Hematopathology MCQs

Pathology · 14 free questions with answers & explanations.

1. A 28-year-old woman from West Africa presents with fatigue and jaundice. Her CBC reveals Hb 8.2 g/dL, MCV 75 fL, reticulocyte count 9%, and the peripheral smear shows target cells, sickle-shaped cells, and Howell-Jolly bodies. Hemoglobin electrophoresis shows HbS 92%, HbF 6%, HbA2 2%, HbA 0%. What is the mechanism of her anemia?
2. A 68-year-old man presents with fatigue, night sweats, and splenomegaly. CBC shows WBC 85,000/µL with a left shift (blasts 2%, promyelocytes 5%, myelocytes 12%, bands 18%, segmented neutrophils 55%, basophilia, eosinophilia). Bone marrow biopsy is hypercellular with predominant granulocytic proliferation. Cytogenetics reveals t(9;22)(q34;q11). Which fusion protein drives this disease?
3. A 72-year-old woman is found to have Hb 7.8 g/dL, MCV 110 fL, WBC 3,200/µL, and platelets 98,000/µL. The peripheral smear shows macro-ovalocytes and hypersegmented neutrophils (>5% with ≥5 lobes). Serum vitamin B12 is 85 pg/mL (normal >200). Which of the following is the PRIMARY pathophysiological mechanism of her anemia?
4. A 55-year-old man with progressive cervical lymphadenopathy for 8 months undergoes lymph node biopsy. Histology shows effacement of nodal architecture by a nodular proliferation of small, cleaved lymphocytes (centrocytes) admixed with fewer large non-cleaved cells (centroblasts). Immunohistochemistry: CD20+, CD10+, BCL-2+, BCL-6+, CD5−. Which molecular alteration is MOST responsible for the BCL-2 overexpression in this tumor?
5. A 35-year-old man presents with sudden-onset pancytopenia, a WBC of 22,000/µL, and a peripheral smear showing cells with reniform nuclei and prominent azurophilic granules that form bundles. Bone marrow confirms hypercellularity with >20% blasts. The pathognomonic finding on electron microscopy would reveal:
6. The PML-RARα fusion oncoprotein in APL drives leukemogenesis primarily by:
7. A 58-year-old man is found on routine CBC to have a WBC of 85,000/µL with a differential showing neutrophils at all stages of maturation, basophilia, and <2% blasts. Spleen is massively enlarged. BCR-ABL1 is detected by FISH. Which of the following best explains the massive splenomegaly in this condition?
8. A 70-year-old woman with known CLL develops sudden worsening anemia with a positive direct Coombs test. Her lymphocyte count was stable at 40,000/µL for 2 years. The most likely pathomechanism of her new anemia is:
9. Smoldering myeloma differs from active multiple myeloma in that it:
10. A 65-year-old man presents with fatigue and recurrent bacterial infections. CBC shows normocytic anemia, thrombocytopenia, and a WBC of 3,200/µL. Bone marrow biopsy reveals hypercellularity with dysplastic megakaryocytes showing hypolobated nuclei and ringed sideroblasts comprising 20% of erythroid precursors. Cytogenetics show deletion 5q. Which MDS subtype does this most likely represent?
11. In Hodgkin lymphoma, Reed-Sternberg cells are best characterized by which immunophenotype?
12. A 28-year-old woman presents with cervical lymphadenopathy and constitutional B symptoms. Biopsy shows a nodular architecture with a mixed infiltrate of lymphocytes, eosinophils, plasma cells, and scattered large cells with prominent 'owl eye' nucleoli. The background contains bands of fibrosis. This morphology is MOST consistent with which subtype of Hodgkin lymphoma, and what is its most common chromosomal abnormality?
13. Burkitt lymphoma carries a translocation involving MYC. Which of the following correctly pairs the translocation with its immunoglobulin partner and the resulting molecular event?
14. A 55-year-old woman presents with petechiae and gum bleeding. CBC reveals platelet count of 8,000/µL with normal WBC and hemoglobin. Peripheral smear shows large platelets. PT and aPTT are normal. Bone marrow shows increased megakaryocytes. Anti-platelet IgG antibodies are detected. The bleeding in this condition is primarily due to: