Hematopathology Practice Questions

Q: A 15-year-old boy presented with a one-day history of bleeding gums, subconjunctival bleed, and purpuric rash. Investigations revealed the following results: Hb - 6.4 gm/dL; TLC - 26,500/mm3; Platelets - 35,000/mm3; Prothrombin time - 20 sec (control 13 sec); Partial thromboplastin time - 50 sec; and Fibrinogen - 10 mg/dL. Peripheral smear was suggestive of acute myeloblastic leukemia. Which of the following is the most likely diagnosis?

Promyelocytic leukemia. **Explanation:** The clinical presentation of a young patient with sudden onset bleeding (gums, subconjunctival, purpura) and laboratory evidence of **Disseminated Intravascular Coagulation (DIC)** is the hallmark of **Acute Promyelocytic Leukemia (APL)**, classified as AML-M3. **Why Option C is correct:** The key to this diagnosis is the combination of leukocytosis and severe coagulopathy. In APL, the promyelocytes contain numerous **procoagulant-rich granules** (and multiple Auer rods). When these cells lyse, they release tissue factor-like substances and plasminogen activators, triggering a massive consumption of clotting factors. This is reflected in the patient's labs: prolonged PT/aPTT and **profoundly low Fibrinogen (10 mg/dL)**. **Why other options are incorrect:** * **Options A (M1) and B (M2):** While these are common forms of AML, they typically present with features of bone marrow failure (anemia, infections) but are rarely associated with primary DIC at presentation. * **Option D (M4):** Myelomonocytic leukemia often presents with gum hypertrophy and extramedullary involvement (skin/CNS), but DIC is not its defining initial feature. **High-Yield Clinical Pearls for NEET-PG:** * **Cytogenetics:** Associated with **t(15;17)**, involving the PML-RARA fusion gene. * **Morphology:** Presence of **"Faggot cells"** (cells with bundles of Auer rods). * **Treatment:** Medical emergency! Start **ATRA (All-Trans Retinoic Acid)** immediately to induce differentiation of promyelocytes and resolve coagulopathy. * **Complication:** Watch for **Differentiation Syndrome** (fever, respiratory distress, pulmonary infiltrates) during ATRA therapy.

Question 1

Which of the following is NOT a B cell marker?

Accepted Answer

CD-15

Answer

CD-19

Answer

CD-21

Answer

CD-24

Question 2

Target cells are seen in peripheral blood in which of the following conditions?

Accepted Answer

Thalassemia

Answer

Pernicious anemia

Answer

Aplastic anemia

Answer

Sickle cell anemia

Question 3

In Fanconi anemia, what is the underlying cause?

Accepted Answer

Mutation of a DNA repair gene

Answer

Deficiency of copper

Answer

No increased risk of squamous cell carcinoma

Answer

Purely nutritional disorder etiology

Question 4

Which of the following cytokines acts as a specific hematopoietic growth factor of eosinophils?

Accepted Answer

IL 5

Answer

IL 2

Answer

IL 4

Answer

M CSF

Question 5

Which of the following conditions does NOT prolong the Prothrombin Time (PT)?

Accepted Answer

Immune Thrombocytopenic Purpura (ITP)

Answer

Christmas Disease (Factor IX deficiency)

Answer

Hemophilia A (Factor VIII deficiency)

Answer

Hemophilia B (Factor IX deficiency)

Question 6

Sezary-Lutzner cells are characterized by all of the following except?

Accepted Answer

Malignant CD 4 T-cells

Answer

Hyperconvoluted cerebriform nucleus

Answer

Hallmark of mycosis fungoides

Answer

Mostly affects the older population over 40 years

Question 7

Direct Coombs test is positive in hemolytic anemia due to which of the following conditions?

Accepted Answer

Paroxysmal cold hemoglobinuria

Answer

Paroxysmal nocturnal hemoglobinuria

Answer

Idiopathic thrombocytopenic purpura

Answer

Hemolytic uremic syndrome

Question 8

A lymph node from a 10-year-old boy reveals large pleomorphic lymphocytes with CD30 positivity, frequent mitoses, and scattered cells bearing kidney-shaped nuclei. Which of the following statements is true?

Accepted Answer

Hallmark cells are a feature.

Answer

t(2;5) translocation imparts a worsened prognosis.

Answer

ALK protein immunostaining is seen in a minority of cases.

Answer

This tumor occurs exclusively in children.

Question 9

A 15-year-old boy presented with a one-day history of bleeding gums, subconjunctival bleed, and purpuric rash. Investigations revealed the following results: Hb - 6.4 gm/dL; TLC - 26,500/mm3; Platelets - 35,000/mm3; Prothrombin time - 20 sec (control 13 sec); Partial thromboplastin time - 50 sec; and Fibrinogen - 10 mg/dL. Peripheral smear was suggestive of acute myeloblastic leukemia. Which of the following is the most likely diagnosis?

Accepted Answer

Promyelocytic leukemia

Answer

Myeloblastic leukemia without maturation

Answer

Myeloblastic leukemia with maturation

Answer

Myelomonocytic leukemia

Question 10

Gingiva are enlarged in leukemia because of which of the following?

Accepted Answer

WBC infiltration

Answer

Capillary dilation

Answer

Erythrocyte engorgement

Answer

Edema

Hematopathology — MCQs

Hematopathology — MCQs

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