Upgrade to remove ads
Only $35.99/year

Hematology Final

Terms in this set (334)

1. Leukocytosis can be defined as an increase in: (Objective 1)
a . neutrophils, monocytes, and macrophages
b . neutrophils, eosinophils, erythrocytes, and basophils
c . neutrophils, eosinophils, basophils, monocytes, and
lymphocytes
d . neutrophils, eosinophils, basophils, monocytes,
lymphocytes,
and megakaryocytes
C
2. The hallmark of differentiating myelocytes from promyelocytes
morphologically is the visual identification of what in
the myelocytes? (Objective 2)
a . primary granules
b . secondary granules
c . loss of nucleoli
d . pink cytoplasm
B
3. Primary granules first appear in the: (Objective 2)
a . myeloblast
b . promyelocyte
c . myelocyte
d . band
B
4. The eosinophil's primary function is to: (Objective 5)
a . protect the host from helminth parasites
b . protect the host from autoimmune destruction
c . secrete cytokines to attract monocytes to the site
of infection
d . secrete cytokines to attract lymphocytes to the site
of infection
A
5. Leukocyte migration to the tissues is regulated by leukocyteendothelial
cell recognition that requires: (Objective 6)
a . interaction of adhesion molecules and their receptors
b . activation of membrane oxidase
c . leukocyte degranulation
d . hematopoietic growth factors
A
6. A(n) _____________________ has cytoplasm with a ground
glass appearance while a _____________________ contains
cytoplasm that is pinkish to clear in color. (Objective 4)
a . eosinophil; neutrophil
b . monocyte; lymphocyte
c . lymphocyte; basophil
d . monocyte; neutrophil
D
7. Basophils and mast cells have receptors for which immunoglobulin?
(Objectives 3, 5)
a . IgA
b . IgG
c . IgM
d . IgE
D
8. The total WBC count for an adult is 13.1 * 109/L with a
differential count that reveals 20% eosinophils. This represents
a: (Objectives 1, 7, 8, 9)
a . relative and absolute eosinophilia
b . relative eosinophilia and normal absolute count
c . normal relative count and absolute eosinophilia
d . normal eosinophil count
A
9. An absolute neutrophilia is most likely to be associated
with a(n): (Objectives 1, 10)
a . allergic response
b . parasitic infection
c . bacterial infection
d . viral infection
C
10. Routine hematological analysis was performed on a 1-day-old
baby. The WBC count was 21.3 * 109/L. This finding represents
a(n): (Objectives 1, 11)
a . normal leukocyte count
b . absolute leukocytosis
c . relative leukopenia
d . absolute leukopenia
A
11. Which of the following leukocytes are most likely to resemble
the morphology of a monocyte? (Objective 4)
a . neutrophils
b . basophils
c . reactive lymphocytes
d . eosinophils
C
12. Monocytes function in the innate immune response by
their ability to _______________________ and function in the
adaptive immune response by _______________________ and
_______________________. (
Objective 5)
a . phagocytose; antigen presentation; cytokine secretion
b . degranulate; erythrophagocytosis; diapedesis
c . stimulate T cells; secretion of IgM; remove helminths
d . secrete cytokines; chemotaxis; degranulation
A
13. Patients with chronic granulomatous disease lack the ability
to produce a neutrophilic respiratory burst and often
die of bacterial infections. Which phase of phagocytosis is
disrupted? (Objective 6)
a . ingestion of bacteria
b . bacterial cell killing
c . neutrophilic degranulation
d . bacterial cell recognition
B
14. What would be the major effect on the body of a severe
monocytopenia? (Objectives 1, 5)
a . increased risk of parasitic infections
b . increased risk of bacterial infections
c . increased risk of viral infections
d . decreased risk of allergic reactions
B
15. If a neutrophil lacked the ability to produce L-selectin, which
of its functions or abilities would be disrupted? (Objective 6)
a . phagocytosis
b . degranulation
c . cytokine secretion
d . margination
D
1. The average cell turnover rate for granulocytes and monocytes
in the peripheral blood is: (Objective 1)
a . hours
b . 24 hours
c . 8-10 days
d . 10 years
A
2. The following cells are found in the granulocytic proliferating
pool (mitotic pool) of the marrow: (Objective 1)
a . pluripotential stem cells
b . unipotential progenitor cells
c . monoblasts, myeloblasts, and macrophages
d . myeloblasts, promyelocytes, and myelocytes
D
3. Which leukocyte is important in fighting helminth parasitic
infection? (Objective 3)
a . eosinophil
b . neutrophil
c . monocyte
d . basophil
A
4. An individual who has a mutation in the CD18 gene that
results in absence of the b2-integrin on the leukocyte
membrane will likely have: (Objective 2)
a . severe allergic reactions
b . leukocytosis with neutrophilia
c . life-threatening bacterial infections
d . a defect in phagocytosis
C
5. A patient was seen in the ER for symptoms of appendicitis.
A complete blood count was ordered. The WBC count was
20 * 109/L and the differential revealed 60% segmented
neutrophils, 15% bands, 20% lymphocytes, 4% monocytes,
and 1% eosinophils. All other parameters were within the
reference interval. These results are most likely due to:
(Objectives 1, 4, 5)
a . release of neutrophils from the bone marrow proliferating/
mitotic compartment
b . release of neutrophils from the bone marrow maturation/
postmitotic compartment
c . a shift in the marginated pool of neutrophils in the
peripheral blood compartment
d . a shift in the circulating pool of neutrophils in the
peripheral blood compartment
B
6. Segmented neutrophils are more capable of egressing
from the bone marrow into the peripheral blood than
myelocytes because: (Objective 2)
a . mature neutrophils more easily deform through the
small pore diameter in endothelial cells lining the
marrow
sinusoids
b . mature neutrophils secrete a cytokine that enables them
to adhere to endothelial cells of the marrow sinusoids
c . there is a higher concentration of mature neutrophils
in the bone marrow but myelocytes are rare
d . only neutrophils possess the secondary granules
required for chemotaxis
A
7. A 30-year-old healthy male needed a CBC as part of his
physical examination for purchasing a life insurance policy.
He decided to combine his daily 5-mile run with his
appointment to get his blood drawn. He ran 3 miles to the
laboratory, had his blood drawn, and returned home. His
WBC count was increased to 15 * 109/L but all other CBC
parameters were normal. What is the most likely explanation
for the increased WBC count? (Objectives 1, 5)
a . He has a bacterial or viral infection.
b . He has a leukemia with leukemic cells present.
c . Nucleated RBCs have entered the peripheral blood.
d . The marginating neutrophil pool entered the
circulating
pool.
D
8. If the neutrophil count was determined before and after
the run in the patient in question 7, what would be the
most likely results? (Objective 5)
a . absolute neutrophilia before and relative neutrophilia
after
b . relative neutrophilia before and absolute neutrophilia
after
c . neutropenia before and absolute neutrophilia after
d . increased neutrophils after in comparison to before
D
9. An absence of the E- and P-selectin receptors on neutrophils
results in: (Objective 2)
a . increased movement of neutrophils from the circulation
into the tissues
b . increased neutrophil response to chemotaxins
c . arrest of neutrophil rolling on the VEC surface
d . inability of the neutrophil to interact with the VEC
D
10. Monocytes contribute to a proper functioning adaptive
immune response by: (Objective 3)
a . processing and presenting foreign antigens to
lymphocytes
b . removing red blood cells from the circulation
c . removing lymphocytes from the circulation
d . secreting substances that neutralize inflammatory
products of eosinophils
A
11. A gene defect that reduces the ability of M-CSF to be produced
in sufficient quantity would result in a: (Objectives 1, 4)
a . monocytosis
b . neutrophilia
c . monocytopenia
d . basophilia
C
12. While neutrophils predominantly function in the tissues,
they can function as phagocytic cells in the blood stream
during which of the following? (Objectives 3, 4)
a . when bacteria are present in the blood
b . during times of intense physical activity
c . during an allergic response
d . during a viral infection
A
13. An adult male presents to the emergency department
after experiencing severe nausea and vomiting. The total
WBC count for the patient is 7.8 * 109/L with a differential
count that reveals 10% monocytes. The laboratory data for
this patient represent a: (Objective 5)
a . relative and absolute monocytosis
b . relative monocytosis and normal absolute count
c . normal relative count and absolute monocytosis
d . normal monocyte count
D
14. During a severe bacterial infection, the concentration of
neutrophils will decrease in which of the following locations?
(Objective 1)
a . the site of infection
b . the tissues
c . the proliferating pool
d . the storage pool
D
15. A genetic alteration that produces improperly formed Fc
receptors on the surface of neutrophils would have which
of the following effects? (Objective 3)
a . The neutrophil would not recognize IgG-coated bacterial
cells.
b . The neutrophil would not be able to phagocytize viral
particles.
c . Activated complement could not bind to the neutrophil
receptors.
d . Phagocytosis could not take place at all.
A
1. The function of the lymphocyte is: (Objective 1)
a . phagocytosis
b . antigen recognition
c . hypersensitivity
d . allergic response
B
2. Which description best fits the plasma cell? (Objectives 5, 6)
a . high N:C ratio, nuclear chromatin lacy and fine,
nucleoli
present, agranular cytoplasm
b . nucleus eccentric, chromatin in a cartwheel
arrangement,
deeply basophilic cytoplasm
c . decreased N:C ratio, nucleus irregular, abundant
cytoplasm
indented by erythrocytes
d . round nucleus, abundant cytoplasm, cytoplasm
contains
large pink granules
B
3. Lymphocytes can be differentiated from monocytes
because lymphocytes have: (Objective 5)
a . cytoplasm with fine granules and a lobulated nucleus
b . lacey chromatin pattern with a low N:C ratio
c . low N:C ratio with intense cytoplasmic basophilia
d . round dense chromatin nuclear pattern and sky blue
cytoplasm
D
4. A cell on a Wright's stain peripheral blood smear was
observed with a stretched or irregular nucleus; occasional
nucleoli were present. The cytoplasm was abundant and
scalloped around the erythrocytes. This description best
fits the: (Objective 6)
a . plasma cell
b . lymphoblast
c . reactive lymph
d . monocyte
C
5. The first immunoglobulin heavy chain produced in the
maturing B lymphocyte is: (Objective 5)
a . a
b . b
c . m
d . g
C
6. The adult reference interval for peripheral blood lymphocytes
is: (Objective 3)
a . 0.2-0.8 * 109/L
b . 1.0-4.8 * 109/L
c . 2.0-7.0 * 109/L
d . 3.9-10.6 * 109/L
B
7. An 80% lymphocyte count with a total WBC count of
4.4 * 109/L on an adult indicates a: (Objectives 2, 3)
a . relative and absolute decrease in lymphocytes
b . relative decrease in lymphocytes but an absolute
number
within the reference interval
c . relative increase in lymphocytes but an absolute
number
within the reference interval
d . relative and absolute increase in lymphocytes
C
8. Lymphocyte concentrations in the peripheral blood are
highest at what age level? (Objectives 2, 3)
a . 6 months
b . 5 years
c . 25 years
d . 75 years
A
9. Which of the following is a characteristic of B lymphocytes?
(Objective 1)
a . regulate immune response
b . synthesize antibody
c . secrete cytokines
d . are majority of peripheral blood lymphocytes
B
10. Which of the following are cells of the innate immune system?
(Objective 1)
a . plasma cells
b . natural killer cells
c . B lymphocytes
d . T lymphocytes
B
1. Pre-B cells are characterized by the presence of: (Objective 3)
a . CD4 antigen
b . CD8 antigen
c . CD19
d . CD3
C
2. A major function of CD4+ lymphocytes is: (Objective 4)
a . to produce immunoglobulin
b . cellular immunity
c . to phagocytize microbes
d . nonspecific cytotoxic function
B
3. Natural killer cells are: (Objective 4)
a . T lymphocytes
b . B lymphocytes
c . plasma cells
d . non-T, non-B lymphocytes
D
4. The most likely explanation for a patient who has a WBC
count of 16 * 109/L with many reactive lymphocytes and
a few immunoblasts present is: (Objective 4)
a . a heightened immune response
b . early leukemia or lymphoma
c . the presence of immunodeficiency
d . qualitatively abnormal lymphocytes
A
5. A patient has lymphocytic leukemia with 60% lymphoblasts
in the peripheral blood. The best way for the clinical laboraty
professional to determine whether these are T or B
lymphoblasts is to: (Objective 5)
a . do a TdT stain on the blood
b . determine the CD surface markers on the blasts by
flow cytometry
c . do a molecular analysis to find oncogenes
d . send the peripheral blood specimen to
cytogenetics
B
6. A patient diagnosed with infectious mononucleosis would
most likely produce: (Objective 7)
a . monoclonal antibody
b . paraprotein
c . polyclonal antibody
d . M protein
C
7. A patient who is immunosuppressed would most likely
have: (Objective 4)
a . an increase in CD4+ lymphocytes
b . lymphocytosis and eosinophilia
c . a decrease in CD4+ lymphs
d . an increase in the T-cell to B-cell ratio
C
8. Interleukin 4 plays a role in: (Objectives 2, 3)
a . inducing proliferation and activation of lymphocytes
b . enhancing T lymphocytes cell survival
c . stimulating proliferation of B lymphocytes
d . activating macrophages and granulocytes
C
9. KIR molecules are found on which type of lymphocyte?
(Objective 4)
a . B lymphocytes
b . T lymphocytes
c . TReg cells
d . NK cells
D
10. CD surface markers including CD2, CD3, CD5, and CD7 are
associated with which subclass of lymphocytes?: (Objective
5)
a . B lymphocytes
b . T lymphocytes
c . TReg cells
d . NK cells
B
1. What bone marrow cell is the precursor of platelets?
(Objective 2)
a . myeloblast
b . erythroblast
c . endothelial cell
d . megakaryocyte
D
2. What is a reasonable reference interval for platelets in the
peripheral blood? (Objective 1)
a . 10-20 * 109/L
b . 150-200 * 1012/L
c . 150-400 * 109/L
d . 400-600 * 109/L
C
3. Which of the following best describes the normal
morphology
of platelets on a peripheral blood smear?
(Objective 1)
a . They are larger than erythrocytes.
b . They are filled with azurophilic granules.
c . They are light blue in color without granules.
d . They have large nuclei.
B
4. Which of the following best describe the appearance
of mature megakaryocytes in the bone marrow?
(Objective 2)
a . They are large cells with scanty basophilic cytoplasm
(high N:C ratio).
b . They are large cells with multiple discrete nuclei, basophilic
cytoplasm.
c . They have abundant acidophilic cytoplasm filled with
azurophilic granules and a single, large, lobulated
nucleus.
d . They are about the size of a marrow macrophage with
a high N:C ratio and granular cytoplasm.
C
5. The major cytokine responsible for regulating both megakaryocyte
and platelet production is: (Objective 4)
a . TPO
b . IL-11
c . SCF
d . IL-6
A
6. Endomitosis is defined as: (Objective 3)
a . cell proliferation endogenous to the bone marrow
b . fragmentation of megakaryocyte cytoplasm to produce
platelets
c . fusion of megakaryocyte progenitor cells to produce
polyploidy megakaryocytes
d . rounds of DNA synthesis without nuclear division or
cellular division
D
7. What is the normal life span of platelets in the peripheral
blood? (Objective 1)
a . 8 hours
b . 1 day
c . 10 days
d . 100 days
C
1. Which of the following statements best describes the role
of the platelet parameters MPV and PDW in evaluating
patients? (Objective 1)
a . They are theoretical constructs, and we do not yet
have the capacity to measure either variable.
b . They are measurable but not on current laboratory
hematology instrumentation.
c . Variations in both MPV and PDW can be measured,
but their clinical significance is unknown.
d . Variations in both MPV and PDW can be measured
and can contribute to the differential diagnosis of
platelet disorders.
C
2. Place the following megakaryocyte precursor cells in the
correct developmental sequence: (Objective 2)
a . BFU-Mk > CFU-Mk > megakaryoblast S granular
megakaryocyte
b . CFU-Mk > BFU-Mk > basophilic megakaryocyte
S granular megakaryocyte
c . BFU-Mk > CFU-Mk > basophilic megakaryocyte
S megakaryoblast
d . CFU-Mk > BFU-Mk > megakaryoblast > basophilic
megakaryocyte
A
3. Which of the following is believed to be the mechanism
of platelet formation and release by megakaryocytes?
(Objectives 2, 3)
a . dissolution of the megakaryocyte cell membrane and
release of preformed platelets
b . release of individual reticulated platelets from the
cytoplasm
c . formation of proplatelet processes, which subsequently
segment into individual platelets
d . apoptotic cell death of the megakaryocyte and the
disintegration of the cytoplasm as platelets
C
4. A patient receiving chemotherapy experienced severe
marrow suppression and anemia, leukopenia, and thrombopenia
as a result. After about one week, the platelet
count remained low, and the number of reticulated platelets
was above the reference interval for that parameter.
This would likely indicate that the: (Objective 4)
a . patient's marrow is failing to initiate recovery of the
thrombocytopenia
b . patient is a candidate for erythropoietin
c . patient should receive a blood transfusion
d . the patient's marrow is showing early signs of recovery
of the thrombocytopenia
D
5. What effect does thrombopoietin have on the megakaryocyte?
(Objective 2)
a . It decreases the ploidy level and number of platelets
formed.
b . It increases size, DNA ploidy level, and rate of
maturation.
c . It induces the release of megakaryocytes to the
peripheral blood.
d . It decreases the rate of endomitosis and increases
ploidy level.
B
6. What is the effect of a significant number of giant platelets
(megathrombocytes) resulting in an increased MPV on the
peripheral blood platelet count? (Objective 4)
a . It would have no effect on the platelet count.
b . It would generally be associated with an increased
platelet count.
c . It would generally be associated with a decreased
platelet count.
d . It would result in an unreliable reading on the automated
instrument and require a manual platelet count
C
1. Which of the following hematologic values would you
expect if the peripheral blood smear revealed toxic granulation,
Döhle bodies, and vacuoles in neutrophils? (Objectives
1, 2)
a . WBC: 4.0 * 109/L
b . the differential shows 15% bands
c . the differential shows 20% eosinophils
d . Hb: 10 g/dL; platelets 20 * 109/L
B
2. The white count in an adult is 2.0 * 109/L. The differential
shows 60% segmented neutrophils. Which of the following
correctly describes these results? (Objective 6)
a . normal
b . leukocytosis and neutrophilia
c . leukopenia with normal number of neutrophils
d . leukopenia and neutropenia
D
3. Which of the following is the most common cause of neutrophilia?
(Objective 1)
a . bacterial infection
b . acute leukemia
c . chemotherapy
d . aplastic anemia
A
4. Blue-gray oval inclusions composed of RNA near the
periphery of neutrophils is a description of: (Objective 3)
a . toxic granules
b . Döhle bodies
c . vacuoles
d . primary granules
B
5. Which of the following is a common reason for neutropenia
in hospitalized patients? (Objective 6)
a . chronic myeloproliferative disorders such as CML
b . chemotherapy and/or radiation treatment for cancer
c . childbirth
d . lack of exercise
A
6. Which of the following causes a false neutropenia?
(Objective 7)
a . EDTA-induced agglutination
b . bone marrow aplasia
c . splenomegaly
d . immune neutropenia
A
7. Which of the following can be used to distinguish a leukemoid
reaction from CML? (Objective 5)
a . a total WBC count 725 * 109/L
b . the presence of immature cells of the myeloid lineage
c . LAP stain
d . presence/absence of autoantibodies
C
8. Which of the following is a common cause of eosinophilia?
(Objective 10)
a . parasitic infection
b . eosinophilic leukemia
c . CML
d . acute hemorrhage
A
9. What substances build up and are ingested by macrophages
in qualitative macrophage disorders such as Gaucher
disease? (Objective 11)
a . proteins
b . carbohydrates
c . lipids
d . rough endoplasmic reticulum
C
10. Distinct, large, unidentified inclusions are found in the
cytoplasm of many granulocytes. Select the best course
of action. (Objective 9)
a . Ignore them because they probably are not significant.
b . Report them as intracellular yeast.
c . Suspect rare or unusual conditions such as
Chédiak-Higashi.
d . Report them as toxic granulation.
C
A patient's white count is 30.0 * 109/L. The differential is
as follows:
Segmented neutrophils 54%
Band neutrophils 10%
Metamyelocytes 2%
Lymphocytes 26%
Monocytes 5%
Eosinophils 3%
6 Nucleated RBCs/100 WBCs
1. Select the additional information most important to assess
whether these results are normal or indicate a disease process.
(Objective 1)
a . platelet count
b . LAP stain
c . patient history
d . patient age
D
A patient's white count is 30.0 * 109/L. The differential is
as follows:
Segmented neutrophils 54%
Band neutrophils 10%
Metamyelocytes 2%
Lymphocytes 26%
Monocytes 5%
Eosinophils 3%
6 Nucleated RBCs/100 WBCs
2. Which of the following correctly describes the absolute
neutrophil count for the patient? (Objectives 1, 12)
a . normal for both an infant and an adult
b . neutrophilia for both an infant and an adult
c . normal for an infant and neutrophilia for an adult
d . normal for an adult and neutrophilia for an infant
C
A patient's white count is 30.0 * 109/L. The differential is
as follows:
Segmented neutrophils 54%
Band neutrophils 10%
Metamyelocytes 2%
Lymphocytes 26%
Monocytes 5%
Eosinophils 3%
6 Nucleated RBCs/100 WBCs
3. Which of the following correctly describes the neutrophil
concentration if the patient is an infant? (Objective 1)
a . pseudo-neutrophilia
b . leukemoid reaction
c . leukoerythroblastic reaction
d . physiologic neutrophilia
D
A patient's white count is 30.0 * 109/L. The differential is
as follows:
Segmented neutrophils 54%
Band neutrophils 10%
Metamyelocytes 2%
Lymphocytes 26%
Monocytes 5%
Eosinophils 3%
6 Nucleated RBCs/100 WBCs
4. Which of the following correctly describes the differential
if the patient is an adult? (Objective 1)
a . pseudo-neutrophila
b . leukoerythroblastic reaction
c . agranulocytosis
d . physiologic neutrophilia
B
A patient's white count is 30.0 * 109/L. The differential is
as follows:
Segmented neutrophils 54%
Band neutrophils 10%
Metamyelocytes 2%
Lymphocytes 26%
Monocytes 5%
Eosinophils 3%
6 Nucleated RBCs/100 WBCs
5. A leukoerythroblastic reaction can be associated with:
(Objectives 1, 2, 12)
a . chronic granulomatous disease
b . Chédiak-Higashi syndrome
c . severe hemolytic anemia
d . leukocyte adhesion deficiency
C
6. Alder-Reilly anomaly can be differentiated from toxic granulation
by: (Objectives 7, 11)
a . presence/absence of other toxic features (leukocytosis,
toxic granulation, Döhle bodies, vacuoles)
b . the presence of hypersegmentation in neutrophils
c . other CBC parameters abnormal (RBC, HCT, or PLT)
d . patient symptoms related to an allergic reaction
A
7. May-Hegglin can be differentiated from conditions with
toxic Döhle bodies by: (Objectives 7, 11)
a . presence of thrombocytosis
b . presence or absence of other toxic features such as
toxic granulation
c . foam cells in the bone marrow
D. patient history of recent trauma
B
8. Pelger-Huët anomaly can be differentiated from an increase
in band neutrophils by: (Objectives 5, 11)
a . flow cytometry for the presence of CD11b
b . abnormal inclusions found in cells other than
neutrophils
c . other CBC parameters abnormal (RBC, HCT, or PLT)
d . finding all bilobed segmented neutrophils
D
9. Chédiak-Higashi can be differentiated from intracellular
yeasts or morulae by: (Objectives 6, 7, 11)
a . presence of giant platelets
b . abnormal inclusions in neutrophils and lymphocytes
c . other CBC parameters abnormal (RBC, HCT, or PLT)
d . lack of glucosidase enzyme activity
B
10. An adult patient's white blood cell count was 10.1 * 109/L,
and the absolute neutrophil count was 1.3 * 109/L. The
medical laboratory scientist who analyzed the data suspected
a false neutropenia and requested a redraw for
the patient. Which of the following could have caused the
medical laboratory scientist to question the CBC results?
(Objective 4)
a . The blood specimen was drawn 6 days before testing.
b . The patient's history indicated hypersplenism.
c . The neutrophil count was too high for an adult.
d . The patient suffered from congenital neutropenia.
A
11. Leukemia can be differentiated from infection by:
(Objectives 2, 11)
a . lack of glucosidase enzyme activity in monocytes
b . a shift to the left in granulocytic cells
c . a leukocyte alkaline phosphatase stain
d . flow cytometry for the presence of CD11b
C
12. A sample with toxic vacuoles can be differentiated from a
sample with prolonged storage by: (Objectives 4, 6, 11)
a . presence of other toxic features (leukocytosis, toxic
granulation, Döhle bodies, vacuoles)
b . abnormal inclusions found in lymphocytes
c . other abnormal CBC parameters (RBC, HCT, or PLT)
D. family history
A
1. Advanced HIV disease (AHD) patients have numerous
infections because the HIV virus has infected: (Objective 9)
a . neutrophils
b . CD8+ lymphocytes
c . CD4+ lymphocytes
d . B lymphocytes
C
2. According to the CDC definition, a patient is considered
to have progressed from AHD to AIDS when the following
is detected: (Objective 10)
a . a leukopenia
b . a CD4:CD8 ratio of 2:1
c . the absolute CD4+ count of <200/mcL
d . the absolute CD4+ count of <500/mcL
B
3. Which of the following infectious agents is associated with
a newborn found to have jaundice and microcephaly with
an enlarged spleen and decreased platelet and red cell
counts? (Objective 7)
a . cytomegalovirus
b . Epstein-Barr virus
c . Toxoplasmosis gondii
d . Bordetella pertussis
C
4. A teenager is seen at the clinic for a sore throat and enlarged
cervical lymph nodes. He has reactive, atypical lymphocytes
along with an elevated CRP and elevated aminotransferases.
He should also be tested for: (Objectives 1, 3)
a . pertussis antitoxin antibodies
b . HIV antibodies
c . Toxoplasmosis antibodies
d . heterophile antibodies
D
5. A 29-year-old female patient was seen for abdominal fullness,
fever, and lethargy. Her total leukocyte count was
11.8 * 109/L. The differential showed 32% neutrophils,
65% lymphocytes, and 3% monocytes. A few of her lymphocytes
were small round lymphocytes with a high N:C
ratio and overall size similar to the red cells, but many of
her lymphocytes appeared large with basophilic cytoplasm
and increased N:C ratio. This patient should be considered
for: (Objective 5)
a . a urinary tract infection
b . hepatitis
c . bacterial meningitis
d . Streptococcus pneumonia
B
6. The morphology of lymphocytes found in infectious mononucleosis
is described as: (Objective 2)
a . segmented nucleus with pinkish-tan cytoplasm
b . horseshoe-shaped nucleus with blue/gray cytoplasm
c . irregular shaped nucleus with spreading, deep blue
cytoplasm
d . small cells with condensed chromatin and deep blue
cytoplasm
C
7. A 2-year-old child has a total leukocyte count of 10 * 109/L
and 60% lymphocytes. Which of the following best
describes the child's blood count? (Objectives 4, 8)
a . absolute lymphocytosis
b . relative lymphocytosis
c . normal lymphocyte count for the age given
d . absolute lymphocytopenia
C
A 19-year-old female college student went to student health
complaining of lethargy and a sore throat for the past two
weeks. Physical exam shows pharyngitis, lymphadenopathy,
and splenomegaly with a total leukocyte count of 11 * 109/L
and 70% lymphocytes (50% of lymphs are reactive).

8. She probably has: (Objective 1)
a . HIV
b . hepatitis
c . X-linked SCIDS
d . infectious mononucleosis
D
A 19-year-old female college student went to student health
complaining of lethargy and a sore throat for the past two
weeks. Physical exam shows pharyngitis, lymphadenopathy,
and splenomegaly with a total leukocyte count of 11 * 109/L
and 70% lymphocytes (50% of lymphs are reactive)
9. Her absolute lymphocyte count is: (Objective 4)
a . 10 * 109/L
b . 11 * 109/L
c . 5.5 * 109/L
d . 7.7 * 109/L
D
A 19-year-old female college student went to student health
complaining of lethargy and a sore throat for the past two
weeks. Physical exam shows pharyngitis, lymphadenopathy,
and splenomegaly with a total leukocyte count of 11 * 109/L
and 70% lymphocytes (50% of lymphs are reactive)
10. The best description of this patient's leukocyte count is
a(n): (Objectives 4, 8)
a . relative lymphocytopenia
b . relative neutrophilia
c . absolute lymphocytosis
d . absolute neutrophilia
C
1. A 17-year-old female patient is seen at the clinic because
she has a lingering cough. She had a total leukocytosis
of 23 * 109/L with 79% normal-looking lymphocytes. She
should be screened for: (Objective 6)
a . pertussis antitoxin antibodies
b . VCA IgM
c . EBNA
d . CMV antibodies
A
2. A patient with lethargy, pharyngitis, and lymphadenopathy
is found to have many lymphocytes that are large
with spreading, irregular cytoplasm and some with deep
basophilia. A study of the lymphyocyte subsets would be
expected to show: (Objective 2)
a . decreased reactive B lymphocytes with increased cytotoxic
T lymphocytes
b . increased reactive B lymphocytes with decreased cytotoxic
T lymphocytes
c . decreased reactive B lymphocytes with decreased
cytotoxic T lymphocytes
d . increased reactive B lymphocytes with increased cytotoxic
T lymphocytes
A
3. Epstein-Barr virus infects lymphocytes by attaching to
which receptor? (Objective 2)
a . CD4
b . CD8
c . CD21
d . TCR
C
A young male sees his physician for an ongoing cough. He is
found to have a total leukocyte count of 28 * 109/L with a
differential of 22% neutrophils, 72% lymphocytes, 5% monocytes,
and 1% eosinophils. The majority of the lymphocytes
appear small with dense chromatin.
4. Which of the following describes his blood count?
(Objective 7)
a . absolute neutrophilia
b . relative neutrophilia
c . absolute lymphocytosis
d . relative eosinophilia
C
A young male sees his physician for an ongoing cough. He is
found to have a total leukocyte count of 28 * 109/L with a
differential of 22% neutrophils, 72% lymphocytes, 5% monocytes,
and 1% eosinophils. The majority of the lymphocytes
appear small with dense chromatin.
5. The most likely cause of illness is: (Objectives 5, 7, 10)
a . Epstein-Barr virus
b . Bordetella pertussis
c . Cytomegalovirus
d . hepatitis
B
6. After taking care of a pair of cats, a 25-year old male saw
his physician for fever of unknown origin. He had a total
leukocyte count of 16 * 109/L with 78% lymphocytes,
many showing reactivity, basophilia, and increased cytoplasm.
His monospot test was negative. What other testing
should be considered? (Objective 4)
a . screening for Toxoplasmosis gondii
b . screening for HIV
c . detection of pertussis antitoxin antibodies
d . detection of hepatitis B antigen
A
A 39-year-old male went to the clinic with complaints of
nagging cough, weight loss, diarrhea, and low-grade temperature.
Results of physical examination showed lymphadenopathy,
congested lungs, and increased heart rate. Slight
splenomegaly and hepatomegaly were noted. A CBC and
flow cytometry studies were ordered. Histologic examination
of sputum with Gomori's methenamine silver nitrate stain
revealed Pneumocystis carinii.
Laboratory data
WBC 2.8 * 109/L
count
RBC 3.86 * 1012/L
count
Hb 13.6 g/dL (136 g/L)
Hct 0.41 L/L
Platelet count 104 * 109/L
Differential
Segmented 68%
neutrophils
Lymphocytes 21%
Monocytes 10%
Eosinophils 1%
Positive for HIV-1
antibodies

7. What clinical condition does this patient have? (Objectives
8, 10)
a . congenital immune deficiency
b . infectious mononucleosis
c . AHD
d . AIDS
D
A 39-year-old male went to the clinic with complaints of
nagging cough, weight loss, diarrhea, and low-grade temperature.
Results of physical examination showed lymphadenopathy,
congested lungs, and increased heart rate. Slight
splenomegaly and hepatomegaly were noted. A CBC and
flow cytometry studies were ordered. Histologic examination
of sputum with Gomori's methenamine silver nitrate stain
revealed Pneumocystis carinii.
Laboratory data
WBC 2.8 * 109/L
count
RBC 3.86 * 1012/L
count
Hb 13.6 g/dL (136 g/L)
Hct 0.41 L/L
Platelet count 104 * 109/L
Differential
Segmented 68%
neutrophils
Lymphocytes 21%
Monocytes 10%
Eosinophils 1%
Positive for HIV-1
antibodies

8. Which lymphocytes are periodically counted to monitor
the disease? (Objective 8)
a . infected B lymphocytes
b . CD4+ T lymphocytes
c . CD8+ T lymphocytes
d . natural killer lymphocytes
B
A 39-year-old male went to the clinic with complaints of
nagging cough, weight loss, diarrhea, and low-grade temperature.
Results of physical examination showed lymphadenopathy,
congested lungs, and increased heart rate. Slight
splenomegaly and hepatomegaly were noted. A CBC and
flow cytometry studies were ordered. Histologic examination
of sputum with Gomori's methenamine silver nitrate stain
revealed Pneumocystis carinii.
Laboratory data
WBC 2.8 * 109/L
count
RBC 3.86 * 1012/L
count
Hb 13.6 g/dL (136 g/L)
Hct 0.41 L/L
Platelet count 104 * 109/L
Differential
Segmented 68%
neutrophils
Lymphocytes 21%
Monocytes 10%
Eosinophils 1%
Positive for HIV-1
antibodies
9. Which laboratory test will be used to follow this patient's
disease? (Objective 8)
a . HIV-1 viral load
b . throat swab
c . serologic test for heterophile antibody
d . PCR for genetic mutations
A
10. Immune deficiency associated with HIES is attributed to
the abnormal signaling or loss of cytokine: (Objective 11)
a . IL-2
b . IL-7
c . IL-15
d . IL-17
D
1. A gap in the normal maturation pyramid of cells with many
blasts and some mature forms is known as: (Objectives 2, 5)
a . leukemic hiatus
b . chronic leukemia
c . mixed cell lineage
d . lineage restricted
A
2. Auer rods are inclusions found in: (Objective 5)
a . myeloblasts
b . lymphoblasts
c . erythrocytes
d . prolymphocytes
A
3. Chromosome changes in hematologic neoplasms are:
(Objective 8)
a . present in AL but not MPN or MDS
b . nonrandom
c . associated with a poor outcome
d . not usually present
B
4. Genes that can cause tumors if activated are: (Objective 6)
a . cancer genes
b . proto-oncogenes
c . preleukemia genes
d . tumor suppressor genes
B
5. A common characteristic of acute lymphoblastic leukemia
is: (Objective 2)
a . BCR/ABL1 gene mutation
b . bone pain
c . many blast cells with Auer rods
d . leukocytopenia
B
6. Which of the following does the WHO classification use to
subgroup the ALL into T- and B-cell neoplasms? (Objective 3)
a . immunophenotype
b . clinical presentation
c . cytogenetics
d . morphology
A
7. A leukemia that shows a profusion of granulocytes at all
stages of development from blasts to segmented neutrophils
is: (Objectives 2, 5)
a . AML
b . CML
c . ALL
d . CLL
B
8. Acute lymphoblastic leukemia occurs with greatest
frequency
in which age group? (Objective 7)
a . 2-5 years
b . 10-15 years
c . 20-30 years
d . >50 years
A
9. Chronic leukemias primarily affect: (Objectives 2, 7)
a . all ages, progress rapidly, and have immature cells in
peripheral circulation
b . children, progress rapidly, and have mature cells in
peripheral circulation
c . young adults, progress slowly, and have immature cells
in peripheral circulation
d . adults, progress slowly, and have mature cells in
circulation
D
10. The WHO system classifies a 19-year-old patient's bone
marrow as a precursor B-cell leukemia. Which of the
following
best describes this leukemia? (Objectives 2, 3, 5)
a . CLL
b . ALL
c . AML
d . CML
B
11. Immunologic phenotyping of blast cells is important to:
(Objective 8)
a . help determine cell lineage
b . identify the leukemia's etiology
c . determine whether cytogenetic analysis is necessary
d . replace the need to do multiple cytochemical stains
A
12. The minimum percentage of blast cells required for a diagnosis
of acute myeloid leukemia using the WHO classification
is: (Objective 3)
a . 50%
b . 40%
c . 30%
d . 20%
D
13. Proteins encoded by proto-oncogenes serve to: (Objective 10)
a . provide signaling pathways for normal cell growth
control
b . inactivate tumor suppressor genes
c . cause unregulated cell proliferation
d . demethylate oncogenes
A
14. Which of these genes cause unregulated cell growth?
(Objective 10)
a . tumor suppressor genes
b . antioncogenes
c . proto-oncogenes
d . oncogenes
D
1. The stain helpful in distinguishing myeloblasts from
lymphoblasts
is: (Objective 8)
a . myeloperoxidase
b . TRAP
c . LAP
d . esterase
A
2. If the cell of origin for a neoplastic tumor undergoes
genetic mutations that gives the cell the ability to selfrenew
and blocks terminal differentiation, the resulting
malignancy will be: (Objective 11)
a . chronic myelogenous leukemia
b . chronic lymphocytic leukemia
c . acute leukemia
d . myeloproliferative neoplasm
C
3. The PAS stain is helpful in diagnosing: (Objectives 3, 8)
a . CLL
b . CML
c . MDS
d . ALL
D
4. Which of the following factors has not been proposed as
playing a role in causing leukemia? (Objective 6)
a . benzene
b . therapeutic radiation for Hodgkin disease
c . living at high altitudes
d . chromosome translocations
C
5. A 3-year-old child with Down syndrome presents with pallor,
fatigue, lymphadenopathy, and hepatosplenomegaly. The
initial CBC results were: (Objectives 3, 7)
WBC 18.7 * 109/L WBC Differential
RBC 2.34 * 1012/L 10% segs
Hb 5.8 g/dL (58 g/L) 27% lymphs
Hct 17.4% (0.174 L/L) 63% blasts
PLT 130 * 109/L
These findings are suggestive of:
a . acute lymphoblastic leukemia
b . chronic lymphocytic leukemia
c . acute myeloid leukemia
d . chronic myelogenous leukemia
A
6. A patient with a hypercellular, dysplastic bone marrow;
anemia; and neutropenia in peripheral blood most likely
has which of the following neoplasms? (Objective 7)
a . MPN
b . MDS
c . AML
d . ALL
B
7. A 52-year-old female was admitted to the hospital for
minor elective surgery. Her pre-op CBC was:
WBC 49.4 * 109/L WBC Differential
RBC 4.50 * 1012/L 3% segs
Hb 12.7 g/dL (127 g/L) 97% lymphs
Hct 38% (0.38 L/L)
PLT 213 * 109/L
What is the best explanation for the cause of this patient's
leukocytosis and lymphocytosis? (Objectives 3, 7)
a . ALL
b . AML
c . CLL
d . CML
C
A 43-year-old male had been working with the Peace Corps
in Mexico for the past 10 years. His primary responsibilities
were taking radiographs and doing laboratory work at
the various clinics. He had been complaining of weakness
and fatigue for about a month and had had several severe
nosebleeds. His CBC upon admission to the hospital was:
WBC 25.6 * 109/L Differential
RBC 3.11 * 1012/L 75% blasts
Hb 8.9 g/dL (89 g/L) with Auer rods
Hct 26.7% (0.267 L/L) 20% lymphs
PLT 13 * 109/L 3% monos
2% segs
8. Which leukemia is this patient most likely to have? (Objectives
3, 7)
a . ALL
b . AML
c . CLL
d . CML
B
A 43-year-old male had been working with the Peace Corps
in Mexico for the past 10 years. His primary responsibilities
were taking radiographs and doing laboratory work at
the various clinics. He had been complaining of weakness
and fatigue for about a month and had had several severe
nosebleeds. His CBC upon admission to the hospital was:
WBC 25.6 * 109/L Differential
RBC 3.11 * 1012/L 75% blasts
Hb 8.9 g/dL (89 g/L) with Auer rods
Hct 26.7% (0.267 L/L) 20% lymphs
PLT 13 * 109/L 3% monos
2% segs
9. What would be the most likely causative agent of the
leukemia?
(Objective 2)
a . virus
b . age
c . hepatitis
d . ionizing radiation
D
A 43-year-old male had been working with the Peace Corps
in Mexico for the past 10 years. His primary responsibilities
were taking radiographs and doing laboratory work at
the various clinics. He had been complaining of weakness
and fatigue for about a month and had had several severe
nosebleeds. His CBC upon admission to the hospital was:
WBC 25.6 * 109/L Differential
RBC 3.11 * 1012/L 75% blasts
Hb 8.9 g/dL (89 g/L) with Auer rods
Hct 26.7% (0.267 L/L) 20% lymphs
PLT 13 * 109/L 3% monos
2% segs
10. What treatment would result in the best prognosis for this
patient if there were no complicating factors? (Objective 5)
a . hematopoietic growth factors
b . stem cell transplantation
c . radiation therapy
d . chemotherapy
B
11. You are doing several cytochemical stains on a bone
marrow
from a patient who was recently diagnosed with
acute leukemia. You are looking at the MPO, and the blasts
are negative. However, the reagent is nearing its expiration
date, and you are not sure whether the stain worked
properly. What cells found in the bone marrow normally
express myeloperoxidase and could be used to assess the
stain's integrity? (Objectives 8, 9)
a . neutrophils
b . red cell precursors
c . megakaryocytes
d . lymphocytes
A
A pathologist is looking at the bone marrow aspirate of a
26-year-old male. The marrow is packed with undifferentiated
blasts. After careful searching, she could not find any
Auer rods. She thinks that the patient most probably has
acute lymphoblastic leukemia but cannot rule out AML by
using morphology.
12. The pathologist is thinking of ordering a TdT stain on the
slides. Is that going to be useful? (Objectives 8, 9)
a . Yes, TdT is always positive in acute lymphoid leukemia
but never in myeloid leukemia.
b . Yes, TdT is always positive in acute myeloid leukemia
but never in lymphoid leukemia.
c . No, TdT is positive in the majority of acute lymphoid
leukemias, but approximately 20% of acute myeloid
leukemias can be positive.
d . No, TdT is positive in the majority of acute myeloid
leukemias, but approximately 20% of acute lymphoid
leukemias can be positive.
C
A pathologist is looking at the bone marrow aspirate of a
26-year-old male. The marrow is packed with undifferentiated
blasts. After careful searching, she could not find any
Auer rods. She thinks that the patient most probably has
acute lymphoblastic leukemia but cannot rule out AML by
using morphology.
13. Which stain would you suggest the pathologist order?
(Objectives 8, 9)
a . PAS
b . myeloperoxidase
c . nonspecific esterase
d . trichrome
B
14. Heritable changes in gene expression not from changes in
DNA are known as: (Objective 10)
a . chromosomal mutations
b . pseudo-mutations
c . epigenetic changes
d . cytogenetic mutations
C
15. Mutations in tumor suppressor genes can result in:
(Objective 1)
a . inhibition of normal cell growth
b . triggering growth-promoting signals in the absence of
ligand binding
c . activation of oncogenes
d . tumor development
D
1. The most prominent cell line in CML is the: (Objective 2)
a . erythroid
b . myeloid
c . megakaryocyte
d . fibroblast
B
2. The most prominent cell line found in polycythemia vera
(PV) is: (Objective 2)
a . erythroid
b . myeloid
c . megakaryocyte
d . fibroblast
A
3. The Philadelphia chromosome (Ph) results from a translocation
of chromosomes: (Objective 4)
a . 8 and 14
b . 9 and 22
c . 12 and 17
d . 15 and 17
B
4. The peak age for CML is: (Objective 5)
a . <5 years
b . 15-30 years
c . 40-59 years
d . >60 years
C
5. The Philadelphia chromosome (Ph) can be found in patients
with: (Objective 4)
a . CML
b . ALL
c . ET
d . PV
A
6. Which of the following represent a characteristic peripheral
blood finding in patients with PMF? (Objective 7)
a . elliptocytes
b . dacrocytes
c . target cells
d . schistocytes
B
7. PV can be distinguished from secondary polycythemia by
measuring: (Objective 9)
a . hematocrit
b . plasma volume
c . hemoglobin concentration
d . erythropoietin
D
8. A 50-year-old man was admitted to the emergency room
for chest pain and a blood count was ordered. The results
showed erythrocyte count 6.5 * 1012/L; hematocrit 0.60
L/L (60%); leukocyte count 15 * 109/L; and platelet count
500 * 109/L. These results indicate: (Objective 3)
a . the need for further investigation of a possible diagnosis
of MPN
b . normal findings for an adult male
c . the patient has experienced a thrombotic episode
d . a malfunction of the cell-counting instrument
A
9. A patient previously diagnosed with CML now has a
platelet count of 540 * 109/L and a leukocyte count of
350 * 109/L with a peripheral blood differential showing
15% segmented neutrophils, 23% bands, 2% metamyelocytes,
35% blasts, 6% lymphocytes, 4% monocytes, 6%
eosinophils, and 8% basophils. These results are most consistent
with: (Objective 6)
a . CML
b . ET
c . CML in blast crisis
d . PMF
C
10. A patient presenting in the ER with a platelet count of
71000 109/L and a leukocyte count of 25 109/L with
a normochromic, normocytic anemia should be evaluated
for: (Objective 10)
a . Ph chromosome
b . essential thrombocythemia
c . PMF
d . primary polycythemia
B
Chapter 24 Image
1. What findings suggest that this patient has a defect in the
pluripotential stem cell rather than a benign proliferation
of hematopoietic cells? (Objective 4)
a . the presence of a leukoerythroblastic blood picture
b . the involvement of several cell lineages in the proliferative
process including neutrophilic cells and platelets
c . the shift to the left in the neutrophilic cell line
d . an increase in the RDW
B
Chapter 24 Image
2. Molecular analysis (RT-PCR) revealed the presence of a
BCR/ABL1 fusion product. Based on this information, what
myeloproliferative disorder is present? (Objectives 1, 3)
a . CML
b . PV
c . ET
d . PMF
A
Chapter 24 Image
3. What cytochemical stain is used to help differentiate a leukemoid
reaction from CML? (Objectives 1, 4)
a . myeloperoxidase
b . new methylene blue
c . leukocyte alkaline phosphatase
d . Perl's Prussian blue
C
Chapter 24 Image
4. Which of the following terms most accurately describes
this patient's peripheral blood picture? (Objectives 10, 13)
a . leukemoid reaction
b . leukoerythroblastic
c . leukopenia
d . myelodysplastic
B
Chapter 24 Image
5. What is the best description of the bone marrow? (Objective
1)
a . decreased M:E ratio and increased cellularity
b . increased M:E ratio and decreased cellularity
c . increased M:E ratio and increased cellularity
d . decreased M:E ratio and decreased cellularity
C
6. Extensive bone marrow fibrosis, leukoerythroblastic
peripheral blood, and the presence of anisocytosis with
dacryocytes are most characteristic of which MPN? (Objective
6)
a . CML
b . PV
c . ET
d . PMF
D
7. A 68-year-old man was seen in the clinic for lethargy, dyspnea,
and light-headedness. Results of his blood counts
were erythrocyte count 5.0 * 1012/L; hematocrit 0.55
L/L (55%); leukocyte count 60 * 109/L; platelet count
70 * 109/L. His differential showed a shift to the left in
myeloid elements with 40% eosinophils. The bone marrow
revealed 10% blasts. Ph chromosome was negative. He
most likely has: (Objective 10)
a . PV
b . CML in blast crisis
c . essential thrombocythemia
d . chronic eosinophilic leukemia
A
8. A molecular test should be performed on the patient in
question 7 for which mutation? (Objective 3)
a . JAK2(V617F)
b . BCR/ABL1
c . FIP1L1/PDGFRA
d . MPL(W515)
A
9. Which of the following does not cause secondary polycythemia?
(Objective 7)
a . chronic obstructive pulmonary disease
b . smoking
c . emphysema
d . dehydration
D
10. Which of the following gene mutations are uniquely associated
with clonal hypereosinophilia? (Objective 11)
A. JAK2(V617F)
b . F1P1L1/PDGFRA
c . MPL(W515)
d . BCR/ABL1
B
1. In addition to the number of blasts, what other criterion is
essential for a diagnosis of RARS? (Objective 2)
a . at least 15% ring sideroblasts
b . at least 30% ring sideroblasts
c . dyshematopoiesis in all three cell lineages
d . pancytopenia
A
2. A patient with suspected MDS exhibits anemia, neutropenia,
anisocytosis, poikilocytosis, oval macrocytes,
Howell-Jolly bodies, hypogranular neutrophils, and a few
pseudo-Pelger-Huët cells. The differential shows a few
immature granulocytes but no blasts. Which MDS subgroup
is most likely? (Objective 2)
a . RCUD
b . RARS
c . RCMD
d . RAEB
C
3. The WHO classification system incorporates which of the
following for diagnosis: (Objective 2)
a . the presence of cellular dysplasia
b . cytogenetics
c . morphology
d . all of the above
D
4. The type of anemia usually seen in MDS is: (Objectives 1, 3)
a . macrocytic, normochromic
b . normocytic, normochromic
c . microcytic, hypochromic
d . normocytic, hypochromi
A
5. The most common cytopenia(s) seen in MDS is(are):
(
Objective 3)
a . leukopenia
b . thrombocytopenia
c . anemia
d . a combination of two of the above
C
6. The typical bone marrow cellularity in MDS is: (Objective 3)
a . hypocellular
b . normocellular
c . hypercellular
d . fibrotic
C
7. aCML, BCR/ABL1- is classified as: (Objective 5)
a . MDS
b . AML
c . MPN
d . MDS/MPN
D
8. The most common dyserythropoietic finding in the bone
marrow in MDS is: (Objective 3)
a . megaloblastoid development
b . impaired hemoglobinization
c . pseudo-Pelger-Huët cells
d . agranular cytoplasm
A
9. Which abnormality demonstrates myelocytic dysplasia?
(Objective 3)
a . dimorphism
b . pseudo-Pelger-Huët cells
c . sideroblasts
d . all of the above
B
10. This group of neoplasms is characterized by a hypercellular
bone marrow, effective proliferation of one or more
myeloid lineages, but morphologically and functionally
dysplastic cells. (Objective 4)
a . MDS
b . MPN
c . MDS/MPN
d . AML
C
1. According to the 2008 WHO Classification System, what is
the minimum percentage of bone marrow blasts needed
for a diagnosis of acute leukemia? (Objective 4)
a . 19%
b . 30%
c . 5%
d . 20%
D
2. The t-MDS differ from primary MDS in that in t-MDS:
(Objective 6)
a . the abnormal stem cell arises de novo
b . the dysplastic stem cell often develops after
chemotherapy
c . the dysplastic stem cells have fewer and less complex
abnormal karyotypes
d . the prognosis is more favorable
B
3. Progression of MDS to acute leukemia is characterized by:
(Objective 4)
a . an increase in blast population
b . decreased bone marrow cellularity
c . a decreased M:E
d . splenomegaly
A
4. The IWGM-MDS has determined that the distinguishing
feature between promyelocytes and granular blasts in
MDS is: (Objective 2)
a . the presence of dysplasia in promyelocytes but not in
blasts
b . the presence of a poorly staining golgi in
promyelocytes
c . the presence of fine, azurophilic chromatin in blasts
B
5. The contrast between a hypercellular bone marrow and a
cytopenic peripheral blood film seen in MDS is attributed
to: (Objective 1)
a . premature destruction of abnormal cells in the bone
marrow (ineffective hematopoiesis)
b . production of blood cells outside the bone marrow
(extramedullary hematopoiesis)
c . immune destruction of cells in the peripheral blood
d . splenic sequestration
A
6. Which of the following would be most helpful to differentiate
RCUD from del(5q)? (Objective 9)
a . percentage of bone marrow blasts
b . elevated leukocyte count
c . presence of nucleated RBCs
d . karyotype
D
7. Promising new treatment for low risk MDS includes:
(Objective 3)
a . AML-like chemotherapy
b . drugs that reverse epigenetic changes in the dysplastic
stem cell
c . hematopoietic growth factors
d . bone marrow transplant
B
A patient presents with the following laboratory data:
RBC 2.30 * 1012/L
Hb 7.8 g/dL (78 g/L)
Hct 0.24 L/L
MCV 104 fL
RDW 20
WBC 8.5 * 109/L
PLT 140 * 109/L
The differential was normal except for 2% metamyelocytes.
Oval macrocytes, a few abnormal NRBC, and a few siderocytes
were seen. The bone marrow contained 3% blasts
and exhibited hypercellularity with megaloblastoid development
in erythroid cells.

8. What is the most probable MDS subgroup? (Objective 10)
a . RCUD
b . RARS
c . RCMD
d . RAEB
A
A patient presents with the following laboratory data:
RBC 2.30 * 1012/L
Hb 7.8 g/dL (78 g/L)
Hct 0.24 L/L
MCV 104 fL
RDW 20
WBC 8.5 * 109/L
PLT 140 * 109/L
The differential was normal except for 2% metamyelocytes.
Oval macrocytes, a few abnormal NRBC, and a few siderocytes
were seen. The bone marrow contained 3% blasts
and exhibited hypercellularity with megaloblastoid development
in erythroid cells.
9. What other hematologic disorder does this peripheral
blood picture resemble? (Objective 7)
a . aplastic anemia
b . megaloblastic anemia
c . iron-deficiency anemia
d . anemia of chronic disease
B
A patient presents with the following laboratory data:
RBC 2.30 * 1012/L
Hb 7.8 g/dL (78 g/L)
Hct 0.24 L/L
MCV 104 fL
RDW 20
WBC 8.5 * 109/L
PLT 140 * 109/L
The differential was normal except for 2% metamyelocytes.
Oval macrocytes, a few abnormal NRBC, and a few siderocytes
were seen. The bone marrow contained 3% blasts
and exhibited hypercellularity with megaloblastoid development
in erythroid cells.
10. What laboratory test(s) would be helpful to distinguish
MDS from megaloblastic anemia? (Objective 7)
a . serum lysozyme
b . serum ferritin
c . serum folate and cobalamin
d . combined esterase stain
C
1. A differential report notes the presence of 720% blasts. This
number supports the diagnosis of: (Objective 1)
a . CML
b . AML
c . CLL
d . MDS
B
2. The presence of blasts with no evidence of myeloid differentiation
by morphology and 63% positive for SBB or MPO
is commonly seen in: (Objective 2)
a . AML—minimally differentiated
b . AML—without maturation
c . acute basophilic leukemia
d . myeloid sarcoma
A
3. Which M:E ratio is most characteristic of acute leukemia ?
(Objective 4)
a . 1:1
b . 10:1
c . 1:5
d . 4:1
B
4. A large cell with an immature nucleus containing multiple
prominent nucleoli and Auer rods is a(n): (Objective 3)
a . erythroblast
b . myeloblast
c . promyelocyte
d . promyelocyte with hypergranulation
B
5. The leukemia that belongs to the WHO classification of
AML with recurrent genetic abnormalities is: (Objective 2)
a . APL
b . megakaryoblastic leukemia
c . erythroleukemia
d . AML minimally differentiated
A
6. Which of the following subcategories of AML give a positive
result with PAS? (Objective 5)
a . AML without maturation
b . Acute basophilic leukemia
c . Acute erythroid leukemia
d . AML with minimal differentiation
C
7. Auer rods have been determined to be: (Objective 6)
a . important to exclude ALL
b . composed of histamine
c . positive for proteolytic esterases
d . present in high numbers in adolescent AML
A
8. A patient who had been treated previously for myelodysplasia
developed AML. What subgroup is most appropriate
for a diagnosis in this case? (Objective 2)
a . AML with recurrent genetic abnormalities
b . AML with MDS-related changes
c . t-AML
d . AML with differentiation
C
9. The minimum number of blasts in the peripheral blood or bone
marrow needed for a diagnosis of AML is: (Objectives 1, 3)
a . 30%
b . 10%
c . 50%
d . 20%
D
10. Circulating micromegakaryocytes typically can be found in
which of the following acute leukemias? (Objectives 2, 3)
a . AML with t(8;21)
b . APL
c . AML therapy related
d . acute megakaryoblastic
D
1. In attempting to subtype a case of acute leukemia, a laboratory
professional noted that the blasts were negative
with myeloperoxidase, SBB, specific and nonspecific esterase
but positive when stained with PAS and platelet peroxidase.
These blasts should show positivity with which of
the following monoclonal antibody(ies)? (Objectives 2, 4)
a . CD41, CD42, CD61
b . CD24
c . CD7
d . glycophorin A
A
2. The WHO classification of AML is based on: (Objectives 2, 7)
a . genetic abnormalities
b . morphology and cytochemistry of blasts
c . immunophenotyping of blasts
d . all of the above
D
3. Which of the following leukemias is associated with cells
containing an abundance of Auer rods occurring in bundles?
(Objective 2)
a . APL
b . AML with multilineage dysplasia
c . AML t(8;21)
d . AML therapy related
A
4. Which of these leukemic blasts demonstrate t(1;22)
(p13;q13) positivity? (Objective 4)
a . erythroblasts
b . myeloblasts
c . megakaryoblasts
d . monoblasts
C
5. A bone marrow from a 20-year-old male revealed 40%
agranular blasts. Cytochemical stains were negative for
MPO, SBB, and specific and nonspecific esterases. What
immunophenotype panel should be used to help identify
the blast cell lineage? (Objective 6)
a . CD13, CD33, CD34, CD10, CD19, CD2, CD3, CD5
b . CD11a, CD14, CD10, CD2, CD3, CD71, CD61
c . CD13, CD33, CD34, CD11b, CD71, CD41
d . CD41, CD61, CD13, CD15, CD38, CD117
A
6. A patient has a leukocyte count of 75 * 109/L. A large number
of blast cells are present in the peripheral blood smear.
Cytochemical stain reveals positive staining with SBB.
Immunophenotyping is CD13+, CD33+, CD19-, CD22-,
CD3-, CD5-. Karyotyping reveals t(8;21)(q22;q22). Based
on the results, these cells would be considered: (Objective
4)
a . myeloblasts
b . stem cells
c . monoblasts
d . promyelocytes
A
7. A patient with leukemia is receiving chemotherapy including
a drug that is an antagonist to folic acid metabolism. Which
of the following types of erythrocytes will be produced?
(Objective 5)
a . macrocytes
b . microcytes
c . spherocytes
d . codocytes
A
8. Hypergranular promyelocytic leukemia is characterized by
which cytogenetic abnormality? (Objective 2,4)
a . t(15;17)
b . 11q23 abnormality
c . t(8;21)
d . inv(16)(p13;q22)
A
9. The presence of CD34, CD13, and CD14 is typically associated
with a positive: (Objective 4)
a . PAS stain
b . TdT
c . CD71
d . myeloperoxidase
D
10. All transretinoic acid therapy is used in leukemia patients
with this genetic abnormality: (Objectives 3, 5)
a . t(9;22)
b . t(8;21)
c . trisomy 8
d . t(15;17)
D
1. Acute lymphoblastic leukemia is characterized by the presence
of: (Objective 1)
a . <20% small resting lymphoblasts in the bone marrow
b . hypercellular bone marrow with increased
lymphoblasts
c . 30% or more lymphoblasts with erythroid dysplasia in
the bone marrow
d . >30% myeloblasts in the peripheral blood
B
2. Acute lymphoblastic leukemia is most often seen in
patients: (Objective 5)
a . older than 60 years
b . between the ages of 35 and 60 years
c . between the ages of 10 and 35 years
d . younger than 5 years
D
3. ALL characterized by the presence of small basophilic
lymphoblasts
with a round nucleus, finely granular chromatin,
and inconspicuous neucleoli can be classified as: (Objective 3)
a . ALL—Burkitt's type
b . Acute biphenotypic leukemia
c . Acute lymphoblastic leukemia
d . Acute leukemia of ambiguous lineage
C
4. The presence of CD19 and CD22(c) and absence of CD10
(CALLA) on neoplastic lymphoblasts is most often a sign
of: (Objective 4)
a . biphenotypic leukemia
b . pro-B ALL
c . pre-B ALL
d . T-cell ALL
B
5. The anemia most often seen in patients with ALL is:
(Objective 5)
a . microcytic hypochromic
b . normocytic normochromic
c . macrocytic normochromic
d . macrocytic hypochromic
B
6. Leukemia of ambiguous lineage is most often described as
the presence of: (Objective 6)
a . large, basophilic blasts with slight to moderate
granulation
b . blasts demonstrating both CD10 and C33
c . CD3 and CD4 markers
d . no demonstrable markers using immunophenotyping
D
7. The over-secretion of monoclonal immunoglobulins is most
often seen in: (Objectives 3, 5)
a . B-cell ALL
b . T-cell ALL
c . B-cell LBL
d . T-cell LBL
A
8. CD2, CD3, and CD4 are present on the cells found in a
patient with a previously undiagnosed leukemia. These
markers are characteristic of: (Objective 4)
a . pre-B-cell ALL
b . pro-B-cell ALL
c . T-cell ALL
d . ALL—Burkitt's type
C
9. Acute biphenotypic leukemia is characterized by the
presence
of: (Objective 6)
a . ultrastructual evidence of primary granules
b . CD19, CD20, and CD23
c . CD2, CD4, CD8, and presence of myeloperoxidase
d . negative immunophenoptying
C
10. Which of the following laboratory results are most
commonly
found in ALL? (Objective 3)
a . eosinophilia and basophilia
b . neutropenia and thrombocytopenia
c . neutrophilia and thrombocytopenia
d . lymphocytosis and thrombocytosis
B
1. Cells that are positive for t(9;22) are characteristic of which
of the following? (Objective 4)
a . T-cell ALL
b . reactive lymphocytosis
c . acute undifferentiated leukemia
d . B-cell ALL
D
2. Monoclonal rearrangement of the TCR genes is associated
with blasts that have the following immunophenotype:
(Objective 2)
a . CD2+, CD4+, CD19+
b . CD19+, CD20+, CD10+
c . CD3+, CD13-, CD34+
d . CD2+ CD3+, CD4+
D
3. A peripheral blood smear is noted to have 80% blasts.
There are two different types of blast cells present: one
that is small, with a round nucleus, indistinct nucleoli, and
scanty cytoplasm while the second is a large blast with
basophilic cytoplasm. One possible interpretation for this
is: (Objectives 1, 6)
a . precursor B ALL
b . AU L
c . T-cell ALL
d . bilineage ALL
A
4. An adult patient with splenomegaly has an increase in
mononuclear cells in the peripheral blood. The bone marrow
was filled with a heterogeneous collection of blasts with
no granulation. Flow cytometry shows a positive CD20 and
CD10 and negative surface immunoglobulin. Which of the
following conditions is most likely? (Objective 4)
a . intermediate pre-B ALL (CALLA)
b . pro-B ALL
c . pre-T-cell ALL
d . cortical T-cell ALL
A
5. Which of the following represents the most common chromosomal
translocation found in ALL? (Objective 4)
a . t(1;19)(q23;p13.3)/PBX1-E2A
b . t(12;21)(p13;q22)/ETV6-RUNX1
c . t(4;11)(q21;q23)/MLL-AFF1
d . t(9;22)(q34;q11)/BCR-ABL1
B
6. The CD10 antigen found in ALL is also known as the:
(Objective 4)
a . B-cell ALL antigen
b . T-cell ALL antigen
c . CALLA antigen
d . NK-cell ALL antigen
C
7. The most likely patient presentation for ALL in an adult
includes: (Objective 2)
a . male aged 18-30 with mild anemia and no
thrombocytopenia
b . male older than 60 years with significant anemia and
thrombocytopenia
c . female 10-25 years old with significant bone pain and
hemolytic anemia
d . female 30-50 years old with hemorrhage and bulky
nodes
B
8. The objective of induction therapy includes: (Objective 7)
a . reduction in the tumor burden
b . elimination of tumor cells in the central nervous
system
c . replacement with peripheral blood stem cells from
another person
d . prevention of relapse
A
9. Poor prognostic findings for patients with ALL include:
(Objective 8)
a . young age at time of diagnosis
b . presence of chromosomal mutations such as BCR/ABL1
c . hyperploidy
d . presence of TEL-AML1 gene
B
10. A large mediastinal mass is found in a 60-year-old male.
The bone marrow has 15% lymphoblasts. This is most characteristic
of: (Objective 9)
a . precursor T-cell LBL
b . ALL—Burkitt's type
c . precursor T-cell ALL
d . precursor B-cell ALL
A
1. Which of the following is the most likely distribution of
disease in a patient with leukemia? (Objective 3)
a . lytic bone lesion
b . tumorous mass involving lymph nodes
c . tumorous mass involving the tonsil
d . widespread involvement of the bone marrow
D
2. A 60-year-old male being evaluated for insurance purposes
was found to have lymphocytosis. The peripheral smear
revealed a uniform population of small mature lymphocytes.
Which of the following is helpful in differentiating a
benign from a malignant lymphocytosis? (Objectives 8, 9)
a . cytochemistry
b . immunophenotyping
c . morphology
d . absolute lymphocyte count
B
3. Which of the following indicate(s) the presence of a mature
lymphoid neoplasm? (Objective 2)
a . clonal immunoglobulin gene rearrangement
b . population of lymphocytes expressing only one immunoglobulin
light chain
c . population of lymphocytes expressing an abnormal
phenotype
d . all of the above
D
4. A patient with chronic lymphocytic leukemia had a complete
blood count (CBC) with differential. The differential showed
20% nucleated cells similar to the ones in Figure
28-2. This
indicates: (Objective 8)
a . transformation of CLL to ALL
b . development of hairy cell leukemia
c . Richter's transformation
d . prolymphocytic transformation of CLL
D
5. You are asked to perform a peripheral blood smear review
on a 56-year-old male with a history of lytic bone lesions,
hypercalcemia, and a recent diagnosis of plasmacytoma.
Which of the following is the most likely peripheral blood
finding? (Objective 10)
a . plasmacytosis
b . lymphocytosis
c . agglutination
d . rouleaux
C
6. A bone marrow biopsy was performed on a patient with
bone pain. The bone marrow differential revealed 40%
plasma cells. Serum electrophoresis showed an increased
protein with an M spike. What would you expect to find
on the peripheral blood smear in this patient? (Objectives
3, 10)
a . rouleaux
b . spherocytes
c . plasma cells
d . 720% blasts
A
7. The WHO classification of lymphoid neoplasms recommends
which of the following studies to identify neoplastic
cells and type of lymphoid malignancy? (Objective 9)
a . genotype
b . morphology
c . phenotype
d . all of the above
D
8. The Reed-Sternberg cell is found in what type of lymphoid
malignancy? (Objective 6)
a . chronic lymphocytic leukemia
b . multiple myeloma
c . HL
d . NHL
C
9. A peripheral smear performed on a 35-year-old male with
lymphocytosis reveals numerous smudge cells. Which of
the following does this finding indicate? (Objectives 3, 8)
a . chronic lymphocytic leukemia
b . infectious mononucleosis
c . lymphoblastic leukemia
d . none because the finding is not diagnostic
D
10. Peripheral smear examination of a patient with chronic
lymphocytic leukemia reveals 8% prolymphocytes. This
finding is consistent with which of the following diagnoses?
(Objective 8)
a . chronic lymphocytic leukemia
b . prolymphocytic leukemia
c . prolymphocytoid transformation of CLL
d . Richter's transformation
A
1. Which of the following is(are) involved in the pathogenesis
of low-grade follicular lymphoma? (Objective 8)
a . genes involved in apoptosis
b . inherited immunodeficiency
c . proto-oncogenes
d . tumor suppressor genes
A
2. Which type of lymphoma can antimicrobial therapy cure?
(Objective 8)
a . Burkitt lymphoma
b . Hodgkin lymphoma
c . MALT lymphoma
d . HIV-associated non-Hodgkin lymphoma
C
3. A lymph node biopsy is performed on a patient with
lymphadenopathy. Which of the following findings is(are)
characteristic of a reactive proliferation rather than malignant
lymphoma? (Objective 9)
a . a mixed population of cells varying in size, shape, and
color
b . clonality of cells
c . presence of large, bizarre cells
d . many cells with mitotic activity
A
4. A CBC performed on a 65-year-old female reveals lymphocytosis.
A bone marrow reveals replacement of the
hematopoietic precursors by an infiltrate of mature lymphocytes.
Which of the following is the most likely course
of the disease? (Objective 5)
a . cure following therapy
b . rapid progression
c . slow progression
d . spontaneous remission
C
5. Which of the following phenotypes is characteristic of
chronic lymphocytic leukemia? (Objective 1)
a . CD19+, CD5+, CD23+
b . CD19+, CD5-, CD23+
c . CD19+, CD5+, CD23-
d . CD19+, CD5-, CD23-
A
6. A CBC performed on an 80-year-old female reveals an
absolute lymphocyte count of 8 * 109/L. Examination of
the peripheral blood smear reveals a uniform population
of small lymphocytes. Which of the following procedures
is most likely to establish a diagnosis? (Objectives 1, 5)
a . cytogenetics
b . flow cytometry immunophenotyping
c . immunoglobulin gene rearrangement
d . lymph node biopsy
B
7. A patient presents with pancytopenia and massive splenomegaly
but no lymphadenopathy. Unusual cells noted
on the blood smear had abundant pale-staining cytoplasm
and cytoplasmic projections. The nuclei were oval with a
fine chromatin pattern. What cytochemical stain would be
helpful in identifying these cells? (Objective 5)
a . acid phosphatase stain after incubation with tartrate
b . periodic acid-Schiff
c . Sudan black B
d . myeloperoxidase
A
8. A CBC performed on a 60-year-old male with a history
of rheumatoid arthritis revealed neutropenia and an absolute
lymphocytosis. Examination of the peripheral smear
revealed many lymphocytes with abundant pale-staining
cytoplasm and cytoplasmic granules. Which of the following
is the most likely phenotype? (Objectives 1, 5)
a . CD3+, CD2+, CD57+
b . CD19+, CD5+, CD57-
c . CD2+, CD3-, CD56+
d . CD19+, CD10+, CD34+
A
9. A patient previously diagnosed with SLL is found to have
peripheral blood lymphocytosis. The lymphocytes are
small and have round nuclei with clumped chromatin.
Which of the following is the most appropriate interpretation?
(Objective 3)
a . This is a different presentation (CLL) of the same disease
process.
b . The patient has a new lymphoid neoplasm: chronic
lymphocytic leukemia.
c . The lymphoma has transformed.
d . The patient has developed a therapy-related
neoplasm.
A
10. A lymph node biopsy revealed an infiltrate of small lymphoid
cells with a vaguely nodular growth pattern. Flow cytometry
revealed a monoclonal population of B cells expressing
CD5. Immunohistochemistry revealed nuclear staining for
cyclin-D1 protein. Which of the following translocations is
associated with these neoplastic cells? (Objective 3)
a . t(11;14)
b . t(15;17)
c . t(1;14)
d . t(8;14) follicular lymphoma
A
1. Which of the following property(ies) can be attributable to
stem cells? (Objective 3)
a . self-renewal
b . multilineage differentiation
c . mononuclear morphology
d . all the above
D
2. What is (are) the source(s) of hematopoietic stem cells?
(Objective 1)
a . bone marrow
b . peripheral blood
c . umbilical cord blood
d . all of the above
D
3. What form of transplant can be used for inherited genetic
diseases? (Objective 2)
a . autologous stem cell transplant
b . allogeneic stem cell transplant
c . syngeneic stem cell transplant
d . stored autologous cord blood
B
4. What is a syngeneic transplant? (Objective 1)
a . infusion of stem cells from any donor into the recipient
b . infusion of patient's own stem cells
c . infusion of stem cells from an identical twin
d . infusion of stem cells from different species
C
5. What cells are usually CD34+? (Objective 3)
a . maturing myeloid cells
b . stem cells
c . B lymphocytes
d . T lymphocytes
B
6. Which of the following is correct regarding allogeneic stem
cell transplant and ABO antigens? (Objective 4)
a . ABO antigens do not need to be matched.
b . ABO antigens are strongly expressed on stem cells.
c . The O group patient should not receive stem cells
from A or B blood group donors.
d . ABO antigens should always be matched.
A
7. What is the single most important factor to consider in
donor selection for an allogeneic transplant? (Objective 4)
a . HLA compatibility with the recipient
b . ABO compatibility with the recipient
c . CMV status of the donor
d . HLA and ABO compatibility with the recipient
A
8. Which of the following infections can be serious in the peritransplant
period? (Objective 5)
a . bacterial
b . fungal
c . cytomegalovirus
d . all of the above
D
9. Severe GVHD usually is seen in which group of patients?
(Objective 6)
a . syngeneic SCT
b . autologous SCT
c . unmatched allogeneic SCT
d . umbilical cord stem transplant
C
10. What organ(s)/tissue(s) is(are) usually involved in GVHD?
(Objective 6)
a . skin only
b . skin, liver, and/or the gastrointestinal tract
c . liver only
d . gastrointestinal tract only
B
1. What does the term chimerism mean? (Objective 6)
a . recovery of recipient's red cells
b . absence of malignant cells
c . presence of donor hematopoietic stem cells in a
recipient
d . recovery of patient's white cells and platelets only
C
2. What is the most appropriate form of transplant for an
adult patient with CML weighing 80 kg? (Objective 7)
a . autologous SCT
b . umbilical cord SCT
c . allogeneic SCT
d . none of the above; transplant is not indicated in
patients with CML
C
3. A risk for GVHD is carried by a patient who has: (Objective 4)
a . received allogeneic SCT
b . received autologous SCT
c . received both allogeneic and autologous SCT
d . received autologous SCT for only solid organ tumors
A
4. What are the three factors necessary to set the stage for
GVHD? (Objective 4)
a . immunocompetent donor T lymphocytes, ABO antigens,
and immunosuppressed host
b . immunosuppressed donor T lymphocytes, HLA alloantigens,
and immunosuppressed host
c . immunocompetent donor B lymphocytes, HLA alloantigens,
and immunosuppressed host
d . immunocompetent donor T lymphocytes, HLA alloantigens,
and immunosuppressed host
D
5. What procedure usually is used to quantify HSCs?
(
Objective 3)
a . lymphocyte count
b . CD4+ count by flow cytometry
c . monocyte count by automated cell counter
d . CD34+ count by flow cytometry
D
6. Patients who receive this type of stem cell transplant are
more at risk for disease recurrence than of transplantrelated
complications. (Objective 4)
a . allogenic
b . syngeneic
c . cord blood
d . autologous
D
7. This test is appropriate to determine long-term engraftment
of HSCs only when donor and recipient are of the
opposite sex. (Objective 6)
a . detection of RBC antigens
b . Fluorescent in situ hybridization with sex
chromosomes
c . CD34+ cell enumeration by flow cytometry
d . platelet and neutrophil counts
B
8. GVL effect is seen after SCT in patients who have received:
(Objective 4)
a . autologous transplant
b . allogeneic transplant
c . either autologous or allogeneic transplant
d . umbilical cord transplant
B
9. For autologous peripheral SCT, the patient usually undergoes
therapy in which sequence? (Objective 5)
a . myeloablative therapy, apheresis, and then G-CSF
b . G-CSF followed by myeloablative therapy and then
apheresis
c . apheresis to collect CD34+ cells, myeloablative therapy,
and then infusion of collected CD34+ cells.
d . myeloablative therapy and then apheresis to collect
CD34+ cells
C
10. What is the sequence in which successful engraftment
occurs after SCT? (Objective 6)
a . Neutrophils are increased first followed by an increase
in platelets.
b . Platelets are increased first followed by an increase in
neutrophils.
c . Red cells are increased first followed by an increase in
platelets.
d . Red cells and platelets are increased first followed by
an increase in neutrophils.
A
1. The definition of hemostasis includes the: (Objective 1)
a . process of maintaining the body temperature
b . termination of bleeding following a traumatic injury
c . process of forming a hematoma
d . regulation of kidney function
B
2. Which of the following is the primary element that prevents
blood from clotting inside blood vessels? (Objective 5)
a . fibrinogen
b . arteriole
c . endothelial cells
d . platelets
C
3. What is the action of the blood vessels in hemostasis
immediately after an injury? (Objective 5)
a . thrombosis
b . aggregation
c . vasoconstriction
d . vasodilation
C
4. Which of the following has happened when a cut finger
initially stops bleeding? (Objectives 6, 7)
a . vasoconstriction of vessels proximal to the cut
b . vasodilation of vessels distal to the cut
c . formation of the primary hemostatic plug by aggregated
platelets
d . completion of fibrin formation and formation of the
secondary hemostatic plug
C
5. What is the first step in platelet function after an injury?
(Objective 6)
a . fibrin formation
b . release of ADP
c . platelet aggregation
d . platelet adhesion to collagen
D
6. What is the process of platelets binding to one another?
(Objective 6)
a . platelet secretion
b . fibrin formation
c . platelet adhesion
d . platelet aggregation
D
7. Each of the following is involved in hemostasis except:
(Objective 2)
a . vasoconstriction by the blood vessels
b . adhesion and aggregation by the platelets
c . fibrin formation by proteins in the plasma and
platelets
d . regulation of blood pressure
D
8. An abnormal condition in which a blood clot forms on the
interior of blood vessel is known as: (Objective 1)
a . secondary hemostasis
b . thrombosis
c . primary hemostasis
d . fibrinolysis
B
9. The generation of fibrin by a series of reactions of procoagulant
proteins is called: (Objective 3)
a . secondary hemostasis
b . primary hemostasis
c . fibrinolysis
d . hemolysis
A
10. The formation of a primary hemostatic plug results from
reaction between: (Objective 4)
a . platelets and subendothelial tissue
b . platelets and coagulation proteins
c . coagulation proteins and subendothelial tissue
d . coagulation proteins and VWF
A
1. What are the cells that line the central cavity of all blood
vessels and related tissues called? (Objective 1)
a . epithelial cells
b . endothelial cells
c . capillaries
d . smooth muscle cells
B
2. Platelet dense granules are storage organelles for which of
the following that are released after activation? (Objective 2)
a . calcium, ADP, and serotonin
b . fibrinogen, glycoprotein Ib, and VWF
c . ADP, thromboxane A2, and FV
d . lysosomal granules, ATP, and FVIII
A
3. Which of the following is the platelet receptor needed for
platelet adhesion? (Objective 3)
a . glycoprotein IIb/IIIa
b . actin
c . VWF
d . glycoprotein Ib/IX
D
4. The platelet glycoprotein IIb/IIIa complex is: (Objective 3)
a . a membrane receptor for fibrinogen
b . secreted from the dense granules
c . secreted by endothelial cells
d . also called actin
A
5. The formation of thromboxane A2 in the activated platelet:
(Objective 6)
a . is needed for platelets to adhere to collagen
b . is caused by the a-granule proteins
c . requires the enzyme cyclooxygenase
d . occurs via a pathway involving VWF
C
6. The function of microtubules in the resting platelet is to:
(Objective 4)
a . keep a high level of calcium in the cytoplasm
b . store and sequester calcium
c . provide a negative charge on the platelet surface
d . maintain the disc shape
D
7. The contents of the platelet granules are released from the
platelet: (Objective 3)
a . through the open membrane system after fusion with
the granules
b . through the microtubules after fusion with the granules
c . by disintegration of the platelet plasma membrane
d . by the mitochondria
A
8. Which of the following is true about the relationship
between ADP and platelets? (Objective 5)
a . ADP is necessary for platelet adhesion.
b . ADP released from the dense granules is required
for adequate platelet aggregation.
c . ADP is synthesized in the platelet from arachidonic acid.
d . ADP is released from the platelets' a-granules.
B
9. The process by which a platelet agonist causes a change in
shape of the platelet from a disc to a spiny sphere is known
as platelet: (Objective 5)
a . secretion
b . aggregation
c . activation
d . release
C
10. Which of the following statements correctly describes the
role of cAMP in platelet function? (Objective 7)
a . Elevated cAMP induces platelet aggregation.
b . Elevated cAMP inhibits platelet activation.
c . Elevated cAMP activates cyclooxygenase and TXA2
production.
d . Decreased cAMP inhibits platelet activation
B
1. Which of the following is/are involved in hemostasis?
(Objective 1)
a . only blood clotting
b . clot formation, clot dissolution, vessel repair
c . only blood clotting and bleeding
d . only keeping blood in the fluid state
B
2. Which of the following describes the events involved in
secondary hemostasis? (Objective 2)
a . lead to the formation of a chemically stable fibrin clot
b . usually occur independently of primary hemostasis
c . are uncontrolled
d . occur in a random fashion
A
3. Which factor is known as the antihemophilic factor?
(Objective
3)
a . FIX
b . FXI
c . FVIII
d . FXII
C
4. The prothrombin group includes which of the following
coagulation proteins? (Objective 4)
a . factors I, V, VIII, XIII
b . PK, HK, FXI, FXII
c . factors II, VII, IX, X
d . factors I, II, V, X
C
5. Which of the following function as cofactors in hemostasis?
(Objective 6)
a . fibrinogen, prothrombin
b . FVa, FVIIIa
c . factors IXa, XIa, XIIa
d . platelet phospholipid, Ca++
B
6. What activates the extrinsic pathway? (Objective 7)
a . exposure to negatively charged surfaces
b . contact with tissue factor
c . the intrinsic pathway
d . FXIIa
B
7. Which factors are involved in the initial activation of the
coagulation system and require contact with a negatively
charged surface for their activation? (Objectives 7, 8)
a . factors II, V, VII, X
b . factors XII, XI, PK, HK
c . factors II, VII, IX, X
d . factors I, V, VIII, XIII
B
8. Which of the following is not involved in the fibrinolytic
system? (Objective 10)
a . plasminogen activator inhibitors
b . plasmin
c . FXa
d . FXII, kallikrein
C
9. Which of the following is/are end products in the breakdown
of fibrin? (Objective 11)
a . fragment X
b . fragments Y and D
c . fragments D and E
d . fibrin monomer
C
10. Which of the following pairs the correct protease with its
inhibitor? (Objective 12)
a . thrombin-antithrombin
b . tissue factor-TFPI
c . heparin-heparin cofactor II
d . fibrin-TAFI
A
1. Hemostasis depends on the balance of which of the following?
(Objective 1)
a . the interaction of blood vessels, platelets, and coagulation
proteins
b . the interaction between platelets and coagulation
proteins
c . the interaction between blood vessels and coagulation
proteins
d . the rate of complex formation
A
2. Which statement most accurately describes the domains
of coagulation proteins? (Objective 2)
a . The catalytic region distinguishes each of them from
trypsin.
b . The catalytic region gives each protein its own
identity.
c . The noncatalytic regions are identical in all coagulation
proteins.
d . The domains impart specificity and recognition to control
hemostasis.
D
3. Which of the following is true concerning the formation
of protein complexes that occur during coagulation?
(Objective
3)
a . slows the rate of reaction
b . does not require the presence of Ca++
c . is not necessary for normal coagulation
d . localizes the reaction to the site of injury
D
4. Which of the following describes the contact factors?
(Objective 4)
a . have a significant role in initiating hemostasis in vivo
b . cause a serious bleeding problem when defective or
deficient
c . contribute to fibrinolysis, inflammation, and complement
activation
d . can be assayed by the prothrombin time
C
5. The role of ADAMTS-13 in hemostasis is to: (Objective 6)
a . activate protein C to activated protein C
b . cleave ULVWF to multimers normally found in the
circulation
c . serve as a receptor for uPA on hepatocytes
d . inhibit activated hemostatic proteases
B
6. What is the hepatic cell receptor that binds and clears tPA/
PAI-1, plasmin/AP, and uPA/PAI-1 complexes from the circulation?
(Objective 6)
a . UPAR
b . LRP
c . annexin-2
d . TM
B
7. Which of the following is a procoagulant function of thrombin?
(Objective 5)
a . activate FXII
b . inactivate protein C
c . suppress platelet activation
d . activate FV and FVIII
D
8. What is needed for fibrinolysis to occur at a physiologically
significant rate? (Objective 7)
a . tPA must bind to fibrin.
b . Circulating plasminogen must be activated to plasmin.
c . PAI-1 must be inhibited by a2@antiplasmin.
d . Plasminogen must be bound to fibrinogen.
A
9. Which is true of TFPI? (Objective 8)
a . is found in platelets
b . is unique because two different proteases are inhibited
at the same time
c . does not require Ca++
d . inhibits the entire coagulation cascade by inhibiting
the extrinsic pathway
B
10. The following results were reported on a 10-year-old male
with a history of bleeding problems: prothrombin time:
29.5 seconds (control, 12.5 seconds), partial thromboplastin
time: 51.0 seconds (control, 55.4 seconds). What do
these results indicate? (Objective 9)
a . An FVII defect or deficiency exists.
b . A defect in the intrinsic system exists.
c . The child has hemophilia A.
d . Platelet testing should be done.
A
1. Which of the following platelet counts indicates thrombocytopenia?
(Objective 1)
a . 200 * 109/L
b . 2000 * 109/L
c . 200 * 1012/L
d . 20.0 * 109/L
D
2. What laboratory test(s) is (are) most often ordered to screen
for abnormalities of the hemostatic system? (Objective 3)
a . platelet count
b . prothrombin time
c . activated partial thromboplastin time
d . all of the above
D
3. Which of the following thrombocytopenic conditions is not the
result of an immune-mediated mechanism? (Objectives 6, 7)
a . NAIT
b . drug-induced thrombocytopenia
c . post-transfusion purpura
d . TTP
D
4. What is the name of purple lesions that are larger than 1 cm
in diameter but are not raised? (Objective 2)
a . petechiae
b . ecchymoses
c . hematoma
d . purpura
B
5. In which hematologic disorder would you expect to
observe a decreased platelet count? (Objective 6)
a . acute leukemia
b . chronic myelocytic leukemia
c . hemolytic anemia
d . iron-deficiency anemia
A
6. How long should a patient be off aspirin or aspirin-containing
products before having platelet function
testing?
(Objective 9)
a . 2 hours
b . 2 days
c . 7 days
d . 30 days
C
7. Bernard Soulier syndrome is caused by: (Objective 10)
a . mutation in the gene for either GPIIb or GPIIIa
b . mutation in the von Willebrand factor gene
c . mutation in the gene for fibrinogen a@, b@, or g@chain
d . mutation in the gene for GPIba, GPIbb, or GPIX
D
8. What level of platelet count is associated with a risk of
life-threatening bleeding into the central nervous system?
(Objective 5)
a . 200 * 109/L
b . 100 * 109/L
c . 50 * 109/L
d . 5 * 109/L
D
9. Thrombocytosis is: (Objective 8)
a . a platelet count within the reference interval for age
b . an abnormal platelet function
c . the presence of a blood clot in a leg vein
d . a platelet count higher than the reference interval
D
10. ITP (immune thrombocytopenia) is characterized by all of
the following except: (Objective 7)
a . in adults, frequently presents following a viral infection
b . in children, frequently presents as an abrupt onset,
acute disease
c . in adults, can persist for months or years
d . in children, results in spontaneous remissions in 790%
of cases
B
Chapter 33
1. What disorder is most probably indicated by the boy's
history?
(Objectives 4, 5)
a . acute leukemia
b . Bernard-Soulier syndrome
c . immune thrombocytopenia
d . Marfan syndrome
C
Chapter 33
2. If a bone marrow examination had been performed, what
morphology would it likely have shown? (Objective 4)
a . normal to increased numbers of megakaryocytes
b . a high number of blast cells
c . decreased numbers of erythrocyte precursors
d . absence of all myeloid precursors and replacement
by fat
A
Chapter 33
3. What is the mechanism of platelet destruction in immune
thrombocytopenia? (Objective 4)
a . lysis by complement in the peripheral blood
b . increased sequestration of platelets by the spleen
c . removal of antibody-coated platelets by splenic
macrophages
d . activation and increased utilization by forming
aggregates
in the blood stream
C
4. The small purple spots seen on this boy's ankles are most
probably: (Objective 2)
a . petechiae
b . ecchymoses
c . allergic purpura
d . hematoma
A
5. What is the boy's expected prognosis? (Objective 2)
a . imminent death from overwhelming infection
b . complete spontaneous recovery within 6 months
c . similar problems for the rest of his life
d . recovery after a long period of steroid therapy
B
6. Which of the following is characteristic in a patient with
Bernard-Soulier syndrome? (Objective 7)
a . abnormal glycoprotein IIb/IIIa
b . increased prothrombin time
c . increased platelet count
d . abnormal platelet agglutination with ristocetin
D
7. Which of the following is found in Glanzmann thrombasthenia?
(Objective 7)
a . mutation in the gene for VWF
b . acquired abnormality of fibrinogen
c . genetic abnormality of glycoprotein IIb or IIIa
d . acquired vascular disorder
C
8. Hereditary telangiectasias is characterized by which of the
following? (Objective 3)
a . abnormal platelet adhesion to collagen
b . thrombocytosis
c . deficiency of platelet dense granules
d . skin lesions that are arterioles connected directly
to venules
D
9. Platelet aggregation studies were performed and showed
a primary wave of aggregation with ADP that returned to
the baseline with no secondary wave. Which of the following
conditions is consistent with these results? (Objectives 7, 8)
a . senile purpura
b . chronic immune thrombocytopenia
c . aspirin effect
d . Bernard-Soulier syndrome
C
10. Reactive thrombocytosis is associated with: (Objectives 4, 6)
a . postsurgery
b . MPN
c . aspirin ingestion
d . heparin therapy
A
1. A patient who has a deficiency of a clotting factor could
have: (Objective 1)
a . inherited an abnormal gene from a parent
b . acquired the deficiency because of another disease
present
c . decreased amount of the particular factor in the blood
d . all of the above
D
2. Why do patients who have deficiencies of clotting factors
usually have abnormal bleeding? (Objectives 1, 2)
a . Fibrin formation is slower and less effective than
normal.
b . Platelets do not aggregate normally.
c . Fibrin is formed too fast and in too large a quantity.
d . Fibrin is broken down as fast as it is formed.
A
3. What clotting factor is deficient in a patient with hemophilia
A? (Objective 4)
a . FVII
b . FVIII
c . FIX
d . FXIII
B
4. Which laboratory tests are outside their reference interval?
(Objective 2)
a . all tests shown
b . platelet aggregation with ristocetin, activated partial
thromboplastin time, FVIII assay
c . platelet count, prothrombin time, FIX assay
d . prothrombin time, activated partial thromboplastin
time, FIX assay
B
5. The most probable cause of this patient's bleeding is:
(Objectives 3, 10)
a . vascular disorder
b . FIX deficiency
c . von Willebrand disease
d . disseminated intravascular coagulation
C
6. What laboratory test that is abnormal in this patient is different
from that of a patient with hemophilia A? (Objectives
5, 6)
a . FVIII assay
b . FIX assay
c . platelet aggregation studies with ADP
d . platelet aggregation studies with ristocetin
D
7. What result of the platelet count would you expect in a
patient with hemophilia A? (Objective 5)
a . normal
b . increased
c . decreased
d . unpredictable
A
8. Which is/are characteristic/s of a patient with DIC?
(
Objective 8)
a . a prolonged PT
b . a prolonged APTT
c . a decreased platelet count
d . all of the above
D
9. What is the cause of disseminated intravascular coagulation
(DIC)? (Objective 8)
a . an inherited deficiency of FX
b . a reaction to another disease that causes the hemostatic
system to become activated
c . a deficiency of vitamin K
d . an antibody to FVIII
B
10. Which result would be expected in a newborn infant?
(Objective 9)
a . a shorter APTT test than that in an adult
b . a longer APTT test than that in an adult
c . a lower platelet count than that in an adult
d . a higher platelet count than that in an adult
B
1. Referring to the case study for Level I questions 4-6,
the results of the platelet aggregation studies indicate
that the patient has a defect in which of the following?
(Objective 4)
a . FVIII
b . platelet adhesion
c . fibrinolysis
d . intrinsic system of fibrin formation
B
2. What is the usual inheritance pattern of von Willebrand
disease? (Objective 3)
a . autosomal dominant
b . autosomal recessive
c . X-linked recessive
d . not inherited, usually acquired
A
3. Which of the following is characteristic of type I von Willebrand
disease? (Objective 4)
a . decreased amounts of large multimers of VWF
b . increased amounts of large multimers of VWF
c . decreased amounts of all VWF multimers
d . decreased amounts of small VWF multimers only
C
4. Which laboratory procedure analyzes VWF qualitatively for
abnormalities of the molecular structure? (Objective 4)
a . ristocetin-induced platelet aggregation
b . FVIII assay
c . SDS-page gel electrophoresis
d . activated partial thromboplastin time
C
5. What is the cause of von Willebrand disease? (Objective 3)
a . genetic mutations in the FVIII gene
b . genetic mutations in the VWF gene
c . genetic mutations in the glycoprotein Ib gene
d . exposure to dyes and chemicals
B
6. In which of the following patients would the presence of
delayed bleeding and deep muscular hematomas be most
likely? (Objectives 1, 5)
a . a patient with FVIII deficiency
b . a patient with FXII deficiency
c . a patient who is heterozygous for FV deficiency
d . a patient with dysfibrinogenemia
A
7. In which of the following diseases would you most likely
find an abnormal prothrombin time? (Objectives 4, 6)
a . FVIII deficiency
b . FIX deficiency
c . disseminated intravascular coagulation
d . prekallikrein deficiency
C
8. Which of the following is true concerning acquired circulating
pathologic inhibitors to single coagulation factors?
(Objective 9)
a . They do not cause bleeding symptoms.
b . They cause the same symptoms in the patient as an
inherited deficiency of the same factor.
c . They are often found in patients with von Willebrand
disease.
d . They are antibodies to the phospholipid in the coagulation
reagents.
B
9. Which of the following is true in the condition known as
disseminated intravascular coagulation (DIC)? (Objective 7)
a . FV and FVIII become increased in activity.
b . Fibrinolytic activity is absent.
c . The patient has a single coagulation factor deficiency.
d . Fibrinogen and platelets become depleted.
D
10. What laboratory test is helpful in differentiating primary
and secondary fibrino(geno)lysis? (Objective 9)
a . thrombin time
b . D-dimer test
c . plasmin-antiplasmin complexes
d . platelet count
B
Students also viewed