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Hematology exam with correct answers
Neutrophils that roll across the endothelium looking for trouble are in the [] pool. - correct answer marginating The term [_] refers to the movement of the neutrophil between endothelial cells. - correct answer diapedesis Foreign cells that have been coated with IgG1 & 3, and C3b & C3bi are termed - correct answer opsonized Which does not refer to the oxygen dependent killing of microorganisms? - correct answer Production of complement During phagocytosis, the material is degraded in the [_________]. - correct answer phagolysosome Which enzyme from the primary granules is involved in the respiratory burst? - correct answer myeloperoxidase Which enzyme from the secondary granules is involved in the respiratory burst? - correct answer NADH oxidase The enzyme [____] combines H2O2 with Cl to produce hypochlorite. - correct answer myeloperoxidase Mutation in [_____] will result in chronic granulomatous disease. - correct answer NADH oxidase What is the reference range for neutrophils in adults? - correct answer 1.8-7.0 x 109/L
Which cell is most similar to mast cells? - correct answer basophil Which cell is elevated in asthma, hives, and worms? - correct answer eosinophil The defect in chronic granulomatous disease is attributed to - correct answer defective bacterial killing A decrease in neutrophils below 1.5 x 109/L is - correct answer neutropenia Which of the following is true about segmented neutrophils - correct answer It has 2 X chromosomes Which of these would be the most likely to cause neutrophilia, giving a range between 10- 25 x 109/L? - correct answer Staphylococcus infection Which of the following is not associated with a leukemoid reaction? - correct answer BCR/ABL mutation Is this leukemia or leukemoid? 32 year old patient presented with WBC of 32.5 x 109/L. Diff was 70% segs, 15% bands, 5% metamyelocytes, 8% lymphocytes, and 2% monocytes. LAP was 150. - correct answer Leukemoid Is this leukemia or leukemoid? 72 year old patient presented with WBC of 32.5 x 109/L. Diff was 30% segs, 15% bands, 25% metamyelocytes, 10% myelocytes, 2% promyelocytes, 8% lymphocytes. LAP was 11. - correct answer leukemia Large Dohle-like inclusions and giant platelets - correct answer May Hegglin Increased mucopolysaccharides are seen in all of these except - correct answer May Hegglin
When testing with NBT Initroblue tetrazolium slide test), patients with CGD will show a robust accumulation of dark crystals in their neutrophils. - correct answer False In the neutrophilic maturation series, the cell: [_______] is the last stage capable of mitotic activity. - correct answer myelocyte Which is not one of the three stains that will be positive for the granulocytic series? - correct answer TdT Which stain is associated with phospholipids, sterols, and neutral fats? - correct answer Sudan Black B Which stains late myeloblasts, granulocytes, and monocytes? - correct answer myeloperoxidase Which is associated with neutrophilic granulocytes and mast cell; used on paraffin embedded tissues? - correct answer Specific esterase CAE Which is positive for monocytes but not for granulocytes? - correct answer Nonspecific esterase butyrate Which is associated with glycogen, and is helpful to diagnose erythroleukemia? - correct answer Periodic acid schiff A new patient is immunophenotyped using the markers in the chart. The blasts were weakly positive with CD11b and strongly positive with HLA-DR. Which blast type is this likely to be?
- correct answer Monoblast A new patient is immunophenotyped using the markers in the chart. The blasts were weakly positive with CD11b and strongly positive with HLA-DR. What cytochemical stain will be postiive for that patient? - correct answer Nonspecific esterase butyrate The use of cell specific antibodies to classify leukemia is referred to as - correct answer Immunophenotyping
What type of leukemia is positive for peroxidase and Sudan Black? - correct answer AML What cytochemical stain detects peroxidase, the enzyme in primary granulocytic granules? - correct answer MPO What cytochemical is ideal for fixed samples such as biopsies in paraffin, and detects the lipids of the primary and secondary granules of the granulocytic series? - correct answer SBB Early T and B lymphocytes have an elevatoin of this type of polymerase. - correct answer Terminal deoxynucleotyidyl transferase High levels of TdT are found in? - correct answer ALL Cytoplasmic mu chains can be identified by flow cytometry and are first seen in the - correct answer Pre-B cell Cytochemical stains were performed on a bone marrow from a patient with acute leukemia. All blasts were TdT negative. The majority of the blasts showed varying amounts of Sudan black stain. 50% of them stained with nonspecific esterase. What is ruled out by the TdT? - correct answer ALL Cytochemical stains were performed on a bone marrow from a patient with acute leukemia. All blasts were TdT negative. The majority of the blasts showed varying amounts of Sudan black stain. 50% of them stained with nonspecific esterase. What cell type is positive for the nonspecific esterase? - correct answer Monocytes Cytochemical stains were performed on a bone marrow from a patient with acute leukemia. All blasts were TdT negative. The majority of the blasts showed varying amounts of Sudan black stain. 50% of them stained with nonspecific esterase. What cell type is strongly positive for Sudan Black B? - correct answer Myeloblasts and granulocytes
The WBC count is 15 x 109/L with 90% blasts, 6% segs, and 4% monocytes. The blasts are relatively large and have abundant cytoplasm. More than 90% of them are positive with nonspecific esterase stain, and an occasional blast is SBB positive. You would expect a positive for TdT staining with this type of leukemia. - correct answer False The presence of CD34, CD13, and CD14 is typically associated with a positive - correct answer MPO stain A patient's CBC and peripheral blood smear examination suggests a diagnosis of CML. They physician orders an LAP score to be performed on the current hematology sample (lavender top tube). What should the laboratory scientist tell the physician? - correct answer The current hematology sample is unacceptable because it would result in a falsely decreased LAP score. A new sample must be collected in heparin. You are performing several cytochemical stains on a bone marrow sample from a patient recently diagnosed with acute leukemia. You are examining the MPO slide and the blasts are negative. However, the reagent is nearing the expiration date, and you question whether the stain is working properly. Which cells found in bone marrow normally express myeloperoxidase and could be used to assess the stain's integrity? - correct answer Neutrophils Myeloperoxidase - correct answer Stains primary granules of neutrophils Sudan Black B - correct answer stains monocytes weakly- older samples are acceptable CAE- specific esterase - correct answer Stains neutrophils, negative for monocytes can be used with embedded tissue Nonspecific Esterase Stain - correct answer Positive in acute monocytic leukemia Periodic Acid Schiff - correct answer Stains erythroblast in erythroleukemia Tartarate Resistan Acid Phosphatase (TRAP) - correct answer only Hairy cell leukemia
Terminal deoxynucleotyidyl transerase (TdT) - correct answer Stains nuclear markers The translocation of t(8;21) - correct answer is the RUNX1/ETO FISH can be used to detect all of these except - correct answer the presence of fusion genes in a test tube The WHO classification of AML is based on - correct answer the presence of 20% or more blasts genetic abnormalities morphology and cytochemistry of blasts This recurrent genetic abnormality is found largely in promyelocytic leukemia - correct answer PML-RAR(alpha) Which of these is associated with cells containing an abundance of Auer rods occurring in bundles? - correct answer APL Found in CML, known as the Philadelphia gene - correct answer BCR-ABL Not a translocation, but an inversion- association with AMML and eosinophils - correct answer CBF(beta)-MYH Translocation is t(9;22) - correct answer BCR-ABL Found in APL, t(15;17) - correct answer PML-RAR(alpha) A patient who had been treated previously for myelodysplasia developed AML. What subgroup is most appropriate for a diagnosis? - correct answer t-AML/t-MDS
A differential report notes the presence of >20% blasts. This number supports the diagnosis of: - correct answer AML Which M:E ratio is most characteristic of acute leukemia? - correct answer 10: A large cell with a large nucleus to cytoplasm ratio, an immature nucleus containing multiple prominent nucleoli and Auer rods is a(n): - correct answer myeloblast The leukemia that belongs to the WHO classification of AML with recurrent genetic abnormalities is: - correct answer APL Which of these leukemic blasts demonstrate t(8;21) positivity? - correct answer myeloblasts All transretinoic acid therapy is used in leukemia patients with this genetic abnormality. - correct answer t(9;22) t(15;17) Which is characterized by a very elevated hemoglobin? - correct answer polycythemia vera Which will have the highest basophil percent? - correct answer CML A platelet count of 450 x 109/L rules out - correct answer essential thrombocythemia LAP is always decreased in which one? - correct answer CML Expect to have a WBC > 50 x 109/L - correct answer CML Which has variable expression of cells, such that they are increased early and decreased later? - correct answer primary myelofibrosis
Which of the myeloproliferative syndromes is not positive for a JAK 2 mutation? - correct answer CML What phase is this CML patient in? 30% seg, 15% myelocytes, 25% basophils, 30% blasts, multiple chromosomal abnormalities
- correct answer blast The blast phase of CML is - correct answer the terminal phase of CML with > 20% blasts in blood and bone marrow The worst prognosis for CML is associated with - correct answer thrombocytosis The most prominant cell line in CML is the - correct answer myeloid The most prominent cell line found in polycythemia vera is - correct answer erythroid The peak age for CML is: - correct answer >60 years A 68 year old male was seen in the clinic for lethargy, dyspnea and light-headedness. RBC count is 5.0 x 1012/L, WBC count is 60 x 109/L, platelet count is 70 x 109/L. His differential showed a shift to the left in myeloid cells with 40% eosinophis. Bone marrow revealed 10% blasts. Ph chromosome is negative. He most likely has: - correct answer chronic eosinophilic leukemia Which movement is considered directional? - correct answer Chemotaxis Which of the following is associated with bacterial infections? - correct answer Acute neutrophilia Dohle bodies Toxic granulation Primary granules first appear in the: - correct answer Promyelocyte
All of the following are risk factors for the development of leukemia except? - correct answer Paroxysmal cold hemoglobinuria Leukemic cells also infiltrate organs that were originally responsible for fetal hematopoiesis. Which organs will be enlarged? - correct answer Spleen and liver The presence of Auer rods in blasts excludes the diagnosis of - correct answer ALL Cytochemical stains were performed on a bone marrow from a patient with acute leukemia. All blasts were TdT negative. The majority of the blasts showed varying amounts of Sudan black stain. 50% of them stained with nonspecific esterase. What cell type is positive for nonspecific esterase? - correct answer Monocytes Cytochemical stains were performed on a bone marrow from a patient with acute leukemia. All blasts were TdT negative. The majority of the blasts showed varying amounts of Sudan black stain. 50% of them stained with nonspecific esterase. What cell type is strongly positive for Sudan Black? - correct answer 1.Myeloblasts & granulocytes Cytochemical stains were performed on a bone marrow from a patient with acute leukemia. All blasts were TdT negative. The majority of the blasts showed varying amounts of Sudan black stain. 50% of them stained with nonspecific esterase. What type of leukemia is indicated? - correct answer 1.Acute myelomonocytic leukemia The WBC count is 15 X 109/L with 90% blasts, 6% segs, 4% monocytes. The blasts are relatively large and have abundant cytoplasm. More than 90% of them are positive with nonspecific esterase stain, and an occasional blast is SBB positive. What clue is most important here? - correct answer 1.High positivity with nonspecific esterase The WBC count is 15 X 109/L with 90% blasts, 6% segs, 4% monocytes. The blasts are relatively large and have abundant cytoplasm. More than 90% of them are positive with nonspecific esterase stain, and an occasional blast is SBB positive. What type is this? - correct answer 1.AMoL The Tartrate Resistant Acid Phosphatase stain is positive with which type of leukemia? - correct answer 1.Hairy Cell Leukemia
Translocation of t(8;21) associated with AML M2 - correct answer ETO-AML Not a translocation, but an inversion. Association with AMML and eosinophils - correct answer CBFb-MYH This is a translocation of t(8;14), found in ALL-L3 - correct answer c-myc-IgH Which WHO classification has poor differentiation, and no staining with SBB and MPO - correct answer 1.AML with minimal differentiation Which WHO classification is associated with t(15;17) the mutation known as PML-RARa? - correct answer APL Bone marrow results: all blasts TdT negative. Majority are SBB positive; 50% are positive for nonspecific esterase. What type is this? - correct answer AMML Which cytochemical stain is useful in separating myeloblasts from monoblasts? - correct answer 1.Nonspecific esterase A platelet count of 450 x 109/L rules out - correct answer 1.Essential thrombocythemia Which of the Myeloproliferative syndromes is not positive for a JAK 2 mutation? - correct answer 1.Chronic myeloid leukemia In all CMPD except CML, what is the common mutation found? - correct answer 1.JAK V617F A key finding to distinguish polycythemia vera from secondary erythrocytosis is - correct answer 1.Erythropoietin is decreased in PV The high hematocrit in PV will alter laboratory results. Which is correct? - correct answer 1.Na citrate tubes must have some anticoagulant removed to correct for the lower plasma amount
Genes that can cause tumors if activated are: - correct answer A.Proto-oncogenes Round or oval ; delicate lacy chromatin, nucleoli no granules - correct answer myeloblast Round or oval ; delicate lacy chromatin but more dense , nucleoli present large reddish purple granules (nonspecific) - correct answer promyelocyte Round or oval ; chromatin more dense , nucleoli absent small granules (specific), secretory vesicles - correct answer myelocyte chromatin condensed , kidney bean shaped small granules (specific), secretory vesicles - correct answer metamyelocyte chromatin condensed, horseshoe at the ends, stains dark purple small granules (specific), secretory vesicles - correct answer band nucleus segmented into 2-4 lobes chromatin condensed, granules in band - correct answer segmented neutrophil Associated with mucosopolysaccrides such as hurles syndrome large purple cytoplasmic granules, cell functions normally - correct answer Alder-Reilly anomaly serious, fatal condition with repeated pyrogenic infections cells engulf but dont kill, giant fused granules neutrophils and lymps - correct answer A.Chediak Higashi syndrome Bleeding tendency from associated thrombocytopenia cell function normally, - correct answer May hegglin anomaly
Defective respiratory burst cells engulf but dont kill microorganisms recurrent infections , especially in childhood - correct answer Chronic Granulomatous disease low or absent myeloperoxide enzyme normal cell morphology
usually benign other bacterial systems
prevent most infections - correct
answer myeloperoxide deficiency
