Hematology Practice Questions

Q: Which of the following statements is true regarding oral therapy for iron deficiency anemia?

Absorption of iron decreases as symptoms improve.. The correct answer is **D: Absorption of iron decreases as symptoms improve.** **1. Why Option D is Correct:** Iron absorption is a tightly regulated physiological process. In iron deficiency anemia (IDA), the body’s iron stores are depleted, leading to a downregulation of **hepcidin** (the master regulator of iron). Low hepcidin levels allow for maximal absorption of iron through the ferroportin channels in the duodenum [1]. As oral therapy progresses and hemoglobin levels/iron stores normalize, hepcidin levels rise, which subsequently inhibits ferroportin and **decreases the efficiency of iron absorption** [3]. **2. Why the Other Options are Incorrect:** * **Option A:** In a state of iron deficiency, only about **10–20% (approx. 30–60 mg)** of a 300 mg dose of elemental iron is absorbed. The body cannot absorb 100 mg from a single dose due to the mucosal block and limited transport capacity [2]. * **Option B:** Reticulocytosis begins within 3–5 days, but it **peaks much earlier**, typically between **7 to 10 days**. It does not take 3–4 weeks to peak. * **Option C:** A response to therapy (indicated by a rise in hemoglobin) is seen much sooner. Hemoglobin typically begins to rise within **1 to 2 weeks**, and a significant increase (usually >2 g/dL) is expected by 3–4 weeks. **3. NEET-PG High-Yield Pearls:** * **Best Absorption:** Iron is best absorbed in the **ferrous (Fe2+) state** in an acidic environment (often prescribed with Vitamin C/Orange juice) [2]. * **Dose:** The standard therapeutic dose for IDA is **100–200 mg of elemental iron** daily. * **Duration:** Therapy must continue for **3–6 months** after hemoglobin normalizes to replenish bone marrow iron stores (monitored via Serum Ferritin). * **Side Effects:** Gastrointestinal upset (nausea, constipation, metallic taste) is the most common reason for non-compliance.

Q: Aplastic anemia is characterized by which of the following findings?

Normocytic normochromic anemia with thrombocytopenia. **Explanation:** **Aplastic Anemia (AA)** is a bone marrow failure syndrome characterized by **pancytopenia** (reduction in all three cell lines: RBCs, WBCs, and platelets) and a **hypocellular bone marrow** where hematopoietic tissue is replaced by fat. 1. **Why Option A is correct:** In Aplastic Anemia, the primary defect is a reduction in the number of hematopoietic stem cells. Since the cells that *are* produced are typically structurally normal, the red blood cells usually maintain a **normocytic (normal size) and normochromic (normal hemoglobin content)** appearance. Thrombocytopenia is a hallmark finding due to the failure of megakaryopoiesis. 2. **Why other options are incorrect:** * **Option B (Megaloblasts):** These are seen in Megaloblastic Anemias (Vitamin B12 or Folate deficiency) due to impaired DNA synthesis. While AA can sometimes show mild macrocytosis, true megaloblasts are absent. * **Option C (Hypochromic microcytic):** This is characteristic of impaired hemoglobin synthesis, most commonly seen in **Iron Deficiency Anemia** or Thalassemia. * **Option D (Hyperchromic macrocytic):** "Hyperchromic" is a misnomer as RBCs cannot be over-saturated with hemoglobin. Macrocytic changes are seen in B12 deficiency or MDS, but not typically as a defining feature of AA. **High-Yield Clinical Pearls for NEET-PG:** * **Gold Standard Diagnosis:** Bone marrow aspiration and **trephine biopsy** (shows "dry tap" and fatty replacement). * **Key Finding:** Reticulocytopenia (low corrected reticulocyte count) indicating lack of RBC production. * **Modified Camitta Criteria:** Used to define "Severe Aplastic Anemia" (Marrow cellularity <25% plus two of: Neutrophils <500/µL, Platelets <20,000/µL, or Reticulocytes <1%). * **Treatment of Choice:** Allogeneic Stem Cell Transplant (in young patients) or Immunosuppressive Therapy (Antithymocyte globulin + Cyclosporine).

Q: Which of the following is a major criterion for the diagnosis of polycythemia vera?

Presence of JAK-2 mutation. Polycythemia Vera (PV) is a chronic myeloproliferative neoplasm characterized by the autonomous overproduction of red blood cells. The diagnosis is based on the **WHO 2016/Revised 4th Edition criteria**, which divides findings into Major and Minor categories. **1. Why Option A is Correct:** The **presence of a JAK2 mutation** (specifically *JAK2V617F* in ~95% of cases or *JAK2* exon 12 mutation in ~5%) is a **Major Criterion** [1]. This mutation leads to constitutive activation of the JAK-STAT signaling pathway, making erythroid progenitors hypersensitive to erythropoietin (EPO) and driving erythropoiesis independent of physiological control. **2. Analysis of Incorrect Options:** * **Option B (Low EPO levels):** While characteristic of PV, a subnormal serum EPO level is classified as a **Minor Criterion**, not a major one. It helps differentiate primary polycythemia (low EPO) from secondary causes like hypoxia (high EPO). * **Option C (High LAP score):** An elevated LAP score is often seen in PV, but it is a non-specific finding and is **not part of the formal WHO diagnostic criteria**. * **Option D (Thrombocytosis):** While PV is a panmyelosis (increase in all cell lines), thrombocytosis is a common clinical feature but **not a diagnostic criterion**. **3. NEET-PG High-Yield Pearls:** * **WHO Major Criteria for PV:** 1. Hemoglobin >16.5 g/dL (men) / >16.0 g/dL (women) OR Hematocrit >49% (men) / >48% (women) [1]. 2. Bone marrow biopsy showing hypercellularity for age with trilineage growth (panmyelosis) [1]. 3. Presence of *JAK2V617F* or *JAK2* exon 12 mutation [1]. * **Clinical Presentation:** Patients often present with **aquagenic pruritus** (itching after a hot bath), facial plethora, and splenomegaly [1]. * **Complications:** Increased risk of thrombotic events (Budd-Chiari syndrome) and transformation to myelofibrosis or AML [1].

Q: For which procedure is the following instrument used?

Bone marrow examination. ***Bone marrow examination*** - The instrument shown is a **Jamshidi needle** (bone marrow biopsy needle) with characteristic **trocar tip**, **outer cannula with stylet**, and **T-shaped handle** for optimal grip and control. - Specifically designed for **bone marrow aspiration** and **core biopsy** from sites like **posterior iliac crest**, allowing collection of both liquid marrow and solid tissue samples. *Liver biopsy* - Liver biopsies use **Menghini needles** or **Tru-cut needles** which are thinner, shorter, and lack the robust construction needed for penetrating bone. - These needles have **different tip designs** (cutting or suction) optimized for soft tissue sampling, not the thick cortical bone overlying marrow. *Pleural biopsy* - Pleural biopsies utilize **Abrams needles** or **Cope needles** which have **hooked or notched tips** specifically designed to scrape pleural tissue. - These instruments are **smaller gauge** and designed for accessing the **pleural space**, not for penetrating dense bone tissue. *Lumbar puncture* - Lumbar puncture uses **Quincke spinal needles** or **Whitacre needles** which are much **thinner (22-25 gauge)** and **longer** for reaching the subarachnoid space. - These needles have **pencil-point or cutting tips** designed for **CSF aspiration** only, without the robust construction needed for bone penetration.

Question 1

Which of the following statements is not true regarding hemophilia A?

Accepted Answer

Factor VIII levels less than 50% are associated with spontaneous hemorrhage.

Answer

Hemophilia A is due to deficiency of factor VIII.

Answer

In hemophilia A, females are typically carriers.

Answer

Desmopressin can be useful in the management of hemophilia A.

Question 2

Platelet function defect is seen in which of the following conditions?

Accepted Answer

Bernard-Soulier syndrome

Answer

Glanzmann syndrome

Answer

Wiskott-Aldrich syndrome

Answer

Von Willebrand disease

Question 3

A 19-year-old college student develops a severe sore throat, cervical lymphadenopathy, and atypical lymphocytes on blood film. A heterophil antibody test is positive. For the above patient with a hematologic abnormality, select the most likely diagnosis.

Accepted Answer

infectious mononucleosis

Answer

hyperthyroidism

Answer

rectal cancer

Answer

renal cell carcinoma

Question 4

What is the recommended daily amount of elemental iron required for iron replacement therapy?

Accepted Answer

300 mg of elemental iron per day

Answer

60 mg of elemental iron per day

Answer

160 mg of elemental iron per day

Answer

360 mg of elemental iron per day

Question 5

While managing a febrile neutropenic patient, all of the following are essential EXCEPT:

Accepted Answer

White cell infusion

Answer

Repeated hand washing by hospital personnel

Answer

Prophylactic antibiotics

Answer

Colony-stimulating factor for macrophages

Question 6

Which of the following statements is true regarding oral therapy for iron deficiency anemia?

Accepted Answer

Absorption of iron decreases as symptoms improve.

Answer

Approximately 100 mg of elemental iron is absorbed from a 300 mg dose.

Answer

Reticulocytosis appears within one to two weeks and peaks in three to four weeks.

Answer

A response to therapy is typically seen within four weeks.

Question 7

All of the following statements about hereditary hemochromatosis are true EXCEPT?

Accepted Answer

Desferroxamine is the treatment of choice

Answer

Arthropathy involving small joints of hands may be seen

Answer

Skin pigmentation is a frequent presentation

Answer

Hypogonadism may be seen

Question 8

Aplastic anemia is characterized by which of the following findings?

Accepted Answer

Normocytic normochromic anemia with thrombocytopenia

Answer

Presence of megaloblasts

Answer

Hypochromic microcytic anemia

Answer

Hyperchromic macrocytic anemia

Question 9

Which of the following is a major criterion for the diagnosis of polycythemia vera?

Accepted Answer

Presence of JAK-2 mutation

Answer

Low erythropoietin levels

Answer

High leukocyte alkaline phosphatase (LAP) score

Answer

Thrombocytosis

Question 10

For which procedure is the following instrument used?

Accepted Answer

Bone marrow examination

Answer

Liver biopsy

Answer

Pleural biopsy

Answer

Lumbar puncture

Hematology — MCQs

Hematology — MCQs

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