Hematopathology Practice Questions

Q: Popcorn cells are characteristic of which type of Hodgkin's lymphoma?

Lymphocyte predominance. **Explanation:** **Popcorn cells** (also known as **L&H cells** – Lymphocytic and Histiocytic variants) are the hallmark diagnostic feature of **Nodular Lymphocyte Predominant Hodgkin Lymphoma (NLPHL)** [1]. Unlike the classic Reed-Sternberg (RS) cells, these cells have a multi-lobed, folded nucleus resembling a kernel of popped corn, with inconspicuous nucleoli and a B-cell phenotype (CD20+, CD45+, but CD15- and CD30-) [1][2]. **Analysis of Options:** * **Nodular Sclerosis (Option A):** Characterized by **Lacunar cells** (RS cells sitting in empty spaces due to formalin fixation) and broad bands of collagen fibrosis [2]. It is the most common subtype. * **Mixed Cellularity (Option B):** Characterized by **classic "Owl-eye" RS cells** (CD15+, CD30+) in a polymorphic background of eosinophils, plasma cells, and histiocytes [2]. Often associated with EBV. * **Lymphocyte Depletion (Option D):** The rarest and most aggressive form, showing numerous **pleomorphic/anaplastic RS cells** with very few background lymphocytes. **High-Yield Pearls for NEET-PG:** 1. **Immunophenotype:** Popcorn cells are **CD20+ and CD45+**, whereas Classic Hodgkin Lymphoma (CHL) cells are **CD15+ and CD30+**. 2. **Clinical Course:** NLPHL usually presents as localized peripheral lymphadenopathy (cervical/axillary) and has an excellent prognosis, though it can transform into Diffuse Large B-Cell Lymphoma (DLBCL) [1]. 3. **Background:** In NLPHL, the background consists predominantly of small B-lymphocytes arranged in a nodular pattern, unlike the T-cell rich background of CHL [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, p. 618. [2] 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, p. 616.

Q: Increased Prothrombin time results from a deficiency of which factor?

Fibrinogen. **Explanation:** Prothrombin Time (PT) measures the integrity of the **Extrinsic** and **Common pathways** of the coagulation cascade [1]. The factors involved in these pathways are Factors **I (Fibrinogen)**, **II (Prothrombin)**, **V**, **VII**, and **X** [1]. 1. **Why Fibrinogen is correct:** Fibrinogen (Factor I) is the final substrate in the common pathway [2]. It is converted into fibrin to form a stable clot. Since PT monitors the common pathway, a significant deficiency in Fibrinogen (<100 mg/dL) will lead to a prolonged PT [1]. 2. **Why the others are incorrect:** * **Factor IX and Factor XI:** These are components of the **Intrinsic pathway** [1]. Deficiencies in these factors (e.g., Hemophilia B for Factor IX) will prolong the **Activated Partial Thromboplastin Time (aPTT)**, but the PT will remain normal. * **Factor VI:** This is a historical term. There is no "Factor VI" in the modern coagulation cascade (it was originally thought to be activated Factor V). **High-Yield Clinical Pearls for NEET-PG:** * **PT** is the most sensitive marker for **Vitamin K deficiency** and **Warfarin therapy** because it measures Factor VII, which has the shortest half-life (approx. 6 hours) [3]. * **Isolated prolonged PT:** Suggests Factor VII deficiency or early liver disease. * **Prolonged PT and aPTT:** Suggests a deficiency in the **Common Pathway** (Factors I, II, V, X) or severe Vitamin K deficiency/liver failure [1]. * **Mixing Study:** If PT/aPTT corrects with normal plasma, it indicates a **factor deficiency**; if it does not correct, it indicates the presence of an **inhibitor** (e.g., Lupus anticoagulant) [1].

Q: A 10-year-old child presents with pallor and a history of blood transfusion 2 months prior. Investigations reveal Hb 4.5 gm/dL, total leukocyte count 60,000/mm³, platelet count 2 lakhs/mm³, CD10 positive, CD19 positive, CD117 positive, VEPO positive, and CD33 negative. What is the most likely diagnosis?

Mixed phenotypic acute leukemia. ### Explanation The diagnosis of **Mixed Phenotypic Acute Leukemia (MPAL)** is based on the presence of markers from two different lineages on the same blast population (biphenotypic) or two distinct blast populations (bilineal). **1. Why Option D is Correct:** The child presents with hyperleukocytosis (TLC 60,000/mm³) and blasts expressing both lymphoid and myeloid markers: * **Lymphoid markers:** CD10 and CD19 are classic B-cell lineage markers. * **Myeloid markers:** CD117 (c-kit) and MPO (Myeloperoxidase, indicated here as VEPO positive) are definitive for myeloid lineage. According to the **WHO criteria**, the expression of strong B-cell markers (CD19) alongside definitive myeloid markers (MPO) confirms MPAL. **2. Why Other Options are Incorrect:** * **Option A (ALL):** While CD10 and CD19 are positive, the presence of MPO (VEPO) and CD117 strictly excludes a pure diagnosis of ALL. * **Option B (AML):** Although CD117 and MPO are present, the strong expression of B-cell markers (CD10, CD19) is not typical for pure AML. * **Option C (Undifferentiated Leukemia):** This diagnosis is reserved for cases where blasts lack any lineage-specific markers (negative for MPO, T-cell, and B-cell markers). **3. NEET-PG High-Yield Pearls:** * **MPO (Myeloperoxidase):** The most specific marker for Myeloid lineage. * **CD19:** The most specific marker for B-cell lineage. * **Cytoplasmic CD3:** The most specific marker for T-cell lineage. * **Prognosis:** MPAL generally carries a poorer prognosis compared to lineage-restricted ALL or AML and often requires intensive "hybrid" chemotherapy protocols followed by Stem Cell Transplant.

Q: Thrombocytopenia occurs in all of the following conditions except?

Henoch-Schönlein purpura. **Explanation:** The core concept tested here is the distinction between **quantitative** and **qualitative** platelet disorders. **1. Why Henoch-Schönlein Purpura (HSP) is the correct answer:** HSP is a small-vessel **leukocytoclastic vasculitis** mediated by IgA immune complex deposition. The "purpura" seen in HSP is **non-thrombocytopenic**; in fact, the platelet count in HSP is typically **normal or even elevated** (as an acute-phase reactant). The skin lesions occur due to inflammation and leakage of the blood vessels, not due to a deficiency in platelets. **2. Analysis of Incorrect Options:** * **Thrombotic Thrombocytopenic Purpura (TTP):** Characterized by the classic pentad, which includes **consumptive thrombocytopenia** due to the formation of extensive microthrombi in small vessels (ADAMTS13 deficiency). * **Disseminated Intravascular Coagulation (DIC):** Involves widespread activation of the coagulation cascade, leading to the **massive consumption** of both clotting factors and platelets, resulting in profound thrombocytopenia. * **Wiskott-Aldrich Syndrome:** A X-linked recessive immunodeficiency characterized by the triad of eczema, immunodeficiency, and **micro-thrombocytopenia** (small-sized platelets and low counts due to impaired production and increased destruction). **Clinical Pearls for NEET-PG:** * **HSP Tetrad:** Palpable purpura (without thrombocytopenia), arthritis/arthralgia, abdominal pain (intussusception risk), and renal involvement (IgA nephropathy). * **Platelet Size:** Wiskott-Aldrich is unique for **small** platelets, whereas ITP and Bernard-Soulier Syndrome feature **large** (giant) platelets. * **Rule of Thumb:** If a question mentions "Palpable Purpura," always think of Vasculitis (like HSP) rather than simple thrombocytopenia.

Question 1

Ringed sideroblasts are seen in which of the following conditions?

Accepted Answer

Myelodysplastic syndrome

Answer

Iron deficiency anemia

Answer

Thalassemia

Answer

Anemia of chronic disease

Question 2

Popcorn cells are characteristic of which type of Hodgkin's lymphoma?

Accepted Answer

Lymphocyte predominance

Answer

Nodular sclerosis

Answer

Mixed cellularity

Answer

Lymphocyte depletion

Question 3

Which of the following conditions follows an autosomal dominant inheritance pattern?

Accepted Answer

Hereditary spherocytosis

Answer

Albinism

Answer

Sickle cell anemia

Answer

Thalassemia

Question 4

What is a cause of Vitamin B12 deficiency megaloblastic anemia?

Accepted Answer

Fish tapeworm infestation

Answer

Dilantin therapy

Answer

Gastrectomy

Answer

Ileal resection

Question 5

Increased Prothrombin time results from a deficiency of which factor?

Accepted Answer

Fibrinogen

Answer

Factor IX

Answer

Factor VI

Answer

Factor XI

Question 6

A 10-year-old child presents with pallor and a history of blood transfusion 2 months prior. Investigations reveal Hb 4.5 gm/dL, total leukocyte count 60,000/mm³, platelet count 2 lakhs/mm³, CD10 positive, CD19 positive, CD117 positive, VEPO positive, and CD33 negative. What is the most likely diagnosis?

Accepted Answer

Mixed phenotypic acute leukemia

Answer

Acute lymphoblastic leukemia (ALL)

Answer

Acute myeloid leukemia (AML)

Answer

Undifferentiated leukemia

Question 7

What is the most common tumor of the spleen?

Accepted Answer

Lymphoma

Answer

Sarcoma

Answer

Hemangioma

Answer

Metastasis

Question 8

Acid phosphatase cytochemical staining is used in the diagnosis of which of the following hematological neoplasms?

Accepted Answer

T-cell acute lymphoblastic leukemia

Answer

Chronic myeloid leukemia

Answer

Acute myeloid leukemia

Answer

B-cell acute lymphoblastic leukemia

Question 9

Which of the following is pathognomonic of thalassemia major?

Accepted Answer

Raised HbF

Answer

Conjugated hyperbilirubinemia

Answer

Raised HbA2

Answer

Severe anemia

Question 10

Thrombocytopenia occurs in all of the following conditions except?

Accepted Answer

Henoch-Schönlein purpura

Answer

Thrombotic thrombocytopenic purpura (TTP)

Answer

Disseminated intravascular coagulation (DIC)

Answer

Wiskott-Aldrich syndrome

Hematopathology — MCQs

Hematopathology — MCQs

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