Hematology- 2013 SDD

12. The values below were obtained on an automated blood count system performed on a blood sample from a 25 year old man:

Patient Normal

WBC 5.1x103/ uL 5.0- 10.0 x 103/uLRBC 2.94 x 106/ uL 4.6-6.2x 106/ uLHgb 13.8 g/dl 14-18 g/dlHct 35.4% 40%- 54%MCV 128fL 82- 90 fLMCH 46.7 pg 27-31 pgMCHC 40% 32%-36%

These results are most consistent with which of the following:

a. Megaloblastic anemia c. A high titer of cold agglutininsb. Hereditary spherocytosis d. An elevated reticulocyte count

13. Which of the following measures platelet function?

a. Bleeding time c. Thrombin timeb. Prothrombin time d. Partial thromboplastin time

14. The most common form of childhood leukemia is:

a. Acute lymphocytic c. Acute Monocyticb. Acute granulocytic d.Chronic granulocytic

15. Which of the following is the standard calibration method for hematology instrumentation against which other methods must be verified?

a. Latex particles of known dimensionb. Stabilized red cell suspensionsc. Stabilized 7 parameter reference controlsd. Normal whole blood

16. Te following results were obtained on an electric particle counter:

WBC 6.5x 103/ uL RBC 4.55 x 108/ uL Hgb 18.0 g/dl Hct 41.5 % MCV 90.1 fL MCH 39.6 pg MCHC 43.4%

The first step in obtaining valid results is to:

a. Perform a Microhemaocritb. Correct the hemoglobin for lipemiac. Dilute the bloodd. Replace the lysing agent

17. Which of the following tests is used to monitor red cell production?

a. Packed cell volumeb. Total iron- binding capacityc. Schilling testd. Reticulocyte count

18. The differential was performed on an asymptomatic patient. The differential included 60% neutrophils; 55 of which had 2 lobes and 5 had 3 lobes. There were no other abnormalities. This is consistent with which of the following anomalies?

a. Pelger- Huetb. May- Hegglinc. Alder- Rellyd. Chedlak- Higashi

19. The following results were obtained on an electronic particle counter:

WBC 61.3x 103/uL RBC 1.19 x 105/uL Hgb 9.9 g/dl Hct 21% MCV 125 fL MCHC 54.1%

What action should be taken to obtain accurate results?

a. Dilute the specimen and recountb. Warm the specimen and recountc. Check the tube for clotsd. Clean the aperture and recount

20. Thalassemias are characterized by:

a. Structural abnormalities in the hemoglobin moleculeb. Absence of iron in hemoglobinc. Decrease rate of heme synthesisd. Decreased rate of globin synthesis

21. Phagocytosis is a function of:

a. Erythrocytesb. Granulocytesc. Lymphocytesd. Thrombocytes

22. Cells involved in hemostasis are:


23. Cells for the transport of 02 and CO2 are:


24. Cells that produce antibodies and lymphokines are:


25. In polycythemia vera, the hemoglobin, hematocrit, red blood cell count, and red cell mass are:

a. Elevatedb. Normal c. Deceased

26. In polycythemia vera, the platelet count is:

a. Elevatedb. Normalc. Decreased

27. 50%-90% myeloblasts in a peripheral blood sample is typical of which of the following?


28. Auer rods are most likely present in which of the following?


29. All stages of neutrophils are most likely to be seen in the peripheral blood of a patient with:


30. Erythropoietin acts to:

a. Shorten the replication time of the granulocytesb. Stimulate RNA synthesis of erythroid cellsc. Increase colony – stimulating factors produced by the B- lymphocytesd. Decrease the release of marrow reticulocytes

31. In the French- American-British (FAB) classification, acute lymphocytic leukemia is divided into groups according to:

a. Prognosisb. Immunologyc. Cytochemistryd. Morphology

32. The specimen of choice for preparation of blood films for manual differential leukocyte counts is whole blood collected in:

a. EDTAb. Oxalatec. Citrated. Heparin

33. When platelets concentrate at the edges and feathered end of a blood smear, it is usually due to:

a. Abnormal proteinsb. Inadequate mixing of blood and anticoagulantc. Hemorrhaged. Poorly made wedge smear

34. Irregular clumping of platelets is usually due to:

a. Inadequate mixing of blood and anticoagulantb. Hemorrhagec. Poorly made wedge smeard. Hypersplenism

35 .Platelet satellitosis is usually due to

a. Abnormal proteinsb. Inadequate mixing of blood and anticoagulantc. Hemorrhaged. Poorly made wedge smear

36.Elevation of the granulocyte percentage above 75% is termed:

a. Absolute lymphocytosisb. Leukocytosisc. Relative neutrophilic leukocytosisd. Absolute neutrophilic leukocytosis

37. Elevation of the lymphocyte percentage above 47% is termed:

a. Relative lymphocytosisb. Absolute lymphocytosisc. Leukocytosisd. Absolute Neutrophilic leukocytosis

38. Elevation of the total granulocyte count above 9.0x103/ uL is termed:

a. Absolute lymphocytosisb. Leukocytosisc. Relative neutrophilic leukocytosisd. Absolute neutrophilic leukocytosis

39. Elevation of the total white cell count above 12x 109/ uL is termed:

a. Relative lymphocytosisb. Absolute lymphocytosisc. Leukocytosisd. Absolute Neutrophilic leukocytosis

40. The chamber counting method of platelet enumeration:

a. Allows direct visualization of the particles being countedb. Has high degree of precisionc. Has a high degree of reproducibilityd. Is the method of choice for the performance of 50-60 counts per day

41. Specific (secondary) granules of the neutrophilic granulocyte:

a. Appear first at the myelocyte stageb. Contain the lysosomal enzymesc. Are formed in the mitochondriad. Are derived from azurophil (primary) granules

42. The anemia of chronic infection is characterized by:

a. Decreased iron stores in the reticuloendothelial system b. Decreased serum iron levelsc. Macrocytic erythrocytesd. Increased serum iron- binding capacity

43. Which of the following are characteristic of polycythemia vera?

a. Elevated urine erythropoietinnlevelsb. Increased oxygen affinity of hemoglobinc. “Teardrop” poikilocytosisd. Decreased or absent bone marrow iron stores

44. Factors commonly involved in producing anemia in patients with chronic renal disease include:

a. Maarow hypoplasiab. Ineffective erythropoiesisc. Vitamin B12 defeciencyd. Increased erythropoietin production

45. Thrombocytopenia is a characteristic of:

a. Classic von Willebrands diseaseb. Hemophilia Ac. Galnzmann’s thromobastheniad. May- Hegglin anomaly

46. A leukocyte count and differential on a 40- year-old Caucasian man revealed:

WBC 5.4x 103/ uL Differential Segs 20% Lymphs 58% Monos 20% Eos 2%

These data represent:

a. Relative lymphocytosisb. Absolute lymphocytosisc. Relative Neutrophiliad. Leukopenia

47. A leukocyte count and differential on a 40- year-old white man revealed:

WBC 5.4x 103/ uL Differential Segs 20% Lymphs 58% Monos 20% Eos 2%

These data represent:

a. Absolute lymphocytosisb. Relative neutrophiliac. Absolute Neutropeniad. Leukopenia

48. Which of the following platelet responses is most likely associated with classic von Willebrand’s disease?

a. Decreased platelet aggregation to ristocetinb. Normal platelet aggregation to ristocetinc. Absent aggregation to epinephrine, ADP, and collagend. Decreased amount of ADP in platelets

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

a. Hemoglobinb. Hemosiderinc. Myoglobind. Transferrin

50. A patient has the following blood values:

RBC 6.5x103/ uL Hgb 14.0 g/dl Hct 42.0% MCV 65 fL MCH 21.5 pg MCHC 33%

These results are compatible with:

a. Iron deficiencyb. Pregnancyc. Thalassemia minord. Beta Thalassemia major

51. A 50- year old woman who has been receiving busulfan for 3 years for chronic myelogenos leukemia becomes anemic. Laboratory tests reveal:

Thrombocytopenia Many peroxidise- negative blast cells in the peripheral blood Bone marrow hypercellular in blast transformation Markedly increased bone marrow TdT

Which of the following complications is the patient most likely to have?

a. Acute lymphocytic leukemiab. Acute myelocytic leukemiac. Acute myelomonocytic leukemiad. Busulfan toxicity

52. Which of the following is the most common cause of an abnormality in hemostasis?

a. Decreased plasma fibrinogen levelb. Decreased Factor VIII levelc. Decreased Factor IX leveld. Quantitative abnormality of patients

53. A hemophiliac male and a normal female can produce a:

a. Female carrierb. Male carrierc. Male hemophiliacd. Normal female

54. A patient has a normal prothrombin time and a prolonged activated partial thromboplastin time (APTT) using a kaolin activator. The APTT corrects to normal when the incubation time is increased. These results suggest that the patient has:

a. Hemophilia A (Factor VIII deficiency)b. Hageman (Factor XII deficiency)c. Fletcher factor deficiency (prekallikrein)d. Factor V deficiency

55. Acute disseminated intravascular coagulation is characterized by:

a. Hypofibrinogenemiab. Thrombocytosisc. Negative D dimerd. Shortened thrombin time

56. Coagulation factors affected by coumarin drugs are:

a. VIII, IX, and Xb. I, II, V and VIIc. II, VII, IX, and Xd. II, V and VII

57. The following data were obtained on a patient:

PT 20 sec Thrombin Time 13 sec APTT 55 sec APTT plus aged serum Corrected APTT plus absorbed plasma Not corrected Circulatory inhibitor None present

Which of the following coagulation factors is deficient?

a. Factor Vb. Factor VIIIc. Factor Xd. Factor XI

58. Which of the following laboratory procedures is most helpful in differentiating severe liver disease and accomapanying secondary fibrinolysis from disseminated intravascular coagulation?

a. Presence of fibrin split productsb. Increased APTTc. Factor VIII activityd. Fibrinogen level

59. Which of the following laboratory findings is associated with Factor XIII deficiency?

a. Prolonged activated partial thromboplastin timeb. Clot solubility in a 5 molar urea solutionc. Prolonged thrombin timed. Prolg/donged prothrombin time

60. An automated leukocyte count is 22.5 x 103/uL. The differential reveals 200 normoblasts/100 leukocytes. What is the actual leukocyte count per microliter?

a. 7500/uLb. 11, 500/uLc. 14,400/uLd. 22,300/uL

61. On Monday a patient’s hemoglobin determination was 11.3 g/dL and on Tuesday it measured 11.8 g/dL. The standard deviation of the method used is +- 0.2 g/dL. What can be concluded about the hemoglobin values given?

a. One value probably resulted from laboratory errorb. There is poor precision; daily quality control charts should be checked.c. The second value is out of range and should be repeatedd. There is no significant change in the patient’s hemoglobin concentration

62. A patient has a high cold agglutinin titer. Automated cell counter results reveal an elevated MCV, MCH, and MCHC. Individual erythrocytes appear normal on a stained smear, but agglutinates are noted. The appropriate course of action would be to:

a. Perform the RBC, Hgb, and Hct determinations using manual methodsb. Perform the RBC determination by a manual method; use the automated results

for the Hgb and Hctc. Repeat the determinations using a microsample of diluted bloodd. Repeat the determinations using a prewarmed microsample of diluted blood

63. The anticoagulant of choice for routine coagulation procedure is:

a. Sodium oxalateb. Sodium citratec. Heparind. Sodium fluoride

64. The most commom cause of error when using automated cell counter is:

a. Contamination of diluentsb. Inadequate mixing of the sample prior to testingc. Variation in voltage of the current supplyd. A calibrating error

65. Which of the following is associated with May- Hegglin anomaly?

a. Membrane defect of lysosomesb. Dohle bodies and giant plateletsc. Chronic myelogeneous leukemiad. Mucopolysaccharidosis

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

a. Membrane defect of lysosomesb. Dohle bodies and giant plateletsc. Two- lobed neutrophilsd. Mucopolysaccharidosis

67. Which of the following is associated with pseudo- Pelger- Heut anomaly?

a. Aplastic anemiab. Iron Deficiency anemiac. Myelogenous Leukemiad. Chediak- Higashi syndrome

68. Which of the following is associated with Alder- Reilly inclusions?

a. Membrane defect of lysosomesb. Dohle bodies and giant plateletsc. Two lobed neutrophilsd. Mucopolysaccharides

69. Many microspherocytes and schistocytes and budding off of spherocytes can be seen on peripheral blood smears of patients with:

a. Hereditary spherocytosisb. Disseminated intravascular coagulation (DIC)c. Acquired autoimmune haemolytic anemiad. Extensive burns

70. Muramidase (lysozyme) is present in:

a. Granulocytes and their precursorsb. Monocytes and their precursorsc. Granulocytes, monocytes, and their precursorsd. Lymphocytes and their precursors

71. Hemolysis in paroxysmal nocturnal hemoglobinuria(PNH) is:

a. Temperature dependentb. Complement- independentc. Antibody- mediatedd. Caused by a red cell membrane defect

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

a. Complexed with haptoglobinb. Freely circulating cytoplasmc. Attached to transferrind. In the ferrous state

73. Heinz bodies are:

a. Readily identified with polychrome stainsb. Rarely found in glucose-6- phosphate dehydrogenase deficient erythrocytesc. Closely associated with spherocytesd. Denatured hemoglobin inclusions that are readily removed by the spleen

74. Which of the following sets of laboratory findings is consistent with hemolytic anemia?

a. Normal or slightly increased erythrocyte survival; normal osmotic fragilityb. Decreased erythrocyte survival; increased catabolism of hemec. Decreased serum lactate dehydrogenase activity, normal catabolism of hemed. Normal concentration of haptoglobin; marked hemoglobinuria

75. Evidence indicates that the genetic defect in thalassemia usually results in:

a. The production of abnormal globin chainsb. A quantitative deficiency in RNA resulting in decreased globin chain productionc. A structural change in the heme portion of the hemoglobind. An abnormality in the alpha or beta chain binding or affinity

76. Hemoglobin H disease results from:

a. Absence of 3 of 4 alpha genesb. Absence of 2 of 4 alpha genesc. Absence of 1of 4 alpha genesd. Absence of all 4 alpha genes

77. Which of the following represents characteristic features of iron metabolism in patients with anemia of a chronic disorder?

a. Serum iron is normal, transferrin saturation is normal, TIBC is normalb. Seum iron is increased, transferrin saturation is increased, TIBC is normal or

slightly increasedc. Serum iron is normal, transferrin saturation is markedly increased, TIBC is

normald. Serum iron is decreased, transferrin saturationis decreased, TIBC is normal or

decreased

78. A patient with polycythemia vera who is treated by phlebotomy is most likely to develop deficiency of:

a. Ironb. Vitamin B12c. Folic acidd. Erythropoietin

79. Hemorrhage in polycythemia vera is the result of:

a. Increased plasma viscosityb. Persistent thrombocytosisc. Splenic sequestration of plateletsd. Abnormal platelet function

80. In chronic myelocytic leukemia, blood histamine concentrations tend to reflect the:

a. Number of platelets presentb. Serum uric acid concentrationsc. Number of basophils presentd. Total number of granulocytes

81. Which of the following anomalies is an autosomal dominant disorder characterized by irregularly sized inclusions in polymorphonuclear neutrophils, abnormal giant platelets, and often thrombocytopenia?

a. Pelger- Huetb. Chediak- Higashic. Alder- Reillyd. May- Hegglin

82. The bone marrow in the terminal stage of erythroleukemia (DI Gugillelmo’s syndrome) is often indistinguishable from that seen in:

a. Myeloid metaplasiab. Polycythemia verac. Acute myelocytic leukemiad. Aplastic anemia

83. Which of the following is significant feature of erythroleukemia (DI Gugillelmo’s syndrome)?

a. Persistently increased M:E ratiob. Megaloblastoid erythropoiesisc. Marked thrombocytosisd. Decreased stainable iron in the marrow

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

a. Chronic myelocytic leukemiab. Multiple myelomac. Thalassemiad. Myeloid Metaplasia

85. In the French- American- British (FAB) classification, myelomonocytic leukemia would be:

a. M1 and M2b. M3c. M4d. M5

86. Which of the following is characteristic of platelet disorders?

a. Deep muscle hemorrhagesb. Retroperitoneal hemorrhagesc. Mucous membrane hemmorhagesd. Severely prolonged clotting time

87.Which of the following is true statement about acute idiopathic thrombocytopenic purpura (ITP)?

a. It is found primarily in adultsb. Spontaneous remission usually occurs within several weeksc. Women are commonly affectedd. Peripheral destruction of platelets is decreased

88. Which of the following is the most useful in differentiating hemophilias A and B?

a. Pattern of inheritanceb. Clinical historyc. Activated partial thromboplastin timed. Mixing studies( substitution studies)

89. A 56-year-old woman was admitted to the hospital with a history of a moderate to severe bleeding tendency several years’ duration. Epistaxis and menorrhagia were reported. Prolonged APTT was corrected with normal plasma, absorbed plasma and aged serum. Deficiency of which of the following is most likely?

a. Factor XIIb. Factor VIIIc. Factor XId. Factor IX

90. A patient has a history of mild hemorrhagic episodes. Laboratory results include a prolonged prothrombin time and activated partial thromboplastin time. The abnormal prothrombin time was corrected by normal and adsorbed plasma, but not aged serum. Which of the following coagulation factor is deficient?

a. Prothrombinb. Factor Vc. Factor Xd. Factor VII

91. A bone marrow slide shows foam cells ranging from 200 t0 100 um in size with vacuolated cytoplasm containing sphingomyelin and is faintly PAS positive. This cell type is most characteristic of:

a. Gaucher’s diseaseb. Myeloma with Russell bodiesc. DI Gugillelmo diseased. Niemann- Picki disease

92. Patients with chronic granulomatous disease suffer from frequent pyogenic infections owing to the inability of:

a. Lymphocytes to produce bacterial antibodiesb. Eosinophils to degranulate in the presence of bacteriac. Neutrophils to kill phagocytised bacteriad. Basophils to release histamine in the presence of bacteria

93. A 40-year-old man had an erythrocyte count of 2.5x 106/ uL, hematocrit of 22%, and a reticulocyte count of 2.0%. Which of the following statements best describes his condition?

a. The absolute reticulocyte count is 50x 103/uL, indicating that the bone marrow is not adequately compensating for the anemia

b. The reticulocyte count is greatly increased, indicating an adequate bone marrow response for the anemia

c. The absolute reticulocyte count is 500x 103/uL, indicating that the bone marrow is adequately compensating for the anemia

d. The reticulocyte count is slightly increased, indicating an adequate response to the slight anemia

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

a. White blood cell countb. Red blood cell countc. Hemoglobind. Hematocrit

95. When using an electronic cell counter, which of the following results can occur in the presence of a cold agglutinin?

a. Increased MCV and decreased RBCb. Increased MCV and normal RBCc. Decreased MCV and increased MCHCd. Decreased MCV and RBC

96. A properly functioning electronic cell counter obtains the following results:

WBC 5.1 x 103/uLRBC 4.87x 106/uLHgb 10.1 g/dlHct 39.3%MCV 82.o fLMCH 33.1 pgMCHC 41.3%

What is the most likely cause of these results?

a. Lipemiab. Cold agglutininsc. Increased WBCd. Rouleaux

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

a. Increased hematocrit and MCVb. Increased ESR and MCVc. Increased MCHC and MCVd. Decreased reticulocyte and hematocrit

98. On setting up the electronic particle counter in the morning, one of the controls is slightly below the range for the MCV. Which of the following is indicated?

a. Call for servieb. Adjust the MCV up slightlyc. Shut down the instrumentd. Repeat the control

99. Which of the following is associated with Glanzmann’s thrombasthenia?

a. Normal bleeding timeb. Normal ADP aggregationc. Abnormal initial wave ristocetin aggregationd. Absence of clot retraction

100. Which of the following is a characteristic of Bernard – Souller syndrome?

a. Negative bleeding historyb. Normal clotting timesc. Decreased risk of thrombosisd. Epistaxis

101. Which of the following is characteristic of Bernard- Souller syndrome?

a. Giant plateletsb. Normal bleeding timec. Abnormal aggregation with ADPd. Increased Platelet count

102. Which of the following will not cause erroneous results when using a phase optical system for enumerating platelets?

a. Incipient clottingb. Decreased hematocritc. Howell- Jolly bodiesd. Leukocyte cytoplasmic fragments

Questions 103-107 refer to the following illustration:

50

40

30

20

10

0-6 -3 Birth 3 6

103. Which curve represents the production of alpha polypeptide chains of hemoglobin?

a. Ab. Bc. Cd. D

104. Which curve represents the production of beta polypeptide chains of hemoglobin?

a. Bb. Cc. Ed. D

105. Which curve represents the production of gamma polypeptide chains of hemoglobin?

a. Ab. Bc. Cd. D

106. Which curve represents the production of delta polypeptide chains of hemoglobin?

a. Bb. Cc. Dd. E

107. Which curve represents the production of epsilon polypeptide chains of hemoglobin?

a. Ab. Bc. Cd. D

108 Which curve represents the production is mostly associated with:

a. Polycythemia verab. Polycythemia, secondary to hypoxiac. Relative polycythemia related to dehydrationd. Polycythemia associated with renal disease

109. Decreased to normal erythropoietin production is most likely to be asscociated with:

a. Polycythemia verab. Polycythemia, secondary to hypoxiac. Benign Familial polycythemiad. Polycythemia associated with renal disease

110. Which of the following types of polycythemia is a severely burned patient most likely to have?

a. Polycythemia verab. Polycythemia, secondary to hypoxiac. Relative polycythemia associated with dehydrationd. Polycythemia associated with renal disease

111. Which of the following types of polycythemia is most often associated with emphysema?

a. Polycythemia verab. Polycythemia, secondary to hypoxiac. Relative polycythemia associated with dehydrationd. Polycythemia associated with renal disease

112. Which of the following is most closely associated with idiopathic hemochromatosis?

a. Iron overload in tissueb. Target cellsc. Basophilic stipplingd. Ringed sideroblasts

113. Which of the following is most closely associated with iron deficiency anemia?

a. Iron overload in tissueb. Target cellsc. Basophilic stipplingd. Ringed sideroblasts

114. Which of the following is seen most often in thalassemia?

Hematology- 2013 SDD

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