RODAK – CLINICAL PRINCIPLES AND APPLICATIONS, 5TH EDITION 5TH EDITION STUDY QUESTIONS

CHAPTER 2 SAFETY IN THE HEMATOLOGY 7. Under which of the following circumstances would a
LABORATORY SDS be helpful?
a. A phlebotomist has experienced a needle puncture
1. Standard precautions apply to all of the following with a clean needle.
except: b. A fire extinguisher failed during routine testing.
a. Blood c. A pregnant laboratory employee has asked whether
b. Cerebrospinal fluid she needs to be concerned about working with a given
c. Semen reagent.
d. Concentrated acids d. During a safety inspection, an aged microscope
power supply is found to have a frayed power cord.
2. The most important practice in preventing the spread
of disease is: 8. It is a busy evening in the City Hospital hematology
a. Wearing masks during patient contact department. One staff member called in sick, and there
b. Proper hand washing was a major auto accident that has one staff member

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c. Wearing disposable laboratory coats tied up in the blood bank all evening. Mary, the medical

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d. Identifying specimens from known or suspected HIV laboratory scientist covering hematology, is in a hurry to

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and HBV-infected patients with a red label get a stat sample on the analyzer but needs to pour off
an aliquot for another department. She is wearing

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3. The appropriate dilution of bleach to be used in gloves and a lab coat. She carefully covers the stopper

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laboratory disinfection is: of the well-mixed ethylenediaminetetraacetic acid
a. 1:2
b. 1:5 i sm
(EDTA) tube with a gauze square and tilts the stopper
toward her so it opens away from her. She pours off
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c. 1:10 about 1 mL into a prelabeled tube, replaces the stopper
d. 1:100 of the EDTA tube, and puts it in the sample rack and
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sets it on the conveyor. She then brings the poured

4. How frequently should fire alarms and sprinkler sample off to the other department. How would you
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systems be tested? assess Mary’s safety practice?

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a. Weekly a. Mary was careful and followed all appropriate

b. Monthly procedures.
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c. Quarterly b. Mary should have used a shield when opening the

d. Annually tube.
d

c. Mary should have poured the sample into a sterile

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5. Where should alcohol and other flammable chemicals tube.

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be stored? d. Mary should have wiped the tube with alcohol after
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a. In an approved safety can or storage cabinet away replacing the stopper.

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from heat sources

b. Under a hood and arranged alphabetically for ease of 9. What class fire extinguisher would be appropriate to
identification in an emergency use on a fire in a chemical cabinet?
c. In a refrigerator at 28 C to 88 C to reduce a. Class A
volatilization b. Class B
d. On a low shelf in an area protected from light c. Class C
d. Class D
6. The most frequent cause of needle punctures is:
a. Patient movement during venipuncture 10. According to OSHA standards, laboratory coats must
b. Improper disposal of phlebotomy equipment be all of the following except:
c. Inattention during removal of needle after a. Water resistant
venipuncture b. Made of cloth fabric that can be readily laundered
d. Failure to attach needle firmly to syringe or tube c. Long-sleeved
holder d. Worn fully buttoned
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 RODAK – CLINICAL PRINCIPLES AND APPLICATIONS, 5TH EDITION 5TH EDITION STUDY QUESTIONS
d. One of the hand veins, because they are most
11. Which one of the following would NOT be part of a superficial and easily accessed
safety management plan?
a. Job safety analysis 5. The most important step in phlebotomy is:
b. Risk assessment of potential safety hazards a. Cleansing the site
c. Mechanism for reporting accidents b. Identifying the patient
d. Budget for engineering controls and personal c. Selecting the proper needle length
protective equipment d. Using the correct evacuated tube

6. The venipuncture needle should be inserted into the

-------------------------------------------------------------------------- arm with the bevel facing:
CHAPTER 3 BLOOD SPECIMEN COLLECTION a. Down and an angle of insertion between 15 and 30
degrees
1. Which step in the CLSI procedure for venipuncture is b. Up and an angle of insertion less than 30 degrees

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part of standard precautions? c. Down and an angle of insertion greater than 45

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a. Wearing gloves degrees

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b. Positively identifying the patient d. Up and an angle of insertion between 30 and 45
c. Cleansing the site for the venipuncture degrees

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d. Bandaging the venipuncture site

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7. Failure to obtain blood by venipuncture may occur

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2. Select the needle most commonly used in standard because of all of the following except:
venipuncture in an adult: a. Incorrect needle positioning
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a. One inch, 18 gauge b. Tying the tourniquet too tightly
b. One inch, 21 gauge c. Inadequate vacuum in the tube
c. One-half inch, 23 gauge
A.

d. Collapsed vein
d. One-half inch, 25 gauge
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8. What is the recommended order of draw when the

3. For a complete blood count (hematology) and
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evacuated tube system is used?

measurement of prothrombin time (coagulation), the a. Gel separator, nonadditive, coagulation, and blood
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phlebotomist collected blood into lavender stopper and culture

green stopper tubes. Are these specimens acceptable? b. Additive, nonadditive, gel separator, and blood
d

a. Yes, EDTA is used for hematologic testing and heparin culture

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is used for coagulation testing. c. Nonadditive, blood culture, coagulation, and other
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b. No, although EDTA is used for hematologic testing, additives

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citrate, not heparin, is used for coagulation testing. d. Blood culture, coagulation, nonadditive, and gel
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c. No, although heparin is used for hematologic testing, separator or other additives
citrate, not EDTA, is used for coagulation testing.
d. No, hematologic testing requires citrate and 9. Which one of the following is an acceptable site for
coagulation testing requires a clot, so neither tube is skin puncture on infants:
acceptable. a. Back curvature of the heel
b. Lateral or medial plantar surface of the heel
4. The vein of choice for performing a venipuncture is c. Plantar surface of the heel close to the arch of the
the: foot
a. Basilic, because it is the most prominent vein in the d. Middle of the plantar surface of the heel
antecubital fossa
b. Cephalic or accessory cephalic, because it is the least 10. An anticoagulant is an additive placed in evacuated
painful site tubes to:
c. Median or median cubital, because it has the lowest a. Make the blood clot faster
risk of damaging nerves in the arm b. Dilute the blood before testing
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 RODAK – CLINICAL PRINCIPLES AND APPLICATIONS, 5TH EDITION 5TH EDITION STUDY QUESTIONS
c. Prevent the blood from clotting 4. Which objective has the greatest degree of color
d. Ensure the sterility of the tube correction?
a. Achromatic
11. Which one of the following is a reason for specimen b. Plan apochromatic
rejection: c. Bichromatic
a. Clot in a red stopper tube d. Plan achromatic
b. Specimen collected for blood cortisol in the morning
c. Specimen in lavender stopper tube grossly 5. In adjusting the microscope light using Koehler
hemolyzed illumination, which one of the following is true?
d. Room number is missing from the specimen tube a. Condenser is first adjusted to its lowest position
label b. Height of the condenser is adjusted by removing the
eyepiece
12. One legal area of concern for the phlebotomist is: c. Image of the field diaphragm iris is used to center
a. Breach of patient confidentiality the condenser
b. Failure to obtain written consent for phlebotomy d. Closing the aperture diaphragm increases the

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c. Entering a patient’s room when the family is present resolution of the image

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d. Asking an outpatient for his or her full name in the

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process of identification 6. The total magnification obtained when a 103
eyepiece and a 103 objective lens are used is:

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a. 13

or
b. 103

CHAPTER 4 CARE AND USE OF THE MICROSCOPE i sm

-------------------------------------------------------------------------- c. 1003
d. 10003
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7. After a microscope has been adjusted for Koehler
1. Use of which one of the following types of objective
A.

illumination, and the specimen is being viewed with an

lens causes the center of the microscope field to be in oil immersion objective lens, light intensity should never
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focus, whereas the periphery is blurred? be regulated by adjusting the:

a. Plan achromatic
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a. Rheostat
b. Achromatic b. Neutral density filter
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c. Plan apochromatic c. Light control knob

d. Flat field d. Condenser
d
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2. Which of the following gathers, organizes, and directs 8. The recommended cleaner for removing oil from
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light through the specimen? objectives is:

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a. Eyepiece a. 70% alcohol or lens cleaner

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b. Objective lens b. Xylene

c. Condenser c. Water
d. Optical tube d. Benzene

3. After focusing a specimen by using the 403 9. Which of the following types of microscopy is
objectives, the laboratory professional switches to a 103 valuable in the identification of crystals that are double
objective. The specimen remains in focus at 103. refractive?
Microscopes with this characteristic are described as: a. Compound brightfield
a. Parfocal b. Darkfield
b. Parcentric c. Polarizing
c. Compensated d. Phase-contrast
d. Parachromatic
10. A laboratory science student has been reviewing a
hematology slide using the 103 objectives to find a
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 RODAK – CLINICAL PRINCIPLES AND APPLICATIONS, 5TH EDITION 5TH EDITION STUDY QUESTIONS
suitable portion of the slide for examination. He moves d. Proportional systematic error
the 103 objectives out of place, places a drop of oil on
the slide, rotates the nosepiece so that the 403 3. Which is a statistical test comparing means?
objective passes through the viewing position, and a. Bland-Altman
continues to rotate the 1003 oil b. Student’s t-test
objective into viewing position. This practice should be c. ANOVA
corrected in which way? d. Pearson
a. The stage of a parfocal microscope should be lowered
before the objectives are rotated. 4. The acceptable hemoglobin control value range is 13
b. The 1003 oil objective should be in place for viewing 6 0.4 g/dL. The control is assayed five times and
before the oil is added. produces the following five results:
c. The drop of oil should be in place and the 1003 12.0 g/dL 12.3 g/dL 12.0 g/dL 12.2 g/dL 12.1 g/dL
objective lowered into the oil, rather than swinging the These results are:
objective into the drop. a. Accurate but not precise
d. The objectives should be rotated in the opposite b. Precise but not accurate

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direction so that the 403 objectives does not risk c. Both accurate and precise

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entering the oil. d. Neither accurate nor precise

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11. Darkfield microscopes create the dark field by: 5. A WBC count control has a mean value of 6000/mL

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a. Using two filters that cancel each other out, one and a standard deviation of 300/mL. What is the 95.5%

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above and the other below the condenser confidence interval?
b. Angling the light at the specimen so that it misses
the objective unless something in the specimen bends i sm
a. 3000 to 9000/mL
b. 5400 to 6600/mL
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it backward c. 5500 to 6500/mL
c. Closing the condenser diaphragm entirely, limiting d. 5700 to 6300/mL
A.

light to just a tiny ray in the center of the otherwise

dark field 6. The ability of an assay to distinguish the targeted
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d. Using a light source above the specimen and analyte from interfering substances within the
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collecting light reflected from the specimen, rather than specimen matrix is called:
transmitted through the specimen, so that when there a. Analytical specificity
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is no specimen in place, the field is dark b. Analytical sensitivity

c. Clinical specificity
d

d. Clinical sensitivity
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--------------------------------------------------------------------------
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CHAPTER 5 QUALITY ASSURANCE IN 7. The laboratory purchases reagents from a

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HEMATOLOGY AND HEMOSTASIS TESTING manufacturer and develops an assay using standard
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references. What FDA category is this assay?

1. What procedure is employed to validate a new assay? a. Cleared
a. Comparison of assay results to a reference method b. Home-brew
b. Test for assay precision c. Research use only
c. Test for assay linearity d. Analyte-specific reagent
d. All of the above
8. A laboratory scientist measures prothrombin time for
2. You validate a new assay using linear regression to plasma aliquots from 15 healthy males and 15 healthy
compare assay calibrator results with the distributor’s females. She computes the mean and 95.5% confidence
published calibrator results. The slope is 0.99 and the y interval and notes that they duplicate the
intercept is 110%. What type of error is present? manufacturer’s statistics within 5%. This procedure is
a. No error known as:
b. Random error a. Confirming linearity
c. Constant systematic error b. Setting the reference interval
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 RODAK – CLINICAL PRINCIPLES AND APPLICATIONS, 5TH EDITION 5TH EDITION STUDY QUESTIONS
c. Determining the therapeutic range b. Preanalytical quality assurance
d. Establishing the reference interval by transference c. Analytical quality control
d. External quality assurance
9. You purchase a preserved whole blood specimen
from a distributor who provides the mean values for 14. Review of laboratory report integrity is an example
several complete blood count analytes. What is this of:
specimen called? a. Preanalytical quality assurance
a. Normal specimen b. Analytical quality control
b. Calibrator c. Postanalytical quality assurance
c. Control d. External quality assurance
d. Blank
15. When performing a receiver operating curve
10. You perform a clinical efficacy test and get the analysis, what
following parameter assesses the overall efficacy of an assay?
results: a. Area under the curve

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Unaffected by Affected by b. Performance limit (threshold)

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Disease or Disease or c. Positive predictive value

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Condition Condition d. Negative predictive value
Assay is 40 5

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negative 16. You require your laboratory staff to annually

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perform manual lupus anticoagulant profiles on a set of

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Assay is 10 45 plasmas with known values. This exercise is known as:
positive a. Assay validation
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b. Proficiency testing
What is the number of false-negative results? c. External quality assessment
A.

a. 40 d. Pre-pre-analytical variable assay

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b. 10
c. 5
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d. 45 --------------------------------------------------------------------------
CHAPTER 6 CELLULAR STRUCTURE AND
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11. What agency provides external quality assurance FUNCTION

(proficiency) surveys and laboratory accreditation?
d

1. The organelle involved in packaging and trafficking of

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a. Clinical Laboratory Improvement Advisory Committee

cellular products is the:
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(CLIAC)
a. Nucleus
b. Centers for Medicare and Medicaid Services (CMS)
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b. Golgi apparatus
c. College of American Pathologists (CAP)
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c. Mitochondria
d. Joint Commission
d. Rough endoplasmic reticulum
12. What agency provides continuing medical
2. The glycocalyx is composed of membrane:
laboratory education?
a. Phospholipids and cholesterol
a. Colorado Association for Continuing Medical
b. Glycoproteins and glycolipids
Laboratory Education (CACMLE)
c. Transmembrane and cytoskeletal proteins
b. Clinical Laboratory Improvement Advisory Committee
d. Rough and smooth endoplasmic reticulum
(CLIAC)
c. Centers for Medicare and Medicaid Services (CMS)
3. The “control center” of the cell is the:
d. College of American Pathologists (CAP)
a. Nucleus
b. Cytoplasm
13. Regular review of blood specimen collection quality
c. Membrane
is an example of:
d. Microtubular system
a. Postanalytical quality assurance
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 RODAK – CLINICAL PRINCIPLES AND APPLICATIONS, 5TH EDITION 5TH EDITION STUDY QUESTIONS
12. The transition from the G1 to S stage of the cell
4. The nucleus is composed largely of: cycle isregulated by:
a. RNA a. Cyclin B/CDK1 complex
b. DNA b. Cyclin A/CDK2 complex
c. Ribosomes c. Cyclin D1
d. Glycoproteins d. Cyclin E/CDK2 complex
5. Protein synthesis occurs in the:
a. Nucleus 13. Apoptosis is morphologically identified by:
b. Mitochondria a. Cellular swelling
c. Ribosomes b. Nuclear condensation
d. Golgi apparatus c. Rupture of the cytoplasm
d. Rupture of the nucleus
6. The shape of a cell is maintained by which of the
following? 14. Regulation of the hematopoietic microenvironment
a. Microtubules is provided by the:

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b. Spindle fibers a. Stromal cells and growth factors

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c. Ribosomes b. Hematopoietic stem cells

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d. Centrioles c. Liver and spleen
d. Cyclins and caspases

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7. Functions of the cell membrane include all of the

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following except:
a. Regulation of molecules entering or leaving the cell
b. Receptor recognition of extracellular signals i sm
--------------------------------------------------------------------------
CHAPTER 7 HEMATOPOIESIS
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c. Maintenance of electrochemical gradients
d. Lipid production and oxidation 1. The process of formation and development of blood
cells is termed:
A.

8. The energy source for cells is the: a. Hematopoiesis

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a. Golgi apparatus b. Hematemesis

c. Hematocytometry
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b. Endoplasmic reticulum
c. Nucleolus d. Hematorrhea
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d. Mitochondrion
2. During the second trimester of fetal development,
d

9. Ribosomes are synthesized by the: the primary site of blood cell production is the:
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a. Endoplasmic reticulum a. Bone marrow

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b. Mitochondrion b. Spleen
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c. Nucleolus c. Lymph nodes

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d. Golgi apparatus d. Liver

10. Euchromatin functions as the: 3. Which one of the following organs is responsible for
a. Site of microtubule production the maturation of T lymphocytes and regulation of their
b. Transcriptionally active DNA expression of CD4 and CD8?
c. Support structure for nucleoli a. Spleen
d. Attachment site for centrioles b. Liver
c. Thymus
11. The cell cycle is regulated by: d. Bone marrow
a. Cyclins and CDKs
b. Protooncogenes 4. The best source of active bone marrow from a 20-
c. Apoptosis year-old would be:
d. Growth factors a. Iliac crest
b. Femur

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 RODAK – CLINICAL PRINCIPLES AND APPLICATIONS, 5TH EDITION 5TH EDITION STUDY QUESTIONS
c. Distal radius b. Decreased production of erythropoietin by the kidney
d. Tibia c. Increased apoptosis of erythrocyte progenitor cells
d. Increase the proportion of yellow marrow in the long
5. Physiologic programmed cell death is termed: bones
a. Angiogenesis
b. Apoptosis 12. Hematopoietic stem cells produce all lineages of
c. Aneurysm blood cells in sufficient quantities over the lifetime of an
d. Apohematics individual because they:
a. Are unipotent
6. Which organ is the site of sequestration of platelets? b. Have the ability of self-renewal by asymmetric
a. Liver division
b. Thymus c. Are present in large numbers in the bone marrow
c. Spleen niches
d. Bone marrow d. Have a low mitotic potential in response to growth
factors

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7. Which one of the following morphologic changes

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occurs during normal blood cell maturation:

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a. Increase in cell diameter --------------------------------------------------------------------------
b. Development of cytoplasm basophilia CHAPTER 8 ERYTHROCYTE PRODUCTION AND

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c. Condensation of nuclear chromatin DESTRUCTION

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d. Appearance of nucleoli

8. Which one of the following cells is a product of the i sm

1. Which of the following is an erythrocyte progenitor?
a. Pronormoblast
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CLP? b. Reticulocyte
a. Megakaryocyte c. CFU-E
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b. T lymphocyte d. Orthochromic normoblast

c. Erythrocyte
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d. Granulocyte 2. Which of the following is the most mature

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normoblast?
9. What growth factor is produced in the kidneys and is a. Orthochromic normoblast
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used to treat anemia associated with kidney disease? b. Basophilic normoblast

a. EPO c. Pronormoblast
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b. TPO d. Polychromatic normoblast

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c. G-CSF
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d. KIT ligand 3. What erythroid precursor can be described as

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follows: the cell is of medium size compared with other

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10. Which one of the following cytokines is required normoblasts, with an N:C ratio of nearly 1:1. The
very early in the differentiation of a hematopoietic stem nuclear chromatin is condensed and chunky throughout
cell? the nucleus. No nucleoli are seen. The cytoplasm is a
a. IL-2 muddy, blue-pink color.
b. IL-8 a. Reticulocyte
c. EPO b. Pronormoblast
d. FLT3 ligand c. Orthochromic normoblast
d. Polychromatic normoblast
11. When a patient has severe anemia and the bone
marrow is unable to effectively produce red blood cells 4. Which of the following is not related to the effects of
to meet the increased demand, one of the body’s erythropoietin?
responses is: a. The number of divisions of a normoblast
a. Extramedullary hematopoiesis in the liver and b. The formation of pores in sinusoidal endothelial
spleen cells for marrow egress

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 RODAK – CLINICAL PRINCIPLES AND APPLICATIONS, 5TH EDITION 5TH EDITION STUDY QUESTIONS
c. The time between mitoses of normoblasts 11. A pronormoblast in its usual location belongs to the
d. The production of antiapoptotic molecules by RBC mass of the body, but not to the erythron.
erythroid progenitors a. True
b. False
5. Hypoxia stimulates RBC production by:
a. Inducing more pluripotent stem cells into the 12. A cell has an N:C ratio of 4:1. Which of the following
erythroid lineage statements would describe it?
b. Stimulating EPO production by the kidney a. The bulk of the cell is composed of cytoplasm.
c. Increasing the number of RBC mitoses b. The bulk of the cell is composed of nucleus.
d. Stimulating the production of fibronectin by c. The proportions of cytoplasm and nucleus are roughly
macrophages of the bone marrow equal.

6. In the bone marrow, RBC precursors are located:

a. In the center of the hematopoietic cords
b. Adjacent to megakaryocytes along the adventitial cell --------------------------------------------------------------------------

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lining CHAPTER 9 ERYTHROCYTE METABOLISM AND

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c. Surrounding fat cells in apoptotic islands MEMBRANE STRUCTURE AND FUNCTION

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d. Surrounding macrophages in erythroid islands
7. Which of the following determines the timing of 1. Which RBC process does not require energy?

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egress of RBCs from the bone marrow? a. Oxygen transport

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a. Maturing normoblasts slowly lose receptors for b. Cytoskeletal protein deformability
adhesive molecules that bind them to stromal cells.
b. Stromal cells decrease production of adhesive i sm
c. Preventing the peroxidation of proteins and lipids
d. Maintaining cytoplasm cationic electrochemical
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molecules over time as RBCs mature. gradients
c. Endothelial cells of the venous sinus form pores at
A.

specified intervals of time, allowing egress of free cells. 2. What pathway anaerobically generates energy in the
d. Periodic apoptosis of pronormoblasts in the marrow form of ATP?
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cords occurs. a. Hexose monophosphate pathway

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b. Rapoport-Luebering pathway
8. What single feature of normal RBCs is most c. Embden-Meyerhof pathway
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responsible for d. 2,3-BPG pathway

limiting their life span?
d

a. Loss of mitochondria 3. Which is true concerning 2,3-BPG?

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b. Increased flexibility of the cell membrane a. The least abundant of RBC organophosphates
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c. Reduction of hemoglobin iron b. Enhances O2 release from hemoglobin

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d. Loss of the nucleus c. Source of RBC glucose

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d. Source of RBC ATP

9. Intravascular or fragmentation hemolysis is the result
of trauma to RBCs while in the circulation. 4. To survive, the RBC must detoxify peroxides. What
a. True hexose- monophosphate shunt product(s) accomplishes
b. False detoxification?
a. ATP
10. Extravascular hemolysis occurs when: b. 2,3-BPG
a. RBCs are mechanically ruptured c. Pyruvic and lactic acid
b. RBCs extravasate from the blood vessels into the d. NADPH and reduced glutathione
tissues
c. Splenic macrophages ingest senescent cells 5. Which of the following helps maintain RBC shape?
d. Erythrocytes are trapped in blood clots outside the a. Membrane phospholipids
blood vessels b. Cytoskeletal proteins
c. GPI anchor

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 RODAK – CLINICAL PRINCIPLES AND APPLICATIONS, 5TH EDITION 5TH EDITION STUDY QUESTIONS
d. Glycocalyx a. Shape changes.
b. Methemoglobin increase.
6. The glycolipids of the RBC membrane: c. Reduced hemoglobin content.
a. Provide flexibility. d. Enzyme pathway deficiencies.
b. Carry RBC antigens.
c. Constitute ion channels.
d. Attach the cytoskeleton to the lipid layer.
--------------------------------------------------------------------------
7. RBC membranes block passage of most large CHAPTER 10 HEMOGLOBIN METABOLISM
molecules such as proteins, but allow passage of small
molecules such as the cations Na1, K1, and Ca11. What 1. A hemoglobin molecule is composed of:
is the term for this membrane property? a. One heme molecule and four globin chains
a. Semipermeable b. Ferrous iron, protoporphyrin IX, and a globin chain
b. Deformable c. Protoporphyrin IX and four globin chains
c. Intangible d. Four heme molecules and four globin chains

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d. Flexible

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2. Normal adult Hb A contains which polypeptide

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8. RBC membrane phospholipids are arranged: chains?
a. In a hexagonal lattice. a. a and b

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b. In chains beneath a protein exoskeleton. b. a and d

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c. In two layers whose composition is asymmetric. c. a and g

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d. So that hydrophobic portions are facing the plasma. d. a and e
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9. RBC membrane cholesterol is replenished from the: 3. A key rate-limiting step in heme synthesis is
a. Plasma. suppression of:
a. Aminolevulinate synthase
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b. Mitochondria.
c. Cytoplasm. b. Carbonic anhydrase
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d. EMB pathway. c. Protoporphyrin IX reductase

d. Glucose 6-phosphate dehydrogenase
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10. The hemoglobin iron ion may become oxidized to

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the 13-valence state by several pathological 4. Which of the following forms of hemoglobin molecule
mechanisms. What portion of the Embden-Meyerhof has the lowest affinity for oxygen?
d

pathway reduces iron to the physiologic 12 valence a. Tense

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state? b. Relaxed
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a. Methemoglobin reductase pathway

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b. Hexose monophosphate pathway 5. Using the normal hemoglobin-oxygen dissociation

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c. Rapoport-Luebering pathway curve in Figure 10-7 for reference, predict the position
d. The 2,3-BPG shunt of the curve when there is a decrease in pH.
a. Shifted to the right of normal with decreased
11. Which of the following is an example of a oxygen affinity
transmembrane b. Shifted to the left of normal with increased oxygen
or integral membrane protein? affinity
a. Glycophorin A c. Shifted to the right of normal with increased oxygen
b. Ankyrin affinity
c. Spectrin d. Shifted to the left of normal with decreased oxygen
d. Actin affinity

12. Abnormalities in the horizontal and vertical linkages 6. The predominant hemoglobin found in a healthy
of the transmembrane and cytoskeletal RBC membrane newborn is:
proteins may be seen as: a. Gower-1

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 RODAK – CLINICAL PRINCIPLES AND APPLICATIONS, 5TH EDITION 5TH EDITION STUDY QUESTIONS
b. Gower-2 c. Binds to amino acids of the globin chain,
c. A contributing to a conformational change that inhibits
d. F oxygen from binding to heme
d. Oxidizes hemoglobin iron, diminishing oxygen binding
7. What is the normal distribution of hemoglobins in and promoting oxygen delivery to the tissues
healthy adults?
a. 80% to 90% Hb A, 5% to 10% Hb A2, 1% to 5% Hb F
b. 80% to 90% Hb A2, 5% to 10% Hb A, 1% to 5% Hb F
c. .95% Hb A, ,3.5% Hb A2, 1% to 2% Hb F --------------------------------------------------------------------------
d. .90% Hb A, 5% Hb F, ,5% Hb A2 CHAPTER 11 IRON KINETICS AND LABORATORY
ASSESSMENT
8. Which of the following is a description of the
structure of oxidized hemoglobin? 1. Iron is transported in plasma via:
a. Hemoglobin carrying oxygen on heme; synonymous a. Hemosiderin
with oxygenated hemoglobin b. Ferritin

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b. Hemoglobin with iron in the ferric state c. Transferrin

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(methemoglobin) and not able to carry oxygen d. Hemoglobin

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c. Hemoglobin with iron in the ferric state so that
carbon dioxide replaces oxygen in the heme structure 2. What is the major metabolically available storage

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d. Hemoglobin carrying carbon monoxide; hence form of iron in the body?

or
“oxidized” refers to the single oxygen a. Hemosiderin

9. In the quaternary structure of hemoglobin, the globin

b. Ferritin
c. Transferrini sm
Qu
chains associate into: d. Hemoglobin
a. a tetramer in some cells and b tetramers in others
A.

b. A mixture of a tetramers and b tetramers 3. The total iron-binding capacity (TIBC) of the serum is
c. a dimers and b dimers an indirect measure of which iron-related protein?
dy

d. Two ab dimers a. Hemosiderin

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b. Ferritin
10. How are the globin chain genes arranged? c. Transferrin
by

a. With a genes and b genes on the same chromosome, d. Hemoglobin

including two a gene and two b genes
d

b. With a genes and b genes on separate 4. For a patient with classic iron study values that are
le

chromosomes, including two a genes on one equivocal for iron deficiency, which of the following
pi

chromosome and one tests would be most helpful in determining whether

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b gene on a different chromosome iron deficiency is present or not?

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c. With a genes and b genes on the same chromosome, a. Zinc protoporphyrin

including four a gene and four b genes b. Peripheral blood sideroblast assessment
d. With a genes and b genes on separate chromosomes, c. Soluble transferrin receptor
including four a gene on one chromosome and two b d. Mean cell hemoglobin
genes on a different chromosome
5. What membrane-associated protein in enterocytes
11. The nature of the interaction between 2,3-BPG and transports iron from the intestinal lumen into the
hemoglobin is that 2,3-BPG: enterocyte?
a. Binds to the heme moiety, blocking the binding of a. Transferrin
oxygen b. Ferroportin
b. Binds simultaneously with oxygen to ensure that it c. DMT1
stays bound until it reaches the tissues, when both d. Ferrochelatase
molecules are released from hemoglobin

COMPILED BY RUDY A. QUISMORIO, RMT 10 | P a g e

 RODAK – CLINICAL PRINCIPLES AND APPLICATIONS, 5TH EDITION 5TH EDITION STUDY QUESTIONS
6. Iron is transported out of macrophages, hepatocytes, Soluble transferrin receptor: increased above reference
and enterocytes by what membrane protein? interval
a. Transferrin Ferritin: decreased below reference interval
b. Ferroportin Hemoglobin content of reticulocytes: within the
c. DMT1 reference interval
d. Ferrochelatase a. Normal iron status
b. Latent iron deficiency
7. Below are several of the many steps in the process c. Functional iron deficiency
from absorption and transport of iron to incorporation d. Iron deficiency
into heme. Place them in proper order.
i. Transferrin picks up ferric iron. 12. A physician is concerned that a patient is developing
ii. Iron is transferred to the mitochondria. iron deficiency from chronic intestinal bleeding due to
iii. DMT1 transports ferrous iron into the enterocyte. aspirin use for rheumatoid arthritis. The iron studies on
iv. Ferroportin transports iron from enterocyte to the patient show the following results:
plasma.

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v. The transferrin receptor transports iron into the cell. LABORATORY ADULT PATIENT

M
a. v, iv, i, ii, iii ASSAY REFERENCE VALUES

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b. iii, ii, iv, i, v INTERVALS
c. ii, i, v, iii, iv SERUM

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d. iii, iv, i, v, ii FERRITIN 12-400 ng/mL 25 ng/mL

or
LEVEL
8. What is the fate of the transferrin receptor when it
has completed its role in the delivery of iron to a cell? i sm
SERUM IRON
LEVEL 50–160 mg/dL 45 mg/dL
Qu
a. It is recycled to the plasma membrane and released
into the plasma.
TOTAL IRON-
A.

b. It is recycled to the plasma membrane, where it can

bind its ligand again. BINDING 250–400 405 mg/dL
dy

CAPACITY mg/dL
c. It is catabolized and the amino acids are returned to
(TIBC)
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the metabolic pool.

d. It is retained in the endosome for the life span of the TRANSFERRIN
SATURATION 20%–55% CALCULATE IT
by

cell.
d

9. The transfer of iron from the enterocyte into the

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plasma is REGULATED by: How would these results be interpreted?

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a. Transferrin a. Latent iron deficiency

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b. Ferroportin b. Functional iron deficiency

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c. Hephaestin c. Iron deficiency

d. Hepcidin d. Equivocal for iron deficiency

10. What is the percent transferrin saturation for a

patient with total serum iron of 63 mg/dL and TIBC of
420 mg/dL ? --------------------------------------------------------------------------
a. 6.7% CHAPTER 12 LEUKOCYTE DEVELOPMENT,
b. 12% KINETICS, AND FUNCTIONS
c. 15%
d. 80% 1. Neutrophils and monocytes are direct descendants of
a common progenitor known as:
11. Referring to Figure 11-6, into which quadrant of a a. CLP
Thomas plot would a patient’s results fall with the b. GMP
following test results: c. MEP

COMPILED BY RUDY A. QUISMORIO, RMT 11 | P a g e

 RODAK – CLINICAL PRINCIPLES AND APPLICATIONS, 5TH EDITION 5TH EDITION STUDY QUESTIONS
d. HSC b. Ingesting and digesting organisms that neutrophils
cannot
2. The stage in neutrophilic development in which the c. Synthesizing complement components
nucleus is indented in a kidney bean shape and the d. Storing iron from senescent red cells
cytoplasm has secondary granules that are lavender in
color is the: 9. Which of the following is the final stage of B cell
a. Band maturation after activation by antigen?
b. Myelocyte a. Large, granular lymphocyte
c. Promyelocyte b. Plasma cell
d. Metamyelocyte c. Reactive lymphocyte
d. Immunoblast
3. Type II myeloblasts are characterized by:
a. Presence of fewer than 20 primary granules per cell 10. The following is unique to both B and T lymphocytes
b. Basophilic cytoplasm with many secondary granules and occurs during their early development:
c. Absence of granules a. Expression of surface antigens CD4 and CD8

T
d. Presence of a folded nucleus b. Maturation in the thymus

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c. Synthesis of immunoglobulins

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4. Which one of the following is a function of d. Rearrangement of antigen receptor genes
neutrophils?

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a. Presentation of antigen to T and B lymphocytes

or
b. Protection against reexposure by same antigen
c. Nonspecific destruction of foreign organisms
d. Initiation of delayed hypersensitivity response i sm
--------------------------------------------------------------------------
CHAPTER 13 PLATELET PRODUCTION,
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STRUCTURE, AND FUNCTION
5. Which of the following cells are important in immune
A.

regulation, allergic inflammation, and destruction of 1. The megakaryocyte progenitor that undergoes
tissue invading helminths? endomitosis is:
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a. Neutrophils and monocytes a. MK-I

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b. Eosinophils and basophils b. BFU-Meg

c. T and B lymphocytes c. CFU-Meg
by

d. Macrophages and dendritic cells d. LD-CFU-Meg

d

6. Basophils and mast cells have high-affinity surface 2. The growth factor that is produced in the kidney and
le

receptors for which immunoglobulin? induces growth and differentiation of committed

pi

a. A megakaryocyte progenitors is:

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b. D a. IL-3
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c. E b. IL-6
d. G c. IL-11
d. TPO
7. Which of the following cell types is capable of
differentiating into osteoclasts, macrophages, or 3. What platelet organelle sequesters ionic calcium and
dendritic cells? binds a series of enzymes of the eicosanoid pathway?
a. Neutrophils a. G protein
b. Lymphocytes b. Dense granules
c. Monocytes c. DTS
d. Eosinophils d. SCCS

8. Macrophages aid in adaptive immunity by: 4. What platelet membrane receptor binds fibrinogen
a. Degrading antigen and presenting it to lymphocytes and supports platelet aggregation?
a. GP Ib/IX/V

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 RODAK – CLINICAL PRINCIPLES AND APPLICATIONS, 5TH EDITION 5TH EDITION STUDY QUESTIONS
b. GP IIb/IIIa
c. GP Ia/IIa --------------------------------------------------------------------------
d. P2Y1 CHAPTER 14 MANUAL, SEMIAUTOMATED, AND
POINT-OF-CARE TESTING IN HEMATOLOGY
5. What platelet membrane phospholipid flips from the
inner surface to the plasma surface on activation and 1. A 1:20 dilution of blood is made with 3% glacial acetic
serves as the assembly point for coagulation factors? acid as the diluent. The four large corner squares on
a. Phosphatidylethanolamine both sides of the hemocytometer are counted, for a
b. Phosphatidylinositol total of 100 cells.
c. Phosphatidylcholine What is the total WBC count (3109/L)?
d. Phosphatidylserine a. 0.25
b. 2.5
6. What is the name of the eicosanoid metabolite c. 5
produced from endothelial cells that suppresses platelet d. 10
activity?

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a. TXA2 2. The total WBC count is 20 3 109/L. Twenty-five

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b. Arachidonic acid NRBCs per 100 WBCs are observed on the peripheral

,R
c. Cyclooxygenase blood film. What is the corrected WBC count (3109/L)?
d. Prostacyclin a. 0.8

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b. 8

or
7. Which of the following molecules is stored in platelet c. 16
dense granules?
a. Serotonin
d. 19
i sm
Qu
b. Fibrinogen 3. If potassium cyanide and potassium ferricyanide are
c. PF4 used in the manual method for hemoglobin
A.

d. Platelet-derived growth factor determination, the final product is:

a. Methemoglobin
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8. What plasma protein is essential to platelet b. Azide methemoglobin

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adhesion? c. Cyanmethemoglobin
a. VWF d. Myoglobin
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b. Factor VIII
c. Fibrinogen 4. Which of the following would not interfere with the
d

d. P-selectin result when hemoglobin determination is performed by

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9. Reticulated platelets can be enumerated in the cyanmethemoglobin method?

pi

peripheral blood to detect: a. Increased lipids

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a. Impaired production in disease states b. Elevated WBC count

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b. Abnormal organelles associated with diseases such as c. Lyse-resistant RBCs

leukemia d. Fetal hemoglobin
c. Increased platelet production in response to need
d. Inadequate rates of membrane cholesterol exchange 5. A patient has a hemoglobin level of 8.0 g/dL.
with the plasma According to the rule of three, what is the expected
range for the hematocrit?
10. Platelet adhesion refers to platelets: a. 21% to 24%
a. Sticking to other platelets b. 23.7% to 24.3%
b. Releasing platelet granule constituents c. 24% to 27%
c. Providing the surface for assembly of coagulation d. 21% to 27%
factors
d. Sticking to surfaces such as subendothelial collagen 6. Calculate the MCV and MCHC for the following
values:
RBCs 5 5.00 3 1012/L

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 RODAK – CLINICAL PRINCIPLES AND APPLICATIONS, 5TH EDITION 5TH EDITION STUDY QUESTIONS
HGB 5 9 g/dL 1. Which printout lets the end user know at a glance
HCT 5 30% that the results are acceptable and no manual work
MCV (Fl) MCHC (g/Dl) needs to be performed?
a. 30 18 a. CELL-DYN Sapphire
b. 60 30 b. UniCel DxH 800
c. 65 33 c. ADVIA 2120i
d. 85 35 d. Sysmex XN-series

7. What does the reticulocyte count assess? 2. Which instrument printout has a system flag on the
a. Inflammation platelet count?
b. Response to infection a. CELL-DYN Sapphire
c. Erythropoietic activity of the bone marrow b. UniCel DxH 800
d. Ability of red blood cells to form rouleaux c. ADVIA 2120i
d. XN-series
8. For a patient with the following test results, which

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measure of bone marrow red blood cell production 3. What do you suspect is the cause of the variation in

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provides the most accurate information? platelet counting among the four instruments?

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Observed reticulocyte count 5 5.3% a. Different instruments have different levels of
HCT 5 35% sensitivity.

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Morphology—moderate polychromasia b. All instruments use the same principle for counting

or
a. Observed reticulocyte count platelets.
b. Corrected reticulocyte count
c. RPI i sm
c. Some instruments are susceptible to false-positive
platelet flagging under certain conditions.
Qu
d. ARC d. Different instruments use different thresholds to
capture and count platelets.
A.

9. Given the following values, calculate the RPI:

Observed reticulocyte count 5 6% 4. Based on the overall flagging for this specimen on
dy

HCT 5 30% each instrument, should a manual differential count be

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a. 2 performed for this patient?

b. 3 a. Yes, because immature granulocytes are present in
by

c. 4 the sample.
d. 5 b. Yes, because the WBC scatterplots are abnormal.
d

c. No, because each differential count is complete with

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10. Which of the following would be associated with an no system or morphology flags.
pi

elevated ESR value?

m

a. Microcytosis 5. A patient peripheral blood film demonstrates

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b. Polycythemia agglutinated RBCs, and the CBC shows an elevated

c. Decreased globulins MCHC. What other parameters will be affected by the
d. Inflammation agglutination of the RBCs?
a. MCV will be decreased and the RBC count will be
increased.
b. MCV will be decreased and the RBC count will be
-------------------------------------------------------------------------- decreased.
CHAPTER 15 AUTOMATED BLOOD CELL ANALYSIS c. MCV will be increased and the RBC count will be
decreased.
Examine the histograms/scatterplots obtained from d. MCV will be increased and the RBC count will be
four major instruments for the same patient specimen increased.
(Figure 15-14, A-D). Compare the results, and respond 6. Match the cell-counting methods listed with the
to questions 1 to 4 based on the results. appropriate definition:

COMPILED BY RUDY A. QUISMORIO, RMT 14 | P a g e

 RODAK – CLINICAL PRINCIPLES AND APPLICATIONS, 5TH EDITION 5TH EDITION STUDY QUESTIONS
a. Uses Siemens ADVIA 2120i b. MAPSS
IMPEDANCE diffraction, technology
C reflection, and Answer: C and three-
refraction of color
light waves fluorescence
b. Uses high- Sysmex XN-1000 c. Peroxidase-
RF voltage staining
B electrical waves absorbance
to measure the Answer: D and light
internal scatter
complexity of Beckman Coulter d. Detection of
cells Unicel DxH 800 forward and
c. Involves side scattered
detection and light and
OPTICAL SCATTER A measurement Answer: A fluorescence

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of changes in

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electrical

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current
between two --------------------------------------------------------------------------

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electrodes CHAPTER 16 EXAMINATION OF THE PERPHERAL

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BLOOD FILM AND CORRELATION WITH THE
7. Low-voltage DC is used to measure:
a. Cell nuclear volume i sm
COMPLETE BLOOD COUNT
Qu
b. Total cell volume 1. A laboratory science student consistently makes
c. Cellular complexity in the nucleus wedge technique blood films that are too long and thin.
A.

d. Cellular complexity in the cytoplasm What change in technique would improve the films?
a. Increasing the downward pressure on the pusher
dy

8. Orthogonal light scatter is used to measure: slide

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a. Cell volume b. Decreasing the acute angle of the pusher slide

b. Internal complexity of the cell c. Placing the drop of blood closer to the center of the
by

c. Cellular granularity slide

d. Nuclear density d. Increasing the acute angle of the pusher slide
d
le

9. On the Beckman Coulter instruments, hematocrit is a 2. When a blood film is viewed through the microscope,
pi

calculated value. Which of the following directly the RBCs appear redder than normal, the neutrophils
m

measured parameters is used in the calculation of this are barely visible, and the eosinophils are bright orange.
Co

value? What is the most likely cause?

a. RDW a. The slide was overstained.
b. Hemoglobin b. The stain was too alkaline.
c. MCV c. The buffer was too acidic.
d. MCHC d. The slide was not rinsed adequately.

10. Match each instrument listed with the technology it 3. A stained blood film is held up to the light and
uses to determine WBC differential counts. observed to be bluer than normal. What microscopic
abnormality might be expected on this film?
Abbott CELL-DYN a. volume, a. Rouleaux
Sapphire conductivity, b. Spherocytosis
and five c. Reactive lymphocytosis
Answer: B angles of light d. Toxic granulation
scatter
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 RODAK – CLINICAL PRINCIPLES AND APPLICATIONS, 5TH EDITION 5TH EDITION STUDY QUESTIONS
4. A laboratorian using the 403 objective lens sees the c. Red blood cells look flattened, with none touching.
following numbers of WBCs in 10 fields: 8, 4, 7, 5, 4, 7, d. Red blood cells are separated and holes appear
8, 6, 4, 6. Which of the following WBC counts most among the cells.
closely correlates with the estimate?
a. 1.5 3 109/L 10. Use the reference intervals provided inside the front
b. 5.9 3 109/L cover of this text. Given the following data, summarize
c. 11.8 3 109/L the following blood picture:
d. 24 3 109/L WBC: 86.3 3 109/L
HGB: 9.7 g/dL
5. A blood film for a very anemic patient with an RBC HCT: 24.2%
count of 1.25 3 1012/L shows an average of seven MCV: 87.8 fL
platelets per oil immersion field. Which of the following MCHC: 33.5%
values most closely correlates with the estimate per PLT: 106 3 109/L
microliter? a. Leukocytosis, normocytic-normochromic anemia,
a. 14,000 thrombocytopenia

T
b. 44,000 b. Microcytic-hypochromic anemia, thrombocytopenia

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c. 140,000 c. Neutrophilia, macrocytic anemia, thrombocytosis

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d. 280,000 d. Leukocytosis, thrombocytopenia

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6. A blood film for a patient with a normal RBC count

or
has an average of 10 platelets per oil immersion field.
Which of the following values best correlates with the
estimate per microliter? i sm
--------------------------------------------------------------------------
CHAPTER 17 BONE MARROW EXAMINATION
Qu
a. 20,000
b. 100,000 1. Where is most hematopoietic tissue found in adults?
a. Liver
A.

c. 200,000
d. 400,000 b. Lungs
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c. Spleen
d. Long bones
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7. What is the absolute count (3 109/L) for the

lymphocytes if the total WBC count is 9.5 3 109/L and
by

there are 37% lymphocytes? 2. What is the preferred bone marrow collection site in
a. 3.5 adults?
d

b. 6.5 a. Second intercostal space on the sternum

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c. 13 b. Anterior or posterior iliac crest

pi

d. 37 c. Any of the thoracic vertebrae

m

d. Anterior head of the femur

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8. Which of the following blood film findings indicates

EDTA-induced pseudothrombocytopenia? 3. The aspirate should be examined under low power to
a. The platelets are pushed to the feathered end. assess all of the following except:
b. The platelets are adhering to WBCs. a. Cellularity
c. No platelets at all are seen on the film. b. Megakaryocyte numbers
d. The slide has a bluish discoloration when examined c. Morphology of abnormal cells
macroscopically. d. Presence of tumor cell clusters

9. Which of the following is the best area to review or 4. What is the normal M:E ratio range in adults?
perform a differential on a stained blood film? a. 1.5:1 to 3.3:1
a. Red blood cells are all overlapped in groups of three b. 5.1:1 to 6.2:1
or more. c. 8.6:1 to 10.2:1
b. Red blood cells are mostly separated, with a few d. 10:1 to 12:1
overlapping.
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 RODAK – CLINICAL PRINCIPLES AND APPLICATIONS, 5TH EDITION 5TH EDITION STUDY QUESTIONS
5. Which are the most common erythrocytic stages 11. The advantage of a core biopsy bone marrow
found in normal marrow? sample over an aspirate is that the core biopsy
a. Pronormoblasts specimen:
b. Pronormoblasts and basophilic normoblasts a. Can be acquired by a less invasive collection
c. Basophilic and polychromatophilic normoblasts technique
d. Polychromatophilic and orthochromic normoblasts b. Permits assessment of the architecture and cellular
arrangement
6. What cells, occasionally seen in bone marrow biopsy c. Retains the staining qualities of basophils owing to
specimens, are responsible for the formation of bone? the use of Zenker fixative
a. Macrophages d. Is better for the assessment of bone marrow iron
b. Plasma cells stores with Prussian blue stain.
c. Osteoblasts
d. Osteoclasts

7. What is the largest hematopoietic cell found in a --------------------------------------------------------------------------

T
normal bone marrow aspirate? CHAPTER 18 BODY FLUID ANALYSIS IN THE

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a. Osteoblast LABORATORY

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b. Myeloblast
c. Pronormoblast Refer to the following scenario to answer questions 1

io
d. Megakaryocyte and 2: A spinal fluid specimen is diluted 1:2 with Türk

or
solution to perform the nucleated cell count. A total of
8. Which of the following is not an indication for a bone
marrow examination? i sm
6 nucleated cells are counted on both sides of the
hemocytometer, with all nine squares counted on both
Qu
a. Pancytopenia (reduced numbers of RBCs, WBCs, and sides. Undiluted fluid is used to perform the
platelets in the peripheral blood) RBC count. A total of 105 RBCs is counted on both sides
A.

b. Anemia with RBC indices corresponding to low of the hemocytometer, with four large squares on both
serum iron and low ferritin levels sides counted.
dy

c. Detection of blasts in the peripheral blood

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d. Need for staging of Hodgkin lymphoma 1. The nucleated cell count is ___/mL.
a. 3
by

9. In a bone marrow biopsy specimen, the RBC b. 7

precursors were estimated to account for 40% of the c. 13
d

cells in the marrow, and the other 60% were d. 66

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granulocyte precursors. What

pi

is the M:E ratio? 2. The RBC count is ___/mL.

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a. 4:6 a. 131
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b. 1.5:1 b. 263
c. 1:1.5 c. 1050
d. 3:1 d. 5830

10. On a bone marrow core biopsy sample, several large 3. Based on the cell counts, the appearance of the fluid
cells with multiple nuclei were noted. They were is:
located close to the endosteum, and their nuclei were a. Turbid
evenly spaced b. Hemolyzed
throughout the cell. What are these cells? c. Clear
a. Megakaryocytes d. Cloudy
b. Osteoclasts
c. Adipocytes 4. All of the following cells are normally seen in CSF,
d. Fibroblasts serous fluids, and synovial fluids except:
a. Lining cells

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 RODAK – CLINICAL PRINCIPLES AND APPLICATIONS, 5TH EDITION 5TH EDITION STUDY QUESTIONS
b. Neutrophils c. Large lymphocytes
c. Lymphocytes d. Mesothelial cells
d. Monocytes/histiocytes (macrophages)
Refer to the following scenario to answer questions 9
5. Spinal fluid was obtained from a 56-year-old woman. and 10: A 56-yearold man came to the physician’s office
On receipt in the laboratory, the fluid was noted to be with complaints of pain and swelling in his left big toe.
slightly bloody. When a portion of the fluid was Fluid aspirated from the toe was strawcolored and
centrifuged, the supernatant was clear. The cell counts cloudy. The WBC count was 2543/mL. The differential
were 5200 RBCs/mL3 and 24 WBCs/mL. On the consisted mainly of neutrophils and
cytocentrifuge preparation, several nucleated RBCs monocytes/histiocytes. Intracellular and extracellular
were seen. crystals were seen on the cytocentrifuge slide. The
The differential was crystals were needle-shaped and, when polarized with
52% lymphocytes, 20% neutrophils, 22% monocytes, 4% the use of the red compensator, appeared yellow on
myelocytes, and 2% blasts. What is the most likely the y-axis.
explanation for these results?

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a. Bone marrow contamination 9. The crystals are:

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b. Bacterial meningitis a. Cholesterol

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c. Peripheral blood contamination b. Hyaluronidase
d. Leukemic infiltration in the central nervous system c. Monosodium urate

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d. Calcium pyrophosphate

or
6. A 34-year-old woman with a history of breast cancer
developed a pleural effusion. The fluid obtained was
bloody and had a nucleated cell count of 284/mL. On i sm
10. This patient’s painful toe was caused by:
a. Gout
Qu
the cytocentrifuge preparation, there were several b. Infection
neutrophils and a few monocytes/histiocytes. There c. Inflammation
A.

were also several clusters of large, dark-staining cells. d. Pseudogout

These cell clumps appeared “three-dimensional” and
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contained some mitotic figures. What is the most likely

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identification of the cells in clusters?

a. Mesothelial cells
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b. Metastatic tumor cells --------------------------------------------------------------------------

c. Cartilage cells CHAPTER 19 ANEMIAS: RED BLOOD CELL
d

d. Pneumocytes
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MORPHOLOGY AND APPROACH TO DIAGNOSIS

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7. A serous fluid with a clear appearance, specific 1. Which of the following patients would be considered
m

gravity of 1.010, protein concentration of 1.5 g/dL, and anemic with a hemoglobin value of 14.5 g/dL? Refer to
Co

fewer than 500 mononuclear cells/mL would be reference intervals inside the front cover of this text.
considered: a. An adult man
a. Infectious b. An adult woman
b. An exudate c. A newborn boy
c. A transudate d. A 10-year-old girl
d. Sterile
2. Common clinical symptoms of anemia include:
8. On the cytocentrifuge slide prepared from a a. Splenomegaly
peritoneal fluid sample, many large cells are seen, singly b. Shortness of breath and fatigue
and in clumps. The cells have a “fried egg” appearance c. Chills and fever
and basophilic cytoplasm, and some are multinucleated. d. Jaundice and enlarged lymph nodes
These cells should be reported as:
a. Suspicious for malignancy
b. Macrophages
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 RODAK – CLINICAL PRINCIPLES AND APPLICATIONS, 5TH EDITION 5TH EDITION STUDY QUESTIONS
3. Which of the following are important to consider in c. Hypochromia
the in the patient’s history when investigating the cause d. Poikilocytosis
of an anemia?
a. Diet and medications 9. Schistocytes, ovalocytes, and acanthocytes are
b. Occupation, hobbies, and travel examples of abnormal changes in RBC:
c. Bleeding episodes in the patient or in his or her family a. Volume
members b. Shape
d. All of the above c. Inclusions
d. Hemoglobin concentration
4. Which one of the following is reduced as an
adaptation to long-standing anemia? 10. Refer to Figure 19-3 to determine which one of the
a. Heart rate following conditions would be included in the
b. Respiratory rate differential diagnosis of an anemic adult patient with an
c. Oxygen affinity of hemoglobin absolute reticulocyte count of 20 3 109/L and an MCV
d. Volume of blood ejected from the heart with each of 65 fL.

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contraction a. Aplastic anemia

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b. Sickle cell anemia

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5. An autoimmune reaction destroys the hematopoietic c. Iron deficiency
stem cells in the bone marrow of a young adult patient, d. Folate deficiency

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and the amount of active bone marrow, including RBC

or
precursors, is diminished. The RBC precursors that are 11. Which one of the following conditions would be
present are normal in appearance, but there are too
few to meet the demand for circulating red blood cells, i sm
included in the differential diagnosis of an anemic adult
patient with an MCV of 125 fL and an RDW of 20%
Qu
and anemia develops. The reticulocyte count is low. The (reference interval 11.5% to 14.5%)?
mechanism of the anemia would be described as: a. Aplastic anemia
A.

a. Effective erythropoiesis b. Sickle cell anemia

b. Ineffective erythropoiesis c. Iron deficiency
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c. Insufficient erythropoiesis d. Vitamin B12 deficiency

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6. What are the initial laboratory tests that are

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performed for the diagnosis of anemia?

a. CBC, iron studies, and reticulocyte count --------------------------------------------------------------------------
d

b. CBC, reticulocyte count, and peripheral blood film CHAPTER 20 DISORDERS OF IRON KINETICS AND
le

examination HEME METABOLISM

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c. Reticulocyte count and serum iron, vitamin B12, and

m

folate assays 1. The mother of a 4-month-old infant who is being

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d. Bone marrow study, iron studies, and peripheral breastfed sees her physician for a routine postpartum
blood film examination visit. She expresses concern that she may be
experiencing postpartum depression because she does
7. An increase in which one of the following suggests a not seem to have any energy. Although the physician is
shortened life span of RBCs and hemolytic anemia? sympathetic to the patient’s concern, she orders a CBC
a. Hemoglobin and iron studies seeking an organic explanation for the
b. Hematocrit patient’s symptoms. The results are as follows:
c. Reticulocyte count
d. Red cell distribution width CBC: all results within reference intervals except RDW 5
15%
8. Which of the following is detectable only by Serum iron: decreased
examination of a peripheral blood film? TIBC: increased
a. Microcytosis % transferrin saturation: decreased
b. Anisocytosis Serum ferritin: decreased

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 RODAK – CLINICAL PRINCIPLES AND APPLICATIONS, 5TH EDITION 5TH EDITION STUDY QUESTIONS
Correlate the patient’s laboratory and clinical findings. woodwork. Her CBC results showed a mild
What can you conclude? hypochromic, microcytic anemia, with polychromasia
a. The results of the iron studies reveal findings and basophilic stippling noted. Which of the following
consistent with a thalassemia that was apparently tests would be most useful in confirming the cause of
previously undiagnosed. her anemia?
b. The patient is in stage 2 of iron deficiency, before a. Serum lead level
frank anemia develops. b. Serum iron level and TIBC
c. The results of the iron studies are inconsistent with c. Absolute reticulocyte count
the CBC results, and a laboratory error should be d. Prussian blue staining of the bone marrow to detect
suspected. iron stores in macrophages
d. There is no evidence of a hematologic explanation for
the patient’s symptoms. 5. In men and postmenopausal women whose diets are
adequate, iron deficiency anemia most often results
2. A bone marrow biopsy was performed as part of the from:
cancer staging protocol for a patient with Hodgkin a. Increased need associated with aging

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lymphoma. Although no evidence of spread of the b. Impaired absorption in the gastric mucosa

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tumor was apparent in the marrow, other abnormal c. Chronic gastrointestinal bleeding

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findings were noted, including a slightly elevated d. Diminished resistance to hookworm infections
myeloid-to-erythroid ratio. WBC and RBC morphology

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appeared normal, however. The Prussian blue stain 6. Which one of the following individuals is at greatest

or
showed abundant stainable iron in the marrow risk for the development of iron deficiency anemia?
macrophages. The patient’s CBC revealed a hemoglobin
of 10.8 g/dL, but RBC indices were within reference i sm
a. A 15-year-old boy who eats mainly fast food and
junk food
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intervals. RBC morphology was unremarkable. These b. A 37-year-old woman who has never been pregnant
findings would be consistent with: and has amenorrhea
A.

a. Anemia of chronic inflammation c. A 63-year-old man with reactivation of tuberculosis

b. Sideroblastic anemia from his childhood
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c. Thalassemia d. A 40-year-old man who lost blood during surgery to

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d. Iron deficiency anemia repair a fractured leg

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3. Predict the iron study results for the patient with 7. Which of the following individuals is at the greatest
Hodgkin lymphoma described in question 2. risk for the development of anemia of chronic
d

inflammation?
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a. A 15-year-old girl with asthma

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SERUM % SERUM b. A 40-year-old woman with type 2 diabetes mellitus

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IRON TIBC TRANSFERRIN FERRITIN c. A 65-year-old man with hypertension

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LEVEL SATURATION LEVEL d. A 30-year-old man with severe rheumatoid arthritis

a. Decreased Increased Decreased Decreased
8. In what situation will increased levels of free
b. Increased Normal Increased Normal
erythrocyte protoporphyrin be present?
c. Increased Increased Normal Increased a. Gain of function mutation to one of the enzymes in
d. Decreased Decreased Normal Normal the heme synthesis pathway
b. A mutation that prevents heme attachment to globin
so that protoporphyrin remains free
4. A 35-year-old white woman went to her physician
c. Any condition that prevents iron incorporation into
complaining of headaches, dizziness, and nausea. The
protoporphyrin IX
headaches had been increasing in severity over the past
d. When red blood cells lyse, freeing their contents into
6 months. This was coincident with her move into an
the plasma
older house built about 1900. She had been renovating
the house, including stripping paint from the

COMPILED BY RUDY A. QUISMORIO, RMT 20 | P a g e

 RODAK – CLINICAL PRINCIPLES AND APPLICATIONS, 5TH EDITION 5TH EDITION STUDY QUESTIONS
9. In the pathogenesis of the anemia of chronic 2. A patient has a clinical picture of megaloblastic
inflammation, hepcidin levels: anemia. The serum folate level is decreased, and the
a. Decrease during inflammation and reduce iron serum vitamin B12 level is 600 pg/mL (reference
absorption from enterocytes interval is 200–900 pg/mL). What is the expected value
b. Increase during inflammation and reduce iron for the methylmalonic acid assay?
absorption from enterocytes a. Increased
c. Increase during inflammation and increase iron b. Decreased
absorption from enterocytes c. Within the reference interval
d. Decrease during inflammation and increase iron
absorption from enterocytes 3. Which one of the following statements characterizes
the relationships among macrocytic anemia,
10. Sideroblastic anemias result from: megaloblastic anemia, and pernicious anemia?
a. Sequestration of iron in hepatocytes a. Macrocytic anemias are megaloblastic.
b. Inability to incorporate heme into apohemoglobin b. Macrocytic anemia is pernicious anemia.
c. Sequestration of iron in myeloblasts c. Megaloblastic anemia is macrocytic.

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d. Failure to incorporate iron into protoporphyrin IX d. Megaloblastic anemia is pernicious anemia.

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11. In general, the hereditary hemochromatoses result 4. Which of the following CBC findings is most
from suggestive of

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mutations that impair: a megaloblastic anemia?

or
a. The manner in which developing red cells acquire and a. MCV of 103 fL
manage iron
b. The hepcidin-ferroportin iron regulatory system i sm
b. Hypersegmentation of neutrophils
c. RDW of 16%
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c. The TfR-Tf endocytic iron acquisition process for body d. Hemoglobin concentration of 9.1 g/dL
cells other than blood cells
A.

d. The function of divalent metal transporter in 5. In the following description of a bone marrow smear,
enterocytes and macrophages find the statement that is inconsistent with the
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expected picture in megaloblastic anemia. “The marrow

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12. In the erythropoietic porphyrias, mild anemia may appears hypercellular with a myeloid-toerythroid ratio
be accompanied by what distinctive clinical finding? of 1:1 due to prominent erythroid hyperplasia.
by

a. Gallstones Megakaryocytes appear normal in number and

b. Impaired night vision appearance. The WBC elements appear larger than
d

c. Unintentional nighttime leg movements normal, with especially large metamyelocytes, although
le

d. Heightened propensity for sunburn they otherwise appear morphologically normal. The RBC
pi

precursors also appear large. There is nuclear-

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cytoplasmic asynchrony, with

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the nucleus appearing more mature than expected for

the color of the cytoplasm.”
-------------------------------------------------------------------------- a. Erythroid nuclei that are more mature than
CHAPTER 21 ANEMIAS CAUSED BY DEFECTS OF cytoplasm
DNA METABOLISM b. Larger than normal WBC elements
c. Larger than normal RBCs
1. Which of the following findings is consistent with a d. Normal appearance of megakaryocytes
diagnosis of megaloblastic anemia?
a. Hyposegmentation of neutrophils 6. Which one of the following findings would be
b. Decreased serum lactate dehydrogenase level inconsistent with elevated titers of intrinsic factor
c. Absolute increase in reticulocytes blocking antibodies?
d. Increased MCV a. Hypersegmentation of neutrophils
b. Low levels of methylmalonic acid
c. Macrocytic RBCs
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 RODAK – CLINICAL PRINCIPLES AND APPLICATIONS, 5TH EDITION 5TH EDITION STUDY QUESTIONS
d. Low levels of vitamin B12 d. Unknown cause

7. Which of the following is the most metabolically 3. The pathophysiologic mechanism in acquired
active form of absorbed vitamin B12? idiosyncraticaplastic anemia is:
a. Transcobalamin a. Replacement of bone marrow by abnormal cells
b. Intrinsic factor–vitamin B12 complex b. Destruction of stem cells by autoimmune T cells
c. Holotranscobalamin c. Defective production of hematopoietic growth factors
d. Haptocorrin–vitamin B12 complex d. Inability of bone marrow stroma to support stem
cells
8. Folate and vitamin B12 work together in the
production of: 4. Based on the criteria in Table 22-1, what is the
a. Amino acids aplastic anemia classification of a 15-year-old female
b. RNA with a bone marrow cellularity of 10%, hemoglobin of 7
c. Phospholipids g/dL, absolute neutrophil count of 0.1 3 109/L, and
d. DNA platelet count of 10 3 109/L?

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a. Nonsevere

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9. The macrocytosis associated with megaloblastic b. Moderate

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anemia results from: c. Severe
a. Reduced numbers of cell divisions with normal d. Very severe

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cytoplasmic development

or
b. Activation of a gene that is typically active only in 5. The most consistent peripheral blood findings in
megakaryocytes
c. Reduced concentration of hemoglobin in the cells so i sm
severe aplastic anemia are:
a. Hairy cells, monocytopenia, and neutropenia
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that larger cells are needed to provide the same oxygen b. Macrocytosis, thrombocytopenia, and neutropenia
carrying capacity c. Blasts, immature granulocytes, and
A.

d. Increased production of reticulocytes in an attempt thrombocytopenia

to compensate for the anemia d. Polychromasia, nucleated RBCs, and hypersegmented
dy

neutrophils
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10. Which one of the following groups has the highest

risk for pernicious anemia? 6. The treatment that has shown the best success rate
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a. Malnourished infants in young patients with severe aplastic anemia is:

b. Children during growth periods a. Immunosuppressive therapy
d

c. Persons older than 60 years of age b. Long-term red blood cell and platelet transfusions
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d. Pregnant women c. Administration of hematopoietic growth factors and

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androgens
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d. Stem cell transplant with an HLA-identical sibling

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-------------------------------------------------------------------------- 7. The test that is most useful in differentiating FA from

CHAPTER 22 BONE MARROW FAILURE other causes of pancytopenia is:
a. Bone marrow biopsy
1. The clinical consequences of pancytopenia include: b. Ham acidified serum test
a. Pallor and thrombosis c. Diepoxybutane-induced chromosome breakage
b. Kidney failure and fever d. Flow cytometric analysis of CD55 and CD59 cells
c. Fatigue, infection, and bleeding
d. Weakness, hemolysis, and infection 8. Mutations in genes that code for the telomerase
complex may induce bone marrow failure by causing
2. Idiopathic acquired aplastic anemia is due to a(n): which one of the following?
a. Drug reaction a. Resistance of stem cells to normal apoptosis
b. Benzene exposure b. Autoimmune reaction against telomeres in stem cells
c. Inherited mutation in stem cells

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 RODAK – CLINICAL PRINCIPLES AND APPLICATIONS, 5TH EDITION 5TH EDITION STUDY QUESTIONS
c. Decreased production of hematopoietic growth 3. A sign of hemolysis that is typically associated with
factors both fragmentation and macrophage-mediated
d. Premature death of hematopoietic stem cells hemolysis is:
a. Hemoglobinuria
9. Diamond-Blackfan anemia differs from inherited b. Hemosiderinuria
aplastic anemia in that in the former: c. Hemoglobinemia
a. Reticulocyte count is increased d. Elevated urinary urobilinogen level
b. Fetal hemoglobin is decreased
c. Only erythropoiesis is affected 4. An elderly white woman is evaluated for worsening
d. Congenital malformations are absent anemia, with a decrease of approximately 0.5 mg/dL of
hemoglobin each week. The patient is pale, and her
10. Which anemia should be suspected in a patient with skin and eyes are slightly yellow. She complains of
refractory anemia, reticulocytopenia, hemosiderosis, extreme fatigue and is unable to complete the tasks of
and binucleated erythrocyte precursors in the bone daily living without napping in midmorning and
marrow? midafternoon. She also tires with exertion, finding it

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a. Fanconi anemia difficult to climb even five stairs. Which of the features

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b. Dyskeratosis congenita of this description points to a hemolytic cause for her

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c. Acquired aplastic anemia anemia?
d. Congenital dyserythropoietic anemia a. Pallor

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b. Yellow skin and eyes

or
11. The primary pathophysiologic mechanism of anemia c. Need for naps
associated with chronic kidney disease is:
a. Inadequate production of erythropoietin i sm
d. Tiredness on exertion
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b. Excessive hemolysis 5. Which of the following tests provides a good
c. Hematopoietic stem cell mutation indication of accelerated erythropoiesis?
A.

d. Toxic destruction of stem cells a. Urine urobilinogen level

b. Hemosiderin level
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c. Reticulocyte count
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d. Glycated hemoglobin level

--------------------------------------------------------------------------
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CHAPTER 23 INTRODUCTION TO INCREASED 6. A 5-year-old girl was seen by her physician several
DESTRUCTION OF ERYTHROCYTES days prior to this visit and was diagnosed with
d

pneumonia. Her mother has brought her to the

le

1. The term hemolytic disorder in general refers to a physician again because the girl’s urine began to darken
pi

disorder in which there is: after the first visit and now is alarmingly dark. The girl
m

a. Increased destruction of RBCs after they enter the has no history of anemia, and there is no family history
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bloodstream of any hematologic disorder. The CBC shows a mild

b. Excessive loss of RBCs from the body anemia, polychromasia, and a few schistocytes. This
c. Inadequate RBC production by the bone marrow anemia could be categorized as:
d. Increased plasma volume with unchanged red cell a. Acquired, fragmentation
mass b. Acquired, macrophage-mediated
c. Hereditary, fragmentation
2. RBC destruction that occurs when macrophages d. Hereditary, macrophage-mediated
ingest and destroy RBCs is termed:
a. Extracellular 7. A patient has a personal and family history of a mild
b. Macrophage-mediated hemolytic anemia. The patient has consistently elevated
c. Intra-organ levels of total and indirect serum bilirubin and urinary
d. Extrahematopoietic urobilinogen. The serum haptoglobin level is
consistently decreased, whereas the reticulocyte count
is elevated. The latter can be seen as polychromasia on
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 RODAK – CLINICAL PRINCIPLES AND APPLICATIONS, 5TH EDITION 5TH EDITION STUDY QUESTIONS
the patient’s blood film, along with spherocytes. Which b. Decreased Negative Negative
of the findings reported for this patient is inconsistent
with a classical diagnosis of fragmentation hemolysis? c. Decreased Positive Positive
a. Elevated total and indirect serum bilirubin
b. Elevated urinary urobilinogen d. Increased Positive Negative
c. Decreased haptoglobin
d. Spherocytes on the peripheral film

8. Select the statement that is true about bilirubin

metabolism.
a. Indirect bilirubin is formed in the liver by the addition --------------------------------------------------------------------------
of two sugar molecules to direct bilirubin. CHAPTER 24 INTRINSIC DEFECTS LEADING TO
b. Macrophages of the spleen liberate bilirubin during INCREASED ERYTHROCYTE DESTRUCTION
hemoglobin catabolism.
c. Urobilinogen is not water soluble and is not excreted 1. In HS a characteristic abnormality in the CBC results

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in the urine. is:

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d. Normally, the major fraction of bilirubin in the blood a. Increased MCV

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is the direct (conjugated) form released from b. Increased MCHC
macrophages. c. Decreased MCH

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d. Decreased platelet and WBC counts

or
9. A patient has anemia that has been worsening over
the last several months. The hemoglobin level has been
declining slowly, with a drop of 1.5 g/dL of hemoglobin i sm
2. The altered shape of the spherocyte in HS is due to:
a. An abnormal RBC membrane protein affecting
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over about 6 weeks. Polychromasia and anisocytosis are vertical protein interactions
seen on the blood film, consistent with the elevated b. Defective RNA synthesis
A.

reticulocyte count and RBC distribution width (RDW). c. An extrinsic factor in the plasma
Serum levels of total bilirubin and indirect fractions are d. Abnormality in the globin composition of the
dy

normal. Urinary urobilinogen level also is normal. When hemoglobin molecule

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these findings are evaluated, the conclusion is drawn

that the anemia does not have a hemolytic component. 3. Which of the following results are consistent with
by

Based on the data given here, why was hemolysis ruled HS?
out as the cause of the anemia? a. Increased osmotic fragility, negative DAT result
d

a. The decline in hemoglobin is too gradual to be b. Decreased osmotic fragility, positive DAT result
le

associated with hemolysis. c. Increased osmotic fragility, positive DAT result

pi

b. The elevation of the reticulocyte count suggests a d. Decreased osmotic fragility, negative DAT result
m

malignant cause.
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c. Evidence of increased protoporphyrin catabolism is 4. The RBCs in HE are abnormally shaped and have
lacking. unstable cell membranes as a result of:
d. Elevated RDW points to an anemia of decreased a. Abnormal shear stresses in the circulation
production. b. Defects in horizontal membrane protein interactions
c. Mutations in ankyrin
10. Which of the following sets of test results is typically d. Lack of all Rh antigens in the RBC membrane
expected with chronic fragmentation hemolysis?
5. The peripheral blood film for patients with mild HE is
characterized by:
Urine Sediment a. Elliptical RBCs
Serum Urine Prussian Blue b. Oval RBCs with one or two transverse ridges
Haptoglobin Hemoglobin Stain c. Overhydrated RBCs with oval central pallor
a. Increased Positive Positive d. Densely stained RBCs with a few irregular projections

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 RODAK – CLINICAL PRINCIPLES AND APPLICATIONS, 5TH EDITION 5TH EDITION STUDY QUESTIONS
6. Laboratory test results for patients with HPP include c. Flow cytometry for detection of eosin-59-maleimide
all of the following except: binding on erythrocytes
a. RBCs that show marked thermal sensitivity at 41° C to d. Flow cytometry for detection of CD55, CD59, and
45° C FLAER binding on neutrophils and monocytes
b. Marked poikilocytosis with elliptocytes, RBC
fragments, and microspherocytes
c. Low fluorescence when incubated with eosin-59-
maleimide
d. Increased MCV and normal RDW --------------------------------------------------------------------------

7. Acanthocytes are found in association with: CHAPTER 25 EXTRINSIC DEFECTS LEADING TO

a. Abetalipoproteinemia INCREASED ERYTHROCYTE DESTRUCTION
b. G6PD deficiency NONIMMUNE CAUSES
c. Rh deficiency syndrome
d. Vitamin B12 deficiency 1. Which one of the following is a feature found in all

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microangiopathic hemolytic anemias?

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8. The most common manifestation of G6PD deficiency a. Pancytopenia

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is: b. Thrombocytosis
a. Chronic hemolytic anemia caused by cell shape c. Intravascular RBC fragmentation

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change d. Prolonged prothrombin time and partial

or
b. Acute hemolytic anemia caused by drug exposure or thromboplastin time
infections
c. Mild compensated hemolysis caused by ATP i sm
2. Typical laboratory findings in TTP and HUS include:
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deficiency a. Schistocytosis and thrombocytopenia
d. Chronic hemolytic anemia caused by intravascular b. Anemia and reticulocytopenia
A.

RBC lysis c. Reduced levels of lactate dehydrogenase and

aspartate
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9. A patient experiences an episode of acute aminotransferase

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intravascular hemolysis after taking primaquine for the d. Increased levels of free plasma hemoglobin and
first time. The physician suspects that the patient may serum haptoglobin
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have G6PD deficiency and orders an RBC G6PD assay 2

days after the hemolytic episode begins. How will this 3. The pathophysiology of idiopathic TTP involves:
d

affect the test result? a. Shiga toxin damage to endothelial cells and
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a. No effect obstruction of small blood vessels in glomeruli

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b. False increase due to reticulocytosis b. Formation of platelet-VWF thrombi due to

m

c. False decrease due to hemoglobinemia autoantibody inhibition of ADAMTS-13

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d. Absence of enzyme activity c. Overactivation of the complement system and

endothelial cell damage due to loss of regulatory
10. The most common defect or deficiency in the function
anaerobic d. Activation of the coagulation and fibrinolytic systems
glycolytic pathway that causes chronic HNSHA is: with fibrin clots throughout the microvasculature
a. Pyruvate kinase deficiency
b. Lactate dehydrogenase deficiency 4. Which of the following tests yields results that are
c. Glucose-6-phosphate dehydrogenase deficiency abnormal in DIC but are usually within the reference
d. Methemoglobin reductase deficiency interval or just slightly abnormal in TTP and HUS?
a. Indirect serum bilirubin and serum haptoglobin
11. Which of the following laboratory tests would be b. Prothrombin time and partial thromboplastin time
best to confirm PNH? c. Lactate dehydrogenase and aspartate
a. Acidified serum test (Ham test) aminotransferase
b. Osmotic fragility test d. Serum creatinine and serum total protein

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 RODAK – CLINICAL PRINCIPLES AND APPLICATIONS, 5TH EDITION 5TH EDITION STUDY QUESTIONS
a. Macrocytosis and polychromasia
5. Which one of the following laboratory results may be b. Burr cells and crenated cells
seen in BOTH traumatic cardiac hemolytic anemia and c. Howell-Jolly bodies and bite cells
exerciseinduced hemoglobinuria? d. Schistocytes and microspherocytes
a. Schistocytes on the peripheral blood film
b. Thrombocytopenia 11. A 36-year-old woman was brought to the
c. Decreased serum haptoglobin emergency department by her husband because she
d. Hemosiderinuria had experienced a seizure. He reported that she had
6. Which of the following species of Plasmodium been well until that morning, when she complained of a
produce hypnozoites that can remain dormant in the sudden headache and malaise. She was not taking any
liver and cause a relapse months or years later? medications and had no history of previous surgery or
a. P. falciparum pregnancy. Laboratory studies showed a WBC count of
b. P. vivax 15 3 109/L, hemoglobin level of 7.8 g/dL, a platelet
c. P. knowlesi count of 18 3 109/L, and schistocytes and helmet cells
d. P. malariae on the peripheral blood film. Chemistry test results

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included markedly elevated serum lactate

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7. Which one of the following is not a mechanism dehydrogenase activity and a slight increase in the level

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causing anemia in P. falciparum infections? of total and indirect serum bilirubin. The urinalysis
a. Inhibition of erythropoiesis results were positive for protein and blood, but there

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b. Lysis of infected RBCs during schizogony were no RBCs in the urine sediment. Prothrombin time

or
c. Competition for vitamin B12 in the erythrocyte and partial thromboplastin time were within the
d. Immune destruction of noninfected RBCs in the
spleen i sm
reference interval. When the entire clinical and
laboratory picture is considered, which of the following
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is the most likely diagnosis?
8. Which Plasmodium species is widespread in Malaysia, a. HUS
A.

has RBCs with multiple ring forms, has band-shaped b. HELLP syndrome
early trophozoites, shows a 24-hour erythrocytic cycle, c. TTP
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and can cause severe disease and high parasitemia? d. Exercise-induced hemoglobinuria
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a. P. falciparum
b. P. vivax
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c. P. knowlesi
d. P. malariae --------------------------------------------------------------------------
d

CHAPTER 26 EXTRINSIC DEFECTS LEADING TO

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9. One week after returning from a vacation in Rhode INCREASED ERYTHROCYTE DESTRUCTION—
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Island, a 60-year-old man experienced fever, chills, IMMUNE CAUSES

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nausea, muscle aches, and fatigue of 2 days’ duration. A

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complete blood count (CBC) showed a WBC count of 4.5 1. Immune hemolytic anemia is due to a(n):
3 109/L, hemoglobin level of 10.5 g/dL, a platelet count a. Structural defect in the RBC membrane
of 134 3 109/L, and a reticulocyte count of 2.7%. The b. Allo- or autoantibody against an RBC antigen
medical laboratory scientist noticed tiny ameboid ring c. T cell immune response against an RBC antigen
forms in some of the RBCs and some tetrad forms in d. Obstruction of blood flow by intravascular thrombi
others. These findings suggest:
a. Bartonellosis 2. The pathophysiology of immune hemolysis with IgM
b. Malaria antibodies always involves:
c. Babesiosis a. Complement
d. Clostridial sepsis b. Autoantibodies
c. Abnormal hemoglobin molecules
10. What RBC morphology is characteristically found d. Alloantibodies
within the first 24 hours following extensive burn
injury?
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 RODAK – CLINICAL PRINCIPLES AND APPLICATIONS, 5TH EDITION 5TH EDITION STUDY QUESTIONS
3. In hemolysis mediated by IgG antibodies, which
abnormal RBC morphology is typically observed on the 9. Chronic secondary CAD is most often associated with:
peripheral blood film? a. Antibiotic therapy
a. Spherocytes b. M. pneumoniae infection
b. Nucleated RBCs c. B cell malignancies
c. RBC agglutination d. Infectious mononucleosis
d. Macrocytes
4. The most important finding in the diagnostic 10. A 63-year-old man is being evaluated because of a
investigation of a suspected autoimmune hemolytic decrease
anemia is: in hemoglobin of 5 gm/dL after a second cycle of
a. Detection of a low hemoglobin and hematocrit fludarabine for treatment of chronic lymphocytic
b. Observation of hemoglobinemia in a specimen leukemia. The patient’s DAT result is strongly positive
c. Recognition of a low reticulocyte count for IgG only, and antibody testing on his serum and an
d. Demonstration of IgG and/or C3d on the RBC eluate of his RBCs yield positive results with all panel
surface cells and the patient’s own cells. This suggests which

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mechanism of immune hemolysis for this patient?

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5. In autoimmune hemolytic anemia, a positive DAT is a. Drug-RBC membrane protein complex

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evidence that an: b. Drug adsorption
a. IgM antibody is in the patient’s serum c. RBC autoantibody induction

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b. IgG antibody is in the patient’s serum d. Drug-induced nonimmunologic protein adsorption

or
c. IgM antibody is sensitizing the patient’s red blood
cells
d. IgG antibody is sensitizing the patient’s red blood i sm
11. A Group A Rh-negative mother gave birth to a Group
O Rh-positive baby. The baby is at risk for HDFN if:
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cells a. This was the mother’s first pregnancy
b. The mother has IgG ABO antibodies
A.

6. Which of the following is NOT a mechanism of drug c. The mother was previously immunized to the D
induced hemolytic anemia? antigen
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a. Drug adsorption on red blood cell membrane d. The mother received Rh immune globulin prior to
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b. Drug–RBC membrane protein immunogenic complex delivery

c. RBC autoantibody induction
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d. IgM autoantibody sensitization of RBCs after

exposure to the cold
d

--------------------------------------------------------------------------
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7. Which of the following describes a penicillin-induced CHAPTER 27 HEMOGLOBINOPATHIES

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AIHA? (STRUCTURAL DEFECTS IN HEMOGLOBIN)

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a. Extravascular hemolysis, positive DAT with IgG,

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gradual anemia 1. A qualitative abnormality in hemoglobin may involve

b. Intravascular, possible renal failure, positive DAT with all of the following except:
C3d a. Replacement of one or more amino acids in a globin
c. Rare hemolysis, positive DAT with IgG chain
d. Intravascular hemolysis, positive DAT with IgG b. Addition of one or more amino acids in a globin chain
c. Deletion of one or more amino acids in a globin chain
8. Which one of the following statements is true about d. Decreased production of a globin chain
DHTR:
a. It is usually due to an ABO incompatibility 2. The substitution of valine for glutamic acid at position
b. Hemoglobinemia and hemoglobinuria frequently 6 of the b chain of hemoglobin results in hemoglobin
occur that:
c. It is due to an anamnestic response after repeat a. Is unstable and precipitates as Heinz bodies
exposure to a blood group antigen b. Polymerizes to form tactoid crystals
d. The DAT yields a positive result for C3d only c. Crystallizes in a hexagonal shape

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 RODAK – CLINICAL PRINCIPLES AND APPLICATIONS, 5TH EDITION 5TH EDITION STUDY QUESTIONS
d. Contains iron in the ferric (Fe31) state What percentage of their children potentially could
have sickle cell anemia (Hb SS)?
3. Patients with SCD usually do not exhibit symptoms a. 0%
until 6 months of age because: b. 25%
a. The mother’s blood has a protective effect c. 50%
b. Hemoglobin levels are higher in infants at birth d. 100%
c. Higher levels of Hb F are present
d. The immune system is not fully developed 9. Painful crises in patients with SCD occur as a result of:
a. Splenic sequestration
4. Megaloblastic episodes in SCD can be prevented by b. Aplasia
prophylactic administration of: c. Vasoocclusion
a. Iron d. Anemia
b. Folic acid
c. Steroids 10. The screening test for Hb S that uses a reducing
d. Erythropoietin agent, such as sodium dithionite, is based on the fact

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that hemoglobins that sickle:

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5. Which of the following is the most definitive test for a. Are insoluble in reduced, deoxygenated form

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Hb S? b. Form methemoglobin more readily and cause a color
a. Hemoglobin solubility test change

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b. Hemoglobin electrophoresis at alkaline pH c. Are unstable and precipitate as Heinz bodies

or
c. Osmotic fragility test d. Oxidize quickly and cause turbidity
d. Hemoglobin electrophoresis at acid pH
i sm
11. DNA analysis documents a patient has inherited the
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6. A patient presents with mild normochromic, sickle mutation in both b-globin genes. The two terms
normocytic anemia. On the peripheral blood film, there that best describe this genotype are:
A.

are a few target cells, rare nucleated RBCs, and a. Homozygous/trait

hexagonal crystals within and lying outside of the RBCs. b. Homozygous/disease
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Which abnormality in the hemoglobin molecule is most c. Heterozygous/trait

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likely? d. Heterozygous/disease
a. Decreased production of b chains
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b. Substitution of lysine for glutamic acid at position 6 12. In which of the following geographic areas is Hb S
of the b chain most
d

c. Substitution of tyrosine for the proximal histidine in prevalent?

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the b chain a. India

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d. Double amino acid substitution in the b chain b. South Africa

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c. United States
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7. A well-mixed specimen obtained for a CBC has a d. Sub-Saharan Africa

brown color. The patient is being treated with a
sulfonamide for a bladder infection. Which of the
following could explain? 13. Which hemoglobinopathy is more common in
the brown color? Southeast Asian patients?
a. The patient has Hb M. a. Hb S
b. The patient is a compound heterozygote for Hb S and b. Hb C
thalassemia. c. Hb O
c. The incorrect anticoagulant was used. d. Hb E
d. Levels of Hb F are high.
14. Which of the following Hb S compound
8. Through routine screening, prospective parents heterozygote exhibits the mildest symptoms?
discover that they are both heterozygous for Hb S. a. Hb S-b-Thal
b. Hb SG
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 RODAK – CLINICAL PRINCIPLES AND APPLICATIONS, 5TH EDITION 5TH EDITION STUDY QUESTIONS
c. Hb S-C-Harlem d. Structurally abnormal hemoglobin
d. Hb SC
4. b-Thalassemia minor (heterozygous) usually exhibits:
15. A 1-year-old Indian patient presents with anemia, a. Increased Hb Constant Spring
and both parents claim to have an “inherited anemia” b. 50% Hb F
but can’t remember the type. The peripheral blood c. No Hb A
shows target d. Increased Hb A2
cells, and the hemoglobin solubility is negative. Alkaline
hemoglobin electrophoresis shows a single band at the 5. RBC morphologic features in b-thalassemia would
“Hb C” position and a small band at the “Hb F” position. most likely include:
Acid hemoglobin electrophoresis shows two bands. The a. Microcytes, hypochromia, target cells, elliptocytes,
most likely diagnosis is: stippled cells
a. Hb CC b. Macrocytes, acanthocytes, target cells, stippled cells
b. Hb AC c. Microcytes, sickle cells
c. Hb CO d. Macrocytes, hypochromia, target cells, stippled cells

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d. Hb SC

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6. The predominant hemoglobin present in b0-

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16. Unstable hemoglobins show all of the following thalassemia major is:
findings EXCEPT: a. Hb A

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a. Globin chains precipitate intracellularly b. Hb A2

or
b. Heinz body formation c. Hb F
c. Elevated reticulocyte count
d. Only homozygotes are symptomatic i sm
d. Hb C
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7. Heterozygous HPFH is characterized by:
a. 10% to 35% Hb F with normal RBC morphology
A.

b. 100% Hb F with slightly hypochromic, microcytic cells

c. A decreased amount of Hb F with normal RBC
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-------------------------------------------------------------------------- morphology
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CHAPTER 28 THALASSEMIAS d. 5% to 15% Hb F with hypochromic, macrocytic cells

by

1. The thalassemias are caused by: 8. Hb H is composed of:

a. Structurally abnormal hemoglobins a. Two a and two b chains
d

b. Absent or defective synthesis of a polypeptide chain b. Two e and two g chains

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in hemoglobin c. Four b chains

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c. Excessive absorption of iron d. Four g chains

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d. Abnormal or defective protoporphyrin synthesis

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9. Hb Bart is composed of:

2. Thalassemia is more prevalent in individuals from a. Two a and two b chains
areas along the tropics because it confers: b. Two e and two g chains
a. Heat resistance to those heterozygous for a c. Four b chains
thalassemia gene d. Four g chains
b. Selective advantage against tuberculosis
c. Selective advantage against malaria 10. When one a gene is deleted (a–/aa), a patient has:
d. Resistance to mosquito bites a. Normal hemoglobin levels
b. Mild anemia (hemoglobin range 9 to 11 g/dL)
3. The hemolytic anemia associated with the c. Moderate anemia (hemoglobin range 7 to 9 gm/dL)
thalassemias is due to: d. Marked anemia requiring regular transfusions
a. Imbalance of globin chain synthesis
b. Microcytic, hypochromic cells 11. In which part of the world is a gene mutation
c. Ineffective erythropoiesis caused by immune factors causing Hb Bart hydrops fetalis (– –/– –) most common?
COMPILED BY RUDY A. QUISMORIO, RMT 29 | P a g e
 RODAK – CLINICAL PRINCIPLES AND APPLICATIONS, 5TH EDITION 5TH EDITION STUDY QUESTIONS
a. Northern Africa 1. Which of the following inherited leukocyte disorders
b. Mediterranean is caused by a mutation in the lamin B receptor?
c. Middle East a. Pelger-Huët anomaly
d. Southeast Asia b. Chédiak-Higashi disease
c. Alder-Reilly anomaly
12. The condition Hb S-b0-thalassemia has a clinical d. May-Hegglin anomaly
course that resembles:
a. Sickle cell trait 2. Which of the following inherited leukocyte disorders
b. Sickle cell anemia is one of a group of disorders with mutations in
c. b-Thalassemia minor nonmuscle myosin heavy-chain IIA?
d. b-Thalassemia major a. Pelger-Huët anomaly
b. Chédiak-Higashi disease
13. Hb H inclusions in a supravital stain preparation c. Alder-Reilly anomaly
appear as: d. May-Hegglin anomaly
a. A few large, blue, round bodies in the RBCs with

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aggregated reticulum 3. Which of the following inherited leukocyte disorders

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b. Uniformly stained blue cytoplasm in the RBC might be seen in Hurler syndrome?

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c. Small, evenly distributed, greenish-blue granules a. Pelger-Huët anomaly
that pit the surface of RBCs b. Chédiak-Higashi disease

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d. Uniform round bodies that adhere to the RBC c. Alder-Reilly anomaly

or
membrane d. May-Hegglin anomaly

14. Which of the following laboratory findings is i sm

4. Which of the following lysosomal storage diseases is
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inconsistent with b-thalassemia minor? characterized by macrophages with striated cytoplasm
a. A slightly elevated RBC count and marked and storage of glucocerebroside?
A.

microcytosis a. Sanfilippo syndrome

b. Target cells and basophilic stippling on the peripheral b. Gaucher disease
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blood film c. Fabry disease

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c. Hemoglobin level of 10 to 13 g/dL d. Niemann-Pick disease

d. Elevated MCHC and spherocytic RBCs
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5. The neutrophils in chronic granulomatous disease are

15. A 4-month-old infant of Asian heritage is seen for a incapable of producing:
d

well-baby check. Because of pallor, the physician a. Hydrogen peroxide

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suspects anemia and orders a CBC. The RBC count is 4.5 b. Hypochlorite
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3 109/L, Hb concentration is 10 g/dL, and MCV is 77 fL, c. Superoxide

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with microcytosis, hypochromia, poikilocytosis, and mild d. All of the above

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polychromasia noted on the peripheral blood film.

These findings should lead the physician to suspect: 6. Individuals with X-linked SCID have a mutation that
a. b-Thalassemia major affects their ability to synthesize:
b. a-Thalassemia silent carrier state a. Deaminase
c. Iron deficiency anemia b. Oxidase
d. Homozygous a-thalassemia (– –/– –) c. IL-2 receptor
d. IL-8 receptor
7. An absolute lymphocytosis with reactive lymphocytes
suggests which of the following conditions?
-------------------------------------------------------------------------- a. DiGeorge syndrome
CHAPTER 29 NONMALIGNAT LEUKOCYTE b. Bacterial infection
DISORDERS c. Parasitic infection
d. Viral infection

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 RODAK – CLINICAL PRINCIPLES AND APPLICATIONS, 5TH EDITION 5TH EDITION STUDY QUESTIONS
8. What leukocyte cytoplasmic inclusion is composed of
ribosomal RNA? 4. Which of the following is not an advantage of the use
a. Primary granules of FISH?
b. Toxic granules a. It can be used on nondividing cells.
c. Döhle bodies b. It can be used on paraffin-embedded tissue.
d. Howell-Jolly bodies c. It can detect mutations that do not result in abnormal
banding patterns.
9. The expected complete blood count (CBC) results for d. It must be performed on dividing cells.
women in active labor would include:
a. High total white blood cell (WBC) count with 5. Which of the following types of mutations would
increased lymphocytes likely not be detectable with cytogenetic banding
b. High total WBC count with a slight shift to the left in techniques?
neutrophils a. Point mutation resulting in a single amino acid
c. Normal WBC count with increased eosinophils substitution
d. Low WBC count with increased monocytes b. Transfer of genetic material from one chromosome

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to another

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10. Which of the following is true of an absolute c. Loss of genetic material from a chromosome that

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increase in lymphocytes with reactive morphology? does not appear on any other chromosome
a. The population of lymphocytes appears d. Duplication of a chromosome resulting in 3n of that

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morphologically homogeneous. genetic material

or
b. They are usually effector B cells.
c. The reactive lymphocytes have increased cytoplasm
with variable basophilia. i sm6. Which of the following describes a chromosomal
deletion?
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d. They are most commonly seen in bacterial infections. a. Point mutation resulting in a single amino acid
substitution
A.

b. Transfer of genetic material from one chromosome

to another
dy

-------------------------------------------------------------------------- c. Loss of genetic material from a chromosome that

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CHAPTER 30 CYTOGENETICS does not appear on any other chromosome

d. Duplication of a chromosome resulting in 3n of that
by

1. G-banding refers to the technique of staining genetic material

chromosomes:
d

a. To isolate those in the G group (i.e., chromosomes 21 The chromosome analysis performed on a patient’s
le

and 22) leukemic cells is reported as 47, XY,14,del(5)(q31)[20].

pi

b. In the G0 or resting stage Answer questions 7 to 9 based on this description.

m

c. Using Giemsa stain

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d. To emphasize areas high in guanine residues 7. This patient’s cells have which of the following
mutations?
2. Which of the following compounds is used to halt a. Loss of the entire number 31 chromosome
mitosis in metaphase for chromosome analyses? b. Loss of the entire number 5 chromosome
a. Imatinib c. Loss of a portion of the short arm of chromosome 4
b. Fluorescein d. Loss of a portion of the long arm of chromosome 5
c. Trypsin
d. Colchicine 8. What other mutation is present in this patient’s cells?
a. Polyploidy
3. One arm of a chromosome has 30 bands. Which band b. Tetraploidy
would be nearest the centromere? c. An extra chromosome 4
a. Band 1 d. Four copies of chromosome 5
b. Band 15
c. Band 30 9. This patient’s leukemic cells demonstrate:
COMPILED BY RUDY A. QUISMORIO, RMT 31 | P a g e
 RODAK – CLINICAL PRINCIPLES AND APPLICATIONS, 5TH EDITION 5TH EDITION STUDY QUESTIONS
a. Structural chromosomal defects only ambitious laboratory developed a molecular test to
b. Numeric chromosomal defects only verify the type of cancer present. This molecular test
c. Both structural and numeric chromosomal defects would require patient samples taken from which two
tissues?
10. Aneuploidy describes the total chromosome a. Abnormal growths found on the skin and in the bone
number: marrow
a. That is a multiple of the haploid number b. Normal splenic tissue and cancerous tissue
b. That reflects a loss or gain of a single chromosome c. Cancerous tissue in spleen and bone marrow
c. That is diploid but has a balanced deletion and d. Peripheral blood and cancerous tissue in the spleen
duplication of whole chromosomes
d. In gametes; diploid is the number in somatic cells 6. One main difference between PCR and reverse
transcriptase PCR is that:
a. PCR requires primers
b. PCR uses reverse transcriptase to elongate the
-------------------------------------------------------------------------- primers

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CHAPTER 31 MOLECULAR DIAGNOSTICS IN c. Reverse transcriptase PCR forms millions of Cdna

M
HEMATOPATHOLOGY fragments

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d. Reverse transcriptase PCR requires ligase to amplify
1. If the DNA nucleotide sequence is 59-ATTAGC-39, the target DNA

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then the mRNA sequence transcribed from this 7. Which one of the following statements about gel

or
template is: electrophoresis is false?
a. 59-GCUAAU-39
b. 59-AUUAGC-39 i sm
a. The gel is oriented in the chamber with the wells at
the positive terminal.
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c. 59-TAATCG-39 b. A buffer solution is required to maintain the electrical
d. 59-UAAUCG-39 current.
A.

c. The matrix of a polyacrylamide gel is tighter than that

2. Cells with damaged DNA and mutated or of an agarose gel.
dy

nonfunctioning cell cycle regulatory proteins: d. The larger DNA fragments will be closest to the wells
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a. Are arrested in G1 and the DNA is repaired of the gel.

b. Continue to divide, which leads to tumor
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progression 8. Autoradiography of DNA is the:

c. Divide normally, producing identical daughter cells a. Detection of radioactive or chemoluminescent
d

d. Go through apoptosis oligonucleotides

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b. Exposure of the gel to UV light

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3. To start DNA replication, DNA polymerase requires an c. Transfer of DNA to a nitrocellulose filter
m

available 39 hydroxyl group found on the: d. Use of ethidium bromide to visualize the DNA
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a. Leading strand banding pattern

b. mRNA
c. Parent strand 9. One major difference between endpoint PCR and
d. Primer real-time PCR is that:
a. Endpoint PCR requires thermostable DNA
4. Ligase joins Okazaki fragments of the: polymerase,
a. 59-to-39 template strand deoxynucleotides, and primers
b. Lagging strand b. Endpoint PCR requires a separate step to detect the
c. Leading strand amplicons formed in the reaction
d. Primer fragments c. Real-time PCR uses capillary gel electrophoresis to
detect amplicons during PCR cycling
5. A 40-year-old patient enters the hospital with a rare d. Real-time PCR detects and quantifies amplicons using
form of cancer caused by faulty cell division regulation. cleavage-based signal amplification
This cancer localized in the patient’s spleen. An

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 RODAK – CLINICAL PRINCIPLES AND APPLICATIONS, 5TH EDITION 5TH EDITION STUDY QUESTIONS
10. Which of the following statements about minimal
residual disease is true? 5. Antigens expressed by B-LL include:
a. Clinical remission of hematologic cancers is a. CD3, CD4, and CD8
determined by molecular techniques such as PCR and b. CD19, CD34, and CD10
flow cytometry. c. There are no antigens specific for B-LL.
b. Real-time quantitative PCR–determined copy d. Myeloperoxidase
number of BCR/ABL1 transcripts will always be lower
in molecular remission than in clinical remission. 6. Which of the following is true of flow cytometric
c. Qualitative PCR that uses a known copy number of a gating?
target sequence is of use in determining minimal a. It is best defined as selection of a target population
residual disease levels. for flow cytometric analysis.
d. Minimal residual disease assessment can aid b. It can be done only at the time of data acquisition.
physicians in making treatment decisions but does not c. It can be done only at the time of final analysis and
yet offer insights into prognosis. interpretation of flow cytometric data.
d. It is accomplished by adjusting flow rate.

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M
7. Collection of ungated events:

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-------------------------------------------------------------------------- a. Facilitates comprehensive analysis of all cells
CHAPTER 32 FLOW CYTOMETRIC ANALYSI S IN b. Does not help in detection of unexpected abnormal

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HEMATOLOGIC DISORDERS populations

or
c. Allows the collection of data on a large number of
1. What is the most common clinical application of flow
cytometry? i sm
rare cells
d. Is used for leukemia diagnosis only
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a. Diagnosis of platelet disorders
b. Detection of fetomaternal hemorrhage 8. Mycosis fungoides is characterized by:
A.

c. Diagnosis of leukemias and lymphomas a. Loss of certain antigens compared with the normal T
d. Differentiation of anemias cell population
dy

b. Polyclonal T cell receptor

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2. Which of the following is true of CD45 antigen? c. Immunophenotype indistinguishable from that of
a. It is present on every cell subpopulation in the bone normal T cells
by

marrow. d. Expression of CD3 and CD8 antigens

b. It is expressed on all hematopoietic cells, with the
d

exception of megakaryocytes and late erythroid 9. Mature granulocytes show the expression of:
le

precursors. a. CD15, CD33, and CD34

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c. It is not measured routinely in flow cytometry. b. CD15, CD33, and CD41

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d. It may be present on nonhematopoietic cells. c. CD15, CD33, and CD13

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d. CD15, CD33, and CD7

3. Erythroid precursors are characterized by the
expression of: 10. During the initial evaluation of flow cytometric data,
a. CD71 cell size, cytoplasmic complexity, and expression of
b. CD20 CD45 antigen are used to define cell subpopulations.
c. CD61 Which of the following parameters defines cytoplasmic
d. CD3 complexity/granularity?
a. SS
4. In Figure 32-2A, the cell population colored in aqua b. FS
represents: c. CD45
a. Monocytes d. HLA-DR
b. Nonhematopoietic cells
c. Granulocytes 11. The most important feature of the mature
d. Lymphocytes neoplastic B cell population is:
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 RODAK – CLINICAL PRINCIPLES AND APPLICATIONS, 5TH EDITION 5TH EDITION STUDY QUESTIONS
a. The presence of a specific immunophenotype with c. Transformation to acute leukemia
expression of CD19 antigen d. Temporary remission
b. A clonal light chain expression (i.e., exclusively k- or
l-positive population) 5. The most common mutation found in patients with
c. A clonal T cell receptor expression primary PV is:
d. Aberrant expression of CD5 antigen on CD191 cells a. BCR/ABL
b. Philadelphia chromosome
c. JAK2 V617F
d. t(15;17)
--------------------------------------------------------------------------
CHAPTER 33 MYELOPROLIFERATIVE NEOPLASMS 6. The peripheral blood in PV typically manifests:
a. Erythrocytosis only
1. A peripheral blood film that shows increased b. Erythrocytosis and thrombocytosis
neutrophils, basophils, eosinophils, and platelets is c. Erythrocytosis, thrombocytosis, and granulocytosis
highly suggestive of: d. Anemia and thrombocytopenia

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a. AML

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b. CML 7. A patient has a platelet count of 700 3 109/L with

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c. MDS abnormalities in the size, shape, and granularity of
d. Multiple myeloma platelets; a WBC count of 12 3 109/L; and hemoglobin

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of 11 g/dL. The Philadelphia chromosome is not

or
2. Which of the following chromosome abnormalities is present. The most likely diagnosis is:

i sm
associated with CML? a. PV
a. t(15;17) b. ET
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b. t(8;14) c. CML
c. t(9;22) d. Leukemoid reaction
d. Monosomy 7
A.

8. Complications of ET include all of the following

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3. A patient has a WBC count of 30 3 109/L and the except:

following WBC differential:
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a. Thrombosis
Segmented neutrophils—38% b. Hemorrhage
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Bands—17% c. Seizures
Metamyelocytes—7% d. Infections
d

Myelocytes—20%
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Promyelocytes—10% 9. Which of the following patterns is characteristic of

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Eosinophils—3% the peripheral blood in patients with PMF?

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Basophils—5% a. Teardrop-shaped erythrocytes, nucleated RBCs,

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immature granulocytes
Which of the following test results would be helpful in b. Abnormal platelets only
determining whether the patient has CML? c. Hypochromic erythrocytes, immature granulocytes,
a. Nitroblue tetrazolium reduction product increased and normal platelets
b. Myeloperoxidase increased d. Spherocytes, immature granulocytes, and increased
c. Periodic acid–Schiff staining decreased numbers of platelets
d. FISH positive for BCR/ABL1 fusion
10. The myelofibrosis associated with PMF is a result of:
4. A patient in whom CML has previously been a. Apoptosis resistance in the fibroblasts of the bone
diagnosed has circulating blasts and promyelocytes that marrow
total 30% of leukocytes. The disease is considered to be b. Impaired production of normal collagenase by the
in what phase? mutated cells
a. Chronic stable phase c. Enhanced activity of fibroblasts owing to increased
b. Accelerated phase stimulatory cytokines
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 RODAK – CLINICAL PRINCIPLES AND APPLICATIONS, 5TH EDITION 5TH EDITION STUDY QUESTIONS
d. Increased numbers of fibroblasts owing to cytokine a. Serum iron and ferritin levels
stimulation of the pluripotential stem cells b. Erythropoietin level
c. Vitamin B12 and folate levels
d. Chromosome analysis

-------------------------------------------------------------------------- 7. A 60-year-old woman comes to the physician with

CHAPTER 34 MYELODYSPLASTIC SYNDROMES fatigue and malaise. Her hemoglobin is 8 g/dL,
hematocrit is 25%, RBC count is 2.00 3 1012/L, platelet
1. MDSs are most common in which age group? count is 550 3 109/L, and WBC count is 3.8 3 109/L. Her
a. 2 to 10 years WBC differential is unremarkable. Bone marrow shows
b. 15 to 20 years erythroid hypoplasia and hypolobulated
c. 25 to 40 years megakaryocytes; granulopoiesis appears normal. Ring
d. Older than 50 years sideroblasts are rare. Chromosome analysis reveals the
deletion of 5q only. Based on the classification
2. What is a major indication of MDS in the peripheral of this disorder, what therapy would be most

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blood and bone marrow? appropriate?

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a. Dyspoiesis a. Supportive therapy; lenalidomide if the disease

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b. Leukocytosis with left shift progresses
c. Normal bone marrow with abnormal peripheral blood b. Aggressive chemotherapy

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features c. Bone marrow transplantation

or
d. Thrombocytosis d. Low-dose cytosine arabinoside, accompanied by cis-

3. An alert hematologist should recognize all of the i sm

retinoic acid
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following peripheral blood abnormalities as diagnostic 8. Which of the following is least likely to contribute to
clues in MDS except: the death of patients with MDS?
a. Oval macrocytes
A.

a. Neutropenia
b. Target cells b. Thrombocytopenia
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c. Agranular neutrophils c. Organ failure

d. Circulating micromegakaryocytes
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d. Neuropathy
by

4. For an erythroid precursor to be considered a ring 9. Into what other hematologic disease does MDS often
sideroblast, the iron-laden mitochondria must encircle convert?
d

how much of the nucleus? a. Megaloblastic anemia

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a. One quarter b. Aplastic anemia

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b. One third c. AML

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c. Two thirds d. Myeloproliferative disease

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d. Entire nucleus
10. Chronic myelomonocytic leukemia is classified in the
5. According to the WHO classification of MDS, what WHO system as:
percentage of blasts would constitute transformation to a. A myeloproliferative neoplasm
an acute leukemia? b. Myelodysplastic syndrome, unclassified
a. 5% c. MDS/MPN
b. 10% d. Acute leukemia
c. 20%
d. 30%

6. A patient has anemia, oval macrocytes, and --------------------------------------------------------------------------

hypersegmented neutrophils. Which of the following CHAPTER 35 ACUTE LEUKEMIAS
tests would be most efficient in differential diagnosis of
this disorder?

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 RODAK – CLINICAL PRINCIPLES AND APPLICATIONS, 5TH EDITION 5TH EDITION STUDY QUESTIONS
1. According to the WHO classification, except in d. t(15;17)(q22;q12)
leukemias
with specific genetic anomalies, the minimal percentage 7. Which of the following leukemias affects primarily
of blasts necessary for a diagnosis of acute leukemia is: children, is characterized by an increase in monoblasts
a. 10% and monocytes, and often is associated with gingival
b. 20% and skin involvement?
c. 30% a. Pre-B lymphoblastic leukemia
d. 50% b. Pure erythroid leukemia
c. AML with t(9;11)(p22;q23)
2. A 20-year-old patient has an elevated WBC count d. AML with t(15;17)(q22;q12)
with 70% blasts, 4% neutrophils, 5% lymphocytes, and
21% monocytes in the peripheral blood. Eosinophils 8. A 20-year-old patient presents with fatigue, pallor,
with dysplastic changes are seen in the bone marrow. easy bruising, and swollen gums. Bone marrow
AML with which of examination reveals 82% cells with delicate chromatin
the following karyotypes would be most likely to be and prominent nucleoli that are CD141, CD41, CD11b1,

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seen? and CD361. Which of the following acute leukemias is

M
a. AML with t(8;21)(q22;q22) likely?

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b. AML with t(16;16)(p13;q22) a. Minimally differentiated leukemia
c. AML with t(15;17)(q22;q12) b. Leukemia of ambiguous lineage

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d. AML with t(9;11)(p22;q23) c. Acute monoblastic/monocytic leukemia

or
d. Acute megakaryoblastic leukemia
3. Which of the following would be considered a sign of
potentially favorable prognosis in children with ALL? i sm
9. Pure erythroid leukemia is a disorder involving:
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a. Hyperdiploidy a. Pronormoblasts only
b. Presence of CD 19 and 20 b. Pronormoblasts and basophilic normoblasts
A.

c. Absence of trisomy 8 c. All forms of developing RBC precursors

d. Presence of BCR/ABL gene d. Equal numbers of pronormoblasts and myeloblasts
dy
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4. Signs and symptoms of cerebral infiltration with 10. A patient with normal chromosomes has a WBC
blasts are more commonly seen in: count of 3.0 3 109/L and dysplasia in all cell lines. There
by

a. AML with recurrent cytogenetic abnormalities are 60% blasts of varying sizes. The blasts stain positive
b. Therapy-related myeloid neoplasms for CD61. The most likely type of leukemia is:
d

c. AML with myelodysplasia-related changes a. Acute lymphoblastic

le

d. ALL b. Acute megakaryoblastic

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c. Acute monoblastic
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5. An oncology patient exhibiting signs of renal failure d. AML with t(15;17)

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with seizures after initial chemotherapy may potentially

develop: 11. SBB stains which of the following component of
a. Hyperleukocytosis cells?
b. Tumor lysis syndrome a. Glycogen
c. Acute leukemia secondary to chemotherapy b. Lipids
d. Myelodysplasia c. Structural proteins
d. Enzymes
6. Disseminated intravascular coagulation is more often
seen in association with leukemia characterized by 12. The cytochemical stain a-naphthyl butyrate is a
which of the nonspecific esterase stain that shows diffuse positivity
following mutations? in cells of which lineage?
a. t(12;21)(p13;q22) a. Erythroid
b. t(9;22)(q34;q11.2) b. Monocytic
c. inv(16)(p13;q22) c. Granulocytic
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 RODAK – CLINICAL PRINCIPLES AND APPLICATIONS, 5TH EDITION 5TH EDITION STUDY QUESTIONS
d. Lymphoid c. The presence of numerous tingible-body
macrophages in Hodgkin lymphoma
d. The preservation of normal lymph node architecture
-------------------------------------------------------------------------- in Hodgkin lymphoma
CHAPTER 36 MATURE LYMPHOID NEOPLASMS
7. Which morphologic diagnosis has to be confirmed
1. In most cases, the diagnosis of lymphoma relies on all with molecular studies demonstrating the presence of
of the following except: t(8;14)?
a. Microscopic examination of affected lymph nodes a. Mantle cell lymphoma
b. Immunophenotyping using immunohistochemistry or b. Burkitt lymphoma
flow cytometry c. Follicular lymphoma
c. Molecular or cytogenetic analysis d. Sézary syndrome
d. Peripheral blood examination and a complete blood
count 8. What is the function of the germinal center?
a. Generation of B cells producing immunoglobulins

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2. The most common lymphoma occurring in young with the highest affinity for a particular antigen

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adults is: through the process of somatic mutation

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a. Follicular lymphoma b. Production of plasma cells that secrete specific
b. DLBCL immunoglobulins following antigenic stimulation

io
c. Hodgkin lymphoma c. T cell maturation following T cell education in the

or
d. Mycosis fungoides thymus

3. In a normal lymph node, the medulla includes i sm

d. Generation of dendritic cells with unique antigen-
processing capabilities
Qu
predominantly:
a. T cells 9. Marked paracortical expansion is most commonly
b. B cells
A.

seen in:
c. Tingible-body macrophages a. Rheumatoid arthritis
dy

d. Plasma cells b. Syphilis

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c. Dermatopathic lymphadenopathy
4. The t(11;14) is the defining feature of: d. Follicular lymphoma
by

a. Follicular lymphoma
b. Hodgkin lymphoma 10. MGUS is best described as:
d

c. CLL a. The presence of monoclonal immunoglobulin in

le

d. Mantle cell lymphoma serum with only mild bone marrow plasmacytosis
pi

b. The presence of monoclonal serum or urine

m

5. The immunophenotype of mycosis fungoides is: immunoglobulin with significant bone marrow
Co

a. The normal T cell immunophenotype plasmacytosis

b. An abnormal T cell immunophenotype with c. The presence of significant bone marrow
expression plasmacytosis in a patient with only a few clinical
of CD4 and loss of CD7 antigen symptoms of
c. A mix of CD41 and CD81 T cells plasma cell myeloma
d. An abnormal T cell immunophenotype with d. The presence of monoclonal immunoglobulin in a
expression patient with a solitary mass composed of plasma cells
of CD8 and loss of CD7 antigen

6. What is the major morphologic difference between

Hodgkin lymphoma and other B cell lymphomas? --------------------------------------------------------------------------
a. The extent of the lymph node involvement CHAPTER 37 NORMAL HEMOSTASIS AND
b. The presence of numerous reactive lymphocytes COAGULATION
and only a few malignant cells in Hodgkin lymphoma

COMPILED BY RUDY A. QUISMORIO, RMT 37 | P a g e

 RODAK – CLINICAL PRINCIPLES AND APPLICATIONS, 5TH EDITION 5TH EDITION STUDY QUESTIONS
1. What intimal cell synthesizes and stores VWF? d. TAFI
a. Smooth muscle cell
b. Endothelial cell 8. What two regulatory proteins form a complex that
c. Fibroblast digests activated factors V and VIII?
d. Platelet a. TFPI and Xa
b. Antithrombin and protein C
2. What subendothelial structural protein triggers c. APC and protein S
coagulation d. Thrombomodulin and plasmin
through activation of factor VII?
a. Thrombomodulin 9. Coagulation factor VIII circulates bound to:
b. Nitric oxide a. VWF
c. Tissue factor b. Factor IX
d. Thrombin c. Platelets
d. Factor V
3. What coagulation plasma protein should be assayed

T
when platelets fail to aggregate properly? 10. Most coagulation factors are synthesized in:

M
a. Factor VIII a. The liver

,R
b. Fibrinogen b. Monocytes
c. Thrombin c. Endothelial cells

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d. Factor X d. Megakaryocytes

or
4. What role does vitamin K play for the prothrombin
group factors? i sm
Qu
a. Provides a surface on which the proteolytic reactions --------------------------------------------------------------------------
of the factors occur CHAPTER 38 HEMORRHAGIC DISORDERS AND
A.

b. Protects them from inappropriate activation by LABORATORY ASSESSMENT

compounds such as thrombin
dy

c. Accelerates the binding of the serine proteases and 1. What is the most common acquired bleeding
Ru

their cofactors disorder?

d. Carboxylates the factors to allow calcium binding a. Vitamin K deficiency
by

b. Liver disease
5. What is the source of fibrinopeptides A and B? c. ACOTS
d

a. Plasmin proteolysis of fibrin polymer d. VWD

le

b. Thrombin proteolysis of fibrinogen

pi

c. Proteolysis of prothrombin by factor Xa 2. Which is a typical form of anatomic bleeding?

m

d. Plasmin proteolysis of cross-linked fibrin a. Epistaxis

Co

b. Menorrhagia
6. What serine protease forms a complex with factor c. Hematemesis
VIIIa, and d. Soft tissue bleed
what is the substrate of this complex?
a. Factor VIIa, factor X 3. What factor deficiency has the speediest effect on
b. Factor Va, prothrombin the prothrombin time?
c. Factor Xa, prothrombin a. Prothrombin deficiency
d. Factor IXa, factor X b. Factor VII deficiency
c. Factor VIII deficiency
7. What protein secreted by endothelial cells activates d. Factor IX deficiency
fibrinolysis?
a. Plasminogen 4. Which of the following conditions causes a prolonged
b. TPA thrombin time?
c. PAI-1 a. Antithrombin deficiency

COMPILED BY RUDY A. QUISMORIO, RMT 38 | P a g e

 RODAK – CLINICAL PRINCIPLES AND APPLICATIONS, 5TH EDITION 5TH EDITION STUDY QUESTIONS
b. Prothrombin deficiency a. Acquired hemorrhagic disorders
c. Hypofibrinogenemia b. Localized hemorrhagic disorders
d. Warfarin therapy c. Defects in primary hemostasis
5. In what subtype of VWD is the RIPA test result d. Defects in fibrinolysis
positive when ristocetin is used at a concentration of
less than 0.5 mg/mL?
a. Subtype 2A
b. Subtype 2B --------------------------------------------------------------------------
c. Subtype 2N CHAPTER 39 THROMBOTIC DISORDERS AND
d. Type 3 LABORATORY ASSESSMENT

6. What is the typical treatment for vitamin K deficiency 1.What is the prevalence of venous thrombosis in the
when the patient is bleeding? United States?
a. Vitamin K and PCC a. 0.01
b. Vitamin K and plasma b. 1 in 1000

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c. Vitamin K and platelet concentrate c. 10% to 15%

M
d. Vitamin K and factor VIII concentrate d. 500,000 cases per year

,R
7. If a patient has anatomic soft tissue bleeding and 2. What is thrombophilia?

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poor wound healing, but the PT, PTT, thrombin time, a. Predisposition to thrombosis secondary to a

or
platelet congenital or acquired disorder
count, and platelet functional assay results are normal,
what factor deficiency is indicated? i sm
b. Inappropriate triggering of the plasma coagulation
system
Qu
a. Fibrinogen c. A condition in which clots form uncontrollably
b. Prothrombin d. Inadequate fibrinolysis
A.

c. Factor XII
d. Factor XIII 3. What acquired thrombosis risk factor is assessed in
dy

the hemostasis laboratory?

Ru

8. What therapy may be used for a hemophilic boy who a. Smoking

is bleeding and who has a high titer of factor VIII b. Immobilization
by

inhibitor? c. Body mass index

a. rFVIIa d. Lupus anticoagulant
d

b. Plasma
le

c. Cryoprecipitate 4. Trousseau syndrome, a low-grade chronic DIC, is

pi

d. Factor VIII concentrate often associated with what type of disorder?

m

a.Renal disease
Co

9. What is the most prevalent form of VWD? b. Hepatic disease

a. Type 1 c. Adenocarcinoma
b. Type 2A d. Chronic inflammation
c. Type 2B
d. Type 3 5. What is the most common heritable thrombosis risk
factor in Caucasians?
10. Which of the following assays is used to distinguish a. APC resistance (factor V Leiden mutation)
vitamin K deficiency from liver disease? b. Prothrombin G20210A mutation
a. PT c. Antithrombin deficiency
b. Protein C assay d. Protein S deficiency
c. Factor V assay
d. Factor VII assay 6. In most LA profiles, what screening test is primary
because it detects LA with the fewest interferences?
11. Mucocutaneous hemorrhage is typical of: a. Low-phospholipid PTT

COMPILED BY RUDY A. QUISMORIO, RMT 39 | P a g e

 RODAK – CLINICAL PRINCIPLES AND APPLICATIONS, 5TH EDITION 5TH EDITION STUDY QUESTIONS
b. DRVVT 13. Which is not a fibrinolysis control protein?
c. KCT a. Thrombin-activatable fibrinolysis inhibitor
d. PT b. Plasminogen activator inhibitor-1
c. a2-antiplasmin
7. A patient with venous thrombosis is tested for d. D-dimer
protein S deficiency. The protein S activity, antigen, and
free antigen all are less than 65%, and the C4bBP level is 14. What is the most important application of the
normal. What type of deficiency is likely? quantitative
a. Type I D-dimer test?
b. Type II a. Diagnose primary fibrinolysis
c. Type III b. Diagnose liver and renal disease
d. No deficiency is indicated, because the reference c. Rule out deep venous thrombosis
range includes 65%. d. Diagnose acute myocardial infarction

8. An elevated level of what fibrinolytic system assay is

T
associated with arterial thrombotic risk? --------------------------------------------------------------------------

M
a. PAI-1 CHAPTER 40 THROMBOCYTOPENIA AND

,R
b. TPA THROMBOCYTOSIS
c. Factor VIIa

io
d. Factor XII 1. The autosomal dominant disorder associated with

or
decreased platelet production is:
9. How does lipoprotein (a) cause thrombosis?
a. It causes elevated factor VIII levels. i sm
a. Fanconi anemia
b. TAR syndrome
Qu
b. It coats the endothelial lining of arteries. c. May-Hegglin anomaly
c. It substitutes for plasminogen or TPA in the forming d. Wiskott-Aldrich anomaly
A.

clot.
d. It contributes additional phospholipid in vivo for 2. Which of the following is not a hallmark of ITP?
dy

formation of the Xase complex. a. Petechiae

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b. Thrombocytopenia
10. What test may be used to confirm the presence of c. Large overactive platelets
by

LA? d. Megakaryocyte hypoplasia

a. PT
d

b. Bethesda titer 3. The specific antigen most commonly responsible for

le

c. Antinuclear antibody the development of NAIT is:

pi

d. PTT using high-phospholipid reagent a. Bak

m

b. HPA-1a
Co

11. What molecular test may be used to confirm APC c. GP Ib

resistance? d. Lewis antigen a
a. Prothrombin G20210A
b. MTHFR 1298 4. A 2-year-old child with an unexpected platelet count
c. MTHFR 677 of 15,000/mL and a recent history of a viral infection
d. FVL most likely has:
a. HIT
12. What therapeutic agent may occasionally cause b. NAIT
DIC? c. Acute ITP
a. Factor VIII d. Chronic ITP
b. Factor VIIa
c. Antithrombin concentrate 5. What is the first step in the treatment of HIT?
d. Activated prothrombin complex concentrate a. Start low-molecular-weight heparin therapy
b. Stop heparin infusion immediately

COMPILED BY RUDY A. QUISMORIO, RMT 40 | P a g e

 RODAK – CLINICAL PRINCIPLES AND APPLICATIONS, 5TH EDITION 5TH EDITION STUDY QUESTIONS
c. Switch to warfarin (Coumadin) immediately
d. Initiate a platelet transfusion

6. A defect in primary hemostasis (platelet response to --------------------------------------------------------------------------

an injury) often results in: CHAPTER 41 QUALITATIVE DISORDERS OF
a. Musculoskeletal bleeding PLATELETS AND VASCULATURE
b. Mucosal bleeding
c. Hemarthroses 1. The clinical presentation of platelet-related bleeding
d. None of the above may include all of the following except:
a. Bruising
7. When a drug acts as a hapten to induce b. Nosebleeds
thrombocytopenia, an antibody forms against which of c. Gastrointestinal bleeding
the following? d. Bleeding into the joints (hemarthroses)
a. Typically unexposed, new platelet antigens
b. The combination of the drug and the platelet 2. A defect in GP IIb/IIIa causes:

T
membrane protein to which it is bound a. Glanzmann thrombasthenia

M
c. The drug alone in the plasma, but the immune b. Bernard-Soulier syndrome

,R
complex then binds to the platelet membrane c. Gray platelet syndrome
d. The drug alone, but only when it is bound to the d. Storage pool disease

io
platelet membrane

or
3. Aspirin ingestion blocks the synthesis of:

8. TAR refers to: i sm

a. Thromboxane A2
b. Ionized calcium
Qu
a. Abnormal platelet morphology in which the radial c. Collagen
striations of the platelets are missing d. ADP
A.

b. Abnormal appearance of the iris of the eye in which

radial striations are absent 4. Patients with Bernard-Soulier syndrome have which
dy

c. Abnormal bone formation, including hypoplasia of of the following laboratory test findings?
Ru

the forearms a. Abnormal platelet response to arachidonic acid

d. Neurologic defects affecting the root (radix) of the b. Abnormal platelet response to ristocetin
by

spinal nerves c. Abnormal platelet response to collagen

d. Thrombocytosis
d

9. Neonatal autoimmune thrombocytopenia occurs

le

when: 5. Which of the following is the most common of the

pi

a. The mother lacks a platelet antigen that the infant hereditary platelet function defects?
m

possesses, and she builds antibodies to that antigen, a. Glanzmann thrombasthenia

Co

which cross the placenta b. Bernard-Soulier syndrome

b. The infant develops an autoimmune process such as c. Storage pool defects
ITP secondary to in utero infection d. Multiple myeloma
c. The infant develops an autoimmune disease such as
lupus erythematosus before birth 6. A mechanism of antiplatelet drugs targeting GP
d. The mother has an autoimmune antibody to her IIb/IIIa function is:
own platelets, which crosses the placenta and reacts a. Interference with platelet adhesion to the
with the infant’s platelets subendothelium by blocking of the collagen binding site
b. Inhibition of transcription of the GP IIb/IIIa gene
10. HUS in children is associated with: c. Direct binding to GP IIb/IIIa
a. Diarrhea caused by Shigella species d. Interference with platelet secretion
b. Meningitis caused by Haemophilus species
c. Pneumonia caused by Mycoplasma species 7. The impaired platelet function in myeloproliferative
d. Pneumonia caused by respiratory viruses neoplasms results from:

COMPILED BY RUDY A. QUISMORIO, RMT 41 | P a g e

 RODAK – CLINICAL PRINCIPLES AND APPLICATIONS, 5TH EDITION 5TH EDITION STUDY QUESTIONS
a. Abnormally shaped platelets
b. Extended platelet life span 3. What is the effect of hemolysis on a hemostasis
c. Increased procoagulant activity specimen?
d. Decreased numbers of a- and dense granules a. In vitro platelet and coagulation activation occur
b. The specimen is icteric or lipemic
8. Which is a congenital qualitative platelet disorder? c. Hemolysis has no effect
a. Senile purpura d. The specimen is clotted
b. Ehlers-Danlos syndrome
c. Henoch-Schönlein purpura 4. Most coagulation testing must be performed on PPP,
d. Waldenström macroglobulinemia which is plasma with a platelet count less than:
a. 1000/mL
9. In uremia, platelet function is impaired by higher b. 10,000/mL
than normal levels of: c. 100,000/mL
a. Urea d. 1,000,000/Ml
b. Uric acid

T
c. Creatinine 5. You wish to obtain a 5-mL specimen of whole-blood/

M
d. NO anticoagulant mixture. The patient’s hematocrit is 65%.

,R
What volume of anticoagulant should you use?
10. The platelet defect associated with increased a. 0.32 mL

io
paraproteins is: b. 0.5 mL

or
a. Impaired membrane activation owing to protein c. 0.64 mL
coating
b. Hypercoagulability owing to antibody binding and i sm
d. 0.68 mL
Qu
membrane activation 6. You perform whole-blood lumiaggregometry on a
c. Impaired aggregation because the hyperviscous specimen from a patient who complains of easy
A.

plasma prevents platelet-endothelium interaction bruising. Aggregation and secretion are diminished
d. Hypercoagulability because the increased proteins when the agonists, thrombin, ADP, arachidonic acid,
dy

bring platelets closer together, which leads to and collagen are used. What is the most likely platelet
Ru

inappropriate aggregation abnormality?

a. Storage pool disorder
by

b. Aspirin-like syndrome
c. ADP receptor anomaly
d

-------------------------------------------------------------------------- d. Glanzmann thrombasthenia

le

CHAPTER 42 LABORATORY EVALUATION OF

pi

HEMOSTASIS 7. What is the reference assay for HIT?

m

a. Enzyme immunoassay
Co

1. What happens if a coagulation specimen collection b. Serotonin release assay

tube is underfilled? c. Platelet lumiaggregometry
a. The specimen clots and is useless d. Washed platelet aggregation
b. The specimen is hemolyzed and is useless
c. Clot-based test results are falsely prolonged 8. What agonist is used in platelet aggregometry to
d. Chromogenic test results are falsely decreased detect VWD?
a. Arachidonic acid
2. If you collect blood into a series of tubes, when in the b. Ristocetin
sequence should the hemostasis (blue stopper) tube be c. Collagen
filled? d. ADP
a. After a lavender-topped or green-topped tube
b. First, or after a nonadditive tube 9. Deficiency of which single factor is likely when the PT
c. After a serum separator tube result is prolonged and the PTT result is normal?
d. Last a. Factor V
COMPILED BY RUDY A. QUISMORIO, RMT 42 | P a g e
 RODAK – CLINICAL PRINCIPLES AND APPLICATIONS, 5TH EDITION 5TH EDITION STUDY QUESTIONS
b. Factor VII 1. What is the PT/INR therapeutic range for Coumadin
c. Factor VIII therapy when a patient has a mechanical heart valve?
d. Prothrombin a. 1 to 2
b. 2 to 3
10. A prolonged PT, a low factor VII level, but a normal c. 2.5 to 3.5
factor V level are characteristic of an acquired d. Coumadin is not indicated for patients with
coagulopathy associated with which of the following? mechanical heart valves
a. Hemophilia
b. Liver disease 2. Monitoring of a patient taking Coumadin showed that
c. Thrombocytopenia her anticoagulation results remained stable over a
d. Vitamin K deficiency period of about 7 months. The frequency of her visits to
the laboratory began to decrease, so the period
11. The patient has deep vein thrombosis. The PTT is between testing averaged 6 weeks. This new testing
prolonged and is not corrected in an immediate mix of interval is:
patient plasma with an equal part of normal plasma. a. Acceptable for a patient with stable anticoagulation

T
What is the presumed condition? results after 6 months

M
a. Factor VIII inhibitor b. Unnecessary, because monitoring for patients taking

,R
b. Lupus anticoagulant oral anticoagulants can be discontinued entirely after 4
c. Factor VIII deficiency months of stable test results

io
d. Factor V Leiden mutation c. Too long even for a patient with previously stable

or
test results; 4 weeks is the standard
12. What condition causes the most pronounced
elevation in the result of the quantitative D-dimer i smd. Acceptable as long as the patient performs self-
monitoring daily using an approved home testing
Qu
assay? instrument and reports unacceptable results promptly
a. Deep vein thrombosis to her physician
A.

b. Fibrinogen deficiency
c. Paraproteinemia 3. What is the greatest advantage of point-of-care PT
dy

d. DIC testing?
Ru

a. It permits self-dosing of Coumadin

13. What is the name given to the type of assay that b. It is inexpensive
by

uses a synthetic polypeptide substrate that releases a c. It is convenient

chromophore on digestion by its serine protease? d. It is precise
d

a. Clot-based assay
le

b. Molecular diagnostic assay 4. You collect a citrated whole-blood specimen to

pi

c. Fluorescence immunoassay monitor UFH therapy. What is the longest it may stand
m

d. Chromogenic substrate assay before the plasma must be separated from the cells?
Co

a. 1 hour
14. What component of the fibrinolytic process binds b. 4 hours
and neutralizes free plasmin? c. 24 hours
a. PAI-1 d. Indefinitely
b. TPA
c. a2-Antiplasmin 5. What test is used to monitor high-dose UFH therapy
d. Urokinase in the cardiac catheterization lab?
a. PT
b. PTT
c. Bleeding time
-------------------------------------------------------------------------- d. ACT
CHAPTER 43 ANTITHROMBOTIC THERAPIES AND
THEIR LABORATORY ASSESSMENT 6. What test is used most often to monitor UFH therapy
in the central laboratory?
COMPILED BY RUDY A. QUISMORIO, RMT 43 | P a g e
 RODAK – CLINICAL PRINCIPLES AND APPLICATIONS, 5TH EDITION 5TH EDITION STUDY QUESTIONS
a. PT 13. Which of the following is an intravenous antiplatelet
b. PTT drug
c. ACT used in the cardiac catheterization laboratory?
d. Chromogenic anti-factor Xa heparin assay a. Abciximab
b. Ticagrelor
7. What test is used most often to monitor LMWH c. Prasugrel
therapy in d. Clopidogrel
the central laboratory?
a. PT 14. Which of the following is a newly developed oral
b. PTT anticoagulant?
c. ACT a. Argatroban
d. Chromogenic anti-factor Xa heparin assay b. Lepirudin
c. Bivalirudin
8. What is an advantage of LMWH therapy over UFH d. Rivaroxaban
therapy?

T
a. It is cheaper 15. Which of the following is not a point-of-care

M
b. It causes no bleeding instrument for the measurement of PT?

,R
c. It has a stable dose response a. CoaguChek XS PT
d. There is no risk of HIT b. Gem PCL Plus

io
c. Cascade POC

or
9. In what situation is an intravenous DTI used? d. Multiplate
a. DVT
b. HIT i sm
Qu
c. Any situation in which Coumadin could be used
d. Uncomplicated AMI
A.

--------------------------------------------------------------------------
10. What laboratory test may be used to monitor CHAPTER 44 HEMOSTASIS AND COA GULATION
dy

intravenous DTI therapy when PTT results are INSTRUMENTATION

Ru

unreliable?
a. PT 1. The photo-optical method of end-point detection can
by

b. ECT be described as:

c. Reptilase clotting time a. Measurement of a color-producing chromophore at a
d

d. Chromogenic anti-factor Xa heparin assay wavelength of 405 nm

le

b. Measurement of the change in OD of a test solution

pi

11. What is the reference method for detecting aspirin as a result of fibrin formation
m

or clopidogrel resistance? c. Application of an electromagnetic field to the test

Co

a. Platelet aggregometry cuvette to detect the decreased motion of an iron ball

b. AspirinWorks within the cuvette
c. VerifyNow d. Measurement of the turbidity of a test solution
d. PFA-100 resulting from the formation of antigen-antibody
complexes using latex particles
12. What is the name of the measurable platelet
activation 2. Modern coagulation analyzers have greatly enhanced
metabolite used in the AspirinWorks assay to monitor the ability to perform coagulation testing as a result of
aspirin resistance? which of the following?
a. 11-dehydrothromboxane B2 a. Maintenance of a level of accuracy and precision
b. Arachidonic acid similar to that of manual methods
c. Thromboxane A2 b. Increase in reagent volume capabilities to improve
d. Cyclooxygenase sensitivity

COMPILED BY RUDY A. QUISMORIO, RMT 44 | P a g e

 RODAK – CLINICAL PRINCIPLES AND APPLICATIONS, 5TH EDITION 5TH EDITION STUDY QUESTIONS
c. Automatic adjustment of results for interfering c. Increased therapeutic use of aspirin in the treatment
substances of heart disease
d. Improved flagging capabilities to identify problems d. Increased outpatient/outreach testing that prevents
in sample quality or instrument function the laboratory from having access to patients to do
bleeding time tests
3. Which of the following is considered to be an
advantage of the mechanical end-point detection 8. All of the following are performance characteristics to
methodology? consider in the selection of a coagulation analyzer
a. It is not affected by lipemia in the test sample except:
b. It has the ability to provide a graph of clot formation a. Location of the manufacturer’s home office
c. It can incorporate multiple wavelengths into a single b. Instrument footprint
testing sequence c. Ease of use for the operator
d. It can measure proteins that do not have fibrin d. Variety of tests the instrument can perform
formation as the end-point
9. The PFA-100 measures platelet function by:

T
4. Which of the following methods use the principle of a. Detecting the change in blood flow pressure along a

M
changes in light scatter or transmission to detect the small tube when a clot impairs blood flow

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endpoint of the reaction? b. Detecting the aggregation of latex beads coated with
a. Immunologic, mechanical, photo-optical platelet activators

io
b. Photo-optical, nephelometric, mechanical c. Graphing the transmittance of light through platelet-

or
c. Photo-optical, nephelometric, immunologic rich plasma over time after addition of platelet
d. Chromogenic, immunologic, mechanical activators
i sm
d. Detecting the time it takes for a clot to form as
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5. Which of the following is a feature of semiautomated blood flows through a small aperture in a tube coated
coagulation testing analyzers? with
A.

a. The temperature is maintained externally by a heat platelet activators

block or water bath
dy

b. Reagents and samples usually are added manually 10. Point-of-care coagulation testing is used mainly:
Ru

by the operator a. To monitor patients receiving oral anticoagulant

c. Timers are automatically started as soon as the therapy
by

analyzer adds reagents to the test cuvette b. To monitor patients taking platelet inhibitors such as
d. The end-point must be detected by the operator aspirin
d

c. To provide a baseline for all subsequent patient test

le

6. When a sample has been flagged as being icteric by result comparisons when the patient starts any kind of
pi

an automated coagulation analyzer, which method anticoagulant therapy

m

would be most susceptible to erroneous results because d. To monitor obstetric patients at risk of fetal loss
Co

of the interfering substance?

a. Mechanical clot detection
b. Immunologic antigen-antibody reaction detection
c. Photo-optical clot detection --------------------------------------------------------------------------
d. Chromogenic end-point detection CHAPTER 45 PEDIATRIC AND GERIATRIC
HEMATOLOGY AND HEMOSTASIS
7. Platelet function testing has been incorporated into
the routine coagulation laboratory in recent years as a 1. The CBC results for children (aged 3 to 12 years)
result of: differ from those of adults chiefly in what respect?
a. Increased use of drugs that stimulate platelet a. NRBCs are present.
production in patients receiving chemotherapy b. Notable polychromasia is seen, indicating increased
b. The convenience of being able to do the testing on reticulocytosis.
the same instrument that performs the coagulation c. Platelet count is lower.
testing d. The percentage of lymphocytes is higher.

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 RODAK – CLINICAL PRINCIPLES AND APPLICATIONS, 5TH EDITION 5TH EDITION STUDY QUESTIONS
c. Myelophthisic anemia and anemia of chronic
2. Physiologic anemia of infancy results from: inflammation
a. Iron deficiency caused by a milk-only diet during the d. Iron deficiency anemia and anemia of chronic
early neonatal period inflammation
b. Increased oxygenation of blood and decreased
erythropoietin 8. When iron deficiency is recognized in an elderly
c. Replacement of active marrow with fat soon after individual, the cause is usually:
birth a. An iron-deficient diet
d. Hb F and its diminished oxygen delivery to tissues b. Gastrointestinal bleeding
c. Diminished absorption
3. The CBC report on a 3-day-old neonate who was born d. Impaired incorporation of iron into heme as a result
6 weeks prematurely shows a decrease in hemoglobin of telomere loss
compared with the value obtained 2 days earlier. Which
of the following should be considered as an explanation 9. Which of the following conditions is least likely in an
for this result when no apparent source of hemolysis or elderly individual?

T
bleeding is evident? a. Acute lymphoblastic leukemia

M
a. The sample was collected from a vein at the time b. Multiple myeloma

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that an intravenous line was inserted. c. Myelodysplasia
b. The sample was collected by heel puncture rather d. Chronic lymphocytic leukemia

io
than finger puncture because of the infant’s small size.

or
c. The umbilical cord was clamped quickly to begin 10. The multiple medications used by the elderly makes
appropriate treatment for a preterm infant.
d. The infant has become dehydrated. i sm
this population more prone to:
a. Anemia of chronic inflammation
Qu
b. Megaloblastic anemia
4. Morphologically, the hematogones in newborns are: c. Hemolytic anemia
A.

a. Similar to those seen in megaloblastic anemia d. Iron deficiency anemia

b. Easily confused with leukemic blasts
dy

c. Monocytoid in appearance
Ru

d. Similar to adult lymphocytes

by

5. The most frequent cause of anemia in childhood is:

a. Vitamin B12 deficiency
d

b. Drug-related hemolysis
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c. Iron deficiency
pi

d. Folate deficiency
m
Co

6. As age increases, the hemoglobin level of elderly

adults:
a. Remains unchanged from that of middle-aged adults
b. Increases due to diminished respiration and poor
tissue
oxygenation
c. Decreases for reasons that are unclear
d. Becomes comparable to that of newborns

7. Which of the following are the most common

anemias in the elderly population?
a. Megaloblastic anemia and iron deficiency anemia
b. Sideroblastic anemia and megaloblastic anemia

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