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Exercises for Lesson 9

1. What are the three major laboratory manifestations of anemia?

a. Increased hemoglobin concentration, decreased RBCs/L, increased hematocrit.
b. Reduced hematocrit, decreased RBCs/L, decreased hemoglobin concentration.
c. Decreased hemoglobin concentration, decreased hematocrit, increased RBCs/L.
d. Increased hemoglobin concentration, increased hematocrit, increased RBCs/L.

2. Which of the following formulas should you use to calculate the mean corpuscular hemoglobin (MCH)?

a. (Hct x 10)/RBC count.
b. (Hgb x 10)/RBC count.
c. (Hgb x 100)/Hct.
d. (Hct x 100)/Hbg.

3. (Hgb x 100)/Hct is the formula used to determine?

a. MCV (Mean Corpuscular Volume).
b. MCH (Mean Corpuscular Hemoglobin).
c. MCHC (Mean Corpuscular Hemoglobin Concentration).
d. RDW (Red Cell Distribution Width).

4. A patient had a CBC done , the test results were:

Hgb 10.0 g/dL; Hct 35%; RBC 4.2 x 10/L; WBC 10.0 x 10/L

What is the MCH? pg

a. 24.
b. 83.
c. 22.
d. 88.

5. What laboratory procedure is not used for assessment of anemia?

a. Sugar water screening test.
b. Malarial smears.
c. Thyroid function test.
d. Reticulocyte count.

6. Intrinsic defects within the RBC, extracorpuscular causes, and liver disease fall under which pathophysiological categories of anemia?

a. Decreased or impaired red blood cell production.
b. Accelerated destruction of the RBC.
c. Blood Loss.
d. Accelerated repair of the WBC.

7. What kind of RBC morphology would you expect to see on a blood smear from a patient with a MCV of 83 fL?

a. Normocytic.
b. Macrocytic.
c. Microcytic.
d. Normochromic.

8. Macroovalocytes, pancytopenia, hypersegmented neutrophils, increased MCV, and decreased reticulocyte count are normally associated with:

a. Sideroblastic.
b. Megaloblastic.
c. Aplastic.
d. Myelophthistic.

9. Which of the following is a macrocytic anemia?

a. Aplastic anemia.
b. Folic acid deficiency.
c. Iron deficiency anemia.
d. Chronic blood loss.

10. What categories of anemia are aplastic anemia, anemia of endocrine disease, and myelophthisic anemia?

a. Normocytic anemia.
b. Macrocytic anemia.
c. Microcytic anemia.
d. Monochromic anemia.

11. The laboratory findings on a peripheral blood smear are burr cells, increased blood urea nitrogen and decreased Hct of 22%. What type of anemia would you suspect?

a. Anemia of endocrine disease.
b. Anemia caused by blood loss.
c. Hemolytic anemia.
d. Anemia of chronic renal disease.

12. An increase in RBC destruction and a decrease in the normal average life span of the RBC is defined as:

a. Myelophthisic anemia.
b. Microcytic anemia.
c. Hemolytic anemia.
d. Macrocytic anemia.

13. Which of the following is/are hemolytic anemia caused by an RBC enzyme deficiency?

a. Pernicious anemia and thalessemia.
b. Iron deficiency anemia and folic acid deficiency.
c. Pyruvate kinase deficiency and g6pd deficiency.
d. Pure red cell aplasia.

14. A patient whose anemia was caused by physical trauma to the cells would usually have in his peripheral blood smear.

a. Stacked cells.
b. Acanthocytes.
c. Spherocytes.
d. Schistocytes.

15. Sideroblastic anemia is commonly:

a. Macrocytic.
b. Normocytic.
c. Microcytic.
d. Spherocytic.

16. RBCs are seen in iron deficiency anemia.

a. Normocytic, hyperchromic.
b. Macrocytic, normochromic.
c. Normocytic, normochromic.
d. Microcytic, hypochromic.

17. Secondary polycythemia and polycythemia vera are examples of:

a. Absolute polycythemia.
b. Myelophthisic anemia .
c. Relative polycythemia.

18. Relative polycythemia is caused by:

a. Increased erythropoietin.
b. A decrease in the plasma portion of the blood.
c. Stem cell disorder.
d. Decreased erythropoietin.

19. The is used to screen for cells which are normally sensitive to lysis by complement.

a. Bone marrow examination.
b. Reticulocyte count.
c. Sugar water screening test.
d. Activated partial thromboplastin.

20. The reference range for the mean corpuscular hemoglobin concentration (MCHC) is g/dL.

a. 31 to 36.
b. 27 to 31 .
c. 80 to 100.
d. 4 to 11.

21. HGB 7 g/dL, RBCs 3.9 x 1012/L, HCT 27%, WBCs 11.1 x 10 9/L

Based on these indices result, what is the patients MCH?

a. 18.
b. 67.
c. 22.
d. 27.

22. Which of the following lab findings is usually associated with anemia caused by acute blood loss?

a. Target cells and basophilic stippling.
b. Extreme microcytosis.
c. Low WBC count and decreased reticulocytes.
d. Increased platelet and WBC counts; reticulocytosis.

23. anemia results from deficiencies of vitamin B12 and folic acid in the body.

a. Sideroblastic.
b. Megaloblastic.
c. Aplastic.
d. Myelopthisic.

24. What laboratory findings are associated with paroxysmal nocturnal hemoglobinuria (PNH)?

a. Macrocytic.
b. Normocytic.
c. Microcytic.
d. Megaloblastic.

25. Laboratory findings normally associated with hereditary sideroblastic anemia include:

a. Acanthocytes, normal to increased reticulocytes.
b. Spherocytes, polychromasia, and reticulocytes.
c. Dimorphic population of RBCs, target cells, and basophilic stippling.

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

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

27. A great suppression of RBC production with normal WBC and platelet production is a depiction of:

a. Pyruvate kinase deficiency.
b. Pure red cell aplasia.
c. Paroxysmal nocturnal hemoglobinuria.
d. Vitamin B12.

28. Which anemia is usually associated with traumatic conditions such as accidents or severe injury?

a. Sideroblastic anemia.
b. Hereditary spherocytosis.
c. Anemia due to acute blood loss.
d. Iron deficiency anemia.

29. Hereditary xerocytosis is characterized as having which of these problems?

a. Outflow of Na+ is greater than inflow of K+ and the net decrease in cellular cation concentration results in movement of water out of cell which dehydrates the cell.
.b. Outflow of K+ is greater than inflow of Na+ and the net decrease in cellular cation concentration results in movement of water out of cell which dehydrates the cell.
c. Outflow of K+ is greater than inflow of Ca+ and the net decrease in cellular cation concentration results in movement of water out of cell which dehydrates the cell.
d. Outflow of K+ is less than inflow of Na+ and the net increase in cellular cation concentration results in movement of water into the cell which hydrates the cell.

30. Acanthocytes are predominantly seen in patients with:

a. Severe liver disease.
b. Vitamin B12 deficiency.
c. Chronic hemolytic anemia.
d. Sideroblastic anemia.

31. Celiac disease and sprue are two conditions that affect the body and create an abnormal absorption of what vitamin?

a. Thiomine.
b. Ferritin.
c. Folate.
d. Ascorbic acid.

32. Failure of the body to produce RBCs, WBCs, and platelets is known as:

a. Anemia.
b. Hemoglobin deficiency.
c. Pancytopenia.
d. Polycythemia vera.

33. Which condition is characterized by decreased tissue oxygen tension resulting in a decreased need for erythropoiesis?

a. Hypopituitarism.
b. Hypogonadism.
c. Hypothyroidism.
d. Hyperplasia.

34. Which disorder is characterized by aggregation of platelets and occlusion of blood vessels, most often seen in young adults, and may occur secondarily to infections and connective tissue disease?

a. Disseminated intravascular coagulation (DIC).
b. Thrombotic thrombocytopenic purpura (TTP).
c. a and b.
d. None of the above.

35. Sideroblastic anemia is:

a. An abnormal iron metabolism and/or absorption where iron loading is a result of a defect in heme synthesis.
b. A regular skin eruption across the nose and mouth (butterfly rash), with arthritis that can be accompanied by various visceral manifestations.
c. A chronic, sometimes fatal, disease of unknown etiology.
d. Sometimes not diagnosed early because the early symptoms do not appear after intense exposure to sunlight.

36. Which is normally present in the clinical findings for macrocytic anemia?

a. MCV < 80 pg.
b. MCV > 100 fL.
c. MCV > 100 pg.
d. MCV < 80 fL.

37. What laboratory diagnostic test is calculated using the MCV and RBC count, indicates the degree of anisocytosis, and is useful in the early detection of iron deficiency anemia?

a. Complete blood count.
b. Hamís acidified serum test.
c. Mean corpuscular hemoglobin concentration.
d. RDW.

38. How many types of congenital aplastic anemia have been discovered?

a. 5.
b. 3.
c. 4.
d. 2.

39. Which method is the most widely used as a screening test for paroxysmal nocturnal hemoglobinuria (PNH)?

a. Hamís acidified serum test.
b. Serum iron levels.
c. Sugar water test.
d. Schillings test.

40. If a MCHC result is > 38, what is the possible cause of this erroneous result?

a. Clotted specimen.
b. Cold agglutinins and lipemia.
c. Contaminated specimen.
d. Decreased platelet count.

41. When exposed to primaquine, which enzyme deficiency results in 10 percent of African Americans experiencing a hemolytic episode?

a. Glucose-6-phosphate dehydrogenase (G6PD).
b. Pyruvate kinase.
c. Protease.
d. Lipase.

42. The normal and expected morphology for an elevated MCH is:

a. Normochromic/hypochromic RBCs.
b. Normochromic/normocytic RBCs.
c. Macrocytic/normochromic RBCs.
d. Microcytic/hypochromic RBCs.

43. Which parasites infect and rupture RBCs?

a. Flea.
b. Mosquito.
c. Tick.
d. Malarial parasites.

44. Increased erythropoietin levels due to compensatory response to hypoxia while living at high altitudes can lead to:

a. Autoimmune hemolytic anemia.
b. Stem cell disorder.
c. Secondary polycythemia.
d. Acute hemolytic anemia.

45. Alloimmune hemolytic anemia is caused by:

a. Alloantibodies produced by an individual exposed to antigens of another individual that are not already present on the exposed individualís cells.
b. Alloantibodies produced by an individual exposed to antibodies of another individual that are not already present on the exposed individualís cells.
c. Alloantibodies produced by an individual exposed to antigens of the fetus that are already present on the exposed individualís cells.
d. Alloantibodies produced by an individual exposed to antibodies of the fetus that are not already present on the exposed individualís cells.

46. When antibodies transfer from the mother to the antigens of the fetusís RBCs what disorder will occur?

a. Autoimmune hemolytic anemia.
b. Hemolytic disease of the newborn.
c. Hemolytic transfusion reaction.
d. Immune hemolytic anemia.

47. The first classification scheme was developed by:

a. Wintrobe.
b. Collins.
c. T. Canemia.
d. Embden-Meyerhof.

48. Anemia can manifest from all of the following EXCEPT:

a. Blood loss.
b. Defect in hemoglobin synthesis.
c. Healthy diet and exercise.
d. RBC membrane defect.

49. Anemia due to Vitamin B12 deficiency may be the result of:

a. Over-productive bone marrow processes.
b. Inability of iron to be absorbed by the muscles.
c. Decreased/suppressed liver function.
d. Inability of gastric mucosa to secrete intrinsic factor.

50. Which statement is correct?

a. The average adult absorbs 0.1-0.5 mg iron per day through diet.
b. 75- 80 mL RBCs are broken down each day as a result of normal aging.
c. Platelets possess carbon dioxide and metabolic systems, expend energy, and respond to stimuli.
d. Approximately 3/5 of iron in the body is present in hemoglobin and iron storage pools in bone marrow.

Solutions to Exercises for Lesson 9

26. b
27. b
28. c
29. b
30. a
31. c
32. c
33. c
34. b
35. a
36. b
37. d
38. d
39. c
40. b
41. a
42. c
43. d
44. c
45. a
46. b
47. a
48. c
49. d
50. d

End of Lesson 3

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