Hematology — MCQs

Hematology Indian Medical PG Practice Questions and MCQs

Question 991: A 55-year-old male with fatigue and a palpable spleen is found to have a high white cell count predominantly consisting of mature lymphocytes. What is the most likely diagnosis?

A. Acute lymphoblastic leukemia
B. Chronic lymphocytic leukemia (Correct Answer)
C. Myelodysplastic syndrome (ineffective hematopoiesis and cytopenias)
D. Hairy cell leukemia (characterized by "hairy" appearing cells)

Explanation: ***Chronic lymphocytic leukemia*** - The presence of **fatigue**, a **palpable spleen**, and an elevated white cell count predominantly consisting of **mature lymphocytes** is highly characteristic of CLL [1]. - CLL is a common leukemia in older adults, where **monoclonal B-lymphocytes** accumulate in the blood, bone marrow, and lymphoid organs [1]. *Acute lymphoblastic leukemia* - This leukemia typically presents with **immature lymphocytes (blasts)** and a more aggressive clinical course, often seen in children [2]. - While it causes fatigue and can lead to organomegaly, the predominance of **mature lymphocytes** in the peripheral blood rules out ALL [2]. *Myelodysplastic syndrome (ineffective hematopoiesis and cytopenias)* - This syndrome is characterized by **ineffective hematopoiesis** and **cytopenias** (low blood cell counts), rather than a high white cell count. - It involves dysplasia in one or more myeloid cell lines, and the peripheral smear would show abnormal cell morphology, not a predominance of mature lymphocytes. *Hairy cell leukemia (characterized by "hairy" appearing cells)* - While it presents with **splenomegaly** and can cause fatigue, the characteristic cells have **"hairy" cytoplasmic projections** and are rarely found in high numbers in the peripheral blood initially. - The diagnosis is confirmed by flow cytometry and bone marrow biopsy, and the classic picture often includes **pancytopenia**, not just a high white cell count from mature lymphocytes.

Question 992: A 55-year-old woman presents with fatigue, pallor, numbness and tingling in her hands and feet, and a high mean corpuscular volume (MCV). A peripheral smear shows hypersegmented neutrophils and oval macrocytes. What is the most likely deficiency?

A. Iron
B. Folate
C. Vitamin B12 (Correct Answer)
D. Vitamin C

Explanation: ***Vitamin B12*** - **Fatigue**, **pallor**, and **pancytopenia** are characteristic of megaloblastic anemia, which can be caused by **Vitamin B12 deficiency** [1]. - **Numbness** and **tingling** (neuropathy) are specific to **Vitamin B12 deficiency**, as it affects myelin synthesis, and the peripheral smear findings of **hypersegmented neutrophils** and **oval macrocytes** indicate impaired DNA synthesis during erythropoiesis [1]. *Iron* - **Iron deficiency anemia** typically presents with a **microcytic hypochromic anemia** (low MCV), in contrast to the high MCV seen here [1]. - Neurological symptoms like numbness and tingling are not characteristic of **iron deficiency**. *Folate* - **Folate deficiency** also causes **macrocytic anemia** with **hypersegmented neutrophils** and **oval macrocytes**, similar to B12 deficiency [2]. - However, **folate deficiency** does not typically cause the **neurological symptoms** (numbness and tingling) described, which are a key differentiating factor [1]. *Vitamin C* - **Vitamin C deficiency** leads to **scurvy**, characterized by **gingival bleeding**, **petechiae**, and impaired wound healing. - It can cause **anemia**, but it is usually **normocytic or macrocytic** due to impaired iron absorption or megaloblastic changes, not the primary cause of the neurological symptoms or the specific peripheral smear findings seen here.

Question 993: Which of the following is a significant risk factor for developing deep vein thrombosis (DVT)?

A. Advanced age
B. Recent surgery (Correct Answer)
C. Use of oral contraceptives
D. Long periods of immobility

Explanation: **Recent surgery** - **Surgical procedures**, especially orthopedic surgeries (e.g., hip or knee replacement), cause **endothelial injury** and activate the coagulation cascade [3]. - The **postoperative period** is associated with reduced mobility and systemic inflammatory responses, significantly increasing the risk of **venous stasis** and **hypercoagulability** [2]. *Long periods of immobility* - While immobility is a significant contributor to DVT, it is a broader category of risk. **Recent surgery** often combines immobility with additional risk factors like tissue trauma and inflammation, making it a more specific and acute risk factor [2]. - **Venous stasis** due to immobility allows clotting factors to accumulate, promoting clot formation. *Use of oral contraceptives* - **Estrogen-containing oral contraceptives** increase the synthesis of clotting factors and decrease natural anticoagulants, leading to a **hypercoagulable state**. - While a risk factor, it is often a chronic predisposition rather than an acute precipitating factor like recent surgery. *Advanced age* - **Advanced age** is associated with an increased risk of DVT due to age-related changes in the coagulation system, endothelial function, and higher prevalence of comorbidities [1], [4]. - However, it is a general predisposing factor, whereas **recent surgery** represents a more immediate and potent trigger.

Question 994: A 50-year-old man presents with fatigue and dizziness. Blood work shows normocytic anemia with elevated ferritin levels. Genetic testing reveals a homozygous HFE mutation. What is the best treatment option for this condition?

A. Phlebotomy is the best treatment option. (Correct Answer)
B. Transfusion with packed RBCs is recommended.
C. Chelation therapy with deferoxamine is indicated.
D. High-dose corticosteroids should be used.

Explanation: PHLEBOTOMY IS THE BEST TREATMENT OPTION. - The patient's presentation with **fatigue, dizziness, normocytic anemia, elevated ferritin**, and a **homozygous HFE mutation** strongly suggests **hereditary hemochromatosis**. [1], [2] - **Phlebotomy** is the first-line treatment as it directly removes excess iron from the body by drawing blood, preventing organ damage. [1] *Transfusion with packed RBCs is recommended.* - **Transfusions** would further increase iron levels in a patient with **iron overload**, exacerbating the condition and potentially causing more harm. - This treatment is appropriate for severe symptomatic anemia due to **iron deficiency** or other causes, not iron overload. *Chelation therapy with deferoxamine is indicated.* - **Chelation therapy** is used for iron overload when phlebotomy is contraindicated (e.g., severe anemia, poor venous access) or ineffective. - While effective, **deferoxamine** is typically a second-line therapy for hereditary hemochromatosis, as phlebotomy is generally safer and more efficient. *High-dose corticosteroids should be used.* - **Corticosteroids** are anti-inflammatory and immunosuppressive agents, primarily used for autoimmune conditions or certain types of anemia (e.g., autoimmune hemolytic anemia). - They have **no role** in the treatment of **hereditary hemochromatosis** or iron overload.

Question 995: A 45-year-old woman presents with diffuse hair thinning over her scalp. She denies any scarring or itching. Laboratory tests reveal low serum ferritin levels. What is the most appropriate management?

A. Topical minoxidil
B. Oral finasteride
C. Iron supplementation (Correct Answer)
D. Systemic corticosteroids

Explanation: ***Iron supplementation*** - **Low serum ferritin** indicates **iron deficiency**, a common cause of **diffuse hair thinning** (telogen effluvium) in women [1]. - Replenishing iron stores is crucial for hair regrowth and should be the primary treatment [1]. *Topical minoxidil* - This promotes hair growth and is commonly used for **androgenetic alopecia**, but it does not address the underlying nutritional deficiency in this case. - While it can be an adjunctive treatment, addressing the **iron deficiency** is more fundamental for this patient [1]. *Oral finasteride* - This medication is primarily used in **men** for **androgenetic alopecia** as it inhibits 5-alpha-reductase, reducing DHT levels. - It is generally not indicated for women with diffuse hair thinning, especially when an underlying cause like **iron deficiency** is identified. *Systemic corticosteroids* - These are used for inflammatory or autoimmune hair loss conditions like **alopecia areata** or **lichen planopilaris** [1]. - They are not indicated for **iron deficiency-induced hair thinning**, and their side effects outweigh any potential benefits in this scenario.

Question 996: A 54-year-old male presents with fever, confusion, and petechiae. Laboratory results show decreased platelets, increased PT/INR, increased D-dimer, and decreased fibrinogen. Analyze and determine the diagnosis and appropriate initial management.

A. Disseminated intravascular coagulation; treat underlying cause (Correct Answer)
B. Thrombocytopenic purpura; plasma exchange
C. Sepsis; broad-spectrum antibiotics
D. ITP; corticosteroids

Explanation: ***Disseminated intravascular coagulation; treat underlying cause*** - The combination of **fever, confusion, petechiae**, and laboratory findings of **decreased platelets, increased PT/INR, increased D-dimer, and decreased fibrinogen** is highly characteristic of **Disseminated Intravascular Coagulation (DIC)** [1], [3]. - The primary management for DIC involves identifying and treating the **underlying cause**, as DIC is always secondary to another condition (e.g., sepsis, trauma, malignancy) [1]. *Thrombocytopenic purpura; plasma exchange* - **Thrombocytopenic purpura (TTP)** typically presents with the pentad of **fever, microangiopathic hemolytic anemia, thrombocytopenia, renal failure, and neurological symptoms**, but would not show the profound coagulation abnormalities like **increased PT/INR** and **decreased fibrinogen** [2]. - **Plasma exchange** is the primary treatment for TTP to remove ADAMTS13 antibodies. *Sepsis; broad-spectrum antibiotics* - While **sepsis** can be an **underlying cause of DIC** and presents with fever and confusion, the laboratory findings here directly point to the **coagulopathy of DIC** itself rather than solely sepsis [1]. - Administering **broad-spectrum antibiotics** is appropriate for sepsis, but if DIC is already established, simply treating sepsis without considering DIC-specific management might be insufficient. *ITP; corticosteroids* - **Immune thrombocytopenic purpura (ITP)** is characterized by **isolated thrombocytopenia** (low platelets) due to autoimmune destruction, but would not present with widespread coagulopathy, such as **increased PT/INR** or **decreased fibrinogen** [2]. - **Corticosteroids** are the first-line treatment for ITP to suppress the immune response.

Question 997: A beta-thalassemia patient was given 125 units of packed red blood cells. Which additional drug should be administered?

A. Cytarabine
B. Desferroxamine (Correct Answer)
C. Hydroxyurea
D. Butyrates

Explanation: ***Desferroxamine*** - Patients with **beta-thalassemia** often require frequent **packed red blood cell transfusions** to manage severe anemia. - These transfusions lead to **iron overload** (hemosiderosis), necessitating iron chelation therapy with drugs like **Desferroxamine** to prevent organ damage. *Cytarabine* - **Cytarabine** is a **chemotherapeutic agent** primarily used in the treatment of various leukemias, particularly **acute myeloid leukemia**. - It is not indicated for the management of **iron overload** in thalassemia patients. *Hydroxyurea* - **Hydroxyurea** is used to increase **fetal hemoglobin** production in conditions like **sickle cell anemia** and some forms of beta-thalassemia [1]. - While it can reduce transfusion requirements in some thalassemia patients, its primary role is not to address **iron overload** already caused by transfusions. *Butyrates* - **Butyrates** are being investigated for their potential to induce **fetal hemoglobin** production, similar to hydroxyurea, in hemoglobinopathies. - They do not directly address **iron overload** and are not standard therapy for this complication.

Question 998: A 60-year-old man presents with fatigue, weight loss, and bone pain. Laboratory tests reveal anemia, hypercalcemia, and renal insufficiency. What is the most likely diagnosis?

A. Multiple myeloma (Correct Answer)
B. Chronic lymphocytic leukemia
C. Non-Hodgkin lymphoma
D. Primary hyperparathyroidism

Explanation: ***Multiple myeloma*** - The constellation of **fatigue (due to anemia)**, **weight loss**, **bone pain**, **hypercalcemia**, and **renal insufficiency** is characteristic of multiple myeloma, often described by the mnemonic **CRAB criteria** (Calcium elevation, Renal failure, Anemia, Bone lesions) [1, 2]. - This plasma cell malignancy leads to overproduction of **monoclonal immunoglobulins** (M-proteins) which can cause kidney damage, and osteolytic lesions leading to bone pain and hypercalcemia [1, 2]. *Chronic lymphocytic leukemia* - While it can present with fatigue and weight loss, specific features like **bone pain**, **hypercalcemia**, and **renal insufficiency** are not typical primary manifestations. [3] - Diagnosis usually involves **lymphocytosis** and the presence of **clonal B-cells** with specific immunophenotypes. *Non-Hodgkin lymphoma* - Patients often present with **lymphadenopathy**, **fever**, **night sweats**, and **weight loss**, but **hypercalcemia** and **renal insufficiency** due to direct bone involvement or myeloma kidney are less common. - Bone pain might occur if there's extensive **bone marrow involvement**, but it's not the primary feature compared to myeloma. *Primary hyperparathyroidism* - This condition primarily causes **hypercalcemia** and can lead to **bone pain** (osteitis fibrosa cystica) and **renal stones/insufficiency**. - However, **anemia** and significant **weight loss** are not typical presenting features; severe anemia is more indicative of a hematologic malignancy.

Question 999: Which of the following conditions is not associated with venous and arterial thrombotic events?

A. Heparin-Induced Thrombocytopenia (HIT), a condition associated with immune-mediated thrombosis.
B. Paroxysmal Nocturnal Hemoglobinuria (PNH), a condition linked to hemolysis and thrombosis.
C. Disseminated Intravascular Coagulation (DIC), a condition involving widespread clotting and bleeding.
D. Idiopathic Thrombocytopenic Purpura (ITP), a condition primarily causing bleeding. (Correct Answer)

Explanation: Which of the following conditions is not associated with venous and arterial thrombotic events? ***Idiopathic Thrombocytopenic Purpura (ITP), a condition primarily causing bleeding.*** - **ITP** is an autoimmune disorder characterized by **low platelet counts** due to increased destruction, leading to a primary risk of **bleeding**, not thrombosis [1]. - While extremely rare, some atypical cases or specific treatments might involve thrombotic risk, but it is not a direct or common association with the disease itself, unlike the other options. *Paroxysmal Nocturnal Hemoglobinuria (PNH), a condition linked to hemolysis and thrombosis.* - **PNH** is strongly associated with both **venous and arterial thrombosis**, often in unusual sites like hepatic or cerebral veins, due to increased red blood cell fragility and activation of complement. - The lack of **GPI-anchored proteins** on hematopoietic cells in PNH leads to uncontrolled complement activation, which then promotes pro-thrombotic states. *Heparin-Induced Thrombocytopenia (HIT), a condition associated with immune-mediated thrombosis.* - **HIT** is a severe, immune-mediated adverse drug reaction that leads to **thrombocytopenia** and paradoxically, a high risk of both **venous and arterial thrombosis**. - It involves antibodies against **platelet factor 4 (PF4)** complexed with heparin, causing platelet activation and widespread procoagulant activity. *Disseminated Intravascular Coagulation (DIC), a condition involving widespread clotting and bleeding.* - **DIC** involves systemic activation of coagulation, leading to the formation of **microthrombi** throughout the microvasculature, which consumes platelets and coagulation factors [2]. - This widespread clotting can cause both **venous and arterial thrombotic events**, along with subsequent bleeding due to factor consumption [2].

Question 1000: A 50-year-old male presents with fatigue and pallor. His peripheral smear shows hypersegmented neutrophils and macro-ovalocytes. What is the most likely diagnosis?

A. Iron deficiency anemia
B. Folate deficiency anemia (Correct Answer)
C. Thalassemia
D. Chronic myeloid leukemia

Explanation: ***Folate deficiency anemia*** - The presence of **hypersegmented neutrophils** and **macro-ovalocytes** on peripheral smear is characteristic of **megaloblastic anemia**, which can be caused by folate deficiency. - **Fatigue** and **pallor** are common symptoms of anemia. *Iron deficiency anemia* - This typically presents with **microcytic, hypochromic** red blood cells, which is contrary to the macro-ovalocytes seen in this patient. - Iron deficiency does not cause **hypersegmented neutrophils**. *Thalassemia* - Thalassemia usually causes **microcytic, hypochromic anemia** and is characterized by abnormal hemoglobin production. - It does not involve **hypersegmented neutrophils** or **macro-ovalocytes**. *Chronic myeloid leukemia* - This condition is characterized by an overproduction of **granulocytes**, often with a **left shift** in the myeloid lineage. - It does not typically present with **hypersegmented neutrophils** and **macro-ovalocytes** as the primary diagnostic features.

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Anemia Evaluation and Management

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Hemoglobinopathies

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Thalassemias

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Platelet Disorders

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Coagulation Disorders

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Thrombotic Disorders

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Leukemias

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Lymphomas

Practice Questions

Multiple Myeloma and Plasma Cell Disorders

Practice Questions

Myeloproliferative Neoplasms

Practice Questions

Transfusion Medicine

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Hematopoietic Stem Cell Transplantation

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Hematology — MCQs

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