ONLINE MTLE REVIEW ASSESSMENT EXAM #1 – HEMATOLOGY QUESTIONNAIRE

ACTS REVIEW CENTER

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MARCH 2021 ONLINE MTLE REVIEW

SECTION A
ASSESSMENT EXAM 1 – HEMATOLOGY

1. To establish a standard curve for reading hemoglobin concentration,

a. a commercial control material is used
b. a wavelength of 640nm is employed
c. certified standards are used
d. a patient blood sample of known hemoglobin concentration is used
2. Which of the following is not a source of error when measuring hemoglobin by the cyanmethemoglobin method?
a. excessive anticoagulant
b. white blood cell count that exceeds linearity limits
c. lipemic plasma
d. scratched or dirty hemoglobin measuring cell
3. Which of the following statements about microhematocrit is false?
a. excessive centrifugation causes falsely low results
b. a tube less than half full causes falsely low results
c. hemolysis causes falsely low results
d. trapped plasma causes falsely high results
4. Which of the following statements about the manual reticulocyte counts is false?
a. the blood/stain mixture is incubated for 5 to 10 minutes
b. new methylene blue, a supravital stain is used
c. RBC inclusions can result in falsely elevated counts
d. An erythrocyte must have at least 4 blue particles to be counted as a reticulocyte
5. When are automated cell counters required to have a calibration check performed?
a. at least every 3 months
b. after replacement of any major part
c. after performing monthly maintenance
d. when the control values are greater than 2 standard deviations from the mean
6. A blood sample was run through an automated cell counter and the following results were obtained:
WBC count: 6.9 x 109/L (6.9 x 103/μL)
RBC count: 3.52 x 1012/L (5.32 x 106/μL)
Hemoglobin: 120g/L (12.0g/dL)
Hematocrit 0.32L/L (32%)
MCH: 34.1pg
MCHC: 37.5g/dL
Which of the troubleshooting steps that follows should be performed to obtain reportable results?
a. perform a saline replacement procedure
b. warm the specimen to 37°C and rerun
c. perform a microhematocrit
d. none, the results are reportable
7. What reagents are used in the PT test?
a. Thromboplastin and sodium chloride c. Thromboplastin and calcium chloride
b. Thromboplastin and potassium chloride d. Actin and calcium chloride

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 ONLINE MTLE REVIEW ASSESSMENT EXAM #1 – HEMATOLOGY QUESTIONNAIRE

8. Which of the following tests could be performed on a hemolyzed blood sample?

a. hemoglobin only c. RBC count and hematocrit
b. hemoglobin and platelet count d. No results would be reportable
9. Which results would be expected for the prothrombin time (PT) and activated partial thromboplastin time (APTT) in a
patient with polycythemia?
a. Both prolonged c. Normal PT, prolonged APTT
b. Both shortened d. Both normal
10. Which test will be abnormal in a patient with Stuart-Prower factor deficiency?
a. PT b. APTT c. Thrombin time d. Two of the above
11. Which test result will be normal in a patient with dysfibrinogenemia?
a. Thrombin time c. PT
b. APTT d. Immunologic fibrinogen level
12. A patient with a prolonged PT is given intravenous vitamin K. The PT corrects to normal after 24 hours. What clinical
condition most likely caused these results?
a. Liver disease c. Fibrinogen deficiency
b. Factor X deficiency d. Obstructive jaundice
13. All of the following are characteristics of vitamin K EXCEPT:
a. Required for biological activity of some coagulation factors.
b. Activity is enhanced by heparin therapy.
c. Required for carboxylation of glutamate residues of some coagulation factors
d. Prolonged antibiotic treatment causes vitamin K deficiency
14. Situation: The PT and APTT are corrected with aged serum, but not with adsorbed plasma. What factor is deficient?
a. V b. VII c. X d. XI
15. A prolonged APTT is corrected with factor VIII-deficient plasma but not with factor IX-deficiency plasma. What factor is
deficient?
a. IX b. VIII c. V d. X
16. In an individual with factor V Leiden, activated protein C cannot bind to factor V, and the individual would be at risk for:
a. Exsanguinations b. thrombosis c. anticoagulation d. hemarthrosis
17. Iron deficiency anemia is characterized by:
a. decreased plasma iron, increased TIBC, and microcytic, hypochromic indices
b. decreased bone marrow iron, decreased plasma ferritin and normocytic normochromic indices
c. decreased plasma iron, increased TIBC and normocytic, normochromic indices
d. decreased plasma iron, decreased TIBC and microcytic, hypochromic indices
18. Which laboratory method can best differentiate protein C deficiency from type I from type II?
a. clot sensing c. immunoassay
b. chromogenic substrate d. electrophoresis
19. A patient’s CBC result show the following:
RBC count = 5.6 x 1012/L Hematocrit =39%
Hemoglobin = 13 g/dL MCV = 69.9 fL
MCH = 23.2 pg MCHC = 33.3%
These results are consisted with which of the following disorders?
a. iron deficiency anemia c. beta thalassemia minor
b. beta thalassemia major d. lead poisoning
20. Which of the following does not occur during the first stage (stage I) of iron deficiency anemia?
a. iron stores are mobilized and become depleted
b. hemosiderin in the bone marrow aspirates is decreased or absent
c. serum ferritin levels are decreased
d. microcytic hypochromic anemia is present

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21. The following results were reported on a 30-year-old white woman:

WBC count: 3.5 x 109/L RBC count: 2.5 x 1012/L
Hemoglobin: 10g/dL Hematocrit: 31%
MCV: 124fL MCH: 40pg
MCHC: 32% Platelet count: 130 x 109/L
WBC differential: PMNs 56% with occasional hypersegmented neutrophils; lymphocytes 38%, monocytes 5%,
eosinophils 1%
RBC morphology: 2+ macrocytes, moderate macro-ovalocytes
These results are consistent with:
a. liver disease
b. folic acid deficiency
c. alcoholism
d. erythroid leukemia
22. A 40-year old woman is admitted to the hospital for menorrhagia and epistaxis. The patient’s past history revealed several
moderate to severe bleeding episodes. The coagulation results are as follows:
PT: 12 seconds APTT: 50 seconds Bleeding time: 4 minutes
Mixing studies corrected the APTT to 30 seconds. What is the most probable diagnosis?
a. factor V deficiency
b. factor IX deficiency
c. factor X deficiency
d. factor XII deficiency
23. The prothrombinase complex consists of which factors?
a. I, Va, VIII:C, XIII
b. Xa, Va, PF3, Ca2+
c. IIa, VII, IX, X
d. IXa, VIII:C, PF3, Ca2+
24. Which of the following may interfere with heparin therapy?
a. normal platelet count
b. thrombocytosis
c. recent thrombosis or surgery
d. normal aPTT baseline
25. All of the following are characteristic of chronic myelogenous leukemia, except:
a. marked leukocytosis
b. splenomegaly
c. increased leukocyte alkaline phosphatase score
d. mature granulocytes
26. Which of the following leukemias is most often associated with an autoimmune hemolytic anemia?
a. acute lymphoblastic leukemia
b. acute myeloblastic leukemia
c. chronic lymphocytic leukemia
d. chronic myelocytic leukemia
27. Refer to the following results obtained from a patient with a severe bacterial infection:
PT: 30 seconds APTT: 60 seconds
Platelet count: 50 x 10 /L9 Fibrinopeptides A and B: Increased
Which of the following is the most probable cause?
a. factor IX deficiency
b. factor X deficiency
c. lupus anticoagulant
d. disseminated intravascular coagulation

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28. A newborn infant has a WBC count of 37,000/μL with the differential count revealing the presence of 50 nRBCs per 100
WBCs. What is the corrected WBC count?
a. 12,500/μL b. 15,000/μL c. 24,700/μL d. 27,300/μL
29. Which of the following may interfere with the activated protein C resistance (APCR) screening test?
a. heparin-induced thrombocytopenia
b. factor deficiencies
c. acute thrombocytopenic purpura
d. post transfusion purpura
30. A leukocyte count and differential on a 40-year-old white man revealed the following:
WBC: 5.4 x 103/μL (5.4 x 109/L)
Differential: neutrophils 20%; lymphocytes 58%; monocytes 20%; eosinophils 2%
Normal absolute values:
Lymphocytes = 960 to 4,752/μL
Neutrophils = 2,400 to 7,560/μL
This represents:
a. relative and absolute lymphocytosis
b. absolute lymphocytosis
c. relative and absolute granulocytosis
d. relative and absolute granulocytopenia
31. All of the following are characteristics of classic hemophilia A EXCEPT:
a. Normal bleeding time c. Severe hemarthrosis
b. Sex-linked inheritance d. Decreased vWF:Ag
32. All of the following are characteristics of antithrombin III EXCEPT:
a. Synthesized in the liver c. Is a cofactor of heparin
b. Is an alpha2 globulin d. Is a pathological inhibitor of coagulation
33. Which statement about the fibrin degradation product (FDP) test is false?
a. Detects early degradation products
b. Elevated in disseminated intravascular coagulation (DIC)
c. Evaluates the fibrinolytic system
d. Detects late degradation products
34. All of the following tests are affected by heparin therapy EXCEPT:
a. Thrombin time c. Whole blood clotting time
b. APTT d. Reptilase time
35. An abnormal APTT seen with a pathological circulating anticoagulant is:
a. Corrected with a aged serum c. Corrected with normal plasma
b. Corrected with adsorbed plasma d. Not corrected with any of the above
36. The lupus anticoagulant is directed against:
a. Factor VIII b. Factor X c. Factor IX d. Phospholipid
37. All of the following statements regarding coumadin are true EXCEPT:
a. Vitamin K antagonist
b. Needs antithrombin III (AT-III) as a cofactor
c. PT is used to monitor the dosage
d. Not recommended for pregnant and lactating women
38. In DIC, which tests result is unlikely?
a. Prolonged thrombin time c. Increased euglobulin lysis time
b. Decreased platelet count d. Prolonged PT
39. Which of the following is a predisposing condition for the development of DIC?
a. Adenocarcinoma c. Liver disease
b. Sepsis d. All of the above

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40. All of the following physiological conditions may be associated with thrombocytopenia EXCEPT:
a. Decreased platelet production
b. Abnormal platelet distribution
c. Increased platelet distribution
d. Increased proliferation of pluripotential stem cells
41. All of the following laboratory results support the diagnosis of von Willebrand’s disease EXCEPT:
a. Increased bleeding time
b. Decreased factor VIII assay
c. Decreased platelet retention
d. Normal platelet aggregation response to ristocetin
42. When performing platelet aggregation studies, which set of platelet aggregation responses would most likely occur in a
patient with Bernard-Soulier syndrome?
a. Normal platelet aggregation response to collagen, ADP, and ristocetin
b. Normal platelet aggregation response to collagen, ADP, and epinephrine: decreased response to ristocetin
c. Normal platelet aggregation response to epinephrine and ristocetin: decreased response to collagen and ADP
d. Normal platelet aggregation response to epinephrine, ristocetin, and collagen: decreased response to ADP.
43. Which set of platelet responses would 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 ristocetin.
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.
44. Which of the following is a characteristic of acute idiopathic thrombocytopenic purpura (ITP)?
a. Spontaneous remission within several weeks c. Nonimmune platelet destruction
b. Found predominantly in adults d. Insidious onset
45. All of the following are characteristics of protein C except:
a. Vitamin K-dependent zymogen c. Inhibits cofactors Va and VIIIa
b. Activated by thrombin d. Activity is inhibited by protein S
46. Which of the following is necessary for activation of the vitamin K-dependent coagulation factors?
a. Antithrombin III c. Carboxy residues
b. Calcium d. Arachidonic acid
47. In a vitamin K-deficient patient, which of the following coagulation tests would be abnormal?
a. PT and APTT c. Fibrinogen level
b. Bleeding time d. Thrombin time
48. A positive protamine sulfate test is suggestive of:
a. von Willebrand’s disease c. DIC
b. Primary fibrinolysis d. Glanzmann’s thrombasthenia
49. Which of the following coagulation test results is normal in a patient with classic von Willebrand’s disease?
a. Bleeding time c. Platelet count
b. APTT d. Factor VIII:C and VWF levels
50. Acute idiopathic thrombocytopenic purpura is an ________ condition and may be associated with a(n) _________.
a. alloimmune; viral infection
b. autoimmune; viral infection
c. alloimmune; bacterial infection
d. autoimmune; allergy reaction
51. A clinical laboratory scientist examined a Wright’s stained peripheral smear and saw what appeared to be dark-staining
granules in the mature erythrocytes. A second smear was stained with Prussian blue and a positive result was obtained.
Based on this information, which of the following would you expect to be abnormal?
a. plasma hemoglobin level c. hemoglobin electrophoresis
b. serum ferritin level d. test for parietal cell antibodies

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52. Which of the following statements about hereditary spherocytosis is true?

a. abnormally shaped cells are produced in the bone marrow
b. cells have a decreased mean cell hemoglobin concentration (MCHC)
c. membrane loss and red cell trapping occur in the splenic microcirculation
d. red cell osmotic fragility is decreased
53. Which of the following statements about hereditary elliptocytosis (HE) is true?
a. characteristic oval shape occurs in mature erythrocytes
b. heterogeneous group of disorders linked to Rh null individuals
c. cellular defect involves the lipid composition of the membrane
d. HE cells are abnormally permeable to calcium
54. Which of the following disorders is not commonly linked to the development of anemia of chronic disease?
a. persistent infections
b. non infectious inflammatory disorders
c. chronic gastrointestinal blood loss
d. malignancy
55. Which of the following statements about hemoglobin F is false?
a. electrophoresis shows approximately 60% hemoglobin A and 40% hemoglobin C
b. target cells are frequently seen on peripheral smears
c. red cells may contain bar-shaped intracellular crystals
d. the disorder is less severe than sickle cell disease
56. A bone marrow M:E ratio of 4:1 would be an expected finding for:
a. sickle cell anemia c. beta-thalassemia major
b. aplastic anemia d. megaloblastic anemia
57. An elderly man with a 10-year history of chronic lymphocytic leukemia presented with jaundice and fatigue that was
attributed to a recent 3-gram drop in his hemoglobin. Many spherocytes and polychromatophilic red cells were found on
his Wright’s stained blood smear. Which type of immune hemolytic anemia is most likely?
a. idiopathic warm autoimmune hemolytic anemia
b. secondary warm autoimmune hemolytic anemia
c. primary cold hemagglutinin disease
d. paroxysmal cold hemoglobinuria
58. A moderately anemic patient with suspected pernicious anemia (PA) shows intrinsic factor antibodies and a low
cobalamin level. Which of the following would not support the diagnosis of PA?
a. gastric atrophy and achlorhydria
b. oval macrocytes and Howell Jolly bodies
c. bone marrow erythroid precursors exhibit normoblastic maturation
d. elevated serum lactate dehydrogenase (LD) and bilirubin levels
59. A cellulose acetate electrophoresis revealed a large band of hemoglobin in the hemoglobin S position. This band quantified
at 95%. The peripheral smear revealed 70% target cells, and the solubility test was negative. Based on this information,
what is the hemoglobin?
a. hemoglobin C b. hemoglobin D c. hemoglobin E d. hemoglobin S
60. A previously healthy man experiences weakness and hemoglobinuria after taking the antimalarial drug primaquine. This
hemolytic attack most likely occurred because of a deficiency of:
a. pyruvate kinase c. 2,3-biphosphoglycerate
b. glucose-6-phosphate dehydrogenase d. Methemoglobin reductase
61. What values would you expect to obtain on hemoglobin and hematocrit determinations done immediately after a major
hemorrhage, if hemoglobin and hematocrit values were normal prior to the hemorrhage?
a. both normal c. hemoglobin decreased, hematocrit normal
b. both decreased d. hemoglobin normal, hematocrit decreased

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62. Result from a 1-day old infant include a hemoglobin of 201g/L (20.1g/dL), hematocrit of 0.60L/L (60%), MCV of 110.2fL
and 4 nucleated red cells per 100 WBCs. How should the test results be interpreted?
a. the elevated hemoglobin and hematocrit values indicate possible dehydration
b. the nucleated red cells suggest accelerated erythropoiesis due to a hemolytic process
c. testing should be done to identify the cause of the macrocytosis
d. no further testing is indicated
63. A patient with normocytic, normochromic anemia secondary to small cell carcinoma may be exhibiting an anemia
designated as:
a. Hemolytic b. megaloblastic c. myelophthisic d. sideroblastic
64. Idiopathic aplastic anemia is best defined as a form of anemia that:
a. has no identifiable case c. follows exposed to ionizing radiation
b. is caused by a physician’s treatment d. develops after viral infection
65. Which of the following is true regarding red blood cell aplasia?
a. marrow replacement anemia c. Diamond-Blackfan anemia
b. Fanconi anemia d. Donath-Landsteiner anemia
66. Which of the following is not a cause of absolute secondary erythrocytosis?
a. defective cardiac or pulmonary function c. dehydration secondary to diuretic use
b. high –altitude adjustment d. hemoglobin with increased oxygen affinity
67. A cellulose acetate hemoglobin electrophoresis (alkaline pH), performed on the blood of a stillborn infant, revealed a
single band that migrated farther toward the anode than did the HbA control. What is the most likely composition of the
stillborn infant’s hemoglobin?
a. four beta chains c. two alpha and two beta chains
b. four gamma chains d. two alpha and two gamma chains
68. A cellulose acetate hemoglobin electrophoresis (alkaline pH), performed on the blood of a stillborn infant, revealed a
single band that migrated farther toward the anode than did the HbA control. What is the most likely condition of the
infant?
a. erythroblastosis fetalis c. Hydrops fetalis
b. Rh hemolytic disease of the fetus d. ABO hemolytic disease of the newborn
69. Which of the following conditions show similar CBC and blood smear findings?
a. beta thalassemia major and minor c. acute and chronic blood loss
b. folic acid and vitamin B12 deficiencies d. sickle cell disease and trait
70. Which of the following conditions is not associated with the presence of schistocytes and spherocytes?
a. clostridial septicemia c. severe thermal burns
b. prosthetic heart valves d. aplastic anemia
71. A 30-year-old woman who has been vomiting for 3 days has a hemoglobin value of 180g/L (18.0g/dL) and a hematocrit of
0.54L/L (54%). Her results suggest the presence of:
a. absolute erythrocytosis c. secondary polycythemia
b. primary polycythemia d. relative polycythemia
72. Which of the following does not characterize beta-thalassemia major?
a. transfusion-dependent anemia
b. decreased alpha chains result in excess beta chains
c. iron chelation therapy is necessary
d. common in persons of Mediterranean ancestry
73. In the anemia of chronic disease, what are the usual serum iron and transferrin levels?
a. serum iron decreased, transferrin decreased
b. serum iron decreased, transferrin increased
c. serum iron normal, transferrin normal
d. serum iron increased, transferrin increased

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74. On what is the classification of sickle cell trait versus sickle cell disease based?
a. severity of the clinical symptoms
b. number of irreversibly sickled cells (ISCs)
c. level of compensatory hemoglobin F
d. percentage of hemoglobin S on electrophoresis
75. Which of the following is the most appropriate treatment for sickle cell anemia?
a. hydroxyurea
b. supportive therapy
c. hyperbaric oxygen
d. iron
76. A preoperative, 20-year-old female has a mild microcytic anemia, with target cells and stippled red cells observed on the
blood smear. Her hemoglobin A2 level is quantified at 5%. What do these findings suggest?
a. iron deficiency anemia
b. heterozygous alpha-thalassemia
c. heterozygous beta thalassemia
d. hemoglobin S/beta thalassemia
77. What causes the hemolytic process in glucose-6-phosphate dehydrogenase deficiency following oxidant exposure?
a. coating of red cells by antibody
b. osmotic pressure changes
c. complement attachment
d. precipitation of denatured hemoglobin
78. In clinically severe hereditary spherocytosis, which of the following findings would not be found post-splenectomy?
a. rise in the red cell count and hemoglobin level
b. higher number of circulating reticulocytes
c. increased number of Howell-Jolly bodies
d. transient elevation of platelet count
79. Which of the following laboratory results is not consistent with accelerated red cell destruction?
a. increased serum bilirubin
b. increased plasma hemoglobin
c. increased serum lactate dehydrogenase
d. increased serum-haptoglobin
80. Acquired hemolytic anemias are usually due to:
a. extracorpuscular factors
b. defects within the bone marrow
c. intracellular factors
d. changes in hemoglobin stability
81. Spectrin is a protein that occupies a major role in:
a. red cell membrane structure
b. reducing ferric iron
c. red cell transport and removal of CO2
d. iron recovery during hemoglobin degradation
82. What is the function of reduced glutathione (GSH) in the red blood cells?
a. promotes Kreb’s cycle activity
b. maintains anion balance during the chloride shift
c. neutralizes intracellular oxidants that accumulate
d. prevents oxygen uptake by hemoglobin
83. What does measuring the total iron binding capacity (TIBC) represent?
a. amount of free iron in serum c. amount of iron that transferrin can bind
b. circulating protein bound iron d. indirect measurement of iron stores

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84. Which of the following is associated with glucose-6-phosphate dehydrogenase (G6PD) deficiency?
a. G6PD gene is located on X chromosome
b. Ongoing intravascular hemolysis occurs
c. All circulating red cells, including reticulocytes, lack enzyme activity
d. Splenectomy can relieve the rate of red cell destruction
85. In regard to variant hemoglobin E, α2β226 Glu→Lys, which of the following statements is false?
a. there are two normal alpha chains
b. glutamic acid replaces lysine on position 26 of the beta chains
c. hemoglobin E is the second most common variant known
d. glutamic acid is normally found at position 26 of the beta chain
86. Which of the following statements about sickle cell syndromes is false?
a. asplenism may result from repeated sickling crises in homozygous state
b. heterozygous persons may be partly protected from infection by falciparum malaria
c. hemoglobin S is more soluble in dithionite than is normal hemoglobin
d. trait conditions are generally asymptomatic with no sickle cell formation
87. Which of the following blood findings does not correlate with the presence of ringed sideroblasts in the bone marrow?
a. Pappenheimer bodies
b. Basophilic stippling
c. Increased total iron binding capacity
d. Increased percent transferrin saturation
88. 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 autoimmune hemolytic anemia d. pernicious anemia
89. In addition to an increase in red blood cells, which of the following is characteristic of polycythemia vera?
a. decreased platelets, decreased granulocytes, decreased erythropoietin level
b. decreased platelets, decreased granulocytes, increased erythropoietin levels
c. increased platelets, increased granulocytes, increased erythropoietin levels
d. increased platelets, increased granulocytes, decreased erythropoietin levels
90. Which of the following describes the process known as “culling”?
a. release of red cells from the bone marrow
b. binding of free hemoglobin by transport proteins
c. incorporation of iron into protoprophyrin IX
d. removal of abnormal red cells by the spleen
91. Which of the following statements about iron absorption is true?
a. absorption occurs in the ileum
b. the mucosal cells always absorbs the correct amount of iron to meet needs
c. absorption increases when erythropoietic activity increases
d. alkaline pH favors absorption
92. Which of the following is associated with a “shift to the left” in the oxygen dissociation curve of hemoglobin?
a. decreased pH and elevated temperature
b. decreased oxygen affinity
c. decreased oxygen release
d. presence of 2,3 biphosphoglycerate (2,3-BPG)
93. Which of the following statements does not characterize erythropoietin (EPO)?
a. transforms the CFU-E into the earliest recognizable RBC precursor
b. increases the rate of red blood cell production by the bone marrow
c. shortens the maturation time of developing erythroid precursors
d. decreases stimulation of erythropoiesis when cellular hypoxia increases

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94. Which of the following factors will result in an immediate increase in oxygen delivery to the tissue?
a. increased pH
b. high altitudes
c. increased hemoglobin binding of 2,3-BPG
d. increased renal release of erythropoietin
95. Periods of intense erythropoietin activity cause premature release of marrow reticulocytes into the blood. Which of the
following is not true of these early reticulocyte?
a. loss of residual RNA occurs immediately upon marrow release
b. circulate longer than usual before reaching maturity
c. may be termed shift or stress reticulocytes
d. show diffuse basophilia with Wright’s stain
96. The presence of schistocytes on the peripheral blood smear is commonly associated with:
a. increased iron mobilization
b. increased red cell destruction
c. decreased erythropoietin activity
d. decreased red cell proliferation
97. Which of the following may be a sign of accelerated bone marrow erythropoiesis?
a. hypercellular marrow with decreased number of RBC precursors
b. bone marrow M:E ratio of 6:1
c. nucleated red cells in the peripheral circulation
d. low erythrocyte, hemoglobin and hematocrit levels
98. Which of the following red blood cell precursors is the last stage to undergo mitosis?
a. pronormoblast
b. basophilic normoblasts
c. polychromatophilic normoblasts
d. orthochromic normoblasts
99. The red cells observed on a peripheral blood smear show extreme anisocytosis with an equal number of macrocytes and
microcytes. Which of the following values correlate with this finding?
a. MCV 108.0fL; RDW 14.0%
b. MCV 90.0fL; RDW 25.0%
c. MCV 75.0fL; RDW 16.0%
d. MCV 88.0fL; RDW 12.0%
100. Which of the following is not characteristic of aplastic anemia?
a. extramedullary hematopoiesis
b. bone marrow hypoplasia
c. absolute reticulocytosis
d. blood findings of pancytopenia
101. Which of the following characteristics would be least likely to distinguish reactive lymphocytes from monocytes?
a. sharp indentation of the cytoplasmic margin by adjacent red blood cells
b. presence of large azurophilic granules
c. irregular, indented nuclear shape
d. abundant, deeply basophilic cytoplasm
102. Lymphocyte concentrations in the peripheral blood are greatest during what age interval?
a. 1 to 4 years b. 4 to 15 years c. 16 to 40 years d. 40 to 70 years
103. Which of the following is the least likely to be expressed by early B cell precursors?
a. SIgM, a surface membrane immunoglobulin
b. CD34, a hematopoietic stem cell marker
c. TdT (terminal deoxynucleotidyl transferase), a nuclear enzyme
d. CD10 (CALLA), a surface antigen

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104. Which of the following statements about macrophages is incorrect?

a. they are mature tissue forms of blood monocytes
b. they serve as antigen-presenting cells to the immune system
c. their quantity of lysosomes and acid hydrolases decreases during maturation
d. they remove damaged or dying cells and cellular debris
105. A patient with normal hemoglobin and WBC count values, a persistently elevated platelet count (over 1000 x 10 9/L),
increased marrow megakaryocytes, and a history of frequent bleeding and clotting episodes most likely has:
a. polycythemia vera
b. chronic myelofibrosis
c. essential thrombocythemia
d. chronic myelogenous leukemia
106. An adult patient with massive splenomegaly has mild anemia, a slightly elevated WBC count, and an LAP score of 170.
The blood smear shows teardrop erythrocytes and leukoerythroblastosis. These findings are most consistent with:
a. chronic myelogenous leukemia
b. idiopathic myelofibrosis
c. primary polycythemia
d. primary thrombocythemia
107. Which of the following are characteristic findings of Waldenstrom disease?
a. increased IgA and hepatosplenomegaly
b. increased IgE and renal failure
c. increased IgG and hypercalcemia
d. increased IgM and blood hyperviscosity
108. A Gaucher cells 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
109. Which of the following suggests a diagnosis of Hodgkin disease rather than other lymphoproliferative disorders?
a. presence of a monoclonal population of large lymphoid cells
b. predominance of immature B cells with irregular nuclear clefts
c. circulating T cells with convoluted, cerebriform nucleus
d. presence of giant binucleated Reed-Sternberg cells with prominent nucleoli
110. In a patient with fever of unknown origin, which of the following findings is not consistent with an inflammatory
process?
a. increased C reactive protein
b. increased albumin level
c. increased fibrinogen level
d. increased erythrocyte sedimentation rate
111. The presence of the chromosomal abnormality t(15;17) and a high incidence of disseminated intravascular
coagulation (DIC) is diagnostic of:
a. acute myeloblastic leukemia without maturation (FAB type M1)
b. acute myeloblastic leukemia with matration (FAB type M2)
c. acute promyelocytic leukemia (FAB type M3)
d. acute myelomonocytic leukemia (FAB type M4)
112. Which of the following is not commonly found in acute myelogenous leukemia?
a. Neutropenia b. thrombocytopenia c. hepatosplenomegaly d. lymphadenopathy
113. Multiple myeloma is characterized by the presence in urine of large amounts of:
a. Cryoglobulins b. IgG heavy chains c. IgG light chains d. Beta microglobulins

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114. Which of the following is not classified as a myeloproliferative disorder?

a. polycythemia vera
b. essential thrombocythemia
c. multiple myeloma
d. chronic myelogenous leukemia
115. Which of the following gene mutations correlates with the t(9;22) that is present in Philadelphia chromosome positive
chronic myelogenous leukemia?
a. MYC/IGH b. BCR/ABL c. PML/RARA d. JAK2
116. Which of the following statements does not correctly describe the WHO (World Health Organization) classification of
hematopoietic neoplasms?
a. acute leukemia is defined as the presence of at least 20% bone marrow blasts
b. diagnosis is based on cellular morphology and cytochemistry
c. it groups lymphoid disorders into B cells, T/NK cells and Hodgkin lymphoma
d. diagnostic criteria include morphologic, cytochemical, immunologic, cytogenetic and molecular features
117. Which of the following would be least helpful in distinguishing chronic myelogenous leukemia (CML) from a
neutrophilic leukomoid reaction?
a. an extreme leukocytosis with increased neutrophilic bands, metamyelocytes and myelocytes
b. leukocyte alkaline phosphatase score
c. presence of marked splenomegaly
d. neutrophils with Dohle bodies and toxic granulation
118. Which of the following is a typical finding in chronic leukemias at onset?
a. symptoms of infection and bleeding
b. significant thrombocytopenia
c. severe anemia
d. elevated leukocyte count
119. In what condition would an LAP score of 10 most likely be found?
a. bacterial septicemia b. late pregnancy c. polycythemia vera d. chronic myelogenous leukemia
120. Which of the following is not associated with neutrophilia?
a. staphylococcal pneumonia c. infectious hepatitis
b. crushing injury d. neoplasms (tumors)
121. In which of the following would an absolute monocytosis not be seen?
a. Tuberculosis c. collagen disorders
b. recovery stage of acute bacterial infection d. infectious mononucleosis
122. Coarse PAS positivity may be found in the leukemic cells of:
a. acute myeloblastic leukemia (FAB type M1)
b. acute lymphoblastic leukemia (FAB type L1)
c. acute myelomonocytic leukemia (FAB type M4)
d. acute monocytic leukemia (FAB type M5)
123. Which of the following is not among the diagnostic criteria used for classifying the myelodysplastic syndrome?
a. unexplained anemia refractory to treatment
b. hypogranular and hyposegmented neutrophils
c. abnormal platelet size and granulation
d. hypocellular bone marrow with 25% blasts
124. Naphthol AS-D chloroacetate esterase (specific) is usually positive in _________ cells and alpha naphthyl acetate esterase
(non specific) is useful for identifying blast cells of ___________ lineage.
a. granulocytic; monocytic
b. monocytic; granulocytic
c. granulocytic; lymphocytic
d. monocytic; lymphocytic

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125. The familial disorder featuring pseudo-Dohle bodies, thrombocytopenia and large platelets is called:
a. May-Hegglin anomaly
b. Chediak Higashi syndrome
c. Pelger Huet anomaly
d. Alder Reilly anomaly
126. What is the initial laboratory technique for the diagnosis of monoclonal gammopathies?
a. immunologic markers of marrow biopsy cells
b. cytochemical staining of marrow and peripheral blood cells
c. serum and urine electrophoresis
d. cytogenetic analysis of marrow cells
127. Which of the following statements about Hodgkin disease is false?
a. peak incidence occurs in young adults
b. staging determines extent of diseases treatment and course
c. stage IV has the best prognosis
d. almost a 2:1 male predominance over females is characteristic
128. What is the key diagnostic test for Hodgkin’s lymphoma?
a. bone marrow biopsy b. lymph node biopsy c. spinal tap d. skin biopsy
129. A bone marrow with 90% cellularity and myeloid: erythroid ratio of 10:1 is most characteristic of:
a. chronic myelogenous leukemia
b. primary polycythemia
c. beta-thalassemia major
d. aplastic anemia
130. A 60-year old patient present with extreme fatigue. Her blood and bone marrow findings are as follows: severe
anemia with a dual RBC population, 3% marrow blasts and numerous ringed sideroblasts. This information is most
consistent with:
a. refractory anemia (RA)
b. refractory anemia with ringed sideroblasts (RARS)
c. refractory anemia with excess blasts (RAEB)
d. chronic myelomonocytic leukemia (CMML)
131. Which of the following is not a mechanism by which neutropenia may be produced?
a. hypersplenism
b. marrow injury or replacement
c. recent strenuous exercise
d. drug-induced antibodies
132. Which of the following is not a characteristic finding in polycythemia vera?
a. blood pancytosis
b. increased red cell mass
c. increased erythropoietin level
d. increased blood viscosity
133. In what disorder is significant basophilia most commonly seen?
a. hairy cell leukemia
b. plasma cell leukemia
c. acute lymphoblastic leukemia
d. chronic myelogenous leukemia
134. Acute erythroleukemia (FAB type M6) is characterized by increased:
a. promyelocytes and lysozyme activity
b. marrow megakaryocytes and thrombocytosis
c. marrow erythroblasts and multinucleated red cells
d. marrow monoblasts and immature monocytes

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135. Myeloid Metaplasia refers to:

a. displacement of normal marrow cells by fibrous tissue
b. hematopoietic failure
c. extramedullary hematopoiesis
d. tumors (neoplasms) of the bone marrow
136. Which of the following statements about non-Hodgkin types of lymphoma is true?
a. lymphadenopathy is the most common presenting symptom
b. initially, they present as a systemic disease rather than a localized tumor
c. they are often associated with multiple bone lesions
d. they are characterized by proliferation of malignant cells primarily involving the bone marrow
137. A patient with suspected sickle cell train has negative solubility test results, but hemoglobin electrophoresis at pH 8.6
shows an apparent A-S pattern. What is the most likely explanation?
a. patient has hemoglobin AS and the solubility test is incorrect
b. patient has hemoglobin AA and the electrophoresis is incorrect
c. patient has hemoglobin AD or AG and both procedures are correct
d. tests need to be repeated; impossible to determine which procedure is correct
138. Which of the following is an incorrect statement about the solubility test for hemoglobin S?
a. hemoglobin S polymerizes when deoxygenated
b. testing performed on a 2-day old infant can result in a false negative result
c. sickle cell trait can be differentiated from sickle cell anemia with this test
d. the test is positive in hemoglobin CHarlem
139. The blood smear made on a patient with polycythemia vera is too short. What should be done to correct this problem?
a. decrease the angle of the spreader slide
b. increase the angle of the spreader slide
c. adjust the angle of the spreader slide to 45 degrees
d. use a smaller drop of blood
140. What is the reason for red blood cells to be bright red and the WBC nuclei to b poorly stained when using Wright’s
stain?
a. the staining time is too long
b. the stain or buffer is too alkaline
c. the stain or buffer is too acidic
d. the smear was not washed long enough
141. If the reticulocyte count is 6% and RBC count is 3.00 x 1012/L (3.00 x 106/μL), the calculated absolute reticulocyte
count reported in SI units is:
a. 1.8 x 109/L b. 18 x 109/L c. 180 x 109/L d. 180 x 103/μL
142. The following numbers were obtained in evaluating leukocyte alkaline phosphatase (LAP) activity in neutrophils.
What is the score?
0 = 15 1+ = 20 2+ = 30 3+ = 20 4+ = 15
a. 100 b. 115 c. 200 d. 215
143. Which of the following red cell inclusions stain with both Perl’s Prussian blue and Wright’s stain?
a. Howell Jolly bodies
b. Basophilic stippling
c. Pappenheimer bodies
d. Heinz bodies
144. A WBC count is performed on a hemocytometer using a 1:20 dilution. 308 cells are seen in a total area of 8mm2. What
is the WBC count?
a. 3.8 x 109/L b. 7.7 x 109/L c. 15.4 x 109/L d. 38.5 x 109/L

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 ONLINE MTLE REVIEW ASSESSMENT EXAM #1 – HEMATOLOGY QUESTIONNAIRE

145. Which set of results indicates that an error in measurement has occurred?
RBC x 1012/L Hemoglobin (g/dL) Hematocrit (%)
a. 2.50 7.6 22.9
b. 2.75 9.5 24.8
c. 3.40 10.0 31.0
d. 3.75 11.1 34.0
146. Which of the following would not be the cause of a falsely high MCHC of 38.3g/dL on an automated instrument?
a. hereditary spherocytosis
b. lipemia
c. presence of a cold agglutinin
d. instrument sampling or mixing error
147. A clinically significant difference between two electronic cell counts is indicated when the standard deviation is
greater than:
a. ±1.0 b. ±1.5 c. ±2.0 d. ±3.0
148. The hemoglobin A2 quantitation using anion exchange chromatography will be valid in:
a. hemoglobin C disease c. hemoglobin O trait
b. hemoglobin E trait d. beta-thalassemia minor
149. Which of the following is not associated with an increased osmotic fragility and a decreased surface area-to-volume
ratio?
a. beta thalassemia major
b. hereditary spherocytosis
c. warm autoimmune hemolytic anemia
d. burn victims
150. The test value range that includes 95% of the normal population is the:
a. reference interval
b. linearity limit
c. reportable range
d. critical range
151. Which of the following is an acquired red cell membrane defect that results in increased sensitivity to complement
binding?
a. March hemoglobinuria
b. Paroxysmal nocturnal hemoglobinuria
c. Paroxysmal cold hemoglobinuria
d. Methemoglobinemia
152. Which of the following is not associated with acquired reversible sideroblastic anemias?
a. methotrexate therapy
b. lead intoxication
c. isoniazid treatment for tuberculosis
d. acute alcohol ingestion
153. Which of the following statements about the relative anemia of pregnancy is false?
a. it is due to a reduction in the number of erythrocytes
b. it is normocytic and normochromic
c. it does not produce an oxygen deficit for the fetus
d. it is associated with an increase in plasma volume
154. An increased in erythropoietin is not a normal compensating mechanism in which of the following conditions?
a. renal tumors
b. heavy smoking
c. cardiovascular diseases
d. pulmonary disease

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155. Which of the following characterizes iron deficiency anemia?

a. decreased serum iron, decreased transferrin saturation, normal ferritin
b. decreased serum iron, decreased transferrin saturation, decreased ferritin
c. increased serum iron, decreased transferrin saturation, decreased ferritin
d. increased serum iron, increased transferrin saturation, decreased ferritin
156. A clinical laboratory scientist received a 5mL-EDTA tube that contained 0.5mL of anticoagulated blood. A smear was
prepared and stained with Wright’s stain. When examined microscopically, the majority of the cells appeared to have
many, evenly distributed, blunt spicules on the surface. How should this cellular appearance be interpreted?
a. an anemic condition requiring further testing
b. spur cells caused by using incorrect technique during slide preparation
c. artifact caused by a dirty spreader slide
d. crenated cells caused by incorrect blood-to-anticoagulant ratio
157. A failure to generate sufficient ATP is characteristic of red blood cells with:
a. pyruvate kinase deficiency
b. glucose-6-phosphate dehydrogenase deficiency
c. lipoprotein deficiency
d. hexokinase deficiency
158. When iron use exceed absorption, which of the following occurs first?
a. hemoglobin level decreases c. transferrin synthesis increases
b. iron stores are depleted d. excretion of iron decreases
159. The major mechanism responsible for the anemia of chronic disease is:
a. impaired release of storage iron because of increased hepcidin levels
b. damaged bone marrow stem cells
c. immune destruction caused by red cell autoantibodies
d. increased erythropoietin response by committed red cell progenitor cells
160. Which of the following is not a characteristic of the idiopathic type of sideroblastic anemia?
a. refractory to treatment
b. blocks in heme synthesis are unknown
c. reversible with intramuscular vitamin B12 injections
d. subtype of myelodysplatic syndromes
161. Thinning of bones and deformation of facial bone structure seen in homozygous beta-thalassemia is a:
a. consequence of disturbances in calcium metabolism
b. result of hyperplastic marrow activity
c. secondary disorder due to immunologic response
d. result of increased fibroclast activity
162. Which of the following does not accurately describe cold autoimmune hemolytic anemia?
a. red cell agglutination in extremities induces Raynaud’s phenomenon
b. it may occur secondary to Mycoplasma pneumoniae infection
c. hemolysis is complement-mediated or via removal of coated cells
d. the autoantibody is usually an IgG type directed against Rh antigens
163. Which of the following represents an anemia that would have a high red cell distribution width (RDW)?
a. sickle cell disease during crisis c. aplastic anemia
b. thalassemia minor d. anemia of chronic disorders
164. In which of the following disorders would splenomegaly not be a common finding?
a. homozygous beta thalassemia c. hemoglobin SC disease
b. hereditary spherocytosis d. folic acid deficiency
165. What is the approximate amount of time a granulocyte spends in the circulation before migrating into the tissues?
a. less than 1 day c. up to 5 days
b. about 3 days d. more than 10 days

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166. A “shift to the left”, when used to describe a cell population refers to:
a. increased cells in the blood de to a redistribution of blood pools
b. an increase in immature blood cells following release of bone marrow pools
c. a cell production “hiatus” or gap
d. a higher percentage of lymphocytes than neutrophils
167. Which of the following is characteristic of agranulocytosis?
a. neutrophils without granules
b. decreased number of granulocytes, red cells and platelets
c. immature granulocytes in the peripheral blood
d. decreased numbers of granulocytes
168. An adult has a total white blood cell count of 4.0 x 10 9/L (4.0 x 103/μL). The differential count is as follows:
polymorphonuclear neutrophils (PMNs) 25%; bands 5%; lymphocytes 65%; and monocytes 5%. The absolute value
reference range for lymphocytes is 1.0 to 4.0 x 109/L. Which of the following is true?
a. the percentage of lymphocytes is normal
b. there is an absolute lymphocytosis
c. there is a relative lymphocytosis
d. there is both an absolute and a relative lymphocytosis
169. Which of the following statements is correct?
a. hypersegmented neutrophils have four nuclear lobes
b. Auer rods are composed of fused primary granules
c. Toxic granules are prominent secondary granules
d. Dohle bodies are agranular patches of DNA
170. Which of the following statements about basophils is false?
a. morphologically, basophils resemble tissue mast cells
b. membrane receptors bind IgG, initiating anaphylactic reactions
c. basophilic granules contain heparin and histamine
d. granules are water soluble
171. Which of the following statements about eosinophils is false?
a. they contain a type of peroxidase that is distinct from that of neutrophils
b. eosinophilic granules contain lysozyme
c. eosinophils are an important line of defense against parasite
d. major basic protein is a component of eosinophilic granules
172. Which of the following is characteristic of primary granules?
a. coated with a phospholipid membrane
b. called azurophilic or specific granules
c. contain myeloperoxidase and lactoferrin
d. present in the promyelocyte stage only
173. Which of the following are indicators of neutrophilic response to tissue damage or inflammatory stimuli?
a. toxic granules and Dohle bodies in the neutrophils
b. vacuoles and Barr bodies in the neutrophils
c. hypersegmented neutrophils and Auer rods
d. pyknotic neutrophils and Russell bodies
174. On what basis can B and T lymphocytes be distinguished?
a. differences in nuclear shape
b. monoclonal antibody reactions to surface and cytoplasmic antigens
c. cytoplasmic granularity and overall cell size
d. chromatin pattern in the nucleus

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175. Which of the following statements about neutrophils is false?

a. suppress allergic reactions caused by basophils
b. have surface receptors for IgG and complement components
c. contain alkaline phosphatase and muramidase
d. act in nonspecific phagocytosis and are destined to die
176. The following laboratory results are obtained on a 60-year old woman:
WBC count = 4.3 x 109/L RBC count = 3.5 x 1012/L
Hemoglobin = 11g/dL Platelet count = 100 x 109/L
Hematocrit = 34%
WBC differential = neutrophils 50%; lymphocytes 40%; monocytes 7%; eosinophils 3%
RBC morphology = moderate rouleaux
A bone marrow aspirate showed many aggregates of morphologically abnormal plasma cells. What is the most probable
diagnosis?
a. Waldenstrom’s macroglobulinemia
b. monoclonal gammopathy of undetermined significance
c. multiple myeloma
d. heavy chain disease
177. A 40-year-old patient has the following laboratory result:
WBC count: 6.5 x 109/L
WBC differential: PMNs 30%; lymphocytes 65%; monocytes 4%; eosinophils 1%
Reference ranges (per μL) –
PMNs 2200-8250; lymphocytes = 880-4840; monocytes 88-990; eosinophils 44-550
These results represent:
a. relative neutrophilia c. absolute leukopenia
b. relative lymphocytosis d. absolute lymphocytosis
178. The following laboratory results are obtained on a 50-year old woman:
Bleeding time = 15 minutes Platelet count = 200 x 109/L
Prothrombin time = 13 seconds Activated partial thromboplastin time = 50 seconds
Abnormal platelet aggregation in response to ristocetin
What is the most probable diagnosis?
a. Bernard Soulier syndrome c. Glanzmann thrombasthenia
b. Hemophilia A d. Von Willebrand’s disease
179. Which of the following hemoglobin electrophoresis results is consistent with a diagnosis of thalassemia major?
a. HbA 60%, HbS 38%, HbA2 2%
b. HbA 25%, HbA2 50%, HbF 5%
c. HbA 80%, HbA2 10%, HbF 10%
d. HbA 0%, HbA2 5%, HbF 95%
180. A patient with thalassemia minor may be distinguished from a patient with idiopathic dyserythropoietic anemia by:
a. microcytic indices b. elevated RDW c. target cells d. elevated RBC count
181. Which of the following is not characteristic of pluripotent hematopoietic stem cells?
a. possess self-renewal ability
b. produce progenitor cells committed to a single cell lineage
c. express the stem cell marker CD13
d. are morphologically unrecognizable
182. Which of the following does not accurately describe hematopoietic growth factors?
a. bind to target cell receptors to express activity
b. action of majority is lineage restricted
c. may promote or suppress cell death
d. can stimulate or inhibit cell proliferation

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183. In what area of the bone marrow does hematopoiesis take place?
a. Cords b. endosteum c. endothelium d. sinuses
184. Bone marrow cellularity refers to the ratio of:
a. red cell precursors to white cell precursor
b. hematopoietic tissue to adipose tissue
c. granulocytic cells to erythrocytic cells
d. extravascular tissue to intravascular tissue
185. Interleukins and colony stimulating factors are cytokines produced by the:
a. B lymphocytes and erythrocytes
b. Erythrocytes and thrombocytes
c. Monocytes and T lymphocytes
d. Neutrophils and monocytes
186. Which of the following is not performed under oil immersion?
a. WBC differential
b. Platelet estimate
c. Evaluation of RBC and platelet morphology
d. WBC count
187. Which of the following disorders is associated with Dohle bodies and giant platelets?
a. Chediak Higashi syndrome
b. Alder-Reilly anomaly
c. May-Hegglin anomaly
d. Pelger-Huet anomaly
188. The Philadelphia chromosome is found in ________, and its presence indicates a _________ prognosis.
a. acute myelocytic leukemia; better
b. chronic myelocytic leukemia; worse
c. acute lymphocytic leukemia; better
d. chronic myelocytic leukemia; better
189. A platelet count is performed using a 1:100 dilution, and the number of platelets counted in the large center square on
both sides is 200. The total platelet count is:
a. 100,000/μL
b. 200,000/μL
c. 300,000/μL
d. 400,000/μL
190. Which laboratory finding is associated with the lupus anticoagulant?
a. prolonged PT, normal APTT
b. prolonged PT, normal dilute Russell’s viper venom test
c. prolongation of all in vitro phospholipid-dependent tests
d. prolongation of all in vivo phospholipid-dependent tests
191. Use the following data to calculate the indices, and morphologically classify the anemia of this patient?
Hemoglobin = 4.6g/dL Hematocrit = 16% RBC count = 3.07 x 1012/L
a. normocytic/ normochromic
b. microcytic/ microchromic
c. microcytic/ hypochromic
d. macrocytic/ normochromic
192. Which laboratory findings are associated with lupus anticoagulant?
a. prolonged APTT and normal dilute Russell’s viper venom
b. prolongation of in vivo phospholipid-dependent tests
c. prolongation of in vitro phospholipid-dependent tests
d. prolonged PT and normal dilute Russell’s viper venom test

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193. All of the following events occur under control of the intrinsic pathway except:
a. factor XII is activated to factor XIIa
b. factor VII activates factor X to factor Xa
c. factor XIa activates factor IX to factor IXa in the presence of calcium
d. factor IXa works with cofactor VIII and PF3 to activate factor X
194. Promyelocyte constitute 10% of this acute leukemia with >50% of leukemia cells positive for peroxidase or Sudan
Black B. What is the FAB classification?
a. M1 b. M2 c. M3 d. M4
195. Which of the following is not characteristic of HbC disease?
a. mild chronic hemolytic anemia
b. splenomegaly
c. normocytic, normochromic anemia with sickle cells
d. HbC (bar of gold) crystals present in the peripheral smear of splenectomized patients
196. When evaluating a bone marrow aspirate smear, which finding is considered abnormal?
a. a predominance of granulocyte precursors as compared to nucleated red cells
b. detection of stainable iron in macrophages and erythroid precursors with Prussian blue
c. an average of three megakaryocytes seen per low power (10x) field
d. the presence of 10% myeloblasts on the cell differential count
197. As most blood cell lines mature, which of the following is characteristic?
a. cell diameter increases
b. nucleus to cytoplasm ratio decreases
c. nuclear chromatin becomes less condensed
d. basophilia of the cytoplasm increases
198. Which of the following described thrombopoietin (TPO)?
a. renal hormone that regulates marrow red cell production
b. marrow hormone secreted by developing megakaryoblasts
c. hormone produced by the liver that stimulates megakaryopoiesis
d. pituitary hormone that controls platelet sequestration by the spleen
199. When the hepatic phase of fetal life is reactivated in an adult, hematopoiesis can be termed:
a. myeloid or medullary
b. myeloid metaplasia or extramedullary
c. myelophthisis or myelodysplasia
d. mesoblastic or mesenchymal
200. The Na+–K+ pump is an important mechanism in keeping the red blood cell intact. Its function is to maintain a high
level of:
a. intracellular Na+
b. intracellular K+
c. plasma Na+
d. plasma K+

***NOTHING FOLLOWS***
JMBP March 2021

SCORE: 54/200

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 Assessment Exam 1 (Hematology) Rationalization

1. C
2. A
• Techniques which measure hemoglobin, including the cyamethemoglobin method, lyse
RBCs before measurement, so factors which distort or contribute to hemolysis of RBC’s
(such as excessive anticoagulant) DO NOT cause errors in Hb measurement
3. A
• Excessive centrifugation do not affect measurements of hematocrit; however,
UNDERCENTRIFUGATION does falsely increase HCT slightly (as the RBC’s have not
properly settled yet)
4. D
• A RBC must have at least 2, not 4 blue particles to be counted as a reticulocyte
5. B
6. A
• All of the parameters given are normal with the exemption of the RBC count which is
decreased. Possible presence of clotting is suspected. A saline replacement procedure
may be done in order to help disperse the RBC clots if any.
7. C
8. A
• As stated above, techniques for Hb determination lyse RBC’s before measurement;
hence, they may be performed on hemolyzed samples.
9. A
• In polycythemia, plasma is decreased relatively in comparison with the increased amount
of cells. In further comparison with the relatively decreased blood plasma, the
anticoagulant of most tubes would be considered high causing a prolongation in
coagulation pathway tests (PT and APTT). This problem may be remedied by adjusting the
anticoagulant ratio as needed.
10. D.
• Factor X is part of common pathway so both tests are affected.
11. D.
• In dysfibrogenemia, fibrinogen is non-functional; however, the fibrinogen level itself is
normal.
12. D
• In obstructive jaundice, the flow of bile towards the intestines is affected negatively.
Vitamin K, which is important for the production of many coagulation factors, is fat
soluble and requires bile for proper emulsification and absorption.
13. B
14. C
• Clotting factors present in aged serum: All except I, II, V, and VIII
• Adsorbed Plasma: all except II, VII, IX, and X
• We are left with the choices of either B (VII) or C (X); however, as factor VII is present in
both adsorbed plasma and aged serum, we’re left with factor X
15. A.
• The fact that the APPT results were NOT corrected after the addition of IX-DEFICIENT
plasma means that the patient is IX deficient.
16. B
17. A
18. C
19. C
• The parameters only slightly deviate from the norm, so the condition must be mild which
is characteristic of beta thalassemia MINOR.
20. D
• Microcytic, hypochromic anemia only appears in stage 4 of IDA, not in the early stages.
21. B
• Key Parameters: MCV is very high, and neutrophils are hyper-segmented. These are
indicative of megaloblastic anemia which is caused by folic acid deficiency. Additionally,
macro-ovalocytes seen in the peripheral blood smear are unique to megaloblastic
anemia, further confirming the diagnosis.
22. B
• APPT, which measures factors VIII, IX, XI, XII, is increased
• Factor XII deficiency has no bleeding tendencies (which is present in the case study)
• We’re left with factor IX
23. B
24. C
25. C
• LAP is decreased in CML, not increased
26. C
27. D
• Both PT and APTT are prolonged, and the platelet count is markedly decreased leading
one to assume that they have been consumed in the formation of clots as seen in DIC.
28. C
29. B
30. D
31. D
• Decreased vWF:Ag is seen in von Willerbrand Disease, not hemophilia A
32. D
• Antitrhombin III is a natural inhibitor of coagulation produced in the body. It is not
pathological.
33. A
• Fibrinogen is converted to FIBRIN in later part of the cycle, not the earlier stages.
34. D
35. D
• There is no factor deficiency in the patient. There is a pathological circulating
anticoagulant present. None of the given choices can correct the condition (they are used
to correct factor deficiencies).
36. D
37. B
• Heparin is the anticoagulant that needs antithrombin III as a cofactor, not coumadin
38. C
• Euglobulin lysis time should be decreased, as it is a test for fibrinolysis which is increased
in DIC
39. D
40. D
41. D
• Platelet aggregation should be decreased.
42. B
43. C
44. A
45. D
• Protein S is actually a cofactor of protein C, so activity should be enhanced, not inhibited.
46. C
47. A
• Factors IX and X are part of the common pathway, so both PT and APTT are affected
48. C
49. C
50. B
51. B
• Prussian blue stains iron, and ferritin is the storage form of iron in the body
52. C
53. A
54. C
55. A
56. B
• The M:E ratio of 4:1 is actually normal
• In abnormal cases with a normal M:E ratio, one can expect that the myeloid and erythroid
populations of the bone marrow were both decreased or increased at the SAME TIME
• Pancytopenia, is an example in which ALL CELL populations are simultaneously
decreased, leading to a normal M:E ratio
• Of the choices given, aplastic anemia exhibits pancytopenia
57. B
58. C
• Pernicious anemia shows megaloblastic RBCs not normoblastic ones
59. B
• The Hb fractions which co-migrate with HbS are HbD and HbG
60. B
61. A
62. D
• All parameters are normal for INFANTS.
63. C
64. A
• “Idiopathic” means unknown cause
65. C
66. C
• Dehydration causes RELATIVE erthrocytosis, as RBC’s seem increased in relation with the
decreased plasma
67. B
• This electrophoretic picture describes Hb Bart which is composed of 4 gamma globin
chains
68. C
69. B
• Folic acid and vitamin B12 deficiencies are causes of Megaloblastic Anemia
70. D
71. D
• Patient is dehydrated due to repetitive vomiting leading to relative polycythemia
72. B
• Alpha chains are unaffected
73. A
74. D
• Electrophoretic measurement of HbS can differentiate the trait from disease as the
disease shows a much higher level
75. B
76. C
• The case shows a MILD case of anemia with Hb with affected beta chains which is
congruent with a case of HETEROZYGOUS (minor) beta thalassemia
77. D
78. B
79. D
• Serum haptoglobin should be decreased not increased
80. A
• AQUIRED cases of anemia are almost always due to extra-corpuscular (OUTSIDE of the
blood cell) factors
81. A
82. C
83. C
84. A
• G6PD is a sex-linked disease
85. B
86. C
• HbS tends to precipitate in dithionite, not solubilize
87. C
88. D
• There is usually no reticulycytosis in pernicious anemia
89. D
• By characteristic of negative feedback mechanisms of the body, hormones which increase
production of cells should decrease once said cells are increased (as in the case of
polycythemia). Hence, erythropoietin should be decreased while cell populations are
increased.
90. D
91. C
92. C
93. D
• Erythropoietin should be increased as the need for O2 increases
94. C
• 2,3-BPG binds to Hb to release oxygen
95. A
96. B
• Schistocytes are RBC fragments left after RBC destruction
97. C
98. C
99. B
• An equal number of macrocytes and microcytes means that when averaged, the MCV
would be relatively normal; however, extreme anisocytosis (difference of shape of RBCs)
should show a marked increase in RDW
100. A
101. C
102. A
103. A
104. C
• Lysosomes and acid hydrolases should increase
105. C
106. B
• Tear drop cells with leukoerthrocytosis is characteristic of idiopathic
myelofibrosis
107. D
• Waldenstrom disease involves an over-production of IgM which is the biggest
antibody, consequently increasing blood viscosity
108. A
109. D
• Reed-Sternberg cells are characteristic to Hodgkin disease.
110. B
111. C
112. D
113. C
• Multiple myeloma shows the presence Bence jones proteins in urine. Bence jones
proteins are composed of IgG light chains
114. C
• Plasma cells (which are affected in multiple myeloma) arise from the LYMPHOID
lineage not the myelogenous lineage
115. B
116. B
• B refers to the FAB system
117. A
• Leukocytosis is common to both CML and leukemoid reaction.
118. D
119. D
120. C
121. D
122. B
123. D
124. A
125. A
126. C
127. C
• The later the stage, the worse the prognosis
128. B
129. A
130. B
131. C
132. C
• Following the negative feedback mechanism, erythropoietin should be decreased
133. D
134. C
135. C
136. A
137. C
• HbD and HbG co-migrate with HbS
138. C
139. A
140. C
141. C
142. C
143. C
144. B
145. B
• Use the rule of 3.
146. A
• Hereditary spherocytosis shows a TRUE elevation of MCHC
147. C
148. D
149. A
150. A
151. B
152. A
153. A
154. A
155. B
156. D
157. A
158. B
159. A
160. C
161. B
162. D
163. A
164. D
165. A
166. B
167. D
168. C
169. B
170. B
• Basophils membrane receptors bind to IgE, not IgG
171. B
172. A
173. A
174. B
175. A
• “A” describes the job of eosinophils, not neutrophils
176. C
177. B
178. D
• The abnormal platelet aggregation response to ristocetin is characteristic to both
Bernard-Soulier syndrome and von Willerbrand disease. However, BSS does not
exhibit the thrombocytopenia presented in the case; therefore, vWD is the
condition involved.
179. D
180. D
181. C
182. B
183. A
184. B
185. C
186. D
187. C
188. D
189. A
190. C
191. C
192. C
193. B
194. B
195. C
• “C” describes HBs Disease
196. D
197. B
198. C
199. B
200. B