Hematology Practice Questions

Q: Which of the following is NOT true about Hemophilia A?

Prothrombin time (PT) is increased. **Explanation:** Hemophilia A is an X-linked recessive bleeding disorder caused by a deficiency or dysfunction of **Coagulation Factor VIII** [1]. To answer this question, one must understand the coagulation cascade and which laboratory tests evaluate specific pathways [2]. **Why Option B is the Correct Answer (The False Statement):** Prothrombin Time (PT) measures the **Extrinsic** and **Common pathways** (Factors VII, X, V, II, and I) [2]. Since Factor VIII is part of the **Intrinsic pathway**, its deficiency does not affect the PT. Therefore, PT remains **normal** in Hemophilia A [2]. **Analysis of Other Options:** * **Option A (Fibrinogen-to-thrombin time/Clotting dynamics):** While "FIT" is a less common term, in the context of hemophilia, any deficiency in the intrinsic pathway delays the generation of thrombin, which is essential for converting fibrinogen to fibrin. * **Option C (Clotting Time):** Clotting time is a global measure of the time required for blood to coagulate. In Hemophilia A, the defect in the intrinsic pathway significantly prolongs the clotting time. * **Option D (Factor VIII levels):** This is the hallmark of the disease [1]. Hemophilia A is defined by decreased serum levels of Factor VIII. **High-Yield Clinical Pearls for NEET-PG:** * **Lab Profile:** Prolonged aPTT (Activated Partial Thromboplastin Time) + Normal PT + Normal Bleeding Time + Normal Platelet Count [2]. * **Mixing Study:** If aPTT corrects after mixing the patient's plasma with normal plasma, it indicates a factor deficiency (like Hemophilia) [2]. If it does not correct, it suggests an inhibitor (like Lupus Anticoagulant). * **Clinical Presentation:** Characterized by deep tissue bleeding, **hemarthrosis** (bleeding into joints), and postsurgical bleeding. * **Treatment:** Recombinant Factor VIII concentrate; Desmopressin (DDAVP) can be used in mild cases to release stored Factor VIII from endothelial cells [3].

Q: A 39-year-old man with chronic alcoholism presents with a hemoglobin of 9.6 g/dL. His platelets and WBC are normal. Additional tests, including ferritin, vitamin B12, and folate levels, are also normal. Which of the following findings is most likely to be seen on his peripheral blood film?

Macrocytosis. The correct answer is **Macrocytosis (Option A)**. In a patient with chronic alcoholism and anemia, macrocytosis (increased Mean Corpuscular Volume or MCV) is the most common hematologic finding [1]. While macrocytosis is often associated with Vitamin B12 or Folate deficiency (megaloblastic anemia), it frequently occurs in alcoholics even when these levels are **normal** [1]. **The underlying mechanism:** Alcohol has a direct toxic effect on the bone marrow and interferes with erythrocyte membrane lipid metabolism, leading to an increased surface area-to-volume ratio. This results in "non-megaloblastic" macrocytosis, characterized by round macrocytes rather than the oval macrocytes seen in B12/Folate deficiency [2]. **Why other options are incorrect:** * **Basophilia (Option B):** Associated with myeloproliferative disorders (e.g., CML) or lead poisoning, not typically seen in chronic alcoholism. * **Red cell fragments (Option C):** These (schistocytes) are markers of microangiopathic hemolytic anemia (MAHA) or mechanical heart valve destruction, not alcohol toxicity. * **Increased platelet adhesiveness (Option D):** Alcohol actually **decreases** platelet aggregation and function, often leading to a mild bleeding tendency despite normal platelet counts. **High-Yield Clinical Pearls for NEET-PG:** 1. **Most common cause of Macrocytosis:** Alcohol consumption (even in the absence of anemia) [1]. 2. **MCV in Alcoholism:** Usually ranges between 100–110 fL. 3. **Target Cells:** May also be seen in alcoholic liver disease due to increased cholesterol deposition in the RBC membrane. 4. **Sideroblastic Anemia:** Chronic alcohol use can also cause ringed sideroblasts in the bone marrow due to interference with heme synthesis [2].

Q: Thrombocytopenia is not a feature of which of the following conditions?

Henoch-Schonlein purpura. **Explanation:** The core concept tested here is the differentiation between **palpable purpura** (vasculitic) and **non-palpable purpura** (thrombocytopenic). **1. Why Henoch-Schonlein Purpura (HSP) is the correct answer:** HSP is an **IgA-mediated small-vessel vasculitis**. The skin lesions (purpura) are caused by inflammation of the blood vessel walls, leading to RBC extravasation into the skin. Crucially, the **platelet count in HSP is normal or even elevated** (as an acute-phase reactant). The hallmark clinical triad includes palpable purpura (usually on lower limbs/buttocks), arthritis, and abdominal pain. **2. Why the other options are incorrect:** * **Cavernous Angioma (Kasabach-Merritt Syndrome):** Large vascular tumors can sequester and destroy platelets (consumptive coagulopathy), leading to profound thrombocytopenia. * **Thrombotic Thrombocytopenic Purpura (TTP):** Characterized by the formation of microthrombi in small vessels. This consumes platelets, leading to severe thrombocytopenia (part of the classic pentad: Microangiopathic hemolytic anemia, Thrombocytopenia, Fever, Renal failure, and Neurological symptoms). * **Disseminated Intravascular Coagulation (DIC):** Involves systemic activation of the coagulation cascade, leading to the widespread consumption of both clotting factors and platelets. **High-Yield Clinical Pearls for NEET-PG:** * **HSP:** Most common vasculitis in children; often follows an Upper Respiratory Tract Infection (URTI). Renal involvement (IgA Nephropathy) determines long-term prognosis. * **Platelet Count:** Always check the platelet count in a child with purpura. If it's normal, think HSP; if low, think ITP, Leukemia, or DIC. * **Kasabach-Merritt Syndrome:** High-yield association between "Giant Hemangioma" and "Thrombocytopenia."

Q: A couple with a family history of beta-thalassemia major in a distant relative has come for counseling. The husband has HbA2 of 4.8% and the wife has HbA2 of 2.3%. What is the risk of them having a child with beta-thalassemia major?

0%. ### Explanation **1. Understanding the Correct Answer (D: 0%)** To have a child with **Beta-Thalassemia Major**, both parents must be carriers (**Beta-Thalassemia Trait/Minor**). * **The Husband:** His HbA2 is **4.8%**. In clinical practice, an HbA2 level **>3.5%** is the diagnostic hallmark of Beta-Thalassemia Trait. Thus, the husband is a carrier. * **The Wife:** Her HbA2 is **2.3%**. The normal range for HbA2 is **1.5% to 3.5%**. Since her value is within the normal range, she is not a carrier of the beta-thalassemia gene. Beta-thalassemia is an **autosomal recessive** disorder. For a child to manifest the "Major" form ($β^0/β^0$ or $β^+/β^+$), they must inherit one defective gene from each parent. Since the wife is hematologically normal, she will always pass on a normal beta-globin gene. Therefore, the risk of having a child with Thalassemia Major is **0%**. (The risk of having a child with Thalassemia Trait is 50%). **2. Why Other Options are Incorrect** * **A (50%) & B (25%):** These probabilities would only apply if both parents were carriers. If both were carriers, the risk for Major would be 25% and for Trait would be 50%. * **C (5%):** This is a distractor with no genetic basis in Mendelian inheritance for this condition. **3. NEET-PG High-Yield Pearls** * **Gold Standard Diagnosis:** Hb electrophoresis or HPLC (High-Performance Liquid Chromatography). * **HbA2 Levels:** * Normal: 1.5–3.5% * β-Thalassemia Trait: >3.5% (usually 4–8%) * Iron Deficiency Anemia: Can falsely **lower** HbA2 levels, potentially masking a Thalassemia trait. * **Mentzer Index:** MCV/RBC count. If ** 13**, it suggests Iron Deficiency Anemia.

Q: Cold agglutinins are seen in which of the following conditions?

Influenza. **Explanation:** Cold agglutinins are autoantibodies (usually **IgM**) that bind to the 'I' or 'i' antigens on the surface of red blood cells at low temperatures (typically <30°C), leading to agglutination and extravascular hemolysis [1]. **1. Why Influenza is correct:** Cold agglutinin disease is frequently secondary to specific infections. The most common triggers are ***Mycoplasma pneumoniae*** (associated with anti-I antibodies) and viral infections like **Infectious Mononucleosis (EBV)**, **Cytomegalovirus (CMV)**, and **Influenza** [2]. These pathogens can trigger a transient, polyclonal IgM response that cross-reacts with RBC antigens [2]. **2. Why the other options are incorrect:** * **Polyarteritis nodosa (PAN):** This is a systemic necrotizing vasculitis of medium-sized arteries. It is classically associated with Hepatitis B, but not with cold agglutinins. * **Multiple myeloma:** This is a plasma cell dyscrasia characterized by IgG or IgA monoclonal spikes. While it can cause anemia of chronic disease or hyperviscosity, it is not a typical cause of cold agglutinins. * **Systemic lupus erythematosus (SLE):** SLE is the classic cause of **Warm Autoimmune Hemolytic Anemia (WAIHA)**, mediated by **IgG** antibodies that react at body temperature (37°C) [1]. **High-Yield Clinical Pearls for NEET-PG:** * **Warm AIHA:** IgG; associated with SLE, CLL, and drugs (α-methyldopa) [1]. * **Cold AIHA:** IgM; associated with *Mycoplasma*, EBV, and Lymphoma [2]. * **Blood Smear:** Look for **RBC clumps/agglutination** (unlike Rouleaux, which is linear) [2]. * **Direct Coombs Test:** In Cold AIHA, the test is positive for **C3d** (complement) but negative for IgG [1].

Q: Regarding multiple myeloma, which of the following statements is wrong?

Multiple hot spots on bone scan.. In Multiple Myeloma (MM), the primary mechanism of bone destruction is **osteoclastic activation** coupled with the **suppression of osteoblasts**. Bone scans (Technetium-99m MDP) rely on osteoblastic activity (new bone formation) to show "hot spots." Because MM lesions are purely lytic with minimal to no osteoblastic response, bone scans are notoriously insensitive and often appear "cold" or normal despite extensive bone involvement. Therefore, statement C is incorrect. **Analysis of other options:** * **Option A:** MM is by definition a malignant proliferation of monoclonal plasma cells in the bone marrow, producing an M-protein spike [1]. * **Option B:** The classic radiographic hallmark of MM is "punched-out" lytic lesions, most visible on a skeletal survey of the skull, spine, and long bones [1]. * **Option C (Correct Answer):** As explained, bone scans are typically negative; **MRI or PET-CT** are the preferred advanced imaging modalities. * **Option D:** Melphalan (an alkylating agent) remains a cornerstone of treatment, especially in transplant-ineligible patients (often combined with Prednisone and Bortezomib). **High-Yield Clinical Pearls for NEET-PG:** * **CRAB Criteria:** Calcium (elevated), Renal insufficiency, Anemia, and Bone lesions. * **Diagnosis:** Bone marrow plasma cells ≥10% or biopsy-proven plasmacytoma PLUS myeloma-defining events [1]. * **Bence-Jones Proteins:** These are free light chains in the urine; they are **not** detected by standard dipsticks (which detect albumin). * **M-Spike:** Usually IgG (most common) or IgA. * **Peripheral Smear:** Characterized by **Rouleaux formation** due to increased serum proteins [1].

Question 1

Which of the following is NOT true about Hemophilia A?

Accepted Answer

Prothrombin time (PT) is increased

Answer

Fibrinogen-to-thrombin time (FIT) is increased

Answer

Clotting time is increased

Answer

Serum levels of Factor VIII are decreased

Question 2

A 39-year-old man with chronic alcoholism presents with a hemoglobin of 9.6 g/dL. His platelets and WBC are normal. Additional tests, including ferritin, vitamin B12, and folate levels, are also normal. Which of the following findings is most likely to be seen on his peripheral blood film?

Accepted Answer

Macrocytosis

Answer

Basophilia

Answer

Red cell fragments

Answer

Increased platelet adhesiveness

Question 3

Thrombocytopenia is not a feature of which of the following conditions?

Accepted Answer

Henoch-Schonlein purpura

Answer

Cavernous angioma

Answer

Thrombotic thrombocytopenic purpura

Answer

Disseminated Intravascular Coagulation

Question 4

A couple with a family history of beta-thalassemia major in a distant relative has come for counseling. The husband has HbA2 of 4.8% and the wife has HbA2 of 2.3%. What is the risk of them having a child with beta-thalassemia major?

Accepted Answer

0%

Answer

50%

Answer

25%

Answer

5%

Question 5

Cold agglutinins are seen in which of the following conditions?

Accepted Answer

Influenza

Answer

Polyarteritis nodosa (PAN)

Answer

Multiple myeloma

Answer

Systemic lupus erythematosus (SLE)

Question 6

The parents of a 13-month-old boy are contacted by a local social agency because the day care reported them for suspected child abuse based on 'too many bruises.' The parents deny the abuse and promptly arrange to have their child seen by a medical specialist. The child has multiple large bruises on his legs, anus, and buttocks. No skin abrasions and no 'pattern marks' are seen. PTT is prolonged and PT and bleeding time are normal. Which of the following is the most probable diagnosis?

Accepted Answer

Von Willebrand disease

Answer

Acute myelogenous leukemia

Answer

Disseminated intravascular coagulation

Answer

Vitamin K deficiency

Question 7

Which of the following conditions is associated with raised levels of fetal hemoglobin (HbF)?

Accepted Answer

Juvenile chronic myeloid leukemia (CML)

Answer

Hereditary spherocytosis

Answer

Congenital red cell aplasia

Answer

Myasthenia gravis

Question 8

Decreased osmotic fragility is seen in which of the following conditions?

Accepted Answer

Thalassemia

Answer

Hereditary spherocytosis

Answer

Sickle cell disease

Answer

Autoimmune hemolytic anemia

Question 9

Regarding multiple myeloma, which of the following statements is wrong?

Accepted Answer

Multiple hot spots on bone scan.

Answer

Malignant neoplasm derived from plasma cells.

Answer

Multiple punched-out lesions on radiograms of the skull.

Answer

Melphalan is used in treatment.

Question 10

Compared to a hemolytic crisis, an aplastic crisis in sickle cell anemia leads to which of the following?

Accepted Answer

Decrease in reticulocytes

Answer

Increased blood volume

Answer

Total leukocyte count decreased

Answer

Same findings

Hematology — MCQs

Hematology — MCQs

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