Hematology Questions for NEET SS Medicine

 

Preparing for the NEET SS exam can feel like navigating a maze, but fear not! We have got the perfect strategy to help you gauge your readiness by giving you a sneak peek into the exam format.

Dive into the NEET SS high-yield questions to gain insight into what to expect. Get started by practicing the questions below, boost your confidence and fine tune your NEET SS Medicine preparation.

A 65-year-old female, who declined transplant referral, and progressed on treatment with bortezomib, thalidomide, and dexamethasone while being treated for IgG lambda MM comes to you for follow-up. Prior to starting he had Creatinine 1.4 mg/dL, hemoglobin of 8.9 g/dL, total protein 8.9 g/dL, monoclonal protein load of 4.1 g/dL. Skeletal survey revealed a single lytic lesion in the femur. Due to progression, she switched to pomalidomide + elotuzumab + dexamethasone. Which secondary malignancies should she be monitored for and what is the underlying mechanism?

1. Skin cancer - mechanism involves dual binding to natural killer cells and myeloma sells
2. Skin cancer - mechanism involves effect on macrophage release of TNF-alpha
3. Hodgkin's Lymphoma - mechanism involves effects on neutrophil dysfunction
4. Non-Hodgkin's Lymphoma - mechanism involves effects on eosinophil dysfunction

2. A 58-year-old male with a known history of a solitary plasmacytoma of the bone (SPB) presents to your clinic, concerned that he was misdiagnosed with SPB, when in reality it was Multiple Myeloma. Evaluation of his imaging studies (CT/MRI/PET) demonstrate a solitary T6 vertebral body lesion with no evidence of any additional lesions. His CBC/CMP/ calcium, renal function, LDH, beta-2 microglobulin, CRP, SPEP, and UPEP are all within normal limits. Evaluation of his bone marrow biopsy (BMB) demonstrates 8.2% involvement of plasma cells. Based on this information what should you tell the patient?

1. You were diagnosed correctly; you need to have >10% bone marrow to meet the diagnostic criteria for multiple myeloma
2. You were diagnosed correctly; you need to have >20% bone marrow to meet the diagnostic criteria for multiple myeloma
3. You were diagnosed incorrectly; you need to have >5% bone marrow to meet the diagnostic criteria for multiple myeloma
4. You were diagnosed incorrectly; you need to have >8% bone marrow to meet the diagnostic criteria for multiple myeloma

3. A 59-year-old female patient with SLE on intermittent steroids since 7 years, now presenst to you with a fall in hemoglobin from 10.5 g/dl to of 7.9 g/dL. Work-up reveals that she has a hemolytic anemia, with undetectable haptoglobin, elevated lactate dehydrogenase to 531 U/L. Reticulocytosis is also present. LFT revealed that she has a gammaglobulin gap. Quantitative immunoglobulins reveal that she has 2.4 g/dL her IgM. Hemoglobin electrophoresis reveals that she has a monoclonal Spike, IgM. Her peripheral smear reveals that she has clumping of red blood cells. Warming of the serum to 37°C relieves the clumping. Direct Coombs’ test reveals that she has antibodies to complement C3d. Upon review, the patient states that she has pain in her fingertips and toes, when exposed to cold weather. Abdominal ultrasound does not reveal splenomegaly. The patient is diagnosed with cold agglutinin disease. Which of the following therapies would provide the best long-term therapy for this patient?

1. Splenectomy
2. Corticosteroids
3. Anti-CD20 directed monoclonal antibody
4. As needed red blood cell transfusion's

4. A 23-year-old female presents to the ER with complaints of progressive fatigue over the last 3 to 4 weeks. Her CBC reveals a white blood cell count of 7800/µL with a normal differential. Platelet count is 317,000/µL. Hemoglobin is 6.4 g/dL. MCV is 85fL. You order a reticulocyte count which comes back at 0.05%. The patient has a normal LDH as well as haptoglobin. You perform a bone marrow biopsy which reveals giant pronormoblasts. White blood cell and megakaryocyte morphology are unremarkable. What is the next mode of therapy for this patient?

1. Provide 3 units of packed red blood cells
2. Perform CT scan of the chest
3. Start patient on rituximab
4. Start induction chemotherapy with idarubicin and cytarabine

5. An 18-year-old female patient, with a diagnosis of Schwachman diamond syndrome is referred to you with an absolute neutrophil count of 1800, hemoglobin of 9.2 g/dL and platelets of 70,000. Exocrine pancreatic deficiency was diagnosed in childhood for which she son PERT and fat soluble vitamins. SBDS mutation analysis was confirmed by her pediatric hematologist. Her last bone marrow biopsy 3 years ago revealed a mildly hypocellular bone marrow. She has required growth factor for neutropenic sepsis twice in her life. What would you recommend?

1. Androgen therapy with oxymethalone
2. Routine CBC checks with consideration for bone marrow biopsy and encouragement to follow-up with a transplantation center
3. Discussion about ATG/CsA therapy
4. Clinical observation

6. A 22 year old female patient with hemoglobin of 12.5 g/dL and has an MCV of 62 fL, with peripheral smear showing numerous target cells and poikilocytosis follows up with you, with a report showing Alpha Thalassemia trait. She has never required a transfusion, and has no palpable spleen. Which of the following is a true statement regarding this condition ?

1. (--/aa) is more common amongst those of Asian ancestry than African ancestry
2. (-a/-a) is more common amongst those of Asian ancestry than African ancestry
3. Genetic counseling should be encouraged for all alpha thalassemia trait patients with or planning on having children
4. Transfusion requirements are rare throughout one's lifetime

7. A 19 year old male patient k/c/o beta thalassemia presents to you with h/o numerous blood transfusions, and says that he has never been on iron chelation. Which of the following ferritin targets is appropriate to start considering chelation therapy for patients with beta-thalassemia?

1. 200 ng/mL to 500 ng/mL
2. 500 to 1,000 ng/mL
3. 1,000 to 1,500 ng/mL
4. 2,500 to 5,000 ng/mL

8. A 65-year-old male, k/c/o Systemic HTN, dyslipidaemia, and low back ache on hydrochlorothiazide, simvastatin, and on acetaminophen, presents to his physician with c/o number of bruises on his arms and legs with no obvious signs of trauma. On physical examination, he demonstrates multiple bruises on his bilateral arms, legs, and lower back. Pertinent labs from this encounter demonstrates his PT/PTT are within normal limits, hepatitis B/C are negative, WBC 6.5 x 103 µL, HGB, 14.2 g/dL, and platelets 18,000/µL. In previous laboratory examinations, all laboratory levels were found to be within normal limits. Based on the patient's clinic presentation which of the following is the most likely explanation of the patient's findings?

1. Formation of drug-dependent antibodies
2. Inherited platelet disorder
3. Idiopathic thrombocytopenia
4. Thrombotic thrombocytopenic purpura (TTP)

9. An 18-year-old woman with spontaneous bleeds from her gums presents to you with her bleeding diathesis work up, that showed, normal coagulation studies, and a CBC demonstrating a normal platelet count (327 x10^9/L) with peripheral blood morphology demonstrating normal platelet morphology without clumping or giant platelets. She was told she has a platelet function disorder but forgets its exact name. She brings a copy of prior platelet aggregation studies for review. Which pattern of platelet aggregometry is consistent with the diagnosis of Glanzmann thrombasthenia?

1. No response to ADP or collagen; near normal response to ristocetin
2. Normal response to ADP and collagen; no response to ristocetin
3. Normal primary response to ADP with reduced secondary response; normal response to collagen and ristocetin
4. Normal response to ADP, collagen, and ristocetin

10. You are consulted on a patient in the hospital. The patient had presented to the emergency room for. The patient is 19 years old with progressive dyspnea and shortness of breath following a very long period of menorrhagia during her menstrual cycle, is referred for your opinion. Her work-up is notable for hb of 6.2 g/dL but a normal platelet count. Von Willebrand antigen, ristocetin assay and multimer assay are within normal limits. She has an elevation in her PT to 18 seconds and PTT to 45 seconds. She has no underlying liver disease. Fibrinogen level is normal. Factor activity levels for 12,11, 9, 8 and 7 are unremarkable. She has a normal factor II and factor X level. Her factor V level is suppressed to 1%. What therapy do you recommend besides blood and IV iron transfusions?

1. Cryoprecipitate
2. Recombinant factor V
3. Fresh frozen plasma
4. Platelet transfusions

11. A 25-year-old woman 12 weeks antenatal mother was tested for inheritable thrombophilia because both of her parents have a strong family history of venous thrombosis. Her mother has a h/o an unprovoked PE at age 42, and her father had a post-operative proximal lower extremity DVT at age 50. Her mother was found to be a Factor V Leiden heterozygote, while her father was never tested.Testing performed by her obstetrician revealed a homozygous point mutation in the Factor V gene. Considering the American College of Chest Physicians (ACCP) guidelines, what is the recommended anti-thrombotic management in the antepartum and postpartum settings?

1. Enoxaparin 40 mg SC daily antepartum and for 4-6 weeks postpartum
2. Surveillance but no prophylactic anticoagulation throughout
3. Surveillance in the antepartum period and warfarin targeting INR 2.0-3.0 for 6 weeks postpartum
4. Enoxaparin 1 mg/kg SC BID antepartum and for 6 weeks postpartum

12. A 58-year-old gentleman with a history of low risk MDS presents to you with scattered new skin lesions that are evolving over the course of the last 3 weeks. Physical exam reveals 7 different maculopapular lesions with an ulcerated center scattered across his back and extremities varying in size from 3 to 4 cm. Biopsy from one of the lesions reveals myeloid precursors in varying stages of maturation. His complete blood count reveals a white blood cell count of 4200/µL , hemoglobin 11.7 g/dL, platelet count of 190,000/µL. What is the ideal mode of management at this point?

1. Continued observation
2. AML induction regimen
3. Radiotherapy
4. Hypomethylating agent

13. A 78 years old male, k/c/o primary myelofibrosis with CKD stage II, and treated with ruxolitinib for anemia , stopped therapy as it was met with limited success after 3 months. Given an EPO level of 250 mU/mL, he failed a trial of ESA for three months as well as a 3-month trial of danazol. Besides the fatigue associated with the anemia, he does not have constitutional symptoms, and his spleen is not bothersome. His platelets had also worsened but are now at 140000/µL. What is proper mode of management at this point?

1. Lenalidomide + prednisone
2. Autologous stem cell transplant
3. Allogeneic stem cell transplant
4. Hydroxyurea

14. A 66-year-old male presents to his physician, with an enlarged lymph node in his right cervical neck, with no fevers, night sweats, or weight loss, undergoes a core needle biopsy which demonstrates polylobulated nuclei with laterally located nucleoli, the cells are found to be CD20+ and CD15-. He then undergoes a PET/CT which demonstrates hypermetabolic activity only within the right cervical neck. What is the recommended treatment for this patient?

1. ABVD x 2 cycles followed by 20 Gy involved-field radiation
2. Radiotherapy alone 30-36 Gy
3. Rituximab monotherapy
4. Radiotherapy alone to 45 Gy (50.4 Gy if bulky)

15. A 44-year-old gentleman while evaluating for 2-week history of progressive fatigue and petechiae of his lower extremities, reports with a CBC that reveals a white blood cell count of 1400/µL, hemoglobin of 6.9 g/dL and a platelet count of 18,000/µL. There are myeloblasts noted in the periphery. Bone marrow biopsy reveals AML with IHC staining for CD 13,33,34,117 and MPO. TDT is negative. Cytogenetics stratifies the patient as good risk and he completes a successful induction with 7+3. He is now scheduled for consolidation with high dose cytarabine. Which of the following is the correct dose?

1. 100 mg/m²
2. 1 g/m²
3. 3 g/m²
4. 5 g/m²

16. A 42-year-old gentleman with CBC showing a total WBC count of 124,000/µL, hemoglobin of 7.2 g/dL, and a platelet count of 20,000/µL is referred to your OPD. Review of the peripheral smear shows that he has numerous myeloblasts, but no Auer rods are identified. Bone marrow biopsy showed high staining for myeloperoxidase and FISH for the t(15;17) translocation is positive, and the patient is diagnosed with APL. He is started on induction therapy with ATRA, doxorubicin, and cytarabine. On day 4 of his therapy, the patient complains of shortness of breath in the morning. Physical exam reveals lower extremity edema as well as diffuse crackles over lung auscultation. Metabolic panel reveals worsening kidney function with a creatinine elevation to 2.2 mg/dL from a baseline of 1.1 mg/dL in 48 hours. He has hypoxia with an oxygen saturations of 85%. Which of the following is the most appropriate mode of therapy?

1. Start dexamethasone but continue with chemotherapy
2. Start dexamethasone and discontinued ATRA
3. Start dexamethasone and discontinue cytarabine
4. Provide supportive care, and check a DIC panel before discontinuing chemotherapy

17. A 21-year-old female patient after losing 1.5 liters of blood due to RTA was receiving 3 units of RBCs. Within minutes of starting the transfusion, she developed shortness of breath and her pulse oximetry was 88% on room air. Her dyspnea was exacerbated and she was intubated. Her CXR demonstrates bilateral pulmonary infiltrates and her vitals were temperature 38.0 degrees C, pulse 151/min, and blood pressure 90/58 mm of Hg. O/E she was tachycardic with no jugular venous distention and no peripheral edema. What is the mechanism underlying this disorder?

1. HLA antigen-antibody complexes accumulate in pulmonary capillaries resulting in pulmonary hemorrhage
2. Activation of neutrophil cytokines that damage pulmonary capillary endothelium resulting in pulmonary edema
3. Intravascular hemolysis of red blood cells
4. IgA antibodies react with IgA antigens resulting in circulatory instability and pulmonary edema

18. A 33-year-old male patient,status post matched unrelated donor allogeneic stem cell transplantation, for Philadelphia chromosome positive ALL who was treated with ponatinib + HyperCVAD, on day 13 of his transplant, with c/o abdominal pain and distension, is referred for your treatment recommendations. O/E- he has notable tenderness in the right upper quadrant. He has now shown an elevation in his bilirubin from 0.8 mg/dL to 2.2 mg/dL. The following day it is increased to 3.2 mg/dL. The patient is also gained 2 kg during the last 3 days. What is the leading cause of hyperbilirubinemia in the early pre- engraftment period ( before Day 21 ) for allogeneic stem cell transplant patients?

1. Hepatitis B reactivation
2. CMV hepatitis
3. HSV hepatitis
4. Sinusoidal Obstruction Syndrome

19. A 42-year-old female presents to the emergency department with complaints of easy bruising, petechiae, and dark-colored urine. She reports feeling increasingly fatigued over the past week. Physical examination reveals scattered petechiae and ecchymoses. Laboratory results show thrombocytopenia, anemia, and elevated serum lactate dehydrogenase (LDH). Peripheral blood smear shows schistocytes. A diagnosis of thrombotic microangiopathy is suspected. Which of the following laboratory findings is most characteristic of Thrombotic Thrombocytopenic Purpura (TTP) among thrombotic microangiopathies?

1. Increased levels of von Willebrand factor (vWF)
2. Elevated platelet counts
3. Normal ADAMTS13 activity
4. Response to vitamin K supplementation

20. A 27-year-old man presents to the emergency room with a 2-day history of multiple episodes of emesis and watery diarrhea. He reports attending a picnic 3 days ago in warm weather and eating homemade potato salad that had been unrefrigerated for several hours. On physical examination, he is afebrile with a heart rate of 120 beats/minute and a blood pressure of 95/65 mmHg. A basic laboratory evaluation reveals an elevated hemoglobin level of 18 g/dL and a hematocrit of 54%. What is the most likely cause of this patient’s polycythemia?

1. JAK-2 mutation
2. Volume depletion
3. Pheochromocytoma
4. Erythropoietin injections

21. A 46-year-old man presents to the emergency room with frequent fevers, malaise, and myalgias developing over the past week. He denies abdominal pain, diarrhea, or shortness of breath. Vital signs are temperature of 102.2°F (39°C),  pulse of 90/min, blood pressure of 130/85 mm Hg, respiratory rate of 12/min, and oxygen saturation of 98% in room air. A complete blood count shows WBC of 3000/mL, a hemoglobin of 14 g/dL, and a platelet count of 100,000/mL. The buffy coat is notable for intracytoplasmic monocyte and neutrophil inclusions (morulae). A mild elevation in aminotransferases is also noted. Which of the following acts as a vector for the infectious agent in this case?

1. Amblyomma Americanum
2. Dermacentor variabilis
3. Anopheles gambiae
4. Aedes aegypti

22. A patient with stage III HD who had relapsed disease 6 months post autologous stem cell transplant, after being in remission for sometime, presents to your OPD. How would you manage this high-risk disease?

1. Observation
2. Anti-pd – l1 therapy
3. Brentuximab vedontin
4. Tandem autologous stem cell transplant

Also Read: NEET SS Medicine: List of Important Topics

23. A 48-year-old man, ECOG 0, presents to your OPD with a recent diagnosis of  AML. He complains of mild fatigue, with no other clinical stigmata related to his disease process. What would be your category 1 recommendation for induction therapy

1. Standard dose cytarabine 100-200 mg/m2 continuous infusion x 7 days with idarubicin 12 mg/m2 or daunorubicin 60-90 mg/m2 x 3 days.
2. Standard dose cytarabine 200 mg/m2 continuous infusion x 7 days with daunorubicin 60 mg/m2 x 3 days and cladribine 5 mg/m2 x 5 days.
3. High-dose cytarabine (HiDAC) 2 g/m2 every 12 hours for 6 days or 3 g/m2 every 12 hours x 4 days with idarubicin 12 mg/m2 or daunorubicin 60 mg/m2 x 3 days.
4. Fludarabine 30 mg/m2 IV days 2-6, HiDAC 2 g/m2 over 4 hours starting 4 hours after fludarabine on days 2-6, idarubicin 8 mg/m2 IV days 4-6, and G-CSF SC daily days 1-7

24. A 95 years gentleman, with newly diagnosed MDS, with hb of 6.5g/dL is planned for a PRBC transfusion. He is scared about contracting HIV. What is the incidence of contracting HIV from 1 unit of packed red blood cells?

1. 1/100
2. 1/1000
3. 1/100,000
4. 1/2,000,000

25. Which of the following characteristics makes umbilical cord blood ideal as a stem cell source for hematopoietic stem cell transplant?

1. The large volume of cord blood acquired from each donor
2. Expanded donor pool when compared to adult stem cell donor pool
3. The large number of T cell present in cord blood
4. Cord blood stem cells will not result in Graft versus Host Disease

26. A 41-year-old female that presents to the ER with profound anemia, Hb of 6.2 g/dL. The patient has had around 40 units of blood transfusions last year. She has undergone upper endoscopies, colonoscopies, push enteroscopy, two capsule endoscopies, and several fecal occult blood test all of which of been negative. Iron studies are not reliable, as she has had several blood transfusions during the last 3 weeks. Reticulocyte count is elevated to 15%. B12/folate work-up has been normal. Bone marrow biopsy reveals repleted iron stores. There has never been any sign of hemolysis. Hemoglobin electrophoresis is normal as well. Patient states that she is always vomiting blood at home. The patient has a central line that was placed given the chronic nature of blood transfusions. What is the ideal mode of management?

1. Repeat upper endoscopy
2. Ethics, psychiatry and social worker consult
3. Hemoglobin mutation analysis
4. Repeat vitamin B12 and folate studies

27. An 18-year-old female patient, with a diagnosis of Schwachman diamond syndrome is referred to you with an absolute neutrophil count of 1800, hemoglobin of 9.2 g/dL and platelets of 70,000. Exocrine pancreatic deficiency was diagnosed in childhood for which she son PERT and fat soluble vitamins. SBDS mutation analysis was confirmed by her pediatric hematologist. Her last bone marrow biopsy 3 years ago revealed a mildly hypocellular bone marrow. She has required growth factor for neutropenic sepsis twice in her life. What would you recommend?

1. Androgen therapy with oxymethalone
2. Routine CBC checks with consideration for bone marrow biopsy and encouragement to follow-up with a transplantation center          
3. Discussion about ATG/CsA therapy
4. Clinical observation

28. A 22 year old female patient with hemoglobin of 12.5 g/dL and has an MCV of 62 fL, with peripheral smear showing numerous target cells and poikilocytosis follows up with you, with a report showing Alpha Thalassemia trait. She has never required a transfusion, and has no palpable spleen. Which of the following is a true statement regarding this condition ?

1. (--/aa) is more common amongst those of Asian ancestry than African ancestry
2.    (-a/-a) is more common amongst those of Asian ancestry than African ancestry
3. Genetic counselling should be encouraged for all alpha thalassemia trait patients with or planning on having children
4. Transfusion requirements are rare throughout one's lifetime

29. A 45-year-old male patient who 8 weeks ago was treated with IVIG and high dose dexamethasone for new isolated thrombocytopenia with a platelet count of 4 x 10^9/L, now comes to you for follow-up. You discover that he is having a relapse, and despite retreatment with glucocorticoids his platelet count continues to be 8 x 10^9/L. You discuss treatment options including splenectomy and rituximab as second line therapy. Which of the following is true regarding therapy with rituximab for ITP?

1. Time to response is typically around 6 months

2. Overall response rate (plt > 50) is around 85%

3. Median duration of response is less than 1 year

4. Response rates to rituximab were higher in splenectomy naive patients

30. A 27-year-old gentleman with bone marrow biopsy confirmed AML, while evaluating for pancytopenia reports to you 2 weeks later with his repeat BMA biopsy after completing induction chemotherapy with a standard 7+3 regimen. The report shows a recovering marrow with no evidence of blasts. You now have a report of his molecular studies cytogenetics and FISH. He has FLT3-ITD ( high allelic ratio) and mutated NPM1. What is the patient’s risk status ?

1. Low
2. Intermediate
3. High
4. Very high

31. A 27-year-old female, with progressive fatigue and weight loss was noted to have WBC count of 45,000/µL. Differential reveals 90% neutrophils and 5% basophils, hemoglobin of 11.2 g/dL, and a normal platelet count. Her spleen is only 2 cm below the costal margin. Bone marrow biopsy does not reveal excess blasts. BCR-ABL transcript is detected. She has a low Sokal index score. Which therapy would be most appropriate for her?

1. Imatinib

2. Bosutinib

3. Dasatinib

4. All of the above

32. A 36 year-old male presents with an early-stage favourable risk Hodgkin lymphoma. After 2-3 cycles of ABVD, the patient receives a PET/CT. Three large clinical trials evaluated omitting radiation therapy after a negative PET/CT in this clinical scenario (HD16, EORTC H10 and UK RAPID). All three clinical trials had the same Deauville score cut off for a positive post-chemotherapy PET/CT. What is the lowest Deauville score to be considered positive on all three clinical trials

 1. Deauville 2

2. Deauville 3

3. Deauville 4

4. Deauville 5

33. A 35-year-old gentleman on day 145 post allogeneic stem cell transplantation for high risk FLT 3+ AML, while evaluating for fatigue was found to have a drop in hemoglobin from of baseline 10.5 g/dL to 7.4 g/dL, with an elevation in LDH to 720U/L and an undetectable haptoglobin. Platelet count is now 35,000/µL from 210,000/µL a few weeks ago. Review the peripheral smear shows numerous schistocytes, >20 per high power field. ADAMTS13 level is at 60% activity. He is on prednisone and cyclosporine. What is the ideal mode of therapy?

1. Discontinuation of CSA and provide supportive PRBC

2. Plasmapheresis

3. Red cell exchange

4. Observation

34. A 65-year-old female, who declined transplant referral, and progressed on treatment with bortezomib, thalidomide, and dexamethasone while being treated for IgG lambda MM comes to you for follow-up. Prior to starting he had Creatinine 1.4 mg/dL, hemoglobin of 8.9 g/dL, total protein 8.9 g/dL, monoclonal protein load of 4.1 g/dL. Skeletal survey revealed a single lytic lesion in the femur. Due to progression, she switched to pomalidomide + elotuzumab + dexamethasone. Which secondary malignancies should she be monitored for and what is the underlying mechanism?

1. Skin cancer - mechanism involves dual binding to natural killer cells and myeloma sells

2. Skin cancer - mechanism involves effect on macrophage release of TNF-alpha

3. Hodgkin's Lymphoma - mechanism involves effects on neutrophil dysfunction

4. Non-Hodgkin's Lymphoma - mechanism involves effects on eosinophil dysfunction

35. A 21-year-old female patient after losing 1.5 liters of blood due to RTA was receiving 3 units of RBCs. Within minutes of starting the transfusion, she developed shortness of breath and her pulse oximetry was 88% on room air. Her dyspnea was exacerbated and she was intubated. Her CXR demonstrates bilateral pulmonary infiltrates and her vitals were temperature 38.0 degrees C, pulse 151/min, and blood pressure 90/58 mm of Hg. O/E she was tachycardic with no jugular venous distention and no peripheral edema. What is the mechanism underlying this disorder?

1. HLA antigen-antibody complexes accumulate in pulmonary capillaries resulting in pulmonary hemorrhage

2. Activation of neutrophil cytokines that damage pulmonary capillary endothelium resulting in pulmonary edema

3. Intravascular hemolysis of red blood cells

4. IgA antibodies react with IgA antigens resulting in circulatory instability and pulmonary edema

36. A 31-year-old female, with intermediate risk AML, who went into complete remission after induction therapy with daunorubicin and cytarabine, presents for follow-up after her transplant evaluation. She has several siblings, 2 of which are perfect HLA match. You are considering a myelo ablative regimen in her reviewing the treatment protocol along with the GVHD prophylactic regimen. Which of the following GVHD prophylactic regimens is acceptable for a patient undergoing myeloablative stem cell transplantation?

1. Methotrexate

2. Methotrexate plus cyclosporine

3. Methotrexate plus cyclosporine plus ATG

4. Methotrexate plus cyclosporine plus ATG plus ciprofloxacin

37. A 42-year-old female presents to the emergency department with complaints of easy bruising, petechiae, and dark-colored urine. She reports feeling increasingly fatigued over the past week. Physical examination reveals scattered petechiae and ecchymoses. Laboratory results show thrombocytopenia, anemia, and elevated serum lactate dehydrogenase (LDH). Peripheral blood smear shows schistocytes. A diagnosis of thrombotic microangiopathy is suspected. Which of the following laboratory findings is most characteristic of Thrombotic Thrombocytopenic Purpura (TTP) among thrombotic microangiopathies?

1. Increased levels of von Willebrand factor (vWF)

2. Elevated platelet counts

3. Normal ADAMTS13 activity

4. Response to vitamin K supplementation

38. A 13-year-old boy with a past medical history of Crohn’s disease is in the recovery room following an upper endoscopy. He complains to the nurse that he feels dizzy and has a headache. His pulse oximetry reading of 85% in room air and physical examination is remarkable for cyanosis and lethargy. An arterial blood gas (ABG) reveals blood with a “brown” discoloration and the patient is placed on supplemental oxygen. The partial pressure of oxygen (PaO2) on the arterial blood gas analysis is likely to be which of the following

1. 250 mm Hg

2. 55 mm Hg

3. 30 mm Hg

4. 90 mm Hg

39. A 47 yrs. female, severe case of schizophrenia is referred to you with a CBC revealing a white blood cell count of 1,700/µL, a hemoglobin of 8.2 g/dL, a platelet count of 110,000/µL. Bone marrow biopsy reveals dysplastic features and myeloid precursors. Which of the following medications, if taken in excess can lead to a pancytopenia with dysplastic features?

1. Lithium

2. Zinc

3. Calcium

4. Vitamin C

40. A 42-year-old female post Roux-en-Y gastric bypass for morbid obesity 24 months ago presents to you with a hemoglobin decline from 12 g/dL to 8g/dL. There is no evidence of any gastrointestinal blood loss. You perform a bone marrow biopsy which reveals ringed sideroblasts. Which of the following is the most likely cause?

1. Magnesium deficiency

2. Iron deficiency

3. Copper deficiency

4. Zinc deficiency

41. A 23-year-old male presents to the ER with progressive fatigue and increasing episodes of epistaxis. O/E you discover undescended testicles and numerous large freckles. CBC demonstrated thrombocytopenia, neutropenia, and anaemia, bone marrow biopsy demonstrated numerous fat cells and <25% of normal cellularity. What condition is most closely linked to this patient's clinical presentation?

1. Acute leukaemia

2. Fanconi anemia 

3. Paroxysmal noctural hemoglobinuria

4. HIV infection

42. A 19 year old male patient k/c/o beta thalassemia presents to you with h/o numerous blood transfusions, and says that he has never been on iron chelation. Which of the following ferritin targets is appropriate to start considering chelation therapy for patients with beta-thalassemia?

1. 200 ng/mL to 500 ng/mL

2. 500 to 1,000 ng/mL

3. 1,000 to 1,500 ng/mL

4. 2,500 to 5,000 ng/mL

43. In a patient with Glanzmann’s Thrombasthenia, the step in haemostasis that is most likely to be disrupted is which of the following?

1. Exposure of the endothelium

2. Platelet activation

3. Platelet production

4. Binding and immobilization of vWF and fibrinogen

44. A 44 year with c/o fatigue of 2 weeks duration, now presents with WBC 3400/µL, Hb 7g/dL and platelet count 25,000 cells/mm3. There are blasts on the peripheral smear, and is diagnosed with IDH1 mutated AML, and starts standard induction chemotherapy. Which of the followed metabolites is a product of this mutated enzyme?

1. Isocitrate

2. ?-hydroxy-glutarate

3. ?-keto-glutarate

4. Succinate

45. A 59-year-old female undergoes a core biopsy from a slowly growing 4 cm firm lymph node in her supraclavicular region. Biopsy reveals a population of lymphocytes that stain positively for CD5, 19, 20, 23. You perform a staging CT, revealing only a single lymph node chain without evidence of adenopathy anywhere else. Serum LDH, CMP and CBC are within normal limits. Bone marrow biopsy with flow cytometry and cytogenetics are also unremarkable. What would be your neck step in management?

1. PET / CT for proper staging

2. Radiotherapy to the supraclavicular lymph node

3. Ibrutinib

4. Bendamustine plus rituximab

46. A 77-year-old gentleman ECOG 1-2 is diagnosed with AML , while evaluating for fatigue. His CBC showed WBC 2,100, hb 8.0 g/dL and plt 37,000. Besides pallor, and pulmonary wheezing, physical examination was non-contributory. Bone marrow biopsy confirms the presence of M2 AML with no mutations. Which of the listed treatments is most appropriate?

1. Idarubicin plus low dose cytarabine (5+ 2)

2. Ara-C 1g/m2 for 3 cycles

3. Idarubicin alone

4. Decitabine plus venetoclax

47. Which two factors are used to determine median overall survival in the multiple myeloma International Staging System(ISS)?

1. Beta-2 microglobulin and Albumin

2. PTT and Bilirubin

3. Calcium and INR

4. M-protein and LDH

48. A 27-year-old female, who is now day 47 of a matched unrelated donor stem cell transplant, for high-risk ALL, develops a maculopapular rash on her right forearm, 3% of her TBSA, with no other lesions anywhere, but occasional loose stools and is referred for your opinion. LFT is normal, and she’s on oral cyclosporine with a serum trough of 150 µg / L. What would you recommend as far as treatment is concerned ?

1. Topical hydrocortisone

2. Topical fluocinonide

3. Increase cyclosporine dose to target a trough between 200 - 300 µg / L

4. Increase cyclosporine dose to target a trough between 200 to 300 µg / L and add topical fluocinonide

Also Read: Basics of Neutrophils And Disorders of Neutrophils

Hope you found this blog helpful for your NEET SS hematology preparation. For more informative and interesting posts like these, keep reading PrepLadder’s blogs.