ABPath Hematopathology Subspecialty Certification Examination Practice Test
Hematopathology focuses on diseases of blood, bone marrow, lymph nodes, and related tissues. Relevant diagnostic work includes classifying leukemias, lymphomas, myeloid neoplasms, and non-neoplastic blood disorders through morphology, immunophenotyping, cytogenetics, and molecular findings. This question bank includes examples involving marrow patterns, red-cell abnormalities, and lineage assignment.
Exam overview
About the ABPath Hematopathology Subspecialty Certification Examination Exam
Hematopathology diagnosis depends on integrating peripheral blood and tissue morphology with flow cytometry, immunohistochemistry, cytogenetic results, and molecular alterations. Questions may require distinguishing myeloid from lymphoid lineage, recognizing characteristic marrow architecture, or relating a mutation or fusion to a disease classification. Other sampled tasks include interpreting red-cell indices and membrane disorders, identifying abnormal mast-cell populations, and separating clonal neoplasms from reactive or infectious processes. These decisions reflect practical work such as selecting ancillary tests, reconciling discordant findings, and formulating a classification from limited specimens. The available practice bank also includes a small number of broader pathology examples, so not every question represents a hematopathology-specific diagnostic task.
Sample Practice Questions
Review a selection from this exam's published US Practice Tests practice bank.
A young child has a soft-tissue mass composed of small round blue cells. The tumor cells express CD99, and molecular testing identifies an EWSR1::FLI1 fusion. Which tumor is most likely?
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Correct answer: AEWSR1::FLI1 is the characteristic fusion in most Ewing sarcomas. CD99 is commonly expressed, although it is not specific and must be interpreted with morphology and molecular findings.
A patient with splenomegaly has circulating lymphocytes with abundant pale cytoplasm and irregular cytoplasmic projections. The cells are positive for CD103, CD25, and CD11c. Which diagnosis is most likely?
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Correct answer: AHairy cell leukemia typically involves blood, marrow, and spleen and often shows cells with cytoplasmic projections. The combined expression of CD103, CD25, and CD11c is a characteristic immunophenotypic pattern.
A bone marrow biopsy shows atypical megakaryocytic proliferation with bulbous, cloud-like nuclei and increased reticulin fibrosis. Which finding would most strongly support a diagnosis of primary myelofibrosis?
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Correct answer: APrimary myelofibrosis is commonly associated with mutations in JAK2, CALR, or MPL, which support a clonal myeloproliferative neoplasm in the appropriate morphologic and clinical context. Fibrosis alone is not sufficient for diagnosis.
In a patient with hereditary spherocytosis, which erythrocyte membrane protein abnormality is commonly involved?
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Correct answer: AHereditary spherocytosis commonly results from defects in vertical interactions anchoring the membrane skeleton to the lipid bilayer, including abnormalities of ankyrin, spectrin, band 3, or protein 4.2. Ankyrin is one of the commonly affected proteins.
A young adult has persistent thrombocytosis. Bone marrow shows increased large, mature megakaryocytes with deeply lobulated nuclei in loose clusters, without significant erythroid or granulocytic proliferation. Which diagnosis is most consistent with this marrow pattern?
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Correct answer: AEssential thrombocythemia typically shows predominant proliferation of large, mature megakaryocytes with hyperlobulated nuclei and relatively preserved erythropoiesis and granulopoiesis. Prefibrotic primary myelofibrosis more often has atypical megakaryocytes and increased granulopoiesis.
A patient with iron deficiency has a low mean corpuscular volume and an increased red-cell distribution width. Which peripheral blood finding is most likely?
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Correct answer: AIron deficiency commonly produces microcytic, hypochromic erythrocytes with variable cell size, reflected by increased red-cell distribution width. The other patterns suggest different disorders or are not the typical predominant finding.
A bone marrow biopsy shows increased mast cells, including multifocal aggregates of spindle-shaped cells. The mast cells aberrantly express CD25, and molecular testing detects KIT D816V. Which diagnosis is best supported?
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Correct answer: AMultifocal dense mast-cell aggregates, atypical spindle-shaped morphology, aberrant CD25 expression, and KIT D816V are characteristic findings supporting systemic mastocytosis.
How to use this practice test
Access is free. A practice session presents up to 20 random questions from the 50 published questions in this bank, with results shown after the session. Use the cases to check how well you connect morphology with immunophenotypic and molecular findings; revisit any missed distinctions, such as lineage markers or marrow patterns.
Preparation tips
- Compare marrow patterns in essential thrombocythemia and primary myelofibrosis, paying attention to megakaryocyte morphology, clustering, and reticulin fibrosis.
- Practice assigning acute leukemia lineage from flow cytometry, distinguishing cytoplasmic CD3 from myeloid and B-lineage markers.
- Review characteristic immunophenotypes and molecular findings for entities such as hairy cell leukemia and systemic mastocytosis, and note which findings support rather than independently establish a diagnosis.
- Connect red-cell indices and smear morphology with mechanisms such as iron deficiency and hereditary spherocytosis.