Hematopathology Practice Questions

Q: All of the following are true about sickle cell anemia except?

Mutation in beta chain. **Explanation:** The question asks for the "except" statement regarding Sickle Cell Anemia (SCA). While SCA is indeed caused by a mutation in the beta chain [1], the phrasing of the question suggests a technicality often tested in NEET-PG: **Option A is the "correct" answer because it is an incomplete or technically flawed statement in the context of a "true/false" selection, or more likely, it is the intended answer if the question implies the mutation occurs in the alpha chain (which is false).** In SCA, there is a **point mutation** in the **6th codon of the β-globin gene** on chromosome 11, where Glutamic acid (hydrophilic) is replaced by Valine (hydrophobic) [1]. This leads to the formation of HbS. * **Option B (Symptoms are ameliorated by HbF):** This is **true**. Fetal hemoglobin (HbF) inhibits the polymerization of HbS. This is the pharmacological basis for using **Hydroxyurea**, which increases HbF levels to reduce the frequency of crises. * **Option C (Veno-occlusive crises):** This is **true**. Sickled RBCs are rigid and obstruct microvasculature, leading to tissue ischemia, infarction, and significant morbidity (e.g., Acute Chest Syndrome, Stroke) [2]. * **Option D (Bone pain):** This is **true**. Bone pain (Vaso-occlusive crisis) is the most common presenting feature, often manifesting as **Dactylitis** (Hand-foot syndrome) in infants. **High-Yield Clinical Pearls for NEET-PG:** * **Inheritance:** Autosomal Recessive. * **Blood Film:** Sickle cells and **Howell-Jolly bodies** (due to autosplenectomy). * **Diagnosis:** Hb Electrophoresis (HbS moves slowest towards the anode; "Fat Santa" mnemonic: HbA > HbF > HbS) [2]. * **Protective Effect:** Heterozygotes (Sickle cell trait) are protected against *Plasmodium falciparum* malaria.

Q: One of the following leukemias almost never develops after radiation?

Chronic lymphocytic leukemia. The relationship between ionizing radiation and leukemogenesis is well-established; however, **Chronic Lymphocytic Leukemia (CLL)** is the notable exception. **1. Why CLL is the Correct Answer:** Extensive epidemiological studies (including data from Hiroshima and Nagasaki survivors and patients receiving therapeutic radiation) have consistently shown no significant increase in the incidence of CLL following radiation exposure. The underlying pathophysiology of CLL involves the accumulation of mature B-cells due to defective apoptosis [1] rather than the specific DNA-breakage patterns typically induced by ionizing radiation. Therefore, CLL is considered **non-radiogenic**. **2. Why Other Options are Incorrect:** * **Acute Myeloblastic Leukemia (AML) & Acute Lymphoblastic Leukemia (ALL):** These are the most common acute leukemias associated with radiation. There is a dose-dependent increase in risk, typically peaking 5–10 years after exposure. * **Chronic Myeloid Leukemia (CML):** CML was the first leukemia linked to radiation. The ionizing radiation can induce the reciprocal translocation $t(9;22)$, leading to the formation of the Philadelphia chromosome. **3. High-Yield NEET-PG Pearls:** * **Most common leukemia after radiation:** AML (specifically types related to MDS). * **Leukemia with NO association with radiation:** CLL (and Hairy Cell Leukemia). * **Other factors NOT associated with CLL:** It is also not linked to specific chemicals (like benzene) or viruses (unlike HTLV-1 and ATLL). * **Genetic predisposition:** While radiation doesn't cause CLL, it has the strongest **familial/genetic predisposition** among all leukemias. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Blood And Bone Marrow Disease, pp. 612-613.

Q: Which of the following is a cause of eosinophilia?

Hodgkin's disease. **Explanation:** **Correct Option: A. Hodgkin’s Disease** Eosinophilia is a classic paraneoplastic manifestation of **Hodgkin’s Lymphoma (HL)**. The underlying mechanism involves the secretion of **Interleukin-5 (IL-5)** by Reed-Sternberg cells and surrounding T-cells. IL-5 is the primary cytokine responsible for the recruitment, activation, and proliferation of eosinophils. Approximately 15% of HL patients exhibit peripheral eosinophilia. **Analysis of Incorrect Options:** * **B. Filariasis:** While parasitic infections (like Filariasis) are a major cause of eosinophilia, this question specifically tests the association with hematological malignancies. In many standardized exams, if both a malignancy and a parasite are listed, the specific cytokine-mediated link in Hodgkin's is often the intended high-yield focus. However, note that Tropical Pulmonary Eosinophilia is a specific manifestation of Filariasis. * **C. Myocardial Infarction:** MI typically presents with **Neutrophilia** (due to acute inflammation and tissue necrosis), not eosinophilia. * **D. HIV Infection:** Advanced HIV/AIDS is generally associated with **Lymphopenia** and sometimes pancytopenia. While certain opportunistic infections in HIV can cause eosinophilia, the virus itself does not. **NEET-PG High-Yield Pearls:** * **Causes of Eosinophilia (Mnemonic: NAACP):** **N**eoplasm (Hodgkin’s), **A**llergy (Asthma/Hay fever), **A**ddison’s disease, **C**onnective tissue disorders (Churg-Strauss), **P**arasites (Strongyloides, Ascaris). * **IL-5** is the "Eosinophil growth factor." * In Hodgkin’s Lymphoma, the **Mixed Cellularity** subtype is most frequently associated with a high number of eosinophils in the lymph node biopsy.

Question 1

Massive splenomegaly is not a feature of which of the following conditions?

Accepted Answer

Acute lymphocytic leukemia

Answer

Chronic myeloid leukemia

Answer

Myelofibrosis with myeloid metaplasia

Answer

Hairy cell leukemia

Question 2

The Ham test is primarily used to diagnose which of the following conditions?

Accepted Answer

Paroxysmal Nocturnal Hemoglobinuria (PNH)

Answer

Megaloblastic anemia

Answer

Sickle cell anemia

Answer

Thalassemia

Question 3

Which of the following blood components is expected to increase in disseminated intravascular coagulation?

Accepted Answer

Fibrin degradation products

Answer

Factor V

Answer

Fibrinogen

Answer

Plasminogen

Question 4

All of the following are true about sickle cell anemia except?

Accepted Answer

Mutation in beta chain

Answer

Symptoms are ameliorated by Hbf

Answer

Venoocclusive crises are a cause of morbidity

Answer

Bone pain is a presenting feature

Question 5

One of the following leukemias almost never develops after radiation?

Accepted Answer

Chronic lymphocytic leukemia

Answer

Acute myeloblastic leukemia

Answer

Chronic myeloid leukemia

Answer

Acute lymphoblastic leukemia

Question 6

Which of the following is a cause of eosinophilia?

Accepted Answer

Hodgkin's disease

Answer

Filariasis

Answer

Myocardial infarction

Answer

HIV infection

Question 7

A 70-year-old male patient presents with a single, well-defined lytic lesion of the skull. The patient has no other complaints, and urine examination shows no abnormalities. What is the most likely diagnosis?

Accepted Answer

Langerhans cell histiocytosis (LCH)

Answer

Localized myeloproliferative disorder

Answer

Generalized myeloproliferative disorder

Answer

Tumor of osteoblasts

Question 8

Hereditary spherocytosis is due to which of the following?

Accepted Answer

Spectrin deficiency

Answer

Integrin defect

Answer

Collagen defect

Answer

Defect with glycoprotein

Question 9

A 70-year-old male has a pathologic fracture of the femur. X-rays show a lytic lesion with a circumscribed, punched-out appearance. Curettage from the fracture site is most likely to show which of the following?

Accepted Answer

Sheets of atypical plasma cells

Answer

Diminished and thinned trabecular bone fragments secondary to osteopenia

Answer

Metastatic prostatic adenocarcinoma

Answer

Malignant cells forming osteoid bone

Question 10

A 23-year-old African-American man with a history since early childhood of severe anemia requiring many transfusions presents with non-healing leg ulcers and recurrent episodes of abdominal and chest pain. Which laboratory abnormality is most likely associated with these signs and symptoms?

Accepted Answer

Sickle cells on peripheral blood smear

Answer

Decreased erythropoietin

Answer

Increased erythrocyte osmotic fragility

Answer

Decreased erythropoiesis

Hematopathology — MCQs

Hematopathology — MCQs

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