Test Bank For Hematology in Practice 3rd Edition By Betty Ciesla

Test Bank For Hematology in Practice 3rd Edition By Betty Ciesla Chapter 1. Introduction to Hematology and Basic Laboratory Practice Multiple Choice 1. Tube length when referring to the microscope is the: A. Resolution power of the objective B. Distance from the eyepiece to the objective C. Numerical aperture D. Magnitude of the image on the stage ANS: B OBJ: 1.3 2. What is the most useful corrective action for the microscope when fine details cannot be visualized in immature cells? A. Open up the diaphragm for maximum light. B. Wipe off lenses with lens cleaner. C. Get a new slide. D. Move to a lower power. ANS: A OBJ: 1.4 3. Which of the following behaviors is a violation of standard precautions? A. Hand washing after glove removal B. Use of impermeable laboratory gowns C. Use of goggles and face shields D. Placing laboratory notebooks on laboratory work area ANS: D OBJ: 1.5 4. Standards and calibrators differ from control materials because: A. An exact amount of analyte is present in a standard or calibrator B. A variable amount of analyte is present depending on patient samples C. Standards only need to be within a target range Hematology in Practice 3e Betty Ciesla (Teast Bank) D. Standards are run to the best estimate of the known value ANS: A OBJ: 1.7 5. Which of the following is involved in the study of hematology and used to determine sickness and health? A. Quantity of cells B. Cellular structure C. Cellular function D. All of the above ANS: D OBJ: 1.1 6. Proper mixing of samples and timely delivery of samples to the laboratory are both examples of: A. Delta checks B. Postanalytic variables C. Preanalytic variables D. Reflex testing ANS: C OBJ: 1.8 7. A delta check is a historical reference on samples run in the laboratories. Once a sample fails a delta check, the most obvious corrective action is to: A. Verify the identification of the patient sample B. Reestablish the parameters of the delta check C. Perform reflex testing D. Perform a manual method ANS: A 8. Which of the following is the definition of a reference interval? A. A solution of a known amount of analyte B. Materials analyzed concurrently with unknown samples C. Values established for a particular analyte, given a method, instrument, or patient population D. Validation techniques on flagged samples ANS: C OBJ: 1.8 9. Which of the following is not considered a postanalytic variable? A. Delta checks B. Proper anticoagulant used C. Specimen checked for clots D. Calling critical results ANS: B OBJ: 1.8 10. Error analysis, standard protocols, and turnaround time are all part of the: A. Quality assurance system B. Quality control program C. Reference standards D. Delta check protocol ANS: A OBJ: 1.7 11. The average of a group of data points is defined as the: A. Mean B. Mode C. Median D. Modicum ANS: A OBJ: 1.7 12. Safety training is part of new employee training in health care and includes: A. Biological hazards B. Chemical hazards C. Environmental hazards D. All of the above ANS: D OBJ: 1.6 13. When viewing a slide with the 50 objective lens, the total magnification being used is: A. 50 B. 100 C. 500 D. 5000 ANS: C OBJ: 1.3 14. Delta checks are used in the hematology laboratory to: A. Compare past patient results with the current result B. Verify control accuracy C. Establish a target range D. Establish reference ranges for a particular analyte ANS: A OBJ: 1.8 15. When hand washing after a patient contact, the soap application process should last at least: A. 5 seconds B. 15 seconds C. 20 seconds D. 30 seconds ANS: B OBJ: 1.6 16. Which of the following represents an example of a safety violation in the laboratory? A. Application of cosmetics B. Mouth pipetting C. Consuming bottled water D. All the above ANS: D OBJ: 1.6 True/False 17. Standard deviation is a measurement of precision. ANS: True OBJ: 1.7 18. Accuracy is a measurement of the true value of an analyte. ANS: True OBJ: 1.8 19. A normal distribution curve will have 99.7% of the measured values fall within 2 SDs. ANS: False OBJ: 1.7 Completion (Ordered Response) NARRBEGIN: NARREND 20. Label the parts of the microscope. _______________________1 _______________________2 _______________________3 _______________________4 _______________________5 _______________________6 _______________________7 _______________________8 _______________________9 _______________________10 ANS: NAR: Figure 1-1 OBJ: 1.2 Chapter 2. From Hematopoiesis to the Complete Blood Count Multiple Choice 1. What is the average M:E ratio for normal adult bone marrow? A. 1:3 B. 4:1 C. 1:4 D. 6:1 ANS: B OBJ: 2.6 2. The key organs involved in extramedullary hematopoiesis include the: A. Kidney and thymus B. Lymph nodes and heart C. Liver and spleen D. Kidney and liver ANS: C OBJ: 2.5 3. Which of these assays is the best test to assess the bone marrow’s response to anemic stress? A. Hemoglobin value B. MCV value C. Reticulocyte count D. Hematocrit ANS: C OBJ: 2.12 4. All of the following splenic functions are related to hematopoiesis, except: A. Production of opsonizing antibodies B. Production of WBCS, if necessary C. Filtering out of old or deformed cells D. Storage of platelets and granulocytes ANS: A OBJ: 2.4 5. Which of the following is a primary site for hematopoiesis in a fetus of 4 to 5 months’ gestation? A. Yolk sac B. Spleen C. Distal long bones D. Axial skeleton ANS: B OBJ: 2.2 6. A patient with the following values—RBC = 4.01  1012/L, Hgb = 12.5 g/dL, and Hct = 37.2%—will most likely have which of the following RBC indices? A. MCV = 92.8 fL, MCH = 31.2 pg, MCHC = 33.6% B. MCV = 92.8 fL, MCH = 33.6 pg, MCHC = 31.2% C. MCV = 107.8 fL, MCH = 32.1 pg, MCHC = 33.6% D. MCV = 132.2 fL, MCH = 32.1 pg, MCHC = 33.5% ANS: A OBJ: 2.9 7. The hormone responsible for red blood cell development in the bone marrow is: A. Thyroxin B. Insulin C. Leukopoietin D. Erythropoietin ANS: D OBJ: 2.1 8. Which of the following sites is the most preferable for bone marrow aspiration and biopsy in adults? A. Sternum B. Iliac crest C. Fibula D. Vertebra ANS: B OBJ: 2.7 9. A patient’s hemoglobin is 12.3 g/dL. On the peripheral smear, the red cells appear normochromic and normocytic. The hematocrit value that correlates with these data is: A. 34% B. 37% C. 40% D. 43% ANS: B OBJ: 2.10 10. A Wright-stained smear of a patient’s bone marrow would effectively reveal all the following cells except: A. Iron-containing cells B. RBC precursor cells C. WBC precursor cells D. Mature WBCs ANS: A OBJ: 2.7 11. Erythropoietin is produced by the: A. Kidneys B. Liver C. Spleen D. Thymus gland ANS: A OBJ: 2.1 12. Bone marrow aspiration is usually required in conditions of: A. Anemia B. Hypoxia C. Leukemia D. Hepatosplenomegaly ANS: C OBJ: 2.7 13. Opsonizing antibodies produced by the spleen serve to: A. Strip the capsule from bacterial pathogens B. Recycle erythrocyte byproducts C. Aid in extramedullary hematopoiesis D. Fight viral infection ANS: A OBJ: 2.4 14. The spleen harbors _____ of the circulatory platelet mass. A. one-quarter B. one-third C. one-half D. three-quarters ANS: B OBJ: 2.4 15. Mature red blood cells leave the bone marrow and enter the circulation via the: A. Reticuloendothelial system B. Osteoclasts C. Spleen D. Bone marrow sinuses ANS: D OBJ: 2.1 16. Which of the following is a site of extramedullary hematopoiesis in an adult? A. Spleen B. Liver C. Iliac crest D. Both A and B ANS: D OBJ: 2.5 17. The ______ is one of the most stable parameters in a CBC. A. MCV B. Hct C. MCHC D. MCH ANS: A OBJ: 2.10 18. The CBC parameter that gives insight into the amount of anisocytosis present in a specimen is: A. RDW B. MCHC C. MCV D. Hgb ANS: A OBJ: 2.8 True/False 19. The CFU-GEMM is a multipotential stem cell, capable of differentiating into a lymphoid or nonlymphoid precursor committed cell. ANS: False OBJ: 2.3 20. Patients with moderate anemias (7 to 10 g/dL) may be asymptomatic. ANS: True OBJ: 2.10 Chapter 3. Blood Cell Production and FUNCTION and Relevant Red Cell Morphology Multiple Choice 1. Hemoglobin begins to appear in which of the following erythrocyte stages? (listed using College of American Pathologists terminology) A. Basophilic normoblast B. Polychromatophilic normoblast C. Orthochromic normoblast D. Pronormoblast ANS: B OBJ: 3.1, 3.2, 3.4 2. As a red blood cell matures, what is one key morphological feature of the stages containing a nucleus? A. Basophilic cytoplasm through every stage of maturation B. Granules in the cytoplasm C. A round nucleus D. An increase in size as the cell matures ANS: C OBJ: 3.1 & 3.2 3. What is the red cell protein that is responsible for deformability and flexibility of the red cell? A. Spectrin B. Glycophorin C. Glycine D. EPO ANS: A OBJ: 3.6 4. Increased plasma cholesterol may lead to the development of which of these abnormal red cell morphologies? A. Spherocytes B. Target cells C. Microcytes D. Helmet cells ANS: B OBJ: 3.12 5. Which of the following RBC pathways is responsible for providing 90% of the cellular ATP for red cell metabolism? A. Embden-Meyerhof pathway B. Methemoglobin reductase pathway C. Rapoport-Luebering pathway D. Hexose monophosphate shunt ANS: A OBJ: 3.5 6. When tissues become hypoxic, which of the following organs is stimulated to release erythropoietin? A. Pituitary gland B. Thyroid C. Pancreas D. Kidneys ANS: D OBJ: 3.3 7. For a red blood cell to live its full 120-day life span, which condition is necessary? A. The red blood cell membrane must be deformable. B. The red blood cell must have enough granules. C. The red blood cell must always remain in a round shape. D. There must be enough hemoglobin, regardless of function. ANS: A OBJ: 3.7 8. Which of the following electrolytes maintains its highest concentration within the red blood cell cytoplasm as opposed to circulating in the plasma? A. Sodium B. Bicarbonate C. Chloride D. Potassium ANS: D OBJ: 3.8 9. Polychromatophilic macrocytes seen in the peripheral smear as a result of anemic stress are most likely which type of red blood cell? A. Siderocytes B. Reticulocytes C. Spherocytes D. Pappenheimer bodies ANS: B OBJ: 3.11 10. Which of the following red cell inclusions are derived from denatured hemoglobin? A. Howell-Jolly bodies B. Pappenheimer bodies C. Heinz bodies D. Siderotic granules ANS: C OBJ: 3.13 11. The degree of effective erythropoietic activity in any hematological disorder can most readily be assessed by which analysis? A. Red cell count B. Reticulocyte count C. M:E ratio D. Hemoglobin determination ANS: B OBJ: 3.14 12. When hemolysis is produced by the intravascular fragmentation of red cells, which red cell morphology may be seen in peripheral smear examination? A. Spherocytes B. Macrocytes C. Acanthocytes D. Schistocytes ANS: D OBJ: 3.12 13. Most hypochromic cells will have an MCHC that is _____ and are often seen in ________. A. greater than 36%; thalassemia B. less than 32%; iron-deficiency anemia C. greater than 27%; iron-deficiency anemia D. less than 27%; sideroblastic conditions ANS: B OBJ: 3.10 14. Reversible sickled cells are described as having which of the following shapes? A. Crescent shape with one pointed projection B. Crescent shape with two pointed projections C. Half-moon shape with rounded ends D. Half-moon shape with pointed projection ANS: C OBJ: 3.12 15. Which of the following cells is in the last nucleated stage of erythrocytic maturation? (using CAP terminology) A. Pronormoblast B. Orthochromic normoblast C. Polychromatophilic normoblast D. Basophilic normoblast ANS: B OBJ: 3.1 16. Which red cell inclusions are remnants of DNA? A. Cabot rings B. Howell-Jolly bodies C. Heinz bodies D. Pappenheimer bodies ANS: B OBJ: 3.13 17. From each pronormoblast precursor cell, _____ mature red blood cells are produced. A. 4 B. 8 C. 12 D. 16 ANS: D OBJ: 3.3 18. Pappenheimer bodies are composed of which of the following components? A. Iron B. Denatured hemoglobin C. DNA D. RNA ANS: A OBJ: 3.13 19. Microcytic cells have MCV values of _______ and are often seen in _______. A. less than 90 fL; iron-deficiency anemia B. less than 80 fL; iron-deficiency anemia C. greater than 100 fL; megaloblastic anemia D. greater than 110 fL; megaloblastic anemia ANS: B OBJ: 3.9 NARRBEGIN: NARREND 20. Describe the hemoglobin content of the cell at the end of the pointer that is often seen in response to anemic stress. A. Normochromic B. Hypochromic C. Polychromatophilic D. Hyperchromic ANS: C OBJ: 3.11 NAR: Figure 3-10 NARRBEGIN: NARREND 21. Identify the cell at the end of the pointer that has an elevated MCHC of 38% and may indicate a cell that is aged. A. Spherocyte B. Schistocyte C. Acanthocyte D. Normocyte ANS: A OBJ: 3.10 & 3.12 NAR: Figure 3-12 NARRBEGIN: NARREND 22. Identify the cell at the end of the pointers that may indicate liver disease. A. Reticulocyte B. Spherocyte C. Sickle cell D. Target cell ANS: D OBJ: 3.12 NAR: Figure 3-16 NARRBEGIN: NARREND 23. Which term is used to describe the inclusions seen in the cell at the center of the picture (Wright’s stain), often seen in patients with lead poisoning? A. Pappenheimer bodies B. Basophilic stippling C. Howell-Jolly bodies D. Siderotic granules ANS: B OBJ: 3.13 NAR: Figure 3-23 True/False 24. The higher the N:C ratio is, the more mature the cell. ANS: False OBJ: 3.2 25. The anucleate mature red blood cell has no ability to produce protein. ANS: True OBJ: 3.5 Chapter 4. Hemoglobin Function and Principles of Hemolysis Multiple Choice 1. What percentage of hemoglobin is synthesized in the reticulocyte stage? A. 65% B. 95% C. 35% D. 45% ANS: C L.O. 4.4 2. Epsilon and zeta chains are part of which of the following hemoglobins? A. Hemoglobin Portland B. Hemoglobin F C. Hemoglobin A D. Hemoglobin A2 ANS: A L.O. 4.6 3. Fetal hemoglobin consists of which of the following chains? A. α2β2 B. α2γ2 C. α2δ2 D. α2ε2 ANS: B L.O.4.6 4. Which of the following variables affect how the hemoglobin molecule either holds on to or releases oxygen? A. Amount of alpha or beta chains B. Relationship between the pulmonary and venous circulations C. Viscosity of the blood D. Ferritin levels ANS: B L.O. 4.8 5. Which of the following abnormal hemoglobins will result in a cyanotic condition? A. Sulfhemoglobin B. Cyanmethemoglobin C. Hemoglobin F D. Hemoglobin M ANS: D L.O. 4.10 6. Each hemoglobin molecule consists of four ____ . A. alpha chain molecules B. beta chain molecules C. heme molecules with with Fe2+ D. heme molecules with Fe3+ ANS: C L.O. 4.1 7. Which of the following factors will result in an immediate increase in oxygen delivery to the tissues? A. Increased pH B. Increased altitude C. Increased 2,3-DPG D. Increased carboxyhemoglobin ANS: C L.O. 4.9 8. How many genes are responsible for the productions of alpha chains? A. Two B. One C. Three D. Four ANS: A L.O. 4.7 9. Which of the following clinical conditions is a definitive sign of intravascular lysis? A. Bilirubinemia B. Decreased RBC count C. Hemoglobinuria D. Elevated LDH ANS: C L.O. 4.11 10. Which organ(s) is(are) the most affected during extravascular lysis? A. Liver and spleen B. Kidneys C. Pancreas D. Heart ANS: A L.O. 4.12 11. Each hemoglobin molecule consists of ____ globin structures. A. two B. four C. six D. eight ANS: B L.O. 4.1 & 4.2 12. Physiological conditions in the body that can decrease hemoglobin’s oxygen affinity include: A. Increased pH B. Decreased 2,3-DPG C. Increased body temperature D. The presence of abnormal hemoglobins ANS: C L.O. 4.9 13. When iron is present in an oxidized state as Fe+3 or ferric iron, the resulting hemoglobin is known as: A. Methemoglobin B. Carboxyhemoglobin C. Sulfhemoglobin D. Deoxyhemoglobin ANS: A L.O. 4.10 14. ________ may be seen in intravascular hemolysis but not in extravascular hemolysis. A. Hemoglobinuria B. Splenomegaly C. Increased LDH D. Elevated serum bilirubin ANS: A L.O. 4.13 15. Intrinsic red cell defects that can lead to hemolysis include: A. Environmental effects B. Inherited deficiencies C. A shift in pH D. A decrease in G6PD ANS: B L.O. 4.14 16. Which of the following is not a normal adult hemoglobin? A. Hgb A B. Hgb Portland C. Hgb F D. Hgb A2 ANS: B L.O. 4.5 True/False 17. Hemoglobin begins to be synthesized at the polychromatophilic stage of red blood cell development. ANS: True L.O. 4.4 18. Abnormal hemoglobins have a lower affinity for oxygen. ANS: False L.O. 4.10 19. Ninety percent of in vivo hemolysis is intravascular. ANS: False L.O. 4.11 20. Oxygen delivery is the primary purpose of hemoglobin. ANS: True L.O. 4.3 Chapter 5. The Microcytic Anemias Multiple Choice 1. Transferrin receptors for iron uptake are located on the: A. Basophilic normoblast B. Pronormoblast C. Reticulocyte D. Orthochromic normoblast ANS: B L.O. 5.3 2. Which of the following lab analyses determines iron stores? A. Serum transferrin level B. Hemoglobin value C. Myoglobin value D. Serum ferritin level ANS: D L.O. 5.7 3. In addition to iron ingestion, over 90% of iron in adults used for erythropoiesis is obtained through: A. Transfusion B. Recycling of iron C. Storage forms from spleen and the liver D. Hemosiderin ANS: B L.O. 5.3 4. The first stage of iron deficiency anemia is termed: A. Microcytic hypochromic anemia B. Iron depletion C. Iron deficiency D. Iron overload ANS: B L.O. 5.4 5. All of the following are symptoms of iron deficiency anemia except: A. Pallor B. Pica C. Vertigo D. Numbness ANS: D L.O. 5.5 6. In adults, which of the following is the most common cause of iron-deficiency anemia? A. Intestinal parasites B. Malabsorptive disorders C. Dietary content D. Chronic blood loss ANS: D L.O. 5.6 7. Ringed sideroblasts in the bone marrow are indicative of which of the following disorders? A. Chronic disease B. Infection C. Sideroblastic anemia D. Inflammation ANS: C L.O. 5.8 8. Given the laboratory results of serum iron = 300 μg/dL, transferrin = 312 mg/dL, transferrin saturation = 122%, and ferritin = 1,000 ng/mL, and physical symptoms of hair loss and cardiac arrhythmia, which of the following should be considered? A. Hereditary hemochromatosis B. Anemia of inflammation C. Iron-deficiency anemia D. Lead poisoning ANS: A L.O. 5.9 and 5.11 9. Which type of inclusion is likely to be seen in a patient with hereditary hemochromatosis? A. Howell-Jolly bodies B. Pappenheimer bodies C. Hemoglobin H inclusion bodies D. Cabot rings ANS: B L.O. 5.11 10. A 15-year-old Lebanese boy was sent to the laboratory for an evaluation of anemia and had the following lab results: A. WBC = 7.5  109 /L B. RBC = 5.9  1012 /L C. Hgb = 11.6 g/dL D. Hct = 36% What is the presumptive clinical condition? A. Pernicious anemia B. Autoimmune hemolytic anemia C. Iron deficiency trait D. Thalassemia trait ANS: D L.O. 5.15 12. Which of the following alpha thalassemic conditions are incompatible with life? A. Hemoglobin H disease B. Bart’s hydrops fetalis C. Alpha thalassemia trait D. Silent carrier condition ANS: B L.O. 5.13 13. Which inclusion is associated with a “pitted” golf ball appearance and seen in one of the thalassemic conditions? A. Hgb H inclusion B. Howell-Jolly bodies C. Cabot rings D. Pappenheimer bodies ANS: A L.O. 5.13 and 5.16 14. Failure to thrive, facial structure abnormalities, severe anemia, and splenomegaly are signs of which of the following disorders? A. Thalassemia minor B. Alpha thalassemia trait C. Thalassemia major D. Thalassemia intermedia ANS: C L.O. 5.15 15. One of the gravest clinical problems for individuals with thalassemia major is: A. Chronic anemia B. Iron overload C. Therapeutic phlebotomy D. Collapsed veins ANS: B L.O. 5.15 16. The majority of the hemoglobin made in individuals with thalassemia major is: A. Hemoglobin H B. Hemoglobin A C. Hemoglobin F D. Hemoglobin Barts ANS: C L.O. 5.17 17. Which of the following is also known as Cooley’s anemia? A. Alpha thalassemia B. Beta thalassemia major C. Hereditary hemochromatosis D. IDA ANS: B L.O. 5.15 and 5.14 18. The alpha thalassemias result from which of the following? A. Gene deletion B. Defective alpha genes C. Iron overload D. Excessive production of alpha chains ANS: A L.O. 5.13 19. Which of the following red blood cell indices combinations is accurate for microcytic, hypochromic anemia? A. Low MCV, low MCH, low MCHC B. Normal MCV, low MCH, low MCHC C. High MCV, normal MCH, low MCHC D. Low MCV, normal MCH, high MCHC ANS: A L.O. 5.1 20. When a pregnant patient is seen to have a microcytic, hypochromic anemia, which condition should seriously be investigated? A. Alpha thalassemia B. Iron-deficiency anemia C. Hereditary hemochromatosis D. Sideroblastic anemia ANS: B L.O. 5.2 21. Hemoglobin H disease is associated with: A. Bart’s hydrops fetalis B. Alpha thalassemia disease C. Thalassemia major D. Hereditary hemochromatosis ANS: B L.O. 5.13 22. The primary storage forms of iron are: A. Ferritin and hemosiderin B. Ferritin and transferrin C. Hemosiderin and ferrous iron D. Heme and ferritin ANS: A L.O. 5.3 23. In the United States, approximately ____ of the anemias seen are due to IDA. A. 25% B. 40% C. 50% D. 75% ANS: C L.O. 5.6 24. In iron-deficiency anemia, the reticulocyte count will be: A. Normal B. Low C. High D. Extremely high ANS: B L.O. 5.7 25. In patients with iron overload, Desferal may be administered to chelate the excess iron. The chelated iron is shed in: A. Feces B. Urine C. Gastric secretions D. None of the above ANS: B L.O. 5.10 True/False 26. In the thalassemias, the deficit has nothing to do with iron. ANS: True L.O. 5.12 Short Answer 27. Describe the transfusion protocols for patients with thalassemia major, including contraindications. ANS: See page 81 for answer L.O. 5.18 Chapter 6. The Macrocytic Anemias Multiple Choice 1. Which of the following terms describes the appearance of the erythropoietic precursors in the megaloblastic process? A. Ordered arrangement of chromatin B. Asynchrony C. Eccentric nucleus D. Pale cytoplasm ANS: B L.O. 6.2 2. What would be an appropriate M:E ratio in the case of megaloblastic anemia? A. 1:3 B. 4:1 C. 5:1 D. 1:10 ANS: A L.O. 6.1 & 6.4 3. Which of the following can distinguish treated versus untreated megaloblastic anemia? A. Polychromasia B. Hypochromia C. Howell-Jolly bodies D. Siderocytes ANS: A L.O. 6.9 & 6.10 4. Which of the following is a key substance required for the incorporation of vitamin B12 in the nuclear synthesis of red blood cells? A. EPO B. Transferrin C. Intrinsic factor D. Cytokines ANS: C L.O. 6.5 5. Evidence of ineffective erythropoiesis in the CBC of patients with megaloblastic anemia are: A. Anemia, thrombocytopenia, leukopenia B. Anemia, thrombocytosis, leukopenia C. Anemia, thrombophilia, leukocytosis D. Anemia, thrombocytosis, leukopenia ANS: A L.O. 6.4 6. All of the following are possible causes of low levels of intrinsic factor (IF) except which statement? A. Partial gastrectomy may lead to the lack of IF. B. Fifty-six percent of patients with pernicious anemia have antibodies to IF. C. Atrophic gastritis may lead to the lack of IF. D. Kidney failure may lead to lack of IF. ANS: D L.O. 6.8 7. Which MCV range is indicative of pernicious anemia? A. 70 to 80 fL B. 85 to 95 fL C. 110 to 120 fL D. 90 to 98 fL ANS: C L.O. 6.9 8. Which of the following red blood cell morphologies is classic in the megaloblastic anemias? A. Polychromasia B. Macroovalocytes C. Basophilic stippling D. Hypochromia ANS: B L.O. 6.3 9. A macrocytosis that is not megaloblastic in origin can be seen in all of the following except: A. Chemotherapy B. Postsplenectomy C. Hypoglycemic patients D. Reticulocytosis ANS: C L.O. 6.11 10. Which of the following describes ineffective erythropoiesis? A. An increase in the M:E ratio B. A synthetic defect in hemoglobin C. Premature destruction of red blood cell precursors D. A DNA maturation defect ANS: C L.O. 6.4 11. Intrinsic factor is secreted by the: A. Parietal cells of the stomach B. Ileum C. Thyroid D. Bone marrow ANS: A L.O. 6.5 12. One of the most common pathophysiologies that contribute to folic acid deficiency is: A. Tropical sprue B. Intrinsic factor deficiency C. IDA D. Infection with Diphyllobothrium latum ANS: A L.O. 6.7 13. The Schilling test continues to be a historic reference method for the determination of: A. IDA B. Pernicious anemia C. Folic acid deficiency D. Hereditary hemochromatosis ANS: B L.O. 6.8 14. Macrocytic red blood cells are routinely seen in all the following except: A. Pernicious anemia B. Liver disease C. Response to anemic stress D. Thalassemia ANS: D L.O. 6.3 & 6.11 15. Which of the following is a clinical symptom specific to megaloblastic anemia? A. Fever B. Numbness and trouble with balance C. Pallor D. Splenomegaly ANS: B L.O. 6.6 NARRBEGIN: NARREND 16. The cell pictured here may be seen in which of the following conditions? A. Iron-deficiency anemia B. Megaloblastic anemia C. Thalassemia major D. Hereditary hemochromatosis ANS: B NAR: Figure 6-4 L.O. 6.3 NARRBEGIN: NARREND 17. The stage of development of the cell at the end of the pointer is a(n): A. Polychromatophilic normoblast B. Reticulocyte C. Rubricyte D. Orthochromatic normoblast ANS: A NAR: Figure 6-2 L.O. 6.2 True/False 18. A bone marrow aspiration/examination is not necessary for patients with megaloblastic anemia. ANS: True L.O. 6.9 Chapter 7. Normochromic Anemias: Biochemical and Membrane Disorders and Miscellaneous Red Cell Disorders Multiple Choice 1. Spherocytes do not function well in the splenic environment because the: A. Osmotic environment of the spherocyte is impaired B. Immunologic function of the spleen is impaired C. Reservoir function is impaired D. Filtration function of the spleen is compromised ANS: A L.O. 7.1 2. Cholelithiasis is a frequent complication of patients with hereditary spherocytosis because: A. Spherocytes are an abnormal red blood cell morphology B. The gallbladder does not function well in this condition C. Continued hemolysis in this condition causes gallstones to form D. The filtration function of the spleen is overworked ANS: C L.O. 7.3 3. Spherocytes differ from normal cells in all of the following ways except having: A. Decreased surface-to-volume ratio B. Decreased central pallor C. Decreased resistance to hypotonic saline D. Increased deformability ANS: D L.O. 7.2 4. The RBC inclusions that are composed of denatured hemoglobin are called: A. Pappenheimer bodies B. Howell-Jolly bodies C. Heinz bodies D. Siderotic granules ANS: C L.O. 7.10 5. Red blood cells that are rigid, provide resistance to malaria, and are spoon shaped are termed: A. Burr cells from kidney disease B. Spherocytes from hereditary spherocytes C. Ovalocytes from Southeast Asian ovalocytosis D. Sickle cells from sickle cell disease ANS: C L.O. 7.11 6. Spherocytes may enter the circulation via a variety of mechanisms. To distinguish the CBC of a patient with hereditary spherocytosis from the CBC of a patient with autoimmune hemolytic anemia, one could use the: A. MCHC B. Hematocrit C. MCH D. MCV ANS: A L.O. 7.3 7. One of the least severe clinical manifestations of G6PD deficiency is: A. Acute hemolytic anemia B. Favism C. Neonatal jaundice D. Congenital non-spherocytic hemolytic anemia ANS: D L.O. 7.8 & 7.9 8. An anemia that manifests as decreased marrow cellularity, pancytopenia, and a reticulocytopenia is appropriately termed: A. Megaloblastic anemia B. Aplastic anemia C. Sideroblastic anemia D. Iron deficiency anemia ANS: B L.O. 7.12 9. Individuals with Fanconi’s anemia characteristically will have: A. Intravascular hemolysis B. Increased Hgb F C. Ringed sideroblastics D. Thrombocytosis ANS: B L.O. 7.12 10. An osmotic fragility test is performed on a patient’s sample. Initial hemolysis occurs at 0.75% NaCl and complete hemolysis occurs at 0.50% NaCl. These results are indicative of which of the following disorders? A. Sickle cell anemia B. Hgb C disease C. Thalassemia major D. Hereditary spherocytosis ANS: D L.O. 7.5 11. Which of the following is most closely associated with G6PD deficiency? A. Continuous intravascular hemolysis occurs. B. G6PD deficiency is a sex-linked inherited disease. C. Splenectomy is commonly done to control symptoms. D. The majority of the erythrocytes in these individuals are microcytic. ANS: B L.O. 7.9 12. In hereditary spherocytosis, the reticulocyte count will typically be: A. Less than 0.5% B. 0.5% to 1.5% C. 3% to 10% D. Greater than 10% ANS: C L.O. 7.3 13. The deficit of which of these is most closely associated with Southeast Asian ovalocytosis? A. Spectrin B. Ankyrin C. Molecular band 3 D. G6PD ANS: C L.O. 7.11 14. Bite cells are formed from: A. The spleen “pitting” out Heinz bodies B. Third-degree burns C. Spectrin deficiency D. G6PD deficiency ANS: A L.O. 7.10 15. The inability of the red blood cell to generate ATP for membrane function is most closely associated with: A. Pyruvate kinase deficiency B. G6PD deficiency C. Fanconi’s anemia D. Congenital hemolytic anemia ANS: A L.O. 7.8 16. Which of the following red blood cell membrane defects results in an increased sensitivity to complement lysis? A. Cold agglutinin syndrome B. Paroxysmal nocturnal hemoglobinemia C. Diamond Blackfan anemia D. Hereditary spherocytosis ANS: B L.O. 7.8 17. An eccentric “puddling” of a red blood cell’s hemoglobin contents is most closely associated with: A. Stomatocytosis B. Xerocytosis C. G6PD deficiency D. Pyruvate kinase deficiency ANS: B L.O. 7.11 NARRBEGIN: NARREND 18. The cell at the tip of the pointer is seen in which of the following conditions? A. G6PD deficiency B. Hereditary stomatocytosis C. Hereditary elliptocytosis D. Hereditary spherocytosis ANS: D NAR: Figure 7-1 L.O. 7.4 & 7.7 NARRBEGIN: NARREND 19. The cell at the tip of the pointer is referred to as which of the following? A. Acanthocyte B. Bite cells C. Spherocyte D. Stomatocyte ANS: B NAR: Figure 7-7 L.O. 7.10 NARRBEGIN: NARREND 19. The inclusions pictured here are seen with supravital staining only. These inclusions are most likely: A. Heinz bodies B. Howell-Jolly bodies C. Pappenheimer bodies D. Due to stain contamination ANS: A NAR: Figure 7-8 L.O. 7.10 True/False 20. A defect in stomatin is the main cause of hereditary spherocytosis. ANS: False L.O. 7.6 Chapter 8. The Normochromic Anemias Due to Hemoglobinopathies Multiple Choice 1. The hemoglobin variant that is seen frequently in the Southeast Asian population and migrates with Hgb C at pH 8.6 is: A. Bart’s B. F C. E D. H ANS: C L.O. 8.9 & 8.12 2. A blood smear from a patient with sickle cell crisis shows 80 nucleated red blood cells per 100 leukocytes. The total leukocyte count is 18  109 /L. The corrected white blood cell count is: A. 17,200 B. 9,000 C. 10,000 D. 13,400 ANS: C L.O. 8.14 3. A patient with sickle cell anemia may develop cardiopulmonary disease due to: A. Untreated leg ulcers B. High blood viscosity C. Increased Hgb F levels D. Hemolytic crisis ANS: B L.O. 8.6, 8.7, & 8.2 4. Autosplenectomy is characteristic of: A. Sickle cell trait B. Hgb C disease C. Thalassemia D. Sickle cell anemia ANS: D L.O. 8.5, 8.6, & 8.7 6. When the bone marrow temporarily ceases to produce cells in a sickle cell patient, a(n) _________ crisis has occurred. A. aplastic B. hemolytic C. vaso-occlusive D. cardiac ANS: A L.O. 8.5, 8.6, & 8.7 7. Mr. Bennett was admitted with a hematocrit of 28%. He has a history of chronic anemia, moderate splenomegaly, and recent retinal hemorrhages. His peripheral smear reveals target cells, and some show structures jutting from the red blood cell membrane. The most probable diagnosis is: A. Hgb S-S B. Hgb A-C C. Hgb S-C D. Hgb A-A ANS: C L.O. 8.5 8. Sickle cell disease is best differentiated from sickle cell trait by: A. Wright smear examination B. Determination of fetal hemoglobin C. Genetic testing D. Hemoglobin electrophoresis ANS: D L.O. 8.5 9. Which of the following “poikilocytes” are classically associated with hemoglobinopathies and liver disease? A. Spherocytes B. Sickle cells C. Acanthocytes D. Target cells ANS: D L.O. 8.1 10. A male with sickle cell trait and a female sickle cell trait have what likelihood of having a child with sickle cell anemia? A. 10% B. 25% C. 50% D. 100% ANS: B L.O. 8.4 & 8.10 11. Painful swelling of hands and feet caused by sickle cells in the microcirculation of infants is termed: A. Dactylitis B. Necrosis C. Apoptosis D. Fibrosis ANS: A L.O. 8.5 & 8.7 12. In patients with sickle cell trait and no complicating disease: A. NRBCs and polychromasia are usually seen on the peripheral smear B. Sickle cells are prevalent in the peripheral blood C. There may be occasional hematuria D. There is a severe decrease in Hgb, Hct, and RBC count ANS: C L.O. 8.5 & 8.11 13. The hemoglobin that cannot be separated from Hgb S through electrophoresis in buffer at pH 8.6 is: A. Hgb D B. Hgb C C. Hgb A D. Hgb F ANS: A L.O. 8.8 & 8.9 14. The lungs are particularly susceptible in individuals with sickle cell disease and may be susceptible to: A. COPD B. Pulmonary hypertension C. Aplastic crisis D. Cardiac crisis ANS: B L.O. 8.7 15. A 26-year-old day laborer with a long history of anemia has a several months’ history of dyspnea, fever, and pulmonary pain. Additionally, he complains of tightness in the chest and upper abdominal region. His hematology values are as follows: WBC 15.9  109 /L RBC 2.9  1012/L Hgb 9.5 g/dL Hct 30% MCV 103 fL MCH 31 pg MCHC 32% NRBC 15/100 WBC Platelets 275  109 /L Reticulocytes 16.8% The hemoglobin electrophoresis results are as follows: Hgb A =3% Hgb A2 = 2% Hgb S = 85% Hgb F = 10% The most likely diagnosis is: A. Sickle cell trait B. Sickle cell disease C. Beta thalassemia minor D. Sickle thalassemia ANS: B L.O. 8.5, 8.6, & 8.9 16. In sickle cell anemia, _____is substituted for glutamine. A. valine B. lysine C. adenine D. leucine ANS: A L.O. 8.3 17. Patients with sickle cell anemia generally have a hemoglobin value between: A. 2 and 4 g/dL B. 6 and 8 g/dL C. 8 and 10 g/dL D. 10 and 12 g/dL ANS: B L.O. 8.5 18. In hemoglobin C disease, ____ is substituted for glutamic acid. A. valine B. adenine C. lysine D. leucine ANS: C L.O. 8.3 19. Alkaline electrophoresis will not separate hemoglobin C from: A. Hemoglobin A2 B. Hemoglobin F C. Hemoglobin S D. Hemoglobin A ANS: A L.O. 8.8 & 8.9 20. In hemoglobin C disease, the majority of the red blood cells appear as: A. Target cells B. Spherocytes C. Elliptocytes D. “Bars of gold” ANS: A L.O. 8.5 21. ____ is the second most common hemoglobin variant worldwide. A. Hemoglobin S B. Hemoglobin E C. Hemoglobin C D. Hemoglobin D ANS: B L.O. 8.12 22. Which of the following hemoglobins contain an alpha chain variant? A. Hemoglobin C B. Hemoglobin G C. Hemoglobin S D. Hemoglobin A2 ANS: B L.O. 8.12 23. The clinical picture of a patient with Hgb S–beta-thalassemia is similar to that seen in which other hemoglobinopathy? A. Sickle cell anemia B. Sickle cell trait C. Hgb C disease D. Hgb E disease ANS: A L.O. 8.13 24. The principle behind hemoglobin electrophoresis is best represented by which of the following statements? A. Normal hemoglobin does not precipitate in high-molarity buffered phosphate solutions. B. Hemoglobins migrate to different locations depending on time, pH, and media used. C. In a pH range of 3 to 10, hemoglobins achieve their isoelectric point. D. Hematology analyzers count nucleated red blood cells as white blood cells. ANS: B L.O. 8.15 NARRBEGIN: NARREND 25. The cell at the tip of the pointer would be described as a(n): A. Acanthocyte B. Elliptocyte C. Sickle cell D. Stomatocyte ANS: C NAR: Figure 8-2 L.O. 8.5 Chapter 9. Leukopoiesis and Leukopoietic Function Multiple Choice 1. Lymphocyte concentrations in peripheral blood are greatest during what age interval? A. Immediately after birth B. Older adult (40 to 70 years) C. Young adult (16 to 40 years) D. Young child (1 to 4 years) ANS: D L.O. 9.1 2. The “marginating pool” of neutrophils is located: A. In the kidneys B. In the tissue C. Next to marrow sinuses D. On the blood vessel walls ANS: D L.O. 9.1 3. The CBC results for a 3-month-old child are as follows: WBC 9.5  109 /L Differential RBC 3.4  1012/L Segmented neutrophils 25% Hgb 6.7 g/dL Lymphocytes 75% Hct 25% The absolute lymphocyte count in this patient would be: A. 1.2  109 /L B. 2.4  109/L C. 7.1  109 /L D. 7.5  109 /L ANS: C L.O. 9.7 4. Which of the following CD markers are more appropriately associated with the myelocyte? A. CD4, CD8 B. CD33, CD13, CD14 C. CD45, CD33, CD13 D. CD19, CD22 ANS: C L.O. 9.4 5. One of the primary glands responsible for lymphocyte origination in the infant is the: A. Thymus B. Adrenal C. Thyroid D. Pituitary ANS: A L.O. 9.1 & 9.8 6. An adult has a total white blood cell count of 4.0  109 /L. The differential count is as follows: Segmented neutrophils 25% Lymphocytes 65% Bands 5% Monocytes 5% If the normal values for absolute lymphocyte count are 1.2 to 3.4  109 /L, which of the following is true? A. The absolute number of lymphocytes is low. B. There is an absolute lymphocytosis. C. There is a relative lymphocytosis. D. There is an absolute and a relative lymphocytosis. ANS: C L.O. 9.7 7. The initial appearance of specific granulation in the granulocytic series is predominantly seen in the: A. Promyelocyte B. Metamyelocyte C. Myelocyte D. Eosinophil ANS: C L.O. 9.3 8. The amount of time a granulocyte spends in the circulation before migrating into the tissues is normally: A. 8 hours B. 48 hours C. 5 days D. 20 days ANS: B L.O. 9.2 9. Monocytes recognize foreign antigens and present them to which of the following cells? A. B cells B. T cells C. Neutrophils D. NK cells ANS: B L.O. 9.9 10. All of the following are features of the lymphatic system except: A. Stimulation of the kidney by EPO B. Blood filtration C. Antibody generation D. Lymphopoiesis ANS: A L.O. 9.8 11. There are ___ maturation stages in the neutrophil. A. five B. four C. three D. six ANS: A L.O. 9.2 12. The N:C ratio in a myeloblast is: A. 2:1 B. 4:1 C. 3:1 D. 5:1 ANS: B L.O. 9.1 NARRBEGIN: NARREND 13. Identify the white cell in this picture. A. Lymphocyte B. Myeloblast C. Promyelocyte D. Monocyte ANS: B NAR: Figure 9-1 L.O. 9.2 NARRBEGIN: NARREND 14. Identify the white cell in this picture. A. Band neutrophil B. Metamyelocyte C. Promyelocyte D. Monocyte ANS: B NAR: Figure 9-4 L.O. 9.2 NARRBEGIN: NARREND 15. Identify the white cell in the center of this picture. A. Band neutrophil B. Metamyelocyte C. Promyelocyte D. Monocyte ANS: A NAR: Figure 9-5 L.O. 9.2 16. The plasma cell is responsible for: A. Humoral immunity B. Cell-mediated immunity C. Tumor suppression D. Delayed hypersensitivity ANS: A L.O. 9.9 17. At present, most lymphocyte subpopulations are recognized by their CD markers. CD refers to: A. Codon designation B. Cluster designation C. Cytoplasmic designation D. Cytokine designation ANS: B L.O. 9.4 18. The spleen harbors approximately ___ of the white blood cell population A. one-fourth B. one-half C. one-third D. three-fourths ANS: A L.O. 9.1 True/False 19. The absolute WBC count refers to the percentage of a particular cell counted from the 100 WBC differential. ANS: False L.O. 9.7 20. The primary function of lymphocytes is immunologic. ANS: True L.O. 9.6 21. Mature neutrophils have large, evenly sized, bright orange granules in their cytoplasm. ANS: False L.O. 9.5 22. Lymphocyte production differs from myeloid cell production in that there are two major sites of cellular production. ANS: True L.O. 9.6 23. The myeloid stem cell produces cell lines that end in the production of granulocytes, monocytes, platelets, and red blood cells. ANS: True L.O. 9.6 24. NK cells are unique in that they contribute to immunity without the needed aid of T or B cells. ANS: True L.O. 9.9 25. It is possible for a patient to have a relatively high lymphocyte count, but with a low white blood cell count, the absolute lymphocyte count may be normal. ANS: True L.O. 9.7 Chapter 10. Abnormalities of White Cells: Quantitative, Qualitative, and the Lipid Storage Diseases Multiple Choice 1. A 17-year-old boy is admitted to the hospital with a fever of unknown origin. His WBC count is 20.0  109 /L. All of the following can be seen on his peripheral smear except: A. Toxic granulation B. Reactive monocytes C. Increased band neutrophils D. Döhle bodies ANS: B L.O. 10.1 & 10.2 & 10.6 2. A typical blood picture in infectious mononucleosis is an absolute: A. Lymphocytosis and anemia with many reactive lymphocytes B. Lymphocytosis without anemia and many reactive lymphocytes C. Monocytosis and anemia with many atypical monocytes D. Monocytosis without anemia and many atypical monocytes ANS: B L.O. 10.9 3. Opsonization of foreign bodies is defined as: A. Preparing a foreign body for phagocytosis B. Degranulation of neutrophils C. Fusion of cytoplasmic granules D. Bacteriocidal activity ANS: A L.O. 10.4 4. A patient who presents with a low white cell count, thrombocytopenia, elevated liver enzymes, and mulberry-like inclusions in the granulocytes is most likely suffering from: A. May-Hegglin anomaly B. Chediak-Higashi anomaly C. Human ehrlichiosis D. Alder’s anomaly ANS: C L.O. 10.6 5. All of the following are mechanisms by which neutropenia is usually produced except: A. Decreased production by the bone marrow B. Impaired release from the bone marrow to the blood C. Increased destruction D. Bacterial infection ANS: D L.O. 10.12 6. Which of the following statements is common to most lipid storage diseases? A. They are caused by an amino acid substitution. B. They are caused by a DNA synthetic defect. C. They are caused by a missing metabolic enzyme. D. They are caused by the invasion of a rickettsial organism. ANS: C L.O. 10.11 7. An autosomal disorder that manifests itself with large lysosomal inclusions, recurring infections, and albinism is: A. Chediak-Higashi B. Pelger-Huët C. May-Hegglin D. Alder-Reilly ANS: A L.O. 10.5 8. 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 ANS: C L.O. 10.9 9. The best corrective action for a patient who exhibits platelet satellitism on peripheral blood smear is to: A. Make a duplicate slide and see if this phenomenon disappears B. Warm the tube of blood C. Redraw the sample in sodium citrate D. Vortex the sample of blood ANS: C L.O. N/A 10. A patient who has a persist leukocytosis, Döhle bodies, and an elevated LAP score most likely has a(n): A. Leukemoid reaction B. Pelger-Huët anomaly C. Parasitic infection D. HIV infection ANS: A L.O. 10.3 11. Toxic vacuolization occurs most frequently in: A. Neutrophils B. Monocytes C. Lymphocytes D. Erythrocytes ANS: A L.O. 10.6 12. Toxic granulation in neutrophils is a direct result of: A. Cytokine production B. Enhanced lysosome enzyme production C. Toxic granulation D. Ehrlichia infection ANS: B L.O. 10.6 13. Pelger-Huët anomaly is characterized mainly by: A. Neutrophils with gray-green granules B. Lipid depositions in the cytoplasm C. Giant platelets D. Hyposegmentation of the nucleus in the neutrophils ANS: D L.O. 10.7 14. Döhle bodies consist of: A. DNA B. Primary granules C. Ribosomes RNA D. Lipid deposits ANS: C L.O. 10.6 15. In which white blood cell disorder will you see prominent deposition of granules in every cell line? A. May-Hegglin anomaly B. Alder’s anomaly C. Pelger-Huët anomaly D. Chediak-Higashi syndrome ANS: B L.O. 10.5 16. In which white blood cell disorder will you see gray-green cytoplasmic granules in the neutrophils? A. May-Hegglin anomaly B. Alder’s anomaly C. Pelger-Huët anomaly D. Chediak-Higashi syndrome ANS: D L.O. 10.5 17. HIV inverses the normal ratio of CD4 to CD8 lymphocytes, which is: A. 1:2 B. 1:1 C. 2:1 D. 4:1 ANS: C L.O. 10.10 18. All of the following are lipid storage syndromes/diseases except: A. Gaucher’s disease B. Tay-Sachs disease C. Chediak-Higashi syndrome D. Niemann-Pick disease ANS: C L.O. 10.11 True/False 19. Infectious mononucleosis is caused by the EBV virus, which infects B lymphocytes. ANS: True L.O. 10.9 20. A patient with bacteremia will have an increase in lymphocytes. ANS: False L.O. 10.8 & 10.12 Chapter 11. Acute Leukemias Multiple Choice 1. The basic pathophysiology mechanism responsible for producing signs and symptoms in leukemia includes all of the following except: A. Replacement of normal marrow precursors by leukemic cells B. Decrease in functional leukocytes causing infection C. Hemorrhage secondary to thrombocytopenia D. Decreased erythropoietin production ANS: D L.O. 11.1 2. Migration to extramedullary sites is a feature of which of the following leukemias? A. Acute progranulocytic leukemia B. Acute myelocytic leukemia C. Acute monocytic leukemia D. Acute lymphocytic leukemia ANS: C L.O. 11.2 & 11.3 3. A patient presents with generalized lymphadenopathy and a WBC of 100  109 /L. This hematologic picture would most likely be seen in: A. Chronic lymphocytic leukemia B. Acute lymphocytic leukemia C. Burkitt’s lymphoma D. Hairy cell leukemia ANS: A L.O. 11.1 4. A patient with AML is likely to have a cytochemical stain panel that is positive for: A. Sodium fluoride with tartrate resistance B. MPO, SBB, specific esterase C. MP0, SBB, nonspecific esterase D. SBB and TdT ANS: B L.O. 11.4 5. The monoclonal marker that is often positive in T-ALL is: A. CD1 B. CD7 C. CD10 D. CD41 ANS: B L.O. 11.6 6. The translocation t(15:17)(q22;q12) is associated with which of the following leukemias? A. Acute promyelocytic leukemia B. Acute myelomonocytic leukemia C. Acute lymphocytic leukemia D. Acute myelocytic leukemia ANS: A L.O. 11.5 7. Acute leukemic processes are marked by: A. Slow onset, slow progression, anemia B. Rapid onset anemia, thrombocytopenia C. Splenomegaly D. Less than 30% in the BM ANS: B L.O. 11.1 8. Which of the following is characteristic of Auer rods? A. Composed of fused primary granules B. Predominantly seen in ALL C. Predominantly seen in HCL D. Composed of specific granules ANS: A L.O. 11.2 9. When performing flow cytometry, the technologist interpreted the flow pattern as exhibiting a high degree of CD14- and CD4-positive cells. The peripheral smear showed large multilobulated blast cells. This pattern is most representative of: A. ALL B. AMonoL C. AMML D. AML ANS: B L.O. 11.6 10. Which CD marker best represents the earliest progenitor cells? A. CD11 B. CD19 C. CD34 D. CD57 ANS: C L.O. 11.6 11. According to current WHO classification criteria, acute leukemia is characterized by which of the following? A. Hypercellular bone marrow with greater than 20% blasts B. Hypercellular bone marrow with less than 20% blasts C. Hypocellular bone marrow with greater than 20% blasts D. Hypocellular bone marrow with less than 20% blasts ANS: A L.O. 11.7 12. Pure erythroid leukemia is defined as: A. Erythroid precursors greater than 30%, myeloblasts less than 20% B. Erythroid precursors greater than 50%, myeloblasts less than 40% C. Erythroid precursors less than 50% D. Erythroid precursors greater than 80% ANS: D L.O. 11.2 13. The leukemia with a predominance of WBC cells positive for CD41 is: A. AMML B. AML C. AMonoL D. AMegL ANS: D L.O. 11.6 NARRBEGIN: NARREND 14. The cells pictured here are most consistent for: A. Acute myeloid leukemia B. Acute myelomonocytic leukemia C. Acute lymphoblastic leukemia D. Acute erythroid leukemia ANS: A NAR: Figure 11-2 L.O. 11.2 NARRBEGIN: NARREND 15. The cells pictured here are most consistent with: A. Acute myeloid leukemia B. Acute myelomonocytic leukemia C. Acute lymphoblastic leukemia D. Acute erythroid leukemia ANS: D NAR: Figure 11-11A L.O. 11.2 16. The presence of CD2, CD5, and CD7 and the absence of CD10 is seen in: A. B lymphocytes B. T lymphocytes C. Myeloblasts D. Monoblasts ANS: B L.O. 11.6 NARRBEGIN: NARREND 17. The structure at the end of the pointer is a(n): A. Auer rod B. Döhle body C. Engulfed bacteria D. None of the above ANS: A NAR: Figure 11-11C L.O. 11.2 18. _____ is predominantly a disease of children. A. AML B. CML C. ALL D. CLL ANS: C L.O. 11.7 19. Greater than ______ of bone marrow cells must be identified as lymphoblasts to meet the WHO definition of ALL. A. 10% B. 20% C. 25% D. 30% ANS: B L.O. 11.7 20. Pediatric patients with ALL have an overall complete remission rate of: A. 50% B. 65% C. 75% D. 85% ANS: D L.O. 11.8 Chapter 12. Myeloproliferative Neoplasms Multiple Choice 1. A term describing a peripheral blood finding of leukocytosis with a shift to the left accompanied by occasional nucleated red cells and platelet abnormalities is: A. Dysplasia B. Leukoerythroblastic C. Megaloblastoid D. Leukemoid ANS: B L.O. 12.6 2. The accelerated phase of chronic myeloid leukemia is marked by: A. Increased basophils B. Thrombocytopenia C. Increase in blasts D. Increased fibrosis ANS: A L.O. 12.6 & 12.7 3. Pancytosis is a prominent feature of which of the following disorders? A. Chronic myelocytic leukemia B. Idiopathic myelofibrosis C. Polycythemia vera D. Essential thrombocythemia ANS: C L.O. 12.2 & 12.3 & 12.6 & 12.7 4. A patient has the following CBC results: WBC count: 35  109 /L Differential: 60 segmented neutrophils 12 lymphocytes 8 metamyelocytes 10 band neutrophils 7 monocytes 3 eosinophils Platelets: Normal RBC morphology: Normocytic, normochromic LAP score: 5 These results are consistent with: A. Chronic myelocytic leukemia B. Reaction to severe infection C. Acute leukemia D. Polycythemia vera ANS: A L.O. 12.3 & 12.6 & 12.7 5. What is the pathophysiology of the myeloproliferative disorders? A. Fibroid infiltration of major organs B. Neoplastic transformation of multipotential stem cells C. Widespread deterioration of cellular function D. Splenic sequestration of normal blood cells ANS: B L.O. 12.1 & 12.4 6. Myocardial infarctions, transient ischemic attacks, and deep vein thrombosis are likely to be complications of: A. Chronic myelocytic leukemia B. Acute myelocytic leukemia C. Polycythemia vera D. Myelofibrosis with myeloid metaplasia ANS: C L.O. 12.2 & 12.5 7. A “dry tap” is a characteristic of myeloid fibrosis with myeloid metaplasia due to increased infiltration of: A. Blast cells B. Abnormal platelets C. Abnormal red cells D. Fibrotic elements ANS: D L.O. 12.5 8. What effect does the Ph chromosome have on the prognosis of patients with chronic myelocytic leukemia? A. It is not predictive. B. The prognosis is better if the Ph chromosome is present. C. The prognosis is worse if the Ph chromosome is present. D. The disease usually transforms into AML when the Ph chromosome is present. ANS: B L.O. 12.10 9. The red cell morphology associated with PMF is: A. Burr cells B. Acanthocytes C. Teardrop cells D. Target cells ANS: C L.O. 12.6 10. A high-risk factor for the diagnosis of essential thrombocythemia is: A. A platelet count greater than 600,000 B. Extramedullary hematopoiesis C. The presence of BCR/ABL D. Fibrotic bone marrow ANS: A L.O. 12.2 & 12.3 & 12.6 11. The translocation of genetic material t9:22 is associated with: A. The Philadelphia chromosome B. ALL C. A leukemoid reaction D. Polycythemia vera ANS: A L.O. 12.10 12. _______ indicates the transformation of a chronic process to an acute process. A. An increased WBC count B. Bone marrow fibrosis C. The presence of the Philadelphia chromosome D. An increase in the percentage of blasts in the peripheral blood or bone marrow ANS: D L.O. 12.9 13. Plethora is a condition associated with: A. Polycythemia vera B. CML C. Leukemoid reaction D. Myelofibrosis ANS: A L.O. 12.2 & 12.5 & 12.8 14. The JAK2 chromosomal mutation is associated with: A. Polycythemia vera B. CML C. Leukemoid reaction D. Myelofibrosis ANS: A L.O. 12.2 & 12.10 15. ________ has the worst prognosis of all the myeloproliferative disorders. A. Polycythemic vera B. Essential thrombocythemia C. Primary myelofibrosis D. Chronic myelogenous leukemia ANS: C L.O. 12.2 & 12.9 16. Essential thrombocytosis can affect all three cell lines, but the main cell line affected is the: A. Megakaryocytes B. Erythrocytes C. Granulocytes D. Lymphocytes ANS: A L.O. 12.3 17. Chronic myelogenous leukemia will present with less than _____ blasts in the peripheral blood. A. 5% B. 10% C. 20% D. 30% ANS: A L.O. 12.6 18. The highest concentration of eosinophils seen in peripheral smear is seen in which of the following? A. CML B. CEL C. PV D. ET ANS: B L.O. 12.6 True/False 19. Myeloproliferative neoplasms are disorders of the young. ANS: False L.O. 12.1 20. Patients with essential thrombocytosis do not experience fibrosis of their bone marrow. ANS. True L.O. 12.6 Chapter 13. Lymphoproliferative Disorders and Related Plasma Cell Disorders Multiple Choice 1. Which of the following genetic alterations is associated with a poor prognosis in CLL? A. Trisomy 13 B. Trisomy 12 C. t(15:17) D. t(9:21) ANS: B L.O. 13.2 2. Hypogammaglobulinemia is a significant feature in half of patients with CLL. This complication can lead to: A. Refractory anemia B. Essential thrombocytosis C. Autoimmune hemolytic anemia D. Pernicious anemia ANS: C L.O. 13.2 3. A peripheral blood picture dominated by mature lymphocytes that resemble nucleated red blood cells would most likely be seen in: A. Sézary syndrome B. Burkitt’s lymphoma C. CLL D. Infectious mononucleosis ANS: C L.O. 13.2 4. All of the following are consistent with the clinical and pathological picture of Waldenström’s macroglobulinemia except: A. M spike due to IgM B. Lymphadenopathy and splenomegaly C. Proliferation of lymphocytes and plasmacytoid lymphocytes D. Destructive bone lesions ANS: D L.O. 13.7 5. A significant feature of hairy cell leukemia not seen is other acute leukemias is: A. Panmyelosis B. Pancytosis C. Pancytopenia D. Panhyperplasia ANS: C L.O. 13.3 6. The most characteristic change seen in the peripheral smear of a patient with multiple myeloma is the presence of: A. Microcytic hypochromic cells B. Intracellular inclusion bodies C. Rouleaux D. Agglutination ANS: C L.O. 13.5 7. An abnormal proliferation of B lymphocytes seen in lymph node biopsy with a morphology resembling an owl’s eye is commonly associated with: A. Acute lymphocytic leukemia B. Chronic lymphocytic leukemia C. Infectious mononucleosis D. Hodgkin’s disease ANS: D L.O. 13.4 8. All of the following are related to the pathophysiology of multiple myeloma except: A. Acceleration of plasma cells in the bone marrow B. Increased levels of tyrosine kinase activity C. Activation of osteoclasts D. Production of an abnormal monoclonal protein ANS: B L.O. 13.6 9. Patients with CLL: A. Die most often of blast crisis B. Are usually younger than 40 years C. May develop monoclonal spikes D. Often are immunocompromised ANS: D L.O. 13.2 10. A new treatment for multiple myeloma that was once banned from use in pregnant women is: A. EPO B. Thalidomide C. Demerol D. Interferon ANS: B L.O. 13.6 11. The CD markers associated with CLL include all of the following except: A. CD 4 B. CD 15 C. CD 19 D. CD 20 ANS: A L.O. 13.8 NARRBEGIN: NARREND 12. The cells at the tip of the pointer are most frequently associated with: A. CLL B. Hairy cell leukemia C. Sézary syndrome D. Multiple myeloma ANS: B NAR: Figure 13-4 L.O. 13.3 13. Lymphoma cells in the peripheral smear are associated with: A. Hodgkin’s lymphoma B. CLL C. non-Hodgkin’s lymphoma D. Multiple myeloma ANS: C L.O. 13.4 14. The immunoglobulin responsible for secondary immunological response and a monoclonal over-production in multiple myeloma is: A. IgA B. IgM C. IgD D. IgG ANS: D L.O. 13.6 15. Russell bodies are associated with: A. Multiple myeloma B. Hodgkin’s lymphoma C. Non-Hodgkin’s lymphoma D. Waldenström’s macroglobulinemia ANS: A L.O. 13.6 16. The TRAP stain is useful in the diagnosis of: A. CLL B. PLL C. Hairy cell leukemia D. Hodgkin’s lymphoma ANS: C L.O. 13.3 NARRBEGIN: NARREND 17. The protein electrophoresis pattern pictured here is most frequently associated with: A. Hodgkin’s lymphoma B. Multiple myeloma C. Thalassemia major D. Essential thrombocytopenia ANS: B NAR: Figure 13-8B L.O. 13.6 18. All of the following describe characteristics of a plasma cell except: A. Medium-sized cell B. Eccentric nucleus C. Well-defined Golgi apparatus D. Very little, light blue cytoplasm ANS: D L.O. 13.5 19. Which of the following statements about Hodgkin’s disease is false? A. The peak incidence for the disease is 15 to 40 years of age. B. The disease occurs more frequently in males. C. It is a precursor to T-cell lymphoma D. Individuals who have been exposed to the Epstein-Barr virus may be more vulnerable to Hodgkin’s lymphoma. ANS: C L.O. 13.4 20. Which of the following statements is true about chronic lymphoproliferative disorders? A. Complications are related to overactive immune systems. B. They are often seen in elderly patients and progress quickly. C. They are often seen in elderly patients and progress slowly. D. They are a clonal proliferation of granulocytes. ANS: C L.O. 13.1 Chapter 14. The Myelodysplastic Syndromes Multiple Choice 1. The most common hematological malignancy in the adult population is: A. Acute leukemia B. Multiple myeloma C. Myelodysplastic syndrome D. Chronic leukemias ANS: C L.O. 14.1 2. Which of the following bone marrow blast percentages will be consistent with the FAB classification of refractory anemia with excess of blasts (RAEB)? A. 5% to 20% B. 20% to 30% C. Greater than 30% D. Less than 5% ANS: A L.O. 14.3 & 14.4 3. All of the following are features of the myelodysplastic syndromes except: A. Anemia B. Organomegaly C. Dysplasia D. Hypercellular marrow ANS: B L.O. 14.1 4. The morphological classification of anemia in the myelodysplastic syndromes is: A. Normocytic, normochromic B. Microcytic, hypochromic C. Macrocytic, normochromic D. Microcytic, normochromic ANS: C L.O. 14.1 & 14.3 5. The most effective means of treating iron overload in the myelodysplastic syndromes is: A. Therapeutic phlebotomy B. Limiting iron-containing foods C. Iron chelation therapy D. Fasting ANS: C L.O. 14.6 6. The blast count in most individuals with MDS is less than: A. 10% B. 40% C. 5% D. 20% ANS: D L.O. 14.3 7. Reticulocytopenia is a feature of MDS. Which one of the following is the mechanism behind this process? A. Heavy tumor burden B. Marrow aplasia C. Ineffective erythropoiesis D. Toxic effects ANS: B L.O. 14.1 & 14.3 8. One of the key white cell features in MDS is: A. Hypersegmented neutrophils B. Auer rods C. Döhle bodies D. Pseudo–Pelger-Huët ANS: D L.O. 14.3 9. Which of the following chromosome disorders in MDS has a poor predictive influence? A. Chromosome 7 disorder B. Trisomy 12 C. Trisomy 13 D. 17q deletion ANS: A L.O. 14.5 10. All of the following are dysplastic changes of platelets frequently seen in MDS except: A. Abnormal granulation B. Micromega karyocytes C. Giant platelets D. Platelet satellitism ANS: D L.O. 14.3 11. Typically, patients with MDS will exhibit partial or complete absence of: A. Chromosomes 5 and 7 B. Chromosomes 8 and 12 C. The Y chromosome D. Dysplasia ANS: A L.O. 14.2 12. Refractory anemia is an anemia that: A. Has more than 5% blasts in the peripheral blood B. Is resistant to treatment C. Will usually demonstrate a hypoplastic bone marrow D. Demonstrates a 17q deletion routinely ANS: B L.O. 14.1 NARRBEGIN: NARREND 13. The cell at the tip of the pointer is: A. A basophil B. A malignant cell C. A hypogranular neutrophil D. Not a cell; it’s an artifact ANS: C NAR: Figure 14-2 L.O. 14.3 NARRBEGIN: NARREND 14. The cell at the tip of the pointer is a: A. Hairy cell B. Basket cell C. Degenerating lymphocyte D. Giant platelet ANS: D NAR: Figure 14-4 L.O. 14.3 NARRBEGIN: NARREND 15. The correct name for the cell at the end of the pointer is a: A. Ringed sideroblast B. Reticulocyte C. Giant platelet D. Siderocyte ANS: A NAR: Figure 14-1 L.O. 14.3 16. All of the following are associated with the development of the MDSs except: A. Alkylating therapy B. Benzene exposure C. Alcoholism D. Radiation ANS: C L.O. 14.2 17. The bone marrow and peripheral smear of a patient with an MDS will show dysplastic changes in _____ over time. A. white blood cells B. red blood cells C. platelets D. All of the above ANS: D L.O. 14.3 True/False 18. Deleted 5q MDS is primarily seen in male patients. ANS: False L.O. 14.5 19. A major concern for the management of patients with MDSs is iron overload. ANS: True L.O. 14.6 20. A large percentage of the MDSs end in an acute leukemia. ANS: True L.O. 14.6 Chapter 15. Overview of Hemostasis and Platelet Physiology Multiple Choice 1. Factor II is also known as which of the following? A. Thrombin B. Fibrinogen C. Prothrombin D. Fibrin ANS: C L.O. 15.7 2. Platelet aggregation is dependent on the presence of: A. Calcium ions B. Sodium citrate C. Magnesium D. Potassium ANS: A L.O. 15.2 & 15.3 3. The vasoconstrictor substance released from the platelets at the site of injury is: A. Thrombin B. Thromboxane A2 C. Adenosine diphosphate D. Prostacyclin ANS: B L.O. 15.2 & 15.3 4. Which organ is responsible for sheltering 20% of the total platelet volume in the circulation? A. Kidneys B. Adrenal gland C. Spleen D. Liver ANS: C L.O. 15.1 5. The main substrate of the coagulation system is: A. Calcium B. ADP C. Collagen D. Fibrinogen ANS: D L.O. 15.3 & 15.6 6. A decreased platelet count is most often anticipated when a patient demonstrates: A. Thrombosis B. Petechiae C. Hemarthrosis D. Glossitis ANS: B L.O. 15.1 & 15.4 7. Which of the following is not a component of the fibrinolytic system? A. Thrombin B. Plasmin C. Tissue-type plasminogen activator (tPA) D. Urokinase ANS: A L.O. 15.10 8. The prothrombin group of factors consists of factors: A. I, V, VIII, and XIII B. XI, XII, prekallikrein, and HMWK C. II, VII, IX, and X D. III, VIII, IX, and X ANS: C L.O. 15.7 9. The anticoagulant known as heparin: A. Inhibits PF3 activity B. Inhibits thrombin activity C. Degrades antithrombin activity D. Chelates calcium ANS: B L.O. 15.10 10. Which factor is involved in contact activation? A. Factor X B. Fibrinogen C. Fitzgerald factor D. Factor II ANS: C L.O. 15.6 & 15.7 11. Which factor is measured by both the PT and the aPTT? A. VIII B. IX C. V D. XIII ANS: C L.O. 15.6 12. Which of the following proteins is not made in the liver? A. Anti-hemophiliac factor B. Prothrombin C. Fibrinogen D. von Willebrand factor ANS: D L.O. 15.1 13. Tissue factor pathway inhibitor (TFPI): A. Prevents activation of factor X by VIIa B. Activates the common pathway C. Inhibits fibrinolysis D. Inhibits the kallikrein proteins ANS: A L.O. 15.10 14. The two inhibitors that keep the activation of coagulation under control are: A. TFPI and thrombomodulin B. Protein C and protein S C. Protease inhibitors and the protein C pathway D. Alpha 2 macroglobulin and alpha 1 antitrypsin ANS: B L.O. 15.10 15. In the prothrombin test, the patient’s citrated plasma is combined with: A. Phospholipids B. Thromboplastin only C. Ca2+ and actin D. Ca2+ and thromboplastin ANS: D L.O. 15.8 16. The first response of a cut vessel is: A. Vasocons