HEMATOLOGY II POST EXAM

1. Asynchronous development of hematopoietic cells within the bone marrow is the result of:
a. Inadequate levels of RNA c. defective stem cells
b. Decreased production of erythropoietin d. Impaired DNA synthesis

2. Abnormalities in the shape of the red cell include which of the following?
1. acanthocytes 2. Ovalocytes 3. Schistocytes 4. Crenation
a. 1, 2 and 3 b. 1 and 3 c. 2 and 4 d. 4 only e. all of the above

3. A decrease in the total blood volume with a normal erythrocyte volume leads to an increased hematocrit or relative erythrocytosis. It is associated with
1. diuretic theraphy 3. Decrease in fluid intake
2. burns 4. Gaisbock’s syndrome
a. 1, 2 and 3 b. 1 and 3 c. 2 and 4 d. 4 only e. all of the above

4. The neutrophil normally is present in which of the following body compartments?

a. bone marrow 2. Circulation 3.marginal pool 4. Spleen
a. 1,2 and 3 b. 1 and 3 c. 2 and 4 d. 4 only e. all of the above

5. Characteristic associated with vitamin B12 (cyanocobalamin) include

1. intrinsic factor is necessary for it’s absorption
2. minimum daily requirement is 1 ug
3. it is also known as extrinsic factor
4. a deficiency causes impaired nucleic acid synthesis
a. 1,2 and 3 b. 1 and 3 c. 2 and 4 d. 4 only e. all of the above

6. Iron deficiency anemia is the most common type of anemia and may occur as a resultof
1. lack of iron in the diet (two-year-old milk-fed children)
` 2. Lack of absorption from the intestinal tract
3. occult carcinoma of the colon with chronic blood loss
4. increased physiologic requirements such as in pregnancy
a. 1, 2 and 3 b. 1 and 3 c. 2 and 4 d. 4 only e. all of the above

7. A neutrophil leukocytosis may occur as the result of

1. acute infection 2. Inflammation 3. Metabolic disturbance 4. Hemorrhage
a. 1, 2 and 3 b. 1 and 3 c. 2 and 4 d. 4 only e. all of the above

8. Hematologic findings associated with erythroleukemia are which of the following?

1. cytoplasm of the erythroblast is PAS positive
2. erythropoiesis appears megaloblastic, not responsive to B12
3. hyperbilirubinemia
4. may terminate as a frank myeloblastic leukemia
a. 1, 2 and 3 b. 1 and 3 c. 2 and 4 d. 4 only e. all of the above

9. Gross appearance of slide excessively blue, with blue-red erythrocytes and dark, granular leukocytes may be due to:
a. improper washing or old stain
b. overfixing, overstaining, underwashing; too alkaline stain or buffer, or too thick blood film
c. overwashing, understaining, underfixing
d. understaining, overwashing, too-acid stain, buffer or water

10. Bone marrow evaluation of a patent having multiple myelomo shows

1. increased number of plasma cells 3. Russell bodies (eosinophilic bodies)
2. Molt cells (multiple vacuolation) 4. Flame cells (eosinophilic cytoplasm)
a. 1, 2 and 3 b. 1 and 3 c. 2 and 4 d. 4 only e. all of the above

11. The finding of significant amounts of macroglobulins in the serum may be associated with:
1. chronic lymphocytic leukemia 2. Lymphomas 3. Myeloma 4. Normality
a. 1, 2 and 3 b. 1 and 3 c. 2 and 4 d. 4 only e. all of the above

12. In Waldenstrom’s macroglobulinemia, one notes:

1. atypical lymphocytic leukemia 3. Positive antiglobulin test
2. a cryoglobulin (positive Sia water test) 4. Abnormal “spike” on serum electrophoresis
a. 1, 2 and 3 b. 1 and 3 c. 2 and 4 d. 4 only e. all of the above

13. Morphologic classification of aplastic anemia from bone marrow suppression

a. Hypochromic-microcytic b. macrocytic c. normochromic-nomocytic d. AOTA

14. Morphologic classification of thalassemia and other hemoglobinopathies

a. Hypochromic-microcytic b. macrocytic c. normochromic-nomocytic d. AOTA

15. Characteristic of the erythrocyte include

1. a life span of about 120 days
2. a biconcave disc, favoring oxygen and carbon dioxide exchange
3. blood group antigens attached to the surface
4. no nucleus or organelles
a. 1, 2 and 3 b. 1 and 3 c. 2 and 4 d. 4 only e. all of the above

16. Which of the following statements are relevant to erythrocyte survival and destruction?
1. approximately 1% of the total erythrocyte mass is replaced everyday
2. senescent erythrocytes are removed from the circulation primarily by the liver
3. within the reticuloendothelial cells, the iron is split off from the globin
4. iron is recirculated and stored as hemopexin in the tissues
a. 1, 2 and 3 b. 1 and 3 c. 2 and 4 d. 4 only e. all of the above

17. Structurally, hemoglobin has which of the following characteristics?

1. It consists of heme group surrounded by two pairs of peptide chains.
2. Hemoglobin A has two pairs of chains, alpha and beta.
3. The alpha chain has 141 amino acids , the beta 146.
4. The heme group consists of four pyrrole rings bound by methylene (CH) bridges and linked to iron by their N atoms.
a. 1, 2 and 3 b. 1 and 3 c. 2 and 4 d. 4 only e. all of the above

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18. Functions of hemoglobin include
1. transports oxygen from the lungs to the tissues
2. assists in the acid-base regulation by eliminating CO2
3. transports CO2 from the tissues to the lungs
4. assists in the acid-base regulation via the buffering action of the imidazole histamine group of hemoglobin
a. 1, 2 and 3 b. 1 and 3 c. 2 and 4 d. 4 only e. all of the above

19. Unit of measurement is in picograms

a. MCV b. MCH c, MCHC d. RDW

20. Diluent which induces hemolysis of erythrocytes

a. acetic acid b. normal saline c. both d. neither

21. A blood specimen reveals 97% hemoglobin A1, 2% hemoglobin A2, and 1% Hemoglobin F. The next step is to:
a. recollect the specimen c. send-out the report
b. perform a Kleihauer-Betke stain d. quantitate Hemoglobin A2 by column chromatography

22. Increased osmotic fragility is seen in:

a. microcytic anemia c. hypochromic anemia e. pernicious anemia
b. hereditary spherocytosis d. sickle cell anemia

23. For osmotic fragility determination the solution used is:

a. acetic acid c. sodium citrate e. sodium chloride
b. sodium carbonate d. distilled water

24. The most common enzyme defect associated with the hexose monophosphate shunt is:
a. methemoglobin reductase deficiency
b. glutathione reductase deficiency
c. pyruvate kinase deficiency
d. glucose-6-phosphate dehydrogenase deficiency
e. catalase deficiency

25. Abnormal hemoglobins may be detected using electrophoretic techniques. Of the following which is the most useful for routine purposes?
a. starch gel c. polyacylamide gel e. paper
b. cellulose acetate d. agar

26. Dirty or chipped slides

a. good blood film
b. incorrect distribution of WBC types in the body of the film
c. neutrophils accumulate in the feathered edge
d. unusually thick blood film
e. platelets decreased in the body of the blood film

27. Large drop of blood, large angle and slow stroke

a. good blood film
b. incorrect distribution of WBC types in the body of the film
c. neutrophils accumulate in the feathered edge
d. unusually thick blood film
e. platelets decreased in the body of blood film

28. Using cellulose acetate electrophoresis which of the following hemoglobins migreae withS?
a. D b. C d. A d. A2 e. H

29. Anemia, leucopenia or leukocytosis, thrombocytopenia, monocytosis with onion skin cells in the bone marrow is indicative of:
a. chronic granulocytic leukemia c. lymphoma
b. Gaucher’s disease d. infectious mononucleosis

30. Reducing agent which will make erythrocytes to sickle:

a. Sodium hydroxide c. Metabisufite
b. Citric acid d. Sodium sulphate

31. Retard rather than accelerate erythrocyte sedimentation:

a. Albumin b. Globulin c. Neither d. Either

32. On routine peripheral blood smear, which of the following cell are not discernible?
a. Nucleated cells c. Plasma cells
b. B-lymphocytes d. Basket cells

33. What does erythrocytes sedimentation rate measure?

a. fragility of erythrocytes
b. Total erythrocytes mass
c. Packed cell volume
d. suspension stability of erythrocyte

34. These are some laboratory tests that will differentiate thalassemia minor and iron deficiency anemia?
1. RBC count 2. TIBC
3. Serum iron 4. Transferrin saturation
a. 1,2,3,4 b. 2 and 3 c. 1,2,3 d. 1 and 2

35. Tilting a wetergreen tube at an angle of even 3 degrees from the vertical may accelerate the ESR by:
a. 10% b. 80% c. 50% d. 30%

36. What is the oxygen binding capacity of one gram of haemoglobin?

a. 0.75 b. 1.00 c. 1.34 d. 2.24

37. What are the outstanding marks found in a Thomas WBC pipet?
1. 0.5 2. 1.0 3. 11 4. 11.1
a. 2 and 3 c. 1,2,3
b. 1 and 2 d. 1,2,3,4

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38. Which of the following disease has a high neutrophil alkaline phosphatase score?
a. Polycythemia vera
b. Sickle cell anemia
c. Chronic myelogenous leukemia
d. Paroxysmal nocturnal hemoglobinuria

39. In the tissue , monocytes mature into cells known as:

a. Mast cell c. Macrophages
b. Ferrata cells d. Osteoclast

40. What narrow cells may be confused with plasma cells as they both tend to have eccentric nuclei and basophilic cytoplasms?
a. Osteoclast c. Mast cell
b. Osteoblast d. Macrophages

41. Which of these special hematology tests does not require a defibrinated specimen?
a. Sugar water test c. Osmotic fragility test
b. Autohemolytic test d. Acidefied serum test

42. The granules and cytoplasm of basophils contain abundant deposits of glycogen. Glycogen stain positively with
a. Sudan black B c. Peroxidase
b. Alkaline Phosphate d. PAS

43 . All of the following can cause a shift to the right in the dissociation curve, except:
a. increased pH c. increased 2,3 DPG
b. increased blood temperature d. increased carbon dioxide

44. Which of the following matches are correctly paired?

a. acute myelomonocytic leukemia – Naegeli leukemia
b. acute monocytic leukemia – Schilling’s leukemia
c. both A and B
d. none of the above

45. The following statements regarding haemoglobin types are true, except:
a. Portland hemoglobin is composed of a pair of zeta and a pair of gamma chains
b. Gower 1 hemoglobin is composed of a pair of gamma and a pair of epsilon chains
c. Gower 2 hemoglobin is composed of a pair of alpha and a pair of epsilon chains
d. Hemoglobin A2 is composed of a pair of alpha and a pair of delta chains.

46. Factors that affect the rate of sedimentation of erythrocytes include:

1. tilting the tube
2. using refrigerated blood
3. use of specimen collected 24 hours previously
4. using heparin as the anticoagulant
a. 1, 2,3 c. 2 and 4 e. 1, 2, 3, 4
b. 1 and 3 d. 4 only

47. Typical findings on blood smears from patients with severe pernicious anemia include:
1. hypersegemented neutrophils 3. Macrocytes
2. thrombocytopenia 4. Atypical lymphocytes
a. 1, 2,3 c. 2 and 4 e. 1, 2, 3, 4
b. 1 and 3 d. 4 only

48. The results compatible with a peripheral smear showing macrocytic, normochromic red cell morphology are:
a. Hct 40.0%; Hb 13.2g/dL, RBC 4.8x106/L
b. Hct 36.0%; Hb 12.2g/dL, RBC 4.1x106/L
c. Hct 37.0%; Hb 11.7g/dL, RBC 3.48x106/L
d. Hct 8.9%; Hb 4.0/dL, RBC 1.5x106/L
e. Hct 45.0%; Hb 15.2g/dL, RBC 5.1x106/L

49. Red, needle-like leukocyte inclusions found in myeloblast in acute myelogenous leukemia are called:
a. Toxic granules c. Auer rods e. Barr bodies
b. Dohle bodies d. Pappenheimer bodies

50. A neutrophilic leukocyte with a homogenous red-purple mass of nuclear material describes:
a. Tart cell d. LE cell
b. Reed-sternberg cell e. Downey cell
c. atypical lymphocyte

51. Screening tests for sickle cell haemoglobin using reducing agent and concentrated phosphate buffer are based on the principle that haemoglobin S:
a. migrates quickly in the buffer
b. sickles in the presence of the buffer
c. soluble in the buffer
d. insoluble in the buffer
e. resist alkali denaturation

52. In the acid elution test, erythrocytes containing fetal haemoglobin stain an even pink-red shen
a. normal adult blood is used
b. hereditary homozygous persistence of fetal haemoglobin is present
c. heterozygous beta-thalassemia is present
d. sickle cell disease is present
e. alpha thalassemia is present

53. Increase in target cells, accompanied by decrease in the synthesis of beta chains indicates:
a. Hemoglobin H disease d. Pyridoxine anemia
b. Beta thalassemia e. Sickle cell anemia
c. Hemoglobin SC disease

54. The erythrocytes on a smear stain blue-green and the nuclear chromatin of leukocytes stains blue-purple due to:
a. prolonged buffering of the smear

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 b. insufficient staining time
c. wright’s stainig reaction is too acidic
d. wright’s staining reaction is too alkaline
e. methyl alcohol has oxidized to formic acid

55. Hemoglobin CC crystals:

a. hexagonal crystals with blunt ends that form within the membrane
b. found in haemoglobin C disease and haemoglobin C trait
c. both
d. neither

56. Solubility test for sickle cell:

1. uses sodium metabisulfite as reagent
2. uses sodium dithionite as reagent
3. positive result is holly leaf formation
4. positive result is turbidity of solution
a. 1 and 3 c. 2 and 3
b. 1 and 4 d. 2 and 4

57. Increase 2,3-DPG levels cause:

1. increased formation of tense forms of haemoglobin
2. increased formation of relaxed forms of haemoglobin
3. a shift to the left of the oxygen dissociation curve
4. a shift to the right of the oxygen dissociation curve
a. 1 and 3 c. 2 and 3
b. 1 and 4 d. 2 and 4

58. Presence of Hb S and Hb C are one of the physiologic sources of error in terms of haemoglobin measurement. This can be corrected by:
a. preparing a patient blank
b. centrifuging a mixture and using supernatant fluid
c. diluting one part of haemoglobin mixture with one part distilled water
d. addition of potassium phosphate salt

59. The dye used for vital staining for the reticulocyte count
a. basic fuchsin c. brillian cresyl blue e. sodium carbonate
b. sodium notropusside d. potassium ferricyanide

60. The normal number of reticulated erythrocytes in an adult does not normally exceed
a. 0.2 percent b. 0.3 percent c. 2.0 percent d. 5.0 percent

61. Alkali denaturation is a procedure employed to detect

a. Heinz body information d. fetal haemoglobin
b. sickle cells e. paroxysmal nocturnal hemoglobinuria
c. haemoglobin M

62. All but which one of the following are derivatives of heme catabolism?
a. urobilinogen d. stecobilinogen
b. blilrubin diglucuronide e. porphyrin
c. biliburin

63. All but which one of the following irregularities in the shape of red cells are associated with hemolysis?
a. spherocytosis d. ellipocytes
b. stomatocytes e. burr cells
c. sickle cells

64. Which one of the following hematologic findings does not apply to polycythemia vera?
a. haemoglobin level of 20 g/dL d. extramedullary hematopoiesis present
b. leucocytosis e. total blood volume decreased
c. thrombocytosis

65. All but which one of the following are lipid storage diseases?
a. Gaucher’ disease d. histocytosis X
b. Gargoylism e. amaurotic familial idiocy (Tay-Sachs variety)
c. Niemann- Pick disease

66. Which one of the following is not a congenital defect associated with the leukocyte?
a. Alder-Reilly syndrome c. Pelger-Huet anomaly e. May-hegglin anomaly
b. Chediak-Higashi syndrome d. Dohle-Amato body

67. Basic conditions predisposing to hemolysis are

1. abnormalities of haemoglobin (sickle cell ) influencing flow
2. exposure of red cells to excessive physical trauma
3. abnormalities of the cell membrane
4. instrinsic enzyme defects (G-6-PD deficiency)
a. 1 , 2 and 3 b. 1 and 3 c. 2 and 4 d. 4 only e. all of the above

68. The international council for standardization in hematology (ICSH) accepts as suitable units for the measurement of hemoglobbin concentration
1. FL 2. g/dl 3. g/L 4. mmoI/L 5. %
a. 1 , 2 ,3 b. 1, 2 c. 3 , 4 , 5 d 3,4

69. Most likely haematological abnormality associated with the administration of corticosteroids
a. neutrophilia c. non-lobulated neutrophils e. atypical lymphocytes
b. neutropenia d. right shift

70. If a patient who has an iron deficiency anemia receives blood transfusion from healthy adults, the peripheral blood smear most likely will show:
a. polychromasia b. reticulocytes c. anisocytosis d. poikilocytosis

71. A patients WBC count is 13.6 X 109/L The differential reveals 75 nucleated RBCs per 100 WBCs. The corrected WBC count is ______ x10 9/L
a. 1.8 b. 4.9 c. 7.8 d. 18.1

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72. A male with sickle cell anemia had a RBC count of 2.55 x 1012/L, hematocrit of 0.25L/L , and 91 reticulocytes per 1000 RBCs. The corrected reticulocyte count is
a. 1.5% b. 2.5% c. 5.1% d. 9.1%

73. Blood is pipetted to the 0.5 mark of a RBC pipet. The number of cells counted in the standard RBC squares of one side of aNeubauer hemocytemeter is 198. The total RBC count is
____ x1012/L
a. 0.9 b. 1.98 c. 3.96 d. 5.94

74. The one of the following that a positive Heinz test does NOT specifically indicate is
a. protein denaturation in red blood cells c.megaloblastic anemia
b. haemolytic anemia d. glucose-6-phosphate-dehydrogenase deficiency

75. The majority of hemoglobinopathies are caused by :

a. a defect in iron metabolism b. decreased production of iron
c. defective syuthesis of the heme molecule d. an amino acid substitution in the beta globin chain

76. True of the siderotic granule

a. an iron containing granule of Perls stain d. an iron containing granule on a Romanowsky stain
b. denatured haemoglobin e. a network of precipitated ribosomes
c. a nuclear fragment in the cytoplasm

77. Hemoglobin H disease results from:

a. absence of 3 of 4 alpha genes c. absence of 1 of 4 alpha genes
b. absence of 2 or 4 alpha genes d. absence of all four alpha genes

78. Calibration verification of the coulter S counter should be done

a. daily b. weekly c. monthly d. anually

79. The coulter R blood cell counter is based on the principle that it
a. detects difference in color of stain from which red and white cell counts are calculated
b. determines the optical density of each cell
c. counts changes in electric resistance as cells in suspension pass
d. senses the magnetic resonance of atomic nuclei

80. All of the following are required for normal erythropoiesis EXCEPT:
a. vitamin B12 b. vitamin B6 c. folate d. cobalt e. vitamin K

81. A falsely high estimate of haemoglobin concentration with some instruments can result from:
1. The presence of giant platelets 3. Hyperlipidemia 5. marked WBC count elevation
2. reticulocytosis 4. paraproteinemia
a. all except 1 and 2 b. all except 3 and 4 c. all except 4 and 5 d. none of the above

82. Megaloblastic anemia is characterized by all of the following except

a. decresead white cell count c. oval macrocytes e. increased platelets
b. hypersegmented neutrophils d. decreased reticulocytes

83. Sudan Black B cytochemical stain differentiates

a. monocytic from myelogenous leukemia d. myelogenous from myelomoncytic leukemia
b. myelogenous from lymphoblastic leukemia e. FAB M1 from FAB M2
c. myelogenous leukemia from a leukemoid reaction

84. A falsely high white cell count with some instruments can result from:
1. leukocyte aggregation 3. the presence of giant platelets 4. aging of the blood sample
2. the presence of nucleated red blood cells 5. non-lysis of red blood cells
a. All except 1 and 2 b. all except 1 and 3 c. all except 1 and 4 d. all except 1 and 5

85. Which of the following erythrocytes inclusions cannot stained and visualized with romanowsky stains?
a. Pappenheimer bodies b. Howell jolly bodies c. Heinz bodies d. Basocphilic stippling

86. In an anemia caused by haemorrhage or hemolysis what would you expect to find in your laboratory investigation?
a. presence of plychhromatophilic macrocytes on the peripheral blood smear
b. A hypoplastic bone marrow
c. Megaloblastosis in the bone marrow and pancytopenia in the peripheral blood
d. An RPI less than 2

87. All of the following statements are true about Chloroacetate esterase stain EXCEPT:
a. it differentiates cells of the granulocytic series from monocytic cell lines
b. positive reactions are observed in cells of lymphocytic series
c. positive reactions are observed in cells of granulocytic lineage
d. negative reactions are observed in cells of monocytic series
e. it is a specific stain

88. A falsely high MCV with some instruments can result from:
1. the presence of a cold agglutinin
2. the presence of a warm autoantibody
3. hyperosmolar states
4. marked elevation of the white cell count
5. red cell hypochromania
a. all except 2 and 5 b. all except 2 c. all except 5 d. all of the above.

89. A peripheral blood smear examination was done, the medical technologist noted presence of neutrophils with vacuoles and Dohle bodies with the patient being diagnosed with Acute
Bacterial Peritonitis. The changes in the neutrophils are indicative of what type of abnormality?
a. myeloperoxidase deficiency c. reactive toxic changes
b. intracellular parasites d. glucocerebrosidase deficiency

90. In a patient with a positive sugar water test, the diagnosis of PNH should be confirmed with a:
a. Coomb’s test c. Donath-Landsteiner test e. Osmotic fragility
b. Ham’s test d. Auto-hemolysis test

91. Hemolysis that is due to an intracorposcular defect in all of the following, except:
a. hereditary spherocytosis c. Sickle cell disease e. PCH

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 b. thalassemia d. PNH

92. In PNH, one might find all of the following, except:

a. anemia c. pancytopenia e. hemosidenuria
b. high LAP d. hemoglobinuria

93. In beta- thalassemia defect:

a. depressed synthesis of alpha chains c. increased synthesis of beta chains
b. depressed synthesis of beta chains d. amino acid substitution in the beta chain

94. A wright-stained erythrocyte that is 9um, bluish in color and with one small, round nuclear fragmented body is a:
a. macrocyte with a siderotic granule
b. polychromatophilic normocyte with stippling
c. normocyte containing a malarial ring
d. polychromatophilic macrocyte with a howell-jolly body

95. Differentiation of the granules in the white cell takes place at the stage of:
a. myelocyte c. promyelocyte e. myeloblast
b.metamyelocyte d. polymorphonuclear cell

96. The metamyelocyte is differentiated from the myelocyte primarily by:

a. presence of granule c. absence of nucleoli e. size
b. shape of nucleus d. color of the granules

97. The promyelocyte is characterized by all of the following, except:

a. nucleus is indented d. N:C ratio is lower than in the myeloblast
b. larger than the myeloblast e. has basophilic staining granules
c. it has nucleoli

98. Numerous granules which may obscure the nucleus are frequently observed in what cell?
a. promyelocyte b. metamyelocyte c. basophil d. eosinophil e. neutrophil

99. Increased storage iron in the bone marrow in the face of hypochromic microcytic anemia may be seen in all of the following, except:
a. thalassemia c. chronic infections e. lead poisoning
b. sideroblastic anemia d. iron deficiency

100. What is the action of phyloxine in the diluting fluid for direct eosinophil count?
a. Acts as accentuator c. Lyses red blood cells
b. Stains the eosinophil red d. Prevents clumping of red cells

“To know that you do not know is the best.

To think you know when you do not is a disease.
Recognizing this disease as a disease is to be free of it.” 
- Lao Tzu