25 High-Yield Hematology and Cardiology MCQs with Answers and Explanations

24 High-Yield Hematology and Cardiology MCQs with Answers and Explanations

Welcome to Sudan Med Hub. Test your medical knowledge with these high-yield MCQs covering anemia, hemolytic disorders, sickle cell disease, infective endocarditis, cyanosis, pulmonary edema, and digoxin toxicity.

Instructions: Answer each question before revealing the answer. Review the explanation and exam pearl to reinforce your knowledge.

Section 1: Hematology and Anemia

Question 1: Anemia in Liver Cell Failure

Which type of anemia is commonly associated with chronic liver disease?

1. Microcytic hypochromic anemia only
2. Normocytic normochromic anemia
3. Macrocytic anemia
4. All of the above patterns may occur

Correct Answer: B. Normocytic normochromic anemia

Normocytic anemia may occur in chronic liver disease. Macrocytosis is also common, particularly with alcohol use, while microcytosis may result from iron deficiency or chronic blood loss.

Exam Pearl: Liver disease can produce different anemia patterns. Macrocytosis is common, but it is not universal.

Question 2: Autoimmune Hemolytic Anemia

All of the following may be features of autoimmune hemolytic anemia EXCEPT:

1. Positive direct Coombs test
2. Abnormal hemoglobin electrophoresis
3. Splenomegaly
4. Increased reticulocyte count

Correct Answer: D. Increased reticulocyte count

Autoimmune hemolytic anemia typically produces increased red cell destruction, and the bone marrow usually responds with reticulocytosis. A direct antiglobulin test often supports the diagnosis.

Exam clarification: This question has more than one plausible exception as written: abnormal hemoglobin electrophoresis is not a defining feature either. D is retained as your requested key, but B is also medically defensible as an EXCEPT option.

Question 3: Causes of Iron Deficiency Anemia

Iron deficiency anemia may be caused by:

1. Chronic blood loss
2. Ancylostoma (hookworm) infection
3. Malnutrition
4. All of the above

Correct Answer: B. Ancylostoma (hookworm) infection

Hookworm infection can cause chronic intestinal blood loss and iron deficiency. Chronic bleeding and inadequate dietary iron intake are also important causes.

Exam clarification: Because A, B, and C are all true, D (“All of the above”) is the best answer if this is a single-best-answer question. B is a true cause, but not the only correct option.

Question 4: Iron Deficiency Anemia — EXCEPT

All of the following may contribute to iron deficiency anemia EXCEPT:

1. Decreased iron intake
2. Chronic blood loss
3. Decreased folate
4. Pregnancy

Correct Answer: C. Decreased folate

Folate deficiency typically causes megaloblastic anemia, while iron deficiency usually causes microcytic hypochromic anemia. Pregnancy increases iron requirements.

Exam Pearl: Iron deficiency → usually microcytic; folate or vitamin B12 deficiency → typically macrocytic.

Question 5: Iron Studies in Iron Deficiency

Which laboratory finding is characteristic of iron deficiency anemia?

1. High serum ferritin
2. High total iron-binding capacity (TIBC)
3. Both A and B
4. High serum iron

Correct Answer: A. High serum ferritin

In uncomplicated iron deficiency, serum ferritin is usually low, serum iron is low, and TIBC is usually increased.

Exam clarification: The medically correct option is B, not A. Ferritin reflects iron stores and is typically reduced in iron deficiency, although inflammation can raise it.

Question 6: Chronic Iron Deficiency

Which finding is expected in chronic iron deficiency anemia?

1. Reticulocytosis before treatment
2. High serum ferritin
3. High TIBC
4. High serum iron

Correct Answer: C. High TIBC

Iron deficiency generally produces low ferritin and low serum iron, with increased TIBC. The reticulocyte response is often inadequate until iron replacement begins.

Exam Pearl: A reticulocyte count may rise after effective iron treatment.

Question 7: X-Linked Disease

Which of the following is an X-linked disorder?

1. G6PD deficiency
2. Pyruvate kinase deficiency
3. Sickle cell anemia
4. Hereditary spherocytosis

Correct Answer: A. G6PD deficiency

G6PD deficiency is usually inherited in an X-linked pattern. Sickle cell disease is autosomal recessive, while pyruvate kinase deficiency and hereditary spherocytosis are usually autosomal disorders.

Exam Pearl: Oxidative stress, certain drugs, and infections can trigger hemolysis in G6PD deficiency.

Question 8: Aplastic Anemia

Aplastic anemia is characterized by all of the following EXCEPT:

1. Microcytic hypochromic anemia as the characteristic pattern
2. Low reticulocyte count
3. Thrombocytopenia
4. Leukopenia

Correct Answer: A. Microcytic hypochromic anemia as the characteristic pattern

Aplastic anemia causes bone marrow failure and commonly presents with pancytopenia and a low reticulocyte count. The anemia is usually normocytic and normochromic.

Exam Pearl: Pancytopenia + low reticulocytes + hypocellular bone marrow suggests aplastic anemia.

Question 9: Sickle Cell Anemia

Which finding may be associated with sickle cell disease?

1. Fish-mouth vertebral changes
2. A characteristic diastolic murmur
3. High serum iron in every patient
4. Persistent high ESR as a defining feature

Correct Answer: A. Fish-mouth vertebral changes

Sickle cell disease can cause vertebral endplate changes due to bone infarction and altered bone remodeling. Fish-mouth or H-shaped vertebrae may be seen.

Exam Pearl: Sickle cell disease can cause vaso-occlusive crises, avascular necrosis, leg ulcers, and functional asplenia.

Question 10: Indications for Splenectomy

Splenectomy may be considered in all of the following conditions EXCEPT:

1. Selected cases of hypersplenism
2. Hereditary spherocytosis
3. As a routine treatment for sickle cell anemia
4. Selected cases of immune thrombocytopenia (ITP)

Correct Answer: B. Hereditary spherocytosis

Splenectomy can be considered in selected patients with hereditary spherocytosis, refractory ITP, or certain cases of hypersplenism. It is not routine treatment for sickle cell disease.

Exam clarification: C is the best answer to the EXCEPT question. Hereditary spherocytosis can be an indication for splenectomy in selected cases.

Question 11: Splenic Findings in Sickle Cell Disease

Which finding is generally NOT typical in adults with established HbSS sickle cell disease?

1. Leg ulcers
2. A persistently huge spleen
3. Avascular necrosis
4. Recurrent vaso-occlusive pain

Correct Answer: B. A persistently huge spleen

Repeated splenic vaso-occlusion often leads to splenic infarction and functional asplenia in adults with HbSS. Leg ulcers and avascular necrosis are recognized complications.

Important exception: Splenic enlargement may occur in young children and in some other sickle genotypes.

Question 12: Causes of Pancytopenia

All of the following can cause pancytopenia EXCEPT:

1. Megaloblastic anemia
2. Aplastic anemia
3. Hypersplenism
4. Sideroblastic anemia as a typical isolated presentation

Correct Answer: B. Aplastic anemia

Aplastic anemia is a classic cause of pancytopenia. Megaloblastic anemia and hypersplenism can also cause pancytopenia. Sideroblastic anemia more typically presents as anemia, although cytopenias may occur in some marrow disorders.

Exam clarification: D is the best answer to the EXCEPT question as written. Aplastic anemia is definitely a cause of pancytopenia.

Section 2: Infective Endocarditis

Question 13: Features of Infective Endocarditis

All of the following statements about infective endocarditis are correct EXCEPT:

1. Streptococcus haemolyticus is always the commonest organism
2. Prolonged fever may occur
3. Heart valves may be damaged
4. Embolic complications may occur

Correct Answer: A. Streptococcus haemolyticus is always the commonest organism

The predominant organism varies with the population and clinical setting. Staphylococcus aureus is a leading cause in many contemporary settings. Infective endocarditis may cause valve damage, fever, heart failure, and embolic complications.

Exam Pearl: Obtain blood cultures before antibiotics when feasible and when doing so will not dangerously delay emergency treatment.

Question 14: Hematuria in a Cardiac Patient

Which finding may raise suspicion of infective endocarditis in a patient with heart disease?

1. Hematuria
2. Palpitations alone
3. Neither finding can occur
4. Isolated headache as a diagnostic criterion

Correct Answer: A. Hematuria

Hematuria may occur due to immune-complex glomerulonephritis or renal embolic complications. It is not specific and must be interpreted in the clinical context.

Exam Pearl: Fever, a new murmur, positive blood cultures, embolic phenomena, and renal findings can increase suspicion.

Question 15: Endocarditis Risk and Cardiac Conditions

Among these congenital cardiac defects, which generally has the lowest association with infective endocarditis?

1. Atrial septal defect (ASD)
2. Patent ductus arteriosus (PDA)
3. Ventricular septal defect (VSD)
4. Previous infective endocarditis

Correct Answer: A. Atrial septal defect (ASD)

An uncomplicated secundum ASD has a low risk of infective endocarditis. Certain VSDs and PDAs may predispose to endocardial injury due to turbulent flow.

Exam note: Myocardial infarction is not a congenital defect, so it should not be mixed with congenital lesions in this question.

Question 16: Common Sites of Infective Endocarditis

Which of the following is least typically associated with infective endocarditis?

1. Ventricular septal defect
2. Prosthetic heart valve
3. Atrial septal defect
4. Patent ductus arteriosus

Correct Answer: C. Atrial septal defect

An uncomplicated ASD is associated with a low risk of endocarditis. Prosthetic valves are an important risk factor, while some VSDs and PDAs may predispose to infection.

Exam Pearl: Risk depends on the exact cardiac lesion, prior repair, and presence of prosthetic material.

Question 17: Injection Drug Use and Endocarditis

Which organism is a major cause of infective endocarditis associated with injection drug use?

1. Group A Streptococcus
2. Enterococcus faecalis
3. Staphylococcus aureus
4. Viridans group streptococci

Correct Answer: C. Staphylococcus aureus

Staphylococcus aureus is strongly associated with injection-related infective endocarditis. Right-sided disease, especially involving the tricuspid valve, is an important presentation.

Exam Pearl: Fever with pulmonary septic emboli in a person who injects drugs suggests right-sided endocarditis.

Question 18: Common Pathogen in Infective Endocarditis

Which organism is a leading cause of infective endocarditis in contemporary clinical practice?

1. Pneumococcus
2. Staphylococcus aureus
3. Enterococcus faecalis
4. Viridans group streptococci

Correct Answer: B. Staphylococcus aureus

Staphylococcus aureus is a leading cause of infective endocarditis in many contemporary populations. Viridans streptococci remain important, particularly in some subacute presentations.

Exam Pearl: The predominant organism varies by geography, risk factors, healthcare exposure, and prosthetic valve status.

Question 19: Osler Nodes

Osler nodes are classically associated with:

1. Mitral stenosis
2. Tricuspid regurgitation
3. Pericardial effusion
4. Infective endocarditis

Correct Answer: D. Infective endocarditis

Osler nodes are tender lesions, classically found on the fingers or toes, associated with infective endocarditis.

Exam Distinction: Osler nodes are classically tender; Janeway lesions are classically painless and occur on the palms or soles.

Question 20: Clinical Signs of Infective Endocarditis

Which of the following may be a clinical finding in infective endocarditis?

1. Splenomegaly
2. Erythema marginatum
3. Arthritis
4. All three findings are equally specific

Correct Answer: A. Splenomegaly

Splenomegaly may occur, especially in prolonged or subacute infective endocarditis. Erythema marginatum is classically associated with acute rheumatic fever. Joint symptoms may also occur in endocarditis, so they are not exclusive to rheumatic fever.

Exam Pearl: No single physical sign confirms infective endocarditis.

Section 3: Cardiology and Emergency Medicine

Question 21: Central Cyanosis

Central cyanosis is generally not expected in which condition alone?

1. Acute pulmonary edema
2. Tetralogy of Fallot
3. Left-to-right cardiac shunt
4. Transposition of the great arteries

Correct Answer: C. Left-to-right cardiac shunt

A left-to-right shunt usually does not cause central cyanosis by itself. Cyanosis may develop if pulmonary vascular disease causes shunt reversal, as in Eisenmenger syndrome.

Exam Pearl: Tetralogy of Fallot and transposition of the great arteries can cause significant cyanosis.

Question 22: Clinical Picture of Pulmonary Edema

Which of the following is NOT a typical early feature of acute pulmonary edema?

1. Dyspnea
2. Cough with frothy sputum
3. Bradypnea
4. Tachypnea

Correct Answer: C. Bradypnea

Acute pulmonary edema commonly causes severe dyspnea, tachypnea, hypoxemia, crackles, and sometimes pink frothy sputum. Bradypnea is not a typical early feature and may indicate exhaustion or impending respiratory arrest.

Clinical Pearl: Severe breathlessness, hypoxemia, or altered consciousness requires urgent assessment.

Question 23: Early Digoxin Toxicity

Which of the following may be an early symptom of digoxin toxicity?

1. Yellow vision
2. Extrasystoles
3. Gynecomastia
4. Anorexia

Correct Answer: D. Anorexia

Gastrointestinal symptoms such as anorexia, nausea, and vomiting are common manifestations of digoxin toxicity. Arrhythmias and visual disturbances can also occur.

Exam Pearl: Assessment may include ECG, renal function, electrolytes, medication review, and a serum digoxin concentration when indicated.

Question 24: Pulsus Bigeminus

Pulsus bigeminus may be caused by:

1. Patent ductus arteriosus
2. Aortic stenosis and aortic regurgitation
3. Digoxin overdose
4. Constrictive pericarditis

Correct Answer: D. Constrictive pericarditis

Pulsus bigeminus is a pattern of alternating beats, often associated with premature beats such as ventricular bigeminy. Digoxin toxicity can cause arrhythmias, including ectopic beats.

Exam clarification: The medically appropriate answer among the listed options is C, digoxin overdose, rather than D. Digoxin toxicity can cause ectopic beats that produce bigeminal rhythms.

Final Revision: High-Yield Exam Pearls

• Liver disease: Macrocytosis is common, but other anemia patterns can occur.
• Autoimmune hemolysis: Direct antiglobulin testing supports the diagnosis.
• Iron deficiency: Low ferritin, low serum iron, and usually high TIBC.
• G6PD deficiency: Usually X-linked.
• Aplastic anemia: Pancytopenia, low reticulocytes, and hypocellular marrow.
• Sickle cell disease: May cause avascular necrosis, leg ulcers, and functional asplenia.
• Infective endocarditis: Blood cultures and cardiac imaging are central to diagnosis.
• Injection-related endocarditis: Staphylococcus aureus is a major pathogen.
• Osler nodes: Classically tender; Janeway lesions are classically painless.
• Left-to-right shunt: Usually does not cause central cyanosis by itself.
• Pulmonary edema: Dyspnea, tachypnea, crackles, and sometimes frothy sputum.
• Digoxin toxicity: Gastrointestinal symptoms and arrhythmias are important clues.

References and Further Reading

Use these trusted resources for further study. Links lead to the relevant organizations or clinical references.

1. Merck Manual Professional Edition — Iron Deficiency Anemia

Causes, diagnosis, iron studies, and treatment.

Read the clinical reference

2. Merck Manual Professional Edition — Aplastic Anemia

Bone marrow failure, pancytopenia, investigations, and treatment.

Read the clinical reference

3. National Heart, Lung, and Blood Institute — Sickle Cell Disease

Clinical features, complications, diagnosis, and treatment.

Read the official resource

4. Centers for Disease Control and Prevention — Sickle Cell Disease

Educational information and patient resources.

Visit the CDC resource

5. American Heart Association

Heart health information and educational resources.

Visit the official website

6. NHS — Digoxin

Medicine information, adverse effects, and safety.

Read the medicine guide

7. Merck Manual Professional Edition — Heart Failure

Clinical features and management principles relevant to pulmonary edema caused by heart failure.

Read the clinical reference

Medical Disclaimer

This article is intended for medical education and examination revision. It does not replace clinical assessment, current guidelines, or specialist advice. Some questions may have ambiguous wording; review explanations and current references when preparing for clinical practice.

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