Hematology Practice Questions

Q: For extraction in a leukemic patient, what is the appropriate initial step?

All of the above. **Explanation:** The management of a leukemic patient requiring an invasive procedure like dental extraction necessitates a multidisciplinary approach due to the systemic risks of the disease and its treatment [1]. 1. **Consult Physician (Option A):** This is the mandatory first step to determine the patient’s current status (remission vs. active phase), the type of leukemia, and the timing of chemotherapy [1]. The physician provides clearance and coordinates the timing of the procedure to coincide with the patient's "best" hematologic window. 2. **Obtain WBC Count (Option B):** Leukemic patients are often neutropenic (due to the disease or chemotherapy), making them highly susceptible to post-operative infections and sepsis. A total and differential WBC count is essential to decide if prophylactic antibiotics are required. 3. **Obtain Platelet Count (Option C):** Thrombocytopenia is a hallmark of leukemia. For a safe extraction, a minimum platelet count (typically >50,000/mm³) is required to ensure primary hemostasis and prevent life-threatening hemorrhage. **Conclusion:** Since all three steps are interdependent and vital for patient safety, **Option D** is the correct answer. **High-Yield Clinical Pearls for NEET-PG:** * **Safe Thresholds:** For minor oral surgery, the Absolute Neutrophil Count (ANC) should ideally be **>1,000 cells/mm³** and Platelets **>50,000/mm³**. * **Timing:** The best time for dental treatment is usually during the maintenance phase or when the patient is in remission [1]. Avoid procedures during the "nadir" (lowest blood counts) following chemotherapy. * **Prophylaxis:** If the ANC is <1,000, antibiotic prophylaxis is mandatory to prevent opportunistic infections.

Q: Classical "Rain drop" lesions are seen in which of the following conditions?

Multiple myeloma. **Explanation:** **Multiple Myeloma (Option C)** is the correct answer. The "Rain drop" appearance (also known as "punched-out" lesions) refers to multiple, small, well-circumscribed radiolucent areas seen on a skull X-ray [1]. These lesions occur because malignant plasma cells in the bone marrow secrete **Osteoclast Activating Factors** (such as IL-6 and RANK-L), which stimulate osteoclasts to resorb bone while inhibiting osteoblastic activity [1]. This leads to purely lytic bone destruction without any surrounding reactive sclerosis. **Why other options are incorrect:** * **Burkitt’s Lymphoma (Option A):** Characterized histologically by a "Starry sky" appearance (macrophages among neoplastic B-cells) and radiologically by jaw involvement, but not rain-drop skull lesions. * **Hodgkin’s Lymphoma (Option B):** Typically presents with lymphadenopathy and Reed-Sternberg cells. Bone involvement is less common and often osteoblastic (sclerotic), such as the "Ivory vertebra." * **Haemophilia (Option D):** Primarily a bleeding disorder. Chronic joint bleeds lead to "Haemophilic arthropathy" and "Pseudotumors" (subperiosteal hemorrhage), not diffuse lytic skull lesions. **NEET-PG High-Yield Pearls:** * **Skeletal Survey:** In Multiple Myeloma, a plain X-ray is superior to a Bone Scan (Technetium-99m), as bone scans require osteoblastic activity to show "hot spots," which is absent in myeloma. * **CRAB Criteria:** Calcium (high), Renal failure, Anemia, and Bone lesions. * **M-Spike:** Found on Serum Protein Electrophoresis (usually IgG). * **Bence-Jones Proteins:** Free light chains found in urine that precipitate at 40-60°C and redissolve at 100°C.

Q: Which of the following clinical findings is not typically present in sickle cell anemia?

Leukopenia. **Explanation:** In **Sickle Cell Anemia (SCA)**, the underlying pathophysiology involves chronic hemolysis and recurrent vaso-occlusive crises (VOC) [1]. **Why Leukopenia is the correct answer:** Patients with SCA typically present with **Leukocytosis** (elevated WBC count), not leukopenia. This occurs because the chronic inflammatory state and the stress of hemolysis lead to the demargination of neutrophils and increased bone marrow output. A high baseline leukocyte count is actually a poor prognostic marker, as it correlates with an increased risk of stroke and acute chest syndrome. **Analysis of Incorrect Options:** * **Pulmonary Arterial Hypertension (PAH):** This is a common chronic complication (found in ~10% of patients). It results from chronic hemolysis, which releases free hemoglobin that scavenges Nitric Oxide (NO), leading to vasoconstriction and vascular remodeling. * **Fish Vertebrae:** Also known as "codfish vertebrae," this refers to the biconcave appearance of vertebral bodies on X-ray. It occurs due to micro-infarctions of the endplates and compensatory overgrowth of the remaining bone, leading to central depression. * **Cardiomegaly:** Chronic severe anemia leads to a **hyperdynamic circulation**. To maintain oxygen delivery, the stroke volume increases, eventually resulting in eccentric left ventricular hypertrophy and cardiomegaly. **High-Yield Clinical Pearls for NEET-PG:** 1. **Autosplenectomy:** Recurrent splenic infarcts lead to a shrunken, fibrotic spleen by childhood, making patients susceptible to encapsulated organisms (*S. pneumoniae*, *H. influenzae*) [1]. 2. **Howell-Jolly Bodies:** These are seen on peripheral smears post-autosplenectomy. 3. **Salmonella Osteomyelitis:** While *S. aureus* is the most common cause of osteomyelitis overall, *Salmonella* is uniquely associated with SCA. 4. **Aplastic Crisis:** Most commonly triggered by **Parvovirus B19** infection [1].

Q: Which of the following is true regarding lymph node enlargement in Hodgkin's Lymphoma?

Painless. In Hodgkin’s Lymphoma (HL), the classic presentation is a young adult with asymptomatic lymphadenopathy. ### **Explanation of the Correct Answer** **Option B (Painless)** is correct because the lymph node enlargement in HL is typically due to the slow, clonal expansion of B-cells (Reed-Sternberg cells) and an associated inflammatory infiltrate. Unlike infections, where rapid expansion causes stretching of the lymph node capsule and subsequent pain, the growth in lymphoma is gradual and does not trigger an acute inflammatory pain response. ### **Analysis of Incorrect Options** * **Option A (Matted):** Matted lymph nodes (nodes that feel fused together) are characteristic of **Tuberculosis (TB)** or metastatic carcinoma. In HL, nodes are typically discrete, rubbery, and firm. * **Option C (Non-progressive):** Lymphomatous nodes are **progressive**. They continue to enlarge over time and may eventually involve adjacent node groups in a predictable, contiguous fashion. * **Option D (Tender):** Tenderness is a hallmark of **lymphadenitis** (acute infection). Malignant nodes are characteristically non-tender. ### **High-Yield Clinical Pearls for NEET-PG** * **Alcohol-Induced Pain:** A unique, pathognomonic feature of HL is the onset of **pain in the lymph nodes immediately after alcohol consumption** (seen in 10% in 6 months) are critical for staging and prognosis.

Q: CD19 positive, CD22 positive, CD103 positive monoclonal B-cells with bright kappa positivity, comprising 60% of peripheral blood lymphoid cells, were found on flow cytometric analysis in a 55-year-old man with massive splenomegaly and a total leukocyte count of 3.3 × 10^9/L. What is the most likely diagnosis?

Hairy cell leukemia. ### Explanation The correct diagnosis is **Hairy Cell Leukemia (HCL)**. This is a rare B-cell lymphoproliferative disorder typically seen in middle-aged men, characterized by the classic triad of **splenomegaly** (often massive), **pancytopenia** (due to bone marrow fibrosis and splenic sequestration), and **monocytosis-absentia**. **Why HCL is the correct answer:** The flow cytometry profile provided is pathognomonic for HCL. While CD19 and CD22 confirm a B-cell lineage, the presence of **CD103** is a highly specific marker for Hairy Cell Leukemia. Other characteristic markers (not mentioned here but high-yield) include CD11c, CD25, and Annexin A1. The "bright" light chain (kappa) expression is also typical of the mature B-cell phenotype seen in HCL. **Why the other options are incorrect:** * **Splenic lymphoma with villous lymphocytes (SLVL):** While it presents with splenomegaly, it is typically **CD103 negative** and does not show the same degree of cytopenia as HCL. * **Mantle cell lymphoma (MCL):** MCL is characterized by **CD5 positivity** and the t(11;14) translocation leading to Cyclin D1 overexpression. It is CD103 negative. * **B-cell prolymphocytic leukemia (B-PLL):** This presents with a very high white cell count (usually >100 × 10⁹/L) and prominent nucleoli in prolymphocytes, unlike the leucopenia/pancytopenia seen in this case. **High-Yield Clinical Pearls for NEET-PG:** * **Morphology:** "Hairy" cytoplasmic projections on peripheral smear. * **Bone Marrow:** Often results in a **"Dry Tap"** due to increased reticulin fibrosis; biopsy shows a **"Fried Egg" appearance**. * **Cytochemistry:** **TRAP positive** (Tartrate-Resistant Acid Phosphatase). * **Genetic Marker:** **BRAF V600E** mutation is present in nearly 100% of classic HCL cases. * **Treatment of Choice:** Cladribine (2-CdA) or Pentostatin.

Q: Cryoprecipitate contains which of the following factors EXCEPT?

Albumin. **Explanation:** Cryoprecipitate is a concentrated blood product prepared by thawing one unit of Fresh Frozen Plasma (FFP) at 1–6°C and collecting the insoluble precipitate. This process selectively concentrates specific high-molecular-weight proteins while leaving behind most plasma proteins, including albumin. **Why Albumin is the correct answer:** Albumin is the most abundant protein in plasma, but it remains in the supernatant (the liquid portion) during the cold-thawing process [2]. It is **not** concentrated in the cryoprecipitate. Albumin is typically replaced using 5% or 25% albumin solutions or FFP, but not cryoprecipitate [1]. **Why the other options are incorrect:** Cryoprecipitate is specifically rich in the following "cold-insoluble" factors: * **Fibrinogen (Factor I):** It is the primary source of fibrinogen (approx. 150–250 mg per unit). * **Factor VIII:** Contains significant levels of anti-hemophilic factor. * **Von Willebrand Factor (vWF):** Essential for platelet adhesion. * **Factor XIII:** Also known as fibrin-stabilizing factor. * **Fibronectin:** A glycoprotein involved in cell adhesion. **NEET-PG High-Yield Clinical Pearls:** 1. **Indication of Choice:** Cryoprecipitate is the preferred treatment for **Hypofibrinogenemia** (e.g., in DIC or massive transfusion protocols) and **Factor XIII deficiency**. 2. **Storage:** It is stored at **-18°C or colder** and has a shelf life of 1 year. Once thawed, it must be used within 4–6 hours. 3. **Dosage:** 1 unit of cryoprecipitate per 10 kg of body weight typically raises fibrinogen by 50–100 mg/dL. 4. **Historical Note:** While it contains Factor VIII and vWF, recombinant or plasma-derived concentrates are now preferred for Hemophilia A and vWD to reduce viral transmission risks.

Question 1

For extraction in a leukemic patient, what is the appropriate initial step?

Accepted Answer

All of the above

Answer

Consult physician

Answer

Obtain WBC count

Answer

Obtain platelet count

Question 2

A crisis in a patient with sickle cell disease is most likely to be caused by which of the following conditions?

Accepted Answer

Acidosis

Answer

Alkalosis

Answer

Increased oxygen concentration

Answer

Decreased CO2 concentration

Question 3

Haemoglobinuria does not occur in:

Accepted Answer

Copper sulfate poisoning

Answer

Snake bite

Answer

Mismatched blood transfusion

Answer

Thalassemia

Question 4

Isolated prolongation of the activated partial thromboplastin time (aPTT) is typically seen in which of the following conditions?

Accepted Answer

Antiphospholipid antibodies

Answer

Von Willebrand's disease

Answer

Factor VII deficiency

Answer

Vitamin K deficiency

Question 5

Classical "Rain drop" lesions are seen in which of the following conditions?

Accepted Answer

Multiple myeloma

Answer

Burkitt's lymphoma

Answer

Hodgkin's lymphoma

Answer

Haemophilia

Question 6

Which of the following clinical findings is not typically present in sickle cell anemia?

Accepted Answer

Leukopenia

Answer

Pulmonary arterial hypertension (PAH)

Answer

Fish vertebrae

Answer

Cardiomegaly

Question 7

Which of the following is true regarding lymph node enlargement in Hodgkin's Lymphoma?

Accepted Answer

Painless

Answer

Matted lymph nodes

Answer

Non-progressive

Answer

Tender

Question 8

CD19 positive, CD22 positive, CD103 positive monoclonal B-cells with bright kappa positivity, comprising 60% of peripheral blood lymphoid cells, were found on flow cytometric analysis in a 55-year-old man with massive splenomegaly and a total leukocyte count of 3.3 × 10^9/L. What is the most likely diagnosis?

Accepted Answer

Hairy cell leukemia

Answer

Splenic lymphoma with villous lymphocytes

Answer

Mantle cell lymphoma

Answer

B-cell prolymphocytic leukemia

Question 9

Cryoprecipitate contains which of the following factors EXCEPT?

Accepted Answer

Albumin

Answer

Fibrinogen

Answer

Factor VIII

Answer

Von Willebrand factor

Question 10

Which of the following statements is false regarding Multiple Myeloma?

Accepted Answer

It is a plasma cell malignancy characterized by the overproduction of a monoclonal immunoglobulin.

Answer

Bence Jones proteins are typically found in the urine.

Answer

Lytic bone lesions are a common radiological finding.

Answer

Rouleaux formation of red blood cells may be observed on peripheral blood smear.

Hematology — MCQs

Hematology — MCQs

On this page

Practice by Chapter

Want unlimited practice?