Hematopathology Practice Questions

Q: Periodic acid-Schiff (PAS) stain shows block positivity in which of the following cells?

Lymphoblasts. **Explanation:** The **Periodic acid-Schiff (PAS)** stain is a cytochemical stain used to detect glycogen and mucopolysaccharides. In hematopathology, it is a crucial tool for differentiating various types of acute leukemias. **1. Why Lymphoblasts are correct:** In **Acute Lymphoblastic Leukemia (ALL)**, lymphoblasts typically exhibit a characteristic **"block-like" or "chunky" positivity** (coarse granules) against a clear cytoplasmic background. This occurs because lymphoblasts contain large aggregates of glycogen. This pattern is highly suggestive of the L1 or L2 subtypes of ALL [1]. **2. Analysis of Incorrect Options:** * **Myeloblasts (Option A):** These cells are typically **PAS negative** or show only faint, diffuse cytoplasmic tinging. They are better identified using Myeloperoxidase (MPO) or Sudan Black B (SBB) stains. * **Monoblasts (Option B):** These cells usually show a **diffuse, fine granular positivity** scattered throughout the cytoplasm, rather than distinct blocks. They are best identified using Non-specific Esterase (NSE) stains. * **Megakaryoblasts (Option D):** While megakaryoblasts can be PAS positive, the staining is usually **diffuse or peripheral (fringe-like)** rather than the classic coarse blocks seen in lymphoblasts. **Clinical Pearls for NEET-PG:** * **MPO/SBB:** Positive in AML (Myeloid); Negative in ALL. * **PAS Block Positivity:** Classic for **ALL** and **Erythroleukemia (AML-M6)** (where it appears in the proerythroblasts). * **NSE (Non-specific Esterase):** Positive in Monocytic lineages (**AML-M4 and M5**); inhibited by Sodium Fluoride. * **Acid Phosphatase:** Shows focal "polar" positivity in **T-cell ALL** [1]. **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. 599-600.

Q: In hemolytic anemia, what changes occur in the skull bones?

Diploic space widening. In chronic hemolytic anemias (such as Thalassemia major and Sickle Cell Anemia), the fundamental process is **Compensatory Erythroid Hyperplasia** [1]. To compensate for the shortened lifespan of red blood cells, the bone marrow undergoes massive expansion to increase erythropoiesis [1]. ### Why the correct answer is right: * **Diploic Space Widening:** The skull is a major site of hematopoiesis in children. As the bone marrow expands, it pushes against the inner and outer tables of the skull, leading to a significant **widening of the diploic space** (the spongy bone layer between the tables). * **Radiological Correlation:** This expansion causes the characteristic **"Crew-cut" or "Hair-on-end" appearance** on X-ray, as new bone trabeculae are laid down perpendicular to the skull tables [1]. ### Why the incorrect options are wrong: * **Outer Table Thickening:** In reality, the expanding marrow causes **thinning of the outer table** due to pressure atrophy [1]. The inner table is usually spared. * **Diploic Space Narrowing:** This occurs in conditions of osteosclerosis or aging, not in hemolytic anemia where marrow hypercellularity demands more space. ### NEET-PG High-Yield Pearls: 1. **Thalassemia Major:** Shows the most classic "Hair-on-end" appearance due to ineffective erythropoiesis and extreme marrow expansion [1]. 2. **Chipmunk Facies:** Marrow expansion also occurs in the maxillary bones, leading to prominent cheekbones and malocclusion of teeth [1]. 3. **Extramedullary Hematopoiesis:** When the marrow cannot keep up, the liver and spleen take over, leading to hepatosplenomegaly [1]. 4. **Paranasal Sinuses:** These are often obliterated by the expanding marrow, except for the ethmoid sinuses. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Red Blood Cell and Bleeding Disorders, pp. 644-649.

Question 1

Hemophilia clinically manifests as a rise in which laboratory parameter?

Accepted Answer

Activated Partial Thromboplastin Time (APTT)

Answer

Prothrombin Time (PT)

Answer

Clotting Time (CT)

Answer

Fibrin Degradation Products (FDP)

Question 2

A young female patient presented with symptoms related to anemia. Peripheral blood smear showed neutrophil hypersegmentation and bone marrow aspirate smear showed giant myelocytes. Which of the following is the likely etiology?

Accepted Answer

Folic acid deficiency

Answer

Sideroblastic anemia

Answer

Iron deficiency anemia

Answer

Thalassemia

Question 3

Hemophilia is associated with which chromosome?

Accepted Answer

X chromosome

Answer

Y chromosome

Answer

Chromosome 3

Answer

Chromosome 16

Question 4

Which of the following causes of anemia is associated with a hypoplastic marrow?

Accepted Answer

Fanconi's Anemia

Answer

Paroxysmal Nocturnal Hemoglobinuria (PNH)

Answer

Hypersplenism

Answer

Myelofibrosis

Question 5

Lacunar cells are characteristic of which of the following conditions?

Accepted Answer

Nodular sclerosing type of Hodgkin’s disease

Answer

Pleomorphic adenoma

Answer

Hurler’s syndrome

Answer

None of the above

Question 6

What is the cause of fragmented RBCs in peripheral blood?

Accepted Answer

Option 1, 2, and 4

Answer

Microangiopathic hemolytic anemia

Answer

Disseminated intravascular coagulation (DIC)

Answer

Malignant hypertension

Question 7

Which of the following is NOT true about Multiple Myeloma?

Accepted Answer

Protein casts in the urine are composed of complete immunoglobulin chains.

Answer

It involves clonal proliferation of plasma cells.

Answer

It is more common in individuals over 50 years of age.

Answer

Amyloidosis can be a complication.

Question 8

The lymphocytic and histiocytic variant of Reed-Sternberg cell is seen in which of the following conditions?

Accepted Answer

Lymphocyte predominant Hodgkin's disease

Answer

Follicular center lymphoma

Answer

Lymphocyte depleted Hodgkin's disease

Answer

Nodular sclerosis Hodgkin's disease

Question 9

Periodic acid-Schiff (PAS) stain shows block positivity in which of the following cells?

Accepted Answer

Lymphoblasts

Answer

Myeloblasts

Answer

Monoblasts

Answer

Megakaryoblasts

Question 10

In hemolytic anemia, what changes occur in the skull bones?

Accepted Answer

Diploic space widening

Answer

Outer table thickening

Answer

Diploic space narrowing

Answer

None of the above

Hematopathology — MCQs

Hematopathology — MCQs

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