Special pathology

Red blood cell & bleeding disorder

Written by
Dr Naveed Ahmed Panhwar
“Everything must be made as simple as possible. But not
simpler.”

Points portion
1.CAUSES OF MICROCYTIC ANEMIA
(TAILS)
T-Thalassemia
A-Anemia of chronic disease
I-Iron deficiency anemia
L-Lead poisoning
S-Sideroblastic anemia
Or
Iron SALT-
Iron= iron def anaemia,
S= sideroblastic anaemia
A= anemia of ch. Diseases
L= lead poisoning
T= thalesemia

2.Anaemia – Categorized by Cell Size

Microcytic
Small Typically Iron
S-Sideroblastic
T-Thalassaemia
I-Iron deficiency

Macrocytic
My Blood Has Large Erythrocytes
M- Myelodysplasia
B-B12 deficiency
H-Haemolysis
L-Liver disease
E-Embryo (pregnancy)

Normocytic
  Exclude Chronic Anaemia
E-Endocrine (hypopituitary, thyroid, adrenal)
C-Combined deficiency
A-Acute blood loss/A plastic

3.mnemonic for plummer vinson syndrome:

" DIG AKA patterson brown kelly"

D: dysphagia(esophagal webs)
I:  iron deficiency anaemia.
G: glossitis(atrophic)

A: angular stomatitis.
K:  koilonichia.
A: achlorhdria.
patterson brown kelly

4 . Normal value of hemoglobin in men is === 13.5 -17.5 gm/dl

5.Normal value of hemoglobin in Women is====12-15gm/dl

6.Normal value Of MCV (mean corpuscular volume)  is===

82-96femtolitres
7.Normal value of mean corpuscular hemoglobin is ====
27-33picograms

8.Normal value of mean corpuscular hemoglobin concentration is

=== 33-37 gm/dl

9.Normal value of red cell distribution width is ==== 11.5-14 .5

10.reflects variation in size of RBC's In the peripheral blood is

called ==== Red cell distribution width

11.Anemia classified on the basis of === MCV

12.in microcytic anemia, the MCV is <80um3

13.Examples  of microcytic anemia are==== (SITA)

S-sideroblastic anemia
I-iron deficiency anemia
T-thalasemia
A-anemia of chronic disease

14 .in macrocytic anemia,  the MCV is == >100 micrometer

15.mnemonic for different types of anemia

''IT'S ANEMIA'S BRAND''

Microcytic:
I- iron def
T- thalassemia
S- sideroblastic

Normochromic:
A- anemia of chronic illness
N- Nephgogenic anemia (eg: uremia)
E- Endocrine causes (eg: thyroid hormone)
M- malignancy
I- IV fluids
A- aplastic anemia
S- sickle cell anemia

macrocytic:
B- B12 deficiency
R- reticulocytosis
A- alcohol
N- nutritional (malnutrition, pregnancy)
D- drugs (methotrexate,triamterene, azathioprine

15.Chipmunk facies ====== Untreated β

Thalassemia

16. Causes of anemia of chronic disease (ACD)

(CAlM)
C-chronic inflammation
Al-alcoholism
M-malignancy

17.What is the best way to distinguish iron deficiency anemia

from anemia of chronic disease ==== serum ferritin level

18.Causes of sideroblastic anemia

Mnemonic: LIARS
Lead
Isoniazid
Alcohol
Ringed Sideroblasts
Six (Vitamin B6 deficiency)

19.causes of Microcytic anemia is TICS:

T: thalassemias
I: iron deficiency
C: chronic diseases
S: sideroblastic anemia

20.MACROCYTIC anemia causes

"BIG  FAT RED CELLS"

B-B12 Malabsorbtion
I-Inherited
G-Gastrointestinal disease or surgery  

F-Folic Acid Deficiency

A-Alcoholism
T-Thiamin responsive  

R-Reticulocytes miscounted as large RBCs

E- Endocrine - hypothyroid
D-Dietary

C-Chemotherapeutic Drugs
E-Erythro Leukemia
L- Liver Disease
L- Lesch-Nyhan Syndrome
S-Splenectomy
ANEMIA: NORMOCYTIC = "NORMAL SIZE"

N - Normal Pregnancy
O - Over hydration
R - Renal Disease
M - Myelophthistic
A - Acute Blood loss
L - Liver Disease

SI - Systemic Infection or Inflamation

Z -  Zero production - Aplastic
E -  Endocrine: Hypothyroid, hypoadrenal,    decreased androgen

ANEMIA: MICROCYTIC = "TICS"

T - Thalassemias
I - Iron Deficiency:  Source: GI Bleed 56%  Menses   29%  Diet     19%
C - Chronic Inflammation
S - Sideroblastic -lead toxicity

21. Megaloblastic anemia is caused by === vitamin B12 deficiency &

folate deficiency

22.Non megaloblastic anemia is caused =====

(HYPO-LAL)
hypo= hypothyroidism
L-liver disease
A-alcoholism
L-lesch nyhan syndrome

23.Leishmania donovani ...Aplastic anaemia.

Plasmodia species....Haemolytic anaemia.
Shistosoma species..iron deficiency anaemia.
Hookworms............iron deficiency anaemia.
Diphyllobothrium latum...Perniciuos anaemia.
Trichuris trichiura......... Perniciuos anaemia.

24 .Asides B12 & Folate Deficiency

25.Mnemonic for causes of Macrocytic Anemia:

DrAPHy L(o)ver of LeuK(a)em
Drugs: Phenytoin, Trimethoprim
Alcohol
Pernicious Anaemia
Hypothyroidism
Liver Disease
Leukaemia

26.Most common anemia is === iron deficiency anemia

27.most common nutritional disorder in the world === iron

deficiency anemia

28.Peptic ulcer in men of age less than 50 most common cause

of=== iron deficiency anemia

29.monorhhagea in women of age less than 50 most common

cause of=== iron deficiency anemia

30.colorectal Of age greater  than 50 most common cause of===

iron deficiency anemia

31.koilonchya (nail spooning) +angular cheilosis +atrophic

gastritis +pica+plummer Vinson syndrome all are clinical finding
of === iron deficiency anemia

32.iron deficiency anemia +dysphagia (esophageal webs) for solids

+atrophic gastritis +squamous cell carcinoma are are causes of
==== plummer Vinson syndrome

33. The Plumber "Vincent"  DIGS a hole for IRON pipe

D-dysphagia
I-iron deficiency anemia
G-dysphagia
S-squamous cell carcinoma
IRON -treatment iron supplement

34 .thrombocytosis is common finding in === chronic Iron

deficiency anemia

35.total iron binding capacity (TIBC) is  Increase only in === iron
deficiency anemia

36.beta thalassemia is === autosomal recessive disorder

37.beta thalassamia is characterized by == decreased synthesis of

B-globin chain with relative excessive of alpha chain

38.point mutation are the most common === beta thalassemia

39.splicing mutation are most common type of== point mutation

4 0. beta thalassemia minor causes == mild microcytic anemia

4 1.beta thalassemia minor is mildly protective against ===

falciparum malaria
4 2.beta thalassemia major also known as == cooley's anemia

4 3.crew cut appearance on X-ray & hepatosplenomegaly is a

clinical feature of == beta thalassemia major

4 4 .chipmunk facies are seen in === beta thalassemia major

4 5.hemosiderosis== accumulation of hemosiderin (iron pigment) 

4 6.hemochromatosis == accumulation of iron in tissue

4 7.Hb A is absent in == beta thalassemia major

4 8.alpha thalassemia is an ===autosomal recessive disorder

4 9.silent carrier is a type of alpha thalassemia caused by ===

deletion of one alpha chain

50.Hb H disease is characterized by precipitation of === beta chain

tetramers

51. Chronic hemolysis + juandice +gall stones +skeletal Changes +

increase reticulocyte count +intra erythrocytic inclusion all are
clinical finding of === Hb H disease

52.most common anemia in hospitalized patients === anemia of

chronic disease

53.hepciden = is an antimicrobial peptide synthesized and released

by liver
54 .hepcidin = = inhabits the release of iron from storage pool
which results in increased macrophages iron store ""reticulo-
endothelial cell block

55.sideroblastic anemia is results from defect in == heme

synthesis within mitochondria

56.chronic alcoholism is most common cause of ==== sideroblastic

anemia

57.in sideroblastic anemia  == vitamin B6 deficiency can occur

58.ringed sideroblast == refers to dark blue granules within

mitochondria

59.megaloblastic anemia is due to == impaired DNA  synthesis

60.megaloblastic anemia is associated with == hypersegmented

neutrophils on Peripheral smear

61.pernicious anemia is an autoimmune disease characterized by

=== atrophic gastritis

62.pernicious anemia is a=== type II hypersensitivity reaction

63.type I antibody (intrinsic factor antibodies)== most specific

antibody for pernicious anemia

64 .pancytopenia occurs in === megaloblastic anemia

65. Decreased reticulocyte count +pancytopenia +marrow

hyperplasia due to increased erythropoetin == megaloblastic
anemia

66.increase demand causes of folate deficiency anemia ===(PMDC)

P-pregnancy
M-malignancy
D-dialysis
C-chronic hemolytic anemia

67.RBC coated with IgG causes of ==== extravascular hemolysis

68.IgM mediated hemolysis is a cause of == intravascular

hemolysis

69.Hereditary spherocytosis is an == autosomal dominent disorder

70.Hereditary spherocytosis is  == normocytic anemia with high

reticulocyte count

71.most common mutation associated with Hereditary

spherocytosis are == ankyrin, band 3,spectrin & band 4

72.sickle cell disease is an === autosomal recessive disorder

73.in sickle cell disease ,the heterozygous condition is known as

=== single chain mutation

74 ..in sickle cell disease ,the homozygous condition is known as

=== double chain mutation

75.howell jelly bodies are seen in == sickle cell disease

76.septicemia most commonly caused by === streptococcus

pneumoniae

77.meningitis most commonaly caused by =====

streptococcus pneumoniae & hemophilus influenza

78.Vaso occlusive crises is the commonest of the crises suffered by

the sickle cell warriors.
It comprises of: *bone pain, dactylitis, acute chest syndrome,
priapism and abdominal pain*

79.TYPES OF SICKLE CELL CRISES

Vaso occlusive crisis
       -Hand and foot Syndrome (dactylitis)
       -Acute chest Syndrome
       -priapism
       -Abdomninal crisis
       -cerebrovascular accident(stroke)
       -Bone pain crisis
Sequestration crisis
      -Splenic sequestration crisis
      -Hepatic sequestration crisis
Aplastic crisis
Haemolytic crisis

80.The most common cause of vitamin B-12 deficiency is====

pernicious anemia.

81. The most common cause of folate deficiency is=== alcohol .

82.Auto-splenectomy is occur in ====sickle cell anemia and celiac

disease.
83.Itching after hot shower with dizziness and splenomegaly is
found in==== Polycythemia.

84 . In Aplastic anemia=== splenomegaly is characteristically

absent.

85. Increase MCHC only occur in Hereditary spherocytosis that’s

why it is also called ===Normocytic hyperchromic anemia .

86.Hb-F protect us from sickling=== in sickle cell anemia .

87.Hb electrophoresis is the most accurate test for=== sickle cell

anemia.

88.PNH is the only hemolytic anemia caused by=== an “acquired”

intrinsic defect in cell Membrane.

89. Extra-vascular hemolysis occur in ====sickle cell anemia and

hereditary spherocytosis.

90.Intra-vascular hemolysis occur in=== PNH and G6PD deficiency.

91. Warm antibody auto immune hemolytic anemia (AIHA) is the

most common ====hemolytic anemia (70%) and is IgG mediated.

92.Cold agglutinin disease is==== less common(30%) and igM

mediated.

93.Reticulocytosis is most commonly seen in ===hemolytic

anemia.

94 .Phytates ,Tannates, phosphate, oxalate and carbonate all these

have negative influence on ===iron absorption.

95.Vitamin –C ===citrate and glucose all help to convert ferric iron

to ferrous iron which is easily absorbable.

96. Intestinal absorption of iron occur mainly in ===ferrous form

which found in most abundant in meat.

97. Iron deficiency anemia is ====Microcytic hypochromic anemia.

98.Sickle cell disease: in Heterozygous condition which is also

called sickle cell trait i-e hbs contain two population of RBC,
contain 60% normal and 4 0% is sickle Hb (hbs). This is
===protective against falciparum malaria

99.Sickle cell disease: in homozygous condition which is also

called sickle cell anemia i-e Hbss . It contain 100% Hbs with no
normal cell . This is ===not protective against falciparum malaria

100. Sickling Is precipitated by ====hypoxia, dehydration, acidosis

and infection(To remember HIDA).

101. Vaso-occlusive crises is the most common crises in sick cell

anemia which cause=== hand and foot syndrome(Dactylitis) and
acute chest syndrome(which is the most common cause of death
in adults).

102. Clinical finding of sickle cell anemia is == susceptibility to

infection like ostemyelitis , meningitis and sepsis, three kind of
crises like Vaso-occlusive crises, Aplastic crises and sequestration
crises.
103.Splenomegaly is most common and prominent in== hereditary
spherocytosis than any other form of hemolytic anemia .

104 .Beta Thalassemia major ===also called Cooley’s anemia : Hb

electrophoresis show absent HbA ,markedly raised HbF and HbA2
normal, high or low.

105. Beta Thalassemia minor=== Hb electrophoresis show decrease

HbA, normal HbF and raised HbA2.

106.Patient of beta Thalassemia major who are on high blood

transfusion is an increase risk of ===Iron overload.

107.The most common cause of anemia of chronic disease (ACD) is

====rheumatoid arthritis and tuberculosis.

108.How to differentiate between hemolytic crises and

sequestration crises?
Sequestration is when something gets squeezed.. In sickle cell
anemia sequestration crisis , if present, they usually become
evident in first 3 years of life resulting in autosplenectomy.
Features appear like severe abdominal pain, cold calm extremities,
internal hemorrhage leading to hypovolemic shock and paleness.
Hemolytic crisis are simple .. Jaundice + anemia is equal to
hemolysis

109.chest pain + shortness of breath +wheezing +hypoxemia &

infiltrates on chest X-ray is clinical feature of === acute chest
syndrome

110.reticulocytopenia occurs in == aplastic crises

111.Sequestration crises mainly affects == children with functional
spleen.

112.[1] Cold agglutinin disease (CAD) = IgM antibodies = directed at

the RBC I antigen.
[2] Paroxysmal cold hemoglobinuria (PCH) = Donath-Landsteiner
antibody = IgG hemolysin = directed against the P antigen.
[3] Warm Autoimmune Hemolytic Anemia = IgG antibodies =
Panagglutinin.
[4 ] Drug Induced AIHA = IgG antibodies.
 
  113.G-6-PD deficiency is an == X-linked recessive disorder

114 .Bite cells are seen in ==G-6-PD deficiency

115.Heinz test is used to diagnose the ===G-6-PD deficiency

116.lymphoma & leukemias are causes of === warm antibody AIHA

117.R.BCs are coated with IgG are phagocytosed by splenic

macrophages is a mechanism of === warm antibody AIHA

118.mycoplasma infection most common cause of == cold

agglutination disease

119.mycoplasma infection + measels +mumps all are causes of ===

cold hemolysin hemolytic anemia

120.PNH== hemolytic anemia

121.aplastic anemia is == normocytic anemia with low reticulocyte

count
122.fanconii anemia is a inherited cause of == aplastic anemia

123.Hepatitis ,EBV, cytomegalovirus (CMV) & varicella zooster (HEC-

V) all are infectious causes of === aplastic anemia

124 .splenomegaly is characteristicaly absent in== aplastic anemia

125.Partial ThromboPlastin time == 25-4 0 Second

126.bleeding time === 2-9 minutes

127.prothrombin time === 9-15 seconds

128.site of bleeding in pletelates defects == superficial (e. g= skin

nd mucous membrane)

129.site of bleeding in coagulation defects == deep (e. g= muscles &

joints )

130.lesion occurs  in pletelates defects  == petechiae & Ecchymosis

131.lesion occurs  in coagulation defects == hemarthrosis &

hemartomas

132.idiopathic thrombocytopenic purpurea (ITP)  is caused by ==

IgG antibodies against glycoprotein IIb / IIIa receptor

133.acute ITP = = most common cause of thrombocytopenia in

children 2-6 years of age

134 .chronic ITP = = most common cause of thrombocytopenia in

adults

135.thrombotic thrombocytopenic purpurea is caused by

deficiency of enzyme === ADAMTS -13 also called Vwf (von will
brand factor -cleaving metalloprotease)

136.TTP smear == schistocytes

137.ITP=== micro-spherocytes

138.MHA smear ===schistocytes

139.HUS smear ====schistocytes

14 0.type 1 heparin -induced thrombocytopenia === is a non

immune

14 1.type 2 heparin -induced thrombocytopenia is a === type 2

hypersensitivity

14 2.thrombosis (venous thrombosis > arterial thrombosis) is a

complication of === type 2 heparin -induced thrombocytopenia

14 3.von will brand disease is an == autosomal dominent disorder

14 4 .most common inherited bleeding disorder === von will brand

disease

14 5.type 1 von will brand disease= = autosomal dominent

14 6.type 2 von will brand disease ==autosomal dominent disorder

14 7.type 3 von will brand disease == autosomal recessive

14 8.Hemophillia A is === most common hereditary disease is

associated with serious bleeding

14 9.hemophillia A is  a=== X-linked recessive

150.hemophillia B also known as=== Christmas disease

151.spontanous hemorrhage +hemarthrosis +petechiae are

characteristicaly absent +crippling arthopathy all are clinical
finding of ==== hemophilia A

152.DIC (disseminated intravascular coagulation) is a --- thrombo -

haemorrhagic disorder

153.bleeding is common in ==== acute DIC

154 .thrombotic complication is a common im === chronic DIC

Bcqs portion
1.Regarding Reticulocyte count :
a. appear red on wright stain
b.contain remnant of cytoplasmic DNA
c. corrected reticulocytes count  is excellent index of
erythropoeitn activity T
d. normal count more than 2.5

2.A client has been receiving cyanocobalamine (B12) injections for

the past 6 weeks. Which laboratory finding indicates that the med-
ication is having the desired effect?
A. Neutrophil count of 60% T
B. Basophil count of 0.5%
C. Monocyte count of 2%
D. Reticulocyte count of 1%

3.Heinz bodies and bite cells diagnostic of

A, megaloblastic anemia
B, lead poisoning
C, liver disease
D, reticulocytosis
E, glucose -6-phosphate dehydrogenase deficiency T

4 .A man has developed basophilic stippling of rbcs.the said

stippling represents presence of
A, Copper
B, Iron
C, Zinc
D, Protein
E, RNA T

5.Basophilic  stippling
A.lead poisoning
B.myrloproliferative syndromes
C.sideroblastic anaemia
D.all T

6.RBC stacked like poker chips in blood smear

( rouleaux formation ) in
A, Giant cell tumor
B, Lekemia
C, Myelofibroais
D, Multiple myeloma T
E, Adult t cell lymphoma
7.Microcytic Anaemia is caused due to Deficiency of
A) Iron T
B) Vitamin B12
C) Both a and b
D)  Folate

8.Koilonychia is seen in:

A. Vit C deficiency
B. Malignancy
C. Folic acid deficiency
D. Iron deficiency anaemia T

9.Most common hematological disorder following gastrectomy is:

a. Megaloblastic anemia
b. Dimorphic anemia
c. Iron deficiency anemia T
d. Folate deficiency

10.Patients with Plummer-Vinson syndrome are at an increased

risk for
A. Adenocarcinoma of the esophagus
B. Barrett's esophagus
C. Candida infection
D. Cytomegalovirus esophagitis
E. Squamous cell carcinoma of esophagus T

11.Plummer vinson syndrome is not associated with

A,Atrophic gastritis
B,haematemesis T
C,squamous cell carcinoma
D, esophageal webs (dysphagia)
E, iron deficiency anaemia

12.Plummer-vinson syndrome associated with

a.Megaloblabstc anemia
b.thalessemia
c.lead posoining
d.iron deficiency anemia T
e.sickle cell disease

13.Pencil Cells are feature of

A, Iron Deficiency Anemia T
B, Thlasamia
C, Sickle cell anemia
D, Aplastic anemia

14 .pencil cells on smear,characteristic of which disease??

a.aplastic anemia
b.pernicious anemia
c.iron deficiency  anemia T
d.H.S
e.megaloblastic anemia

15. Roulaeux formation is seen in

A, multiple myeloma
B, para-proteinuria
C, chronic inflammation
D, all of these T
E, none of these

16.Bitz cells and hens bodies are seen in

A, multiple myeloma
B, para-proteinuria
C, chronic inflammation
D, glucose -6-phosphate dehydrogenase T

17.All the following are suggestive of iron deficiency anemia

except  ?
A, koilonychia
B, pica
C, decreased serum ferritin
D, decreased total iron-binding capacity (TIBC) T
E, low reticulocyte response

18.in iron deficiency anemia,total iron

binding capacity
A, high T
B, low
C, boderline
D, none

19.In Iron deficiency anemia the most useful diagnostic test is:

A- TIBC  (Total iron binding capacity)

B- Serum ferritin T
C- RBC protoporphyrin
D- MCV
E- Plasma transferrin

20.Regarding beta thalassemia

A. Mutation in promoter region of beta gene T
B. Point mutation in beta gene
C. Large deletion in beta gene
D. Small deletion in beta gene
21.Diagnosis of beta thalassemia is established by
A, Nestroti test
B, HbA1c concentration
C, Hb electrophoresis T
D,  Target cell in peripheral blood

22.Beta thalasmia?
a) point mutation T
b) Nonsense mutation
C)missence mutation
D) none

23.Qualitative change in gene expression:

A, point mutation.T
B, promoter insertion.
C, gene amplification.
D,none

24 .Thalassemia occurs due to which mutations -

a) Missense
b) Splicing T
c) Transition
d) Frame-shift
e) Truncation

25.The most common cause of β- Thalassemia are defects in

mRNA splicing of the beta globin gene. Mutations that affect the
splicing create aberrant transcripts that are degraded before they
are translated. If patients inherit a single mutated gene
(thalassemia minor), the disease manifests with a mild anemia.
However, patients with homozygous mutations (thalassemia
major) have severe transfusion-dependent anemia. Which of the
following types of RNA are involved in the splicing process?
A. Ribosomal RNA (rRNA)
B. Small nuclear RNA (snRNA) T
C. Transfer RNA (tRNA)
D. Small cytoplasmic RNA (scRNA)
E. Heterogeneous nuclear RNA (hnRNA)

26.the beta chain is absent.

A. Beta-minor thalassemia
B. Beta-major thalassemia T
C. Both
D. None

27.Major diagnostic feature of Beta thalassemia is

a) Microcytic hypochromic anemia
b) Mild splenomegaly
c) One parent has thalassemia minor
d) Raised HbA2 fraction T
e) Raised level of HbF

28.Which of the following is not seen on hemoglobin

electrophoresis in sickle cell anemia:
A HbA T
B HbA2
C HbF
D HbS

29.The presence of many abnormal hemoglobins can be confirmed

by this laboratory test, which depends on differences in the
charge of the hemoglobin molecule?
A, Hemoglobin solubility test 
B, Hemoglobin heat instability 
C, Hemoglobin electrophoresis  T
D, Determination of P50 of hemoglobin

30.Cooley's anemia also known as

A. Leukaemia
B.Beta Thalassemia minor
C. Sickle cell anemia
D.Beta thalassemia major T

31.Most common cause of death in Cooley anemia??

A, CHF T
B, Renal
C, gastric ulcer
D, peptic ulcer
E, volvulitis

32."HAIR-ON-END" APPEARANCE IN SKULL X-RAY IS A FEATURE OF:

A) IRON-DEFICIENCY ANEMIA
B) COOLEY'S ANEMIA T
C) SICKLE-CELL ANEMIA
D) HEREDITARY SPHEROCYTOSIS

33.Which of the following α-thalassemias is typically

asymptomatic?
A, α -thalassemia minor 
B, Cooley’s anemia  T
C, Hb H disease 
D, Hydrops fetalis

34 . Cooley's anemia is occur due to

a) absence of beta gene T
b) absence of RBC
c) absence of all blood cell
d) increase of WBC

35. A child with ** B-thalassemaia** (Cooley anemia) is admitted to

the ambulatory care unit for a transfusion. What instructions
should the nurse include in the discharge plan?
A, Encourage fluids
B, Restrict activitics.
C, Protect from infections T
D, Offer small meals frequently

36.crew hair cut appearance of skull in x _ray is a feature of

a.sickle cell anemia
b,thalassemia major T
c,hereditary spherocytosis
d,G6PD deficiency

37.Chipmunk facies are seen in

A) folate def anemia
B) macroangipathic anemia
C) G6PD def anemia
D) thalasemia minor
E) thalasemia major T

38.Microcytic anemia with increased reticulocyte count

A, Iron deficiency anemia
B, Alpha thalassemia
C, Beta thalassemia T
D, Sideroblastic anemia

39.impaired production of hemiglobin A or A2 or fetal hemoglobin

is typically for?
A)alpha thalassemia T
B)beta thalassmia
C)Sickle Cell anemia
D) none

4 0.A 2-year-old boy appears with diminished growth and

hepatosplenomegaly. Blood
smear reveals target cells and poikilocytes. CBC reveals
hemoglobin 4 .5, hematocrit
14 .0, MCV 4 5, WBC 6,000, polymorphs 55%, lymphocytes 4 5%, and
platelet 205,000.
Hemoglobin electrophoresis reveals hemoglobin A 20%,
hemoglobin A2 4 %,
hemoglobin F 76%, hemoglobin S 0%, and an elevated ratio of A2
and A. Most likely
diagnosis:
a) Thalassemia minor
b) Thalassemia major T
c) Sickle cell disease
d) Sickle alpha thalassemia
e) Hemoglobin SC disease

4 1. genes coding for alpha globin chain deletion causes

a.beta thalessemia minor
b. a Silent carier
c.alpha thalessemia trait T
d.Hb F
e.Hb H

4 2.silent carrier is type of alpha thalassemia is caused by

A, deletion of one alpha chain T
B, deletion of two alpha chain
C, deletion of three alpha chain
D, deletion of four alpha chain
E, deletion of five alpha chain

4 3.alpha thalassemia trait is type of alpha thalassemia is caused by

A, deletion of one alpha chain
B, deletion of two alpha chain T
C, deletion of three alpha chain
D, deletion of four alpha chain
E, deletion of five alpha chain

4 4 .hemoglobin H disease is type of alpha thalassemia is caused by

A, deletion of one alpha chain
B, deletion of two alpha chain
C, deletion of three alpha chain T
D, deletion of four alpha chain
E, deletion of five alpha chain

4 5.cis-form (most worse form) of alpha thalassemia trait is

A, asian type T
B, african type
C, amrican type
D, germian type

4 6.Hemoglobin H disease results from :

a)absence of 3 of 4 alpha genes.T
b)absence of 2 of 4 alpha genes
c)absence of 1 of 1 alpha genes
D)absence of all 4 alpha genes.

4 7.Hemoglobin H disease results from :

a)absence of 3 of 4 alpha genes.T
b)absence of 2 of 4 alpha genes
c)absence of 1 of 1 alpha genes
D)absence of all 4 alpha genes.

4 8.hydrops fetalis is type of alpha thalassemia is caused by

A, deletion of one alpha chain
B, deletion of two alpha chain
C, deletion of three alpha chain
D, deletion of four alpha chain T
E, deletion of five alpha chain

4 9.One of the following is characterized by precipitation of Beta

chain tetramers?
A, silent carrier
B, alpha thalassemia trait
C, Hb -H disease T
D, hydrops fetalis
E, none

50.One of the following is characterized by precipitation of gamma

chain tetramers(hemoglobin barts) ?
A, silent carrier
B, alpha thalassemia trait
C, Hb -H disease
D, hydrops fetalis T
E, none

51.one of the following is type of alpha thalassemia is the most

severe form & is incompatible with life?
A, silent carrier
B, alpha thalassemia trait
C, Hb -H disease
D, hydrops fetalis T
E, none

52.whats Hb H disease??
a) omission of 3 alpha chains of Hb T
b) presence of barts hemoglobin
c) requires frequent blood transfusion
D, all

53.hydrops fetalis is type of alpha thalassemia in which signs of

fetal distress become evident by
A, 1st Trimester
B, 2nd Trimester
C, 3rd Trimester T
D, 4 th Trimester
E, 5th Trimester

54 .hepcidin is an antimicrobial peptide synthesized & released by

A, stomach
B, pancreas
C, spleen
D, gall bladder
E, liver T

55.Which hormone regulates iron homeostasis in humans....?

a) thyroid stimulating hormone
b) ADH
c) hepcidin T
d) aldosterone

56.Normally Hepcidin production suppressed by?

a.ferriportn
b.Iron over load
c.dec:Serum Iron level
d.heptic transmembrne serine protease T
e.hephaestin

57.A 25 years old female having complains of dysphagia and

weakness. Labs show Hb 6.2 mg/dl, MCV 68 fl,and target cells in
peripheral film , what is the most likely diagnosis?
A, Iron deficiency anemia .T
B, Anemia of chronic disease .
C, Thalassemia.
D, None

58.A 24 yrs old lady who is 6 months pregnant complains of

generalized weakness and lethargy.her Hb is 9.8 g/dl with mcv 58
fl and mch 15 pg her serum ferritin level is 150 mg /dl .cause?
A, Anemia of chronic disorder
B, Iron deficinecy anemi.
C, Thalasemia trait T
D, Megaloblastic
E, Sideroblastic

59.Rheumatic arthritis & Tuberculosis both are chronic

inflammation is a causes of which of the following??
A, iron deficiency anemia
B, beta thalassemia major
C, beta thalassemia minor
D, alpha thalassemia trait
E, Anemia of chronic disease T

60.One of the following regarding lab finding of Anemia of chronic

disease is correct except
A, decreased MCV
B, decreased serum iron
C, decreased TIBC
D, increase serum ferritin
E, increase TIBC T

61.The only type of the following that has increase in TIBC is :

A) iron deficiency anemia T
B) alpha thalasemia major
C) sideroblastic anemia
D) anemia of chronic disease 
E) macrocytic anemia

62.A 50-year-old woman complains of pain and swelling in her

proximal interphalangeal joints, both wrists, and both knees. She
complains of morning stiffness. She had a hysterectomy 10 years
ago. Physical exam shows swelling and thickening of the PIP
joints. Hemoglobin is 10.3 g/dL, MCV is 80 fL, serum iron is 8 μmol/
L, iron-binding capacity is 200 μg/dL (normal is 250 to 370 μg/dL),
and saturation is 10%. The most likely explanation for this
woman’s anemia is:
A. Occult blood loss
B. Vitamin deficiency
C. Anemia of chronic disease T
D. Sideroblastic anemia
E. Thalassemia

63.Iron overload occurs in all except

A Thalassemia
B Myelodysplastic syndrome T
C Polycythemia Vera
D Sideroblastic anemia

64 .Sideroblastic anemia is observed in the deficiency of which of

the following?
A) Thiamine                                                              
B)vitamin B6 T
C)vitaminB12                                                              D) Niacin
E) Vitamin K

65.sideroblastic anemia is results from defect in

A, heme synthesis T
B, DNA synthesis
C, steroid synthesis
D, porphoblinogens
E, none

66.One of the following regarding lab finding of sideroblastic

Anemia is correct except
A, ringed sideroblasts
B, increase serum iron
C, Normal TIBC
D, increase  ferritin
E, increase TIBC T

67.Transferrin saturation is decreased in one of the following

disease
A, iron deficiency anaemia
B, anemia of chronic disease
C, thalassemia
D, sideroblastic anemia
E, Both A&B T
68.Anemia in pregnancy is:
A normocytic normochromic T
B microcytic hypochromic
C megaloblastic anemia
D none

69.megaloblastic anemia associated with degeneration of spinal

cord is observed in severe deficiency of
(a).riboflavin
(b).ascorbic acid
(c).biotin
(d).cobalamine T
(e).thiamin

70.ileocecal tuberculosis is associated with???

A, megaloblastic anemia T
B, iron def anemia
C, sideroblastic anemia
D, normocytic normochromic anemia

71.Which of the following peripheral blood findings is associated

with lead poisoning?
A. Megaloblastic anemia
B. Basophilic stippling T
C. Microangiopathic changes
D. Lead line
E. Leukocytosis

72.Which of the following is more likely to be associated with

megaloblastic anemia?
a. Breast milk
b. Goat's milk T
c. Cow's milk
d. None

73.The type of anemia in pediatrics associated with leg ulcers is:

A-iron deficiency
B-megaloblastic anemia
C-thalassemia
D-sickle cell anemia T
E-hereditary spherocytosis

74 .Which of the following are most characteristic of the red cell

indices associated with megaloblastic anemias?
A. MCV 99 fl, MCH 28 pg, MCHC 31%
B. MCV 62 fL, MCH 27 pg, MCHC 30%
C. MCV 125 fL, MCH 36 pg, MCHC 34 % T
D. MCV 78 fL, MCH 23 pg, MCHC 30%

75.The condition directly related to bone marrow suppression

is.........:
A. Megaloblastic anemia
B. Iron Deficiency anemia
C. Aplastic anemia T
D. Sickle cell anemia

76.Anemia associated with pancytopenia is

a. Hemolytic
b. Megaloblastic T
c. Iron deficiency
d. All of the above

77. Non megaloblastic anemia is caused by all of the following

except
A, Hypothyroidism
B, liver disease
C, alcoholism
D, lesch -nyhan syndrome
E, antimetabolic drugs T

78.Triphalangeal thumbs is feature of????

A) non megaloblastic anemia
B) megaloblastic anemia T
C) lead poisoning
D) none

79.Which of the following anemia caused by parasitic worms?

A. aplastic anemia
B. Hemolytic anemia
C. Megablastic anemia
D. Iron deficiency anemia
E. Pernicious anemia T

80. A doctor is caring for a 32-year-old client admitted with

pernicious anemia. Which set of findings should the doctor expect
when assessing the client?
A. Pallor, bradycardia, and reduced pulse pressure
B. Pallor, tachycardia, and a sore tongue T
C. Sore tongue, dyspnea, and weight gain
D. Angina, double vision, and anorexia

81.A patient has anemia, hypersegmented neutrophils on

peripheral blood examination and neurological manifestation.
Which type of anemia he is suffering from ?
A) Folic acid deficiency anemia
B) Iron deficiency anemia
C) Pernicious anemia T
D) Thalassemia
E) Autoimmune hemolytic anemia

82.Pernicious Anemia is an autoimmune disease characterized by

A, Angina
B, double vision
C, anorexia
D, gastritis (atrophic) T
E, volvulitis

83. Pernicious Anemia is a

A, type I hypersensitivity reaction
B, type II hypersensitivity reaction T
C, type III hypersensitivity reaction
D, type IV hypersensitivity reaction
E, type V hypersensitivity reaction

84 .Pernicious Anemia is higher incidence in if

A, blood group A T
B, blood group B
C, blood group O
D, blood group AB
E, none

85.Pernicious anaemia is associated with the deficiency of:

A.Folic acid
B.Vitamin B1
C.Vitamin B6
D.Vitamin B12 T

86. Pernicious anaemia is associated with all of the following

except
A, thyroid disease
B, Addison disease
C, carcinoma of stomach
D, crohn's disease T

87.one of the following antibody is the most specific antibody for

Pernicious anaemia
A, Type 1 antibody T
B, Type 2 antibody
C, Type 3 antibody
D, perietal cell antibody

88.Concave or spoon shaped finger nails is a clinical feature of

which anaemia??
a- pernicious anaemia
b- iron deficiency anaemia T
c- folic acid deficiency anaemia
d- aplastic anaemia

89.one of the following is most common clinical finding of

pernicious anemia?
A, glossitis
B, angular cheilosis
C, fatigue
D, weakness
E, peripheral neuropathy T

90.classic traide = extensor plantaris (UMN sign), absent knee jerks

(LMN-sign ),absent ankle jerks (LMN sign)  is clinical feature of
which disease
A, anemia of chronic disease
B, sickle cell anemia
C, pernicious anemia T
D, iron deficiency anemia

91.One of the following regarding lab finding of pernicious

Anemia is correct except
A, increased homocystine
B, increased urine methylmalonic acid
C, decreased reticulocyte count
D, increase LDH & indirect bilirubin level
E, increase serum B12 T

92.  Schilling test is done for?

Vitamin B12 deficiency T
Vitamin folic acid deficiency
Vitamin B6 deficiency
Vitamin D deficiency

93.The doctor understands that the client with pernicious anemia

will have which distinguishing laboratory findings?
A. Schilling’s test, elevated
B. Intrinsic factor, absent T
C. Sedimentation rate, 16 mm/hour
D. RBCs 5.0 million

94 .The primary purpose of the Schilling test is to measure the

client’s ability to:
A. Store vitamin B12
B. Digest vitamin B12
C. Absorb vitamin B12 T
D. Produce vitamin B12
95.Schilling test is done for?
A, anemia of chronic disease
B, sickle cell anemia
C, pernicious anemia T
D, iron deficiency anemia

96.Most common cause of anemia in pregnancy? 

A, Heamodilution
B, Iron deficiency T
C, Folate deficiency
D, B12 deficiency

97.Folate deficiency causes

(A) Microcytic anemia
(B) Hemolytic anemia
(C) Iron deficiency anemia
(D) Megaloblastic T

98.Vitamin c deficiency causes Which Type of anemia

A, Microcytic anemia T
B, Macroctic anemia
C, Normocytic anemia
D, none

99.Intravascular hemolysis is diagnosed by

A)reticulocytosis T
B)increase hemosiderin in blood
C)decrease hb in blood
D)none

100.Complement mediated intravascular Hemolysis

A.heriditory spherocytosis
B.G6PD def
C.PNH T
D.pyruvate kinase def
E.aplastic anemia

101.Anemia in hereditary spherocytosis occurs due to??

A..RBC shape
B..RBC fragility T
C..Bone marrow depression
D... None

102.Only hemolytic anemia with autosomal dominant inheritance

is
a. Hereditary  spherocytosis T
b. Thalassemia
c. Sickle  cell anemia
d. None

103.Which of the following tests is the best for diagnosis of

hereditary spherocytosis?
A- Acid hemolysis test
B- Coombs' test
C- Osmotic fragility test T
D- Schilling test

104 . All of the following are recognized causes of hemolytic

disease in the newborn except  ?
A-hereditary spherocytosis .
B-G6PD  .
C-sickle cell disease  T
D-ABO incompatibility  .
E-RH incompatibility
105.crew hair cut appearance of skull in x _ray is a feature of
a.sickle cell anemia
b,thalassemia T
c,hereditary spherocytosis
d,G6PD deficiency

106.hereditary spherocytosis
a.membranous defect T
b.structural defect
C.functional defect
D. Heme defect
E.DNA defect

107.Spherocytes differ from normal red cells in all of the

following except:
A. Decreased surface to volume
B. No central pallor
C. Decreased resistance to hypotonic saline
D. Increased deformability T

108.Which of the following conditions may produce spherocytes

in a peripheral smear?
A. Pelger–Huet anomaly
B. Pernicious anemia
C. Autoimmune hemolytic anemia T
D. Sideroblastic anemia

109.about heriditary spherocytes?

A.membrane cytoskeleton defect
B.ankyrin & spectrin defect T
C, both
D, none

110.RBC osmotic fragility test?

A .Complete hemolysis in 0.35 nacl T
B. Shrink in hypersonic solution
C .Swell in hypotonic solution
D. none

111.Typical feature of hereditary spherocytosis include

A, splenomegaly amd gall stone T
B, intravascular hemolysis
C, dec rbc osmotic fragility
D, positive coombs test

112.A 35 year old female recovering from mycoplasma pneumonia

develops increasing weakness.  Her Hb is 9.0 g/dl and MCV is 110
fL. What test is most helpful in determining the cause of this
anemia?
a) Serum bilirubin
b) Reticulocyte count
c) Coomb's test T
d) Osmotic fragility test
e) Blood film

113. The best test to assess the prognosis of the patients is:
A. Osmotic fragility
B. Hemoglobin level
C. Packed cell volume
D. Erythrocyte sedimentation rate T

114 .Test used for the diagnosis of the hereditary spherocytosis

a. Schilling test
b. Sucrase hemolysis test
c. osmotic fragility test T
d. Coombs test

115.Which test can be used to detect Hemolytic Anemia?

A - Coombs test T
B - Genetic testing
C - peripheral Blood smear
D - Schilling test

116.of the following is is normocytic anemia with high

reticulocyte count?
A, hereditary spherocytosis
B, sickle cell disease
C, G-6-PD deficiency
D, all of above T
E, none

117.How sickle cell anaemia is different from Thalassemia ?

a.Being autosomal recessive
b.Being a blood disease
c.Being a qualitative disorder T
d.Involvement of mutation
e.Both B&D

118.Sickle cell anemia is a disease caused by

(a) virus  
(b) bacteria 
(c) fungus 
(d) abnormal gene T

119.what is howell jolly bodies ?

a. remnannt of nuclear chromatine T
b. degenerative structure of nuclues
c. deformed cellular constitiuent
d. immature cytoplasmic structure

120.Which of the following can be found on smear in sickle cell

disease?
A-Basophilic stippling
B-Howell-Jolly bodies T
C-Bite cells
D-Schistocytes
E-Morulae

121.we can see Howell Jolly Bodies in the blood film in all of the
following except :
A)-Sickle cell anemia .
B)-Megaloplastic anemia .
C)-Post splenectomy .
D)-Aplastic anemia T

122.Howell jolly bodies Present n:

A, hemolytic anemia
B, sickle cell anemia T
C, pernicious anemia
D, herditry spherocytosis

123.Choose the most common cause of iron deficiency anemia in

early childhood:
A. chronic diseases
B. nutritional factor T
C. chronic bleeding
D. iron absorption disorders
E. infectious diseases

124 .Choose the laboratory result that is not characteristic for iron
deficiency anemia:
A. decreased transferrin saturation
B. decreased serum iron level
C. decreased serum ferritin level
D. decreased MCHC (Mean Corpuscular
Hemoglobin Concentration) in red blood cells
E. decreased total iron-binding capacity T

125.Choose the factor that increase the iron absorption from oral
iron supplements:
A) acidity of gastric juice;
B) activity of salivary amylase;
C) secretory function of the stomach;
D) characteristics of iron from oral iron supplementation
preparations; T
E) the proteolytic activity of human gastric juice.

126. Choose the etiology of the “late” anemia of premature infant:

A. hemolytic anemia
B. iron deficiency anemia T
C. posthemorrhagic anemia
D. aplastic anemia
E. hereditary anemia

127.Select the food from which irons is easier absorbed:

A. Meat T
B. Fruits
C. Vegetables
D. Cereals
E. Milk and dairy products

128.choose the feature that is not characteristic for B12 -

deficiency anemia:
A. megaloblastic type of hematopoiesis
B. disorder of the intrinsic factor (castle factor) secretion
C. hyperchromy
D. insufficient intake of vit. b12 with food
E. increased serum iron level

129.Choose the feature that is not characteristic for iron

deficiency:
A. it’s more frequently diagnosed in children of 6-24 months of
age
B. usually children with iron deficiency are fed mostly with cow’s
milk and buckwheat porridge
C. evolution of iron deficiency is mostly asymptomatic
D. hypochromic anemia
E. increased serum iron levels T

130.Indicate the type of anemia that is not microcytic and

hypochromic:
A. Iron deficiency anemia
B. Beta-thalassemia major
C. Beta-thalassemia minor
D. Hemolytic anemia due to insufficiency of glucoso-6-
phosphatdehydrogenase T
E. Anemia of chronic diseases

131.Choose the statement that is not correct for the folic acid
deficiency anemia:
A. intake of phenobarbital influences folic acid metabolization
B. folic acid deficiency anemia develops in cancer patients
C. folic acid deficiency anemia doesn’t develop in children fed with
goat milk T
D. folic acid deficiency anemia can develop during pregnancy
E. folic acid deficiency anemia develops in children with
malabsorption

132. During foetal life, haematopoiesis commences in the bone

marrow by:
A. 2nd to 3rd month
B. 4 th to 5th month T
C. 6th to 7th month
D. 7th to 8th month

133. Bone marrow trephine biopsy has advantage over aspiration

since:
A. The former method is less time-consuming
B. Romanowsky stains can be done in the former
C. Architectural pattern of marrow is better in the former T
D. Cell morphology is better appreciated in the former

134 . Erythroid cells continue to proliferate up to the stage of:

A. Reticulocytes
B. Late normoblasts
C. Intermediate normoblasts T
D. Early normoblasts

135. Weight of haemoglobin in RBC is:

A. 50%
B. 70%
C. 90% T
D. 99%

136. Red cell membrane defects include the following except:

A. Spherocytosis
B. Ovalocytosis
C. Leptocytosis T
D. Echinocytosis

137. The following factors determine the release of oxygen from

haemoglobin in tissue capillaries except:
A. Nature of globin chains in Hb
B. Bicarbonate ions in blood T
C. pH of blood
D. Concentration of 2,3-BPG

138. Absorption of iron is enhanced by the following except:

A. Ascorbic acid
B. Citric acid
C. Tannates T
D. Sugars

139. In iron deficiency anaemia, TIBC is:

A. Low
B. Normal
C. High T
D. Borderline

14 0. Pappenheimer bodies are found in:

A. Sideroblasts
B. Siderocytes T
C. Late normoblasts
D. Intermediate normoblasts

14 1. In anaemia of chronic disorders, serum ferritin is:

A. Normal
B. Low
C. Increased T
D. Absent

14 2. Folate circulates in plasma as:

A. Methyl tetrahydrofolate T
B. Polyglutamate
C. Monoglutamate
D. Diglutamate

14 3. Measurement of formiminoglutamic acid (FIGLU) for folate

deficiency is done in:
A. Whole blood
B. Serum
C. Plasma
D. Urine T

14 4 . Pernicious anaemia causes pathologic changes in the

anatomic region of stomach as under except:
A. Antrum T
B. Body
C. Body-fundic area
D. Fundus

14 5. In warm antibody autoimmune haemolytic anaemias, the

antibody is commonly:
A. IgA
B. IgG T
C. IgM
D. IgD

14 6. Cold agglutinin antibody in autoimmune haemolytic anaemia

affects:
A. Mature erythrocytes
B. Reticulocytes T
C. Siderocytes
D. Late erythroblasts

14 7. In paroxysmal nocturnal haemoglobinuria (PNH), the undue

sensitivity of red cells to complement can be detected by:
A. Ham’s test T
B. Heinz body test
C. Direct Coombs’ test
D. Indirect Coombs’ test

14 8. In hereditary spherocytosis, the following membrane

structure is deficient:
A. Band 3 protein
B. Glycophorin
C. Spectrin T
D. Glycolipid

14 9. G6PD deficiency has the following genetic basis of

inheritance:
A. Autosomal dominant
B. Autosomal recessive
C. Sex-linked trait T
D. Sex-linked homozygous

150. The rate of sickling in sickle cell anaemia is directly

correlated with the following factors except:
A. Higher concentration of HbS
B. Lower concentration of HbA
C. Higher concentration of HbF T
D. Higher deoxygenation

151. Molecular pathogenesis of a-thalassaemia involves:

A. Mutation in transcription promoter sequence
B. Gene deletion T
C. Codon termination mutation
D. mRNA splicing defect

152. The pathognomonic abnormality in b-thalassaemia minor is:

A. Marked rise in HbA2 T
B. Marked rise in HbF
C. Marked unconjugated hyperbilirubinaemia
D. Marked anaemia

153. In aplastic anaemia, there is generally:

A. Relative neutrophilia
B. Relative lymphocytosis T
C. Microcytosis
D. Reticulocyte count normal

154 . Erythropoietin is produced by:

A. Liver
B. Lungs
C. Bone marrow
D. Kidney T

155. Pappenheimer bodies represent:

A. DNA
B. RNA
C. Non-haem iron T
D. Mitochondria

156. In Schilling’s test ‘hot’ B12 is given:

A. Intramuscular
B. Subcutaneous
C. Intravenous
D. Oral T

157. All are major criteria for diagnosis of pernicious anaemia

except:
A. Low serum B12
B. Megaloblastic anaemia
C. IF antibody
D. Gastric parietal cell antibody T

158. Antibody in paroxysmal cold haemoglobinuria is against:

A. P blood group antigen T
B. I blood group antigen
C. A blood group antigen
D. Rh blood group antigen

159. Which of the following G6PD variant provides protection

against malaria?
A. Type B
B. Type A+
C. Type A – T
D. G6PD Mediterranean

160. Which of the following is not microangiopathic haemolytic

anaemia?
A. March haemoglobinuria
B. TTP
C. HUS
D. Lead poisoning T

161. Precipitated gamma chains are known as:

A. Heinz bodies T
B. Pappenheimer bodies
C. Hb Barts
D. Russel Bodies

162.pencile cells are characteristics feature of

A, aplastic anemia
B, megaloblastic anemia
C, pernicious anemia
D, iron deficiency anemia T

163.beta thalassemia is
A, autosomal recessive disorder T
B, autosomal dominent disorder
C, both
D, none

164 .Beta thalassemia is common in

A, blacks
B, greeks
C, italians
D, all T
E, none

165.in beta thalassemia, beta globins chains are two in number nd

expressed post nataly only, therefore anemia menefested
A, 5-6 month after birth
B, 5-6 month before birth
C, 6-9 month after birth T
D, 6-9 month before birth

166.splicing mutation are most common type of

A, gene mutation
B, gene deletion
C, gene amplification
D, point mutation T
E, gene insertion

167.splicing mutation most commonaly involve

A, cistron
B, exon
C, intron T
D, gene
E, DNA

168.alpha thalassemia occurs due to

A, gene mutation
B, gene deletion
C, gene amplification
D, point mutation T
E, gene insertion

169.Rh-ve mother delievrd baby at 34 weeks with anemia nd

pallor.Baby died 6 hr aftr transfusion cause?
A.Cardiac Anomly
B.Basal ganglia staining
C.Hydrops fetalis T
D.None
170.Hydrops fetalis is a disease of??
A. Elderly
B. Newborn T
C. Alcoholics
D. None

171.Hydrops fetalis in pregnant women..

A, Rubella
B, Parvovirus T
C, rhinovirus
D, rhabdovirus

172.most common site of Extravascular hemolysis is

A, liver macrophages
B, bone marrow macrophages
C, pancreatic macrophages
D, spleen macrophages T

173.Hereditary spherocytosis is an
A, autosomal dominent disorder T
B, autosomal recessive  disorder
C, both
D, none

174 .osteomyelitis most commonaly caused by which organism

A, S. Pneumoniae
B, H. Influenza
C, salmonella T
D, brucella

175.hepatoglobin decreased in
A, intravascular hemolysis
B, extravascular hemolysis
C, megaloblastic anemia
D, all of these T
E, none

176.Complement mediated intravascular Hemolysis

A. heriditory spherocytosis
B.G6PD def
C.PNH T
D.pyruvate kinase def
E.aplastic anemia

177.Vaso-occlusive crisis , characterized by painful episodes is

commonly observed  in patients  suffering from
A  Burns
B   Fracture
C    sickle cell disease T
D    Bullet wound
E     Dislocation

178.An african with vaso occlusive crisis and normocytic anemia

got fever with chills along with nausea vomiting with positive
malarial parasite in blood..which organism wud least likely be
seen in his blood
A. plasmodium falciparum T
B. p. ovale
C. p. vivax
D. p. malariae

179. What is priapism

A) Inability to void the bladder
B) Abnormal curvature of the penis
C) Painful erection lasting > 4 hours T
D) Cyst due to a dilated testicular duct

180.hand foot syndrome is caused by

A, vasso-occulsive crises T
B, aplastic crises
C, sequestration crises
D, all of above

181.Which of the following is an unusual complication that may

occur in infectious mononucleosis?
A. Splenic infarctions
B. Dactylitis
C. Hemolytic anemia T
D. Giant platelets

182.Which one of the following viruses most likely causes aplastic

crisis in sickle cell disease?
A- Hepatitis C virus
B- Herpes simplex virus
C- Parvovirus B19 T
D- Rotavirus

183.A boy having hb 5.6 deeply juandice. Plt 260000 and tlc 10000
reticulocytes count.. 10 Percent Conjugated bilirubin . O. 9
hypersplenism Having non Healing Ulcers Abdominal Pain After
Tooth Extraction?
A. Aplastic crises.
B. Painful crises.
C. Sequestration crises.
D. Hemolytic crises T
184 .A patient comes with anemia , His cell change shape and
causes vascular occlusive crises but not aplastic crises , what is
cause ,
A G6PD
B Heriditary spherocytosis
c hyperchromic anemia
D sickle cell T

185.Which one of the following viruses most likely causes aplastic

crisis in sickle cell disease?
A- Hepatitis C virus
B- Herpes simplex virus
C- Parvovirus B19 T
D- Rotavirus

186.Aplastic Crisis of Sickle cell Anemia is characterized by

a.Lymphocytosis
B.Lymphoctyopenia
c.No change in Red blood cell count
D.Reticulocytosis
E.Reticulocytopenia T

187.Which of the following is the most common cause of death in

patients with sickle cell disease?
A. Myocardial infarction (MI)
B. Stroke T
C. Sepsis
D. Aplastic crisis
E. Splenic sequestration

188.In sickling test, sickling is induced by

A. 5% sodium chloride
B. 2% sodium metabisulfite T
C. 3% sodium citrate
D. 5% sodium trithionate

189.Sodium metabisulfite is used for

a) schiling test
b)Sickling test T
c) figlu test
d) OF test

190.The test used for mass screening of sickle disease is

A. Hb electrophoresis
B. Sickling test T
C. Solubility test
D. HPLC

191.Which test is not useful in Thalassemia trait  ?

A Nestroft test
B HbA2 estimation
C Presence of target & stippled cells in peripheral smear
D Sickling test T

192.Glucose 6-phosphate dehydrogenase deficiency is associated

with haemolysis of 
a) Leucocytes 
b) Lymphocytes 
c) Platelets 
d) RBCs  T

193.What is the most common enzyme deficiency?

A, Pyruvate kinase deficiency.
B, 21-hydroxylase.
C, Glucose-6-phosphate dehydrogenase deficiency. T
D, 5-alpha-reductase deficiency.

194 .Which of the following adverse drug reactions is most closely

associated with glucose-6-phosphate dehydrogenase (G6PD)
deficiency?
A. Angioedema
B. Cinchonism
C. Hemolysis T
D. Hypoglycemia
E. Skin rashes

195.paroxysmal nocturnal haemoglobinuria (PNH), the undue

sensitivity of red cells to complement can be detected by:
A. .Ham’s test T
B. Heinz body test
C. Direct Coombs’ test
D. Indirect Coombs’ test

196.Most likely finding seen in G6PD deficiency is

A..antoglobulin coombs test
B..Heinz bodies T
C..increased osmotic fragility
D. Microcytes

197.THE MOST LIKELY FINDING SEEN IN G6PD DEFICIENCY IS

a) antiglobulin (coombs) test
b) heinz body T
c) hemoglobin crystal
d) increased osmotic fragility
e) microcytes
198.A patient has anemia, hypersegmented neutrophils on
peripheral blood examination and neurological manifestation.
Which type of anemia he is suffering from ?

A) Folic acid deficiency anemia

B) Iron deficiency anemia
C) Pernicious anemia T
D) Thalassemia
E) Autoimmune hemolytic anemia

199.Hemolytic disorder which respond best to splenectomy??

A, Autoimmune hemolytic anemia
B, G6pd deficiency
C, Hereditary spherocytosis T
D, Sickle cell anemia
E, Thallasemia

200.which is false about warm antibody in autoimmune hemolytic

anemia
a,Ig G
b,active at 37cectigrade
c,fixes complement T (C. Correct b/c donot fix complement)
d,may be seen in neoplasias

201.In warm antibody autoimmune haemolytic anaemias, the

antibody is commonly:
A. IgA
B. IgG T
C. IgM
D. IgD
E. IgE
202Which type of anemia doesn't respond clinically to blood
transfusion?
A. Warm Antibody AIHA
B. Cold Agglutinin disease T
C. Thalassemia
D. None of these

203.Most Common immune hemolytic anemia?

A. Cold agglutinin disease
B. Erythroblastosis Fetalis
C. Chronic Cold Agglutinin disease
D. Warm antibody hemolytic anemia T

204 .Leucocyte alkaline phosphatase score is diminished in ?

A, Sickle-cell anemia
B, Lymphoma
C, Paroxysmal nocturnal hemoglobinuria T
D, Thalassemia major

205..Paroxysmal Nocturnal Hemoglobinuria is best diagnosed by

Which of the following.
A.Blood Compelte picture
B.HAM acidified serum Test
C.Sugar –Water Test.
D.Flow Cytometery T
E.Hypocomplementemia

206.Confermatry test for PNH

A.flow cytometry
B.ham's test T
C.sucrose hemolysis test
D.osmatic fragility test

207.Splenectomy is recommended in all EXCEPT:

A. Idiopathic thrombocytopenic purpura
B. Congenital spherocytosis
C. Autoimmune haemolytic anaemia
D. Vascular purpura T
E. Hypersplenism

208.A patient is brought to the emergency department with

purpura and increased bleeding time. What is the diagnosis?
A. von willebrand disease T
B. idiopathic thrombocytopenic purpura
C. hemophilia
D. vitamin c deficiency
E. decreased platelet concentration

209.A pregnant woman arrives at the emergency department (ED)

with abruptio placentae at 34 weeks gestation. She’s at risk for
which of the following blood dyscrasias?
a. Thrombocytopenia.
b. Idiopathic thrombocytopenic purpura (ITP).
c. Disseminated intravascular coagulation (DIC) T
d. Heparin-associated thrombosis and thrombocytopenia (HATT).

210.Features of thrombotic thrombocytopenic purpura are all

except
A. Thrombocytopenia
B. Renal failure
C. Fever
D. Diarrhoea T
211.About thrombotic thrombocytopenic purpura all are true
except
A. Normal prothrombin time
B. normal aPTT
C. Normal platelet count T
D. Normal clotting time

212.Which of the following exhibits decreased Factor VIII activity

due to increased rates of degradation?

A. Hemophilia B.
B. Hemophilia C.
C. Liver disease
D. Von Willebrand Disease T

213. ‘Hemophilia A’ is a
A. Christmas disease
B. Factor VIII deficiency T
C. Factor IX deficiency
D. Von Willebrand disease

214 .Bleeding time is prolonged in all the following EXCEPT?

A. Viper bite
B. Idiopathic Thrombocytopenia
C. Haemophilia A T
D. Von-Willebrand disease

215.Which of the following disorders results from a deficiency of

factor VIII?
A.Sickle cell disease
B.Christmas disease
C.Hemophilia A T
D.Hemophilia B

216.Which of the following disorders results from a deficiency of

factor IX?
A.Sickle cell disease
B.Christmas disease T
C.Hemophilia A
D.Hemophilia C

217.  Crippling arthopathy & Petechiae are characteristicaly absent

both are clinical finding of
A.Sickle cell disease
B.Christmas disease
C.Hemophilia A T
D.Hemophilia B

218.bone marrow contains fat cell is cause of

A, aplastic anemia T
B, megaloblastic anemia
C, pernicious anemia
D, iron deficiency anemia

Written by
DR NAVEED AHMED PANHWAR
Grades don't measure intelligence and age doesn't define
maturity