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Diagnostic Laboratory Medicine focuses on the principles, methodologies, and clinical applications of laboratory tests used in the diagnosis, monitoring, and prevention of diseases. The course covers a range of topics including specimen collection and processing, quality control, interpretation of laboratory data, and the use of various analytical techniques in disciplines such as clinical chemistry, hematology, microbiology, immunology, and molecular diagnostics. Emphasis is placed on the integration of laboratory findings with patient care, laboratory safety, regulatory standards, and ethical considerations in diagnostic testing.
Recommended Textbook
Clinical Hematology and Fundamentals of Hemostasis 5th Edition by Denise M. Harmening
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36 Chapters
1596 Verified Questions
1596 Flashcards
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28 Verified Questions
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Sample Questions
Q1) Reactive lymphocytes are present in the evaluation of certain diseases such as:
A) Infectious mononucleosis
B) Cancer
C) Bacterial infections
D) Tumors
E) Anemias
Answer: A
Q2) What percentage of band neutrophils is present in the peripheral blood?
A) 1-4%
B) 2-6%
C) 10-12%
D) 4-8%
E) None of the above
Answer: B
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Sample Questions
Q1) Which cells have the two unique biologic characteristics of self-renewal and multilineage differentiation?
A) Pronormoblasts
B) Stem cells
C) Myeloblasts
D) Lymphoblast
E) Eosinophil
Answer: B
Q2) Under which magnification should bone marrow initially be examined?
A) (\(\times\)40)
B)( \(\times\)4)
C) (\(\times\)10)
D) (\(\times\)100)
E) None of the above
Answer: C
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Sample Questions
Q1) This abnormal hemoglobin forms when the iron is oxidized to the ferric (Fe<sup>3+</sup>) state, and normally, less than 1% of the total circulatory hemoglobin is in this form in the normal individual.
A) Carboxyhemoglobin
B) Methemoglobin
C) Sulfhemoglobin
D) All of the above
E) None of the above
Answer: B
Q2) At what level of increased circulating methemoglobin may cyanosis, anemia, and death occur due to a tissue oxygen deficit related to the increased concentration of this abnormal hemoglobin?
A) 5.0 g/dL
B) 1.5 g/dL
C) 0.5 g/dL
D) 0.1 g/dL
Answer: B
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Sample Questions
Q1) Polychromasia on the peripheral smear represents an increase in what cell and is a measure of the bone marrow's ability to replace red cells which have been destroyed?
A) Pronormoblast
B) Reticulocyte
C) Basophilic normoblast
D) Orthochromic normoblast
E) None of the above
Q2) A patient's hemoglobin is 12 g/dL. What would you expect the hematocrit to be?
A) 36%
B) 33%
C) 42%
D) 39%
E) None of the above
Q3) Which of the following can cause anemia?
A) Blood loss
B) Iron or vitamin B<sub>12</sub> deficiency
C) Cancer
D) Infection
E) All of the above
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Sample Questions
Q1) Target cells may be found in which of the following conditions?
A) Thalassemia
B) Liver disease
C) Hemoglobin C disease
D) Sickle cell anemia
E) All of the above
Q2) The grading of "slight" anisocytosis and poikilocytosis would indicate what percentage of RBCs would differ from normal red cells?
A) 5-10%
B) 25-50%
C) 50-75%
D) >75%
E) 10-25%
Q3) A 2+ grading for poikilocytosis would indicate what percentage of RBCs would differ from normal red cells?
A) 5-10%
B) 25-50%
C) 50-75%
D) >75%
E) 10-25%
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Sample Questions
Q1) Iron-deficiency anemia is characterized by:
A) Macrocytic, hyperchromic RBCs
B) Microcytic, hypochromic RBCs
C) Increased bone marrow storage iron
D) Increased bone marrow ringed sideroblasts
E) None of the above
Q2) Disorders commonly associated with anemia of chronic disease include:
A) Infections
B) Malignant neoplasms
C) Autoimmune diseases
D) All of the above
E) None of the above
Q3) Approximately how many milligrams (mg) of iron is lost during pregnancy?
A) 10 mg
B) 100 mg
C) 500 mg
D) 1000 mg
E) 5000 mg
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Sample Questions
Q1) What percentage of megaloblastic anemia is due to vitamin B<sub>12 </sub>or folic acid deficiency?
A) 50%
B) 90%
C) 40%
D) 60%
E) 20%
Q2) In megaloblastic anemia, the band and metamyelocyte may exhibit:
A) Toxic granulation
B) Auer rods
C) Giantism
D) Pelger-Huët anomaly
E) None of the above
Q3) Which of the following can lead to a folic acid deficiency?
A) Malabsorption
B) Poor diet
C) Hemolytic anemia
D) All of the above
E) None of the above
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Nocturnal Hemoglobinuria
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Sample Questions
Q1) What membrane deficiency renders PNH erythrocytes more sensitive to lysis by complement?
A) C3 convertase enzymes
B) GPI-anchor proteins
C) Acetylcholinesterase
D) All of the above
E) None of the above
Q2) Which condition will lead to iron-deficiency anemia masking the diagnosis of PNH?
A) Hemoglobinuria
B) Hemosiderinuria
C) Hemoglobinemia
D) Hemochromatosis
E) None of the above
Q3) What is the function of decay-accelerating factor (DAF) as a complement protein?
A) Accelerates the spontaneous decay of C5-convertase
B) Accelerates the spontaneous decay of C3-convertase
C) Slows the spontaneous decay of C5-convertase
D) Slows the spontaneous decay of C3-convertase
E) None of the above
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Sample Questions
Q1) An RPI of greater than __________ is generally regarded as indicative of a hemolytic state.
A) 2.5-3.0
B) 1-1.5
C) 0-1
D) 4-5
E) 5-6
Q2) Which of the following RPI results will suggest an inadequate response of erythropoiesis by bone marrow in response to anemia?
A) >3.0
B) 2.0-3.0
C) <2.0
D) 2.5
E) None of the above
Q3) Which of the following describes the procedure of the autohemolysis test?
A) Incubation of patient RBCs with a series of graded hypotonic salt solutions
B) Sterile incubation of patient RBCs in their own plasma for 48 hours at 37°C
C) Sterile incubation of patient RBCs in their own plasma for 24 hours at 25°C
Page 11
D) Sterile incubation of patient RBCs in their own plasma for 72 hours at 56°C
E) None of the above
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Sample Questions
Q1) Which variant of the G6PD enzyme is commonly found in the Chinese and in people of Southeast Asia?
A) Gd A+
B) Gd A-
C) Gd Med
D) Gd B
E) Gd Canton
Q2) Which of the following can cause methemoglobinemia?
A) Hereditary enzyme deficiency of NADH-methemoglobin reductase
B) Exposure to strong oxidizing drugs or toxic substances
C) Hemoglobin M disease
D) All of the above
E) None of the above
Q3) Which of the following types of G6PD enzyme is the most common form in all populations and exists in 99% of whites in the United States?
A) Gd A+
B) Gd A-
C) Gd Med
D) Gd B
E) Gd Canton

Page 13
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Sample Questions
Q1) Increases in which of the following hemoglobins can occur in adult patients with sickle cell anemia, thereby improving the anemia by modifying the degree and severity of the sickling?
A) HbA<sub>2</sub>
B) Hb Gower
C) Hb Portland
D) HbF
E) HbH
Q2) Most hemoglobin variant traits without coexisting conditions of iron-deficiency anemia or thalassemia have approximately what percentage ratio of normal to abnormal hemoglobin?
A) 50:50
B) 30:70
C) 60:40
D) 80:20
E) 40:60
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Sample Questions
Q1) What lethal disease is characterized by homozygosity of the \(\alpha\)<sup>0</sup>-thalassemia gene haplotype in utero?
A) Hydrops fetalis
B) Hemolytic disease of the newborn (HDN)
C) Hemoglobin Portland disease
D) Hemoglobin H disease
E) Hemoglobin Zurich
Q2) It has been hypothesized that a person who is heterozygous for the thalassemia gene is resistant to malaria caused by __________.
A) Plasmodium ovale
B) Plasmodium falciparum
C) Plasmodium vivax
D) Plasmodium malariae
E) None of the above
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Sample Questions
Q1) Plasmodium __________ has proven to be the most fatal of species of malaria presenting with massive intravascular hemolysis, jaundice, and hypotension.
A) vivax
B) ovale
C) malariae
D) falciparum
E) hemolytica
Q2) A patient received a blood transfusion that contained a foreign red cell antigen. The patient developed antibody to this foreign antigen. In this case a/an __________ response has occurred.
A) Alloimmune
B) Autoimmune
C) Drug-induced
D) Non-immune
E) Allergic
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Sample Questions
Q1) The presence of both immature white and red cells on a peripheral smear is referred to as:
A) Leukoerythrocytopenia
B) Leukoerythroblastosis
C) Leukoerythrocytosis
D) Myelophthisic
E) Leukopenia
Q2) Folate deficiency in patients with liver disease is usually due to:
A) Blood loss
B) Poor dietary habits
C) Antibodies to intrinsic factor
D) Dysfunctional hemoglobin
E) Dysfunctional iron metabolism
Q3) In the anemia of alcoholism, treatment of the underlying __________ disease is essential to the reversal of anemia.
A) Kidney
B) Liver
C) Thyroid
D) Renal
E) Lymph node
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Sample Questions
Q1) __________ is the consequence of either severe neutropenia or neutrophil dysfunction.
A) Bacterial infection
B) Viral infection
C) Hypersensitivity reactions
D) Parasitic infection
E) Allergic reaction
Q2) A rare autosomal recessive congenital disorder that features partial albinism, mild bleeding tendencies, and giant lysosomal granules in blood and tissue cells is known as
A) Fanconi's anemia
B) Chédiak-Higashi disease
C) Pelger-Huët anomaly
D) Hunter's syndrome
E) Hurler's syndrome
Q3) Which of the following features are seen in reactive lymphocytes?
A) Low N:C ratio
B) Blue cytoplasm
C) Indented cytoplasmic borders
D) All of the above

Page 18
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Sample Questions
Q1) The alpha-naphthyl butyrate stain is used to identify __________ cells.
A) Monocytic
B) Granulocytic
C) Megakaryocytic
D) B lymphocytes
E) None of the above
Q2) Leukemia of the myeloid lineage may include:
A) Granulocytic leukemia
B) Monocytic leukemia
C) Megakaryocytic leukemia
D) All of the above
E) None of the above
Q3) Lack of a significant increase in reticulocytes in erythroleukemia is due to:
A) Extramedullary hematopoiesis
B) Intramedullary hematopoiesis
C) Ineffective erythropoiesis
D) Ineffective hematopoiesis
E) None of the above
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Sample Questions
Q1) The only curative treatment for CML is __________.
A) Steroids
B) Immunosuppressive drugs
C) Radiation therapy
D) Hematopoietic stem cell transplant (HSCT)
E) Tyrosine kinase
Q2) The usual objective of therapy for the chronic phase of CML is to:
A) Reduce the proliferating myeloid mass
B) Relieve symptoms of hyperleukocytosis
C) Relieve symptoms of thrombocytosis
D) Relieve symptoms of splenomegaly
E) All of the above
Q3) When CML is diagnosed in infants and toddlers, it is called __________ CML.
A) Young
B) Juvenile
C) Infant
D) Myelofibrosis
E) AML
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Sample Questions
Q1) Which conditions are known to cause a possible false diagnosis of polycythemia vera?
A) Heavy smoking
B) Alcoholic liver disease
C) Systemic lupus erythematosus
D) A and C
E) A and B
Q2) A patient diagnosed with myelofibrosis secondary to gastrointestinal disease may develop a __________ anemia due to excessive blood loss.
A) Normocytic/normochromic
B) Microcytic/hypochromic
C) Macrocytic/hyperchromic
D) Normocytic/hypochromic
E) None of the above
Q3) In relative erythrocytosis, the red cell mass is __________.
A) Decreased
B) Increased
C) Normal
D) All of the above
E) None of the above

21
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Q1) Which type of MDS demonstrates a mild decreased white blood cell (WBC) count (3.9 \(\times\) 10/L), increased erythropoiesis and normal numbers of blast cells in the marrow, and <15% sideroblasts?
A) Refractory anemia with ringed sideroblasts (RARS)
B) Refractory anemia (RA)
C) Refractory anemia with excess blasts (RAEB)
D) Chronic myelomonocytic leukemia (CMML)
E) None of the above
Q2) What specific features are characteristic of dysmegakaryocytopoiesis morphology in MDS (myelodysplastic syndrome)?
A) Macromegakaryocytes
B) Small platelets
C) Micromegakaryocytes
D) Normal segmentation
E) None of the above
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Q1) The demonstration of SIg (surface immunoglobulin) is the classic marker for
A) T cells
B) B cells
C) Null cells
D) NK cells
E) None of the above
Q2) Well-differentiated lymphocytic leukemia is a diffuse non-Hodgkin's lymphoma that is characterized by neoplastic transformation of __________.
A) T lymphocytes
B) B lymphocytes
C) NK cells
D) Null cells
E) None of the above
Q3) In CLL, all of the following might result from the autoimmune phenomenon except: A) Thalassemia
B) Autoimmune hemolytic anemia
C) Idiopathic thrombocytopenic purpura (ITP)
D) Immune neutropenia
E) None of the above

24
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Q1) Which of the following are T-cell disorders?
A) Mycosis fungoides
B) Sézary's syndrome
C) Hepatosplenic gamma/delta lymphoma
D) Angioimmunoblastic lymphadenopathy with dysproteinemia (AILD)-like T-cell lymphoma
E) All of the above
Q2) Which classification system is most often used by clinicians in the characterization of non-Hodgkin's lymphoma?
A) Rye
B) Working formulation
C) Ann Arbor
D) Lukes and Butler
E) None of the above
Q3) Which of the following is true regarding the low-grade non-Hodgkin's lymphomas?
A) Survival without treatment averages greater than 5 years.
B) Disease is usually advanced at diagnosis.
C) Multiagent chemotherapy can prolong survival.
D) Usually express B-cell phenotype
E) All of the above
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Q1) Which light chain protein is characteristically present in multiple myeloma?
A) Protein C
B) Protein 4.1
C) Tamm-Horsfall
D) Bence-Jones
E) None of the above
Q2) The plasma cell disorders are characterized by:
A) Excess production of immune globulins
B) Decrease production of immune globulins
C) Normal production of immune globulins
D) Decreased erythrocyte sedimentation ratio
E) None of the above
Q3) Which class of immunoglobulin has the largest molecular weight?
A) IgG
B) IgA
C) IgM
D) IgD
E) IgE
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Q1) What is the most common type of Gaucher's disease?
A) Adult
B) Infantile
C) Juvenile
D) Subacute
E) None of the above
Q2) Gaucher cells are which type of cells?
A) Megakaryocytes
B) Erythrocytes
C) Histiocytes
D) Macrophages
E) None of the above
Q3) The aim of control in the lipid storage diseases is directed at:
A) Controlling anemia
B) Prenatal detection
C) Correcting bone malformation
D) Dietary nutrition to lower cholesterol
E) Hyperlipidemia
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Sample Questions
Q1) Factor III is involved with which clotting pathway?
A) Intrinsic
B) Extrinsic
C) Common
D) A and B
E) All of the above
Q2) The prothrombin proteins are comprised of:
A) Factors II, VIII, IX, X
B) Factors II, VII, IX, X
C) Factors I, VII, IX, X
D) Factors II, V, VII, X
E) None of the above
Q3) What is the function of plasmin?
A) Destroy fibrin and fibrinogen
B) Produce FDP
C) Destroy factors V, VIII
D) Indirectly enhances factor XII to XIIa
E) All of the above
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Sample Questions
Q1) Which nonimmunologic quantitative platelet disorder is characterized by thrombocytopenia, microangiopathic hemolytic anemia, fluctuating neurologic abnormalities, renal disease, and hyaline microthrombi?
A) Hemolytic uremic syndrome
B) Thrombotic thrombocytopenic purpura (TTP)
C) Respiratory distress syndrome
D) Idiopathic thrombocytopenic purpura (ITP)
E) None of the above
Q2) Laboratory findings that are hallmarks of Glanzmann's thrombasthenia include all but which of the following?
A) Normal platelet count
B) Prolonged bleeding time
C) Presence of clot retraction
D) Absence of aggregation to ADP
E) Absence of aggregation to collagen
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Q1) Which laboratory test is abnormal in afibrinogenemia?
A) TT
B) PT
C) APTT
D) Reptilase time
E) All of the above
Q2) All of the following are laboratory findings consistent with hemophilia A except:
A) Prolonged APTT
B) Prolonged bleeding time
C) Normal PT
D) Normal vWF:Ag
E) Normal platelet count
Q3) In the laboratory assessment of hemophilia B, the one-stage APTT factor assay for factor IX is __________.
A) Increased
B) Normal
C) Decreased
D) Variable
E) None of the above
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Q1) Which of the following are laboratory tests to detect the action of plasmin on fibrin/fibrinogen?
A) D-dimer assay
B) Euglobulin test
C) Level of plasminogen in plasma
D) FDPs
E) All of the above
Q2) What is meant by primary fibrinolysis?
A) Thrombin is formed without coagulation taking place.
B) Plasmin is formed without coagulation taking place.
C) Formation of plasmin with evidence of coagulation
D) Formation of thrombin with evidence of coagulation
E) None of the above
Q3) Which substance forms a complex with protein C in the inhibition of activated factors V and VIII?
A) Protein S
B) Urokinase
C) Tissue plasminogen activator (TPA)
D) Kallikrein
E) None of the above Page 31
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Q1) There is increased risk of thrombosis during pregnancy because of all of the following factors except:
A) Significant decline in plasma levels of free and total protein S
B) Increased production of most procoagulant proteins
C) Absorption of activated protein C from the mother by the fetus
D) The placenta is rich in tissue factor that may produce increased thrombin.
E) Mechanical factors such as venous stasis of the lower extremities caused by the gravid uterus and trauma to pelvic veins during delivery
Q2) The INR is calculated by:
A) Patient value in seconds divided by control value in seconds
B) Patient value in seconds divided by the mean of the reference range in seconds
C) Control value in seconds divided by patient value in seconds
D) Patient value in minutes divided by mean of the reference range in minutes, raised to the ISI
E) Patient value in seconds divided by mean of the reference range in seconds, raised to the ISI
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Q1) Calculate the mean of the following hemoglobin values: 6.2, 8.1, 7.9, 9.0, 5.8, 6.6, 7.3, 8.4, 10.2, 11.6
A) 7.3
B) 8.1
C) 8.6
D) 7.8
Q2) Which of the following can be considered a matrix?
A) Urine
B) Whole blood
C) Synovial fluid
D) All of the above
Q3) Which of the following is an example of a random error?
A) Bubbles in syringes
B) Leaky tubing
C) Clogs in tubing
D) All of the above
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34

Quantitative, and
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Q1) Which of the following laboratory data is not suggestive of a transudate?
A) White blood cell (WBC) count greater than 1000/µL
B) Specific gravity less than or equal to 1.015
C) Total protein (TP) less than or equal to 3.0 g/dL
D) Fluid TP to serum TP ratio less than 0.5
Q2) Exudates are caused by:
A) Bacterial infection
B) Viral infection
C) Trauma
D) Neoplasms
E) All of the above
Q3) A characteristic feature of a malignant cell is _________________.
A) Small cell size
B) Smooth nuclear membrane
C) Nuclear molding
D) Low N:C ratio
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Q1) The normal WBC values for a 2-year old are ________.
A) 4.8-10.8 \(\times\) 10<sup>9</sup>/L
B) 5-21 \(\times\) 10<sup>9</sup>/L
C) 6.2-17 \(\times\) 10<sup>9</sup>/L
D) 6-17.5 \(\times\) 10<sup>9</sup>/L
E) 5-19.5 \(\times\) 10<sup>9</sup>/L
Q2) Normal values for the autohemolysis test at 48 hours with the addition of ATP are
A) 0-0.9%
B) 0.2-2.0%
C) 0-0.8%
D) 0-0.5%
E) None of the above
Q3) The normal hemoglobin value for an adult female is _______.
A) 14-18 g/dL
B) 12-16 g/dL
C) 17-23 g/dL
D) 10-12 g/dL
E) None of the above
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Q1) The Coulter S Plus IV differential of granulocytes by cell volume consists of:
A) Metamyelocytes
B) Segmented neutrophils
C) Bands
D) Eosinophils
E) All of the above
Q2) The RDW is calculated as the coefficient of variation (CV) of the __________.
A) Mean corpuscular volume (MCV)
B) Mean corpuscular hemoglobin (MCH)
C) Mean corpuscular hemoglobin concentration (MCHC)
D) Mean platelet volume (MPV)
E) None of the above
Q3) The Coulter S Plus IV automated differential generates three histograms representing __________ volume distributions.
A) White blood cell (WBC)
B) RBC
C) Platelet
D) All of the above
E) None of the above
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Q1) The activated partial thromboplastin time (APTT) is a screening test to measure the __________ pathway of coagulation.
A) Intrinsic
B) Extrinsic
C) Common
D) A and C
E) All of the above
Q2) If a patient's PT is normal and their APTT is prolonged, and corrects with a 1:1 mix with normal plasma, this could be due to:
A) Factor V deficiency
B) Factor II deficiency
C) Factor IX deficiency
D) Factor VII deficiency
E) All of the above
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Q1) ______________ occurs when a chemical absorbs light, causing its electrons to be excited briefly to a higher, less-stable energy state.
A) Electronegativity
B) Light scatter
C) Fluorescence
D) Refraction
Q2) Immunophenotyping is a staining approach that uses antibodies chemically linked to fluorochromes to recognize cell types by identifying specific ______________ on the surface of the cell or inside the cell.
A) Antibodies
B) Antigens
C) Haptens
D) Light chains
Q3) Which of the following is a software feature that allows the operator to focus on a single population of cells?
A) Data analysis
B) Quadrant statistics
C) Gating
D) Fluorescence compensation
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Q1) Which of the following diagnostic procedures for analyzing DNA is the most accurate method for detecting gene rearrangements in lymphoid leukemias and lymphomas?
A) Southern blot analysis
B) Northern blot analysis
C) Western blot analysis
D) Eastern blot analysis
E) None of the above
Q2) Which of the following are clinical applications of in situ hybridization to cells or tissues immobilized on glass slides?
A) Determine the disease related location of foreign organisms
B) Detect and localize gene expression by targeting RNA transcripts
C) Detect point mutations such as the sickle cell anemia mutation
D) A and B
E) All of the above
Q3) Which of the following is/are true regarding "probes"?
A) Help to identify a specific RNA nucleotide sequence.
B) Help to identify a specific DNA nucleotide sequence.
C) Follow the rules of complementary nucleotide pairing.
D) All of the above.

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Q1) Red blood cells that stain peroxidase positive are an indication that:
A) Smears were made too thin.
B) The incubation period was too short.
C) The incubation period was too long.
D) Smears were made too thick.
E) None of the above
Q2) In the Sudan black B staining procedures, the granules of myelocytic precursors stain __________.
A) Brownish-black
B) Red-brown
C) Orange-red
D) Pink
E) None of the above
Q3) In the combined esterase staining procedure, a dark, brown-red staining indicates:
A) Monocytes
B) T lymphocytes
C) Early promyelocytes
D) Mast cells
E) Late granulocytes
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