Hematology Practice Questions

Q: Thrombocytosis is a recognized feature of which of the following conditions?

Azidothymidine therapy. AZT therapy is classically associated with bone marrow suppression, leading to macrocytic anemia and neutropenia [2]. However, a unique and paradoxical hematological feature of AZT therapy is **rebound or reactive thrombocytosis**. While the exact mechanism is not fully elucidated, it is believed to be a compensatory response or a direct stimulatory effect on megakaryopoiesis during the recovery phase of marrow suppression. **Analysis of Incorrect Options:** * **A. Myelofibrosis:** In the early (pre-fibrotic) stage, there may be thrombocytosis; however, the hallmark of established Primary Myelofibrosis is **thrombocytopenia** due to progressive bone marrow fibrosis and splenic sequestration (massive splenomegaly). * **B. Systemic Lupus Erythematosus (SLE):** SLE is typically associated with **thrombocytopenia** (immune-mediated destruction) as part of the ACR diagnostic criteria [1]. While reactive thrombocytosis can occur during acute inflammation, it is not a "recognized feature" compared to the characteristic cytopenias. * **D. Myelodysplastic Syndrome (MDS):** MDS is characterized by ineffective hematopoiesis leading to **cytopenias** (anemia, neutropenia, and thrombocytopenia). An exception is the 5q- syndrome, which may present with normal or elevated platelets, but overall, MDS is synonymous with low counts. **NEET-PG High-Yield Pearls:** * **AZT Side Effects:** Macrocytic anemia (most common), nail hyperpigmentation, and myopathy [2]. * **Reactive Thrombocytosis:** Most commonly caused by iron deficiency anemia, acute hemorrhage, and post-splenectomy states. * **Drug-induced Thrombocytopenia:** Common culprits include Heparin (HIT), Quinine, and Sulfonamides [1].

Q: Iron deficiency is best demonstrated by?

S. ferritin. **Explanation:** **Serum Ferritin** is the single most accurate and reliable non-invasive test for diagnosing Iron Deficiency Anemia (IDA). Ferritin is the primary storage protein for iron; its levels in the blood are directly proportional to the total body iron stores [1]. A low serum ferritin level (<15–30 ng/mL) is highly specific and indicates depleted iron stores, which is the earliest stage of iron deficiency. **Analysis of Options:** * **RDW (Red Cell Distribution Width):** While RDW increases early in IDA (indicating anisocytosis), it is a non-specific marker. It can also be elevated in Vitamin B12/Folate deficiency or sideroblastic anemia. * **BM (Bone Marrow) Examination:** Historically, Prussian blue staining of bone marrow aspirate was the "Gold Standard" for assessing iron stores (hemosiderin) [1]. However, it is an invasive, painful, and expensive procedure. Examination of the marrow may ultimately be required to assess iron stores directly in difficult cases [2]. * **Differential Leucocyte Count (DLC):** This measures white blood cells and has no diagnostic value in assessing iron status. **NEET-PG High-Yield Pearls:** * **Earliest indicator of IDA:** Increased RDW. * **Best biochemical test/Best screening test:** Serum Ferritin [1]. * **Gold Standard (Invasive):** Bone marrow iron (Prussian blue stain) [1][2]. * **Confirmatory test for IDA:** Response to oral iron therapy (increase in Reticulocyte count within 5–7 days) [2]. * **Note:** Ferritin is an **Acute Phase Reactant**. In the presence of inflammation, infection, or malignancy, ferritin levels may be falsely normal or high despite underlying iron deficiency [2]. In such cases, Transferrin Saturation (<16%) is used.

Q: What is the first-line treatment for the T315I mutation in Chronic Myeloid Leukemia (CML) management?

Ponatinib. **Explanation:** Chronic Myeloid Leukemia (CML) is characterized by the BCR-ABL1 fusion gene [2]. While first and second-generation Tyrosine Kinase Inhibitors (TKIs) are effective, resistance often develops due to mutations in the ABL kinase domain [1]. **1. Why Ponatinib is correct:** The **T315I mutation** (often called the "gatekeeper mutation") involves a substitution of threonine with isoleucine at position 315. This change creates a bulky side chain that sterically hinders the binding of most TKIs. **Ponatinib** is a third-generation TKI specifically designed with a carbon-carbon triple bond ethynyl linkage that bypasses this steric hindrance, making it the **first-line and only standard TKI effective against the T315I mutation.** **2. Why other options are incorrect:** * **Bosutinib (Option A):** A second-generation TKI. While effective against many mutations, it is ineffective against T315I. * **Tofacitinib (Option B):** This is a JAK inhibitor used in rheumatoid arthritis and ulcerative colitis; it has no role in BCR-ABL1 inhibition. * **Nilotinib (Option D):** A second-generation TKI. Like Imatinib and Dasatinib, it cannot bind to the ABL kinase domain when the T315I mutation is present [2]. **Clinical Pearls for NEET-PG:** * **Asciminib:** A newer "STAMP" inhibitor (Specifically Targeting the ABL Myristoyl Pocket) is also effective against T315I and is used in resistant cases. * **Side Effect Alert:** Ponatinib is associated with a high risk of **arterial occlusive events** (thrombosis) and hypertension; patients must be monitored for cardiovascular complications. * **Imatinib:** Still the first-line treatment for standard (non-mutated) chronic phase CML [2].

Q: Pseudotumor syndrome is seen in which condition?

Hemophilia. Explanation: Hemophilic Pseudotumor is a rare but serious complication occurring in approximately 1–2% of patients with severe hemophilia (Factor VIII or IX deficiency). Why Hemophilia is correct: A pseudotumor is essentially a chronic, encapsulated, progressive hematoma. It occurs due to repeated subperiosteal or soft tissue hemorrhages, most commonly in the long bones (femur, pelvic bones) or small bones of the hands/feet [1]. The pressure from the expanding hematoma causes pressure necrosis of the surrounding muscles and bone destruction, mimicking a neoplastic process (hence the name "pseudotumor") [1]. On X-ray, it appears as a well-demarcated lytic lesion with cortical thinning. Why other options are incorrect: * Systemic Lupus Erythematosus (SLE): While SLE can cause "Pseudotumor Cerebri" (idiopathic intracranial hypertension) due to venous sinus thrombosis or vasculitis, the term "Pseudotumor syndrome" in a hematological context specifically refers to the hemophilic complication. * Thalassemia: Thalassemia is associated with extramedullary hematopoiesis, which can present as masses (often paravertebral), but these are not referred to as pseudotumors. * Hyperparathyroidism: This condition leads to "Brown Tumors" (osteitis fibrosa cystica) due to increased osteoclast activity, not hematoma formation. High-Yield Clinical Pearls for NEET-PG: * Most common site: The femur is the most common site in adults; small bones of the hand/foot in children. * Management: Conservative management with factor replacement is the first line; however, large pseudotumors often require surgical excision or radiation [1]. * Radiology: Look for a "soap bubble" appearance or large soft tissue mass with adjacent bone erosion [1].

Q: Neurological symptoms and premature graying of hair are associated with which of the following conditions?

Pernicious anemia. **Explanation:** The correct answer is **Pernicious Anemia (Option B)**. This condition is an autoimmune disorder characterized by the destruction of gastric parietal cells, leading to a deficiency of **Intrinsic Factor (IF)**. Since IF is essential for the absorption of Vitamin B12 in the terminal ileum, its absence results in Vitamin B12 deficiency [1]. **Why Pernicious Anemia is correct:** 1. **Neurological Symptoms:** Vitamin B12 is crucial for myelin synthesis. Deficiency leads to **Subacute Combined Degeneration (SCD)** of the spinal cord, involving the posterior and lateral columns. Symptoms include loss of vibration/position sense, paresthesia, and ataxia. 2. **Premature Graying of Hair:** Vitamin B12 deficiency is a well-documented cause of reversible premature graying (canities) and skin hyperpigmentation. **Analysis of Incorrect Options:** * **Option A (Folic acid deficiency):** While it causes megaloblastic anemia similar to B12 deficiency, it **does not** cause neurological symptoms or premature graying. * **Options C & D (Plummer-Vinson / Paterson-Kelly syndrome):** These are synonyms for the same condition characterized by the triad of **Iron Deficiency Anemia, esophageal webs, and dysphagia**. It is associated with glossitis and koilonychia, but not neurological deficits or graying hair. **High-Yield Clinical Pearls for NEET-PG:** * **Schilling Test:** Historically used to diagnose Pernicious Anemia (now largely replaced by Anti-Intrinsic Factor and Anti-Parietal cell antibody titers). * **MCV:** Typically >100 fL (Megaloblastic). * **Peripheral Smear:** Shows hypersegmented neutrophils (earliest sign) and macro-ovalocytes. * **Metabolic Markers:** Both **Methylmalonic acid (MMA)** and **Homocysteine** levels are elevated in B12 deficiency (only Homocysteine is elevated in Folate deficiency).

Q: All are true in megaloblastic anemia except?

Microcytes. Explanation: Megaloblastic anemia is a type of macrocytic anemia primarily caused by a deficiency in Vitamin B12 or Folic acid [1]. These vitamins are essential cofactors for DNA synthesis. 1. Why "Microcytes" is the correct answer (The Exception): In megaloblastic anemia, impaired DNA synthesis leads to "nuclear-cytoplasmic asynchrony." While the nucleus matures slowly, the cytoplasm continues to grow, resulting in abnormally large cells. Therefore, the hallmark peripheral smear finding is Macrocytes (specifically oval macrocytes), not microcytes. Microcytes are characteristic of iron deficiency anemia or thalassemias. 2. Analysis of other options: * Megakaryocytes: These are the precursor cells for platelets in the bone marrow. In megaloblastic anemia, the marrow is hypercellular and contains giant, abnormal megakaryocytes with multi-lobed nuclei due to defective DNA synthesis. * Decrease in platelets: Severe megaloblastic anemia often leads to pancytopenia (reduction in RBCs, WBCs, and platelets) because the ineffective erythropoiesis affects all cell lines in the bone marrow. * Neurological symptoms: This is a classic feature of Vitamin B12 deficiency (Subacute Combined Degeneration of the spinal cord), presenting as loss of vibration/position sense, paresthesia, and ataxia. Note: Folic acid deficiency does not cause neurological symptoms. NEET-PG High-Yield Pearls: * Peripheral Smear: Look for Hypersegmented Neutrophils (earliest sign) and Howell-Jolly bodies. * Bone Marrow: Shows "sieve-like" chromatin and megaloblastic changes. * Biochemical markers: Increased Homocysteine (both B12 and Folate deficiency) and increased Methylmalonic Acid (MMA) (specific to B12 deficiency only). * Schilling Test: Historically used to determine the cause of B12 malabsorption (e.g., Pernicious Anemia).

Q: Which of the following presents with microcytic, hypochromic anemia?

Iron deficiency anemia. **Explanation:** **1. Why Iron Deficiency Anemia (IDA) is correct:** Microcytic, hypochromic anemia is characterized by a Mean Corpuscular Volume (MCV) < 80 fL and Mean Corpuscular Hemoglobin Concentration (MCHC) < 32 g/dL. In IDA, iron—a critical component of the heme molecule—is deficient. This leads to a decrease in hemoglobin synthesis. To compensate for the lack of hemoglobin, erythroid precursors undergo additional cell divisions, resulting in smaller (microcytic) and paler (hypochromic) red blood cells [1]. **2. Why other options are incorrect:** * **Megaloblastic Anemia:** This is a **macrocytic** anemia (MCV > 100 fL). It is caused by impaired DNA synthesis (usually due to Vitamin B12 or Folate deficiency), leading to nuclear-cytoplasmic asynchrony where the cell grows but cannot divide properly. * **Aplastic Anemia:** This is typically a **normocytic, normochromic** anemia [2]. It involves bone marrow failure leading to pancytopenia (reduction in RBCs, WBCs, and platelets) without a change in the size or color of the individual red cells. **3. NEET-PG High-Yield Pearls:** * **Differential Diagnosis for Microcytic Hypochromic Anemia (Mnemonic: TAILS):** **T**halassemia, **A**nemia of Chronic Disease (late stage), **I**ron Deficiency, **L**ead Poisoning, **S**ideroblastic Anemia [1]. * **Gold Standard Investigation for IDA:** Bone marrow aspiration (Prussian Blue staining for iron stores); however, **Serum Ferritin** is the most sensitive initial biochemical test. * **Mentzer Index:** (MCV/RBC count) — If 13, it suggests Iron Deficiency Anemia.

Question 1

Thrombocytosis is a recognized feature of which of the following conditions?

Accepted Answer

Azidothymidine therapy

Answer

Myelofibrosis

Answer

Systemic lupus erythematosus

Answer

Myelodysplastic syndrome

Question 2

Which of the following is absent in hemolytic anemia?

Accepted Answer

Increased direct bilirubin

Answer

Increased indirect bilirubin

Answer

Increased reticulocyte count

Answer

Jaundice

Question 3

Iron deficiency is best demonstrated by?

Accepted Answer

S. ferritin

Answer

RDW

Answer

BM examination

Answer

Differential leucocyte count

Question 4

What is the first-line treatment for the T315I mutation in Chronic Myeloid Leukemia (CML) management?

Accepted Answer

Ponatinib

Answer

Bosutinib

Answer

Tofacitinib

Answer

Nilotinib

Question 5

Pseudotumor syndrome is seen in which condition?

Accepted Answer

Hemophilia

Answer

Systemic lupus erythematosus

Answer

Thalassemia

Answer

Hyperparathyroidism

Question 6

A patient underwent bilateral adrenalectomy for bilateral pheochromocytoma. One day later, the patient developed lethargy, fatigue, low blood pressure, and a normal pulse. There are no signs of volume deficit. What is the likely course?

Accepted Answer

Addisonian Crisis

Answer

SIADH

Answer

Diabetes Insipidus (DI)

Answer

Cerebral Salt Wasting Syndrome

Question 7

Microangiopathic hemolytic anemia is seen in all of the following diseases except?

Accepted Answer

Antiphospholipid antibody syndrome

Answer

Thrombotic thrombocytopenic purpura

Answer

Microscopic polyangitis

Answer

Metallic cardiac valves

Question 8

Neurological symptoms and premature graying of hair are associated with which of the following conditions?

Accepted Answer

Pernicious anemia

Answer

Folic acid deficiency

Answer

Plummer-Vinson syndrome

Answer

Paterson-Kelly syndrome

Question 9

All are true in megaloblastic anemia except?

Accepted Answer

Microcytes

Answer

Megakaryocytes

Answer

Decrease in platelets

Answer

Neurological symptoms

Question 10

Which of the following presents with microcytic, hypochromic anemia?

Accepted Answer

Iron deficiency anemia

Answer

Megaloblastic anemia

Answer

Aplastic anemia

Answer

All of the above

Hematology — MCQs

Hematology — MCQs

On this page

Practice by Chapter

Want unlimited practice?