Deck 28: Nonmalignant Leukocyte Disorders

Question 1

A chemotherapy patient's WBC is count is 1.0 *10⁹ /L. There are 60% segmented neutrophils, 38% lymphocytes, and 2% monocytes. What is the absolute neutrophil count?

A) 60 * 10⁹/L
B) 6 * 10⁹/L
C) 0.6 * 10⁹/L
D) 0.16* 10⁹/L

Answer 1

0.6 * 10⁹/L

Question 2

A patient has a white count of 15.0 *10⁹/L. What is the best test to determine the reason for the leukocyte count?

A) Bacterial cultures
B) White cell differential
C) Bone marrow aspirate
D) Serologic test for infectious mononucleosis

Answer 2

White cell differential

Question 3

Which of the following is the poorest prognostic sign for a patient with a bacterial infection?

A) High white count with mature neutrophils
B) High white count with immature neutrophils
C) High white count with few toxic changes in neutrophils
D) Low white count with immature neutrophils and toxic changes

Answer 3

Low white count with immature neutrophils and toxic changes

Question 4

Deficient enzymes that allow various lipids to accumulate in macrophages and monocytes describe:

A) Chronic granulomatous disease
B) Congenital C3 deficiencies
C) Storage cell diseases
D) Familial hyperlipidemia disorders

Question 5

The abnormal granules seen in Alder-Reilly anomaly could be confused for:

A) Toxic granulation
B) Intracellular bacteria
C) Döhle bodies
D) Intracellular yeasts

Question 6

Gaucher cells and Niemann-Pick cells are found in:

A) Peripheral blood
B) Bone marrow only
C) Spleen only
D) Bone marrow and spleen

Question 7

The nitroblue tetrazolium test is used to diagnose:

A) Chronic granulomatous disease
B) Pelger-Huët anomaly
C) May-Hegglin anomaly
D) Necrobiosis

Question 8

A patient has a white count of 8.3*10⁹/L and 65% lymphocytes. What is the correct interpretation?

A) Depends on the patient's age
B) Lymphocytosis
C) Lymphopenia
D) Patient probably has infectious mononucleosis

Question 9

A patient has a white count of 15.0 *10⁹/L. What is the correct interpretation?

A) Normal for an infant, leukocytosis for an adult
B) Normal for an infant, leukemoid reaction for an adult
C) Leukocytosis for any patient
D) Normal for any patient

Question 10

Toxic granulation, Döhle bodies, and vacuolization in neutrophils are often found together in:

A) May-Hegglin anomaly
B) Bacterial infection
C) Chédiak-Higashi syndrome
D) Alder-Reilly anomaly

Question 11

Nuclear hyposegmentation and denser than normal chromatin clumping are features of:

A) Alder-Reilly anomaly
B) Chédiak-Higashi syndrome
C) May-Hegglin anomaly
D) Pelger-Huët anomaly

Question 12

A patient has 20% eosinophils. Which of the following can probably be eliminated?

A) Allergy
B) Parasitic infection
C) Pertussis
D) Chronic myelogenous leukemia

Question 13

Neutrophilia and a left shift are most often found in patients with:

A) Autoimmune disorder
B) Acute bacterial infection
C) Hemolytic anemia
D) Acute viral infection

Question 14

Neutrophilia accompanied by immature granulocytes and nucleated red cells is what kind of reaction?

A) Leukoerythroblastic
B) Leukemoid
C) Myelophthisic
D) Myeloproliferative

Question 15

What abnormal findings are found in May-Hegglin anomaly?

A) Toxic granulation and vacuoles
B) Fused primary and secondary granules
C) Hypersegmented neutrophils and twinning
D) Döhle body-like cytoplasmic inclusions and thrombocytopenia

Question 16

What is the concern if Pelger-Huët anomaly is not recognized?

A) Without treatment, the patient will probably die.
B) The cells could be misclassified as immature neutrophils, indicating that the patient has a bacterial infection when he or she does not.
C) The patient could develop pseudo-Pelger-Huët followed by leukemia.
D) The cells could be misclassified as blasts, indicating that the patient has acute leukemia when he or she does not.

Question 17

Nonmalignant disorders of leukocytes are:

A) Inherited and cause no symptoms
B) Acquired and cause serious disease
C) Acquired and affect the nuclei of cells
D) Acquired or inherited and range from benign to life threatening

Question 18

What are the abnormal cytoplasmic inclusions in Chédiak-Higashi?

A) Nuclear fragments that prevent cell division
B) Ribosomal material that looks like Döhle bodies
C) Fused granules that inhibit bactericidal functions
D) Mucopolysaccharide lipids that disrupt cell function

Question 19

What is the correct interpretation of the absolute neutrophil count in the chemotherapy patient in Question 1?

A) Normal
B) Neutrophilia
C) Neutropenia
D) Qualitative neutrophil disorder

Question 20

A chemotherapy patient's white blood cell (WBC) count is 1.0 *10⁹ /L. There are 60% segmented neutrophils, 38% lymphocytes, and 2% monocytes. What is the correct interpretation of the relative differential?

A) Normal
B) Neutrophilia
C) Neutropenia
D) Lymphopenia

Question 21

Most often the clinician makes a diagnosis of infectious mononucleosis by which of the following findings?

A) Significant lymphocytosis, with reactive lymphocytes predominating
B) Presence of mild thrombocytopenia, with a significant lymphocytosis
C) Demonstration of the presence of the heterophil antibody
D) Demonstration of the presence of cytomegalovirus antibody

Question 22

The Epstein-Barr virus is the causative agent for:

A) Infectious mononucleosis
B) Infectious lymphocytosis
C) Lymphocytic leukemia
D) Monocytic leukemia

Question 23

A college student seeks medical care for extreme fatigue and swollen lymph nodes in the neck. The WBC count is 11.3 *10⁹/L. The differential shows a relative and absolute lymphocytosis. Many of the lymphocytes are larger than normal, with a basophilic cytoplasm indented by the red blood cells (RBCs). The nuclei are less clumped than normal and some have nucleoli. The rest of the complete blood count (CBC) is normal. What is the most likely diagnosis?

A) Infectious lymphocytosis
B) Infectious mononucleosis
C) Lymphoma
D) Lymphocytic leukemia

Question 24

The lymphocytes in the student in Question 22 are most likely:

A) Differentiated T cells
B) Lymphoblasts
C) Plasma cells
D) B cells

Question 25

A clinical laboratory scientist sees unusual darkly stained cytoplasmic inclusions in leukocytes that she has not seen before. She should:

A) Ignore them; they probably are not significant.
B) Report that the patient has Alder-Reilly anomaly.
C) Report toxic granulation if the patient is known to have an infection.
D) Have a supervisor or pathologist look at the cells.