MEDICAL LABORATORY SCIENCE 9. SUMMATIVE EXAM REVIEW QUESTIONS #14 + ANSWERS & RATIONALIZATIONS 1. 2. 3. 4. 5. 6. 7. 8. The most common erythrocytic enzyme deficiency involving the Embden-Meyerhof glycolytic pathway is a deficiency of: a. ATPase b. Pyruvate kinase c. Glucose-6-phosphate dehydrogenase d. Lactic dehydrogenase The final steps in heme synthesis, including the formation of protoporphyrin take place in: a. Cell’s nucleus b. Cell’s cytoplasm c. Spleen d. Mitochondria In an alkaline pH (pH of 8.6) electrophoresis is performed, hemoglobin E has the same mobility as hemoglobin: a. S b. F c. A d. C The type of hemoglobin that is detectable with the Kleihauer-Betke test is: a. A b. A2 c. F d. S If female patient is diagnosed with anemia and her follow-up assays indicated blood serum results of increased bilirubin and decreased haptoglobin and hemosiderin in her urinary sediment, what is the most probable diagnosis? a. Extravascular catabolism b. Intravascular catabolism c. Defective hemoglobin synthesis d. Thalassemia If you are grading changes in erythrocytic size or shape using a scale of 0 to 4+ and many erythrocytes deviate from normal per microscopic field, the typical score would be ___. a. 1+ → slight increased, few b. 2+ → moderate c. 3+ → many d. 4+ → marked Which of the following is associated with a defect in nuclear maturation? a. Microcytes b. Sickle cells c. Megalocytes d. Acanthocytes Which of the following represents an imbalance between erythrocytic and plasma lipids? a. Microcytes b. Sickle cells c. Macrocytes d. Acanthocytes 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. Acanthocytes may be associated with the clinical condition of: a. Iron deficiency anemia b. Abetalipoproteinemia c. Pernicious anemia d. No related disease state Spherocytes: a. Short, scalloped, or spike-like projections that are regularly distributed around the cell → echinocyte b. Fragments of erythrocytes → schistocyte c. The scooped-out part of an erythrocyte that remains after a blister cell ruptures → helmet cell d. Compact round shape Dacryocytes may be seen in: a. Hepatic disorders b. Hemolytic disease of the fetus and newborn c. Hemoglobinopathies d. Pernicious anemia Basophilic stippling represents: a. DNA b. Precipitated denatured hemoglobin c. Granules of ribosomes and RNA d. Aggregates of iron, mitochondria and ribosomes Pappenheimer bodies represent: a. DNA b. Precipitated denatured hemoglobin c. Granules of ribosomes and RNA d. Aggregates of iron, mitochondria and ribosomes Fanconi’s anemia is associated with abnormal genes located on chromosomes: a. 9, 20 b. 5, 22 c. 9, 12 d. 8, 23 The average adult has ______ g of total iron. a. 0.2 to 1.4 b. 1.5 to 3.4 c. 3.5 to 5.0 d. 5.1 to 10.0 The cytochemical stain that can demonstrate iron, hemosiderin and ferritin is: a. New methylene blue b. Romanowsky c. Prussian blue d. Wright-Giemsa What is the major metabolically available storage form of iron in the body? a. Hemosiderin b. Ferritin c. Transferrin d. Hemoglobin The total iron-binding capacity (TIBC) of the serum is an indirect measure of which iron-related protein? a. Hemosiderin b. Ferritin c. Transferrin d. Hemoglobin The transfer of iron from the enterocyte into the plasma is regulated by: a. Transferrin b. Ferroportin c. Hephaestin d. Hepcidin 1 20. In stage 3 IDA, the erythrocyte indices are typically: a. MCV increased, MCH decreased, and MCHC decreased b. MCV decreased, MCH decreased, and MCHC decreased c. MCV decreased, MCH increased, and MCHC decreased d. MCV decreased, MCH decreased, and MCHC normal 21. In megaloblastic anemia, the typical erythrocytic indices are: a. MCV increased, MCH increased, and MCHC normal b. MCV increased, MCH variable, and MCHC normal c. MCV increased, MCH decreased, and MCHC normal d. MCV normal, MCH increased, and MCHC normal 22. Which of the following can be found in a patient with classic megaloblastic anemia? a. Ovalocytes and hypersegmented neutrophils b. Hypochromic macrocytes and variant lymphocytes c. Howell-Jolly bodies and Pappenheimer bodies d. Lymphocytosis 23. In cold-type AIHA: a. IgM, usually anti-I is present b. Rh antibodies are the most frequent cause c. IgM usually occurs in newborn infants d. Autoantibodies are present 24. Which of the following is NOT associated with hemolytic anemia? a. Decrease hemoglobin and packed cell volume b. Increased reticulocyte count c. Increased serum haptoglobin d. Decreased erythrocyte survival 25. Paroxysmal nocturnal hemoglobinuria exhibit sensitivity of one population of red cells to: a. Warm antibodies b. Cold antibodies c. Complement d. Either A and B 26. The defect in PNH is a/an ______ associated defect of the RBC membrane. a. Structural protein b. Hemoglobin c. Antibody d. Enzyme 27. What factors contribute to the sickling of erythrocytes in sickle cell disease crisis? a. Increase in blood pH and increase in oxygen b. Extremely hot weather c. Extremely reduced oxygen and increased acidity in the blood d. Sickling is spontaneous 28. Lymphocyte development in the thymus and bursal equivalent are: a. Antigen-independent b. Antigen-dependent c. Antibody-independent d. Antibody-dependent 29. Which of the following is characteristic of Dohle body inclusions? a. Gigantic peroxidase positive deposits b. Precipitated mucopolysaccharides c. Dark blue cytoplasmic inclusions d. Single or multiple pale-blue staining inclusions 30. Which of the following is characteristic of May-Hegglin anomaly? a. Gigantic peroxidase-positive deposits b. Precipitated mucopolysaccharides c. Dohle body-like inclusions and giant platelets d. Single or multiple pale blue staining inclusions 31. Cytoplasmic inclusion in Alder-Reilly anomaly can resemble: a. Dohle bodies b. Toxic granulation c. Auer rods d. Parasites 32. Lazy leukocyte syndrome is associated with the: a. Neutrophilic series b. Monocytic-macrophage series c. Lymphocytic series d. Erythrocytic series 33. Smudge cells are associated with: a. Niemann Pick disease and Burkitt’s lymphoma b. CLL c. Leukosarcoma d. Natural artifact 34. The EBV infects: a. T cells b. B cells c. Monocytes d. Macrophages 35. Multiple myeloma is a disorder of: a. T lymphocytes b. Megakaryocytes c. Plasma cells d. Lymph notes 36. Waldenstrom’s macroglobulinemia is characterized by increased levels of: a. IgG b. IgM c. IgD d. IgA 37. According to the WHO classification, except in leukemias with specific genetic anomalies, the minimal percentage of blasts necessary for a diagnosis of acute leukemia is: a. 10% b. 20% c. 30% d. 50% 38. Acute leukemia can be described as being: a. Short duration with many mature leukocyte forms in the peripheral blood b. Short duration with many immature leukocyte forms in the peripheral blood c. Short duration with little alteration of the leukocytes of the peripheral blood d. Long duration with many mature leukocyte forms in the peripheral blood 39. Myeloid without maturation acute leukemias is classified as: a. M1 b. M4 c. M5 d. L1 2 40. Myeloblasts, promyelocytes and myelocytes predominate in: a. M2 → AML w/ maturation b. M3 c. M4 d. M6 41. Many coarsely granular promyelocytes with dumbbellshaped or bilobed nuclei predominate in: a. M2 b. M3 → Auer rods, faggot cells c. M4 d. M6 42. Myeloid and monocytic acute leukemias are classified as FAB: a. M1 b. M4 → myelomonocytic leukemia c. M5 d. L1 43. Monocytic acute leukemia is classified as FAB: a. M1 b. M4 c. M5 d. L1 44. Immature leukocytic and erythrocytic cell types predominate in: a. M2 b. M3 c. M4 d. M6 → erythroleukemia or DiGuglielmo’s 45. Chloromas are associated with: a. FAB M1 b. FAB M3 c. FAB M4 d. FAB M5 46. Myeloperoxidase (MPO) and Sudan Black B (SBB) staining results: a. Opposite b. Parallel c. Undetermined d. Variable 47. Which cell type demonstrates the most intense peroxidase reaction? a. Neutrophil b. Basophil c. Lymphocyte d. Monocyte 48. Cells do not exhibit myeloperoxidase (MPO) activity: a. Eosinophils b. Neutrophils c. Lymphocytes d. Monocytes 49. Detects lymphocytic cells and certain abnormal erythrocytic cells by staining of cytoplasmic glycogen: a. MPO b. SBB c. PAS d. Tdt 50. A laboratory assay that can be used to differentiate a leukemoid reaction from chronic myelogenous leukemia is: a. Leukocyte alkaline phosphatase (LAP) stain b. Erythrocyte sedimentation rate (ESR) c. Assessment of the shift to the left d. Absolute neutrophil count → LAP Values: 3