Hematopathology Practice Questions

Q: Which of the following is a marker for Langerhans cell histiocytosis?

CD 1a. **Explanation:** **Langerhans Cell Histiocytosis (LCH)** is a clonal proliferation of Langerhans cells, which are specialized dendritic cells normally found in the skin. The diagnosis relies on identifying these cells through specific immunophenotypic markers and ultrastructural findings [1]. **Why CD1a is correct:** Langerhans cells are characterized by the expression of **CD1a** and **Langerin (CD207)**. CD1a is a glycoprotein structurally related to MHC molecules and is highly specific for Langerhans cells when found in the context of histiocytic lesions. Another gold-standard marker is **S100** (though it is less specific). **Analysis of Incorrect Options:** * **CD10:** Also known as CALLA (Common Acute Lymphoblastic Leukemia Antigen), it is a marker for pre-B cells and germinal center B-cells. It is used to diagnose **B-ALL** and Follicular Lymphoma. * **CD30:** A marker for activated T and B cells. It is the hallmark of **Hodgkin Lymphoma** (Reed-Sternberg cells) and **Anaplastic Large Cell Lymphoma (ALCL)**. * **CD56:** An adhesion molecule used as a marker for **Natural Killer (NK) cells** and certain neuroendocrine tumors. **High-Yield Clinical Pearls for NEET-PG:** * **Electron Microscopy:** The pathognomonic finding in LCH is the **Birbeck Granule**, which has a characteristic "tennis-racket" appearance [1]. * **Langerin (CD207):** This is the most specific marker for LCH as it is directly associated with the formation of Birbeck granules [1]. * **Clinical Triad (Hand-Schüller-Christian disease):** Calvarial bone defects, exophthalmos, and diabetes insipidus. * **BRAF V600E Mutation:** Seen in approximately 50% of LCH cases [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. 629-630.

Q: Auto-splenectomy is associated with which of the following conditions?

Systemic lupus erythematosus. **Explanation:** **Auto-splenectomy** refers to the progressive fibrosis and atrophy of the spleen due to repeated vascular insults, eventually leading to a non-functional, shrunken organ. **Why A is correct:** While **Sickle Cell Anemia** is the most common cause of auto-splenectomy (due to repeated micro-infarctions) [1], **Systemic Lupus Erythematosus (SLE)** is a well-recognized cause in adults. In SLE, the mechanism involves vasculitis of the splenic vessels and the deposition of immune complexes, leading to infarction and subsequent atrophy. A characteristic histological finding in SLE is **"onion-skin" thickening** of the splenic penicilliary arteries due to concentric perivascular fibrosis. **Why the other options are incorrect:** * **B. Trauma:** Splenic trauma typically leads to surgical splenectomy (splenectomy due to rupture) or the formation of accessory splenic tissue (splenosis), but not the gradual physiological atrophy known as auto-splenectomy. * **C. Sarcoidosis:** This condition typically causes **splenomegaly** (enlargement) due to the infiltration of non-caseating granulomas. * **D. ITP:** In ITP, the spleen is the site of platelet destruction, but it usually remains **normal in size** or shows only mild enlargement. It does not undergo atrophy. **High-Yield Clinical Pearls for NEET-PG:** * **Most common cause of auto-splenectomy:** Sickle Cell Anemia (usually complete by childhood) [1]. * **Howell-Jolly bodies:** These nuclear remnants in RBCs are a hallmark of a non-functional spleen (seen after auto-splenectomy) [1]. * **Onion-skin lesion:** Pathognomonic splenic finding in SLE. * **Other causes of small spleen:** Celiac disease and Essential Thrombocythemia. **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. 631-632.

Question 1

Which of the following is NOT a laboratory finding in thalassemia major?

Accepted Answer

Normal ferritin level

Answer

Normal TIBC

Answer

Microcytic hypochromic anemia

Answer

High saturation percentage

Question 2

Low serum haptoglobin in hemolysis is masked by which of the following conditions?

Accepted Answer

Bile duct obstruction

Answer

Pregnancy

Answer

Liver disease

Answer

Malnutrition

Question 3

Which of the following is a laboratory finding of Multiple myeloma?

Accepted Answer

Both

Answer

Bence jones protein

Answer

Hyperglobulinemia

Answer

None

Question 4

Which of the following is a marker for Langerhans cell histiocytosis?

Accepted Answer

CD 1a

Answer

CD 10

Answer

CD 30

Answer

CD 56

Question 5

Auto-splenectomy is associated with which of the following conditions?

Accepted Answer

Systemic lupus erythematosus

Answer

Trauma

Answer

Sarcoidosis

Answer

Idiopathic thrombocytopenic purpura (ITP)

Question 6

Leukocyte alkaline phosphatase is increased in all conditions except?

Accepted Answer

Chronic myeloid leukemia (CML)

Answer

Polycythemia vera

Answer

Myelofibrosis

Answer

Myeloid metaplasia

Question 7

A 59-year-old male patient presents with multiple neck swellings, fever, and weight loss. General examination reveals painless lymph node enlargement in the neck, and blood investigations show anemia. Serum albumin is 32 gm/l. Lymph node biopsy shows Reed-Sternberg cells. What is the 5-year rate of overall survival (in %) for this patient, according to the Hasenclever prognostic index for advanced Hodgkin lymphoma?

Accepted Answer

74

Answer

90

Answer

70

Answer

59

Question 8

As compared to iron deficiency anemia, which of the following is decreased in anemia of chronic disease?

Accepted Answer

Total iron-binding capacity (TIBC)

Answer

Endogenous bone marrow iron stores

Answer

Serum ferritin

Answer

Transferrin saturation

Question 9

Which of the following is not a feature of multiple myeloma?

Accepted Answer

t(8;14) translocation

Answer

Recurrent infection

Answer

Neurological manifestation

Answer

Hypercalcemia

Question 10

Deficiency of GpIIb-IIIa results in which of the following conditions?

Accepted Answer

Glanzmann thrombasthenia

Answer

Wiskott-Aldrich syndrome

Answer

Bernard-Soulier syndrome

Answer

None of the above

Hematopathology — MCQs

Hematopathology — MCQs

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