Photomicrographs and Color Plate Examination Flashcards
1
Q
- Plate 1 is a photomicrograph of an antinuclear
antibody test using human fibroblasts, fluorescein
isothiocyanate (FITC)–conjugated antihuman
serum, and transmitted fluorescence microscopy.
Which pattern of immunofluorescence is
demonstrated in this 400× field?
A. Homogenous
B. Peripheral
C. Nucleolar
D. Speckled
A
A. Homogenous
2
Q
- Plate 2 shows the electrophoresis of serum
proteins on a high-resolution agarose gel at
pH 8.6. Sample 1 (in lane 1) is a normal serum
control. Which sample can be presumptively
classified as a monoclonal gammopathy?
A. Sample 2
B. Sample 4
C. Sample 6
D. Sample 8
A
C. Sample 6
3
Q
- Plate 3 shows a densitometric scan of a control
serum for protein electrophoresis. The percentages
of each fraction are shown below the scan. Given
these results, what is the most appropriate initial
corrective action?
A. Repeat the electrophoresis run using fresh
control serum
B. Report the results, provided that the previous
run was in control
C. Move the fourth fraction mark to the right and
redraw the scan
D. Calculate the concentration of each fraction in
grams per deciliter
A
C. Move the fourth fraction mark to the right and
redraw the scan
4
Q
- Plate 4 shows the electrophoresis of serum proteins
on a high-resolution agarose gel at pH 8.6. Which
band represents the β lipoprotein?
A. A
B. B
C. C
D. D
A
C. C
5
Q
- Plate 5 is a densitometric scan of a serum protein
electrophoresis sample. The relative and absolute
concentration of each fraction and reference limits
are shown below the scan. What is the correct
classification of this densitometric pattern?
A. Polyclonal gammopathy associated with chronic
inflammation
B. Nephrotic syndrome
C. Acute inflammation
D. Hepatic cirrhosis
A
C. Acute inflammation
6
Q
- Plate 6 shows an agarose gel on which
immunofixation electrophoresis (IFE) was
performed at pH 8.6. The gel contains the
same serum sample as number 6 shown in Plate 2.
What is the heavy and light chain type of the
monoclonal protein present in this sample?
A. IgA κ
B. IgG κ
C. IgG λ
D. IgM λ
A
B. IgG κ
7
Q
- Plate 7 shows the electrophoresis of hemoglobin
(Hgb) samples performed on agarose gel, pH 8.8.
The control sample is located in lanes 2 and 10
and contains Hgb A, S, and C. Which sample(s)
are from neonates?
A. Samples 1 and 5
B. Sample 3
C. Sample 7
D. Samples 8 and 9
A
A. Samples 1 and 5
8
Q
- Plate 8 shows the electrophoresis of Hgb samples
on acid agar gel, pH 6.0. The sample order is the
same as for plate 7 with the A, S, C control
hemolysate in lanes 2 and 10. Based upon the
electrophoretic mobility of sample 7 as seen in
both plate 7 and plate 8, what is the patient’s
Hgb phenotype?
A. SS
B. AS
C. AD
D. AG
A
A. SS
9
Q
- Plate 12 is a bronchoalveolar lavage sample
concentrated by cytocentrifugation and stained
with Wright’s stain, 1,000×. The sample was
obtained from a patient with AIDS who resides in
the midwestern United States. Which infectious
agent is present?
A. Pneumocystis jiroveci (carinii)
B. Mycobacterium avium–intracellulare
C. Histoplasma capsulatum
D. Cryptococcus neoformans
A
C. Histoplasma capsulatum
10
Q
- Plate 18 is a peripheral blood film stained with
Giemsa’s stain, 1,000×. What condition is
suspected from this field?
A. Macrocytic anemia
B. Agranulocytosis
C. Relapsing fever
D. Lead poisoning
A
C. Relapsing fever
11
Q
- Plate 19 shows an organism isolated from an eye
wash of a patient with a cornea infection who had
been wearing contact lenses for the past 2 years.
What is the name of the causative agent?
A. Naegleria spp.
B. Acanthamoeba spp.
C. Entamoeba histolytica
D. Trichomonas vaginalis
A
B. Acanthamoeba spp.
12
Q
- Plate 20 is a Wright’s-stained peripheral blood
film, 1,000×. Which malarial stage is present in
the RBC in the center of the plate?
A. Ring trophozoite of Plasmodium vivax
B. Mature trophozoite of Plasmodium malariae
C. Macrogametocyte stage of Plasmodium
falciparum
D. Mature gametocyte stage of Plasmodium ovale
A
A. Ring trophozoite of Plasmodium vivax
13
Q
- Plate 21 is a modified acid-fast stain with
malachite green counterstain of a stool specimen,
1,000× magnification. The oocysts seen in this
field are approximately 5 μ in diameter. Which
organism is present?
A. Isospora belli
B. Cryptosporidium parvum
C. Cyclospora spp.
D. Sarcocystis spp.
A
B. Cryptosporidium parvum
14
Q
- Plate 22 is a Gram-stained CSF concentrated
by centrifugation, 1,000×. Which organism is
present?
A. Neisseria meningitidis
B. Staphylococcus aureus
C. Streptococcus pneumonia
D. Listeria monocytogenes
A
C. Streptococcus pneumonia
15
Q
- Plate 23 is a urinary sediment viewed under
400× magnification using a brightfield microscope.
What is the object located in
the center of the field?
A. Schistosoma haematobium ovum
B. Oval fat body
C. Glitter cell
D. Fecal contaminant
A
B. Oval fat body
16
Q
- Plate 24 is a urinary sediment viewed under
400× magnification using a brightfield microscope.
Which crystals are seen?
A. Uric acid
B. Calcium oxalate
C. Ammonium magnesium phosphate
D. Hippuric acid
A
A. Uric acid
17
Q
- Plate 25 is a urinary sediment viewed under
400× magnification using a brightfield microscope.
Which crystals are seen?
A. Uric acid
B. Calcium oxalate
C. Ammonium magnesium phosphate
D. Hippuric acid
A
C. Ammonium magnesium phosphate
18
Q
- Plate 26 is a urinary sediment viewed under
400× magnification using a brightfield microscope.
Which type of cast is present?
A. Hyaline cast
B. Broad cast
C. Waxy cast
D. Coarse granular cast
A
D. Coarse granular cast
19
Q
- Plate 27 shows a urinary sediment viewed under
400× magnification using brightfield microscopy.
This colorless crystal is presumptively identified as:
A. Calcium phosphate
B. Acetaminophen
C. Cystine
D. Hippuric acid
A
C. Cystine
20
Q
- Plate 28 is a Wright’s-stained cytocentrifuge
preparation of pleural fluid, 1,000×. What is the
correct classification of the largest mononuclear
cell located in the center of the plate?
A. Histiocyte
B. Macrophage
C. Lymphoblast
D. Mesothelial cell
A
D. Mesothelial cell
21
Q
- Plate 29 is a Wright’s-stained smear of pleural
fluid prepared by cytocentrifugation. The largest
cell in this field (see arrow) is identified as a:
A. Signet ring macrophage
B. Reactive mesothelial cell
C. Foam cell
D. Metastatic cell from the breast
A
A. Signet ring macrophage
22
Q
- Plate 30 is from a Wright’s-stained peripheral
blood film, 1,000×. Which of the following best
describes the cells in this plate?
A. Normal morphology
B. Macrocytic red blood cells
C. Hypersegmented neutrophil present
D. Reduced platelets
A
A. Normal morphology
23
Q
- Plate 31 is a Wright’s-stained peripheral blood
film, 1,000×. What is the most appropriate
classification of the red cell morphology seen in
this field?
A. Microcytic, hypochromic
B. Microcytic, normochromic
C. Normocytic, normochromic
D. Macrocytic, normochromic
A
D. Macrocytic, normochromic
24
Q
- Plate 32 is a Wright’s-stained peripheral blood
film, 1,000×. What is the most appropriate
classification of the white blood cells (WBCs)
present in this field?
A. Reactive (atypical) lymphocytes
B. Large lymphoblasts exhibiting L2 morphology
C. The M4 subtype of acute granulocytic leukemia
D. Monocytes
A
A. Reactive (atypical) lymphocytes
25
Q
- Plate 33 is from a Wright’s-stained peripheral
blood film, 400×. Which of the following tests
may be performed to enable an accurate diagnosis?
A. Leukocyte alkaline phosphatase (LAP) stain
B. Myeloid marker study by flow cytometry
C. Myeloperoxidase stain
D. Periodic acid–Schiff (PAS) stain
A
A. Leukocyte alkaline phosphatase (LAP) stain
26
Q
- Plate 34 is from a Wright’s-stained peripheral
blood film, 400×. The cells seen are diagnostic
of which condition?
A. Intravascular hemolytic anemia
B. Sickle cell disease
C. Myelofibrosis
D. Erythroleukemia
A
B. Sickle cell disease
27
Q
- Plate 35 is from a Wright’s-stained peripheral
blood film, 1,000×. Which description of the
RBC morphology and platelets is correct?
A. Microcytic, hypochromic with marked
poikilocytosis and increased platelets
B. Macrocytic, hypochromic with marked
anisocytosis and normal platelets
C. Normocytic, normochromic with mild
poikilocytosis and increased platelets
D. Microcytic, hypochromic, with mild anisocytosis
and normal platelets
A
A. Microcytic, hypochromic with marked
poikilocytosis and increased platelets
28
Q
- Plate 36 is a Wright’s-stained peripheral blood
film, 1,000×. The RBCs in this plate are
characteristic of:
A. Hemolytic anemia
B. Myelofibrosis
C. Hgb C disease
D. Sideroblastic anemia
A
B. Myelofibrosis
29
Q
- Plate 37 is a Wright’s-stained peripheral blood
film, 1,000×. The cells seen in this plate are
associated with:
A. Lead poisoning
B. Aplastic anemia
C. Iron deficiency anemia
D. Intravascular hemolysis
A
A. Lead poisoning
30
Q
- Plate 38 is from a Wright’s-stained peripheral
blood film, 400×. Which of the following
conditions is consistent with this RBC
morphology?
A. Erythroleukemia
B. β Thalassemia major
C. Folate deficiency anemia
D. Autoimmune hemolytic anemia
A
B. β Thalassemia major
31
Q
- Plate 39 is from a Wright’s-stained smear of
peripheral blood, 1,000× from a patient with
a WBC count of 35 × 109/L. The patient is
60 years old with firm, enlarged lymph nodes and
hepatosplenomegaly. These same cells comprise
50% of the bone marrow WBCs and are positive
for PAS and negative for myeloperoxidase and
nonspecific esterase. What is the most likely
diagnosis?
A. Epstein–Barr virus infection
B. Infectious mononucleosis
C. Chronic lymphocytic leukemia
D. Waldenström’s macroglobulinemia
A
C. Chronic lymphocytic leukemia
32
Q
- Plate 40 is from a Wright’s-stained peripheral
blood film, 400×. The RBC morphology is most
consistent with which of the following anemias?
A. Folate deficiency
B. Iron deficiency
C. Hemolytic
D. Sideroblastic
A
D. Sideroblastic
33
Q
- Mr. Vacini, an Italian immigrant, has been
hospitalized with tachycardia, a rapidly
decreasing hematocrit, and blood in his urine.
Twenty-four hours prior to admission, he had
taken his first dose of a sulfonamide prescribed
for a urinary tract infection. Plate 41 is from a
Wright’s-stained smear of his peripheral blood,
1,000×. Which laboratory test would be helpful
in establishing a diagnosis of Mr. Vacini’s
hematologic problem?
A. Heinz body preparation
B. Hgb H preparation
C. Iron stain
D. New methylene blue stain
A
A. Heinz body preparation
34
Q
- Plate 42 is from a Wright’s-stained smear of
peripheral blood, 1,000×. The bone marrow
aspirate of this patient demonstrated an
abundance of cells with this morphology. Which
of the following conditions is most likely to be
associated with this sample?
A. Sézary syndrome
B. Hodgkin’s disease
C. Burkitt’s lymphoma
D. Multiple myeloma
A
D. Multiple myeloma
35
Q
- Plate 43 is from a Wright’s-stained peripheral
blood film, 1,000×. The WBC appearing in this
plate is most likely a:
A. Myeloblast
B. Promyelocyte
C. Myelocyte
D. Monoblast
A
A. Myeloblast
36
Q
- Plate 44 is a Wright’s-stained peripheral blood
film, 1,000×. The white blood cells in this field
are negative for peroxidase, chloroacetate esterase,
and Sudan B. The cells are positive for terminal
deoxynucleotidyl transferase (Tdt) and PAS. On
the basis of these findings, what is the most
appropriate classification of these cells?
A. Lymphoblasts with L1 morphology
B. Lymphoblasts with L2 morphology
C. Lymphoblasts with L3 morphology
D. Chronic lymphocytic leukemia cells
A
A. Lymphoblasts with L1 morphology
37
Q
- Plate 45 is from a Wright’s-stained peripheral
blood film, 1,000×. Sixty percent of the WBCs
are positive for naphthol AS-D chloroacetate
esterase (specific esterase), and 70% are positive
for α-naphthyl acetate esterase (nonspecific
esterase). The WBCs in this plate are characteristic
of which FAB subtype of acute nonlymphocytic
leukemia?
A. M1
B. M2
C. M3
D. M4
A
D. M4
38
Q
- Plate 46 is from a Wright’s-stained peripheral
blood film, 1,000×. The WBCs shown in this
field are classified as:
A. Blasts
B. Prolymphocytes
C. Plasma cells
D. Myelocytes
A
A. Blasts
39
Q
- Plate 47A shows cells from the same sample
as plate 46 after peroxidase staining, 1000×.
Plate 47B is a normal peroxidase-stained
peripheral blood film, 1,000×, which is used
as a control. The blast cell shown in plate 47A is
classified as:
A. Peroxidase positive
B. Weakly peroxidase positive
C. Peroxidase negative
D. Invalid because of an improper control reaction
A
A. Peroxidase positive
40
Q
- Plate 48 is from a Wright’s-stained peripheral
blood film, 1,000×. The WBC shown in the center
of the field (see arrow) is classified as a:
A. Blast
B. Promyelocyte
C. Myelocyte
D. Prolymphocyte
A
B. Promyelocyte
41
Q
- Plate 49 is a Wright’s-stained peripheral blood
film, 1,000×. What is the most appropriate
classification of the WBCs seen in this field?
A. Lymphoblasts
B. Myeloblasts
C. Promyelocytes
D. Prolymphocytes
A
B. Myeloblasts
42
Q
- Plate 50 is a Wright’s-stained peripheral blood
film, 1,000×. Which description best characterizes
the morphology of the neutrophil shown in this
plate?
A. Normal morphology
B. Döhle bodies
C. Toxic granulation
D. Hypersegmentation
A
C. Toxic granulation
43
Q
- Plate 51 shows a urinary sediment under 400×
magnification stained with Sternheimer–Malbin
stain. What is the large object to the right of the
center of this field?
A. Squamous epithelial cell
B. Artifact
C. Renal epithelial cell
D. Transitional epithelial cell
A
A. Squamous epithelial cell
44
Q
- Plate 52 shows a urinary sediment under 400×
magnification stained with Sternheimer–Malbin
stain. What is the large cell to the right of the
center of the field?
A. WBC
B. Transitional epithelial cell
C. Renal epithelial cell
D. Squamous epithelial cell
A
C. Renal epithelial cell
45
Q
- Plate 53 shows a urinary sediment under 400×
magnification stained with Sternheimer–Malbin
stain. What is the large cell in the lower right of
the field?
A. WBC
B. Transitional epithelial cell
C. Renal epithelial cell
D. Squamous epithelial cell
A
B. Transitional epithelial cell
46
Q
- Plate 54 shows a urinary sediment under 400×
magnification stained with Sternheimer–Malbin
stain. What is the large object to the right of the
center of the field?
A. Cast
B. Mucus
C. Artifact
D. Hair
A
A. Cast
47
Q
- Plate 55 is a Wright’s-stained cytocentrifuge
preparation of pleural fluid, 1,000×. What is
the large cell near the center of the field?
A. Macrophage
B. Mesothelial cell
C. Blast
D. Plasma cell
A
B. Mesothelial cell
48
Q
- Plate 56 is a Papanicolaou-stained seminal fluid,
1,000× magnification. What is the round cell near
the center of the field?
A. WBC
B. Primary spermatocyte
C. Histiocyte
D. Spermatid
A
B. Primary spermatocyte
49
Q
- Plate 57 is a Wright’s-stained bronchioalveolar
lavage (BAL) fluid, 1,000× magnification. The
cellularity in this field is suggestive of which
condition?
A. Bacterial pneumonia
B. Rheumatoid arthritis
C. Lymphoma or leukemia
D. Small cell carcinoma
A
C. Lymphoma or leukemia
50
Q
- Plate 58 is a 1,000× field of a FISH test for
BCR/ABL using a dual fusion probe, consisting of
a Spectrum Green–labeled probe to the BCR 22
q11.2 locus, and a Spectrum Orange–labeled
probe to ABL 9q34 and counterstained with
DAPI. The cells are in interphase. The cells in this
field are best described as:
A. BCR/ABL positive
B. BCR/ABL negative
C. BCR/ABL positive with an atypical pattern
D. Inconclusive
A
A. BCR/ABL positive
51
Q
- Plate 59 is a 1,000× field of a FISH test for
BCR/ABL using a dual fusion probe, consisting
of a Spectrum Green–labeled probe to the BCR 22
q11.2 locus, and a Spectrum Orange–labeled
probe to ABL 9q34 and counterstained with
DAPI. The cells are in interphase. The cells in this
field are best described as:
A. BCR/ABL positive
B. BCR/ABL negative
C. BCR/ABL positive with an atypical pattern
D. Inconclusive
A
B. BCR/ABL negative
