Chapter 30: Alterations of Leukocyte, Lymphoid Function

Question 1

What change is observed in leukocytes during an allergic disorder (type I hypersensitivity)
often caused by asthma, hay fever, and drug reactions?
a. Neutrophilia
c. Eosinophilia
b. Basophilia
d. Monocytosis

Answer 1

ANS: C
Eosinophilia is an absolute increase (more than 450/µL) in the total numbers of circulating
eosinophils. Allergic disorders (type I hypersensitivity) associated with asthma, hay fever,
and drug reactions, as well as parasitic infections (particularly with metazoal parasites),
are often cited as causes. This change is not identified by any of other options.
PTS: 1 REF: Pages 1010-1011

Question 2

In infectious mononucleosis (IM), what does the Monospot test detect?

a. Immunoglobulin E (IgE)
c. Immunoglobulin G (IgG)
b. Immunoglobulin M (IgM)
d. Immunoglobulin A (IgA)

Answer 2

ANS: B
Heterophile antibodies are a heterogeneous group of IgM antibodies that are agglutinins
against nonhuman red blood cells (e.g., sheep, horse) and are detected by qualitative
(monospot) or quantitative (heterophile antibody) test methods. This statement is not true
of the other options.
PTS: 1 REF: Pages 1012-1013

Question 3

Which description is consistent with acute lymphocytic leukemia (ALL)?
a. ALL is a progressive neoplasm defined by the presence of greater than 30%
lymphoblasts in the bone marrow or blood.
b. Leukocytosis and a predominance of blast cells characterize the bone marrow and
peripheral blood. As the immature blasts increase, they replace normal myelocytic
cells, megakaryocytes, and erythrocytes.
c. B cells fail to mature into plasma cells that synthesize immunoglobulins.
d. The translocation of genetic material from genes 9 and 22 create an abnormal,
fused gene identified as BCR-ABL.

Answer 3

ANS: A
ALL is a progressive neoplasm defined by the presence of greater than 30% lymphoblasts
in the bone marrow or blood. None of the other options provide an accurate description of
ALL.
PTS: 1 REF: Page 101

Question 4

Which description is consistent with chronic myelogenous leukemia (CML)?
a. Defects exist in the ras oncogene, TP53 tumor-suppressor gene, and INK4A, the
gene encoding a cell-cycle regulatory protein.
b. Leukocytosis and a predominance of blast cells characterize the bone marrow and peripheral blood. As the immature blasts increase, they replace normal myelocytic
cells, megakaryocytes, and erythrocytes.
c. B cells fail to mature into plasma cells that synthesize immunoglobulins.
d. The translocation of genetic material from genes 9 and 22 creates an abnormal,
fused protein identified as BCR-ABL1

Answer 4

ANS: D
The Philadelphia chromosome is present in more than 95% of those with CML, and the
presence of the BCR-ABL1 protein is responsible for the initiation of CML. The other
options do not accurately describe CML.
PTS: 1 REF: Pages 1014-1015 | Page 1021

Question 5

Which description is consistent with chronic lymphocytic leukemia (CLL)?
a. Defects exist in the ras oncogene, TP53 tumor-suppressor gene, and INK4A, the
gene encoding a cell-cycle regulatory protein.
b. Leukocytosis and a predominance of blast cells characterize the bone marrow and
peripheral blood. As the immature blasts increase, they replace normal myelocytic
cells, megakaryocytes, and erythrocytes.
c. B cells fail to mature into plasma cells that synthesize immunoglobulins.
d. The translocation of genetic material from genes 9 and 22 creates an abnormal,
fused protein identified as BCR-ABL.

Answer 5

ANS: C
CLL is derived from transformation of a partially mature B cell that has not yet
encountered antigen. The other options do not accurately describe CLL.
PTS: 1 REF: Pages 1020-1021

Question 6

Which electrolyte imbalance accompanies multiple myeloma (MM)?

a. Hyperkalemia
c. Hyperphosphatemia
b. Hypercalcemia
d. Hypernatremia

Answer 6

ANS: B
Elevated levels of calcium in the blood (hypercalcemia) characterize the common
presentation of MM. The other options do not accompany MM.
PTS: 1 REF: Page 1032

Question 7

Reed-Sternberg (RS) cells represent malignant transformation and proliferation of which
of the following?
a. Interleukin (IL)–1, IL-2, IL-5, and IL-6
b. Tumor necrosis factor–beta
c. B cells
d. T cells

Answer 7

ANS: C
Although the molecular events that cause malignant transformation remain controversial,
RS cells are apparently from B-cell lineage. The other options are not relevant to this
process.

Question 8

Local signs and symptoms of Hodgkin disease–related lymphadenopathy are a result of
which of the following?
a. Pressure and ischemia
c. Inflammation and ischemia
b. Pressure and obstruction d. Inflammation and pressure

Answer 8

ANS: B
Local symptoms caused by pressure and obstruction of the lymph nodes are the result of
lymphadenopathy. The other options do not contribute to the lymphadenopathy associated
with Hodgkin disease.
PTS: 1 REF: Page 1025

Question 9

Which virus is associated with Burkitt lymphoma in African children?

a. Cytomegalovirus
c. Human papillomavirus
b. Adenovirus
d. Epstein-Barr virus

Answer 9

ANS: D
Epstein-Barr virus, found in nasopharyngeal secretions, is associated with Burkitt
lymphoma in African children. The other options are not associated with this malignancy.
PTS: 1 REF: Page 1029

Question 10

Which term is used to describe a red-purple discoloration caused by diffuse hemorrhage
into the skin tissue?
a. Petechiae 
c. Ecchymosis
b. Hematoma 
d. Purpura

Answer 10

ANS: D
Diffuse hemorrhage into skin tissues that is visible through the skin causes a red-purple
discoloration identified as a purpura. None of the other options are used to identify this
symptom.
PTS: 1 REF: Page 1037

Question 11

Which statement best describes heparin-induced thrombocytopenia (HIT)?
a. Immunoglobulin G immune–mediated adverse drug reaction that reduces
circulating platelets
b. Hematologic reaction to heparin in which the bone marrow is unable to produce
sufficient platelets to meet the body’s needs
c. Immunoglobulin E–mediated allergic drug reaction that reduces circulating
platelets
d. Cell-mediated drug reaction in which macrophages process the heparin and platelet
complexes that are then destroyed by activated cytotoxic T cells.

Answer 11

ANS: A
Heparin is a common cause of drug-induced thrombocytopenia. HIT is an
immune-mediated, adverse drug reaction caused by immunoglobulin G antibodies that
leads to increased platelet consumption and a decrease in platelet counts. None of the other
options accurately describe HIT.
PTS: 1 REF: Page 1038

Question 12

Immune thrombocytopenia (ITP) is a(n) \_\_\_\_\_ condition in adults and a(n) \_\_\_\_\_
condition in children.
a. Acute; acute 
c. Acute; chronic
b. Chronic; chronic 
d. Chronic; acute

Answer 12

ANS: D
ITP may be acute or chronic. The acute form is frequently observed in children. Chronic
ITP is more commonly observed in adults, with the highest prevalence in women between
20 and 40 years of age.
PTS: 1 REF: Pages 1038-1039

Question 13

Vitamin _____ is required for normal clotting factor synthesis by the _____.

a. K; kidneys
c. K; liver
b. D; kidneys
d. D; liver

Answer 13

ANS: C
Vitamin K, a fat-soluble vitamin, is necessary for the synthesis and regulation of
prothrombin, procoagulant factors (VII, IX, X), and anticoagulant regulators (proteins C
and S) in the liver.
PTS: 1 REF: Pages 1042-1043

Question 14

What is the most common cause of vitamin K deficiency?

a. Administration of warfarin (Coumadin)
b. Total parenteral nutrition with antibiotic therapy
c. An immunoglobulin G–mediated autoimmune disorder
d. Liver failure

Answer 14

ANS: B
The most common cause of vitamin K deficiency is parenteral nutrition in combination
with broad-spectrum antibiotics that destroy normal gut flora. None of the other options
are commonly associated with vitamin K deficiency.
PTS: 1 REF: Page 1043

Question 15

Which disorder is described as an unregulated release of thrombin with subsequent fibrin
formation and accelerated fibrinolysis?
a. Disseminated intravascular coagulation (DIC)
b. Immune thrombocytopenic purpura (ITP)
c. Heparin-induced thrombocytopenia (HIT)
d. Essential thrombocythemia (ET)

Answer 15

ANS: A
DIC is an acquired clinical syndrome characterized by widespread activation of
coagulation resulting in the formation of fibrin clots in medium and small vessels
throughout the body. This description does not accurately identify any of the other options.
PTS: 1 REF: Page 1043

Question 16

In disseminated intravascular coagulation (DIC), what activates the coagulation cascade?
a. Cytokines, such as platelet-activating factor (PAF), and tumor necrosis factoralpha (TNF-D)
b. Thromboxane A, causing platelets to aggregate and consume clotting factors
c. Tissue factor (TF) located in the endothelial layer of blood vessels and
subcutaneous tissue
d. Endotoxins from gram-negative and gram-positive bacteria circulating in the
bloodstream

Answer 16

ANS: C
Direct tissue damage (ischemia and necrosis, surgical manipulation, crushing injury)
causes the endothelium to release TF. The common pathway for DIC appears to be
excessive and widespread exposure of TF. The other options are not responsible for the
activation of the coagulation cascade.
PTS: 1 REF: Pages 1043-1044

Question 17

Which proinflammatory cytokines are responsible for the development and maintenance of
disseminated intravascular coagulation (DIC)?
a. Granulocyte colony-stimulating factor (G-CSF); interleukin (IL)–2, IL-4, and
IL-10; and tumor necrosis factor-gamma (IFN-J)
b. Granulocyte-macrophage colony-stimulating factor (GM-CSF); and IL-3, IL-5,
IL-9, and IFN-J
c. Macrophage colony-stimulating factor (M-CSF); IL-7, IL-11, and IL-14; and PAF
d. Tumor necrosis factor-alpha (TNF-D); IL-1, IL-6, and IL-8; and platelet-activating
factor (PAF)

Answer 17

ANS: D
Endotoxin, in particular, triggers the release of multiple cytokines that play a significant
role in the development and maintenance of DIC. Proinflammatory cytokines—TNF-D;
IL-1, IL-6, IL-8; PAF—are responsible for the clinical signs and symptoms associated
with the sepsis associated with DIC. None of the other options perform this function.
PTS: 1 REF: Page 1044

Question 18

In disseminated intravascular coagulation (DIC), what are the indications of microvascular
thrombosis?
a. Reduced amplitude in peripheral pulses
b. Symmetric cyanosis of fingers and toes
c. Numbness and tingling in fingers and toes
d. Bilateral pallor and edema of fingers and toes

Answer 18

ANS: B
Several organ systems are susceptible to microvascular thrombosis that affects their
function. Indicators of multisystem failure include changes in the level of consciousness,
behavior, and mentation; confusion; seizure activity; oliguria; hematuria; hypoxia;
hypotension; hemoptysis; chest pain; and tachycardia. Symmetric cyanosis of the fingers
and toes (i.e., “blue finger/toe syndrome”) and, in some instances, of the nose and breasts
may be present. The other options are not recognized indicators of microvascular
thrombosis.
PTS: 1 REF: Page 1046

Question 19

What is the most reliable and specific test for diagnosing disseminated intravascular
coagulation (DIC)?
a. Prothrombin time (PT)
b. Activated partial thromboplastin time (aPTT)
c. Fibrin degradation products (FDP)
d. D-dimer

Answer 19

ANS: D
D-dimer testing measures a specific DIC-related product. This statement is not true of the
other options.
PTS: 1 REF: Page 1047

Question 20

What term is used to identify thrombi that occlude arterioles and capillaries and are made
up of platelets with minimal fibrin and erythrocytes?
a. Essential (primary) thrombocythemia (ET)
b. Acute idiopathic thrombotic thrombocytopenic purpura
c. Thrombotic thrombocytopenic purpura (TTP)
d. Immune thrombocytopenic purpura (ITP)

Answer 20

ANS: C
Of the available options, only TTP is characterized by thrombotic microangiopathy in
which platelets aggregate and cause occlusion of arterioles and capillaries in the
microcirculation.
PTS: 1 REF: Page 1040

Question 21

Which of the following is characterized by what is referred to as pathognomonic pentad of
symptoms?
a. Acute idiopathic thrombotic thrombocytopenic purpura
b. Essential (primary) thrombocythemia (ET)
c. Immune thrombocytopenic purpura (ITP)
d. Thrombotic thrombocytopenic purpura (TTP)

Answer 21

ANS: A
Acute idiopathic thrombotic thrombocytopenic purpura is characterized by a
pathognomonic pentad of symptoms that includes extreme thrombocytopenia (fewer than
20,000 platelets/mm3
), intravascular hemolytic anemia, ischemic signs and symptoms
most often involving the central nervous system (approximately 65% exhibit memory
disturbances, behavioral irregularities, headaches, or coma), kidney failure (affecting
approximately 65% of individuals), and fever (present in approximately 33% of
individuals The other options do not demonstrate these symptoms.
PTS: 1 REF: Page 1040

Question 22

Which statement relates to immune thrombocytopenic purpura (ITP)?
a. ITP is formed in conditions of low flow and is made up of mostly red cells with
larger amounts of fibrin and few platelets.
b. An alteration of multipotent stem cells, resulting in an excess production of
platelets, causes ITP.
c. Mononuclear phagocytes in the spleen remove antibody-coated platelets from
circulation.
d. Arterial clots are made up of mostly platelet aggregates held together by fibrin
strands.

Answer 22

ANS: C
ITP involves the antigen usually forming immune complexes with circulating antibodies,
and it is thought that the immune complexes bind to Fc receptors on platelets, leading to
their destruction in the spleen. None of the other options are accurately related to ITP.
PTS: 1 REF: Pages 1038-1039

Question 23

When the demand for mature neutrophils exceeds the supply, immature neutrophils are
released indicating:
a. A shift to the right 
c. Leukocytosis
b. A shift to the left 
d. Leukemia

Answer 23

ANS: B
When the demand for circulating mature neutrophils exceeds the supply, the marrow
begins to release immature neutrophils (and other leukocytes) into the blood. Premature
release of the immature white cells is responsible for the phenomenon known as a shift to
the left or leukemoid reaction. None of the remaining options would be used to identify the
process described.
PTS: 1 REF: Page 1009

Question 24

Hodgkin disease is characterized by the presence of which of the following?

a. Philadelphia chromosome c. Microvascular thrombi
b. Virchow triad
d. Reed-Sternberg (RS) cells

Answer 24

ANS: D
Hodgkin disease is characterized by its progression from one group of lymph nodes to
another, the development of systemic symptoms, and the presence of RS cells (see Figure
29-8), but not the involvement of the Philadelphia chromosome. Virchow triad is a
symptom related to thrombus formation. Disseminated intravascular coagulation is
associated with microvascular thrombi.
PTS: 1 REF: Page 1024

Question 25

Which classic clinical manifestations are symptoms of IM? (Select all that apply.)

a. Lymph node enlargement
b. Hepatitis
c. Pharyngitis
d. Edema in the area of the eyes
e. Fever

Answer 25

ANS: A, C, E
At the time of diagnosis, the individual usually has the classic triad of symptoms: fever,
pharyngitis, and lymphadenopathy of the cervical lymph nodes. The triad does not include
hepatitis or orbital edema.
PTS: 1 REF: Page 1012

Question 26

Early detection of acute leukemia would include which of the following symptoms?
(Select all that apply.)
a. Dizziness
b. Paresthesia
c. Anorexia
d. Bruising
e. Bone pain

Answer 26

ANS: C, D, E
Signs and symptoms related to bone marrow depression include fatigue caused by anemia,
bleeding resulting from thrombocytopenia (reduced numbers of circulating platelets), and
fever caused by infection. Anorexia can occur in all varieties of acute leukemia and is
associated with weight loss. Pain in the bones and joints is thought to result from leukemia
infiltration with secondary stretching of the periosteum. The other options are not
generally associated with acute leukemia.
PTS: 1 REF: Page 1017 | Page 1019

Question 27

What are the most significant risk factors for the development of thrombus formation as
referred to by the Virchow triad? (Select all that apply.)
a. Endothelial injury to blood vessels
b. Turbulent arterial blood flow
c. Rapid coagulation of the blood
d. Stagnant venous blood flow
e. History of obesity

Answer 27

ANS: A, B, C, D
The risk for developing spontaneous thrombi is related to several factors, referred to as the
Virchow triad: (1) injury to the blood vessel endothelium, (2) abnormalities of blood flow,
and (3) hypercoagulability of the blood. Obesity is not associated with the triad.

Question 28

Which statements are true regarding leukemias? (Select all that apply.)

a. A single progenitor cell undergoes a malignant change.
b. Leukemia is a result of uncontrolled cellular proliferation.
c. Bone marrow becomes overcrowded.
d. Leukocytes are under produced.
e. Hematopoietic cell production is decreased.

Answer 28

ANS: A, B, C, E
In the leukemias, a single progenitor cell undergoes malignant transformation. The
common feature of all forms of leukemia is an uncontrolled proliferation of malignant
leukocytes, causing an overcrowding of bone marrow and decreased production and
function of normal hematopoietic cells.

Question 29

The two major forms of leukemia, acute and chronic, are classified by which criteria?
(Select all that apply.)
a. Predominant cell type
b. Rate of progression
c. Age of individual when cells differentiation occurs
d. Stage of cell development when malignancy first occurs
e. Serum level of leukocytes

Answer 29

ANS: A, B
The current classification of leukemia is based on (1) the predominant cell of origin (either
myeloid or lymphoid) and (2) the rate of progression, which usually reflects the degree at
which cell differentiation was arrested when the cell became malignant (acute or chronic)
(see Figure 29-2). The remaining options are inaccurate statements regarding the
classification criteria.
PTS: 1 REF: Page 1013

Question 30

What are the clinical manifestations of advanced non-African Burkitt lymphoma? (Select
all that apply.)
a. Abdominal swelling
b. Night sweats
c. Fever
d. Weight gain
e. Dementia

Answer 30

ANS: A, B, C
In non-African Burkitt lymphoma, the most common presentation is abdominal swelling.
More advanced disease may exhibit night sweats, fever, and weight loss. Dementia is not
associated with this disease.
PTS: 1 REF: Page 102

Question 31

Match the causes or diagnostic tests with the hematologic disorders.
______ A. Epstein-Barr virus
______ B. Bence Jones protein
______ C. Diagnosed by the Reed-Sternberg cell
______ D. Diagnosed by the Philadelphia chromosome

31. Infectious mononucleosis
32. Chronic myelogenous leukemia
33. Multiple myeloma
34. Hodgkin lymphoma

Answer 31

31. ANS: A PTS: 1 REF: Page 1011
    MSC: The most common etiologic agent is Epstein-Barr virus, a ubiquitous, lymphotrophic,
    gamma-group herpesvirus.
32. ANS: D PTS: 1 REF: Pages 1014-1015
    MSC: The Philadelphia chromosome is present in more than 95% of patients with chronic
    myelogenous leukemia.
33. ANS: B PTS: 1 REF: Page 1032
    MSC: The myeloma may produce free immunoglobulin light chain (Bence Jones protein) that is
    present in the blood and urine in approximately 80% of patients.
34. ANS: C PTS: 1 REF: Page 1024
    MSC: Hodgkin lymphoma is characterized by its progression from one group of lymph nodes to
    another, the development of systemic symptoms, and the presence of Reed-Sternberg cells