Haematology: practice question

A General Medicine question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

Try it

General Medicine · Haematology

Sample item

A 28-year-old woman presents with fever, confusion, haematuria and petechiae. Haemoglobin is low with schistocytes on the smear, platelets are very low, and PT and aPTT are normal. What is the most appropriate treatment?

AUrgent plasma exchangeBOral prednisolone alone with outpatient follow-upCPlatelet transfusionDIntravenous heparin

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

A. Urgent plasma exchange

This is thrombotic thrombocytopenic purpura: microangiopathic haemolytic anaemia, thrombocytopenia, fever, neurological and renal involvement with normal coagulation tests. Plasma exchange replaces ADAMTS13 and removes the inhibitor, and it is started urgently because mortality is high without it.

Option by option

A. Urgent plasma exchange (correct)
Correct. Plasma exchange is the established life-saving treatment for TTP.
B. Oral prednisolone alone with outpatient follow-up
Steroids alone and outpatient care are inadequate for a life-threatening illness with neurological involvement.
C. Platelet transfusion
Platelet transfusion can fuel new microthrombi and is avoided unless there is life-threatening bleeding.
D. Intravenous heparin
Heparin does not treat the ADAMTS13 deficiency and adds bleeding risk in a thrombocytopenic patient.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is A, Urgent plasma exchange. This is thrombotic thrombocytopenic purpura: microangiopathic haemolytic anaemia, thrombocytopenia, fever, neurological and renal involvement with normal coagulation tests.

Why is "Oral prednisolone alone with outpatient follow-up" not the answer?

Steroids alone and outpatient care are inadequate for a life-threatening illness with neurological involvement.

Why is "Platelet transfusion" not the answer?

Platelet transfusion can fuel new microthrombi and is avoided unless there is life-threatening bleeding.

Why is "Intravenous heparin" not the answer?

Heparin does not treat the ADAMTS13 deficiency and adds bleeding risk in a thrombocytopenic patient.

What concept does this question test?

It tests Haematology in General Medicine. Plasma exchange replaces ADAMTS13 and removes the inhibitor, and it is started urgently because mortality is high without it.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Haematology?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.