Hematology BCQs

1. A 12 year boy presents to the OPD medicine department with swelling of knee after a
trauma. Family history reveals his maternal uncle also suffered from similar complaints. The
boy is most likely suffering from
a) Von willebrand disease
b) Hemophilia
c) Thrombocytopenic purpura
d) Hereditary hemorrhagic telengiectasia
e) Disseminated intravascular coagulation
2. A 59 year old man with a history of coronary artery disease and a severe mitral
regurgitation has surgery to replace his mitral valve. Post operatively there were no
complications until 6 months after the surgery when he presented with increasing fatigue.
Workup finds a normocytic normochromic anemia that is due to fragmentation of RBCs by
his artificial heart valves. Which of the following abnormality is indicative of intravascular
hemolysis and is most likely to be seen in peripheral blood film of this patient?
a) Drepanocytes
b) Heinz bodies
c) Pappenheimer bodies
d) Schistocytes
e) Target cells
3. Two days after receiving the anti malarial drug primaquine, a 27 year old man develops
sudden intravascular hemolysis resulting in a decreased hematocrit, hemoglobinemia and
hemoglobinuria. Examination of the peripheral blood reveals erythroctyes with a defect
forming bite cells, when crystal violet stain is applied many Heinz bodies area also seen.
Which of the following is the most likely diagnosis?
a) Hereditary spherocytosis
b) Glucose 6 phosphate dehydrogenase deficiecny
c) Paroxysmal hemoglobinuria
d) Autoimmune hemolytic anemia
e) Micro angiopathic hemolytic anemia
4. A 49 year old woman presents with signs of anemia and states that every morning her
urine is dark. Investigations reveal that her RBC lyse in vitro with acid(positive HAMs tests).
Which of the following Is the most likely diagnosis?
A) Warm autoimmune hemolytic anemia
B) Paroyxsmal nocturnal hemogolbinuria
C) Paroxysmal cold hemogolbinuria
D) Isoimmune hemolytic anemia
E) Cold agglutinin autoimmune hemolytic anemia
5. A 41 year woman presents with increasing fatigue lethargy and muscle weakness. Her
CBC reveals decreased number of erythrocytes, leukocytes and platelets along with an
increase in the MCV of the erythrocytes. Her blood smear shows hypersegmented
neutrophils. Which of the following substances is most likely to be deficient in this
individual.
a) Amino levulinic acid
Imran A. Arain’21 | Hematology Module BCQs
b) Ascorbic acid
c) Folic acid
d) Retinoic acid
e) Vanillyl mandelic acid
6. A 61 year old woman presents with increasing fatigue and is found to have
hypochromic microcytic RBC in her periopheral smear. Physical examination finds her heart
rate and respiratory rate to be both increasd in frequency. Lab examination finds decreased
serum ferritin, the levels of which are inversely propotional to the serum levels of which of
the following substances.
A) Bilirubin
B) Haptoglobin
C) Hemosiderin
D) TIBC
E) Transferrin
7. A 23 year old woman in her 25th week of pregnancy has felt no fetal movement for the
past 3 years. Three weeks later, she still has not given birth and suddenly develops dyspnea
with cyanosis. On physical examination, her temperature is 36.9 C, pulse 102/min,
respiration 21/min and blood pressure 80/40 mm Hg. She has large ecchymoses over the skin
of her entire body. A stool sample is positive for her occult blood. Lab studies show
elevated prothrombin time and partial thromboplastin time. The platelet count is decreased,
plasma fibrinogen is markedly decreased and fibrin split products are detected. A blood
culture is negative. Which of the following is most likely cause of the bleeding diathesis?
a) Increased vascular fragility
b) Toxic injury to the endothelium
c) Reduced production of the platelets
d) Increased consumption of clotting factors and platelets
e) Defects in platelet adhesion and aggregation
8. A 65 year old patient presents with generalized lymphadenopathy. Immunophenotype
shows CD10+ BCL2+ mature B cells expressing surface immunoglobulin. Chromosomal
studies show t(14:18). Which lymphoid neoplasms is most likely he suffering from:
a) Mantle cell lymphoma
b) Burkitt lymphoma
c) Follicular lymphoma
d) MALT lymphoma
e) Plasmacytoma
9. Lacunar cells, a variant of Reed Stenberg cells is seen in which of the following
subtypes:
a) Lymphocyte predominant
b) Mixed cellularity
c) Lymphocyte depleted
d) Nodular sclerosis
e) Lymphocyte rich
10. A 3 year old boy in Japan presents with fever and rash that is desquamating. On
examination he has enlarged cervical lymph nodes conjunctival and oral erythema and
erosion. He also has edema of the hands and feet. The physician says the disease is classically
self limited however if left untreated the important sequelae will be:
Imran A. Arain’21 | Hematology Module BCQs
a) Cerebral artery aneurysms
b) Coronary artery aneurysms
c) Cervical abscess
d) Renal artery aneurysms
e) Conjunctival hemorrhage
11. A 72 year old man presents with increasing fatigue. Physical examination reveals
multiple enlarged non tender lymph nodes with enlarged liver and spleen. Lab examination of
his peripheral blood reveals a normocytic normochromic anemia and a slighty decreased
platelet count and a leukocyte count of 72,000/microlitre. Examination of the peripheral
smear reveals a marked increase in the number of mature looking lymphyocytes and many
smudge cells. What is the most likely diagnosis:
a) Acute lymphoblatic leukemia
b) Atypical lymphocytosis
c) Chronic lymophocytic leukemia
d) Immunoblastic lymphoma
e) Prolymphocytic leukemia
12. A 22 year old woman presents with fever weight loss night sweats and painless
enlargement of various supraclavicular lyphnodes. A biopsy from one of the enlarged lymph
nodes shows binucleated giant cells with prominent acidophilic owl eye nucleoli. Wht is the
most likely diagnosis:
a) Anaplastic large cell lymphoma
b) Diffuse non hodgkins lymphoma
c) Hodgkins disease
d) Reactive lymphnode hyperplasia
e) Mantle cell lymphoma
13. Administration of which one of the following substances would theoretically correct the
abnormal bleeding lab tests in an individual who is deficient in factor V:
a) Activated factor VIII
b) Activated factor X
c) Fibrinogen
d) Plasmin
e) Thrombin
14. In which of the following conditions PT is prolonged and aPTT is normal:
a) Von willibrand disease
b) Factor IX deficeiny
c) DIC
d) Factor VII deficiency
e) ASD
15. A 30 year old female has splenomegaly and anemia with spherocytosis.The circulating
RBCs demonstrate an increased osmotic fragility on laboratory testing. An inherited
abnormality in which of the following RBC components best explains these findings:
a) Glucose-6-phosphate dehydrogenase.
b) A membrane cytoskeletal protein.
c) Α-globin chain
d) Heme
e) Β-globin chain
Imran A. Arain’21 | Hematology Module BCQs
16. one of the following statements about Hemangiomas is not true:
a) They are benign tumors of blood vessels
b) Capillary haemangioma commonly involves skin and mucosal tissue
c) Cavernous haemangiomas involve deeper structures
d) These tumors are encapsulated
e) Strawbwerry haemangioma is a variant present at birth.

1. B
2. D
3. B
4. B
5. C
6. D
7. D
8. C
9. D
10. B
11. C
12. C
13. E
14. D
15. B
16. D

Hematology BCQs part 2

17. Auer rods are characteristically seen in:
a) ALL-L2
b) AML-M1
c) AML-M2
d) AML-M3
e) AML-M4
18. M spike in multiple myeloma is usually due to:
a) IgG
b) Light chains
c) IgA
d) Heavy chains
e) Both light and heavy chains
19. A 60 years old sweeper presents with off & on diarrhea for the last 6 months which has
led to weakness, pallor and numbness of hands & feet. On examination he is pale. His blood
CP reveals Hb of 6.5 g/dl, TLC 3.0 x 10 3/ul and platelets count of 85,000/cmm. MCV is 110
fl with oval macrocytosis and hypersegmented neutrophils. What is the probable diagnosis?
a) Iron deficiency anemia
b) Megaloblastic anemia
c) Aplastic anemia
d) Hemolytic anemia
e) Anemia of underlying disorder
20. What investigation would you like to do next?
Imran A. Arain’21 | Hematology Module BCQs
a) Serum Ferritin
b) Serum iron, TIBC
c) Bone Marrow examination
d) Hb electrophoresis
e) Coombs test.
21. The gene for beta globin chain of Hb is located on chromosome
a) 11
b) 9
c) X
d) 16
e) 1
22. G6PD deficiency is:
a) Inherited as an autosomal dominant disorder
b) Associated with extravascular hemolysis only
c) X linked
d) Characterized by presence of target cells in blood
e) Associated with aggravation of symptoms in hypoxic conditions
23. Sickle cell anemia is
a) Because of a defect in the alpha globin chain of Hb
b) Associated with intravascular hemolysis
c) Diagnosed on bone marrow examination
d) Diagnosed on Hb electrophoresis
e) Associated with painful crisis resulting from acute severe vasoconstriction
24. What is the diagnostic test of choice for iron deficiency anaemia?
a) Peripheral blood film
b) Serum Ferritin levels
c) Serum iron, TIBC
d) Bone Marrow examination
e) Percent Transferrin saturation
25. A young otherwise healthy female presents with sudden onset of symptoms of anaemia
after taking medicine for throat infection. She is very pale with mild splenomegaly. Her blood
CP shows severe normocytic normochromic anaemia with normal TLC & platelet count.
Spherocytes are also seen. What is the likely cause of her anemia?
a) Autoimmune hemolytic anemia
b) Megaloblastic anemia
c) Iron deficiency anemia
d) PNH
e) Cold haemagglutinin disease
26. What is the diagnostic test for your provisional diagnosis in above case?
a) Bone marrow examination
b) Urine for hemosidrin
c) Coombs test
d) Hb electrophoresis
e) Iron profile

Imran A. Arain’21 | Hematology Module BCQs

 27. You have diagnosed a child with beta thalassaemia major. How will you manage this
child?
a. Regular blood transfusions
b. Regular blood transfusion with iron chelation.
c. Haematinics therapy
d. Give supportive care only
e. Advise bone marrow transplant immediately
28. Parasite producing iron deficiency is:
a. Ascaris Lumbricoides
b. Entrobius vermicularis
c. Shistosoma haematobium
d. Entamoeba Histolytica
e. Ancylostoma Duodenale
29. Pernicious anaemia is produced due to:
a) Defective absorption of folic acid
b) Defective absorption of Vit B 12 resulting from deficient R binder
c) Vit B 12 deficiency due to deficiency of Intrinsic Factor
d)Ileal resection
e) Deficiency of transcobalamine
30. The best source of folic acid is
a. Milk
b. Eggs
c. Vegetables
d. Meat
e. Animal liver
31. Bleeding does not become evident until platelet count is less than:
a. 1,00,000/ul
b. 75,000/ul
c. 50,000/ul
d. 20,000/ul
e. 10,000/ul
32. Individuals infected by Plasmodium Falciparum are protected against:
a. Thalasemia
b. Iron deficiency anemia
c. Sickle cell anemia
d. Megaloblastic anemia
e. Anemia of chronic disease

33. Aplastic anaemia is diagnosed on:

a) Blood counts and reticulocyte count
b) Hb electrophoresis
c) Bone marrow aspirate alone
d) Bone marrow trephine alone
e) Both aspirate and trephine biopsy

Imran A. Arain’21 | Hematology Module BCQs

17) d
18) b
19) b
20) b
21) a
22) c
23) d
24) b
25) a
26) c
27) b
28) e
29) c
30) d
31) d
32) c
33) d

Hematology Practice Questions.

1. You are asked to evaluate a 34-year-old female for abnormal coagulation tests. She gives a history of bleeding
after tooth extraction and tonsillectomy, as well as heavy menstrual periods. Her mother and sister also have
histories of excessive bleeding. The patient's CBC is normal; the PT is 12 sec and the PTT is 54 sec.The least
likely diagnosis is:

A. Factor IX deficiency

B. Lupus anticoagulant

C. von Willebrand's disease

D. Factor XI deficiency

E. Factor VIII deficiency

2. In which disorder is thrombocytopenia least likely to be seen?

A. Aplastic anemia

B. Splenomegaly

C. Myeloproliferative disorder

D. Disseminated intravascular coagulation

E. Bernard-Soulier syndrome
3. A patient is diagnosed with Factor V Leiden. Which statement is not correct about this disorder?

A. Factor V Leiden resists degradation by activated protein C.

B. This is a genetic disease.

C. Protein C deficiency is more common than Factor V Leiden.

D. Factor V Leiden is an autosomal dominant disorder.

E. Factor V Leiden is a thrombotic disorder.

4. What tissue serves to provide the majority of blood cells in the mid-gestation fetus?

A. Yolk sac

B. Bone marrow

C. Liver

D. Spleen

E. Thymus
Imran A. Arain’21 | Hematology Module BCQs
5. A 60-year-old man presents with aplastic anemia. What is the most appropriate management plan?

A. HLA typing of siblings in preparation for bone marrow transplant

B. Growth factor support (G-CSF and erythropoietin)

C. Anti-thymocyte globulin (ATG) plus cyclosporin

D. Low molecular weight heparin

E. Bone marrow transplantation from a matched, unrelated donor

6. A 50-year-old lawyer is seen in your clinic for an insurance physical exam. He is feeling well overall but says
that over the past 2 months he has been suffering from increased fatigue and has lost 10 pounds. He is putting in
long hours at work because of an important medical malpractice case he is involved in. He takes no medications.
His past medical history is significant only for a splenectomy following a gunshot wound he sustained in Vietnam.
You find no significant abnormality on his physical exam except for a surgical scar on his abdomen. His
laboratory exam reveals a white blood cell count of 15,000/µl, a platelet count of 550,000/µl, and a hematocrit of
52%. You review the patient's blood film and notice a leukocytosis with Howell-Jolly bodies in his red blood cells.
At this point you should:

A. Do a bone marrow biopsy to rule out leukemia, particularly with a history of fatigue and weight loss.

B. Reassure the patient that his leukocytosis is expected and is secondary to his splenectomy.

C. Since the patient is a malpractice lawyer and you are afraid of being sued, do a bone marrow biopsy to
be sure that nothing is wrong.

D. Start the patient on antibiotics just in case he may have an infection.

E. Obtain a stool sample to determine if he has parasites.

7. You are asked to evaluate a 69 year old woman with diffuse adenopathy and guaiac positive stools. She has
been fatigued and notes night sweats about two times per week for the past three months. She has already had a
biopsy of one of the lymph nodes, and it revealed a diffuse pattern with large B cells that were monoclonal. What
is your next step?

A. Staging evaluation including CT scans of the chest, abdomen and pelvis, and bone marrow aspirate and
biopsy.

B. Careful physical examination with attention to vital signs (in particular blood pressure and pulse), lymph
node groups and rectal exam.

C. Immediate treatment with CHOP chemotherapy.

D. Referral for bone marrow transplant.

8. A 48-year-old Caucasian man develops fatigue, weakness, and early satiety. The physical exam reveals pallor
and splenomegaly. The spleen extends 6 cm below the left costal margin. Laboratory tests reveal a hemoglobin
concentration of 9.0 g/dL, hematocrit 27%, MCV 88 fL, platelet count 600,000/µL, white blood cell count
210,000/µL. A leukocyte differential count reveals 50% segmented neutrophils, 8% band forms, 4%
metamyelocytes, 4% myelocytes, 3% promyelocytes, 1% blasts, 12% monocytes, 8% basophils, 4% eosinophils,
and 6% lymphocytes. A marrow aspiration and biopsy reveals a hypercellular marrow with a myeloid:erythroid
ratio of 9:1. Which of the following tests would most likely establish a specific diagnosis?

A. A leukocyte alkaline phosphatase (LAP) score.

B. A thrombopoietin assay.

C. Special stains of the marrow to detect deposition of collagen.

D. A bone marrow karyotype (cytogenetic study).

E. An erythropoietin assay.
9. A 70-year-old Caucasian woman, previously healthy, develops fatigue, weakness, and exertional dyspnea.
The physical examination reveals only pallor. An anemia is detected with a hemoglobin concentration of 7.0 g/dL
and an hematocrit of 21% with an MCV of 105 fL. The white blood cell count is 8,000/µL and the platelet count is
510,000/µL. The bone marrow is hypercellular. Red cell precursors are reduced in number. Megakaryocytes are
smaller than normal and most have a single, round nucleus. Which of the following is most likely to be found?

Imran A. Arain’21 | Hematology Module BCQs

 A. Mitochondrial iron deposits in erythroid precursors.

B. Translocation of DNA from chromosome 9q to chromosome 22.

C. An abnormal first stage Schilling test, but a normal second stage.

D. Deletion of the long arm (q) of chromosome 5.

E. Blasts containing Auer rods in the blood and marrow.

10. A healthy 19-year-old Caucasian woman develops right upper quadrant abdominal pain. A physical exam
reveals right upper quadrant tenderness and just a "hint" of scleral icterus. The spleen tip is just palpable.
Laboratory tests reveal a hemoglobin concentration of 12 g/dL and an hematocrit of 36%. The MCV is 90 fL. The
reticulocyte count is 5.2%. The total bilirubin is 2.3 mg/dL with an indirect fraction of 2.0 mg/dL. An ultrasound
examination reveals several large gallstones. A laparoscopic cholecystectomy is performed. At the time of
discharge, she is given her gallstones because they are unusual in appearance. Instead of the usual yellow-tan
color, they are deeply pigmented. Which one of the following laboratory tests is likely to be abnormal?

A. Assay of glucose-6-phosphate dehydrogenase activity in an erythrocyte lysate.

B. Mutational analysis of the pyruvate kinase gene.

C. Mutational analysis of the (-spectrin gene.

D. Mutational analysis of the bilirubin-glucoronyltransferase gene.

E. A Heinz body preparation.

11. The methylfolate "trap" hypothesis is based on which one of the following findings?

A. The intracellular formation of folate polyglutamates is a B12-dependent reaction.

B. The conversion of methylmalonyl co-enzyme A to succinyl CoA is catalyzed by a B12-dependent

reaction.

C. The synthesis of methionine from homocysteine is a B12-dependent reaction.

D. Gastrointestinal absorption of folic acid is a B12-dependent reaction.

E. The incorporation of deoxythymidine monophosphate into DNA is a B12-dependent reaction.

12. Match the clinical findings with the disease most likely associated with the finding: Petechiae

A. Protein C deficiency

B. ITP

C. Miscarriage

D. Hemophilia A

E. Liver disease

F. Vitamin K deficiency
13. Match the clinical findings with the disease most likely associated with the finding: Hemarthrosis

A. Protein C deficiency

B. ITP

C. Miscarriage

D. Hemophilia A

E. Liver disease

F. Vitamin K deficiency
14. Match the clinical findings with the disease most likely associated with the finding: Lupus anticoagulant

A. Protein C deficiency
Imran A. Arain’21 | Hematology Module BCQs
 B. ITP

C. Miscarriage

D. Hemophilia A

E. Liver disease

F. Vitamin K deficiency
15. Match the clinical findings with the disease most likely associated with the finding: Pulmonary embolism

A. Protein C deficiency

B. ITP

C. Miscarriage

D. Hemophilia A

E. Liver disease

F. Vitamin K deficiency
16. A 40-year-old Vietnamese male is seen in a health clinic for untreated tuberculosis. His hematocrit is 34%
(normal 39-49%). The MCV is 78 fl (normal 83-97 fl). The serum iron is low, and the TIBC is normal. The ferritin
value is elevated. Why is the serum iron low in the patient?

A. He is iron-deficient from occult G.I. blood loss.

B. He has hemolytic anemia.

C. Iron release from macrophages is impaired.

D. Vitamin B12 absorption is not normal.

E. He has folate deficiency due to malnutrition.

17. Which of the following anemias is usually not macrocytic?

A. Hemolytic anemia.

B. Liver disease.

C. Folate deficiency.

D. Anemia of chronic disease.

E. Myelodysplasia.
18. A 59-year-old woman complains of headaches and visual difficulties. Her examination shows a ruddy
complexion and a spleen palpable 3 cm below the left costal margin. Her complete blood count shows:
 Hematocrit: 59% (normal 39-49%)
 WBC: 12,300/Fl (normal 4,000-9,000/Fl)
 Platelets: 650,000/Fl (normal 140,000-440,000/Fl)

Her arterial oxygen saturation is 95% on room air. You recommend which of the following:

A. Chemotherapy with fludarabine and prednisone.

B. Phlebotomy.

C. Observation.

D. Allogeneic bone marrow transplantation.

E. Inhaled oxygen therapy @ 2 L/min.

Imran A. Arain’21 | Hematology Module BCQs

19. Which one of the following statements about classification of anemias is NOT correct?

A. Increased indirect bilirubin, elevated LDH, and an increased reticulocyte count is characteristic of both
untreated megaloblastic anemia and autoimmune hemolytic anemia.

B. Most sideroblastic anemias are macrocytic.

C. Anemia of chronic disease may be either normocytic or microcytic.

D. Thalassemia can be categorized either as a microcytic anemia or as a hemolytic anemia.

E. Metastatic breast cancer, myeloma, and myelofibrosis are all causes of myelophthisic anemia.
20. Hemoglobin and hematocrit values are usually, but not always, accurate indicators of total body red cell
mass. Under what circumstances would the hematocrit or hemoglobin NOT correlate with red cell mass?

A. Megaloblastic anemia.

B. Hemoglobin of altered oxygen affinity.

C. Acute blood loss.

D. Severe iron deficiency.

E. Hereditary spherocytosis.
21. A 23-year-old man has had three episodes of venous thrombosis. An appropriate laboratory evaluation
should include all of the following except:

A. Protein C.

B. Protein S.

C. Antithrombin III.

D. Factor V Leiden.

E. Alpha2-macroglobulin
Answers

1.B
2.C
3.C
4.C
5.C
6.B
7.B
8.D
9.D
10.C
11.C
12.B
13.D
14.C
15.A
16.C
17.D
18.B
19.A
20.C
21.E

Imran A. Arain’21 | Hematology Module BCQs