Hematopathology Practice Questions

Q: Which subtype of Acute Myeloid Leukemia (AML) is characterized by gum infiltration and hepatosplenomegaly?

M4 subtype. **Explanation:** The correct answer is **M4 subtype (Acute Myelomonocytic Leukemia)**. In the FAB (French-American-British) classification of AML, subtypes with a **monocytic component** (M4 and M5) are uniquely associated with **extramedullary involvement**. This occurs because monoblasts and monocytes have a high propensity to migrate out of the bone marrow and infiltrate tissues [1]. Clinical manifestations of this tissue infiltration include **gum hypertrophy (gingival hyperplasia)**, skin involvement (leukemia cutis), and organomegaly (hepatosplenomegaly). **Analysis of Options:** * **A. Acute Lymphoblastic Leukemia (ALL):** While ALL commonly presents with hepatosplenomegaly and lymphadenopathy (especially in children), it is not typically associated with gum infiltration. * **B. M3 Subtype (Acute Promyelocytic Leukemia):** Characterized by the t(15;17) translocation and a high risk of **DIC (Disseminated Intravascular Coagulation)** due to the release of procoagulants from Auer rods [1]. It does not typically cause gum infiltration. * **C. M2 Subtype (AML with Maturation):** This is the most common subtype of AML. It is often associated with the t(8;21) translocation and the presence of **chloromas** (granulocytic sarcomas), but not specifically gum hypertrophy [1]. **High-Yield Clinical Pearls for NEET-PG:** * **M4 (Myelomonocytic):** Positive for both Myeloperoxidase (MPO) and Non-Specific Esterase (NSE). * **M5 (Monocytic):** Strongest association with gum hypertrophy; predominantly NSE positive. * **M3 (APL):** Associated with **Auer rods in faggot cells** and treated with ATRA (All-Trans Retinoic Acid). * **M0/M1/M2:** Primarily MPO positive. **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.

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.

Question 1

Heterozygous sickle cell anemia provides protection against which of the following?

Accepted Answer

Malaria

Answer

G6PD deficiency

Answer

Thalassemia

Answer

Dengue fever

Question 2

Which subtype of Acute Myeloid Leukemia (AML) is characterized by gum infiltration and hepatosplenomegaly?

Accepted Answer

M4 subtype

Answer

Acute lymphoblastic leukemia (ALL)

Answer

M3 subtype

Answer

M2 subtype

Question 3

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 4

Defect in Bernard Soulier syndrome lies in which of the following?

Accepted Answer

Glycoprotein Ib-IX complex

Answer

Glycoprotein IIIa-IIb complex

Answer

Glycoprotein IIa-IIIb complex

Answer

Glycoprotein IIIb-IIa complex

Question 5

Which of the following conditions is characterized by an intrinsic cell wall defect of red blood cells?

Accepted Answer

Paroxysmal nocturnal hemoglobinuria

Answer

Sickle cell anemia

Answer

Hereditary spherocytosis

Answer

All of the above

Question 6

The cell mass in multiple myeloma is formed by?

Accepted Answer

B-cells turning malignant and secreting light chains

Answer

Circulating B cells settling in bone marrow

Answer

Preformed B cells seen in the marrow

Answer

Circulating B cells settling in bone marrow

Question 7

Nuclear-cytoplasmic asynchrony is usually seen in:

Accepted Answer

Cobalamin Deficiency Anemia

Answer

Myelophthisic Anemia

Answer

Aplastic Anemia

Answer

Iron deficiency Anemia

Question 8

Bone marrow showing positive staining with Periodic Acid Schiff. What is the likely diagnosis?

Accepted Answer

Acute Myeloid Leukemia - M6 (AML-M6)

Answer

Acute Myeloid Leukemia - M2 (AML-M2)

Answer

Acute Myeloid Leukemia - M3 (AML-M3)

Answer

Acute Lymphoblastic Leukemia

Question 9

Dohle bodies are seen in which of the following conditions?

Accepted Answer

May-Hegglin anomaly

Answer

Multiple myeloma

Answer

Waldenstrom macroglobulinemia

Answer

Lymphoma

Question 10

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

Hematopathology — MCQs

Hematopathology — MCQs

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