Hematology — MCQs

Hematology Indian Medical PG Practice Questions and MCQs

Question 1041: Gall stones in hemolytic anaemia are -

A. Pigment (Correct Answer)
B. Mixed
C. Cholesterol
D. Any type

Explanation: ***Pigment*** - In hemolytic anemia, the breakdown of hemoglobin increases bilirubin levels, leading to the formation of **pigment stones (bilirubin stones)** [1]. - These stones are typically small, dark, and made up of **calcium bilirubinate** due to excessive unconjugated bilirubin. *Any type* - This option is incorrect as it suggests that all types of gallstones can occur, which is not true for hemolytic anemia. - While cholesterol stones are common in general, they are not specifically associated with **hemolysis**. *Cholesterol* - Cholesterol stones are primarily associated with **bile saturation** and are not a result of hemolytic conditions. - They arise from an imbalance in bile salts and cholesterol rather than from **bilirubin metabolism**. *Mixed* - Mixed stones contain cholesterol and pigment, but they are less represented in hemolytic conditions compared to **pure pigment stones**. - Hemolytic anemia primarily leads to the formation of **pigment stones** [1], not a predominance of mixed stones.

Question 1042: Hypercoagulability due to a defective factor V gene is known as which of the following?

A. Leiden mutation (Correct Answer)
B. Antiphospholipid syndrome
C. Prothrombin G20210A mutation
D. Protein C deficiency

Explanation: ***Leiden mutation*** - The **factor V Leiden mutation** leads to a hypercoagulable state by causing resistance to activated protein C, increasing the risk of venous thrombosis [1]. - It is the most common inherited cause of venous thromboembolism and directly associates with the defective factor V gene [1]. *Antiphospholipid syndrome* - This syndrome is characterized by the presence of **antiphospholipid antibodies** leading to recurrent thrombosis but is not directly related to the factor V gene. - It often presents with symptoms such as **venous and arterial thrombosis**, but its mechanism differs from that of factor V Leiden [2]. *Inducible thrombocytopenia syndrome* - This condition involves **thrombocytopenia** (low platelet count) often due to medication, which is unrelated to the hypercoagulable state from factor V mutation. - It does not involve the **factor V gene** nor lead to an increased risk of clotting as seen in the Leiden mutation. *Lisbon mutation* - The Lisbon mutation is a rare variant of factor V but is not the primary mutation associated with the hypercoagulable state in most cases. - It does not have the same wide clinical implications or prevalence as the **factor V Leiden mutation**.

Question 1043: Maximum life of transfused RBCs is

A. 60-80 days
B. 50-60 days
C. 110-120 days
D. 80-100 days (Correct Answer)

Explanation: ***80-100 days*** - The maximum lifespan of **transfused red blood cells (RBCs)** is reduced compared to naturally occurring RBCs in vivo. - This is due to storage conditions and the age of the donated blood, leading to a shorter survival time post-transfusion. *110-120 days* - This range typically represents the **normal lifespan of red blood cells in the human body** *in vivo*, not the effective lifespan of transfused units. - Transfused RBCs undergo various changes during storage (storage lesion) that reduce their post-transfusion survival. *60-80 days* - While closer to the actual range for transfused RBCs, this is generally considered a slightly **underestimated maximum lifespan**. - The survival of transfused RBCs can vary, but good quality units usually last longer than 80 days. *50-60 days* - This range is typically too low for the maximum lifespan of transfused RBCs, indicating either **poor quality blood products** or significantly **prolonged storage times**. - Most transfused RBCs, when properly stored and handled, will survive for a longer duration post-transfusion.

Question 1044: All of the following statements about Burkitt's lymphoma are true, Except:

A. B cell lymphoma
B. 8, 14 translocation
C. Intensive chemotherapy is the treatment of choice
D. Radiotherapy is the treatment of choice (Correct Answer)

Explanation: ***Radiotherapy is the treatment of choice*** - Treatment for **Burkitt's lymphoma** primarily involves **chemotherapy**, not radiotherapy, due to the aggressive nature of the disease. - While radiotherapy may be used in some cases, it is **not a standard treatment** for this highly aggressive B-cell lymphoma [1]. *Can present as an abdominal mass* - Burkitt's lymphoma can indeed present as an **abdominal mass**, especially in pediatric cases involving the **ileocecal region**. - The **extranodal** involvement is common, contributing to the mass effect in the abdomen [1]. *B cell lymphoma* - Burkitt's lymphoma is classified as a **B-cell lymphoma** arising from the germinal center of B cells [1]. - It is characterized by high proliferation rates and mutations in B cell-related genes, confirming it as a B-cell malignancy [1]. *8, 14 translocation* - A hallmark of Burkitt's lymphoma is the **translocation of the MYC gene** on chromosome 8 and chromosome 14, leading to abnormal cell proliferation. - This genetic alteration is fundamental in the cancer's pathogenesis and is a criterion for diagnosis.

Question 1045: Autoimmune gastritis is associated with a deficiency of which vitamin?

A. Vitamin C
B. Vitamin D
C. Vitamin A
D. Vitamin B12 (Correct Answer)

Explanation: ***B12*** - Autoimmune gastritis leads to destruction of **parietal cells** in the stomach, impairing intrinsic factor production, crucial for vitamin B12 absorption [2]. - Vitamin B12 deficiency can lead to **megaloblastic anemia** and neurological complications due to its key role in DNA synthesis and nerve function [1]. *C* - Vitamin C deficiency is associated with **scurvy**, which is unrelated to autoimmune gastritis and is not a consequence of gastric issues. - This vitamin primarily concerns skin health, collagen synthesis, and immune function, making it irrelevant in this context. *A* - Vitamin A deficiency is associated with **vision problems** and immune function, but it does not have a direct link to autoimmune gastritis. - Unlike B12, vitamin A is not specifically affected by the gastric conditions related to autoimmune processes. *D* - Vitamin D deficiency relates to **bone health** and calcium metabolism, and is not connected to the effects of autoimmune gastritis. - This vitamin's absorption primarily occurs in the intestines rather than involving gastric intrinsic factor or parietal cells.

Question 1046: Which of the following is the MOST characteristic feature of Hemolytic Uremic Syndrome (HUS)?

A. Thrombocytopenia
B. Positive Coomb's test
C. Microangiopathic hemolytic anemia (Correct Answer)
D. All of the options

Explanation: ### a and c - Hemolytic Uremic Syndrome (HUS) is characterized by **microangiopathic hemolytic anemia** along with **thrombocytopenia**, making this correct [1][2]. - It typically results from an **infection**, often associated with **E. coli**, particularly in children [2]. *Positive Coomb's test* - A positive Coomb's test suggests **autoimmune hemolytic anemia**, not HUS. - HUS generally presents with **negative Coomb's test**, indicating hemolysis mechanism is different from autoimmune causes. *Microangiopathic haemolytic anaemia* - While HUS does involve **microangiopathic hemolytic anemia** [2], this alone does not encompass all its characteristics necessary for diagnosis. - HUS must also include **thrombocytopenia**, which is not mentioned in this option [1]. *Thrombocytopenia* - Thrombocytopenia is indeed a feature of HUS, but presenting it alone lacks the context of the complete syndrome [1]. - HUS must also show **microangiopathic hemolytic anemia** to align with the complete clinical picture [2], which is missing here.

Question 1047: First line investigation for deep venous thrombosis is -

A. Ultrasonography (Correct Answer)
B. Venography
C. MRI
D. Nuclear imaging

Explanation: ***Ultrasonography*** - **Duplex ultrasonography** is the preferred first-line investigation due to its **non-invasiveness**, widespread availability, and high accuracy for diagnosing DVT, especially in the proximal veins [1][2]. - It visualizes the vein and assesses compressibility, flow, and presence of thrombus, making it effective for **confirming or excluding DVT** [1][2]. *Venography* - **Venography** is an invasive procedure involving injection of contrast dye and X-rays, carrying risks of allergic reactions and kidney injury. - While considered the **gold standard** for detailed anatomical visualization, its invasiveness and risks make it a second-line or confirmatory test rather than a first-line diagnostic. *MRI* - **Magnetic Resonance Imaging (MRI)** is highly sensitive and specific for DVT, particularly for pelvic or atypical thrombi. - However, its **high cost**, limited availability, and longer acquisition time usually reserve it for cases where ultrasound is inconclusive or technically difficult. *Nuclear imaging* - **Nuclear imaging**, such as scintigraphy, is primarily used for diagnosing **pulmonary embolism (PE)** with Ventilation-Perfusion (V/Q) scans [2]. - It is **not a standard or primary diagnostic tool** for evaluating DVT directly, as it does not visualize thrombi in the venous system.

Question 1048: Sickle cell anemia leads to resistance towards?

A. Plasmodium falciparum (Correct Answer)
B. Plasmodium malariae
C. Plasmodium vivax
D. Plasmodium ovale

Explanation: ***Plasmodium falciparum*** - Individuals with sickle cell trait or disease have **red blood cells** that are less hospitable to the growth and reproduction of **_Plasmodium falciparum_**, the most dangerous malaria parasite [1]. - The abnormal hemoglobin (HbS) reduces parasite growth, and infected sickle cells are prematurely destroyed, limiting parasite burden [1]. *Plasmodium malariae* - While all malaria parasites infect red blood cells, the selective pressure from **sickle cell anemia** is primarily against **_Plasmodium falciparum_**, not _P. malariae_ [2]. - There is no significant evidence of increased resistance to **_P. malariae_** in individuals with sickle cell disease. *Plasmodium vivax* - **_Plasmodium vivax_** preferentially invades **reticulocytes** (immature red blood cells), and its life cycle is not significantly altered by the presence of **hemoglobin S** in mature red blood cells [2]. - Resistance to _P. vivax_ is more commonly associated with the absence of the **Duffy antigen**, not sickle cell anemia. *Plasmodium ovale* - Like _P. vivax_, **_Plasmodium ovale_** also predominantly infects **reticulocytes** [2]. - There is no strong evidence to suggest that sickle cell anemia confers significant protection against **_P. ovale_** infections.

Question 1049: On medical check-up of a Punjabi student, the following findings were seen: Hb of 9.9 gm/dL, RBC count of 5.1 million, MCV of 62.5 fL, and RDW of 13.51%. What is the most probable diagnosis?

A. HbD
B. Thalassemia trait (Correct Answer)
C. Iron deficiency anemia
D. Anemia of chronic disease

Explanation: ***Thalassemia trait*** - The low **MCV (62.5 fl)** and normocytic **RBC count (5.1 million)** indicate microcytic anemia, typical of thalassemia trait. - The **RDW of 13.51%** is relatively normal, distinguishing it from iron deficiency anemia where RDW would be elevated. *Anemia of chronic disease* - This condition usually presents with **normocytic or microcytic anemia**, but typically involves a **low serum iron** and **high ferritin**, which are not mentioned here [1]. - It is often associated with chronic inflammatory conditions, not fitting the RBC parameters given [2]. *HbD* - HbD is a hemoglobin variant typically identified in **specific ethnic groups**, but it does not cause significant anemia like described here with low MCV. - Diagnosis is based on specific hemoglobin electrophoresis patterns, which are not indicated in this case. *Iron deficiency anemia* - Would typically show **lower ferritin levels** and higher RDW, indicating a variation in red cell size, which contrasts with the given RDW [1]. - The RBC count is normal, while iron deficiency often presents with *low RBC counts* and microcytic indices [2].

Question 1050: Which of the following is LEAST likely to increase the risk of developing deep vein thrombosis (DVT)?

A. Obesity
B. Age less than 40 (Correct Answer)
C. Prolonged immobilization
D. Extensive pelvic surgery of more than 30 minutes

Explanation: ### Age less than 40 - Younger age is considered a **protective factor** against DVT, as the risk generally increases with age due to accumulated comorbidities and decreased mobility. [1] - While DVT can occur at any age, the incidence is significantly lower in individuals under 40 years old, especially in the absence of other strong risk factors. [3] ### Prolonged immobilization - **Immobilization** significantly reduces blood flow velocity in the lower extremities, leading to **venous stasis**. [2] - This stasis promotes the accumulation of clotting factors and activation of the coagulation cascade, increasing the risk of thrombus formation. ### Obesity - Obesity is a significant risk factor for DVT due to its association with **chronic inflammation**, **endothelial dysfunction**, and a **prothrombotic state**. - Increased abdominal pressure from obesity can also impede venous return, further contributing to venous stasis. ### Extensive pelvic surgery of more than 30 minutes - Surgical procedures, particularly those involving the pelvis and lasting longer than 30 minutes, cause **endothelial injury**, activate the **coagulation system**, and result in **postoperative immobility**. [2] - These factors collectively contribute to Virchow's triad (venous stasis, endothelial injury, hypercoagulability), significantly increasing DVT risk.

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Anemia Evaluation and Management

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Hemoglobinopathies

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Thalassemias

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Platelet Disorders

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Coagulation Disorders

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Thrombotic Disorders

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Leukemias

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Lymphomas

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Multiple Myeloma and Plasma Cell Disorders

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Myeloproliferative Neoplasms

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Transfusion Medicine

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Hematopoietic Stem Cell Transplantation

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Hematology — MCQs

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