Final Exam Rotation #1 Study Guide

hairy cell leukemia

A very rare leukemia in which the monocytes & lymphocytes have many cytoplasmic projections is called:

Myeloperoxidase

Neutrophilic primary granules contain:

the residual RNA

Reticulocytes are stained with a supravital stain, which stains the:

Hemoglobin reagent is nearing expiration

When evaluating the QC results from your hematology instrument, you note that all results for hemoglobin have trended downward for the past 7 days. All other results are within range and show no discernable trend. What of the following is the most likely explanation?

Ketones

A 17-year-old girl decided to go on a starvation diet. After 1 week of starving herself, what substance would most likely be found in her urine?

The specimen is probably old and the bacteria and yeast have consumed the glucose

A 24-year-old obese diabetic woman had the following blood and urine test results from specimens obtained at the same time: pH = 8.0 Protein = 30 mg/dL Glucose = negative Ketones = 15 mg/dL Bilirubin = negative Blood = negative Nitrate = negative Urobilinogen = 1 EU/dL SG = 1.008 Microscopic:Epithelial cells = 3-5Bacteria = manyYeast = manyAmorphous = moderateBlood sugar = 205 mg/dL Which of the following is the most likely explanation for the negative urine glucose finding?

10.4 ; 0.9

A 45-year-old female has a WBC count and differential performed. Her WBC count is 18.5 x 109 /L with the differential as follows: Neutrophils = 56% Lymphocytes = 35% Monocytes = 5% Eosinophils = 4% The physician wants to know the neutrophil and monocyte absolute counts. They are: neutrophil (x109 /L) ; monocyte (x 109 /L) Select one:

Nephrotic syndrome

A 62-year-old patient with hyperlipoproteinemia has a large amount of protein in his urine. Microscopic analysis yields moderate to many fatty, waxy, granular, and cellular casts. Many oval fat bodies are also noted. This is most consistent with:

3.0 X 1012 RBCs/L

A RBC count was performed on a 1:100 dilution and 600 cells were counted in the 5 small squares in the middle large square. What is the RBC count?

1.5 X 1012 RBCs/L

A RBC count was performed on a 1:200 dilution and 150 cells were counted in the 5 small squares in the middle large square. What is the RBC count?

effusion

A build up of fluid in a body cavity is called:

Hyperglycemia

A cerebrospinal fluid sample from an 8-year-old child with a fever of unknown origin was tested for glucose, total protein, lactate, and IgG index. The glucose was 180 mg/dL but all other results were within the reference range. The CSF WBC count was 9 cells/uL and the RBC count was 10 cells/uL. The differential showed 50% lymphocytes, 35% monocytes, 10% macrophages, 3% neutrophils, and 2% neuroectodermal cells. What is the most likely cause of these results?

between 13.6 and 14.0 g/dL

A clinical laboratory scientist performs 30 replicate hemoglobin determinations on a single blood sample. When statistics are used to determine the precision of the method, the mean is 13.8 g/dL and 1 SD is 0.1 g/dL. This means that 95% of the results on this specimen lie:

Protein S

A deficiency of which of the following can cause an increased risk of thrombosis?

lymphocyte

A leukocyte that is slightly bigger than a normal erythrocyte, has a deep purple nucleus, and has a scant amount of deep blue staining cytoplasm with no granules is the:

0.05 x 109 WBC/l

A manual WBC count is required on a patient CSF sample. The CSF is not diluted. The entire 9 squares are counted. The first side results in 48 WBCs counted and 52 WBCs were counted on the other side of the Neubauer hematocytometer. What is the WBC count?

The results can not be determined because the counts do not agree

A manual WBC count is required on a patient synovial fluid sample. The synovial fluid is diluted using a WBC Unopette. The 4 corner squares are counted. The first side results in 15 WBCs counted and 20 WBCs were counted on the other side of the Neubauer hematocytometer. What is the WBC count?

greater than 10%

A manual cell count should be repeated whenever the variation between the counts in two sides is:

155,000 plt/µl, 38,750 plt/µL

A manual platelet count is required on a patient sample. The EDTA blood is diluted 1/100 with glacial acetic acid. The entire center square is counted. The first side results in 150 cells counted and 160 platelets were counted on the other side of the Neubauer hematocytometer. What is the platelet count?

Acute myelomonocytic leukemia

A patient has a very high white blood cell count with many blasts in the blood and bone marrow. A nonspecific esterase (NSE) stain is positive. What condition is most likely from the options below?

Severe bacterial infection

A patient has a white blood cell count of 35 x 10^9 /L with a left shift. The leukocyte alkaline phosphatase stain is 220 (normal range 22-100). Which of the following is most likely?

inaccurate

A patient specimen is analyzed on an instrument known to be in control and recently calibrated. The instrument gives a hemoglobin result of 13.2 g/dL. Two hours later the same specimen is evaluated on another instrument that is being evaluated for purchase by the laboratory. The result is 11.1 g/dL. This result, when compared with the first, is:

Pale urine with a high specific gravity

A patient with uncontrolled diabetes mellitus will most likely have:

Precision

A patient's white blood cells (WBCs) are counted on an automated cell counter 10 times. The mean white cell count is 8000/mL, and the standard deviation (SD) is 300. What is the coefficient of variation (CV)?

3.8%

A patient's white blood cells (WBCs) are counted on an automated cell counter 10 times. The mean white count is 8000/mL, and the standard deviation (SD) is 300. What is the coefficent of variation (CV)?

Amorphous urates

A pink precipitate in a urine specimen with a pH of 6.0 would most probably be caused by:

calibrator

A purchased hemoglobin standard is used to adjust a hemoglobinometer. This standard is being used as a:

obtain a new specimen and set up the ESR again on the newly collected sample

A sedimentation rate is set up 4 hours after the specimen is collected. Five minutes before it is time to read the result, the technician notices that the tube is tilted. There is only 0.8mL of specimen remaining in the original collection container and 1mL is required for the test. What should the technician do to resolve the situation?

Acute interstitial nephritis

A specimen with a negative nitrate reaction and a positive leukocyte esterase reaction that has white blood cells, white blood cell casts, and NO bacteria in the sediment will be seen in cases of:

5,000,000

A sperm count is diluted 1:20 and 50 sperm are counted in two large squares of the Neubauer counting chamber. The sperm count in mLs is:

hypocellular

A stained bone marrow section that shows a significantly increased amount of fat would be described as:

uric acid

A synovial fluid sample is examined using a polarizing microscope with a red compensating filter. Crystals are seen that are yellow when the long axis of the crystal is parallel to the slow vibrating light. When the long axis of the crystal is perpendicular to the slow vibrating light, the crystals appear blue. What type of crystal is present?

acute glomerulonephritis

A urine sediment with moderate hematuria and RBC casts most likely results from:

1 to 6

A urine tested with Clinitest exhibits a pass through reaction and is diluted by adding 2 drops of urine to 10 drops water. This is a dilution of:

M5

Acute Monoblastic Leukemia

M2

Acute Myeloblastic Leukemia with maturation

M1

Acute Myeloblastic Leukemia with minimal maturation

M0

Acute Myeloblastic Leukemia without any maturation

M4

Acute Myelomonocytic Leukemia

M3

Acute Promyelocytic Leukemia

Bilirubin, which increases in Hemolytic Disease of Newborn

Amniotic fluid is elevated using a Liley graph and change in absorbance at 450nm. What is being evaluated, and why?

Fetal Lung Maturity (FLM)

Amniotic fluid is tested for the concentration of lamellar bodies. This test determines:

normocytic, normochromic

An adult male, age 23, is in the ER with severe abdominal pain. The ER physician orders a CBC. His erythrocytic measurements are as follows: RBC 5.3 x 1012/L Hgb 14.9 g/dL Hct 44 % What would you expect this patient's RBC morphology to be? (calculate the 3 indices to ensure that you select the correct response)

Water

Antidiretic hormone regulates the reabsorption of:

Disorders of primary hemostasis

Bleeding of the gums and nose is most commonly associated with:

5.2, 8.3, 3.3, 41.1

Calculate the INR, given the following data: patient PT: 18.5 sec PT normal range average: 11.7 sec ISI = 5.26

distilled water and sodium chloride

Calibration of a refractometer is done by measuring the specific gravity of:

the saturation of the heme molecule with carbon monoxide

Carboxyhemoglobin is the hemoglobin derivative associated with:

4+ protein

Cholesterol crystals will most likely be observed in urine that contains:

common pathway

Coagulation factos I, II, V, & X are included in the:

anuria

Complete cessation of urine flow is defined as:

von Willebrand Factor

During platelet plug formation, platelets bind to exposed collagen via:

Spherocytes

Erythrocytes that are small, round, lack central pallor, and appear to have increased hemoglobin concentration are:

artifact

Finding codocytes in only one part of the blood smear is indicative of:

calcium oxalate

Following ingestion of ethylene glycol these crystals are found in the urine.

Aspirate is a dry tap

For which of the following is obtaining a bone marrow core biopsy mandatory?

factor deficiency

From what condition does the patient suffer when both the PT and PTT are prolonged and both are corrected with the addition of normal plasma (immediately and after incubation)?

lupus-like anticoagulants

From what condition does the patient suffer with both the PT and PTT are prolonged and neither assay is corrected with the addition of normal plasma (immediately or after incubation)?

all of the above

Hodgkin Disease is: Select one: a.more common in men than women, 3:2 b.more common in young people in their twenties c.indicated by a painless lump generally in the neck d.all of the above CORRECT! e.a & c only

100 cells

How many white blood cells should be counted in a routine WBC differential?

DNA

Howell-Jolly bodies presumably contain:

Uric acid

Identify the crystal:

red blood cells

Identify the urine microscopic constituent in picture.

All elements would appear more blue

If the buffer solution used in the Wright Staining process is too alkaline, how would this affect the stain results?

Acute Myeloblastic Leukemia

If you observe a leukemic hiatus in the peripheral blood of a patient, which diagnosis is most likely?

Normal pooled plasma

In a mixing study, patient plasma is mixed with:

pelvic bone

In a normal healthy adult, an active site of hematopoiesis is the:

Normal or Decreased

In a patient with Myelodysplastic Syndrome, how would you expect to their peripheral cell counts to be affected?

Erythrocytes

In a patient with Polycythemia Vera, which cell count would you expect to be extremely elevated?

time of liquefaction, estimation of motility, morphology

In addition to sperm count in a fertility study, analysis of seminal fluid should also include:

0.1 mm

In the Neubauer hemocytometer, the space between the top of the platform and the cover glass is:

Transferrin

Iron is transported to the red blood cell by a transport protein called:

Megakaryocytes

Low power (x10) is used to count and evaluate which of the following?

Pappenheimer bodies

Mature erythrocytes containing iron deposits may have which inclusion?

Vitamin C

Microscopic analysis of a urine specimen yields a moderate amount of red blood cells in spite of a negative result for blood using the reagent strip. The technologist should determine if this patient has taken:

Cytoskeleton

Microtubules and microfilaments comprised the ____________ within the platelet

Many white blood cells

Milky urine from a 24-year-old woman would most likely contain:

Cyanmethemoglobin read at a wavelength between 535 - 545 nm

Name the standard methodology for hemoglobin measurement:

white blood cells

Name the urine microscopic constituent.

False

Normal erythrocytes can contain Pappenheimer Bodies.

8-10 days

Normal platelets have a life-span of approximately:

water, urea, and sodium chloride

Normal urine primarily consists of:

Rerun the control and if acceptable continue with patients

One of two controls that have been evaluated over the last 28 days gives a result on day 29 between 2 and 3 SDs of the mean; the other control is within 2 SDs of its mean. What is the correct procedure to follow?

Renal tubular epithelial cells that contain lipids

Oval fat bodies are:

Light Blue Tube

PT and aPTT testing require which type of specimen?

Chediak-Higashi anomaly

Patients with partial albinism who have large, abnormal cytoplasmic granules in their white cells may suffer from a genetic disorder called:

cytoplasmic fragmentation

Platelets are formed by __________ of megakaryocytes.

red cells vary in shape

Poikilocytosis describes a condition in which:

Free-floating red blood cells

Prior to reporting a red blood cell cast, it is important to observe:

All of the above

Qualitative changes that neutrophils may undergo in response to infection may include which of the following: Select one: a.Appearance of toxic granulation b.Appearance of Dohle bodies c.Appearance of many vacuoles d.All of the above

Wright's stained blood smear under oil immersion

RBC morphology is routinely viewed:

Wright

What stain is most commonly used for bone marrow aspirates?

all of the above

Rouleaux appears as short or long stacks of erythrocytes. It is characteristic of: Select one: a.hyperproteinemia b.multiple myeloma c.a thick blood part of a blood smear d.all of the above e.a & c only

Eosin, Methylene Blue

Select the two dyes found in the Wright Stain.

Acute myeloid leukemia from acute lymphoblasitc leukemia

Sudan black is used to distinguish which types of leukemia?

Hairy cells

Tartrate-resistant acid phosphatase is strongly positive in which of the following cells?

he hemoglobin multiplied by three equals the HCT

The "rule of three" means that:

myeloblast, promyelocyte, myelocyte, metamyelocyte, band, neutrophil

The 6 stages in maturation of a neutrophil, from most immature to most mature, are:

von Willebrand Disease

The Closure Time Assay (Platelet Function Assay) is most likely to be abnormal in which disorder?

anaerobic glycolysis

The Embden-Myerhof Pathway is best described as the:

A standardized value derived from the Prothrombin Time

The INR value is:

erythrocyte cell size

The MCV is a RBC parameter that indicates:

Fibrinogen Only

The Thrombin Time assay evaluates the function of which factor(s)?

Colorless and clear

The appearance of normal CSF is:

6-10 hours

The average neutrophil remains in the peripheral blood approximately _______.

RNA

The basophilia of the cytoplasm in the maturing erythrocyte is directly proportional to the quantity of:

Counting the differential

The best use for bone marrow aspirate smears is:

Shift

The control values for both controls for the prothombin test were ranging between the mean and ±1 SD for the first 19 days of use. Starting on day 20, the values for both were consistently between +1 and +2 SDs. This is an example of a:

mL/min

The creatine clearance is reported in:

2.1%

The following results were reported on a 20-year-old "Jane Doe". Calculate the CRC. RBC 2.6 x 1012 /L Hgb 8.9 g/dl Hct 25.6% Retic 3.6%

pyelonephritis

The following urine results were obtained on a 25-year-old female: Urinalysis Results Analyte Result pH 7.0 Color Yellow Appearance Cloudy Protein 1+ Glucose Negative Blood Small Specific Gravity 1.015 Microscopic Finding ------------------ Bacteria Many WBC Cast 5-8/lpf WBC 50-60/hpf These results are most compatible with:

Basophilic stippling

The inclusion which is described as ribosomal aggregates, irregularly shaped, and appear homogeneously throughout the erythrocyte is:

negatively charged particles

The intrinsic pathway is initiated by:

All of the above

The liver influences hemostasis by:

vessel wall

The marginated neutrophil pool is located in the:

monocyte, promonocyte, monoblast

The maturation sequence of the monocyte, from most mature to most immature is:

osmolarily

The most accurate test to determine renal concentration is:

CML

The most common type of leukemia in adults is:

ALL

The most common type of leukemia in children is:

metamyelocytes, bands, and neutrophils

The myelocytic maturation and storage pool in the bone marrow includes:

Abnormal, more red cell precursors than normal

The myeloid-to-erythroid (M:E) ratio of a bone marrow is 1:1. Select the correct interpretation.

0 - 20 mm/hr

The normal range for 35-year-old male with the Westergren ESR is:

<35 seconds

The normal range for the APTT is:

160 mg/dL

The normal renal threshold for glucose in the adult is approximately:

polychromatophilic erythrocytes

The presence of a reticulocyte in a Wright's stain peripheral blood smear is indicated by the presence of:

the formation of rod-like polymers of the hemoglobin S

The presence of sickle-shaped cells in a peripheral blood smear is due to:

CML

The presence of the Philadelphia chromosome and marked leukocytosis with a WBC count of 600 x 109/L are associated with:

protein

The primary consituent of hyaline casts is:

thromboplastin and calcium are added to the patient's citrated plasma

The principle of the prothrombin test is:

spleen

The principle site of extravascular erythrocyte destruction is the:

Albumin

The protein section of the urine reagent strip is most sensitive to:

lyse the erythrocytes and preserve the thrombocytes and leukocytes

The purpose of the diluent used for manual WBC counts is:

Candida albicans

The sediment of a urine specimen with a reagent strip glucose of 250 mg/dL and a pH of 5.5 is ideal for the presence of:

Distal ends of the long bones

The sites of active red marrow differ for adults and young children. Which one site is active in children but not in adults?

all of the above

The technique(s) used to classify the acute nonlymphocytic leukemias is/are: Select one: a.immunologic b.morphologic c.cytochemical d.all of the above

immature cell forms in the peripheral blood

The term "shift to the left" refers to:

A, A2, F

The three types of hemoglobin found in the normal healthy adult include:

White blood cell cast

The urine microscopic constituent that best differentiates between cystitis and pyelonephritis is:

Coverslip smears containing a bone marrow fragment called a spicule

What type of bone marrow aspirate smear preparation is preferred for preforming bone marrow cell differentials?

bacterial contamination will cause alkalinization fo the urine

Urine samples should be examined with 1 hour of voiding because:

porphyrins

Urine that develops a port wine color after standing may contain:

mixing the patient's citrated plasma with equal volumes of normal plasma, aged serum, or adsorbed plasma in order to detect the presence of factor deficiencies or circulating inhibitors

What are subsitution/mixing studies in the hemostasis lab?

Core biopsy

What bone marrow sample is best to determine fat-to-cell ratio and overall cellularity?

Malignant lymphoblasts

What cells may demonstrate a coarse block pattern of activity with the PAS stain?

aids in fibrinolysis by forming plasmin

What is plasminogen?

posterior iliac crest

What is the most common site for bone marrow aspiration in an adult?

50% - 150%

What is the normal range for factor activity?

200-400 mg/dL

What is the normal range for fibrinogen assay?

All of the above!

When examining a peripheral smear, you see platelet clumps. Which of the following could cause this phenomenon? a. All of the above! b. Underfilled EDTA tube c. Clotted specimen d. Patient clinical condition

Remake the slide

When examining the feathered edge of a peripheral smear, you see an extremely high concentration of white blood cells compared with the rest of the slide. How would you proceed?

Excessive washing

When observing a peripheral blood smear stained with Wright Stain, you note that all the cells look faded. What is the most likely cause?

acanthocytes

When reviewing a peripheral blood smear, you notice that several red cells have irregular projections and thorn-like spikes. What would you report when describing the red cell morphology?

Sample A

Which CSF results are most consistent with bacterial meningitis? CSF Results CSF Sample Glucose Protein Lactate A 20 mg/dL 60 mg/dL Increased B 75 mg/dL 20 mg/dL Increased C 20 mg/dL 40mg/dL Decreased D 75 mg/dL 120 mg/dL Decreased

Methanol

Which fixative is found in Wright Stain?

the high dry objective (40x or 50x, no oil immersion)

Which objective of the microscope is used when performing manual cell counts?

> 20% blasts present

Which of the following bone marrow findings is significant in the diagnosis of any acute leukemia?

Waxy cast

Which of the following casts is most indicative of severe renal disease?

calcium oxalate

Which of the following crystals may be found in acidic urine?

70%; 26%; 2%; 2%; 0

Which of the following differential results is normal? Neutrophils% ; Lymphocytes% ; Monocytes% ; Eosinophils% ; Basophils%

1 minute at 1000 rpms

Which of the following errors can falsely elevate a spun micro-hematocrit result?

colon cancer

Which of the following is commonly associated with occult blood?

Are ranges of values for an analyte in normal healthy people

Which of the following is true regarding reference ranges?

Sodium Nitroprusside

Which of the following reagents is used to react with ketones in the urine?

Lymphs = 92%

Which of the following results indicates a relative lymphocytosis?

Mesothelial cells, PMNs, lymphocytes, and macrophages may be present in normal fluids

Which of the following statements regarding serous fluids is true?

D-Dimer

Which of the following test is most definitive for detecting Disseminated Intravascular Coagulation?

Bilirubin

Which of the following urine results is most apt to be changed by prolonged exposure to light?

Unexpected pancytopenia

Which of the following would be a valid indication for performing a bone marrow aspiration?

pH

Which of the following would be affected by allowing a urine specimen to remain at room temperature for 5 hours before analysis?

Myeloblasts

Which of the following would stain most strongly for myeloeroxidase?

PT - Prolonged; aPTT - Prolonged

Which set of results below is most consistent with severe Vitamin K deficiency?

PT - normal; aPTT - prolonged

Which set of results is most consistent with a diagnosis of Hemophilia A?

22.8 x 10^9/L

While counting a differential, you notice 15 NRBCs. The total WBC count was reported as 26.3 x 109/L. The corrected WBC count is:

phenylpyruvic acid

While performing an analysis of a baby's urine, the technologist notices the specimen to have a "mousy" odor. Of the following substances that may be excreted in urine, the one that most characteristically produces this odor is:

20%

White blood cell and platelet estimates should correlate with automated results within a margin of:

0.4%

You have just performed a reticulocyte count utilizing the Miller Disk Method. You counted 10 retics in Block A (large block) and 275 red cells in Block B (small block). Now you must calculate the reticulocyte count result. It is:

1.3%

You have just performed a reticulocyte count utilizing the Miller Disk Method. You counted 20 retics in Block A and 175 red cells in Block B. Now you must calculate the reticulocyte count result. It is:

High levels of schistocytes

Your automated instrument gives a platelet count of 460,000/uL. When you perform your platelet estimate on the peripheral smear, you get 280,000/uL. Which of the following may explain the discrepancy?

Check the label on the smear and the specimen

Your automated instrument gives a result of 4.8 x 103 WBC/uL. When performing your estimate from the peripheral smear, you get 12.4 x 103 WBC/uL. What would you do next?

Fibrinolysis

___________________ is the system whereby the temporary clot is systematically & gradually dissolved as the vessel heals.

hemostasis

the body's process of keeping baance between bleeding and clotting is:

150 - 400 x 10^9/L

the normal range for a platelet count is:

extrinsic, intrinsic, and common

the three pathways involved in the coagulation process are: