Dr. Orata Haematology: 108 Past-Paper MCQs OmpathStudy

Question 1

What percentage of normal adult haematopoietic bone marrow is fat?

Accepted Answer

50% — Adult marrow is roughly half hematopoietic cells, half fat.

Question 2

In iron-deficiency anaemia, which laboratory marker most directly reflects depleted iron stores and is typically decreased?

Accepted Answer

Serum ferritin — Ferritin reflects iron stores and drops early; TIBC rises in IDA.

Question 3

NOT a characteristic finding in megaloblastic anemia?

Accepted Answer

Microcytosis — Megaloblastic anemia produces macrocytosis, not microcytosis.

Question 4

Hemoglobin variant protecting against severe malaria?

Accepted Answer

HbS — Sickle trait carriers have reduced risk of severe P. falciparum malaria.

Question 5

Characteristic chromosomal abnormality in CML?

Accepted Answer

t(9;22) — This is the Philadelphia chromosome, forming BCR-ABL1.

Question 6

Most common cause of macrocytic anemia in alcoholics?

Accepted Answer

Direct alcohol-induced marrow toxicity — Alcohol is directly marrow-toxic, causing macrocytosis independent of nutrition.

Question 7

In beta-thalassemia major, which hemoglobin is typically increased?

Accepted Answer

HbF — Fetal hemoglobin rises to compensate for absent HbA production.

Question 8

Most common cause of acquired hemolytic anemia?

Accepted Answer

Autoimmune hemolytic anemia — The other options are inherited causes; AIHA is the leading acquired cause.

Question 9

NOT a typical feature of myelodysplastic syndromes?

Accepted Answer

Hyperproliferative bone marrow — MDS marrow is usually normo/hypercellular but produces ineffective, dysplastic cells — not a true hyperproliferative state.

Question 10

What is the Philadelphia chromosome?

Accepted Answer

t(9;22) — Fusion of BCR (ch22) and ABL1 (ch9).

Question 11

Most common presenting symptom in acute leukemia?

Accepted Answer

Fatigue — Caused by marrow failure leading to anemia.

Question 12

NOT a risk factor for developing MDS?

Accepted Answer

Obesity without prior marrow-toxic exposure — The others are established marrow-damaging risk factors; obesity is not.

Question 13

Most common cause of vitamin B12 deficiency in Western countries?

Accepted Answer

Pernicious anemia — Autoimmune loss of intrinsic factor is the leading cause in Western populations.

Question 14

NOT a typical feature of sickle cell disease?

Accepted Answer

Microcytosis — SCD is a normocytic hemolytic anemia.

Question 15

Most common cause of hereditary hemochromatosis?

Accepted Answer

HFE gene mutation — C282Y mutation in HFE accounts for most cases.

Question 16

Which best describes the Philadelphia chromosome?

Accepted Answer

t(9;22) — Diagnostic translocation for CML.

Question 17

Primary growth factor for megakaryocyte differentiation and platelet production?

Accepted Answer

Thrombopoietin — TPO is the main regulator of megakaryopoiesis and platelet output.

Question 18

NOT a typical feature of vitamin B12 deficiency?

Accepted Answer

Microcytosis — B12 deficiency causes macrocytosis, plus unique neurological features (unlike folate deficiency).

Question 19

Most common cause of hereditary spherocytosis?

Accepted Answer

Ankyrin deficiency — Ankyrin defects (isolated or combined with spectrin) are the most frequent cause.

Question 20

Characteristic immunophenotype of chronic lymphocytic leukemia?

Accepted Answer

CD5+, CD23+ — This co-expression pattern (with CD19) is classic for CLL.

Question 21

NOT a typical feature of polycythemia vera?

Accepted Answer

Thrombocytopenia — PV typically causes thrombocytosis, not thrombocytopenia.

Question 22

Most common cause of warm autoimmune hemolytic anemia?

Accepted Answer

No identifiable cause (idiopathic) — About half of warm AIHA cases have no identifiable underlying cause.

Question 23

NOT a typical feature of paroxysmal nocturnal hemoglobinuria?

Accepted Answer

Positive direct antiglobulin test — PNH hemolysis is complement-mediated, not antibody-mediated, so DAT is negative.

Question 24

Primary mechanism of action of imatinib in CML?

Accepted Answer

Inhibition of BCR-ABL tyrosine kinase — Imatinib is a targeted tyrosine kinase inhibitor against the BCR-ABL fusion protein.

Question 25

Characteristic immunophenotype of acute myeloid leukemia?

Accepted Answer

CD34+, CD117+, MPO+ — MPO positivity confirms myeloid lineage; CD34/CD117 mark blast/progenitor cells.

Question 26

NOT a typical feature of beta-thalassemia major?

Accepted Answer

Increased HbA2 — Raised HbA2 is characteristic of thalassemia trait/minor; major shows predominantly elevated HbF.

Question 27

Most common cause of acquired factor VIII inhibitors?

Accepted Answer

Idiopathic — Most cases of acquired hemophilia have no identifiable trigger.

Question 28

Characteristic cytogenetic abnormality in follicular lymphoma?

Accepted Answer

t(14;18) — This translocation juxtaposes BCL2 with the IGH promoter, causing BCL2 overexpression. --- Understood — continuing straight through, full sets, nothing skipped. These are 4 distinct question papers in your scan (different units/exam dates), so I'll label each clearly and complete all of them now.

Question 29

Leukemoid reactions are almost always a sign of ---

Accepted Answer

Septicaemia — Severe infection/sepsis is the classic trigger for a leukemoid reaction (WBC 50,000 with left shift).

Question 30

True statement concerning staging of non-Hodgkin's lymphoma? ---

Accepted Answer

CT scan is used in imaging studies — CT is standard for staging. (A and B are false; C describes FAB classification, not staging.)

Question 31

Which dietary factor increases non-haem iron absorption from the gastrointestinal tract?

Accepted Answer

Vitamin C in fruit juice — Vitamin C reduces ferric (Fe³⁺) to ferrous (Fe²⁺) iron, greatly enhancing absorption.

Question 32

Abnormality of nuclear segmentation in neutrophils ---

Accepted Answer

Pelger-Huet — Causes hyposegmented, "pince-nez" bilobed neutrophil nuclei.

Question 33

4-year-old African boy, facial mass, "starry sky" pattern, Burkitt's lymphoma — associated translocation involves ---

Accepted Answer

MYC rearrangement with t(8;14) — Burkitt lymphoma classically carries t(8;14), which places MYC under immunoglobulin heavy-chain enhancer control.

Question 34

70-year-old female, tea-and-toast diet, corkscrew hairs, gum bleeding — deficiency of ---

Accepted Answer

Vitamin C — Classic scurvy: perifollicular haemorrhage, corkscrew hairs, gingival bleeding from poor diet.

Question 35

Red cell abnormality most indicative of haemolysis ---

Accepted Answer

Schistocytes — Fragmented RBCs signal mechanical/microangiopathic haemolysis.

Question 36

Markedly decreased blood level most characteristic of intravascular haemolysis ---

Accepted Answer

Haptoglobin — Haptoglobin is consumed mopping up free plasma haemoglobin; it drops sharply.

Question 37

Osmotic fragility test — dashed curve (shifted toward higher NaCl%) represents ---

Accepted Answer

Hereditary spherocytosis — Spherocytes have reduced surface-to-volume ratio, so they lyse at higher (less hypotonic) NaCl…

Question 38

Two days after primaquine, black man develops intravascular haemolysis, bite cells, Heinz bodies — diagnosis ---

Accepted Answer

G6PD deficiency — Classic oxidative-stress haemolysis triggered by primaquine; Heinz bodies = denatured Hb.

Question 39

22-year-old wants to know if he has sickle cell trait — best test ---

Accepted Answer

Metabisulfite test — Sickling/solubility test detects HbS directly.

Question 40

Single nucleotide change on chromosome 11, valine replaces glutamic acid at position 6 of β-chain — associated with ---

Accepted Answer

Sickle cell anaemia — This is the exact molecular defect producing HbS.

Question 41

67-year-old male, prostate nodule, elevated PSA, occasional myelocyte, teardrop cells, nucleated RBCs — best diagnosis ---

Accepted Answer

myelophthisic anaemia — Leukoerythroblastic picture from marrow infiltration (myelophthisis) by metastatic prostate cancer.

Question 42

Megaloblasts result from impaired synthesis of ---

Accepted Answer

DNA — B12/folate deficiency impairs DNA synthesis → nuclear-cytoplasmic asynchrony.

Question 43

In iron deficiency, increased total iron-binding capacity is typically associated with which finding?

Accepted Answer

Ferritin — Low iron stores (low ferritin) trigger increased transferrin synthesis, raising TIBC.

Question 44

A patient has microcytic, hypochromic red cells and a low serum ferritin. What is the most likely diagnosis?

Accepted Answer

Iron-deficiency anaemia — Low ferritin confirms depleted iron stores and supports iron-deficiency anaemia.

Question 45

Sulphonamide-induced antineutrophil antibodies causing neutropenia — expected bone marrow finding ---

Accepted Answer

Hyperplasia of the bone marrow myeloid series — Peripheral immune destruction → compensatory marrow hyperplasia (marrow itself is fine).

Question 46

Trichinosis, schistosomiasis, strongyloidiasis characteristically elevate peripheral blood ---

Accepted Answer

Eosinophils — Classic parasitic (helminth) eosinophilia.

Question 47

Reactive T immunoblasts in viral lymphadenitis are found in which lymph node region? ---

Accepted Answer

Paracortex — T-cell dependent zone of the lymph node.

Question 48

Low-grade NHL resembling CLL cells ---

Accepted Answer

Small lymphocytic lymphoma — SLL is the tissue counterpart of CLL.

Question 49

Lacunar cells (Reed-Sternberg variant) are specifically found in ---

Accepted Answer

Nodular sclerosis Hodgkin's disease — Lacunar cells are the hallmark RS variant of this subtype.

Question 50

28-year-old male, ecchymoses, bleeding gums, DIC picture, blasts with numerous Auer rods (38% of marrow) — diagnosis ---

Accepted Answer

Acute promyelocytic leukemia — Classic association of APL (AML-M3) with DIC and bundles of Auer rods.

Dr. Orata Haematology: 108 Past-Paper MCQs OmpathStudy

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