Hematopathology Practice Questions

Q: What is characteristically found in the bone marrow in lead poisoning?

Ringed siderocytes. **Explanation:** Lead poisoning (Plumbism) interferes with the biosynthesis of heme by inhibiting two key enzymes: **delta-aminolevulinic acid dehydratase (ALAD)** and **Ferrochelatase** [1]. The inhibition of Ferrochelatase prevents the incorporation of iron into the protoporphyrin ring. Consequently, iron accumulates within the mitochondria of developing erythroblasts in the bone marrow. When these cells are stained with **Prussian Blue (Perls' stain)**, the iron-laden mitochondria appear as a necklace-like ring around the nucleus, termed **Ringed Sideroblasts** (or Siderocytes in mature forms). **Analysis of Options:** * **A. Ringed siderocytes (Correct):** These are the hallmark of sideroblastic anemias, which can be hereditary or acquired (e.g., lead poisoning, alcohol, or MDS). * **B. Giant metamyelocytes:** These are characteristic of **Megaloblastic Anemia** (Vitamin B12 or Folate deficiency) due to impaired DNA synthesis and nuclear-cytoplasmic dyssynchrony. * **C. Dwarf megakaryocytes (Micromegakaryocytes):** These are small, mononuclear megakaryocytes typically seen in **Myelodysplastic Syndromes (MDS)** or Chronic Myeloid Leukemia (CML). * **D. Fibrotic changes:** Extensive marrow fibrosis is characteristic of **Primary Myelofibrosis** or late-stage "spent phase" polycythemia vera. **High-Yield Clinical Pearls for NEET-PG:** * **Peripheral Smear:** Look for **Coarse Basophilic Stippling** (due to inhibition of 5'-nucleotidase, leading to ribosomal RNA degradation). * **X-ray:** "Lead lines" at the metaphyses of growing long bones in children [1]. * **Gums:** "Burtonian lines" (bluish-purple pigmentation at the gingival margin). * **Treatment:** Chelation therapy with **Succimer** (oral, first-line in kids) or **CaNa₂EDTA**. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Infectious Diseases, pp. 418-419.

Q: What is the concentration of Hb A2 in thalassemia trait?

Slightly increased. **Explanation:** In **$\beta$-thalassemia trait** (minor), there is a partial deficiency in the production of $\beta$-globin chains. To compensate for this deficit, the body increases the production of alternative hemoglobin types that do not require $\beta$-chains. 1. **Why "Slightly Increased" is correct:** In $\beta$-thalassemia trait, the excess $\alpha$-chains pair with $\delta$-chains to form **Hb A2 ($\alpha_2\delta_2$)**. In a healthy adult, Hb A2 is typically <3%. In $\beta$-thalassemia trait, it characteristically rises to **3.5% – 7%**. While this is a diagnostic increase, it is medically classified as "slight" compared to the massive shifts seen in other hemoglobinopathies. 2. **Analysis of Incorrect Options:** * **Normal:** A normal Hb A2 level (2-3%) usually rules out $\beta$-thalassemia trait (except in rare cases of co-existing iron deficiency). * **Increased/Markedly Increased:** These terms are imprecise or misleading. "Markedly increased" would describe HbF levels in $\beta$-thalassemia major (often >90%). In the context of standardized exams like NEET-PG, the specific elevation of Hb A2 in trait is classically described as "slight." **High-Yield Clinical Pearls for NEET-PG:** * **Gold Standard Diagnosis:** Hb electrophoresis showing Hb A2 >3.5% is the diagnostic hallmark of $\beta$-thalassemia trait. * **Mentzer Index:** (MCV/RBC count) 13 suggests Iron Deficiency Anemia (IDA). * **The IDA Trap:** Concomitant iron deficiency can mask $\beta$-thalassemia trait by lowering Hb A2 levels into the normal range. Always correct iron stores before testing. * **Peripheral Smear:** Shows microcytic hypochromic anemia with **target cells** and basophilic stippling [1]. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Blood And Bone Marrow Disease, pp. 590-591.

Question 1

What is the most accurate statement regarding Disseminated Intravascular Coagulation (DIC)?

Accepted Answer

DIC is associated with increased levels of D-dimer.

Answer

Removal of the underlying cause leads to complete resolution.

Answer

It is associated with increased serum fibrinogen levels.

Answer

Normal clotting parameters excludes DIC.

Question 2

What is characteristically found in the bone marrow in lead poisoning?

Accepted Answer

Ringed siderocytes

Answer

Giant metamyelocytes

Answer

Dwarf megakaryocytes

Answer

Fibrotic changes

Question 3

Which mediastinal tumor is most likely associated with red blood cell aplasia?

Accepted Answer

Thymoma

Answer

Hodgkin's disease

Answer

Neuroblastoma

Answer

Parathyroid adenoma

Question 4

All of the following are true regarding the findings of peripheral smear in vitamin B12 deficiency except?

Accepted Answer

Microcytic red cells

Answer

Hypercellular marrow

Answer

Poikilocytosis

Answer

Hypersegmented neutrophils

Question 5

Which of the following lymph nodes are commonly affected in non-Hodgkin's Lymphoma, except?

Accepted Answer

Mediastinal lymph nodes

Answer

Epitrochlear lymph nodes

Answer

Peripheral lymph nodes

Answer

Inner Waldeyer ring

Question 6

A 25-year-old female presents with palpable lumps in the axilla and supra-clavicular region. Following clinical examination and diagnostic procedures including X-ray, USG-guided biopsy, and HPE, a diagnosis was established. Flow cytometry revealed CD15 and CD30 positivity. The patient was initiated on chemotherapy and subsequently developed skin lesions. Which of the following chemotherapeutic agents is most likely responsible for these skin manifestations?

Accepted Answer

Bleomycin

Answer

Daunorubicin

Answer

Capecitabine

Answer

Cyclophosphamide

Question 7

What is the concentration of Hb A2 in thalassemia trait?

Accepted Answer

Slightly increased

Answer

Normal

Answer

Increased

Answer

Markedly increased

Question 8

A 28-year-old female presents with recurrent abortions and pain in the calves. She is most likely suffering from a deficiency of which of the following?

Accepted Answer

Protein C

Answer

Thrombin

Answer

Factor XIII

Answer

Plasmin

Question 9

What happens to the haptoglobin level in hemolytic anemia?

Accepted Answer

Haptoglobin levels decrease

Answer

Haptoglobin levels increase

Answer

Remains the same

Answer

May increase or decrease depending on chronicity of the disease

Question 10

All of the following precipitate sickling of HBS except?

Accepted Answer

Increased pH

Answer

Dehydration

Answer

Hypoxia

Answer

Infections

Hematopathology — MCQs

Hematopathology — MCQs

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