Haematology MCQs OmpathStudy

Q. Q1. A 62-year-old man has had dull, constant back pain for 3 months. He recently developed a cough productive of yellowish sputum. On physical examination there are crackles at the right lung base. A plain film radiograph of the spine reveals several 1 to 2 cm lytic lesions of the vertebral bodies. Labs: glucose 78, urea nitrogen 49, creatinine 5, total protein 8.3, albumin 3.7, alkaline phosphatase 176, AST 45, ALT 22, total bilirubin 1.2. Sputum culture grows Streptococcus pneumoniae. Which pathologic finding is most likely on bone marrow biopsy? A) Scattered small granulomas B) Nodules of small mature lymphocytes C) Occasional Reed-Sternberg cells D) Numerous plasma cells E) Hypercellularity with many blasts Answer: D — Multiple myeloma (protein/albumin gap, lytic bone lesions, renal failure from light chains, susceptibility to encapsulated organisms). Q2. A 33-year-old woman has experienced low grade fevers, night sweats, and generalized malaise for the past 2 months. On physical examination she has non-tender cervical and supraclavicular lymphadenopathy. Cervical lymph node biopsy at high magnification shows occasional CD15+ and CD30+ Reed-Sternberg cells along with large and small lymphocytes and bands of fibrosis. Most likely diagnosis? A) Burkitt lymphoma B) Hodgkin lymphoma C) Cat scratch disease D) Mycosis fungoides E) Multiple myeloma Answer: B — Reed-Sternberg cells with CD15+/CD30+ markers are diagnostic of Hodgkin lymphoma. Q3. A 17-year-old adolescent has had malaise for the past 3 weeks. He has mild pharyngitis on exam, plus tender axillary and inguinal lymphadenopathy. The spleen is palpable. CBC: Hgb 14.0, Hct 42.2%, MCV 90, platelets 301,300, WBC 8120 with 'atypical lymphocytes' on smear. His illness is most likely acquired via which mechanism? A) Congenital genetic abnormality B) From close contact on a date C) As a result of an insect bite D) Through an environmental exposure at work E) Without any known etiology Answer: B — Infectious mononucleosis (EBV), transmitted via saliva/close contact. Q4. A 30-year-old woman has had mild fatigue for many years. Exam reveals a palpable spleen tip. Labs: Hgb 11.1, Hct 28.8%, MCV 77, platelets 229,000, WBC 7340, reticulocyte count 3.9%. Peripheral smear shows small RBCs lacking central pallor. Which inheritance pattern is most likely? A) Autosomal dominant, European ancestry B) Autosomal recessive, Asian ancestry C) X-linked recessive, Middle Eastern ancestry D) Autosomal recessive, West African ancestry E) Sporadic occurrence Answer: A — Hereditary spherocytosis, autosomal dominant, most common in Northern European descent. Q5. A 3-year-old child has small pinpoint hemorrhages on the skin for the past 3 days. Vital signs normal. Petechiae over extremities and trunk. CBC: Hgb 14.3, Hct 43%, MCV 90, platelet count 19,300, WBC 9370. Resolves over the next month without treatment. Most likely antecedent event? A) Acetylsalicylic acid (aspirin) ingestion B) Congenital HIV infection C) Dietary cobalamin deficiency D) Repetitive trauma E) Respiratory syncytial virus infection F) Sulfonamide ingestion Answer: E — Acute (viral-triggered) immune thrombocytopenia, self-limited in children. Q6. A 30-year-old man has had sore throat with fever for 5 days. Exam: mildly tender generalized cervical lymphadenopathy, enlarged erythematous tonsils with overlying exudate. Labs: Hgb 13, platelets 277,000, WBC 12,670 with differential 75 segs, 10 bands, 15 lymphs. Most likely diagnosis? A) Lymphocytic lymphoma B) Hodgkin lymphoma C) Group A Streptococcus infection D) Human immunodeficiency virus infection E) Brucellosis Answer: C — Exudative pharyngitis with neutrophilic leukocytosis and left shift = bacterial (strep) infection. Q7. A 30-year-old man has had a progressively worsening productive cough for one month. Exam: small non-tender axillary lymph nodes, spleen tip palpable. Labs: Hgb 10.2, Hct 31.1%, MCV 90, WBC 67,000, platelets 36,000. Peripheral smear shows many blasts with Auer rods. Most likely diagnosis? A) Leukemoid reaction B) Acute myelogenous leukemia C) Chronic lymphocytic leukemia D) Lymphoblastic leukemia E) Leukoerythroblastosis Answer: B — Auer rods are pathognomonic for AML. Q8. A 68-year-old man has had malaise for the past year. No abnormal exam findings. Labs: Hgb 10.5, Hct 31.5%, MCV 88, platelets 211,000, WBC 6980. Total serum iron 130, TIBC 230, soluble serum transferrin receptor normal. Bone marrow biopsy: normal maturation in all cell lines, no abnormal cells, increased stainable iron. Most likely underlying disease? A) Diverticulosis B) Hepatitis C infection C) Systemic lupus erythematosus D) Atrophic gastritis E) Fanconi anemia Answer: B — Increased marrow iron stores with normal/high saturation = anemia of chronic disease from chronic infection. Q9. A 69-year-old man has noted several lumps on the right side of his neck for 5 months. Exam: firm, non-tender, movable lymph nodes in right posterior cervical region, no spleno/hepatomega