Topics: Heart and Blood Vessels (Junqueira 12th ed Chap 11); Organogenesis of the Heart; Clinical Histology

Case Discussions – Pancytopenia (Junqueira 12th ed Chap. 12, 13, 14)

1. In the process of erythropoeisis, this cell lineage is seen as abnormal in cases

of megaloblastic anemia:
A. Basophilic erythroblast C. orthochomatophilic erythroblast
B. pleuripotent cells D. proerythroblast

2. In young children with chronic anemia and pancytopenia, a bone marrow

aspiration procedure is best be done at this site.
A. ilium C. sternum
B. tibia D. humerus

3. The main function of the spleen is that:

A. it sieves the blood of microorganisms and cytokines
B. it is an organ that filters the blood for senescent RBC
C. the spleen is important site of lymphocyte and RBC production
D. this organ is considered “primary” for the production of T-cells

4. Where can one find the so-called Hassal’s corpuscles?

A. lymph nodes C. thymic medulla
B. thymic cortex D. splenic cords

5. During the laboratory, you were asked to study the slide with a section of a
lymph node. If you were tasked to look for the "B-cell area", you would find it in the :
A. medullary sinus of the lymph node C. medulla of the lymph node
B. paracortical area D. cortex of the lymph node

6. The spleenic pulp is made up primarily of this type of connective tissue:

A. adipose tissue C. hyaline cartilage
B. reticular tissue D. fibrous connective tissue

7. In the choices below, which is NOT a component of the so-called mucosa-

associated lymphoid tissues?
A. lingual tonsils C. spleen
B. palatine tonsils D. Payer’s patches of the GIT

8. This is a type of T-cell lymphocyte (containing T-cell receptors) that acts

directly against foreign bodies:
A. regulatory T-cells C. helper T-cells
B. natural killer cells D. cytotoxic T-cells

9. An example of a T-cell included in the cluster designation called CD8 is :

A. cytotoxic T-cells C. helper T-cells
B. regulatory T-cells D. natural killer cells
 10. The predominant lymphocyte seen in the circulation is of this type:
A. B-cells C. Natural killer cells
B. T-cells D. RBC

11. After a tooth extraction, Mang Jose noted persistent bleeding of the gums. A
complete blood count was requested by his physician. The results indicated a platelet
count of 60,000/cumm. His platelet count is refered to as:
A. Thrombocytosis C. Thrombocytopenia
B. Leucopenia D. erythrocytopenia

12. Linsay, a 25 year old male patient was evaluated due to anemia and very
prominent icteric (yellow-discoloration) sclerae and skin. Which of the ff. conditions
below would be the primary consideration for the cause of his anemia?
A. increased destruction of RBC
B. Hepatitis
C. Carotenemia
D. decreased production of blood cell component

13. The so-called “Waldeyer’s ring” can be found in the:

A. splenic cords C. 4th digit
B. intestinal tract D. pharynx

14. Yosh, a 25-year old female patient underwent blood extraction for a complete
blood count. The hemoglobin value in the result is 18 g/dL. You would interpret the
hemoglobin result as:
A. There is anemia C. Too much elevated
B. Normal D. The value is erroneous

15. Which of the ff. statements regarding the procedure for bone marrow
transplantation is true?
A. stem cells are removed from a different person (donor) and are stored to be
given to a potential patient
B. stem cells are removed from a person before the same person undergo
chemotherapy, later the same stem cells are given to the same patient
C. stem cells are artificially induced from a living donor and are harvested on an
appropriate time for transplant to a different person
D. stem cells are taken from cadaveric donor and are transplanted to a potential
person/patient

16. In this condition, there is an abnormal production of malignant clones of

leukocyte precursor:
A. anemia C. thrombocytopenic purpura
B. thrombocytosis D. leukemia

17. A child with fever underwent complete blood count. The pediatrician noted a
“shift to the left” findings on the neutrophils. The “shift to the left” appearance of
immature neutrophils called “band cells” indicates:
A. bacterial infection C. pancytopenia
B. cancer cells D. blood loss

18. A glycoprotein growth factor produced in the kidneys responsible in the

stimulation of the production of mRNA for globin is the:
A. thrombopoietin C. granulocyte-colony stimulating factor
B. erithropoetin D. monocytes-colony stimulating factor
 19. In the “erythroid series”, this is the first recognizable cell that can be seen.
A. reticulocytes C. proerythroblast
B. erythroid progenitor cells D. orthochromatophilic erythroblast

20. In a blood smear of a given patient, the pathologist noted several mature
megakaryocytes. What is the nucleus:cytoplasm ratio of the mature megakaryocytes
that the pathologist will see?
A. 1:1 C. 1:10
B. 1:2 D. 10:1

21. Which one of the ff. is affirmative regarding the description of the interleukin
(IL) 2?
A. governs B-cell differentiation
B. this activates fibroblasts, granulocytes
C. promotes the proliferation of T, B, and natural killer cells
D. eosinophils differentiation

22. This immunoglobulin is related to complex triggering of the liberation of

several biologically active substances, such as histamine, heparin, leukotrienes, and
eosinophil-chemotactic factor of anaphylaxis:
A. Ig G C. Ig M
B. Ig E D. Ig A

23. This immunoglobulin, together with immunoglobulin D, is the major

immunoglobulin found on the surface of B lymphocytes:
A. Ig G C. Ig M
B. Ig A D. Ig E

24. The structures called “cords of Bilroth” are located in the:

A. lymph nodes C. spleen
B. Payer’s patches D. thymus

25. These are also known as the CD4 T cells:

A. natural killer cells C. regulatory T cells
B. cytotoxic T cells D. helper cells

26. Which of the ff. is NOT TRUE regarding the thymus gland ?
A. the thymic cortex is composed of an extensive population of T lymphoblasts
B. like the bone marrow and B cells, the thymus is considered a aprimary
lymphoid organ
C. B cells are produced within the thymic medulla
D. the T lymphoblasts are also known as “thymocytes”

27. A 56-year old male patient was admitted because of petechial hemorrhages all
over his body. His complete blood count revealed: WBC=7000/uL (neutrophil=5000/uL;
eosinophil=150/uL; basophil=30/uL), RBC of 5.0x100,000/uL; platelets 300. This patient
has:
A. anemia C. pancytopenia
B. thrombocytopenia D. leukocytosis

28. A 7-year old boy frequently has rashes over his chest. It has been on and off
for the past 3 months. The Pediatrician ordered a CBC, which showed the ff. findings:
WBC=8000/uL (neutrophil=5000/uL; eosinophil=300/uL; basophil=10/uL), RBC of
6.0x100,000/uL; platelets 400,000. This patient has:
A. thombocytosis C. eosinophilia
B. pancytopenia D. anemia
 29. When senescent erythrocytes are broken down, the “iron-free heme” released
and is metabolized to form bilirubin. This is then excreted by the:
A. spleenic macrophages C. mucosal cells of the tonsils
B. bone marrow cells D. liver cells

30. This is a pathologic (autoimmune) condition of the lymph nodes wherein there
is an absence of B cell production in the outer lymph node cortex, but there is T cells in
the inner cortex:
A. DiGeorge syndrome C. Combined immunodeficiency
B. Agammaglobulinemia D. Myeloid metaplasia

31. A 17-year old male patient consulted an ENT Clinic due to frequent tonsillitis
in the past few weeks. Examination revealed enlarged or hypertrophied tonsils which
could have resulted from chronic inflammation. These are called:
A. adenoids C. lympadenitis
B. crypts D. satellite nodes

32. Which one of the ff. does not carry T-cell receptors (TCR)?
A. T cytotoxic lymphocytes C. helper lymphocytes
B. T memory lymphocytes D. Natural killer cells (NK lymphocytes)T

33. The development of an erythrocyte from its first recognizable cell of the
series up to the release of reticulocytes into the blood usually takes approximately
how many days?
A. 3 hours C. 7 days
B. 7 hours D. 70 days

34. Thrombocytes are formed in the:

A. Spleen C. bone marrow
B. Liver D. thymus

35. A 60-year old female patient was seen at the ward due to stroke. Her blood
count revealed an elevated hematocrit, which is reflective of the volume of erythrocytes
in the blood. If the volume of erythrocytes in the blood is elevated together with a
concomitant increased in the number of the “other” cells, it is termed as:
A. erythocytosis C. poikilocytosis
B. polycythemia D. anisocytosis

36. A blood smear revealed variation of sizes of the RBC. This condition is also
known as:
A. poikilocytosis C. macrocytosis
B. erythrocytosis D. anisocytosis

37. A young adult patient suddenly complained of vague abdominal pain which
eventually localized at the right lower abdominal quadrant. If you are considering
ACUTE APPENDICITIS, this type of blood cells would have been elevated in the
patient’s blood count:
A. Eosinophils C. lymphocytes
B. neutrophils D. monocytes

38. In the course of hematopoietic cell differentiation, the group of cells which are
already committed to a specific lineage but are not yet fully functional are called:
A. progenitor cells C. functional RBC
B. stem cells D. polychromatophilic erythroblasts

39. Which among the leukocytes produce a significant amount of histamine?

 A. Neutrophils C. Basophils
B. eosinophils D. monocytes

39. Pencytes are undifferentiated mesenchymal cells that accompany the:

A. sinusoids C.venules
B. arteries D. capillaries

40. The immediate precursor of RBC is the:

A. megakaryocytes C. neutrophils
B. reticulocytes D. proerythroblasts

41. The primitive heart tube starts to pump blood at the earliest stages of its
development due to the increasing demand for circulation of the developing embryo.
The direction of blood flow in the primitive heart tube is:
A. from the cranial pole to the caudal pole of the heart tube
B. the heart tube never pumps blood until it forms the “loop”
C. from the caudal pole to the cranial pole of the heart tube
D. irregular  no distinct direction of flow

42. In the heart, this the homologous structure of the endothelium of the blood
vessels:
A. endocardium C. epicardium
B. pericardium D. myocardium

43. In the formed heart, the cells making up the “conducting system of the heart”
are derived from:
A. endothelial cells C. bulbus cordis
B. myocardial cells D. neuroectoderm

44. The cardiac progenitor cells will be induced by the underlying endoderm to
form the:
A. cardiac myoblasts C. epicardia
B. angioblasts D. angiocytes

45. This is the most frequent positional abnormality of the heart (isolated
positional abnormality):
A. Tetralogy of Fallot C. dextrocardia
B. transposition of great vessels D. situs inversus

46. Where is the oblique vein of the left atrium derived from?
A. sinus venosus C. bulbus cordis
B. truncus arteriosus D. primitive atria

47. In postnatal life, the right atrium contains the fossa ovalis, a shallow
depression in the interarterial septum. Which embryonic structure forms the floor of
the fossa?
A. septum primum C. bulbus cordis
B. endocardial cushion D. septum secundum

48 What is the rarest form of atrial septal defect?

A. sinus venosus defect C. patent ductus arteriosus
B. “common atrium” defect D. patent foramen ovale

49. By the middle of the 4 th week, the sinus venosus receives venous blood from the
right and left sinus horns. One of the venous vessels listed below does not send blood to the
sinus horns:
A. truncus arteriosus C . omphalomesenteric vein
B. common cardinal vein D. umbilical vein
 50. In the developing embryo, the primitive heart will start to pump blood at this
stage of development:
A. Week 2 C. Week 4
B. Week 3 D. Week 5

51. In the formed heart, the cells making up the “conducting system of the heart”
are derived from:
A. myocardial cells C. bulbus cordis
B. neural crest cells D. endothelial cells

52. In the developing “heart tube”, the first segment to be formed is the:
A. bulbus cordis C. sinus venosus
B. right ventricle D. endocardium

53. The primitive heart tube starts to pump blood at the earliest stages of its
development due to the increasing demand for circulation of the developing
embryo. The direction of blood flow in the primitive heart tube is:
A. from the cranial pole to the caudal pole of the heart tube
B. from the caudal pole to the cranial pole of the heart tube
C. irregular  no distinct direction of flow
A. the heart tube never pumps blood until it forms the “loop”

54. The mesothelial cells from the region of sinus venosus will migrate over the
heart to form the:
A. epicardium C. myocardium
B. heart tube D. endocardium

55. At 23-28 days, in the formation of the cardiac loop, the cephalic portion of the
heart tube will have this “looping” direction:
A. ventrally, caudally and to the right
B. dorsocranially and to the left
C. ventrally, caudally and to the left
D. dorsocranially and to the right

56. Which of these blood vessels exhibits a yellowish color on its Tunica
media layer:
A. Large size artery C. Medium size artery
B. Arterials D. Venules

57. Which blood vessels has a constant bore and a complete endothelial lining:
A. Capillaries C. Sinusoids
B. Venules D. Arterioles

58. In arteries, vasa vasorum are generally confined to the :

A. tunica intima C. tunica adventitia
B. tunica media D. endothelium

59. One of the ff. statements below does not describe a large vein:
A. tunica intima is very well developed
B. tunica media is poorly developed & very few smooth muscle fibers are
present
C. tunica adventitia is very thick & consists of 3 distinct zones
D. inferior vena cava,superior vena cava & portal vein are examples
II. Modified Multiple Choice/Multiple True or False. Use the boxed statements as the
basis/bases for your answers. The “guide box” will appear on the subsequent pages.
No erasure nor any alteration will be honored.

If I, II, and III are correct If only IV is correct

If I and III are correct If all are correct
If II and IV are correct

A 60. A patient was presented to your group with a condition called pancytopenia.
Which of the ff. is/are the hallmark/s of pancytopenia?
I. anemia
II. leucopenia
III. thrombocytopenia
IV. polycythemia

B 61. Which of the ff. organs below perform/s extramedullary hematopoeisis?

I. spleen
II. bone marrow
III. liver
IV. patellar bone

C 62. In a patient with pancytopenia, which of the ff. drugs listed below can be
used as bone marrow-stimulating drug/s?
I. cobalamine
II. sargramostin
III. azathioprine
IV. pagfilgrastin

E 63. During the production of RBC, which among the properties of the
developing RBC change/s during the process of differentiation?
I. mitotic activity
II. typical morphological characteristic
III. self-renewing capacity
IV. potentiality

D 64. Which one of the following statements is/are TRUE regarding the
eosinophils?
I. Comprise 60-70% of the total number of leukocytes in the circulation
II. These cells are related to the development of a potentially lethal
condition called anaphylactic shock
III. These cells are inactive and spherical while circulating but become
actively amoeboid during diapedesis and upon adhering to solid
substrates such as collagen
IV. Corticosteroids produce a rapid decrease in the number of these
cells, by interfering with their release from the bone marrow into the
bloodstream

D 65. This/these immunoglobulin crosses the placental barrier and is/are

transported to the circulatory system of the fetus, protecting the newborn against
infections for a certain period of time:
I. Ig D
 II. Ig E
III. Ig M
IV. Ig G

If I, II, and III are correct If only IV is correct

If I and III are correct If all are correct
If II and IV are correct

A 66. Which of the ff. is/are affirmative regarding the large elastic arteries?
I. these include the aorta and its branches
II. the tunica adventitia of these vessels consists of elastic fibers and
a series of concentrically-arranged, perforated elastic laminae
III. between the elastic laminae are smooth muscle cells, reticular
fibers and glycoproteins
IV. the tunica adventitia is well-developed

A 67. Endothelial cells perform which of the ff. function/s?

I. Production of vasoactive factors that affect the vascular tone,
such as endothelins, vasoconstrictive agents, and nitric oxide, a
relaxing factor
II. Conversion of bradykinin, serotonin, prostaglandins,
norepinephrine, thrombin, etc, to biologically inert
compounds
III. Lipolysis of lipoproteins by enzymes located on the surface
of endothelial cells, to yield triglycerides and cholesterol
IV. Conversion of angiotensin II to I

B 68. This/these is/are the most common cell/s found within the lymph nodes:
I. lymphocytes
II. erythrocytes
III. macrophages
IV. thrombocytes

B 69. Which of the ff. statements is/are expected in the erythrocyte maturation:
I. the chromatin becomes increasingly denser
II. the mitochondria and other organelles become very prominent
III. the cell and nuclear volume decrease
IV. the nucleoli diminish in size and will ultimately
become hyperchomatic

D 70. Monocytes, once they enter the connective tissue spaces, are known as:
I. lymphocytes
II. mast cells
III. basophilic granulocyte
IV. macrophages

D 71. This/these protein component/s of the plasma determine/s the osmotic

pressure of blood:
I. gamma globulins
II. fibrinogen
III. plasminogen
IV. albumin

B 72. Which of the ff. statements is TRUE regarding the structural plan of the
tunica intima?
I. intima consists of one layer of endothelial cells
 II. The endothelial cells are supported by a subendothelial layer of
loose connective tissue that does not contain smooth muscle cells
III. In dead tissues/organs/tissue sections, the tunica intima of the
arteries generally has an undulating appearance in tissue
sections
IV. In arteries, the intima is not separated from the media

If I, II, and III are correct If only IV is correct

If I and III are correct If all are correct
If II and IV are correct

D 73. Which of the ff. statements describe/s the structure of the “lymphatic
ducts”?
I. the adventitia does not contain “vasa vasorum”
II. the structure of the walls is the same as the venules
III. the adventitia is well-developed
IV. there are reinforced smooth cells in the middle wall layer

D 74. This/these blood cell/s comprise/s only about 1% of the blood leukocytes
and are very difficult to be identified in blood smears; this/these cell /s may supplement
the functions of the mast cells in immediate hypersensitivity reactions by migrating into
the connective tissues:
I. polymorphonuclear cells
II. monocytes
III. eosinophils
IV. basophils

D 75. Which of the ff. is/are the characteristic/s of the discontinuos sinusoidal
type of capillaries?
I. the basal lamina is discontinuous
II. these capillarie shave a tortous path and greatly enlarged
diameters which slows the blood circulation
III. the endothelial cells form a discontinuous layer and are separated by
wide spaces
IV. the cytroplasm of the endothelial cells has fenestrations

C 76. Which of the following is/are correct regarding cardiac valves?

I. AV valves & semilunar valves have entirely different structural
composition
II. the valves consist of reduplicated endocardia & core of
dense connective tissue
III. they are highly vascular (containing extensive blood supply)
IV. the valves' endocardium is thicker on the atrial surface than on
the ventricular surface

C 77. This/these structure/s is/are derived from the truncus arteriosus:

I. trabeculated part of the ventricles
II. aorta
III. smooth part of the right ventricle
IV. pulmonary artery/trunk

A 78. Which of the following will be evident in the congenital heart disease called
Tetralogy of Fallot?
I. right ventricular hypertrophy
II. pulmonary stenosis (obstruction of the right ventricular outflow)
III. dextroposition of the aorta (overriding of the aorta)
IV. atrial septal defect
 III. Matching type. A letter may be used only once, more than once or not at all.

A. Using the image below, match the lettered items with the lettered items in the image
with the numbered items below.

C 79. This is the only type of leukocyte that, after diapedesis, can return from
the tissues back to the blood circulation.

B 80. The number of these cells increase as a response to allergic reaction and
helminthic infections.

D 81. Comprise 60-70% of the total number of leukocytes in the circulation.

A 82. These cells are related to the development of a potentially lethal

condition called anaphylactic shock.

A 83. The least type of leukocytes in terms of number.

D 84. These cells are inactive and spherical while circulating but become actively
 amoeboid during diapedesis and upon adhering to solid substrates such
as collagen.

B 85. Corticosteroids produce a rapid decrease in the number of these cells, by

interfering with their release from the bone marrow into the bloodstream.

B. Below is the structure of an immunoglobulin. Make use of this image/illustration in

identifying the items being asked in the numbered items below. Use of the letters
indicated on the image.

A C

D 86. This is the isolated carboxyl-terminal portion of the heavy chain molecules.
B 87. “heavy chain” of the immunoglobin (Ig) molecule.
D 88. This region of the molecule is called the “variable region”.
D 89. This portion of the molecule is the “end” that attaches to the cell membrane
of the white blood cells.
D 90. This portion of some immunoglobulins is recognized by receptors
present on the membrane of several cell types.

IV. TRUE or FALSE. Write the whole word of your choice.

Which of the ff. is/are derived from the mesoderm?

Write A = if the statement is TRUE
Write B = if the statement is FALSE

A 91. Blood and lymph vessels

A 92. Heart
A 93. Adrenal cortex
A 94. Spleen
A 95. Kidney

V. Identification. Please write the answers legibly and observe correct spelling of
terms.

96. This is the lining epithelium of the endocardium. (simple

squamous epithelium)

97. This is the thickest among the layers of the walls of the
veins. (tunica adventitia)

98. During the maturation of the granulocytes, this is

considered the most immature recognizable cell in the myeloid series. (myeloblasts)

99. This is the lining epithelium of the lingual tonsils.

(stratified squamous epithelium)

100. This is the term used to describe the erythrocytes when

they form aggregates (stack up) within the small vessels. (Rouleaux formation)