Hematology in Practice, 2nd edition, Chapter questions

5. Hypercalcemia in patients with multiple myeloma is the direct result of: a: increased plasma cell mass b: crystalline inclusions in the plasma cells c: increased osteoclast activity d: hyperviscosity

c: Increased osteoclast activity causes hypercalcemia in patients with multiple myeloma.

10. The most effective means of treating iron overload in MDSs is: a: therapeutic phlebotomy b: limiting iron containing foods c: iron chelation therapy d: fasting

c: Iron chelation therapy is the most effective means of treating iron overload in MDSs.

7. Which of the following hemoglobin separation methods is used for most newborn hemoglobin screening? a: HPLC b: Alkaline electrophoresis c: Isoelectric focusing d: Acid electrophoresis

c: Isoelectric focusing is a hemoglobin separation technique that's used for most newborn hemoglobin screening.

8. Several hours after birth a newborn develops symptoms of petechiae, purpura, and hemorrhage. Laboratory results show a platelet count of 18.0X10^9/L. The most likely explanation is: a: Drug-induced thrombocytopenia b: Secondary thrombocytopenia c: Isoimmune neonatal thrombocytopenia d: neonatal DIC

c: Isoimmune neonatal thrombocytopenia usually occur several hours after birth with symptoms of petechiae, purpura, and hemorrhage.

2. Which one of the following is considered personal protective equipment (PPE)? a: Operating room attire b: Head nets c: Laboratory coats d: White shoes

c: Lab coats

7. Which one of the red blood cell indices reflects the concentration of hemoglobin per individual red blood cell? a: Hgb b: MCV c: MCHC d: MCH

c: MCHC; or Mean Corpuscular Hemoglobin Concentration; reflects the concentration of hemoglobin per individual RBC.

2. Which MDS group has the best prognosis? a: MDS with excess blasts b: Refractory anemia with ringed sideroblasts c: Refractory anemia d: 5q delinquent

c: MDS groups with refractory anemia have the best prognosis.

9. The morphologic classification of anemia in MDSs is: a: normocytic,normochromic b: microcytic,hypochromic c: macrocytic,normochromic d: microcytic,normochromic

c: MDSs are morphologically classified as macrocytic, normochromic.

4. Which mechanism accounts for the reticulocytopenia seen in most cases of MDS? a: heavy blast tumor burden in the marrow b: Effects of toxin c: Marrow aplasia d: Ineffective erythropoiesis

c: Marrow aplasia is the mechanism that accounts for the reticulocytopenia seen in most cases of MDS.

3. In which stage of neutrophilic maturation are specific secondary granules first seen? a: Myeloblast b: Metamyelocyte c: Myelocyte d: Band

c: Myelocyte is the stage of neutrophilic maturation where specific secondary granules are first seen.

6. The most common hematologic malignancy(ies) in adults is(are): a: acute leukemia b: multiple myeloma c: Myelodysplastic syndromes d: Chronic leukemias

c: Myelodysplastic syndromes are the most common hemolytic malignancies in adults.

1. Which of the following is one of the key roles of thrombin with respect to fibrinogen? a: changes fibrinogen into plasmin b: releases fibrin split products c: converts fibrinogen into fibrin d: activates factor V and VIII

c: One of the key roles of thrombin is to convert fibrinogen to fibrin.

9. A significant feature of hairy cell leukemia not seen in other acute leukemias is: a: Panmyelosis b: Pancytosis c: Pancytopenia d: Panhyperplasia

c: Pancytopenia is a feature of hairy cell leukemia that is not seen in other acute leukemias.

10. Which result is normal in a patient with dysfibrinogenemia? a: thrombin time b: activated partial thromboplastin time c: immunologic fibrinogen level d: protein electrophoresis

c: Patients with dysfibrinogenemia will have a normal immunologic fibrinogen level.

1. What is a significant morphologic difference between irreversibly sickled cells and reversible sickled cells? a: puddled hemoglobin b: crystal formation central to the sickled cells c: pointed projections to the sickled cell d: fragmentation of the red blood cell membrane

c: Pointed projections to the sickled cell;

8. Of the following formulas, which formula indicates the correlation check between hemoglobin and hematocrit? a: (Hgb/Hct) X 100 b: Hgb X 3 = Hct c: Hct= MCV X RBC d: (Hgb/RBC) X 100

b: Hgb X 3 = Hct; is the formula that indicates the correlation check between hemoglobin and hematocrit.

2. Which of these symptoms is specific for IDA? a: fatigue b: koilonychia c: palpitations d: dizziness

b: Koilonychia is a specific symptom for iron deficiency anemia.

6. What is the most stable parameter of the CBC? a: WBC b: MCV c: RDW d: Platelet count

b: MCV; is the most stable parameter of the complete blood count.

1. Which of the following is the predominant red blood cell morphology in patients with MDSs? a: schistocytes b: Macrocytes c: Target cells d: Bite cells

b: Macrocytes are the predominant RBC morphology in patients with myelodsyplastic syndromes (MDS).

7. When the iron in hemoglobin is in ferric (Fe3+) state, hemoglobin is termed: a: carboxyhemoglobin b: methemoglobin c: Ferrihemoglobin d: sulfhemoglobin

b: Methemoglobin; is the term used to describe hemoglobin in the ferric state (Fe3+).

3. Which of the following statements pertains to most clinically significant hemoglobin variants? a: Most are fusion hemoglobins b: Most are single amino acid substitutions c: Most are synthetic defects d: Most are extensions of the amino acid chain

b: Most are single amino acid substitutions

7. In the osmotic fragility test, normal RBCs hemolyze at which level? a: 0.65% b: 0.45% c: 0.20% d: 0.30%

b: Normal RBCs hemolyze at 0.45% in an osmotic fragility test.

8. All of the following are features of MDSs EXCEPT: a: Anemia b: Organomegaly c: Dysplasia d: Hypercellular marrow

b: Organomegaly is NOT a feature of MDSs.

6. Pancytopenia in IMF may be caused by: a: An aplastic origin b: Increase in reticulin fiber in the bone marrow c: Extramedullary hematopoiesis d: The pH chromosome

b: Pancytopenia in IMF is caused by an increase in reticulin fiber in the bone marrow.

8. The erythrocyte stage that marks the beginning of hemoglobinization is called: a: basophilic normoblast b: polychromatophilic normoblast c: orthochromic normoblast d: pronormoblast

b: Polychromatophilic normoblast marks the dawn of hemoglobinization.

11. Protein C and it's cofactor protein S inactivates factors: a: VIIa and Xa b: Va and VIIIa c: IXa and VIIa d: VIIIa and XIIa

b: Protein C and it's cofactor protein S inactivates factors Va and VIIIa (5a and 8a)

4. Which bacterial cell product would precipitate a DIC event? a: Neuraminidase b: streptokinase c: urokinase d: tPA

b: Streptokinase is a bacterial cell product that would precipitate a DIC event.

5. In an adult, the usual location for obtaining a bone marrow aspirate is the; a: sternum b: Iliac crest c: Long bones d: lower lumbar spine

b: The Iliac crest; is the usual location in a adult for obtaining a bone marrow aspirate.

2. Why is the bleeding time normal in individuals with hemophilia A? a: Because of an increase in factor XIII b: Because the clotting problem is a factor VIII problem. c: Because vWF is normal. d: Because the clotting problem is a factor IX problem?

b: The bleeding time in individuals with hemophilia A are normal because the clotting problem is a factor VIII problem.

6. The life span of a platelet is: a: 5 to 8 days b: 7 to 10 days c: 6 to 9 days d: 9 to 12 days

b: The life span of a platelet is approximately 7 to 10 days.

6. The process of fibrin degradation is called_______and is controlled by the enzyme______. a: fibrination,plasmin b: fibrinolysis,plasmin c: fibrination,protease d: fibrinolysis,protease

b: The process of fibrin degradation is called fibrinolysis and is controlled the enzyme plasmin.

10. What effect does the Ph chromosome have on the prognosis of patients with chronic myelocytic leukemia? a: It is not predictive b: The prognosis is better if the Ph chromosome is present c: The prognosis is worse if the Ph chromosome is present d: The disease usually transforms into AML when the Ph1 chromosome is present.

b: The prognosis is better if the Ph chromosome is present in patients with chronic myelocytic leukemia.

4. In contrast to most of the other leukemias, which of the following conditions manifests with a pancytopenia? a: CLL b: HCL c: CGL d: PV

b: Unlike other leukemias, HCL (hairy cell leukemia) manifests with a pancytopenia.

8. Which of the following is not considered a postanalytical variable? a: Delta checks b: proper anticoagulant used c: specimen check for clots d: Critical results called

b: proper anticoagulants used is NOT considered a postanalytical variable. It is a preanalytical variable.

6. Activated protein C resistance is associated with: a: mutation of factor VIII b: deletion of factor VI c: mutation of factor V d: deletion of factor VIII

c: Activated protein C resistance is associated with mutation of factor V.

9. Migration to extramedullary sites is a feature of which of the following leukemias? a: Acute progranulocytic leukemia b: Acute myelocytic leukemia c: Acute monocytic leukemia d: Acute lymphocytic leukemia

c: Acute monocytic leukemia migrates to extramedullary sites.

5. Acute promyelocytic leukemia has a high incidence of which of the following cytogenetic abnormalities? a: t(8;21)(q22;q22) b: inv(16)(p13;q22) c: t(15;17)(q22;q12) d: 1(9;11)(p22;q23)

c: Acute promyelocytic leukemia has a high incidence of t(15;17)(q22;q12) cytogenetic abnormalities.

7. Alpha granules are found in: a: The peripheral zone b: The sol gel zone c: organelles d: membranes

c: Alpha granules are found in organelles.

7. The diagnostic criteria for essential thrombocythemia includes all of the following criteria EXCEPT: a: Increased platelet count b: Absence of collagen fibers c: Increased hematocrit d: No cytogenic abnormalities

c: An increased hematocrit is NOT a criteria for diagnosis of essential thrombocythemia.

10. An inhibitor of plasmin activity is: a: tPA b: PAI-1 c: Alpha-2-antiplasmin d: Plasminogen

c: An inhibitor of plasmin activity is alpha-2-antiplasmin.

1. Which of the following is most often associated with acute leukemia? a: Erythrocytosis and thrombocytosis b: Neutropenia and thrombosis c: Anemia and thrombocytopenia d: Lymphocytosis and thrombocythemia

c: Anemia and thrombocytopenia are most often associated with acute leukemia.

7. Aspirin prevents platelet aggregation by inhibiting the action of: a: PF 3 b: GPII c: TXA2 d: GPIb

c: Aspirin inhibits platelet aggregation by inhibiting the action of TXA2.

1. Which of bone marrow changes are most prominent in the megaloblastic anemias? a: M:E ratio of 10:1 b: hypocellular bone marrow c: Asynchrony in the red blood cell precursors d: Shaggy cytoplasm of the RBC precursors

c: Asynchrony in RBC precursors are the most prominent bone marrow changes in megaloblastic anemias.

1. Which of the following are defects of platelet adhesion? a: Hermansky-Pudlak syndrome b: Glanzsmann's thrombasthenia c: Bernard-Soulier syndrome d: Wiskott-Aldrich syndrome

c: Bernard-Soulier syndrome is a defect of platelet adhesion.

5. What is the cutoff blasts count used to distinguish a patient with MDS from a patient with acute leukemia? a: 50% b: 30% c: 20% d: 14%

c: Blast count of 20% or less in MDS distinguishes from acute leukemia, which is more than 20% blasts in the bone marrow.

1. The primary lymphoid organs are: a: Liver and spleen b: Gallbladder and liver c: Bone marrow and thymus d: spleen and tonsils

c: Bone marrow and thymus are primary lymphoid organs.

7. The monoclonal marker that is often positive in B lymphoblastic leukemia/B lymphoblastic lymphoma is: a: CD1 b: CD7 c: CD10 d: CD41

c: CD10 is the monoclonal marker that is often positive in B lymphoblastic leukemia/B lymphoblastic lymphoma.

9. Which CD markers are associated with myelocytes? a: CD4,CD8 b: CD33,CD13,CD14 c: CD45,CD33,CD13 d: CD19,CD22

c: CD45,CD33,CD13 are CD markers associated with myelocytes.

9. D-dimers may be elevated in which of the following conditions? a: sickle cell disease b: Glanzmann's thrombasthenia c: Deep vein thrombosis d: Bernard-Soulier syndrome

c: D-dimers may be elevated in deep vein thrombosis (DVT).

2. Dilute Russell's Viper Venom test (DRVVT) is helpful in the diagnosis of: a: HIT b: factor VIII inhibitor c: lupus anticoagulant d: ACA

c: Dilute Russell's Viper venom test is helpful in the diagnosis of lupus anticoagulant (LA).

4. Which of the following are characteristics of hereditary pyropoikilocytosis? a: Elliptocytes with spherocytes intermixed in the peripheral smear b: Spherocytes with polychromasia and low MCV c: Elliptocytes, spherocytes, and budding red cells d: mostly elliptocytes and other morphologies

c: Elliptocytes, spherocytes, and budding red cells are characteristic of hereditary pyropoikilocytosis.

1. Which of the clotting factors is not a protease? a: factor II b: factor VII c: factor XIII d: factor IX

c: Factor XIII is a transglutaminase, the other clotting factors are proteases.

2. How many total genes does a person possess for the production of alpha chains? a: One b: Two c: Four d: Three

c: Four; A person receives two genes from each parent for alpha chain production.

5. Qualitative changes in the WBC include all EXCEPT: a: Toxic granulation b: Toxic vacuolization c: Gaucher's cell d: Dohle bodies

c: Gaucher's cell is NOT a qualitative change in WBCs.

3. A round-shaped nucleus with fragile, spiny projections similar to cytoplasm best describes: a: Sezary cells b: lymphoblasts c: hairy cells d: smudge cells

c: Hairy cells have a round shaped nucleus with fragile, spiny projections similar to cytoplasm.

7. A prolonged thrombin time and a normal reptilase time are indicative of: a: aspirin therapy b: FDPs c: heparin therapy d: warfarin therapy

c: Heparin therapy usually results in a prolonged thrombin time(TT) and normal reptilase time.

9. A white blood cell disorder that manifests with low WBC, thrombocytopenia, and a mulberry like inclusion in the monocytes is: a: May-Hegglin anomaly b: Chediak-Higashi anomaly c: Human erlichiosis d: Alder's anomaly

c: Human erlichiosis manifests with low WBC, thrombocytopenia, and mulberry like inclusions in the monocytes.

7. Hypochromia is used to define: a: Color change in the red blood cell b: variation in shape of the red blood cell c: Decrease in hemoglobin content of the red blood cell

c: Hypochromia is used to define; Decrease in hemoglobin content of the RBC.

9. Which of the following test results is normal in a patient with classic von Willebrand's disease? a: bleeding time b: Activated partial thromboplastin time c: platelet count d: factor VIII:C and vWF levels

c: In classic von Willebrand's disease the patients platelet count usually tests normal.

8. Myocardial infarctions, transient ischemic attacks, and deep vein thrombosis are most likely to be complications of: a: Chronic myelocytic leukemia b: Acute myelocytic leukemia c: Polycythemia vera d: Idiopathic myelofibrosis

c: Polycythemia vera often leads to myocardial infarctions, transient ischemic attacks, and deep vein thrombosis.

2. If a patient has a prolonged PT, the patient most likely is deficient in factor: a: VIII b: II c: VII d: X

c: Prolonged PT is mostly associated with factor VII deficiency.

1. The morphological classification of anemias is based on the: a: RBC b: cause of the anemia c: RBC indices d: Reticulocyte count

c: RBC indices; is used to morphologically classify anemias.

1. What is the most common presenting symptom in patients with chronic lymphocytic leukemia? a: Massive spleens b: Thrombocytosis c: Increased calcium d: Enlarged lymph nodes

d: Enlarged lymph nodes are a common symptom in patients with chronic lymphocytic leukemia.

9. The factor that is responsible for stabilizing a soluble fibrin monomer into an insoluble clot is: a: II b: X c: XII d: XIII

d: Factor XIII (13) is responsible for stabilizing a soluble fibrin monomer into an insoluble clot.

6. Which of the following clinical findings is indicative of intramedullary hemolysis in megaloblastic processes? a: Increased RBC b: Increased hemoglobin c: decreased bilirubin d: Increased LDH

d: Increased LDH is indicative of intramedullary hemolysis in megaloblastic process.

4. Myeloperoxidase stain is strongly positive in: a: Acute lymphoblastic leukemia b: Acute monocytic leukemia c: Acute megakaryoblastic leukemia d: Acute myeloblastic leukemia

d: Myeloperoxidase stain is strongly positive in acute myeloblastic leukemia.

9. Which of the following drugs would put an individual at risk for thrombosis? a: aspirin b: Dipyridamole c: Streptokinase d: Oral contraceptives

d: Oral contraceptives would put an individual at risk for thrombosis.

5. Which statement is correct regarding Protein C? a: It is a cofactor to Protein S b: It's activity is inhibited by heparin c: It forms a complex with antithrombin d: It is a physiologic inhibitor of coagulation

d: Protein C is a physiologic inhibitor of coagulation.

3. Which of the following lab tests would be abnormal through each stage of iron deficiency? a: Serum iron b: hemoglobin and hematocrit c: RBC d: Serum ferritin

d: Serum ferritin would be abnormal in lab tests through each sage of iron deficiency.

8. Autosplenectomy is characteristic of: a: sickle cell trait b: Hgb C disease c: Thalassemia d: Sickle cell anemia

d: Sickle cell anemia; Autosplenectomy is characteristic of sickle cell anemia.

6. The proper definition for a standard is: a: Materials used to calibrate a method b: A normal distribution curve c: A target range d: Solutions with a known amount of the analyte

d: The definition of a standard is: Solutions with a known amount of the analyte

5. The presence of thrombocytopenia and giant platelets best describes: a: Classic von Willebrand's disease b: Wiskott-Aldrich syndrome c: Glanzmann's thrombasthenia d: Bernard-Soulier syndrome

d: The presence of thrombocytopenia and giant platelets best describe Bernard-Soulier syndrome.

4. Which statement is correct regarding warfarin(Coumarin)? a: It it used to treat bleeding disorders. b: it acts on factors IX,X,XI,and XII c: it is used for short term therapy d: It acts on vitamin-K dependent factors

d: Warfarin(Coumarin) acts on vitamin-K dependent factors (II,VII,IX, and X) 2,7,9, and 10.

6. The following lab results have been obtained for a 40 year old woman. PT 20 seconds (reference 11 to 15 seconds), aPTT 50 seconds (reference 22 to 40 seconds). What is the most probable diagnosis? a: factor VII deficiency b: factor VIII deficiency c: factor X deficiency d: factor XIII deficiency

c: Increased PT and aPTT times are associated with deficiencies in factors II,V, and X. In this list factor X deficiency would be correct.

6. Plasmapheresis is a possible treatment for: a: Waldenstrom's macroglobulinemia b: HCL c: PCL d: CLL

a: Waldenstrom's macroglobulinemia is possibly treated with plasmapheresis.

2. What are the peripheral cell indicators of an autoimmune hemolytic anemia in a patient with CLL? a: Nucleated RBCs and spherocytes b: Smudge cells and normal lymphs c: Howell-Jolly bodies and sideroctyes d: Lymphoblasts and prolymphocytes

a: Nucleated RBCs and spherocytes are peripheral cell indicators of an autoimmune hemolytic anemia in a patient with CLL.

2. Which morphologic changes in the peripheral smear are markers for megaloblastic anemias? a: Oval macrocytes and hypersegmented neutrophils b: Oval and hypochromic macrocytes c: Pappenheimer bodies and hypochromic microcytes d: Dimorphic RBCs and Howell-Jolly bodies

a: Oval macrocytes and hypersegmented neutrophils are markers for megaloblastic anemias.

6. Which of the following hemolytic disorders has RBCs that are especially sensitive to lysis by complement? a: paroxysmal nocturnal hemoglobinuria b: Fanconi's anemia c: Aplastic anemia d: Hereditary spherocytosis

a: Paroxysmal nocturnal hemoglobinuria a hemolytic disorder where RBCs are especially sensitive to lysis by complement.

6. Which of the following statements regarding 2-3-DPG is correct? a: It catalyzes porphyrin synthesis b: It controls hemoglobin affinity for oxygen c: It prevents oxidative penetration of hemoglobin d: It converts methemoglobin to oxyhemoglobin

b: 2-3-DPG controls hemoglobin affinity for oxygen

2. What is the requisite blast percentage for the diagnosis of acute myeloid leukemia recommended by the WHO? a: 10% b: 20% c: 30% d: 40%

b: 20% is the requisite blast percentage for the diagnosis of acute myeloid leukemia recommended by the WHO.

8. Which of the following morphologic features is classic in the megaloblastic RBC precursors? a: Appropriate N:C ratio b: Asynchrony c: Basophilic cytoplasm d: Average size of cells

b: Asynchrony is a classic morphologic feature in megaloblastic RBC precursors.

6. A 17 year old boy is admitted for a FUO. His WBC is 20.0 X10^9/L. All of the following can be seen in his peripheral smear EXCEPT: a: toxic granulation b: Reactive monocytes c: increased band neutrophils d: Dohle bodies

b: Reactive monocytes are not seen in peripheral smears.

10. Which of the following tests is the most effective means of assessing red blood cell generation in response to anemia? a: RDW b: Reticulocyte count c: Platelet count d: CBC

b: Reticulocyte count; is the most effective means of assessing red blood cell generation in response to anemia.

6. Which RBC morphology may form as a result of excess cholesterol taken on the RBC membrane? a: Macrocytes b: Target cells c: Schistocytes d: Ovalocytes

b: Target cells; may form as a result of excess cholesterol taken on RBC membrane.

2. The BCR:ABL fusion gene leads to: a: Increased LAP activity b: Increased tyrosine kinase activity c: organomegaly d: Increased platelet count

b: The BCR:ABL fusion gene leads to increased tyrosine kinase activity.

1. A hallmark in the diagnosis of a patient with CML is: a: splenomegaly b: presence of teardrop cells c: thrombocytosis d: M:E ratio of 10:1 or greater

d: A M:E ratio of 10:1 or greater is a hallmark diagnosis of a patient with CML.

9. A dry tap is a characteristic of idiopathic myelofibrosis secondary to: a: Increased infiltration of blasts cells b: Increased infiltration of abnormal platelets c: Increased infiltration of abnormal RBCs d: Increased infiltration of fibrotic elements

d: A dry tap is characteristic of idiopathic myelofibrosis secondary to increased infiltration of fibrotic elements.

10. All of the following are mechanisms by which neutropenia is produced except: a: Decreased production by the bone marrow b: Impaired release from the bone marrow to the blood c: Increased destruction d: Bacterial infection

d: Bacterial infection is not a mechanism by which neutropenia is usually produced.

4. Which CD marker is specific for monocytes? a: CD45 b: CD19 c: CD20 d: CD14

d: CD14 is the specific CD marker for monocytes.

4. Which part on the microscope is used for focusing? a: oculars b: stage c: diaphragm d: coarse and fine adjustments

d: Coarse and fine adjustments

7. Patient's with Waldenstrom's macroglobulinemia frequently encounter thrombotic complications because of: a: increased platelet count b: increased megakaryocytes in the bone marrow c: increased plasma cells d: Coating of platelets and clotting by increased IgM.

d: Coating of platelets and clotting by increased IgM frequently cause thrombotic complications in patients with Waldenstrom's macroglobulinemia.

5. In which conditions can you see eliptocytes? a: Iron loading process b: Aplastic anemia c: Iron deficiency anemia d: Hereditary spherocytosis

Eliptocytes can be seen in; C; Iron deficiency anemia (IDA)

6. Which cytochemical reactions is most helpful in identifying the blasts in acute monoblastic leukemia? a: NSE b: TdT c: PAS d: SBB

a: NSE is the cytochemical reaction most helpful in identifying the blasts in acute monoblastic leukemia.

3. Auer rods may be seen in which of the following cells? a: Myeloblasts b: Myelocytes c: Lymphoblasts d: Megakaryoblasts

a: Auer rods are seen in myeloblasts in patients with acute myelocytic leukemia.

5. Which one of the following is a postanalytic factor? a: Calling results when a critical value is obtained b: tube checked for clots c: patient ID d: sample mixing

a: Calling results when a critical value is obtained

9. Epsilon and zeta chains are part of which of the following hemoglobins? a: Hgb Portland b: Hgb F c: Hgb A d: Hgb A2

a: Hgb Portland; Epsilon and zeta are part of Hgb Portland

9. A key of the morphologic feature of the nucleated red blood cell stages is: a: Basophilic cytoplasm through every stage of maturation b: Granules in the cytoplasm c: "Baseball" round nucleus d: Increase in size as the cell matures

c: "Baseball" round nucleus is a key morphologic feature of the RBC maturation stages.

8. What percent of hemoglobin is synthesized in the reticulocyte stage? a: 65% b: 95% c: 35% d: 45%

c: 35% of hemoglobin is synthesized during the reticulocyte stage.

8. If a patient has a prolonged aPTT only, the patient may be deficient in the following factors: a: VIII,X,II, and I b: VIII,IX,XI, and XII c: VIII,X,XI, and XII d: VIII,XI,II and XII

b: A patient who only has a prolonged aPTT may be deficient in factors VIII,IX,XI, and XII (8,9,11, and 12)

7. A typical blood picture in infectious mononucleosis is an absolute: a: Lymphocytosis and anemia with many reactive lymphocytes b: Lymphocytosis without anemia and with many reactive lymphocytes c: Monocytosis and anemia with many atypical monocytes d: Monocytosis without anemia and with many atypical monocytes.

b: Absolute lymphocytosis WITHOUT anemia and many reactive lymphocytes is a typical blood picture in infectious mono.

9. An anemia that manifests as decreased marrow cellularity, cytopenias in two cellular elements, and a reticulocytopenia is appropriately termed: a: Megaloblastic anemia b: Aplastic anemia c: Sideroblastic anemia d: Iron deficiency anemia

b: Aplastic anemia manifests as decreased marrow cellularity, cytopenias in two cellular elements, and a reticulocytopenia.

1. Standard precautions involve: a: Behavior that prevents contact with virally infected patients. b: Behavior that prevents direct contact with bodily fluids or contaminated surfaces. c: Behavior that prevents contact with pediatric patients. d: Behavior that prevents contact with terminally ill patients.

b: Behavior that prevents direct contact with bodily fluids or contaminated surfaces.

3. Blast crisis in CML means that there are more than _____blasts in the peripheral smear. a: 10% b: 20% c: 5% d: 15%

b: Blast crisis in CML means that there are more than 20% blasts in the peripheral smear.

4. Nose bleeding, deep bruising,and gum bleeding are usually manifestations of which type of coagulation disorder? a: Clotting factor disorder b: Platelet defect c: thrombosis d: vascular disorder

b: Common manifestations of platelet defects include nose bleeding, deep bruising, and gum bleeding.

4. A hormone released by the kidney that is unique for erythroid regeneration is: a: Estrogen b: Erythropoietin c: Progestin d: Testosterone

b: Erythropoietin; is a hormone released by the kidney that is unique for erythroid regeneration.

5. The vitamin K-dependent factors are: a: I,II,V,and X b: II,VII,IX, and X c: I,VII,V, and VIII d: II,IX,XI, and X

b: Factors II,VII,IX, and X (2,7,9,and 10) are vitamin K dependent

10. Fetal hemoglobin consists of which of the following chains? a: A2B2 b: A2Y2 c: A2S2 d: A2E2

b: Fetal hemoglobin consists of alpha2,gamma2 chains.

2. What are two integral proteins in the red blood cell structure that house red blood cell antigen? a: Glycoproteins and glycolipids b: Glycophorin A and glycophorin B c: Cholesterol and spectrin d: sodium and potassium

b: Glycophorin A and B; are two integral proteins in RBC structure that house RBC antigens.

4. Which RBC inclusions originate as a result of denatured hemoglobin? a: Howell-Jolly bodies b: Heinz bodies c: Pappenheimer bodies d: Malarial parasites

b: Heinz bodies; are RBC inclusions that originate as a result of denatured hemoglobin.

8. Heparin-induced thrombocytopenia is caused by: a: antibody to platelet factor 4 b: antibody to heparin-platelet factor 4 complex c: lupus anticoagulant d: antibody to heparin

b: Heparin induced thrombocytopenia is caused by antibody to heparin-platelet factor 4 complex.

1. Which of these hemoglobins is an embryonic hemoglobin? a: Hgb A b: Hgb Gower c: Hgb F d: Hgb A2

b: Hgb Gower is an embryonic hemoglobin.

3. What is considered a significant percentage of ringed sideroblasts in the MDS classification? a: 15% b: 5% c: 10% d: 20%

a: 15% is considered a significant percentage of ringed sideroblasts in the MDS classification.

7. Which of the following bone marrow blast percentages would be consistent with the FAB classification of refractory anemias with excess of blasts (RAEB)? a: 5% to 20% b: 20% to 30% c: greater than 30% d: less than 5%

a: 5% to 20% of bone marrow blasts would be consistent with the FAB classification of refractory anemias with excess of blasts (RAEB).

4. A fatal bleed in a hemophilia patient involves: a: intracranial bleeding b: mucosal bleeding c: joint bleeding d: epistaxis

a: A fatal bleed in a hemophilia patient involves intracranial bleeding.

8. A man with hemophilia A and an unaffected woman can produce a: a: Female carrier b: male carrier c: male with hemophilia A d: normal female

a: A man with hemophilia A and a normal woman can produce a female carrier.

10. A primary inhibitor of the fibrinolytic system is: a: alpha-2-antiplasmin b: alpha-2-macroglobulin c: antithrombin d: Protein C

a: Alpha-2-antiplasmin is a primary inhibitor of the fibrinolytic system.

3. Which chemical substances are responsible for differentiation and replication of the pluripotent stem cell? a: cytokines b: insulin C: thyroxine d: oxygen

a: Cytokines; are responsible for differentiation and replication of the pluripotent stem cell.

1. The factor with the longest half-life is: a: I b: V c: VII d: X

a: Factor I has the longest half-life.

4. A patient presents with a microcytic, hypochromic anemia with ragged looking red blood cells in the peripheral smear and a high reticulocyte count. A brilliant cresol blue preparation reveals inclusions that look like pitted golf balls. These inclusions are suggestive of: a: Hgb H disease b: Beta thalassemia major c: Hereditary chromatosis d: Beta thalassemic trait

a: Hgb H disease; Pitted golf balls are suggestive of Hgb H disease

9. A prolonged aPTT is corrected with factor VIII deficient plasma but not with factor IX deficient plasma. What factor is deficient? a: IX b: VIII c: V d: X

a: If a patient is given plasma that does not have factor VIII but it does have factor IX then obviously that patient must be deficient in factor IX. Duh!!!

3. Name one condition that may shift the OD (oxygen dissociation) curve to the left. a: Inheriting a high oxygen affinity hemoglobin b: Metabolic acidosis c: Anemia d: Increased hemoglobin concentration

a: Inheriting a high affinity hemoglobin can shift the oxygen dissociation curve to the left.

7. Which of the following adequately describes the pathophysiology of the megaloblastic anemias? a: Lack of DNA synthesis b: Defect in globin synthesis c: Defect in iron metabolism d: Excessive iron loading

a: Lack of DNA synthesis would adequately describe the pathophysiology of the megaloblastic anemias.

3. The lupus anticoagulant is directed against: a: phospholipid-dependent coagulation tests. b: factor VIII inhibitor c: fibrinogen d: vitamin-K dependent clotting factors

a: Lupus anticoagulant is directed against phospholipid-dependent coagulation tests.

10. A patient presents with lymphadenopathy and WBC of 100X10^9/L. This blood picture would most likely be seen in: a: Chronic lymphocytic leukemia b: Acute lymphocytic leukemia c: Burkitt's lymphoma d: Hairy cell leukemia

a: Lymphadenopathy and WBC of 100X10^9/L is mostly seen in chronic lymphocytic leukemia.

10. The average of a group of data points is defined as the: a: mean b: Mode c: median d: modicum

a: Mean; is defined as the average group of data points.

3. One of the main differences between TTP and HUS is: a: Neurologic involvement b: Kidney failure c: Thrombocytopenia d: Microangiopathic hemolytic anemia

a: Neurologic involvement: TTP (Thrombocytopenic purpura) and HUS (Hemolytic Uremic Syndrome) are consumptive disorders of platelets. The main difference between the two conditions is that TTP also has neurologic involvement. Kidney failure, thrombocytopenia, and microangiopathic hemolytic anemia are commonalities between the two conditions.

9. Error analysis, standard protocols, and turn around time all are part of the: a: Quality assurance system b: Quality control program c: Reference standards d: Delta check protocol

a: Quality assurance system

9. Which of the following CBC parameters may provide an indication of anemia before the MCV indicates an overt size change? a: RDW b: MCH c: WBC d: MCHC

a: RDW; or Red blood cell distribution width; is a CBC parameter that may provide indication of anemia before the MCV indicates an overt size change.

3. Receptors found on the platelets are called: a: Glycoproteins b: VwF c: Fibrinogen d: Beta-thromboglobulin

a: Receptors found on the platelets are called glycoproteins.

6. List two sets of laboratory data that can distinguish IDA from beta thalassemia trait. a: serum iron and rbc b: hemoglobin and hematocrit c: WBC and RDW d: RBC indices and platelets

a: Serum iron and RBC; can distinguish IDA from beta thalassemia trait.

10. The red blood cell protein that is responsible for deformability and flexibility of the red blood cell is: a: Spectrin b: Glycophorin c: Glycine d: EPO

a: Spectrin; is the RBC protein responsible for deformability and flexibility of the RBC.

10. Which of the following results are correct regarding lupus inhibitors? a: Prolonged aPTT on undiluted plasma and 1:1 mix of patient plasma with normal plasma. b: Corrected aPTT on a 1:1 mix of patient plasma after 2 hours incubation c: Normal undiluted aPTT and prolonged aPTT on a 1:1 mix of patient plasma with normal plasma d: Normal undiluted aPTT and 1:1 mix of patient plasma with normal plasma.

a: The correct result for lupus inhibitors is a prolonged aPTT on undiluted plasma and 1:1 mix of patient plasma with normal plasma.

2. Which of the following lab assays is normal for patients with dysfibrinogenemia? a: immunologic assay for fibrinogen b: reptilase time c: thrombin time d: PT and PTT

a: The immunologic assay for fibrinogen would be normal for a patient with dysfibrinogenemia.

2. How does the bone marrow respond to anemic stress? a: Production is expanded and red blood cells are released to the circulation prematurely. b: Production is expanded and platelets are rushed into circulation c: Production is diminished and the M:E ratio is increased d: Production is diminished and the M:E ratio is unaffected

a: The marrow responds to anemic stress by; Expanding production and red blood cells are released into circulation prematurely.

10. One of the primary glands in an infant responsible for lymphocyte origination is: a: Thymus gland b: Adrenal gland c: Thyroid gland d: Pituitary gland

a: The thymus gland is one of the primary gland responsible for lymphocyte origination in infants.

7. Thrombin-thrombomodulin complex is necessary for: a: activation of protein C b: activation of antithrombin c: activation of protein S d: activation of factors V and VIII

a: Thrombin-thrombomodulin complex is necessary for activation of protein C.

5. Thrombotic symptoms in polycythemia vera are generally related to: a: Hyperviscosity syndrome b: Increased M:E ratio c: Increased LAP d: splenomegaly

a: Thrombotic symptoms in PV are generally related to hyperviscosity syndrome.

3. What types of samples are used primarily in the clinical laboratory? a: Blood and bodily fluids b: solid organs c: bone d: skin

a: blood and bodily fluids

7. Which of the following is the most prevalent inherited bleeding disorder? a: von Willebrand's disease b: Hemophilia A c: Factor VII deficiency d: Factor XII deficiency

a: von Willebrand's disease is the most prevalent inherited bleeding disorder.

7. Which of the following is the definition of a reference interval? a: A solution with a known amount of analyte b: Materials analyzed concurrently with unknown samples c: Values established for a particular analyte, given a method, instrument, or patient population d: Validation techniques on flagged samples

c: Reference intervals are: Values established for a particular analyte, given a method, instrument, or patient population.

4. If polychromasia is increased in the peripheral smear, the_______should be elevated. a: WBC b: RBC c: reticulocyte count d: basophil count

c: Reticulocyte count should be elevated if polychromasia is increased in the peripheral smear.

5. If 2-3-DPG increases, the hemoglobin molecule releases more oxygen. This is known as a ________ OD curve. a: left shift b: normal physiologic c: right-shifted d: neutral

c: Right-shifted OD curve occurs when 2-3-DPG increases and hemoglobin releases more oxygen.

10. What is the most characteristic change seen in the peripheral smear of a patient with multiple myeloma? a: Microcytic hypochromic cells b: Intracellular inclusion bodies c: Rouleaux d: agglutination

c: Rouleaux is the most characteristic change seen in the peripheral smear of patients with multiple myeloma.

1. What are the organs of hematopoiesis in fetal life? a: Bone marrow b: Thymus and thyroid gland c: spleen and liver d: Pancreas and kidney

c: Spleen and Liver; are organs of hematopoiesis during fetal life.

2. Which one of the following conditions would produce a thrombocytopenia due to an altered distribution of platelets? a: platelet satellitism b: IDA c: splenomegaly d: Chemotherapy

c: Splenomegaly may produce a thrombocytopenia due to an altered distribution of platelets.

10. The autoantibody generated in ITP is directed against: a: vWF b: collagen c: GP IIb/IIIa and GPIb-IX d: fibrinopeptides A and B

c: The autoantibody generated in ITP is directed against GP IIb/IIIa and GPIb-IX.

5. Which of the following is the best possible treatment for a patient with DIC? a: provide supporting blood products b: give the patient tPA if there is excessive clotting c: resolve the underlying cause of the DIC d: give the patient heparin therapy

c: The best possible treatment for a patient with DIC is to resolve the underlying cause of the DIC.

4. The origin of the dry tap in IMF occurs as a result of? a: extramedullary hematopoiesis b: The presence of teardrop cells in IMF c: The infiltration of fibrotic tissue in IMF d: The increase of megakaryocytes in IMF

c: The infiltration of fibrotic tissue often results in a dry tap in IMF.

3. What is the primary purpose of the fibrinolytic system? a: To form a stable fibrin clot b: to activate the complement system c: to restore blood flow at the local level d: to inhibit coagulation

c: The primary purpose of the fibrinolytic system is to restore blood flow at the local level.

9. A macrocytosis that is not megaloblastic in origin can be seen in all of the following EXCEPT: a: Chemotherapy b: Postsplenectomy c: Thyroid conditions d: Reticulocytosis

c: Thyroid conditions

4. Vasoconstriction is caused by several regulatory molecules, which include: a: fibrinogen and VwF b: ADP and EPI c: Thromboxane A2 and serotonin d: collagen and actomyosin

c: Vasoconstriction is caused by several regulatory molecules, which include thromboxane A2 and serotonin.

5. which clotting factor deficiency is associated with poor wound healing? a: factor II b: factor X c: factor XII d: factor XIII

d: A deficiency in factor XIII (13) is associated with poor wound healing.

8. All of the following are functions of thrombin EXCEPT: a: initiating the platelet release reaction b: Stimulating platelets to produce PGI2 c: activating factor V and VIII d: activating thromboplastin

d: Activating thromboplastin is NOT a function of thrombin.

3. The purest treatment product for hemophilia A patients is: a: cryoprecipitate b: fresh frozen plasma c: prothrombin complex concentrate d: recombinant factor VIII

d: Because individuals with hemophilia A are deficient in factor VIII, the purest treatment product for these patients would be recombinant factor VIII.

6. Chronic idiopathic thrombocytopenia purpura (ITP): a: is found in children b: usually remits spontaneously within several weeks c: Affects males more commonly than females d: involves the immune destruction of platelets.

d: Chronic idiopathic thrombocytopenia purpura (ITP) involves the immune destruction of platelets.

8. One of the least severe clinical manifestations of G6PD deficiency is: a: Acute hemolytic anemia b: Favism c: neonatal jaundice d: congenital nonspherocytic hemolytic anemia

d: Congenital nonspherocytic hemolytic anemia is one of the least severe clinical manifestations of G6PD deficiency.

8. The basic pathophysiology mechanism responsible for producing signs and symptoms in leukemia includes all of the following EXCEPT: a: Replacement of normal marrow precursors by leukemic cells. b: Decrease in functional leukocytes causing infection. c: Hemorrhage secondary to thrombocytopenia d: Decreased erythropoietin production

d: Decreased erythropoietin production is NOT a basic pathophysiological mechanism responsible for the signs and symptoms in leukemia.

8. All of the following are consistent with the clinical and pathologic picture of Waldenstrom's macroglobulinemia EXCEPT: a: M spike secondary to IgM b: Lymphadenopathy and splenomegaly c: proliferation of lymphocytes and plasmacytoid lymphocytes d: Destructive bone lesions

d: Destructive bone lesions are NOT consistent with the clinical and pathologic picture of Waldenstrom's macroglobulinemia.

3. All of the following are characteristic of the RBC in stages of development except; a: Nuclei are "baseball" round b: Immature cells are larger c: N:C ratio decreases as the cell matures d: distinct granulation in the cytoplasm

d: Distinct granulation in the cytoplasm; is not a characteristic of RBC maturation or development.