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.
Medicine
Hematology
Which finding most strongly suggests acute leukemia rather than uncomplicated iron deficiency?
A. Low ferritin alone
B. Isolated microcytosis
C. Circulating blasts with multiple cytopenias
D. Pica with normal white-cell count
Correct Answer: C
Blasts and multilineage cytopenias reflect marrow replacement or failure and require urgent hematologic evaluation.
Medicine
Hematology
Which complication or major adverse outcome is particularly associated with Acute leukemia?
A. Severe symptomatic anemia
B. Tumor lysis syndrome
C. Acute chest syndrome
D. Intracranial hemorrhage
Correct Answer: B
Rapid destruction of a large malignant-cell burden can cause hyperuricemia, hyperkalemia, hyperphosphatemia and kidney injury.
Medicine
Hematology
A patient is diagnosed with Acute leukemia. Which is the most appropriate management principle?
A. Urgent hematology referral for subtype-specific induction therapy and supportive care
B. Replace vitamin B12 and address the underlying cause
C. Treat the cause and use corticosteroid therapy for typical warm autoimmune hemolytic anemia
D. Provide rapid analgesia, appropriate hydration and evaluate for complications such as infection or acute chest syndrome
Correct Answer: A
Acute leukemias require rapid specialist treatment because infection, bleeding and tumor lysis can develop quickly.
Medicine
Hematology
In a patient with suspected Acute leukemia, which investigation or diagnostic approach is most appropriate at this stage?
A. Serum ferritin and evaluation for the source of iron loss
B. Serum vitamin B12 with further testing for cause when needed
C. Direct antiglobulin (Coombs) test
D. Peripheral smear followed by bone marrow examination with immunophenotyping
Correct Answer: D
Bone marrow assessment establishes the diagnosis and lineage and supports molecular risk classification.
Medicine
Hematology
A patient has fatigue, recurrent infection, bruising and a blood count showing cytopenias with circulating blasts. What is the most likely diagnosis?
A. Multiple myeloma
B. Iron deficiency anemia
C. Acute leukemia
D. Vitamin B12 deficiency anemia
Correct Answer: C
Marrow failure with blasts is highly concerning for acute leukemia.
Medicine
Hematology
Which blood-smear finding may be seen in DIC because of microangiopathic red-cell injury?
A. Spherocytes only
B. Schistocytes
C. Target cells as the defining finding
D. Auer rods
Correct Answer: B
Fibrin strands in the microcirculation can mechanically fragment red cells, producing schistocytes.
Medicine
Hematology
Which paired clinical problem is characteristic of disseminated intravascular coagulation (DIC)?
A. Bleeding with simultaneous microvascular thrombosis
B. Intracranial hemorrhage
C. Tumor lysis syndrome
D. Pathologic fracture
Correct Answer: A
DIC uniquely produces both hemorrhage from factor consumption and organ ischemia from microthrombi.
Medicine
Hematology
What is the central management principle for hematologic abnormalities caused by disseminated intravascular coagulation (DIC)?
A. Provide rapid analgesia, appropriate hydration and evaluate for complications such as infection or acute chest syndrome
B. Observe selected low-risk patients or use corticosteroid or IVIG-based therapy when indicated by bleeding risk and platelet level
C. Urgent hematology referral for subtype-specific induction therapy and supportive care
D. Treat the underlying trigger and provide component support for bleeding or procedures when indicated
Correct Answer: D
Correction of sepsis, trauma or another precipitant is the cornerstone of DIC management.
Medicine
Hematology
Which coagulation laboratory panel is most useful when consumptive coagulopathy from DIC is suspected?
A. Direct antiglobulin (Coombs) test
B. Clinical assessment plus targeted testing for serious triggers or complications
C. Platelets, PT/INR, aPTT, fibrinogen and D-dimer
D. Peripheral blood smear and evaluation to exclude secondary causes
Correct Answer: C
The combination of low platelets, prolonged coagulation times, low fibrinogen and increased fibrin breakdown supports DIC.
Medicine
Hematology
A patient has severe infection with oozing from venipuncture sites, thrombocytopenia and abnormal coagulation studies. What is the most likely diagnosis?
A. Vitamin B12 deficiency anemia
B. Disseminated intravascular coagulation (DIC)
C. Autoimmune hemolytic anemia
D. Sickle cell vaso-occlusive crisis
Correct Answer: B
Systemic activation and consumption of coagulation factors in critical illness produces the classic DIC pattern.
Medicine
Hematology
Which laboratory feature is most typical of primary ITP?
A. Isolated thrombocytopenia
B. Pancytopenia with blasts
C. Prolonged PT and aPTT in every case
D. Marked neutrophilia as the defining feature
Correct Answer: A
Primary ITP usually causes isolated low platelets rather than broad marrow failure.
Medicine
Hematology
Which complication or major adverse outcome is particularly associated with Immune thrombocytopenia (ITP)?
A. Pathologic fracture
B. Symptomatic reduced exercise tolerance and cardiac strain when severe
C. Potentially irreversible neurologic dysfunction
D. Intracranial hemorrhage
Correct Answer: D
Severe thrombocytopenia can rarely cause life-threatening internal bleeding.
Medicine
Hematology
A patient is diagnosed with Immune thrombocytopenia (ITP). 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. Observe selected low-risk patients or use corticosteroid or IVIG-based therapy when indicated by bleeding risk and platelet level
D. Replace iron and investigate and treat the cause of deficiency
Correct Answer: C
Treatment is individualized; clinically significant bleeding requires prompt therapy.
Medicine
Hematology
In a patient with suspected Immune thrombocytopenia (ITP), which investigation or diagnostic approach is most appropriate at this stage?
A. Platelets, PT/INR, aPTT, fibrinogen and D-dimer
B. Peripheral blood smear and evaluation to exclude secondary causes
C. Peripheral smear followed by bone marrow examination with immunophenotyping
D. Serum or urine monoclonal-protein testing plus bone marrow evaluation and appropriate skeletal imaging
Correct Answer: B
ITP is a diagnosis of exclusion; the smear helps rule out pseudothrombocytopenia and alternative hematologic disease.
Medicine
Hematology
A patient has petechiae and mucosal bleeding with isolated thrombocytopenia and otherwise normal blood counts. What is the most likely diagnosis?
A. Immune thrombocytopenia (ITP)
B. Sickle cell vaso-occlusive crisis
C. Disseminated intravascular coagulation (DIC)
D. Acute leukemia
Correct Answer: A
Isolated thrombocytopenia without another obvious cause is typical of ITP.
Medicine
Hematology
A patient with sickle cell disease develops fever, chest pain, hypoxemia and a new pulmonary infiltrate. What is the most likely complication?
A. Simple iron deficiency
B. Nephrotic syndrome
C. Migraine aura
D. Acute chest syndrome
Correct Answer: D
A new infiltrate plus respiratory symptoms in sickle cell disease should be treated as acute chest syndrome.