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Hematology Flashcards

1
Q

Insufficient centrifugation will result in:
A. A false increase in hematocrit (Hct) value
B. A false decrease in Hct value
C. No effect on Hct value
D. All of these options, depending on the patient

A

A. A false increase in hematocrit (Hct) value

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2
Q

Variation in red cell size observed on the
peripheral smear is described as:
A. Anisocytosis
B. Hypochromia
C. Poikilocytosis
D. Pleocytosis

A

A. Anisocytosis

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3
Q

Which of the following is the preferable site for bone marrow aspiration and biopsy in an adult?
A. Iliac crest
B. Sternum
C. Tibia
D. Spinous processes of a vertebra

A

A. Iliac crest

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4
Q

Mean cell volume (MCV) is calculated using the following formula:
A. (Hgb ÷ RBC) × 10
B. (Hct ÷ RBC) × 10
C. (Hct ÷ Hgb) × 100
D. (Hgb ÷ RBC) × 100

A

B. (Hct ÷ RBC) × 10

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5
Q

What term describes the change in shape of
erythrocytes seen on a Wright’s-stained peripheral blood smear?
A. Poikilocytosis
B. Anisocytosis
C. Hypochromia
D. Polychromasia

A

A. Poikilocytosis

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6
Q

Calculate the mean cell hemoglobin concentration (MCHC) using the following values:
Hgb = 15 g/dL (150 g/L)
Hct = 47 mL/dL (0.47)
RBC = 4.50 × 106/μL (4.50 × 1012/L)
A. 9.5% (.095)
B. 10.4% (.104)
C. 31.9% (.319)
D. 33.3% (.333)

A

C. 31.9% (.319)

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7
Q

A manual white blood cell (WBC) count was
performed. A total of 36 cells were counted in all 9-mm2 squares of a Neubauer-ruled
hemacytometer. A 1:10 dilution was used. What is the WBC count?
A. 0.4 × 109/L
B. 2.5 × 109/L
C. 4.0 × 109/L
D. 8.0 × 109/L

A

A. 0.4 × 109/L

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8
Q

When an erythrocyte containing iron granules is stained with Prussian blue, the cell is called a:
A. Spherocyte
B. Leptocyte
C. Schistocyte
D. Siderocyte

A

D. Siderocyte

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9
Q

A 7.0-mL ethylenediaminetetraacetic acid (EDTA) tube is received in the laboratory containing only 2.0 mL of blood. If the laboratory is using manual techniques, which of the following tests will most likely be erroneous?
A. RBC count
B. Hemoglobin (Hgb)
C. Hct
D. WBC count

A

C. Hct

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10
Q

A 1:200 dilution of a patient’s sample was
made and 336 red cells were counted in an area of 0.2 mm2. What is the RBC count?
A. 1.68 × 1012/L
B. 3.36 × 1012/L
C. 4.47 × 1012/L
D. 6.66 × 1012/L

A

B. 3.36 × 1012/L

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11
Q

What phagocytic cells produce lysozymes that are bacteriocidal?
A. Eosinophils
B. Lymphocytes
C. Platelets
D. Neutrophils

A

D. Neutrophils

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12
Q

If a patient has a reticulocyte count of 7% and an
Hct of 20%, what is the corrected reticulocyte
count?
A. 1.4%
B. 3.1%
C. 3.5%
D. 14%

A

B. 3.1%

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13
Q

A decreased osmotic fragility test would be
associated with which of the following conditions?
A. Sickle cell anemia
B. Hereditary spherocytosis
C. Hemolytic disease of the newborn
D. Acquired hemolytic anemia

A

A. Sickle cell anemia

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14
Q

What effect would using a buffer at pH 6.0 have on a Wright’s-stained smear?
A. Red cells would be stained too pink
B. White cell cytoplasm would be stained too blue
C. Red cells would be stained too blue
D. Red cells would lyse on the slide

A

A. Red cells would be stained too pink

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15
Q

Which of the following erythrocyte inclusions can be visualized with supravital stain but cannot be detected on a Wright’s-stained blood smear?
A. Basophilic stippling
B. Heinz bodies
C. Howell–Jolly bodies
D. Siderotic granules

A

B. Heinz bodies

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16
Q

A falsely elevated Hct is obtained. Which of the following calculated values will not be affected?
A. MCV
B. MCH
C. MCHC
D. Red cell distribution width (RDW)

A

B. MCH

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17
Q

A Miller disk is an ocular device used to facilitate counting of:
A. Platelets
B. Reticulocytes
C. Sickle cells
D. Nucleated red blood cells (NRBCs)

A

B. Reticulocytes

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18
Q

SITUATION: RBC indices obtained on an anemic patient are as follows: MCV 88 μm3 (fL); MCH 30 pg; MCHC 34% (.340). The RBCs on the peripheral smear would appear:
A. Microcytic, hypochromic
B. Microcytic, normochromic
C. Normocytic, normochromic
D. Normocytic, hypochromic

A

C. Normocytic, normochromic

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19
Q

All of the following factors may influence the erythrocyte sedimentation rate (ESR) except:
A. Blood drawn into a sodium citrate tube
B. Anisocytosis, poikilocytosis
C. Plasma proteins
D. Caliber of the tube

A

A. Blood drawn into a sodium citrate tube

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20
Q

What staining method is used most frequently to stain and manually count reticulocytes?
A. Immunofluorescence
B. Supravital staining
C. Romanowsky staining
D. Cytochemical staining

A

B. Supravital staining

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20
Q

The Coulter principle for counting of cells is based upon the fact that:
A. Isotonic solutions conduct electricity better than cells do
B. Conductivity varies proportionally to the number of cells
C. Cells conduct electricity better than saline does
D. Isotonic solutions cannot conduct electricity

A

A. Isotonic solutions conduct electricity better than cells do

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21
Q

A correction is necessary for WBC counts when nucleated RBCs are seen on the peripheral smear because:
A. The WBC count would be falsely lower
B. The RBC count is too low
C. Nucleated RBCs are counted as leukocytes
D. Nucleated RBCs are confused with giant
platelets

A

C. Nucleated RBCs are counted as leukocytes

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22
Q

Using an electronic cell counter analyzer, an
increased RDW should correlate with:
A. Spherocytosis
B. Anisocytosis
C. Leukocytosis
D. Presence of NRBCs

A

B. Anisocytosis

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23
Q

Given the following values, which set of red blood cell indices suggests spherocytosis?
A. MCV 76 μm3 MCH 19.9 pg MCHC 28.5%
B. MCV 90 μm3 MCH 30.5 pg MCHC 32.5%
C. MCV 80 μm3 MCH 36.5 pg MCHC 39.0%
D. MCV 81 μm3 MCH 29.0 pg MCHC 34.8%

A

C. MCV 80 μm3 MCH 36.5 pg MCHC 39.0%

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24
Q

Which of the following statistical terms reflects the best index of precision when comparing two CBC parameters?
A. Mean
B. Median
C. Coefficient of variation
D. Standard deviation

A

C. Coefficient of variation

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25
Q

Which of the following is considered a normal hemoglobin?
A. Carboxyhemoglobin
B. Methemoglobin
C. Sulfhemoglobin
D. Deoxyhemoglobin

A

D. Deoxyhemoglobin

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26
Q

Which condition will shift the oxyhemoglobin dissociation curve to the right?
A. Acidosis
B. Alkalosis
C. Multiple blood transfusions
D. Increased quantities of hemoglobin S or C

A

A. Acidosis

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27
Q

What is the major type of leukocyte seen in
the peripheral smear of a patient with aplastic anemia?
A. Segmented neutrophil
B. Lymphocyte
C. Monocyte
D. Eosinophil

A

B. Lymphocyte

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28
Q

What is the normal WBC differential lymphocyte percentage (range) in the adult population?
A. 5%–10%
B. 10%–20%
C. 20%–44%
D. 50%–70%

A

C. 20%–44%

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29
Q

In which age group would 60% lymphocytes be a normal finding?
A. 6 months–2 years
B. 4–6 years
C. 11–15 years
D. 40–60 years

A

A. 6 months–2 years

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30
Q

Which of the following results on an automated differential suggests that a peripheral smear should be reviewed manually?
A. Segs = 70%
B. Band = 6%
C. Mono = 15%
D. Eos = 2%

A

C. Mono = 15%

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31
Q

Which is the first stage of erythrocytic maturation in which the cytoplasm is pink due to the formation of hemoglobin?
A. Reticulocyte
B. Pronormoblast
C. Basophilic normoblast
D. Polychromatic normoblast

A

D. Polychromatic normoblast

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32
Q

Which of the following can shift the hemoglobin oxygen dissociation curve to the right?
A. Increases in 2,3 DPG
B. Acidosis
C. Hypoxia
D. All of these options

A

D. All of these options

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33
Q

Which of the following Hgb configurations is
characteristic of Hgb H?
A. γ4
B. α2-γ2
C. β4
D. α2-β2

A

C. β4

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34
Q

Autoagglutination of red cells at room temperature can cause which of the following abnormal test results?
A. Low RBC count
B. High MCV
C. Low hematocrit
D. All of these options

A

D. All of these options

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35
Q

Hypersplenism is characterized by:
A. Polycythemia
B. Pancytosis
C. Leukopenia
D. Myelodysplasia

A

C. Leukopenia

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36
Q

Which of the following organs is responsible for the “pitting process” for RBCs?
A. Liver
B. Spleen
C. Kidney
D. Lymph nodes

A

B. Spleen

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37
Q

Spherocytes differ from normal red cells in all of the following except:
A. Decreased surface to volume
B. No central pallor
C. Decreased resistance to hypotonic saline
D. Increased deformability

A

D. Increased deformability

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38
Q

Which of the following is not associated with hereditary spherocytosis?
A. Increased osmotic fragility
B. An MCHC greater than 36%
C. Intravascular hemolysis
D. Extravascular hemolysis

A

C. Intravascular hemolysis

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39
Q

Which of the following disorders has an increase in osmotic fragility?
A. Iron deficiency anemia
B. Hereditary elliptocytosis
C. Hereditary stomatocytosis
D. Hereditary spherocytosis

A

D. Hereditary spherocytosis

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40
Q

The anemia seen in sickle cell disease is usually:
A. Microcytic, normochromic
B. Microcytic, hypochromic
C. Normocytic, normochromic
D. Normocytic, hypochromic

A

C. Normocytic, normochromic

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41
Q

Select the amino acid substitution that is
responsible for sickle cell anemia.
A. Lysine is substituted for glutamic acid at the sixth position of the α-chain
B. Valine is substituted for glutamic acid at the sixth position of the β-chain
C. Valine is substituted for glutamic acid at
the sixth position of the α-chain
D. Glutamine is substituted for glutamic acid at the sixth position of the β-chain

A

B. Valine is substituted for glutamic acid at the sixth position of the β-chain

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41
Q

Which is the major Hgb found in the RBCs of
patients with sickle cell trait?
A. Hgb S
B. Hgb F
C. Hgb A2
D. Hgb A

A

D. Hgb A

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42
Q

All of the following are usually found in Hgb C disease except:
A. Hgb C crystals
B. Target cells
C. Lysine substituted for glutamic acid at the sixth position of the β–chain
D. Fast mobility of Hgb C at pH 8.6

A

D. Fast mobility of Hgb C at pH 8.6

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43
Q

Which of the following hemoglobins migrates to the same position as Hgb A2 at pH 8.6?
A. Hgb H
B. Hgb F
C. Hgb C
D. Hgb S

A

C. Hgb C

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44
Q

Which of the following electrophoretic results is consistent with a diagnosis of sickle cell trait?
A. Hgb A: 40% Hgb S: 35% Hgb F: 5%
B. Hgb A: 60% Hgb S: 40% Hgb A2: 2%
C. Hgb A: 0% Hgb A2: 5% Hgb F: 95%
D. Hgb A: 80% Hgb S: 10% Hgb A2: 10%

A

B. Hgb A: 60% Hgb S: 40% Hgb A2: 2%

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45
Q

In which of the following conditions will autosplenectomy most likely occur?
A. Thalassemia major
B. Hgb C disease
C. Hgb SC disease
D. Sickle cell disease

A

D. Sickle cell disease

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46
Q

Which of the following is most true of paroxysmal nocturnal hemoglobinuria (PNH)?
A. It is a rare acquired stem cell disorder that results in hemolysis
B. It is inherited as a sex-linked trait
C. It is inherited as an autosomal dominant trait
D. It is inherited as an autosomal recessive trait

A

A. It is a rare acquired stem cell disorder that results in hemolysis

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47
Q

Hemolytic uremic syndrome (HUS) is characterized by all of the following except:
A. Hemorrhage
B. Thrombocytopenia
C. Hemoglobinuria
D. Reticulocytopenia

A

D. Reticulocytopenia

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48
Q

An autohemolysis test is positive in all the
following conditions except:
A. Glucose-6-phosphate dehydrogenase (G6PD) deficiency
B. Hereditary spherocytosis (HS)
C. Pyruvate kinase (PK) deficiency
D. Paroxysmal nocturnal hemoglobinuria (PNH)

A

D. Paroxysmal nocturnal hemoglobinuria (PNH)

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49
Q

Which antibody is associated with paroxysmal cold hemoglobinuria (PCH)?
A. Anti-I
B. Anti-i
C. Anti-M
D. Anti-P

A

D. Anti-P

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50
Q

All of the following are associated with
intravascular hemolysis except:
A. Methemoglobinemia
B. Hemoglobinuria
C. Hemoglobinemia
D. Decreased haptoglobin

A

A. Methemoglobinemia

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51
Q

Autoimmune hemolytic anemia is best
characterized by which of the following?
A. Increased levels of plasma C3
B. Spherocytic red cells
C. Decreased osmotic fragility
D. Decreased unconjugated bilirubin

A

B. Spherocytic red cells

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52
Q

“Bite cells” are usually seen in patients with:
A. Rh null trait
B. Chronic granulomatous disease
C. G6PD deficiency
D. PK deficiency

A

C. G6PD deficiency

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53
Q

The morphological classification of anemias is based on which of the following?
A. M:E (myeloid:erythroid) ratio
B. Prussian blue stain
C. RBC indices
D. Reticulocyte count

A

C. RBC indices

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54
Q

Which of the following is a common finding in aplastic anemia?
A. A monoclonal disorder
B. Tumor infiltration
C. Peripheral blood pancytopenia
D. Defective DNA synthesis

A

C. Peripheral blood pancytopenia

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55
Q

Congenital dyserythropoietic anemias (CDAs) are characterized by:
A. Bizarre multinucleated erythroblasts
B. Cytogenetic disorders
C. Megaloblastic erythropoiesis
D. An elevated M:E ratio

A

A. Bizarre multinucleated erythroblasts

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56
Q

Microangiopathic hemolytic anemia is
characterized by:
A. Target cells and Cabot rings
B. Toxic granulation and Döhle bodies
C. Pappenheimer bodies and basophilic stippling
D. Schistocytes and nucleated RBCs

A

D. Schistocytes and nucleated RBCs

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57
Q

Which antibiotic(s) is (are) most often implicated in the development of aplastic anemia?
A. Sulfonamides
B. Penicillin
C. Tetracycline
D. Chloramphenicol

A

D. Chloramphenicol

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58
Q

Sickle cell disorders are:
A. Hereditary, intracorpuscular RBC defects
B. Hereditary, extracorpuscular RBC defects
C. Acquired, intracorpuscular RBC defects
D. Acquired, extracorpuscular RBC defects

A

A. Hereditary, intracorpuscular RBC defects

59
Q

Which of the following conditions may produce spherocytes in a peripheral smear?
A. Pelger–Huët anomaly
B. Pernicious anemia
C. Autoimmune hemolytic anemia
D. Sideroblastic anemia

A

C. Autoimmune hemolytic anemia

60
Q

A patient’s peripheral smear reveals numerous NRBCs, marked variation of red cell morphology, and pronounced polychromasia. In addition to a decreased Hgb and decreased Hct values, what other CBC parameters may be anticipated?
A. Reduced platelets
B. Increased MCHC
C. Increased MCV
D. Decreased red-cell distribution width (RDW)

A

C. Increased MCV

61
Q

What red cell inclusion may be seen in the
peripheral blood smear of a patient
postsplenectomy?
A. Toxic granulation
B. Howell–Jolly bodies
C. Malarial parasites
D. Siderotic granules

A

B. Howell–Jolly bodies

62
Q

Reticulocytosis usually indicates:
A. Response to inflammation
B. Neoplastic process
C. Aplastic anemia
D. Red cell regeneration

A

D. Red cell regeneration

63
Q

Hereditary pyropoikilocytosis (HP) is a red cell membrane defect characterized by:
A. Increased pencil-shaped cells
B. Increased oval macrocytes
C. Misshapen budding fragmented cells
D. Bite cells

A

C. Misshapen budding fragmented cells

64
Q

The osmotic fragility test result in a patient with thalassemia major would most likely be:
A. Increased
B. Decreased
C. Normal
D. Decreased after incubation at 37°C

A

B. Decreased

65
Q

All of the following are characteristic findings in a patient with iron deficiency anemia except:
A. Microcytic, hypochromic red cell morphology
B. Decreased serum iron and ferritin levels
C. Decreased total iron-binding capacity (TIBC)
D. Increased RBC protoporphyrin

A

C. Decreased total iron-binding capacity (TIBC)

66
Q

Iron deficiency anemia may be distinguished from anemia of chronic infection by:
A. Serum iron level
B. Red cell morphology
C. Red cell indices
D. Total iron-binding capacity

A

D. Total iron-binding capacity

67
Q

Which anemia has red cell morphology similar to that seen in iron deficiency anemia?
A. Sickle cell anemia
B. Thalassemia syndrome
C. Pernicious anemia
D. Hereditary spherocytosis

A

B. Thalassemia syndrome

68
Q

Iron deficiency anemia is characterized by:
A. Decreased plasma iron, decreased % saturation, increased total iron-binding capacity (TIBC)
B. Decreased plasma iron, decreased plasma ferritin, normal RBC porphyrin
C. Decreased plasma iron, decreased % saturation, decreased TIBC
D. Decreased plasma iron, increased % saturation, decreased TIBC

A

A. Decreased plasma iron, decreased % saturation, increased total iron-binding capacity (TIBC)

69
Q

Storage iron is usually best determined by:
A. Serum transferrin levels
B. Hgb values
C. Myoglobin values
D. Serum ferritin levels

A

D. Serum ferritin levels

70
Q

All of the following are associated with
sideroblastic anemia except:
A. Increased serum iron
B. Ringed sideroblasts
C. Dimorphic blood picture
D. Increased RBC protoporphyrin

A

D. Increased RBC protoporphyrin

71
Q

What is the basic hematological defect seen in patients with thalassemia major?
A. DNA synthetic defect
B. Hgb structure
C. β-Chain synthesis
D. Hgb phosphorylation

A

C. β-Chain synthesis

72
Q

Which of the following is the primary Hgb in
patients with thalassemia major?
A. Hgb D
B. Hgb A
C. Hgb C
D. Hgb F

73
Q

A patient has an Hct of 30%, a hemoglobin of 8 g/dL, and an RBC count of 4.0 × 1012/L. What is the morphological classification of this anemia?
A. Normocytic normochromic
B. Macrocytic hypochromic
C. Microcytic hypochromic
D. Normocytic hyperchromic

A

C. Microcytic hypochromic

74
Q

In which of the following conditions is Hgb A2 elevated?
A. Hgb H
B. Hgb SC disease
C. β-Thalassemia minor
D. Hgb S trait

A

C. β-Thalassemia minor

75
Q

Which of the following parameters may be similar for the anemia of inflammation and iron deficiency anemia?
A. Normocytic indices
B. Decreased serum iron concentration
C. Ringed sideroblasts
D. Pappenheimer bodies

A

B. Decreased serum iron concentration

76
Q

Which morphological classification is
characteristic of megaloblastic anemia?
A. Normocytic, normochromic
B. Microcytic, normochromic
C. Macrocytic, hypochromic
D. Macrocytic, normochromic

A

D. Macrocytic, normochromic

77
Q

Which anemia is characterized by a lack of
intrinsic factor that prevents B12 absorption?
A. Tropical sprue
B. Transcobalamin deficiency
C. Blind loop syndrome
D. Pernicious anemia

A

D. Pernicious anemia

78
Q

All of the following are characteristics of
megaloblastic anemia except:
A. Pancytopenia
B. Elevated reticulocyte count
C. Hypersegmented neutrophils
D. Macrocytic erythrocyte indices

A

B. Elevated reticulocyte count

79
Q

A patient with a vitamin B12 anemia is given a high dosage of folate. Which of the following is expected as a result of this treatment?
A. An improvement in neurological problems
B. An improvement in hematological abnormalities
C. No expected improvement
D. Toxicity of the liver and kidneys

A

B. An improvement in hematological abnormalities

80
Q

Which of the following disorders is associated with ineffective erythropoiesis?
A. G6PD deficiency
B. Liver disease
C. Hgb C disease
D. Megaloblastic anemia

A

D. Megaloblastic anemia

81
Q

A 50-year-old patient is suffering from pernicious anemia. Which of the following laboratory data are most likely for this patient?

A. RBC = 2.5 × 1012/L; WBC =12,500/μL (12.5 × 109/L); PLT = 250,000/μL (250 × 109/L)
B. RBC = 4.5 × 1012/L; WBC = 6,500/μL (6.5 × 109/L); PLT = 150,000/μL (150 × 109/L)
C. RBC = 3.0 × 1012/L; WBC = 5,000/μL (5.0 × 109/L); PLT = 750,000/μL (750 × 109/L)
D. RBC = 2.5 × 1012/L; WBC = 2,500/μL (2.5 × 109/L); PLT = 50,000/μL (50 × 109/L)

A

D. RBC = 2.5 × 1012/L; WBC = 2,500/μL (2.5 × 109/L); PLT = 50,000/μL (50 × 109/L)

82
Q

Which of the following may be seen in the
peripheral blood smear of a patient with
obstructive liver disease?
A. Schistocytes
B. Macrocytes
C. Howell–Jolly bodies
D. Microcytes

A

B. Macrocytes

83
Q

The macrocytes typically seen in megaloblastic processes are:
A. Crescent-shaped
B. Teardrop-shaped
C. Ovalocytic
D. Pencil-shaped

A

C. Ovalocytic

84
Q

Which of the following are most characteristic of the red cell indices associated with megaloblastic anemias?
A. MCV 99 fl, MCH 28 pg, MCHC 31%
B. MCV 62 fL, MCH 27 pg, MCHC 30%
C. MCV 125 fL, MCH 36 pg, MCHC 34%
D. MCV 78 fL, MCH 23 pg, MCHC 30%

A

C. MCV 125 fL, MCH 36 pg, MCHC 34%

85
Q

A patient has 80 nucleated red blood cells per 100 leukocytes. In addition to increased polychromasia on the peripheral smear, what other finding may
be present on the CBC?
A. Increased platelets
B. Increased MCV
C. Increased Hct
D. Increased red blood cell count

A

B. Increased MCV

86
Q

Which of the following is an unusual complication that may occur in infectious mononucleosis?
A. Splenic infarctions
B. Dactylitis
C. Hemolytic anemia
D. Giant platelets

A

C. Hemolytic anemia

87
Q

In a patient with human immunodeficiency virus (HIV) infection, one should expect to see:
A. Shift to the left in WBCs
B. Target cells
C. Reactive lymphocytes
D. Pelgeroid cells

A

C. Reactive lymphocytes

88
Q

Which inclusions may be seen in leukocytes?
A. Döhle bodies
B. Basophilic stippling
C. Malarial parasites
D. Howell–Jolly bodies

A

A. Döhle bodies

89
Q

Which of the following is contained in the primary granules of the neutrophil?
A. Lactoferrin
B. Myeloperoxidase
C. Histamine
D. Alkaline phosphatase

A

B. Myeloperoxidase

90
Q

What is the typical range of relative lymphocyte percentage in the peripheral blood smear of a 1-year-old child?
A. 1%–6%
B. 27%–33%
C. 35%–58%
D. 50%–70%

A

D. 50%–70%

91
Q

Qualitative and quantitative neutrophil changes noted in response to infection include all of the following except:
A. Neutrophilia
B. Pelgeroid hyposegmentation
C. Toxic granulation
D. Vacuolization

A

B. Pelgeroid hyposegmentation

92
Q

Neutropenia is present in patients with which absolute neutrophil counts?
A. <1.5 × 109/L
B. <5.0 × 109/L
C. <10.0 × 109/L
D. <15.0 × 109/L

A

A. <1.5 × 109/L

93
Q

The morphological characteristic(s) associated with the Chédiak–Higashi syndrome is (are):
A. Pale blue cytoplasmic inclusions
B. Giant lysosomal granules
C. Small, dark-staining granules and condensed nuclei
D. Nuclear hyposegmentation

A

B. Giant lysosomal granules

94
Q

The familial condition of Pelger–Huët anomaly is important to recognize because this disorder must be differentiated from:
A. Infectious mononucleosis
B. May–Hegglin anomaly
C. A shift-to-the-left increase in immature granulocytes
D. G6PD deficiency

A

C. A shift-to-the-left increase in immature granulocytes

95
Q

SITUATION: A differential shows reactive
lymphocytes, and the physician suspects a viral infection is the cause. What is the expected laboratory finding in a patient with a cytomegalovirus (CMV) infection?
A. Heterophile antibody: positive
B. Epstein–Barr virus (EBV)–immunoglobulin (IgM): positive
C. Direct antiglobulin test (DAT): positive
D. CMV–IgM: positive

A

D. CMV–IgM: positive

96
Q

Neutrophil phagocytosis and particle ingestion are associated with an increase in oxygen utilization called respiratory burst. What are the two most important products of this biochemical reaction?
A. Hydrogen peroxide and superoxide anion
B. Lactoferrin and NADPH oxidase
C. Cytochrome b and collagenase
D. Alkaline phosphatase and ascorbic acid

A

A. Hydrogen peroxide and superoxide anion

97
Q

Which of the morphological findings are
characteristic of reactive lymphocytes?
A. High nuclear:cytoplasmic ratio
B. Prominent nucleoli
C. Basophilic cytoplasm
D. All of these options

A

D. All of these options

98
Q

Auer rods may be seen in all of the following except:
A. Acute myelomonocytic leukemia (M4)
B. Acute lymphoblastic leukemia
C. Acute myeloid leukemia without maturation (M1)
D. Acute promyelocytic leukemia (M3)

A

B. Acute lymphoblastic leukemia

99
Q

Which type of anemia is usually present in a
patient with acute leukemia?
A. Microcytic, hyperchromic
B. Microcytic, hypochromic
C. Normocytic, normochromic
D. Macrocytic, normochromic

A

C. Normocytic, normochromic

100
Q

In leukemia, which term describes a peripheral blood finding of leukocytosis with a shift to the left, accompanied by nucleated red cells?
A. Myelophthisis
B. Dysplasia
C. Leukoerythroblastosis
D. Megaloblastosis

A

C. Leukoerythroblastosis

101
Q

The basic pathophysiological mechanisms responsible for producing signs and symptoms in leukemia include all of the following except:
A. Replacement of normal marrow precursors by leukemic cells causing anemia
B. Decrease in functional leukocytes causing
infection
C. Hemorrhage secondary to thrombocytopenia
D. Decreased erythropoietin production

A

D. Decreased erythropoietin production

102
Q

Which type of acute myeloid leukemia is called the true monocytic leukemia and follows an acute or subacute course characterized by monoblasts, promonocytes, and monocytes?
A. Acute myeloid leukemia, minimally differentiated
B. Acute myeloid leukemia without maturation
C. Acute myelomonocytic leukemia
D. Acute monocytic leukemia

A

D. Acute monocytic leukemia

103
Q

In which age group does acute lymphoblastic leukemia occur with the highest frequency?
A. 1–15 years
B. 20–35 years
C. 45–60 years
D. 60–75 years

A

A. 1–15 years

104
Q

Disseminated intravascular coagulation (DIC) is most often associated with which of the following types of acute leukemia?
A. Acute myeloid leukemia without maturation
B. Acute promyelocytic leukemia
C. Acute myelomonocytic leukemia
D. Acute monocytic leukemia

A

B. Acute promyelocytic leukemia

105
Q

An M:E ratio of 10:1 is most often seen in:
A. Thalassemia
B. Leukemia
C. Polycythemia vera
D. Myelofibrosis

A

B. Leukemia

106
Q

Which of the following is a characteristic of
Auer rods?
A. They are composed of azurophilic granules
B. They stain periodic acid–Schiff (PAS) positive
C. They are predominantly seen in chronic myelogenous leukemia (CML)
D. They are nonspecific esterase positive

A

A. They are composed of azurophilic granules

107
Q

SITUATION: A peripheral smear shows 75%
blasts. These stain positive for both Sudan Black B (SBB) and peroxidase. Given these values, which of the following disorders is most likely?
A. Acute myelocytic leukemia (AML)
B. CML
C. Acute undifferentiated leukemia (AUL)
D. Acute lymphocytic leukemia (ALL)

A

A. Acute myelocytic leukemia (AML)

108
Q

In myeloid cells, the stain that selectively identifies phospholipid in the membranes of both primary and secondary granules is:
A. PAS
B. Myeloperoxidase
C. Sudan Black B stain
D. Terminal deoxynucleotidyl transferase (TdT)

A

C. Sudan Black B stain

109
Q

Sodium fluoride may be added to the naphthyl ASD acetate (NASDA) esterase reaction. The fluoride is added to inhibit a positive reaction with:
A. Megakaryocytes
B. Monocytes
C. Erythrocytes
D. Granulocytes

A

B. Monocytes

110
Q

Leukemic lymphoblasts reacting with anti-CALLA are characteristically seen in:
A. B-cell ALL
B. T-cell ALL
C. Null-cell ALL
D. Common ALL

A

D. Common ALL

111
Q

Which of the following reactions are often positive in ALL but are negative in AML?
A. Terminal deoxynucleotidyl transferase and PAS
B. Chloroacetate esterase and nonspecific esterase
C. Sudan Black B and peroxidase
D. New methylene blue and acid phosphatase

A

A. Terminal deoxynucleotidyl transferase and PAS

112
Q

A patient’s peripheral blood smear and bone marrow both show 70% blasts. These cells are negative for Sudan Black B stain. Given these data, which of the following is the most likely diagnosis?
A. Acute myeloid leukemia
B. Chronic lymphocytic leukemia
C. Acute promyelocytic leukemia
D. Acute lymphocytic leukemia

A

D. Acute lymphocytic leukemia

113
Q

Which of the following leukemias are included in the 2008 World Health Organization classification of myeloproliferative neoplasms?
A. Chronic myelogenous leukemia (CML)
B. Chronic neutrophilic leukemia (CNL)
C. Chronic eosinophilic leukemia (CEL)
D. All of these options are classified as myeloproliferative neoplasms (MPN)

A

D. All of these options are classified as myeloproliferative neoplasms (MPN)

114
Q

In addition to morphology, cytochemistry, and immunophenotyping, the WHO classification of myelo- and lymphoproliferative disorders is based upon which characteristic?
A. Proteomics
B. Cytogenetic abnormalities
C. Carbohydrate-associated tumor antigen
production
D. Cell signaling and adhesion markers

A

B. Cytogenetic abnormalities

115
Q

The WHO classification requires what percentage for the blast count in the blood or bone marrow for the diagnosis of AML?
A. At least 30%
B. At least 20%
C. At least 10%
D. Any percentage

A

B. At least 20%

116
Q

What would be the most likely designation by the WHO for the FAB AML M2 by the French–American–British classification?
A. AML with t(15;17)
B. AML with mixed lineage
C. AML with t(8;21)
D. AML with inv(16)

A

C. AML with t(8;21)

117
Q

What would be the most likely designation
by the WHO for the FAB AML M3 by the
French–American–British classification?
A. AML with t(15;17)
B. AML with mixed lineage
C. AML with t(8;21)
D. AML with inv(16)

A

A. AML with t(15;17)

118
Q

Which AML cytogenetic abnormality is associated with acute myelomonocytic leukemia with marrow eosinophilia under the WHO classification of AML with recurrent genetic abnormalities?
A. AML with t(15;17)
B. AML with mixed lineage
C. AML with t(8;21)
D. AML with inv(16)

A

D. AML with inv(16)

119
Q

What would be the most likely classification by the WHO for the FAB AML M7 by the French–American–British classification?
A. Acute myeloid leukemias with recurrent genetic abnormalities
B. Acute myeloid leukemia with multilineage dysplasia
C. Acute myeloid leukemia not otherwise categorized
D. Acute leukemias of ambiguous lineage

A

C. Acute myeloid leukemia not otherwise categorized

120
Q

Repeated phlebotomy in patients with polycythemia vera (PV) may lead to the
development of:
A. Folic acid deficiency
B. Sideroblastic anemia
C. Iron deficiency anemia
D. Hemolytic anemia

A

C. Iron deficiency anemia

121
Q

In essential thrombocythemia, the platelets are:
A. Increased in number and functionally abnormal
B. Normal in number and functionally abnormal
C. Decreased in number and functional
D. Decreased in number and functionally abnormal

A

A. Increased in number and functionally abnormal

122
Q

Which of the following cells is considered pathognomonic for Hodgkin’s disease?
A. Niemann–Pick cells
B. Reactive lymphocytes
C. Flame cells
D. Reed–Sternberg cells

A

D. Reed–Sternberg cells

123
Q

In myelofibrosis, the characteristic abnormal red blood cell morphology is that of:
A. Target cells
B. Schistocytes
C. Teardrop cells
D. Ovalocytes

A

C. Teardrop cells

124
Q

PV is characterized by:
A. Increased plasma volume
B. Pancytopenia
C. Decreased oxygen saturation
D. Absolute increase in total red cell mass

A

D. Absolute increase in total red cell mass

125
Q

Features of secondary polycythemia include all of the following except:
A. Splenomegaly
B. Decreased oxygen saturation
C. Increased red cell mass
D. Increased erythropoietin

A

A. Splenomegaly

126
Q

The erythrocytosis seen in relative polycythemia occurs because of:
A. Decreased arterial oxygen saturation
B. Decreased plasma volume of circulating blood
C. Increased erythropoietin levels
D. Increased erythropoiesis in the bone marrow

A

B. Decreased plasma volume of circulating blood

127
Q

In PV, what is characteristically seen in the
peripheral blood?
A. Panmyelosis
B. Pancytosis
C. Pancytopenia
D. Panhyperplasia

A

B. Pancytosis

128
Q

CML is distinguished from leukemoid reaction by which of the following?
A. CML: low LAP; leukemoid: high LAP
B. CML: high LAP; leukemoid: low LAP
C. CML: high WBC; leukemoid: normal WBC
D. CML: high WBC; leukemoid: higher WBC

A

A. CML: low LAP; leukemoid: high LAP

129
Q

Which of the following occurs in idiopathic
myelofibrosis (IMF)?
A. Myeloid metaplasia
B. Leukoerythroblastosis
C. Fibrosis of the bone marrow
D. All of these options

A

D. All of these options

130
Q

What influence does the Philadelphia (Ph1)
chromosome have on the prognosis of patients with chronic myelocytic leukemia?
A. It is not predictive
B. The prognosis is better if Ph1 is present
C. The prognosis is worse if Ph1 is present
D. The disease usually transforms into AML when Ph1 is present

A

B. The prognosis is better if Ph1 is present

131
Q

Which of the following is (are) commonly found in CML?
A. Many teardrop-shaped cells
B. Intense LAP staining
C. A decrease in granulocytes
D. An increase in basophils

A

D. An increase in basophils

132
Q

In which of the following conditions does LAP show the least activity?
A. Leukemoid reactions
B. Idiopathic myelofibrosis
C. PV
D. CML

133
Q

A striking feature of the peripheral blood of a patient with CML is a:
A. Profusion of bizarre blast cells
B. Normal number of typical granulocytes
C. Presence of granulocytes at different stages of development
D. Pancytopenia

A

C. Presence of granulocytes at different stages of development

134
Q

Which of the following is often associated with CML but not with AML?
A. Infections
B. WBCs greater than 20.0 × 109/L
C. Hemorrhage
D. Splenomegaly

A

D. Splenomegaly

135
Q

Multiple myeloma and Waldenström’s macroglobulinemia have all the following in common except:
A. Monoclonal gammopathy
B. Hyperviscosity of the blood
C. Bence–Jones protein in the urine
D. Osteolytic lesions

A

D. Osteolytic lesions

136
Q

What is the characteristic finding seen in the peripheral smear of a patient with multiple myeloma?
A. Microcytic hypochromic cells
B. Intracellular inclusion bodies
C. Rouleaux
D. Hypersegmented neutrophils

A

C. Rouleaux

137
Q

All of the following are associated with the
diagnosis of multiple myeloma except:
A. Marrow plasmacytosis
B. Lytic bone lesions
C. Serum and/or urine M component (monoclonal protein)
D. Philadelphia chromosome

A

D. Philadelphia chromosome

138
Q

Multiple myeloma is most difficult to distinguish from:
A. Chronic lymphocytic leukemia
B. Acute myelogenous leukemia
C. Benign monoclonal gammopathy
D. Benign adenoma

A

C. Benign monoclonal gammopathy

139
Q

The pathology of multiple myeloma includes
which of the following?
A. Expanding plasma cell mass
B. Overproduction of monoclonal immunoglobulins
C. Production of osteoclast activating factor (OAF) and other cytokines
D. All of these options

A

D. All of these options

140
Q

Waldenström’s macroglobulinemia is a malignancy of the:
A. Lymphoplasmacytoid cells
B. Adrenal cortex
C. Myeloblastic cell lines
D. Erythroid cell precursors

A

A. Lymphoplasmacytoid cells

141
Q

Cells that exhibit a positive stain with acid phosphatase and are not inhibited with tartaric acid are characteristically seen in:
A. Infectious mononucleosis
B. Infectious lymphocytosis
C. Hairy cell leukemia
D. T-cell acute lymphoblastic leukemia

A

C. Hairy cell leukemia

142
Q

The JAK2(V617F) mutation may be positive in all of the following chronic myeloproliferative disorders except:
A. Essential thrombocythemia
B. Idiopathic myelofibrosis
C. PV
D. CML

143
Q

All of the following are major criteria for the 2008 WHO diagnostic criteria for essential thrombocythemia except:
A. Platelet count >450 × 109/L
B. Megakaryocyte proliferation with large and mature morphology, and no or little granulocyte or erythroid proliferation
C. Demonstration of JAK2(V617F) or other clonal marker
D. Sustained platelet count >600 × 109/L

A

D. Sustained platelet count >600 × 109/L

144
Q

The function(s) of a hematology laboratory is/are to:
A. confirm the physician’s impression of a possible hematological disorder
B. establish or rule out a diagnosis
C. screen for asymptomatic disorders
D. all of the above

A

D. all of the above

145
Q

The major intended purpose of the laboratory safety manual is to
A. protect the patient and laboratory personnel
B. protect laboratory and other hospital personnel
C. comply with local health and state regulatory requirements
D. comply with OSHA regulations

A

A. protect the patient and laboratory personnel

146
Q

Which of the following is not an appropriate safety practice?
A. disposing of needles in biohazard, puncture-proof containers
B. frequent handwashing
C. sterilising lancets for reuse
D. keeping food out of the same areas as specimens

A

C. sterilising lancets for reuse

147
Q

If a blood specimen is spilled on a laboratory bench or floor area, the first step in clean up should be
A. wear gloves and a lab coat
B. absorb blood with disposable towels
C. clean with freshly prepared 1% chlorine solution
D. wash with water

A

B. absorb blood with disposable towels

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