Hematopathology — MCQs

Hematopathology Indian Medical PG Practice Questions and MCQs

Question 1401: The immunoglobulin most commonly involved in Multiple Myeloma is:

A. IgG (Correct Answer)
B. IgM
C. IgA
D. IgD

Explanation: ***IgG*** - In Multiple Myeloma, the most commonly involved immunoglobulin is **IgG**, which is often produced in excess by malignant plasma cells [1][2]. - The presence of **monoclonal IgG** in serum is a key indicator of this malignancy, evident in diagnostic tests like serum protein electrophoresis. *IgM* - While **elevated IgM** levels can occur in other conditions like Waldenström's macroglobulinemia, it is not typically associated with Multiple Myeloma [2]. - IgM is produced by a different type of plasma cell and does not reflect the classic presentation of Multiple Myeloma. *IgA* - Although **IgA** can be involved in some cases of Multiple Myeloma, it is much less common than IgG [1][2]. - Patients with predominately **IgA Multiple Myeloma** are relatively rare compared to those with IgG. *IgD* - **IgD** myeloma is a very rare type of Multiple Myeloma, accounting for less than 2% of cases [1][2]. - It is not typically associated with the classic symptoms and conditions that characterize the more common IgG or IgA forms. **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. 608-609. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Blood And Bone Marrow Disease, pp. 616-617.

Question 1402: Which of the following is a characteristic feature of Hereditary Spherocytosis?

A. Splenomegaly
B. Increased Osmotic Fragility (Correct Answer)
C. Gallstones
D. Direct Coombs Test Negative

Explanation: ***Direct Coomb's Positive*** - In hereditary spherocytosis, the **Coomb's test is typically negative**, indicating that the hemolysis is non-immune. - The condition is primarily due to defects in **red blood cell membrane proteins** [2], not autoimmune mechanisms. *Increased Osmotic Fragility* - A hallmark of hereditary spherocytosis; these red blood cells are more **sensitive to osmotic changes** due to their spherical shape [2]. - This fragility is used in clinical tests to help diagnose the condition [1]. *Gall stones* - Patients with hereditary spherocytosis may develop **pigment gallstones** due to chronic hemolysis and excess bilirubin [1]. - This is a common complication resulting from increased breakdown of red blood cells. *Splenomegaly* - Often presents in hereditary spherocytosis as the spleen works harder to clear **damaged red blood cells** [2]. - Splenomegaly is a common clinical feature due to the increased workload on the spleen. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Blood And Bone Marrow Disease, pp. 597-598. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Red Blood Cell and Bleeding Disorders, pp. 640-641.

Question 1403: Which of the following best describes the shape of Birbeck granules?

A. Resembling a tennis racket (Correct Answer)
B. Resembling a hockey stick
C. Resembling a bat
D. Resembling a ball

Explanation: ***Tennis racket*** [1] - Birbeck granules are distinctive for their **tennis racket shape**, consisting of an elongated area and a bulbous end [1]. - They are typically found in **Langerhans cell histiocytosis** and are associated with **CD1a+** staining [1]. *Bat* - The term "bat" does not accurately describe the structure or morphology of Birbeck granules. - Unlike bats, Birbeck granules have a **specific elongated shape** with a bulbous tip rather than bat wings. *Hockey stick* - This shape implies a straight handle and a flat blade, which does not represent the **widely tapered ends** of Birbeck granules. - The **characteristic morphology** does not align with any hockey stick features. *Ball* - The term "ball" indicates a spherical shape, which is not fitting for Birbeck granules, as they are **elongated** and striated. - Birbeck granules are defined specifically by their **tapered structure**, contrasting markedly with a circular form. **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 1404: What type of anaemia is primarily associated with leukaemia?

A. Aplastic anaemia
B. Iron deficiency anaemia
C. Megaloblastic anaemia
D. Myelophthisic anaemia (Correct Answer)

Explanation: ***Myelophthisic anaemia*** - This condition arises from the **displacement of normal hematopoietic tissue** in the bone marrow by abnormal cells, like those seen in leukaemia, leading to **extramedullary hematopoiesis**. - Marrow infiltration causes **pancytopenia** and often results in the presence of **immature granulocytes** and **nucleated red blood cells** in the peripheral blood (leukoerythroblastosis). *Iron deficiency anaemia* - This type of anaemia is caused by insufficient iron for **hemoglobin synthesis**, often due to chronic blood loss or inadequate dietary intake. - While leukaemia patients can develop iron deficiency due to bleeding, it is not the **primary type of anaemia** directly resulting from the marrow infiltration by leukaemic cells. *Megaloblastic anaemia* - Characterized by the production of abnormally large, immature red blood cells, primarily due to **vitamin B12** or **folate deficiency**. - There is no direct causal link between leukaemia and the development of megaloblastic anaemia as a **primary haemato-pathological mechanism**. *Aplastic anaemia* - Characterized by **pancytopenia** due to bone marrow failure with hypocellular marrow, not marrow infiltration. - While both leukaemia and aplastic anaemia can present with cytopenias, aplastic anaemia shows a **hypocellular marrow** whereas leukaemia shows a **hypercellular marrow** with infiltration by malignant cells.

Question 1405: Helmet cells are characteristic of anemia of?

A. Hemolytic uremic syndrome (HUS) (Correct Answer)
B. Disseminated intravascular coagulation (DIC)
C. Thrombotic thrombocytopenic purpura (TTP)
D. Autoimmune hemolytic anemia (AIHA)

Explanation: ***Hemolytic uremic syndrome*** - Helmet cells are **fragmented red blood cells** associated with **microangiopathic hemolytic anemia** [1], commonly seen in hemolytic uremic syndrome. - This condition frequently results in **thrombocytopenia** and acute renal failure. *Acanthocytosis* - Acanthocytosis is characterized by **spiky red blood cells** (acanthocytes) rather than helmet cells. - It is commonly associated with **liver disease** and **abetalipoproteinemia**, not hemolytic anemia. *Polysplenia* - Polysplenia is a condition involving multiple spleens but does not typically relate to the **formation of helmet cells**. - It may cause **asplenic complications**, but anemia characteristics do not include helmet cells. *Spherocytosis* - Spherocytosis involves the presence of **spherical red blood cells** rather than fragmented (helmet) cells. - It is associated with **hereditary conditions** like hereditary spherocytosis, which leads to increased hemolysis but not typically to helmet cells. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Blood And Bone Marrow Disease, pp. 596-597.

Question 1406: Which type of immunoglobulin is primarily associated with cold agglutinin disease?

A. IgG
B. IgM (Correct Answer)
C. IgA
D. IgD

Explanation: ***IgM*** - Cold agglutinins are primarily composed of **IgM antibodies** [1] which are produced in response to certain infections, notably Mycoplasma pneumoniae. - They can cause **cold agglutinin disease**, leading to hemolytic anemia when the blood is exposed to cooler temperatures [2]. *IgG* - While IgG is the most abundant antibody in blood, it is not responsible for cold agglutination. - IgG typically functions in **immune memory** and neutralization rather than agglutination at cold temperatures. *IgD* - IgD is mainly found on the surface of **B cells** and has a role in initiating B cell activation. - It plays a minimal role in the antibody response and does not participate in cold agglutination. *IgA* - IgA is primarily involved in mucosal immunity, found in secretions like saliva and tears. - It does not function as a cold agglutinin; hence, it is not associated with cold temperature-related agglutination. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. (Basic Pathology) introduces the student to key general principles of pathology, both as a medical science and as a clinical activity with a vital role in patient care. Part 2 (Disease Mechanisms) provides fundamental knowledge about the cellular and molecular processes involved in diseases, providing the rationale for their treatment. Part 3 (Systematic Pathology) deals in detail with specific diseases, with emphasis on the clinically important aspects., pp. 154-155. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Red Blood Cell and Bleeding Disorders, pp. 651-652.

Question 1407: Starry sky appearance is seen in which of the following?

A. Burkitt's Lymphoma (Correct Answer)
B. Diffuse Large B Cell Lymphoma
C. Anaplastic Large Cell Lymphoma (ALCL)
D. Follicular Lymphoma

Explanation: ***Burkitts lymphoma*** - The **starry sky appearance** is a characteristic histopathological finding due to interspersed macrophages containing **phagocytosed apoptotic cells** and necrotic debris in Burkitt's lymphoma [1]. - It is associated with **MYC gene translocation** and presents typically in children or young adults, commonly affecting the **jaw or abdomen**. *CIL* - CIL (chronic inflammatory leukocytosis) does not exhibit a **starry sky appearance**; it typically reflects a reactive process without specific histological features. - The histology is more characterized by **increased white blood cell counts** rather than tissue architecture alterations seen in lymphomas. *Diffuse large B cell lymphoma* - While this lymphoma can show **varied morphology**, it does not have a **starry sky appearance** as a defining feature, rather presenting with **large atypical B-cells**. - The histological appearance is generally of a **diffuse infiltrate**, which lacks the classic starry sky histology. *ALCL* - Anaplastic large cell lymphoma (ALCL) is characterized by **large, pleomorphic cells** but does not show a starry sky appearance. - The histological pattern primarily focuses on **large anaplastic lymphoid cells** rather than the scattered macrophages seen in Burkitt's lymphoma. **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.

Question 1408: What is the cell of origin of B-cell Acute Lymphoblastic Leukemia (B-ALL)?

A. T cells
B. Immature B cells (Correct Answer)
C. Immature T cells
D. Both T & B cells

Explanation: ***Immature B cells*** - B acute lymphoblastic leukemia (B ALL) is primarily derived from the **malignant transformation of precursor B lymphocytes** [1]. - The disease is characterized by the presence of **immature B cell blasts** in the bone marrow and peripheral blood [1]. *T cells* - T cells are involved in a different lineage of leukemia known as T-ALL, not B ALL [1]. - The pathophysiology of B ALL specifically relates to **B cell precursors**, not T cell involvement. *Both T & B cells* - This option is incorrect as B ALL specifically originates from **B cell lineage**, and T cells are unrelated to its pathogenesis [1]. - The presence of both T and B cells together characterizes mixed lineage leukemias, which is not the case here. *Immature T cells* - Immature T cells are precursors for **T acute lymphoblastic leukemia (T-ALL)**, not for B ALL [1]. - B ALL does not involve T cell precursors; the focus is solely on **immature B cells** [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. 596-600.

Question 1409: What is the chromosomal translocation associated with Acute Myeloid Leukemia M3?

A. t(18;21)
B. t(15;17) (Correct Answer)
C. t(9;11)
D. t(8;21)

Explanation: ***T (15,17)*** [1][2][3] - This translocation pertains to **Acute Promyelocytic Leukemia (APL)**, associated with the fusion gene **PML-RARA** [1][3]. - APL is characterized by **promyelocytes** with heavy granulation and a clinical presentation that includes coagulopathy [2][3]. *T (8, 21)* - This translocation is associated with **AML M2**, involving the **RUNX1-RUNX1T1** fusion gene [3]. - It does not correlate with the classic features of AML M3, which is specifically characterized by T (15,17). *T (9,11)* - Primarily seen in **AML M5**, this translocation is not related to the pathophysiology of AML M3. - The fusion commonly observed here is **MLL-AFF1**, which affects different types of leukemias, not APL. *T (18,21)* - This translocation does not have a significant association with any specific type of acute myeloid leukemia. - Unlike T (15,17), it is not linked to the classic features or unique clinical presentation seen in AML M3. **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] 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. [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. 620.

Question 1410: In which type of Hodgkin's Lymphoma are lacunar cells typically observed?

A. Mixed cellularity type
B. Lymphocyte predominant type
C. Nodular Sclerosis type (Correct Answer)
D. All of the options

Explanation: ***Nodular Sclerosis Type*** - **Lacunar cells** are characteristically seen in **Nodular Sclerosis Hodgkin lymphoma**, which is the most common subtype [1][3]. - These cells are large **Reed-Sternberg cells** with a distinctive morphology, typically found in **fibrous areas** of the lymph node [1]. *Mixed cellularity type* - This subtype is associated with a diverse cell population but does not primarily feature **lacunar cells** [2][4]. - It predominantly contains **Reed-Sternberg cells** without the specific morphology seen in nodular sclerosis [2]. *Lymphocyte predominant* - Lymphocyte predominant type mainly consists of **lymphocytes** with few Reed-Sternberg cells, and lacks **lacunar cells** [5]. - The histology is significantly different, exhibiting a more lymphocytic composition and not the classic lucent spaces [5]. *All of the above* - This option is incorrect as neither **Mixed cellularity** nor **Lymphocyte predominant** types contain **lacunar cells** [2][4][5]. - Lacunar cells are a distinctive feature solely of the **Nodular Sclerosis type** in Hodgkin lymphoma [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, p. 616. [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. 616-618. [3] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Diseases Of The Urinary And Male Genital Tracts, pp. 558-559. [4] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Diseases Of The Urinary And Male Genital Tracts, pp. 559-560. [5] 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. 618.

Practice by Chapter

Anemias: Classification and Approach

Practice Questions

Hemolytic Anemias

Practice Questions

Myeloproliferative Neoplasms

Practice Questions

Myelodysplastic Syndromes

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Acute Leukemias

Practice Questions

Chronic Leukemias

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Lymphomas and Lymphoid Neoplasms

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Plasma Cell Disorders

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Bleeding Disorders

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Thrombotic Disorders

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