Medical Laboratory Science Exam Bank
Course
Introduction
Medical Laboratory Science is an interdisciplinary field focused on the analysis of biological specimens to aid in the diagnosis, treatment, and prevention of disease. This course covers fundamental laboratory techniques, principles of clinical chemistry, hematology, microbiology, immunology, and molecular diagnostics. Students learn to operate sophisticated laboratory equipment, accurately interpret test results, and uphold quality assurance and safety standards. Emphasis is placed on the critical role medical laboratory professionals play within the healthcare team, as well as the ethical and professional responsibilities required in clinical laboratory practice.
Recommended Textbook
Clinical Laboratory Hematology 2nd Edition by Shirlyn B. McKenzie
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40 Chapters
1419 Verified Questions
1419 Flashcards
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Page 2
Chapter 1: Introduction
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Sample Questions
Q1) Which of the following blood cell components would be most influenced in a patient with tonsillitis?
A)Leukocyte
B)Erythrocyte
C)Thrombocyte
D)Hemoglobin
Answer: A
Q2) Which of the following is an expected finding in a newborn?
A)WBC count = 2 x 10 /L
B)PLT count = 100 x 10 /L
C)Hemoglobin = 17.0 g/dL
D)RBC count = 3.50 x 10 /L
Answer: C
Q3) All of the following must be taken into consideration when establishing a reference interval for a group of individuals EXCEPT:
A)The geographic area.
B)Age of the population.
C)Occupations of the population.
D)Sex of the population.
Answer: C
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Chapter 2: Cellular Homeostasis
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Sample Questions
Q1) Clearance of cytotoxic T cells after an immune response results from:
A)Accelerated apoptosis.
B)Inhibited apoptosis.
C)Normal occurrence of apoptosis.
D)None of the above.
Answer: A
Q2) The plasma membrane of blood cells is characterized by which of the following?
A)Carbohydrate components (of glycolipids, glycoproteins) embededed in the lipid bilayer
B)The asymmetric distribution of the phospholipids
C)The hydrophilic ends of the phospholipids directed toward the inside of the lipid bilayer
D)The absence of peripheral proteins
Answer: B
Q3) All of the following are promoters of apoptosis except:
A)BCL-2.
B)Caspases.
C)TNF-alpha.
D)Fas Ligand.
Answer: A
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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) Which lineage promotes differentiation and maturation primarily with the use of interleukins?
A)Monocytes
B)Erythrocytes
C)Platelets
D)Lymphocytes
Answer: D
Q3) Which of the following is an example of a lineage-specific cytokine?
A)Kit ligand
B)CFU-GEMM
C)IL-3
D)G-CSF
Answer: D
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Chapter 4: Structure and Function of Hematopoietic Organs
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Sample Questions
Q1) Where in the body does maturation of T lymphocytes take place?
A)Lymph node
B)Bone marrow
C)Spleen
D)Thymus
Q2) What is the primary hematopoietic function of the spleen?
A)Extramedullary hematopoiesis
B)Lymphatic drainage
C)Culling and pitting
D)T cell maturation
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) The process of culling and pitting occurs in the spleen's:
A)Germinal centers.
B)Follicles.
C)Vascular sinuses.
D)Red pulp cords.
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Chapter 5: The Erythrocyte
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Sample Questions
Q1) Which metabolic pathway protects hemoglobin from oxidation via NADH?
A)Rapoport-Luebering shunt
B)Embden Meyerhof pathway
C)Hexose monophosphate shunt
D)Methemoglobin reductase pathway
Q2) Where does normal extravascular hemolysis take place?
A)Blood vessels and bone marrow
B)Lymph nodes and spleen
C)Spleen and liver
D)Bone marrow and liver
Q3) The deformability of the RBC membrane is attributed to which of the following?
A)Peripheral proteins
B)Integral proteins
C)Sodium potassium pump
D)Glycophorins
Q4) What growth factor influences the production of the erythrocyte?
A)Transforming growth factor-
B)Interferon-
C)Erythropoietin
D)CFU-E
7
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Chapter 6: Hemoglobin
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Sample Questions
Q1) Oxyhemoglobin is in the _______ configuration.This is achieved by the _______ of 2, 3 DPG.
A)Tense; presence
B)Tense; absence
C)Relaxed; presence
D)Relaxed; absence
Q2) What are normal values for forms of hemoglobin found in an infant under the age of 1 year? Over the age of 1? If they are the same, why are they the same? If they are different, why are they different?
Q3) Oxygen affinity of hemoglobin is expressed by which of the following?
A)Oxyhemoglobin
B)Deoxyhemoglobin
C)PCO
D)P50
Q4) A shift to the left is caused by which of the following? (normal blood pH: 7.35-7.45)
A)A blood pH of 7.54
B)A body temperature of 103°F
C)An increased 2, 3 BPG concentration
D)An increased PCO
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Chapter 7: The Leukocyte
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Sample Questions
Q1) An instrument printout shows a WBC count of 4.5 x 109/L with 75% neutrophils.What is the absolute neutrophil count?
A)1.9 x 109/L
B)3.8 x 109/L
C)3.4 x 109/L
D)4.5 x 109/L
Q2) The lymphoid progenitor that gives rise to T, B, and NK lymphocytes is recognized as which of the following?
A)CFU_GM
B)CLP
C)CMP
D)CFU-T
Q3) A 15-year-old boy sees his physician because of a prolonged fever and swollen lymph glands.His PB smear shows 20% atypical lymphocytes with a 16 × 109LWBC count.What can you conclude from this?
A)The boy has a genetic lymphocytosis.
B)The boy has leukemia.
C)The boy is healthy.
D)The boy has clinical features of infectious mononucleosis.
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Page 9
Chapter 8: Introduction to Anemia
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Sample Questions
Q1) Codocytes are associated with all of the following conditions except:
A)Iron-deficiency anemia.
B)Thalassemias.
C)Hemoglobinopathies.
D)Hemolytic anemia.
Q2) A patient sample has an RBC count of 4.30 x 10<sup>12</sup> ? This is a superscript ? /L and a reticulocyte count of 4%.What is the absolute retic count? This is a superscript
A)142 x 10<sup>9</sup>/L
B)172 x 10<sup>9</sup>/L
C)350 x 10<sup>9</sup>/L
D)90 x 10<sup>9</sup>/L
Q3) An instrument printout reveals an RDW of 33.Which of the following would best correlate with those results?
A)The presence of a dimorphic cell population on the PB smear
B)The presence of marked polychromasia on the PB smear
C)The presence of spherocytes on the PB smear
D)The presence of macro-ovalocytes on the PB smear
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Chapter 9: Anemias of Disordered Iron Metabolism and Heme Synthesis
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Sample Questions
Q1) What measurements are used in the percent saturation calculation?
A)Transferrin and ferritin
B)Ferritin and bone marrow iron
C)Serum iron and TIBC
D)Serum iron and ferritin
Q2) The most common form of hereditary hemochromatosis is due to which gene mutation?
A)HFE
B)hepcidin gene
C)Ferroportin gene
D)HJV
Q3) Hypochromic, microcytic anemia is found in this stage of iron deficiency:
A)1.
B)2.
C)3.
Q4) Explain the absorption and assimilation of non-heme iron into hemoglobin in the RBC.
Q5) Explain the difference in the chemical composition of hemosiderin and ferritin.
Q6) Explain how lead inhibits heme synthesis.
Q7) Differentiate primary and secondary hemochromatosis? Page 11
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Chapter 10: Hemoglobinopaties: Qualitative Defects
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Sample Questions
Q1) Thalassemias are produced as a result of:
A)Quantitative defects in globin chain synthesis.
B)Qualitative defects in globin chain synthesis.
C)Structural defects in heme synthesis.
D)Molecular defects in hemoglobin synthesis.
Q2) In Hemoglobin C disease how does the mutation affect the hemoglobin molecule?
A)It cannot carry oxygen.
B)It forms insoluble aggregates.
C)It is unstable.
D)It has increased oxygen affinity.
Q3) The peripheral blood smear contains a normocytic, normochromic morphology with marked reticulocytosis.The hemoglobin solubility test is positive.What confirmatory test should follow?
A)Bilirubin analysis
B)Haptoglobin analysis
C)Hemoglobin electrophoresis
D)Bone marrow aspiration
Q4) Other than hemoglobin S, name two abnormal hemoglobins that produce a positive sickle solubility test.Explain how they could be differentiated from HbS.
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Chapter 11: Thalassemia
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Sample Questions
Q1) Hemoglobin H disease can be detected by which of the following laboratory methods?
A)Complete blood count
B)PB smear for Heinz bodies
C)Bone marrow aspirate
D)Brilliant cresyl blue staining for Hb H inclusions
Q2) When three of the four alpha genes are deleted, the disorder is known as what?
A) -thalassemia
B) -thalassemia
C)Hydrops fetalis
D)Hemoglobin H disease
Q3) Impaired beta chain production translates to what on hemoglobin electrophoresis?
A)An increase in Hb H
B)An increase in Hb A1
C)An increase in Hb F and Hb A2
D)A decrease in Hb S
Q4) Correlate the mutation type to each of the disorders below:
A)Alpha thal major
B)Beta thal major
C)Alpha thal silent carrier
Page 14
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Chapter 12: Megaloblastic and Nonmegaloblastic
Macrocytic Anemias
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Sample Questions
Q1) 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 .
Q2) Hypoproliferative anemia is defined as:
A)Decreased hematopoiesis in the bone marrow.
B)Decreased hematopoiesis in the liver.
C)Decreased erythropoiesis in the bone marrow.
D)Ineffective erythropoiesis in the bone marrow.
Q3) Which of the following is found in megaloblastic macrocytosis and not in nonmegaloblastic macrocytosis?
A)Decreased WBC count and vitamin B levels
B)Decreased hemoglobin and hematocrit
C)Normal-to-decreased reticulocyte count
D)Serum bilirubin increased
Q4) Explain why peripheral neuropathy is a common finding in vitamin B deficiency.
Q5) Explain why patients undergoing gastric bypass surgery are prone to developing pernicious anemia.
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Chapter 13: Introduction to Hemolytic Anemia
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Sample Questions
Q1) This test result is helpful in assessing erythropoietic activity in the bone marrow in response to hemolysis in the peripheral blood.
A)Myeloid-to-erythroid relation
B)Plasma iron-to-erythroid iron index
C)Reticulocyte production index
D)MCV
Q2) In immune mediated hemolytic anemia this test is helpful in identifying erythrocytes sensitized with antibodies and/or complement.
A)DAT
B)RPI
C)IRF
D)Erythrocyte survival studies?
Q3) All of the following support the diagnosis of hemolytic anemia except:
A)Low haptoglobin.
B)Low hemoglobin.
C)Reticulocyte count of 1%.
D)Bilirubin above 2.5 mg/dL.
Q4) List three laboratory test results from peripheral blood that indicate increased erythropoietic activity in the bone marrow.
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Chapter 14: Hemolytic Anemia: Membrane Defects
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Sample Questions
Q1) The screening sucrose hemolysis (sugar-water) test is useful in identifying PNH cells by what mechanism?
A)Immunophenotyping
B)Hemoglobin electrophoresis
C)Erythrocyte survival test
D)Complement lysis
Q2) 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
Q3) Which of these disorders has a defective vertical protein interaction between RBC skeleton and the membrane?
A)Hereditary elliptocytosis
B)Hereditary pyropoikilocytosis
C)Hereditary spherocytosis
D)Acanthocytosis
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Chapter 15: Hemolytic Anemia: Enzyme Deficiencies
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Sample Questions
Q1) PK deficiency causes which of the following to occur in the erythrocyte?
A)Denatured hemoglobin to precipitate
B)Splenic sequestration of normal erythrocytes
C)Premature apoptosis due to lack of ATP formed
D)Membrane instability with excessive sodium and calcium influx
Q2) The presence of which poikilocyte in the peripheral blood could indicate G6PD deficiency?
A)Schistocyte
B)Spherocyte
C)Blister cell
D)Elliptocyte
Q3) Which G6PD variant has normal activity and no hemolysis present?
A)G6PD-Mediterranean
B)Minnesota
C)Iowa
D)G6PD-B
Q4) What is the purpose of the HMP shunt, and why is it important?
Q5) Why are Heinz bodies seen in G6PD deficiency?
Q6) Why are echinocytes seen in PK deficiency?
Q7) How do Heinz bodies differ morphologically from other erythrocyte inclusions?
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Chapter 16: Hemolytic Anemia: Immune Anemias
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Sample Questions
Q1) A Group O, Rh negative woman with no evidence of antibodies delivers her first child who shows a slightly decreased hemoglobin and the presence of spherocytes on the peripheral blood film.The DAT is positive with polyspecific AHG and anti-IgG.The baby is Group A, Rh negative and is slightly jaundiced with a bilirubin of 2.1 mg/dl.What is the most likely cause of the baby's jaundice?
A)Normal physiologic jaundice
B)Rh HDFN
C)ABO HDFN
D)Other type HDFN
Q2) Acute hemolytic transfusion reaction is characterized by which of the following?
A)Extravascular hemolysis
B)Gastrointestinal hemorrhage
C)Intravascular hemolysis
D)Thrombosis
Q3) Compare the differences in the activation of complement that lead to intravascular hemolysis or extravascular hemolysis.
Q4) Compare the three mechanisms of drug-induced immune hemolysis.
Q5) Explain why the DAT profile in CAD is reactive only with polyspecific AHG and anti-C3 but not with anti-IgG.
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Chapter 17: Hemolytic Anemia: Nonimmune Defects
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Sample Questions
Q1) The type of anemia commonly associated with HUS is:
A)Microcytic, hypochromic.
B)Macrocytic, normochromic.
C)Normocytic, normochromic.
D)Microcytic, normochromic.
Q2) Damage to the endothelial lining of the small vessels results in deposits of fibrin with the vessels in what type of hemolytic anemia?
A)Exercise-induced hemoglobinuria
B)That associated with infectious agents
C)That associated with animal venoms
D)Microangiopathic hemolytic anemia
Q3) Plasmodium falciparum infection is accompanied by a severe form of anemia due to what factor?
A)Toxins produced by P.falciparum
B)High levels of parasitemia
C)Lack of spleen removal of the infected cells
D)Production of exotoxins that affect host cell membranes
Q4) Explain how the action of E.coli O157:H7 toxin is related to the development of HUS.
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Page 20
Chapter 18: Nonmalignant Granulocyte and Monocyte Disorders
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Sample Questions
Q1) A patient presents with a leukocyte count of 120 x 10<sup>9</sup>/L and splenomegaly.The blood smear reveals a shift to the left with promyelocytes and blasts.The platelets are increased, and the LAP is decreased.Which condition is associated with these results?
A)Bacterial infection
B)Reactive chronic neutrophilia
C)Leukemoid reaction
D)CML
Q2) Acute infection, inflammatory reaction, and administration of glucocorticosteroids may result in:
A)Basophilia.
B)Eosinopenia.
C)Mastocytosis.
D)Histiocytosis.
Q3) What must be done when blood is drawn in EDTA and the neutrophils adhere to erythrocytes?
A)Draw the blood in heparin anticoagulant.
B)Recollect the blood from a finger stick and make manual dilutions.
C)Draw the blood in citrate anticoagulant.
D)Draw the blood in a plain red top tube.
Page 21
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Chapter 19: Nonmalignant Lymphocyte Disorders
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Sample Questions
Q1) Which of the following statements best describes the pathogenesis of HIV infection?
A)HIV virus selectively infects T helper cells, incorporates its own DNA into the DNA of the T helper, and lyses the cell.
B)HIV virus infects all lymphocytes, incorporates its own DNA into the DNA of the T helper, and changes the identity of the T helper.
C)HIV virus infects all cells involved in cell-mediated immunity, incorporates its own DNA into the DNA of the infected cells, and lyses the cells.
D)HIV infects T-suppressor cells and initiates apoptosis.
Q2) Correlate antibody titers with the stage of infection.What antibody titer excludes current infection?
Q3) Which of the following is an expected finding regarding the morphology of an activated lymphocyte that is different from a normal lymphocyte?
A)Oval nucleus
B)Prominent nucleoli
C)Abundant cytoplasm
D)Clumped chromatin
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Chapter 20: Introduction to Hematopoietic Neoplasms
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Q1) Name the two main classification systems that identify the following leukemias.Indicate how they are different.
A)MDS
B)Acute leukemias
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) How are the FAB and WHO classifications different with respect to acute leukemias?
A)FAB classifies acute leukemias by lineage morphology, whereas WHO classifies acute leukemias by immunophenotyping.
B)FAB classifies acute leukemias by their precursor conditions, whereas WHO classifies acute leukemias by DNA profiling.
C)Acute leukemia is classified by FAB as having greater than 30% blasts, whereas WHO classifies acute leukemia as having greater than 20% blasts.
D)Both a and c
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Chapter 21: Myeloproliferative Disorders
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Q1) Contrast primary polycythemia and secondary polycythemia based on pathophysiology.
Q2) Which of the following myeloproliferative disorders is characterized by an elevated white count and a markedly elevated platelet count?
A)CML
B)ET
C)PV
D)CIMF
Q3) What feature distinguishes CML from a leukemoid reaction?
A)CML has no blasts in the peripheral blood; in a leukemoid reaction blasts are common.
B)CML often has abnormal platlet morphology and leukemoid reaction has normal platelets.
C)LAP is increased in CML and decreased in leukemoid reaction.
D)Chromosome karyotype is abnormal in leukemoid reaction and normal in CML.
Q4) Explain how a variant of CML is identified utilizing laboratory values.
Q5) Discuss the role of EDTA in the LAP score evaluation.
Q6) Contrast MDS and MPD utilizing laboratory test result information.
Q7) Explain the significance of the Philadelphia chromosome in ALL.
Page 24
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Chapter 22: Myelodysplastic Syndromes
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Q1) What must be seen in the bone marrow to confirm refractory anemia with ringed sideroblasts?
A)A minimum of 30% ringed sideroblasts
B)A minimum of 5% ringed sideroblasts
C)A minimum of 5% monoblasts
D)A minimum of 15% ringed sideroblasts
Q2) Which type of blasts contains fewer than 20 primary granules in the cytoplasm, has a centralized nucleus, and can be found in both AML and MDS?
A)Type I and II
B)Type I
C)Type II
D)Type III
Q3) According to the WHO classification, how many blasts must be present in the bone marrow to classify a patient with acute leukemia?
A)19%
B)20%
C)30%
D)1%
Q4) Explain the IPSS score system for prognosis and treatment of MDS.
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Chapter 23: Acute Myeloid Leukemias
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Q1) List the common cytochemical stains used in the detection of AML, and predict their results in AML.
Q2) According to the WHO classification, what must be true to differentiate myelodysplastic syndromes from acute leukemia? In acute leukemia:
A)The blasts must be greater than 20% in the bone marrow.
B)The blasts must be greater than 20% in the bone marrow and contain Auer rods.
C)The bone marrow must contain fibrosis.
D)The blast count is close to 100%.
Q3) A patient presents with a morphological smear examination revealing greater than 20% blasts with prominent granules and ++ Auer rods, MPO, and Sudan Black positive.A 25% monocyte count was seen in the peripheral smear.There were no recurrent cytogenetic abnormalities observed.Under which classification of acute leukemia, not otherwise categorized, does this picture fall?
A)Acute myeloblastic leukemia with no maturation
B)Acute myelomonocytic leukemia
C)Acute monoblastic leukemia
D)Acute promyelocytic leukemia
Q4) What is the definition of acute leukemia, according to the World Health Organization?
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Chapter 24: Acute Lymphoblastic Leukemias
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Q1) 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.
Q2) Explain how ALL and Burkitt-type ALL are different morphologically.
Q3) Cytogenetic analysis confirms the presence of t (1, 14).This verifies which of the following types of ALL?
A)Precursor B cell ALL
B)Precursor T cell ALL
C)L1 (FAB)
D)Burkitt's lymphoma
Q4) As part of their disease progression, ALL patients are at risk for developing which of the following?
A)Recurrent infections
B)Bleeding episodes
C)Fatigue
D)All of the above
Q5) Name at least five classifications of ALL, and explain how they are different.
Q6) Explain why acute unclassified leukemias are difficult to identify.
Page 27
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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 lymphoproliferative disorders is most closely associated with Richter's transformation?
A)CLL
B)PLL
C)Sézary syndrome
D)Hairy cell leukemia
Q2) A lymph node biopsy is performed in a patient with lymphadenopathy.Which of the following findings would support the diagnosis of a reactive proliferation rather than a malignant lymphoma?
A)A mixed population of cells varying in size, shape, and color
B)Clonality
C)Presence of large, bizarre cells
D)Mitotic activity
Q3) Which of the following detects clonality in an unknown cell population?
A)Absolute lymphocytosis using morphology
B)CD4-positive T cells
C)Kappa light chain only present on B cells
D)Both kappa and lambda light chains present on B cells
Q4) Explain how environmental factors contribute to the pathogenesis of lymphoid neoplasms.
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Chapter 26: Hematopoietic Stem Cell Transplantation
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Q1) Stem cells can treat a variety of different disorders due to their ability to:
A)Self-renew.
B)Give rise to other cells.
C)Regenerate quickly.
D)Possess immunity against toxic agents.
Q2) The most important antigens that need to be matched for a successful outcome in stem cell transplants are:
A)ABO.
B)Rh.
C)HLA.
D)Ii.
Q3) Autologous stem cell transplant is commonly used as treatment for:
A)Hodgkin lymphoma.
B)Acute myelogenous leukemia.
C)Inherited diseases.
D)Aplastic anemia.
Q4) Compare and contrast the collection of umbilical cord stem cells for transplantation and that of allogeneic stem cells for transplantation.
Q5) Explain graft-versus-leukemia process in stem cell transplantation.
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Chapter 27: Morphologic Analysis of Body Fluids in the
Hematology
Laboratory
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Q1) Examination of joint fluid on a 60-year-old patient with right knee pain reveals many intracellular needlelike crystals that polarize yellow to blue.What is the most likely identification of the crystal?
A)Calcium pyrophosphate
B)Cholesterol crystal
C)Monosodium urate
D)Talc particle
Q2) A crystal with long, thin, needlelike, pointed ends is identified in synovial fluid.The crystals are located within the cells and outside the cells.A quartz compensator is used, and it is determined that the crystals are negatively birefringent, and are a yellow color when parallel to the axis of the compensator.The crystal is blue when turned perpendicular to the axis of the compensator.What is the type of crystal?
A)Monosodium urate
B)Calcium pyrophosphate
C)Cholesterol crystals
D)Pseudogout
Q3) How would the technologist differentiate between a traumatic specimen collection and a cerebral hemorrhage? Provide at least three macroscopic and three microscopic findings.
Page 30
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Chapter 28: Primary Hemostasis
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Q1) After a blood vessel injury, hemostasis is initiated by which of the following?
A)Endothelial communication
B)Platelet function inhibition
C)Vasoconstriction
D)Vasodilation
Q2) During what stage of megakaryocyte development are the platelets released into the circulation?
A)Between stages III and IV
B)At the end of stage II
C)During the cycling phase
D)At the point of proplatelet formation.
Q3) Which of the following substances functions to stabilize platelet aggregates in the platelet plug?
A)PDGF
B)Thrombospondin
C)Factor V receptor
D)PF4
Q4) Correlate blood vessel histology to vessel type and function in hemostasis.
Q5) How does the vascular system contribute to hemostasis?
Q6) Explain the biochemistry involved in platelet function.
31
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Chapter 29: Secondary Hemostasis and Fibrinolysis
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Q1) Which plasma PA is unique among the serine proteases because it does not circulate as a zymogen but is fully active toward its substrate plasminogen in a single-chain form?
A)uPA
B)uPAR
C)PLG
D)tPA
Q2) Thrombin activity impacts coagulation by which of the following mechanism(s)?
A)Altering blood flow
B)Positive feedback only
C)Negative feedback only
D)positive and negative feedback
Q3) On which chromosome does the factor VIII locus reside?
A)3
B)4
C)11
D)X
Q4) What are the roles of thrombin in coagulation?
Q5) Compare and contrast systemic and physiologic fibrinolysis.
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Chapter 30: Disorders of Primary Hemostasis
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Q1) Which hemostatic disorder usually is represented by a decreased platelet count, normal PT, normal APTT, and abnormal bleeding time?
A)Thrombocytosis
B)Thrombocytopenia
C)Vascular disorders
D)Platelet dysfunction
Q2) 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
Q3) When petechiae and ecchymoses are found in a higher-than-normal number with less-than-usual trauma, the condition is called which of the following?
A)Hematoma
B)Purpura
C)Easy bruisability
D)Excess bleeding
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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Q1) Which of the following clinical symptoms correlates with a severe form of hemophilia A or B?
A)Bleeding at circumcision with a factor level of 1-5 U/dL
B)Excessive bleeding after surgery or trauma with factor levels of 6-30 U/dL
C)Frequent spontaneous hemarthroses
D)Infrequent spontaneous joint and tissue bleeds
Q2) A physician has confirmed von Willebrand's disease in his patient.Further testing is needed to determine which subtype the patient has.Multimer analysis is performed, and comes back normal.What is the most probable explanation for this?
A)The patient is not suffering from von Willebrand's disease.
B)The patient is suffering from type I VWD.
C)The patient has BSS.
D)The wrong patient was drawn.
Q3) Explain how disseminated intravascular coagulation is not a primary disease state.Correlate etiology, pathophysiology, and laboratory analysis in your response.
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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Q1) How do red thrombi differ from white thrombi?
A)Their location
B)Their composition
C)Their location and composition
D)Their degree of severity
Q2) Antibodies to which component(s) are thought to complex with the phospholipids resulting in antiphospholipid antibody syndrome?
A)Homocysteine
B)Fibrinogen and fibrin
C) <sub>2</sub>-glycoprotein-1, prothrombin, PC, PS, and F-VII
D)Plasminogen and plasmin
Q3) A patient with thrombophilia has a decreased functional and antigenic activity of protein C.What is the diagnosis?
A)APCR
B)Protein S deficiency
C)Type I PC deficiency
D)Type II PC deficiency
Q4) Explain why many patients with an inherited thrombophilia are misdiagnosed.
Q5) How does a thrombus become a thromboembolus?
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Chapter 33: Hematology Procedures and Hemostasis
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Q1) The following erythrocyte indices were determined as part of a CBC: MCV 84 fL, MCH 24 pg, MCHC 30 g/dL.What would you expect to observe on the Wright-stained peripheral blood smear?
A) Normochromic, normocytic erythrocytes
B) Hypochromic, microcytic erythrocytes
C) Hypochromic, normocytic erythrocytes
D) Normochromic, macrocytic erythrocytes
Q2) The patient has difficult veins, and a winged infusion set is used to collect the blood from a small vein in the patient's hand.After successfully filling all the SST tubes, the phlebotomist proceeds to fill the light blue-top tube, but is unsuccessful.She changes tubes, thinking that it might be a tube with a lost vacuum, but there is still no blood flow.She inspects the entry site and notices some bruising around it that wasn't present before.Discuss possibilities of the unsuccessful draw, and explain how to correct them.
Q3) The resolution of a microscope is a function of:
A)Numerical aperture.
B)Wavelength of reflected light.
C)Refractive index.
D)The presence of chromatic aberrations.
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Chapter 34: Bone Marrow Examination
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Q1) A physician performing a bone marrow biopsy on a patient suspected of having acute leukemia was unable to obtain any aspirate, but was able to obtain two core biopsies.What is the best way for the clinical laboratorian to use the material obtained?
A)Place both core biopsies in formalin and process one immediately; save the other for ancillary tests.
B)Place one core biopsy in formalin and freeze the second one at -70°C.
C)Place one core biopsy in formalin after making touch imprints; put the second in saline.
D)Place both core biopsies in saline; freeze one at 0°C, and process the other immediately.
Q2) Which of the following is required information on a bone marrow report?
A)Site of sampling and type of sample(s) obtained
B)Side-by-side comparison of bone marrow differential and peripheral blood differential results
C)Results of ancillary studies
D)All of the above
Q3) 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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Q1) What is the principle of impedance? Name at least two instruments that employ this method for blood cell counting.
Q2) Which instrument utilizes contour gating to classify different leukocyte cell types?
A) ADVIA 120
B) XE-2100
C) LH 750
D) CELL-DYN Sapphire
Q3) The immunologic technique available on the AMAX Destiny Plus utilizes specific reagents with:
A) Soluble monoclonal antibody.
B) Fluorescent-labeled microparticles.
C) Enzyme-labeled monoclonal antibody.
D) Monoclonal antibody-coated microparticles.
Q4) Using the chromogenic methodology, a coagulation protein's activity level is related to:
A) An increase in turbidity.
B) The observed color change.
C) Time needed to convert fibrinogen to fibrin.
D) Decreased viscosity as plasmin digests fibrin.
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Chapter 36: Flow Cytometry
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Q1) Neoplasms are made up of a population of identical cells, or a clone of cells.A clone, when identified, can lead to discovery of a lymphoid malignancy or other lymphoproliferative disorder.In what ways can clonality be detected?
A)Uniform expression of one immunoglobulin light chain
B)Mixture of cells with either kappa or lambda light chains
C)Surface immunoglobulin detection
D)Bright intensity of all monoclonal markers
Q2) Which two CD markers would be helpful in differentially identifying CLL from hairy cell leukemia?
A)CD19 and CD5
B)CD5 and CD11c
C)CD5 and CD25
D)sIg and CD25
Q3) What is the purpose of CD34 count?
Q4) Explain the advantages of using flow cytometry to count reticulocytes.
Q5) How can flow cytometry be used in cell quantitation?
Q6) Explain why flow cytometry is of limited use in identifying AML.
Q7) Name at least two pitfalls in immunophenotyping mature lymphoid malignancies, and explain how you would correct this.
Page 39
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Chapter 37: Chromosome Analysis of Hematopoietic and Lymphoid Disorders
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Q1) A patient is receiving treatment for Hodgkin lymphoma.Six weeks after the cessation of his treatment, a cytogenetic analysis is performed.A structural aberration is found.Name the most probable aberration(s), and explain why they performed it.
Q2) A patient is receiving chemotherapy for Hodgkin's lymphoma.After his treatment ends, a cytogenetic analysis is ordered to see if the treatment was successful.Which of the following would be the most appropriate specimen to collect for this?
A)Bone marrow
B)Lymphoid tissue
C)Peripheral blood
D)Skin biopsy
Q3) A cytogenetic analysis is performed, and the result is: inv (7) (q21q32).Name the structural aberration, and explain how it was formed.
Q4) Which specimen would be optimal for the study of lymphoma?
A)Peripheral blood
B)Amniotic fluid
C)Involved Lymph node
D)Solid tumor biopsy
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Chapter 38: Molecular Analysis of Hematologic Diseases
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Q1) Which of the following assays would be most appropriate for monitoring minimal residual disease?
A)Karyotyping
B)Southern Blot analysis
C)PCR
D)All of the above
Q2) Explain why molecular testing is essential not only in identifying disorders, such as cancer, but also during the course of a disease.
Q3) A Hodgkin lymphoma patient is admitted for treatment.What would be the benefit in performing an EBV-DNA test on him?
A)It would identify the cause of the Hodgkin lymphoma.
B)Since the patient is immunocompromised, it would identify an opportunistic pathogen.
C)It would help monitor the efficacy of his treatment.
D)It would help rule out other types of lymphomas.
Q4) Name and compare two molecular methods that are used to detect mutations associated with sickle-cell disease.
Q5) Explain the central dogma of molecular biology using proper nomenclature.Define each phase.
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Chapter 39: Laboratory Testing in Coagulation
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Q1) The aPTT is the most common procedure used to monitor the unfractionated heparin therapy.Which of the reagents used in the testing provides the activation of the formation of the fibrin clot?
A)Thromboplastin/calcium mixture
B)Activated partial thromboplastin and calcium
C)Thrombin and fibrinogen
D)Normal pooled plasma and thrombin
Q2) A patient with a fibrinolytic deficiency would:
A)Be prone to increased lysis.
B)Have increased levels of plasminogen.
C)Have abnormal screening tests (PT and APTT).
D)Be prone to increased clotting.
Q3) Laboratory testing for von Willebrand factor contains variables that can result in difficulty in diagnosing the disease.Which of the factors below is identified as a variable that can contribute to this difficulty?
A)Abnormal screening results
B)Difficulty in obtaining the specimen
C)Age of patient
D)Standardization of the reference plasma
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Chapter 40: Quality Assessment in the Hematology
Laboratory
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Q1) Identify the critical information that must be on a material safety data sheet.
Q2) What is the first step in the selection of a new instrument?
A)Conduct a needs assessment survey.
B)Determine the cost per test.
C)Perform an in-house evaluation of the instrument.
D)Evaluate the quality control program offered.
Q3) Which of the following represents the BEST method to assess a clinical laboratory professional's competency in performing leukocyte differentials?
A) Give the individual a 25-question written examination
B) Observe the individual during performance of a leukocyte differential
C) Assign the individual to complete the next CAP survey for hematology
D) Monitor the number of differentials that require pathology review for this individual
Q4) On average, how often should proficiency testing be performed in the laboratory?
A)Once a month
B)Three times a year
C)Once a year
D)Every day
Q5) What is the importance of documentation in a quality assessment program?
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Q6) What are the components of a method evaluation? Explain the purpose of each.