BLOOD

child 13 month just start walking and fall in gruond had laceration bleeding
and sever hematoma not resolve and no family history of blood diseas
mother scared ask about diagnosis ? 
1 VWD 
2 haemophilia A
3 immune thrombocytopenia
4 prothrombin def
5 haemophilia B
man back from Thailand, neighbours say his is clumsy, unkempt,
clothes look loose, which lead to diagnosis
a. hiv serology*** ( hiv
encephalitis)
b. ct brain
c. thick and thin smear

Young parents come to your clinic asking about the possibilities of their
children to get Haemophilia as the mother is known to
be haemophiliacarrier, what will you tell them:
A- Reassure as it will not affect their children
B- Half of the boys will have haemophilia and half of their daughters
will be carriers 
C- All the boys will have haemophilia
D- ¼ the children will have haemophilia
E- Only the girls will have haemophilia as carriers
. A mother comes with hemochromatosis in brother. she has 2
kids aged 2 and 5 yrs respectively. Wants advice regarding
screening
A. screen only mother ****(mother carrier, autosomal
recessive)
B. mother n kids
C. ask her to come with husband
D. Screen only children
A 12 years old girl presents with a sudden history of loss of sensation
on the lower limbs associated with decreased reflexes and

1
progressive ataxia . Which of the following is most likely the cause of
her condition
A. B12 deficiency
B. Friedreich´s ataxia ****
C. Charcot marie tooth disease
D. Dermatomyositis
https://rarediseases.info.nih.gov/diseases/6468/friedreich-ataxia?
fbclid=IwAR2GYXLLok7LSPP6eqLW-z4CqKLtdvRsTs6SHSbNU-
CvPcxzENnqz1WO0_c
14 yr old girl bought by parents , abnormal menstrual cycle heavy bleeding
when it occurs. on some bruises on legs history of easy bruising 
a. platelet count
b. protein s def
c. haemophilia 
d. vwD

7 mnths old child with mother came that he is continually bleeding from
mouth since yesterday after he struck his head in table.you notice old
bruises on forhead nd legs cause
Hemophilia
ITP
Vwd
Non accidental ( exclude child abuse 1st)

baby present with hematoma in scalp not resolved by pressure or ice has
no family history of blood disorder asking diagnosis
a.hemophilia 
b. von willbrand 
c. platelet dysfunction

Boy hit to coffee table while playing, presents with epistaxis, lip and
mucosal bleeds, thigh
With bruises, petachie, no hepatomegaly.
ITP
Vwd 
Factor 8

2
14 yr old girl bought by parents , abnormal menstrual cycle heavy bleeding
when it occurs. on some bruises on legs history of easy bruising 
a. platelet count b. protein s def c. haemophilia d. vwD

21. A mother brought a child of 8 months who is bleeding from the

frenulum (site of abuse) from one day,some other old marks of bruises
there,what could be the cause?
A)..Non accidental B)factor 8 defeciencc
c).VWD,
D).platlets def

Elective cholecystectomy, has vWD, what does he need before surgery?

FFP, 
Platelets, 
Factors 8
blood transfusion
Factor 8 or
Q.50 years old man who suffers from rheumatoid arthritis and who has
been treated with prednisolone for 3 years developed peripheral
neuropathy of the lower extremities. This neuropathy is most likely due to
A. arsenic poisoning
B. thiamine deficien
C.necrotising arteritis(complication of RA)
Non diabetic patient complaining of weakness and clumsiness of lft hand
numbness on both feet, foot drop on left side. What inv to find out the
lesssion
A.Nerve conduction study
B.Muscle biopsy ( PAN
C.Vit B12
D.MRI of spine (dx cervical myelopathy)

A guy after coming back from a trip suffering from chronic diarrhea, no
blood and mucus for 7 months, weight loss for 6 kg but appetite is good,
stool is greasy and fat globules are seen, He has undergone repeated tests
for enteropathic organisms and all negative, also antigliadin and
antiendomysial tests negative, his B12 and iron level are also normal. What

3
is most appropritate next management?
1) Colonoscopy and biopsy
2) Serum immunoglobulins
3) ERCP
4) Small bowel biopsy. dx-tropical spreu..tx-tetracycline

55 female , micr. Hypo anemia . with fracture vertebrae, ferritin decrease

with angular stomatitis and thin skin with pigmentation.. normal bowel
habit and normal stool consistency..she also have clubbing ..next
a.small bowe biopsy
b.colonoscopy (mets in ca colon)
c.b12 level

A lady lethargic anaemia .. mild icterus ... not a vegetarian no menorrhagia

.... macrocytosis n megaloblasts .. what is next i think
A red cell folate level
B iron studies
C intrinsic factor antibodies
D vit b12 levels
(A. Red folate cell (folic acid) in macrocytocis

She is NOT vegetarian, therefore we don't have to worry about vit B12 and
intrinsic factor. Vegetarians obtain folic acid from vegetables
Iron deficiency: microcytosis)

5) A guy after coming back from a trip suffering from chronic diarrhea, no
blood and mucus for 7 months, weight loss for 6 kg but appetite is good,
stool is greasy and fat globules are seen, He has undergone repeated tests
for enteropathic organisms and all negative, also antigliadin and
antiendomysial tests negative, his B12 and iron level are also normal. What
is most appropritate next management?
1) Colonoscopy and biopsy
2) Serum immunoglobulins

4
3) ERCP
4) Small bowel biopsy (dx tropical sprue)

confusing scenerio of wasting of hand muscle, weakness of tibialis anterior,

weak hip flexors, fasiculations in hand n leg. All lower motor signs with few
weeks history. No sensory or cranial nerve issue (dx lmn lesion)
Options emg, ck levels, anti ach antibodies, b12 levels

pallor patient with picture of microcytic anemia MCV low Serum ferritin
normal Almost same scenario above but increase reticulocytres. Cause?
A) Iron def
B) Vit B12 Def
C) Hemolytic Anemia

pallor patient with picture of microcytic anemia MCV low Serum ferritin
normal
A) HB electerophoressis
B) Vit B12 levels
C) folate levels

2 years old male complains of inability to climb stairs on examination his

muscle bulk is normal has loss of ankle reflex his mother also has loss of
ankle reflex most appropriate next investigation
CK level (dx spinal muscular atrophy)
Vit B 12
Muscle biopsy

( DMD )

case of a baby with Macrocytic anemia and malapsorption (watery

diarrhoea, flatus) , how u manage?
Decrease Lactose (dx lactose intolerance)
Cow milk
Soy based Milk

70years Algerian lady with weakness and anaemia and is vegetarian lab inv
given typical of microcytic anaemia.cause

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(whenever elderly pt comes with microcytic anemia go for colon cancer)
1.hook warm infestation √
2.ca cecum √
3.vit B12 deficiency
4.thalassaemia minor
5.diet
in July recalls people answering DIET and in june answered CA.Cecum  any
difference both recalls Anemia if macrocytic anaemia answer will b same or
change 
Macrocytic is IDA or vit B 12 deficiency???

ESR is elevated in all of the following except:

a. Multiple Myeloma
b Sickle cell anaemia
c. Macrocytic anaemia
d.pregnancy
e. chronic hepatitis

Lead poisoning anemia?

A- Hypochromic microcytic (pica pg 215jm)
B- normochromic normocytic
C- hypochromic normocytic
D- macrocytic

55 yrs old patient with low folic acid, howel jolly body , stomatitis , normal
bowel, weight loss...Inv?? 
a. small bowel biopsy……. appropriate ( dx,celiac disease )
b. colonoscopy 
c. Vit B 12…. Next
http://www.pathologyoutlines.com/topic/
bonemarrowhowelljollybodies.html?
fbclid=IwAR05GAGXtIZdejy6QQQBnEJFb2_BcRFVGEA6M3DuuGSmBt83hQz
G2Bt15uQ

6
Patient on methotrexate and prednisolone complaining of mouth & tongue
ulcer. Treatment asked?
a) Folic acid ( synthetic form present as medicine)
b) Folinic acid (active form present in food)
c) Stop methotrexate
d) Increase prednisolone

31-year-old woman G2P1 presents at 10 weeks’ gestation for antenatal

visit. She is found to have a twin pregnancy. Her previous pregnancy was
complicated with placental abruption at 34 weeks. Which one of the
following is the next best step in management in addition to standard
antenatal care?�The options I have seen for this question are:�•
a.Admit to the hospital for rest after 34 weeks.�•
b. Cervical suture.�•
c. Vitamin supplementation.�•
d. iron and folic acid supplementation. ... �•
e. serial CTGs from 34 wks�

Pregnant woman 10 weeks of gestation comes with anemia and MCV 60

most likely cause
Folic acid
Iron 
Pernicious 
Thalassaemia trait ( as 1st trimester )
A vegan pregnant woman (in early first trimester) came to you for
antenatal care.She takes folic acid pill regularly.What is your advice?
Zinc and Iron(zinc & iron are better provided and absorbed from animal
product)
Iron and Vitamin K
Iron and vit C

( iron. Iodine. vit b .folic acid. vid d .have to give )

Vit A & E supplements should b avoided in pregnancy )

Young girl came with parents for check up,labs-HB:9 or 10,rest all normal
except APTT raised,HBA2 positive,what to do next?

7
A.Iron studies (dx, we cannot give iron and blood transfusion in
thalassemia)
B.Blood transfusion
C.Folate
7 months old female with pallor and mild icterus hb low MCV low mchc low
hbA2 raised ferritin raised hepatomegaly, most appropriate next
Genetic counselling (dx thalassemia)
Blood transfusion
Folate
Iron gluconate
Splenectom

A mother brings her child to ur clinic who has history of spherocyrosis and
neonatal jaundice. He recently became progressively pale for last 2 months
after an upper rti episode. On inv anemia hb 5 and increased reticulocytes
with normal WBC and plat. Bilirubin normal. What is the cause
Folate deficiency 
Spherocytosis
Aplastic crisis
Hemolysis
Leukaemia

Hereditary Spherocytosis scenario. Child had URTI. Pallor, no jaundice.

Retics count 6% (increase), low HB, low platelets. On exam child had
pansystolic murmur at left sterna border. Cause asked? 
A. Parvovirus
B.Hep A
C.ITP
D. Subacute infective endocarditis
E.Folate deficiency.

hereditary spherocytosis pt , now come with aneamia , low platelet count ,

but wbc count normal splenomegaly 2 cm below costal margin , what is the
cause of anemia ? 

8
A. Hemolysis crisis (  Retic increase )
B. Aplastic crisis (  Retic decrease )
http://nepscc.org/2017/wp-content/uploads/2017/06/2-aplastic_Crisis.pdf?
fbclid=IwAR2WUD1WdV7Aa7DxS_sS-NBxvSSRP3TrIhU3BF-
hjTFmD45RUB_8R1VG1GE
C. Chronic occult blood loss

Parents came to you because their son has hereditary spherocytosis and

they want to know what is the chance that his siblings have the same
disease?
25% of his brothers
50% of his sisters
50% of his brothers and sisters
0 % of his brothers and sisters
50 % of his brothers

1) Hereditary spherocytosis in brother of family, asking the chance of other

siblings?
a.25
b.50. ( autosomal dominant )

Scenario pointing towards Hereditary spherocytosis , pt wid Hb 4 ,what

next management ?
a) packed cell transfusion ( initial ) ( if hb less than 6 go for transfusion)
b) splenectomy ( best )

32.a young patient with history of sickle cell anemia, after along history of
flight, came with calf pain, all well wth respiratory part, which one of the
following is the most appropriate next step in Rx?
• O2 therapy( dx sickle cell triat, pg 164jm pg 247 master the board Rx)
• IVIG
• enoxaparine
• steroids
.anelgesics

9
Focal neuro deficits in a sickle cell patient, next step ?
a) Head CT (next)
b) Plasma exchange(pg 248 mtb)(next best)

Young patient while travelling by airplane had cheat pain with mild
dyspnoea,no other symptoms,has history of sickle cell trait.What to do
next?
Oxygen by mask
Hydration
Blood transfusion
Intubation and oxygen
Splenectomy
https://lifeinthefastlane.com/ccc/sickle-cell-crisis/?fbclid=IwAR1rWs7-
9LLOt3aegMfBLFi9bOzek1HfUFPDq6QQtQM78NsbaqcC5f07Fm8

A 16 year old female presents with Sickle cell anaemia and heavy

menstrual bleeding. What is the best treatment of choice?
A. Combined Oral Contraceptive Pill (COCP)
B. Inj Depoprovera( depo should be avoided under 18yr and more then 45
year as t causes bone loss)
C. Mirena
D. IUCD
E. Implanon
http://pediatrics.aappublications.org/content/134/4/e1257?
fbclid=IwAR37pTUTumOku-
Xz_H8mQPXT2ChCjhPybrl4iPXBo5TjhM9kX4tq9PFWGkk

An 11-month-old African American boy has a hematocrit of 24% on

a screening laboratory done at his well-child checkup. Further testing
demonstrates:
hemoglobin 7.8 g/dL; hematocrit 22.9%; leukocyte count 12,200/μL
with 39% neutrophils, 6% bands, 55% lymphocytes; hypochromia on
smear;
free erythrocyte protoporphyrin (FEP) 114 μg/dL; lead level 6 μg/dL whole
blood; platelet count 175,000/μL; reticulocyte count 0.2%; sickle-cell
preparation
negative; stool guaiac-negative( FOBT ) ; and mean corpuscular volume
(MCV)

10
64 fL. Which of the following is the most appropriate recommendation?
a. Blood transfusion
b. Oral ferrous sulfate ( as hb is very low )
c. Intramuscular iron dextran
d. An iron-fortified cereal
e. Calcium EDTA

(. Elevation of erythrocyte protoporphyrin (EP) level is one of the

consequences of iron deficiency. As the EP test has been established to be
a screening test for lead poisoning, the screening capability of the EP test
for iron deficiency was investigated. Normal value 35 microgram/dl ..)

A 2950-g (6.5-lb) black baby boy is born at home at term. On arrival at

the hospital, he appears pale, but the physical examination is otherwise
normal.
Laboratory studies reveal the following: mother’s blood type A, Rh-positive;
baby’s blood type O, Rh-positive; hematocrit 38%; and reticulocyte count
5%. Which of the following is the most likely cause of the anemia?
a. Fetomaternal transfusion
b. ABO incompatibility (mother should be ‘O’ )
c. Physiologic anemia of the newborn(develop wks later following rapid
growth)
d. Sickle-cell anemia(after 6 month old)
e. Iron-deficiency anemia(years later)

ESR is elevated in all of the following except

: a. Multiple Myloma
, b. Sickle cell anaemia,
c. Macrocytic anaemia,
d.pregnancy,
e. chronic hepatitis
Woman with 2 children presents to you with malaise and fatigue.This is her
3rd pregnancy.All antenatal examination is normal except for microcytic
anemia with MCV 65.All other investigations are normal.Cause?
Iron deficiency anemia ? Depending upon labs
Thalassemia trait

Q.Which one of the following is not a cause of IUGR?

11
Renal disease in mother
Thalassemia trait with Hb 9
Htn taking Methyldopa
Cmv infection
Alcohol intake

In thalassemia , Maternal complication rates of gestational diabetes,

preterm birth, antepartum bleeding, postpartum bleeding, shoulder
dystocia and puerperal morbidity, and the rates of neonatal complications:
macrosomia, fetal weight <2,000 g, intrauterine growth restriction (IUGR),
stillbirth, low Apgar score (<7) at 1 and 5 min and NICU admission, were
not significantly different between the two groups. The rate of pre-
eclampsia, however, was significantly differentu, with RRs of 1.73 (CI
1.01–3.00).

1 hr
44-a mother of two children healthy presented to you asking you to have
test for hemochromatosis for her and children as her brother diagnosed
with this disease. What is your most appropriate advice? 
A-iron blood test for children 
B-do test for mother alone 
C-refer her and children for DNA test 
D-ask for an appointment with the husband and the mother

A 35 year old man acutely complained of Right knee pain and swelling right
after playing golf. Arthrocentesis done revealing 25 mL of brown
pigmented fluid aspirated. What is the diagnosis?
A. Rheumatoid arthritis
B. Gout
C. Osteoarthritis
D. Pigmented villonodular synovitis
E. Hemochromatosis Achondrosis

12
Man with history of hemochromatosis. He is in intensive care unit. Has
flapping tremors. He is confused and restless. He also has ascites with
shifting dullness. Ascites tap done which shows
Cells – 300
LDH –
Which of the following is the most appropriate immediate management?
A) Amlodipine
B) Albumin
C) Lactulose ( for scities always give lactulose to wash all toxics)
D) Cefotaxime ( as ascites is infected ) (dx spontaneous bacterial
peritonitis)

Hemochromatosis scenario asking for most appropriate Ix? 

Liver biopsy 
serum ferritin &transferrin 
genotype 
U/S

A 55-year-old woman came to your clinic due to progressive tiredness,

associated with occasional arthralgias for 5 months. Upon examination, you
note some skin pigmentation and slight enlargement of the liver. Her father
died due to liver cirrhosis secondary to primary hemochromatosis.
Which of the following is diagnostic result for primary haemochromatosis?
a. Transferrin saturation > 70% 
b. Increased total iron binding capacity  
c. Decreased ferritin 
d. Decreased serum iron 
e. Increased ESR

Mother with G6PD now pregnant at 18.weeks.Previously she had a child

with cystic fibrosis.What is the possibility off the current pregnancy to have
cystic fibrosis?
0%
25% (autosomal recessive)

13
33%
100%

4 years old child has pallor and jaundice after urti.He has splenomegaly
with history of phototherapy at neonatal period.Diagnosis?
G6PD
HEREDITARY SPHEROCYTOSIS
ITP

. a child with anemia and low platelet after facing with a

parvovirus .the retic count is 6 % . What is the possibility of this
condition in her siblings? H.SPHEROCYTOSIS. A.D

1. 25% of boys

2. 50% of boys

3.4. 50% of all siblings *****

5. No sibling gets this condition

29. Hereditary spherocytosis scenario of a lady with blood picture

which shows Hb 8.9 and 0.05% retic count. Rest of the cells are
within normal range. Which is the most likely organism for her
condition?

a. Adenovirus

b. Parvovirus***

. 12 yrs old school girl suddenly collapsed at school.she was

brought by ambulance with dextose drip 60/ml min.on exam dolls

14
eye reflex were present but she was not responding to painful
stimulus.her

vitals signs were as follows: > R/R 12/min > PR 50/min > SaO2
100% > bp 180/110(?) > if you are working in a tertiary
hospital.What is the Next step of management?

A) Arrange for urgent CT Scan

B) Stop her dextrose infusion and start on saline (dx cushing triad)

C)Give Steroids

D)Intubate the patient

E)Neurosurgical Reference

Raised ICT: increased B.P, decreased B.P, PR

increased.cushing reflex..NS will further increase BP.

36. Man came in for motor vehicular accident with multiple rib
fractures, widened mediastinum, ___aortic knob (can't remember the
term used) what do do next –

a. pericardiocentesis

b. Intubation and mechanical ventilation

c. 2d echo(aortic dissection)

37. A lady comes with sudden severe headache subsiding after 2 hour
+ vomiting. Normal ct scan. No fever but neck stiffness present. No
trauma history. Cause?

a. Acute cerebral haemorrhage

15
b. Subarachnoid haemorrhage

c. Atypical migraine

https://migraine.com/migraine-symptoms/neck-pain/?
fbclid=IwAR2uH3ak28HNnRXzHYQ3In_lYQ0KD_6fca34xi7mTh83Nwp2pHxZ
dP-ePRA
d. Temporal arteritis

.old lady came with lethargy & constipation,u hv done FOBT & some
other test & u dx it as a colon cancer,what is the most appropriate
test now ?

a.ct abdomen

b.ct colonography

c.colonoscopy

d.usg

E.xray
ans-c

Guy takes cocaine .. initially only for a few days .. now taking even
before work and affects his work somthat his employer tells him to
take stress leave .. but he doesnt feel he is addicted .. what will you
do--
A. ask collateral h/0 from employer
B. discuss his ambivalence to drug
C. supportive psychotherapy

thalassaemia:AR..50% will be carrier.. 25% n, 25% affected

-Young girl came with parents for check up,labs-HB:9 or 10,rest all normal
except APTT raised,HBA2 positive,what to do next?
16
A.Iron (contraindicated in thalassemia)
B.Blood transfusion
C.Folate
C.. raised Aptt can be present in around 8% thalessamia patient. and in
mild thalessemia treat with folate. blood transfusion in thalesamia dose not
indicated if hb level above 6, if the baby is doing well.. in sick baby we can
transfuse blood at hb 7

lady lethargic anaemia .. mild icterus ... not a vegetarian no

menorrhagia .... macrocytosis n megaloblasts .. what is next i think
A red cell folate level ( to differentiate that disease is bcoz of folic acid or
vit b12 deficiency)
B iron studies
C intrinsic factor antibodies
D vit b12 levels
(She is NOT vegetarian, therefore we don't have to worry about vit B12
and intrinsic factor. Vegetarians obtain folic acid from vegetables
Iron deficiency: microcytosis)

10. Patient with known Waldenström's macroglobulinemia is admitted with

fever. He has a history of glandular fever infection and varicella infection in
childhood. He is given ampicillin and azythromycin. The next day he
develops rash. Picture: rash is on the abdomen and chest. It doesn’t look
like erythema multiforme at all. Most of the elements are raised papules,
but couples of them are pustules. What is the initial next step to identify
cause of rash?
a. swab from the lesion
b. biopsy of the lesion
c. bone marrow biopsy
d. drug allergy test.
Rx-prednisolone
10. Patient with known Waldenström's macroglobulinemia is admitted with
fever. He has a history of glandular fever infection and varicella infection in
childhood. He is given ampicillin and azythromycin. The next day he
develops rash. Picture: rash is on the erythema multiforme at all. Most of
the elements are vesicular.What is the initial next step to identify cause of
rash?

17
a. swab from the lesion
b. biopsy of the lesion (dx steven johnsons syndrome)
c. bone marrow biopsy
d. drug allergy test.
Rx-antiviral

waldenstorm macroglobenemia patient came with rigors and fever and

right lower lobar pneumonia or some infection like this admitted and
started ampicillin and after minimal time generalised vesicular rash
appeared asking management
A. prednisolone-drug induced
B. immunoglobulin
C. cease ampicillin
D. Ganicyclovir-herpes/CMV( anti viral bcoz of reactivation of virus)
https://www.rarecancers.org.au/directory/65/waldenstrm-
macroglobulinemia

77-pt with chest pain radiate to the back unstable s&s with sweating
&pallor they say in scenario he had aortic dissection about 4cm distally
from left subclavian artery what is the rx.
A.iv nitruptusside
B.iv labetalol
C.iv verapamil
D.surgery interference

q13)- beta thalassemia minor- Autosomal Recessive Disorder

what advice to be given to parents regarding child:

a. Repeat cbc
b. tsh
c. thalassemia minor genetic counselling
d. reassure it normal in children
e. rule out hidden lesion (this was exact word)

qtn regarding genetics is like mother had thalassemia minor trait what are
the chances of thalasemia minor in children?

A .25%( autosomal recessive)

18
B.50%

C0

. A couple who have both beta thalassemia minor trait came to your clinic
asking about the chances of their child acquiring it.

A. 0

B. 0.25(autosomal recessive)

C. 0.5

D. 0.75

E. 1.0

RUQ pain, low hb, low mcv, low mchc

A. Thalassemia
B. Hydatid
(Thalassemia 》》microcytic hypchromoc anemia,
Hepatomegaly can result from a number of mechanisms; extramedullary
erthyropoiesis, hepatitis due to chronic transfusion associated infections,
and iron overload..)

Recurrent URTI in girl aged 9 years Hb 9 WBC normal MCV 90

(normal) MCHC decreased (dx iron def.anemia)
Repeat CBC/serum ferritin
TSH
https://www.healthline.com/health/low-mchc?
fbclid=IwAR0IgRpeLeEcQBfWlt7nGjoZTFAEu1kiWicxJC5QMrCWK-
2QWL3H3CIB7g8#causes

Thalassaemia minor genetic counselling

Reassure
Rule out hidden lesions

19