BOC Hematology Question Set 1

3) The majority of the iron in an adult is found as a constituent of: a. hemoglobin b. hemosiderin c. myoglobin d. transferrin

A) (2/3 iron in body bound to Hgb.)

14) After the removal of RBCs from the circulation hemoglobin is broken down into: a. iron, prophyrin, amino acids b. iron, protoporphyrin, globin c. heme, protoporphyrin, amino acids d. heme, hemosiderin, globin

B (Normal degradation products of red blood cells.)

4) The main function of the hexose monophosphate shunt in the erythrocyte is to: a. regulate the level of 2,3-DPG b. provide reduced glutathione to prevent oxidation of hemoglobin c. prevent the reduction of heme iron d. provide energy for membrane maintenance

B) (Maintains in Fe++ form by way of reduced glutathione.)

11) In which of the following disease states are teardrop cells and abnormal platelets most characteristically seen? a. hemolytic anemia b. multiple myeloma c. G-6-PD deficiency d. myeloid metaplasia

D)

10) In order for hemoglobin to combine reversibly with oxygen, the iron must be: a. complexed with haptoglobin b. freely circulating in the cytoplasm c. attached to transferrin d. in the ferrous state

D) (Functional form of Fe [reduced].)

15) Heinz bodies are: a. readily identified with polychrome stains b. rarely found in glucose-6-phosphate dehydrogenase deficient erythrocytes c. closely associated with spherocytes d. denatured hemoglobin inclusion that are readily removed by the spleen

D) (Formed with oxidization of Fe and formation of methemoglobin.)

312) The most potent plasminogen activator in the contact phase of coagulation is: a. kallikrein b. streptokinase c. HMWK d. fibrinogen

a (A clot is degraded by plasmin in the fibrinolytic system. Plasminogen is the zymogen produced when Factor XIIa and kallikrein are produced by contact activation.)

320) A hemophiliac male and a normal female can produce: a. a female carrier b. a male carrier c. a male hemophiliac d. a normal female

a (All daughters of hemophiliac men are carriers of the disease; all sons are normal. The gene for Factor VIII lies on the X chromosome.)

228) An unexplained elevation of the prothrombin time in a 72 yr. old smoker who has been diagnosed with chronic pulmonary obstructive disease is most likely due to: a. an elevated hematocrit b. a decreased hematocrit c. vitamin K deficiency d. decreased thrombin activity

a (An elevated hematocrit decreases the amount of plasma in whole blood, and causes an effective increase in the amount of citrate added to that plasma. Recalcification incompletely overcomes the additional citrate, and prolongations in clotting time tests can be expected, unless the amount of citrate is adjusted for the abnormal hematocrit.)

240) In synovial fluid, the most characteristic finding in pseudogout is: a. calcium pyrophosphate dihydrate crystals b. cartilage debris c. monosodium urate crystals d. hemosiderin-laden macrophages

a (Association of pseudogout with calcium pyrophosphate crystals.)

184) A patient diagnosed with polycythemia vera 5 yrs. ago has a normal hematocrit, decreased hemoglobin, and microcytic, hypochromic red cells. What is the most probable cause for the current blood situation? a. phlebotomy b. myelofibrosis c. proleukemia d. aplastic anemia

a (Hypochromic, microcytic RBC is most commonly associated with iron deficiency, which would most likely result from repeated therapeutic phlebotomies.)

105) When using an electronic cell counter, which of the following results can occur in the presence of a cold Agglutinin: a. increased MCV and decreased RBC b. increased MCV and normal RBC c. decreased MCV and increased MCHC d. decreased MCV and RBC

a (Autoagglutination of anticoagulated blood can occur at room temperature in patients with a cold autoagglutinin. The MCV will be falsely elevated and the RBC count falsely decreased, resulting in an elevated MCHC. The blood sample should be warmed to 37 C and rerun.)

297) Which of the following detects or measures platelet function? a. bleeding time b. prothrombin time c. thrombin time d. partial thromboplastin time

a (BT assesses platelet function; PT, TT and PTT do not assess platelet function.)

294) A bleeding time is used to evaluate the activity of: a. platelets b. prothrombin c. labile factor d. Factor VIII

a (Bleeding time [BT] assesses platelet activity.)

298) Platelet aggregation is dependent in vitro on the presence of: a. calcium ions b. sodium citrate c. thrombin d. potassium

a (Calcium is required for platelet aggregation.)

108) What is the MCH if the Hct is 20%, the RBC is 2.4 x 10^6/mL (2.4 x 10^12/L) and the Hgb is 5 g/dL (50 g/L)? a. 21 mm3 (21 fL) b. 23 mm3 (23 fL) c. 25 mm3 (25 fL) d. 84 mm3 (84 fL)

a (Calculation of RBC indices.)

110) Which of the following is the formula for MCHC? a. (Hgb x 100) / Hct b. Hgb / RBC c. RBC / Hct d. (Hct x 1000) / RBC

a (Calculation of RBC indices.)

236) A patient diagnosed as having bacterial septicemia. Which of the following would best describe the expected change in his peripheral blood? a. granulocytic leukemoid reaction b. lymphocytic leukemoid reaction c. neutropenia d. eosinophilia

a (Correlation of sepsis with a leukemoid reaction.)

348) D-Dimers are produced from: a. cross-linked and stabilized fibrin clot b. decreased fibrinogen and platelets c. plasminogen converting to plasmin d. generation of thrombin from endothelial cells

a (D-dimers are produced from crosslinked and stabilized fibrin clots. This clot is dissolved by plasma and d-dimers are released. Therefore, d-dimers suggest a breakdown of fibrin clots, and indicate that clots have been formed at the site of injury.)

137) Elevation of the lymphocyte percentage above 47% is termed: a. relative lymphocytosis b. absolute lymphocytosis c. leukocytosis d. absolute neutrophilic leukocytosis

a (Definition of relative lymphocytosis.)

216) Al leukocyte count and differential on a 40-year-old Caucasian man revealed: This represents: a. relative lymphocytosis b. absolute lymphocytosis c. relative neutrophilia d. leukopenia

a (Definition of relative lymphocytosis.)

178) All stages of neutrophils are most likely to be seen in the peripheral blood of patient with: a. chronic myelocytic leukemia b. myelofibrosis with myeloid metaplasia c. erythroleukemia d. acute myelocytic leukemia

a (Demonstrates difference between acute vs chronic leukemias; intermediate cell maturity seen in chronic myelogenous, but would not predominate in erythroleukemia.)

9) Which curve represents the production of epsilon polypeptide chains of hemoglobin? a. A b. B c. C d. D

a (Development time line of production of Hgb epsilon chains.)

211) Of the following, the disease most closely associated with glucocerbrosidase deficiency is: a. Gauchers disease b. Chediak-Higashi c. Pelger- Huet d. May-Hegglin

a (Differentiation of lipid storage disease from other anomalies of leukocytes.)

214) An oncology patient has the following results: The most probable explanation is: a. chemotherapy b. cold antibody c. clotted specimen d. inadequate mixing

a (Effect of conventional chemotherapy on WBC count.)

98) Which electrophoresis pattern is consistent with sickle cell trait? a. pattern A b. pattern B c. pattern C d. pattern D

a (Electrophoretic pattern for sickle cell trait on cellulose acetate.)

43) The characteristic morphologic feature in folic acid deficiency is: a. macrocytosis b. target cells c. basophilic stippling d. rouleaux formation

a (Folate deficiency-peripheral smear will show abnormally large RBCs.)

38) A patient has a congenital nonspherocytic hemolytic anemia. After exposure to anti-malarial drugs the patient experiences a severe hemolytic episode. This episode is characterized by red cell inclusions caused by hemoglobin denaturation. Which of the following conditions is consistent with these findings? a. G-6-PD deficiency b. thalassemia major c. pyruvate kinase deficiency d. paroxysmal nocturnal hemoglobinuria

a (G-6-PD deficiency-anti-malarial drugs.)

205) Which of the following is associated with Chediak-Higashi syndrome? a. membrane defect of lysosomes b. Dohle bodies and giant platelets c. two-lobed neutrophils d. mucopolysaccharidosis

a (Giant granulocyte inclusions due to fusion of lysosomes.)

283) Which of the following is characteristic of Bernard - Soulier syndrome? a. giant platelets b. normal bleeding time c. abnormal aggregation with ADP d. increased platelet count

a (Giant platelets, abnormal bleeding time, normal aggregation with ADP, decreased platelet count are characteristic of Bernard-Soulier.)

220) Which of the following is the formula for manual white cell count? a.(number of cells counted x dilution x 10)/number of squares counted b. (number of cells counted x dilution)/10 x number of squares counted c. number of cells counted x dilution d. number of cell counted x number of squares counted

a (Hemacytometer calculation .)

52) Lab findings in hereditary spherocytosis do not include: a. decreased osmotic fragility b. increased autohemolysis corrected by glucose c. reticulocytosis d. shortened erythrocyte survival

a (Hereditary spherocytosis-lab results.)

381) The specimen of choice for preparation of blood films for manual differential leukocyte counts is whole blood collected in: a. EDTA b. oxalate c. citrate d. heparin

a (High-quality blood smears can be made from the EDTA tube within 2-3 hours of collecting the specimen.)

234) The large cell in the center of the image would be best described as a(n): a. neutrophil b. basophil c. eosinophil d. myelocyte

b (Morphology of a basophil.)

201) Of the following, the disease most closely associated with cytoplasmic granule fusion is: a. Chediak-Higashi syndrome b. Pelger-Huet anomaly c. May-Hegglin anomaly d. Alder-Reilly anomaly

a (Identification of condition with morphologic alteration in neutrophils, representing giant fused lysosomes.)

256) In flow cytometric analysis, low angle or forward scatter of a laser light beam provides information that pertains to a cell's: a. volume b. viability c. granularity d. lineage

a (In a flow cytometer, forward scatter provides an estimate of cell volume or size.)

79) The M:E ratio in polycythemia vera is usually: a. normal b. high c. low d. variable

a (Increase in both myeloid and erythroid precursors)

382) A platelet determination was performed on an automated instrument and a very low value was obtained. The platelets appeared adequate when estimated from the stained blood film. The best explanation for this discrepancy is: a. many platelets are abnormally large b. blood sample is hemolyzed c. white cell fragments are present in the blood' d. red cell fragments are present in the blood

a (Instruments count particles within defined size limits. The upper limit is to separate large platelets from erythrocytes. Large platelets may be counted as erythrocytes.)

106) In polycythemia vera, the leukocyte alkaline phosphatase activity is: a. elevated b. normal c. decreased

a (LAP activity may be increased in polycythemia Vera.)

168) Biochemical abnormalities characteristic of polycythemia vera include: a. increased serum B12 binding capacity b. hypouricemia c. hypohistaminemia d. decreased leukocyte alkaline phosphatase activity

a (Lab findings are reflective of erythroid rather that myeloid metaplasia.)

151) The following results were obtained on a 45-year-old man complaining of chills and fever: These results are consistent with: a. neutrophilic leukemoid reaction b. polycythemia Vera c. chronic myelocytic leukemia d. leukoerythroblastosis in myelofibrosis

a (Lab findings, increased WBC but with increased LAP; negative Philadelphia chromosome differentiates leukemoid response from leukemia.)

287) The chamber counting method of platelet enumeration: a. allows direct visualization of the particles being counted b. has a high degree of precision c. has a high degree of reproducibility d. is the method of choice for the performance of 50 - 60 counts per day

a (Manual chamber counts do not have a high degree of precision or reproducibility, and require a significant amount of time.)

265) Which of the following cells is the largest cell in the bone marrow? a. megakaryocyte b. histiocyte c. osteoblast d. mast cell

a (Megakaryocytes are the largest cell in the bone marrow.)

208) A differential was performed on an asymptomatic patient. The differential included 60% neutrophils, 55 of which had 2 lobes and 5 had 3 lobes. There were no other abnormalities. This is consistent with which of the following anomalies? a. Pelger-Huet b. May-Hegglin c. Alder-Reilly d. Chediak-Higashi

a (Morphologic alteration of neutrophils- primary feature is hyposegmentation.)

230) The large nucleated cell in the lower right-hand side of the image below is a: a. myelocyte b. metamyelocyte c. basophil d. plasma

a (Morphology of a myelocyte.)

237) The most characteristic morphologic features of atypical lymphs include: a. course nuclear chromatin and basophilic cytoplasm b. blue-grey cytoplasm, fine nuclear chromatin c. nucleoli and deep blue RNA-rich cytoplasm d. a stretched nucleus and cytoplasmic indentations

a (Morphology of reactive lymphocytes.)

45) The most likely cause of the macrocytosis that often accompanies anemia of myelofibrosis is: a. folic acid deficiency b. increased reticulocyte count c. inadequate B12 absorption d. pyridoxine deficiency

a (Myelofibrosis is often accompanied by folate deficiency, which causes macrocytic anemia.)

250) Which of the following stains in closely associated with the lysosomal enzyme in primary granules? a. peroxidase b. Sudan black B c. periodic acid-Schiff d. Prussian blue

a (Myeloperoxidase as a marker of primary granules in granulocytes.)

326) Plasma from a patient with lupus coagulation inhibitor can show: a. prolonged APTT and normal PT b. prolonged thrombin timer c. no change with platelet neutralization d. complete correction when incubated with normal plasma

a (Patients suspected of a lupus anticoagulant present with a prolonged APTT. Laboratory assays to detect lupus anticoagulants are the APTT, dilute Russell viper venom test, and Kaolin clotting time. In the presence of a LA, the mixing study doesn't correct.)

314) Which of the following is characteristic of Factor XII deficiency. a. negative bleeding history b. normal clotting times c. decreased risk of thrombosis d. epistaxis

a (Patients with a deficiency of Factor XII tend to have thrombotic complications. They do not have bleeding problems most likely due to the lack of activation of fibrin lysis, also due to pathway activation of IX by VIIa/TF complex as well as the activation of Factor XI by thrombin.)

40) Peripheral blood smears from patients with untreated anemia are characterized by: a. pancytopenia and macrocytosis b. leukocytosis and elliptocytosis c. leukocytosis and ovalocytes d. pancytopenia and microcytosis

a (Patients with pernicious anemia have fewer of all types of blood cells, but they are abnormally large.)

140) The Philadelphia chromosome is formed by a translocation between the: a. long arm of chromosome 22 and long arm of chromosome 9 b. long arm of chromosome 21 and long arm of chromosome 9 c. long arm of chromosome 21 and short arm of chromosome 6 d. long arm of chromosome 22 and short arm of chromosome 6

a (Philadelphia chromosome composition.)

373) The photo-optical method of endpoint detection is described as: a. change in optical density as a result of a fibrin clot b. measurement of turbidity of antigen-antibody formation c. decreased motion of a mechanical ball d. color-producing chromophore

a (Photo-optical endpoint is a change in optical density. Nephelometry is an immunometric method for measuring proteins. Chromogenic methods employs a color-producing substance called a chromophore. Immunologic assays are based on antigen-antibody reactions.)

19) What cell shape is most commonly associated with an increased MCHC? a. teardrop cells b. target cells c. spherocytes d. sickle cells

c

385) On a smear made directly from a finger stick, no platelets were found in the counting area. The first thing to do is: a. examine the slide for clumping b. obtain another smear c. perform a total platelet count d. request another finger stick

a (Platelet clumping is expected if smears are made directly from the finger. Smears must be made promptly before any clotting begins. It is important to examine the edges for platelet clumping.)

289) A phase-platelet count was performed and the total platelet count was 356 x 10^3/mL (356 x 10^9/L). 10 fields on the stained blood smear were examined for platelets and the results per field were: 16, 18, 15, 20,19, 17, 19, 18, 20, 16 The next step would be to: a. report the phase-platelet count since it correlated well with the slide b. repeat the phase-platelet count on a recollected specimen and check for clumping c. check ten additional fields on the blood smear d. repeat the platelet count using a different method

a (Platelet count matches estimate well [average of 17.8 platelets per oil immersion field x 20,000].)

74) Evidence of active red cell regeneration may be indicated on a blood smear by: a. basophilic stippling, NRBC, and polychromasia b. hypochromia, macrocytes and NRBC's c. hypochromia, basophilic stippling and NRBC's d. Howell-Jolly bodies, Cabot rings and basophilic stippling

a (Polychromatophilic red blood cells and basophilic stippling can be associated with accelerated heme synthesis.)

279) In polycythemia vera, the platelet count is: a. elevated b. normal c. decreased d. variable

a (Polycythemia Vera is characterized by increased WBC, RBC, and platelet counts.)

340) A patient is taking 10 mg per day of coumadin. The results of which of the following lab tests will be most impacted? a. protein C level b. antithrombin III level c. Factor V Leiden mutation d. Factor VIII level

a (Protein C is a vitamin K dependent protein; hence warfarin therapy will lower levels of this protein.)

310) Prothrombin is: a. a protein formed by the liver in the presence of Vitamin K b. an enzyme that converts fibrinogen into fibrin threads c. the end product of the reaction between fibrinogen and thrombin d. a protein released by platelets during coagulation

a (Prothrombin is produced by the liver cells dependent on Vitamin K as a coenzyme for its functionality. It is released into the blood as a zymogen as a precursor for its active form thrombin.)

81) Which of the following is most closely associated with erythroleukemia? a. ringed sideroblasts, nuclear budding and Howell-Jolly bodies b. DIC c. micromegakaryocytes d. lysozymuria

a (RBC morphologic features of erythroleukemia include nuclear budding and fragmentation cytoplasmic vacuoles, Howell-Jolly bodies, ringed sideroblasts and megaloblastic changes.)

65) The RDW-CV and RDW-SD performed by automated cells counters are calculations that provide: a. an index of the distribution of RBC volume b. a calculated mean RBC hemoglobin concentration c. a calculated MCH d. the mean RBC volume

a (RDW-CV is a new parameter available from automated instruments.)

72) A RBC about 5 um in diameter that stains bright red and shows no central pallor is a: a. spherocyte b. leptocyte c. microcyte d. macrocyte

a (Recognize spherocytes on a blood smear.)

193) The most common form of childhood leukemia: a. acute lymphocytic b. acute granulocytic c. acute monocytic d. chronic granulocytic

a (Recognizes ALL as most common malignancy of children.)

192) A 50-year-old woman who has been receiving busulfan for three years for chronic myelogenous leukemia becomes anemic. Laboratory tests reveal: - Thrombocytopenia - Many peroxidase-negative blast cells in the peripheral blood - Bone marrow hypercellular in blast transformation - Markedly increased bone marrow TdT Which of the following complications is this patient most likely to have? a. acute lymphocytic leukemia b. acute myelocytic leukemia c. acute myelomonocytic leukemia d. busulfan toxicity

a (Recognizes ALL as possible progression for 1/3 of CML cases.)

132) Specific granules of the neutrophilic granulocyte: a. appear first at the myelocyte stage b. contain lysosomal enzymes c. are formed on the mitochondria d. are derived from azurophilic granules

a (Secondary granule appearance in neutrophils.)

154) Which of the following cells is the atypical lymphocyte seen on the peripheral blood smear of patients with infectious mononucleosis? a. T lymphocytes b. B lymphocytes c. monocytes d. mast cells

a (T-cell activation follows during second week of IM in response to the EBV induced B-cell infection and activation.)

350) A bedside test that can be used to monitor heparin activity is the: a. activated clotting time b. stypven time c. reptilase time d. partial thromboplastin time

a (The ACT monitors high dose heparin therapy at clinics, bedside, cardiac catheterization or at a surgical suite. The Stypven time is a test using snake venom for testing for lupus. The reptilase time is used to distinguish between heparin contamination and a decreased fibrinogen level.)

78) In polycythemia vera, the hemoglobin, hematocrit, RBC count and red cell mass are: a. elevated b. normal c. decreased

a (The National Polycythemia Vera Study group criteria for the diagnosis of polycythemia Vera include increased red cell mass, increased platelet count, increased LAP score.)

353) Low molecular weight heparin is monitored by a: a. anti-Xa assay b. APTT c. PT d. anti-IIa assay

a (The chromogenic anti-Xa assay is the only assay available to monitor LMWH; it may also be used to measure UFH. The APTT cannot be used to monitor low-molecular-weight heparin therapy.)

332) Acute DIC is characterized by: a. hypofibrinogenemia b. thrombocytosis c. negative D-dimer d. shortened thrombin time

a (The laboratory profile for a patient with acute DIC is: increased PT, APTT, D-dimer and a decrease in platelets and hypofibrinogenemia.)

117) The primary confirmatory test for hereditary spherocytosis is: a. osmotic fragility b. sucrose hemolysis c. heat instability test d. Kleihauer-Betke

a (The principle screening test would be a peripheral smear and RBC indices. The confirmatory osmotic fragility is frequently a reference lab only test.)

66) The erythrocyte sedimentation rate can be falsely elevated by: a. tilting the tube b. refrigerated blood c. air bubbles in the column d. specimen being to old

a (Tilting of the tube accelerates the fall of the red blood cells.)

380) Blood collected in EDTA undergoes which of the following changes if kept at room temp for 6 - 24 hrs. a. increased Hct and MCV b. increased ESR and MCV c. increased MCHC and MCV d. decreased reticulocyte count and Hct

a (Tubes that remain at room temperature for >5 hours have unacceptable blood cell artifacts. This will affect the Hct and the MCV.)

100) The lab findings on a patient are as follows: MCV = 55 um MCHC = 25% MCH = 17 pg A stained blood film of this patient would most likely reveal a red cell picture that is: a. microcytic, hypochromic b. macrocytic, hypochromic c. normocytic, normochromic d. microcytic, normochromic

a (Using RBC indices to classify anemia.)

120) Supravital staining is important for reticulocytes since the cells must be living in order to stain the: a. remaining RNA in the cell b. iron before it precipitates c. cell membrane before it dries out d. denatured hemoglobin in the cell

a (Using a supravital stain, residual ribosomal RNA is precipitated within the reticulocytes.)

223) An automated leukocyte count is 22.5 x 10^9/mL (22.5 x 10^9/L). The differential reveals 200 normoblasts/100 leukocytes. What is the actual leukocyte count per microliter? a. 7,500/mL (7.5 x 10^9/L) b. 11,500/mL (11.5 x 10^9/L) c. 14,400/mL (14.4 x 10^9/L) d. 22,300/mL (22.3 x 10^9/L)

a (WBC correction for nRBC.)

18) Erythropoietin acts as: a. shorten the replication time of the granulocytes b. stimulate RNA synthesis of erythroid cells c. increase colony-stimulating factors produced by the B-lymphs d. decrease the release of marrow reticulocytes

b (Erythropoietin action.)

27) Which of the following characteristics are common to hereditary spherocytosis, hereditary elliptocytosis, hereditary stomatocytosis, and paroxysmal nocturnal hemoglobinuria? a. autosomal dominant inheritance b. red cell membrane defect c. positive DAT d. measured platelet count

b (RBC membrane defects are common to PNH, HS, and HE.)

354) In an automated cell counter the WBC printed result is "+++" The next step is to: a. repeat after warming the sample to 37 C b. make an appropriate dilution of the sample c. recalibrate the machine from pooled samples d. request a new sample immediately

b ("+++" is an indicator that the WBC count exceeds the upper reportable limit.)

339) Aliquots of plasma with a prolonged PT and prolonged APTT are mixed using various ratios of patient plasma and normal plasma. All samples are incubated at 37 C and are tested at 10-,30-, and 60-min. intervals. The PT and APTT results on all of the mixtures are corrected .These results would indicate the presence of: a. circulating anticoagulant b. factor deficiency c. contaminated reagent d. antibodies

b (A mixing study, when corrected, indicates a factor deficiency. Lack of correction indicates an inhibitor. Some inhibitors may only become evident after the patient's plasma is allowed to interact with the normal plasma after incubation. In this case, correction occurred immediately, as well as after incubation, confirming a factor deficiency.)

344) The best test to determine if a sample is contaminated with heparin is: a. fibrinogen b. thrombin time c. prothrombin time d. stypven time

b (A prolonged thrombin time may be considered evident of diminished or abnormal fibrinogen; however, the presence of AT activity, such as heparin, must be ruled out.)

86) A common source of interference in the cyanmethemoglobin method is: a. hemolysis b. very high WBC count c. cold agglutinins d. clumped platelets

b (A very high WBC count causes turbidity in cyanmethemoglobin reagent-patient specimen that will result in falsely elevated hemoglobin values.)

127) An increased amount of cytoplasmic basophilia in a blood cell indicates: a. increased cytoplasmic maturation b. decreased cytoplasmic maturation c. reduction in size of the cell d. decreased nuclear maturation

b (An increased amount of cytoplasmic basophilia in a blood cell indicates decreased cytoplasmic maturation.)

41) Lab tests performed on a patient indicate macrocytosis, anemia, leukopenia and thrombocytopenia. Which of the following disorders is the patient most likely to have? a. anemia of chronic disorder b. vitamin B12 deficiency c. iron deficiency d. acute hemorrhage

b (Anemia differentiation-vitamin B12 deficiency results in pernicious anemia [pancytopenia, macrocytosis].)

370) Which area in the automated cell counter histogram indicates the lymphocyte curve? a. A b. B c. C d. D

b (Appearance of WBC histogram.)

371) Which area in the automated cell counter histogram indicates the non-lymphocyte curve? a. B b. C c. D d. E

b (Appearance of WBC histogram.)

269) Platelet activity is affected by: a. calcium b. aspirin c. hyperglycemia d. hypoglycemia

b (Aspirin interferes with prostaglandin metabolism in the platelet; see answer #267. answer 267 - Aspirin interferes with prostaglandin metabolism in the platelet by inhibiting cyclooxygenase, which participates in the conversion of arachidonic acid to protein G2; protein G2 is necessary to produce thromboxane, which stimulates secretion from the platelet granules.)

266) Normal platelets have a circulating life-span of approximately: a. 5 days b. 10 days c. 20 days d. 30 days

b (Average life span of platelets in peripheral blood is 9.5 days.)

295) A patient has been taking aspirin regularly for arthritic pain. Which of the following tests is most likely to be abnormal in this patient? a. platelet count b. template bleeding time c. prothrombin time d. activated partial thromboplastin time

b (BT assesses platelet number and function; platelet count only assesses platelet number; PT and APTT do not assess platelet number or function.)

111) What is the MCHC if the Hct is 20%, the RBC is 2.4 x 10^6/mL (2.4 x 10^12/L) and the Hgb is 5 g/dL (50 g/L)? a. 21% b. 25% c. 30% d. 34%

b (Calculation of RBC indices.)

112) What is the MCHC if the Hct is 20%, the RBC is 1.5 x 10^6/mL (1.5 x 10^12/L) and the Hgb is 6 g/dL (60 g/L)? a. 28% b. 30% c. 40% d. 75%

b (Calculation of RBC indices.)

115) What is the MCV if the hematocrit is 20%, the RBC is 2.4 x 10^6/mL (2.4 x 10^12/L) and the hemoglobin is 5 g/dL (50 g/L)? a. 68 pg b. 83 pg c. 100 pg d. 120 pg

b (Calculation of RBC indices.)

219) What is the absolute eosinophil count? a. 170/mL (0.17 x 10^9/L) b. 510/mL (0.51 x 10^9/L) c. 2,550/mL (2.55 x 10^9/L) d. 4,760/mL (4.76 x 10^9/L)

b (Calculation of absolute eosinophil count.)

356) The electrical resistance method of cell counting requires: a. equal-sized particles b. a conductive liquid c. 2 internal electrodes for current d. 3 apertures for counting

b (Coulter principle of particle counting.)

128) The term "shift to the left" refers to: a. a microscope adjustment b. immature cell forms in the peripheral blood c. a trend on a levy-jennings chart d. a calibration adjustment on an instrument

b (Definition of left shift.)

153) The atypical lymphocyte seen in the peripheral smear of patients with infectious mono is probably derived from which of the following: a. T lymphs b. B lymphs c. monocytes d. mast cells

b (Delineates pathophysiology of initial B-cell proliferation in EBV infection.)

146) The M:E ratio in chronic myelocytic leukemia is usually: a. normal b. high c. low d. variable

b (Demonstrates CML as having predominant myeloid cell line.)

5) Which curve represents the production of alpha polypeptide chains of hemoglobin? a. A b. B c. C d. D

b (Development time line of production of Hgb alpha chains)

155) The disease most frequently present in patients with atypical lymphocytosis and persistently negative tests is: a. toxoplasmosis b. cytomegalovirus infection c. herpes virus infection d. viral hepatitis

b (Differentiates CMV as most common of viral diseases that lacks serological evidence of infection.)

179) All of the following conditions are myeloproliferative disorders except: a. myelocytic leukemia b. lymphocytic leukemia c. polycythemia vera d. idiopathic thrombocythemia

b (Discriminates between conditions due to granulocytic precursor, which would exclude lymphocytic leukemia.)

311) Which of the following coagulation factors is considered to be labile? a. II b. V c. VII d. X

b (Factor V is called labile factor, because its activity diminishes quickly at room temperature. Factor II: prothrombin, VII: stable factors, X: Stuart-Prower.)

325) Patient presents with bleeding 48 hours post tooth extraction. Results are as follows: Possible causes are a deficiency in: a. plasminogen b. Factor XIII c. alpha2 anti-plasmin d. Factor XII

b (Factor XIII activity is <5% in congenital or acquired disorders. In adults, bleeding is slow and delayed The PT, APTT, fibrinogen and platelets will be normal.)

351) Which of the following lab findings is associated with Factor VIII deficiency? a. prolonged activated partial thromboplastin time b. clot solubility in a 5 molar urea solution c. prolonged thrombin time d. prolonged prothrombin time

b (Fibrin stabilizing factor is needed to polymerize a clot. Primary screening tests are normal in Factor XIII deficiency. A screening test is based on the solubility of a fibrin clot in SM urea.)

36) An enzyme deficiency associated with a moderate to severe hemolytic anemia after the patient is exposed to certain drugs and characterized by red cell inclusions formed by denatured hemoglobin is: a. LD deficiency b. G-6-PD deficiency c. pyruvate kinase deficiency d. hexokinase deficiency

b (G-6-PD deficiency.)

221) If a WBC count is performed on a 1:10 dilution and the number of cells counted in 8 squares is 120, the total WBC count is: a. 1,200/mL (1.2 x 10^9/L) b. 1,500/mL (1.5 x 10^9/L) c. 12,000/mL (12.0 x 10^9/L) d. 15,000 /mL (15.0 x 10^9/L)

b (Hemacytometer calculation .)

222) If a WBC count is performed on a 1:100 dilution and the number of cells counted in eight squares is 50, the total WBC count is: a. 5,000/mL (5.0 x 10^9/L) b. 6,250/mL (6.25 x 10^9/L) c. 50,000/mL (50.0 x 10^9/L) d. 62,500/mL (62.5 x 10^9/L)

b (Hemacytometer calculation .)

75) The smear represented below displays: a. congenital ovalocytosis b. hemoglobin C disease c. poor RBC fixation d. delay in smear preparation

b (Hgb C crystals can be seen in patients with Hgb C disease, more often in individuals who have undergone splenectomy.)

363) Which of the following will not cause erroneous results when using a phase optical system for enumerating platelets? a. incipient clotting b. decreased hematocrit c. Howell-Jolly bodies d. leukocyte cytoplasmic fragments

b (Howell-Jolly bodies and WBC fragments may be mistaken for platelets; clotting may affect platelet numbers; decreased Hct would have no effect on a phase platelet count.)

209) The cytoplasmic abnormality of the white blood cell of Alder-Reilly anomaly is found in the: a. endoplasmic reticulum b. lysosomes c. mitochondria d. ribosomes

b (Identification of cellular structure where accumulation of partially degraded mucopolysaccharides occurs.)

160) Increased numbers of basophils are often seen in: a. acute infections b. chronic myelocytic leukemia c. chronic lymphocytic leukemia d. erythroblastosis fetalis (hemolytic disease of the newborn)

b (Identifies classic cellular findings in CML.)

152) In an uncomplicated case of infectious mononucleus, which of the following cells are affected? a. erythrocytes b. lymphocytes c. monocytes d. thrombocytes

b (Identifies predominant cell line impacted in viral response.)

346) If a patient presents with a prolonged APTT that does not correct upon mixing, the next test performed should be: a. Factor II b. DRVVT c. Factor VIII d. platelet count

b (If the initial APTT remains prolonged in a mix, a second assay should be performed. The lupus anticoagulant has multiple targets. The second test is the DRVVT, which triggers coagulation at Factor X.)

345) In the Clauss fibrinogen method, the time to clot formation in plasma is measured after the addition of: a. calcium b. thrombin c. phospholipids d. kaolin

b (In a Clauss fibrinogen, a standard amount of thrombin is added to diluted plasma, and the time required for clot formation is recorded.)

379) A citrated blood specimen for coagulation studies is to be collected from a polycythemic patient. the anticoagulant should be: a. the standard volume b. reduced in volume c. changed to EDTA d. changed to oxalate

b (In polycythemia, the decrease in plasma volume relative to whole blood alters the 9 parts blood to 1 part anticoagulant ratio falsely prolonging results. Therefore, a tube with a reduced volume of anticoagulant is need when the Hct is > 55%.)

316) Which of the following factors typically shows an increase in liver disease? a. Factor VII b. Factor VIII c. Factor IX d. Factor X

b (Liver disease affects all Vitamin K dependent factors [II, VII, IX, and X] which will be decreased Factor VIII is an acute phase reactant that may be elevated in liver disease.)

32) Evidence indicates that the genetic defect in thalassemia usually results in: a. the production of abnormal globin chains b. a quantitative deficiency in RNA resulting in decreased globin chain production c. a structural change in the heme portion of the hemoglobin d. an abnormality in the alpha- or beta- chain binding or affinity

b (Mechanism of genetic abnormality in thalassemia reduces globin chain production.)

207) Which of the following is associated with May-Hegglin anomaly? a. membrane defect of lysosomes b. Dohle bodies and giant platelets c. chronic myelogenous leukemia d. mucopolysaccharides

b (Morphologic alteration of neutrophils- differentiated from Chediak-Higashi, CML and Alder-Reilly anomalies)

203) Of the following, the disease most closely associated with granulocyte hyposegmentation is: a. May-Hegglin b. Pelger-Huet c. Chediak-Higashi d. Gaucher disease

b (Morphologic alteration of neutrophils; majority of nuclei are bilobed and rounded.)

204) Which of the following cell types is characteristic of Pelger-Huet anomaly: a. band form b. pince-nez form c. normal neutrophil d. myelocyte

b (Morphologic alteration of neutrophils; majority of nuclei are bilobed, rounded and dumbbell-shaped.)

231) In the image below, the small nucleated cell seen in the lower left corner is a: a. polychromatophilic normoblast (rubricyte) b. mature lymphocyte c. plasma cell d. lymphoblast

b (Morphology of a lymphocyte.)

313) Which of the following factor deficiencies is associated with either no bleeding or only a minor bleeding tendency, even after trauma or surgery? a. Factor X b. Factor XII c. Factor XIII d. Factor V

b (Patients with a deficiency of Factor XII tend to have thrombotic complications. They do not have bleeding problems most likely due to the lack of activation of fibrin lysis, also due to pathway activation of IX by VIIa/TF complex as well as the activation of Factor XI by thrombin.)

141) Phagocytosis is a function of: a. erythrocytes b. granulocytes c. lymphocytes d. thrombocytes

b (Phagocytosis is performed by granulocytes.)

364) The most common cause of error when using automated cell counters is: a. contamination of the element b. inadequate mixing of the sample prior to testing c. variation in voltage of the current supply d. a calibrating error

b (Problems with diluent contamination, voltage variation and calibration errors are not common and are detected by daily quality control.)

378) If a blood smear is dried too slowly, the RBCs are often: a. clumped b. crenated c. lysed d. destroyed

b (Prolonged drying of slides will produce erythrocyte distortion [crenated] on microscopic examination.)

123) Which of the following stains can be used to differentiate siderotic granules from basophilic stippling? a. Wright b. Prussian Blue c. crystal violet d. periodic acid-Schiff

b (Prussian blue stain is used to differentiate siderotic granules [Pappenheimer bodies] from basophilic stippling.)

182) Which of the following types of polycythemia is most often associated with emphysema? a. polycythemia vera b. polycythemia, secondary to hypoxia c. relative polycythemia associated with dehydration d. polycythemia associated with renal disease

b (RBC production is inversely regulated by 02 levels. 02 would decrease in emphysema [hypoxia]; therefore, RBC levels would compensate, i.e., increase.)

149) Neutropenia is not usually associated with: a. viral infections b. Hodgkin disease c. select antibodies d. chemotherapy

b (Recognizes multiple causes impacting granulocyte production.)

171) The M:E ratio in acute myelocytic leukemia is usually: a. normal b. high c. low d. variable

b (Recognizes myeloid predominance in AML would increase normal [2:1 to 4:1] myeloid:erythroid ratio.)

76) The presence of excessive rouleaux formation on a blood smear is often accompanied by an increased: a. reticulocyte count b. sedimentation rate c. hematocrit d. erythrocyte count

b (Rouleaux and an increased sedimentation rate are caused by increased fibrinogen and/or with increased immunoglobulin.)

119) The Prussian blue staining of peripheral blood identifies: a. Howell-Jolly bodies b. siderotic granules c. reticulocytes d. basophilic stippling

b (Sideroblasts and siderocytes may be identified with Perl Prussian blue iron stain.)

386) The anticoagulant of choice for routine coagulation procedures is: a. sodium oxalate b. sodium citrate c. heparin d. sodium fluoride

b (Sodium citrate is the only anticoagulant used for hemostasis testing. Sodium citrate hinds free calcium ions. EDTA inhibits the thrombin-mediated conversion of fibrinogen to fibrin and binds reagent calcium added to initiate clot based tests. Heparin inhibits Ila, Xa, XIIa, XIa and IXa.)

124) A patient has pancytopenia, decreased total serum iron, decreased serum iron binding capacity, and show a homogeneous fluorescence pattern with a high titer on a fluorescent anti-nuclear antibody test. This is suggestive of : a. polycythemia vera b. SLE c. iron deficiency anemia d. hemoglobin SC disease

b (Systemic lupus erythematosus [SLE] is an autoimmune disease. The ANA procedure is a screening tool for SLE.)

77) The characteristic peripheral blood morphologic feature in multiple myeloma is: a. cytotoxic T cells b. rouleaux formation c. spherocytosis d. macrocytosis

b (The peripheral smear allows microscopic examination of the blood cells. The most characteristic finding in multiple myeloma is rouleaux formation of the red cells.)

90) The most appropriate screening test for hemoglobin S is: a. Kleihauer-Betke b. dithionite solubility c. osmotic fragility d. sucrose hemolysis

b (The solubility test is a rapid test for Hgb S. This should not be used for screening newborns, needs to be corrected in severe anemia and is not specific for Hgb S as there are other hemoglobins that will sickle. The presence of Hgb S is confirmed by hemoglobin electrophoresis.)

118) A screening test for paroxysmal nocturnal hemoglobinuria is: a. heat instability test b. sucrose hemolysis c. osmotic fragility d. dithionite solubility

b (The sucrose hemolysis test is still sometimes used for screening; however, the most accurate measurement is immunophenotyping.)

286) A phase-platelet count is performed using a platelet Unopette. 155 platelets are counted on one side of the hemacytometer in the center square millimeter, and 145 are counted on the other side in the same area. After making the appropriate calculations, the next step would be to: a. repeat the procedure, using a 1:20 dilution with acetic acid b. report the calculated value c. collect a new specimen d. repeat the procedure, using a 1:200 dilution with saline

b (There is no indication that any part of the procedure has been done incorrectly.)

224) A total leukocyte count is 10.0 x 10^3/mL (10.0 x 10^9/L) and 25 NRBCs are seen per 100 leukocytes on the differential. What is the corrected leukocyte count? a. 2,000/mL (2.0 x 10^9/L) b. 8,000/mL (8.0 x 10^9/L) c. 10,000/mL (10.0 x 10^9/L) d. 12,000/mL (12.0 x 10^9/L)

b (WBC correction for nRBC.)

63) Which of the following technical factors will cause a decreased erythrocyte sedimentation rate? a. gross hemolysis b. small fibrin clots in the sample c. increased room temp d. tilting of the tube

b (When the shape or size of the red blood cells prevents rouleaux formation a decreased or low ESR is expected. This is observed with sickle cells, acanthocytes, and spherocytes.)

317) A patient has a normal prothrombin time and a prolonged activated partial thromboplastin time using a kaolin activator. The APTT corrects to normal when the incubation time is increased. These suggest that the patient has: a. hemophilia A b. Hageman Factor (XII) deficiency c. Fletcher Factor deficiency d. Factor V deficiency

c (A prolonged APTT with a normal PT denotes a problem with the intrinsic pathway, so Factors VIII, IX, XI would be looked at, these deficiencies would correct in a mixing study. A characteristic of prekallikrein deficiency is the correction of the PTT when incubated for 10 minutes with kaolin, Celite*, silica, or ellagic acid.)

296) A platelet count done by phase microscopy is 200 x 10^3/mL (200 x 10^9/L) (reference range 150-450 x 10^3/mL (150-450 x 10^9/L). A standardized template bleeding time on the same person is 15 minutes (reference range 4.5 +/- 1.5 minutes). This indicates that: a. the Duke method should have been used for the bleeding time b. the manual platelet count is in error c. abnormal platelet function should be suspected d. the results are as expected

c (BT assesses both platelet number and function.)

264) Which of the following cells contain hemosiderin? a. megakaryocyte b. osteoclast c. histiocyte d. mast cell

c (Bone marrow and splenic macrophages contain hemosiderin; histiocyte is a collective term for macrophages.)

101) A patient has the following laboratory results: The mean corpuscular volume (MCV) of the patient is: a. 35 mm3 (35 fL) b. 83 mm3 (83 fL) c. 120 mm3 (120 fL) d. 150 mm3 (150 fL

c (Calculating RBC indices.)

109) What is the MCH if the Hct is 20%, the is 1.5 x 10^6/mL (1.5 x 10^12/L) and the Hgb is 6 g/dL (60 g/L)? a. 28 mm3 (28 fL) b. 30 mm3 (30 fL) c. 40 mm3 (40 fL) d. 75 mm3 (75 fL)

c (Calculation of RBC indices.)

113) Which of the following is the formula for MCV? a. (Hgb x 10) / RBC b. Hgb / Hct c. (Hct x 10) / RBC d. RBC / Hct

c (Calculation of RBC indices.)

218) What is the absolute lymphocyte count? a. 170/mL (0.17 x 10^9/L) b. 510/mL (0.51 x 10^9/L) c. 2,550/mL (2.55 x 10^9/L) d. 4,760/mL (4.76 x 10^9/L)

c (Calculation of absolute from relative % and WBC.)

191) Which of the following is true of acute lymphoblastic leukemia? a. occurs most commonly in children 1 -2 yrs. old b. patient is asymptomatic c. massive accumulation of primitive lymphoid-appearing cells in bone marrow occurs d. children under 1 yr. of age have a good prognosis

c (Characteristics of ALL; onset highest 1-5 years of age with peak at 2-3 years of age; presents with lethargy, fever, bone pain, with poor prognosis under 1 year of age.)

217) In synovial fluid , the most characteristic microscopic finding in gout is: a. calcium pyrophosphate crystals b. cartilage debris c. monosodium urate crystals d. hemosiderin laden macrophages

c (Correlation of gout with sodium urate crystals.)

347) Excess D-Dimer indicate that clots have been: a. converted to fibrin monomers b. released into circulation c. formed and are being excessively lysed d. stimulated to activate platelets

c (D-dimers are produced from crosslinked and stabilized fibrin clots. This clot is dissolved by plasma and d-dimers are released. Therefore, d-dimers suggest a breakdown of fibrin clots, and indicate that clots have been formed at the site of injury.)

174) The absence of intermediate maturing cells between the blast and mature neutrophil commonly seen in acute myelocytic leukemia and myelodysplastic syndrome is called: a. subleukemia b. aleukemic leukemia c. leukemic hiatus d. leukemoid reaction

c (Definition of 'hiatus' as opening or break demonstrates the absence of intermediate maturing cells)

215) A leukocyte count and differential on a 40-year-old Caucasian man revealed: This data represents: a. absolute lymphocytosis b. relative neutrophilia c. absolute neutropenia d. leukopenia

c (Definition of absolute neutropenia.)

135) Elevation of the total white cell count above 12 x 10^3 is termed: a. relative lymphocytosis b. absolute lymphocytosis c. leukocytosis d. relative neutrophilic leukocytosis

c (Definition of leukocytosis.)

129) A term that means varying degrees of leukocytosis with a shift to the left and occasional nucleated red cells in the peripheral blood is: a. polycythemia vera b. erythroleukemia c. leukoerythroblastosis d. megaloblastoid

c (Definition of leukoerythroblastosis.)

136) Elevation of the granulocyte percentage above 75% is termed: a. absolute lymphocytosis b. leukocytosis c. relative neutrophilic leukocytosis d. absolute neutrophilic leukocytosis

c (Definition of relative neutrophilic granulocytosis.)

167) In chronic myelocytic leukemia, blood histamine concentrations tend to reflect the : a. number of platelets present b. serum uric acid concentrations c. number of basophils present d. the total number of granulocytes

c (Demonstrates nature of basophils.)

7) Which curve represents the production of gamma polypeptide chains of hemoglobin? a. A b. B c. C d. D

c (Development time line of production of Hgb gamma chains.)

157) Which of the following is associated with pseudo-Pelger-Huet anomaly? a. aplastic anemia b. iron deficiency anemia c. myelogenous leukemia d. Chediak-Higashi syndrome

c (Differentiates leukemia with classic granulocyte anomaly.)

148) Abnormalities found in erythroleukemia include: a. rapid DNA synthesis b. marrow fibrosis c. megaloblastoid development d. increased erythrocyte survival

c (Differentiates this from other myeloid leukemias or other red cell abnormalities.)

359) On an electronic particle counter, if the RBC is erroneously increased, how will other parameters be affected? a. increased MCHC b. increased Hgb c. decreased MCH d. increased MCV

c (Formulas for calculation of indices; falsely increased RBC should not affect Hgb.)

144) The white cell feature most characteristic of pernicious anemia is: a. eosinophilia b. toxic granulation c. hypersegmentation d. atypical lymphocytes

c (Hypersegmented neutrophils in pernicious anemia.)

334) Patient results are as follows: This workup suggests: a. blood dot b. hemorrhage c. DIC d. HUS

c (The laboratory profile for a DIC workup includes increased PT, APTT and D-dimers, with decreased fibrinogen and platelets.)

257) In flow cytometric analysis, right angle of side scatter of a laser light beam provides information that pertains to the cell's: a. volume b. viability c. granularity d. lineage

c (In a flow cytometer, side scatter provides an estimate of a cell complexity or granularity.)

97) Which pattern is consistent with beta-thalassemia major? a. pattern A b. pattern B c. pattern C d. pattern D

c (In beta-thalassemia major, reduced synthesis of beta chains affects the production of Hgb A. Hgb A2 and Hgb F are increased and Hgb A decreased.)

83) The values below were obtained on an automated blood count system performed on a blood sample from a 25-year-old man: These results are most consistent with which of the following? a. megaloblastic anemia b. hereditary spherocytosis c. a high titer of cold agglutinins d. an elevated reticulocyte count

c (In patients with cold agglutinins, the automated cell counters show an erroneously elevated MCV and an erroneously decreased red blood cell count due to clumping of the red cells.)

125) In an uncomplicated case of severe iron deficiency anemia, which of the following sets represents the typical pattern of results? a. A b. B c. C d. D

c (Iron deficiency anemia laboratory features include: decreased RBC, hemoglobin, MCV, MCH, MCHC, serum iron, serum ferritin % saturation, bone marrow iron stores; and increased RDW, TIBC, FEP and serum soluble transferrin receptor levels.)

29) A patient is admitted with a history of chronic bleeding secondary to peptic ulcer. Hematology workup reveals a severe microcytic, hypochromic anemia. Iron studies were requested. Which of the following would be expected in this case? a. result A b. result B c. result C d. result D

c (Iron studies: microcytic hypochromic anemia results in a decrease in serum and storage iron, but an increase in TIBC.)

54) Which of the following is most likely to be seen in lead poisoning? a. iron overload in tissue b. codocytes c. basophilic stippling d. ringed sideroblasts

c (Lead poisoning-basophilic stippling.)

165) The following results were obtained on a 35-year-old woman complaining of fatigue and weight loss: These results are consistent with: a. neutrophilic leukemoid reaction b. idiopathic thrombocythemia c. chronic myelocytic leukemia d. leukoerythroblastosis in myelofibrosis

c (Leukopenia with immature granulocytes in all stages, including blast with markedly decreased LAP and Philadelphia chromosome, positively identify CML. Leukopenia is consistent with engorged marrow space.)

355) A specimen run on an automatic cell counter has a platelet count of 19 x 10^3. The first thing the tech should do is: a. report the count after the batch run is completed b. request a new specimen c. review the stained blood smear d. notify the lab manager

c (Low platelet count values should be verified with a slide estimate.)

130) Cells that produce antibodies and lymphokines are: a. erythrocytes b. granulocytes c. lymphocytes d. thrombocytes

c (Lymphocyte function.)

235) The large cell indicated by the arrow in image below is a: a. myeloblast b. promyelocyte c. myelocyte d. metamyelocyte

c (Morphology of a myelocyte.)

71) The mean value of a reticulocyte count on a specimen of cord blood from a healthy, full term newborns is approximately: a. 0.5 % b. 2.0 % c. 5.0 % d. 8.0 %

c (Newborn infants have elevated reticulocyte counts.)

263) Which of the following is characteristic of cellular changes as megakaryoblasts mature into megakaryocytes within the bone marrow? a. progressive decrease in overall cell size b. increasing basophilia of cytoplasm c. nuclear division without cytoplasmic division d. fusion of the nuclear lobes

c (Nuclear maturation and division occurs first, and is largely complete before cytoplasmic maturation begins.)

53) Which of the following types of polycythemia is a severely burned patient most likely to have? a. polycythemia vera b. polycythemia, secondary to hypoxia c. relative polycythemia associated with dehydration d. polycythemia associated with renal disease

c (Polycythemia, in burn patient.)

213) Of the following, the disease most closely associated with pale blue inclusions in granulocytes and giant platelets: a. Gauchers disease b. Alder-Reilly c. May-Hegglin d. Pelger-Huet

c (Primary characteristic distinguishing May-Hegglin from other neutrophil and lipid storage anomalies.)

58) The characteristic morphologic feature in lead poisoning is: a. macrocytosis b. target cells c. basophilic stippling d. rouleaux formation

c (RBC morphology in lead poisoning.)

70) The lab tests performed on a patient indicate macrocytosis, anemia, leukopenia and thrombocytopenia. Which of the following disorders is the patient most likely to have? a. iron deficiency b. hereditary spherocytosis c. vitamin B12 deficiency d. acute hemorrhage

c (Recognize the laboratory findings in megaloblastic anemia.)

288) Blood is diluted 1:200, and a platelet count is performed. 180 platelets were counted in the center square millimeter on one side of the hemacytometer and 186 on the other side. The total platelet count is: a. 146 x 10^3/mL (146 x 10^9/L) b. 183 x 10^3/mL (183 x 10^9/L) c. 366 x 10^3/mL (366 x 10^9/L) d. 732 x 10^3/mL (732 x 10^9/L)

c (Standard calculation for hemacytometer cell count.)

337) In the APTT test, the patient's plasma is mixed with: a. ADP and calcium b. tissue thromboplastin and collagen c. phospholipid and calcium d. tissue thromboplastin and calcium

c (The APTT reagent contains phospholipid and a negatively-charged particulate activator such as kaolin, ellagic acid, or Celite@ . Ionic calcium and phospholipid are supplied as reagents)

308) Which of the following factors is used only in the extrinsic coagulation pathway? a. II b. V c. VII d. VIII

c (The extrinsic pathway is initiated by the release of tissue thromboplastin that has been expressed after damage to a vessel Factor VII forms a complex with tissue thromboplastin and calcium. Factors II and VII are found in the common pathway, and Factor VIII is in the intrinsic pathway.)

376) The ideal capillary blood collection site on a newborn is: a. tip of the thumb b. ear lobe c. plantar surface of the heel d. the great toe

c (The heel is the preferred site for drawing capillary blood from the newborn. the posterior curvature of the heel should never be used.)

73) The following results were obtained on a patient's blood: Examination of a Wright-stained smear of the same sample would most likely show: a. macrocytic, normochromic erythrocytes b. microcytic, hypochromic erythrocytes c. normocytic, hypochromic erythrocytes d. normocytic, normochromic erythrocytes

c (Use knowledge of RBC indices to classify anemia.)

121) Which of the following is used for staining reticulocytes? a. Giemsa stain b. Wright stain c. new methylene blue d. Prussian blue

c (Using a supravital stain [new methylene blue], residual ribosomal RNA is precipitated within the reticulocytes.)

306) Which of the following statements concerning Vitamin K is NOT true? a. there are 2 sources of Vit. K: vegetables and bacterial b. Vit. K converts precursor molecules into functional coagulation factors c. heparin inhibits the action of Vit. K d. Vit. K is fat soluble

c (Vitamin K is present in green vegetables, fish, liver and tobacco and synthesized by bacteria in the intestine. Naturally occurring vitamin K is fat soluble. Warfarin is the most popular vitamin K antagonist. Heparin inhibits Factor Xa and thrombin.)

225) If the total leukocyte count is 20.0 x 10^3/mL (20.0 x 10^9/L) and 50 NRBCs are seen per 100 leukocytes on the differential, what is the corrected leukocyte count? a. 6,666/mL (6.666 x 10^9/L) b. 10,000/mL (10.0 x 10^9/L) c. 13,333/mL (13.333 x 10^9/L) d. 26,666/mL (26.666 x 10^9/L)

c (WBC correction for nRBC.)

226) A blood smear shows 80 nucleated red cells per 100 leukocytes. The total leukocyte count is 18 x 10^3/mL (18 x 10^9/L). The true white cell count expressed in SI units is: a. 17.2 x 10^3/mL (17.2 x 10^9/L) b. 9.0 x 10^3/mL (9.0 x10^9/L) c. 10.0 x 10^3/mL (10.0 x 10^9/L) d. 13.4 x 10^3/mL (13.4 x 10^9/L)

c (WBC correction for nRBC.)

305) Coagulation factors affected by warfarin (Coumadin) drugs are: a. VIII, IX, and X b. I, II, V, and VII c. II, VII, IX and X d. II, V, and VII

c (Warfarin interferes with the carboxylation of vitamin K factors by interrupting the enzymatic phase of the reaction. Factors are inhibited according to their half-life, VII having the shortest [4-5 hours] and II the longest [2-3 days].)

282) Which of the following is characteristic of platelet disorders? a. deep muscle hemorrhage b. retroperitoneal hemorrhage c. mucous membrane hemorrhages d. severely prolonged clotting times

c (mucous membrane hemorrhage is typical of platelet disorders; remaining choices are typical of coagulation factor disorders.)

89) The most appropriate screening test for detecting hemoglobin F is: a. osmotic fragility b. dithionite solubility c. Kleihauer-Betke d. heat instability test

c (the Kleihauer-Betke procedure is commonly used as a screening test to determine the amount of fetal blood that has mixed with maternal blood.)

30) Which of the following is most closely associated with iron deficiency anemia? a. iron overload in tissue b. target cells c. basophilic stippling d. chronic blood loss

d (Chronic blood loss frequently results in iron deficiency anemia.)

361) The following results were obtained on an electronic particle counter: What step should be taken before recycling the sample? a. clean the apertures b. warm the specimen c. replace the lysing agent d. dilute the specimen

d ("+++" indicates a WBC that is above the reportable range of the instrument; dilute the sample and rerun.)

170) 50% - 90% myeloblasts in a peripheral blood smear is typical of which of the following? a. chronic myelocytic leukemia b. myelofibrosis with myeloid metaplasia c. erythroleukemia d. acute myelocytic leukemia

d (>20% of myeloblasts without other immature stages differentiates AML from CML and myeloid metaplasia; erythroleukemia requires at least 50% erythroid precursors in marrow.)

342) A prolonged thrombin time and a normal reptilase-R time are characteristic of : a. dysfibrinogenemia b. increased D-Dimer c. fibrin monomer-split product complexed d. therapeutic heparinization

d (A prolonged thrombin time can indicate diminished or abnormal fibrinogen, the presence of FDPs, paraproteins, and heparin. Reptilase is insensitive to the effects of heparin, and sensitive to dysfibrinogenemia. Therefore, when the TT is prolonged and the reptilase test is normal, this confirms the presence of heparin.)

177) A block in the differentiation or maturation of, and an accretion of immature hematopoietic progenitors is a hallmark of: a. chronic lymphocytic leukemia b. myeloproliferative diseases c. polycythemia vera d. acute myelogenous leukemia

d (Acute leukemia is characterized by a maturation defect, whereby immature hematopoietic progenitors cannot overcome a block in differentiation, also known as the leukemic hiatus.)

227) A mean cell hemoglobin concentration over 36 g/dL is frequently found in : a. hereditary spherocytosis b. lipemia c. active cold agglutinin disease d. all of the above

d (An elevation in the MCHC occurs in approximately 50% of individuals with hereditary spherocytosis. Elevation in the MCHC above the upper normal limit should prompt an investigation of the sample for autoantibodies that agglutinate RBC, or on older instruments when the hemoglobin concentration is artifactually elevated by lipemia.)

102) The following results were obtained from a post-surgical patient receiving total parenteral nutrition: The most consistent explanation for the above data is: a. acute surgical bleeder b. specimen on day 19 from wrong patient c. improperly mixed specimen on day 19 d. lipid interference on days 17 and 18

d (Any turbidity in the cyanmethemoglobin reagent- patient specimen will result in falsely elevated values.)

369) Which area in the automated cell counter histogram represents the distribution curve? a. A b. B c. C d. D

d (Appearance of RBC histogram.)

241) In synovial fluid, the most characteristic finding in traumatic arthritis is: a. monosodium urate crystals b. cartilage debris c. calcium pyrophosphate dihydrate crystals d. hemosiderin laden macrophages

d (Association of traumatic arthritis with macrophages containing hemosiderin.)

104) A blood sample from a patient with a high titer cold agglutinin, analyzed at room temp, with an electronic particle counter would cause an error in the: a. Hgb and MCV b. MCHC and WBC c. WBC and RBC d. MCV and MCHC

d (Autoagglutination of anticoagulated blood can occur at room temperature in patients with a cold autoagglutinin. The MCV will be falsely elevated and the RBC count falsely decreased, resulting in an elevated MCHC. The blood sample should be warmed to 37 C and rerun.)

103) A patient has a high cold agglutinin titer. Automated cell counter results reveal an elevated MCV, MCH and MCHC. Individual erythrocytes appear normal on a stained smear, but agglutinates are noted. The appropriate course of action would be to: a. perform the RBC, Hgb and Hct determinations using manual methods b. perform the RBC determination by a manual method; use the automated results for the Hgb and Hct c. repeat the determination using a microsample of diluted blood d. repeat the determinations using a prewarmed microsample of diluted blood

d (Autoagglutination of anticoagulated blood can occur at room temperature in patients with a cold autoagglutinin. The MCV will be falsely elevated and the count falsely decreased, resulting in an elevated MCHC. The blood sample should be warmed to 37 C and rerun.)

107) Which of the following is the formula for MCH? a. Hct / (RBC x 1000) b. Hgb / Hct c. RBC / Hct d. (Hgb x 10) / RBC

d (Calculation of RBC indices.)

114) Given the following data: Hgb: 8 g/dL (80 g/L) Hct: 28% RBC: 3.6 x 10^6/uL (3.6 x 10^12/L) The MCV is: a. 28 mm3 (28 fL) b. 35 mm3 (35 fL) c. 40 mm3 (40 fL) d. 77 mm3 (77 fL)

d (Calculation of RBC indices.)

116) What is the MCV if the hematocrit is 20%, the RBC is 1.5 x 10^6/mL (1.5 x 10^12/L) and the hemoglobin is 6 g/dL (60 g/L)? a. 68 pg b. 75 pg c. 115 pg d. 133 pg

d (Calculation of RBC indices.)

196) Which of the following is not a characteristic usually associated with hairy cell leukemia? a. pancytopenia b. mononuclear cells with ruffled edges c. splenomegaly d. increased resistance to infection

d (Characteristics features of hairy cell leukemia include all answers listed as well as decreased resistance to infection.)

175) Which of the following is most closely associated with chronic myelogenous leukemia? a. ringed sideroblasts b. DIC c. micromegakaryocytes d. Philadelphia chromosome

d (Classic discrimination between CML vs other hematological conditions: sideroblastic anemia, AML, myelofibrosis.)

150) Auer rods are most likely present in which of the following? a. chronic myelocytic leukemia b. myelofibrosis with myeloid metaplasia c. erythroleukemia d. acute myelocytic leukemia

d (Classic feature discriminates AML from other types of erythroid/ myeloid metaplasia.)

134) Elevation of the total granulocyte count above 7.7 x 10^3 is termed: a. relative lymphocytosis b. leukocytosis c. relative neutrophilic leukocytosis d. absolute neutrophilic leukocytosis

d (Definition of absolute neutrophilic leukocytosis.)

280) Thrombocytosis would be indicated by a platelet count of: a. 100 x 10^3/mL (100 x 10^9/L) b. 200 x 10^3/mL (200 x 10^9/L) c. 300 x 10^3/mL (300 x 10^9/L) d. 600 x 10^3/mL (600 x 10^9/L)

d (Definition of increased platelet count.)

139) Multipotent stem cells are capable of producing: a. daughter cells of only one cell line b. only T-lymphs and B-lymphs c. erythopoeitin, thrombopoietin and leukopoietin d. lymphoid and myeloid stem cells

d (Definition of multipotent stem cell.)

202) Which of the following anomalies is an autosomal dominant disorder characterized by irregularly-sized inclusions in polymorphonuclear neutrophils, abnormal giant platelets and often thrombocytopenia? a. Pelger-Huet b. Chediak-Higashi c. Alder-Reilly d. May-Hegglin

d (Description of MH anomaly.)

6) Which curve represents the production of beta polypeptide chains of hemoglobin? a. B b. C c. E d. D

d (Development time line of production of Hgb beta chains.)

8) Which curve represents the production of delta polypeptide chains of hemoglobin? a. B b. C c. D d. E

d (Development time line of production of Hgb delta chains.)

145) Which of the following conditions is not associated with a high incidence of leukemia? a. paroxysmal nocturnal hemoglobinuria b. Fanconi anemia c. aplastic anemia d. megaloblastic anemia

d (Differentiates anemia due to conditioned nutritional deficiency from those of bone marrow dysfunction.)

186) In infectious mono, lymphocytes tend to be: a. small with little cytoplasm b. normal c. decreased in number d. enlarged and indented by surrounding structures

d (Differentiates morphologic features of IM.)

183) Hemorrhage in polycythemia vera is the result of: a. increased plasma viscosity b. persistent thrombocytosis c. splenic sequestration of platelets d. abnormal platelet function

d (Discriminates between faulty function of platelets, which would inhibit clotting and other PCV characteristics.)

187) In comparison to malignant lymphoma cells, reactive lymphs: a. have a denser nuclear chromatin b. are known to be T cells c. have more cytoplasm and more mitochondria d. are morphologically more variable throughout the smear

d (Discriminates between reactive cell line and more homogenous malignant cell line.)

194) Chronic lymphocytic leukemia is defined as: a. malignancy of the thymus b. accumulation of prolymphocytes c. accumulation of hairy cells in the spleen d. accumulation of monoclonal B cells with a block in cell maturation

d (Discrimination of CLL from other major mature B cell neoplasms)

210) Of the following, the disease most closely associated with mucopolysaccharidosis is: a. Pelger-Huet b. Chediak-Higashi c. Gauchers disease d. Alder-Reilly

d (Discrimination of anomaly from others involving nuclear hyposegmentation; large granules in leukocytes; lipid storage disease.)

307) Which of the following is Vitamin-K dependent? a. Factor XII b. fibrinogen c. antithrombin III d. Factor VII

d (Factor VII [proconvertin] is a single- chain glycoprotein that is Vitamin K dependent and remains stable 4-5 hours in blood. Produced in the liver, it has the shortest half-life; therefore, it is the first factor affected when a Vitamin K antagonist such as warfarin is administered)

309) Hageman Factor (XII) is involved in each of the following reactions except: a. activation of C1 to C1 esterase b. activation of plasminogen c. activation of Factor XI d. transformation of fibrinogen to fibrin

d (Factor XII is a contact factor, which is activated to Factor XIla. It is responsible for the activation of Factor XI to Factor XIa. Fibrinogen is converted to fibrin by the action of thrombin.)

315) The 2 factors that differentiate liver disease from Vit. K deficiency are: a. II and VII b. IX and VII c. VIII and IX d. V and VII

d (Factors V and VII are helpful in distinguishing between liver disease and Vitamin K deficiency. Factor VII is a Vitamin K dependent factor; however, Factor V is not and will not be decreased. Both factors will be decreased in liver disease.)

387) A blue top tube is drawn for coagulation studies, the sample is a short draw results may be: a. falsely shortened b. correct c. unable to be obtained d. falsely prolonged

d (Falsely prolonged results will occur if there is too much anticoagulant for the plasma; this also occurs with an increased Hct. Conversely, if a tube is overdrawn, there may be too little anticoagulant, resulting in a clot.)

173) Which of the following is most closely associated with chronic myelononocytic leukemia? a. Philadelphia chromosome b. DIC c. micromegakaryocytes d. lysozymuria

d (Findings differentiate between CMML vs CML, AML, and myelofibrosis.)

37) Patients with A(-) type G-6-PD deficiency are least likely to have hemolytic episodes in which of the following situations? a. following the administration of oxidizing drugs b. following the ingestion of fava beans c. during infections d. spontaneously

d (G-6-PD deficiency-hemolytic stimulus.)

91) Hematology standards include: a. stabilized RBC suspension b. latex particles c. stabilized avian RBC's d. certified cyanmethemoglobin solution

d (Hemoglobin concentration is calibrated using commercially available HiCN solutions of known content.)

352) Heparin acts by: a. precipitating fibrinogen b. binding calcium c. activating plasma d. inhibiting thrombin

d (Heparin acts by inhibiting thrombin and Factor Xa. Anticoagulants, such as sodium citrate, act by binding calcium to prevent a blood sample from clotting.)

88) With this blood picture, an additional test indicated is: a. alkali denaturation b. alkaline phosphatase stain c. peroxidase stain d. hemoglobin electrophoresis

d (Hgb C crystals can be seen in patients with Hgb C disease, more often in individuals who have undergone splenectomy.)

62) A 14-year-old boy is seen in the ER complaining of a sore throat swollen glands and fatigue. The CBC results are: What is the most likely diagnosis? a. acute lymphocytic leukemia b. chronic lymphocytic leukemia c. viral hepatitis d. infectious mononucleosis

d (In infectious mononucleosis, the leukocyte is usually increased due to an absolute lymphocytosis. The platelet count is often mildly decreased.)

48) Which of the following represents characteristic features of iron metabolism in patients with anemia of a chronic disorder? a. result A b. result B c. result C d. result D

d (Iron studies in anemia of chronic disease show decreased serum iron and transferrin saturation; TIBC may be decreased as well.)

319) A 4-year-old boy presents with chronic ear infections and is on prophylactic antibiotics. He presents with bleeding. Factor assays reveal: Possible causes are: a. Factor II deficiency b. lupus anticoagulant c. hemophilia d. Vitamin K deficiency

d (Long-term antibiotic therapy disrupts normal flora, which provide a source of Vitamin K synthesis, This results in a Vitamin K deficiency.)

13) In the normal adult, the spleen acts as a site for: a. storage of RBCs b. production of RBCs c. synthesis of erythropoietin d. removal of imperfect and aging cells

d (Major site of destruction of senescent red blood cells.)

206) Which of the following is associated with Alder-Reilly inclusions? a. membrane defect of lysosomes b. Dohle bodies and giant platelets c. chronic myelogenous leukemia d. mucopolysaccharidosis

d (Morphologic alteration of neutrophils- differentiated from Chediak-Higashi; May-Hegglin and Pelger-Huet anomalies.)

233) This cell is a: Size: 12 to 16 um Nucleus: oval, notched, folded over to horseshoe shape Chromatin: fine lacy, stains light purple-pink Nucleoli: none present Cytoplasm: abundant, slate gray, with many fine lilac-colored granules a. promyelocyte b. lymphocyte c. neutrophil d. monocyte

d (Morphological description of a monocyte.)

49) A characteristic morphologic feature in hemoglobin C disease is: a. macrocytosis b. spherocytosis c. rouleaux formation d. target cells

d (Morphology in Hgb C disease.)

126) Inclusions in the cytoplasm of neutrophils as shown in the figure below are known as : a. Auer bodies b. Howell-Jolly bodies c. Heinz bodies d. Dohle bodies

d (Morphology of Dohle bodies.)

229) Which of the following statements about this field is true? a. reticulocytes are demonstrable b. toxic granulation is present c. the cell in the center is a basophilic normoblast d. the large cell on the left is a monocyte

d (Morphology of a monocyte, although the RBC inclusions [Pappenheimer bodies] look more interesting.)

133) In normal adult bone marrow, the most common granulocyte is the: a. basophil b. myeloblast c. eosinophil d. metamyelocyte

d (Normal bone marrow differential.)

336) The prothrombin time test requires that the patient's citrated plasma be combined with: a. platelet lipids b. thromboplastin c. Ca++ and platelets and lipids d. Ca++ and thromboplastin

d (PT thromboplastin reagents are prepared from recombinant or affinity purified tissue factor suspended in phospholipid mixed with a buffered O.025 M solution of calcium chloride.)

64) Which of the RBC indices is a measure of the amount of hemoglobin in individual RBC's? a. MCHC b. MCV c. Hct d. MCH

d (Patients unable to synthesize normal amounts of hemoglobin show reduction in the MCH.)

80) Many microspherocytes, schistocytes and budding off of spherocytes can be seen on peripheral blood smears of patients with: a. hereditary spherocytosis b. DIC c. acquired autoimmune hemolytic anemia d. extensive burns

d (Patients who have suffered severe burns to more than 15 % of their body generally show evidence of intravascular hemolysis. RBCs show changes including fragmentation, budding and microspherocytes formation.)

383) When platelets concentrate at the edges and feathered end of a blood smear, it is usually due to: a. abnormal proteins b. inadequate mixing of blood and anticoagulant c. hemorrhage d. poorly made wedge smear

d (Platelet clumping is expected if smears are made directly from the finger. Smears must be made promptly before any clotting begins. It is important to examine the edges for platelet clumping.)

290) An automated platelet count indicates platelet clumping, which is confirmed by examining the smear. The technician should: a. repeat the count on the same sample b. report the automated count c. perform a manual count d. recollect in sodium citrate

d (Platelet clumping is reduced by collecting sample in sodium citrate.)

291) The automated platelet count on an EDTA specimen is 58 x 10^3/mL (58 x 10^9/L). The platelet estimate on the blood smear appears normal, but it was noted that the platelets were surrounding the neutrophils. The next step should be to: a. report the automated platelet count since it is more accurate than a platelet estimate b. warm the EDTA tube and repeat the automated platelet count c. rerun the original specimen since the platelet count and blood smear estimate do not match d. recollect a specimen for a platelet count using a different anticoagulant

d (Platelet satellitism is reduced by collecting sample in sodium citrate.)

122) Which of the following stains is used to demonstrate iron, ferritin and hemosiderin? a. peroxidase b. Sudan black B c. periodic acid-Schiff d. Prussian Blue

d (Prussian blue stain is used for assessing iron stores in bone marrow.)

197) Morphologic variants of plasma cells do not include: a. flame cells b. morula cells c. grape cells d. Gaucher Cells

d (Recognition that Gaucher cell is from lipid storage disease, not plasma cell variant.)

180) The following results were obtained on a 55-year-old man complaining of headaches and blurred vision: These results are consistent with: a. neutrophilic leukemoid reaction b. polycythemia vera c. chronic myelocytic leukemia d. leukoerythroblastosis in myelofibrosis

d (Recognizes red cell increase secondary to stimulation of excessive erythropoietin produced in kidney.)

181) A patient has a tumor that concentrates erythropoietin. He is most likely to have which of the following types of polycythemia? a. polycythemia vera b. polycythemia, secondary to hypoxia c. benign familial polycythemia d. polycythemia associated with renal disease

d (Recognizes red cell increase secondary to stimulation of excessive erythropoietin produced in kidney.)

360) On setting up the electronic particle counter in the morning, one of the controls is slightly below the range for the MCV. Which of the following is indicated? a. call for service b. adjust the MCV up slightly c. shut down the instrument d. repeat the control

d (Repeat of one out-of-range controls the first appropriate course of action.)

82) The most characteristic peripheral blood smear finding in multiple myeloma is: a. plasmacytic satellitosis in the bone marrow b. many plasma cells in the peripheral blood c. many Mott cells in the peripheral blood d. rouleaux formation of the red cells

d (Rouleaux is the stacking of red cells like coins and is caused by increased amounts of immunoglobulins in the blood causing the RBCs to adhere to each other.)

185) A patient has been treated for polycythemia vera for several yrs. His blood smear now shows: Oval macrocytes Howell-Jolly bodies Hypersegmented neutrophil Large, agranular platelets the most probable cause of this blood picture is: a. iron deficiency b. alcoholism c. dietary B12 deficiency d. chemotherapy

d (Smear findings demonstrate drug impact: megaloblastic changes due to interference with DNA synthesis [oval macrocytes] as well as other toxic nuclear effects ([Howell-Jolly, hypersegmentation].)

138) Terminal deoxynucleotidyl tranferase is a marker found on: a. hairy cell b. myeloblasts c. monopolists d. lymphoblasts

d (TdT staining in lymphoblasts.)

50) Thalassemias are characterized by: a. structural abnormalities in the hemoglobin molecule b. absence of iron in hemoglobin c. decreased rate of heme synthesis d. decreased rate of globin synthesis

d (Thalassemia cause.)

338) The APTT: a. tests the extrinsic coagulation pathway b. monitors Coumadin therapy c. requires tissue thromboplastin d. monitors heparin therapy

d (The APTT is performed to monitor the effects of unfractionated heparin, to detect factor deficiencies, and the presence of inhibitors. The PT tests the extrinsic pathway and requires tissue thromboplastin. It is also used to monitor warfarin therapy.)

388) The ISI in the INR represents the reagents: a. activator b. specificity c. phospholipids d. sensitivity

d (The ISI represents the international sensitivity index. The most responsive reagents have an ISI of 1.)

68) Which of the following is the formula for absolute cell count? a. number of cells counted /total count b. total count/number of cells counted c. 10 x total count d. % of cells counted x total count

d (The absolute concentration of each type of cell in a WBC differential is important for determining an increase or decrease.)

394) On Monday a patient's Hgb determination was 11.3 g/dL and on Tuesday it measured 11.8 g/dL. The standard deviation of the method used is +/- 0.2 g/dL. Which of the following can be concluded about the Hgb values given? a. one value probably resulted from lab error b. there is poor precision, daily quality control chars should be checked c. the second value is out of range and should be repeated d. there is no significant change in the patient's Hgb concentration

d (The distribution of data around the mean is the standard deviation. Using a specific confidence interval of 95.5%, or 2 standard deviations, the results fall between +/- 0 .2 [1 SD] or +/- O .4 [2 SD].)

96) When using the turbidity method for detecting the presence of hemoglobin S, an incorrect interpretation may be made when there is a: a. concentration of <7 g/dL hemoglobin b. glucose concentration >150 mg/dL c. blood sugar > 2 hrs. old d. increased hemoglobin

d (The low hemoglobin can result in a false-negative result.)

270) Cells involved in hemostasis are: a. erythrocytes b. granulocytes c. lymphocytes d. thrombocytes

d (Thrombocytes [platelets] participate in several aspects of hemostasis.)

377) When evaluating a smear for a retic count, the tech observes that the RBC's are overlapping throughout the entire slide. The most likely explanation is: a. grease on the slide prevented even spreading b. improper proportions of blood and stain were used c. the slide was dried to quickly d. the drop used for the slide preparation was too large

d (Too large of a drop will produce a thick smear; slowly pushing the blood will affect the distribution of the cells.)

318) The results on a patient are: These results reflect: a. thrombophilia b. Factor IX deficiency c. heparin d. warfarin

d (Warfarin is a Vitamin K antagonist; coagulation Factors II, VII, IX, X, Protein C, and S are reduced as nonfunctional molecules are produced. The rate of reduction is based on the half-life of the factors.)

262) vWF antigen can be found in which of the following? a. myeloblast b. monoblast c. lymphoblast d. megakaryoblast

d (vWF is a constituent of platelet alpha granules, and is synthesized in the megakaryocyte as it develops.)