Hematology Practice Questions

Q: Which tumor is associated with polycythemia?

Cerebellar hemangioblastoma. ### Explanation The correct answer is **Cerebellar hemangioblastoma**. **1. Why Cerebellar Hemangioblastoma is Correct:** Polycythemia in the context of malignancy is usually a **paraneoplastic syndrome** caused by the ectopic production of **Erythropoietin (EPO)**. Cerebellar hemangioblastoma is a classic "EPO-secreting tumor" [1]. These tumors are highly vascular and are frequently associated with **Von Hippel-Lindau (VHL) syndrome**. The excess EPO stimulates the bone marrow to increase red blood cell production, leading to secondary polycythemia (erythrocytosis) [1]. **2. Why Other Options are Incorrect:** * **Sarcoma:** While some rare sarcomas (like uterine fibroids/leiomyomas) have been sporadically linked to erythrocytosis, "Sarcoma" as a general category is not a classic or high-yield association for polycythemia. * **Pituitary Adenoma:** These tumors typically present with hormonal excesses (like GH in acromegaly or ACTH in Cushing’s) or mass effect symptoms (visual field defects). They do not typically secrete EPO. **3. High-Yield Clinical Pearls for NEET-PG:** To master questions on ectopic EPO production, remember the mnemonic **"Potentially Really High Hematocrit"**: * **P:** **P**heochromocytoma * **R:** **R**enal Cell Carcinoma (The most common cause) [1] * **H:** **H**epatocellular Carcinoma (HCC) [1] * **H:** **H**emangioblastoma (Cerebellar) [1] * **Uterine Leiomyoma:** Occasionally associated (Myomatous Erythrocytosis Syndrome) [1]. **Key Distinction:** * **Primary Polycythemia (Polycythemia Vera):** Low EPO levels (due to JAK2 mutation). * **Secondary Polycythemia (Paraneoplastic):** High EPO levels (due to ectopic secretion by the tumors listed above) [1].

Q: A 16-year-old female presents with generalized weakness and palpitations. Her Hb is 7 g/dL and peripheral smear shows microcytic hypochromic anemia. Reticulocyte count is 0.8%. Serum bilirubin is 1 mg%. What is the most likely diagnosis?

Iron deficiency anemia. ### Explanation The correct diagnosis is **Iron Deficiency Anemia (IDA)**. This conclusion is based on the integration of the clinical presentation and laboratory findings: 1. **Microcytic Hypochromic Anemia:** The peripheral smear shows small, pale red blood cells [2]. This is the hallmark of impaired hemoglobin synthesis, most commonly caused by iron deficiency [1]. 2. **Low Reticulocyte Count (0.8%):** A reticulocyte count <2% indicates an **underproduction anemia** (bone marrow failure or nutrient deficiency) rather than a regenerative response to blood loss or hemolysis. 3. **Normal Bilirubin:** A serum bilirubin of 1 mg% (normal range) rules out significant active hemolysis. #### Why the other options are incorrect: * **Hemolytic Anemia:** While it can cause weakness, it typically presents with a **high reticulocyte count** (compensatory erythropoiesis) and **indirect hyperbilirubinemia** (jaundice) due to RBC breakdown. * **Aplastic Anemia:** This presents as **pancytopenia** (low RBCs, WBCs, and platelets). While the reticulocyte count is low, the smear is usually **normocytic normochromic**, not microcytic. * **Folic Acid Deficiency:** This is a megaloblastic anemia characterized by **macrocytic** (large) RBCs and hypersegmented neutrophils on the peripheral smear. #### NEET-PG High-Yield Pearls: * **Most common cause of microcytic hypochromic anemia:** Iron Deficiency Anemia (Global and India) [1]. * **Mentzer Index:** (MCV/RBC count) >13 suggests IDA; <13 suggests Thalassemia trait. * **Earliest sign of response to Iron therapy:** Increase in reticulocyte count (peaks at 7–10 days). * **Serum Ferritin:** The most sensitive and specific biochemical test to diagnose iron deficiency.

Q: Hepatitis-associated aplastic anemia is caused by which type of hepatitis virus?

Non-A, Non-B, Non-C hepatitis viruses. Explanation: Hepatitis-associated aplastic anemia (HAAA) is a distinct clinical syndrome where pancytopenia follows an episode of acute hepatitis. Why the correct answer is right: In the majority of cases (up to 90%), the causative agent is not one of the known hepatotropic viruses (A, B, C, D, or E). Instead, it is attributed to Non-A, Non-B, Non-C, Non-E hepatitis viruses [1]. The pathophysiology involves an immune-mediated destruction of hematopoietic stem cells. It is believed that an unknown virus triggers a T-cell-mediated (CD8+ cytotoxic T-lymphocytes) inflammatory response that cross-reacts with bone marrow antigens, leading to marrow aplasia. Why other options are incorrect: * Hepatitis A, B, and C: While there are rare case reports of aplastic anemia following infection with these specific viruses, they are statistically insignificant causes of HAAA. In standard clinical practice and for examination purposes, HAAA is specifically linked to seronegative (Non-A-E) hepatitis. High-Yield Clinical Pearls for NEET-PG: * Demographics: Most commonly affects young males. * Timeline: Aplastic anemia typically develops 2 to 3 months after the peak of the acute hepatitis episode. * Severity: The hepatitis is usually mild or resolving when the anemia begins, but the subsequent bone marrow failure is often severe or even fatal if untreated. * Treatment: The treatment of choice is Allogeneic Bone Marrow Transplantation (if a donor is available) or Immunosuppressive Therapy (IST) with Antithymocyte Globulin (ATG) and Cyclosporine. * Prognosis: Without treatment, the mortality rate is very high.

Q: A 25-year-old female presented in December with chronic fatigue and cyanosis with bluish lips and arthralgia. Peripheral blood film is shown below. What is the likely cause?

Cold autoimmune hemolytic anemia (AIHA). ***Cold autoimmune hemolytic anemia (AIHA)*** - Presentation in **December** (cold weather) with **cyanosis** and **bluish lips** indicates **cold agglutinins** causing vascular occlusion and hemolysis at low temperatures. - **RBC agglutination** (clumping) on peripheral blood smear is the hallmark feature, along with **fatigue** from hemolysis and **arthralgia** from immune complex deposition. *Warm autoimmune hemolytic anemia (AIHA)* - Occurs at **body temperature** (37°C) and would not be triggered by cold weather or cause **acrocyanosis**. - Peripheral blood smear shows **spherocytes** rather than **RBC agglutination**, and **direct Coombs test** is positive for **IgG**. *Hemoglobinopathy* - Structural or quantitative **hemoglobin disorders** like sickle cell disease or thalassemia would show characteristic **RBC morphology** (sickle cells, target cells). - Symptoms are typically **chronic** from childhood and not specifically triggered by **cold weather** exposure. *G6PD Deficiency* - **X-linked disorder** causing hemolysis triggered by **oxidative stress** from medications, foods (fava beans), or infections. - Peripheral blood smear shows **bite cells** and **Heinz bodies**, not **RBC agglutination**, and symptoms are episodic rather than cold-induced.

Q: A patient presents with increased serum ferritin, decreased TIBC, increased serum iron, and increased % saturation. What is the most probable diagnosis?

Sideroblastic anemia. ### Explanation The correct answer is **Sideroblastic Anemia**. This condition is characterized by a defect in heme synthesis, leading to the accumulation of iron within the mitochondria of erythroid precursors (forming ringed sideroblasts). Because iron cannot be incorporated into hemoglobin, it leaks out of the cells, leading to **iron overload**. #### Why Sideroblastic Anemia is Correct: In Sideroblastic anemia, the body has an abundance of iron that it cannot utilize. This results in: * **Increased Serum Iron & % Saturation:** Iron is not being used for heme synthesis. * **Increased Ferritin:** Reflects high systemic iron stores. * **Decreased TIBC:** A compensatory response to high iron levels (the liver produces less transferrin when iron is plentiful). #### Why Other Options are Incorrect: * **Iron Deficiency Anemia (IDA):** This is the polar opposite. You would see **decreased** ferritin, **decreased** serum iron, and **increased** TIBC (the body’s attempt to "catch" more iron) [2]. * **Anemia of Chronic Disease (ACD):** While ferritin is increased (as an acute phase reactant), the hallmark is **decreased serum iron** and **decreased TIBC** because iron is "trapped" inside macrophages and unavailable for circulation [1]. * **Thalassemia Minor:** Usually presents with a normal iron profile. It is a defect in globin chain synthesis, not iron metabolism. #### NEET-PG High-Yield Pearls: * **Gold Standard Diagnosis:** Bone marrow aspiration showing **Ringed Sideroblasts** (Prussian Blue stain). * **Common Causes:** Alcohol (most common), Lead poisoning, Isoniazid (B6 deficiency), and X-linked ALAS2 mutation. * **Treatment:** Pyridoxine (Vitamin B6) is the first-line treatment for sideroblastic anemia, as it is a cofactor for the ALAS enzyme.

Question 1

Which of the following is true about aplastic anemia?

Accepted Answer

Reticulocytopenia

Answer

Splenomegaly

Answer

Nucleated RBCs in peripheral blood

Answer

Thrombocytopenia

Question 2

Pancytopenia with cellular marrow is seen in which of the following conditions?

Accepted Answer

Paroxysmal nocturnal hemoglobinuria

Answer

G6PD deficiency

Answer

Acquired aplastic anemia

Answer

Thalassemia

Question 3

A 38-year-old woman presents with repeated episodes of sore throat. She is on no medications, does not use ethanol, and has no history of renal disease. Physical examination is normal. Hemoglobin is 9.0 g/dL, mean corpuscular volume is 85 fL, white blood cell count is 2000/mL, and platelet count is 30,000/mL. Which of the following is the best approach to diagnosis?

Accepted Answer

Bone marrow biopsy

Answer

Erythropoietin level

Answer

Serum B12

Answer

Liver spleen scan

Question 4

Which tumor is associated with polycythemia?

Accepted Answer

Cerebellar hemangioblastoma

Answer

Sarcoma

Answer

Pituitary adenoma

Answer

None of the above.

Question 5

A 16-year-old female presents with generalized weakness and palpitations. Her Hb is 7 g/dL and peripheral smear shows microcytic hypochromic anemia. Reticulocyte count is 0.8%. Serum bilirubin is 1 mg%. What is the most likely diagnosis?

Accepted Answer

Iron deficiency anemia

Answer

Hemolytic anemia

Answer

Aplastic anemia

Answer

Folic acid deficiency

Question 6

A 69-year-old woman presents with a hip fracture sustained from a fall. She has a history of recurrent pneumonia over the past year. Laboratory findings include a normal white blood cell count, thrombocytopenia, and an elevated erythrocyte sedimentation rate (ESR). X-rays show multiple lytic bone lesions. Serum electrophoresis reveals an M-protein spike. What is the most likely diagnosis?

Accepted Answer

Multiple myeloma (plasma cell myeloma)

Answer

Chronic lymphocytic leukemia

Answer

Monoclonal gammopathy of uncertain significance

Answer

Plasmacytoma

Question 7

Hepatitis-associated aplastic anemia is caused by which type of hepatitis virus?

Accepted Answer

Non-A, Non-B, Non-C hepatitis viruses

Answer

Hepatitis A

Answer

Hepatitis B

Answer

Hepatitis C

Question 8

A 25-year-old female presented in December with chronic fatigue and cyanosis with bluish lips and arthralgia. Peripheral blood film is shown below. What is the likely cause?

Accepted Answer

Cold autoimmune hemolytic anemia (AIHA)

Answer

Warm autoimmune hemolytic anemia (AIHA)

Answer

Hemoglobinopathy

Answer

G6PD Deficiency

Question 9

A patient presents with increased serum ferritin, decreased TIBC, increased serum iron, and increased % saturation. What is the most probable diagnosis?

Accepted Answer

Sideroblastic anemia

Answer

Anemia of chronic disease

Answer

Iron deficiency anemia

Answer

Thalassemia minor

Question 10

A young person presents with a history of severe menorrhagia, palpable spleen, prolonged bleeding time, and normal clotting time and platelet count. What is the most likely diagnosis?

Accepted Answer

Thrombasthenia

Answer

Hemophilia

Answer

Henoch-Schonlein purpura

Answer

Allergic purpura

Hematology — MCQs

Hematology — MCQs

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