Hematopathology Practice Questions

Q: Which of the following is a pan B lymphocyte marker?

CD 19. **Explanation:** **1. Why CD19 is the Correct Answer:** CD19 is considered the most reliable **pan-B cell marker** because it is expressed throughout B-cell development, from the earliest pro-B cell stage until just before terminal differentiation into plasma cells [1]. It is a transmembrane glycoprotein that acts as a co-receptor for B-cell receptor (BCR) signaling. In clinical practice, CD19 (along with CD20) is used in flow cytometry to identify the B-cell lineage in leukemias and lymphomas [1]. **2. Analysis of Incorrect Options:** * **CD5:** This is primarily a **T-cell marker**. However, it is aberrantly expressed on B-cells in specific malignancies like **Chronic Lymphocytic Leukemia (CLL)** and **Mantle Cell Lymphoma (MCL)** [1]. * **CD10:** Also known as **CALLA** (Common Acute Lymphoblastic Leukemia Antigen). It is a marker for pre-B cells and germinal center B-cells [1]. It is not "pan-B" because it is lost as the B-cell matures. * **CD38:** This is a marker for **plasma cells** and activated lymphocytes. It is not specific to the entire B-cell lineage and is often used as a prognostic marker in CLL. **3. High-Yield Clinical Pearls for NEET-PG:** * **Pan-B Markers:** CD19, CD20, CD22, and PAX-5 (PAX-5 is the most specific B-cell lineage marker) [1]. * **Pan-T Markers:** CD2, CD3, CD5, CD7 [1]. * **Plasma Cell Markers:** CD138 (most specific), CD38. * **CD20 Note:** While CD20 is a pan-B marker, it is **not** expressed on pro-B cells or plasma cells; CD19 appears earlier in ontogeny [1]. * **Rituximab:** A monoclonal antibody used in treatment that targets **CD20**. **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, p. 598.

Q: What happens to hepcidin levels in Anemia of chronic disease?

Increases. **Explanation:** **1. Why the Correct Answer is Right:** In Anemia of Chronic Disease (ACD), the primary driver is chronic inflammation. [1] Inflammatory cytokines, most notably **Interleukin-6 (IL-6)**, stimulate the liver to increase the synthesis of **Hepcidin**, an acute-phase reactant. [1] Hepcidin acts as the "master regulator" of iron homeostasis. It binds to and triggers the degradation of **ferroportin**, the only known iron exporter on the surface of enterocytes and macrophages. [1] This leads to: * **Reduced intestinal iron absorption.** [1] * **Sequestration of iron** within the Reticuloendothelial System (macrophages). [1] Consequently, while total body iron stores are normal or high, the iron is "locked away" and unavailable for erythropoiesis, leading to anemia. **2. Why Incorrect Options are Wrong:** * **B (Decreases):** Hepcidin levels decrease in **Iron Deficiency Anemia (IDA)** and conditions with ineffective erythropoiesis (like Thalassemia) to maximize iron absorption. [1] In ACD, the inflammatory stimulus overrides the body's need for iron. * **C (Remains Normal):** A normal hepcidin level would not explain the characteristic finding of low serum iron despite high ferritin levels seen in ACD. **3. Clinical Pearls & High-Yield Facts for NEET-PG:** * **Diagnostic Triad of ACD:** Low serum iron, Low TIBC (Total Iron Binding Capacity), and **High/Normal Ferritin**. * **Hepcidin vs. Ferroportin:** Remember that Hepcidin is the "brake" on iron flow; more Hepcidin = less iron in the blood. [1] * **Morphology:** ACD is typically **normocytic normochromic**, but can become microcytic hypochromic in long-standing cases. * **Key Cytokine:** IL-6 is the specific inducer of Hepcidin in inflammatory states. [1] **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Red Blood Cell and Bleeding Disorders, pp. 658-662.

Q: Acute myeloid leukemia (AML) is characterized by which of the following findings?

Auer rods. **Explanation:** **Acute Myeloid Leukemia (AML)** is a clonal proliferation of myeloid precursors (blasts) in the bone marrow. The presence of **Auer rods** is a pathognomonic hallmark of AML [1]. These are needle-like, azurophilic cytoplasmic inclusions formed by the crystallization of fused primary granules (lysosomes) containing **myeloperoxidase (MPO)** [2]. They are most commonly seen in the M1, M2, M3 (APML), and M4 subtypes of the FAB classification. **Analysis of Incorrect Options:** * **A. Philadelphia chromosome [t(9;22)]:** This is the hallmark of **Chronic Myeloid Leukemia (CML)**, involving the *BCR-ABL1* fusion gene. While it can occur in some cases of B-ALL or AML (as a poor prognostic marker), it is not a defining characteristic of AML. * **C. Hemolytic anemia:** While AML patients present with anemia due to bone marrow infiltration (myelophthisis), it is typically **normocytic normochromic** and non-hemolytic. * **D. Dohle bodies:** These are light blue, peripheral cytoplasmic inclusions (remnants of rough endoplasmic reticulum) found in **neutrophils** during states of inflammation, infection, or burns (toxic changes), rather than in leukemic blasts. **High-Yield Clinical Pearls for NEET-PG:** * **M3 Subtype (APML):** Characterized by "faggot cells" (bundles of Auer rods) and a high risk of **DIC** due to the release of procoagulants [1]. * **Diagnosis:** According to WHO criteria, AML requires **≥20% blasts** in the peripheral blood or bone marrow. * **Cytochemistry:** AML blasts are typically **MPO positive** and Sudan Black B positive, helping differentiate them from ALL. **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, p. 620. [2] 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. 621-622.

Question 1

A biopsy of a nasopharyngeal mass in a 30-year-old man shows a plasma cell proliferation. Serum electrophoresis reveals a monoclonal IgG spike. Bone marrow examination does not show plasma cell proliferation, and skeletal x-rays are negative for lesions. What is the most likely diagnosis?

Accepted Answer

Plasmacytoma

Answer

Heavy chain disease

Answer

Monoclonal gammopathy of undetermined significance

Answer

Multiple myeloma

Question 2

Which of the following is a differentiating feature between Hodgkin's lymphoma and non-Hodgkin's lymphoma?

Accepted Answer

Presence of Reed-Sternberg cells

Answer

Presence of B symptoms (fever, night sweats, weight loss)

Answer

Generalized lymphadenopathy

Answer

Predominance in the elderly

Question 3

Burkitt's lymphoma is associated with which of the following genetic abnormalities?

Accepted Answer

t(8:14)

Answer

t(9:22)

Answer

del.5q

Answer

t(17:15)

Question 4

Thrombocytosis is seen in which of the following conditions?

Accepted Answer

Haemolytic anaemia

Answer

Osteopetrosis

Answer

Disseminated intravascular coagulation

Answer

Thiazide therapy

Question 5

Which of the following is a pan B lymphocyte marker?

Accepted Answer

CD 19

Answer

CD 5

Answer

CD 10

Answer

CD 38

Question 6

What happens to hepcidin levels in Anemia of chronic disease?

Accepted Answer

Increases

Answer

Decreases

Answer

Remains normal

Answer

Any of the above

Question 7

Acute myeloid leukemia (AML) is characterized by which of the following findings?

Accepted Answer

Auer rods

Answer

Philadelphia chromosome

Answer

Hemolytic anemia

Answer

Dohle bodies

Question 8

Osmotic fragility is:

Accepted Answer

Negative in iron deficiency anemia

Answer

Negative in autoimmune hemolytic anemia

Answer

Based on the principle of lysis in serial dilutions of hypertonic saline

Answer

Best if performed in a citrated blood sample

Question 9

Eosin-5-maleimide flow cytometry is used for the diagnosis of which condition?

Accepted Answer

Hereditary spherocytosis

Answer

Glucose-6-phosphate dehydrogenase deficiency

Answer

Sickle cell anemia

Answer

Alpha thalassemia

Question 10

Auer rods are typically not seen in which subtype of Acute Myeloid Leukemia?

Accepted Answer

Acute promyelocytic leukemia (APL)

Answer

Acute myeloid leukemia subtype M2

Answer

Acute myeloid leukemia subtype M3

Answer

Acute myeloid leukemia subtype M1

Hematopathology — MCQs

Hematopathology — MCQs

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