12.

The values below were obtained on an automated blood count system performed on a blood sample from a 25 year old man: Patient WBC RBC Hgb Hct MCV MCH MCHC 5.1x103/ uL 2.94 x 106/ uL 13.8 g/dl 35.4% 128fL 46.7 pg 40% Normal 5.0- 10.0 x 103/uL 4.6-6.2x 106/ uL 14-18 g/dl 40%- 54% 82- 90 fL 27-31 pg 32%-36%

These results are most consistent with which of the following: a. Megaloblastic anemia b. Hereditary spherocytosis c. A high titer of cold agglutinins d. An elevated reticulocyte count

13. Which of the following measures platelet function? a. Bleeding time b. Prothrombin time c. Thrombin time d. Partial thromboplastin time

14. The most common form of childhood leukemia is: a. Acute lymphocytic b. Acute granulocytic c. Acute Monocytic d.Chronic granulocytic

15. Which of the following is the standard calibration method for hematology instrumentation against which other methods must be verified? a. b. c. d. Latex particles of known dimension Stabilized red cell suspensions Stabilized 7 parameter reference controls Normal whole blood

16. Te following results were obtained on an electric particle counter: WBC RBC Hgb Hct MCV MCH MCHC 6.5x 103/ uL 4.55 x 108/ uL 18.0 g/dl 41.5 % 90.1 fL 39.6 pg 43.4%

The first step in obtaining valid results is to: a. b. c. d. Perform a Microhemaocrit Correct the hemoglobin for lipemia Dilute the blood Replace the lysing agent

17. Which of the following tests is used to monitor red cell production? a. b. c. d. Packed cell volume Total iron- binding capacity Schilling test Reticulocyte count

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

19. The following results were obtained on an electronic particle counter: WBC RBC Hgb Hct MCV MCHC 61.3x 103/uL 1.19 x 105/uL 9.9 g/dl 21% 125 fL 54.1%

What action should be taken to obtain accurate results? a. b. c. d. Dilute the specimen and recount Warm the specimen and recount Check the tube for clots Clean the aperture and recount

20. Thalassemias are characterized by: a. b. c. d. Structural abnormalities in the hemoglobin molecule Absence of iron in hemoglobin Decrease rate of heme synthesis Decreased rate of globin synthesis

21. Phagocytosis is a function of: a. b. c. d. Erythrocytes Granulocytes Lymphocytes Thrombocytes

22. Cells involved in hemostasis are: a. b. c. d. Erythrocytes Granulocytes Lymphocytes Thrombocytes

23. Cells for the transport of 02 and CO2 are: a. b. c. d. Erythrocytes Granulocytes Lymphocytes Thrombocytes

24. Cells that produce antibodies and lymphokines are: a. b. c. d. Erythrocytes Granulocytes Lymphocytes Thrombocytes

25. In polycythemia vera, the hemoglobin, hematocrit, red blood cell count, and red cell mass are: a. Elevated b. Normal c. Deceased 26. In polycythemia vera, the platelet count is: a. Elevated b. Normal c. Decreased 27. 50%-90% myeloblasts in a peripheral blood sample is typical of which of the following? a. b. c. d. Erythrocytes Granulocytes Lymphocytes Thrombocytes

28. Auer rods are most likely present in which of the following? a. b. c. d. Erythrocytes Granulocytes Lymphocytes Thrombocytes

29. All stages of neutrophils are most likely to be seen in the peripheral blood of a patient with: a. b. c. d. Erythrocytes Granulocytes Lymphocytes Thrombocytes

30. Erythropoietin acts to: a. b. c. d. Shorten the replication time of the granulocytes Stimulate RNA synthesis of erythroid cells Increase colony stimulating factors produced by the B- lymphocytes Decrease the release of marrow reticulocytes

31. In the French- American-British (FAB) classification, acute lymphocytic leukemia is divided into groups according to: a. b. c. d. Prognosis Immunology Cytochemistry Morphology

32. The specimen of choice for preparation of blood films for manual differential leukocyte counts is whole blood collected in: a. b. c. d. EDTA Oxalate Citrate Heparin

33. When platelets concentrate at the edges and feathered end of a blood smear, it is usually due to: a. b. c. d. Abnormal proteins Inadequate mixing of blood and anticoagulant Hemorrhage Poorly made wedge smear

34. Irregular clumping of platelets is usually due to: a. b. c. d. Inadequate mixing of blood and anticoagulant Hemorrhage Poorly made wedge smear Hypersplenism

35 .Platelet satellitosis is usually due to a. b. c. d. Abnormal proteins Inadequate mixing of blood and anticoagulant Hemorrhage Poorly made wedge smear

36.Elevation of the granulocyte percentage above 75% is termed: a. b. c. d. Absolute lymphocytosis Leukocytosis Relative neutrophilic leukocytosis Absolute neutrophilic leukocytosis

37. Elevation of the lymphocyte percentage above 47% is termed: a. b. c. d. Relative lymphocytosis Absolute lymphocytosis Leukocytosis Absolute Neutrophilic leukocytosis

38. Elevation of the total granulocyte count above 9.0x10 3/ uL is termed: a. b. c. d. Absolute lymphocytosis Leukocytosis Relative neutrophilic leukocytosis Absolute neutrophilic leukocytosis

39. Elevation of the total white cell count above 12x 10 9/ uL is termed: a. b. c. d. Relative lymphocytosis Absolute lymphocytosis Leukocytosis Absolute Neutrophilic leukocytosis

40. The chamber counting method of platelet enumeration: a. b. c. d. Allows direct visualization of the particles being counted Has high degree of precision Has a high degree of reproducibility Is the method of choice for the performance of 50-60 counts per day

41. Specific (secondary) granules of the neutrophilic granulocyte: a. b. c. d. Appear first at the myelocyte stage Contain the lysosomal enzymes Are formed in the mitochondria Are derived from azurophil (primary) granules

42. The anemia of chronic infection is characterized by: a. b. c. d. Decreased iron stores in the reticuloendothelial system Decreased serum iron levels Macrocytic erythrocytes Increased serum iron- binding capacity

43. Which of the following are characteristic of polycythemia vera? a. b. c. d. Elevated urine erythropoietinnlevels Increased oxygen affinity of hemoglobin Teardrop poikilocytosis Decreased or absent bone marrow iron stores

44. Factors commonly involved in producing anemia in patients with chronic renal disease include: a. b. c. d. Maarow hypoplasia Ineffective erythropoiesis Vitamin B12 defeciency Increased erythropoietin production

45. Thrombocytopenia is a characteristic of: a. b. c. d. Classic von Willebrands disease Hemophilia A Galnzmanns thromobasthenia May- Hegglin anomaly

46. A leukocyte count and differential on a 40- year-old Caucasian man revealed: WBC 5.4x 103/ uL Differential Segs 20% Lymphs 58% Monos 20% Eos 2% These data represent: a. b. c. d. Relative lymphocytosis Absolute lymphocytosis Relative Neutrophilia Leukopenia

47. A leukocyte count and differential on a 40- year-old white man revealed: WBC 5.4x 103/ uL Differential Segs 20% Lymphs 58% Monos 20% Eos 2% These data represent: a. b. c. d. Absolute lymphocytosis Relative neutrophilia Absolute Neutropenia Leukopenia

48. Which of the following platelet responses is most likely associated with classic von Willebrands disease? a. b. c. d. Decreased platelet aggregation to ristocetin Normal platelet aggregation to ristocetin Absent aggregation to epinephrine, ADP, and collagen Decreased amount of ADP in platelets

49. The majority of the iron in an adult is found as a constituent of: a. b. c. d. Hemoglobin Hemosiderin Myoglobin Transferrin

50. A patient has the following blood values: RBC Hgb Hct MCV MCH MCHC 6.5x103/ uL 14.0 g/dl 42.0% 65 fL 21.5 pg 33%

These results are compatible with: a. b. c. d. Iron deficiency Pregnancy Thalassemia minor Beta Thalassemia major

51. A 50- year old woman who has been receiving busulfan for 3 years for chronic myelogenos leukemia becomes anemic. Laboratory tests reveal: Thrombocytopenia Many peroxidise- negative blast cells in the peripheral blood Bone marrow hypercellular in blast transformation Markedly increased bone marrow TdT Which of the following complications is the patient most likely to have? a. b. c. d. Acute lymphocytic leukemia Acute myelocytic leukemia Acute myelomonocytic leukemia Busulfan toxicity

52. Which of the following is the most common cause of an abnormality in hemostasis? a. b. c. d. Decreased plasma fibrinogen level Decreased Factor VIII level Decreased Factor IX level Quantitative abnormality of patients

53. A hemophiliac male and a normal female can produce a: a. b. c. d. Female carrier Male carrier Male hemophiliac Normal female

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

55. Acute disseminated intravascular coagulation is characterized by: a. b. c. d. Hypofibrinogenemia Thrombocytosis Negative D dimer Shortened thrombin time

56. Coagulation factors affected by coumarin drugs are: a. b. c. d. VIII, IX, and X I, II, V and VII II, VII, IX, and X II, V and VII

57. The following data were obtained on a patient: PT 20 sec Thrombin Time 13 sec APTT 55 sec APTT plus aged serum Corrected APTT plus absorbed plasma Not corrected Circulatory inhibitor None present Which of the following coagulation factors is deficient? a. b. c. d. Factor V Factor VIII Factor X Factor XI

58. Which of the following laboratory procedures is most helpful in differentiating severe liver disease and accomapanying secondary fibrinolysis from disseminated intravascular coagulation? a. b. c. d. Presence of fibrin split products Increased APTT Factor VIII activity Fibrinogen level

59. Which of the following laboratory findings is associated with Factor XIII deficiency? a. b. c. d. Prolonged activated partial thromboplastin time Clot solubility in a 5 molar urea solution Prolonged thrombin time Prolg/donged prothrombin time

60. An automated leukocyte count is 22.5 x 103/uL. The differential reveals 200 normoblasts/100 leukocytes. What is the actual leukocyte count per microliter? a. b. c. d. 7500/uL 11, 500/uL 14,400/uL 22,300/uL

61. On Monday a patients hemoglobin determination was 11.3 g/dL and on Tuesday it measured 11.8 g/dL. The standard deviation of the method used is +- 0.2 g/dL. What can be concluded about the hemoglobin values given? a. b. c. d. One value probably resulted from laboratory error There is poor precision; daily quality control charts should be checked. The second value is out of range and should be repeated There is no significant change in the patients hemoglobin concentration

62. A patient has a high cold agglutinin titer. Automated cell counter results reveal an elevated MCV, MCH, and MCHC. Individual erythrocytes appear normal on a stained smear, but agglutinates are noted. The appropriate course of action would be to: a. Perform the RBC, Hgb, and Hct determinations using manual methods b. Perform the RBC determination by a manual method; use the automated results for the Hgb and Hct c. Repeat the determinations using a microsample of diluted blood d. Repeat the determinations using a prewarmed microsample of diluted blood 63. The anticoagulant of choice for routine coagulation procedure is: a. b. c. d. Sodium oxalate Sodium citrate Heparin Sodium fluoride

64. The most commom cause of error when using automated cell counter is: a. b. c. d. Contamination of diluents Inadequate mixing of the sample prior to testing Variation in voltage of the current supply A calibrating error

65. Which of the following is associated with May- Hegglin anomaly? a. b. c. d. Membrane defect of lysosomes Dohle bodies and giant platelets Chronic myelogeneous leukemia Mucopolysaccharidosis

66. Which of the following is associated with Chediak- Higashi syndrome? a. b. c. d. Membrane defect of lysosomes Dohle bodies and giant platelets Two- lobed neutrophils Mucopolysaccharidosis

67. Which of the following is associated with pseudo- Pelger- Heut anomaly? a. b. c. d. Aplastic anemia Iron Deficiency anemia Myelogenous Leukemia Chediak- Higashi syndrome

68. Which of the following is associated with Alder- Reilly inclusions? a. b. c. d. Membrane defect of lysosomes Dohle bodies and giant platelets Two lobed neutrophils Mucopolysaccharides

69. Many microspherocytes and schistocytes and budding off of spherocytes can be seen on peripheral blood smears of patients with: a. b. c. d. Hereditary spherocytosis Disseminated intravascular coagulation (DIC) Acquired autoimmune haemolytic anemia Extensive burns

70. Muramidase (lysozyme) is present in: a. b. c. d. Granulocytes and their precursors Monocytes and their precursors Granulocytes, monocytes, and their precursors Lymphocytes and their precursors

71. Hemolysis in paroxysmal nocturnal hemoglobinuria(PNH) is: a. b. c. d. Temperature dependent Complement- independent Antibody- mediated Caused by a red cell membrane defect

72. In order for hemoglobin to combine reversibly with oxygen, the iron must be: a. b. c. d. Complexed with haptoglobin Freely circulating cytoplasm Attached to transferrin In the ferrous state

73. Heinz bodies are: a. b. c. d. Readily identified with polychrome stains Rarely found in glucose-6- phosphate dehydrogenase deficient erythrocytes Closely associated with spherocytes Denatured hemoglobin inclusions that are readily removed by the spleen

74. Which of the following sets of laboratory findings is consistent with hemolytic anemia? a. b. c. d. Normal or slightly increased erythrocyte survival; normal osmotic fragility Decreased erythrocyte survival; increased catabolism of heme Decreased serum lactate dehydrogenase activity, normal catabolism of heme Normal concentration of haptoglobin; marked hemoglobinuria

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

76. Hemoglobin H disease results from: a. b. c. d. Absence of 3 of 4 alpha genes Absence of 2 of 4 alpha genes Absence of 1of 4 alpha genes Absence of all 4 alpha genes

77. Which of the following represents characteristic features of iron metabolism in patients with anemia of a chronic disorder? a. Serum iron is normal, transferrin saturation is normal, TIBC is normal b. Seum iron is increased, transferrin saturation is increased, TIBC is normal or slightly increased c. Serum iron is normal, transferrin saturation is markedly increased, TIBC is normal d. Serum iron is decreased, transferrin saturationis decreased, TIBC is normal or decreased 78. A patient with polycythemia vera who is treated by phlebotomy is most likely to develop deficiency of: a. b. c. d. Iron Vitamin B12 Folic acid Erythropoietin

79. Hemorrhage in polycythemia vera is the result of: a. b. c. d. Increased plasma viscosity Persistent thrombocytosis Splenic sequestration of platelets Abnormal platelet function

80. In chronic myelocytic leukemia, blood histamine concentrations tend to reflect the: a. Number of platelets present b. Serum uric acid concentrations c. Number of basophils present d. Total number of granulocytes

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

82. The bone marrow in the terminal stage of erythroleukemia (DI Gugillelmos syndrome) is often indistinguishable from that seen in: a. b. c. d. Myeloid metaplasia Polycythemia vera Acute myelocytic leukemia Aplastic anemia

83. Which of the following is significant feature of erythroleukemia (DI Gugillelmos syndrome)? a. b. c. d. Persistently increased M:E ratio Megaloblastoid erythropoiesis Marked thrombocytosis Decreased stainable iron in the marrow

84. In which of the following disease states are teardrop cells and abnormal platelets most characteristically seen? a. b. c. d. Chronic myelocytic leukemia Multiple myeloma Thalassemia Myeloid Metaplasia

85. In the French- American- British (FAB) classification, myelomonocytic leukemia would be: a. b. c. d. M1 and M2 M3 M4 M5

86. Which of the following is characteristic of platelet disorders? a. b. c. d. Deep muscle hemorrhages Retroperitoneal hemorrhages Mucous membrane hemmorhages Severely prolonged clotting time

87.Which of the following is true statement about acute idiopathic thrombocytopenic purpura (ITP)? a. b. c. d. It is found primarily in adults Spontaneous remission usually occurs within several weeks Women are commonly affected Peripheral destruction of platelets is decreased

88. Which of the following is the most useful in differentiating hemophilias A and B? a. b. c. d. Pattern of inheritance Clinical history Activated partial thromboplastin time Mixing studies( substitution studies)

89. A 56-year-old woman was admitted to the hospital with a history of a moderate to severe bleeding tendency several years duration. Epistaxis and menorrhagia were reported. Prolonged APTT was corrected with normal plasma, absorbed plasma and aged serum. Deficiency of which of the following is most likely? a. b. c. d. Factor XII Factor VIII Factor XI Factor IX

90. A patient has a history of mild hemorrhagic episodes. Laboratory results include a prolonged prothrombin time and activated partial thromboplastin time. The abnormal prothrombin time was corrected by normal and adsorbed plasma, but not aged serum. Which of the following coagulation factor is deficient? a. b. c. d. Prothrombin Factor V Factor X Factor VII

91. A bone marrow slide shows foam cells ranging from 200 t0 100 um in size with vacuolated cytoplasm containing sphingomyelin and is faintly PAS positive. This cell type is most characteristic of: a. b. c. d. Gauchers disease Myeloma with Russell bodies DI Gugillelmo disease Niemann- Picki disease

92. Patients with chronic granulomatous disease suffer from frequent pyogenic infections owing to the inability of: a. b. c. d. Lymphocytes to produce bacterial antibodies Eosinophils to degranulate in the presence of bacteria Neutrophils to kill phagocytised bacteria Basophils to release histamine in the presence of bacteria

93. A 40-year-old man had an erythrocyte count of 2.5x 106/ uL, hematocrit of 22%, and a reticulocyte count of 2.0%. Which of the following statements best describes his condition? a. The absolute reticulocyte count is 50x 103/uL, indicating that the bone marrow is not adequately compensating for the anemia b. The reticulocyte count is greatly increased, indicating an adequate bone marrow response for the anemia c. The absolute reticulocyte count is 500x 103/uL, indicating that the bone marrow is adequately compensating for the anemia d. The reticulocyte count is slightly increased, indicating an adequate response to the slight anemia 94. In an electronic or laser particle cell counter, clumped platelets may interfere with which of the following parameters? a. b. c. d. White blood cell count Red blood cell count Hemoglobin Hematocrit

95. When using an electronic cell counter, which of the following results can occur in the presence of a cold agglutinin? a. b. c. d. Increased MCV and decreased RBC Increased MCV and normal RBC Decreased MCV and increased MCHC Decreased MCV and RBC

96. A properly functioning electronic cell counter obtains the following results: WBC RBC Hgb Hct MCV MCH MCHC 5.1 x 103/uL 4.87x 106/uL 10.1 g/dl 39.3% 82.o fL 33.1 pg 41.3%

What is the most likely cause of these results? a. b. c. d. Lipemia Cold agglutinins Increased WBC Rouleaux

97. Blood collected in EDTA undergoes which of the following changes if kept at room temperature for 6- 24 hours? a. b. c. d. Increased hematocrit and MCV Increased ESR and MCV Increased MCHC and MCV Decreased reticulocyte and hematocrit

98. On setting up the electronic particle counter in the morning, one of the controls is slightly below the range for the MCV. Which of the following is indicated? a. b. c. d. Call for servie Adjust the MCV up slightly Shut down the instrument Repeat the control

99. Which of the following is associated with Glanzmanns thrombasthenia? a. b. c. d. Normal bleeding time Normal ADP aggregation Abnormal initial wave ristocetin aggregation Absence of clot retraction

100. Which of the following is a characteristic of Bernard Souller syndrome? a. b. c. d. Negative bleeding history Normal clotting times Decreased risk of thrombosis Epistaxis

101. Which of the following is characteristic of Bernard- Souller syndrome? a. b. c. d. Giant platelets Normal bleeding time Abnormal aggregation with ADP Increased Platelet count

102. Which of the following will not cause erroneous results when using a phase optical system for enumerating platelets? a. b. c. d. Incipient clotting Decreased hematocrit Howell- Jolly bodies Leukocyte cytoplasmic fragments

Questions 103-107 refer to the following illustration:

50 40 30 20 10 0 -6 -3 Birth 3 6

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

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

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

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

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

108 Which curve represents the production is mostly associated with: a. b. c. d. Polycythemia vera Polycythemia, secondary to hypoxia Relative polycythemia related to dehydration Polycythemia associated with renal disease

109. Decreased to normal erythropoietin production is most likely to be asscociated with: a. b. c. d. Polycythemia vera Polycythemia, secondary to hypoxia Benign Familial polycythemia Polycythemia associated with renal disease

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

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

112. Which of the following is most closely associated with idiopathic hemochromatosis? a. b. c. d. Iron overload in tissue Target cells Basophilic stippling Ringed sideroblasts

113. Which of the following is most closely associated with iron deficiency anemia? a. b. c. d. Iron overload in tissue Target cells Basophilic stippling Ringed sideroblasts

114. Which of the following is seen most often in thalassemia?