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Exercises for Lesson 7

1. A critical examination of a stained blood smear includes the differential count that quantitates the three types of:

a. Thrombocytes.
b. Granulocytes.
c. Lympocytes.
d. Leukocytes.

2. Which area of the blood smear is used for the differential leukocyte count?

a. Thin end.
b. Thick end.
c. Inner portion.
d. Peripheral area.

3. The objective lens is used to perform the differential leukocyte count.

a. 10X (low power).
b. 40X (high power).
c. 100X (oil immersion).

4. When nucleated erythrocytes are located on a blood smear, they are reported by the counted.

a. Number per 100 leukocytes.
b. Number per 100 erythrocytes.
c. Percentage of all leukocytes.
d. Percentage of all erythrocytes.

5. What is the normal average number of thrombocytes counted per oil immersion field when performing a qualitative platelet evaluation of a blood smear?

a. 0-2.
b. 4-6.
c. 6-8
d. 8-10.

6. Which test is indicated when the amount of thrombocytes appear to be decreasing significantly on an oil immersion field blood smear?

a. Rosettes.
b. Alkali denaturation.
c. Clot retraction.
d. pH acid.

7. Which white blood cells are counted as part of the 100 in a differential leukocyte count and reported in a separate category in percent?

a. Immature leukocyte.
b. Ruptured leukocyte.
c. Fragmented leukocyte.
d. Degenerated leukocyte.

8. A cell with a nuclear mass twice as great as the cytoplasmic mass would have an N:C ratio of:

a. 1:2.
b. 2:3.
c. 1:1.
d. 2:1.

9. What has the second highest value in the normal differential count?

a. Monocytes.
b. Eosinophils.
c. Lymphocytes.
d. Segmented neutrophils.
e. Neutrophilic band cells.

10. The myeloid-erythroid (M:E) ratio of the bone marrow is the ratio of the granulocytic white blood cells to the:

a. Red blood cells.
b. Mature red blood cells.
c. Nucleated red blood cells.
d. Bone marrow cells other than granulocytes.

11. The bone marrow study should be accompanied by a:

a. Hematocrit.
b. Red blood cell count.
c. Peripheral blood evaluation.
d. Total white blood cell count.

12. What is the normal M:E (myeloid-erythroid) ratio of the bone marrow? a. 1:1.

b. 2:1 to 3:1.
c. 3:1 to 4:1.
d. 4:1 to 7:1.

13. The hematocrit and the RBC count are needed to calculate the:

a. MCV.
b. MCH.
c. MCHC.

14. When calculating the MCV in femtoliters, what is the divisor after multiplying the hemotocrit and 10?

a. RBC count (millions).
b. Hematocrit (percent).
c. WBC count (thousands).
d. Hemoglobin concentration (g/dl).

15. What is the MCV if the hematocrit is 44 percent, the RBC count is 5.2 million per cu mm, and the hemoglobin concentration is 14 g/dl?

a. 1.2 fl.
b. 8.5 fl.
c. 12 fl.
d. 85 fl.

16. What is the MCV if the hematocrit is 36 percent. the RBC is 4.6 million per cu mm, and the hemoglobin concentration is 11 g/dl?

a. 1.2 fl.
b. 78 fl.
c. 118 fl.
d. 783 fl.

17. The RBC count and the hemoglobin concentration are needed to calculate the:

a. MCV.
b. MCH.
c. MCHC.

18. To calculate the MCH in micromicrograms, the is multiplied by to 10.

a. RBC count (millions).
b. WBC count (thousands).
c. Hematocrit (percent).
d. Hemoglobin concentration (g/dl).

19. If the hematocrit is 44 percent, the RBC is 5.2 million per cu mm, and the hemoglobin concentration is 14 g/dl, what is the MCH?

a. 12 micromicrograms.
b. 27 micromicrograms.
c. 37 micromicrograms.
d. 85 micromicrograms.

20. If the hematocrit is 36 percent, the RBC is 4.6 million per cu mm, and the hemoglobin concentration is 11 g/dl, what is the MCH?

a. 24 micromicrograms.
b. 31 micromicrograms.
c. 33 micromicrograms.
d. 1/2 micromicrogram.

21. To calculate the MCHC, is multiplied by 100, then divided by the Hemocrit. The result equals the percent of hemoglobin in the average RBC.

a. RBC count (millions).
b. WBC count (thousands).
c. Hematocrit (percent).
d. Hemoglobin concentration (g/dl).

22. If the hematocrit is 44 percent, the RBC is 5.2 million per cu mm, and the hemoglobin concentration is 14 g/dl, what is the MCHC?

a. 12 percent.
b. 27 percent.
c. 32 percent.
d. 37 percent.

23. If the hematocrit is 36percelt, the RBC is 4.6 million per cu mm, and the hemoglobin concentration is 11 g/dl, what is the MCHC?

a. 24 percent.
b. 31 percent.
c. 33 percent.
d. 42 percent.
24. A mean corpuscular volume below 80 fl indicates that the erythrocytes are:
a. Macrocytic.
b. Normocytic.
c. Microcytic.
d. Megaloblastic.

25. The maximum value for the is included in its normal range.

a. MCV.
b. MCH.
c. MCHC.

26. The normal range for the mean corpuscular volume of an erythrocyte is approximately:

a. 62 to 82 fl.
b. 70 to 80 fl.
c. 80 to 97 fl.
d. 90 to 100 fl.

27. The osmotic fragility of erythrocytes is increased in:

a. Thalassemia major.
b. Sickle cell anemia.
c. Iron deficiency (hypochromic) anemia.
d. Congenital spherocytic (hemolytic) anemia.

28. When the osmotic fragility test is performed visually, the salt concentrations are recorded for the two tubes that show:

a. 0 percent and 50 percent hemolysis.
b. 0 percent and 100 percent hemolysis.
c. Least and greatest hemolysis.
d. Initial hemolysis and first complete hemolysis.

29. What is the normal percentage of hemolysis in 0.55 percent saline?

a. 0 percent.
b. 40 percent.
c. 65 percent.
d. 100 percent.

30. The Ham test is positive in:

a. Polycythemia.
b. Paroxysmal nocturnal hemoglobinuria.
c. Chronic lymphocytic leukemia.
d. All hemoglobinopathies.

31. Erythrocytes in paroxysmal nocturnal hemoglobinuria lyse easily in serum which is slightly:

a. Basic.
b. Acidic.
c. Hypotonic.
d. Hypertonic.

32. A false-positive Ham test may occur in:

a. Sickle cell anemia.
b. Congenital spherocytic anemia.
c. Severe iron deficiency anemia.
d. Paroxysmal nocturnal hemoglobinuria.

33. When demonstrating "L.D." cells, which of the following has degenerative nuclear material that attracts phagocytic cells, particular segmented neutrophis?

a. Jaundice.
b. Leukemia.
c. Lupus erythematossus.
d. Pernicious amenia.

34. Which method is used to determine L.E. cell and antinuclear antibodies with a 75 to 80 percent accuracy rate?

a. Rotary bead.
b. Fluorescent antibody.
c. a and b.
d. None of the above.

35. Lupus erythematosus is:

a. A chronic, sometimes fatal, disease of unknown etiology.
b. A regular skin eruption across the nose and mouth (butterfly rash), with arthritis that can be accompanied by various visceral manifestations.
c. A rash, which is sometimes not present. Diagnosis depends on demonstration of the L.E. cell.
d. Sometimes not diagnosed early because the early symptoms do not appear after intense exposure to sunlight.

36. Which statement is correct for the erythrocyte osmotic fragility test?

a. In hypertonic salt solutions, erythrocytes take up water, swell to a spheroid shape and burst.
b. In congenital spherocytic anemia, the WBCs with defective structure, will more rapidly rupture at salt concentrations closer to isotonicity (0.85 percent).
c. The RBCs cells thus show an increased osmotic fragility. In contrast, the flat or thin but otherwise normal red cells of hypochromic anemia show a decreased osmotic fragility and do not hemolyze until lower salt concentrations are reached.
d. When hemolysis begins within the normal range of the prepared solutions or when intermediate dilutions are desired, the additional dilutions are readily prepared using the 1 percent sodium chloride stock solution.

37. Which statement is correct for the erythrocyte osmotic fragility test?

a. When the results of the fragility test are normal, one procedure is immediately followed to enhance any latent abnormality in fragility.
b. Incubate samples of defibrinated blood (control and patient's) at 37șC for 24 hours under sterile conditions and controlled pH (7.35 to 7.50).
c. The test does not need to be performed.
d. Increases in pH decrease osmotic fragility. The reagents are buffered to maintain a constant pH of 7.35 to 7.50.

38. Which statement is correct for the erythrocyte osmotic fragility test?

a. This test may also be run visually, with some sacrifice of accuracy, by allowing the blood-saline dilutions to stand at 20șC for 45 minutes.
b. The tubes are then vigorously centrifuged (1,000 rpm for 3 minutes) and observed for signs of initial and complete hemolysis.
c. A rich dark pink coloration of the supernatant fluid indicates initial hemolysis and a cloudy red solution indicates complete hemolysis.
d. Salt free concentrations in these two tubes are noted and recorded.
e. The control does not have to be reported along with results of patient's tubes.

39. When there is no "butterfly rash," diagnosis of lupus erythematosus often depends upon demonstration of:

a. Collagen.
b. L.E. cells.
c. Leukocytosis.
d. Polycythemia.

40. In addition to L.E. cells, two characteristic phenomena in lupus erythematosus are:

a. Free nuclear masses and rosettes.
b. Rouleaux and Cabot rings.
c. Basket cells and toxic granulation.
d. Distorted lymphocytes and smudge cells.

41. Which of the following is easily mistaken for an L.E. cell?

a. Tart cell.
b. Monocyte.
c. Plasmocyte.
d. Segmented neutrophil.

42. Which of the following is peroxidase negative?

a. Lymphocytes.
b. Promyelocytes.
c. Neutrophilic myelocytes.
d. Neutrophilic metamyelocytes.
e. Neutrophilic band cells.
f. Neutrophilic segmented cells.

43. Which of the following is peroxidase positive?

a. Lymphocytes.
b. Plasmocytes.
c. Segmented neutrophils.

44. With the alkaline phosphatase stain, a segmented neutrophil exhibiting no darkly stained granules is rated:

a. 0.
b. 1+.
c. 2+.
d. 3+.
e. 4+.

45. Generally speaking, when leukocyte alkaline phosphatase is used, a patient with what score is considered to be a healthy adult?

a. 10 to 50.
b. 10 to 80.
c. 13 to 100.
d. 13 to 130.

46. Heinz bodies are often present in the erythrocytes of hemolytic anemia caused by:

a. Toxic agents.
b. Spherocytosis.
c. Thalassemia major.
d. Paroxysmal nocturnal hemoglobinuria.

47. What color are Heinz-bodies when stained with methyl violet?

a. Colorless.
b. Blue-green.
c. Purple.
d. Black.

48. Heienz-bodies prepared with Wright-stain are what color?

a. Green.
b. Purple.
c. Colorless.
d. Orange.

49. Siderocytes are:

a. Iron granules.
b. Denatured hemoglobin.
c. Nucleated erythrocytes.
d. Erythrocytes containing iron granules.

50. Siderocytes may be observed:

a. All of the below.
b. In several anemias.
c. After splenectomy.
d. In lead poisoning.

Answers to Exercises for Lesson 7

 1. d
 2. a
 3. d
 4. a
 5. d
 6. c
 7. a
 8. d
 9. c
10. c
11. c
12. c
13. a
14. a
15. d
16. b
17. b
18. d
19. b
20. a
21. d
22. c
23. b
24. c
25. c
26. c
27. d
28. d
29. a
30. b
31. b
32. b
33. c
34. a
35. a
36. c
37. b
38. a
39. b
40. a
41. a
42. a
43. c
44. a
45. d
46. a
47. c
48. c
49. d
50. a


David L. Heiserman, Editor

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Revised: June 06, 2015