Hematopathology Practice Questions

Q: What is the most common subtype of adult acute lymphoblastic leukemia (ALL)?

B-cell lineage ALL. **Explanation:** Acute Lymphoblastic Leukemia (ALL) is a malignant transformation of lymphoid progenitor cells. In adults, the distribution of subtypes differs slightly from children, but the overall predominance remains the same [1]. **1. Why B-cell lineage ALL is correct:** Approximately **75-80% of adult ALL cases** are of B-cell lineage [1]. This category encompasses the entire spectrum of B-cell development, from early pro-B to mature B-cells. Because it represents the vast majority of cases, it is classified as the most common subtype. **2. Why the other options are incorrect:** * **Pre-B-cell ALL:** While this is a specific stage within the B-cell lineage (characterized by cytoplasmic mu chains), it is a *subset* of B-cell ALL. The question asks for the broader lineage subtype. * **T-cell lineage ALL:** This accounts for only about **20-25%** of adult ALL cases [1]. It typically presents in younger males with a high white cell count and a mediastinal mass. * **Cortical T-ALL:** This is a specific immunophenotypic subcategory of T-ALL. While it often carries a slightly better prognosis than other T-cell subtypes, it is far less common than B-cell lineage ALL. **High-Yield Clinical Pearls for NEET-PG:** * **Cytogenetics:** The most common translocation in **adult B-ALL** is **t(9;22)**, the Philadelphia chromosome (BCR-ABL1), which carries a poor prognosis [1]. In contrast, children more commonly show t(12;21). * **Markers:** B-ALL typically expresses **CD19, CD20, and CD22** [1]. T-ALL expresses **CD2, CD3, CD5, and CD7**. * **Commonality:** ALL is the most common cancer in children, but in adults, it is less common than AML (Acute Myeloid Leukemia). * **Prognosis:** Adult ALL generally has a poorer prognosis compared to pediatric ALL [1].

Q: An 18-year-old woman presents with a low hemoglobin value of 10.5 g/dL on routine CBC testing. The red cells are microcytic, but WBC and platelet counts are normal. Her iron intake is adequate, menstrual flow is normal, and there is no other history of blood loss. Physical examination is normal, and iron studies reveal a normal ferritin level. She reports that other family members have also been diagnosed with anemia and alpha-thalassemia. Which of the following hemoglobins is increased in alpha-thalassemia?

Hemoglobin H. The clinical presentation of microcytic anemia with normal ferritin levels and a positive family history strongly suggests a thalassemia syndrome. In **Alpha-Thalassemia**, there is a deficiency in the production of alpha-globin chains. Since alpha chains are essential components of all normal adult hemoglobins (HbA, HbA2, and HbF), a deficiency leads to an excess of the remaining non-alpha chains. 1. **Why Hemoglobin H is correct:** In alpha-thalassemia (specifically the 3-gene deletion or HbH disease), the relative excess of beta-globin chains leads them to aggregate into tetramers ($\beta_4$). These tetramers are known as **Hemoglobin H**. In neonates with alpha-thalassemia, excess gamma chains form tetramers ($\gamma_4$) known as **Hb Barts**. 2. **Why other options are incorrect:** * **HbA ($\alpha_2\beta_2$):** This is the major adult hemoglobin. In alpha-thalassemia, its production is decreased, not increased. * **HbF ($\alpha_2\gamma_2$) and HbA2 ($\alpha_2\delta_2$):** Both require alpha chains. Unlike Beta-thalassemia (where HbA2 and HbF increase to compensate for the lack of beta chains), in Alpha-thalassemia, these levels are typically **normal or decreased** because the alpha-chain substrate is the limiting factor. **High-Yield Clinical Pearls for NEET-PG:** * **HbH Disease:** Characterized by a "3-gene deletion" (- - / - $\alpha$). * **Golf Ball Appearance:** On supra-vital staining (Brilliant Cresyl Blue), HbH precipitates as multiple small inclusions, giving RBCs a "golf ball" appearance. * **Mentzer Index:** (MCV/RBC count) 13 suggests Iron Deficiency Anemia. * **Diagnosis:** Hb Electrophoresis is the gold standard, but in alpha-thalassemia trait (1 or 2 gene deletion), electrophoresis may be normal; definitive diagnosis requires genetic testing.

Question 1

What is the most common subtype of adult acute lymphoblastic leukemia (ALL)?

Accepted Answer

B-cell lineage ALL

Answer

Pre-B-cell ALL

Answer

T-cell lineage ALL

Answer

Cortical T-ALL

Question 2

Beta Thalassemia is best diagnosed by?

Accepted Answer

Hb electrophoresis

Answer

NESTROFT Test

Answer

HbA1c estimation

Answer

Target cells in peripheral smear

Question 3

Hereditary spherocytosis is characterized by what type of abnormality?

Accepted Answer

Membrane skeleton abnormalities

Answer

Microtubule defect

Answer

Accumulation of intermediate filament

Answer

None of the above

Question 4

Rate of sickling in sickle cell anemia is directly proportional to all of the following EXCEPT:

Accepted Answer

Raised HbF

Answer

Raised HbS

Answer

Raised HbC

Answer

Hb deoxygenation

Question 5

Progressive transformation of germinal centers (PTGC) is a precursor lesion of which of the following?

Accepted Answer

Hodgkin lymphoma, lymphocytic predominant

Answer

Hodgkin lymphoma, nodular sclerosis

Answer

Hodgkin lymphoma, mixed cellularity

Answer

Peripheral T cell lymphoma

Question 6

An 18-year-old woman presents with a low hemoglobin value of 10.5 g/dL on routine CBC testing. The red cells are microcytic, but WBC and platelet counts are normal. Her iron intake is adequate, menstrual flow is normal, and there is no other history of blood loss. Physical examination is normal, and iron studies reveal a normal ferritin level. She reports that other family members have also been diagnosed with anemia and alpha-thalassemia. Which of the following hemoglobins is increased in alpha-thalassemia?

Accepted Answer

Hemoglobin H

Answer

Hemoglobin A

Answer

Hemoglobin F

Answer

Hemoglobin A2

Question 7

Patients with lymphoproliferative disorders undergo cytogenetic analysis. A subset of these cases shows the BCR-ABL fusion gene from the reciprocal translocation t(9;22)(q34;11), resulting in increased tyrosine kinase activity. Which of the following conditions is most likely to present with this gene?

Accepted Answer

Chronic myelogenous leukemia

Answer

Acute promyelocytic leukemia

Answer

Follicular lymphoma

Answer

Hodgkin lymphoma, lymphocyte depletion type

Question 8

What is the major source of Von Willebrand factor (vWF)?

Accepted Answer

Endothelial cells

Answer

Erythrocytes

Answer

Neutrophils

Answer

Monocytes

Question 9

Hemophilia clinically manifests as a rise in which laboratory parameter?

Accepted Answer

Activated Partial Thromboplastin Time (APTT)

Answer

Prothrombin Time (PT)

Answer

Clotting Time (CT)

Answer

Fibrin Degradation Products (FDP)

Question 10

A young female patient presented with symptoms related to anemia. Peripheral blood smear showed neutrophil hypersegmentation and bone marrow aspirate smear showed giant myelocytes. Which of the following is the likely etiology?

Accepted Answer

Folic acid deficiency

Answer

Sideroblastic anemia

Answer

Iron deficiency anemia

Answer

Thalassemia

Hematopathology — MCQs

Hematopathology — MCQs

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