Hematology Practice Questions

Q: What is a hallmark of hemophilia?

Hemarthrosis. **Explanation:** **Hemophilia** (A or B) is a classic example of a **secondary hemostasis defect** (clotting factor deficiency) [1]. Unlike primary hemostasis defects (platelet disorders), which present with superficial bleeding like petechiae and epistaxis, secondary hemostasis defects typically manifest as deep-seated bleeding [3]. **Why Hemarthrosis is the Correct Answer:** **Hemarthrosis** (bleeding into joint spaces) is the clinical hallmark of hemophilia [1]. It most commonly affects large weight-bearing joints like the knees, elbows, and ankles [1]. Recurrent hemarthrosis leads to synovial hypertrophy and chronic joint destruction, known as **hemophilic arthropathy** [1]. **Analysis of Incorrect Options:** * **A. Epistaxis:** This is more characteristic of **primary hemostasis defects** (e.g., Von Willebrand Disease or thrombocytopenia) [3]. While it can occur in hemophilia, it is not the "hallmark" feature. * **C. Abdominal pain:** While internal bleeding (like iliopsoas hematoma) can cause pain, it is a complication rather than a diagnostic hallmark [1]. * **D. Anemia:** Anemia is a non-specific consequence of chronic or acute blood loss and is not diagnostic of any specific bleeding disorder. **High-Yield Clinical Pearls for NEET-PG:** * **Inheritance:** Both Hemophilia A (Factor VIII deficiency) and B (Factor IX deficiency) are **X-linked recessive** [2]. * **Lab Profile:** Characterized by **Prolonged aPTT** with a **Normal PT and Normal Bleeding Time**. * **Mixing Study:** A prolonged aPTT that **corrects** upon mixing with normal plasma indicates a factor deficiency (like Hemophilia), whereas failure to correct suggests an inhibitor. * **Treatment:** Factor replacement is the mainstay. For mild Hemophilia A, **Desmopressin (DDAVP)** can be used to release stored Factor VIII and vWF.

Q: All of the following are poor prognostic factors for Hodgkin's disease, except?

Younger age. In Hodgkin’s Lymphoma (HL), prognosis is determined by the clinical stage, histological subtype, and specific clinical markers. **Explanation of the Correct Answer:** **Option A (Younger age)** is the correct answer because it is actually a **favorable** prognostic factor. In HL, **older age (>45–50 years)** is consistently associated with a poorer prognosis due to a higher frequency of comorbidities, decreased tolerance to intensive chemotherapy, and a higher prevalence of unfavorable histological subtypes (like Mixed Cellularity). Younger patients typically have better performance status and a higher cure rate. **Explanation of Incorrect Options (Poor Prognostic Factors):** * **Option B (Systemic manifestations):** Also known as **"B symptoms"** (fever, night sweats, weight loss), these indicate a higher tumor burden and more aggressive disease, correlating with a worse prognosis. * **Option C (Lymphocyte depletion):** This is the rarest histological subtype of HL and carries the **worst prognosis**. Conversely, Lymphocyte Predominant HL has the best prognosis. * **Option D (Mediastinal disease):** Specifically "Bulky disease" (mediastinal mass >1/3 of the maximum intrathoracic diameter) is a major poor prognostic factor in early-stage HL, as it increases the risk of local recurrence. **High-Yield Clinical Pearls for NEET-PG:** * **Hasenclever Index (International Prognostic Score):** Used for advanced HL. Poor prognostic factors include: Age ≥45, Male sex, Stage IV disease, Albumin <4 g/dL, Hemoglobin <10.5 g/dL, WBC ≥15,000/µL, and Lymphocytes <600/µL (or <8%). * **Ann Arbor Staging:** The most important factor for determining treatment. * **Reed-Sternberg Cells:** The hallmark "Owl’s eye" appearance; CD15+ and CD30+ (except in Nodular Lymphocyte Predominant HL, which is CD20+).

Q: A 42-year-old female presents with bleeding gums for the past 20 days. Intra-oral examination shows thickened and friable gums. She also has hepatosplenomegaly and generalized non-tender lymphadenopathy. Laboratory findings include: Hemoglobin 11.4 g/dL, Platelet count 90,000/mm³, WBC count 4600/mm³. Bone marrow biopsy shows 100% cellularity with many large blasts that are peroxidase negative and non-specific esterase positive. What is the most likely diagnosis for this patient?

Acute monocytic leukemia. ### Explanation The correct diagnosis is **Acute Monocytic Leukemia (AML-M5)**. **1. Why Acute Monocytic Leukemia is correct:** The clinical hallmark of monocytic leukemia is **extramedullary involvement**, specifically **gingival hypertrophy** (thickened, friable gums) [1], hepatosplenomegaly, and lymphadenopathy [2]. Monoblasts have a high propensity to infiltrate tissues. * **Laboratory Findings:** The bone marrow shows large blasts that are **Myeloperoxidase (MPO) negative** (common in M5) but strongly **Non-Specific Esterase (NSE) positive**. NSE is the characteristic marker for the monocytic lineage. **2. Why other options are incorrect:** * **A. Acute Lymphoblastic Leukemia (ALL):** While common in children and presenting with lymphadenopathy [2], ALL blasts are typically **PAS positive** and would not show NSE positivity or specific gingival infiltration. * **B. Acute Megakaryocytic Leukemia (AML-M7):** This is often associated with myelofibrosis (dry tap) and Down Syndrome. Blasts are identified by platelet markers (CD41/CD61), not NSE. * **C. Acute Promyelocytic Leukemia (AML-M3):** Characterized by Auer rods, DIC, and strong **MPO positivity**. It does not typically present with gingival hypertrophy or NSE positivity. **3. NEET-PG High-Yield Pearls:** * **Gingival Hyperplasia:** Classic for AML-M4 (Myelomonocytic) and **AML-M5 (Monocytic)** [1]. * **NSE Stain:** Highly specific for monocytes. If the stain is inhibited by sodium fluoride, it confirms the monocytic origin. * **MPO Stain:** The most sensitive marker for the myeloid lineage (positive in M1, M2, M3, M4). * **M5 Subtypes:** M5a (mostly monoblasts) and M5b (monoblasts + promonocytes + monocytes).

Q: Which of the following is true about Chronic Lymphocytic Leukemia (CLL)?

Can present as acute leukemia. **Explanation:** Chronic Lymphocytic Leukemia (CLL) is a monoclonal proliferation of mature, functionally incompetent B-lymphocytes. **Why Option A is Correct:** While CLL is typically an indolent (slow-growing) chronic disease, it can undergo a sudden transformation into an aggressive, high-grade malignancy. This is known as **Richter’s Transformation**. In approximately 2–10% of cases, CLL transforms into Diffuse Large B-cell Lymphoma (DLBCL) or, less commonly, into **Prolymphocytic Leukemia (PLL)** or acute leukemia. This clinical shift presents with rapidly worsening lymphadenopathy, fever, and weight loss, mimicking an acute leukemic state. **Analysis of Incorrect Options:** * **Option B:** While CLL is often *incidentally* discovered during routine blood tests (as asymptomatic lymphocytosis), the question asks what is "true" regarding its nature/presentation. Option A is a more specific pathological characteristic of the disease's progression [1]. * **Option C:** Leukocytosis (specifically lymphocytosis >5,000/µL) is a hallmark of CLL. However, in the context of standardized exams, if a "transformation" or "complication" option is provided, it often tests the student's knowledge of the disease's natural history (Richter’s). * **Option D:** CLL is a malignancy of **B-lymphocytes** (CD5+, CD19+, CD20+, and CD23+). **NEET-PG High-Yield Pearls:** * **Smudge Cells (Basket Cells):** Characteristically seen on peripheral smear due to the fragility of lymphocytes. * **Immunophenotype:** Characterized by the co-expression of **CD5** (normally a T-cell marker) and B-cell markers (**CD19, CD23**). * **Hypogammaglobulinemia:** Most common complication leading to recurrent infections [1]. * **Autoimmune Hemolytic Anemia (AIHA):** A frequent paraneoplastic association [1].

Q: A 34-year-old man presents with a 5-month history of weakness and fatigue. There is no history of drug or alcohol abuse. A CBC shows megaloblastic anemia and a normal reticulocyte count. Further laboratory studies reveal vitamin B12 deficiency. Anemia in this patient is most likely caused by which of the following?

Autoimmune gastritis. The patient presents with **megaloblastic anemia** due to **Vitamin B12 deficiency**. In the absence of dietary restrictions (like strict veganism) or drug use, the most common cause of B12 deficiency is **Pernicious Anemia**, which is the end-stage of **Autoimmune Gastritis (Type A Gastritis)** [1, 2]. **Why Autoimmune Gastritis is correct:** Autoimmune gastritis involves the production of autoantibodies against **gastric parietal cells** and **Intrinsic Factor (IF)** [2]. Parietal cells, located in the body and fundus of the stomach, are responsible for secreting hydrochloric acid and IF. Since IF is essential for the absorption of Vitamin B12 in the terminal ileum, its absence leads to malabsorption, resulting in megaloblastic anemia [1]. **Why other options are incorrect:** * **A. Acute erosive gastritis:** This typically presents with hematemesis or melena due to superficial mucosal injury (often from NSAIDs or alcohol) [2]. It does not cause B12 malabsorption. * **C. Helicobacter pylori gastritis:** This is **Type B Gastritis**, primarily affecting the antrum. While it can cause iron deficiency, it does not typically cause the profound parietal cell atrophy required to produce B12 deficiency [2]. * **D. Menetrier disease:** A rare protein-losing hypertrophic gastropathy characterized by enlarged gastric folds and TGF-α overexpression. It leads to hypoproteinemia, not B12 deficiency. **High-Yield Clinical Pearls for NEET-PG:** * **Location:** Autoimmune Gastritis affects the **Body and Fundus** (spares the antrum) [2]. * **Markers:** Increased serum **Gastrin** (due to loss of acid feedback) and decreased **Pepsinogen I**. * **Associations:** Often associated with other autoimmune conditions like Vitiligo, Hashimoto’s thyroiditis, and Type 1 Diabetes. * **Risk:** Increased risk of **Gastric Adenocarcinoma** and **Carcinoid tumors**.

Question 1

A 39-year-old man is seeing red-colored urine in the morning. The CBC reveals anemia, low serum iron, and an elevated reticulocyte count. Laboratory studies show increased lysis of erythrocytes when incubated with either sucrose or acidified serum. Which of the following is the appropriate diagnosis?

Accepted Answer

Paroxysmal nocturnal hemoglobinuria

Answer

Anemia of chronic renal failure

Answer

Hereditary spherocytosis

Answer

Microangiopathic hemolytic anemia

Question 2

What is a hallmark of hemophilia?

Accepted Answer

Hemarthrosis

Answer

Epistaxis

Answer

Abdominal pain

Answer

Anemia

Question 3

Which of the following statements is true regarding Chronic Myeloid Leukemia (CML)?

Accepted Answer

The size of splenomegaly can indicate prognosis.

Answer

Phagocytic activity of white blood cells is reduced.

Answer

Sudan black stain is specific for myeloblasts.

Answer

Myeloblasts, granuloblasts, and lymphoblasts become Philadelphia chromosome positive following remission.

Question 4

A 42-year-old female diagnosed with iron deficiency anemia was treated with oral iron therapy. Her hemoglobin level during review was 8 g%. What is the most likely cause for the failure of treatment?

Accepted Answer

Poor compliance to oral iron

Answer

Acquired sideroblastic anemia

Answer

Inadequate iron dosage

Answer

Folate deficiency

Question 5

All of the following are poor prognostic factors for Hodgkin's disease, except?

Accepted Answer

Younger age

Answer

Systemic manifestations

Answer

Lymphocyte depletion

Answer

Mediastinal disease

Question 6

A 42-year-old female presents with bleeding gums for the past 20 days. Intra-oral examination shows thickened and friable gums. She also has hepatosplenomegaly and generalized non-tender lymphadenopathy. Laboratory findings include: Hemoglobin 11.4 g/dL, Platelet count 90,000/mm³, WBC count 4600/mm³. Bone marrow biopsy shows 100% cellularity with many large blasts that are peroxidase negative and non-specific esterase positive. What is the most likely diagnosis for this patient?

Accepted Answer

Acute monocytic leukemia

Answer

Acute lymphoblastic leukemia

Answer

Acute megakaryocytic leukemia

Answer

Acute promyelocytic leukemia

Question 7

Chronic hemolysis from which of the following conditions may be associated with iron deficiency?

Accepted Answer

Paroxysmal cold Hemoglobinuria

Answer

Thalassemia

Answer

Hereditary spherocytosis

Answer

G 6PD deficiency

Question 8

Which of the following is true about Chronic Lymphocytic Leukemia (CLL)?

Accepted Answer

Can present as acute leukemia

Answer

Diagnosed in routine blood tests

Answer

Leukocytosis is present

Answer

More T lymphocytes are seen

Question 9

All of the following are criteria for diagnosing severe aplastic anemia except?

Accepted Answer

Absolute neutrophil count < 1500/µL

Answer

Bone marrow cellularity < 25%

Answer

Reticulocyte count < 1%

Answer

Platelet count < 20,000/µL

Question 10

A 34-year-old man presents with a 5-month history of weakness and fatigue. There is no history of drug or alcohol abuse. A CBC shows megaloblastic anemia and a normal reticulocyte count. Further laboratory studies reveal vitamin B12 deficiency. Anemia in this patient is most likely caused by which of the following?

Accepted Answer

Autoimmune gastritis

Answer

Acute erosive gastritis

Answer

Helicobacter pylori gastritis

Answer

Menetrier disease

Hematology — MCQs

Hematology — MCQs

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