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126 Cards in this Set
- Front
- Back
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Which of the following cells is not produced in the bone marrow of normal adults?
Neutrophil Monocyte Lymphocyte Thrombocyte where is it produced |
lymphocyte
thymus and bone marrow |
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In myelopoiesis, which is the first developmental stage to present with primary granules?
Myeloblast Promyelocyte Myelocyte Metamyeloctye |
promyelocyte
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Of the following cells, which is never found in the peripheral circulation in its mature form?
Myeloblast Promyelocyte Promonocyte Megakaryoctye |
Megakaryoctye
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Normally, what is the largest white blood cell found in the peripheral blood?
Eosinophil Neutrophil Lymphocyte Monocyte |
monocyte
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What is the major phagocytic cell involved in the initial defense against pathogens such as bacteria?
Neutrophil Eosinophil Basophil Monocyte |
neutrophil
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What is the growth factor primarily responsible for regulating granulocyte and monocyte production?
Erythropoietin GM-CSF Interleukin Thrombopoietin |
GM-CSF
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A “shift to the left” when used to describe a cell population refers to
Increased cells in the blood due to redistribution of marginating and circulating blood pools Increase in immature blood cells following release of bone marrow pools Cell production gap Higher percentage of lymphocytes than neutrophils |
Increase in immature blood cells following release of bone marrow pools
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T lymphocytes are characterized by all the following except
Secrete cytokines Synthesize antibody Comprise majority of cells in blood lymphocyte pool Regulate immune response |
Synthesize antibody
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An adult has a total WBC count of 4.0 x 109/L. The differential count is as follows: PMN 25%, Bands 5%, lymphs 65%, and monos 5%. Which of the following statements is true?
The percentage of lymphocytes is normal There is an absolute lymphoctyosis There is a relative lymphocytosis There is both an absolute and a relative lymphocytosis |
There is a relative lymphocytosis
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what is the WBC ref range
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4.5-11.5
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what is the Hgb ref range
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M-14-18
F-12-15 |
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what is the HCT ref range
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M 40-54
F 35-49 |
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what is the MCV ref range
and how do you calculate it |
80-100
HCT * 10/RBC |
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what is the MCH ref range
and how is it calculated |
26-32
HGB * 10/RBC |
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what is the MCHC ref range
and how is it calculated |
32-36
HGB* 100/HCT |
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what is the RDW ref range
>14.5 means what |
11.5 - 14.5
anisocytosis |
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what is the RBC ref range
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M 4.6-6
F 4-5.4 |
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ref range of segs
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50-70
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ref range of bands
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0-5
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ref range of lymphs
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18-42
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ref range of monos
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2-11
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ref range of eos
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1-3
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ref range of basos
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0-2
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ref range of PLTs
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150-450
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ref range of erythrocyte sed rate
1hr |
M 0-15mm >50 0-20mm
F 0-20mm >50 0-30mm |
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Which of the following statements is correct?
Hypersegmented neutrophils have greater than 6 nuclear lobes Auer rods are composed of fused primary granules Toxic granules are prominent secondary granules Dohle bodies are agranular patches of DNA and what is this typical in |
Auer rods are composed of fused primary granules
acute myelogenous leukemia (AML) |
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With which of the following is an absolute neutrophil count of 1.0 x 109/L associated?
Shortness of breath Bleeding tendencies Risk of infection No clinical symptoms |
Risk of infection
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What is the most mature cell that can undergo mitosis?
Myeloblast Promyelocyte Myelocyte Metamyelocyte |
Myelocyte
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Production of primary granules ceases and production of secondary granules commences with what cell stage?
Myeloblast Promyelocyte Myelocyte Metamyelocyte |
Myelocyte
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Which of the following are indicators of a neutrophilic response to tissue damage or inflammatory stimuli?
Toxic granules and Dohle bodies in the neutrophils Vacuoles and Barr bodies in the neutrophils Hypersegmented neutrophils and Auer rods Pyknotic neutrophils and Russell bodies |
Toxic granules and Dohle bodies in the neutrophils
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What is the term for cell movement through blood vessels to a tissue site?
Diapedesis Opsonization Margination Chemotaxis |
Diapedesis
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Cells that produce immunoglobulins in response to antigenic stimulation are designated
Sezary cells Plasma cells Virocytes Thymocytes |
Plasma cells
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Which of the following is characteristic of metamyelocytes?
Appearance of specific granules Indentation of nucleus Absence of nucleoli Color of cytoplasm |
Indentation of nucleus
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Lymphocyte concentrations in the peripheral blood are greatest during what age interval?
Young child (1-4 years) Older child (4-15 years) Young adult (16-40 years) Older adult (40-70 years) |
Young child (1-4 years)
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Which of the following statements about hairy cell leukemia is true?
It is an acute disease, primarily affecting young adults Splenomegaly is an unusual finding Hairy cells contain tartrate resistant acid phosphatase Hairy cells are abnormal T lymphocytes |
Hairy cells contain tartrate resistant acid phosphatase
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The presence of both immature neutrophils and nucleated erythrocytes in the peripheral blood is most accurately called a
Neutrophilic left shift Regenerative left shift Neutrophilic leukemoid reaction Leukoerythroblastic reaction |
Leukoerythroblastic reaction
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In which anomaly is a failure of granulocytes to divide beyond the band or two-lobed stage observed?
Pelger-Huet May-Hegglin Alder-Reilly Chediak-Higashi |
Pelger-Huet
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Eosinophils are increased in all the following except
Cushing’s disease Allergic disorders Skin disorders Parasitic infection |
Cushing’s disease
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A patient with normal hemoglobin and WBC values, a persistently elevated platelet count (>1000 x 109/L), increased marrow megakaryocytes, and a history of frequent bleeding and clotting episodes most likely has
Polycythemia vera Myelofibrosis with myeloid metaplasia Essential thrombocythemia Chronic myelocytic leukemia |
Essential thrombocythemia
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normal LAP score
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20-100
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LAP score of <13 =
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CML
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LAP score of >100=
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leukomoid reaction
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Lap score of 100-200 =
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Polycythemia vera
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An adult patient with massive splenomegaly has mild anemia, a slightly elevated WBC count, and an LAP score of 170. The blood smear shows teardrop erythrocytes and leukoerythroblastosis. In addition, the bone marrow aspirate was a “dry tap”. These findings are most consistent with
Chronic myelocytic leukemia Myelofibrosis with myeloid metaplasia Polycythemia vera Essential thrombocythemia |
Myelofibrosis with myeloid metaplasia
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Which of the following is increased in Waldenstrom’s macroglobulinemia?
IgA IgE IgG IgM |
IgM
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A leukemoid reaction is an increase in peripheral blood cells associated with
A preleukemic state An extreme infectious response Presence of leukemia Fibrotic bone marrow |
An extreme infectious response
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A Gaucher’s cell is best described as a macrophage with
Wrinkled cytoplasm due to an accumulation of glucocerebroside Foamy cytoplasm filled with unmetabolized sphingomyelin Pronounced vacuolization and deposits of cholesterol Abundant cytoplasm containing storage iron and cellular remnants |
Wrinkled cytoplasm due to an accumulation of glucocerebroside
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Which of the following suggests a diagnosis of Hodgkin’s disease rather than other lymphoproliferative disorders?
An absolute lymphocytosis with mature appearing lymphocytes Predominance of immature B cells with irregular nuclear clefts Circulating T cells with a convoluted, cerebriform nucleus Presence of giant Reed-Sternberg cells binucleated with prominent nucleoli |
Presence of giant Reed-Sternberg cells binucleated with prominent nucleoli
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The FAB type of AML most often associated with DIC is
M2 M3 M4 M5 |
M3
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The peripheral blood shown below is from a 69-year-old female. Her WBC count is 83 x 109/L and her platelet count was normal. Based on the smear morphology and this information, what is the most likely diagnosis?
pic had smudge cell ALL CLL Waldenstrom’s disease Viral infection |
CLL
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Multiple myeloma is characterized by the presence in urine of large amounts of
IgM antibodies IgG heavy chains IgG light chains Beta microglobulins WHATS ANOTHER NAME FOR THIS |
IgG light chains
bence jones protein |
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Which of the following is not usually classified as a myeloproliferative disorder?
Polycythemia vera Essential thrombocythemia Multiple myeloma Chronic myelocytic leukemia |
Multiple myeloma
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The Philadelphia chromosome is a reciprocal translocation of material between chromosomes
8 and 14 8 and 21 9 and 22 15 and 17 |
9 and 22
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The Philadelphia chromosome is present in approximately 90% of patients with
ALL CLL AML CML |
CML
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The cytoplasmic inclusion present below
(auer rods) Excludes a diagnosis of AML Stains positive with leukocyte alkaline phosphatase (LAP) Stains positive with myeloperoxidase Identifies the cell as a malignant lymphoblast |
Stains positive with myeloperoxidase
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In what condition would a LAP score of 10 most likely be found?
Bacterial septicemia Late pregnancy Polycythemia vera Chronic myelocytic leukemia |
Chronic myelocytic leukemia
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Coarse PAS positivity is found most often in the leukemic cells of
AML, M2 ALL, L1 AMML, M4 AML, M5 |
ALL, L1
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Naphthol AS-D chloroacetate esterase (specific) is usually positive in ______ cells and alpha-naphthyl acetate esterase (nonspecific) is useful for identifying blast cells of _______ lineage.
Granulocytic, monocytic Monocytic, granulocytic Granulocytic, lymphocytic Monocytic, megakaryocytic |
Granulocytic, monocytic
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The familial disorder featuring pseudo-Dohle bodies, thrombocytopenia, and large platelets is called
May-Hegglin anomaly Chediak-Higashi syndrome Pelger-Huet anomaly Alder-Reilly anomaly |
May-Hegglin anomaly
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Alder-Reilly anomaly is an abnormality of
Lysosomal fusion Nuclear maturation Oxidative metabolism Mucopolysaccharide metabolism |
Mucopolysaccharide metabolism
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Multiple myeloma is characterized by the presence in urine of large amounts of
IgM antibodies IgG heavy chains IgG light chains Beta microglobulins WHATS ANOTHER NAME FOR THIS |
IgG light chains
bence jones protein |
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Which of the following is not usually classified as a myeloproliferative disorder?
Polycythemia vera Essential thrombocythemia Multiple myeloma Chronic myelocytic leukemia |
Multiple myeloma
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The Philadelphia chromosome is a reciprocal translocation of material between chromosomes
8 and 14 8 and 21 9 and 22 15 and 17 |
9 and 22
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The Philadelphia chromosome is present in approximately 90% of patients with
ALL CLL AML CML |
CML
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The cytoplasmic inclusion present below
(auer rods) Excludes a diagnosis of AML Stains positive with leukocyte alkaline phosphatase (LAP) Stains positive with myeloperoxidase Identifies the cell as a malignant lymphoblast |
Stains positive with myeloperoxidase
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In what condition would a LAP score of 10 most likely be found?
Bacterial septicemia Late pregnancy Polycythemia vera Chronic myelocytic leukemia |
Chronic myelocytic leukemia
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Coarse PAS positivity is found most often in the leukemic cells of
AML, M2 ALL, L1 AMML, M4 AML, M5 |
ALL, L1
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Naphthol AS-D chloroacetate esterase (specific) is usually positive in ______ cells and alpha-naphthyl acetate esterase (nonspecific) is useful for identifying blast cells of _______ lineage.
Granulocytic, monocytic Monocytic, granulocytic Granulocytic, lymphocytic Monocytic, megakaryocytic |
Granulocytic, monocytic
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The familial disorder featuring pseudo-Dohle bodies, thrombocytopenia, and large platelets is called
May-Hegglin anomaly Chediak-Higashi syndrome Pelger-Huet anomaly Alder-Reilly anomaly |
May-Hegglin anomaly
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Alder-Reilly anomaly is an abnormality of
Lysosomal fusion Nuclear maturation Oxidative metabolism Mucopolysaccharide metabolism |
Mucopolysaccharide metabolism
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A 60-year-old patient presents with extreme fatigue. Her blood and bone marrow findings are as follows: severe anemia with a dual RBC population, 3% marrow blasts, and numerous ringed sideroblasts. This information is mostly consistent with
RA RARS RAEB RAEB-t |
RARS
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Usual findings in Polycythemia Vera include all the following except
Pancytosis Increased red cell mass Increased erythropoietin Increased blood viscosity |
Increased erythropoietin
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Di Guglielmo’s syndrome or FAB acute leukemia type M6 is characterized by increased
Promyelocytes and lysozyme activity Marrow megakaryocytes and thrombocytosis Marrow erythroblasts and multinucleated red cells Marrow monoblasts and monocytes |
Marrow erythroblasts and multinucleated red cells
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The Sudan Black B stain is a stain for
Glycogen Lipids Myeloperoxidase Acid phosphatase |
Lipids
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The following numbers were obtained in evaluating LAP activity in neutrophils. What is the score?
0 1 2 3 4 32 24 21 15 8 100 143 175 241 |
143
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Right-angle scatter in a laser-based cell counting system is used to measure
Cell size Cytoplasmic granularity Cell number Immunologic (antigenic) identification |
Cytoplasmic granularity
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What is the basis for the Coulter principle of electronic particle counting?
Angle of laser beam scatter by particles Amplification of an electrical current by the particles Impedance of an electrical current by the particles Change in optical density of the solution containing the particles |
Impedance of an electrical current by the particles
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To evaluate normal platelet numbers in an appropriate area of a blood smear, approximately how many platelets should be observed per oil immersion field?
1-4 4-10 8-20 20-50 |
8-20
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Which stain should be used to differentiate a neutrophilic leukemoid reaction from chronic myelogenous leukemia?
Sudan black B Periodic acid-Schiff reagent Myeloperoxidase Leukocyte alkaline phosphatase |
Leukocyte alkaline phosphatase
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The presence of CD2, CD5, CD7 and the absence of CD10 (CALLA) are associated with
B-cell acute lymphocytic leukemia T-cell acute lymphocytic leukemia Acute myelomonocytic leukemia Acute monocytic leukemia |
T-cell acute lymphocytic leukemia
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Terminal deoxyribonucleotidyl transferase (TdT) is found in 90% of the cases of
ALL CLL AML CML |
ALL
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Thrombocytopenia may be caused by all the following except
Post-splenectomy Chemotherapy Decreased thrombopoietin Aplastic anemia |
Post-splenectomy
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A 4-year-old child is seen in the ER with petechiae and a platelet count of 15 x 109/L. She has no previous history of bleeding problems. 3 weeks earlier she had chicken pox. The physician advises the parents to keep the child off the playground to avoid injury and the child will recover within several weeks to a month with no further treatment. What condition does this child most likely have?
ET ITP TTP Wiskott-Aldrich Syndrome |
ITP
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During the hemostatic process, platelets interacting with and binding to other platelets is referred to as
Adhesion Aggregation Release Retraction |
Aggregation
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Which therapeutic agent affects platelet function?
Aspirin Coumadin Heparin Streptokinase |
Aspirin
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What is the approximate normal mean platelet volume (MPV) expressed in femtoliters (fL)?
5 7 10 18 |
10
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All the following are normal maturation stages of platelets except
Megakaryoblast Promegakaryocyte Micromegakaryocyte Megakaryocyte |
Micromegakaryocyte
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What is the specimen of choice for routine coagulation testing?
Heparin Sodium citrate Sodium oxalate EDTA |
Sodium citrate
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The ratio of anticoagulant to blood for coagulation procedures should be 1 to
4.5 7.0 9.0 10.0 |
9
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When thrombin binds with thrombomodulin on the endothelial cell surface, thrombin can
Activate protein C Activate Factor V and Factor VIII Convert fibrinogen to fibrin Stimulate platelet aggregation |
Activate protein C
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What is the coagulation factor that has a sex-linked recessive inheritance pattern?
Factor V Factor IX Factor X Von Willebrand’s factor |
Factor IX
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The thrombin time will be prolonged in the presence of all the following except
Elevated fibrinogen degradation products Heparin Factor I deficiency Factor II deficiency |
Factor II deficiency
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What would be the expected screening test results for a patient with a fibrin stabilizing factor deficiency?
PT prolonged APTT prolonged PT and APTT prolonged PT and APTT normal |
PT and APTT normal
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Fibrin strands are cross-linked and the fibrin clot stabilized by the activity of
Alpha-antiplasmin Factor XIIIa Plasmin Thrombin |
Factor XIIIa
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Which of the following enzymatically degrades the stabilized fibrin clot?
Plasminogen Plasmin Prothrombin Thrombin |
Plasmin
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The activity of the lupus anticoagulant appears to be directed against
Factor V Factor VIII Factor IX Phospholipid |
Phospholipid
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Measurement of time required for fibrin formation when thrombin is added to plasma evaluates the
Fibrinogen concentration Prothrombin concentration Extrinsic clotting system Intrinsic clotting system |
Fibrinogen concentration
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All the following are true of the INR except
INR is dependent on reagents and instrumentation used INR is calculated using the PT ratio taken to the power of ISI value WHO recommends reporting of the INR on patients with long-term oral anticoagulant therapy Desired INR on a patient on coumadin is between 2.0 and 2.5 but may be higher depending on the cause of the patient’s hypercoagulable state |
INR is dependent on reagents and instrumentation used
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A prolonged APTT is obtained on a patient diagnoses as having acute DIC. The patient has not yet been treated for this syndrome. How can the prolonged APTT be explained?
In addition to DIC, the patient is deficient in a factor required for the intrinsic pathway DIC is characterized by synthesis of less stable coagulation factors, which deteriorate rapidly in the circulation Continuous activation of the coagulation system uses some factors more rapidly than the liver can make them Patient has been misdiagnosed |
Continuous activation of the coagulation system uses some factors more rapidly than the liver can make them
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All the following test results are characteristic of DIC except
Decreased fibrinogen concentration Negative test for degradation products Decreased platelet count Prolonged prothrombin time test |
Negative test for degradation products
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Thrombocytosis is a characteristic of
DIC Splenomegaly PV ITP |
PV
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Lab results on a patient with a severe bleeding problem are as follows:
Platelet count 193 x 109/L Bleeding time >15 minutes PT 12.0 sec APTT 92.0 sec Plt aggregation Normal response to ADP, collagen, epinephrine; no response with ristocetin These results are consistent with Christmas disease Hemophilia A Glanzmann’s thrombasthenia Von Willebrand’s disease |
Von Willebrand’s disease
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Lab results on a patient with a severe bleeding problem are as follows:
Platelet count 125 x 109/L MPV 16.0 fL (ref. range = 8-10 fL) Bleeding time >15 min (ref. range = 2-10 min) PT 12 sec APTT 32 sec Platelet Aggregation Normal response to ADP, collagen, epinephrine; no response with ristocetin Bernard-Soulier syndrome Von Willebrand’s disease Glanzmann’s thrombasthenia Ehlers-Danlos syndrome |
Bernard-Soulier syndrome
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The following results are obtained on a patient with a severe bleeding problem:
Platelet count 256 x 109/L Bleeding time >15 min Clot retraction Deficient Platelet Normal response to ristocetin; weak Aggregation response to ADP, collagen, epinephrine These results are characteristic of: Von Willebrand’s disease Glanzmann’s thrombasthenia Storage pool disease Christmas disease |
Glanzmann’s thrombasthenia
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Results on a patient presenting with sudden severe hemorrhagic problems are as follows:
Bleeding time Normal PT Normal APTT Prolonged APTT 1:1 mixing study No correction These clinical manifestations and lab results are consistent with Coumadin therapy Von Willebrand disease Hemophilia A Presence of a circulating inhibitor |
Presence of a circulating inhibitor
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The following results are obtained on a 3-year-old boy with sudden severe hemorrhagic problems:
Bleeding time Normal PT Normal APTT Prolonged APTT 1:1 Mixing Study Corrected Platelet aggregation Normal with ristocetin, ADP, collagen, and epinephrine These clinical manifestations and lab results are consistent with Aspirin Von Willebrand’s disease Hemophilia A Factor VII deficiency |
Hemophilia A
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An APTT on a 46-year-old male patient admitted for minor surgery is markedly abnormal, whereas the PT is within normal range. The patient has no clinical manifestations of a bleeding problem and has no personal or family history of bleeding problems. Several family members have been treated for thrombotic episodes. The prolonged APTT is corrected with a 1:1 mixing study using normal plasma. Based on these lab results and clinical history, what factor deficiency would be expected?
II VIII XII XIII |
XII
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A 25-year-old obstetrical patient at 35 weeks gestation is admitted through the ER. She has bleeding in the genitourinary tract and there are visible petechiae and ecchymoses. The following lab results are obtained:
Platelet count Decreased PT Prolonged APTT Prolonged Fibrinogen Decreased Thrombin Time Prolonged D-Dimer Positive RBC morphology Schistocytes present These lab results are consistent with: Primary fibrinolysis DIC Factor II deficiency Heparin therapy |
DIC
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Which of the following is a component of platelet alpha granules?
ADP Calcium ions Serotonin Von Willebrand’s factor |
Von Willebrand’s factor
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Which may be the cause of defective clot retraction?
Lack of platelet receptor GP Ib Lack of platelet receptor GP IIb/IIIa for fibrinogen Insufficient storage of ADP Absence of von Willebrand’s factor |
Lack of platelet receptor GP IIb/IIIa for fibrinogen
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Abnormal platelet function is the suspected cause of the bleeding problem in a patient who has a normal platelet count. Which of the following laboratory procedures gives information with regard to platelet function and, therefore, could provide information as to the cause of the bleeding problem?
APTT PT TT BT |
BT
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Which coagulation factors are referred to as “vitamin K dependent”?
I, V, VIII, XIII II, V, IX, XII II, VII, IX, X XI, XII, Fletcher, Fitzgerald |
II, VII, IX, X
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Which factors are consumed in clotting and, therefore, absent in serum?
I, V, VIII, XIII I, II, V, VIII, XIII II, VII, IX, X VIII, IX, XI, XII |
I, II, V, VIII, XIII
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A severe vitamin K deficiency will affect all the following except
Fibrinogen Stable factor Christmas factor Protein C |
Fibrinogen
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All the following are associated with thrombosis except
Factor V Leiden mutation Hypofibrinogenemia Lupus anticoagulant Anticardiolipin antibody |
Hypofibrinogenemia
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Fitzgerald factor is another name for
Factor II Factor XII Prekallikrein HMWK |
HMWK
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The prothrombin time will detect deficiencies in the _______ pathway(s) when calcium and an extract of tissue such as brain are added to plasma.
Extrinsic Extrinsic and common Intrinsic Intrinsic and common |
Extrinsic and common
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Which of the following is a characteristic of acute idiopathic thrombocytopenic purpura?
Spontaneous remission within a few weeks Predominantly seen in adults Nonimmune platelet destruction Insidious onset |
Spontaneous remission within a few weeks
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TTP differs from DIC in that:
APTT is normal in TTP but prolonged in DIC Schistocytes are not present in TTP but are present in DIC Platelet count is decreased in TTP but normal in DIC PT is prolonged in TTP but decreased in DIC |
APTT is normal in TTP but prolonged in DIC
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Hemolytic uremic syndrome (HUS) is associated with:
Fever, thrombocytosis, anemia, and renal failure Fever, granulocytosis, and thrombocytosis Escherichia coli 0157:H7 Leukocytosis and thrombocytosis |
Escherichia coli 0157:H7
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Neurological findings may be commonly associated with which of the following disorders?
HUS TTP ITP PTP |
TTP
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The coagulation factor associated with hemophilia A is:
VIII V IX XI |
VIII
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Bernard-Soulier syndrome is associated with:
Decreased bleeding time Decreased factor VIII assay Thrombocytopenia and giant platelets Abnormal platelet aggregation to ADP |
Thrombocytopenia and giant platelets
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When performing platelet aggregation studies, which set of platelet aggregation results would most likely be associated with Bernard-Soulier syndrome?
Normal platelet aggregation to collagen, ADP, and ristocetin Normal platelet aggregation to collagen, ADP, and epinephrine; decreased aggregation to ristocetin Normal platelet aggregation to epinephrine and ristocetin; decreased aggregation to collagen and ADP Normal platelet aggregation to epinephrine, ristocetin, and collagen; decreased aggregation to ADP |
Normal platelet aggregation to collagen, ADP, and epinephrine; decreased aggregation to ristocetin
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Hereditary hemorrhagic telangiectasia is a disorder of:
Platelets Clotting proteins Fibrinolysis Connective tissue |
Connective tissue
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Which defect characterizes Gray’s syndrome?
Platelet adhesion defect Dense granule defect Alpha granule defect Coagulation defect |
Alpha granule defect
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