Question 1

Which of the following would be a valid indication for performing a bone marrow aspiration?&#10;A)iron deficiency&#10;B)folate deficiency&#10;C)unexpected pancytopenia&#10;D)leukocytosis from a severe infection

Accepted Answer

An unexpected pancytopenia is a valid reason for performing a bone marrow aspiration so that the cause of the pancytopenia can be determined.Iron deficiency,folate deficiency,and leukocytosis from a severe infection can all be evaluated and diagnosed from tests performed on peripheral blood (and perhaps other tissues and/or fluids such as urine in a urinary tract infection).

Question 2

The sites of active red marrow differ for adults and young children.Which one site is active in children but not in adults?&#10;A)proximal end of the long bones&#10;B)skull&#10;C)distal ends of the long bones&#10;D)pelvis

Accepted Answer

Red marrow is found in all the bones in children,including the distal ends of the long bones.It also initially has no fat.As the child grows and the bones lengthen and enlarge,all the available marrow space is no longer needed for blood cell production.The marrow space no longer needed becomes inactive and fatty ("yellow marrow").It can be converted to active marrow if the demand for blood cells becomes excessive.Red marrow in an adult is composed of both blood-producing cells and fat in a roughly 1:1 ratio.

Question 3

A cell is described as having an eccentric,heavily stained (condensed chromatin)nucleus with blue cytoplasm.A pale perinuclear Golgi complex is noted next to the nucleus.What is this cell?&#10;A)myelocyte&#10;B)plasma cell&#10;C)lymphocyte&#10;D)myeloblast

Accepted Answer

The description fits that of a plasma cell.These are fully differentiated B cells,whose function is to make and secrete specific immunoglobulin (antibody).Because the cytoplasm is rich in ribonucleic acid (RNA)needed for this synthesis,the cytoplasm often stains a brilliant blue.

Question 4

Low power (*10)is used to count and evaluate which of the following?&#10;A)immature neutrophils&#10;B)megakaryocytes&#10;C)nucleated red cells&#10;D)plasma cells

Accepted Answer

Megakaryocytes are the largest cell in the bone marrow,and they are easily seen and counted under *10.

Question 5

For which of the following is obtaining a bone marrow core biopsy mandatory?&#10;A)Anemia is suspected.&#10;B)Leukemia is suspected.&#10;C)Megakaryocyte disorders are suspected.&#10;D)Aspirate is a dry tap.

Accepted Answer

When the aspirate is a dry tap,it is imperative that a bone marrow biopsy be obtained.This gives the hematologist and/or pathologist a way of assessing the bone marrow in the absence of an aspirate (dry tap).If the aspirate is a dry tap,then something significant is present in the marrow and the biopsy will help determine the cause.

Question 6

What type of preparation is preferred for bone marrow aspirates?&#10;A)coverslip smears from a bone marrow fragment called a spicule&#10;B)wedge smears made from the blood surrounding marrow fragments&#10;C)touch preps from rolling the biopsy on a glass slide&#10;D)smears of the biopsy made with an automated slide maker

Accepted Answer

Coverslip smears from a bone marrow spicule are the preferred type of preparation for bone marrow aspirates.The advantage to them over slides is that less trauma occurs to the cells because they weigh so much less (relatively speaking).If done correctly,a good monolayer of cells in the marrow can be stained and then evaluated.

Question 7

The myeloid-to-erythroid (M:E)ratio of a bone marrow in a 35-year-old male is 1:1.Select the correct interpretation.&#10;A)normal&#10;B)abnormal, more fat cells than normal&#10;C)abnormal, more white cell precursors than normal&#10;D)abnormal, more red cell precursors than normal

Accepted Answer

The normal M:E ratio of bone marrow is 1.5:1 to 3.3:1.A ratio of 1:1 is therefore decreased,meaning that either the number of red cell precursors has increased or the number of white cell precursors has decreased.The fat-to-cell ratio assesses the overall cellularity of the marrow and should be roughly 1:1.

Question 8

A bone marrow aspirate shows copious blue granules with the Prussian blue stain.Select the correct interpretation.&#10;A)iron overload&#10;B)iron deficiency&#10;C)tumor cells present&#10;D)megakaryocytes increased

Accepted Answer

The Prussian blue stain is an iron-specific stain (nonheme iron).When iron is in the storage form of hemosiderin,it stains blue.If copious granules are visible,it suggests iron overload.The granules must be found in macrophage cytoplasm to rule out possible contamination of the slide or stain with iron.

Question 9

What bone marrow sample is best to determine fat-to-cell ratio and overall cellularity,as well as for searching for malignant cells?&#10;A)core biopsy&#10;B)aspirate smears&#10;C)peripheral blood&#10;D)Prussian blue stain

Accepted Answer

The core biopsy is the best sample for determining overall cellularity and fat-to-cell ratio and searching for malignant cells.It provides an intact portion of the bone marrow.

Question 10

Osteoblasts can be easily confused with&#10;A)megakaryocytes.&#10;B)osteoclasts.&#10;C)plasma cells.&#10;D)macrophages.

Accepted Answer

Osteoblasts can be easily confused with plasma cells.They have an eccentric nucleus and blue cytoplasm;however,they do not have a well-defined Golgi complex (area of "hof").Osteoblasts tend to be found in clusters,which is not true of normal plasma cells.

Question 11

The best use for bone marrow aspirate smears is&#10;A)counting the differential.&#10;B)determining overall cellularity.&#10;C)estimating fat-to-cell ratio.&#10;D)evaluating for focal lesions such as lymphoma.

Accepted Answer

The answer of The best use for bone marrow aspirate...

Question 12

Which of the following is least helpful in evaluating bone marrow findings?&#10;A)differential performed on the aspirate&#10;B)clinical findings&#10;C)laboratory data from chemistry, immunology, and microbiology&#10;D)examination of peripheral blood

Accepted Answer

The answer of Which of the following is least helpful...

Question 13

What stain is most commonly used for bone marrow aspirates?&#10;A)Prussian blue&#10;B)new methylene blue&#10;C)hematoxylin and eosin (H&E)&#10;D)Wright

Accepted Answer

The answer of What stain is most commonly used for...

Question 14

What is the most common site for bone marrow aspiration in an adult?&#10;A)sternum&#10;B)posterior iliac crest&#10;C)tibia&#10;D)ribs

Accepted Answer

The answer of What is the most common site for...

Question 15

Which of the following cell types tend to be found in molded clusters in the bone marrow?&#10;A)megakaryocytes&#10;B)malignant cells&#10;C)immature granulocytes&#10;D)monocytes

Accepted Answer

The answer of Which of the following cell types tend...

Deck 17: Bone Marrow Examination