Hematopathology Practice Questions

Q: Which of the following features may be used to differentiate hemophilia A from von Willebrand disease?

Bleeding time. To differentiate between Hemophilia A and von Willebrand Disease (vWD), one must distinguish between a **coagulation factor deficiency** and a **platelet adhesion defect**. [1] ### **Why Bleeding Time is the Correct Answer** * **Bleeding Time (BT)** measures primary hemostasis (platelet plug formation). * In **vWD**, von Willebrand Factor is deficient or defective. Since vWF is essential for anchoring platelets to the subendothelium, the BT is **prolonged**. [2] * In **Hemophilia A**, the defect is strictly in the coagulation cascade (secondary hemostasis). Platelet function is normal; therefore, the BT is **normal**. ### **Why Other Options are Incorrect** * **B. Prothrombin Time (PT):** PT measures the extrinsic and common pathways (Factors VII, X, V, II, I). Both Hemophilia A and vWD involve the intrinsic pathway, so PT is **normal in both**. [1] * **C. Partial Thromboplastin Time (aPTT):** aPTT measures the intrinsic pathway. Since Factor VIII activity is reduced in both Hemophilia A and vWD (vWF stabilizes Factor VIII), the aPTT can be **prolonged in both**. [1][2] * **D. Factor VIII levels:** Factor VIII levels are decreased in Hemophilia A (primary deficiency) and often decreased in vWD (secondary to low vWF). Thus, it cannot reliably differentiate the two without further testing (like vWF Ag or Ristocetin cofactor assay). [2] ### **NEET-PG High-Yield Pearls** * **Inheritance:** Hemophilia A is **X-linked recessive** (mostly males); vWD is **Autosomal Dominant** (most common inherited bleeding disorder). * **Clinical Presentation:** Hemophilia presents with deep tissue bleeds and **hemarthrosis**. vWD presents with **mucocutaneous bleeding** (epistaxis, menorrhagia). [3] * **Ristocetin Cofactor Assay:** The gold standard for diagnosing vWD (measures vWF-induced platelet agglutination). [2] * **Mixing Study:** Both will show correction of aPTT when mixed with normal plasma (indicating a deficiency, not an inhibitor). [1]

Q: A 23-year-old male presents with fever and cervical lymphadenopathy. The peripheral smear shows a specific finding. What is the most likely diagnosis?

Infectious mononucleosis. ***Infectious mononucleosis*** - The "specific finding" on peripheral smear refers to **atypical lymphocytes (Downey cells)**, which are characteristic of **EBV infection** in young adults. - Classic presentation of **fever** and **cervical lymphadenopathy** in a young male strongly suggests **infectious mononucleosis**. *Acute Myeloid Leukemia (AML)* - Would show **blast cells** (>20% myeloblasts) on peripheral smear, not atypical lymphocytes. - Typically presents with **pancytopenia**, **bleeding**, and **bone marrow failure** rather than isolated lymphadenopathy. *Acute Lymphoblastic Leukemia (ALL)* - Characterized by **lymphoblasts** on peripheral smear, which are immature cells with high nuclear-to-cytoplasmic ratio. - More common in **children** and presents with **bone marrow failure symptoms** like fatigue, bleeding, and infections. *None of the above* - The clinical scenario of a **young adult** with **fever**, **cervical lymphadenopathy**, and **atypical lymphocytes** is classic for infectious mononucleosis. - **EBV-induced atypical lymphocytes** are the pathognomonic finding that confirms the diagnosis.

Q: All the following conditions cause thrombocytopenia except?

Iron deficiency anemia. **Explanation:** The correct answer is **Iron deficiency anemia (IDA)** because it is typically associated with **reactive thrombocytosis** (an increase in platelet count) rather than thrombocytopenia. This occurs because erythropoietin, which is elevated in IDA, has a structural similarity to thrombopoietin, leading to cross-stimulation of megakaryocytes. **Analysis of Options:** * **Iron deficiency anemia (Option D):** In most cases, IDA presents with a normal or elevated platelet count. Thrombocytopenia is extremely rare in IDA and only occurs in cases of severe, long-standing nutritional depletion. * **Giant hemangioma (Option A):** This refers to **Kasabach-Merritt Syndrome**, where platelets are sequestered and consumed within the vascular channels of a large hemangioma, leading to consumptive thrombocytopenia [2]. * **Infectious mononucleosis (Option B):** Caused by the Epstein-Barr virus (EBV), it can cause thrombocytopenia through immune-mediated destruction (anti-platelet antibodies) or transient bone marrow suppression. * **HIV infection (Option C):** Thrombocytopenia is a common hematological manifestation of HIV [1]. It occurs via multiple mechanisms: direct infection of megakaryocytes, immune-mediated destruction (ITP-like picture), and hypersplenism [1]. **NEET-PG High-Yield Pearls:** 1. **Kasabach-Merritt Syndrome:** Triad of Giant Hemangioma + Thrombocytopenia + Consumptive Coagulopathy. 2. **Reactive Thrombocytosis:** Common causes include IDA, acute hemorrhage, inflammation, and post-splenectomy. 3. **HIV & Platelets:** Thrombocytopenia can be the initial presenting sign of an undiagnosed HIV infection. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Red Blood Cell and Bleeding Disorders, pp. 665-667. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Blood And Bone Marrow Disease, pp. 619-621.

Q: What is the most malignant form of Non-Hodgkin Lymphoma (NHL)?

Diffuse large cell lymphoma. **Explanation:** The classification of Non-Hodgkin Lymphoma (NHL) is primarily based on clinical behavior, categorized into **Indolent (Low-grade)** and **Aggressive (High-grade)** types [1]. **Why Diffuse Large B-Cell Lymphoma (DLBCL) is correct:** DLBCL is the most common subtype of NHL and is classified as an **aggressive (high-grade)** lymphoma [1]. It is characterized by rapidly enlarging lymph nodes and systemic "B" symptoms [1]. While it is highly malignant and fatal if left untreated, it is also potentially curable with intensive chemotherapy (e.g., R-CHOP regimen) because high-grade cells have a high mitotic index, making them more sensitive to cytotoxic drugs [1]. **Analysis of Incorrect Options:** * **B. Small cell lymphocytic lymphoma (SLL):** This is the tissue equivalent of Chronic Lymphocytic Leukemia (CLL) [1]. It is an **indolent** lymphoma. While it is generally incurable, it has a slow, protracted clinical course [1]. * **C. Follicular predominantly small cleaved cell lymphoma:** This is a Grade 1/2 Follicular Lymphoma. It is the classic example of an **indolent** lymphoma with a median survival of many years, though it can eventually transform into a more aggressive type (Richter’s transformation). * **D. Large cell follicular lymphoma:** This corresponds to Grade 3 Follicular Lymphoma. While more aggressive than small-cell types, it typically follows a less rapid course than the purely **diffuse** large cell variant. **NEET-PG High-Yield Pearls:** * **Most common NHL overall:** Diffuse Large B-Cell Lymphoma (DLBCL) [1]. * **Most common indolent NHL:** Follicular Lymphoma [1]. * **Most aggressive (fastest growing) NHL:** Burkitt Lymphoma (associated with c-myc translocation) [1]. * **Key distinction:** Indolent lymphomas are "slow but incurable," whereas aggressive lymphomas are "fast but potentially curable" [1].

Q: A 23-year-old man of northern European lineage presents with anemia. His father and paternal aunt had a similar illness that was treated successfully by splenectomy. His peripheral blood smear is similar to that shown in the illustration. Which of the following additional abnormalities is expected?

Polychromatophilic erythrocytes on peripheral blood smear. ***Polychromatophilic erythrocytes on peripheral blood smear*** - **Compensatory reticulocytosis** occurs in response to chronic hemolysis in hereditary spherocytosis, appearing as **polychromatophilic cells** on blood smear. - These immature red cells indicate active **bone marrow response** to replace hemolyzed spherocytes. *Bilirubinuria* - **Unconjugated bilirubin** from extravascular hemolysis is **protein-bound** and cannot be filtered by kidneys, so no bilirubinuria occurs. - Only **conjugated bilirubin** can appear in urine, which is not elevated in hereditary spherocytosis. *High mean corpuscular volume* - Hereditary spherocytosis typically shows **normal to slightly decreased MCV** due to membrane loss during splenic conditioning. - The characteristic finding is **increased MCHC** (mean corpuscular hemoglobin concentration), not increased MCV. *Increased direct (conjugated) serum bilirubin* - **Extravascular hemolysis** in hereditary spherocytosis produces **unconjugated hyperbilirubinemia**, not conjugated. - **Conjugated bilirubin elevation** suggests hepatocellular dysfunction or biliary obstruction, not hemolytic anemia.

Question 1

Which of the following features may be used to differentiate hemophilia A from von Willebrand disease?

Accepted Answer

Bleeding time

Answer

Prothrombin time

Answer

Partial thromboplastin time

Answer

Factor VIII levels

Question 2

A 30-year-old male presents with cervical lymphadenopathy for 2 months. There is no past history of TB or TB contact. On examination, two lymph nodes measuring 1x1 cm are palpable, rubbery in consistency without matting. Histopathological biopsy findings were noted (image not provided, assume characteristic findings for the diagnosis). Based on the clinical presentation and likely histopathological findings, what is the most likely diagnosis among the subtypes of Hodgkin's lymphoma?

Accepted Answer

Nodular lymphocyte predominant Hodgkin's lymphoma

Answer

Mixed cellularity Hodgkin's lymphoma

Answer

Lymphocyte depleted Hodgkin's lymphoma

Answer

Nodular sclerosis Hodgkin's lymphoma

Question 3

A 23-year-old male presents with fever and cervical lymphadenopathy. The peripheral smear shows a specific finding. What is the most likely diagnosis?

Accepted Answer

Infectious mononucleosis

Answer

Acute Myeloid Leukemia (AML)

Answer

Acute Lymphoblastic Leukemia (ALL)

Answer

None of the above

Question 4

Leucopenia is not seen in which of the following conditions?

Accepted Answer

Pyogenic bacterial infection

Answer

Viral infection

Answer

Malnutrition

Answer

Enteric fever

Question 5

All the following conditions cause thrombocytopenia except?

Accepted Answer

Iron deficiency anemia

Answer

Giant hemangioma

Answer

Infectious mononucleosis

Answer

HIV infection

Question 6

What is the most malignant form of Non-Hodgkin Lymphoma (NHL)?

Accepted Answer

Diffuse large cell lymphoma

Answer

Small cell lymphocytic lymphoma

Answer

Follicular predominantly small cleaved cell lymphoma

Answer

Large cell follicular lymphoma

Question 7

A leukemic patient develops disseminated intravascular coagulation. Examination of the marrow reveals hypergranular promyelocytes, some of which contain multiple Auer rods. The diagnosis of acute promyelocytic leukemia is made. Which of the following translocations is associated with the development of this disorder?

Accepted Answer

t (15;17)

Answer

t (4;11)

Answer

t (6;9)

Answer

t (8;14)

Question 8

Crew haircut appearance on X-ray skull and Gandy gamma bodies are characteristic findings in which of the following conditions?

Accepted Answer

Sickle cell anemia

Answer

G-6-PD deficiency

Answer

Hodgkin's lymphoma

Answer

Hereditary spherocytosis

Question 9

A 23-year-old man of northern European lineage presents with anemia. His father and paternal aunt had a similar illness that was treated successfully by splenectomy. His peripheral blood smear is similar to that shown in the illustration. Which of the following additional abnormalities is expected?

Accepted Answer

Polychromatophilic erythrocytes on peripheral blood smear

Answer

Bilirubinuria

Answer

High mean corpuscular volume

Answer

Increased direct (conjugated) serum bilirubin

Question 10

In sickle cell anemia, the sickle shape of red blood cells occurs due to the polymerization of which of the following?

Accepted Answer

Deoxyhemoglobin

Answer

Oxyhemoglobin

Answer

Methoxyglobin

Answer

Carboxy hemoglobin

Hematopathology — MCQs

Hematopathology — MCQs

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