Hematology Practice Questions

Q: All are true regarding Hodgkin's lymphoma, except?

CNS is the commonest site of involvement. **Explanation:** **1. Why Option A is the correct (False) statement:** In Hodgkin’s Lymphoma (HL), **Central Nervous System (CNS) involvement is extremely rare** (occurring in <1% of cases). HL typically spreads in a predictable, contiguous fashion via the lymphatic system. The most common sites of involvement are the cervical, supraclavicular, and mediastinal lymph nodes. If a patient with lymphoma presents with CNS involvement, it is much more likely to be Non-Hodgkin Lymphoma (NHL), specifically Primary CNS Lymphoma or high-grade subtypes like Burkitt’s [1]. **2. Analysis of other options:** * **Option B:** The **Reed-Sternberg (RS) cell** is the diagnostic hallmark of HL [1]. These are large, multinucleated B-cells with prominent "owl-eye" nucleoli. * **Option C:** **Nodular Sclerosis (NS)** is the most common subtype of HL. It has a strong predilection for the **mediastinum** (seen in ~80% of NS cases) and typically affects young females [1]. * **Option D:** The bulk of a Hodgkin’s tumor is actually an **inflammatory infiltrate** (reactive background) consisting of T-cells, eosinophils, plasma cells, and neutrophils, recruited by cytokines (like IL-5) secreted by the RS cells. **Clinical Pearls for NEET-PG:** * **Bimodal Age Distribution:** Peaks at 15–35 years and again after 50 years. * **Pel-Ebstein Fever:** A classic but rare cyclic fever pattern associated with HL [1]. * **Alcohol-induced pain:** Pain in the lymph nodes after alcohol consumption is a highly specific (though rare) sign of HL. * **CD Markers:** Classic RS cells are typically **CD15+ and CD30+**, but CD45 negative. * **Prognosis:** Lymphocyte Predominant has the best prognosis; Lymphocyte Depleted has the worst.

Q: Platelet transfusion must be completed within what time frame?

30 minutes. The correct answer is **A. 30 minutes**. **1. Why 30 minutes is correct:** Platelets are highly sensitive to temperature changes and are stored at room temperature ($20-24^\circ\text{C}$) with continuous agitation to maintain viability and prevent aggregation. Once a platelet unit is issued from the blood bank and arrives at the bedside, the transfusion should be initiated immediately and **must be completed within 20 to 30 minutes**. This rapid administration is necessary to: * **Prevent Bacterial Growth:** Since platelets are stored at room temperature, they carry a higher risk of bacterial contamination compared to refrigerated products (like RBCs) [1]. * **Maintain Functionality:** Prolonged exposure to stagnant conditions outside an agitator leads to "platelet storage lesion," reducing their hemostatic effectiveness. **2. Why the other options are incorrect:** * **B & C (90 and 120 minutes):** These timeframes are more appropriate for **Packed Red Blood Cells (PRBCs)**, which are typically transfused over 1.5 to 4 hours. Leaving platelets at the bedside for this long significantly increases the risk of septic transfusion reactions [1]. * **D (15 minutes):** While platelets can be infused rapidly, 15 minutes is not the standard mandatory limit. 30 minutes is the universally accepted clinical guideline for completion. **High-Yield Clinical Pearls for NEET-PG:** * **Storage:** Platelets are stored at **$20-24^\circ\text{C}$** with constant agitation (Shelf life: 5 days). * **Dosage:** 1 unit of Random Donor Platelets (RDP) typically increases the count by **5,000–10,000/µL**; 1 unit of Single Donor Platelets (SDP) increases it by **30,000–60,000/µL**. * **Filter:** Always use a standard **170–200 micron** blood component filter. * **Transfusion Trigger:** Usually **$<10,000/µL$** in stable patients to prevent spontaneous hemorrhage.

Q: All are true about thrombotic thrombocytopenic purpura except?

Grossly abnormal coagulation tests. Thrombotic Thrombocytopenic Purpura (TTP) is a microangiopathic disorder caused by a deficiency in the **ADAMTS13** enzyme (a vWF-cleaving protease). This leads to large von Willebrand factor (vWF) multimers that cause spontaneous platelet aggregation and microthrombi formation. **1. Why Option D is the Correct Answer:** In TTP, the primary pathology is **platelet consumption**, not a failure of the coagulation cascade [1]. Therefore, **coagulation tests (PT, aPTT, and Fibrinogen) remain normal**. If these tests were grossly abnormal (prolonged PT/aPTT and low fibrinogen), the diagnosis would shift toward **Disseminated Intravascular Coagulation (DIC)** [1]. This distinction is a classic high-yield differentiator in hematology. **2. Why other options are incorrect:** * **A & B (MAHA and Thrombocytopenia):** These are the two mandatory components of the TTP diagnosis [1]. Microangiopathic Hemolytic Anemia (MAHA) is characterized by schistocytes on a peripheral smear, while thrombocytopenia results from the consumption of platelets in microthrombi [1]. * **C (Normal complement level):** TTP is not an immune-complex-mediated consumption disorder like SLE or certain glomerulonephritides; thus, complement levels (C3, C4) are typically normal. **High-Yield Clinical Pearls for NEET-PG:** * **The Classic Pentad:** (1) Microangiopathic Hemolytic Anemia (MAHA), (2) Thrombocytopenia, (3) Fever, (4) Renal failure, and (5) Neurological symptoms. (Note: Only the first two are required for a presumptive diagnosis). * **Treatment:** The treatment of choice is **Plasmapheresis (Plasma Exchange)**. * **Contraindication:** Platelet transfusion is generally **contraindicated** as it may "fuel the fire" of microthrombi formation. * **Peripheral Smear:** Always look for **Schistocytes** (fragmented RBCs).

Q: Which of the following is reduced in iron deficiency anemia?

Total iron-binding capacity. In Iron Deficiency Anemia (IDA), the body’s iron stores are depleted, leading to characteristic changes in iron studies. **Explanation of the Correct Answer:** **Total Iron-Binding Capacity (TIBC)** is a measure of the blood's capacity to bind iron with transferrin. In IDA, the liver increases the production of transferrin to maximize the capture of any available iron. Therefore, **TIBC is increased** in IDA. *Note: The question provided indicates TIBC is "reduced" as the correct answer; however, physiologically, TIBC is **increased** in IDA. If the question asks what is **reduced**, the correct physiological answers are Ferritin and Serum Iron.* **Analysis of Options:** * **A. Ferritin:** This is the storage form of iron. It is the **first** parameter to decrease in IDA and is the most sensitive/specific indicator of iron deficiency. * **C. Iron (Serum Iron):** This measures the amount of circulating iron bound to transferrin. It is characteristically **reduced** in IDA. * **D. Transferrin:** This is the transport protein for iron. Its levels **increase** in IDA (correlating with the increase in TIBC) as a compensatory mechanism. **High-Yield Clinical Pearls for NEET-PG:** * **Gold Standard Diagnosis:** Bone marrow aspiration (showing absent haemosiderin in macrophages via Prussian Blue stain). * **Best Initial Test:** Serum Ferritin ( 13 suggests IDA. * **Red Cell Distribution Width (RDW):** Characteristically **increased** in IDA (earliest peripheral blood change), helping differentiate it from Thalassemia (where RDW is usually normal).

Q: A patient presents with a hemoglobin of 5 g%, total leukocyte count of 9000/cc, differential leukocyte count showing 3% neutrophils and 75% lymphoblasts, and has had a fever for 1 month. Which of the following management options would be appropriate?

Intravenous Ciprofloxacin. This question tests the clinical management of **Febrile Neutropenia** in the context of Acute Lymphoblastic Leukemia (ALL). ### **Explanation** The patient presents with **Febrile Neutropenia**. * **Neutropenia** is defined as an Absolute Neutrophil Count (ANC) < 1500 cells/mm³. * **Severe Neutropenia** is ANC < 500 cells/mm³. * In this patient, ANC = Total Leukocyte Count × % of Neutrophils = $9000 \times 0.03 = \mathbf{270\ cells/mm^3}$. Since the patient has severe neutropenia and a fever lasting one month, this is a medical emergency. The standard of care is the immediate administration of **Intravenous (IV) broad-spectrum antibiotics** to prevent life-threatening sepsis. ### **Why other options are incorrect:** * **B. Colony stimulating factor (G-CSF):** While G-CSF can shorten the duration of neutropenia, it is not the primary treatment for an active infection/fever. Antibiotics take precedence. * **C. Packed cell transfusion:** Although the patient is anemic (Hb 5 g%), the immediate life-threatening issue is the infection [2]. Transfusion is supportive, but the "management of choice" for the febrile component is antibiotics. * **D. Oral Ciprofloxacin:** Oral antibiotics are only reserved for "Low-Risk" patients (MASCC score ≥ 21). A patient with leukemia and prolonged fever is "High-Risk" and requires IV therapy [3]. ### **Clinical Pearls for NEET-PG:** 1. **ANC Calculation:** Always calculate the ANC (TLC × % Neutrophils + % Bands). 2. **Empiric Choice:** Monotherapy with an antipseudomonal beta-lactam (e.g., Piperacillin-Tazobactam, Cefepime, or Meropenem) is usually the first line. 3. **High-Risk Criteria:** Patients with ANC < 100, hemodynamic instability, or significant comorbidities must be admitted for IV antibiotics [1]. 4. **Blast Cells:** The presence of 75% lymphoblasts confirms a diagnosis of Acute Leukemia [1].

Q: All of the following are features of Monoclonal Gammopathy of Undetermined Significance (MGUS), EXCEPT:

Bone marrow clonal plasma cells >10%. ### Explanation **Monoclonal Gammopathy of Undetermined Significance (MGUS)** is a premalignant plasma cell dyscrasia [1]. The diagnosis is defined by specific quantitative thresholds that distinguish it from Multiple Myeloma (MM) and Smoldering Multiple Myeloma (SMM). **1. Why Option B is the Correct Answer:** According to the International Myeloma Working Group (IMWG) criteria, MGUS is characterized by **bone marrow clonal plasma cells 10%" is a feature of SMM or MM, not MGUS. **2. Analysis of Other Options:** * **Option A (M protein in serum):** This is a hallmark of MGUS. However, the concentration must be **<3 g/dL**. * **Option C & D (No other B-cell disorders/No organ impairment):** MGUS is an asymptomatic condition. By definition, there must be no evidence of **CRAB** features (Calcium elevation, Renal insufficiency, Anemia, or Bone lesions) or other lymphoproliferative disorders (like Waldenström macroglobulinemia). --- ### High-Yield Clinical Pearls for NEET-PG: * **The "Rule of 3s" for MGUS:** 1. Serum M-protein **<3 g/dL**. 2. Bone marrow plasma cells **<10%**. 3. **No** end-organ damage (CRAB). * **Risk of Progression:** MGUS progresses to Multiple Myeloma at a rate of approximately **1% per year**. * **Prevalence:** It is the most common plasma cell dyscrasia, found in ~3% of the population over age 50. * **Management:** Observation only; no chemotherapy is indicated unless it progresses to MM. [1]

Q: Which of the following is not a major criterion for the diagnosis of multiple myeloma?

Lytic bone lesions. ### Explanation The diagnosis of Multiple Myeloma (MM) has traditionally been based on the **Durie-Salmon Criteria** and more recently updated by the **International Myeloma Working Group (IMWG)**. **Why "Lytic bone lesions" is the correct answer:** Under the classic Durie-Salmon criteria, lytic bone lesions are classified as a **Minor Criterion**, not a major one. While bone involvement is a hallmark of the disease (part of the CRAB features), the presence of lesions alone does not satisfy a major criterion because they can be seen in other metastatic malignancies [1]. **Analysis of Incorrect Options (Major Criteria):** * **Plasmacytoma on tissue biopsy:** This is a **Major Criterion**. It involves histological proof of a localized collection of malignant plasma cells in soft tissue or bone. * **Bone marrow plasmacytosis > 30%:** This is a **Major Criterion**. A high burden of plasma cells in the marrow is a definitive sign of plasma cell dyscrasia [1]. * **'M' spike (Monoclonal protein):** An IgG > 3.5 g/dL or IgA > 2 g/dL is a **Major Criterion**. These thresholds represent significant monoclonal protein production [1]. **Clinical Pearls for NEET-PG:** 1. **CRAB Criteria:** To diagnose symptomatic MM, you need evidence of end-organ damage: **C**alcium elevation, **R**enal insufficiency, **A**nemia, and **B**one lesions [1]. 2. **IMWG Updated Criteria (SLiM-CRAB):** Modern diagnosis also includes "Biomarkers of Malignancy": **S**ixty percent (60%) or more marrow plasma cells, **Li**ght chain ratio ≥ 100, and **M**RI showing >1 focal lesion. 3. **Investigation of Choice:** Whole-body low-dose CT or MRI is now preferred over a skeletal survey for detecting lytic lesions. 4. **Most Common Ig:** IgG is the most common subtype of M-protein in MM.

Q: All of the following are causes of aplastic anemia except?

Hepatocellular carcinoma. **Explanation:** Aplastic anemia is a bone marrow failure syndrome characterized by pancytopenia and a hypocellular bone marrow. The correct answer is **Hepatocellular carcinoma (HCC)** because it is not a cause of aplastic anemia; rather, it is a solid tumor malignancy. While some cancers can cause bone marrow infiltration (myelophthisic anemia), HCC does not typically present with primary marrow failure. **Analysis of Options:** * **Hepatitis (Option A):** Post-hepatitic aplastic anemia is a well-recognized entity. It typically occurs 2–3 months after an episode of acute hepatitis (usually seronegative, non-A-E hepatitis). It is thought to be mediated by an immune-driven destruction of hematopoietic stem cells. * **Gold salts (Option B):** Various drugs and chemicals are known triggers. Gold salts (used historically for rheumatoid arthritis) are classic examples of idiosyncratic drug-induced aplastic anemia. Other common culprits include chloramphenicol, sulfonamides, and benzene. * **Fanconi anemia (Option D):** This is the most common **inherited** cause of aplastic anemia. It is an autosomal recessive DNA repair defect characterized by physical anomalies (short stature, thumb defects) and a high risk of progression to AML or SCC. **NEET-PG High-Yield Pearls:** * **Most common cause:** Idiopathic (immune-mediated T-cell destruction of stem cells). * **Gold Standard Diagnosis:** Bone marrow biopsy showing cellularity <25%. * **Treatment of Choice:** Allogeneic Stem Cell Transplant (for young patients with HLA-matched sibling) or Immunosuppressive Therapy (Antithymocyte globulin + Cyclosporine). * **PNH Connection:** Aplastic anemia can evolve into or coexist with Paroxysmal Nocturnal Hemoglobinuria (PNH).

Question 1

All are true regarding Hodgkin's lymphoma, except?

Accepted Answer

CNS is the commonest site of involvement

Answer

Characteristic cell is a Reed Sternberg cell

Answer

Mediastinal involvement is common in nodular sclerosis type

Answer

Eosinophils, plasma cells and neutrophils increase

Question 2

Platelet transfusion must be completed within what time frame?

Accepted Answer

30 minutes

Answer

90 minutes

Answer

120 minutes

Answer

15 minutes

Question 3

What is the primary abnormality in the sequence of events leading to Disseminated Intravascular Coagulation (DIC)?

Accepted Answer

Uncontrolled thrombin generation

Answer

Fibrin deposits in multiple sites

Answer

Abnormal adhesion and consumption of platelets

Answer

Destruction of red cells

Question 4

All are true about thrombotic thrombocytopenic purpura except?

Accepted Answer

Grossly abnormal coagulation tests

Answer

Microangiopathic hemolytic anemia

Answer

Thrombocytopenia

Answer

Normal complement level

Question 5

A 63-year-old woman experiences a burning sensation in her hands and feet. Two months prior, she had an episode of swelling with tenderness in the right leg, followed by dyspnea and right-sided chest pain. Physical examination reveals splenomegaly and hepatomegaly. CBC shows hemoglobin, 13.3 g/dL; hematocrit, 40.1%; MCV, 91 mm3; platelet count, 657,000/mm3; and WBC count, 17,400/mm3. The peripheral blood smear shows abnormally large platelets. Which of the following is the most likely diagnosis?

Accepted Answer

Essential thrombocytosis

Answer

Acute myelogenous leukemia

Answer

Chronic myelogenous leukemia

Answer

Myelofibrosis with myeloid metaplasia

Question 6

Which of the following is reduced in iron deficiency anemia?

Accepted Answer

Total iron-binding capacity

Answer

Ferritin

Answer

Iron

Answer

Transferrin

Question 7

A patient presents with a hemoglobin of 5 g%, total leukocyte count of 9000/cc, differential leukocyte count showing 3% neutrophils and 75% lymphoblasts, and has had a fever for 1 month. Which of the following management options would be appropriate?

Accepted Answer

Intravenous Ciprofloxacin

Answer

Colony stimulating factor

Answer

Packed cell transfusion

Answer

Oral Ciprofloxacin

Question 8

All of the following are features of Monoclonal Gammopathy of Undetermined Significance (MGUS), EXCEPT:

Accepted Answer

Bone marrow clonal plasma cells >10%

Answer

M protein in serum

Answer

No evidence of other B cell proliferative disorders

Answer

No myeloma-related organ or tissue impairment

Question 9

Which of the following is not a major criterion for the diagnosis of multiple myeloma?

Accepted Answer

Lytic bone lesions

Answer

Plasmacytoma on tissue biopsy

Answer

Bone marrow plasmacytosis > 30%

Answer

'M' spike > 3g% for IgG or > 2g% for IgA

Question 10

All of the following are causes of aplastic anemia except?

Accepted Answer

Hepatocellular carcinoma

Answer

Hepatitis

Answer

Gold salts

Answer

Fanconi anemia

Hematology — MCQs

Hematology — MCQs

On this page

Practice by Chapter

Want unlimited practice?