Haematology — Practice Questions

Medicine — Blood Cancers and Bleeding Disorders, NMC MBBS licence examination syllabus (Nepal Medical Council).

Haematology — NMC-style practice questions

Practice questions written for this chapter. These are not past NMC papers.

📋 About these questions: These are practice questions written to test the reasoning in this chapter. They are NOT reproduced from any past Nepal Medical Council examination, and no verified past NMC questions were supplied for this chapter. Cell count thresholds, transfusion triggers and chemotherapy regimens come from local protocol and specialist guidance.

Level 1–2 — recall and understanding

Q1. Which bleeding pattern suggests a COAGULATION FACTOR problem rather than a platelet problem? A. Petechiae and bleeding gums B. HAEMARTHROSIS and deep muscle haematoma C. Nosebleeds D. Heavy menstrual bleeding ANSWER: B. Why: factor deficiencies bleed DEEPLY and with DELAY — into joints and muscles. Platelet problems bleed superficially and immediately, into skin and mucosa. LEARNING POINT: petechiae = platelets, haemarthrosis = factors.

Q2. Anaemia together with a LOW platelet count and LOW white cell count most suggests: A. Iron deficiency B. A problem in the BONE MARROW C. Dietary deficiency alone D. Dehydration ANSWER: B. Why: anaemia alone has many causes, but involvement of all three cell lines points to marrow infiltration, failure or destruction. LEARNING POINT: request a blood film and refer for further investigation including marrow examination.

Level 3–4 — application and clinical reasoning

Q3. A patient on chemotherapy develops fever. He looks well, his chest is clear and no source is found. The correct action is: A. Await the blood count and cultures before treating B. Take cultures and give BROAD-SPECTRUM ANTIBIOTICS IMMEDIATELY C. Oral antibiotics and review tomorrow D. Paracetamol and observation ANSWER: B. Why: this is neutropenic sepsis until proven otherwise. Without neutrophils there is no inflammatory response, so there may be no pus and no localising signs — and looking well is characteristic of the early phase. LEARNING POINT: deterioration is measured in hours.

Q4. A young man has recurrent haemarthrosis, delayed prolonged bleeding after dental work, a normal platelet count, and an affected maternal uncle. This suggests: A. Immune thrombocytopenia B. An inherited COAGULATION FACTOR deficiency C. Vitamin C deficiency D. Aspirin use ANSWER: B. Why: deep delayed bleeding with normal platelets indicates a factor problem, and affected male relatives on the maternal side fit an inherited factor deficiency. LEARNING POINT: avoid intramuscular injections and NSAIDs, and plan ahead for surgery or dental procedures.

Q5. A septic patient oozes from cannula sites and gums, with falling platelets and prolonged clotting times. Repeated blood products do not control it. The key management step is: A. More platelets B. TREAT THE UNDERLYING SEPSIS C. Vitamin K alone D. Stop all fluids ANSWER: B. Why: DIC is always secondary. Factors and platelets are consumed faster than they can be replaced, so product support cannot keep pace while the trigger continues. LEARNING POINT: source control and antibiotics, with product support per protocol alongside.

Level 5 — exception-based

Q6. Which lymph node feature most warrants investigation rather than a further course of antibiotics? A. Tender, soft and mobile B. HARD, FIXED, PAINLESS and PERSISTENT C. Appearing during a sore throat D. Resolving over two weeks ANSWER: B. Why: reactive nodes are soft, tender, mobile and settle. Hard, fixed, painless and persistent nodes suggest malignancy — and in this region tuberculosis is also a leading cause. LEARNING POINT: lymphoma, TB and HIV can present similarly and all require tissue or specific testing.

Q7. Tumour lysis syndrome characteristically causes: A. Low potassium and high calcium B. HIGH POTASSIUM, high phosphate, high urate and LOW calcium C. Isolated anaemia D. Low urate ANSWER: B. Why: cells breaking down after treatment release their contents. The risks are arrhythmia from hyperkalaemia and acute kidney injury. LEARNING POINT: it follows the START of treatment and is anticipated and prevented rather than simply treated.

Syllabus points

Recall and understanding questions
Application and clinical reasoning questions
Exception-based questions

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