Hematopathology Practice Questions

Q: Which one of the labeled boxes in the diagram below is most consistent with the expected findings for an individual with polycythemia rubra vera?

Box E. ***Box E*** - Shows **markedly elevated RBC/Hct**, **elevated WBC**, and **elevated platelets** with **decreased EPO** - the classic triad of polycythemia rubra vera due to **JAK2 mutation** causing autonomous bone marrow proliferation. - **Normal oxygen saturation** with **low EPO** distinguishes primary polycythemia (PRV) from secondary causes where EPO would be elevated. *Box A* - Likely represents **normal values** with balanced RBC, WBC, platelets, and appropriate EPO levels. - Does not show the **panmyelosis** (increased RBC, WBC, and platelets) characteristic of polycythemia rubra vera. *Box B* - Probably shows **secondary polycythemia** with elevated RBC/Hct but **normal WBC and platelets** with **elevated EPO**. - Lacks the **autonomous proliferation** of all cell lines seen in PRV due to **JAK2 mutation**. *Box D* - May represent **relative polycythemia** or **dehydration** with elevated Hct but normal other parameters. - Missing the **clonal myeloproliferation** affecting multiple cell lines that defines polycythemia rubra vera.

Q: What is the most suitable test to assess iron stores?

Serum ferritin. No changes were made to the explanation because none of the provided references met the relevance threshold for citation. Serum ferritin is considered the most suitable and sensitive initial test to assess total body iron stores. Ferritin is an intracellular protein that stores iron in a non-toxic form and releases it in a controlled manner. In a healthy individual, the amount of ferritin in the serum is directly proportional to the total iron stores in the reticuloendothelial system (liver, spleen, and bone marrow). It is the first parameter to decrease in iron deficiency anemia, often before clinical symptoms or changes in red cell morphology appear. **Analysis of Incorrect Options:** * **Serum Iron (A):** Measures the amount of circulating iron bound to transferrin. It fluctuates significantly due to dietary intake, diurnal variation, and acute illness, making it an unreliable measure of long-term stores. * **TIBC (C):** Total Iron Binding Capacity measures the blood's capacity to bind iron with transferrin. While it increases in iron deficiency, it is an indirect measure and can be affected by liver function and protein status. * **Transferrin Saturation (D):** This is a calculated percentage (Serum Iron/TIBC × 100). It indicates how much serum iron is actually bound but does not quantify the reserve stores in the tissues. **Clinical Pearls for NEET-PG:** * **Gold Standard:** While serum ferritin is the best *non-invasive* test, the **Prussian Blue stain of bone marrow aspirate** remains the absolute gold standard for assessing iron stores. * **Acute Phase Reactant:** Ferritin is an acute-phase reactant. Its levels may be falsely elevated in inflammatory states, malignancy, or liver disease, even if iron stores are low. * **Diagnostic Threshold:** A serum ferritin level **<15–30 ng/mL** is highly specific for iron deficiency anemia.

Q: Which of the following statements about sickle cell disease is false?

Hemolysis is predominantly intravascular.. In Sickle Cell Disease (SCD), the primary mechanism of red cell destruction is extravascular hemolysis [1]. Sickled erythrocytes are rigid and non-deformable; as they pass through the splenic sinusoids, they are recognized as abnormal and sequestered by splenic macrophages [1]. While some minor intravascular hemolysis occurs due to mechanical fragility, the predominant site of destruction is the reticuloendothelial system (spleen and liver). **Analysis of Options:** * **Option A (True):** Sickle cell trait (HbAS) provides a survival advantage against *Plasmodium falciparum* malaria. The parasite consumes oxygen, causing the cell to sickle and be cleared by the spleen, thereby reducing the parasite burden. * **Option B (True):** The molecular basis of SCD is a point mutation (GAG → GTG) in the β-globin gene, resulting in the substitution of **Glutamic acid (polar) by Valine (non-polar)** at the 6th position of the β-chain [2]. * **Option C (True):** **Hyposthenuria** (inability to concentrate urine) is a classic finding. Repeated micro-infarctions in the renal medulla (due to the hypertonic, hypoxic environment) damage the vasa recta, impairing the countercurrent exchange mechanism. **NEET-PG High-Yield Pearls:** 1. **Autosplenectomy:** Repeated splenic infarctions lead to a shrunken, fibrotic spleen by childhood, increasing susceptibility to encapsulated organisms (*S. pneumoniae*, *H. influenzae*) [1]. 2. **Howell-Jolly Bodies:** These nuclear remnants are seen on peripheral smears post-autosplenectomy. 3. **Salmonella Osteomyelitis:** While *S. aureus* is the most common cause of osteomyelitis overall, patients with SCD have a uniquely high predisposition to *Salmonella* species. 4. **Aplastic Crisis:** Most commonly triggered by **Parvovirus B19** infection [1].

Question 1

Which one of the labeled boxes in the diagram below is most consistent with the expected findings for an individual with polycythemia rubra vera?

Accepted Answer

Box E

Answer

Box A

Answer

Box B

Answer

Box D

Question 2

What is the most common extranodal site for non-Hodgkin's lymphoma?

Accepted Answer

Stomach

Answer

Brain

Answer

Intestines

Answer

Tonsils

Question 3

Nuclear-cytoplasmic asynchrony is usually seen in:

Accepted Answer

Cobalamin Deficiency Anemia

Answer

Myelophthisic Anemia

Answer

Aplastic Anemia

Answer

Iron deficiency Anemia

Question 4

What is the most suitable test to assess iron stores?

Accepted Answer

Serum ferritin

Answer

Serum iron

Answer

TIBC

Answer

Transferrin saturation

Question 5

Acquired mutations in the PIGA gene give rise to which condition?

Accepted Answer

Paroxysmal Nocturnal Hemoglobinuria

Answer

Hereditary Spherocytosis

Answer

Isoimmune hemolytic anemia

Answer

Fanconi’s anemia

Question 6

All of the following are true about nodular sclerosis of Hodgkin's disease except?

Accepted Answer

CD20 positive

Answer

Well-formed fibrous bands

Answer

CD15 positive

Answer

Infiltration by plasma cells

Question 7

Which of the following statements about sickle cell disease is false?

Accepted Answer

Hemolysis is predominantly intravascular.

Answer

Sickle cell trait confers a protective effect against malaria.

Answer

There is a replacement of glutamic acid by valine at the beta-6 position.

Answer

Hyposthenuria is a characteristic finding.

Question 8

Erythrocyte Sedimentation Rate is zero in which of the following conditions?

Accepted Answer

Afibrinogenemia

Answer

Abetalipoproteinemia

Answer

Asplenia

Answer

Aplastic anemia

Question 9

What is true about acquired disorders of coagulation?

Accepted Answer

Shows defects in platelets as well

Answer

Shows specific clotting factor deficiency

Answer

Are less frequent than inherited disorders

Answer

Hemarthrosis is specifically seen

Question 10

A 19-year-old man has had recurrent bleeding occur in his knee when playing contact sports. He has no history of spontaneous bleeding, but his brother had similar problems. Consultation with a specialist reveals that he has "mild" hemophilia A. Which of the following factor abnormalities is consistent with this diagnosis?

Accepted Answer

decreased levels of functional factor VIII

Answer

abnormal factor VIII function

Answer

decreased factor IX level

Answer

decreased von Willebrand factor

Hematopathology — MCQs

Hematopathology — MCQs

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