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1. A 5-year-old African American child presents with hepatosplenomegaly, skeletal
abnormalities, and severe anemia. Lab results show: HGB 6.2 g/dL, many target cells, marked
microcytosis, elevated serum iron, negative sickle solubility, and elevated HGB F. What is the
probable cause?
• A) Aplastic anemia
• B) Beta-thalassemia major
• C) Sickle cell anemia
• D) HGB C disease
• Correct Answer: B) Beta-thalassemia major
Rationale: The combination of severe anemia, target cells, elevated HGB F, and negative
sickle solubility points to beta-thalassemia major, not aplastic anemia or sickling
disorders.
2. Identify the nucleated blood cell shown in a typical image with large dark blue/purple
granules obscuring an S-shaped nucleus:
• A) Neutrophil
• B) Monocyte
• C) Eosinophil
• D) Basophil
• Correct Answer: D) Basophil
Rationale: Basophils are the least numerous granulocytes, characterized by large dark
blue/purple granules that often obscure the nucleus, which is typically S-shaped.
3. A patient with a history of mild bleeding episodes has a normal PT but a prolonged aPTT
that corrects with normal plasma. Which factor deficiency is most likely?
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• A) Factor VII deficiency
• B) Factor IX deficiency
• C) Factor X deficiency
• D) Circulating inhibitor
• Correct Answer: B) Factor IX deficiency
Rationale: A prolonged aPTT that corrects with mixing indicates a factor deficiency in
the intrinsic pathway; Factor IX deficiency (Hemophilia B) fits, while Factor VII affects PT
only.
4. What is the abnormal RBC shape characterized by a rod or cigar shape, often seen in
hereditary elliptocytosis?
• A) Elliptocytes
• B) Acanthocytes
• C) Sickle cells
• D) Echinocytes
• Correct Answer: A) Elliptocytes
Rationale: Elliptocytes are elongated, oval-shaped red blood cells, a defining feature of
hereditary elliptocytosis, distinguishing them from the spiculated acanthocytes or
crescent-shaped sickle cells.
5. A patient's CBC shows: RBC 5.6, HGB 11.2, HCT 34.5%, with microcytes, basophilic
stippling, and target cells. Which beta-thalassemia type is this?
• A) Minima
• B) Minor
• C) Intermedia
• D) Major
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• Correct Answer: B) Minor
Rationale: Moderate anemia with microcytosis and target cells in an otherwise
asymptomatic or mildly symptomatic patient is characteristic of beta-thalassemia minor
(trait).
6. During phagocytosis, a neutrophil's granules fuse with the phagosome. Which substance is
NOT contained in these granules?
• A) Lysozyme
• B) Myeloperoxidase
• C) Lactoferrin
• D) Lactase
• Correct Answer: D) Lactase
Rationale: Neutrophil granules contain lysozyme, myeloperoxidase, and lactoferrin for
microbial killing, but lactase is a digestive enzyme not found in these granules.
7. Calculate the MCHC given: HGB = 17.5 g/dL, HCT = 53%.
• A) 28 pg
• B) 33 g/dL
• C) 36 g/dL
• D) 102 fL
• *Correct Answer: B) 33 g/dL*
*Rationale: MCHC is calculated as (HGB / HCT) x 100. (17.) x 100 = 33.0 g/dL,
which is within the normal range of 32-36 g/dL.*
8. A patient with immune thrombocytopenic purpura (ITP) would most likely present with
which clinical symptom directly related to the low platelet count?
• A) Shortness of breath
• B) Joint pain
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• C) Petechiae
• D) Fever
• Correct Answer: C) Petechiae
Rationale: Petechiae are small, pinpoint hemorrhages caused by thrombocytopenia,
directly resulting from the decreased platelet count in ITP.
9. Which alpha thalassemia syndrome has the genotype -a/aa (one gene deleted)?
• A) Silent carrier
• B) Alpha thalassemia minor
• C) HGB H disease
• D) Alpha thalassemia major
• Correct Answer: A) Silent carrier
Rationale: The -a/aa genotype represents the loss of one alpha globin gene, which is
clinically silent with no anemia or significant red cell changes.
10. The causative agent of infectious mononucleosis (EBV) attaches to a receptor on which
cell type?
• A) T-helper cells
• B) B lymphocytes
• C) T-suppressor cells
• D) NK cells
• Correct Answer: B) B lymphocytes
*Rationale: Epstein-Barr virus specifically binds to CD21 receptors on B lymphocytes,
infecting them and leading to the characteristic atypical lymphocytosis.*
11. Which immunophenotypic marker is associated with normal mature B-cell expression?
• A) CD19
• B) CD8
1. A 5-year-old African American child presents with hepatosplenomegaly, skeletal
abnormalities, and severe anemia. Lab results show: HGB 6.2 g/dL, many target cells, marked
microcytosis, elevated serum iron, negative sickle solubility, and elevated HGB F. What is the
probable cause?
• A) Aplastic anemia
• B) Beta-thalassemia major
• C) Sickle cell anemia
• D) HGB C disease
• Correct Answer: B) Beta-thalassemia major
Rationale: The combination of severe anemia, target cells, elevated HGB F, and negative
sickle solubility points to beta-thalassemia major, not aplastic anemia or sickling
disorders.
2. Identify the nucleated blood cell shown in a typical image with large dark blue/purple
granules obscuring an S-shaped nucleus:
• A) Neutrophil
• B) Monocyte
• C) Eosinophil
• D) Basophil
• Correct Answer: D) Basophil
Rationale: Basophils are the least numerous granulocytes, characterized by large dark
blue/purple granules that often obscure the nucleus, which is typically S-shaped.
3. A patient with a history of mild bleeding episodes has a normal PT but a prolonged aPTT
that corrects with normal plasma. Which factor deficiency is most likely?
,2|Page
• A) Factor VII deficiency
• B) Factor IX deficiency
• C) Factor X deficiency
• D) Circulating inhibitor
• Correct Answer: B) Factor IX deficiency
Rationale: A prolonged aPTT that corrects with mixing indicates a factor deficiency in
the intrinsic pathway; Factor IX deficiency (Hemophilia B) fits, while Factor VII affects PT
only.
4. What is the abnormal RBC shape characterized by a rod or cigar shape, often seen in
hereditary elliptocytosis?
• A) Elliptocytes
• B) Acanthocytes
• C) Sickle cells
• D) Echinocytes
• Correct Answer: A) Elliptocytes
Rationale: Elliptocytes are elongated, oval-shaped red blood cells, a defining feature of
hereditary elliptocytosis, distinguishing them from the spiculated acanthocytes or
crescent-shaped sickle cells.
5. A patient's CBC shows: RBC 5.6, HGB 11.2, HCT 34.5%, with microcytes, basophilic
stippling, and target cells. Which beta-thalassemia type is this?
• A) Minima
• B) Minor
• C) Intermedia
• D) Major
,3|Page
• Correct Answer: B) Minor
Rationale: Moderate anemia with microcytosis and target cells in an otherwise
asymptomatic or mildly symptomatic patient is characteristic of beta-thalassemia minor
(trait).
6. During phagocytosis, a neutrophil's granules fuse with the phagosome. Which substance is
NOT contained in these granules?
• A) Lysozyme
• B) Myeloperoxidase
• C) Lactoferrin
• D) Lactase
• Correct Answer: D) Lactase
Rationale: Neutrophil granules contain lysozyme, myeloperoxidase, and lactoferrin for
microbial killing, but lactase is a digestive enzyme not found in these granules.
7. Calculate the MCHC given: HGB = 17.5 g/dL, HCT = 53%.
• A) 28 pg
• B) 33 g/dL
• C) 36 g/dL
• D) 102 fL
• *Correct Answer: B) 33 g/dL*
*Rationale: MCHC is calculated as (HGB / HCT) x 100. (17.) x 100 = 33.0 g/dL,
which is within the normal range of 32-36 g/dL.*
8. A patient with immune thrombocytopenic purpura (ITP) would most likely present with
which clinical symptom directly related to the low platelet count?
• A) Shortness of breath
• B) Joint pain
, 4|Page
• C) Petechiae
• D) Fever
• Correct Answer: C) Petechiae
Rationale: Petechiae are small, pinpoint hemorrhages caused by thrombocytopenia,
directly resulting from the decreased platelet count in ITP.
9. Which alpha thalassemia syndrome has the genotype -a/aa (one gene deleted)?
• A) Silent carrier
• B) Alpha thalassemia minor
• C) HGB H disease
• D) Alpha thalassemia major
• Correct Answer: A) Silent carrier
Rationale: The -a/aa genotype represents the loss of one alpha globin gene, which is
clinically silent with no anemia or significant red cell changes.
10. The causative agent of infectious mononucleosis (EBV) attaches to a receptor on which
cell type?
• A) T-helper cells
• B) B lymphocytes
• C) T-suppressor cells
• D) NK cells
• Correct Answer: B) B lymphocytes
*Rationale: Epstein-Barr virus specifically binds to CD21 receptors on B lymphocytes,
infecting them and leading to the characteristic atypical lymphocytosis.*
11. Which immunophenotypic marker is associated with normal mature B-cell expression?
• A) CD19
• B) CD8
