Hematopathology — MCQs

A 35 year old woman presents with fatigue. Investigations revealed the following: Hb, 5 g/dL; MCH, 24; low MCV; leukocytes, 11,000/ uL, and platelets, 5 lakhs. The peripheral smear is shown below. What is the diagnosis? Normal values: - Mean cell volume (MCV); 90 ± 8 fL - Mean cell Hb(MCH); 30 ± 3 pg

Q1273

Match the following cell types/patterns (Column A) with their associated malignancies (Column B): Column A (Cell types/patterns): a) Faggot cell b) Popcorn cell c) Starry sky pattern d) Cerebriform nuclei Column B (Associated malignancies): 1) Acute promyelocytic leukemia 2) Lymphocyte-predominant Hodgkin's lymphoma 3) Burkitt lymphoma 4) Sezary syndrome

Q1274

The Hb is 5 g/dL and the reticulocyte count is 9%. What is the corrected reticulocyte count?

Q1275

Which of the following cells is shown in the given image?

Q1276

Which of the following are characteristic laboratory findings in Iron Deficiency Anemia (IDA)? 1. Low serum ferritin 2. Low transferrin saturation 3. Low serum iron 4. Increased TIBC

Q1277

The graphical representation for flow cytometry analysis is done by which of the following?

Q1278

A boy presents with fever, night sweats, and neck swelling. The biopsy of swelling showed a starry sky appearance. What is the most likely genetic abnormality seen in this case?

Q1279

A patient with lytic lesions on the skull is suspected of a diagnosis of Langerhans cell histiocytosis. Which of the following is a characteristic finding on electron microscopy?

Q1280

Which is the cell of origin of Chronic Lymphocytic Leukaemia / Small Lymphocytic Lymphoma?

Hematopathology Indian Medical PG Practice Questions and MCQs

Question 1271: In a patient with general fatigue, normal TLC/ DLC, and superficial discrete lymphadenopathy, with lymph node biopsy showing effaced architecture, atypical cells with indented nuclei and prominent nucleoli, positive for CD10 and BCL-2, which of the following is the most likely diagnosis?

A. Mycosis Fungoides
B. Burkitt's Lymphoma
C. Follicular Lymphoma (Correct Answer)
D. Hodgkin Lymphoma

Explanation: ***Follicular Lymphoma*** - The description of **atypical cells with indented nuclei** (cleaved cells) and **prominent nucleoli**, along with **CD10** and **BCL-2 positivity**, are classic features of follicular lymphoma [1], [2]. - **Effaced architecture** of the lymph node, and **superficial discrete lymphadenopathy** in an adult, further support this diagnosis [1]. *Mycosis Fungoides* - This is a **cutaneous T-cell lymphoma** characterized by skin lesions (patches, plaques, tumors) and rarely involves lymph nodes in the early stages. - It would show **CD3+ T-cells** on immunophenotyping, not CD10+ B-cells. *Burkitt's Lymphoma* - Characterized by rapidly growing tumors and a **"starry sky"** histological pattern with numerous macrophages [3]. - While it is CD10 positive, it would typically be **BCL-2 negative** due to the specific translocation involved (t(8;14) c-MYC/IgH). *Hodgkin Lymphoma* - Defined by the presence of **Reed-Sternberg cells** (large, multinucleated cells with prominent nucleoli, often described as "owl's eye" appearance). - These cells are typically **CD15+ and CD30+**, and BCL-2 expression is less specific and CD10 is not characteristic. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Diseases Of The Urinary And Male Genital Tracts, pp. 561-562. [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. 602-604. [3] 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. 606.

Question 1272: A 35 year old woman presents with fatigue. Investigations revealed the following: Hb, 5 g/dL; MCH, 24; low MCV; leukocytes, 11,000/ uL, and platelets, 5 lakhs. The peripheral smear is shown below. What is the diagnosis? Normal values: - Mean cell volume (MCV); 90 ± 8 fL - Mean cell Hb(MCH); 30 ± 3 pg

A. Essential thrombocytosis
B. Iron - deficiency anemia (Correct Answer)
C. Thalassemia major
D. Megaloblastic anemia

Explanation: ***Iron-deficiency anemia*** - The patient presents with **severe anemia (Hb 5 g/dL)**, **low MCH (24 pg)**, and **low MCV**, which are classic indicators of **microcytic, hypochromic anemia** [3]. The peripheral smear shows **hypochromic microcytic red cells** with abundant central pallor and **anisopoikilocytosis**, consistent with iron-deficiency anemia [1]. - While the **platelet count is elevated (5 lakhs)**, it can occur in iron deficiency as reactive thrombocytosis [1]. Leukocytosis in the absence of infection may be a mild reactive process secondary to severe anemia. *Essential thrombocytosis* - This is a **myeloproliferative neoplasm** characterized by significantly elevated platelet counts (often > 450,000/uL), but typically does not present with severe anemia, low MCH, or low MCV. - The primary issue in this patient is severe anemia with microcytic hypochromic features, not isolated thrombocytosis. *Thalassemia major* - While thalassemia major also presents with **microcytic, hypochromic anemia** and can have a very low MCV, it usually manifests in early childhood and is associated with significant **hemolysis**, **splenomegaly**, and characteristic red blood cell morphology such as **target cells** and **nucleated red blood cells** [2]. - The extremely low Hb and microcytic indices alone are not enough to distinguish it from severe iron deficiency without further specific markers like iron studies or hemoglobin electrophoresis. *Megaloblastic anemia* - Megaloblastic anemia is characterized by **macrocytic anemia** (high MCV), which is the opposite of the low MCV presented in this case. - It typically results from **vitamin B12** or **folate deficiency** and the peripheral smear would show **macro-ovalocytes** and **hypersegmented neutrophils**, which are not seen here. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Blood And Bone Marrow Disease, pp. 590-591. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Red Blood Cell and Bleeding Disorders, p. 648. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Red Blood Cell and Bleeding Disorders, pp. 638-639.

Question 1273: Match the following cell types/patterns (Column A) with their associated malignancies (Column B): Column A (Cell types/patterns): a) Faggot cell b) Popcorn cell c) Starry sky pattern d) Cerebriform nuclei Column B (Associated malignancies): 1) Acute promyelocytic leukemia 2) Lymphocyte-predominant Hodgkin's lymphoma 3) Burkitt lymphoma 4) Sezary syndrome

A. 1-a, 2-d, 3-c, 4-b
B. 1-b, 2-c, 3-a, 4-d
C. 1-a, 2-b, 3-c, 4-d (Correct Answer)
D. 1-b, 2-a, 3-d, 4-c

Explanation: ***1-a, 2-b, 3-c, 4-d*** - **Acute promyelocytic leukemia (APL)** is characterized by **faggot cells**, which are abnormal promyelocytes containing multiple **Auer rods**. - **Lymphocyte-predominant Hodgkin's lymphoma** is associated with **popcorn cells** (also known as L&H cells), which are large, multilobated Reed-Steinberg variant cells [3]. - **Burkitt lymphoma** shows the characteristic **starry sky pattern**, resulting from uniformly sized tumor cells interspersed with numerous tingible body macrophages [1]. - **Sézary syndrome** is characterized by **cerebriform nuclei** in Sézary cells, which are a hallmark of this leukemic variant of cutaneous T-cell lymphoma [2]. *1-a, 2-d, 3-c, 4-b* - This option incorrectly associates **cerebriform nuclei** with lymphocyte-predominant Hodgkin's lymphoma; this lymphoma is characterized by **popcorn cells**. - It also mismatches **Sézary syndrome** with popcorn cells; Sézary syndrome is defined by **cerebriform nuclei** [2]. *1-b, 2-c, 3-a, 4-c* - This option incorrectly links **popcorn cells** with acute promyelocytic leukemia; APL is characterized by **faggot cells** with Auer rods. - It also misassociates **Burkitt lymphoma** with faggot cells; Burkitt lymphoma shows the distinctive **starry sky pattern** [1]. *1-b, 2-a, 3-d, 4-c* - This option incorrectly matches **popcorn cells** with acute promyelocytic leukemia; APL contains **faggot cells** with multiple Auer rods. - It also wrongly associates **faggot cells** with lymphocyte-predominant Hodgkin's lymphoma; this condition features **popcorn cells** (L&H cells) [3]. **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. 606. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Diseases Of The Urinary And Male Genital Tracts, pp. 564-565. [3] 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. 613-614, 616.

Question 1274: The Hb is 5 g/dL and the reticulocyte count is 9%. What is the corrected reticulocyte count?

A. 5
B. 3 (Correct Answer)
C. 1.8
D. 4.5

Explanation: ***3*** - The **corrected reticulocyte count (CRC)** is calculated to adjust for varying degrees of anemia, providing a more accurate assessment of bone marrow erythropoietic activity. The formula is: **CRC = observed reticulocyte % × (patient's HCT / normal HCT)**. - Assuming a normal hematocrit (HCT) of 45% and a direct hemoglobin to hematocrit conversion of 1:3 for 5 g/dL Hb (so HCT = 15%), then CRC = 9% × (15/45) = 9% × 1/3 = **3%**. *5* - This value is likely obtained by an **incorrect calculation** or by applying an inappropriate correction factor. - It does not properly account for the **severity of anemia** in the calculation of the corrected reticulocyte count [2]. *1.8* - This result may represent confusion with the **Reticulocyte Production Index (RPI)**, which further corrects for premature reticulocyte release by dividing CRC by a maturation time factor (typically 1.5-2 in severe anemia) [1]. - However, the question specifically asks for the **corrected reticulocyte count**, not the RPI, making this an inappropriate over-correction. *4.5* - This value might be a result of **dividing the observed reticulocyte count by a factor of 2**, which is not the standard correction for anemia. - It does not accurately reflect the **bone marrow's response** to the severe anemic state. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Blood And Bone Marrow Disease, pp. 586-587. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Blood And Bone Marrow Disease, pp. 590-591.

Question 1275: Which of the following cells is shown in the given image?

A. Hairy cell (Correct Answer)
B. Sickle cell
C. Gaucher cell
D. Target cell

Explanation: ***Hairy cell*** - The image displays prominent **cytoplasmic projections** or "hairs" on the cell surface, which are characteristic features of **hairy cells** (lymphocytes seen in hairy cell leukemia) [1]. - These cells typically have an irregularly shaped nucleus and cytoplasm rich in ribosomes, as suggested by the granular appearance [1]. *Sickle cell* - **Sickle cells** are **red blood cells** that have a characteristic crescent or sickle shape due to abnormal hemoglobin polymerization. - The cell in the image is a **white blood cell** with a large nucleus and cytoplasmic extensions, clearly not a red blood cell. *Gaucher cell* - **Gaucher cells** are **macrophages** that accumulate glucocerebroside, giving them a characteristic **"crinkled paper"** or **"chicken scratch"** cytoplasm. - While they are large cells, they lack the distinct, fine, hair-like projections seen in the provided image. *Target cell* - **Target cells** are **red blood cells** with a central bullseye appearance due to an abnormal distribution of hemoglobin, often seen in thalassemia or liver disease. - The presented image is not a red blood cell and does not demonstrate the morphology of a target cell. **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. 612.

Question 1276: Which of the following are characteristic laboratory findings in Iron Deficiency Anemia (IDA)? 1. Low serum ferritin 2. Low transferrin saturation 3. Low serum iron 4. Increased TIBC

A. 3 and 4 only
B. 1, 3, and 4 only
C. 1 and 2 only
D. All of the above (Correct Answer)

Explanation: ***All of the above (1, 2, 3, and 4)*** - **All listed parameters are characteristic findings in Iron Deficiency Anemia (IDA):** - **Low serum ferritin** - Indicates depleted iron stores; most specific early marker [1] - **Low serum iron** - Reflects reduced circulating iron availability [1] - **Low transferrin saturation** - Shows decreased percentage of iron-bound transferrin molecules (typically <15%) [1] - **Increased TIBC** - Compensatory increase in total iron-binding capacity as the liver produces more transferrin to capture available iron [1] *Why not just 1, 2, and 3?* - Increased TIBC is also a hallmark finding in IDA, distinguishing it from anemia of chronic disease (where TIBC is typically low) [1] *Why not just 3 and 4?* - Serum ferritin and transferrin saturation are equally important diagnostic parameters [1] *Why not just 1, 3, and 4?* - Low transferrin saturation is a key diagnostic criterion for IDA [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. 657-660.

Question 1277: The graphical representation for flow cytometry analysis is done by which of the following?

A. Pie chart, dot plot
B. Histogram, dot plot (Correct Answer)
C. Line diagram, dot plot
D. Bar diagram, dot plot

Explanation: ***Histogram, dot plot*** - **Histograms** are used in flow cytometry to display the distribution of a single parameter (e.g., cell size, fluorescence intensity) across the cell population. - **Dot plots** are used to visualize the relationship between two or more parameters, allowing for the identification of distinct cell populations based on multiple characteristics. *Pie chart, dot plot* - **Pie charts** are typically used to represent proportions of a whole, which is not the primary way flow cytometry data is presented for detailed cell analysis. - While dot plots are correct, the combination with pie charts makes this option less accurate for typical flow cytometry analysis. *Line diagram, dot plot* - **Line diagrams** are generally used to show trends over time or continuous relationships, which is not the standard graphical representation for direct flow cytometry output. - Although dot plots are used, the inclusion of line diagrams makes this option incorrect in the context of typical flow cytometry data visualization. *Bar diagram, dot plot* - **Bar diagrams** are often used for comparing discrete categories or counting occurrences, not for displaying continuous distributions or multi-parameter relationships in flow cytometry directly. - While dot plots are correct, the pairing with bar diagrams does not represent the common and most informative graphical methods for flow cytometry analysis.

Question 1278: A boy presents with fever, night sweats, and neck swelling. The biopsy of swelling showed a starry sky appearance. What is the most likely genetic abnormality seen in this case?

A. RAS
B. BCR-ABL
C. p53
D. MYC (Correct Answer)

Explanation: ***MYC*** - The clinical presentation of **fever, night sweats, and neck swelling** in a child, coupled with a **starry sky appearance** on biopsy, is highly suggestive of **Burkitt lymphoma** [2, 3]. - **Burkitt lymphoma** is characterized by a **translocation involving the *MYC* gene** on chromosome 8, most commonly t(8;14), which leads to its overexpression and uncontrolled cell proliferation [1]. *RAS* - Mutations in the **RAS family of genes (HRAS, KRAS, NRAS)** are commonly found in a wide variety of cancers, including **leukemias, pancreatic cancer, and colorectal cancer**. - While *RAS* mutations drive proliferation, they are **not the primary genetic driver** of Burkitt lymphoma, nor are they linked to the characteristic starry sky appearance. *BCR-ABL* - The **BCR-ABL fusion gene**, resulting from the **Philadelphia chromosome (t(9;22))**, is the defining genetic abnormality of **chronic myeloid leukemia (CML)**. - CML presents with different symptoms and a distinct peripheral blood and bone marrow morphology, **not the "starry sky" appearance** seen in Burkitt lymphoma. *p53* - The **p53 tumor suppressor gene** is frequently mutated or inactivated in over half of all human cancers, leading to a loss of cell cycle control and apoptosis. - While **p53 mutations can occur in aggressive lymphomas**, including Burkitt lymphoma, the **primary and characteristic genetic abnormality** associated with Burkitt lymphoma and its presentation is the *MYC* translocation, not solely *p53* mutations. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Neoplasia, pp. 324-325. [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. 605-606. [3] 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. 606.

Question 1279: A patient with lytic lesions on the skull is suspected of a diagnosis of Langerhans cell histiocytosis. Which of the following is a characteristic finding on electron microscopy?

A. Eosinophils
B. Histiocytes
C. Birbeck granules (Correct Answer)
D. Giant cells

Explanation: ***Birbeck granules*** - **Birbeck granules** are rod-shaped organelles with a striated core and a dilated end, resembling a "tennis racket," which are pathognomonic for **Langerhans cells** and, by extension, **Langerhans cell histiocytosis** [1]. - Their presence on **electron microscopy** is a definitive diagnostic feature for LCH [1]. *Eosinophils* - While **eosinophils** are often seen infiltrating lesions in **Langerhans cell histiocytosis**, they are not the diagnostic cellular component or ultrastructural finding on electron microscopy [1]. - **Eosinophils** are granulocytes involved in allergic reactions and parasitic infections; their appearance on EM is distinct from Birbeck granules. *Histiocytes* - **Histiocytes** (macrophages) are present in various inflammatory and neoplastic conditions and are the cell lineage from which **Langerhans cells** are derived, but their general presence on **electron microscopy** is not specific enough for diagnosing **LCH** [1]. - Without the characteristic **Birbeck granules**, a generic histiocyte would not distinguish LCH from other histiocytic disorders [1]. *Giant cells* - **Giant cells**, such as **multinucleated giant cells** or **osteoclasts**, can be found in association with bone lesions including **lytic lesions**, but they are not specific to **Langerhans cell histiocytosis** and do not possess Birbeck granules. - Their presence points to bone destruction or inflammation but not the underlying cellular pathology of LCH. **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. 630.

Question 1280: Which is the cell of origin of Chronic Lymphocytic Leukaemia / Small Lymphocytic Lymphoma?

A. Mature B cells
B. Progenitor T cells
C. Mature T cells
D. Naïve B cells (Correct Answer)

Explanation: ***Naïve B cells*** - Chronic Lymphocytic Leukaemia (CLL) and Small Lymphocytic Lymphoma (SLL) originate from **CD5-positive B lymphocytes** arrested in a mature but **naïve differentiation stage** [1]. - These cells express both **B-cell markers (CD19, CD20, CD23)** and a T-cell marker (CD5), which is characteristic of the clone [4]. *Mature B cells* - While CLL/SLL are derived from B cells, they are specifically from **naïve, not fully mature, B cells**. - **Other B-cell lymphomas** like follicular lymphoma or mantle cell lymphoma originate from distinct stages of mature B-cell differentiation [2]. *Progenitor T cells* - **Progenitor T cells** are the cells of origin for **T-cell acute lymphoblastic leukaemia (T-ALL)**, not CLL/SLL [3]. - T-ALL involves immature T lymphocytes and presents with different clinical and immunophenotypic features [3]. *Mature T cells* - **Mature T cells** can give rise to various **peripheral T-cell lymphomas**, like peripheral T-cell lymphoma, not otherwise specified (PTCL-NOS) or cutaneous T-cell lymphoma (Mycosis Fungoides). - These are distinct from CLL/SLL, which is a B-cell neoplasm [4]. **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. 596-598. [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. 610-612. [3] 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. 598-599. [4] 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.

Practice by Chapter

Anemias: Classification and Approach

Practice Questions

Hemolytic Anemias

Practice Questions

Myeloproliferative Neoplasms

Practice Questions

Myelodysplastic Syndromes

Practice Questions

Acute Leukemias

Practice Questions

Chronic Leukemias

Practice Questions

Lymphomas and Lymphoid Neoplasms

Practice Questions

Plasma Cell Disorders

Practice Questions

Bleeding Disorders

Practice Questions

Thrombotic Disorders

Practice Questions

Want unlimited practice?

Get full access to all questions, explanations, and performance tracking.

Start For Free