Hematopathology Practice Questions

Q: Which of the following is not associated with the disorder characterized by findings on a peripheral blood smear?

Predisposition to malaria. ***Predisposition to malaria*** - Sickle cell disease/trait actually provides **protection against malaria**, not predisposition, due to the **hostile environment** for Plasmodium parasites in sickled red blood cells. - This protective effect is an evolutionary advantage in **malaria-endemic regions**, explaining the high prevalence of sickle cell trait in these areas. *Hand-foot syndrome* - Also known as **dactylitis**, this is a common complication of sickle cell disease caused by **vaso-occlusive crises** in small bones. - Results in painful swelling of hands and feet, particularly common in **infants and young children** with sickle cell disease. *Acute chest syndrome* - A serious complication of sickle cell disease involving **pulmonary vaso-occlusion**, infection, or fat embolism. - Presents with chest pain, fever, and **pulmonary infiltrates** on chest X-ray, requiring immediate medical attention. *Predisposition to Salmonella osteomyelitis* - Occurs due to **functional asplenia** from repeated splenic infarctions in sickle cell disease patients. - **Salmonella** species have particular tropism for infarcted bone tissue, making osteomyelitis more common than **Staphylococcus aureus** in these patients.

Q: Stored blood, which has been preserved in a blood bank, is deficient in which of the following coagulation factors?

V and VIII. **Explanation:** The correct answer is **V and VIII** because these are known as **labile coagulation factors**. In blood bank storage (typically at 1–6°C in CPDA-1), the activity of most coagulation factors remains relatively stable. However, Factors V and VIII are highly sensitive to temperature and storage time. Their activity begins to decline significantly within 24–48 hours of collection. By the time a unit of whole blood reaches its expiration (35–42 days), these factors are virtually absent. This is why patients requiring these specific factors (e.g., in Hemophilia A or massive transfusion) require **Fresh Frozen Plasma (FFP)** or **Cryoprecipitate**, where these factors are preserved by rapid freezing. **Analysis of Incorrect Options:** * **Option A & B (II and VII):** Factor II (Prothrombin) and Factor VII are **stable factors** [1]. They maintain adequate activity levels throughout the shelf-life of stored blood. * **Option D (IX and X):** These are also stable factors. Along with Factors II and VII, they are Vitamin K-dependent and do not degrade significantly during standard refrigerated storage [2]. **NEET-PG High-Yield Pearls:** 1. **Massive Transfusion Complication:** Transfusing large volumes of stored blood (which lacks V and VIII) can lead to **dilutional coagulopathy**. 2. **Storage Lesion:** This term refers to the biochemical and morphological changes in stored blood, including decreased 2,3-DPG (shifting the oxygen dissociation curve to the left), decreased pH, and increased potassium. 3. **Factor VIII Source:** Cryoprecipitate is the richest source of Factor VIII, Fibrinogen, and von Willebrand Factor (vWF). **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Blood And Bone Marrow Disease, pp. 582-583. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Blood And Bone Marrow Disease, pp. 624-625.

Q: A 72-year-old female presents with complaints of generalized lymphadenopathy and a total WBC count of 80,000. Flow cytometry revealed CD19+, CD20+, CD5+, CD23-. Cyclin D1 is positive. Which of the following genetic abnormalities is expected in this condition?

t(11;14). ### Explanation The clinical presentation and immunophenotype point toward a diagnosis of **Mantle Cell Lymphoma (MCL)**. **1. Why t(11;14) is correct:** The key diagnostic markers in this case are **CD5+**, **CD23-**, and **Cyclin D1 positivity** [1]. While both Chronic Lymphocytic Leukemia (CLL) and MCL are CD5+ B-cell neoplasms, MCL is characteristically CD23 negative and expresses Cyclin D1 [1]. The genetic hallmark of MCL is **t(11;14)(q13;q32)**. This translocation involves the *CCND1* gene (Cyclin D1) on chromosome 11 and the *IGH* gene (Immunoglobulin Heavy chain) on chromosome 14. This leads to the overexpression of Cyclin D1, which promotes cell cycle progression from G1 to S phase. **2. Why the other options are incorrect:** * **t(8;21):** Associated with **Acute Myeloid Leukemia (AML-M2)**; it involves the *RUNX1-RUNX1T1* fusion. * **13q deletion:** The most common cytogenetic abnormality in **CLL/SLL**. CLL is typically CD5+ but, unlike this case, it is **CD23+** and Cyclin D1 negative [1]. * **t(11;18):** Associated with **MALT lymphoma** (Marginal Zone Lymphoma); it involves the *BIRC3-MALT1* fusion. **3. High-Yield Clinical Pearls for NEET-PG:** * **Mantle Cell Lymphoma:** Typically presents in elderly males with lymphadenopathy and often involves the GI tract (Lymphomatous polyposis). * **Immunophenotype Triad:** CD5+, CD23 negative, and FMC7+. * **Cyclin D1:** Overexpression is the "gold standard" for diagnosis; if Cyclin D1 is negative, **SOX11** is used as a highly specific alternative marker [1]. * **CLL vs. MCL:** Always check CD23. **CLL = CD23+**; **MCL = CD23-** [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of White Blood Cells, Lymph Nodes, Spleen, and Thymus, pp. 610-612.

Question 1

A blood smear is best visualized at which pH?

Accepted Answer

6.8

Answer

7.2

Answer

6.6

Answer

7

Question 2

Which of the following is not associated with the disorder characterized by findings on a peripheral blood smear?

Accepted Answer

Predisposition to malaria

Answer

Hand-foot syndrome

Answer

Acute chest syndrome

Answer

Predisposition to Salmonella osteomyelitis

Question 3

Estimation of the degradation products of the cross-linked fibrin fibers in DIC can best, specifically, and accurately be done by which of the following tests?

Accepted Answer

D-dimer assay

Answer

Fibrinopeptide assay

Answer

Euglobin lysis test

Answer

Coombs test

Question 4

Which of the following statements regarding megaloblastic anemia is true?

Accepted Answer

Serum lactate dehydrogenase (LDH) is increased.

Answer

Megaloblastic precursors are present in the bone marrow.

Answer

Mean corpuscular volume is increased.

Answer

Thrombocytosis occurs.

Question 5

Stored blood, which has been preserved in a blood bank, is deficient in which of the following coagulation factors?

Accepted Answer

V and VIII

Answer

II only

Answer

II and VII

Answer

IX and X

Question 6

A 62-year-old man develops itchy, scaling, and non-scaling patches and plaques over his chest and back. The rest of the examination is normal, except for lymphadenopathy. Blood film and skin biopsy histology both reveal unusually large monocytoid cells. Which of the following is the most likely diagnosis?

Accepted Answer

Primary cutaneous T-cell lymphoma

Answer

Leukemia

Answer

Visceral B-cell lymphoma

Answer

Viral infection (usually Epstein-Barr)

Question 7

Which of the following conditions is LEAST likely to be accompanied by lymphocytosis in the peripheral blood?

Accepted Answer

Bacterial infection

Answer

Viral infection

Answer

Fungal infection

Answer

Protozoal infection

Question 8

Which of the following subtypes of Acute Myeloid Leukemia (AML) is characterized by gum hyperplasia, bleeding, and visceral infiltration?

Accepted Answer

Monocytic

Answer

Promyelocytic

Answer

Megakaryocytic

Answer

Erythrocytic

Question 9

A localized presentation of Non-Hodgkin Lymphoma (NHL) is typically associated with which histological subtype?

Accepted Answer

Nodular well differentiated

Answer

Nodular poorly differentiated

Answer

Diffuse

Answer

None of the above

Question 10

A 72-year-old female presents with complaints of generalized lymphadenopathy and a total WBC count of 80,000. Flow cytometry revealed CD19+, CD20+, CD5+, CD23-. Cyclin D1 is positive. Which of the following genetic abnormalities is expected in this condition?

Accepted Answer

t(11;14)

Answer

t(8;21)

Answer

13q deletion

Answer

t(11;18)

Hematopathology — MCQs

Hematopathology — MCQs

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