Hematopathology US Medical PG Practice Questions and MCQs
Practice US Medical PG questions for Hematopathology. These multiple choice questions (MCQs) cover important concepts and help you prepare for your exams.
Hematopathology US Medical PG Question 1: A 45-year-old woman comes to the physician because of a 1-week history of fatigue and bruises on her elbows. Examination shows a soft, nontender abdomen with no organomegaly. Laboratory studies show a hemoglobin concentration of 7 g/dL, a leukocyte count of 2,000/mm3, a platelet count of 40,000/mm3, and a reticulocyte count of 0.2%. Serum electrolyte concentrations are within normal limits. A bone marrow biopsy is most likely to show which of the following findings?
- A. Increased myeloblast count
- B. Sheets of abnormal plasma cells
- C. Wrinkled cells with a fibrillary cytoplasm
- D. Hypocellular bone marrow (Correct Answer)
- E. Dysplastic bone with ringed sideroblasts
Hematopathology Explanation: ***Hypocellular bone marrow***
- The patient presents with **pancytopenia** (low hemoglobin, leukocytes, and platelets) and a very low **reticulocyte count**, indicating severely impaired hematopoiesis [1].
- This constellation of findings, in the absence of organomegaly or other specific features, strongly suggests **aplastic anemia**, which is characterized by a **hypocellular bone marrow** with significant reduction in hematopoietic cells and replacement by fat [1][3].
*Increased myeloblast count*
- An increased **myeloblast count** in the bone marrow is characteristic of **acute myeloid leukemia (AML)**.
- While pancytopenia can occur in AML, the distinguishing feature would be a high percentage of blasts (typically >20%) in the bone marrow, which is not implied by the general presentation [1].
*Sheets of abnormal plasma cells*
- **Sheets of abnormal plasma cells** are the hallmark of **multiple myeloma** [2].
- This condition primarily presents with bone pain, hypercalemia, renal failure, and anemia, but not typically with severe pancytopenia and bruising as the primary presenting symptoms without other myeloma-defining events [2].
*Wrinkled cells with a fibrillary cytoplasm*
- **Wrinkled cells with a fibrillary cytoplasm** (Gaucher cells) are pathognomonic for **Gaucher disease**, a lysosomal storage disorder.
- Gaucher disease typically presents with hepatosplenomegaly, bone crises, and neurological symptoms, not primarily with aplastic anemia.
**References:**
[1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Red Blood Cell and Bleeding Disorders, pp. 662-663.
[2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Blood And Bone Marrow Disease, pp. 617-618.
[3] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Blood And Bone Marrow Disease, pp. 595-596.
Hematopathology US Medical PG Question 2: A 24-year-old woman complains of intermittent fever and joint pain. She says that these symptoms have been present for the past month. Before that, she had no signs or symptoms and was completely healthy. She has also lost her appetite and some weight. A complete blood count (CBC) showed severe pancytopenia. What is the next best step in evaluating this patient?
- A. Repeated CBCs for several weeks and reassess
- B. Treatment with corticosteroids
- C. Treatment with antibiotics
- D. Treatment for acute leukemia
- E. Bone marrow examination (Correct Answer)
Hematopathology Explanation: ***Bone marrow examination***
- The combination of **fever**, **joint pain**, **weight loss**, and **pancytopenia** in a previously healthy young woman raises suspicion for serious hematologic conditions like **aplastic anemia** or **acute leukemia**.
- A **bone marrow examination** is crucial for definitive diagnosis by evaluating the cellularity, morphology, and presence of abnormal cells.
*Repeated CBCs for several weeks and reassess*
- This approach is inappropriate given the **severe pancytopenia** and progressive symptoms, which indicate an urgent underlying pathology.
- Delaying diagnosis could worsen the patient's condition and compromise treatment outcomes due to the potential for severe infections or bleeding.
*Treatment with corticosteroids*
- While corticosteroids might be used in some autoimmune conditions causing pancytopenia, initiating treatment without a definitive diagnosis is premature and could mask the underlying cause, especially in cases of malignancy.
- There is no specific indication for corticosteroid use in this scenario without further diagnostic information.
*Treatment with antibiotics*
- Although **fever** is present, there's no clear evidence of an infection (like localized symptoms or positive cultures), and **pancytopenia** is not primarily managed with antibiotics.
- Administering antibiotics empirically without a confirmed infection addresses a symptom rather than the underlying progressive hematological disorder.
*Treatment for acute leukemia*
- While **acute leukemia** is a strong possibility, definitive treatment should only commence after a confirmed diagnosis through **bone marrow examination**, as misdiagnosis can lead to inappropriate and harmful therapy.
- Other conditions like severe aplastic anemia also present with similar features but require different management strategies.
Hematopathology US Medical PG Question 3: A 63-year-old man comes to the physician because of increasing generalized fatigue for 3 months. He is having more difficulty with keeping up with his activities of daily living and has lost 2.5 kg (5.5 lb) over the past month. He has hypertension and hyperlipidemia. He does not smoke and drinks two to three beers on weekends. His medications include lisinopril, hydrochlorothiazide, and atorvastatin. His temperature is 37.1°C (98.8°F), pulse is 85/min, respirations are 15/min, and blood pressure is 125/73 mm Hg. Examination shows pale conjunctivae. The remainder of the examination shows no abnormalities. His hematocrit is 27.3%, leukocyte count is 4500/mm3, and platelet count is 102,000/mm3. A peripheral blood smear shows numerous blast cells that stain positive for myeloperoxidase, CD33, and CD34. Which of the following is the most likely diagnosis?
- A. Non-Hodgkin lymphoma
- B. Acute myeloid leukemia (Correct Answer)
- C. Hairy cell leukemia
- D. Chronic lymphocytic leukemia
- E. Acute lymphoblastic leukemia
Hematopathology Explanation: ***Acute myeloid leukemia***
- The presence of **numerous blast cells** that stain positive for **myeloperoxidase (MPO)** and **CD33** is highly characteristic of **acute myeloid leukemia (AML)**.
- The patient's symptoms of **fatigue**, **weight loss**, **pale conjunctivae (anemia)**, and **pancytopenia** (low hematocrit, leukopenia, thrombocytopenia) are consistent with bone marrow infiltration by leukemic blasts.
*Non-Hodgkin lymphoma*
- Characterized by **lymphadenopathy** and systemic 'B' symptoms (fever, night sweats, weight loss), which are not prominent features here.
- While it can cause cytopenias, the presence of **myeloperoxidase-positive blasts** would point away from lymphoma, which involves lymphocytes.
*Hairy cell leukemia*
- Typically presents with **pancytopenia**, **splenomegaly**, and characteristic **hairy cells** on peripheral smear.
- These cells are **CD103, CD123, and CD25 positive** and tartrate-resistant acid phosphatase (TRAP) positive, which differs from the findings in this case.
*Chronic lymphocytic leukemia*
- Characterized by an accumulation of **mature-appearing lymphocytes** (not blasts) in the blood, bone marrow, and lymph nodes.
- These cells typically express **CD5 and CD20**, and **myeloperoxidase** would be negative.
*Acute lymphoblastic leukemia*
- Involves **lymphoblasts**, which are typically **MPO-negative** and express lymphoid markers like **CD10, CD19, and CD22**.
- While it can present with similar symptoms and pancytopenia as AML, the **MPO positivity rules it out**.
Hematopathology US Medical PG Question 4: A 64-year-old woman comes to the physician because of a 7-month history of abdominal discomfort, fatigue, and a 6.8-kg (15-lb) weight loss. Physical examination shows generalized pallor and splenomegaly. Laboratory studies show anemia with pronounced leukocytosis and thrombocytosis. Cytogenetic analysis shows a BCR-ABL fusion gene. A drug with which of the following mechanisms of action is most appropriate for this patient?
- A. Ribonucleotide reductase inhibitor
- B. Monoclonal anti-HER-2 antibody
- C. Topoisomerase II inhibitor
- D. Monoclonal anti-CD20 antibody
- E. Tyrosine kinase inhibitor (Correct Answer)
Hematopathology Explanation: ***Tyrosine kinase inhibitor***
- The patient's symptoms (abdominal discomfort, fatigue, weight loss, pallor, splenomegaly), laboratory findings (**anemia with pronounced leukocytosis and thrombocytosis**), and the presence of a **BCR-ABL fusion gene** are highly characteristic of **Chronic Myeloid Leukemia (CML)**.
- The **BCR-ABL fusion gene** encodes a constitutively active **tyrosine kinase**, which is the hallmark of CML and the primary therapeutic target for **tyrosine kinase inhibitors (TKIs)** like imatinib.
*Ribonucleotide reductase inhibitor*
- **Ribonucleotide reductase inhibitors** (e.g., hydroxyurea) block DNA synthesis and are used in myeloproliferative disorders to reduce cell counts, but they are not specific to the **BCR-ABL fusion gene** and are not the most appropriate first-line targeted therapy for CML.
- While they can control symptoms, they do not target the underlying molecular defect in CML as effectively as TKIs.
*Monoclonal anti-HER-2 antibody*
- **Monoclonal anti-HER-2 antibodies** (e.g., trastuzumab) are used to treat **HER-2 positive breast cancer** and some gastric cancers.
- They are not relevant to the treatment of CML, which is characterized by the **BCR-ABL fusion gene**.
*Topoisomerase II inhibitor*
- **Topoisomerase II inhibitors** (e.g., etoposide, doxorubicin) prevent DNA unwinding and replication, leading to cell death, and are used in various hematologic malignancies and solid tumors.
- These drugs are broad-spectrum chemotherapeutic agents not specifically targeted to the **BCR-ABL fusion protein** in CML and are not first-line therapy for this condition.
*Monoclonal anti-CD20 antibody*
- **Monoclonal anti-CD20 antibodies** (e.g., rituximab) target the CD20 protein on B lymphocytes and are primarily used to treat **B-cell non-Hodgkin lymphoma** and some autoimmune diseases.
- They have no role in the direct treatment of CML, which is a myeloid malignancy.
Hematopathology US Medical PG Question 5: A 67-year-old man comes to the physician because of a 2-month history of generalized fatigue. On examination, he appears pale. He also has multiple pinpoint, red, nonblanching spots on his extremities. His spleen is significantly enlarged. Laboratory studies show a hemoglobin concentration of 8.3 g/dL, a leukocyte count of 81,000/mm3, and a platelet count of 35,600/mm3. A peripheral blood smear shows immature cells with large, prominent nucleoli and pink, elongated, needle-shaped cytoplasmic inclusions. Which of the following is the most likely diagnosis?
- A. Acute lymphoblastic leukemia
- B. Myelodysplastic syndrome
- C. Hairy cell leukemia
- D. Acute myelogenous leukemia (Correct Answer)
- E. Chronic myelogenous leukemia
Hematopathology Explanation: ***Acute myelogenous leukemia***
- The presence of immature cells with **large, prominent nucleoli** and **pink, elongated, needle-shaped cytoplasmic inclusions** (**Auer rods**) on peripheral blood smear is pathognomonic for **acute myeloid leukemia (AML)**.
- The pancytopenia (anemia, thrombocytopenia) and extreme leukocytosis, along with generalized fatigue and pale appearance, are consistent with the presentation of AML.
*Acute lymphoblastic leukemia*
- Characterized by the proliferation of **lymphoblasts** (immature lymphocytes) in the bone marrow and peripheral blood, which typically lack Auer rods.
- While it can present with fatigue, pallor, and cytopenias, the specific morphologic features of the blast cells are different.
*Myelodysplastic syndrome*
- Involves ineffective hematopoiesis leading to **cytopenias** and dysplastic features in mature blood cells, but typically features less aggressive proliferation of immature cells than acute leukemias and **lacks Auer rods**.
- While it can progress to AML, the current description points to actively proliferating immature cells.
*Hairy cell leukemia*
- Characterized by **B lymphocytes with cytoplasmic projections** ("hairy cells") and is typically associated with **massive splenomegaly** and **pancytopenia**, but the characteristic Auer rods are absent.
- The cell morphology described (large nucleoli, needle-shaped inclusions) is inconsistent with hairy cells.
*Chronic myelogenous leukemia*
- Characterized by the **Philadelphia chromosome (BCR-ABL1 fusion gene)** and a marked increase in mature and immature myeloid cells, including granulocytes at various stages of maturation, but typically **lacks Auer rods** and usually has a higher proportion of mature rather than acutely immature cells.
- While it presents with leukocytosis and splenomegaly, the prominent immature cells with nucleoli and Auer rods are not features of CML.
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