Hematology Practice Questions

Q: A 69-year-old woman, with poor dietary habits and alcoholism, is found to have a macrocytic anemia with hyper segmented neutrophils. Which of the following is the most appropriate diagnostic test?

RBC folate levels. RBC folate levels - **RBC folate levels** reflect **tissue folate stores** and are less susceptible to daily dietary fluctuations than serum folate. - This test is considered a more reliable indicator for diagnosing **chronic folate deficiency**, which is consistent with poor dietary habits and alcoholism. *serum folate levels* - **Serum folate levels** are easily influenced by recent dietary intake, making them less indicative of long-term folate stores [1]. - A normal serum folate level can be seen in patients with **tissue folate deficiency** if they have recently ingested folate-rich foods [1]. *bone marrow* - A **bone marrow biopsy** might show megaloblastic changes, but it is an invasive procedure and is usually reserved for cases where the diagnosis remains unclear after less invasive tests [2]. - While it can confirm **megaloblastic anemia**, it does not specifically differentiate between **folate** and **B12 deficiencies** as the primary diagnostic tool. *Schilling test* - The **Schilling test** is used to diagnose **vitamin B12 malabsorption** (pernicious anemia or other causes), not folate deficiency. - This patient's clinical picture points more towards a **folate deficiency** given the poor dietary habits and alcoholism, although B12 deficiency can also cause macrocytic anemia [3].

Q: Bleeding crisis in acute idiopathic thrombo-cytopenic purpura is managed by all except -

Eltrombopag. ***Eltrombopag*** - **Eltrombopag** is a **thrombopoietin receptor agonist** used for chronic idiopathic thrombocytopenic purpura (ITP) to increase platelet production. - It is **not** used for the immediate management of an acute bleeding crisis, as its effects on platelet counts take several days to manifest. *Intravenous immunoglobulin* - **Intravenous immunoglobulin (IVIG)** works by blocking **Fc receptors** on macrophages, thereby reducing the destruction of antibody-coated platelets. - It is a **first-line treatment** for acute ITP, especially in cases with severe bleeding or very low platelet counts, providing a rapid increase in platelet count. *Prednisolone* - **Prednisolone**, a corticosteroid, is a **first-line treatment** for acute ITP, as it suppresses the immune system and reduces antibody production and platelet destruction. - It helps to quickly raise platelet counts and is effective in managing bleeding episodes, though its effects are not as immediate as IVIG. *RhIG* - **Rh immune globulin (RhIG)** is used in **Rh-positive** patients with ITP to cause a transient hemolytic anemia, which occupies splenic macrophages and reduces platelet destruction. - It `is an effective option` for acute ITP, particularly in patients who require a rapid increase in platelet count and are Rh-positive.

Q: The following is not true of platelet transfusion -

Effective for 9-10 days. ***Effective for 9-10 days*** - Platelets have a normal lifespan of about 7-10 days in the circulation, but **transfused platelets** are effective for a much shorter duration, typically **3-4 days** at most. - This short post-transfusion lifespan is due to various factors including immediate consumption, destruction, and removal from the circulation. *Used in DIC* - Platelet transfusions are often indicated in **Disseminated Intravascular Coagulation (DIC)**, especially if there is significant bleeding and a platelet count below 50,000/microL [1]. - DIC involves widespread activation of the coagulation cascade, leading to the consumption of platelets and clotting factors, resulting in both **thrombosis** and **hemorrhage** [1]. *Useful in ITP* - Transfusions are generally **not useful in Immune Thrombocytopenic Purpura (ITP)**, except in severe, life-threatening hemorrhage. - In ITP, platelets are rapidly destroyed by **autoantibodies**, so transfused platelets would also be quickly destroyed, providing only a transient, minimal benefit. *Effects decrease with repeated usage* - With repeated transfusions, patients can develop **alloimmunization** to HLA antigens on donor platelets, leading to refractoriness. - This means subsequent transfusions may have a **diminished or no therapeutic effect**, as the immune system rapidly destroys the transfused platelets.

Q: A patient presents with pain in back. Lab investigation shows elevated ESR. X-ray skull shows multiple punched out lytic lesions. Most important investigation to be done is:

Serum electrophoresis. ***Serum electrophoresis*** - Elevated **ESR** coupled with **punched-out lytic lesions** on skull X-ray is highly suggestive of **multiple myeloma** [1]. - **Serum electrophoresis** is the most important investigation to confirm this by detecting a **monoclonal protein (M-spike)**, which is characteristic of the disease [1]. *Whole body scan* - While a **whole body scan** (like a bone scan or PET scan) can assess the extent of bone involvement, it is not the primary diagnostic test for multiple myeloma itself [1]. - The initial step after suspecting multiple myeloma is to confirm the presence of the **monoclonal gammopathy** [1]. *Serum acid phosphatase* - **Serum acid phosphatase** is more commonly associated with **prostate cancer**, especially its bone metastases. - It is not a primary diagnostic marker for multiple myeloma with the presented symptoms. *CT head with contrast* - A **CT head with contrast** would be useful for brain lesions or other intracranial pathologies directly, but the **punched-out lesions** seen on X-ray are indicative of bone marrow involvement rather than brain tissue. - It would not provide the specific diagnostic information for **multiple myeloma** that serum electrophoresis does.

Q: Hand-foot syndrome is seen in ?

Sickle cell disease. Hand-foot syndrome is seen in ? ***Sickle cell disease*** - **Hand-foot syndrome (dactylitis)** is an early manifestation of sickle cell disease, particularly in infants and young children [2]. - It results from **vaso-occlusion** in the small blood vessels of the hands and feet, leading to painful swelling [3]. *Raynaud's phenomenon* - Characterized by episodes of **vasospasm** in the fingers and toes, causing color changes (white, blue, red) due to cold exposure or stress. - It does not involve the continuous, painful swelling seen in dactylitis. *Thalassemia* - A group of **inherited blood disorders** characterized by abnormal hemoglobin production, leading to anemia [3]. - While it can cause various bone changes due to marrow expansion, hand-foot syndrome (dactylitis) is not a typical presentation. *Frostbite* - This is an injury caused by tissue freezing due to prolonged exposure to **extremely cold temperatures** [1]. - It can lead to numbness, blistering, and tissue damage, but it is distinct from the vaso-occlusive crisis of hand-foot syndrome [1].

Q: Which of the following is true about iron deficiency anemia?

Microcytic hypochromic anemia. ***Microcytic hypochromic anemia*** - **Iron deficiency anemia** is characterized by red blood cells that are **smaller than normal (microcytic)** and **paler than normal (hypochromic)** due to insufficient hemoglobin [1]. - This morphology is a classic finding on a **peripheral blood smear** and reflects the impaired heme synthesis caused by iron depletion [1]. *Bone marrow iron stores are depleted before serum iron levels drop* - This statement is incorrect because **serum ferritin levels**, which reflect **iron stores**, are typically the first to decrease, even before changes in serum iron or hemoglobin are evident. - **Bone marrow iron stores** (assessed by biopsy) would also be depleted early on, but changes in serum ferritin and iron saturation can be detected before a significant drop in serum iron. *TIBC is typically decreased in this condition* - This is incorrect; **total iron-binding capacity (TIBC)** is typically **increased** in iron deficiency anemia, not decreased. - The liver produces more **transferrin** (the protein that binds iron) in an attempt to capture any available iron, leading to a higher TIBC. *Ferritin levels are elevated in this condition* - This is incorrect; **ferritin levels** are typically **decreased** in iron deficiency anemia. - **Ferritin** is a storage protein for iron, and its levels correlate with the body's iron stores, so a low ferritin is indicative of iron deficiency.

Q: One unit of fresh blood rises the Hb% concentration by:

1 gm%. **_1 gm%_** - Each unit of **packed red blood cells (PRBCs)** is expected to increase the recipient's hemoglobin by approximately **1 g/dL** (or 1 gm%). - This is a general guideline used in clinical practice for estimating the effectiveness of **blood transfusions**. _2.2 gm%_ - A rise of **2.2 gm%** is significantly higher than the expected increase from a single unit of PRBCs. - Such a substantial increase might suggest multiple units transfused or an unusual patient response. _0.1 gm%_ - A rise of only **0.1 gm%** is too low and would generally indicate either no significant effect from the transfusion or a rapid loss of the transfused blood. - This small increase is not consistent with the expected therapeutic effect of a **single unit of PRBCs**. _2gm%_ - While a **2 gm%** rise could be seen after two units of PRBCs, it is not the expected increase for a **single unit**. - The standard expectation for a single unit of PRBCs is approximately **1 gm%** increase in hemoglobin.

Q: Mantle Field Radiotherapy is generally used in treatment of?

Hodgkins Lymphoma. **Hodgkins Lymphoma** - **Mantle field radiotherapy** is a classic technique used to treat Hodgkin's lymphoma, particularly when the disease is localized to the **mediastinum, neck, and axillary lymph nodes** [1]. - This field encompasses the major lymphatic regions above the diaphragm, providing comprehensive treatment for common sites of involvement without exceeding dose limits to critical organs [1]. *Breast carcinoma* - Treatment for **breast carcinoma** typically involves surgery, chemotherapy, and localized radiation therapy to the breast and regional lymph nodes (axillary, supraclavicular, internal mammary), but not a widespread "mantle field." - Radiation fields for breast cancer are more specific to the breast tissue and regional nodes, aiming to minimize cardiac and pulmonary toxicity. *Neuroblastoma* - **Neuroblastoma** is a childhood cancer originating from neural crest cells and typically involves the adrenal glands or sympathetic ganglia; its treatment involves surgery, chemotherapy, and sometimes localized radiation, not mantle fields. - Radiation therapy for neuroblastoma is usually directed at specific tumor sites, such as the abdomen or chest, with techniques tailored to spare developing organs. *Lung cancer* - **Lung cancer** radiation therapy focuses on the primary tumor in the lung and involved mediastinal lymph nodes, using highly conformal techniques like IMRT or SBRT [2]. - A "mantle field" would be too broad and deliver unnecessary radiation to healthy lung tissue and other structures, increasing toxicity without improving outcomes for lung cancer.

Q: Indications for FFP include

All of the options. ***All of the options*** - **Fresh frozen plasma (FFP)** is a versatile blood product with several key indications, including supplying deficient plasma proteins, rapidly reversing warfarin effects, and treating thrombotic thrombocytopenic purpura (TTP). [1] - Its broad utility stems from its content of **all coagulation factors**, naturally occurring anticoagulants, and plasma proteins. *Supplying deficient plasma proteins* - FFP is a good source of various **plasma proteins**, which can be deficient in certain conditions, though specific protein concentrates are often preferred if available. [1] - This use is considered when there are specific protein deficiencies leading to clinical symptoms, where replacement is necessary. *Rapid reversal of (effects of) warfarin* - FFP contains **all vitamin K-dependent coagulation factors** (II, VII, IX, X) that are inhibited by warfarin, making it effective for rapid reversal, especially in cases of active bleeding or urgent surgery. - However, **4-factor prothrombin complex concentrates (PCCs)** are often preferred for more rapid and concentrated factor replacement in this scenario due to their lower volume and faster administration. *Treatment of TTP* - **Thrombotic thrombocytopenic purpura (TTP)** is characterized by a deficiency of **ADAMTS13**, an enzyme that cleaves von Willebrand factor (vWF). FFP replacement provides this deficient enzyme. - **Plasma exchange**, which involves removing the patient's plasma and replacing it with FFP, is the cornerstone of TTP treatment.

Q: An asymptomatic patient on regular health checkup has platelet counts of 8,00,000/cu.mm. Next line of management is:

Follow up and observe. ***Follow up and observe*** - This patient is **asymptomatic** despite a high platelet count (800,000/cu.mm), suggesting that the thrombocytosis may be **benign** or a **transient phenomenon**. - In an asymptomatic patient with isolated thrombocytosis, it is crucial to **repeat the complete blood count (CBC)** to rule out laboratory error or a temporary reactive process before proceeding with invasive or extensive investigations. *Phlebotomy* - **Phlebotomy** is primarily used to reduce red cell mass in conditions like **polycythemia vera**, not typically for high platelet counts. - While it can be considered in specific cases of **thrombocytosis with erythrocytosis**, it is not the initial management for isolated asymptomatic thrombocytosis. *Plasmapheresis* - **Plasmapheresis** involves removing plasma and is indicated for conditions like thrombotic thrombocytopenic purpura (TTP) or some autoimmune diseases [2]. - It is **not used to manage isolated thrombocytosis**, as it does not directly affect platelet production or removal in a sustained manner. *Bone marrow biopsy* - A **bone marrow biopsy** is an invasive procedure generally reserved for investigating suspected **myeloproliferative neoplasms (MPN)** or other hematological malignancies [1]. - In an **asymptomatic patient** with an initial high platelet count, it is premature and not the first line of management without prior re-evaluation of the platelet count and exclusion of reactive causes [1].

Question 1

A 69-year-old woman, with poor dietary habits and alcoholism, is found to have a macrocytic anemia with hyper segmented neutrophils. Which of the following is the most appropriate diagnostic test?

Accepted Answer

RBC folate levels

Answer

serum folate levels

Answer

bone marrow

Answer

Schilling test

Question 2

Bleeding crisis in acute idiopathic thrombo-cytopenic purpura is managed by all except -

Accepted Answer

Eltrombopag

Answer

Intravenous immunoglobulin

Answer

Prednisolone

Answer

RhIG

Question 3

The following is not true of platelet transfusion -

Accepted Answer

Effective for 9-10 days

Answer

Used in DIC

Answer

Useful in ITP

Answer

Effects decrease with repeated usage

Question 4

A patient presents with pain in back. Lab investigation shows elevated ESR. X-ray skull shows multiple punched out lytic lesions. Most important investigation to be done is:

Accepted Answer

Serum electrophoresis

Answer

Whole body scan

Answer

Serum acid phosphatase

Answer

CT head with contrast

Question 5

Hand-foot syndrome is seen in ?

Accepted Answer

Sickle cell disease

Answer

Raynaud's phenomenon

Answer

Thalassemia

Answer

Frost bite

Question 6

Which of the following is true about iron deficiency anemia?

Accepted Answer

Microcytic hypochromic anemia

Answer

Bone marrow iron stores are depleted before serum iron levels drop

Answer

TIBC is typically decreased in this condition

Answer

Ferritin levels are elevated in this condition

Question 7

One unit of fresh blood rises the Hb% concentration by:

Accepted Answer

1 gm%

Answer

2.2 gm%

Answer

0.1 gm%

Answer

2gm%

Question 8

Mantle Field Radiotherapy is generally used in treatment of?

Accepted Answer

Hodgkins Lymphoma

Answer

Breast carcinoma

Answer

Neuroblastoma

Answer

Lung cancer

Question 9

Indications for FFP include

Accepted Answer

All of the options

Answer

Supplying deficient plasma proteins

Answer

Rapid reversal of (effects of) warfarin

Answer

Treatment of TTP

Question 10

An asymptomatic patient on regular health checkup has platelet counts of 8,00,000/cu.mm. Next line of management is:

Accepted Answer

Follow up and observe

Answer

Phlebotomy

Answer

Plasmapheresis

Answer

Bone marrow biopsy

Hematology — MCQs

Hematology — MCQs

On this page

Practice by Chapter

Want unlimited practice?