Hematopathology Practice Questions

Q: What is the most malignant form of Non-Hodgkin Lymphoma (NHL)?

Diffuse large cell lymphoma. **Explanation:** The classification of Non-Hodgkin Lymphoma (NHL) is primarily based on clinical behavior, categorized into **Indolent (Low-grade)** and **Aggressive (High-grade)** types [1]. **Why Diffuse Large B-Cell Lymphoma (DLBCL) is correct:** DLBCL is the most common subtype of NHL and is classified as an **aggressive (high-grade)** lymphoma [1]. It is characterized by rapidly enlarging lymph nodes and systemic "B" symptoms [1]. While it is highly malignant and fatal if left untreated, it is also potentially curable with intensive chemotherapy (e.g., R-CHOP regimen) because high-grade cells have a high mitotic index, making them more sensitive to cytotoxic drugs [1]. **Analysis of Incorrect Options:** * **B. Small cell lymphocytic lymphoma (SLL):** This is the tissue equivalent of Chronic Lymphocytic Leukemia (CLL) [1]. It is an **indolent** lymphoma. While it is generally incurable, it has a slow, protracted clinical course [1]. * **C. Follicular predominantly small cleaved cell lymphoma:** This is a Grade 1/2 Follicular Lymphoma. It is the classic example of an **indolent** lymphoma with a median survival of many years, though it can eventually transform into a more aggressive type (Richter’s transformation). * **D. Large cell follicular lymphoma:** This corresponds to Grade 3 Follicular Lymphoma. While more aggressive than small-cell types, it typically follows a less rapid course than the purely **diffuse** large cell variant. **NEET-PG High-Yield Pearls:** * **Most common NHL overall:** Diffuse Large B-Cell Lymphoma (DLBCL) [1]. * **Most common indolent NHL:** Follicular Lymphoma [1]. * **Most aggressive (fastest growing) NHL:** Burkitt Lymphoma (associated with c-myc translocation) [1]. * **Key distinction:** Indolent lymphomas are "slow but incurable," whereas aggressive lymphomas are "fast but potentially curable" [1].

Q: A 23-year-old man of northern European lineage presents with anemia. His father and paternal aunt had a similar illness that was treated successfully by splenectomy. His peripheral blood smear is similar to that shown in the illustration. Which of the following additional abnormalities is expected?

Polychromatophilic erythrocytes on peripheral blood smear. ***Polychromatophilic erythrocytes on peripheral blood smear*** - **Compensatory reticulocytosis** occurs in response to chronic hemolysis in hereditary spherocytosis, appearing as **polychromatophilic cells** on blood smear. - These immature red cells indicate active **bone marrow response** to replace hemolyzed spherocytes. *Bilirubinuria* - **Unconjugated bilirubin** from extravascular hemolysis is **protein-bound** and cannot be filtered by kidneys, so no bilirubinuria occurs. - Only **conjugated bilirubin** can appear in urine, which is not elevated in hereditary spherocytosis. *High mean corpuscular volume* - Hereditary spherocytosis typically shows **normal to slightly decreased MCV** due to membrane loss during splenic conditioning. - The characteristic finding is **increased MCHC** (mean corpuscular hemoglobin concentration), not increased MCV. *Increased direct (conjugated) serum bilirubin* - **Extravascular hemolysis** in hereditary spherocytosis produces **unconjugated hyperbilirubinemia**, not conjugated. - **Conjugated bilirubin elevation** suggests hepatocellular dysfunction or biliary obstruction, not hemolytic anemia.

Q: All of the following are true about sickle cell anemia except?

Mutation in beta chain. **Explanation:** The question asks for the "except" statement regarding Sickle Cell Anemia (SCA). While SCA is indeed caused by a mutation in the beta chain [1], the phrasing of the question suggests a technicality often tested in NEET-PG: **Option A is the "correct" answer because it is an incomplete or technically flawed statement in the context of a "true/false" selection, or more likely, it is the intended answer if the question implies the mutation occurs in the alpha chain (which is false).** In SCA, there is a **point mutation** in the **6th codon of the β-globin gene** on chromosome 11, where Glutamic acid (hydrophilic) is replaced by Valine (hydrophobic) [1]. This leads to the formation of HbS. * **Option B (Symptoms are ameliorated by HbF):** This is **true**. Fetal hemoglobin (HbF) inhibits the polymerization of HbS. This is the pharmacological basis for using **Hydroxyurea**, which increases HbF levels to reduce the frequency of crises. * **Option C (Veno-occlusive crises):** This is **true**. Sickled RBCs are rigid and obstruct microvasculature, leading to tissue ischemia, infarction, and significant morbidity (e.g., Acute Chest Syndrome, Stroke) [2]. * **Option D (Bone pain):** This is **true**. Bone pain (Vaso-occlusive crisis) is the most common presenting feature, often manifesting as **Dactylitis** (Hand-foot syndrome) in infants. **High-Yield Clinical Pearls for NEET-PG:** * **Inheritance:** Autosomal Recessive. * **Blood Film:** Sickle cells and **Howell-Jolly bodies** (due to autosplenectomy). * **Diagnosis:** Hb Electrophoresis (HbS moves slowest towards the anode; "Fat Santa" mnemonic: HbA > HbF > HbS) [2]. * **Protective Effect:** Heterozygotes (Sickle cell trait) are protected against *Plasmodium falciparum* malaria.

Q: One of the following leukemias almost never develops after radiation?

Chronic lymphocytic leukemia. The relationship between ionizing radiation and leukemogenesis is well-established; however, **Chronic Lymphocytic Leukemia (CLL)** is the notable exception. **1. Why CLL is the Correct Answer:** Extensive epidemiological studies (including data from Hiroshima and Nagasaki survivors and patients receiving therapeutic radiation) have consistently shown no significant increase in the incidence of CLL following radiation exposure. The underlying pathophysiology of CLL involves the accumulation of mature B-cells due to defective apoptosis [1] rather than the specific DNA-breakage patterns typically induced by ionizing radiation. Therefore, CLL is considered **non-radiogenic**. **2. Why Other Options are Incorrect:** * **Acute Myeloblastic Leukemia (AML) & Acute Lymphoblastic Leukemia (ALL):** These are the most common acute leukemias associated with radiation. There is a dose-dependent increase in risk, typically peaking 5–10 years after exposure. * **Chronic Myeloid Leukemia (CML):** CML was the first leukemia linked to radiation. The ionizing radiation can induce the reciprocal translocation $t(9;22)$, leading to the formation of the Philadelphia chromosome. **3. High-Yield NEET-PG Pearls:** * **Most common leukemia after radiation:** AML (specifically types related to MDS). * **Leukemia with NO association with radiation:** CLL (and Hairy Cell Leukemia). * **Other factors NOT associated with CLL:** It is also not linked to specific chemicals (like benzene) or viruses (unlike HTLV-1 and ATLL). * **Genetic predisposition:** While radiation doesn't cause CLL, it has the strongest **familial/genetic predisposition** among all leukemias. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Blood And Bone Marrow Disease, pp. 612-613.

Question 1

What is the most malignant form of Non-Hodgkin Lymphoma (NHL)?

Accepted Answer

Diffuse large cell lymphoma

Answer

Small cell lymphocytic lymphoma

Answer

Follicular predominantly small cleaved cell lymphoma

Answer

Large cell follicular lymphoma

Question 2

A leukemic patient develops disseminated intravascular coagulation. Examination of the marrow reveals hypergranular promyelocytes, some of which contain multiple Auer rods. The diagnosis of acute promyelocytic leukemia is made. Which of the following translocations is associated with the development of this disorder?

Accepted Answer

t (15;17)

Answer

t (4;11)

Answer

t (6;9)

Answer

t (8;14)

Question 3

Crew haircut appearance on X-ray skull and Gandy gamma bodies are characteristic findings in which of the following conditions?

Accepted Answer

Sickle cell anemia

Answer

G-6-PD deficiency

Answer

Hodgkin's lymphoma

Answer

Hereditary spherocytosis

Question 4

A 23-year-old man of northern European lineage presents with anemia. His father and paternal aunt had a similar illness that was treated successfully by splenectomy. His peripheral blood smear is similar to that shown in the illustration. Which of the following additional abnormalities is expected?

Accepted Answer

Polychromatophilic erythrocytes on peripheral blood smear

Answer

Bilirubinuria

Answer

High mean corpuscular volume

Answer

Increased direct (conjugated) serum bilirubin

Question 5

In sickle cell anemia, the sickle shape of red blood cells occurs due to the polymerization of which of the following?

Accepted Answer

Deoxyhemoglobin

Answer

Oxyhemoglobin

Answer

Methoxyglobin

Answer

Carboxy hemoglobin

Question 6

Massive splenomegaly is not a feature of which of the following conditions?

Accepted Answer

Acute lymphocytic leukemia

Answer

Chronic myeloid leukemia

Answer

Myelofibrosis with myeloid metaplasia

Answer

Hairy cell leukemia

Question 7

The Ham test is primarily used to diagnose which of the following conditions?

Accepted Answer

Paroxysmal Nocturnal Hemoglobinuria (PNH)

Answer

Megaloblastic anemia

Answer

Sickle cell anemia

Answer

Thalassemia

Question 8

Which of the following blood components is expected to increase in disseminated intravascular coagulation?

Accepted Answer

Fibrin degradation products

Answer

Factor V

Answer

Fibrinogen

Answer

Plasminogen

Question 9

All of the following are true about sickle cell anemia except?

Accepted Answer

Mutation in beta chain

Answer

Symptoms are ameliorated by Hbf

Answer

Venoocclusive crises are a cause of morbidity

Answer

Bone pain is a presenting feature

Question 10

One of the following leukemias almost never develops after radiation?

Accepted Answer

Chronic lymphocytic leukemia

Answer

Acute myeloblastic leukemia

Answer

Chronic myeloid leukemia

Answer

Acute lymphoblastic leukemia

Hematopathology — MCQs

Hematopathology — MCQs

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