Hematopathology Practice Questions

Q: Which of the following statements are true regarding Burkitt's lymphoma?

It can present as an abdominal mass.. **Explanation:** Burkitt’s Lymphoma (BL) is a highly aggressive B-cell non-Hodgkin lymphoma characterized by the translocation of the **MYC gene**. **Why Option C is Correct:** Burkitt’s lymphoma is categorized into three clinical variants: Endemic (African), Sporadic (Non-African), and Immunodeficiency-associated. The **Sporadic form** most commonly involves the **ileocecal region and peritoneum**, frequently presenting as a rapidly enlarging **abdominal mass**, pain, or bowel obstruction [1]. **Analysis of Incorrect Options:** * **Option A:** While BL is indeed a B-cell lymphoma, the question asks for the "most true" or specific clinical characteristic in many exam patterns. However, in a "multiple true" context, A is technically correct. In the context of this specific single-choice question, the clinical presentation (Option C) is the classic examiner focus. * **Option B:** BL is associated with **t(8;14)** in 80% of cases, involving the *c-MYC* gene on chromosome 8 and the *IgH* gene on chromosome 14. Other variants include t(2;8) and t(8;22). t(6;14) is not associated with BL. * **Option D:** BL is a systemic disease with a very high proliferation rate (nearly 100% Ki-67 index). Therefore, it is primarily treated with **intensive chemotherapy** (e.g., CODOX-M/IVAC) [1]. Radiotherapy is rarely used as a primary modality. **High-Yield Clinical Pearls for NEET-PG:** * **Morphology:** "Starry-sky" appearance [1] (tingible body macrophages against a sea of cohesive B-cells). * **Genetics:** Overexpression of **c-MYC** (a transcription factor). * **Endemic Form:** Strongly associated with **EBV**; typically presents as a **jaw mass** [1]. * **Cytology:** Medium-sized cells with basophilic cytoplasm and prominent lipid vacuoles. **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. 605-606.

Q: Heinz bodies are composed of?

Denatured haemoglobin. **Explanation:** **Heinz bodies** are inclusions within red blood cells composed of **denatured (precipitated) hemoglobin** [1]. 1. **Why Option D is Correct:** Heinz bodies form when hemoglobin undergoes oxidative damage. In conditions like **G6PD deficiency**, the lack of NADPH prevents the reduction of glutathione. Without reduced glutathione, reactive oxygen species (ROS) attack the globin chains of hemoglobin, causing them to denature and form insoluble precipitates [1]. These precipitates attach to the RBC membrane, damaging it and leading to splenic removal, which results in "Bite cells" [1]. 2. **Why Other Options are Incorrect:** * **A. DNA:** Inclusions of nuclear DNA remnants are called **Howell-Jolly bodies**, typically seen in asplenia or megaloblastic anemia. * **B. RNA:** Ribosomal RNA precipitates are known as **Basophilic stippling**, seen in lead poisoning, thalassemias, and sideroblastic anemia. * **C. Iron:** Inclusions of non-heme iron are called **Pappenheimer bodies** (seen on Wright stain) or **Siderotic granules** (seen on Prussian blue stain), characteristic of sideroblastic anemia. **High-Yield Clinical Pearls for NEET-PG:** * **Staining:** Heinz bodies are **NOT visible on routine Leishman or Romanowsky stains**. They require **Supravital stains** (e.g., Crystal Violet, Brilliant Cresyl Blue, or Methylene Blue). * **Morphology:** They appear as dark, round granules attached to the inner RBC membrane. * **Clinical Association:** Most commonly associated with **G6PD deficiency**, but also seen in unstable hemoglobin variants (e.g., Hb Cologne) and chronic drug-induced oxidative stress [1]. * **Sequence of events:** Heinz bodies → Splenic macrophages "bite" them out → **Bite cells (Degmacytes)** [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Red Blood Cell and Bleeding Disorders, pp. 642-643.

Q: Which of the following statements is not true regarding hemolytic uremic syndrome?

Direct Coombs test is positive.. **Explanation:** Hemolytic Uremic Syndrome (HUS) is a classic triad of **Microangiopathic Hemolytic Anemia (MAHA)**, **Thrombocytopenia**, and **Acute Kidney Injury (AKI)**. **Why Option D is the correct answer (False statement):** The hemolysis in HUS is **non-immune** in nature. It is caused by mechanical destruction of RBCs as they pass through fibrin-platelet thrombi in small vessels (fragmentation hemolysis). Therefore, the **Direct Coombs Test (DAT) is characteristically negative**. A positive Coombs test would instead suggest an autoimmune hemolytic anemia (AIHA). **Analysis of Incorrect Options (True statements):** * **Option A:** HUS is a prototype of MAHA. The primary pathology involves endothelial injury leading to microvascular thrombosis. * **Option B:** Consumption of platelets within these microthrombi leads to **thrombocytopenia**. The mechanical shearing of RBCs results in fragmented cells known as **schistocytes** (helmet cells) on the peripheral smear. * **Option C:** The renal microvasculature is the primary target, leading to decreased GFR, hematuria, proteinuria, and often severe **renal insufficiency** requiring dialysis. **Clinical Pearls for NEET-PG:** * **Most common cause:** Shiga toxin-producing *E. coli* (STEC), specifically serotype **O157:H7**. * **Prodrome:** Usually begins with bloody diarrhea (D+ HUS). * **Atypical HUS (D- HUS):** Associated with genetic mutations in the alternative complement pathway (e.g., Factor H deficiency). * **Management:** Primarily supportive (fluid/electrolyte balance, dialysis). **Antibiotics and anti-motility agents are contraindicated** as they may increase toxin release and worsen the condition.

Question 1

Which of the following statements are true regarding Burkitt's lymphoma?

Accepted Answer

It can present as an abdominal mass.

Answer

It is a B cell lymphoma.

Answer

It is associated with the 6;14 translocation.

Answer

Radiotherapy is used in its treatment.

Question 2

Leukostasis is common in which of the following hematological conditions?

Accepted Answer

AML

Answer

ALL

Answer

CML

Answer

CLL

Question 3

Heinz bodies are composed of?

Accepted Answer

Denatured haemoglobin

Answer

DNA

Answer

RNA

Answer

Iron

Question 4

Which of the following statements is not true regarding hemolytic uremic syndrome?

Accepted Answer

Direct Coombs test is positive.

Answer

It is a microangiopathic hemolytic anemia.

Answer

Thrombocytopenia and schistocytes are seen in the peripheral blood smear.

Answer

Renal insufficiency is a complication.

Question 5

Post-transplant lymphoma occurs due to proliferation of which of the following cells?

Accepted Answer

B cell

Answer

T cell

Answer

NK cell

Answer

Monocyte

Question 6

Which of the following is the only hemolytic anemia caused by an acquired intrinsic defect in the cell membrane?

Accepted Answer

Paroxysmal nocturnal hemoglobinuria (PNH)

Answer

Sickle cell anemia

Answer

Thalassemia

Answer

None of the above

Question 7

Translocation of t(8;14) is characteristic of which of the following malignancies?

Accepted Answer

Burkitt's lymphoma

Answer

Hairy cell leukemia

Answer

Mantle cell lymphoma

Answer

Follicular lymphoma

Question 8

What is the marker for granulocytic sarcoma?

Accepted Answer

CD117

Answer

CD33

Answer

CD38

Answer

CD137

Question 9

A 72-year-old man who has undergone aortic valve replacement presents with pallor and fatigue. Laboratory findings include a decreased red blood cell count, the presence of schistocytes on peripheral blood smear examination, and significantly elevated indirect (unconjugated) bilirubin. What is the likely cause of this patient's anemia?

Accepted Answer

Mechanical disruption of red cells

Answer

Cold agglutinin disease

Answer

Dietary deficiency

Answer

Hereditary spherocytosis

Question 10

All of the following are true for the Philadelphia chromosome, EXCEPT:

Accepted Answer

It is seen in plasma cell tumors.

Answer

It is an acquired genetic defect.

Answer

It is a marker of chronic myeloid leukemia (CML).

Answer

It results from a translocation of genetic material from chromosome 22 to chromosome 9.

Hematopathology — MCQs

Hematopathology — MCQs

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