Bone Marrow Examination

Question 1

1. Where is most hematopoietic tissue found in adults?
   a. Liver
   b. Lungs
   c. Spleen
   d. Long bones

Answer 1

c. Spleen

Question 2

2. What is the preferred bone marrow collection site in adults?
   a. Second intercostal space on the sternum
   b. Anterior or posterior iliac crest
   c. Any of the thoracic vertebrae
   d. Anterior head of the femur

Answer 2

b. Anterior or posterior iliac crest

Question 3

3. The aspirate should be examined under low power to assess
   all of the following except:
   a. Cellularity
   b. Megakaryocyte numbers
   c. Morphology of abnormal cells
   d. Presence of tumor cell clusters

Answer 3

c. Morphology of abnormal cells

Question 4

4. What is the normal M:E ratio range in adults?
   a. 1.5:1 to 3.3:1
   b. 5.1:1 to 6.2:1
   c. 8.6:1 to 10.2:1
   d. 10:1 to 12:1

Answer 4

a. 1.5:1 to 3.3:1

Question 5

5. Which are the most common erythrocytic stages found in
   normal marrow?
   a. Pronormoblasts
   b. Pronormoblasts and basophilic normoblasts
   c. Basophilic and polychromatophilic normoblasts
   d. Polychromatophilic and orthochromic normoblasts

Answer 5

d. Polychromatophilic and orthochromic normoblasts

Question 6

6. What cells, occasionally seen in bone marrow biopsy specimens, are responsible for the formation of bone?
   a. Macrophages
   b. Plasma cells
   c. Osteoblasts
   d. Osteoclasts

Answer 6

c. Osteoblasts

Question 7

7. What is the largest hematopoietic cell found in a normal
   bone marrow aspirate?
   a. Osteoblast
   b. Myeloblast
   c. Pronormoblast
   d. Megakaryocyte

Answer 7

d. Megakaryocyte

Question 8

8. Which of the following is not an indication for a bone
   marrow examination?
   a. Pancytopenia (reduced numbers of RBCs, WBCs, and
   platelets in the peripheral blood)
   b. Anemia with RBC indices corresponding to low serum
   iron and low ferritin levels
   c. Detection of blasts in the peripheral blood
   d. Need for staging of Hodgkin lymphoma

Answer 8

b. Anemia with RBC indices corresponding to low serum
iron and low ferritin levels

Question 9

9. In a bone marrow biopsy specimen, the RBC precursors
   were estimated to account for 40% of the cells in the marrow, and the other 60% were granulocyte precursors. What
   is the M:E ratio?
   a. 4:6
   b. 1.5:1
   c. 1:1.5
   d. 3:1

Answer 9

b. 1.5:1

Question 10

10. On a bone marrow core biopsy sample, several large cells
    with multiple nuclei were noted. They were located close
    to the endosteum, and their nuclei were evenly spaced
    throughout the cell. What are these cells?
    a. Megakaryocytes
    b. Osteoclasts
    c. Adipocytes
    d. Fibroblasts

Answer 10

b. Osteoclasts

Question 11

11. The advantage of a core biopsy bone marrow sample over
    an aspirate is that the core biopsy specimen:
    a. Can be acquired by a less invasive collection technique
    b. Permits assessment of the architecture and cellular
    arrangement
    c. Retains the staining qualities of basophils owing to the
    use of Zenker fixative
    d. Is better for the assessment of bone marrow iron stores
    with Prussian blue stain

Answer 11

b. Permits assessment of the architecture and cellular
arrangement