Hematology Practice Questions

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: 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: Which of the following statements about CNS leukemia is false?

Single blast in CSF is sufficient for diagnosis. ***Seen with acute myeloid leukemia*** - CNS involvement is typically not a common feature of **acute myeloid leukemia (AML)**; it's more associated with acute lymphoblastic leukemia (ALL) [1]. - While leukemia can affect the CNS, **AML is not predominantly known** for this complication compared to ALL . *Single blast in CSF is sufficient for diagnosis* - A **single blast** in the cerebrospinal fluid (CSF) does **not establish a definitive diagnosis** of CNS leukemia; multiple blasts are typically required. - Diagnosis involves considering clinical symptoms, laboratory findings, and often requires **a combination of findings** to confirm CNS involvement. *Intrathecal methotrexate is given* - **Intrathecal methotrexate** is used for treatment of CNS leukemia; however, this statement is true and does not meet the 'except' criteria. - It is a common practice to deliver chemotherapy directly to the CNS to combat leukemia effectively. *CNS irradiation is given* - CNS irradiation can be used as a treatment modality in certain instances of leukemia; thus, this statement is also true. - It is part of the therapeutic strategies for managing CNS involvement but is not universally applied for all cases.

Q: Thrombocythemia is characterized by an elevated platelet count.

Elevated platelet count. Elevated platelet count - Thrombocythemia is a condition specifically defined by an abnormally high number of platelets (thrombocytes) in the blood [2]. - This elevated count can lead to issues with both bleeding and clotting [2]. Low platelets - Low platelets, also known as thrombocytopenia, is the opposite of thrombocythemia [1]. - This condition is associated with an increased risk of bleeding [1]. Neutrophilia - Neutrophilia refers to an elevated count of neutrophils, a type of white blood cell, which is typically seen in bacterial infections. - It does not directly describe the platelet count. Monocytosis - Monocytosis indicates an increase in monocytes, another type of white blood cell, often seen in chronic infections or inflammatory conditions. - This term is unrelated to platelet levels.

Q: Which subtype of Acute Myeloid Leukemia (AML) is associated with the best prognosis?

Acute promyeloblastic leukemia (M3). ***Acute promyeloblastic leukemia (M.3)*** [1] - **Best prognosis** in acute myeloid leukemia (AML) is associated with acute promyeloblastic leukemia due to its responsiveness to **all-trans retinoic acid (ATRA)** treatment. [1] - This type often presents with a **prominent coagulopathy**, but successful treatment can lead to **long-term remission**. *Acute monocytic leukemia* - Generally associated with **poor prognosis** and is characterized by a high white blood cell count and organ infiltration. - It lacks the favorable features seen in acute promyeloblastic leukemia, such as effective treatment outcomes. *Erythroleukemia* - Known for having a **poor prognosis** due to its aggressive nature and frequent association with complex chromosomal abnormalities. [1] - Treatment responses are often suboptimal compared to that of acute promyeloblastic leukemia. *Acute myelomonocytic leukemia* - Typically has an **intermediate prognosis** [1] and presents with a mixture of myeloid and monocytic features. - It does not have the same treatment responsiveness and favorable outcomes as seen in acute promyeloblastic leukemia.

Q: Which of the following statements about sickle cell disease is true?

Fetal hemoglobin inhibits sickling.. ***Sickling is reversible with oxygenation*** - When oxygen tension is restored, hemoglobin S can re-hydrate and revert to its normal shape, reducing sickling. - This reversible process is essential for managing episodes of vaso-occlusive crisis in sickle cell disease. *Fetal hemoglobin facilitates Sickling* - Fetal hemoglobin (HbF) actually inhibits sickling by stabilizing the erythrocyte shape and reducing the proportion of hemoglobin S [1]. - Individuals with higher levels of HbF experience fewer sickling-related complications [1]. *Sickling occurs both in heterozygous and homozygous state* - Sickling primarily occurs in the homozygous state (HbSS); heterozygotes (HbAS) usually do not experience significant sickling effects [1]. - Heterozygous individuals may have a selective advantage against malaria, but they are not prone to sickle cell crises. *Sickling Leads to decreased MCHC* - Sickling does not directly lead to decreased mean corpuscular hemoglobin concentration (MCHC); MCHC is typically normal in sickle cell patients. - In fact, sickle cell disease often results in hemolysis and can lead to increased MCHC in some cases.

Q: Pagophagia is associated with the consumption of which substance?

Ice. ***Ice*** - **Pagophagia** is the compulsive consumption of **ice**, ice water, or iced beverages. - It is a specific form of **pica** [1] and is often associated with **iron deficiency anemia**. *Sand* - The compulsive consumption of **sand** is known as **geophagia**, a form of pica [1]. - It is not directly termed "pagophagia." *Clay* - The compulsive consumption of **clay** is also a form of **geophagia** [1]. - This term distinguishes it from the consumption of ice. *Salt* - While excessive salt intake can be a craving, it is not referred to as **pagophagia**. - Salt cravings can sometimes indicate certain electrolyte imbalances but are distinct from **pica** presentations like pagophagia [1].

Q: Which of the following is commonly seen in Polycythemia Vera?

Thrombosis. ***Spontaneous severe infection*** - In Polycythemia Vera, there is usually an **increased red blood cell mass** leading to complications like thrombosis, rather than a predisposition to severe infections. - Severe infections are not a typical feature, as the condition usually maintains **functional immunity** despite hyperviscosity. *Thrombosis* - Individuals with Polycythemia Vera have increased blood viscosity that results in a higher risk of **thrombosis**, which is a common complication [1]. - Events like **deep vein thrombosis (DVT)** or **cerebral venous sinus thrombosis** are often observed due to altered hemodynamics. *Hyperuricemia* - Hyperuricemia occurs due to increased cell turnover and breakdown of red cells in Polycythemia Vera, leading to elevated **uric acid levels** [1]. - Patients may experience **gout attacks** as a consequence of this elevated uric acid [1]. *Prone for acute leukemia* - While there is an increased risk of transformation to myeloid neoplasms, the risk for **acute leukemia** is not directly attributed to Polycythemia Vera in most cases. - It is more related to myelofibrosis or secondary conditions developing over time rather than a direct association.

Q: What is the recommended time frame for completing a blood transfusion after initiation?

1-4 hours. ***1-4 hours*** - This timeframe is recommended to **minimize the risk of bacterial growth** in the blood product, as bacteria can multiply quickly at room temperature. - Completing the transfusion within 4 hours also reduces the likelihood of **red blood cell degeneration** and loss of efficacy. *3-6 hours* - This period extends beyond the recommended maximum of 4 hours, increasing the risk of **bacterial proliferation** in the blood product. - Prolonged infusion times can also lead to a **decrease in the viability and function** of transfused cells. *4-8 hours* - Transfusing over 4-8 hours significantly elevates the risk of **bacterial contamination** and potential septic reactions. - The extended duration compromises the **quality and safety** of the blood product. *8-12 hours* - This timeframe is unacceptably long for a blood transfusion, posing a **critical risk of severe bacterial growth** and infection. - Blood products should not be administered beyond 4 hours due to the rapid decline in **cell integrity and increased adverse reaction potential**.

Question 1

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 2

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 3

All of the following are characteristic features of treatment of iron deficiency anemia with oral iron supplements, except which of the following?

Accepted Answer

The treatment should be discontinued immediately once hemoglobin normalizes to prevent side effects of iron

Answer

Bioavailability is enhanced with vitamin C

Answer

The proportion of iron absorbed reduces as hemoglobin improves

Answer

The reticulocyte count should begin to increase within 7-10 days and peak at 2-4 weeks; this suggests good response to treatment

Question 4

Which of the following statements about CNS leukemia is false?

Accepted Answer

Single blast in CSF is sufficient for diagnosis

Answer

Intrathecal methotrexate is given

Answer

Seen with acute myeloid leukemia

Answer

CNS irradiation is given

Question 5

Thrombocythemia is characterized by an elevated platelet count.

Accepted Answer

Elevated platelet count

Answer

Low platelets

Answer

Neutrophilia

Answer

Monocytosis

Question 6

Which subtype of Acute Myeloid Leukemia (AML) is associated with the best prognosis?

Accepted Answer

Acute promyeloblastic leukemia (M3)

Answer

Acute myelo monocytic leukemia.

Answer

Acute monocytic leukemia.

Answer

Erythro leukemia

Question 7

Which of the following statements about sickle cell disease is true?

Accepted Answer

Fetal hemoglobin inhibits sickling.

Answer

Sickling is completely reversible with oxygenation, making it clinically insignificant.

Answer

Sickling leads to a significant increase in overall MCHC levels in the blood.

Answer

Sickling occurs exclusively in the homozygous state and never in the heterozygous state.

Question 8

Pagophagia is associated with the consumption of which substance?

Accepted Answer

Ice

Answer

Sand

Answer

Clay

Answer

Salt

Question 9

Which of the following is commonly seen in Polycythemia Vera?

Accepted Answer

Thrombosis

Answer

Hyperuricemia

Answer

Prone for acute leukemia

Answer

Spontaneous severe infection

Question 10

What is the recommended time frame for completing a blood transfusion after initiation?

Accepted Answer

1-4 hours

Answer

3-6 hours

Answer

4-8 hours

Answer

8-12 hours

Hematology — MCQs

Hematology — MCQs

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