Hematopathology Practice Questions

Q: A 68-year-old man with prostate cancer and bone metastases presents with shaking chills and fever. The peripheral WBC count is 1,000/mL (normal = 4,000 to 11,000/mL). Which of the following terms best describes this hematologic finding?

Leukopenia. **Explanation:** **1. Why Leukopenia is Correct:** The patient’s peripheral White Blood Cell (WBC) count is **1,000/mL**, which is significantly below the normal reference range of **4,000 to 11,000/mL**. The medical term for a reduction in the total number of circulating leukocytes is **Leukopenia** [1]. In this clinical scenario, the leukopenia is likely secondary to **myelophthisis** (replacement of bone marrow by metastatic prostate cancer) or sepsis-induced consumption [1]. **2. Why the Other Options are Incorrect:** * **A. Leukocytosis:** This refers to an *increase* in the total WBC count (>11,000/mL), typically seen in infections, inflammation, or malignancy. * **C. Neutrophilia:** This is a specific increase in the absolute *neutrophil* count (>7,000/mL). While neutrophils are a subset of WBCs, the question provides the total WBC count, and the value is decreased, not increased. * **D. Leukemoid Reaction:** This is an extreme leukocytosis (usually >50,000/mL) characterized by a significant left shift (immature precursors), often mimicking leukemia but occurring in response to severe infection or inflammation. **3. Clinical Pearls for NEET-PG:** * **Myelophthisic Anemia:** When bone marrow is infiltrated by tumors (like prostate or breast cancer), fibrosis, or granulomas, it leads to a "space-occupying" effect. This often results in **pancytopenia** and the presence of **teardrop RBCs (dacrocytes)** and immature cells on a peripheral smear (leukoerythroblastic picture). * **Agranulocytosis:** A severe form of leukopenia where the neutrophil count drops below 500/mL, making the patient highly susceptible to life-threatening infections. * **Prostate Cancer Metastasis:** Classically presents as **osteoblastic** (bone-forming) lesions on imaging, which can displace normal hematopoietic tissue. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Inflammation and Repair, pp. 110-111.

Q: All of the following syndromes are associated with Acute Myeloid Leukemia except?

Turner's syndrome. **Explanation:** The association between chromosomal aneuploidies and hematological malignancies is a high-yield topic in NEET-PG. The correct answer is **Turner’s syndrome (45, XO)**, as it is notably **not** associated with an increased risk of Acute Myeloid Leukemia (AML). While Turner’s syndrome is linked to certain solid tumors (like gonadoblastoma in those with Y-chromosome mosaicism), it does not predispose patients to leukemogenesis. **Analysis of Options:** * **Down’s Syndrome (Trisomy 21):** This has the strongest association with AML [1]. Children with Down’s syndrome have a 10-20 fold increased risk of leukemia. Specifically, they are prone to **AML-M7 (Acute Megakaryoblastic Leukemia)** before age 3, often preceded by Transient Myeloproliferative Disorder (TMD). After age 3, the risk for ALL also increases. * **Klinefelter’s Syndrome (47, XXY):** This syndrome is associated with an increased risk of germ cell tumors (especially mediastinal) and hematological malignancies, including **AML** and non-Hodgkin lymphoma. * **Patau Syndrome (Trisomy 13):** Along with Edwards syndrome (Trisomy 18), Patau syndrome is associated with an increased incidence of neonatal leukemia and AML, though survival is often limited by the severity of the congenital malformations. **Clinical Pearls for NEET-PG:** * **GATA1 Mutation:** This is the characteristic mutation found in Down’s syndrome patients who develop TMD or AML-M7. * **Fanconi Anemia:** The most common inherited bone marrow failure syndrome that progresses to AML. * **Bloom Syndrome & Ataxia-Telangiectasia:** Other DNA repair defect syndromes with a high predisposition to AML. **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. 620.

Question 1

Non-specific esterase is present in which of the following?

Accepted Answer

Acute Myeloid Leukemia (AML)

Answer

Megakaryocytic leukemia

Answer

Lymphocytic leukemia

Answer

Erythroleukemia

Question 2

A 68-year-old man with prostate cancer and bone metastases presents with shaking chills and fever. The peripheral WBC count is 1,000/mL (normal = 4,000 to 11,000/mL). Which of the following terms best describes this hematologic finding?

Accepted Answer

Leukopenia

Answer

Leukocytosis

Answer

Neutrophilia

Answer

Leukemoid reaction

Question 3

Which subtype of Hodgkin's disease is histogenetically distinct from all other subtypes?

Accepted Answer

Lymphocyte predominant

Answer

Nodular sclerosis

Answer

Mixed cellularity

Answer

Lymphocyte depleted

Question 4

All of the following syndromes are associated with Acute Myeloid Leukemia except?

Accepted Answer

Turner's syndrome

Answer

Down's syndrome

Answer

Klinefelter's syndrome

Answer

Patau syndrome

Question 5

If both parents have sickle cell anemia, what is the likelihood of their offspring having the disease?

Accepted Answer

100%

Answer

0%

Answer

25%

Answer

50%

Question 6

BCR-ABL gene mutation is seen in which hematological malignancy?

Accepted Answer

Chronic Myeloid Leukemia (CML)

Answer

Acute Myeloid Leukemia (AML)

Answer

Chronic Lymphocytic Leukemia (CLL)

Answer

Acute Lymphoblastic Leukemia (ALL)

Question 7

Which of the following is the most common hemoglobinopathy?

Accepted Answer

Sickle cell anemia

Answer

Thalassemia

Answer

Hemoglobin C

Answer

Spherocytosis

Question 8

A 50-year-old female patient complains of weakness and pain in her back. She has a history of recurrent infections. Laboratory investigations reveal the presence of Bence Jones proteins in her urine. This condition results from the overproduction of abnormal immunoglobulins, which are mostly of which type?

Accepted Answer

IgG

Answer

IgM

Answer

IgA

Answer

IgD

Question 9

In β-thalassemia, what is the characteristic defect regarding the beta-globin chain?

Accepted Answer

Absence of beta chains

Answer

Excess beta chain production

Answer

Absence of any globin chains

Answer

Production of normal beta chains

Question 10

Which of the following is involved in hereditary spherocytosis?

Accepted Answer

Ankyrin

Answer

Troponin

Answer

Pyrin

Answer

Actin

Hematopathology — MCQs

Hematopathology — MCQs

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