Cherries are Red

Question 1

Autoantibodies against parietal cells and intrinsic factor are associated with

Answer 1

Pernicious anemia

Question 2

A 3-month old infant is exhibiting pallor and fatigue. the pediatrician orders a CBC which displays a low RBC count…

Answer 2

Diamond Blackfan anemia

Question 3

the WBC noted were seen when performing a peripheral smear examination. these could be observed in which of the following condition.

Answer 3

Megaloblastic Anemia

Question 4

The mode of inheritance for G6PD deficiency is:

Answer 4

sex-linked

Question 5

Which of the following is an important marker of the presence of immature T cells in patients with leukemia and lymphomas:

Answer 5

Terminal Deoxynucleotidyl transferase (TdT)

Question 6

The laboratory professional notes about 20% spherocytes on a peripheral blood smear of a 4-year-old boy. An osmotic fragility test is performed. The control shows initial hemolysis at 0.50% NaCl and complete hemolysis at 0.35% NaCl. The patient sample has initial hemolysis 60% NaCl and complete hemolysis at 0.45% NaCl. What does this indicate?

Answer 6

The patient is exhibiting increased osmotic fragility.

Question 7

n PNH, cells are susceptible to complement-induced lysis. This is thought to result from the lack of what two regulating factors?

Answer 7

Decay accelerating factor (DAF) and membrane inhibitor of reactive Lysis (MRL)

Question 8

intravascular hemolysis releases this component into the peripheral blood and urine.

Answer 8

Hemoglobin

Question 9

in the initial state of porphyrin synthesis, activated glycine combines with:

Answer 9

Succinyl CoA

Question 10

laboratory findings in thalassemia often include which of the following?

Answer 10

Microcytic hypochromic anemia

Question 11

neurological symptoms are prevalent in vitamin B12 deficiency because of:

Answer 11

Improper fatty acid metabolism

Question 12

pyruvate kinase (PK) deficiency causes which of the following to occur in the erythrocyte?

Answer 12

Erythrocyte membrane failure with loss of potassium

Question 13

which of the following is found to be a factor in the thrombotic thrombocytopenia purpura (TTP)?

Answer 13

Escherichia coli O157:H7

Question 14

why are blister cells or bite cells NOT seen in PK deficiency?

Answer 14

Because Heinz bodies are not formed in PK deficiency

Question 15

which of the following disorders has a defective vertical protein interaction between RBC skeleton and the membrane?

Answer 15

hereditary pyropoikilocytosis

Question 16

a hypercellular marrow with a M:E ratio of 6:1 is most commonly due to:

Answer 16

granulocyte hyperplasia

Question 17

which of the following sets of disorders is characterized by increased osmotic fragility?

Answer 17

Hereditary spherocytosis and thalassemia

Question 18

which of the following organisms causes erythrocyte damage by releasing hemolytic toxins?

Answer 18

Clostridium sp.

Question 19

which of the following mechanism is thought to cause exercise-induced hemoglobinuria?

Answer 19

erythrocyte membrane protein changes

Question 20

A 5 year old girl has a WBC count of 11 x 10^9/L with 55% lymphocytes. which of the following best describes this phenomenon?

Answer 20

Absolute lymphocytes

Question 21

Which of the following is a disorder with absent platelet glycoprotein Ib/IX/V and where the patient presents with moderate thrombocytopenia, large platelets, and normal aggregometry with all agents except ristocetin.

Answer 21

Bernard-Soulier syndrome

Question 22

A 58 year old male visits his physician for extreme fatigue. after conducting a standard investigation, the physician strongly suspects that his patient is suffering from CML. which one of the following lab results would confirm the picture?

Answer 22

Positive molecular analysis for BCR/ABL1 with Ph chromosome

Question 23

A 60-year-old patient visited his general practitioner because of fatigue and unexplained bruising. Physical examination revealed a frail, thin, pale man with widespread bruising.

A CBC was ordered and revealed abnormal granularity of platelets and leukocytes. Red cells appeared dimorphic. Bone marrow analysis showed 20 ringed sideroblasts with
dysplastic changes in RBC and WBC precursors. No cytogenetic abnormalities were detected. Based on this information, what is a probable diagnosis?

Answer 23

Myelodysplastic syndrome

Question 24

A bone marrow sample is sent to the lab for cytomechanical staining MPO,SBB, AND NSE have been ordered. staining results come
as follows:
MPO: Positive SBB: Positive, Specific: Positive, NSE: Positive
Based on these findings what lineage(s) is/are most likely affected?

Answer 24

myeloid and monocytic

Question 25

The CAP smear presented was sent to a hospital laboratory as part of an external quality control. which of the following test would also be useful in assessing this condition?

Answer 25

????

Question 26

what is the pathogenesis of MAHA?

Answer 26

microthrombi and fibrin formed on damaged endothelial cells trap and break red cells

Question 27

In the four large corner squares of a hemocytometer, 95,102,105, and 98 white cells were counted from a 1:20 dilution. select the correct interpretation for the white blood count calculated from these values.

Answer 27

normal for infant and elevated for an adult

Question 28

A technologist is reviewing a blood smear of an AML patient. she notices single azurophilic needle-like inclusions in the cytoplasm of many of the circulating blasts. what is the most probable identification of the inclusions?

Answer 28

Auer rods

Question 29

which of the following hemoglobins results from crossing over and fusion of delta and beta chain genes?

Answer 29

Hb D

Question 30

Bone marrow review on a 15 year old girl with acute leukemia revealed many blast with the following characteristics: high N;C ratio, prominent nucleoli, open chromatin pattern and basophilic cytoplasm. Cytochemical staining revealed negative reactivity with MPO and SBB nonspecific esterase was positive. No cytogenetic abnormalities were detected. What is the most likely lineage of the blast cells in question?

Answer 30

Monocytic

Question 31

CML is characterized by which of the following?

Answer 31

a left shift in WBC granulocyte

Question 32

which of the following anomalies is an autosomal dominant disorder characterized by irregularity sized inclusions in polymorphonuclear neutrophils , and monocytes, abnormal giant platelets and often thrombocytopenia?

Answer 32

May-Hegglin anomaly

Question 33

Hairy cell leukemia and chronic lymphocytic leukemia appear morphologically similar to the untrained eye. which of the following tests would help differentiate between the two?

Answer 33

TRAP stain

Question 34

in the identification of the pelger-Huet cells, what nuclear characteristic other than the dumbbell shape aids in differentiating theses cells from bands?

Answer 34

excessive coarse clumping of chromatin

Question 35

a patient presents with 25% blasts (nonerythroid) 34% monocytic cells, and 31% granulocytic cells in the bone marrow. the peripheral blood smear has 10% monocytes. the alpha-naphthyl esterase and chloroacetate esterase are positive. what is the probable diagnosis of theses finings?

Answer 35

acute myelomonocytic leukemia

Question 36

a patient presents with a leukocyte count of 120x10^9/L and splenomegaly. The blood smear reveals a shift to the left with promyelocytes, myelocytes, metamyelocytes and bands. the platelets are increased and the LAP is decreased. what condition is associated with theses results?

Answer 36

CML

Question 37

A PAS stain is ordered on a leukemic patient. the test is performed, and the technologist confirms that the PAS stain is positive with Block course granularity. Immunophenotyping showed glycophorin positivity. based on these findings, from what is the patient most likely suffering?

Answer 37

acute erythroleukemia

Question 38

A benign condition has the following characteristics: WBC count 55 x 10^9/L with a left shift and it occurs in response to inflammatory processes. what is this condition?

Answer 38

leukemoid reaction

Question 39

A healthy individual has his blood drawn as part of a routine physical. the laboratory professional performing the differential notes a neutrophil with a nucleus that appears dumbbell shaped. after scanning the entire slide, it appears the vast majority of neutrophils have the same nuclei. all the other leukocytes appear normal. what can be concluded from this?

Answer 39

The patient has Pelger Huet anomaly

Question 40

A 34 year old woman has just given birth to a healthy baby boy. after the delivery of the baby, the physician proceeds to deliver the placenta. after it has been extracted from the mother uterus, the resident examines it and notes that it appears incomplete. then try to deliver the remainder, but are unsuccessful. A few moments later, the mother loses consciousness, and and is bleeding profusely from her uterus. blood is collected and the results are shown below.

Answer 40

DIC

Question 41

acceptable sites for bone marrow aspiration in an adult include the:

Answer 41

the anterior or posterior iliac crest and midline of the sternum.

Question 42

A patient being treated with heparin therapy has 65% decrease in platelet count from the baseline count after 6 days of being on the anticoagulant. what is the probable cause of the disease?

Answer 42

Heparin Induced Thrombocytopenia (HT)

Question 43

a patient has a platelet count of 80 x 10^9/L, a bleeding time of 15 min and 3+ positive tourniquet test. from what is the patient most likely suffering?

Answer 43

A quantitative platelet disorder

Question 44

a patient has severe liver disease. what test results would you expect?

Answer 44

prolonged PT, APTT, increased FDP

Question 45

George Jones is admitted to the hospital with abdominal pain. upon physical examination, the attending physician notices a yellow ring around georges green eyes. george has a significant swelling in his abdomen, and has been suffering from swollen joints for the last month. the physician runs a battery for labs. The results are below:

Answer 45

Liver Disease

Question 46

Interpret the results below 1. PT= 32 sec 2. APTT= 92 sec 3. TT= 20 sec What is the most likely reason for these aberrant results?

Answer 46

There us heparin contamination of the sample

Question 47

Interpret the following results: PT: 11.8 sec (RR: 11.2-13.8 sec) INR: 1.07 APTT: 57 sec (RR: @3-32 sec) BT: 12 min Ristocetin aggregation; decreased aggregation Based on this information, from what is the patient most likely suffering?

Answer 47

Hemophilia A

Question 48

Patients with protein C and or S deficiencies are at risk for which type of complication

Answer 48

Thrombosis

Question 49

Proper collection and processing of coagulation specimens is necessary for optimum results. what should be avoided when processing the sodium citrated specimens for testing?

Answer 49

clotting of the specimen and underfilling the tube

Question 50

A 5- year old boy visits his PCP after a bike accident. He fell on his knees.... Physician notes small hematomas on his elbows and knees.. Blood results below: PT: 12.2 sec (RR: 11.3-12.8 sec) INR: 1.12 APTT: 72 sec (RR:23-32 sec) Platelet aggregation studies: normal aggregation with all agonists The physician admits him to the area hospital. What should the physicians next course of action be in investigating these results?

Answer 50

He should order factor assays of the intrinsic pathway

Question 51

A 15-year old boy sees his physician because of a prolonged fever and swollen lymph glands. His PB smear shows 20% reactive lymphocytes with a 16 x 10^9L WBC count. What can you conclude from this?

Answer 51

This boy has clinical features of infectious mononucleosis

Question 52

An instrument printout shows a WBC count of 4.5 x 10^9/L with 75% neutrophils. What is the absolute neutrophil count?

Answer 52

3.4 x 10^9/L

Question 53

Choose the hemoglobin that has the highest oxygen affinity.

Answer 53

Hb F

Question 54

What analyte may help to differentiate between intravascular and extravascular hemolysis?

Answer 54

Haptoglobin

Question 55

Pernicious anemia can be distinguished from folate deficiency by the:

Answer 55

presence of autoantibodies to IF

Question 56

The leukemia smear presented shows (arrowed cells):

Answer 56

faggot cell with auer rods

Question 57

Which of following are typical laboratory results for anemia of chronic inflammation/disorder (ACI)?

Answer 57

low serum iron and low TIBC

Question 58

What is the test commonly used to monitor the high heparin doses used in cardiac bypass surgery?

Answer 58

aPTT

Question 59

What is the most important step in the phlebotomy procedure?

Answer 59

proper patient identification

Question 60

Twenty cells are counted in one of the nine large squares of a hemocytometer. The sample is diluted 1:10. How many cells are present per mL?

Answer 60

2000

Question 61

Toxic granulation, Dohle bodies and vacuolization in neutrophils are often found together in

Answer 61

Bacterial infection

Question 62

The urea solubility test evaluates factor:

Answer 62

XIII

Question 63

Homozygous alpha thalassemia (--/--) has what clinical outcome?

Answer 63

incompatible with life

Question 64

How do sickle cells or spherocytes interfere with the ESR?

Answer 64

prevent rouleaux formation, so falsely decrease

Question 65

The following smear was obtained from a patient suffering from an anemia. Based on this smear, which additional test would be useful to further evaluate the anemia

Answer 65

????

Question 66

The smear presented was obtained from a 27 year old male suffering from an anemia. Which of the following would also be expected laboratory result for this patient?

Answer 66

????

Question 67

This smear was obtained from a 7 year old girl at a childrens hospital suspected of suffering from an leukemia. This smear suggests the child could be suffering from:

Answer 67

????

Question 68

The peripheral smear presented was obtained from a female suffering from an anemia. Its morphological presentation suggests:

Answer 68

????

Question 69

The following smear was obtained from a patient suffering from an acute leukemia. based on the smear presented what additional biochemistry result would be expected?

Answer 69

????

Question 70

The smear presented indicates:

Answer 70

CLL

Question 71

A urine specimen is tested and has the following results: reagent strip: glucose 3+ protein 1+ microscopic findings: >100 WBCs/ hpf many yeast cells

Answer 71

Diabetes mellitus

Question 72

A patient presenting with polyuria, nocturia, polydipsia, and high specific gravity is exhibiting symptoms.

Answer 72

diabetes insipidus

Question 73

A slightly hazy CSF specimen is diluted 1:10 with acetic acid. A total number of 25 cells are counted. Five large squares on each side of the Neubauer counting chamber were used in the evaluation. The count is reported as:

Answer 73

500 WBCs cell

Question 74

Ammonium sulfate is added to a red colored urine. The urine had a positive reaction for blood, but there were no red blood cells in the sediment. After centrifugation, the sedimented ammonium sulfate is clear. This abnormal color is caused by:

Answer 74

myoglobin if sediment was red it would be due to hemoglobin

Question 75

Calculate the creatinine clearance from the information provided below: 24hr urine volume: 1000ml ; Serum creatinine: 2.0mg/dL; urine creatinine: 200mg/dL

Answer 75

((200)(1000)) / (2.0) | = 100,000 ml/min

Question 76

Clue cells are derived from:

Answer 76

Squamous epithelial cells

Question 77

The following crystals were detected using phase microscopy on a synovial fluid from a patient with symptoms of gout. These crystals are most likely:

Answer 77

Monosodium urate

Question 78

Which of the following characteristics best differentiates waxy cast from fibers that may contaminate urine sediment?

Answer 78

Waxy casts do not polarize light: fibers do

Question 79

Identify the cast on the color plate presented below

Answer 79

Hyaline cast

Question 80

Identify the crystals shown in the picture below:

Answer 80

triple phosphate

Question 81

Lumbar puncture for cerebrospinal fluid analysis is most essential to diagnose which of the following conditions?

Answer 81

meningitis

Question 82

Identifying the urine crystals below from a patient with kidney stones:

Answer 82

uric acid crystals

Question 83

Phenylketonuria is caused by:

Answer 83

Lack of enzyme phenylalanine hydroxylase

Question 84

A urine showing a spotted or speckled reaction on the reagent strip for blood can indicate:

Answer 84

Hematuria

Question 85

Tests for the detection of occult blood rely on which chemical reaction?

Answer 85

The psuedo-peroxidase activity of hemoglobin

Question 86

Which of the following statements regarding sperm concentration is true?

Answer 86

In normal ejaculate, sperm concentration ranges from 20 million to 250 million per milliliter.

Question 87

The presence of a white precipitate in freshly voided urine can be caused by:

Answer 87

Amorphous phosphates in alkaline urine

Question 88

Which of the following specimens usually eliminates contamination of the urine with entities from the external genitalia and distal urethra?

Answer 88

Midstream "clean catch" specimen"

Question 89

The tubes of CSF are submitted to the laboratory. They are numbered 1, 2, 3 and show blood in all tubes, but decreasing in amount as one inspects tubes through 1 and 3. This observation should be interpreted as:

Answer 89

A traumatic or bloody tap is suspected and, in all likelihood, no pathogenic significance should be attached to the presence of the blood

Question 90

During the microscopic examination of urine sediment, which of the following are numerated using low-power magnification?

Answer 90

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