Hematopathology Practice Questions

Q: Which of the following subtypes of Hodgkin lymphoma has the strongest association with HIV?

Lymphocyte-depleted. The association between HIV and Hodgkin Lymphoma (HL) is unique. Unlike non-Hodgkin lymphoma, HL is not an AIDS-defining illness, but its incidence is significantly higher in HIV-positive individuals [1]. **Why Lymphocyte-depleted is correct:** In the setting of advanced HIV/AIDS, patients typically have severe immunosuppression and low CD4 counts. The **Lymphocyte-depleted (LD)** subtype is the rarest form of HL in the general population but is the **most strongly associated with HIV**. It is characterized by a paucity of lymphocytes and an abundance of Reed-Sternberg (RS) cells [1]. In HIV patients, HL often presents at an advanced stage (Stage III/IV), involves extranodal sites (bone marrow, liver), and is almost 100% associated with **Epstein-Barr Virus (EBV)**. Mixed Cellularity is the second most common subtype in HIV. **Analysis of Incorrect Options:** * **Nodular sclerosis:** This is the most common subtype of HL in the general population (especially young females). While it can occur in HIV patients, it does not have the strongest specific association with the virus. * **Lymphocyte-rich:** This subtype has a very good prognosis and is characterized by many reactive lymphocytes; it is rarely seen in the immunodeficient state of HIV. * **Nodular lymphocyte-predominant (NLPHL):** This is a distinct clinical entity (CD20+) and is generally not associated with EBV or HIV infection. **High-Yield Pearls for NEET-PG:** * **Most common HL subtype in HIV:** Mixed Cellularity (historically) or Nodular Sclerosis (in the HAART era), but **LD** has the strongest *relative* association. * **EBV Association:** Nearly all HL cases in HIV patients are EBV-positive. * **Prognosis:** HL in HIV patients is more aggressive, presents with B-symptoms, and has a poorer prognosis compared to HIV-negative patients. * **CD4 Count:** Unlike NHL, HL often occurs when CD4 counts are relatively preserved (often >200 cells/mm³).

Q: All are true about anemia of chronic disease, except?

Decreased ferritin. **Explanation:** Anemia of Chronic Disease (ACD), also known as Anemia of Inflammation, is driven by the cytokine-mediated increase in **Hepcidin**. Hepcidin inhibits ferroportin, preventing iron release from macrophages and decreasing intestinal iron absorption. **Why Option B is the correct answer (The "Except"):** In ACD, iron is "trapped" within the reticuloendothelial system (macrophages). Since **Ferritin** is an acute-phase reactant and reflects stored iron, its levels are **increased or normal**, never decreased. A decreased ferritin is the hallmark of Iron Deficiency Anemia (IDA), not ACD [1]. **Analysis of Incorrect Options:** * **A. Decreased serum iron:** True. Since iron is sequestered in macrophages and not released into the plasma, circulating serum iron levels fall [1]. * **C. Decreased TIBC:** True. Total Iron Binding Capacity (TIBC) is a measure of transferrin. In inflammatory states, the liver decreases transferrin production. This helps differentiate ACD (Low TIBC) from IDA (High TIBC) [1]. * **D. Increased bone marrow iron:** True. Prussion blue staining of a bone marrow aspirate in ACD shows abundant iron within macrophages, confirming that the body has iron but cannot utilize it for erythropoiesis. **NEET-PG High-Yield Pearls:** * **Key Mediator:** Interleukin-6 (IL-6) stimulates the liver to produce **Hepcidin**. * **Morphology:** Usually Normocytic Normochromic, but can become Microcytic Hypochromic in long-standing cases [1]. * **The "Gold Standard" Differentiator:** * **ACD:** High Ferritin, Low TIBC, High Marrow Iron. * **IDA:** Low Ferritin, High TIBC, Absent Marrow Iron [1]. * **Transferrin Saturation:** Decreased in both ACD and IDA.

Question 1

A 55-year-old male presents with renal failure, bone pain for 7 years, and osteolytic lesions on X-ray. Serum electrophoresis shows an M spike and 35% plasma cells with aberrant protein expression. What is the diagnosis?

Accepted Answer

Multiple myeloma

Answer

MGUS

Answer

Smoldering myeloma

Answer

Plasma cell leukemia

Question 2

High mitotic activity with rapid cellular turnover and characteristic "Starry sky" appearance is seen in which of the following conditions?

Accepted Answer

Burkitt's lymphoma

Answer

Follicular lymphoma

Answer

Diffuse lymphoma

Answer

Hodgkin's lymphoma

Question 3

A patient being investigated for anemia has a dry marrow tap. Peripheral smear reveals tear drop cells. What is the likely diagnosis?

Accepted Answer

Myelofibrosis

Answer

Leukemia

Answer

Lymphoma

Answer

Polycythemia rubra vera

Question 4

Which one of the following platelet counts is usually associated with an increased incidence of spontaneous bleeding?

Accepted Answer

Less than 20,000/mm³

Answer

Greater than 80,000/mm³

Answer

40,000/mm³

Answer

20,000/mm³

Question 5

Which of the following subtypes of Hodgkin lymphoma has the strongest association with HIV?

Accepted Answer

Lymphocyte-depleted

Answer

Lymphocyte-rich

Answer

Nodular lymphocyte-predominant

Answer

Nodular sclerosis

Question 6

All of the following cause intravascular hemolysis, except?

Accepted Answer

Thalassemia

Answer

Mismatched blood transfusion

Answer

Snake bite

Answer

Paroxysmal Nocturnal Hemoglobinuria (PNH)

Question 7

What is the normal ratio of Kappa to Lambda free light chains in serum?

Accepted Answer

4:6

Answer

7:3

Answer

6:4

Answer

3:7

Question 8

All are true about anemia of chronic disease, except?

Accepted Answer

Decreased ferritin

Answer

Decreased serum iron

Answer

Decreased TIBC

Answer

Increased bone marrow iron

Question 9

What is true regarding prothrombin time measurement?

Accepted Answer

Should be measured within 2 hours

Answer

Platelet-rich plasma is required

Answer

Activated with kaolin

Answer

Immediate refrigeration is necessary to preserve coagulation factor viability

Question 10

Which of the following is NOT a feature of intravascular hemolysis?

Accepted Answer

Thrombocytopenia

Answer

Hemosiderinuria

Answer

Decreased haptoglobin

Answer

Raised indirect bilirubin

Hematopathology — MCQs

Hematopathology — MCQs

On this page

Practice by Chapter

Want unlimited practice?