Hematopathology Practice Questions

Q: What is the most common lymph node involved in Hodgkin's lymphoma?

Cervical. **Explanation:** **Hodgkin’s Lymphoma (HL)** typically presents as a painless, rubbery enlargement of lymph nodes. The disease characteristically follows a predictable, contiguous pattern of spread through the lymphatic system. **1. Why Cervical is Correct:** The **cervical lymph nodes** (specifically the upper cervical, supraclavicular, or mediastinal groups) are the most common site of involvement, seen in approximately **60-80% of cases** at the time of diagnosis [1]. This predilection is particularly strong in the Nodular Sclerosis and Mixed Cellularity subtypes [1]. The involvement is usually asymmetrical and often starts in the neck before spreading to the mediastinum. **2. Why Other Options are Incorrect:** * **Axillary (C):** While frequently involved, it is less common than cervical nodes (approx. 10-15%). * **Inguinal (A):** Involvement of the inguinal nodes is relatively rare in HL (approx. 6-10%) and is more commonly associated with Non-Hodgkin Lymphoma (NHL) or localized infections/malignancies of the lower extremities and pelvis. * **Sub-clavicular (D):** While supraclavicular nodes are common, "sub-clavicular" nodes are not a primary or most frequent site of presentation compared to the cervical chain. **Clinical Pearls for NEET-PG:** * **Bimodal Age Distribution:** HL shows two peaks—one in the 20s and another after age 50. * **Reed-Sternberg (RS) Cells:** The diagnostic hallmark (e.g., "Owl’s eye" appearance) [1]. * **Alcohol-Induced Pain:** A classic, high-yield clinical sign where pain occurs in the involved lymph nodes after alcohol consumption. * **Staging:** The **Ann Arbor Staging System** is used, and the presence of "B symptoms" (fever, night sweats, weight loss) indicates a worse prognosis [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. 616-618.

Q: Which of the following statements regarding Myelodysplasia is FALSE?

Patients with 5q deletion have a poor prognosis.. **Explanation:** **1. Why Option A is the Correct (False) Statement:** In Myelodysplastic Syndromes (MDS), the **5q deletion (5q- syndrome)** is actually associated with a **favorable prognosis** [1]. It typically occurs in elderly females and is characterized by severe macrocytic anemia, a normal or elevated platelet count, and a low risk of transformation to Acute Myeloid Leukemia (AML) [1]. These patients show an excellent therapeutic response to **Lenalidomide**. **2. Analysis of Other Options (True Statements):** * **Option B:** Dyserythropoiesis in MDS often manifests as **basophilic stippling**, ring sideroblasts, and nuclear budding/fragmentation [1]. * **Option C:** Dysmegakaryopoiesis is a hallmark of MDS. **Micromegakaryocytes** (Pawn ball megakaryocytes) with small, non-lobulated nuclei are classic bone marrow findings [1]. * **Option D:** Dysgranulopoiesis leads to the formation of **Pseudo-Pelger-Huët cells**, which are hyposegmented (bilobed or peanut-shaped) and hypogranular neutrophils seen in the peripheral blood [1]. **3. High-Yield Clinical Pearls for NEET-PG:** * **Definition:** MDS is a clonal stem cell disorder characterized by "Ineffective Hematopoiesis" (Hypercellular marrow but peripheral cytopenia) [1]. * **IPSS Score:** Used for prognosis; based on blast percentage, cytogenetics, and number of cytopenias. * **Cytogenetics:** Good prognosis (5q-, 20q-, -Y); Poor prognosis (Complex karyotype, Chromosome 7 abnormalities) [1]. * **Ring Sideroblasts:** Defined as $\geq$ 5 iron granules encircling $\geq$ 1/3rd of the nucleus (Prussian Blue stain). * **Transformation:** MDS can transform into AML if blasts in the marrow reach $\geq$ 20% [1]. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Blood And Bone Marrow Disease, pp. 613-614.

Q: What is the term for a dilated endoplasmic reticulum?

Dohle bodies. **Explanation:** **Dohle bodies** are the correct answer. They are light blue-gray, oval, or teardrop-shaped inclusions found in the cytoplasm of neutrophils. Ultrastructurally, they represent **dilated strands of rough endoplasmic reticulum (RER)**. They are typically seen in "toxic" states such as severe bacterial infections, burns, trauma, or pregnancy, often alongside toxic granulation and cytoplasmic vacuolation. **Analysis of Incorrect Options:** * **Asteroid bodies:** These are star-shaped eosinophilic inclusions found within giant cells in granulomatous diseases, most classically **Sarcoidosis** and Sporotrichosis. * **Bamboo bodies:** These are ferruginous bodies (asbestos bodies) that appear segmented or beaded, resembling bamboo. They are found in the lungs of patients with **Asbestosis**. * **Hirano bodies:** These are eosinophilic, rod-like inclusions made of actin-binding proteins found in the neurons (specifically the hippocampus) of patients with **Alzheimer’s disease**. **High-Yield Clinical Pearls for NEET-PG:** * **May-Hegglin Anomaly:** This is a rare autosomal dominant disorder characterized by large, "Dohle-like" bodies in leukocytes, associated with giant platelets and thrombocytopenia. * **Toxic Granulation:** Often seen with Dohle bodies, these represent prominent primary granules (lysosomes) in neutrophils during inflammation. * **Chediak-Higashi Syndrome:** Characterized by giant lysosomal granules in neutrophils (due to a defect in vesicle trafficking), which should not be confused with Dohle bodies.

Question 1

What is the most common lymph node involved in Hodgkin's lymphoma?

Accepted Answer

Cervical

Answer

Inguinal

Answer

Axillary

Answer

Sub-clavicular

Question 2

Fresh frozen plasma is used in which of the following conditions?

Accepted Answer

Specific clotting factor deficiency

Answer

Acute blood loss

Answer

Nutritive support

Answer

Decreased blood volume

Question 3

On which chromosome is the ABO blood group gene located?

Accepted Answer

Chromosome 9

Answer

Chromosome 1

Answer

Chromosome 3

Answer

Chromosome 6

Question 4

Sezary syndrome is classified under which category?

Accepted Answer

T cell leukemia

Answer

Lymphoma

Answer

B cell leukemia

Answer

Pigmented disorder of skin

Question 5

Which of the following statements regarding Myelodysplasia is FALSE?

Accepted Answer

Patients with 5q deletion have a poor prognosis.

Answer

Erythroid cells with basophilic stippling are seen.

Answer

Micromegakaryocytes are seen in the bone marrow.

Answer

Hypolobulated neutrophils are seen in peripheral blood.

Question 6

Eosinophilic granuloma results from the proliferation of which cell type?

Accepted Answer

Histiocytes

Answer

Eosinophils

Answer

Lymphocytes

Answer

Fibroblasts

Question 7

During a routine blood test among members of a family, abnormally high potassium values were noted. Which hematological anomaly is known to cause such a finding?

Accepted Answer

Hereditary elliptocytosis

Answer

Idiopathic Thrombocytopenic Purpura (ITP)

Answer

Polycythemia rubra vera

Answer

Bernard-Soulier syndrome

Question 8

What is the term for a dilated endoplasmic reticulum?

Accepted Answer

Dohle bodies

Answer

Asteroid bodies

Answer

Bamboo bodies

Answer

Hirano bodies

Question 9

Deficiency of all three components of coagulation factor VIII results in which of the following conditions?

Accepted Answer

Von Willebrand's disease

Answer

Hemophilia A

Answer

Parahemophilia

Answer

Hemophilia B

Question 10

A 32-year-old asymptomatic female, not requiring blood transfusion, presents with Hb 13.0 gm/dl. Her HbF levels are 95% and Hb A2 levels are 1.5%. Which of the following is the most likely diagnosis?

Accepted Answer

Hereditary persistence of fetal hemoglobin

Answer

Beta homozygous thalassemia

Answer

Thalassemia intermedia

Answer

Beta heterozygous thalassemia

Hematopathology — MCQs

Hematopathology — MCQs

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