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MediaLab Hematology Practice Questions Part 1
Terms in this set (140)
Detecting the BCR/ABL1 mutation by molecular techniques is useful in the diagnosis of which of the following diseases/conditions?
A) Paroxysmal Nocturnal Hemoglobinuria (PNH)
B) Chronic myelogenous leukemia (CML)
C) Acute Promyelocytic Leukemia (APL)
D) Iron Deficiency Anemia (IDA)
Chronic myelogenous leukemia (CML)
What is a common early laboratory marker of hereditary hemochromatosis (HH)?
A) Increased serum ferritin
B) Decreased serum iron
C) Decreased transferrin saturation
D) Increased hemoglobin
Increased serum ferritin
What is the predominant abnormal erythrocyte morphology associated with idiopathic myelofibrosis?
A) Target cells
C) Teardrop cells
A hemoglobin F concentration of 100% may be seen in which beta thalassemia?
A) Beta thalassemia minor (ß0/ß)
B) Beta thalassemia major (ß0/ß0)
C) Delta-beta thalassemia minor (dß0/ß)
D) Delta-beta thalassemia major (dß0/dß0)
Delta-beta thalassemia major (dß0/dß0)
Which of the following conditions would produce the results listed below in an anemic patient?
MCV = 115 fL
MCH = 30 pg
MCHC = 34 %
A) Sickle cell anemia
B) Aplastic anemia
C) Iron deficiency anemia
D) Pernicious anemia
Which abnormal gene is inherited with Chediak-Higashi syndrome resulting in dysfunctional cells causing greater susceptibility to infections?
A) CHS1 LYST
What is the composition of the granules associated with basophilic stippling?
A) Aggregates of iron
B) Aggregates of hemoglobin
C) Aggregates of ribosomes
D) Aggregates of DNA
Aggregates of ribosomes
A 1:100 dilution of a patient's peripheral blood was made, and a total of 136 platelets were counted in 5 squares of the RBC area of a Neubauer-ruled hemocytometer. What is the Platelet count? Note: The volume correction factor is 50 µL.
A) 27 x 103/µL
B) 68 x 103/µL
C) 136 x 103/µL
D) 680 x 103/µL
680 x 103/µL
A cerebrospinal fluid sample was taken from an inpatient with severe neurological symptoms. The image shows a field from a cytospin preparation from this patient's fluid. What findings are present in this field?
A) Blast cells
B) Mesothelial cells
C) Choroid plexus clump
D) Tumor cells
What principle(s) of flow cytometry is employed when performing immuno-phenotyping?
A) Diffraction grating
C) Diffraction grating and impedance
D) Fluorescent antibody tagging and light scatter
Fluorescent antibody tagging and light scatter
What are the smallest nucleated cells seen in normal peripheral blood?
B) Segmented neutrophils
Esterase stains are used to help differentiate which of the following?
A) Myeloblasts from lymphoblasts
B) Monoblasts from myeloblasts
C) Monoblasts from lymphoblasts
D) Erythroblasts from lymphoblasts
Monoblasts from myeloblasts
What is the most significant cause of decreased haptoglobin levels?
A) Acute infection
B) Intravascular hemolysis
C) Liver disease
The large blue staining cells represented in the photomicrographs comprise 50% of the total white blood cell count. Which of the following conditions is this peripheral blood picture most consistent with?
A) Infectious mononucleosis
B) Chronic lymphocytic leukemia
C) Acute lymphoblastic leukemia
D) Bacterial infection
A patient has a prolonged non-therapeutic PT and a normal aPTT. The physician orders a PT mixing study. The results are as follows:
Original PT test- 32 seconds
1:1 Mix (room temp immediate) - 22 seconds
1:1 Mix (incubated for 90 minutes) - 23 seconds
Which factor may be present in abnormally low levels and causing the prolongation?
A) Factor XI
B) Factor VII
C) Factor IX
D) Factor VIII
Which of the following bone marrow sampling methods would be advisable if the quantity is inadequate for an aspirate smear?
A) Touch imprint
B) Bone marrow core biopsy
C) Direct aspirate smear
D) Clot section
A complete blood count is performed on a post-surgical, post-transfusion patient. The red cell distribution width (RDW) reported with the automated cell count is 16.5%. The reference interval in this laboratory is 11.0-14.5%. What would be demonstrated on the peripheral smear that relates directly to the RDW value?
D) Nucleated red blood cells
Which of the following conditions can produce a normal aPTT and a prolonged PT?
A) Factor IX deficiency
B) Factor VII deficiency
C) Factor VIII deficiency
D) Factor X deficiency
Factor VII deficiency
Which of the following factors is known as Hageman factor?
A) Factor X
B) Factor XII
C) Factor V
D) Factor VII
The cells included in the composite image were found in the peripheral blood smear of a patient with the following results:
total WBC of 21.5 x 109/L.
band neutrophils 16
segmented neutrophils 48
This hematologic picture is most consistent with:
A) Leukemoid reaction
B) Chronic myeloid leukemia
C) Left shift
Whole blood if composed of approximately:
A) 75% formed elements and 25% plasma
B) 60% formed elements and 40% plasma
C) 45% formed elements and 55% plasma
D) 30% formed elements and 70% plasma
45% formed elements and 55% plasma
A known sickle cell trait patient has a hemoglobin electrophoresis test performed. Which of the following hemoglobin percentage sets would most closely match this patient's diagnostic state?
A) Hgb A = 90%, Hgb S = 8%, Hgb A2 = 2%, Hgb F = 0%
B) Hgb A = 60%, Hgb S = 38%, Hgb A2 = 2%, Hgb F = 0%
C) Hgb A = 40%, Hgb S = 58%, Hgb A2 = 2%, Hgb F = 0%
D) Hgb A = 25%, Hgb S = 70%, Hgb A2 = 2%, Hgb F = 3%
Hgb A = 60%, Hgb S = 38%, Hgb A2 = 2%, Hgb F = 0%
The arrangement of the erythrocytes shown by the blue arrows in this peripheral smear should be reported out as ____________________ .
C) Normal distribution
Decrease platelet production can be caused by a lack of or decreased amount of which of the following?
C) von Willebrand factor (vWF)
D) Factor VIII
Which of the following statements are true for the hematopoietic cords?
A) Hematopoietic cells develop at random locations in the marrow cells
B) Reticular cells (adventitial cells) provide support for developing hematopoietic cells within the hematopoietic cords
C) Lymphocytes are not seen in normal marrow
D) Fat cells content of bone marrow decrease with aging
Reticular cells (adventitial cells) provide support for developing hematopoietic cells within the hematopoietic cords
An alpha thalassemia patient is diagnosed as having three of their four genes deleted which code for alpha hemoglobin chains. Which one of the following types of hemoglobin is abnormal and would be found in such a patient?
A) Hb A
B) Hb S
C) Hb F
D) Hb H
Calculate the red cell indices from the following set of patient data:
RBC count = 3.19 x 1012/L
Hemoglobin = 11.3 g/dL
Hematocrit = 35%
A) MCV = 99 fL, MCH = 38 pg, MCHC = 34 g/dL
B) MCV = 109 fL, MCH = 36 pg, MCHC = 34 g/dL
C) MCV = 110 fL, MCH = 35 pg, MCHC = 32 g/dL
D) MCV = 105 fL, MCH = 38 pg, MCHC = 32 g/dL
MCV = 110 fL, MCH = 35 pg, MCHC = 32 g/dL
Which of the following conditions would be associated with an increased osmotic fragility test result?
A) Hereditary spherocytosis
B) Iron deficiency anemia
C) Sickle cell anemia
A peripheral smear with red blood cells photographed in a typical field was submitted for review. All of the following conditions are most likely associated with the red blood cell population found here, EXCEPT:
A) Severe liver disease
C) Beta thalassemia
D) Hereditary Hemochromatosis
The granules that basophils contain are composed of:
D) Alkaline phosphatase
What is the best description of the phenomenon seen in this illustration?
A) Rouleau formation
B) Cold agglutination
C) Rosette formation
D) Monocyte activation
In the hemoglobin methodology using potassium ferricyanide the following measurable reaction occurs:
A) Carboxyhemoglobin is formed
B) Iron remains in the ferrous state
C) Ferrous iron is oxidized to ferric iron to form methemoglobin
D) Acid hematin is formed
Ferrous iron is oxidized to ferric iron to form methemoglobin
All of the following CD markers are present on a normal mature T cell, EXCEPT?
Fifty percent blasts are found on a peripheral blood smear. The cells are large (3-5x the size of a lymphocyte) with a nucleus that contains fine homogeneous chromatin and two to three nucleoli. There is moderate blue-grey cytoplasm with Auer rods. What leukemia is most likely?
A) Acute myelogenous leukemia (AML)
B) Hairy cell leukemia (HCL)
C) Acute lymphoblastic leukemia (ALL)
D) Chronic lymphocytic leukemia (CLL)
Acute myelogenous leukemia (AML)
Which of the following inclusions are frequently seen on the same peripheral blood smear along with toxic granulation?
A) May-Hegglin bodies
C) Auer rods
D) Primary granules
Which of the following laboratory results would be seen in a patient with acute Disseminated Intravascular Coagulation (DIC)?
A) Prolonged PT, decreased fibrinogen, elevated platelet count, increased FDP
B) Normal PT, decreased fibrinogen, decreased platelet count, decreased FDP
C) Prolonged PT, decreased fibrinogen, decreased platelet count, increased FDP
D) Normal PT, increased fibrinogen, decreased platelet count, decreased FDP
Prolonged PT, decreased fibrinogen, decreased platelet count, increased FDP
Which of the following set of results would be consistent for a patient with the following findings: macrocytosis, anemia, leukopenia, and thrombocytopenia?
A) MCV 115 fL; Hgb 9.5 g/dL; WBC 6.5 x 103/µL; Platelets 75,000/µL
B) MCV 115 fL; Hgb 7.5 g/dL; WBC 2.5 x 103/µL; Platelets 75,000/µL
C) MCV 75 fL; Hgb 7.5 g/dL; WBC 2.5 x 103/µL; Platelets 75,000/µL
D) MCV 75 fL; Hgb 9.5 g/dL; WBC 6.5 x 103/µL; Platelets 175,000/µL
MCV 115 fL; Hgb 7.5 g/dL; WBC 2.5 x 103/µL; Platelets 75,000/µL
Gastrointestinal infections of which of the following a organisms are associated with hemolytic uremic syndrome?
A) Shiga toxin producing E. coli
C) Proteus mirabilis
D) Clostridium difficile
Shiga toxin producing E. coli
Which of the following statements is correct regarding bone marrow evaluation?
A) Bone marrow cellularity increases with age.
B) Bone marrow cellularity is highest in young children compared to adults.
C) In a healthy person, the expected myeloid : erythroid ratio is less than 1 (one).
D) As we age, the amount of adipose tissue (fat) decreases
Bone marrow cellularity is highest in young children compared to adults.
The photomicrograph is a representative field from a peripheral blood smear. Which of the following MCV values correlates best with the peripheral blood picture?
A) 68 fL
B) 82 fL
C) 105 fL
D) 149 fL
A patient presents to the ER with prolonged bleeding. PT and aPTT tests both come back prolonged. After running Factor assays, it was determined the patient has Hemophilia B, also known as Christmas disease, a deficiency of which factor?
A) Factor VII
B) Factor VIII
C) Factor X
D) Factor IX
Why is hereditary hemochromatosis (HH) thought to be underdiagnosed?
A) Its early symptoms are nonspecific and vague, and generally do not get serious until later in life.
B) It is an extremely rare disease.
C) It appears shortly after birth, but then symptoms rapidly subside.
D) It is a mild disorder and has no severe implications for one's health.
Its early symptoms are nonspecific and vague, and generally do not get serious until later in life.
Which of the following is the most common method for diagnosing malaria?
A) Serological testing
B) Polymerase chain reaction (PCR) techniques
C) Demonstration of the organism in peripheral blood
D) Biochemical reactions
Demonstration of the organism in peripheral blood
When scanning a Wright's stained blood smear, which of the following would describe the optimum area to begin your blood smear analysis and differential white blood cell count?
A) RBCs are fairly far apart showing a "cobblestone effect."
B) RBCs are lying singly, barely touching, with occasional overlapping.
C) RBCs are stacked like coins with the majority of cells overlapping.
D) RBCs are aggregated.
RBCs are lying singly, barely touching, with occasional overlapping.
Four tubes of CSF on the same patient were received in the laboratory. It was noted on the report that all four tubes contained visible blood. Which of the following is the best explanation for this finding?
A) Traumatic tap
B) Subarachnoid hemorrhage
Which of the following stains is used to differentiate a neutrophilic leukemoid reaction from chronic myelogenous leukemia (CML)?
A) Sudan black B
B) Periodic acid-Schiff reagent (PAS)
C) Acid phosphatase with tartrate
D) Leukocyte alkaline phosphatase (LAP)
Leukocyte alkaline phosphatase (LAP)
Which of the following laboratory test results indicates that a sickle cell patient may be in aplastic crisis?
A) Decreased reticulocyte count
B) Decreased haptoglobin level
C) Increased bilirubin level
D) Increased lactate dehydrogenase (LDH)
Decreased reticulocyte count
Blood is diluted at 1:100 and charged on the hemocytometer counting chambers on both sides. If the average platelet count from a counting chamber in one mm2 (one large square) is 68, what is the calculated platelet count?
Consider the following set of results from a mixing study of a patient with a suspected coagulopathy.
Initial aPTT: 86 sec. (reference range 21-34 sec.)
Immed. aPTT mixing study: 87 sec.
Incubated aPTT mixing study: 88 sec.
What is the most likely cause of these results?
A) The assay corrected, indicating a likely coagulation factor deficiency.
B) The assay corrected, indicating a likely coagulation inhibitor.
C) The assay did not correct, indicating a likely coagulation factor deficiency.
D) The assay did not correct, indicating a likely coagulation inhibitor.
The assay did not correct, indicating a likely coagulation inhibitor.
A) Percentage of blood made up of serum
B) Concentration of serum X 100
C) Percentage of blood made up of red blood cells
D) Concentration of red cells X 100
Percentage of blood made up of red blood cells
All of the following disorders would affect the results of a Prothrombin time (PT) EXCEPT?
A) Factor VIII deficiency
B) Coumadin therapy
C) Vitamin K deficiency
D) Alcoholic cirrhosis
Factor VIII deficiency
This image represents a field of red blood cells (RBCs) stained using a supravital stain. How would these cells appear if viewed on a Wright-stained smear?
A) Polychromatophilic RBCs
B) RBCs containing basophilic stippling
C) RBCs containing Cabot's rings
D) RBCs containing Pappenheimer bodies
When performing a manual white blood cell count, 236 cells were counted on side number one of the hemacytometer, 224 cells on side number two. A 1/20 dilution of 1% HC1 was used, and the area counted on each side was 4 sq. mm. Twenty-five nucleated red blood cells in the differential were observed per 100 white blood cells. What is the CORRECT WBC/µL?
This image depicts a brilliant cresyl blue-stained blood smear. What inclusion bodies are shown in the erythrocyte indicated by the arrow (B)?
A) Howell-Jolly bodies
B) Hb H inclusions
C) Pappenheimer bodies
D) Siderotic granules
Hb H inclusions
What RBC morphology on a Wright-stained smear may indicate the presence of an unstable hemoglobin?
What are Howell-Jolly bodies composed of?
All of the following factors would cause an increase erythrocyte sedimentation rate (ESR) values EXCEPT?
A) Severe anemia
B) Abnormal proteins (Rouleaux)
C) Blood drawn into sodium citrate anticoagulant
D) A slanted (not perpendicular) tube
Blood drawn into sodium citrate anticoagulant
When performing your mixing study, you aliquot your sample plasma and the pooled normal plasma to create your "mix." You then place the sample in a water bath to incubate for 90 minutes before running your new mixed sample. What is the problem with the steps involved in the procedure above?
A) You don't need to incubate your sample.
B) You have forgotten to add a reagent.
C) You have not run a PT or aPTT on the new mix before incubating.
D) You have incubated too long.
You have not run a PT or aPTT on the new mix before incubating.
How is beta thalassemia defined?
A) A decrease in the rate of production of beta chains due to a partial or total deletion of loci from chromosome 16 that code for the beta chain.
B) A decrease in the rate of production of Hb A due to a substitution of an amino acid in the beta chain.
C) A decrease in the rate of production of beta chains due to a partial or total deletion of loci from chromosome 11 that code for the beta chain.
D) The production of an abnormal form of hemoglobin due to the substitution of an amino acid in the beta chain.
A decrease in the rate of production of beta chains due to a partial or total deletion of loci from chromosome 11 that code for the beta chain.
The MOST accurate observation about osmotic pressure is that it is:
A) Proportional to concentration of solute particles
B) Equal to number of solvent molecules times a factor
C) Measurable by how much it raises the freezing point of water
D) Directly proportional to the inverse log of solvent molecules
Proportional to concentration of solute particles
What is the identity of the white blood cell inclusions present in this image?
A) Toxic granulation
B) May-Hegglin bodies
C) Auer rods
D) Barr bodies
This autosomal recessive disorder is associated with recurrent bacterial infections and cells consistent with the cell in the image.
A) Alder-Reilly anomaly
B) May-Hegglin anomaly
C) Chediak-Higashi syndrome
D) Pelger-Huet anomaly
Which of the following cells is the most common nucleated cell in normal adult bone marrow?
What is the prominent red blood cell (RBC) morphologic feature found in lead poisoning (plumbism)?
A) Basophilic stippling
D) Target cell
What are the red cell inclusions in this split frame photomicrograph of peripheral smears (Wright's and Prussian Blue)?
A) Howell-Jolly bodies
B) Basophilic stippling
C) Malarial ring forms
D) Pappenheimer bodies
The structure indicated by the arrow in this image, along with giant platelets (also present in the image), is characteristic of which of the following conditions?
A) Chediak-Higashi anomaly
B) Alder-Reilly anomaly
C) May-Hegglin anomaly
D) Infectious Mononucleosis
A newly admitted patient has the following coagulation results:
PT: 12.9 seconds (N = 12-14 seconds)
aPTT: 84 seconds (N = 25-35 seconds)
Platelet Count: 200 x 109/L (N = 150-450 x 109/L)
A mixing study was performed due to the abnormal aPTT test results. The mixing study demonstrated the following:
aPTT was corrected by normal plasma, factor IX deficient plasma, but not by factor VIII deficient plasma.
What factor assay should be performed next?
A) None; a platelet disorder is indicated
B) Factor V assay
C) Factor VIII assay
D) Factor IX assay
Factor VIII assay
A patient's coagulation mixing study results are shown below after an initially prolonged aPTT result.
Initial aPTT: 63 sec. (normal range 21-34 seconds)
Immediate aPTT mixing study: 26 sec.
Incubated aPTT mixing study: 65 sec.
Has the aPTT been corrected by the mix? Is a factor deficiency or a coagulation inhibitor the more likely cause of the patient's prolonged aPTT?
A) Corrected, Factor Deficiency
B) Corrected, Coagulation Inhibitor
C) Not Corrected, Factor Deficiency
D) Not Corrected, Coagulation Inhibitor
Not Corrected, Coagulation Inhibitor
In which of the following conditions would you NOT expect to find Howell-Jolly bodies?
A) Sickle cell anemia
B) Iron deficiency anemia
C) Post splenectomy
D) Megaloblastic anemia
Iron deficiency anemia
A technologist decides to make a 1:20 dilution of cerebrospinal fluid (CSF) after briefly evaluating a portion of the sample microscopically. After making the dilution and charging the chambers, the number of observed cells in each of the large squares of the hemocytometer is >100. What should the technologist do to obtain the most accurate count?
A) Count all four corner squares.
B) Make a smaller dilution.
C) Make a larger dilution.
D) No dilution is necessary.
Make a larger dilution.
A 55-year-old white male had the following lab data:
RBC 3.7 X 1012/L
Serum iron 220 µg/dL (N: 60-80 µg/dL)
TIBC 300 µg/dL (N: 260-400 µg/dL)
Serum Ferritin 2,800 ng/mL (N: 10-200 ng/mL)
WBC 5.8 x 109/L
MCV 86 fL
MCH 26 pg
Prussian Blue stain of bone marrow aspirate indicates markedly elevated iron stores.
These laboratory results are MOST consistent with which of the following conditions?
A) Sideroblastic anemia
B) Anemia of chronic disease
D) Megaloblastic anemia
One of the most common forms of hereditary hemochromatosis has been found to result from genetic mutations of the HFE gene. This mutation causes hemochromatosis by which of the following mechanisms?
A) Impairs hepcidin regulation of ferroportin activity
B) Increased binding of ß2 microglobulin
C) Impairs transferrin synthesis
D) Increases hepcidin synthesis therefore increasing iron absorption.
Impairs hepcidin regulation of ferroportin activity
Which of the following leukocytes is most directly associated with antibody production?
D) NK Cell
All of the following are causes of hemolytic anemia, EXCEPT?
A) Thermal injury
B) Iron deficiency anemia
C) Brown recluse spider bite
D) Plasmodium infection
Iron deficiency anemia
Which disease/condition can be indicated by the morphology displayed in the white blood cell to the right?
A) Chediak-Higashi syndrome
B) Pelger-Huet anomaly
C) Dohle bodies
D) Toxic granulation
The granules of Basophil contain which of the following?
C) The contents of helminth digestion
D) Initiators of allergic inflammation
Initiators of allergic inflammation
Electrophoretic separation of hemoglobin fundamentally relies on:
A) Weight differences of molecules
B) Electrical charge differences of molecules
C) Concentration differences of molecules
D) Shape variations of molecules
Electrical charge differences of molecules
Methods of identifying many of the major hemoglobin variants such as Hb A, Hb F, Hb S, etc. include all of the following EXCEPT:
A) Sodium metabisulfite solubility test
B) High performance liquid chromatography (HPLC)
C) Citrate agar electrophoresis
D) Alkaline electrophoresis
Sodium metabisulfite solubility test
A patient with suspected intraabdominal malignancy had a paracentesis procedure performed. The fluid was then sent to the laboratory for examination and fluid differential. Which cells predominate in this cytospin field from the patient's sample?
B) Atypical lymphocytes
D) Plasma cells
Approximately what percentage of pulmonary emboli originate from deep veins of the legs?
Calculate the mean corpuscular hemoglobin content (MCHC) when Hgb = 15 g/dL (150 g/L), RBC count = 4.50 x 106/µL (4.50 x 1012/L), and Hct = 47% (0.47).
A) 34.7 g/dL
B) 10.4 g/dL
C) 31.9 g/dL
D) 33.9 g/dL
The three main types of peripheral blood cells are:
A) White blood cells, red platelets, and thrombocytes
B) White blood cells, red blood cells, and platelets
C) Leukocytes, erythrocytes, red blood cells
D) Thrombocytes, platelets, and leukocytes
White blood cells, red blood cells, and platelets
After experiencing crippling pain in her chest, Elizabeth's mother rushes her to the Emergency Room. After a complete blood count and differential are ordered, the hematology technologist views many peripheral cells similar in appearance to those found in the image below. Which condition is most likely present?
A) Beta Thalassemia
B) Myocardial Infarction
C) Sickle Cell Anemia
D) Hemoglobin C Disease
Sickle Cell Anemia
Adult (normal) Hemoglobin is made up of the following composition:
A) >90% HbA, 1% HbA2, 5% HbF
B) >95% HbA, <3.5% HbA2, <1-2% HbF
C) <90% HbA, 10% HbA2, 5% HbF
D) >90% HbA, 1% HbA2, 5-10% HbF
>95% HbA, <3.5% HbA2, <1-2% HbF
How many 1 mm x 1 mm squares is the Neubauer hemacytometer counting grid composed of?
A) Nine per side
B) Ten per side
C) Twenty-two between both sides
D) Thirty between both sides
Nine per side
Which statement best describes the relationship between dietary iron and iron absorption in a healthy individual?
A) Only a small percentage of dietary iron is absorbed and used.
B) All dietary iron is needed for hemoglobin synthesis and therefore absorbed.
C) Most people need to take dietary iron supplements to meet their needs for iron.
D) All dietary iron is absorbed and excess is stored.
Only a small percentage of dietary iron is absorbed and used.
Which one of the following is a true statement about Lupus Anticoagulant (LA)?
A) LA is a specific inhibitor found mainly in patients with the autoimmune disease, Systemic Lupus Erythematosus (SLE).
B) LA is common in hemophiliacs
C) LA prolongs coagulation leading to bleeding problems in patients.
D) LA is an immunoglobulin.
LA is an immunoglobulin.
All of the following conditions are consistent with this peripheral blood picture, EXCEPT?
B) Alcoholic cirrhosis with hemolytic anemia
C) Hepatitis of the newborn
A small child has albino characteristics, photophobia, frequent pyogenic infections, and her blood smear shows giant dark granules in her monocytes and granulocytes. What is the probable diagnosis?
A) Pelger-Huet anomaly
C) Toxic granulation
D) Chediak-Hegashi syndrome
A patient with multiple myeloma is admitted to the hospital due to a flare-up of symptoms. Her physician orders a complete blood count with differential. The peripheral blood smear is shown. Which morphology is consistent with the findings in this case?
Which one of these test systems can be used to evaluate the adequacy of fibrinogen in heparinized patients?
B) Reptilase Time
C) Thrombin Time
D) Prothrombin Time
If a Mycobacterium sp. infection is suspected on a bone marrow or body fluid, what stain should be used to detect these bacteria?
A) Wright's stain
B) New methylene blue stain
C) Hematoxylin and Eosin (H&E) stain
D) Acid fast stain
Acid fast stain
Which of the following is the cause of thrombotic thrombocytopenic purpura (TTP)?
A) Thrombopoietin (TPO) deficiency
B) ADAMTS13 deficiency
C) Platelet antibodies
D) The cause of TTP is idiopathic
All of the following are ways hemoglobin functions EXCEPT:
A) Transport Oxygen
B) Transport Carbon Dioxide
C) Transport Nitric Oxide
D) Transport Haptoglobin
Which of the following processes can lead to the formation of microclots in a patient specimen that is collected in a tube containing EDTA anticoagulant?
A) Failing to invert the tube after specimen collection.
B) Filling the tube as full as the vacuum in the tube allows.
C) Inverting the tube 5 - 10 times after specimen collection.
D) Using the EDTA tube for an automated platelet count.
Failing to invert the tube after specimen collection.
How long are healthy neutrophils expected to reside in the peripheral blood of an adult?
A) 3 days
B) 1 day
C) 7-8 hours
D) 12-14 hours
If the red cell count is known, which of the following MUST also be known in order to calculate the mean corpuscular volume (MCV)?
B) Leukocyte count
C) Reticulocyte count
The diagram above represents which of the following beta thalassemias?
A) Beta thalassemia minor
B) Beta thalassemia intermedia
C) Beta thalassemia major
D) Beta thalassemia minima
Beta thalassemia intermedia
This diagram represents ßo/ß+ beta thalassemia intermedia. It is intermedia even though one locus is deleted because only a small part of the remaining locus is missing. Beta thalassemia intermedia (ßo/ß+, ß+/ß+, or ßo/ß) causes a moderate anemia.
ß+/ß denotes one partially deleted or inactive beta chain gene and one fully functional beta gene. This results in beta thalassemia minor (ßo/ß can also phenotype as beta thalassemia minor). This genotype causes decreased production of beta chains and a mild, asymptomatic anemia.
Beta thalassemia major (ßo/ßo, ßo/ß+, or ß+/ß+ ), also known as Cooley's anemia, causes a severe anemia approximately six months after birth.
Beta thalassemia minima (ßsc/ß) is an asymptomatic beta thalassemia (silent carrier).
The mediator cell type that binds to IgE antibodies is the:
C) Polymorphonuclear neutrophil (PMN)
The large cell shown in the illustration to the right is occasionally seen in the bone marrow and can be mistaken for a plasma cell. What is this cell?
C) Stem cell
A 27-year-old man with Down syndrome has the following CBC results which are MOST suggestive of what condition?
WBC: 27 x 103/µL
HGB: 8.5 g/dl
PLT: 30 x 109/L
Differential blood smear results:
8% segmented neutrophils
67% TdT-positive blasts
A) Acute myelogenous leukemia
B) Myeloproliferative disorder
C) Leukemoid reaction
D) Acute lymphocytic leukemia
Acute lymphocytic leukemia
Which of the following is most likely to interfere with the measurement of hemoglobin?
What is the optimal time to begin initial microscopic examination of a semen specimen, assuming liquefaction is complete?
A) 30 minutes
B) 2 hours
C) 4 hours
D) 8 hours
A cell count is ordered on a CSF sample that is bloody. Which of the following procedures would improve count accuracy?
A) Dilute the sample to minimize the number of red blood cells in the squares being counted.
B) Use Spinal Diluting Fluid, a mixture of acetic acid and crystal violet.
C) Use an automated hematology cell counter.
D) Use of electronic cell counter.
Dilute the sample to minimize the number of red blood cells in the squares being counted.
A WBC differential count on CSF should be performed using the following technique:
A) Wet mount of sample from collection tube
B) Stained smear of a cytocentrifuged specimen
C) Directly from hemocytometer chamber count
D) Directly from stained hemocytometer count
Stained smear of a cytocentrifuged specimen
The image on the right is a representative field from a peripheral blood smear. What characteristics would describe the red cell distribution curve that you would expect to see?
A) Histogram with two peaks
B) Histogram with a shift to the left
C) Histogram that is wider than normal
D) Histogram with a shift to the right
Histogram with a shift to the left
The cell population represented is a homogenous, single cell population. The histogram would be one of normal width but may demonstrate a left shift, as most of the red cells are microcytes.
A histogram with a double peak would be seen when a peripheral smear demonstrates two specific cell populations.
A widened histogram would represent a heterogenous red cell population.
Prominent vacuolation involving the cytoplasm of abnormal lymphoblast-like cells seen in the peritoneal body fluid preparation shown is a distinctive feature of which disease?
A) Hodgkin Lymphoma
B) Burkitt Lymphoma
C) Hairy Cell Leukemia
D) Chronic Lymphocytic Leukemia
Pluripotential stem cells are capable of producing which of the following?
A) Only T-lymphocyte and B-lymphocyte subsets
B) Erythropoietin, thrombopoietin, and leukopoietin
C) Lymphoid and myeloid stem cells
D) Daughter cells from only a single cell line
Lymphoid and myeloid stem cells
Disseminated intravascular coagulation (DIC) is associated with all of the following clinical conditions EXCEPT:
B) Obstetric emergencies
C) Intravascular hemolysis
All of the following erythrocyte alterations are always associated with pathological conditions EXCEPT:
B) Basophylic stippling
C) Howell Jolly bodies
D Pappenheimer bodies.
MCV is calculated using which of the following parameters?
A) Hgb and RBC
B) Hct and Hgb
C) RBC and Hct
D) RBC and MCHC
RBC and Hct
Which of the following is considered one of the most common coagulation inhibitors?
A) Lupus anticoagulant (anti-phospholipid antibody)
B) Anti-factor II
C) Anti-factor V
D) Anti-factor X
Lupus anticoagulant (anti-phospholipid antibody)
Formation of which of the following forms of poikilocytosis listed below is associated with absence of beta-lipoproteins (abetalipoproteinemia)?
A deficiency in which of the following coagulation factors will produce an abnormal prothrombin time (PT) test result but will not affect the activated partial thromboplastin time (APTT) test result?
A) Factor X
B) Factor VII
C) Factor V
D) Factor II
On a Cytospin preparation from a pleural fluid specimen, 50% of the cells have the following characteristics:
- uniform, regular arrangement
- some cells resemble a "fried egg"
- multiple nuclei
- smooth nuclear outline and homogeneous chromatin
- when present in clumps, there are clear spaces between the cells ("windows")
How should these cells be classified?
A) Atypical cancer cells
B) Mesothelial cells
C) Tumor cells
D) Ependymal cells
Which of the following best represents the quantity of resultant bleeding in order of smallest bleed to largest (assuming identical trauma)?
A) Artery, Arteriole, Vein
B) Venule, Artery, Vein
C) Venule, Vein, Artery
D) Artery, Vein, Arteriole
Venule, Vein, Artery
A leukocyte on a Wright stained blood smear has numerous large reddish-orange granules in the cytoplasm and a bi-lobed nucleus. Which of the following is it?
D) Reactive lymphocyte
All of the following descriptions are characteristic of monocytes, EXCEPT?
A) Vacuoles are common.
B) Cytoplasm may have pseudopods.
C) Granules in the cytoplasm give a ground glass appearance.
D) The nuclear chromatin appears very condensed.
The nuclear chromatin appears very condensed.
The principle behind point-of-care devices to measure hematocrit is:
A) Counting the RBCs and determining the MCV; then, multiplying the MCV x RBC/10
B) Calculating the conductance of the blood sample and correcting for temperature, conductivity of the plasma, and size of the fluid segment
C) Detecting cumulative pulse height
D) Centrifuging the sample at a standard speed and time, then measuring the RBC column vs. whole blood.
Calculating the conductance of the blood sample and correcting for temperature, conductivity of the plasma, and size of the fluid segment
Disorders affecting the thyroid, pituitary, and adrenal glands can all lead to anemia (mild to moderate). This is most often associated to which of the following?
A) Increase in direct effector hormones
B) Increase in tropic hormones
C) Decrease in erythropoietin (EPO)
D) Decrease in tropic hormones
Decrease in erythropoietin (EPO)
Which of the following tests could be used to determine whether an abnormal screening coagulation test result (PT or aPTT) is caused by a factor deficiency or an inhibitor?
A) Bleeding time
B) Mixing studies
D) Fibrinogen assay
All of the following are present in normal bone marrow EXCEPT?
C) Ringed sideroblast
Which of the following laboratory tests would be most helpful in determining the number of T cells in circulation?
A) Complete blood count
B) Nitroblue tetrazolium (NBT)
C) Manual differential
D) Flow cytometry
How are Barr bodies usually classified?
A ten-year-old boy came to a physician's attention because of recent jaundice and icteric sclera after taking the medication Primaquine before a trip to Africa. The immediate laboratory work revealed: Hct 24% (normal 36%-47%), MCV 79.5 fL (normal 78-95fL), RDW 13% (normal 11.5-15.0%).
His blood smear findings are reflected in the images to the right. The upper image is a Wright-Giemsa stained smear, while the lower is a supravital-stained smear. Which condition should be considered for this patient when analyzing his symptoms, history, and laboratory results?
A) G6PD deficiency
B) Pyruvate kinase deficiency
C) Iron deficiency anemia
D) Megaloblastic anemia
Which hemoglobin will be increased in delta-beta thalassemia?
A) Hb A
B) Hb A2
C) Hb F
D) Hb H
In patients who have developed heparin-induced thrombocytopenia with thrombosis (HIT), which of the following should be used to prevent ischemic stroke?
A) Unfractionated heparin
B) Direct thrombin inhibitors
C) Oral anticoagulant
D) Vitamin K
Direct thrombin inhibitors
Identify the neutrophil nuclear projection in this image.
A) Barr body
The descriptions below refer to the appearance of inclusions found in Wright-stained or supravital-stained peripheral blood smears. Which best describes basophilic stippling?
A) Round and smooth and usually one per erythrocyte
B) Variable in size and aggregated near cell periphery
C) Relatively evenly distributed fine or coarse granules throughout the red cell
D) Reddish figure-eight strand within the red cell
Relatively evenly distributed fine or coarse granules throughout the red cell
Which of the following is NOT a condition in which coarse basophilic stippling is typically found?
A) Anemias of abnormal hemoglobin synthesis
C) Lead poisoning
D) Hemolytic anemia
Approximately 10% of the circulating white cells were similar to the one seen in this image. The patient is 42-years-old which visited his physician because of recent bruising. Note the absence of platelets on the smear. Possible associated conditions include:
A) Chronic infection
B) Multiple myeloma
C) Active viral infection
D) Parasitic infections
In which of the following disorders would you probably observe coarse basophilic stippling on a Wright-stained peripheral blood smear?
A) Hemolytic anemia
B) Sideroblastic anemia
C) Multiple myeloma
D) Lead poisoning
The small club-shaped, "drumstick" nuclear appendage attached to one lobe of a neutrophil (marked by the blue arrow in the image) may be found in:
A) Normal male
B) Homozygous hemophilia A male
C) Normal female
D) Turner's syndrome
A manual platelet count was performed using a Neubauer hemacytometer. The total platelet count was 356 x 103/µL. A platelet estimate was then performed on the peripheral blood smear. Ten fields were counted and yielded the following results: 17, 16, 15, 20, 19, 17, 19, 16, 20, 18. The platelet estimation factor for the microscope used was 20,000. What is the next logical step?
A) Report the manual platelet count since it correlates well with the platelet estimate
B) Repeat the hemacytometer count on a recollected specimen and check for clumping
C) Check ten additional fields on the peripheral blood smear
D) Repeat the platelet count using a different method
Report the manual platelet count since it correlates well with the platelet estimate
When red blood cells hemolyze, what is the molecule released that will give the plasma its reddish appearance?
What is an appropriate use for molecular (DNA) tests for mutations of the HFE gene, the gene found in the majority of patients diagnosed with hereditary hemochromatosis (HH)?
A) Testing family members of persons with HH
B) Screening of all newborns
C) Predicting the severity of iron overload
D) Identifying persons with iron overload
Testing family members of persons with HH
Abnormal granulation can be seen in the cytoplasm of leukocytes in which of the following conditions?
A) Pelger-Huët anomaly
B) Pseudo-Pelger-Huët anomaly
C) May-Hegglin anomaly
D) Chediak-Higashi syndrome
Which of following descriptors would apply to the bone marrow displayed in the image to the right?
A) High myeloid to erythroid (M:E) ratio -- Many WBC precursors, few RBC precursors, Megakaryocyte present
B) Inverted or Low M:E ratio -- Few WBC precursors, many RBC precursors, Megakaryocyte present
C) Normal myeloid to erythroid (M:E) ratio -- Many WBC precursors, many RBC precursors, Megakaryocyte present
D) High myeloid to erythroid (M:E) ratio -- Many WBC precursors, Many RBC precursors, Megakaryocyte present
High myeloid to erythroid (M:E) ratio -- Many WBC precursors, few RBC precursors, Megakaryocyte present
How long should therapy continue for patients with hereditary hemochromatosis (HH)?
A) Therapy should continue throughout the lifetime.
B) Therapy should continue only until ferritin levels have returned to normal.
C) Therapy should continue for one year only.
D) The length of therapy is variable for each patient.
Therapy should continue throughout the lifetime.
Which of the following hemoglobins is replaced by hemoglobin H (HbH) after birth in individuals with HbH disease?
A) Constant Spring
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