Hematology Practice Questions

Q: A 5-year-old boy presents with petechial bleeding and bruising on his torso and limbs. He has no other signs or symptoms and does not appear ill. His mother reports a gastrointestinal infection several weeks prior to the onset of petechiae and bruising. Complete blood count reveals thrombocytopenia (<20 x 10^9/L), with other parameters within the expected range for his age. Prothrombin time, partial thromboplastin time, and metabolic panels are all within the reference range. What is the expected outcome of this blood disorder?

Complete resolution is expected.. ### Explanation The clinical presentation describes a classic case of **Immune Thrombocytopenic Purpura (ITP)**, the most common cause of isolated thrombocytopenia in children. **1. Why Option A is Correct:** In children, ITP typically follows a viral infection (respiratory or gastrointestinal) after a 1–4 week latent period. It is characterized by the sudden onset of petechiae and bruising in an otherwise healthy-appearing child. The hallmark is **isolated thrombocytopenia** (Platelets <100 x 10⁹/L) with normal PT, PTT, and hemoglobin. The prognosis is excellent; approximately **70–80% of children achieve complete spontaneous resolution** within 6 months, regardless of therapy. **2. Why the Other Options are Incorrect:** * **Option B:** This refers to the survival rates of pediatric malignancies like Acute Lymphoblastic Leukemia (ALL). While ALL presents with bruising, it typically involves "sick" symptoms (fever, bone pain), hepatosplenomegaly, and abnormalities in other cell lines (anemia/leukocytosis). * **Options C & D:** These describe **Hemophilia A (Factor VIII)** and **Hemophilia B (Factor IX)**. Hemophilias are coagulation factor deficiencies that present with deep tissue bleeds (hemarthrosis/hematomas) and a **prolonged aPTT**, rather than petechiae and isolated thrombocytopenia. **3. NEET-PG High-Yield Pearls:** * **Pathophysiology:** Anti-platelet antibodies (IgG) directed against GP IIb/IIIa or GP Ib/IX. * **Bone Marrow:** Not routinely required but would show **increased megakaryocytes** (compensatory). * **Management:** Observation is preferred if bleeding is minimal (dry purpura). If treatment is needed (wet purpura/active bleeding), **IVIG** or **Corticosteroids** are first-line. * **Chronic ITP:** Defined as thrombocytopenia persisting >12 months (occurs in ~20% of cases).

Q: A patient presents with ecchymoses and petechiae all over the body and no hepatosplenomegaly. Which of the following statements is NOT true?

Bleeding into the joints. **Explanation:** The clinical presentation of petechiae and ecchymoses (superficial skin bleeds) without hepatosplenomegaly in a pediatric patient is a classic description of **Immune Thrombocytopenic Purpura (ITP)**. **Why Option B is the Correct Answer (The "NOT True" statement):** Bleeding into the joints (**Hemarthrosis**) is a hallmark of **coagulation factor deficiencies** (secondary hemostasis defects), such as Hemophilia. In contrast, platelet disorders like ITP present with **mucocutaneous bleeding** (petechiae, purpura, epistaxis, and gum bleeding). Hemarthrosis is extremely rare in ITP. **Analysis of Incorrect Options:** * **Option A (Increased megakaryocytes):** In ITP, platelets are destroyed peripherally by anti-platelet antibodies. The bone marrow responds by increasing production, leading to an increased number of megakaryocytes. * **Option C (Decreased platelets):** Thrombocytopenia (isolated low platelet count) is the defining laboratory feature of ITP. * **Option D (Self-resolution):** Acute ITP in children is typically a self-limiting condition. Approximately 80% of cases resolve spontaneously within 2–6 months (often following a viral infection) without requiring aggressive intervention. **Clinical Pearls for NEET-PG:** * **ITP Diagnosis:** It is a diagnosis of exclusion. The absence of hepatosplenomegaly and lymphadenopathy is crucial to rule out leukemia. * **First-line Treatment:** If treatment is indicated (usually when platelets 12 months. * **Platelet vs. Coagulation Bleeding:** * *Platelet defects:* Immediate bleeding, petechiae, mucosal involvement. * *Coagulation defects:* Delayed bleeding, deep hematomas, hemarthrosis.

Q: In a newborn, Harlequin skin change is due to what underlying condition?

Autonomic dysfunction. **Explanation:** **Harlequin Color Change** is a transient, benign phenomenon seen in approximately 10% of healthy newborns, typically between the 2nd and 5th day of life. 1. **Why Autonomic Dysfunction is Correct:** The condition is attributed to the **immaturity of the hypothalamic centers** that control peripheral vascular tone. This leads to temporary **autonomic instability**, causing a sharp midline demarcation where one half of the body appears deep red (dependent side) and the other half appears pale (upper side) when the infant is placed on their side. Gravity causes blood to pool in the lower half due to dysregulated capillary tone. 2. **Why Other Options are Incorrect:** * **Polycythemia:** Presents as generalized "plethora" (ruddy, dusky red skin) throughout the body, not a midline-demarcated color change. * **Septicemia:** While sepsis can cause mottled skin (cutis marmorata) or peripheral cyanosis, it is accompanied by systemic signs like lethargy, poor feeding, and temperature instability. Harlequin change occurs in otherwise healthy infants. * **Ichthyosis:** Specifically "Harlequin Ichthyosis" is a severe genetic skin disorder characterized by thick, plate-like scales and ectropion. It is a structural skin defect, not a transient vascular phenomenon. **High-Yield Clinical Pearls for NEET-PG:** * **Duration:** The episodes typically last from 30 seconds to 20 minutes. * **Management:** It is a **benign, self-limiting** condition. No treatment is required other than reassurance and changing the baby's position. * **Differential:** Do not confuse this with *Harlequin Ichthyosis* (genetic) or *Port-wine stain* (permanent capillary malformation). * **Trigger:** Most commonly seen when the infant is placed in a lateral recumbent position.

Q: A 3-year-old child presented with progressive anemia, jaundice, and failure to thrive. On examination, pallor and splenomegaly are seen. Peripheral smear showed normoblasts and small round intensely stained red cells. What is the likely diagnosis?

Hereditary spherocytosis. ### Explanation **1. Why Hereditary Spherocytosis (HS) is Correct:** The clinical triad of **anemia, jaundice, and splenomegaly** in a young child strongly suggests a chronic hemolytic process. The definitive clue lies in the peripheral smear: **"small round intensely stained red cells"** are **Spherocytes**. These cells lack central pallor because they have lost their biconcave shape due to defects in RBC membrane proteins (most commonly **Ankyrin**, followed by Spectrin). The presence of **normoblasts** (nucleated RBCs) indicates a robust compensatory bone marrow response to hemolysis. **2. Why Other Options are Incorrect:** * **Thalassemia:** While it presents with anemia and splenomegaly, the peripheral smear typically shows **microcytic hypochromic** cells, target cells, and basophilic stippling, not spherocytes. * **Sickle Cell Anemia:** Characterized by **sickle-shaped cells** and Howell-Jolly bodies. Splenomegaly is usually seen only in early childhood; later, "autosplenectomy" occurs due to repeated infarcts. * **Vitamin B12 Deficiency:** This is a **megaloblastic anemia** (macrocytic). The smear would show macro-ovalocytes and hypersegmented neutrophils, not spherocytes or jaundice from hemolysis. **3. High-Yield Clinical Pearls for NEET-PG:** * **Inheritance:** Most commonly Autosomal Dominant. * **Gold Standard Test:** Eosin-5-maleimide (EMA) binding test (Flow cytometry). * **Screening Test:** Osmotic Fragility Test (increased fragility). * **MCHC:** Characteristically **elevated** (>36 g/dL) due to relative dehydration of the cell. * **Complications:** Pigmented gallstones (calcium bilirubinate) and Aplastic crisis (associated with **Parvovirus B19**). * **Treatment of Choice:** Splenectomy (usually deferred until after age 5–6 to reduce sepsis risk).

Question 1

A 5-year-old boy presents with petechial bleeding and bruising on his torso and limbs. He has no other signs or symptoms and does not appear ill. His mother reports a gastrointestinal infection several weeks prior to the onset of petechiae and bruising. Complete blood count reveals thrombocytopenia (<20 x 10^9/L), with other parameters within the expected range for his age. Prothrombin time, partial thromboplastin time, and metabolic panels are all within the reference range. What is the expected outcome of this blood disorder?

Accepted Answer

Complete resolution is expected.

Answer

Survival rate is up to 70% depending on risk stratification.

Answer

Lifelong disease dependent on factor VIII substitution.

Answer

Lifelong disease dependent on factor IX substitution.

Question 2

A 9-year-old girl develops widespread pinpoint skin hemorrhages after recovering from a flu-like illness 1 week earlier. Laboratory findings reveal a platelet count of 20,000/mL with no other abnormalities. Her bone marrow shows an increased number of megakaryocytes. The platelet count is normal after 2 months. Which of the following is the appropriate diagnosis?

Accepted Answer

Idiopathic thrombocytopenic purpura

Answer

Antiphospholipid antibody syndrome

Answer

Disseminated intravascular coagulation

Answer

Hemolytic-uremic syndrome

Question 3

A patient presents with ecchymoses and petechiae all over the body and no hepatosplenomegaly. Which of the following statements is NOT true?

Accepted Answer

Bleeding into the joints

Answer

Increased megakaryocytes in bone marrow

Answer

Decreased platelets in blood

Answer

Disease resolves itself in 80% of patients in 2-6 weeks

Question 4

In a newborn, Harlequin skin change is due to what underlying condition?

Accepted Answer

Autonomic dysfunction

Answer

Polycythemia

Answer

Septicemia

Answer

Ichthyosis

Question 5

A 3-year-old child presented with progressive anemia, jaundice, and failure to thrive. On examination, pallor and splenomegaly are seen. Peripheral smear showed normoblasts and small round intensely stained red cells. What is the likely diagnosis?

Accepted Answer

Hereditary spherocytosis

Answer

Thalassemia

Answer

Sickle cell anemia

Answer

Vitamin B12 deficiency anemia

Hematology — MCQs

Hematology — MCQs

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