Hematology Flashcards
Select the needle most commonly used in
standard venipuncture in an adult:
a. One inch, 18 gauge
b. One inch, 21 gauge
c. One-half inch, 21 gauge
d. One-half inch, 25 gauge
B.
Placement of fire extinguishers every ____feet.
a. 75 feet
b. 100 feet
c. 125 feet
d. 150 feet
A.
The most common complication encountered in obtaining a blood specimen; it is caused by leakage of a small amount of blood in the tissue around the puncture site:
a. Petechiae
b. Hematoma
c. Ecchymosis
d. Hemoconcentration
C.
The recommended cleaner for removing oil
from objectives is:
a. Benzene
b. Xylene
c. Water
d. 70% alcohol or lens cleaner
D.
True for PRECISION:
a. Measure of agreement between
an assay value and the theoretical “true
value” of its analyte
b. Magnitude of error separating the assay result from the true value
c. Easy to define but difficult to establish and maintain
d. Relatively easy to measure and maintain
D.
All of the following are examples of pre-
analytical errors, except:
a. Specimen, obtained from the wrong
patient
b. Specimen collected in the wrong tube or
container
c. Improper processing of specimen
d. Wrong assay performed
D.
EDTA is used in concentrations of ____ mg/mI
whole blood
a. 0.5 mg/1 mL of whole blood
ng/ml
b. 1 mg/1mL of whole blood
c. 1.5 mg/1 mL of whole blood
d. 2 mg/1 mL of whole blood
C.
Cardiovascular complications include
1. Orthostatic hypotension
2. Syncope/passing out
3. Shock
4. Cardiac arrest
a. 1,2
b. 3,4
c. 1,2,3
d. 1,2,3,4
D
Complications include diaphoresis, seizure
and pain:
a. Vascular complications
b. Cardiovascular complications
c. Neurological complications
d. Dermatological complications
C.
In the tetraploid DNA is checked for proper replication and damage takes approximately 4 hours.
a. G1
b. S
c. G2
d. GO
C.
All of the following statements refers to
APOPTOSIS, except:
a. Enlarged cell size due to swelling
b. Reduced cell size due to shrinkage
c. Condensation and fragmentation of the
nucleus between nucleosomes
d. Mostly physiologic to remove unwanted
cells
A.
Stage in maturational sequence of red blood
cells where detectable hemoglobin synthesis
occurs.
a. Polychromatic normoblast
b. Basophilic normoblast
c. Orthochromic normoblast
d. Reticulocyte
B.
Hemoglobin appears for the first time in
which maturational sequence of RBC?
a. Rubriblast(pronormoblast)
b. Prorubricyte (basophilic normoblast)
c. Rubricyte (polychromatophilic normoblast)
d. Metarubricyte (orthochromic normoblast)
C.
If first detectable hemoglobin synthesis- Basophilic normoblast
If appears first time- Polychromatophilic normoblast
Tertiary granules of the neutrophils are formed during the:
a. Promyelocyte stage
b. Myelocyte and metamyelocyte stage
c. Metamyelocyte and band stage
d. Band and segmented neutrophil stage
C.
This pathway prevents denaturation of
globin of the hemoglobin molecule by
oxidation:
a. Embden-Meyerhof pathway
b. Hexose-monophosphate shunt
C. Methemoglobin reductase pathway
d. Luebering-Rapoport pathway
B.
RBCs inclusions, 0.2 to 2.0 mm in size, that
can be seen with a stain such as crystal violet
or brilliant cresyl blue: represent precipitated, denatured hemoglobin and are clinicallv associated with congenital hemolytic anemia, G6PD deficiency, hemolytic anemias secondary to drugs such phenacetin, and some hemoglobinopathies.
a. Hemoglobin C crystals
b. Heinz bodies
C. Howell-Jolly bodies
d. Pappenheimer bodies
B.
Nuclear remnants predominantly composed
of DNA; believed to develop in periods of
accelerated or abnormal erythropoiesis,
because the spleen cannot keep upwith
pitting these remnants from the cell. Its presence is associated with hemolytic anemias, pernicious anemia, and particularly
post-splenectomy, physiological atrophy of
the spleen.
a. Basophilic stippling
b. Heinz bodies
c. Howell Jolly bodies
d. Pappenheimer bodies
C.
Anemias with low MCV and MCHC;
microcytic, hypochromic RBCs, EXCEPT:
a. Iron deficiency anemia
b. Thalassemia
C. Sideroblastic anemia
d. Leukemia
D.
The most severe state of erythrocytic
abnormality, with the abnormality prevalent
throughout each microscopic field; comparable terms are marked or marked increase.
a. 2+
b. 3+
C. 4+
d. 5+
C.
Sezary cell is an example of
a. T cell
b. B cell
c. Plasma cell
d. Monocyte
A.
Inherited hemolytic anemia due to membrane defect:
a. Thalassemia
b. Sickle cell anemia
C. Pyruvate kinase deficiency
d. Hereditary stomatocytosis
D.
All of the following are defects of hemoglobin molecule, except:
a. Hgb C disorder
b. Thalassemia
c. Hgb SC disorder
d. Hereditary spherocytosis
D.
Immature WBC with elongated and curved
nucleus, and very clumped chromatin:
a. Myelocyte
b. Metamyelocyte
c. Band
d. Segmented neutrophil
C.
Myelocyte- slightly clumped nucleus
Metamyelocyte- clumped nucleus
Band- Very clumped nucleus
Segmented- Densely packed nucleus
Stage in maturational sequence of WBC with
indented nucleus and clumped chromatin:
a. Promyelocyte
b. Myelocyte
c. Metamyelocyte
d. Band
C.
Once the metamyelocyte stage has been
reached, cells have undergone____
cell divisions and the proliferative phase comes to an end.
a. 1 or 2 cell divisions
b. 2 or 3 cell divisions
c. 4 or 5 cell divisions
d. 6 or 7 cell divisions
C.
Myeloid cells demonstrate maturation beyond the blast and promyelocyte stage:
a. MO myeloid
b. M1 myeloid
c. M2 myeloid
d. M3 myeloid
C.
Abnormal proliferation of both erythroid and
granulocytic precursors; may include
abnormal megakaryocytic and monocytic
proliferations:
a. M3
b. M4
c. M6
d. M7
C.
Small cells predominant; nuclear shape is
regular with an occasional cleft; chromatin
pattern is homogeneous and nucleoli are
rarely visible; cytoplasm is moderately
basophilic:
a. L1
b. L2
c. L3
d. L4
A.
Cells are large and homogeneous in size;
nuclear shape is round or oval; one to three
prominent nucleoli; cytoplasm is deeply
basophilic with vacuoles often prominent:
a. L1
b. L2
c. L3
d. L4
C.
Solid tumor counterpart of acute lymphoblastic leukemia:
a. Lymphoma, undifferentiated
b. Lymphoma, poorly differentiated leukemia
c. Lymphoma, leukemia well-differentiated
d. Chloroma granulocytic leukemia
B.
Solid tumor counterpart of plasma cell leukemia:
a. Reticulum cell sarcoma
b. Chloroma granulocytic leukemia
c. Myeloma
d. Lymphoma, undifferentiated
C.
The major site of blood cell production during the second trimester of fetal development.
a. Yolk sac
b. Liver
c. Spleen
d. Bone marrow
B.
Last step in phagocytosis:
a. Recognition and attachment
b. Ingestion
c. Killing and digestion
d. Formation of neutrophil extracellular
traps
D.
Which of the following cells does not exhibit
myeloperoxidase activity?
a. Neutrophils
b. Eosinophils
c. Monocytes
d. Lymphocytes
D.
Forward, low angle light scatter:
a. O degree angle
b. 2 to 3 degree angle
c. 5 to 15 degree angle
d. 90 degree angle
B.
Forward, high angle light scatter:
a. O degree angle
b. 2 to 3 degree angle
c. 5 to 15 degree angle
d. 90 degree angle
C.
The ESR _______to the red blood cell mass.
a. Is Inversely proportional
b. Has no relationship
c. Has little relevance
d. Is directly proportional
D.
Red blood cell mass is directly proportional; Red cell number is inversely proportional
In automated cell counters, which parameters are directly measured:
1. WBC
2. RBC
3. Hemoglobin
4. Hematocrit
a. 2 only
b. 1,2
c. 1,2,3
d. 1,2,3,4
C.
All of the following are causes of spurious
increase in RBCs, except:
a. Hemolysis
b. Cryoglobulin
c. Giant platelets
d. High WBC
A.
All of the following are causes of spurious
increase in WBCs, except:
a. Cryoglobulin
b. Cryofibrinogen
c. Monoclonal proteins
d. Smudge cells
D.
Leukemia, especially with chemotherapy:
1. Decreased WBCs
2. Decreased platelets
3. Increased WBCs
4. Increased platelets
a. 1,2
b. 3,4
c. 1,4
d. 2,3
C.
WBC > 100,000/uL:
1. Decreased hemoglobin
2. Increased hemoglobin
3. Increased RBCs
4. Decreased RBCs
a. 1,3
b. 2,4
c. 1,4
d. 2,3
D.
Shift to the left in RBC histogram means:
a. Population of smaller cells
b. Population of larger cells
c. Population of normal size cells
d. Population of slightly large cells
A.
A stained blood film has holes all over the
blood film, it indicates which of the film, the
following?
a. RBC agglutination
b. Markedly increased WBC and platelet
counts
c. Increased lipid levels
d. Increased blood proteins as in multiple
myeloma
C.
Which of the following conditions is not usually associated with marked reticulocytosis?
a. Four days after ,a major hemorrhage
b. Drug-induced autoimmune hemolytic anemia
c. Sickle cell anemia
d. Pernicious anemia
D.
If 70 reticulocytes are counted in 1000 red
blood cells, what is the reticulocyte count?
a. 0.07%
b. 0.7%
c. 7.0%
d. 70.0%
C.
FORMULA: # of reticulocytes counted
________________________________x 100
1000 RBCs
To improve accuracy of the RETICULOCYTE
COUNT, have another laboratorian count the
other film; counts should agree within:
a. 20%
b. 30%
c. 40%
d. 1%
A.
Which of the following is the reagent for
hemoglobin solubility test?
a. Hydrochloric acid
b. Ferric cyanide and detergent
c. 2% sodium, metabisulfite test
d. Sodium hydrosulfite (dithionite) and a
detergent-based lying agent (saponin)
D.
Positive result in the solubility test (sodium
dithionite test for hemoglobin S):
a. Normal looking RBs or slightly crenated RBCS
b. Sickle cells or ‘holly leaf’ form of RBCs
C. Clear solution, black lines of the reader
scale are visible through the solution
D. Turbid solution, reader scale is not
visible through the test solution
D.
Paroxysmal nocturnal hemoglobinuria is characterized by flow cytometry results that are:
a. Negative for CD55 and CD59
b. Positive for CD55 and CD59
c. Negative for CD4 and CD8
d. Positive for all normal CD markers lysis
A.
Anticoagulant for the sugar water and
sucrose hemolysis test:
a. EDTA
b. Citrate
c. Heparin
d. Oxalate
B.
What is the dilution for WBC count in automated cell counters?
a. 1:100
b. 1:200
c. 1: 50, 000
d. 1:500
D.
A decreased osmotic fragility test would be associated which of the following conditions?
a. Sickle cell anemia
b. Hereditary spherocytosis
c. HDN
d. Acquired hemolytic anemia
A.
Which of the following is the length of
Microhematocrit tube and size of its inner
bore?
a. Length 75 mm, inner bore of 1.2 mm
b. Length 115 mm, bore of 3 mm
c. Length of 300 mm, bore of 2.5 mm
d. Length of 11.5 cm, bore of 3 mm
A.
Duplicate hematocrit results should agree within ____unit (%).
a. 1%
b. 2%
c. 5%
d. 10%
A.
If the WBC count is 100 to 300 x 10 9th/L, it
is advisable to use this dilution:
a. 1:10
b. 1:20
c. 1:100
d. 1:200
D.
For manual WBC count, the filled counting
chamber should be allowed to stand for
prior to performing the count to give the
WBCs time to settle.
a. 3 minutes
b. 5 minutes
c. 10 minutes
d. 15 minutes
C.
For manual platelet count, the filled counting
chamber should be allowed to stand for
prior to performing the count to give the
platelets time to settle.
a. 3 minutes
b. 5 minutes
c. 10 minutes
d. 15 minutes
D.
Over 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
B.
Which of the following is not a cause of
ABSOLUTE secondary erythrocytosis?
a. Defective cardiac or pulmonary function
b. High-altitude adjustment
c. Dehydration secondary to diuretic use
d. Hemoglobins with increased oxygen affinity
C.
Which of the following is NOT a characteristic
finding in primary polycythemia vera?
a. Blood pancytosis
b. Increased red cell mass
c. Increased erythropoietin level
d. Increased blood viscosity
C.
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
B.
Which mutation is shared by a large
percentage of patients with polycythemia
vera, essential thrombocythemia, and primary myelofibrosis?
a. BCR/ABL
b. JAK2 V617F
c. PDGFR
d. RUNX1
B.
Naphthol AS- chloroacetate esterase
(specific) is usually positive in cells, and alpha naphthyl acetate esterase (nonspecific)is useful for identifying blast cells of lineage.
a. Granulocytic; monocytic
b. Monocytic; granulocytic
c. Granulocytic; lymphocytic
d. Monocytic; lymphocytic
A.
Which of the following red cell inclusions
stain with both Feulgen and Wright’s stain?
a. Howell-Jolly bodies
b. Basophilic stippling
c. Pappenheimer bodies
d.Heinz bodies
A.
Which of the following is NOT a source of
error when measuring hemoglobin by the
cyanmethemoglobin method?
a. Excessive anticoagulant
b. White blood cell count that exceeds linearity limits
c. Lipemic plasma
d. Platelet count that exceeds linearity
limits
A.
WBC COUNT that can cause turbidity in the
cyanmethemoglobin method resulting to
falsely high hemoglobin value:
a. Greater than 700 x 10 9th/L
b. Greater than 10 x 10 9th/L
c. Greater than 15 x 10 9th/L
d. Greater than 20 x 10 9th/L
D.
What is the effect of excess anticoagulant to hematocrit?
a. Increase
b. Decrease
c. No effect
d. Cannot be determine,
B.
In preparing manual wedge technique, the PUSHER SLIDE is held securely in the dominant hand at about:
a. 15 to 20 degree angle
b. 30 to 45 degree angle
c. 45 to 50 degree angle
d. 80 to 90 degree angle
B.
In the preparing wedge smear fro
samples of polycythemic patients, the angle
between the two slides should be:
a. 25
b. 30
c. 35
d. 45
A.
What is the counting area for manual WBC count?
a. 0.2 mm2
b. 1 mm2
c. 4 mm2
d.2 mm2
C.
If MORE THAN 500 PLATELETS are counted on each side a dilution should be made.
a. 1:10
b. 1:20
c. 1:100
d. 1:200
D.
Globin chain composition of Hgb F
a. 2 alpha + 2 delta
b. 2 alpha + 2 beta
c. 2 alpha + 2 gamma
d. 4 beta
C.
Which conditions
shift the oxyhemoglobin
dissociation curve to the right?
a. Acidosis
b. Alkalosis
c. Decreased CO2
d. Increased 02 affinity to hemoglobin
A.
Which is the major hemoglobin found in the
RBCs of patients with SICKLE CELL DISEASE?
a. Hemoglobin S
b. Hemoglobin F
c. Hemoglobin A2
d. Hemoglobin A1
A.
Which of these hemoglobin derivatives cannot be reduced back to normal hemoglobin?
a. Methemoglobin
b. Hemiglobin-Deoxyhemoglobin
c. Carboxyhemoglobin
d. Sulfhemoglobin
D.
What is the type of nuclear reproduction seen in megakaryocytes?
a. Polypoid mitosis
b. Endomitosis
c. Meiosis
d. Binary fission
B.
What is the outermost zone of platelet?
a. Peripheral zone
b. Sol-gel zone
c. Alpha zone
d. Organelle zone
A.
Terminal maturation stage of platelet where
moderately condensed chromatins are seen.
a. MK-I
b. MK-Il
c. MK-IlI
d. MK-IV
B.
What is the reliable way to differentiate
PLATELET PRECURSORS?
a. Size of the cell
b. Cytoplasmic appearance
c. Nucleus
d. Chromatin pattern
B.
Small lysosomal granules of eosinophils
1. Acid phosphatase
2. Catalase
3. Arylsulfatase B
4. Cyclooxygenase
a. 1,2
b. 3,4
c.1,2,3
d. 1,2,3,4
C.
Sodium citrate in the concentration of solution has been adopted as the appropriate concentration for coagulation studies.
a. 1.5%
b. 2.8%
c. 3.2%
d. 3.8%
C.
What is the life span of a platelet?
a. 5 days
b. 14 days
c. 8 to 11 days
d. 120 days
C.
What is the normal range of plateles in the systemic circulation?
a. 50 - 150 x 10 9th/L
b. 100 - 200 x 10 9th/L
c. 200 - 400 x 10 9th/L
d. Greater than 500 x 10 9th/L
C.
In thrombocythemia, the platelets are:
a. Increased
b. Decreased
c. Normal
d. Normal
A.
Which of the following is characteristic of
Bernard-Soulier syndrome?
a. Giant platelets
b. Normal bleeding time
c. Abnormal agregation with ADP
d. Increased platelet count
A.
What is the primary substrate of thrombin?
a. Fibrinogen
b. Prothrombin
c. Factor V
d. Factor X
A.
Which of the following participates ONLY in
the extrinsic pathway?
a. Factor VIl
b. Factor IX
c. Factor X
d. Factor Il
A.
Prothrombin time is NOT affected by deficiency of:
a. Factor VIII
b. Factor V
c. Factor I
d. Factor X
A.
PTT measures all factors except for:
a. I and V
b. VIII and IX
c. V and VIII
d. VII and XIll
D.
Which of the following laboratory findings is
associated with Factor XIlI deficiency?
a. Prolonged activated partial thromboplastin time
b. Clot solubility in a 5 molar urea solution
c. Prolonged thrombin time
d. Prolonged prothrombin time
B.
Vitamin K dependent coagulation factor
1. X
2. VIl
3. II
4. Protein S
a. 1,2
b. 1,2,3
c. 1,2,3,4
d. 1 only
C.
Which of the following is the last coagulation
factor to be depressed in vitamin K deficiency?
a. Factor Il
b. Factor VIl
c. Factor X
d. Factor IX
A.
Which of the following factors is not present
in BaSO4 adsorbed plasma?
a. Factor VII
b. Factor Il
c. Factor XIl
d. Factor V
B.
In which of the following diseases would you
most likely find an abnormal PROTIME:
a. Hemophilia A
b. Hemophilia B - 9
c. VWD
d. DIC
D.
Reversal of heparin overdose can be achieved by administration of which of the following?
a. Vitamin K
b. Anti-thrombin
c. Protamine sulfate
d. Warfarin
C.
A prolonged Stypven (Russell viper venom)
time is associated with deficiency of the
following factors EXCEPT:
a. Factor I
b. Factor Il
c. Factor X
d. Factor VIl
D.
The only abnormal test result in CHRONIC DIC:
a. PT
b. APTT
c. Thrombin time
d. D-dimer
D.
The target INR for PULMONARY EMBOLISM
(PE) treatment:
a. 2-3
b. 2.5-3.5
c. 6
d. 4
A.
The ESR ________ to the plasma viscosity
a. Is inversely proportional
b. Has no relationship
c. Has little relevance
d. Is directly proportional
A.
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. Insufficient centrifugation does not pack down the red blood cells; therefore, the Hct, which is the volume of packed cells, will increase.
Variation in red cell size observed on the peripheral smear is described as:
A. Anisocytosis
B. Hypochromia
C. Poikilocytosis
D. Pleocytosis
A.
A mature erythrocyte is approximately 7–8 μm in diameter. Variation in normal size is denoted by the term anisocytosis. Hypochromia is a term that indicates increased central pallor in erythrocytes, and poikilocytosis denotes variation in red cell shape.
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.
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
B.
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 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.
When an erythrocyte containing iron granules is stained with Prussian blue, the cell is called a:
A. Spherocyte
B. Leptocyte
C. Schistocyte
D. Siderocyte
D.
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
C.
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
B.
What phagocytic cells produce lysozymes that are bacteriocidal?
A. Eosinophils
B. Lymphocytes
C. Platelets
D. Neutrophils
D.
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%
B.
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.
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.
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
B.
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)
B.
A Miller disk is an ocular device used to facilitate counting of:
A. Platelets
B. Reticulocytes
C. Sickle cells
D. Nucleated red blood cells
B.
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
C.
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.
What staining method is used most frequently to stain and manually count reticulocytes?
A. Immunofluorescence
B. Supravital staining
C. Romanowsky staining
D. Cytochemical staining
B.
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 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
C.
Using an electronic cell counter analyzer, an increased RDW should correlate with:
A. Spherocytosis
B. Anisocytosis
C. Leukocytosis
D. Presence of giant platelets
B.
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
C.
Which of the following is considered a normal hemoglobin?
A. Carboxyhemoglobin
B. Methemoglobin
C. Sulfhemoglobin
D. Deoxyhemoglobin
D.
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.
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
B.
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%
C.
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.
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%
C.
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
D.
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
D.
Which of the following Hgb configurations is characteristic of Hgb H?
A. γ4
B. α2-γ2
C. β4
D. α2-β2
C.
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
D.
Hypersplenism is characterized by: A. Polycythemia
B. Pancytosis
C. Leukopenia
D. Myelodysplasia
C.
Which of the following organs is responsible for the “pitting process” for RBCs?
A. Liver
B. Spleen
C. Kidney
D. Lymph nodes
B.
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
D.
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
C.
Which of the following disorders has an increase in osmotic fragility?
A. Iron deficiency anemia
B. Hereditary elliptocytosis
C. Hereditary stomatocytosis
D. Hereditary spherocytosis
D.
The anemia seen in sickle cell disease is usually:
A. Microcytic, normochromic
B. Microcytic, hypochromic
C. Normocytic, normochromic
D. Normocytic, hypochromic
C.
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
D.
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
B.
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
D.
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
C.
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.
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
D.
Hemolytic uremic syndrome (HUS) is characterized by all of the following except:
A. Hemorrhage
B. Thrombocytopenia
C. Hemoglobinuria
D. Reticulocytopenia
D.
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)
D.
Which antibody is associated with paroxysmal cold hemoglobinuria (PCH)?
A. Anti-I
B. Anti-i
C. Anti-M
D. Anti-P
D.
All of the following are associated with intravascular hemolysis except:
A. Methemoglobinemia
B. Hemoglobinuria
C. Hemoglobinemia
D. Decreased haptoglobin
A.
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
B.
“Bite cells” are usually seen in patients with:
A. Rh null trait
B. Chronic granulomatous disease
C. G6PD deficiency
D. PK deficiency
C.
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
C.
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
C.
Congenital dyserythropoietic anemias (CDAs) are characterized by:
A. Bizarre multinucleated erythroblasts
B. Cytogenetic disorders
C. Megaloblastic erythropoiesis
D. An elevated M:E ratio
A.
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
D.
Which antibiotic(s) is (are) most often implicated in the development of aplastic anemia?
A. Sulfonamides
B. Penicillin
C. Tetracycline
D. Chloramphenicol
D.
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.
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
C.
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)
C.
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
B.
Reticulocytosis usually indicates:
A. Response to inflammation
B. Neoplastic process
C. Aplastic anemia
D. Red cell regeneration
D.
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
C.
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
C.
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
D.
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
B.
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.
Storage iron is usually best determined by:
A. Serum transferrin levels
B. Hgb values
C. Myoglobin values
D. Serum ferritin levels
D.
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
D.
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
C.
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
D.
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
C.
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
C.
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
B.
Which morphological classification is characteristic of megaloblastic anemia?
A. Normocytic, normochromic
B. Microcytic, normochromic
C. Macrocytic, hypochromic
D. Macrocytic, normochromic
D.
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
D.
All of the following are characteristics of megaloblastic anemia except:
A. Pancytopenia
B. Elevated reticulocyte count
C. Hypersegmented neutrophils
D. Macrocytic erythrocyte indices
B.
A patient with a vitamin B12 anemia is given a high dosage of folate. Which of the following isexpected 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
B.
Which of the following disorders is associated with ineffective erythropoiesis?
A. G6PD deficiency
B. Liver disease
C. Hgb C disease
D. Megaloblastic anemia
D.
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)
D.
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
B.
The macrocytes typically seen in megaloblastic processes are:
A. Crescent-shaped
B. Teardrop-shaped
C. Ovalocytic
D. Pencil-shaped
C.
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%
C.
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
B.
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
C.
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
C.
Which inclusions may be seen in leukocytes?
A. Döhle bodies
B. Basophilic stippling
C. Malarial parasites
D. Howell–Jolly bodies
A.
Which of the following is contained in the primary granules of the neutrophil?
A. Lactoferrin
B. Myeloperoxidase
C. Histamine
D. Alkaline phosphatase
B.
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%
D.
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
B.
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.
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
B.
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
C.
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
D.
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.
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
D.
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)
B.
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
C.
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
C.
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
D.
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
D.
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.
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
B.
An M:E ratio of 10:1 is most often seen in:
A. Thalassemia
B. Leukemia
C. Polycythemia vera
D. Myelofibrosis
B.
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.
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.
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)
C.
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
B.
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
D.
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 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
D.
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)
D.
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
B.
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
B.
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)
C.
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.
What is 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)
D.
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
C.
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
C.
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.
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
D.
In myelofibrosis, the characteristic abnormal red blood cell morphology is that of:
A. Target cells
B. Schistocytes
C. Teardrop cells
D. Ovalocytes
C.
PV is characterized by:
A. Increased plasma volume
B. Pancytopenia
C. Decreased oxygen saturation
D. Absolute increase in total red cell mass
D.
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.
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
B.
In PV, what is characteristically seen in the peripheral blood?
A. Panmyelosis
B. Pancytosis
C. Pancytopenia
D. Panhyperplasia
B.
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.
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
D.
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
B.
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
D.
In which of the following conditions does LAP show the least activity?
A. Leukemoid reactions
B. Idiopathic myelofibrosis
C. PV
D. CML
D.
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
C.
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
D.
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
D. Osteolytic lesions only seen in multiple myeloma
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
C.
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
D.
Multiple myeloma is most difficult to distinguish from:
A. Chronic lymphocytic leukemia
B. Acute myelogenous leukemia
C. Benign monoclonal gammopathy
D. Benign adenoma
C.
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
D.
Waldenström’s macroglobulinemia is a malignancy of the:
A. Lymphoplasmacytoid cells
B. Adrenal cortex
C. Myeloblastic cell lines
D. Erythroid cell precursors
A.
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
C.
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
D.
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
D.
A manual WBC count is performed. Eighty WBCs are counted in the four large corner squares of a Neubauer hemacytometer. The dilution is 1:100. What is the total WBC count?
A. 4.0 × 109/L
B. 8.0 × 109/L
C. 20.0 × 109/L
D. 200.0 × 109/L
C.
A manual RBC count is performed on a pleural fluid. The RBC count in the large center square of the Neubauer hemacytometer is 125, and the dilution is 1:200. What is the total RBC count?
A. 27.8 × 109/L
B. 62.5 × 109/L
C. 125.0 × 109/L
D. 250.0 × 109/L
D.
Which of the following initiates in vivo coagulation by activation of factor VII?
A. Protein C
B. Tissue factor
C. Plasmin activator
D. Thrombomodulin
B.
Which of the following clotting factors plays a role in clot formation in vitro, but not in vivo? in vitro clot formation and not in vivo coagulation?
A. VIIa
B. IIa
C. XIIa
D. Xa
C.
The anticoagulant of choice for most routine coagulation studies is:
A. Sodium oxalate
B. Sodium citrate
C. Heparin
D. Ethylenediaminetetraacetic acid (EDTA)
B.
Which ratio of anticoagulant-to-blood is correct for coagulation procedures?
A. 1:4
B. 1:5
C. 1:9
D. 1:10
C.
Which results would be expected for the prothrombin time (PT) and activated partial thromboplastin time (APTT) in a patient with polycythemia?
A. Both prolonged
B. Both shortened
C. Normal PT, prolonged APTT
D. Both normal
A.
What reagents are used in the PT test?
A. Thromboplastin and sodium chloride
B. Thromboplastin and potassium chloride
C. Thromboplastin and calcium
D. Actin and calcium chloride
C.
Which test would be abnormal in a patient with factor X deficiency?
A. PT only
B. APTT only
C. PT and APTT
D. Thrombin time
C.
Which clotting factor is not measured by PT and APTT tests?
A. Factor VIII
B. Factor IX
C. Factor V
D. Factor XIII
D.
A modification of which procedure can be used to measure fibrinogen?
A. PT
B. APTT
C. Thrombin time
D. Fibrin degradation products
C.
Which of the following characterizes vitamin K?
A. It is required for biological activity of fibrinolysis
B. Its activity is enhanced by heparin therapy
C. It is required for carboxylation of glutamate residues of some coagulation factors
D. It is made by the endothelial cells
C.
Which statement about the fibrinogen/fibrin degradation product test is correct?
A. It detects early degradation products (X and Y)
B. It is decreased in disseminated intravascular coagulation (DIC)
C. It evaluates the coagulation system
D. It detects late degradation products (D and E)
D.
Which of the following clotting factors are measured by the APTT test?
A. II, VII, IX, X
B. VII, X, V, II, I
C. XII, XI, IX, VIII, X, V, II, I
D. XII, VII, X, V, II, I
C.
Which coagulation test(s) would be abnormal in a vitamin K–deficient patient?
A. PT only
B. PT and APTT
C. Fibrinogen level
D. Thrombin time
B.
Which of the following is correct regarding the international normalized ratio (INR)?
A. It uses the International Sensitivity Ratio (ISR)
B. It standardizes PT results
C. It standardizes APTT results
D. It is used to monitor heparin therapy
B.
Which of the following is referred to as an endogenous activator of plasminogen?
A. Streptokinase
B. Transamidase
C. Tissue plasminogen activator
D. Tissue plasminogen activator inhibitor
C.
Which protein is the primary inhibitor of the fibrinolytic system?
A. Protein C
B. Protein S
C. α2-Antiplasmin
D. α2-Macroglobulin
C.
Which of the following statements is correct regarding the D-dimer test?
A. Levels are decreased in DIC
B. Test detects polypeptides A and B
C. Test detects fragments D and E
D. Test has a negative predictive value
D. D dimer tests is used to rule out thrombosis. A negative predictive value is the probability that a person has a negative result
A protein that plays a role in both coagulation and platelet aggregation is:
A. Factor I
B. Factor VIII
C. Factor IX
D. Factor XI
A.
A standard 4.5-mL blue-top tube filled with 3.0 mL of blood was submitted to the laboratory for PT and APTT tests. The sample is from a patient undergoing surgery the following morning for a tonsillectomy. Which of the following is the necessary course of action by the technologist?
A. Run both tests in duplicate and report the average result
B. Reject the sample and request a new sample
C. Report the PT result
D. Report the APTT result
B.
Which statement is correct regarding sample storage for the prothrombin time test?
A. Stable for 24 hours if the sample is capped
B. Stable for 24 hours if the sample is refrigerated at 4°C
C. Stable for 4 hours if the sample is stored at 4°C
D. Should be run within 8 hours
A.
In primary fibrinolysis, the fibrinolytic activity results in response to:
A. Increased fibrin formation
B. Spontaneous activation of fibrinolysis
C. Increased fibrin monomers
D. DIC
B.
Plasminogen deficiency is associated with:
A. Bleeding
B. Thrombosis
C. Increased fibrinolysis
D. Increased coagulation
B.
Which of the following clotting factors are activated by thrombin that is generated by tissue pathway (TF-VIIa)?
A. XII, XI
B. XII, I
C. I, II
D. V, VIII
D.
What substrate is used in a chromogenic factor assay?
A. p-nitroanaline
B. Chloropheonol red
C. Prussian blue
D. Ferricyanide
A.
Which of the following antibodies is used in the D-dimer assay?
A. Polyclonal directed against X and Y fragments
B. Polyclonal directed against D-dimer
C. Monoclonal against D and E fragments
D. Monoclonal against D-dimer
D.
Thrombotic thrombocytopenic purpura (TTP) is characterized by:
A. Prolonged PT
B. Increased platelet aggregation
C. Thrombocytosis
D. Prolonged APTT
B.
Thrombocytopenia may be associated with:
A. Postsplenectomy
B. Hypersplenism
C. Acute blood loss
D. Increased proliferation of pluripotential stem cells
B.
Aspirin prevents platelet aggregation by inhibiting the action of which enzyme?
A. Phospholipase
B. Cyclo-oxygenase
C. Thromboxane A2 synthetase
D. Prostacyclin synthetase
B.
Normal platelet adhesion depends upon:
A. Fibrinogen
B. Glycoprotein Ib
C. Glycoprotein IIb, IIIa complex
D. Calcium
B.
Which of the following test results is normal in a patient with classic von Willebrand’s disease?
A. Bleeding time
B. Activated partial thromboplastin time
C. Platelet count
D. Factor VIII:C and von Willebrand’s factor (VWF) levels
C.
Bernard–Soulier syndrome is associated with:
A. Decreased bleeding time
B. Decreased factor VIII assay
C. Thrombocytopenia and giant platelets
D. Abnormal platelet aggregation to ADP
C.
When performing platelet aggregation studies, which set of platelet aggregation results would most likely be associated with Bernard–Soulier syndrome?
A. Normal platelet aggregation to collagen, ADP, and ristocetin
B. Normal platelet aggregation to collagen, ADP, and epinephrine; decreased aggregation to ristocetin
C. Normal platelet aggregation to epinephrine and ristocetin; decreased aggregation to collagen and ADP
D. Normal platelet aggregation to epinephrine, ristocetin, and collagen; decreased aggregation to ADP
B.
Which set of platelet responses would be most likely associated with Glanzmann’s thrombasthenia?
A. Normal platelet aggregation to ADP and ristocetin; decreased aggregation to collagen
B. Normal platelet aggregation to collagen; decreased aggregation to ADP and ristocetin
C. Normal platelet aggregation to ristocetin; decreased aggregation to collagen, ADP, and
epinephrine
D. Normal platelet aggregation to ADP; decreased aggregation to collagen and ristocetin
C.
Which of the following is a characteristic of acute immune thrombocytopenic purpura?
A. Spontaneous remission within a few weeks
B. Predominantly seen in adults
C. Nonimmune platelet destruction
D. Insidious onset
A.
TTP differs from DIC in that:
A. APTT is normal in TTP but prolonged in DIC
B. Schistocytes are not present in TTP but are present in DIC
C. Platelet count is decreased in TTP but normal in DIC
D. PT is prolonged in TTP but decreased in DIC
A.
Several hours after birth, a baby boy develops petechiae and purpura and a hemorrhagic diathesis. The platelet count is 18 × 109/L. What is the most likely explanation for the low platelet count?
A. Drug-induced thrombocytopenia
B. Secondary thrombocytopenia
C. Neonatal alloimmune thrombocytopenia
D. Neonatal DIC
C.
Which of the following is associated with post-transfusion purpura (PTP)?
A. Nonimmune thrombocytopenia/alloantibodies
B. Immune-mediated thrombocytopenia/ alloantibodies
C. Immune-mediated thrombocytopenia/ autoantibodies
D. Nonimmune-mediated thrombocytopenia/ autoantibodies
B.
Hemolytic uremic syndrome (HUS) is associated with:
A. Fever, thrombocytosis, anemia, and renal failure
B. Fever, granulocytosis, and thrombocytosis
C. Escherichia coli 0157:H7
D. Leukocytosis and thrombocytosis
C.
Storage pool deficiencies are defects of:
A. Platelet adhesion
B. Platelet aggregation
C. Platelet granules
D. Platelet production
C.
Lumi-aggregation measures:
A. Platelet aggregation only
B. Platelet aggregation and ATP release
C. Platelet adhesion
D. Platelet glycoprotein Ib
B.
Neurological findings may be commonly associated with which of the following disorders?
A. HUS
B. TTP
C. ITP
D. PTP
B.
Which of the following is correct regarding acquired thrombotic thrombocytopenic purpura?
A. Autoimmune disease
B. Decreased VWF
C. Decreased platelet aggregation
D. Decreased platelet adhesion
A.
Hereditary hemorrhagic telangiectasia is a disorder of:
A. Platelets
B. Clotting proteins
C. Fibrinolysis
D. Connective tissue
D.
Which of the following prevents platelet aggregation?
A. Thromboxane A2
B. Thromboxane B2
C. Prostacyclin
D. Antithrombin
C.
Which defect characterizes Gray’s syndrome?
A. Platelet adhesion defect
B. Dense granule defect
C. Alpha granule defect
D. Coagulation defect
C.
The P2Y12 ADP receptor agonist assay may be used to monitor platelet aggregation inhibition to which of the following drugs?
A. Warfarin
B. Heparin
C. LMWH
D. Clopidogrel (Plavix)
D.
Which of the following instruments can be used to evaluate platelet function?
A. Platelet aggregometer
B. VerifyNow
C. PFA-100
D. All of the above
D.
Which of the following platelet aggregating agents demonstrates a monophasic aggregation curve when used in optimal concentration?
A. Thrombin
B. Collagen
C. Adenosine diphosphate (ADP)
D. Epinephrine
B.
The APTT is sensitive to a deficiency of which clotting factor?
A. Factor VII
B. Factor X
C. PF3
D. Calcium
B.
Which test result would be normal in a patient with dysfibrinogenemia?
A. Thrombin time
B. APTT
C. PT
D. Immunologic fibrinogen level
D.
A patient with a prolonged PT is given intravenous vitamin K. The PT corrects to normal after
24 hours. What clinical condition most likely caused these results?
A. Necrotic liver disease
B. Factor X deficiency
C. Fibrinogen deficiency
D. Obstructive jaundice
D.
Which factor deficiency is associated with a prolonged PT and APTT?
A. X
B. VIII
C. IX
D. XI
A.
A prolonged APTT is corrected with factor VIII– deficient plasma but not with factor IX–deficient plasma. Which factor is deficient?
A. V
B. VIII
C. IX
D. X
C.
Refer to the following results:
PT = prolonged
APTT = prolonged
Platelet count = decreased
Which disorder may be indicated?
A. Factor VIII deficiency
B. von Willebrand’s disease
C. DIC
D. Factor IX deficiency
C.
Which of the following is a predisposing condition for the development of DIC?
A. Adenocarcinoma
B. Idiopathic thrombocytopenic purpura (ITP)
C. Post-transfusion purpura (PTP)
D. Heparin-induced thrombocytopenia (HIT)
A.
Factor XII deficiency is associated with:
A. Bleeding episodes
B. Epistaxis
C. Decreased risk of thrombosis
D. Increased risk of thrombosis
D.
The following results were obtained on a patient: normal platelet count and function, normal PT, and prolonged APTT. Which of the following disorders is most consistent with these results?
A. Hemophilia A
B. Bernard–Soulier syndrome
C. von Willebrand’s disease
D. Glanzmann’s thrombasthenia
A.
The following laboratory results were obtained from a 40-year-old woman:
PT = 20 sec
APTT = 50 sec
Thrombin time = 18 sec
What is the most probable diagnosis?
A. Factor VII deficiency
B. Factor VIII deficiency
C. Factor X deficiency
D. Hypofibrinogenemia
D.
When performing a factor VIII activity assay, a patient’s plasma is mixed with:
A. Normal patient’s plasma
B. Factor VIII deficient plasma
C. Plasma with a high concentration of factor VIII
D. Normal control plasma
B.
The most suitable product for treatment of factor VIII deficiency is:
A. Fresh frozen plasma
B. Factor VIII concentrate
C. Prothrombin complex concentrate
D. Factor V Leiden
B.
Normal PT and APTT results in a patient with a poor wound healing may be associated with:
A. Factor VII deficiency
B. Factor VIII deficiency
C. Factor XII deficiency
D. Factor XIII deficiency
D.
Which of the following is associated with abnormal platelet aggregation test?
A. Factor VIII deficiency
B. Factor VIII inhibitor
C. Lupus anticoagulant
D. Afibrinogenemia
D.
Which results are associated with hemophilia A?
A. Prolonged APTT, normal PT
B. Prolonged PT and APTT
C. Prolonged PT, normal APTT
D. Normal PT and APTT
A.
Fibrin monomers are increased in which of the following conditions?
A. Primary fibrinolysis
B. DIC
C. Factor VIII deficiency
D. Fibrinogen deficiency
B.
Which of the following is associated with multiple factor deficiencies?
A. An inherited disorder of coagulation
B. Severe liver disease
C. Dysfibrinogenemia
D. Lupus anticoagulant
B.
Normal PT and APTT results in a patient with a poor wound healing may be associated with:
A. Factor VII deficiency
B. Factor VIII deficiency
C. Factor XII deficiency
D. Factor XIII deficiency
D.
Fletcher factor (prekallikrein) deficiency may be associated with:
A. Bleeding
B. Thrombosis
C. Thrombocytopenia
D. Thrombocytosis
B.
One of the complications associated with a severe hemophilia A is:
A. Hemarthrosis
B. Mucous membrane bleeding
C. Mild bleeding during surgery
D. Immune-mediated thrombocytopenia
A.
The most common subtype of classic von Willebrand’s disease is:
A. Type 1
B. Type 2A
C. Type 2B
D. Type 3
A.
A prolonged APTT and PT are corrected when mixed with normal plasma. Which factor is most likely deficient?
A. VIII
B. V
C. XI
D. IX
B.
Which characteristic describes antithrombin (AT)?
A. It is synthesized in megakaryocytes
B. It is activated by protein C
C. It is a cofactor of heparin
D. It is a pathological inhibitor of coagulation
C.
Which laboratory test is affected by heparin therapy?
A. Thrombin time
B. Fibrinogen assay
C. Protein C assay
D. Protein S assay
A.
An abnormal APTT caused by a pathological circulating anticoagulant is:
A. Corrected with factor VIII–deficient plasma
B. Corrected with factor IX–deficient plasma
C. Corrected with normal plasma
D. Not corrected with normal plasma
D.
The lupus anticoagulant affects which of the following tests?
A. Factor VIII assay
B. Factor IX assay
C. VWF assay
D. Phospholipid-dependent assays
D
Which statement about Coumadin (warfarin) is accurate?
A. It is a vitamin B antagonist
B. It is not recommended for pregnant and lactating women
C. It needs antithrombin as a cofactor
D. APTT test is used to monitor its dosage
B
Which statement regarding protein C is correct?
A. It is a vitamin K–independent zymogen
B. It is activated by fibrinogen
C. It activates cofactors V and VIII
D. Its activity is enhanced by protein S
D
Which of the following is an appropriate screening test for the diagnosis of lupus anticoagulant?
A. Thrombin time test
B. Diluted Russell’s viper venom test (DRVVT)
C. D-dimer test
D. FDP test
B
Which of the following is most commonly associated with activated protein C resistance (APCR)?
A. Bleeding
B. Thrombosis
C. Epistaxis
D. Menorrhagia
B
A 50-year-old man has been on heparin for the past 7 days. Which combination of the tests is expected to be abnormal?
A. PT and APTT only
B. APTT, TT only
C. APTT, TT, fibrinogen assay
D. PT, APTT, TT
D
Which of the following drugs inhibits ADP mediated platelet aggregation?
A. Heparin
B. Warfarin
C. Aspirin
D. Prasugrel
D
Thrombin-thrombomodulin complex is necessary for activation of:
A. Protein C
B. Antithrombin
C. Protein S
D. Factors V and VIII
A
What test is used to monitor heparin therapy?
A. INR
B. APTT
C. TT
D. PT
B
What test is commonly used to monitor warfarin therapy?
A. INR
B. APTT
C. TT
D. Ecarin time
A
What clotting factors (cofactors) are inhibited by protein S?
A. V and X
B. Va and VIIIa
C. VIII and IX
D. VIII and X
B
Which drug promotes fibrinolysis?
A. Warfarin
B. Heparin
C. Urokinase
D. Aspirin
C
Diagnosis of lupus anticoagulant is confirmed by which of the following criteria?
A. Decreased APTT
B. Correction of the APPT by mixing studies
C. Neutralization of the antibody by high concentration of platelets
D. Confirmation that abnormal coagulation tests are time and temperature dependent
C
Which of the following abnormalities is consistent with the presence of lupus anticoagulant?
A. Decreased APTT/bleeding complications
B. Prolonged APTT/thrombosis
C. Prolonged APTT/thrombocytosis
D. Thrombocytosis/thrombosis
B
Which of the following is a characteristic of low molecular weight heparin (LMWH)?
A. Generally requires monitoring
B. Specifically acts on factor Va
C. Has a longer half-life than unfractionated heparin
D. Can be used as a fibrinolytic agent
C
Which of the following tests is most likely to be abnormal in patients taking aspirin?
A. Platelet morphology
B. Platelet count
C. Bleeding time
D. Prothrombin time
C
Which of the following is associated with antithrombin deficiency?
A. Thrombocytosis
B. Thrombosis
C. Thrombocytopenia
D. Bleeding
B
Which of the following may be associated with thrombotic events?
A. Decreased protein C
B. Increased fibrinolysis
C. Afibrinogenemia
D. ITP
A
Aspirin resistance may be associated with:
A. Bleeding
B. Factor VIII deficiency
C. Thrombosis
D. Thrombocytosis
C
A prolonged thrombin time is indicative of which of the following antithrombotic therapies?
A. Prasugrel
B. Clopidogrel
C. Aspirin
D. Heparin
D
Screening tests for thrombophilia should be performed on:
A. All pregnant women because of the thrombotic risk
B. Patients with a negative family history
C. Patients with thrombotic events occurring at a young age
D. Patients who are receiving anticoagulant therapy
C.
Prothrombin G20210A is characterized by which of the following causes and conditions?
A. Single mutation of prothrombin molecule/ bleeding
B. Single mutation of prothrombin molecule/ thrombosis
C. Decreased levels of prothrombin in plasma/ thrombosis
D. Increased levels of prothrombin in plasma/ bleeding
B. Single mutation of prothrombin molecule/ thrombosis
Factor V Leiden promotes thrombosis by preventing:
A. Deactivation of factor Va
B. Activation of factor V
C. Activation of protein C
D. Activation of protein S
A. Deactivation of factor Va
What is the approximate incidence of antiphospholipid antibodies in the general population?
A. <1%
B. 2%
C. 10%
D. 20%
B
Which of the following laboratory tests is helpful in the diagnosis of aspirin resistance?
A. APTT
B. PT
C. Platelet count and morphology
D. Platelet aggregation
D
Which of the following complications may occur as a result of decreased tissue factor pathway inhibitor (TFPI)?
A. Increased hemorrhagic episodes
B. Increased thrombotic risk
C. Impaired platelet plug formation
D. Immune thrombocytopenia
B
Which therapy and resulting mode of action are appropriate for the treatment of a patient with a high titer of factor VIII inhibitors?
A. Factor VIII concentrate to neutralize the antibodies
B. Recombinant factor VIIa (rVIIa) to activate factor X
C. Factor X concentrate to activate the common pathway
D. Fresh frozen plasma to replace factor VIII
B
The Bethesda assay is used for which determination?
A. Lupus anticoagulant titer
B. Factor VIII inhibitor titer
C. Factor V Leiden titer
D. Protein S deficiency
B
Hyperhomocysteinemia may be a risk factor for:
A. Bleeding
B. Thrombocythemia
C. Thrombosis
D. Thrombocytopenia
C
Which drug may be associated with deep venous thrombosis (DVT)?
A. Aspirin
B. tPA
C. Oral contraceptives
D. Plavix (clopidogrel)
C
Argatroban may be used as an anticoagulant drug in patients with:
A. DVT
B. Hemorrhage
C. TTP
D. Thrombocytosis
A
Heparin-induced thrombocytopenia (HIT) results from:
A. Antibodies to heparin
B. Antibodies to platelets
C. Antibodies to PF4
D. Antibodies to heparin-PF4 complex
D
Which laboratory test is used to screen for activated protein C resistance?
A. Mixing studies with normal plasma
B. Mixing studies with factor-deficient plasma
C. Modified APTT with and without activated protein C
D. Modified PT with and without activated protein C
C
Ecarin clotting time may be used to monitor:
A. Heparin therapy
B. Warfarin therapy
C. Fibrinolytic therapy
D. Hirudin therapy
D
Which of the following may interfere with the activated protein C resistance (APCR) screening test?
A. Lupus anticoagulant
B. Protein C deficiency
C. Antithrombin deficiency
D. Protein S deficiency
A
Thrombophilia may be associated with which of the following disorders?
A. Afibrinogenemia
B. Hypofibrinogenemia
C. Factor VIII inhibitor
D. Hyperfibrinogenemia
D
Which of the following anticoagulant drugs can be used in patients with HIT?
A. Warfarin
B. Heparin
C. Aspirin
D. Lepirudin
D
Which of the following is the preferred method to monitor heparin therapy at the point of care during cardiac surgery?
A. APTT
B. Activated clotting time test (ACT)
C. PT
D. TT
B
Mrs. Smith has the following laboratory results, and no bleeding history:
APTT: prolonged
APTT results on a 1:1 mixture of the patient’s plasma
with normal plasma: Preincubation: prolonged
APTT 2-hour incubation: prolonged APTT
These results are consistent with:
A. Factor VIII deficiency
B. Factor VIII inhibitor
C. Lupus anticoagulant
D. Protein C deficiency
C.
Which test may be used to monitor LMWH therapy?
A. APTT
B. INR
C. Anti-Xa heparin assay
D. Activated clotting time
C
The following results are obtained from a patient who developed severe bleeding:
Prolonged PT and APTT
Platelet count = 100 × 109 /L
Fibrinogen = 40 mg/dL
Which of the following blood products should be recommended for transfusion?
A. Factor VIII concentrate
B. Platelets
C. Fresh frozen plasma
D. Cryoprecipitate
D
A 30-year-old woman develops signs and symptoms of thrombosis in her left lower leg following 5 days of heparin therapy. The patient had open-heart surgery 3 days previously and has been on heparin ever since. Which of the following would be the most helpful in making the diagnosis?
A. Fibrinogen assay
B. Prothrombin time
C. Platelet counts
D. Increased heparin dose
C
The following laboratory results were obtained on a 25-year-old woman with menorrhagia after delivery of her second son. The patient has no previous bleeding history.
Normal platelet count; normal bleeding time; normal PT; prolonged APTT
Mixing of the patient’s plasma with normal plasma corrected the prolonged APTT on immediate testing. However, mixing followed by 2-hour incubation at 37°C caused a prolonged APTT.
What is the most probable cause of these laboratory results?
A. Lupus anticoagulant
B. Factor VIII deficiency
C. Factor IX deficiency
D. Factor VIII inhibitor
D
A 62-year-old female presents with jaundice and the following laboratory data:
Peripheral blood smear: macrocytosis, target cells
Platelet count: 355 × 109/L
PT: 25 sec (reference range =10–14)
APTT: 65 sec (reference range = 28–36)
Transaminases: elevated (AST:ALT>1)
Total and direct bilirubin: elevated
These clinical presentations and laboratory results are consistent with:
A. Inherited factor VII deficiency
B. DIC
C. Cirrhosis of the liver
D. von Willebrand’s disease
C
When performing a mixing study, the patient’s APTT is corrected to 12% of normal. What is the most appropriate interpretation of these findings?
A. The APTT is considered corrected
B. The APTT is considered uncorrected
C. The mixing study needs to be repeated
D. A circulating anticoagulant can be ruled out
C
A standard blue-top tube filled appropriately (with 4.5 mL blood) was submitted to the laboratory for preoperative PT and APTT testing. The results
of both tests were elevated. The patient’s PT and APTT from the previous day were within normal limits, and he is not on heparin therapy. Which is the most appropriate first step to investigate the abnormal results?
A. Report the result as obtained
B. Perform a mixing study
C. Check the sample for a clot
D. Report the APTT only
C
A plasma sample submitted to the lab for PT testing has been stored for 25 hours at 4°C. The PT result is shortened. What is the most probable cause?
A. Factor VII deficiency
B. Activation of factor VII due to exposure to cold temperature
C. Lupus inhibitor
D. Factor X inhibitor
B
The APTT results are not elevated in a patient receiving heparin. Which of the following factors may be associated with the lack of response to heparin therapy in this patient?
A. Protein C deficiency
B. Antithrombin deficiency
C. Protein S deficiency
D. Factor VIII deficiency
B
A 50-year-old patient was admitted to the emergency department complaining of pain in her right leg. Her leg was red, swollen, and warm to the touch. Deep venous thrombosis was suspected, and the patient was started on heparin therapy. Which of the following is (are) the proper protocol to evaluate patients receiving heparin therapy?
A. A baseline APTT and platelet count; APTT testing every 6 hours until the target is reached
B. Repeat APTT after 5 days postheparin therapy to adjust the therapeutic dose
C. Monitor the platelet count daily and every other day after heparin therapy is completed
D. Monitor PT daily to adjust the therapeutic dose
A
A 60-year-old patient was admitted to a hospital for a liver biopsy. The biopsy was scheduled for 11:00 a.m. The coagulation results performed at the time of admission revealed a prolonged PT with an INR of 4.5. What is the physician’s most appropriate course of action?
A. Proceed with biopsy, because a prolonged PT is expected in liver disease
B. Postpone the procedure for a couple of days
C. Cancel the procedure and start the patient on vitamin K therapy
D. Put patient on vitamin K and proceed with the procedure immediately
C
A fresh blood sample was sent to the laboratory at 8:00 a.m. for a PT test. At 4:00 p.m., the doctor requested an APTT test to be done on the same sample. What should the technologist do?
A. Rerun APTT on the 8:00 a.m. sample and report the result
B. Request a new sample for APTT
C. Run APTT in duplicate and report the average
D. Mix the patient plasma with normal plasma and run the APTT
B
An APTT test is performed on a patient and the result is 50 sec (reference range 27–37 sec). The instrument flags the result owing to failure of the delta check. The patient had an APTT of 35 sec the previous day. The technologist calls the nursing unit to check whether the patient is on heparin therapy. The patient is not receiving heparin. What is the next appropriate step?
A. Check the family history for an inherited factor VIII deficiency
B. Check to see if the patient has received any other anticoagulant medications
C. Perform mixing studies
D. Perform a factor VIII assay
B
A patient was put on heparin therapy postoperatively for prevention of thrombosis.
The patient had the following laboratory results on admission:
Platelet count = 350 × 109/L;
PT = 12 sec (reference: 10–13 sec);
APTT = 35 sec (reference: 28–37).
After 6 days of heparin therapy, the patient complained of pain and swelling in her left leg. Her platelet count dropped to 85 × 109/L and her APTT result was 36 sec. The physician suspected heparin-induced thrombocytopenia (HIT) and ordered a platelet aggregation test to be performed immediately. The heparin-induced platelet aggregation test result was negative. Heparin therapy was continued. Several days later, the patient developed a massive clot in her left leg that necessitated amputation.
Which of the following should have been recognized or initiated?
A. The patient should have been placed on LMWH
B. The heparin dose should have been increased
C. The negative platelet aggregation does not rule out HIT
D. The patient should have been placed on warfarin
therapy
C
A 50-year-old female was admitted to a hospital for hip replacement surgery. The preoperative tests were performed and the results showed an Hgb of 13.5 g/dL; Hct = 42%; PT = 12 sec; APTT = 36 sec. The patient was bleeding during surgery and the postoperative test results revealed an Hgb = 5.0 g/dL; Hct = 16%; PT = 8 sec; and APTT = 25 sec. What steps should be taken before releasing these results?
A. No follow-up steps are needed; report the results as obtained
B. Report Hgb and Hct results, adjust the anticoagulant volume, and redraw a new sample for PT and APTT
C. Call the nurse and ask if the patient is receiving heparin
D. Because the patient is severely anemic, multiply the PT and APTT results by two and report the results
B
Which of the following lists the steps of the hemostatic response in the correct order?
a. Fibrinolysis-injury-secondary hemostasis -primary hemostasis
b. Injury -primary hemostasis - secondary hemostasis -fibrinolysis
c. Injury -secondary hemostasis -primary hemostasis -fibrinolysis
d. Injury -fibrinolysis - primary hemostasis - secondary hemostasis
B
Which of the following properties renders the vessel wall prothrombotic?
a. Negatively charged surface
b. Production of prostacyclin and nitric oxide
c. Release of tissue factor
d. Inactivation of thrombin
C
Which of the following is not true regarding platelets?
a. Platelets are not affected by aspirin
b. Platelets have a life span of 7 to 10 days
c. Platelets undergo shape change and develop pseu- dopods when activated
d. Von Willebrand factor serves as a bridge between platelets and collagen
A
Which of the following factors binds to platelets via the glycoprotein IIb/IIIa receptor?
a. Von Willebrand factor
b. Factor II
c. Fibrinogen
d. Thrombin
C
Which of the following is not an agonist of platelet aggregation?
a. Saline
b. ADP
c. Collagen
d. Epinephrine
B
Which enzyme is blocked by the presence of aspirin?
a. Phospholipase A2
b. Cyclooxygenase
c. Protein kinase
d. ATPase
B
Secondary hemostasis occurs when a sufficient stimulus is present to cause the release of internal ADP, synthesis and release of thromboxane A2, and increased calcium release.
a. True
b. False
A
Which of the following factors is called prothrombin?
a. Fibrinogen
b. Factor II
c. Factor X
d. Factor XIII
B
Which of the following factors usually results in no clinical bleeding when deficient?
a. Factor XII
b. Factor IX
c. Factor VIII
d. Factor VII
A
The step necessary for the functionary factors II, VII, IX, and X is called the ______________ step.
a. Oxidation
b. Hydrolysis
c. Cleavage
d. g-Carboxylation
D
Monitoring of the intrinsic pathway is accomplished by performing which of the following analytical tests?
a. PT
b. PTT
c. Thrombin time
d. Fibrinogen assay
B
Monitoring of the extrinsic pathway is accomplished by performing which of the following analytical tests?
a. PT
b. PTT
c. Thrombin time
d. Fibrinogen assay
A
Which of the following cleaves the fibrinopeptides from fibrinogen?
a. Factor VIII
b. Thrombin
c. Tissue factor
d. Factor XIII
B
Activation of factor VII after the release of tissue fac- tor initiates which of the following pathways?
a. Intrinsic pathway
b. Extrinsic pathway
c. Common pathway
d. Fibrinolytic pathway
B
Which of the following is not true?
a. Factor VIII is a cofactor for factor IXa
b. Factor V is a cofactor for factor Xa
c. Protein K is a cofactor for protein C
d. High-molecular-weight kininogen is a cofactor for factor XIIa
C
If a deficiency of this factor is present, the cross-linking of fibrin will not occur.
a. Factor II
b. Factor V
c. Factor XI
d. Factor XIII
D
Factor VIII is protected from degradation when circulating in the plasma by its carrier protein __________.
a. Factor IX
b. Thrombin
c. Von Willebrand factor
d. Glycoprotein IIb/IIIa
C
Which of the following factors is associated with hemophilia B?
a. Factor VIII
b. Factor IX
c. Factor XI
d. Fibrinogen
B
The activation of plasmin results in which of the
following?
a. The formation of a fibrin clot
b. The formation of the bridge between platelets and the vessel wall
c. The start of the process to break down a fibrin clot
d. The point at which the intrinsic and extrinsic pathways feed into the common pathway
C
Which of the following proteins is degraded by plasmin?
a. Fibrin
b. Fibrinogen
c. AandB
d. None of the above
C
Streptokinase differs from urokinase plasminogen activator (uPA) in that:
a. Streptokinase activates plasminogen to plasmin conversion, whereas uPA inhibits the conversion
b. uPA is effective only when given as a medication
c. Streptokinase is an exogenous activator, whereas uPA is a physiologic activator
d. No difference exists between streptokinase and uPA
C
Which of the following are fibrin degradation products?
a. Fragment X
b. Fragment Y
c. Fragment D
d. All of the above
D
Which of the following describes the role of PAI-1 in hemostasis?
a. Plasminogen activator inhibitor–1 limits the activation of plasminogen
b. Plasminogen activator inhibitor–1 stimulates the activation of plasminogen
c. Plasminogen activator inhibitor–1 is involved in limiting clot formation in vessels
d. Plasminogen activator inhibitor–1 blocks platelet binding to the fibrin clot
A
Which of the following fibrinolytic inhibitors is useful when a2-antiplasmin activity has been exhausted?
a. PAI-1
b. Thrombin-activatable fibrinolysis inhibitor
c. a2-Macroglobulin
d. Plasminogen
C
Positive feedback control of the hemostatic response is accomplished by:
a. Fibrin binding to thrombin to limit further activation
b. Fibrin degradation products interfere with fibrin formation and polymerization
c. Thrombin activates platelets and promotes the release of platelet factor V
d. Thrombin initiates activation of the protein C pathway
C
Which of the following descriptions best describes the actions of protein S?
a. Protein S inactivates factors Va and VIIIa
b. ProteinSisinvolvedintheactivationofthrombin
c. Protein S serves as a cofactor for protein C
d. None of above are functions of protein S
C
A child presents to the pediatrician after having recovered from a viral infection, because the child now has petechiae. The pediatrician orders laboratory testing, and the results reveal that the platelets are decreased. An increase in lymphocytes and eosinophils is also found. What is the probable diagnosis?
a. Acute ITP
b. Chronic ITP
c. NAIT
d. Medication reaction
A
Which of the following tests would help to differen- tiate between Bernard-Soulier syndrome and Glanzmann’s thrombasthenia?
a. Bleeding time
b. Platelet count
c. PT
d. Response to ADP, collagen, and epinephrine in an aggregation assay
D
Glanzmann’s thrombasthenia is best described as a:
a. Platelet deficiency
b. Deficiency of glycoprotein Ib/IX
c. Deficiency of glycoprotein IIb/IIIa
d. Deficiency of dense granules
C
The lack of a secondary wave of platelet aggregation in response to ADP is associated with which of the following disorders?
a. Bernard-Soulier syndrome
b. Gray platelet syndrome
c. Glanzmann’s thrombasthenia
d. D-Storage pool disease
D
A young boy is taken to his pediatrician because his par- ents noticed that he seems to bleed easily and has swollen knees. The following test results were obtained:
PT=Normal Fibrinogen=Normal Platelet count=Normal
aPTT=Prolonged
aPTT with normal pooled
plasma=Corrected the aPTT
Which of the following statements best describes the next steps?
a. The pediatrician should order factor assays for factors VIII and IX
b. The pediatrician should order factor assays for factors X and V
c. The pediatrician should order platelet aggrega- tion testing
d. The pediatrician should request a molecular test for the factor V Leiden defect
A
Which of the following results would be expected in a patient with dysfibrinogenemia?
a. Normal PT, normal aPTT, prolonged thrombin time
b. Abnormal PT, normal aPTT, prolonged thrombin time
c. Abnormal PT, abnormal aPTT, normal thrombin time
d. Normal PT, normal aPTT, normal thrombin time
A
In factor deficiencies, normal PT and aPTT results may be recorded until a factor level is ________.
a. Less than 30%
b. Less than 50%
c. Less than 75%
d. Less than 100%
A
Which of the following conditions is not usually associated with thrombosis?
a. Protein C deficiency
b. Antithrombin deficiency
c. Factor V Leiden mutation
d. Factor V deficiency
D
Which of the following accelerates the activity of antithrombin?
a. Coumadin
b. Aspirin
c. Heparin
d. tPA
C
Which of the following tests is helpful in differentiat- ing fibrinogenolysis from DIC?
a. PT
b. aPTT
c. Fibrinogen
d. D-Dimer
D
A patient who has been receiving a broad-spectrum antibiotic is found to have a prolonged PT. After run- ning a couple of factor assays, you conclude that both the factor X and factor VII levels are decreased. The PT corrected when mixed with normal pooled plasma. What is a possible cause?
a. Inherited factor deficiency
b. Circulating anticoagulant
c. Vitamin K deficiency
d. Effect resulting from antibiotic presence in plasma
A
Which of the following descriptions best describes the principle of platelet aggregation?
a. The decrease in optical density is observed after the addition of an agonist in platelet-poor plasma
b. The increase in optical density is observed after the addition of an agonist in platelet-rich plasma
c. The decrease in optical density is observed after the addition of an agonist in platelet-rich plasma
d. The increase in optical density is observed after the addition of an agonist in platelet-poor plasma
C
When performing platelet aggregation assays, which of the following is an important preanalytical factor?
a. The patient should have fasted overnight
b. The patient must refrain from aspirin-containing products for 7 days before testing
c. After collection, the specimen can be frozen before transport to the laboratory
d. All of the above are important
B
Which of the following conditions will cause an increase in fibrinogen levels?
a. DIC
b. Afibrinogenemia
c. Acute phase reactions
d. Liver disease
B
Which of the following describes the principle of the thrombin time test?
a. After the addition of thromboplastin, the time needed for plasma to form a clot is measured
b.Patient plasma is mixed with thrombin-deficient plasma, and the time to clot is measured
c. An excess of thrombin is added to patient plasma, and the time to clot is measured
d. Clot solubility is assessed using 5 M urea
C
When performing a factor assay for factor VIII, the MLS accidentally added factor IX–deficient plasma to the patient specimens. Which of the following best
describes the expected results?
a. The test will not be affected because the correct factor-deficient plasma was added
b. The test will not be affected because factor-deficient plasma is not needed in a factor assay
c. The test results will not be an assessment of factor VIII levels because factor VIII is present in the factor IX–deficient plasma
d. The test results will be an assessment of factor IX levels and can be calculated using the factor VIII standard curve
C
What are the reagents needed to perform the aPTT test?
a. Calcium chloride
b. Partial thromboplastin
c. AandB
d. None of the above
C
Which of the following tests is reported in conjunction with the INR?
a. PT
b. APTT
c. Thrombin time
d. Fibrinogen assay
A
During a lengthy overseas trip, a 60-year-old man went to a laboratory in Italy to have PT measured to assess his dosage of Coumadin. Typically, in the United States, his results are in the range of 17 to 18 seconds, with an average INR of 1.75. In the laboratory in Italy, his PT was 20.2 seconds and his INR was 1.74. Which of the following descriptions best describes the situation?
a. The patient is taking excessive anticoagulation medication, causing his PT to be prolonged
b. An error is expected in the results from the labo- ratory in Italy
c. The result is not concerning because the INR results are essentially the same
d. He should immediately return to the United States for further assessment
C
During presurgical testing, the aPTT for a patient was longer than 120 seconds. The patient’s history for bleeding is negative. The result was corrected after mixing with normal pooled plasma. The sur- gery is delayed because the surgeon is concerned about bleeding. Which of the following descriptions best describes this situation?
a. The patient is at risk for a bleeding incident if the surgery proceeds
b. The patient likely has a circulating inhibitor
c. The patient likely has a deficiency of a contact factor that is not associated with bleeding
d. The sample was likely contaminated with heparin
C
A 30-year-old woman with a history of miscarriages is being seen by an obstetrician/gynecologist. Which of the following tests would be included in a panel to
assess her condition?
a. DRVVT
b. PT and PTT
c. PT and PTT using normal pooled plasma mix
d. All of the above
D
A patient presents to the emergency department with symptoms consistent with a DVT. Which of the fol- lowing tests is helpful as a screening test for the factor V Leiden mutation?
a. Protein S assay
b. Antithrombin assay
c. Prothrombin 20210 molecular test
d. APCR test
D
A physician wants to obtain a measure of a patient’s iron stores. Which of the following tests would be the most suitable?
a. Serum iron
b. Serum transferrin (TIBC)
c. Serum ferritin
d. Transferrin saturation
C
A 68-year-old woman visited her physician with reports of fatigue and weakness. A CBC was ordered, and the patient’s results were as follows:
RBC 2.50 x 1012/L Hgb 6.2 g/dL
Hct 18.8% MCV 75.2 fL
MCH 24.8 pg MCHC 33%
Which of the following would be a plausible diagnosis for this patient?
a. Iron-deficiency anemia
b. Vitamin B12 deficiency
c. Anemia of chronic inflammation
d. Hemochromatosis
A
A peripheral smear shows a decreased RBC count with microcytic, hypochromic cells with small grape- like inclusions in the RBCs on both Wright stain and Prussian blue stain. This is consistent with:
a. Iron-deficiency anemia
b. Sideroblastic anemia
c. Pernicious anemia
d. b-Thalassemia minor
B
Acquired sideroblastic anemia may be present in all of the following except:
a. Alcoholism
b. Lead poisoning
c. Malabsorption
d. Myelodysplastic syndromes
C
A patient has a macrocytic anemia, and the physician suspects pernicious anemia. Which test would best rule in a definitive diagnosis of pernicious anemia?
a. Homocysteine
b. Intrinsic factor antibodies
c. Ova and parasite examination for D. latum
d. Bone marrow examination
B
Megaloblastic anemias result from which of the following?
a. Deficiencies in free erythrocyte protoporphyrin
b. Deficiencies in Vitamin B12 and folic acid
c. Increases in iron and hepcidin
d. Decreases in liver function
B
A patient’s bone marrow showed erythroid hyperplasia with signs of dysplastic maturation, particularly in the RBC precursors. This is consistent with which of the following?
a. Sickle cell anemia
b. b-Thalassemia major
c. Pernicious anemia
d. G6PD deficiency
C
The CBC for a 57-year-old man had the following results. Which tests would be best to order next?
RBC 2.50x1012/L Hgb 8.5 g/dL
Hct 26.0% MCV 104 fL
MCH 34 pg MCHC 33%
a. Iron studies
b. Vitamin B12 and folic acid levels
c. Bone marrow examination
d. Intrinsic factor antibodies
B
The majority of acquired aplastic anemia cases usu- ally results from which of the following?
a. Unknown causes
b. Pregnancy
c. Chloramphenicol exposure
d. Radiation exposure
A
Which of the following values is the most likely to be normal in a patient with aplastic anemia?
a. RBC count
b. Absolute neutrophil count
c. Absolute lymphocyte count
d. Platelet count
C
Fanconi’s anemia is an inherited aplastic anemia with mutations that lead to:
a. Increased chromosome fragility
b. Myelophthisic anemia
c. Pancreatic issues
d. RBC enzymatic defects
A
Which of the following is decreased in cases of intra- vascular hemolytic anemia?
a. Bilirubin
b. Urine hemosiderin
c. Haptoglobin
d. Plasma hemoglobin
C
Typical CBC findings in hemolytic anemia include:
a. Microcytic, hypochromic cells with increased poikilocytosis
b. Macrocytic, normochromic cells with increased polychromasia
c. Microcytic, normochromic cells with increased poikilocytosis
d. Macrocytic, hypochromic cells with increased polychromasia
B
Which of the following disorders does not have a hemolytic component?
a. Sickle cell anemia
b. Autoimmune hemolytic anemia
c. Glucose-6-phosphate dehydrogenase deficiency
d. Anemia of chronic disease
d
A patient presents with evidence of a hemolytic anemia. Spherocytes, polychromasia, and macro- cytosis are observed. Which of the following would best help to distinguish the cause of the anemia?
a. Osmotic fragility
b. DAT
c. G6PD activity assay
d. Vitamin B12 level
B
Paroxysmal nocturnal hemoglobinuria is character- ized by flow cytometry results that are:
a. Negative for CD55 and CD59
b. Positive for CD55 and CD59
c. Negative for CD4 and CD8
d. Positive for all normal CD markers
A
G6PD deficiency episodes are related to which of the following?
a. Exposure to oxidant damage
b. Defective globin chains
c. Antibodies to RBCs
d. Abnormal protein structures
A
Which of the following disorders is not classified as a microangiopathic hemolytic anemia?
a. Disseminated intravascular coagulation
b. Hemolytic uremic syndrome
c. Traumatic cardiac hemolytic anemia
d. Thrombotic thrombocytopenic purpura
C
A previously healthy 36-year-old woman with visited her physician because of a sudden onset of easy bruising and bleeding. Of the following, which is the most likely cause of her laboratory results?
WBC 10.5 x10^9/L Hct 25.0%
MCHC 32%
PT: 12.8 seconds
RBC 3.00 x10^12/L MCV 83 fL Platelets 18x10^9/L
aPTT: 34 seconds
Hgb 8.0 g/dL MCH 26 pg Differential:
Normal WBCs with moderate schistocytes and polychromasia
a.Sickle cell anemia
b. Chronic myelogenous leukemia
c. Disseminated intravascular coagulation
d. Thrombotic thrombocytopenic purpura
D
Warm autoimmune hemolytic anemia is usually caused by which of the following?
a. IgA antibodies
b. IgG antibodies
c. IgM antibodies
d. Complement
B
Which of the following conditions is not associated with secondary warm autoimmune hemolytic anemia?
a. CLL
b. Idiopathic onset
c. Rheumatoid arthritis
d. Viral infections
B
The majority of hospitalizations associated with sickle cell anemia are due to:
a. Cardiomegaly
b. Cholelithiasis
c. Pneumonia
d. Vasoocclusion
D
Patients with sickle cell trait usually have RBC morphology that includes which of the following?
a. Normocytic, normochromic RBCs with occasional target cells
b. Normocytic, normochromic RBCs with rare sickle cells
c. Hypochromic, microcytic RBCs with moderate target cells
d. Macrocytic, normochromic cells with occasional NRBCs
A
Which laboratory test is best used for definitive diag- nosis of sickle cell anemia?
a. Solubility testing
b. Hemoglobin electrophoresis
c. Peripheral smear review for sickle cells
d. Bone marrow analysis
B
A peripheral smear review shows mildly anemic sample with target cells and oblong hexagonal crystalloids. What is a possible identity for the crystalloids?
a. Hemoglobin S
b. Hemoglobin C
c. Hemoglobin SC
d. Hemoglobin E
B
An 18-year-old man has a CBC done when visiting his physician for a persistent sore throat. He has the following results:
WBC 12.5 x10^9/L Hct 30.0%
MCHC 33%
RBC 6.00 x10^12/L MCV 60 fL
Platelet 218x10^9/L
Hgb 10.0 g/dL MCH 20 pg
Which of the following is most likely?
a. This patient is normal with a slightly elevated WBC count because of his sore throat
b. This patient has infectious mononucleosis and warm autoimmune hemolytic anemia
c. This patient is likely to have b-thalassemia minor
d. There is a specimen quality issue because of a cold agglutinin
C
Hemoglobin H disease is described as:
a. /a
b. a/a
c. /bb
d. b/b
A
A 3-year-old female patient is seen in the hematology clinic to investigate the cause of her persistent anemia. Hemoglobin electrophoresis was ordered, and results showed an elevation in Hgb F, with a small increase in Hgb A2. What is the most likely disorder based on these results?
a. a-Thalassemia major
b. b-Thalassemia major
c. a-Thalassemia minor
d. Hemoglobin H disease
B
A 36-year-old male patient has a CBC performed as part of a routine work physical. The WBC count was 6.5 109/L with a differential count of 48% neutro- phils, 40% lymphocytes, 8% monocytes, 3% eosin- ophils, and 1% basophils. The majority of the neutrophils were mature but hyposegmented, show- ing bandlike or single nuclei. What disorder would be suspected?
a. Alder-Reilly anomaly
b. Leukocyte adhesion deficiency
c. Pelger-Huet anomaly
d. Reed Sternberg syndrome
C
A 38-year-old male patient has the following CBC results:
WBC 32.5 x10^9/L
Hct 48.0%
RBC =5.50 x10^12/L
Platelet= 225 x 10^9/L
Hgb 16.0 g/dL
Differential: 49% segmented neutrophils, 9% bands, 25% lymphocytes, 9% monocytes, 1% eosinophils, 4% metamyelocytes, 3% myelocytes; RBC and platelet morphology appear normal
Which of the following conditions is the most likely cause of these results?
a. Bacterial infection
b. CML
c. Refractory anemia
d. Viral infection
A
Which of the following cytochemical stains is best used to distinguish cells of monocytic origin?
a. a-Naphthyl acetate esterase
b. Naphthol AS-D chloroacetate esterase
c. Myeloperoxidase
d. Periodic acid–Schiff
A
A positive tartrate-resistant acid phosphatase (TRAP) stain is indicative of:
a. Burkitt’s lymphoma
b. Chronic myelogenous leukemia
c. Hairy cell leukemia
d. Multiple myeloma
C
Which mutation is shared by a large percentage of patients with polycythemia vera, essential thrombocythemia, and primary myelofibrosis?
a. BCR/ABL
b. JAK2 V617F
c. PDGFR
d. RUNX1
B
A patient has a CBC and peripheral smear with an elevated WBC count and left shift, suggestive of a diagnosis of CML. Which of the following tests would be the most helpful in confirming the sus- pected diagnosis?
a. Cytochemical staining for myeloperoxidase and LAP
b. Karyotyping for the Philadelphia chromosome
c. Flow cytometry for myeloid cell markers
d. Lymph node biopsies for metastasis
B
A patient has a splenomegaly, and his CBC shows a left shift; bizarre RBCs, including dacryocytes; and notable platelet abnormalities. Which of the follow- ing would be the most helpful in determining the patient’s diagnosis?
a. Bone marrow biopsy
b. LAP staining
c. Karyotyping for the Philadelphia chromosome
d. Spleen biopsy
A
Which of the following peripheral blood findings would not be expected in a patient with a myelodysplastic syndrome?
a. Hypogranular neutrophils
b. Binucleate neutrophils and NRBCs
c. Circulating micromegakaryocytes
d. Decreased vitamin B12 and folic acid
D
The WHO system classifies this disorder as a Myelo- proliferative/Myelodysplastic syndrome.
a. Refractory Anemia with Ringed Sideroblasts
b. 5qSyndrome
c. Chronic Myelomonocytic Leukemia
d. Refractory Anemia with Multilineage Dysplasia
C
A 4-year-old male patient presents with a slightly elevated WBC count, and occasional blasts are present on the differential. Flow cytometry is performed with the following results: CD10(+), CD19 (+), CD22(+), CD79a(+), TdT(+). Which of the following diagnoses is the most likely?
a. Intermediate B-cell ALL
b. Pre–B-cell ALL
c. T-cell ALL
d. Pre–T-cell ALL
A
Which of the following may predict a better progno- sis in patients with ALL?
a. The patient is a child
b. Peripheral blood blast counts greater than 30 x10^9/L
c. The Philadelphia chromosome is present
d. The patient is hypodiploid
A
A 28-year-old female patient presented to the emergency department with symptoms suggestive of DIC. A CBC and coagulation studies were ordered. The peripheral smear showed blasts and immature cells with heavy granulation and Auer rods. Which of the following disorders would be the most likely?
a. AML with t(9;11)(p22;q23); MLLT3-MLL
b. AML with t(15;17)(q22;q12); PML-RARa
c. ALL with t(12;21)(p13;q22); ETV6-RUNX1
d. ALL with t(9;22)(q34;q11.2); BCR-ABL1
B
A patient presents with an elevated WBC count, increased monocytes, and blasts present on the differential. Flow cytometry is performed with the following results: CD4+, CD11b+, CD11c+, CD13+, CD14+, CD33+, CD36+, CD64+. Which of the following diagnoses is the most likely?
a. AML with minimal differentiation
b. AML with maturation
c. Acute myelomonocytic leukemia
d. Acute monoblastic leukemia
C
A 75-year-old male patient visits his physician for an annual checkup. His CBC showed an elevated WBC count with numerous small lymphocytes and smudge cells, and a subsequent bone marrow biopsy and aspirate showed hypercellularity with increased lymphoid cells. What is a presumptive diagnosis based on this information?
a. Acute lymphoblastic leukemia
b. Chronic lymphocytic leukemia/small cell lymphocytic lymphoma
c. Hairy cell leukemia
d. Therapy-related acute myelogenous leukemia
B
Which of the following is not considered a disorder of plasma cells?
a. Monoclonal gammopathy of undetermined significance
b. Multiple myeloma
c. Se ́zary syndrome
d. Waldenstrom’s macroglobulinemia
C
Which of the following sets of CD markers are associated with T lymphocytes?
a. CD2, CD3, CD4
b. CD13, CD14, CD15
c. CD19, CD20, CD22
d. CD34, CD71, CD117
A
Bone marrow cellularity is most often estimated by examining which of the following?
a. Aspirate
b. Buffy coat
c. Core biopsy
d. Crush preparations
C
A dry tap may be seen in bone marrow aspirations in
all of the following conditions except:
a. Aplastic anemia
b. Hairy cell leukemia
c. Multiple myeloma
d. Primary myelofibrosis
C
The largest hematopoietic cells present in the bone marrow are:
a. Lymphoblasts
b. Megakaryocytes
c. Osteoblasts
d. Pronormoblasts
B
Hemoglobin A contains which of the following con- figurations of globin chains?
a. a2b2
b. a2d2
c. a2g2
d. a2e2
A
Which of the following locations is not a site of extra- medullary hematopoiesis?
a. Bone marrow
b. Liver
c. Spleen
d. Thymus
A
Patients with renal failure often exhibit compro- mised hematopoietic activity because of which of the following?
a. Concurrent depression of thyroid hormones
b. Decreased production of erythropoietin
c. Decreased production of GM-CSF
d. Bone marrow suppression caused by medications
B
Which of the following best describes the function of the Rapoport-Luebering pathway?
a. It produces ATP to help maintain RBC membrane deformability
b. It results in the reduction of glutathione
c. It produces 2,3 diphosphoglycerate (2,3 DPG)
d. It produces cytochrome b reductase
C
A 3-year-old male patient visits the pediatrician for a well-child checkup and routine CBC. He has
a total WBC count of 5.0 109/L, RBC count of 3.8 1012/L, and platelet count of 225 109/L. The differential showed 25% segmented neutrophils, 62% lymphocytes, 10% monocytes, and 3% eosinophils. This patient is likely:
a. A normal child
b. Suffering from an acute bacterial infection
c. Immunosuppressed
d. A patient with leukemia
A
Which of the following cell types exhibit IgE recep- tors on their surface membranes?
a. Basophils
b. Eosinophils
c. Band neutrophils
d. Monocytes
A
A 62-year-old female patient’s CBC showed the fol- lowing results: total WBC count of 14.0 109/L, RBC count of 3.95 1012/L, and platelet count of 245 109/L. The differential showed 65% seg- mented neutrophils, 10% bands, 15% lymphocytes, and 10% monocytes. Toxic granulation and Do ̈hle bodies were seen in many of the neutrophils. Which of the following is most likely?
a. The patient had just finished running a half marathon
b. The patient has a bacterial infection
c. The patient is normal
d. The patient has a helminth infection
B
A CBC on a patient with Chediak-Higashi syndrome is expected to exhibit which of the following?
a. Giant platelets and Do ̈hle-like inclusions in the cytoplasm of all granulocytes
b. Large, darkly staining cytoplasmic granules in all WBCs
c. Giant fused granules and lysosomes in WBC cytoplasm
d. Leukocytosis and bilobed eosinophils
C
Patients with infectious mononucleosis often have the following CBC results:
a. Lymphocytosis, including increased variant/ reactive lymphocytes
b. Lymphocytopenia with numerous small lymphocytes
c. Neutrophilia, including a predominant shift to the left
d. Neutropenia with a distinct predominance of toxic granulation
A
Flow cytometry for monitoring a patient with acqui- red immunodeficiency syndrome should include markers for which of the following?
a. CD30 and CD42
b. CD4 and CD8
c. CD34 and CD33
d. CD21 and CD22
B
Which of the following disorders is classified as a myelodysplastic/myeloproliferative disease?
a. Acute promyelocytic leukemia
b. Chronic lymphocytic leukemia
c. Atypical chronic myelogenous leukemia
d. Essential thrombocythemia
C
All of the following cells are derived from CFU-GEMM, common myeloid progenitor cells except:
a. Basophils
b. Lymphocytes
c. Neutrophils
d. RBCs
B
A patient’s differential count shows an elevated eosinophil count. This is consistent with which of the following?
a. Aplastic anemia
b. Bacterial infection
c. Parasitic infection
d. Viral infection
C
Antibodies are produced by which of the following:
a. Macrophages
b. T lymphocytes
c. Plasma cells
d. Basophils
C
The nitroblue tetrazolium reduction test is used to assist in the diagnosis of:
a. Leukocyte adhesion disorders (LADs)
b. Chronic granulomatous disease (CGD)
c. May-Hegglin anomaly
d. Pelger-Huet anomaly
B
A newly diagnosed patient has an acute leukemia. Which of the following would initially be the most useful in determining the origin of the blasts seen?
a. Leukocyte alkaline peroxidase (LAP) and nonspecific esterase (NSE)
b. Periodic acid–Schiff (PAS) and tartrate-resistant acid phosphatase (TRAP)
c. Myeloperoxidase (MPO) and terminal dexoynucleotidyl transferase (TdT)
d. Sudan black B and brilliant cresyl blue
C
Therapy for CML often includes the use of a targeted tyrosine kinase inhibitor, such as:
a. Imatinib mesylate
b. All-trans retinoic acid
c. Ablative chemotherapy
d. 2-CDA/cladribine
A
Polycythemia vera can be differentiated from secondary polycythemia because of polycythemia vera presenting with which of the following?
a. Elevated hemoglobin results
b. Decreased erythropoietin levels
c. Normal to decreased WBC counts
d. Erythroid hyperplasia in the marrow
B
The genetic mutation associated with CML is:
a. t (15;17)(q22;q12)
b. t(11;14)(p15;q11)
c. t(9:22)(q34;q11.2)
d. t(8:21)(q22;q22)
C
Which of the following is not classified as a myeloproliferative neoplasm?
a. Chronic eosinophilic leukemia
b. Essential thrombocythemia
c. Mastocytosis
d. Waldenstrom’s macroglobulinemia
D
What is the minimum percentage of ringed sidero- blasts present in the bone marrow for a diagnosis of refractory anemia with ringed sideroblasts?
a. 10%
b. 15%
c. 20%
d. >25%
B
All of the following are considered to be signs of dyserythropoiesis except:
a. Multinucleate RBCs
b. Basophilic stippling
c. Do ̈hle bodies
d. Oval macrocytes
C
Features of dysmyelopoiesis and dysmegakaryopoi- esis seen on a peripheral smear or bone marrow in cases of myelodysplastic syndromes include all of the following except:
a. Pelgeroid neutrophils
b. Neutrophils showing hypogranulation
c. Giant abnormal platelets with abnormal granules
d. Siderotic granules
D
The peripheral blood and bone marrow picture sometimes will look similar in myelodysplastic syn- dromes and some RBC disorders. Which of the following RBC disorders tends to have a peripheral smear appearance similar to cases of myelodysplastic syndromes?
a. Iron deficiency anemia
b. a-Thalassemia minor
c. Megaloblastic anemia
d. Warm autoimmune hemolytic anemia
C
Most of the chromosome abnormalities seen in myelodysplastic syndrome involve which of the following chromosomes?
a. 5,7,8,11,13,20
b. 2,3,9,15,16,26
c. 3, 6, 10, 14, 21
d. 1, 4, 15, 17, 21
A
Which of the following is not one of the recurrent genetic abnormalities seen in cases of acute myeloid leukemia?
a. AML with t(8;21)(q22;q22); AML1(CBFa)/ETO
b. AML with t(15;17)(q22;q12); (PML/RARa)
c. AML with inv(16)/p(13;q22); (CBFb/MYH11)
d. AML with t(1;19)(q23;q13); (E2A/PBX1)
D
AML with 11q23 (MLL) abnormalities are associated with which cell line?
a. Eosinophil
b. Erythrocyte
c. Monocyte
d. Neutrophil
C
T-cell ALL most commonly affects which of the following?
a. Infants
b. Teenaged males
c. Adult females
d. Elderly males
B
Which of the following disorders is considered to be classified by WHO as an AML, not otherwise classified?
a. Acute erythroid leukemia
b. Acute megakaryoblastic leukemia
c. Acute promyelocytic leukemia
d. AML without maturation
C
A 69-year-old female patient presented with symp- toms of fatigue and easy bruising. A CBC was ordered. The peripheral smear showed a large number of blasts, anemia, and thrombocytopenia. A bone mar- row examination was performed, revealing hypercel- lularity and a blast appearance similar to that of the peripheral smear. Flow cytometry revealed cells positive for CD13,CD33,CD34,CD38,CD117,and HLA-DR. Cells were negative for TdT, myeloperoxidase, and nonspecific esterase. Based on this informa- tion, which of the following is most likely?
a. AML with minimal differentiation
b. AML without maturation
c. B-cell ALL without maturation
d. Acute monoblastic leukemia
A
A 3-year-old female patient was having symptoms of lethargy and bruising and reported pain in her legs. Her mother also mentioned noticing several swollen lymph nodes when bathing the child. The pediatri- cian ordered a CBC, which had the following results.
WBC- 18.5 x10/L
RBC- 3.00 1012/L
Hgb 9.0 g/dL
Hct 27.0%
MCHC 33%
Differential: 80%
MCV 90 fL
Platelet- 58 x109/L
MCH 30 pg
blastocytes, 6% segmented neutrophils, 8% lymphocytes, 6% monocytes. RBC morphology was normal, and platelets were markedly decreased. What is the most likely reason that the physician ordered a lumbar puncture after receiving the CBC results?
a. To rule out an acute case of meningitis
b. To look for leukemia cells in the spinal fluid
c. To rule out infectious mononucleosis
d. To rule out multiple sclerosis
B
