Hematology — MCQs
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A 22-year-old man presents to the emergency department with dyspnea, palpitations, and a headache, which developed shortly after taking trimethoprim-sulfamethoxazole for a urinary tract infection. Laboratory studies reveal a normochromic, normocytic anemia, and a peripheral blood smear shows Heinz bodies. Which of the following is the most likely cause of this patient's anemia?
All of the following are causes of microcytic hypochromic anemia except:
Hemolytic anemia may be characterized by all of the following except which of the following?
What is the treatment for chemotherapy-induced agranulocytopenia?
Plummer-Vinson syndrome is characterized by all of the following except:
Which of the following is more likely associated with a platelet disorder rather than hemophilia A?
Which of the following is a potential complication of blood transfusion?
A 15-year-old boy suffering from Hodgkin's disease with lymph node involvement. Which treatment option is likely to have a high success rate?
All-trans-retinoic acid is used in the treatment of:
A female with recurrent abortion and isolated prolonged activated partial thromboplastin time (APTT) is most likely associated with.
Hematology Indian Medical PG Practice Questions and MCQs
Question 1161: A 22-year-old man presents to the emergency department with dyspnea, palpitations, and a headache, which developed shortly after taking trimethoprim-sulfamethoxazole for a urinary tract infection. Laboratory studies reveal a normochromic, normocytic anemia, and a peripheral blood smear shows Heinz bodies. Which of the following is the most likely cause of this patient's anemia?
- A. Glucose-6-phosphate dehydrogenase deficiency (Correct Answer)
- B. Folate deficiency
- C. Lead poisoning
- D. Hereditary spherocytosis
Explanation: ***Glucose-6-phosphate dehydrogenase deficiency*** - The patient's symptoms (dyspnea, palpitations, headache) along with **normochromic, normocytic anemia** and the presence of **Heinz bodies** after taking **trimethoprim-sulfamethoxazole** are highly indicative of **hemolytic anemia** due to G6PD deficiency [1], [2]. - Trimethoprim-sulfamethoxazole is an **oxidative stressor** that can trigger hemolysis in individuals with G6PD deficiency, as they cannot produce sufficient **NADPH** to protect red blood cells from oxidative damage [1]. *Lead poisoning* - Lead poisoning typically causes a **microcytic, hypochromic anemia** and is associated with **basophilic stippling** on a peripheral blood smear, not Heinz bodies. - Symptoms usually include **abdominal pain**, **neuropathy**, and **cognitive deficits**, which are not clearly described here. *Folate deficiency* - Folate deficiency leads to a **macrocytic, megaloblastic anemia**, characterized by **hypersegmented neutrophils** and large red blood cells. - It would not typically present with Heinz bodies or be exacerbated by trimethoprim-sulfamethoxazole in this manner. *Hereditary spherocytosis* - This condition is characterized by **spherocytes** on the peripheral smear and increased osmotic fragility, often leading to chronic hemolytic anemia. - While it causes hemolytic anemia, the presence of **Heinz bodies** specifically after an oxidative stressor (like trimethoprim-sulfamethoxazole) points more strongly to G6PD deficiency [2].
Question 1162: All of the following are causes of microcytic hypochromic anemia except:
- A. Thalassemia
- B. Fanconi's anemia (Correct Answer)
- C. Iron deficiency anemia
- D. Lead poisoning
Explanation: ***Fanconi anaemia*** - Fanconi anemia is a type of **aplastic anemia** caused by bone marrow failure, which does not typically result in **microcytic hypochromic anemia**. - The anemia in Fanconi's is usually **normocytic** due to inadequate production of red blood cells rather than defective hemoglobin production. *Iron deficiency* - Iron deficiency anemia is the most common cause of **microcytic hypochromic anemia**, characterized by decreased **iron stores** affecting hemoglobin synthesis [1]. - Common clinical features include **fatigue**, **pallor**, and **koilonychia** (spoon nails). *Lead poisoning* - Lead poisoning leads to microcytic hypochromic anemia by causing **inhibition of heme synthesis**, resulting in the accumulation of **protoporphyrin**. - Alongside anemia, symptoms may include **abdominal pain** and **neurological dysfunction**. *Thalassemia* - Thalassemia is a genetic disorder that also causes **microcytic hypochromic anemia** due to inadequate formation of **alpha or beta globin chains**. - Patients often present with **chronic anemia** and **splenomegaly** due to hemolysis.
Question 1163: Hemolytic anemia may be characterized by all of the following except which of the following?
- A. Hyperbilirubinemia
- B. Reticulocytosis
- C. Hemoglobinuria
- D. Increased plasma haptoglobin level (Correct Answer)
Explanation: ***Increased plasma haptoglobin level*** - **Haptoglobin** binds to free hemoglobin released during **hemolysis** and is then cleared from the circulation [1]. Therefore, in hemolytic anemia, the plasma haptoglobin level would be **decreased**, not increased. - An increased haptoglobin level typically indicates an **inflammatory response** or is observed in conditions without significant intravascular hemolysis. *Hyperbilirubinemia* - **Increased breakdown of red blood cells** releases large amounts of **heme**, which is metabolized into **unconjugated bilirubin** [2]. - This leads to an overload of the liver's capacity to conjugate bilirubin, resulting in **unconjugated hyperbilirubinemia** [2]. *Reticulocytosis* - The body responds to the loss of red blood cells through hemolysis by **increasing production of new red blood cells** in the bone marrow. - This increased production leads to a higher-than-normal percentage of immature red blood cells, known as **reticulocytes**, in the peripheral blood. *Hemoglobinuria* - When **intravascular hemolysis** occurs, free hemoglobin is released into the bloodstream and exceeds the binding capacity of haptoglobin [1]. - This excess unbound hemoglobin is filtered by the kidneys and excreted in the urine, leading to **dark-colored urine** due to hemoglobin.
Question 1164: What is the treatment for chemotherapy-induced agranulocytopenia?
- A. Packed red blood cells
- B. Platelet transfusion
- C. Granulocyte colony-stimulating factor (G-CSF) (Correct Answer)
- D. Granulocyte-macrophage colony-stimulating factor (GM-CSF), less commonly used.
Explanation: ***Granulocyte colony-stimulating factor (G-CSF)*** - **G-CSF** directly stimulates the production and maturation of **granulocytes** (including neutrophils) in the bone marrow, - This helps to **increase neutrophil counts** and shorten the duration of **chemotherapy-induced agranulocytopenia**, reducing the risk of infection. *Packed red blood cells* - **Packed red blood cells (PRBCs)** are used to treat **anemia**, not agranulocytopenia. - They increase **hemoglobin** levels but have no effect on neutrophil count. *Platelet transfusion* - **Platelet transfusions** are administered to treat **thrombocytopenia** (low platelet count) and prevent bleeding. - They do not address the low neutrophil count seen in **agranulocytopenia**. *Granulocyte-macrophage colony-stimulating factor (GM-CSF), less commonly used.* - **GM-CSF** stimulates the production of both **granulocytes** and **macrophages**. - While it can increase neutrophil counts, **G-CSF** is generally preferred due to its more specific action and lower incidence of side effects for neutropenia.
Question 1165: Plummer-Vinson syndrome is characterized by all of the following except:
- A. Megaloblastic anemia (Correct Answer)
- B. Iron deficiency anemia
- C. Dysphagia
- D. Glossitis
Explanation: ***Megaloblastic anemia*** - Plummer-Vinson syndrome is associated with **iron deficiency anemia**, not megaloblastic anemia [2]. - **Megaloblastic anemia** is caused by deficiencies in **vitamin B12** or **folate**, leading to impairment in DNA synthesis [1]. *Glossitis* - **Glossitis**, or inflammation of the tongue, is a common symptom of Plummer-Vinson syndrome due to **iron deficiency**. - This symptom can contribute to the difficulty in swallowing experienced by patients. *Iron deficiency anemia* - **Iron deficiency anemia** is a primary characteristic of Plummer-Vinson syndrome, leading to various symptoms [2]. - The anemia is thought to contribute to the formation of esophageal webs which cause dysphagia. *Dysphagia* - **Dysphagia**, or difficulty swallowing, is a hallmark symptom of Plummer-Vinson syndrome, usually caused by **esophageal webs**. - These webs are thin mucosal folds that form in the upper esophagus, obstructing **food passage**.
Question 1166: Which of the following is more likely associated with a platelet disorder rather than hemophilia A?
- A. Epistaxis (Correct Answer)
- B. Late rebleeding
- C. Hemarthrosis
- D. Prolonged activated partial thromboplastin time
Explanation: ***Epistaxis*** - **Epistaxis**, or nosebleeds, is commonly associated with **platelet disorders** due to poor **platelet function** or **thrombocytopenia** [1]. - It occurs due to **vascular fragility** and inadequate platelet response, unlike hemophilia A, which primarily affects coagulation factors [1]. *Late rebleeding* - **Late rebleeding** is more characteristic of **coagulation disorders** like hemophilia A, where hemophilic patients may experience delayed bleeding after injury. - It results from factors' prolonged activity rather than intrinsic platelet dysfunction. *Hemarthrosis* - **Hemarthrosis** (bleeding into joints) is a classic manifestation of hemophilia A, specifically due to deficiencies in **coagulation factors** [1]. - This is not typical for platelet disorders, which do not significantly affect joints [1]. *Prolonged partial thromboplastin time* - A **prolonged partial thromboplastin time (PTT)** is indicative of deficiencies in intrinsic pathway factors, which is more aligned with hemophilia rather than platelet disorders. - Platelet disorders typically do not affect PTT but may prolong bleeding time due to poor platelet function [2].
Question 1167: Which of the following is a potential complication of blood transfusion?
- A. Hyponatremia
- B. Hypercalcemia
- C. Increased serum albumin
- D. Hyperkalemia (Correct Answer)
Explanation: ***Hyperkalemia*** - Stored red blood cells can release **intracellular potassium** into the storage solution, leading to elevated potassium levels in transfused blood. - Rapid or massive transfusions deliver a significant potassium load, potentially causing **cardiac arrhythmias**. *Hyponatremia* - This is generally not a direct complication of blood transfusions; instead, blood products themselves contain electrolytes, and massive transfusion can disrupt electrolyte balance, but usually not to cause hyponatremia. - Volume overload from transfusion could dilute existing electrolytes, but most commonly, other electrolyte imbalances such as hyperkalemia or hypocalcemia occur. *Hypercalcemia* - Often, the opposite, **hypocalcemia**, is a complication of massive transfusion due to **citrate toxicity**. - Citrate, an anticoagulant in transfused blood, chelates calcium, reducing free calcium levels in the recipient. *Increased serum albumin* - Blood transfusions primarily administer **red blood cells**, plasma, or platelets, not typically albumin in amounts that would significantly increase serum albumin levels in the absence of an albumin-specific infusion [1]. - Low albumin (hypoalbuminemia) is a common finding in critically ill patients, and a blood transfusion usually doesn't correct this unless plasma or albumin is specifically administered [1].
Question 1168: A 15-year-old boy suffering from Hodgkin's disease with lymph node involvement. Which treatment option is likely to have a high success rate?
- A. Chemotherapy (Correct Answer)
- B. Surgical resection of lymph nodes
- C. Targeted immunotherapy
- D. Surgery combined with immunotherapy
Explanation: ***Chemotherapy*** - **Hodgkin's disease** (lymphoma) is a systemic malignancy, and chemotherapy is the cornerstone of treatment, especially for widespread disease like lymph node involvement [1]. - Combination chemotherapy regimens, such as **ABVD** (Adriamycin, Bleomycin, Vinblastine, Dacarbazine), achieve high cure rates in pediatric Hodgkin's lymphoma. *Surgical resection of lymph nodes* - Surgical resection is generally **not curative** for Hodgkin's disease because it is a systemic malignancy, meaning cancer cells can be present in other lymph nodes or organs not visible [1]. - It might be used for **biopsy** or to debulk very large masses causing symptoms, but not as primary curative therapy [1]. *Targeted immunotherapy* - While immunotherapy agents like **Brentuximab vedotin** are used in Hodgkin's lymphoma, they are typically reserved for **relapsed/refractory disease** or in specific high-risk settings, not usually as first-line monotherapy. - Traditional chemotherapy remains the primary curative approach for initial presentation with lymph node involvement [1]. *Surgery combined with immunotherapy* - This combination is **not the standard primary treatment** for Hodgkin's lymphoma with lymph node involvement. - Surgery has a limited role, and while immunotherapy has a role, it's often in conjunction with chemotherapy or for specific cases, not typically as the initial combined approach with surgery.
Question 1169: All-trans-retinoic acid is used in the treatment of:
- A. Acute promyelocytic leukemia (APL) (Correct Answer)
- B. Acute lymphoblastic leukemia (ALL)
- C. Chronic myeloid leukemia (CML)
- D. Transient myeloproliferative disorder (TMD)
Explanation: ***Acute promyelocytic leukemia (APL)*** - **All-trans-retinoic acid (ATRA)** is a cornerstone of APL treatment, targeting the specific **PML-RARα fusion protein** responsible for the disease [1]. - ATRA induces the differentiation of immature promyelocytes into mature granulocytes, thereby resolving the **leukemic block** in differentiation [1]. *Acute lymphoblastic leukemia (ALL)* - While ALL involves immature lymphocytes, ANTRA has no significant role in its treatment, which typically involves **multi-agent chemotherapy**, **corticosteroids**, and sometimes **targeted therapies** like tyrosine kinase inhibitors (for Ph+ ALL) [1]. - The mechanism of action of ATRA is specific to the myeloid lineage and the **PML-RARα fusion** [1]. *Chronic myeloid leukemia (CML)* - CML is characterized by the **BCR-ABL1 fusion gene** and is primarily treated with **tyrosine kinase inhibitors (TKIs)** like imatinib, nilotinib, or dasatinib. - ATRA does not target the molecular pathogenesis of CML and is not used in its standard treatment. *Transient myeloproliferative disorder (TMD)* - TMD, also known as transient abnormal myelopoiesis, is a myeloproliferative disorder seen in infants with **Down syndrome** and usually resolves spontaneously. - While it has myeloid features, ATRA is not a standard treatment; management is often **supportive** or involves low-dose chemotherapy if severe.
Question 1170: A female with recurrent abortion and isolated prolonged activated partial thromboplastin time (APTT) is most likely associated with.
- A. Lupus anticoagulant (Correct Answer)
- B. Hemophilia
- C. Von Willebrand disease
- D. DIC
Explanation: ***Lupus anticoagulant*** - **Lupus anticoagulant** is an antibody that paradoxically prolongs **APTT** [1] in vitro but is associated with a **prothrombotic state** in vivo, leading to recurrent abortions. - It is a key feature of **Antiphospholipid Syndrome (APS)**, which classically presents with **recurrent pregnancy loss and thrombotic events**. *DIC* - **Disseminated Intravascular Coagulation (DIC)** involves widespread activation of the clotting cascade, leading to both **thrombosis** and **hemorrhage**. - While it can cause prolonged **APTT**, it would also be characterized by **thrombocytopenia**, **prolonged PT**, and elevated **D-dimer** [2], which are not mentioned. *Von Willebrand disease* - **Von Willebrand disease (vWD)** is a common **bleeding disorder** due to deficiency or dysfunction of **von Willebrand factor** [3]. - It can cause a prolonged **APTT** (if factor VIII levels are significantly low) and bleeding, but it is not typically associated with **recurrent abortions** due to thrombosis [3]. *Hemophilia* - **Hemophilia** (A or B) is an **X-linked recessive bleeding disorder** characterized by a deficiency of **Factor VIII (Hemophilia A)** or **Factor IX (Hemophilia B)**. - It causes a prolonged **APTT** and significant bleeding episodes, but it is not associated with **thrombosis** or **recurrent abortions**.
Practice by Chapter
Anemia Evaluation and Management
Practice Questions
Hemoglobinopathies
Practice Questions
Thalassemias
Practice Questions
Platelet Disorders
Practice Questions
Coagulation Disorders
Practice Questions
Thrombotic Disorders
Practice Questions
Leukemias
Practice Questions
Lymphomas
Practice Questions
Multiple Myeloma and Plasma Cell Disorders
Practice Questions
Myeloproliferative Neoplasms
Practice Questions
Transfusion Medicine
Practice Questions
Hematopoietic Stem Cell Transplantation
Practice Questions
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