PRE-BOARD EXAMINATION IN HEMATOLOGY (PART3)

1. The sequence of erythropoiesis from prenatal life to adulthood is:

a. Yolk sac, red bone marrow, liver and spleen c. Red bone marrow, yolk sac, liver and spleen
b. Yolk sac, liver and spleen, red bone marrow d. Liver and spleen, yolk sac, red bone marrow
2. The correct maturation order of erythrocyte morphologic stages is:
a. Prorubricyte, rubricyte, rubriblast, metarubricyte c. Rubriblast, prorubricyte, rubricyte, metarubricyte
b. Rubriblast, metarubricyte, rubricyte, prorubricyte d. Rubriblast, rubricyte, prorubricyte, metarubricyte
3. Compared to a rubricyte, a metarubricyte looks different because of its:
a. Dark blue cytoplasm b. Larger size c. Pyknotic nucleus d. Nucleoli
4. Primary granules in the neutrophil appear at which stage:
a. Myeloblast b. Promyelocyte c. Myelocyte d. Metamyelocyte
5. Specific (secondary) granules of the neutrophilic granulocyte:
a. appear first at the myelocyte stage c. are formed on the mitochondria
b. contain lysosomal enzymes d. are derived from azurophil (primary) granules
6. The earliest stage in the myeloid series at which it is possible to classify a given cell:
a. Myeloblast b. Promyelocyte c. Myelocyte d. Metamyelocyte
7. The last cell in the granulocytic series capable of mitosis is the:
a. Myeloblast b. Myelocyte c. Promyelocyte d. Metamyelocyte
8. In the neutrophil series of leukocyte development, the earliest stage to normally appear in the peripheral blood
is the:
a. Myeloblast b. Promyelocyte c. Myelocyte d. Band
9. Which of the following is characteristic of cellular changes as megakaryoblasts mature into megakaryocytes
within the bone marrow?
a. progressive decrease in overall cell size c. nuclear division without cytoplasmic division
b. increasing basophilia of cytoplasm d. fusion of the nuclear lobes
10. The type of nuclear reproduction seen in megakaryocytes is:
a. Polyploid mitosis b. Endomitosis c. Meiosis d. Binary fission
11. These pairs of chains make up the majority of hemoglobin in normal adults:
a. α2 β2 b. α2 γ2 c. α2 δ2 d. ζ2 λ2
12. With respect to globin chain genes, which of the following statements is correct?
a. The genes for the alpha globin chains are located on chromosome 16 and the genes for the gamma, delta
and beta chains are located on chromosome 11
b. The genes for the gamma, delta and beta globin chains are located on chromosome 16 and the genes for
the alpha chains are located on chromosome 11
c. The genes for the alpha globin chains are located on chromosome 10 and the genes for the gamma, delta
and beta chains are located on chromosome 15
d. The genes for the alpha and delta globin chains are located on chromosome 11 and the genes for the
gamma and beta chains are located on chromosome 16
13. Most of the erythrocyte’s energy comes from the:
a. Embden-Meyerhof pathway c. Hexose monophosphate shunt
b. Rapoport-Leubering pathway d. Methemoglobin pathway
14. This metabolic pathway facilitates the oxygen release from hemoglobin to tissues:
a. Embden-Meyerhof pathway c. Hexose monophosphate shunt
b. Rapoport-Leubering pathway d. Methemoglobin pathway
15. A shift to the right in the ODC occurs when there is a(an):
a. Increase in O2 b. Increase in CO2 c. Increase in pH d. Decrease in CO2
16. The substance that is present in the urine in increased amounts if extravascular hemolysis is increased but
there is no intravascular hemolysis:
a. Methemoglobin b. Urobilinogen c. Hemoglobin d. Hemosiderin
17. Hemolytic anemia is not indicated by a(an):
a. Positive urine hemosiderin c. Positive fecal occult blood
b. Increased in plasm unconjuagted bilirubin d. Decreased serum haptoglobin
18. The following are compounds formed in the synthesis of heme:
1. coproporphyrinogen 3. uroporphyrinogen
2. porphobilinogen 4. protoporphyrinogen
Which of the following responses lists these compounds in the order in which they are formed?
a. 4,3,1,2 b. 2,3,1,4 c. 2,4,3,1 d. 2,1,3,4
19. Asynchronous development of hematopoietic cells within the bone marrow is the result of:
a. Inadequate levels of RNA c. Defective stem cells
b. Decreased erythropoietin d. Impaired DNA synthesis
20. Megaloblastic anemia is characterized by all of the following, EXCEPT:
a. Decreased WBC and retics c. Oval macrocytes
b. Hypersegmented neutrophils d. Increased platelets
21. Bite cells are associated with:
a. Pyruvate kinase deficiency b.PNH c. G6PD d. H. pyropoikiloctosis
22. What disorder is associated with erythrocytes that are thermally unstable and fragment when heated to 45 o
to 46oC?
a. Hereditary spherocytosis c. PNH
b. Hereditary elliptocytosis d. Hereditary pyropoikilocytosis
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23. Many microspherocytes and schistocytes and budding off of spherocytes can be seen on peripheral blood
smears of patients with:
a. hereditary spherocytosis c. acquired autoimmune hemolytic anemia
b. disseminated intravascular coagulation (DIC) d. extensive burns
24. Which of the following is most likely to be seen in lead poisoning?
a. iron overload in tissue b. codocytes c. basophilic stippling d. ringed sideroblasts
25. What cell shape is MOST commonly associated with an increased MCHC?
a. teardrop cells b. target cells c spherocytes d. sickle cells
26. Microangiopathic hemolytic anemia is characterized by:
a. Target cells and Cabot rings c. Pappenheimer bodies and basophilic stipplings
b. Toxic granules and Dohle bodies d. Schistocytes and nucleated RBCs
27. In myelofibrosis, the characteristic abnormal red cell morphology is:
a. Target cells b. Schistocytes c. Teardrop cells d. Ovalocytes
28. An enzyme deficiency associated with a moderate to severe hemolytic anemia after the patient is exposed
to certain drugs and that is characterized by red cell inclusions formed by denatured hemoglobin is:
a. lactate dehydrogenase deficiency c. pyruvate kinase deficiency
b. G-6-PD deficiency d. hexokinase deficiency
29. A 15-year-old girl is taking primaquine for a parasitic infection and notices her urine is a brownish color. A
CBC shows mild anemia. The laboratorian performing the reticulocyte count notices numerous irregular
shaped granules near the periphery of the RBC. These cellular inclusions are most likely:
a. Howell-Jolly bodies b. basophilic stippling c. Heinz bodies d. Pappenheimer bodies
30. What primary defect does the amino acid substitution in the -chain of Hb S have on the hemoglobin
molecule?
a. Increases its oxygen affinity c. Decreases its solubility
b. Alters its stability d. Increases its solubility
31. Which of the following hemoglobin electrophoresis results is most typical of sickle cell trait?
a. 85% HbS and 15% HbA c. 45% HbS and 55% HbA
b. 85% HbF and 15% HbS d. 55% HbF and 45% HbS
32. What is the pathophysiology of β-thalassemia?
a. Decreased synthesis of α- chains c. Synthesis of structurally abnormal β-chains
b. Decreased synthesis of β-chains d. Abnormal heme synthesis
33. Iron deficiency anemia may be distinguished from anemia of chronic infection by:
a. Serum iron level b. Red cell morphology c. Red cell indices d TIBC
34. Which antibiotic is most often implicated in the development of aplastic anemia?
a. Sulfonamides b. Chloramphenicol c. Teracycline d. Penicillin
35. Which of the following is a pure red cell aplasia?
a. Bernard-Soulier syndrome c. Diamond-Blackfan anemia
b. DiGuglielmo’s disease d. Fanconi’s anemia
36. Spherocytes may be seen in the peripheral blood of patients with:
a. Autoimmune hemolytic anemia c. Iron deficiency anemia
b. Vitamin B12 deficiency d. Pyruvate kinase deficiency
37. In a jaundiced 16-year-old, laboratory studies indicate that the MCHC is increased, the Coombs' test is
negative, and osmotic fragility of the red cells is increased. Erythrocytes on a peripheral smear are most likely
to be:
a. Acanthocytes b. Spherocytes c. Teardrop cells d. Target cells
38. Which of these hemoglobin derivatives cannot be reduced back to normal hemoglobin?
a. Methemoglobin b. Oxyhemoglbin c. Sulfhemoglobin d. Carboxyhemoglobin
39. Which of the following is associated with Chediak-Higashi syndrome?
a. membrane defect of lysosomes c. two-lobed neutrophils
b. Dohle bodies and giant platelets d. mucopolysaccharidosis
40. Which of the following is associated with Alder-Reilly inclusions?
a. membrane defect of lysosomes c. two-lobed neutrophils
b. Dohle bodies and giant platelets d. mucopolysaccharidosis
41. A differential was performed on an asymptomatic patient. The differential included 60% neutrophils: 55 of
which had 2 lobes and 5 had 3 lobes. There were no other abnormalities. This is consistent with which of the
following anomalies?
a. Pelger-Huet b. May-Hegglin c. Alder-Reilly d. Chediak-Higashi
42. Of the following, the disease most closely associated with pale blue inclusions in granulocytes and giant
platelets is:
a. Gaucher’s disease b. May-Hegglin anomaly c. Alder-Reilly anomaly d. Pelger-Huet anomaly
43. Of the following, the disease most closely associated with glucocerebrosidase deficiency is:
a. Gaucher’s disease b. Pelger-Huet anomaly c. Chediak-Higashi syndrome d. May-Hegglin anomaly
44. Bone marrow slide shows foam cells ranging from 20 to 100 m in size with vacuolated cytoplasm containing
sphingomyelin and is faintly PAS positive. This cell type is most characteristic of:
a. Gaucher’s disease b. Di Guglielmo disease c. myeloma with Russell bodies d. Niemann-Pick disease
45. In the French-American-Bristish (FAB) classification, myelomonocytic leukemia would be:
a. M1 and M2 b. M3 c. M4 d. M5
46. DIC is most often associated with which of the following FAB designation of acute leukemia?
a. M1 b. M3 c. M4 d. M5
47. Auer rods are most likely present in which of the following?
a. chronic granulocytic leukemia c. erythroleukemia
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b. myelofibrosis with myeloid metaplasia d. acute granulocytic leukemia

48. Which of the following stains is helpful in the diagnosis of suspected erythroleukemia?
a. peroxidase b. periodic acid-Schiff c. nonspecific esterase d. acid phosphatase
49. The FAB classification of ALL seen most commonly in children is:
a.L1 b. L2 c. L3 d. Burkitt’s type
50. A 50-year-old woman who has been receiving busulfan for 3 years for chronic myelogenous leukemia
becomes anemic. Laboratory tests reveal:
Thrombocytopenia
Many peroxidase-negative blast cells in the peripheral blood
Bone marrow hypercellular in blast transformation
Markedly increased bone marrow TdT
Which of the following complications is this patient most likely to have?
a. acute lymphocytic leukemia c. acute myelomonocytic leukemia
b. acute myelocytic leukemia d. busulfan toxicity
51. A peripheral smear shows 75% blasts. These stain positive for SBB and peroxidase. Given these values,
which of the following disorders is most likely?
a. AML b. CML c. Undiff.leukemia d. ALL
52. A peripheral blood smear demonstrating an absolute increase in small “hypermature” lymphocytes and
“smudge” cells would be suggestive of:
a. Chronic lymphocytic leukemia c. Leukomoid reaction
b. Acute lymphocytic leukemia d. Infectious mononucleosis
53. Chromosome analysis revealed the presence of the Philadelphia chromosome. Based on this information,
what myeloproliferative disorder is present?
a. CML b. PV c. ET d. MMM
54. The absence of the Philadelphia chromosome in granulocytic leukemia suggests:
a. Rapid progression of the disease c. Excellent response to therapy
b. Polyclonal origin to the disease d. Conversion to another myeloproloferative disorder
55. Which of the following tests can be useful in differentiating leukemoid reactions from chronic granulocytic
leukemias?
a. peroxidase stain b. surface membrane markers c. Sudan black B stain d. LAP
56. The following results were obtained on a leukocyte alkaline phosphatase stain:
Score 4+ 3+ 2+ 1+ 0
No. of cells counted 40 30 20 5 5
These reactions are most consistent with:
a. leukemoid reaction c. chronic granulocytic leukemia
b. nephrotic syndrome d. progressive muscular dystrophy
57. The esterase cytochemical stains are useful to differentiate:
a. Granulocytic from monocytic leukemias
b. Lymphocytic leukemias from myelocytic leukemias
c. Monocytic leukemias from megakaryocytic leukemias
d. Lymphocytic leukemias from monocytic leukemias
58. The FAB classification of a leukemia with large blasts that are myeloperoxidase and specific esterase
negative but have strong Positivity for nonspecific esterase inhibited by sodium fluoride is:
a. M1 b. M4 c. M5 d. M7
59. Which of the following cells are most likely identified in lesions of mycosis fungoides?
a. T lymphocytes b. B lymphocytes c. monocytes d. mast cells
60. The atypical lymphocyte seen in the peripheral smear of patients with infectious mononucleosis is reacting
to which of the following?
a. T lymphocytes b. B lymphocytes c. monocytes d. mast cells
61. Which of the following cells are the atypical lymphocytes seen on the peripheral blood smear of patients
with infectious mononucleosis?
a. T lymphocytes b. B lymphocytes c. monocytes d. mast cells
62. The results of a bone marrow differential are: 40% neutrophils and precursors; 20% lymphocytes, 20%
monocytes, and 20% red cell precursors. The M;E ratio for this patient is:
a. 1:2 b. 2:1 c. 3:1 d. 4:1
63. When Reed-Sternberg cells are found in a lymph node biopsy, they are indicative of:
a. Hodgkin disease c. Sezary syndrome
b. Intermediate-grade non-Hodgkin lymphoma d. High-grade non-Hodgkin lymphoma
64. The antigen referred to as CALLA, the common ALL antigen is:
a. CD 10 b. CD 16 c. CD 56 d. CD 73
65. Normal platelets have a circulating life span of approximately:
a. 5 days b. 10 days c. 20 days d. 30 days
66. Platelet dense granules contain:
1. Calcium 2. Storage ADP 3. Serotonin 4. Plt factor 4
a. 1 and 3 b. 2 and 4 c. 1, 2 and 3 d. 1, 2, 3 and 4
67. The type of microscopy recommended for a manual platelet count is:
a. Fluorescence b. Phase c. Brightfiled d. Oil immersion
68. Which of the following is characteristic of Bernard-Soulier syndrome?
a. giant platelets c. abnormal aggregation with ADP
b. normal bleeding time d. increased platelet count
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69. The enzyme inhibited by aspirin is:

a. Thromboxane synthetase c. Lactate dehydrogenase
b. Cyclooxygenase d. Phospholipase
70. A patient has been taking aspirin regularly for arthritic pain. Which one of the following tests is most likely
to be abnormal in this patient?
a. platelet count c. prothrombin time
b. template bleeding time d. activated partial thromboplastin time
71. Platelet glycoprotein IIb/IIIa complex is:
a. Membrane receptor for fibrinogen c. secreted by endothelial cells
b. Secreted from the dense bodies d. Also called actin
72. Which set of platelet responses would be most likely be associated with Glanzmann’s thrombasthenia?
a. Normal platelet aggregation response to ADP and ristocetin; decreased response to collagen
b. Normal platelet aggregation response to collagen; decreased response to ADP and collagen
c. Normal platelet aggregation response to ristocetin; decreased response to collagen, ADP and epinephrine
d. Normal platelet aggregation response to ADP; decreased response to collagen and ristocetin
73. Platelet aggregation studies revealed normal aggregation curves with collagen, epinephrine, and ADP, but
an abnormal aggregation curve with ristocetin. Based on these findings, what is the differential diagnosis?
a. Von Willebrand disease and Bernard-Soulier syndrome
b. Glanzmann’s thrombasthenia and von Willebrand disease
c. Storage pool disease and Glanzmann’s thrombasthenia
d. Bernard-Soulier syndrome and storage pool disease
74. The preferred blood product for a bleeding patient with von Willebrand’s disease is transfusion with:
a. Factor II, VII, IX, X concentrates c. Fresh Frozen Plasma and Platelets
b. Platelet Concentrates d. Cryoprecipitated AHF
75. Which of the following is vitamin K dependent?
a. Factor XII b. fibrinogen c. antithrombin III d. Factor VII
76. Last factor to be depressed n vitamin K deficiency:
a. Factor II b. Factor VII c. Factor X d. Factor IX
77. Coagulation factors affected by coumarin drugs are:
a. VIII, IX , and X b. I, II, V, and VII c. II, VII, IX, and X d. II, V, and VII
78. Which of the following factors is not present in BaSO 4 adsorbed plasma?
a. VIII b. II c. XII d. V
79. Which of the following is NOT a contact factor?
a. Prekallikrein b. Stable factor c. HMWK d. Hageman factor
80. The most concentrated coagulation factor in the blood is:
a. XII b. IX c. X d. Fibrinogen
81. Which of the following factor deficiencies is associated with either no bleeding or only a minor bleeding
tendency, even after trauma or surgery?
a. Factor X b. Factor XII c. Factor XIII d. Factor V
82. Classic hemophilia is condition in which there may be a:
a. Prolonged BT b. Decreased platelets c. Prolonged PT d. Prolonged APTT
83. Increased APTT with a normal PT would indicate a deficiency of:
a. Factor II b. Factor VII c. Factor IX d. Factor X
84. PTT measures all factors except for:
a. I and V b. VIII and IX c. V and VIII d. VII and XIII
85. The international normalized ratio (INR) is useful for:
a. Determining coagulation reference ranges c. Monitoring thrombolytic therapy
b. Monitoring heparin therapy d. Monitoring warfarin therapy
86. The following results are obtained:
PT Normal
APTT Prolonged
Absorbed plasma Corrects APTT
The factor deficiency is:
a. VIII b. IX c. X d. V
87. Which of the following laboratory findings is associated with Factor XIII deficiency?
a. prolonged activated partial thromboplastin time c. prolonged thrombin time
b. clot solubility in a 5 molar urea solution d. prolonged prothrombin time
88. In factor X deficiency, a prolonged PT or APTT is corrected by the addition of:
1. Aged plasma 2. Aged serum 3. Fresh serum 4. Adsorbed plasma
a. 1, 2 and 3 b. 1 and 3 c. 2 and 4 d. 1, 2, 3 and 4
89. A 56-year-old woman was admitted to the hospital with a history of a moderate to severe bleeding tendency of
a several years’ duration. Epistaxis and menorrhagia were reported. Prolonged APTT was corrected with fresh
normal plasma, adsorbed plasma, and aged serum. Deficiency of which of the following is most likely?
a. Factor XII b. Factor VIII c. Factor XI d. Factor IX
90. A patient has a history of mild hemorrhagic episodes. Laboratory resutls include a prolonged prothrombin
time and activated partial thromboplastin time. The abnormal prothrombin time was corrected by normal and
adsorbed plasma, but not aged serum. Which of the following coagulation factors is deficient?
a. prothrombin b. Factor V c. Factor X d. Factor VII
91. A prolonged Stypven (Russell viper venom) time is associated with deficiency of the following factors
EXCEPT:
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a. Factor I b. Factor II c. Factor X d. Factor VII

92. The observation of a normal reptilase time and a prolonged thrombin time is indicative of:
a. Presence of fibrin degradation products c. Dysfibrinogenemia
b. Hypoplasminogenemia d. Presence of heparin
93. When making a blood film using the spreader slide technique, a thinner film can be obtained by:
a. Increasing the angle of the spreader slide c. Spreading the blood at lower speed
b. Using a larger drop of blood d. All of the above
94. A false increase in ESR value can be caused by:
a. Cold room temperatures c. Reading ESR after exactly 30 minutes
b. Slight tilting of the ESR tube rack d. Overanticoagulation of the blood specimen
95. Which of the following statements concerning reticulocyte count is/are true?
1. The adult reference range is approximately 0.5 to 5.0%
2. Newborns have a higher reference range than adults
3. The material that stains in reticulocytes is DNA
4. The Miller disk is a device used to aid in reticulocyte counting
a. 1 and 3 b. 2 and 4 c. 1, 2 and 3 d. 4 only
96. In an automated instrument, which parameter is calculated rather than directly measured:
a. Hematocrit b. RBC count c. WBC count d. Hemoglobin
97. The cyanmethemoglobin method measures:
a. All hemoglobin pigments c. All hemoglobin pigments except sulfhemoglobin
b. Only oxyhemoglobin d. Only methemoglobin
98. Two hemoglobins that migrate together on cellulose acetate electrophoresis at an alkaline pH are:
a. A1 and A2 b. A1 and E c. S and C d. S and D
99. A decreased result in the osmotic fragility test would be associated with which of the following conditions?
a. Sickle cell anemia b. H. spherocytosis c. HDN d. AIHA
100. A patient has the following results: erythrocyte count, 2.5 x 10 12/L, hemoglobin 5.3 g/dL; hematocrit 0.17
L/L; reticulocyte count, 1%. What are the erythrocyte indices in the above patient?
a. MCV 47 MCH 28 MCHC 31 c. MCV 80 MCH 21 MCHC 41
b. MCV 68 MCH 21 MCHC 31 d. MCV 80 MCH 28 MCHC 41

END OF THE EXAM