final exam quiz

7/28/2019 Final Exam Quiz

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IntroductionLevel I & ll Multiple Choice

1 . A hemoglobin concentration of 19 g/dL is normal for which individual listed below? [Hint]

1-day-old infant

5-year-old child

20-year-old male

65-year-old female

2 . If a patient were suffering from appendicitis, you would expect which cells to be increased in the peripheral blood? [Hint]

erythrocytes

lymphocytes

neutrophils

platelets

3 . Which cells make up the biggest mass of cells in the peripheral blood? [Hint]

erythrocytes

platelets

neutrophils

lymphocytes

4 . These cells are important in maintaining normal hemostasis: [Hint]

erythrocytes

platelets

neutrophils

monocytes

5 . A patient has a WBC count of 25 x 10 /L. The doctor subsequently orders a differential count. This is an example of __________. [Hint]

extensive screening

doctors error in ordering

reflex testing

prospective ordering

6 . In a fee-for-service system, laboratory testing is considered ________ to the hospital. [Hint]revenue

unnecessary

wasteful

a cost

7 . You are asked to be a member of a team designing a cost-efficient quality care protocol for patients receiving anticoagulant therapy.This is an example of: [Hint]

clinical pathway development
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reflexive testing development

prospective care protocol

disease management

8 . Which of the following is NOT a method to help control costs of medical care? [Hint]

clinical pathway development

disease management

fee-for-service plans

reflexive testing

9 . An increase in the concentration of neutrophils in the peripheral blood is most commonly due to: [Hint]

blood loss

infection

poor diet

increasing age

10.

Your laboratory hematology team decides to create a testing protocol that will help physicians identify the cause of anemia. This is anexample of: [Hint]

reflexive testing

capitated testing

prospective testing

critical pathway development

Cellular Homeostasis and HematopoiesisLevel I Multiple Choice

1 . The protein kinase responsible for triggering the sequential steps in the cell-division cycle is: [Hint]

cyclin

Cdk

Cdk inhibitor

p21

2 . Apoptosis is best described as: [Hint]

pathologic cell death resulting

accelerated differentiation

programmed cell death

terminal differentiation and loss of ability to undergo proliferation

3 . Which of the following are considered to be initiators of apoptosis? [Hint]

growth factor withdrawal
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loss of attachment to extracellular matrix

cell-damaging stress

all of the above

4 . All of the following are events regulated by apoptosis EXCEPT: [Hint]

elimination of autoreactive lymphocytes

elimination of expanded lymphocytes following cessation of immune response

elimination of expanded erythrocytes following cessation of hypoxic episode

elimination of expanded phagocytic cells following cessation of infection/inflammatory response

5 . Differentiation is best described as: [Hint]

a. the appearance of different properties in cells that were initially equivalent

the instance when two cells, derived from the same precursor, take separate routes of development

the totality of phenomena that begins with commitment and ends when the cell has all of its characteristics

The "aging" or senescence of a cell

6 . The morphologically recognizable population of hematopoietic precursor cells, capable of amplification by proliferation, is the: [Hint]

mature cells

stem cells

maturing cells

progenitor cells

7 . Hematopoietic growth factors exert all of the following effects on hematopoietic cells EXCEPT: [Hint]

promote cell survival by suppressing apoptosis

promote cell proliferation

regulate the processes of differentiation

promote senescence

8 . All of the following are characteristics of hematopoietic growth factors EXCEPT: [Hint]

Most growth factors are produced by stromal cells in the microenvironment.

Individual growth factors, by themselves, are poor stimulators of colony growth.

Most growth factors are relatively lineage-specific.

Growth factors commonly act synergistically with other cytokines.

9 . All of the following are considered early-acting (multilineage) growth factors EXCEPT: [Hint]

stem cell factor

thrombopoietin

Flt3 ligand

GM-CSF


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10 . A gene with the capacity to transform a cell into a malignant phenotype is a/an: [Hint]

proto-oncogene

tumor suppressor gene

oncogene

anti-oncogene

Cellular Homeostasis and HematopoiesisLevel II Multiple Choice

1 . The cyclin that is synthesized in response to growth factor stimulation, and is responsible for G1 progression, is: [Hint]

Cyclin A

Cyclin B

Cyclin D

Cyclin E

2 . The cell cycle regulatory protein that functions to inhibit cell cycling by sequestering transcription factors required for cell cycle progression from

G1/S is: [Hint]Rb

p53

E2F

p21

3 . The protein responsible for monitoring for DNA damage, and the integrity of the genome, is: [Hint]

Rb

p53

E2F

p16

4 . The Bcl-2 family of proteins, important in regulating activation of execution caspases, is located: [Hint]

free in the cytosol

associated with the cellular membrane

associated with the mitochondrial membrane

associated with the endoplasmic reticulum membrane

5 . Which of the following is considered an example of a death cytokine/death receptor pair? [Hint]

kit ligand/kit receptor

flt3 ligand/flt receptor

fas ligand/fas receptor

mpl/mpl receptor

6 . All of the following are considered diseases associated with increased apoptosis EXCEPT: [Hint]


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AIDS

Parkinsons Disease

Systemic lupus erythematosus

Aplastic anemia

7 . All of the following are important regulators of thrombopoiesis except: [Hint]

TPO

IL-11

IL-4

IL-6

8 . The adhesive glycoprotein largely responsible for the retention of developing erythrocyte precursors in the bone marrow is: [Hint]

fibronectin

hemonectin

thrombospondin

glycosaminoglycans

9 . A major factor in maintaining stem cell quiescence in the hematopoietic microenvironment is: [Hint]

MIP-1

TNF

SCF

Flt3 ligand

10.

Proto-oncogenes encode which of the following regulatory proteins? [Hint]growth factors

growth factor receptors

transcription factors

all of the above

Structure and Function of Hematopoietic OrgansLevel I Multiple Choice

1 . The correct sequence of location of hematopoiesis during development is: [Hint]AGM bone marrow liver

bone marrow liver spleen

yolk sac liver bone marrow

yolk sac thymus AGM

2 . All of the following cell types are found in bone marrow except: [Hint]

adipocytes


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macrophages

osteoblasts

thymocytes

3 . Which of the following is true of the thymus? [Hint]

It enlarges after adolescence.

It provides mature macrophages to the rest of the body.

It has a high rate of cell death.

It is nonfunctional in old age.

4 . Which region of the spleen would most likely be normal in an immune-deficient person? [Hint]

white pulp

marginal zone

germinal center

red pulp

5 . Both lymph node and spleen have which structure? [Hint]

B-cell follicle

marginal zone

medulla

red pulp

Structure and Function of Hematopoietic OrgansLevel II Multiple Choice

1 . Bone marrow hyperplasia occurs most commonly in association with: [Hint]

immune response

marrow fibrosis

ineffective erythropoiesis

toxin exposure

2 . All of the following may cause hypersplenism except: [Hint]

metastatic tumor

antibody-coated red blood cells

clot in the splenic artery

cirrhosis

3 . A common cause of lymphadenopathy is: [Hint]

infection

liver disease


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extramedullary hematopoiesis

antibody-coated platelets

4 . Which of the following may occur after splenectomy for blood disorders associated with antibodies directed against blood cells? [Hint]

decreased platelet count

removal of antibodies from circulation

increased numbers of spherocytes

increased risk of infection

5 . Hereditary spherocytosis may lead to splenomegaly because of: [Hint]

increased removal of erythrocytes

increased lymphoid tissue

the presence of tumor cells

the accumulation of undigestible substances

1 . Which of the following stages in erythrocyte development can be found in both the bone marrow and peripheral blood? [Hint]

reticulocyte

pronormoblast

polychromatophilic normoblast

orthochromatic normoblast

2 . A NRBC has the following characteristics: no visible nucleoli, moderate N:C ratio, deeply basophilic cytoplasm, irregular clumping of chromatinon the nuclear rim. These characteristics describe which of the following maturation stages? [Hint]

orthochromic normoblast

basophilic normoblast

pronormoblast

metarubricyte

3 . The majority (90%) of the erythrocyte's metabolism for energy production is produced from: [Hint]

NADH

2,3-DPG

glucose

glycogen

4 . Predict which of the following erythroid maturation stages would be the most sensitive to erythropoietin stimulation: [Hint]

polychromatic normoblast

BFU-E

reticulocyte

CFU-E

5 . The presence of hemosideruria infers which of the following? [Hint]


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increased serum iron

increased intravascular hemolysis

increased serum haptoglobin levels

increased serum ferritin

6 . The erythrocyte membrane is important in all the following EXCEPT: [Hint]

maintaining erythrocyte flexibility

generation of ATP

maintaining erythrocyte shape

carrier for cell antigens

7 . Which of the following describes normal erythrocytes? [Hint]

contain iron granules

cell volume between 70 to 100 fL

mean diameter of 7 - 8

Life span of 90 days

8 . In extravascular hemoglobin destruction, heme rings are broken down with the resulting direct production of which of the following? [Hint]

transferrin

conjugated bilirubin

carbon monoxide

hemopexin

9 . The body's most common and efficient method of removal of aged or abnormal erythrocyte, and recovery of essential components such as ironand amino acids, is: [Hint]

intravascular erythrocyte destruction

red cell fragmentation and removal in the biliary tract

extravascular erythrocyte destruction

breakdown of old erythrocytes in the small intestine

10.

Which of the following describes the reticulocyte ? [Hint]

contains RNA

reference range is 5-15%

has a pyknotic nucleus

is smaller than a mature RBC

HemoglobinLevel I Multiple Choice

1 . Which of the following is a minor hemoglobincomponent in an adult? [Hint]

hemoglobin A


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hemoglobin A2

hemoglobin Portland

hemoglobin Gower I

2 . The Bohr effect refers to the ability of hemoglobinto: [Hint]

accept H+

carry CO2

exchange Cl-for HCO3

-

respond to changes in 2,3-DPG levels

3 . What effect would iron deficiency have on the rate ofhemoglobin synthesis? [Hint]

increase it

decrease it

no effect

cant be predicted

4 . When 2,3-DPG increases, the oxygen affinity ofhemoglobin: [Hint]

increases

is unaffected

decreases

is unpredictable

5 . How many iron molecules are present in a moleculeof hemoglobin? [Hint]

one

two

three

four

6 . An increase in the concentration of HbA1c is anindication of: [Hint]

iron deficiency

methemoglobinemia

diabetes

increased HbA

7 . Which of the following shifts the ODC to theright? [Hint]

decreased PCO2


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increased PO2

decreased H+

concentration

increased temperature

8 . Which of the following hemoglobins is thepredominant hemoglobin in infants? [Hint]

hemoglobin A

hemoglobin A2

hemoglobin F

hemoglobin Portland

9 . Normally, hemoglobin concentration is maintained ina steady state by: [Hint]

balance in the production and destruction oferythrocytes

coordination of production of equal quantitiesof and globin chains

regulation of transferrin receptors

regulation of destruction of ferritin mRNA

10.

A hemoglobin of 160 g/L in an adult male isconsidered: [Hint]

decreased

normal

increased

borderline abnormal

HemoglobinLevel II Multiple Choice

1 . Which of the following is the major hemoglobin found in adults? [Hint]

22

22

22

22

2 . Insertion of iron into the protoporphyrin ring takes place in the: [Hint]cytoplasm

ribosomes

mitochondria

nucleus

3 . Hemoglobin electrophoresis should be considered when a patient has: [Hint]

methemoglobinemia


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carboxyhemoglobinemia

sulfhemoglobinemia

elevated glucose level

4 . A patient has lost blood due to chronic intestinal bleeding, and has no symptoms of anemia although his hemoglobin is 9 g/dL. The bestexplanation for this is: [Hint]

His ODC curve is shifted left.

His ODC is shifted right.

The lab result is in error.

He has increased synthesis of HbF.

5 . A one-month-old baby was cyanotic. The methemoglobin level is 12%. Hemoglobin electrophoresis is normal. What additional test should bedone on this baby? [Hint]

NADPH reductase activity

reticulocyte count

isoelectric focusing

Hemoglobin A1C determination

6 . A patient with emphysema is treated with long term O2 therapy. Why does this result in an increase in the amount of O2 delivered to thetissues? [Hint]

The synthesis of erythrocytes is increased.

The synthesis of 2,3-DPG is enhanced.

It decreases the amount of O2 expired.

It increases the PO2 of inspired air.

7 . What effect does the release of O2 in the capillaries have on the H+ concentration in tissues? [Hint]

increases it

decreases it

has no effect

variable effect

8 . You are a healthy male from New York who normally does 60 minutes of aerobic exercise daily. While on vacation, you climb to 8,000 feetabove sea level at a mountain resort. Your heart rate is rapid and you are breathing fast. You feel dizzy. What is the best explanation for this setof symptoms? [Hint]

the atmospheric PO2 is increased

the atmospheric PO2 is decreased

your hemoglobin content is decreased

you have hypothermia

9 . In iron deficiency, you would expect which of the following to occur: [Hint]

increased synthesis of ferritin

decreased synthesis of transferrin receptors


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decreased ALAS activity

increased synthesis of globin chains

10.

In a child with hemoglobin M, you would expect to find: [Hint]

abnormal NADPH reductase activity

shift to the right in ODC

shift to the left in ODC

an improvement after treatment with ascorbic acid

The LeukocyteLevel l Multiple Choice

1 . Diapedesis refers to cell movement: [Hint]

through the blood stream

through endothelial cells

in the tissues

in the bone marrow

2 . The first morphologically identifiable cell in the granulocytic series is: [Hint]

CFU-GM cell

CFU- G progenitor cell

CD34+ cell

myeloblast

3 . Traditionally, the hallmark of differentiating myeloblasts from promyelocytes morphologically has been the visual identification of ____ in thepromyelocytes: [Hint]

primary granules

secondary granules

loss of nucleoli

pink cytoplasm

4 . Peroxidase containing granules are present in the following granulocytes: [Hint]

only myeloblasts

only promyelocytes

only promyelocytes and myelocytes

promyelocytes, myelocytes, metamyelocytes, band and segmented neutrophils

5 . The cells that are polymorphonuclear include: [Hint]

neutrophils

monocytes and neutrophils

neutrophils, basophils, and eosinophils


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neutrophils, monocytes, and lymphocytes

6 . A neutrophils primary function is to:[Hint]

protect the host from infectious agents

protect the host from autoimmune destruction

secrete cytokines to attract monocytes to the site of infection

secrete cytokines to attract lymphocytes to the site of infection

7 . The leukocytes responsible for phagocytosis include: [Hint]

lymphocytes and monocytes

lymphocytes and macrophages

monocytes and neutrophils

eosinophils and basophils

8 . An adult reference range for monocytes is: [Hint]

0.0 - 0.45 x 109/L

0.2 - 0.8 x 109/L

0.2 - 4.0 x 109/L

0.2 - 7.0 x 109/L

9 . Calculate the absolute number of neutrophils given the following information: Total white count = 10 x 109/L. Total RBC count = 5.0 x 10

12/L,

Neutrophils = 40%, metamyelocytes = 30%, myelocytes = 20%, and lymphocytes = 10%. [Hint]

4 x 103/L

2 x 109/L

4 x 109

/L

20 x 109/L

10.

Causes of increased lymphocytes include: [Hint]

hypersensitivity reactions

eosinophilia and viral infections

viral infections

tuberculosis, Hodgkins, and nonhematologic malignancies

11.

Physiologic variations that affect the leukocyte concentration include all of the following except: [Hint]

pregnancy

time of day

race

weight and height

12.

The newborn peripheral blood white cell differential, contrasted to that of adults, is the following finding in a newborns smear:[Hint]

leukopenia


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leukocytosis

neutropenia

monocytosis

13.

Immunoglobulin diversity is provided by: [Hint]

rearrangement of the immunoglobulin light and heavy chains gene segments in B-lymphocytes

selective translation of portions of immunoglobulin mRNA in the B-lymphocyte

rearrangement and recombination of gene coding sequences for immunoglobulin in the T-lymphocyte

rearrangement and recombination of the VH, DH, and JH genes in the T-lymphocyte

14.

Causes of monocytosis include: [Hint]

hypersensitivity reactions

eosinophilia and viral infections

viral infections and Bordetella pertussis infections

tuberculosis, Hodgkins, and nonhematologic malignancies

15.

Physiologic variations that affect the leukocyte concentration include all of the following except: [Hint]

gender

age

activity level

platelet count

16.

The most striking difference, when contrasting infants peripheral blood white cell differential to that of adults, is the follow ing finding in aninfants smear:[Hint]

neutrophilia

eosinophilia

monocytosis

lymphocytosis

17.

Immunoglobulin diversity allows the: [Hint]

B-lymphocyte to produce a variety of specific immunoglobulins that can react with foreign antigens.

selective translation of portions of immunoglobulin mRNA in the B-lymphocyte

rearrangement and recombination of gene coding sequences for immunoglobulin in the T-lymphocyte

rearrangement and recombination of the TCR genes in the T-lymphocyte

Routine Hematology ProceduresLevel I Multiple Choice

Top of Form

1 . Which anticoagulant prevents coagulation by inhibiting thrombin? [Hint]

lithium heparin


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sodium citrate

EDTA

sodium fluoride

2 . When collecting a series of tubes during a phlebotomy, which specimen collection tube should be filled last? [Hint]

green top

red top

blue top

lavender top

3 . The 1992 OSHA Bloodborne Pathogens Standard did NOT require laboratory facilities to: [Hint]

supply phlebotomists with gloves

implement the use of sharps containers

mandate vaccination for HCV

provide training in potential risk of bloodborne pathogens

4 . Which of the following will NOT affect the phlebotomist's choice of venipuncture site? [Hint]

presence of an intravenous line

large hematoma

invisible but palpatable vein

previous mastectomy on left side

5 . What is the function of a microscope's objective? [Hint]

magnify the image to the eyepieces

collect the diffracted light from the condenser

direct the light beam onto the specimen

project image to the field lens

6 . An achromat lens will correct: [Hint]

chromatic aberrations at two colors and field curvature

spherical aberrations at two colors and chromatic aberrations at two colors

chromatic aberrations at two colors and spherical aberrations at one colors

spherical aberrations at three colors and field curvature

7 . A manual leukocyte count was performed on an EDTA-anticoagulated specimen. The specimen was diluted 1:20 and a total of 132 leukocyteswere counted in the four corner squares of the hemacytometer. What is the leukocyte count? [Hint]

2.6 x 109/L

5.3 x 109/L

6.6 x 109/L


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11.0 x 109/L

8 . The following erythrocyte data were obtained from an EDTA-anticoagulated specimen: erythrocyte count = 3.92 x 1012

/L, hemoglobin = 11.4g/dL, hematocrit = 34% (.34 L/L). Calculate the MCH. [Hint]

29.1 pg

33.5 pg

67.2 pg

86.7 pg

9 . Which diluent is used for manual platelet counts? [Hint]

1% phyloxine B

3% acetic acid

0.85% sodium chloride

1% ammonium oxalate

10

.

A reticulocyte count was performed using a Miller disk, and 30 reticulocytes (square A) were observed in 290 erythrocytes (square B). What is

the reticulocyte count? [Hint]0.9%

1.1%

2.3%

3.0%

11.

Which of the following will be observed if a purple top collection tube is underfilled? [Hint]

falsely elevated leukocyte count

falsely decreased erythrocyte sedimentation rate

falsely elevated hemoglobin

falsely decreased reticulocyte count

12.

A patient has an elevated fibrinogen level. How will this affect the patient's ESR? [Hint]

ESR will be unaffected.

ESR will be elevated.

ESR will be decreased.

ESR will be uninterpretable.

13.

The clinical laboratory scientist overfilled the second side of the hemacytometer, but carefully removed excess fluid with a kimwipe. What effectwould this have on the hemacytometer cell count? [Hint]

Result would be unaffected.

Result would be falsely decreased.

Result would be falsely increased.

Result would be equivocal.

14.

In performing an examination on a Wright-stained peripheral blood smear, the clinical laboratory professional observes enlarged platelets andvacuolated leukocytes. What is the appropriate course of action? [Hint]


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Perform a second 100-cell differential.

Ignore them, since they are artifacts, and report platelet and leukocyte morphology as normal.

Collect new specimen and prepare blood smear within three hours.

Send smear for pathology review, since these changes are abnormal.

15

.

The following erythrocyte data were obtained from an EDTA-anticoagulated specimen: erythrocyte count = 2.93 x 10 /L, hemoglobin = 5.9

g/dL, hematocrit = 21% (.21 L/L). What would you expect to observe on a Wright-stained peripheral blood smear? [Hint]normochromic, normocytic erythrocytes

hypochromic, microcytic erythrocytes

normochromic, macrocytic erythrocytes

hypochromic, normocytic erythrocytes

16.

A patient is known to have high levels of sulfhemoglobin. How will this affect the patient's hemoglobin determination? [Hint]

Result will be unaffected, since sulfhemoglobin is measured by the cyanmethemoglobin method.

Result will be falsely elevated, since sulfhemoglobin will be precipitated, causing turbidity.

Result will be falsely decreased, since sulfhemoglobin is not measured by the cyanmethemoglobin method..

Result must be corrected for the presence of sulfhemoglobin using a correction factor.

Bottom of Form

Peripheral Blood SmearLevel I Multiple Choice

Top of Form

1 . The microscopic examination of a Wright-stained blood smear revealed bluish-gray erythrocytes and intensely black leukocyte nuclei. What isthe best explanation for this appearance? [Hint]

The buffer was too acidic.

The rinsing process was prolonged.

The blood smear was too thin.

The Wright stain was too alkaline.

2 . In the examination of a blood smear, 95 leukocytes were observed in five fields of view. What is the leukocyte estimate? Assume an EDTAblood specimen was used to prepare the smear. [Hint]

1.9 x 109/L

3.8 x 109/L

19.0 x 109/L

38 x 109/L

3 . If the leukocyte count in question #2 was 4.5 x 109/L, does the leukocyte estimate correlate? [Hint]

yes

no

4 . A leukocyte count of 28.5 x 109/L was obtained on an EDTA-anticoagulated specimen. Examination of the blood smear revealed 112

nucleated erythrocytes per 100 leukocytes. What is the corrected leukocyte count? [Hint]

13.4 x 109/L


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16.8 x 109/L

25.4 x 109/L

28.5 x 109/L

5 . Which component of Wrights stain is responsible for the red-orange color of an erythrocyte? [Hint]

azure B

methylene blue

eosin

methanol

6 . A patient's CBC results included an MCV = 72 fL, MCH = 30 pg, and MCHC = 33%. What would you expect to observe for the erythrocytemorphology? [Hint]

normochromic and normocytic

normochromic and microcytic

normochromic and macrocytic

hypochromic and microcytic

7 . If you observe platelet satellitism on the Wright-stained blood smear of a patient, what CBC parameter should you check for accuracy? [Hint]

platelet count

WBC count

RBC count

reticulocyte count

8 . You count 15 platelets in each of five microscopic fields at 100x magnification on a Wright stained blood smear. What is the approximate

platelet count? [Hint]500 x 10

9/L

225 x 109/L

100 x 109/L

23 x 109/L

9 . You count about six platelets per field at 100x magnification on a Wright-stained smear. What is the most accurate description of the plateletcount? [Hint]

normal

decreased

increased

cant tell from this information

10.

One day the clinical laboratory technician notices that all blood smears examined under the microscope show crenated red blood cells. What isthe potential problem ? [Hint]

The smears are too thin.

The room is too cold.


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The smear is too thick.

The smears are dried too slowly.

Bottom of FormPeripheral Blood SmearLevel II Multiple Choice

1 . A patient with a history of polycythemia is seen for a routine checkup. What might the clinical laboratory personnel have to do to prepare anoptimal blood smear? [Hint]

Decrease the angle of the spreader slide and decrease the push speed.

Decrease the angle of the spreader slide and increase the push speed.

Increase the angle of the spreader slide and increase the push speed.

Increase the angle of the spreader slide and decrease the push speed.

2 . Initial examination of a Wright-stained blood smear reveals bright red erythrocytes and very pale leukocyte nuclei. To correct this improperstaining, the clinical laboratory professional should: [Hint]

Decrease the staining time.

Prepare a thinner blood smear.

Decrease the pH of the stain.

Increase the pH of the buffer

3 . In examining the patient's Wright-stained blood smear, the clinical laboratory professional noted the presence of platelet clumps. How would anaccurate platelet estimate be obtained on this patient? [Hint]

Warm specimen to 37oC for 15 minutes, then prepare peripheral blood smear.

Allow specimen to set at 25oC for five hours, then prepare peripheral blood smear.

Recollect specimen in citrate and prepare peripheral blood smear.

No corrective action is available.

4 . A peripheral blood smear examination of a Wright-stained blood smear revealed leukocytes with cytoplasmic vacuolization and karyorrhexis ofthe nucleus. What action should be taken to determine if these changes are true or artifact? [Hint]

Prepare and stain a second smear after blood has stabilized for four hours.

Recollect the specimen and prepare blood smear immediately.

Mix a portion of the blood with 22% albumin and prepare a blood smear.

Collect specimen using heparin and prepare a blood smear.

5 . A patient has cold agglutinin disease. How can a good blood smear be made from this patients blood?[Hint]

Dry the smear quickly.

Decrease the angle of the spreader slide.

Press hard on the spreader slide

Warm the blood to 37 degrees C before making the smear.

6 . A new employee complains that the staining procedure is washing all the blood off the slide. What is the likely problem? [Hint]

The stain is old.

The blood smear is too thick.


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The step with methanol is being skipped.

The buffer is too acid.

7 . You want to determine if a patients platelet count is falsely decreased due to platelet clumping. What is the most appropriate action totake? [Hint]

Examine the stained blood smear at 1000X.

Examine the stained blood smear at 100X.

Shake the EDTA tube vigorously and reanalyze.

Collect the blood in lithium heparin and reanalyze.

8 . You note rouleaux on the stained periperal blood smear. How will this affect the CBC? [Hint]

This will not affect the CBC.

The WBC count will be falsely decreased.

The RBC count will be falsely decreased.

The platelet count will be falsely increased.

9 . You are doing a differential count on a peripheral blood smear and note that there are many smudge cells present. What should you do? [Hint]

Add 1 drop of saline to a drop of blood and make another smear.

Add a lysing agent to the patients blood and make another smear.

Add 1 drop of albumin to 5 drops of blood and make another smear.

Recollect the blood in citrate and make another smear.

10.

A renal dialysis patient has a hematocrit of 15%. What adaptation can you make to assure a good blood smear? [Hint]

Increase the angle of the spreader slide and push speed.

Decrease the angle of the spreader slide and push speed.

Increase the angle of the spreader slide and decrease push speed.

Decrease the angle of the spreader slide and decrease push speed.

Bone MarrowLevel I Multiple Choice

1 . What is the preferred site for bone marrow aspiration in adults? [Hint]

posterior iliac crest

vertebral bodies

tibia

sternum

2 . Which of the following are indications for a bone marrow biopsy? [Hint]

35-year-old HIV-positive male with fever of unknown origin

60-year-old male with anemia secondary to malignancy

20-year-old woman with iron deficiency


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a child with infectious mononucleosis

3 . The anteromedial surface of the tibia is sometimes used for bone marrow aspiration in: [Hint]

patients more than 60 years old

children less than 2 years old

women in their 30s

adults

4 . Which of the following is not an indication for a bone marrow biopsy? [Hint]

Pancytopenia with rare circulating blasts

Thrombocytopenia with rare circulating blasts

Mild leukocytosis after receiving growth factor

Unexplained anemia and leukopenia

5 . Which bone marrow sample is best for evaluating cell morphology and performing the differential count? [Hint]

aspirate

biopsy

clot section

touch prep

6 . The normal M:E ratio ranges between: [Hint]

1: 2 to 1: 4

2: 1 to 4: 1

1: 4 to 1: 6

4: 1 to 6: 1

7 . A pathologist examined the core biopsy of a 50-year old male. The overall cellularity is 20%. Interpret this finding. [Hint]

Normocellular marrow for age

Hypercellular marrow for age

Hypocellular marrow for age

You cannot estimate from a core biopsy.

8 . A physician is evaluating a patient with systemic lupus erythematosus. The patient is anemic. There is difficulty interpreting the serum ironstudies. The anemia could be due to chronic disease secondary to lupus or iron deficiency. A bone marrow biopsy was performed. What specialstain should be used to evaluate the marrow? [Hint]

myeloperoxidase

Sudan black B

Prussian blue

new methylene blue

9 . A physician did a bone marrow biopsy in a patient with previous diagnosis of primary myelofibrosis. He wants to evaluate the degree of fibrosis.What stain should be used?[Hint]


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Reticulin

Prussian blue

myeloperoxidase

TdT

10

.

Why would special stains such as myeloperoxidase be performed on a bone marrow specimen? [Hint]

to differentiate types of anemia

to differentiate types of leukemia

to evaluate cellularity

to determine M:E ratio

Bone Marrow

Level II Multiple Choice

1 . A 20-year-old male with suspicion of acute leukemia had a bone marrow biopsy. His platelet count is 30 x 10 L. The man is oozing from thebiopsy site. What should be done? [Hint]

Request platelets from the blood bank for platelet transfusion.

Transfuse the patient with fresh frozen plasma.

Apply local pressure and ask the patient to lie on his back. Watch the bleeding site periodically.

Give factor VIII concentrate.

2 . You are in the laboratory to process a bone marrow biopsy. The patient is suspected to have acute leukemia. The physician who performed thebone marrow couldnt get any aspirate. You see several unstained slides that appear to be bone marrow imprints. What is the best way to usethese slides? [Hint]

Stain all slides with Wright-Giemsa.

Stain a few slides with Wright-Giemsa; save the unstained slides for possible cytochemical stains.

Stain a couple of slides with Wright-Giemsa. You cannot perform cytochemical stains on bone marrow imprints.

Perform routine cytogenetics on unstained slides.

3 . A patient is suspected of having an acute leukemia. His bone marrow revealed 40% blasts. What ancillary study can be done on the bonemarrow aspirate in almost any laboratory to determine the lineage of the blasts? [Hint]

molecular diagnostics

cytogenetics

flow cytometry

cytochemical stains

4 . A pathologist is evaluating a bone marrow aspirate performed on a 10-month-old boy who required a bone marrow for a non-hematolymphoidmalignancy. He sees an increased number of small, lymphoid-appearing cells with high nuclear cytoplasmic ratio and fine chromatin that looksimilar to blasts. What are these cells? [Hint]

mature lymphocytes

hematogones: normal lymphoid progenitor cells

immature megakaryocytes

normal erythroid precursors
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5 . The following is the bone marrow differential obtained in a patient with a recent diagnosis of chronic myeloid leukemia: Blasts 2%, promyelocytes10%, myelocytes 40%, metamyelocytes 20%, bands 5%, segmented neutrophils 10%, basophils 3%, pronormoblasts 2%, basophilicnormoblasts 3%, polychromatophilic normoblasts 3%, orthochromatophilic normoblasts 2%. What is the M:E ratio? [Hint]

9:1

11:1

10:1

5:1

6 . What is the overall bone marrow cellularity expected in a 30-year-old woman? [Hint]

100%

60 to 80%

20%

10%

7 . A pathologist is evaluating a bone marrow and saw morphologic features suggestive of a myelodysplastic syndrome. She wants to know if theseare ringed sideroblasts. What sample is not suitable to evaluate ringed sideroblasts?" [Hint]

aspirate smear

core biopsy

clot preparation

particle smears

8 . A 50-year-old male with neutropenia and splenomegaly had a bone marrow biopsy. The bone marrow revealed 60% blasts. On the peripheralblood smear are several suspicious, blast-like cells. The diagnosis is leukemia. Why do ancillary studies need to be done? [Hint]

to determine the lineage of the blasts

to determine if the leukemia is secondary to exposure to toxins

to determine the presence or absence of oncogenes

to get a more accurate blast count in the bone marrow

9 . You are assisting a physician with a bone marrow biopsy. The patient is a 30-year-old male suspected of having acute leukemia. He was able toobtain a good bone marrow aspirate and a good core biopsy. He wants to make sure you send material for flow cytometry and cytogenetics.What is the best way to divide the material you have for the different labs? [Hint]

Make several smears out of the aspirate for morphology and possible special stains. Allocate the remaining aspirate material into twotubes, an EDTA tube for flow cytometry and a heparin tube for cytogenetics. Fix the entire core biopsy in formalin.

Use all aspirate, making smears for morphology and special stains. Divide the core biopsy in two and send one piece for the flow lab andone piece for the cytogenetics lab.

Allocate the aspirate material in two EDTA tubes, one for the flow lab and one for cytogenetics. Dont make aspirate smears. P lace thecore biopsy in formalin.

None of the above is correct.

10.

A patient has had several bone marrow biopsies. The number of lymphocytes varied significantly from one specimen to another. What could bethe possible explanation for this? [Hint]

The patient had a viral infection during one of the procedures.

A lymphoid follicle may have been aspirated in one procedure.

There is a mix-up of patient specimens.

Not enough cells were counted in the differential to get a good distribution.

1 . A cell with an MCV of 69 fL is called a(n): [Hint]
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