Hematology Practice Questions

Q: Treatment of chronic phase of CML in pregnant women is -

Interferon therapy. ***Interferon therapy*** - **Interferon-alpha** is the preferred treatment for chronic phase **CML** in pregnant women because it is not associated with teratogenic effects. - It works by modulating the **immune system** and inhibiting cell proliferation [1]. *Imatinib* - **Imatinib** is a **tyrosine kinase inhibitor (TKI)** that is highly effective for CML [1], [2]. - However, TKIs are generally **contraindicated in pregnancy** due to potential **teratogenic effects** on the developing fetus. *Leukapheresis* - **Leukapheresis** is a procedure used to reduce the **white blood cell count** significantly and rapidly, often in cases of **hyperleukocytosis**. - It is a supportive measure for managing very high cell counts but not a definitive long-term treatment for CML itself, especially in the chronic phase. *Spleenectomy* - **Spleenectomy** may be considered in CML for specific complications such as massive **splenomegaly**, **splenic infarction**, or severe **thrombocytopenia** secondary to splenic sequestration. - It is not a primary first-line treatment for chronic phase CML, particularly in pregnant women, as it doesn't target the underlying **Philadelphia chromosome abnormality**.

Q: What is the percentage of patients with multiple myeloma that exhibit vertebral involvement?

88% of patients. ***66%*** - Approximately **66% of patients** with multiple myeloma exhibit some degree of **vertebral involvement**, primarily due to osteolytic lesions. - These lesions lead to **vertebral compression fractures** and pain, making vertebrae a common site of affection in this condition [1]. *22%* - This figure is significantly lower than the established data indicating **higher vertebral involvement** in multiple myeloma patients. - Such a low percentage does not reflect the **typical clinical realities** associated with this disease. *88%* - While vertebral involvement is common, **88%** is an overestimation and not supported by clinical evidence. - The risk of **spinal lesions** generally peaks around **66%**, indicating a lower frequency than suggested here. *44%* - This percentage underrepresents the true prevalence of vertebral involvement in multiple myeloma, which is higher. - Clinical findings consistently show that most patients demonstrate at least **some level of vertebral affection**.

Q: Multiple episodes of acute chest syndrome are associated with which of the following conditions?

Sickle Cell Disease. ***Sickle Cell Disease*** - **Acute chest syndrome** is a leading cause of morbidity and mortality in patients with **sickle cell disease (SCD)**. - It involves new pulmonary infiltrates with fever, chest pain, or respiratory symptoms, often triggered by fat embolism, infection, or vaso-occlusion. *SLE* - While **Systemic Lupus Erythematosus (SLE)** can affect the lungs (e.g., **lupus pneumonitis**, **pulmonary hemorrhage**), it does not typically manifest as recurrent "acute chest syndrome" in the same distinct pattern as SCD [1]. - Lung involvement in SLE is usually due to inflammation or vasculitis, not vaso-occlusive crises [1]. *Sjogren's syndrome* - **Sjogren's syndrome** is primarily an autoimmune disease affecting exocrine glands, leading to dry eyes and mouth. - Pulmonary involvement in Sjogren's, such as **interstitial lung disease** or **bronchiolitis**, is less common and differs from acute chest syndrome. *Bronchiectasis* - **Bronchiectasis** is characterized by permanent dilation and damage to the airways, leading to chronic cough and recurrent infections. - While it involves recurrent lung problems, its pathology and clinical presentation are distinct from the acute, crisis-driven nature of acute chest syndrome.

Q: Which of the following is the MOST characteristic feature of Hemolytic Uremic Syndrome (HUS)?

Microangiopathic hemolytic anemia. ### a and c - Hemolytic Uremic Syndrome (HUS) is characterized by **microangiopathic hemolytic anemia** along with **thrombocytopenia**, making this correct [1][2]. - It typically results from an **infection**, often associated with **E. coli**, particularly in children [2]. *Positive Coomb's test* - A positive Coomb's test suggests **autoimmune hemolytic anemia**, not HUS. - HUS generally presents with **negative Coomb's test**, indicating hemolysis mechanism is different from autoimmune causes. *Microangiopathic haemolytic anaemia* - While HUS does involve **microangiopathic hemolytic anemia** [2], this alone does not encompass all its characteristics necessary for diagnosis. - HUS must also include **thrombocytopenia**, which is not mentioned in this option [1]. *Thrombocytopenia* - Thrombocytopenia is indeed a feature of HUS, but presenting it alone lacks the context of the complete syndrome [1]. - HUS must also show **microangiopathic hemolytic anemia** to align with the complete clinical picture [2], which is missing here.

Q: All of the following statements about Burkitt's lymphoma are true, Except:

Radiotherapy is the treatment of choice. ***Radiotherapy is the treatment of choice*** - Treatment for **Burkitt's lymphoma** primarily involves **chemotherapy**, not radiotherapy, due to the aggressive nature of the disease. - While radiotherapy may be used in some cases, it is **not a standard treatment** for this highly aggressive B-cell lymphoma [1]. *Can present as an abdominal mass* - Burkitt's lymphoma can indeed present as an **abdominal mass**, especially in pediatric cases involving the **ileocecal region**. - The **extranodal** involvement is common, contributing to the mass effect in the abdomen [1]. *B cell lymphoma* - Burkitt's lymphoma is classified as a **B-cell lymphoma** arising from the germinal center of B cells [1]. - It is characterized by high proliferation rates and mutations in B cell-related genes, confirming it as a B-cell malignancy [1]. *8, 14 translocation* - A hallmark of Burkitt's lymphoma is the **translocation of the MYC gene** on chromosome 8 and chromosome 14, leading to abnormal cell proliferation. - This genetic alteration is fundamental in the cancer's pathogenesis and is a criterion for diagnosis.

Q: In which of the following conditions is Bendamustine most commonly used for treatment?

Non-Hodgkin lymphoma (NHL). ***Non-Hodgkin lymphoma (NHL)*** - **Bendamustine** is an **alkylating agent** frequently used in the treatment of various subtypes of **Non-Hodgkin lymphoma (NHL)**, particularly in relapsed or refractory settings, or as first-line therapy [1]. - It is known for its efficacy with a relatively manageable toxicity profile compared to other alkylating agents in NHL [1]. *Colon carcinoma* - **Bendamustine** is **not a standard treatment** for **colon carcinoma**. - Treatment regimens for colon carcinoma commonly involve agents like **5-fluorouracil**, **oxaliplatin**, and **irinotecan**. *Breast carcinoma* - **Bendamustine** is **not a primary chemotherapy agent** for **breast carcinoma**. - Standard chemotherapy for breast cancer often includes **anthracyclines**, **taxanes**, and **cyclophosphamide**. *Chronic lymphocytic leukemia (CLL)* - While **Bendamustine** is also approved and used for **Chronic lymphocytic leukemia (CLL)**, especially in combination with rituximab, it is arguably **most commonly associated with NHL** due to its broader application across various NHL subtypes and different lines of therapy [1]. - For CLL, it is an important option, but its use in NHL is generally more encompassing [1].

Q: The most common organ to be involved in the acute phase of Graft vs host disease is?

Skin. ***Skin*** - The **skin** is the **most frequently affected organ** in acute graft-versus-host disease (GVHD), with nearly all patients exhibiting some dermatologic manifestations. - Initial symptoms often include a **maculopapular rash** that can progress to erythroderma or bullous lesions. *Bone marrow* - While the bone marrow is the site of the **allogeneic stem cell transplant**, it is not typically considered an **acute target organ** for GVHD symptoms in the same way as the skin, gut, or liver. - Although the donor immune cells originate here, the manifestations of GVHD primarily affect other host tissues. *Liver* - The **liver** is a common organ involved in acute GVHD, often presenting with **elevated bilirubin** and alkaline phosphatase levels. - However, **liver involvement is less common** than skin involvement and typically occurs alongside or after skin manifestations. *Gut* - The **gastrointestinal tract** (gut) is frequently affected in acute GVHD, leading to symptoms like **diarrhea, nausea, vomiting**, and abdominal pain. - Similar to liver involvement, gut involvement is common but **occurs less frequently than skin involvement** as the primary acute manifestation.

Q: Hypercoagulability due to a defective factor V gene is known as which of the following?

Leiden mutation. ***Leiden mutation*** - The **factor V Leiden mutation** leads to a hypercoagulable state by causing resistance to activated protein C, increasing the risk of venous thrombosis [1]. - It is the most common inherited cause of venous thromboembolism and directly associates with the defective factor V gene [1]. *Antiphospholipid syndrome* - This syndrome is characterized by the presence of **antiphospholipid antibodies** leading to recurrent thrombosis but is not directly related to the factor V gene. - It often presents with symptoms such as **venous and arterial thrombosis**, but its mechanism differs from that of factor V Leiden [2]. *Inducible thrombocytopenia syndrome* - This condition involves **thrombocytopenia** (low platelet count) often due to medication, which is unrelated to the hypercoagulable state from factor V mutation. - It does not involve the **factor V gene** nor lead to an increased risk of clotting as seen in the Leiden mutation. *Lisbon mutation* - The Lisbon mutation is a rare variant of factor V but is not the primary mutation associated with the hypercoagulable state in most cases. - It does not have the same wide clinical implications or prevalence as the **factor V Leiden mutation**.

Q: Sickle cell anemia leads to resistance towards?

Plasmodium falciparum. ***Plasmodium falciparum*** - Individuals with sickle cell trait or disease have **red blood cells** that are less hospitable to the growth and reproduction of **_Plasmodium falciparum_**, the most dangerous malaria parasite [1]. - The abnormal hemoglobin (HbS) reduces parasite growth, and infected sickle cells are prematurely destroyed, limiting parasite burden [1]. *Plasmodium malariae* - While all malaria parasites infect red blood cells, the selective pressure from **sickle cell anemia** is primarily against **_Plasmodium falciparum_**, not _P. malariae_ [2]. - There is no significant evidence of increased resistance to **_P. malariae_** in individuals with sickle cell disease. *Plasmodium vivax* - **_Plasmodium vivax_** preferentially invades **reticulocytes** (immature red blood cells), and its life cycle is not significantly altered by the presence of **hemoglobin S** in mature red blood cells [2]. - Resistance to _P. vivax_ is more commonly associated with the absence of the **Duffy antigen**, not sickle cell anemia. *Plasmodium ovale* - Like _P. vivax_, **_Plasmodium ovale_** also predominantly infects **reticulocytes** [2]. - There is no strong evidence to suggest that sickle cell anemia confers significant protection against **_P. ovale_** infections.

Q: What is used for exchange blood transfusion?

Whole blood. ***Whole blood*** - Exchange blood transfusion aims to replace a significant volume of the patient's blood with donor blood, making **whole blood** the most appropriate component. - Using whole blood helps to concurrently address **anemia** (due to red blood cells), correct **coagulopathies** (due to plasma and platelets), and remove harmful substances like bilirubin or antibodies. *EPP* - EPP likely refers to **Erythrocyte Progenitor Cells** or another experimental component not routinely used for massive blood replacement. - It does not contain the plasma or platelets necessary for comprehensive exchange transfusion. *Serum* - **Serum** is plasma from which clotting factors have been removed and primarily contains antibodies and other proteins. - It lacks red blood cells and clotting factors, making it unsuitable for an exchange transfusion that requires oxygen-carrying capacity and coagulation support. *Packed cells* - **Packed red blood cells** are primarily used to increase oxygen-carrying capacity and treat anemia. - While they are a component of whole blood, they lack plasma and platelets, which are crucial for maintaining oncotic pressure, replacing clotting factors, and diluting harmful substances during an exchange transfusion.

Question 1

Treatment of chronic phase of CML in pregnant women is -

Accepted Answer

Interferon therapy

Answer

Leukapheresis

Answer

Imatinib

Answer

Spleenectomy

Question 2

What is the percentage of patients with multiple myeloma that exhibit vertebral involvement?

Accepted Answer

88% of patients

Answer

66% of patients

Answer

22% of patients

Answer

44% of patients

Question 3

Multiple episodes of acute chest syndrome are associated with which of the following conditions?

Accepted Answer

Sickle Cell Disease

Answer

SLE

Answer

Sjogren's syndrome

Answer

Bronchiectasis

Question 4

Which of the following is the MOST characteristic feature of Hemolytic Uremic Syndrome (HUS)?

Accepted Answer

Microangiopathic hemolytic anemia

Answer

Thrombocytopenia

Answer

Positive Coomb's test

Answer

All of the options

Question 5

All of the following statements about Burkitt's lymphoma are true, Except:

Accepted Answer

Radiotherapy is the treatment of choice

Answer

B cell lymphoma

Answer

8, 14 translocation

Answer

Intensive chemotherapy is the treatment of choice

Question 6

In which of the following conditions is Bendamustine most commonly used for treatment?

Accepted Answer

Non-Hodgkin lymphoma (NHL)

Answer

Colon carcinoma

Answer

Breast carcinoma

Answer

Chronic lymphocytic leukemia (CLL)

Question 7

The most common organ to be involved in the acute phase of Graft vs host disease is?

Accepted Answer

Skin

Answer

Bone marrow

Answer

Liver

Answer

Gut

Question 8

Hypercoagulability due to a defective factor V gene is known as which of the following?

Accepted Answer

Leiden mutation

Answer

Antiphospholipid syndrome

Answer

Prothrombin G20210A mutation

Answer

Protein C deficiency

Question 9

Sickle cell anemia leads to resistance towards?

Accepted Answer

Plasmodium falciparum

Answer

Plasmodium malariae

Answer

Plasmodium vivax

Answer

Plasmodium ovale

Question 10

What is used for exchange blood transfusion?

Accepted Answer

Whole blood

Answer

EPP

Answer

Serum

Answer

Packed cells

Hematology — MCQs

Hematology — MCQs

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