Hematopathology Practice Questions

Q: Plasma cell dyscrasias include all of the following except?

Systemic lupus erythematosus. **Explanation:** **Plasma cell dyscrasias** are a group of disorders characterized by the neoplastic proliferation of a single clone of plasma cells. These cells typically secrete a monoclonal immunoglobulin or a fragment thereof (M-protein/paraprotein), which can be detected in the serum or urine. **Why Systemic Lupus Erythematosus (SLE) is the correct answer:** SLE is a chronic **autoimmune disease** characterized by the loss of self-tolerance and the production of a wide array of autoantibodies (like ANA and anti-dsDNA). While it involves B-cell hyperactivity, it is **not** a monoclonal neoplastic proliferation of plasma cells. Therefore, it does not fall under the category of plasma cell dyscrasias. **Analysis of incorrect options:** * **Waldenström’s Macroglobulinemia:** A lymphoplasmacytic lymphoma where malignant cells secrete monoclonal **IgM**, leading to hyperviscosity syndrome. * **Heavy Chain Disease:** A rare B-cell proliferative disorder where plasma cells produce only truncated heavy chains without light chains. * **Monoclonal Gammopathy (MGUS):** The most common plasma cell dyscrasia, characterized by the presence of M-protein in the absence of end-organ damage (CRAB features). It is often a precursor to Multiple Myeloma. **High-Yield Clinical Pearls for NEET-PG:** * **Multiple Myeloma** is the prototype plasma cell dyscrasia. Look for the **CRAB** mnemonic: **C**alcium elevation, **R**enal insufficiency, **A**nemia, and **B**one lesions (lytic). * **Diagnosis:** The presence of **"Clock-face" or "Cartwheel" nuclei** in plasma cells on histology is a classic descriptor. * **Bence-Jones Proteins:** These are monoclonal light chains found in the urine of patients with plasma cell dyscrasias; they precipitate at 40-60°C and redissolve at 100°C. * **Russell Bodies:** Cytoplasmic inclusions of immunoglobulins found in plasma cells.

Q: Isolated deletion of which chromosome causes myelodysplastic syndrome?

5q. **Explanation:** **Myelodysplastic Syndrome (MDS)** is a group of clonal hematopoietic stem cell disorders characterized by cytopenia, ineffective hematopoiesis, and a risk of transformation to Acute Myeloid Leukemia (AML) [1]. **Why 5q is correct:** The **isolated deletion of the long arm of chromosome 5 [del(5q)]** defines a specific clinical entity known as **"5q-minus syndrome."** This is the most common cytogenetic abnormality in MDS. It typically affects elderly women and is characterized by: * Refractory macrocytic anemia. * Normal or elevated platelet counts (thrombocytosis). * Hypolobated micromegakaryocytes in the bone marrow. * A favorable prognosis and excellent response to **Lenalidomide**. **Why other options are incorrect:** * **2q:** Deletions or translocations involving 2q are rare in MDS and do not define a specific isolated syndrome. * **8q:** While **Trisomy 8 (+8)** is a common cytogenetic finding in MDS, isolated deletions of the long arm of chromosome 8 are not characteristic of the disease. * **11q:** Deletions of 11q (specifically involving the *CBL* or *MLL* genes) can occur in various myeloid neoplasms, but they are not the classic "isolated deletion" associated with a specific MDS subtype like 5q. **High-Yield Clinical Pearls for NEET-PG:** * **Most common cytogenetic abnormality in MDS:** del(5q). * **Other common abnormalities:** Trisomy 8 (+8), Monosomy 7 (-7), and del(20q) [1]. * **Poor Prognostic Marker:** Monosomy 7 (-7) or complex karyotypes (>3 abnormalities) [1]. * **Drug of Choice for 5q- syndrome:** Lenalidomide (a thalidomide analogue). * **Morphological Hallmark:** "Pawn ball" megakaryocytes (small, mononuclear) are highly suggestive of MDS. **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. 622-624.

Question 1

Plasma cell dyscrasias include all of the following except?

Accepted Answer

Systemic lupus erythematosus

Answer

Waldenstrom's macroglobulinemia

Answer

Heavy chain disease

Answer

Monoclonal gammopathy

Question 2

Bence Jones proteins are derived from:

Accepted Answer

Gamma Globulins

Answer

Alpha Globulins

Answer

Beta Globulins

Answer

Delta Globulins

Question 3

Which of the following can cause thrombocytopenia?

Accepted Answer

Heparin, DIC, Hemolytic uremic syndrome (HUS)

Answer

Heparin, DIC, Henoch-schonlein purpura (HSP)

Answer

DIC, Henoch-schonlein purpura (HSP), Hemolytic uremic syndrome (HUS)

Answer

Heparin, Henoch-schonlein purpura (HSP), Hemolytic uremic syndrome (HUS)

Question 4

Which of the following conditions, characterized by spherocytes on peripheral smear, is Coombs negative?

Accepted Answer

G6PD Deficiency

Answer

Paroxysmal nocturnal hemoglobinuria

Answer

Hemolytic disease of newborn

Answer

Autoimmune Hemolytic Anemia (AIHA)

Question 5

Sickle cell anemia is usually associated with all of the following, except:

Accepted Answer

Normal reticulocyte count

Answer

Shortened RBC life span

Answer

Abnormality in Hemoglobin

Answer

Polymer formation is reversible

Question 6

Isolated deletion of which chromosome causes myelodysplastic syndrome?

Accepted Answer

5q

Answer

2q

Answer

8q

Answer

11q

Question 7

A 30-year-old female presents with an RBC count of 4.5 million/µL, MCV of 55 fL, and TLC of 8000/µL. She has no history of blood transfusion. What is the most likely diagnosis?

Accepted Answer

Thalassemia minor

Answer

Iron deficiency anemia

Answer

Thalassemia major

Answer

Megaloblastic anemia

Question 8

In alpha-thalassemia trait, what is shown on electrophoresis?

Accepted Answer

Normal HbF and normal HbA2

Answer

Increased HbF and normal HbA2

Answer

Normal HbF and decreased HbA2

Answer

Decreased HbF and normal HbA2

Question 9

In sickle cell trait, how many hemoglobin bands are typically found?

Accepted Answer

2

Answer

1

Answer

4

Answer

5

Question 10

Decreased LAP score is found in:

Accepted Answer

Pernicious anemia

Answer

Leukaemoid reaction

Answer

Myelofibrosis

Answer

Polycythemia

Hematopathology — MCQs

Hematopathology — MCQs

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