Hematology — MCQs
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An elderly patient is receiving a blood transfusion for anemia due to myelodysplastic syndrome (MDS). He was diagnosed with MDS two years ago and has required blood transfusions every six weeks for symptomatic anemia over the past six months. His past medical history also includes hypertension, type 2 diabetes, and coronary artery disease. Halfway through the transfusion of the second unit of packed red blood cells, he develops tachypnea, lumbar pain, tachycardia, and nausea. Which of the following is the most likely explanation?
Which of the following conditions is most commonly associated with disease activity in Systemic Lupus Erythematosus (SLE)?
A 60-year-old man presented to the emergency department with sudden-onset cough, yellow sputum production, and dyspnea, while taking amlodipine for hypertension. Chest X-ray revealed a left upper lobe alveolar infiltrate, and laboratory investigations showed Hb of 6 g/dL, BUN of 60 mg/dL, Creatinine of 2.8 mg/dL, Calcium of 12.3 mg/dL, total protein of 9 g/dL, and albumin of 4.2 g/dL. Echocardiogram revealed a dilated heart, and peripheral neuropathy was also present. What is the most common cause of death in patients with multiple myeloma?
Which of the following statements about Transfusion-Related Acute Lung Injury (TRALI) is false?
Haemochromatosis affects all of the following organs except:
What is the most common hematological response to bacterial infections?
A 9-year-old boy presents with elevated PT and APTT. What is the most likely underlying condition?
Von Willebrand disease involves a deficiency of which factor?
Which of the following is false about monoclonal gammopathy of unknown significance (MGUS)?
Which of the following does not cause deep venous thrombosis (DVT)?
Hematology Indian Medical PG Practice Questions and MCQs
Question 1171: An elderly patient is receiving a blood transfusion for anemia due to myelodysplastic syndrome (MDS). He was diagnosed with MDS two years ago and has required blood transfusions every six weeks for symptomatic anemia over the past six months. His past medical history also includes hypertension, type 2 diabetes, and coronary artery disease. Halfway through the transfusion of the second unit of packed red blood cells, he develops tachypnea, lumbar pain, tachycardia, and nausea. Which of the following is the most likely explanation?
- A. fluid overload
- B. hemolysis (Correct Answer)
- C. pulmonary embolism
- D. anxiety
Explanation: ***hemolysis*** * The sudden onset of **tachypnea**, **lumbar pain**, and **tachycardia** during a blood transfusion is highly suggestive of an acute **hemolytic transfusion reaction**. Lumbar pain is a classic symptom due to **hemoglobinuria** and acute kidney injury [1]. * Patients with a history of frequent transfusions, like this patient with **myelodysplastic syndrome (MDS)**, are at increased risk for developing **alloantibodies** that can cause such reactions [1]. *anxiety* * While anxiety can cause **tachycardia** and **tachypnea**, it typically does not present with **lumbar pain** or **nausea** specifically during a transfusion. * Anxiety is a less specific diagnosis given the constellation of sudden, severe symptoms occurring precisely mid-transfusion. *fluid overload* * **Fluid overload** (TRALI) typically presents with signs of respiratory distress, such as **dyspnea**, **cough**, and **pulmonary edema**, but not typically with severe **lumbar pain**. * While a patient with underlying cardiovascular disease is at risk, the sudden onset of lumbar pain points away from isolated fluid overload. *pulmonary embolism* * **Pulmonary embolism (PE)** can cause tachypnea and tachycardia, but the presence of **lumbar pain** and **nausea** during a transfusion makes it a less likely primary diagnosis. * PE symptoms are generally more acutely focused on respiratory and cardiovascular compromise, often without the systemic symptoms seen here.
Question 1172: Which of the following conditions is most commonly associated with disease activity in Systemic Lupus Erythematosus (SLE)?
- A. Neutropenia
- B. Thrombocytopenia
- C. Autoimmune Hemolytic anemia
- D. Lymphopenia (Correct Answer)
Explanation: ***Lymphopenia*** - **Lymphopenia** (low lymphocyte count) is the most common hematological manifestation associated with active SLE, occurring in approximately 50-80% of patients [1]. - It is often seen in individuals with active disease due to increased peripheral destruction of lymphocytes or their sequestration and redistribution. *Autoimmune Hemolytic anemia* - While **autoimmune hemolytic anemia (AIHA)** can occur in SLE, it is less common than lymphopenia, affecting about 5-10% of patients [1]. - AIHA is characterized by the destruction of red blood cells by autoantibodies, leading to **anemia**. *Thrombocytopenia* - **Thrombocytopenia** (low platelet count) is another hematologic manifestation of SLE, occurring in 10-25% of patients [1]. - It is caused by autoantibodies directed against platelets, leading to their premature destruction. *Neutropenia* - **Neutropenia** (low neutrophil count) is observed in about 10-15% of SLE patients. - Although it can be a sign of active disease, it is less frequent than lymphopenia [1].
Question 1173: A 60-year-old man presented to the emergency department with sudden-onset cough, yellow sputum production, and dyspnea, while taking amlodipine for hypertension. Chest X-ray revealed a left upper lobe alveolar infiltrate, and laboratory investigations showed Hb of 6 g/dL, BUN of 60 mg/dL, Creatinine of 2.8 mg/dL, Calcium of 12.3 mg/dL, total protein of 9 g/dL, and albumin of 4.2 g/dL. Echocardiogram revealed a dilated heart, and peripheral neuropathy was also present. What is the most common cause of death in patients with multiple myeloma?
- A. Bleeding
- B. CHF
- C. Infection
- D. Kidney failure (Correct Answer)
Explanation: ***Kidney failure*** - **Renal impairment** is common in multiple myeloma due to **Bence-Jones proteinuria**, hypercalcemia, and amyloidosis, significantly contributing to morbidity and mortality. - The presented labs show elevated **BUN** (60 mg/dL) and **creatinine** (2.8 mg/dL), indicating significant kidney dysfunction, making it a highly likely cause of death in this context. *Infection* - While **infection** is a significant cause of death in multiple myeloma patients due to **immunodeficiency**, the immediate lab findings point more strongly to acute renal failure. - The patient's **cough** with **yellow sputum** and **alveolar infiltrate** suggest pneumonia, but other presented lab values are more indicative of advanced kidney damage. *Bleeding* - **Bleeding diathesis** can occur in multiple myeloma due to **platelet dysfunction** and **coagulation factor deficiencies**, but there is no direct evidence of severe bleeding in the provided case details. - The symptoms and lab findings provided do not directly support bleeding as the primary or most common cause of death in this patient's presentation. *CHF* - **Congestive heart failure (CHF)** can develop in multiple myeloma due to **amyloidosis** affecting the heart or due to severe anemia, which is present (Hb 6 g/dL). - While the echocardiogram revealed a **dilated heart**, the pronounced **renal failure** indicated by BUN and creatinine levels is a more direct and common cause of mortality in multiple myeloma patients.
Question 1174: Which of the following statements about Transfusion-Related Acute Lung Injury (TRALI) is false?
- A. Leucocytes aggregate in the pulmonary vasculature
- B. Develops signs of non cardiogenic pulmonary edema
- C. Anti-HLA antibodies are never implicated in TRALI. (Correct Answer)
- D. Implicated donors are frequently multiparous women
Explanation: ***Anti-HLA antibodies are never implicated in TRALI*** - This statement is **false**, as **anti-HLA antibodies**, specifically anti-HLA class I and II antibodies, are **frequently implicated** in the pathogenesis of TRALI [1]. - These antibodies in donor plasma can react with recipient neutrophils, leading to their activation and subsequent lung injury [1]. *Leucocytes aggregate in the pulmonary vasculature* - This statement is **true**; the aggregation of **activated neutrophils** and other leukocytes in the pulmonary capillaries is a key pathophysiological event in TRALI. - This aggregation contributes to the inflammatory cascade and damage to the **alveolar-capillary membrane**. *Develops signs of non cardiogenic pulmonary edema* - This statement is **true**; TRALI is characterized by **acute respiratory distress** and evidence of **non-cardiogenic pulmonary edema**. - This means the pulmonary edema is not due to elevated left atrial pressure, but rather increased vascular permeability caused by inflammatory mediators. *Implicated donors are frequently multiparous women* - This statement is **true**; **multiparous women** are often implicated as donors in TRALI cases because they are more likely to have developed **anti-HLA antibodies** due to exposure to fetal antigens during pregnancy. - These antibodies, if present in high titers in donor plasma, can trigger TRALI in susceptible recipients.
Question 1175: Haemochromatosis affects all of the following organs except:
- A. Liver
- B. Pancreas
- C. Salivary glands (Correct Answer)
- D. Heart
Explanation: ***Salivary glands*** - Haemochromatosis primarily affects **organs involved in iron metabolism**, such as the liver and pancreas, but has **no direct pathological involvement of salivary glands**. - Salivary glands are not known to accumulate iron significantly in haemochromatosis, thus they do not exhibit the same dysfunction seen in affected organs. *Heart* - The heart can be affected by **restrictive cardiomyopathy** due to iron overload, leading to heart failure or arrhythmias. - It may also exhibit **iron deposition**, which can adversely impact cardiac function in patients with haemochromatosis. *Liver* - The liver is the primary organ affected by haemochromatosis, leading to **cirrhosis**, **fibrosis**, and **hepatocellular carcinoma** due to excessive iron accumulation [1]. - Elevated liver enzymes and the risk of liver disease are hallmarks of this condition, making it a critical organ of concern [1]. *Pancreas* - The pancreas can suffer from **diabetes mellitus** due to iron deposition affecting insulin-producing cells, leading to **endocrine dysfunction** [1]. - Additionally, it can experience **exocrine insufficiency**, which is also associated with excessive iron levels in the body.
Question 1176: What is the most common hematological response to bacterial infections?
- A. Neutropenia
- B. Eosinophilia
- C. Neutrophilia (Correct Answer)
- D. Lymphocytosis
Explanation: Neutrophilia - **Neutrophilia** is a hallmark of acute bacterial infections, as the body ramps up production and release of **neutrophils** to combat the invading pathogens [1], [2]. - This increase in **neutrophils** is part of the innate immune response, directly targeting and phagocytosing bacteria [1]. *Neutropenia* - **Neutropenia** (a low neutrophil count) is less common in typical bacterial infections and is often associated with severe, overwhelming infections or conditions like **sepsis**, where neutrophil consumption exceeds bone marrow production. - It can also be seen in certain viral infections, bone marrow disorders, or as a side effect of some medications. *Eosinophilia* - **Eosinophilia** (an elevated eosinophil count) is primarily associated with **allergic reactions**, **parasitic infections**, and certain **drug reactions** or dermatological conditions [2]. - It does not typically occur in response to bacterial infections. *Lymphocytosis* - **Lymphocytosis** (an elevated lymphocyte count) is most commonly seen in **viral infections**, such as **infectious mononucleosis**, or in chronic bacterial infections like **tuberculosis**. - It is not the most common hematological response to acute bacterial infections.
Question 1177: A 9-year-old boy presents with elevated PT and APTT. What is the most likely underlying condition?
- A. Vitamin K deficiency
- B. Hemophilia A
- C. Liver disease (Correct Answer)
- D. Defect in common pathway
Explanation: ***Defect in common pathway*** - Elevation in both PT (Prothrombin Time) and APTT (Activated Partial Thromboplastin Time) indicates a dysfunction affecting the **common coagulation pathway** [1]. - Conditions such as Vitamin K deficiency or certain coagulation factor deficiencies (like factor II, V, X) would result in **both PT and APTT prolongation** [1]. *Defect in intrinsic pathway* - A defect in the intrinsic pathway typically leads to **prolonged APTT** while PT remains normal, which does not match this case [1]. - Intrinsic pathway defects involve factors such as **VIII, IX, XI**, and they wouldn't elevate PT. *Platelet function defect* - Platelet function defects mainly cause **bleeding disorders** but do not typically prolong PT or APTT; they result in **normal coagulation screening tests** [2]. - Symptoms usually involve **petechiae, purpura**, or excessive bleeding, distinct from coagulation pathway issues [2]. *Defect in extrinsic pathway* - A defect in the extrinsic pathway would primarily lead to a **prolonged PT**, with APTT remaining normal, which is contrary to the findings here [1]. - This pathway defect is usually related to **factor VII** and does not explain the elevation in both tests.
Question 1178: Von Willebrand disease involves a deficiency of which factor?
- A. Defect in platelet adhesion due to von Willebrand factor deficiency (Correct Answer)
- B. Defect in fibrin formation affecting clot stabilization
- C. Generalized defects involving small blood vessels
- D. Defect in clotting factors affecting secondary hemostasis
Explanation: ***Primary hemostasis*** - Von Willebrand disease primarily affects **primary hemostasis** due to defective or deficient **von Willebrand factor (vWF)**, which is crucial for platelet adhesion [1][3]. - This defect results in **increased bleeding tendencies**, exemplified by symptoms like easy bruising and prolonged bleeding from cuts [2]. *Secondary hemostasis* - Secondary hemostasis involves the **coagulation cascade**, not primarily affected in von Willebrand disease [3]. - Disorders related to secondary hemostasis typically involve factors like **factor VII, IX, or X**, unlike the vWF defect seen here [3]. *Generalized defects involving small vessels* - Generalized defects imply broader issues affecting the **microcirculation**, which is not the primary issue in von Willebrand disease. - While small vessel bleeding can occur, it is not specific to this condition as it does not primarily involve the **platelet aggregation** defect [1]. *Clot stabilization and resorption* - Clot stabilization and resorption primarily involve factors such as **fibrinogen** and cross-linking factors, rather than vWF. - Von Willebrand disease specifically impacts the **platelet function** and does not directly relate to stabilization processes once the clot has formed [1][3].
Question 1179: Which of the following is false about monoclonal gammopathy of unknown significance (MGUS)?
- A. No evidence of Bence-Jones proteinuria
- B. Bone marrow plasma cells less than 10%
- C. Does not progress to multiple myeloma (Correct Answer)
- D. Less than 3g/dL of monoclonal protein
Explanation: ***Does not progress to multiple myeloma*** - This statement is **false**, as Monoclonal Gammopathy of Unknown Significance (MGUS) is a **precursor condition** that can progress to multiple myeloma [1] or other plasma cell disorders in a small percentage of patients. - MGUS is characterized by the presence of a **monoclonal protein** without evidence of end-organ damage, but its malignant potential is why regular monitoring is crucial. *No evidence of Bence-Jones proteinuria* - This statement is **true** for MGUS, as the presence of significant **Bence-Jones proteinuria** (light chain spilling into urine) often indicates progression to multiple myeloma or other plasma cell dyscrasias [2]. - In MGUS, the amount of monoclonal protein is generally low, and **significant renal involvement** or light chain production is typically absent. *Bone marrow plasma cells less than 10%* - This statement is **true** for MGUS; the bone marrow must contain **less than 10% plasma cells** to meet the diagnostic criteria for MGUS [2]. - If plasma cells exceed 10% in the bone marrow, the diagnosis may shift towards **smoldering multiple myeloma** or **active multiple myeloma**, depending on other clinical findings. *Less than 3g/dL of monoclonal protein* - This statement is **true** for MGUS, as the serum **monoclonal protein (M-protein) concentration** must be **less than 3 g/dL** [2]. - A higher M-protein level, particularly above 3 g/dL, is a diagnostic criterion for **smoldering multiple myeloma** or **active multiple myeloma**.
Question 1180: Which of the following does not cause deep venous thrombosis (DVT)?
- A. Lower limb trauma
- B. Subungual hematoma (Correct Answer)
- C. Hip & pelvic surgeries
- D. Cushing's syndrome
Explanation: ***Subungual hematoma*** - A **subungual hematoma** is a collection of blood under the fingernail or toenail, usually caused by trauma. - It is a localized injury that **does not affect systemic coagulation** or venous blood flow, thus not increasing DVT risk. *Lower limb trauma* - **Trauma to the lower limb**, especially involving fractures or significant soft tissue damage, can lead to **venous stasis** due to immobility and direct vessel injury [1]. - This immobility and vessel damage activate the **coagulation cascade**, significantly increasing the risk of DVT [1]. *Cushing's syndrome* - **Cushing's syndrome** is characterized by **hypercortisolism**, which leads to a **hypercoagulable state**. - **Elevated cortisol levels** increase circulating procoagulant factors and decrease fibrinolytic activity, predisposing patients to DVT. *Hip & pelvic surgeries* - **Major surgeries**, particularly those involving the **hip and pelvis**, frequently cause **endothelial injury**, blood stasis, and activate the coagulation system [1]. - Patients undergoing these procedures are at a **very high risk for DVT** due to prolonged immobility and surgical trauma [1].
Practice by Chapter
Anemia Evaluation and Management
Practice Questions
Hemoglobinopathies
Practice Questions
Thalassemias
Practice Questions
Platelet Disorders
Practice Questions
Coagulation Disorders
Practice Questions
Thrombotic Disorders
Practice Questions
Leukemias
Practice Questions
Lymphomas
Practice Questions
Multiple Myeloma and Plasma Cell Disorders
Practice Questions
Myeloproliferative Neoplasms
Practice Questions
Transfusion Medicine
Practice Questions
Hematopoietic Stem Cell Transplantation
Practice Questions
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