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HEMA 1 FINAL EXAM

Total questions: 100

Worksheet time: 58mins

Name
Class
Date
1.

Which of the following cells is considered pathognomonic for Hodgkin’s disease?

a)

Niemann-Pick cells

b)

Reactive lymphocytes

c)

Flame cells

d)

Reed-Sternberg cells

2.

In which of the following conditions does LAP show the least activity?

a)

Leukomoid reactions

b)

IMF

c)

PV

d)

Chronic Myelogenous Leukemia

3.

What is the anticoagulant of choice for coagulation studies?

a)

EDTA

b)

Sodium fluoride

c)

Sodium citrate

d)

Acid citrate dextrose

4.

Which of the following does not characterize anemia of chronic disease?

a)

Decreased serum iron

b)

Increased ferritin

c)

Decreased % saturation

d)

Increased TIBC

5.

With what leukemia is disseminated intravascular coagulation associated?

a)

M1

b)

M3

c)

M6

d)

CML

6.

The characteristic cell found to be increased in infectious mononucleosis is

a)

Eosinophil

b)

Variant lymphocyte

c)

Monocyte

d)

Neutrophil

7.

The following are compounds formed in the synthesis of heme:

1. coproporphyrin

2. porphobilinogen

3. urophorphyrinogen

4. protoporphyrinogen

Which of the following responses lists these compounds in the order in which they are formed?

a)

4, 3, 2,1

b)

2, 3, 1, 4

c)

4, 2, 3, 1

d)

2, 1, 3,4

8.

The majority of the iron in an adult is found as a constituent of:

a)

hemoglobin

b)

hemosiderin

c)

myoglobin

d)

transferrin

9.

The main function of the hexose monophosphate shunt in the erythrocyte is:

a)

regulate the level of 2,3 DPG

b)

Provide reduced glutathione to prevent oxidation of hemoglobin

c)

Prevent the reduction of heme iron

d)

provide energy for membrane maintenance

10.

In order for hemoglobin to combine reversibly with oxygen, the iron must be:

a)

complexed with haptoglobulin

b)

freely circulating in the cytoplasm

c)

attached to transferrin

d)

in the ferrous state

11.

In which of the following disease states are teardrops cells and abnormal platelets most characteristically seen?

a)

hemolytic anemia

b)

multiple myeloma

c)

G6PD deficiency

d)

Myeloid Metaplasia

12.

The characteristic erythrocyte found in pernicious anemia

a)

microcytic

b)

spherocytic

c)

hypochromic

d)

macrocytic

13.

Platelet originates in the bone marrow from:

a)

Megaloblasts

b)

Myeloblasts

c)

Macrophages

d)

Monocytes

e)

Megakaryocytes

14.

RBC inclusion body seen in megaloblastic anemia:

a)

Basophilic stipplings

b)

Howell Jolly bodies

c)

Hemoglobin H inclusion bodies

d)

Heinz bodies

15.

Red blood cell inclusions are removed without destroying the cell itself by the:

a)

Liver

b)

Spleen

c)

Kidney

d)

Bone marrow

16.

Hemoglobin Bart’s is composed of

a)

Four alpha chains

b)

Four beta chains

c)

Four gamma chains

d)

Two alpha and tow gamma chains

17.

Which of the following is characteristically seen in abetalipoproteinemia?

a)

Discocytes

b)

Acanthocytes

c)

Stomatocytes

d)

Codocytes

e)

Spherocytes

18.

Plasma from a patient with lupus coagulation inhibitor (lupus anticoagulant) can show:

a)

a prolonged APTT and normal PT

b)

may exhibit bleeding tendencies

c)

no change with platelet neutralization

d)

complete correction when incubated with normal plasma

19.

A patient is diagnosed as having bacterial septicemia. Which of the following would best describe the expected change in his peripheral blood?

a)

granulocytic leukemoid reaction

b)

lymphocytic leukemoid reaction

c)

neutropenia

d)

eosinophilia

20.

Which of the following stains is most frequently used to differentiate acute myelocytic (AML) from acute lymphocytic leukemia (ALL)?

a)

alkaline phosphatase

b)

nonspecific esterase

c)

acid phosphatase

d)

peroxidase

21.

Which of the following stains is helpful in the diagnosis of suspected erythroleukemia?

a)

peroxidase

b)

nonspecific esterase

c)

periodic acid-Schiff (PAS)

d)

acid phosphatase

22.

Of the following, the disease most closely associated with pale blue inclusions in granulocytes and giant platelets is:

a)

Gaucher's disease

b)

Alder-Reilly anomaly

c)

May-Hegglin anomaly

d)

Pelger-Huet anomaly

23.

A patient has a congenital nonspherocytic hemolytic anemia. After exposure to antimalarial drugs, the patient experiences a severe hemolytic episode. This episode is characterized by red cell inclusions caused by hemoglobin denaturation. Which of the following conditions is most consistent with these findings?

a)

G-6-PD deficiency

b)

thalassemia major

c)

pyruvate kinase deficiency

d)

paroxysmal nocturnal hemoglobinuria

24.

A useful chemical test for the diagnosis of hairy-cell leukemia is the:

a)

peroxidase test

b)

Sudan black B test

c)

periodic acid-Schiff test

d)

tartrate-resistant acid phosphatase test

25.

Which of the following bone marrow findings favors the diagnosis of multiple myeloma?

a)

presence of Reed-Sternberg cells

b)

sheaths of immature plasma cells

c)

presence of flame cells and Russell bodies

d)

presence of plasmacytic satellitosis

26.

The Philadelphia chromosome is formed by a translocation between the:

a)

long arm of chromosome 22 and long arm of chromosome 9

b)

long arm of chromosome 21 and long arm of chromosome 9

c)

long arm of chromosome 21 and short arm of chromosome 6

d)

long arm of chromosome 22 and short arm of chromosome 6

27.

In normal adult bone marrow, the most common granulocyte is the:

a)

basophil

b)

myeloblast

c)

eosinophil

d)

metamyelocyte

28.

Heparin acts by:

a)

precipitating calcium

b)

binding calcium

c)

activating plasmin

d)

inhibiting thrombin

29.

Supravital staining is important for reticulocytes since the cells must be living in order to stain the:

a)

remaining RNA in the cell

b)

iron before it precipitates

c)

cell membrane before it dries out

d)

denatured hemoglobin in the cell

30.

Most childhood leukemias are:

a)

acute lymphocytic

b)

acute monocytic

c)

chronic myelocytic

d)

chronic lymphocytic

31.

Contains lithium heparin as anticoagulant:

a)

blue top

b)

pink top

c)

gray top

d)

green top

32.

Three methods of venipuncture except:

a)

arterial

b)

ETS

c)

syringe

d)

butterfly

33.

Which of the following is NOT a characteristic of the Brachial Artery?

a)

It has pulse

b)

The wall is thicker than a vein

c)

The blood is bright red

d)

It is preferred for venipuncture

34.

Which of the following may result in the hemolysis of blood?

a)

Using a needle with too small a lumen

b)

Removing the needle before the tourniquet

c)

Storing the tube at room temperature

d)

Allowing the tube to fill to the exhaustion of the vacuum

35.

Leaving a tourniquet on for too long can cause what complication?

a)

Syncope

b)

Hematoma

c)

Hemolysis

d)

Hemoconcentration

36.

Shaking a tube rather than inverting it, can cause what complication?

a)

Syncope

b)

Hematoma

c)

Hemolysis

d)

Hemoconcentration

37.

Thalassemias are characterized by:

a)

structural abnormalities in the hemoglobin molecule

b)

absence of iron in hemoglobin

c)

decreased rate of heme synthesis

d)

decreased rate of globin synthesis

38.

Which of the following is associated with Chediak-Higashi syndrome?

a)

membrane defect of lysosomes

b)

Dohle bodies and giant platelets

c)

two-lobed neutrophils

d)

mucopolysaccharidosis

39.

Morphologic variants of plasma cells do NOT include:

a)

flame cells

b)

morula cells

c)

grape cells

d)

Gaucher's cells

40.

Which of the following cell types is characteristic of Pelger Huet anomaly?

a)

band form

b)

pince-nez form

c)

normal neutrophil

d)

myelocyte

41.

Which of the following is the formula for mean corpuscular volume (MCV)?

a)

(Hgb x 10)/RBC

b)

Hgb/Hct

c)

(Hct x 10)/RBC

d)

RBC/Hct

42.

Which of the following characteristics are common to hereditary spherocytosis, hereditary elliptocytosis, hereditary stomatocytosis, and paroxysmal nocturnal hemoglobinuria?

a)

autosomal dominant inheritance

b)

red cell membrane defects

c)

positive direct antiglobulin test

d)

measured platelet count

43.

Which is the first stage of erythrocytic maturation in which the cytoplasm is pink due to the formation of hemoglobin?

a)

Reticulocyte

b)

Pronormoblast

c)

Basophilic normoblast

d)

Polychromatic normoblast

44.

Which is the major Hgb found in the RBCs of patients with sickle cell trait?

a)

Hgb S

b)

Hgb F

c)

Hgb A2

d)

Hgb A1

45.

Which antibiotic(s) is (are) most often implicated in the development of aplastic anemia

a)

Sulfonamides

b)

Penicillin

c)

Tetracycline

d)

Chloramphenicol

46.

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.

a)

Calibrators

b)

Standard

c)

Controls

d)

Blank reagent

47.

When controls are run, they must fall within predetermined dispersal limits, typically at ________________.

a)

+1SD

b)

+2SD

c)

+3SD

d)

+4SD

48.

It is a measure of the smallest increment/amount of the analyte that can be distinguished by the assay.

a)

Accuracy

b)

Precision

c)

Specificity

d)

Sensitivity

49.

At what hematopoietic stage does Hgb F produced?

a)

Hepatic Stage

b)

Mesoblastic Stage

c)

Myeloid Stage

d)

Medullary Stage

50.

It is the reference method for hemoglobin assay that is performed manually but has been adapted to automated instruments.

a)

Alkaline Agar Electrophoresis

b)

Citrate Agar Electrophoresis

c)

Cyanmethemoglbin method

d)

Copper Sulfate Method

51.

Which granulocyte maturation stage does secondary granules occurs?

a)

Myeloblast

b)

Myelocyte

c)

Promyelocyte

d)

Metamyelocyte

52.

It is a group of disorder characterized by iron loading and its accumulation in the mitochondria of erythroid precursors due to a defect in the heme synthesis.

a)

Anemia of chronic disease

b)

Thalassemia

c)

Sideroblastic Anemia

d)

Iron deficiency Anemia

53.

The earliest granulocytic stage in the myeloid series capable of mitosis is:

a)

Myeloblast

b)

Metamyelocyte

c)

Promyelocyte

d)

Band cell

e)

Myelocyte

54.

The earliest stage in the myeloid series at which it is possible to classify a given cell

a)

Myeloblast

b)

Metamyelocyte

c)

Promyelocyte

d)

Band

e)

Myelocyte

55.

The earliest stage in the myeloid series to appear normally in the peripheral blood is the:

a)

Myeloblast

b)

Metamyelocyte

c)

Promyelocyte

d)

Band cell

e)

Myelocyte

56.

An extremely high speed centrifuge able to reach very high RCF values:

a)

Horizontal head centrifuge

b)

Angle head centrifuge

c)

Ultracentrifuge

d)

All of the given choices

57.

Dilution for the RBC count in automated counting instruments:

a)

1:5

b)

1:250

c)

1:2,500

d)

1:50,000

58.

Three values are counted directly on electronic impedance instruments

a)

RBCs, WBCs, and platelets

b)

RBCs, WBCs, and hemoglobin

c)

RBCs, RDW, and MCV

d)

Hematocrit

59.

The correct sequence(s) of events in successful phagocytosis is (are)

a)

chemotaxis, opsonization, phagosome formation, and the action of antibacterial substances

b)

opsonization, chemotaxis, phagosome formation, and the action of antibacterial substances

c)

engulfment, opsonization, digestion, and destruction of bacteria or particulate matter

d)

None of the given choices

60.

The incidence of leukemia is higher in

a)

Scandinavian versus Japanese populations

b)

American blacks versus American whites

c)

chronic forms in children versus chronic forms in adults

d)

acute forms in older adults versus acute forms in children

61.

Which of the following is the correct maturation series of T lymphocyte?

a)

Plasmablast, Proplasmacyte, Plasma cell

b)

Proplasmacyte, Plasma cell, Plasmablast,

c)

Lymphoblast, Prolymphocyte, Mature lymphocyte

d)

Prolymphocyte, Lymphoblast, Mature lymphocyte

62.

Which of the following is the correct maturation series of B lymphocyte?

a)

Plasmablast, Proplasmacyte, Plasma cell

b)

Proplasmacyte, Plasma cell, Plasmablast,

c)

Lymphoblast, Prolymphocyte, Mature lymphocyte

d)

Prolymphocyte, Lymphoblast, Mature lymphocyte

63.

Associated with DIC.

a)

M1

b)

M2

c)

M3

d)

M4

e)

M5

64.

Spherocytes

a)

Short, scalloped, or spike-like projections that are regularly distributed around the cell

b)

Fragments of erythrocytes

c)

The scooped-out part of an erythrocyte that remains after a blister cell ruptures

d)

Compact round shape

65.

Pappenheimer bodies

a)

Nuclear remnants of DNA

b)

Precipitated denatured hemoglobin

c)

Granules composed of ribosomes and RNA

d)

Aggregates of iron, mitochondria, and ribosomes near the red cell periphery as purple dots.

66.

Auer rods may be seen in all of the following except:

a)

Acute myelomonocytic leukemia (M4)

b)

Acute lymphoblastic leukemia

c)

Acute myeloid leukemia without maturation (M1)

d)

Acute promyelocytic leukemia (M3)

67.

Which type of anemia is usually present in a patient with acute leukemia?

a)

Microcytic, hyperchromic

b)

Microcytic, hypochromic

c)

Normocytic, normochromic

d)

Macrocytic, normochromic

68.

In which age group does acute lymphoblastic leukemia occur with the highest frequency?

a)

1–15 years

b)

20–35 years

c)

45–60 years

d)

60–75 years

69.

Muramidase (lysozyme) is present in:

a)

granulocytes and their precursors

b)

monocytes and their precursors

c)

granulocytes, monocytes, and their precursors

d)

lymphocytes and their precursors

70.

In an electronic or laser particle cell counter, clumped platelets may interfere with which of the following parameters?

a)

white blood cell count

b)

red blood cell count

c)

hemoglobin

d)

hematocrit

71.

Blood collected in EDTA undergoes which of the following changes if kept at room temperature for 6-24 hours?

a)

increased hematocrit and MCV

b)

increased ESR and MCV

c)

increased MCHC and MCV

d)

decreased reticulocyte count and hematocrit

72.

Decreased to normal erythropoietin production is most likely to be associated with:

a)

polycythemia Vera

b)

polycythemia, secondary to hypoxia

c)

relative polycythemia associated with dehydration

d)

polycythemia associated with renal disease

73.

Multiple myeloma is generally characterized by:

a)

plasmacytic satellitosis in the bone marrow

b)

many plasma cells in the peripheral blood

c)

many Mott cells in the peripheral blood

d)

rouleaux formation

74.

Of the following, the disease most closely associated with granulocyte hyposegmentation is:

a)

May-Hegglin anomaly

b)

Pelger-Huet anomaly

c)

Chediak-Higashi syndrome

d)

Gaucher's disease

75.

Erythropoietin acts to:

a)

shorten the replication time of the granulocytes

b)

stimulate RNA synthesis of erythroid cells

c)

increase colony-stimulating factors produced by the B-lymphocytes

d)

decrease the release of marrow reticulocytes

76.

Which of the following is associated with Chediak-Higashi syndrome?

a)

membrane defect of lysosomes

b)

Dohle bodies and giant platelets

c)

two-lobed neutrophils

d)

mucopolysaccharidosis

77.

Which of the following describes the process known as culling?

a)

Release of red cells from the bone marrow

b)

Binding of free hemoglobin by transport proteins

c)

Incorporation of iron into protoporphyrin IX

d)

Removal of abnormal red cells by the spleen

78.

Hemoglobin forms that are incapable of oxygen transport include

a)

Deoxyhemoglobin and oxyhemoglobin

b)

Oxyhemoglobin and carboxyhemoglobin

c)

Carboxyhemoglobin and methemoglobin

d)

Methemoglobin and deoxyhemoglobin

79.

The Na+-K+ cation pump is an important mechanism in keeping the red blood cell intact. Its function is to maintain a high level of

a)

Intracellular Na+

b)

Intracellular K+

c)

Plasma Na+

d)

Plasma K+

80.

When spherocytes are reported, what is observed on the peripheral blood smear?

a)

Red cells without a central pallor

b)

Red cells with blunt projections

c)

Red cells with sharp projections

d)

Red cells with intracellular rod-shaped crystals

81.

Which of the following factors will result in an immediate increase in oxygen delivery to the tissues?

a)

Increased pH

b)

High altitudes

c)

Increased hemoglobin binding of 2,3-BPG

d)

Increased renal release of erythropoietin

82.

The major storage form of iron is

a)

Ferritin

b)

Transferrin

c)

Hemosiderin

d)

Hemachromatin

83.

Which protein is primarily responsible for transport of hemoglobin dimers resulting from intravascular hemolysis?

a)

Hemopexin

b)

Albumin

c)

Hemosiderin

d)

Haptoglobin

84.

A patient with normocytic, normochromic anemia secondary to small cell carcinoma may be exhibiting an anemia designated a

a)

Hemolytic

b)

Megaloblastic

c)

Myelopthisic

d)

Sideroblastic

85.

Which of the following is the most appropriate treatment for sickle cell anemia?

a)

Hydroxyurea

b)

Supportive therapy

c)

Hyperbaric oxygen

d)

Iron

86.

In children, the most important effect of lead poisoning is on the

a)

Liver

b)

Kidney

c)

Neurologic system

d)

Development of erythrocytes

87.

An increase in erythropoietin is not a normal compensating mechanism in which of the following conditions?

a)

Renal tumors

b)

Heavy smoking

c)

Cardiovascular disease

d)

Pulmonary disease

88.

Which of the following factors is not associated with variations in the total white blood cell count?

a)

Age

b)

Exercise

c)

Emotional stress

d)

Sex

89.

The presence of both immature neutrophils and nucleated erythrocytes in the peripheral blood is most accurately called a

a)

Neutrophilic left shift

b)

Regenerative left shift

c)

Neutrophilic leukemoid reaction

d)

Leukoerythroblastic reaction

90.

In which of the following are eosinophils not increased?

a)

Cushing Syndrome

b)

Allergic Disorders

c)

Skin Disorders

d)

Parasitic Infection

91.

Which of the following is not commonly found in acute myelogenous leukemias?

a)

Neutropenia

b)

Thrombocytopenia

c)

Hepatosplenomegaly

d)

Lymphadenopathy

92.

A Gaucher cell is best described as a macrophage with

a)

"Wrinkled" cytoplasm due to an accumulation of glucocerebroside

b)

"Foamy" cytoplasm filled with unmetabolized sphingomyelin

c)

Pronounced vacuolization and deposits of cholesterol

d)

Abundant cytoplasm containing storage iron and cellular remnants

93.

The presence of the chromosomal abnormality t(15;17) and a high incidence of disseminated intravascular coagulation (DIG) is diagnostic of

a)

Acute myeloblastic leukemia without maturation (FAB type Ml)

b)

Acute myeloblastic leukemia with maturation (FAB type M2)

c)

Acute promyelocytic leukemia (FAB type M3)

d)

Acute myelomonocytic leukemia (FAB type M4)

94.

Which of the following gene mutations correlates with the t(9;22) that is present in Philadelphia chromosome positive chronic myelogenous leukemia?

a)

MYC/IGH

b)

BCR/ABL

c)

PML/RARA

d)

JAK2

95.

What is the key diagnostic test for Hodgkin lymphoma?

a)

Bone marrow biopsy

b)

Lymph node biopsy

c)

Spinal tap

d)

Skin biopsy

96.

What combination of reagents is used to measure hemoglobin?

a)

Hydrochloric acid and p-dimethyl-aminobenzaldehyde

b)

Potassium ferricyanide and potassium cyanide

c)

Sodium bisulfite and sodium metabisulfite

d)

Sodium citrate and hydrogen peroxide

97.

The slowest-moving hemoglobin(s) on an alkaline electrophoresis at pH 8.6 is(are)

a)

A

b)

A2, C,E, andO

c)

F

d)

S, D, andG

98.

The components of Wright's stain include

a)

Crystal violet and safranin

b)

Brilliant green and neutral red

c)

New methylene blue and carbolfuchsin

d)

Methylene blue and eosin

99.

What is the principle of automated impedance cell counters?

a)

Angle of laser beam scatter by cells

b)

Amplification of an electrical current by cells

c)

Interruption of an electrical current by cells

d)

Change in optical density of the solution containing cell

100.

Side angle scatter in a laser-based cell counting system is used to measure

a)

Cell size

b)

Cytoplasmic granularity

c)

Cell number

d)

Immunologic (antigenic) identification

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