Hematopathology — MCQs

A 68-year-old woman was admitted with a history of weakness for two months. On examination, cervical lymph nodes were found enlarged and the spleen was palpable 2 cm below the costal margin. Her hemoglobin was 10.5 g/dL, platelet count 27 × 10^9/L, and total leukocyte count 40 × 10^9/L, which included 80% mature lymphoid cells with coarse clumped chromatin. Bone marrow revealed a nodular lymphoid infiltrate. The peripheral blood lymphoid cells were positive for CD19, CD5, CD20, and CD23, and negative for CD79B and FMC-7. The histopathological examination of the lymph node in this patient will most likely exhibit effacement of lymph node architecture by?

Q1417

Which of the following Non-Hodgkin's lymphomas was historically classified as intermediate grade in the Working Formulation?

Q1418

The 'hair on end' appearance is characteristically seen in which of the following conditions?

Q1419

A 62-year-old man presents with back pain for 4 months. Laboratory tests show a white blood cell count of 3700/microliter, hemoglobin of 10.3 g/dL, hematocrit of 31.1%, mean corpuscular volume of 85 fL, and a platelet count of 110,000/microliter. His total serum protein is 8.5 g/dL, with an albumin level of 4.1 g/dL. A chest radiograph shows lucencies in the vertebral bodies. A sternal bone marrow aspirate yields a dark red jelly-like material. Which cell type is most likely to be numerous in this aspirate?

Q1420

Which of the following findings is characteristic of megaloblastic anemia?

Hematopathology Indian Medical PG Practice Questions and MCQs

Question 1411: Which of the following is not typically seen in Disseminated Intravascular Coagulation (DIC)?

A. Thrombocytopenia
B. PT elevation
C. Fibrinogen decreased
D. Normal aPTT (Correct Answer)

Explanation: ***Normal APTT*** - In Disseminated Intravascular Coagulation (**DIC**), **APTT** is typically **prolonged** due to consumption of clotting factors [1]. - The presence of normal APTT indicates that coagulation pathways are not significantly affected, which is contrary to what is seen in DIC. *Fibrinogen decreased* - **Decreased fibrinogen levels** are common in DIC, reflecting its consumption during the coagulation process [1]. - This depletion is linked to the increased clotting and is a hallmark of DIC, making this statement false in the context of the question. *Thrombocytopenia* - **Thrombocytopenia** occurs in DIC as platelets are consumed during the formation of microclots [1]. - A significant drop in platelet count is a key feature of DIC, therefore this statement does not align with the "except" clause. *PT elevation* - Prothrombin Time (**PT**) is usually **elevated** in DIC due to the consumption of clotting factors [1]. - This reflects the ongoing activation of the coagulation cascade, supporting the exclusion in the question context. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Blood And Bone Marrow Disease, pp. 625-626.

Question 1412: 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 1413: Which acquired condition is most commonly associated with spherocytes?

A. Autoimmune hemolytic anemia (AIHA) (Correct Answer)
B. Vitamin B12 deficiency anemia
C. Aplastic anemia
D. None of the options

Explanation: ***Autoimmune haemolytic anemia*** - This condition is characterized by the **production of antibodies** against the patient's own red blood cells, leading to **destruction** and the formation of spherocytes [1]. - The presence of ***maximum spherocytes*** in blood smears is a hallmark of this disorder due to **extravascular hemolysis** [1]. *Aplastic anemia* - Aplastic anemia is mainly due to **failure of hematopoiesis**, resulting in pancytopenia rather than spherocyte formation. - It typically presents with **normocytic** or **macrocytic anemia**, not spherocytes, as the bone marrow is not producing enough red blood cells [2]. *Vit B12 deficiency* - Vit B12 deficiency usually causes **macrocytic anemia** characterized by **megaloblastic changes** in the bone marrow and peripheral blood, not the formation of spherocytes. - The primary indicators would be **hypersegmented neutrophils** and large, ovalocytes rather than spherocytes. *None* - This option incorrectly implies that no condition causes maximum spherocytes, while autoimmune hemolytic anemia is the known condition for this finding. - Spherocytes are a specific sign in hemolytic processes and are definitely seen in conditions like **autoimmune hemolytic anemia**. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Blood And Bone Marrow Disease, pp. 602-603. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Red Blood Cell and Bleeding Disorders, pp. 662-663.

Question 1414: The subtype of Hodgkin's disease which is histogenetically distinct from all the other subtypes is:

A. Lymphocyte predominant (Correct Answer)
B. Nodular sclerosis
C. Mixed cellularity
D. Lymphocyte depleted

Explanation: ***Lymphocyte predominant*** - This subtype is characterized by the presence of **popcorn cells** (a variant of Reed-Sternberg cells) and is histogenically distinct from other forms of Hodgkin's lymphoma [1]. - It typically features a **predominance of lymphocytes**, contrasting with the other subtypes that may show mixed cellularity or different cell backgrounds [1]. *Lymphocyte depleted* - This subtype has a high number of **Reed-Sternberg cells** and is often associated with **immunocompromised states**, making it less distinct than lymphocyte predominant [2]. - It typically presents with a poor prognosis and is characterized by **depletion** of lymphocytes rather than predominance [2]. *Nodular sclerosis* - This is one of the most common subtypes of Hodgkin's lymphoma, featuring **fibrosis** and often affecting mediastinal lymph nodes. - While distinct, it shares histopathological features with other standard forms of Hodgkin's lymphoma, thus not being **histogenically distinct**. *Mixed cellularity* - This subtype presents a heterogeneous mix of cells, including **Reed-Sternberg cells** and leukocytes, and is the most frequent subtype after nodular sclerosis [2]. - It is associated with lower lymphocyte predominance, thus lacking the unique histological characteristics found in lymphocyte predominant Hodgkin'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. 618. [2] 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.

Question 1415: BCR-ABL fusion gene is MOST CHARACTERISTICALLY seen in?

A. CML (Correct Answer)
B. AML
C. Chronic Lymphocytic Leukemia (CLL)
D. Acute Lymphoblastic Leukemia (ALL)

Explanation: ***CML*** - The **BCR-ABL gene mutation** is characteristic of **Chronic Myeloid Leukemia (CML)**, resulting from a translocation between chromosomes 9 and 22 [1]. - This mutation leads to the production of the **BCR-ABL fusion protein**, which promotes cell proliferation and inhibits apoptosis [1]. *AML* - Acute Myeloid Leukemia (AML) does not typically exhibit the **BCR-ABL fusion gene**; rather, it is associated with various other genetic mutations. - Key features of AML include **myeloblast proliferation** and it presents with different cytogenetic abnormalities like **FLT3 or NPM1 mutations**. *CLL* - Chronic Lymphocytic Leukemia (CLL) is characterized by the accumulation of **mature lymphocytes**, not the **BCR-ABL mutation**. - It is often associated with mutations such as **TP53** and **NOTCH1**, distinct from myeloid malignancies. *ALL* - Acute Lymphoblastic Leukemia (ALL) is primarily linked with **chromosomal translocations** involving **the TCF3** gene or others, but not specifically with **BCR-ABL**. - In ALL, **lymphoid progenitor cells** proliferate, whereas CML is primarily a **myeloid process** associated with the BCR-ABL gene [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. 624-625.

Question 1416: A 68-year-old woman was admitted with a history of weakness for two months. On examination, cervical lymph nodes were found enlarged and the spleen was palpable 2 cm below the costal margin. Her hemoglobin was 10.5 g/dL, platelet count 27 × 10^9/L, and total leukocyte count 40 × 10^9/L, which included 80% mature lymphoid cells with coarse clumped chromatin. Bone marrow revealed a nodular lymphoid infiltrate. The peripheral blood lymphoid cells were positive for CD19, CD5, CD20, and CD23, and negative for CD79B and FMC-7. The histopathological examination of the lymph node in this patient will most likely exhibit effacement of lymph node architecture by?

A. A monomorphic lymphoid proliferation with admixed proliferation centers (Correct Answer)
B. A polymorphous population of lymphocytes, plasma cells, eosinophils and scattered large binucleated cells
C. A predominantly follicular pattern with variably-sized follicles effacing nodal architecture
D. A diffuse proliferation of medium to large lymphoid cells with high mitotic rate

Explanation: ***A monomorphic lymphoid proliferation with admixed proliferation centers*** - The clinical and laboratory findings suggest **chronic lymphocytic leukemia (CLL)** [1], characterized by a predominance of **mature lymphoid cells** [2] and a nodular infiltrate in the bone marrow. - Histopathological examination would typically show a **monomorphic proliferation** of small, mature lymphocytes [1], which efface the lymph node architecture. *A diffuse proliferation of medium to large lymphoid cells with high mitotic rate.* - This description aligns more with **aggressive lymphomas**, such as diffuse large B-cell lymphoma, rather than CLL. - CLL is characterized by **low mitotic activity** and predominantly small, mature lymphocytes [2], not medium to large cells. *A predominantly follicular pattern with variably-sized follicles effacing nodal architecture* - This finding is typical of **follicular lymphoma**, where the architecture features multiple follicles rather than a monomorphic infiltrate. - The malignant cells in CLL do not form **follicular patterns** but rather disrupt the normal architecture with a more uniform appearance [1]. *A polymorphous population of lymphocytes, plasma cells, eosinophils and scattered large binucleated cells* - A polymorphous pattern suggests a **reactive lymphadenopathy** or conditions such as Hodgkin lymphoma, which show mixed cellularity. - CLL is characterized by **uniformity** in cell type [1] with little to no diversity in the lymphocyte population, making this option unsuitable. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Blood And Bone Marrow Disease, pp. 612-613. [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, p. 602.

Question 1417: Which of the following Non-Hodgkin's lymphomas was historically classified as intermediate grade in the Working Formulation?

A. Small non-cleaved cell lymphoma
B. Diffuse, small cleaved cell lymphoma (Correct Answer)
C. Lymphoblastic lymphoma
D. Large cell immunoblastic lymphoma

Explanation: ***Diffuse, small cleaved cell lymphoma*** - This subtype was classified under the **intermediate-grade** category in the Working Formulation, which was an older classification system for non-Hodgkin lymphomas. - The Working Formulation aimed to group lymphomas based on their **prognostic behavior**, with intermediate grade indicating a moderate clinical course. *Small non-cleaved cell lymphoma* - This lymphoma, now recognized as **Burkitt lymphoma**, was classified as **high-grade** in the Working Formulation due to its aggressive nature and rapid progression [3]. - It is characterized by a very high **proliferative rate** and aggressive clinical course [3]. *Lymphoblastic lymphoma* - This aggressive lymphoma was also classified as **high-grade** in the Working Formulation [2]. - It arises from immature lymphoid precursors and is notorious for its rapid growth and tendency to involve the **bone marrow** and **CNS** [2],[3]. *Large cell immunoblastic lymphoma* - This aggressive subtype was categorized under the **high-grade** category in the Working Formulation. - It is histologically defined by large, immature-appearing immunoblasts and typically has an **unfavorable prognosis** if left untreated [1]. **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. 563-564. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Diseases Of The Urinary And Male Genital Tracts, pp. 560-561. [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 1418: The 'hair on end' appearance is characteristically seen in which of the following conditions?

A. Sickle cell anaemia
B. Hereditary spherocytosis
C. Thalassemia major (Correct Answer)
D. G6PD deficiency

Explanation: ***Thalassemia major*** - The "hair-on-end" appearance on skull X-rays is caused by **extramedullary hematopoiesis** to compensate for severe anemia [2]. This leads to bone marrow expansion, particularly in the cranium, with perpendicular new bone formation [2]. - This characteristic radiological finding is a hallmark of **chronic hemolytic anemias**, especially those like thalassemia major [2], where there is ineffective erythropoiesis and significantly increased red blood cell turnover [3]. *Sickle cell anemia* - While sickle cell anemia can also cause **bone marrow expansion** and some changes in bone [1], the "hair-on-end" appearance is much less common and less pronounced compared to thalassemia major. - The primary bone changes in sickle cell disease are often related to **avascular necrosis** and **infarction**, not typically the prominent periosteal reaction seen in thalassemia [1]. *G6PD deficiency* - G6PD deficiency causes **intermittent hemolytic crises** triggered by oxidative stress, rather than chronic severe hemolytic anemia. - The bone marrow expansion is usually not severe or chronic enough to lead to the characteristic "hair-on-end" appearance seen in thalassemia major. *Hereditary spherocytosis* - Hereditary spherocytosis is characterized by abnormal red blood cell shape leading to premature destruction in the spleen, resulting in **chronic hemolytic anemia**. - While chronic hemolysis can induce some bone marrow expansion, the "hair-on-end" appearance is rare and not a classic feature, unlike in thalassemia major. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Red Blood Cell and Bleeding Disorders, pp. 644-645. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Red Blood Cell and Bleeding Disorders, pp. 648-649. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Red Blood Cell and Bleeding Disorders, p. 648.

Question 1419: A 62-year-old man presents with back pain for 4 months. Laboratory tests show a white blood cell count of 3700/microliter, hemoglobin of 10.3 g/dL, hematocrit of 31.1%, mean corpuscular volume of 85 fL, and a platelet count of 110,000/microliter. His total serum protein is 8.5 g/dL, with an albumin level of 4.1 g/dL. A chest radiograph shows lucencies in the vertebral bodies. A sternal bone marrow aspirate yields a dark red jelly-like material. Which cell type is most likely to be numerous in this aspirate?

A. Osteoblasts
B. Plasma cells (Correct Answer)
C. Giant cells
D. Fibroblasts

Explanation: ***Plasma cells*** - The presence of **dark red jelly-like material** in the bone marrow aspirate indicates a possible **myeloma**, which is characterized by an abundance of plasma cells [1]. - The lucencies in the vertebral bodies combined with low white blood cell count and **anemia** further support a diagnosis related to plasma cell dyscrasias like multiple myeloma [1][2][3]. *Osteoblasts* - Osteoblasts are responsible for **bone formation** and would not be expected to be numerous in this scenario where there is evidence of **bone loss** (lucencies). - Their presence would typically indicate **active bone remodeling**, not consistent with the findings of anemia and low cellularity in the context presented. *Fibroblasts* - Fibroblasts are involved in **connective tissue formation** and repair, and their numbers are not typically indicative of any hematologic disorders. - They do not directly relate to the findings of **anemia** and **bone lesions**, making them unlikely to be predominant in this aspirate. *Giant cells* - Giant cells, often associated with **inflammatory responses** or granulomatous conditions, do not correlate with the clinical picture of myeloma or the findings outlined in the case. - Their presence would suggest a different pathological process, unrelated to the presence of **plasma cells** in bone marrow aspirate [2]. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Blood And Bone Marrow Disease, pp. 616-617. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Blood And Bone Marrow Disease, pp. 617-618. [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. 606-609.

Question 1420: Which of the following findings is characteristic of megaloblastic anemia?

A. Macrocytic red blood cells
B. Reticulocytopenia
C. Hypersegmented neutrophils
D. All of the options (Correct Answer)

Explanation: ***All of the above*** - In megaloblastic anemia, various atypical red blood cell characteristics can be observed, including **Cabot rings**, **Howell-Jolly bodies**, and **basophilic stippling** [1]. - These features arise due to ineffective erythropoiesis and increased reticulocyte production, which are hallmark traits of megaloblastic changes [1]. *Cabot ring* - These are **red cell inclusions** that can be seen in conditions associated with **disrupted hemoglobin synthesis** or **abnormal nucleic acid metabolism**, but are not specific to megaloblastic anemia. - More commonly observed in conditions like **lead poisoning** or **myelodysplastic syndromes**. *Howell Jolly bodies* - These are nuclear remnants seen in red blood cells, typically present after **splenectomy** or in cases of **hemolytic anemia**, rather than specifically indicating megaloblastic anemia. - While they can be seen in megaloblastic anemia, they are not definitive; they signify **poor splenic function**. *Basophilic stippling* - Generally associated with **lead poisoning**, **thalassemias**, and certain types of **anemia**, but not exclusively indicative of megaloblastic anemia. - It results from **RNA remnants** in red blood cells and is more frequently noted in other forms of anemia. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Blood And Bone Marrow Disease, pp. 594-595.

Practice by Chapter

Anemias: Classification and Approach

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Hemolytic Anemias

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Myeloproliferative Neoplasms

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Myelodysplastic Syndromes

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Acute Leukemias

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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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