TEST BANK FOR HEMATOLOGY IN PRACTICE, 3RD EDITION, BETTY CIESLA
Table of Contents Chapter 1. Introduction to Hematology and Basic Laboratory Practice
... [Show More] ................................ .... 1 Chapter 2. From Hematopoiesis to the Complete Blood Count ................................ ......... 10 Chapter 3. Blood Cell Production and FUNCTION and Relevant Red Cell Morphology ...................... 14 Chapter 4. Hemoglobin Function and Principles of Hemolysis ................................ ......... 21 Chapter 5. The Microcytic Anemias ................................ ................................ 25 Chapter 6. The Macrocytic Anemias ................................ ............................... 31 Chapter 7. Normochromic Anemias: Biochemical and Membrane Disorders and Miscellaneous Red Cell Disorders ................................ ................................ .............................. 36 Chapter 8. The Normochromic Anemias Due to Hemoglobinopathies ................................ ... 42 Chapter 9. Leukopoiesis and Leukopoietic Function ................................ .................. 48 Chapter 10. Abnormalities of White Cells: Quantitative, Qualitative, and the Lipid Storage Diseases .......... 55 Chapter 11. Acute Leukemias................................ ................................ ..... 59 Chapter 12. Myeloproliferative Neoplasms ................................ ......................... 65 Chapter 13. Lymphoproliferative Disorders and Related Plasma Cell Disorders ........................... 69
Chapter 1. Introduction to Hematology and Basic Laboratory Practice 1 | P a g eMultiple Choice
1. Tube length when referring to the microscope is the:
A. Resolution power of the objective
B. Distance from the eyepiece to the objective
C. Numerical aperture
D. Magnitude of the image on the stage
ANS: B OBJ: 1.3
2. What is the most useful corrective action for the microscope when fine details cannot be
visualized in immature cells?
A. Open up the diaphragm for maximum light.
B. Wipe off lenses with lens cleaner.
C. Get a new slide.
D. Move to a lower power.
ANS: A
OBJ: 1.4
3. Which of the following behaviors is a violation of standard precautions?
A. Hand washing after glove removal
B. Use of impermeable laboratory gowns
C. Use of goggles and face shields
D. Placing laboratory notebooks on laboratory work area
ANS: D OBJ: 1.5
2 | P a g e4. Standards and calibrators differ from control materials because:
A. An exact amount of analyte is present in a standard or calibrator
B. A variable amount of analyte is present depending on patient samples
C. Standards only need to be within a target range
D. Standards are run to the best estimate of the known value
ANS: A OBJ: 1.7
5. Which of the following is involved in the study of hematology and used to determine sickness
and health?
A. Quantity of cells
B. Cellular structure
C. Cellular function
D. All of the above
ANS: D OBJ: 1.1
6. Proper mixing of samples and timely delivery of samples to the laboratory are both examples
of:
A. Delta checks
B. Postanalytic variables
C. Preanalytic variables
D. Reflex testing
ANS: C OBJ: 1.8
3 | P a g e7. A delta check is a historical reference on samples run in the laboratories. Once a sample fails a
delta check, the most obvious corrective action is to:
A. Verify the identification of the patient sample
B. Reestablish the parameters of the delta check
C. Perform reflex testing
D. Perform a manual method
ANS: A
8. Which of the following is the definition of a reference interval?
A. A solution of a known amount of analyte
B. Materials analyzed concurrently with unknown samples
C. Values established for a particular analyte, given a method, instrument, or patient population
D. Validation techniques on flagged samples
ANS: C OBJ: 1.8
9. Which of the following is not considered a postanalytic variable?
A. Delta checks
B. Proper anticoagulant used
C. Specimen checked for clots
D. Calling critical results
ANS: B
4 | P a g eOBJ: 1.8
10. Error analysis, standard protocols, and turnaround time are all part of the:
A. Quality assurance system
B. Quality control program
C. Reference standards
D. Delta check protocol
ANS: A OBJ: 1.7
11. The average of a group of data points is defined as the:
A. Mean
B. Mode
C. Median
D. Modicum
ANS: A OBJ: 1.7
12. Safety training is part of new employee training in health care and includes:
A. Biological hazards
B. Chemical hazards
C. Environmental hazards
5 | P a g eD. All of the above
ANS: D OBJ: 1.6
13. When viewing a slide with the 50 objective lens, the total magnification being used is:
A. 50
B. 100
C. 500
D. 5000
ANS: C OBJ: 1.3
14. Delta checks are used in the hematology laboratory to:
A. Compare past patient results with the current result
B. Verify control accuracy
C. Establish a target range
D. Establish reference ranges for a particular analyte
ANS: A OBJ: 1.8
15. When hand washing after a patient contact, the soap application process should last at least:
A. 5 seconds
B. 15 seconds
C. 20 seconds
D. 30 seconds
ANS: B OBJ: 1.6
6 | P a g e16. Which of the following represents an example of a safety violation in the laboratory?
A. Application of cosmetics
B. Mouth pipetting
C. Consuming bottled water
D. All the above
ANS: D OBJ: 1.6
True/False
17. Standard deviation is a measurement of precision.
ANS: True OBJ: 1.7
18. Accuracy is a measurement of the true value of an analyte.
ANS: True OBJ: 1.8
19. A normal distribution curve will have 99.7% of the measured values fall within 2 SDs.
ANS: False OBJ: 1.7
7 | P a g eCompletion (Ordered Response)
NARRBEGIN:
8 | P a g eNARREND
20. Label the parts of the microscope.
1
2
9 | P a g e3
4
5
6
7
8
9
10
ANS:
NAR: Figure 1-1
OBJ: 1.2
Chapter 2. From Hematopoiesis to the Complete Blood Count
Multiple Choice
1. What is the average M:E ratio for normal adult bone marrow?
A. 1:3
B. 4:1
C. 1:4
D. 6:1
ANS: B OBJ: 2.6
2. The key organs involved in extramedullary hematopoiesis include the:
A. Kidney and thymus
B. Lymph nodes and heart
C. Liver and spleen
D. Kidney and liver
ANS: C OBJ: 2.5
3. Which of these assays is the best test to assess the bone marrow’s response to anemic stress? A.
Hemoglobin value
B. MCV value
C. Reticulocyte count
D. Hematocrit
ANS: C OBJ: 2.12
10 | P a g e4. All of the following splenic functions are related to hematopoiesis, except:
A. Production of opsonizing antibodies
B. Production of WBCS, if necessary
C. Filtering out of old or deformed cells
D. Storage of platelets and granulocytes
ANS: A OBJ: 2.4
5. Which of the following is a primary site for hematopoiesis in a fetus of 4 to 5 months’
gestation? A. Yolk sac
B. Spleen
C. Distal long bones
D. Axial skeleton
ANS: B OBJ: 2.2
6. A patient with the following values—RBC = 4.01 1012/L, Hgb = 12.5 g/dL, and Hct =
37.2%—will most likely have which of the following RBC indices?
A. MCV = 92.8 fL, MCH = 31.2 pg, MCHC = 33.6%
B. MCV = 92.8 fL, MCH = 33.6 pg, MCHC = 31.2%
C. MCV = 107.8 fL, MCH = 32.1 pg, MCHC = 33.6%
D. MCV = 132.2 fL, MCH = 32.1 pg, MCHC = 33.5%
ANS: A OBJ: 2.9
7. The hormone responsible for red blood cell development in the bone marrow is:
A. Thyroxin
B. Insulin
C. Leukopoietin
D. Erythropoietin
ANS: D OBJ: 2.1
8. Which of the following sites is the most preferable for bone marrow aspiration and biopsy in adults?
A. Sternum
B. Iliac crest
C. Fibula
D. Vertebra
ANS: B OBJ: 2.7
9. A patient’s hemoglobin is 12.3 g/dL. On the peripheral smear, the red cells appear normochromic
and normocytic. The hematocrit value that correlates with these data is:
11 | P a g eA. 34%
B. 37%
C. 40%
D. 43%
ANS: B OBJ: 2.10
10. A Wright-stained smear of a patient’s bone marrow would effectively reveal all the following cells
except:
A. Iron-containing cells B.
RBC precursor cells
C. WBC precursor cells
D. Mature WBCs
ANS: A OBJ: 2.7
11. Erythropoietin is produced by the:
A. Kidneys
B. Liver
C. Spleen
D. Thymus gland
ANS: A OBJ: 2.1
12. Bone marrow aspiration is usually required in conditions of:
A. Anemia
B. Hypoxia
C. Leukemia
D. Hepatosplenomegaly
ANS: C OBJ: 2.7
13. Opsonizing antibodies produced by the spleen serve to:
A. Strip the capsule from bacterial pathogens
B. Recycle erythrocyte byproducts
C. Aid in extramedullary hematopoiesis
D. Fight viral infection
ANS: A OBJ: 2.4
14. The spleen harbors
A. one-quarter
B. one-third
12 | P a g e
of the circulatory platelet mass.C. one-half
D. three-quarters
ANS: B OBJ: 2.4
15. Mature red blood cells leave the bone marrow and enter the circulation via the:
A. Reticuloendothelial system
B. Osteoclasts
C. Spleen
D. Bone marrow sinuses
ANS: D OBJ: 2.1
16. Which of the following is a site of extramedullary hematopoiesis in an adult?
A. Spleen
B. Liver
C. Iliac crest
D. Both A and B
ANS: D OBJ: 2.5
17. The
A. MCV
B. Hct
C. MCHC
D. MCH
ANS: A OBJ: 2.10
18. The CBC parameter that gives insight into the amount of anisocytosis present in a specimen is:
A. RDW
B. MCHC
C. MCV
D. Hgb
ANS: A OBJ: 2.8
True/False
19. The CFU-GEMM is a multipotential stem cell, capable of differentiating into a lymphoid or nonlymphoid
13 | P a g e
is one of the most stable parameters in a CBC.precursor committed cell.
ANS: False OBJ: 2.3
20. Patients with moderate anemias (7 to 10 g/dL) may be asymptomatic.
ANS: True OBJ: 2.10
Chapter 3. Blood Cell Production and FUNCTION and Relevant Red Cell Morphology
Multiple Choice
1. Hemoglobin begins to appear in which of the following erythrocyte stages? (listed using
College of American Pathologists terminology)
A. Basophilic normoblast
B. Polychromatophilic normoblast
C. Orthochromic normoblast
D. Pronormoblast
ANS: B
OBJ: 3.1, 3.2, 3.4
2. As a red blood cell matures, what is one key morphological feature of the stages containing a
nucleus?
A. Basophilic cytoplasm through every stage of maturation
B. Granules in the cytoplasm
C. A round nucleus
D. An increase in size as the cell matures
ANS: C
OBJ: 3.1 & 3.2
3. What is the red cell protein that is responsible for deformability and flexibility of the red cell?
A. Spectrin
B. Glycophorin
C. Glycine
D. EPO
ANS: A
OBJ: 3.6
14 | P a g e4. Increased plasma cholesterol may lead to the development of which of these abnormal red cell
morphologies?
A. Spherocyte
B. Target cells
C. Microcytes
D. Helmet cells
ANS: B
OBJ: 3.12
5. Which of the following RBC pathways is responsible for providing 90% of the cellular ATP for
red cell metabolism?
A. Embden-Meyerhof pathway
B. Methemoglobin reductase pathway
C. Rapoport-Luebering pathway
D. Hexose monophosphate shunt
ANS: A OBJ: 3.5
6. When tissues become hypoxic, which of the following organs is stimulated to release
erythropoietin?
A. Pituitary gland
B. Thyroid
C. Pancreas
D. Kidneys
ANS: D
OBJ: 3.3
7. For a red blood cell to live its full 120-day life span, which condition is necessary?
A. The red blood cell membrane must be deformable.
B. The red blood cell must have enough granules.
C. The red blood cell must always remain in a round shape.
D. There must be enough hemoglobin, regardless of function.
ANS: A OBJ: 3.7
8. Which of the following electrolytes maintains its highest concentration within the red blood
cell cytoplasm as opposed to circulating in the plasma?
A. Sodium
15 | P a g eB. Bicarbonate
C. Chloride
D. Potassium
ANS: D
OBJ: 3.8
9. Polychromatophilic macrocytes seen in the peripheral smear as a result of anemic stress are
most likely which type of red blood cell?
A. Siderocytes
B. Reticulocytes
C. Spherocytes
D. Pappenheimer bodies
ANS: B OBJ: 3.11
10. Which of the following red cell inclusions are derived from denatured hemoglobin?
A. Howell-Jolly bodies
B. Pappenheimer bodies
C. Heinz bodies
D. Siderotic granules
ANS: C OBJ: 3.13
11. The degree of effective erythropoietic activity in any hematological disorder can most readily
be assessed by which analysis?
A. Red cell count
B. Reticulocyte count
C. M:E ratio
D. Hemoglobin determination
ANS: B OBJ: 3.14
12. When hemolysis is produced by the intravascular fragmentation of red cells, which red cell
morphology may be seen in peripheral smear examination?
A. Spherocytes
B. Macrocytes
C.Acanthocytes
D. Schistocytes
ANS: D
OBJ: 3.12
16 | P a g e13. Most hypochromic cells will have an MCHC that is
A. greater than 36%; thalassemia
B. less than 32%; iron-deficiency anemia
C. greater than 27%; iron-deficiency anemia
D. less than 27%; sideroblastic conditions
ANS: B OBJ: 3.10
14. Reversible sickled cells are described as having which of the following shapes?
A. Crescent shape with one pointed projection
B. Crescent shape with two pointed projections
C. Half-moon shape with rounded ends
D. Half-moon shape with pointed projection
ANS: C OBJ: 3.12
15. Which of the following cells is in the last nucleated stage of erythrocytic maturation? (using
CAP terminology)
A. Pronormoblast
B. Orthochromic normoblast
C. Polychromatophilic normoblast
D. Basophilic normoblast
ANS: B
OBJ: 3.1
16. Which red cell inclusions are remnants of DNA?
A. Cabot rings
B. Howell-Jolly bodies
C. Heinz bodies
D. Pappenheimer bodies
ANS: B OBJ: 3.13
17. From each pronormoblast precursor cell,
A. 4
B. 8
C. 12
D. 16
ANS: D
17 | P a g e
mature red blood cells are produced.
and are often seen in
.OBJ: 3.3
18. Pappenheimer bodies are composed of which of the following components?
A. Iron
B. Denatured hemoglobin
C. DNA
D. RNA
ANS: A
OBJ: 3.13
19. Microcytic cells have MCV values of
A. less than 90 fL; iron-deficiency anemia
B. less than 80 fL; iron-deficiency anemia
C. greater than 100 fL; megaloblastic anemia
D. greater than 110 fL; megaloblastic anemia
ANS: B OBJ: 3.9
NARRBEGIN:
and are often seen in
.
NARREND
20. Describe the hemoglobin content of the cell at the end of the pointer that is often seen in
response to anemic stress.
A. Normochromic
B. Hypochromic
C. Polychromatophilic
D. Hyperchromic
ANS: C OBJ: 3.11
NAR: Figure 3-10
18 | P a g eNARRBEGIN:
NARREND
21. Identify the cell at the end of the pointer that has an elevated MCHC of 38% and may
indicate a cell that is aged.
A. Spherocyte
B. Schistocyte
C. Acanthocyte
D. Normocyte
ANS: A
OBJ: 3.10 & 3.12
NAR: Figure 3-12
NARRBEGIN:
NARREND
22. Identify the cell at the end of the pointers that may indicate liver disease.
A. Reticulocyte
19 | P a g eB. Spherocyte C. Sickle cell D. Target cell [Show Less]