HEMA 6TH TURGEON (HIGHLIGHT) PDF Review Questions

REVIEW QUESTIONS *Indicates MLT (optional) and MLS advanced content. An Overview of the Hematology Laboratory Patient Safety 1. The National Patient Safety Goals include A. use of the patient identifiers B. use of proper evacuated collection tube anticoagulants C. proper disinfection of laboratory counter tops D. proper donning of latex gloves 2. The primary intended purpose of the laboratory safety manual is to A. protect the patient and laboratory personnel B. protect laboratory and other hospital personnel C. comply with local health and state regulatory requirements D. comply with OSHA regulations Safety in the Hematology Laboratory 3. If a blood specimen is spilled on a laboratory bench or floor area, the first step in cleanup should be A. wear gloves and a lab coat B. absorb blood with disposable towels C. clean with freshly prepared 1% chlorine solution D. wash with water 4. The likelihood of infection after exposure to HBV-infected or HIV- infected blood or body fluids depends the least on the A. source (anatomical site) of the blood or fluid B. concentration of the virus C. duration of the contact D. presence of nonintact skin 5. Standard precautions have been instituted in clinical laboratories to prevent __________ exposures of healthcare workers to bloodborne pathogens such as HIV and HBV. A. parenteral B. nonintact mucous membrane C. nonintact skin D. all of the above 6. Exposure to __________ constitutes the major source of HIV and HBV infection in health care personnel. A. sputum B. blood C. urine D. semen 7 and 8. Diluted bleach for disinfecting work surfaces, equipment, and spills should be freshly prepared by making a __________ (6) dilution of household bleach. This dilution requires __________ (7) mL of bleach diluted to 100 mL with H2O. 7. A. 1:5 B. 1:10 C. 1:20 D. 1:100 8. A. 1 B. 10 C. 25 D. 50 9. In which of the following laboratory situations is a verbal report permissible? A. When the patient is going directly to the physician’s office and would like to have the report available B. When the report cannot be found at the nurse’s station C. When emergency test results are needed by a physician D. None of the above Quality Assessment in the Hematology Laboratory 10. The most frequent type of laboratory specimen error is A. preanalytical error B. analytical error C. postanalytical error D. A or B 11. The delta check is used to detect A. the use of the correct anticoagulant B. the time of storage of a tested specimen C. the difference between current and past patient results D. the proper collection time of a patient specimen 12. Which of the following errors represent a preanalytical (preexamination) error? A. wrong assay performed B. Failure to run a normal control specimen when testing C. Calling the ER with stat results D. incorrect labeling of a specimen *13. Instrument calibration should be performed, at least, __________, according to CLIA. A. Once a year B. Twice a year C. Three times a year D. Daily Quality Control in the Hematology Laboratory 14. A control specimen is A. a known value in a specimen similar to a patient specimen B. closeness to the true value C. the process of monitoring accuracy D. comparison to a known physical constant 15. The term accuracy means A. a known value in a specimen similar to a patient specimen B. closeness to the true value C. the process of monitoring accuracy D. comparison to a known physical constant 16. The term precision means A. how close test results are when repeated B. a purified substance of a known composition C. the process of monitoring accuracy and reproducibility of known control results D. the value is unknown 17. The term calibration means A. a known value in a specimen similar to a patient specimen B. closeness to the true value C. the process of monitoring accuracy D. comparison to a known physical constant *18. Which of the following is not a function of a quantitative QC program? A. Monitors the correct functioning of equipment, reagents, and individual technique B. Confirms the correct identity of patient specimens C. Compares the accuracy of controls to reference values D. Detects shifts in control values 19. The standard deviation is A. the difference between the upper and lower measurements in a series of results B. The expression of the position of each test result to the average C. The arithmetic average D. The degree to which test data vary about the average *20. The term variance means A. sum of the squared differences from the mean B. square root of the variance from the mean C. standard deviation expressed as a percentage of the mean D. degree to which test data vary about the average *21. When validating a control reference range, what is the minimum number of patient samples needed to calculate the deviations from the mean value? A. 10 B. 20 C. 30 D. 100 22. Acceptable limits of a control value must fall A. within ±1 standard deviation of the mean B. between 1 and 2 standard deviations of the mean C. within ±2 standard deviations of the mean D. within ±3 standard deviations of the mean *23. A trend change in QC data is A. a progressive change all in one direction away from the mean for at least 3 days B. an abrupt shift in the control values C. scattered variations from the mean D. a progressive change in various directions away from the mean for at least 1 week 24. A continuously increasing downward variation in a control sample in one direction from the mean can indicate A. deterioration of reagents used in the test B. deterioration of the control specimen C. deterioration of a component in an instrument D. all of the above 25. Which of the following statements is true of a Gaussian distribution A. It represents the standard deviation. B. It represents the coefficient of variation. C. It represents variance of a population. D. It represents a normal bell-shaped distribution. 26. Two standard deviations (2 SD) from the mean in a normal distribution curve would include A. 99% of all values B. 95% of all values C. 75% of all values D. 68% of all values COMPANION RESOURCES Each student is encouraged to access and use the Web-based companion resources developed for this chapter. Here, you will find additional learning tools to increase your understanding of the concepts and clinical applications of the chapter. REVIEW QUESTIONS *Indicates MLT (optional) and MLS advanced content. 1. When the coagulation of fresh whole blood is prevented through the use of an anticoagulant, the straw-colored fluid that can be separated from the cellular elements is A. serum B. plasma C. whole blood D. platelets 2. Which characteristic is inaccurate with respect to the anticoagulant K3 EDTA? A. Removes ionized calcium (Ca2+) from fresh whole blood by the process of chelation B. Is used for most routine coagulation studies C. Is the most commonly used anticoagulant in hematology D. Is conventionally placed in lavender-stoppered evacuated tubes 3. Heparin inhibits the clotting of fresh whole blood by neutralizing the effect of A. platelets B. ionized calcium (Ca2+) C. fibrinogen D. thrombin 4. The conventional color-coded evacuated tube stopper for EDTA anticoagulant is A. red B. lavender C. blue D. green The conventional color-coded evacuated tube stopper for heparin 5. is A. red B. lavender C. blue D. green 6. The conventional color-coded evacuated tube stopper for sodium citrate is A. red B. lavender C. blue D. green 7. The conventional color-coded stopper when no anticoagulant or additive is present in an evacuated tube is A. red B. lavender C. blue D. green 8 through 12. List the following five procedural steps in the performance of a venipuncture in the correct sequence. A. Select an appropriate site and prepare E 8. ______ the site. B B. Identify the patient, check test 9. ______ requisitions, assemble equipment, wash A hands, and put on latex gloves. 10. ______ C. Remove tourniquet, remove needle, D 11. ______ apply pressure to site, and label all tubes. C D. Reapply the tourniquet and perform the 12. ______ venipuncture. E. Introduce yourself and briefly explain the procedure to the patient. 13. The appropriate veins for performing a routine venipuncture are the A. cephalic, basilic, and median cubital B. subclavian, iliac, and femoral C. brachiocephalic, jugular, and popliteal D. saphenous, suprarenal, and tibial *14. A blood sample is needed from a patient with IV fluids running in both arms. Which of the following is an acceptable procedure? A. Any obtainable vein is satisfactory. B. Obtain sample from above the IV site. C. Obtain sample from below the IV site with special restrictions. D. Disconnect the IV line. E. Do not draw a blood specimen. 15. The bevel of the needle should be held ______ in the performance of a venipuncture. A. sideways B. upward C. downward D. in any direction 16. A hematoma can form if A. improper pressure is applied to a site after the venipuncture B. the patient suddenly moves and the needle comes out of the vein C. the needle punctures both walls of the vein D. all of the above 17. Phlebotomy problems can include A. the use of improper anticoagulants B. misidentification of patients C. improper angle of the needle or having the needle up against the side of the vessel wall D. all of the above 18. Which of the following skin puncture areas is acceptable for the collection of capillary blood from an infant? A. Previous puncture site B. Posterior curve of the heel C. The arch D. Medial or lateral plantar surface 19. The proper collection of capillary blood includes A. wiping away the first drop of blood B. occasionally wiping the site with a plain gauze pad to avoid the buildup of platelets C. avoiding the introduction of air bubbles into the column of blood in a capillary collection tube D. all of the above 20. A peripheral blood smear can be prepared from A. EDTA-anticoagulated blood within 1 hour of collection B. free-flowing capillary blood C. citrated whole blood D. both A and B 21. Identify the characteristic(s) of a good peripheral blood smear. A. It progresses from thick at the point of origin to thin. B. It has a blunt feathered termination. C. The outer margins do not touch the edges of the slide. D. All of the above. 22. Poor blood smears can be caused by A. a delay in preparing the smear once the drop of blood has been placed on the slide B. a drop of blood that is too large or too small C. holding the pusher slide at the wrong angle and poor drying conditions D. all of the above 23. If a blood smear is too long, the problem can be resolved by A. decreasing the angle of the pusher slide B. increasing the angle of the pusher slide C. using a larger drop of blood D. pushing the slide slower in smearing out the blood *24. The examination of bone marrow is useful in A. diagnosing a bleeding disorder B. diagnosing some disorders associated with erythrocytes and leukocytes C. diagnosing acute leukemias D. both B and C *25. Appropriate bone marrow aspiration sites in an adult are A. the anterior and posterior iliac crest B. the sternum and posterior iliac crest C. the tibia and sternum D. both A and B 26. A basic staining effect imparts a(n) _____________ color to blood cells. A. orange-red color B. pink-lilac color C. blue-purple color D. no effect 27. An acidic staining effect imparts a(n) _____________ color to blood cells. A. orange-red color B. pink-lilac color C. blue-purple color D. no effect 28. A neutrophilic staining effect imparts a(n) _____________ color to blood cells. A. orange-red color B. pink-lilac color C. blue-purple color D. no effect 29. Wright’s stain is a(n) ______ stain. A. Romanowsky-type B. non–Romanowsky-type *30. If a blood smear stains too red on microscopic examination of a Wright-stained preparation, possible causes include that A. the staining time was too long B. the stain was too basic C. the buffer was too acidic and the exposure time was too short D. the buffer was too basic and the exposure time was too long NOTE: This is a good time for a review of the Chapter Highlights and a comprehensive review of all of the Review Questions before proceeding to the case studies. CHAPTER 2 CHAPTER 3 REVIEW QUESTIONS *Indicates MLT (optional) and MLS advanced content. Cell Morphology: Ultrastructure and Organization 1. The smallest organized unit of living tissue is the A. nucleus B. cell C. organelle D. cytoplasm 2. The cell membrane’s major components are A. carbohydrates and proteins B. proteins and lipids C. lipids and glycoproteins D. polysaccharides and lipids 3. Which of the following is a characteristic of osmosis? A. Requires energy (ATP) B. Movement of water molecules C. An unusual cellular activity D. Requires a carrier molecule 4. Which of the following is a characteristic of active transport? A. Requires energy (ATP) B. Movement of molecules up the concentration gradient C. Requires a carrier molecule D. All of the above 5. Phagocytosis is A. a type of endocytosis B. the engulfment of fluid molecules C. the engulfment of particulate matter D. Both A and C Cytoplasmic Organelles and Metabolites 6. The appropriate function of centrioles is A. protein production B. concentration of secretory granules C. lipid synthesis D. points of attachment of the spindle fibers 7. The appropriate function of the rough ER is A. protein production B. concentration of secretory granules C. lipid synthesis D. DNA synthesis 8. The appropriate function of the smooth ER is A. protein production B. concentration of secretory granules C. lipid synthesis D. DNA synthesis 9. The appropriate function of the Golgi apparatus is A. protein production B. concentration of secretory granules C. lipid synthesis D. DNA synthesis 10. The appropriate function of the lysosomes is A. energy production and heme synthesis B. protein synthesis C. cytoskeleton D. intracellular digestion 11. The appropriate function of the microtubules is A. energy production and heme synthesis B. protein synthesis C. cytoskeleton D. intracellular digestion 12. The appropriate function of the mitochondria is A. energy production and heme synthesis B. protein synthesis C. cytoskeleton D. intracellular digestion 13. The appropriate function of the ribosomes is A. energy production and heme synthesis B. protein synthesis C. cytoskeleton D. intracellular digestion 14. Glycogen is a A. protein B. lipid C. carbohydrate D. hormone 15. A cellular inclusion that represents a common storage form of iron is A. glycogen B. vacuoles C. Auer body D. ferritin 16. The nucleus of the cell contains A. chromatin, nucleoli, and nucleoplasm B. chromatin, nucleoli, and ribosomes C. DNA, RNA, and ribosomes D. DNA, RNA, and mitochondria 17. The overall function of DNA is A. protein and enzyme production B. control of cellular function and transmission of genetic information C. control of heterochromatin and euchromatin synthesis D. production of cellular energy and transmission of genetic information *18. Heterochromatin is A. genetically inactive B. found in patches or clumps C. genetically inactive and pale staining D. Both A and B 19. Chromosomal translocation is A. a frequent activity of homologous chromosomes in meiosis B. a rearrangement of genetic material C. the process in which a segment of one chromosome breaks away from its normal location D. All of the above 20. A chromosomal deletion is A. loss of a pair of chromosomes B. loss of a segment of chromosome C. attachment of a piece of a chromosome D. an exchange of genetic material 21. In the G1 phase of mitotic activity, _____. A. DNA replication occurs B. a protracted state of mitotic inactivity occurs C. immediately precedes actual mitotic division D. protein synthesis and cellular metabolism are active 22. In the S phase of mitotic division, _________. A. DNA replication occurs B. a protracted state of mitotic inactivity occurs C. immediately precedes actual mitotic division D. protein synthesis and cellular metabolism are active 23. In the G2 phase of mitotic activity, ________. A. DNA replication occurs B. a protracted state of mitotic inactivity occurs C. immediately precedes actual mitotic division D. protein synthesis and cellular metabolism are active 24. In the G0 phase, _________. A. DNA replication occurs B. a protracted state of mitotic inactivity occurs C. actual mitotic division occurs D. protein synthesis and cellular metabolism are active 25. In prophase A. Chromosomes line up at the cell’s equator B. Two identical daughter cells form C. Division of the cellular cytoplasm occurs D. Chromosomes tightly coil and condense 26. In metaphase A. Chromosomes line up at the cell’s equator B. Two identical daughter cells form C. Division of the cellular cytoplasm occurs D. Chromatids separate and move to opposite ends of the mitotic spindle 27. In anaphase A. Chromosomes line up at the cell’s equator B. Two identical daughter cells form C. Division of the cellular cytoplasm occurs D. Chromatids separate and move to opposite ends of the mitotic spindle 28. In telophase A. Chromosomes line up at the cell’s equator B. Two identical daughter cells form C. Division of the cellular cytoplasm occurs D. Chromatids separate and move to opposite ends of the mitotic spindle 29. In cytokinesis A. Chromosomes line up at the cell’s equator B. Two identical daughter cells form C. Division of the cellular cytoplasm occurs D. Chromatids separate and move to opposite ends of the mitotic spindle Apoptosis 30. Apoptosis is described as A. active cell growth B. active cell death C. passive cell growth D. passive cell death *31. Apoptosis is characterized by A. chromatin condensation and fragmentation B. cell shrinkage C. elimination of dead cells by phagocytosis D. all of the above *32. Apoptosis can be prevented by A. synthesis of antiapoptotic proteins B. hematopoietic progenitor cell growth factors C. caspases activity D. either A or B 33. Beneficial outcomes of apoptosis can include all of the following except: A. controlling the size of the lymphocyte pool B. removal of tumor cells C. removal of virally infected lymphocytes D. removal of natural killer (NK) cells *34. The intrinsic pathway of apoptosis focuses on A. mitochondria as initiators of cell death B. tumor necrosis factor (TNF) family death receptors C. Bcl-2 as the antideath gene D. stressed endoplasmic reticulum (ER) 35. Apoptosis is morphologically identified by A. nuclear condensation B. cell membrane rupture C. nuclear rupture D. development of cytoplasmic granules *36. The extrinsic pathway of apoptosis focuses on A. mitochondria as initiators of cell death B. tumor necrosis factor (TNF) family death receptors C. stressed endoplasmic reticulum D. CD95 *37. A major function of protein p53 is to A. promote cell cycle arrest B. promote apoptosis to eliminate defective cells C. induce genes involved in cell growth, differentiation, and development D. activate NF-kB molecules *38. Decreased apoptosis is found in A. cancers with p53 mutations B. aplastic anemias C. myelodysplastic syndromes D. acquired immunodeficiency syndrome Meiosis 39. In meiosis, the cells produced contain A. a 2n number of chromosomes B. 22 pairs of chromosomes C. 23 pairs of chromosomes D. 23 chromosomes 40. Hematologists are interested in inherited disorders. Which of the following are inherited disorders? A. Sickle cell trait B. Sickle cell anemia C. Hemophilia D. All of the above The Foundations of Genetic Interactions 41. The first inherited hematologic disorder to be diagnosed using molecular biologic assay was A. hemophilia A B. factor V Leiden C. sickle cell anemia D. CML 42. Genomics is the study of: A. the entire genetic composition of an organism B. the composition, structure, function, and interaction of proteins C. the mitotic cell cycle D. the frequency of genetic distribution 43. All of the following are deoxyribonucleotide bases except: A. adenine (A) B. thymine (T) C. cytosine (C) D. uracil (U) *44. The pre-mRNA template includes A. the entire gene B. exons C. introns D. all of the above *45. Exons are ultimately translated on the ribosomes into A. carbohydrate B. lipid C. protein D. spliced out and ultimately processed into mature RNA *46. All of the following characteristics are true of UTRs except: A. effect the stability of mRNA B. effect the efficiency of translation protein C. regulate many cellular proteins D. regulate the cell cycle rate of division *47. A region of DNA that differs in only a single DNA nucleotide is specifically called A. a mutation B. a polymorphism C. allele D. an SNP *48. Mutations usually affect A. a single base in the DNA B. multiple base pairs in DNA C. translation of mRNA into protein D. Both A and C *49. In chronic myelogenous leukemia (CML), all of the characteristics are accurate except: A. initiated by a reciprocal to t(9;22) chromosomal translocation B. a fusion of the ABL protooncogene to the BCR gene C. a state of enhanced tyrosine kinase activity exists D. a fusion gene is found in only the most serious cases of CML *50. A cluster of differentiation (CD) for specific lineages of cells A. aids in determining the cellular lineage of malignant proliferating cells B. identifies antibodies on the cell surface of hematopoietic cells C. detect heavy chain or kappa chain rearrangements D. both A and B COMPANION RESOURCES Each student is encouraged to access and use the Web-based companion resources developed for this chapter. Here you will find additional learning tools to increase your understanding of the CHAPTER 3 CHAPTER 4 REVIEW QUESTIONS *Indicates MLT (optional) and MLS advanced content. Ontogeny of Hematopoiesis 1. Tissues and organs associated with the hematopoietic system include A. the bone marrow B. the fetal liver C. the lymph nodes and thymus D. all of the above 2. The normal sequence of blood cell development is A. yolk sac—red bone marrow—liver and spleen B. yolk sac—thymus—liver and spleen—red bone marrow C. yolk sac—liver and spleen—red bone marrow D. liver and spleen—yolk sac—red bone marrow 3. The maturational sequence of the thrombocyte (platelet) is A. megakaryoblast—promegakaryocyte—megakaryocyte— metamegakaryocyte—thrombocyte B. B promegakaryocyte—megakaryocyte—metamegakaryocyte —thrombocyte C. megakaryoblast—promegakaryocyte—megakaryocyte— thrombocyte D. megakaryoblast—promegakaryocyte—metamegakaryocyte— thrombocyte 4. The maturational sequence(s) of the erythrocyte is (are) A. rubriblast—prorubricyte—rubricyte—metarubricyte— reticulocyte—mature erythrocyte B. prorubricyte—rubricyte—metarubricyte—reticulocyte—mature erythrocyte C. pronormoblast—basophilic normoblast—polychromatophilic normoblast—orthochromic normoblast—reticulocyte—mature erythrocyte D. both A and C 5. The cell maturation sequence of the segmented neutrophil is A. promyelocyte—myeloblast—myelocyte—metamyelocyte— band or stab—segmented neutrophil (PMN) B. myeloblast—promyelocyte—myelocyte—metamyelocyte— band or stab—segmented neutrophil (PMN) C. monoblast—promyelocyte—myelocyte—metamyelocyte— band or stab—segmented neutrophil (PMN) D. promyelocyte—myelocyte—metamyelocyte—band or stab— segmented neutrophil (PMN) Hematopoietic Organs and Tissues 6. The hematopoietically active area of bone marrow is (are) A. yellow marrow B. red marrow C. storage compartments D. calcified structures 7. Bone marrow represents approximately __________of total body weight and averages 1500 gms. in adults. A. 1.0% to 3.0% B. 3.5% to 6% C. 8% to 10% D. more than 25% 8. By age 18, red marrow can be found in the A. skull bones B. vertebrae and ribs C. sternum and pelvis D. all of the above *9. When the body reverts back to extramedullary hematopoiesis, abnormal conditions in the bone marrow such as __________ can be present. A. hemolytic or aplastic anemias B. infiltration by malignant cells C. overproliferation of a cell line D. any of the above Cellular Elements of Bone Marrow 10. Stem cells are functionally defined at the single cell level as A. having the capacity for self-renewal B. having the capacity of multipotential differentiation C. being essential in tissues with low cellular turnover D. A and B 11. The abbreviation MAPCs stands for A. multiple adult progenitor cells B. multipotent adult progenitor cells C. many abnormal progenitor cells D. multiply active potential cells 12. Erythropoiesis occurs in specialized niches (erythropoietic niches) where erythroid precursors can A. proliferate B. differentiate C. enucleate D. all of the above *13. Erythroid cells account for __________ of nucleated cells in normal bone marrow. A. 1% to 2% B. 5% to 38% C. 40% to 50% D. >50% *14. During granulopoiesis, mature cells spend an average of __________ in the proliferating pool. A. 1 week *15. Once in the blood circulation, granulocytes have an average life span of A. 1 to 2 hours B. 2 to 4 hours C. 6 to 10 hours D. >24 hours *16. Myeloid cells account for __________of the nucleated cells in normal bone marrow. A. 5% to 10% B. 15% to 25% C. 23% to 85% D. >95% *17. Macrophages in the bone marrow of patients with Gaucher’s disease have __________ in the cytoplasm. A. iron-rich hemosiderin B. iron-rich ferritin C. uncatabolized glucocerebrosides D. erythrocytes filled with hemoglobin *18. The term interleukin is used to describe A. a group of protein molecules B. cytokines C. molecules that influence blood cell proliferation, maturation, migration, and adhesion D. all of the above *19. The major role of hematopoietic growth factors appears to be regulating A. the proliferation of HPCs B. the differentiation of HPCs C. the survival and function of mature blood cells D. all of the above Examination of Maturing Blood Cells 20. As a blood cell matures, the overall cell diameter in most cases A. increases B. decreases C. remains the same 21. As a blood cell matures, the ratio of nucleus to cytoplasm (N:C) in most cases A. increases B. decreases C. remains the same 22. The chromatin pattern, in most cells, as the cell matures A. becomes more clumped B. becomes less clumped C. remains the same 23. The presence of nucleoli is associated with A. immature cells B. all young cells, except myeloblasts C. only erythroblasts D. disintegrating cells 24. In the blast stage of development of leukocytes, the cytoplasm of the cell is A. dark blue and lacks vacuoles B. light blue and lacks granules C. light blue and has specific granules D. gray with many dark-blue granules Mature Blood Cells in Peripheral Blood 25. A characteristic of a segmented neutrophil is A. large orange granules B. an elongated and curved nucleus C. light, sky-blue cytoplasm D. the greatest number of WBCs in the peripheral blood of an adult 26. A characteristic of a mature monocyte is A. large orange granules B. an elongated and curved nucleus C. light, sky-blue cytoplasm D. kidney bean–shaped nucleus 27. A characteristic of a mature lymphocyte is A. large orange granules B. an elongated and curved nucleus C. light, sky-blue cytoplasm D. kidney bean–shaped nucleus 28. A characteristic of a band form neutrophil is A. an elongated and curved nucleus B. light, sky-blue cytoplasm C. kidney bean–shaped nucleus D. averages approximately 56% of normal adult leukocytes in the peripheral blood 29. A characteristic of a mature eosinophil is A. large orange granules B. an elongated and curved nucleus C. light, sky-blue cytoplasm D. kidney bean–shaped nucleus COMPANION RESOURCES Each student is encouraged to access and use the Web-based companion resources developed for this chapter. Here, you will find additional learning tools to increase your understanding of the concepts and clinical applications of the chapter. CHAPTER 4 CHAPTER 5 REVIEW QUESTIONS *Indicates MLT (optional) and MLS advanced content. Erythropoiesis 1. The progression of erythropoiesis from prenatal life to adulthood is A. yolk sac, red bone marrow, and liver and spleen B. yolk sac, liver and spleen, and red bone marrow C. red bone marrow, liver and spleen, and yolk sac D. liver and spleen, yolk sac, and red bone marrow 2. Which of the following is (are) characteristic(s) of erythropoietin? A. Glycoprotein B. Secreted by the liver C. Secreted by the kidneys D. All of the above 3. Which of the following is a characteristic of erythropoietin? A. Produced primarily in the liver of the unborn. B. Gene for erythropoietin is found on chromosome 11. C. Most erythropoietin is secreted by the liver in adults. D. Cannot cross the placental barrier. 4. Stimulation of erythropoietin is caused by A. tissue hypoxia B. hypervolemia C. inflammation D. infection 5. The maturational sequences of an erythrocyte are A. rubriblast, prorubricyte, metarubricyte, and rubricyte- reticulocyte B. rubriblast, prorubricyte, rubricyte, and metarubricyte- reticulocyte pronormoblast, basophilic normoblast, polychromatic C. normoblast, orthochromatic normoblast, and reticulocyte D. both B and C 6. What is the immature erythrocyte found in the bone marrow with the following characteristics: 12 to 17 μm in diameter, N:C of 4:1, nucleoli not usually apparent, and basophilic cytoplasm? A. Rubriblast (pronormoblast) B. Reticulocyte C. Metarubricyte (orthochromatic normoblast) D. Prorubricyte (basophilic normoblast) 7. The nucleated erythrocyte with a reddish-pink cytoplasm and condensed chromatin pattern is a A. rubricyte (polychromatic normoblast) B. basophilic normoblast (prorubricyte) C. metarubricyte (orthochromatic normoblast) D. either B or C 8. With a normal diet, an erythrocyte remains in the reticulocyte stage in the circulating blood for A. 1 day B. 2.5 days C. 3 days D. 120 days General Characteristics of Maturation and Development 9. In a Wright-stained peripheral blood film, the reticulocyte will have a blue appearance. This is referred to as A. megaloblastic maturation B. bluemia C. polychromatophilia D. erythroblastosis 10. In the reticulocyte stage of erythrocytic development, A. nuclear chromatin becomes more condensed B. RNA is catabolized and ribosomes disintegrate C. full hemoglobinization of the cell occurs D. both B and C Disorders Related to Erythrocyte Maturation and Production *11. Increased erythropoietin production in secondary polycythemia can be caused by A. chronic lung disease B. smoking C. renal neoplasms D. all of the above Questions 12 and 13 Refer to Case Study 5.1 *12. What level of serum erythropoietin would you expect in this patient? A. Significantly increased B. Slightly increased C. Within the reference range D. Decreased *13. What is the cause of this patient’s anemia? A. Chronic bleeding B. An acute bleeding episode C. Lack of adequate EPO stimulation D. Hepatic dysfunction *14. Relative polycythemia exists when A. increased erythropoietin is produced B. the total blood volume is expanded C. the plasma volume is increased D. the plasma volume is decreased 15. Which of the following is (are) characteristic(s) of megaloblastic maturation? A. Cells of some leukocytic cell lines are smaller than normal. B. Nuclear maturation lags behind cytoplasmic maturation. C. Cytoplasmic maturation lags behind nuclear maturation. D. Erythrocytes are smaller than normal. Membrane Characteristics and Metabolic Activities of Erythrocytes *16. Increased amounts of 2,3-DPG _____ the oxygen affinity of the hemoglobin molecule. A. Increases B. Decreases C. Does not alter 17. After a molecule of hemoglobin gains the first two oxygen molecules, the molecule A. expels 2,3-DPG B. has decreased oxygen affinity C. becomes saturated with oxygen D. adds a molecule of oxygen to an alpha chain *18. The limited metabolic ability of erythrocytes is owing to A. the absence of RNA B. the absence of ribosomes C. no mitochondria for oxidative metabolism D. the absence of DNA *19. Which of the following statements is (are) true of the erythrocytic cytoplasmic contents? A. High in potassium ion B. High in sodium ion C. Contain glucose and enzymes necessary for glycolysis D. Both A and C *20. The Embden-Meyerhof glycolytic pathway uses _____ % of the erythrocyte’s total glucose. A. 10 B. 20 C. 50 D. 90 *21. The Embden-Meyerhof pathway net gain of ATP provides high- energy phosphates to A. maintain membrane lipids B. power the cation pump needed for the sodium-potassium concentration pump and calcium flux C. preserve the shape and flexibility of the cellular membrane D. all of the above *22. The end product of the Embden-Meyerhof pathway of glucose metabolism in the erythrocyte is A. pyruvate B. lactate C. glucose-6-phosphate D. the trioses *23. The net gain in ATPs in the Embden-Meyerhof glycolytic pathway is A. 1 B. 2 C. 4 D. 6 *24. The most common erythrocytic enzyme deficiency involving the Embden-Meyerhof glycolytic pathway is a deficiency of A. ATPase B. pyruvate kinase C. glucose-6-phosphate dehydrogenase D. lactic dehydrogenase *25. If a defect in the oxidative pathway (hexose monophosphate shunt) occurs, what will result? A. Insufficient amounts of reduced glutathione B. Denaturation of globin C. Precipitation of Heinz bodies D. All of the above *26. The function of the methemoglobin reductase pathway is to A. prevent oxidation of heme iron B. produce methemoglobinemia C. provide cellular energy D. control the rate of glycolysis *27. To maintain reduced levels of methemoglobin in the red blood cell, what chemical is necessary to maintain heme iron in a functional (2+) state? A. vitamin B12 B. 2,3-DPG C. lactic acid D. NADH *28. Why would a patient have Heinz bodies in her red blood cells? A. reduced amounts of glutathione B. Decreased hemoglobin-oxygen affinity C. Increased glycolysis D. Decreased levels of ATP *29. The Luebering-Rapoport pathway A. permits the accumulation of 2,3-DPG B. promotes glycolysis C. produces cellular energy D. produces acidosis *30. In conditions of acidosis, A. erythrocytic glycolysis is reduced B. available oxygen is decreased C. the pH of the blood increases D. all of the above Aging Erythrocytes 31. As the erythrocyte ages, A. the membrane becomes more flexible with loss of cell membrane B. cellular hemoglobin decreases C. enzyme activity, particularly glycolysis, decreases D. the cell maintains the ability move through the capillary circulation. 32. Extravascular red blood cell destruction occurs in A. the circulatory system B. macrophages of the spleen C. lymphatic circulation D. wandering macrophages COMPANION RESOURCES Each student is encouraged to access and use the Web-based companion resources developed for this chapter. Here you will find additional learning tools to increase your understanding of the concepts and clinical applications of the chapter. CHAPTER 5 CHAPTER 6 REVIEW QUESTIONS *Indicates MLT (optional) and MLS advanced content. Characteristics of Hemoglobin 1. Normal adult hemoglobin has A. two alpha and two delta chains B. three alpha and one beta chains C. two alpha and two beta chains D. two beta and two epsilon chains 2. The number of heme groups in a hemoglobin molecule is A. 1 B. 2 C. 3 D. 4 3. Most defects in the hemoglobin molecule are related to A. amino acid substitutions B. diminished production of one of the polypeptide chains C. homozygous A/A inheritance D. either A or and B 4. The correct molecular composition of hemoglobin is A. four heme groups two α and two ß globin chains B. four heme groups, four α globin chains C. two heme groups, four ß globin chains D. two heme groups, one α and one ß globin chains Hemoglobin Function *5. Increased amounts of 2,3-DPG _____ the oxygen affinity of the hemoglobin molecule. A. increase B. decrease C. do not alter *6. After a molecule of hemoglobin gains the first two oxygen molecules, the molecule A. expels 2,3-DPG B. has decreased oxygen affinity C. becomes saturated with oxygen D. adds a molecule of oxygen to an alpha chain Oxygen Dissociation and Alterations *7. If normal adult (A1) and fetal hemoglobin F are compared, fetal hemoglobin has _____ affinity for oxygen. A. less B. the same C. a greater *8. Oxyhemoglobin is a _____ than deoxyhemoglobin. A. weaker acid B. stronger acid *9. If a young male was preparing for olympic competition and had his blood drawn for the measurement of oxygen dissociation, his results would demonstrate A. a shift to the right B. a shift to the left C. no deviation from a normal curve D. no results could be recorded Carbon Dioxide Transport *10. In cases of chronic carboxyhemoglobin exposure, the patient’s oxygen dissociation curve would exhibit A. a shift to the left B. a shift to the right C. decreased affinity for oxygen D. a normal curve Biosynthesis of Hemoglobin 11. Heme is synthesized predominantly in A. the liver B. the red bone marrow C. the mature erythrocytes D. both A and B 12. The upper limit of the reference range of hemoglobin in an adult male is A. 10.5 to 12.0 g/dL B. 12.5 to 14.0 g/dL C. 13.5 to 15.0 g/dL D. 14 to 18.0 g/dL *13. When iron availability is depleted in a cell, the translational rates of ferritin mRNA is A. increased oxygen affinity B. decreased oxygen affinity C. no effect on oxygen affinity D. 2,3-DPG will enter the center cavity of the hemoglobin molecule *14. The protein responsible for the transport of iron in hemoglobin synthesis is A. globin B. transferrin C. oxyhemoglobin D. ferritin *15. If globin synthesis is insufficient in a person, iron accumulates in the cell as _____ aggregates. A. transferrin B. ferritin C. albumin D. heme *Questions 16 and 17: The initial condensation reaction in the synthesis of porphyrin preceding heme formation takes place in the (16) _____ and requires (17) _____. 16. A. liver B. spleen C. red bone marrow D. mitochondria 17. A. iron B. vitamin B6 C. vitamin B12 D. vitamin D *18. The final steps in heme synthesis, including the formation of protoporphyrin, take place in A. a cell’s nucleus B. a cell’s cytoplasm C. the spleen D. the mitochondria Disorders Related to Hemoglobin Biosynthesis Questions 19 and 20. Refer to case 5.2 *19. The dark-staining granules in the red blood cells when a bone marrow smear stained with Prussian Blue stain is examined represent a defect of A. membrane development B. hemoglobin synthesis C. globulin synthesis D. red blood cell aging *20. The child’s medical history and the appearance of dense, dark- staining particles in some of the red blood cells on a peripheral blood smear suggest a diagnosis of A. iron deficiency anemia B. malaria C. ingestion of lead D. sickle cell disease Ontogeny of Hemoglobin 21. The major hemoglobin synthesized in the second trimester fetus is A. A B. F C. A2 D. A1c 22. Which of the following hemoglobin types is the major type present in a normal adult? A. A B. S C. A2 D. A1c 23. Hemoglobin A consists of A. two alpha and two delta chains B. zeta chains and either epsilon or gamma chains C. two alpha and two beta chains D. two alpha and two gamma chains *24. Hemoglobin A2 consists of A. two alpha and two delta chains B. zeta chains and either epsilon or gamma chains C. two alpha and two beta chains D. two alpha and two gamma chains *25. Hemoglobin F consists of A. two alpha and two delta chains B. zeta chains and either epsilon or gamma chains C. two alpha and two beta chains D. two alpha and two gamma chains *26. Embryonic hemoglobin consists of A. two alpha and two delta chains B. zeta chains and either epsilon or gamma chains C. two alpha and two beta chains D. two alpha and two gamma chains 27. In normal infants, fetal hemoglobin (hemoglobin F) persists until A. a few days after birth B. a few weeks after birth C. several months after birth D. adulthood Variant Forms of Normal Hemoglobin *28. After a man was found unconscious in his garage with the car motor running, he was transported to the emergency department. When blood was drawn for a complete blood count, the plasma was noted to be bright red. What kind of variant hemoglobin should be suspected? A. Hemoglobin F B. Hemoglobin A C. Methemoglobin D. Carboxyhemoglobin 29. Heinz bodies are associated with A. hemoglobin F B. hemoglobin A C. sulfhemoglobin D. carboxyhemoglobin *30. A characteristic of methemoglobin is that it is A. incapable of combining with oxygen B. incapable of combining with carbon dioxide C. susceptible to precipitation as Heinz bodies D. present in normal in vivo concentration of greater than 15% Abnormal Hemoglobin Molecules *31. Altered solubility of the hemoglobin S molecule is due to A. substitution of a nonpolar amino acid residue for a polar residue near the surface of the chain B. substitution of a polar amino acid residue for a nonpolar residue near the surface of the chain C. replacement of glutamic acid amino acid residue at the sixth position on the β-globin chain by a lysine amino acid residue D. replacement of lysine amino acid residue at the sixth position on the β-globin chain by a glutamic acid amino acid residue *32. The sickle gene may commonly occur with hemoglobin____. A. C B. F C. Bart D. H Analysis of Hemoglobin 33. The alkaline denaturation test detects the presence of hemoglobin A. A1C B. F C. C D. S Questions 34 and 35. Refer to case 5.1. *34. The type of hemoglobin that is detectable with the Kleihauer-Betke test is A. A B. A2 C. F D. S *35. The physical difference in the detectable type of hemoglobin in the Kleihauer-Betke test is that this form of hemoglobin A. resists denaturation in the procedure B. is denatured in the procedure C. lacks gamma globulin genes D. has a lower affinity for oxygen 36. Cellulose acetate at pH 8.6 separates the hemoglobin fractions A. S B. H C. A D. both A and C Catabolism of Erythrocytes 37. As the erythrocyte ages, A. the membrane becomes less flexible with loss of cell membrane B. cellular hemoglobin increases C. enzyme activity, particularly glycolysis, decreases D. all of the above *38. Erythrocytic catabolism produces the disassembling of hemoglobin followed by A. iron transported in the plasma by transferrin B. globin catabolized in the liver to amino acids and then entering the amino acid pool C. bilirubin formed from opened porphyrin ring and carried by plasma albumin to the liver, conjugated, and excreted in bile D. all of the above *39. Which of the following statements are true of the intravascular destruction of erythrocytes? A. It accounts for less than 10% of normal erythrocyte breakdown. B. Hemoglobin is released directly into blood. C. Alpha and beta dimers are bound to haptoglobin. D. All of the above. *40. If a female patient is diagnosed with anemia and her follow-up assays indicate blood serum results of increased bilirubin and decreased haptoglobin with hemosiderin in her urinary sediment, what is the most probable diagnosis? A. Extravascular catabolism B. Intravascular catabolism C. Defective hemoglobin synthesis D. Thalassemia COMPANION RESOURCES Each student is encouraged to access and use the Web-based companion resources developed for this chapter. Here, you will find additional learning tools to increase your understanding of the concepts and clinical applications of the chapter. CHAPTER 6 CHAPTER 7 REVIEW QUESTIONS *Indicates MLT (optional) and MLS advanced content. Erythrocytes: Normal and Abnormal 1. The average diameter of a normal erythrocyte is _____ μm. A. 5.2 B. 6.4 C. 7.2 D. 8.4 Types of Variations in Erythrocyte Size 2. The description of macrocytic is A. variation in erythrocyte size B. larger than normal C. smaller than normal D. variation in erythrocyte shape 3. The description of microcytic is A. variation in erythrocyte size B. larger than normal C. smaller than normal D. variation in erythrocyte shape 4. The description of anisocytosis is A. variation in erythrocyte size B. larger than normal C. smaller than normal D. variation in erythrocyte shape *5. Which of the following is associated with a defect in nuclear maturation? A. Microcytes B. Sickle cells C. Megalocytes D. Acanthocytes *6. Which of the following is associated with a decrease in hemoglobin synthesis? A. Microcytes B. Sickle cells C. Macrocytes D. Acanthocytes *7. Macrocytes may be associated with the clinical condition of A. iron deficiency anemia B. abetalipoproteinemia C. pernicious anemia D. no related disease state *8. Microcytes may be associated with the clinical condition of A. iron deficiency anemia B. abetalipoproteinemia C. pernicious anemia D. no related disease state Kinds of Variations in Erythrocyte Shape 9. The description of poikilocytosis is A. variation in erythrocyte size B. larger than normal C. smaller than normal D. variation in erythrocyte shape 10. The equivalent nomenclature for normal erythrocyte is A. megalocyte B. drepanocyte C. codocyte D. discocyte 11. The equivalent nomenclature for oval macrocyte is A. megalocyte B. drepanocyte C. codocyte D. discocyte 12. The equivalent nomenclature for target cell is A. megalocyte B. drepanocyte C. codocyte D. discocyte 13. The equivalent nomenclature for sickle cell is A. megalocyte B. drepanocyte C. codocyte D. discocyte 14. A morphological description of echinocytes is A. short, scalloped, or spike-like projections that are regularly distributed around the cell B. fragments of erythrocytes C. the scooped-out part of an erythrocyte that remains after a blister cell ruptures D. compact round shape 15. A morphological description of helmet cells is A. short, scalloped, or spike-like projections that are regularly distributed around the cell B. fragments of erythrocytes C. the scooped-out part of an erythrocyte that remains after a blister cell ruptures D. compact round shape 16. A morphological description of schistocytes is A. short, scalloped, or spike-like projections that are regularly distributed around the cell B. fragments of erythrocytes C. the scooped-out part of an erythrocyte that remains after a blister cell ruptures D. compact round shape 17. A morphological description of spherocytes is A. short, scalloped, or spike-like projections that are regularly distributed around the cell B. fragments of erythrocytes C. the scooped-out part of an erythrocyte that remains after a blister cell ruptures D. compact round shape 18. Which of the following represents an imbalance between erythrocytic and plasma lipids? A. Microcytes B. Sickle cells C. Macrocytes D. Acanthocytes *19. Results from the gelation of polymerized deoxygenated Hb S A. Microcytes B. Sickle cells C. Macrocytes D. Acanthocytes *20. Acanthocytes may be associated with the clinical condition of A. iron deficiency anemia B. abetalipoproteinemia C. pernicious anemia D. no related disease state *21. Echinocytes may be associated with the clinical condition of A. iron deficiency anemia B. abetalipoproteinemia C. pernicious anemia D. no related disease state *22. Leptocytes may be seen in A. hepatic disorders B. hemolytic disease of the fetus and newborn C. hemoglobinopathies D. pernicious anemia *23. Microspherocytes may be seen in A. hepatic disorders B. hemolytic disease of the fetus and newborn C. hemoglobinopathies D. pernicious anemia *24. Codocytes may be seen in A. hepatic disorders B. hemolytic disease of the fetus and newborn C. hemoglobinopathies D. pernicious anemia *25. Dacryocytes may be seen in A. hepatic disorders B. hemolytic disease of the fetus and newborn C. hemoglobinopathies D. pernicious anemia Alterations in Erythrocyte Color 26. A specific term for a variation in the normal coloration of an erythrocyte is A. hypochromia B. polychromatophilia C. hyperchromia D. pale appearance 27. Polychromatophilia is A. a blue-colored erythrocyte when stained with Wright stain B. caused by diffusely distributed RNA in the cytoplasm C. equivalent to a reticulocyte when stained with a supravital stain D. all of the above Varieties of Erythrocyte Inclusions 28. Basophilic stippling represents A. DNA B. precipitated denatured hemoglobin C. granules composed of ribosomes and RNA D. aggregates of iron, mitochondria, and ribosomes 29. Howell-Jolly bodies represent A. DNA B. precipitated denatured hemoglobin C. granules composed of ribosomes and RNA D. aggregates of iron, mitochondria, and ribosomes 30. Pappenheimer bodies represent A. DNA B. precipitated denatured hemoglobin C. granules composed of ribosomes and RNA D. aggregates of iron, mitochondria, and ribosomes 31. Heinz bodies represent A. DNA B. precipitated denatured hemoglobin C. granules composed of ribosomes and RNA D. aggregates of iron, mitochondria, and ribosomes *32. Basophilic stippling can be observed in cases of A. pernicious anemia B. G6PD deficiency C. iron loading anemia D. lead poisoning *33. Howell-Jolly bodies can be observed in cases of A. pernicious anemia B. G6PD deficiency C. iron loading anemia D. lead poisoning *34. Heinz bodies can be observed in cases of A. pernicious anemia B. G6PD deficiency C. iron loading anemia D. lead poisoning *35. Pappenheimer bodies can be observed in cases of A. pernicious anemia B. G6PD deficiency C. iron loading anemia D. lead poisoning Alterations in Erythrocyte Distribution 36. Which of the following is the term for erythrocytes resembling a stack of coins on thin sections of a peripheral blood smear? A. Anisocytosis B. Poikilocytosis C. Agglutination D. Rouleaux formation Parasitic Inclusions in Erythrocytes 37. Plasmodium vivax is characterized by A. the schizont contains 6 to 12 merozoites; generally abundant in hematin granules; may contain Ziemann stippling B. the most predominant species worldwide; 12 to 24 merozoites; may contain Schüffner dots or granules C. infected erythrocytes may be enlarged and oval shaped; may contain Schüffner dots; 6 to 14 merozoites in the schizont D. young trophozoites and gametocytes are generally the only stage seen in peripheral blood; gametocytes appear as crescent- or sausage-shaped structures in erythrocytes; Maurer dots may be present 38. Plasmodium falciparum is characterized by A. the schizont contains 6 to 12 merozoites; generally abundant in hematin granules; may contain Ziemann stippling B. the most predominant species worldwide; 12 to 24 merozoites; may contain Schüffner dots or granules C. infected erythrocytes may be enlarged and oval shaped; may contain Schüffner dots; 6 to 14 merozoites in the schizont D. young trophozoites and gametocytes are generally the only stage seen in peripheral blood; gametocytes appear as crescent- or sausage-shaped structures in erythrocytes; Maurer dots may be present 39. Plasmodium malariae is characterized by A. the schizont contains 6 to 12 merozoites; generally abundant in hematin granules; may contain Ziemann stippling B. the most predominant species worldwide; 12 to 24 merozoites; may contain Schüffner dots or granules C. infected erythrocytes may be enlarged and oval shaped; may contain Schüffner dots; 6 to 14 merozoites in the schizont D. young trophozoites and gametocytes are generally the only stage seen in peripheral blood; gametocytes appear as crescent- or sausage-shaped structures in erythrocytes; Maurer dots may be present 40. Plasmodium ovale is characterized by A. the schizont contains 6 to 12 merozoites; generally abundant in hematin granules; may contain Ziemann stippling B. the most predominant species worldwide; 12 to 24 merozoites; may contain Schüffner dots or granules C. infected erythrocytes may be enlarged and oval shaped; may contain Schüffner dots; 6 to 14 merozoites in the schizont D. young trophozoites and gametocytes are generally the only stage seen in peripheral blood; gametocytes appear as crescent- or sausage-shaped structures in erythrocytes; Maurer dots may be present 41. Nantucket Island is an endemic area for A. P. vivax B. P. falciparum C. babesiosis D. all of the above 42. Babesiosis infection shares many of the same symptoms as A. Plasmodium falciparum malaria B. Lyme disease C. Ehrlichia D. none of the above COMPANION RESOURCES Each student is encouraged to access and use the Web-based companion resources developed for this chapter. Here, you will find additional learning tools to increase your understanding of the concepts and clinical applications of the chapter. CHAPTER 7 CHAPTER 8 REVIEW QUESTIONS *Indicates MLT (optional) and MLS advanced content. Introduction 1. The most frequent leukocytes found in peripheral blood are A. neutrophils B. lymphocytes C. monocytes D. eosinophils 2. The function of the entire leukocytic system is to A. defend the body against disease B. synthesis of antibodies C. protect against allergic reactions D. secrete enzymes Granulocytic Series: Production of Neutrophils, Eosinophils, and Basophils 3. The granulocyte cells that are believed to descend from a common multipotential stem cell in the bone marrow are A. neutrophils and eosinophils B. basophils and lymphocytes C. lymphocytes and monocytes D. both A and B Granulocyte Sites of Development and Maturation 4. The types of granulocytic leukocytes found in the proliferative compartment of the bone marrow are A. myeloblasts, myelocytes, and metamyelocytes B. myeloblasts, promyelocytes, and myelocytes C. myeloblasts, promyelocytes, myelocytes, and metamyelocytes myeloblasts, promyelocytes, myelocytes, metamyelocytes, D. and band neutrophils 5. The types of granulocytic leukocytes found in the maturation- storage compartment of the bone marrow are A. metamyelocytes, band form neutrophils, segmented neutrophils, mature eosinophils, and mature basophils B. only band form neutrophils, segmented neutrophils, mature eosinophils, and mature basophils C. metamyelocytes, band form neutrophils, segmented neutrophils, mature eosinophils, and mature basophils D. segmented neutrophils, immature and mature monocytes, and mature lymphocytes Distribution of Neutrophils, Eosinophils, and Basophils 6. Release of neutrophils from the bone marrow is believed to be influenced by A. CSF B. interleukins C. interferon D. all of the above 7. The stages of neutrophilic granulocyte development are A. promyelocyte, myeloblast, myelocyte, metamyelocyte, and band and segmented neutrophils B. myeloblast, promyelocyte, myelocyte, metamyelocyte, and band and segmented neutrophils C. myelocyte, myeloblast, promyelocyte, metamyelocyte, and band and segmented neutrophils D. myeloblast, promyelocyte, metamyelocyte, myelocyte, and band and segmented neutrophils 8. Marginating granulocytes in the peripheral blood can be found A. in the circulating pool B. in the tissues C. adhering to the vascular endothelium D. all of the above 9. The half-life of circulating granulocytes in normal blood is estimated to be A. 2.5 to 5 hours B. 7 to 10 hours C. 24 hours D. 2 days Normal Maturational Characteristics of Granulocytes 10. Identify the cell with these characteristics: prominent primary granules that are rich in myeloperoxidase and chloroacetate esterase and have a diameter of 14 to 20 μm. A. Myeloblast B. Promyelocyte C. Myelocyte D. Promonocyte 11. The earliest granulocytic maturational stage in which secondary or specific granules appear is A. myeloblast B. monoblast C. promyelocyte D. myelocyte 12. The mature granulocytes seen in the peripheral blood of healthy persons include A. band form and segmented neutrophils B. eosinophils and basophils C. lymphocytes and monocytes D. both A and B 13. The granules of segmented neutrophils contain A. lysosomal hydrolases B. lysozymes C. myeloperoxidase D. all of the above 14. Which of the following are contents of basophilic granules? A. Heparin B. Histamine C. Myeloperoxidase D. Both A and B 15. The tissue basophil can be referred to as A. a mast cell B. a macrophage C. a mononuclear cell D. an antibody-producing cell 16. A leukocyte with the morphological characteristics of being the largest normal mature leukocyte in the peripheral blood and having a convoluted or twisted nucleus is the A. myelocyte B. metamyelocyte C. promonocyte D. monocyte Leukocyte Surface Markers *17. A cluster designation (CD) for specific lineages of cells A. indicates a known cluster of monoclonal antibodies binding to a known antigen B. identifies antibodies on the cell surface of hematopoietic cells C. detects heavy chain or kappa chain rearrangements D. both A and B The Monocytic-Macrophage Series 18. Cells of the mononuclear phagocyte system include A. monocytes B. macrophages C. lymphocytes D. both A and B 19. The immediate precursor of the macrophage is the A. myeloblast B. monoblast C. promonocyte D. monocyte 20. Monocytes are capable of A. phagocytosis B. synthesis of biologically important compounds C. assuming a killer role D. all of the above *21. Classical monocytes participate in immune body defenses by A. neutralizing invading viruses B. phagocytizing bacteria C. participating in extravascular catabolism of erythrocytes D. processing and presenting foreign antigens to lymphocytes 22. The mononuclear phagocyte system consists of histiocytes. These cells can be found in the A. loose connective tissue B. spleen C. lymph nodes D. all of the above Normal Reference Ranges and Variations 23. The reference range for the segmented neutrophil count in adults is A. 20% to 40% B. 40% to 74% C. 60% to 80% D. 80% to 100% 24. The total leukocyte count can be increased in certain states. Select the conditions when this is not true. A. Strenuous exercise B. Overwhelming bacterial infection C. Sepsis D. Use of immunosuppressive agents 25. On the basis of the following data, calculate the absolute value of the segmented neutrophils. Total leukocyte count = 12 × 109/L; percentage of segmented neutrophils on the differential count = 80%. The absolute segmented neutrophil value is A. 2.5 × 109/L B. 4.5 × 109/L C. 6.5 × 109/L D. 9.6 × 109/L 26. An adult female had a total WBC count of 5.5 × 109/L. Her leukocyte differential was segmented neutrophils 20%, eosinophils 4%, basophils 1%, monocytes 3%, and lymphocytes 68%. She is demonstrating A. leukopenia B. absolute neutropenia C. absolute neutrophilia D. relative neutrophilia 27. An increase in metamyelocytes, myelocytes, and promyelocytes can be referred to as A. leukocytopenia B. a shift to the right C. a shift to the left D. Pelger-Hüet anomaly 28. What is the normal reference range of the segmented neutrophil absolute value? A. 1.4 to 6 × 109/L B. 2.5 to 6.5 × 109/L C. 3.5 to 8 × 109/L D. 5.5 to 10 × 109/L 29. The absolute value of segmented neutrophils can be an unreliable indicator of overwhelming infection because A. it drops in many patients because the circulating granulocytes are mobilized into the tissue site of infection B. the bone marrow reserve becomes exhausted C. the infection suppresses granulocytic production D. all of the above Functional Properties of Monocytes/Macrophages 30. The functions of monocytes and macrophages include all of the following functions except A. recognize bacterial organisms B. degrade antigens C. synthesize growth inhibitory factors D. present antigen fragments as antigen-presenting cells 31. M1 macrophages mainly A. secrete proinflammatory cytokines B. have anti-inflammatory characteristics C. have wound healing characteristics D. both b and c Phagocytosis 32. The major function of neutrophilic granulocytes is A. antibody production B. destruction of parasites C. phagocytosis D. suppression of inflammation 33. The major function of eosinophils is A. suppression of inflammatory reactions B. destruction of protozoa C. participation in anaphylaxis D. phagocytosis 34. The principal leukocyte type involved in phagocytosis is the A. monocyte B. neutrophil C. eosinophil D. basophil 35. The correct sequence(s) of events in successful phagocytosis is (are) A. chemotaxis, opsonization, phagosome formation, and the action of antibacterial substances B. opsonization, chemotaxis, phagosome formation, and the action of antibacterial substances C. engulfment, opsonization, digestion, and destruction of bacteria or particulate matter D. both A and C *36. Neutrophils function as phagocytic cells in the circulating blood A. to defend the body against viral infections B. during severe allergic reactions C. when bacteria enter the circulation D. to sustain high levels of cellular multiplication *37. Why are mature neutrophils more easily able to enter the circulating blood from the bone marrow than immature neutrophils? A. They have plasticity that allows them to squeeze through the endothelial cells that line bone marrow sinusoids. B. Chemical factors enlarge endothelial pores that allow mature neutrophils to easily exit the bone marrow. C. The higher concentration of mature neutrophils in the bone marrow can crowd out the immature neutrophils in order to enter the circulating blood. D. More well-developed granules in mature cells enable them to destroy endothelial tissue to escape into the circulating blood. Case Study *38. In reference to case 8.1, the white blood cell abnormalities should be followed up with an assay A. erythrocyte sedimentation rate B. leukocyte alkaline phosphate stain C. correction of the WBC to compensate for the nucleated RBCs D. assessment of phagocytic function *39. The value of the LAP stain is to A. differentiate malignant disorders from leukemoid reactions B. distinguish myelocytes from monocytes C. assess the quality of enzymatic granules D. identify immature granulocytes COMPANION RESOURCES Each student is encouraged to access and use the Web-based companion resources developed for this chapter. Here you will find additional learning tools to increase your understanding of the concepts and clinical applications of the chapter. CHAPTER 8 CHAPTER 9 REVIEW QUESTIONS *Indicates MLT (optional) and MLS advanced content. Lymphopoiesis: Anatomical Origin and Development of Lymphocytes 1. Lymph nodes are A. primary lymphoid tissue B. secondary lymphoid tissue C. either primary or secondary tissue D. not a lymphoid tissue 2. Liver is A. primary lymphoid tissue B. secondary lymphoid tissue C. either primary or secondary tissue D. not a lymphoid tissue 3. Spleen is A. primary lymphoid tissue B. secondary lymphoid tissue C. either primary or secondary tissue D. not a lymphoid tissue 4. Red bone marrow is A. primary lymphoid tissue B. secondary lymphoid tissue C. either primary or secondary tissue D. not a lymphoid tissue 5. Thymus is A. primary lymphoid tissue B. secondary lymphoid tissue C. either primary or secondary tissue D. not a lymphoid tissue 6. Peyer’s patches of the intestine are A. primary lymphoid tissue B. secondary lymphoid tissue C. either primary or secondary tissue D. not a lymphoid tissue Lymphocyte Kinetics: Life Span and Proliferation 7. T cells are found in the A. perifollicular areas of the lymph nodes B. paracortex regions of the lymph nodes C. periarteriolar regions of the spleen D. all of the above 8. A major site of B-lymphocyte localization and proliferation is A. lymphoid follicles B. deep cortical zone C. paracortex D. all of the above Lymphocyte Kinetics: Recirculation of Lymphocytes 9. The process of lymphocyte recirculation is important in A. antibody production B. lymphocyte proliferation C. dissemination of antigen-sensitized memory cells D. commitment of lymphocytes to T and B cells Normal Reference Values 10. T lymphocytes constitute _____% of the blood lymphocyte pool in adults. A. 0–20 B. 20–40 C. 40–60 D. 60–85 11. Lymphocytes represent approximately _____% of the total circulating leukocytes in adults. A. 15 B. 35 C. 55 D. 75 12. The percentage of lymphocytes as compared with the other types of leukocytes in the peripheral blood _____ as humans age. A. increases B. decreases C. remains the same D. is not predictable 13. If an adult patient has a total leukocyte count of 20 × 109/L and a 50% lymphocyte count on the differential count, the absolute lymphocyte value is _____ × 109/L. A. 1 B. 5 C. 10 D. 15 14. If an adult has a percentage of lymphocytes exceeding the normal reference range, this is called A. absolute lymphocytosis B. relative lymphocytosis C. leukocytosis D. leukopenia 15. If an adult female has a total white blood cell count of 4.6 × 109/L and a leukocyte differential of segmented neutrophils 24%, eosinophils 4%, monocyte 8%, and lymphocytes 64%, she is demonstrating A. absolute lymphocytosis B. relative lymphocytosis C. leukopenia D. leukocytosis Morphological Characteristics of Normal Lymphocytes 16. As a lymphocyte matures, the nuclear-cytoplasmic ratio A. increases B. decreases C. remains about the same D. is not predictable 17. As a lymphocyte matures, the overall size generally _________________ in older cells. A. increases B. decreases C. remains about the same D. is not predictable 18. As a lymphocyte matures, the number of nucleoli A. increases B. decreases C. remains about the same D. is not predictable 19. As a lymphocyte matures, the chromatin clumping A. increases B. decreases C. remains about the same D. is not predictable 20. As a lymphocyte matures, the quantity of cytoplasm A. increases B. decreases C. remains about the same D. is not predictable 21. The most characteristic morphological features of variant lymphocytes include A. increased overall size, possibly one to three nucleoli, and abundant cytoplasm B. increased overall size, round nucleus, and increased granulation in the cytoplasm C. segmented nucleus, light-blue cytoplasm, and no nucleoli D. enlarged nucleus, six to eight nucleoli, and dark-blue cytoplasm *22. Rieder’s cells are associated with A. Niemann-Pick disease and Burkitt’s lymphoma B. CLL C. leukosarcoma D. Natural artifact *23. Vacuolated lymphocytes are associated with A. Niemann-Pick disease and Burkitt’s lymphoma B. CLL C. leukosarcoma D. natural artifact CLL *24. Crystalline inclusions are associated with *SMUDGE CELLS A. drug toxicity *RIEDER'S CELL B. T-cell lymphoproliferative disorder C. B-cell lymphoproliferative disorder D. natural artifact *25. Smudge cells are associated with A. Niemann-Pick disease and Burkitt’s lymphoma B. CLL C. leukosarcoma D. natural artifact Characteristics of Lymphocytes 26. Antibody production is associated with A. granulocytes B. lymphocytes C. monocytes D. macrophages 27. T cells are responsible for A. humoral immunity B. cell-mediated immunity C. Growth and differentiation D. all of the above *28. Functions of sensitized T lymphocytes include A. protection against intracellular pathogens B. chronic rejection in organ transplantation C. production of immune antibodies D. both A and B *29. A major function of CD4+ (Th2 subset) lymphocytes is A. extracellular bacteria defense B. phagocytosis C. extracellular fungi defense 30. A patient with AIDS most likely has a decrease in A. CD4+ cells B. CD8+ cells C. monocytes D. macrophages *31. The CD markers including CD4 and CD8 are associated with A. NK cells B. T lymphocytes C. B lymphocytes D. plasma cells *32. The subset of B lymphocytes that can produce high levels of IL-10 is A. CD21lo B. B2 cells C. B1 D. regulator B cells *33. Antibody-independent roles for B cells in immune responses include A. production of antibody B. production of cytokines to shape type and strength of immune response C. blocking of cellular activation and recruitment of other immune cells D. blocking of T-reg lymphocyte expansion *34. The effect of IL-21 on B lymphocytes is A. promoting differentiation of B cells to become plasma cells B. stimulating B lymphocyte proliferation C. promoting apoptosis D. promoting stem cell production Major Lymphocyte Membrane Characteristics and Development *35. One of the CD markers that distinguishes early-B cells from other maturational stages of B cell development is A. CD4 B. CD3 C. CD10 D. CD56 36. Lymphocyte development in the thymus and bursal equivalent are A. antigen independent B. antigen dependent C. antibody independent D. antibody dependent *37. A characteristic feature of a early or immature B cell is A. cytoplasmic (cIg) immunoglobulin chains B. surface immunoglobulin (sIg) as IgM C. surface immunoglobulin (sIg) as IgG D. both A and B *38. The surface marker associated with B lymphocytes is A. CD43+ B. CD19+ C. CD10+ D. IgM *39. Mature B cell produces surface immunoglobulin (sIg) A. IgM B. IgD C. IgA D. both A and B *40. A phenotypic marker of a distinct subset of NK cells is A. CD19 B. CD20 C. CD56bright D. CD4 T Lymphocytes, B Lymphocytes, and Plasma Cell Kinetics 41. B lymphocytes A. are activated by antigen B. can secrete antibodies C. participate in cellular immunity response D. both A and B Plasma Cell Development and Maturation 42. Plasma cells are A. CD4+ T cells B. CD8+ B cells C. terminally (end stage) of differentiated B cells D. end stage of differentiated T cells *43. Long-lived plasma cells are generated in A. T-independent germinal centers B. T-dependent germinal centers C. B-independent germinal centers D. B-dependent germinal centers *44. An abnormal plasma cell with red-staining cytoplasm is a A. Russell’s body B. Mott cell C. grape cell D. flame cell COMPANION RESOURCES Each student is encouraged to access and use the Web-based companion resources developed for this chapter. Here, you will find additional learning tools to increase your understanding of the concepts and clinical applications of the chapter. CHAPTER 9 CHAPTER 10 REVIEW QUESTIONS *Indicates MLT (optional) and MLS advanced content. Quantitative Assessment of Erythrocytes 1. Which of the following blood specimen conditions would not cause a falsely elevated concentration with a manually performed cyanmethemoglobin determination? A. Lipemia B. Extremely elevated WBC count C. Hemoglobin S D. Hemoglobin F 2. If a patient has a microhematocrit of 36% and a hemoglobin value of 11.5 g/dL, the “rule of three” calculation would be ________ plus or minus (3). A. 108 B. 47.5 C. 34.5 D. 14.5 3. The formula for MCV is A. packed cell volume or hematocrit (in L/L)/ erythrocyte count (×1012/L) = fL B. hemoglobin (in g/dL)/packed cell volume or hematocrit (in L/L) = g/dL C. hemoglobin (×10 g/dL)/erythrocyte count (×1012/L) = pg D. microhematocrit × 3 = percent 4. The formula for MCH is A. packed cell volume or hematocrit (in L/L)/ erythrocyte count (×1012/L) = fL B. hemoglobin (in g/dL)/packed cell volume or hematocrit (in L/L) = g/dL C. hemoglobin (×10 g/dL)/erythrocyte count (×1012/L) = pg D. microhematocrit × 3 = percent 5. The formula for MCHC is A. packed cell volume or hematocrit (in L/L)/ erythrocyte count (×1012/L) = fL B. hemoglobin (in g/dL)/packed cell volume or hematocrit (in L/L) = g/dL C. hemoglobin (×10 g/dL)/erythrocyte count (×1012/L) = pg D. microhematocrit × 3 = percent *6. If an MCHC result of 40 g/dL is discovered in a patient’s instrumentation printout, what is a possible cause? A. Increased RDW B. Hypochromic RBCs C. Agglutinated RBCs D. Increased number of RBC fragments *7. If a patient specimen is slightly hemolyzed, which of the RBC indices would be most affected? A. MCV B. MCH C. MCHC D. Reticulocyte count Laboratory Assessment 8. What hematology test is useful in monitoring the production of erythrocytes? A. Total iron binding capacity B. Ferritin level C. Reticulocyte count D. Hemoglobin 9. The normal range for reticulocytes in adults is A. 0% to 0.5% B. 0.5% to 1.0% C. 0.5% to 2.5% D. 1.5% to 2.5% 10. If a male patient has a reticulocyte count of 5.0% and a packed cell volume of 0.45 L/L, what is his corrected reticulocyte count? A. 2.5% B. 4.5% C. 5.0% D. 10% 11. If a male patient has a reticulocyte count of 6.0% and a packed cell volume of 45%, what is his RPI? A. 1.5 B. 3.0 C. 4.5 D. 6.0 12. What is the appropriate reagent for the reticulocyte count? A. New methylene blue. B. Phyloxine B. C. Solution lyses erythrocytes and darkens the cells to be counted. D. Any laboratory acid. 13. On a Wright-stained peripheral blood smear, stress or shift reticulocytes are A. smaller than normal reticulocytes B. about the same size as normal reticulocytes C. larger than normal reticulocytes D. noticeable because of a decreased blue tint *14. If a 40-year-old female patient had a corrected reticulocyte count of 8%, what would you expect to encounter on the peripheral blood smear stained with Wright stain? A. Polychromatophilia B. Poikilocytosis C. >10 nucleated red blood cells/100 WBC D. An increased estimated total platelet count 15. The reference value for the reticulocyte count in a newborn infant is A. up to 13 mm/hour B. 2.5% to 6.5% C. 150 to 450 × 109/L D. 36% to 45% Quantitative Assessment of Leukocytes 16. An anticoagulated blood specimen was diluted 1:20 dilution with 3% glacial acetic acid. If a total of 150 cells was counted in the appropriate four large corner squares of a hemacytometer, what is the patient’s total WBC count (×109/L)? A. 1.5 B. 3.0 C. 5.0 D. 7.5 17. The reference value for total leukocyte count is A. up to 13 mm/hour B. 2.5% to 6.0% C. 150 to 450 × 109/L D. 4.5 to 11.0 × 109/L 18. What clinical or specimen condition will produce an increased total leukocyte count? A. Active allergies B. Immediate hypersensitivity reactions C. Inflammation D. A lipemic blood specimen 19. What clinical condition will produce an increased value of neutrophils? A. Invasive parasites B. Bacterial infections C. Viral infections D. Tuberculosis 20. What clinical condition will produce an increased value of lymphocytes? A. Invasive parasites B. Bacterial infections C. Viral infections D. Tuberculosis 21. What clinical condition will produce an increased value of eosinophils? A. Invasive parasites B. Bacterial infections C. Viral infections D. Tuberculosis 22. If the results of WBC count and differential smear were as follows for a 45-year-old female patient, what condition would the results represent? WBC 5.6 × 109/L differential: segmented neutrophils 22%, lymphocytes 56%, monos 18%, eosinophils 4%. A. Leukopenia B. Absolute neutropenia C. Relative neutrophilia D. Absolute lymphocytosis 23. What is the absolute count if a patient’s total WBC is 2.6 × 109/L with 30% lymphocytes? A. 2.6 x 109/L B. 2.0 x 109/L C. 1.3 x 109/L D. 0.78 x 109/L 24. What is the formula for calculating a manual white blood cell count? A. Average total of leukocytes counted × dilution factor × volume correction B. Average total of leukocytes counted × dilution factor × 10/number of squares counted C. Average total of leukocytes counted × dilution factor D. Average total of leukocytes counted × number of squares counted Other Leukocyte-Related Assessments *25. A defect in leukocyte adhesion defect (LAD), can lead to A. decreased cell locomotion B. increased cell locomotion C. decreased cellular killing capacity D. increased cellular killing capacity *26. The LAP test is helpful in A. differentiating malignant disorders from leukemoid reactions. B. differentiating acute and chronic leukemias C. diagnosing sickle cell anemia D. detecting platelet dysfunctions 27. The ESR is a nonspecific indicator of disease with increased sedimentation of erythrocytes in A. infections B. inflammation C. tissue necrosis D. all of the above 28. The reference value for the Westergren ESR method for adult male less than 50 years of age) is A. 0 to 10 mm/hour B. 2.5% to 6.0% C. 150 to 450 × 109/L D. 36% to 45% Quantitative Assessment of Platelets 29. The correct dilution of blood for a manual platelet count is A. 1:10 B. 1:20 C. 1:100 D. 1:200 30. When calculating the total platelet count of a blood specimen that has been diluted at a 1:100 dilution, the calculation should ______________ of the appropriate areas of the Neubauer counting chamber. A. average the total number of platelets counted on both sides B. use only the number of platelets counted on one side C. add the total number of platelets counted on both sides D. subtract the number of platelets counted on one side from the other side 31. The normal reference value for a direct platelet count is A. up to 13 mm/hour B. 2.5% to 6.0% C. 150 to 450 × 109/L D. 4.4 to 11.3 × 109/L 32. If a small blood clot exists in an anticoagulated blood specimen, which blood cell parameter will be affected the most? A. Leukocyte count B. Erythrocyte count C. Platelet count D. Microhematocrit *33. If platelet clumping was observed by direct observation of a stained peripheral blood smear and/or indicated by the output of an automated instrument, what corrective action can be taken? A. Retrieve the patient specimen and prepare a new blood smear. B. Retrieve the patient specimen and warm it up to 37°C for 15 minutes and reanalyze. C. Recollect a new EDTA-anticoagulated specimen and promptly examine the platelets. D. Recollect a new citrate anticoagulated specimen and reexamine the platelets. 34. If the identification of platelets by direct visualization using a phase microscope is problematic, what strategy can be taken to possibly improve seeing the platelets? A. Be sure that the annular ring is centered to the phase ring. B. Lower the condenser. C. Carefully refocus with the fine adjustment knob of the microscope. D. Close the iris diaphragm to reduce illumination. Semiquantitative Grading of Erythrocytes 35. If you are grading changes in erythrocytic size or shape using a scale of 0 to 4+ and many erythrocytes deviate from normal per microscopic field, the typical score would be A. 1+ B. 2+ C. 3+ D. 4+ 36. Rouleaux appears as _____________ when examining a blood smear microscopically. A. hollow red blood cells B. polychromatophilia C. a roll of stacked coins D. larger than normal RBCs Semiquantitative Assessment of Leukocytes 37. Semi-quantitative estimation of a leukocyte count generated by an automated instrument can A. Confirm a low count B. Confirm a high count C. Substitute for an actual count D. Indicate if the dilution of the whole blood was correct Semiquantitative Assessment of Platelets 38. A normal blood smear should have no more than approximately _____ (maximum) number of platelets per oil immersion field in an area where the erythrocytes are just touching each other. A. 10 B. 15 C. 20 D. 25 *39. Ten fields on a properly prepared and stained peripheral blood smear were examined to estimate the quantitative total number of platelets. In these ten fields, the following observations were made: 10, 12, 10, 15, 17, 12, 14, 15, 11, 10. In correlating this semiquantitative assessment with the actual quantitative total platelet count measured by an automated instrument, you would expect to see a total platelet count around ________ 109/L. A. 90 B. 130 C. 250 D. 400 Leukocyte Differential Count 40. If a febrile, newborn infant had 4 nucleated red blood cells when a 100 cell WBC differential was performed, how would this be interpreted? A. Lymphocytes were mistaken for nucleated red blood cells. B. The baby was suffering from hemolytic disease of the fetus and newborn (HDFN). C. Nucleated red blood cells can be expected in febrile patients. D. During the first few days of life, the presence of a few nucleated red blood cells is normal. 41. If a total white blood cell count is 25.0 × 109/L and 50 nucleated red blood cells were counted per 100 leukocytes in the differential count, what is the corrected total white blood cell count? A. 5.0 × 109/L B. 7.5 × 109/L C. 16.7 × 109/L D. No correction needed 42. If a cell observed on a stained peripheral blood smear is 12 to 16 μm with abundant, muddy gray cytoplasm, a kidney bean–shaped nucleus with lacey chromatin, and no nucleoli, what type of cell is this? A. Lymphocyte B. Monocyte C. Segmented neutrophil D. Band neutrophil COMPANION RESOURCES Each student is encouraged to access and use the Webbased companion resources developed for this chapter. Here, you will find additional learning tools to increase your understanding of the concepts and clinical applications of the chapter. CHAPTER 10 CHAPTER 11 REVIEW QUESTIONS *Indicates MLT (optional) and MLS advanced content. Overview of Anemia 1. The laboratory based definition of anemia is a reduced concentration of _________ compared to a reference value. A. hemoglobin B. leukocytes C. packed erythrocytes D. either A or C Development of Anemia 2. Functional anemia A. results in hypoxia B. is a decrease in the ability of RBCs to carry oxygen C. has inadequate stored body iron D. both A and B 3. The steady-state total erythrocyte mass is A. a balance between new and old erythrocytes B. the reference value for leukocytes in peripheral blood C. homeostasis of erythrocytes D. both A and C *4. If the survival time of an erythrocyte is decreased, A. bone marrow must slow down RBC production B. bone marrow does not have to react C. bone marrow must increase erythropoiesis D. bone marrow must decrease granulopoiesis Clinical Signs and Symptoms *5. The clinical signs and symptoms of anemia can result from A. diminished delivery of oxygen to the tissues B. increased reticulocyte production C. increased blood volume D. both A and B Classification of Anemias 6. Anemias can be categorized into A. hemolytic types B. blood loss types C. impaired production types D. all of the above Laboratory Assessment of Anemias 7. Which of the following is a significant laboratory finding in anemia? A. Decreased hemoglobin B. Increased packed cell volume C. Increased erythrocyte count D. Normal erythrocyte indices 8. The adult reference range for MCV is A. 32 to 36 g/dL B. 27 to 33 pg C. 80 to 96 fL D. 40% to 50% 9. The adult reference range for MCH is A. 32 to 36 g/dL B. 27.5 to 33.2 pg C. 80 to 96 fL D. 40% to 50% 10. The adult reference range for MCHC is A. 33% to 36% (32 to 36 g/dL) B. 27 to 32 pg C. 80 to 96 fL D. 40% to 50% COMPANION RESOURCES Each student is encouraged to access and use the Web-based companion resources developed for this chapter. Here, you will find additional learning tools to increase your understanding of the concepts and clinical applications of the chapter. CHAPTER 11 CHAPTER 12 REVIEW QUESTIONS *Indicates MLT (optional) and MLS advanced content. 1. Disorders of the GI system or heavy menstruation can cause A. acute blood loss B. chronic blood loss 2. Increased thrombocytes (platelets) can be observed in A. acute blood loss B. chronic blood loss ACUTE BLOOD LOSS *INCREASED THROMBOCYTES 3. Traumatic conditions can cause *TRAUMATIC CONDITIONS A. acute blood loss B. chronic blood loss *4. The blood volume is not disrupted in cases of A. acute blood loss B. chronic blood loss 5. Results in an iron deficiency and a hypochromic/microcytic erythrocyte morphology on a peripheral blood smear. A. Acute blood loss B. Chronic blood loss *6. The erythrocyte morphology associated with anemia in an otherwise healthy individual caused by acute blood loss is usually A. microcytic B. megaloblastic C. normochromic D. hypochromic 7. Anemia caused by chronic blood loss is characterized by A. hypochromic, microcytic erythrocytes B. macrocytic erythrocytes C. increased platelets D. both A and B COMPANION RESOURCES Each student is encouraged to access and use the Web-based companion resources developed for this chapter. Here you will find additional learning tools to increase your understanding of the concepts and clinical applications of the chapter. CHAPTER 12 CHAPTER 13 REVIEW QUESTIONS *Indicates MLT (optional) and MLS advanced content. 1. Acquired aplastic anemia may be caused by A. benzene or benzene derivatives B. ionizing radiation and vitamin B12 C. purine or pyrimidine analogues D. all of the above 2. The sudden appearance of aplastic anemia or pure red cell aplasia is often caused by A. a hemolytic process B. an immune process C. acute leukemias D. chronic leukemias 3. Aplastic anemia can occur years before a diagnosis of _____ is made. A. paroxysmal nocturnal hemoglobinuria B. myelodysplasia C. acute myelogenous leukemia D. all of the above 4. If a patient with aplastic anemia is referred to as exhibiting pancytopenia, which cell lines are affected? A. Erythrocytes B. Leukocytes C. Thrombocytes D. All of the above 5. A characteristic of Fanconi’s anemia is A. a subset of Fanconi’s anemia B. a rare congenital form of red cell aplasia C. is characterized by selective failure of red blood cell production D. the best-described congenital form of aplastic anemia 6. A characteristic of familial aplastic anemia is A. a subset of Fanconi’s anemia B. a rare congenital form of red cell aplasia C. is characterized by selective failure of red blood cell production D. the best-described congenital form of aplastic anemia 7. A characteristic of pure red cell anemia is A. a subset of Fanconi’s anemia B. a rare congenital form of red cell aplasia C. is characterized by selective failure of red blood cell production D. the best-described congenital form of aplastic anemia 8. A characteristic of Diamond-Blackfan syndrome is A. a subset of Fanconi’s anemia B. a rare congenital form of red cell aplasia C. Is characterized by selective failure of red blood cell production D. the best-described congenital form of aplastic anemia 9. Fanconi’s anemia is associated with abnormal genes located on chromosomes __q___, __q___. A. 9, 20 B. 5, 22 C. 9, 12 D. 8, 23 10. Acute (transient) red cell aplasia can be associated with A. a recent viral infection B. a bacterial infection C. a parasitic infection D. idiopathic causes 11. Diamond-Blackfan anemia (DBA) is a A. microcytic, hypochromic anemia B. megaloblastic anemia C. congenital form of aplastic anemia D. white blood cell deficiency 12. Congenital amegakaryocytic thrombocytopenia is manifested A. in infancy B. at about 10 years of age C. in adolescence D. in adulthood COMPANION RESOURCES Each student is encouraged to access and use the web-based companion resources developed for this chapter. Here, you will find additional learning tools to increase your understanding of the concepts and clinical applications of the chapter. CHAPTER 13 CHAPTER 14 REVIEW QUESTIONS *Indicates MLT (optional) and MLS advanced content. Iron Deficiency and Iron Overload 1. Most operational iron in human beings is found in A. the bone marrow B. the liver C. heme portion of hemoglobin and myoglobin D. the free hemoglobin in the circulation Iron Deficiency and Iron Deficiency Anemia 2. The etiology of IDA is A. nutritional deficiency B. faulty iron absorption C. excessive loss of iron D. all of the above 3. Iron deficiency is still common in A. toddlers B. adolescent girls C. women of childbearing age D. all of the above 4. Decreased iron intake can result from A. sprue B. colon cancer C. adolescent growth spurt D. red meat–deficient diet 5. Faulty iron absorption can result from A. celiac disease B. colon cancer C. adolescent growth spurt D. menstruation 6. Pathological iron loss can be caused by A. sprue B. colon cancer C. adolescent growth spurt D. menstruation 7. Physiological iron loss can be caused by A. sprue B. GI bleeding C. adolescent growth spurt D. heavy menstruation 8. Increased iron utilization can be the result of A. sprue B. colon cancer C. adolescent growth spurt D. menstruation 9. The average adult has _____ g of total iron. A. 0.2 to 1.4 B. 1.5 to 3.4 C. 3.5 to 5.0 D. 5.1 to 10.0 10. 10 and 11. Approximately (10) _____% of iron from food is in the form of (11) _____ iron. A. 25 B. 50 C. 70 D. 90 11. A. non heme B. Heme 12. The cytochemical stain that can demonstrate iron, hemosiderin, and ferritin is: A. New Methylene blue B. Romanowsky C. Prussian Blue D. Wright-Giemsa 13. Most ingested iron is readily absorbed into the body in the A. stomach and duodenum B. duodenum and upper jejunum C. ileum and duodenum D. upper jejunum and ileum 14. Transferrin represents a A. storage form of iron B. beta globulin that moves iron C. glycoprotein that moves iron D. both B and C 15. In stage 3 IDA, the erythrocytic indices are typically A. MCV increased, MCH decreased, and MCHC decreased B. MCV decreased, MCH decreased, and MCHC decreased C. MCV decreased, MCH increased, and MCHC decreased D. MCV decreased, MCH decreased, and MCHC normal 16. The peripheral blood smear demonstrates _____ red blood cells in IDA. A. microcytic, hypochromic B. macrocytic, hypochromic C. macrocytic and spherocytic D. either a or b 17. If a patient’s peripheral blood smear reve

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