Hematology Practice Questions

Q: Which of the following treatments are recommended for a pregnant woman suffering from sickle cell disease ? I. Folic acid 1 mg daily II. Azathioprine III. Penicillin prophylaxis IV. Thromboprophylaxis with low molecular weight heparin Select the correct answer using the code given below :

I, III and IV. ***I, III and IV*** - **Folic acid 5 mg daily** (not 1mg) is essential in pregnancy, especially for women with **sickle cell disease**, to prevent **megaloblastic anemia** due to increased red cell turnover [1]. - **Penicillin prophylaxis** is crucial to prevent **Bacterial infections** as patients with sickle cell disease are at increased risk of infection, especially from encapsulated organisms, due to **functional asplenia** [1]. - **Thromboprophylaxis with low molecular weight heparin** is recommended because pregnancy in sickle cell disease significantly increases the risk of **venous thromboembolism** [1]. *I, II and IV* - **Azathioprine** is an immunosuppressant typically used for autoimmune conditions or organ transplantation, and it is **not a standard treatment** for managing sickle cell disease itself during pregnancy. - While folic acid and thromboprophylaxis are indicated, the inclusion of azathioprine makes this option incorrect. *I, II and III* - This option incorrectly includes **azathioprine**, an immunosuppressant not indicated for routine sickle cell management in pregnancy. - It also omits crucial **thromboprophylaxis**, which is vital given the increased risk of blood clots. *II, III and IV* - This option correctly includes **penicillin prophylaxis** and **thromboprophylaxis** but **incorrectly omits folic acid**, which is a cornerstone of daily management for all pregnant women with sickle cell disease. - It also incorrectly includes **azathioprine**, which is not a standard treatment.

Q: Which of the following are secondary iron overload conditions? I. Transfusion related iron load II. Thalassemia III. Hepatitis C associated liver disease Select the correct answer using the code given below :

I, II and III. ***I, II and III*** - All three listed conditions—**transfusion-related iron load**, **thalassemia**, and **Hepatitis C associated liver disease**—are well-recognized causes of secondary iron overload. - Secondary iron overload occurs due to external factors or underlying diseases that cause increased iron absorption or repeated administration of iron. [1] *I and II only* - This option is incomplete as **Hepatitis C associated liver disease** can also lead to secondary iron overload due to impaired iron metabolism and chronic inflammation. - It dismisses a known cause of secondary iron accumulation. *I and III only* - This option is incomplete because **thalassemia**, particularly **transfusion-dependent thalassemia**, is a classic example of secondary iron overload due to frequent blood transfusions and ineffective erythropoiesis. - It overlooks a major cause of transfusion-related iron accumulation. [1] *II and III only* - This option is incomplete as **transfusion-related iron load** is a direct and common cause of secondary iron overload, especially in patients requiring regular blood transfusions for conditions like anemia. [1] - It ignores the most direct mechanism of iron accumulation in many chronic diseases.

Q: With regard to management of idiopathic thrombocytopenic purpura, consider the following statements : I. All patients with ITP with platelet count less than 100 x 10^9 / L should receive high dose of glucocorticoids II. For patient with spontaneous bleeding, 40 mg of dexamethasone daily is indicated for 4 days III. Intravenous immunoglobulin can raise the platelet count IV. Life threatening bleeding should be treated with platelet transfusion Which of the statements given above are correct?

II, III and IV. ***II, III and IV*** - Statement II is correct because **40 mg of dexamethasone daily for 4 days** is a common regimen for newly diagnosed ITP with a platelet count <30 x 10^9/L or with bleeding, aiming for rapid platelet increase. - Statement III is correct as **Intravenous Immunoglobulin (IVIG)** works by blocking Fc receptors on macrophages, reducing platelet destruction and rapidly raising platelet counts, especially in cases of active bleeding or before urgent procedures. - Statement IV is correct because in **life-threatening bleeding** associated with ITP, platelet transfusions are indicated to provide immediate hemostasis, often given alongside other therapies like IVIG or high-dose steroids. *I, II and IV* - Statement I is incorrect; not all ITP patients with platelet counts <100 x 10^9/L require high-dose glucocorticoids [1]. Treatment decisions are based on **platelet count, bleeding symptoms**, and patient risk factors, with many asymptomatic patients with counts between 30-100 x 10^9/L being observed. - While statements II and IV are correct, the inclusion of statement I makes this option incorrect. *I, II and III* - Statement I is incorrect for the reasons mentioned above; not all ITP patients with platelet counts <100 x 10^9/L need high-dose glucocorticoids. - Although statements II and III are correct, the presence of the incorrect statement I renders this option invalid. *I, III and IV* - Statement I is incorrect because immediate high-dose glucocorticoid treatment is not indicated for all ITP patients with platelet counts below 100 x 10^9/L; it's reserved for those with **significant bleeding or very low counts** (<30 x 10^9/L) [1]. - Statements III and IV are correct, but the inaccuracy of statement I makes this choice incorrect.

Q: First line therapy in chronic phase of chronic myeloid leukemia is

Imatinib. ***Imatinib*** - **Imatinib** is a **tyrosine kinase inhibitor (TKI)** that specifically targets the **BCR-ABL fusion protein**, which is the hallmark of **chronic myeloid leukemia (CML)** [1][2]. - It is highly effective in inducing **hematologic and cytogenetic remissions** in the chronic phase of CML and has significantly improved prognosis [2]. *Thalidomide* - **Thalidomide** is an immunomodulatory drug primarily used in **multiple myeloma** and as a teratogen. - It does not target the **BCR-ABL fusion protein** and is not indicated for CML. *Rituximab* - **Rituximab** is a **monoclonal antibody** that targets the **CD20 antigen** found on B-lymphocytes. - It is used in the treatment of **B-cell non-Hodgkin lymphoma** and **chronic lymphocytic leukemia**, not CML. *Chlorambucil* - **Chlorambucil** is an **alkylating agent**, a type of chemotherapy drug. - While historically used in some hematologic malignancies, it has been largely superseded by targeted therapies like TKIs in CML due to its non-specific action and greater toxicity [2].

Q: Which one of the following causes low-volume erythrocytosis?

Gaisbock's syndrome. ***Gaisbock's syndrome*** - **Gaisbock's syndrome**, also known as **stress erythrocytosis** or **relative polycythemia**, is characterized by a high hematocrit due to reduced plasma volume rather than an absolute increase in red blood cell (RBC) mass. - It is often associated with **hypertension**, **obesity**, and **stress**, predominantly affecting middle-aged men with a normal total erythrocyte mass [1]. *High altitude* - Living at **high altitudes** can cause **secondary erythrocytosis** due to chronic hypoxia, leading to increased erythropoietin production and an absolute increase in red blood cell mass [2]. - This is a **true erythrocytosis**, where both red blood cell count and total blood volume are elevated. *Polycythemia Rubra Vera* - **Polycythemia vera** is a **myeloproliferative neoplasm** causing an absolute increase in the red blood cell mass, resulting from uncontrolled production by the bone marrow. - It is characterized by a **JAK2V617F mutation** and leads to increased total blood volume, not reduced plasma volume [1]. *Exogenous testosterone therapy* - **Exogenous testosterone therapy** can stimulate erythropoiesis, leading to an **increase in red blood cell mass** and hematocrit, which is a form of **secondary erythrocytosis**. - This effect is mediated by increased erythropoietin production and is an absolute increase in RBCs, not a low-volume condition.

Q: A 35 year female presents with easy fatigability. Investigations show that Hb is 6 g %; Red cell morphology is normocytic normochromic; and reticulocyte production index is 5.5 . Which one of the following conditions favours this abnormality?

Intravascular hemolysis. ***Intravascular hemolysis*** - **Normocytic, normochromic anemia** with a **high reticulocyte production index** (RPI > 2-3) is characteristic of hemolytic anemias, indicating the bone marrow is effectively responding to increased red cell destruction [1]. - **Easy fatigability** is a common symptom of severe anemia, and the low Hb of 6g% confirms significant red blood cell loss, consistent with active hemolysis. *Folate deficiency* - This typically causes **macrocytic anemia** with **megaloblastic red cell morphology**, which contradicts the given normocytic finding [2]. - While it can lead to anemia and fatigue, the **reticulocyte index would be low**, indicating impaired red blood cell production, not increased destruction. *Sideroblastic anemia* - This anemia is usually **microcytic or dimorphic** and can be normocytic, but it is characterized by **ring sideroblasts** in the bone marrow, reflecting impaired heme synthesis. - The **reticulocyte production index is typically low or inappropriately normal**, as the primary issue is ineffective erythropoiesis rather than rapid peripheral destruction. *Iron deficiency anemia* - This is classically a **microcytic, hypochromic anemia**, meaning red blood cells are smaller and paler than normal [3]. - The **reticulocyte production index would be low or normal**, as the bone marrow's ability to produce new red blood cells is limited by the lack of iron.

Q: Which of the following are blood values of Iron Deficiency Anaemia ? 1. Serum iron is less than 30 mg/100 mL 2. Total iron binding capacity is less than 400 µg/mL 3. Percentage saturation is 10% or less 4. Serum ferritin is below 30 µg/mL Select the correct answer using the code given below :

1, 3 and 4. ***1, 3 and 4*** - In **iron deficiency anemia**, **serum iron** levels are typically **less than 30 µg/dL** [1] (or 30 mg/100 mL), indicating a reduced iron supply. - The **percentage saturation** of transferrin with iron falls to **10% or less** [1] because there is insufficient iron to bind to the available transferrin. - **Serum ferritin**, which reflects iron stores, is significantly **reduced, usually below 30 ng/mL** (or 30 µg/mL) [1]. *1, 2 and 4* - While options 1 and 4 are correct, option 2 stating **total iron binding capacity (TIBC) less than 400 µg/mL** is incorrect. - In iron deficiency, the body attempts to increase iron absorption by producing more transferrin, leading to an **elevated TIBC** [1] (often >400 µg/dL). *1, 2 and 3* - Although options 1 and 3 are correct for iron deficiency anemia, option 2, which states **TIBC is less than 400 µg/mL**, is false. - **TIBC is elevated** in iron deficiency, reflecting an increased capacity for iron binding due to increased transferrin. *2, 3 and 4* - While options 3 and 4 are correct, option 2, suggesting **TIBC is less than 400 µg/mL**, is inaccurate. - **TIBC** is typically **increased** in iron deficiency anemia as the body tries to maximize any available iron.

Q: Which of the following statements are correct regarding iron deficiency? 1. More common in older age group 2. More common in females of reproductive age 3. Associated with heavy menstrual bleeding 4. Commonly caused by chronic blood loss Select the correct answer using the code given below.

1, 2 and 4. ***1, 2 and 4*** * **Iron deficiency** is indeed more common in **older age groups**, often due to decreased dietary intake, malabsorption, or chronic diseases [1], [3]. * It is also frequently observed in **females of reproductive age**, primarily due to physiological iron loss through menstruation [2]. * **Chronic blood loss** from various sources, such as gastrointestinal bleeding [1] or heavy menstruation [2], is a very common cause of iron deficiency [3]. *1, 2 and 3* * While iron deficiency is common in older age groups and females of reproductive age, the statement that it is *only* associated with heavy menstrual bleeding isn't comprehensive enough, as chronic blood loss is a broader and more common cause [1]. * Though heavy menstrual bleeding is a significant cause of iron deficiency in women, this option omits chronic blood loss as a more general and equally important cause. *2, 3 and 4* * This option incorrectly implies that iron deficiency is *not* more common in older age groups, which is a known demographic at risk [3]. * While **heavy menstrual bleeding** and **chronic blood loss** are major causes, excluding the increased prevalence in older populations makes this option incomplete. *1, 3 and 4* * This option inaccurately suggests that iron deficiency is *not* more common in females of reproductive age, which is a key demographic for iron deficiency due to menstrual blood loss [2]. * It correctly identifies chronic blood loss and heavy menstrual bleeding as causes but misses a significant demographic for prevalence.

Q: Which of the following statements are correct in respect of haemophilia? 1. It is hereditary bleeding disorder. 2. It has a higher incidence among Asians. 3. It affects females occasionally and mildly.

1 and 3 only. ***1 and 3 only*** - Haemophilia is a well-known **hereditary bleeding disorder**, primarily affecting males, caused by a deficiency in certain clotting factors [1]. - While haemophilia mainly affects males, females can be carriers and, in rare instances, experience mild to moderate symptoms, especially due to **extreme X-inactivation**. *2 and 3 only* - The statement that it has a higher incidence among Asians is **incorrect**; haemophilia incidence is generally consistent across ethnic groups, approximately 1 in 5,000 live male births worldwide [2]. - While females can be affected, their involvement is typically mild and occasional, making statement 3 correct. *1 and 2 only* - Haemophilia is indeed a **hereditary bleeding disorder** (statement 1 is correct) [1]. - However, the claim of higher incidence among Asians is **unsupported** by epidemiological data, rendering statement 2 incorrect. *1, 2 and 3* - While haemophilia is a **hereditary bleeding disorder** and can affect females, the assertion of a higher incidence among Asians is **false** [2]. - Its global incidence rates do not show a significant racial or ethnic predilection.

Q: The following are the common features of Idiopathic Thrombocytopenic Purpura except

Massive splenomegaly. ***Massive splenomegaly*** - Idiopathic Thrombocytopenic Purpura (ITP) typically involves only **mild to moderate splenomegaly**, if any, due to increased platelet destruction in the spleen [1]. **Massive splenomegaly** is not a characteristic feature. - **Massive splenomegaly** would suggest other conditions like chronic myeloid leukemia, myelofibrosis, or certain infectious diseases. *Cutaneous ecchymoses* - **Ecchymoses (bruising)** are a common symptom of ITP due to the low platelet count, leading to easier bleeding under the skin [2]. - These present as larger, purplish patches on the skin, indicating extravasated blood. *Thrombocytopenia* - **Thrombocytopenia** (low platelet count) is the hallmark and diagnostic criterion for ITP [1]. - The reduced number of platelets impairs the body's ability to form clots, leading to bleeding manifestations [2]. *Epistaxis* - **Epistaxis (nosebleeds)** is a common mucocutaneous bleeding symptom in ITP, reflecting the impaired primary hemostasis due to low platelet count [2]. - Bleeding from mucosal surfaces is typical in platelet disorders [2].

Question 1

Which of the following treatments are recommended for a pregnant woman suffering from sickle cell disease ?
I. Folic acid 1 mg daily
II. Azathioprine
III. Penicillin prophylaxis
IV. Thromboprophylaxis with low molecular weight heparin
Select the correct answer using the code given below :

Accepted Answer

I, III and IV

Answer

I, II and IV

Answer

I, II and III

Answer

II, III and IV

Question 2

Which of the following are secondary iron overload conditions?
I. Transfusion related iron load
II. Thalassemia
III. Hepatitis C associated liver disease

Select the correct answer using the code given below :

Accepted Answer

I, II and III

Answer

I and II only

Answer

I and III only

Answer

II and III only

Question 3

With regard to management of idiopathic thrombocytopenic purpura, consider the following statements :
I. All patients with ITP with platelet count less than 100 x 10^9 / L should receive high dose of glucocorticoids
II. For patient with spontaneous bleeding, 40 mg of dexamethasone daily is indicated for 4 days
III. Intravenous immunoglobulin can raise the platelet count
IV. Life threatening bleeding should be treated with platelet transfusion

Which of the statements given above are correct?

Accepted Answer

II, III and IV

Answer

I, II and IV

Answer

I, II and III

Answer

I, III and IV

Question 4

First line therapy in chronic phase of chronic myeloid leukemia is

Accepted Answer

Imatinib

Answer

Thalidomide

Answer

Rituximab

Answer

Chlorambucil

Question 5

Which one of the following causes low-volume erythrocytosis?

Accepted Answer

Gaisbock's syndrome

Answer

High altitude

Answer

Polycythemia Rubra Vera

Answer

Exogenous testosterone therapy

Question 6

A 35 year female presents with easy fatigability. Investigations show that Hb is 6 g %; Red cell morphology is normocytic normochromic; and reticulocyte production index is 5.5 . Which one of the following conditions favours this abnormality?

Accepted Answer

Intravascular hemolysis

Answer

Folate deficiency

Answer

Sideroblastic anemia

Answer

Iron deficiency anemia

Question 7

Which of the following are blood values of Iron Deficiency Anaemia ?

1. Serum iron is less than 30 mg/100 mL
2. Total iron binding capacity is less than 400 µg/mL
3. Percentage saturation is 10% or less
4. Serum ferritin is below 30 µg/mL

Select the correct answer using the code given below :

Accepted Answer

1, 3 and 4

Answer

1, 2 and 4

Answer

1, 2 and 3

Answer

2, 3 and 4

Question 8

Which of the following statements are correct regarding iron deficiency?

1. More common in older age group
2. More common in females of reproductive age
3. Associated with heavy menstrual bleeding
4. Commonly caused by chronic blood loss

Select the correct answer using the code given below.

Accepted Answer

1, 2 and 4

Answer

1, 2 and 3

Answer

2, 3 and 4

Answer

1, 3 and 4

Question 9

Which of the following statements are correct in respect of haemophilia?

1. It is hereditary bleeding disorder.
2. It has a higher incidence among Asians.
3. It affects females occasionally and mildly.

Accepted Answer

1 and 3 only

Answer

2 and 3 only

Answer

1 and 2 only

Answer

1, 2 and 3

Question 10

The following are the common features of Idiopathic Thrombocytopenic Purpura except

Accepted Answer

Massive splenomegaly

Answer

Cutaneous ecchymoses

Answer

Thrombocytopenia

Answer

Epistaxis

Hematology — MCQs

Hematology — MCQs

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