WRITTEN COMPETENCY HEMATOLOGY
Name:
Date:
Select the one BEST answer for each of the following statements. Circle the appropriate response on
the answer sheet.
1. The following results were obtained on analysis of an anemic patient:
MCV = 115
MCH = 50
MCHC = 34
Which of the following conditions would produce these results?
A. acute blood loss
B. aplastic anemia
C. iron deficiency
D. pernicious anemia
2. The term that indicates a variation in the shape of red blood cells is:
A. anisocytosis
B. poikilocytosis
C. macrocytosis
D. hypochromia
3. Which of the following hemoglobins is NOT found in normal adult blood?
A. HbA
B. HbA2
C. HbF
D. HbC
4. Which of the following conditions will usually result in leukopenia?
A. measles
B. tonsillitis
C. appendicitis
D. peritoniti
5. Upon examination of a peripheral blood smear, a technologist finds 8 nucleated red blood cells
per 100 white blood cells. The white blood cell count is found to be 15,5 X 109/L Which of the
following is the next step to be taken?
A. report the 15,500 white blood cell count
B. report the 15,500 white blood cell count and make note of the nucleated red blood cells
C. correct the white blood cell count for the nucleated red blood cells present
D. none of the above
Written Competency Hematology 2008
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6. The normal white blood cell count is:
A. 3,5-7,0 X 109/L
B. 5,0-10,0 X 109/L
C. 8,0-12,0 X 109/L
D. 10,0-15,0 X 109/L
7. Which of the following would indicate a macrocytic anemia?
A. MCV = 83 fl
B. MCV = 87fl
C. MCV = 94 fl
D. MCV = 103 fl
8. Which of the following hemoglobin values would be considered abnormal in a male patient?
A. 125 g/L
B. 135 g/L
C. 155 g/L
D. 175 g/L
9. Normal hemoglobin A is made up of which of the following?
A. 2 alpha chains and 2 beta chains
B. 2 alpha chains and 2 delta chains
C. 2 alpha chains and 2 gamma chains
D. none of the above
10. Which of the following cells shows an affinity for the acid dyes?
A. eosinophils
B. basophils
C. neutrophils
D. monocytes
11. What is the normal daily requirement for folic acid?
A. 0.2 mg/day
B. 10 mg/day
C. 20 mg/day
D. 40 mg/day
12. Which of the following hemoglobins is abnormal hemoglobin composing of four betaglobin
chains?
A. hemoglobin F
B. hemoglobin G
C. hemoglobin H
D. hemoglobin S
13. Which of the following hemoglobin characteristically resists alkali denaturation?
A. hemoglobin A
B. hemoglobin F
C. hemoglobin C
D. hemoglobin S
14. Which of the following criteria should be used when attempting to identify cells?
A. cell size
B. nuclear characteristics
Written Competency Hematology 2008
C. cytoplasmic characteristics
D. all of the above
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15. An increase in the total white blood cell count is known as:
A. leukopenia
B. leukocytosis
C. lymphocytosis
D. eosinophilia
16. Which of the following conditions is NOT a cause of eosinophilia?
A. trichinosis
B. asthma
C. skin disease
D. appendicitis
17. The normal range for a platelet count X 10 9/ L is:
A. 5 – 10
B. 50 – 100
C. 150– 400
D. 1,000 – 3,500
18. Which of the following is the structure of hemoglobin F, fetal hemoglobin?
A. 2 alpha chains and 2 beta chains
B. 2 alpha chains and 2 delta chains
C. 2 alpha chains and 2 gamma chains
D. 4 beta chains
19. Which of the following terms is used to indicate a variation of size in red blood cells?
A. anisocytosis
B. poikilocytosis
C. hypochromia
D. polychromasia
20. Which of the following is NOT one of the Romanowsky's stains?
A. Giemsa's stain
B. May-Grunwald stain
C. Pappenheim's stain
D. new methylene blue
21. Which of the following structures is that of hemoglobin A2?
A. 2 alpha chains and 2 beta chains
B. 2 alpha chains and 2 delta chains
C. 2 alpha chains and 2 gamma chains
D. 4 alpha chains
Question 22
Directions: One, some, or all of the responses for each of the following statements may be correct.
Indicate your response as follows:
A.
B.
C.
D.
E.
if items 1 and 3 are correct
if items 2 and 4 are correct
if three of the items are correct
if all of the items are correct
if only one of the items is correct
Written Competency Hematology 2008
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22. Which of the following diseases may exhibit drepanocytes?
1. Hb SC disease
2. Hb S disease
3. Hb S-thalassemia syndrome
4. Hereditary spherocytosis
Question 23- 24
Direction: The column on the left contains 3 scientifically related categories while the column on the
right contains 4 items which may illustrate scientific phenomena or processes. Three of the items
in the column on the right relate to only one of the categories in the column on the left. FIRST,
indicate the category in which the 3 processes or phenomena belong. SECOND, indicate the one
process or phenomena which is not related to that category.
Category
23. A. iron deficiency anemia
B. pernicious anemia
C. sickle cell anemia
Phenomenon
24. A. MCV 99
B. MCHC 30
C. MCH 25
D. B12 deficiency
Question 25- 60
Direction: For each of the numbered items select the appropriate lettered response. Do not use the
same letter more than once.
25. Hemoglobin C
26. Hemoglobin S-C
27. Hemoglobin D
28. Hemoglobin E
A.
B.
C.
D.
E.
Term
migrates like hemoglobin S but non-sickling
decreased osmotic fragility
at pH 6.5 moves slower that hemoglobin S
heterozygous state with 2 abnormal alleles
increased red blood cell survival
Red Blood Cells
29.
30.
31.
32.
polychromatophilia
hypochromia
basophilic stippling
Howell-Jolly bodies
A.
B.
C.
D.
E.
larger central pale area
coarse blue-black granules
blue-gray tint
loop shaped structures
smooth round, dark granule
33.
34.
35.
36.
azurophilic granules
large red granules
large purple granules
bluish gray cytoplasm
A.
B.
C.
D.
E.
eosinophil
monocyte
plasma cell
neutrophil
basophil
Written Competency Hematology 2008
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37.
38.
39.
40.
hypersegmented neutrophils
Barr body
Pelger-Huet anomaly
toxic granulation
A.
B.
C.
D.
E.
two-lobed nuclei
folic acid deficiencies
found normally in females
dark blue-black cytoplasmic granules
darkly stained lymphocytes
Test
41.
42.
43.
44.
Formula
mean corpuscular volume (MCV)
mean corpuscular hemoglobin (MCH)
mean cell hemoglobin concentration (MCHC)
corrected reticulocyte count
A. Retic % X Patient’s HCT
Normal HCT
B. hematocrit X10
red cell count
C. hemoglobin X 100
Hematocrit
D. hemoglobin X 10
red cell count
45. leptocyte
46. acanthocytes
47. elliptocytes
48. schistocytes
A. cigar shaped red cells
B. red cells with thorn-like projections
C. target cells
D. crescent shaped cells
E. red cell fragments
49.
50.
51.
52.
A.
B.
C.
D.
E.
Factor I
Factor IV
Factor VIII
Factor XII
Anticoagulant
calcium
Hageman factor
fibrinogen
prothrombin
antihemophilic factor
Mode of Action
53.
54.
55.
56.
EDTA
Ammonium potassium oxalate
Sodium citrate
Heparin
A.
B.
C.
D.
E.
inactivates calcium irons
anti-thrombin and anti- thromboplastin
chelating agent
forms insoluble calcium
neutralizes fibrinogen
57.
58.
59.
60.
granulocyte
erythrocyte
platelet
lymphocyte
A.
B.
C.
D.
E.
B cell
promyelocyte
promonocyte
megakaryocyte
basophilic normoblast
Written Competency Hematology 2008
Page 5 of 12
Select the one BEST answer for each of the following statements. Circle the appropriate Response on
the answer sheet.
61. The mobility’s obtained on hemoglobin electrophoresis at pH 8.6 shows:
A.
B.
C.
D.
HbS moves faster than HbA
HbC moves faster than HbA
HbA moves slower that HbC or HbS
HbS moves faster than HbC but more slowly than HbA
62. Which of the following would give a reliable hematocrit determination?
A.
B.
C.
D.
collect 1 ml of blood in a 5 ml EDTA tube
perform fingerstick and squeeze finger to fill the capillary tube
omit the buffy coat from the measurement of the cell column height
centrifuge the hematocrit until you think the RBC are well packed
63. Which of the following is the average red blood cell survival time?
A. 1-5 days
B. 9-10 days
C. 60 days
D. 120 days
64. Consider the following indices:
MCV = 60.6
MCH = 25
MCHC = 15.1
Which of the following would you expect to find on the differential blood smear evaluation of
red blood cell morphology?
A.
B.
C.
D.
normochromic red blood cells
hypochromic, macrocytic red blood cells
hypochromic microcytic red blood cells
macrocytic red blood cells
65. Hemoglobinopathies such as Hgb S and C have abnormalities occurring in their:
A. alpha chains of globin
B. beta chains of globin
C. heme
D. pyrrole ring structure
66. An eosinophil count of 800 cells/cu. Mm. could be indicative of which of the following?
A.
B.
C.
D.
normal finding
the patient is suffering from an allergic reaction
the patient has adrenal gland disease
the patient is harboring a virus
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67. According to the laboratory procedure manual at "Hospital X", hemotocrits are to be spun at
10,000 RPM for 4 minutes. A new employee centrifuged the hemotocrits for only 2 minutes at
5,000 RPM. The hemotocrit value may be:
A. falsely decreased
B. falsely increased
C. both of the above
D. neither of the above
68. A positive peroxidase stain will be seen in:
A. lymphocytes
B. promyelocytes
C. myeloblasts
D. lymphoblasts
69. There may be a prolonged bleeding time in many patients taking aspirin because
it interferes with:
A. platelet factor 3 production
B. clot retraction
C. vascular constriction
D. platelet aggregation
70. The activated substance responsible for lysis of the fibrin clot is called:
A. actomysin
B. plasminogen
C. plasmin
D. thromboplastin
Questions 71- 72
Directions: The column on the left contains 3 scientifically related categories while the column on
the right contains 4 items which may illustrate scientific phenomena or processes. Three of the
items in the column on the right relate to only one of the categories in the column on the left.
FIRST, indicate the category in which the 3 processes or phenomena belong. SECOND, indicate the
one process or phenomenon which is not related to that category.
Category
Phenomenon
71. A. calcium
B. thrombin
C. thromboplastin
72. A. EDTA
B. potassium oxalate
C. heparin
D. sodium citrate
Questions 73- 84
Directions: One, some, or all of the responses for each of the following statements may be correct.
Indicate your response as follows:
A.
B.
C.
D.
E.
if items 1 and 3 are correct
if items 2 and 4 are correct
if three of the items are correct
if all of the items are correct
if only one of the items is correct
Written Competency Hematology 2008
Page 7 of 12
73. Which of the following statements are true about HbA, HbA2, and HbF?
1.
2.
3.
4.
are all normal hemoglobins
are present in equal amounts at birth
each have a pair of apha chains
each have a pair of beta chains
74. Examples of microcytic hypochromic anemias include which of the following?
1. iron deificiency anemia
2. sideroblastic anemia
3. Thalassemia
4. Folic acid deficiency
75. Wright's stain consists of:
1. eosin
2. janus green
3. methylene blue
4. safranin
76. Which of the following statements concerning capillary specimens are NOT true?
1. milking or squeezing the finger dilutes the specimen with tissue juices
2. for most determinations, the first drop is acceptable
3. with capillary smears, platelets are clumped
4. smears can be made from heparinized hematocrit capillary tubes
77. Which of the following values would be increased from a patient with hereditary spherocytosis?
1. reticulocyte count
2. osmotic fragility
3. Autohemolysis
4. MCHC
78. Which of the following will cause erroneous results with the Coulter Model LH 500?
1.
2.
3.
4.
WBC count greater than 50,000
cold agglutinin titer 1,500
erythroblastosis fetalis with significant nucleated red blood cells
WBC counts less than 1000
79. A newborn has a hemoglobin of 10 gm/dl, a reticulocyte count of 12%, 25 normoblasts per 100
WBC, marked polychromasia and is jaundiced. What additional tests should be done on the
child?
1. direct Coombs test
2. bilirubin
3. ABO group and Rh
4. Hemoglobin electrophoresis
80. Which of the following will be increased in a patient with hereditary spherocytosis?
1. MCV
2. MCHC
Written Competency Hematology 2008
3. red cell count
4. osmotic fragility
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81. Which of the following are examples of normochromic, normocytic anemias?
1. hemolytic anemias
2. acute blood loss
3. Pernicious anemia
4. Myelophthisic anemia
82. Which of the following laboratory tests are useful in diagnosing an abnormality in platelet function?
1. template bleeding time
2. platelet aggregation
3. platelet adhesion
4. clot retraction
83. Platelet function includes which of the following?
1.
2.
3.
4.
formation of a platelet plug
release of phospholipids (Pf3)
maintenance of vascular integrity
release of thromboplastin for proper clot retraction
84. Overall competence of the coagulation system is assessed by performing which of the following
tests?
1. prothrombin time
2. partial trhomboplastin time
3. Fibrinogen level
4. Clot solubility test
Questions 85- 87
Directions: One, some, or all of the responses for each of the following statements may be correct.
Indicate your response as follows:
A.
B.
C.
D.
E.
if items 1 and 3 are correct
if items 2 and 4 are correct
if three of the items are correct
if all of the items are correct
if only one of the items is correct
85. The erythrocyte sedimentation rate (ESR) will be increased in the following situations:
1. Increased room temperature
2. Anemia
3. ESR tube is not exactly vertical
4. Increased red cell mass
86. The Coulter Model LH 500 directly measures which of these parameters?
1. MCV
2. RBC
3. WBC
4. PLT
5. HCT
87. As the red cell matures, which of the following changes occur?
1. Cell becomes smaller
2. Nucleus becomes denser and smaller and is finally extruded
3. The amount of hemoglobin increases in the cytoplasm
4. Cytoplasm progresses from blue to red with Wright’s stain
Written Competency Hematology 2008
Page 9 of 12
Select the one BEST answer for each of the following statements. Circle the Appropriate response on
the answer sheet.
88. The bleeding time is a test for:
A. factor VIII deficiency
B. fibrin formation
C. contact factor activation
D. platelet and vascular function
89. If a differential has 10-20 white blood cells per high power field, what would be the patient’s
estimated white cell count?
A. 8,000-12,000/cu.mm.
B. 13,000-18,000/cu.mm
C. 25,000-30,000/cu.mm.
D. 35,000-40,000/cu.mm.
90. A patient with the following indices could be said to have what type of anemia?
MCV--71
MCH--22
A. hypochromic, normocytic
B. normochromic, microcytic
MCHC—31
C. hypochromic, microcytic
D. normochromic, normocytic
91. Which of the following is produced by the first stage of coagulation?
A. thrombin
B. fibrin
C. plasmin
D. thromboplastin (plasma)
92. An increased erythropoietin level is seen in which of the following?
A. secondary erythrocytosis
B. polycythemia vera
C. rheumatoid arthritis
D. cancer
Questions 93- 95
Directions: One, some, or all of the responses for each of the following statements may be correct.
Indicate your response as follows:
A.
B.
C.
D.
if items 1 and 3 are correct
if items 2 and 4 are correct
if three of the items are correct
if all of the items are correct
93. Patient reports for correct INR calculations, patient values, and reference ranges should be
checked under the following circumstances:
1. Change in lot or type of PT reagent
2. Change in instrument
3. Establishment of new PT reference range
4. Change in INR calculation
5. Annually, in the absence of the above changes
Written Competency Hematology 2008
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94. A hematocrit value >55% may:
1. Lead to spurious coagulation results.
2. The citrate anticoagulant distributes only in the plasma and not into the blood cells.
3. Plasma citrate concentration will be increased if the patient's hematocrit is greater than
55%,
4. Leading to prolonged PT and aPTT results,
5. Erroneous results for other calcium-dependent clotting tests such as clottable protein
C/protein S.
95. Incorrect data maybe due to instrument malfunction or problems with the sample itself. Some
examples may include:
1. spurious elevated MCVs and MCHCs with cold agglutinins,
2. falsely elevated MCHCs with lipemia and plasma paraproteins,
3. spuriously low MCHCs with leukocytosis and
4. osmotic effects such as hyperglycemia altering MCV.
96. MCV and MCH are fairly constant for each patient, and monitoring these indices in a delta
check error detection program may provide rapid patient-bases detection of instrument
malfunction or specimen misidentification.
A. True
B. False
97. The following illustrates a typical calculation of the INR from actual patient information and
the ISI value:
Patient PT value = 18.5 seconds
Mean of normal range - 10.5 seconds
ISI = 1.3
INR = -----------------------------98. How to handle a specimen with elevated hematocrits?
---------------------------------------------------------------------------------------------------------------
99. Compute the amount of anticoagulant needed for a 5 ml total volume specimen and
hematocrit 60%
Written Competency Hematology 2008
Page 11 of 12
100. The following could give false- positive results in the solubility test for detection of HB S except:
A.
B.
C.
D.
Presence of many nucleated red blood cells in the peripheral blood
Large amount of proteins in patient plasma
Incomplete lysis of red blood cells
Severe anemia
101. The following findings may occur in sickle cell trait except
a.
b.
c.
d.
Painless hematuria
Isosthenuria
Markedly increased HB A2
Sudden death
102. All of the following laboratory findings are consistent with HB SC disease except:
a.
b.
c.
d.
Rare sickle cells
Crystals
Boat-shaped cells
HB A2 will be contained within HB S by HB electrophoresis alkaline pH
103. All the following statements regarding the red blood cells indices are true except:
a. Mean corpuscular hemoglobin MCH is calculated from hemoglobin and RBC
b. MCV is determined by the distribution of the red blood cell histogram
c. MCH is the most useful of the red blood cell indices
d. MCH concentration is of minimal diagnostic use
104. HB S and HB F migrates together
A. True
B. False
105. PT test is used to evaluate the adequacy of the extrinisic system and common pathway the
clotting mechanism
A. True
B. False
106. If the MCV indices are increased, the RBC is said to be macrocytic
A. True
B. False
Written Competency Hematology 2008
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