Hematopathology Practice Questions

Q: The histological feature shown is seen in which of the following conditions?

Burkitt’s lymphoma. ***Burkitt's lymphoma*** - The **"starry sky" pattern** is pathognomonic for Burkitt's lymphoma, characterized by **tingible body macrophages** scattered among sheets of **monomorphic lymphoid cells**. - This high-grade B-cell lymphoma shows **rapid cell turnover** with macrophages phagocytosing apoptotic debris, creating the distinctive starry appearance. *Hodgkin's lymphoma* - Distinguished by the presence of **Reed-Sternberg cells** (large, multinucleated giant cells) which are absent in the starry sky pattern. - Shows **mixed inflammatory infiltrate** including eosinophils, plasma cells, and lymphocytes, not the monomorphic appearance of Burkitt's. *Non-Hodgkin's lymphoma* - This is a **broad category** that technically includes Burkitt's lymphoma, but the starry sky pattern is **specific to Burkitt's** subtype. - Other NHL subtypes like **follicular lymphoma** or **DLBCL** have different histological patterns without the characteristic starry sky appearance. *All of the above* - Incorrect because the **starry sky pattern** is **pathognomonic specifically for Burkitt's lymphoma**. - While Burkitt's is technically a type of NHL, the distinctive histological feature shown is **not seen** in Hodgkin's lymphoma or other NHL subtypes.

Q: All are true about hemolytic disease of the newborn except?

Anti-Rh agglutinins are of IgM type. **Explanation:** Hemolytic Disease of the Newborn (HDN), or **Erythroblastosis Fetalis**, occurs due to Rh-incompatibility between an Rh-negative mother and an Rh-positive fetus. **Why Option D is the correct answer (the "Except" statement):** The hallmark of HDN is the placental transfer of maternal antibodies. **IgM antibodies** are pentameric and large, making them **incapable of crossing the placenta**. In HDN, the mother’s immune system produces **IgG type anti-Rh agglutinins** (specifically anti-D) following sensitization. IgG is monomeric and can cross the placental barrier to attack fetal RBCs. Therefore, stating they are IgM is incorrect. **Analysis of other options:** * **A. Hemolytic anemia:** This is the primary pathology. Maternal IgG coats fetal RBCs, leading to their destruction (hemolysis) in the fetal spleen. * **B. Hydrops fetalis:** Severe hemolysis leads to profound anemia, which causes high-output cardiac failure, generalized edema (anasarca), and ascites. This is the most severe form of the disease. * **C. Kernicterus:** Rapid hemolysis produces high levels of unconjugated bilirubin. In neonates, the blood-brain barrier is immature, allowing bilirubin to deposit in the basal ganglia, leading to permanent neurological damage known as kernicterus. **High-Yield NEET-PG Pearls:** * **Sensitization:** Usually occurs during the first delivery; hence, the first child is typically unaffected, but subsequent Rh+ pregnancies are at risk. * **Prophylaxis:** Administer **Anti-D (RhoGAM)** to Rh-negative mothers at 28 weeks gestation and within 72 hours of delivery to neutralize fetal Rh+ cells before the mother’s immune system reacts. * **Diagnosis:** **Direct Coombs Test** is used on the newborn’s cord blood to detect antibodies bound to RBCs.

Q: Low LAP score may be seen in the following EXCEPT:

Polycythemia vera. **Explanation:** The **Leukocyte Alkaline Phosphatase (LAP) score** (also known as the Neutrophil Alkaline Phosphatase/NAP score) measures the activity of the enzyme alkaline phosphatase within the secondary granules of mature neutrophils. This score is a classic diagnostic tool used to differentiate between a **Leukemoid Reaction** (high score) and **Chronic Myeloid Leukemia** (low score). **Why Polycythemia Vera is the correct answer:** In **Polycythemia Vera (PV)**, which is a myeloproliferative neoplasm (MPN), there is typically an **increased LAP score**. The question asks for the condition where a low LAP score is *not* seen (the "EXCEPT"). Since PV is associated with an elevated score, it is the correct choice [1]. **Analysis of Incorrect Options (Conditions with Low LAP Score):** * **CML (Chronic Myeloid Leukemia):** This is the classic cause of a **low LAP score** due to the presence of functionally immature neutrophils that lack the enzyme [1]. * **Paroxysmal Nocturnal Hemoglobinuria (PNH):** This is a stem cell disorder where the GPI-anchor is missing. Since LAP is a GPI-anchored protein, its expression is significantly **decreased**. * **Autoimmune Hemolytic Anemia (AIHA):** While not a primary diagnostic marker for AIHA, certain types of anemia and marrow stress can result in a **low LAP score**. **High-Yield Clinical Pearls for NEET-PG:** * **High LAP Score:** Leukemoid reaction, Pregnancy (3rd trimester), Polycythemia Vera, and Down Syndrome [1]. * **Low LAP Score:** CML, PNH, Hypophosphatasia, and Aplastic Anemia [1]. * **Normal Range:** 40–100. * **Modern Shift:** In clinical practice, the LAP score has largely been replaced by cytogenetics (Philadelphia chromosome) and molecular testing (BCR-ABL1) for CML diagnosis [1]. **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, pp. 624-627.

Q: Aplastic anemia is characterized by which of the following findings?

Normocytic normochromic anemia with thrombocytopenia. **Explanation:** **Aplastic Anemia (AA)** is a bone marrow failure syndrome characterized by **pancytopenia** (reduction in all three cell lines: RBCs, WBCs, and platelets) and a **hypocellular bone marrow** where hematopoietic tissue is replaced by fat. 1. **Why Option A is correct:** In Aplastic Anemia, the primary defect is a reduction in the number of hematopoietic stem cells. Since the cells that *are* produced are typically structurally normal, the red blood cells usually maintain a **normocytic (normal size) and normochromic (normal hemoglobin content)** appearance. Thrombocytopenia is a hallmark finding due to the failure of megakaryopoiesis. 2. **Why other options are incorrect:** * **Option B (Megaloblasts):** These are seen in Megaloblastic Anemias (Vitamin B12 or Folate deficiency) due to impaired DNA synthesis. While AA can sometimes show mild macrocytosis, true megaloblasts are absent. * **Option C (Hypochromic microcytic):** This is characteristic of impaired hemoglobin synthesis, most commonly seen in **Iron Deficiency Anemia** or Thalassemia. * **Option D (Hyperchromic macrocytic):** "Hyperchromic" is a misnomer as RBCs cannot be over-saturated with hemoglobin. Macrocytic changes are seen in B12 deficiency or MDS, but not typically as a defining feature of AA. **High-Yield Clinical Pearls for NEET-PG:** * **Gold Standard Diagnosis:** Bone marrow aspiration and **trephine biopsy** (shows "dry tap" and fatty replacement). * **Key Finding:** Reticulocytopenia (low corrected reticulocyte count) indicating lack of RBC production. * **Modified Camitta Criteria:** Used to define "Severe Aplastic Anemia" (Marrow cellularity <25% plus two of: Neutrophils <500/µL, Platelets <20,000/µL, or Reticulocytes <1%). * **Treatment of Choice:** Allogeneic Stem Cell Transplant (in young patients) or Immunosuppressive Therapy (Antithymocyte globulin + Cyclosporine).

Q: Iron deficiency is best demonstrated by?

S. ferritin. **Explanation:** **Serum Ferritin** is the single most accurate and reliable non-invasive test for diagnosing Iron Deficiency Anemia (IDA). Ferritin is the primary storage protein for iron; its levels in the blood are directly proportional to the total body iron stores [1]. A low serum ferritin level (<15–30 ng/mL) is highly specific and indicates depleted iron stores, which is the earliest stage of iron deficiency. **Analysis of Options:** * **RDW (Red Cell Distribution Width):** While RDW increases early in IDA (indicating anisocytosis), it is a non-specific marker. It can also be elevated in Vitamin B12/Folate deficiency or sideroblastic anemia. * **BM (Bone Marrow) Examination:** Historically, Prussian blue staining of bone marrow aspirate was the "Gold Standard" for assessing iron stores (hemosiderin) [1]. However, it is an invasive, painful, and expensive procedure. Examination of the marrow may ultimately be required to assess iron stores directly in difficult cases [2]. * **Differential Leucocyte Count (DLC):** This measures white blood cells and has no diagnostic value in assessing iron status. **NEET-PG High-Yield Pearls:** * **Earliest indicator of IDA:** Increased RDW. * **Best biochemical test/Best screening test:** Serum Ferritin [1]. * **Gold Standard (Invasive):** Bone marrow iron (Prussian blue stain) [1][2]. * **Confirmatory test for IDA:** Response to oral iron therapy (increase in Reticulocyte count within 5–7 days) [2]. * **Note:** Ferritin is an **Acute Phase Reactant**. In the presence of inflammation, infection, or malignancy, ferritin levels may be falsely normal or high despite underlying iron deficiency [2]. In such cases, Transferrin Saturation (<16%) is used.

Question 1

The histological feature shown is seen in which of the following conditions?

Accepted Answer

Burkitt’s lymphoma

Answer

Hodgkin’s lymphoma

Answer

Non-Hodgkin’s lymphoma

Answer

All of the above

Question 2

Which of the following statements regarding leukemias is true?

Accepted Answer

Acute lymphoid leukemia in individuals less than 1 year old has a poor prognosis.

Answer

Acute lymphoid leukemia commonly occurs beyond 50 years of age.

Answer

Hairy cell leukemia in individuals less than 50 years old has a good prognosis.

Answer

Chronic lymphocytic leukemia commonly occurs in individuals less than 50 years of age.

Question 3

All are true about hemolytic disease of the newborn except?

Accepted Answer

Anti-Rh agglutinins are of IgM type

Answer

Hemolytic anemia

Answer

Hydrops fetalis

Answer

Kernicterus

Question 4

Low LAP score may be seen in the following EXCEPT:

Accepted Answer

Polycythemia vera

Answer

CML

Answer

Paroxysmal nocturnal hemoglobinuria

Answer

Autoimmune hemolytic anemia

Question 5

Which of the following toxic states is not associated with anemia?

Accepted Answer

Listerosis

Answer

Clostridial sepsis

Answer

Snake venom

Answer

Lead poisoning

Question 6

Pancytopenia with hypercellular marrow may be seen due to all of the following except:

Accepted Answer

Dyskeratosis congenita

Answer

Myelodysplasia

Answer

Paroxysmal Nocturnal Hemoglobinuria

Answer

Sarcoidosis

Question 7

Aplastic anemia is characterized by which of the following findings?

Accepted Answer

Normocytic normochromic anemia with thrombocytopenia

Answer

Presence of megaloblasts

Answer

Hypochromic microcytic anemia

Answer

Hyperchromic macrocytic anemia

Question 8

Which of the following are types of Hodgkin's lymphoma?

Accepted Answer

Lymphocyte depletion

Answer

Nodular sclerosis

Answer

Mixed cellularity

Answer

Mantle cell lymphoma

Question 9

A 36-year-old male presents with weakness, pallor, and bleeding gums. His HB was 7 g/dL, total leukocyte count was 110,000/mm³ with many immature white blood cells positive for MPO, and platelet count was 22,000/mm³. What is the most likely diagnosis?

Accepted Answer

Acute Myeloid Leukemia (AML)

Answer

Chronic Myeloid Leukemia (CML)

Answer

Acute Lymphoid Leukemia (ALL)

Answer

Chronic Lymphoid Leukemia (CLL)

Question 10

Iron deficiency is best demonstrated by?

Accepted Answer

S. ferritin

Answer

RDW

Answer

BM examination

Answer

Differential leucocyte count

Hematopathology — MCQs

Hematopathology — MCQs

On this page

Practice by Chapter

Want unlimited practice?