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?
a. low RBC count b. high MCV c. low hematocrit d. all of these
 2

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 A2 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
 3

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
b. prognosis is better if Ph1 is present d. disease usually transforms into AML when Ph1 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
70. The anticoagulant of choice for most routine coagulation studies is:
a. sodium oxalate b. sodium citrate c. EDTA d. heparin
 4

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
93. Which of the following test is abnormal in Hemophilia B
a. platelet count b. BT c. PT d. APTT
 5

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. afibrinogenemia b. hypofibrinogenemia c. aspirin therapy d. heparin therapy

END OF THE EXAM

PRE-BOARD EXAMINATION IN HEMATOLOGY (PART 2)

1. Platelet alpha granules contain:

1. Platelet factor 4 3. Platelet derived growth factor (PDGF)
2. Beta thromboglobulin 4. Fibrinogen
A. 1 and 3 C. 1, 2 and 3
B. 2 and 4 D. 1, 2, 3 and 4
2. The activated partial thromboplastin time (APTT) is prolonged in:
1. Hemophilia B 3. Parahemophilia
2. Hemophilia A 4. Thrombocytopenia
A. 1, 2 and 3 C. 2 and 4
B. 1 and 3 D. Only 4
3. Bleeding disorders associated with vascular abnormality:
1. Hemorrhagic telangiectasia 3. Scurvy
2. Ehlers-Danlos syndromes 4. Senile purpura
A. 1 and 3 C. 1, 2 and 3
B. 2 and 4 D. 1, 2, 3 and 4
4. The test reagent in PT contains which of the following substance(s)?
1. Calcium ions 3. Tissue thromboplastin
2. Kaolin 4. Celite
A. 1, 2 and 3 C. 2 and 4
B. 1 and 3 D. Only 4
5. The test reagent in APTT contains which of the following substance(s)?
1. Citrated plasma 3. Tissue thromboplastin
2. Calcium ions 4. Phospholipids
A. 1, 2 and 3 C. 2 and 4
B. 1 and 3 D. Only 4
6. Bleeding disorder(s) in which platelets fail to aggregate with ristocetin:
1. von Willebrand’s disease 3. Bernard-Soulier syndrome
2. Glanzmann’s disease 4. Storage pool disease
A. 1, 2 and 3 C. 2 and 4
B. 1 and 3 D. Only 4
7. The fibrinogen group of coagulation factors is:
1. Present in serum 3. Adsorbed by barium sulfate
2. Not vitamin K dependent 4. Consumed during coagulation
A. 1, 2 and 3 C. 2 and 4
B. 1 and 3 D. Only 4
8. Thrombocytosis may be associated with:
1. Post-splenectomy 3. Polycythemia vera
2. DIC 4. Megaloblastic anemia
A. 1, 2 and 3 C. 2 and 4
B. 1 and 3 D. Only 4
9. Which coagulation factor(s) is(are) removed by barium sulfate or aluminum hydroxide?
1. Factor II 3. Factor IX
2. Factor VIII 4. Factor I
A. 1, 2 and 3 C. 2 and 4
B. 1 and 3 D. Only 4
10. Coagulation factor(s) affected by coumarin drugs is(are):
1. II 3. IX
2. VII 4. X
A. 1 and 3 C. 1, 2 and 3
B. 2 and 4 D. 1, 2, 3 and 4
11. The hemorrhagic problems associated with scurvy are due to a deficiency of which of the following:
A. Vitamin C C. Vitamin K
B. Prothrombin D. Protein C
12. The number of platelets an average megakaryocyte generates is approximately:
A. 25 - 50 C. 200 - 500
B. 200 - 500 D. 2000 - 4000
13. Which of the following is NOT a cause of thrombocytopenia?
A. Splenomegaly C. Increased thrombopoietin
B. Chemotheraphy D. Aplastic anemia
14. Which of the following is NOT a normal maturation stage for platelets?
A. Megakaryoblast C. Micromegakaryocyte
B. Promegakaryocyte D. Megakaryocyte
15. The recommended type of microscopy for the performance of manual platelet counts is:
A. Electron C. Light
B. Darkfield D. Phase contrast
16. Which of the following is not synthesized in the liver?
A. Protein C C. von Willebrand factor
B. Plasminogen D. All of these
17. Which of the following will NOT cause the thrombin time to be prolonged?
A. Fibrin degradation products C. Factor I deficiency
B. Heparin D. Factor II deficiency
 2

18. A patient on therapeutic warfarin will most likely have a(an):

A. Normal PT/INR, increased APTT, prolonged bleeding time, low platelet count
B. Increased PT/INR, increased APTT, normal bleeding time, normal platelet count
C. Normal PT/INR, normal APTT, normal bleeding time, normal platelet count
D. Increased PT/INR, normal APTT, prolonged bleeding time, low platelet count
19. The activity of the lupus anticoagulant and anticardiolipin antibodies appears to be directed against:
A. Factor V C. Factor IX
B. Factor VIII D. Phospholipid
20. Thrombocytosis is characteristic of:
A. DIC C. Polycythemia vera
B. Splenomegaly D. Idiopathic thrombocytopenic purpura
21. If a physician suspects a qualitative platelet defect, the most useful test to order is the:
A. Platelet count C. Urea solubility test
B. Prothrombin time D. Bleeding time
22. Reversal of heparin overdose can be achieved by administration of:
A. Vitamin K C. Antithrombin
B. Protamine sulfate D. Warfarin
23. The prothrombin time will detect deficiencies in which pathway(s)?
A. Extrinsic C. Intrinsic
B. Extrinsic and common D. Intrinsic and common
24. Relative polycythemia is characterized by:
1. Increase total red cell mass 3. Normal plasma volume
2. Normal total red cell mass 4. Decreased plasma volume
A. 1, 2 and 3 C. 2 and 4
B. 1 and 3 D. Only 4
25. Microcytic, hypochromic anemia:
1. Aplastic anemia 3. Pernicious anemia
2. Acute blood loss 4. Chronic blood loss
A. 1, 2 and 3 C. 2 and 4
B. 1 and 3 D. Only 4
26. Most patients with beta thalassemia have:
1. Normocytic, normochromic anemia 3. Decreased hemoglobin F
2. Occasional target cells 4. Increased hemoglobin A2
A. 1, 2 and 3 C. 2 and 4
B. 1 and 3 D. Only 4
27. Peripheral blood picture of megaloblastic anemia:
1. Hypersegmented neutrophil 3. Oval macrocytes
2. Thrombocytopenia 4. Leukopenia
A. 1 and 3 C. 1, 2 and 3
B. 2 and 4 D. 1, 2, 3 and 4
28. Laboratory findings in hereditary spherocytosis include:
1. Increased autohemolysis corrected by glucose 3. Reticulocytosis
2. Decreased osmotic fragility 4. Positive direct antiglobulin test
A. 1, 2 and 3 C. 2 and 4
B. 1 and 3 D. Only 4
29. Reticulocytes:
1. Immature red cells 3. Increased after hemorrhage
2. Contain remnants of RNA 4. Stained with Romanowsky stains
A. 1, 2 and 3 C. 2 and 4
B. 1 and 3 D. Only 4
30. Hemolytic anemias are associated with:
1. Increase in reticulocytes 3. Reduced RBC survival
2. Increase serum haptoglobin 4. Decrease free hemoglobin
A. 1, 2 and 3 C. 2 and 4
B. 1 and 3 D. Only 4
31. The hemoglobins which can be differentiated by using only cellulose acetate electrophoresis at pH 8.6 are:
1. D and S 3. C and E
2. O and C 4. A1 and H
A. 1, 2 and 3 C. 2 and 4
B. 1 and 3 D. Only 4
32. Heinz bodies are formed in which of the following conditions?
1. G6PD deficiency 3. Presence of unstable hemoglobin
2. Hereditary spherocytosis 4. Microangiopathic hemolytic anemia
A. 1, 2 and 3 C. 2 and 4
B. 1 and 3 D. Only 4
33. Which of the following red cell inclusions cannot be seen by Romanowsky stain?
1. Basophilic stipplings 3. Pappenheimer bodies
2. Howell-Jolly bodies 4. Heinz bodies
A. 1, 2 and 3 C. 2 and 4
B. 1 and 3 D. Only 4
 3

34. The structural proteins of red cell is made up of:

1. Spectrin 3. Actin
2. Glycophorins 4. Transport protein
A. 1, 2 and 3 C. 2 and 4
B. 1 and 3 D. Only 4
35. Abnormal osmotic fragility test:
1. Immediately after acute hemorrhage 3. Aplastic anemia
2. Thalassemia 4. Hereditary spherocytosis
A. 1 and 3 C. 1, 2 and 3
B. 2 and 4 D. 1, 2, 3 and 4
36. What is the first type of cell produced by the developing embryo?
A. Erythrocyte C. Lymphocyte
B. Granulocyte D. Thrombocyte
37. In an adult, what are the two best areas for obtaining active bone marrow by aspiration?
A. Vertebra, tibia C. Anterior iliac crest, tibia
B. Sternum, vertebra D. Posterior iliac crest, sternum
38. Antigen-independent lymphopoiesis occurs primary lymphoid tissue located in the:
A. Liver and kidney C. Peyer’s patches and spleen
B. Spleen and lymph nodes D. Thymus and bone marrow
39. Programmed cell death is called:
A. Necrosis C. Cellular senescence
B. Apoptosis D. Terminal differentiation
40. Interleukin and colony stimulating factors are cytokines produced by:
A. B lymphocytes and erythrocytes C. Monocytes and T lymphocytes
B. erythrocytes and thrombocytes D. Neutrophils and monocytes
41. What is the approximate total blood volume in an adult?
A. 1 L C. 6 L
B. 2 L D 12 L
42. The largest hematopoietic cells in normal bone marrow are:
A. Osteoblasts C. Megakaryocytes
B. Osteoclasts D. Plasma cells
43. As most blood cells mature, which of the following is characteristic?
A. Cell diameter increases C. nuclear chromatin becomes less condensed
B. Nucleus to cytoplasm ratio decreases D. Basophilia of the cytoplasm increases
44. Which of the following depicts the structure of the hemoglobin molecule?
A. Two heme groups, two globin chains C. Two heme groups, four globin chains
B. Four heme groups, two globin chains D. Four heme groups, four globin chains
45. The majority of iron found in an adult is a constituent of:
A. Ferritin C. Hemoglobin
B. Myoglobin D. Peroxidase
46. Howell-Jolly bodies are composed of:
A. DNA C. Reticulum
B. Iron D. RNA
47. When spherocytes are reported, what is observed on the peripheral blood smear?
A. Red cells without a central pallor C. Red cells with sharp projections
B. Red cells with blunt projections D. Red cells with rod-shaped crystals
48. Rouleaux of red blood cells when seen in the monolayer of a blood smear is characteristic of:
A. Hypersplenism C. Cold agglutinin disease
B. Hypogammaglobulinemia D. Multiple myeloma
49. Which of the following factors will result in an immediate increase in oxygen delivery to the tissues?
A. Increased pH C. High altitudes
B. Increased hb binding of 2,3-BPG D. Increased renal release of erythropoietin
50. Which of the following red blood cell precursors is the last stage to undergo mitosis?
A. Pronormoblast C. Polychromatophilic normoblast
B. Basophilic normoblast D. Orthochromic normoblast
51. Defective nuclear maturation commonly results in the production of red cells that are:
A. Normocytic C. Macrocytic
B. Hypochromic D. Microcytic
52. Which of the following conditions is NOT usually associated with marked reticulocytosis?
A. Four days after a major hemorrhage C. Sickle cell anemia
B. Drug-induced AIHA D. Pernicious anemia
53. Hereditary stomatocytosis is manifested physiologically by changes in:
A. Hemoglobin oxygen affinity C. Efficiency of hemoglobin reduction
B. Membrane cation permeability D. Glycolytic ATP production
54. Which of the following values can be sued to indicate the presence of a hemolytic anemia?
A. Hemoglobin level C. Erythrocyte count
B. Hematocrit level D. Reticulocyte count
55. What causes the hemolytic process in glucose-6-phosphate dehydrogenase deficiency following oxidant exposure?
A. Coating of red cells by antibody C. Complement attachment
B. Osmotic pressure changes D. Precipitation of denatured hemoglobin
 4

56. Which of the following is an acquired red cell membrane defect that result in increased sensitivity to complement
binding?
A. March hemoglobinuria C. Paroxysmal cold hemoglobinuria
B. Paroxysmal nocturnal hemoglobinuria D. Methemoglobinemia
57. An increase in erythropoietin is NOT a normal compensating mechanism in which of the following conditions?
A. Renal tumors C. Cardiovascular disease
B. Heavy smoking D. Pulmonary disease
58. The LAP activity will usually be increased in:
1. Chronic myelogenous leukemia 3. Paroxysmal nocturnal hemoglobinuria
2. Third trimester of pregnancy 4. Polycythemia vera
A. 1, 2 and 3 C. 2 and 4
B. 1 and 3 D. Only 4
59. In differentiating a neutrophilic leukomoid reaction from chronic granulocytic leukemia, which of the following is(are)
helpful:
1. LAP score 3. Chromosome studies
2. Bone marrow cellularity 4. Sudan black stain
A. 1, 2 and 3 C. 2 and 4
B. 1 and 3 D. Only 4
60. The neutrophil mitotic pool includes:
1. Promyelocytes 3. Myelocytes
2. Myeloblasts 4. Metamyelocytes
A. 1, 2 and 3 C. 2 and 4
B. 1 and 3 D. Only 4
61. The neutrophil post-mitotic pool includes:
1. Promyelocytes 3. Myelocytes
2. Metamyelocytes 4. Bands
A. 1, 2 and 3 C. 2 and 4
B. 1 and 3 D. Only 4
62. FAB classification of myelodysplastic syndrome (MDS) includes:
1. Refractory anemia 3. Refractory anemia with excess blasts
2. Refractory anemia with ringed sideroblasts 4. Chronic myelomonocytic leukemia
A. 1 and 3 C. 1, 2 and 3
B. 2 and 4 D. 1, 2, 3 and 4
63. Tartrate-resistant acid phosphatase (TRAP) activity is diagnostic of:
1. Acute lymphoblastic leukemia 3. Chronic lymphocytic leukemia
2. Hodgkin’s lymphoma 4. Hairy cell leukemia
A. 1, 2 and 3 C. 2 and 4
B. 1 and 3 D. Only 4
64. The most mature granulocyte precursor that can undergo mitosis is the:
A. Myeloblast C. Myelocyte
B. Promyelocyte D. Metamyelocyte
65. Vasodilation and bronchostriction are the result of dgranulation by which of the following blood cells?
A. Eosinophils C. Neutrophils
B. Monocytes D. Basophils
66. In patients with infectious mononucleosis, which blood cells are infected by the causative agent?
A. Monocytes C. B lymphocytes
B. T lymphocytes D. Histiocytes
67. In which of the following are eosinophils NOT increased?
A. Cushing syndrome C. Skin disorders
B. Allergic disorders D. Parasitic infection
68. A Gaucher cell is best described as a macrophage with:
A. Wrinkled cytoplasm due to an accumulation of glucocerebroside
B. Foamy cytoplasm filled with unmetabolized sphingomyelin
C. Pronounced vacuolization and deposits of cholesterol
D. Abundant cytoplasm containing storage iron and cellular remnants
69. Which of the following is NOT classified as a myeloproliferative disorder?
A. Polycythemia vera C. Multiple myeloma
B. Essential thromcythemia D. Chronic myelogenous leukemia
70. In which of the following would an absolute monocytosis NOT seen?
A. Tuberculosis C. Collagen disorders
B. Infectious mononucleosis D. Recovery stage of acute bacterial infection
71. Alder-Reilly anomaly is an abnormality of:
A. Lysosomal fusion C. Oxidative metabolism
B. Nuclear maturation D. Mucopolysaccharide metabolism
72. What is the key diagnostic test for Hodgkin lymphoma?
A. Bone marrow biopsy C. Spinal tap
B. Lymph node biopsy D. Skin biopsy
73. The presence of both immature neutrophils and nucleated erythrocytes in the peripheral blood is most accurately
called:
A. Neutrophilic left shift C. Neutrophilic leukomoid reaction
B. Regenerative left shift D. Leukoerythroblastic reaction
 5

74. Which of the following is NOT a characteristic finding in polycythemia vera?

A. Blood pancytosis C. Increased erythropoietin level
B. Increased red cell mass D. Increased blood viscosity
75. Which of the following can differentiate metamyelocyte from other stages of granulocyte maturation?
A. Presence of specific granules C. Absence of nucleoli
B. Indentation of the nucleus D. Color of cytoplasm
76. What combination of reagents is used to measure hemoglobin?
A. Hydrochloric acid and p-dimethyl-aminobenzaldehyde
B. Potassium ferricyanide and potassium cyanide
C. Sodium bisulfate and sodium metabisulfite
D. Sodium citrate and hydrogen peroxide
77. The slowest moving hemoglobin(s) on an alkaline electrophoresis at pH 8.6 is (are):
A. A C. F
B. A2, C, E and O D. S, D and G
78. If 60 reticulocytes are counted in 1000 red blood cells, what is the reticulocyte count?
A. 0.06% C. 0.6%
B. 6 % D. 60.0 %
79. What is the depth between the counting platform and the coverslip on a hemacytometer?
A. 0.01 mm C. 1.00 mm
B. 0.10 mm D. 0.1 cm
80. Side angle scatter in a laser-based cell counting system is used to measure:
A. Cell size C. Cell number
B. Cytoplasmic granularity D. Immunologic identification
81. To evaluate normal platelet numbers in an appropriate area of a blood smear, approximately how many platelets,
should be observed per oil immersion field?
A. 1 - 4 C. 8 - 20
B. 4 - 10 D. 20 - 50
82. For which of the following procedures would heparin be recommended anticoagulant?
A. Platelet count C. Smear-based red cell morphology
B. Coagulation tests D. Osmotic fragility
83. Falsely elevated hemoglobin values by the cyanmethemoglobin method may be caused by:
1. Lipemia 3. Extremely high WBC count
2. Hemoglobin C 4. Excessive anticoagulant
A. 1, 2 and 3 C. 2 and 4
B. 1 and 3 D. Only 4
84. Using the automated cell counter, which of the following laboratory results might be expected in the presence of
cold agglutinins?
1. Low RBC count 3. High MCV
2. Low MCH 4. Low MCHC
A. 1, 2 and 3 C. 2 and 4
B. 1 and 3 D. Only 4
85. 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)
Hct 47 mL/dL (0.47)
A. 9.5% C. 10.4%
B. 31.9% D. 33.3%
86. A decreased osmotic fragility test would be associated which of the following conditions?
A. Sickle cell anemia C. Hereditary spherocytosis
B. HDN D. Acquired hemolytic anemia
87. Which of the following erythrocyte inclusions can be visualized with supravital stain but cannot be detected on a
Wright’s-stained blood smear?
A. Basophilic stippling C. Heinz bodies
B. Howell-Jolly bodies D. Siderotic granules
88. A Miller disk is an ocular device used to facilitate counting of:
A. Platelets C. Reticulocytes
B. Sickle cells D. Nucleated RBCs
89. SITUATION: RBC indices obtained on a patient are as follows: MCV 88 µm 3 (fL); MCH 30 pg; MCHC 34%. The
RBCs on the peripheral smear would appear:
A. Microcytic, hypochromic C. Normocytic, normochromic
B. Microcytic, normochrmic D. Normocytic, hypochromic
90. 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
91. Which morphological classification is characteristic of megaloblastic anemia?
A. Normocytic, normochromic C. Macrocytic, hypochromic
B. Microcytic, normochromic D. Macrocytic, normochromic
92. Sodium fluoride maybe added to naphthyl ASD (NASDA) esterase reaction. The fluoride is added to inhibit a
positive reaction with:
A. Megakaryocytes C. Monocytes
B. Erythrocytes D. Granulocytes
 6

93. What influence does the Philadelphia (Ph1) chromosome have on the prognosis of patients with chronic myelocytic
leukemia?
A. It is not predictive C. The prognosis is worse if Ph1 is present
1
B. The prognosis is better if Ph is present D. The disease usually transforms into AML when Ph1 is
94. Laboratory findings in hereditary spherocytosis do NOT include:
A. Decreased osmotic fragility C. Reticulocytosis
B. Increased autohemolysis corrected by glucose D. Shortened erythrocyte survival
95. The laboratory findings on a patient are as follows:
MCV 55fL MCHC 25% MCH 17 pg
A stained blood film of this patient would most likely reveal a red cell picture that is:
A. Microcytic, hypochromic C. Normocytic, normochromic
B. Macrocytic, hypochromic D. Microcytic, normochromic
96. 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
97. Which test would be abnormal in patient with Stuart-Prower factor (factor X) deficiency?
A. PT only C. APTT only
B. PT and APTT D. Thrombin time
98. Aspirin prevents platelet aggregation by inhibiting the action of which enzyme?
A. Phospholipase C. Cyclooxygenase
B. Thromboxane A2 synthetase D. Prostacyclin synthetase
99. Which of the following is most likely to be abnormal in patients taking aspirin?
A. Platelet morphology C. Platelet count
B. Bleeding time D. Prothrombin time
100. 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

END OF THE EXAM

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
 2

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
b. myelofibrosis with myeloid metaplasia d. acute granulocytic leukemia
 3

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
 4

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 BaSO4 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:
a. Factor I b. Factor II c. Factor X d. Factor VII
 5

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 1012/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