Hematopathology Practice Questions

Q: Which of the following is NOT part of the triad of hairy cell leukemia?

Erythema nodosum. **Explanation:** Hairy Cell Leukemia (HCL) is a rare, chronic B-cell lymphoproliferative disorder characterized by the classic clinical triad of **Splenomegaly, Pancytopenia, and "Dry Tap" on bone marrow aspiration.** [1] 1. **Why Erythema Nodosum is correct:** Erythema nodosum is a form of panniculitis (inflammation of fat cells under the skin) associated with infections (Streptococcal, TB), Sarcoidosis, or Inflammatory Bowel Disease. It is **not** a feature of HCL. 2. **Why the other options are part of HCL:** * **Splenomegaly:** This is the most common physical finding (often massive) due to the infiltration of the red pulp by "hairy" cells [1]. Notably, lymphadenopathy is usually absent. * **Pancytopenia:** Resulting from bone marrow infiltration and splenic sequestration [1]. Monocytopenia is a highly specific hallmark of HCL. * **Hypercellular marrow (with fibrosis):** While the marrow is often hypercellular with a characteristic "fried egg" appearance (cells with abundant cytoplasm and distinct borders), the increased reticulin fibrosis leads to a **"Dry Tap"** during aspiration [1]. **High-Yield Clinical Pearls for NEET-PG:** * **Morphology:** B-cells with hair-like cytoplasmic projections [1]. * **Cytochemistry:** **TRAP positive** (Tartrate-Resistant Acid Phosphatase). * **Immunophenotype:** Positive for **CD11c, CD25, CD103**, and CD123. * **Genetic Mutation:** **BRAF V600E** mutation is seen in almost all cases. * **Treatment:** Cladribine (2-CdA) is the drug of choice. * **Biopsy Finding:** "Fried egg" appearance in the bone marrow and "Beefy red" appearance of the spleen [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. 610-612.

Question 1

What is the most specific investigation in disseminated intravascular coagulation?

Accepted Answer

D-dimer assay

Answer

Bleeding time

Answer

Clotting time

Answer

Fibrinogen level

Question 2

Which of the following is NOT a cause of congenital hypercoagulability?

Accepted Answer

Antiphospholipid antibody syndrome

Answer

Protein C deficiency

Answer

Protein S deficiency

Answer

MTHFR gene mutations

Question 3

Which of the following features cannot be used to differentiate between Hodgkin's lymphoma and Non-Hodgkin's lymphoma?

Accepted Answer

Painless lymphadenopathy

Answer

Extranodal involvement

Answer

Contiguous spread

Answer

Localization to a particular group of lymph nodes

Question 4

Which of the following is NOT part of the triad of hairy cell leukemia?

Accepted Answer

Erythema nodosum

Answer

Splenomegaly

Answer

Pancytopenia

Answer

Hypercellular marrow

Question 5

Which of the following are common features of hemolytic anemia?

Accepted Answer

Decreased RBC life span, Unconjugated hyperbilirubinemia, Altered erythroid and myeloid ratio

Answer

Decreased RBC life span, Unconjugated hyperbilirubinemia, Bile salt and bile pigments in urine

Answer

Unconjugated hyperbilirubinemia, Bile salt and bile pigments in urine, Altered erythroid and myeloid ratio

Answer

Decreased RBC life span, Bile salt and bile pigments in urine, Altered erythroid and myeloid ratio

Question 6

Which of the following is a cold agglutinin?

Accepted Answer

IgM antibody

Answer

IgG antibody

Answer

Donath-Landsteiner antibody

Answer

IgA antibody

Question 7

Osmotic fragility is increased in which of the following conditions?

Accepted Answer

Hereditary spherocytosis

Answer

Sickle cell anemia

Answer

Thalassaemia

Answer

Chronic lead poisoning

Question 8

Castleman's disease is associated with which of the following?

Accepted Answer

Benign lymphoid hyperplasia

Answer

Necrotizing vasculitis

Answer

Necrotizing lymphadenitis

Answer

Coagulation defect

Question 9

A normotensive patient with normal hemoglobin suffered massive blood loss. The following findings could be expected, except:

Accepted Answer

Increased PCV

Answer

Increased MCV

Answer

Thrombocytosis

Answer

Reticulocytosis

Question 10

A 42-year-old man sustained severe injuries in an automobile accident and is admitted to the intensive care unit. Examination of a peripheral blood smear on the 3rd day of admission reveals helmet cells, schistocytes, and decreased platelets. Which of the following is most strongly suggested by these findings?

Accepted Answer

Disseminated intravascular coagulation (DIC)

Answer

Autoimmune hemolysis

Answer

Hereditary spherocytosis

Answer

Megaloblastic anemia

Hematopathology — MCQs

Hematopathology — MCQs

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