Haematopathology: practice question

A Pathology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Pathology · Haematopathology

Sample item

A 62-year-old man has fatigue and massive splenomegaly. Marrow aspiration is a dry tap, and the blood film shows teardrop red cells, nucleated red cells and immature granulocytes. What best explains the splenomegaly?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

A. Extramedullary haematopoiesis in the spleen as marrow fibrosis displaces blood formation

The dry tap and leukoerythroblastic film with teardrop cells indicate primary myelofibrosis, a myeloproliferative neoplasm often with JAK2 V617F. As the marrow becomes fibrotic, haematopoiesis shifts to the spleen and liver, which enlarge.

Option by option

  • A. Extramedullary haematopoiesis in the spleen as marrow fibrosis displaces blood formation (correct)

    Correct. Blood cell production moves to the spleen as the marrow fibroses, causing massive enlargement.

  • B. Congestion from portal hypertension due to cirrhosis

    Congestive splenomegaly occurs with portal hypertension but would not produce a dry tap with teardrop cells.

  • C. Amyloid deposition in the splenic pulp

    Amyloid can enlarge the spleen but does not produce marrow fibrosis or teardrop red cells.

  • D. Reactive hyperplasia due to chronic infection

    Reactive hyperplasia from infection does not explain marrow fibrosis or a leukoerythroblastic blood film.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

More Pathology questions

Questions about this Pathology question

What is the answer to this Pathology question?

The best answer is A, Extramedullary haematopoiesis in the spleen as marrow fibrosis displaces blood formation. The dry tap and leukoerythroblastic film with teardrop cells indicate primary myelofibrosis, a myeloproliferative neoplasm often with JAK2 V617F.

Why is "Congestion from portal hypertension due to cirrhosis" not the answer?

Congestive splenomegaly occurs with portal hypertension but would not produce a dry tap with teardrop cells.

Why is "Amyloid deposition in the splenic pulp" not the answer?

Amyloid can enlarge the spleen but does not produce marrow fibrosis or teardrop red cells.

Why is "Reactive hyperplasia due to chronic infection" not the answer?

Reactive hyperplasia from infection does not explain marrow fibrosis or a leukoerythroblastic blood film.

What concept does this question test?

It tests Haematopathology in Pathology. As the marrow becomes fibrotic, haematopoiesis shifts to the spleen and liver, which enlarge.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Haematopathology?

Learn each disease as a bundle: cause, key histology, markers, and the clinical hallmark. Then use the flashcards and the other Pathology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.