Haematopathology MCQs: Blood Disorders, Lymphoma & Anemia

Question 1

Leukemoid reactions are almost always a sign of?

Accepted Answer

Septicaemia — Leukemoid reactions — very high WBC counts with immature cells — are most commonly a reactive response to severe infection/sepsis.

Question 2

True statement about staging of non-Hodgkin's lymphoma?

Accepted Answer

CT scan used in imaging — CT scanning is standard for staging NHL; Burkitt's is a B-cell lymphoma, and stages have very different prognoses.

Question 3

Which increases dietary iron uptake by the alimentary canal?

Accepted Answer

Vitamin C in fruit juice — Vitamin C (ascorbic acid) reduces Fe³⁺ to Fe²⁺, the absorbable form, enhancing non-haem iron absorption.

Question 4

Abnormality of nuclear segmentation in neutrophils?

Accepted Answer

Pelger-Huet — Pelger-Huet anomaly is characterized by hyposegmented (bilobed "pince-nez") neutrophil nuclei.

Question 5

Burkitt's lymphoma chromosomal translocations involve?

Accepted Answer

c-myc — Burkitt's lymphoma involves t(8;14) placing c-myc under IGH control, causing uncontrolled cell proliferation.

Question 6

Elderly woman with corkscrew hair follicles, perifollicular hemorrhages, gum bleeding — deficiency of?

Accepted Answer

Vitamin C — Perifollicular hemorrhage and corkscrew hairs are classic signs of scurvy (Vitamin C deficiency), as collagen synthesis is impaired.

Question 7

Which red cell abnormality is most indicative of haemolysis?

Accepted Answer

Schistocytes — Schistocytes (fragmented RBCs) are the hallmark of mechanical hemolysis, seen in microangiopathic haemolytic anaemia and TTP/HUS.

Question 8

Markedly decreased blood level most characteristic of intravascular haemolysis?

Accepted Answer

Haptoglobin — Free haemoglobin released in intravascular haemolysis binds and depletes haptoglobin rapidly.

Question 9

Dashed curve on osmotic fragility test represents?

Accepted Answer

Hereditary spherocytosis — Spherocytes have less surface area relative to volume, making them lyse at higher NaCl concentrations — a right-shifted curve.

Question 10

Patient on primaquine develops bite cells and Heinz bodies — diagnosis?

Accepted Answer

G6PD deficiency — G6PD-deficient RBCs cannot neutralize oxidative stress from primaquine; denatured Hb forms Heinz bodies and macrophages bite them out.

Question 11

Test to detect haemoglobin S (sickle cell trait)?

Accepted Answer

Metabisulfite test — Sodium metabisulfite deoxygenates blood, inducing sickling of HbS-containing cells — a simple screening test.

Question 12

Valine replacing glutamic acid at position 6 of beta chain is associated with?

Accepted Answer

Sickle cell anaemia — This single amino acid substitution (Glu→Val) causes HbS polymerization under deoxygenation, the basis of sickle cell disease.

Question 13

67-year-old with elevated PSA, myelocytes on blood film, nucleated RBCs, no teardrop cells — best diagnosis for anaemia?

Accepted Answer

Myelopathic anaemia — Metastatic prostate cancer to bone marrow displaces normal haematopoiesis, releasing immature cells (leukoerythroblastic picture).

Question 14

Megaloblasts result from impaired synthesis of?

Accepted Answer

DNA — B12 and folate are required for thymidine synthesis; without them, DNA replication is impaired, causing nuclear-cytoplasmic asynchrony.

Question 15

TIBC is inversely proportional to serum levels of?

Accepted Answer

Ferritin — When iron stores (ferritin) are high, TIBC decreases; when stores are low, TIBC increases.

Question 16

MCV 70 fL, MCH 22 pg, MCHC 34% — most consistent diagnosis?

Accepted Answer

Iron deficiency anaemia — Low MCV + low MCH = microcytic hypochromic anaemia, classic for iron deficiency.

Question 17

Patient on sulphonamide with isolated neutropenia due to antineutrophil antibodies — expected bone marrow finding?

Accepted Answer

Hyperplasia of myeloid series — The marrow compensates by ramping up production of neutrophils in response to their peripheral destruction.

Question 18

Parasitic infections (trichinosis, schistosomiasis, strongyloidiasis) cause elevated numbers of?

Accepted Answer

Eosinophils — Tissue-invasive parasites trigger Th2 immune responses and IgE production, driving eosinophilia.

Question 19

Reactive T immunoblasts in enlarged lymph nodes during viral infection are found in which region?

Accepted Answer

Paracortex — The paracortex is the T-cell zone of the lymph node; it expands during viral infections.

Question 20

Low-grade NHL with cells similar to CLL?

Accepted Answer

Small lymphocytic lymphoma — SLL and CLL are essentially the same disease — SLL is the tissue/lymph node form, CLL is the blood/marrow form.

Question 21

Lacunar cells are variants of Reed-Sternberg cells found specifically in?

Accepted Answer

Nodular sclerosis HD — Lacunar cells are RS cell variants pathognomonic of the nodular sclerosis subtype.

Question 22

28-year-old male with Auer rods in blast cells making up 38% of marrow — diagnosis?

Accepted Answer

Acute promyelocytic leukemia — Auer rods in granular blasts + DIC is classic for APL with t(15;17).

Question 23

4-year-old with TdT+, PAS+, MPO− blasts — cells originated from?

Accepted Answer

Lymphoblasts — TdT is a marker of immature lymphoid cells; MPO negativity rules out myeloid origin.

Question 24

Hairy cell leukemia suspected — which stain is useful?

Accepted Answer

Acid phosphatase — Hairy cells are TRAP-positive (tartrate-resistant acid phosphatase) — a classic diagnostic marker.

Question 25

72-year-old with nontender lymphadenopathy, splenomegaly, leukocyte count 72,000 — diagnosis?

Accepted Answer

Chronic lymphocytic leukemia — Elderly patient, massive lymphocytosis, nontender nodes, splenomegaly = classic CLL presentation.

Question 26

Morphological classification of anaemias is based on?

Accepted Answer

RBC size — Morphological classification uses MCV: microcytic (<80 fL), normocytic (80–100 fL), or macrocytic ( 100 fL).

Question 27

Which factor may NOT cause an increase in RBC production?

Accepted Answer

Low altitude — Low altitude means higher oxygen availability, reducing EPO stimulus — no need to increase RBC production.

Question 28

What is affected in HbS?

Accepted Answer

Solubility — HbS polymerizes (becomes insoluble) when deoxygenated due to the hydrophobic valine substitution.

Question 29

Anisocytosis means?

Accepted Answer

Increased variation in cell size — Aniso = unequal; cytosis = cells. Poikilocytosis refers to variation in shape.

Question 30

Peak age of onset of acute lymphoblastic leukemia in childhood?

Accepted Answer

3–5 years — ALL has a peak incidence between ages 2–5, making it the most common childhood malignancy.

Haematopathology MCQs: Blood Disorders, Lymphoma & Anemia

Questions, Answers & Explanations