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WorksheetsHEMATOLOGY 1 REMEDIAL EXAM
Total questions: 100
Worksheet time: 54mins
The causes of anemia include
blood loss
impaired red cell production
accelerated red cell destruction
all of the choices
none of the choices
The clinical signs and symptoms of anemia can result from
diminished delivery of oxygen to the tissues
higher hemoglobin concentration
increased blood volume
All of the choices
None of the choices
Which of the following is a significant laboratory finding in anemia?
Decreased hemoglobin
Increased packed cell volume
Increased erythrocyte count
Normal erythrocyte indices
Disorders of the GI system or heavy menstruation
Acute blood loss
Chronic blood loss
Traumatic conditions/injury
Acute blood loss
Chronic blood loss
The erythrocyte morphology associated with anemia in
an otherwise healthy individual caused by acute blood
loss is usually
microcytic
megaloblastic
normochromic
hypochromic
Anemia caused by chronic blood loss is characterized by
hypochromic, microcytic erythrocytes
decreased packed cell volume
increased platelets
hypochromic, microcytic erythrocytes and decreased packed cell volume
Acquired aplastic anemia may be caused by
benzene or benzene derivatives
ionizing radiation and vitamin B12
purine or pyrimidine analogues
all of the choices
The sudden appearance of aplastic anemia or pure red
cell aplasia is often caused by
a hemolytic process
an immune process
acute leukemias
chronic leukemias
The average adult has _____ g of total iron.
0.2 to 1.4
1.5 to 3.4
3.5 to 5.0
5.1 to 10.0
Most functional iron in humans is found in
the bone marrow
the liver
hemoglobin molecules of erythrocytes (RBCs)
the free hemoglobin in the circulation
In IDA, the erythrocytic indices are typically
MCV increased, MCH decreased, and MCHC decreased
MCV decreased, MCH decreased, and MCHC decreased
MCV decreased, MCH increased, and MCHC decreased
MCV decreased, MCH decreased, and MCHC normal
The peripheral blood smear demonstrates _____ red blood cells in IDA.
microcytic, hypochromic
macrocytic, hypochromic
macrocytic and spherocytic
normocytic hyperchrominc
The typical peripheral blood film of a patient with anemia of chronic infection/inflammation typically reveals _____ erythrocytes.
microcytic, hypochromic
macrocytic, hypochromic
normocytic, normochromic
many spherocytes
Heinz bodies are associated with the congenital hemolytic anemia
G6PD deficiency
abetalipoproteinemia
hereditary spherocytosis
hemolytic anemias
What is the most common glycolytic enzyme deficiency associated with the aerobic pathway of erythrocyte metabolism?
Glucose-6-phosphate dehydrogenase (G6PD)
Pyruvate kinase (PK)
Methemoglobin reductase deficiency
Hexokinase deficiency
What is the most common glycolytic enzyme deficiency associated with the anaerobic pathway of erythrocyte metabolism?
Glucose-6-phosphate dehydrogenase (G6PD)
Pyruvate kinase (PK)
Methemoglobin reductase deficiency
Hexokinase deficiency
Acquired hemolytic anemia can be caused by
chemicals or drugs
infectious organisms
antibody reactions
all of the choices
none of the choices
The process of formation and development of blood cells is termed:
Hematopoiesis
Hematemesis
Hematocytometry
Hematorrhea
During the second trimester of fetal development, the primary site of blood cell production is the:
Bone marrow
Spleen
Lymph nodes
Liver
The best source of active bone marrow from a 20-year-old would be:
Iliac crest
Femur
Distal radius
Tibia
Physiologic programmed cell death is termed:
Angiogenesis
Apoptosis
Aneurysm
Apohematics
Which organ is the site of sequestration of platelets?
Spleen
Liver
Thymus
Bone marrow
Which one of the following morphologic changes occurs during normal blood cell maturation:
Increase in cell diameter
Development of cytoplasm basophilia
Condensation of nuclear chromatin
Appearance of nucleoli
What growth factor is produced in the kidneys and is used to treat anemia associated with kidney disease?
EPO
TPO
G-CSF
KIT ligand
When a patient has severe anemia and the bone marrow is unable to effectively produce red blood cells to meet the increased demand, one of the body’s responses is:
Extramedullary hematopoiesis in the liver and spleen
Decreased production of erythropoietin by the kidney
Increased apoptosis of erythrocyte progenitor cells
Increase the proportion of yellow marrow in the long
bones
Hematopoietic stem cells produce all lineages of blood
cells in sufficient quantities over the lifetime of an individual because they
Are unipotent
Have the ability of self-renewal by asymmetric division
Are present in large numbers in the bone marrow niches
Have a low mitotic potential in response to growth factors
What erythroid precursor can be described as follows: the cell is of medium size compared with other normoblasts, with an N:C ratio of nearly 1:1. The nuclear chromatin is condensed and chunky throughout the nucleus. No nucleoli are seen. The cytoplasm is a muddy, blue-pink color.
Reticulocyte
Pronormoblast
Orthochromic normoblast
Polychromatic normoblast
What pathway anaerobically generates energy in the form of ATP?
Hexose monophosphate pathway
Rapoport-Luebering pathway
Embden-Meyerhof pathway
2,3-BPG pathway
Which is true concerning 2,3-DPG?
The least abundant of RBC organophosphates
Enhances O2 release from hemoglobin
Source of RBC glucose
Source of RBC ATP
The glycolipids of the RBC membrane:
Provide flexibility
Carry RBC antigens
Constitute ion channels.
Attach the cytoskeleton to the lipid layer
RBC membranes block passage of most large molecules such as proteins, but allow passage of small molecules such as the cations Na+, K+, and Ca2+. What is the term for this membrane property?
Semipermeable
Deformable
Intangible
Flexible
The hemoglobin iron ion may become oxidized to the +3 valence state by several pathological mechanisms. What portion of the Embden-Meyerhof pathway reduces iron to the physiologic +2 valence state?
Methemoglobin reductase pathway
Hexose monophosphate pathway
Rapoport-Luebering pathway
The 2,3-BPG shunt
Which of the following is an example of a transmembrane or integral membrane protein?
Glycophorin A
Ankyrin
Spectrin
Actin
A hemoglobin molecule is composed of:
One heme molecule and four globin chains
Ferrous iron, protoporphyrin IX, and a globin chain
Protoporphyrin IX and four globin chains
Four heme molecules and four globin chains
Normal adult Hb A contains which polypeptide chains?
alpha and beta
alpha and delta
alpha and gamma
alpha and epsilon
The predominant hemoglobin found in a healthy newborn is:
Gower-1
Gower-2
Hb A
Hb F
What is the normal distribution of hemoglobins in healthy adults?
80% to 90% Hb A1, 5% to 10% Hb A2, 1% to 5% Hb F
80% to 90% Hb A2, 5% to 10% Hb A1, 1% to 5% Hb F
>95% Hb A1, <3.5% Hb A2, 1% to 2% Hb F
>90% Hb A1, 5% Hb F, <5% Hb A2
Iron is transported in plasma via:
Hemosiderin
Ferritin
Transferrin
Hemoglobin
The normal sequence of blood cell development is
yolk sac—red bone marrow—liver and spleen
yolk sac—thymus—liver and spleen—red bone marrow
yolk sac—liver and spleen—red bone marrow
liver and spleen—yolk sac—red bone marrow
The maturational sequence(s) of the erythrocyte is
(are)
rubriblast—prorubricyte—rubricyte—metarubricyte reticulocyte—mature erythrocyte
prorubricyte—rubricyte—metarubricyte—reticulocyte—mature erythrocyte
pronormoblast—basophilic normoblast-polychromatophilic normoblast—orthochromic normoblast—reticulocyte—mature erythrocyte
All of the above
As a blood cell matures, the overall cell diameter in most cases
increases
decreases
remains the same
None of the given choices
As a blood cell matures, the ratio of nucleus to cytoplasm (N:C) in most ca
increases
decreases
remains the same
None of the given choices
The chromatin pattern, in most cells, as the cell
matures
becomes more clumped
becomes less clumped
remains the same
Any of the choices
The presence of nucleoli is associated with
immature cells
all young cells, except myeloblasts
only erythroblasts
disintegrating cells
With a normal diet, an erythrocyte remains in the reticulocyte stage in the circulating blood for
1 day
3 days
35 days
120 days
In a Wright-stained peripheral blood film, the reticulocyte will have a blue appearance. This is referred to as
megaloblastic maturation
bluemia
polychromatophilia
erythroblastosis
Match the hemoglobin types.
Hgb A2
Two alpha and two delta chains
Zeta chains and either epsilon or gamma chains
Two alpha and two beta chains
Two alpha and two gamma chains
The Embden-Meyerhof glycolytic pathway uses _____ % of the erythrocyte’s total glucose
10
20
50
90
The Luebering-Rapoport pathway
permits the accumulation of 2,3-DPG
promotes glycolysis
produces cellular energy
produces acidosis
Shift to the left on the oxygen dissociation curve results in the following except?
Increase Hb affinity to O2
Increase delivery of oxygen to tissues
Decrease Carbon dioxide
Decrease 2,3 DPG
Shift to the right on the oxygen dissociation curve results on all of the following except?
Decrease oxygen affinity
Increase release of oxygen in the tissues
Decrease Carbon Dioxide
Increase 2, 3 DPG
Bart's Hemoglobin is due to the presence of?
4 beta chains
4 gamma chains
4 alpha chains
4 delta chains
Hemoglobin C is due to?
The VALINE that replaces GLUTAMIC ACID at 6th position
The LYSINE that replaces GLUTAMIC ACID at 6th position
The LYSINE that replaces GLUTAMIC ACID at 26th position
Any of the choices
None of the choices
Hemoglobin E is due to?
The VALINE that replaces GLUTAMIC ACID at 6th position
The LYSINE that replaces GLUTAMIC ACID at 6th position
The LYSINE that replaces GLUTAMIC ACID at 26th position
Any of the choices
None of the choices
This variant of hemoglobin is irreversible and this can be caused by oxidation of hemoglobin caused by drugs and exposure to sulfur chemicals.
Methemoglobin
Sulfhemoglobin
Carboxyhemoglobin
Monoxyhemoglobin
Gene involved in the alpha and zeta chains.
Chromosome 16
Chromosome 11
Chromosome 6
Chromosome 10
The erythrocyte intracellular-to-extracellular ratios for Na and K are ______, respectively
1:12 and 25:1
12:1 and 1:25
1:25 and 1:12
25:1 and 12:1
Select the needle most commonly used in standard venipuncture in an adult
One inch, 18 gauge
One inch, 21 gauge
One-half inch, 23 gauge
One-half inch, 25 gauge
The vein of choice for performing a venipuncture is the:
Basilic, because it is the most prominent vein in the
antecubital fossa
Cephalic or accessory cephalic, because it is the least
painful site
Median or median cubital, because it has the lowest risk
of damaging nerves in the arm
One of the hand veins, because they are most superficial
and easily accessed
The most important step in phlebotomy is:
Cleansing the site
Identifying the patient
Selecting the proper needle length
Using the correct evacuated tube
Failure to obtain blood by venipuncture may occur because of all of the following except:
Incorrect needle positioning
Tying the tourniquet too tightly
Inadequate vacuum in the tube
Collapsed vein
What is the recommended order of draw when the evacuated tube system is used?
Gel separator, nonadditive, coagulation, and blood culture
Additive, nonadditive, gel separator, and blood culture
Nonadditive, blood culture, coagulation, and other additives
Blood culture, coagulation, nonadditive, and gel separator or other additives
Which one of the following is an acceptable site for skin puncture on infants:
Back curvature of the heel
Lateral or medial plantar surface of the heel
Plantar surface of the heel close to the arch of the foot
Middle of the plantar surface of the heel
A blood sample is needed from a patient with IV fl uids
running in both arms. Which of the following is an
acceptable procedure?
Any obtainable vein is satisfactory.
Obtain sample from above the IV site
Obtain sample from below the IV site with special restrictions
Disconnect the IV line
Do not draw a blood specimen
Which of the following skin puncture areas is (are)
acceptable for the collection of capillary blood from an
infant?
Previous puncture site
Posterior curve of the heel
The arch
Medial or lateral plantar surface
It inhibits the metabolism of glucose by blood cells.
Anticoagulants
Clot Activators
Antiglycolytic
Separator Gel
This is an inert material that undergoes a temporary change in viscosity during the centrifugation process; this enables it to serve as a separation barrier between the liquid.
Anticoagulants
Clot Activators
Antiglycolytic
Separator Gel
This accelerates the clotting process and decreases the specimen preparation time.
Anticoagulants
Clot Activators
Antiglycolytic
Separator Gel
The most common skin antiseptic used in venipuncture is?
Ethyl aclohol
Isopropyl alcohol
Methanol
Povidone iodine
This results when leakage of a large amount of blood around the puncture site causes the area to rapidly swell.
Hematoma
Hemolysis
Petechiae
Allergies
Prior to venipuncture, the phlebotomist should ask an authorized caregiver to stop the infusion for ______________ before the specimen is drawn.
1 min
2 mins
3 mins
4 mins
All of the following are reasons why a phlebotomist is unable to draw blood except?
Partial needle insertion
Bevel resting on the wall of the vein
Needle is too near on the vein valve
Collapsed vein
Needle is positioned correctly
In obese patients, veins may be neither readily visible nor easy to palpate hence blood pressure cuff can be used to locate the vein. The cuff should not be inflated any higher than ___________ and should not be left on the arm for longer than ____.
40 mm Hg, 2 mins
40 mm Hg, 1 min
50 mm Hg, 1 min
50 mm Hg, 2 min
Heel punctures in infants should not be made more than _____ deep because of the risk of bone injury and possible infection
2 mm
1 mm
3 mm
2.5 mm
The last tube to be filled up during skin puncture should be?
Serum microcollection tubes
EDTA microcollection tube
Tube for blood gas analysis
Other microcollection tubes with anticoagulant
The first tube to be filled up during skin puncture should be?
Serum microcollection tubes
EDTA microcollection tube
Tube for blood gas analysis
Other microcollection tubes with anticoagulant
The average specific gravity of blood is
1.040
1.035
1.055
1.045
This is usually lower in the morning but higher in the afternoon.
Cortisol
Thyroid Stimulating Hormone
Iron
Eosinophil count
All of the following are affected by exercise except?
Creatinine
WBC Count
AST
Cholesterol
ALP
Sodium fluoride is used in glucose analysis because it inhibits the enzyme __________ that acts in the glycolytic pathway.
Esterase
Enolase
Lipase
Amylase
Versene contains what anticoagulant?
Dipotassium EDTA
Disodium EDTA
Tripotassium EDTA
Monosodium EDTA
This is the anticoagulant of choice for Osmotic Fragility test.
Heparin
Thrombin
EDTA
Citrate
This is the anticoagulant of choice for Modified Westergren Method.
Heparin
Thrombin
EDTA
Citrate
This is the anticoagulant of choice for blood smear preparation.
Heparin
Thrombin
EDTA
Citrate
Which of the following may occur in case of platelet satellitism?
Pseudothrombocytopenia
Pseudoleukocytpenia
Platelet clumping
Pseudothrombocytosis
All of the following are important factors that must be considered when making a peripheral blood smear except?
Drop of blood
Speed of Spreader
Hematocrit of the patient
RBC count
This pattern of smear reading used the side to side pattern.
Crenellation
Battlement
Longitudinal
None of the given choices
On this pattern of smear reading, cells are counted in
consecutive fields from the tail toward the head of
the smear.
Crenellation
Battlement
Longitudinal
None of the given choices
Which of the following is not a good characteristic of an ideal smear?
Feathery edge has rainbow appearance.
2/3 to ¾ the length of the film inside
Gradual transition from thick to thin
Finger shaped/Tongue shaped
Uneven distribution of WBCs in various areas of the slide
This method of blood film preparation is used for bone marrow aspirate smear preparation.
Coverslip technique
Automated Technique
Two glass slide method
Wedge Method
This method of blood film preparation is recommended when dealing with patients diagnosed with Chronic Lymphocytic Leukemia
Coverslip technique
Automated Technique (Miniprep)
Automated Technique (Centrifugal)
Wedge Method
What is the most common fixative used in blood smear staining?
Methanol
Formalin
Bouin's
Helly's fixative
What is the possible cause of this problem in a stained smear: Eosinophil granules are colored gray.
Buffer is too acidic
Heparinized blood was used.
Underbuffering
Over rinsing
What is the estimated WBC count if the number of WBC's seen per HPF in a stained smear is 4-6 WBCs/HPF.
4,000-7,000
7,000-10,000
10,000-13,000
13,000-18,000
Which microscope is suitable to used when performing manual platelet counts?
Brightfield
Phase Contrast
Oil Immersion
Fluorescence
Sickle cell patients are known to be resistant with _________infection.
P. ovale
P. falciparum
P. vivax
P. knowlesi
This specie of trypanosomes can be found in blood and is associated with East African Sleeping Sickness.
Trypanosoma brucei gambiense
Trypanosoma brucei rhodesiense
Trypanosoma cruzi
Loa Loa
Peripheral Blood Smear should be retained in the lab for?
1 year
1 years
7 days
1 day
It occurs due to iron overload wherein excess iron are deposited in organs or tissues.
Primary iron overload
Secondary iron overload
Sideroblastic anemia
Hereditary hemochromatosis
