Hematopathology Practice Questions

Q: Popkorn cells are found in which of the following conditions?

Hodgkin's Lymphoma. **Explanation:** **Popcorn cells** (also known as **L&H cells**—Lymphocytic and Histiocytic variants) are the characteristic diagnostic hallmark of **Nodular Lymphocyte Predominant Hodgkin Lymphoma (NLPHL)**, a specific subtype of Hodgkin Lymphoma [1]. 1. **Why Option A is Correct:** Popcorn cells are large, neoplastic B-cells with multi-lobed, folded nuclei resembling a kernel of popped corn [1]. Unlike the "classic" Reed-Sternberg (RS) cells found in other subtypes, popcorn cells are **CD20+** and **CD45+**, but typically **CD15- and CD30-**. Their presence in a background of small B-lymphocytes confirms the diagnosis of NLPHL [1]. 2. **Why Other Options are Incorrect:** * **Non-Hodgkin Lymphoma (NHL):** While NHL involves various malignant B or T cells (e.g., "flower cells" in HTLV-1 or "buttock cells" in Follicular Lymphoma), the specific "popcorn" morphology is unique to the NLPHL subtype of Hodgkin's. * **Multiple Myeloma:** This is a plasma cell dyscrasia characterized by "clock-face" nuclei, perinuclear halos (hof), and occasionally **Mott cells** or **Russell bodies**, but not popcorn cells. * **Iron Deficiency Anemia:** This is a microcytic hypochromic anemia characterized by peripheral smear findings like **pencil cells** (elliptocytes) and target cells, not neoplastic giant cells. **NEET-PG High-Yield Pearls:** * **Classic RS Cell:** Found in Mixed Cellularity and Nodular Sclerosis; markers are **CD15+ and CD30+**. * **Lacunar Cells:** Characteristic of **Nodular Sclerosis** HL (seen in formalin-fixed tissue). * **Mummy Cells:** Degenerated RS cells with pyknotic nuclei. * **NLPHL Prognosis:** Generally carries an excellent prognosis but has a risk of transformation into Diffuse Large B-Cell Lymphoma (DLBCL) [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. 614-618.

Q: A 40-year-old female presented with the following findings: Hb 9.8 gm%, TLC 15,700/cumm, Platelet count 3 lac/cumm. Peripheral smear showed increased neutrophils with 14% blasts, 15% myelocytes and metamyelocytes with some dysplasia. Cytogenetic study revealed t(8;21). What is your diagnosis?

AML. **Explanation:** The key to this diagnosis lies in the cytogenetic finding of **t(8;21)**. According to the WHO classification of myeloid neoplasms, the presence of specific recurrent genetic abnormalities—namely **t(8;21), inv(16), or t(15;17)**—is diagnostic of **Acute Myeloid Leukemia (AML)** regardless of the blast count [1]. While the peripheral smear shows 14% blasts (which is below the traditional 20% threshold), the genetic marker overrides the blast percentage requirement. **Why other options are incorrect:** * **CML (Chronic Myeloid Leukemia):** Characterized by the Philadelphia chromosome **t(9;22)** and a "myelocyte bulge." While this patient has myelocytes and metamyelocytes, the t(8;21) is pathognomonic for AML (specifically AML-M2 in the FAB classification). * **MDS (Myelodysplastic Syndrome):** Although dysplasia is mentioned, the presence of t(8;21) automatically upgrades the diagnosis to AML [1]. MDS typically presents with cytopenias, not leukocytosis [2]. * **ALL (Acute Lymphoblastic Leukemia):** This involves a proliferation of lymphoblasts. The presence of myelocytes, metamyelocytes, and t(8;21) (a myeloid marker) points exclusively to a myeloid lineage [1]. **High-Yield Pearls for NEET-PG:** * **WHO Exception Rule:** AML can be diagnosed with <20% blasts if t(8;21), inv(16), or t(15;17) is present [1]. * **AML with t(8;21):** Often associated with **RUNX1-RUNX1T1** fusion gene, good prognosis, and the presence of **Auer rods** [1]. * **Morphology:** Frequently shows large blasts with prominent granules and "maturation" (presence of myelocytes/metamyelocytes), which can mimic CML or MDS [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. 620-621. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Blood And Bone Marrow Disease, pp. 613-614.

Q: What is the specific type of cells found in infectious mononucleosis?

Downey cells. **Explanation:** **Infectious Mononucleosis (IM)**, caused primarily by the **Epstein-Barr Virus (EBV)**, is characterized by the presence of **Downey cells** (Option A) in the peripheral blood smear. These are **atypical T-lymphocytes** (specifically CD8+ cytotoxic T-cells) that have been activated to respond against EBV-infected B-cells [1]. Morphologically, Downey cells are larger than normal lymphocytes, possessing an abundant, "ballpoint-pen" blue cytoplasm that appears to "hug" or indent around adjacent red blood cells (scalloping) [1]. **Analysis of Incorrect Options:** * **Raquet cells (Option B):** These are characteristic of **Rhabdomyosarcoma**. They are tadpole or racquet-shaped cells with a single nucleus and a long cytoplasmic process containing cross-striations. * **Arbiskov cells (Option C):** This is a distractor term and does not represent a recognized pathological cell type in standard hematopathology. **High-Yield Clinical Pearls for NEET-PG:** * **Triad of IM:** Fever, pharyngitis, and lymphadenopathy (typically posterior cervical) [1]. * **Paul-Bunnell Test:** A classic heterophile antibody test used for diagnosis (positive in EBV-induced IM). * **Splenic Rupture:** A rare but serious complication; patients are advised to avoid contact sports for 3–4 weeks. * **Ampicillin Rash:** Patients with IM who are mistakenly treated with Ampicillin or Amoxicillin often develop a characteristic maculopapular rash. * **Downey Classification:** Downey cells are categorized into three types (Type I, II, and III), with Type II being the most common "atypical" form seen in IM. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Infectious Diseases, pp. 369-370.

Q: What is the shelf life of platelets?

Less than 5 days. **Explanation:** **1. Why Option A is Correct:** Platelets are unique among blood components because they must be stored at **room temperature (20–24°C)** with continuous agitation to maintain their viability and function. Because they are stored at room temperature, there is a significantly high risk of **bacterial proliferation**. To minimize the risk of transfusion-transmitted bacterial infections (sepsis), the shelf life is strictly limited to **5 days**. Some newer technologies (like pathogen reduction or large-volume delayed sampling) may extend this to 7 days in specific settings, but for examination purposes, 5 days remains the standard. **2. Why Incorrect Options are Wrong:** * **Option B (3 weeks):** This corresponds to the shelf life of Whole Blood or Packed Red Blood Cells (PRBCs) collected in **CPD (Citrate Phosphate Dextrose)** anticoagulant, which is 21 days. * **Option C (5 weeks):** This corresponds to the shelf life of PRBCs collected in **CPDA-1** (35 days) or those using additive solutions like SAGM (42 days). * **Option D (2 years):** This refers to the storage of **Fresh Frozen Plasma (FFP)** or Cryoprecipitate when stored at temperatures below -65°C. **3. High-Yield Clinical Pearls for NEET-PG:** * **Storage Temperature:** Platelets = 20–24°C; PRBCs = 2–6°C; FFP = < -18°C. * **Agitation:** Continuous agitation is required for platelets to prevent pH drop and aggregation. * **Bacterial Sepsis:** Platelets are the blood component most commonly associated with transfusion-related sepsis (most common organism: *Staphylococcus epidermidis*). * **Dose Effect:** One unit of Random Donor Platelets (RDP) typically raises the platelet count by 5,000–10,000/µL in an average adult.

Question 1

Increase in MCHC is associated with which of the following?

Accepted Answer

Hereditary spherocytosis

Answer

Iron deficiency anemia

Answer

Megaloblastic anemia

Answer

Anemia of chronic disease

Question 2

Which of the following cytogenetic abnormalities is associated with the worst prognosis in Acute Myeloid Leukemia (AML)?

Accepted Answer

Monosomy 7

Answer

t(8;21)

Answer

inv(16)

Answer

Normal cytogenetics

Question 3

Which of the following is positive in Follicular lymphoma?

Accepted Answer

Bcl 2

Answer

Bcl 6

Answer

Bcl 1

Answer

Bcl 10

Question 4

Leukemoid reaction is seen in which of the following conditions?

Accepted Answer

Acute infection

Answer

Erythroleukemia

Answer

Myelomatosis

Answer

Hemorrhage

Question 5

Popkorn cells are found in which of the following conditions?

Accepted Answer

Hodgkin's Lymphoma

Answer

Non-Hodgkin's lymphoma

Answer

Multiple myeloma

Answer

Iron deficiency anemia

Question 6

A 40-year-old female presented with the following findings: Hb 9.8 gm%, TLC 15,700/cumm, Platelet count 3 lac/cumm. Peripheral smear showed increased neutrophils with 14% blasts, 15% myelocytes and metamyelocytes with some dysplasia. Cytogenetic study revealed t(8;21). What is your diagnosis?

Accepted Answer

AML

Answer

CML

Answer

MDS

Answer

ALL

Question 7

What is the specific type of cells found in infectious mononucleosis?

Accepted Answer

Downey cells

Answer

Raquet cells

Answer

Arbiskov cells

Answer

None of the above

Question 8

A patient presents with cervical lymphadenopathy. Biopsy demonstrates a nodular lymphoma with follicle formation. This lesion would most likely be associated with which of the following?

Accepted Answer

bcl-2 activation

Answer

bcr-abl hybrid

Answer

c-myc activation

Answer

t(8, 14)

Question 9

What is the shelf life of platelets?

Accepted Answer

Less than 5 days

Answer

Less than 3 weeks

Answer

Less than 5 weeks

Answer

Less than 2 years

Question 10

A 56-year-old woman with a history of breast cancer treated 5 years ago with lumpectomy and radiation, but no chemotherapy, presents with bone pain, fatigue, and weakness. Her complete blood count shows severe anemia, decreased white blood cells, and thrombocytopenia. Examination of a peripheral blood smear reveals a few nucleated red cells, an occasional blast cell, and myelocyte. What is the likely cause of these hematologic abnormalities?

Accepted Answer

Myelophthisic anemia

Answer

Chloramphenicol toxicity

Answer

Diphyllobothrium latum infestation

Answer

Megaloblastic anemia

Hematopathology — MCQs

Hematopathology — MCQs

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