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Hematology

Total questions: 92

Worksheet time: 2hrs 32mins

Name
Class
Date
1.

The following tests are included in a complete blood count (CBC)

a)

RBC count, Hb, Hct, WBC count, platelet count, MCV, MCH, MCHC, RDW, MPV, WBC differential

b)

RBC count, Hb, Hct, WBC count, platelet count, MCV, MCH, MCHC, RDW, MPV

c)

RBC count, WBC count, platelet count, MCV, MCH, MCHC, RDW, MPV

d)

any of the choices, depending on where you work

2.

An instrument printout reveals an RDW of 21. Which of the following would best correlate with those results

a)

the presence of a dimorphic population on the peripheral blood smear

b)

the presence of marked polychromatic on the peripheral blood smear

c)

the presence of spherocytes on the peripheral blood smear

d)

the presence of macroovalocytes on the peripheral blood smear

3.

An increased red cell distribution width (RDW) usually indicates what abnormality

a)

increase of average erythrocyte volume

b)

increase of average weight of hemoglobin

c)

decrease in ratio of hemoglobin mass to volume

d)

variation in erythrocyte size

4.

Platelet estimates are usually performed on a blood smear using which microscopic magnification

a)

10X

b)

40X

c)

100X

d)

1000X

5.

At what magnification would a MLT observe for cold agglutinin and rouleaux

a)

10X

b)

100X

c)

400X

d)

1000X

6.

Anisocytosis is defined as ____; Poikilocytosis is defined as:

a)

variation in sizes of RBC; variation of color of RBC

b)

Variation in shapes of RBC; variation of color of RBC

c)

Variation in shapes of RBC: Variation in sizes of RBC

d)

Variation in sizes of RBC; variation in shapes of RBC

7.

Acanthocytes or spur cells have membranes with irregular distribution of spikes. What other significant features does this cell possess

a)

Increased in size

b)

Presence of Pappenheimer bodies

c)

Decreased life span

d)

Lack of central pallor

8.

Codocytes are associated with all of the following conditions except:

a)

Iron deficiency anemia

b)

Thalassemia

c)

Hemoglobinopathies

d)

Hemolytic anemia

9.

Howell-Jolly bodies are red cell inclusions associated with what disease state?

a)

Lead poisoning

b)

G6PD deficiency

c)

Megaloblastic anemia

d)

Normal reticulocytes

10.

How does the mean cell volume value classify cells

a)

Normochromic, hypo chromic, and hyperchromic

b)

Normochromic, microcytic, macrocytic

c)

Poikilocytosis

d)

Polychromasis

11.

What cell shape is most commonly associated with an increased MCHC

a)

Teardrop

b)

Target

c)

Spherocyte

d)

Sickle cell

12.

What staining method cal be used to differentiate Pappenhemier bodies from reticulocytes

a)

New methylene blue

b)

Prussian blue

c)

PAS

d)

Any of the other options

13.

What is the anticoagulant most commonly utilized tube in hematology, and how does it prevent coagulation from taking place?

a)

Sodium citrate; chelates calcium

b)

Sodium citrate; decreases thrombin activity

c)

EDTA; chelates calcium

d)

EDTA; chelates thrombin

14.

A CBC is performed on a polycythemic patient. What must the MLT do to ensure that this specimen has an optimal blood smear?

a)

increase the angle of the spreader slide

b)

decrease the angle of the spreader slide

c)

retry without the need of changing the spreader angle

d)

dilute the specimen then remake the smear

15.

A laboratory professional is reviewing differentials and notices that the last few smears appear blue. What can be done to correct this?

a)

Lengthen the staining time

b)

Change the buffer which may be too alkaline

c)

Change the buffer which may be too acidic

d)

Shorten the staining time

16.

The ESR determination is based on

a)

decrease in height of the erythrocyte column at a given time

b)

decrease in absorbance as erythrocytes aggregate in column at a given time

c)

distance that erythrocytes settle within a column in one hour

d)

decrease of light by the erythrocyte aggregates I the column at 1 hour

17.

A laboratory professional observes numerous smudge cells on a Wright-stained blood smear and experience difficulty performing the 100-cell differential. Wha should be done to obtain an accurate differential

a)

recollect the sample using sodium citrate and prepare a smear

b)

warm the blood to 37C for 15 minutes are prepare a smear

c)

add one drop of isotonic saline to five drops of blood, mix, prepare smear

d)

add one drop of 22% bovine albumin to five drops of blood, mix, prepare smear

18.

Using the 10X objective to examine a peripheral blood smear, 150 WBCs were counted from 10 fields. What is the WBC estimate?

a)

3 x103/dL

b)

3x 103/L

c)

3x 103/UI

d)

30 x 103/UI

19.

Generally as cells mature

a)

total cell size decreased, N:C ratio increased, denser chromatin, less basophilia

b)

total cell size decreased, N:C ratio decreased, denser chromatin, less basophilia

c)

total cell size decrease, N:C ratio increased, lacy chromatin, less basophilia

d)

total cell size decreased, N:C ratio decreased, lacy chromatin, less basophilia

20.

An instrument printout shows a normal WBC count with a neutrophil count of 30%. What can be concluded from this?

a)

Patient is suffering from infection

b)

There is a normal neutrophil concentration

c)

Patient has a relative neutropenia

d)

Patient is an infant

21.

What characteristic that is present in promyelocytes morphologically differentiates a promyelocyte from a myeloblast

a)

Primary granules

b)

Secondary granules

c)

Loss of nucleoli

d)

Pink cytoplasm

22.

what is the earliest identifiable cell in the granulocyte maturation sequence

a)

pluripotent stem cell

b)

CFU-GEMM

c)

myeloblast

d)

myelocyte

23.

The hallmark for differentiating myelocyte from promyelocyte morphologically is the visual identification of

a)

loss of nucleoli

b)

primary granules

c)

secondary granules

d)

pink cytoplasm

24.

A segmented neutrophil performs all of the following except

a)

chemotaxis

b)

phaocytosis

c)

mitosis

d)

pinocytosis

25.

A patient has 20% eosinophils. Which of the following can probably be eliminated

a)

allergy

b)

parasitic infection

c)

pertussis

26.

an immediate precursor of the macrophage is the

a)

myeloblast

b)

monoblast

c)

pronormoblast

d)

monocyte

27.

All of the following are included in the kill mechanism of a neutrophil except

a)

chemoattraction of neutrophils to infectious agent

b)

diapedesis of neutrophils from blood into tissues

c)

the formation of the phagolysosome by the neutrophil

d)

the presentation of the infectious agent to a monocyte for phagocytosis

28.

Which of the following is associated with an increased leukocyte concentration

a)

Birth, pregnancy, infection

b)

Older adults, birth

c)

Older adults, pregnancy

d)

Tissue necrosis, whole body irradiation

29.

A cell having a round nucleus with delicate chromatin, prominent nucleoli, and scant basophilic cytoplasm without or a possible rare azurophilic granule is an accurate description of a

a)

myeloblast

b)

myelocyte

c)

metamyelocyte

d)

band

30.

Which of the following is a feature of a normal segmented neutrophil

a)

basophilic cytoplasm

b)

round nucleus with fine chromatin

c)

small pink-lilac granules

d)

prominent primary granules

31.

Auer rods are most likely to be present in which of the following

a)

myelocytic cells

b)

lymphocytic cells

c)

erythrocytic cells

d)

all of the other options

32.

The primary granules of the promyelocytes contian

a)

heparin

b)

myeloperoxidase

c)

histamine

33.

A cell with a 20 um size, round nucleus with fine chromatin and several nucleoli, deep blue cytoplasm with large bluish-purplish granules describe with stage of neutrophil maturation

a)

promyelocyte

b)

metamyelocyte

c)

band neutrophil

d)

myelocyte

34.

Which of the following cells in the peripheral blood is described as large cell with abundant cytoplasm containing minute granules, lacy chromatin, and an indented or curved nucleus

a)

monocyte

b)

macrophage

c)

lymphocyte

d)

basophil

35.

A 45 year old male visited his physical for a routine check up. his absolute neutrophil count was 8.5 x 10^9/L. Which of the following terms describes these results

a)

Absolute neutrophilia

b)

Relative neutrophila

c)

Acute neutrophilia

d)

Intermediate neutrophilic

36.

Which of the following characteristics is associated with the neutrophilia that accompanies bacterial infection

a)

left shift

b)

toxic granulation

c)

Dohle body

d)

all of the other choices

37.

A patient has a fever and a WBC of 25 x 10^9/L with bands and metamyelocytes present. Which of the following conditions describes these results

a)

reaction leukopenia

b)

pseudoneutrophilia

c)

left shift

d)

May-Hegglin anomaly

38.

A patient presents with neutrophilia of 40 x10^0/L with many circulating immature cells. The blood contains may bands, metas, myelocytes, promyelocytes, and a rare blast. What disease state is likely with these results?

a)

Leukoerythroblastosis

b)

Hypersenitivity reaction

c)

Tissue damage from burns

d)

Neutrophilic leukemia reaction

39.

Which of the following is most likely able to distinguish a leukemia reaction from CML

a)

LAP score

b)

platelet count

c)

shift to the left

d)

all of the other choices

40.

A healthy individual has his blood drawn as part of a routine physical. The lab technician performing the differential notes a neutrophil with a nucleus that appears dumbbell shaped. After scanning the entire slide, it appears that the vast majority of neutrophils have the same nuclei. All other leukocytes appear normal. That conclusion from this is that the patient has:

a)

May-Hegglin anomaly

b)

Hypersegmented neutrophils

c)

Alder-Reilly anomaly

d)

Pelger-Huët anomaly

41.

Which of the following can result in basophilia

a)

chronic myeloproliferative neoplasm

b)

parasitic infections

c)

connective tissue disorders

d)

all of the other choices

42.

A disorder characteristic by a defect in glucocerebrosidase that results in a macrophage with cytoplasm appearing wrinkled and striated is

a)

Neimann-Pick's disease

b)

Gaucher's disease

c)

Fabry's disease

d)

Tay-Sachs disease

43.

How does immediate neutrophilia differ from acute neutrophilia

a)

Immediate neutrophilia occurs within 4-5 hours, acute occurs within 30 minutes

b)

immediate neutrophilia lasts 20-30 minutes, whereas acute lasts hours to days

c)

In immediate neutrophilia, circulation neutrophils show an increase in early neutrophil precursors, acute neutrophilia has mature neutrophil

d)

In immediate neutrophilia, the leukocytes return to normal as the bone marrow production increases, acute neutrophilia has more mature neutrophils

44.

which of the following anomalies is morphologically similar to toxic granulation and is often seen in patients who have poor mucopolysaccharide degradation

a)

May-Hegglin

b)

Pelger-Huët

c)

Chédiak-Higashi

d)

Alder-Reilly

45.

Interpret the following results: WBC count 1.4 x 10^9/L; bone marrow shows myeloid hypoplasia with a decreased M:E ratio of 1:1. There is no history of medication or drug exposure. What can be concluded?

a)

patient has pseudoneutropenia

b)

patient has neutropenia resulting from decreased production

c)

patient has neutropenia from increased loss in circulation

d)

patient has neutropenia resulting from toxin exposure

46.

In the identification of Pelger-Huët cells, what nuclear characteristic other than dumbbell shape aids in differentiating these from band cells

a)

excessive coarse clumping of chromatin

b)

lack of primary granules

c)

presence of Dohle bodies

d)

toxic granules present

47.

What disease state correlates highly with the presence of cytoplasmic vacuoles in freshly drawn blood

a)

Ehrliche sp. infection

b)

Septicemia

c)

HIV infection

d)

Malaria

48.

A neutrophil contains may giant gray-green peroxidase positive bodies and giant lysosomes. Which is associated

a)

May-Hegglin

b)

Chédiak-Higashi

c)

Pelger-Huët

d)

Alder-Reilly

49.

Which of the following diseases is characterized by a defect in sphingomyelinase, which results in macrophages with a foamy appearance

a)

Gaucher's

b)

Niemann-Pick

c)

Tay-Sachs

d)

Fabry's

50.

A peripheral blood smear exam shows many WBCs with many blue-staining round inclusions. Thrombocytopenia with giant platelets is present. What autosomal dominant disease is associated with these findings?

a)

May-Hegglin

b)

Alder-Reilly

c)

Chédiak-Higashi

d)

Megaloblastic anemia

51.

Which of the following is characteristic of T lymphocytes

a)

phagocytosis of bacteria

b)

antibody synthesis

c)

cytokine secretion

d)

few in number within peripheral blood

52.

An instrument printout show a normal WBC count on an adult with a lymphocyte count of 30%. What can be concluded from this

a)

patient is suffering from infection

b)

normal lymphocyte concentration

c)

patient is an infant

d)

patient has leukemia

53.

Which two CD markers are used to differentiate helper T cells and cytotoxic T cells

a)

CD1 and CD3

b)

CD4 and CD8

c)

CD10 and CD19

d)

BCR and TCR

54.

A 6 year old has a WBC count of 7 x 10^9/L with 48% lymphocytes. Which of the following best describes this phenomenon

a)

Absolute lymphocytosis

b)

Relative lymphocytosis

c)

Normal leukocyte count

d)

Absolute lymphocytopenia

55.

All of the following are expected of findings of AIDS except

a)

Lymphocytopenia

b)

Leukocytopenia

c)

Anemia

d)

Thrombocytosis

56.

A negative heterophiles antibody test in a patient with symptoms of infectious mononucleosis count be caused by what factor if the patient is being treated for cancer

a)

infection by another virus

b)

level of the antibody not high enough to be detected

c)

immunosuppressed antibody response

d)

CMV infection

57.

Which of the following disorders is associated with lymphocytosis

a)

X-linked immunodeficiency syndrome

b)

AIDS

c)

SCID

d)

Whooping cough

58.

Which of the following is characteristic of cellular changes as megakaryoblasts mature into megakarycyte within the bone marrow

a)

progressive decrease in overall size

b)

increasing basophilia of the cytoplasm

c)

nuclear division without cytoplasmic division

d)

fusion of the nuclear lobes

59.

Which of the following describes how platelet clumping artificially alters platelet parameters

a)

increases both the PDW and MPV

b)

decreases both the PDW and MPV

c)

increases the PDW and decreases the MPV

d)

decrease the PDW and increases the MPV

60.

What is the first step in platelet function after an injury

a)

fibrin formatin

b)

release of ADP

c)

platelet aggregation

d)

platelet adhesion to collagen

61.

Congenital immunodeficiencies can be caused by defects of T or B lymphocytes, or both

a)

True

b)

False

62.

Which is the last nucleated stage of erythrocytic maturation

a)

pronormaoblast

b)

orthochromic normoblast

c)

polychromatophilic normoblast

d)

basophilic normoblast

63.

Hemoglobin beings to appear in which of the following erythrocyte stages

a)

probomoblast

b)

basophilic normoblast

c)

polychromatophilic normoblast

d)

orthochromic normoblast

64.

The higher the N:C ratio is, the more mature the cell

a)

True

b)

False

65.

For each pronormaoblast precursor cell, ___ mature RBCs are produced

a)

4

b)

8

c)

12

d)

16

66.

The enucleate mature RBC has no ability to produce proteins

a)

True

b)

False

67.

What is the red cell protein the is responsible for deformability and flexibility fo the red cell

a)

Spectrin

b)

Glycoprotein

c)

Glycine

d)

EPO

68.

For a RBC to live its full 120-day life span what condition is necessary

a)

must be deformable

b)

must have enough granules

c)

must always remain in round shape

d)

must be enough hemoglobin, regardless of function

69.

Which of the following electrolytes maintains its highest concentration within the RBC cytoplasm as opposed to circulating in the plasma

a)

Sodium

b)

Bicarbondate

c)

Potassium

d)

Chloride

70.

Increased plasma cholesterol may lead to

a)

Spherocytes

b)

Target cells

c)

Microcytes

d)

Helmet cells

71.

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

72.

When iron is present in an oxidized state as Fe+3 or ferric iron, the resulting hemoglobin is known as

a)

Methemoglobin

b)

Sulfhemoglobin

c)

Carboxyhemoglobin

d)

Deoxyhemoglobin

73.

Abnormal hemoglobins have a lower affinity for oxygen

a)

True

b)

False

74.

90% of in vivo hemolysis is intravascular

a)

True

b)

False

75.

Which of the following is a definitive sign of intravascular lysis

a)

bilirubinemia

b)

decrease RBC count

c)

hemoglobinura

d)

elevated LDH

76.

Which organ(s) is(are) the most affected during extravascular lysis

a)

Liver and spleen

b)

Kidneys

c)

Pancreas

d)

Heart

77.

Which is true about iron absorption

a)

it occurs in the stomach

b)

phytates and tannates enhance absorption

c)

ascorbic acid inhibits its absorption

d)

it must be in ferrous form for absorption

78.

where is the largest percentage of iron in the body located

a)

bone marrow

b)

liver

c)

attached to hemoglobin in RBCs

d)

in the cytoplasm of macrophages

79.

An elevated reticulocyte count rules out which of the following

a)

acute blood loss

b)

aplastic crisis

c)

acute hemolysis

d)

successful patient response to iron therapy

80.

an analyzer report has a platelet count of 850 x10^9/L. This would be interpreted as

a)

normal platelet count

b)

thrombocytosis

c)

thrombocytopenia

d)

cannot be determined

81.

A patient's peripheral blood smear reveals many giant platelets. All platelet function tests show normal aggregation with the exception of ristocetin. From what is the patient most likely suffering from?

a)

Glanzmann's thrombasthenia

b)

Bernard-Soulier

c)

Storage pool disorder

d)

Wiscott-Aldrich

82.

Acquired inhibitor of a single factor can be acquired after treatment of factor deficiency

a)

True

b)

False

83.

Interpret: PT 11.8 sec (11.2-13.8); INR 1.07; APTT 57 sec (23-32); BT 15 min. (increased); Ristocetin: decreased aggregation. What is the patient most likely suffering from?

a)

Hemophilia A

b)

Bernard-Soulier

c)

DIC

d)

vWD

84.

Primary fibrinolysis is a disorder closely related to DIC. All of the coagulation profile assays are the same as that for DIC with the exceptionof

a)

D-dimer, which is increased

b)

Fibrinogen, which is decreased

c)

Platelet count, which is normal

d)

PT/INR, which is increased

85.

Which assay would be useful in identifying the presence of primary fibrinolysis

a)

Fibrinogen and FDP

b)

FDP and D-dimer

c)

D-dimer and plasmin

d)

Fibrinogen and platelet count

86.

Early fragments

a)

X and Y

b)

D and E

c)

X, Y, D, and E

87.

The best way to monitor oral anticoagulant therapy is

a)

PT

b)

APTT

c)

PT and APTT

88.

Proper specimen collection for coagulation testing must be performed to eliminate contamination of substances that will interfere with the test results. Which of the following are considered contaminants for coagulation testing?

a)

Sodium citation and heparin anticoagulant

b)

Tissue factor and anticoagulant carryover

c)

Ari and tissue factor

d)

High hematocrit and anticoagulant carryover

89.

Thrombin time is prolonged with a patient who has

a)

increased levels of FDPs

b)

increased levels of fibrinogen

c)

factor deficiencies

d)

presence of lupus anticoagulants

90.

A patient's laboratory coagulation test results in an immediate correction of the PT and APTT after mixing studies and no correction after performing the PT and APTT after a 2-hour incubation at 37C. What is the possible inhibitor or deficiency?

a)

factor deficiency

b)

lupuslike anticoagulant

c)

F-VIII inhibitor

d)

F-V loss

91.

Interpret the following results. PT= 32 sec. APTT = 92 sec. TT = 20 sec. What is the most likely reason for these results?

a)

Patient in DIC

b)

Heparin contamination of sample

c)

Patient is taking coumadin

d)

Patient has liver disease

92.

A patient has severe liver disease, what test results would you expect

a)

Prolonged PT, TT, increased FDP

b)

Prolonged APTT, normal TT

c)

Decreased fibrinogen and normal TT

d)

Prolonged BT and normal APTT