Hematology — MCQs
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What does ristocetin testing indicate in von Willebrand disease?
Which of the following statements about sickle cell disease is true?
Which antibody is primarily associated with warm autoimmune hemolytic anemia (AIHA)?
Which of the following findings is diagnostic of iron deficiency anemia?
Which of the following is not classified as a cutaneous porphyria?
Pagophagia is associated with the consumption of which substance?
What are the key characteristics of Evans syndrome?
Which of the following is commonly seen in Polycythemia Vera?
Which of the following conditions is associated with megaloblastic anemia?
What is the recommended time frame for completing a blood transfusion after initiation?
Hematology Indian Medical PG Practice Questions and MCQs
Question 1081: What does ristocetin testing indicate in von Willebrand disease?
- A. Normal agglutination
- B. Increased agglutination
- C. No agglutination
- D. Decreased agglutination (Correct Answer)
Explanation: ***Decreased agglutination*** - In von Willebrand disease, **ristocetin induces less agglutination** due to a deficiency or dysfunction of von Willebrand factor. - This results in **impaired platelet adhesion** [1], crucial for effective hemostasis. *Increased agglutination* - Would suggest an increased platelet interaction, which is **not characteristic of von Willebrand disease**. - It can occur in conditions with enhanced von Willebrand factor, unlike in this case. *No agglutination* - Suggests complete lack of platelet interaction, which is **not typical** in von Willebrand disease. - There is often some level of interaction, albeit reduced, not a total absence of agglutination. *Normal agglutination* - Indicates no abnormalities, which **contradicts the known pathology** of von Willebrand disease. - Patients typically demonstrate decreased levels of agglutination, not normal findings in this test.
Question 1082: Which of the following statements about sickle cell disease is true?
- A. Sickling is completely reversible with oxygenation, making it clinically insignificant.
- B. Sickling leads to a significant increase in overall MCHC levels in the blood.
- C. Fetal hemoglobin inhibits sickling. (Correct Answer)
- D. Sickling occurs exclusively in the homozygous state and never in the heterozygous state.
Explanation: ***Sickling is reversible with oxygenation*** - When oxygen tension is restored, hemoglobin S can re-hydrate and revert to its normal shape, reducing sickling. - This reversible process is essential for managing episodes of vaso-occlusive crisis in sickle cell disease. *Fetal hemoglobin facilitates Sickling* - Fetal hemoglobin (HbF) actually inhibits sickling by stabilizing the erythrocyte shape and reducing the proportion of hemoglobin S [1]. - Individuals with higher levels of HbF experience fewer sickling-related complications [1]. *Sickling occurs both in heterozygous and homozygous state* - Sickling primarily occurs in the homozygous state (HbSS); heterozygotes (HbAS) usually do not experience significant sickling effects [1]. - Heterozygous individuals may have a selective advantage against malaria, but they are not prone to sickle cell crises. *Sickling Leads to decreased MCHC* - Sickling does not directly lead to decreased mean corpuscular hemoglobin concentration (MCHC); MCHC is typically normal in sickle cell patients. - In fact, sickle cell disease often results in hemolysis and can lead to increased MCHC in some cases.
Question 1083: Which antibody is primarily associated with warm autoimmune hemolytic anemia (AIHA)?
- A. IgE
- B. IgM
- C. IgG (Correct Answer)
- D. IgD
Explanation: ***IgG*** - **Warm autoimmune hemolytic anemia (AIHA)** is primarily associated with **IgG antibodies**, which mediate hemolysis at body temperature [1]. - IgG antibodies typically bind to red blood cells and lead to their destruction by the **reticuloendothelial system** [1]. *IgM* - Often involved in **cold agglutinin disease**, not warm AIHA, as it primarily reacts at lower temperatures [2]. - Usually results in **hemolysis** in peripheral areas, like the extremities, rather than at normal body temperature [2]. *IgD* - Known primarily as a marker on **B cells**, it plays a minimal role in hemolytic anemia and is not involved in antibody-mediated hemolysis. - Lack of significant **serological presence** in autoimmune hemolytic processes makes it an unlikely candidate. *IgE* - Primarily associated with **allergic reactions** and parasitic infections rather than autoimmune hemolytic conditions [2]. - Does not typically participate in **hemolysis** or bind to red blood cells in AIHA.
Question 1084: Which of the following findings is diagnostic of iron deficiency anemia?
- A. Increased TIBC, decreased serum ferritin (Correct Answer)
- B. Decreased TIBC, decreased serum ferritin
- C. Increased TIBC, increased serum ferritin
- D. Decreased TIBC, increased serum ferritin
Explanation: ***Increased TIBC, decreased serum ferritin*** - **Iron deficiency anemia** is characterized by depleted iron stores, leading to a **decreased serum ferritin** level, which is the most sensitive and specific marker for iron deficiency [4]. - In response to low iron stores, the body upregulates iron absorption and transport mechanisms, resulting in an **increased Total Iron Binding Capacity (TIBC)**, as there are more transferrin molecules available to bind iron [1]. *Decreased TIBC, decreased serum ferritin* - While a **decreased serum ferritin** is consistent with iron deficiency, a **decreased TIBC** is more indicative of **anemia of chronic disease** [1], where the body sequesters iron, leading to reduced iron availability for binding. - In **anemia of chronic disease**, both ferritin (an acute phase reactant) and TIBC can be reduced due to the inflammatory state [1], [2]. *Increased TIBC, increased serum ferritin* - An **increased TIBC** is seen in iron deficiency, but an **increased serum ferritin** indicates adequate or even **overloaded iron stores**, which contradicts the diagnosis of iron deficiency anemia. - High ferritin levels can be seen in conditions like **hemochromatosis** (iron overload) or **inflammation**, where ferritin acts as an acute phase reactant [5]. *Decreased TIBC, increased serum ferritin* - This combination is typical of **anemia of chronic disease**, where inflammation causes **increased serum ferritin** (as an acute phase reactant) and a **decreased TIBC** due to reduced production of transferrin [1]. - In this type of anemia, iron is often trapped within macrophages, making it unavailable for erythropoiesis despite seemingly normal or elevated stores [3].
Question 1085: Which of the following is not classified as a cutaneous porphyria?
- A. Congenital erythropoietic porphyria
- B. Erythropoietic protoporphyria
- C. Sideroblastic anemia (Correct Answer)
- D. Hereditary coproporphyria
Explanation: ***Hereditary coproporphyria*** - This condition is primarily associated with **acute episodes** and **neuropathy**, rather than cutaneous manifestations. [2] - Unlike cutaneous porphyrias, symptoms are more systemic and do not commonly present with **skin lesions**. Although skin features can occur in some instances, they mimic porphyria cutanea tarda. [2] *Congenital erythropoeitic porphyria* - Characterized by severe **cutaneous symptoms** such as blistering and photosensitivity due to **skin exposure**. - Patients exhibit notable **facial disfigurement** and can have **hemolytic anemia**, aligning it clearly with the cutaneous forms of porphyria. *Sideroblastic anemia* - This condition involves issues with **hemoglobin synthesis** and does not fit the porphyria classification. [1] - It primarily presents with **microcytic anemia**, and the symptoms are primarily hematological, not cutaneous. [1] *Erythropoeitic porphyria* - Characterized by **severe photosensitivity** and skin manifestations, similar to congenital erythropoeitic porphyria. [1] - Patients may develop **blisters** and **hyperpigmentation** upon sun exposure, categorizing it among cutaneous porphyrias. [2]
Question 1086: Pagophagia is associated with the consumption of which substance?
- A. Ice (Correct Answer)
- B. Sand
- C. Clay
- D. Salt
Explanation: ***Ice*** - **Pagophagia** is the compulsive consumption of **ice**, ice water, or iced beverages. - It is a specific form of **pica** [1] and is often associated with **iron deficiency anemia**. *Sand* - The compulsive consumption of **sand** is known as **geophagia**, a form of pica [1]. - It is not directly termed "pagophagia." *Clay* - The compulsive consumption of **clay** is also a form of **geophagia** [1]. - This term distinguishes it from the consumption of ice. *Salt* - While excessive salt intake can be a craving, it is not referred to as **pagophagia**. - Salt cravings can sometimes indicate certain electrolyte imbalances but are distinct from **pica** presentations like pagophagia [1].
Question 1087: What are the key characteristics of Evans syndrome?
- A. Autoimmune hemolytic anemia and immune thrombocytopenia (Correct Answer)
- B. Low lymphocyte and red blood cell counts
- C. High platelet and lymphocyte counts
- D. A reduction in all blood cell types
Explanation: ***Autoimmune hemolytic anemia and immune thrombocytopenia*** - **Evans syndrome** is defined by the simultaneous or sequential occurrence of **autoimmune hemolytic anemia (AIHA)** and **immune thrombocytopenia (ITP)** [1], [2]. - Both conditions involve the immune system mistakenly attacking and destroying **red blood cells** and **platelets**, respectively [1], [2]. *Low lymphocyte and red blood cell counts* - While **red blood cell counts** are low in Evans syndrome due to AIHA, **lymphocyte counts** are not a defining characteristic; they can vary. - This option does not fully capture the dual autoimmune destruction of red blood cells and platelets specific to Evans syndrome. *High platelet and lymphocyte counts* - **Platelet counts** are **low** in Evans syndrome due to ITP, not high. - **Lymphocyte counts** are not characteristically high; a high count might suggest other conditions like leukemias or lymphomas. *A reduction in all blood cell types* - A reduction in all (red blood cells, white blood cells, and platelets) is known as **pancytopenia**, which is not the defining feature of Evans syndrome. - Evans syndrome specifically involves the destruction of **red blood cells** and **platelets**, but not necessarily all white blood cell types.
Question 1088: Which of the following is commonly seen in Polycythemia Vera?
- A. Hyperuricemia
- B. Prone for acute leukemia
- C. Spontaneous severe infection
- D. Thrombosis (Correct Answer)
Explanation: ***Spontaneous severe infection*** - In Polycythemia Vera, there is usually an **increased red blood cell mass** leading to complications like thrombosis, rather than a predisposition to severe infections. - Severe infections are not a typical feature, as the condition usually maintains **functional immunity** despite hyperviscosity. *Thrombosis* - Individuals with Polycythemia Vera have increased blood viscosity that results in a higher risk of **thrombosis**, which is a common complication [1]. - Events like **deep vein thrombosis (DVT)** or **cerebral venous sinus thrombosis** are often observed due to altered hemodynamics. *Hyperuricemia* - Hyperuricemia occurs due to increased cell turnover and breakdown of red cells in Polycythemia Vera, leading to elevated **uric acid levels** [1]. - Patients may experience **gout attacks** as a consequence of this elevated uric acid [1]. *Prone for acute leukemia* - While there is an increased risk of transformation to myeloid neoplasms, the risk for **acute leukemia** is not directly attributed to Polycythemia Vera in most cases. - It is more related to myelofibrosis or secondary conditions developing over time rather than a direct association.
Question 1089: Which of the following conditions is associated with megaloblastic anemia?
- A. Pernicious anemia (Correct Answer)
- B. Iron deficiency anemia
- C. Intestinal lymphatic ectasia
- D. Chronic kidney disease
Explanation: a and b - Megaloblastic anemia is commonly associated with **vitamin B12** [1] and **folate deficiencies** [2], which can occur due to various causes. - Conditions leading to malabsorption (such as those related to the gastrointestinal tract) contribute significantly to megaloblastic anemia [1, 2]. *ileal resection* - Ileal resection can indeed lead to **malabsorption** of vitamin B12 [1], particularly if the distal ileum is removed. - However, it is important to note that megaloblastic anemia specifically reflects a broader range of potential deficiencies, thus it is not an exclusive answer. *Crohn's disease* - Crohn's disease can cause **malabsorption** and result in vitamin B12 deficiency but is not a direct cause of megaloblastic anemia on its own. - The anemia may occur due to complications like **ileo-pouch anastomosis** rather than the disease itself. *Intestinal lymphatic ectasia* - This condition leads to **protein-losing enteropathy**, potentially causing deficiencies but not specifically leading to megaloblastic anemia. - The anemia associated with this condition is typically due to **hypoalbuminemia** and not a result of any vitamin deficiency directly.
Question 1090: What is the recommended time frame for completing a blood transfusion after initiation?
- A. 1-4 hours (Correct Answer)
- B. 3-6 hours
- C. 4-8 hours
- D. 8-12 hours
Explanation: ***1-4 hours*** - This timeframe is recommended to **minimize the risk of bacterial growth** in the blood product, as bacteria can multiply quickly at room temperature. - Completing the transfusion within 4 hours also reduces the likelihood of **red blood cell degeneration** and loss of efficacy. *3-6 hours* - This period extends beyond the recommended maximum of 4 hours, increasing the risk of **bacterial proliferation** in the blood product. - Prolonged infusion times can also lead to a **decrease in the viability and function** of transfused cells. *4-8 hours* - Transfusing over 4-8 hours significantly elevates the risk of **bacterial contamination** and potential septic reactions. - The extended duration compromises the **quality and safety** of the blood product. *8-12 hours* - This timeframe is unacceptably long for a blood transfusion, posing a **critical risk of severe bacterial growth** and infection. - Blood products should not be administered beyond 4 hours due to the rapid decline in **cell integrity and increased adverse reaction potential**.
Practice by Chapter
Anemia Evaluation and Management
Practice Questions
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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