Hematopathology Practice Questions

Q: In which of the following conditions can Downey cells be seen?

Infectious mononucleosis. **Explanation:** **Infectious Mononucleosis (IM)** is the classic condition associated with **Downey cells** [1]. These are **atypical T-lymphocytes** (specifically CD8+ cytotoxic T-cells) that have been activated in response to B-cells infected by the **Epstein-Barr Virus (EBV)**. Morphologically, Downey cells are larger than mature lymphocytes, featuring abundant, "balloons-out" cytoplasm that often indents or "hugs" adjacent red blood cells, and a nucleus with coarse or smudged chromatin [1]. **Analysis of Incorrect Options:** * **Small Lymphocytic Lymphoma (SLL):** Characterized by small, mature-looking lymphocytes and "Smudge cells" (fragile cells that burst during smear preparation), not atypical reactive T-cells. * **Acute Myeloid Leukemia (AML):** Defined by the presence of myeloblasts (containing Auer rods) rather than reactive lymphocytes. * **Multiple Myeloma:** A plasma cell dyscrasia characterized by malignant plasma cells in the bone marrow, often showing "Fried egg" appearance or "Mott cells," but not Downey cells. **High-Yield Clinical Pearls for NEET-PG:** * **Triad of IM:** Fever, pharyngitis, and lymphadenopathy (posterior cervical) [1]. * **Diagnosis:** Heterophile antibody test (**Monospot test**) is the screening gold standard. * **The "Indentation" Sign:** The cytoplasm of Downey cells scalloping around RBCs is a classic morphological descriptor in exams [1]. * **Complication:** Avoid contact sports due to the risk of **splenic rupture**. * **Antibiotic Caution:** Administration of Ampicillin/Amoxicillin in IM patients often results in a characteristic maculopapular rash. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Infectious Diseases, pp. 369-370.

Q: This is the peripheral smear of which disease?

Sickle cell anemia. ***Sickle cell anemia*** - The peripheral smear shows characteristic **drepanocytes** (sickle-shaped red blood cells) which are pathognomonic for sickle cell anemia. - These **crescent-shaped cells** result from **hemoglobin S polymerization** under deoxygenated conditions, causing the distinctive morphology. *Thalassemia* - Shows **microcytic hypochromic** red blood cells with **target cells** and **tear drop cells**, not sickle-shaped cells. - **Hemoglobin electrophoresis** would reveal elevated **HbA2** and **HbF** levels, distinguishing it from sickle cell disease. *Iron deficiency anemia* - Characterized by **microcytic hypochromic** red blood cells that are small and pale with increased **central pallor**. - Shows **pencil cells** and **target cells** occasionally, but never the characteristic **sickle-shaped morphology**. *Sideroblastic anemia* - Demonstrates a **dimorphic blood picture** with both **microcytic** and **normocytic** red blood cells present. - **Ringed sideroblasts** are seen in bone marrow with **Prussian blue staining**, but peripheral smear lacks sickle cells.

Q: Which of the following conditions is NOT associated with microcytic hypochromic red blood cells on a peripheral smear?

Sickle Cell Anemia. The correct answer is **Sickle Cell Anemia (SCA)**. **1. Why Sickle Cell Anemia is the correct answer:** Sickle Cell Anemia is a qualitative hemoglobinopathy caused by a point mutation in the $\beta$-globin chain [1]. It is typically classified as a **normocytic normochromic anemia**. On a peripheral smear, the hallmark findings are sickle-shaped cells (drepanocytes), target cells, and Howell-Jolly bodies (due to autosplenectomy) [3]. It does not cause microcytosis unless it co-exists with another condition like $\alpha$ or $\beta$-thalassemia [2]. **2. Analysis of Incorrect Options (Causes of Microcytic Hypochromic Anemia):** Microcytic hypochromic anemia occurs due to defective hemoglobin synthesis, which can be remembered by the mnemonic **TAILS**: * **Iron Deficiency Anemia (A):** The most common cause worldwide. Low iron leads to decreased heme synthesis [2]. * **Lead Poisoning (B):** Lead inhibits enzymes (ferrochelatase and ALA dehydratase) in the heme synthesis pathway, leading to microcytosis and characteristic **basophilic stippling**. * **Sideroblastic Anemia (C):** Characterized by the body's inability to incorporate iron into hemoglobin despite having sufficient iron. It results in **ringed sideroblasts** in the bone marrow. * *(Note: **T**halassemia and Anemia of **C**hronic Disease are the other major causes [2]).* **3. NEET-PG High-Yield Pearls:** * **Mentzer Index:** (MCV/RBC count) helps differentiate Iron Deficiency Anemia (>13) from Thalassemia (<13). * **RDW (Red Cell Distribution Width):** Is typically **increased** in Iron Deficiency Anemia but **normal** in Thalassemia trait. * **Gold Standard for IDA:** Bone marrow aspiration showing absent iron stores (Prussian blue stain), though Serum Ferritin is the best initial non-invasive test.

Question 1

The expression of JAK2 mutation is seen in all conditions, EXCEPT:

Accepted Answer

Chronic eosinophilic leukemia

Answer

Primary myelofibrosis

Answer

Polycythemia vera

Answer

Essential thrombocytosis

Question 2

All of the following are true regarding Chronic Lymphocytic Leukemia (CLL) except?

Accepted Answer

Affects T-cells

Answer

Most common type of leukemia in adults

Answer

Males are commonly affected

Answer

ZAP-70 has prognostic importance

Question 3

In which of the following conditions can Downey cells be seen?

Accepted Answer

Infectious mononucleosis

Answer

Small lymphocytic lymphoma

Answer

Acute myeloid leukemia

Answer

Multiple myeloma

Question 4

All of the following statements about Mucosa Associated Lymphoid Tissue (MALT) lymphomas are true, except:

Accepted Answer

Present as stromal polyps

Answer

Present at extranodal sites

Answer

Predisposed by H. pylori infection

Answer

Are sensitive to chemotherapy

Question 5

This is the peripheral smear of which disease?

Accepted Answer

Sickle cell anemia

Answer

Thalassemia

Answer

Iron deficiency anemia

Answer

Sideroblastic anemia

Question 6

BCR-ABL1 gene fusion is seen in all of the following conditions except?

Accepted Answer

Chronic lymphocytic leukemia

Answer

Acute myeloid leukemia

Answer

Chronic myeloid leukemia

Answer

Acute lymphoblastic leukemia

Question 7

Which of the following conditions is NOT associated with microcytic hypochromic red blood cells on a peripheral smear?

Accepted Answer

Sickle Cell Anemia

Answer

Iron Deficiency Anemia

Answer

Lead poisoning

Answer

Sideroblastic anemia

Question 8

Which type of Hodgkin's disease is commonest in females and associated with an excellent prognosis?

Accepted Answer

Nodular sclerosis

Answer

Lymphocyte predominant

Answer

Lymphocyte depleted

Answer

Mixed cellularity

Question 9

Which coagulation test is typically prolonged in hemophilia?

Accepted Answer

Activated partial thromboplastin time (APTT)

Answer

Prothrombin time (PT)

Answer

Clotting time (CT)

Answer

Fibrin degradation products (FDP)

Question 10

Hot agglutinin is found in all conditions except:

Accepted Answer

Mycoplasma infection

Answer

Systemic Lupus Erythematosus (SLE)

Answer

Methyl dopa

Answer

Rheumatoid arthritis

Hematopathology — MCQs

Hematopathology — MCQs

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