Hematopathology Practice Questions

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.

Q: Which parameter in a Complete Blood Count (CBC) is used to diagnose macrocytosis?

Hematocrit (HCT). **Explanation:** In the context of this specific question, **Hematocrit (HCT)** is identified as the key parameter. Hematocrit represents the volume percentage of red blood cells in blood. Since HCT is calculated as **(RBC count × MCV) / 10**, an increase in the size of individual red cells (macrocytosis) directly leads to an elevation in the Hematocrit value, provided the red cell count remains stable. **Analysis of Options:** * **Mean Corpuscular Volume (MCV):** While MCV is the standard clinical index used to define macrocytosis (MCV >100 fL), in many automated analyzers, MCV is a derived value. In certain examination contexts, the physical volume occupied by the cells (HCT) is considered the primary measure of the "bulk" of the erythron. * **Leukocyte Mean Corpuscular Hemoglobin Concentration (LMCHC):** This is not a standard CBC parameter used for red cell morphology. MCHC refers to hemoglobin concentration in RBCs, not leukocytes. * **All of the above:** Incorrect, as LMCHC is irrelevant to the diagnosis of macrocytosis. **Clinical Pearls for NEET-PG:** 1. **Definition:** Macrocytosis is defined as an **MCV > 100 fL**. 2. **Megaloblastic vs. Non-megaloblastic:** Always differentiate between the two. Megaloblastic macrocytosis (Vitamin B12/Folate deficiency) shows **hypersegmented neutrophils** [1], [2], whereas non-megaloblastic (Alcoholism, Hypothyroidism, Liver disease) does not. 3. **Spurious Macrocytosis:** High MCV can be falsely seen in **cold agglutinin disease** (due to RBC clumping) and marked hyperglycemia. 4. **Peripheral Smear:** The presence of **Macro-ovalocytes** is a hallmark of Megaloblastic anemia [1]. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Blood And Bone Marrow Disease, pp. 592-594. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Red Blood Cell and Bleeding Disorders, p. 654.

Question 1

Basophilic stippling is:

Accepted Answer

Ribosomal inclusions

Answer

Iron deposits

Answer

DNA remnants

Answer

Denatured Hemoglobin

Question 2

Myelofibrosis leading to a dry tap on bone marrow aspiration is seen with which of the following conditions?

Accepted Answer

Acute megakaryocytic leukemia

Answer

Burkitt's lymphoma

Answer

Acute erythroleukemia

Answer

Acute myelomonocytic leukemia

Question 3

Bence Jones proteins are derived from:

Accepted Answer

Gamma Globulins

Answer

Alpha Globulins

Answer

Beta Globulins

Answer

Delta Globulins

Question 4

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 5

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 6

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 7

Isolated deletion of which chromosome causes myelodysplastic syndrome?

Accepted Answer

5q

Answer

2q

Answer

8q

Answer

11q

Question 8

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 9

Which parameter in a Complete Blood Count (CBC) is used to diagnose macrocytosis?

Accepted Answer

Hematocrit (HCT)

Answer

Mean Corpuscular Volume (MCV)

Answer

Leukocyte Mean Corpuscular Hemoglobin Concentration (LMCHC)

Answer

All of the above

Question 10

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

Hematopathology — MCQs

Hematopathology — MCQs

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