Hematopathology Practice Questions

Q: Which of the following findings is characteristic of megaloblastic anemia?

All of the options. ***All of the above*** - In megaloblastic anemia, various atypical red blood cell characteristics can be observed, including **Cabot rings**, **Howell-Jolly bodies**, and **basophilic stippling** [1]. - These features arise due to ineffective erythropoiesis and increased reticulocyte production, which are hallmark traits of megaloblastic changes [1]. *Cabot ring* - These are **red cell inclusions** that can be seen in conditions associated with **disrupted hemoglobin synthesis** or **abnormal nucleic acid metabolism**, but are not specific to megaloblastic anemia. - More commonly observed in conditions like **lead poisoning** or **myelodysplastic syndromes**. *Howell Jolly bodies* - These are nuclear remnants seen in red blood cells, typically present after **splenectomy** or in cases of **hemolytic anemia**, rather than specifically indicating megaloblastic anemia. - While they can be seen in megaloblastic anemia, they are not definitive; they signify **poor splenic function**. *Basophilic stippling* - Generally associated with **lead poisoning**, **thalassemias**, and certain types of **anemia**, but not exclusively indicative of megaloblastic anemia. - It results from **RNA remnants** in red blood cells and is more frequently noted in other forms of anemia. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Blood And Bone Marrow Disease, pp. 594-595.

Q: A 9-year-old girl has a bleeding diathesis, with prolonged activated partial thromboplastin time (APTT) but normal prothrombin time (PT) and normal platelet count. The diagnosis is?

Von Willebrand's disease. ***Von Willebrand's disease*** - This condition is characterized by a **deficiency or dysfunction of von Willebrand factor (vWF)**, leading to impaired platelet adhesion and stabilization of factor VIII [2], [3]. - While it primarily affects **platelet function**, it can also cause a prolonged **APTT** due to the role of vWF in protecting factor VIII from degradation, thus impacting the intrinsic coagulation pathway [3]. *Factor V deficiency* - Factor V is a component of the **common pathway** of coagulation. - A deficiency would typically prolong both the **PT and APTT** [1]. *Haemophilia A* - This is a deficiency of **Factor VIII**, which is part of the **intrinsic pathway** [1]. - Haemophilia A causes a prolonged **APTT** but a normal PT, similar to the patient's presentation. However, vWD is more common and can also present with similar findings. *Haemophilia B* - This is a deficiency of **Factor IX**, also part of the **intrinsic pathway** [1]. - Haemophilia B also causes a prolonged **APTT** but a normal PT. However, vWD is a more common inheritable bleeding disorder.

Q: What is the most common type of non-Hodgkin's lymphoma found in the orbit?

B-cell. ***B-cell*** - The most common type of non-Hodgkin's lymphoma in the orbit is **B-cell lymphoma**, which typically presents as a **painless mass** [1]. - **B-cell lymphomas** are more frequently associated with systemic lymphoproliferative disorders and have a higher incidence in this region. *NK-cell* - NK-cell lymphomas are rare compared to B-cell and usually present with more aggressive features. - They are less common in the orbit and are often associated with other systemic diseases like **HIV**. *Plasma cell* - Plasma cell neoplasms, such as **multiple myeloma**, are more related to bone marrow involvement rather than orbit-specific lymphomas. - These do not typically arise in the orbit and are less frequently classified under non-Hodgkin's lymphomas. *T-cell* - T-cell lymphomas are less prevalent compared to B-cell lymphomas and have different clinical presentations. - They can be aggressive and may occur in the orbit, but not as commonly as B-cell types. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Eye, pp. 1341-1342.

Q: Which one of the following is used for the preservation of blood for transfusions?

Citrate phosphate dextrose. ***Citrate phosphate dextrose*** - This anticoagulant solution is commonly used for blood preservation in blood banks because **citrate** chelates **calcium ions**, preventing coagulation. - The **phosphate** acts as a buffer to maintain pH, and **dextrose** provides energy for red blood cell metabolism during storage. - **CPD** allows blood storage for up to **21 days**, and when adenine is added (CPDA-1), storage can be extended to **35 days**. *Heparin* - **Heparin** is an anticoagulant that works by enhancing the activity of **antithrombin III**, but it is generally not used for long-term blood storage for transfusion due to its short half-life and potential to activate platelets upon prolonged contact. - While effective as an anticoagulant, heparin is not suitable for routine blood bank storage as it does not adequately support the viability of red blood cells over extended periods. *Thrombin* - **Thrombin** is a procoagulant enzyme involved in the final stages of the coagulation cascade, converting fibrinogen to fibrin, thus promoting clot formation. - Using thrombin would cause immediate blood clotting, making it entirely unsuitable for preserving blood for transfusion purposes. *EDTA* - **EDTA (Ethylenediaminetetraacetic acid)** is a chelating anticoagulant commonly used in **laboratory samples** for hematological testing (e.g., CBC). - However, it is **not used for blood transfusion** because it can cause morphological changes in cells and is toxic when transfused, making it unsuitable for therapeutic blood storage.

Q: Which of the following immunophenotypic features is characteristic of mantle cell lymphoma?

CD 5+, CD 23-. ***CD 5+, CD 23-*** - Mantle cell carcinoma is characterized by **CD5 positivity** and **CD23 negativity**, helping differentiate it from other B-cell neoplasms [1][2]. - This immunophenotype is significant in identifying the **unique biological behavior** of mantle cell lymphoma [2]. *CD 5+, CD 10+* - CD10 positivity is more commonly associated with **follicular lymphoma** or **Burkitt lymphoma**, not mantle cell carcinoma. - Therefore, this oes not accurately reflect the immunophenotypic profile required for a diagnosis. *CD 5+, CD 23+* - CD23 positivity typically indicates **chronic lymphocytic leukemia (CLL)**, which contrasts with the profile seen in mantle cell carcinoma [1]. - This means that mantle cell carcinoma will not be identified with both CD5 and CD23 positivity together. *CD 5+, CD 25-* - CD25 is often expressed in conditions like **Hairy cell leukemia**, and its absence is not characteristic of mantle cell carcinoma. - Thus, while CD5+ is present, the lack of CD25 alone does not define mantle cell features. **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. 610-612. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Diseases Of The Urinary And Male Genital Tracts, pp. 562-563.

Q: All of the following are features of juvenile chronic myeloid leukemia except one.

Increased lymphadenopathy. ***Increased lymphadenopathy*** **(Correct Answer - This is the EXCEPTION)** - While juvenile chronic myeloid leukemia (JCML) can cause some **lymphadenopathy**, it is typically described as **mild** to **moderate**, not significantly increased. - **Prominent or markedly increased lymphadenopathy is NOT a typical feature of JCML** and would suggest a different diagnosis such as acute lymphoblastic leukemia or other lymphoproliferative disorders [1]. - This is the exception among the given options, as it does NOT characterize JCML. *Thrombocytopenia* - **Thrombocytopenia** (low platelet count) is a **common and typical feature** of juvenile chronic myeloid leukemia (JCML) due to bone marrow infiltration and increased platelet turnover [2]. - It often contributes to bruising and bleeding tendencies observed in affected children. *Mild lymphadenopathy* - **Mild lymphadenopathy** is a feature often observed in juvenile chronic myeloid leukemia (JCML), reflecting involvement of the reticuloendothelial system [1]. - This mild degree of lymph node enlargement is generally not prognostically significant and helps differentiate from more aggressive lymphoproliferative disorders. *Philadelphia chromosome is negative* - Juvenile chronic myeloid leukemia (JCML) is characterized by the **absence of the Philadelphia chromosome (Ph chromosome)**, which is a key diagnostic criterion. - This distinguishes JCML from adult chronic myeloid leukemia (CML), where the Ph chromosome (t(9;22) translocation) is present in >95% of cases. - The Ph-negative status is an essential feature of JCML diagnosis. **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. 625-629. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Blood And Bone Marrow Disease, pp. 604-605.

Q: A 15-year-old boy presented with anemia and jaundice. On examination, his hemoglobin was 6 g/dL, ultrasound showed gallstones, and the peripheral smear showed the following. What is the most likely diagnosis?

Hereditary ovalocytosis. ***Hereditary ovalocytosis*** - Displays **anemia and jaundice** due to increased destruction of oval-shaped red blood cells [1]. - Associated with **gallstones** due to hemolysis, leading to bilirubin overload [1]. *Hereditary spherocytosis* - Characterized by **spherically shaped red blood cells**, leading to hemolytic anemia but not specifically ovalocytes [4,5]. - Typically presents with **splenomegaly** and increased fragility in osmotic fragility tests, which may not apply in this case [3]. *Hereditary acanthocytosis* - Involves irregularly shaped **acanthocytes** and primarily causes **neuroacanthocytosis syndrome**. - Symptoms include **movement disorders** and are not typically associated with uncomplicated jaundice and gallstones. *Hereditary xerocytosis* - Characterized by **dehydrated, stiff red blood cells**, leading to osmotically fragile cells but does not present with typical oval-shaped cells. - It is less common and mainly associated with **hyperbilirubinemia** but without typical jaundiced presentations. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Red Blood Cell and Bleeding Disorders, p. 640. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Red Blood Cell and Bleeding Disorders, pp. 641-642. [3] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Blood And Bone Marrow Disease, pp. 597-598.

Q: A 50-year-old woman is discovered to have metastatic breast cancer and develops bacterial pneumonia one week after receiving her first dose of chemotherapy. Which of the following best explains this patient's susceptibility to bacterial infection?

Neutropenia. ***Neutropenia*** - **Chemotherapy** often causes **bone marrow suppression**, leading to a decrease in the absolute number of **neutrophils**, a condition known as neutropenia. - Neutrophils are crucial for the primary defense against **bacterial and fungal infections**, and their depletion significantly increases susceptibility, especially to **bacterial pneumonia**. *Depletion of serum complement* - While complement deficiency can increase susceptibility to certain infections, it is not a direct or common side effect of typical **chemotherapy regimens**. - Complement deficiencies are often **genetic** or related to specific **autoimmune diseases**, which are not indicated as the primary cause here. *Impaired neutrophil respiratory burst* - Impaired **neutrophil respiratory burst** (e.g., in **chronic granulomatous disease**) leads to a reduced ability to kill ingested bacteria, resulting in recurrent infections. - While chemotherapy can affect neutrophil function, severe impairment of the respiratory burst is not the primary mechanism of increased infection risk one week post-treatment; **neutropenia** is more immediate and profound. *Inhibition of clotting factor activation* - **Inhibition of clotting factor activation** would primarily manifest as **bleeding disorders**, not increased susceptibility to bacterial infections. - Chemotherapy can affect platelet count and function, but this mechanism does not directly explain increased risk of **bacterial pneumonia**.

Q: A 22-year-old woman presents with painless cervical lymphadenopathy, night sweats, and generalized pruritus. An enlarged cervical lymph node is removed for diagnosis, which shows broad bands of fibrosis on cut surface and histologically contains a mixture of cells, including lymphocytes, histiocytes, eosinophils, plasma cells, and scattered large cells with prominent nucleoli. Which of the following is the most likely condition?

Hodgkin disease. ***Hodgkin disease*** - The presence of **painless cervical lymphadenopathy**, night sweats, and **generalized pruritus** is classical for Hodgkin lymphoma [3][4]. - Histological findings of **broad bands of fibrosis** and a mixture of cell types including **Reed-Sternberg cells** confirm the diagnosis [1][2][3]. *Non-Hodgkin lymphoma* - Typically presents with **rapidly enlarging lymph nodes** and is often associated with extra-nodal involvement, differing from the features in this case [3]. - Histology usually shows a more homogeneous population of **malignant lymphoid cells**, not the fibrotic bands seen in Hodgkin disease [3]. *Reactive non-specific lymphadenitis* - This condition is characterized by **hyperplastic lymphoid tissue** and **neutrophilic infiltration**, often following infection, which does not match the findings. - It typically lacks the distinct cell types and fibrosis observed in the biopsy of Hodgkin disease. *Cat-scratch disease* - Caused by *Bartonella henselae*, it often presents with **granulomatous lymphadenopathy** rather than the mixed cellular response seen in Hodgkin disease. - Symptoms usually include a history of cat exposure and may present with **fever, fatigue**, and localized lymphadenopathy, not generalized pruritus. **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. 616-618. [2] 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. 616. [3] 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. 614-616. [4] 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. 618.

Question 1

Which of the following findings is characteristic of megaloblastic anemia?

Accepted Answer

All of the options

Answer

Macrocytic red blood cells

Answer

Reticulocytopenia

Answer

Hypersegmented neutrophils

Question 2

A 9-year-old girl has a bleeding diathesis, with prolonged activated partial thromboplastin time (APTT) but normal prothrombin time (PT) and normal platelet count. The diagnosis is?

Accepted Answer

Von Willebrand's disease

Answer

Factor V deficiency

Answer

Haemophilia A

Answer

Haemophilia B

Question 3

What is the most common type of non-Hodgkin's lymphoma found in the orbit?

Accepted Answer

B-cell

Answer

T-cell

Answer

NK-cell

Answer

Plasma cell

Question 4

An intensive care patient develops sepsis. His blood pressure drops to 60/15 mmHg, and he starts to bleed from venipuncture sites. Disseminated intravascular coagulation is suspected. Which of the following sets of stat laboratory values would confirm the likely diagnosis?

Accepted Answer

Elevated PT, elevated PTT, decreased platelets

Answer

Decreased PT, elevated PTT, decreased platelets

Answer

Decreased PT, elevated PTT, elevated platelets

Answer

Decreased PT, decreased PTT, decreased platelets

Question 5

Which one of the following is used for the preservation of blood for transfusions?

Accepted Answer

Citrate phosphate dextrose

Answer

Heparin

Answer

Thrombin

Answer

EDTA

Question 6

Which of the following immunophenotypic features is characteristic of mantle cell lymphoma?

Accepted Answer

CD 5+, CD 23-

Answer

CD 5+, CD 25-

Answer

CD 5+, CD 10+

Answer

CD 5+, CD 23+

Question 7

All of the following are features of juvenile chronic myeloid leukemia except one.

Accepted Answer

Increased lymphadenopathy

Answer

Thrombocytopenia

Answer

Mild lymphadenopathy

Answer

Philadelphia chromosome is negative

Question 8

A 15-year-old boy presented with anemia and jaundice. On examination, his hemoglobin was 6 g/dL, ultrasound showed gallstones, and the peripheral smear showed the following. What is the most likely diagnosis?

Accepted Answer

Hereditary ovalocytosis

Answer

Hereditary acanthocytosis

Answer

Hereditary spherocytosis

Answer

Hereditary xerocytosis

Question 9

A 50-year-old woman is discovered to have metastatic breast cancer and develops bacterial pneumonia one week after receiving her first dose of chemotherapy. Which of the following best explains this patient's susceptibility to bacterial infection?

Accepted Answer

Neutropenia

Answer

Depletion of serum complement

Answer

Impaired neutrophil respiratory burst

Answer

Inhibition of clotting factor activation

Question 10

A 22-year-old woman presents with painless cervical lymphadenopathy, night sweats, and generalized pruritus. An enlarged cervical lymph node is removed for diagnosis, which shows broad bands of fibrosis on cut surface and histologically contains a mixture of cells, including lymphocytes, histiocytes, eosinophils, plasma cells, and scattered large cells with prominent nucleoli. Which of the following is the most likely condition?

Accepted Answer

Hodgkin disease

Answer

Cat-scratch disease

Answer

Reactive non-specific lymphadenitis

Answer

Non-Hodgkin lymphoma

Hematopathology — MCQs

Hematopathology — MCQs

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