Question 1

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

Low power magnification is typically used to count and evaluate megakaryocytes in bone marrow aspirates because they are large cells and can be easily identified at this magnification.

Question 2

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 3

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 most common site for bone marrow aspiration in an adult is the posterior iliac crest. This location is preferred because it contains a large amount of trabecular bone, which is less painful to aspirate from than the thicker, corticated bone found in other locations such as the sternum or tibia.

Question 4

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

Laboratory data from chemistry, immunology, and microbiology are less directly related to evaluating bone marrow findings compared to the other options, which are more directly involved in assessing bone marrow health and function.

Question 5

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

Malignant cells often form clusters in the bone marrow due to their uncontrolled proliferation and tendency to aggregate, which is a characteristic feature in various types of cancers.

Question 6

The myeloid-to-erythroid (M:E) ratio of a bone marrow 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 myeloid-to-erythroid (M:E) ratio of 1:1 indicates an abnormal increase in red cell precursors compared to myeloid (white cell) precursors, as the normal M:E ratio typically ranges from 2:1 to 4:1.

Question 7

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

Bone marrow aspirate smears are primarily used for counting the differential, which involves assessing the types and proportions of different blood cells present.

Question 8

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

Bone marrow aspiration is an important test that helps physicians diagnose hematological disorders. Unexpected pancytopenia, which is the simultaneous presence of low counts of all three blood cell types (white blood cells, red blood cells, and platelets), is a valid indication for performing a bone marrow aspiration. In such cases, bone marrow aspiration can help determine the underlying cause of pancytopenia by providing important diagnostic clues, such as abnormal cell morphology, increased or decreased cellularity, or infiltrative disorders such as leukemia or lymphoma. Iron deficiency and folate deficiency are diagnosed by measuring the levels of iron and folate in the blood, respectively. Leukocytosis from a severe infection is not an indication for bone marrow aspiration but may warrant further testing to determine the underlying cause.

Question 9

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

Wright stain is most commonly used for bone marrow aspirates because it effectively differentiates between the various cell types present in the marrow, allowing for detailed examination of blood cells.

Question 10

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 eccentric and heavily stained nucleus with blue cytoplasm are typical characteristics of a plasma cell, which is a type of antibody-producing cell derived from B lymphocytes. The pale perinuclear Golgi complex is also a distinctive feature of plasma cells. Myelocytes and myeloblasts are precursors of granulocytes and typically have a more centrally located nucleus. Lymphocytes do not have a perinuclear Golgi complex.

Question 11

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

The answer of What type of preparation is preferred for...

Question 12

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

The answer of The sites of active red marrow differ...

Question 13

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 answer of A bone marrow aspirate shows copious blue...

Question 14

Osteoblasts can be easily confused with:&#10;A) Megakaryocytes&#10;B) Osteoclasts&#10;C) Plasma cells&#10;D) Macrophages

Accepted Answer

The answer of Osteoblasts can be easily confused with:&#10;A) Megakaryocytes&#10;B)...

Question 15

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 answer of What bone marrow sample is best to...

Deck 16: Bone Marrow Examination