Quiz
Clinical Pathology
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Questions in this quiz (100)
1Which of the following is least likely to damage blood cells during sampling?
- AUse of a sharp needle
- BStrong suction on the syringe.
- CShaking the blood tube.
- DSampling from a cat’s cephalic vein.
2Select the most appropriate tube, from the following list, for routine haematology
- AEDTA
- BHeparin
- CPlain
- DFluoride
3Select the most appropriate tube, from the following list, for routine biochemistry.
- AEDTA
- BCitrate
- CPlain
- DFluoride
4Select the most appropriate tube, from the following list, for serology
- AEDTA
- BHeparin
- CCitrate
- DACD
5Select the most appropriate tube, from the following list, for D Dimer assay
- AEDTA
- BHeparin
- CPlain
- DCitrate
6Select the most appropriate tube, from the following list, for coagulation times
- ACitrate
- BHeparin
- CSerum gel
- DPlain
7Which is the difference between plasma and serum?
- APlasma contains fibrinogen but serum does not.
- BSerum contains fibrinogen but plasma does not
- CSerum contains clotting factors while plasma does not.
- DPlasma is more stable for transport than serum but takes longer to prepare.
8Select the least accurate statement concerning the general testing of blood samples.
- ABiochemistry relies on photosensitive electrodes.
- BHormone assays usually require antibodies.
- CLipaemia and haemolysis are common causes of inaccurate tests.
- DElectrolytes are measured using chemical titration.
9What are the best variables for centrifugation of blood samples to measure the PCV?
- A800 - 1000 rpm for 2 minutes.
- B5000 - 6000 rpm for 5 minutes.
- C10000 - 12000 rpm for 15 minutes.
- D12500 - 15000 rpm for 5 minutes.
10After centrifugation what is the correct order of the blood layers in a capillary tube?
- AClay plug, buffy coat, PCV, plasma.
- BClay plug, PCV, buffy coat, plasma.
- CClay plug, plasma, PCV, buffy coat.
- DClay plug, PCV, plasma, buffy coat.
11When estimating the [WBC] of a centrifuged blood sample what rule of thumb can be used?
- AIf the buffy coat is visible to the naked eye the [WBC] > 5x10^9/l.
- BThe buffy coat % height equates to 10x10^9 WBC/l for the first 1% then an additional 20x10^9 for each 1% thereafter.
- CThe buffy coat depth corresponds with 10x10^9 WBC/l per mm.
- DSince the buffy coat comprises of platelets and WBCs no accurate estimations of [WBC] can be made without platelet counting.
12Impedance cell counters do not measure directly
- AHaematocrit.
- BMean cell volume.
- C[Haemaglobin].
- DRed blood cell count.
13Impedance cell counters cannot calculate which of the following?
- AMean cell haemoglobin concentration.
- BMean cell haemoglobin content.
- CSample volume.
- DRed cell distribution width.
14Impedance cell counters
- AMeasure differential [WBC] after lysis of RBCs.
- BEasily distinguish between RBCs and aggregated platelets.
- CDistinguish between nucleated RBCs and leukocytes.
- DCannot distinguish between types of WBCs.
15A blood sample from which of the following species is least likely likely to have platelet aggregates?
- ADogs.
- BCats.
- CHorses.
- DNo significant difference between species samples.
16The blood smear of an anaemic sample is most likely to face what problem when it is made?
- AThe smear is too long.
- BThe smear is too short.
- CThe feathered edge is too streaky.
- DThere are gaps in the smear.
17Where on a blood smear should microscopic analysis be performed.
- AAt the most cell dense section.
- BWhere there are no cells touching each other.
- CAt the feathered edge.
- DIt make no difference to the result.
18What is the main feature of a test that merits it having high precision?
- AThe results are very close to the true value.
- BUpon replication of the test the results are always very similar.
- CThe apparatus is regularly calibrated with control samples.
- DThe variable being tested is strongly correlated with the clinical parameter of interest.
19What variability in the daily control test suggests there is an error in the procedure/ apparatus and so warrants repeating the control testing?
- AControl result is not identical to the established mean.
- BControl result falls outside a 5% range of the established mean.
- CControl result falls outside 1 standard deviation of the established mean.
- DControl result falls outside 2 standard deviations of the established mean.
20What is not a feature of aged blood samples?
- AHaemolysis.
- BCoagulation.
- CLow [glucose].
- DAll of the above are falsely represented in aged samples.
21What is not a typical expected finding in blood samples from the following patients?
- AHigh PCV, low [platelet] and low [neutrophil] in a Greyhound.
- BHigh [Ca2+], [phosphate] and [ALP] but low [protein] in a young animal.
- CHigh [PCV] in a sedated dog.
- DHigh [eosinophil] in a German Shepherd Dog.
22Select the least accurate statement regarding erythropoeisis.
- ANurse cell macrophages are the focal points for RBC production as they phagocytose debris, supply iron and store haemosiderin.
- BThe chain of progression in RBC production is from erythroid stem cell to pro-erythroblast, reticulocyte, early normoblast (prorubricyte), intermediate erythroblast (rubricyte), late normoblast (metarubricyte), erythrocyte.
- CLate normoblasts have a pyknotic nucleus and cannot replicate.
- DHaemoglobin synthesis is responsible for extrusion of the nucleus.
23What is the main stimulus for erythropoeitin secretion?
- ALow PCV.
- BHypovolaemia.
- CRenal tissue hypoxia.
- DHypotension.
24Select the false statement concerning reticulocytes.
- AThey are polychromatic due to blue/pink staining of clumps of ribosomes on Romanosky slides e.g. Diff-Quick.
- BThey are smaller than mature RBCs.
- CElevated circulating levels are concurrent with a regenerative anaemia.
- DMethylene blue staining is used for accurate counting of reticulocytes.
25What is the expected finding on blood testing in a case of acute or ongoing haemorrhage?
- ALow PCV and plasma [protein].
- BLow PCV and normal plasma [protein].
- CNormal PCV and low plasma protein.
- DHigh PCV and plasma [protein].
- ENormal PCV and high plasma [protein].
26What is the expected finding on blood testing in a case of dehydration?
- ALow PCV and plasma [protein].
- BLow PCV and normal plasma [protein].
- CNormal PCV and low plasma protei
- DHigh PCV and plasma [protein].
- ENormal PCV and high plasma [protein].
27What is the expected finding on blood testing in a case of chronic liver disease?
- ALow PCV and plasma [protein].
- BLow PCV and normal plasma [protein].
- CNormal PCV and low plasma protein
- DHigh PCV and plasma [protein].
- ENormal PCV and high plasma [protein].
28What is the expected finding on blood testing in a case of haemolytic anaemia?
- ALow PCV and plasma [protein]
- BLow PCV and normal plasma [protein].
- CNormal PCV and low plasma protein.
- DHigh PCV and plasma [protein].
- ENormal PCV and high plasma [protein]
29What is the expected finding on blood testing in a case of myelome?
- ALow PCV and plasma [protein].
- BLow PCV and normal plasma [protein].
- CNormal PCV and low plasma protein.
- DHigh PCV and plasma [protein].
- ENormal PCV and high plasma [protein].
30Which of the following statements concerning the interpretation of PCV and total protein (TP) is least accurate?
- AIntestinal bleeding is associated with only mild decreases in TP.
- BIntravenous fluid therapy can cause artefactual low PCV.
- CEhrlichia can cause hyperglobulinaemia.
- DPCV is at the nadir immediately after acute haemorrhage
31What is not a cause of increased MCV?
- ARegenerative anaemia.
- BFeLV infection.
- CSample aging.
- DAll of the above can cause macrocytic results.
32What is the most common cause of microcytic results on haematology?
- AExcess EDTA in the tube.
- BIron deficiency.
- CFamilial microcytosis.
- DCongenital portosystemic shunt.
33Which of the following is least likely to be elevated following acute haemorrhage?
- AMCV.
- BRed cell distribution width.
- CMCHC
- DAll of the above are elevated in regenerative anaemia.
34Normochromic and hypochromic anaemia refer to normal or reduced levels of which blood parameter?
- APCV.
- BMCV.
- CMCHC.
- D[WBC].
35What is the most sensitive measure for distinguishing regenerative and non-regenerative anaemia?
- AMCV
- BMCHC
- CManual assessment of polychromasia
- DBone marrow aspirate
36How long does it take after acute haemorrhage for elevated circulating levels of reticulocytes to be noticeable?
- A12 hours.
- B24 hours.
- C48 hours.
- D72 hours.
37Select the most accurate statement concerning reticulocytes.
- AA lower reticulocyte percentage correlates with more severe anaemia.
- BThe reticulocyte percentage is the most reliable way to gauge the severity and regeneration status of anaemia.
- CCirculating reticulocytes reach maximum levels 3 days after acute haemorrhage.
- DCats have two types of reticulocytes with severe regenerative anaemia indicated by elevated levels of circulating aggregate, not punctate, reticulocytes.
38The red blood cells of what species have the most prominent area of central pallor?
- ACats
- BDogs
- CCattle
- DHorses
39What is the maximum percentage of RBC are polychromatic on a normal blood smear?
- A0.5%
- B1.5%
- C5%
- D10%
40Select the false statement concerning colour of RBCs on a giemsa blood smear.
- APolychromatic RBCs have a blue colour
- BHypochromic RBCs are typical of iron deficient anaemia
- CDogs exhibits weaker polychromasia than cats for the same degree of regenerative anaemia
- DChronic GI tract haemorrhage results in hypochromasia
41A canine blood smear contains >8 polychomic RBCs and >10 macrocytes per high power field. What grade is it?
- A1+
- B2+
- C3+
- D4+
42What term refers to RBCs have abnormal shapes?
- AAnisocytosis
- BPoikilocytosis
- CMacrocytosis
- DNormocytosis
43You see a RBC with short, evening spaced, uniform surface projections. What term best describes the appearance?
- AAcanthocyte
- BCrenated Erythrocyte
- CSpherocyte
- DSchistocyte
44An excess of EDTA in the blood tube is the most likely cause of which abnormal RBC appearance?
- ACrenated Erythrocyte.
- BHeinz bodies.
- CSpherocytes.
- DHowell-Jolly bodies.
45What types of RBCs, along with acanthocytes, are most likely to be seen in the blood smear from a patient suffering intravascular trauma e.g. hepatic, splenic or renal trauma?
- ALeptocytes
- BSpherocytes.
- CSchistocytes
- DNone of the above
46You see a RBC with rounded surface projections of variable length. What term best describes the appearance?
- AAcanthocyte.
- BLeptocyte.
- CSpherocyte
- DSchistocyte.
47What is the most likely cause for spherocytes to be present in a blood smear?
- ASnake venom toxicity.
- BRegenerative anaemia.
- CImmune mediated haemolytic anaemia (IMHA)
- DOxidative damage.
48What term refers to the RBCs with a ‘target’ appearance that are present in cases of regenerative anaemia, lipid disorders and iron deficiency?
- AAcanthocyte
- BSpherocyte.
- CSchistocyte.
- DLeptocyte.
49Fragmented RBCs are known as
- ASchistocytes.
- BHowell-Jolly bodies.
- CLeptocytes
- DSpherocytes.
50Select the false statement concerning spherocytes.
- AThey easiest to spot in canine samples since the normal RBCs of other species lack central pallor anyway
- BThey are small, round and densely staining
- CTheir presence is always diagnostic of IMHA
- DOnly one of the above statements is false.
51Howell-Jolly bodies are best described as
- ANuclear remnants of RBCs present in regenerative anaemia.
- BAggregates of retained RNA seen in ruminants with lead poisoning.
- CRound refractile inclusions on the inner surface of the RBC membrane.
- DIndicative of parasitic infection
52Which of the following are not intracellular features of abnormal RBCs?
- ABasophilic stippling.
- BHeinz bodies
- CHaemobartonella felis (Mycoplasma haemofelis/ Mycoplasma haemominutum) infection.
- DBabesia infection
53In what species is it not of pathological concern to find 10% of RBCs to feature Heinz bodies?
- ACats.
- BDogs.
- CSheep
- DHorses.
54What condition is associated with rouleaux formation of RBCs?
- AAnaemia.
- BLeukopaenia.
- CHyperglobulinaemia.
- DHypoalbuminaemia.
55Which of the following statements concerning information gleaned from taking a history of a patient with anaemia is of least relevance is untrue?
- AYoung male Golden Retrievers are predisposed to hereditary haemophilia.
- BMales are more prone to IMHA than females.
- CIngestion of bracken fern is associated with bone marrow suppression.
- DIMHA is associated with potentiated sulphonamide therapy.
56A dog presents with acute anaemia and abdominal pain. What is the most credible diagnosis?
- AVon Willebrand’s disease.
- BLymphoma.
- CSplenic haemangiosarcoma.
- DIMHA.
57Which of the following pairings of ancillary test and pathology is least accurate?
- ACoomb’s test and IMHA.
- BUrinalysis and haemolysis.
- CBone marrow aspirate and leukaemia
- DAll of the above are true tests.
58Which of the following is not associated with acute internal haemorrhage?
- ASmaller fall in PCV than plasma [protein].
- BAcanthocytes in circulation as reabsorbed RBCs are damaged
- CRebound thrombocytosis.
- DNeutrophilic leucocytosis.
59Which statement regarding chronic haemorrhage is false?
- AOlder animals are more prone to iron deficient anaemia than growing animals.
- BMicrocytes should be present but are difficult to see on blood smears since they do not always have a reduced diameter.
- CPersistent thrombocytosis commonly occurs.
- DPlasma [protein] is low persistently.
60Which of the following is least likely to be the cause of haemolytic anaemia?
- ALeptospirosis.
- BParacetamol toxicity.
- CHaemangiosarcoma
- DHyperactive phosphofructokinase.
61Which of the following statements concerning haemolytic anaemia is least accurate?
- AIntravascular haemolysis is more acute than extravascular haemolysis.
- BOnion toxicity is characterised by Howell-Jolly bodies in RBCs.
- CFeLV, Haemobartonella (Mycoplasma haemofelis/ Mycoplasma haemominutum) and Babesia all cause haemolysis in cats.
- DIdiopathic IMHA is more common than secondary IMHA in dogs.
62What is not a recognised epidemiological feature of IMHA?
- AIncreased incidence in Spring and Summer.
- BLower risk for high BCS animals.
- CBreed predisposition in Spaniels, Poodles and Setters.
- DPost-vaccination occurrence.
63Select the most accurate statement concerning the pathophysiology of IMHA?
- ASevere cases usually involve extravascular haemolysis.
- BAntibody attachment of RBCs results in recognition by splenic macrophages.
- CPartly phagocytosed RBCs have increased flexibility.
- DRBC agglutination is inhibited in severe cases by very high antibody titre.
64Which of the following collections are not all clinical signs of IMHA?
- ALethargy, pallor and weakness.
- BTachypnoea and fever.
- CJaundice, bilirubinaemia and haemaglobinuria.
- DLymphadenopathy, microhepatica and bradycardia.
65What clinical pathological signs are not characteristic of IMHA?
- AMacrocytic hypochromic anaemia.
- BNeutopaenia.
- CElevated liver enzyme activity in plasma
- DPositive Coomb’s test reaction.
66What component of plasma is responsible for binding free haemoglobin?
- AAlbumin
- BHaptoglobin.
- CFibrinogen.
- DInterleukin 1.
67Select the false statement regarding the Coomb’s test.
- AAgglutination of RBCs indicates a negative result.
- BFalse negative results can occur following high doses of steroids.
- CThe presence of antibodies bound to the surface of RBCs results in a positive result.
- DFalse positives can be caused by recent systemic infection.
68How can rouleaux be distinguished from agglutination?
- AExamination of a normal plain blood smear.
- BDilution of blood with saline then microscopic examination.
- CStaining with osmium tetraoxide to define RBC surfaces for microscope study.
- DThere is no practical way to distinguish between the two.
69Which of the following statements regarding neonatal isoerythrolysis is least accurate?
- ACats and horses are the only domestic species affected.
- BThe offspring of a blood type B Tom and type A queen will be affected.
- CHaemolysis is induced by colostral antibodies.
- DThere are three feline blood types (A, B and AB) with most DSH cats being type A.
70Select the most accurate statement regarding feline infectious anaemia.
- AThe main route of transmission is transplacentally.
- BParasitic attachment to the surface of RBC can cause intravascular, extravascular or immune mediated haemolysis with a cyclical pattern.
- CCats become free of infection by 4 weeks post clinical disease.
- DIdentification of parasites on a blood film is the easiest way to confirm infection.
71Which of the following infections does not trigger IMHA?
- ABabesia canis.
- BHaemobartonella felis (Mycoplasma haemofelis/ Mycoplasma haemominutum).
- CFeLV.
- DAll of the above trigger IMHA.
72What is not a major way that oxidants damage haemoglobin?
- ADirect oxidation of haem
- BOxidative damage to ribosomes.
- COxidation of the globin chain forming Heinz bodies.
- DOxidative damage of the plasma membrane -SH groups.
73Typically what percentage of haemoglobin needs to be converted into methaemoglobin for death to occur?
- A10 - 20%.
- B30 - 40%.
- C55% - 65%.
- D80 - 90%.
74Zinc and naphthalene can oxidative damage to RBCs without generating Heinz bodies. What RBC morphology is seen instead?
- ATotal haemolysis.
- BEccentrocytes (pale Hb free area in half the RBC).
- CSickle cell - like RBCs.
- DNo morphological change.
75Which of the following oxidants is likely to generate the most methaemoglobin?
- AOnion.
- BZinc.
- CNapthalene.
- DParacetamol.
76Which of the following statements concerning oxidative damage to RBCs is least accurate?
- AN-acetylcysteine can be used to treat paracetamol toxicity.
- BRBCs with Heinz bodies or directly damaged membranes have reduced flexibility.
- COnion toxicity tends to be self-limiting.
- DBlood transfusions should be avoided in cases of oxidative damage as they increase the potential for free radical chain reactions to occur.
77Select the false statement concerning mechanical damage to RBCs.
- AAbnormal blood vessels caused by vasculitis or neoplasia can fragment RBCs.
- BSchistocytes in blood indicate screening for haemoangiosarcoma.
- CDisseminated intravascular coagulation does not damage RBCs but impairs blood flow therefore causes the signs of anaemia.
- DMechanical damage tends to cause mild anaemia.
78What breed of dog is most predisposed to haemolysis following Pyruvate kinase deficiency?
- ABasenji.
- BGerman Shepherd Dog.
- CSpringer Spaniel.
- DDoberman Pinscher.
79What is a common trigger for mild anaemia caused by phosphofructokinase deficiency suddenly to escalate in severity?
- AHyperglycaemia following a rich meal.
- BAlkalaemia following exercise induced hyperventilation.
- CIncreased shunting of blood away from the periphery when the extremities get cold.
- DHypoproteinaemia due to liver disease.
80Which of the following causes of anaemia is likely to induce the weakest clinical signs for the same severity of reduction in PCV?
- AAcute haemorrhage.
- BIMHA
- CBabesiosis.
- DPrimary bone marrow disorder.
81Which of the following causes of aplastic anaemia is least likely to be reversible?
- AFeLV infection.
- BOestrogen therapy.
- CParvovirus infection.
- DSertoli cell tumour dependant oestrogen suppression.
82What species is most likely to be affected by pure red cell aplasia?
- ACats.
- BDogs.
- CCattle.
- DHorses.
83What is the most likely mechanism of pathology in pure red cell aplasia?
- AHereditary genetic mutation.
- BToxigenic damage to bone marrow.
- CImmune mediated depletion of erythroid precursors.
- DHormone dependant suppression of erythropoiesis.
84What bone marrow cell type is least likely to undergo neoplastic change?
- AMegakaryocyte precursors.
- BErythroid precursors.
- CGranulocyte precursors
- DLymphocyte precursors
85Evan’s syndrome is characterised by which two haematological findings?
- AAnaemia and neutropaenia.
- BEosinopaenia and thrombocytopaenia.
- CAnaemia and leukopaenia.
- DAnaemia and thrombocytopaenia.
86Which of the following statements regarding leukaemia is least accurate?
- ANeoplastic cells compete for nutrients and release inhibitory factors into the bone marrow.
- BIn chronic leukaemia under 30% of bone marrow cells are blasts.
- CIn chronic leukaemia under 30% of bone marrow cells are blasts.
c. Acute leukaemia is more responsive to therapy than chronic leukaemia due to the high mitotic potential of neoplastic cells increasing the sensitivity to cytotoxic drugs. - DLeukaemia should be suspected in any patient with anaemia, thrombcytopaenia and neutropaenia.
87What is the most typical presentation of RBCs in a patient with myelofibrosis?
- ANormocytic normochromic anaemia.
- BNormocytic hypochromic anaemia
- CMacrocytic hypochromic anaemia.
- DMacrocytic normochromic anaemia.
88Select the most accurate statement with regards to the mechanisms of anaemia of chronic disease.
- AAnaemia usually is severe, macrocytic and normochromic.
- BChronic hepatitis causes anaemia as it reduced iron availability.
- CPCV falls in hypoadrenocorticism more than expected due to haemodilution.
- DAnaemia in chronic kidney disease mainly is due to loss of RBCs in urine.
89Erythropoietin supplements
- AOnly work in the short term until antibodies develop.
- BInvolves synthetic erythropoietin in dogs and recombinant human erythropoietin in cats.
- CIs a cheap symptomatic treatment.
- DIs contraindicated in patients with endocrine disorders.
90Which of the following statements regarding the FeLV dependant anaemia is least accurate?
- AMacrocytic non-regenerative anaemia is caused by direct myelodysplastic effects as nuclear development is retarded RBCs do not divide the appropriate number of times.
- BFeLV can be responsible for pure red cell aplasia, aplastic anaemia and leukaemia.
- CCats that are seropositive to FeLV have an increased risk of anaemia of infectious disease.
- DFeLV causes haemolytic anaemia by RBC lysis when viral replication is complete.
91What is not a feature of canine primary absolute polycythaemia?
- AElevated PCV, RBC count and [haemoglobin].
- BDehydration and haemoconcentration.
- CLow levels of circulating [erythropoietin].
- DNormal or reduced blood [leukocyte].
92Secondary polycythaemia
- AIs commoner in cats than primary disease.
- BIs an appropriate response to patent ductus arteriosus.
- CDecreases blood viscosity so increases the risk of ischaemic damage to the CNS, kidneys and retinas.
- DIs only present in neoplastic disease is there are renal tumours.
93How can one distinguish between primary and secondary polycythaemia?
- A[EPO] assay.
- BTrial therapy of dilution of blood with i.v. crystalloids.
- CTrial treatment with hydroxyurea.
- DPost-mortem exam.
94What morphological feature distinguishes a band neutrophil from a monocyte with a U-shaped nucleus?
- ABands have strongly granular cytoplasm
- BMonocytes have a darker blue, vacuolated cytoplasm.
- CBands are 2-3 times the diameter of the nucleus while monocytes are only 1.5 times larger.
- DMonocytes with U-shaped nuclei are only found in tissues not in circulation.
95What is not a feature of toxic changes of neutrophils?
- ADohle bodies (blue-black cytoplasmic inclusions).
- BFoamy cytoplasm
- CBasophilic cytoplasm.
- DAll of the above are feature of neutrophils undergoing toxic change.
96What morphological changes are most likely to affect a the neutrophils of an animals being treated with steroids?
- ANo change.
- BLeft shift
- CRight shift.
- DToxic change.
97What pool of neutrophils in the body is responsible for preventing depletion when demand for neutrophils increases?
- AThe mitotic pool of myeloblasts, promyeloblasts and myelocytes.
- BThe storage/maturation pool of metamyelocytes, myelocytes and neutrophils.
- CThe circulating pool.
- DThe marginating pool adherent to vascular endothelium.
98What is the approximate half life of neutrophils in circulation?
- A6 - 14 hours
- B20 - 28 hours.
- C36 - 42 hours.
- DOver 48 hours.
99Which of the following statements regarding neutrophil kinetics is least accurate?
- AThe marginating pool in cats is 2-3 times larger than the circulating pool.
- BApproximately 5 days worth of neutrophils are present in the storage pool.
- CThe half life of neutrophils in plasma is increased by infection
- DLeft shift of neutrophils suggests increased demand.
100What species exhibits a strongest neutrophilia and left shift response to inflammation?
- ACats.
- BDoggos
- CCattle.
- DHorses.
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- Quiz on Clinical Pathology, created by Jonny Whiting on 24/04/2018.
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- Jonny Whiting
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