Hematopathology Practice Questions

Q: A peripheral smear demonstrates leukemia composed of small mature lymphocytes without blast forms. What is the most likely age of this patient?

65 years. ### Explanation The peripheral smear description of **small mature lymphocytes without blast forms** is the classic hematological hallmark of **Chronic Lymphocytic Leukemia (CLL)**. **1. Why 65 years is correct:** CLL is primarily a disease of the elderly, with a median age at diagnosis of approximately 70 years. It is characterized by the clonal proliferation of morphologically mature but immunologically incompetent B-lymphocytes. On a peripheral smear, these cells appear as small, round lymphocytes with scant cytoplasm and "block-like" chromatin. A key diagnostic feature often seen alongside these cells is **Smudge cells** (Gumprecht shadows), which are fragile lymphocytes ruptured during slide preparation. **2. Why other options are incorrect:** * **1 year (Option A):** This age group is most commonly associated with **Acute Lymphoblastic Leukemia (ALL)**. ALL presents with "blasts" (large cells with high N:C ratio and nucleoli), not mature lymphocytes. * **20 years (Option B):** While lymphomas can occur in young adults, a leukemia of mature lymphocytes is extremely rare in this age group. * **45 years (Option C):** This age is more characteristic of **Chronic Myeloid Leukemia (CML)**, which would show a full spectrum of myeloid cells (myelocytes, metamyelocytes) rather than mature lymphocytes. **3. High-Yield Clinical Pearls for NEET-PG:** * **Most common leukemia:** CLL is the most common leukemia in adults in Western countries. * **Immunophenotype:** CLL cells characteristically express **CD5** (a T-cell marker) along with B-cell markers **CD19, CD20, and CD23**. * **Richter Transformation:** In about 5-10% of cases, CLL can transform into a high-grade Diffuse Large B-cell Lymphoma (DLBCL). * **Pathognomonic sign:** Look for the mention of "Smudge cells" or "Basket cells" in the question stem to confirm CLL.

Question 1

A peripheral smear demonstrates leukemia composed of small mature lymphocytes without blast forms. What is the most likely age of this patient?

Accepted Answer

65 years

Answer

1 year

Answer

20 years

Answer

45 years

Question 2

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 3

Low haptoglobin in hemorrhage is masked by the concurrent presence of which of the following conditions?

Accepted Answer

Liver parenchymal disease

Answer

Malnutrition

Answer

Pregnancy

Answer

Obstructive biliary disease

Question 4

A patient presents with anemia and thrombocytopenia, and peripheral blood smear shows neutrophils with inclusions. What is the most probable diagnosis?

Accepted Answer

May-Hegglin anomaly

Answer

Evans syndrome

Answer

Alder-Reilly anomaly

Answer

Pelger-Huet anomaly

Question 5

A 30-year-old female patient presents with weakness and fatigue. Physical examination reveals koilonychia and pale mucous membranes. She also gives a history of irregular and heavy menstruation. The peripheral blood smear will most likely show anemia of which kind?

Accepted Answer

Microcytic and hypochromic.

Answer

Normocytic and normochromic.

Answer

Macrocytic and normochromic.

Answer

Macrocytic and hypochromic.

Question 6

Which of the following is a characteristic feature of chronic myeloid leukemia (CML)?

Accepted Answer

Basophilia

Answer

Auer rods

Answer

Increased LAP score

Answer

Bone marrow fibrosis

Question 7

Thrombocytopenia is not seen in which of the following conditions?

Accepted Answer

Henoch-Schönlein purpura

Answer

Disseminated intravascular coagulation (DIC)

Answer

Leukemia

Answer

Metastasis

Question 8

A child presents with spontaneous bleeding into the joint. Investigations reveal a prolonged aPTT and decreased levels of factor VIII. What is the likely inheritance pattern of this disease?

Accepted Answer

X-linked recessive

Answer

Autosomal dominant

Answer

Autosomal recessive

Answer

X-linked dominant

Question 9

All of the following are true about parahemophilia except?

Accepted Answer

X-linked recessive inheritance

Answer

Due to Factor V deficiency

Answer

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

Answer

All are true

Question 10

Decreased osmotic fragility is not seen in which of the following conditions?

Accepted Answer

Hereditary spherocytosis

Answer

Thalassemia

Answer

Sickle cell anemia

Answer

Iron deficiency

Hematopathology — MCQs

Hematopathology — MCQs

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