Hematology ASCP BOC Exam Questions d d d d d
With Mark Scheme d d
The following are compounds formed in the synthesis of heme:
d d d d d d d d d
1 coproporphyrinogen
d
2 porphobilinogen
d
3 uroporphyrinogen
d
4 protoporphyrinogen
d d
Which of the following responses lists these compounds in the order in which they are
d d d d d d d d d d d d d d d
formed? - d d
2, 3, 1, 4
d d d d d d d d d d d d d d d d d d
The majority of the iron in an adult is found as a constituent of: -
d d d d d d d d d d d d d d d
hemoglobin
d d d d d d d d d d d d d d d
In order for hemoglobin to combine reversibly with oxygen, the iron must be: -
d d d d d d d d d d d d d d
in the ferrous state
d d d d d d d d d d d d d d d d d d
Which description best fits the Donath-Landsteiner antibody? -
d d d d d d d d
IgG biphasic hemolysin
d d d d d d d d d d d d d d d d d
the abnormal erythrocyte in the center of this image (arrow) may result from which of the
d d d d d d d d d d d d d d d d
following processes? - d d d
deficiencies of cellular membrane proteins
d d d d d d d d d d d d d d d d d d d
what is the composition of the inclusion seen in this RBC? -
d d d d d d d d d d d d
DNA
d d d d d d d d d d d d d d d
Which of the following ions is bound to hemoglobin in methemoglobin? -
d d d d d d d d d d d d
Fe3+
d d d d d d d d d d d d d d d
An increased amount of cytoplasmic basophilia in a blood cell indicates: -
d d d d d d d d d d d d
decreased cytoplasmic maturation
d d d d d d d d d d d d d d d d d
Specific (secondary) granules of the neutrophilic granulocyte: -
d d d d d d d d
appear first at the myelocyte stage
d d d d d d d d d d d d d d d d d d d d
In normal adult bone marrow, the most common granulocyte is the? -
d d d d d d d d d d d d
metamyelocyte
d d d d d d d d d d d d d d d
Pluripotent hematopoietic stem cells are capable of producing: -
d d d d d d d d d
lymphoid and myeloid stem cells
d d d d d d d d d d d d d d d d d d d
Which of the following cytokines is most responsible for eosinophil differentiation and
d d d d d d d d d d d d
release from the bone marrow? -
d d d d d d
IL-5
d d d d d d d d d d d d d d d
1|Page
,Auer rods are characterized as: -
d d d d d d
DNA precipitates
d d d d d d d d d d d d d d d d
Which of the following is characteristic of cellular changes as megakaryoblasts mature into
d d d d d d d d d d d d d
megakaryocytes with the bone marrow? - d d d d d d
nuclear division without cytoplasmic division
d d d d d d d d d d d d d d d d d d d
Which of the following cells is the largest cell in the bone marrow: -
d d d d d d d d d d d d d d
megakaryocyte
d d d d d d d d d d d d d d d
Which one of the following is a true statement about megakaryocytes in a bone marrow
d d d d d d d d d d d d d d d
aspirate? - d d
an average of 2-10 should be found in each low power field (10x)
d d d d d d d d d d d d d d d d d d d d d d d d d d d
After the removal of red blood cells from the circulation, hemoglobin is broken down into: -
d d d d d d d d d d d d d d d d
iron, protoporphyrin, and globin
d d d d d d d d d d d d d d d d d d
The main function of the hexose monophosphate shunt in the erythrocyte is to: -
d d d d d d d d d d d d d d
provide reduced glutatione to prevent hemoglobin oxidation
d d d d d d d d d d d d d d d d d d d d d
In the normal adult, the spleen acts as a site for: -
d d d d d d d d d d d d
removal of imperfect and aging cells
d d d d d d d d d d d d d d d d d d d d
Cells for the transport of O2 and CO2 are: -
d d d d d d d d d d
erythrocytes
d d d d d d d d d d d d d d d
Erythropoietin acts to: - d d d d
stimulates RNA synthesis of erythroid cells
d d d d d d d d d d d d d d d d d d d d
Cells that produce antibodies and lymphokines are: -
d d d d d d d d
lymphocytes
d d d d d d d d d d d d d d d
Phagocytosis is a function of" - d d d d d d
granulocytes
d d d d d d d d d d d d d d d
Which cells are involved in immediate hypersensitivity reactions? -
d d d d d d d d d
basophils
d d d d d d d d d d d d d d d
Alpha granules are found on the platelet in the: -
d d d d d d d d d d
organelle zone
d d d d d d d d d d d d d d d d
Which of the following best represents the 3 steps of normal hemostasis (in order)? -
d d d d d d d d d d d d d d d
vasoconstriction, platelet aggregation, fibrin formation
d d d d d d d d d d d d d d d d d d d
Which of the following platelet antigens is the receptor for collagen? -
d d d d d d d d d d d d
GPIa/lla complex
d d d d d d d d d d d d d d d d
Which platelet surface antigen acts as the receptor for fibrinogen? -
d d d d d d d d d d d
GPIIb/IIIa complex
d d d d d d d d d d d d d d d d
2|Page
,How does GPib become activated in vivo and in vitro respectively? -
d d d d d d d d d d d d
shear force, ristocetin
d d d d d d d d d d d d d d d d d
a patient is on 100 mg of aspirin / day to prevent the formation of clot caused by palettes the
d d d d d d d d d d d d d d d d d d d d
mechanism in which aspirin impairs platelet function is by - d d d d d d d d d d
inactivating cyclooxygenase which blocks thromboxane A2
d d d d d d d d d d d d d d d d d d d d
The characteristic erythrocyte found in pernicious anemia is: -
d d d d d d d d d
macrocytic
d d d d d d d d d d d d d d d
Hemolysis in paroxsymal nocturnal hemoglobinuria (PNH) is: -
d d d d d d d d
caused by a red cell membrane defect
d d d d d d d d d d d d d d d d d d d d d
Which of the following is most closely associated with idiopathic hemochromatosis? -
d d d d d d d d d d d d
iron overload in tissue
d d d d d d d d d d d d d d d d d d
A patient with polycythemia vera who is treated by phlebotomy is most likely to develop a
d d d d d d d d d d d d d d d d
deficiency of: - d d d
iron
d d d d d d d d d d d d d d d
the direct antiglobulin test can help distinguish: -
d d d d d d d d
inherited from acquired spherocytosis
d d d d d d d d d d d d d d d d d d
The anemia of chronic infection is characterized by: -
d d d d d d d d d
decreased serum iron levels
d d d d d d d d d d d d d d d d d d
Factors commonly involved in producing anemia in patients with chronic renal disease
d d d d d d d d d d d d
include: - d d
inadequate erythropoiesis
d d d d d d d d d d d d d d d d
A 20 year old woman with sickle cell anemia whose usual hemoglobin concentration is 8
d d d d d d d d d d d d d d d
g/dL develops fever, increased weakness and malaise. The hemoglobin concentration is 4
d d d d d d d d d d d d
g/dL and the reticulocyte count is 0.1%. The most likely explanation for her clinical picture
d d d d d d d d d d d d d d d
is: - d d
aplastic crisis
d d d d d d d d d d d d d d d d
The hypoproliferative red cell population in the bone marrow of uremic patients is caused by:
d d d d d d d d d d d d d d
-
d d
decreased levels of circulating of erythropoietin
d d d d d d d d d d d d d d d d d d d d
Which of the following characteristics are common to hereditary sperocytosis, hereditary
d d d d d d d d d d d
elliptocytosis, hereditary stomatocytosis, and paroxysmal nocturnal hemoglobinuria -d d d d d d d d
red cell membrane defects
d d d d d d d d d d d d d d d d d d
Which of the following is most closely associated with iron deficiency anemia? -
d d d d d d d d d d d d d
chronic blood loss
d d d d d d d d d d d d d d d d d
Which one of the following hypochromic anemias is usually associated with a normal free
d d d d d d d d d d d d d d
erythrocyte protoporphyrin level? - d d d d
thalassemia minor
d d d d d d d d d d d d d d d d
3|Page
, Evidence indicates that the genetic defect in thalassemia usually results in: -
d d d d d d d d d d d d
a quantitative deficiency in RNA resulting in decreased globin chain production
d d d d d d d d d d d d d d d d d d d d d d d d d
A 20 year old African American man has peripheral blood changes suggesting thalassemia
d d d d d d d d d d d d d
minor. The quantitative hemoglobin A2 level is normal but the hemoglobin level is 5%
d d d d d d d d d d d d d d
(normal <2%). This is most consistent with: -
d d d d d d d d
delta beta thalassemia minor
d d d d d d d d d d d d d d d d d d
Anemia secondary to uremia characteristically is: -
d d d d d d d
normocytic, normochromic
d d d d d d d d d d d d d d d d
Which of the following sets of laboratory findings is consistent with hemolytic anemia? -
d d d d d d d d d d d d d d
decreased erythrocyte survival: increased catabolism of heme
d d d d d d d d d d d d d d d d d d d d d
An enzyme deficiency associated with a moderate to severe hemolytic anemia after the
d d d d d d d d d d d d d
patient is exposed to certain drugs and characterized by red cell inclusions formed by
d d d d d d d d d d d d d d
denatured hemoglobin is? - d d d d
G6PD deficiency
d d d d d d d d d d d d d d d d
Patients with G6PD deficiency are least likely to have hemolytic episodes in which of the
d d d d d d d d d d d d d d d
following situations? - d d d
spontaneously
d d d d d d d d d d d d d d d
A patient has a congenital nonspherocytic hemolytic anemia. After exposure to anti-malaria
d d d d d d d d d d d d
drugs the patient experiences a severe hemolytic episode. This episode is characterized by red
d d d d d d d d d d d d d
cells inclusions caused by hemoglobic denaturation. Which of the following conditions is
d d d d d d d d d d d d d
most consistent with these findings? -
d d d d d d
G6PD deficiency
d d d d d d d d d d d d d d d d
All of the findings listed below may be seen in acquired hemolytic anemias of the
d d d d d d d d d d d d d d d
autoimmune variety. The one considered to be the MOST characteristic is: -
d d d d d d d d d d d d
positive direct antiglobulin test
d d d d d d d d d d d d d d d d d d
Peripheral blood smears from patients with untreated pernicious anemia are characterized by:
d d d d d d d d d d d d
- d
pancytopenia and macrocytosis
d d d d d d d d d d d d d d d d d
The laboratory tests performed on a patient indicate macrocytosis, anemia, leukopenia, and
d d d d d d d d d d d d
thrombocytopenia. Which of the following disorders is the patient most likely to have? - d d d d d d d d d d d d d d
vitamin B12 deficiency
d d d d d d d d d d d d d d d d d
The characteristic morphologic feature in folic acid deficiency is: -
d d d d d d d d d d
macrocytosis
d d d d d d d d d d d d d d d
Megaloblastic asynchronus development in the bone marrow indicates which one of the
d d d d d d d d d d d d
following? - d d
impaired synthesis of DNA
d d d d d d d d d d d d d d d d d d
Which of the following are found in association with megaloblastic anemia? -
d d d d d d d d d d d d
4|Page
With Mark Scheme d d
The following are compounds formed in the synthesis of heme:
d d d d d d d d d
1 coproporphyrinogen
d
2 porphobilinogen
d
3 uroporphyrinogen
d
4 protoporphyrinogen
d d
Which of the following responses lists these compounds in the order in which they are
d d d d d d d d d d d d d d d
formed? - d d
2, 3, 1, 4
d d d d d d d d d d d d d d d d d d
The majority of the iron in an adult is found as a constituent of: -
d d d d d d d d d d d d d d d
hemoglobin
d d d d d d d d d d d d d d d
In order for hemoglobin to combine reversibly with oxygen, the iron must be: -
d d d d d d d d d d d d d d
in the ferrous state
d d d d d d d d d d d d d d d d d d
Which description best fits the Donath-Landsteiner antibody? -
d d d d d d d d
IgG biphasic hemolysin
d d d d d d d d d d d d d d d d d
the abnormal erythrocyte in the center of this image (arrow) may result from which of the
d d d d d d d d d d d d d d d d
following processes? - d d d
deficiencies of cellular membrane proteins
d d d d d d d d d d d d d d d d d d d
what is the composition of the inclusion seen in this RBC? -
d d d d d d d d d d d d
DNA
d d d d d d d d d d d d d d d
Which of the following ions is bound to hemoglobin in methemoglobin? -
d d d d d d d d d d d d
Fe3+
d d d d d d d d d d d d d d d
An increased amount of cytoplasmic basophilia in a blood cell indicates: -
d d d d d d d d d d d d
decreased cytoplasmic maturation
d d d d d d d d d d d d d d d d d
Specific (secondary) granules of the neutrophilic granulocyte: -
d d d d d d d d
appear first at the myelocyte stage
d d d d d d d d d d d d d d d d d d d d
In normal adult bone marrow, the most common granulocyte is the? -
d d d d d d d d d d d d
metamyelocyte
d d d d d d d d d d d d d d d
Pluripotent hematopoietic stem cells are capable of producing: -
d d d d d d d d d
lymphoid and myeloid stem cells
d d d d d d d d d d d d d d d d d d d
Which of the following cytokines is most responsible for eosinophil differentiation and
d d d d d d d d d d d d
release from the bone marrow? -
d d d d d d
IL-5
d d d d d d d d d d d d d d d
1|Page
,Auer rods are characterized as: -
d d d d d d
DNA precipitates
d d d d d d d d d d d d d d d d
Which of the following is characteristic of cellular changes as megakaryoblasts mature into
d d d d d d d d d d d d d
megakaryocytes with the bone marrow? - d d d d d d
nuclear division without cytoplasmic division
d d d d d d d d d d d d d d d d d d d
Which of the following cells is the largest cell in the bone marrow: -
d d d d d d d d d d d d d d
megakaryocyte
d d d d d d d d d d d d d d d
Which one of the following is a true statement about megakaryocytes in a bone marrow
d d d d d d d d d d d d d d d
aspirate? - d d
an average of 2-10 should be found in each low power field (10x)
d d d d d d d d d d d d d d d d d d d d d d d d d d d
After the removal of red blood cells from the circulation, hemoglobin is broken down into: -
d d d d d d d d d d d d d d d d
iron, protoporphyrin, and globin
d d d d d d d d d d d d d d d d d d
The main function of the hexose monophosphate shunt in the erythrocyte is to: -
d d d d d d d d d d d d d d
provide reduced glutatione to prevent hemoglobin oxidation
d d d d d d d d d d d d d d d d d d d d d
In the normal adult, the spleen acts as a site for: -
d d d d d d d d d d d d
removal of imperfect and aging cells
d d d d d d d d d d d d d d d d d d d d
Cells for the transport of O2 and CO2 are: -
d d d d d d d d d d
erythrocytes
d d d d d d d d d d d d d d d
Erythropoietin acts to: - d d d d
stimulates RNA synthesis of erythroid cells
d d d d d d d d d d d d d d d d d d d d
Cells that produce antibodies and lymphokines are: -
d d d d d d d d
lymphocytes
d d d d d d d d d d d d d d d
Phagocytosis is a function of" - d d d d d d
granulocytes
d d d d d d d d d d d d d d d
Which cells are involved in immediate hypersensitivity reactions? -
d d d d d d d d d
basophils
d d d d d d d d d d d d d d d
Alpha granules are found on the platelet in the: -
d d d d d d d d d d
organelle zone
d d d d d d d d d d d d d d d d
Which of the following best represents the 3 steps of normal hemostasis (in order)? -
d d d d d d d d d d d d d d d
vasoconstriction, platelet aggregation, fibrin formation
d d d d d d d d d d d d d d d d d d d
Which of the following platelet antigens is the receptor for collagen? -
d d d d d d d d d d d d
GPIa/lla complex
d d d d d d d d d d d d d d d d
Which platelet surface antigen acts as the receptor for fibrinogen? -
d d d d d d d d d d d
GPIIb/IIIa complex
d d d d d d d d d d d d d d d d
2|Page
,How does GPib become activated in vivo and in vitro respectively? -
d d d d d d d d d d d d
shear force, ristocetin
d d d d d d d d d d d d d d d d d
a patient is on 100 mg of aspirin / day to prevent the formation of clot caused by palettes the
d d d d d d d d d d d d d d d d d d d d
mechanism in which aspirin impairs platelet function is by - d d d d d d d d d d
inactivating cyclooxygenase which blocks thromboxane A2
d d d d d d d d d d d d d d d d d d d d
The characteristic erythrocyte found in pernicious anemia is: -
d d d d d d d d d
macrocytic
d d d d d d d d d d d d d d d
Hemolysis in paroxsymal nocturnal hemoglobinuria (PNH) is: -
d d d d d d d d
caused by a red cell membrane defect
d d d d d d d d d d d d d d d d d d d d d
Which of the following is most closely associated with idiopathic hemochromatosis? -
d d d d d d d d d d d d
iron overload in tissue
d d d d d d d d d d d d d d d d d d
A patient with polycythemia vera who is treated by phlebotomy is most likely to develop a
d d d d d d d d d d d d d d d d
deficiency of: - d d d
iron
d d d d d d d d d d d d d d d
the direct antiglobulin test can help distinguish: -
d d d d d d d d
inherited from acquired spherocytosis
d d d d d d d d d d d d d d d d d d
The anemia of chronic infection is characterized by: -
d d d d d d d d d
decreased serum iron levels
d d d d d d d d d d d d d d d d d d
Factors commonly involved in producing anemia in patients with chronic renal disease
d d d d d d d d d d d d
include: - d d
inadequate erythropoiesis
d d d d d d d d d d d d d d d d
A 20 year old woman with sickle cell anemia whose usual hemoglobin concentration is 8
d d d d d d d d d d d d d d d
g/dL develops fever, increased weakness and malaise. The hemoglobin concentration is 4
d d d d d d d d d d d d
g/dL and the reticulocyte count is 0.1%. The most likely explanation for her clinical picture
d d d d d d d d d d d d d d d
is: - d d
aplastic crisis
d d d d d d d d d d d d d d d d
The hypoproliferative red cell population in the bone marrow of uremic patients is caused by:
d d d d d d d d d d d d d d
-
d d
decreased levels of circulating of erythropoietin
d d d d d d d d d d d d d d d d d d d d
Which of the following characteristics are common to hereditary sperocytosis, hereditary
d d d d d d d d d d d
elliptocytosis, hereditary stomatocytosis, and paroxysmal nocturnal hemoglobinuria -d d d d d d d d
red cell membrane defects
d d d d d d d d d d d d d d d d d d
Which of the following is most closely associated with iron deficiency anemia? -
d d d d d d d d d d d d d
chronic blood loss
d d d d d d d d d d d d d d d d d
Which one of the following hypochromic anemias is usually associated with a normal free
d d d d d d d d d d d d d d
erythrocyte protoporphyrin level? - d d d d
thalassemia minor
d d d d d d d d d d d d d d d d
3|Page
, Evidence indicates that the genetic defect in thalassemia usually results in: -
d d d d d d d d d d d d
a quantitative deficiency in RNA resulting in decreased globin chain production
d d d d d d d d d d d d d d d d d d d d d d d d d
A 20 year old African American man has peripheral blood changes suggesting thalassemia
d d d d d d d d d d d d d
minor. The quantitative hemoglobin A2 level is normal but the hemoglobin level is 5%
d d d d d d d d d d d d d d
(normal <2%). This is most consistent with: -
d d d d d d d d
delta beta thalassemia minor
d d d d d d d d d d d d d d d d d d
Anemia secondary to uremia characteristically is: -
d d d d d d d
normocytic, normochromic
d d d d d d d d d d d d d d d d
Which of the following sets of laboratory findings is consistent with hemolytic anemia? -
d d d d d d d d d d d d d d
decreased erythrocyte survival: increased catabolism of heme
d d d d d d d d d d d d d d d d d d d d d
An enzyme deficiency associated with a moderate to severe hemolytic anemia after the
d d d d d d d d d d d d d
patient is exposed to certain drugs and characterized by red cell inclusions formed by
d d d d d d d d d d d d d d
denatured hemoglobin is? - d d d d
G6PD deficiency
d d d d d d d d d d d d d d d d
Patients with G6PD deficiency are least likely to have hemolytic episodes in which of the
d d d d d d d d d d d d d d d
following situations? - d d d
spontaneously
d d d d d d d d d d d d d d d
A patient has a congenital nonspherocytic hemolytic anemia. After exposure to anti-malaria
d d d d d d d d d d d d
drugs the patient experiences a severe hemolytic episode. This episode is characterized by red
d d d d d d d d d d d d d
cells inclusions caused by hemoglobic denaturation. Which of the following conditions is
d d d d d d d d d d d d d
most consistent with these findings? -
d d d d d d
G6PD deficiency
d d d d d d d d d d d d d d d d
All of the findings listed below may be seen in acquired hemolytic anemias of the
d d d d d d d d d d d d d d d
autoimmune variety. The one considered to be the MOST characteristic is: -
d d d d d d d d d d d d
positive direct antiglobulin test
d d d d d d d d d d d d d d d d d d
Peripheral blood smears from patients with untreated pernicious anemia are characterized by:
d d d d d d d d d d d d
- d
pancytopenia and macrocytosis
d d d d d d d d d d d d d d d d d
The laboratory tests performed on a patient indicate macrocytosis, anemia, leukopenia, and
d d d d d d d d d d d d
thrombocytopenia. Which of the following disorders is the patient most likely to have? - d d d d d d d d d d d d d d
vitamin B12 deficiency
d d d d d d d d d d d d d d d d d
The characteristic morphologic feature in folic acid deficiency is: -
d d d d d d d d d d
macrocytosis
d d d d d d d d d d d d d d d
Megaloblastic asynchronus development in the bone marrow indicates which one of the
d d d d d d d d d d d d
following? - d d
impaired synthesis of DNA
d d d d d d d d d d d d d d d d d d
Which of the following are found in association with megaloblastic anemia? -
d d d d d d d d d d d d
4|Page
