Hematopathology Practice Questions

Q: Reticulocytes are stained by which of the following dyes?

Brilliant cresyl blue. **Explanation:** Reticulocytes are immature red blood cells that contain residual ribosomal RNA (rRNA). Because these cells lack a nucleus but still possess organelles, they cannot be identified using routine Romanowsky stains (like Leishman or Giemsa), which only show them as slightly larger, bluish cells (polychromasia). **1. Why Brilliant Cresyl Blue is correct:** To visualize the network of rRNA (the "reticulum"), **supravital staining** is required. This involves staining living cells before they are fixed. **Brilliant cresyl blue** (or New Methylene Blue) is a basic dye that reacts with the acidic rRNA, causing it to precipitate into a visible blue, granular filament or network. This allows for an accurate reticulocyte count, which is a key indicator of bone marrow erythropoietic activity. **2. Analysis of Incorrect Options:** * **Methyl violet:** Primarily used as a histological stain and for staining **Heinz bodies** (denatured hemoglobin) in G6PD deficiency [1]. * **Sudan black:** A lipid-soluble dye used to stain neutral triglycerides and lipids. In hematology, it is used to differentiate **Acute Myeloid Leukemia (AML)** from ALL by staining myeloblasts. * **Indigo carmine:** A dye used primarily in surgery and urology to highlight the urinary tract or to detect amniotic fluid leaks; it is not used for blood cell morphology. **Clinical Pearls for NEET-PG:** * **Supravital Stains:** Remember the mnemonic **"RNB"** (Reticulocytes, New Methylene Blue, Brilliant Cresyl Blue). * **Reticulocyte Count:** It is the best indicator of **effective erythropoiesis**. A high count is seen in hemolytic anemias, while a low count suggests bone marrow failure (e.g., Aplastic anemia). * **Heinz Bodies:** These also require supravital stains (like Crystal Violet) but appear as single coccoid granules at the cell periphery, unlike the network seen in reticulocytes [1].

Q: EBV positivity is higher in which type of Hodgkin lymphoma?

Mixed cellularity. **Explanation:** The association between **Epstein-Barr Virus (EBV)** and Hodgkin Lymphoma (HL) varies significantly across histological subtypes. EBV is found in the Reed-Sternberg (RS) cells, where it expresses LMP-1 (Latent Membrane Protein-1), mimicking CD40 signaling to promote B-cell survival. * **Mixed Cellularity (MC):** This subtype shows the strongest association with EBV in classical HL, with **75% to 85%** of cases being EBV-positive. It typically affects older patients or those in developing countries and is characterized by a polymorphic inflammatory infiltrate (eosinophils, plasma cells, histiocytes) [1]. * **Lymphocyte Depleted (LD):** This also has a very high association with EBV (approx. 90%), but it is the rarest subtype. In the context of standard NEET-PG questions, **Mixed Cellularity** is the classic answer for "highest association" among the common subtypes [1]. * **Nodular Sclerosis (NS):** This is the most common subtype overall (especially in young females). It has a relatively low EBV association (approx. 10-40%) [1]. * **Lymphocyte Rich (LR):** This subtype has an intermediate association (approx. 40%) and carries a very good prognosis [1]. * **Nodular Lymphocyte Predominant HL (NLPHL):** This is a non-classical HL and is almost **always EBV-negative**. **High-Yield Pearls for NEET-PG:** 1. **Most common subtype:** Nodular Sclerosis (characterized by Lacunar cells and collagen bands) [1]. 2. **Best prognosis:** Lymphocyte Rich (among classical) or NLPHL. 3. **Worst prognosis:** Lymphocyte Depleted. 4. **RS Cell Markers:** Classical HL is **CD15+, CD30+, and CD45–**. NLPHL is **CD20+ and CD45+** (Popcorn cells). **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. 616-618.

Question 1

Bone marrow biopsy is useful in the diagnosis of which of the following conditions?

Accepted Answer

Aleukemic Leukemia

Answer

Chronic Myeloid Leukemia (CML)

Answer

Acute Lymphoblastic Leukemia (ALL)

Answer

Hodgkin's disease

Question 2

Reticulocytes are stained by which of the following dyes?

Accepted Answer

Brilliant cresyl blue

Answer

Methyl violet

Answer

Sudan black

Answer

Indigo carmine

Question 3

EBV positivity is higher in which type of Hodgkin lymphoma?

Accepted Answer

Mixed cellularity

Answer

Nodular sclerosis

Answer

Lymphocyte depleted

Answer

Lymphocyte rich

Question 4

Primary hemostasis is disturbed in which of the following conditions?

Accepted Answer

Platelet disorder

Answer

Lupus anticoagulant

Answer

Hemophilia

Answer

Liver disease

Question 5

Spherocytosis of RBC is a common feature in which of the following conditions?

Accepted Answer

G6PD deficiency

Answer

Sickle cell anemia

Answer

CML

Answer

All of the above

Question 6

A 70-year-old male has a pathologic fracture of the femur. X-rays show a lytic lesion with a circumscribed, punched-out appearance. Curettage from the fracture site is most likely to show which of the following?

Accepted Answer

Sheets of atypical plasma cells

Answer

Diminished and thinned trabecular bone

Answer

Metastatic prostatic adenocarcinoma

Answer

Malignant cells forming osteoid bone

Question 7

Mycosis cells are altered:

Accepted Answer

T Lymphocytes

Answer

Monocytes

Answer

B lymphocytes

Answer

Eosinophils

Question 8

Which of the following conditions is associated with an increased Erythrocyte Sedimentation Rate (ESR)?

Accepted Answer

Multiple myeloma

Answer

Sickle cell anemia

Answer

Polycythemia vera

Answer

Thalassemia

Question 9

The highest ESR is seen in which of the following conditions except?

Accepted Answer

Polycythemia rubra

Answer

Polymyositis rheumatica

Answer

Multiple myeloma

Answer

Temporal arteritis

Question 10

Which of the following statements are true about blood transfusion reactions?

Accepted Answer

Renal blood flow is decreased

Answer

Complement mediated severe hemolysis

Answer

Transfusion should not be stopped

Answer

Death is not seen

Hematopathology — MCQs

Hematopathology — MCQs

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