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*Refer to the TBL slides


1)The three mechanisms leading to pallor are:

a) Acute blood loss
b) Reduced production
c) Increased destruction
d) Excessive usage
e) All above

2)Iron deficiency in infants associated with

a) Prematurity
b) Meckel diverticulum
c) Bacterial infection
d) Stomach carcinoma
e) Excessive cow’s milk intake

3)Some of the arliest sign of iron deficiency are:

a) Esophageal web
b) Intelectual impairment
c) Heart failure
d) Angular stomatitis
e) Pica

4)Peripheral blood film was presented for you attention.You diagnosed it as iron
deficiency.What are the clues available in blood film to confirm your diagnosis?
a) Microcytosis
b) Poikilocytosis
c) Aur Rod
d) Blast cells
e) Hypochromic

5)Anemia of prematurity is very common in newborn as EPO reduces in first few days of
life.What are the significant clinical features attributable to AOP?
a) Bradycardia
b) Tachypnoe
c) Cyanosis
d) Poor weight gain
e) Murmur

6)Megaloblastic anemia is caused by:

a) Poor iron absorption
b) Stomach cancer
c) Mild alcohal intake
d) Myeloid leukemia
e) Myelofibrosis
7)You are required to advice a patient with newly diagnosed of megaloblastic anemia on the
food intake.So what are the foods would you advice for the patient?
a) Aloe vera
b) Spinach
c) Red meat
d) Mushroom
e) Brocolli

8)What are the common neurological complications of B12 deficiency?

a) Ataxia
b) Paresthesia
c) Weakness
d) Dementia
e) Optic athrophy

9)Regarding Thallasemia:
a) Thallasemia major is asymptomatic
b) Presented with normochromic normocytic anemia
c) Skull bossing occurs
d) Regulat tranfusion is a must in all thallasemia
e) May presented with jaundice

10)Some of the investigations to detect Thallasemia are:

a) Chrionic villi sampling
b) BMA
c) Trephine biopsy
d) FBC
e) Peripheral blood film

11)Regarding bone marrow failure:

a) Aplastic anemia are inherited only
b) The secondary causes includes leads
c) Diagnostic tool are chromosal lineage test
d) Fanconi anemia is uncommon
e) BM transplant is not advisable

12)The clinical manifestations of bone marrow failure are:

a) Microcephaly
b) Extra digits
c) Short stature
d) Heart failure
e) Cafe au laits

13)Following are the essence in history taking :

a) Male more prone to G6PD
b) Lead poisoning leads to myelofibrosis
c) Indian are at higher risk of getting Thallasemia
d) Chronic bruise associated with blood dyscrasia
e) Vegetarian related to nutritional deficinecy
14)The case study done to investigate prevalence of iron deficiency (ID) and iron deficiency
anaemia in pre-school children and identifying the risk factors of ID I Kelantan on 490
children aged 8 to 26 months.The probable risk factors are except:
a) Not intro to formula milk
b) Left hemiparesis
c) Breast feed more less than 2 months
d) High socioeconomic status
e) Housewife mothers


Dolores Welborn is a 28-year-old attorney living in Portland, Oregon. Dolores is in the

second trimester of pregnancy with her first child, and though her pregnancy had been
progressing normally, recently she has noticed that she tires very easily and is short of breath
from even the slightest exertion. She also has experienced periods of light-headedness, though
not to the point of fainting. Other changes she has noticed are cramping in her legs, a desire to
crunch on ice, and the fact that her tongue is sore. She doubts that all of these symptoms are
related to one another, but she is concerned, and she makes an appointment to see her

Upon examining Dolores, her physician finds that she has tachycardia, pale gums and nail
beds, and her tongue is swollen. Given her history and the findings on her physical exam, the
physician suspects that Dolores is anemic and orders a sample of her blood for examination.
The results are shown below:

Table 1. Blood Sample Results

Red Blood Cell Count 3.5 million/mm3

Hemoglobin (Hb) 7 g/dl

Hematocrit (Hct) 30%

Serum Iron low

Mean Corpuscular Volume (MCV) low

Mean Corpuscular Hb Concentration (MCHC) low

Total Iron Binding Capacity in the Blood (TIBC) high

1) What are the other questions that you would like to ask to reach the diagnosis?


2) On physical examination you will look for...........


3)Intepret the above investigations.

4)What is the diagnosis?Judge your answers.

5)What is your differential diagnosis?