatosis
D. primary biliary cirrhosis
E. alcoholic cirrhosis
15. The diagnosis of immunohemolytic anemia is made using which of the following lab tests?
A. Indirect Coombs test
B. Direct Coombs test
C. Reticulocyte count
D. Serum C3 level
E. Osmotic fragility test
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16. Elevated serum igE is MOST commonly seen in:
A. psorlasis
S. stasis dermatitis
C. dyshidrotic eczema
D. atopic dermatitis
E. contact dermatitis
17. Which of the following is NOT LIKELY to occur in acute hemorrhagic pancreatitis?
A. Decreased hematocrit
B. Elevated serum amylase.
C. Death
D. Hypocalcemia
E. Diarrhea
18. All of the following findings are characteristic of iron-deficiency anemia, EXCEPT:
A. Decreased serum ferritin.
B. Decreased hematocrit
C. Decreased marrow hemosiderin
D. Decreased serum transferrin
E. Decreased serum iron
19. The blood component Red Blood Cells (RBCs):
A. Has the shortest “shelf life" of all the blood components.
B. Contains heparin as an anticoagulant.
C. Can be used to prepare fibrin sealant for microvascular surgery.
D. Controls bleeding associated with deficiencies of Factor IX and X.
E. Increases oxygen carrying capacity in anemic patients.
20. A 35 year old woman presents to the emergency room in hypotension, a thready pulse, and
complaining of right upper quadrant pain. Patients current medications include Tylenol for
headaches and oral contraceptives since she was in her early 20s9. Emergent abdominal
ultrasound confirms peritoneal fluid and a single 4 cm liver mass, and a paracentesis confirms
bloody fluid. An emergent laparatomy is performed confirming a single liver mass that has
ruptured into the peritoneum. The remainder of the liver appears normal. What Is the MOST
LIKELY diagnosis?
A. cryptogenic cirrhosis
B. hepatocellular carcinoma
C. metastatic carcinoma of the breast
D. focal nodular hyperplasia
E. hepatocellular adenoma
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21. Thickening of the spinous layer of the epidermis is pathologically known as:
A. acanthosis
B. acantholysis
C. orthokeratosis
D. parakeratosis
E. epidermolytic hyperkeratosis
22. A 36-year-o1d man is brought to the emergency department after being involved in a motor
vehicle accident. The patient was in good health prior to the accident. A chest x-ray reveals a
large mediastinal mass. A biopsy shows a polymorphous population of cells and Hodgkin's
disease is suspected. Which of the following findings is necessary to confirm this diagnosis?
A. Phagocytic histiocytes
B. Eosinophils
C. Blasts in the peripheral blood
D. T cell immunophenotye of small lymphocytes
E. Reed-Sternberg cell(s)
23. Rh Immune Globulin:
A. Can be administered IM or PO.
B. Should be given to Rh Positive mothers.
C. Is a purified preparation of igG anti-D.
D. Removes Rh-Negative ABCs from the circulation.
E. Is administered routinely at 14 weeks gestation.
24. An elderly male presents with iron-deficiency anemia. The MOST LIKELY cause is:
A. Gastrointestinal blood lose
B. Barbiturate addiction
C. Chronic hemolysls
D. Alcoholism
E. Poor diet
25. Which of the following is NOT considered a risk factor for development of hepatocellular
carcinoma?
A. chronic hepatitis C
B. chronic hepatitis B
C. Focal nodular hyperplasia of the liver
D. cirrhosis
E. hemochromatosis
Choose the single BEST answer from the choices below. Each answer may be used once, more
than once or not at all.
26. Osteosarcoma
27. Ewing's sarcoma
28. Fibrous dysplasia
29. Osteiod osteoma
A. Developmental defect
B. Limited growth potential
C. Paget’s disease
D. Small blue Dells
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30. Thick scaly plaques that are sharply demarcated are BEST characterizes as.
A. eczematous
B. papulosquamous
C. frambisiform
D. seborrheic
E. morbiliform
31. The greatest infectious risk of blood components currently is due to:
A. HTLV-I/II
B. HCV
C. Malaria
D. Bacterial contamination
E. HIV-1
32. Which of the following clinical conditions is NOT USUALLY associated with development
of fatty metamorphosis of the liver?
A. Alcohol abuse
B. Primary sclerosing cholangitis
C. Tetracycline toxicity
D. Malnutrition
E. Reye's syndrome
Choose the single BEST answer from the choices below. Each answer may be used once,
more than once or not at all.
33. Tuberculous osteomyelitis
34. Osteomalacla
36. Ankylosing spondylibs
38. Gout
A. HLA B27
B. Lead toxicity
C. Psoas abscess
D. Vitamin D deficiency
37. All of the following are often bluish EXCEPT:
A. hemangioma
B. blue nevus
C. Intradermal nevus
D. Mongolian spot
E. melanoma
38. An Infant is born at 32 weeks gestation to a mother who did not receive prenatal cage.
When the results of various laboratory tests are received, the infant is diagnosed with
hemolytic disease of the newborn. You can expect unconjugated bilirubin to begin
accumulating due to:
A. Rapid excretion of conjugated bilirubin.
B. Absence of gamma glutamyltransferase.
C. Low tiers of anti-A and anti-B.
D. Low levels of glucuronyl transferase.
E. Elevation of the Delta OD 450.
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39. A 60 year old male presents with right upper quadrant pain. Further work-up with an
abdominal CT confirms a large tumor compressing his hepatic vein. Liver biopsy
confirms centrilobular hemorrhage and necrosis with severe congestion. Given the
clinical and liver biopsy findings, the MOST LIKELY diagnosis is:
A. Primary biliary cirrhosis
B, Reye's syndrome
C. Hepatitis C
D. Budd-Chiarl syndrome
E. Poet-necrotic cirrhosis
40. Several babies In the neonatal intensive care unit develop blisters and start to exfoliate
their skin. A skin biopsy on one baby shows a cleft in the upper epidermis. Which is
LEAST likely to play a role in the development of this disorder?
A. lack of protective antibodies
B. bacteria In the blistered epidermis
C. exfoliatin
D. microorganisms in the umbilicus
E. toxin
41. All of the following are true of Pager's disease of bone EXCEPT:
A. Is frequently asymptomatic
B. A mosaic pattern can be seen on a histologic section of bone
C. Viral infection has been postulated as in the etiology
D. Causes lyric and sclerotic areas in bone
E. Most commonly involves bones of the hands and feet
42. A 58-year-old woman undergoing chemotherapy for metastatic breast cancer is
scheduled for placement of a feeding tube to aid in nutrition. Her current platelet count
is 10,000/uL and the surgeon wants to bring her platelet count to 60,000/uL prior to
surgery. She weighs 80 kg. The number of random donor platelets you should order
to raise her platelet count to 60,000/uL is,
A. Eight
B. Twelve
C. Eighteen
D. Twenty
E. Four
43. A 68 year old women develops sepsis and prolonged hypotension. She has no history
of prior liver disease. Upon recovery and re-establishment of normal blood pressure,
she develops elevation of liver function studies and liver failure. A liver biopsy is
obtained. Which of the following is MOST LIKELY to be identified histologically?
A. peripheral lobular (zone 1) hepatocyte ballooning degeneration
B. diffuse acinar Mallory’s hyaline
C. cholangitis
D. normal liver biopsy
E. centrilobular (zone 3) hepatocyte necrosis
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44. A 62-year-old man seeks medical attention for a large, ulcerated lesion on his right lower leg.
He says he has had a scaly area there for several months. A biopsy shows a lymphocytic infiltrate
which is T cell by immunophenotype. Which of the following types of lymphoma is MOST
LIKELY in this setting?
A. Mucosa-associated tissue (MALT) lymphoma
B. Mycosis fungoidea
C. Diffuse small lymphocytic lymphoma
D. Lymphoblastlc lymphoma
E. Burkitt’s lymphoma
45. A 70 year old with advanced alcoholic cirrhosis develops a row grade fever, hemorrhoids,
ascites, spider angiomata, testicular atrophy of unknown etiology. No infectious source can be
localized, and chest X-ray, blood cultures, CSF cultures, and urine cultures are negative for
infection with microbiologic work-up. Given the clinical history and MOST LIKELY clinical
diagnosis, which additional study should be ordered on this patient?
A. pharyngeal swab and culture
B. pancreatic biopsy and culture
C. brain biopsy and culture
D. stool culture
E. peritoneal aspirate and culture
46. Sponglosis is characteristically seen with:
A. erythema nodosum
B. urticaria
C. achrochordon
D. psoriasis
E. eczema
47. Paroxysmal hemoglobinuria is caused by which of the following pathophysiologic
mechanisms?
A. Opsonization of circulating red cells by igM
B. Non-immune complement-mediated destruction of circulating red cells
C. Autoimmune destruction of red cell precursors in the marrow
D. Autoimmune destruction of circulating red cells
E. Opsonization of circulating red cells by IgG
48. All of the following are true of gout EXCEPT:
A. Urate crystals may be found in soft tissues and organs
B. Excessive alcohol consumption is a contributing factor
C. It most commonly presents before 20 years of age
D. Renal failure is a complication
E. Patients have hyperuncemia
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49. Epidermal proliferation is seen in:
A. Mongolian spot
B. Spitz nevus
C. pyogenic granuloma
D. neurofibroma
E. seborrheic keratosis
50. Folate deficiency is most characteristic of which clinical scenario:
A. Sephardic Jews with hereditary dihydrofolate reductase deficiency
B. Elderly people of northern European descent presenting with symptoms and signs
of peripheral neuropathy.
C. Alcoholics
D. Middle-aged people with long-standing Crohn's ileitis
E. Pure vegetarians (vegans) who do not take vitamin supplements.
51. All of the following are true of rheumatoid arthritis (RA) EXCEPT:
A. The majority of adult RA patients have rheumatoid factor in the serum
B. Tophi are seen in patients with rheumatoid nodules of the skin
C. Affected joints are warm and tender
D. The juvenile form of RA is NOT usually associated with rheumatoid factor or
rheumatoid nodules
B. The synovium of affected joints is thick and inflamed
52. A 64-year-ofd man has marked splenomegaly and peripheral blood pancytopenia. With
this information, which of the following should be included in the differential diagnosis?
A. Hairy cell leukemia
B. Lymphoma involving the bone marrow and spleen
C. Idiopathic myclofibrosis
D. Acute lymphoblastic leukemia
E. All of the above
53. You perform a skin biopsy on a 5 year old girl who has a few 3mm umbilicated papules
on her face. What is the MOST LIKELY diagnosis?
A. molluscum cantagiosum
B. condyloma acuminatum
C. deep pairnoplantar wart
D. dermatophyte infection
E. scabies
54. A patient with intractable peptic ulcers of the duodenum is MOST LIKELY to have which
of the following tumors?
A. Glucagonoma
B. Insulinoma
C. Gastrinoma of the duodenum
D. MEN II (multiple endocrine neoptasia II; Sipple's syndrome)
E. VIPoma
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55. Cases of Sickle cell disease MOST COMMONLY present as:
A. Hypersplenism
B. Asplenia
C. Myocardial infarction
D. Stroke
E. Acute dactylitis
56. Most skin-colored intradermal nevi have a proliferation of which kinds of cells?
A. Langermans cells
B. keratinocytes
C. endothelial cells
D. fibroblasts
E. melanocytes
57. A previously healthy 10 month old Infant develops nausea, vomiting, loss of appetite.
and jaundice. The mother is a healthy 30 year old who works as an accountant, and the
patient stays in daycare while she works. Upon inquiry, the mother describes a similar
illness in another child and worker at the same daycare facility. Given this history,
which of the following is the MOST LIKELY diagnosis?
A. hepatitis C
B. hepatitis A
C. hepatitis F
D. primary biliary cirrhosis
E. hepatitis D
58. All of the following are true of osteomyelitis EXCEPT:
A. Staph. aureus is the most common causative bacterium
B. Patients with Sickle Cell Disease are prone to Salmonella infection
C. Pyogenic osteomyelitis typically affects the diaphysis of bone in children
D. The sequestrum of osteomyelitis is the necrotic bone
E. Organisms reach the bone mainly via the bloodstream
59. The greatest proportion of the total body iron content is represented by which of the
following physiological compartments?
A. Transferrin
B. Myoglobin
C. Hemosiderin
D. Hemoglobin
E. Ferritin
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60. An ambulance arrives with a 21-year-old victim of a hit-and-run accident. Initial exam
reveals massive internal injuries and she is Immediately taken to the Operating Room.
While collecting blood samples for laboratory tests, you immediately call the Blood
Bank to request emergency release of
A. Group AB Cryoprecipitate
B. Group O Fresh Frozen Plasma
C. Group O Negative Red Blood Cells
D. Group AB Negative Red Blood Cells
E. Group A Pheresis Platelets
61. Granulation tissue (“proud flesh') is assn in:
A. hemangloma
B. Kapoel sarcoma
C. pyogenic granuloma
D. Spitz nevus
E. spider angloma
62. A normal hematocrit may be seen in which of the following anemias?
A. Iron deficiency anemia
B. Anemia of acute blood loss
C. Warm autoimmune hemolytic anemia
D. Pemicious anemia
E. None of the above
63. A 60 year old presents with progressive jaundice and elevated liver function studies. He
is not currently taking any medications, illicit drugs and does not drink ethanol. He has
no history for hepatitis, unprotected sex, transfusions or IV drug abuse. Your exam
confirms a prominent S3, dependent edema, jugular venous distension, hepatomegaly,
spider angiomata, ascites, and dark skin, despite the icterus. Laboratory studies
confirm a glucose level of 400, and the patient has not eaten anything for
approximately 12 hours. Prothrombin time is mildly elevated and albumin is mildly
decreased. Hemoglobin A1C is also moderately elevated. Echocardiogram confirms
findings consistent with left ventricular hypertrophy, intact valves, and LV chamber
dilatation with a mildly decreased election fraction. Given the clinical information, what
is the MOST LIKELY diagnosis?
A. non-A, non-B hepatitis
B. hepatitis C
C. alpha-1 antitrypein deficiency
D. hemochromatosis
E alcoholic liver disease
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64. A 40 year old obese woman presents to the ER with nausea, vomiting, right upper
quadrant pain and (ever (101°F). She exhibits right upper quadrant tenderness but no
rebound tenderness. Alkaline phosphatase (ALP) is mildly elevated and WBC is 12,000
cells/ul. Ultrasound confirms gallstone impaction in the thickened gallbladder neck.
What Is the MOST LIKELY diagnosis?
A. ascending clrolangitis
B. primary gallbladder carcinoma
C. gellstone pancreatitis
D. “porcelain" gallbladder
E. acute cholecystitis
65. Which lesion is LEAST LIKELY to metastasize?
A. superficial spreading melanoma
B. acral lentiginous melanoma
C. squamous cell carcinoma
D. superficial malignant fibrous hisliocytoma
E. basal cell carcinoma
66. Pernicious anemia is caused by:
A. Dietary deficiency of folate
B. Inactivation of intrinsic factor by alcohol
C. Destruction of the gastric mucosa by contact with alcohol
D. Autoimmune destruction of cells in the small bowel mucosa
E. Autoimmune destruction of cells In the gastric mucosa
67. All of the following are true of osteoarthritis EXCEPT:
A. Affected joints are warm and tender
B. Is characterized by progressive erosion of articular cartilage
C. Weight bearing joints are commonly affected
D. Excessive load on joints has been implicated in the pathogenesis
E. Heberden's nodes may be found in the fingers
66. Your pregnant patient with pemphigold gestationis (a.k.a. herpes gestationis) is worried
about effects of the disorder on her unborn baby. What do you tell her?
A. the baby may exhibit signs of herpes infection at birth
B. the baby has a high likelihood of having severe, but not life-threatening, disease
C. the baby may die from the disease
D. the baby may have a mild version of the disease
E. the baby will be unaffected
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69. In beta-thalassemia major, increased hemoglobin-oxygen affinity occurs as a result of.
A. Inhibition of 2,3-dlphosphoglycarate synthesis
B. Stimulation of erythropoietin production by the kidney
C. Formation of alpha-gain teramers
D. Increased production of hemoglobin A2
E. Selective survival of red cells rich in fetal hemoglobin
70. A 62 year old male suburbanite presents to Hermann Hospital with jaundice, elevated
liver function studies, anorexia, nausea. and vomiting. Hepatomegaly is identified on
physical exam. Upon further questioning, the patient admits to multiple attempts at
“kicking” alcohol abuse, with history of rehabilitation attempts for greater than 10 years.
He also admits to “falling off the wagon" more recently, with a binge drinking session
over the weekend. Which of the following is MOST LIKELY to be identified his liver
biopsy?
A Centrtiobular hepatocyte necrosis.
B. Normal liver histology
C. Deposits of alpha-1-antitrypsin
D. Inflammation of bile ducts
E. Mallory’s hyalin
71. A 72-year--old man complains of sudden-onset of back pain and is found to have a total
protein of 10g/dL with a globulin traction of 7.2g. Serum protein electrophoresis shows
a monoclonal IgG kappa band. A skeletal survey reveals multiple lytic bone lesions.
Which of the following is a bone marrow aspirate MOST LIKELY to show?
A. Metastatic prostate carcinoma
B. Increased number of myeloblasts
C. Extensive marrow fibrosis
D. Granulomatous inflammation
E. Sheets of plasma cells
72. In the ABO blood group system:
A. Group O individuals are considered Rh Negative,
B. Anti-B can cause hemolysis in a Group A individual.
C. The Group B individual can make anti-AB.
D. The universal plasma donor Is Group O.
F. Anti-A and anti-B are naturally occurring antibodies.
73. The mutation in the structure of the beta-globin chain in hemoglobin C causes which of
the following phenomena:
A. Formation of Heinz bodies in red cells
B. Sickling of red cells
C. Formation of crystalloids in red cells
D. Increased hemoglobin-oxygen affinity
E. Decreased hemoglobin-oxygen affinity
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74. Purplish, polygonal, pruritic, planar papules are characteristic of.
A. pifyriasis rosea
B. Kaposi sarcoma
C. pyogenic granulomas
D. psoriasis
E. lichen plants
75. A 70 year old man with a history of cirrhosis develops pruritis, Jaundice, and worsening
of fatigue. CT of the abdomen confirms a large single mass of the liver. It is biopsied,
and reported as hepatocellular carcinoma. Which of the following is the MOST
LIKELY
underlying condition?
A. Budd-Chian syndrome
B. hepatitis A
C. hepatitis E
D. hepatitis D alone
E. hepatitis B
78. In anemia, a systolic ejection murmur may develop as a result of:
A. Damage to the aortic valve by blood with abnormal viscosity
B. Damage to the pulmonic valve by blood with abnormal viscosity
C. Weakening of the heart muscle due to hypoxia
D. Increased cardiac output
E. Laxity of the mitral valve ring due to hypoxia
77. An otherwise healthy 22-year-old woman is placed on Coumadin (warfarin) following a
deep vein thrombosis that occurred during a flight to New Zealand. Six months later,
she is seen in the Emergency Center with acute appendicitis. Surgery is scheduled
immediately. Which, if any, of the following blood components is indicated?
A. Red B1ood Cells
B. Fresh Frozen Plasma
C. Random Donor Platelets
D. Cryoprecipitate
E. None of the above
78. Your 90 year old patient with hypertension, diabetes mellitus, and angina suddenly
develops large, tense blisters on his forearms, inner thighs, and lower abdomen /groin.
This has never happened to him before. What should you do first?
A. begin dapsone therapy
B. stop all medications immediately
C. nothing - this will resolve on its own in a few weeks
D. perform a Tzanck smear
E. submit a skin biopsy for routine and direct immunofluorescence studies
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79. A 56-year-old man develops bleeding gums when he brushes his teeth. A CBC reveals
pancytopenia along with a few very immature cells in his peripheral blood. Which of the
following is the best next step in evaluation of this patient?
A. Serum and urine protein erectrophoresis
B. LAP (Leukocyte alkaline phosphatase) stain of the peripheral blood smear
C. Lymph node biopsy
D. Bone marrow aspiration and biopsy
E. CT scan of the chest and abdomen
80. Due to falling hemoglobin levels during colon resection for cancer in a 58-year-old
woman, the anesthesiologist begins transfusion of 1 unit of RBCs. When
approximately 100mL of the unit have been transfused, the anesthesiologist notices
that there is blood oozing around her endotracheal tube. Her blood pressure (BP)
abruptly falls to 70/50 mmHg and the anesthesiologist immediately administers a bolus
of 1 liter of normal saline. No other symptoms are apparent. The patient's BP does not
respond to the saline bolus and the anesthesiologist now notices that she is having
some oozing from the IV sites in both hands. Which of the following etiologies is MOST
LIKELY?
A. Transfusion-relaxed acute lung injury.
B. Anaphylactic transfusion reaction.
C. Acute hemolytic transfusion reaction.
D. Graft-vs-host disease.
E. Febrile nonhemolytic transfusion reaction.
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D
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C