Deck 22: Nonmalignant Lymphocyte Disorders

Question 1

Lymphocytosis is found about 1 week after symptoms appear in infectious mononucleosis and lymphocytes remain elevated for 2-8 weeks. What morphologic characteristics are present in the blood smear?

A) Leukemic lymphoblasts
B) Reactive lymphocytes with mild thrombocytopenia
C) Decreased lymphocytes
D) Homogeneous lymphocyte population

Answer 1

Reactive lymphocytes with mild thrombocytopenia

Question 2

What is the agent responsible for infectious mononucleosis?

A) Toxoplasmosis
B) CMV
C) EBV
D) Bordetella pertussis

Answer 2

EBV

Question 3

Which of the following cell types is commonly infected by the HIV-1 virus?

A) Cytotoxic T cell
B) CD8 cell
C) CD4 cell
D) Neutrophil

Answer 3

CD4 cell

Question 4

All of the following are expected findings of AIDS except:

A) Lymphocytopenia
B) Leukocytopenia
C) Anemia
D) Thrombocytosis

Question 5

Which of the following is used as a screening test for infectious mononucleosis?

A) Heterophile antibody test
B) EBV IgG and IgM tests
C) HBsAg
D) ANA IFA

Question 6

What characteristics are associated with reactive lymphocytes?

A) They can contain vacuoles, and chromatin pattern is very fine.
B) They can contain vacuoles, deep blue abundant cytoplasm.
C) Their nucleus has a fine chromatin pattern, and the N:C ratio is increased.
D) They have high N:C ratio with a small amount of deep blue cytoplasm.

Question 7

An 18-year old patient has a WBC count of 9 × 10⁹/L and 60% lymphs, 30% neutrophils, 6% monocytes, 3% eosinophils, and 1% basophils. The following that best describe this condition are:

A) Relative and absolute neutrophilia
B) Absolute neutropenia and absolute lymphocytosis
C) Relative neutropenia and absolute lymphocytosis
D) Relative lymphocytopenia and relative neutropenia

Question 8

Which of the following statements best describes the pathogenesis of HIV infection?

A) HIV virus selectively infects T helper cells, incorporates its own DNA into the T helper's DNA, and lyses the cell.
B) HIV virus infects all lymphocytes, incorporates its own DNA into the T helper's DNA, and changes the T helper's identity.
C) HIV virus infects all cells involved in cell-mediated immunity, incorporates its own DNA into the DNA of the infected cells, and lyses the cells.
D) HIV infects T-suppressor cells and initiates apoptosis.

Question 9

A patient with infectious mononucleosis is having serologic blood tests. Results are as follows: EBVCA IgG: 1:320; EBVCA IgM: not detected; EBNA: 1:20. What stage of infection is the patient in?

A) Acute
B) Recent
C) Past
D) Cannot be determined

Question 10

Which of the following infectious agents that can be transmitted from mother to a growing fetus can result in physically and mentally impaired development?

A) Bordetella pertussis
B) Toxoplasma gondii
C) Coxsackievirus A
D) Clostridium botulinum

Question 11

What are the most common laboratory findings in CMV infection in the newborn?

A) Thrombocytopenia and hemolytic anemia
B) Leukocytosis
C) Positive heterophile agglutinin test.
D) Viral DNA assay is negative.

Question 12

Which of the following is an expected finding regarding the morphology of an activated lymphocyte that is different from a normal lymphocyte?

A) Oval nucleus
B) Prominent nucleoli
C) Abundant cytoplasm
D) Clumped chromatin

Question 13

A 5-year-old girl has a WBC count of 8.4 × 10⁹/L with 55% lymphocytes. Which of the following best describes this phenomenon?

A) Absolute lymphocytosis
B) Relative lymphocytosis
C) Normal leukocyte count
D) Absolute lymphocytopenia

Question 14

A 19-year-old male visits his physician because of a persistent cough and progressive fatigue over the past month. Physical examination reveals prominent lymphadenopathy. Laboratory analysis reveals a WBC count of 20 × 10⁹/L with 23% reactive lymphocytes. Patient serum is positive for both IgG and IgM antibodies against EBV. Based on this information, from what is the patient most likely suffering?

A) Hodgkin lymphoma
B) Reactive leukocytosis
C) Infectious mononucleosis
D) Malaria

Question 15

CMV infections complicate transplants by which of the following mechanisms?

A) Suppress normal immune function and elicit the formation of autoantibodies that are lymphocytotoxic
B) Form antibodies to CMV-infected cells that cross-react with stem cells
C) Impair mitotic division of normal hematopoietic cells and stimulate neoplastic cells to proliferate
D) Stimulate antibodies against RBCs resulting in an autoimmune hemolytic anemia

Question 16

The Epstein-Barr virus targets B cells that express ________. Once infected, they cause expression of the ________ marker.

A) CD21; CD23
B) CD23; CD21
C) CD22; CD23
D) CD34; CD19

Question 17

What clinical condition does the Centers for Disease Control and Prevention include in its case definition for HIV infection?

A) Bordetella pertussis
B) Infectious mononucleosis
C) Kaposi's sarcoma
D) Plasmacytosis

Question 18

Which of the following is expected to decrease as the HIV infection progresses into AIDS?

A) WBC count
B) CD4:CD8 ratio
C) Lymphocyte count
D) All of the above

Question 19

The prominent lymphocytosis in whooping cough is the result of:

A) An exacerbated immune response
B) Cell-mediated immunity accompanying a neutrophilia
C) Redistribution of lymphocytes from the lymphatics into peripheral circulation
D) Increased cytokine stimulation of lymphopoiesis in the bone marrow

Question 20

A 5-year-old patient is suspected of having infectious mononucleosis. The patient's blood smear reveals 55% reactive lymphocytes and a WBC count of 15 × 10⁹/L. The heterophile antibody test is negative. IgG and IgM antibodies to EBV both come back positive. What is the best explanation for these results?

A) When infected with EBV, 50% of children under the age of 10 do not have a positive heterophile test.
B) The patient does not have EBV but acute lymphoid leukemia.
C) The serologic tests are false positive for IgG and IgM antibodies to EBV.
D) The heterophile test is never positive in children under 10 years of age.

Question 21

A 17 year-old female was seen in ER for fever, sore throat, headache and general malaise. The CBC showed a leukocytosis and absolute lymphocytosis. The peripheral smear showed a heterogenous mix of lymphocytes with many large, irregular shaped cells with spreading cytoplasm and irregular basophilia. What is your diagnosis and what follow up testing would you preform to confirm that?

Question 22

Bordetella pertussis is characterized by rapid peripheral lymphocytosis and decreased cellularity of the lymph nodes. What can explain this phenomenon?

A) Increased CD4:CD8 ratio
B) Loss of homing of T cells to lymphoid tissue
C) Abnormal homing of lymphocytes to the bone marrow
D) Increase of L-selectin expression by T cells

Question 23

What component is responsible for the accumulation of lymphocytes in the blood during a whooping cough infection?

A) Pertussis toxin
B) Leukemoid reaction
C) T lymphocytes
D) VCA-IgG

Question 24

Compare and contrast X-linked SCID and autosomal SCID.

Question 25

Which of the following disorders is associated with a lymphocytosis?

A) X-linked immunodeficiency syndrome
B) AIDS
C) Whooping cough
D) SCID

Question 26

Bordetella pertussis and chronic lymphocytic leukemia have increased small lymphocytes with condensed nuclear chromatin on the blood smear. What laboratory test could distinguish whooping cough from CLL?

A) Heterophile testing
B) Biopsy of lymph nodes
C) Molecular testing
D) Culture and serological antibody testing

Question 27

Name five hematologic findings associated with HIV infections other than lymphocytopenia.

Question 28

Diagnosis of an active toxoplasmosis infection is established by?

A) Molecular tests
B) Heterophile antibody test
C) Biopsy of lymph nodes from various sites
D) Rising titer and seroconversion of antibodies to Toxoplasma gondii

Question 29

Newborns infected with CMV exhibit all of the following except:

A) Jaundice
B) Thrombocytosis
C) Microcephaly
D) Hepatosplenomegaly

Question 30

Correlate antibody titers with the stage of infection. What antibody titer excludes current infection?

Question 31

A 42-year-old HIV-positive patient recently was diagnosed with disseminated histoplasmosis. Which of the following should be ordered to monitor this patient's progression?

A) HIV antibody screen
B) HBsAg
C) CBC
D) CD4:CD8 ratio

Question 32

Correlate each disorder with the following: (1) population(s) most affected by it, (2) whether it produces a lymphocytosis or lymphocytopenia, (3) morphology associated with it, and (4) pathophysiology of the infection.
a. Infectious mononucleosis
b. Whooping cough
c. Toxoplasmosis
d. CMV infection

Question 33

HIES is due to a deficiency in:

A) IL-2
B) IL-5
C) IL-15
D) IL-17

Question 34

An unknown patient blood sample on an adult has the following results: WBC count = 9.5 × 10⁹/L with 70% lymphocytes. What term describes this condition? Name a disease in which this is seen.

Question 35

A negative heterophile antibody test in a patient with symptoms of infectious mononucleosis could be caused by what factor if the patient is being treated for cancer?

A) Infection by another virus
B) Level of the antibody not high enough to be detected
C) Immunosuppressed antibody response
D) CMV infection