Hematopathology Practice Questions

Q: The histological feature shown is seen in which of the following conditions?

Burkitt’s lymphoma. ***Burkitt's lymphoma*** - The **"starry sky" pattern** is pathognomonic for Burkitt's lymphoma, characterized by **tingible body macrophages** scattered among sheets of **monomorphic lymphoid cells**. - This high-grade B-cell lymphoma shows **rapid cell turnover** with macrophages phagocytosing apoptotic debris, creating the distinctive starry appearance. *Hodgkin's lymphoma* - Distinguished by the presence of **Reed-Sternberg cells** (large, multinucleated giant cells) which are absent in the starry sky pattern. - Shows **mixed inflammatory infiltrate** including eosinophils, plasma cells, and lymphocytes, not the monomorphic appearance of Burkitt's. *Non-Hodgkin's lymphoma* - This is a **broad category** that technically includes Burkitt's lymphoma, but the starry sky pattern is **specific to Burkitt's** subtype. - Other NHL subtypes like **follicular lymphoma** or **DLBCL** have different histological patterns without the characteristic starry sky appearance. *All of the above* - Incorrect because the **starry sky pattern** is **pathognomonic specifically for Burkitt's lymphoma**. - While Burkitt's is technically a type of NHL, the distinctive histological feature shown is **not seen** in Hodgkin's lymphoma or other NHL subtypes.

Q: All are true about hemolytic disease of the newborn except?

Anti-Rh agglutinins are of IgM type. **Explanation:** Hemolytic Disease of the Newborn (HDN), or **Erythroblastosis Fetalis**, occurs due to Rh-incompatibility between an Rh-negative mother and an Rh-positive fetus. **Why Option D is the correct answer (the "Except" statement):** The hallmark of HDN is the placental transfer of maternal antibodies. **IgM antibodies** are pentameric and large, making them **incapable of crossing the placenta**. In HDN, the mother’s immune system produces **IgG type anti-Rh agglutinins** (specifically anti-D) following sensitization. IgG is monomeric and can cross the placental barrier to attack fetal RBCs. Therefore, stating they are IgM is incorrect. **Analysis of other options:** * **A. Hemolytic anemia:** This is the primary pathology. Maternal IgG coats fetal RBCs, leading to their destruction (hemolysis) in the fetal spleen. * **B. Hydrops fetalis:** Severe hemolysis leads to profound anemia, which causes high-output cardiac failure, generalized edema (anasarca), and ascites. This is the most severe form of the disease. * **C. Kernicterus:** Rapid hemolysis produces high levels of unconjugated bilirubin. In neonates, the blood-brain barrier is immature, allowing bilirubin to deposit in the basal ganglia, leading to permanent neurological damage known as kernicterus. **High-Yield NEET-PG Pearls:** * **Sensitization:** Usually occurs during the first delivery; hence, the first child is typically unaffected, but subsequent Rh+ pregnancies are at risk. * **Prophylaxis:** Administer **Anti-D (RhoGAM)** to Rh-negative mothers at 28 weeks gestation and within 72 hours of delivery to neutralize fetal Rh+ cells before the mother’s immune system reacts. * **Diagnosis:** **Direct Coombs Test** is used on the newborn’s cord blood to detect antibodies bound to RBCs.

Q: Low LAP score may be seen in the following EXCEPT:

Polycythemia vera. **Explanation:** The **Leukocyte Alkaline Phosphatase (LAP) score** (also known as the Neutrophil Alkaline Phosphatase/NAP score) measures the activity of the enzyme alkaline phosphatase within the secondary granules of mature neutrophils. This score is a classic diagnostic tool used to differentiate between a **Leukemoid Reaction** (high score) and **Chronic Myeloid Leukemia** (low score). **Why Polycythemia Vera is the correct answer:** In **Polycythemia Vera (PV)**, which is a myeloproliferative neoplasm (MPN), there is typically an **increased LAP score**. The question asks for the condition where a low LAP score is *not* seen (the "EXCEPT"). Since PV is associated with an elevated score, it is the correct choice [1]. **Analysis of Incorrect Options (Conditions with Low LAP Score):** * **CML (Chronic Myeloid Leukemia):** This is the classic cause of a **low LAP score** due to the presence of functionally immature neutrophils that lack the enzyme [1]. * **Paroxysmal Nocturnal Hemoglobinuria (PNH):** This is a stem cell disorder where the GPI-anchor is missing. Since LAP is a GPI-anchored protein, its expression is significantly **decreased**. * **Autoimmune Hemolytic Anemia (AIHA):** While not a primary diagnostic marker for AIHA, certain types of anemia and marrow stress can result in a **low LAP score**. **High-Yield Clinical Pearls for NEET-PG:** * **High LAP Score:** Leukemoid reaction, Pregnancy (3rd trimester), Polycythemia Vera, and Down Syndrome [1]. * **Low LAP Score:** CML, PNH, Hypophosphatasia, and Aplastic Anemia [1]. * **Normal Range:** 40–100. * **Modern Shift:** In clinical practice, the LAP score has largely been replaced by cytogenetics (Philadelphia chromosome) and molecular testing (BCR-ABL1) for CML diagnosis [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. 624-627.

Question 1

Which of the following is NOT an autosomal recessive coagulopathy?

Accepted Answer

Von Willebrand disease

Answer

Bernard-Soulier syndrome

Answer

Glanzmann thrombasthenia

Answer

Afibrinogenemia

Question 2

A 59-year-old male presents with multiple neck swellings, fever, and weight loss for 6 months. He has a history of hypertension managed with medication. General examination reveals painless lymphadenopathy in the neck, and blood investigations show anemia. Lymph node biopsy reveals cells with a delicate multilobed, 'popped corn' nucleus. Which variant of lymphoma is this?

Accepted Answer

Lymphocyte predominant

Answer

Nodular sclerosis

Answer

Lymphocyte rich

Answer

Lymphocyte depletion

Question 3

What is the most severe form of hereditary spherocytosis caused by the mutation of?

Accepted Answer

Alpha spectrin

Answer

Ankyrin

Answer

Beta spectrin

Answer

Band 3

Question 4

An infant presents with mild anemia, jaundice, and splenomegaly. A complete blood count with differential reveals spherocytosis, and the reticulocyte count is elevated. The parents state that several relatives have also suffered from a similar illness. The infant's condition is most likely caused by a defect in which of the following?

Accepted Answer

Spectrin

Answer

Clathrin

Answer

Connexon

Answer

Dynein

Question 5

The quantity of globin chain synthesis is reduced in which of the following conditions?

Accepted Answer

Thalassemia

Answer

Hemoglobin S (HbS)

Answer

Hemoglobin C (HbC)

Answer

Hemoglobin F (HbF)

Question 6

The histological feature shown is seen in which of the following conditions?

Accepted Answer

Burkitt’s lymphoma

Answer

Hodgkin’s lymphoma

Answer

Non-Hodgkin’s lymphoma

Answer

All of the above

Question 7

Which of the following statements regarding leukemias is true?

Accepted Answer

Acute lymphoid leukemia in individuals less than 1 year old has a poor prognosis.

Answer

Acute lymphoid leukemia commonly occurs beyond 50 years of age.

Answer

Hairy cell leukemia in individuals less than 50 years old has a good prognosis.

Answer

Chronic lymphocytic leukemia commonly occurs in individuals less than 50 years of age.

Question 8

All are true about hemolytic disease of the newborn except?

Accepted Answer

Anti-Rh agglutinins are of IgM type

Answer

Hemolytic anemia

Answer

Hydrops fetalis

Answer

Kernicterus

Question 9

Low LAP score may be seen in the following EXCEPT:

Accepted Answer

Polycythemia vera

Answer

CML

Answer

Paroxysmal nocturnal hemoglobinuria

Answer

Autoimmune hemolytic anemia

Question 10

Which of the following toxic states is not associated with anemia?

Accepted Answer

Listerosis

Answer

Clostridial sepsis

Answer

Snake venom

Answer

Lead poisoning

Hematopathology — MCQs

Hematopathology — MCQs

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