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Exercises for Lesson 10

1. Patients with Chediak-Higashi syndrome have neutrophils containing large, fused lysosomes which appear as:

a. Lipid droplets.
b. Large acidophilic granules.
c. Giant Dohle bodies.
d. Chromosome fragments.

2. Patients with Alder-Reilly anomly have neutrophils and monocytes containing:

a. Large azurophilic granules resembling severe toxic granulation.
b. Large orange-red granules overlaying the nucleus.
c. Phagocytized RBCs.
d. Large blue inclusions resembling giant Dohle bodies.

3. What anomaly is characterized by large, blue cytoplasmic inclusions in granulocytes, abnormal giant platelets, and often thrombocytopenia?

a. Pelger-Huet.
b. Chediak-Higashi.
c. Alder-Reilly.
d. May-Hegglin.

4. The accumulation of spingomyelin in the macrophage is indicative of:

a. Niemann-Pick disease.
b. May-Hegglin anamoly.
c. Toxoplasmosis.
d. Acute monocytic leukemia.

5. What non-malignant lymphocytic disorder has a positive heterophile antibody test?

a. Cytomegalovirus.
b. Toxoplasmosis.
c. Infectious mononucleosis.
d. Gaucher’s disease.

6. Which disease state is usually associated with an increase in lymphocytes with reactive lymphocytes present on a peripheral blood smear?

a. Toxoplasmosis.
b. Gaucher’s disease.
c. Iron defiency anemia.
d. Prolymphocytic leukemia.

7. What disease state is usually associated with reactive lymphocytosis and negative heterophile antibody test?

a. Infectious mononucleosis.
b. Cytomegalovirus infection.
c. Acute nonlymphoblastic leukemia.
d. Multiple myeloma.

8. Which statement is true about reactive lymphocytes?

a. Cells generally contain blue-black specific granules.
b. Both large and small cells, basophilic and pale cells and cell with immature chromatin.
c. Cells are only found in children.
d. Cells are only found in the bone marrow and not in periphal smear.

9. In what type of leukemia are many immature cells found?

a. Infectious.
b. Occult.
c. Acute.
d. Chronic.

10. Which of the following is characterized by mostly mature cells?

a. Acute leukemia.
b. Chronic leukemia.
c. Philadelphia leukemia.
d. Burkitt’s lymphoma.

11. What type of leukemia is the prognosis of the patient with untreated disease usually from months to years?

a. Acute.
b. Infectious.
c. Occult.
d. Chronic.

12. The predominant cell associated with acute myeloblastic leukemia with minimal differentiation (M0) is?

a. Blast with no granulocytic maturation.
b. Eosinophils.
c. Monoblast.
d. Immature granulocytes.

13. The FAB classification system of acute nonlymphoblastic leukemias classifies M1 as:

a. Acute megakaryocytic leukemia.
b. Acute myeloblastic leukemia without maturation.
c. Hairy cell leukemia.
d. Acute promelocytic leukemia.

14. Acute myeloblastic leukemia with maturation is which FAB classification?

a. M0.
b. M1.
c. M2.
d. M10.

15. The predominant cells associated with acute promyelocytic leukemia are:

a. Promyelocytes.
b. Monoblast.
c. Immature RBCs.
d. Megakaryocyte fragments.

16. Erthroleukemia frequently progresses to what other FAB classifications?

a. M0, M2, M4.
b. M3, M6, M7.
c. M1, M2, M4.
d. M4, M5, M7.

17. Myelodysplastic syndromes (MDS) are disorders that result from clonal abnormalities of:

a. Refractory anemia with ringed sideroblast.
b. Refractory anemia with excess blast in transformation.
c. Hematopoietic pluripotent stem cells.
d. Refractory anemia with with excess blast.

18. Which of the myelodysplastic syndrome has the highest rate of progression to acute lymphyblastic leukemia (ANLL)?

a. Chronic myelomonocytic leukemia (CMML).
b. Refractory anemia with excess blast in transformation (RAEB-T).
c. Refractory anemia.
d. Refractory anemia with ringed sideroblast (RARS).

19. Chronic myeloproliferative disorders develop from:

a. A problem in the cellular lipid metabolism.
b. Proliferation of an abnormal pleuripotential stem cell.
c. The infection of lymphocytes with Epstein Barr virus.
d. Replacement of normal cells in the bone marrow by abnormal lymphoid cells.

20. Which chronic myeloproliferative disorder is caused by myeloid hyperplasia in the bone marrow, and has giant platelets on the peripheral smear?

a. Chronic myelomonocytic leukemia.
b. Chronic megakarocytic leukemia.
c. Idiopathic myelofibrosis.
d. Malignant thrombocythemia.

21. _____ is the result of megakaracytic hyperplasia in the bone marrow.

a. Pernicious anemia.
b. Cytomegalovirus infection.
c. Prolymphocytic leukemia.
d. Essential thrombocythemia.

22. A patient with idiopathic myelofibrosis characteristically has leukoerthroblastosis which is the presence of both _____ and _____ in the perphial blood.

a. NRBCs, immature neutrophils.
b. Reactive lymphocytes, crenated RBCs.
c. Smudge cells, hairy cells.
d. Mature monocytes, monoblast.

23. ______ is a myeloproliferative disorder associated with dwarf megakarocytes; large bizarre platelets; and teardrop shaped RBCs.

a. Essential thrombocythemia.
b. Polymorphic leukemia.
c. Pernicious anemia.
d. Idiopathic myelofibriosis.

24. Which of the following is normally associated with essential thrombocythemia?

a. Increased platelet count.
b. Normal platelet count.
c. Decreased platelet count.
d. Decreased WBC count.

25. What is the most common malignant disease seen in children from about age two to ten?

a. Acute lymphoblastic leukemia (ALL).
b. Acute myelocytic leukemia (AML).
c. Chronic lymphoblastic leukemia (CML).

26. In the FAB system of classification of acute lymphoblastic leukemias, L1 is:

a. Homogeneous lymphoblast.
b. Heterogeneous lymphoblast.
c. Large lymphoblast.
d. Pleomorphic lymphoblast.

27. Acute lymphoblastic leukemias, “Burkitt’s type” lymphoma is designated as:

a. L2.
b. L3.
c. M2.
d. M3.

28. Which acute lymphoblastic leukemia has abundant cytoplasm and an irregular nucleus?

a. Small heterogenous lymphoblast.
b. Small homogenous lymphoblast.
c. Large heterogenous lymphoblast.
d. Large homogenous lymphoblast.

29. The predominant cells found in chronic lymphocytic leukemia are:

a. Myelocytes.
b. Prolymphocytes.
c. Lymphoblast.
d. Small mature lymphocytes.

30. The presence of smudge cells on a perpherial blood smear is often associated with:

a. Chronic lymohocytic leukemia.
b. Hairy cell leukemia.
c. Mast cell leukemia.
d. Erythroleukemia.

31. What is the predominant cell associated with prolymphocytic leukemia?

a. Hairy cell.
b. Prolymphocytes.
c. Lymphoblast.
d. Myelocytes.

32. Identify the leukemia that is characterized by lymphocytes that have a round oval nucleus with fine chromatin, one to five distinct nucleoli, and a moderate amount of cytoplasm with hair like projection.

a. Prolymphocytic leukemia.
b. Hairy cell leukemia.
c. Chronic lymohocytic leukemia.
d. Hodgkin’s disease.

33. What disorder is distinguished from other lymphomas by the presence of the Reed-Steinburg cell?

a. Non-Hodgkins lymphoma.
b. Hodgkins disease.
c. Sezary syndrome.
d. Multiple myeloma.

34. What type of lymphoma affects the skin and may also involve the lymph nodes, liver, spleen, and lungs?

a. Non-Hodgkins lymphoma.
b. Hodgkins lymphoma.
c. Chronic lymohocytic leukemia.
d. Sezary syndrome.

35. is caused by malignant proliferation of atypical and immature forms of plasma cells.

a. Multiple myeloma.
b. Acute monocytic leukemia.
c. Acute myeloblastic leukemia.
d. Idiopathic myelofibrosis.

36. On a patient with multiple myeloma, what would you see on the peripheral blood smear?

a. Acanthocytes.
b. Agglutination.
c. Marked rouleaux.
d. Sickle cells.

37. Lab findings associated with patients with plasma cell leukemia often include:

a. Anemia, thrombocytopenia, and abnormal plasma cells.
b. Hairy cells and panctopenia.
c. Early myelogenous cell and monocytes.
d. Undifferentiated blast and megakaryocyte fragments.

38. Waldenstrom’s macroglobulinemia is caused by:

a. Growth of mature lymphocytes in the lymph nodes.
b. Infiltration of the bone marrow with a clone of B lymphocytes.
c. A stem cell defect resulting in abnormal growth of granulocytes, erythrocytes, and megakaryocytes.
d. Mutant stem cells which produce a monoclonal population of myeloid cells.

39. The leukocyte alkaline phosphate stain is useful in distinguishing chronic myelogenous leukemia from a reaction.

a. Blast crisis.
b. Malignant.
c. Leukomoid.
d. Lymphoid.

40. The stain is used to differentiate acute myelogenous or monocytic leukemias from acute lymphocytic leukemia.

a. Toludine blue.
b. Nonspecific esterase.
c. Myeloperxidase.
d. Acid phosphate.

41. The stain used to stain lipoproteins present in granuales of monocytes and granulocytes is:

a. Toludine blue.
b. Myeloperoxidase.
c. Sudan black B.
d. PAS.

42. What stain is helpful in diagnosing hairy cell leukemia?

a. Leukocyte Alkaline Phosphate stain.
b. Myeloperoxidase.
c. Toludine blue.
d. Acid phosphatase with tartrate resistance.

43. Which stain differentiates granulocytic leukemias (-) from monocytic leukemias (+)?

a. Sudan purple.
b. Toludine blue.
c. Acid phosphate.
d. Nonspecific esterase.

44. What cytochemical stain will stain the granules in basophils and mast cells?

a. Leukocyte alkaline phosphatase stain.
b. Sudan black P.
c. Toluidine blue.
d. Methylene blue.

45. Lymphoma is abnormal growth of cell confined to the tissue.

a. Brain.
b. Bone.
c. Lymphatic.
d. Heart.

46. Which of the following cells are usually counted when determining the M:E ratio?

a. Erthyocytes and megakarocytes.
b. Lymphocytes and myelocytes.
c. Megakarocytes and eosinophils.
d. Granulocytes and red blood cells.

47. The predominant cells associated with acute monocytic leukemia are:

a. Mature and immature eosinophils, monocytes.
b. Promyelocytes, metamyelocytes, and myelocytes.
c. Myeloblasts, lymphoblast, prolymphocytes.
d. Eighty percent monoblasts, promonocytes, and monocytes.

48. In , the predominant cells are small mature lymphocytes show a small cleft or indentation in the nucleus

a. Chronic lymphocytic leukemia.
b. Hair cell leukemia.
c. Prolymphocytic leukemia.
d. Hodgkin’s disease.

49. Which of the following is a lab finding for multiple myeloma?

a. Decrease ESR.
b. Decrease albumin and gamma globulins in the serum.
c. The presence of the myeloma cells.
d. Yellowish tinge to the peripherial blood smear.

50. Acute myelomonocytic leukemia is classified under the FAB system as:

a. M3.
b. M4.
c. M5.
d. M6.

Solutions to Exercises for Lesson 10

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

 

David L. Heiserman, Editor

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All Rights Reserved

Revised: June 06, 2015