Hematopathology Practice Questions

Q: Nodular lymphocyte predominant type of Hodgkin lymphoma is characterized by the presence of which specific cell type?

Popcorn cell. **Explanation:** **Nodular Lymphocyte Predominant Hodgkin Lymphoma (NLPHL)** is a distinct clinical entity that differs from Classical Hodgkin Lymphoma (CHL) in both morphology and immunophenotype [1]. **1. Why "Popcorn cell" is correct:** The hallmark of NLPHL is the presence of **L&H cells (Lymphocytic and Histiocytic variants)**, popularly known as **"Popcorn cells."** [1] These are large cells with delicate, multi-lobed, folded nuclei resembling a kernel of popped corn [2]. Unlike the Reed-Sternberg (RS) cells seen in classical types, popcorn cells are **CD20+ and CD45+**, but negative for CD15 and CD30. **2. Why other options are incorrect:** * **Foam cells:** These are lipid-laden macrophages commonly seen in atherosclerosis, xanthomas, or certain storage diseases (e.g., Niemann-Pick), but they have no diagnostic role in Hodgkin lymphoma. * **Pale cells:** This is a non-specific descriptive term. While some cells in the germinal center may appear pale, it is not a diagnostic feature of NLPHL. **3. NEET-PG High-Yield Pearls:** * **Immunophenotype:** NLPHL is **CD20+, CD45+, BCL6+,** and **EMA+**. It is characteristically **CD15- and CD30-** (the opposite of Classical Hodgkin Lymphoma). * **Clinical Presentation:** It usually involves isolated peripheral lymphadenopathy (cervical or axillary) and has a very indolent (slow) clinical course with a high survival rate [1]. * **Background:** The background in NLPHL consists primarily of follicular dendritic cells and small B-lymphocytes, whereas CHL has a background of reactive T-lymphocytes, eosinophils, and plasma cells [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: Castleman disease is associated with which of the following?

Human Herpesvirus 8 (HHV-8). **Explanation:** **Castleman Disease (CD)**, also known as angiofollicular lymph node hyperplasia, is a rare lymphoproliferative disorder. The association with **Human Herpesvirus 8 (HHV-8)** is the cornerstone of its pathogenesis, particularly in the **Multicentric** variant (MCD). **Why HHV-8 is the correct answer:** HHV-8 (also known as Kaposi Sarcoma-associated Herpesvirus) encodes a viral homolog of **Interleukin-6 (vIL-6)**. This viral cytokine mimics human IL-6, driving B-cell proliferation, plasma cell differentiation, and systemic inflammation. This is especially prevalent in HIV-positive patients with MCD, where HHV-8 is found in nearly 100% of cases. **Why other options are incorrect:** * **HSV (A) & CMV (B):** While these are common herpesviruses, they are not etiologically linked to the pathogenesis of Castleman disease. CMV is more commonly associated with infectious mononucleosis-like syndromes or retinitis in immunocompromised states. * **EBV (C):** EBV is strongly associated with other lymphoid malignancies like Burkitt lymphoma, Hodgkin lymphoma, and Nasopharyngeal carcinoma, but it is not the primary driver of Castleman disease. **High-Yield Clinical Pearls for NEET-PG:** * **Histological Variants:** 1. **Hyaline-Vascular (80-90%):** Characterized by "Lollipop lesions" (sclerotic vessels entering germinal centers) and "Onion-skinning" of the mantle zone. Usually unicentric. 2. **Plasma Cell Variant:** Associated with systemic symptoms (fever, anemia) and elevated ESR due to IL-6. * **Clinical Association:** HHV-8 positive MCD is a significant risk factor for developing **Kaposi Sarcoma** and **Primary Effusion Lymphoma (PEL)**. * **Key Cytokine:** **IL-6** is the "master regulator" of the disease symptoms and progression.

Q: In iron deficiency anemia, which of the following are seen in a peripheral blood smear?

High TIBC, Low Ferritin. ### Explanation Iron Deficiency Anemia (IDA) is characterized by a depletion of total body iron stores, leading to impaired hemoglobin synthesis. To understand the biochemical markers, one must look at the body's compensatory mechanisms. **1. Why Option B is Correct:** * **Low Ferritin:** Ferritin is the primary storage form of iron in the liver and reticuloendothelial system. In IDA, these stores are the first to be depleted to maintain serum iron levels. Therefore, a **low serum ferritin** is the most specific initial laboratory finding for IDA. * **High TIBC (Total Iron Binding Capacity):** TIBC is an indirect measure of **Transferrin**, the protein that transports iron. When iron stores are low, the liver increases the synthesis of transferrin to maximize the capture of any available iron. Thus, TIBC increases as the body attempts to compensate for the deficiency. **2. Why Other Options are Incorrect:** * **Options A & C (Low TIBC):** A low TIBC is typically seen in **Anemia of Chronic Disease (ACD)** or iron overload states. In ACD, inflammatory cytokines (like Hepcidin) sequester iron and downregulate transferrin production. * **Options C & D (High Ferritin):** High ferritin levels indicate iron overload (Hemochromatosis) or an acute phase response (inflammation/infection), which contradicts a deficiency state. **3. NEET-PG High-Yield Pearls:** * **Gold Standard Diagnosis:** Bone marrow aspiration showing absent stainable iron (Prussian Blue/Perl’s stain). * **Earliest Sign:** Decreased serum ferritin. * **Peripheral Smear:** Microcytic hypochromic RBCs with increased **RDW** (Red Cell Distribution Width), pencil cells, and occasional target cells [1]. * **Mentzer Index:** (MCV/RBC count) >13 suggests IDA, while <13 suggests Thalassemia trait. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Blood And Bone Marrow Disease, pp. 590-591.

Q: What is the pH of freshly collected blood in a CPD solution bag?

7.4. **Explanation:** The correct answer is **7.4 (Option C)**. **1. Why 7.4 is correct:** When blood is freshly collected from a healthy donor, its physiological pH is approximately **7.4**. Although the Citrate Phosphate Dextrose (CPD) anticoagulant solution itself is acidic (pH ~5.6), the high buffering capacity of the plasma proteins and the bicarbonate system in the donor's blood initially neutralizes the acidity of the preservative. Therefore, immediately after collection, the pH of the blood in the bag remains close to the physiological level of 7.4. **2. Analysis of Incorrect Options:** * **Option A (7.1):** This is the pH of blood after approximately **21 days** of storage. As RBCs undergo glycolysis during storage, they produce lactic acid, which causes the pH to drop over time. * **Option B (7.3):** While closer to physiological pH, it does not represent the immediate post-collection state. * **Option D (7.6):** This is alkaline. Blood becomes increasingly acidic, not alkaline, during storage due to metabolic byproducts. **3. NEET-PG High-Yield Pearls:** * **Storage Lesion:** This refers to the biochemical and morphological changes in blood during storage. Key changes include **decreased pH**, **decreased 2,3-DPG** (shifting the oxygen dissociation curve to the left), and **increased Plasma Potassium** (due to leakage from RBCs). * **CPD vs. CPDA-1:** CPD allows for a storage life of **21 days**. The addition of Adenine (CPDA-1) extends the shelf life to **35 days** by maintaining ATP levels. * **pH at Expiry:** By the end of the storage period (35 days for CPDA-1), the pH typically drops to approximately **6.7 to 6.9**.

Question 1

Nodular lymphocyte predominant type of Hodgkin lymphoma is characterized by the presence of which specific cell type?

Accepted Answer

Popcorn cell

Answer

Foam cell

Answer

Pale cell

Answer

None of the above

Question 2

ADAMTS-13 is a metalloproteinase. It is produced by the:

Accepted Answer

Stellate cells in the liver

Answer

Alpha cells of the pancreas

Answer

Oligodendrocytes in the brain

Answer

Tubular epithelial cells of the kidney

Question 3

Giant platelets are seen in which of the following conditions?

Accepted Answer

Bernard-Soulier syndrome

Answer

Von Willebrand disease

Answer

Polycythemia rubra vera

Answer

Leukemia

Question 4

"Cabot" rings are characteristically seen in:

Accepted Answer

Post spleenectomy

Answer

Hemochromatosis

Answer

Thalassemia

Answer

Acquired hemolytic anemia

Question 5

Castleman disease is associated with which of the following?

Accepted Answer

Human Herpesvirus 8 (HHV-8)

Answer

Herpes Simplex Virus (HSV)

Answer

Cytomegalovirus (CMV)

Answer

Epstein-Barr Virus (EBV)

Question 6

Neutropenia is not a feature of which of the following conditions?

Accepted Answer

Congenital asplenia

Answer

Wiskott-Aldrich syndrome

Answer

Kostmann syndrome

Answer

X-linked hyper-IgM syndrome

Question 7

ADAMTS deficiency is seen in which of the following conditions?

Accepted Answer

Thrombotic thrombocytopenic purpura (TTP)

Answer

Essential thrombocythemia

Answer

Immune thrombocytopenic purpura (ITP)

Answer

Chronic lymphocytic leukemia (CLL)

Question 8

In iron deficiency anemia, which of the following are seen in a peripheral blood smear?

Accepted Answer

High TIBC, Low Ferritin

Answer

Low TIBC, Low Ferritin

Answer

Low TIBC, High Ferritin

Answer

High TIBC, High Ferritin

Question 9

What is the pH of freshly collected blood in a CPD solution bag?

Accepted Answer

7.4

Answer

7.1

Answer

7.3

Answer

7.6

Question 10

Aplastic anemia in sickle cell anemia is typically due to infection with which of the following viruses?

Accepted Answer

Parvovirus B19

Answer

Herpes simplex virus

Answer

Cytomegalovirus (CMV)

Answer

Papovavirus

Hematopathology — MCQs

Hematopathology — MCQs

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