Deck 36: Special Stainscytochemistry

Question 1

LAP activity is not decreased in:

A) CML
B) Paroxysmal nocturnal hemoglobinuria (PNH)
C) Leukemoid reaction
D) Hereditary hypophosphatasia
E) None of the above

Answer 1

Leukemoid reaction

Question 2

In the Sudan black B staining procedures, the granules of myelocytic precursors stain __________.

A) Brownish-black
B) Red-brown
C) Orange-red
D) Pink
E) None of the above

Answer 2

Brownish-black

Question 3

Which is the anticoagulant of choice in the LAP staining procedure?

A) Ethylenediaminetetraacetic acid (EDTA)
B) Heparin
C) Sodium citrate
D) Sodium fluoride
E) None of the above

Answer 3

Heparin

Question 4

Red-brown peroxidase positive granules are found in:

A) Promyelocytes
B) Myelocytes
C) Metamyelocytes
D) All of the above
E) None of the above

Question 5

From what population is the control specimens obtained for LAP staining?

A) Patients with chronic myelogenous leukemia
B) Patients with liver disease
C) Patients in their third trimester of pregnancy
D) All of the above
E) None of the above

Question 6

Sudan black B stains which constituent of cells?

A) Lysosomes
B) Glycoproteins
C) Phospholipids
D) All of the above
E) None of the above

Question 7

What is the specimen of choice for the peroxidase staining procedure?

A) EDTA-anticoagulated blood
B) Fresh capillary blood
C) Oxalated blood
D) Sodium citrate anticoagulated blood
E) None of the above

Question 8

The enzyme peroxidase is present in the __________ granules of myeloid cells.

A) Primary
B) Secondary
C) Tertiary
D) All of the above
E) None of the above

Question 9

The peroxidase reaction is positive for __________ cells.

A) Plasma
B) Lymphoid
C) Myeloid
D) All of the above
E) None of the above

Question 10

The peroxidase reaction parallels the Sudan black B stain except that the peroxidase enzyme is found only in __________ granules.

A) Primary
B) Secondary
C) Tertiary
D) All of the above
E) None of the above

Question 11

Red blood cells that stain peroxidase positive are an indication that:

A) Smears were made too thin.
B) The incubation period was too short.
C) The incubation period was too long.
D) Smears were made too thick.
E) None of the above

Question 12

What is the principle of the LAP (leukocyte alkaline phosphatase) stain?

A) The LAP within the cell hydrolyzes the substrate naphthol AS-BI phosphate, which couples with the dye (fast red violet LB salt) and precipitates out.
B) The LAP within the cell hydrolyzes the mitochondria, which couples with the dye (fast violet LB salt) and precipitates out.
C) The LAP within the cell hydrolyzes the nuclear chromatin, which couples with the dye (fast violet LB salt) and precipitates out.
D) All of the above
E) None of the above

Question 13

Only segmented neutrophils and __________ are scored in LAP staining.

A) Monocytes
B) Band neutrophils
C) Eosinophils
D) All of the above
E) None of the above

Question 14

What is the specimen of choice for the Sudan black B staining procedure?

A) Fresh capillary blood
B) Oxalated blood
C) EDTA-anticoagulated blood
D) Sodium citrate anticoagulated blood
E) None of the above

Question 15

The purpose of the leukocyte alkaline phosphatase (LAP) procedure is to distinguish the cells of a leukemoid reaction from those of __________.

A) Acute myelocytic leukemia (AML)
B) Chronic myelocytic leukemia (CML)
C) Chronic lymphocytic leukemia (CLL)
D) Polycythemia vera
E) None of the above

Question 16

An LAP classification score of 2 corresponds to what morphology?

A) Colorless
B) Diffuse, slight positivity or occasional granules
C) Diffuse positivity and moderate number of granules
D) Strong positive (granules fill cell)
E) Very deep staining, nucleus almost obscured

Question 17

What is the principle of the peroxidase staining procedure?

A) In the presence of lactate dehydrogenase (LDH), the enzyme peroxidase oxidizes the substrate to a red-brown color.
B) In the presence of KOH, the enzyme peroxidase oxidizes the substrate to a red-brown color.
C) In the presence of hydrogen peroxide, the enzyme peroxidase oxidizes the substrate to a red-brown color.
D) In the presence of hydrogen peroxide, the enzyme peroxidase oxidizes the substrate to a blue-green color.
E) None of the above.

Question 18

Auer rods are peroxidase __________.

A) Positive
B) Negative
C) Variable
D) All of the above
E) None of the above

Question 19

The alternate peroxidase stain differs from the regular procedure by using the substrate __________, which results in peroxidase positive granules stained __________.

A) Benzidine dihydrochloride/red-brown
B) Benzidine dihydrochloride/black
C) 3-Amino-9-ethylcarbazole/red-brown
D) 3-Amino-9-ethylcarbazole/black
E) None of the above

Question 20

What is the first cell in the myeloid lineage in which the enzyme peroxidase can be detected?

A) Metamyelocyte
B) Band neutrophils
C) Neutrophil
D) Promyelocyte
E) Myelocyte

Question 21

The __________ stain incorporates the substrate alpha-naphthol butyrate coupled with the diazo salt for staining of macrophages.

A) Peroxidase
B) Specific esterase
C) Nonspecific esterase
D) Periodic acid-Schiff (PAS)
E) None of the above

Question 22

What is the specimen of choice for the specific esterase (naphthol AS-D chloroacetate) stain?

A) Fresh capillary blood
B) Oxalated blood
C) Heparinized blood
D) Ethylenediaminetetraacetic acid-anticoagulated blood
E) None of the above

Question 23

Terminal deoxynucleotidyl transferase (TdT) is an enzyme marker for primitive __________ cells.

A) Megakaryocytoid
B) Myeloid
C) Lymphoid
D) All of the above
E) None of the above

Question 24

Esterase is inhibited by __________.

A) Mercury
B) Acid solutions
C) Heat
D) Iodine
E) All of the above

Question 25

Which specimen requirements apply to the TdT test?

A) A nonheparinized bone marrow aspirate
B) Separated marrow cells washed with culture media
C) Slides must be stored at 4°C in the dark
D) None of the above
E) All of the above

Question 26

Isoenzyme 5, the acid phosphatase fraction found in hairy cell leukemia, is __________ to the addition of tartaric acid.

A) Sensitive
B) Resistant
C) Variable
D) All of the above
E) None of the above

Question 27

What is the principle of the specific esterase (naphthol AS-D chloroacetate) stain?

A) The esterase enzyme within the cell hydrolyzes the substrate, which couples with the diazo salt.
B) The esterase enzyme within the cell hydrolyzes the diazo salt, which couples with the substrate.
C) The nucleotidyl transferase within the cell hydrolyzes the diazo salt, which couples with the substrate.
D) All of the above.
E) None of the above.

Question 28

The staining pattern in the PAS reaction may be __________.

A) Granular
B) Diffuse
C) Block
D) All of the above
E) None of the above

Question 29

Material that stains PAS positive appears __________.

A) Bluish-green
B) Bright orange
C) Bright red
D) Pink
E) None of the above

Question 30

This esterase staining procedure utilizes both alpha-naphthol butyrate and naphthol AS-D chloroacetate as substrates.

A) Nonspecific esterase
B) Specific esterase
C) Combined esterase
D) All of the above
E) None of the above

Question 31

Which constitutes a positive result with the acid phosphatase/tartrate resistant stain?

A) Two or more cells are found with a 4+ activity showing a bluish-black precipitate.
B) Two or more cells are found with a 4+ activity showing an orange-red precipitate.
C) >5 cells are found with a 4+ activity showing an orange-red precipitate.
D) >5 cells are found with a 4+ activity showing a bluish-black precipitate.
E) None of the above

Question 32

PAS stains __________ in the cell.

A) Lipid
B) Glycogen
C) Mitochondria
D) Proteins
E) None of the above

Question 33

The acid phosphatase/tartrate resistant stain is used for making diagnosis of:

A) Thalassemia
B) Hairy cell leukemia
C) Acute myeloblastic leukemia
D) Chronic myelocytic leukemia
E) None of the above

Question 34

The purpose of the positive nonspecific esterase reaction which can be inhibited by the addition of sodium fluoride is to aid in differentiation of French-American-British (FAB) subclasses__________ and _____________.

A) M1, M2
B) M1, M3
C) M1, M6
D) M4, M5
E) L1, L3

Question 35

In the combined esterase staining procedure, a dark, brown-red staining indicates:

A) Monocytes
B) T lymphocytes
C) Early promyelocytes
D) Mast cells
E) Late granulocytes

Question 36

____________ percent of patients in CML blast crisis exhibit positive TdT activity.

A) 50
B) 5
C) 20
D) 30
E) Zero

Question 37

What is the principle of the TdT test?

A) Washed lymphocytes are incubated with washed sheep red blood cells; rosettes will form if TdT is present.
B) Phycoerythrin (PE)-labeled antigoat antibody is incubated with cells; if nuclei contain TdT, cells will appear greenish-yellow.
C) Fluorescein isothiocyanate (FITC)-labeled antirabbit antibody is incubated with cells, if cells contain TdT in nucleus they will fluoresce.
D) All of the above.
E) None of the above.

Question 38

__________ percent of patients with acute undifferentiated leukemia will have positive TdT activity.

A) 50
B) 30
C) 20
D) 5
E) None of the above