Hematopathology Practice Questions

Q: What is the typical HbA2 concentration in thalassemia trait?

Greater than 3.5%. **Explanation:** The hallmark of **$\beta$-thalassemia trait (minor)** is a compensatory increase in **HbA2 ($\alpha_2\delta_2$)**. In this condition, there is a reduced synthesis of $\beta$-globin chains. To compensate for the lack of $\beta$-chains, there is a relative increase in the synthesis of $\delta$-globin chains, which combine with free $\alpha$-chains, leading to elevated HbA2 levels [1]. * **Correct Answer (D):** In $\beta$-thalassemia trait, HbA2 levels typically range between **3.5% and 7%**. A value >3.5% is the most reliable diagnostic marker for identifying carriers in a screening setting (using HPLC or electrophoresis). **Analysis of Incorrect Options:** * **Option A (<1%):** This is abnormally low. Low HbA2 is seen in **$\alpha$-thalassemia** or severe **iron deficiency anemia (IDA)** [1]. * **Option B (1% to 2.5%):** This is below the normal range. * **Option C (2.5% to 3.5%):** This represents the **normal physiological range** of HbA2 in a healthy adult. **High-Yield Clinical Pearls for NEET-PG:** 1. **Mentzer Index:** (MCV/RBC count) $ 13$ suggests Iron Deficiency Anemia. 2. **Iron Deficiency Masking:** Co-existing iron deficiency can lower HbA2 levels, potentially masking a $\beta$-thalassemia trait diagnosis. Iron stores should be replenished before confirming the HbA2 status. 3. **HbF Levels:** In $\beta$-thalassemia trait, HbF is usually normal or only slightly elevated (1–5%). 4. **Peripheral Smear:** Characterized by microcytic hypochromic anemia with **target cells** and basophilic stippling. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Red Blood Cell and Bleeding Disorders, pp. 647-650.

Q: Maltoma is positive for which of the following markers?

CD 23. **Explanation:** MALToma (Mucosa-Associated Lymphoid Tissue lymphoma) is a type of Extranodal Marginal Zone B-cell Lymphoma. It typically arises in the setting of chronic inflammation, most commonly in the stomach associated with *H. pylori* infection [1]. **Why CD 23 is the correct answer:** MALTomas are derived from post-germinal center B-cells. While the neoplastic B-cells themselves are typically CD20+, CD19+, and **CD23 negative**, the characteristic histological feature of MALToma is the presence of **expanded follicular dendritic cell (FDC) networks** within the colonized reactive germinal centers. These FDC networks are strongly positive for **CD 23** and CD 21. In the context of NEET-PG questions, CD 23 is often used as a marker to identify these underlying meshworks that support the tumor architecture. **Analysis of Incorrect Options:** * **CD 3:** This is a pan-T-cell marker. MALToma is a B-cell neoplasm, so it will be negative for CD 3. * **CD 10:** This is a marker for Germinal Center B-cells (found in Follicular Lymphoma and Burkitt Lymphoma). MALToma is a marginal zone lymphoma and is typically CD 10 negative. * **CD 5:** This marker is positive in Chronic Lymphocytic Leukemia (CLL/SLL) and Mantle Cell Lymphoma. MALToma is characteristically **CD 5 negative**, which helps in its differential diagnosis from other small B-cell lymphomas. **High-Yield Clinical Pearls for NEET-PG:** * **Most common site:** Stomach (*H. pylori* association) [1]. * **Cytogenetics:** t(11;18)(q21;q21) is the most common translocation (API2-MALT1 fusion). * **Hallmark Histology:** Lymphoepithelial lesions (invasion of glandular epithelium by neoplastic B-cells). * **Treatment:** Early-stage gastric MALToma often regresses with *H. pylori* eradication (triple therapy). **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Alimentary System Disease, pp. 356-357.

Question 1

Which of the following are types of Hodgkin's lymphoma?

Accepted Answer

All of the above

Answer

Nodular sclerosing

Answer

Lymphocyte depletion

Answer

Mixed cellularity

Question 2

Which of the following is not a type of Langerhans cell histiocytosis?

Accepted Answer

Thomsen disease

Answer

Hand-Schüller-Christian disease

Answer

Eosinophilic granuloma

Answer

Letterer-Siwe syndrome

Question 3

The Philadelphia chromosome is most commonly associated with which of the following conditions?

Accepted Answer

Chronic Myeloid Leukemia (CML)

Answer

Leukemoid reaction

Answer

Eosinophilia

Answer

Malaria

Question 4

What is the typical HbA2 concentration in thalassemia trait?

Accepted Answer

Greater than 3.5%

Answer

Less than 1%

Answer

1% to 2.5%

Answer

2.5% to 3.5%

Question 5

All of the following are true regarding Leukemoid reaction, EXCEPT:

Accepted Answer

Neutrophil count >= 11600/mL

Answer

Blast cells <5%

Answer

Platelet count 100,000/mL

Answer

Hemoglobin > 9 gm%

Question 6

Which of the following statements about hematological disorders is true?

Accepted Answer

Both PT and aPTT are increased in DIC.

Answer

In Hemophilia B, cryoprecipitate is useful.

Answer

Desmopressin has no role in von Willebrand disease.

Answer

Hemorrhagic disease of the newborn is due to vitamin C deficiency.

Question 7

Which of the following findings is false regarding thrombotic thrombocytopenic purpura?

Accepted Answer

High ADAMTS13 activity

Answer

Renal failure

Answer

Schistocytes in peripheral smear

Answer

Transient neurological deficits

Question 8

Which of the following conditions is associated with necrotizing lymphadenitis?

Accepted Answer

Kikuchi disease

Answer

Hodgkin's disease

Answer

Kimura disease

Answer

Sarcoidosis

Question 9

Reticulocytosis is seen in all conditions EXCEPT:

Accepted Answer

Nutritional anemia

Answer

Paroxysmal nocturnal hemoglobinuria (PNH)

Answer

Hemolysis

Answer

Dyserythropoietic syndrome

Question 10

Maltoma is positive for which of the following markers?

Accepted Answer

CD 23

Answer

CD 3

Answer

CD 10

Answer

CD 5

Hematopathology — MCQs

Hematopathology — MCQs

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