Hematology Indian Medical PG Practice Questions and MCQs
Practice Indian Medical PG questions for Hematology. These multiple choice questions (MCQs) cover important concepts and help you prepare for your exams.
Hematology Indian Medical PG Question 1: Which of the following is the most common myeloproliferative disorder?
- A. Essential Thrombocythemia (Correct Answer)
- B. Polycythemia rubra vera
- C. CML
- D. Myelofibrosis
Hematology Explanation: ***Essential Thrombocythemia***
- **Essential thrombocythemia (ET)** is the **most common myeloproliferative neoplasm**, with an incidence of approximately 1.5-2.4 per 100,000 per year.
- It is characterized by **persistent thrombocytosis** (platelet count >450,000/μL) and megakaryocytic proliferation [1].
- Commonly associated with **JAK2 V617F mutation** (~55-60%), **CALR mutations** (~25-30%), and **MPL mutations** (~3-5%) [2].
*Polycythemia rubra vera*
- **Polycythemia vera (PV)** is the **second most common** classic MPN, with an incidence of approximately 0.8-2.3 per 100,000 per year.
- Characterized by increased red blood cell mass, often with leukocytosis and thrombocytosis [1].
- Strongly associated with **JAK2 V617F mutation** (present in >95% of cases) [2][3].
*CML*
- **Chronic myeloid leukemia (CML)** has similar incidence to PV (approximately 1-2 per 100,000 per year).
- Defined by the presence of the **Philadelphia chromosome (BCR-ABL1 fusion gene)** [2].
- Treated distinctly with tyrosine kinase inhibitors (TKIs).
*Myelofibrosis*
- **Primary myelofibrosis (PMF)** is the **least common** of the classic MPNs, with an incidence of approximately 0.3-1.5 per 100,000 per year.
- Characterized by bone marrow fibrosis, extramedullary hematopoiesis, and splenomegaly [3].
- Associated with **JAK2, CALR, or MPL mutations** [2].
**References:**
[1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of White Blood Cells, Lymph Nodes, Spleen, and Thymus, pp. 627-628.
[2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of White Blood Cells, Lymph Nodes, Spleen, and Thymus, p. 624.
[3] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Blood And Bone Marrow Disease, pp. 614-615.
Hematology Indian Medical PG Question 2: Which is the cell of origin of Chronic Lymphocytic Leukaemia / Small Lymphocytic Lymphoma?
- A. Mature B cells
- B. Progenitor T cells
- C. Mature T cells
- D. Naïve B cells (Correct Answer)
Hematology Explanation: ***Naïve B cells***
- Chronic Lymphocytic Leukaemia (CLL) and Small Lymphocytic Lymphoma (SLL) originate from **CD5-positive B lymphocytes** arrested in a mature but **naïve differentiation stage** [1].
- These cells express both **B-cell markers (CD19, CD20, CD23)** and a T-cell marker (CD5), which is characteristic of the clone [4].
*Mature B cells*
- While CLL/SLL are derived from B cells, they are specifically from **naïve, not fully mature, B cells**.
- **Other B-cell lymphomas** like follicular lymphoma or mantle cell lymphoma originate from distinct stages of mature B-cell differentiation [2].
*Progenitor T cells*
- **Progenitor T cells** are the cells of origin for **T-cell acute lymphoblastic leukaemia (T-ALL)**, not CLL/SLL [3].
- T-ALL involves immature T lymphocytes and presents with different clinical and immunophenotypic features [3].
*Mature T cells*
- **Mature T cells** can give rise to various **peripheral T-cell lymphomas**, like peripheral T-cell lymphoma, not otherwise specified (PTCL-NOS) or cutaneous T-cell lymphoma (Mycosis Fungoides).
- These are distinct from CLL/SLL, which is a B-cell neoplasm [4].
**References:**
[1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of White Blood Cells, Lymph Nodes, Spleen, and Thymus, pp. 596-598.
[2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of White Blood Cells, Lymph Nodes, Spleen, and Thymus, pp. 610-612.
[3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of White Blood Cells, Lymph Nodes, Spleen, and Thymus, pp. 598-599.
[4] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of White Blood Cells, Lymph Nodes, Spleen, and Thymus, p. 598.
Hematology Indian Medical PG Question 3: What is the typical bone marrow finding in myelofibrosis?
- A. Megaloblastic cells
- B. Microcytic cells
- C. Thrombocytosis
- D. Dry tap (hypocellular) (Correct Answer)
Hematology Explanation: ***Dry tap (hypocellular)***
- In myelofibrosis, the bone marrow is often **hypocellular** due to fibrosis [1][2], leading to a **dry tap** during aspiration.
- The presence of **reticulin** and collagen deposition replaces normal hematopoietic cells [2], resulting in ineffective hematopoiesis.
*Thrombocytosis*
- Myelofibrosis typically leads to **thrombocytopenia**, not thrombocytosis, due to ineffective megakaryopoiesis and splenic sequestration.
- Though elevated platelets can occur, they are generally a **secondary response** to the disease and not a hallmark finding.
*Megaloblastic cells*
- Megaloblastic changes are associated with **vitamin B12** or **folate deficiencies**, which do not occur in myelofibrosis.
- In myelofibrosis, the predominant issue is **marrow fibrosis** [1][2], which does not lead to megaloblastosis.
*Microcytic cells*
- Microcytic cells are commonly linked to **iron deficiency anemia**, not myelofibrosis.
- Myelofibrosis typically results in **variable red cell morphology** [1], but microcytic anemia is not a primary characteristic.
**References:**
[1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of White Blood Cells, Lymph Nodes, Spleen, and Thymus, pp. 628-629.
[2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Blood And Bone Marrow Disease, pp. 615-616.
Hematology Indian Medical PG Question 4: Which of the following are neonatal complications of maternal diabetes during pregnancy?
I. Hyperbilirubinemia
II. Hypocalcemia
III. Cardiomyopathy
IV. Hypoglycemia
Select the correct answer using the code given below :
- A. I, II and III
- B. I, II and IV (Correct Answer)
- C. II, III and IV
- D. I, III and IV
Hematology Explanation: ***I, II and IV***
- This correctly identifies the three **most common and clinically significant neonatal complications** of maternal diabetes: **hyperbilirubinemia**, **hypocalcemia**, and **hypoglycemia**.
- **Hypoglycemia** is the **most frequent complication** (25-50% of infants), occurring due to fetal hyperinsulinemia that persists after birth when maternal glucose supply is cut off.
- **Hypocalcemia** occurs in 20-50% of cases due to impaired parathyroid hormone response, hypomagnesemia, and altered calcium-phosphorus metabolism.
- **Hyperbilirubinemia** results from polycythemia (due to chronic intrauterine hypoxia), increased RBC breakdown, and impaired hepatic conjugation.
*I, II and III*
- While this includes **hyperbilirubinemia**, **hypocalcemia**, and **cardiomyopathy**, it inappropriately excludes **hypoglycemia**, which is the **most common and most critical** neonatal complication requiring immediate monitoring and management.
- Omitting hypoglycemia makes this option medically incorrect as a primary answer.
*II, III and IV*
- This option excludes **hyperbilirubinemia**, which is a very common finding (occurs in up to 25% of infants of diabetic mothers) due to increased erythropoiesis and RBC destruction.
- Fetal hyperinsulinemia drives increased oxygen consumption, leading to relative hypoxia and compensatory polycythemia.
*I, III and IV*
- This option misses **hypocalcemia**, which is one of the **classic metabolic complications** seen in 20-50% of infants of diabetic mothers.
- Hypocalcemia typically presents in the first 24-72 hours of life and is exacerbated by concurrent **magnesium deficiency**, which impairs PTH secretion and action.
**Note:** All four listed complications (I, II, III, and IV) are recognized complications of maternal diabetes. Hypertrophic cardiomyopathy occurs in 10-20% of cases but is generally less common than the metabolic triad of hypoglycemia, hypocalcemia, and hyperbilirubinemia, which require routine screening in all infants of diabetic mothers.
Hematology Indian Medical PG Question 5: A newborn presents with the clinical features shown in the image below. What is the most likely diagnosis?
- A. Trisomy 21
- B. Trisomy 18 (Correct Answer)
- C. Trisomy 13
- D. Trisomy 12
Hematology Explanation: ***18 trisomy***
- The image shows a newborn with an **omphalocele (abdominal wall defect)** and characteristic **clenched hands with overlapping fingers**, which are common features of Trisomy 18 (Edwards syndrome).
- Other typical features include **low-set ears**, **micrognathia**, **rocker-bottom feet**, and severe developmental delay, contributing to a poor prognosis.
*21 trisomy*
- Trisomy 21 (Down syndrome) typically presents with **upslanting palpebral fissures**, an **epicanthal fold**, a **single palmar crease**, and **intellectual disability**, which are not the prominent features seen here.
- While congenital heart defects can be present in both, the specific hand posture and omphalocele are more indicative of Trisomy 18.
*13 trisomy*
- Trisomy 13 (Patau syndrome) is characterized by severe malformations, including **cleft lip and palate**, **polydactyly**, **cutis aplasia**, and **microphthalmia**, which are distinct from the features in the image.
- **Holoprosencephaly** is also common in Trisomy 13, which is not suggested by the visual findings.
*12 trisomy*
- Trisomy 12 is **not a recognized viable chromosomal aneuploidy** in humans that leads to a distinct syndrome such as those related to chromosomes 13, 18, or 21.
- Genetic disorders involving chromosome 12 are typically mosaic or involve partial aneuploidies.
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