Photomicrographs and Color Plate Examination Flashcards by H. JG

Plate 1 is a photomicrograph of an antinuclear
antibody test using human fibroblasts, fluorescein
isothiocyanate (FITC)–conjugated antihuman
serum, and transmitted fluorescence microscopy.
Which pattern of immunofluorescence is
demonstrated in this 400× field?
A. Homogenous
B. Peripheral
C. Nucleolar
D. Speckled

A. Homogenous

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Plate 2 shows the electrophoresis of serum
proteins on a high-resolution agarose gel at
pH 8.6. Sample 1 (in lane 1) is a normal serum
control. Which sample can be presumptively
classified as a monoclonal gammopathy?
A. Sample 2
B. Sample 4
C. Sample 6
D. Sample 8

C. Sample 6

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Plate 3 shows a densitometric scan of a control
serum for protein electrophoresis. The percentages
of each fraction are shown below the scan. Given
these results, what is the most appropriate initial
corrective action?
A. Repeat the electrophoresis run using fresh
control serum
B. Report the results, provided that the previous
run was in control
C. Move the fourth fraction mark to the right and
redraw the scan
D. Calculate the concentration of each fraction in
grams per deciliter

C. Move the fourth fraction mark to the right and
redraw the scan

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Plate 4 shows the electrophoresis of serum proteins
on a high-resolution agarose gel at pH 8.6. Which
band represents the β lipoprotein?
A. A
B. B
C. C
D. D

C. C

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Plate 5 is a densitometric scan of a serum protein
electrophoresis sample. The relative and absolute
concentration of each fraction and reference limits
are shown below the scan. What is the correct
classification of this densitometric pattern?
A. Polyclonal gammopathy associated with chronic
inflammation
B. Nephrotic syndrome
C. Acute inflammation
D. Hepatic cirrhosis

C. Acute inflammation

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Plate 6 shows an agarose gel on which
immunofixation electrophoresis (IFE) was
performed at pH 8.6. The gel contains the
same serum sample as number 6 shown in Plate 2.
What is the heavy and light chain type of the
monoclonal protein present in this sample?
A. IgA κ
B. IgG κ
C. IgG λ
D. IgM λ

B. IgG κ

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Plate 7 shows the electrophoresis of hemoglobin
(Hgb) samples performed on agarose gel, pH 8.8.
The control sample is located in lanes 2 and 10
and contains Hgb A, S, and C. Which sample(s)
are from neonates?
A. Samples 1 and 5
B. Sample 3
C. Sample 7
D. Samples 8 and 9

A. Samples 1 and 5

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Plate 8 shows the electrophoresis of Hgb samples
on acid agar gel, pH 6.0. The sample order is the
same as for plate 7 with the A, S, C control
hemolysate in lanes 2 and 10. Based upon the
electrophoretic mobility of sample 7 as seen in
both plate 7 and plate 8, what is the patient’s
Hgb phenotype?
A. SS
B. AS
C. AD
D. AG

A. SS

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Plate 12 is a bronchoalveolar lavage sample
concentrated by cytocentrifugation and stained
with Wright’s stain, 1,000×. The sample was
obtained from a patient with AIDS who resides in
the midwestern United States. Which infectious
agent is present?
A. Pneumocystis jiroveci (carinii)
B. Mycobacterium avium–intracellulare
C. Histoplasma capsulatum
D. Cryptococcus neoformans

C. Histoplasma capsulatum

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Plate 18 is a peripheral blood film stained with
Giemsa’s stain, 1,000×. What condition is
suspected from this field?
A. Macrocytic anemia
B. Agranulocytosis
C. Relapsing fever
D. Lead poisoning

C. Relapsing fever

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Plate 19 shows an organism isolated from an eye
wash of a patient with a cornea infection who had
been wearing contact lenses for the past 2 years.
What is the name of the causative agent?
A. Naegleria spp.
B. Acanthamoeba spp.
C. Entamoeba histolytica
D. Trichomonas vaginalis

B. Acanthamoeba spp.

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Plate 20 is a Wright’s-stained peripheral blood
film, 1,000×. Which malarial stage is present in
the RBC in the center of the plate?
A. Ring trophozoite of Plasmodium vivax
B. Mature trophozoite of Plasmodium malariae
C. Macrogametocyte stage of Plasmodium
falciparum
D. Mature gametocyte stage of Plasmodium ovale

A. Ring trophozoite of Plasmodium vivax

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Plate 21 is a modified acid-fast stain with
malachite green counterstain of a stool specimen,
1,000× magnification. The oocysts seen in this
field are approximately 5 μ in diameter. Which
organism is present?
A. Isospora belli
B. Cryptosporidium parvum
C. Cyclospora spp.
D. Sarcocystis spp.

B. Cryptosporidium parvum

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Plate 22 is a Gram-stained CSF concentrated
by centrifugation, 1,000×. Which organism is
present?
A. Neisseria meningitidis
B. Staphylococcus aureus
C. Streptococcus pneumonia
D. Listeria monocytogenes

C. Streptococcus pneumonia

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Plate 23 is a urinary sediment viewed under
400× magnification using a brightfield microscope.
What is the object located in
the center of the field?
A. Schistosoma haematobium ovum
B. Oval fat body
C. Glitter cell
D. Fecal contaminant

B. Oval fat body

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Plate 24 is a urinary sediment viewed under
400× magnification using a brightfield microscope.
Which crystals are seen?
A. Uric acid
B. Calcium oxalate
C. Ammonium magnesium phosphate
D. Hippuric acid

A. Uric acid

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Plate 25 is a urinary sediment viewed under
400× magnification using a brightfield microscope.
Which crystals are seen?
A. Uric acid
B. Calcium oxalate
C. Ammonium magnesium phosphate
D. Hippuric acid

C. Ammonium magnesium phosphate

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Plate 26 is a urinary sediment viewed under
400× magnification using a brightfield microscope.
Which type of cast is present?
A. Hyaline cast
B. Broad cast
C. Waxy cast
D. Coarse granular cast

D. Coarse granular cast

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Plate 27 shows a urinary sediment viewed under
400× magnification using brightfield microscopy.
This colorless crystal is presumptively identified as:
A. Calcium phosphate
B. Acetaminophen
C. Cystine
D. Hippuric acid

C. Cystine

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Plate 28 is a Wright’s-stained cytocentrifuge
preparation of pleural fluid, 1,000×. What is the
correct classification of the largest mononuclear
cell located in the center of the plate?
A. Histiocyte
B. Macrophage
C. Lymphoblast
D. Mesothelial cell

D. Mesothelial cell

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Plate 29 is a Wright’s-stained smear of pleural
fluid prepared by cytocentrifugation. The largest
cell in this field (see arrow) is identified as a:
A. Signet ring macrophage
B. Reactive mesothelial cell
C. Foam cell
D. Metastatic cell from the breast

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A. Signet ring macrophage

Plate 30 is from a Wright’s-stained peripheral
blood film, 1,000×. Which of the following best
describes the cells in this plate?
A. Normal morphology
B. Macrocytic red blood cells
C. Hypersegmented neutrophil present
D. Reduced platelets

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A. Normal morphology

Plate 31 is a Wright’s-stained peripheral blood
film, 1,000×. What is the most appropriate
classification of the red cell morphology seen in
this field?
A. Microcytic, hypochromic
B. Microcytic, normochromic
C. Normocytic, normochromic
D. Macrocytic, normochromic

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D. Macrocytic, normochromic

Plate 32 is a Wright’s-stained peripheral blood
film, 1,000×. What is the most appropriate
classification of the white blood cells (WBCs)
present in this field?
A. Reactive (atypical) lymphocytes
B. Large lymphoblasts exhibiting L2 morphology
C. The M4 subtype of acute granulocytic leukemia
D. Monocytes

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A. Reactive (atypical) lymphocytes

33. Plate 33 is from a Wright’s-stained peripheral blood film, 400×. Which of the following tests may be performed to enable an accurate diagnosis? A. Leukocyte alkaline phosphatase (LAP) stain B. Myeloid marker study by flow cytometry C. Myeloperoxidase stain D. Periodic acid–Schiff (PAS) stain

A. Leukocyte alkaline phosphatase (LAP) stain

34. Plate 34 is from a Wright’s-stained peripheral blood film, 400×. The cells seen are diagnostic of which condition? A. Intravascular hemolytic anemia B. Sickle cell disease C. Myelofibrosis D. Erythroleukemia

B. Sickle cell disease

35. Plate 35 is from a Wright’s-stained peripheral blood film, 1,000×. Which description of the RBC morphology and platelets is correct? A. Microcytic, hypochromic with marked poikilocytosis and increased platelets B. Macrocytic, hypochromic with marked anisocytosis and normal platelets C. Normocytic, normochromic with mild poikilocytosis and increased platelets D. Microcytic, hypochromic, with mild anisocytosis and normal platelets

A. Microcytic, hypochromic with marked poikilocytosis and increased platelets

36. Plate 36 is a Wright’s-stained peripheral blood film, 1,000×. The RBCs in this plate are characteristic of: A. Hemolytic anemia B. Myelofibrosis C. Hgb C disease D. Sideroblastic anemia

B. Myelofibrosis

37. Plate 37 is a Wright’s-stained peripheral blood film, 1,000×. The cells seen in this plate are associated with: A. Lead poisoning B. Aplastic anemia C. Iron deficiency anemia D. Intravascular hemolysis

A. Lead poisoning

38. Plate 38 is from a Wright’s-stained peripheral blood film, 400×. Which of the following conditions is consistent with this RBC morphology? A. Erythroleukemia B. β Thalassemia major C. Folate deficiency anemia D. Autoimmune hemolytic anemia

B. β Thalassemia major

39. Plate 39 is from a Wright’s-stained smear of peripheral blood, 1,000× from a patient with a WBC count of 35 × 109/L. The patient is 60 years old with firm, enlarged lymph nodes and hepatosplenomegaly. These same cells comprise 50% of the bone marrow WBCs and are positive for PAS and negative for myeloperoxidase and nonspecific esterase. What is the most likely diagnosis? A. Epstein–Barr virus infection B. Infectious mononucleosis C. Chronic lymphocytic leukemia D. Waldenström’s macroglobulinemia

C. Chronic lymphocytic leukemia

40. Plate 40 is from a Wright’s-stained peripheral blood film, 400×. The RBC morphology is most consistent with which of the following anemias? A. Folate deficiency B. Iron deficiency C. Hemolytic D. Sideroblastic

D. Sideroblastic

41. Mr. Vacini, an Italian immigrant, has been hospitalized with tachycardia, a rapidly decreasing hematocrit, and blood in his urine. Twenty-four hours prior to admission, he had taken his first dose of a sulfonamide prescribed for a urinary tract infection. Plate 41 is from a Wright’s-stained smear of his peripheral blood, 1,000×. Which laboratory test would be helpful in establishing a diagnosis of Mr. Vacini’s hematologic problem? A. Heinz body preparation B. Hgb H preparation C. Iron stain D. New methylene blue stain

A. Heinz body preparation

42. Plate 42 is from a Wright’s-stained smear of peripheral blood, 1,000×. The bone marrow aspirate of this patient demonstrated an abundance of cells with this morphology. Which of the following conditions is most likely to be associated with this sample? A. Sézary syndrome B. Hodgkin’s disease C. Burkitt’s lymphoma D. Multiple myeloma

D. Multiple myeloma

43. Plate 43 is from a Wright’s-stained peripheral blood film, 1,000×. The WBC appearing in this plate is most likely a: A. Myeloblast B. Promyelocyte C. Myelocyte D. Monoblast

A. Myeloblast

44. Plate 44 is a Wright’s-stained peripheral blood film, 1,000×. The white blood cells in this field are negative for peroxidase, chloroacetate esterase, and Sudan B. The cells are positive for terminal deoxynucleotidyl transferase (Tdt) and PAS. On the basis of these findings, what is the most appropriate classification of these cells? A. Lymphoblasts with L1 morphology B. Lymphoblasts with L2 morphology C. Lymphoblasts with L3 morphology D. Chronic lymphocytic leukemia cells

A. Lymphoblasts with L1 morphology

45. Plate 45 is from a Wright’s-stained peripheral blood film, 1,000×. Sixty percent of the WBCs are positive for naphthol AS-D chloroacetate esterase (specific esterase), and 70% are positive for α-naphthyl acetate esterase (nonspecific esterase). The WBCs in this plate are characteristic of which FAB subtype of acute nonlymphocytic leukemia? A. M1 B. M2 C. M3 D. M4

D. M4

46. Plate 46 is from a Wright’s-stained peripheral blood film, 1,000×. The WBCs shown in this field are classified as: A. Blasts B. Prolymphocytes C. Plasma cells D. Myelocytes

A. Blasts

47. Plate 47A shows cells from the same sample as plate 46 after peroxidase staining, 1000×. Plate 47B is a normal peroxidase-stained peripheral blood film, 1,000×, which is used as a control. The blast cell shown in plate 47A is classified as: A. Peroxidase positive B. Weakly peroxidase positive C. Peroxidase negative D. Invalid because of an improper control reaction

A. Peroxidase positive

48. Plate 48 is from a Wright’s-stained peripheral blood film, 1,000×. The WBC shown in the center of the field (see arrow) is classified as a: A. Blast B. Promyelocyte C. Myelocyte D. Prolymphocyte

B. Promyelocyte

49. Plate 49 is a Wright’s-stained peripheral blood film, 1,000×. What is the most appropriate classification of the WBCs seen in this field? A. Lymphoblasts B. Myeloblasts C. Promyelocytes D. Prolymphocytes

B. Myeloblasts

50. Plate 50 is a Wright’s-stained peripheral blood film, 1,000×. Which description best characterizes the morphology of the neutrophil shown in this plate? A. Normal morphology B. Döhle bodies C. Toxic granulation D. Hypersegmentation

C. Toxic granulation

51. Plate 51 shows a urinary sediment under 400× magnification stained with Sternheimer–Malbin stain. What is the large object to the right of the center of this field? A. Squamous epithelial cell B. Artifact C. Renal epithelial cell D. Transitional epithelial cell

A. Squamous epithelial cell

52. Plate 52 shows a urinary sediment under 400× magnification stained with Sternheimer–Malbin stain. What is the large cell to the right of the center of the field? A. WBC B. Transitional epithelial cell C. Renal epithelial cell D. Squamous epithelial cell

C. Renal epithelial cell

53. Plate 53 shows a urinary sediment under 400× magnification stained with Sternheimer–Malbin stain. What is the large cell in the lower right of the field? A. WBC B. Transitional epithelial cell C. Renal epithelial cell D. Squamous epithelial cell

B. Transitional epithelial cell

54. Plate 54 shows a urinary sediment under 400× magnification stained with Sternheimer–Malbin stain. What is the large object to the right of the center of the field? A. Cast B. Mucus C. Artifact D. Hair

A. Cast

55. Plate 55 is a Wright’s-stained cytocentrifuge preparation of pleural fluid, 1,000×. What is the large cell near the center of the field? A. Macrophage B. Mesothelial cell C. Blast D. Plasma cell

B. Mesothelial cell

56. Plate 56 is a Papanicolaou-stained seminal fluid, 1,000× magnification. What is the round cell near the center of the field? A. WBC B. Primary spermatocyte C. Histiocyte D. Spermatid

B. Primary spermatocyte

57. Plate 57 is a Wright’s-stained bronchioalveolar lavage (BAL) fluid, 1,000× magnification. The cellularity in this field is suggestive of which condition? A. Bacterial pneumonia B. Rheumatoid arthritis C. Lymphoma or leukemia D. Small cell carcinoma

C. Lymphoma or leukemia

58. Plate 58 is a 1,000× field of a FISH test for BCR/ABL using a dual fusion probe, consisting of a Spectrum Green–labeled probe to the BCR 22 q11.2 locus, and a Spectrum Orange–labeled probe to ABL 9q34 and counterstained with DAPI. The cells are in interphase. The cells in this field are best described as: A. BCR/ABL positive B. BCR/ABL negative C. BCR/ABL positive with an atypical pattern D. Inconclusive

A. BCR/ABL positive

59. Plate 59 is a 1,000× field of a FISH test for BCR/ABL using a dual fusion probe, consisting of a Spectrum Green–labeled probe to the BCR 22 q11.2 locus, and a Spectrum Orange–labeled probe to ABL 9q34 and counterstained with DAPI. The cells are in interphase. The cells in this field are best described as: A. BCR/ABL positive B. BCR/ABL negative C. BCR/ABL positive with an atypical pattern D. Inconclusive

B. BCR/ABL negative

Photomicrographs and Color Plate Examination Flashcards

(51 cards)