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
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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
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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
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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
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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
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B. Erythrocytes D. Granulocytes

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 Ph 1 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