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Clinical Laboratory Studies

MULTIPLE CHOICE

     1.   Which of the following terms is used for red blood cells?

a.
Leukocytes
b.
Hemocytes
c.
Monocytes
d.
Erythrocytes

ANS:  D

Red blood cells are also known as erythrocytes.

REF:   pg. 128           OBJ:   2

     2.   Which of the following is a formed element found in circulating blood?

a.
Sodium
b.
Platelets
c.
Potassium
d.
Bicarbonate

ANS:  B

Formed elements in the blood include white blood cells, red blood cells, and platelets.

REF:   pg. 128           OBJ:   2

     3.   Which of the following terms is used for white blood cells?

a.
Erythrocytes
b.
Thrombocytes
c.
Leukocytes
d.
Hemocytes

ANS:  C

White blood cells are also called leukocytes.

REF:   pg. 128           OBJ:   2

     4.   Which of the following terms is used for blood platelets?

a.
Erythrocytes
b.
Thrombocytes
c.
Leukocytes
d.
Hemocytes

ANS:  B

Blood platelets are also called thrombocytes.

REF:   pg. 128           OBJ:   2

     5.   Which of the following white blood cells is not a granulocyte?

a.
Basophil
b.
Eosinophil
c.
Neutrophil
d.
Lymphocyte

ANS:  D

Lymphocytes do not have granular matter in their cytoplasm.

REF:   pg. 129           OBJ:   2

     6.   What type of white blood cell typically is most prevalent in the circulating blood?

a.
Monocyte
b.
Eosinophil
c.
Neutrophil
d.
Lymphocyte

ANS:  C

The neutrophil is produced by the bone marrow in large quantities.

REF:   pg. 129           OBJ:   2

     7.   What percentage of circulating white blood cells is made up of neutrophils?

a.
10% to 30%
b.
25% to 50%
c.
40% to 75%
d.
60% to 85%

ANS:  C

Neutrophils make up 50% to 70% of circulating white blood cells.

REF:   pg. 130           OBJ:   2 | 7

     8.   Which of the following terms describes the immature neutrophil?

a.
Band
b.
Monocyte
c.
Erythrocyte
d.
Reticulocyte

ANS:  A

Immature neutrophils are known as bands because of the shape of their nuclei.

REF:   pg. 130           OBJ:   4 | 7

     9.   What percentage of normal circulating white blood cells are immature and nonsegmented?

a.
0% to 5%
b.
5% to 10%
c.
10% to 15%
d.
15% to 22%

ANS:  A

Normally, a very small portion of circulating white blood cells is nonsegmented.

REF:   pg. 130           OBJ:   4

   10.   Which of the following types of white blood cells fights bacterial infection?

a.
Basophil
b.
Monocyte
c.
Neutrophil
d.
Lymphocyte

ANS:  C

The neutrophil is best known for its ability to fight infection.

REF:   pg. 130           OBJ:   3 | 7

   11.   What is the normal lifespan of the neutrophil?

a.
10 days
b.
21 days
c.
60 days
d.
90 days

ANS:  A

The normal neutrophil lives about 10 days.

REF:   pg. 130           OBJ:   2 | 7

   12.   Which of the following terms describes an increase in white blood cell count associated with a shift of cells from the marginated pool to the circulating pool?

a.
Pseudoneutrophilia
b.
Pseudoneutropenia
c.
Neutropenia
d.
Lymphocytosis

ANS:  A

When marginated neutrophils shift back into the circulating pool, this is known as pseudoneutrophilia.

REF:   pg. 131           OBJ:   6 | 7

   13.   Which of the following types of white blood cells is useful against allergic reactions and defends against parasitic infestations?

a.
Monocyte
b.
Neutrophil
c.
Eosinophil
d.
Lymphocyte

ANS:  C

The eosinophil is known to react in situations caused by exposure to allergens.

REF:   pg. 130           OBJ:   6 | 7

   14.   Which of the following types of white blood cells exists as two types—the B cell and the T cell?

a.
Basophil
b.
Monocyte
c.
Neutrophil
d.
Lymphocyte

ANS:  D

Lymphocytes can be either T cells or B cells.

REF:   pg. 130           OBJ:   6 | 7

   15.   What is the normal percentage of lymphocytes in circulating white blood cells?

a.
5% to 10%
b.
15% to 25%
c.
20% to 45%
d.
50% to 70%

ANS:  C

Normally, 20% to 45% of circulating white blood cells are lymphocytes.

REF:   pg. 130           OBJ:   6 | 7

   16.   Which of the following types of white blood cells is physically the largest?

a.
Basophil
b.
Monocyte
c.
Neutrophil
d.
Lymphocyte

ANS:  B

As viewed through the microscope, the monocyte is physically the largest white blood cell.

REF:   pg. 130           OBJ:   7

   17.   Which of the following types of white blood cells is responsible for phagocytosis?

a.
Basophil
b.
Monocyte
c.
Neutrophil
d.
Lymphocyte

ANS:  B

The monocyte has the ability to engulf bacteria and foreign dust particles and eliminate them from the lung.

REF:   pg. 130           OBJ:   9

   18.   Which of the following terms describes an abnormal increase in the proportion of circulating immature neutrophils?

a.
Neutrophilia
b.
Left shift
c.
Leukopenia
d.
Leukocytosis

ANS:  B

When the number of bands circulating in the blood is higher than normal, this is referred to as a left shift.

REF:   pg. 130           OBJ:   7

   19.   Which of the following terms describes the change in white blood cell count that often occurs in patients with tuberculosis?

a.
Lymphocytosis
b.
Monocytosis
c.
Eosinophilia
d.
Basophilia

ANS:  B

Patients with tuberculosis usually develop monocytosis.

REF:   pg. 130           OBJ:   7 | 9

   20.   Which of the following terms describes an overall abnormal decrease in white blood cell count?

a.
Anemia
b.
Leukopenia
c.
Leukocytosis
d.
Polycythemia

ANS:  B

An abnormal drop in the number of circulating white blood cells is known as leukopenia.

REF:   pg. 130           OBJ:   8

   21.   Which of the following types of leukocytosis is typically seen in patients with viral infection?

a.
Basophilia
b.
Neutrophilia
c.
Monocytosis
d.
Lymphocytosis

ANS:  D

Viral infections often cause lymphocytosis.

REF:   pg. 130           OBJ:   7 | 10

   22.   What is believed to cause neutropenia in patients with viral infection?

a.
Phagocytosis
b.
Increased margination of neutrophils
c.
Increased neutrophil lysis
d.
Increased loss of neutrophils to gastrointestinal waste

ANS:  B

Viral infections cause neutrophils to marginate in larger numbers, and marginated neutrophils are not counted in the white blood cell count.

REF:   pg. 130           OBJ:   7 | 9

   23.   What cells proliferate in patients with leukemia?

a.
Reticulocytes
b.
Segmented neutrophils
c.
Monocytes
d.
Blasts

ANS:  D

Leukemia is a disease of the bone marrow. It causes the bone marrow to release very immature cells such as blasts.

REF:   pg. 132           OBJ:   8

   24.   What is the typical lifespan of a red blood cell?

a.
30 days
b.
60 days
c.
120 days
d.
None of the above

ANS:  C

The typical red blood cell will live for 120 days.

REF:   pg. 132           OBJ:   7

   25.   What can be said about the nucleus of the mature circulating red blood cell?

a.
It is round.
b.
It is absent.
c.
It is large and red.
d.
All of the above can be said.

ANS:  B

The mature red blood cell has no nucleus.

REF:   pg. 132           OBJ:   9

   26.   What substance is responsible for carrying red blood cell oxygen on to the tissues?

a.
Thrombin
b.
Cytokines
c.
Hemoglobin
d.
Prothrombin

ANS:  C

Hemoglobin is the major substance found in red blood cells. Its main function is to carry oxygen.

REF:   pg. 132           OBJ:   10

   27.   What substance is a vital constituent of the heme portion of hemoglobin?

a.
Iron
b.
Protein
c.
Sodium
d.
Calcium

ANS:  A

Iron is vitally important to the function of hemoglobin.

REF:   pg. 132           OBJ:   10

   28.   Which of the following terms describes an abnormal decrease in red blood cell count?

a.
Anemia
b.
Cytothemia
c.
Leukopenia
d.
Polycythemia

ANS:  A

A low red blood cell count is known as anemia.

REF:   pg. 133           OBJ:   8

   29.   Which of the following terms describes red blood cells that are larger than normal?

a.
Macrocytic
b.
Hypercytotic
c.
Hyperchromic
d.
None of the above

ANS:  A

Red blood cells that are larger than normal are termed macrocytic.

REF:   pg. 133           OBJ:   8

   30.   The most common type of anemia worldwide is the result of:

a.
Hemorrhage.
b.
Gastrointestinal bleeding.
c.
Iron deficiency.
d.
Vitamin B12 deficiency.

ANS:  C

Iron deficiency is a very common cause of anemia because it reduces the presence of hemoglobin in the red blood cells.

REF:   pg. 133           OBJ:   8

   31.   Which of the following terms describes anemia due to low hemoglobin levels?

a.
Microcytic
b.
Leukopenic
c.
Hypocytotic
d.
Hypochromic

ANS:  D

Chromic refers to color, and hemoglobin is known for giving the red blood cell its bright red color. Hypochromic refers to red cells that lack hemoglobin.

REF:   pg. 133           OBJ:   8

   32.   In which of the following conditions would secondary polycythemia not be expected?

a.
Pulmonary fibrosis
b.
Pulmonary embolism
c.
Living at high altitude
d.
Congenital heart disease

ANS:  B

Secondary polycythemia occurs with chronic hypoxemia. Pulmonary embolism may cause acute hypoxemia.

REF:   pg. 134           OBJ:   9

   33.   Heavy smokers are prone to what change in the red blood cell count?

a.
Secondary polycythemia
b.
Microcytic anemia
c.
Hypochromic anemia
d.
Macrocytic anemia

ANS:  A

Heavy smokers have significant carbon monoxide in their blood. This is perceived by the bone marrow as hypoxia. Thus, the bone marrow increases its production of red blood cells.

REF:   pg. 134           OBJ:   9

   34.   In which of the following conditions would spurious polycythemia most likely be seen?

a.
Lung cancer
b.
Dehydration
c.
Fever
d.
Hypertension

ANS:  B

Dehydration causes an increase in the concentration of red blood cells in the blood and causes false polycythemia.

REF:   pg. 134           OBJ:   9

   35.   A patient with a platelet count of about 80,000/mm3 is likely to have what condition?

a.
Infection
b.
Renal failure
c.
Excessive bleeding
d.
None of the above, because this is a normal value

ANS:  C

A platelet count of 80,000/mm3 is too low. The patient will have problems with bleeding.

REF:   pg. 133           OBJ:   9 | 10

   36.   What problem is associated with an abnormal international normalized ratio (INR) value?

a.
Kidney disease
b.
Liver failure
c.
Bleeding
d.
Pulmonary edema

ANS:  C

An abnormal INR value suggests problems with blood clotting.

REF:   pg. 134           OBJ:   10

   37.   Which of the following is considered the major cation of the extracellular fluid?

a.
Sodium
b.
Calcium
c.
Chloride
d.
Potassium

ANS:  A

Sodium is considered the major cation of the extracellular fluid.

REF:   pg. 136           OBJ:   12

   38.   Which of the following symptoms is commonly seen with hyponatremia?

a.
Confusion
b.
Headache
c.
Chest pain
d.
Shortness of breath

ANS:  A

A low sodium concentration often causes acute confusion in the patient.

REF:   pg. 136           OBJ:   12

   39.   What electrolyte abnormality is associated with irregular pulse, muscle weakness, and abdominal distention?

a.
Hyperkalemia
b.
Hypokalemia
c.
Hyponatremia
d.
Hypernatremia

ANS:  B

Hypokalemia (reduced potassium concentration) causes an irregular pulse and muscle weakness.

REF:   pg. 136           OBJ:   12

   40.   Which of the following terms is used to describe an abnormally low potassium level?

a.
Hyponatremia
b.
Hypokalemia
c.
Hypochloremia
d.
Hypocalcemia

ANS:  B

A low potassium level is known as hypokalemia.

REF:   pg. 136           OBJ:   12

   41.   Elevation of blood urea nitrogen (BUN) and creatinine levels in the blood suggests what type of problem?

a.
Renal failure
b.
Liver failure
c.
Heart disease
d.
Gallbladder disease

ANS:  A

BUN and creatinine are waste products of metabolism that usually are excreted by the kidneys. If they are found to be elevated in the blood, kidney failure is possible.

REF:   pg. 139           OBJ:   13

   42.   What disease is associated with elevations in sodium and chloride in sweat?

a.
Pneumonia
b.
Emphysema
c.
Renal disease
d.
Cystic fibrosis

ANS:  D

Patients with cystic fibrosis have elevated sodium and chloride levels in their sweat.

REF:   pg. 137           OBJ:   12

   43.   During evaluation of the enzymes, what disorder is associated with elevation of the CK-MB on electrophoresis?

a.
Hepatitis
b.
Renal failure
c.
Metabolic acidosis
d.
Myocardial infarction

ANS:  D

Elevation of the creatine kinase MB (CK-MB) fraction indicates damage to the heart muscle.

REF:   pg. 141           OBJ:   14 | 15

   44.   The highest levels of aspartate aminotransferase (AST) are seen in acute:

a.
pulmonary infarction.
b.
hepatitis.
c.
myocardial infarction.
d.
renal failure.

ANS:  B

AST is an enzyme that is found primarily in the liver. Hepatitis causes damage to the liver and an abnormal increase in AST.

REF:   pg. 140           OBJ:   13

   45.   Elevation of troponin is associated with what disorder?

a.
Acute myocardial infarction
b.
Hepatitis
c.
Pulmonary embolism
d.
Trauma

ANS:  A

Troponin is an enzyme that is elevated by damage to the myocardium.

REF:   pg. 141           OBJ:   14 | 15

   46.   Which of the following disorders is associated with hyperglycemia?

a.
Hepatitis
b.
Diabetes
c.
Renal failure
d.
Myocardial infarction

ANS:  B

Hyperglycemia, which refers to an increase in blood glucose level, is associated most often with diabetes.

REF:   pg. 138           OBJ:   13

   47.   Hypoalbuminemia may result in what pulmonary problem?

a.
Asthma
b.
Emphysema
c.
Diaphragm paralysis
d.
Pulmonary edema

ANS:  D

Hypoalbuminemia refers to a low blood protein level. This causes the osmotic pressure of the blood to decrease, which leads to increased water in the lung.

REF:   pg. 139           OBJ:   13

   48.   Which of the following terms is used to describe the microorganisms present in the saliva of a healthy person?

a.
Normal flora
b.
Acid-fast bacteria
c.
Gram-negative pathogens
d.
Gram-positive pathogens

ANS:  A

The normal flora refers to the microorganisms normally present in the saliva.

REF:   pg. 143           OBJ:   17

   49.   The purpose of performing the sensitivity test on sputum samples is to:

a.
determine the best antibiotic to prescribe.
b.
determine the viscosity of the sputum.
c.
determine the quality of the sputum sample.
d.
identify the general type of organism responsible for the infection.

ANS:  A

The sensitivity determines what antibiotics will be most effective against a microorganism that is causing an infection.

REF:   pg. 143           OBJ:   18

   50.   Which of the following organisms is responsible for most cases of bacterial pneumonia?

a.
Pseudomonas
b.
Klebsiella pneumoniae
c.
Staphylococcus aureus
d.
Streptococcus pneumoniae

ANS:  D

Most community-acquired pneumonias are caused by the Streptococcus organism.

REF:   pg. 142           OBJ:   17 | 18

   51.   What procedure is performed by a pulmonologist to obtain organisms that may be present deep in the lung in patients with pneumonia?

a.
Sputum induction with hypotonic nebulized solution
b.
Bronchoalveolar lavage (BAL)
c.
Tracheal intubation with lavage
d.
All of the above

ANS:  B

BAL is done to flush out organisms deep in the lung that cannot be obtained for culture through less invasive procedures.

REF:   pg. 144           OBJ:   19

   52.   The classic dividing line between transudates and exudates is a protein level of __ g/dL.

a.
3
b.
6
c.
9
d.
None of the above is correct.

ANS:  A

Pleural fluid that has a protein concentration of more than 3 g/dL is known as an exudate. Pleural fluid with a lower concentration of proteins is known as a transudate.

REF:   pg. 144           OBJ:   24

   53.   Which of the following conditions is not known to cause anergy?

a.
Chronic hypertension
b.
Sarcoidosis
c.
Lung cancer
d.
Aging

ANS:  A

Chronic hypertension does not cause anergy.

REF:   pg. 145           OBJ:   25

   54.   For which of the following disorders does a skin test use purified protein derivative (PPD)?

a.
Sarcoidosis
b.
Tuberculosis
c.
Coccidioidomycosis
d.
Histoplasmosis

ANS:  B

PPD is injected under the skin when testing for tuberculosis.

REF:   pg. 145           OBJ:   28

   55.   If an infection is being effectively treated by an antibiotic, which of the following would be true?

a.
The Gram-stained smear will no longer demonstrate the pathogen.
b.
The patient’s white blood count will increase.
c.
The patient’s platelet count will rapidly increase.
d.
The patient will present with foul-smelling sputum.

ANS:  A

After a patient has been on a regimen of antimicrobial therapy, the Gram stain and culture results can change. If the antibiotic is effective against the pathogen causing the infection, the Gram stain and culture will no longer demonstrate the pathogen, but instead will reveal organisms consistent with normal flora.

REF:   pg. 143           OBJ:   18

   56.   A patient presents with a D-dimer of 210 ng/mL. Which of the following would not be a suspected disease process or condition?

a.
Streptococcal pneumonia
b.
Pleural effusion
c.
Pulmonary embolism
d.
Tuberculosis

ANS:  C

The D-dimer test has high sensitivity; a level below the upper limit of the reference range can help rule out both systemic thrombosis, such as disseminated intravascular coagulation, and local thrombosis, such as pulmonary embolism and deep vein thrombosis.

REF:   pg. 136           OBJ:   11

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