Hematology Practice Questions

Q: Hand-foot syndrome is seen in ?

Sickle cell disease. Hand-foot syndrome is seen in ? ***Sickle cell disease*** - **Hand-foot syndrome (dactylitis)** is an early manifestation of sickle cell disease, particularly in infants and young children [2]. - It results from **vaso-occlusion** in the small blood vessels of the hands and feet, leading to painful swelling [3]. *Raynaud's phenomenon* - Characterized by episodes of **vasospasm** in the fingers and toes, causing color changes (white, blue, red) due to cold exposure or stress. - It does not involve the continuous, painful swelling seen in dactylitis. *Thalassemia* - A group of **inherited blood disorders** characterized by abnormal hemoglobin production, leading to anemia [3]. - While it can cause various bone changes due to marrow expansion, hand-foot syndrome (dactylitis) is not a typical presentation. *Frostbite* - This is an injury caused by tissue freezing due to prolonged exposure to **extremely cold temperatures** [1]. - It can lead to numbness, blistering, and tissue damage, but it is distinct from the vaso-occlusive crisis of hand-foot syndrome [1].

Q: One unit of fresh blood rises the Hb% concentration by:

1 gm%. **_1 gm%_** - Each unit of **packed red blood cells (PRBCs)** is expected to increase the recipient's hemoglobin by approximately **1 g/dL** (or 1 gm%). - This is a general guideline used in clinical practice for estimating the effectiveness of **blood transfusions**. _2.2 gm%_ - A rise of **2.2 gm%** is significantly higher than the expected increase from a single unit of PRBCs. - Such a substantial increase might suggest multiple units transfused or an unusual patient response. _0.1 gm%_ - A rise of only **0.1 gm%** is too low and would generally indicate either no significant effect from the transfusion or a rapid loss of the transfused blood. - This small increase is not consistent with the expected therapeutic effect of a **single unit of PRBCs**. _2gm%_ - While a **2 gm%** rise could be seen after two units of PRBCs, it is not the expected increase for a **single unit**. - The standard expectation for a single unit of PRBCs is approximately **1 gm%** increase in hemoglobin.

Q: Indications for FFP include

All of the options. ***All of the options*** - **Fresh frozen plasma (FFP)** is a versatile blood product with several key indications, including supplying deficient plasma proteins, rapidly reversing warfarin effects, and treating thrombotic thrombocytopenic purpura (TTP). [1] - Its broad utility stems from its content of **all coagulation factors**, naturally occurring anticoagulants, and plasma proteins. *Supplying deficient plasma proteins* - FFP is a good source of various **plasma proteins**, which can be deficient in certain conditions, though specific protein concentrates are often preferred if available. [1] - This use is considered when there are specific protein deficiencies leading to clinical symptoms, where replacement is necessary. *Rapid reversal of (effects of) warfarin* - FFP contains **all vitamin K-dependent coagulation factors** (II, VII, IX, X) that are inhibited by warfarin, making it effective for rapid reversal, especially in cases of active bleeding or urgent surgery. - However, **4-factor prothrombin complex concentrates (PCCs)** are often preferred for more rapid and concentrated factor replacement in this scenario due to their lower volume and faster administration. *Treatment of TTP* - **Thrombotic thrombocytopenic purpura (TTP)** is characterized by a deficiency of **ADAMTS13**, an enzyme that cleaves von Willebrand factor (vWF). FFP replacement provides this deficient enzyme. - **Plasma exchange**, which involves removing the patient's plasma and replacing it with FFP, is the cornerstone of TTP treatment.

Q: An asymptomatic patient on regular health checkup has platelet counts of 8,00,000/cu.mm. Next line of management is:

Follow up and observe. ***Follow up and observe*** - This patient is **asymptomatic** despite a high platelet count (800,000/cu.mm), suggesting that the thrombocytosis may be **benign** or a **transient phenomenon**. - In an asymptomatic patient with isolated thrombocytosis, it is crucial to **repeat the complete blood count (CBC)** to rule out laboratory error or a temporary reactive process before proceeding with invasive or extensive investigations. *Phlebotomy* - **Phlebotomy** is primarily used to reduce red cell mass in conditions like **polycythemia vera**, not typically for high platelet counts. - While it can be considered in specific cases of **thrombocytosis with erythrocytosis**, it is not the initial management for isolated asymptomatic thrombocytosis. *Plasmapheresis* - **Plasmapheresis** involves removing plasma and is indicated for conditions like thrombotic thrombocytopenic purpura (TTP) or some autoimmune diseases [2]. - It is **not used to manage isolated thrombocytosis**, as it does not directly affect platelet production or removal in a sustained manner. *Bone marrow biopsy* - A **bone marrow biopsy** is an invasive procedure generally reserved for investigating suspected **myeloproliferative neoplasms (MPN)** or other hematological malignancies [1]. - In an **asymptomatic patient** with an initial high platelet count, it is premature and not the first line of management without prior re-evaluation of the platelet count and exclusion of reactive causes [1].

Q: All are predisposing factors of Deep Vein thrombosis, EXCEPT :

Subungual melanoma. ***Subungual melanoma*** - This is a rare form of melanoma that develops under the nail, and while serious, it is **not a recognized predisposing factor for deep vein thrombosis (DVT)**. Its primary concerns are local invasion and metastasis. - Unlike conditions affecting blood clotting or endothelium, **subungual melanoma does not directly promote hypercoagulability, venous stasis, or endothelial damage** that contribute to DVT. *Lower limb trauma* - **Trauma to the lower limb** can cause **endothelial damage** to blood vessels and **venous stasis** due to immobility or swelling, both key components of **Virchow's triad** for DVT [1]. - **Fractures or severe soft tissue injuries** often necessitate immobilization and can lead to inflammation, further increasing the risk of clot formation [1]. *Cushing's syndrome* - **Cushing's syndrome** is associated with **hypercoagulability** due to increased levels of clotting factors, such as **factor VIII** and **fibrinogen**, and decreased fibrinolytic activity. - The **elevated cortisol levels** seen in Cushing's syndrome [2] can directly contribute to a prothrombotic state, significantly increasing DVT risk. *Hip surgery* - **Major orthopedic surgeries**, especially hip surgery [1], are well-known to cause significant **venous stasis** and **endothelial damage**. - **Post-operative immobility** and a generalized **inflammatory response** following surgery contribute to a high risk of DVT formation [1].

Q: Which of the following is most Likely to be fatal?

Multiple myeloma. No changes made because no provided references reached the relevance threshold of 7. The provided text fragments discuss coagulation factor deficiency (Waldenström macroglobulinemia), physiology of taste, and Lambert-Eaton Myasthenic Syndrome, which do not directly support the clinical descriptions of Multiple Myeloma, Osteochondroma, Paget's disease, or Giant Cell Tumour as presented in the explanation.

Q: Most common cause of iron deficiency in elderly

Gastric bleeding/ hemorrhage. ***Gastric bleeding/ hemorrhage*** - In elderly patients, **chronic blood loss** from the gastrointestinal (GI) tract due to conditions like **peptic ulcers**, **gastritis**, or **GI malignancies** is the most common cause of iron deficiency [1], [3]. - This **slow, insidious blood loss** often goes unnoticed until significant iron stores are depleted, leading to anemia [1]. *Decreased absorption of iron* - While iron absorption can be reduced in the elderly due to conditions like **atrophic gastritis** or certain medications, it is less common than blood loss as a primary cause in symptomatic iron deficiency [1]. - Impaired absorption usually contributes to iron deficiency but is rarely the **sole and most significant cause** compared to chronic GI bleeding. *Achlorhydria* - **Achlorhydria**, or reduced gastric acid production, can impair the conversion of ferric iron (Fe3+) toferrous iron (Fe2+), which is more readily absorbed. - This condition is common in the elderly and can contribute to iron malabsorption but is generally not the **leading cause of significant iron deficiency** in this population without underlying blood loss [3]. *Nutritional deficiency* - While elderly individuals may have **poor dietary intake** and therefore decreased iron intake, it is typically less common than chronic blood loss as the primary cause of iron deficiency in resource-rich settings [2]. - Significant iron deficiency due solely to diet usually requires extremely **restricted diets** or severe malnutrition, which is not the most prevalent reason in general elderly populations presenting with iron deficiency.

Q: A 16-year-old adolescent boy with a history of severe hemophilia A is undergoing an elective inguinal hernia repair. Which of the following is the best option for preventing or treating a bleeding complication in the setting of this disease?

Combination of ε-aminocaproic acid and desmopressin. ***Combination of ε-aminocaproic acid and desmopressin*** - For **mild hemophilia A**, **desmopressin** can aid in increasing factor VIII levels temporarily [1]. **ε-aminocaproic acid (EACA)** is an **antifibrinolytic agent** which is useful for mucosal bleeding conditions or as an adjunct during dental procedures or minor surgeries to prevent clot breakdown. - While desmopressin alone may not fully prevent surgical bleeding in hemophilia A, the addition of EACA helps stabilize the clot, reducing the risk of bleeding for minor surgical procedures like inguinal hernia repair [1]. *Combination of desmopressin and fresh-frozen plasma* - **Desmopressin** is useful for **mild hemophilia A** as it releases stored factor VIII [1]. **Fresh-frozen plasma (FFP)** provides all clotting factors. - Using FFP carries a higher risk of **volume overload** and **transfusion-related acute lung injury (TRALI)** compared to factor concentrates or desmopressin alone. *Factor IX concentrate* - **Factor IX concentrate** is used to treat **hemophilia B**, which is a deficiency in factor IX, not factor VIII. - Administering factor IX concentrate to a patient with hemophilia A would not correct their coagulation defect or prevent bleeding [1]. *Fresh-frozen plasma* - While **fresh-frozen plasma (FFP)** contains factor VIII, it is in **non-concentrated amounts**, making it less effective for severe hemophilia A. - FFP also carries a risk of transfusion reactions and **volume overload**, especially when large quantities are needed.

Q: International prognostic index for lymphomas includes the following prognostic factors, EXCEPT:

Hemoglobin and albumin. ***Hemoglobin and albumin*** - While hemoglobin and albumin can be indicators of overall health and nutritional status, they are **not part of the standard International Prognostic Index (IPI)** for lymphomas. - The IPI specifically focuses on factors directly related to tumor burden and patient vitality, not general systemic markers like these. *LDH* - **Lactate dehydrogenase (LDH)** is a crucial component of the IPI, reflecting tumor burden and aggressiveness [1]. - Elevated LDH levels indicate a higher risk and are associated with a poorer prognosis [1]. *Number of extralymphatic sites involved* - The **number of extralymphatic sites involved** is a key prognostic factor in the IPI. - Involvement of more than one extralymphatic site indicates more widespread disease and a worse prognosis. *Stage of disease* - The **stage of disease**, as defined by the Ann Arbor staging system, is an essential element of the IPI [1]. - Advanced stages (III or IV) are associated with a poorer prognosis compared to early stages [1].

Q: Which of the following types of leukemia is administered prophylactic methotrexate for CNS prophylaxis –

ALL. ***ALL*** - **Acute Lymphoblastic Leukemia (ALL)** has a high propensity for **central nervous system (CNS) involvement**, necessitating prophylactic intrathecal methotrexate to prevent CNS relapse [1]. - Prophylactic treatment of the CNS is a standard component of ALL treatment protocols due to the risk of leukemic cell infiltration into the brain and spinal cord [1]. *AML* - **Acute Myeloid Leukemia (AML)** has a lower incidence of CNS involvement compared to ALL, so prophylactic CNS treatment is generally not routine unless specific risk factors are present. - While CNS involvement can occur in AML, it is more commonly treated with systemic chemotherapy that has CNS penetration or intrathecal treatment only when CNS disease is confirmed. *CLL* - **Chronic Lymphocytic Leukemia (CLL)** rarely involves the CNS, and prophylactic CNS treatment is not part of standard management. - When CNS involvement does occur in CLL, it is an aggressive, late-stage complication and typically requires specific, targeted therapy rather than prophylaxis. *CML* - **Chronic Myeloid Leukemia (CML)** has an extremely low risk of CNS involvement, especially in the chronic phase, and therefore, prophylactic CNS treatment is not administered. - CNS involvement in CML is usually seen during a blast crisis and is rare, making prophylaxis unnecessary.

Question 1

Hand-foot syndrome is seen in ?

Accepted Answer

Sickle cell disease

Answer

Raynaud's phenomenon

Answer

Thalassemia

Answer

Frost bite

Question 2

One unit of fresh blood rises the Hb% concentration by:

Accepted Answer

1 gm%

Answer

2.2 gm%

Answer

0.1 gm%

Answer

2gm%

Question 3

Indications for FFP include

Accepted Answer

All of the options

Answer

Supplying deficient plasma proteins

Answer

Rapid reversal of (effects of) warfarin

Answer

Treatment of TTP

Question 4

An asymptomatic patient on regular health checkup has platelet counts of 8,00,000/cu.mm. Next line of management is:

Accepted Answer

Follow up and observe

Answer

Phlebotomy

Answer

Plasmapheresis

Answer

Bone marrow biopsy

Question 5

All are predisposing factors of Deep Vein thrombosis, EXCEPT :

Accepted Answer

Subungual melanoma

Answer

Lower limb trauma

Answer

Cushing's syndrome

Answer

Hip surgery

Question 6

Which of the following is most Likely to be fatal?

Accepted Answer

Multiple myeloma

Answer

Osteochondroma

Answer

Paget's disease

Answer

Giant cell tumour

Question 7

Most common cause of iron deficiency in elderly

Accepted Answer

Gastric bleeding/ hemorrhage

Answer

Decreased absorption of iron

Answer

Achlorhydria

Answer

Nutritional deficiency

Question 8

A 16-year-old adolescent boy with a history of severe hemophilia A is undergoing an elective inguinal hernia repair. Which of the following is the best option for preventing or treating a bleeding complication in the setting of this disease?

Accepted Answer

Combination of ε-aminocaproic acid and desmopressin

Answer

Combination of desmopressin and fresh-frozen plasma

Answer

Factor IX concentrate

Answer

Fresh-frozen plasma

Question 9

International prognostic index for lymphomas includes the following prognostic factors, EXCEPT:

Accepted Answer

Hemoglobin and albumin

Answer

LDH

Answer

Number of extralymphatic sites involved

Answer

Stage of disease

Question 10

Which of the following types of leukemia is administered prophylactic methotrexate for CNS prophylaxis –

Accepted Answer

ALL

Answer

AML

Answer

CLL

Answer

CML

Hematology — MCQs

Hematology — MCQs

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