Hematopathology Practice Questions

Q: Which of the following is NOT a cause of microcytic hypochromic anemia?

Sickle cell disease. Microcytic hypochromic anemia is characterized by a Mean Corpuscular Volume (MCV) < 80 fL and a Mean Corpuscular Hemoglobin Concentration (MCHC) < 32 g/dL. This occurs due to defects in hemoglobin synthesis (heme or globin). **Why Sickle Cell Disease is the correct answer:** Sickle cell disease (SCD) is a qualitative hemoglobinopathy [1] (substitution of valine for glutamic acid) [2]. It typically presents as a **Normocytic Normochromic Anemia** with a high reticulocyte count due to its hemolytic nature. While chronic hemolysis can lead to secondary iron deficiency (microcytosis), the primary disease process itself is normocytic. **Analysis of other options:** * **Iron Deficiency Anemia (IDA):** The most common cause of microcytic hypochromic anemia worldwide due to defective heme synthesis [2]. * **Aplastic Anemia:** This is a bone marrow failure syndrome characterized by pancytopenia. It typically presents as **Normocytic** or occasionally **Macrocytic** anemia (due to stress erythropoiesis), but never microcytic. * **Hereditary Spherocytosis:** This is a red cell membrane defect. It typically presents as **Normocytic** anemia, but it is unique for having an **elevated MCHC** (hyperchromic appearance) due to membrane loss and cellular dehydration. *(Note: The question as provided contains a technical discrepancy. Both A, B, and D are typically NOT microcytic. However, in the context of NEET-PG, if forced to choose the "most" correct among non-microcytic options, SCD is often grouped with hemolytic anemias which are normocytic.)* **NEET-PG High-Yield Pearls:** * **Mnemonic for Microcytic Anemia (TAILS):** **T**halassemia, **A**nemia of chronic disease (late), **I**ron deficiency, **L**ead poisoning, **S**ideroblastic anemia. * **Mentzer Index (MCV/RBC):** 13 suggests Iron Deficiency Anemia. * **Hereditary Spherocytosis:** Look for increased MCHC and a positive Osmotic Fragility Test.

Q: What is the best method for hemoglobin estimation?

Cyanmethemoglobin method. **Explanation:** The **Cyanmethemoglobin (HiCN) method** is the gold standard and the internationally recommended method (by the ICSH) for hemoglobin estimation. **Why it is the best method:** 1. **Universal Conversion:** It converts almost all forms of hemoglobin (oxyhemoglobin, deoxyhemoglobin, carboxyhemoglobin, and methemoglobin) into a single stable compound called cyanmethemoglobin. The only exception is **sulfhemoglobin**. 2. **Stability:** The color produced is highly stable and does not fade quickly, allowing for accurate spectrophotometric measurement. 3. **Standardization:** Commercially available Drabkin’s solution and certified HiCN standards ensure high precision and minimal inter-observer variability. **Analysis of Incorrect Options:** * **Sahli’s Method (Acid Hematin):** This is an obsolete visual method. It is prone to significant errors (up to 10-15%) due to subjective color matching, slow conversion of hemoglobin to acid hematin, and the fact that it does not measure carboxy- or methemoglobin. * **Calorimetric Method:** While the HiCN method is technically a colorimetric/spectrophotometric technique, "Calorimetric" is a broad category, not a specific method. In the context of this question, the specific chemical reaction (Cyanmethemoglobin) is the superior answer. **High-Yield Clinical Pearls for NEET-PG:** * **Drabkin’s Solution:** Contains Potassium Ferricyanide (converts Hb to MetHb) and Potassium Cyanide (converts MetHb to HiCN). * **Wavelength:** Absorbance is measured at **540 nm**. * **Lipemia/Leukocytosis:** High WBC counts (>20,000/µL) or high lipids can cause turbidity in the solution, leading to a falsely elevated Hb reading. * **Sulfhemoglobin:** This is the only form of hemoglobin **not** measured by the HiCN method.

Question 1

Hypopigmentation, gray streaks of hair, degranulation defect of neutrophils, and neuropathy are seen in which of the following conditions?

Accepted Answer

Chediak-Higashi syndrome

Answer

Aleukemic Leukemia

Answer

Chronic granulocytic leukemia

Answer

Lazy leukocyte syndrome

Question 2

What is the most common site of lymph node enlargement in Hodgkin's lymphoma?

Accepted Answer

Mediastinal

Answer

Axillary

Answer

Cervical

Answer

Abdominal

Question 3

Which of the following is NOT a cause of microcytic hypochromic anemia?

Accepted Answer

Sickle cell disease

Answer

Aplastic anemia

Answer

Iron deficiency anemia

Answer

Hereditary spherocytosis

Question 4

Which is the most common subtype of acute myeloid leukemia according to the FAB classification?

Accepted Answer

M2

Answer

M3

Answer

M4

Answer

M5

Question 5

Which of the following is NOT a cause for Disseminated Intravascular Coagulation (DIC)?

Accepted Answer

Cholera

Answer

Septicemia

Answer

Visceral carcinoma

Answer

Antepartum hemorrhage

Question 6

Increased rouleaux formation in the peripheral blood is a characteristic feature of which of the following conditions?

Accepted Answer

Multiple myeloma

Answer

Non-Hodgkin's lymphoma

Answer

Tuberculosis

Answer

Malaria

Question 7

What is the best method for hemoglobin estimation?

Accepted Answer

Cyanmethemoglobin method

Answer

Sahli's hemoglobinometer

Answer

Calorimetric method

Answer

None of the above

Question 8

Which of the following is true about alpha-thalassemia trait?

Accepted Answer

Microcytosis

Answer

Increased HbF

Answer

Increased HbA2

Answer

Severe anemia

Question 9

A 35-year-old woman is evaluated for a long history of easy bruising. The peripheral smear shows only a few, large, young platelets, while other cell lines are normal. Marrow studies show increased megakaryocytes. Which of the following is the most likely diagnosis?

Accepted Answer

Idiopathic thrombocytopenic purpura

Answer

Microangiopathic hemolytic anemia

Answer

Thrombasthenia

Answer

Thrombotic thrombocytopenic purpura

Question 10

All of the following are true about the etiology of primary myelofibrosis, EXCEPT:

Accepted Answer

Mutations in the thrombopoietin receptor Mpl occur in 50% of cases.

Answer

JAK2 mutation is seen in 50% of cases.

Answer

Overproduction of transforming growth factor.

Answer

Overproduction of osteoprotegerin.

Hematopathology — MCQs

Hematopathology — MCQs

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