Medicine
Hematology
A patient with beta-thalassemia major receiving repeated transfusions is at risk for which long-term complication?
A. Iron overload
B. Vitamin C deficiency only
C. Severe thrombocytosis always
D. Hypercoagulability never occurs
Correct Answer: A
Chronic transfusions cause iron accumulation that can damage the heart, liver and endocrine organs unless appropriately monitored and chelated.
Medicine
Hematology
A pregnant woman with prior unprovoked DVT requires anticoagulation. Which agent is generally preferred during pregnancy?
A. Low-molecular-weight heparin
B. Warfarin throughout pregnancy
C. A direct oral anticoagulant as first choice
D. Aspirin alone
Correct Answer: A
LMWH is commonly preferred for treatment and prevention of venous thromboembolism during pregnancy because it does not cross the placenta.
Medicine
Hematology
A patient with polycythemia vera is most likely to have which mutation?
A. JAK2 mutation
B. BCR-ABL1
C. Factor V Leiden only
D. HFE C282Y only
Correct Answer: A
Most patients with polycythemia vera have a JAK2 driver mutation causing constitutive signaling.
Medicine
Hematology
Which finding suggests hemolysis?
A. High LDH, low haptoglobin and indirect hyperbilirubinemia
B. Low LDH and high haptoglobin
C. Direct hyperbilirubinemia only with normal reticulocytes
D. Low reticulocyte count in all cases
Correct Answer: A
Red-cell destruction releases LDH and hemoglobin, lowers haptoglobin and increases unconjugated bilirubin; reticulocytes usually rise if marrow function is intact.
Medicine
Hematology
A patient has bone pain, anemia, renal impairment, hypercalcemia and a monoclonal protein. What is the most likely diagnosis?
A. Multiple myeloma
B. Polycythemia vera
C. ITP
D. Thalassemia trait
Correct Answer: A
The CRAB features—hyperCalcemia, Renal dysfunction, Anemia and Bone disease—are classic for symptomatic multiple myeloma.
Medicine
Hematology
A patient with acute promyelocytic leukemia is at high risk for DIC. Which targeted agent should be started promptly when APL is suspected?
A. All-trans retinoic acid
B. Imatinib only
C. Rituximab
D. Hydroxyurea alone
Correct Answer: A
APL is a hematologic emergency; ATRA should be initiated promptly because it reduces coagulopathy-related mortality.
Medicine
Hematology
A patient with chronic myeloid leukemia most characteristically has which genetic abnormality?
A. BCR-ABL1 fusion
B. JAK2 V617F in every case
C. PML-RARA
D. MYC translocation only
Correct Answer: A
CML is defined by the Philadelphia chromosome resulting in the BCR-ABL1 tyrosine kinase fusion.
Medicine
Hematology
A patient with immune thrombocytopenia has platelets 8,000/µL and active mucosal bleeding. Which initial treatment is appropriate?
A. Corticosteroids with IVIG when rapid rise is needed
B. Warfarin
C. Aspirin
D. Iron chelation
Correct Answer: A
Severe ITP with bleeding requires treatment to raise platelet counts rapidly, commonly corticosteroids and IVIG depending on severity.
Medicine
Hematology
A young man has recurrent hemarthroses, prolonged aPTT and normal PT and platelet count. What is the most likely disorder?
A. Hemophilia
B. Vitamin K deficiency
C. DIC
D. Immune thrombocytopenia
Correct Answer: A
Hemophilia A or B causes intrinsic-pathway factor deficiency with prolonged aPTT and deep-tissue bleeding such as hemarthroses.
Medicine
Hematology
A patient on unfractionated heparin has a platelet fall of 60% and develops a new DVT on day 7. What is the next step?
A. Stop all heparin and start a non-heparin anticoagulant
B. Increase heparin dose
C. Give platelets routinely and continue heparin
D. Switch to aspirin only
Correct Answer: A
Heparin-induced thrombocytopenia is strongly suspected with a major platelet fall and new thrombosis; heparin should be stopped and alternative anticoagulation started.
Medicine
Hematology
Which laboratory pattern is most typical of disseminated intravascular coagulation?
A. Prolonged PT/aPTT, low fibrinogen, high D-dimer
B. Normal coagulation tests with isolated neutropenia
C. High fibrinogen with normal D-dimer
D. Isolated prolonged bleeding time only
Correct Answer: A
DIC consumes clotting factors and platelets, causing prolonged coagulation times, reduced fibrinogen and elevated fibrin degradation products.
Medicine
Hematology
A patient has thrombocytopenia, microangiopathic hemolytic anemia, neurologic symptoms, fever and renal dysfunction. Which treatment should be started urgently for suspected TTP?
A. Plasma exchange
B. Platelet transfusion alone
C. Oral iron
D. Warfarin
Correct Answer: A
TTP is a thrombotic microangiopathy and requires urgent plasma exchange; treatment should not await confirmatory ADAMTS13 results when suspicion is high.
Medicine
Hematology
A patient with sickle cell disease develops chest pain, fever, hypoxemia and a new pulmonary infiltrate. What is the diagnosis?
A. Acute chest syndrome
B. Simple vaso-occlusive pain crisis only
C. Pulmonary edema from nephrotic syndrome
D. Asthma only
Correct Answer: A
New pulmonary infiltrate with respiratory symptoms in sickle cell disease defines acute chest syndrome and requires urgent treatment.
Medicine
Hematology
A patient has macrocytic anemia, paresthesias and loss of vibration sense. Which deficiency is most likely?
A. Vitamin B12 deficiency
B. Iron deficiency
C. Vitamin K deficiency
D. Copper excess
Correct Answer: A
Vitamin B12 deficiency causes megaloblastic anemia and neurologic dysfunction involving posterior columns and peripheral nerves.
Medicine
Hematology
A woman has fatigue, pica, microcytosis and low ferritin. What is the most likely diagnosis?
A. Iron deficiency anemia
B. Anemia of chronic disease only
C. Vitamin B12 deficiency
D. Hereditary spherocytosis
Correct Answer: A
Low ferritin with microcytosis and pica strongly supports iron deficiency anemia.
Medicine
Hematology
Which group of findings is classically associated with symptomatic multiple myeloma?
A. Asthma, eczema, rhinitis and urticaria
B. Hematuria, dysuria, frequency and flank pain
C. Tremor, rigidity, bradykinesia and postural instability
D. Hypercalcemia, renal impairment, anemia and bone lesions
Correct Answer: D
The CRAB features summarize common end-organ manifestations of symptomatic myeloma.
Medicine
Hematology
Which complication or major adverse outcome is particularly associated with Multiple myeloma?
A. Symptomatic reduced exercise tolerance and cardiac strain when severe
B. Potentially irreversible neurologic dysfunction
C. Pathologic fracture
D. Severe symptomatic anemia
Correct Answer: C
Lytic bone disease weakens the skeleton and predisposes to fractures.
Medicine
Hematology
A patient is diagnosed with Multiple myeloma. Which is the most appropriate management principle?
A. Urgent hematology referral for subtype-specific induction therapy and supportive care
B. Refer for specialist myeloma therapy and treat complications such as hypercalcemia, renal injury and bone disease
C. Replace iron and investigate and treat the cause of deficiency
D. Replace vitamin B12 and address the underlying cause
Correct Answer: B
Therapy is risk- and patient-specific and is delivered by hematology or oncology teams.
Medicine
Hematology
In a patient with suspected Multiple myeloma, which investigation or diagnostic approach is most appropriate at this stage?
A. Serum or urine monoclonal-protein testing plus bone marrow evaluation and appropriate skeletal imaging
B. Platelets, PT/INR, aPTT, fibrinogen and D-dimer
C. Peripheral smear followed by bone marrow examination with immunophenotyping
D. Serum ferritin and evaluation for the source of iron loss
Correct Answer: A
Diagnosis requires demonstration of clonal plasma-cell disease and assessment for myeloma-defining organ injury.
Medicine
Hematology
A patient has persistent bone pain, anemia, kidney dysfunction, hypercalcemia and a monoclonal protein. What is the most likely diagnosis?
A. Immune thrombocytopenia (ITP)
B. Disseminated intravascular coagulation (DIC)
C. Acute leukemia
D. Multiple myeloma
Correct Answer: D
The combination of CRAB-type organ injury with monoclonal protein strongly suggests plasma-cell myeloma.