Hematopathology Practice Questions

Q: JAK-2 mutation is seen in which of the following conditions?

Polycythemia Vera. **Explanation:** The **JAK2 (Janus Kinase 2)** mutation is a hallmark of **BCR-ABL1 negative Myeloproliferative Neoplasms (MPNs)**. The most common mutation is a point mutation (V617F) in exon 14, which leads to constitutive activation of the JAK-STAT signaling pathway. This results in hypersensitivity of hematopoietic stem cells to growth factors (like erythropoietin), leading to autonomous cell proliferation [1]. * **Polycythemia Vera (PV):** This is the correct answer. The JAK2 V617F mutation is present in **>95% of PV cases** [1]. It is a major diagnostic criterion according to the WHO classification. * **Idiopathic Thrombocytopenic Purpura (ITP):** This is an immune-mediated destruction of platelets (Type II hypersensitivity). It is not a clonal stem cell disorder and does not involve JAK2 mutations. * **Chronic Myeloid Leukemia (CML):** CML is characterized by the **Philadelphia chromosome [t(9;22)]**, which creates the **BCR-ABL1** fusion gene [1]. While it is an MPN, it is "BCR-ABL1 positive" and typically does not harbor the JAK2 mutation. * **Chronic Myelomonocytic Leukemia (CMML):** This is a Myelodysplastic/Myeloproliferative overlap syndrome. While mutations like TET2 or SRSF2 are common, JAK2 is rare ( 95%) > Essential Thrombocythemia (~50-60%) = Primary Myelofibrosis (~50-60%) [1]. * **PV Diagnostic Clue:** Low serum Erythropoietin (EPO) levels combined with JAK2 positivity. * **Clinical Sign:** Aquagenic pruritus (itching after a hot bath) is a classic symptom of PV. * **Treatment:** Ruxolitinib is a JAK1/2 inhibitor used in refractory cases. **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. 624.

Q: The "Owl's eye" nucleus is a characteristic finding in which type of lymphoma?

Hodgkin's lymphoma. **Explanation:** The "Owl’s eye" appearance is the hallmark morphological feature of the **classic Reed-Sternberg (RS) cell**, which is diagnostic for **Hodgkin’s Lymphoma** [1]. These are large, multinucleated or bilobed cells where each lobe contains a prominent, eosinophilic, inclusion-like nucleolus surrounded by a clear halo, mimicking the eyes of an owl [1]. **Why the other options are incorrect:** * **Non-Hodgkin’s Lymphoma (NHL):** This is a diverse group of malignancies (e.g., Follicular, DLBCL) that typically lack RS cells [1]. They are characterized by a diffuse or nodular proliferation of lymphoid cells without the specific "Owl's eye" morphology. * **Burkitt’s Lymphoma:** This is characterized by a **"Starry sky" appearance** on low power, created by tingible body macrophages (the "stars") consuming apoptotic debris against a background of dark neoplastic B-cells (the "sky"). * **Cutaneous T-cell Lymphoma (Mycosis Fungoides):** This is characterized by **Pautrier’s microabscesses** in the epidermis and "Cerebriform" nuclei (Sezary cells) in the peripheral blood. **High-Yield Clinical Pearls for NEET-PG:** * **Immunophenotype:** Classic RS cells are typically **CD15+ and CD30+**, but negative for CD45 and CD20 (except in the Nodular Lymphocyte Predominant subtype, which is CD20+ and CD45+). * **Variants:** The "Lacunar variant" is specifically associated with the **Nodular Sclerosis** subtype of Hodgkin's Lymphoma [1]. * **Bimodal Age Distribution:** Hodgkin’s Lymphoma typically shows two peaks of incidence (20s and 50s) [1]. * **EBV Association:** The Mixed Cellularity subtype has the strongest association with the Epstein-Barr Virus [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. 614-618.

Question 1

JAK-2 mutation is seen in which of the following conditions?

Accepted Answer

Polycythemia Vera

Answer

Idiopathic Thrombocytopenic Purpura (ITP)

Answer

Chronic Myeloid Leukemia (CML)

Answer

Chronic Myelomonocytic Leukemia (CMML)

Question 2

In multiple myeloma, there is a proliferation of which cell type?

Accepted Answer

Plasma cells

Answer

Basophils

Answer

Eosinophils

Answer

Neutrophils

Question 3

Juvenile myelomonocytic leukemia (JMML) is characterized by all EXCEPT:

Accepted Answer

Philadelphia chromosome

Answer

Increased HbF

Answer

Immature granulocyte

Answer

Nucleated RBC

Question 4

Anemia of chronic disorder is characterized by which of the following laboratory findings?

Accepted Answer

Increased bone marrow iron stores

Answer

Increased serum ferritin

Answer

Increased total iron-binding capacity (TIBC)

Answer

Increased erythrocyte protoporphyrin

Question 5

Failure of clot retraction indicates which of the following?

Accepted Answer

Low platelet count

Answer

Factor VIII deficiency

Answer

Factor XIII deficiency

Answer

Fibrinogen deficiency

Question 6

The "Owl's eye" nucleus is a characteristic finding in which type of lymphoma?

Accepted Answer

Hodgkin's lymphoma

Answer

Non-Hodgkin's lymphoma

Answer

Burkitt's lymphoma

Answer

Cutaneous T-cell lymphoma

Question 7

A deficiency of intrinsic factor can result in anemia. What type of anemia would occur if intrinsic factor were deficient?

Accepted Answer

Megaloblastic anemia

Answer

Hypochromic, microcytic anemia

Answer

Hemolytic anemia

Answer

Sickle cell anemia

Question 8

Flame cells are characteristic of which of the following conditions?

Accepted Answer

Multiple myeloma

Answer

Ewing's sarcoma

Answer

Leukemia

Answer

Osteosarcoma

Question 9

Find the false statement regarding megaloblastic anemia.

Accepted Answer

MCHC is increased

Answer

Macro-polycytes

Answer

Reduced reticulocyte count

Answer

Hypercellular bone marrow

Question 10

Hemolytic anemia is a feature of deficiency of all RBC enzymes EXCEPT?

Accepted Answer

Lactate dehydrogenase

Answer

Glucose 6 phosphate dehydrogenase

Answer

Pyruvate kinase

Answer

Aldolase A

Hematopathology — MCQs

Hematopathology — MCQs

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