Written by Dr. Roupen Odabashian MD, FRCPC, FASC
Hematologist-Oncologist | Founder, MeDucation AI | Updated February 2026
The verdict: The fastest way to judge any hematology question bank is to actually do a few questions from it and read the explanations — not the marketing page. Below are five board-style hematology questions, written in the same format and difficulty range you'd expect on the ABIM Hematology exam, each with a full explanation of why the correct answer is right and why every distractor is wrong. This is a direct sample of what MeDucation AI's question bank looks like, not a teaser with the real content behind a paywall.
Conflict of interest, up front: I'm a practicing oncologist and I founded MeDucation AI, which sells a heme/onc question bank among other study tools. The questions below are representative of our bank's style and depth. I'm not going to pretend they're from some neutral third party — they're ours, and I built this article so you can judge the quality yourself before you ever consider paying for anything.
# | Topic | Blueprint category[1] | Difficulty |
|---|---|---|---|
1 | Immune thrombocytopenia (ITP) initial management | Hematologic Neoplastic Disorders / Coagulation overlap | Medium |
2 | Multiple myeloma diagnostic criteria (SLiM-CRAB) | Hematologic Neoplastic Disorders | Medium-High |
3 | Polycythemia vera diagnosis | Hematopoietic System | Medium |
4 | Smoldering myeloma imaging work-up | Hematologic Neoplastic Disorders | High |
5 | Renal insufficiency criteria in myeloma (CRAB) | Hematologic Neoplastic Disorders | Medium |
Why does question format matter this much for hematology boards?
Because the exam itself is built almost entirely out of vignette-based, single-best-answer questions tied to a specific content blueprint[1]. The ABIM Hematology blueprint allocates 35% of the exam to Hematologic Neoplastic Disorders, 27% to Coagulation, 25% to Hematopoietic System, 8% to Cellular Therapy, and 5% to Transfusion Medicine[1]. Questions are also tagged by task type — Diagnosis/Testing, Treatment/Care Decisions, Risk Assessment/Prognosis/Epidemiology, and Pathophysiology/Basic Science[1] — and at least 65% of real exam questions address content rated "high importance" by practicing hematologists, with no questions drawn from low-importance content[1]. A question bank that doesn't mirror that structure is training you for a different test than the one you're taking.
Question 1: How should you approach initial therapy in a newly diagnosed adult with ITP?
A 42-year-old woman presents with petechiae and a platelet count of 8,000/µL. Hemoglobin, white count, and peripheral smear are otherwise unremarkable. She has no bleeding beyond skin findings. What is the most appropriate next step?
A. Observation alone with repeat CBC
B. Platelet transfusion
C. Corticosteroids as initial therapy
D. Splenectomy
E. Rituximab as first-line therapy
Correct answer: C.
Why C is correct: Updated 2026 ASH guidelines specifically address initial and second-line therapy choices for adults with primary ITP, including a shared decision-making tool to help clinicians and patients choose among initial options[2].
Why the distractors are wrong:
A — Observation: A platelet count of 8,000/µL with any bleeding symptoms (even skin-only) is not a scenario for observation alone; the risk of progression to more serious bleeding warrants treatment.
B — Platelet transfusion: Transfused platelets are rapidly destroyed by the same autoimmune process and transfusion is reserved for life-threatening bleeding, not routine initial management.
D — Splenectomy: Splenectomy is a second-line or later option after initial medical therapy has been tried, not a first step.
E — Rituximab: Rituximab is a second-line therapy option, not standard initial treatment.
Question 2: Which laboratory finding alone is sufficient to diagnose multiple myeloma without CRAB features?
A 61-year-old man has a high percentage of clonal plasma cells on bone marrow biopsy, normal calcium, normal creatinine, a normal hemoglobin level, and no lytic lesions on imaging. Does he meet diagnostic criteria for multiple myeloma?
A. No, because he has no CRAB features
B. No, because bone marrow plasma cells must exceed a much higher percentage
C. Yes, because ≥60% clonal bone marrow plasma cells is itself a myeloma-defining event[3]
D. Yes, but only if confirmed by PET-CT
E. No, this meets criteria for smoldering myeloma instead
Correct answer: C.
Why C is correct: The revised IMWG criteria allow a diagnosis of active multiple myeloma based on clonal bone marrow plasma cells plus any one of three myeloma-defining events (MDEs), even without CRAB features[3]. Sixty percent or greater clonal plasma cells on bone marrow examination is explicitly one of those three MDEs[3][4], and each MDE marker is associated with an approximately 80% or higher risk of progression to CRAB-defined organ damage within two years[3][4].
Why the distractors are wrong:
A — No CRAB needed: This is the whole point of the 2014 revision — the presence of an MDE is "considered sufficient for a diagnosis of multiple myeloma, regardless of the presence or absence of symptoms or CRAB features"[3].
B — higher threshold: The threshold for this specific MDE is 60% clonal plasma cells, not a much higher percentage[3][4].
D — Requires PET-CT confirmation: The bone marrow plasma cell percentage MDE does not require imaging confirmation; imaging is used to evaluate the separate bone lesion criterion.
E — Smoldering myeloma: Smoldering myeloma requires bone marrow clonal plasma cells of 10% to less than 60% without an MDE or CRAB feature; a patient with 60% or greater clonal plasma cells, with no MDE needed beyond the count itself, has crossed into active myeloma[3].
Question 3: What combination of findings confirms a diagnosis of polycythemia vera?
A 58-year-old man has an elevated hemoglobin level, a bone marrow biopsy showing trilineage hypercellularity with pleomorphic megakaryocytes, and a subnormal serum erythropoietin level. JAK2 testing is pending. Based on the WHO criteria, can PV be diagnosed now?
Correct answer: B.
Why the distractors are wrong:
A — JAK2 mandatory: JAK2 V617F or exon 12 mutation is one of the three major criteria, but the WHO framework allows diagnosis using the first two major criteria plus the minor criterion as an alternative path[5], so a mutation result isn't mandatory if that combination is already met. About 95% of PV patients do carry a JAK2 V617F mutation and a further 3% carry an exon 12 mutation[5], but the diagnostic pathway used here doesn't depend on it.
C — Biopsy never sufficient alone: The biopsy requirement can actually be waived in patients with sustained absolute erythrocytosis above specific hemoglobin/hematocrit thresholds if the JAK2 and erythropoietin criteria are present[5] — it's not an absolute requirement in every case, and it certainly isn't "never sufficient" when combined with other criteria as it is here.
D — EPO should be elevated: The minor criterion specifically requires a subnormal erythropoietin level, not an elevated one[5] — elevated EPO points toward secondary erythrocytosis instead.
E — Hematocrit threshold too high: The major criterion threshold for hematocrit is above 49% in men or above 48% in women[5], not a higher value.
Question 4: Which imaging study should be used to evaluate a patient with suspected smoldering multiple myeloma?
A patient meets laboratory criteria for smoldering myeloma. A whole-body skeletal survey is negative for lytic lesions. Insurance has denied FDG-PET-CT. What is the most appropriate next step?
A. Accept the skeletal survey result as sufficient and proceed to active surveillance
B. Pursue whole-body low-dose CT or MRI
C. Repeat the skeletal survey after an interval
D. No further imaging is needed if bone marrow plasma cells are below a certain percentage
E. Proceed directly to bone marrow MRI of the hips only
Correct answer: B.
Why B is correct: The IMWG recommends that one of PET-CT, low-dose whole-body CT (LDWBCT), or whole-body/spine MRI be performed in all patients with suspected smoldering myeloma, with the specific modality chosen based on availability and resources[3]. Whole-body skeletal survey has major sensitivity limitations for detecting bone disease in plasma cell dyscrasias and isn't recommended unless access to contemporary imaging is limited[6]; among patients with smoldering myeloma and a negative skeletal survey, roughly 20 to 30 out of 100 are typically found to have myeloma-defining bone lesions on more sensitive imaging such as FDG-PET-CT[6].
Why the distractors are wrong:
A — Accept the skeletal survey: Skeletal survey's sensitivity limitations mean a negative result does not rule out bone involvement, and it specifically should not be the last word when more sensitive imaging is accessible[6].
C — Repeat skeletal survey: Repeating the same lower-sensitivity test doesn't address its fundamental limitation; the IMWG direction is toward a different, more sensitive modality[3], not a repeat of the same one.
D — No further imaging below a plasma cell threshold: Imaging recommendations for suspected smoldering myeloma are not contingent on the bone marrow plasma cell percentage being below a specific cutoff; imaging is recommended for the work-up regardless[3].
E — MRI of the hips only: IMWG guidance favors whole-body or spine MRI rather than an isolated regional study; isolated spine MRI alone may already miss approximately 10% of myeloma bone lesions, and a hip-only study would be narrower still[6].
How is renal insufficiency defined for myeloma CRAB criteria, and why does it trip people up?
This definition is tested often because the exact numeric cutoff is easy to misremember. For myeloma CRAB criteria, renal insufficiency is defined as creatinine clearance below 40 mL per minute or serum creatinine above 177 micro mol/L (above 2 mg/dL)[3]. The 2014 IMWG criteria actually prioritize using measured or estimated glomerular filtration rate below 40 mL/min (roughly a 40% decrease from the lower limit of normal GFR) over a fixed serum creatinine threshold, but allow the fixed creatinine cutoff of >2 mg/dL because not every institution worldwide reports estimated GFR[6].
CRAB feature | Threshold[4] |
|---|---|
Hypercalcemia | Serum calcium >0.25 mmol/L (>1 mg/dL) higher than the upper limit of normal or >2.75 mmol/L (>11 mg/dL)[3] |
Renal impairment | Serum creatinine >177 micro mol/L (>2 mg/dL), or creatinine clearance <40 mL per minute[3] |
Anemia | Hemoglobin value >20 g/L below the lowest limit of normal, or a hemoglobin value <100 g/L[3] |
Bone lesions | One or more osteolytic lesion on skeletal radiography, CT, or PET/CT[3] |
Question 5: A patient has a creatinine of 2.3 mg/dL attributed to a monoclonal plasma cell disorder. Does this meet the "R" in CRAB?
A. No, the cutoff is higher
B. Yes, because it exceeds the >2 mg/dL threshold[3]
C. No, only creatinine clearance can be used, never serum creatinine
D. Yes, but only if accompanied by hypercalcemia
E. No, renal insufficiency is not part of CRAB
Correct answer: B.
Why B is correct: A serum creatinine exceeding the >177 micro mol/L (>2 mg/dL) threshold satisfies the renal impairment CRAB criterion[3] on its own.
Why the distractors are wrong:
A — Cutoff is higher: The published threshold is >177 micro mol/L (>2 mg/dL), not a higher value[3].
C — Only CrCl counts: Both creatinine clearance <40 mL/min and serum creatinine >2 mg/dL are accepted, with the 2014 IMWG criteria preferring estimated GFR but explicitly retaining the fixed serum creatinine cutoff as an alternative[6].
D — Requires concurrent hypercalcemia: Each CRAB feature stands on its own; only one feature is required to satisfy the "CRAB" portion of diagnostic criteria, not a combination.
E — Not part of CRAB: Renal impairment is literally the "R" in CRAB[3][4].
What should these five questions tell you about a question bank before you buy one?
They should tell you whether explanations teach the reasoning or just reveal the answer. Every explanation above addresses the correct choice and walks through why each distractor fails — the same structure MeDucation's physician-written and physician-reviewed hematology-oncology question bank uses throughout, with explanations covering why the correct answer is right and why each distractor is wrong, embedded images and tables where relevant, and direct PubMed links for further reading. The questions are not AI-generated; they're written and reviewed by board-certified hematologist-oncologists. The bank also includes AI read-aloud, adjustable text size, and highlight/underline/strikethrough tools for active review.
If you're deciding whether a paid bank is worth it at all for your study plan, our free vs. paid board prep breakdown walks through that decision directly, and our ABIM Hematology blueprint and resource guide covers how to map any question bank's coverage against the actual exam weighting.
How do these questions map onto what will actually be tested in 2026?
They map onto the content categories the exam is built from, not a generic "hematology topics" list. The 2026 blueprint weights Hematologic Neoplastic Disorders at 35% of the exam, Coagulation at 27%, Hematopoietic System at 25%, Cellular Therapy at 8%, and Transfusion Medicine at 5%[1]. Four of the five questions above sit inside Hematologic Neoplastic Disorders — myeloma diagnosis, ITP, and PV diagnosis — reflecting where the exam itself puts the most weight. If your current question bank is heavy on coagulation trivia and light on neoplastic disorders, that imbalance alone could be costing you points relative to how the exam is actually built[1].
It's also worth remembering that the traditional 10-year MOC exam gives examinees access to UpToDate for the entire exam[1] — a detail that changes what's actually worth memorizing versus what's worth understanding conceptually, since lookup-able facts matter less than being able to reason through a vignette under time pressure.
Frequently Asked Questions
Are these five questions representative of the full MeDucation question bank?
Yes, in format and explanation depth. They're written in the same vignette style, with the same two-part explanation structure — why the correct answer is right and why each distractor is wrong — that runs through the full bank. The full product also includes embedded images and tables, direct PubMed links, AI read-aloud, and spaced-repetition flashcards built from the same content, none of which fit into a blog post format.
Is the MeDucation question bank AI-generated?
No. It is physician-written and reviewed by board-certified hematologist-oncologists. MeDucation does use an AI layer around the content — for things like read-aloud, flashcard generation from your notes, and mind maps — but the questions themselves are authored and reviewed by practicing physicians, not generated by a model.
Do I need to know the exact SLiM-CRAB numeric cutoffs cold for the boards?
Yes, this is one of the more frequently tested numeric detail sets in hematologic neoplasms. The 60% clonal plasma cell threshold, the light chain ratio of 100, the 5mm MRI lesion size, and the CRAB thresholds for calcium, creatinine, and hemoglobin are all specific, examinable numbers rather than general concepts[3][4].
How does ITP management testing differ from myeloma diagnostic criteria testing on the exam?
ITP questions tend to test treatment and care decisions, while myeloma questions more often test diagnosis and testing, asking you to apply specific numeric criteria to determine whether a diagnosis is met[1][3]. Both task types appear throughout the Hematologic Neoplastic Disorders category, which makes up 35% of the exam[1].
Where can I try more questions like these before deciding whether to subscribe?
Start with our guide on how the question bank is actually made, which explains the physician review process in more detail, or see current plans and pricing to see what's included at each tier.
