Hematopathology Practice Questions

Q: Which organ is most commonly affected in the disorder characterized by the given peripheral blood smear findings?

Spleen. ***Spleen*** - The spleen is the **most commonly affected organ** in sickle cell disease due to **vaso-occlusive crises** causing repeated infarction and congestion. - Early in the disease, the spleen undergoes **sequestration crises**, and later develops **autosplenectomy** from repeated sickling episodes. *Lungs* - While **acute chest syndrome** can occur in sickle cell disease, it is not the most commonly affected organ overall. - Pulmonary complications are **episodic** rather than the primary site of chronic organ damage. *Kidney* - **Nephropathy** can develop in sickle cell disease due to chronic hypoxia and sickling in renal medulla. - However, renal involvement typically occurs **later in the disease course** and is less frequent than splenic complications. *Liver* - **Hepatic sequestration** and cholestasis can occur but are **less common** than splenic involvement. - Liver complications are usually **secondary** to hemolysis and transfusion-related iron overload rather than primary sickling effects.

Q: Reticulocytes are stained with which of the following reagents?

Brilliant Cresyl blue. **Explanation:** Reticulocytes are immature red blood cells that contain residual ribosomal RNA (rRNA). Because these cells lack a nucleus, they cannot be identified on a standard Leishman or Wright stain (where they appear as polychromatic cells). To visualize the characteristic "reticulum" or network of RNA, **Supravital Staining** is required [1]. **1. Why Brilliant Cresyl Blue is correct:** Supravital stains are applied to living, unfixed cells. Reagents like **Brilliant Cresyl Blue** or **New Methylene Blue** penetrate the living cell membrane and cause the acidic ribosomal RNA to aggregate and precipitate into a visible blue-stained network or granules [1]. This allows for an accurate reticulocyte count, which is the best indicator of bone marrow erythropoietic activity. **2. Analysis of Incorrect Options:** * **Methyl Violet:** Used primarily to visualize **Heinz bodies** (denatured hemoglobin) in conditions like G6PD deficiency. * **Sudan Black:** A lipid-soluble stain used to identify myeloblasts in **Acute Myeloid Leukemia (AML)**; it stains the phospholipid membranes of primary granules. * **Indigo Carmine:** A dye used primarily in surgery and urology to highlight urinary tract patency or as a marker for chromoendoscopy; it has no role in hematological cell staining. **3. NEET-PG High-Yield Pearls:** * **Supravital Stains:** Remember the duo—**New Methylene Blue** (preferred/more stable) and **Brilliant Cresyl Blue**. * **Reticulocyte Index (RI):** In anemia, always look for the "Corrected Reticulocyte Count." An RI > 2-3% indicates a brisk marrow response (e.g., hemolysis or acute blood loss). * **Miller Disc:** An optical tool used in the eyepiece of a microscope to standardize the manual counting of reticulocytes. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Blood And Bone Marrow Disease, pp. 578-579.

Q: Histiocytosis X is a spectrum of disorders that includes which of the following conditions?

All of the above. **Explanation:** **Histiocytosis X**, now more commonly known as **Langerhans Cell Histiocytosis (LCH)**, is a group of idiopathic disorders characterized by the abnormal proliferation of Langerhans cells (dendritic cells) [1]. These cells are identified by their characteristic "coffee-bean" nuclei and **Birbeck granules** (tennis-racket shaped) on electron microscopy [1]. The spectrum of Histiocytosis X includes three distinct clinical entities based on the extent of involvement and age of onset: 1. **Letterer-Siwe Disease (Option C):** The most severe form, typically seen in infants (<2 years). it is a **multifocal, multisystem** disorder involving the skin (seborrheic-like rash), organs (hepatosplenomegaly), and bone marrow. It carries a poor prognosis. 2. **Hand-Schüller-Christian Disease (Option B):** A **multifocal, unisystem** variant usually seen in children. It is classically defined by a high-yield triad: **Calvarial bone defects, Exophthalmos, and Diabetes Insipidus** (due to pituitary involvement). 3. **Eosinophilic Granuloma (Option A):** The mildest and most common form, usually **unifocal**. It typically presents as a solitary osteolytic lesion in the skull, ribs, or femur in older children or young adults. Since all three conditions are part of the Histiocytosis X spectrum, **Option D** is the correct answer. **High-Yield NEET-PG Pearls:** * **Immunohistochemistry (IHC):** LCH cells are characteristically positive for **CD1a, S100, and CD207 (Langerin)** [1]. Langerin is the most specific marker. * **Radiology:** Bone lesions are typically "punched-out" lytic lesions without a sclerotic rim. * **Morphology:** On H&E stain, look for "grooved" or "folded" nuclei resembling coffee beans [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. 629-630.

Question 1

Disseminated Intravascular Coagulation (DIC) is seen with all of the following conditions EXCEPT:

Accepted Answer

Accidental hemorrhage

Answer

Black water fever

Answer

Amniotic fluid embolism

Answer

Overdosage with Vitamin K

Question 2

Which anticoagulant is used for chelating calcium?

Accepted Answer

All of the above

Answer

EDTA

Answer

Oxalate

Answer

Sodium citrate

Question 3

Which of the following conditions predisposes to leukemia?

Accepted Answer

Infectious mononucleosis

Answer

Ionizing radiation

Answer

Myelofibrosis

Answer

Polycythemia vera

Question 4

Which organ is most commonly affected in the disorder characterized by the given peripheral blood smear findings?

Accepted Answer

Spleen

Answer

Lungs

Answer

Kidney

Answer

Liver

Question 5

In leucopenia, which white blood cell type is predominantly involved?

Accepted Answer

Granulocytes

Answer

Erythrocytes

Answer

Eosinophils

Answer

Monocytes

Question 6

Which cell is not seen in Hodgkin lymphoma?

Accepted Answer

Langerhans cell

Answer

Reed-Sternberg cell

Answer

Lacunar cell

Answer

L&H cell

Question 7

Lupus anticoagulants may cause all of the following except:

Accepted Answer

Increased prothrombin time

Answer

Recurrent abortion

Answer

False positive VDRL results

Answer

Arterial thrombosis

Question 8

Reticulocytes are stained with which of the following reagents?

Accepted Answer

Brilliant Cresyl blue

Answer

Methyl violet

Answer

Sudan black

Answer

Indigo carmine

Question 9

Which of the viruses is not commonly implicated in the pathogenesis of Non-Hodgkin's lymphomas?

Accepted Answer

Cytomegalovirus (CMV)

Answer

Human T-cell leukemia virus-1 (HTLV-1)

Answer

Epstein-Barr virus (EBV)

Answer

Human herpesvirus-8 (HHV-8)

Question 10

Histiocytosis X is a spectrum of disorders that includes which of the following conditions?

Accepted Answer

All of the above

Answer

Eosinophilic granuloma

Answer

Hand-Schüller-Christian disease

Answer

Letterer-Siwe disease

Hematopathology — MCQs

Hematopathology — MCQs

On this page

Practice by Chapter

Want unlimited practice?