Biomedical Laboratory Diagnostics
Review Questions
Course Introduction
Biomedical Laboratory Diagnostics provides an in-depth exploration of the principles and practices essential for analyzing biological specimens in clinical laboratories. The course covers topics such as specimen collection, handling, and processing; instrumentation and automation; quality assurance and control processes; and interpretation of diagnostic test results. Students learn the fundamental techniques used in hematology, clinical chemistry, immunology, microbiology, and molecular diagnostics. The curriculum also addresses laboratory safety, ethical considerations, and the critical role laboratory diagnostics play in patient care and disease management. Through hands-on laboratory experience and case studies, students gain the skills necessary for effective problem-solving and decision-making in biomedical laboratory settings.
Recommended Textbook
Clinical Laboratory Hematology 2nd Edition by Shirlyn B. McKenzie
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Chapter 1: Introduction
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Q1) Explain how the hemostatic pathway is activated in times of need.
Answer: Traumatic events to body tissue stimulate the activation of repair mechanisms.As a result of both external and internal stimuli, the hemostatic pathway becomes activated in stages called primary, secondary hemostasis and fibrinolysis
Q2) What is the main difference between the clinical pathway and the critical pathway?
A)Nothing; they are the same thing.
B)The clinical pathway helps determine a method of diagnosis and treatment, whereas a critical pathway occurs after treatment has begun.
C)Physicians are reimbursed for services based on the clinical pathway used while the laboratory is reimbursed based on a critical pathway.
D)Critical pathways are developed by the physicians and clinical pathways are developed by the laboratory team.
Answer: B
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3
Chapter 2: Cellular Homeostasis
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Q1) Which cytoplasmic organelle's function is lipid synthesis?
A)Smooth endoplasmic reticulum
B)Golgi apparatus
C)Mitochondria
D)Ribosomes
Answer: A
Q2) Which phospholipids are predominantly found in the inner layer of the lipid bilayer?
A)PE and PC
B)PE and PS
C)PS and SM
D)PC and SM
Answer: B
Q3) Which two proteins are critical for the effective function of the G1 checkpoint?
A)Cdk4 and Cdk6
B)Cyclin E
C)P21 and p57
D)P53 and Rb
Answer: D
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4
Chapter 3: Hematopoiesis
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Sample Questions
Q1) All of the following are characteristics of an optimal hematopoietic environment except:
A)Fibronectin.
B)Extracellular matrix.
C)Stromal cells.
D)Synthetic cytokines.
Answer: D
Q2) Cytokine receptors that lack an intrinsic kinase domain transmit signals primarily through:
A)Transmembrane protein activation.
B)Activation of cytoplasmic kinases.
C)Heterodimer integral protein activation.
D)None of the above.
Answer: B
Q3) Regulation of stem cell homeostasis via SCF and Flt3 is predominantly via:
A)Autocrine signaling.
B)Paracrine signaling.
C)Juxtacrine signaling.
D)Endocrine signaling.
Answer: C
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Chapter 4: Structure and Function of Hematopoietic Organs
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Q1) Acute blood loss can cause bone marrow hyperplasia.What factor will determine the ultimate effect of this pathologic state?
A)Ineffective hematopoiesis
B)Severity of the blood loss
C)Severity and duration of the blood loss
D)Bone marrow activity
Q2) Hypersplenism associated with compensatory hypertrophy of the spleen is associated with:
A)Neoplasms where malignant cells occupy much of the splenic space.
B)Congestive heart failure.
C)Liver cirrhosis with portal hypertension.
D)Infection and inflammatory diseases.
Q3) The hematopoietic compartment of the bone marrow contains what components?
A)Connective tissue and stroma
B)Hematopoietic cells and stroma
C)Tissues and vasculature
D)Tissues and stroma
Q4) What would you expect to see on microscopic examination of a stained blood smear if the patient has had a splenectomy and why?
Page 6
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Chapter 5: The Erythrocyte
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Q1) A blood sample has an elevated bilirubin, low haptoglobin, and low hemopexin.What is the most likely reason for this occurrence?
A)Increased extravascular hemolysis
B)Hypersplenism
C)Ineffective Erythropoiesis
D)Increased intravascular hemolysis
Q2) The life span of a normal erythrocyte is about:
A)9-11 days.
B)5-7 days.
C)120 days.
D)6 hours.
Q3) What element or property contributes to the normal shape of the RBC?
A)Sodium
B)Flexible coiled spectrin tetramers
C)Calcium
D)Magnesium
Q4) Explain how EPO regulates RBC production.
Q5) Explain how hemoglobin is catabolized by the body in both extravascular and intravascular hemolysis.
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Chapter 6: Hemoglobin
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Q1) How would a tense configuration of hemoglobin impact transport of oxygen? Explain your answer.
Q2) How is globin chain production regulated in the body?
A)By regulating the amount of heme produced
B)By regulating the amount of iron incorporated into the heme moiety
C)By regulating the number of RBCs produced
D)By regulating the rate of transcription for protein synthesis
Q3) The majority of carbon dioxide is transported in the body by:
A)Dissolving in plasma.
B)As carbonic acid.
C)Binding to hemoglobin.
D)Methemoglobin
Q4) Which of the following is a control for hemoglobin synthesis?
A)Bohr effect
B)Cyanosis
C)Oxygen affinity
D)Activity of the heme enzyme (ALAS)
Q5) How will oxygen transport be affected in a patient with a defect in beta globin chain production? A patient with a defect in alpha chain production?
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Chapter 7: The Leukocyte
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Q1) The identity of immunoglobulins is determined by:
A)The number of B cells containing the antibody.
B)The complexity of the antibody.
C)The isotype of the heavy chain.
D)The specificity of the variable region.
Q2) Phagocytosis consumes a large amount of energy provided by what processes?
A)Diapedesis
B)Erythrophagocytosis
C)Innate immune response
D)Aerobic and/or anaerobic glycolysis
Q3) What stage of neutrophil maturation is described by the following: 20 m in size, round nucleus with lacey chromatin and several nucleoli, deep blue cytoplasm with large bluish-purple granules.
A)Promyelocyte
B)Metamyelocyte
C)Band neutrophil
D)Myelocyte
Q4) What are three defining characteristics that would help the laboratory professional differentiate between a blast and an activated lymphocyte?
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Chapter 8: Introduction to Anemia
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Q1) An increased red cell distribution width (RDW) usually indicates what abnormality?
A)Increase of average erythrocyte volume
B)Increase of average weight of hemoglobin
C)Decrease in ratio of hemoglobin mass to volume
D)Variation in erythrocyte size
Q2) Remnants of DNA inside an RBC produce which type of inclusion?
A)Howell-Jolly bodies
B)Basophilic stippling
C)Cabot rings
D)Pappenheimer bodies
Q3) How does the mean cell volume value classify cells?
A)Normochromic, hypochromic, and hyperchromic
B)Normocytic, microcytic, macrocytic
C)Poikilocytosis
D)Polychromasia
Q4) Patient results indicate an RPI of 1.8 and an MCV of 109 fl.Do these results make sense? Why or why not?
Q5) Why do we see Howell-Jolly bodies in patients who have had a splenectomy?
Explain your answer.
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Chapter 9: Anemias of Disordered Iron Metabolism and Heme Synthesis
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Q1) Which of the following is NOT characteristic of iron deficiency anemia?
A)Decreased ZPP
B)Decreased serum iron
C)Increased TIBC
D)Decreased serum ferritin
Q2) A storage form of iron is:
A)Pappenheimer bodies.
B)Hemoglobin.
C)Ferritin.
D)Transferrin.
Q3) A bone marrow aspirate is performed on a patient with sideroblastic anemia.The smear is stained with Prussian blue iron stain.What would be the expected findings in this patient? Iron stores:
A)Will be decreased as compared with the normal control.
B)Will be the same as those in the normal control.
C)Will be increased as compared with the normal control.
D)Cannot be determined based on the diagnosis alone.
Q4) Differentiate primary and secondary hemochromatosis?
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Q5) How is sideroblastic anemia confirmed by laboratory analysis? Explain your answer.
Chapter 10: Hemoglobinopaties: Qualitative Defects
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Q1) A patient has a positive sickle solubility test.Further investigation reveals hemoglobin of 8.5 g/dL.What can be done to confirm these findings? Explain your answer.
Q2) What reflex test is most appropriate to investigate these results?
A)Hemoglobin electrophoresis and iron studies
B)Bone marrow aspirate
C)Vitamin B?? and folate assays
D)Cytogenetic analysis
Q3) Hemoglobinopathies are detected by which laboratory method?
A)Spectrophotometric analysis at 450 nm
B)Careful examination of peripheral blood cellular components
C)Separation and quantification of protein subunits through an electrical field
D)Turbidimetric analysis of whole blood
Q4) Electrophoresis at an acid pH using a citrate agar gel separates what hemoglobin variants that travel together on cellulose acetate at pH 8.6?
A)Hemoglobins A and S
B)Hemoglobins S and C
C)Hemoglobins D and S
D)Hemoglobins E and A
Q5) How is methemoglobin detected in the laboratory?
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Chapter 11: Thalassemia
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Q1) Molecular analysis on a 4-month-old Chinese patient revealed three alpha genes deleted on chromosome 16.The physician ordered a hemoglobin electrophoresis on this patient.What would be the expected finding?
A)80% F; 15% A<sub>1</sub>; 5% A<sub>2</sub>
B)95% Hgb H
C)95% Hgb Bart's
D)80% A<sub>1</sub>; 10% F; 10% A<sub>2</sub>
Q2) Choose the thalassemia with the best prognosis from the choices below.
A)Hgb H disease
B)Silent carrier alpha thal
C)Beta thal minor
D)Beta thal intermedia
Q3) Thalassemias are defined as:
A)Qualitative defects in globin chain synthesis.
B)Quantitative defects in globin chain synthesis.
C)Kinetic defects of iron in heme synthesis.
D)Structural defects in heme synthesis.
Q4) Nucleated red blood cells in the peripheral blood are a common finding in beta thalassemia patients.Explain why.
Q5) Why are thalassemias considered a separate entity from hemoglobinopathies?
Page 13
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Chapter 12: Megaloblastic and Nonmegaloblastic
Macrocytic Anemias
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Q1) Pernicious anemia is a malabsorption of vitamin B due to what component deficiency?
A)Gastric juice
B)Intrinsic factor
C)Histamine
D)Folate
Q2) The reason that lack of vitamin B causes megaloblastic changes is because vitamin
B :
A)Is needed for the formation of nucleotide bases.
B)Is needed for the conversion of methionine to SAM.
C)Initiates mitosis.
D)Is needed for synthesis of intrinsic factor.
Q3) It is much easier to become folate-deficient than B -deficient because:
A)The body utilizes folate quicker than it does vitamin B .
B)The body has larger vitamin B stores than it does folate stores.
C)The body has a greater need for folate than for vitamin B .
D)It has not been determined why folate is needed by the body more so than vitamin B .
Q4) Explain why peripheral neuropathy is a common finding in vitamin B deficiency.
Q5) Explain how high alcohol intake can cause macrocytosis.
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Chapter 13: Introduction to Hemolytic Anemia
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Q1) A laboratory professional is reviewing blood smears, and notices moderate spherocytes on one patient.What appropriate follow-up test would help determine the etiology of these cells?
A)MCV
B)Hemoglobin electrophoresis
C)Direct antiglobulin test
D)Unconjugated bilirubin
Q2) In severe intravascular hemolysis, synthesis of this protein may not be sufficient to what is being used to transport hemoglobin to the liver.
A)Bilirubin
B)Haptoglobin
C)Albumin
D)Methemoglobin
Q3) Which of the following is associated with intravascular hemolysis and not extravascular hemolysis?
A)Hemosiderinuria
B)Increased bilirubin
C)Reticulocytosis
D)Polychromasia on the blood smear
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Chapter 14: Hemolytic Anemia: Membrane Defects
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Q1) A sample has the following test results: hemoglobin 9 g/dL; autohemolysis is increased after 48 hours; increased hemolysis is observed with the Ham test and sucrose hemolysis test.Based on these findings, what is the patient most likely suffering from?
A)HS
B)HE
C)PNH
D)PCH
Q2) The laboratory professional notes about 20% spherocytes on a peripheral blood smear of a 4-year-old boy.An osmotic fragility test is performed.The control shows initial hemolysis at 0.50% NaCl and complete hemolysis at 0.35% NaCl.The patient sample has initial hemolysis 60% NaCl and complete hemolysis at 0.45% NaCl.What does this indicate?
A)The patient is exhibiting increased osmotic fragility.
B)The patient has AIHA
C)The patient is not exhibiting decreased osmotic fragility.
D)The control result is out of control so patient results are invalid.
Q3) Explain why patients with HS sometimes suffer from gallstones.
Q4) Differentiate between the three different subtypes of HE based on PB smear morphology.
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Chapter 15: Hemolytic Anemia: Enzyme Deficiencies
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Q1) Intrinsic erythrocyte enzyme deficiencies lead to:
A)Increased erythrocyte oxidative susceptibility.
B)Exacerbated immune response against erythrocytes.
C)Increased opsonization of erythrocytes.
D)Increased extravascular hemolysis.
Q2) Why are echinocytes seen in PK deficiency?
Q3) The majority of glucose catabolism occurs via the:
A)Hexose monophosphate shunt.
B)Embden-Meyerhof pathway.
C)Luebering-Rapoport pathway.
D)Synthesis of nucleotides.
Q4) Exposure to which of the following can induce hemolysis due to G6PD deficiency?
A)Primaquine
B)Fava beans
C)Divicine
D)All of the above
Q5) How do Heinz bodies differ morphologically from other erythrocyte inclusions?
Q6) What is the purpose of the HMP shunt, and why is it important?
Q7) Why are Heinz bodies seen in G6PD deficiency?
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Chapter 16: Hemolytic Anemia: Immune Anemias
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Q1) Explain why the DAT profile in CAD is reactive only with polyspecific AHG and anti-C3 but not with anti-IgG.
Q2) The most likely cause of immediate hemolytic transfusion reaction is due to antibodies of which system?
A)Kidd
B)Rh
C)ABO
D)I
Q3) The absence of spherocytes on the peripheral blood smear in a case of suspected HDFN usually indicates that which of the following is the most likely cause of the condition?
A)ABO HDFN
B)Splenic hypertrophy
C)Rh HDFN
D)HDFN due to other blood group antibodies
Q4) Which of the following conditions is NOT paired with the correct autoantibody?
A)Infectious mononucleosis / autoanti-i
B)WAIHA / autoanti-K
C)CAD / autoanti-I
D)PCH / autoanti-P
Page 18
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Chapter 17: Hemolytic Anemia: Nonimmune Defects
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Q1) A patient who presents with DIC would most likely have which of the following sets of coagulation test results? \(\begin{array}{llll}
&\text { PT } & \text { PTT } & \text { D-dimer } & \text { Fibrinogen } \\ \hline a.&\text { Prolonged } & \text { prolonged } & \text { elevated } & \text { decreased } \\
b.&\text { Normal } & \text { prolonged } & \text { normal } & \text { normal } \\
c.&\text { Prolonged } & \text { prolonged } & \text { decreased } & \text { increased } \\
d.&\text { Normal } & \text { prolonged } & \text { decreased } & \text { decreased } \end{array}\)
Q2) Describe the mechanism that causes the production of schistocytes in microangiopathic hemolytic anemia.
Q3) The underlying cause of TTP is:
A)An unregulated coagulation cascade.
B)Deficiency in vWF multimers.
C)Deficiency of ADAMTS13 protease.
D)Overproduction of cryoprecipitate.
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Chapter 18: Nonmalignant Granulocyte and Monocyte Disorders
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Q1) Define leukoerythroblastosis, and name a condition in which this is seen.
Q2) Acute infection, inflammatory reaction, and administration of glucocorticosteroids may result in:
A)Basophilia.
B)Eosinopenia.
C)Mastocytosis.
D)Histiocytosis.
Q3) Name a type of condition which might cause the following alterations in morphology.
a.Toxic granulation
b.Vacuolization
c.Morulae
d.Eosinophilia
Q4) A patient has a high fever, leukopenia, thrombocytopenia, and elevated liver enzymes.A blood smear shows WBCs with large basophilic, spherical cellular inclusions.What could be The cause?
A)Toxic drugs
B)Ehrlichia sp.infection
C)Severe burns
D)Malaria infection
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Chapter 19: Nonmalignant Lymphocyte Disorders
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Q1) A 5-year-old patient is suspected of having infectious mononucleosis.The patient's blood smear reveals 55% reactive lymphocytes along with a WBC count of 15 x 10<sup>9</sup>/L.The heterophile antibody test is negative.IgG and IgM antibodies to EBV both come back positive.What is the best explanation for these results?
A)50% of children under the age of 10 do not have a positive heterophile test when infected with EBV.
B)The patient does not have EBV but rather acute lymphoid leukemia.
C)The serologic tests are false positive for IgG and IgM antibodies to EBV.
D)The heterophile test is never positive in children under 10 years of age.
Q2) The prominent lymphocytosis in whooping cough is due to:
A)An exacerbated immune response.
B)Cell-mediated immunity accompanying a neutrophilia.
C)Redistribution of lymphocytes from the lymphatics into peripheral circulation.
D)Increased cytokine stimulation of lymphopoiesis in the bone marrow.
Q3) What are the most common laboratory findings in CMV infection in the newborn?
A)Thrombocytopenia and hemolytic anemia
B)Leukocytosis
C)Positive heterophile agglutinin test.
D)Viral DNA assay is negative.
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Chapter 20: Introduction to Hematopoietic Neoplasms
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Q1) For the following cytochemical stains, indicate: 1.what they stain and 2.disease correlation to a positive result.
A)MPO
B)SBB
C)NSE
D)PAS
Q2) Which of the following combinations leads to tumor formation?
A)Activation of oncogenes and suppression of proto-oncogenes
B)Activation of proto-oncogenes with concurrent suppression of oncogenes
C)Activation of oncogenes and suppression of tumor suppressor genes
D)Activation of tumor suppressor genes and suppression of proto-oncogenes
Q3) What is the difference between the HSC and the cancer stem cell?
Q4) A bone marrow differential is performed on a patient suspected of having leukemia.Cytochemical stains are performed.MPO and SBB are negative.Blasts appear homogeneous and small in size.What would you expect to find when performing immunophenotyping?
A)Positive reactivity with immature B cell or T cell markers
B)Positive reactivity with immature myeloid markers
C)Positive reactivity with mature myeloid markers
D)Positive reactivity with plasma cell markers
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Chapter 21: Myeloproliferative Disorders
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Q1) Which CBC findings would be suggestive of a MPD?
A)Erythrocytosis, leukopenia, thrombocytopenia
B)Marked anemia, leukocytosis, thrombocytopenia
C)Leukoerythroblastosis, thrombocytosis
D)Leukoerythroblastosis, thrombocytopenia
Q2) The Philadelphia chromosome results from a fusion of which of the following?
A)Chromosomes 9 and 22
B)Chromosomes 15 and 17
C)Chromosomes 8 and 21
D)Chromosomes 8 and 14
Q3) CML typically is found in which population?
A)Male children
B)Female adults
C)Male and female elderly patients
D)Teenagers
Q4) Which age range is nearest to the peak incidence of CML?
A)0-5 years
B)20-25 years
C)35-45 years
D)55-65 years
Page 23
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Chapter 22: Myelodysplastic Syndromes
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Q1) Which of the following MDS/MPDclassifications includes the immunophenotype CD33, CD13 + MPO +?
A)CMML-1
B)CMML-2
C)aCML
D)JMML
Q2) Many of the myelodysplastic syndromes share a common cytogenetic abnormality.What is it?
A)Philadelphia chromosome
B)5q- deletion
C)t(8, 14)
D)t(15;17)
Q3) Explain the IPSS score system for prognosis and treatment of MDS.
Q4) A patient blood smear shows oval macrocytes, a dimorphic population, and basophilic stippling.There are also 6% blasts in the peripheral blood.What is the presumptive classification based on these findings?
A)Refractory anemia
B)Refractory anemia with ringed sideroblasts
C)Refractory anemia with excess blasts -1
D)Refractory anemia with excess blasts -2
Page 24
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Chapter 23: Acute Myeloid Leukemias
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Q1) Why are Auer rods seen only in myeloblasts?
Q2) The M:E ratio of a patient with AML typically displays which of the following?
A)Myeloid hyperplasia
B)Erythroid hyperplasia
C)Both myeloid and erythroid hyperplasia
D)Normal
Q3) All of the following AML subtypes have positive reactivity with myeloperoxidase stain except:
A)Acute monocytic leukemia.
B)AML with maturation.
C)Acute erythroid leukemia.
D)AML minimally differentiated.
Q4) Which of the following markers are positive for monoblasts?
A)HLA-DR
B)CD33
C)CD14
D)All of the above
Q5) Explain how bone marrow analysis helps establish an AML diagnosis.
Q6) Compare and contrast WHO and FAB classification systems of AML.
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Chapter 24: Acute Lymphoblastic Leukemias
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Q1) Which of the following cytochemical stains would be positive in this case?
A)MPO
B)LAP
C)NSE
D)PAS
Q2) Which of the following patient populations is most commonly afflicted with ALL?
A)Newborns
B)Adults
C)Pregnant females
D)Children
Q3) The most common form of ALL relapse in children is:
A)CNS leukemia.
B)BM relapse.
C)Relapse in extramedullary hematopoietic organs.
D)Relapse in the lymphatic system.
Q4) Explain why acute unclassified leukemias are difficult to identify.
Q5) Explain the molecular and cytogenetic profile of a patient with Burkitt's ALL.
Q6) Patients with ALL are at risk for developing which types of symptoms? Explain your answer.
Q7) Name at least five classifications of ALL, and explain how they are different.
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Chapter 25: Lymphoid Malignancies: Chronic Lymphoid
Leukemias, Lymphomas, and Plasma Cell Neoplasms
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Q1) Which of the following laboratory tests would best help differentiate multiple myeloma and Waldenstrom's macroglobulinemia?
A)Peripheral blood smear
B)Isoelectric focusing
C)Bone marrow aspirate
D)Total protein measurement
Q2) Which of the following test results is most consistent with a diagnosis of multiple myeloma?
A)Increased plasma cell concentration in peripheral circulation
B)Low calcium levels
C)RBC aggregates on the peripheral blood smear
D)Blasts in the peripheral blood
Q3) A bone marrow aspirate is performed for staging purposes on a patient with Hodgkin's lymphoma.The results come back positive for infiltration by RS cells.What does this mean for the patient?
A)The patient is in the early stages of the disease.
B)The patient is in the late stages of the disease.
C)The patient is converting to non-Hodgkin's lymphoma.
D)The patient is entering remission.
Page 27
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Chapter 26: Hematopoietic Stem Cell Transplantation
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Q1) Which of the following best represents the correct order of maturation (youngest to most mature) for hematopoiesis?
A)HSC > precursor >committed progenitor
B)Precursor >HSC >committed progenitor
C)HSC > committed progenitor > precursor
D)Committed progenitor >precursor > HSC
Q2) The advantages of using cord blood stem cells as the source of HSC are numerous.What can be seen as one of the drawbacks when used in the adult population?
A)The GVL effect is increased.
B)Reduction of total number of stem cells for adult transplant patients
C)Cord blood contains sufficient numbers, but is not compatible within ethnic groups.
D)The risk of viral contamination is low.
Q3) Explain graft-versus-leukemia process in stem cell transplantation.
Q4) Compare and contrast the collection of umbilical cord stem cells for transplantation and that of allogeneic stem cells for transplantation.
Q5) Explain the significance of HLA and ABO antigen compatibility in stem cell transplantation.
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Chapter 27: Morphologic Analysis of Body Fluids in the
Hematology
Laboratory
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Sample Questions
Q1) Explain how the following are formed:
a.Transudate
b.Exudate
c.Chylous fluid
Q2) An effusion can accumulate due to a systemic disease, as with congestive heart failure.The correct term for this fluid is:
A)Transudate.
B)Exudates.
C)Chylous.
D)Pleural fluid.
Q3) Cells found in fluids can be reactive mesothelial cells, or malignant cells.Which features are found in reactive cells but not in malignant cells?
A)Smooth nuclear membranes
B)Chromatin unevenly distributed
C)Nucleoli prominent and frequently multiply
D)Nuclear molding
Q4) How would the technologist differentiate between a traumatic specimen collection and a cerebral hemorrhage? Provide at least three macroscopic and three microscopic findings.
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Chapter 28: Primary Hemostasis
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Sample Questions
Q1) Formation of a blood clot on the interior surface of an intact (unsevered) vessel is referred to as:
A)Blood coagulation.
B)Hemostasis.
C)Thrombosis.
D)Fibrinolysis.
Q2) Transient cessation of blood loss is achieved through which of the following?
A)Formation of secondary hemostatic plug
B)Fibrinolysis of established thrombus
C)Formation of primary platelet plug
D)Inhibition of thrombus formation
Q3) How does the vascular system contribute to hemostasis?
Q4) Which of the following is a role of the platelets in secondary hemostasis?
A)To provide factors needed for serine protease activation
B)To initiate cross-linking of the fibrin monomers
C)To activate thrombin
D)To initiate contact activation
Q5) Explain the biochemistry involved in platelet function.
Q6) Describe megakaryocyte development, and the role of endomitosis and thrombopoietin in this process.
Page 30
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Chapter 29: Secondary Hemostasis and Fibrinolysis
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Sample Questions
Q1) Interpret the results below: -Patient: 12-year-old boy with unexplained bruising, swollen knee joints, and prolonged bleeding from injuries
-Screening tests:
-PT = 12.2 sec (control: 11.5-13.3 sec)/INR: 1.09
-APTT = 57 sec (control: 23-32 sec)
-Bleeding time = 5 min (control: 2-10 min)
Pending results from confirmation tests, this patient could be suffering from:
A)An intrinsic pathway problem.
B)An extrinsic pathway problem.
C)A primary hemostasis problem.
D)A common pathway problem.
Q2) Why is vitamin K necessary for some coagulation proteins to become functional?
A)Vitamin K activates coagulation zymogens.
B)Vitamin K binds coagulation factors to a phospholipid surface.
C)Vitamin K combines with VWF in the circulation.
D)Vitamin K is required for gamma-carboxylation of glutamic acid residues.
Q3) Compare and contrast systemic and physiologic fibrinolysis.
Q4) What are the roles of thrombin in coagulation?
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Chapter 30: Disorders of Primary Hemostasis
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Sample Questions
Q1) Minimum screening tests that should be considered in the evaluation of abnormal bleeding is/are which of the following?
A)Thrombin time
B)Fibrinogen level
C)Factor studies
D)Platelet count, PT, APTT
Q2) Describe the following, and indicate where they are typically seen (disorders of primary hemostasis or secondary hemostasis).
A)Petechiae
B)Purpura
C)Ecchymoses
D)Hematomas
Q3) What would be the expected laboratory results in a patient with thrombocytopenia?
A)Platelet counts < 50 x 10<sup>9</sup>/L
B)Bleeding time normal
C)PT and APTT abnormally prolonged
D)Fibrinogen decreased
Q4) How do hematologic disorders contribute to the pathogenesis of thrombocytopenia?
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Chapter 31: Disorders of Secondary Hemostasis
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Sample Questions
Q1) What is the inheritance pattern of hemophilia A?
A)Autosomal dominant
B)Autosomal recessive
C)Sex-linked
D)None of the above
Q2) Predict results that will confirm the patient's diagnosis.
A)Abnormal aggregation with Ristocetin
B)An increased D-dimer
C)Decreased activity of either factors VIII or IX
D)The presence of an inhibitor pattern in a mixing study
Q3) A patient might be suffering from a coagulopathy.Which of the following physical manifestations would suggest a primary hemostatic pathway problem?
A)Hematomas
B)Petechiae
C)Joint and muscle bleeding
D)Ecchymoses
Q4) What tests typically are utilized in the detection of lupus anticoagulants in the laboratory?
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Chapter 32: Thrombophilia
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Sample Questions
Q1) What are the physiological processes involved in hypercoagulability?
Q2) A tendency to favor thrombus formation that is produced from an imbalance in the major constituents of the hemostatic system is defined as:
A)Hypercoagulability.
B)Thrombophilia.
C)Thrombosis.
D)Thromboembolism.
Q3) Patients with protein C and/or S deficiencies are at risk for which type of complication?
A)Hemorrhage
B)Delayed bleeding after injury
C)Thrombosis
D)Fibrinolysis
Q4) How do unfractionated heparin and low-molecular weight heparin differ?
A)In their pharmacokinetics
B)In their composition
C)In the tests used to monitor their biologic activity
D)All of the above
Q5) Explain why many patients with an inherited thrombophilia are misdiagnosed.
Page 34
Q6) Why are clotting and molecular assays both needed for a diagnosis of APCR?
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Chapter 33: Hematology Procedures and Hemostasis
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Sample Questions
Q1) Which of the following is the most appropriate test to differentiate hemoglobin S trait from hemoglobin S disease?
A) Quantitation of hemoglobin A
B) Hemoglobin electrophoresis
C) Acid elution for hemoglobin F
D) Solubility for hemoglobin S
Q2) An instrument printout reports a platelet count of 85x 109/L.The technologist reviewing the peripheral blood smears notices aggregates of platelets around many of the neutrophils.What is the best course of action to correct this problem?
A)Warm the specimen for 10 min at 45°C and rerun the sample.
B)Centrifuge and rerun the sample.
C)Remake the smear and use alkaline buffer to stain the slide.
D)Redraw the sample in sodium citrate and repeat the platelet count.
Q3) Which substance when added to the acid phosphatase stain is useful in the identification of hairy cells?
A) Sodium fluoride
B) Sodium tartrate
C) Potassium chloride
D) Disodium phosphate
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Chapter 34: Bone Marrow Examination
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Sample Questions
Q1) The cellularity of the bone marrow is determined by examining the ratio of:
A)Stromal cells to hematopoietic cells.
B)Hematogones to hematopoietic cells.
C)Adipose tissue to hematopoietic cells.
D)Hematopoietic cells to non-hematopoietic cells.
Q2) A 2-year-old boy is suspected of having leukemia, and a bone marrow examination is requested.From which body site should the bone marrow be collected?
A)Superior iliac crest
B)Vertebrae
C)Tibia
D)Sternum
Q3) The cellularity of the marrow is best examined in ________, and it is determined by the red bone marrow's relationship to _________.
A)BM aspirate; the patient's age
B)BM aspirate; hematogones
C)BM biopsy; yellow marrow
D)BM biopsy; stromal cells
Q4) What are the main differences in uses between a core biopsy specimen and aspirate specimen?
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Chapter 35: Automation in Hematology and Hemostasis
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Sample Questions
Q1) Which of the following analyzers uses radio frequency as a means of detecting and differentiating leukocytes?
A)Bayer Advia 2120
B)Abbott Sapphire
C)Sysmex XE-2100
D)Coulter Gen-S
Q2) Which parameter does the Coulter LH 750 instrument derive from a histogram?
A) Platelet count
B) MCH
C) Leukocyte count
D) Hct
Q3) Explain the purpose of the following used in the standard hematologic cell counting detection methods:
A)VCS flow cell
B)Photodetector
C)Sheath fluid
D)Direct current detection block
Q4) Name two analytes that can be measured immunologically, and list two instruments that currently use this method.
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Chapter 36: Flow Cytometry
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Sample Questions
Q1) A single group of cells possessing identical aberrant phenotypes is defined as:
A)Monoclonal.
B)Clonality.
C)Tumorigenic.
D)Contour gating.
Q2) Immunophenotyping is essential for the diagnosis of ALL, separation of T and B lineage ALL, and identification of subtypes of B lineage ALL.What markers can blasts express in precursor B cell ALL?
A)CD10 and TdT
B)CD1 and CD2
C)CD4 and CD8
D)CD41 and CD61
Q3) An unknown cell resembling a hematogone has CD19 and CD20 antigens.What is the lineage of the unknown cell?
A)Myeloid
B)Monocytic
C)Lymphoid
D)Erythroid
Q4) Explain why flow cytometry is of limited use in identifying AML.
Q5) How can flow cytometry be used in cell quantitation?
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Chapter 37: Chromosome Analysis of Hematopoietic and Lymphoid Disorders
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Sample Questions
Q1) The presence of a chimerism after a bone marrow transplant indicates:
A)A rejected transplant.
B)A partial engraftment.
C)A complete engraftment.
D)A successful transplant.
Q2) The cell cycle contains four phases: G1, S, G2, and mitosis.Which phase must be active to study human chromosomes?
A)S
B)G2
C)G1
D)Mitosis
Q3) A karyotype is a representation of:
A)The molecular structure of DNA.
B)The double-helix structure of DNA.
C)The cell's immunophenotype
D)Chromosome grouping.
Q4) List at least five indications for performing FISH analysis in patients suspected of having a hematolymphoid disorder.
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Chapter 38: Molecular Analysis of Hematologic Diseases
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Sample Questions
Q1) Give the advanatgaes of PCR over Southern Blot and advantages of Southern Blot over PCR.
Q2) Which of the following methods would be most useful for identifying point mutations anywhere in the DNA segment?
A)Southern Blot analysis
B)PCR
C)DNA sequencing
D)FISH
Q3) Explain the central dogma of molecular biology using proper nomenclature.Define each phase.
Q4) Choose the correct statement regarding molecular oncology from the choices below.
A)The genes responsible for tumor formation are oncogenes.
B)Molecular testing is needed for cancer diagnosis.
C)Molecular testing is not sensitive for monitoring minimal residual disease.
D)All genetic mutations responsible for cancer can be identified by molecular techniques.
Q5) Explain the impact of a positive test for HTLV-1 in a lymphoma patient.
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Chapter 39: Laboratory Testing in Coagulation
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Sample Questions
Q1) A patient is screened positive for APCR.What does this mean for the patient?
A)The patient is at risk for hemorrhage.
B)The patient has a factor VL d n mutation.
C)The patient is at risk for thrombosis.
D)The patient is on heparin.
Q2) Proper pecimen collection for coagulation testing must be performed to eliminate contamination of substances that will interfere with the test results.Which of the following are considered contaminates for coagulation testing?
A)Sodium citrate and heparin anticoagulant
B)Tissue factor and anticoagulant carryover
C)Air and tissue factor
D)High hematocrit and anticoagulant carryover
Q3) A patient is admitted with prolonged epistaxis and prolonged bleeding from a recent tooth extraction.Initial screening workup reports prolonged APTT and BT, and abnormal aggregation on the PFA.Which of the following tests would help define the disorder?
A)von Willebrand's factor activity
B)von Willebrand's factor antigen
C)Factor VIII assay
D)All of the above
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Chapter 40: Quality Assessment in the Hematology
Laboratory
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Sample Questions
Q1) An instrument printout reveals the following: PT = 9.0 sec and APTT = 20.0 sec.What should the technologist do next?
A)Report patient results.
B)Check the sample for the presence of small clots.
C)Observe the sample for the presence of hemolysis.
D)Examine the collection tube for underfilling.
Q2) The regulatory body responsible for establishing proper guidelines for biohazardous waste material removal is:
A)OSHA.
B)CAP.
C)JCAHO. D)MSDS.
Q3) Implementation of a quality assessment program in laboratories is mandated by: A)OSHA. B)JCAHO.
C)CLIA 88. D)CAP.
Q4) What is the importance of documentation in a quality assessment program?
Q6) Identify the critical information that must be on a material safety data sheet. Page 42
Q5) What are the components of a method evaluation? Explain the purpose of each.
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