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Hematology > Exam 3 > Flashcards

Exam 3 Flashcards

1
Q 
A rare autosomal recessive congenital disorder that features partial albinism,
mild bleeding tendencies, and giant lysosomal granules in blood and tissue
cells is known as \_\_\_\_\_\_\_\_\_\_\_\_.
A. Fanconi's anemia
B. Chédiak­Higashi
C Pelger­Huët anomaly
D. Hunter's syndrome
E. Hurler's syndrome
A

Chédiak­Higashi disease

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2
Q 
\_\_\_\_\_\_\_\_\_\_ are the most numerous leukocytes found in the blood.
A. Neutrophils
B. Lymphocytes
C. Monocytes
D. Eosinophils
E. Basophils
A

A. Neutrophils

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3
Q 
Basophilia occurs when the absolute count is greater than which of the following?
A. 2.0 ´ 10^9 cells/L
B. 0.2 ´ 10^9 cells/L
C. 0.6 ´ 10^9 cells/L
D. 5.0 ´ 10^9 cells/L
E. 0.5 ´ 10^9 cells/L
A

B. 0.2 ´ 10^9 cells/L

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4
Q 
Döhle bodies consist of \_\_\_\_\_\_\_\_\_\_.
A. Endoplasmic reticulin
B. Cytoplasmic granules
C. Mucopolysaccharide
D. RNA
E. DNA
A

A. Endoplasmic reticulin

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5
Q 
During bacterial infection the granulocyte­to­erythroid ratio can increase due to \_\_\_\_\_\_\_\_\_\_ production.
A. Decreased granulocytes
B. Increased granulocytes
C. Decreased erythrocytes 
D. Increased lymphocytes
E. Increased erythrocytes
A

B. Increased granulocytes

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6
Q 
Eosinophilia occurs when the absolute eosinophil count is greater than which of the following?
A. 0.6 ´ 10^9/L
B. 6.0 ´ 10^9/L
C. 2.0 ' 10^9/L
D. 1.5 ´  10^9/L
A

A. 0.6 ´ 10^9/L

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7
Q 
Hyposegmentation of the nucleus is characteristic of which white blood cell anomaly?
A. Alder­Reilly anomaly
B. Pelger­Huët anomaly 
C. May­Hegglin anomaly
D. Chédiak­Higashi anomaly
E. Chronic granulomatous disease
A

B. Pelger­Huët anomaly

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8
Q 
\_\_\_\_\_\_\_\_\_\_ is the consequence of either severe neutropenia or neutrophil dysfunction.
A. Bacterial infection 
B. Viral infection
C. Hypersensitivity reactions
D. Parasitic infection
E. Allergic reaction
A

A. Bacterial infection

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9
Q 
Morphological features that can be manifested in the neutrophils in the peripheral blood of patients with severe infections include:
A. Döhle bodies
B. Toxic vacuolization
C. Toxic granulation
D. All of the above
E. None of the above
A

D. All of the above

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10
Q 
Neutropenia is a quantitative disease, defined as an absolute neutrophil count of less than \_\_\_\_\_\_\_\_\_\_.
A. 1.0 ´ 10^9/L
B. 1.2 ´ 10^9/L
C. 1.5 ´ 10^9/L
D. 2.0 ´ 10^9/L
E. 5.0 ´ 10^9/L
A

C. 1.5 ´ 10^9/L

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11
Q

Reactive lymphocytes in infectious mononucleosis represent:
A. Epstein Barr virus­infected B lymphocytes
B. T lymphocytes responding to infection
C. NK cells responding to infection
D. Plasma cells
E. None of the above

A

B. T lymphocytes responding to infection

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12
Q

__________, seen in association with mucopolysaccharidosis, has characteristic dark staining and coarse cytoplasmic granules in the cytoplasm
of neutrophils, lymphocytes, and monocytes.
A. Alder­Reilly anomaly
B. May­Hegglin anomaly
C. Chédiak­Higashi disease
D. Pelger­Huët anomaly
E. None of the above

A

A. Alder­Reilly anomaly

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13
Q

The susceptibility to infections in Chédiak­Higashi disease is due to:
A. Neutropenia
B. Impaired chemotaxis
C. Abnormal distribution of lysosomal enzymes
D. All of the above
E. None of the above

A

D. All of the above

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14
Q 
What is the causative agent of infectious mononucleosis?
A. Herpes virus
B. Epstein­Barr virus 
C. Cytomegalovirus
D. Coxsackie virus
E. None of the above
A

B. Epstein­Barr virus

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15
Q 
What is the most common morphological change seen in neutrophils in response to bacterial infection?
A. Auer rods
B. Cytoplasmic vacuolization
C. Dohle bodies 
D. Toxic granulation 
E. Agranulation
A

D. Toxic granulation

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16
Q 
Which of the following features are seen in reactive lymphocytes?
A. Low N:C ratio
B. Blue cytoplasm
C. Indented cytoplasmic borders
D. All of the above
A

D. All of the Above

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17
Q 
Which qualitative white blood cell (WBC) disorder demonstrates blue­staining cytoplasmic inclusions in neutrophils that resemble Döhle bodies?
A. Alder's anomaly
B. Chédiak­Higashi disease
C. May­Hegglin anomaly
D. Pelger­Huët anomaly
E. Chronic granulomatous disease
A

C. May­Hegglin anomaly

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18
Q

A 14­year­old male presents with a mediastinal mass, a WBC of 110 ´ 10^9/L, hepatosplenomegaly, and early central nervous system involvement. Both L1
and L2 morphology are seen, and surface markers CD7, CD2, and CD5 are expressed. Which type of ALL is present?
A. Precursor B­-cell
B. T­-cell
C. B­-cell
D. Null cell
E. None of the above

A

B. T­-cell

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19
Q

A 35­year­old man presents with anemia, neutropenia, thrombocytopenia, myeloblasts with the presence of Auer rods, and one or two distinct nucleoli
and promyelocytes. Cytochemistry examination demonstrates peroxidase and Sudan black B (SBB) positive and TdT terminal deoxynucleotidyl transferase (TdT) negative. This hematologic picture is consistent with:
A. Acute lymphoblastic leukemia (ALL)
B. Acute myeloblastic leukemia (AML)
C. Chronic myelocytic leukemia (CML)
D. Chronic lymphocytic leukemia (CLL)
E. None of the above

A

B. Acute myeloblastic leukemia (AML)

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20
Q 
A 5­year­old girl presents with anemia, neutropenia, thrombocytopenia, lymphoblasts, and prolymphocytes. Cytochemical examination shows myeloperoxidase and SBB negative, and a positive for TdT. This hematologic picture is consistent with:
A. ALL
B. AML
C. CML
D. CLL
E. None of the above
A

A. ALL

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21
Q 
A clinical feature of acute leukemia is:
A. Sudden onset 
B. Untreated course < 6 months
C. Presence of immature leukemic cells
D. All of the above 
E. None of the above
A

D. All of the above

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22
Q 
Anemia in acute leukemia is generally \_\_\_\_\_\_\_\_\_\_.
A. Microcytic/normochromic
B. Normocytic/normochromic
C. Microcytic/hypochromic
D. Macrocytic/normochromic
E. None of the above
A

B. Normocytic/normochromic

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23
Q 
A positive myeloperoxidase or SBB stain indicates \_\_\_\_\_\_\_\_\_\_ differentiation.
A. Myeloid 
B. Lymphoid
C. Megakaryocytoid
D. Plasmacytoid
E. None of the above
A

A. Myeloid

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24
Q 
A positive nonspecific esterase stain indicates \_\_\_\_\_\_\_\_\_\_ differentiation.
A. Megakaryocytoid
B. Monocytic
C. Lymphoid
D. Plasmacytoid
E. Erythrocytic
A

B. Monocytic

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25
Q 
Cell \_\_\_\_\_\_\_\_\_\_ is used to distinguish between acute and chronic forms of leukemia.
A. Maturity
B. Lineage
C. Count
D. Kinetics
E. None of the above
A

A. Maturity

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26
Q 
Cell \_\_\_\_\_\_\_\_\_\_ is used to distinguish between lymphoid and myeloid groups in leukemia.
A. Maturity
B. Lineage
C. Count
D. Kinetics
E. None of the above
A

B. Lineage

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27
Q 
Cytoplasmic µ, in the immunologic classification of ALL, is expressed in \_\_\_\_\_\_\_\_\_\_ ALL.
A. Common ALL
B. T­-cell
C. Precursor B­-cell 
D. B-­cell
E. Burkitt's lymphoma
A

C. Precursor B­-cell

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28
Q 
In leukemia, the presence of immature malignant cells is classified as \_\_\_\_\_\_\_\_\_\_.
A. Chronic
B. Myeloid
C. Acute
D. Lymphoid
E. Myeloid metaplasia
A

C. Acute

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29
Q 
In leukemia, the presence of predominantly mature malignant cells is classified as: \_\_\_\_\_\_\_\_\_\_.
A. Chronic
B. Myeloid
C. Acute
D. Lymphoid
E. Myeloid metaplasia
A

A. Chronic

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30
Q 
Leukemia cells are frequently present in the peripheral blood and commonly invade the reticuloendothelial tissue which includes the \_\_\_\_\_\_\_\_\_\_.
A. Spleen
B. Liver
C. Lymph nodes
D. All of the above
E. None of the above
A

D. All of the above

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31
Q 
On Romanowsky­stained smears, Auer rods appear as:
A. Brown staining rods
B. Orange staining rods
C. Pink or purple staining rods
D. Blue staining rods 
E. None of the above
A

C. Pink or purple staining rods

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32
Q 
TdT terminal deoxynucleotidyl transferase is found in 90% of acute \_\_\_\_\_\_\_\_\_\_ leukemia.
A. Myelocytic
B. Lymphoblastic 
C. Promyelocytic
D. Monocytic
E. None of the above
A

B. Lymphoblastic

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33
Q 
The presence of Auer rods in the cytoplasm of cells rules out \_\_\_\_\_\_\_\_\_\_.
A. ALL 
B. AML
C. Myelodysplastic syndrome
D. Acute promyelocytic leukemia
E. None of the above
A

A. ALL

34
Q 
What percentage of blasts is recommended by the French­American­British (FAB) classification system for a diagnosis of acute leukemia?
A. 30%
B. 50%
C. 20%
D. 10%
E. None of the above
A

A. 30%

35
Q 
When a leukemia is suspected in a patient, what laboratory test should be required for the initial diagnosis?
A. CBC, differential, platelet count
B. Cytochemical stains
C. Immunologic surface markers
D. All of the above
E. None of the above
A

D. All of the above

36
Q 
Which cytochemical stains show strong positivity in acute monocytic leukemia (M5)?
A. Peroxidase
B. Nonspecific esterase
C. SBB
D. TdT
E. None of the above
A

B. Nonspecific esterase

37
Q 
Which of the following cytochemical stains differentiates AML from ALL?
A. Myeloperoxidase Correct Answer
B. PAS
C. Nonspecific esterase
D. All of the above
E. None of the above
A

A. Myeloperoxidase

38
Q 
All of the following are characteristics of chronic leukemias except:
A. Insidious onset
B. Mature leukemia cells
C. Found in adults
D. Found primarily in children 
E. Organomegaly
A

D. Found primarily in children

39
Q 
Chronic myelocytic leukemia (CML) is characterized by examining the production of \_\_\_\_\_\_\_\_\_\_ and their precursors.
A. Erythrocytes
B. Platelets
C. Granulocytes
D. Lymphocytes
E. None of the above
A

C. Granulocytes

40
Q 
CML can be differentiated from polycythemia vera, essential thrombocythemia, and agnogenic myeloid metaplasia by the presence of \_\_\_\_\_\_\_\_\_\_.
A. Leukocytosis
B. Ph chromosome
C. Splenomegaly
D. Erythrocytosis
E. Thrombocytosis
A

B. Ph chromosome

41
Q

How is CML differentiated from a leukemoid reaction?
A. WBC >100,000/µL
B. Decreased leukocyte alkaline phosphatase (LAP)
C. Shift to the left
D. Increased LAP
E. RBC indices

A

B. Decreased leukocyte alkaline phosphatase (LAP)

42
Q 
In CML, transformation to a more critical phase is evident by the appearance of which cells?
A. Blasts 
B. Promyelocytes
C. Myelocytes
D. Bands
E. Metamyelocytes
A

A. Blasts

43
Q 
Most patients (85%) are diagnosed in which phase of CML?
A. Chronic 
B. Accelerated
C. Blast
D. Remission
E. Refractory
A

A. Chronic

44
Q 
Philadelphia chromosome is present in \_\_\_\_\_\_\_\_\_\_ percent of patients with typical leukemia cells.
A. 90­-95%
B. 40­-50%
C. 40­-60%
D. 30-­40%
E. 65-­75%
A

A. 90­-95%

45
Q 
What is characteristic of the bone marrow morphology in CML?
A. Myeloid hyperplasia 
B. Normal M/E ratio
C. Myeloid hypoplasia
D. Hypocellularity
E. Erythroid hyperplasia
A

A. Myeloid hyperplasia

46
Q 
What is the M/E ratio in patients with CML?
A. 1:10
B. 1:5
C. 10:1
D. 3­-4:1
E. 4:1
A

C. 10:1

47
Q 
Which clinical signs are evident in CML?
A. Splenomegaly
B. Hepatomegaly
C. Pallor
D. Epistaxis
E. All of the above
A

E. All of the above

48
Q 
Which of the following is not consistent with leukemoid reaction?
A. High WBC count
B. High LAP
C. Toxic granulation of neutrophils
D. Presence of Philadelphia chromosome 
E. Associated with a bacterial infection
A

D. Presence of Philadelphia chromosome

49
Q 
Which of the following myeloproliferative disorders is characterized by a decreased LAP score?
A. PV
B. IMF
C. ET
D. AML
E. CML
A

E. CML

50
Q 
Which phase of CML carries the worst prognosis and is generally unresponsive to treatment?
A. Chronic phase
B. Accelerated phase
C. Blast crisis 
D. Chemotherapy­ resistant phase
E. None of the above
A

C. Blast crisis

51
Q 
A \_\_\_\_\_\_\_\_\_\_ anemia is found in most myelofibrosis patients at presentation:
A. Normocytic/hypochromic
B. Normocytic/normochromic
C. Macrocytic/hyperchromic
D. Microcytic/hypochromic
E. None of the above
A

B. Normocytic/normochromic

52
Q

All of the following are included in the classic findings of chronic idiopathic myelofibrosis (CIMF) except:
A. Extramedullary hematopoiesis
B. Fibrosis of the marrow
C. Leukoerythroblastosis of the peripheral blood
D. Teardrop poikilocytosis of the peripheral blood
E. Erythroid hyperplasia

A

E. Erythroid hyperplasia

53
Q 
Almost all patients with this CMPD are positive for the JAK2(V617F) mutation:
A. CIMF
B. ET
C. PV 
D. CML
E. None of the above
A

C. PV

54
Q

A patient presents with a hematocrit of 55%, elevated red cell mass, normal arterial oxygen saturation, elevated LAP score, and thrombocytosis. What is
the most probable cause of these laboratory findings?
A. Secondary erythrocytosis
B. Polycythemia vera
C. Relative erythrocytosis
D. Idiopathic myelofibrosis
E. Essential thrombocythemia

A

B. Polycythemia vera

55
Q 
At onset of disease, essential thrombocythemia will present with a \_\_\_\_\_\_\_\_\_\_\_\_\_ anemia.
A. Normocytic/normochromic 
B. Microcytic/hypochromic
C. Macrocytic/hyperchromic
D. Normocytic/hypochromic
E. None of the above
A

A. Normocytic/normochromic

56
Q 
Bone marrow aspiration in myelofibrosis frequently results in a \_\_\_\_\_\_\_\_\_\_.
A. Clotted specimen
B. Dry tap 
C. Hemolysis
D. Normal aspirate
E. None of the above
A

B. Dry tap

57
Q 
Essential thrombocythemia is a rare, chronic myeloproliferative disorder characterized by marked \_\_\_\_\_\_\_\_\_\_ associated with abnormal platelet
function.
A. Thrombocytopenia 
B. Thrombocytosis 
C. Erythrocytosis
D. Granulocytosis
E. Lymphocytosis
A

B. Thrombocytosis

58
Q 
In polycythemia vera, erythropoietin is \_\_\_\_\_\_\_\_\_\_.
A. Decreased Correct
B. Increased
C. Normal
D. All of the above
E. None of the above
A

A. Decreased Correct

59
Q 
In polycythemia vera, therapeutic phlebotomies reduce the total red cell mass by removing 350-­500 mL over 2­3 days until the hematocrit is
maintained at \_\_\_\_\_\_\_\_\_\_ percent.
A. 50-­60
B. 40­-45 
C. 30-­40
D. >60
E. <30
A

B. 40­-45

60
Q 
In secondary erythrocytosis, the underlying mechanism is release of \_\_\_\_\_\_\_\_\_\_ as part of a compensatory effect to minimize impending tissue
hypoxia.
A. Erythropoietin 
B. Thrombopoietin
C. Interleukin­1
D. Colony­-stimulating factors
E. None of the above
A

A. Erythropoietin

61
Q

Polycythemia vera is characterized by:
A. Suppression of erythropoiesis and excessive proliferation of myeloid elements
of the bone marrow
B. Accelerated erythropoiesis and excessive proliferation of myeloid and
megakaryocytic elements of the bone marrow
C. Accelerated erythropoiesis and excessive proliferation of lymphoid elements in
the bone marrow
D. Suppression of erythropoiesis and excessive proliferation of lymphoid
elements of the bone marrow
E. All of the above

A

B. Accelerated erythropoiesis and excessive proliferation of myeloid and
megakaryocytic elements of the bone marrow

62
Q 
What bone marrow findings are usually seen in essential thrombocythemia?
A. Trilineage hyperplasia
B. Large megakaryocytes
C. Stainable iron
D. Dysplastic megakaryocyte
E. All of the above
A

E. All of the above

63
Q

What is/are the strongest differentiating feature(s) that distinguish chronic myelocytic leukemia (CML) from IMF?
A. Decreased leukocyte alkaline phosphatase (LAP)
B. Presence of Philadelphia chromosome
C. Splenomegaly
D. A and B
E. B and C

A

D. A and B

64
Q 
Which laboratory features are helpful in supporting a diagnosis of CIMF instead of essential thrombocythemia?
A. Teardrop poikilocytosis
B. Leukoerythroblastic blood picture
C. Increased prominent fibrosis
D. All of the above
E. B and C
A

D. All of the above

65
Q 
Which myeloproliferative disorder is characterized by fibrosis of the marrow, extramedullary hematopoiesis of the spleen or liver, leukoerythroblastosis, and teardrop poikilocytosis?
A. Secondary polycythemia
B. Essential thrombocythemia (ET)
C. Idiopathic myelofibrosis (IMF) 
D. Polycythemia vera (PV)
E. Chronic myelogenous leukemia (CML)
A

C. Idiopathic myelofibrosis (IMF)

66
Q

A type III sideroblast in dyserythropoiesis is demonstrated by:
A. 1­5 granules
B. Blue ring around the nucleus with Prussian blue
C. 5-­10 granules
D. No granules
E. None of the above

A

B. Blue ring around the nucleus with Prussian blue

67
Q 
MDS occurs more often in which age group?
A. Pediatric
B. Child
C. Adult
D. Elderly
E. None of the above
A

D. Elderly

68
Q 
RAEB contains a maximum of \_\_\_\_\_\_\_\_\_\_ blasts in the bone marrow.
A. 30%
B. 20%
C. 10%
D. 5%
E> None of the above
A

B. 20%

69
Q 
Ringed sideroblasts (type III) are seen in what MDS classification?
A. RA
B. RAEB
C. RAEB­T
D. RARS 
E. None of the above
A

D. RARS

70
Q 
The following morphologies are characteristic of dyserythropoiesis in MDS:
A. Basophilic stippling
B. Normochromic, normocytic red cells
C. Multinuclearity
D. A and C
E. A, B, and C
A

D. A and C

71
Q

The fundamental characteristic of MDS is:
A. Peripheral blood cytopenia and bone marrow hypocellularity
B. Peripheral blood cytopenia and bone marrow hypercellularity
C. Peripheral blood cytosis and bone marrow hypocellularity
D. Peripheral blood cytosis and bone marrow hypercellularity
E. None of the above

A

B. Peripheral blood cytopenia and bone marrow hypercellularity

72
Q 
What is the purpose of transfusing granulocytes to a patient with RA?
A. Prevent hemorrhages
B. Prophylaxis to infection 
C. Increase blood volume
D. Decrease plasma viscosity
E. None of the above
A

B. Prophylaxis to infection

73
Q 
What specific features are characteristic of dysmegakaryocytopoiesis morphology in MDS (myelodysplastic syndrome)?
A. Macromegakaryocytes 
B. Small platelets
C. Micromegakaryocytes 
D. Normal segmentation
E. None of the above
A

C. Micromegakaryocytes

74
Q

Which MDS classification has the worst prognosis?
A. Refractory anemia with excess blasts in transformation (RAEB­T)
B. Refractory anemia (RA)
C. Chronic myelomonocytic leukemia (CMML)
D. Refractory anemia with excess blasts (RAEB)
E. None of the above

A

A. Refractory anemia with excess blasts in transformation (RAEB­T)

75
Q 
Which MDS classification has the best prognosis?
A. RAEB­T
B. RAEB
C. RA
D. CMML
E. None of the above
A

C. RA

76
Q

Which of the following is the most significant prognostic indicator in MDS?
A. Degree of cytopenia
B. Degree of dysplasia in peripheral blood
C. Percentage of bone marrow blasts
D. Degree of dysplasia in bone marrow
E. None of the above

A

C. Percentage of bone marrow blasts

77
Q 
Which of the following is most likely to affect prognosis in MDS?
A. Leukopenia
B. Increased bone marrow myeloblasts
C. Erythroid hyperplasia
D. Thrombocytosis
E. None of the above
A

B. Increased bone marrow myeloblasts

78
Q 
Which of the following biological and/or genetic anomalies are important in the pathogenesis of MDS?
A. Chromosomal translocations
B. Chromosomal deletions
C. Hemolysis
D. Increased intramedullary apoptosis
E. B and D
A

E. B and D

79
Q 
Which of the MDS subtypes is more closely related to the chronic myeloproliferative disorders?
A. RAEB
B. CMML with WBC > 13 ´ 10^9/L 
C. RARS
D. None of the above
A

B. CMML with WBC > 13 ´ 10^9/L

80
Q

Which type of MDS demonstrates a mild decreased white blood cell (WBC) count (3.9 ´ 10^9/L), increased erythropoiesis and normal numbers of blast
cells in the marrow, and <15% sideroblasts?
A. Refractory anemia with ringed sideroblasts (RARS)
B. Refractory anemia (RA)
C. Refractory anemia with excess blasts (RAEB)
D. Chronic myelomonocytic leukemia (CMML)
E. None of the above

A

B. Refractory anemia (RA)

Hematology (16 decks)

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