Hematology Reviewer PDF

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Hematology reviewer questions and answers...

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1. What is the proper angle of needle insertion for phlebotomy? a. 5 degrees b. 15 degrees c. 35 degrees d. 45 degrees 2. Acceptable sites for skin puncture on infants are: a. middle of the heel and tip of the big toe b. lateral or medial surface of the bottom of the heel and plantar surface of the big toe c. inside of the heel, close to the arch of the foot, and any of the toes, close to the tip d. middle of the bottom of the heel and middle of the big toe 3. Which of the following procedures is the most basic and effective in preventing nosocomial infections? a. washing hands between patient contacts b. wearing laboratory coats c. isolating infectious patients d. isolating infectious specimens 4. Which of the following is not an appropriate safety practice? a. disposing of needles in biohazard, puncture-proof containers b. frequent handwashing c. sterilizing lancets for reuse d. keeping food out of the same areas as specimens 5. Diluted bleach for disinfecting work surface, equipment, and spills should be prepared daily by preparing a ____ dilutiong of household bleach. This dilution requires ____ mL of bleach diluted to 100 mL with H2O. a. 1:5 dilution, 10 mL bleach c. 1:5 dilution, 5 mL bleach b. 1:10 dilution, 10 mL bleach d. 1:10 dilution, 5 mL bleach 6. A blood sample is needed from a patient with IV fluids running in both arms. Which of the following is an acceptable procedure? a. any obtainable vein is satisfactory b. obtain sample from above the IV site c. obtain sample from below the IV site with special restrictions d. disconnect the IV line e. do not draw a blood specimen 7. Which of the following skin areas is (are) acceptable for the collection of capillary blood from an infant? a. previous puncture site c. posterior curve of the heel b. the arch d. medial or lateral plantar surface 8. If a blood smear is too red on microscopic examination of a Wright-stained preparation, possible causes include that: a. the staining time was too long b. the stain was to basic c. the buffer was too acidic and the exposure time was too short d. the buffer was too basic and the exposure was too long 9. Stimulation of erythropoietin is caused by: a. tissue hypoxia b. hypervolemia c. inflammation d. infection 10. What is the immature erythrocyte found in the bone marrow with the following characteristics: 12 to 17 µm in diameter, N:C of 4:1, nucleoli not usually apparent, and basophilic cytoplasm? a. prorubricyte (basophilic normoblast) c. reticulocyte b. metarubricyte (orthochromatic normoblast) d. rubriblast (pronormoblast) 11. On a Wright-stained PBS, stress or shift reticulocytes are:

a. smaller than normal reticulocytes b. about the same size as normal reticulocytes c. larger than normal reticulocytes d. noticeable because of a decreased blue tint 12. If a male patient has a reticulocyte count of 5.0% and a packed cell volume of 0.45 L/L, what is his corrected reticulocyte count? c. 5.0% a. 2.5% b. 4.5% d. 10% 13. Increased amounts of 2,3-DPG ____ the oxygen affinity of the hemoglobin molecule. a. increases c. does not alter d. no effect b. decreased 14. What is the composition of normal adult hemoglobin? a. 92-95% HbA; 5-8% HbA2; 1-2% HbF c. 80-85% HbA; 2-3% HbA2; 1-2% HbF d. 92-95% HbA; 2-3% HbA2; 1-2% HbF b. 90-92% HbA; 2-3% HbA2 15. The alkaline denaturation test detects the presence of hemoglobin b. F a. A1c c. C d. S 16. If an alkaline (pH 8.6) electrophoresis is performed, hemoglobin E has the same mobility as hemoglobin: d. C a. S b. F c. A 17. The Embden-Meyerhof pathway net gain of ATP provides high energy phosphates to: a. maintain membrane lipids b. power the caption pump needed for the sodium potassium concentration pump and calcium flux c. preserve the shape and flexibility of the cellular membrane d. AOTA 18. The most common eryhtrocytic enzyme deficiency involving the Emden-Meyerhof glycolytic pathway is a deficiency of: a. ATPase b. G6PD c. pyruvate kinase d. LD 19. Which of the following statements are true of the intravascular destruction of erythrocytes? a. it accounts for 8 µm. If there are 25% to 50% macrocytic RBCs present per high-power field, it is graded as: a. 1+ c. 3+ to 4+ d. 4+ b. 2+ to 3+ 26. Hypochromia refers to RBCs that show a less than normal amount of hemoglobin staining, and the cells’ central pallor is increased to more than one third of guidelines for RBC color appearance. Hypochromia graded as 2+ to 3+ (i.e., moderate) if: a. RBCs show a central pallor occupying one third to two thirds of the cell’s diameter b. RBCs show central pallor occupying more than two thirds of the cell’s diameter c. RBCs show red hemoglobin staining that appears only as a rim on the periphery of the cell d. NOTA 27. Ovalocytosis indicates red cells that vary in shape from slightly oval to pencil-shaped or cigar-shaped. Ovalocytosis is reported if more than ___ of RBCs per microscopic field are oval or elliptical in shape. a. 1% b. 2% c. 5% d. 10% 28. Polychromatophilia (polychromasia) refers to an increase in the number of younger RBCs (reticulocytes) with incomplete hemoglobinization. These cells are larger than normal RBCs, lack a central pallor, and stain a pale blue. 1+ polychromasia if: a. 1-3 polychromatic cells are found per microscopic field b. 3-5 polychromatic cells are found per microscopic field c. more than five polychromatic cells are found per microscopic field d. NOTA 29. Basophilic stippling describes cytoplasmic inclusions. RBCs have cytoplasm that is stippled with a number of fine blue granules, which are ribosomal-RNA remnants. Stippled cells are quantified as slight, moderate and marked. Moderate if: a. 1 stippled RBC is noted in every other microscopic field b. 1-2 stippled RBCs are noted in every microscopic filed c. 3 or more stippled RBC are noted in every microscopic field d. NOTA 30. Rouleaux formation is reported if the RBCs become aligned in aggregates resembling stacks of coins. Rouleaux are often seen as an artifact in thick areas of blood film. Rouleaux are quantitated in the following manner: slight, moderate and marked. Marked if: a. 1-2 RBC chains are found per thin microscopic field b. 3-4 RBC chains are found per thin microscopic field c. 5 or more chains are found per thin microscopic field d. NOTA 31. In hypochromia grading, 2+ corresponds to: a. one-half of cell diameter b. area of pallor is two-thirds of cell diameter c. area of pallor is three-quarters d. thin rim of hemoglobin 32. 3+ target cells is equivalent to: d. >20/field a. 1-5/field b. 3-10/field c. 11-20/field 33. The eryhtrocyte morphology associated with anemia in an otherwise healthy individual caused by acute blood loss is usually: c. normochromic d. hypochromic a. microcytic b. megaloblastic 34. If a patient with aplastic anemia is referred to as exhibiting pancytopenia, which cell lines are affected? d. AOTA a. erythrocytes b. leukocytes c. thrombocytes 35. In IDA, the:

a. serum iron is severely decreased and the TIBC is increased b. serum iron is decreased and the TIBC is normal c. serum iron is normal and the TIBC is normal d. serum iron is increased and the TIBC is normal 36. In a case of classic pernicious anemia, the patient has: d. AOTA a. leucopenia b. anemia c. hypersegmented neutrophils 37. What enzyme deficiency causes methemoglobinemia? c. NADH-methemoglobin reductease a. G6PD b. PK d. Hexokinase deficiency 38. The erythrocyte alteration characteristically associated with hemolytic anemia is: a. hypochromia b. macrocytosis c. spherocytosis d. burr cells 39. Hgb H disease results from: a. absence of 3 of 4 alpha genes c. absence of `1 of 1 alpha genes b. absence of 2 of 4 alpha genes d. absence of all 4 alpha genes 40. The laboratory findings on a patient are as follows: MCV : 55 fL MCHC : 25% MCH : 17 pg A stained blood film of this patients would most likely reveal a red cell picture that is: a. microcytic, hypochromic c. normocytic, normochromic b. macrocytic, hypochromic d. microcytic, normochromic 41. A patient has the following laboratory results: RBC : 2.00 x 1012/L Hct : 24% Reticulocytes : 0.8% Hgb : 6.8 g/dL (68 g/L) The mean corpuscular volume (MCV) of the patient is: b. 120 fL a. 35 fL c. 83 fL d. 150 fL 42. 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 RBC c. decreased MCV and dincreased RBC b. increased MCV and normal RBC d. decreased MCV and decreased RBC 43. Paroxysmal nocturnal hemoglobinuria exhibits sensitivity of one population of RBCs to: c. complement d. A or B a. warm antibodies b. cold antibodies 44. Paroxysmal nocturnal hemoglobinuria episodes are usually associated with: a. cold temperatures c. hot temperatures b. sleep d. certain foods or drugs 45. The sugar water screening test should be performed within __ hours of obtaining the specimen. a. 2 hrs b. 3 hrs c. 4 hrs d. 5 hrs 46. To detect anemia, the two most widely used tests are: a. Hgb and hct c. Hgb electrophoresis, OFT b. serum iron and iron binding capacity d. autohemolysis, acid serum 47. The life span of RBC may be determined by the use of radioisotopes. The patient RBC may be tagged with radioactive ___. Blood samples are then measured for the radioactivity over a period of time and a RBC survival curve plotted. a. Iron (59Fe)

b. Cesium (137Cs)

c. Cobalt (60Co)

d. Chromium (51Cr)

48. A group of disorders characterized by iron loading and its accumulation in the mitochondria of the erythroid precursors due to a defect in heme synthesis. a. Hemosiderosis c. Sideroblastic anemia b. Hemochromatosis d. Porphyria

49. Excessive amounts of iron that accumulates in the blood and tissues. Iron accumulation in macrophages cause little parenchymal cell injury. a. Hemosiderosis c. Sideroblastic anemia b. Hemochromatosis d. Porphyria 50. Excessive amounts of iron that accumulates in the blood and tissues. Iron accumulates in the parenchymal cell and injures the tissue. a. Hemosiderosis c. Sideroblastic anemia b. Hemochromatosis d. Porphyria 51. Anemia due to failure to produce erythropoietin and to a decreased bone marrow response to erythropoietin. a. anemia of chronic renal insufficiency c. anemia of blood loss b. anemia of endocrine disorder d. anemia of liver disease 52. This anemia is usually as a result of decreased bone marrow production of red cells caused by a decrease in the oxygen requirements of the tissues. a. anemia of chronic renal insufficiency c. anemia of blood loss b. anemia of endocrine disorder d. anemia of liver disease 53. Thalassemias are characterized by: a. abnormal amino acid sequence of hemoglobin molecules b. defective iron synthesis c. absence or decrease in synthesis of one or more globin subunits d. skeletal membrane defects 54. Asplenia (the absence of splenic function) can be caused by either surgical removal (splenectomy) or radiation overexposure. This condition can also occur in association with malabsorption syndromes. The hematologic results of asplenia include: 1. increased susceptibility to infection 2. acute granulocytosis 3. acute thrombocytosis, with occasional giant platelets 4. chronic and absolute lymphocytosis and monocytosis 5. increased appearance of immature RBCs in the circulation 6. increased amount of circulating RBCs with cytoplasmic inclusions or abnormal forms (Howell-Jolly bodies, target cells, and burr cells) d. AOTA a. 1, 3, 5 b. 2, 4, 6 c. 1, 2, 3, 4 and 5 55. Which of the following results would not be part of the usual diagnostic criterion for patient with anemia? a. decreased hgb b. decreased hct c. decreased plt count d. decreased rbc count 56. How is hematocrit measured in an automated instruments? a. centrifugation c. calculation (MCV x RBC count) b. photometrically d. calculation (MCH x Hgb) 57. It is an anemia associated with bone marrow infiltration and hyperproliferation by nonerythroid cells. A leukoeryhtroblastic reaction commonly accompanies the anemia. a. aplastic anemia c. pure red cell aplasia b. myelophthisic anemia d. refractory anemia 58. Which condition will not cause an absolute eryhtrocytosis? a. high altitude c. chronic pulmonary disease b. polycythemia vera d. dehydration 59. What factors contribute to the sickling of RBCs?

a. increase in pH and oxygenation b. decrease in pH, oxygenation and dehydration c. increase in pH and decreased in oxygenation d. decrease in dehydration and increased in pH and oxygenation 60. When microhematocrit is spun for the correct time period and at the proper speed, a small amount of plasma still remains in the RBC portion. This is termed trapped plasma and is usually expressed as percentage of RBC column. When comparing spun microhematocrit results with hematocrit results may vary from __ because of this trapped plasma. b. 1-3% higher a. 1-3% lower c. variable d. no effect 61. Blood is drawn to the 0.5 mark in an RBC diluting pipette. In five small squares of the center square in a Neubauer hemocytometer, 21 cells are counted. What is the RBC count? a. 2.1 x 1012/L b. 210 x 1012/L c. 0.21 x 1012/L d. 5.1 x 1012/L 62. The reticulocyte count is 20 per 1000 RBCs. Calculate the percentage of reticulocytes? b. 2% a. 20% c. 200% d. 0.2% 63. Calculate the WBC count if blood is drawn to the 1.0 mark in a WBC diluting pipette and a total of 150 WBCs are counted in 4 large squares. c. 3.75 x 109/L a. 37 x 109/L b. 375 x 109/L d. 0.375 x 109/L 9 64. If the total leukocyte count is 20.0 x 10 /L and 50 NRBCs are seen per 100 leukocytes on differential, what is the corrected leukocyte count? c. 13.333 x 109/L a. 7.777 x 109/L b. 10.0 x 109/L d. 26.666 x 109/L 65. If a patient has a total leukocyte count of 20 x 10 9/L and a 50% lymphocyte count on the differential count, the absolute lymphocyte value is ___ x 109/L. c. 10 a. 1 b. 5 d. 15 66. The term “shift to the left” refers to: a. a microscope adjustment b. a trend on Levy-Jennings chart c. immature cell forms in the peripheral blood d. a calibration adjustment on an instrument 67. Identify the cell with these characteristics: prominent primary granules that are rich in myeloperoxidase and chloroacetate esterase and have a diameter of 14-20 mm. b. promyelocyte c. myelocyte d. promonocyte a. myeloblast 68. The earliest granulocytic maturational stage in which secondary or specific granules appear is: a. myeloblast b. monoblast c. promyelocyte d. myelocyte 69. Which granulocytic cell has a kidney shaped nucleus with clumped chromatin and small, pink secondary granules with a few primary dark granules? a. band b. myelocyte c. promyelocyte d. metamyelocyte 70. An increase in metamyelocytes, myelocytes, and promyelocytes can be referred to as: a. leukocytopenia c. shift to the right b. shift to the left d. pelger-huet anomaly 71. Charcot-Leyden crystals can be found in __ of patients with active eosinophilic inflammation. a. sputum b. tissues c. stool d. AOTA 72. T lymphocytes constitute ___% of the blood lymphocyte pool in adults. d. 60-80 a. 0-20 b. 20-40 c. 40-60 73. Which of the following statements is (are) true of T cells? a. responsible for humoral responses b. responsible for cellular immune responses c. responsible for chronic rejection in organ transplantation

d. B and C 74. Rieder cells are similar to normal lymphocytes except that the nucleus is notched, lobulated, and cloverleaf-like. They occur in: c. CLL a. niemann-pick disease and Burkitt lymphoma b. leukosarcoma d. natural artifact 75. The etiological agents of leukemias can include: a. ionizing radiation c. certain infectious agents d. AOTA b. chemical exposure to benzene 76. The alkaline phosphatase cytochemical staining reaction is used to differentiate between c. CML and severe bacterial infection d. a. CLL and AML b. ALL and AML leukemoid 77. Grade of 4+ in LAP scoring: a. no staining b. faint and diffuse staining c. pale, with moderate amount of blue staining d. strong blue precipitated staining e. deep blue or brilliant staining with no visible cytoplasm 78. Leukocytes that demonstrates a positive reaction in the tartrate acid-resistant acid phosphatase cytochemical stain are the lymphocytes seen in: a. infectious lymphocytosis c. ALL (non-T type) b. malignant lymphoma d. hairy cell leukemia 79. Which lymphoma characteristically shows macrophages with phagocytized debris in a “starry sky” pattern? a. immunoblastic lymphoma c. HTLV-I associated T cell lymphoma/leukemia b. burkitt’s lymphoma d. small lymphocytic lymphoma 80. What is the enzyme deficiency in Gaucher’s disease? c. β-glucocerebrosidase a. sphingomyelinase b. hexosaminidase A d. α-galactosidase 81. WBCs are counted in consecutive fields from the tail toward the head of the smear. c. longitudinal a. crenellation b. cross-sectional d. battlement 82. WBC differential counting method that uses a pattern of consecutive fields beginning near the tail on a horizontal edge: count 3 consecutive horizontal edge fields, count 2 fields towards the center of the smear, count 2 fields horizontally, count 2 fields vertically to the edge. d. battlement a. crenellation b. cross-sectional c. longitudinal 83. Thrombocytopenia in multiple blood transfusions is due to: a. decreased platelet production c. decreased platelet survival time b. increased platelet sequestration d. dilution of the platelet count 84. Thrombocytopenia is a characteristic of: a. classic vWd b. Hemophilia A c. Glanzmann thrombasthenia d. May-Hegglin anomaly 85. A platelet determination was performed on an automated instrument and a very low value was obtained. The platelets appeared adequate when estimated from the stained blood film. The best explanation for this discrepancy is: a. many platelets are abnormally large c. blood sample is hemolyzed b. white cell fragments are present in the blood d. red cell fragments are present in the blood 86. What zone regulates platelet response for secretion and shape change? b. sol-gel zone c. organelle zone d. AOTA a. peripheral zone

87. In differentiating the maturation stages of the megakaryocyte cells, emphasis should be placed on the ___. a. cytoplasmic appearance c. number of nuclei b. chromatin structure d. size of the cell 88. A blue top tube is drawn for coagulation studies, the sample is a short draw results may be: a. falsely shortened c. unable to obtained d. falsely prolonged b. correct 89. The most commonly used agonist, particularly in aggregometry systems that measure only aggregation. a. epinephrine b. collagen d. ristocetin c. ADP 90. A citrated blood specimen for coagulation studies is to be collected from a polycythemic patient. The AC should be: a. standard volume c. changed to EDTA b. reduced in volume d. changed to oxalate 91. Specimens collected for PT testing may be held at 18 ᵒ C to 24ᵒ C and tested within __ hours of the time of collection. Specimens collected for PTT testing also may be held at 18ᵒ C to 24ᵒ C, but must be tested within __ house of the time of collection, provided that the specimen does not contain unfractionated heparin anticoagulant. a. within 1 hour for PT, 4 hours for PTT c. within 4 hour for PT, 24 hours for PTT b. within 4 hour for PT, 1 hours for PTT d. within 24 hour for PT, 4 hours for PTT 92. All are true for factor XI deficiency, except: a. currently though to be transmitted as an incompletely recessive autosomal trait b. common in eastern European Jewish descent c. in the laboratory, the PT is prolonged and the APTT is normal d. when necessary, FFP may be used to treat this disorder 93. A patient develops unexpected bleeding and the following test results were obtained: PT and APTT: prolonged D-dimer: increased Fibrinogen: decreased Platelets: decreased What is the most probable cause of these results? c. DIC a. familial afibrinogenemia b. primary fibrinolysis d. liver disease 94. The following test results were obtained: PT and APTT: prolonged D-dimer: normal Fibrinogen: decreased Platelets: normal What is the most probable cause of these results? a. hemophilia A c. DIC d. fibrinolysis, liver disease b. vWD 95. The lupus inhibitor is the most frequently occurring inhibitor and one of the commonest causes of prolonged APTT encountered in the laboratory. In the presence of lupus inhibitor: 1. PT may be normal or slightly prolonged, APTT will be prolonged 2. platelet neutralization (PNP) is positive 3. dilute Rusell vipe...