Hematology 1 Exam, Medical Colleges of Northern Philippines, 2023-2024

## MEDICAL COLLEGES OF NORTHERN PHILIPPINES **COLLEGE OF MEDICAL LABORATORY SCIENCE** ### MT 112 : HEMATOLOGY 1 --- **PRELIM EXAMINATION** **Term:** FIRST **Semester:** **Fiscal Year:** 2023-2024 **Name:** RINNY **Proctor:** **Year and Section:** **Score:** **DIRECTION:** Read the questions...

## MEDICAL COLLEGES OF NORTHERN PHILIPPINES **COLLEGE OF MEDICAL LABORATORY SCIENCE** ### MT 112 : HEMATOLOGY 1 --- **PRELIM EXAMINATION** **Term:** FIRST **Semester:** **Fiscal Year:** 2023-2024 **Name:** RINNY **Proctor:** **Year and Section:** **Score:** **DIRECTION:** Read the questions carefully and choose the best answer. ERASURE, SUPERIMPOSITION OR ANY FORM OF ALTERATION ARE considered WRONG. Use black ballpoint pen only. **SET A** 1. Which of the following is not an appropriate safety practice? a. sterilizing lancets for reuse b. keeping food out of the same areas as specimens c. disposing of needles in biohazard, puncture-proof containers d. frequent handwashing 2. Standard precautions have been instituted in clinical laboratories to prevent healthcare workers to bloodborne pathogens such as HIV and HBV. a. parenteral b. nonintact mucous membrane c. exposures d. all of the above 3. Gloves for medical use may be a. sterile or nonsterile b. latex or vinyl c. nonintact skin d. all of the above 4. 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. whole blood b. platelets c. serum d. plasma 5. Which characteristic is inaccurate with respect to the anticoagulant K3 EDTA? a. is the most commonly used anticoagulant in hematology b. is conventionally placed in lavender-stoppered evacuated tubes c. removes ionized calcium (Ca ²⁺) from fresh whole blood by the process of chelation d. is used for most routine coagulation studies 6. If a blood smear is too long, the problem can be resolved by a. using a larger drop of blood b. pushing the slide slower in smearing out the blood c. decreasing the angle of the pusher slide d. increasing the angle of the pusher slide 7. 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 8. With a normal diet, an erythrocyte remains in the reticulocyte stage in the circulating blood for a. 3 days b. 120 days c. 1 day d. 2.5 days **SET B** 9. In a Wright-stained peripheral blood film, the reticulocyte will have a blue appearance. This is referred to as a. polychromatophilla b. erythroblastosis c. megaloblastic maturation d. bluemla 10. The protein responsible for the transport of iron in hemoglobin synthesis is a. oxyhemoglobin b. ferritin c. globin d. transferrin 11. Embden-Meyerhof glycolytic pathway uses _______% of the erythrocyte's total glucose. a. 50 b. 90 c. 10 d. 20 12. 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 13. 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 14. Which of the following is the term for erythrocytes resembling a stack of coins on thin sections of a peripheral blood smear? a. agglutination b. rouleaux formation c. anisocytosis d. poikilocytosis 15. The clinical signs and symptoms of anemia result from a. diminished delivery of oxygen to the tissues b. lowered hemoglobin concentration c. increased blood volume d. both a and b 16. What growth factor is produced in the kidneys and is used to treat anemia associated with kidney disease? a. G-CSF b. KIT ligand c. EPO d. TPO 17. Which of the following is the most mature normoblast? a. pronormoblast b. polychromatic normoblast c. orthochromic normoblast d. basophilic normoblast 18. Hypoxia stimulates RBC production by: a. increasing the number of RBC mitoses b. stimulating the production of fibronectin by macrophages of the bone marrow. c. inducing more pluripotent stem cells into the erythroid lineage d.stimulating EPO production by the kidney 19. To survive, the RBC must detoxify peroxides. What hexose-monophosphate shunt product(s) accomplishes detoxification? a. Pyruvic and lactic acid b. NADPH and reduced glutathione c. ATP d. 2,3-BPG 20. Which of the following helps maintain RBC shape a. GPI anchor b. Glycocalyx c. Membrane phospholipids d. Cytoskeletal proteins 21. A hemoglobin molecule is composed of: a. Protoporphyrin IX and four globin chains b. Four heme molecules and four globin chains c. One heme molecule and four globin chains d. Ferrous iron, protoporphyrin IX, and a globin chain 22. The predominant hemoglobin found in a healthy newborn is: a. Gower-1 b. Gower-2 c. Hb A d. Hb F 23. What is the normal distribution of hemoglobins in healthy adults? a. 95% Hb A₁, 3.5% Hb A₂, 1% to 2% Hb F b. 90% Hb A, 5% Hb F, 5% Hb A₂ c. 80% to 90% Hb A, 5% to 10% Hb A₂, 1% to 5% Hb F d. 80% to 90% Hb A₂, 5% to 10% Hb A, 1% to 5% Hb F 24. What effect would using a buffer at pH 6.0 have on a Wright's-stained smear? a. Red cells would be stained too pink b. White cell cytoplasm would be stained too blue c. Red cells would be stained too blue d. Red cells would lyse on the slide 25. Which of the following is considered a normal hemoglobin? a. Sulfhemoglobin b. Deoxyhemoglobin c. Carboxyhemoglobin d. Methemoglobin 26. Which condition will shift the oxyhemoglobin dissociation curve to the right? a. Multiple blood transfusions b. Increased quantities of hemoglobin S or C c. Acidosis d. Alkalosis 27. In normal adults, the spleen acts as a site of: a. Synthesis of EPO b. Removal of imperfect and aging cells c. Storage of RBC d. Production of RBC 28. For complete blood count (hematology) and measurement of prothrombin time (coagulation), the phlebotomist collected blood into lavender stopper and green stopper tubes. Are these specimens acceptable? a. Yes, EDTA is used for hematologic testing and heparin is used for coagulation testing. b. No, although EDTA is used for hematologic testing, citrate, not heparin, is used for coagulation testing. c. No, although heparin is used for hematologic testing, citrate, not EDTA, is used for coagulation testing. d. No, hematologic testing requires citrate and coagulation testing requires a clot, so neither tube is acceptable. 29. After focusing a specimen by using the 40x objectives, the laboratory professional switches to a 100x objective. The specimen remains in focus at 100x. Microscopes with this characteristic are described as: a. Compensated b. Parachromatic c. Parfocal d. Parcentric 30. What single feature of normal RBCs is most responsible for limiting their life span? a. Loss of mitochondria b. Increased flexibility of the cell membrane c. Reduction of hemoglobin iron d. Loss of the nucleus **SET A** 31. Which of the following does not accurately describe hematopoietic growth factors? a. bind to target cell receptors to express activity b. action of majority is lineage restricted c. may promote or suppress cell death d. can stimulate or inhibit cell proliferation 32. In the third month of gestation, what is the primary site of hematopoiesis? a. liver b. marrow of long bones c. spleen d. yolk sac 33. The mechanism that relays information about tissue oxygen levels to erythropoietin-producing sites is located in the a. liver b. spleen c. brain d. kidney 34. Hemoglobin forms that are incapable of oxygen transport include a. carboxyhemoglobin and methemoglobin b. methemoglobin and deoxyhemoglobin c. deoxyhemoglobin and oxyhemoglobin d. oxyhemoglobin and carboxyhemoglobin 35. Which of the following may be a sign of accelerated bone marrow erythropoiesis? a. Nucleated red cells in the peripheral circulation b. Low erythrocyte, hemoglobin, and hematocrit levels c. Hypercellular marrow with a decreased number of RBC precursors d. Bone marrow M:E ratio of 6:1 36. Platelet satellitosis causes EDTA-induced a. Pseudothrombocytopenia b. Pseudoleukocytopenia c. Pseudothrombocytosis d. Pseudoleukocytosis 37. All causes excessively blue stain of blood smear except: a. thick blood films b. too acidic buffer c. inadequate washing d. prolonged staining time 38. Pan-myeloid growth factor that stimulates production of erythroid, granulocyte, monocyte, megakaryocyte, and eosinophil progenitors: a. G-CSF b. TPO c. GM-CSF d. EPO 39. True of the pathways for red blood cell maturation: 1. 90% of the glycolysis in the RBC follows the aerobic Embden-Myerhof pathway 2. The methemoglobin reductase pathway maintains the iron in the Hb in a functional oxidized (Fe⁺⁺⁺) state. 3. The Rapoport-Luebering pathway allows for the production of 2,3-DPG 4. Decreased activity of an enzyme in the HMP shunt results to formation of Heinz bodies a. 1, 3 b. 3, 4 c. 1, 2, 3 d. 2, 3 40. Swelling due to leakage of large amounts of blood a. ecchymoses b. purpura c. hematoma d. bruise 41. Precursor cell of a Neutrophil a. lymphoblast b. erythroblast c. myeloblast d. megakaryoblast 42. Which of the following are parts of stromal cells? 1. Endothelial 2. Adipose 3. Osteoclast 4. Hematopoietic a. 1 and 4 b. 2, 3 and 4 c. 2 and 3 d. 1, 2 and 3 **SET B** 43. In erythropoiesis, at what maturational stage does mitosis end? a. Third b. Second c. Fifth d. Fourth 44. Which hemoglobins are produced during early embryogenesis? 1. fetal/Hb F 2. Gower 1 3. Gower 2 4. Portland a. 1, 2, 3, and 4 b. 1, 2 and 3 c. 2 and 3 d. 2, 3 and 4 45. Ratio of anticoagulant to blood for coagulation studies: a. 1:4 b. 4:1 c. 1:9 d. 9:1 46. Which of the following are examples of cytokines? 1. Chemokines 2. Interleukins 3. Heparan sulfate 4. Colony stimulating factor a. I, II, III b. II, III, IV c. I, II, IV d. II, IV 47. Which of the following is/are true related to platelet satellitosis? I. Platelet satellitosis occurred in citrated blood sample II. Satelittosis refers to platelet surrounding a PMN’s III. EDTA anticoagulant is used for remedy a. 1, 2, 3 b. 2 only c. 2, 3 d. NOTA 48. All are true for skin puncture except: a. povidone-iodine should not be used because of possible blood contamination, which would produces falsely elevated levels of potassium, phosphorus, or uric acid. b. punctures should not be made more than 4mm deep because of the risk of bone injury and possible infection (osteomyelitis) c. the site of choice in infants is the lateral or medial surface of the plantar side of the heel. d. the site should be warmed to a temperature no greater than 42 'c for no longer than 2 to 5 minutes, unless the collection is for capillary blood gas analysis. 49. The volume of Packed Red Blood Cells that occupies a given volume of whole blood: a. cyanmethemoglobin b. reticulocyte c. ESR d. hematocrit 50. Most of the erythrocyte's energy comes from the: a. hexose monophosphate shunt b. methemoglobin reduction pathway c. embden meyerhof pathway d. rapoport luebering 51. These pairs of chains make up the majority of hemoglobin in normal adults? a. 2-Alpha, 2-Delta b. 2-Zeta and 2 Gamma c. 2-Alpha and 2 Beta d. 2-Alpha, 2-Gamma 52. A shift to the right in the ODC occurs when there is a/an: a. Increase in Oxygen b. Decrease in CO₂ c. Increase pH d. Increase in CO₂ 53. On which of these physiologic errors in manual hemoglobin measurement can be corrected by adding 0.2ml of patient's plasma to 6.0ml of cyanmethemoglobin reagent and use this as a patient blank? a. Extremely high WBC count b. Lipemia c. Abnormal plasma proteins d. AOTA 54. Which of these EDTA concentration is recommended for complete anticoagulant without cellular alteration a. 0.5 mg/ml b. 1 mg/ml c. 1.5 mg/ml d. 2 mg/ml 55. Sex-linked enzyme defect; most common enzyme deficiency in the Hexose Monophosphate Shunt a. glucose oxidase deficiency b. G6PD deficiency c. pyruvate kinase deficiency d. NOTA 56. All of the following are environmental factors that affects the ETS EXCEPT: a. Altitude b. pH c. Sunlight exposure d. Temperature 57. Which of the following case/s would extramedullary hematopoiesis occur? 1. bone marrow becomes dysfunctional in cases such as aplastic anemia 2. bone marrow is unable to meet the demands placed on it, as in the hemolytic anemias 3. in cases of myeloproliferative conditions a. 1 and 2 b. 1 c. 1, 2 and 3 d. 1 and 3 58. Which of the following is true regarding to extravascular or macrophage mediated hemolysis? a. presence of many schistocytes b. total serum bilirubin is increased c. hemoglobinuria d. AOTA 59. Types of hemoglobin that can be measured by Cyanmethemoglobin method a. carboxyhemoglobin b. deoxyhemoglobin c. sulfhemoglobin d. 2 of the above 60. Blood is mauve-lavender in color. This may be due to: a. carboxyhemoglobin b. deoxyhemoglobin c. sulfhemoglobin d. methemoglobin 61. If the level of methemoglobin increases to 30% or more of total hemoglobin, intravenous _______ is administered. a. methylene green b. methylene blue c. bromcresol green d. NOTA 62. Absence of ferrochelatase and D-ALA in heme synthesis will result to: a. Variegate porphyria b. lead poisoning c. Erythropoietic protoporphyria d. NOTA 63. All of the following is not true except: 1. Heme synthesis occurs in the ribosomes of normoblasts 2. Globin synthesis occurs in the mitochondria 3. Rubricyte is the first stage of hemoglobin synthesis a. 3 only b. NOTA c. 1, 2, 3 d. 2, 3 64. All of the following is false except 1. 1 Hb: 1 moles of Oxygen 2. 1 heme molecule: 4 pyrrole rings 3. 1 heme molecule: 1 ferrous iron a. 1, 2, 3 b. 2, 3 c. 3 only d. NOTA 65. All of the following is not true except: 1. Extravascular Hemolysis is responsible for 90% of RBC destruction 2. Also known as the Fragmentation Hemolysis 3. Also known as the Macrophage mediated hemolysis a. 1, 2, 3 b. 1 only c. 2 of the above d. NOTA 66. Shift to the right 1. decrease pH 2. increase Hb affinity to O₂ 3. increase tissue O₂ 4. increase CO₂ 5. Decrease 2,3-DPG 6. Increase temperature a. 1, 2, 3, 5 b. 1, 3, 4, 6 c. AOTA d. 3, 4, 5, 6 67. Shift to the right of the ODC: 1. high altitude 2. low altitude 3. Hypoxia 4. Hb F 5. Myoglobin a. 1 only b. 1, 2, 3 c. 2, 3 d. 1, 3 68. Provides reduced glutathione (GSH) to prevent oxidative denaturation of hemoglobin which makes it a protective mechanism. a. hexose monophosphate shunt b. methemoglobin reduction pathway c. embden meyerhof pathway d. rapoport luebering **SET B** 69. Integral/Transmembrane proteins 1. spectrin 2. Ankyrin 3. Band 3 4. Aquaporin 1 5. RhAg a. 1, 2 b. 3, 4 c. 1, 2, 4 d. AOTA 70. Nucleated stages of RBC maturation series 1. Rubriblast 2. Prorubricyte 3. Rubricyte 4. Metarubricyte a. 1, 2 b. 3, 4 c. 1, 2, 4 d. AOTA 71. Late in this stage, the nucleus is ejected from the cell. a. Rubriblast b. Prorubricyte c. Rubricyte d. Metarubricyte 72. Last stage capable for the production of hemoglobin a. Reticulocyte b. Polychromatic erythrocyte c. Orthochromic erythroblast d. 2 of the above 73. Three Major Effects of EPO 1. allowing early release of reticulocytes from the bone marrow 2. preventing apoptotic cell death 3. Increasing the transit time or time needed for cells to mature in the bone marrow. a. 1, 2, 3 b. 1, 3 c. 1, 2 d. 2, 3 74. The CFU-GEMM gives rise to the earliest identifiable colony of RBCs, called the _____ , that contains only a few receptors for EPO. a. BFU-E b. CFU-E c. CRU-GEMM d. CMP 75. Removal of mature or senescent RBC through phagocytosis that leads to eventual degradation of cell organelles. a. pitting b. culling 76. Graveyard of the RBCs a. liver b. heart c. kidney d. spleen 77. Medullary Hematopoiesis 1. Primary hematopoiesis 2. Usually seen during compensatory state 3. Bone marrow 4. Hepatomegaly a. 1, 2 b. 2, 3 c. 1, 3 d. 3, 4 78. 1. The hepatic phase of hematopoiesis begins at 6th to 8th week of gestation. 2. In the 4th month of gestation or prior to the fifth month of fetal development, hematopoiesis begins in the bone marrow cavity. 3. Myeloblastic phase begins around 19th day of embryonic development after fertilization. a. 1, 2, 3 b. 1, 2 c. 1, 3 d. 2, 3 79. This theory suggests that all blood cells are derived from a single progenitor stem cell called a pluripotent. a. Monophyletic theory b. Polyphyletic theory c. a & b d. NOTA 80. In this method WBCs are counted in consecutive fields from tail toward the head of the smear. a. Longitudinal b. Cross sectional c. Battlement d. serpentine 81. Characteristic of an ideal blood smear 1. Gradual transition from thin to thick area 2. 2/3 to 4 the length of the film slide 3. Finger-shaped 4. Visible lateral edges 5. Appears smooth with irregularities, holes, streaks, waves or gaps a. AOTA b. 2 of the above c. 3 of the above d. 4 of the above 82. Too Thin smears: 1. heavy pressure 2. Light pressure 3. High angle 4. slow speed a. AOTA b. 2 of the above c. 3 of the above d. 4 of the above 83. The distance of the drop of blood to the end of the slide in PBS a. 0.5 inch b. a & b c. 1 cm d. 2 of the above 84. Used for bone marrow samples a. wedge method b. Ehrlich c. beacom d. 2 of the above 85. Color needle 1. Black - 17x 2. Red - 20x 3. White - 25x 4. Yellow - 25x a. 1, 2, 3 b. 2, 3, 4 c. AOTA d. NOTA 86. EDTA anticoagulated tube 1. CBC 2. PBS 3. HbA1C 4. Platelet count a. 1, 2, 3 b. 2, 3, 4 c. AOTA d. NOTA 87. The following are the general trends that are happening during RBC maturation except a. The nuclear chromatin pattern becomes coarser, clumped, and condensed. b. nucleoli disappear c. The overall diameter of the cell decreases. d. N:C ratio increases. 88. The stage's name refers to this combination of multiple colors, because polychromatophilic means many-color-loving. a. Rubricyte b. Metarubricyte c. Rubriblast d. Prorubricyte 89. In this stage the chromatin may be partially clumped, and the pattern may suggest a wheel. a. Rubriblast b. Prorubricyte c. Rubricyte d. Metarubricyte 90. In this stage hemoglobin appears for the first time. a. Rubricyte b. Metarubricyte c. Rubriblast d. Prorubricyte 91. The most important step in phlebotomy is: a. Selecting the proper needle length b. Using the correct evacuated tube c. Cleansing the site d. Identifying the patient 92. During the second trimester of fetal development, the primary site of blood cell production is the: a. Bone marrow b. Spleen c. Lymph nodes d. Liver 93. Which of the following forms of hemoglobin molecule has the least affinity for oxygen? a. Tense b. Relaxed c. both d. NOTA 94. Using the normal hemoglobin-oxygen dissociation, predict the position of the curve when there is a decrease in pH. a. Shifted to the right of normal with increased oxygen affinity b. Shifted to the left of normal with decreased oxygen affinity c. Shifted to the right of normal with decreased oxygen affinity d. Shifted to the left of normal with increased oxygen affinity 95. The presence of nucleoli is associated with a. immature cells b. all young cells, except myeloblasts c. only erythroblasts d. disintegrating cells 96. The number of heme groups in a hemoglobin molecule is a. 1 b. 2 c. 3 d. 4 **SET B** 97. 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 98. Hemoglobin globin chains: 1. Hb A1= 2 alpha + 2 beta 2. Hb F= 2 alpha + 2 gamma 3. Gower 1 = 2 alpha + 2 delta 4 Gower 2= 2 alpha + 2 epsilon a. 1, 2 ,3 b. 1, 2, 4 c. 2, 3, 4 d. 1, 3, 4 99. Composition of Drabkin's Reagent 1. Potassium ferricyanide 2. Potassium cyanide 3. Non-ionic detergent 4. Dihydrogen potassium phosphate a. AOTA b. 2 of the above c. 3 of the above d. 4 of the above 100. 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