CHAPTER 17: 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