Rodak's 5th Ed. Compiled Chapter Quizzes (CTTO) PDF Study Questions

RODAK – CLINICAL PRINCIPLES AND APPLICATIONS, 5TH EDITION 5TH EDITION STUDY QUESTIONS d. During a safety inspection, an aged microscope power CHAPTER 2 SAFETY IN THE HEMATOLOGY supply is found to have a fr...

RODAK – CLINICAL PRINCIPLES AND APPLICATIONS, 5TH EDITION 5TH EDITION STUDY QUESTIONS d. During a safety inspection, an aged microscope power CHAPTER 2 SAFETY IN THE HEMATOLOGY supply is found to have a frayed power cord. LABORATORY 8. It is a busy evening in the City Hospital hematology 1. Standard precautions apply to all of the following except: department. One staff member called in sick, and there was a a. Blood major auto accident that has one staff member tied up in the b. Cerebrospinal fluid blood bank all evening. Mary, the medical laboratory scientist c. Semen covering hematology, is in a hurry to get a stat sample on the d. Concentrated acids analyzer but needs to pour off an aliquot for another department. She is wearing gloves and a lab coat. She 2. The most important practice in preventing the spread of carefully covers the stopper of the well-mixed disease is: ethylenediaminetetraacetic acid (EDTA) tube with a gauze a. Wearing masks during patient contact square and tilts the stopper toward her so it opens away from b. Proper hand washing her. She pours off about 1 mL into a prelabeled tube, replaces c. Wearing disposable laboratory coats the stopper of the EDTA tube, and puts it in the sample rack d. Identifying specimens from known or suspected HIV and and sets it on the conveyor. She then brings the poured HBV-infected patients with a red label sample off to the other department. How would you assess Mary’s safety practice? 3. The appropriate dilution of bleach to be used in laboratory a. Mary was careful and followed all appropriate procedures. disinfection is: b. Mary should have used a shield when opening the tube. a. 1:2 c. Mary should have poured the sample into a sterile tube. b. 1:5 d. Mary should have wiped the tube with alcohol after c. 1:10 replacing the stopper. d. 1:100 9. What class fire extinguisher would be appropriate to use 4. How frequently should fire alarms and sprinkler systems be on a fire in a chemical cabinet? tested? a. Class A a. Weekly b. Class B b. Monthly c. Class C c. Quarterly d. Class D d. Annually 10. According to OSHA standards, laboratory coats must be 5. Where should alcohol and other flammable chemicals be all of the following except: stored? a. Water resistant a. In an approved safety can or storage cabinet away from b. Made of cloth fabric that can be readily laundered heat sources c. Long-sleeved b. Under a hood and arranged alphabetically for ease of d. Worn fully buttoned identification in an emergency c. In a refrigerator at 28 C to 88 C to reduce volatilization 11. Which one of the following would NOT be part of a safety d. On a low shelf in an area protected from light management plan? a. Job safety analysis 6. The most frequent cause of needle punctures is: b. Risk assessment of potential safety hazards a. Patient movement during venipuncture c. Mechanism for reporting accidents b. Improper disposal of phlebotomy equipment d. Budget for engineering controls and personal protective c. Inattention during removal of needle after venipuncture equipment d. Failure to attach needle firmly to syringe or tube holder 7. Under which of the following circumstances would a SDS be helpful? -------------------------------------------------------------------------- a. A phlebotomist has experienced a needle puncture with a CHAPTER 3 BLOOD SPECIMEN COLLECTION clean needle. b. A fire extinguisher failed during routine testing. 1. Which step in the CLSI procedure for venipuncture is part c. A pregnant laboratory employee has asked whether she of standard precautions? needs to be concerned about working with a given reagent. a. Wearing gloves b. Positively identifying the patient 1|Page  RODAK – CLINICAL PRINCIPLES AND APPLICATIONS, 5TH EDITION 5TH EDITION STUDY QUESTIONS c. Cleansing the site for the venipuncture 8. What is the recommended order of draw when the d. Bandaging the venipuncture site evacuated tube system is used? a. Gel separator, nonadditive, coagulation, and blood culture 2. Select the needle most commonly used in standard b. Additive, nonadditive, gel separator, and blood culture venipuncture in an adult: c. Nonadditive, blood culture, coagulation, and other a. One inch, 18 gauge additives b. One inch, 21 gauge d. Blood culture, coagulation, nonadditive, and gel separator c. One-half inch, 23 gauge or other additives d. One-half inch, 25 gauge 9. Which one of the following is an acceptable site for skin 3. For a complete blood count (hematology) and puncture on infants: measurement of prothrombin time (coagulation), the a. Back curvature of the heel phlebotomist collected blood into lavender stopper and b. Lateral or medial plantar surface of the heel green stopper tubes. Are these specimens acceptable? c. Plantar surface of the heel close to the arch of the foot a. Yes, EDTA is used for hematologic testing and heparin is d. Middle of the plantar surface of the heel used for coagulation testing. b. No, although EDTA is used for hematologic testing, 10. An anticoagulant is an additive placed in evacuated tubes citrate, not heparin, is used for coagulation testing. to: c. No, although heparin is used for hematologic testing, a. Make the blood clot faster citrate, not EDTA, is used for coagulation testing. b. Dilute the blood before testing d. No, hematologic testing requires citrate and coagulation c. Prevent the blood from clotting testing requires a clot, so neither tube is acceptable. d. Ensure the sterility of the tube 4. The vein of choice for performing a venipuncture is the: 11. Which one of the following is a reason for specimen a. Basilic, because it is the most prominent vein in the rejection: antecubital fossa a. Clot in a red stopper tube b. Cephalic or accessory cephalic, because it is the least b. Specimen collected for blood cortisol in the morning painful site c. Specimen in lavender stopper tube grossly hemolyzed c. Median or median cubital, because it has the lowest risk d. Room number is missing from the specimen tube label of damaging nerves in the arm d. One of the hand veins, because they are most superficial 12. One legal area of concern for the phlebotomist is: and easily accessed a. Breach of patient confidentiality b. Failure to obtain written consent for phlebotomy 5. The most important step in phlebotomy is: c. Entering a patient’s room when the family is present a. Cleansing the site d. Asking an outpatient for his or her full name in the b. Identifying the patient process of identification c. Selecting the proper needle length d. Using the correct evacuated tube -------------------------------------------------------------------------- 6. The venipuncture needle should be inserted into the arm CHAPTER 4 CARE AND USE OF THE MICROSCOPE with the bevel facing: a. Down and an angle of insertion between 15 and 30 degrees b. Up and an angle of insertion less than 30 degrees 1. Use of which one of the following types of objective lens c. Down and an angle of insertion greater than 45 degrees causes the center of the microscope field to be in focus, d. Up and an angle of insertion between 30 and 45 degrees whereas the periphery is blurred? a. Plan achromatic 7. Failure to obtain blood by venipuncture may occur because b. Achromatic of all of the following except: c. Plan apochromatic a. Incorrect needle positioning d. Flat field b. Tying the tourniquet too tightly c. Inadequate vacuum in the tube 2. Which of the following gathers, organizes, and directs light d. Collapsed vein through the specimen? a. Eyepiece b. Objective lens 2|Page  RODAK – CLINICAL PRINCIPLES AND APPLICATIONS, 5TH EDITION 5TH EDITION STUDY QUESTIONS c. Condenser b. Darkfield d. Optical tube c. Polarizing d. Phase-contrast 3. After focusing a specimen by using the 403 objectives, the laboratory professional switches to a 103 objective. The 10. A laboratory science student has been reviewing a specimen remains in focus at 103. Microscopes with this hematology slide using the 103 objectives to find a suitable characteristic are described as: portion of the slide for examination. He moves the 103 a. Parfocal objectives out of place, places a drop of oil on the slide, b. Parcentric rotates the nosepiece so that the 403 objective passes c. Compensated through the viewing position, and continues to rotate the d. Parachromatic 1003 oil objective into viewing position. This practice should be 4. Which objective has the greatest degree of color corrected in which way? correction? a. The stage of a parfocal microscope should be lowered a. Achromatic before the objectives are rotated. b. Plan apochromatic b. The 1003 oil objective should be in place for viewing before c. Bichromatic the oil is added. d. Plan achromatic c. The drop of oil should be in place and the 1003 objective lowered into the oil, rather than swinging the objective into 5. In adjusting the microscope light using Koehler the drop. illumination, which one of the following is true? d. The objectives should be rotated in the opposite direction a. Condenser is first adjusted to its lowest position so that the 403 objectives does not risk entering the oil. b. Height of the condenser is adjusted by removing the eyepiece 11. Darkfield microscopes create the dark field by: c. Image of the field diaphragm iris is used to center the a. Using two filters that cancel each other out, one above and condenser the other below the condenser d. Closing the aperture diaphragm increases the resolution of b. Angling the light at the specimen so that it misses the the image objective unless something in the specimen bends it backward 6. The total magnification obtained when a 103 eyepiece and c. Closing the condenser diaphragm entirely, limiting light to a 103 objective lens are used is: just a tiny ray in the center of the otherwise dark field a. 13 d. Using a light source above the specimen and collecting b. 103 light reflected from the specimen, rather than transmitted c. 1003 through the specimen, so that when there is no specimen in d. 10003 place, the field is dark 7. After a microscope has been adjusted for Koehler illumination, and the specimen is being viewed with an oil -------------------------------------------------------------------------- immersion objective lens, light intensity should never be CHAPTER 5 QUALITY ASSURANCE IN HEMATOLOGY regulated by adjusting the: AND HEMOSTASIS TESTING a. Rheostat b. Neutral density filter 1. What procedure is employed to validate a new assay? c. Light control knob a. Comparison of assay results to a reference method d. Condenser b. Test for assay precision c. Test for assay linearity 8. The recommended cleaner for removing oil from objectives d. All of the above is: a. 70% alcohol or lens cleaner 2. You validate a new assay using linear regression to b. Xylene compare assay calibrator results with the distributor’s c. Water published calibrator results. The slope is 0.99 and the y d. Benzene intercept is 110%. What type of error is present? a. No error 9. Which of the following types of microscopy is valuable in b. Random error the identification of crystals that are double refractive? c. Constant systematic error a. Compound brightfield d. Proportional systematic error 3|Page  RODAK – CLINICAL PRINCIPLES AND APPLICATIONS, 5TH EDITION 5TH EDITION STUDY QUESTIONS b. Calibrator 3. Which is a statistical test comparing means? c. Control a. Bland-Altman d. Blank b. Student’s t-test c. ANOVA 10. You perform a clinical efficacy test and get the following d. Pearson results: Unaffected by Affected by 4. The acceptable hemoglobin control value range is 13 6 0.4 Disease or Disease or g/dL. The control is assayed five times and produces the Condition Condition following five results: Assay is 40 5 12.0 g/dL 12.3 g/dL 12.0 g/dL 12.2 g/dL 12.1 g/dL negative These results are: a. Accurate but not precise Assay is 10 45 b. Precise but not accurate positive c. Both accurate and precise d. Neither accurate nor precise What is the number of false-negative results? 5. A WBC count control has a mean value of 6000/mL and a a. 40 standard deviation of 300/mL. What is the 95.5% confidence b. 10 interval? c. 5 a. 3000 to 9000/mL d. 45 b. 5400 to 6600/mL c. 5500 to 6500/mL 11. What agency provides external quality assurance d. 5700 to 6300/mL (proficiency) surveys and laboratory accreditation? a. Clinical Laboratory Improvement Advisory Committee 6. The ability of an assay to distinguish the targeted analyte (CLIAC) from interfering substances within the specimen matrix is b. Centers for Medicare and Medicaid Services (CMS) called: c. College of American Pathologists (CAP) a. Analytical specificity d. Joint Commission b. Analytical sensitivity c. Clinical specificity 12. What agency provides continuing medical laboratory d. Clinical sensitivity education? a. Colorado Association for Continuing Medical Laboratory 7. The laboratory purchases reagents from a manufacturer Education (CACMLE) and develops an assay using standard references. What FDA b. Clinical Laboratory Improvement Advisory Committee category is this assay? (CLIAC) a. Cleared c. Centers for Medicare and Medicaid Services (CMS) b. Home-brew d. College of American Pathologists (CAP) c. Research use only d. Analyte-specific reagent 13. Regular review of blood specimen collection quality is an example of: 8. A laboratory scientist measures prothrombin time for a. Postanalytical quality assurance plasma aliquots from 15 healthy males and 15 healthy b. Preanalytical quality assurance females. She computes the mean and 95.5% confidence c. Analytical quality control interval and notes that they duplicate the manufacturer’s d. External quality assurance statistics within 5%. This procedure is known as: a. Confirming linearity 14. Review of laboratory report integrity is an example of: b. Setting the reference interval a. Preanalytical quality assurance c. Determining the therapeutic range b. Analytical quality control d. Establishing the reference interval by transference c. Postanalytical quality assurance d. External quality assurance 9. You purchase a preserved whole blood specimen from a distributor who provides the mean values for several 15. When performing a receiver operating curve analysis, complete blood count analytes. What is this specimen called? what a. Normal specimen parameter assesses the overall efficacy of an assay? 4|Page  RODAK – CLINICAL PRINCIPLES AND APPLICATIONS, 5TH EDITION 5TH EDITION STUDY QUESTIONS a. Area under the curve a. Regulation of molecules entering or leaving the cell b. Performance limit (threshold) b. Receptor recognition of extracellular signals c. Positive predictive value c. Maintenance of electrochemical gradients d. Negative predictive value d. Lipid production and oxidation 16. You require your laboratory staff to annually perform 8. The energy source for cells is the: manual lupus anticoagulant profiles on a set of plasmas with a. Golgi apparatus known values. This exercise is known as: b. Endoplasmic reticulum a. Assay validation c. Nucleolus b. Proficiency testing d. Mitochondrion c. External quality assessment d. Pre-pre-analytical variable assay 9. Ribosomes are synthesized by the: a. Endoplasmic reticulum b. Mitochondrion -------------------------------------------------------------------------- c. Nucleolus CHAPTER 6 CELLULAR STRUCTURE AND FUNCTION d. Golgi apparatus 1. The organelle involved in packaging and trafficking of 10. Euchromatin functions as the: cellular products is the: a. Site of microtubule production a. Nucleus b. Transcriptionally active DNA b. Golgi apparatus c. Support structure for nucleoli c. Mitochondria d. Attachment site for centrioles d. Rough endoplasmic reticulum 11. The cell cycle is regulated by: 2. The glycocalyx is composed of membrane: a. Cyclins and CDKs a. Phospholipids and cholesterol b. Protooncogenes b. Glycoproteins and glycolipids c. Apoptosis c. Transmembrane and cytoskeletal proteins d. Growth factors d. Rough and smooth endoplasmic reticulum 12. The transition from the G1 to S stage of the cell cycle 3. The “control center” of the cell is the: isregulated by: a. Nucleus a. Cyclin B/CDK1 complex b. Cytoplasm b. Cyclin A/CDK2 complex c. Membrane c. Cyclin D1 d. Microtubular system d. Cyclin E/CDK2 complex 4. The nucleus is composed largely of: 13. Apoptosis is morphologically identified by: a. RNA a. Cellular swelling b. DNA b. Nuclear condensation c. Ribosomes c. Rupture of the cytoplasm d. Glycoproteins d. Rupture of the nucleus 5. Protein synthesis occurs in the: a. Nucleus 14. Regulation of the hematopoietic microenvironment is b. Mitochondria provided by the: c. Ribosomes a. Stromal cells and growth factors d. Golgi apparatus b. Hematopoietic stem cells c. Liver and spleen 6. The shape of a cell is maintained by which of the following? d. Cyclins and caspases a. Microtubules b. Spindle fibers c. Ribosomes -------------------------------------------------------------------------- d. Centrioles CHAPTER 7 HEMATOPOIESIS 7. Functions of the cell membrane include all of the following 1. The process of formation and development of blood cells is except: termed: 5|Page  RODAK – CLINICAL PRINCIPLES AND APPLICATIONS, 5TH EDITION 5TH EDITION STUDY QUESTIONS a. Hematopoiesis b. TPO b. Hematemesis c. G-CSF c. Hematocytometry d. KIT ligand d. Hematorrhea 10. Which one of the following cytokines is required very 2. During the second trimester of fetal development, the early in the differentiation of a hematopoietic stem cell? primary site of blood cell production is the: a. IL-2 a. Bone marrow b. IL-8 b. Spleen c. EPO c. Lymph nodes d. FLT3 ligand d. Liver 11. When a patient has severe anemia and the bone marrow 3. Which one of the following organs is responsible for the is unable to effectively produce red blood cells to meet the maturation of T lymphocytes and regulation of their increased demand, one of the body’s responses is: expression of CD4 and CD8? a. Extramedullary hematopoiesis in the liver and spleen a. Spleen b. Decreased production of erythropoietin by the kidney b. Liver c. Increased apoptosis of erythrocyte progenitor cells c. Thymus d. Increase the proportion of yellow marrow in the long d. Bone marrow bones 4. The best source of active bone marrow from a 20-year-old 12. Hematopoietic stem cells produce all lineages of blood would be: cells in sufficient quantities over the lifetime of an individual a. Iliac crest because they: b. Femur a. Are unipotent c. Distal radius b. Have the ability of self-renewal by asymmetric division d. Tibia c. Are present in large numbers in the bone marrow niches d. Have a low mitotic potential in response to growth factors 5. Physiologic programmed cell death is termed: a. Angiogenesis b. Apoptosis -------------------------------------------------------------------------- c. Aneurysm CHAPTER 8 ERYTHROCYTE PRODUCTION AND d. Apohematics DESTRUCTION 6. Which organ is the site of sequestration of platelets? 1. Which of the following is an erythrocyte progenitor? a. Liver a. Pronormoblast b. Thymus b. Reticulocyte c. Spleen c. CFU-E d. Bone marrow d. Orthochromic normoblast 7. Which one of the following morphologic changes occurs 2. Which of the following is the most mature normoblast? during normal blood cell maturation: a. Orthochromic normoblast a. Increase in cell diameter b. Basophilic normoblast b. Development of cytoplasm basophilia c. Pronormoblast c. Condensation of nuclear chromatin d. Polychromatic normoblast d. Appearance of nucleoli 3. What erythroid precursor can be described as follows: the 8. Which one of the following cells is a product of the CLP? cell is of medium size compared with other normoblasts, with a. Megakaryocyte an N:C ratio of nearly 1:1. The nuclear chromatin is b. T lymphocyte condensed and chunky throughout the nucleus. No nucleoli c. Erythrocyte are seen. The cytoplasm is a muddy, blue-pink color. d. Granulocyte a. Reticulocyte b. Pronormoblast 9. What growth factor is produced in the kidneys and is used c. Orthochromic normoblast to treat anemia associated with kidney disease? d. Polychromatic normoblast a. EPO 6|Page  RODAK – CLINICAL PRINCIPLES AND APPLICATIONS, 5TH EDITION 5TH EDITION STUDY QUESTIONS 4. Which of the following is not related to the effects of b. False erythropoietin? a. The number of divisions of a normoblast 12. A cell has an N:C ratio of 4:1. Which of the following b. The formation of pores in sinusoidal endothelial cells for statements would describe it? marrow egress a. The bulk of the cell is composed of cytoplasm. c. The time between mitoses of normoblasts b. The bulk of the cell is composed of nucleus. d. The production of antiapoptotic molecules by erythroid c. The proportions of cytoplasm and nucleus are roughly progenitors equal. 5. Hypoxia stimulates RBC production by: a. Inducing more pluripotent stem cells into the erythroid lineage -------------------------------------------------------------------------- b. Stimulating EPO production by the kidney CHAPTER 9 ERYTHROCYTE METABOLISM AND c. Increasing the number of RBC mitoses MEMBRANE STRUCTURE AND FUNCTION d. Stimulating the production of fibronectin by macrophages of the bone marrow 1. Which RBC process does not require energy? a. Oxygen transport 6. In the bone marrow, RBC precursors are located: b. Cytoskeletal protein deformability a. In the center of the hematopoietic cords c. Preventing the peroxidation of proteins and lipids b. Adjacent to megakaryocytes along the adventitial cell lining d. Maintaining cytoplasm cationic electrochemical gradients c. Surrounding fat cells in apoptotic islands d. Surrounding macrophages in erythroid islands 2. What pathway anaerobically generates energy in the form 7. Which of the following determines the timing of egress of of ATP? RBCs from the bone marrow? a. Hexose monophosphate pathway a. Maturing normoblasts slowly lose receptors for adhesive b. Rapoport-Luebering pathway molecules that bind them to stromal cells. c. Embden-Meyerhof pathway b. Stromal cells decrease production of adhesive molecules d. 2,3-BPG pathway over time as RBCs mature. c. Endothelial cells of the venous sinus form pores at specified 3. Which is true concerning 2,3-BPG? intervals of time, allowing egress of free cells. a. The least abundant of RBC organophosphates d. Periodic apoptosis of pronormoblasts in the marrow cords b. Enhances O2 release from hemoglobin occurs. c. Source of RBC glucose d. Source of RBC ATP 8. What single feature of normal RBCs is most responsible for limiting their life span? 4. To survive, the RBC must detoxify peroxides. What hexose- a. Loss of mitochondria monophosphate shunt product(s) accomplishes b. Increased flexibility of the cell membrane detoxification? c. Reduction of hemoglobin iron a. ATP d. Loss of the nucleus b. 2,3-BPG c. Pyruvic and lactic acid 9. Intravascular or fragmentation hemolysis is the result of d. NADPH and reduced glutathione trauma to RBCs while in the circulation. a. True 5. Which of the following helps maintain RBC shape? b. False a. Membrane phospholipids b. Cytoskeletal proteins 10. Extravascular hemolysis occurs when: c. GPI anchor a. RBCs are mechanically ruptured d. Glycocalyx b. RBCs extravasate from the blood vessels into the tissues c. Splenic macrophages ingest senescent cells 6. The glycolipids of the RBC membrane: d. Erythrocytes are trapped in blood clots outside the blood a. Provide flexibility. vessels b. Carry RBC antigens. c. Constitute ion channels. 11. A pronormoblast in its usual location belongs to the RBC d. Attach the cytoskeleton to the lipid layer. mass of the body, but not to the erythron. a. True 7|Page  RODAK – CLINICAL PRINCIPLES AND APPLICATIONS, 5TH EDITION 5TH EDITION STUDY QUESTIONS 7. RBC membranes block passage of most large molecules such as proteins, but allow passage of small molecules such 2. Normal adult Hb A contains which polypeptide chains? as the cations Na1, K1, and Ca11. What is the term for this a. a and b membrane property? b. a and d a. Semipermeable c. a and g b. Deformable d. a and e c. Intangible d. Flexible 3. A key rate-limiting step in heme synthesis is suppression of: a. Aminolevulinate synthase 8. RBC membrane phospholipids are arranged: b. Carbonic anhydrase a. In a hexagonal lattice. c. Protoporphyrin IX reductase b. In chains beneath a protein exoskeleton. d. Glucose 6-phosphate dehydrogenase c. In two layers whose composition is asymmetric. d. So that hydrophobic portions are facing the plasma. 4. Which of the following forms of hemoglobin molecule has the lowest affinity for oxygen? 9. RBC membrane cholesterol is replenished from the: a. Tense a. Plasma. b. Relaxed b. Mitochondria. c. Cytoplasm. 5. Using the normal hemoglobin-oxygen dissociation curve in d. EMB pathway. Figure 10-7 for reference, predict the position of the curve when there is a decrease in pH. 10. The hemoglobin iron ion may become oxidized to the 13- a. Shifted to the right of normal with decreased oxygen valence state by several pathological mechanisms. What affinity portion of the Embden-Meyerhof pathway reduces iron to b. Shifted to the left of normal with increased oxygen affinity the physiologic 12 valence state? c. Shifted to the right of normal with increased oxygen affinity a. Methemoglobin reductase pathway d. Shifted to the left of normal with decreased oxygen affinity b. Hexose monophosphate pathway c. Rapoport-Luebering pathway 6. The predominant hemoglobin found in a healthy newborn d. The 2,3-BPG shunt is: a. Gower-1 11. Which of the following is an example of a transmembrane b. Gower-2 or integral membrane protein? c. A a. Glycophorin A d. F b. Ankyrin c. Spectrin 7. What is the normal distribution of hemoglobins in healthy d. Actin adults? a. 80% to 90% Hb A, 5% to 10% Hb A2, 1% to 5% Hb F 12. Abnormalities in the horizontal and vertical linkages of b. 80% to 90% Hb A2, 5% to 10% Hb A, 1% to 5% Hb F the transmembrane and cytoskeletal RBC membrane proteins c..95% Hb A, ,3.5% Hb A2, 1% to 2% Hb F may be seen as: d..90% Hb A, 5% Hb F, ,5% Hb A2 a. Shape changes. b. Methemoglobin increase. 8. Which of the following is a description of the structure of c. Reduced hemoglobin content. oxidized hemoglobin? d. Enzyme pathway deficiencies. a. Hemoglobin carrying oxygen on heme; synonymous with oxygenated hemoglobin b. Hemoglobin with iron in the ferric state (methemoglobin) and not able to carry oxygen -------------------------------------------------------------------------- c. Hemoglobin with iron in the ferric state so that carbon CHAPTER 10 HEMOGLOBIN METABOLISM dioxide replaces oxygen in the heme structure d. Hemoglobin carrying carbon monoxide; hence “oxidized” 1. A hemoglobin molecule is composed of: refers to the single oxygen a. One heme molecule and four globin chains b. Ferrous iron, protoporphyrin IX, and a globin chain 9. In the quaternary structure of hemoglobin, the globin c. Protoporphyrin IX and four globin chains chains associate into: d. Four heme molecules and four globin chains a. a tetramer in some cells and b tetramers in others 8|Page  RODAK – CLINICAL PRINCIPLES AND APPLICATIONS, 5TH EDITION 5TH EDITION STUDY QUESTIONS b. A mixture of a tetramers and b tetramers 4. For a patient with classic iron study values that are c. a dimers and b dimers equivocal for iron deficiency, which of the following tests d. Two ab dimers would be most helpful in determining whether iron deficiency is present or not? 10. How are the globin chain genes arranged? a. Zinc protoporphyrin a. With a genes and b genes on the same chromosome, b. Peripheral blood sideroblast assessment including two a gene and two b genes c. Soluble transferrin receptor b. With a genes and b genes on separate chromosomes, d. Mean cell hemoglobin including two a genes on one chromosome and one b gene on a different chromosome 5. What membrane-associated protein in enterocytes c. With a genes and b genes on the same chromosome, transports iron from the intestinal lumen into the including four a gene and four b genes enterocyte? d. With a genes and b genes on separate chromosomes, a. Transferrin including four a gene on one chromosome and two b genes b. Ferroportin on a different chromosome c. DMT1 d. Ferrochelatase 11. The nature of the interaction between 2,3-BPG and hemoglobin is that 2,3-BPG: 6. Iron is transported out of macrophages, hepatocytes, and a. Binds to the heme moiety, blocking the binding of oxygen enterocytes by what membrane protein? b. Binds simultaneously with oxygen to ensure that it stays a. Transferrin bound until it reaches the tissues, when both molecules are b. Ferroportin released from hemoglobin c. DMT1 c. Binds to amino acids of the globin chain, contributing to a d. Ferrochelatase conformational change that inhibits oxygen from binding to heme 7. Below are several of the many steps in the process from d. Oxidizes hemoglobin iron, diminishing oxygen binding absorption and transport of iron to incorporation into heme. and promoting oxygen delivery to the tissues Place them in proper order. i. Transferrin picks up ferric iron. ii. Iron is transferred to the mitochondria. iii. DMT1 transports ferrous iron into the enterocyte. -------------------------------------------------------------------------- iv. Ferroportin transports iron from enterocyte to plasma. CHAPTER 11 IRON KINETICS AND LABORATORY v. The transferrin receptor transports iron into the cell. ASSESSMENT a. v, iv, i, ii, iii b. iii, ii, iv, i, v 1. Iron is transported in plasma via: c. ii, i, v, iii, iv a. Hemosiderin d. iii, iv, i, v, ii b. Ferritin c. Transferrin 8. What is the fate of the transferrin receptor when it has d. Hemoglobin completed its role in the delivery of iron to a cell? a. It is recycled to the plasma membrane and released into 2. What is the major metabolically available storage form of the plasma. iron in the body? b. It is recycled to the plasma membrane, where it can bind a. Hemosiderin its ligand again. b. Ferritin c. It is catabolized and the amino acids are returned to the c. Transferrin metabolic pool. d. Hemoglobin d. It is retained in the endosome for the life span of the cell. 3. The total iron-binding capacity (TIBC) of the serum is an 9. The transfer of iron from the enterocyte into the plasma is indirect measure of which iron-related protein? REGULATED by: a. Hemosiderin a. Transferrin b. Ferritin b. Ferroportin c. Transferrin c. Hephaestin d. Hemoglobin d. Hepcidin 9|Page  RODAK – CLINICAL PRINCIPLES AND APPLICATIONS, 5TH EDITION 5TH EDITION STUDY QUESTIONS 10. What is the percent transferrin saturation for a patient 1. Neutrophils and monocytes are direct descendants of a with total serum iron of 63 mg/dL and TIBC of 420 mg/dL ? common progenitor known as: a. 6.7% a. CLP b. 12% b. GMP c. 15% c. MEP d. 80% d. HSC 11. Referring to Figure 11-6, into which quadrant of a Thomas 2. The stage in neutrophilic development in which the plot would a patient’s results fall with the following test nucleus is indented in a kidney bean shape and the cytoplasm results: has secondary granules that are lavender in color is the: Soluble transferrin receptor: increased above reference a. Band interval b. Myelocyte Ferritin: decreased below reference interval c. Promyelocyte Hemoglobin content of reticulocytes: within the reference d. Metamyelocyte interval a. Normal iron status 3. Type II myeloblasts are characterized by: b. Latent iron deficiency a. Presence of fewer than 20 primary granules per cell c. Functional iron deficiency b. Basophilic cytoplasm with many secondary granules d. Iron deficiency c. Absence of granules d. Presence of a folded nucleus 12. A physician is concerned that a patient is developing iron deficiency from chronic intestinal bleeding due to aspirin use 4. Which one of the following is a function of neutrophils? for rheumatoid arthritis. The iron studies on the patient show a. Presentation of antigen to T and B lymphocytes the following results: b. Protection against reexposure by same antigen c. Nonspecific destruction of foreign organisms LABORATORY ADULT PATIENT d. Initiation of delayed hypersensitivity response ASSAY REFERENCE VALUES INTERVALS 5. Which of the following cells are important in immune regulation, allergic inflammation, and destruction of tissue SERUM invading helminths? FERRITIN LEVEL 12-400 ng/mL 25 ng/mL a. Neutrophils and monocytes b. Eosinophils and basophils SERUM IRON c. T and B lymphocytes LEVEL 50–160 mg/dL 45 mg/dL d. Macrophages and dendritic cells 6. Basophils and mast cells have high-affinity surface TOTAL IRON- receptors for which immunoglobulin? BINDING 250–400 mg/dL 405 mg/dL a. A CAPACITY (TIBC) b. D TRANSFERRIN c. E SATURATION 20%–55% CALCULATE IT d. G 7. Which of the following cell types is capable of differentiating into osteoclasts, macrophages, or dendritic How would these results be interpreted? cells? a. Latent iron deficiency a. Neutrophils b. Functional iron deficiency b. Lymphocytes c. Iron deficiency c. Monocytes d. Equivocal for iron deficiency d. Eosinophils 8. Macrophages aid in adaptive immunity by: a. Degrading antigen and presenting it to lymphocytes -------------------------------------------------------------------------- b. Ingesting and digesting organisms that neutrophils cannot CHAPTER 12 LEUKOCYTE DEVELOPMENT, KINETICS, c. Synthesizing complement components AND FUNCTIONS d. Storing iron from senescent red cells 10 | P a g e  RODAK – CLINICAL PRINCIPLES AND APPLICATIONS, 5TH EDITION 5TH EDITION STUDY QUESTIONS c. Phosphatidylcholine 9. Which of the following is the final stage of B cell d. Phosphatidylserine maturation after activation by antigen? a. Large, granular lymphocyte 6. What is the name of the eicosanoid metabolite produced b. Plasma cell from endothelial cells that suppresses platelet activity? c. Reactive lymphocyte a. TXA2 d. Immunoblast b. Arachidonic acid c. Cyclooxygenase 10. The following is unique to both B and T lymphocytes and d. Prostacyclin occurs during their early development: a. Expression of surface antigens CD4 and CD8 7. Which of the following molecules is stored in platelet b. Maturation in the thymus dense granules? c. Synthesis of immunoglobulins a. Serotonin d. Rearrangement of antigen receptor genes b. Fibrinogen c. PF4 d. Platelet-derived growth factor -------------------------------------------------------------------------- 8. What plasma protein is essential to platelet adhesion? CHAPTER 13 PLATELET PRODUCTION, STRUCTURE, a. VWF AND FUNCTION b. Factor VIII c. Fibrinogen 1. The megakaryocyte progenitor that undergoes endomitosis d. P-selectin is: 9. Reticulated platelets can be enumerated in peripheral a. MK-I blood to detect: b. BFU-Meg a. Impaired production in disease states c. CFU-Meg b. Abnormal organelles associated with diseases such as d. LD-CFU-Meg leukemia c. Increased platelet production in response to need 2. The growth factor that is produced in the kidney and d. Inadequate rates of membrane cholesterol exchange with induces growth and differentiation of committed the plasma megakaryocyte progenitors is: a. IL-3 10. Platelet adhesion refers to platelets: b. IL-6 a. Sticking to other platelets c. IL-11 b. Releasing platelet granule constituents d. TPO c. Providing the surface for assembly of coagulation factors d. Sticking to surfaces such as subendothelial collagen 3. What platelet organelle sequesters ionic calcium and binds a series of enzymes of the eicosanoid pathway? a. G protein b. Dense granules -------------------------------------------------------------------------- c. DTS CHAPTER 14 MANUAL, SE MIAUTOMATED, AND d. SCCS POINT-OF-CARE TESTING IN HEMATOLOGY 4. What platelet membrane receptor binds fibrinogen and 1. A 1:20 dilution of blood is made with 3% glacial acetic acid supports platelet aggregation? as the diluent. The four large corner squares on both sides of a. GP Ib/IX/V the hemocytometer are counted, for a total of 100 cells. b. GP IIb/IIIa What is the total WBC count (3109/L)? c. GP Ia/IIa a. 0.25 d. P2Y1 b. 2.5 c. 5 5. What platelet membrane phospholipid flips from the inner d. 10 surface to the plasma surface on activation and serves as the assembly point for coagulation factors? 2. The total WBC count is 20 3 109/L. Twenty-five NRBCs per a. Phosphatidylethanolamine 100 WBCs are observed on the peripheral blood film. What is b. Phosphatidylinositol the corrected WBC count (3109/L)? 11 | P a g e  RODAK – CLINICAL PRINCIPLES AND APPLICATIONS, 5TH EDITION 5TH EDITION STUDY QUESTIONS a. 0.8 b. 8 9. Given the following values, calculate the RPI: c. 16 Observed reticulocyte count 5 6% d. 19 HCT 5 30% a. 2 3. If potassium cyanide and potassium ferricyanide are used b. 3 in the manual method for hemoglobin determination, the c. 4 final product is: d. 5 a. Methemoglobin b. Azide methemoglobin 10. Which of the following would be associated with an c. Cyanmethemoglobin elevated ESR value? d. Myoglobin a. Microcytosis b. Polycythemia 4. Which of the following would not interfere with the result c. Decreased globulins when hemoglobin determination is performed by the d. Inflammation cyanmethemoglobin method? a. Increased lipids b. Elevated WBC count c. Lyse-resistant RBCs -------------------------------------------------------------------------- d. Fetal hemoglobin CHAPTER 15 AUTOMATED BLOOD CELL ANALYSIS 5. A patient has a hemoglobin level of 8.0 g/dL. According to Examine the histograms/scatterplots obtained from four the rule of three, what is the expected range for the major instruments for the same patient specimen (Figure 15- hematocrit? 14, A-D). Compare the results, and respond to questions 1 to a. 21% to 24% 4 based on the results. b. 23.7% to 24.3% c. 24% to 27% 1. Which printout lets the end user know at a glance that the d. 21% to 27% results are acceptable and no manual work needs to be performed? 6. Calculate the MCV and MCHC for the following values: a. CELL-DYN Sapphire RBCs 5 5.00 3 1012/L b. UniCel DxH 800 HGB 5 9 g/dL c. ADVIA 2120i HCT 5 30% d. Sysmex XN-series MCV (Fl) MCHC (g/Dl) a. 30 18 2. Which instrument printout has a system flag on the b. 60 30 platelet count? c. 65 33 a. CELL-DYN Sapphire d. 85 35 b. UniCel DxH 800 c. ADVIA 2120i d. XN-series 7. What does the reticulocyte count assess? a. Inflammation 3. What do you suspect is the cause of the variation in b. Response to infection platelet counting among the four instruments? c. Erythropoietic activity of the bone marrow a. Different instruments have different levels of sensitivity. d. Ability of red blood cells to form rouleaux b. All instruments use the same principle for counting platelets. 8. For a patient with the following test results, which measure c. Some instruments are susceptible to false-positive platelet of bone marrow red blood cell production provides the most flagging under certain conditions. accurate information? d. Different instruments use different thresholds to capture Observed reticulocyte count 5 5.3% and count platelets. HCT 5 35% Morphology—moderate polychromasia 4. Based on the overall flagging for this specimen on each a. Observed reticulocyte count instrument, should a manual differential count be performed b. Corrected reticulocyte count for this patient? c. RPI d. ARC 12 | P a g e  RODAK – CLINICAL PRINCIPLES AND APPLICATIONS, 5TH EDITION 5TH EDITION STUDY QUESTIONS a. Yes, because immature granulocytes are present in the c. MCV sample. d. MCHC b. Yes, because the WBC scatterplots are abnormal. c. No, because each differential count is complete with no 10. Match each instrument listed with the technology it uses system or morphology flags. to determine WBC differential counts. 5. A patient peripheral blood film demonstrates agglutinated Abbott CELL-DYN a. volume, RBCs, and the CBC shows an elevated MCHC. What other Sapphire conductivity, parameters will be affected by the agglutination of the RBCs? and five angles a. MCV will be decreased and the RBC count will be Answer: B of light scatter increased. Siemens ADVIA 2120i b. MAPSS b. MCV will be decreased and the RBC count will be technology and decreased. Answer: C three-color c. MCV will be increased and the RBC count will be fluorescence decreased. Sysmex XN-1000 c. Peroxidase- d. MCV will be increased and the RBC count will be increased. staining 6. Match the cell-counting methods listed with the absorbance and appropriate definition: Answer: D light scatter Beckman Coulter Unicel d. Detection of a. Uses DxH 800 forward and IMPEDANCE diffraction, side scattered C reflection, and light and refraction of light Answer: A fluorescence waves b. Uses high- RF voltage electrical B waves to measure -------------------------------------------------------------------------- the internal CHAPTER 16 EXAMINATION OF THE PERPHERAL complexity of BLOOD FILM AND CORRELATION WITH THE cells COMPLETE BLOOD COUNT c. Involves detection and 1. A laboratory science student consistently makes wedge OPTICAL SCATTER A measurement of technique blood films that are too long and thin. What changes in change in technique would improve the films? electrical current a. Increasing the downward pressure on the pusher slide between two b. Decreasing the acute angle of the pusher slide electrodes c. Placing the drop of blood closer to the center of the slide d. Increasing the acute angle of the pusher slide 7. Low-voltage DC is used to measure: a. Cell nuclear volume 2. When a blood film is viewed through the microscope, the b. Total cell volume RBCs appear redder than normal, the neutrophils are barely c. Cellular complexity in the nucleus visible, and the eosinophils are bright orange. What is the d. Cellular complexity in the cytoplasm most likely cause? a. The slide was overstained. 8. Orthogonal light scatter is used to measure: b. The stain was too alkaline. a. Cell volume c. The buffer was too acidic. b. Internal complexity of the cell d. The slide was not rinsed adequately. c. Cellular granularity d. Nuclear density 3. A stained blood film is held up to the light and observed to be bluer than normal. What microscopic abnormality might 9. On the Beckman Coulter instruments, hematocrit is a be expected on this film? calculated value. Which of the following directly measured a. Rouleaux parameters is used in the calculation of this value? b. Spherocytosis a. RDW c. Reactive lymphocytosis b. Hemoglobin d. Toxic granulation 13 | P a g e  RODAK – CLINICAL PRINCIPLES AND APPLICATIONS, 5TH EDITION 5TH EDITION STUDY QUESTIONS 10. Use the reference intervals provided inside the front 4. A laboratorian using the 403 objective lens sees the cover of this text. Given the following data, summarize the following numbers of WBCs in 10 fields: 8, 4, 7, 5, 4, 7, 8, 6, 4, following blood picture: 6. Which of the following WBC counts most closely correlates WBC: 86.3 3 109/L with the estimate? HGB: 9.7 g/dL a. 1.5 3 109/L HCT: 24.2% b. 5.9 3 109/L MCV: 87.8 fL c. 11.8 3 109/L MCHC: 33.5% d. 24 3 109/L PLT: 106 3 109/L a. Leukocytosis, normocytic-normochromic anemia, 5. A blood film for a very anemic patient with an RBC count of thrombocytopenia 1.25 3 1012/L shows an average of seven platelets per oil b. Microcytic-hypochromic anemia, thrombocytopenia immersion field. Which of the following values most closely c. Neutrophilia, macrocytic anemia, thrombocytosis correlates with the estimate per microliter? d. Leukocytosis, thrombocytopenia a. 14,000 b. 44,000 c. 140,000 d. 280,000 -------------------------------------------------------------------------- CHAPTER 17 BONE MARROW EXAMINATION 6. A blood film for a patient with a normal RBC count has an average of 10 platelets per oil immersion field. Which of the 1. Where is most hematopoietic tissue found in adults? following values best correlates with the estimate per a. Liver microliter? b. Lungs a. 20,000 c. Spleen b. 100,000 d. Long bones c. 200,000 d. 400,000 2. What is the preferred bone marrow collection site in adults? 7. What is the absolute count (3 109/L) for the lymphocytes if a. Second intercostal space on the sternum the total WBC count is 9.5 3 109/L and there are 37% b. Anterior or posterior iliac crest lymphocytes? c. Any of the thoracic vertebrae a. 3.5 d. Anterior head of the femur b. 6.5 c. 13 3. The aspirate should be examined under low power to d. 37 assess all of the following except: a. Cellularity 8. Which of the following blood film findings indicates EDTA- b. Megakaryocyte numbers induced pseudothrombocytopenia? c. Morphology of abnormal cells a. The platelets are pushed to the feathered end. d. Presence of tumor cell clusters b. The platelets are adhering to WBCs. c. No platelets at all are seen on the film. 4. What is the normal M:E ratio range in adults? d. The slide has a bluish discoloration when examined a. 1.5:1 to 3.3:1 macroscopically. b. 5.1:1 to 6.2:1 c. 8.6:1 to 10.2:1 9. Which of the following is the best area to review or d. 10:1 to 12:1 perform a differential on a stained blood film? a. Red blood cells are all overlapped in groups of three or 5. Which are the most common erythrocytic stages found in more. normal marrow? b. Red blood cells are mostly separated, with a few a. Pronormoblasts overlapping. b. Pronormoblasts and basophilic normoblasts c. Red blood cells look flattened, with none touching. c. Basophilic and polychromatophilic normoblasts d. Red blood cells are separated and holes appear among the d. Polychromatophilic and orthochromic normoblasts cells. 6. What cells, occasionally seen in bone marrow biopsy specimens, are responsible for the formation of bone? 14 | P a g e  RODAK – CLINICAL PRINCIPLES AND APPLICATIONS, 5TH EDITION 5TH EDITION STUDY QUESTIONS a. Macrophages Refer to the following scenario to answer questions 1 and 2: b. Plasma cells A spinal fluid specimen is diluted 1:2 with Türk solution to c. Osteoblasts perform the nucleated cell count. A total of 6 nucleated cells d. Osteoclasts are counted on both sides of the hemocytometer, with all nine squares counted on both sides. Undiluted fluid is used to 7. What is the largest hematopoietic cell found in a normal perform the bone marrow aspirate? RBC count. A total of 105 RBCs is counted on both sides of the a. Osteoblast hemocytometer, with four large squares on both sides b. Myeloblast counted. c. Pronormoblast d. Megakaryocyte 1. The nucleated cell count is ___/mL. a. 3 8. Which of the following is not an indication for a bone b. 7 marrow examination? c. 13 a. Pancytopenia (reduced numbers of RBCs, WBCs, and d. 66 platelets in the peripheral blood) b. Anemia with RBC indices corresponding to low serum iron 2. The RBC count is ___/mL. and low ferritin levels a. 131 c. Detection of blasts in the peripheral blood b. 263 d. Need for staging of Hodgkin lymphoma c. 1050 d. 5830 9. In a bone marrow biopsy specimen, the RBC precursors were estimated to account for 40% of the cells in the marrow, 3. Based on the cell counts, the appearance of the fluid is: and the other 60% were granulocyte precursors. What a. Turbid is the M:E ratio? b. Hemolyzed a. 4:6 c. Clear b. 1.5:1 d. Cloudy c. 1:1.5 d. 3:1 4. All of the following cells are normally seen in CSF, serous fluids, and synovial fluids except: 10. On a bone marrow core biopsy sample, several large cells a. Lining cells with multiple nuclei were noted. They were located close to b. Neutrophils the endosteum, and their nuclei were evenly spaced c. Lymphocytes throughout the cell. What are these cells? d. Monocytes/histiocytes (macrophages) a. Megakaryocytes b. Osteoclasts 5. Spinal fluid was obtained from a 56-year-old woman. On c. Adipocytes receipt in the laboratory, the fluid was noted to be slightly d. Fibroblasts bloody. When a portion of the fluid was centrifuged, the supernatant was clear. The cell counts were 5200 RBCs/mL3 11. The advantage of a core biopsy bone marrow sample over and 24 WBCs/mL. On the cytocentrifuge preparation, several an aspirate is that the core biopsy specimen: nucleated RBCs were seen. a. Can be acquired by a less invasive collection technique The differential was b. Permits assessment of the architecture and cellular 52% lymphocytes, 20% neutrophils, 22% monocytes, 4% arrangement myelocytes, and 2% blasts. What is the most likely c. Retains the staining qualities of basophils owing to the use explanation for these results? of Zenker fixative a. Bone marrow contamination d. Is better for the assessment of bone marrow iron stores b. Bacterial meningitis with Prussian blue stain. c. Peripheral blood contamination d. Leukemic infiltration in the central nervous system 6. A 34-year-old woman with a history of breast cancer -------------------------------------------------------------------------- developed a pleural effusion. The fluid obtained was bloody CHAPTER 18 BODY FLUID ANALYSIS IN THE and had a nucleated cell count of 284/mL. On the LABORATORY cytocentrifuge preparation, there were several neutrophils and a few monocytes/histiocytes. There were also several 15 | P a g e  RODAK – CLINICAL PRINCIPLES AND APPLICATIONS, 5TH EDITION 5TH EDITION STUDY QUESTIONS clusters of large, dark-staining cells. These cell clumps -------------------------------------------------------------------------- appeared “three-dimensional” and contained some mitotic CHAPTER 19 ANEMIAS: RED BLOOD CELL figures. What is the most likely identification of the cells in MORPHOLOGY AND APPROACH TO DIAGNOSIS clusters? a. Mesothelial cells 1. Which of the following patients would be considered b. Metastatic tumor cells anemic with a hemoglobin value of 14.5 g/dL? Refer to c. Cartilage cells reference intervals inside the front cover of this text. d. Pneumocytes a. An adult man b. An adult woman 7. A serous fluid with a clear appearance, specific gravity of c. A newborn boy 1.010, protein concentration of 1.5 g/dL, and fewer than 500 d. A 10-year-old girl mononuclear cells/mL would be considered: a. Infectious 2. Common clinical symptoms of anemia include: b. An exudate a. Splenomegaly c. A transudate b. Shortness of breath and fatigue d. Sterile c. Chills and fever d. Jaundice and enlarged lymph nodes 8. On the cytocentrifuge slide prepared from a peritoneal fluid sample, many large cells are seen, singly and in clumps. 3. Which of the following are important to consider in the in The cells have a “fried egg” appearance and basophilic the patient’s history when investigating the cause of an cytoplasm, and some are multinucleated. These cells should anemia? be reported as: a. Diet and medications a. Suspicious for malignancy b. Occupation, hobbies, and travel b. Macrophages c. Bleeding episodes in the patient or in his or her family c. Large lymphocytes members d. Mesothelial cells d. All of the above Refer to the following scenario to answer questions 9 and 10: 4. Which one of the following is reduced as an adaptation to A 56-yearold man came to the physician’s office with long-standing anemia? complaints of pain and swelling in his left big toe. Fluid a. Heart rate aspirated from the toe was strawcolored and cloudy. The b. Respiratory rate WBC count was 2543/mL. The differential c. Oxygen affinity of hemoglobin consisted mainly of neutrophils and monocytes/histiocytes. d. Volume of blood ejected from the heart with each Intracellular and extracellular crystals were seen on the contraction cytocentrifuge slide. The crystals were needle-shaped and, when polarized with the use of the red compensator, 5. An autoimmune reaction destroys the hematopoietic stem appeared yellow on the y-axis. cells in the bone marrow of a young adult patient, and the amount of active bone marrow, including RBC precursors, is 9. The crystals are: diminished. The RBC precursors that are present are normal a. Cholesterol in appearance, but there are too few to meet the demand for b. Hyaluronidase circulating red blood cells, and anemia develops. The c. Monosodium urate reticulocyte count is low. The mechanism of the anemia d. Calcium pyrophosphate would be described as: a. Effective erythropoiesis 10. This patient’s painful toe was caused by: b. Ineffective erythropoiesis a. Gout c. Insufficient erythropoiesis b. Infection c. Inflammation 6. What are the initial laboratory tests that are performed for d. Pseudogout the diagnosis of anemia? a. CBC, iron studies, and reticulocyte count b. CBC, reticulocyte count, and peripheral blood film examination c. Reticulocyte count and serum iron, vitamin B12, and folate assays 16 | P a g e  RODAK – CLINICAL PRINCIPLES AND APPLICATIONS, 5TH EDITION 5TH EDITION STUDY QUESTIONS d. Bone marrow study, iron studies, and peripheral blood film explanation for the patient’s symptoms. The results are as examination follows: 7. An increase in which one of the following suggests a CBC: all results within reference intervals except RDW 5 15% shortened life span of RBCs and hemolytic anemia? Serum iron: decreased a. Hemoglobin TIBC: increased b. Hematocrit % transferrin saturation: decreased c. Reticulocyte count Serum ferritin: decreased d. Red cell distribution width Correlate the patient’s laboratory and clinical findings. What can you conclude? 8. Which of the following is detectable only by examination of a. The results of the iron studies reveal findings consistent a peripheral blood film? with a thalassemia that was apparently previously a. Microcytosis undiagnosed. b. Anisocytosis b. The patient is in stage 2 of iron deficiency, before frank c. Hypochromia anemia develops. d. Poikilocytosis c. The results of the iron studies are inconsistent with the CBC results, and a laboratory error should be suspected. 9. Schistocytes, ovalocytes, and acanthocytes are examples of d. There is no evidence of a hematologic explanation for abnormal changes in RBC: the patient’s symptoms. a. Volume b. Shape 2. A bone marrow biopsy was performed as part of the cancer c. Inclusions staging protocol for a patient with Hodgkin lymphoma. d. Hemoglobin concentration Although no evidence of spread of the tumor was apparent in the marrow, other abnormal findings were noted, including a 10. Refer to Figure 19-3 to determine which one of the slightly elevated myeloid-to-erythroid ratio. WBC and RBC following conditions would be included in the differential morphology appeared normal, however. The Prussian blue diagnosis of an anemic adult patient with an absolute stain showed abundant stainable iron in the marrow reticulocyte count of 20 3 109/L and an MCV of 65 fL. macrophages. The patient’s CBC revealed a hemoglobin of a. Aplastic anemia 10.8 g/dL, but RBC indices were within reference intervals. b. Sickle cell anemia RBC morphology was unremarkable. These findings would be c. Iron deficiency consistent with: d. Folate deficiency a. Anemia of chronic inflammation b. Sideroblastic anemia 11. Which one of the following conditions would be included c. Thalassemia in the differential diagnosis of an anemic adult patient with d. Iron deficiency anemia an MCV of 125 fL and an RDW of 20% (reference interval 11.5% to 14.5%)? 3. Predict the iron study results for the patient with Hodgkin a. Aplastic anemia lymphoma described in question 2. b. Sickle cell anemia c. Iron deficiency d. Vitamin B12 deficiency SERUM % SERUM IRON TIBC TRANSFERRIN FERRITIN LEVEL SATURATION LEVEL a. Decreased Increased Decreased Decreased -------------------------------------------------------------------------- CHAPTER 20 DISORDERS OF IRON KINETICS AND b. Increased Normal Increased Normal HEME METABOLISM c. Increased Increased Normal Increased 1. The mother of a 4-month-old infant who is being breastfed d. Decreased Decreased Normal Normal sees her physician for a routine postpartum visit. She expresses concern that she may be experiencing postpartum 4. A 35-year-old white woman went to her physician depression because she does not seem to have any energy. complaining of headaches, dizziness, and nausea. The Although the physician is sympathetic to the patient’s headaches had been increasing in severity over the past 6 concern, she orders a CBC and iron studies seeking an organic months. This was coincident with her move into an older house built about 1900. She had been renovating the house, 17 | P a g e  RODAK – CLINICAL PRINCIPLES AND APPLICATIONS, 5TH EDITION 5TH EDITION STUDY QUESTIONS including stripping paint from the woodwork. Her CBC results d. Decrease during inflammation and increase iron absorption showed a mild hypochromic, microcytic anemia, with from enterocytes polychromasia and basophilic stippling noted. Which of the following tests would be most useful in confirming the cause 10. Sideroblastic anemias result from: of her anemia? a. Sequestration of iron in hepatocytes a. Serum lead level b. Inability to incorporate heme into apohemoglobin b. Serum iron level and TIBC c. Sequestration of iron in myeloblasts c. Absolute reticulocyte count d. Failure to incorporate iron into protoporphyrin IX d. Prussian blue staining of the bone marrow to detect iron stores in macrophages 11. In general, the hereditary hemochromatoses result from mutations that impair: 5. In men and postmenopausal women whose diets are a. The manner in which developing red cells acquire and adequate, iron deficiency anemia most often results from: manage iron a. Increased need associated with aging b. The hepcidin-ferroportin iron regulatory system b. Impaired absorption in the gastric mucosa c. The TfR-Tf endocytic iron acquisition process for body c. Chronic gastrointestinal bleeding cells other than blood cells d. Diminished resistance to hookworm infections d. The function of divalent metal transporter in enterocytes and macrophages 6. Which one of the following individuals is at greatest risk for the development of iron deficiency anemia? 12. In the erythropoietic porphyrias, mild anemia may be a. A 15-year-old boy who eats mainly fast food and junk accompanied by what distinctive clinical finding? food a. Gallstones b. A 37-year-old woman who has never been pregnant and b. Impaired night vision has amenorrhea c. Unintentional nighttime leg movements c. A 63-year-old man with reactivation of tuberculosis from d. Heightened propensity for sunburn his childhood d. A 40-year-old man who lost blood during surgery to repair a fractured leg 7. Which of the following individuals is at the greatest risk for -------------------------------------------------------------------------- the development of anemia of chronic inflammation? CHAPTER 21 ANEMIAS CAUSED BY DEFECTS OF DNA a. A 15-year-old girl with asthma METABOLISM b. A 40-year-old woman with type 2 diabetes mellitus c. A 65-year-old man with hypertension 1. Which of the following findings is consistent with a d. A 30-year-old man with severe rheumatoid arthritis diagnosis of megaloblastic anemia? a. Hyposegmentation of neutrophils 8. In what situation will increased levels of free erythrocyte b. Decreased serum lactate dehydrogenase level protoporphyrin be present? c. Absolute increase in reticulocytes a. Gain of function mutation to one of the enzymes in the d. Increased MCV heme synthesis pathway b. A mutation that prevents heme attachment to globin so 2. A patient has a clinical picture of megaloblastic anemia. that protoporphyrin remains free The serum folate level is decreased, and the serum vitamin c. Any condition that prevents iron incorporation into B12 level is 600 pg/mL (reference interval is 200–900 pg/mL). protoporphyrin IX What is the expected value for the methylmalonic acid assay? d. When red blood cells lyse, freeing their contents into the a. Increased plasma b. Decreased c. Within the reference interval 9. In the pathogenesis of the anemia of chronic inflammation, hepcidin levels: 3. Which one of the following statements characterizes the a. Decrease during inflammation and reduce iron absorption relationships among macrocytic anemia, megaloblastic from enterocytes anemia, and pernicious anemia? b. Increase during inflammation and reduce iron absorption a. Macrocytic anemias are megaloblastic. from enterocytes b. Macrocytic anemia is pernicious anemia. c. Increase during inflammation and increase iron absorption c. Megaloblastic anemia is macrocytic. from enterocytes d. Megaloblastic anemia is pernicious anemia. 18 | P a g e  RODAK – CLINICAL PRINCIPLES AND APPLICATIONS, 5TH EDITION 5TH EDITION STUDY QUESTIONS d. Increased production of reticulocytes in an attempt to 4. Which of the following CBC findings is most suggestive of compensate for the anemia a megaloblastic anemia? a. MCV of 103 fL 10. Which one of the following groups has t