Hematopathology Practice Questions

Q: Acute promyelocytic leukaemia (AML - M3) includes which of the following subtypes?

Hyper granular and micro granular type. **Explanation:** Acute Promyelocytic Leukaemia (APL), classified as **AML-M3** in the FAB classification, is characterized by the malignant proliferation of promyelocytes [1]. Morphologically, APL is divided into two distinct subtypes based on the appearance of the cytoplasm: 1. **Hypergranular Type (Typical/Classic):** This is the most common form. The cells contain numerous coarse, azurophilic granules and characteristic **Auer rods**, often found in bundles called **"Faggot cells"** [1]. 2. **Microgranular Type (Hypogranular/M3v):** In this variant, the granules are so small and fine that they are often invisible under a light microscope, giving the cytoplasm a "dust-like" or clear appearance [1]. A key diagnostic feature is the **bilobed or reniform (kidney-shaped) nucleus**, which can sometimes be mistaken for monocytes (AML-M5) [1]. **Analysis of Options:** * **Option A & D:** While "hypogranular" is often used interchangeably with "microgranular" in clinical practice, the formal morphological classification specifically uses the term **Microgranular** to describe the M3 variant. * **Option B:** "Hypersegmented" refers to neutrophils in megaloblastic anemia, not the morphology of promyelocytes in APL. **High-Yield Clinical Pearls for NEET-PG:** * **Cytogenetics:** Strongly associated with **t(15;17)**, involving the *PML-RARA* fusion gene [1]. * **Complication:** High risk of **Disseminated Intravascular Coagulation (DIC)** due to the release of procoagulants from granules [1]. * **Treatment:** Highly responsive to **All-Trans Retinoic Acid (ATRA)** and Arsenic Trioxide, which induce differentiation of the blast cells. * **Immunophenotype:** Typically **CD34 negative** and **HLA-DR negative**, but strongly positive for MPO. **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. 620-622.

Q: Which of the following are inherited coagulation disorders?

All of the above. **Explanation:** The correct answer is **D (All of the above)**. Inherited coagulation disorders (thrombophilias) are genetic predispositions to thromboembolism caused by mutations in genes encoding coagulation factors or their regulators [1]. 1. **Factor V Leiden (Option C):** This is the **most common** inherited cause of hypercoagulability [1]. It involves a point mutation (G1691A) in the Factor V gene, making Factor Va resistant to cleavage by Activated Protein C (APC) [1]. This leads to a prothrombotic state. 2. **Protein C and Protein S Deficiencies (Options A & B):** Both are natural anticoagulants. Protein C, when activated, degrades Factors Va and VIIIa. Protein S acts as a necessary cofactor for Protein C. Inherited deficiencies in either (usually autosomal dominant) result in a failure to inhibit the clotting cascade, significantly increasing the risk of venous thromboembolism (VTE). **Clinical Pearls for NEET-PG:** * **Most Common Inherited Thrombophilia:** Factor V Leiden mutation [1]. * **Second Most Common:** Prothrombin G20210A mutation [1]. * **Warfarin-Induced Skin Necrosis:** Classically associated with **Protein C deficiency**. When starting Warfarin, Protein C levels drop faster than other factors (due to a short half-life), leading to a transient hypercoagulable state and microvascular thrombosis. * **Antithrombin III (ATIII) Deficiency:** Another major inherited disorder; patients may show **heparin resistance** because heparin requires ATIII to exert its anticoagulant effect. * **Screening:** These tests should generally not be performed during an acute thrombotic event or while the patient is on anticoagulants, as results may be falsely low. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Hemodynamic Disorders, Thromboembolic Disease, and Shock, pp. 133-134.

Q: What is the most common malignancy affecting the spleen?

Lymphoma. **Explanation:** The spleen is the largest lymphoid organ in the body, making it a primary site for hematological malignancies. **Lymphoma** is the most common malignancy involving the spleen [1]. It can present either as a primary splenic lymphoma (rare) or, more commonly, as part of systemic involvement in Non-Hodgkin Lymphoma (NHL) or Hodgkin Lymphoma [1]. In systemic lymphoma, the spleen is involved in approximately 30-40% of cases. **Analysis of Options:** * **A. Angiosarcoma:** This is the most common **primary non-lymphoid** malignant tumor of the spleen. However, it is extremely rare in absolute terms compared to lymphoma. * **B. Hamartoma:** This is a benign, non-neoplastic vascular malformation (composed of disorganized splenic red pulp). It is not a malignancy. * **C. Secondaries (Metastasis):** While the spleen is highly vascular, solid tumor metastases (e.g., from lung or breast) are relatively **uncommon**. This is attributed to the spleen’s sharp rhythmic contractions, the inhibitory effect of the high concentration of lymphoid cells, and the splenic microenvironment which is hostile to solid tumor seeding. **High-Yield Clinical Pearls for NEET-PG:** * **Most common benign tumor of the spleen:** Hemangioma. * **Most common primary malignancy of the spleen:** Lymphoma (specifically Splenic Marginal Zone Lymphoma is a classic primary type) [1]. * **Most common primary non-lymphoid malignancy:** Angiosarcoma (associated with high risk of spontaneous rupture). * **Gaucher Disease:** The most common cause of massive splenomegaly among storage disorders. * **Gamna-Gandy Bodies:** Siderofibrotic nodules (calcium and iron deposits) seen in the spleen in portal hypertension. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Diseases Of The Urinary And Male Genital Tracts, pp. 569-570.

Question 1

Acute promyelocytic leukaemia (AML - M3) includes which of the following subtypes?

Accepted Answer

Hyper granular and micro granular type

Answer

Hyper granular and hypo granular type

Answer

Hyper granular and hyper segmented

Answer

Hypo granular and micro granular type

Question 2

Which of the following laboratory tests is affected by platelet count?

Accepted Answer

Bleeding time

Answer

Prothrombin time

Answer

Partial thromboplastin time

Answer

Thrombin time

Question 3

Which of the following are inherited coagulation disorders?

Accepted Answer

All of the above

Answer

Protein C deficiency

Answer

Protein S deficiency

Answer

Factor V Leiden

Question 4

Which of the following is NOT a method of hemoglobin estimation?

Accepted Answer

Wintrobe's method

Answer

Drabkin's method

Answer

Sahli's method

Answer

Spectrophotometric method

Question 5

In sickle cell crisis, bone pain is primarily due to which of the following mechanisms?

Accepted Answer

Bone infarction

Answer

Osteoporosis

Answer

Osteomalacia

Answer

Periosteal reaction

Question 6

Which of the following conditions is NOT typically associated with a lymphatic leukemoid reaction?

Accepted Answer

Lobar Pneumonia

Answer

Tuberculosis

Answer

Pertussis

Answer

Viral infections

Question 7

Which of the following statements is not true regarding Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma (CLL/SLL)?

Accepted Answer

Transformation to Richter syndrome is commonly seen.

Answer

The tumor cells are positive for CD5 and CD20.

Answer

ZAP-70 expression is a poor prognostic marker.

Answer

Proliferation centers in lymph nodes are pathognomonic.

Question 8

Which of the following is NOT included in chronic myeloproliferative disorders?

Accepted Answer

Erythroleukemia

Answer

Chronic myeloid leukemia (CML)

Answer

Polycythemia vera

Answer

Essential thrombocytosis

Question 9

What is the most common malignancy affecting the spleen?

Accepted Answer

Lymphoma

Answer

Angiosarcoma

Answer

Hamartoma

Answer

Secondaries

Question 10

Post-transfusion hepatitis is most commonly associated with which component?

Accepted Answer

Packed red blood cells

Answer

Platelets

Answer

Whole blood

Answer

Albumin

Hematopathology — MCQs

Hematopathology — MCQs

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