HEMA Flashcards
1
Q
- In patients with infectious mononucleosis, which blood cells are infected by the causative agent?
A. Monocytes
B. T lymphocytes
C. B lymphocytes
D. Histiocytes
A
C. B lymphocytes
2
Q
- Which of the following statements about hairy cell leukemia is true?
A. It is an acute disease, primarily affecting young adults.
B. Splenomegaly is an unusual finding.
C. Hairy cells contain tartrate-resistant acid phosphatase.
D. Hairy cells are abnormal T lymphocytes.
A
C. Hairy cells contain tartrate-resistant acid phosphatase.
3
Q
- Based on the WHO classification system, B cell ALL (FAB type L3) and ___ represent different clinical presentations of the same disease entity.
A. Burkitt lymphoma
B. Hodgkin lymphoma
C. Mycosis fungoides
D. Small lymphocytic lymphoma
A
A. Burkitt lymphoma
4
Q
- The presence of both immature neutrophils and nucleated erythrocytes in the peripheral blood is most accurately called a
A. Neutrophilic left shift
B. Regenerative left shift
C. Neutrophilic leukemoid reaction
D. Leukoerythroblastic reaction
A
D. Leukoerythroblastic reaction
5
Q
- In which anomaly is a failure of granulocytes to divide beyond the band or two-lobed stage observed?
A. Pelger-Huet
B. May-Hegglin
C. Alder-Reilly
D. Chediak-Higashi
A
A. Pelger-Huet
6
Q
- In which of the following are eosinophils not increased?
A. Gushing syndrome
B. Allergic disorders
C. Skin disorders
D. Parasitic infection
A
A. Gushing syndrome
7
Q
- Which of the following represents the principal defect in chronic granulomatous disease (CGD)?
A. Chemotactic migration
B. Phagocytosis
C. Lysosomal formation and function
D. Oxidative respiratory burst
A
D. Oxidative respiratory burst
8
Q
- The blood shown in Color Plate 11 * is from
a leukemia patient following treatment.
These findings are most suggestive of
therapy with
A. Corticosteroids (e.g., prednisone)
B. A folate antagonist (e.g., methotrexate)
C. Recombinant erythropoietin
D. Chloramphenicol
A
B. A folate antagonist (e.g., methotrexate)
9
Q
- A patient with normal hemoglobin and
WBC count values, a persistently elevated
platelet count (over 1000 X 109/L),
increased marrow megakaryocytes, and a
history of frequent bleeding and clotting
episodes most likely has
A. Polycythemia vera
B. Chronic myelofibrosis
C. Essential thrombocythemia
D. Chronic myelogenous leukemia
A
C. Essential thrombocythemia
10
Q
- An adult patient with massive splenomegaly has mild anemia, a slightly elevated WBC count, and an LAP score of 170. The blood smear shows teardrop erythrocytes and leukoerythroblastosis. These findings are most consistent with
A. Chronic myelogenous leukemia
B. Idiopathic myelofibrosis
C. Primary polycythemia
D. Primary thrombocythemia
A
B. Idiopathic myelofibrosis
11
Q
- Which of the following infections does not
reveal a blood picture as seen in Color
Plate 12B?
A. Epstein-Barr virus (EBV)
B. Bordetella pertussis (whooping cough)
C. Cytomegalovirus (CMV)
D. Toxoplasma gondii (toxoplasmosis)
A
B. Bordetella pertussis (whooping cough)
12
Q
- The most common type of chronic
lymphocytic leukemia (CLL) in the
United States involves the
A. B cell
B. NK cell
C. T cell
D. Plasma cell
A
A. B cell
13
Q
- Which of the following are characteristic
findings in Waldenstrom disease?
A. Increased IgA and hepatosplenomegaly
B. Increased IgE and renal failure
C. Increased IgG and hypercalcemia
D. Increased IgM and blood hyperviscosity
A
D. Increased IgM and blood hyperviscosity
14
Q
- Which of the following would not cause a
total WBC count of 62.2 X 109/L (62.2 X
103/jjLL) and the blood findings seen in
Color Plate 13B?
A. Treatment with myeloid growth factors
B. Gram-negative septicemia
C. Human immunodeficiency virus (HIV)
D. Systemic fungal infection
A
C. Human immunodeficiency virus (HIV)
15
Q
- The peripheral blood shown in Color Plate
14B is from a 69-year-old female. Her
WBC count was 83.0 X 109 cells/L (83.0 X
103/(xL) and her platelet count was
normal. Based on the cell morphology and
this information, what is the most likely
diagnosis?
A. Acute lymphoblastic leukemia
B. Chronic lymphocytic leukemia
C. Waldenstrom macroglobulinemia
D. Viral infection
A
B. Chronic lymphocytic leukemia
16
Q
- In which of the following is progression to
acute leukemia least likely?
A. Chronic myelogenous leukemia (CML)
B. Refractory anemia with excess blasts
(RAEB)
C. Refractory anemia with ringed
sideroblasts (RARS)
D. Chronic lymphocytic leukemia (CLL)
A
D. Chronic lymphocytic leukemia (CLL)
17
Q
- A Gaucher cell is best described as a macrophage with
A. “Wrinkled” cytoplasm due to an accumulation of glucocerebroside
B. “Foamy” cytoplasm filled with unmetabolized sphingomyelin
C. Pronounced vacuolization and deposits of cholesterol
D. Abundant cytoplasm containing storage iron and cellular remnants
A
A. “Wrinkled” cytoplasm due to an accumulation of glucocerebroside
18
Q
- Which of the following suggests a diagnosis of Hodgkin disease rather than other lymphoproliferative disorders?
A. Presence of a monoclonal population of large lymphoid cells
B. Predominance of immature B cells with irregular nuclear clefts
C. Circulating T cells with a convoluted, cerebriform nucleus
D. Presence of giant binucleated Reed-Sternberg cells with prominent nucleoli
A
D. Presence of giant binucleated Reed-Sternberg cells with prominent nucleoli
19
Q
- In a patient with fever of unknown origin, which of the following findings is not consistent with an inflammatory process?
A. Increased C-reactive protein
B. Increased albumin level
C. Increased fibrinogen level
D. Increased erythrocyte sedimentation rate
A
B. Increased albumin level
20
Q
- The presence of the chromosomal abnormality t(15;17) and a high incidence of disseminated intravascular coagulation (DIG) is diagnostic of
A. Acute myeloblastic leukemia without maturation (FAB type Ml)
B. Acute myeloblastic leukemia with maturation (FAB type M2)
C. Acute promyelocytic leukemia (FAB type M3)
D. Acute myelomonocytic leukemia (FAB type M4)
A
C. Acute promyelocytic leukemia (FAB type M3)
21
Q
- Which of the following is not commonly found in acute myelogenous leukemias?
A. Neutropenia
B. Thrombocytopenia
C. Hepatosplenomegaly
D. Lymphadenopathy
A
D. Lymphadenopathy
22
Q
- The child whose blast cells are shown in Color Plate 15> has acute lymphoblastic leukemia that is precursor B cell type and CALLA positive. Analysis by flow cytometry would likely show cells that immunophenotype for
A. CD2,CD7
B. CD10,CD19
C. CD13,CD33
D. CD14,CD34
A
B. CD10,CD19
23
Q
- The patient whose bone marrow is shown in Color Plate 16 * most likely has a(n)
A. Acute leukemia
B. Chronic leukemia
C. Myelodysplastic syndrome
D. Aplastic anemia
A
A. Acute leukemia
24
Q
- Multiple myeloma is characterized by the presence in urine of large amounts of
A. Cryoglobulins
B. IgG heavy chains
C. IgG light chains
D. Beta microglobulins
A
C. IgG light chains
25
Q
- Which of the following is not classified as a myeloproliferative disorder?
A. Polycythemia vera
B. Essential thrombocythemia
C. Multiple myeloma
D. Chronic myelogenous leukemia
A
C. Multiple myeloma
26
Q
- Which of the following gene mutations correlates with the t(9;22) that is present in Philadelphia chromosome positive chronic myelogenous leukemia?
A. MYC/IGH
B. BCR/ABL
C. PML/RARA
D. JAK2
A
B. BCR/ABL
27
Q
- Which of the following statements does not correctly describe the WHO (World Health Organization) classification of hematopoietic neoplasms?
A. Acute leukemia is defined as the presence of at least 20% bone marrow blasts.
B. Diagnosis is based on cellular morphology and cytochemistry.
C. It groups lymphoid disorders into B cell, T/NK cell, and Hodgkin lymphoma.
D. Diagnostic criteria include morphologic, cytochemical, immunologic, cytogenetic, and molecular features.
A
B. Diagnosis is based on cellular morphology and cytochemistry.
28
Q
- Which of the following would be least helpful in distinguishing chronic myelogeous leukemia (CML) from a neutrophilic leukemoid reaction?
A. An extreme leukocytosis with increased neutrophilic bands, metamyelocytes, and myelocytes
B. Leukocyte alkaline phosphatase score
C. Presence of marked splenomegaly
D. Neutrophils with Dohle bodies and toxic granulation
A
A. An extreme leukocytosis with increased neutrophilic bands, metamyelocytes, and myelocytes
29
Q
- The cytoplasmic inclusion present in the cell shown in Color Plate 17
A. Excludes a diagnosis of acute myelogenous leukemia
B. Stains positive with leukocyte alkaline phosphatase (LAP)
C. Stains positive with myeloperoxidase (MPO)
D. Identifies the cell as a malignant lymphoblast
A
C. Stains positive with myeloperoxidase (MPO)
30
Q
- Which of the following is a typical finding in chronic leukemias at onset?
A. Symptoms of infection and bleeding
B. Significant thrombocytopenia
C. Severe anemia
D. Elevated leukocyte count
A
D. Elevated leukocyte count
31
Q
- In what condition would an LAP score of 10 most likely be found?
A. Bacterial septicemia
B. Late pregnancy
C. Polycythemia vera
D. Chronic myelogenous leukemia
A
D. Chronic myelogenous leukemia
32
Q
- Which of the following is not associatedwith neutrophilia?
A. Staphylococcal pneumonia
B. Crushing inj ury
C. Infectious hepatitis
D. Neoplasms (tumors)
A
C. Infectious hepatitis
33
Q
- In which of the following would anabsolute monocytosis not be seen?
A. Tuberculosis
B. Recovery stage of acute bacterial infection
C. Collagen disorders
D. Infectious mononucleosis
A
D. Infectious mononucleosis
34
Q
- Coarse PAS positivity may be found in the
leukemic cells of
A. Acute myeloblastic leukemia (FAB
type Ml)
B. Acute lymphoblastic leukemia (FAB
type LI)
C. Acute myelomonocytic leukemia
(FAB type M4)
D. Acute monocytic leukemia (FAB
type M5)
A
B. Acute lymphoblastic leukemia (FAB
type LI)
35
Q
- Which of the following is not among the
diagnostic criteria used for classifying the
myelodysplastic syndromes?
A. Unexplained anemia refractory to
treatment
B. Hypogranular and hyposegmented
neutrophils
C. Abnormal platelet size and
granulation
D. Hypocellular bone marrow with 25%
blasts
A
D. Hypocellular bone marrow with 25%
blasts
36
Q
- Naphthol AS-D chloroacetate esterase
(specific) is usually positive in
cells, and alphanaphthyl acetate esterase (nonspecific)
is useful for identifying blast cells of
lineage.
A. Granulocytic; monocytic
B. Monocytic; granulocytic
C. Granulocytic; lymphocytic
D. Monocytic; lymphocytic
A
A. Granulocytic; monocytic
37
Q
- The familial disorder featuring pseudoDohle bodies, thrombocytopenia, and
large platelets is called
A. May-Hegglin anomaly
B. Chediak-Higashi syndrome
C. Pelger-Huet anomaly
D. Alder-Reilly anomaly
A
A. May-Hegglin anomaly
38
Q
- Alder-Reilly anomaly is an abnormality of
A. Lysosomal fusion
B. Nuclear maturation
C. Oxidative metabolism
D. Mucopolysaccharide metabolism
A
D. Mucopolysaccharide metabolism
39
Q
- What is the initial laboratory technique
for the diagnosis of monoclonal
gammopathies?
A. Immunologic markers of marrow
biopsy cells
B. Cytochemical staining of marrow and
peripheral blood cells
C. Serum and urine protein
electrophoresis
D. Cytogenetic analysis of marrow cells
A
C. Serum and urine protein
electrophoresis
40
Q
- Which of the following statements about
Hodgkin disease is false?
A. Peak incidence occurs in young adults.
B. Staging determines extent of disease
and treatment course.
C. Stage IV has the best prognosis.
D. Almost a 2:1 male predominance over
females is characteristic.
A
C. Stage IV has the best prognosis.
41
Q
- The blast cells shown in Color Plate 18 *
are CD14 and CD33 positive, Sudan black
B positive, specific esterase positive, and
nonspecific esterase positive. Which type
of acute leukemia is most consistent with
the immunophenotyping and cytochemical
staining results?
A. Acute lymphoblastic leukemia, T cell
type
B. Acute erythroleukemia
C. Acute myelomonocytic leukemia
D. Acute monocytic leukemia
A
C. Acute myelomonocytic leukemia
42
Q
- Which type of leukemia is associated with
the best prognosis for a cure?
A. Chronic lymphocytic leukemia in the
elderly
B. Acute lymphoblastic leukemia in
children
C. Acute myelogenous leukemia in
children
D. Chronic myelogenous leukemia in
young adults
A
B. Acute lymphoblastic leukemia in
children
43
Q
- What is the key diagnostic test for
Hodgkin lymphoma?
A. Bone marrow biopsy
B. Lymph node biopsy
C. Spinal tap
D. Skin biopsy
A
B. Lymph node biopsy
44
Q
- A bone marrow with 90% cellularity and
myeloid:erythroid (M:E) ratio of 10:1 is
most characteristic of
A. Chronic myelogenous leukemia
B. Primary polycythemia
C. Beta-thalassemia major
D. Aplastic anemia
A
A. Chronic myelogenous leukemia
45
Q
- A 60-year-old patient presents with
extreme fatigue. Her blood and bone
marrow findings are as follows: severe
anemia with a dual RBC population, 3%
marrow blasts, and numerous ringed
sideroblasts. This information is most
consistent with
A. Refractory anemia (RA)
B. Refractory anemia with ringed
sideroblasts (RARS)
C. Refractory anemia with excess blasts
(RAEB)
D. Chronic myelomonocytic leukemia
(CMML)
A
B. Refractory anemia with ringed
sideroblasts (RARS)
46
Q
- Which of the following is not a
mechanism by which neutropenia
may be produced?
A. Hypersplenism
B. Marrow injury or replacement
C. Recent strenuous exercise
D. Drug-induced antibodies
A
C. Recent strenuous exercise
47
Q
- Which of the following is not a characteristic finding in polycythemia vera?
A. Blood pancytosis
B. Increased red cell mass
C. Increased erythropoietin level
D. Increased blood viscosity
A
C. Increased erythropoietin level
48
Q
- In what disorder is significant basophilia
most commonly seen?
A. Hairy cell leukemia
B. Plasma cell leukemia
C. Acute lymphoblastic leukemia
D. Chronic myelogenous leukemia
A
D. Chronic myelogenous leukemia
49
Q
- Acute erythroleukemia (FAB type M6) is characterized by increased
A. Promyelocytes and lysozyme activity
B. Marrow megakaryocytes and thrombocytosis
C. Marrow erythroblasts and multinucleated red cells
D. Marrow monoblasts and immature monocytes
A
C. Marrow erythroblasts and multinucleated red cells
50
Q
- The blood findings present in Color Plate 20 * are from a patient with complaints of fatigue and severe lower back pain. Which of the following would not be typical of this disease?
A. Bone tumors of plasma cells
B. Hypercalcemia
C. Progressive renal impairment
D. Normal sedimentation rate
A
D. Normal sedimentation rate
51
Q
- Myeloid metaplasia refers to
A. Displacement of normal marrow cells by fibrous tissue
B. Hematopoietic failure
C. Extramedullary hematopoiesis
D. Tumors (neoplasms) of the bone marrow
A
C. Extramedullary hematopoiesis
52
Q
- Which of the following statements about non-Hodgkin types of lymphoma is true?
A. Lymphadenopathy is the most common presenting symptom.
B. Initially, they present as a systemic disease rather than a localized tumor.
C. They are often associated with multiple bone lesions.
D. They are characterized by proliferation of malignant cells primarily involving the bone marrow.
A
A. Lymphadenopathy is the most common presenting symptom.
