Hematology Practice Questions

Q: Moeller's glossitis is due to a deficiency in which of the following?

Pernicious anemia. **Explanation:** **Moeller’s glossitis** (also known as Hunter’s glossitis) is a classic clinical finding characterized by a smooth, red, and "glazed" appearance of the tongue, often accompanied by a burning sensation or pain. 1. **Why Pernicious Anemia is correct:** Pernicious anemia results from a deficiency of Vitamin B12 (cobalamin) due to a lack of intrinsic factor [1]. Vitamin B12 is essential for DNA synthesis in rapidly dividing cells. In the oral cavity, this deficiency leads to the atrophy of the filiform and fungiform papillae. The loss of these papillae results in the characteristic smooth, beefy red tongue seen in Moeller’s glossitis. 2. **Why other options are incorrect:** * **Riboflavin (B2) deficiency:** Typically presents with **Magenta tongue**, angular cheilitis, and corneal vascularization. * **Acute Monocytic Leukemia (AML-M5):** Characteristically associated with **gingival hypertrophy** or hyperplasia due to leukemic infiltration, rather than atrophic glossitis. * **Late Acquired Syphilis:** Associated with **interstitial glossitis**, which may present with leukoplakia and carries a risk of malignant transformation, but it does not cause the diffuse papillary atrophy of Moeller’s glossitis. **NEET-PG High-Yield Pearls:** * **Hunter’s/Moeller’s Glossitis:** Pathognomonic for Vitamin B12 deficiency/Pernicious Anemia [1]. * **Plummer-Vinson Syndrome:** Characterized by Iron deficiency anemia, esophageal webs, and atrophic glossitis. * **Bald Tongue of Sandwith:** Seen in Pellagra (Niacin/B3 deficiency). * **Strawberry Tongue:** Seen in Scarlet Fever and Kawasaki Disease.

Q: Which of the following drugs has the least bone marrow suppression?

Vincristine. The correct answer is **Vincristine**. ### **Explanation** The primary dose-limiting toxicity of most cytotoxic chemotherapy agents is **myelosuppression** (bone marrow suppression). However, certain drugs are known for being "bone marrow sparing." **Vincristine**, a Vinca alkaloid that inhibits microtubule assembly (mitotic inhibitor), is unique because it causes **minimal to no bone marrow suppression**. Its dose-limiting toxicity is instead **peripheral neuropathy** (paresthesia, loss of deep tendon reflexes, and autonomic dysfunction like constipation). ### **Analysis of Incorrect Options** * **Cisplatin:** A platinum compound known for being highly emetogenic and nephrotoxic, but it also causes significant cumulative myelosuppression. * **Cyclophosphamide:** An alkylating agent that causes significant neutropenia. Its other classic side effect is hemorrhagic cystitis (prevented by Mesna). * **Methotrexate:** An antimetabolite (folate antagonist) that is highly myelosuppressive. This effect is managed using "Leucovorin rescue." ### **High-Yield Clinical Pearls for NEET-PG** * **Bone Marrow Sparing Agents:** Remember the mnemonic **"V-B-L-S"** for drugs with minimal myelosuppression: **V**incristine, **B**leomycin (Lung fibrosis), **L**-Asparaginase (Pancreatitis/Thrombosis), and **S**teroids. * **Vincristine vs. Vinblastine:** While they belong to the same class, **V**inblastine "**B**lasts" the bone marrow (highly myelosuppressive), whereas **V**incristine spares it. * **Vincristine Warning:** It is **fatal if given intrathecally**; it must only be administered intravenously.

Q: JAK-2 mutation is strongly associated with which of the following conditions?

Polycythemia vera. **Explanation:** **JAK2 (Janus Kinase 2)** is a non-receptor tyrosine kinase involved in the signal transduction pathway of hematopoietic growth factor receptors (like erythropoietin and thrombopoietin). The **V617F mutation** leads to constitutive activation of this pathway, causing autonomous production of blood cells independent of growth factors. * **Polycythemia Vera (PV):** This is the correct answer because the JAK2 V617F mutation is found in **>95% of cases**. It is a major diagnostic criterion according to WHO classification. It is also found in Essential Thrombocythemia (ET) and Primary Myelofibrosis (PMF), but with lower frequency (~50-60%). **Why other options are incorrect:** * **Burkitt’s Lymphoma:** Characterized by the **t(8;14)** translocation involving the **c-myc** oncogene. * **Multiple Myeloma:** A plasma cell dyscrasia primarily associated with chromosomal abnormalities like trisomies or translocations involving the IgH locus (e.g., t(11;14), t(4;14)). * **Mantle Cell Lymphoma:** Defined by the **t(11;14)** translocation, leading to the overexpression of **Cyclin D1**. **High-Yield Clinical Pearls for NEET-PG:** 1. **JAK2 V617F:** Substitution of Valine (V) by Phenylalanine (F) at codon 617. 2. **PV Diagnosis:** Low serum Erythropoietin (EPO) levels + JAK2 mutation + Increased Red Cell Mass. 3. **Aquagenic Pruritus:** Itching after a hot bath is a classic clinical sign of PV. 4. **Treatment:** Ruxolitinib is a JAK1/2 inhibitor used in patients resistant to hydroxyurea.

Q: Cell of origin of hairy cell leukemia is?

B-cell. Hairy Cell Leukemia (HCL) is a rare, chronic lymphoproliferative disorder characterized by the proliferation of mature B-lymphocytes. **1. Why B-cell is correct:** The cell of origin in HCL is a **mature memory B-cell** (post-germinal center). These cells exhibit characteristic "hairy" cytoplasmic projections. They express pan-B-cell markers such as **CD19, CD20, and CD22**. Crucially, they also express highly specific markers like **CD103** (most specific), **CD11c, CD25, and Annexin A1**. Almost all cases (approx. 95%) harbor the **BRAF V600E mutation**, which is a key diagnostic feature. **2. Why other options are incorrect:** * **T-cell & NK-cell:** While some rare T-cell leukemias can mimic the morphology of HCL (e.g., T-cell prolymphocytic leukemia), HCL is strictly a B-cell malignancy. T-cell and NK-cell markers (like CD3, CD4, CD8, or CD56) are negative in HCL. * **Dendritic reticulum cell:** These are antigen-presenting cells found in lymphoid follicles. While they interact with B-cells, they are not the progenitors of HCL. **High-Yield Clinical Pearls for NEET-PG:** * **Clinical Triad:** Splenomegaly (often massive), Pancytopenia, and "Dry Tap" on bone marrow aspiration (due to increased reticulin fibrosis). * **Diagnosis:** TRAP (Tartrate-Resistant Acid Phosphatase) positive staining; "Fried egg appearance" on bone marrow biopsy. * **Treatment:** Cladribine (2-Chlorodeoxyadenosine) is the drug of choice. * **Key Association:** Increased risk of atypical mycobacterial infections (e.g., *Mycobacterium avium-intracellulare*).

Q: Platelet count is decreased in all of the following conditions except?

Henoch-Schönlein purpura. **Explanation:** The core concept tested here is the distinction between **quantitative** and **qualitative** platelet disorders. **1. Why Henoch-Schönlein Purpura (HSP) is the correct answer:** HSP is a **small-vessel vasculitis** mediated by IgA immune complex deposition. The hallmark of HSP is **palpable purpura** occurring in the presence of a **normal platelet count** [1]. The bleeding into the skin occurs because the blood vessel walls are inflamed and "leaky," not because platelets are deficient. Therefore, it is a vascular cause of purpura, not a thrombocytopenic one. **2. Analysis of Incorrect Options:** * **Idiopathic Thrombocytopenic Purpura (ITP):** Characterized by isolated thrombocytopenia due to anti-platelet antibodies (IgG) leading to premature destruction of platelets in the spleen [2]. * **Thrombotic Thrombocytopenic Purpura (TTP):** A pentad of symptoms (including microangiopathic hemolytic anemia and thrombocytopenia) caused by a deficiency of ADAMTS13, leading to extensive platelet-rich microthrombi that consume platelets [2]. * **Systemic Lupus Erythematosus (SLE):** An autoimmune condition where hematological abnormalities are common. Thrombocytopenia in SLE is usually immune-mediated (secondary ITP) or part of Evans syndrome [2]. **NEET-PG High-Yield Pearls:** * **HSP Tetrad:** Palpable purpura (buttocks/legs), Arthralgia, Abdominal pain (intussusception risk), and Renal involvement (IgA nephropathy). * **Platelet Count in Vasculitis:** Always remember that in most vasculitides (like HSP or Polyarteritis Nodosa), the platelet count is normal or even elevated (as an acute phase reactant) [1]. * **Rule of Thumb:** If the question mentions "palpable purpura," think Vasculitis (Normal Platelets). If it mentions "flat/non-palpable purpura/petechiae," think Thrombocytopenia (Low Platelets) [2].

Q: Which of the following is NOT a feature of hemolytic anemia?

Increased haptoglobin. ### Explanation In hemolytic anemia, the hallmark is the premature destruction of red blood cells (RBCs). This process leads to the release of free hemoglobin into the plasma [1]. **Why "Increased haptoglobin" is the correct answer:** Haptoglobin is a plasma protein produced by the liver whose primary function is to bind free hemoglobin to prevent oxidative damage and iron loss. In hemolytic states (especially intravascular hemolysis), large amounts of hemoglobin are released. Haptoglobin binds to this hemoglobin, and the resulting **haptoglobin-hemoglobin complex** is rapidly cleared by the reticuloendothelial system (liver). Consequently, serum **haptoglobin levels decrease** (often becoming undetectable), not increase. **Analysis of incorrect options:** * **A. Hemoglobinuria:** When the hemoglobin-binding capacity of haptoglobin is saturated, free hemoglobin is filtered by the renal glomeruli, appearing in the urine [1]. * **B. Jaundice:** Hemolysis leads to an increase in unconjugated bilirubin (a byproduct of heme breakdown). When this exceeds the liver's conjugating capacity, acholuric jaundice occurs. * **D. Hemosiderinuria:** This is a sign of chronic intravascular hemolysis. Iron from reabsorbed hemoglobin accumulates in renal tubular cells as hemosiderin; when these cells slough off into the urine, it is detected via Prussian blue staining [1]. **Clinical Pearls for NEET-PG:** * **Best initial test for hemolysis:** Peripheral blood smear (look for schistocytes or spherocytes) and Reticulocyte count (increased). * **Most specific biochemical marker for intravascular hemolysis:** Decreased serum haptoglobin. * **Markers of Hemolysis:** ↑ Indirect Bilirubin, ↑ LDH, ↑ Reticulocytes, ↓ Haptoglobin. * **Intravascular vs. Extravascular:** Hemoglobinuria and Hemosiderinuria are specific to **intravascular** hemolysis [1].

Question 1

Moeller's glossitis is due to a deficiency in which of the following?

Accepted Answer

Pernicious anemia

Answer

Riboflavin deficiency

Answer

Acute monocytic leukemia

Answer

Late acquired syphilis

Question 2

Which of the following drugs has the least bone marrow suppression?

Accepted Answer

Vincristine

Answer

Cisplatin

Answer

Cyclophosphamide

Answer

Methotrexate

Question 3

JAK-2 mutation is strongly associated with which of the following conditions?

Accepted Answer

Polycythemia vera

Answer

Burkitt's lymphoma

Answer

Multiple myeloma

Answer

Mantle cell lymphoma

Question 4

A 68-year-old patient developed atrophic gastritis and, 2 years later, developed a macrocytic, hyperchromic anemia. His anemia has most likely occurred due to which one of the following reasons?

Accepted Answer

The atrophic gastritis leads to vitamin B12 malabsorption.

Answer

The atrophic gastritis raises the pH in the duodenum, leading to folate malabsorption.

Answer

The terminal ileum is also involved, so iron is malabsorbed.

Answer

The atrophic gastritis leads to increased red blood cell absorption by the spleen.

Question 5

Which of the following is NOT a feature of polycythemia rubra vera?

Accepted Answer

Low arterial oxygen saturation

Answer

Increased red cell mass

Answer

Presence of JAK2 mutation

Answer

Splenomegaly

Question 6

What are the characteristic laboratory findings of hemophilia A?

Accepted Answer

Presence of 30% of factor level expressing the disease

Answer

Prolonged prothrombin time (PT)

Answer

Prolonged activated partial thromboplastin time (aPTT)

Answer

X-linked recessive inheritance

Question 7

Cell of origin of hairy cell leukemia is?

Accepted Answer

B-cell

Answer

T-cell

Answer

NK-cell

Answer

Dendritic reticulum cell

Question 8

What is the most common cause of precipitation of renal failure in multiple myeloma?

Accepted Answer

Hypercalcemia

Answer

Hyperuricemia

Answer

Infection

Answer

Amyloidosis

Question 9

Platelet count is decreased in all of the following conditions except?

Accepted Answer

Henoch-Schönlein purpura

Answer

Idiopathic thrombocytopenic purpura

Answer

Thrombotic thrombocytopenic purpura

Answer

Systemic lupus erythematosus

Question 10

Which of the following is NOT a feature of hemolytic anemia?

Accepted Answer

Increased haptoglobin

Answer

Hemoglobinuria

Answer

Jaundice

Answer

Hemosiderinuria

Hematology — MCQs

Hematology — MCQs

On this page

Practice by Chapter

Want unlimited practice?