Hematology Practice Questions

Q: Mentzer index more than 13 suggests a diagnosis of

Iron deficiency anemia. ***Iron deficiency anemia*** - A Mentzer index of **greater than 13** (calculated as MCV/RBC count) is highly suggestive of **iron deficiency anemia**. [1] - This index helps differentiate iron deficiency from thalassemia trait in microcytic anemias, as **MCV is disproportionately low** compared to RBC count in IDA. *Thalassemia* - Thalassemia typically presents with a **Mentzer index less than 13**, meaning the MCV reduction is proportional to or less severe than the RBC count reduction. - This condition is characterized by **reduced alpha or beta globin chain synthesis**, leading to microcytic hypochromic red blood cells but often with an elevated RBC count. *Hereditary Spherocytosis* - Hereditary spherocytosis is a **normocytic or macrocytic anemia**, not typically microcytic, making the Mentzer index less relevant for its diagnosis. - It is characterized by **spherocytes** on peripheral smear and increased red cell fragility due to membrane defects. *Autoimmune Hemolytic Anemia* - Autoimmune hemolytic anemia is typically a **normocytic to macrocytic anemia** [2] with features of hemolysis, such as elevated LDH and indirect bilirubin. - While it can be severe, it is not primarily characterized by **microcytosis** and therefore the Mentzer index is not a diagnostic tool for this condition.

Q: Which of the following statements about Hematochromatosis is true?

Hypogonadism may be seen. *Hypogonadism may be seen* - **Iron deposition** in the **pituitary gland** and **gonads** can lead to hormonal dysfunction, manifesting as **hypogonadism**. [1] - This symptom is common in **hemochromatosis** due to the systemic effects of iron overload. *Arthropathy is not a hallmark feature* - **Arthropathy** is a **hallmark feature** of hemochromatosis, often presenting as chronic pain in the **second and third metacarpophalangeal joints**. - It is caused by **iron deposition** in the joints, leading to inflammation and damage. *Desferrioxamine is treatment of choice* - While **desferrioxamine** is an iron chelating agent, the **treatment of choice** for hereditary hemochromatosis is generally **phlebotomy**, which is more effective at removing excess iron. [2] - Chelating agents like desferrioxamine are typically reserved for patients who cannot undergo phlebotomy, such as those with **anemia** or **cardiac disease**. *Diabetes Mellitus is rare in Hematochromatosis* - **Diabetes mellitus**, often referred to as "**bronze diabetes**" due to associated skin pigmentation, is a **common complication** of hemochromatosis. [1] - It results from **iron deposition** in the **pancreas**, leading to damage of **beta-islet cells** and impaired insulin production.

Q: Which of the following is LEAST likely to increase the risk of developing deep vein thrombosis (DVT)?

Age less than 40. ### Age less than 40 - Younger age is considered a **protective factor** against DVT, as the risk generally increases with age due to accumulated comorbidities and decreased mobility. [1] - While DVT can occur at any age, the incidence is significantly lower in individuals under 40 years old, especially in the absence of other strong risk factors. [3] ### Prolonged immobilization - **Immobilization** significantly reduces blood flow velocity in the lower extremities, leading to **venous stasis**. [2] - This stasis promotes the accumulation of clotting factors and activation of the coagulation cascade, increasing the risk of thrombus formation. ### Obesity - Obesity is a significant risk factor for DVT due to its association with **chronic inflammation**, **endothelial dysfunction**, and a **prothrombotic state**. - Increased abdominal pressure from obesity can also impede venous return, further contributing to venous stasis. ### Extensive pelvic surgery of more than 30 minutes - Surgical procedures, particularly those involving the pelvis and lasting longer than 30 minutes, cause **endothelial injury**, activate the **coagulation system**, and result in **postoperative immobility**. [2] - These factors collectively contribute to Virchow's triad (venous stasis, endothelial injury, hypercoagulability), significantly increasing DVT risk.

Q: Which of the following statements about Fanconi anemia is false?

Type I RTA. ***Type I RTA*** - **Fanconi's anemia** is mainly associated with **proximal renal tubular acidosis (RTA)**, not type I RTA, which specifically affects distal tubule function. - The renal manifestations include **glycosuria**, **aminoaciduria**, and **phosphate wasting**, distinct from the characteristics of type I RTA. *Pancytopenia* - **Pancytopenia** is a common feature of Fanconi's anemia due to **bone marrow failure** resulting in decreased blood cell production. - It manifests as a decrease in **red blood cells**, **white blood cells**, and **platelets** which are critical signs of this condition. *Autosomal recessive* - Fanconi's anemia is classified as an **autosomal recessive disorder**, requiring two copies of the mutated gene for the disease to manifest. - It involves multiple genetic defects that can affect the body's ability to repair DNA. *All are true* - This statement is incorrect as it includes the false assertion regarding **Type I RTA**, which does not apply to Fanconi's anemia. - At least one of the previous options is false, making this statement invalid.

Q: A young patient presents with a large retroperitoneal hemorrhage and a history of intermittent knee swelling after strenuous exercise. There is no history of mucosal bleeding. Which of the following clotting factors is primarily deficient in Hemophilia A?

Factor VIII. ***Factors VIII and IX*** - The symptoms indicate a **hemophilia**, where deficiencies in factors VIII or IX lead to a tendency for **retroperitoneal hemorrhage** and joint swelling, particularly after exercise [1]. - Intermittent swelling of the knees indicates **hemarthrosis**, a common manifestation in hemophilia, supporting the dysfunction of these factors [1]. *Factors XI and XII* - These factors are part of the **intrinsic pathway** but are not primarily associated with **joint bleeding** or sporadic retroperitoneal hemorrhage in young patients. - Deficiencies of these factors typically lead to a milder form of bleeding disorders and not the severe joint symptoms seen here. *Von Willebrand factor* - This factor is crucial for **platelet adhesion** and is associated with **mucosal bleeding**, which is not reported in this patient's history [2]. - The patient's **retroperitoneal hemorrhage** and knee swelling are not characteristic of von Willebrand disease, which typically involves more superficial bleeding [1,2]. *Lupus anticoagulant* - This is an **antiphospholipid antibody** associated with **thrombosis** rather than bleeding, and does not explain the joint swelling or hemorrhagic symptoms. - It leads to a false-positive on coagulation tests and can result in complications like recurrent **thromboembolic events**, rather than bleeding tendencies.

Q: A female patient presented with fatigue and a history of piles. Routine complete blood count analysis showed hemoglobin of 9 g/dL, MCV 60fL, and RBC count of 5.2 million. A peripheral smear is provided. Which of the following is the next best investigation after the smear for this patient?

Serum ferritin levels. ***Serum ferritin levels*** - The **low hemoglobin** and **low MCV (microcytic anemia)** indicate a likely iron deficiency, commonly assessed by serum ferritin levels [1]. - The patient's **history of piles** suggests possible gastrointestinal bleeding, further pointing to the need for iron studies. *Serum folate levels* - Typically evaluated in cases of **macrocytic anemia**, which is not indicated here due to a **low MCV**. - Folate deficiency leads to larger, immature red cells, contrasting the findings of microcytic anemia in this patient. *Serum homocysteine levels* - While elevated levels can indicate **vitamin B12 or folate deficiency**, they are not specific for iron deficiency anemia. - The current presentation does not suggest deficiencies of B12 or folate, making this test less relevant. *HbA2 levels* - Useful in diagnosing **beta-thalassemia**, but not indicated in the context of evident **microcytic anemia** and fatigue without hemolysis or family history [1]. - The patient's profile does not align with thalassemia, thus making this investigation unnecessary. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Blood And Bone Marrow Disease, pp. 590-591.

Q: A 23-year-old male presented with a history of fatigue and tiredness. On investigation, he was found to have Hb values of 9gm%, MCV of 101 FL. Peripheral smear examination showed hypersegmented neutrophils. Which is the most probable etiology?

Vitamin B12 deficiency. ***Lead poisoning*** - Characterized by **microcytic anemia** and the presence of **hypersegmented neutrophils**, often related to **lead-induced interference** with heme synthesis [2]. - It frequently presents with symptoms of **fatigue**, and the laboratory findings align with lead's known hematological effects [1]. *Hemolytic anemia* - Typically features **normocytic or macrocytic RBCs** following destruction of red blood cells rather than microcytic. - Symptoms usually include **jaundice** and **dark urine**, which are absent in this case. *Iron deficiency anemia* - Generally presents with **microcytic hypochromic RBCs** but would not show **hypersegmented neutrophils**. - Associated with external factors like **malnutrition** or chronic blood loss, which were not indicated in this scenario. *Chronic alcoholism* - Commonly leads to **macrocytic anemia** due to folate deficiency, rather than microcytic anemia seen here. - Symptoms usually include **liver dysfunction** signs, which are not mentioned in this case.

Q: Which of the following statements about deep venous thrombosis (DVT) is incorrect?

Mostly bilateral. ***Mostly bilateral*** - DVT is typically **unilateral**, affecting one limb [2]. Bilateral DVT is less common, making this statement incorrect [2]. - The symptoms of **pain, swelling, and tenderness** are usually localized to one leg [1]. *Most common clinically presents as pain and tenderness in calf* - **Calf pain and tenderness** are common clinical presentations of DVT, especially in the lower extremities [1]. - Other common signs include **swelling, warmth, and redness** in the affected leg [1]. *Some cases may directly present as pulmonary thromboembolism* - A significant concern with DVT is that a **clot can dislodge** and travel to the lungs, causing a **pulmonary embolism (PE)**, which can be the initial presentation [1]. - PE is a potentially life-threatening complication and may present with **dyspnea, chest pain, and hemoptysis**. *Clinical assessment highly reliable* - **Clinical assessment alone is not highly reliable** for diagnosing DVT due to its variable and often non-specific presentation [2]. - A definitive diagnosis usually requires objective diagnostic tests such as **compression ultrasonography** or **D-dimer assay** [3].

Q: A 50-year-old man presents with paresthesia. HB-6.8g/dl. Peripheral smear shows macrocytosis and neutrophils with hypersegmented nuclei. Endoscopy reveals atrophic gastritis. What is the most probable diagnosis?

Vitamin B12 deficiency. ***Vitamin B12 deficiency*** - The combination of **paresthesia** (neurological symptoms), **macrocytic anemia** (HB-6.8g/dl and macrocytosis), **hypersegmented neutrophils**, and **atrophic gastritis** is highly characteristic of vitamin B12 deficiency [1]. - **Atrophic gastritis** often leads to impaired intrinsic factor production, which is essential for vitamin B12 absorption [1]. *Riboflavin deficiency* - Riboflavin (B2) deficiency primarily causes **cheilosis**, **angular stomatitis**, **glossitis**, and **seborrheic dermatitis**, not macrocytic anemia or neurological symptoms. - It does not cause hypersegmented neutrophils or atrophic gastritis. *Iron deficiency* - Iron deficiency typically causes **microcytic, hypochromic anemia**, which is characterized by small, pale red blood cells, not macrocytosis or hypersegmented neutrophils. - Neurological symptoms like paresthesia are uncommon, and atrophic gastritis is not a direct consequence. *Folate deficiency* - Folate deficiency can cause **macrocytic anemia** and **hypersegmented neutrophils**, similar to vitamin B12 deficiency [2]. - However, it typically **does not cause neurological symptoms** like paresthesia, which are a hallmark of B12 deficiency, and is not directly linked to atrophic gastritis in the same way B12 deficiency is [2].

Q: In which condition are solitary lytic lesions typically seen?

Multiple myeloma. ***Multiple myeloma*** - **Solitary lytic lesions**, also known as **"punched-out" lesions**, are a classic radiographic finding in multiple myeloma due to **plasma cell proliferation** in the bone [1]. - Patients often have **elevated serum proteins** and show signs of **renal impairment** and anemia, alongside these bone lesions [1]. *Atherosclerosis* - Primarily affects **blood vessels**, leading to plaque formation, and does not cause **lytic bone lesions**. - Clinical manifestations focus on **cardiovascular disease** rather than bone abnormalities. *Mitral stenosis* - Affects the **heart valves** and results in **heart failure** symptoms rather than causing lytic lesions in bones. - Clinical findings include **dyspnea** and signs of **pulmonary congestion**, which are unrelated to bone pathology. *Osteoblast* - Osteoblasts are **bone-forming cells**, and while they may be involved in certain bone diseases, they do not create **solitary lytic lesions**. - Lytic lesions typically arise from **osteoclast activity** or **tumor infiltration**, not from osteoblastic processes [1].

Question 1

Mentzer index more than 13 suggests a diagnosis of

Accepted Answer

Iron deficiency anemia

Answer

Thalassemia

Answer

Hereditary Spherocytosis

Answer

Autoimmune Hemolytic Anemia

Question 2

Which of the following statements about Hematochromatosis is true?

Accepted Answer

Hypogonadism may be seen

Answer

Desferrioxamine is treatment of choice

Answer

Arthropathy is not a hallmark feature

Answer

Diabetes Mellitus is rare in Hematochromatosis

Question 3

Which of the following is LEAST likely to increase the risk of developing deep vein thrombosis (DVT)?

Accepted Answer

Age less than 40

Answer

Obesity

Answer

Prolonged immobilization

Answer

Extensive pelvic surgery of more than 30 minutes

Question 4

Which of the following statements about Fanconi anemia is false?

Accepted Answer

Type I RTA

Answer

Associated with pancytopenia

Answer

All statements are true

Answer

Autosomal recessive

Question 5

A young patient presents with a large retroperitoneal hemorrhage and a history of intermittent knee swelling after strenuous exercise. There is no history of mucosal bleeding. Which of the following clotting factors is primarily deficient in Hemophilia A?

Accepted Answer

Factor VIII

Answer

Von Willebrand factor

Answer

Lupus anticoagulant

Answer

Factor IX

Question 6

A female patient presented with fatigue and a history of piles. Routine complete blood count analysis showed hemoglobin of 9 g/dL, MCV 60fL, and RBC count of 5.2 million. A peripheral smear is provided. Which of the following is the next best investigation after the smear for this patient?

Accepted Answer

Serum ferritin levels

Answer

HbA2 levels

Answer

Serum folate levels

Answer

Serum homocysteine levels

Question 7

A 23-year-old male presented with a history of fatigue and tiredness. On investigation, he was found to have Hb values of 9gm%, MCV of 101 FL. Peripheral smear examination showed hypersegmented neutrophils. Which is the most probable etiology?

Accepted Answer

Vitamin B12 deficiency

Answer

Hemolytic anemia

Answer

Folate deficiency

Answer

Iron deficiency anemia

Question 8

Which of the following statements about deep venous thrombosis (DVT) is incorrect?

Accepted Answer

Mostly bilateral

Answer

Most common clinically presents as pain and tenderness in calf

Answer

Some cases may directly present as pulmonary thromboembolism

Answer

Clinical assessment highly reliable

Question 9

A 50-year-old man presents with paresthesia. HB-6.8g/dl. Peripheral smear shows macrocytosis and neutrophils with hypersegmented nuclei. Endoscopy reveals atrophic gastritis. What is the most probable diagnosis?

Accepted Answer

Vitamin B12 deficiency

Answer

Riboflavin deficiency

Answer

Iron deficiency

Answer

Folate deficiency

Question 10

In which condition are solitary lytic lesions typically seen?

Accepted Answer

Multiple myeloma

Answer

Atherosclerosis

Answer

Mitral stenosis

Answer

Osteosarcoma

Hematology — MCQs

Hematology — MCQs

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