Hematology Final exam
Population C
The scatterplot that is pictured below represents results from a normal peripheral blood sample that was analyzed using flow cytometery. The cell that is indicated by the arrow on the right would fall into which of the circled areas? Population A Population B Population C
check specimen for clots
What action should be taken when a platelet count of 60 X 10^9/L is obtained? check specimen for clots call physician reflex a differential release results
Turn the slide over
What is the proper corrective action if an image cannot be seen at any power using a light microscope? Turn the slide over open diaphragms to the maximum width and length Clean the objectives Clean the eyepiece
Primary myelofibrosis
What myeloproliferative disorder is associated with the abnormal erythrocyte morphology indicated by the arrows in the peripheral blood smear image on the right? Please select the single best answer Primary myelofibrosisEssential thrombocythemiaChronic myeloid leukemiaPolycythemia vera
Mature T cells
CD5 antigen is normally found on which of the following lymphocyte populations? Mature T cells Normal B cells Both mature T cells and normal B cells
Eosinophil granule release
What causes the characteristic heart and/or lung damage frequently demonstrated in patients with chronic eosinophilic leukemia? A. Fibrosis of the bone marrowEosinophil deficiencyEosinophil granule releaseIncreased red cell mass
Lymphocytes
What cell population is gated in this peripheral blood sample case analyzed by flow cytometry? Monocytes Lymphocytes Granulocytes Neutrophils
4:1
What is the average M:E ratio for normal adult bone marrow? 1:3 4:1 1:4 6:1
CD20
Which of the following CD markers is NOT present on a normal mature T cell? CD20 CD7 CD3 CD5
Iliac crest
Which of the following sites is the most preferable for bone marrow aspiration and biopsy in adults? Sternum Iliac crest Fibula Vertebra
CD 4
The CD markers associated with CLL include all of the following except: CD 4 CD 5 CD 19 CD 20
False
The CFU-GEMM is a multipotential stem cell, capable of differentiating into a lymphoid or nonlymphoid precursor committed cell True False
CLL
A peripheral blood picture dominated by mature lymphocytes that resemble nucleated red blood cells would most likely be seen in: Sézary syndrome Burkitt's lymphoma CLL Infectious mononucleosis
37%
A patient's hemoglobin is 12.3 g/dL. On the peripheral smear, the red cells appear normochromic and normocytic. The hematocrit value that correlates with these data is: 34% 37% 40% 43%
Cells in the gated population are coexpressing CD5 and CD20.
A population of small lymphocytes is gated for further evaluation in the flow cytometry laboratory. The scatterplot for one of the evaluations is shown on the right. How would you interpret this scatterplot? Cells in the gated population are predominantly expressing CD5, but not expressing CD20 Cells in the gated population are predominantly expressing CD20, but not CD5 Cells in the gated population are coexpressing CD5 and CD20. Cells in the gated population are expressing neither CD5 nor CD20.
TRUE
All helper cells are T cells. Consequently, in a normal lymphocyte population, it is reasonable to expect all CD4-positive cells to be CD3-positive as well. True or False? True False
Destructive bone lesions
All of the following are consistent with the clinical and pathological picture of Waldenström's macroglobulinemia except: M spike due to IgM Lymphadenopathy and splenomegaly Proliferation of lymphocytes and plasmacytoid lymphocytes Destructive bone lesions
Increased levels of tyrosine kinase activity
All of the following are related to the pathophysiology of multiple myeloma except: Acceleration of plasma cells in the bone marrow Increased levels of tyrosine kinase activity Activation of osteoclasts Production of an abnormal monoclonal protein
Very little, light blue cytoplasm
All of the following describe characteristics of a plasma cell except: Medium-sized cell Eccentric nucleus Well-defined Golgi apparatus Very little, light blue cytoplasm
Production of opsonizing antibodies
All of the following splenic functions are related to hematopoiesis, except: Production of opsonizing antibodies Production of WBCS, if necessary Filtering out of old or deformed cells Storage of platelets and granulocytes
Hodgkin's disease
An abnormal proliferation of B lymphocytes seen in lymph node biopsy with a morphology resembling an owl's eye is commonly associated with: Acute lymphocytic leukemia Chronic lymphocytic leukemia Infectious mononucleosis Hodgkin's disease
A round nucleus
As a red blood cell matures, what is one key morphological feature of the stages containing a nucleus? Basophilic cytoplasm through every stage of maturation Granules in the cytoplasm A round nucleus An increase in size as the cell matures
Leukemia
Bone marrow aspiration is usually required in conditions of: Anemia Hypoxia Leukemia Hepatosplenomegaly
TRUE
Cell size is indicated by forward scatter and granularity is indicated by side scatter in flow cytometry. True False
30-70%
Chronic eosinophilic leukemia is associated with a clonal proliferation of eosinophils in the bone marrow. Which of the following eosinophil percentage ranges is typically demonstrated in the peripheral blood of these patients? Please provide an answer Please select the single best answer 5-10%10-20%30-70%80-90%
Myeloid
Chronic myeloid leukemia (CML)
Waldenström's macroglobulinemia
Cryoglobulins (foamy, purple blobs on peripheral smear) are associated with: Multiple myeloma Hodgkin's lymphoma Non-Hodgkin's lymphoma Waldenström's macroglobulinemia
Lysed
During the 'staining' process prior to flow cytometry analysis of white blood cells, erythrocytes are _______ . Lysed Bound Counted
All of the above
During the flow cytometry analysis process, cells exiting the flow cell intersect a laser, and produce what kind of data? Intrinsic cell characteristics Extrinsic cell characteristics Forward scatter Fluorescence All of the above
Kidneys
Erythropoietin is produced by the: Kidneys Liver Spleen Thymus gland
Megakaryocytic
Essential thrombocythemia
False
Extrinsic cell characteristics are reflected by the forward and side scatter on a flow cytometry cytogram. True False
16
From each pronormoblast precursor cell, _____ mature red blood cells are produced. 4 8 12 16
pathophysiology
Hematology is a discipline of medicine in which basic morphologic observations can be traced to a distinct ____________. pathophysiology error action area
Autoimmune hemolytic anemia
Hypogammaglobulinemia is a significant feature in half of patients with CLL. This complication can lead to: Refractory anemia Essential thrombocytosis Autoimmune hemolytic anemia Pernicious anemia
93%
If 100% of the cells in the gated lymphocyte population are positive for CD45 (i.e., they are leukocytes) and 7% are B cells (represented by CD19 and CD20 positivity), approximately what percentage of T cells would be expected? 10% 50% 93% It's impossible to predict
B cells
It has already been established that the gated cell population is lymphocytic in nature. CD19 and CD20 cell surface antigens both appear on what type of lymphocytes? B cells T-helper cells Cytotoxic T cells
non-Hodgkin's lymphoma
Lymphoma cells in the peripheral smear are associated with: Hodgkin's lymphoma CLL non-Hodgkin's lymphoma Multiple myeloma
Bone marrow sinuses
Mature red blood cells leave the bone marrow and enter the circulation via the: Reticuloendothelial system Osteoclasts Spleen Bone marrow sinuses
False
Monoclonal antibodies are designed to bind to all antigens on cell surfaces. True False
Strip the capsule from bacterial pathogens
Opsonizing antibodies produced by the spleen serve to: Strip the capsule from bacterial pathogens Recycle erythrocyte byproducts Aid in extramedullary hematopoiesis Fight viral infection
Often are immunocompromised
Patients with CLL: Die most often of blast crisis Are usually younger than 40 years May develop monoclonal spikes Often are immunocompromised
True
Patients with moderate anemias (7 to 10 g/dL) may be asymptomatic. True False
ErythrocyticMyeloid
Polycythemia vera
Fibroblast
Primary myelofibrosis
CD19 CD20 Kappa or Lambda
Select each marker listed below that is expressed by a normal mature B cell. More than one answer is correct. CD19 CD20 Kappa or Lambda CD2
An exact amount of analyte is present in a standard or calibrator
Standards and calibrators differ from control materials because: An exact amount of analyte is present in a standard or calibrator A variable amount of analyte is present depending on patient samples Standards only need to be within a target range Standards are run to the best estimate of the known value
RDW
The CBC parameter that gives insight into the amount of anisocytosis present in a specimen is: RDW MCHC MCV Hgb
9 and 22
The Philadelphia chromosome, associated with chronic myeloid leukemia (CML), involves a reciprocal translocation of genes from which two chromosomes? 7 8 9 10 20 21 22
Hairy cell leukemia
The TRAP stain is useful in the diagnosis of: CLL PLL Hairy cell leukemia Hodgkin's lymphoma
10X
The ____ objective is used for locating the feathered edge and gross slide abnormalities. 10X 40X 50X 100X
40X
The ____ objective is used for scan and estimating counts. 10X 40X 50X 100X
MCV
The ______ is one of the most stable parameters in a CBC MCV Hct MCHC MCH
Rouleaux
The most characteristic change seen in the peripheral smear of a patient with multiple myeloma is the presence of: Microcytic hypochromic cells Intracellular inclusion bodies Rouleaux Agglutination
TRUE
The primary WHO criteria for diagnosis of polycythemia vera are bone marrow morphology (hypercellularity with prominent erythroid, granulocytic, and megakaryocytic proliferation), along with JAK2(V617F) or exon 12 mutation. Select true or false TrueFalse
Multiple myeloma
The protein electrophoresis pattern pictured here is most frequently associated with: Hodgkin's lymphoma Multiple myeloma Thalassemia major Essential thrombocytopenia
one-third
The spleen harbors _____ of the circulatory platelet mass. one-quarter one-third one-half three-quarters
reference interval
To establish a ___________, at least 25 samples are taken from individuals representing healthy male and female adults and children. reference interval delta check target range critical value
Hairy cell leukemia
The cells at the tip of the pointer are most frequently associated with: CLL Hairy cell leukemia Sézary syndrome Multiple myeloma
Liver and spleen
The key organs involved in extramedullary hematopoiesis include the: Kidney and thymus Lymph nodes and heart Liver and spleen Kidney and liver
100X
he ____ objective is used for fine microscopic work. 10X 40X 50X 100X
ocular, objectives, diaphragm and stage
The compound microscope is composed of which of the following parts? ocular, objectives, diaphragm and stage stage, wings, curtains, cyclorama resin, geodes, prismatic sand, verdant salts pharynx, larynx, diaphragm and trachea
Erythropoietin
The hormone responsible for red blood cell development in the bone marrow is: Thyroxin Insulin Leukopoietin Erythropoietin
Leukocytes
The image on the right contains the fluorescence data from CD45 from a flow cytometry analysis. Note that virtually all cells in the gated population have CD45 surface antigens, indicating they are which type of cells? Leukocytes Erythrocytes Platelets
IgG
The immunoglobulin responsible for secondary immunological response and a monoclonal over-production in multiple myeloma is: IgA IgM IgD IgG
Chronic myeloid leukemia (CML)
A 67-year-old man visits his primary care physician due to some abdominal discomfort. The physician notes that the man has also experienced malaise lately that has prevented him from completing his daily exercise routine. A CBC and chemistry panel are ordered. The chemistry panel results were relatively normal, but the CBC was abnormal and triggered a manual differential. The image to the right represents a typical field of this patient's peripheral blood smear. The CBC and differential revealed the following results: AnalyteValueReference IntervalWBC72 x 109/L3.8-9.8 x 109/LRBC3.1 x 1012/L4.5-5.9 x 1012/LPlatelet500 x 109/L140-440 x 109/L Manual Differential: Blasts - 2%, Promyelocytes - 2%, Myelocytes - 8%, Metamyelocytes - 13%, Bands - 28%, Neutrophils - 26%, Lymphocytes - 17%, Monocytes - 4% Which of the following myeloproliferative neoplasms is MOST consistent with these results? Please select the single best answer Chronic myeloid leukemia (CML)Chronic eosinophilic leukemia (CEL)Polycythemia vera (PV)Essential thrombocytosis (ET)
Iron-containing cells
A Wright-stained smear of a patient's bone marrow would effectively reveal all the following cells except: Iron-containing cells RBC precursor cells WBC precursor cells Mature WBCs
Chronic lymphocytic leukemia
A monoclonal B-cell population (Kappa or Lambda predominant) with expression of CD19, CD20, CD23, and co-expression of CD5 is consistent with which of the following? A normal B cell Chronic lymphocytic leukemia Mantle cell lymphoma A mature T cell
Thalidomide
A new treatment for multiple myeloma that was once banned from use in pregnant women is: EPO Thalidomide Demerol Interferon
Primary myelofibrosis
A patient suspected of having a myeloproliferative disorder is undergoing a bone marrow aspiration to confirm the diagnosis. The physician was unable to collect the sample and reported a "dry tap." Which myeloproliferative disorder is commonly associated with failure to aspirate bone marrow successfully (known as dry tap)? Please select the single best answer Chronic neutrophilic leukemiaPolycythemia veraEssential thrombocythemiaPrimary myelofibrosis
MCV = 92.8 fL, MCH = 31.2 pg, MCHC = 33.6%
A patient with the following values—RBC = 4.01X10^12/L, Hgb = 12.5 g/dL, and Hct = 37.2%—will most likely have which of the following RBC indices? MCV = 92.8 fL, MCH = 31.2 pg, MCHC = 33.6% MCV = 92.8 fL, MCH = 33.6 pg, MCHC = 31.2% MCV = 107.8 fL, MCH = 32.1 pg, MCHC = 33.6% MCV = 132.2 fL, MCH = 32.1 pg, MCHC = 33.5%
Pancytopenia
A significant feature of hairy cell leukemia not seen is other acute leukemias is: Panmyelosis Pancytosis Pancytopenia Panhyperplasia
Polychromatophilic
Describe the hemoglobin content of the cell at the end of the pointer that is often seen in response to anemic stress. Normochromic Hypochromic Polychromatophilic Hyperchromic
The red blood cell membrane must be deformable
For a red blood cell to live its full 120-day life span, which condition is necessary? The red blood cell membrane must be deformable. The red blood cell must have enough granules. The red blood cell must always remain in a round shape. There must be enough hemoglobin, regardless of function
Polycythemia vera (PV)
Pruritis (itching) after exposure to warm water is associated with which type of myeloproliferative disorder? Essential thrombocytosis (ET)Polycythemia vera (PV)Chronic neutrophilic leukemia (CNL)Primary myelofibrosis (PMF)
WBC >100 x 10^9/L, left shift with <20% blasts
What peripheral blood findings shown below are MOST consistent with the chronic phase of chronic myeloid leukemia (CML)? Please select the single best answer WBC >100 x 109/L, left shift with <20% blastsWBC >100 x 109/L, left shift with >20% blastsWBC <100 x 109/L, neutropenia, increased nucleated red blood cellsWBC <100 x 109/L, absence of basophils and eosinophils
Gated
When analyzing the raw data of a sample on the flow cytometer, CD marker information on the histograms represents data inside the _____ population. Gated Non-gated
Patient does not meet all required diagnostic criteria for a specific MPN. Patient demonstrates features of more than one specific MPN.
When would a myeloproliferative neoplasm be classified as "myeloproliferative neoplasm, unclassifiable (MPN-u)"? More than one answer is correct. Please select all correct answers Patient does not meet the age requirement for a specific MPN.Patient does not meet all required diagnostic criteria for a specific MPN.Patient does not meet the gender requirement for a specific MPN.Patient demonstrates features of more than one specific MPN.
Trisomy 12
Which of the following genetic alterations is associated with a poor prognosis in CLL? Trisomy 13 Trisomy 12 t(15:17) t(9:21)
Allergic
Which of the following is NOT a category of clonal hypereosinophilic syndrome (HES)? Please select the single best answer MyeloproliferativeAllergicLymphocyticIdiopathic
Spleen
Which of the following is a primary site for hematopoiesis in a fetus of 4 to 5 months' gestation? Yolk sac Spleen Distal long bones Axial skeleton
Both A and B Spleen Liver
Which of the following is a site of extramedullary hematopoiesis in an adult? Spleen Liver Iliac crest Both A and B
Essential thrombocytosis
Which of the following myeloproliferative neoplasms is characterized by a marked increase in platelets; giant abnormal platelets; abnormal response to ADP, collagen, and epinephrine in platelet aggregration testing? MastocytosisChronic myeloid leukemiaPrimary myelofibrosisEssential thrombocytosis
> 20% basophils
Which of the following peripheral blood findings is consistent with the onset of the accelerated phase of chronic myeloid leukemia (CML)? Please select the single best answer > 20% basophils> 20% eosinophils> 20% monocytes> 20% lymphocytes
Tear drop cells
Which of the following red blood cell morphologic features is associated with primary myelofibrosis? Please select the single best answer Tear drop cellsSickle cellsSpherocytesTarget cells
All the above
Which of the following represents an example of a safety violation in the laboratory? Application of cosmetics Mouth pipetting Consuming bottled water All the above
40%
Which of the following represents the percent population of T-helper cells in this sample data? Absolute lymphocyte count= 2.4 x 109/L %CD3 = 60%CD4 = 40%CD8 = 20 60% 40% 20%
It is a precursor to T-cell lymphoma
Which of the following statements about Hodgkin's disease is false? The peak incidence for the disease is 15 to 40 years of age. The disease occurs more frequently in males. It is a precursor to T-cell lymphoma Individuals who have been exposed to the Epstein-Barr virus may be more vulnerable to Hodgkin's lymphoma.
They are often seen in elderly patients and progress slowly.
Which of the following statements is true about chronic lymphoproliferative disorders? Complications are related to overactive immune systems. They are often seen in elderly patients and progress quickly. They are often seen in elderly patients and progress slowly. They are a clonal proliferation of granulocytes.
Giant platelets in peripheral bloodPlatelet clumps in peripheral blood
Which of the following thrombocytic characteristics are often associated with essential thrombocythemia (ET)? Absence of megakaryocytes in the bone marrowGiant platelets in peripheral bloodPlatelet clumps in peripheral blood
T-helper cells
Which of the following types of lymphocytes express CD4? T-helper cells T-cytotoxic cells All T cells B cells
Reticulocyte count
Which of these assays is the best test to assess the bone marrow's response to anemic stress? Hemoglobin value MCV value Reticulocyte count Hematocrit
Granulocytes
Which of these white blood cell populations would have the MOST side scatter when analyzed using flow cytometry? Monocytes Lymphocytes Granulocytes
Hypercellular bone marrow and Neutrophils/bands >80%
Which two of the following laboratory blood test results are associated with chronic neutrophilic leukemia (CNL)? More than one answer is correct. Please select all correct answers WBC count = <5 x 109/LPresence of Philadelephia chromosomeNeutrophils/bands >80%Hypercellular bone marrow
Iron deficiency anemia
Which type of anemia can be caused by the common treatment for polycythemia vera, which is used to manage patient symptoms? Please select the single best answer Megaloblastic anemiaIron deficiency anemiaPernicious anemiaAplastic anemia
critical values
______ are results that exceed or are markedly decreased from the reference interval. critical values reference values delta checks analytes
PPE
_______ include gloves, masks, eye and face shields, countertop shields, and fluid-resistant gowns or laboratory coats PPE OSHA CDC CAP
postanalytical
_______ variables refer to laboratory practice after the sample has been analyzed. preanalytical postanalytical technical reflex
preanalytical
________ variables refer to events or circumstances that occur to the unknown sample before analysis preanalytical postanalytical technical reflex
handwashing
____________ to prevent contamination should occur before and after each patient encounter, each time gloves are removed, and any time gloved or ungloved hands have been contaminated with a bodily fluid. handwashing standard precautions universal cautions safety practices
