PRE-BOARD EXAMINATION IN HEMATOLOGY (PART 1)

1. Gauge of the needle indicating the largest bore is:

a. 16 gauge b. 19 gauge c. 21 gauge d. 23 gauge
2. What is the anticoagulant of choice for the osmotic fragility test?
a. heparin b. double oxalate c. EDTA d. potassium oxalate
3. Hemoglobin migration pattern on cellulose acetate from point of application to anode is:
a. C < F < A2 < A < S c. C and A2 < S < F < A
b. C < S < A and A2 < F d. C < A < F < S < A2
4. Insufficient centrifugation will result in:
a. a false increase in hematocrit value c. no effect in hematocrit value
b. a false decrease in hematocrit value d. all of the above, depending on the patient
5. Calculate the mean cell hemoglobin concentration (MCHC) using the following values:
Hgb: 15 g/dL (150 g/L) RBC 4.50 x 106/µL (4.50 x 1012/L)
Hct: 47% (0.47)
a. 9.5% b. 10.4% c. 31.9% d. 33.3%
6. A 7-mL EDTA tube is received in the laboratory containing only 2 mL of blood. If the laboratory is using manual
techniques, which of the following tests will most likely be erroneous?
a. WBC count b. hemoglobin c. hematocrit d. none of these
7. A decreased OFT would be associated with which of the following conditions?
a. sickle cell anemia c. haemolytic disease of the newborn
b. hereditary spherocytosis d. acquired haemolytic anemia
8. What effect would using a buffer at pH 6.0 have on Wright’s-stained smear?
a. red cell would be stained too pink c. red cells would be stained blue
b. white cell cytoplasm would be stained too blue d. red cells would lyse on the slide
9. Which of the following erythrocyte inclusions can be visualized with supravital stain but cannot be detected on a
Wright-stained blood smear?
a. basophilic stippling b. Heinz bodies c. Howell-Jolly bodies d. siderotic granules
10. A Miller disk is an ocular device used to facilitate counting of:
a. platelets b. reticulocytes c. sickle cells d. N-RBCs
11. RBC indices obtained on a patient are as follows: MCV 88 fL; MCH 30 pg; MCHC 34%. The RBCs on the peripheral
smear would appear:
a. microcytic, hypochromic c. normocytic, normochromic
b. microcytic, normochromic d. normocytic. hypochromic
12. All of the following may influence the ESR, except:
a. blood drawn into a sodium citrate tube c. plasma proteins
b. anisocytosis, poikilocytosis d. calibre of the tube
13. What staining method is used most frequently to stain and count reticulocytes?
a. immunofluorescence c. Romanowsky staining
b. supravital staining d. cytochemical staining
14. The Coulter principle for counting of cells is based upon the fact that:
a. isotonic solutions conduct electricity better than cells do
b. conductivity varies proportionally to the number of cells
c. cells conduct electricity better than saline does
d. isotonic solutions cannot conduct electricity
15. A correction is necessary for WBC counts when nucleated RBCs are seen on the peripheral smear because:
a. the WBC count would be falsely lower c. N-RBCs are counted as leukocytes
b. the RBC count is too low d. N-RBCs are confused with giant platelets
16. Using a Coulter counter analyzer, an increased RDW should correlate with:
a. spherocytosis b. anisocytosis c. leukocytosis d. presence of N-RBCs
17. Given the following values, which set of red blood cell indices suggests spherocytosis?
a. MCV 76 fL, MCH 19.9 pg, MCHC 28.5% c. MCV 80 fL, MCH 36.5 pg, MCHC 38.0%
b. MCV 90 fL, MCH 30.5 pg, MCHC 32.5% d. MCV 81 fL, MCH 29.0 pg, MCHC 34.8%
18. Which of the following is considered a normal hemoglobin?
a. carboxyhemoglobin b. methemoglobin c. sulfhemoglobin d. deoxyhemoglobin
19. Which condition will shift the oxyhemoglobin dissociation curve to the right?
a. acidosis b. alkalosis c. hb S or C d. multiple blood transfusions
20. In which stage of erythrocytic maturation does hemoglobin formation begin?
a. reticulocyte b. pronormoblast c. basophilic normoblast d. polychromatophilic normoblast
21. Which of the following can shift the hemoglobin oxygen dissociation curve to the right?
a. increase 2,3 DPG b. acidosis c. hypoxia d. all of these
22. Which of the following hemoglobin configurations is characteristic of hemoglobin H?
a. γ4 b. α2 γ2 c. β4 d. α2 β2
23. Autoagglutination of red cells at room temperature can result in which of the following?
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a. low RBC count b. high MCV c. low hematocrit d. all of these

24. Which of the following organs is responsible for the “pitting process” for RBCs?
a. liver b. spleen c. kidney d. lymph nodes
25. Which of the following disorders has an increase in osmotic fragility?
a. iron deficiency anemia c. hereditary stomatocytosis
b. hereditary elliptocytosis d. hereditary spherocytosis
26. What is the major hemoglobin found in the RBCs of patients with sickle cell trait?
a. hgb S b. hgb F c. hgb A2 d. Hgb A
27. Select the amino acid substitution that is responsible for sickle cell anemia?
a. lysine is substituted for glutamic acid at the sixth position of the alpha chain
b. valine is substituted for glutamic acid at the sixth position of the beta chain
c. valine is substituted for glutamic acid at the sixth position of the alpha chain
d. glutamine is substituted for glutamic acid at the sixth position of the beta chain
28. All of the following are usually found in hemoglobin C disease, except:
a. Hemoglobin C crystals c. lysine substituted for glutamic acid at sixth position of β-chain
b. Target cells d. fast mobility of hemoglobin C at pH 8.6
29. Which of the following hemoglobins migrates to the same position as hgb A 2 at pH 8.6?
a. hgb H b. hgb F c. hgb C d. hgb S
30. Which of the following electrophoretic results is consistent with a diagnosis of sickle cell trait?
a. hgb A: 40%, hgb S 35%, hgb F 5% c. hgb A: 0%, hgb A2 5%, hgb F 95%
b. hgb A: 60%, hgb S 40%, hgb A2 2% d. hgb A: 80%, hgb S 10%, hgb A2 10%
31. Which of the following is true of paroxysmal nocturnal hemoglobinuria (PNH)?
a. it is an acquired hemolytic anemia c. it is inherited as an autosomal dominant trait
b. it is inherited as a sex-linked trait d. it is inherited as an autosomal recessive trait
32. Hemolytic uremic syndrome (HUS) is characterized by all of the following, except:
a. hemorrhage b. thrombocytopenia c. hemoglobinuria d. reticulocytopenia
33. An autohemolysis test is positive in all of the following except:
a. G6PD deficiency b. HS c. pyruvate kinase deficiency d. PNH
34. Which antibody is associated with paroxysmal cold hemoglobinuria (PCH)?
a. anti-I b. anti-i c. anti-M d. anti-P
35. All of the following are associated with hemolytic anemia except:
a. methemoglobinemia c. hemoglobinemia
b. hemoglobinuria d. increased haptoglobin
36. Bite cells are usually seen in patients with:
a. Rh null trait b. CGD c. G6PD deficienct d. PK deficiency
37. The morphological classification of anemias is based on which of the following?
a. M:E ratio b. Prussian blue stain c. RBC indices d. reticulocyte count
38. Microangioathic 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
39. Which antibiotic is most often implicated in the development of aplastic anemia?
a. sulfonamides b. penicillin c. tetracycline d. chloramphenicol
40. Which of the following conditions may produce spherocytes in a peripheral smear?
a. Pelger-Huet anomaly c. autoimmune hemolytic anemia
b. perncious anemia d. sideroblastic anemia
41. Reticulocytosis usually indicates:
a. response to inflammation c. aplastic anemia
b. neoplastic process d. red cell regeneration
42. The OFT result in a patient with thalassemia major would most likely be:
a. increased b. decreased c. normal d. all of these
43. Iron deficiency anemia may be distinguished from anemia of chronic infection by:
a. serum iron level c. red cell indices
b. red cell morphology d. total iron binding capacity
44. Which anemia has red cell morphology similar to that seen in IDA?
a. sickle cell anemia b. thalassemia syndrome c. pernicious anemia d. HS
45. Which morphological classification is characteristic of megaloblastic anemia?
a. normocytic, normochromic c. macrocytic, hypochromic
b. microcytic, normochromic d. macrocytic, normochromic
46. All of the following are characteristics of megaloblastic anemia except:
a. pancytopenia c. hypersegmented neutrophil
b. elevated reticulocyte count d. macrocytic erythrocyte indices
47. Which of the disorders below causes ineffective erythropoiesis?
a. G6PD deficiency b. liver disease c. Hgb C disease d. pernicious anemia
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48. Which of the following may be seen in the peripheral blood smear of a patient with obstructive liver disease?
a. schistocytes b. macrocytes c. Howell-Jolly bodies d. microcytes
49. The macrocytes typically seen in megaloblastic processes are:
a. creascent-shaped b. teardrop-shaped c. ovalocytic d. pencil-shaped
50. Which inclusions may be seen in leukocytes?
a. Dohle bodies b. basophilic stippling c. malarial parasite d. Howell-Jolly bodies
51. Which of the following is contained in the primary granules of the neutrophil?
a. lactoferrin b. myeloperoxidase c. histamine d. alkaline phosphatase
52. The morphological characteristic associated with Chediak-Higashi syndrome is:
a. pale blue cytoplasmic inclusiosns c. small, dark staining granules and condensed nuclei
b. giant lysosomal granules d. nuclear hyposegmentation
53. Auer rods may be seen in all of the following except:
a. acute myelomonocytic leukemia (M4) c. acute myeloid leukemia without maturation (M1)
b. acute lymphoblastic leukemia d. acute promyelocytic leukemia (M3)
54. Which type of anemia is usually present in a patient with acute leukemia?
a. microcytic, hyperchromic c. normocytic, normochromic
b. microcytic, hypochromic d. macrocytic, normochromic
55. In leukemia, which term describes a peripheral blood finding of leukocytosis with a shift to the left, accompanied by
occasional nucleated red cells?
a. megaloblastosis b. dysplasia c. leukoerythroblastosis d. none of these
56. DIC is most often associated with which of the following types of acute leukemia?
a. acute myeloid leukemia without maturation c. acute myelomonocytic leukemia
b. acute promyelocytic leukemia d. acute monocytic leukemia
57. A peripheral smear shows 75% blasts. These stain positive for both Sudan black B (SBB) and peroxidase (Px). Given
these values, which of the following disorders is most likely?
a. AML b. CML c. AUL d. ALL
58. Sodium fluoride may be added to the naphthyl ASD acetate (NASDA) esterase reaction. The fluoride is added to
inhibit a positive reaction with:
a. megakaryocytes b. monocytes c. erythrocytes d. granulocytes
59. In essential thrombocythemia, the platelets are:
a. increased in number and functionally abnormal c. decreased number and functional
b. normal in number and functionally abnormal d. decreased in number and functionally abnormal
60. Which of the following cells is considered pathognomonic for Hodgkin’s disease?
a. Niemann-Pick cells b. reactive lymphocytes c. flame cells d. Reed-Sternberg cells
61. In myelofibrosis, the characteristic abnormal red blood cell morphology is that of:
a. target cells b. schistocytes c. teardrop cells d. ovalocytes
62. PV is characterized by:
a. increased plasma volume c. decreased oxygen saturation
b. pancytopenia d. absolute increase in total red cell mass
63. The erythrocytosis seen in relative polycythemia occurs because of:
a. decreased arterial oxygen saturation c. increased erythropoietin levels
b. decreased plasma volume of circulating blood d. increased erythropoiesis in the bone marrow
64. The leukocyte alkaline phosphatase stain of a patient gives the following results: 10 (0); 48(1+); 38(2+); 3(3+); 1(4+).
Calculate the LAP score:
a. 100 b. 117 c. 137 d. 252
65. CML is distinguished from leukomoid reaction by which of the following?
a. CML low LAP; leukomoid high LAP c. CML high WBC; leukomoid normal WBC
b. CML high LAP; leukomoid low LAP d. CML high WBC; leukomoid high WBC
66. What influence does the Philadelphia chromosome have on the prognosis of patients with chronic myelocytic
leukemia?
a. it is not predictive c. prognosis is worse is Ph1 is present
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b. prognosis is better if Ph is present d. disease usually transforms into AML when Ph 1 is present

67. What is the characteristic finding is seen in the peripheral smear of a patient with multiple myeloma?
a. microcytic hypochrmic cells c. rouleaux
b. intracellular inclusion bodies d. hypersegmented neutrophils
68. In which of the following conditions does LAP show the least activity?
a. leukomoid recations b. idiopathic myelofibrosis c. PV d. CML
69. Cells that exhibit a positive stain with acid phosphatase and are not inhibited with tartaric acid are characteristically
seen in:
a. infectious mononucleosis c. hairy cell leukemia
b. infectious lymphocytosis d. T-cell acute lymphoblastic leukemia
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70. The anticoagulant of choice for most routine coagulation studies is:
a. sodium oxalate b. sodium citrate c. EDTA d. heparin
71. Which ratio of anticoagulant to blood is correct for coagulation procedures?
a. 1:4 b. 1:5 c. 1:9 d. 1:10
72. What reagents are used in the PT test?
a. thromboplastin and sodium chloride c. thromboplastin and calcium
b. thromboplastic and potassium chloride d. actin and calcium chloride
73. Which test would be abnormal in a patient with Stuart-Prower factor (factor X) deficiency?
a. PT only b. APTT only c. PT and APTT d. thrombin time
74. Which clotting factor is not measured by PT and APTT tests?
a. factor VIII b. factor IX c. factor V d. factor XIII
75. Which coagulation test(s) would be abnormal in a vitamin K-deficient patient?
a. PT only b. PT and APTT c. fibrinogen level d. thrombin time
76. Which of the following is correct regarding the international normalized ratio (INR)?
a. it uses the international sensitivity ratio(ISR) c. standardizes the APTT results
b. standardizes PT results d. used to monitor heparin therapy
77. Which protein is the primary inhibitor of the fibrinolytic system?
a. protein C b. protein S c. α2 antiplasmin d. α2 macroglobulin
78. A protein that plays a role in both coagulation and platelet aggregation is:
a. factor I b. factor VIII c. factor IX d. factor XI
79. Aspirin prevents platelet aggregation by inhibiting the action of which enzyme?
a. phospholipase b. cyclo-oxygenase c. thromboxane A2 synthetase d. prostacyclin synthetase
80. Bernard-Soulier syndrome is associated with:
a. decreased bleeding time c. thrombocytopenia and giant platelets
b. decreased factor VIII assay d. abnormal platelet aggregation to ADP
81. When performing platelet aggregation studies, which set of platelet aggregation result would most likely be associated
with Bernard-Soulier syndrome?
a. normal platelet aggregation to collagen, ADP and ristocetin
b. normal platelet aggregation to collagen, ADP, epinephrine; decreased aggregation to ristocetin
c. normal platelet aggregation to epinephrine and ristocetin; decreased aggregation to collagen and ADP
d. normal platelet aggregation to epinephrine, ristocetin and collagen; decreased aggregation to ADP
82. Which set or platelet responses would most likely be associated to Glanzmann’s thrombasthenia?
a. normal platelet aggregation to ADP and ristocetin; decreased aggregation to collagen
b. normal platelet aggregation to collagen; decreased aggregation to ADP and ristocetin
c. normal platelet aggregation to ristocetin; decreased aggregation to collagen, ADP and epinephrine
d. normal platelet aggregation to ADP; decreased aggregation to collagen and ristocetin
83. Storage pool deficiencies are defects of:
a. platelet adhesion b. platelet aggregation c. platelet granules d. platelet production
84. Hereditary hemorrhagic telangiectasia is a disorder of:
a. platelets b. clotting proteins c. fibrinolysis d. connective tissue
85. Which defect characterizes Gray’s syndrome?
a. platelet adhesion defect c. alpha granule defect
b. dense granule defect d. coagulation defect
86. Normal serum contains:
a. factor I b. factor V c. factor VIII d. factor VII
87. In the APTT procedure the time taken for clot formation is measured after the addition of:
a. tissue thromboplastin b. calcium chloride c. phospholipid d. activator
88. A prolonged APTT and PT are corrected when mixed with normal plasma. Which factor is most likely deficient?
a. V b. VIII c. IX d. XI
89. Refer to the following results:
PT prolonged APTT prolonged platelet count decreased bleeding time increased
Which disorder may be indicated?
a. factor VIII deficiency b. vWD c. DIC d. factor IX deficiency
90. The following results were obtained on a patient: prolonged bleeding time, normal platelet count, normal PT, and
prolonged APTT. Which of the following disorders is most consistent with these results?
a. hemophilia A b. hemophilia B c. vWD d. Glanzmaann’s thrombasthenia
91. Refer to the following results:
PT normal APTT prolonged Bleeding time increased
Platelet count normal Platelet aggreagation to ristocetin abnormal
a. factor VIII deficiency b. DIC c. vWD d. factor IX deficiency
92. Which results are associated with hemophilia A?
a. prolonged APTT, normal PT c. prolonged PT, normal APTT
b. prolonged PT and APTT d. normal PT and APTT
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93. Which of the following test is abnormal in Hemophilia B

a. platelet count b. BT c. PT d. APTT
94. Normal PT and APTT results in a patient with poor wound healing may be associated with:
a. factor VII deficiency b. factor VIII deficiency c. factor XII deficiency d. factor XIII deficiency
95. The lupus anticoagulant is directed against:
a. factor VIII b. factor IX c. factor X d. phospholipid
96. What test is used to monitor heparin therapy?
a. INR b. APTT c. PT d. none of these
97. What test is commonly used to monitor warfarin therapy?
a. INR b. APTT c. TT d. BT
98. Which clotting factors (cofactors) are inhibited by protein S?
a. V and X b. Va and VIIIa c. VIII and IX d. VIII and X
99. Which of the following tests is most likely to be abnormal in patients taking aspirin?
a. platelet morphology b. platelet count c. bleeding time d. prothrombin time
100. A prolonged thrombin time and a normal reptilase time are indicative of:
a. afibrinogenemiab. hypofibrinogenemia c. aspirin therapy d. heparin therapy

END OF THE EXAM