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WorksheetsHEMA MIDTERM EXAM
Total questions: 130
Worksheet time: 2hrs 43mins
Of the following, the disease most closely associated with granulocyte hyposegmentation is:
May-Hegglin anomaly
Pelger-Huet anomaly
Chediak-Higashi syndrome
Gaucher's disease
A characteristic morphologic feature in hemoglobin C disease is:
macrocytosis
spherocytosis
rouleaux formation
target cells
Thalassemias are characterized by:
structural abnormalities in the hemoglobin molecule
absence of iron in hemoglobin
decreased rate of heme synthesis
decreased rate of globin synthesis
Phagocytosis is a function of
erythrocytes
granulocytes
lymphocytes
thrombocytes
Cells for the transport of 02 and CO2 are:
erythrocytes
granulocytes
lymphocytes
thrombocytes
Cells that produce antibodies and lymphokines are:
erythrocytes
granulocytes
lymphocytes
thrombocytes
In polycythemia vera, the hemoglobin, hematocrit, red blood cell count, and red cell mass are:
elevated
normal
decreased
None of the choices given
In polycythemia vera, the platelet count is:
elevated
normal
decreased
None of the choices given
Erythropoietin acts to:
shorten the replication time of the granulocytes
stimulate RNA synthesis of erythroid cells
increase colony-stimulating factors produced by the B-lymphocytes
decrease the release of marrow reticulocytes
The anemia of chronic infection is characterized by:
decreased iron stores in the reticuloendothelial system
decreased serum iron levels
macrocytic erythrocytes
increased serum iron-binding capacity
Factors commonly involved in producing anemia in patients with chronic renal disease include:
marrow hypoplasia
ineffective erythropoiesis
vitamin B12 deficiency
increased erythropoietin production
The majority of the iron in an adult is found as a constituent of:
hemoglobin
hemosiderin
myoglobin
transfenin
Which of the following is associated with Chediak-Higashi syndrome?
membrane defect of lysosomes
Dohle bodies and giant platelets
two-lobed neutrophils
mucopolysaccharidosis
Which of the following is associated with Alder-Reilly inclusions?
membrane defect of lysosomes
Dohle bodies and giant platelets
two-lobed neutrophils
mucopolysaccharidosis
In order for hemoglobin to combine reversibly with oxygen, the iron must be:
complexed with haptoglobin
freely circulating in the cytoplasm
attached to transferrin
in the ferrous state
Heinz bodies are:
readily identified with polychrome stains
rarely found in glucose-6-phosphate dehydrogenase deficient erythrocytes
closely associated with spherocytes
denatured hemoglobin inclusions that are readily removed by the spleen
A bone marrow slide shows foam cells ranging from 20 to 100 pm in size with vacuolated cytoplasm containing sphingomyelin and is faintly PAS positive. This cell type is most characteristic of?
Gaucher's disease
myeloma with Russell bodies
Di Guglielmo disease
Niemann-Pick disease
Patients with chronic granulomatous disease suffer from frequent pyogenic infections owing to the inability of:
lymphocytes to produce bacterial antibodies
eosinophils to degranulate in the presence of bacteria
neutrophils to kill phagocytized bacteria
basophils to release histamine in the presence of bacteria
Which of the following is most closely associated with iron deficiency anemia?
iron overload in tissue
target cells
basophilic stippling
chronic blood loss
Which of the following is seen most often in thalassemia?
acanthocytes
target cells
basophilic stippling
ringed sideroblasts
Which of the following is most likely to be seen in lead poisoning?
iron overload in tissue
codocytes
basophilic stippling
ringed sideroblasts
Auer rods are:
a normal aggregation of lysosomes or primary (azurophilic) granules
predominantly found in acute myelogenous leukemia
peroxidase negative
alkaline phosphatase positive
Morphologic variants of plasma cells do NOT include:
flame cells
morula cells
grape cells
Gaucher's cells
Pluripotent stem cells are capable of producing
daughter cells of only one cell line
only T-lymphocytes and B-lymphocytes
erythropoietin, thrombopoietin, and leukopoietin
lymphoid and myeloid stem cells
The anemia found in myeloproliferative disorders is usually:
microcytic, hypochromic
macrocytic, normochromic
normocytic, normochromic
microcytic, normochromic
Hairy cell leukemia (leukemic reticuloendotheliosis) is:
an acute myelocytic leukemia
a chronic leukemia of myelocytic origin
a chronic leukemia of lymphocytic origin
an acute myelocytic monocytic-type leukemia
Which of the following cell types is characteristic of Pelger Huet anomaly?
band form
pince-nez form
normal neutrophil
myelocyte
Which of the following is the formula for mean corpuscular volume (MCV)?
(Hgb x 10)/RBC
Hgb/Hct
(Hct x 10)/RBC
RBC/Hct
Which of the following is used for staining reticulocytes?
Giemsa stain
Wright's stain
new methylene blue
Prussian blue
The characteristic erythrocyte found in pernicious anemia is:
microcytic
spherocytic
hypochromic
macrocytic
The white cell feature most characteristic of pernicious anemia is
eosinophilia
toxic granulation
hypersegmentation
atypical lymphocytes
The ideal capillary blood collection site on a newborn is
tip of the thumb
ear lobe
plantar surface of the heel
the great toe
In the normal adult, the spleen acts as a site for:
storage of red blood cells
production of red blood cells
synthesis of erythropoietin
removal of imperfect and aging cells
The term "shift to the left" refers to:
a microscope adjustment
immature cell forms in the peripheral blood
a trend on a Levy-Jennings chart
a calibration adjustment on an instrument
Of the following, the disease most closely associated with glucocerebrosidase deficiency is:
Gaucher's disease
Chediak-Higashi syndrome
Pelger-Huet anomaly
May-Hegglin anomaly
Of the following, the disease most closely associated with cytoplasmic granule fusion is:
Chediak-Higashi syndrome
Pelger-Huet anomaly
May-Hegglin anomaly
Alder-Reilly anomaly
The morphologic feature most characteristic of hemolytic anemia is:
spherocytosis
rouleaux formation
basophilic stippling
target cells
The characteristic morphologic feature in lead poisoning is
macrocytosis
target cells (codocytes)
basophilic stippling
rouleaux formation
The characteristic morphologic feature in folic acid deficiency is:
macrocytosis
target cells
basophilic stippling
rouleaux formation
Which of the following characteristics are common to hereditary spherocytosis, hereditary elliptocytosis, hereditary stomatocytosis, and paroxysmal nocturnal hemoglobinuria?
autosomal dominant inheritance
red cell membrane defects
positive direct antiglobulin test
measured platelet count
Precursors of tissue macrophages of the reticuloendothelial system most likely are:
T lymphocytes
B lymphocytes
monocytes
mast cells
Which of the following cells are most likely identified in lesions of mycosis fungoides?
T lymphocytes
B lymphocytes
monocytes
mast cells
In normal adult bone marrow, the most common granulocyte is the:
basophil
myeloblast
eosinophil
metamyelocyte
Which of the following cells is the largest cell in the bone marrow:
megakaryocyte
histiocyte
osteoblast
mast cell
Variation in red cell size observed on the peripheral smear is described as:
Anisocytosis
Hypochromia
Poikilocytosis
Pleocytosis
Which of the following is the preferable site for bone marrow aspiration and biopsy in an adult?
Iliac crest
Sternum
Tibia
Spinous processes of a vertebra
Which of the following erythrocyte inclusions can be visualized with supravital stain but cannot be detected on a Wright’s-stained blood smear?
Basophilic stippling
Heinz bodies
Howell–Jolly bodies
Siderotic granules
Which of the following statistical terms reflects the best index of precision when comparing two CBC parameters
Mean
Median
Coefficient of variation
Standard deviation
Which of the following is considered a normal hemoglobin?
Carboxyhemoglobin
Methemoglobin
Sulfhemoglobin
Deoxyhemoglobin
Which condition will shift the oxyhemoglobin dissociation curve to the right
Acidosis
Alkalosis
Multiple blood transfusions
Increased quantities of hemoglobin S or C
Which is the first stage of erythrocytic maturation in which the cytoplasm is pink due to the formation of hemoglobin?
Reticulocyte
Pronormoblast
Basophilic normoblast
Polychromatic normoblast
Which of the following can shift the hemoglobin oxygen dissociation curve to the right?
Increases in 2,3 DPG
Acidosis
Hypoxia
All of these options
Which of the following organs is responsible for the “pitting process” for RBCs?
Liver
Spleen
Kidney
Lymph nodes
Spherocytes differ from normal red cells in all of the following except:
Decreased surface to volume
No central pallor
Decreased resistance to hypotonic saline
Increased deformability
Which is the major Hgb found in the RBCs of patients with sickle cell trait?
Hgb S
Hgb F
Hgb A2
Hgb A1
Select the amino acid substitution that is responsible for sickle cell anemia.
Lysine is substituted for glutamic acid at the
sixth position of the α-chain
Valine is substituted for glutamic acid at the sixth position of the β-chain
Valine is substituted for glutamic acid at the sixth position of the α-chain
Glutamine is substituted for glutamic acid at the sixth position of the β-chain
All of the following are usually found in Hgb C disease except:
Hgb C crystals
Target cells
Lysine substituted for glutamic acid at the sixth position of the β–chain
Fast mobility of Hgb C at pH 8.6
Which of the following electrophoretic results is consistent with a diagnosis of sickle cell trait?
Hgb A: 40% Hgb S: 35% Hgb F: 5%
Hgb A: 60% Hgb S: 40% Hgb A2: 2%
Hgb A: 0% Hgb A2: 5% Hgb F: 95%
Hgb A: 80% Hgb S: 10% Hgb A2: 10%
“Bite cells” are usually seen in patients with:
Rh null trait
Chronic granulomatous disease
G6PD deficiency
PK deficiency
The morphological classification of anemias is based on which of the following?
M:E (myeloid:erythroid) ratio
Prussian blue stain
RBC indices
Reticulocyte count
Which of the following is a common finding in aplastic anemia?
A monoclonal disorder
Tumor infiltration
Peripheral blood pancytopenia
Defective DNA synthesis
Which antibiotic(s) is (are) most often implicated in the development of aplastic anemia
Sulfonamides
Penicillin
Tetracycline
Chloramphenicol
What red cell inclusion may be seen in the peripheral blood smear of a patient postsplenectomy?
Toxic granulation
Howell–Jolly bodies
Malarial parasites
Siderotic granules
Iron deficiency anemia is characterized by
Decreased plasma iron, decreased % saturation, increased total iron-binding capacity (TIBC)
Decreased plasma iron, decreased plasma ferritin, normal RBC porphyrin
Decreased plasma iron, decreased % saturation, decreased TIBC
Decreased plasma iron, increased % saturation, decreased TIBC
Which anemia is characterized by a lack of intrinsic factor that prevents B12 absorption?
Tropical sprue
Transcobalamin deficiency
Blind loop syndrome
Pernicious anemia
Which morphological classification is characteristic of megaloblastic anemia?
Normocytic, normochromic
Microcytic, normochromic
Macrocytic, hypochromic
Macrocytic, normochromic
Which inclusions may be seen in leukocytes?
Döhle bodies
Basophilic stippling
Malarial parasites
Howell–Jolly bodies
It is the process by which erythroid precursor cells differentiate to become mature RBC.
Leukopoiesis
Erythropoiesis
Thrombopoiesis
Hematopoiesis
Components of quality assurance/assessment programs includes all of the following except?
Preexamination variables
Examination variables
Post examination variables
None of the given choices
Which of the following is not included in the examination/analytical phase of testing?
laboratory staff competence
assay and instrument selection
accuracy in transcription and filing of results
external and internal quality control
assay validation
Which of the following is part of the preexamination/preanalytical phase of testing?
specimen collection equipment and technique
patient and physician satisfaction
turnaround time
assay validation
content and format of laboratory report
It is a sample of known quantity and are prepared from the same matrix as patient specimens and are sampled alongside patient specimens to accomplish within-run assay validation.
Calibrators
Standard
Controls
Blank reagent
When controls are run, they must fall within predetermined dispersal limits, typically at ________________.
+1SD
+2SD
+3SD
+4SD
These are materials of known concentration used in developing a standard curve/for calibration of instrument.
Calibrators
Standard
Controls
Blank reagent
These are materials used to adjust instrument accuracy by configuring an instrument to provide a result for a sample within an acceptable range.
Calibrators
Standard
Controls
Blank reagent
The main cause of the error is due to improper calibration of the instrument causing an abrupt change in the mean.
Shift
Trend
The main cause of the error is due to deterioration of reagent causing 6 or more control values continue to either increase or decrease
Shift
Trend
It refers to the closeness of a measured value to a standard or known value.
Accuracy
Precision
Specificity
Sensitivity
It is a measure of the smallest increment/amount of the analyte that can be distinguished by the assay.
Accuracy
Precision
Specificity
Sensitivity
This error occurs when 4 consecutive control values exceeds +1s .
41s
42s
14s
24s
Primary site of hematopoiesis in Mesoblastic stage.
Liver
Kidney
Yolk Sac
Bone Marrow
Primary site of hematopoiesis in Hepatic stage.
Liver
Kidney
Yolk Sac
Bone Marrow
Cells that is produced as early as mesoblastic stage of hematopoiesis.
Erythrocytes
Lymphocytes
Monocytes
Granuloytes
Megakaryocytes
At what hematopoietic stage does Hgb F produced?
Hepatic Stage
Mesoblastic Stage
Myeloid Stage
Medullary Stage
Which hemoglobin contains 2 alpha chains and 2 delta chains.
HgB A1
Hgb A2
Hgb F
Hgb A1c
The bone marrow has two forms, which one is normally active in the production of most types of leukocytes, erythrocytes, and thrombocytes.
Yellow Marrow
Red marrow
This is a common disorder characterized by an enlarged spleen which causes rapid and premature destruction of blood cells since the spleen becomes overactive and removes the blood cells too early and too quickly.
Splenectomy
Splenomegaly
Hyposplenism
Hypersplenism
This is considered the first human hematopoietic growth factor to be identified.
Thrombopoietin
Erythropoietin
Progesterone
Growth Hormone
Which of the following statement is incorrect as RBC matures?
The overall diameter of the cell decreases cytoplasm changes from blue to salmon pink.
The diameter of the nucleus decreases more rapidly and the size of the cell. As a result, the N:C ratio also decreases
The nuclear chromatin pattern becomes coarser, clumped, and condensed as RBC matures.
Nucleoli remains until the RBC matures and released in the bloodstream.
Which of the following is incorrectly paired:
Pronormoblasts aka Rubriblasts
Basophilic Normoblasts aka Prorubricyte
Polychromatophilic Normoblast aka Rubricyte
Orthochromic normoblast aka Polychromatophilic erythrocyte
Reticulcyte aka Diffusely Basophilic Erythrocyte
Which of the following RBC maturation stage does hemoglobin first appear?
Rubricyte
Metarubricyte
Reticulocyte
Rubriblasts
Which of the following RBC maturation stage is not anymore capable of mitosis as well as the last nucleated stage.
Rubricyte
Metarubricyte
Reticulocyte
Rubriblasts
Which protein maintains the biconcavity of the RBCs?
Glycophorin A
Spectrin
Actin
phosphatidyl choline
The loss of this important RBC component leads to loss of membrane deformability due to a decrease in phosphorylation of spectrin.
ATP
Sialic Acid
phosphatidylethanolamine
phosphatidylinositol
The RBC membrane is freely permeable to:
Water
Na
K
Ca2+
This pathway of RBC metabolism is the aerobic pathway.
Pentose phosphate pathway
Embden Meyerhoff Pathway
Rapoprt-Luebering Pathway
Methemoglobin Pathway
It is the reference method for hemoglobin assay that is performed manually but has been adapted to automated instruments.
Alkaline Agar Electrophoresis
Citrate Agar Electrophoresis
Cyanmethemoglbin method
Copper Sulfate Method
Which of the following is incorrect regarding anemia?
Anemia refers to the decrease in the oxygen carrying capacity of the blood which can arise if there is insufficient hemoglobin or the hemoglobin has impaired function.
Anemia is operationally defined as the reduction in the hemoglobin content of blood that can be caused by a decrease in RBCs, hemoglobin, and hematocrit below the reference interval for healthy individuals of similar age, sex, and race, under similar environmental conditions.
Anemia can be acute or chronic.
Anemia occurs when there is a decrease in the number of leukocyte precursors in the bone marrow.
A type of anemia that is usually associated with traumatic conditions such as an accident or severe injury and an anemia that may occur during or after surgery.
Chronic Blood Loss Anemia
Acute Blood Loss Anemia
Aplastic Anemia
Iron deficiency Anemoa
A type of anemia that is frequently associated with disorders of the gastrointestinal (GI) tract, although chronic blood loss may be related to heavy menstruation in women or urinary tract abnormalities.
Chronic Blood Loss Anemia
Acute Blood Loss Anemia
Aplastic Anemia
Iron deficiency Anemoa
Which iatrogenic agents causes aplastic anemia when patients are exposed to burning gasoline for a long time.
Benzene
Tetracyclines
Organic Arsenals
Phenylbutazone
It is considered the congenital form of aplastic anemia.
Diamond Black Fan Anemia
Fanconi Anemia
Pure Red Cell Aplasia
Transient Erythroblastopenia of Childhood
It is a compulsive ingestion of nonnutritive substances has association with iron deficiency.
Papilledema
Pica
Lead Poisoning
Cyanide Poisoning
A full manifestation of iron deficiency anemia will exhibit ___________________ red cell pattern.
hypochromic and microcytic
Hyperchromic and microcytic
Hyperchromic and macrocytic
hypochromic and normocytic
It is considered an effective early indicator of iron deficiency.
Reticulocyte hemoglobin content
Soluble transferrin receptor
Serum Ferritin
All of the given choices
This type of anemia is usually due to common complication in patients with disorders as diverse as inflammation, infection, malignancy.
Iron Deficiency Anemia
Anemia of Chronic Inflammation/disorder
Aplastic Anemia
Autoimmune Hemolytic Anemia
This type of anemia is usually caused by an altered immune response resulting in production of antibody against the patient’s own erythrocytes, with subsequent hemolysis.
Iron Deficiency Anemia
Anemia of Chronic Inflammation/disorder
Aplastic Anemia
Autoimmune Hemolytic Anemia
A type of autoimmune hemolytic anemia that is due to immunoglobulin G (IgG) coating of erythrocytes with or without complement fixation.
Warm Autoimmune Hemolytic Anemia
Cold Autoimmune Hemolytic Anemia
Isoimmune Hemolytic Anemia
Drug Induced Hemolytic Anemia
A type of autoimmune hemolytic anemia that is due to IgM antibody that coats the erythrocytes causing extra-vascular hemolysis.
Warm Autoimmune Hemolytic Anemia
Cold Autoimmune Hemolytic Anemia
Isoimmune Hemolytic Anemia
Drug Induced Hemolytic Anemia
Macrocytes are usually seen in all of the following except?
Liver Disease
Alcoholism
Megaloblastic Anemia
Chronic Disease
Which RBC shape is seen in abetalipoproteinemia and alcoholic cirrhosis.
Echinocyte
Acanthocyte
Codocyte
Spherocyte
This are erythrocytes containing one or more vacuoles that resemble a blister on the skin as a result from the traumatic interaction of blood vessels and circulating blood such as fibrin deposits.
Stomatocytes
Dacryocytes
Blister cells
Microspherocytes
When central pallor area exceeds 1/3 of the diameter of the cell, this is termed?
Hyperchromia
Hypochromia
Normochromia
None of the given choices
This RBC inclusion appears round, solid- staining, dark-blue to purple inclusions, 1 to 2 mm in size formed as nuclear remnants of DNA.
Heinz Bodies
Howell Jolly Bodies
Basophilic Stippling
Pappenheimer Bodies
Which stage of thrombopoiesis shows a horseshoe shape nucleus.
Megakaryoblast
Granular Megakaryocyte
Promegakaryocyte
Mature Megakaryocyte
Dense granules of platelets includes all of the following except?
Calcium
ADP
Serotonin
vWF
2/3 of the circulating platelets are located in the _____.
Bloodstream
Spleen
Liver
Bone marrow
Which granulocyte maturation stage has a kidney shaped nucleus?
Myeloblast
Myelocyte
Promyelocyte
Metamyelocyte
Which granulocyte maturation stage does secondary granules occurs?
Myeloblast
Myelocyte
Promyelocyte
Metamyelocyte
Which granulocyte maturation stage does primary granules occurs?
Myeloblast
Myelocyte
Promyelocyte
Metamyelocyte
Which WBC type has pink to rose-violet specific granules.
Neutrophils
Eosinophils
Basophils
Monocytes
Charcott-leyden crystals are formed from the disintegration of which WBC type?
Neutrophils
Eosinophils
Basophils
Monocytes
Responds to parasitic and allergic reaction and its concentration is normally high at night.
Neutrophils
Eosinophils
Basophils
Monocytes
The nucleus of this cell is eccentric and exhibits cartwheel like pattern and has well-defined hof/perinuclear halo in the cytoplasm
Plasmablast
Plasma cell
Monocyte
Small Lymphocyte
It refers to the inability of phagocytes to kill ingested
microorganisms.
Job Syndrome
Lazy Leukocyte Syndrome
Chronic Granulomatous Disease
Toxic Granules
It is a monocyte with ingested lymphocyte.
Tart Cell
LE cell
Flame cell
Hairy Cell
It is a plasma cell with red to pink cytoplasm that is found in multiple myeloma.
Tart Cell
LE cell
Flame cell
Hairy Cell
This lipid storage disease is mainly due to deficiency in Glucocerebrosidase or Beta-glucosidase.
Gaucher's Disease
Niemann-pick Disease
Tay-Sachs
Sandhoff
This lipid storage disease is mainly due to deficiency in Sphingomyelinase.
Gaucher's Disease
Niemann-pick Disease
Tay-Sachs
Sandhoff
It formed from degenerated /disintegrated nucleus of a ruptured white blood cell usually found in Chronic Lymphocytic
Leukemia (CLL).
Tart Cell
LE cell
Flame cell
Basket cell
