Hematopathology Practice Questions

Q: All of the following are poor prognostic markers of multiple myeloma, except?

t(1;14). **Explanation:** In Multiple Myeloma (MM), cytogenetic abnormalities are the strongest predictors of prognosis. These are broadly categorized into **High-Risk (Poor Prognosis)** and **Standard-Risk (Good/Intermediate Prognosis)**. **1. Why t(1;14) is the correct answer:** Translocation **t(1;14)** involves the *BCL9* gene and the immunoglobulin heavy chain (*IGH*) locus. Unlike other translocations involving chromosome 14, t(1;14) is considered a **standard-risk** cytogenetic marker. Patients with this translocation generally have outcomes similar to those with standard-risk disease, making it the "exception" among the poor prognostic markers listed. **2. Analysis of Incorrect Options (Poor Prognostic Markers):** * **t(14;16):** Involves the *MAF* gene. It is a classic high-risk translocation associated with aggressive disease and shorter survival. * **1q gain:** Gain of the long arm of chromosome 1 (1q21) is one of the most common high-risk features. It is associated with disease progression and resistance to standard therapies. * **t(14;20):** Involves the *MAFB* gene. Similar to t(14;16), it is categorized as a high-risk cytogenetic abnormality. **High-Yield Clinical Pearls for NEET-PG:** * **High-Risk Markers (Poor Prognosis):** del(17p) [TP53 mutation], t(4;14), t(14;16), t(14;20), and 1q gain. * **Standard-Risk Markers:** t(11;14), t(6;14), and hyperdiploidy. * **Revised ISS (R-ISS):** Prognosis is now determined by combining Serum Albumin, Beta-2 Microglobulin, LDH levels, and High-risk Cytogenetics (FISH) [1]. * **Most common translocation in MM:** t(11;14). (Note: While the provided literature discusses the clinical features and protein types in Multiple Myeloma [1], it confirms that renal failure is a significant poor prognostic indicator [1].) **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Blood And Bone Marrow Disease, pp. 618-619.

Q: Increased levels of hemoglobin A2 is characteristic of which condition?

Beta-thalassemia trait. **Explanation:** **Why Beta-thalassemia trait is correct:** In Beta-thalassemia trait (minor), there is a partial deficiency in the production of $\beta$-globin chains. To compensate for this deficit, the body increases the production of alternative globin chains. Specifically, there is an increase in $\delta$-chain synthesis, which combines with $\alpha$-chains to form **Hemoglobin A2 ($\alpha_2\delta_2$)**. [1] * **Diagnostic Hallmark:** An HbA2 level **>3.5%** (typically 4–8%) on Hb electrophoresis is the gold standard for diagnosing Beta-thalassemia trait. HbF levels may also be slightly elevated (1–5%). **Why the other options are incorrect:** * **Sickle cell trait (HbAS):** Characterized by the presence of HbA and HbS. HbA2 levels remain within the normal range (2–3%). * **G6PD deficiency:** This is an enzyme deficiency affecting the hexose monophosphate shunt, leading to episodic hemolysis. It does not involve globin chain synthesis defects; thus, the hemoglobin profile remains normal. * **Alpha-thalassemia:** Since HbA2 ($\alpha_2\delta_2$) requires $\alpha$-chains, a decrease in $\alpha$-globin production leads to **low or normal** HbA2 levels. [1] In severe forms (HbH disease), one sees $\beta_4$ tetrads instead. **NEET-PG High-Yield Pearls:** 1. **Mentzer Index:** (MCV/RBC count) 13 suggests Iron Deficiency Anemia (IDA). 2. **Differentiating IDA from Thalassemia:** HbA2 is **decreased** in IDA and **increased** in Beta-thalassemia trait. 3. **Peripheral Smear:** Look for microcytic hypochromic anemia with **target cells** and basophilic stippling. 4. **Silent Carrier:** Alpha-thalassemia minima (one gene deletion) usually has a completely normal electrophoresis. [1] **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Red Blood Cell and Bleeding Disorders, p. 650.

Question 1

Transient myeloproliferative disorder of the newborn is seen in association with which of the following conditions?

Accepted Answer

Down's syndrome

Answer

Turner's syndrome

Answer

Neurofibromatosis

Answer

Ataxia telangiectasia

Question 2

What is the normal myeloid:erythroid ratio?

Accepted Answer

3:1

Answer

2:1

Answer

1:1

Answer

4:1

Question 3

Which subtype of Hodgkin lymphoma is characterized by the lymphohistiocytic variant of Reed-Sternberg cells?

Accepted Answer

Lymphocyte predominant

Answer

Nodular sclerosis

Answer

Lymphocyte rich

Answer

Lymphocyte depleted

Question 4

For a thalassemic patient requiring recurrent transfusions who develops fever and chills after transfusion, what modification of the blood product can decrease the incidence of transfusion reactions?

Accepted Answer

Leukocyte depletion

Answer

Antibiotics

Answer

Irradiation

Answer

Washed RBCs

Question 5

Which of the following is not a feature of disseminated intravascular coagulation (DIC)?

Accepted Answer

Platelet function defect

Answer

Prolonged prothrombin time (PT) and activated partial thromboplastin time (aPTT)

Answer

Increased fibrin degradation products

Answer

Thrombocytopenia

Question 6

What is the most common cause of hereditary spherocytosis?

Accepted Answer

Ankyrin

Answer

Spectrin

Answer

Glycophorin

Answer

Band 4

Question 7

All of the following are poor prognostic markers of multiple myeloma, except?

Accepted Answer

t(1;14)

Answer

t(14;16)

Answer

1q gain

Answer

t(14;20)

Question 8

Which one of the following is the cause of non-cardiogenic pulmonary edema seen in immunologic blood transfusion reactions?

Accepted Answer

Donor antibody to leukocyte of patient

Answer

Antibody to IgA in donor plasma

Answer

Antibody to donor leukocyte antigen

Answer

RBC incompatibility

Question 9

The c-myc oncogene is located on chromosome 8. Which of the following hematologic malignancies is characteristically associated with a translocation involving the c-myc gene?

Accepted Answer

Burkitt's lymphoma

Answer

Follicular lymphoma

Answer

Mantle cell lymphoma

Answer

Body cavity lymphoma

Question 10

Increased levels of hemoglobin A2 is characteristic of which condition?

Accepted Answer

Beta-thalassemia trait

Answer

Sickle cell trait

Answer

Glucose-6-phosphate dehydrogenase deficiency

Answer

Alpha-thalassemia

Hematopathology — MCQs

Hematopathology — MCQs

On this page

Practice by Chapter

Want unlimited practice?