Haematopathology MCQs: Blood Disorders, Lymphoma & Anemia – 30 MCQs | Kenya MBChB

30 Year 3: Hematopathology exam questions on Haematopathology MCQs: Blood Disorders, Lymphoma & Anemia for medical students. Includes MCQs, answers, explanation

This MCQ set contains 30 questions on Haematopathology MCQs: Blood Disorders, Lymphoma & Anemia in the Year 3: Hematopathology unit. Each question includes the correct answer and a detailed explanation for active recall and exam preparation.

Q1: Leukemoid reactions are almost always a sign of?

  1. A. Severe malaria
  2. B. Septicaemia
  3. C. Leukemia
  4. D. Metastatic cancer

Correct answer: B – Septicaemia

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

Q2: True statement about staging of non-Hodgkin's lymphoma?

  1. A. Stage I & II confined above diaphragm
  2. B. All stages similar prognosis
  3. C. Burkitt's classified as ALL-L3
  4. D. CT scan used in imaging

Correct answer: D – 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.

Q3: Which increases dietary iron uptake by the alimentary canal?

  1. A. Vitamin C in fruit juice
  2. B. Ligand in meat diet
  3. C. Phytates in green vegetables
  4. D. Gastric acidity (pH 2)

Correct answer: A – Vitamin C in fruit juice

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

Q4: Abnormality of nuclear segmentation in neutrophils?

  1. A. Chediak-Higashi
  2. B. May-Hegglin
  3. C. Alder-Riley
  4. D. Pelger-Huet

Correct answer: D – Pelger-Huet

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

Q5: Burkitt's lymphoma chromosomal translocations involve?

  1. A. bcl-2
  2. B. c-abl
  3. C. c-myc
  4. D. erb-B

Correct answer: C – c-myc

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

Q6: Elderly woman with corkscrew hair follicles, perifollicular hemorrhages, gum bleeding — deficiency of?

  1. A. Thiamine
  2. B. Pyridoxine
  3. C. Niacin
  4. D. Vitamin C

Correct answer: D – Vitamin C

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

Q7: Which red cell abnormality is most indicative of haemolysis?

  1. A. Target cells
  2. B. Acanthocytes
  3. C. Schistocytes
  4. D. Basophilic stippling

Correct answer: C – Schistocytes

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

Q8: Markedly decreased blood level most characteristic of intravascular haemolysis?

  1. A. Alkaline phosphatase
  2. B. Bilirubin
  3. C. LDH
  4. D. Haptoglobin

Correct answer: D – Haptoglobin

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

Q9: Dashed curve on osmotic fragility test represents?

  1. A. G6PD deficiency
  2. B. Thalassemia
  3. C. Hereditary spherocytosis
  4. D. Drug-induced haemolytic anaemia

Correct answer: C – Hereditary spherocytosis

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

Q10: Patient on primaquine develops bite cells and Heinz bodies — diagnosis?

  1. A. Hereditary spherocytosis
  2. B. G6PD deficiency
  3. C. PNH
  4. D. Autoimmune haemolytic anaemia

Correct answer: B – G6PD deficiency

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

Q11: Test to detect haemoglobin S (sickle cell trait)?

  1. A. Coombs' test
  2. B. Osmotic fragility test
  3. C. Metabisulfite test
  4. D. Schilling test

Correct answer: C – Metabisulfite test

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

Q12: Valine replacing glutamic acid at position 6 of beta chain is associated with?

  1. A. Alpha thalassemia
  2. B. G6PD deficiency
  3. C. Hereditary spherocytosis
  4. D. Sickle cell anaemia

Correct answer: D – Sickle cell anaemia

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

Q13: 67-year-old with elevated PSA, myelocytes on blood film, nucleated RBCs, no teardrop cells — best diagnosis for anaemia?

  1. A. Fanconi's anaemia
  2. B. Microangiopathic haemolytic anaemia
  3. C. Myelopathic anaemia
  4. D. Autoimmune haemolytic anaemia

Correct answer: C – Myelopathic anaemia

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

Q14: Megaloblasts result from impaired synthesis of?

  1. A. DNA
  2. B. RNA
  3. C. Glutathione
  4. D. Beta-globin chains

Correct answer: A – DNA

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

Q15: TIBC is inversely proportional to serum levels of?

  1. A. Bilirubin
  2. B. Ferritin
  3. C. Haptoglobin
  4. D. Hemopexin

Correct answer: B – Ferritin

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

Q16: MCV 70 fL, MCH 22 pg, MCHC 34% — most consistent diagnosis?

  1. A. Folic acid deficiency
  2. B. Pernicious anaemia
  3. C. Iron deficiency anaemia
  4. D. Sideroblastic anaemia

Correct answer: C – Iron deficiency anaemia

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

Q17: Patient on sulphonamide with isolated neutropenia due to antineutrophil antibodies — expected bone marrow finding?

  1. A. Atrophic spleen
  2. B. Decreased Vit B12
  3. C. Hypoplasia of myeloid series
  4. D. Hyperplasia of myeloid series

Correct answer: D – Hyperplasia of myeloid series

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

Q18: Parasitic infections (trichinosis, schistosomiasis, strongyloidiasis) cause elevated numbers of?

  1. A. Basophils
  2. B. Eosinophils
  3. C. Macrophages
  4. D. Neutrophils

Correct answer: B – Eosinophils

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

Q19: Reactive T immunoblasts in enlarged lymph nodes during viral infection are found in which region?

  1. A. Hilum
  2. B. Medullary sinuses
  3. C. Paracortex
  4. D. Primary follicles

Correct answer: C – Paracortex

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

Q20: Low-grade NHL with cells similar to CLL?

  1. A. Diffuse large cell lymphoma
  2. B. Follicular large cell lymphoma
  3. C. Immunoblastic lymphoma
  4. D. Small lymphocytic lymphoma

Correct answer: D – Small lymphocytic lymphoma

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

Q21: Lacunar cells are variants of Reed-Sternberg cells found specifically in?

  1. A. Nodular sclerosis HD
  2. B. Lymphocyte-depleted HD
  3. C. Mixed cellularity HD
  4. D. Lymphocyte-predominant HD

Correct answer: A – Nodular sclerosis HD

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

Q22: 28-year-old male with Auer rods in blast cells making up 38% of marrow — diagnosis?

  1. A. Acute erythroid leukemia
  2. B. Acute lymphoblastic leukemia
  3. C. Acute monocytic leukemia
  4. D. Acute promyelocytic leukemia

Correct answer: D – Acute promyelocytic leukemia

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

Q23: 4-year-old with TdT+, PAS+, MPO− blasts — cells originated from?

  1. A. Lymphoblasts
  2. B. Monoblasts
  3. C. Megakaryoblasts
  4. D. Myeloblasts

Correct answer: A – Lymphoblasts

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

Q24: Hairy cell leukemia suspected — which stain is useful?

  1. A. Myeloperoxidase
  2. B. Sudan black B
  3. C. Acid phosphatase
  4. D. Leukocyte alkaline phosphatase

Correct answer: C – Acid phosphatase

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

Q25: 72-year-old with nontender lymphadenopathy, splenomegaly, leukocyte count 72,000 — diagnosis?

  1. A. ALL
  2. B. Atypical lymphocytosis
  3. C. Immunoblastic lymphoma
  4. D. Chronic lymphocytic leukemia

Correct answer: D – Chronic lymphocytic leukemia

Elderly patient, massive lymphocytosis, nontender nodes, splenomegaly = classic CLL presentation.

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