Hematology — MCQs

Hematology Indian Medical PG Practice Questions and MCQs

Question 1071: What is the main contraindication for performing a liver biopsy?

A. Severe thrombocytopenia
B. Liver hemangioma
C. Presence of ascites
D. Severe coagulopathy (Correct Answer)

Explanation: ***Severe coagulopathy*** - **Severe coagulopathy** is the main contraindication for liver biopsy due to a significantly increased risk of **hemorrhage** [1]. - A **prothrombin time (PT)** or **activated partial thromboplastin time (aPTT)** significantly prolonged beyond the normal range, or an **INR > 1.5**, should be corrected before the procedure [1]. *Severe thrombocytopenia* - While **thrombocytopenia** (platelet count <50,000/µL) does increase bleeding risk, it is often correctable with a **platelet transfusion** prior to biopsy, making it a relative rather than an absolute contraindication [1]. - The risk of major bleeding is typically lower with isolated thrombocytopenia compared to severe coagulopathy. *Liver hemangioma* - The presence of a **liver hemangioma** at the biopsy site is a contraindication as biopsying it can lead to massive hemorrhage. - However, if the biopsy can be performed safely away from the hemangioma, it is not an absolute contraindication to the procedure itself. *Presence of ascites* - **Ascites** can complicate a liver biopsy by increasing the risk of **peritoneal bleeding** and difficulty in targeting the liver [1]. - However, it is often manageable by draining the ascites or using imaging guidance, making it a relative contraindication rather than an absolute one [1].

Question 1072: In cobalamin deficiency which is not seen

A. Loss of proprioception
B. Rhomberg sign
C. Microcytic anemia (Correct Answer)
D. Long tract signs

Explanation: Microcytic anemia - Cobalamin deficiency typically leads to macrocytic anemia due to impaired DNA synthesis, not microcytic anemia [1]. - Microcytic anemia is usually associated with iron deficiency, thalassemia, or anemia of chronic disease [1]. Long tract signs - Long tract signs are common in cobalamin deficiency due to posterior column and corticospinal tract involvement leading to symptoms like spasticity. - They indicate involvement of pathways that are affected by vitamin B12 deficiency. Loss of proprioception - Loss of proprioception can occur in cobalamin deficiency due to damage to the dorsal columns of the spinal cord. - It is a common clinical finding indicating the involvement of sensory pathways. Rhomberg sign - A positive Rhomberg sign indicates impaired proprioception, which can happen in cobalamin deficiency. - It reflects difficulty maintaining balance, emphasizing sensory dysfunction associated with the deficiency.

Question 1073: Chronic hemolytic anaemia is associated with which of the following -

A. Brown Pigment stone of the gall bladder
B. Black Pigment stone of the gall bladder (Correct Answer)
C. Uric acid Renal Calculus
D. Intestinal Obstruction

Explanation: ***Black Pigment stone of the gall bladder*** - Chronic hemolytic anemia leads to increased **bilirubin**, particularly unconjugated bilirubin, which can result in the formation of **black pigment stones** [1]. - These stones are associated with conditions causing **excess bilirubin production**, such as sickle cell disease and thalassemia. *Brown Pigment stone of the gall bladder* - Brown pigment stones are primarily associated with **infection** and **biliary tract disorders**, not directly with chronic hemolytic anemia. - They are mainly composed of **calcium bilirubinate**, which arises in cases of **bacterial infections** or parasitic infestations. *Intestinal Obstruction* - While hemolytic anemia can have various complications, it is **not directly linked with intestinal obstruction**. - Obstruction typically arises from **mechanical causes** such as adhesions, tumors, or hernias, rather than from hemolytic processes. *Uric acid Renal Calculus* - Uric acid stones are formed due to conditions leading to **hyperuricemia** and are not a primary consequence of chronic hemolytic anemia. - They are often associated with **gout** and **certain metabolic disorders**, rather than hemolytic processes.

Question 1074: Gaisbock syndrome is known as:

A. Primary Familial Polycythemia
B. High Altitude Erythrocytosis
C. Spurious Polycythemia (Correct Answer)
D. Polycythemia Vera

Explanation: ***Spurious Polycythemia*** - Gaisbock syndrome is characterized by an increase in **red blood cells** due to **dehydration** and is a form of **spurious or relative polycythemia** [1]. - It typically occurs in individuals with **high hematocrit levels** without true pathological erythrocytosis [1]. *High Altitude Erythrocytosis* - This condition is caused by **hypoxia** at high altitudes leading to increased **erythropoietin**, resulting in genuine **erythrocytosis** [2]. - Unlike Gaisbock syndrome, it reflects a true physiological response to reduced oxygen levels [2]. *Polycythemia Vera* - Polycythemia vera is a **myeloproliferative disorder** characterized by increased red blood cell mass due to intrinsic bone marrow changes. - It entails elevated **erythropoietin** levels and features such as **splenomegaly** and other cytogenetic changes, which are not present in Gaisbock syndrome [1][3]. *Primary Familial Polycythemia* - This hereditary condition results in increased red blood cells due to genetic mutations leading to overproduction of erythrocytes. - It is distinct from Gaisbock syndrome as it typically manifests from genetic predisposition rather than environmental factors such as dehydration.

Question 1075: Therapeutic phlebotomy is not done in which of the following conditions?

A. CML (Correct Answer)
B. Polycythemia vera
C. Hemochromatosis
D. Porphyria cutanea tarda

Explanation: CML - **Chronic Myeloid Leukemia (CML)** is typically treated with targeted therapies like **Tyrosine Kinase Inhibitors** (e.g., Imatinib), not phlebotomy [1]. - Therapeutic phlebotomy is ineffective in managing the **hypercellularity** or symptoms associated with this condition compared to other conditions [1]. *Polycythemia vera* - Therapeutic phlebotomy is a key treatment in **Polycythemia vera** to reduce **hyperviscosity** symptoms. - This condition features increased red blood cell mass, which is directly addressed by phlebotomy. *Hemochromatosis* - In **Hemochromatosis**, phlebotomy is employed to lower **iron overload** by removing excess iron from the body. - This reduces the risk of complications such as **liver cirrhosis** and **diabetes** associated with iron excess. *Porphyria cutanea tarda* - Therapeutic phlebotomy is sometimes used in cases of **Porphyria cutanea tarda** to manage iron levels as a potential precipitating factor [2]. - It helps alleviate symptoms and prevent complications associated with **photosensitivity** and skin lesions [2].

Question 1076: Which of the following statements about CNS leukemia is false?

A. Intrathecal methotrexate is given
B. Seen with acute myeloid leukemia
C. CNS irradiation is given
D. Single blast in CSF is sufficient for diagnosis (Correct Answer)

Explanation: ***Seen with acute myeloid leukemia*** - CNS involvement is typically not a common feature of **acute myeloid leukemia (AML)**; it's more associated with acute lymphoblastic leukemia (ALL) [1]. - While leukemia can affect the CNS, **AML is not predominantly known** for this complication compared to ALL . *Single blast in CSF is sufficient for diagnosis* - A **single blast** in the cerebrospinal fluid (CSF) does **not establish a definitive diagnosis** of CNS leukemia; multiple blasts are typically required. - Diagnosis involves considering clinical symptoms, laboratory findings, and often requires **a combination of findings** to confirm CNS involvement. *Intrathecal methotrexate is given* - **Intrathecal methotrexate** is used for treatment of CNS leukemia; however, this statement is true and does not meet the 'except' criteria. - It is a common practice to deliver chemotherapy directly to the CNS to combat leukemia effectively. *CNS irradiation is given* - CNS irradiation can be used as a treatment modality in certain instances of leukemia; thus, this statement is also true. - It is part of the therapeutic strategies for managing CNS involvement but is not universally applied for all cases.

Question 1077: Which of the following is not a characteristic of Zieve syndrome?

A. Alcohol abuse
B. Chronic pancreatitis (Correct Answer)
C. Hemolysis
D. Hypertriglyceridemia

Explanation: ***Chronic pancreatitis*** - **Zieve syndrome** is an acute, not chronic, condition, and its primary feature is not chronic pancreatic inflammation, though severe alcohol use can cause both. - While **alcohol abuse** is a risk factor for both Zieve syndrome and chronic pancreatitis, **chronic pancreatitis** itself is not considered a characteristic component of Zieve syndrome [1]. *Alcohol abuse* - **Alcohol abuse** is the underlying cause for the development of Zieve syndrome, leading to the characteristic triad of hemolytic anemia, hyperlipidemia, and jaundice. - It triggers the **liver damage** and metabolic disturbances that define the syndrome. *Hemolysis* - **Hemolysis** (destruction of red blood cells) is a key feature of Zieve syndrome, leading to **hemolytic anemia** and jaundice. - It results from increased red blood cell fragility and splenic sequestration exacerbated by altered lipid metabolism. *Hypertriglyceridemia* - **Hypertriglyceridemia** is a hallmark of Zieve syndrome, arising from impaired lipid metabolism secondary to alcohol-induced liver damage. - Elevated **triglyceride levels** contribute to red blood cell membrane abnormalities, thereby promoting hemolysis.

Question 1078: Thrombocythemia is characterized by an elevated platelet count.

A. Low platelets
B. Neutrophilia
C. Monocytosis
D. Elevated platelet count (Correct Answer)

Explanation: Elevated platelet count - Thrombocythemia is a condition specifically defined by an abnormally high number of platelets (thrombocytes) in the blood [2]. - This elevated count can lead to issues with both bleeding and clotting [2]. Low platelets - Low platelets, also known as thrombocytopenia, is the opposite of thrombocythemia [1]. - This condition is associated with an increased risk of bleeding [1]. Neutrophilia - Neutrophilia refers to an elevated count of neutrophils, a type of white blood cell, which is typically seen in bacterial infections. - It does not directly describe the platelet count. Monocytosis - Monocytosis indicates an increase in monocytes, another type of white blood cell, often seen in chronic infections or inflammatory conditions. - This term is unrelated to platelet levels.

Question 1079: Which subtype of Acute Myeloid Leukemia (AML) is associated with the best prognosis?

A. Acute myelo monocytic leukemia.
B. Acute monocytic leukemia.
C. Erythro leukemia
D. Acute promyeloblastic leukemia (M3) (Correct Answer)

Explanation: ***Acute promyeloblastic leukemia (M.3)*** [1] - **Best prognosis** in acute myeloid leukemia (AML) is associated with acute promyeloblastic leukemia due to its responsiveness to **all-trans retinoic acid (ATRA)** treatment. [1] - This type often presents with a **prominent coagulopathy**, but successful treatment can lead to **long-term remission**. *Acute monocytic leukemia* - Generally associated with **poor prognosis** and is characterized by a high white blood cell count and organ infiltration. - It lacks the favorable features seen in acute promyeloblastic leukemia, such as effective treatment outcomes. *Erythroleukemia* - Known for having a **poor prognosis** due to its aggressive nature and frequent association with complex chromosomal abnormalities. [1] - Treatment responses are often suboptimal compared to that of acute promyeloblastic leukemia. *Acute myelomonocytic leukemia* - Typically has an **intermediate prognosis** [1] and presents with a mixture of myeloid and monocytic features. - It does not have the same treatment responsiveness and favorable outcomes as seen in acute promyeloblastic leukemia.

Question 1080: Which of the following does not predispose to leukemia?

A. Smoking
B. Chemical exposure
C. Alcohol (Correct Answer)
D. Genetic disorder

Explanation: ***Alcohol*** - Alcohol consumption does not have a well-established association with an increased risk of leukemia compared to other factors. - While excessive alcohol can impact overall health, it is not considered a primary risk factor for developing leukemia. *Chemical exposure* - Certain chemicals, such as **benzene** and **formaldehyde**, are known to be **leukemogenic** and can increase the risk of leukemia. [1] - Occupational exposure to these chemicals has been linked to **acute myeloid leukemia (AML)** and other types of leukemia. [1] *Smoking* - Smoking has been clearly associated with an increased risk of **acute myeloid leukemia (AML)** and other hematologic malignancies. [1] - The toxins in tobacco smoke can cause **DNA damage**, contributing to the development of leukemia. *Genetic disorder* - Certain genetic disorders, like **Down syndrome** and **Fanconi anemia**, are associated with an increased risk of leukemia. - Individuals with these genetic predispositions have a higher likelihood of developing various forms of leukemia.

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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

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Multiple Myeloma and Plasma Cell Disorders

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Myeloproliferative Neoplasms

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Transfusion Medicine

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Hematopoietic Stem Cell Transplantation

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Hematology — MCQs

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