Hematology Practice Questions

Q: A 23-year-old male presented with a history of fatigue and tiredness. On investigation, he was found to have Hb values of 9gm%, MCV of 101 FL. Peripheral smear examination showed hypersegmented neutrophils. Which is the most probable etiology?

Vitamin B12 deficiency. ***Lead poisoning*** - Characterized by **microcytic anemia** and the presence of **hypersegmented neutrophils**, often related to **lead-induced interference** with heme synthesis [2]. - It frequently presents with symptoms of **fatigue**, and the laboratory findings align with lead's known hematological effects [1]. *Hemolytic anemia* - Typically features **normocytic or macrocytic RBCs** following destruction of red blood cells rather than microcytic. - Symptoms usually include **jaundice** and **dark urine**, which are absent in this case. *Iron deficiency anemia* - Generally presents with **microcytic hypochromic RBCs** but would not show **hypersegmented neutrophils**. - Associated with external factors like **malnutrition** or chronic blood loss, which were not indicated in this scenario. *Chronic alcoholism* - Commonly leads to **macrocytic anemia** due to folate deficiency, rather than microcytic anemia seen here. - Symptoms usually include **liver dysfunction** signs, which are not mentioned in this case.

Q: In which condition are solitary lytic lesions typically seen?

Multiple myeloma. ***Multiple myeloma*** - **Solitary lytic lesions**, also known as **"punched-out" lesions**, are a classic radiographic finding in multiple myeloma due to **plasma cell proliferation** in the bone [1]. - Patients often have **elevated serum proteins** and show signs of **renal impairment** and anemia, alongside these bone lesions [1]. *Atherosclerosis* - Primarily affects **blood vessels**, leading to plaque formation, and does not cause **lytic bone lesions**. - Clinical manifestations focus on **cardiovascular disease** rather than bone abnormalities. *Mitral stenosis* - Affects the **heart valves** and results in **heart failure** symptoms rather than causing lytic lesions in bones. - Clinical findings include **dyspnea** and signs of **pulmonary congestion**, which are unrelated to bone pathology. *Osteoblast* - Osteoblasts are **bone-forming cells**, and while they may be involved in certain bone diseases, they do not create **solitary lytic lesions**. - Lytic lesions typically arise from **osteoclast activity** or **tumor infiltration**, not from osteoblastic processes [1].

Q: Which of the following statements about deep venous thrombosis (DVT) is incorrect?

Mostly bilateral. ***Mostly bilateral*** - DVT is typically **unilateral**, affecting one limb [2]. Bilateral DVT is less common, making this statement incorrect [2]. - The symptoms of **pain, swelling, and tenderness** are usually localized to one leg [1]. *Most common clinically presents as pain and tenderness in calf* - **Calf pain and tenderness** are common clinical presentations of DVT, especially in the lower extremities [1]. - Other common signs include **swelling, warmth, and redness** in the affected leg [1]. *Some cases may directly present as pulmonary thromboembolism* - A significant concern with DVT is that a **clot can dislodge** and travel to the lungs, causing a **pulmonary embolism (PE)**, which can be the initial presentation [1]. - PE is a potentially life-threatening complication and may present with **dyspnea, chest pain, and hemoptysis**. *Clinical assessment highly reliable* - **Clinical assessment alone is not highly reliable** for diagnosing DVT due to its variable and often non-specific presentation [2]. - A definitive diagnosis usually requires objective diagnostic tests such as **compression ultrasonography** or **D-dimer assay** [3].

Q: Which of the following statements is true regarding Hemophilia A?

Deficiency of factor VIII. ***Serum levels of factor VIII are decreased*** - Hemophilia A is characterized by a **deficiency of factor VIII** [1], which leads to decreased serum levels of this factor. - This deficiency results in a **prolonged activated partial thromboplastin time (aPTT)** [3] but normal prothrombin time (PT). *Deficiency of factor IX* - This escribes **Hemophilia B**, which is caused by a deficiency of factor IX, not factor VIII as in Hemophilia A [1]. - Hemophilia A specifically refers to the **deficiency of factor VIII** [1][2], where factor IX is not involved. *PT increased* - In Hemophilia A, the **prothrombin time (PT)** is usually normal because the intrinsic pathway is not affected [3]. - The primary test affected is the **activated partial thromboplastin time (aPTT)**, which is prolonged due to factor VIII deficiency [3]. *FIT decreased* - The term "FIT" is not standard in the context of hemophilia; it might refer to some other tests or assessments not directly relevant to factor levels. - The relevant lab finding in Hemophilia A is the **decrease in factor VIII** [2], not a direct measure of "FIT".

Q: Which of the following can result in dactylitis

Sickle Cell Anemia. ***Sickle Cell Anemia*** - **Dactylitis**, often referred to as **hand-foot syndrome**, is a common early manifestation of **sickle cell anemia** in infants and young children [2]. - It results from **vaso-occlusion** in the small bones of the hands and feet, leading to **inflammation, pain, and swelling**. *Hemophilia* - Hemophilia is a bleeding disorder characterized by a deficiency in certain **clotting factors**, leading to uncontrolled bleeding. - It primarily causes **hemarthrosis** (bleeding into joints) and muscle hematomas, but not dactylitis. *Measles* - Measles is a viral infection characterized by a distinctive **rash, fever, cough, coryza, and conjunctivitis**. - It does not directly cause dactylitis; musculoskeletal symptoms are not typical of measles. *Von Willebrand disease* - This is the most common **inherited bleeding disorder**, caused by a deficiency or dysfunction of **von Willebrand factor** [1]. - Similar to hemophilia, it primarily manifests with **mucocutaneous bleeding** and **menorrhagia**, not dactylitis.

Q: What is the first-line treatment for severe or chronic idiopathic thrombocytopenia purpura (ITP)?

Corticosteroid therapy. ***Corticosteroid therapy*** - **Corticosteroids** are the cornerstone of first-line treatment for severe or chronic ITP due to their ability to suppress the **autoimmune destruction of platelets** [1]. - They work by reducing antibody production, improving platelet survival, and stabilizing endothelial integrity, thereby **decreasing bleeding risk** [1]. *Platelet transfusion* - **Platelet transfusions** are generally reserved for **life-threatening hemorrhage** in ITP, as transfused platelets are quickly destroyed by the same autoantibodies. - They are not a first-line treatment for chronic management because they do not address the underlying **immune-mediated destruction**. *Observation and monitoring* - **Observation and monitoring** may be appropriate for patients with **mild ITP** (platelet count >30,000/µL) and no significant bleeding symptoms. - However, for **severe or chronic ITP**, active treatment is required to prevent serious bleeding complications. *Splenectomy* - **Splenectomy** is a treatment option for **refractory ITP**, typically considered after failure of first-line therapies like corticosteroids [1]. - The spleen is the primary site of antiplatelet antibody production and platelet destruction, so its removal can be effective but carries surgical risks and is not an initial approach [1].

Q: In which of the following conditions is marked bleeding typically observed?

Thrombocytopenia. ***ALL*** - **Acute Lymphoblastic Leukemia (ALL)** often presents with significant **thrombocytopenia**, leading to **marked bleeding** due to the low platelet count. - The disease disrupts normal hematopoiesis in the bone marrow, contributing to leukopenia and anemia, which may also result in bleeding complications [1]. *Haemophilia B* - This condition is characterized by a deficiency of **Factor IX**, leading to bleeding, but typically presents with **mild to moderate** bleeding rather than marked bleeding [1]. - Bleeding often occurs following trauma or surgery, unlike the more significant bleeding seen in ALL [1]. *VMA disease* - VMA disease (likely referring to **Vanillylmandelic Acid**), associated with **neuroblastoma**, does not primarily cause bleeding issues but rather is related to catecholamine excretion. - Symptoms are more aligned with **tumor-related effects** rather than coagulopathy or bleeding diathesis. *Haemophilia A* - Similar to Haemophilia B, it involves a deficiency of a clotting factor (**Factor VIII**) and can cause bleeding, but it usually results in **moderate bleeding** rather than marked bleeding [1]. - Bleeding is generally more controlled, relating to specific injury rather than spontaneous significant hemorrhage [1].

Q: Chronic hemolytic anaemia is associated with which of the following -

Black Pigment stone of the gall bladder. ***Black Pigment stone of the gall bladder*** - Chronic hemolytic anemia leads to increased **bilirubin**, particularly unconjugated bilirubin, which can result in the formation of **black pigment stones** [1]. - These stones are associated with conditions causing **excess bilirubin production**, such as sickle cell disease and thalassemia. *Brown Pigment stone of the gall bladder* - Brown pigment stones are primarily associated with **infection** and **biliary tract disorders**, not directly with chronic hemolytic anemia. - They are mainly composed of **calcium bilirubinate**, which arises in cases of **bacterial infections** or parasitic infestations. *Intestinal Obstruction* - While hemolytic anemia can have various complications, it is **not directly linked with intestinal obstruction**. - Obstruction typically arises from **mechanical causes** such as adhesions, tumors, or hernias, rather than from hemolytic processes. *Uric acid Renal Calculus* - Uric acid stones are formed due to conditions leading to **hyperuricemia** and are not a primary consequence of chronic hemolytic anemia. - They are often associated with **gout** and **certain metabolic disorders**, rather than hemolytic processes.

Q: CAR-T cell therapy (Chimeric Antigen Receptor T-cell therapy) is being investigated for the treatment of which malignancy?

Acute Lymphoblastic Leukemia. ***Acute Lymphoblastic Leukemia*** - **CAR T-cell therapy** has shown remarkable success, particularly in treating refractory or relapsed **B-cell acute lymphoblastic leukemia (ALL)** in children and young adults. - The therapy targets the **CD19 antigen** found on malignant B-cells, leading to their destruction by engineered T-cells. *Renal Cell Carcinoma* - While immune therapies are used for **renal cell carcinoma (RCC)**, traditional CAR T-cell therapy targeting specific antigens has not yet achieved widespread clinical success for this solid tumor. - RCC often presents with a **heterogeneous antigenic landscape**, making it challenging for single-target CAR T-cells. *Pancreatic Cancer* - **Pancreatic cancer** is a challenging malignancy due to its dense stroma and immunosuppressive microenvironment, which limits T-cell infiltration and efficacy. - CAR T-cell therapy for pancreatic cancer is still largely in **early-stage clinical trials**, facing significant hurdles in solid tumor treatment. *Glioblastoma Multiforme* - **Glioblastoma multiforme (GBM)** is an aggressive brain tumor with unique challenges for CAR T-cell therapy, including the **blood-brain barrier** and tumor heterogeneity. - Research is ongoing to develop CAR T-cells that can effectively target GBM, often using **regional delivery methods** or targeting multiple antigens.

Q: In cobalamin deficiency which is not seen

Microcytic anemia. Microcytic anemia - Cobalamin deficiency typically leads to macrocytic anemia due to impaired DNA synthesis, not microcytic anemia [1]. - Microcytic anemia is usually associated with iron deficiency, thalassemia, or anemia of chronic disease [1]. Long tract signs - Long tract signs are common in cobalamin deficiency due to posterior column and corticospinal tract involvement leading to symptoms like spasticity. - They indicate involvement of pathways that are affected by vitamin B12 deficiency. Loss of proprioception - Loss of proprioception can occur in cobalamin deficiency due to damage to the dorsal columns of the spinal cord. - It is a common clinical finding indicating the involvement of sensory pathways. Rhomberg sign - A positive Rhomberg sign indicates impaired proprioception, which can happen in cobalamin deficiency. - It reflects difficulty maintaining balance, emphasizing sensory dysfunction associated with the deficiency.

Question 1

A 23-year-old male presented with a history of fatigue and tiredness. On investigation, he was found to have Hb values of 9gm%, MCV of 101 FL. Peripheral smear examination showed hypersegmented neutrophils. Which is the most probable etiology?

Accepted Answer

Vitamin B12 deficiency

Answer

Hemolytic anemia

Answer

Folate deficiency

Answer

Iron deficiency anemia

Question 2

In which condition are solitary lytic lesions typically seen?

Accepted Answer

Multiple myeloma

Answer

Atherosclerosis

Answer

Mitral stenosis

Answer

Osteosarcoma

Question 3

Which of the following statements about deep venous thrombosis (DVT) is incorrect?

Accepted Answer

Mostly bilateral

Answer

Most common clinically presents as pain and tenderness in calf

Answer

Some cases may directly present as pulmonary thromboembolism

Answer

Clinical assessment highly reliable

Question 4

Which of the following statements is true regarding Hemophilia A?

Accepted Answer

Deficiency of factor VIII

Answer

PT is typically prolonged

Answer

PTT is typically normal

Answer

Serum levels of factor VIII are increased

Question 5

Which of the following can result in dactylitis

Accepted Answer

Sickle Cell Anemia

Answer

Hemophilia

Answer

Measles

Answer

Von Willebrand disease

Question 6

What is the first-line treatment for severe or chronic idiopathic thrombocytopenia purpura (ITP)?

Accepted Answer

Corticosteroid therapy

Answer

Splenectomy

Answer

Platelet transfusion

Answer

Observation and monitoring

Question 7

In which of the following conditions is marked bleeding typically observed?

Accepted Answer

Thrombocytopenia

Answer

Von Willebrand disease

Answer

Hemophilia A

Answer

Hemophilia B

Question 8

Chronic hemolytic anaemia is associated with which of the following -

Accepted Answer

Black Pigment stone of the gall bladder

Answer

Brown Pigment stone of the gall bladder

Answer

Uric acid Renal Calculus

Answer

Intestinal Obstruction

Question 9

CAR-T cell therapy (Chimeric Antigen Receptor T-cell therapy) is being investigated for the treatment of which malignancy?

Accepted Answer

Acute Lymphoblastic Leukemia

Answer

Renal Cell Carcinoma

Answer

Pancreatic Cancer

Answer

Glioblastoma Multiforme

Question 10

In cobalamin deficiency which is not seen

Accepted Answer

Microcytic anemia

Answer

Loss of proprioception

Answer

Rhomberg sign

Answer

Long tract signs

Hematology — MCQs

Hematology — MCQs

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