Saint Louis University

SCHOOL OF NURSING, ALLIED HEALTH, AND BIOLOGICAL SCIENCES

Department of Medical Laboratory Science

MLS 412 MEDICAL TECHNOLOGY ASSESSMENT PROGRAM (MTAP) 2

PRE-ASSESSMENT: HEMATOLOGY
MULTIPLE CHOICE. Choose the BEST answer.
1. What is the first type of cell produced by the developing embryo?
A. Erythrocyte B. Granulocyte C. Lymphocyte D. Thrombocyte
2. Which of the following is not characteristic of pluripotent hematopoietic stem cells?
A. Possess self-renewal ability C. Produce progenitor cells committed to a single-cell lineage
B. Express the stem cell marker CD 13 D. Are morphologically unrecognizable
3. In an adult, what are the two best areas for obtaining active bone marrow by aspiration?
A. Vertebra,tibia B. Sternum,vertebra C. Anterior iliac crest, tibia D. Posterior iliac crest, sternum
4. What is the normal ratio of myeloid to erythroid precursors in bone marrow (M:E ratio)?
A. 1:1 B. 1:3 C. 4:1 D. 8:1
5. Which of the following does not accurately describe hematopoietic growth factors?
A. Bind to target cell receptors to express activity C. Action of majority is lineage-restricted
B. May promote or suppress cell death D. Can stimulate or inhibit cell proliferation
6. The mechanism that relays information about tissue oxygen levels to erythropoietin-producing sites is located in the:
A. Brain B. Kidney C. Liver D. Spleen
7. Bone marrow cellularity refers to the ratio of:
A. Red cell precursors to white cell precursors C. Hematopoietic tissue to adipose tissue
B. Granulocytic cells to erythrocytic cells D. Extravascular tissue to intravascular tissue
8. The myeloid progenitor cell can produce cells committed to
A. Granulocytic, erythrocytic, monocytic, or megakaryocytic lineages C. Granulocytic, monocytic, lymphocytic, or megakaryocytic lineages
B. Erythrocytic, granulocytic, monocytic, or lymphocytic lineages D. Erythrocytic, granulocytic, lymphocytic, or megakaryocytic lineages
9. When evaluating a bone marrow aspirate smear, which finding is considered abnormal?
A. A predominance of granulocyte precursors as compared to nucleated red cells
B. Detection of stainable iron in macrophages and erythroid precursors with Prussian blue
C. An average of three megakaryocytes seen per low power (10X) field
D. The presence of 10% myeloblasts on the cell differential count
10. As most blood cell lines mature, which of the following is characteristic?
A. Cell diameter increases C. Nucleus to cytoplasm ratio (N:C) decreases
B. Nuclear chromatin becomes less condensed D. Basophilia of the cytoplasm increases
11. What is the average life span of a normal red blood cell?
A. 1day B. 10days C. 60 days D. 120days
12. Which of the following depicts the structure of the hemoglobin molecule?
A. Two heme groups, two globin chains C. Four heme groups, two globin chains
B. Two heme groups, four globin chains D. Four heme groups, four globin chains
13. Hemoglobin forms that are incapable of oxygen transport include
A. Deoxyhemoglobin and oxyhemoglobin C. Oxyhemoglobin and carboxyhemoglobin
B. Carboxyhemoglobin and methemoglobin D. Methemoglobin and deoxyhemoglobin
14. What red cell morphologic abnormality is described by the term "poikilocytosis"?
A. Variations in size C. Deviations from normal shape
B. Presence of inclusions D. Alterations in hemoglobin concentration
15. Howell-Jolly bodies are composed of
A. DNA B. Iron C. Reticulum D. RNA
16. Rouleaux of red blood cells when seen in the monolayer of a blood smear is characteristic of
A. Hypersplenism B. Hypogammaglobulinemia C. Cold hemagglutinin disease D. Multiple myeloma
17. Which of the following is associated with a "shift to the left" in hemoglobin's oxygen dissociation curve?
A. Decreased pH and elevated temperature C. Decreased oxygen affinity
B. Decreased oxygen release D. Presence of 2,3-bisphosphoglycerate (2,3-BPG)
18. Which of the following statements does not characterize erythropoietin (EPO)?
A. Transforms the CFU-E into the earliest recognizable RBC precursor
B. Increases the rate of red blood cell production by the bone marrow
C. Shortens the maturation time of developing erythroid precursors
D. Decreases stimulation of erythropoiesis when cellular hypoxia increases
19. Which of the following inclusions is only visible with supravital staining?
A. Basophilic stippling B. Cabot rings C. Heinz bodies D. Pappenheimer bodies
20. The presence of schistocytes on the peripheral blood smear is commonly associated with
A. Increased iron mobilization C. Increased red cell destruction
B. Decreased erythropoietin activity D. Decreased red cell proliferation
21. Which of the following may be a sign of accelerated bone marrow erythropoiesis?
A. Hypercellular marrow with a decreased number of RBC precursors C. Bone marrow M:E ratio of 6:1
B. Nucleated red cells in the peripheral circulation D. Low erythrocyte, hemoglobin, and hematocrit levels
22. Microcytic, hypochromic red cells are most often associated with impaired
A. DNA synthesis B. RNA metabolism C. Hemoglobin synthesis D. Enzyme metabolism
23. When acanthocytes are found on the blood smear, it is usually the result of
A. Abnormal membrane permeability C. Altered membrane lipids
B. Mechanical trauma D. Polymerization of hemoglobin molecules
24. Which of the following red blood cell precursors is the last stage to undergo mitosis?
A. Pronormoblast B. Basophilic normoblast C. Polychromatophilic normoblast D. Orthochromic normoblast
25. The red cells observed on a peripheral blood smear show extreme anisocytosis with an equal number of macrocytes and microcytes. Which of the
following values correlate with this finding?
A. MCV 108.0 fL, RDW 14.0% B. MCV 90.0 fL, RDW 25.0% C. MCV 75.0 fL, RDW 16.0% D. MCV 88.0 fL, RDW 12.0%
26. What does measuring the total iron- binding capacity (TIBC) represent?
A. Amount of free iron in serum C. Circulating protein-bound iron
B. Amount of iron that transferrin can bind D. Indirect measurement of iron stores
27. Serum ferritin is a good indicator of the amount of
A. Cytochrome iron B. Storage iron C. Hemoglobin iron D. Transferrin saturation
28. Fetal hemoglobin differs from adult hemoglobin in that hemoglobin F
A. Has a lower oxygen affinity C. Resists elution from red cells with acid solutions
B. Is no longer synthesized after birth in a normal individual D. Has four gamma-globin chains
29. Impaired DNA metabolism is characteristic of
A. Hemoglobin C disease B. Iron-deficiency anemia C. Sideroblastic anemia D. Megaloblastic anemia
30. Which of the following statements about sickle cell syndromes is false?
A. A splenism may result from repeated sickling crises in the homozygous state.
B. Heterozygous persons may be partly protected from infection by falciparum malaria.
C. Hemoglobin S is more soluble in dithionite than normal hemoglobin.
D. Trait conditions are generally asymptomatic with no sickle cell formation.
31. Which of the following conditions is not usually associated with marked reticulocytosis?
A. Four days after a major hemorrhage C. Drug-induced autoimmune hemolytic anemia
B. Sickle cell anemia D. Pernicious anemia
32. In addition to an increase in red blood cells, which of the following is characteristic of polycythemia vera?
A. Decreased platelets, decreased granulocytes, decreased erythropoietin level
B. Decreased platelets, decreased granulocytes, increased erythropoietin level
C. Increased platelets, increased granulocytes, increased erythropoietin level
D. Increased platelets, increased granulocytes, decreased erythropoietin level
33. Which of the following is not characteristic of aplastic anemia?
A. Extramedullary hematopoiesis C. Bone marrow hypoplasia
B. Absolute reticulocytopenia D. Blood findings of pancytopenia
34. What values would you expect to obtain on hemoglobin and hematocrit determinations done immediately after a major hemorrhage, if hemoglobin
and hematocrit values were normal prior to the hemorrhage?
A. Both normal C. Both decreased
B. Hemoglobin decreased, hematocrit normal D. Hemoglobin normal, hematocrit decreased
35. Which of the following is not a cause of absolute secondary erythrocytosis?
A. Defective cardiac or pulmonary function C. High-altitude adjustment
B. Dehydration secondary to diuretic use D. Hemoglobins with increased oxygen affinity
36. In the anemia of chronic disease, what are the usual serum iron and transferrin levels?
A. Serum iron decreased, transferrin decreased C. Serum iron decreased, transferrin increased
B. Serum iron normal, transferrin normal D. Serum iron increased, transferrin increased
37. Which of the following values can be used to indicate the presence of hemolytic anemia?
A. Hemoglobin level B. Hematocrit level C. Erythrocyte count D. Reticulocyte count
38. Which of the following statements about hereditary spherocytosis is true?
A. Abnormally shaped cells are produced in the bone marrow. B. Cells have a decreased mean cell hemoglobin concentration
C. Membrane loss and red cell trapping occur in the splenic microcirculation. D. Red cell osmotic fragility is decreased
39. Which of the following statements about hemoglobin C disease is false?
A. Electrophoresis shows approximately 60% hemoglobin A and 40% hemoglobin C.
B. Target cells are frequently seen on peripheral smears.
C. Red cells may contain bar-shaped intracellular crystals.
D. The disorder is less severe than sickle cell disease.
40. Which of the following characterizes iron- deficiency anemia?
A. Decreased serum iron, decreased transferrin saturation, normal ferritin
B. Decreased serum transferrin, decreased transferrin saturation, decreased ferritin
C. Increased serum transferrin, decreased transferrin saturation, decreased ferritin
D. Increased serum transferrin, increased transferrin saturation, decreased serum iron
41. What major phagocytic cell is involved in the initial defense against bacterial pathogens?
A. Neutrophil B. Eosinophil C. Basophil D. Monocyte
42. What growth factor is primarily responsible for regulating granulocyte and monocyte production?
A. Erythropoietin B. Colony stimulating factor C. Interleukin D. Thrombopoietin
43. A "shift to the left," when used to describe a cell population, refers to
A. Increased cells in the blood due to a redistribution of blood pools
B. An increase in immature blood cells following release of bone marrow pools
C. A cell production "hiatus" or gap
D. A higher percentage of lymphocytes than neutrophils
44. Which of the following is not a characteristic of T lymphocytes?
A. Secrete cytokines C. Synthesize antibody
B. Comprise majority of cells in the blood lymphocyte pool D. Regulate the immune response
45. An adult has a total white blood cell count of 4.0 X 109/L. The differential count is as follows: polymorphonuclear neutrophils (PMNs) 25%, bands 5%,
lymphocytes 65%, and monocytes 5%. The absolute value reference range for lymphocytes is 1.0—4.0 X 109/L. Which of the following is true?
A. The percentage of lymphocytes is normal. C. There is an absolute lymphocytosis.
B. There is a relative lymphocytosis. D. There is both an absolute and a relative lymphocytosis.
46. Which of the following statements about basophils is false?
A. Morphologically, basophils resemble tissue mast cells. C. Membrane receptors bind IgG, initiating anaphylactic reactions.
B. Basophilic granules contain heparin and histamine. D. Granules are water-soluble.
47. The most mature granulocyte precursor that can undergo mitosis is the
A. Myeloblast B. Promyelocyte C. Myelocyte D. Metamyelocyte
48. Which of the following statements about eosinophils is false?
A. They contain a type of peroxidase that is distinct from that of neutrophils. C. Eosinophilic granules contain lysozyme.
B. Eosinophils are an important line of defense against parasites. D. Major basic protein is a component of eosinophil granules.
49. Vasodilation and bronchoconstriction are the result of degranulation by which of the following blood cells?
A. Eosinophils B. Monocytes C. Neutrophils D. Basophils
50. Which of the following statements about neutrophils is false?
A. Suppress allergic reactions caused by basophils C. Have surface receptors for IgG and complement components
B. Contain alkaline phosphatase and muramidase D. Act in nonspecific phagocytosis and are destined to die
51. In patients with infectious mononucleosis, which blood cells are infected by the causative agent?
A. Monocytes B. T lymphocytes C. B lymphocytes D. Histiocytes
52. Based on the WHO classification system, B cell ALL (FAB type L3) and represent different clinical presentations of the same disease entity.
A. Burkitt lymphoma B. Hodgkin lymphoma C. Mycosis fungoides D. Small lymphocytic lymphoma
53. In which anomaly is a failure of granulocytes to divide beyond the band or two- lobed stage observed?
A. Pelger-Huet B. May-Hegglin C. Alder-Reilly D. Chediak-Higashi
54. In which of the following are eosinophils not increased?
A. Cushing syndrome B. Allergic disorders C. Skin disorders D. Parasitic infection
55. Which of the following represents the principal defect in chronic granulomatous disease (CGD)?
A. Chemotactic migration B. Phagocytosis C. Lysosomal formation and function D. Oxidative respiratory burst
56. A patient with normal hemoglobin and WBC count values, a persistently elevated platelet count (over 1000 X 10 9/L), increased marrow
megakaryocytes, and a history of frequent bleeding and clotting episodes most likely has
A. Polycythemia vera B. Chronic myelofibrosis C. Essential thrombocythemia D. Chronic myelogenous leukemia
57. An adult patient with massive splenomegaly has mild anemia, a slightly elevated WBC count, and an LAP score of 170. The blood smear shows
teardrop erythrocytes and leukoerythroblastosis. These findings are most consistent with
A. Chronic myelogenous leukemia B. Idiopathic myelofibrosis C. Primary polycythemia D. Primary thrombocythemia
58. The most common type of chronic lymphocytic leukemia (CLL) involves the
A. Bcell B. NKcell C. Tcell D. Plasma cell
59. Which of the following are characteristic findings in Waldenstrom disease?
A. Increased IgA and hepatosplenomegaly C. Increased IgE and renal failure
B. Increased IgG and hypercalcemia D. Increased IgM and blood hyperviscosity
60. In which of the following is progression to acute leukemia least likely?
A. Chronic myelogenous leukemia (CML) C. Refractory anemia with excess blasts (RAEB)
B. Refractory anemia with ringed sideroblasts (RARS) D. Chronic lymphocytic leukemia (CLL)
61. The presence of the chromosomal abnormality t(15;17) and a high incidence of disseminated intravascular coagulation (DIG) is diagnostic of
A. Acute myeloblastic leukemia without maturation (FAB type Ml) C. Acute myeloblastic leukemia with maturation (FAB type M2)
B. Acute promyelocytic leukemia (FAB type M3) D. Acute myelomonocytic leukemia (FAB type M4)
62. Which of the following is not classified as a myeloproliferative disorder?
A. Polycythemia vera B. Essential thrombocythemia C. Multiple myeloma D. Chronic myelogenous leukemia
63. Which of the following would be least helpful in distinguishing chronic myelogenous leukemia (CML) from a neutrophilic leukemoid reaction?
A. An extreme leukocytosis with increased neutrophilic bands, metamyelocytes, and myelocytes
B. Leukocyte alkaline phosphatase score
C. Presence of marked splenomegaly
D. Neutrophils with Dohle bodies and toxic granulation
64. Naphthol AS-D chloroacetate esterase (specific) is usually positive in ______ cells, and alpha-naphthyl acetate esterase (nonspecific) is useful for
identifying blast cells of lineage.
A. Granulocytic; monocytic B. Monocytic; granulocytic C. Granulocytic; lymphocytic D. Monocytic; lymphocytic
65. The familial disorder featuring pseudo-Dohle bodies, thrombocytopenia, and large platelets is called
A. May-Hegglin anomaly B. Chediak-Higashi syndrome C. Pelger-Huet anomaly D. Alder-Reilly anomaly
66. The hemorrhagic problems associated with scurvy are due to a deficiency of _____, which is a cofactor required for collagen synthesis.
A. Vitamin C B. Prothrombin C. Vitamin K D. Protein C
67. Prekallikrein deficiency is associated with
A. Prolonged aPTT that does not correct with a mixing study C. Autosomal dominant inheritance
B. Increased risk of thrombosis D. Delayed bleeding at the incision site following surgery
68. The expected screening test results for a patient with a fibrin stabilizing factor deficiency are
A. Prolonged prothrombin time C. Prolonged activated partial thromboplastin time
B. Prolonged prothrombin time and activated partial thromboplastin time D. Normal prothrombin time and activated partial thromboplastin time
69. A patient on therapeutic warfarin will most likely have a(n)
A. Normal PT/INR, increased aPTT, prolonged bleeding time, low platelet count
B. Increased PT/INR, increased aPTT, normal bleeding time, normal platelet count
C. Normal PT/INR, normal aPTT, normal bleeding time, normal platelet count
D. Increased PT/INR, normal aPTT, prolonged bleeding time, low platelet count
70. von Willebrand factor is a
A. Phospholipid required for multiple reactions in the coagulation sequence
B. Plasma protein that binds platelets to exposed subendothelial collagen
C. Plasma protein with procoagulant activity in the intrinsic coagulation system
D. Platelet membrane glycoprotein that attaches the platelet to the injured vessel wall
71. Which of the following is not true of the international normalized ratio (INR)?
A. INR is dependent on the reagents and instrumentation used.
B. INR is calculated using the PT ratio taken to the power of the ISI value.
C. The WorldHealth Organization recommends reporting the INR on stable oral anticoagulant therapy patients.
D. A therapeutic INR for a patient on Coumadin® is between 2.0 and 3.0, but may be higher depending on the cause of the patient's underlying
disease state.
72. A prolonged aPTT result is obtained on a patient diagnosed with acute disseminated intravascular coagulation (DIC). The patient has not yet been
treated for this disorder. The most likely cause of the prolonged aPTT is
A. In addition to DIC, the patient is deficient in a factor required for the extrinsic pathway.
B. DIC is characterized by the synthesis of less stable coagulation factors, which deteriorate rapidly in circulation.
C. Systemic coagulation system activation depletes some factors more rapidly than the liver can synthesize them.
D. The patient has been misdiagnosed; a prolonged aPTT indicates that the problem is deficient, not excessive, coagulation.
73. A clot retraction defect is most likely due to
A. Lack of platelet receptor glycoprotein Ib C. Lack of platelet receptor glycoprotein Ilb/IIIa
B. Insufficient ADP in dense bodies D. Absence of von Willebrand factor
74. The coagulation factors referred to as "vitamin K-dependent" are
A. I,V,VIII,XIII B. II,V,IX,XII C. II,VII,IX,X D. XI, XII, Fletcher, Fitzgerald
75. A specimen is received for a prothrombin time and activated partial thromboplastin time. The 5 mL tube has 2.5 mL of blood in it. Expected test
results are
A. PT and aPTT both falsely short C. PT and aPTT both falsely long
B. PT and aPTT both unaffected. D. PT unaffected, aPTT falsely short
76. A 24-year-old female with painful swelling in her left leg is seen by her physician, who orders laboratory testing for PT and aPTT. The PT is normal.
The aPTT is prolonged, but shortens with a 10-minute incubation of patient plasma with partial thromboplastin reagent that uses kaolin as the activator.
A 1:1 aPTT mixing study corrects to normal. The most likely diagnosis is
A. Factor II deficiency B. Factor VIII inhibitor C. Factor XIII deficiency D. Prekallikrein deficiency
77. Which of the following statements is correct regarding the D-dimer test?
A. Levels are decreased in DIC C. Test detects polypeptides A and B
B. Test detects fragments D and E D. Test has a negative predictive value
78. Bernard–Soulier syndrome is associated with:
A. Decreased bleeding time C. Decreased factor VIII assay
B. Thrombocytopenia and giant platelets D. Abnormal platelet aggregation to ADP
79. A prolonged APTT is corrected with factor VIII– deficient plasma but not with factor IX–deficient plasma. Which factor is deficient?
A. V B. VIII C. IX D. X
80. Refer to the following results:
PT = prolonged
APTT = prolonged
Platelet count = decreased
Which disorder may be indicated?
A. Factor VIII deficiency B. von Willebrand’s disease C. DIC D. Factor IX deficiency