MCQ: Hematopathology – 30 MCQs | Kenya MBChB

30 Year 3: Hematopathology exam questions on MCQ: Hematopathology for medical students. Includes MCQs, answers, explanations and written questions. Sample: What

This MCQ set contains 30 questions on MCQ: Hematopathology in the Year 3: Hematopathology unit. Each question includes the correct answer and a detailed explanation for active recall and exam preparation.

Q1: What percentage of Non-Hodgkin Lymphomas are of B-cell origin?

  1. A. 70%
  2. B. 75%
  3. C. 85%
  4. D. 90%

Correct answer: C – 85%

NHL is 85% B-cell and 15% T/NK-cell origin. This is a foundational fact frequently tested.

Q2: Which is the most common subtype of B-cell NHL?

  1. A. Follicular lymphoma
  2. B. Mantle cell lymphoma
  3. C. Burkitt lymphoma
  4. D. Diffuse large B-cell lymphoma

Correct answer: D – Diffuse large B-cell lymphoma

DLBCL is the most common NHL subtype overall. Follicular is second at 29%.

Q3: A 60-year-old woman has widespread painless lymphadenopathy. Biopsy shows BCL-2+, CD10+, CD20+ cells. The disease has been present for years with slow progression. What is the most likely diagnosis?

  1. A. DLBCL
  2. B. Mantle cell lymphoma
  3. C. Follicular lymphoma
  4. D. Burkitt lymphoma

Correct answer: C – Follicular lymphoma

Indolent course + BCL-2+/CD10+ markers + t(14;18) = classic follicular lymphoma presentation.

Q4: Which translocation is required for the diagnosis of Mantle Cell Lymphoma?

  1. A. t(14;18)
  2. B. t(8;14)
  3. C. t(2;5)
  4. D. t(11;14)

Correct answer: D – t(11;14)

This juxtaposes the Cyclin D1 gene to the Ig heavy-chain gene → Cyclin D1 overexpression. Its presence is required for MCL diagnosis.

Q5: A patient with NHL has CD5+, CD19+, CD22+, CD23− immunophenotype. Which lymphoma does this suggest?

  1. A. CLL/SLL
  2. B. Mantle cell lymphoma
  3. C. Follicular lymphoma
  4. D. MALT lymphoma

Correct answer: B – Mantle cell lymphoma

Both MCL and CLL are CD5+/CD19+, but MCL is CD23− while CLL is CD23+. CD22+ also favours MCL.

Q6: Which organism is directly implicated in the pathogenesis of gastric MALT lymphoma?

  1. A. Epstein-Barr virus
  2. B. HTLV-1
  3. C. Helicobacter pylori
  4. D. HHV-8

Correct answer: C – Helicobacter pylori

Gastric MALT lymphoma is strongly linked to H. pylori. Early-stage disease can regress completely with antibiotics alone.

Q7: What is the first-line treatment for early-stage gastric MALT lymphoma?

  1. A. R-CHOP chemotherapy
  2. B. Radiotherapy
  3. C. H. pylori eradication with antibiotics
  4. D. Rituximab monotherapy

Correct answer: C – H. pylori eradication with antibiotics

In early-stage gastric MALT, eliminating H. pylori can be curative. Chemotherapy is reserved for advanced or refractory disease.

Q8: A 55-year-old man presents with visual disturbances, fatigue and epistaxis. Serum protein electrophoresis shows a monoclonal IgM spike. Bone marrow biopsy reveals lymphoplasmacytoid infiltration. What gene mutation is present in 90% of cases?

  1. A. BRAF
  2. B. TP53
  3. C. MYD88
  4. D. MYC

Correct answer: C – MYD88

This is Waldenström's macroglobulinaemia (LPL). MYD88 mutation is present in 90% and is near-diagnostic.

Q9: Why is plasmapheresis particularly effective in treating hyperviscosity in Waldenström's macroglobulinaemia compared to IgG myeloma?

  1. A. IgM is smaller and easier to filter
  2. B. IgM is mainly intravascular, making it accessible to plasmapheresis
  3. C. IgG has higher viscosity than IgM
  4. D. IgM activates complement more efficiently

Correct answer: B – IgM is mainly intravascular, making it accessible to plasmapheresis

Because IgM stays in the bloodstream (unlike IgG which redistributes extravascularly), plasmapheresis efficiently removes it and rapidly relieves hyperviscosity.

Q10: A child from sub-Saharan Africa presents with a rapidly growing jaw mass. EBV is detected. Histology shows a 'starry sky' pattern with 95% proliferative index. What is the diagnosis?

  1. A. DLBCL
  2. B. Lymphoblastic lymphoma
  3. C. Endemic Burkitt lymphoma
  4. D. Mantle cell lymphoma

Correct answer: C – Endemic Burkitt lymphoma

Jaw mass + EBV + malaria-endemic region + starry sky histology + 95% mitotic index = classic endemic Burkitt. Translocation is t(8;14) → MYC overexpression.

Q11: Which oncogene is overexpressed in virtually all cases of Burkitt lymphoma?

  1. A. BCL-2
  2. B. ALK
  3. C. MYC
  4. D. Cyclin D1

Correct answer: C – MYC

t(8;14) translocates MYC to the Ig heavy-chain locus → constitutive MYC expression during phases it should be OFF → uncontrolled proliferation.

Q12: What is the gold standard investigation for diagnosing NHL?

  1. A. Fine needle aspiration
  2. B. PET/CT scan
  3. C. Trucut / whole lymph node biopsy
  4. D. Bone marrow trephine alone

Correct answer: C – Trucut / whole lymph node biopsy

FNA is specifically insufficient for NHL diagnosis. A biopsy providing tissue architecture is essential for accurate histological subtyping.

Q13: A 45-year-old HIV-positive patient develops a brain mass. MRI shows a ring-enhancing lesion. Biopsy confirms large B-cells with prominent nucleoli. What is the most likely diagnosis?

  1. A. Toxoplasma encephalitis
  2. B. Primary CNS lymphoma
  3. C. Burkitt lymphoma
  4. D. Glioblastoma multiforme

Correct answer: B – Primary CNS lymphoma

Primary CNS lymphoma is more common in elderly and HIV+ patients. It is usually DLBCL type. Treat with high-dose methotrexate + cytosine arabinoside.

Q14: What is the standard first-line treatment for DLBCL?

  1. A. CODOX-M/IVAC
  2. B. R-CVP
  3. C. R-CHOP × 6–8 cycles
  4. D. Ibrutinib monotherapy

Correct answer: C – R-CHOP × 6–8 cycles

R-CHOP (Rituximab + Cyclophosphamide + Hydroxydaunorubicin + Vincristine + Prednisolone) given every 3 weeks is the backbone of DLBCL treatment.

Q15: Which subtype of DLBCL carries a worse prognosis?

  1. A. Germinal centre B-cell (GCB) type
  2. B. Activated B-cell (ABC) type
  3. C. Both have equal prognosis
  4. D. Centroblastic type

Correct answer: B – Activated B-cell (ABC) type

ABC type stains MUM1+ and activates the NFκB pathway. It has a worse prognosis compared to GCB type which stains BCL-6+.

Q16: A 35-year-old patient is diagnosed with lymphoma. Biopsy reveals TdT-positive cells. The presentation overlaps significantly with acute lymphoblastic leukaemia. What is the diagnosis?

  1. A. Burkitt lymphoma
  2. B. Mantle cell lymphoma
  3. C. Lymphoblastic lymphoma
  4. D. Peripheral T-cell lymphoma

Correct answer: C – Lymphoblastic lymphoma

TdT (terminal deoxynucleotidyl transferase) positivity is the hallmark of lymphoblastic lymphoma — it is negative in ALL other NHL types. Treated with ALL protocols.

Q17: Which virus is associated with Adult T-cell Leukaemia/Lymphoma?

  1. A. EBV
  2. B. HIV-1
  3. C. HTLV-1
  4. D. HHV-8

Correct answer: C – HTLV-1

Human T-lymphotropic virus type 1 (HTLV-1) is the causative agent of Adult T-cell Leukaemia/Lymphoma. This is a must-know association.

Q18: A 70-year-old woman presents with skin rash, hepatosplenomegaly, lymphadenopathy and a polyclonal rise in IgG. What is the diagnosis?

  1. A. Mycosis fungoides
  2. B. Sézary syndrome
  3. C. Angioimmunoblastic T-cell lymphoma
  4. D. Peripheral T-cell lymphoma

Correct answer: C – Angioimmunoblastic T-cell lymphoma

Key triad: lymphadenopathy + hepatosplenomegaly + skin rash + polyclonal IgG in an an elderly patient. Treated with chemotherapy or histone deacetylase inhibitors.

Q19: A patient presents with severe pruritus and psoriasis-like skin plaques. Years later they develop lymph node and bone marrow involvement. What is the diagnosis?

  1. A. Sézary syndrome
  2. B. Mycosis fungoides
  3. C. ALCL
  4. D. Angioimmunoblastic lymphadenopathy

Correct answer: B – Mycosis fungoides

Mycosis fungoides is a chronic cutaneous T-cell lymphoma starting with pruritus and skin plaques, eventually spreading to deeper organs. Treatment is phototherapy.

Q20: What distinguishes Sézary syndrome from Mycosis fungoides on blood film?

  1. A. Reed-Sternberg cells
  2. B. Circulating T-lymphoma cells with cerebriform nuclei
  3. C. Circulating plasma cells
  4. D. Blast cells with Auer rods

Correct answer: B – Circulating T-lymphoma cells with cerebriform nuclei

Sézary syndrome = Sézary cells (CD4+ T-cells with cerebriform nuclei) in the blood + erythroderma + lymphadenopathy. This is pathognomonic.

Q21: Which lymphoma is most strongly associated with coeliac disease?

  1. A. MALT lymphoma
  2. B. Mantle cell lymphoma
  3. C. Enteropathy-associated T-cell lymphoma (EATL)
  4. D. Anaplastic large cell lymphoma

Correct answer: C – Enteropathy-associated T-cell lymphoma (EATL)

EATL arises as a complication of coeliac disease and carries a very poor prognosis with poor treatment response.

Q22: Which serum marker is the most important prognostic indicator in NHL?

  1. A. ESR
  2. B. Serum LDH
  3. C. Beta-2 microglobulin
  4. D. Serum uric acid

Correct answer: B – Serum LDH

Elevated LDH reflects rapid tumour proliferation and high disease burden. It is a key component of the IPI and NCCN-IPI prognostic scoring systems.

Q23: A patient with follicular lymphoma is Stage III but completely asymptomatic. What is the recommended management?

  1. A. Immediate R-CHOP
  2. B. Autologous stem cell transplant
  3. C. Watch and wait
  4. D. Radiotherapy

Correct answer: C – Watch and wait

Stage II–IV asymptomatic follicular lymphoma is managed with watch and wait. Treatment begins only when symptoms or complications develop.

Q24: What is the ONLY curative option for follicular lymphoma?

  1. A. Rituximab maintenance
  2. B. Autologous SCT
  3. C. Allogeneic SCT
  4. D. R-bendamustine

Correct answer: C – Allogeneic SCT

Chemotherapy can achieve remission but is not curative in follicular lymphoma. Allogeneic SCT offers the only prospect of cure via graft-vs-lymphoma effect.

Q25: Anaplastic Large Cell Lymphoma (ALCL) is associated with which translocation and its resulting overexpressed protein?

  1. A. t(14;18) → BCL-2
  2. B. t(11;14) → Cyclin D1
  3. C. t(2;5) → ALK
  4. D. t(8;14) → MYC

Correct answer: C – t(2;5) → ALK

t(2;5) causes overexpression of anaplastic lymphoma kinase (ALK). ALK+ ALCL has better prognosis than ALK− ALCL. Crizotinib specifically inhibits ALK.

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