"Hematology" AAB MOCK EXAM missed questions
Malignant infiltration of the bone marrow
A cause of thrombocytopenia due to decreased production of platelets is: Von Willebrand's disease Malignant infiltration of the bone marrow Glanzmann's thrombasthenia High doses of aspirin
Hgb A = 60%, Hgb S = 38%, Hgb A2 = 2%, Hgb F = 0% Patients with sickle cell trait commonly have Hgb A values between 40 and 60%, Hgb S values between 20 and 40%, and Hgb A2 values between 2 and 3%.
A known sickle cell trait patient has a hemoglobin electrophoresis test performed. Which of the following hemoglobin percentage sets would most closely match this patient's diagnostic state? Hgb A = 90%, Hgb S = 8%, Hgb A2 = 2%, Hgb F = 0% Hgb A = 60%, Hgb S = 38%, Hgb A2 = 2%, Hgb F = 0% Hgb A = 40%, Hgb S = 58%, Hgb A2 = 2%, Hgb F = 0% Hgb A = 25%, Hgb S = 70%, Hgb A2 = 2%, Hgb F = 3%
Factor X
All of the following factors are involved in the initial contact phase of the intrinsic pathway, EXCEPT: Factor XII Fitzgerald Factor (high-molecular weight kininogen) Fletcher Factor (prekallikrein) Factor X
Sodium metabisulfite solubility test
Methods of identifying many of the major hemoglobin variants such as Hb A, Hb F, Hb S, etc. include all of the following EXCEPT: Sodium metabisulfite solubility test High performance liquid chromatography (HPLC) Citrate agar electrophoresis Alkaline electrophoresis
Schistocytes
What RBC morphology on a Wright-stained smear may indicate the presence of an unstable hemoglobin? Acanthocytes Codocytes Schistocytes Xerocytes
Beta thalassemia minima
Codocytes (target cells) are an expected finding in all of the following phenotypes of beta thalassemia, EXCEPT? Beta thalassemia minima Beta thalassemia minor Beta thalassemia intermedia Beta thalassemia major
Homozygous HbSS
A completely sickled cell (drepanocyte) is most commonly seen in which of these conditions? Homozygous HbSS Heterozygous HbSA Double heterozygous HbSC Hb S with beta thalassemia Truly sickled cells are a result of a homozygous HbSS state. Heterozygous HbSA or Sickle cell trait patients typically do not exhibit any red blood cell abnormalities on the peripheral smear. In double heterozygous HbSC, sickle cells are rarely seen on the peripheral smear. Typically more than half the erythrocytes are target cells. Plump sickle forms may also be noted as well. Hb S with beta-thalassemia is characterized by microcytes and 4+ target cells on the peripheral smear.
Bone marrow hypoplasia
A low platelet count, along with a low white blood cell count and red blood cell count is most likely caused by: Increased platelet destruction Ineffective erythropoiesis DIC (disseminated intravascular coagulation) Bone marrow hypoplasia
Monocyte
Identify the nucleated blood cell. Lymphocyte Band neutrophil Monocyte Eosinophil
Basophil
Identify the white blood cell seen in this illustration: Myelocyte Neutrophil Eosinophil Basophil
MCV - hct/RBC x 10 MCH - hb/RBC x 10 MCHC - hb/hct x 100
state the formulas used for calculating the RBC indices. MCV MCH MCHC
Beta
Hemoglobin H (HbH) bodies are tetramers of which globin chain? Alpha Beta Delta Gamma
Acute lymphocytic leukemia
A 27-year-old man with Down syndrome has the following CBC results which are MOST suggestive of what condition? WBC: 27 x 103/µL HGB: 8.5 g/dl HCT: 25.0% PLT: 30 x 109/L Differential blood smear results: 8% segmented neutrophils 25% lymphocytes 67% TdT-positive blasts Acute myelogenous leukemia Myeloproliferative disorder Leukemoid reaction Acute lymphocytic leukemia
Defective glycoprotein Ib/IX
Abnormal platelet function seen in patients with Bernard-Soulier Syndrome is caused by which of the following platelet components? Defective glycoprotein Ib/IX Dense granule deficiency a-granule deficiency Defective glycoprotein IIb/IIIa
Decreased ferritin
Anemia of chronic inflammation, also known as anemia of chronic disease, can be caused by all of the following mechanisms EXCEPT: EPO production inhibited by cytokines Direct cytokine inhibition of erythropoiesis Decreased ferritin Shortened erythrocyte survival
Staining cellular components that have an acidic pH such as ribosomes, DNA, and RNA
Methylene blue stain works by: Staining cellular components that have a neutral pH, such as neutrophilic granules Staining cellular components that have an acidic pH such as ribosomes, DNA, and RNA Staining cellular components that have a basic pH such as cytoplasmic proteins Staining cellular components regardless of the pH
Dyspoiesis
Myelodysplastic Syndromes are characterized by cytopenias with at least one cell line decreased as well as this: Left shift Leukoerythroblastosis Dyspoiesis Leukemoid Reaction
Sideroblastic anemia
Note the iron-stained bone marrow preparation in the image to the right. The cells as shown can be associated with which type of anemia? Iron deficiency anemia Sickle cell anemia Sideroblastic anemia Megaloblastic anemia
Beta thalassemia minor
These test results are most consistent with which of the following types of beta thalassemia? Red blood cell (RBC) count 5.6 x 1012/L REF RANGE : 4.1 - 5.1 x 1012/L Hemoglobin (Hb) 11.2 g/dL REF RANGE : 12.3 - 15.3 g/dL Hematocrit (HCT) 34.5% REF RANGE : 35.9 - 44.6% RDW 14.0 REF RANGE : <14.5 RBC morphology- Microcytes, basophilic stippling, codocytes (target) present. Beta thalassemia minima Beta thalassemia minor Beta thalassemia intermedia Beta thalassemia major
HbS/HPFH The patient lanes 3 & 4 shows nearly equal bands in the "S" and "F" positions. In HbS/HPFH, there would be two bands on alkaline electrophoresis, one would be in the S position. Hereditary Persistence of Fetal Hemoglobin (HPFH) will result in a band in the F position. This is consistent with HbS/HPFH. In alkaline hemoglobin electrophoresis, the sample is applied closest to the cathode (negatively charged electrode). Once current is applied, the hemoglobins move toward the anode (positively charged electrode). Based on the hemoglobin controls shown in the alkaline electrophoresis, hemoglobin A is the fastest moving hemoglobin and is represented by the band closest to the anode in lanes 1, 2, 5 & 6. Hemoglobin F is the next fastest and is represented by the band second closest to the anode in lanes 2 & 5. Hemoglobin S is next and is represented by the second band in lanes 1 & 6. Hemoglobin C is the slowest hemoglobin and is represented by the band closest to the cathode in lanes 1 & 6. In HbSA, there would be bands in the A and S positions on alkaline electrophoresis. In HbSD, there would be one band on the alkaline electrophoresis pattern. Hemoglobin D migrates with S in alkaline electrophoresis.
The alkaline hemoglobin electrophoresis pattern shown on the right includes controls for A, S, and C; and A and F above and below the patient results. (NOTE: ASC and AF are labeled for the controls and do not indicate the migration order.) The patient was tested in duplicate, and the results are in lanes 3 and 4. The patient lanes (3 and 4) displayed in these hemoglobin electrophoresis patterns are consistent with what diagnosis? HbSA HbSC HbSD HbS/HPFH
Hereditary spherocytosis
The autohemolysis test is MOST useful in the diagnosis of which condition? Pyruvate kinase (PK) deficiency G6PD deficiency Sickle cell anemia Hereditary spherocytosis
Hb H inclusions
This image depicts a brilliant cresyl blue-stained blood smear. What inclusion bodies are shown in the erythrocyte indicated by the arrow (B)? Howell-Jolly bodies Hb H inclusions Pappenheimer bodies Siderotic granules
Decreased RBCs, platelets, and WBCs
This photo shows the bone marrow aspirate of a patient with a history of fatigue and petechiae. The CBC from the peripheral blood would confirm: Decreased RBCs, platelets, and WBCs Decreased RBCs Decreased WBCs Decreased platelets
DNA
What are Howell-Jolly bodies composed of? Hemoglobin DNA Iron RNA
Increased serum ferritin
What is a common early laboratory marker of hereditary hemochromatosis (HH)? Increased serum ferritin Decreased serum iron Decreased transferrin saturation Increased hemoglobin
The serum ferritin decreases to between 20 and 50 ng/mL
What is a typical finding for determining the endpoint for the initial or iron-depletion phase of treatment for hereditary hemochromatosis (HH)? The serum ferritin decreases to between 20 and 50 ng/mL The hepatic iron index returns to normal The transferrin saturation drops below 20% The serum iron falls to below 35 µg/dL.
10% to 12%
What is the approximate percentage of individuals in the US who are heterozygous for HFE mutations for hereditary hemochromatosis? 0.05% to 0.10% 1% to 2% 10% to 12% 20% to 25%
The Kleihauer-Betke test capitalizes on the resistance of fetal hemoglobin to acid treatment.
What is the principle of the Kleihauer-Betke test? The Kleihauer-Betke test capitalizes on the resistance of fetal hemoglobin to alkaline treatment. The Kleihauer-Betke test capitalizes on the resistance of fetal hemoglobin to acid treatment. The Kleihauer-Betke test capitalizes on the resistance of fetal hemoglobin to enzymatic treatment. The Kleihauer-Betke test capitalizes on the resistance of fetal hemoglobin to radiation treatment
Basophilic stippling
A mother brings in her 6-year-old son to the clinic with concerns of learning difficulties from his school and also states he seems very tired all the time. The family has been staying in an old, run-down motel recently as they try to find housing with no other significant family history. Testing was ordered to include a CBC. The CBC shows a microcytic anemia but otherwise normal results. Which of the following may be present upon manual differential review? Sickle cells Pappenheimer bodies Howell-Jolly bodies Basophilic stippling
Iron deficiency anemia The correct answer choice here is iron deficiency anemia. The patient's clinical symptoms and laboratory picture are most consistent with iron deficiency anemia. The cells appear hypochromic with a marked poikilocytosis and anisocytosis. Sickle cell, megaloblastic, and aplastic anemias do not have the clinical symptoms or peripheral smear characteristics that this case displays. Sickle cell anemia can be easily recognized by the distinct sickle-shaped cells that form when oxygenated blood releases oxygen particles to parts of the body. The hematology technologist should note the sickled cells and notify the attending physician so that a sickle cell screen can be performed to confirm the patient has sickle cell anemia. Megaloblastic anemia is a macrocytic (oval macrocytes) anemia and would present with characteristic hypersegmented neutrophils. Megaloblastic anemia's two most common causes are vitamin B12 deficiency and folate deficiency. Aplastic anemia can present on a manual differential similar to iron deficiency anemia. Patients with aplastic anemia usually have some type of infection, are on medication that can cause a decrease in RBCs, or have been exposed to toxic chemicals.
A patient is admitted to the emergency room with severe lethargy, glossitis, and muscle dysfunction. After the physician orders a complete blood count with differential, the hematology technologist observes cells matching the image to the right. Which condition is most consistent with the clinical and laboratory findings? Sickle cell anemia Megaloblastic anemia Iron deficiency anemia Aplastic anemia
Cells in the gated population are co-expressing CD5 and CD20. The scatterplot represents the co-expression of CD5 and CD20. Quadrant 2 (Q2) of the scatterplot contains CD5/CD20 + cells. Normally CD5 positive cells represent T lymphocytes, while CD20 positive cells represent B lymphocytes. In this case, a single cell population is expressing both markers. If cells were predominantly expressing CD5 but not CD20, the cells would be in quadrant 1 (Q1). If cells were predominantly expressing CD20 but not CD5, the cells would be in quadrant 4 (Q4). If cells were expressing neither CD5 nor CD20, the cells would be in quadrant 3 (Q3).
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 co-expressing CD5 and CD20. Cells in the gated population are expressing neither CD5 nor CD20.
Dietary iron deficiency Iron deficiency anemia is the most likely diagnosis because the RBC, Hct, and Hgb are all very low. Idiopathic thrombocytopenia can be ruled out since the platelet count is normal Lymphocytic leukemia can also be ruled out because the WBC is normal. Finally, lead poisoning is ruled out since this condition does not usually cause severe anemia.
A two-year old male patient has the following hemogram results: Hgb = 6.7g/dL Hct = 20% Platelets = 355 x 109/L RBC = 3.0 x1012/L WBC = 8.75 x 109/L Differential = 6% eos, 20% segs, 68% lymphs, 6% monos Which of the following is the MOST likely diagnosis? Dietary iron deficiency Idiopathic thrombocytopenia Lymphocytic leukemia Lead poisoning
MCV = 110 fL, MCH = 35 pg, MCHC = 32 g/dL
Calculate the red cell indices from the following set of patient data: RBC count = 3.19 x 1012/L Hemoglobin = 11.3 g/dL Hematocrit = 35% MCV = 99 fL, MCH = 38 pg, MCHC = 34 g/dL MCV = 109 fL, MCH = 36 pg, MCHC = 34 g/dL MCV = 110 fL, MCH = 35 pg, MCHC = 32 g/dL MCV = 105 fL, MCH = 38 pg, MCHC = 32 g/dL
Factor IX
Hemophilia B or Christmas disease is the result of a hereditary deficiency in which coagulation factor? Factor X Factor VIII Factor XI Factor IX
Hemoglobin H disease
In which disorder do neonates demonstrate the presence of Bart's hemoglobin that changes to beta chain tetramers in adults? Alpha thalassemia major Alpha thalassemia minor Hemoglobin H disease Hydrops fetalis
fourth to Fifth
The bone marrow begins producing cells in the _____________ month of fetal life. First fourth to Fifth Sixth Eighth
Hyperplasia
The bone marrow in alpha thalassemia major usually demonstrates: Normoplasia Hypoplasia Aplasia Hyperplasia
Left shift
The cells included in the composite image were found in the peripheral blood smear of a patient with the following results: total WBC of 21.5 x 109/L. Differential count: metamyelocytes 4 band neutrophils 16 segmented neutrophils 48 monocytes 6 eosinophils 1 basophils 1 lymphocytes 24 This hematologic picture is most consistent with: Leukemoid reaction Chronic myeloid leukemia Left shift Leukoerythroblastosis
Request additional medical information
The photograph here is of a peripheral smear sent for hematologic review. No clinical information for the patient was sent with the slide. What is the first course of action that the reviewer should take to assist him/her in interpreting the findings on this blood smear? Perform hemoglobin electrophoresis Request a repeat smear preparation Perform lipid electrophoresis assay Request additional medical information
Provide microbicidal action.
The primary purpose of neutrophil granules is to: Facilitate nuclear maturation Help distinguish neutrophils from lymphocytes. Prepare cells for removal from circulation. Provide microbicidal action.
Plasminogen Plasminogen is correct as it is activated into plasmin by the thrombin-thrombomodulin complex which will begin the fibrinolytic system. Factor VII is not correct as it is activated by tissue factor (Factor III) upon tissue injury. Fibrin is not correct as it is created from Fibrinogen (Factor I). Factor XII is not correct as it is activated by contact with a foreign surface to start the intrinsic pathway.
The thrombomodulin-thrombin complex is known to aid in the activation of which of the following? Factor VII Plasminogen Fibrin Factor XII
Rouleaux formation
What physiological factor causes sedimentation in the Erythrocyte Sedimentation Rate (ESR)? Elevated levels of immunoglobulins Increased concentrations of fibrinogen Rouleaux formation Tilted tube, varying from the vertical
Monocyte
What type of cell is indicated by the arrow? Monocyte Blast Macrophage Tumor cell
Recollect a specimen for a platelet count without using EDTA Occasionally platelet satellitosis can occur in some patient samples when collected in EDTA. The solution for this problem is to recollect in a different type of anticoagulated tube, usually a sodium citrate tube, to prevent the platelets from adhering to the neutrophils. The platelet count would be multiplied by 1.11 to account for the dilution of the blood sample with sodium citrate (9:1).
What would be the next step when an EDTA specimen had an automated platelet count of 61,000/mm3 and the platelets were surrounding the neutrophils on the differential? Report the automated platelet count since it is more accurate than a platelet estimate Warm the EDTA tube and repeat the automated platelet count Rerun the original specimen since the platelet count and blood smear estimate do not match Recollect a specimen for a platelet count without using EDTA
The presence of round macrocytes in nonmegaloblastic anemia.
When distinguishing megaloblastic from nonmegaloblastic macrocytic anemia, which of the following is a key difference in red blood cell morphology? The presence of target cells in nonmegaloblastic macrocytic anemia The presence of oval macrocytes in nonmegaloblastic anemia The presence of round macrocytes in megaloblastic anemia The presence of round macrocytes in nonmegaloblastic anemia.
Transfusion dimorphism
Which of the following conditions/findings is most likely associated with the peripheral blood picture in the photomicrograph? Hereditary spherocytosis Lead poisoning Transfusion dimorphism Folic acid deficiency
Beta, gamma, epsilon
Which of the following globin genes are found on Chromosome 11? Beta, gamma, epsilon Beta, epsilon, alpha Gamma, epsilon, zeta Alpha, zeta
Deletion of a globin chain.
Which of the following is NOT a way hemoglobinopathies can be caused? Deletion of a globin chain. Substitution of amino acids in a globin chain. Deletion of an amino acid in a globin chain. Addition of an amino acid in a globin chain.
MDS with Philadelphia Chromosome (MDS-PC)
Which of the following is NOT classified as a Myelodysplastic Syndrome? MDS with Philadelphia Chromosome (MDS-PC) MDS with Ring Sideroblasts (MDS-RS) MDS with Single Lineage Dysplasia (MDS-SLD) MDS with Excess Blasts (MDS-EB)
Presence of HFE mutation
Which of the following is an expected or common laboratory finding in patients with hereditary hemochromatosis (HH)? Elevated hemoglobin and hematocrit Decreased transferrin saturation Presence of HFE mutation Decreased serum ferritin
Myelophthisic anemia
Which of the following is characterized by the bone marrow being invaded by fibrotic, granulomatous, or neoplastic cells? Fanconi anemia Megaloblastic anemia Myelophthisic anemia Diamond-Blackfan anemia
The two main compartments of the bone marrow are the vascular sinuses and hematopoietic cords.
Which of the following statements is correct regarding the bone marrow compartments? The two main compartments of the bone marrow are the vascular sinuses and hematopoietic cords. The two main compartments of the bone marrow are the vascular sinuses and blood vessels. Erythropoiesis in the bone marrow occurs in all areas of the marrow. A unique bone marrow microenvironment is not necessary for hematopoiesis
Platelet count
Which of the following tests is expected to have a normal result in a patient with type 1 von Willebrand disease? Bleeding time APTT Platelet count VWF antigen levels
Dyskeratosis congenita
Which of the following types of anemia can be described as an inherited bone marrow failure syndrome with patients developing dystrophic nails and white patches in the mouth? Fanconi anemia Dyskeratosis congenita Chronic aquired pure red cell aplasia Diamond-Blackfan anemia
Mast cell
Which of the marrow cells from the list below has highly granular basophilic cytoplasm but does not show nuclear lobules? Macrophage Mast cell lipocyte Osteoblast
Tartrate-resistant acid phosphatase test
Which one of the following is a useful chemical test for the diagnosis of hairy cell leukemia? Peroxidase test Sudan black test Alpha-naphthyl acetate esterase test Tartrate-resistant acid phosphatase test