Hematology Practice Questions

Q: All of the following are minor criteria for multiple myeloma except?

Plasmacytoma on tissue biopsy. This question is based on the **Durie-Salmon Diagnostic Criteria** for Multiple Myeloma, which categorizes findings into Major and Minor criteria. [1] ### **Explanation of the Correct Answer** **Option D (Plasmacytoma on tissue biopsy)** is a **Major Criterion**, not a minor one. According to the Durie-Salmon criteria, a tissue biopsy proven plasmacytoma (extra-medullary or solitary bone) is one of the three major pillars of diagnosis, alongside marrow plasmacytosis >30% and high-level monoclonal (M) protein spikes. ### **Analysis of Incorrect Options (Minor Criteria)** * **Option A (Plasmacytosis 10–30%):** Bone marrow plasmacytosis between 10% and 30% is a minor criterion. (Note: >30% is Major). [1] * **Option B (Multiple lytic lesions):** While "punched-out" lytic lesions are classic for myeloma, they are classified as a minor criterion. [1] * **Option C (Hypogammaglobulinemia):** A reduction in normal immunoglobulins (IgG 30%. 3. M-component: IgG >3.5 g/dL, IgA >2 g/dL, or Bence-Jones proteinuria >1g/24h. * **Diagnosis:** Requires (I+b, I+c, I+d) OR (II+b, II+c, II+d) OR (III+b, III+c, III+d) OR (a+b+c) OR (a+b+d). * **Modern Update:** In clinical practice, the **IMWG (International Myeloma Working Group)** criteria are now preferred, focusing on **SLiM-CRAB** features (60% plasma cells, Light chain ratio >100, MRI lesions, Calcium elevation, Renal failure, Anemia, and Bone lesions). [1]

Q: Which marker differentiates Chronic Lymphocytic Leukemia (CLL) from Mantle Cell Lymphoma?

CD 23. **Explanation:** Chronic Lymphocytic Leukemia (CLL) and Mantle Cell Lymphoma (MCL) are both mature B-cell neoplasms that share several immunophenotypic markers, most notably **CD5** and **CD19/20**. Differentiating between them is crucial for prognosis and treatment. **Why CD23 is the correct answer:** **CD23** (the low-affinity IgE receptor) is the classic marker used to distinguish these two entities. * **CLL/SLL:** Characteristically **CD23 positive**. * **Mantle Cell Lymphoma:** Characteristically **CD23 negative**. In clinical practice, the Matutes scoring system utilizes CD23 positivity as a key parameter to diagnose CLL. **Analysis of Incorrect Options:** * **A. CD5:** This is a T-cell marker aberrantly expressed in both CLL and MCL. Therefore, it cannot be used to differentiate the two. * **B. CD17:** This is a glycosphingolipid marker (lactosylceramide) found on granulocytes and monocytes; it has no diagnostic utility in differentiating B-cell lymphomas. * **C. CD22:** This is a pan-B-cell marker present in most B-cell malignancies, including both CLL and MCL (though expression is often "dim" in CLL). **High-Yield Clinical Pearls for NEET-PG:** * **FMC-7:** Another differentiating marker; it is typically **negative** in CLL and **positive** in MCL. * **Cyclin D1:** MCL is characterized by the **t(11;14)** translocation, leading to overexpression of Cyclin D1. CLL is Cyclin D1 negative. * **SOX11:** A highly specific nuclear marker for Mantle Cell Lymphoma, especially useful in Cyclin D1-negative cases. * **Smudge Cells:** Classically seen on the peripheral smear of CLL patients due to the fragility of the lymphocytes.

Q: Sudden abdominal pain in polycythemia vera is most commonly due to which of the following complications?

Hepatic vein thrombosis. Explanation: 1. Why Hepatic Vein Thrombosis is Correct: Polycythemia Vera (PV) is a chronic myeloproliferative neoplasm characterized by an absolute increase in red cell mass. This leads to a prothrombotic state due to both increased blood viscosity and qualitative platelet abnormalities. A classic and high-yield complication of PV is Budd-Chiari Syndrome (BCS), which is the obstruction of hepatic venous outflow. Sudden abdominal pain, hepatomegaly, and ascites in a PV patient are hallmark signs of hepatic vein thrombosis. PV is, in fact, the most common underlying primary myeloproliferative cause of BCS. The presence of a JAK-2 mutation supports the diagnosis of such myeloproliferative disorders [1]. 2. Why the Other Options are Incorrect: * B. Hyperviscosity: While PV causes hyperviscosity, it typically presents with neurological symptoms (headache, dizziness, visual disturbances) or mucosal bleeding rather than sudden, localized abdominal pain. * C. Pancreatitis: While patients with PV may have an increased risk of gallstones (due to high cell turnover), pancreatitis is not a direct or "most common" vascular complication of the disease itself. * D. Small bowel obstruction: This is usually a mechanical issue (adhesions, hernias). While mesenteric ischemia can occur in PV due to thrombosis, hepatic vein involvement is more classically associated with the sudden presentation of the "abdominal triad" in this specific pathology. Clinical Pearls for NEET-PG: * JAK2 V617F Mutation: Present in >95% of PV cases [1]. * Aquagenic Pruritus: Itching after a warm bath is a pathognomonic symptom. * Spent Phase: PV can evolve into secondary myelofibrosis or Acute Myeloid Leukemia (AML). * Treatment: Phlebotomy (target Hct <45%) and low-dose aspirin are first-line. Hydroxyurea is used for high-risk patients.

Q: All of the following features may be seen in thrombotic thrombocytopenic purpura, except?

Hypertension. Thrombotic Thrombocytopenic Purpura (TTP) is a life-threatening microangiopathic hemolytic anemia (MAHA) caused by a deficiency of the enzyme **ADAMTS13**. This deficiency leads to large von Willebrand factor (vWF) multimers that cause spontaneous platelet aggregation and microthrombi formation. **Why Hypertension is the Correct Answer:** While TTP involves multi-organ dysfunction, **Hypertension** is not a classic diagnostic feature of the TTP pentad. In contrast, hypertension is a hallmark feature of **Hemolytic Uremic Syndrome (HUS)**, which is often confused with TTP [1]. In HUS, renal involvement is primary and severe, frequently leading to significant fluid overload and high blood pressure. [2] **Analysis of Incorrect Options:** * **Fever (A):** Part of the classic pentad; it occurs due to tissue ischemia and inflammation. * **Hemolysis (B):** Specifically, Microangiopathic Hemolytic Anemia (MAHA). RBCs are sheared as they pass through fibrin-platelet thrombi, leading to **schistocytes** on peripheral smear [1]. * **Low Platelet Count (D):** Thrombocytopenia occurs due to the massive consumption of platelets in the formation of microthrombi throughout the circulation [3]. **Clinical Pearls for NEET-PG:** 1. **The Classic Pentad (FAT RN):** **F**ever, **A**nemia (MAHA), **T**hrombocytopenia, **R**enal failure, and **N**eurological symptoms. 2. **Diagnosis:** Gold standard is decreased **ADAMTS13 activity** (<10%). 3. **Coagulation Profile:** PT and aPTT are typically **normal** in TTP (unlike DIC), as it is a platelet-plug problem, not a clotting factor consumption problem. 4. **Treatment:** Immediate **Plasmapheresis (Plasma Exchange)** is the treatment of choice. Never delay treatment for lab confirmation.

Question 1

All of the following are minor criteria for multiple myeloma except?

Accepted Answer

Plasmacytoma on tissue biopsy

Answer

Plasmacytosis 20%

Answer

Multiple lytic lesions

Answer

IgA < 100 mg/dL and IgG < 600 mg/dL

Question 2

A 72-year-old woman has an elevated WBC count on routine testing, with a manual differential noting an increased number of mature lymphocytes. She reports no recent illnesses or infectious symptoms, and her past medical history is significant for hypertension, osteoarthritis, chronic stable angina, and dyslipidemia. She is taking appropriate medications for these conditions and has no change in symptoms or medications. Her physical examination is normal. Which of the following features best characterizes chronic lymphocytic leukemia (CLL)?

Accepted Answer

Is frequently asymptomatic

Answer

Is usually a T-cell disorder

Answer

Is a disease of children

Answer

Is responsive to splenectomy

Question 3

Which of the following is true about Von Willebrand's disease?

Accepted Answer

Increased platelet aggregation in response to Ristocetin

Answer

Increased bleeding time

Answer

Factor VIII C levels are decreased in circulation.

Answer

APTT is increased

Question 4

Which marker differentiates Chronic Lymphocytic Leukemia (CLL) from Mantle Cell Lymphoma?

Accepted Answer

CD 23

Answer

CD 5

Answer

CD 17

Answer

CD 22

Question 5

Which of the following is true regarding anemia of chronic disease?

Accepted Answer

Decreased serum ferritin level

Answer

Decreased TIBC

Answer

Increased macrophage iron in marrow

Answer

Decreased serum iron levels

Question 6

Sudden abdominal pain in polycythemia vera is most commonly due to which of the following complications?

Accepted Answer

Hepatic vein thrombosis

Answer

Hyperviscosity

Answer

Pancreatitis

Answer

Small bowel obstruction

Question 7

Which of the following is true about aplastic anemia?

Accepted Answer

Reticulocytopenia

Answer

Splenomegaly

Answer

Nucleated RBCs in peripheral blood

Answer

Thrombocytopenia

Question 8

All of the following features may be seen in thrombotic thrombocytopenic purpura, except?

Accepted Answer

Hypertension

Answer

Fever

Answer

Hemolysis

Answer

Low platelet count

Question 9

A 25-year-old man involved in a motorcycle accident incurs a laceration to his thigh. The bleeding is stabilized en route to the hospital, but on arrival, he is noted to have orthostatic hypotension and his hematocrit is 21%. He receives 2 units of PRBCs. As the first unit is nearly finished transfusing, he becomes febrile and hypotensive. Urine output ceases. The serum above the clot in a red top phlebotomy tube is pink. Which of the following complications of transfusion has most likely occurred in this man?

Accepted Answer

Mislabeled specimens were processed in the laboratory

Answer

Donor antibodies were directed against his granulocytes

Answer

Donor blood was contaminated with hepatitis C virus

Answer

Fluid overload led to congestive heart failure

Question 10

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

Hematology — MCQs

Hematology — MCQs

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