003assessment Exam Immunohema

ASSESSMENT EXAM- PART I (IMMUNOHEMATOLOGY LECTURE)
1.The earliest recognizable erythroid precursor on a

Wright-stained smear of the bone marrow is:
A. pronormoblast
B. basophilic normoblast
C. CFU-E
D. BFU-E
2.An increase in the reticulocyte count should be
accompanied by:
A. a shift to the left in the Hb-O2 dissociation curve
B.abnormal maturation of normoblasts in the bone
marrow
C. an increase in total and direct serum bilirubin
D.polychromasia on the Wright's-stained blood
smear
1 | Quiz#1
3.Which of the following is not a characteristic of

reticulocytes?
A.Reticulocytes, like mature erythrocytes, cannot use
oxygen to produce energy.
B.Reticulocytes account for about 1% of all red cells
in the blood of a normal adult.
C.Reticulocytes, unlike mature erythrocytes, can still
synthesize haemoglobin.
D.Reticulocytes normally contain more membrane
cholesterol than do mature erythrocytes.
2 | Quiz#1
4.The primary effector (cause) of increased

erythrocyte production, or erythropoiesis, is:
A. supply of iron
B. rate of bilirubin production
C. tissue hypoxia
D. rate of EPO secretion
3 | Quiz#1
5.The erythrocyte life span is most directly

determined by:
A. spleen size
B. serum haptoglobin level
C. membrane deformability
D. cell size and shape
6.What property of the normal erythrocyte
membrane allows the 7-mcM cell to squeeze through
3- mcM fenestrations in the spleen?
A. fluidity
B. elasticity
C. permeability
D. deformability
4 | Quiz#1
7.Touse glucose to produce ATP, mature

erythrocytes:
A.have to take in glucose from plasma at the expense
of ATP
5 | Quiz#1
B.consume 2 ATP molecules, but also produce 4 ATP

molecules per glucose molecule
C. consume O2 carried by hemoglobin
molecules
within themselves
D. produce CO2 and release this waste product in the
lung during respiration
8. Extravascular erythrocyte destruction occurs in:
A. the bloodstream
B. macrophages in the spleen
C. the lymph nodes
D. bone marrow sinuses
6 | Quiz#1
9. A normal erythrocyte:
A. has a normal life span of about 60 days
B. contains about 30 pg of haemoglobin
C.has a diameter of about 4 mcM so it can squeeze
through capillaries of similar diameter
D. contains about 5 femtomoles of Na+ and 9
femtomoles of K+
10. An increase in 2,3-BPG occurs at high altitude in
an effort to:
A. increase oxygen affinity of hemoglobin
B. decrease oxygen affinity of hemoglobin
7 | Quiz#1
C. decrease the concentration of methemoglobin

D. protect the cell from oxidant damage
8 | Quiz#1
11.A patient lost about 1500 mL of blood during

surgery but was not given blood transfusions. His
hemoglobin before surgery was in the reference range.
The most likely finding 3 days later would be:
A. increase in total bilirubin
B. increase in indirect bilirubin
C. increase in erythropoietin
D. increased haptoglobin
12.Results of a CBC revealed a MCHC of 40 g/dL.
What characteristic of the RBC will this affect?
A. oxygen affinity
B. cell metabolism
C. membrane permeability
D. cell deformability
9 | Quiz#1
13. A 50-year-old patient had a splenectomy after a

car accident that damaged her spleen. She had a
CBC performed at her 6-week postsurgical checkup.
Many target cells were identified on the blood
smear. This finding is most likely:
A. an indication of liver disease
B. a loss of RBC membrane peripheral proteins
C. an abnormal protein to phospholipid ratio of the
RBC membrane
D. an accumulation of cholesterol and phospholipid
in
the RBC membrane
10 | Quiz#1
14.If the erythrocyte cation pump fails because of

inadequate generation of ATP, the result is:
A.decreased osmotic fragility due to formation of
target cell
B. formation of echinocytes due to influx of
potassium
C. cell crenation due to efflux of water and sodium
D. cell swelling due to influx of water and cations
11 | Quiz#1
15.As a person ascends to high altitudes, the increased

activity of the Rapoport-Luebering pathway:
A. causes precipitation of hemoglobin as Heinz
bodies
B. has no effect on oxygen delivery to tissues
C. causes increased release of oxygen to tissues
D. causes decreased release of oxygen to tissues
16. In mature erythrocytes:
A.NADPH is used to reduce methohemoglobin back
to haemoglobin
B.The price of producing a 2,3-BPG molecule is to
gen-erate two less ATP molecules
C.NADH is used to regenerate reduced guthathione
(GSH)
D. Glucose is metabolized to form CO2
12 | Quiz#1
17.A laboratory professional finds evidence of Heinz

bodies in the erythrocytes of a 30-year-old male. This
is evidence of:
A. increased oxidant concentration in the cell
B. decreased hemoglobin-oxygen affinity
C. decreased production of ATP
D. decreased stability of the cell membrane
13 | Quiz#1
18.Which of the following is not a feature of senescent

erythrocytes?
A.Anion exchange protein 1 clusters on red cell
membrane
B. IgG accumulates on red cell membrane
C. ATP production is maintained as usual
D.Phosphatidylserine is exposed on the outer leaflet
of the red cell membrane
14 | Quiz#1
19. A patient with kidney disease has a hemoglobin of

8 g/dL. This is most likely associated with:
A. decreased EPO production
B. increased intravascular hemolysis
C. abnormal RBC membrane
D. permeability
RBC fragility due to
calcium
20. accumulation
A 65-year-old of intracellular
female presents with an anemia of 3
weeks’ duration. In addition to a decrease in her
hemoglobin and hematocrit, she has a reticulocyte
count of 6% and 3+ polychromasia on her blood
smear. on these preliminary findings, what serum
Based
erythropoietin result is expected?
A. decreased
B. normal
C. increased
15 | Quiz#1
D. no correlation
21.Which of the following is the correct molecular

structure of hemoglobin?
A. four heme groups, two iron, two globin chains
16 | Quiz#1
B. two heme groups, two iron, four globin chains

C. two heme groups, four iron, four globin chains
D. four heme groups, four iron, four globin chains
22. During exercise, the oxygen affinity of hemoglobin
is:
E. increased in males but not females
F. decreased due to production of heat and lactic
acid
G. unaffected in those who are physically fit
H. affected only if the duration is more than 1 hour
17 | Quiz#1
23. 2,3-BPG combines with which type of

hemoglobin?
A. oxyhemoglobin
B. relaxed structure of hemoglobin
C. deoxyhemoglobin
D. ab dimer
24.Which of the following types of hemoglobin is the
major component of adult hemoglobin?
A. HbA
B. HbF
C. HbA2
D. Hb Portland
18 | Quiz#1
25.One of the most important buffer systems of the

body is the:
A. chloride shift
B. Bohr effect
19 | Quiz#1
C. heme–heme interaction
D. ODC
26.Which of the following is considered a normal
haemoglo-bin concentration in an adult male?
A. 11.0 g/dL
B. 21.0 g/dL
C. 15.0 g/dL
D. 9.0 g/dL
20 | Quiz#1
27. When iron is depleted from the developing

erythrocyte, the:
A. synthesis of heme is increased
B. activity of ALAS is decreased
C. formation of globin chains stops
D. heme synthesis is not affected
28. Which of the following is true for glycated
hemoglobin?
A. Glycated hemoglobin is an abnormal minor
hemoglobin in adults.
B. Glycated hemoglobin is produced via enzymatic
glycation of the alpha globin chains.
C. HbA1c level reflects the average level of blood
glucose over the previous 2–3 months.
D. HbA and HbA1c have the same net electric
charge. 21 | Quiz#1
22 | Quiz#1
29. A patient with an to

anemia due extravascular increased
hemolysis
which of the would
followinglikely
lab results? present with
A. increased haptoglobin
B. hemoglobinuria
C. normal hemoglobin and hematocrit
D. increased serum bilirubin
30. Which of the following features is not unique to
intravascular hemolysis?
A. depletion of plasma haploglobin
B. Methemalbuminemia
C. Hemoglobinuria
D. Hemosiderinuria
23 | Quiz#1
31.Which of the following hemoglobins is not found in

the normal adult?
A. a2b2
B. a2g2
C. a2d2
D. a2e2
32.When iron in the cell is replete, the translation of
ferritin mRNA is:
A. increased
24 | Quiz#1
B. decreased
C. unaffected
D. variable
25 | Quiz#1
33.A college student from Louisiana vacationed in

Colorado for spring break. He arrived at Keystone
Resort on the first day. The second day, he was
nauseated and had a head-ache. He went to the
medical clinic at the resort and was told he had
altitude sickness. The doctor told him to rest for
another 24 hours before participating in any
activities. What is the most likely reason he will
overcome this condition in the next 24 hours?
A.His level of HbF will increase to help release more
oxy-gen to the tissues.
B.The amount of carboxyhemoglobin will decrease to
normal levels.
C.The levels of ATP in his blood will reach maximal
levels.
D.The level of 2,3-BPG will increase and, in turn,
decrease oxygen affinity.
34.In the lungs, a hemoglobin molecule takes up two
oxygen molecules. What effect will this have on the
haemoglobin molecule?
A. It will increase oxygen affinity.
26 | Quiz#1
B.It will narrow the heme pockets blocking entry of

additional oxygen.
C.The hemoglobin molecule will take on the tense
structure.
D.The center cavity will expand, and 2,3-BPG will
enter.
27 | Quiz#1
35.A 25-year-old male was found unconscious in a car

with the motor running. Blood was drawn and sent to
the chemistry lab for spectral analysis. The blood was
cherry red in color. Which hemoglobin should be
tested for?
A. sulfhemoglobin
B. methemoglobin
C. carboxyhemoglobin
D. oxyhemoglobin
36.A 2-year-old patient who had been cyanotic since
birth was seen by a pediatrician. Blood was drawn for
analysis of NADH methemoglobin reductase and
results were normal. What follow-up test would you
suggest to the physician?
A. hemoglobin electrophoresis
B. bone marrow aspiration and examination
C. haptoglobin and sulfhemoglobin determination
D.glycosylated hemoglobin measurement by column
chromatography
28 | Quiz#1
37.The oxygen dissociation curve in a case of chronic

carboxy-hemoglobin poisoning would show:
A. a shift to the right
B. a shift to the left
C. a normal curve
D. decreased oxygen affinity
29 | Quiz#1
38. Nitric oxide (NO):

A.is produced inside the erythrocytes from arginine
via the action of NO synthase
B. is a vasoconstrictive agent
C.reacts with artificial haemoglobin-based oxygen
carriers in solution to cause complications like
vasoconstriction
D. is removed once it reacts with oxyhemoglobin
30 | Quiz#1
39.An anemic patient has hemosiderinuria, increased

serum bilirubin, and decreased haptoglobin. This is an
indication that there is:
A. increased intravascular hemolysis
B. decreased extravascular hemolysis
C. hemolysis accompanied by renal disease
D. a defect in the Rapoport-Leubering pathway
40. Which of the following is true for the hemoglobin
break-down products?
A. Heme iron cannot be reused by the body.
B. Carbon monoxideis one of the hemoglobin break-
down products.
C. Unconjugated bilirubin is freely transported in
the
plasma without binding to any other molecule.
D. Most urobilinogen is excreted in the urine.
31 | Quiz#1
41.A compensatory mechanism to allow adequate

oxygen delivery to the tissues at high altitudes, where
oxygen concentrations are low, is which one of the
following?
A. An increase in 2,3-BPG synthesis by the red cell
32 | Quiz#1
B. A decrease in 2,3-BPG synthesis by the red cell

C. An increase in hemoglobin synthesis by the red
cell
D. A decrease in hemoglobin synthesis by the red cell
E. Decreasing the blood pH
42.A 2-year-old boy of normal weight and height is
brought to a clinic because of excessive fatigue. Blood
work indicates anemia, with microcytic hypochromic
red cells. The boy lives in a 100-year-old apartment
building and has been seen ingesting paint chips. His
parents indicate that the child eats a healthy diet and
takes a Flintstones vitamin supplement every day. His
anemia is most likely attributable to a deficiency in
which one of the following?
A. Iron
B. Vitamin B12
C. Folate
D. Heme
E. Vitamin B6
33 | Quiz#1
43.Drugs are being developed that will induce the

transcription of certain globin genes, which are
normally silent in patients affected with sickle cell
disease. A good target gene for such therapy in this
disease would be which one of the following?
A. The α1-gene
B. The α2-gene
C. The γ-gene
D. The β-gene
E. The ζ-gene
34 | Quiz#1
44.A mature blood cell that lacks a nucleus is which

one of the following?
A. Lymphocyte
B. Basophil
C. Eosinophil
D. Platelet
E. Neutrophil
35 | Quiz#1
45.A family has two children, one with a mild case of

thalassemia, and a second with a severe case of
thalassemia that requires frequent blood transfusions
as part of the treatment plan. One parent is of
Mediterranean descent; the other is of Asian descent.
Neither parent exhibits clinical signs of thalassemia.
Both children express 20% of the expected level of β-
globin; the more severely affected child expresses
normal levels of α-globin, whereas the less severely
affected child expresses only 50% of the normal levels
of α-globin. Why is the child who has a deficiency in α-
globin expression less severely affected?
A.Thalassemia is caused by a mutation in the α-gene,
and the more severely affected child expresses more of
it.
B.The less severely affected child must be
synthesizing the ζ-gene to make up for the deficiency
in α-chain synthesis.
C. The more severely affected child also has HPFH.
D.The more severely affected child produces more
inactive globin tetramers than the less severely
affected child.
36 | Quiz#1
E. Thalassemia is caused by an iron deficiency, and

when the child is synthesizing normal levels of α-
globin, there is insufficient iron to populate all of
the heme molecules synthesized.
46. An individual displays an anemic condition and
upon molecular analysis is shown to be a compound
heterozygote for HbS/HbC. The symptoms exhibited
by the patient are more severe than those exhibited
by patients with sickle cell trait (HbA/HbS)
owing
primarily to which one of the following?
A. Increased concentration of HbC molecules in the
patient’s RBCs
B. Increased volume of the patient’s RBCs
C. Increased concentration of HbS in the patient’s
RBCs
D. Alterations in the patient’s RBC morphology
E. Precipitation of HbS molecules within the
patient’s
RBCs
37 | Quiz#1
47.A young boy has been observed to have bluish

fingertips and toes. Blood work indicates a mild
anemia, and molecular analysis indicates the child has
an inherited erythrocyte pyruvate kinase deficiency.
This enzyme mutation leads to an increase in the 2,3-
BPG levels in the erythrocyte, which helps to
ameliorate the effects of the mutation. The increase in
2,3-BPG levels occurs because of which one of the
following?
A.The lack of pyruvate kinase leads to an increase in
1,3-BPG levels, which is used to form 2,3-BPG by the
Rapoport-Luebering shunt pathway.
B.The increase in phosphoenolpyruvate levels leads
to the phosphorylation of 3-phosphoglycerate, forming
2,3-BPG.
C.The increase in phosphoenolpyruvate levels leads
to the phosphorylation of 2-phosphoglycerate, forming
2,3-BPG.
38 | Quiz#1
D. The increase in phosphoenolpyruvate levels

leads to an increase in
3-phosphoglycerate,
phosphorylated by ATPwhich
to produce 2,3-BPG. is
E. The lack of pyruvate kinase activity leads to an
increase of glyceraldehyde 3-phosphate, which is
oxidized by an isozyme of glyceraldehyde 3-phosphate
dehydrogenase to form 2,3-BPG.
48.A young boy was recently diagnosed with anemia,
and further analysis demonstrated that he had
hereditary spherocytosis. This disease leads to anemia
through which one of the following mechanisms?
A.Lack of NADPH to protect cell membrane lipids
and proteins from oxidation
B. Nutritional deficiency of iron, folate, or vitamin
B12
C. Inability to reduce ferric hemoglobin to the
normal
ferrous state
D. Improper formation of the RBC membrane
cytoskeleton
E. A mutation in heme synthesis
39 | Quiz#1
49.A patient is a strict vegetarian and, as such, is

concerned about getting sufficient iron in his diet.
Which suggestion below could increase his dietary iron
absorption?
A. Never peel potatoes when preparing a potato dish.
B. Squeeze fresh lemon juice on spinach salad.
C.Reassure him that iron in plants is readily
absorbed.
D. Meat is the only dietary source of iron.
E. Taking a vitamin with vitamin B12 would help
iron
absorption.
50. The pluripotent stem cell of the bone marrow
produces all blood cells through different lineages via
induction of different differentiation pathways. Which
one of the following is produced from the same cell line
as RBCs?
40 | Quiz#1
A. NK-cells
B. B-lymphocytes
C. T-lymphocytes
D. Basophils
E. Platelets
41 | Quiz#1

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ASSESSMENT EXAM- PART I (IMMUNOHEMATOLOGY LECTURE)

1.The earliest recognizable erythroid precursor on a

3.Which of the following is not a characteristic of

4.The primary effector (cause) of increased

5.The erythrocyte life span is most directly

7.Touse glucose to produce ATP, mature

B.consume 2 ATP molecules, but also produce 4 ATP

C. decrease the concentration of methemoglobin

11.A patient lost about 1500 mL of blood during

13. A 50-year-old patient had a splenectomy after a

14.If the erythrocyte cation pump fails because of

15.As a person ascends to high altitudes, the increased

17.A laboratory professional finds evidence of Heinz

18.Which of the following is not a feature of senescent

19. A patient with kidney disease has a hemoglobin of

21.Which of the following is the correct molecular

B. two heme groups, two iron, four globin chains

23. 2,3-BPG combines with which type of

25.One of the most important buffer systems of the

27. When iron is depleted from the developing

29. A patient with an to

31.Which of the following hemoglobins is not found in

33.A college student from Louisiana vacationed in

B.It will narrow the heme pockets blocking entry of

35.A 25-year-old male was found unconscious in a car

37.The oxygen dissociation curve in a case of chronic

38. Nitric oxide (NO):

39.An anemic patient has hemosiderinuria, increased

41.A compensatory mechanism to allow adequate

B. A decrease in 2,3-BPG synthesis by the red cell

43.Drugs are being developed that will induce the

44.A mature blood cell that lacks a nucleus is which

45.A family has two children, one with a mild case of

E. Thalassemia is caused by an iron deficiency, and

47.A young boy has been observed to have bluish

D. The increase in phosphoenolpyruvate levels

49.A patient is a strict vegetarian and, as such, is

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