Q No.1. 3 year old boy presented with complaints of swelling left knee.

He had history of
post circumcision bleed in the past. His coagulation profile showed PT=12 sec, PTT= 80
seconds, BT= 3 minutes. What is the most likely diagnosis?
a. FXIII deficiency
b. Glanzmanns thrombasthenia
c. Haemophilia A
d. Sickle cell disease
e. Von Willi brand disease
Key: c

Q No.2. A 13 year old girl presented with complaints of excessive bruising since child
hood, and menorrhagia since menarche. She has family history of excessive bleed in her
maternal aunt. Her coagulation profile showed BT: > 15 min , PT =14 sec , aPTT = 78 sec .The
most likely diagnosis is:
a. Haemophilia A
b. Haemophilia B
c. Von Willebrand disease
d. F VII Deficiency
e. Protein C deficiency
Key: c

Q No.3. A lady presented with history of DVT left leg, she has been advised thrombophilia
screening. Which of following test are included in thrombophilia Screening.
a. F V Leiden
b. Protein C and S
c. Antithrombin III
d. Prothrombin gene mutation
e. All of above
Key: e

Q No.4. A lady married for 4 years, had history of recurrent abortion in 1 st trimester. She
has been sent for lupus screening. What other tests you will advise to diagnose anti
phospholipid syndrome:
a. Beta 2 microglobulin
b. Anti beta 2 glycoprotein 1 antibodies
c. ANA
d. Anti Ds DNA
e. Platelet function assay
Key: b
Q No.5. A 35 years old male patient presented with History of DVT left leg. What is the
most appropriate time for thrombophilia screening.
a. While on anticoagulant
b. When patient is off the treatment
c. Before surgery
d. Soon after thrombotic event
e. After surgery
Key: b

Q No.6. A 2 year old boy presented with complaints of frequent epistaxis. In the past he
has history of umbilical cord stump bleeding and delayed onset post circumcision bleeding. His
PT = 13 sec, aPTT = 35 sec. BT = 3 min 2 sec. What is the most likely diagnosis is:
a. Haemophilia A
b. FXII deficiency
c. FXIII deficiency
d. Factor VII deficiency
e. von willebrand disease
Key: c

Q No.7. A 5 years old girl presented with complains of profuse bleeding from nose and
gums .His CBC reveal Hb = 8g/dl . TLC = 5X 10 9 and platelet = 35 x10 9/L. Her peripheral film
showed giant platelets. Her BT = >15 min. The diagnosis is:
a. Wiskott Aldrich syndrome
b. Bernard soulier Syndrome
c. Haemophilia
d. ITP
e. FXIII deficiency
Key: b

Q No.8. For monitoring of warfarin therapy, following test is used

a. PT
b. aPTT
c. BT
d. Hess test
e. Factor assay
Key: a
Q No.9. Protein C and S inhibits:
a. Factor V and FVIII
b. Anti thrombin III
c. Factor VII
d. Factor IX
e. Factor XII
Key: a

Q No.10. Heparin potentiates the effects of:

a. Protein C
b. Protein S
c. Anti Thrombin III
d. Factor V
e. Factor VIII
Key: c

Q No.11. Patient with which of the following leukemia may go into DIC?
a. Acute promyelocytic leukemia
b. Acute lymphoblastic leukemia
c. Chronic myeloid leukemia
d. Chronic lymphocytic leukemia
e. Acute myelomonocytic leukemia
Key: a

Q No.12. All of the following terms are technically incorrect except

a. Acute lymphoblastic leukemia
b. Chronic myeloblastic leukemia
c. Chronic lymphoid leukemia
d. Acute myeloproliferative leukemia
e. Chronic myeloid leukemia
Key: e

Q No.13. Which of the following is likely to show a panmyelosis?

a. Acute lymphoblastic leukemia
b. Chronic lymphocytic leukemia
c. Polycythemia Rubra Vera
d. Acute myelmonocytic leukemia
e. Acute monoblastic leukemia
Key: c
Q No.14. Acute lymphoblastic leukemia
a. Often has a relatively good prognosis
b. Never occurs in children
c. Is classified according to morphologic appearance.
d. Is only diagnosed when 25% of nucleated cells are lymphoblasts.
e. Is an indolent disease.
Key: a

Q No.15. While looking a blood smear, you notice a blast with an Auer rod in it. This
patient has.
a. Bacterial infection
b. MDS
c. AML
d. ALL
e. No disease
Key: c

Q No.16. Factor used to predict good risk outcome in ALL is

a. High presenting WCC
b. Younger age
c. Complex karyotype
d. T – Cell phenotype
e. Poor response to steroid therapy
Key: b
 
Q No.17. The optimal response at 03 month in CML is
a. BCR – ABL ≤ 10% IS
b. BCR – ABL ≤ 05% IS
c. BCR – ABL ≤ 01% IS
d. BCR – ABL ≤ 0.1% IS
e. BCR – ABL ≤ 0.01% IS
Key (a)

Q No.18. Good prognosis cytogenetics in CLL is

a. Trisomy 12
b. Del 11q22 – 23
c. Del 13q14
d. Del 17p13.1
e. Trisomy 8
Key: c
Q No.19. Which of the following is the most common inherited malignancy?
a. Infant leukemia
b. Retinoblastoma
c. Wilm’s tumor
d. Neuroblastoma
e. Nephroblastoma
Key: b

Q No.20. A 02 years old child comes with history of skin discharge, seborrheic dermatitis,
polyuria and hepatosplenomegaly. Which of the following is most likely diagnosis?
a. Leukemia
b. Lymphoma
c. Germ cell tumor
d. Langerhan’s cell histiocytosis
e. Melanoma
Key: d

Q No.21. Megaloblastic anemia may be caused by all of the following except:

a. Phenytoin
b. Methotrexate
c. Primthamine
d. Amoxycilline
e. Paracetamol
Key: d

Q No.22. A 1 year old child presented with severe macrocytic anemia with sub-nephrotic
range protienuria. His Vit B12 levels are low. The diagnosis is
a. Imerslund-grasbeck disease
b. Thiamine deficiency
c. Roger syndrome
d. Pearson syndrome
e. DIDMOD Syndrome
Key: a

Q No.23. Which of the following is not true about tropical sprue

a. Not corrected by folate treatment
b. Corrected by antibiotic treatment
c. More severely affect the distal ileum
d. Have both folate and cobalamins deficiency
e. It causes megaloblastic anaemia
Key: a
Q No.24. The earliest specific indicator of folate deficiency is:
a. Serum folate level
b. Red cell folate level
c. Anemia
d. Elevated homocysteine level
e. Serum Vit B12 levels
Key: a

Q No.25. Macrocytic anemia is seen in all except:

a. Acute blood loss
b. Hemolytic anemia
c. B12 deficiency
d. Folate deficiency
e. Combine Vit B12 and Folate deficiency
Key: a

Q No.26. A 60 year old patient presented with anemia requiring blood transfusion, there is
also associated mild thrombocytosis. The most likely diagnosis is
a. GI bleed
b. MDS 5q
c. Both of above
d. Acute Leukaemia
e. Aplastic Anaemia
Key: c

Q No.27. Earliest neurological sign of megaloblastic anemia is:

a. Loss of position sense
b. Loss of vibration sense
c. Dysdiadochokinesia
d. Rombergs sign positive
e. Exaggerated ankle jerk
Key: a
Q No.28. Cobalamin defciency is characterised by all of the following except
a. Esophageal webs
b. Glossitis
c. Cognitive impairment
d. Jaundice
e. Red beefy tongue
Key: a
Q No.29. Which of the following may be associated pernicious anemia
a. Ileal resection
b. Anti-thyroid antibodies
c. Rheumatoid arthritis
d. Malabsorption
e. SLE
Key: b

Q No.30. Folate deficiency of during pregnancy can cause

a. Hemolytic anemia
b. Neural tube defect
c. Phocomelia
d. Duodenal atresia
e. Thrombocytopenia in new born
Key: b

Q No.31. For coagulation studies, blood sample of a patient is taken in anti- coagulant as:
a. Heparin
b. Tri sodium citrate
c. EDTA
d. CPD
e. Coumarin
Key: b
Q No.32. VwF is synthesised in:
a. Endothelial cells
b. Megakaryocytes
c. Platelets
d. All of the above
e. None of the above
Key: d
Q No.33. Platelets have a life span of :-
a. 08 days
b. 10 days
c. 12 days
d. 15 days
e. None of the above
Key: a
Q No.34. Bleeding disorders marked by prolonged bleeding time, normal platelet count and
absence of platelet aggregation in response to aggregants ADP, collagen, arachidonic acid
and thrombin is :-
a. BSS
b. GTT
c. Grey platelet syndrome
d. May-hegglin anomaly
e. vWD
Key: b

Q No.35. PT is a measure of the: -

a. Intrinsic pathway
b. Extrinsic pathway
c. Common pathway
d. Liver status
e. All of the above
Key: b

Q No.36. A defect in which of these coagulation factor would result in abnormal PT and
aPTT:-
a. Factor II
b. Factor VII
c. Factor XII
d. Factor IX
e. None of above
Key: a

Q No.37. Which of the anticoagulant acts on factors V and VIII:-

a. Antithrombin III
b. Protein C
c. TFPI
d. Plasmin
e. t-PA
Key: b

Q No.38. Which test evaluates the intrinsic pathway

a. PT
b. aPTT
c. TT
d. Closure time
e. Bleeding time
Key: b
Q No.39. What does von Willibrand factor do?
a. Binds platelets to each other
b. Binds platelets to the sub endothelium
c. Binds platelets to phospholipid surface
d. Carries factor VII
e. Cleaves factor V
Key: b

Q No.40. Features of the antiphospholipid syndrome include all of the following except
a. A prolonged PT
b. A prolonged aPTT
c. High incidence of venous thrombosis
d. Placental infarction and fetal loss
e. Confirmation by phospholipid neutralization test
Key: a

Q.No.41. After the addition of IgG coated RBCs to a negative AHG reaction during an
antibody screen,a negative result is observed.Which of the following is a correct interpretation?
a. The saline washings were adequate.
b. Reactive AHG was added
c. The antibody screen is negative
d. The antibody screen needs to be repeated
e. AHG reagent was working properly
Key d

QNo.42. Patient appears to have warm autoantibody. She was transfused 2 weeks ago.
What would be next step performed to identify any alloantibodies that might be in her serum?
a. Acid elution
b. Heat elution
c. Warm auto-adsorption using autologous cells
d. Warm differential adsorption
e. RESt adsorption
Key d

Q No.43. Which of the following would be cause for permanent deferral?

a. Close contact of HIV patient
b. Patient who had received blood transfusion
c. Ear or body piercing
d. Positive Hepatitis C test result
e. Donor who had needle stick injury 12 months ago
Key d
Q No.44. Quality control of RBCs requires a maximum hematocrit level of
a. 75%
b. 80%
c. 85%
d. 90%
e. 95%
Key b

Q No.45. Which of the following donors is acceptable?

a. Donors with thalassemia trait having Hb of 10.5gdl
b. Donor who was treated for syphilis 3 months ago
c. Donor who donated double unit of RCCs 8 weeks ago
d. Donor with diabetes on inj. Insulin
e. Donor who had a first trimester abortion 4 weeks ago
Key e

Q No.46. In plasma exchange, the therapeutic effectiveness is

a. Greatest with the first plasma volume removed
b. Affected by the type of replacement fluid used
c. Enhanced if the unwanted antibody is IgG rather than IgM
d. Independent of the use of concomitant immunosuppressive therapy
e. Not related to concentration of the pathological substance in the blood
Key a

Q No.47. How are mild allergic transfusion reactions with isolated symptoms or hives and
urticaria treated?
a. Transfusion is stopped and transfusion workup initiated
b. Transfusion is stopped and antihistamines administered; when symptoms
improve, transfusion is restarted
c. Transfusion is stopped and request for new unit of RCC is made
d. Stop transfusion and prepare washed red cells
e. Continue transfusion with a slower infusion rate
Key b

Q No.48. Which patient does not need an irradiated component

a. Bone marrow transplant recipient
b. Neonate weighing less than 1200g
c. Adult receiving a RBC transfusion
d. Adult receiving an a RBC transfusion from a blood relative
e. Patients receiving fludarabine
Key c
Q No.49. RhIG is indicated in which of the following circumstances?
a. Mothers who have anti D
b. Infants who are Rh negative
c. Infants who have anti- D
d. Mothers who are Rh negative with Rh Positive fetus
e. Mother who are Rh positive
Key d

Q No.50. The patient with aplastic anaemia develops high grade fever and collapse within
20 minutes of starting a platelet transfusion. What is the cause of this reaction?
a. Circulatory overload
b. Delayed transfusion reaction
c. Hypocalcemia
d. Septicemia
e. Transfusion associated Graft versus host disease.
Key d

Q No.51. The major cause of mortality in Fanconi anaemia is the development of

a. Acute leukemia
b. MDS
c. Bone marrow failure
d. Chromosomal breakage
e. Head and neck malignancies
Key: c

Q No.52. DEB / MMC test may be negative or may reveal only chromosomal instability in a
sub group of cells in case of:-
a. Fanconi Anaemia
b. Dyskeratosis congenital
c. Acquired Aplastic anaemia
d. Fanconi anaemia mosaic
e. Myelodysplasia
Key: d
Q No.53. The minimal criteria for diagnosis of dyskeratosis congenital does not include
which one of the following feature.
a. Abnormal skin pigmentation
b. Nail dystrophy
c. Bone marrow failure
d. Short stature
e. Leukoplakia
Key: d
Q No.54. Signs of malabsorption and failure to thrive are apparent in which of the following
inherited syndromes.
a. Fanconi anaemia
b. Shwachman – Diamond syndrome
c. Diamond blackfan anaemia
d. Congenital dyserythropoeitic anaemia
e. Cyclical meutropenia
Key: b

Q No.55. Which of the following pathogenic feature is common to most of the bone marrow
failure, inherited syndromes.
a. FA gene mutations
b. Telomerase shortening
c. Pancreatic insufficiency
d. Acute myeloid leukemia (M4, M5)
e. TERL, TERT, TINF2 mutations
Key: b

Q No.56. A 1 year old child presented with transfusion dependent anaemia and failure to
thrive. What should be the percentage of erythroid precursors in in the bone marrow to label it
as a case of congenital pure red cell aplasia.
a. < 10%
b. < 0.1%
c. < 0.5%
d. < 5.0%
e. < 1.0 %
Key: d

Q No.57. A 25 years old female presented with sever pallor. CBC showed neutrophils < 0.2
x 109/L. Bone marrow cellularity was 20%. How severe is the aplastic anaemia.
a. Non Severe
b. Very Severe
c. Severe
d. Moderately severe
e. Mildly severe
Key: b

Q No.58. A 2 years old child presented with 7 days history of fever, severe pallor and
erythematous rash on both checks. CBC revealed Hb is 3 g/dl with Platelets 90 x 109/L and
TLC 3.5 x 109/L. Bone marrow showed < 5% erythroid precursors. Most likely etiology is:-
a. Diamond blackfan anaemia
b. Congenital dyserythropoietic
 c. Parvo virus B19 infection
d. Fanconi anaemia
e. Pearson syndrome
Key: c

Q No.59. A suspected case of paroxysmal nocturnal haemoglobinuria showed absence of

which of the following markers on flow cytometry of Red cells.
a. CD 50, CD55
b. CD59, CD50
c. CD55, CD59
d. CD71, CD 235
e. CD 41, CD 61
Key: c
Q No.60. Which monoclonal antibody shows promising results in the treatment of PNH.
a. Rituximab
b. Eculizumab
c. Gemtuzumab
d. Alemtuzumab
e. Eltrombopag
Key: b

Q No.61. A 17 year old female presented with history of menorrhagia requiring blood
transfusion .O/E she was pale. CBC Showed, Hb : 8g/dl, Platelet 159 x 10 9/L, BT > 15 mins.
All are causes of prolonged Bleeding time except?
a. Vwd
b. Glanzmann Thrombasthenia
c. Bernard Soulier Syndrome
d. Pseudo VWD
e. Poly cystic ovarian disease
Key: e

Q No.62. Female child of 9 years age presented with pain and swelling left elbow after
injury during sports in school. Past and family history: Not contributory. Coagulation profile
showed Platelets 490x109/L, Hb 12.0 g/dl, WBC 13 x109/L, BT: 6 min, PT: 43 sec (control 12
sec), PTTK: 36 sec (control 35 sec), TT: 12 sec (control 12 sec)
What is your most appropriate diagnosis?
a. FVIII
b. FVII
c. FIX
d. Afibrinogenemia
Key: b
Q No.63. A male of 39 years age presented with excessive bleeding after road traffic
accident. Past and family history is not contributory. Coagulation profile showed, Platelets 230
x 10 9/L, Hb 16.0 g/dl, WBC 11x10 9/L, BT: 3 min, PT: 14 sec (control 12 sec), aPTT: 77 sec
(control 35 sec), TT: 12 sec (control 12 sec). What is your most appropriate diagnosis?
a. FVIII
b. FIX
c. FII
d. FX
e. FXI
Key: e

Q No.64. Male of 29 years age presented with fever, and drowsiness of 9 days duration.
On examination he was febrile, and semiconscious. Leukocyte count was 9.5 x109/L,
hemoglobin was 11.5 g/dl, platelet count was 50 x109/L. Peripheral blood revealed
Shistocytes. What is your diagnosis?
a. HUS
b. TTP
c. Liver disease
d. Diabetic ketoacidosis
e. DIC
Key: b

Q No.65. In Pregnancy which clotting factor is decreased?

a. Protein S
b. FVIII
c. FX
d. Fibrinogen
e. Protein C
Key: a

Q No.66. A full term male infant was born by normal delivery .He received Vitamin K after
birth. On 5th day of birth there was new bleeding at the umbilical stump. What is your
diagnosis?
a. FII
b. FVII
c. FIX
d. FX
e. FXIII
Key: e
Q No.67. What is the level of function: VWD antigen ratio in type 1 disease
a. <0.5
b. <0.4
c. <0.8
d. <0.6
e. >0.5
Key: e

Q No.68. What is level of VWD antigen in type 3 disease?

a. <0.03 iu/ml
b. <0.002 iu/ml
c. <0.001 iu/ml
d. <0.3 iu/ml
e. <0.5 iu/ml
Key: a

Q No.69. A 38 weeks pregnant female with placenta praevia started bleeding profusely per
vagina and developed bruises and ecchymotic spots all over the body. CBC: TLC 12 x 109/l,
Hb 7.9 g/dl, Platelet Count 16 x109/l, PT 42 Sec, aPTT : 93 Sec. What is the diagnosis.
a. Liver disease
b. DIC
c. Preeclampsia
d. HELLP Syndrome
e. Hyperfibrinolysis
Key: b

Q No.70. A 28 years old female with 32 weeks gestation presented with platelet count 70
x10 9/L.
What is the likely diagnosis?
a. Gestational thrombocytopenia
b. HELPP syndrome
c. ITP
d. Liver disease
e. TTP
Key: a

Q No.71. The final common pathway of coagulation involves:

a. The degradation of a transglutaminase (Factor XIII)
b. Formation of the prothrombinase complex.
c. Formation of prothrombin.
d. Formation of fibrinogen.
e. N-acetylation by Vitamin A.
Key: b
Q No.72. Which ONE of the following does NOT contribute to clot formation?
a. Calcium
b. Phospholipids
c. Thrombin
d. Tissue factor
e. Heparin.
Key: e

Q No.73. Which ONE of the following is NOT a cause of acquired thrombocytopenia?

a. A vitamin B12 or folate deficiency
b. Bernard-Soulier Disease
c. Internal bleeding
d. Splenic sequestration of platelets
e. Antibody destruction of platelets
Key: b

Q No.74. Which of the following is not a property shared by intrinsic tenase and
prothrombinase complexes?
a. Both are attracted to and embed into the negatively charged phospholipid
surface membrane of cells
b. Both are Ca2+ dependent
c. Both have vitamin K dependent serine protease activity
d. Both must possess a non-proteolytic cofactor protein to function (fVIIIa in the
tenase, fVa in the prothrombinase)
e. Both require the presence of factor XIIIa to function
Key: e

Q No.75. In the cell based model of cellular coagulation the control of blood coagulation is
controlled by localising the procoagulant reactions on specific cell surfaces. What was found to
be the primary initiator of coagulation?
a. Factor V
b. Factor X
c. Phosphatidylserine
d. Tissue factor
e. Factor II
Key: d
Q No.76. The coagulation cascade is regulated by natural inhibitors, these prevent the
cascade from either forming at the wrong location or forming too much clotting in an area.
Which of the following inhibits the intrinsic tenase and prothrombinase pathway, by interfering
with their rooting proteins?
a. Antithrombin
b. Protein C pathway
c. Tissue Factor Pathway Inhibitor
d. Protein S
e. Factor V
Key: c

Q No.77. Which ONE of the following is the most common inherited bleeding disorder?
a. Hemophilia C
b. Von Willebrand Disease
c. Bernard Soulier Disease
d. Hemophilia A
e. Wiskott-Aldrich Syndrome
Key: b

Q No.78. The process by which platelets and plasma proteins react to convert fibrinogen
into fibrin.
a. Coagulation
b. Hemostasis
c. Vasoconstriction
d. Hemophilia
e. Erythropoiesis
Key: a

Q No.79. Which of the following is true regarding the bleeding time?

a. It is a highly reliable and reproducible test
b. The sample is evaluated using an optical densitometer
c. It evaluates platelet function in vivo
d. It is a commonly ordered test
e. It evaluates the coagulation system
Key: d
Q No.80. Which of the following tests the reaction of the intrinsic pathway, and which drug
greatly increases that reaction time by inhibiting the pathway?
a. Activated partial thromboplastin time 2) Heparin
b. Activated partial thromboplastin time 2) Warfarin
c. Fibrinogen test 2) Heparin
d. Prothrombin time 2) Heparin
e. Prothrombin time 2) Warfarin
Key: a

Q No.81. In Refractory Anaemia ringed sideroblasts in the marrow are:

a. <15
b. <30
c. >15
d. >30
e. >20
Key: c

Q No.82. Refractory Anaemia with Excess Blasts is split in to two groups MDS EB 1 and
MDS EB 2. These groups are defined by the percentage of myeloblasts in bone marrow. In EB
2 this ranges from:
a. 1-5 %
b. 1-19 %
c. 5-9 %
d. 5-19 %
e. 10-19 %
Key: e

Q No.83. Antimetabolite cytarabine interferes with which phase of cell cycle:

a. M-phase
b. S-phase
c. G1-phase
d. G2-phase
e. M0- phase
Key: b

Q No.84. In WHO classification the blast cutoff for a diagnosis of AML is

a. 10%
b. 15%
c. 20%
d. 30%
e. 5%
Key: c
Q No.85. False statement regarding AML with t (15 ; 17) cytogenetic rearrangement
a. Juxtaposes PML with RARα
b. Encodes a chimeric protein
c. Associated with DIC
d. Have poor prognosis
e. Fab AML M3
Key: d

Q no.86. In determining complete remission in AML all included except:

a. Neutrophil count
b. Platelet count
c. Hemoglobin concentration
d. Circulating blasts
e. Asymptomatic
Key: c

Q No.87. A one year old boy presented with progressive pallor, hepatosplenomegaly and
generalized lymphadenopathy. The cytochemistry of bone marrow aspiration revealed PAS
positive cells. Most probable diagnosis is
a. Neuroblastoma
b. Acute Myeloblastic leukemia
c. Acute Lymhoblastic leukemia
d. Juveline CML
e. Storage disorder
Key: b

Q No.88. Refractory anaemia has a 6% annual rate of progression to:

a. Acute leukaemia
b. Chronic leukaemia
c. Myelodysplastic syndrome
d. Myeloproliferative neoplasm
e. Chronic Myeloid Leukaemia
Key: a

Q No.89. Which of the following statements pertaining to leukemia is correct?

a. Blasts of acute myeloid leukemia are typically sudan black negative
b. Blasts of acute lymphoblastic leukemia are typically myloperoxidase positive
c. Low leucocyte alkaline phosphatase score is characteristically seen in blastic
phase of chronic myeloid leukemia
d. Tartarate resistant acid phosphatase positivity is typically seen in hairy cell
leukemia
e. Blasts of AML are Periodic Acid Schiff positive
Key: d
Q No.90. Following is a myeloid marker
a. CD 3
b. CD 10
c. CD 13
d. CD 19
e. CD 20
Key: c

Q.No.91. The characteristic features of hyperfibrinolysis, which differentiate it from

disseminated intravascular coagulation include all of the following except:-
a. Association with pelvic and prostate surgery
b. Normal platelet count
c. Prothrombin time and APTT are only mildly prolonged
d. Marked reduction of factors V and VIII
e. Iatrogenic bleeding may occur after streptokinase
Key; d

Q No.92. Acute hemolytic transfusion reactions:-

a. May occur, secondary to high titer anti-I cold agglutinins
b. Can lead to hepatic failure
c. Are rarely due to incorrect identification of recipient
d. Are characterized by a negative Coomb's test
e. Can present with uncontrollable hypotension in anaesthetized patients
Key: e

Q No.93. A patient has the following results on ABO grouping:-

Anti-A Anti-B Anti-AB A Cells B Cells O Cells
0 0 0 4+ 4+ 4+
The most likely explanation of these results is the following:-
a. Sample of a neonate
b. An elderly patient
c. Bombay blood group
d. Patient with intestinal tumor
e. Acute haemolytic transfusion reaction
Key: c
Q No.94. Treatment of red cells with proteolytic enzymes:-
a. Leads to weakening of Duffy antigens M, N
b. Can destroy RhD antigen
c. Is routinely employed in crossmatch testing
d. Is advised to prevent febrile transfusion reactions
e. Is synonymous with use of low ionic strength saline
Key: a
Q No.95. Donor criteria for pre deposit autologous donation include:-
a. Donation can be made every 48 hours
b. There is no minimum weight requirement or upper age limit
c. Haemoglobin should be more than 14g/dl
d. Congestive cardiac failure is not a contraindication
e. Acceptable if candidate is having aortic stenosis
Key: b

Q No.96. Occult Hepatitis B virus infection may be transmitted by:-

a. Transfusion of blood component which in HBsAg Negative
b. Transfusion of only those blood components containing white cells
c. Interferon therapy
d. A blood donation which is Hepatitis B DNA PCR negative
e. Only in the presence of delta virus
Key: a, Level: C3

Q No.97. Which of the following will suggest the presence of an autoantibody:-

a. Positive indirect antiglobulin test (IAT) and negative direct antiglobulin test
(DAT)
b. Presence of anti-cardiolipin antibodies
c. Haemolytic disease of newborn
d. Graft versus host disease
e. Positive Direct Coomb's test
Key: e

Q No.98. Warm autoimmune haemolytic anaemia may be associated with:-

a. Mycoplasma infection
b. Paroxysmal nocturnal haemoglobinuria
c. Lymphoproliferative disorders
d. Raynaud's phenomenon
e. Presence of anti-I antibodies
Key: c

Q No.99. The recommended method for disposal of blood unit which is positive for viral
markers is:-
a. Draining the bag in laboratory sink
 b. Emptying the bag in 12.5% sodium hypochlorite
c. Burial in a landfill
d. Ncineration
e. To autoclave at 64°C and then burial in landfill
Key: d, Level: C1

Q No.100. All of the following are examples of computer control functions except:-
a. Prevention of release of ABO incompatible blood
b. Printing of crossmatch report
c. Prevention of release of blood which is HBsAg positive
d. Alerting if patient has red cell antibodies
e. Prevention of release of expired blood components
Key: b, Level: C3

Q No.101. Which of the following antibodies can cause Haemolytic disease of newborn
(HDN):-
a. Anti-A,B
b. Anti-Leb
c. Anti-P
d. Anti-I
e. Anti-HPA-1b
Key: a,

Q No.102. The shelf life of red cells in CPD- A1 blood bags is:-
a. 15 days
b. 30 days
c. 35 days
d. 28 days
e. 48 hours
Key: c

Q No.103. The best method to achieve leucoreduction of red cell concentrates is:-
a. Use of WBC filter
b. Inverted centrifugation
c. Spin cool filtration
d. Saline washing
e. Cryopreservation at -20°C
Key: a
Q No.104. Which of the following is not part of routine pre transfusion screening by the
blood bank?
a. Testing of HBsAg, anti-HCV, and anti-HIV
b. Major crossmatch
c. Minor crossmatch
d. Blood ABO and Rh grouping
e. Donor history
Key:c

Q.No.105. While scrubbing a donor’s arm, the phlebotomist was distracted by another
donor’s reaction and did not use the second cleansing solution. What potential problems could
this cause to the recipient?
a. TACO
b. TRALI
c. Transfusion associated sepsis
d. Febrile non hemolytic transfusion reactions
e. Allergic reactions
Key: c, Level: C3

Q No.106. A severely immunosuppressed adult patient has been transfused with a pool of
10 units of platelets, pooled. The pre transfusion platelet count was 6000. One bag of random
donor platelets should raise platelets by about 5000/uL. If the platelet count does not increase
as expected, what is some potential cause?
a. Platelet refractoriness
b. Inappropriate dose of platelets
c. Leukocyte contamination
d. RBC contamination
e. Wrong centrifugation speed
Key: a

Q No.107. Platelet pheresis must contain a minimum of how many platelets to be

acceptable?
a. 5.5 x 1010
b. 3.3 x 1011
c. 5.0 x 1011
d. 3.0x1011
e. 2.5x1011
Key: d
QNo.108. Temperature limits for shipping RBCs are:-
a. 1o to 6o C
b. 1o to 10o C
c. 20o to 24o C
d. 2 o to 8o C
e. 2 o to 8o C
Key: b

Q No.109. A patient experiences chills and fever, nausea, flushing, and lower back pain
following the infusion of 350 mL of blood. To rule out a transfusion reaction because of acute
hemolysis, one should immediately:-
a. Perform a DAT and observe serum on post-transfusion sample
b. Measure serum haptoglobin on pre reaction and postreaction samples
c. Repeat crossmatches on pre reaction and post reaction samples
d. Gram stain and culture the unit
e. Perform CBC of recipient
Key: a

Q No.110. Dyspnea, severe headache, and peripheral edema occurring soon after
transfusion are indicative of which type of transfusion reaction?
a. Hemolytic transfusion reaction
b. Febrile reaction
c. Transfusion associated Circulatory overload
d. Anaphylactic reaction
e. Allergic reaction
Key: c

Q No.111. Which of the following adverse complications of transfusion is prevented by the

irradiation of blood components?
a. Circulatory overload
b. Hyperkalemia
c. Iron overload
d. TA-GVHD
e. AHTR
Key: d, Level: C2

Q No.112. What blood groups system’s antibodies are commonly associated with delayed
HTRs?
a. High titer, low avidity
b. ABO
c. P
d. MNS
e. Kidd
 Key: e; Level: C3
Q No.113. What microorganism grows at 4o C and may result in a transfusion-transmitted
sepsis?
a. Staphylococcus aureus
b. Yersinia enterocolitica
c. Staphylococcus epidermidis
d. Bacillus cereus
e. Streptococcus epidermidis
Key: b, Level: C3

Q No.114. What is the expected therapeutic effect in the recipient’s hematocrit following the
transfusion of 1 unit of RBCs?
a. Increase of 0.5%
b. Increase of 1%
c. Increase of 3%
d. Increase of 2%
e. Increase of 2%
Key: c

Q No.115. A 65 years old lady had her CP done as a part of a routine checkup which
showed Hb 9 gm/dl, platelets 81 x 109/L. Her physical examination was unremarkable except
for mild pallor. She was advised Bone marrow examination which showed dysplasia in > 10%
of cells of two lineages with 17% blasts. What is your likely diagnosis?
a. Refractory anaemia with excess blasts type II
b. Refractory anaemia with excess blasts type I
c. Acute Myeloid leukemia
d. Acute lymphoblastic leukemia
e. Myeloproliferative neoplasm
Key: a

Q No.116. Which of the following adverse complications of transfusion is prevented by the

irradiation of blood components?
a. Circulatory overload
b. Hyperkalemia
c. Iron overload
d. TA-GVHD
e. AHTR
Key: d, Level: C2
Q No.117. What blood groups system’s antibodies are commonly associated with delayed
HTRs?
a. High titer, low avidity
b. ABO
c. P
d. MNS
e. Kidd
Key: e; Level: C3

Q No.118. What microorganism grows at 4o C and may result in a transfusion-transmitted

sepsis?
a. Staphylococcus aureus
b. Yersinia enterocolitica
c. Staphylococcus epidermidis
d. Bacillus cereus
e. Streptococcus epidermidis
Key: b

Q No.119. What is the expected therapeutic effect in the recipient’s hematocrit following the
transfusion of 1 unit of RBCs?
a. Increase of 0.5%
b. Increase of 1%
c. Increase of 3%
d. Increase of 2%
e. Increase of 2%
Key: c 

Q No.120. A 65 years old lady had her CP done as a part of a routine checkup which
showed Hb 9 gm/dl, platelets 81 x 109/L. Her physical examination was unremarkable except
for mild pallor. She was advised Bone marrow examination which showed dysplasia in > 10%
of cells of two lineages with 17% blasts. What is your likely diagnosis?
a. Refractory anaemia with excess blasts type II
b. Refractory anaemia with excess blasts type I
c. Acute Myeloid leukemia
d. Acute lymphoblastic leukemia
e. Myeloproliferative neoplasm
Key: a
Q No.121. A 32 years old male patient presented with history of pallor, fever and
generalized weakness. On CBC Hb was 7 gm/dl. Red cell indices were normal and reticulocyte
count was 5%. All of the following are the signs of extravascular hemolysis except.
a. Jaundice
b. Splenomegaly
c. Hepatomegaly
d. Haemaglobinuria
e. Urobilinoge
Key: D

Q No.122. A known patient of systemic lupus erythematosis presents with fever and fatigue.
Physical examination reveals malar rash, pallor and hepatosplenomegaly. CBC reveals
normocytic anaemia with Hb 6 g/dl, neutrophilia ,borderline thrombocytopenia and raised
reticulocytes. Which of the following test would confirm the cause of patient’s anaemia?
a. Heinz body preparation
b. Enzyme assays of RBC’s
c. BM aspirate
d. Osmotic fragility
e. Direct coombs test
Key: E
Q No.123. A 42 years old patient presented in emergency ward with fever, fluctuating
conscious level, anaemia and thrombocytopenia. All necessary laboratory investigations were
carried out and on their basis patient was diagnosed as suffering from thrombotic
thrombocytopenia purpura. Which of the following abnormality in RBC morphology is
commonly seen in TTP
a. Nucleated red blood cells
b. Schistocytes
c. Acanthocytes
d. Howell – jolly bodies
e. Bite cells
Key: B

Q No.124. A 12 years male child presented with high grade persistent fever associated with
chills and rigors, dyspnea, dizziness and back pain. He also gives history of an episode of
reddish brown urine. On CBC Hb is 7 g/dl, red cell indices were normal. On peripheral film
there were increased retics, Heinz bodies and RBC fragmentation. Coombs test was negative.
The most likely cause of Heinz bodies is
a. Malarial infection
b. Hereditary spherocytosis
c. Sickle cell anaemia
d. Thalassaemia trait
e. G6PD deficiency
Key: E
Q No.125. A 45 years old female presented with pain right hypochondrium. On examination
she was pale, mildly jaundiced and have hepatosplenomegaly. Ultrasound abdomen revealed
multiple small pigment gall stones. Anaemia in such patient is due to;
a. Haemolytic anaemia
b. Iron deficiency anaemia
c. Megaloblastic anaemia
d. Aplastic Anaemia
e. Sideroblastic anaemia
Key: A

Q No.126. A 5 year old child presented with history of anemia since birth. On examination
there was jaundice, painful digits and hepatomegaly. Spleen was not palpable. There was a
non healing ulcer of lower leg. Peripheral film revealed sickle cells, NRBs, target cells and
Howell Jolly bodies. On basis of history, physical findings and peripheral film findings he was
diagnosed as a patient of sickle cell anaemia. All are true of sickle cell anaemia except
a. Red blood cells have shortened life span
b. Autosomal dominant disorder
c. Haemolysis is extravascular
d. Is due to a defective point mutation
e. Red cell dehydration makes cell vulnerable to sickling
Key: B

Q No.127. A 75 years old male presented with pallor, fatigue and lethargy. His blood CP
revealed Hb 7g/dl, Platelets 65 x 109/L and ANC 1 x 109/L. His bone marrow showed
dysplasia in the granulocytic lineage. Which one of the following is not a feature of dysplasia:
a. Pseudo pelger Huet anomaly
b. Hypogranularity
c. Pseudo Chediak Higashi granules
d. Auer rods
e. Dohle bodies
Key: E

Q No.128. A 75 years old male presented with the history of generalized weakness, easy
fatigability and lethargy. On examination he was pale and there was no visceromegaly. His
blood CP revealed Hb 8 g/dl, MCVC 86 fl and MCH 28 pg. Bone marrow examination showed
an increased in erythroid precursors with erythroid dysplasia and > 15% ring sideroblasts. His
diagnosis was refractory anaemia with ring siderobalst (RARS). The most likely defect is
a. Delta-aminolevulinic acid synthetase deficiency
b. Primary defect of mitochondrial iron metabolism
c. Defect in lysosomal enzymes
d. Cellular damage by oxidants
e. Radiation exposure
Key: B
Q No.129. A 65 years old lady had her CP done as a part of a routine checkup which
showed Hb 9 gm/dl, platelets 81 x 109/L. Her physical examination was unremarkable except
for mild pallor. She was advised Bone marrow examination which showed dysplasia in > 10%
of cells of two lineages with 17% blasts. What is your likely diagnosis.
a. Refractory anaemia with excess blasts type II
b. Refractory anaemia with excess blasts type I
c. Acute Myeloid leukemia
d. Acute lymphoblastic leukemia
e. Myeloproliferative neoplasm
Key: A

Q No.130. A 70 years old female presented with Pallor, fatigue and lethargy. Her blood CP
revealed Hb 8 gm/dl, ANC 0.9 X 109/l and platelets 60 x 109/l. Her bone marrow was
hypocellular and she was diagnosed as hypoplastic Myelodysplastic Syndrome. Which one of
the following should be considered in the differential diagnosis
a. Myeloproliferative disorder
b. Aplastic anemia
c. Megaloblastic anaemia
d. Acute Leukemia
e. Hemophagocytic syndrome
Key: B

Q No.131. A 77 years old lady presented with pallor and lethargy. On blood CP Hb was 8
gm/dl and ANC was 1.3 x 109/l. Her bone marrow showed dysplasia in erythroid and
granulocytic lineage. Which one of the following is not a feature of dysplasia.
a. Multinuclearity
b. Karyorrhexis
c. Internuclear bridging
d. Cytoplasmic vacuolation
e. Basophilic stippling
Key: e

Q No.132. A 77 years old male presented with the history of transfusion dependant anaemia
for the last four years. His dietary history is unsatisfactory. On examination he was pale. Blood
CP revealed Hb 7 gm/dl with MCV 101 fl. BM showed megaloblastic changes in the erythroid
lineage. He was given a trial of vitamin B12 and folate therapy for six weeks but there was no
improvement in his condition. What is your likely diagnosis.
a. Myelodysplastic Syndrome
b. Megalobalstic Anaemia
c. Iron Deficiency anemia
d. Anaemia of chronic disorder
e. Myeloproliferative disorder
Key: a
Q No.133. A 10 months old baby girl presented with failure to thrive, progressive pallor and
abdominal distension. Her family history was positive for thalassemia. On examination she was
markedly pale, had hepatosplenomegaly and delayed developmental milestones. She was
transfused RCC two days back. Which of the following test confirms the diagnosis when Hb
electrophoresis is inconclusive?
a. HPLC
b. Isoelectric focusing
c. DNA analysis for thalassemia gene mutations
d. Citrate ager electrophoresis
e. Capillary electrophoresis
Key: c

Q No.134. A 25 year old female presented with mild pallor and moderate
hepatosplenomegaly. Her Hb is 9.2 g/dl. Her Hb electrophoresis shows HbF of 65%. She has
not received any blood transfusion till date. She is most likely suffering from:
a. Thalassemia major
b. Hereditary persistence of fetal haemoglobin
c. Hemoglobin D, homozygous state
d. Thalassemia intermedia
e. Thalassemia minor
Key: d

Q No.135. A 17 year old girl got her Blood CP done as a part of routine examination. Her Hb
was 10 g/dl, RBC 6.9 X10*12/L, MCV 59.2 fl, MCH 21.1 pg, MCHC 31.3 g/dl. Peripheral blood
film showed microcytic hypochromic blood picture with prominent target cells. Her Hb
electrophoresis was done which revealed high HbA2 levels, confirming that girl is having
thalassemia trait. What is the cutoff level of HbA2 taken to label the patient as thalassemia
trait?
a. HbA2 > 1%
b. HbA2 > 2%
c. HbA2 > 5%
d. HbA2 > 3.5%
e. HBA2 > 3.0%
Key: d
Q No.136. A 24 years old female was brought to ER with complaints of fever, dyspnea, pain
in chest and extremities. She had flu and sore throat 4 days back for which she didn’t take any
medicine. Her Hb was 6.2 g/dl, WBC count 14.6 x 10*9/l and oxygen saturation of 77%. Her
peripheral film examination showed numerous sickle shaped red blood cells. What is the basic
defect in this disease?
a. Substitution of glutamic acid for valine in beta globin chain
b. Substitution of valine for glutamic acid in beta globin chain
c. Substitution of valine for glutamic acid in alpha globin chain
d. Abnormality in porphyrin part of Hb
e. Base deletion in HbA
Key: b

Q No.137. A 45 year old male presented with complaints of fatigue, shortness of breath and
progressive pallor for 2 months. Lab reports showed pancytopenia, macrocytosis and
hypersegmented neutrophils. Which of the following is not true regarding macrocytic anemia?
a. It is always caused by vit B12 or folate deficiency
b. Bone marrow appearances are identical in vit B12 or folate deficiency
c. It is caused by defective DNA synthesis
d. It is associated with jaundice
e. Cobalamin deficiency may cause bilateral peripheral neuropathy
Key: a

Q No.138. A 45 year old male presented with shortness of breath, palpitations, difficulty in
walking and decreased touch sensations in lower limbs for the past two months. Peripheral
blood smear showed macrocytosis, anaemia and hypersegmented neutrophils. Patient was
diagnosed as megaloblastic anemia. If this patient is treated with only folic acid, which of the
following will aggravate after treatment
a. Anemia
b. Macrocytosis
c. Neuropathy
d. Atrophic tongue
e. Sterility
Key: C

Q No.139. A male patient 68 years of age was found to have generalized lymphadenopathy
and hepatosplenomegaly. His Peripheral blood film showed lymphocytosis, with mature
lymphocytes and smudge cells. The most likely diagnosis is?
a. Acute lymphoblastic leukaemia
b. Acute myeloid leukaemia
c. Chronic lymphocytic leukaemia
d. Chronic myeloid leukaemia
e. Multiple myeloma
Key: c
Q No.140. A male patient 26 years of age had painless, non-tender & rubbery enlargement
of cervical lymph nodes. Histopathological examination of lymph node revealed total
effacement of architecture & presence of Reed-Sternberg cells. What additional test needed to
confirm the diagnosis?
a. Urine for Bence Jones protein
b. Gene rearrangement studies
c. Osteoclastic factor assay
d. Angiotension converting factor
e. No additional studies
Key: e

Q No.141. A 67 years old male patient presented with history of fever and undocumented
weight loss for 8 months. On examination his left inguinal lymph nodes were palpable with
hepatosplenomegaly. Blood CP revealed WBC of 67x109/l, Hb 7 g/dl, and Platelets 49x109/l.
On lymph node biopsy he was diagnosed to have mantle cell lymphoma. Characteristic
translocation associated with mantle cell lymphoma is
a. t (8:21)
b. t (9:22)
c. t (15:17)
d. t (11:14)
e. t (8:14)
Key: D

Q No.142. A male patient, 40 years of age had presented with pancytopenia &
splenomegaly. Bone marrow aspiration was unsuccessful & trephine showed characteristic
fried egg appearance. The most likely diagnosis is
a. Acute myeloid leukaemia
b. Acute lymphoblastic leukaemia
c. Hairy cell leukaemia
d. Chronic myeloid leukaemia
e. Chronic lymphocytic leukaemia
Key: c

Q No.143. A male patient 60 years of age, who has been diagnosed as case of chronic
lymphocytic leukaemia for last two years and has been taking treatment last 6 months.
Currently he presented with anaemia. During workup for anaemia, he was found to have Hb of
5gm/dl. Causes of anaemia in this patient include all the following except
a. Bone marrow failure
b. Haemolytic anaemia
c. Red cell aplasia
d. Hypersplenism
e. Blood loss
KEY: e
Q No.144. A 68 years old male patient, who is diagnosed case of chronic lymphocytic
leukaemia. All the followings are associated with poor prognosis except
a. ZAP-70 & CD38
b. 17p-deletion
c. High lymphocyte count
d. Female gender
e. Increased lymphocytic doubling time
Key: D
Q No.145. A 30 years women presented with lethargy since childhood. Physical
examination is unremarkable The spleen tip is palpable. Laboratory investigation shows Hb
10.6 g/dl, platelet count 160x109/l, WBC count 5x109/l. Peripheral blood smear shows
spherocytosis. She is diagnosed as hereditary spherocytosis. Which is the most commonly
affected cytoskeletal protein of RBC
a. Ankyrin
b. Spectrin
c. Actin
d. Myosin
e. PIG-A protein
Key: b

Q No.146. A 33 years old female presented with fatigue and shortness of breath for last 01
month. O/E she was pale. Systemic examination was unremarkable. Blood CP was done
which revealed Hb of 9.8 g/dl and MCV 72 fl. Peripheral blood film showed microcytic
hypochromic picture. Her Serum Ferritin is 15 ng/ml. The most likely diagnosis in this case is
a. Megaloblastic anaemia
b. Iron deficiency anaemia
c. Hemolytic anaemia
d. Anaemia of chronic disease
e. Aplastic Anaemia
Key: b

Q No.147. 60 years old male presented with progressive pallor, easy fatigability and
breathlessness after climbing stairs for last three months. He is also patient of chronic kidney
disease for past 3 years. O/E pallor was only significant finding with systemic examination
being unremarkable. His Hb was 10 g/dl with an MCV of 75fl. Which of the following laboratory
findings will support diagnosis of iron deficiency anaemia instead of anaemia of chronic
disease.
a. Decreased serum TIBC
b. Increased serum iron
c. Decreased serum ferritin
d. Decreased serum transferrin receptor
e. Increased serum folate
Key: c
Q No.148. A 45year old man presented with shortness of breath and lethargy for last five
months. He was diagnosed as a case of iron deficiency anemia after examination and
investigations. The doctor prescribed oral iron supplements. In absorption of iron, which one of
the following is involved in transfer of iron from lumen of gut across enterocyte microvilli.
a. Tranferrin
b. Divalent metal transporter- 1
c. Ferroportin
d. Transcobalamin II
e. Haptoglobulin
Key: b

Q No.149. A 25 years old female presented with lethargy, pallor & breathlessness after
climbing stairs for last four months. She also had poor dietary intake. She was diagnosed as
case of iron deficiency anaemia after investigations and prescribed oral iron supplements
which of the following factor favors absorption of iron.
a. Phytates
b. Vitamin C
c. Inflammation
d. Ferric form
e. Alkaline pH
Key: b

Q No.150. A 25 years male presented with H/O fatigue, upper abdominal pain and
progressive pallor for the last three months. He does not have any H/O diarrhea or
constipation. He was diagnosed as a case of iron deficiency anaemia after thorough workup.
The most likely cause of iron deficiency anaemia in this age group is
a. Inadequate diet
b. Worm infestation
c. Genitourinary blood loss
d. Malabsorption
e. Ca colon
Key: b

Q No.151. A 10 years old boy was brought to medical OPD by his mother with H/O fatigue
and poor concentration. He was found to have hypochromic microcytic anaemia. Iron studies
revealed low ferritin. His stool was sent for examination. Which of the following can be a cause
of this anaemia
a. Diphyllobothrium latum
b. Entameoba histolytica
c. Giardia lamblia
d. Ancylostoma duodenale
e. Taenia solium
Key: b
Q No.152. A 36 years old female presented with H/O lethargy and progressive pallor for the
last six months. She also had difficulty in taking solid diet she had past history of taking
NSAIDS for long time. O/E she was pale. Blood CP: Hb 8.9 g/dl, MCV 70fl. She can be labeled
as a case of Plummer Vinson syndrome. What other feature must be present for labeling this
syndrome.
a. Barret esophagus
b. Splenomegaly
c. Hepatomegaly
d. Esophageal webs
e. Atrophic gastritis
Key: D

Q No.153. 65 years old male presented with progressive pallor, black tarry stools for the last
six months. He was found to have iron deficiency anaemia. Serum ferritin levels are used to
assess iron stores. Which of the following statement is not true regarding ferritin.
a. Soluble Haem-protein complex
b. Iron is present in ferric form
c. Normal levels exclude iron deficiency anaemia
d. It is acute phase reactant
e. Cannot be visualized by Geimsa stain
Key: c

Q No.154. An 8 years old boy presented with weakness, progressive pallor for last three
months, he was pale with no other significant findings on examination. His Hb was 9 g/dl with
MCV of 72fl and RBC 4.1x 1012/L. The most likely diagnosis is
a. Thalassaemia trait
b. Lead poisoniong
c. Anemia of chronic disease
d. Iron deficiency anemia
e. Megaloblastic anemia
Key: d

Q No.155. A 55 years old male was diagnosed as case of iron deficiency anemia when he
presented with lethargy and palpitations on climbing stairs. Iron transport is mediated by
transferrin. Most of the iron bound to transferrin comes from
a. Iron absorbed by intestine
b. Ferritin
c. Reticulocyte
d. Myoglobin
e. Macrophages
Key: E
Q No.156. A patient with atrial fibrillation is on tab warfarin. His dose is monitored by his
INR. Warfarin acts via following mechanism
a. Warfarin interferes with action of Vitamin K epoxide reductase leading to
functional vitamin K deficiency
b. Warfarin inhibits platelet functions
c. Vascular permeability is increased
d. Fibrinogen levels are decreased by warfarin
e. Warfarin acts on bone marrow causing depression of megakaryocytes
Key: a

Q No.157. A 15 years of female presented with history of menorrahgia, since menarche. Her
lab investigations showed prolonged bleeding time, PT, aPTT were normal. VWF levels were
low. What is the most likely diagnosis?
a. Haemophilia A
b. Haemophilia B
c. Von Willebrand disease
d. Afibriongenemia
e. Haemolytic anaemia
Key: c

Q No.158. A new born baby, delivered full term at home presented at 3rd day of life with
petechiae and bruises. He is exclusively breast fed. His lab investigations shows prolong PT
and aPTT. Most likely he is suffering from
a. Vitamin K deficiency
b. Haemophilia A
c. Haemophilia B
d. Sickle cell disease
e. Haemolytic anaemia
Key: a

Q No.159. A 60 years old patient had pulmonary embolism. He is given intravenous

Heparin. His lab investigations will show
a. Prolonged aPTT
b. Prolonged BT
c. Prolonged PT
d. Hess test positive
e. Decreased VWF level
Key: A
Q No.160 A 45 years old male presented with myocardial infarction in emergency
department. Which of the following is not a risk factor for arterial thrombosis?
a. Diabetes mellitus
b. Male sex
c. Hyperhomocysteinemia
d. Folic acid intake
e. Hypertension
Key: d

Q No.161. A patient with haemophilia A, which one of the following statement is not true
a. Epistaxis is a common presentation
b. Antenatal diagnosis is possible
c. Inheritance is sex linked
d. Disease may be acquired in some cases
e. Joint bleed is common
Key: a

Q No.162. A 15 years old girl had heavy menstrual flow and occasional epistaxis. Physical
examination was unremarkable. Blood tests showed Hb 10.0 gm/dl, RBC 3.8 x 1012, MCV
68fl, MCH 22.6 pg, WBC 6.2 x 109 /L and platelets 220 x 109 /L. She is suspected to have
vWD. Which of the following would help in the diagnosis
a. Thrombin time
b. Bleeding time
c. Clotting time
d. Serum fibrinogen
e. Prothrombin time
Key: a

Q No.163. A 5 year old male patient presented with history of gum bleeding and epistaxis on
and off since birth. CBC revealed thrombocytopenia. Bleeding time is more than 15 mins. All of
the following are true except?
a. von Willebrand disease.
b. Bernard – Soulier syndrome
c. Glanzmann thrombasthenia
d. Immune thrombocytopenia
e. Hemophilia A
Key: e
Q No.164. A 27 year old pregnant woman referred to haematology clinic for low platelet
count. She is diagnosed as gestational thrombocytopenia. What is the most important
investigation in this case.
a. Bone marrow examination
b. Review of the peripheral blood film
c. Renal function tests
d. Serum Ferritin levels
e. Ultrasound abdomen
Key: b

Q No.165. Unfractionated heparin was started in a male who presented with deep venous
thrombosis. His condition improved after treatment. The anticoagulant therapy in this patient
will be monitored by
a. Prothrombin time
b. Activated partial thromboplastin time
c. Clotting time
d. INR
e. D-dimers
Key: b

Q No.166. A 32 years old female presented to emergency of a hospital with bruises and
bleeding from gums on brushing teeth since one week. Physical examination was normal. CBC
revealed Hb 10.5 gm/dl, MCV 70 fl, WBC 7 x 109/L and platelets 5 x 109/L. What investigation
will be most helpful in diagnosis
a. Bleeding time
b. Bone marrow examination
c. Coagulation profile
d. Thrombophilia screening
e. Platelet function studies
Key: b

Q No.167. A newborn male child born to a multiparous and healthy woman, presented with
purpuric spots on the scalp, abdomen and lower limbs. He is afebrile and there is no
hepatosplenomgaly. CBC revealed a platelet count of 14 x 109/L. There is passage of fresh
blood in the stool. What is the most frequent cause of thrombocytopenia in this patient
a. Maternal hypertension
b. Acute leukaemia
c. Sepsis
d. Neonatal alloimmune thrombocytopenia
e. TTP
Key: d
Q No.168. A two year old child has been admitted due to 3 days history of fever and bloody
diarrhea. On examination he was pale and lethargic. His initial workup shows Hb 7.2 gm/dl,
Platelets 45 x 109/L and presence of burr cells on peripheral blood film. What is the most likely
cause of this illness
a. Haemolytic uraemic syndrome
b. Disseminated Intravascular Coagulation
c. Thrombotic Thrombocytopenic Purpura
d. Von Willebrand Disease
e. Intussusception
Key: a

Q No.169. A 2 days old girl was delivered at home by vaginal delivery. Mother complained
that she passes 5 – 6 stools of normal consistency which contain fresh blood. There is no
history of bleeding from any other site and baby is healthy and breast fed. There is no family
H/O bleeding disorder. Hb = 13.5 gm/dl, TLC = 14 x 109/L, Platelets = 302 x 109/L, PT = 36
sec, aPTT = 64 sec. Bleeding time is normal.
What is most probable diagnosis?
a. vWD
b. Vit K deficiency
c. Haemophilia A
d. Factor XIII deficiency
e. Hemophilia B
Key: b

Q No.170. A 2 year old boy presented with history of gum bleeding and easy bruisability.
There was no hepatosplenomegaly. Her investigation revealed Hb 12.4 gm/dl, TLC = 7.4 x 109
/L, platelets = 230 x 109 /L, PT = 13 / 11 sec, aPTT 34 / 33 sec. Bleeding time is more than 15
mins What further investigation will you advise to reach at a diagnosis
a. Bone marrow examination
b. Thrombin time
c. Platelet function studies
d. Serum fibrinogen
e. PCR for factor VIII mutations
Reference: Essentials Hoff brand Haematology 6th edition Page 340 - 341
Key: c
Q No.171. A 73 year old woman presented with low back pain and progressively worsening
fatigue Bone marrow biopsy revealed large number of plasma cells
Plasma cells are
a. B cells
b. T cells
c. NK cells
d. Myeloid cells
e. Blast cells
Key: a

Q No.172. A 68 year old male presents with generalized weakness and lethargy. He is pale
on examination. CBC shows Hb 8.4 g/dl. A monoclonal band is seen on serum protein
electrophoresis. He is suspected to have multiple myeloma. What will you expect to find on
peripheral blood film?
a. Hypersegmented neutrophils
b. Giant platelets
c. Rouleaux formation
d. Eosinophilia
e. Basophilic stippling
Key: c

Q No.173. A 68 year old man presents with low back pain for the past 3 months. Laboratory
investigations showed Hb 9.1 g/dl and raised serum calcium. He is diagnosed to have multiple
myeloma. The following skeletal system is most affected by multiple myeloma
a. Ulna
b. Tibia
c. Radius
d. Vertebral column
e. Humerus
Key: d

Q No.174. A 64 year female presents with pallor, fatigue and generalized weakness. On
workup paraproteinemia is seen. Which of the following is not associated with paraproteinemia
a. Chronic Lymphocytic Leukemia
b. Lymphoplasmacytic lymphoma
c. Primary amyloidosis
d. Chronic Myeloid Leukemia
e. Multiple myeloma
Key: d
Q No.175. An elderly lady came to the OPD with low backache. On baseline investigations
she is found to have anaemia and a raised ESR. All of the following conditions are
characterized by a high ESR except
a. Multiple myeloma
b. Rheumatic arthritis
c. Tuberculosis infection
d. Sickle cell anaemia
e. Acute sepsis
Key: d

Q No.176. A 60 years old female presented with recurrent headache , dyspnea and blurred
vision. CBC showed Hb 17g/l and HCT 58%. Which are of the following is NOT a cause of
erythrocytosis?
a. Mutation of JAK2
b. Renal disease
c. Congenital Heart disease
d. Haemoglobin abnormality
e. Iron overload
Key: e

Q No.177. A 52 years old female presented with abdominal discomfort .USG showed
massive splenomegaly .CBC revealed Hb 9 g/dl, WBC 44 x 109 /l. Peripheral film showed tear
drop cells. Trephine biopsy confirmed the diagnosis of primary myelofibrosis. Which of the
following is not a typical feature of primary myelofibrosis
a. Leucoerythroblastic blood picture.
b. JAK 2 mutation.
c. Normal serum lactate dehydrogenase level.
d. Anaemia
e. Massive splenomegaly
Key: c

Q No.178. A 20 years old athlete presented for complaints of recurrent headache and
pruritus after hot bath. CBC showed Hb 18.5 g/dl ,Hct 0.50 and RBC count 5.5 x 1012 /l.
Which of the following statements is correct about pseudopolycythemia?
a. It is caused by raised red cell mass
b. It is associated with large spleen
c. It is treated with hydroxycarbamide
d. It is due to plasma volume contraction
e. It is due to fluid over load
Key: d
Q No.179. 60 years old male patient presented with abdominal discomfort , lethargy and
splenomegaly (20 cm). CBC showed Hb 8 g/dl, WBC was 6 x 10 9 /l and platelets 150 x 10 9
/l. Peripheral film showed leucoerythroblastic blood picture. Bone marrow aspirate was dry.
There was marked increase in reticulin on trephine biopsy. Most likely diagnosis is
a. Polycythemia rubra vera
b. Acute leukemia
c. Primary myelofibrosis
d. ITP
e. Essential thrombocythemia
key: c

Q No.180. A 35 years old male presented with fever, easy fatigability breathlessness and
easy bruising. On bone marrow examination he was diagnosed as case of acute myeloid
leukaemia. Which ONE of these is the most likely blood counts in a patient who presents with
acute myeloid leukaemia?
a. Hb 14 g/dL; white blood cell count (WBC) 270x109/L; platelets 100x109/L
b. Hb 9 g/dL; WBC 2x109/L; platelets 140x109/L
c. Hb 7 g/dL; WBC 27x109/L; platelets 9x109/L
d. Hb 14 g/dL; WBC 270x109/L; platelets 1000x109/L.
e. Hb 16g/dl; WBC 270x109/L; platelets 1000x109/L.
Key : c

Q No.181. A 32 years old male presented with fever, easy fatigability, breathlessness and
easy bruising. Blood CP shows Hb 9 g/dL; WBC 29x109/L; platelets 8x109/L. Bone marrow
shows blast cell more than 90 % and was diagnosed as case of acute myeloid leukaemia. He
was advised cytogenetic analysis .In your opinion Which ONE of these genetic abnormalities
defines a patient with acute myeloid leukaemia as having an unfavourable prognosis?
a. t (8:21) translocation.
b. Normal karyotype.
c. Translocation of NPM gene.
d. Deletion of chromosome 7.
e. Inv (16).
Key: d

Q No.182. A 4 years old girl presented with H/O repeated infection and failure to thrive.
Blood CP showed Hb 9 g/dL, WBC 50x109/L, platelets 9x109/L. On BM examination she was
diagnosed as case of Acute lymphoblastic leukaemia. In your opinion Which ONE of these is
NOT associated with poor clinical prognosis in acute lymphoblastic leukaemia?
a. Hyperdiploidy
b. High presenting white cell count.
c. Philadelphia chromosome.
d. Presentation in infants less than 1 year old.
e. CNS disease at presentation.
Key: a
Q No.183. A 76 year old woman presented with small purpuric spots on her hands and
forearms for the last three weeks. On physical examination she is afebrile and has no
organomegaly. Her laboratory investigations show Prothrombin time (PT) 14 / 14, activated
partial thromboplastin time (aPTT) 32/ 32. CBC shows Haemoglobin (Hb) 12.7 g/dl, Hct 37%,
Platelet 276 x 109/L, TLC 5.6 x 109/L, Fibrinogen level is 4g/l and no FDPs are detectable.
Which of the following condition best explains this finding?
a. Disseminated Intravascular coagulation
b. Chronic Renal failure
c. Meningococcemia
d. Senile Purpura
e. Matastatic carcinoma
Key: d

Q No.184. A 24 years old female presented with recurrent fetal loss. Her laboratory
investigation showed only prolonged activated partial thromboplastin time (aPTT) with normal
Prothrombin time (PT) and normal Bleeding time. Activated partial thromboplastin time (aPTT)
is not corrected by normal plasma. What is the most likely diagnosis?
a. Von Willebrand disease
b. Haemophilia A
c. Lupus Anticoagulant
d. Haemophilia B
e. Haemophilia C
Key: c

Q No.185. A 50 years old man presented with pain and swelling in right leg for the last 5
months and was diagnosed as a case of DVT. He was advised tab warfarin 5 mg daily and
monitor the dose with INR. This treatment results in decreased biological activity of which of
the following factors?
a. Factor VIII only
b. Factor II, VII, IX and X
c. Factor VIII & Factor V
d. Factor IX
e. TF and VIIa complex.
Key: b
Q No.186. A 29 years old lady G3P2 is brought to obstetric emergency with thirty weeks of
gestation. Her condition is very critical, she is having high grade fever and with profuse
bleeding P/V. Her laboratory investigations shows her platelet count as 20x109/L, fibrinogen
concentration 0.5g/l, D Dimers >1000 and Prothrombin time (PT), activated partial
thromboplastin time (aPTT) >120 sec. In your opinion what is the most likely diagnosis of the
lady?
a. Thrombotic thrombocytopaenic Purpura
b. Von Willebrand disease
c. Haemolytic uremic syndrome
d. Disseminated intravascular coagulation
e. Accquired Haemophilia A
Key: d

Q No.187. A 75 yrs old man presented to emergency with profuse sweating and left sided
chest pain. His ECG and Echocardiography showed anterior wall myocardial infarction (MI).
He was given injection streptokinase within first hour and managed accordingly. What is the
basic mechanism of action of streptokinase?
a. Inhibits factor V and VIII
b. Inhibits fibrinolysis
c. Promotes thrombin generation
d. Destroys plasma inhibitors of tissue plasminogen activator(TPA)
e. Converts plasminogen to plasmin
Key: e

Q No.188. A 6 year old boy presented with spontaneous bruisibilty and epistaxis since
childhood. His TLC is 5.6 x109/L, Hb 10.5 g/dl, Platelet 250 x 109/L. His Prothrombin time (PT)
and activated partial thromboplastin time (aPTT) are normal but bleeding time is prolonged.
Which further test would you recommend to reach a final diagnosis?
a. Factor VIII assay
b. vWF Activity
c. Factor IX assay
d. Platelet function studies
e. Thrombophilia screening
Key: d
Q No.189. A term infant is born without any complications after a normal pregnancy and
during initial nursery stay, his Prothrombin time (PT) is 14/14, activated partial thromboplastin
time (aPTT) 32/32, Fibrinogen level 4g/l and full blood count were also normal. Infant was
brought to hospital for checkup after two weeks and during checkup it was observed that
umbilical cord has been oozing for four days. What could be the most likely cause?
a. Factor II deficiency
b. Factor XIII deficiency
c. Factor XII deficiency
d. Factor V and VIII deficiency
e. Mild Haempohilia A
Key: b

Q No.190. A 35 years old multiparous lady received 01 unit blood at the end of C-section,
after which she developed high fever, anxiety and passed red colored urine. Which of following
investigation is most informative regarding diagnosis of acute hemolytic transfusion reaction
a. Mixed field reaction on indirect Coombs test
b. Mixed field reaction on direct Coombs test
c. Urine positivity for hemosiderin
d. Coagulation profile
e. Increased reticulocyte count
Key: b

Q No.191. A 28-year pregnant woman from Balochistan , has presented with deep jaundice.
She previously had abnormal liver function tests, which were not investigated. She denies use
of any drugs or chemicals. Her Hb is 7 g/dl, normal platelets and a blood film shows irregularly
contracted cell and some erythrocytes with retraction of haemoglobin to one side of the cell. A
Heinz body preparation is positive. What is most likely diagnosis in the patient?
a. Glucose 6 phosphate hydrogenase deficiency
b. HELPP Syndrome
c. Thrombotic thrombocytopenic purpura
d. Sickle cell disease
e. Wilsons disease
Key: e
Q No.192. A 30-year woman who is eight months pregnant, presented with a 2-day history
of giddy spells. This was her first pregnancy. Her past medical history was unremarkable. She
was taking no medication. Her blood tests on booking were normal. Clinical examination was
unremarkable. Her full blood count showed Hb 10 g/dl, MCV 103 fl, WBC 15 x 109/l and
platelet count 180 x 109/l.
a. B12 deficiency
b. Folate deficiency
c. Physiological anemia of pregnancy
d. Thalassaemia trait
e. Anemia of chronic disease
Key: c

Q No.193. A 52-year-old male factory manager, is short of breath on mild exertion and has
digital polyarthralgia. On examination he is jaundiced with minimal splenomegaly and
investigations show an Hb of 120 g/l and glycosuria. MCV/MCH increased; serum ferritin
increased. Which is most likely based on scenario?
a. Haemochromatosis
b. B12 deficiency
c. Folate deficiency
d. Myelodysplastic syndrome
e. Polycythemia rubra vera
Key: a

Q No.194. A 32 weeks premature irritable infant has fever, tachycardia on first day of birth.
WBC count is 12x109/L, Hb 14 g/dl and platelets 6 x109/L. His blood film shows atypical
lymphocytes. His prothrombin time is 36 sec (N 11-16), Fibrinogen 0.3 g/L (1.5-4 g/L). The
maternal platelets were normal. Which of following test you would undertake first:
a. CMV serology
b. HIV serology
c. Blood culture for bacterial infection
d. Blood culture for candida infection
e. Coxsackie virus serology
Key: e

Q No.195. A term neonate boy has presented with pallor in first week of life but no jaundice.
The Hb is 6 g/dl, MCV 106 fl, WBCs 9.2x109/L, platelet 280x109/L, nucleated RBCs
0/100WBCs and absolute reticulocytes 3x109/L. The neonate is likely to suffer from:
a. Fanconis anemia
b. Congenital dyserythropoietic anemia
c. Diamond Blackfan syndrome
d. Storage disorder
e. HDN due to anti Kell antibody
KEY: c
Q No.196. Two male siblings aged 11 years and 9 years, product of consanguineous
marriage has reported with failure to thrive, epistaxis off and on. Both have Hb less than9 g/dl,
PT 14.4 sec, PTTK 38 sec. Their blood film showed acanthocytes. Both parents have low
cholesterol in their serum. What is the cause of their condition
a. Cystic fibrosis
b. Infantile pyknocytosis
c. Pyruvate kinase deficiency
d. Hypothyroidisnm
e. Abetalipoproteinemia
Key: e

Q No.197. A 65 years old male underwent coronary artery bypass surgery and on his 3rd
post op day developed thrombocytopenia with platelet count of 80x109/L. You were asked to
calculate his pretest clinical probability of heparin induced thrombocytopenia. . You included all
of Ts in scoring system except one of following.
a. Thrombocytopenia recent onset
b. Timings of platelet count fall
c. Thrombosis or other sequelae
d. Transfusion of platelets
e. Thrombocytopenia causes (others)
KEY: d

Q No.198. A 60 years old lady had CABG surgery and needed balloon temponade during
post op period and was heparinized. On 15th post op day she developed high fever and
became restless. She had no preop exposure to heparin. Her Hb is 9 g/dl, retics 3.5 %, platelet
count of 20x109/L while preop platelets were 150x109/L. Which of following investigations is
most likely to clarify cause of thrombocytopenia in this patient.
a. D-Dimers
b. Anti heparin P4 antibody assay
c. ADAMTS-13 assay
d. Antiplatelet IgG assay
e. Complement levels
Key: a

Q No.199. In order to prevent Graft vs Host disease due to transfusion, what is the minimum
irradiation dose through Cesium source irradiator out of following doses?
a. 2500 cGray at the central part of blood bag
b. 2500 Gray at the central part of blood bag
c. 1500 cGray at the central part of the blood bag
d. 1500 Gray at the central part of the blood bag
e. 2000 Gray at the central part of the blood bag
Key: a
Q No.200. A 20 years old male treated for AML is having mild epistaxis and a platelet count
of 10x109/L. He was transfused 6 units of ABO compatible random donor platelets and
increment at one hour was 5x109/L. Which of following is likely cause of this poor response?
a. Non immune mediated refractoriness
b. Immune mediated refractoriness
c. Splenic sequestration of platelets
d. Decreased production of platelets
e. Increased consumption of platelets
Key: b