Hematology - Success questions 1-76
46. Which erythrocyte metabolic pathway generates adenosine triphosphate (ATP) via glycolysis? A. Embden-Meyerhof B. Hexose monophosphate C. Rapoport-Luebering D. Methemoglobin reductase
A. Embden-Meyerhof
1. What is the first type of cell produced by the developing embryo? A. Erythrocyte B. Granulocyte C. Lymphocyte D. Thrombocyte
A. Erythrocyte
75. Which of the following is not characteristic of aplastic anemia? A. Extramedullary hematopoiesis B. Bone marrow hypoplasia C. Absolute reticulocytopenia D. Blood findings of pancytopenia
A. Extramedullary hematopoiesis
50. The major storage form of iron is A. Ferritin B. Transferrin C. Hemosiderin D. Hemachromatin
A. Ferritin
76. What values would you expect to obtain on hemoglobin and hematocrit determinations done immediately after a major hemorrhage, if hemoglobin and hematocrit values were normal prior to the hemorrhage? A. Both normal B. Both decreased C. Hemoglobin decreased, hematocrit normal D. Hemoglobin normal, hematocrit decreased
A. Both normal
II. In what area of the bone marrow does hematopoiesis take place? A. Cords B. Endosteum C. Endotheijum D. Sinuses
A. Cords
29. Howell-Jolly bodies are composed of A. DNA B. Iron C. Reticulum D. RNA
A. DNA
48. The major adult hemoglobin requires the synthesis of apha-globin chains and A. Beta-globin chains B. Delta-globin chains C. Epsilon-globin chains D. Gamma-globin chains
A. Beta-globin chains
73. Hereditary stomatocytosis is manifested physiologically by changes in A. Hemoglobin oxygen affinity B. Membrane cation permeability C. Efficiency of hemoglobin reduction D. Glycolytic ATP production
B. Membrane cation permeability
20. When the hepatic phase of fetal life is reactivated in an adult, hematopoiesis can be termed A. Myeloid or medullary B. Myeloid metaplasia or extramedullary C. Myelophthisis or myelodysplasia D. Mesoblastic or mesenchymal
B. Myeloid metaplasia or extramedullary
18. As most blood cell lines mature, which of the following is characteristic? A. Cell diameter increases B. Nucleus to cytoplasm ratio (N:C) decreases C. Nuclear chromatin becomes less condensed D. Basophilia of the cytoplasm increases
B. Nucleus to cytoplasm ratio (N:C) decreases
59. Serum ferritin is a good indicator of the amount of A. Cytochrome iron B. Storage iron C. Hemoglobin iron D. Transferrin saturation
B. Storage iron
14. What is the approximate total blood volume in an adult? A.1L B. 2L C.6L D. 12L
C.6L
6. Which of the following does not accurately describe hematopoietic growth factors? A. Bind to target cell receptors to express activity B. Action of majority is lineage restricted C. May promote or suppress cell death D. Can stimulate or inhibit cell proliferation
B. Action of majority is lineage restricted
31. The red cells found in lead poisoning characteristically exhibit coarse granules composed of _______________ that are reported as ______________ A. Precipitated hemoglobin; Pappenheimer bodies B. Aggregated ribosomes; basophilic stippling C. Nuclear fragments; Pappenheimer bodies D. Excess iron deposits; basophilic stippling
B. Aggregated ribosomes; basophilic stippling *
45. When acanthocytes are found on the blood smear, it is usually the result of A. Abnormal membrane permeability B. Altered membrane lipids C. Mechanical trauma D. Polymerization of hemoglobin molecules
B. Altered membrane lipids *
5. What is the normal ratio of myeloid to erythroid precursors in bone marrow (M:E ratio)? A. 1:1 B. 1:3 C. 4:1 D. 8:1
C. 4:1
2. What percentage of tissue located in the bone marrow cavities of adults is fat? A. 10% B. 25% C. 50% D. 75%
C. 50%
34. Which of the following statements about iron absorption is true? A. Absorption occurs in the ileum. B. The mucosal cell always absorbs the correct amount of iron to meet needs. C. Absorption increases when erythropoietic activity increases. D. Alkaline pH favors absorption.
C. Absorption increases when erythropoietic activity increases.
58. What does measuring the total iron-binding capacity (TIBC) represent? A. Amount of free iron in serum B. Circulating protein-bound iron C. Amount of iron that transferrin can bind D. Indirect measurement of iron stores
C. Amount of iron that transferrin can bind
21. What is the average life span of a normal red blood cell? A. 1 day B. lOdays C. 60 days D. 120 days
D. 120 days
37. Which of the following statements does not characterize erythropoietin (EPO)? A. Transforms the CFU-E into the earliest recognizable RBC precursor B. Increases the rate of red blood cell production by the bone marrow C. Shortens the maturation time of developing erythroid precursors D. Decreases stimulation of erythropoiesis when cellular hypoxia increases
D. Decreases stimulation of erythropoiesis when cellular hypoxia increases *
23. Which of the following depicts the structure of the hemoglobin molecule? A. Two heme groups, two globin chains B. Four heme groups, two globin chains C. Two heme groups, four globin chains D. Four heme groups, four globin chains
D. Four heme groups, four globin chains
70. The findings seen in Color Plate 6 can be found in patients with microangiopathic hemolytic anemia (MAHA). Which of the following conditions could not be responsible for this type of red cell destruction? A. Disseminated intravascular coagulation (DIC) B. Hemolytic uremic syndrome (HUS) C. Thrombotic thrombocytopenic purpura (TTP) D. Idiopathic thrombocytopenic purpura (ITP)
D. Idiopathic thrombocytopenic purpura (ITP)
61. Impaired DNA metabolism is characteristic of A. Hemoglobin C disease B. Iron-deficiency anemia C. Sideroblastic anemia D. Megaloblastic anemia
D. Megaloblastic anemia
62. Which of the following is associated with glucose-6-phosphate dehydrogenase (G6PD) deficiency? A. G6PD gene is located on the X chromosome. B. Ongoing intravascular hemolysis occurs. C. All circulating red cells, including reticulocytes, lack enzyme activity. D. Splenectomy can relieve the rate of red cell destruction.
A. G6PD gene is located on the X chromosome.
15. The myeloid progenitor cell can produce cells committed to A. Granulocytic, erythrocytic, monocytic, or megakaryocytic lineages B. Granulocytic, monocytic, lymphocytic, or megakaryocytic lineages C. Erythrocytic, granulocytic, monocytic, or lymphocytic lineages D. Erythrocytic, granulocytic, lymphocytic, or megakaryocytic lineages
A. Granulocytic, erythrocytic, monocytic, or megakaryocytic lineages
7. In the third month of gestation, what is the primary site of hematopoiesis? A. Liver B. Marrow of long bones C. Spleen D. Yolk sac
A. Liver
33. Which of the following is most frequently associated with the inclusion bodies seen in Color Plate 1? A. Iron overload state B. Post-transfusion C. Post-splenectomy D. Iron-deficient state
C. Post-splenectomy
39. Periods of intense erythropoietin activity cause premature release of marrow reticulocytes into the blood. Which of the following is not true of these early reticulocytes? A. Loss of residual RNA occurs immediately upon marrow release B. Circulate longer than usual before reaching maturity C. May be termed shift or stress reticulocytes D. Show diffuse basophilia with Wright's stain
A. Loss of residual RNA occurs immediately upon marrow release *
56. Spectrin is a protein that occupies a major role in A. Red cell membrane structure B. Reducing ferric iron C. Red cell transport and removal of CO2 D. Iron recovery during hemoglobin degradation
A. Red cell membrane structure
30. When spherocytes are reported, what is observed on the peripheral blood smear? A. Red cells without a central pallor B. Red cells with blunt projections C. Red cells with sharp projections D. Red cells with intracellular rod-shaped crystals
A. Red cells without a central pallor
10. Programmed cell death is called A. Necrosis B. Apoptosis C. Cellular senescence D. Tenninal differentiation
B. Apoptosis
52. Excessive extravascular red cell destruction is associated with A. Hemoglobinemia B. Bilirubinemia C. Hemoglobinuria D. Hemosiderinuria
B. Bilirubinemia
65. A 9-month-old male was seen in the ER w/femur fracture. hepatosplenomegaly noted w/extreme pallor, and a slight arrhythmia. CBC results: WBC 12.2 X 1 09/L (12.2 Xl O3/pL) RBC 3.OSX 1012/L (3.05X 1O6/pL) Hemoglobin 61 g/L(6.1 g/dL) Hematocrit 0.20 L/L (20%) MCV 65.5fL MCH 20p9 MCHC 305 g/L (30.5 g/dL) RDW 25% See Color Plate 4. Hemoglobin electrophoresis results as follows: HgbA 0% HgbA2 3% HgbF 97% Which condition is most likely causing the hematologic abnormalities? A. Alpha-thalassemia major B. Cooley beta-thalassemia major C. Hemoglobin H disease D. Hereditary persistence of hemoglobin F
B. Cooley beta-thalassemia major
28. What red cell morphologic abnormality is described by the term "poikilocytosis"? A. Variations in size B. Deviations from normal shape C. Presence of inclusions D. Alterations in hemoglobin concentration
B. Deviations from normal shape
68. Of the following, the leading cause of folate deficiency is A. Increased requirements B. Dietary insufficiency C. Drug inhibition D. Malabsorption
B. Dietary insufficiency
63. In regard to variant hemoglobin E, a2 26 Glu — Lys which of the following statements is false? A. There are two normal alpha chains. B. Glutamic acid replaces lysine on position 26 of the beta chains. C. Hemoglobin E is the second most common hemoglobin variant known. D. Glutamic acid is normally found at position 26 of the beta chain.
B. Glutamic acid replaces lysine on position 26 of the beta chains. *
12. Bone marrow cellularity refers to the ratio of A. Red cell precursors to white cell precursors B. Hematopoietic tissue to adipose tissue C. Granulocytic cells to erythrocytic cells D. Extravascular tissue to intravascular tissue
B. Hematopoietic tissue to adipose tissue
55. Where do the early and late stages of heme synthesis occur? A. On ribosomes B. In mitochondria C. In cytoplasm D. In nucleoli
B. In mitochondria
41. The presence of schistocytes on the peripheral blood smear is commonly associated with A. Increased iron mobilization B. Increased red cell destruction C. Decreased erythropoietin activity D. Decreased red cell proliferation
B. Increased red cell destruction
22. The Na—K cation pump is an important mechanism in keeping the red blood cell intact. Its function is to maintain a high level of A. Intracellular Na+ B. Intracellular K+ C. Plasma Na+ D. Plasma K+
B. Intracellular K+
8. The mechanism that relays information about tissue oxygen levels to erythropoietin-producing sites is located in the A. Brain B. Kidney C. Liver D. Spleen
B. Kidney
27. A senescent red blood cell is one that has A. Been hemolyzed B. Lived its life span C. Become deformed D. Lost its mitochondria
B. Lived its life span
51. The red cells observed on a peripheral blood smear show extreme anisocytosis with an equal number of macrocytes and microcytes. Which of the following values correlate with this finding? A. MCV 108.0 fL, RDW 14.0% B. MCV 90.0 fL, RDW 25.0% C. MCV75.OfL,RDW 16.0% D. MCV 88.0 fL, RDW 12.0%
B. MCV 90.0 fL, RDW 25.0% **
60. Fetal hemoglobin differs from adult hemoglobin in that hemoglobin F A. Has a lower oxygen affinity B. Resists elution from red cells with acid solutions C. Is no longer synthesized after birth in a normal individual D. Has four gamma-globin chains
B. Resists elution from red cells with acid solutions
47. Which of the following red blood cell precursors is the last stage to undergo mitosis? A. Pronormoblast B. Basophilic normoblast C. Polychromatophilic normoblast D. Orthochromic normoblast
C. Polychromatophilic normoblast *
64. Color Plate 31 shows the peripheral blood of a 16-year-old female with a sporadic history of dizzy spells, fainting, and jaundice. This patient also had a history of periodic abdominal pain related to gallstones, Upon physical examination, she exhibited mild splenomegaly. Her hemoglobin was 107 g/L (10.7 g/dL), hematocrit was 0.32 L/L (32%), red cell indices were normal, and the direct antiglobulin test was negative. Based on history and peripheral blood morphology, which of the following statements is most likely true? A. Hemoglobin S will be revealed by electrophoresis. B. Tests to confirm iron deficiency should be ordered. C. An intrinsic hereditary defect of red cells should be suspected. D. The anemia is secondary to spleen and gallbladder disorders
C. An intrinsic hereditary defect of red cells should be suspected.
25. Hemoglobin forms that are incapable of oxygen transport include A. Deoxyhemoglobin and oxygemoglobin B. Oxyhemoglobin and carboxyhemoglobin C. Carboxyhemoglobin and methemoglobin D. Methomoglobin and deoxyhemoglobin
C. Carboxyhemoglobin and methemoglobin
54. The morphologic abnormality characteristically found in hemoglobinopathies is A. Elliptocytes B. Dacryocytes C. Codocytes D. Discocytes
C. Codocytes - target cells
36. Which of the following is associated with a "shift to the left" in the oxygen dissociation curve of hemoglobin? A. Decreased pH and elevated temperature B. Decreased oxygen affinity C. Decreased oxygen release D. Presence of 2, 3-bisphosphoglycerate (2,3-BPG)
C. Decreased oxygen release *
3. Which of the following is not characteristic of pluripotent hematopoietic stem cells? A. Possess self-renewal ability B. Produce progenitor cells committed to a single cell lineage C. Express the stem cell marker CD13 D. Are morphologically unrecognizable
C. Express the stem cell marker CD13
40. Which of the following inclusions is only visible with supravital staining? A. Basophilic stippling B. Cabot rings C. Heinz bodies D. Pappenheimer bodies
C. Heinz bodies *
26. The majority of iron found in an adult is a constituent of A. Ferritin B. Myoglobin C. Hemoglobin D. Peroxidase
C. Hemoglobin
69. Which of the following statements about sickle cell syndromes is false? A. Asplenism may result from repeated sickling crises in the homozygous state. B. Heterozygous persons may be partly protected from infection by falciparum malaria. C. Hemoglobin S is more soluble in dithionite than is normal hemoglobin. D. Trait conditions are generally asymptomatic with no sickle cell formation.
C. Hemoglobin S is more soluble in dithionite than is normal hemoglobin.
66. A 14 y/o African-American male seen for abdominal pain. CBC results: WBC 7.0>< 1 09/L (7.0 X 1 O3/pL) RBC 2.90X 1012/L(2.90X 1064i,L) Hemogobn 85 g/L (8.5 g/dL) Hematocrit 0.25 L/L (25%) MCV 86.2 fL MCH 29.3 pg MCHC 340 g/L (34.0 gidL) RDW 21% See Color Plate 5. What condition is suggested by these findings? A. Hemoglobin E disease B. Hemoglobin S disease C. Hemoglobin SC disease D. Hemoglobin C disease
C. Hemoglobin SC disease
43. Microcytic, hypochromic red cells are most often associated with impaired A. DNA synthesis B. RNA metabolism C. Hemoglobin synthesis D. Enzyme metabolism
C. Hemoglobin synthesis
19. Which of the following describes thrombopoietin (TPO)? A. Renal hormone that regulates marrow red cell production B. Marrow hormone secreted by developing megakaryoblasts C. Hormone produced by the liver that stimulates megakaryopoiesis D. Pituitary hormone that controls platelet sequestration by the spleen
C. Hormone produced by the liver that stimulates megakaryopoiesis
38. Which of the following factors will result in an immediate increase in oxygen delivery to the tissues? A. Increased pH B. High altitudes C. Increased hemoglobin binding of 2, 3-BPG D. Increased renal release of erythropoietin
C. Increased hemoglobin binding of 2, 3-BPG *
71. Which of the following blood findings does not correlate with the presence of ringed sideroblasts in the bone marrow? A. Pappenheimer bodies B. Basophilic stippling C. Increased total iron-binding capacity D. Increased percent transferrin saturation
C. Increased total iron-binding capacity
67. Pica is most commonly associated with which of the following conditions? A. Pyridoxine deficiency B. Lack of erythrocyte folate C. Iron deficiency D. Porphyrias
C. Iron deficiency
49. Defective nuclear maturation commonly results in the production of red cells that are A. Normocytic B. Hypochromic C. Macrocytic D. Microcytic
C. Macrocytic
16. The largest hematopoietic cells in normal bone marrow are A. Osteoblasts B. Osteoclasts C. Megakaryocytes D. Plasma cells
C. Megakaryocytes
13. Interleukins and colony stimulating factors are cytokines produced by A. B lymphocytes and erythrocytes B. Erythrocytes and thrombocytes C. Monocytes and T lymphocytes D. Neutrophils and monocytes
C. Monocytes and T lymphocytes
57. What is the function of reduced glutathione (GSH) in the red blood cell? A. Promotes Kreb's cycle activity B. Maintains anion balance during the "chloride shift" C. Neutralizes intracellular oxidants that accumulate D. Prevents oxygen uptake by hemoglobin
C. Neutralizes intracellular oxidants that accumulate
42. Which of the following may be a sign of accelerated bone marrow erythropoiesis? A. Hypercellular marrow with a decreased number of RBC precursors B. Bone marrow M:E ratio of 6:1 C. Nucleated red cells in the peripheral circulation D. Low erythrocyte, hemoglobin, and hematocrit levels
C. Nucleated red cells in the peripheral circulation
44. When in bone marrow, the nucleated red cells present in Color Plate 2 would be staged as A. Basophilic normoblasts B. Polychromatophilic normoblasts C. Orthochromic normoblasts D. Pronormoblasts
C. Orthochromic normoblasts *
53. Which protein is primarily responsible for transport of hemoglobin dimers resulting from intravascular hemolysis? A. Hemopexin B. Albumin C. Hemosiderin D. Haptoglobin
D. Haptoglobin
74. In addition to an increase in red blood cells, which of the following is characteristic of polycythemia vera? A. Decreased platelets, decreased granulocytes, decreased erythropoietin level B. Decreased platelets, decreased granulocytes, increased erythropoietin level C. Increased platelets, increased granulocytes, increased erythropoietin level D. Increased platelets, increased granulocytes, decreased erythropoietin level
D. Increased platelets, increased granulocytes, decreased erythropoietin level
32. Rouleaux of red blood cells when seen in the monolayer of a blood smear is characteristic of A. Hypersplenism B. Hypogammaglobulinemia C. Cold hemagglutinin disease D. Multiple myeloma
D. Multiple myeloma
72. Which of the following conditions is not usually associated with marked reticulocytosis? A. Four days after a major hemorrhage B. Drug-induced autoimmune hemolytic anemia C. Sickle cell anemia D. Pernicious anemia
D. Pernicious anemia
4. In an adult, what are the two best areas for obtaining active bone marrow by aspiration? A. Vertebra, tibia B. Sternum, vertebra C. Anterior iliac crest, tibia D. Posterior iliac crest, sternum
D. Posterior iliac crest, sternum
24. Which of the following describes the process known as culling? A. Release of red cells from the bone marrow B. Binding of free hemoglobin by transport proteins C. Incorporation of iron into protoporphyrin TX D. Removal of abnormal red cells by the spleen
D. Removal of abnormal red cells by the spleen
35. What term describes a mature red blood cell that contains iron granules or deposits? A. Siderosome B. Sideroblast C. Ringed sideroblast D. Siderocyte
D. Siderocyte
17. When evaluating a bone marrow aspirate smear, which finding is considered abnormal? A. A predominance of granulocyte precursors as compared to nucleated red cells B. Detection of stainable iron in macrophages and erythroid precursors with Prussian blue C. An average of three megakaryocytes seen per low power (lOX) field D. The presence of 10% myeloblasts on the cell differential count
D. The presence of 10% myeloblasts on the cell differential count
9. Antigen-independent lymphopoiesis occurs in primary lymphoid tissue located in the A. Liver and kidney B. Spleen and lymph nodes C. Peyer's patches and spleen D. Thymus and bone marrow
D. Thymus and bone marrow