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Physician Board Certification

ABIM Hematology Initial Certification Examination Practice Test

Hematology board preparation requires interpreting blood counts, peripheral smears, coagulation studies, marrow findings, and molecular results in clinical context. The available practice cases involve decisions across malignant and nonmalignant disorders, including thrombotic microangiopathy, anticoagulation, bleeding disorders, acute leukemia, lymphoma, and myeloproliferative neoplasms.

Exam overview

Exam providerAmerican Board of Internal Medicine
Exam codeNot listed
CategoryPhysician Board Certification

About the ABIM Hematology Initial Certification Examination Exam

Questions emphasize linking laboratory patterns to diagnoses and acting on time-sensitive complications. You may need to distinguish an inhibitor from a clotting-factor deficiency using mixing studies, recognize thrombotic thrombocytopenic purpura from hemolysis and thrombocytopenia, or select rapid reversal for life-threatening warfarin-associated bleeding. Other clinical tasks include managing tumor-related thrombosis, deciding when platelet transfusion is appropriate, reducing leukostasis risk in acute myeloid leukemia, and interpreting marrow morphology alongside BCR::ABL1 and mutation testing. Lymphoma scenarios can require recognizing suspected histologic transformation and choosing a diagnostic biopsy strategy. These cases exercise differential diagnosis, interpretation of specialized hematology testing, and treatment selection based on bleeding risk, urgency, and disease context.

Sample Practice Questions

Review a selection from this exam's published US Practice Tests practice bank.

Question 1

A 69-year-old woman with newly diagnosed follicular lymphoma has progressive abdominal discomfort. Imaging shows a rapidly enlarging retroperitoneal node, and an FDG PET scan shows substantially higher uptake in that node than in her other sites. Which diagnostic step is most useful before selecting treatment?

  1. ABiopsy the most metabolically active accessible lesion
  2. BRepeat peripheral-blood flow cytometry only
  3. CBegin treatment without tissue reassessment
  4. DMeasure serum beta-2 microglobulin and use it to establish transformation
Show answerCorrect answer: A

Rapid focal growth and marked metabolic heterogeneity in indolent lymphoma raise concern for histologic transformation. Biopsy of the most suspicious lesion is needed to establish the histology, because treatment choices differ substantially. PET findings can help identify a biopsy target but do not themselves diagnose transformation.

Question 2

A 28-year-old man with severe hemophilia A is scheduled for an elective dental extraction. He has no history of inhibitors and has access to recombinant factor VIII. Which peri-procedural strategy is most appropriate?

  1. AProvide factor VIII replacement to achieve adequate hemostatic coverage for the procedure
  2. BGive vitamin K before the procedure
  3. CTransfuse platelets immediately before the procedure
  4. DUse desmopressin as the only treatment regardless of hemophilia severity
Show answerCorrect answer: A

Hemophilia A results from factor VIII deficiency. For an invasive procedure in a patient with severe disease, factor VIII replacement is used to provide procedural hemostatic coverage, with the target and duration tailored to the procedure and clinical context. Desmopressin may help some patients with mild hemophilia A but is not a substitute for factor replacement in severe disease.

Question 3

A 37-year-old man has schistocytes, thrombocytopenia, elevated indirect bilirubin, and normal coagulation studies. He develops confusion and has no evidence of kidney failure. What is the most appropriate immediate treatment for suspected thrombotic thrombocytopenic purpura?

  1. AUrgent plasma exchange and corticosteroids
  2. BPlatelet transfusion as sole therapy
  3. CVitamin K and fresh frozen plasma only
  4. DObservation while awaiting ADAMTS13 results
Show answerCorrect answer: A

Thrombotic thrombocytopenic purpura is a medical emergency characterized by thrombotic microangiopathy and often severe ADAMTS13 deficiency. Start urgent plasma exchange and immunosuppression when suspected rather than waiting for confirmatory testing. Platelet transfusion is generally avoided unless there is life-threatening bleeding or an urgent procedure.

Question 4

A 62-year-old woman with a mechanical mitral valve takes warfarin. She presents with a spontaneous intracranial hemorrhage and an international normalized ratio of 5.8. Which approach best provides rapid reversal of anticoagulation?

  1. AHold warfarin and observe without reversal
  2. BGive intravenous vitamin K and four-factor prothrombin complex concentrate
  3. CGive protamine sulfate and fresh frozen plasma
  4. DGive oral vitamin K alone and repeat the INR the next day
Show answerCorrect answer: B

Life-threatening bleeding during warfarin therapy requires rapid reversal. Four-factor prothrombin complex concentrate promptly replaces vitamin K–dependent clotting factors, while intravenous vitamin K supports sustained reversal. The presence of a mechanical valve does not outweigh the need to treat an acute intracranial hemorrhage.

Question 5

A 35-year-old woman has recurrent unprovoked deep-vein thromboses and persistent isolated prolongation of the activated partial thromboplastin time. The mixing study does not correct the prolongation. Which explanation best reconciles these findings?

  1. AA factor VIII inhibitor causing a bleeding tendency
  2. BLupus anticoagulant associated with antiphospholipid syndrome
  3. CSevere factor IX deficiency
  4. DVitamin K deficiency
Show answerCorrect answer: B

A lupus anticoagulant can prolong phospholipid-dependent clotting assays in vitro while being associated clinically with thrombosis. A noncorrecting mixing study supports an inhibitor rather than a simple coagulation-factor deficiency; persistent antiphospholipid antibodies in the appropriate clinical setting support antiphospholipid syndrome.

Question 6

A 56-year-old man has a prolonged activated partial thromboplastin time discovered before surgery. He has no personal or family history of abnormal bleeding. A mixing study corrects the aPTT, and factor assays show factor XII activity below 1% with normal factor VIII, IX, and XI activity. Which interpretation is most appropriate?

  1. AThis deficiency usually causes severe spontaneous bleeding
  2. BThe result may prolong laboratory clotting tests without causing a clinical bleeding tendency
  3. CThe result establishes acquired von Willebrand syndrome
  4. DThe result indicates a factor VIII inhibitor despite correction on mixing
Show answerCorrect answer: B

Factor XII deficiency can markedly prolong the aPTT but is not generally associated with a clinical bleeding tendency. Correction on mixing supports a factor deficiency rather than an inhibitor. The laboratory abnormality alone should not be mistaken for a bleeding disorder requiring factor replacement.

Question 7

A 61-year-old man with metastatic prostate cancer has a new proximal deep-vein thrombosis. He has no active bleeding, severe thrombocytopenia, or major drug interactions. Which approach is generally appropriate for anticoagulation?

  1. AUse a direct oral anticoagulant or low-molecular-weight heparin after assessing bleeding risk and interactions
  2. BWithhold anticoagulation because the thrombosis is cancer-associated
  3. CUse aspirin alone for treatment
  4. DPlace an inferior vena cava filter as first-line therapy
Show answerCorrect answer: A

Cancer-associated venous thromboembolism should generally be treated with therapeutic anticoagulation. A direct oral anticoagulant or low-molecular-weight heparin is commonly appropriate, with selection guided by bleeding risk, tumor site, renal function, drug interactions, and patient factors. An IVC filter is reserved for selected situations, such as a contraindication to anticoagulation.

How to use this practice test

Access the free practice bank for a session of up to 20 randomly selected questions from the 50 published items. Work through each clinical vignette before checking the results shown after the session, then use missed or uncertain answers to identify specific gaps in diagnostic reasoning and management.

Preparation tips

  • For prolonged aPTT cases, interpret the mixing-study response alongside bleeding history and factor assays; distinguish factor deficiency from an inhibitor or lupus anticoagulant.
  • Practice recognizing microangiopathic hemolytic anemia from smear and hemolysis findings, and identify suspected TTP as an urgent treatment decision.
  • Compare platelet transfusion decisions by platelet count, active bleeding, fever, and planned procedures rather than count alone.
  • Review emergency anticoagulation reversal and cancer-associated thrombosis choices, including how bleeding severity and clinical setting shape management.
  • Connect marrow morphology and molecular findings when distinguishing essential thrombocythemia and evaluating suspected lymphoma transformation.
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