Hematopathology — MCQs

Q: Infant with anemia, poor growth and bleeding from nose was brought to emergency. On examination hepatosplenomegaly was noted, and serum chitotriosidase levels are elevated. Bone marrow examination was done. Diagnosis is:

Gaucher disease type 1. ***Gaucher disease type 1*** - **Anemia**, **poor growth**, **bleeding from nose** (due to thrombocytopenia), and **hepatosplenomegaly** are classic features of Gaucher disease [1]. - **Elevated serum chitotriosidase** is a highly sensitive and specific biomarker for Gaucher disease, and bone marrow examination would reveal **Gaucher cells** (lipid-laden macrophages) [1]. *Metachromatic leukodystrophy* - This is a **lysosomal storage disorder** primarily affecting the **nervous system**, leading to demyelination. - It typically presents with neurological symptoms like developmental regression, ataxia, and spasticity, not primarily hematological or visceral involvement. *Neuronal ceroid lipofuscinosis* - This is a group of **neurodegenerative disorders** characterized by the accumulation of lipopigments in neurons and other cells. - Clinical features include progressive intellectual decline, seizures, visual impairment, and motor dysfunction, without significant hepatosplenomegaly or bleeding diathesis. *Gaucher disease type 2* - While also a type of Gaucher disease, **Type 2 (neuronopathic)** is characterized by severe, rapidly progressive neurological involvement in infancy. - Although it shares features like hepatosplenomegaly, the prominent neurological symptoms and rapid deterioration are key differentiating factors not explicitly mentioned as primary complaints here. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Genetic Disorders, pp. 162-163.

Q: The vacutainer shown below is used for collecting sample for? (AIIMS Nov 2017)

Serum electrolytes. ***Serum electrolytes*** - The image shows a **green-top vacutainer**, which typically contains **lithium heparin** as an anticoagulant. - **Lithium heparin** is the preferred anticoagulant for collecting samples for **serum electrolyte** measurements, as it does not interfere with the analysis of ions like sodium, potassium, and chloride. *Serum lactate* - Serum lactate measurements usually require a **gray-top tube** containing **sodium fluoride** and **potassium oxalate** to inhibit glycolysis and stabilize lactate levels. - A green-top tube with lithium heparin is not ideal for lactate analysis due to continued glycolysis in the absence of a glycolysis inhibitor. *Serum cholesterol* - Serum cholesterol, along with other lipid profiles, is typically collected in a **red-top tube** (no additive) or a **SST (serum separator tube)**, which has a gel barrier. - While cholesterol can be measured from a heparinized plasma sample, a plain red-top or SST is more commonly used for routine lipid panels. *Serum uric acid* - Serum uric acid measurement can be performed on a sample collected in a **red-top tube** (no additive) or a **SST (serum separator tube)**. - Although lithium heparin tubes can sometimes be used, plain serum tubes are generally preferred as they yield serum directly without an anticoagulant. *Coagulation studies* - Coagulation studies (PT, PTT, INR) require a **blue-top tube** containing **sodium citrate** as the anticoagulant. - The citrate-to-blood ratio must be precise (1:9) for accurate coagulation testing, making the blue-top tube specifically designed for this purpose. - A green-top tube with heparin cannot be used for coagulation studies as heparin itself is an anticoagulant that would interfere with the test results.

Q: Identify the tissue:

Thymus. ***Thymus*** - The presence of a **cortex** and **medulla**, along with **Hassall's corpuscles** (epithelial reticular cells arranged concentrically), is characteristic of the thymus [1]. - The thymus is responsible for **T-cell maturation** and selection [1]. *Lymph node* - Lymph nodes typically show a distinct **cortex** with lymphoid follicles (B-cell areas) and a **paracortex** (T-cell area), but lack Hassall's corpuscles. - They function in **filtering lymph** and initiating immune responses. *Tonsil* - Tonsils are characterized by **crypts** lined by stratified squamous epithelium and prominent **lymphoid follicles** beneath the epithelium, which are not the primary features here. - They are part of the **Waldeyer's ring** and serve as a first line of defense against inhaled and ingested pathogens. *Spleen* - The spleen has distinct **red pulp** (involved in filtering blood and removing old red blood cells) and **white pulp** (lymphoid areas with periarteriolar lymphoid sheaths and follicles), but does not contain Hassall's corpuscles. - It is a major site for **immune surveillance** and blood filtration. **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. 634.

Q: The image shows presence of:

Cardiac muscle. ***Cardiac muscle*** - The image displays **striations** inherent to muscle tissue, characteristic of both skeletal and cardiac muscle. However, the presence of **branched fibers** and **intercalated discs** (visible as darker, irregular lines connecting cells, though sometimes subtle) confirms it as cardiac muscle. - Cardiac muscle cells are typically **uninucleated** or **binucleated** and have centrally located nuclei, which is consistent with the appearance in the micrograph. *Skeletal muscle* - While skeletal muscle also exhibits **striations**, its fibers are **long, unbranched**, and parallel. - Skeletal muscle cells are typically **multinucleated** with peripherally located nuclei. *Smooth muscle* - Smooth muscle lacks **striations** and is characterized by spindle-shaped cells with a single, centrally located nucleus. - Its contractions are involuntary and often slow and sustained. *Dense connective tissue* - Dense connective tissue is composed of **collagen fibers** arranged in parallel bundles with scattered fibroblasts. - It lacks the **striations** and **branching pattern** characteristic of cardiac muscle. *Compact bone* - Compact bone tissue is composed of **osteons** with central Haversian canals surrounded by concentric lamellae. - It would appear as a rigid matrix with lacunae containing osteocytes, which is distinctly different from the muscular tissue shown.

Q: The image shows: (Recent NEET Pattern 2016-17)

Pelger-Huet anomaly. ***Pelger-Huet anomaly*** - The image shows a **neutrophil** with a **bilobed nucleus** (pince-nez appearance) and unusually **coarse chromatin**, which is characteristic of the Pelger-Huët anomaly. - This is a harmless inherited condition where neutrophils fail to segment properly, but their function remains normal. *Golgi body* - The Golgi body (or Golgi apparatus) is an **organelle** found in most eukaryotic cells that is involved in packaging proteins and lipids into vesicles. - It is an intracellular structure and not typically visible as a distinct feature like the one pointed to in a peripheral blood smear. *Barr body* - A Barr body is an **inactivated X chromosome** found in the somatic cells of females. - It appears as a small, dense, dark-staining structure in the periphery of the nucleus, and while it can be confused with a drumstick appendage, the shape in the image is not typical for a Barr body. *Davidson body* - A Davidson body (or drumstick) is a small **drumstick-shaped nuclear appendage** found on the neutrophils of some females, representing the inactive X chromosome. - While it is a nuclear appendage, the structure in the image is more consistent with the characteristic bilobed nucleus of Pelger-Huët anomaly rather than a distinct drumstick appendage. *Döhle bodies* - Döhle bodies are **cytoplasmic inclusions** that appear as pale blue-gray patches in the cytoplasm of neutrophils, representing aggregates of rough endoplasmic reticulum. - They are seen in infections, burns, pregnancy, and toxic states, but the finding in the image is a **nuclear abnormality**, not a cytoplasmic inclusion.

Hematopathology US Medical PG Practice Questions and MCQs

Question 1: Infant with anemia, poor growth and bleeding from nose was brought to emergency. On examination hepatosplenomegaly was noted, and serum chitotriosidase levels are elevated. Bone marrow examination was done. Diagnosis is:

A. Metachromatic leukodystrophy
B. Neuronal ceroid lipofuscinosis
C. Gaucher disease type 1 (Correct Answer)
D. Gaucher disease type 2
E. Niemann-Pick disease

Explanation: ***Gaucher disease type 1*** - **Anemia**, **poor growth**, **bleeding from nose** (due to thrombocytopenia), and **hepatosplenomegaly** are classic features of Gaucher disease [1]. - **Elevated serum chitotriosidase** is a highly sensitive and specific biomarker for Gaucher disease, and bone marrow examination would reveal **Gaucher cells** (lipid-laden macrophages) [1]. *Metachromatic leukodystrophy* - This is a **lysosomal storage disorder** primarily affecting the **nervous system**, leading to demyelination. - It typically presents with neurological symptoms like developmental regression, ataxia, and spasticity, not primarily hematological or visceral involvement. *Neuronal ceroid lipofuscinosis* - This is a group of **neurodegenerative disorders** characterized by the accumulation of lipopigments in neurons and other cells. - Clinical features include progressive intellectual decline, seizures, visual impairment, and motor dysfunction, without significant hepatosplenomegaly or bleeding diathesis. *Gaucher disease type 2* - While also a type of Gaucher disease, **Type 2 (neuronopathic)** is characterized by severe, rapidly progressive neurological involvement in infancy. - Although it shares features like hepatosplenomegaly, the prominent neurological symptoms and rapid deterioration are key differentiating factors not explicitly mentioned as primary complaints here. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Genetic Disorders, pp. 162-163.

Question 2: The vacutainer shown below is used for collecting sample for? (AIIMS Nov 2017)

A. Serum electrolytes (Correct Answer)
B. Serum lactate
C. Serum cholesterol
D. Serum uric acid
E. Coagulation studies

Explanation: ***Serum electrolytes*** - The image shows a **green-top vacutainer**, which typically contains **lithium heparin** as an anticoagulant. - **Lithium heparin** is the preferred anticoagulant for collecting samples for **serum electrolyte** measurements, as it does not interfere with the analysis of ions like sodium, potassium, and chloride. *Serum lactate* - Serum lactate measurements usually require a **gray-top tube** containing **sodium fluoride** and **potassium oxalate** to inhibit glycolysis and stabilize lactate levels. - A green-top tube with lithium heparin is not ideal for lactate analysis due to continued glycolysis in the absence of a glycolysis inhibitor. *Serum cholesterol* - Serum cholesterol, along with other lipid profiles, is typically collected in a **red-top tube** (no additive) or a **SST (serum separator tube)**, which has a gel barrier. - While cholesterol can be measured from a heparinized plasma sample, a plain red-top or SST is more commonly used for routine lipid panels. *Serum uric acid* - Serum uric acid measurement can be performed on a sample collected in a **red-top tube** (no additive) or a **SST (serum separator tube)**. - Although lithium heparin tubes can sometimes be used, plain serum tubes are generally preferred as they yield serum directly without an anticoagulant. *Coagulation studies* - Coagulation studies (PT, PTT, INR) require a **blue-top tube** containing **sodium citrate** as the anticoagulant. - The citrate-to-blood ratio must be precise (1:9) for accurate coagulation testing, making the blue-top tube specifically designed for this purpose. - A green-top tube with heparin cannot be used for coagulation studies as heparin itself is an anticoagulant that would interfere with the test results.

Question 3: Identify the tissue:

A. Lymph node
B. Tonsil
C. Spleen
D. Thymus (Correct Answer)
E. Bone marrow

Explanation: ***Thymus*** - The presence of a **cortex** and **medulla**, along with **Hassall's corpuscles** (epithelial reticular cells arranged concentrically), is characteristic of the thymus [1]. - The thymus is responsible for **T-cell maturation** and selection [1]. *Lymph node* - Lymph nodes typically show a distinct **cortex** with lymphoid follicles (B-cell areas) and a **paracortex** (T-cell area), but lack Hassall's corpuscles. - They function in **filtering lymph** and initiating immune responses. *Tonsil* - Tonsils are characterized by **crypts** lined by stratified squamous epithelium and prominent **lymphoid follicles** beneath the epithelium, which are not the primary features here. - They are part of the **Waldeyer's ring** and serve as a first line of defense against inhaled and ingested pathogens. *Spleen* - The spleen has distinct **red pulp** (involved in filtering blood and removing old red blood cells) and **white pulp** (lymphoid areas with periarteriolar lymphoid sheaths and follicles), but does not contain Hassall's corpuscles. - It is a major site for **immune surveillance** and blood filtration. **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. 634.

Question 4: The image shows presence of:

A. Skeletal muscle
B. Cardiac muscle (Correct Answer)
C. Smooth muscle
D. Compact bone
E. Dense connective tissue

Explanation: ***Cardiac muscle*** - The image displays **striations** inherent to muscle tissue, characteristic of both skeletal and cardiac muscle. However, the presence of **branched fibers** and **intercalated discs** (visible as darker, irregular lines connecting cells, though sometimes subtle) confirms it as cardiac muscle. - Cardiac muscle cells are typically **uninucleated** or **binucleated** and have centrally located nuclei, which is consistent with the appearance in the micrograph. *Skeletal muscle* - While skeletal muscle also exhibits **striations**, its fibers are **long, unbranched**, and parallel. - Skeletal muscle cells are typically **multinucleated** with peripherally located nuclei. *Smooth muscle* - Smooth muscle lacks **striations** and is characterized by spindle-shaped cells with a single, centrally located nucleus. - Its contractions are involuntary and often slow and sustained. *Dense connective tissue* - Dense connective tissue is composed of **collagen fibers** arranged in parallel bundles with scattered fibroblasts. - It lacks the **striations** and **branching pattern** characteristic of cardiac muscle. *Compact bone* - Compact bone tissue is composed of **osteons** with central Haversian canals surrounded by concentric lamellae. - It would appear as a rigid matrix with lacunae containing osteocytes, which is distinctly different from the muscular tissue shown.

Question 5: The image shows: (Recent NEET Pattern 2016-17)

A. Golgi body
B. Barr body
C. Davidson body
D. Pelger-Huet anomaly (Correct Answer)
E. Döhle bodies

Explanation: ***Pelger-Huet anomaly*** - The image shows a **neutrophil** with a **bilobed nucleus** (pince-nez appearance) and unusually **coarse chromatin**, which is characteristic of the Pelger-Huët anomaly. - This is a harmless inherited condition where neutrophils fail to segment properly, but their function remains normal. *Golgi body* - The Golgi body (or Golgi apparatus) is an **organelle** found in most eukaryotic cells that is involved in packaging proteins and lipids into vesicles. - It is an intracellular structure and not typically visible as a distinct feature like the one pointed to in a peripheral blood smear. *Barr body* - A Barr body is an **inactivated X chromosome** found in the somatic cells of females. - It appears as a small, dense, dark-staining structure in the periphery of the nucleus, and while it can be confused with a drumstick appendage, the shape in the image is not typical for a Barr body. *Davidson body* - A Davidson body (or drumstick) is a small **drumstick-shaped nuclear appendage** found on the neutrophils of some females, representing the inactive X chromosome. - While it is a nuclear appendage, the structure in the image is more consistent with the characteristic bilobed nucleus of Pelger-Huët anomaly rather than a distinct drumstick appendage. *Döhle bodies* - Döhle bodies are **cytoplasmic inclusions** that appear as pale blue-gray patches in the cytoplasm of neutrophils, representing aggregates of rough endoplasmic reticulum. - They are seen in infections, burns, pregnancy, and toxic states, but the finding in the image is a **nuclear abnormality**, not a cytoplasmic inclusion.

Practice by Chapter

Red blood cell disorders

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White blood cell disorders

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Platelet disorders

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Coagulation disorders

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Acute leukemias

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Chronic leukemias

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Myeloproliferative neoplasms

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Myelodysplastic syndromes

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Hodgkin lymphoma

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Non-Hodgkin lymphomas

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Plasma cell disorders

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Bone marrow failure syndromes

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Splenic pathology

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