Hematology Practice Questions

Q: Which of the following is a characteristic feature of hypoproliferative anemia?

Normocytic normochromic anemia with reticulocyte index < 2-2.5. Explanation: Hypoproliferative anemias are characterized by a failure of the bone marrow to produce an appropriate number of erythrocytes in response to a decrease in hemoglobin. This failure is objectively measured by the **Reticulocyte Index (RI)**. 1. **Why Option A is Correct:** In hypoproliferative states (such as early iron deficiency, inflammation, or renal disease), the bone marrow cannot mount an appropriate erythropoietic response [1]. Therefore, the RI remains low (**< 2–2.5**). Morphologically, these anemias are typically **normocytic and normochromic** because the RBCs that *are* produced are of normal size and hemoglobin content, but they are simply produced in insufficient quantities. 2. **Why the other options are incorrect:** * **Option B:** While the RI is low, microcytic hypochromic anemia is more characteristic of **maturation disorders** (like established iron deficiency or thalassemia) rather than pure hypoproliferative states [1]. * **Option C:** An RI **> 2.5** indicates an appropriate marrow response, typically seen in **hemolytic anemias** or acute blood loss, where the marrow is hyperproliferative. * **Option D:** Ringed sideroblasts are the hallmark of **Sideroblastic Anemia**, which is classified as a cytoplasmic maturation defect, not a primary hypoproliferative anemia. **High-Yield Clinical Pearls for NEET-PG:** * **The RI Formula:** $\text{Reticulocyte Count} \times (\text{Observed Hct} / \text{Normal Hct}) \times (1 / \text{Maturation Correction Factor})$. * **Common Causes:** The most common cause of hypoproliferative anemia is **Iron Deficiency** (early stage), followed by **Anemia of Chronic Disease/Inflammation** [1]. * **Key Differentiator:** If the MCV is abnormal (high or low) with a low RI, think of **Maturation Disorders**. If the MCV is normal with a low RI, think **Hypoproliferative Anemia**.

Q: The use of desmopressin is best indicated for therapy in which of the following bleeding disorders?

Von Willebrand disease (VWD). **Explanation:** **Desmopressin (DDAVP)** is a synthetic analogue of vasopressin that stimulates the release of **von Willebrand factor (vWF)** and **Factor VIII** from endothelial storage sites (Weibel-Palade bodies) [2]. 1. **Why Option C is Correct:** In **Von Willebrand Disease (VWD)**, particularly Type 1 (the most common form), there is a quantitative deficiency of vWF [2]. DDAVP effectively increases endogenous plasma levels of vWF and Factor VIII, making it the treatment of choice for minor bleeding episodes or surgical prophylaxis in these patients [2]. 2. **Why Other Options are Incorrect:** * **Severe Hemophilia A (Option A):** DDAVP can be used in *mild* Hemophilia A. However, in *severe* cases (Factor VIII <1%), there are no endogenous stores to release; therefore, exogenous Factor VIII replacement is mandatory. [1] * **Severe Hemophilia B (Option B):** Hemophilia B is a deficiency of Factor IX. DDAVP has no effect on Factor IX levels; these patients require Factor IX concentrates. * **Glanzmann Thrombasthenia (Option D):** This is a qualitative platelet disorder (deficiency of GpIIb/IIIa) [3]. DDAVP does not correct this receptor defect; treatment usually involves platelet transfusions or recombinant Factor VIIa. **NEET-PG High-Yield Pearls:** * **Route:** DDAVP can be administered IV, SC, or via a highly concentrated nasal spray (Stimate). * **Side Effects:** The most critical side effect is **hyponatremia** (due to the antidiuretic effect), which can lead to seizures. Patients should be advised on fluid restriction. * **Tachyphylaxis:** Repeated doses lead to a diminishing response as endothelial stores become exhausted. * **Contraindication:** Avoid DDAVP in **VWD Type 2B**, as it can cause paradoxical thrombocytopenia due to the release of abnormal vWF that induces platelet aggregation.

Q: A 65-year-old male patient presents with nonspecific symptoms and moderate splenomegaly. His lab tests show a WBC count of 2000, a normal differential count, Hb 6 g/dL, platelets 80,000/mm³, and 6% blast cells. What is the most likely diagnosis?

Acute myeloid leukemia. The clinical presentation of pancytopenia (low WBC, Hb, and platelets) combined with **splenomegaly** and the presence of **circulating blasts** is a classic indicator of an acute hematological malignancy [1]. **1. Why Acute Myeloid Leukemia (AML) is correct:** In AML, the bone marrow is replaced by malignant blast cells, leading to bone marrow failure (pancytopenia). While the total WBC count is low in this case (aleukemic/subleukemic leukemia), the presence of **6% blasts** in the peripheral blood is the definitive clue. In a patient over 60, AML is a primary consideration when marrow failure is accompanied by splenomegaly and blasts. The diagnosis is suspected from an abnormal blood count and confirmed by bone marrow [1]. **2. Why the other options are incorrect:** * **Aplastic Anemia:** While it presents with pancytopenia, it is characterized by an empty bone marrow. Crucially, **splenomegaly is characteristically absent**, and there are no circulating blasts. * **Idiopathic Thrombocytopenic Purpura (ITP):** This typically presents with isolated thrombocytopenia. Hemoglobin and WBC counts remain normal, and there is no splenomegaly or blasts. * **Hemolytic Anemia:** This would show a decrease in Hb and potentially splenomegaly, but it would be associated with an *increase* in reticulocytes and jaundice, not pancytopenia or circulating blasts. **High-Yield NEET-PG Pearls:** * **Aleukemic Leukemia:** A condition where the total WBC count is normal or low, but the bone marrow is packed with blasts. * **Splenomegaly Rule:** If a patient has pancytopenia **with** splenomegaly, think of AML, Myelofibrosis [2], or Gaucher’s disease. If **without** splenomegaly, think of Aplastic Anemia. * **Diagnosis:** The WHO criteria for AML require ≥20% blasts in the bone marrow or peripheral blood [1]. The presence of any blasts in a pancytopenic elderly patient should immediately trigger a bone marrow biopsy.

Q: The presence of small-sized platelets on the peripheral smear is characteristic of:

Wiskott Aldrich syndrome. ### Explanation **Correct Answer: D. Wiskott-Aldrich Syndrome (WAS)** **Medical Concept:** Wiskott-Aldrich Syndrome is an X-linked recessive disorder caused by a mutation in the **WAS protein (WASP)**, which is essential for actin cytoskeleton remodeling in hematopoietic cells. The hallmark of WAS is the triad of **thrombocytopenia, eczema, and recurrent infections** (due to combined B and T-cell deficiency). Crucially, WAS is the classic condition associated with **microthrombocytes (small-sized platelets)** [1]. This occurs because the defective cytoskeleton leads to abnormal pro-platelet formation and fragmentation in the bone marrow. **Analysis of Incorrect Options:** * **A. Idiopathic Thrombocytopenic Purpura (ITP):** Characterized by peripheral destruction of platelets [1]. The bone marrow compensates by releasing immature "stress platelets," which are typically **large (megathrombocytes)**. * **B. Bernard-Soulier Syndrome (BSS):** A defect in the GpIb-IX-V receptor [2]. It is famously associated with **Giant Platelets** (often as large as red blood cells) and a failure of platelets to agglutinate with Ristocetin. * **C. Disseminated Intravascular Coagulation (DIC):** This is a consumptive coagulopathy [1]. While it causes thrombocytopenia, the platelets present on the smear are usually of **normal size**, though schistocytes (fragmented RBCs) are a prominent feature. **High-Yield Clinical Pearls for NEET-PG:** * **Small Platelets:** Think **Wiskott-Aldrich Syndrome** and **TAR syndrome** (Thrombocytopenia with Absent Radii). * **Large/Giant Platelets:** Think **Bernard-Soulier Syndrome**, **May-Hegglin anomaly** (look for Dohle-like bodies), and **ITP**. * **WAS Triad Mnemonic:** **W**-**A**-**S** (**W**iskott, **A**ctin mutation, **S**mall platelets). * **Laboratory Finding:** Low Mean Platelet Volume (MPV) is a diagnostic clue for WAS.

Q: Which drug is used for the treatment of Acute Myeloid Leukemia (AML) with FLT-3 mutation?

Gilteritinib. **Explanation:** **Acute Myeloid Leukemia (AML)** management has evolved with the identification of specific molecular markers. The **FLT3 (Fms-like tyrosine kinase 3)** mutation is one of the most common genetic alterations in AML (seen in ~30% of cases) and is associated with a poor prognosis and high relapse rates. * **Why Gilteritinib is correct:** **Gilteritinib** is a highly potent, selective **second-generation FLT3 inhibitor**. It targets both FLT3-ITD (Internal Tandem Duplication) and FLT3-TKD (Tyrosine Kinase Domain) mutations. It is specifically FDA-approved for the treatment of adult patients with **relapsed or refractory AML** with a FLT3 mutation. Other FLT3 inhibitors used in AML include Midostaurin (used in induction) and Quizartinib. **Analysis of Incorrect Options:** * **A. Crizotinib:** An ALK (Anaplastic Lymphoma Kinase) and ROS1 inhibitor primarily used in **Non-Small Cell Lung Cancer (NSCLC)** and ALK-positive Anaplastic Large Cell Lymphoma. * **C. Acalabrutinib:** A second-generation **Bruton Tyrosine Kinase (BTK) inhibitor** used in Chronic Lymphocytic Leukemia (CLL) and Mantle Cell Lymphoma. * **D. Ibrutinib:** The first-generation **BTK inhibitor** used for CLL, Small Lymphocytic Lymphoma (SLL), and Waldenström Macroglobulinemia. **High-Yield Clinical Pearls for NEET-PG:** * **FLT3-ITD** mutation is a marker of **poor prognosis** in AML [1]. * **Midostaurin** is the first-generation FLT3 inhibitor added to standard "7+3" chemotherapy for newly diagnosed FLT3+ AML. * **All-trans retinoic acid (ATRA)** and **Arsenic Trioxide** remain the drugs of choice for the M3 subtype (APML) characterized by t(15,17) [1]. * **Venetoclax** (BCL-2 inhibitor) is another high-yield drug now used in AML for elderly patients unfit for intensive chemotherapy.

Q: What is characteristic of anemia of chronic disease?

Serum ferritin. **Explanation:** Anemia of Chronic Disease (ACD), also known as anemia of inflammation, is primarily driven by **Hepcidin**, an acute-phase reactant produced by the liver in response to inflammatory cytokines (mainly IL-6) [1]. Hepcidin degrades ferroportin, leading to the sequestration of iron within macrophages and hepatocytes [2]. **Why Serum Ferritin is the Correct Answer:** In ACD, iron is trapped inside storage cells. Since **Serum Ferritin** reflects total body iron stores and acts as an acute-phase reactant, its levels are characteristically **normal or increased** [3]. This is the most crucial laboratory finding to differentiate ACD from Iron Deficiency Anemia (IDA), where ferritin is always low. **Analysis of Incorrect Options:** * **A. Total Iron-Binding Capacity (TIBC):** In ACD, TIBC is **decreased**. The body attempts to sequester iron away from potential pathogens by reducing the synthesis of transferrin. In contrast, TIBC is increased in IDA. * **B. Serum Iron:** This is **decreased** in ACD [2]. Despite adequate total body stores, the iron is "locked away" and unavailable in the serum for erythropoiesis. * **C. Bone Marrow Iron Stores:** These are **increased or normal** (visible as abundant hemosiderin in macrophages) [3]. The defect is not a lack of iron, but the inability to mobilize it to erythroid precursors. **NEET-PG High-Yield Pearls:** * **The Hallmark:** Low Serum Iron + Low TIBC + **High/Normal Ferritin** [3]. * **Cytokine Mediator:** IL-6 is the primary trigger for Hepcidin synthesis [1]. * **Morphology:** Usually normocytic normochromic, but can become microcytic in long-standing cases [1]. * **Treatment:** Treat the underlying inflammatory condition; recombinant erythropoietin may be used in specific cases (e.g., CKD or malignancy).

Question 1

Thrombocytopenia due to increased platelet destruction is seen in which of the following conditions?

Accepted Answer

Systemic lupus erythematosus

Answer

Aplastic anemia

Answer

Cancer chemotherapy

Answer

Acute leukemia

Question 2

Which of the following is a characteristic feature of hypoproliferative anemia?

Accepted Answer

Normocytic normochromic anemia with reticulocyte index < 2-2.5

Answer

Microcytic hypochromic anemia with reticulocyte index < 2-2.5

Answer

Microcytic hypochromic anemia with reticulocyte index > 2-2.5

Answer

Microcytic anemia with ringed sideroblasts

Question 3

A 22-year-old woman from a large Italian family is screened for a familial blood disorder. Laboratory studies reveal a hemoglobin of 9.5 g/dL and a peripheral smear showing mild microcytosis, hypochromia, and a few target cells. Hemoglobin electrophoresis demonstrates a mild increase in hemoglobin A2 (7.5%). What is the most likely diagnosis?

Accepted Answer

Heterozygous beta-thalassemia

Answer

Anemia of chronic disease

Answer

G6PD deficiency

Answer

Homozygous beta-thalassemia

Question 4

The use of desmopressin is best indicated for therapy in which of the following bleeding disorders?

Accepted Answer

Von Willebrand disease (VWD)

Answer

Severe hemophilia A

Answer

Severe hemophilia B

Answer

Glanzmann thrombasthenia

Question 5

A 65-year-old male patient presents with nonspecific symptoms and moderate splenomegaly. His lab tests show a WBC count of 2000, a normal differential count, Hb 6 g/dL, platelets 80,000/mm³, and 6% blast cells. What is the most likely diagnosis?

Accepted Answer

Acute myeloid leukemia

Answer

Aplastic anemia

Answer

Idiopathic thrombocytopenic purpura

Answer

Hemolytic anemia

Question 6

The presence of small-sized platelets on the peripheral smear is characteristic of:

Accepted Answer

Wiskott Aldrich syndrome

Answer

Idiopathic thrombocytopenic purpura.

Answer

Bernard Soulier syndrome

Answer

Disseminated intravascular coagulation

Question 7

Which drug is used for the treatment of Acute Myeloid Leukemia (AML) with FLT-3 mutation?

Accepted Answer

Gilteritinib

Answer

Crizotinib

Answer

Acalabrutinib

Answer

Ibrutinib

Question 8

Increased iron absorption is seen in which of the following conditions?

Accepted Answer

Iron deficiency anemia

Answer

Hypoxia

Answer

Inflammation

Answer

Antacids

Question 9

What is characteristic of anemia of chronic disease?

Accepted Answer

Serum ferritin

Answer

Total iron-binding capacity (TIBC)

Answer

Serum iron

Answer

Bone marrow iron stores

Question 10

A 58-year-old woman presents with a 6-month history of backache and recurrent chest infections. She develops sudden weakness of the legs and urinary retention. Investigations reveal a hemoglobin of 7.3 g/dL, serum calcium of 12.6 mg/dL, phosphate of 2.5 mg/dL, alkaline phosphatase of 100 U/L, serum albumin of 3 g/dL, globulin of 7.1 g/dL, and urea of 178 mg/dL. What is the most likely diagnosis?

Accepted Answer

Multiple myeloma

Answer

Lung cancer

Answer

Disseminated tuberculosis

Answer

Osteoporosis

Hematology — MCQs

Hematology — MCQs

On this page

Practice by Chapter

Want unlimited practice?