Deck 15: Cell Biology, Disorders of Neutrophils, Infectious Mononucleosis, and Reactive Lymphocytosis

Question 1

What is the function of opsonins?

A) Oxidative destruction of cell membranes
B) To promote the interaction of the surface of microorganisms with receptors on the neutrophils membrane
C) Increase rate of biochemical reactions
D) To lower the resistance of invading organisms to the phagocytizing action of neutrophils
E) To stimulate leukopoiesis

Answer 1

To promote the interaction of the surface of microorganisms with receptors on the neutrophils membrane

Question 2

__________ are the most numerous leukocytes found in the blood.

A) Neutrophils
B) Lymphocytes
C) Monocytes
D) Eosinophils
E) Basophils

Answer 2

Neutrophils

Question 3

What is the most common morphological change seen in neutrophils in response to bacterial infection?

A) Auer rods
B) Cytoplasmic vacuolization
C) Dohle bodies
D) Toxic granulation
E) Agranulation

Answer 3

Toxic granulation

Question 4

Newborns who are afflicted with a bacterial infection will develop severe neutropenia because of:

A) Stem cell defect
B) The neutrophil storage pool being depleted in the bone marrow
C) Intramedullary destruction of precursors in the marrow
D) Dysfunctional chemotaxis
E) Gene mutation

Question 5

Which of the following features are seen in reactive lymphocytes?

A) Low N:C ratio
B) Blue cytoplasm
C) Indented cytoplasmic borders
D) All of the above

Question 6

Neutropenia can be due to:

A) Decrease in production by the bone marrow
B) Impaired release from the marrow into the blood
C) Maldistribution resulting in pseudoneutropenia
D) All of the above
E) None of the above

Question 7

__________ is the consequence of either severe neutropenia or neutrophil dysfunction.

A) Bacterial infection
B) Viral infection
C) Hypersensitivity reactions
D) Parasitic infection
E) Allergic reaction

Question 8

During bacterial infection the granulocyte-to-erythroid ratio can increase due to __________ production.

A) Decreased granulocytes
B) Increased granulocytes
C) Increased erythrocytes
D) Decreased erythrocytes
E) Increased lymphocytes

Question 9

In the process of ingestion of foreign organisms by neutrophils, extensions located on the membrane surface surround the organism in a cup-like fashion until they fuse. These extensions are termed:

A) Pseudopods
B) Flagella
C) Cilia
D) Microtubule
E) Antigens

Question 10

Döhle bodies consist of __________.

A) Endoplasmic reticulin
B) Cytoplasmic granules
C) Mucopolysaccharide
D) RNA
E) DNA

Question 11

__________ is a frequent cause of acquired neutropenia in children younger than 6 years old.

A) Bacterial infection
B) Viral infection
C) Parasitic infection
D) Hypersensitivity reaction
E) None of the above

Question 12

What should be suspected when the left shift is seen in the presence of low leukocyte counts with 70% neutrophils?

A) Multiple sclerosis
B) Leukemia
C) Septicemia
D) Pelger-Huët anomaly
E) Multiple myeloma

Question 13

During the first few days of a newborn's life, varying numbers of immature neutrophils can be identified in the blood. This is referred to as a:

A) Shift to the right
B) Shift to the left
C) Chemotaxis
D) Leukocytosis
E) Leukemia

Question 14

The absolute number of lymphocytes found in the blood of a healthy adult is:

A) 4-11 $\times$ 10⁹/L
B) 1-4.5 $\times$ 10⁹/L
C) 3-5 $\times$ 10⁹/L
D) 1.5-7.5 $\times$ 10⁹/L
E) 6-8 $\times$ 10⁹/L

Question 15

Morphological features that can be manifested in the neutrophils in the peripheral blood of patients with severe infections include:

A) Döhle bodies
B) Toxic vacuolization
C) Toxic granulation
D) All of the above
E) None of the above

Question 16

The classic response to infectious and inflammatory processes is an increase in the _____________ number of __________________.

A) Absolute, neutrophils
B) Absolute, myeloblasts
C) Relative, reticulocytes
D) Absolute, lymphocytes
E) Relative, lymphocytes

Question 17

Which sequence reflects the correct order for phagocytosis?

A) Release of cytoplasmic granules; binding of particle; ingestion; fusion of phagolysosome
B) Ingestion; binding of particles; fusion of phagolysosome; release of cytoplasmic granules
C) Binding of particle; ingestion; fusion of phagolysosome; release of cytoplasmic granules
D) Fusion of phagolysosome; binding of particle; release of cytoplasmic granules; ingestion

Question 18

A white blood cell count (WBC) found in the blood of a healthy adult is:

A) 5-10 $\times$ 10⁹/L
B) 1.5-7.5 $\times$ 10⁹/L
C) 1-5 $\times$ 10⁹/L
D) 3-5 $\times$ 10⁹/L
E) 12- 14 $\times$ 10⁹/L

Question 19

Neutropenia is a quantitative disease, defined as an absolute neutrophil count of less than __________.

A) 1.0 $\times$ 10⁹/L
B) 1.2 $\times$ 10⁹/L
C) 1.5 $\times$ 10⁹/L
D) 2.0 $\times$ 10⁹/L
E) 5.0 $\times$ 10⁹/L

Question 20

A child with chronic benign neutropenia demonstrates an antibody in the serum directed at antigens on the patient's neutrophils. This finding is consistent with the presence of __________.

A) Bacterial infection
B) Antineutrophil antibody
C) Parasitic infection
D) ABO blood group antibodies
E) Viral infection

Question 21

Additional serologic findings may be required to distinguish Epstein-Barr virus infection from which other viral infections?

A) Rubella
B) Hepatitis
C) Cytomegalovirus
D) All of the above
E) None of the above

Question 22

Reactive lymphocytes in infectious mononucleosis represent:

A) Epstein Barr virus-infected B lymphocytes
B) T lymphocytes responding to infection
C) NK cells responding to infection
D) Plasma cells
E) None of the above

Question 23

A patient with leukemia demonstrated bilobed neutrophils on a peripheral blood smear. These are often called:

A) Pelger-Huët neutrophils
B) Pseudo-Pelger-Huët neutrophils
C) Hypersegmented neutrophils
D) Agranular neutrophils

Question 24

Which X-linked recessive disease is characterized by a granuloma formation as a result of the inability of neutrophils, monocytes, and eosinophils to kill microorganisms after normal engulfment?

A) Chédiak-Higashi disease
B) Osteoporosis
C) Chronic granulomatous disease
D) Alder-Reilly syndrome
E) Hurler's syndrome

Question 25

What other hematologic condition will support the diagnosis of May-Hegglin anomaly in addition to the neutrophil abnormalities?

A) Thrombocytopenia
B) Nucleated red blood cells
C) Leukocytosis
D) Thrombocytosis
E) Lymphocytosis

Question 26

Eosinophilia occurs when the absolute eosinophil count is greater than which of the following?

A) 0.6 $\times$ 10⁹/L
B) 6.0 $\times$ 10⁹/L
C) 2.0 $\times$ 10¹²/L
D) 1.5 $\times$ 10⁹/L
E) None of the above

Question 27

Basophilia occurs when the absolute count is greater than which of the following?

A) 2.0 $\times$ 10⁹ cells/L
B) 0.2 $\times$ 10⁹ cells/L
C) 0.6 $\times$ 10⁹ cells/L
D) 5.0 $\times$ 10⁹ cells/L
E) 0.5 $\times$ 10⁹ cells/L

Question 28

The susceptibility to infections in Chédiak-Higashi disease is due to:

A) Neutropenia
B) Impaired chemotaxis
C) Abnormal distribution of lysosomal enzymes
D) All of the above
E) None of the above

Question 29

Which qualitative white blood cell (WBC) disorder demonstrates blue-staining cytoplasmic inclusions in neutrophils that resemble Döhle bodies?

A) Alder's anomaly
B) Chédiak-Higashi disease
C) May-Hegglin anomaly
D) Pelger-Huët anomaly
E) Chronic granulomatous disease

Question 30

Myeloperoxidase is present in the primary granules of __________.

A) Neutrophils
B) Eosinophils
C) Monocytes/macrophages
D) All of the above
E) None of the above

Question 31

The size of a reactive lymphocyte is:

A) 5-10 µm
B) 9-30 µm
C) 80-100 µm
D) >100 µm
E) None of the above

Question 32

What is the causative agent of infectious mononucleosis?

A) Herpes virus
B) Epstein-Barr virus
C) Cytomegalovirus
D) Coxsackie virus
E) None of the above

Question 33

__________, seen in association with mucopolysaccharidosis, has characteristic dark staining and coarse cytoplasmic granules in the cytoplasm of neutrophils, lymphocytes, and monocytes.

A) Alder-Reilly anomaly
B) May-Hegglin anomaly
C) Chédiak-Higashi disease
D) Pelger-Huët anomaly
E) None of the above

Question 34

The presence of prominent, dark-staining, coarse cytoplasmic granules in neutrophils, eosinophils, basophils, monocytes, and occasionally lymphocytes is known as: _______?

A) Chediak-Higashi syndrome
B) May-Hegglin anomaly
C) Alder's anomaly
D) Pelger-Huët anomaly
E) CMV infection

Question 35

Clinical manifestations of infectious mononucleosis include:

A) Sore throat
B) Fatigue
C) Lymphadenopathy
D) Joint pain dysphagia
E) All of the above

Question 36

Hyposegmentation of the nucleus is characteristic of which white blood cell anomaly?

A) Alder-Reilly anomaly
B) Pelger-Huët anomaly
C) May-Hegglin anomaly
D) Chédiak-Higashi anomaly
E) Chronic granulomatous disease

Question 37

Most qualitative white blood cell disorders are characterized by:

A) Bacterial infections due to decreased numbers of neutrophils
B) Bacterial infections due to increased numbers of neutrophils
C) Bacterial infections due to neutrophil dysfunction
D) Bacterial infections due to lymphocyte dysfunction
E) Lymphocyte infections due to lymphocyte dysfunction

Question 38

Slides containing malignant or suspicious lymphocyte morphology must be reviewed by a __________.

A) Pathologist
B) Supervisor
C) Chief technologist
D) Peer technologist
E) None of the above

Question 39

A rare autosomal recessive congenital disorder that features partial albinism, mild bleeding tendencies, and giant lysosomal granules in blood and tissue cells is known as ____________.

A) Fanconi's anemia
B) Chédiak-Higashi disease
C) Pelger-Huët anomaly
D) Hunter's syndrome
E) Hurler's syndrome

Question 40

Which of the following morphologies differentiates reactive lymphocyte from monocytes?

A) Pale blue-gray cytoplasm
B) Even staining quality
C) Increased patchy basophilic cytoplasm
D) Cytoplasmic vacuolation
E) None of the above

Question 41

Monocytosis occurs when the absolute monocyte count exceeds which of the following?

A) 2.0 $\times$ 10⁹ cells/L
B) 0.2 $\times$ 10⁹ cells/L
C) 1.0 $\times$ 10⁹ cells/L
D) 5.0 $\times$ 10⁹ cells/L
E) 0.5 $\times$ 10⁹ cells/L

Question 42

Cold agglutinins of __________ specificity are present in 20% of patients with infectious mononucleosis.

A) Anti-i
B) Anti-I
C) Anti-Fy^a
D) Anti-H
E) None of the above

Question 43

Which other laboratory test(s) has/have significant correlation with infectious mononucleosis?

A) AST
B) Alanine transferase (ALT)
C) Bilirubin
D) All of the above
E) None of the above

Question 44

A patient presents with absolute lymphocytosis with 12% reactive lymphocytes on the peripheral blood smear. The heterophile antibody test is negative. What more specific antibody test should be performed?

A) Cytomegalovirus (CMV)
B) IgM-Epstein-Barr virus
C) Refractory anemia (RA)
D) Bacterial antigens
E) None of the above