Hematology Practice Questions & Ratio

MEDICAL LABORATORY SCIENCE • HEMATOLOGY PRACTICE QUESTIONS + ANSWERS & RATIONALIZATIONS • • • • • • • • • The term phlebotomy is derived from Greek words that, literally translated, mean to: a. Cut a vein b. Draw blood c. Stick a vein d. Withdraw blood → The word phlebotomy comes from the Greek words phlebos, meaning “vein,” and tome meaning “incision”. Literally translated, the word phlebotomy means to make incision in (or cut) a vein Plastic red-top tubes used to collect blood specimens usually contain: a. Anticoagulants b. Clot activators c. No additives d. Preservatives Pink-top tube containing EDTA is primarily used for: a. Blood bank tests b. Chemistry test c. Coagulation tests d. Microbiology tests How many times do you mix non additive tubes? a. 2 or 3 b. 5 to 10 c. 8 to 12 d. None Insufficient mixing of an anticoagulant tube can lead to: a. Hemolysis of the specimen b. Lipemia of the specimen c. Microclots in the specimen d. The sample clotting to fast → Insufficient mixing → microclots → Mixed vigorously → hemolysis Labeling of routine inpatien blood specimens should take place: a. At the bedside immediately after collection b. Before the blood specimens are collected c. In the lab processing area after collection d. Outside the patient’s room after collection According to CLSI, depth of heel puncture should not exceed: a. 1.5 mm b. 2.0 mm c. 2.4 mm d. 4.9 mm Which of the following can be a complication of a heel puncture that is too deep? a. Osteoarthritis b. Osteoporosis c. Osteomyelitis d. Osteosarcoma Select the needle most commonly used in standard venipuncture in an adult: a. 1 inch, 18g b. 1 inch, 21g c. 0.5 inch, 23 g d. 0.5 inch, 25g • • • • • • • This needle gauge is used primarily for infant or child veins, and difficult or hard veins of adults: a. 16 b. 18 c. 21 d. 23 Which of the following veins are listed in the proper order of selection for venipuncture? a. Basilic, cephalic, median cubital b. Cephalic, median cubital, basilic c. Media, median basilic, cephalic d. Median cubital, cephalic, basilic According to CLSI, venipuncture should not be performed on leg, ankle, or foot veins unless: a. Both arms have IVs or other intravascular devices b. Permission of the patient’s physician has been obtained c. There are not acceptable antecubital or hand veins d. The patient does not have any coagulation problems An inpatient vehemently refuses to allow you to collect a blood specimen. What should you do? a. Convince the patient to cooperate and collect the sample anyway b. Have the nurse physically restrain the patient and draw the specimen c. Notify the patient’s nurse and document the patient’s refusal d. Return to the lab, cancel the test request, and inform the physician You have just made two unsuccessful attempts to collect a fasting blood specimen from an outpatient. The patient rotates his arm, and you note a large vein that had not seen before. How do you proceed? a. Ask another phlebotomist to collect the fasting specimen b. Ask the patient to come back later so that you can try again c. Call the supervisor for permission to make a third attempt d. Make a third attempt on newly discovered large vein A diabetic patient has had a mastectomy on her right side and cannot straighten her left arm because of arthritis. The best place to collect a blood specimen is: a. An ankle or foot vein on either of her legs b. The left forearm or hand, using a butterfly c. The right arm, below the antecubital fossa d. The right hand, using a capillary puncture You must collect a PT specimen from a ptient with IVs in both arms. The best place to collect the specimen is: a. Above on of the IVs b. Below one of the IVs c. From an ankle vein d. From one of the IVs An unconscious inpatient does not have an ID band. The name on an envelope on the patinet’s nightstand matches with requisition. What should you do? a. Ask the nurse to verify the patient’s ID and collect the specimen b. Complete the required procedure and then file an incident report c. Do not start any procedure until the nurse attaches an ID bracelet d. Make a computer entry that will alert other phlebotomists of the issue 1 • • • • • • • • • • If you have no choice but collect a specimen from an arm with a hematoma, collect the specimen: a. Above it b. Beside it c. Distal to it d. Through it When encountering a patient with a fistula, the phlebotomist should: a. Apply the tourniquet below the fistula b. Use the other arm c. Collect the blood from the fistula d. Attach a syringe to the T-tube connector Peak levels of this analyte typically occur around 0800 hours. a. Bilirubin b. Cortisol c. Eosinophil d. Glucose Which of the following analytes is typically increased in chronic smokers? a. Bicarbonate b. Hemoglobin c. O2 saturation d. Vitamin B12 → Chronic smokers = ↑ Hgb, RBC, MC, WBC It is not a good idea to collect a CBC from a screaming infant because the: a. Chance of hemolysis is increased b. Platelets are more likely to clump c. Specimen may be hemoconcentrated d. WBCs may be temporarily elevated The best specimens to use for establishing inpatient reference ranges for blood tests are: a. Basal-state specimens b. Fasting specimens c. Postprandial specimens d. Steady-state specimens Going without food or drink except water for 8 to 12 hours is defined as: a. Fasting b. NPO → nothing per orem or nothing by mouth c. Routine d. TDM A 12-hour fast is normally required in testing for this analyte: a. Bilirubin b. Calcium c. Electrolytes d. Triglycerides A patient who is NPO: a. Cannot have any food or drink b. Cannot have anything but water c. Is in critical but stable condition d. Is recovering from minor surgery Which specimen has priority over all other specimens during processing and testing? a. ASAP b. Fasting c. STAT d. Timed • • • • • • • • Which is the proper order for putting on protective clothing? a. Gloves first, then gown, mask last b. Gown first, them gloves, mask last c. Gown first, then mask, gloves last d. Mask first, then gown, gloves last Which order of events should be followed at the conclusion of a laboratory worker’s shift in order to prevent the spread of bloodborne pathogens? a. Remove gloves, disinfect area, wash hands, remove lab coat b. Disinfect area, remove gloves, remove lab coat, wash hands c. Disinfect area, remove gloves, wash hands, remove lab coat d. Remove gloves, wash hands, remove lab coat, disinfect area Which of the following bleach dilutions is recommended for cleaning the surfaces of contaminated specimen collection area? a. 1:1 b. 1:2 c. 1:10 d. 1:25 Patient receiving aspirin: a. BT b. CT c. PT d. APTT Prolonged bleeding time, except: a. vWD b. Uremia c. Paraprotenemia d. Hemophilia A Prolonged BT Normal PT Normal APTT a. Qualitative platelet disorder b. Hemophilia A c. Fibrinogen deficiency d. DIC e. vWD f. Factor X deficiency Prolonged BT Normal PT Prolonged APTT a. Qualitative platelet disorder b. Hemophilia A c. Fibrinogen deficiency d. DIC e. vWD f. Factor X deficiency Normal BT Normal PT Prolonged APTT a. Qualitative platelet disorder b. Hemophilia A c. Fibrinogen deficiency d. DIC e. vWD f. Factor X deficiency 2 • • • • • • Normal BT Prolonged PT Prolonged APTT Normal TT a. Qualitative platelet disorder b. Hemophilia A c. Fibrinogen deficiency d. DIC e. vWD f. Factor X deficiency Normal PT Prolonged PT Prolonged APTT Prolonged TT a. Qualitative platelet disorder b. Hemophilia A c. Fibrinogen deficiency d. DIC e. vWD f. Factor X deficiency Prolonged BT Prolonged PT Prolonged APTT Prolonged TT a. Qualitative platelet disorder b. Hemophilia A c. Fibrinogen deficiency d. DIC e. vWD f. Factor X deficiency Factor X deficiency: a. Normal PT, normal APTT, prolonged TCT b. Normal PT, prolonged APTT, prolonged TCT c. Prolonged PT, prolonged APTT, normal TCT d. Prolonged PT, prolonged APTT, prolonged TCT PT - Normal APTT - prolonged APTT + fresh plasma - C APTT + adsorbed plasma - C APTT + aged serum - NC a. II b. V c. VIII d. IX → Solution (Based from MTAP2 Solutions) ▪ Problem: Intrinsic pathway (XII, XI, IX, VIII) ▪ Fresh Plasma (C) - XII, XI, IX, VIII ▪ Adsorbed Plasma (C) - I, V, VIII, XI, XII ▪ Aged serum (NC) - I, II, V, VIII, XIII PT normal APTT prolonged APTT + fresh plasma - C APTT + adsorbed plasma - NC APTT + aged serum - C a. II b. V c. VIII d. IX → Solution ▪ Problem: Intrinsic pathway (XII, XI, IX, VIII) ▪ Fresh Plasma (C) - XII, XI, IX, VIII ▪ Adsorbed Plasma (NC) - II, VII, IX, X ▪ Aged serum (C) - VII, IX, X, XI, XII • • • • PT prolonged APTT prolonged APTT + fresh plasma - C APTT + adsorbed plasma - C APTT + aged serum - NC a. IX b. VII c. X d. I → Solution: ▪ Problem: Common pathway (X, V, II, I) ▪ Fresh Plasma (C) - X, V, II, I ▪ Adsorbed Plasma (C) - I, V, VIII, XI, XII ▪ Aged serum (NC) - I, II, V, VIII, XIII PT prolonged APTT prolonged PT + fresh plasma - C PT + adsorbed plasma - C PT + aged plasma - NC a. II b. X c. I d. V → Solution: ▪ Problem: Common pathway (X, V, II, I) ▪ Fresh Plasma (C) - X, V, II, I ▪ Adsorbed Plasma (C) - I, V, VIII, XI, XII ▪ Aged plasma (NC) - V, VIII PT prolonged APTT prolonged APTT + fresh plasma - C APTT + adsorbed plasma - NC APTT + aged serum - C a. I b. V c. X d. II → Solution: ▪ Problem: Common pathway (X, V, II, I) ▪ Fresh Plasma (C) - X, V, II, I ▪ Adsorbed Plasma (NC) - II, VII, IX, X ▪ Aged serum (C) - VII, IX, X, XI, XII PT prolonged APTT prolonged APTT + fresh plasma - C APTT + adsorbed plasma - NC APTT + aged serum - NC a. I b. V c. X d. II → Solution: ▪ Problem: Common pathway (X, V, II, I) ▪ Fresh Plasma (C) - X, V, II, I ▪ Adsorbed Plasma (NC) - II, VII, IX, X ▪ Aged serum (NC) - I, II, V, VIII, XIII 3 • • • • • • PT normal APTT prolonged APTT + fresh plasma - C APTT + adsorbed plasma - C APTT + aged serum - C a. XI b. XII c. VII d. IX → Solution: ▪ Problem: Intrinsic pathway (XII, XI, IX, VIII) ▪ Fresh Plasma (C) - XII, XI, IX, VIII ▪ Adsorbed Plasma (C) - I, V, VIII, XI, XII ▪ Aged serum (C) - VII, IX, X, XI, XII → Differentiation of XI & XII ▪ XI → Hemophilia C (moderate to severe bleeding) ▪ XII → negative bleeding In factor X deficiency, a prolonged PT or APTT can be corrected by addition of (1) Fresh serum → (-) 1, 5, 8, 13 = present 10 (2) Aged serum → (-) 1, 2, 5, 8, 13 = present 10 (3) Aged plasma → (-) 5, 8 = present 10 (4) Adsorbed plasma → (-) 2, 7, 9, 10 = absent 10 a. 1, 2 b. 2, 3 c. 1, 2, 3 d. 1, 2, 3, 4 If a patient presents with a prolonged APTT that does not correct upon mixing, the next performed test should be: a. Factor II assay b. Factory VIII assay c. Platelet count d. Dilute Russell Viper Venom Time → Suspect for a circulating anticoagulant ▪ Presence of lupus inhibitor ▪ Tests: • DRVVT • Platelet neutralization test 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 Mrs. Smith has the following laboratory results, and no bleeding history: APTT: prolonged APTT results on a 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 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 c. D-dimer test d. FDP test • • • • • • • • • Diagnosis of lupus anticoagulant is confirmed by which of the following criteria? a. Decreased APTT b. Correction of the APTT by mixing studies c. Neutralization of the antibody by high concentration of platelets d. Confirmation that abnormal coagulation tests are time and temperature dependent As a remedy for lipemic or icteric for hemostasis test, laboratory manager should use: a. Optical instrument b. Mechanical endpoint coagulometer c. Adjust anticoagulant volume d. Use reagent known to be incentive to heparin Which of the following is considered to be an advantage of the mechanical endpoint detection methodology? a. It is not affected by lipemia in the test sample b. It has the ability to provide a graph of clot formation c. It can incorporate multiple wavelengths into a single testing sequence d. It can measure proteins that do not have fibrin formation as the endpoint What test is used to monitor heparin therapy? a. INR b. APTT c. TT d. PT 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 → ACT is POCT for coagulation used to monitor highdose heparin therapy during cardiac surgery, cardiac angioplasty, hemodialysis, and other major surgeries. It is the preferred method to determine if sufficient heparin was administered to9 prevent clotting during surgery because it is more rapid than the APTT test. What test is commonly used to monitor warfarin therapy? a. INR b. APTT c. TT d. Ecarin time A patient on warfarin therapy will be deficient in a functional amount of: a. Fibrinogen and prothrombin b. Stable and labile factors c. Protein C and protein S d. Fletcher and Fitzgerald factors Ecarin clotting time may be used to monitor: a. Heparin therapy b. Warfarin therapy c. Fibrinolytic therapy d. Hirudin therapy Key component of hemostasis: a. Platelets b. Coagulation c. Fibrinolysis → Component of Hemostasis ▪ Platelets - key component ▪ Coagulation - second component ▪ Third component: system of enzymes, cofactors 4 • • • • • • • • • Upon stimulation, platelets change in shape from discoid to ____, extend pseudopods, undergo internal contraction resulting in centralization of their alpha granules and dense granules, and release the granule contents a. Cylindrical b. Irregular c. Oval d. Spherical All but one are related: a. Eicosanoid synthesis pathway b. Prostaglandin pathway c. Cyclooxygenase pathway d. Thromboxane pathway e. IP3-DAG → Platelet Activation Pathways ▪ Eicosanoid synthesis pathway, alternatively called the prostaglandin, cyclooxygenase, or thromboxane pathway ▪ Inositol Triphosphate-Diacylglycerol Activation (IP3-DAG) Pathway Aspirin prevents platelet aggregation by inhibiting the action of which enzyme? a. Phospholipase b. Cyclo-oxygenase c. Thromboxane A2 synthase d. Prostacyclin synthetase 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 At all times, approximately ___ of the total number of platelets are in the systemic circulation: a. One fourth b. One third → spleen (20 - 30%) c. One half d. Two thirds → circulation (70 - 80%) Normal platelet adhesion depends upon: a. Fibrinogen b. Glycoprotein Ib c. Glycoprotein IIb, IIIa complex d. Calcium 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 Primary platelet aggregation disorders: a. Bernard-Soulier syndrome b. Glanzmann’s thrombasthenia c. Essential athrombia d. Both B and C → Glanzmann’s thrombasthenia and Essential athrombia are similar, rare, primary aggregation disorders. Which defect characterizes Gray’s syndrome? a. Platelet adhesion defect b. Dense granule defect c. Alpha granule defect d. Coagulation defect • • • • • • • • • • True of platelet satellitism (satellitosis): a. Antibody-mediated in vitro adhesion of platelets to segmented neutrophils b. Occurs primarily in specimens anticoagulated with EDTA c. Causes pseudothrombocytopenia d. All of these Clot retraction is a function of: a. Factor XIII b. Thromboplastin c. Thrombosthenin d. Thromboxane A2 Which of the following clotting factors plays a role in clot formation in vitro, but not in vivo? a. VIIa b. IIa c. XIIa d. Xa Which of the following initiates in vivo coagulation by activation of factor VII? a. Protein C b. Tissue factor c. Plasmin activator d. Thrombomodulin Primary substrate of thrombin: a. Fibrinogen b. Prothrombin c. FV d. FX Fibrinogen, which has been implicated as a primary risk factor for thrombotic disorders, increases approximately ___ mg/dL per decade in the elderly (65 to 79 years), 174 from 280 mg/dL to over 300 mg/dL. a. 1 mg/dL per decade b. 3 mg/dL per decade c. 5 mg/dL per decade d. 10 mg/dL per decade In end-stage liver disease, the fibrinogen level may fall less than ___ mg/dL, which is a mark for liver failure. a. Less than 100 mg/dL b. Less than 150 mg/dL c. Less than 200 mg/dL d. Less than 300 mg/dL Most common congenital bleeding disorder: a. Von Willebrand’s Disease b. Hemophilia A c. Hemophilia B d. Platelet function disorders Initial workup for vWD: a. CBC b. CBC, PT, APTT c. CBC, PT, APTT, BT d. BT and automated functional platelet assays Definitive diagnosis of vWD: a. CBC, PT, APTT b. CBC, PT, APTT, BT c. BT and automated functional platelet assays d. Personal and family history of mucocutaneous bleeding and the laboratory demonstration of decreased vWF activity 5 • • • • • • • • • • The most common subtype of clasing vWD is: a. Type 1 b. Type 2A c. Type 2B d. Type 3 → 70-80% of vWD cases are subtype 1 which are associated with mild bleeding. → Subtype 3 is associated with sever bleeding Blood to anticoagulant ratio in citrate tube for coagulation studies: a. 9:1 b. 1:9 c. 1:4 d. 1:10 Specimen used for coagulation tests a. Platelet-rich plasma (PRP) b. Platelet-poor plasma (PPP) c. Serum d. Whole blood Which results would be expected for the PT and APTT in a patient with polycythemia? a. Both prolonged b. Both shortened c. Normal PT, prolonged APTT d. Both normal Assess deficiencies of all factors except VII and XIII: a. Platelet count b. PT c. PTT d. Thrombin time Assess deficiencies of factors II, V, VII, or X; a. Platelet count b. PT c. PTT d. Thrombin time 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 New types of thromboplastins for measuring the PT are mixtures of phospholipids and recombinantly derived from: a. Rabbit tissue factor b. Human tissue factor c. Mouse tissue factor d. Horse tissue factor In view of the inherent variations among thromboplastins reagents and to accomplish interlaboratory normalization, all laboratories report PT in ____ for patients who have reached a stable response to Coumadin therapy. a. Seconds b. Minutes c. Percent d. INR Which coagulation test(s) would be abnormal in a vitamin K-deficient patient? a. PT only b. PT and APTT c. Fibrinogen level d. TT • • • • • • • • • • • Prolonged test(s) in a patient with hemophilia A: a. APTT b. APTT, PT c. APTT, PT, TCT d. Thrombin clotting time (TT) Prolonged test(s) in a patient with factor X deficiency: a. APTT b. APTT, PT c. APTT, PT, TCT d. Thrombin clotting time (TT) Prolonged test(s) in a patient with fibrinogen deficiency: a. APTT b. APTT, PT c. APTT, PT, TCT d. Thrombin clotting time (TT) 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 The Bethesda assay is used for which is used for which determination? a. Lupus anticoagulant titer b. Factor VIII inhibitor titer c. Factor V Leiden titer d. Protein S deficiency Fibrin monomers are increased in: a. Primary fibrinolysis b. DIC c. Factor VIII deficiency d. Fibrinogen deficiency Formation, development, or presence of a clot in a blood vessel (i.e., a thrombus): a. Thrombocytopenia b. Thrombocytosis c. Thrombocythemia d. Thrombosis DIC is also known as: a. Defibrination syndrome b. Consumption coagulopathy c. Both of these d. None of these Refer to the following results: PT = prolonged APTT = prolonged Platelet count = decreased Which disorder may be indicated? a. Factor VII deficiency b. Von Willebrand’s disease c. DIC d. Factor IX deficiency The only abnormal test result in chronic DIC: a. PT b. APTT c. TT d. D-dimer Reversal of a heparin overdose can be achieved by administration of: a. Vitamin K b. Protamine sulfate c. Antithrombin d. Warfarin 6 • • • • • • • Normal cells in the BM, except: a. Macrophages b. Myeloblast c. Reticulocyte d. Plasmablast → Plasmablast and proplasmacyte stages are not found in the normal B; however the proplasmacyte will usually present in multiple myeloma 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 Tertiary granules: (1) Promyelocyte (2) Myelocyte (3) Metamyelocyte (4) Band a. 1, 2 b. 2, 3 c. 1, 2, 3 d. 3, 4 Carry proteins from secondary granules to be released into the extracellular medium: a. Primary granules b. Small lysosomal granules c. Lipid bodies d. Storage vesicles Eosinophil lipid bodies: (1) Catalase (2) Cyclooxygenase (3) Elastase (4) Esterase a. 1, 2 b. 1, 3 c. 2, 4 d. 3, 4 The megakaryocyte progenitor that undergoes endomitosis is: a. MK-I b. BFU-Meg c. CFU-Meg d. LD-CFU-Meg In ___, the tetraploid is DNA is checked for proper replication and damage, takes approximately 4 hours. a. G1 b. S c. G2 d. M → Cell Cycle • The portion of DNA that is inactive during transcription to messenger RNA and stains deeply with Wright stain: a. Heterochromatin b. Euchromatin c. Chromatin • Which is the first type of cell produced by the developing embryo? a. Erythrocyte b. Granulocyte c. Lymphocyte d. Thrombocyte 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 As most blood cell lines mature, which of the following is characteristic? a. Cell diameter increases b. N:C ratio decreases c. Nuclear chromatin becomes less condensed d. Basophilia of the cytoplasm increases 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 Which of the following RBC precursors is the last stage to undergo mitosis? a. Pronormoblast b. Basophilic normoblast c. Polychromatophilic normoblast d. Orthochromic normoblast Where do the early and late stages of heme synthesis occur? a. On ribosomes b. In mitochondria c. In cytoplasm d. In nucleoli Reticulocytosis usually indicates: a. Response to inflammation b. Neoplastic process c. Aplastic anemia d. Red cell regeneration • • • • • • • In the ___ stage, DNA replication takes place, a process requiring about 8 hours. a. G1 b. S c. G2 d. M 7 • • • • • • Which of the following is contained in the primary granules of the neutrophil? a. Lactoferrin → secondary neutrophil granule b. Myeloperoxidase c. Histamine → basophil d. Alkaline phosphatase → tertiary neutrophil granule Production of primary granules ceases and production of secondary granules commences with what cell stage? a. Myeloblast b. Promyelocyte c. Myelocyte d. Metamyelocyte The most mature granulocytic precursor that can undergo mitosis is the: a. Myeloblast b. Promyelocyte c. Myelocyte d. Metamyelocyte What does the granulocytic mitotic pool in the bone marrow contain? a. Myeloblasts and promyelocytes b. Band and segmented forms c. The majority if marrow granulocytes d. Myelocytes and metamyelocytes What is the approximate amount of time a granulocyte spends in the circulation before migrating into the tissues? a. Less than 1 day b. About 3 days c. Up to 5 days d. More than 10 days What is the second stage of phagocytosis? a. Ingestion b. Killing and digestion c. Formation of neutrophil extracellular traps d. Recognition and attachment → Stages of Phagocytosis • • • • • • • • • • • Which of the following is not a characteristic of T lymphocytes? a. Secrete cytokines b. Synthesize antibody → B cell/ Plasma cell c. Comprise majority of cells in the blood lymphocyte pool d. Regulate the immune response The largest hematopoietic cells in normal bone marrow: a. Osteoblasts b. Osteoclasts c. Megakaryocytes d. Plasma cells Which of the following is not a normal maturation stage for platelets? a. Megakaryoblast b. Promegakaryocyte c. Micromegakaryocyte d. Megakaryocyte • • Programmed cell death is called: a. Necrosis b. Apoptosis c. Cellular senescence d. Terminal differentiation An increase in which one of the following suggests a shortened lifespan of RBCs and hemolytic anemia? a. Hemoglobin b. Hematocrit c. Reticulocyte count d. Red cell distribution width Which antibiotic/s is/are most often implicated in the development of aplastic anemia? a. Sulfonamides b. Penicillin c. Tetracycline d. Chloramphenicol The macrocytes typically seen in megaloblastic processes are: a. Crescent-shaped b. Teardrop-shaped c. Ovalocytic d. Pencil-shaped Which of the following is detectable only by examination of a peripheral blood film? a. Microcytosis b. Anisocytosis c. Hypochromia d. Poikilocytosis Which of the following disorders has an increase in osmotic fragility? a. Iron deficiency anemia b. Hereditary elliptocytosis c. Hereditary stomatocytosis d. Hereditary spherocytosis Microangiopathic hemolytic anemia is characterized by: a. Target cells and Cabot rings b. Toxic granulation and Dohle bodies c. Pappenheimer bodies and basophilic stippling d. Schistocytes and nucleated RBCs The red cells found in lead poisoning characteristically exhibit coarse granules composed of that are reported as: a. Precipitated hemoglobin, Pappenheimer bodies b. Aggregated ribosomes, basophilic stippling c. Nuclear fragments; Pappenheimer bodies d. Excess iron deposits, basophilic stippling Which of the following RBC inclusions can be visualized with supravital stain but cannot be detected on a Wright’sstained blood smear? a. Basophilic staining b. Heinz bodies c. Howell-jolly bodies d. Siderotic granules Which of the following organs is responsible for the “pitting process” for RBCs? a. Liver b. Spleen c. Kidney d. Lymph nodes → Pitting - removal of inclusion → Culling - destruction of senescent/aged RBCs by spleen 8 • • • • • • • • • • “Bite cells” are usually seen in patients with: a. RH null trait b. Chronic granulomatous disease c. G6PD deficiency d. PK deficiency Which of the following is inherited leukocyte disorders is caused by a mutation in the lamin B receptor? a. Pelger-Huet anomaly b. Chediak-Higashi disease c. Alder-Reilly anomaly d. May-Hegglin anomaly → Lamin B - plays a major role in leukocyte nuclear shape changes that occur during normal maturation In which anomaly is a failure of granulocytes to divide beyond the band or two-lobed stage observed/ a. Pelger-Huet b. May-Hegglin c. Alder-Reilly d. Chediak-Higashi Which of the following inherited leukocyte disorders might be seen in Hurler syndrome? a. Pelger-Huet anomaly b. Chediak-Higashi disease c. Alder-Reilly anomaly d. May-Hegglin anomaly Which of the following inherited disorders is one of a group of disorders with mutations in non-muscle myosin heavychain IIA? a. Pelger-Huet anomaly b. Chediak-Higashi disease c. Alder-Reilly anomaly d. May-Hegglin anomaly What leukocyte cytoplasmic inclusion is composed of ribosomal RNA? a. Primary granules b. Toxic granules c. Dohle bodies d. Howell-Jolly bodies Which of the following represents the principal defect in chronic granulomatous disease (CGD)? a. Chemotactic migration b. Phagocytosis c. Lysosomal formation and function d. Oxidative respiratory burst The neutrophils in CGD are incapable of producing: a. Hydrogen peroxide b. Hypochlorite c. Superoxide d. All of the above The atypical lymphocyte seen in the peripheral smear of patients with infectious mononucleosis is probably derived from which of the following? a. T lymphocytes b. B lymphocytes c. Monocytes d. Mast cells The atypical lymphocyte seen in the peripheral smear of patients with infectious mononucleosis is reacting to which of the following? a. T lymphocytes b. B lymphocytes c. Monocytes d. Mast cells • • • • • • • • Which of the following lysosomal storage diseases is characterized by macrophages with striated cytoplasm and storage of glucocerebroside? a. Sanfilippo syndrome b. Gauc her disease c. Fabry disease d. Niemann-Pick disease 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 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 SITUATION: A peripheral smear shows 75% blasts. These stain positive for both Sudan Black B 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) 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 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) What would be the most likely designation by the WHO for the FAB AML M2 by the French-American-British classification? a. AML with t(15;17) b. AML with mixed lineage c. AML with t(8;21) d. AML with inv(16) A patient with normal chromosomes has a WBC count of 3.0 x 109/L and dysplasia in all cell lines. There are 60% blasts of varying sizes. The blasts stain positive for CD61. The most likely type of leukemia is: a. Acute lymphoblastic b. Acute megakaryoblastic c. Acute monoblastic d. AML with t(15;17) 9 • • • • • • • • • The leukocyte alkaline phosphatase stain on a patient gives the following results: 10 (0) 48 (1+) 38 (2+) 3 (3+) 1 (4+) Calculate the LAP score: a. 100 b. 117 c. 137 d. 252 → Solution: The JAK2 mutation may be positive in all of the following chronic myeloproliferative disorders except: a. Essential thrombocythemia b. Idiopathic myelofibrosis c. PV d. CML Interpret: (+) MPO (+) SBB (-) Tdt a. AML b. ALL Interpret: (-) MPO (-) SBB (+) Tdt a. AML b. ALL Interpret: CAE (+) NSE (-) a. Myeloblastic leukemia (M1, M2) Interpret: CAE (+) NSE (-) a. Monocytic leukemia (M5) Interpret: CAE (+) NSE (+) a. Myelomonocytic leukemia (M4) Which of the following cells is characteristic of Hodgkin’s disease? a. Niemann-Pick cells b. Reactive lymphocytes c. Flame cells d. Reed-Sternberg cells 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 • • • • • • • • • • 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 In which of the following conditions does LAP show the least activity? a. Leukemoid reactions b. Idiopathic myelofibrosis c. PV d. CML 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. Disease usually transforms into AML when Ph1 is present In myelofibrosis, the characteristic abnormal RBC morphology is that of: a. Target cells b. Schistocytes c. Teardrop cells d. Ovalocytes 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 In Polycythemia Vera (PV), what is characteristically seen in peripheral blood? a. Panmyelosis → bone marrow b. Pancytosis → peripheral blood c. Pancytopenia d. Panhyperplasia Detects lymphocytic cells and certain abnormal erythrocytic cells by staining of cytoplasmic glycogen: a. Periodic acid Schiff b. Esterase c. Peroxidase d. Sudan black B If the stain cannot be performed immediately, the unfixed smears may be stored in the dark at room temperature for up to 2 weeks without significant loss of activity. a. Periodic acid Schiff b. Esterase c. Peroxidase d. Sudan black B All are likely cause of turbidity in cyanmethemoglobin method determination of hemoglobin, except: a. High WBC count b. Hb S and Hb C c. Lipemic blood d. Carboxyhemoglobin Platelet hemoglobin is 8 g/dL, what is the hematocrit? a. 21 - 24% b. 24 - 27% c. 21 - 27% d. 25 - 26% → Solution: 10 • What is the total RBC count if an average of 400 RBCs were counted in 5 out of 25 squares in the large 1 mm 2 specimen dilution is 1:200? a. 2.3 x 1012/L b. 3.5 x 1012/L c. 4.0 x 1012/L d. 4.2 x 1012/L → Solution: • 36 WBCs were counted in 9 secondary squares of the Improved Neubauer counting chamber, dilution is 1:10. Compute for the WBC count: a. 2 x 109/L b. 4 x 109/L c. 6 x 109/L d. 0.4 x 109/L → Solution: • • • • • • 200 WBC differential: a. 1% basophils b. 15% eosinophil c. 60% neutrophil d. 20% lymphocytes Retic count expected in patient with hemolytic anemia a. 1% b. 10 x 109/L - ARC value c. 40 x 109/L - ARC value d. 10% Hemoglobin is measured spectrophotometrically at which of the following wavelength: a. 340 nm b. 440 nm c. 450 nm d. 540 nm Using manual techniques, the most reproducible test of the following is: a. Leukocyte count b. Hemoglobin determination c. Hematocrit count d. Platelet count The relative centrifugal force require in the microhematocrit is: a. 2,500 G b. 3,000 G c. 5,000 G d. 10,000 G Which of the following manual tests is least reliable? a. RBC count b. WBC count c. Hemoglobin d. Hematocrit • What is the total WBC count if blood is drawn to the 0.5 mark and diluted to the 11.0 mark, and 100 cells are counted in 4 corner squares of the Neubauer hemacytometer? a. 2.5 x 109/L b. 4.4 x 109/L c. 5.0 x 109/L d. 8.0 x 109/L → Solution: • A 1:20 dilution of blood is made, with 3% glacial acetic acid as the diluent. The four corner squares on both sides of the hemacytometer are counted for a total of 100 cells. What is total WBC count (x 109/L0? a. 0.25 b. 2.5 c. 5 d. 10 → Solution: • When nucleated RBCs are present in the smear, the WBC count must be corrected because: a. Nucleated RBCs are counted as leukocytes b. Leukocyte count should be higher c. Leukocyte count should correlate with the low RBC count d. Nucleated RBCs are confused with platelets The total leukocyte should be corrected if more than ___ nucleated RBC/100 WBCs are seen in the differential count. a. 1 b. 3 c. 5 d. 12 A blood smear shows 25 nucleated RBCs/100 WBCs. The total leukocyte count is 20 x 109/L. The corrected WBC count expressed in SI units is: a. 5.0 b. 6.2 c. 16.0 d. 18.8 • • 11 → • • • • Solution: The total WBC count is 25.0 x 109/L, and the percentage of lymphocytes is 76%. What is the absolute cell count of lymphocytes (x 109/L)? a. 0.03 b. 3.0 c. 19.0 d. 33.0 → Solution: Malarial parasites in the RBCs are best demonstrated with: a. Leishman stain b. Giemsa stain c. Jenner stain d. Wright’s stain If an average of 10 platelets are seen per OIF, what is the estimated platelet count? a. 50 x 109/L b. 100 x 109/L c. 200 x 109/L d. 300 x 109/L → Solution: What is the reticulocyte count (%) if 23 reticulocytes were seen among 1,000 RBCs? a. 0.02 b. 0.23 c. 2.3 d. 23 → Solution: • What is the corrected reticulocyte count for an anemic male with hematocrit of 20% (0.20 L/L) and a reticulocyte of 4%. a. 0.2% b. 1.1% c. 1.8% d. 3.5% → Solution: • If the hemoglobin is 13.0 g/dL, hematocrit is 0.40 L/L, and the RBC is 4.35 x 1012/L, which is the correct value for MCV> a. 22 fL b. 29.9 fL c. 89 fL d. 92 fL → Solution: • If the hemoglobin is 5.8 g/dL, hematocrit is 0.19 L/L, and the RBC is 2.0 x 1012/L, which is the correct value for MCHC? a. 96% b. 29% c. 31% d. 3.3% → Solution: • Which of the following does not increase the sedimentation of red cells? a. Rouleaux b. Increased globulins c. Poikilocytosis d. Increased fibrinogen When blood is placed in a 0.25% solution of sodium chloride, the RBC: a. Shrinks b. Hemolyzes c. Crenates d. Remains the same → Isotonic NSS = 0.85% or 0.9% ▪ Hypotonic = swell, hemolyze ▪ Hypertonic = shrink, crenate • 12 • • • • • • • • The osmotic fragility test is increased in which of the following condition? a. Hereditary spherocytosis b. Thalassemia c. Iron deficiency d. Aplastic anemia In the Coulter series, which parameter is calculated rather than directly measured: a. Hematocrit b. RBC count c. WBC count d. Hemoglobin → Directly measured: RBCs, WBCs, Hgb Difference between the manual hematocrit to the automated hematocrit due to trapped plasma: a. 1 to 3% b. 1 to 5 % c. 10% d. 15% → Spun hematocrit result may vary from 1 to 3% higher because of trapped plasma The X-axis on a blood cell histogram represents: a. Cell size b. Relative number of cells c. Forward light scatter d. Right angle light scatter In EDTA-anticoagulated blood, platelets undergo a change in shape. This alteration (swelling) causes the MPV to increase approximately ___% during the first hour. a. 5% b. 10% c. 15% d. 20% Side angle scatter in a laser-based cell counting system is used to measure: a. Cell size b. Cytoplasmic granularity c. Cell number d. Immunologic (antigenic) identification 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 → Autoagglutination at room temperature may cause a low RBC count and high MCV from an electronic counter. The Hct will be low because it is calculated form the RBC count. Low RBC count & low Hct cause falsely high calculations of MCH & MCHC, respectively. Effects of cold agglutinins: (1) Increased MCHC (2) Increased MCV (3) Decreased MCH (4) Decreased RBC Count a. 1, 3 b. 1, 2, 3 c. 1, 2, 4 d. 1, 2, 3, 4 • • • • • • • • • All of the following are causes of spurious increased in WBCs, except: a. Cryoglobulin b. Cryofibrinogen c. Monoclonal proteins d. Smudge cells All of the following are causes of spurious increase in RBCs, except: a. Autoagglutination b. Cryoglobulin, cryofibrinogen c. Giant platelets d. High WBCs Platelet clumps: a. Decreased platelets and WBCs b. Increased platelets and WBCs c. Decreased platelets, increased WBCs d. Increased platelets, decreased WBCs Leukemia, especially with chemotherapy: a. Decreased platelets and WBCs b. Increased platelets and WBCs c. Decreased platelets, increased WBCs d. Increased platelets, decreased WBCs What are the initial laboratory tests that are performed for the diagnosis of anemia? a. CBC, iron studies, and reticulocyte count b. CBC, reticulocyte count, peripheral blood film examination c. Reticulocyte count and serum iron, vitamin B12, and folate assays d. Bone marrow study, iron studies, & peripheral blood film The morphological classification of anemias is based on which of the following? a. M:E ratio b. Prussian blue stain c. RBC indices d. Reticulocyte count Which of the following is a pure red cell aplasia? a. Bernard-Soulier syndrome b. Diamond-Blackfan anemia → congenital pure red cell aplasia c. DiGuglielmo’s disease d. Fanconi’s anemia → Congenital aplastic anemia → Pure red cell aplasia ▪ ↓ RBCs; Normal WBC, platelets ▪ Congenital: Diamond-Blackfan ▪ Acquired in some hemolytic anemias, thymoma A leucoerythroblastic reaction is characterized by the presence of _____ in the peripheral blood: a. Immature leukocytes and nucleated erythrocytes b. Leukocytosis and erythrocytosis c. Lymphocytosis and neutropenia d. Pseudo-Pelger Huet cells The anemia seen in sickle cell disease is usually: a. Microcytic, normochromic b. Microcytic, hypochromic c. Normocytic, normochromic d. Normocytic, hypochromic 13 • • • 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 → Sickle cell Anemia - Hb S (major) → Sickle cell trait - Hb A1 (major) 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 → IDA = ↑ iron; ↓ TIBC → ACD = ↓ iron, TIBC Which morphological classification is characteristic of megaloblastic anemia? a. Normocytic, normochromic b. Microcytic, normochromic c. Macrocytic, hypochromic d. Macrocytic, normochromic 14