MLS Hematology Mock Exam

B. Hemoglobin

From 60% to 75% of the total body iron is bound to what compound?
A. Transferrin
B. Hemoglobin
C. Myoglobin
D. Heme Enzymes

D. Decreased rate of globin synthesis

Thalassemias are characterized by:
A. Structural abnormalities in the hemoglobin molecule
B. Absence of iron in hemoglobin
C. Decreased rate of heme synthesis
D. Decreased rate of globin synthesis

B. Beta

The majority of hemoglobinpathies result from abnormalities in what chain?
A. Alpha
B. Beta
C. Gamma
D. Delta

B. Normocytic Normochromic

The anemia of the hemoglobinopathies such as Sickle Cell are morphologically classified as:
A. Microcytic Hypochromic
B. Normocytic Normochromic
C. Macrocytic
D. Microcytic normochromic

C. Two alpha and two beta chains

Hemoglobin A consists of:
A. Two alpha and two gamma chains
B. Two alpha and two delta chains
C. Two alpha and two beta chains
D. Two alpha and two globin chains

B. Two

The globin portion of hemoglobin is formed by polypeptide chains consisting of __ identical dimers.
A. One
B. Two
C. Three
D. Four

B. Hemoglobin Bart's

What hemoglobin consists of four gamma chains?
A. Hemoglobin H
B. Hemoglobin Bart's
C. Hemoglobin F
D. Hemoglobin A (2)
E. None of the responses

A. Hemoglobin Bart's disease

Alpha Thalassemia may be clinically expressed as:
A. Hemoglobin Bart's disease
B. Hemoglobin Gower disease
C. Hemoglobin F disease
D. Hemoglobin SC disease

B. Dithionite solubility

The most appropriate screening test for hemoglobin S is:
A. Kleihauer-Betke (acid elution test)
B. Dithionite solubility
C. Osmotic fragility
D. Sucrose hemolysis

A. Osmotic fragility

The most appropriate screening test for hereditary spherocytosis is:
A. Osmotic fragility
B. Sucrose hemolysis
C. Heat instability test
D. Kleinhauer-Betke

B. Decreased serum iron levels

The anemia of chronic infection is characterized by:
A. Decreased iron stores in the reticuloendothelial
B. Decreased serum iron levels
C. Macrocytic erythrocytes
D. Increased serum iron-binding

D. Denatured hemoglobin inclusions that are readily removed by the spleen

Heinz bodies are:
A. Readily identified with polychrome stains
B. Rarely found in G6Pd erythrocytes
C. Closely associated with spherocytes
D. Denatured hemoglobin inclusions that are readily removed by the spleen

A. A and C are correct

A shift to the right on the oxygen dissociation curve indicates:
A. increased levels of 2,3-DPG
B. decreased levels of 2,3-DPG
C. increased oxygen delivery
D. decreased oxygen delivery
A. A and C are correct
B. B and C are correct
C. A and D are correct
D. B and D are correct

A. Iron overload in tissue

Which of the following is most closely associated with hemochromatosis?
A. Iron overload in tissue
B. Target cells
C. Basophilic stippling
D. Ringed sideroblasts

D. Chronic blood loss

Which of the following is most closely associated with iron deficiency anemia?
A. Iron overload in tissue
B. Heinz bodies
C. Basophilic stippling
D. Chronic blood loss

C. heterozygous thalassemia

In a patient with hypochromic, microcytic anemia, it is necessary to distinguish between iron deficiency and:
A. G6PD deficiency
B. hereditary spherocytosis
C. heterozygous thalassemia
D. Pernicious anemia

C. Basophilic stippling

Which of the following is most likely to be seen in lead poisoning?
A. Iron overload in tissue
B. Codocytes
C. Basophilic stippling
D. Pappenheimer bodies

B. Hgb A: 60% Hgb:S 39% Hgb F: 1%

Which of the following electrophoretic results is consistent with a diagnosis of sickle cell trait?
A. Hgb A: 0% Hgb:S 95% Hgb F: 5%
B. Hgb A: 60% Hgb:S 39% Hgb F: 1%
C. Hgb A: 0% Hgb:A2 5% Hgb F: 95%
D. Hgb A: 80% Hgb:S 0% Hgb A2: 20%

B. normocytic, normochromic

Autoimmune hemolytic anemia represents which of the following morphologic features?
A. microcytic, hypochromic
B. normocytic, normochromic
C. macrocytic, normochromic

B. Heinz body

Which red cell inclusion is characteristic of G6PD deficiency?
A. Cabot ring
B. Heinz body
C. Howell-Jolly body
D. Pappenheimer bodies
E. Siderotic granules

D. Schistocytes

A common finding in the peripheral blood of patients with intravascular hemolysis is mechanical trauma to the cell such as:
A. Large platelets
B. Antibodies
C. Target cells ( codocytes )
D. Schistocytes

D. β-Thalassemia major

An 8-month-old Sicilian boy had the following results on a hematology impedance analyzer: WBC 31,000/μL; RBC 2.50 X 106/μL; hemoglobin 4.5 g/dL; hematocrit 16%; platelet count 340,000/μL; reticulocyte count 8.0%; differential smear normal, except for 110 nucleated RBC/100 WBCs; marked anisocytosis, poikilocytosis, polychromasia, serum iron elevated; serum iron binding capacity (TIBC) decreased; serum ferritin elevated.
The CBC, serum iron, TIBC, and ferritin levels are most characteristic of:
A. Sickle cell anemia
B. Iron deficiency anemia
C. Spherocytic anemia
D. β-Thalassemia major

B. Vitamin B12 deficiency

A 60 year-old woman complained to her physician of weakness, fatigue, and shortness of breath for the past few months. Physical examination revealed a slender woman with "lemon-yellow skin" and a smooth, red tongue. She had also experienced a loss of vibratory sense. The patient was not taking any medications. Her laboratory values are as follows: WBC 7,400/μL; RBC 1.90 X 106/μL; hemoglobin 8.6 g/dL; hematocrit 28%; MCV 114 fl; MCHC 34.4%; RDW 15.2%; and platelet count 180,000/μL. Differential: 67% segmented neutrophils (5% hypersegmented), 25% lymphocytes, 5% monocytes, 3% eosinophils. RBC morphology: macrocytes with a few macro-ovalocytes.
Serum LD = 720 U/L (normal 100-190), B12 assay = 120 ng/L.
What is a likely diagnosis?
A. liver disease
B. Vitamin B12 deficiency
C. Thalassemia major
D. Autoimmune hemolytic anemia

E. Iron remnant seen on Wright's Stain

Match the following:
Pappenheimer bodies

A. Fragmented DNA
B. Seen only by supravital stain
C. Remnants of RNA
D. Remnants of nuclear membrane
E. Iron remnant seen on Wright's Stain

B. Seen only by supravital stain

Match the following:
Heinz bodies
A. Fragmented DNA
B. Seen only by supravital stain
C. Remnants of RNA
D. Remnants of nuclear membrane
E. Iron remnant seen on Wright's Stain

B. DIC

Which of the following is most closely associated with acute promyelocytic leukemia?
A. ringed sideroblasts
B. DIC
C. micromegakaryoctyes
D. Philadelphia chromosome

B. normocytic/normochromic

Anemia in acute leukemia is generally _.
A. microcytic/normochromic
B. normocytic/normochromic
C. microcytic/hypochromic
D. macrocytic/normochromic

B. indistinct nucleoli

All of the following are characteristic of a typical myeloblast EXCEPT:
A. 14 - 20 um in diameter
B. indistinct nucleoli
C. delicate, lacy, evenly stained chromatin
D. agranular small amount of cytoplasm

B. blasts

In differentiating Acute Leukemia, a positive cytochemical reaction is determined by finding positive staining in .
A. mature lymphocytes
B. blasts
C. neutrophils
D. monocytes

D. lymphocytes

All of the following cells stain positive for Specific Esterase EXCEPT:
A. basophils
B. neutrophils
C. mast cells
D. lymphocytes

B. Polycythemia Vera

Plasma cell neoplasms consist of all of the following EXCEPT:
A. Waldenstrom's Macroglobulinemia
B. Polycythemia Vera
C. Multiple Myeloma
D. Plasmacytoma

D. all of the responses

What clinical signs are evident in Chronic Myelogenous Leukemia?
A. splenomegaly
B. hepatomegaly
C. pallor
D. all of the responses

D. decreased reticulocytes

The following laboratory features are representative of CML (Chronic Myelocytic Leukemia) EXCEPT:
A. leukocytosis
B. shift to the left
C. giant platelets
D. decreased reticulocytes

B. Glycogen

PAS (Periodic Acid - Schiff) stain is used to detect the presence of:
A. Deoxyribonucleoprotein
B. Glycogen
C. Lipids
D. Iron

A. Periodic Acid - Schiff

What is the stain for bone marrow smears that will help to differentiate rubriblasts and other red cell precursors in Erythroleukemia, also known as Di Guglielmo's Syndrome, from the early red cells in Pernicious Anemia?
A. Periodic Acid - Schiff
B. Leukocyte Alkaline Phosphatase
C. Prussian Blue
D. Wright-Giemsa

B. ALL

Chunky positive (block-like) PAS reactions in white blood cells are most frequently associated with:
A. AMML
B. ALL
C. AML
D. undifferentiated leukemia

A. Specific Esterase Stain

Another name for the Naphthol AS-D Esterase Stain is:
A. Specific Esterase Stain
B. Non-Specific Esterase Stain
C. Acetate Esterase Stain
D. None of the responses

D. All of the responses

As a myeloid cell matures from a promyelocyte to a myelocyte, which of the following is/are true:
A. Primary granules disappear
B. Secondary granules appear
C. "Dawn of Neutrophilia" becomes present
D. All of the responses

D. Markedly elevated serum or urinary level of lysozyme

Which of the following is most closely associated with Acute Monocytic Leukemia?
A. Presence of the Philadelphia Chromosome
B. Schistocytes on smear indicating Disseminated Intravascular Coagulation (DIC)
C. Micromegakaryocytes present in the bone marrow
D. Markedly elevated serum or urinary level of lysozyme

B. Sudan Black B (SBB)

Which of the following may be used to stain neutral fats, phospholipids, and sterols?
A. Peroxidase
B. Sudan Black B (SBB)
C. Periodic Acid-Schiff (PAS)
D. Prussian Blue

C. CD5, CD19, CD20, CD21

Chronic Lymphocytic Leukemia cells are most likely to express which of the following cell surface markers?
A. CD3, CD7, CD19, CD20
B. CD4, CD5, CD19, CD20
C. CD5, CD19, CD20, CD21
D. CD13, CD33, CD107

low

M:E ratio in erythroleukemia

T lyphocytes

reactive lymphs with mononucleosis is derived from

cell size

volumetric impedance utilizes the principle that the measure of resistance from a cell passing through an aperture is directly proportional to

myelogenous leukemia

associated with Pseudo-Pelger-Huet anomaly

CLL

Hairy cell leukemia is a type of which leukemia

relative anisocytosis

RDW measures what in a red cell

erythropoietin

prevents premature apoptosis of RBCs

inadequate mixing of blood and anticoagulant

irregular clumping of platelets is usually due to this

sysmex analyzer

provides info about internal cell structure and granularity

IgG index/CSF electrophoresis

commonly increased in multiple sclerosis

peripheral proteins (ex: Spectrin, band 4.2)

deformability of RBC membrane attributed to this

immunophenotyping

how is PNH detected

myeloid hyperplasia

M:E ratio in AML

EPO

helps differentiate primary vs. secondary polycythemia

CML- abnormal platelet morphology

leukemoid reaction- normal platelets

platelet morphology in CML vs leukemoid reaction

cresyl blue

Hgb H is demonstrated with this stain

spherocytes

most commonly associated with high MCHC

CD5

CD marker negative in hairy cell leukemia

hemoglobin

60-70% of total body iron is bound to

beta

the majority of hemoglobinopathies result from abnormalities in the ___ chain

pernicious anemia

caused by autoantibodies to parietal cells

A. stabilized red blood cell suspension

Hematology quality control material include:

A. stabilized red blood cell suspension

B. latex particles

C. stabilized avian red blood cells

D. lyophilized solution

B. rouleaux formation

The characteristic morphologic feature in multiple myeloma is:

A. cytoxin T cells

B. rouleaux formation

C. spherocytosis

D. macrocytosis

B. sucrose hemolysis

The most appropriate screening test for paroxysmal nocturnal hemoglobinuria (PNH) is:

A. heat instability test

B. sucrose hemolysis

C. osmotic fragility

D. dithionite solubility

A. osmotic fragility

The most appropriate screening test for hereditary spherocytosis is:

A. osmotic fragility

B. sucrose hemolysis

C. heat instability test

D. Kleihauer-Betke

B. dithionite solubility

The most appropriate screening test for hemoglobin S is:

A. Kleihauer-Betke

B. dithionite solubility

C. osmotic fragility

D. sucrose hemolysis

D. heat instability test

The most appropriate screening test for hemoglobin H is:

A. dithionite solubility

B. osmotic fragility

C. sucrose hemolysis

D. heat instability test

C. Kleihauer-Betke (acid elution)

The most appropriate screening test for detecting hemoglobin F is:

A. osmotic fragility

B. dithionite solubility

C. Kleihauer-Betke (acid elution)

D. heat instability test