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Chapter 3: Structure and Function of Hematopoietic Organs

 

Multiple-Choice Questions

Level I

  1. The primary site of hematopoiesis in a 4-month-old maturing fetus is:
    1. The liver
    2. The spleen
    3. The bone marrow
    4. A lymph node

Correct Answer: A

(Objective 1)

  1. The primary site of hematopoiesis in an adult is:
    1. The bone marrow
    2. The spleen
    3. The liver
    4. A lymph node

Correct Answer: A

(Objective 1)

  1. The first sign of erythroid development in an embryo occurs in:
    1. The yolk sac
    2. The AGM
    3. The liver
    4. A lymph node

Correct Answer: A

(Objective 2)

  1. At what point during fetal development does the bone marrow become the primary organ of hematopoiesis?
    1. 3 months’ gestation
    2. 14 days’ gestation
    3. Birth
    4. 6 months’ gestation

Correct Answer: D

(Objective 2)

  1. Which of the following marrow elements provides the microenvironment for proliferation and differentiation of hematopoietic cells?
    1. Yellow marrow
    2. Red marrow
    3. White pulp
    4. Germinal centers

 

Correct Answer: B

(Objective 2)

 

  1. Peyer’s patches are an example of:
    1. Primary lymphoid tissue
    2. Secondary lymphoid tissue
    3. Splenic tissue
    4. Medullary tissue

Correct Answer: B

(Objective 3)

  1. A characteristic that defines a tissue as primary vs. secondary lymphoid tissue is:
    1. That activated cells reside in primary and resting cells reside in secondary lymphoid tissue
    2. The quantity of cells in each
    3. T cells in primary and B cells in secondary tissue
    4. The ability of the lymphoid cells to respond to antigens

Correct Answer: D

(Objective 3)

  1. In cases when the bone marrow is compromised, hematopoiesis can resume in other organs. What is this phenomenon called, and what organs have this ability?
    1. Hematopoiesis; lymph node and spleen
    2. Extramedullary hematopoiesis; liver and spleen
    3. Nuclear asynchrony; thymus and spleen
    4. Diapedesis; blood vessels and brain

Correct Answer: B

(Objective 4)

  1. Where in the body does maturation of T lymphocytes take place?
    1. Lymph node
    2. Bone marrow
    3. Spleen
    4. Thymus

Correct Answer: D

(Objective 4)

  1. The primary hematopoietic function of the spleen is:
    1. Extramedullary hematopoiesis
    2. Lymphatic drainage
    3. Culling and pitting
    4. T cell maturation

Correct Answer: C

(Objective 4)

  1. Which of the following chiefly controls hematopoiesis in the bone marrow?
    1. The amount of fat present
    2. Stromal components
    3. Vasculature
    4. The number of osteoblasts present

Correct Answer: B

(Objective 4)

  1. Acute blood loss can cause bone marrow hyperplasia. What factor determines the ultimate effect of this pathologic state?
    1. Ineffective hematopoiesis
    2. Severity of the blood loss
    3. Severity and duration of the blood loss
    4. Bone marrow activity

Correct Answer:  C

(Objective 4)

  1. What could cause an enlarged lymph node?
  1. Bone marrow tumor
  2. Infection
  3. Allergic reaction
  4. Sluggish blood flow

Correct Answer:  B

(Objective 4)

  1. The splenic architecture includes the largest collection in the body of which two cells?
  1. Erythrocytes and platelets
  2. Lymphocytes and platelets
  3. Erythrocytes and lymphocytes
  4. Lymphocytes and macrophages

Correct Answer:  D

(Objective 4)

Level II

  1. All of the following contribute to a diagnosis of hypersplenism except:
    1. Cytopenia in the peripheral blood
    2. Hyperplastic marrow
    3. Hepatomegaly
    4. Splenomegaly

Correct Answer: C

(Objective 1)

  1. Which of the following could cause lymphadenopathy?
    1. Inflammation
    2. Infection
    3. Tumor
    4. All of the above

Correct Answer: D

(Objective 1)

  1. A hyperplastic marrow can occur with which of the following?
    1. Leukemia
    2. Postchemotherapy
    3. Anemia
    4. Oxygen therapy

Correct Answer: A

(Objective 2)

  1. Splenomegaly as a result of bone marrow failure is indicative of:
    1. Liver disease
    2. Accelerated immune response
    3. Extramedullary hematopoiesis
    4. Nuclear asynchrony

Correct Answer: C

(Objective 2)

  1. Which of the following sets of organs has the capability of extramedullary hematopoiesis?
    1. Thymus and lymph nodes
    2. Thymus and bone marrow
    3. Liver and spleen
    4. Liver and bone marrow

Correct Answer: C

(Objective 3)

  1. The process of culling and pitting occurs in the spleen’s:
    1. Germinal centers
    2. Follicles
    3. Vascular sinuses
    4. Red pulp cords

Correct Answer: D

(Objective 4)

  1. Predict the size of the thymus in a mature adult in comparison with one in an infant thymus.
    1. The adult thymus is the same size as the infant thymus.
    2. The adult thymus is larger than the infant thymus.
    3. The adult thymus is smaller than the infant thymus.
    4. This cannot be determined.

Correct Answer: C

(Objective 4)

  1. Where are plasma cells located in the lymph node?
    1. Cortex
    2. Medulla
    3. Germinal centers
    4. Peripheral zone

Correct Answer: B

(Objective 4)

  1. Hypersplenism associated with compensatory hypertrophy of the spleen is associated with:
    1. Neoplasms when malignant cells occupy much of the splenic space
    2. Congestive heart failure
    3. Liver cirrhosis with portal hypertension
    4. Infection and inflammatory diseases

Correct Answer: D

(Objectives 1 & 4)

  1. Which of the following is considered a MALT tissue?
    1. Lymph node
    2. Thymus
    3. Tonsils
    4. Bone marrow

Correct Answer: C

(Objective 4)

  1. Primitive erythropoiesis in the yolk sac is important to what process?
  1. Transportation of oxygen to developing tissue
  2. Development of immunity
  3. Liver development
  4. Cellular differentiation

Correct Answer:  A

(Objective 5)

  1. Normal proliferation of hematopoietic cells in adulthood takes place at what location?
  1. Peripheral blood
  2. Bone marrow
  3. Stroma
  4. Liver

Correct Answer:  B

(Objective 2)

  1. The primary sites of lymphoid tissue include:
    1. Bone marrow, spleen, and liver
    2. Bone marrow, thymus, and liver
    3. Thymus, spleen, and lymph nodes.
    4. Thymus, bone marrow, and lymph nodes

Correct Answer:  C

(Objective 3)

  1. What feature is true for primary versus secondary lymphoid tissue?
  1. Primary lymph tissue can replace secondary.
  2. Primary lymphoid tissue is necessary to the secondary lymphoid tissue process.
  3. Immunocompetent T and B cells are found only in secondary lymphoid tissue.
  4. Immunocompetent T and B cells are found only in primary lymphoid tissue.

Correct Answer:  B

(Objective 3, 4)

  1. The hematopoietic compartment of the bone marrow contains what components?
  1. Connective tissue and stroma
  2. Hematopoietic cells and stroma
  3. Tissues and vasculature
  4. Tissues and stroma

(Objective 4)

Correct Answer:  B

  1. Which of the following characterizes definitive erythropoiesis?
    1. A self-renewing HSC in the AGM
    2. The production of erythroid cells in the liver
    3. The presence of hemoglobin F in erythroid cells
    4. Megakaryocyte proliferation in the bone marrow

(Objective 5)

Correct Answer:  A

 

Short-Answer Questions

  1. Explain how the bone marrow receives nutrients to survive.

Answer:  The bone marrow receives nutrients primarily through the nutrient artery and the periosteal capillary. The capillaries join with the venous sinuses as they re-enter the marrow. The sinuses gather into wider collecting sinuses that then open into the central longitudinal vein (central sinus).

 (Objective 4, Level II)

  1. List and explain the function of the cells in the bone marrow stroma.

Answer:  The bone marrow stroma provides a supportive microenvironment for developing hematopoietic cells.  It forms a three-dimensional scaffold for support and adhesion of developing cells. It also facilitates cell–cell interactions by providing essential cytokines to the hematopoietic dividing cells.

(Objective 1, Level I)

  1. Track the path of maturation of the T lymphocyte.

Answer:  Precursor T cells leave the bone marrow (where they develop from the committed lymphoid progenitor cell) and enter the thymus through arterioles in the cortex. The thymus is the maturation compartment for T-lymphocytes.   As they travel through the cortex and medulla, the T-lymphocytes interact with epithelial cells and dendritic cells, which provide signals to ensure that T cells recognize foreign antigen, not self-antigen. In addition, the T cells undergo substantial proliferation.  (Objective 2, Level I)

  1. List four causes of a hyperplastic marrow.

Answer:

  1. Acute blood loss causes transient erythrocytosis.
  2. Increased proliferation of monoclonal or polyclonal populations of hematopoietic cells, such as leukemia
  3. Ineffective hematopoiesis. Example: Vitamin B12 deficiency.
  4. Abnormal stimulation or abnormal response to stimulation of stem cells/progenitors from internal or external stimulants.

(Objective 2, Level II)

  1. What would you expect to see on microscopic examination of a stained blood smear if the patient has had a splenectomy and why?

Answer:  You would expect to see erythrocyte inclusions such as Howell-Jolly bodies and Pappenheimer bodies and in some cases abnormal erythrocyte shapes.  This is because the spleen is responsible for pitting inclusions from RBCs and culling abnormal RBCs. The liver can remove some of these abnormal cells but is not as effective as the spleen in doing so.

(Objective 4, Level I)

 

 

Chapter 8: Lymphocytes

Multiple-Choice Questions

Level I

  1. Which of the following terms describes an absolute increase in the number of lymphocytes?
    1. Neutropenia
    2. Eosinophilia
    3. Leukocytosis
    4. Lymphocytosis

Correct Answer: D

(Objectives 4)

  1. T, B, and NK lymphocytes can be differentiated by:
    1. Morphology
    2. Flow cytometry
    3. Cytochemistry
    4. Cytogenetic karyotype

Correct Answer: B

(Objectives 5)

  1. Reactive lymphocytes differ from normal lymphocytes in that the reactive form:
    1. Is larger with an increase in basophilic cytoplasm, vacuoles, and scalloped cell shape
    2. Has a condensed nuclear pattern with light pink cytoplasm
    3. Has many granules, deep basophilic cytoplasm, and blast-like nucleus
    4. Has a condensed nuclear chromatin, eccentric nucleus, and deep blue cytoplasm

Correct Answer: A

(Objective 6)

  1. An instrument printout shows a normal WBC count with a lymphocyte count of 30%. What can be concluded from this?
    1. The patient is suffering from an infection.
    2. There is a normal lymphocyte concentration.
    3. The patient is an infant.
    4. The patient has leukemia.

Correct Answer: B

(Objective 3)

  1. A blood sample from a 40-year-old white female has a WBC count of 10.2 ´ 109/L and a lymphocyte percentage of 47%. What can be concluded from this?
    1. The patient has both a relative and an absolute lymphocytosis.
    2. The patient has only a relative lymphocytosis.
    3. The patient has only an absolute lymphocytosis.
    4. The relative and absolute counts are normal.

Correct Answer: B

(Objective 3)

  1. A blood sample from a 5-month-old infant indicates a WBC count of 12.5 ´ 109/L with 65% lymphocytes. What can you conclude from this?
    1. The infant is normal.
    2. The infant has an infection as indicated by the elevated WBC count.
    3. The infant has a malignancy in the lymphocyte lineage.
    4. There is not enough information to draw accurate conclusions.

Correct Answer: A

(Objective 3)

  1. The identity of immunoglobulins is determined by:
    1. The number of B cells containing the antibody
    2. The complexity of the antibody
    3. The isotype of the heavy chain
    4. The specificity of the variable region

Correct Answer: C

(Objective 7)

  1. Which of the following is a characteristic of T lymphocytes?
    1. Phagocytosis of bacteria
    2. Antibody synthesis
    3. Cytokine secretion
    4. Few in number within peripheral blood

Correct Answer: C

(Objective 1)

  1. Which of the following is a characteristic of NK cells?
    1. They function in the innate immune response.
    2. They are capable of antibody synthesis
    3. They are made up the majority of lymphocytes in peripheral blood.
    4. They phagocytize bacteria.

Correct Answer: D

(Objective 1)

  1. Which of the following describes the distribution of lymphocytes within the body?
    1. 75% exist in peripheral blood, 25% in lymph nodes and spleen
    2. 50% exist in the circulating pool, 50% in the marginating pool
    3. 95% are found in the lymph nodes and spleen, 5% in the peripheral blood
    4. 80% are short-lived, 20% are long lived

Correct Answer: C

(Objective 2)

 

Level II

  1. Which cell line matures and differentiates upon exposure to antigen?
    1. Neutrophilic
    2. Basophilic
    3. Monocytic
    4. Lymphocytic

Correct Answer: D

(Objective 1)

  1. Which of the following is found on early T-cell precursors?
    1. CD2
    2. CD4
    3. CD8
    4. CD34

Correct Answer: D

(Objective 4)

  1. What cell has CD8 on its surface?
  1. T-helper cell
  2. B cell
  3. Macrophage
  4. Cytotoxic T cell

Correct Answer: D

(Objective 4)

  1. A patient with infectious mononucleosis would most likely produce which of the following?
  1. IgD antibodies
  2. Polyclonal antibodies
  3. Monoclonal antibodies
  4. IgE antibodies

Correct Answer: B

(Objective 7)

  1. The lymphoid progenitor that gives rise to T, B, and NK lymphocytes is recognized as which of the following?
  1. CFU_GM
  2. CLP
  3. CMP
  4. CFU-T

Correct Answer:  B

(Objective 2)

 

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