Hematopathology Practice Questions

Q: Which of the following conditions is associated with decreased total iron-binding capacity?

Anemia of chronic inflammation. **Explanation:** The **Total Iron-Binding Capacity (TIBC)** is a functional measurement of the amount of **Transferrin** available in the blood. In the body, Transferrin and Iron levels usually have an inverse relationship to maintain homeostasis. **Why Anemia of Chronic Inflammation (ACD) is correct:** In chronic inflammation, the liver produces high levels of **Hepcidin** (an acute-phase reactant). Hepcidin degrades ferroportin, trapping iron inside macrophages and hepatocytes. Simultaneously, the body downregulates the production of Transferrin to "starve" potential pathogens of iron. Since TIBC is a surrogate marker for Transferrin, a decrease in Transferrin leads to a **decreased TIBC**. **Analysis of Incorrect Options:** * **Iron Deficiency Anemia (IDA):** This is the classic condition where **TIBC is increased**. The liver compensates for low serum iron by synthesizing more Transferrin to maximize iron transport efficiency. * **Thalassemia:** This is a quantitative defect in globin chain synthesis, not a primary disorder of iron metabolism. Iron studies are typically normal, though TIBC may decrease only if the patient develops secondary iron overload from multiple transfusions. * **Sideroblastic Anemia:** This involves a defect in protoporphyrin synthesis leading to iron overload. Here, Transferrin becomes saturated, leading to a **decreased or normal TIBC**, but it is less characteristic than in ACD. **NEET-PG High-Yield Pearls:** * **Hepcidin** is the "Master Regulator" of iron metabolism; it is increased in ACD and decreased in IDA. * **Ferritin** is an acute-phase reactant; it is **increased** in ACD (iron is trapped) but **decreased** in IDA (iron stores are exhausted). * **Soluble Transferrin Receptor (sTfR) test:** This is the best test to differentiate IDA (increased sTfR) from ACD (normal sTfR).

Q: What is the commonest mode of inheritance of Von Willebrand's disease?

Autosomal dominant. **Explanation:** **1. Why Autosomal Dominant is Correct:** Von Willebrand Disease (vWD) is the most common inherited bleeding disorder worldwide. It is primarily caused by quantitative or qualitative defects in Von Willebrand Factor (vWF) [3]. The gene for vWF is located on **Chromosome 12**. The vast majority of clinical cases (approximately 70-80%) fall under **Type 1** (quantitative deficiency) and **Type 2** (qualitative defect), both of which are inherited in an **Autosomal Dominant** fashion. Because it is autosomal, it affects males and females equally, distinguishing it from Hemophilia. **2. Why the Other Options are Incorrect:** * **Codominant:** While some blood group systems (like ABO) exhibit codominance, vWD does not follow this pattern. * **Autosomal Recessive:** This is the mode of inheritance for **Type 3 vWD** (the most severe form with near-total absence of vWF) and certain rare subtypes of Type 2 (like 2N). However, these represent a very small percentage of total cases. * **X-linked Recessive:** This is the classic inheritance pattern for **Hemophilia A (Factor VIII deficiency) and Hemophilia B (Factor IX deficiency)**. vWD is specifically known for being the "autosomal" alternative to Hemophilia [2]. **3. NEET-PG High-Yield Pearls:** * **Most Common Type:** Type 1 (Autosomal Dominant). * **Clinical Presentation:** Mucocutaneous bleeding (epistaxis, menorrhagia, gingival bleeding) [4]. * **Lab Findings:** Prolonged Bleeding Time (BT) and often a prolonged aPTT (since vWF stabilizes Factor VIII). Platelet count is usually normal (except in Type 2B). * **Screening Test:** Ristocetin Cofactor Activity (decreased) [3]. * **Treatment of Choice:** Desmopressin (DDAVP) for Type 1 [1]; Factor VIII concentrates containing vWF for severe cases.

Question 1

What is the most common virus implicated in lymphoproliferative cancer in a child post-kidney transplant?

Accepted Answer

Epstein-Barr virus (EBV)

Answer

Cytomegalovirus (CMV)

Answer

Varicella-zoster virus

Answer

Human papillomavirus (HPV)

Question 2

Acid phosphatase is specific to which of the following cells?

Accepted Answer

Monocyte

Answer

T lymphocyte

Answer

B lymphocyte

Answer

Myelocytes

Question 3

All the following diseases contain abnormal immunoglobulin except:

Accepted Answer

Reactive arthritis

Answer

Multiple myeloma

Answer

Seligman's disease

Answer

Franklin's disease

Question 4

Which anticoagulant is best suited for the osmotic fragility test?

Accepted Answer

Heparin

Answer

EDTA

Answer

Trisodium citrate

Answer

Potassium oxalate

Question 5

Which of the following is used to irradiate blood products?

Accepted Answer

Gamma rays

Answer

Alpha rays

Answer

Beta rays

Answer

X-rays

Question 6

Which of the following statements is FALSE regarding the cytochemistry of Acute Myeloid Leukemia (AML)?

Accepted Answer

Periodic Acid-Schiff (PAS) stain is negative in erythroleukemia.

Answer

Myeloperoxidase and Sudan Black stains are positive.

Answer

Non-specific esterase is positive in M4 and M5 subtypes.

Answer

All the above statements are false.

Question 7

Which of the following human malignancies is highly malignant, rapidly progressive, and where a delay in treatment of even 1-2 days can lead to death?

Accepted Answer

Burkitt's lymphoma

Answer

Hodgkin's lymphoma

Answer

Neuroblastoma

Answer

Mycosis fungoides

Question 8

Which of the following conditions is associated with decreased total iron-binding capacity?

Accepted Answer

Anemia of chronic inflammation

Answer

Iron deficiency

Answer

Thalassemia

Answer

Sideroblastic anemia

Question 9

Richter's transformation is associated with which of the following conditions?

Accepted Answer

Chronic Lymphocytic Leukemia (CLL)

Answer

Chronic Myeloid Leukemia (CML)

Answer

Acute Myeloid Leukemia (AML)

Answer

Acute Lymphoblastic Leukemia (ALL)

Question 10

What is the commonest mode of inheritance of Von Willebrand's disease?

Accepted Answer

Autosomal dominant

Answer

Codominant

Answer

Autosomal recessive

Answer

X-linked recessive

Hematopathology — MCQs

Hematopathology — MCQs

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