Hematology Practice Questions

Q: All of the following disorders are inherited except?

Antiphospholipid antibody syndrome. **Explanation:** The core concept tested here is the classification of **Thrombophilia** into inherited (genetic) and acquired causes. **Why Antiphospholipid Antibody Syndrome (APS) is the correct answer:** APS is an **acquired** autoimmune hypercoagulable state. It is characterized by the presence of clinical features (venous/arterial thrombosis or pregnancy morbidity) and persistent laboratory evidence of antiphospholipid antibodies (Lupus anticoagulant, Anti-cardiolipin, or Anti-̢2 glycoprotein I). Unlike the other options, it is not caused by a single gene mutation passed through families, though it may be associated with other autoimmune diseases like SLE. **Why the other options are incorrect:** * **Factor V Leiden Mutation:** This is the **most common inherited cause** of hypercoagulability. It involves a point mutation (G1691A) that makes Factor V resistant to inactivation by activated Protein C. * **Protein C & Protein S Deficiency:** Both are **inherited** (usually autosomal dominant) deficiencies of natural anticoagulants [1]. Protein C inactivates Factors Va and VIIIa; Protein S acts as a cofactor for Protein C. **High-Yield Clinical Pearls for NEET-PG:** * **Most common inherited thrombophilia:** Factor V Leiden. * **Most common acquired thrombophilia:** Antiphospholipid Antibody Syndrome. * **Warfarin-induced skin necrosis:** Classically seen in patients with **Protein C deficiency** when starting Warfarin without heparin bridging. * **Screening for APS:** Requires two positive lab tests at least 12 weeks apart to confirm "persistence" of antibodies.

Q: Migratory thrombophlebitis is seen in which of the following conditions?

Disseminated cancer. **Explanation:** **Migratory thrombophlebitis**, also known as **Trousseau syndrome**, is a clinical condition characterized by recurrent episodes of superficial venous thrombosis that appear at different sites over time [3]. **1. Why Disseminated Cancer is Correct:** The underlying mechanism is a **paraneoplastic syndrome** associated with occult or disseminated malignancy [2]. Cancer cells (especially **adenocarcinomas**) release procoagulants such as tissue factor and mucins into the circulation [3]. These substances trigger the extrinsic coagulation pathway and cause platelet aggregation, leading to a hypercoagulable state [1]. While most classically associated with **pancreatic carcinoma** (body and tail), it is also seen in lung, gastric, and colon cancers [3]. **2. Why Other Options are Incorrect:** * **Rheumatic Heart Disease (RHD):** While RHD can lead to atrial fibrillation and subsequent systemic embolism, it does not typically cause migratory superficial venous thrombosis. * **Libman-Sacks Endocarditis:** This is a form of non-bacterial verrucous endocarditis seen in Systemic Lupus Erythematosus (SLE). While SLE is a hypercoagulable state (often via Antiphospholipid Syndrome), Libman-Sacks itself refers to sterile vegetations on heart valves, not migratory thrombophlebitis. **Clinical Pearls for NEET-PG:** * **Classic Association:** Pancreatic Adenocarcinoma (High-yield: Look for a patient with weight loss, jaundice, and migrating skin nodules/redness) [4]. * **Trousseau Sign vs. Trousseau Syndrome:** Do not confuse *Trousseau syndrome* (migratory thrombophlebitis) with *Trousseau sign of latent tetany* (carpal spasm induced by BP cuff inflation in hypocalcemia). * **Management:** The definitive treatment is managing the underlying malignancy; however, **Low Molecular Weight Heparin (LMWH)** is the preferred anticoagulant, as these patients often respond poorly to Warfarin.

Q: A 70-year-old male presents with excessive fatigue, fever, and bleeding from gums while brushing. On examination, he has splenomegaly. CBC shows marked pancytopenia with the presence of blasts. A t(15;17)(q22;q12) cytogenetic rearrangement is found in this patient. Which of the following agents will you use in the management of this patient?

Tretinoin. ### Explanation **Diagnosis: Acute Promyelocytic Leukemia (APL) - AML M3** The clinical presentation of pancytopenia, blasts, and the pathognomonic **t(15;17)** translocation confirms the diagnosis of **Acute Promyelocytic Leukemia (APL)** [1]. This translocation involves the **PML** (Promyelocytic Leukemia) gene on chromosome 15 and the **RAR-$\alpha$** (Retinoic Acid Receptor-alpha) gene on chromosome 17. The resulting fusion protein blocks myeloid differentiation at the promyelocyte stage. **Why Tretinoin (All-Trans Retinoic Acid - ATRA) is correct:** ATRA is the cornerstone of APL management. It acts by binding to the PML-RAR$\alpha$ fusion protein, inducing the **differentiation** of leukemic promyelocytes into mature neutrophils. When combined with Arsenic Trioxide (ATO) or chemotherapy (Anthracyclines), it leads to high cure rates. **Why other options are incorrect:** * **Acyclovir:** An antiviral used for Herpes Simplex or Varicella-Zoster; it has no role in treating leukemia. * **Daunorubicin:** While anthracyclines are used in AML induction, ATRA is the specific targeted therapy for the t(15;17) mutation [1]. In modern protocols (low-risk APL), ATRA + Arsenic is often preferred over cytotoxic chemotherapy. * **Rituximab:** A monoclonal antibody against **CD20**, used in B-cell lymphomas and CLL, not in AML/APL. **High-Yield Clinical Pearls for NEET-PG:** * **DIC Risk:** APL is a medical emergency due to the high risk of **Disseminated Intravascular Coagulation (DIC)** triggered by the release of procoagulants from granules. * **Differentiation Syndrome:** A side effect of ATRA/Arsenic treatment characterized by fever, pulmonary infiltrates, and weight gain. It is managed with **Dexamethasone**. * **Auer Rods:** Classically seen in abundance ("faggot cells") in APL. * **Targeted Therapy:** APL is the first example of "differentiation therapy" in oncology.

Q: In polycythaemia vera, what is the most common postoperative complication following major surgery?

Thrombosis. **Explanation:** **Polycythemia Vera (PV)** is a chronic myeloproliferative neoplasm characterized by the autonomous overproduction of red blood cells, often driven by the **JAK2 V617F mutation** [2]. **Why Thrombosis is the correct answer:** The primary pathophysiology in PV involves a significant increase in red cell mass, leading to **hyperviscosity** and slowed blood flow. Additionally, qualitative abnormalities in platelets and increased interaction between leukocytes and the endothelium create a prothrombotic state. Major surgery further exacerbates this risk due to immobilization and systemic inflammation [1]. Consequently, **thrombosis** (both arterial and venous) is the most common and life-threatening postoperative complication [2]. **Analysis of Incorrect Options:** * **B. Gastric Ulcer:** While PV patients have an increased incidence of peptic ulcer disease (due to increased histamine release from basophils), it is a chronic association rather than a specific postoperative complication. * **C. Diabetes Insipidus:** This is not associated with PV. It typically results from ADH deficiency or resistance, unrelated to hyperviscosity. * **D. Haemorrhage:** Paradoxically, PV patients *are* at risk of bleeding (often due to acquired von Willebrand syndrome at very high platelet counts), but statistically, **thrombotic events** occur more frequently and represent the leading cause of morbidity post-surgery [2]. **High-Yield Clinical Pearls for NEET-PG:** * **Target Hematocrit:** To minimize surgical risk, the hematocrit should be controlled to **<45%** (ideally for several months) prior to elective surgery. * **Pruritus:** Characteristically "aquagenic" (itching after a warm bath) due to mast cell degranulation [2]. * **Spent Phase:** PV can progress to myelofibrosis or transform into Acute Myeloid Leukemia (AML). * **Treatment of choice:** Phlebotomy and low-dose aspirin; Hydroxyurea is used for high-risk patients.

Q: Which of the following conditions is not typically associated with macrocytic anemia?

Anemia of chronic disease. The classification of anemia is primarily based on the **Mean Corpuscular Volume (MCV)**. Macrocytic anemia is defined by an MCV >100 fL, whereas **Anemia of Chronic Disease (ACD)** is classically a **normocytic, normochromic anemia** (MCV 80–100 fL) [1]. In long-standing cases, ACD may progress to a microcytic pattern, but it is **not** associated with macrocytosis [2]. The pathophysiology of ACD involves high levels of **Hepcidin**, which sequesters iron in macrophages and decreases intestinal iron absorption [1]. **Analysis of Incorrect Options:** * **Folate deficiency (Option A):** A classic cause of megaloblastic macrocytic anemia [1]. Folate is essential for DNA synthesis; its deficiency leads to nuclear-cytoplasmic dyssynchrony. * **Previous ileum resection (Option C):** Vitamin B12 is absorbed in the **terminal ileum** via the intrinsic factor-cobalamin complex. Resection leads to B12 deficiency, causing macrocytic anemia. * **Regional enteritis (Option D):** Also known as **Crohn’s Disease**, it frequently involves the terminal ileum. Malabsorption of Vitamin B12 in these patients results in macrocytosis. **NEET-PG High-Yield Pearls:** * **Megaloblastic vs. Non-megaloblastic:** Macrocytic anemia with hypersegmented neutrophils (>5 lobes) suggests megaloblastic causes (B12/Folate deficiency). Non-megaloblastic causes include hypothyroidism, liver disease, and alcoholism. * **ACD Hallmark:** Low Serum Iron, **Low TIBC**, and **High/Normal Ferritin** (distinguishes it from Iron Deficiency Anemia) [1]. * **Drug-induced Macrocytosis:** Common triggers include Methotrexate, Phenytoin, and Zidovudine (AZT).

Q: Which viral infection is associated with neutropenia?

All of the above. Neutropenia (absolute neutrophil count <1500/µL) is a common hematological manifestation of various viral infections. The underlying pathophysiology typically involves direct bone marrow suppression, redistribution of neutrophils from the circulating pool to the marginal pool (sequestration), or the production of anti-neutrophil antibodies. * **Hepatitis A:** Viral hepatitis (A, B, and C) is a well-known cause of transient neutropenia during the icteric phase. In rare cases, it can trigger severe aplastic anemia. * **Influenza A:** Many respiratory viruses, including Influenza and RSV, cause neutropenia through marrow suppression and increased peripheral consumption during the acute inflammatory response. * **HIV:** Neutropenia is the most common white cell abnormality in HIV [2]. It occurs due to direct infection of marrow stromal cells, secondary opportunistic infections (like CMV) [1], or as a side effect of antiretroviral therapy (e.g., Zidovudine) [2]. Since all three viruses listed are documented causes of decreased neutrophil counts, **Option D** is the correct answer. **High-Yield Clinical Pearls for NEET-PG:** 1. **Most common viral cause of neutropenia:** Globally, HIV and viral hepatitis are high-frequency causes. 2. **Post-viral Neutropenia:** Usually develops 1–2 days after onset of fever and lasts for 3–7 days. 3. **Other Viral Causes:** Epstein-Barr Virus (EBV), Cytomegalovirus (CMV), Measles, and Varicella [1], [3]. 4. **Drug-Induced Link:** Always differentiate viral neutropenia from drug-induced causes (e.g., Clozapine, PTU, or Ganciclovir). 5. **Felty’s Syndrome Triad:** Rheumatoid arthritis, Splenomegaly, and Neutropenia (a common differential in hematology MCQs).

Question 1

All of the following disorders are inherited except?

Accepted Answer

Antiphospholipid antibody syndrome

Answer

Protein S deficiency

Answer

Protein C deficiency

Answer

Factor V Leiden mutation

Question 2

Migratory thrombophlebitis is seen in which of the following conditions?

Accepted Answer

Disseminated cancer

Answer

Rheumatic heart disease

Answer

Libman-Sacks endocarditis

Answer

All of the above

Question 3

Salmonellosis is most common in which of the following hematologic disorders?

Accepted Answer

Sickle cell anaemia

Answer

Thalassemia

Answer

Haemophilia

Answer

Macrocytic Anaemia

Question 4

A pregnant woman in her second trimester has a hemoglobin level of 6 mg%. If she receives IV transfusion of packed red cells, how much iron is absorbed per unit of packed red cells?

Accepted Answer

500 mg

Answer

2 gm

Answer

2 mg

Answer

1 gm

Question 5

A 70-year-old male presents with excessive fatigue, fever, and bleeding from gums while brushing. On examination, he has splenomegaly. CBC shows marked pancytopenia with the presence of blasts. A t(15;17)(q22;q12) cytogenetic rearrangement is found in this patient. Which of the following agents will you use in the management of this patient?

Accepted Answer

Tretinoin

Answer

Acyclovir

Answer

Daunorubicin

Answer

Rituximab

Question 6

Purpura is a feature of which of the following conditions?

Accepted Answer

Disseminated Intravascular Coagulation

Answer

Henoch Schonlein Purpura

Answer

Meningococcemia

Answer

Schamberg's disease

Question 7

Which of the following statements regarding polycythemia vera are true?

Accepted Answer

a) The JAK2 gene is located on the short arm of chromosome 9; b) Splenomegaly is an early presenting sign in PV; c) Venous and arterial thrombosis may be the presenting manifestation of PV; d) Red cell mass and plasma volume determinations are mandatory to establish the presence of an absolute erythrocytosis; e) A bone marrow aspirate and biopsy provide specific diagnostic information.

Question 8

In polycythaemia vera, what is the most common postoperative complication following major surgery?

Accepted Answer

Thrombosis

Answer

Gastric ulcer

Answer

Diabetes insipidus

Answer

Haemorrhage

Question 9

Which of the following conditions is not typically associated with macrocytic anemia?

Accepted Answer

Anemia of chronic disease

Answer

Folate deficiency

Answer

Previous ileum resection

Answer

Regional enteritis

Question 10

Which viral infection is associated with neutropenia?

Accepted Answer

All of the above

Answer

Hepatitis A

Answer

Influenza A

Answer

HIV

Hematology — MCQs

Hematology — MCQs

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