Hematology Practice Questions

Q: Central nervous system involvement in diffuse large B-cell lymphoma (DLBCL) is not typically seen with involvement of which of the following organs?

Ovary. In Diffuse Large B-cell Lymphoma (DLBCL), certain extranodal sites are associated with a significantly higher risk of secondary Central Nervous System (CNS) relapse. This is often due to the biological behavior of the tumor or the presence of "sanctuary sites" where systemic chemotherapy penetration is poor. [1] **Explanation of the Correct Option:** * **A. Ovary:** While DLBCL can involve the ovaries, it is **not** classically associated with an increased risk of CNS dissemination. In contrast to the male gonads, ovarian involvement does not mandate routine CNS prophylaxis in the same high-risk category as the other options listed. **Explanation of Incorrect Options:** * **B. Testis:** The testis is a classic "sanctuary site" due to the blood-testis barrier. Primary or secondary testicular DLBCL has a very high propensity (up to 15-30%) for CNS relapse. [1] * **C & D. Kidney and Adrenal Gland:** Involvement of the retroperitoneal organs, specifically the kidneys and adrenal glands, is a well-recognized independent risk factor for CNS involvement. [3] The **CNS-IPI (International Prognostic Index)** specifically includes "kidney or adrenal involvement" as a high-risk criterion. **High-Yield Clinical Pearls for NEET-PG:** * **CNS-IPI Score:** Used to predict CNS relapse. It includes the 5 standard IPI factors (Age >60, LDH >normal, Performance Status ≥2, Stage III/IV, >1 Extranodal site) **PLUS** kidney/adrenal involvement. [3] * **High-Risk Sites:** The "Rule of T's and R's" for CNS risk: **T**estis, **R**etroperitoneum (Kidney/Adrenal), and sometimes **B**one Marrow or **B**reast. * **Prophylaxis:** Patients with involvement of the testis, kidney, or adrenal glands often require CNS-directed therapy (e.g., Intrathecal Methotrexate or high-dose systemic Methotrexate) alongside R-CHOP. [2]

Q: In a patient with mild hemophilia, what would be the typical percentage of clotting factor (antihemophilic factor) activity?

Above 5%. Hemophilia (A or B) is an X-linked recessive bleeding disorder caused by a deficiency in Factor VIII or Factor IX [1]. The clinical severity of the disease is directly correlated with the plasma level of the deficient clotting factor. **1. Why Option A is Correct:** According to the standard classification of hemophilia severity: * **Severe:** 5% to <40%** of normal factor activity. (Bleeding usually occurs only after major trauma or surgery). Since mild hemophilia is defined as activity **above 5%**, Option A is the most accurate threshold for diagnosis. **2. Why Other Options are Incorrect:** * **Option B (Above 10%):** While a patient with 10% activity is indeed "mild," this option is too restrictive. A patient with 6% or 8% activity is also classified as mild, and this option would exclude them. * **Option C (Above 30%):** Normal factor levels range from 50% to 150%. The "mild" category ends at approximately 40%. Setting the threshold at 30% misses a significant portion of the mild hemophilia population (those between 5% and 30%). * **Option D:** Incorrect because the specific diagnostic cutoff for mild hemophilia starts at >5%. **High-Yield Clinical Pearls for NEET-PG:** * **Most common cause of death:** Intracranial hemorrhage. * **Most common site of bleeding:** Knee joint (Hemarthrosis) [1]. * **Lab Findings:** Prolonged **aPTT**, normal PT, normal Bleeding Time, and normal Platelet count. * **Treatment:** Factor replacement is the mainstay [1]. In **Mild Hemophilia A**, **Desmopressin (DDAVP)** can be used to transiently raise Factor VIII levels by releasing it from endothelial stores [2].

Q: A 67-year-old woman with a prosthetic aortic valve develops progressive anemia. Examination of a peripheral blood smear reveals reticulocytosis and schistocytes. What is the appropriate diagnosis?

Macroangiopathic hemolytic anemia. ### Explanation **Correct Option: D. Macroangiopathic hemolytic anemia (MAHA)** The clinical presentation of a **prosthetic heart valve** combined with **schistocytes** (fragmented RBCs) and **reticulocytosis** (indicating a compensatory bone marrow response to hemolysis) is a classic description of **Waring Blender Syndrome**. **Medical Concept:** This is a form of **Macroangiopathic Hemolytic Anemia**. It occurs due to mechanical trauma as RBCs pass through the turbulent flow or high-pressure gradients created by a prosthetic valve (especially mechanical valves or paravalvular leaks) [1]. The physical impact shears the RBC membranes, leading to intravascular hemolysis and the formation of schistocytes [1]. **Why Incorrect Options are Wrong:** * **A. Acanthocytosis:** Characterized by "spur cells" (irregularly spiked RBCs), typically seen in **Abetalipoproteinemia** or severe liver disease, not mechanical trauma. * **B. Henoch-Schönlein purpura (HSP):** A small-vessel vasculitis presenting with a triad of palpable purpura, arthralgia, and abdominal pain. It does not typically cause mechanical hemolysis. * **C. Idiopathic thrombocytopenic purpura (ITP):** An immune-mediated destruction of platelets. While it causes bleeding, it does not cause RBC fragmentation or schistocytes. **NEET-PG High-Yield Pearls:** * **Schistocytes** are the hallmark of **Micro**angiopathic Hemolytic Anemia (TTP, HUS, DIC) and **Macro**angiopathic Hemolytic Anemia (Prosthetic valves, Aortic stenosis). * In MAHA due to valves, **haptoglobin** will be decreased, and **LDH** will be elevated. * **Iron deficiency anemia** can eventually develop in these patients due to chronic **hemosiderinuria** (loss of iron in urine following intravascular hemolysis).

Q: Which of the following infections is most commonly related to aplastic anemia?

Hepatitis. **Explanation:** **Aplastic Anemia (AA)** is a clinical syndrome characterized by pancytopenia resulting from bone marrow hypoplasia. While most cases are idiopathic, viral infections are a well-recognized trigger. **Why Hepatitis is the Correct Answer:** **Post-hepatitic aplastic anemia** is a distinct clinical entity. It typically occurs 2–3 months after an episode of acute hepatitis. Interestingly, in the majority of these cases, the common hepatitis viruses (A, B, C, or E) are **not** the culprits; it is usually caused by unidentified non-A, non-B, non-C, non-E viruses. The pathophysiology involves a T-cell-mediated immune destruction of hematopoietic stem cells triggered by the viral infection. It is often severe and carries a high mortality rate if not treated with bone marrow transplantation or immunosuppressive therapy. **Why Other Options are Incorrect:** * **H. pylori:** This is primarily associated with peptic ulcer disease, gastric MALT lymphoma, and **Immune Thrombocytopenic Purpura (ITP)** or Iron Deficiency Anemia, but not aplastic anemia. * **Tetanus:** Caused by *Clostridium tetani* neurotoxins; it affects the neuromuscular system and has no association with bone marrow failure. * **Bacteremia:** While severe sepsis can cause transient cytopenias or DIC, it does not cause the chronic stem cell failure characteristic of aplastic anemia. **High-Yield Clinical Pearls for NEET-PG:** * **Most common virus** associated with AA: Non-A, non-B, non-C, non-G hepatitis viruses. * **Other associated viruses:** EBV (Infectious Mononucleosis), CMV, HIV, and Parvovirus B19 (though B19 typically causes **Pure Red Cell Aplasia**, especially in sickle cell patients). * **Drug of choice:** For patients not eligible for transplant, **Antithymocyte Globulin (ATG) + Cyclosporine** is the standard treatment. * **Gold Standard Diagnosis:** Bone marrow biopsy showing hypocellularity and increased fat content ("dry tap").

Q: Which of the following is NOT part of the ABVD regimen for chemotherapeutic treatment of Non-Hodgkin's Lymphoma?

Vincristine. The **ABVD regimen** is the gold standard first-line chemotherapy for **Hodgkin Lymphoma (HL)** [1]. The question asks which drug is NOT part of this regimen in the context of Non-Hodgkin's Lymphoma (NHL). ### **Explanation of the Correct Answer** **D. Vincristine** is the correct answer because it is not a component of the ABVD regimen. Vincristine is, however, a key component of the **CHOP** or **R-CHOP** regimens, which are the standard treatments for **Non-Hodgkin Lymphoma (NHL)** [1]. It is also part of the older MOPP regimen for Hodgkin Lymphoma. ### **Analysis of Incorrect Options** The acronym **ABVD** stands for: * **A: Adriamycin (Doxorubicin):** An anthracycline that inhibits topoisomerase II. (Option A) * **B: Bleomycin:** A glycopeptide antibiotic that causes DNA strand breaks. (Option C) * **V: Vinblastine:** A microtubule inhibitor (vinca alkaloid). Note that while Vincristine and Vinblastine are in the same class, they are not interchangeable in this regimen. * **D: Dacarbazine:** An alkylating agent. (Option B) ### **Clinical Pearls for NEET-PG** * **Regimen Distinction:** Remember **ABVD for Hodgkin Lymphoma** and **CHOP for Non-Hodgkin Lymphoma**. * **Specific Toxicities (High Yield):** * **Doxorubicin:** Dilated Cardiomyopathy (monitor with ECHO/MUGA scan). * **Bleomycin:** Pulmonary Fibrosis (monitor with Pulmonary Function Tests/DLCO). * **Vinblastine:** Bone marrow suppression (unlike Vincristine, which is more neurotoxic). * **Vincristine:** Peripheral neuropathy and paralytic ileus. * **Historical Note:** ABVD replaced the MOPP regimen because it has a lower risk of causing secondary leukemia and sterility.

Question 1

Central nervous system involvement in diffuse large B-cell lymphoma (DLBCL) is not typically seen with involvement of which of the following organs?

Accepted Answer

Ovary

Answer

Testis

Answer

Kidney

Answer

Adrenal gland

Question 2

A 40-year-old male has Hb-10 gm%, MCV-65 fL, RDW-16%, platelet count 4.5 lac/pt. What additional finding would be expected?

Accepted Answer

Total iron-binding capacity

Answer

Low serum transferrin

Answer

Total serum copper

Answer

Serum ferritin

Question 3

In a patient with mild hemophilia, what would be the typical percentage of clotting factor (antihemophilic factor) activity?

Accepted Answer

Above 5%

Answer

Above 10%

Answer

Above 30%

Answer

Any of the above

Question 4

A 67-year-old woman with a prosthetic aortic valve develops progressive anemia. Examination of a peripheral blood smear reveals reticulocytosis and schistocytes. What is the appropriate diagnosis?

Accepted Answer

Macroangiopathic hemolytic anemia

Answer

Acanthocytosis

Answer

Henoch-Schönlein purpura

Answer

Idiopathic thrombocytopenic purpura

Question 5

Which of the following infections is most commonly related to aplastic anemia?

Accepted Answer

Hepatitis

Answer

H. pylori infection

Answer

Tetanus

Answer

Bacteremia

Question 6

Which of the following statements is not true regarding hemophilia A?

Accepted Answer

Factor VIII levels less than 50% are associated with spontaneous hemorrhage.

Answer

Hemophilia A is due to deficiency of factor VIII.

Answer

In hemophilia A, females are typically carriers.

Answer

Desmopressin can be useful in the management of hemophilia A.

Question 7

A 19-year-old college student develops a severe sore throat, cervical lymphadenopathy, and atypical lymphocytes on blood film. A heterophil antibody test is positive. For the above patient with a hematologic abnormality, select the most likely diagnosis.

Accepted Answer

infectious mononucleosis

Answer

hyperthyroidism

Answer

rectal cancer

Answer

renal cell carcinoma

Question 8

Which of the following is NOT part of the ABVD regimen for chemotherapeutic treatment of Non-Hodgkin's Lymphoma?

Accepted Answer

Vincristine

Answer

Doxorubicin

Answer

Dacarbazine

Answer

Bleomycin

Question 9

What is the recommended daily amount of elemental iron required for iron replacement therapy?

Accepted Answer

300 mg of elemental iron per day

Answer

60 mg of elemental iron per day

Answer

160 mg of elemental iron per day

Answer

360 mg of elemental iron per day

Question 10

While managing a febrile neutropenic patient, all of the following are essential EXCEPT:

Accepted Answer

White cell infusion

Answer

Repeated hand washing by hospital personnel

Answer

Prophylactic antibiotics

Answer

Colony-stimulating factor for macrophages

Hematology — MCQs

Hematology — MCQs

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