1. Haemolysis in patients deficient in G-6PD occurs due to formation of
A. Dohle bodies
B. Heinz bodies
C. Howell jolly bodies
D. Pappenheimer bodies
2. All are True of Sickle cell anemia Except
A, Hemolysis is Extravascular
B. Is due to a Defective point mutation
C. Sickling test is confirmatory
D. RBC have a life span of 10-20 days
3. Which of the following is least likely to be found in multiple myeloma
A. Hypercalcemia
B. Hypergammaglobulinemia
C. Plasma cell leukemia
D. High ESR
4. Majority of NHL are of
A. B cell type
B. T cell type
C. Histiocytic type.
D. Mixed cell type
5. Pancytopenia with 10% myeloblasts and several dyserythroporetic normoblasts in the marrow will be called
A. Erythroleukemia.
B. Cong. Dyserythropoietic anemia
C. Subleukemic leukemia
D. Myelodysplastic syndrome
6. All are conditions causing macrocytic anaemia EXCEPT
A. Pernicious anaemia
B. Chronic liver disease
C. Post hemorrhagic state
D. G6 PD deficiency
7. A 58 year old female has a decreased serum iron and total iron binding capacity (TIBC. in association with an increased serum ferritin. These findings are most indicative of
A. Malabsorption
B. Anemia of chronic disease
C. Auto immune hemolytic anemia
D. Vit B 12 deficiency
E. Chronic blood loss
8. Burr cells are
A. Fragmented cells in uraemia
B. RBC with Howell-jolly bodies
C. Stippled RBC’s
D. Parasited RBC’s
9. Of the following conditions, the one most likely to cause massive splenomegaly (3000gm. is:
A. Myelofibrosis
B. Sickle cell anemia
C. Portal hypertension
D. Infectious mononucleosis E. Hemochromatosis
10. Pelger-Huet like cells are seen in all except
A. MDS
B. AML with dysplastic maturation
C. CML
D. ALL
11. Monocytosis in peripheral blood is seen in all conditions except
A. Tuberculosis
B. Chrons disease
C. AML-M5
D. Chronic myelomonocytic leukemia E. Infectious mononucleosis
12. Increasing basophil count in an already diagnosed CML patient is suggestive of
A. Severe infection
B. Good prognostic indicator
C. Going for accelerated phase
D. Bleeding diathesis
13. Condition in which the platelet lack granules and have a ghost like appearance on stained blood film is
A. Bernard-soulier syndrome
B. Chediak Higashi syndrome
C. Thrombasthenia
D. Grey platelet syndrome
14. All are romanowsky stains except
A. Leishmann
B. Jenner’s
C. Giemsa
D. Wrights
E. Mason fontanna
15. A 15-year-old girl has menorrhagia and tendency to bleed from minor cuts and wounds. PTT and bleeding times are prolonged. She is likely to be having
A. F-XIII deficiency
B. Heamophilia A
C. Platelet function defect
D. Von Williebrand’s disease
16. The test most likely to be useful in the diagnosis of AML M5 on a blood smear is staining by
A. Non specific esterase
B. PAS
C. Sudan black
D. TRAP
17. Which of the following represents a favourable prognosis in childhood ALL
A. Age by six yrs
B. TLC of 80,000/camm
C. Philadelphia chromosome
D. Hb 14 gms/ dl
18. The acute leukemia most likely to lead to DIC
A. AML-M2
B. AML-M3
C. AML-M4
D. AML-M5
E. ALL
19. The normal myeloid erythroid ratio is
A. 1:1
B. 2:1
C. 3:1
D. 10:1
20. Of the following which finding rules out diagnosis of Aplastic anaemia
A. Neutropenia
B. Thrombocytopenia
C. Reduced haemoglobin level
D. Absence of splenomegaly
E. Presence of nucleated red cell (normoblast. in peripheral smear
21. 40 year old man presented with marked anaemia CBC revealed Hb 4 gm%, TC 1500/ cumm with marked neutropenia platelet count 10,000/ cumm. Repeated bone marrow aspirate yielded ‘dry tap’. A diagnosis is made with
A. Serum electrophoresis
B. Trephine biopsy
C. Chromosomal studies
D. Hb electrophoresis
22. All are primary screening tests for haemorhagic disorders except
A. Bleeding time
B. Clotting time
C. Platelet count
D. PT E. PTT
23. a Thalassemia’s are due to
A. Defects in transcription
B. Defects in processing or translation of b- globin m RNA
C. Gene deletion
D. Chromosomal translocations
24. Following complications can occur in the course of sickle cell anaemia
A. Haemolytic crisis
B. Sequestration crisis
C. Aplastic crisis
D. Vaso occlusive crisis E. All of the above
25. The molecular pathology in hereditary spherocytosis is due to
A. Spectrin deficiency
B. Point mutation
C. Gene deletions
D. Balanced chromosomal translocation
26. Warm antibody immune haemolytic anaemia the antibody responsible is
A. Ig G
B. Ig M
C. Ig E
D. Ig A
27. Of this which is a milder disease
A. Hb S
B. Hb SC
C. Hb H
D. Hb Barts
E. Hb AS
28. Bcl2 over expression is seen in
A. Follicular B cell lymphoma
B. Burkitts lymphoma
C. Lymphoblasric lymphoma
D. Small lymphocytic lymphoma
29. All of the following conditions are characterised by a high ESR, except
A. Multiple myeloma
B. Rheumatic fever
C. Tuberculosis infection
D. Sickle cell anaemia
30. Reticulocytosis is not seen with
A. Hereditary spherocytosis
B. Following acute bleeding
C. Paroxysmal nocturnal hbnuria
D. Anaemia of CRF
31. Tart cell is a
A. Monocyte
B. LE cell
C. Atypical lymphocyte
D. A type of myeloblast
32. Immature white blood cells are rarely seen in the peripheral blood in all of the following conditions except:
A. Leukemoid reaction
B. Cml
C. Aml
D. All E. CLL
33. Which of the following statements is incorrect
A. A peripheral blood smear that has target cells is consistent with chronic alcoholism
B. Howell-Jolly bodies suggest previous splenectomy
C. A leukoerythroblastic picture in the peripheral blood suggests metastatic carcinoma to bone
D. Schistocytes on the peipheral smear suggest iron deficiency anemia
E. Basophilic stippling suggests injury by a drug or by a toxin
34. A peripheral blood smear was made when a CBC was ordered on a 66 year old female scheduled to undergo a hernia repair. Many small, mature lymphocytes were seen. Her Hgb was 12. 8, Hct 36. 9, MCV88, platelet count 179000 and WBC count 30500. The best diagnosis is
A. Leukemoid reaction;
B. ALL
C. Infectious mononucleosis
D. CMV infection E. CLL
35. A 51 year old female has been feeling tired for months. A CBC demonstrate the following: Hb 9. 5, Hct 28. 1 and MCV 134. The reticulocyte index is low. Hypersegmented PMNs are seen on the peripheral blood smear. Which of the following tests should be ordered next
A. Serum B12 and folate
B. Bone marrow biopsy
C. Serum ferritin
D. Hb electrophoresis
36. A 16 year old male with hypochromic anemia in association with splenomegaly and hemochromatosis is most likely to have:
A. G6PD deficiency
B. Beta-Thalassemia
C. Sickle cell anemia
D. Hereditary spherocytosis
E. Malaria
37. A 61 year old male has bone pain, renal failure and pneumococcal pneumonia. In this setting, a bone marrow biopsy is most likely to show many
A. Granulomas
B. Plasma cells
C. Small lymphocytes
D. Reed-Sternberg cells
E. Blasts
38. An abdominal ultrasound is performed on a 35yr old male. In which of the following conditions is the spleen most likely to appear normal in size
A. Hemolytic anemia
B. Macronodular cirrosis
C. Myelofibrosis
D. ITP
E. Sickle cell anemia
39. Lymphadenopathy is a feature of all of the following conditions except:
A. HIV infection
B. Toxoplasmosis
C. Multiple myeloma
D. Infectious mononucleosis
E. Non-Hodgkin’s lymphoma
40. A 45 year old male has skin infiltration by neoplastic T lymphocytes. His condition is known as:
A. Hodgkin’s disease
B. Mycosis fungoides
C. Burkitt’s lymphoma
D. ALL
E. Hairy cell leukemia
41. A 69 year old male with pancytopenia and massive splenomegaly has increased numbers of peripheral blood lymphocytes containing tartrate – resistant acid phosphatase. The probable diagnosis is
A. CLL
B. HTLV-1 infection with leukemia
C. Hairy cell leukemia
D. Gaucher’s disease
E. Myelodysplasia
42. Which of the following is not part of Langerhans cell histiocytosis
A. Eosinophilic granuloma of bone
B. Cytoplasmic HX bodies (Birbeck granules.
C. Hypothalamic infiltration and diabetes insipidus
D. Epstein-Barr virus infection
43. Of the following findings which will be most likely to occur with extra vascular, rather than intravascular hemolysis
A. Splenomegaly
B. Increased retic count
C. Acute renal failure
D. Decreased serum haptoglobin
E. Jaundice
44.Serum protein electrophoretic pattern with a large 4gm monoclonal gamma spike is consistent with finding, all of the following additional laboratory findings except:
A. Elevated BUN and creatinine
B. Increased sedimentation rate
C. Chromosomal translocation
D. Hypercalcemia
E. Normocytic anemia
45. The appearance of “helmet cell” (a type of schistocytE. on examination of the peripheral blood smear is most consistent with origin from a patient who has
A. Beta-thalassemia
B. Septicemia with E-coli
C. Hereditary spherocytosis
D. Massive splenomegaly
46. The genetic distribution of sickle cell anemia is based upon the presence of this agent
A. Mycoplasma
B. Parvovirus
C. Plasmodium
D. Hepatitis virus
E. Babesia
47.HLA antigens have not been demonstrated on
A. WBC
B. Platelet
C. RBC
D. Other body cells
48. Diagnostic test for thalassemia trait
A. HbA2
B. HbF
C. Fragility test
D.Coombs test
49. Earliest sign of megaloblastic anaemia
A. Increased MCV
B. Increased neutrophil segmentation
C. Altered ME ratio
D. Decreased Hb
50. Hypochromic red cells in the peripheral smear is characteristic of all except
A. Aplastic anaemia
B. Iron def. Anaemia
C. Sideroblastic anaemia
D. Beta thalassemia
51. Erythroid hyperplasia in bone marrow is seen in the following conditions except
A. Iron deficiency anaemia
B. Pernicious anaemia
C. Fanconis anaemia
D. Hereditary spherocytosis
52. At what stage of erythropoeisis dos Hb appears
A. Early normo blast
B. Intermediate normo blast
C. Reticulocyte
D. Erythroblast
53. Autoimmune hemolytic anaemia is commonly seen in:
A. CLL
B. AML
C. ALL
D. CML
54. The minimum number of blasts present in Bone marrow, for “acute leukemia” diagnosis is
A. 10%
B. 20%
C. 30%
D. 35%
55. The presence of lacunar cells are seen in which type of Hodgkin disease
A. Lymphocyte predominance
B. Mixed cellularity
C. Nodular sclerosis
D. Lymphocyte depleted
56. Dutcher bodies are connected with
A. Plasma cell dyscrasia
B. acute myeloid leukemia
C. polycythemic Vera rubra
D. Myelofibrosis
57. Starry sky pattern is seen in
A. Small lymphocytic lymphoma
B. Burkitts lymphoma
C. Follicular lymphomas
D. Lymphoblastic lymphoma.
58. All trans retinoid acid is connected with
A. AML- M4
B. AML-M2
C. AML-M3
D. AML-M6 E. ALL-L3
59. All are predisposing to leukemia except:
A. Leukemoid reaction
B. Myelofibrosis
C. Poly cythemia vera
D. Myelodysplastic syndrome
60. How long blood can be stored with CPDA
A. 21 days
B. 28 days
C. 35 days
D. 42 days
61. Abeta lipoprotienemia is suggested by the following findings except:
A. Acanthocytosis
B. Severe malnutrition
C. Hypercholesterolemia
D. Retinitis pigmentosa
62. Match the following: Anticoagulants of choice
A. ESR EDTA
B. Ostmotic fragility Na Citrate 1:9
C. Coagulation test Heparin
D. Peripheral smear Na Citrate 1:4
63. Which of the following has a prominent mediastinal involvement
A. B-ALL
B. T-ALL
C. Null cell type
D. CLL
64. Couple with a family history of beta thalassemia major in a distant relative, has come for counseling. The husband has HbA2 of 4. 8% and the wife has HbA2 of 2. 3%. the risk of having a child with beta thalassemia major is:
A. 50%
B. 25%
C. 5%
D. 0%
65. Routine fixative used in biopsy
A. 10% formalin
B. 20% formalin
C. 50% formalin
D. 40% formaldehyde
66. Popcorn cells are seen in
A. Lymphocyte predominant HD
B. Lymphocyte depleted
C. Nodular sclerosis
D. Mixed cellularity
67. Although more than 400 blood groups have been identified, the ABO blood group system remains the most important in clinical medicine because :
A. It was the first blood group system to be discovered.
B. It has four different blood groups A, b, AB, O (H..
C. ABO (H. antigens are present in most body tissues and fluids
D. ABO (H. antibodies are invariably present in plasma when persons RBC lacks the corresponding antigen.
68. In myeloma associated Amyloidosis (Primary. Amyloid protein is made of
A. a heavy chain
B. m heavy chain
C. k light chain
D. l light chain
69. Cancer for which radiation is not a risk factor
a. CML
B. ALL
C. AML,
D. CLL
70. Primary effusion lymphoma is associated with which of the following agents
A. HHV-8
B. EBV
C. HIV
D. HPV
71. Following are pathognomonic forms of Plamodium falciparum
A. Gametocyte
B. Accole forms
C. Multiple rings
D. Schizonts
72. Glitter cells are seen in
A. Pyelonephritis
B. Tuberculous meningitis
C. Nephrotic syndrome
D. Viral meningitis
73. Telescoped urinary sediment are seen in
A. End stage renal disease
B. Nephrotic syndrome
C. Acute on chronic glomerulo nephritis
D. All of the above
74. Fixed specific gravity of 1010 is due to
A. Acute renal failure
B. Chronic renal failure
C. Nephrotic syndrome
D. Acute glomerulonephritis
75. Eddis count is for quantification of
A. Coliforms in urine
B. Leucocytes in urine
C. Urinary sediments
D. RBCs
76. A cast which may present in ithe urine of a healthy individual is
A. Granular cast
B. Hyaline cast
C. Red cell casts
D. Epithelial casts
77. All are urinary fixatives except
A. Formalin
B. Thymol
C. Absolute alcohol
D. Concentrated Hcl E. Boric acid
78. All are crystals formed in acidic urine except,
A. Calcium oxalate
B. Uric acid
C. Triple phosphate
D. Cystine crystals
79. Adequecy of sputum is determined by presence of
A. Squamous epithelial cells
B. Neutrophis
C. Alveolar leyden macrophages
D. bronchial epithelial cells
80. Following condition protect against plasmodium falciparum
a. Lewis antigen positivity
B. Duffy antigen positivity
c. Duffy antigen negativity
D. Lewis antigen negativity
81. Aquired B antigen in a blood group A person is seen all except
A. Gram negative septicemia
B. Carcinoma colon
C. Both of these
D. Leukemia
82. All of these can cause discrepancies in blood grouping except
A. Whartons jelly
B. Rouleaux formation
C. A I H A
D. C- reactive protein
83. Du estimation is to done in these patients
A. Rh positive donor
B. Rh negative donor
C. Rh negative recipient
D. Rh positive recipient
84. In which of the following patient descriptions would you expect the patient to have a normocytic anemia with a corrected reticulocyte count <> 10% band neutrophis, toxic ggranulation, sickle cells, target cells, and Howell – Jolly bodies, you would strongly suspect :
A. A viral infection
B. Salmonella osteomyelitis
C. Streptococcus pneumoniae sepsis
D. Tuberculosis E. A systemic fungal infection
89. A 15 year old girl with severe anaemia were found to have 80% blasts in the peripheral smear. Positivity for which marker indicates a relatively better prognosis?
A. 8 ; 14 translocation.
B. Bcr- abl fusion transcript.
C. MLL – 1 fusion transcript
D. TEL – AML 1 fusion transcript
90. Which of the following cytogenetic abnormalities if detected in a solid haemopoietic neoplasm indicates an indolent course.
A. 9;22 translocation
B. 8;14 translocation
C. 14;18 translocation
D. 11;14 translocation
91. (A) 8 year old girl with anaemia and bleeding manifestations. Smear showed large granular cells with multiple auer rods. (B) 23 year old girl with anaemia and petechial spots. The bone marrow showed more than 30% blasts , positive for non specific esterase. Eosinophil constitute 35% of marrow cells. (C) 60 year old man presented with massive splenomegaly. The WBC count is 2,20000/cumm. Hb 10. 8gm%. Platelet count 130,000/cumm.
A. Trisomy 8.
B. Inversion 16
C. 9; 22 translocation.
D. 15; 17 translocation.
92. Which of the following combination of immunological markers when positive indicates diagnosis of biphenotypic leukemia
A. CD 3 and tdt
B. CD 10 and tdt
C. CD 3 and CD 22
D. CD 13 and MPO (myeloperoxidasE)
93. A 5cm tumour attatched to the wall of the stomach was removed from a 52 year old man. The oncologist wants to know if he needs treatment with GLIVEC(IMATINIB., Positivity for which marker will be decisive
A. CD – 117
B. Cytokines
C. Desmin.
D. Vimentin
94. Which one of the following is not a criterion for making a diagnosis of chronic myeloid leukemia in accelerated phase:
A. Blasts 10-19% of WBC’s in peripheral blood
B. Basophils 10-19% of WBC’s in peripheral blood
C. Increasing spleen size unresponsive to theraphy
D. Persistent thrombocytosis (>1000 X 109/L. unresponsive to therapy.
95. CD 19 Positive, CD22 Positive,CD 103 positive Monoclonal B-Cells with bright kappa positivity were found to comprise 60% of the peripheral blood lymphoid cells on flow cytometric analysis in a 55 year old man with massive splenomegaly and a total leucocyte count of 3. 3 x 109 /L . Which one of the following is the most likely diagnosis?
A. Splenic lymphoma with villous lymphocytes.
B. Mantle cell Lymphoma.
C. B-Cell prolymphocytic leukemia.
D. Hairy cell leukemia.
96. A Four year old boy was admitted with a history of abdominal pain and fever for two months, maculopapular rash for ten days, and dry cough dyspnea and wheezing for three days. On examination, liver and spleen were enlarged 4cm and 3cm respectively below the costal margins. His hemoglobin was 10. 0g/dl, Platelet count 37 x 109/L and total leukocyte count 70 x 109 / L. which included 80% eosinophils. Bone Marrow comprising 45% blasts and 34%. Eosinophils and eosinophilic precurosors. The blasts staind negative for myeloperoxidase ans non – specific esterase and were positive for CD19,CD10,CD22 and CD20. Which one of the following is the most likely dignosis?
A. Biphhenotypic acute leukemia (Lymphoid and eosinophil lineage)
B. Acute eosinophilic leukemia
C. Acute lymphoblastic lekemis with hypereosinophilic syndrome.
D. Acute myeloid leukemia with eosinophilia
97. A 48 Year old women was admitted with a history of weakness for two months. On examination, cervical lymph nodes were found enlarged and spleen was palpable 2cm below the costal margin. Her hemoglobin was 10. 5 g/dl, platelei count 237 x 109/L and total leukocyte count 40 x 109/L, which included 80% Mature lymphoid cells with coarse clumped chromatin. Bone marrow revealed a nodular lymphoid infiltrate. The peripherel blood lymphoid cells were positive for CD 19, CD5, CD20 and CD23 and were negative for CD79B and FMC -7. Which one of the following statements in not true about this disease?
A. Trisomy 12 correlates an aggressive clinical course.
B. Abnormalities of 13q 14 are associated with long term survival.
C. Cases with 11q22-23 deletion have excessive lymphadenopathy.
D. t(11;14) translocation is present in most of the cases
A
1. Ans B
Heinz bodies are red cell inclusions that are seen only after a specific vital stain.
They stain pale pink or purple, attached to the red cell membrane .
Heinz bodies cannot be seen on a routinely stained blood film.
Heinz bodies represent denatured haemoglobin.
They are present when red cells have been exposed to oxidant stress (e.g. certain drugs), in individuals with glucose-6-phosphate dehydrogenase deficiency and unstable haemoglobins.
Dohle body
• A Döhle body is a small, weakly basophilic cytoplasmic inclusion that is composed of endoplasmic Inclusions are small and usually placed towards the periphery of the cell.
Occasional Döhle bodies are seen in healthy people, during pregnancy.
Otherwise they indicate a pathological process, such as infection, inflammation, burns or other
tissue damage.
Alder-Reilly anomaly
• The Alder-Reilly anomaly is a rare inherited condition .
• granulocytes have granules with abnormal staining characteristics.
Autosomal recessive inheritance or as a feature of serious inherited disorders including Tay
Sachs disease and mucopolysaccharidoses.
Mucopolysaccharidoses include Hunter's syndrome and Maroteaux-Lamy syndrome.
The Pelger-Huët anomaly is a harmless inherited condition with autosomal dominant inheritance.
Neutrophils with a completely non-segmented nucleus
Affected individuals also have hypolobulated eosinophils.
B. Heinz bodies
Infection or exposure to oxidants causes oxidation of sulphydryl groups of the globin chains.
This leads to denaturation of Haemoglobin and formation of precipitates (Heinz bodies) that can
be seen within red cells as dark inclusion, when they are stained with cresyl violet. Heinz body
damages the membrane to cause intravascular haemolysis.
Dohle bodies- small round or oval pale blue grey structures (decomposed ribosomes) seen in
bacterial infection in neutrophils
Howel-jolly bodies- Nuclear remnants seen in RBC in conditions like post splenectomy and
prenicious anaemia. Numerous such cells can be seen in conditions like steatorrhoea in which
there is splenic atrophy and folate deficiency.
2. Ans C
Sickling test is a screening test for sickle cell disease.
Sickle cell disease includes sickle cell anaemia and sickle cell trait.
Sickling test will be positive for both.
Confirmatory diagnosis is done by Haemoglobin electrophoresis.
In sickle cell anaemia there is only one broad band of HbS and in trait there will be 2 bands A and S.
Eventhough Haemolysis is predominantly extravascular spleen will be contracted because of
repeated infarction. Prenatal diagnosis is possible by analysis of foetal DNA obtained by
amniocentesis or chronic biopsy.
• Di thionite test.
• Sodium meta bisulphite test.
• Hb solubility test.
4. Ans B
T Cell Lymphoma.
Lymphoblastic Lymphoma.
Mycosis Fungoides.
Anaplastic large cell lymphoma.
HTLV type I leukemia/ lymphoma.
Angioimmunoblastic lymphoma.
Hepato splenic lymphoma.
Lennert lymphoma.(T cell lymphoma with granuloma)
Working formulations
REAL classification
WHO classification
Low grade - SLL
- Follicular
Inter mediate grade - Follicular large cell
- Diffuse large cell
High grade - Small noncleaved
- Lymphoblastic
- Immunoblastic
5. D .MDS showing dysplastic changes in erythroid ,myeloid and megakaryocytic cell lines.
RBC series showing megaloblastic nuclei nuclear lobulation, fragmentation, inter nuclear chromatin bridging.
Myeloid series showing nuclear hypo segmentation, pseudo pelger- huet anomalies etc.
Megakaryocytes shows bilobed or nonlobulated nuclei.
AML-M6 is called erythroleukemia.
Anaemia & thrombocytopenia.
Leukopenia
Dyserythropoiesis – nuclear lobulation
Fragmentation
Chromatin bridging
Dysmyelopoiesis - aberrant deficient granule production.
nuclear segmentation
psudo-pelger huet anomaly
Myelodysplasstic Syndromes
Type
Percent Patients
Survival in months (Median)
Progression to Leukemia(%)
Refractory anemia
28
18-64(50)
12
Ra with RS
24
14-76+(11)
8
RA EB
23
7-16(11)
44
RA EB-t
26
2.5-11(5)
60
CMML
9
9-60(11)
14
6. Ans D
G6 PD deficiency causes spherocytosis.
All other conditions are causes of macrocytosis.
Macro Ovalocyte
Macro Polycyte (Hyper segmented Neutrophil)
Dyserythropoiesis
Megaloblasts
7. Ans B
8. Ans-A fragmented cells in uremia.
Seen in hemolytic uremic syndrome. Synonyms are helmet cells., triangular cells . Thin
red cells are seen in severe iron deficiency.or thalassemia. Target cells are leptocytes in which there is a central round stained area. Target cells are thought to result from cells having a surface area which is disproportionately large compared with their volume.
Drepanocytes - sickle cells
Leptocytes - Thin red cells
9. Ans A
10. Ans D ALL .
pelger- huet anomaly is a benign inherited condition in which neutrophilnuclei fail to
segment properly. They have 2 discrete equal sized lobes connected by a thin chromatin. Similar acquired morphological anomaly known as pseudo pelger cells may be seen in MDS, AML, and rarely in CML.
11. Ans E. IMN
All other conditions shows increase in monocytoid cells. AML-M5 (monoblastic leukemia).
IMN shows absolute lymphocytosis with atypical lymphocytes.(Downey type)
12. Ans C
Chronic mylogenous leukaemia,blast phase
Blast phase my be diagnosed if one or more is present
• Blast > 20%0f peripheral blood white cells or of nucleated bone marrow cells
• Extramedullary blast proliferation
• Large foci or clusters of blasts in the bone marrow biopsy
• Juvenile Chronic Myeloid Leukaemia
• present in early childhood.
• Common haematological features are anaemia, leucocytosis, monocytosis and thrombocytopenia.
• Cytogenetic analysis is usually normal. The Ph chromosome is not present
Going for accelerated phase.
>20% Basophilia, fall in Hb Thrombocytopenia
13. Ans D
• The Bernard-Soulier syndrome is an inherited abnormality of platelet number and function. Platelets are reduced in number and very large.
They lack the normal aggregation response to ristocetin. There is a moderate bleeding tendency. Inheritance is autosomal recessive.
• The grey platelet syndrome is a rare inherited platelet abnormality.
• The platelet count is reduced and platelet size is increased.
• The platelets lack alpha granules and therefore appear agranular or 'grey'.
• There may be a mild bleeding tendency.
D. Grey platelet syndrome.
Characteristic morphological features are seen in two inherited platelet disorders.
Bernard-Soulier syndrome—Giant platelets with defective ristocetin response. Here bleeding
resulting from defective adhesion of platelets due to deficient glycoprotein 1b. This is a recptor for VWF factor and is essential for normal platelet adhesion to collagen.
Defective platelet aggregation—Thrombasthenia(Def. of GPII b—IIIa)
Chediak-Higashi syndrome. Here are giant but scanty azurophil granules, and all the leucocytic types were affected. There is functional defect and manifest by susceptibilty to severe infections.
14. AnsE. Mason fontanna.(Silver stain to demonstrate melanin pigment)
Romanowsky stains make suttle distinctions in shades of staining and of staining granules
diffrentially and depends on two components Azure B and Eosin Y.
15. AnsD. Von willebrands disease
Characterised by increased BT and normal platelet count. The plasma level of VWF can be measured as ristocetin co factor activity and it is reduced. VWF stabilizes F VIII by binding to it, so deficiency of VWF give rise to a secondary decrease in F VIII level.(increased PTT)
• Frequency of vwd – 1%
• Common inherited bleeding disorder
• AD.
• Type I(Mild 70%), Type II & III
Ristocetin aggregation test
Bio assay for V WF
Haemophilia
F VIII Def.
BT Normal
PTT Prolonged
16. Ans A
Panel of monoclonal antibodies for the classification of acute leukaemias
• Haematopoietic precursors:CD34,HLA-Dr,TdT,CD452
• B-lineage:CD19,CD20,CD22’,CD79a1,3
• T – lineage: CD2,CD31,CD5,CD7
• Myeloid: CD13,CD33,CD15MPO1,CD117
• Megakaryoblastic:CD41,CD61
. Non specific esterase. Sudan black and myeloperoxidase are stains for myeloblasts and PAS for lymphoblast. NSE for monocytes and TRAP for hairy cell leukemia.
17. Age by 6 years.
Favourable factors Unfavourable factors
1-10 yrs <1> 10 years
female male
WBC <> 50,000/cmm
L1 morphology L2, L3 morpholgy
Early B cell precursor(CALLA+ve) Pre B cell type (CALLA-ve)
18. Ans B.AML-M3( promyelocytic leukemia)
Cytoplasmic granules liberates procoagualants and this leads to DIC. AML-M4 present with
bleeding disorders and gingival hyperplasia.
19. Ans C. 3:1(Myeloid eryhroid ratio)
Normal value can be varied from 2.5—15:1
20. Ans E
Classification of aplastic anaemias
– Inherited (e.g. Fanconi’s anaemia, dyskeratosis congenita)
– Acquired
• Drug-induced
– Dose-related (e.g. following prolonged use or excessive dosage of cytotoxic drugs)
– Idiosyncratic (e.g. following chloramphenicol or phenylbutazone)
• Irradiation-induced
• Virus-induced (e.g. following non-A, non-B hepatitis)
• Immune (e.g. in graft-versus-host disease)
• Idiopathic
• Common clinical features of Fanconi's anaemia
• Aplastic anaemia and a predisposition to acute myeloid leukaemia
• Reduced stature
• Limb abnormalities such as rudimentary thumbs and radial hypoplasia.
• Genitourinary anomalies
• Abnormalities of skin pigmentation
Common clinical features of dyskeratosis congenita
• Reticulate skin pigmentation
• Dystrophy of nails of fingers and toes
• Mucosal leucoplakia
• Anomalies of other systems (e.g. skeletal, dental, ocular, gastrointestinal, genitourinary, pulmonary)
• Progressive bone marrow failure
• Predisposition to epithelial tumours, e.g. of gastrointestinal tract
. Presence of nucleated red cells denotes presence of younger RBC
producion.Polychromasia/presence of normoblasts in peripheral smear is against a diagnosis of aplastic anaemia.
21. Ans B. Trephine biopsy.
From clinical history- anaemia, neutropenia and thrombocytopenia suggest aplastic
anaemia.Here marrow spaces are replaced by fat tissue hence bone marrow aspiration will yield only a dry tap.
22. AnsB .Clotting time
• This is not having any diagnostic importance. Repeated CT estimation done during heparin therapy
23. Ans C Gene deletion
b thalassemias are due to defects in transcription, processing or translation of mRNA
24. AnsE. All of the above
Sequestration crisis occurs in children with splenomegaly. Massive sequestration of deformed red cells leads to splenic enlargment and hypo volaemia and shock. Aplastic crisis is due to parvo virus infection.Veno occlusive(painful crisis ) represents episodes of hypoxic injury and infarction.
25. A. Spectrin deficiency
The spheroidal shape of RBC appears to result from a fundamental defect in the membrane cyto skeleton(Spectrin)
Sickle cell anaemia is due to point mutation substitution of valine for glutamic acid at the sixth position of b chain.
• Spherocytes have
– decreased diameter & SA to volume ratio
– Cells become more rigid & less deformable
• Difficult to negotiate through microcirculation in spleen
• RE cells recognises abnormal cells and destroys them
• Increased permeability to Na
• More ATPase activity to drive Na pump
• When glucose supply is less due to hypoxia in spleen
– Na followed by H2O enter the cell
– Cells swell and finally burst
An autohaemolysis test in hereditary spherocytosis.
There is increased haemolysis in the patient in comparison with the control.
Glucose has given partial correction.
26. Ans A
Warm autoimmune haemolytic anaemia
The blood film in this condition occasionally shows small red cell agglutinates
Warm autoimmune haemolytic anaemia is consequent on the presence of an autoantibody which is active at body temperature.
It may occur as a feature of an autoimmune disease such as systemic lupus erythematosus, or as a complication of chronic lymphocytic leukaemia.
It can be induced by certain drugs, particularly a methyl dopa, and persists for many months after withdrawal of the drug.
It can occur spontaneously, without any other associated autoimmune disease, when it is
referred to as 'idiopathic warm autoimmune haemolytic anaemia'.
The definitive test for autoimmune haemolytic anaemia in a patient with spherocytosis is a direct antiglobulin test (Coombs' test) which tests for antibody and complement components on the surface of the erythrocyte.
Ig G type. It does not fix the complement and is active at 37°C.The disease is primary or
idiopathic or secondary due to lymphoma/ leukemia.
Cold agglutinin type-Ig M type active at 0-4°C.
Paroxysmal cold haemoglobinuria
Blood film in paroxysmal cold haemoglobinuria showing spherocytes
and erythrophagocytosis.
• Paroxysmal cold haemoglobinuria (PCH) occurs as a chronic condition with episodic haemolysis and as an acute condition in which there is a single episode of haemolysis. Both may be consequent on certain infections. The acute and chronic conditions have in common that they result from the presence of an autoantibody that binds to red cells in the cold with resultant red cell lysis when the cells are rewarmed. A test for this type of biphasic antibody activity is referred to as a Donath-Landsteiner test and the antibody is designated a Donath-Landsteiner antibody. The direct antiglobulin test may be positive. The antibody usually has specificity against the red cell P antigen. The Donath-Landsteiner antibody is unusual in that it is an IgG antibody but nevertheless can cause red cell agglutination.
27. Ans. E
HbAS- sickle cell trait(asymptomatic)
Hb-SS-Sickle cell anaemia(fatal)
HbH (a thalessemia) deletion of 3a genes. Moderately severe disease
Hb Barts g 4(hydrops foetalis)
HbSC – severe disease
28. A .Follicular B cell lymphoma
Bcl 2 gene is the prime regulator gene for apoptosis. So Bcl 2 over expression can be
demonstated in most of follicular lymphomas.
t (14;18) translocation
29. D. Sickle cell anaemia
Since rouleaux formation is not possible due to defective shape, packing of red cells donot occur. Multiple myeloma shows an extremely increased ESR.
30. D. Anaemia of CRF
In CRF erythropoietin production is markedly reduced from the kidney so erythropoises is
reduced. So younger RBCs are not seen in the circulation . All other conditions shows
polychromatic cells.
31. A. Monocyte
Tart cell is a monocyte which has phagocytose another cell or nucleus of another cell.The
phagocytosed material resembles a lymphocyte nucleus .Often associated with leuco agglutinins and may occur in drug therapy.Morphologically mimic LE cells.
40. Cutaneous T cell Lymphoma
Mycosis fungoides -
Pautrier micro abscess
epidermotropism
Sezary syndrome
Convoluted nucleus
46. Sickle cell gene found in malaria endemic areas
• It gives a survival advantage over normal population
• HbS prevents multiplication of malarial parasites inside the red cells
56. Lymphoplasmasmacytic lymphoma (wulden storm macroglobulinemia)
Plasma cytoid lymphocytes-plymphocytes
Russel bodies – immunoglobulin collection
Dutcher bodies- nuclear inclusion
Mot cells- multiple, blue grape like cytoplasmic droplets
57. High grade lymphoma-Burkitts
Lymphoblastic
Immunoblastic
High mitosis
High apototic tumour cell death
58. C.AML –M3- Promyelocytic leukemia t(15,17 )
Translocation results in the fusion of a truncated retinoic acid receptor (RAR a) gene o
chromosome 17 to PML gene on chromosome 15. PML-RAR-fusion gene produces a hybrid m-RNA. This encodes an abnormal retinoic acid receptor which blocks myeloid cell differentiation
63. Ans. Counterpart of lymphoblastic lymphoma
64. HbA2-1.5to 3%
Wife- normal(beta,beta ) husband – beta minor(beta,beta+)
Recessive disorder, Offsprings will be 2 thal minor and 2 normal.
68. Lead interferes with the synthesis of heme. Heme causes microcytic hypochromic anaemia because heme is an integral part of hemoglobin
70. Ans A.Occurs in immunocompromised. Primary is not detectable. Usually affects one body cavity in the form of pleural, percardial effusions.
71. Ans D
72. Ans A. Phagocytic polymorphonuclear cells, granules of which show brownian movement-safranin stain.
73. Ans C. Sediments containing variety of cast and other pathological components.
74. Ans B. The capacity of kidney to concentrate urine is lost.
75. Ans C. Eddis count is a quantitative measurement of urinary sediments in a given period
Ans C.Formalin is used for sediment examination. Concentrated Hcl for chemical examination. –
77. Ans A
78. Ans C
79. Ans C
81. Ans D
82. Ans D
83. Ans B
84. ans. B
85. Ans. D
86. Ans. A
87. Ans. B
88. Ans. C
