HEMATOLOGY EXAM 2025 UPDATED VERIFIED QUESTIONS WITH CORRECT ANSWERS, Exams of Hematology

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HEMATOLOGY EXAM 2025 UPDATED VERIFIED

QUESTIONS WITH CORRECT ANSWERS

1. You require your laboratory staff to annually perform manual lupus anticoagulant profiles on a

set of plasmas with known values. This exercise is known as:

a. Assay validation b. Proficiency testing c. External quality assessment d. Pre-pre-analytical

variable assay: b. Proficiency testing

2. When performing a receiver operating curve analysis, what parameter assesses

the overall efficacy of an assay

a. Area under the curve b. Performance limit (threshold) c. Positive predictive value d. Negative

predictive value: a. Area under the curve

3. Review of laboratory report integrity is an example of: a. Preanalytical quality assurance

b. Analytical quality control c. Postanalytical quality assurance d. External quality assurance: c. Postanalytical quality assurance

4. Regular review of blood specimen collection quality is an example of:

a. Postanalytical quality assurance b. Preanalytical quality assurance c. An- alytical quality control

d. External quality assurance: b. Preanalytical quality assurance

5. What agency provides continuing medical laboratory education?

a. Colorado Association for Continuing Medical Laboratory Education (CACM- LE)

b. Clinical Laboratory Improvement Advisory Committee (CLIAC)

c. Centers for Medicare and Medicaid Services (CMS) d. College of American Pathologists (CAP): a.

Colorado Association for Continuing Medical Laboratory Education (CACMLE)

6. What agency provides external quality assurance (proficiency) surveys and laboratory

accreditation? a. Clinical Laboratory Improvement Advisory Committee (CLIAC) b. Centers for Medicare and Medicaid Services (CMS) c. College of American Pathologists (CAP) d. Joint Commission: c. College of American Pathologists (CAP

7. You perform a clinical efficacy test and get the following results: Unaffected by

Disease or Condition Affected by Disease or Condition Assay is negative 40 Affected by Disease or Condition Assay os negative 5 Unaffected by Disease or Condition Assay is positive 10 Affected by Disease or Condition Assay is positive 45 What is the number of false-negative results? a. 40

b. 10

c. 5 d. 45: c. 5

8. You purchase a preserved whole blood specimen from a distributor who provides the mean

values for several complete blood count analytes. What is this specimen called? a. Normal

specimenb. Calibrator

c. Control

d. Blank: c. Control

9. a. Confirming linearity b. Setting the reference interval 8. A laboratory scientist measures

prothrombin time for plasma aliquots from 15 healthy males and 15 healthy females. She computes the mean and 95.5 % confidence interval and notes that they duplicate the manufacturer's statistics within 5 %. This procedure is known as : c. Determining the therapeutic range d. Establishing the reference interval by transference: d. Establishing the reference interval by transference

10.The laboratory purchases reagents from a manufacturer and develops an assay using standard

references. What FDA category is this assay? a. Cleared b. Home - brew c. Research use only d. Analyte - specific reagent: d

. Analyte - specific reagent

11. The ability of an assay to distinguish the targeted analyte from interfer- ing substances within

the specimen matrix is called : a. Analytical specificity b

. Analytical sensitivity c. Clinical specificity d. Clinical sensitivity: a. Analytical specificity

12. A WBC count control has a mean value of 6000 / mL and a standard deviation of 300 / mL. What

is the 95.5 % confidence interval? a. 3000 to 9000 / mL b. 5400 to 6600 / mL c. 5500 to 6500 / mL d. 5700 to 6300 / mL: b. 5400 to 6600 / mL

13. The acceptable hemoglobin control value range is 13 6 0.4 g / dL. The control is assayed five

times and produces the following five results : 12.0 g / dL 12.3 g / dL 12.0 g / dL 12.2 g / dL 12.1 g dL These results are : a. Accurate but not precise b. Precise but not accurate c. Both accurate and precise d. Neither accurate nor precise: b. Precise but not accurate

14.Which is a statistical test comparing means? a. Bland Altman b. Student's t test c

ANOVA d. Pearson: b. Student's t - test

15. Standard precautions apply to all of the following except

a. Blood b. Cerebrospinal fluid c Semen d Concentrated: d Concentrated acids

16. The most important practice in preventing the spread of disease is

a Wearing masks during patient contact b. Proper hand washing c Wearing disposable laboratory coats d Identifying specimens from known or suspect- ed HIV and HBV infected patients with a red label: b Proper hand washing

17. The appropriate dilution of bleach to be used in laboratory disinfection is :

a.1 : 2 b. 1 : 5 c. 1:10 d 1 100: c 1:

18.How frequently should fire alarms and sprinkler systems be tested a. Weekly b. Monthly

c. Quarterly d. Annually: c. Quarterly

19. Where should alcohol and other flammable chemicals be stored? a. In an approved

safety can or storage cabinet away from heat sources b Under a hood and arranged alphabetically for ease of identification in an emergency c In a refrigerator at 28 C to 88 C to reduce volatilization d. On a low shelf in an area protected from light: a. In an approved safety can or storage cabinet away from heat sources

20. The most frequent cause of needle punctures is :

a. Patient movement during venipuncture b. Improper disposal of phlebotomy equipment c. Inattention during removal of needle after venipuncture d. Failure to attach needle firmly to syringe or tube holder: b. Improper disposal of phlebotomy equipment

21. Under which of the following circumstances would a SDS be helpful?

a. A phlebotomist has experienced a needle puncture with a clean needle.

b. A fire extinguisher failed during routine testing. c. A pregnant laboratory employee has asked

whether she needs to be concerned about working with a given reagent d. During a safety inspection, an aged microscope power supply is found to have a frayed power cord: c. A pregnant laboratory employee has asked whether she needs to be concerned about working with a given reagent

22. It is a busy evening in the City Hospital hematology department. One staff member called in sick

, and there was a major auto accident that has one staff member tied up in the blood bank all evening. Mary , the medical laboratory scientist covering hematology , is in a hurry to get a stat sample on the analyzer but needs to pour off an aliquot for another department. She is wearing gloves and a lab coat She carefully covers the stopper of the well - mixed ethylenediaminetetraacetic acid ( EDTA ) tube with a gauze square and tilts the stopper toward her so it opens away from her She pours off about 1 mL into a prelabeled tube replaces the stopper of the EDTA tube , and puts it in the sample rack and sets it on the conveyor She then brings the poured sample off to the other department How would you assess Mary's safety practice?

. Mary was careful and followed all appropriate procedures. b. Mary should have us: b. Mary should have used a shield when opening the tube.

23.What class fire extinguisher would be appropriate to use on a fire in a chemical cabinet? a.

Class A b. Class B c. Class C d. Class D: b. Class B

24.According to OSHA standards , laboratory coats must be all of the following except a. Water

resistant b. Made of cloth fabric that can be readily laundered c. Long - sleeved d. Worn fully buttoned: b. Made of cloth fabric that can be readily laundered

25.Which one of the following would NOT be part of a safety management plan? a. Job safety

analysis b. Risk assessment of potential safety hazards c. Mechanism for reporting accidents d.

personal equipment: d. Budget for engineering controls and personal protective equipment

26.Which step in the CLSI procedure for venipuncture part of standard pre- cautions? a. Wearing

gloves b. Positively identifying the patient c. Cleansing the site for the venipuncture d. Bandaging the venipuncture site: a. Wearing gloves

27.Select the needle most commonly used in standard venipuncture in an adult : a. One inch , 18

gauge b. One inch , 21 gauge c One - half inch , 23 gauge d. One - half inch , 25 gauge: b. One inch , 21 gauge

28. For a complete blood count ( hematology and measurement of pro- thrombin time ( coagulation )

, the phlebotomist collected blood into lavender stopper and green stopper tubes Are these specimens acceptable? a Yes , EDTA is used for hematologic testing and heparin is used for coagulation testing. b No , although EDTA is used for hematologic testing , citrate , not heparin , is used for coagulation testing c. No , although heparin is used for hematologic testing citrate , not EDTA , is used for coagulation testing. d

. No , hematologic testing requires citrate and coagulation testing requires a clot so neither tube is acceptable: b. No , although EDTA is used for hematologic testing citrate , not heparin , is used for coagulation testing.

29. The vein of choice for performing venipuncture is the : a. Basilic , because it is the most

prominent vein in the antecubital fossa b. Cephalic or accessory cephalic , because it is the least painful site. Median or median cubital , because it has the lowest risk of damaging nerves in the arm d. One of the hand veins , because they are most superficial and easily accessed: c Median or median cubital , because it has the lowest risk of damaging nerves in the arm

30.The most important step in phlebotomy is : a. Cleansing the site b. Identifying the patient

c. Selecting the proper needle length d. Using the correct evacuated tube: b. Identifying the patient

31. The venipuncture needle should be inserted into the arm with the bevel facing : a. Down and an

angle of insertion between 15 and 30 degrees b. Up and an angle of insertion less than 30 degrees c. Down and an angle of insertion greater than 45 degrees d. Up and an angle of insertion between 30 and 45 degrees: b. Up and an angle of insertion less than 30 degrees

32.Failure to obtain blood by venipuncture may occur because of all of the following except : a.

Incorrect needle positioning b. Tying the tourniquet too tightly c. Inadequate vacuum in the tube d. Collapsed vein: b. Tying the tourniquet too tightly

33. What is the recommended order of draw when the evacuated tube sys- tem is used? a. Gel

separator , nonadditive , coagulation , and blood culture b. Additive , nonadditive gel separator , and blood culture c. Nonadditive , blood culture , coagulation , and other additives d. Blood culture , coagulation , nonadditive , and gel separator or other additives: d. Blood culture coagulation nonadditive , and gel separator or other additives

34.Which one of the following is an acceptable site for skin puncture on infants : a. Back curvature

of the heel b. Lateral or medial plantar surface of the heel c. Plantar surface of the heel close to the arch of the foot d. Middle of the plantar surface of the heel: b. Lateral or medial plantar surface of the heel

35.An anticoagulant is an additive placed in evacuated tubes to : a. Make the blood clot faster b.

Dilute the blood before testing c. Prevent the blood from clotting d. Ensure the sterility of the tube: c

. Prevent the blood from clotting

36.Which one of the following is a reason for specimen rejection : a. Clot in a red stopper tube b.

Specimen collected for blood cortisol in the morning c. Specimen in lavender stopper tube grossly hemolyzed d. Room number is missing from the specimen tube label: c. Specimen in lavender

stopper tube grossly hemolyzed

37.One legal area of concern for the phlebotomist is : a. Breach of patient confidentiality b. Failure

to obtain written consent for phlebotomy c. Entering a patient's room when the family is present d. Asking an outpatient for his or her full name in the process of identification: a. Breach of patient confidentiality

38. Use of which one of the following types of objective lens causes the center of the microscope

field to be in focus , whereas the periphery is blurred ? a. Plan achromatic b. Achromatic c. Plan apochromatic d. Flat field: b. Achromatic

39. Which of the following gathers , organizes , and directs light through the specimen? a.

Eyepiece b. Objective lens c. Condenser d. Optical tube: c. Condenser

40. After focusing a specimen by using the 403 objectives , the laboratory professional switches to

a 103 objective. The specimen remains in focus at

103. Microscopes with this characteristic are described as : a. Parfocal b. Parcentricc. Compensated d. Parachromatic: a. Parfocal

41.Which objective has the greatest degree of color correction? a. Achro- matic b. Plan

apochromatic c. Bichromatic d. Plan achromatic: b. Plan apochromatic

42.In adjusting the microscope light using Koehler illumination , which one of the following is true?

a. Condenser is first adjusted to its lowest position b. Height of the condenser is adjusted by removing the eyepiece c. Image of the field diaphragm iris is used to center the condenser d Closing the aperture diaphragm increases the resolution the image: c. Image of the field diaphragm iris is used to center the condenser

43.The total magnification obtained when a 103 eyepiece and a 103 objec- tive lens are used is a.

13 b. 103 c. 1003 d. 10003: c. 1003

44.After a microscope has been adjusted for Koehler illumination , and the specimen is being

viewed with an oil immersion objective lens , light intensity should never be regulated by adjusting the : a. Rheostat b. Neutral density filter c. Light control knob d. Condenser: d. Condenser

45.The recommended cleaner for removing oil from objectives is : a. 70 % alcohol or lens cleaner b.

Xylene c. Water d. Benzene: a. 70 % alcohol or lens cleaner

46. Which of the following types of microscopy is valuable in the identifica- tion of crystals that are

double refractive? a. Compound brightfieldb. Darkfield c. Polarizing d. Phase-contrast: c. Polarizing

47. A laboratory science student has been reviewing a hematology slide using the 103 objectives to

find a suitable portion of the slide for examination

. He moves the 103 objectives out of place , places a drop of oil on the slide , rotates the nosepiece so that the 403 objective passes through the viewing position , and continues to rotate the 1003 oil objective into viewing position . This practice should be corrected in which way? a. The stage of a parfocal microscope should be lowered before the objectives are rotated. b. The 1003 oil objective should be in place for viewing before the oil is added c. The drop of oil should be in place and the 1003 objective lowered into the oil , rather than swinging the objective into the drop. d. The objectives should be rotated in the opposite direction so that the 403 objectives does not risk entering the oil .: d. The objectives should be rotated in the opposite direction so that the 403 objectives does not risk entering the oil

48. Darkfield microscopes create the dark field by : a Using two filters that cancel each other out

, one above and the other below the condenser b. Angling the light at the specimen so that it misses the objective unless something in the specimen bends it backward c. Closing the condenser

diaphragm entirely , limiting light to just a tiny ray in the center of the otherwise dark field d. Using a light source above the specimen and collecting light reflected from the specimen , rather than transmitted through the specimen , so that when there is no specimen in place , the field is dark: b. Angling the light at the specimen so that it misses the objective unless something in the specimen bends it backward

49.What procedure is employed to validate a new assay? a. Comparison of assay results to

reference method b. Test for assay precision c. Test for assay linearity d. All of the above: d. All of the above

50.You validate a new assay using linear regression to compare assay calibrator results with the

distributor's published calibrator results. The slope is 0.99 and the y intercept is 110 %. What type of error is present? a. No error b. Random error c. Constant systematic error d. Proportional systematic error: c. Constant systematic error

51. The organelle involved in packaging and trafficking of cellular products is the:

a. Nucleus

b. Golgi apparatus c. Mitochondria

d. Rough endoplasmic reticulum: b. Golgi apparatus

52. The glycocalyx is composed of membrane: a. Phospholipids and choles- terol

b. Glycoproteins and glycolipids c. Transmembrane and cytoskeletal proteins d. Rough and smooth endoplasmic reticulum: b. Glycoproteins and glycolipids

53. The "control center" of the cell is the:

a. Nucleus b. Cytoplasm c. Membrane d. Microtubular system: a. Nucleus

54. The nucleus is composed largely of: a. RNA

b. DNA c. Ribosomes d. Glycoproteins: b. DNA

55. 5. Protein synthesis occurs in the: a. Nucleus

b. Mitochondria c. Ribosomes: c. Ribosomes

56. The shape of a cell is maintained by which of the following? a. Micro- tubules

b. Spindle fibers c. Ribosomes d. Centrioles: a. Microtubules

57. Functions of the cell membrane include all of the following except:

a. Regulation of molecules entering or leaving the cell b. Receptor recognition of extracellular signals

c. Maintenance of electrochemical gradients d. Lipid production and oxidation: d. Lipid production and oxidation

58. The energy source for cells is the: a. Golgi apparatus

b. Endoplasmic reticulum c. Nucleolus

d. Mitochondrion: d. Mitochondrion

59. Ribosomes are synthesized by the: a. Endoplasmic reticulum

b. Mitochondrion

c. Nucleolus

d. Golgi apparatus: c. Nucleolus

60. Euchromatin functions as the:

a. Site of microtubule production b. Transcriptionally active DNA c. Support structure for nucleoli d.

Attachment site for centrioles: b. Transcriptionally active DNA

61. The cell cycle is regulated by: a. Cyclins and CDKs

b. Protooncogenes c. Apoptosis

d. Growth factors: a. Cyclins and CDKs

62. The transition from the G1 to S stage of the cell cycle isregulated by:

a. Cyclin B/CDK1 complex b. Cyclin A/CDK2 complex c. Cyclin D d. Cyclin E/CDK2 complex: d. Cyclin E/CDK2 complex

63. Apoptosis is morphologically identified by: a. Cellular swelling

b. Nuclear condensation c. Rupture of the cytoplasm d. Rupture of the nucle- us: b. Nuclear condensation

64. Regulation of the hematopoietic microenvironment is provided by the:

a. Stromal cells and growth factors b. Hematopoietic stem cells c. Liver and spleen d. Cyclins and caspases: a. Stromal cells and growth factors

65. The process of formation and development of blood cells is termed:a.

Hematopoiesis b. Hematemesis c. Hematocytometry d. Hematorrhea: a. Hematopoiesis

66. During the second trimester of fetal development, the primary site of blood cell production is

the:

a. Bone marrow b. Spleen c. Lymph nodes d. Liver: d. Liver

67. Which one of the following organs is responsible for the maturation of T lymphocytes and

regulation of their expression of CD4 and CD8? a. Spleen b. Liver c. Thymus d. Bone marrow: c. Thymus

68. The best source of active bone marrow from a 20-year-old would be:

a. Iliac crest b. Femur c. Distal radius d. Tibia: a. Iliac crest

69. Physiologic programmed cell death is termed: a. Angiogenesis

b. Apoptosis c. Aneurysm d. Apohematics: b. Apoptosis

70. Which organ is the site of sequestration of platelets? a. Liver

b. Thymus c. Spleen d. Bone marrow: c. Spleen

71. Which one of the following morphologic changes occurs during normal blood cell maturation:

a. Increase in cell diameter b. Development of cytoplasm basophilia c. Con- densation of nuclear

chromatin d. Appearance of nucleoli: c. Condensation of nuclear chromatin

72. Which one of the following cells is a product of the CLP? a. Megakary- ocyte

b. T lymphocyte c. Erythrocyte d. Granulocyte: b. T lymphocyte

73. What growth factor is produced in the kidneys and is used to treat anemia associated

with kidney disease? a. EPOb. TPO c. G-CSF d. KIT ligand: a. EPO

74. Which one of the following cytokines is required very early in the differentiation of a

hematopoietic stem cell?

a. IL-

b. IL-

c. EPO

d. FLT3 ligand: d. FLT3 ligand

75. When a patient has severe anemia and the bone marrow is unable to effectively produce red

blood cells to meet the increased demand, one of the body's responses is: a. Extramedullary hematopoiesis in the liver and spleen b. Decreased production of erythropoietin by the kidney c. Increased apoptosis of erythrocyte progenitor cells d. Increase the proportion of yellow marrow in the long bones: a. Extramedullary hematopoiesis in the liver and spleen

76. Hematopoietic stem cells produce all lineages of blood cells in suffi- cient quantities over the

lifetime of an individual because they:

a. Are unipotent b. Have the ability of self-renewal by asymmetric division c. Are present in large

numbers in the bone marrow niches d. Have a low mitotic potential in response to growth factors: b. Have the ability of self-renewal by asymmetric division

77. Which of the following is an erythrocyte progenitor? a. Pronormoblast

b. Reticulocyte c. CFU-E

d. Orthochromic normoblast: c. CFU-E

78. Which of the following is the most mature normoblast? a. Orthochromic normoblast

b. Basophilic normoblast c. Pronormoblast d. Polychromatic normoblast: a. Orthochromic normoblast

79. What erythroid precursor can be described as follows: the cell is of medium size compared with

other normoblasts, with an N:C ratio of nearly 1:1. The nuclear chromatin is condensed and chunky throughout the nucleus. No nucleoli are seen. The cytoplasm is a muddy, blue-pink color. a. Reticulocyte

b. Pronormoblast

c. Orthochromic normoblast

d. Polychromatic normoblast: d. Polychromatic normoblast

80. Which of the following is not related to the effects of erythropoietin?

a. The number of divisions of a normoblast b. The formation of pores in sinusoidal endothelial cells

for marrow egress c. The time between mitoses of normoblasts d. The production of antiapoptotic molecules by erythroid progenitors: b. The formation of pores in sinusoidal endothelial cells for marrow egress

81. Hypoxia stimulates RBC production by: a. Inducing more pluripotent stem cells into the

erythroid lineage

b. Stimulating EPO production by the kidney c. Increasing the number of RBC mitoses d. Stimulating

the production of fibronectin by macrophages of the bone marrow: b. Stimulating EPO production by the kidney

82. In the bone marrow, RBC precursors are located: a. In the center of the hematopoietic cords b.

Adjacent to megakaryocytes along the adventitial cell lining c. Surrounding fat cells in apoptotic islands d. Surrounding macrophages in erythroid islands: d. Surrounding macrophages in erythroid islands

83. Which of the following determines the timing of egress of RBCs from the bone marrow?

a. Maturing normoblasts slowly lose receptors for adhesive molecules that bind them to stromal

cells.

b. Stromal cells decrease production of adhesive molecules over time as

RBCs mature.

c. Endothelial cells of the venous sinus form pores at specified intervals of time, allowing egress

of free cells.

d. Periodic apoptosis of pronormoblasts in the marrow cords

occurs: a. Maturing normoblasts slowly lose receptors for adhesive molecules that bind them to stromal cells

84. What single feature of normal RBCs is most responsible for limiting their life span?

a. Loss of mitochondria b. Increased flexibility of the cell membrane c. Reduc- tion of hemoglobin iron d. Loss of the nucleus: d. Loss of the nucleus

85. Intravascular or fragmentation hemolysis is the result of trauma to RBCs while in the circulation.

a. True b. False: a. True

86. Extravascular hemolysis occurs when: a. RBCs are mechanically rup- tured b. RBCs

extravasate from the blood vessels into the tissues c. Splenic macrophages ingest senescent cells d. Erythrocytes are trapped in blood clots outside the blood vessels: c. Splenic macrophages ingest senescent cells

87. A pronormoblast in its usual location belongs to the RBC mass of the body, but not to the

erythron.

a. True

b. False: b. False

88. A cell has an N:C ratio of 4:1. Which of the following statements would describe it?

a. The bulk of the cell is composed of cytoplasm. b. The bulk of the cell

is composed of nucleus. c. The proportions of cytoplasm and nucleus are roughly equal: b. The bulk of the cell is composed of nucleus

89. Which RBC process does not require energy? a. Oxygen transport

b. Cytoskeletal protein deformability c. Preventing the peroxidation of proteins and lipids d.

Maintaining cytoplasm cationic electrochemical gradients: a. Oxygen transport

90. What pathway anaerobically generates energy in the form of ATP?

a. Hexose monophosphate pathway b. Rapoport-Luebering pathway c. Emb- den-Meyerhof pathway d. 2,3-BPG pathway: c. Embden-Meyerhof pathway

91. Which is true concerning 2,3-BPG? a. The least abundant of RBC organophosphates b.

Enhances O2 release from hemoglobin c. Source of RBC glucose d. Source of RBC ATP: b. Enhances O2 release from hemoglobin

92. To survive, the RBC must detoxify peroxides. What hexose onophosphate shunt

product(s) accomplishes detoxification?

a. ATP

b. 2,3-BPG c. Pyruvic and lactic acid d. NADPH and reduced glutathione: d. NADPH and reduced

glutathione

93. Which of the following helps maintain RBC shape? a. Membrane phos- pholipids

b. Cytoskeletal proteins c. GPI anchor d. Glycocalyx: 5. Which of the following helps maintain RBC shape? a. Membrane phospholipids b. Cytoskeletal proteins c. GPI anchor d. Glycocalyx

94. The glycolipids of the RBC membrane: a. Provide flexibility.

b. Carry RBC antigens. c. Constitute ion channels. d. Attach the cytoskeleton to the lipid layer: b. Carry RBC antigens.

95. RBC membrane phospholipids are arranged: a. In a hexagonal lattice.

b. In chains beneath a protein exoskeleton. c. In two layers whose composition is asymmetric. d. So that hydrophobic portions are facing the plasma: c. In two layers whose composition is asymmetric

96. RBC membrane cholesterol is replenished from the: a. Plasma.

b. Mitochondria. c. Cytoplasm. d. EMB pathway: a. Plasma

97. The hemoglobin iron ion may become oxidized to the 13- valence state by several pathological

mechanisms. What portion of the Embden-Meyerhof pathway reduces iron to the physiologic 12 valence state? a. Methemoglobin reductase pathway b. Hexose monophosphate pathway c. Rapoport-Luebering pathway d. The 2,3-BPG shunt: a. Methemoglobin reduc- tase pathway

98. Which of the following is an example of a transmembrane or integral membrane protein?

a. Glycophorin A b. Ankyrin c. Spectrin d. Actin: a. Glycophorin A

99. Abnormalities in the horizontal and vertical linkages of the transmem- brane and cytoskeletal

RBC membrane proteins may be seen as:

a. Shape changes. b. Methemoglobin increase. c. Reduced hemoglobin con- tent. d. Enzyme

pathway deficiencies: a. Shape changes

100. A hemoglobin molecule is composed of: a. One heme molecule and four globin chains

b. Ferrous iron, protoporphyrin IX, and a globin chain c. Protoporphyrin IX and four globin chains d. Four heme molecules and four globin chains: d. Four heme molecules and four globin chains

101. Normal adult Hb A contains which polypeptide chains? a. a and b

b. a and d c. a and g d. a and e: a. a and b

102. A key rate-limiting step in heme synthesis is suppression of: a.

Aminolevulinate synthase

b. Carbonic anhydrase c. Protoporphyrin IX reductase d. Glucose 6-phosphate dehydrogenase: a. Aminolevulinate synthase

103. Which of the following forms of hemoglobin molecule has the lowest affinity for oxygen?

a. Tense b. Relaxed: a. Tense

104. Using the normal hemoglobin-oxygen dissociation curve in Figure 10-7 for reference,

predict the position of the curve when there is a decrease in pH.

a. Shifted to the right of normal with decreased oxygen affinity

b. Shifted to the left of normal with increased oxygen affinity c. Shifted to the right of normal with

increased oxygen affinity d. Shifted to the left of normal with decreased oxygen affinity: a. Shifted to the right of normal with decreased oxygen affinity

105. The predominant hemoglobin found in a healthy newborn is:

a. Gower-1 b. Gower- c. A d. F: d. F

106. What is the normal distribution of hemoglobins in healthy adults?

a. 80% to 90% Hb A, 5% to 10% Hb A2, 1% to 5% Hb F b. 80% to 90% Hb A2, 5% to 10% Hb A, 1% to 5% Hb F c. .95% Hb A, ,3.5% Hb A2, 1% to 2% Hb F d. .90% Hb A, 5% Hb F, ,5% Hb A2: c. .95% Hb A, ,3.5% Hb A2, 1% to 2% Hb F

107. Which of the following is a description of the structure of oxidized hemoglobin?

a. Hemoglobin carrying oxygen on heme; synonymous with oxygenated he- moglobin

b. Hemoglobin with iron in the ferric state (methemoglobin) and not able to carry oxygen

c. Hemoglobin with iron in the ferric state so that carbon dioxide replaces oxygen in the heme

structure d. Hemoglobin carrying carbon monoxide; hence "oxidized" refers to the single oxygen: b. Hemoglobin with iron in the ferric state (methemoglobin) and not able to carry oxygen

108. In the quaternary structure of hemoglobin, the globin chains associate into:

a. a tetramer in some cells and b tetramers in othersb. A mixture of a tetramers and b tetramers c. a dimers and b dimers d. Two ab dimers: d. Two ab dimers

109. How are the globin chain genes arranged? a. With a genes and b genes on the same

chromosome, including two a gene and two b genes

b. With a genes and b genes on separate chromosomes, including two a genes on one chromosome

and one b gene on a different chromosome

c. With a genes and b genes on the same chromosome, including four a gene and four b genes

d. With a genes and b genes on separate chromosomes, including four a gene on one chromosome

and two b genes on a different chromosome: b. With a genes and b genes on separate chromosomes, including two a genes on one chromosome and one b gene on a different chromosome

110. The nature of the interaction between 2,3-BPG and hemoglobin is that 2,3-BPG:

a. Binds to the heme moiety, blocking the binding of oxygen b. Binds simulta- neously with oxygen to ensure that it stays bound until it reaches the tissues, when both molecules are released from hemoglobin c. Binds to amino acids of the globin chain, contributing to a conformational change that inhibits oxygen from binding to heme d. Oxidizes hemoglobin iron, diminishing oxygen binding and promoting oxy- gen delivery to the tissues: c. Binds to amino acids of the globin chain, contributing to a conformational change that inhibits oxygen from binding to heme

111. 1. Iron is transported in plasma via: a. Hemosiderin

b. Ferritin c. Transferrin d. Hemoglobin: d. Hemoglobin

112. 2. What is the major metabolically available storage form of iron in the body?

a. Hemosiderin

b. Ferritin c. Transferrin

d. Hemoglobin: b. Ferritin

113. 3. The total iron-binding capacity (TIBC) of the serum is an indirect measure of

which iron-related protein? a. Hemosiderin b. Ferritin c. Transferrin d. Hemoglobin: c. Transferrin

114. For a patient with classic iron study values that are equivocal for iron deficiency, which of

the following tests would be most helpful in determining whether iron deficiency is present or not? a. Zinc protoporphyrin b. Peripheral blood sideroblast assessment c. Soluble transferrin receptor d. Mean cell hemoglobin: c. Soluble transferrin receptor

115. What membrane-associated protein in enterocytes transports iron from the intestinal

lumen into the enterocyte? a. Transferrin b. Ferroportin c. DMT1 d. Ferrochelatase: c. DMT1

116. Iron is transported out of macrophages, hepatocytes, and enterocytes by what membrane

protein? a. Transferrin b. Ferroportin c. DMT1 d. Ferrochelatase: b. Ferroportin

117. Below are several of the many steps in the process from absorption and transport of iron

to incorporation into heme. Place them in proper order. i. Transferrin picks up ferric iron. ii. Iron is transferred to the mitochondria. iii. DMT1 transports ferrous iron into the enterocyte. iv. Ferroportin transports iron from enterocyte to plasma. v. The transferrin receptor transports iron into the cell. a. v, iv, i, ii, iii b. iii, ii, iv, i, v c. ii, i, v, iii, iv d. iii, iv, i, v, ii: d. iii, iv, i, v, ii

118. What is the fate of the transferrin receptor when it has completed its role in the delivery of

iron to a cell? a. It is recycled to the plasma membrane and released into the plasma.

b. It is recycled to the plasma membrane, where it can bind its ligand again.

c. It is catabolized and the amino acids are returned to the metabolic pool.

d. It is retained in the endosome for the life span of the cell: b. It is recycled to the plasma

membrane, where it can bind its ligand again

119. The transfer of iron from the enterocyte into the plasma is REGULATED by:

a. Transferrin b. Ferroportin c. Hephaestin d. Hepcidin: d. Hepcidin

120. What is the percent transferrin saturation for a patient with total serum iron of 63 mg/dL

and TIBC of 420 mg/dL? a. 6.7% b. 12% c. 15% d. 80%: c. 15%

121. Referring to Figure 11-6, into which quadrant of a Thomas plot would a patient's results

fall with the following test results: Soluble transferrin receptor: increased above reference interval Ferritin: decreased below reference interval Hemoglobin content of reticulo- cytes: within the reference interval

a. Normal iron status b. Latent iron deficiency c. Functional iron deficiency d. Iron deficiency: a.

Normal iron status b. Latent iron deficiency c. Functional iron deficiency d. Iron deficiency

122. A physician is concerned that a patient is developing iron deficiency from chronic

intestinal bleeding due to aspirin use for rheumatoid arthritis.

The iron studies on the patient show the following results SERUM FERRITIN LEVEL 12-400 ng/mL 25 ng/mL SERUM IRON LEVEL 50-160 mg/dL 45 mg/dL TOTAL IRON INDING CAPACITY (TIBC) 250-400 mg/dL 405 mg/dL TRANSFERRIN SATURATION 20%- 55% CALCULATE IT How would these results be interpreted? a. Latent iron deficiency

b. Functional iron deficiency c. Iron deficiency

d. Equivocal for iron deficiency: d. Equivocal for iron deficiency

123. Neutrophils and monocytes are direct descendants of a common prog- enitor known as:

a. CLP b. GMP c. MEP d. HSC: b. GMP

124. The stage in neutrophilic development in which the nucleus is indented in a kidney bean

shape and the cytoplasm has secondary granules that are lavender in color is the: a. Band b. Myelocyte c. Promyelocyte d. Metamyelocyte: d. Metamyelocyte

125. Type II myeloblasts are characterized by: a. Presence of fewer than 20 primary granules