Chapter 12
HALF A THOUSAND
HEMATOLOGY
EXAMINATION BANK
Anwar Sheikha
MBChB, FRCP, FRCPI, FRCPA, FCAP, FRCPath., FACP
Select the most appropriate single answer:
Q 1. The Early Myeloid Cell shown with agranular pale blue cytoplasm and a large
multi-nucleolated nucleus is called:
(A). Myeloblast.
(B). Promyelocyte
(C). Myelocyte
(D). Metamyelocyte
(E) Band Form
Q 2. The large Myeloid Cell shown with both nucleoli and cytoplasmic granules is
called:
(A). Myeloblast
(B). Promyelocyte.
(C). Myelocyte
(D). Metamyelocyte
(E) Band Form
Q 3. The Myeloid Cell shown with no nucleoli but cytoplasmic granules is called:
(A). Myeloblast
(B). Promyelocyte
(C). Myelocyte.
(D). Metamyelocyte
(E) Band Form
Q 4. Leukemia of the mature segmented neutrophils and maturing myeloid cells
shown is called:
(A). M1 (Acute Myeloblastic Leukemia without maturation)
(B). M3 (Acute Hypergranular Promyelocytic Leukemia)
(C). CML (Chronic Myeloid Leukemia).
(D). M5 (Acute Monoblastic Leukemia)
(E) M7 (Acute Megakaryoblastic Leukemia)
Q 5. In the FAB Classification of Acute Leukemias, Leukemia of the Early Myeloid Cell
shown with agranular pale blue cytoplasm and a large multi-nucleolated nucleus
is called:
(A). M1 (Acute Myeloblastic Leukemia without maturation).
(B). M3 (Acute Hypergranular Promyelocytic Leukemia)
(C). M4 (Acute Myelomonocytic Leukemia)
(D). M5 (Acute Monoblastic Leukemia)
(E) M7 (Acute Megakaryoblastic Leukemia)
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Q 6. In the FAB Classification of Acute Leukemias, Leukemia of the large Myeloid
Cell shown with both nucleoli and cytoplasmic granules is called:
(A). M1 (Acute Myeloblastic Leukemia without maturation)
(B). M3 (Acute Hypergranular Promyelocytic Leukemia).
(C). M4 (Acute Myelomonocytic Leukemia)
(D). M5 (Acute Monoblastic Leukemia)
(E) M7 (Acute Megakaryoblastic Leukemia)
Q 7. Leukemia of morphologically mature small lymphocytes is called:
(A). AML (Acute Myeloblastic Leukemia)
(B). ALL (Acute Lymphoblastic Leukemia)
(C). CML (Chronic Myeloid Leukemia)
(D). CLL (Chronic Lymphocytic Leukemia).
(E). Multiple Myeloma
Q 8. Hemolytic anemia secondary to Glucose-6-Phosphate Dehydrogenase
deficiency could present itself in any of the following forms EXCEPT:
(A). Intravascular Hemolysis secondary to Antimalarial medication
(B). Favism
(C). Pancytopenia.
(D). Blister red cells in the blood smear from biting out of Heinz bodies
(E). Neonatal Jaundice
Q 9. One of the following features relate to Warm Autoimmune Hemolytic Anemia:
(A). Positive Coomb’s Test.
(B). Pancytopenia
(C). Elliptocytosis in the blood smear
(D). Blister red cells
(E) Tear Drop red cells
Q 10. What type of red cell abnormalities are expected in Iron Deficiency Anemia:
(A). Macrocytic oval red cells with hypersegmented neutrophils
(B). Normocytic, normochromic red cells
(C). Spherocytosis
(D). Hypochromic, microcytic red cells.
(E). Fragmentation of the red cells
Q 11. What type of red cell morphological abnormalities are expected in Pernicious
Anemia (Megaloblastic Anemia):
(A). Macrocytic oval red cells with hypersegmented neutrophils.
(B). Normocytic, normochromic red cells
(C). Spherocytosis
(D). Hypochromic, microcytic red cells
(E). Fragmentation of the red cells
Q 12. What type of red cell morphological abnormality is expected in both Hereditary
Spherocytosis and Warm Autoimmune Hemolytic Anemia:
(A). Macrocytic oval red cells with hypersegmented neutrophils
(B). Normocytic, normochromic red cells
(C). Spherocytosis.
(D). Hypochromic, microcytic red cells
(E). Fragmentation of the red cells
111
Q 13. What is the most significant feature of ITP (Immune Thrombocytopenic Purpura):
(A). Bleeding with the bone marrow full of blasts
(B). Philadelphia chromosome
(C). Hairy lymphocytes in the blood smear
(D). Pancytopenia with empty bone marrow
(E). Severe thrombocytopenia with purpuric mucocutaneous bleeding.
Q 14. What is the most significant feature of Aplastic Anemia:
(A). Bleeding with the bone marrow full of blasts
(B). Philadelphia chromosome
(C). Hairy lymphocytes in the blood smear
(D). Pancytopenia with empty bone marrow.
(E). Severe thrombocytopenia due to immune destruction.
Q15. What is the most significant diagnostic feature of Chronic Myeloid Leukemia:
(A). Marked lymphadenomegaly
(B). Philadelphia chromosome.
(C). Hairy lymphocytes in the blood smear
(D). Pancytopenia with empty bone marrow
(E). Severe thrombocytopenia with purpuric bleeding.
Q 16. Priapism (Painful Persistent Penile Erection) could be seen in the following
hematological disorders:
(A). Sickle Cell Disease
(B). Chronic Myeloid Leukemia
(C). Acute Leukemia with very high blast cell count
(D). All of the above.
(E). None of the above
Q 17. One of the following laboratory features specifically relates to - thalassemia
major :
(A). Very high hemoglobin F.
(B). Very high Hemoglobin S
(C). High hemoglobin A2
(D). High Hemoglobin C
(E). High Hemoglobin E
Q 18. One of the following features specifically relates to - thalassemia minor:
(A). Very high hemoglobin F
(B). Very high Hemoglobin S
(C). High hemoglobin A2.
(D). High Hemoglobin C
(E). High Hemoglobin E
Q 19. All of the following features relate to - thalassemia major Except:
(A). Huge splenomegaly
(B). Splenic atrophy.
(C). Bone marrow expansion
(D). Iron overload
(E). Hypochromic microcytic red cells with target & nucleated red cells
112
Q 20. All of the following features relate to Sickle Cell Disease Except:
(A). Splenic atrophy
(B). Painful vaso-occlusive crises
(C). Hemolytic anemia
(D). Very high hemoglobin S
(E). Positive Coomb’s Test.
Q 21. One of the following features is specific for Hemophilia A:
(A). Very low level of Factor VIII:c.
(B). Very low level of von Willebrand Factor
(C). Prolonged Bleeding Time
(D). Severe thrombocytopenia
(E). Very low level of Factor IX
Q 22. One of the following features is specific for Christmas Disease:
(A). Very low level of Factor VIII:c
(B). Very low level of von Willebrand Factor
(C). Prolonged Bleeding Time
(D). Severe thrombocytopenia
(E). Very low level of Factor IX.
Q 23. One of the following features is specific for von Willebrand Disease:
(A). Very low level of Factor VIII:c
(B). Very low level of von Willebrand Factor.
(C). Normal Bleeding Time
(D). Severe thrombocytopenia
(E). Very low level of Factor IX
Q 24. One of the following features relates to ITP (Immune Thrombocytopenic Purpura):
(A). Very low level of Factor VIII:c
(B). Very low level of von Willebrand Factor
(C). Normal Bleeding Time
(D). Severe thrombocytopenia with increased marrow megakaryocytes.
(E). Very low level of Factor IX
Q 25. Acute Childhood ITP (Immune Thrombocytopenic Purpura) has all of the
following features EXCEPT:
(A). Usually self limiting
(B). Usually follows a viral infection
(C). Usually affects Girls.
(D). Usually associated with increased marrow megakaryocytes
(E). Usually associated with prolonged Bleeding Time
Q 26. Prothrombin Time (PT) is prolonged in:
(A). Severe thrombocytopenia
(B). Hemophilia A
(C). Christmas Disease
(D). von Willebrand Disease
(E). Overanticoagulation with Warfarin.
113
Q 27. Activated Partial Thromboplastin Time (APTT) could be prolonged in all of the
following bleeding disorders EXCEPT:
(A). Severe thrombocytopenia.
(B). Hemophilia A
(C). Christmas Disease
(D). Severe von Willebrand Disease
(E). Factor XII Deficiency
Q 28. Bleeding Time (BT) is prolonged in:
(A). Severe thrombocytopenia.
(B). Hemophilia A
(C). Christmas Disease
(D). Factor XII Deficiency
(E). Factor VII Deficiency
Q 29. Thrombocytopenia could result from any of the following conditions EXCEPT:
(A). Aplastic Anemia
(B). Acute Myeloid Leukemia
(C). Hypersplenism
(D). Iron Deficiency Anemia.
(E). Breast cancer infiltrating the bone marrow
Q 30. All of the following conditions can cause DIC (Disseminated Intravascular
Coagulation) EXCEPT:
(A). ITP (Immune Thrombocytopenic Purpura).
(B). Brain injury
(C). ABO incompatible blood transfusion
(D). Severe Sepsis
(E). Snake Bite
Q31. One of the following features is specific for chronic myeloid leukemia:
(A). Philadelphia chromosome.
(B). Alcohol-induced lymph node pain
(C). Lymphadenopathy
(D). High Neutrophil Alkaline Phosphatase
(E). Low serum B12
Q32. Anemia of Chronic Lymphocytic Leukemia could result from any of the following
causes EXCEPT:
(A). Fragmentation of the red cells.
(B). Autoimmune hemolysis
(C). Splenomegaly
(D). Bone marrow infiltration
(E). Folate deficiency
MATCH THE FOLLOWING HEMATOLOGICAL CONDITIONS WITH THEIR
APPROPRIATE DESCRIPTIONS OR DEFINITIONS:
Q33. LEUKEMIAS AND AGE INCIDENCE :
Acute Lymphoblastic Leukemia
Acute Myeloblastic Leukemia
Chronic Myeloid Leukemia
Chronic Lymphoid Leukemia
Hairy Cell Leukemia
.......
.......
.......
.......
.......
(a). Elderly
(b). Childhood
(c). Middle Age
(d). Young Adult & Elderly
(e). Middle Aged Male
114
Q34. ANEMIAS AND RELATED DIAGNOSTIC HEMOGLOBIN TYPE :
β- thalassemia major
....... (a). Hemoglobin A2
α- thalassemia intermedia
....... (b). Hemoglobin F
Sickle cell disease
....... (c). Hemoglobin H
β- thalassemia minor
....... (d). Hemoglobin S
Uncontrolled diabetes
....... (e). Glycosylated Hemoglobin
Q35. LYMPHOMAS AND DIAGNOSTIC MALIGNANT CELLS:
Hodgkin's Disease
....... (a). Small lymphocytes
Small lymphocytic lymphoma
....... (b). T-cells
Angiocentric lymphoma
....... (c). NK cells
Waldenstrom’s Lymphoma
....... (d). Lympho-plasmacytoid cells
Mycosis fungoides
....... (e). Reed Sternberg cells
Q36. TYPE OF ANEMIA AND MEAN CORPUSCULAR VOLUME (MCV) :
Iron deficiency anemia
....... (a). 120 fL
Thalassemia major
....... (b). 55 fL
+ (MCHC 38%)
Megaloblastic anemia
....... (c). 55 fL
+ (Ferritin++)
Hereditary spherocytosis
....... (d). 55 fL
Chronic renal failure
....... (e). 86 fL
Q37. TYPE OF BLEEDING AND DEFECTIVE HEMOSTATIC FACTORS:
von Willebrand's Disease
....... (a). Factor VIII:c
Hemophilia A
....... (b). Factor IX
Christmas Disease
....... (c). II,VII,IX & X
Hemorrhagic Newborn Disease ....... (d). von Willebrand Factor
DIC
....... (e). Most Factors
Q38. COMPLICATIONS OF BLOOD TRANSFUSION AND ETIOLOGY :
Febrile transfusion reaction
....... (a). RBC lysis
Anaphylaxis
....... (b). IgA deficiency
Hemolytic transfusion reaction
....... (c). WBC destruction
Hypocoagulability & Bleeding
....... (d). Massive transfusion
AIDS
....... (e). Old hemophiliacs
Q39. WHITE CELL NUMBER ABNORMALITY & RECOGNIZED ETIOLOGY :
Eosinophilia
....... (a). Typhoid fever
Neutropenia
....... (b). CMML
Atypical lymphocytosis
....... (c). Asthma
Monocytosis
....... (d). Infectious mononucleosis
Leukemoid reaction
....... (e). Severe Infection
Q40. PARAPROTEINEMIAS AND RELATED ABNORMALITIES :
Waldenstrom's
....... (a). Monoclonal IgM
Myeloma
....... (b). Monoclonal IgG
Bence Jones Only Myeloma
....... (c). Normal ESR
Heavy Chain Disease
....... (d). Intestinal lymphoma
High Cell Mass Myeloma
.
...... (e). Advanced osteolytic lesions
Q41. MYELOPROLIFERATIVE DISORDERS AND POSSIBLE FINDINGS :
Venesected PRV
....... (a). Iron Deficient RBC
Myelofibrosis
....... (b). Splenic Atrophy
Essential Thrombocythemia
....... (c). Ph Chromosome
Chronic Myeloid Leukemia
....... (d). Pancytopenia
Myelodysplastic Syndromes
....... (e). Leuko-erythroblastic anemia
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Q42. DEGREE OF SPLENOMEGALY & POSSIBLE ASSOCIATED DISEASE :
Marked Splenomegaly
....... (a). Headache
Moderate Splenomegaly
....... (b). Sickle Cell Disease
Mild Splenomegaly
....... (c). Acute Infections
Splenic Atrophy
....... (d). PRV
No Association
....... (e). Myelofibrosis
SELECT THE MOST APPROPRIATE ANSWER:
Q43. Which of the following criteria is a must for the diagnosis of Multiple Myeloma:
(A). Plasma cell infiltration of the bone marrow.
(B). Very high ESR
(C). Light chains in the urine
(D). Osteolytic bone lesions
(E). Renal failure
Q44. Which of the following features is not part of the “POEMS” Syndrome:
(A). Polyneuropathy
(B). Organomegaly
(C). Endocrinopathy
(D). Myocardial Infarction.
(E). Skin changes
Q45. All of the following features suggest the diagnosis of Multiple Myeloma rather
than Benign Monoclonal Gammopathy (Monoclonal Gammopathy of
Undetermined significance/ M-GUS) EXCEPT:
(A). Presence of Plasmablasts
(B). Presence of clusters of plasma cells in the marrow biopsy
(C). Osteolytic bone lesions
(D). Hypercalcemia
(E). Less than 10% plasma cells in the bone marrow.
Q46. The major groups of B-cell Non-Hodgkin’s lymphomas in the new W.H.O.
Classification include any of the followings EXCEPT:
(A). Follicular Lymphoma
(B). Mantle cell lymphoma
(C). Burkitt Lymphoma
(D). Lymphoblastic lymphoma
(E). Mycosis fungoides/ Sezary syndrome.
Q47. The major groups of T-cell Non-Hodgkin’s lymphomas in the new W.H.O.
Classification include any of the followings EXCEPT:
(A). Lymphoblastic lymphoma
(B). Peripheral T-cell lymphoma
(C). Mantle cell lymphoma.
(D). Adult T-cell leukemia/lymphoma
(E). Mycosis fungoides/ Sezary syndrome
Q48. Stage I or Low Cell Mass stage of Myeloma has all of the features EXCEPT:
(A). Renal failure.
(B). Hb > 100 gm/L
(C). Calcium equal or < 3 mmol/L
(D). Low rate of paraprotein production
(E). Normal bones or a solitary lesion in the X-ray
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Q49. Eosinophilia is a well-known feature of :
(A). Viral infections
(B). Asthma.
(C). Myelofibrosis
(D). Visceral Leishmaniasis
(E). Aplastic anemia
Q50. One of the following features is characteristic for Myelofibrosis:
(A). Very high hemoglobin, because it is a myeloproliferative disorder
(B). Splenic atrophy in one third of patients
(C). Extramedullary hemopoiesis.
(D). Hypochromic microcytic red cells from iron exhaustion
(E). Reduced reticulin fibers in the marrow
MATCH EACH OF THE FOLLOWING DISEASES WITH ITS RELATED
MORPHOLOGICAL HEMATOLOGICAL CHANGES.
EACH CHOICE COULD BE USED ONCE ONLY.
Q51.
Q52.
Q53.
Q54.
Q55.
Q56.
Q57.
Q58.
Q59.
Q60.
MYELOFIBROSIS
HODGKIN’S DISEASE
MULTIPLE MYELOMA
ECZEMA
ANGIOCENTRIC NHL
WALDENSTROM’S
HIGH GRADE LYMPHOMA
ITP
KALA AZAR
ESSENTIAL THROMBOCYTHEMIA
(
(
(
(
(
(
(
(
(
(
)
)
)
)
)
)
)
)
)
)
A.
B.
C.
D.
E.
F.
G.
H.
I.
J.
INCREASED PLASMA CELLS
NASAL LYMPHOMA OF NK CELLS
↑ LYMPHOPLASMACYTOID CELLS
EOSINOPHILIA
LACUNAR REED STERNBERG CELLS
PROLIFERATION OF LYMPHOBLASTS
TEAR DROP RED CELLS
VERY HIGH PLATELET COUNT
LOW PLATELET COUNT
MARROW LEISHMAN DONOVAN BODIES
MATCH EACH BLEEDING DISORDER WITH ITS RELATED FEATURE.
Q61. VON WILLEBRAND DISEASE
Q62. HEMOPHILIA A
Q63. ITP
Q64. FACTOR XII DEFICIENCY
Q65. CHRISTMAS DISEASE
(
(
(
(
(
)
)
)
)
)
K.
L.
M.
N.
O.
LOW FACTOR VIII:c
LOW PLATELET COUNT
FACTOR IX DEFICIENCY
THROMBOSIS
PROLONGED APTT &
BLEEDING TIME
Select the most appropriate answer to the following multiple choice questions:
Q66. MACROCYTOSIS could be seen in all of the following EXCEPT:
A. 5 q- syndrome
B. Aplastic anemia
C. Hereditary spherocytosis.
D. Erythroleukemia
E. Myelofibrosis
117
Q67. COOMB'S TEST is positive in:
A. Hereditary spherocytosis
B. Warm autoimmune hemolytic anemia.
C. Iron deficiency anemia
D. Glucose-6-Phosphate Dehydrogenase deficiency
E. Thalassemia minor
Q68. Target cells could be seen in all of the following diseases EXCEPT:
A. Thalassemia major
B. Thalassemia minor
C. Liver disease
D. Splenic atrophy
E. Acute lymphoblastic leukemia.
Q69. All of the following changes could be seen in iron deficiency anemia EXCEPT:
A. Subacute combined degeneration of the spinal cord.
B. Angular stomatitis
C. Koilonychia
D. Glossitis
E. Esophageal web (Plummer-Vinson Syndrome)
Q70. All of the following features are characteristic for pernicious anemia EXCEPT:
A. Oval macrocytosis
B. Hypersegmented neutrophils
C. Howell-Jolly bodies
D. Deficient hemoglobinization of the developing red cells.
E. Active ineffective megaloblastic marrow
Q71. Major criteria to diagnose aplastic anemia include all of the following EXCEPT:
A. Empty bone marrow
B. Anemia
C. Jaundice.
D. Neutropenia
E. Thrombocytopenia
Q72. All of the following features relate to hemolytic anemias EXCEPT:
A. Splenomegaly
B. Gall Stones
C. Indirect hyperbilirubinemia
D. Hypochromic microcytic red cells.
E. Reticulocytosis
Q73. One of the following is characteristic for β- thalassemia minor:
A. High Hemoglobin A2.
B. Very high Hemoglobin F
C. Marked splenomegaly
D. Severe transfusion-dependent anemia
E. High Hemoglobin H
Q74. All of the following features are true for sickle cell disease EXCEPT:
A. Vaso-occlusive crises
B. Hemolytic anemia
C. Leg ulcers
D. Aseptic bone necrosis
E. Splenomegaly in the majority of cases.
118
Q75. Warm autoimmune hemolysis could result from all of the following EXCEPT:
A. Burn.
B. Chronic lymphocytic leukemia
C. Systemic lupus erythematosus
D. Drugs
E. Lymphoma
Q76. Helmet cells could be seen in all of the following diseases EXCEPT:
A. MAHA (Microangiopathic Hemolytic Anemia)
B. March hemoglobinuria
C. TTP (thrombotic thrombocytopenic purpura)
D. Artificial heart valves
E. Aplastic anemia.
Q77. All of the following features relate to G-6-P DH deficiency EXCEPT:
A. Intravascular hemolysis
B. Favism
C. Blister red cells
D. Heinz bodies
E. Moderate splenomegaly.
Q78. One of the following features is not true in Acute Lymphoblastic Leukemia:
A. It is the commonest cancer of children
B. Blast cells are positive for Sudan Black stain.
C. Results from proliferation of lymphoblasts
D. Could present with anemia, neutropenia & thrombocytopenia
E. CNS could be involved
Q79. One of the following features is not true in the FAB classification of
Acute Myeloblastic Leukemia :
A. M1 is AML of the myeloblasts
B. M2 is AML of the lymphoblasts.
C. M3 is AML of the promyelocytes
D. M5 is AML of the monoblasts
E. M7 is AML of the megakaryoblasts
Q80. Marked splenomegaly could be seen in any of the following EXCEPT:
(A). Thalassemia major
(B). Chronic myeloid leukemia
(C). Immune thrombocytopenic purpura “ITP”.
(D). Kala Azar
(E). Malarial splenomegaly or Tropical Splenomegaly Syndrome
SELECT THE MOST APPROPRIATE ANSWER :
Q81. Granulomatous Lymphadenitis could result from any of the following “specific”
conditions EXCEPT:
(A). Tuberculosis
(B). Toxoplasmosis
(C). Sarcoidosis
(D). Cushing’s disease.
(E). Crohn’s disease
119
Q82. One of the following features is not true in Nodular Sclerosis Hodgkin’s disease:
(A). Lacunar type of Reed Sternberg cells
(B). Anterior mediastinal mass
(C). No male preponderance
(D). Alcohol intolerance
(E). The commonest type in the Middle East.
Q83. One of the following conditions cannot cause marked splenomegaly:
(A). Osteopetrosis
(B). Niemann Pick disease
(C). Gaucher’s disease
(D). Hydatid disease of the spleen
(E). Celiac disease.
Q84. One of the following features is not true in Burkitt’s Lymphoma:
(A). It is associated with Epstein Barr virus infection and malaria
(B). It is common at very high altitudes.
(C). It usually affects the jaw bones or the viscera
(D). It is one of the most aggressive tumors but responsive to chemotherapy
(E). It has a “Starry-sky” tissue appearance
Q85. Renal failure complicates myeloma because of any one of the following EXCEPT:
(A). Amyloidosis of the Kidney
(B). Nephrocalcinosis from hypercalcemia
(C). Light chain damage to the renal tubules
(D). Extensive infiltration of the kidney by myeloma cells.
(E). Pyelonephritis secondary to immune paresis & neutropenia
Q86. One of the following features is not true in Waldenstrom’s macroglobulinemia:
(A). IgM Gammopathy
(B). Hyperviscosity
(C). Splenomegaly and lymphadenopathy
(D). Cryoglobulinemia
(E). Large Osteolytic bone lesions.
Q87. One of the following features cannot happen in Myelofibrosis:
(A). Splenic atrophy.
(B). Nucleated red cells and myelocytes in the blood smear
(C). Hemopoiesis in the liver and spleen
(D). Tear drop red blood cells
(E). Portal hypertension
Q88. One of the following features cannot happen in Essential Thrombocythemia:
(A). Splenic atrophy
(B). GIT bleeding
(C). Thrombosis
(D). Splenomegaly
(E). Thrombocytopenia.
Q89. One of the following features cannot happen in Polycythemia Rubra Vera:
(A). Hyperviscosity
(B). Hypermetabolism
(C). Hyperuricemia
(D). Splenic atrophy.
(E). Pruritis
120
Q90. All of the following Non-Hodgkin’s Lymphomas are intermediate grades in the
“old” Working Formulation EXCEPT:
(A). Burkitt’s lymphoma.
(B). Follicular Large Cell lymphoma
(C). Diffuse Large Cell Lymphoma
(D). Diffuse Small Cleaved Cell Lymphoma
(E). Diffuse Mixed Cell Lymphoma
Q91. APTT cannot be prolonged in one of the following conditions:
(A). von Willebrand’s Disease
(B). Hemophilia A
(C). Christmas Disease
(D). Hageman Factor (XII) Deficiency
(E). Factor VII Deficiency.
Q92. All of the following features are true in Acute Childhood ITP EXCEPT:
(A). Marrow megakaryocytosis
(B). Giant platelets with high Mean Platelet Volume (MPV)
(C). Low incidence of spontaneous remission.
(D). Prolonged bleeding time
(E). Purpuric superficial muco-cutaneous type of bleeding
Q93.
Acute childhood ITP is characterized by all of the following features EXCEPT :
(A). It is usually a self limiting disease
(B). MPV “Mean Platelet Volume” could be more than 10 fL (Normal 5-8 fL)
(C). No or few megakaryocytes in the bone marrow.
(D). Platelet count is usually very low
(E). Good response to intravenous immunoglobulin
Q94. Thrombocytosis can result from any of the following causes EXCEPT :
(A). Hodgkin's Disease
(B). Ulcerative colitis
(C). Splenectomy
(D). Aplastic anemia.
(E). Steroid administration
Q95. All of the following relate to DIC EXCEPT:
(A). Hypofibrinogenemia
(B). Prolonged PT, APTT and bleeding time
(C). Thrombocytopenia
(D). Increased D-Dimer & Fibrin(ogen) Degradation Products (FDP)
(E). DIC means “Death Is Coming”.
Q96. One of the following is not true in Acute Hypergranular Promyelocytic Leukemia :
(A). It results from proliferation of promyelocytes
(B). The leukemic cells could be dumb-bell shaped without granules
(C). The chromosome abnormality t(15q+;17q-) is characteristic
(D). Treatment with ATRA could be very effective
(E). Characterized by lymphadenopathy, gum hypertrophy & skin infiltration.
Q97. All of the following features relate to Chronic Granulocytic Leukemia EXCEPT:
(A). Philadelphia chromosome is positive in the majority of cases
(B). The chronic stage usually lasts about four years
(C). Segmented neutrophils and myelocytes are increased
(D). Neutrophil alkaline phosphatase is high.
(E). Usually terminates in blast crisis
121
Q98. One of the following features is not true in Acute Lymphoblastic Leukemia:
(A). It is basically the disease of elderly people.
(B). It could happen in young adults
(C). It is the best type of children’s leukemia with a cure rate of >60%
(D). It is due to proliferation of lymphoblasts
(E). It could present as CNS leukemia
Q99. One of the following features is true in Chronic Lymphocytic Leukemia:
(A). Usually affects elderly people.
(B). It is not uncommon in children
(C). It results from uncontrolled proliferation of immature lymphocytes
(D). All patients should be treated immediately
(E). Thrombocytosis carries a poor prognosis
Q100. Thrombocytopenia in Chronic Lymphocytic Leukemia could not result from:
(A). Bone marrow infiltration by leukemic cells
(B). Autoimmune antibodies to platelets
(C). Hypersplenism
(D). Varicella zoster.
(E). Chemotherapy used in the management of the CLL
Match the following diseases with the most appropriate features:
Each feature should be used once only; Put the right letter in the ANSWER BOX.
No
101
102
103
104
105
106
107
108
109
110
111
112
113
114
115
116
117
118
DISEASE
Hodgkin’s Disease
Myelofibrosis
Multiple Myeloma
Polycythemia
Rubra Vera
Nodular sclerosis HD
Burkitt’s Lymphoma
Essential
Thrombocythemia
Amyloidosis
Tropical
splenomegaly syndrome
T.T.P.
Glanzmann’s Disease
ITP (Immune Thrombocytopenic Purpura)
Mycosis Fungoides
von Willebrand Disease
Waldenstrom’s macroglobulinemia
Hemophilia A
AML (M3)
Centrocytic lymphoma
ANSWER
FEATURES
Prolonged APTT and bleeding time
Osteolytic lesions
IgM Gammopathy
Bleeding with low platelets &
marrow megakaryocytosis
Reed Sternberg cells
Follicular lymphoma
High Hb, Hct. & Red cell count.
Splenomegaly
Factor VIII:c Deficiency
Thrombosis, thrombocytopenia,
CNS symptoms, fever & MAHA.
Lacunar cells
Platelet GP IIb & IIIa deficiency
Tear drop red cells &
extramedullary hemopoiesis
Marked Malarial splenomegaly
plus high polyclonal IgM
Cutaneous T Cell Lymphoma
Thrombocytosis with splenic
atrophy
Macroglossia
Associated with D.I.C.
EBV & starry sky histology
A
B
C
D
E
F
G
H
I
J
K
L
M
N
O
P
Q
R
122
SELECT THE MOST APPROPRIATE ANSWER.
Q119. A dimorphic red cell picture could be seen in all of the following EXCEPT:
(A). Sideroblastic anemia
(B). A transfused iron deficient anemia patient
(C). Untreated iron deficiency anemia.
(D). A normal patient with a two month history of continuously bleeding piles
(E). A thalassemia patient who is recently transfused
Q120. Macrocytosis could not happen in one of the following conditions:
(A). Aplastic anemia
(B). Hypothyroidism
(C). Reticulocytosis
(D). Myelodysplastic syndrome
(E). Thalassemia major.
Q121. All of the following physiological compensatory mechanisms could try to correct
the effect of severe chronic anemia EXCEPT:
(A). Increasing the blood pressure.
(B). Increasing red cell 2,3 DPG
(C). Increasing cardiac output
(D). Redistribution of blood from skin to brain
(E). Increasing plasma volume
Q122. Spherocytosis is a prominent feature of one of the following conditions:
(A). Sickle cell anemia
(B). Warm autoimmune hemolytic anemia.
(C). Cold hemagglutinin disease
(D). Fragmentation anemia
(E). Hereditary elliptocytosis
Q123. All of the following features could be seen in megaloblastic anemia EXCEPT:
(A). Hypersegmented neutrophils
(B). Oval macrocytosis
(C). Glossitis with a beefy tongue
(D). Mild thrombocytopenia or neutropenia
(E). Target cells.
Q124. All of the following cells are regarded as primitive hematological cells EXCEPT:
(A). Megakaryocyte.
(B). Myeloblast
(C). Pronormoblast
(D). Monoblast
(E). Lymphoblast
Q125. Red cell fragmentation is a feature of all of the following conditions EXCEPT:
(A). March hemoglobinuria
(B). Malignant hypertension
(C). Prosthetic heart valve
(D). Hemolytic Uremic syndrome
(E). Warm autoimmune hemolytic anemia.
123
Q126. All of the following could be due to Epstein Barr Virus infection EXCEPT::
(A). Infectious mononucleosis
(B). Angiocentric lymphoma
(C). Nasopharyngeal carcinoma
(D). Hodgkin’s disease.
(E). Burkitt’s lymphoma
Q127. All of the following facts relate to G6PDH deficiency EXCEPT:
(A). The anemia is usually extravascular with remarkable splenomegaly.
(B). Hemolysis is severe in Mediterranean type (no activity in reticulocytes)
(C). In the A- type, reticulocytes has 10% activity & hemolysis is not severe
(D). The disease is sex-linked
(E). Most female with low enzyme level have extreme lyonization
Q128. One of the following features is not true in Hereditary Elliptocytosis:
(A). It is quite common in Saudi Arabia
(B). The hemolytic anemia is even more severe than hereditary spherocytosis.
(C). It is autosomal dominant
(D). Homozygous patients can have a very severe hemolytic disease
(E). Could present with jaundice, gall stones, splenomegaly & reticulocytosis
Q129. Thalassemias are common in the indigenous people of these countries EXCEPT:
(A). England.
(B). Italy
(C). Greece
(D). Saudi Arabia
(E). Kurdistan
Q130. Majority of the leukemic cells are strongly positive for CD10 (CALLA) in which
type of leukemia:
(A). T-CLL
(B). Acute myeloid leukemia
(C). Myelodysplastic syndrome
(D). Common ALL.
(E). Burkitt type of ALL (B-ALL)
Q131. Sudan Black, Myeloperoxidase & Specific Esterase are positive in:
(A). AML without differentiation (M1).
(B). Acute Monoblastic Leukemia (M5)
(C). Acute megakaryoblastic Leukemia (M7)
(D). Acute lymphoblastic Leukemia
(E). Hairy Cell Leukemia
Q132. One of the following features is not true in Acute Promyelocytic Leukemia (M3):
(A). It used to have a very poor prognosis because of DIC following treatment
(B). It is now one of the best types of AML because of treatment with ATRA
(C). Faggot Cells ( Promyelocytes with bundles of Auer Rods) could be seen
(D). Strongly positive Sudan Black stain
(E). Very strong TdT positivity.
Q133. Acute leukemia patients cannot present with:
(A). Fungal infection
(B). Bacterial Infection
(C). Viral Infection
(D). Empty bone marrow.
(E). Mediastinal widening
124
Q134. In Acute Leukemia the white blood cell count could be:
(A). High
(100,000/uL)
(B). Very high
(250 000/uL)
(C). Low
(1000/uL)
(D). Normal
(10,000/uL)
(E). All of the above.
Q135. All of the following are true for chronic myeloid leukemia treatment EXCEPT:
(A). Imatinib mesylate (Glivec) is a new revolutionary oral treatment
(B). Interferon can benefit many patients but side effects are troublesome
(C). Hydroxyurea is still the most widely used treatment
(D). Busulphan is no more used because of its long-term complications
(E). Old patients should be given the choice of stem cell or marrow transplant.
Q136. Which one is not true for chronic lymphocytic leukemia treatment:
(A). Rai stage IV patients benefit from steroid before proper chemotherapy
(B). All Rai stage I & II patients should be immediately treated.
(C). Fludarabine, Chlorambucil, Vincristine & Prednisolone are effective
(D). Coomb’s positive hemolytic anemia patients better be given steroid first
(E). Acyclovir should be used liberally for zoster and herpes simplex
Q137. The following are regarded as Chronic lymphoproliferative disorders EXCEPT:
(A). Hairy cell leukemia
(B). Small lymphocytic lymphoma
(C). Waldenstrom’s macroglobulinemia
(D). Burkitt’s lymphoma.
(E). Chronic lymphocytic leukemia
Q138. All of the following features relate to Hairy Cell Leukemia EXCEPT:
(A). Splenomegaly
(B). Granulocytosis.
(C). Dry bone marrow aspiration tap
(D). Tartarate Resistant Acid Phosphatase (TRAP) positive cells
(E). Monocytopenia
Q139. All of the following features are true in Aplastic Anemia management EXCEPT :
(A). Marrow or stem cell transplantation should be offered to all young patients
(B). Anti-lymphocyte Globulin could benefit many patients
(C). Chemotherapy could be effective in patients with marrow lymphocytosis
(D). Blood transfusion from potential marrow donors should be avoided
(E). Supportive management with red cells, platelets & antibiotics has no role.
Q140. All of the following are true for Vitamin B12 EXCEPT:
(A). Mainly absorbed in the duodenum.
(B). The daily requirement is 1 microgram
(C). The body stores are enough for many years
(D). Deficiency causes megaloblastic anemia
(E). Mostly available in meat products
125
Match the following (lettered) hematological features with the type of anemia you
think it is compatible. Each choice is used once only.
(A). A fifteen year old patient admitted with fever, anemia and bleeding. There is history
of Chloramphenicol medication. Bone marrow was found to be empty.
(B). A fifty year old male patient with uremia and a hemoglobin of 9 gm/dL.
MCV, MCH and MCHC are all within normal limits.
(C). A ten year old child with a history of frequent blood transfusion. His spleen is very
big and Hemoglobin F very high. Blood picture showed hypochromic microcytic anemia
with many target cells.
(D). A Saudi out-patient with a hemoglobin of 10 gm/dL and moderately palpable
spleen. The blood smear showed red cells to be oval in shape. MCV and MCH are low
but MCHC is high. No treatment given.
(E). A multiparous lady from Tihama with ten children and poor nutritional history.
Her hemoglobin is 5 gm/dL and MCV 112 fL. She has never taken iron or Folic Acid
during her pregnancies.
(F). A poor lady from Tihama with ten children and severe anemia. Blood smear showed
hypochromic microcytic red cells. Serum Ferritin was very low.
(G). A normal looking male out-patient with a hemoglobin of 11 gm/dL and many target
cells in the blood smear. The Hemoglobin A2 was 8%. Serum ferritin was normal.
(H). A child with severe anemia and mild jaundice. Coomb’s test was positive. He
responded to Steroid.
(I). A black Saudi child with history of repeated hospital admissions for painful crises.
Her hemoglobin was 7 gm/dL and bilirubin was high. Spleen was atrophic. Hemoglobin
electrophoresis was abnormal with no Hemoglobin A, A2 or F.
(J). An Egyptian child admitted for severe hemolytic anemia after eating “Fool”. Blood
smear showed many blister cells. Fool in Arabic means bean.
(141).
(142).
(143).
(144).
(145).
(146).
(147).
(148).
(149).
(150).
Megaloblastic Anemia
Iron Deficiency Anemia
Thalassemia Minor
Sickle Cell Disease
G6PDH Deficiency
Autoimmune Hemolytic Anemia
Hereditary Elliptocytosis
Thalassemia Major
Anemia of Chronic Disorder
Aplastic Anemia
……. (141)
……..(142)
……..(143)
……..(144)
……..(145)
……..(146)
……..(147)
……..(148)
……..(149)
……. (150)
Select the most appropriate answer:
Q151. Pronormoblasts are cells with all of the following features EXCEPT:
a. They are the earliest recognizable erythroid cells
b. They have deep blue basophilic cytoplasm
c. They do not contain nucleoli.
d. They eventually give rise to normoblasts
e. Their nuclei are round and consist of finely stippled chromatin
126
Q152. Promyelocytes are cells with all of the following features EXCEPT:
a. They are the earliest granulocyte precursors.
b. Their nuclei contain few nucleoli
c. Their cytoplasm contain granules
d. They will give rise to myelocytes
e. They may be larger than myeloblasts
Q153. Plasma cells have all of the following features EXCEPT:
a. They are the end stage cells in the lymphoid lineage
b. They produce immunoglobulins
c. They are elliptical fried-egg like cells with eccentric nuclei
d. Their nuclear chromatin is coarse and clumped
e. They can normally be seen in the peripheral blood smear.
Q154. Megakaryocytes are characterized by all of the following EXCEPT:
a. They are the largest cells in the peripheral blood smear.
b. They produce platelets
c. They are usually multinucleated
d. Their cytoplasm is full of azurophilic granules
e. They can reach the size of up to 100 micrometer in diameter
Q155. The following features relate to the red cell anomalies :
a. Anisocytosis indicates difference in shape
b. Poikilocytosis indicates difference in size
c. Howell-Jolly bodies are precipitated denatured hemoglobin
d. Heinz bodies are nuclear remnants
e. Polychromasia usually indicates reticulocytosis.
Q156. All of the following hematological values are normal EXCEPT:
a. A hemoglobin of 10 gm/dL in a three month old child
b. A hematocrit of 60% in a newborn
c. An MCV of 100 femtoliter in a newborn
d. Red cell volume of 38 ml/Kg body weight in an adult male.
e. A neutrophil count of 2000/uL in a Saudi medical student
Q157. The followings relate to Glucose-6-Phosphate Dehydrogenase Deficiency :
a. Usually affects female patients
b. G6PDH is important in the Embden-Meyerhof (Glycolysis) cycle to provide
reducing power for the protection of the red cells from oxidative injuries
c. Favism usually happens three days after eating beans
d. Inheritance of the deficient gene is sex-linked.
e. Acute Drug-induced hemolysis happens immediately after taking the drug
Q158. One of the following features is not true in pernicious anemia:
a. It is due Vitamin B12 deficiency from poor intake.
b. It is due to autoantibodies against the gastric parietal cells
c. Marrow erythropoiesis is active but ineffective
d. Blood smear shows oval macrocytes and hypersegmented neutrophils
e. There is severe lack of intrinsic factor
Q159. One of the following features is correct in hereditary spherocytosis :
a. It is autosomal recessive
b. Usually associated with marked unconjugated hyperbilirubinemia
c. Usually associated with marked conjugated hyperbilirubinemia
d. Splenectomy reverses the red cell shape to biconcave form
e. Severe unexpected anemia could result from Parvovirus B19 infection.
127
Q160. One of the following features is not true in Warm Autoimmune Hemolytic Anemia:
a. It is usually due to IgG antibodies
b. It is usually due to IgM antibodies.
c. Steroid therapy &/or splenectomy usually benefit the patient
d. The spleen is often enlarged
e. Coomb's test is usually positive
Q161. The following statements relate to Sickle Cell Trait :
a. Patients usually present with painful crises
b. Hemoglobin S is usually more than 50%
c. They are usually protected from Plasmodium falciparum infection.
d. Patients are usually symptomatic from their anemia
e. Priapism is common
Q162. One of the following features relate to β- thalassemia major :
a. Splenomegaly.
b. Splenic atrophy from repeated vaso-occlusion
c. High hemoglobin F at around 40%
d. Reduced iron absorption
e. Effective erythropoiesis
Q163. All of the following features relate to hemophilia A EXCEPT:
a. Prolonged APTT
b. Prolonged bleeding time.
c. It is usually a male disease
d. It is transmitted by female
e. Joint and deep-seated bleeding is common
Q164. von Willebrand disease is characterized by :
a. Prolonged prothrombin time
b. Deficiency of the coagulant portion of factor VIII (VIII:c)
c. Prolonged bleeding time.
d. It only affects male
e. Hemarthrosis is common
Q165. Thrombocytopenic Purpura could complicate any of the following EXCEPT:
a. Acute Leukemia
b. Aplastic anemia
c. Pure red cell aplasia.
d. Myelodysplastic syndromes
e. Bone marrow metastasis
Q166. Thrombocytosis can result from any of the following conditions EXCEPT:
a. Severe iron deficiency from a chronically bleeding duodenal ulcer
b. 5 q- Syndrome
c. Splenectomy
d. Aplastic anemia.
e. Steroid administration
Q167. All of the following are true in DIC EXCEPT:
a. It could complicate snake bite
b. It could complicate mismatched blood transfusion
c. Prolonged PT, APTT and bleeding time
d. It is quite common in obstetric practice
e. Should never be treated with platelet & FFP because fuel is added to the fire.
128
Q168. One of the following cannot happen in Chronic Granulocytic Leukaemia:
a. Priapism
b. Gout
c. Weight loss from hypermetabolism
d. Acute abdomen from splenic infarction
e. Thrombocytopenia unless in blast crisis.
Q169. Only one of the following features is true in Acute Lymphoblastic Leukemia:
a. It is basically the disease of elderly people
b. White cell count is always high in the blood
c. Bone marrow or stem cell transplantation is the early treatment of choice
d. Only a minority of patients could be cured of their disease
e. It could present as CNS leukemia, which has a worse prognosis.
Q170. All of the following is true in Chronic Lymphocytic Leukemia EXCEPT:
a. All stages of the disease should be treated immediately.
b. Fludarabine and Chlorambucil are known drugs in the treatment of CLL
c. Rai and Binet staging systems are utilized in grading the stage of CLL
d. Could be confused with small lymphocytic lymphoma
e. Bone marrow or stem cell transplantation do not benefit majority of patients
EACH OF THE FOLLOWING MULTIPLE CHOICE QUESTIONS IS COMPOSED OF
A STEM AND FIVE STATEMENTS. EACH OF THE STATEMENTS COULD BE TRUE
OR FALSE. IN YOUR ANSWER SHEET, YOU ARE REQUESTED TO FILL THE
CORRECT ONES AND LEAVE THE FALSE ONES EMPTY.
Q171. The following statements relate to hemopoiesis :
a.
Hemopoiesis starts from the bone marrow in a two week old embryo
b.
Pronormoblast is a red cell precursor which is full of hemoglobin
c.
Promyelocyte is a large cell with few nucleoli but no granules
d.
Anisocytosis is a term used to denote variation in red cell size.
e.
Poikilocytes are irregularly shaped red cells.
Q172. The following statements concern normal hematological values :
a.
The normal MCV is between 76 and 96 milliliters
b.
A hemoglobin of 10 gm/dL is normal for a three month old child.
c.
A 70 Kg adult male has around ten units of whole blood.
d.
The red cell life span is between two and three months
e.
The red cell count of a full term infant is less than an adult male.
Q173. The following statements relate to iron status in the human body :
a.
The normal amount of iron in an adult male is about 15 gms
b.
The bone marrow needs about 30 mg of iron daily to produce red cells.
c.
A menstruating female requires about three milligrams of iron daily.
d.
Excessive TEA consumption increases iron absorption
e.
Unconjugated iron binding capacity is reduced in iron deficiency anemia
Q174. Macrocytosis could happen in any of the following conditions :
a.
Alcoholic liver cirrhosis.
b.
Thalassemia
c.
Newborn.
d.
Iron overload
e.
Folic acid deficiency.
129
Q175. The following statements relate to Sickle Cell Anemia :
a.
It is common in the Asir region of Saudi Arabia.
b.
It only affects male patients
c.
Sickle cell trait protects against Falciparum malaria.
d.
It results from reduced production of β-globin chains
e.
Patients with low hemoglobin should immediately be transfused
Q176. The following features relate to Sickle Cell Disease :
a.
Splenomegaly at early childhood.
b.
Hemoglobin S of 40%
c.
Leg ulcers.
d.
Hand-foot syndrome.
e.
Symptomatic anemia
Q177. Sicklers can present with any of the following features :
a.
Biliary colic.
b.
Priapism.
c.
Marked splenomegaly immediately after birth
d.
Salmonella osteomyelitis.
e.
Splenic atrophy in the neonatal period
Q178. The following features relate to Sickle Cell Trait :
a.
Severe hypochromic microcytic anemia
b.
Extramedullary hemopoiesis
c.
Splenic syndrome at high altitude.
d.
Sickling problems during long flights in unpressurized aircrafts.
e.
Hemoglobin S of 73%
Q179 The following statements relate to thalassemias :
a.
Patients with low hemoglobin should be transfused.
b.
β-thalassemia is due to replacement of Glutamic acid by Valine
c.
High Hemoglobin F in a neonate indicates β- thalassemia major
d.
Hemoglobin electrophoresis is essential for proper diagnosis.
e.
Hemoglobin F has a low affinity for oxygen
Q180. The following statements relate to β- thalassemia minor :
a.
Normal hemoglobin A2
b.
Hypochromic microcytic red cells.
c.
Increased numbers of red cells.
d.
Severe anemia necessitating transfusions
e.
Should be counseled regarding marriage to another β- thalassemia minor.
Q181. The following features are seen in β- thalassemia intermedia :
a.
Iron overload.
b.
Continuous and persistent need for blood transfusion
c.
Paravertebral extramedullary hemopoietic deposits.
d.
Deafness from temporal bone involvement.
e.
Positive Coomb’s test
Q182. The following laboratory results relate to β- thalassemia major:
a.
High Hemoglobin F.
b.
Mild unconjugated hyperbilirubinemia.
c.
Normal hemoglobin A
d.
Hypochromic microcytic red cells with many target & nucleated red cells.
e.
sickle shaped red cells
130
Q183. The following statements relate to the laboratory diagnosis of leukemias:
a.
Sudan Black is positive in Acute Lymphoblastic Leukemia
b.
Periodic Acid Schiff is positive in Acute Myeloid Leukemia
c.
Specific (Chloroacetate) Esterase is positive in Acute Monoblastic type
d.
Leukocyte Alkaline Phosphatase is high in chronic myeloid leukemia
e.
Acid phosphatase is polar positive in T cell acute lymphoblastic leukemia.
Q184. The following statements relate to Acute Monoblastic leukaemia (M5) :
a.
It has the best prognosis between the subtypes of AML
b.
Non-specific Butyrate Esterase is positive in the leukemic monoblasts.
c.
DIC is very common if patients are not heparinized before treatment
d.
Gum hypertrophy, skin involvement and lymphadenopathy are common.
e.
Lysozyme enzyme is usually elevated.
Q185. The following tests relate to hemostatic tests :
a.
Prolonged prothrombin time is usually due to prothrombin deficiency
b.
Prolonged APTT could be due to Factor VIII:c deficiency.
c.
Severe hypofibrinogenemia could result in prolonged PT, APTT & TT.
d.
Factor X deficiency results in prolonged PT & APTT but not TT.
e.
Bleeding time is prolonged in Hemophilia A
Q186. The following statements relate to Hemophilia A :
a.
It is almost always transmitted from the mother
b.
It is due to deficiency of the large part of factor VIII (VIII R:Ag)
c.
Activated Partial Thromboplastin Time (APTT) is usually normal
d.
Factor VIII level of 20% is regarded as severe hemophilia
e.
Menorrhagia and nose bleeding are very common
Q187. The following statements are true about von Willebrand Disease :
a.
Prolonged bleeding time.
b.
Failure of platelet aggregation to Ristocetin.
c.
Menorrhagia.
d.
APTT could be normal.
e.
Sex-linked inheritance
Q188. Thrombin Time (TT) is prolonged in the following situations :
a.
Patients on Heparin therapy.
b.
Prothrombin deficiency
c.
von Willebrand Disease
d.
Severe hypofibrinogenemia.
e.
Hemorrhagic Disease of the Newborn
Q189. The following statements relate to Glucose-6-Phosphate Dehydrogenase :
a.
200 million people are deficient of this enzyme worldwide.
b.
Deficiency can cause severe extravascular hemolysis
c.
Splenomegaly is a particular feature of Favism
d.
Deficiency is believed to protect against malaria.
e.
Hemoglobinemia, hemoglobinuria & hemosiderinuria can occur.
Q190. In Cold Hemagglutinin Disease (CHAD) :
a.
Coomb's test could be positive.
b.
Splenomegaly is usually marked
c.
Could be due to lymphoma.
d.
MCV might be very high.
e.
Blood samples should be taken into pre-warmed syringes and tubes.
131
Q191. The following statements relate to Paroxysmal Nocturnal Hemoglobinuria :
a.
Autosomal recessive
b.
Positive Coomb’s test
c.
Extreme sensitivity of the red cell membrane to complement lysis.
d.
Fragmentation anemia
e.
Budd Chiari syndrome (Hepatic vein thrombosis).
Q192. Intravascular hemolysis could happen in the following diseases: :
a.
CHAD “Cold Hemagglutinin Disease”.
b.
PNH “Paroxysmal Nocturnal Hemoglobinuria”.
c.
March Hemoglobinuria.
d.
Mismatched ABO-incompatible blood transfusion.
e.
G-6-P Dehydrogenase deficiency.
Q193. Fragmentation anemia could complicate the following conditions :
a.
Prosthetic cardiac valve.
b.
Burn.
c.
Hemolytic Uremic Syndrome (HUS).
d.
Thrombotic Thrombocytopenic Purpura (TTP).
e.
March hemoglobinuria.
Q194. The following features relate to Hereditary Elliptocytosis :
a.
Autosomal dominant.
b.
Mild splenomegaly.
c.
Reticulocytosis.
d.
Positive Coomb’s test
e.
Hematuria
Q195. Splenomegaly could be seen in the following hemolytic anemias :
a.
Hereditary spherocytosis.
b.
Sickle cell disease in early childhood.
c.
Thalassemia major in adolescents.
d.
Paroxysmal Nocturnal Hemoglobinuria
e.
Cold Hemagglutinin Disease
Select the most appropriate answer:
Q196. One of the following is not true in the W.H.O. Mantle Cell Lymphoma:
A. Described as Centrocytic lymphoma in the Kiel classification
B. It has been found that these cells definitely come from the germinal centers.
C. The lymphoma cells are small to medium sized with cleaved nuclei
D. Lymphomatous polyposis is a GIT form of Mantle cell lymphoma
E. This type of lymphoma is usually nodular
Q197. All of the following cell markers are true in Mantle cell lymphoma EXCEPT:
A. CD5 is commonly present
B. Pan B cell markers (CD19, CD20, CD22 & CD79a) are positive
C. CD 23 is lacking
D. Cyclin D1 expression is common and diagnostically valuable
E. TdT is usually positive.
132
Q198. All of the following feature are true in Mantle cell lymphoma EXCEPT:
A. t(11;14) is a characteristic cytogenetic abnormality
B. Blood and marrow spread is rare.
C. Prognosis and long term survival is poor
D. Contrary to old belief, cells do not come from the germinal centers
E. The growth pattern is commonly nodular or mantle zone pattern
Q199. All of the following features are related to Infectious Mononucleosis EXCEPT:
A. Results from infection with Cytomegalovirus (CMV) .
B. Positive Monospot test
C. Atypical lymphocytosis
D. Possible splenic rupture
E. Development of antibodies to Epstein Barr virus (EBV)
Q200. One of the quantitative blood cell abnormalities is not seen in Hodgkin's Disease:
A. Eosinophilia
B. Basophilia.
C. Lymphopenia
D. Thrombocytosis
E. Anemia
Match the following types of leukemias with their morphological, cytochemical,
immunological and clinical features. Each choice is used once only.
(201).
(202).
(203).
(204).
(205).
(A).
(B).
(C).
(D).
(E).
Common Acute Lymphoblastic Leukemia
Acute Hypergranular Promyelocytic Leukemia (M3)
Chronic Myeloid Leukemia
Acute Myeloblastic Leukemia without Differentiation
T- Acute Lymphoblastic Leukemia
……...
……...
……...
……...
……...
A leukemic patient bleeding from Disseminated Intravascular Coagulation.
Leukemic Promyelocytes with bundles of Auer rods forming “Faggot” cells seen.
There is translocation between chromosomes 15 and 17.
A Middle aged patient with a very high white cell count without blasts.
Philadelphia chromosome is positive. Spleen is very big.
A child with a very high white cell count, most of which are blasts. Blasts are
positive for acid phosphatase. Chest x-ray showed mediastinal widening.
Immunological studies revealed blasts positive for CD5, CD7 and T- antigen.
A young patient with leukemia and 90% blasts.
Blasts are positive for Sudan Black, Myeloperoxidase and Specific Esterase.
No differentiation to promyelocytes seen.
A five year old child with anemia, neutropenia and thrombocytopenia.
Bone marrow is full of blasts that are positive for CD 10 (CALLA) and TdT.
Child responded nicely to chemotherapy and got cured of his disease.
SELECT THE MOST APPROPRIATE SINGLE ANSWERS:
Q206. Pan B cell markers (CD19, 20, 22 & 79a) are positive in all but one of these:
A. Sezary syndrome.
B. Follicular center cell lymphoma
C. B- cell small lymphocytic lymphoma
D. Hairy cell leukemia
E. Diffuse large B- cell lymphoma
133
Q207. All of the following features are related to "HYPERSPLENISM" EXCEPT:
A. Splenomegaly
B. Anemia
C. Active bone marrow
D. Thrombocytosis.
E. Neutropenia
Q208. Erythrocyte Sedimentation Rate (ESR) is usually low in one of the following:
A. Polycythemia.
B. Anemia
C. Multiple Myeloma
D. Rheumatoid arthritis
E. Tuberculosis
Q209. All of these epithelial changes could be seen in severe iron deficiency EXCEPT:
A. Koilonychia
B. Brittle nails
C. Dysphagia from esophageal web
D. Subacute combined degeneration of spinal cord .
E. Glossitis
Q 210. Vitamin B12 deficiency is related to any of the following conditions EXCEPT:
A. Pernicious anemia
B. Myelofibrosis.
C. Gastrectomy
D. Crohn's disease
E. Veganism
Q211. The following features relate to hereditary spherocytosis :
A. It is autosomal recessive
B. Usually associated with marked unconjugated hyperbilirubinemia
C. Usually associated with marked conjugated hyperbilirubinemia
D. Splenectomy reverses the red cell shape change to biconcave form
E. Severe unexpected anemia could happen from hemolytic crisis.
Q212. One of the following features is not true in Adult T-Cell Leukemia/Lymphoma:
A. Hypocalcaemia.
B. Viral etiology
C. Common in Japan
D. Leukemic blood picture
E. Convoluted T lymphoma cells
Q213. One of the following features is not true in Small Lymphocytic Lymphoma:
A. Can be confused with Chronic Lymphocytic Leukemia (CLL)
B. Can terminate in Richter's syndrome
C. Common in children.
D. Hypogammaglobulinemia is common
E. Although it is of low grade nature, treatment is usually not curative
Q214. Which one of the following is regarded as "HIGH GRADE" lymphoma:
A. Small lymphocytic Lymphoma
B. Lymphocyte Rich Hodgkin's Disease
C. Mantle cell Lymphoma
D. Lymphoblastic Lymphoma.
E. Lympho-plasmacytic Lymphoma
134
Q215. All of the following diseases and features relate to Skin lymphomas EXCEPT:
A. Sezary Syndrome
B. Mycosis Fungoides
C. Often of B cell lymphocyte origin.
D. Erythroderma and presence of cerebriform lymphocytes in the blood
E. Adult T cell Leukaemia/Lymphoma usually present with skin lesions
Q216. One of the following features relate to Mixed cellularity Hodgkin's Disease:
A. Lacunar Cells
B. Mediastinal involvement
C. Alcohol-induced nodal pain
D. The commonest type in Saudi Arabia.
E. Bands of collagen separating cellular lymphoma nodules
Q217. All of the following feature are true for Sezary Syndrome EXCEPT:
A. T-Helper cell lymphoma
B. Caused by HTLV-1 virus.
C. Involvement of the skin and the blood
D. Erythroderma
E. It usually passes through patch, plaque and tumor stages
Q218. All of the following features are true for Lymphoblastic lymphoma EXCEPT:
A. Usually affects children
B. "Starry-Sky" tissue appearance .
C. Mediastinal involvement is common
D. Usually have a leukemic phase
E. Cells have distinctive convoluted nuclear morphology
Q219. Paraproteins could be seen in all of the following neoplasms EXCEPT:
A. Acute Myeloblastic Leukemia (AML) .
B. Waldenstrom's Macroglobulinemia
C. Multiple Myeloma
D. Chronic Lymphocytic Leukemia (CLL)
E. Lymphomas
Q220. All of the following features could be seen in Multiple Myeloma EXCEPT:
A. Rouleaux formation in the blood smear
B. Painful osteolytic skull lesions.
C. Osteolytic lesions in the bones
D. Bence-Jones protein in the urine
E. An ESR of 150 mm/hr
Match the following hemoglobin electrophoresis pattern with the corresponding
hemoglobinopathy. Each choice is used once only.
(221).
(222).
(223).
(224).
(225).
β- thalassemia major
Sickle cell disease
β - thalassemia minor
Sickle cell trait
α- thalassemia
…….
…….
…….
…….
…….
(A). Hemoglobin F of 100%
(B). Hemoglobin S of 100%
(C). Hemoglobin A2 of 8%
(D). Hemoglobin S of 40%
(E). Hemoglobin H is increased.
135
THE FOLLOWING QUESTIONS ARE RELATED TO HEMATOLOGICAL
EMERGENCIES & BLOOD PRODUCTS. SELECT THE MOST APPROPRIATE.
Q226. A BLEEDING CHILD CAN HAVE ANY, BUT ONE, OF THE FOLLOWING
BLOOD DISORDERS:
(A). Aplastic Anemia
(B). Multiple Myeloma.
(C). Acute Leukemia
(D). Immune Thrombocytopenic Purpura
(E). Hemophilia
Q227. A SEVERELY ANEMIC CHILD ADMITTED ON EMERGENCY BASIS
MIGHT HAVE ANY, BUT ONE, OF THE FOLLOWING CONDITIONS:
(A). Glucose-6-Phosphate Dehydrogenase Deficiency
(B). Acute Lymphoblastic Leukemia
(C). Hemolytic crisis of sickle cell disease
(D). Autoimmune hemolytic anemia
(E). Chronic lymphocytic leukemia.
Q228. ONE OF THE FOLLOWING FEATURES RELATE TO CHILDHOOD ITP:
(A). Hemarthrosis
(B). Mostly a female disease
(C). Autosomal recessive
(D). Self-limiting in the majority of cases.
(E). Splenectomy is the therapy of choice
Q229. THE FOLLOWING FACTS RELATE TO PLATELET CONCENTRATE :
(A). One unit should be given for each 10 Kg body weight.
(B). It provides all the coagulation factors
(C). The shelf life in the refrigerator is 5 days
(D). The shelf life at room temperature is 24 hours
(E). Should be given to every child with immune thrombocytopenic purpura
230.
ALL, BUT ONE, OF THE FOLLOWING BLOOD PRODUCTS CAN BE GIVEN
WITHOUT CROSS MATCHING:
(A). Packed red cells.
(B). Albumin
(C). Fresh frozen plasma
(D). Platelet concentrate
(E). Factor VIII concentrate
EACH OF THE FOLLOWING MULTIPLE CHOICE QUESTIONS IS COMPOSED OF
A STEM AND FIVE STATEMENTS. EACH OF THE STATEMENTS COULD BE TRUE
OR FALSE. IN YOUR ANSWER SHEET, YOU ARE REQUESTED TO FILL THE
CORRECT ONES AND LEAVE THE FALSE ONES EMPTY.
Q231. ESR IS USUALLY INCREASED IN:
(A). Lymphomas.
(B). Light chain only multiple myeloma
(C). Anemia.
(D). Secondary polycythemia
(E). Hypofibrinogenemia
136
Q232. PANCYTOPENIA COULD RESULT FROM THE FOLLOWING CONDITIONS :
(A). Aplastic Anemia.
(B). Osteopetrosis.
(C). Diamond-Blackfan Syndrome
(D). Kala Azar with hypersplenism.
(E). Fanconi's anemia.
Q233. GROSS SPLENOMEGALY COULD COMPLICATE FOLLOWING DISEASES :
(A). Osteopetrosis.
(B). Thalassemia major.
(C). Primary Lymphoma of the spleen.
(D). Gaucher's disease.
(E). Myelofibrosis.
Q234. NEUTROPENIA COULD BE A FEATURE OF THE FOLLOWING CONDITIONS:
(A). Chloramphenicol therapy.
(B). Typhoid fever.
(C). Staphylococcal osteomyelitis
(D). Chronic Granulocytic Leukemia
(E). Megaloblastic anemia.
Q235. MONOCYTOSIS IS A USUAL FEATURE OF THE FOLLOWING DISEASES :
(A). Filariasis
(B). Tuberculosis.
(C). Hairy cell leukemia
(D). Chronic neutropenia.
(E). Chronic myelomonocytic leukemia.
Q236. THE FOLLOWING STATEMENTS RELATE TO AGRANULOCYTOSIS :
(A). Severe neutrophilia
(B). Mouth ulceration.
(C). Gross splenomegaly
(D). Could result from Phenylbutazone therapy.
(E). Hyperpyrexia.
Q237. THE FOLLOWING RELATES TO GRANULOCYTIC LEUKEMOID REACTION :
(A). Marked neutrophilia.
(B). Low Neutrophil Alkaline Phosphatase score
(C). Positive Philadelphia chromosome
(D). Can result from severe infection, intoxication or malignancy.
(E). Toxic granulation of the neutrophils.
Q238. LEUKO-ERYTHROBLASTIC ANEMIA DENOTES :
(A). Presence of nucleated red cells in the peripheral smear.
(B). Presence of maturing myeloid cells in the peripheral blood smear.
(C). Marrow infiltration by Malignancy, Myelofibrosis or myeloma.
(D). Drug overdose
(E). Presence of blasts in the bone marrow
Q239. THE FOLLOWING STATEMENTS RELATE TO MULTIPLE MYELOMA :
(A). Majority of cases have IgG Myeloma.
(B). Light chains could be detected in the urine in half of all cases.
(C). IgM Myeloma is extremely rare.
(D). Severe pain in the skull bones is a common finding
(E). Bone marrow infiltration by Reed Sternberg cells
137
Q240. THE FOLLOWING STATEMENTS RELATE TO WALDENSTROM'S
MACROGLOBULINEMIA :
(A). Elevated level of polyclonal IgM
(B). Elevated level of monoclonal IgM.
(C). Elevated ESR.
(D). Hyperviscosity syndrome.
(E). Elevated IgG
Q241. ANY OF THE FOLLOWING FEATURES FULFILL THE CRITERIA FOR
HIGH CELL MASS MYELOMA ( STAGE III ):
(A). Hemoglobin of 120 g/L
(B). Calcium of 3.3 mmol/L .
(C). Multiple osteolytic bone lesions.
(D). IgG of 60 g/L.
(E). Bence Jones protein of 2 g/ 24 hour urine
Q242. PURPURA COULD BE MANIFESTATION OF THE FOLLOWING DISORDERS:
(A). Immune Thrombocytopenic Purpura (ITP).
(B). Hemophilia
(C). Essential Thrombocythemia.
(D). Disseminated Intravascular Coagulopathy (DIC).
(E). Thrombotic thrombocytopenic purpura (TTP).
Q243. THE FOLLOWING FEATURES RELATE TO HODGKIN'S DISEASE :
(A). Painless progressive peripheral lymphadenopathy.
(B). Usually affects children in the underdeveloped world.
(C). More common in the young adult in the developed world.
(D). All age groups in Saudi Arabia.
(E). Curable in the majority of cases.
Q244. THE FOLLOWING CYTOGENETIC ABNORMALITIES COULD BE SEEN
IN BURKITT'S LYMPHOMA :
(A). t(8;14).
(B). t(2; 8).
(C). t(8;22).
(D). t(15;17)
(E). t(9;22)
Q245. THE FOLLOWING FEATURES RELATE TO INFECTIOUS MONONUCLEOSIS :
(A). Atypical lymphocytosis.
(B). The lymphoid cells are basically B- Lymphocytes
(C). B- cells and pharyngeal mucosa have receptors for the virus.
(D). Caused by Epstein Barr virus.
(E). Monospot test is positive.
Q246. THE FOLLOWING STATEMENTS RELATE TO DIFFERENT FAB TYPES OF
ACUTE LYMPHOBLASTIC LEUKAEMIA (ALL):
(A). L1 is leukemia of small and monomorphic lymphoblasts.
(B). L2 is leukemia of large and heterogeneous lymphoblasts.
(C). L3 is Burkitt’s lymphoma
(D). Burkitt leukemic cells have vacuolated deeply basophilic cytoplasm.
(E). L3 and B-ALL are the same.
138
Q247. THE FOLLOWING RELATE TO T- CELL LARGE GRANULAR LEUKEMIA :
(A). The disease is usually indolent.
(B). Patients could be asymptomatic for a long time.
(C). Neutropenia and recurrent infections are common.
(D). Rheumatoid arthritis is a strong association.
(E). Prognosis is usually good.
Q248. THE FOLLOWING RELATE TO NK CELL LARGE GRANULAR LEUKEMIA :
(A). The disease is usually more aggressive than T- cell type.
(B). Arthritis and symptomatic neutropenia are rare.
(C). The leukemia tends to follow an aggressive course.
(D). Patients are younger and B- symptoms more common than T-cell type.
(E). Hepato-splenomegaly, GIT involvement and coagulopathy are common.
Q249. THE FOLLOWING COMPLICATIONS CAN FOLLOW BLOOD TRANSFUSION:
(A). Hemolytic transfusion reaction.
(B). Febrile transfusion reaction.
(C). Iron deficiency anemia
(D). AIDS.
(E). Ulcerative colitis
Q250. HEMOLYTIC TRANSFUSION REACTION USUALLY PRESENTS WITH THE
FOLLOWING FEATURES :
(A). Fever as the only and sole manifestation
(B). Heat feeling in the vein into which the blood has been transfused.
(C). Lumbar pain.
(D). DIC.
(E). Hypertension
Q251. THE FOLLOWING DISEASES CAN BE TRANSMITTED THROUGH BLOOD
TRANSFUSION :
(A). Syphilis.
(B). Gonorrhea
(C). Malaria.
(D). Hydatid disease
(E). Hepatitis.
Q252. THE FOLLOWING SUPPORT THE DIAGNOSIS OF POLYCYTHEMIA RUBRA
VERA (PRV) RATHER THAN SECONDARY POLYCYTHEMIA :
(A). Splenomegaly.
(B). Neutrophilia.
(C). Associated Gout.
(D). High ESR
(E). Low plasma volume
Q253. THE FOLLOWING FEATURES ARE MORE SUGGESTIVE OF ESSENTIAL
THROMBOCYTHEMIA (ET) THAN REACTIVE THROMBOCYTOSIS:
(A). Platelet count of more than a million/uL.
(B). Splenic atrophy.
(C). Prolonged bleeding time.
(D). Abnormal platelet function tests.
(E). Recent history of splenectomy
139
Q254. REACTIVE THROMBOCYTOSIS CAN FOLLOW ANY OF THE FOLLOWING :
(A). Iron deficiency.
(B). Aplastic anemia
(C). Kala Azar
(D). Acute lymphoblastic leukaemia
(E). Operative surgery.
Q255. Which of the following is correct :
(A). The average life span of the normal red cell is 60 days
(B). The hemoglobin molecule contains two globin chains
(C). In normal individuals most red cells are destroyed in the bone marrow
(D). Red cells principally metabolize glucose.
(E). The average half-life for decay of radioactive chromium labeled
normal red cells is around 30 days.
Q256. Severe iron deficiency anemia may be associated with :
(A). Clubbing of the fingers
(B). Pica.
(C). Stomatitis.
(D). Peripheral neuropathy with loss of ankle jerks
(E). Hyperemia and ulceration of the lower rectum
Q257. Pernicious anemia could be associated with :
(A). Premature graying of hair.
(B). Brown eyes
(C). Wide jaw bones
(D). Blood Group A.
(E). Vitiligo.
Q258. Drugs which may be associated with Immune Hemolytic Anemia include:
(A). Digoxin
(B). Aspirin
(C). Isoniazid.
(D). Sulphonamides.
(E). Methyl dopa.
Q259. Which of the following statements are correct :
(A). 15% of the male population are Rhesus positive
(B). Rhesus positive males are always homozygous
(C). Naturally occurring Anti-A agglutinin causes marked hemolysis
(D). The indirect Coomb's test is of value in cross-matching of blood.
(E). Transfusion of Rhesus incompatible blood is only safe in males
Q260. Which of the following diseases may be associated with purpura ?
(A). Thyrotoxicosis
(B). Typhoid fever
(C). Systemic Lupus Erythematosus.
(D). Thymic tumor
(E). Typhus.
140
Correlate the following diseases with the most compatible values& features:
(A). Myelofibrosis
(B). Multiple Myeloma
(C). Polycythemia Rubra Vera
(D). Essential Thrombocythemia
(E). Hypersplenism
Hb
261
262
WBC
Platelet
Low
+
Low
+
Low
+
High
High
+
+++
Normal
Other
Features
Huge Spleen
Normal
Plethoric
Tear drop RBC
Leukoerythroblastic
Increased
marrow reticulin
Rouleaux
Formation
Marrow Plasma
Cells of 60%
Blood Smear
High
Diagnosis
++
263
Low
+
High
+
High
+
264
Low
+
265
Low
+
Low
+
Low
+
High
High
+
++++
Full of Platelets
Splenic atrophy
Match the following types of leukemias with their corresponding features.
Put down the correct letter in the blank bracket.
Q266. Acute Myeloblastic Leukemia
Q267. Chronic Myeloid Leukemia
Q268. Hairy cell Leukemia
Q269. Acute Monoblastic Leukemia
Q270. Common
Acute Lymphoblastic Leukemia
(
) (A). Non-specific Esterase +
(
) (B). Hairy lymphocytes.
(
) (C). Philadelphia chromosome +
(
) (D). TdT+/ CD 10+/ HLA-DR+
(
) (E). Sudan Black, Specific
Esterase & Myeloperoxidase + blasts
Match the following blood diseases with the corresponding red cell abnormalities
Q271.
Q272.
Q273.
Q274.
Q275.
Q276.
Q277.
Q278.
Q279.
Q280.
Hereditary elliptocytosis
Uremia
Iron deficiency anemia
Coomb’s positive warm AIHA
Sickle cell anemia
MAHA
Hemoglobin H disease
Myelofibrosis
Megaloblastic anemia
G-6-P DH deficiency
(
(
(
(
(
(
(
(
(
(
)
)
)
)
)
)
)
)
)
)
(A).
(B).
(C).
(D).
(E).
(F).
(G).
(H).
(I).
(J).
Hypochromic cells
Bite or blister cells
Oval macrocytosis
Tear drop cells
Sickle cells
Burr cells
Golf ball red cells
Spherocytosis.
Elliptocytosis
Fragmented cells
141
Match the following hematological diagnoses with their correct criteria.
Q281. Iron deficiency anemia
Q282. Megaloblastic Anemia
Q283. Thalassemia major
Q284. Sickle cell disease
Q285. G6PDH deficiency
Q286. Autoimmune hemolytic Anemia
Q287. Thalassemia minor
Q288. Acute lymphoblastic leukemia
Q289. Acute Myeloblastic leukemia
Q290. Chronic Granulocytic Leukemia (
Q291. Chronic Lymphocytic Leukemia (
Q292. Hairy cell leukaemia
(
Q293. Myelodysplastic syndromes
(
Q294. Hodgkin's Disease
(
Q295. Non-Hodgkin's Lymphoma
(
Q296. Myelofibrosis
(
Q297. PRV
(
Q298. Essential thrombocythemia
(
Q299. Multiple myeloma
(
Q300. Waldenstrom macroglobulinemia (
Q301. Hemophilia A
(
Q302. Hemophilia B
(
Q303. von Willebrand's Disease
(
Q304. DIC
(
Q305. Celiac disease
(
(
(
(
(
(
(
(
(
(
)
)
)
)
)
)
)
)
)
)
)
)
)
)
)
)
)
)
)
)
)
)
)
)
)
A. High hemoglobin A2
B. High hemoglobin S
C. High hemoglobin F
D. Favism
E. Positive Coomb’s test
F. PAS positive blast cells
G. Sudan Black + blasts
H. High MCV
I. Koilonychia
J. Massive splenomegaly/Dry tap
K. High hemoglobin
L. Pre-leukemia
M. Reed Sternberg Cells (RSC)
N. Lymphoma without RSC
O. High mature & maturing WBC
P. High lymphocyte count
Q. Lymphocytosis with hairy cells
R. Splenic atrophy in 1/3 cases
S. Monoclonal IgM
T. Monoclonal IgG
U. Splenic atrophy/ Weight loss
V. Consumption coagulopathy
W. Prolonged APTT/ menorrhagia
X. Reduced factor IX
Y. Reduced factor VIII:c
Correlate the histological type of non-Hodgkin’s Lymphoma with its grade of
aggressiveness. Fill-in the space with “A” for Low Grade type; “B” for Intermediate
Grade and “C” for High Grade type according to the old Working Formulation.
As you know, we are now using the new W.H.O classification, but knowing the aggressiveness
of the disease is still very important.
HISTOLOGICAL TYPE
AS IN WORKING FORMULATION
306
307
308
309
310
311
312
313
314
315
GRADE
Small lymphocytic Lymphoma
Burkitt’s Lymphoma
Lymphoblastic Lymphoma
Immunoblastic Lymphoma
Follicular Small Cleaved Cell Lymphoma
Follicular Mixed Lymphoma
Diffuse Small Cleaved Cell Lymphoma
Diffuse Mixed Lymphoma
Diffuse large Cell Lymphoma
Follicular Large cell Lymphoma
142
EACH ITEM BELOW CONTAINS FOUR SUGGESTED ANSWERS, OF WHICH ONE
OR MORE IS CORRECT. CHOOSE THE CORRECT LETTERED ANSWER
ACCORDING TO THE FOLLOWING FORMAT:
A
if 1,2 and 3
are correct
B
if 1 and 3
are correct
C
if 2 and 4
are correct
D
if 4 alone
is correct
E
if 1,2,3 and 4 are correct
Q316. Patients with Hodgkin’s Disease are immunocompromized because of :(1).
Lymphocytopenia secondary to the advanced nature of the disease.
(2).
Splenectomy as part of the staging procedure.
(3).
Anergy from impaired cell-mediated immunity.
(4).
Chemo-radiotherapy as part of the management plans.
Q317. The histological types of Hodgkin’s Disease include:
(1).
Nodular sclerosis with Lacunar type of Reed Sternberg cells.
(2).
Lymphocyte predominant with the popcorn type of Reed Sternberg cells.
(3).
Mixed cellularity type which is the commonest type in Abha.
(4).
Lymphocyte depleted which is the worst type of the Hodgkin’s Disease.
Q318. The following cells could be seen in Mixed Cellularity Hodgkin’s Disease:
(1).
Reed Sternberg cells.
(2).
Eosinophils.
(3).
Plasma cells.
(4).
Lymphocytes.
Q319. The following types of Non-Hodgkin’s Lymphoma come under the “Low-Grade”
group in the old Working Formulation Classification:
(1).
Burkitt’s Lymphoma
(2).
Lymphoblastic Lymphoma
(3).
Immunoblastic lymphoma
(4).
Small Lymphocytic lymphoma.
Q320. Viruses could be the cause of the following Lymphomas:
(1).
Human T cell Leukemia/Lymphoma.
(2).
Mycosis Fungoides
(3).
Burkitt’s Lymphoma.
(4).
Mediterranean Lymphoma.
Q321. The following types of lymphomas are grouped under the “Intermediate-Group”
according to the old Working Formulation:
(1).
Diffuse Large Cell Lymphoma.
(2).
Follicular Large Cell Lymphoma.
(3).
Diffuse Small Cleaved Cell Lymphoma.
(4).
Diffuse Mixed Cell Lymphoma.
Q322. The following features relate to Burkitt’s Lymphoma:
(1).
Probably the most aggressive human tumor.
(2).
Probably the most homogenous human tumor.
(3).
Starry-sky histological picture.
(4).
The tumor can double its mass in only 24 hours.
143
Q323. The following features relate to Multiple Myeloma:
(1). Bone marrow Infiltration by plasma cells.
(2). IgM paraproteinemia
(3). Osteolytic bone lesions.
(4). Viral etiology
Q324. Waldenstrom’s macroglobulinemia can present with the following features:
(1). IgG paraproteinemia
(2). Hyperviscosity.
(3). Pautrier’s abscesses in the skin
(4). Lymphoma-like picture with splenomegaly and lymphadenopathy.
Q325. Renal failure commonly complicate myeloma because of the following reasons:
(1). Hypercalcemia.
(2). Heavy chain damage to the kidney tubules.
(3). Secondary amyloid deposition in the glomeruli.
(4). Light chain damage to the renal tubules.
Q326. The following features strongly support the diagnosis of polycythemia rubra vera:
(1). High red cell mass (>36 ml/Kg in male & > 32 ml/Kg in female)= A1.
(2). Normal Oxygen saturation of > 92%= A2.
(3). Moderate splenomegaly=A3.
(4). B group of features( Leukocytosis, thrombocytosis, High LAP score and B 12).
Select the most appropriate ANSWER.
Q327. Any, but one, of the following can complicate hemolytic transfusion reaction:
(A). Renal failure
(B). DIC
(C). Hypertension.
(D). Spherocytosis
(E). Hemoglobinemia, hemoglobinuria & hemosiderinuria
Q328. In Secondary Polycythemia:
(A). Spleen is usually enlarged
(B). White cells and platelets are also increased
(C). There is tendency for platelet dysfunction and bleeding
(D). Erythropoietin is usually increased.
(E). Thromboembolism is common
Q329. Direct Antiglobulin (Coomb's) Test could be positive in:
(A). Hereditary spherocytosis
(B). Hereditary elliptocytosis
(C). Glucose 6-Phosphate Dehydrogenase Deficiency
(D). Thalassemia
(E). Hypertensive patients on Methyldopa.
Q330. Hemoglobin F is composed of:
(A). α2 β2
(B). α2 δ2
(C). α2 γ2 .
(D). γ 4
(E). β 4
144
Q331. All, but one, of the following RBC abnormalities are grouped as "Poikilocytosis":
(A). Target Cells
(B). Sickle Cells
(C). Tear Drop Cells
(D). Spherocytes .
(E). Elliptocytes
Q332. Which one of the following statements relate to Acute Lymphoblastic Leukemia:
(A). Results from proliferation of Myeloblasts
(B). Mature and maturing white blood cells are increased
(C). It is the commonest cancer in children.
(D). Blasts are positive for Sudan Black
(E). Never cured by chemotherapy alone
Q333. Neutropenia could be seen in all of the following diseases EXCEPT:
A. Agranulocytosis
B. Hepatitis
C. Chronic Myeloid Leukaemia (CML) .
D. Influenza
E. Severe megaloblastic anemia
Q334. Paraproteins could be seen in all of the following neoplasms EXCEPT:
A. Monoclonal Gammopathy of Undetermined significance
B. Waldenstrom's Macroglobulinemia
C. IPSID “Immunoproliferative Small Intestinal Disease”
D. Chronic Lymphocytic Leukaemia (CLL)
E. Burkitt’s lymphoma.
Q335. Burkitt's Lymphoma could present itself with all, but one, of the following features
A. Pautrier's abscess formation.
B. Intestinal obstruction in a child
C. Tumor necrolysis syndrome after treatment
D. Extreme sensitivity to Cyclophosphamide
E. Aggressive nature
Q336. The following relates "HYPOSPLENISM" :
A. Splenomegaly
B. Anemia
C. Active bone marrow
D. Target, pitted and Heinz-body containing red cells.
E. Neutropenia
Q337. You are provided with a table to comment on the hemostatic test results
for some common bleeding disorders. Write “P” if you think the test is prolonged
and “N” for a normal test result.
To help you, many of the answers are already correctly labeled.
The tests are:
P.T.
A.P.T.T.
meaning
meaning
Prothrombin Time
Activated Partial Thromboplastin Time
B.T.
T.T.
meaning
meaning
Bleeding Time
Thrombin Time
145
The bleeding diseases are:
vWD
meaning
von Willebrand’s Disease
DIC
meaning
Disseminated Intravascular Coagulation
ITP
meaning
Immune Thrombocytopenic Purpura
Hemophilia
which includes both Hemophilia A & B
DISEASE OR FACTOR
DEFICIENCY
PT
APTT
HEMOPHILIA
TT
N
vWD
N
XII & XI
N
N or P
N
N
VII
N
N
X, V & II
FIBRINOGEN
B.T.
N
P
LIVER FAILURE
P
P
N
P
N
DIC
ITP
Select True (T) and False (F) answers.
Q338. Myelofibrosis is often associated with :
a. Large spleen.
b. Lymphadenomegaly
c. Philadelphia chromosome
d. Gout.
e. Portal hypertension.
Q339. The following are true of hemophiliacs :
a. Genes responsible for the disorder are carried on the Y chromosome
b. The condition is inherited as sex-linked recessive characteristic.
c. Patients usually suffer from recurrent dislocation of joints
d. Continued bleeding from the umbilical cord may be the earliest event.
e. Bleeding time is grossly prolonged
Q340. In Hemolytic Uremic Syndrome :
a. Purpura is a common feature.
b. It is much commoner in the USA than in the UK
c. It appears suddenly in a previously healthy child.
d. It is associated with leucopenia
e. Hemoglobinuria may occur.
Q341. Sideroblastic anemia may be associated with :
146
a.
b.
c.
d.
e.
Children with pulmonary Hemosiderosis
Lead poisoning.
Myelodysplastic syndrome.
Partially treated hemorrhagic anemia
Middle aged patient with a moderate refractory normoblastic anemia.
Q342. In Thrombotic Thrombocytopenic Purpura :
a. Fragmentation hemolytic anemia occurs.
b. Mainly males are affected
c. Hypertension is usual
d. Neurological manifestations are common.
e. There is a characteristic petechial rash.
Q343. Hemoglobinuria may occur in :
a. Incompatible blood transfusion.
b. Hereditary spherocytosis
c. Hypersplenism
d. Sickle cell anemia
e. Drowning in fresh water.
Q344. Pernicious anemia :
a. Occurs with equal frequency at all decades over twenty
b. May be associated with severe glossitis.
c. May present with mental disturbances.
d. The spleen is usually palpable
e. Is usually associated with mild jaundice.
Q345. The following are part of the erythroid series :
a. Pronormoblast.
b. Monoblast
c. Plasma cell
d. Megakaryocyte
e. Promyelocyte
Q346. Bone pain is a common symptom in the following :
a. Multiple myeloma.
b. Severe iron deficiency anemia
c. Sickle cell anemia.
d. Pernicious anemia
e. Hereditary spherocytosis
Q347. In which of the following are chromosome abnormalities common :
a. Chronic myeloid leukaemia.
b. Erythroblastosis fetalis
c. Oroya fever
d. Acute leukaemia.
e. Thalassemia
Q348. A decrease in the life span of the red cell is found in the following :
a. Pernicious anemia.
b. Immune Thrombocytopenic Purpura ( ITP )
c. Thalassemia.
d. Hemophilia
e. Pregnancy
147
Q349. Which of the following are often found in the blood after splenectomy ?
a. Megaloblasts
b. Target cells.
c. Howell Jolly bodies.
d. Thrombocytosis.
e. Leucopenia
Q350. The following drugs or toxins may be responsible for aplastic anemia :
a. Quinidine
b. Penicillamine.
c. Benzene.
d. Glibenclamide
e. Sodium aureothiomalate.
MATCH THE FOLLOWING ABNORMAL RED BLOOD CELL FEATURES WITH
THEIR MOST PROBABLE BLOOD DISEASES.
“YOU ARE ONLY REQUESTED TO FILL IN THE SPACES WITH THE POSSIBLE
LETTERS. DON’T RE-WRITE THE WHOLE RED CELL ABNORMALITY. JUST
INSERT THE POSSIBLE CORRECT LETTER.”
(A).
(B).
(C).
(D).
(E).
SHISTOCYTES (Fragmented RBC)
TEAR DROP RED CELLS
SICKLE CELLS
HOWELL-JOLLY BODIES
BASOPHILIC STIPPLING
(F). HYPOCHROMIC MICROCYTIC RBC
(G).
ELLIPTOCYTES
(H).
HEINZ BODIES
(I ).
SPHEROCYTES
(J).
BURR CELLS
BLOOD DISEASE
351
352
353
354
355
356
357
358
359
360
POSSIBLE
RED CELL ABNORMALITY
UREMIA
HEREDITARY SPHEROCYTOSIS
G6P DEHYDROGENASE DEFICIENCY
HEREDITARY ELLIPTOCYTOSIS
MAHA “Microangiopathic Hemolytic Anemia”
MYELOFIBROSIS
SICKLE CELL ANEMIA
IRON DEFICIENCY ANEMIA
LEAD POISONING
MEGALOBLASTIC ANEMIA
Select the most appropriate answers to these morphology questions:
Q361. The following features are true in all of these hematological cells EXCEPT :
(A). Pronormoblasts are relatively large myeloid cells with abundant
cytoplasmic granules and few nucleoli.
(B). Myeloblasts are positive for Sudan Black stain
(C). Lymphoblasts are positive for Periodic Acid Schiff (PAS) stain
(D). Myeloblasts are positive for Specific "Chloroacetate" Esterase stain
(E). Tear drop cells & leuko-erythroblastic feature are seen in myelofibrosis
148
Q362. All of the following features are correct about red cell anomalies, EXCEPT :
(A). Anisocytosis means variation in size
(B). Poikilocytosis means variation in shape
(C). Howell Jolly Bodies are nuclear remnants
(D). Heinz bodies are precipitated denatured hemoglobin debris
(E). Polychromasia indicates reticulocytopenia.
Q363. Reticulocytes have all of the following features EXCEPT :
(A). They are young red blood cells with fine basophilic reticulum
(B). Their number in the blood is between 10 and 100 billion per liter
(C). Their ratio in the blood is between 0.2 to 2 percent
(D). They can best be demonstrated by Supravital stains
(E). After a week in the blood they give rise to mature erythrocytes.
Q364. The following features relate to Target Cells:
(A). Large target cells are usually due to gain of red cell membrane
and characteristically seen in thalassemia major
(B). Small target cells are usually due to defective hemoglobinization
and characteristically seen in liver failure
(C). They are markedly increased after splenectomy
(D). They are markedly increased in Hemoglobin SC disease.
(E). They are usually hyperchromic cells
Q365. Siderocytes have all, but one, of the following features:
(A). They are erythrocytes containing iron granules
(B). They are Pappenheimer bodies as seen by Romanowsky stains
(C). They are best seen when stained by Prussian-blue stains
(D).
Ring sideroblasts are characteristic for sideroblastic anemias
(E).
They are seen in iron deficiency anemia but not in thalassemia.
Q366. Poikilocytosis could mean any one of the following EXCEPT :
(A). Blister cells
(B). Prickle cells
(C). Pear shaped cells
(D). Spherocytes.
(E). Crenated cells
Q367. The following abnormalities are seen in megaloblastic anemias EXCEPT:
(A). Giant metamyelocytes in the bone marrow
(B). Hypersegmented neutrophils in the peripheral blood
(C). Defective hemoglobinization of the developing red cells.
(D). Hypercellular bone marrow
(E). Howell Jolly bodies in the red cells
Q368. All, but one, of the following abnormalities are seen in iron deficiency anemias:
(A). Hypochromic microcytic red cells
(B). Defective hemoglobinization of the developing red cells
(C). Pencil shaped red cells
(D). Ring sideroblasts in the marrow nucleated red cells.
(E). Absent stainable iron stores
Q369. All, EXCEPT one, of the following relate to the clinical features of hemolysis :
149
(A).
(B).
(C).
(D).
(E).
The patient may not be anemic
Splenomegaly is a common feature
Biliary colic may occur
Mild jaundice is a usual feature
Gall stones at young age is an absolute indication of hemolytic anemia.
Q370. All, EXCEPT one, of the following relate to laboratory features of hemolysis:
(A). Reticulocytosis is a usual finding
(B). Polychromasia usually detected
(C). Coomb’s test is positive in all patients.
(D). Cross-matching might be difficult if autoantibodies are present
(E). Mild unconjugated hyperbilirubinemia is usual
LEUKEMIA IMMUNOPHENOTYPING EXMINATION:
There are five main immunological types of Acute Lymphoblastic Leukemias:
Common ALL; T-ALL; Pro-B ALL; Pre-B ALL and B-ALL. Each of these types of ALL is
characteristically positive for certain markers. The main immunological markers used
are TdT; HLA-DR; CD10; Cyt.; SmIg; CD 19 to 22, which are Pan B cell markers and
CD 2 to 8 markers, which are T cell markers.
In the following table, you are requested to fill in the positive tests with the plus (+) sign
and the negative tests with the minus (-) sign.
For your convenience, I have already marked few of the tests.
ALL
TdT
CD10
Cyt. 
SmIg CD19-22
(B-Lineage)
Q371
Q372
Q373
Q374
Q375
Pro-B
cALL
Pre-B
B-ALL
T-ALL
CD 2-8
(T-Lineage)
-
Select the True (T) & False (F) answers:
Q376. The following compensatory mechanisms occur in severe chronic anemia:
(A). Arterial PO2 is decreased
(B). Red cell 2,3 Diphosphoglycerate increases.
(C). There is an increase in cardiac output at rest.
(D). The concentration of erythropoietin in the urine is often increased.
(E). Whole blood viscosity is increased
Q377. The following statements relate to the gain & loss of iron by the body:
(A). Absorption takes place only in the lower part of the small intestine
(B). In adult males at least 2 mg of iron is lost from the body each day
(C). The average iron loss during each menstrual period is 120-150 mg
(D). Iron requirements in pregnancy are increased.
(E). Adult males absorb about 1 mg of iron daily although intake is 10 mg.
Q378. The following relate to the causes of iron deficiency :
150
(A). Partial gastrectomy may be followed by iron deficiency.
(B). Iron deficiency anemia in adult male is quite worrisome.
(C). Iron deficiency is most frequently caused by dietary lack of iron
(D). Hemosiderin can be excreted in large quantities in the urine.
(E). Women of child-bearing age are more common to develop iron deficiency
than adult males.
Q379. Which of the following are consistent with diagnosis of chronic iron deficiency ?
(A). Hemoglobin of 60 gm/L, MCV of 60 fl, MCH of 15.5 pg.
(B). Absent stainable iron in the marrow.
(C). A reticulocyte count of 3.7 %
(D). Tendency to crave for strange things like chalk and ice.
(E). A platelet count of 540 thousand / uL.
Q380. The following are statements about sideroblastic anemia :
(A). There is increased marrow iron with ring sideroblasts.
(B). There is impaired hemoglobin synthesis.
(C). A dimorphic blood picture is often found.
(D). The anemia is due to erythroid hypoplasia in the marrow
(E). In many patients the etiology of acquired sideroblastic anemia is obscure.
Q381. The following are statements about Erythrocyte Sedimentation Rate (ESR):
(A). The rate of sedimentation in one hour at 200 C is about 4 mm in men.
(B). It is raised in anemia.
(C). It is high in defibrinated blood
(D). It can be used to exclude presence of underlying organic disease
(E). The ESR is useful in following the progress of diseases such as
tuberculosis and rheumatoid arthritis.
Q382. The following statements relate to the Anemia of Chronic Disorders :
(A). This type of anemia is uncommon
(B). The blood picture is usually normocytic normochromic.
(C). In the bone marrow, stainable iron stores are normal or increased.
(D). The serum iron and total iron binding capacity ( TIBC ) are raised
(E). The ESR is usually elevated.
Q383. The following are statements concerning some of the hematological
findings during pregnancy :
(A). The hemoglobin concentration decreases.
(B). The red cell mass increases.
(C). The ESR is lower
(D). The concentration of many coagulation factors is increased.
(E). A total white cell count of 20 x 109/l following delivery is common.
Q384. The following concern vitamin B12 :
(A). It is plentiful in a mixed diet, so inadequate intake is rare.
(B). The daily requirement of vitamin B12 is about 100 microgram
(C). The body stores can last 2-3 years.
(D). Pernicious anemia is due to lack of intrinsic factor production.
(E). Vitamin B12 is absorbed in the upper jejunum
Q385. Common features of megaloblastic anemias are as follows :
151
(A). A raised MCV with oval macrocytosis in the peripheral blood smear.
(B). There is hyperplastic erythropoiesis in the bone marrow.
(C). Pancytopenia is rare
(D). Hypersegmented neutrophils may be present in the peripheral blood.
(E). The typical megaloblastic bone marrow and macrocytic red cells
may be masked if concomitant iron deficiency exists.
Q386. The following are related to the diagnosis of pernicious anemia (PA) :
(A). The serum B12 is always reduced.
(B). The red cell folate is low in 60% of patients.
(C). A patient with a megaloblastic anemia, histamine fast achlorhydria
and low serum B12 must have PA
(D). A low radioactive vitamin B12 excretion in the urine ( Schilling
test ) uncorrected by the oral administration of IF is usual
(E). The presence of IF antibodies is essential to confirm the diagnosis
Q387. The following are statements concerning β-thalassemia major :
(A). Iron overload is the major cause of death.
(B). Severe anemia occurs in the neonatal period
(C). Gross hepatosplenomegaly is common.
(D). There is often evidence of endocrine disease.
(E). A pancytopenia may develop.
Q388. The following concern a peripheral blood neutrophil leukocytosis :
(A). If neutrophils comprise 80% of a total WBC of 8,000/uL, then,
by definition, a neutrophil leukocytosis exists
(B). It is commonly caused by an acute pyogenic infection.
(C). A postoperative neutrophilia indicates associated infection
(D). It often follows severe hemorrhage.
(E). It is characteristic of most myeloproliferative diseases.
Q389. The following concern aplastic anemia :
(A). There is commonly a pancytopenia.
(B). A bone marrow aspirate can appear to be of normal cellularity.
(C). Splenomegaly is a consistent feature at the time of diagnosis
(D). The plasma erythropoietin concentration is usually high.
(E). The reticulocyte count is usually greater than 2%
Q390. The following concern the presenting features of Acute Leukemia :
(A). The presenting symptoms are due to bone marrow failure.
(B). Fever can occur without obvious infection.
(C). Enlargement of the spleen below the umbilicus is common
(D). Bone pain can be a feature.
(E). Widespread lymphadenomegaly is a diagnostic feature
Q391. The following are statements concerning Acute Lymphoblastic Leukemia:
(A). The lymphoblasts in culture have a rapid cell cycle
(B). Immunophenotyping of the lymphoblasts is essential.
(C). There is sometimes an associated mediastinal mass.
(D). Lymphoblasts are always found in the peripheral blood
(E). A high WBC & moderate splenomegaly are poor prognostic features.
152
Q392. The following concern Acute Myeloblastic Leukemia ( AML ) :
(A). The absence of physical signs excludes the diagnosis of AML
(B). There are distinct morphological variants.
(C). AML is less common in children than ALL.
(D). Cytogenetic studies suggest the presence of an abnormal cell
line in many patients.
(E). Some patients present with severe bleeding due to coagulation
factor deficiencies.
Q393. The following are statements about the clinical findings of
Chronic Granulocytic Leukemia ( CGL ) :
(A). Night sweats and weight loss are common.
(B). Splenomegaly is the major clinical sign.
(C). Patients can present with priapism.
(D). Bruising may occur despite a normal platelet count.
(E). Lymphadenomegaly is common at presentation
Q394. The following relate to Chronic Lymphocytic Leukemia :
(A). It is discovered as an incidental finding in 25% of cases.
(B). Hepatosplenomegaly may occur without lymph node enlargement.
(C). Thrombocytopenia indicates an advanced stage.
(D). Hemolytic anemia may complicate the disease.
(E). Herpes zoster infections are quite common.
Q395. Infiltration of the bone marrow by myeloma cells could cause the following :
(A). Osteolytic bone lesions.
(B). A normocytic normochromic anemia.
(C). Circulating nucleated RBCs & immature myeloid cells in 60% of cases
(D). The appearance of plasma cells in the peripheral blood.
(E). Hypocalcaemia
Q396. The following relate to the treatment of myelomatosis :
(A). Alkylating agents are the mainstay of treatment.
(B). Therapeutic irradiation is contraindicated
(C). Hypercalcemia must be treated urgently.
(D). Prophylactic antibiotics may be indicated.
(E). Treatment is best monitored by serial paraprotein measurements.
Q397. The following concern patients with Polycythemia :
(A). The red cell mass estimation was a must in the past for diagnosis.
(B). The total blood volume is usually increased in Polycythemia Rubra Vera.
(C). Blood viscosity remains unaltered in Polycythemia Rubra Vera
(D). Platelet function in PRV is usually normal
(E). Pruritus could be from Hyperhistaminemia secondary to basophilia.
Q398. The following statements relate to Myelofibrosis :
(A). Reticulin fibers are increased in the bone marrow.
(B). The development of myelofibrosis can be preceded by PRV.
(C). Extramedullary hemopoiesis is a cardinal feature of the disease.
(D). The disease is often found incidentally
(E). Palpable splenomegaly is usual.
Q399. The following concern the recognition of splenic enlargement :
153
(A).
(B).
(C).
(D).
(E).
There is a left hypochondrial mass that moves down on respiration.
The notch on the anteromedial border of the spleen is rarely felt
Percussion is unhelpful in recognizing the presence of splenomegaly
A plain X-ray of the abdomen is useful.
99Tcm colloid can be used to detect enlargement.
Q400. The following blood changes may be found after splenectomy:
(A). Target cells.
(B). Howell-Jolly bodies.
(C). Thrombocytopenia
(D). Transient neutrophilia.
(E). Red cells containing hemosiderin.
Q401. The following features relate to Hodgkin's disease :
(A). The commonest presentation is painless cervical lymphadenopathy.
(B). A chest X-ray is rarely helpful
(C). Patients with constitutional symptoms have a poorer prognosis.
(D). Although pruritis is not a B-symptom, prognostically it is as important.
(E). A normocytic normochromic anemia is common.
Q402. The following factors inhibit thrombus formation :
(A). Nitrous oxide.
(B). Plasmin.
(C). Antithrombin III.
(D). Stasis
(E). Decreased concentration of coagulation factors.
Q403. The following factors potentiate thrombus formation :
(A). Prostacyclin (PGI2)
(B). Thrombocythemia.
(C). Damaged vascular endothelium.
(D). Depressed RE function.
(E). Inhibitors of fibrinolysis.
Q404. The following concern abnormal bleeding due to thrombocytopenia :
(A). Superficial bleeding into the skin is typical.
(B). Bleeding from a superficial skin cut is often excessive.
(C). Gastrointestinal hemorrhage can occur.
(D). Usually associated with joint bleeding
(E). A history of drug ingestion is important.
Q405. The following are causes of thrombocytopenic purpura :
(A). Henoch-Schonlein purpura
(B). Aplastic anemia.
(C). Systemic lupus Erythematosus (SLE).
(D). Disseminated Intravascular Coagulation (DIC).
(E). Hemorrhagic Disease of the Newborn (HDN)
Q406. The following conditions predisposes to Thromboembolism:
(A). Antiphospholipid antibody syndrome.
(B). Homocystinuria.
(C). (HIT) Heparin-induced thrombocytopenia.
(D). Factor XII deficiency.
(E). Disseminated Intravascular Coagulation.
154
Q407. The following concern Hemophilia:
(A). The severity of bleeding is related to the factor VIII concentration.
(B). Chronic arthritis is uncommon
(C). Hematomas can compress peripheral nerves.
(D). It occurs more commonly than Christmas disease.
(E). If a hemophiliac marries a normal female, all their daughters will be carriers.
Q408. The following concern von Willebrand's disease :
(A). It is inherited as a sex-linked disease
(B). The bleeding time is usually normal
(C). The factor VIII activity measured by clotting assay is usually low.
(D). Factor VIII-related antigen is usually normal
(E). Platelet function test is abnormal.
Q409. The following concern the use of anticoagulants :
(A). During Warfarin therapy factors II, VII, IX and X are reduced.
(B). A single loading dose of 30mg Warfarin is the best way of initiating therapy
(C). Barbiturates affect the action of Warfarin.
(D). The best way of using heparin is by intermittent parenteral dosage
(E). Subcutaneous heparin is helpful in prevention of postoperative thrombosis.
Q410. The following concerns Disseminated Intravascular Coagulation (DIC) :
(A). Thrombosis is rare
(B). Bleeding can be a major feature.
(C). Fragmentation of the red cells may be observed on a blood film.
(D). Thrombin time may be prolonged despite an adequate fibrinogen.
(E). Treatment with heparin is contraindicated
Q411. The following are general statements about blood transfusion and blood groups :
(A). Donor blood is usually collected into heparin which acts as an anticoagulant
(B). Most of ABO-incompatible transfusions are due to failure to check identity.
(C). Anti-A and Anti-B are often absent from the sera of group O babies.
(D). The following blood groups (ABO, Rh(D) and MN) are from a mother, child
and putative father :
mother:
A Rh(D) positive MN
child :
O Rh(D) negative NN
putative father :
A Rh(D) positive NN
The result exclude paternity
(E). Care should be exercised in transfusing chronic anemias to avoid overload.
Q412. Requirements for blood donors are :
(A). The hemoglobin concentration is above 140 gm/l
(B). The donor has not had malaria in the recent past.
(C). The donor has not been pregnant within the previous year.
(D). The donor has never been jaundiced
(E). The donor's blood is free from evidence of active syphilis.
Q413. The following are complications of rapid massive blood transfusion :
(A). Electrocardiographic abnormalities may develop.
(B). Metabolic acidosis is common
(C). Abnormal bleeding.
(D). Hypothermia.
(E). Altered hemoglobin function.
155
Q414. The following concern basic immunological reactions in blood group serology :
(A). Anti-A agglutinate group A erythrocytes when they are suspended in saline.
(B). The addition of albumin improves the sensitivity of some serological tests.
(C). The Antiglobulin ( Coomb's ) test detects antibodies on the erythrocyte
membrane which fail to agglutinate the red cells when suspended in saline.
(D). The direct Coomb’s test detects in vivo sensitization of RBC with antibody.
(E). The Antiglobulin test is used in the standard cross-match procedure.
Q415. The following statements relate to unwanted reactions of blood transfusion :
(A). Complement-mediated red cell lysis follows incompatible blood transfusion.
(B). Renal failure may follow the transfusion of ABO incompatible blood.
(C). Febrile transfusion reaction is usually due to Rhesus incompatibility
(D). Sudden extreme hypotension in the presence of warm extremities
could indicate that the transfused blood was contaminated with bacteria.
(E). One cause of Urticarial & other allergic reactions is anti-IgA in the recipient.
Q416. The following concern other unwanted effects of blood transfusion :
(A). A patient with aplastic anemia requiring 24 units of blood per annum will
accumulate 6 gm of iron during that year.
(B). A rapid fall of hemoglobin together with jaundice 5 to 7 days following
transfusion suggests the development of delayed transfusion reaction.
(C). Post-transfusion hepatitis has been eliminated by routine HBsAg screening
(D). Dyspnea accompanied by a dry cough can be an early sign
of pulmonary edema due to circulatory overload.
(E). Thrombophlebitis of the vein cannulated for transfusion is common
Q417. The following are statements about blood and blood products :
(A). The only indication for whole blood transfusion might be massive bleeding.
(B). Packed RBC has inferior post-transfusion survival compared to whole blood
(C). Cryoprecipitate contains fibrinogen.
(D). Blood product replacement therapy in patients with DIC is contraindicated
(E). Febrile neutropenic patients may benefit from the infusion of white cells from
a patient with chronic granulocytic leukemia ( CGL ).
Q418. The following are further statements about blood products :
(A). Albumin is useful in the treatment of nephrotic syndrome.
(B). Specific immunoglobulins prepared from donor plasma in the convalescent
phase of infectious disease can be used to confer active immunity
(C). The administration of plasma protein fraction (PPF) is accompanied
by the risk of transmitting serum hepatitis
(D). Coagulation deficiencies in liver disease can be treated with FFP.
(E). Factor VIII concentrates has a half-life of nearly 12 hours in the circulation.
Q419. The following concern Hemolytic Disease of the Newborn (HDN) :
(A). Rhesus HDN is common in Rh(D) positive babies born to primiparous
Rh(D) negative mothers
(B). Passively administered anti-D to Rh(D) negative mothers postpartum has
reduced the incidence of Rh HDN.
(C). High concentration of unconjugated bilirubin can cause death.
(D). A jaundiced newborn child whose blood group is O and whose
mother is group A could have HDN due to ABO incompatibility
(E). Exchange transfusion should always be performed in any newborn
with HDN if the cord hemoglobin concentration is below 15 g/dl
156
Q420. The following disorders are inherited as autosomal dominant traits :
(A). Hereditary elliptocytosis.
(B). Hereditary spherocytosis.
(C). Christmas disease (Hemophilia B)
(D). von Willebrand's disease.
(E). Glucose-6-Phosphate Dehydrogenase deficiency
Q421. Methemoglobinemia is a recognized complication of ingestion of or exposure to :
(A). Potassium chlorate.
(B). Nitroglycerine.
(C). Aniline dyes.
(D). Aspirin
(E). Ascorbic acid
Q422. Henoch-Schonlein syndrome :
(A). May be complicated by intussusception.
(B). May run a relapsing course of as long as a year.
(C). Could be associated with nephropathy.
(D). Typically follows infection with β- hemolytic streptococci.
(E). Is characterized by painful erythematous, 3 cm diameter, shin lesions
Q423. Thromboembolism is a possible complication of the following factor deficiency:
(A). Factor VIII
(B). Factor XI
(C). Factor X
(D). Factor XII.
(E). Factor XIII
Q424. The following inherited problems can predispose to venous thromboembolism:
(A). Factor V Leiden.
(B). Protein C deficiency.
(C). Protein S deficiency.
(D). Elevated factor VIII.
(E). Antithrombin III deficiency.
Q425. The following disorders are inherited as X-linked recessive traits :
(A). Wiskott-Aldrich syndrome.
(B). Glucose-6-Phosphate Dehydrogenase deficiency.
(C). Acute intermittent porphyria
(D). Complete testicular feminization.
(E). Homocystinuria
Q426. Causes of macrocytosis in the blood with normoblastic erythropoiesis include :
(A). Hypothyroidism.
(B). Pregnancy.
(C). Jejunal diverticulosis
(D). Hepatic cirrhosis.
(E). Alcoholism.
Q427. Characteristic results of severe folate deficiency include :
(A). Steatorrhoea
(B). A leuko-erythroblastic anemia
(C) Subacute combined degeneration of the spinal cord
(D). Hypersegmentation of the nuclei of the polymorphonuclear leukocytes.
(E). An increases in the total iron binding capacity of the blood
157
Q428. The bleeding time is characteristically prolonged in :
(A). Hemophilia
(B). Christmas disease
(C). von Willebrand's disease.
(D). Factor XII deficiency
(E). Immune thrombocytopenic purpura.
Q429. Recognized complications of Hodgkin's disease include :
(A). Generalized pruritis.
(B). Paraplegia.
(C). Hemolytic anemia.
(D). Cryptococcal meningitis.
(E). Generalized varicella-zoster infection.
Q430. Target cells are a recognized finding in blood films :
(A). In hemoglobin S disease.
(B). In iron deficiency anemia.
(C). In thalassemia.
(D). In cirrhosis.
(E). In microangiopathic hemolytic anemia
Q431. Recognized causes of discrete osteolytic lesions in a two-year-old child include :
(A). Dietary rickets
(B). Histiocytosis X.
(C). Infectious mononucleosis
(D). Acute lymphoblastic leukemia.
(E). Multiple myeloma
Q432. The following statements about Burkitt's Lymphoma are correct :
(A). A virus is etiologically important.
(B). The northernmost part of African continent is relatively little affected.
(C). It is resistant to treatment with alkylating agents
(D). The head and neck are most often involved in Africa but viscera is a
common site in Saudi Arabia.
(E). There are some climatic similarities in areas with the highest incidence.
Q433. In patients with subclinical folate deficiency, megaloblastic anemia may be
precipitated by the administration of :
(A). Co-trimoxazole.
(B). Methotrexate.
(C). Phenytoin.
(D). Chloroform
(E). Metformin.
Q434. In the anticoagulant clinic, one should be careful with the effect of the following
on the enhancement of Warfarin effect on INR:
(A). Vitamin K
(B). Rifampicin
(C). Antiepileptics Carbamazepine & Phenobarbitone
(D). Indulgence in episodic eating of green leafy vegetables & citreous fruits
(E). Oral contraceptives
158
Q435. In the anticoagulant clinic, one should be careful with the effect of the following
on the enhancement of Warfarin effect on INR:
(A). Large amounts of alcohol.
(B). Ulcer-healing drugs Cimetidine & Omeprazole.
(C). Thyroxine.
(D). Ampicillin.
(E). Antifungals fluconazole, itraconazole & ketoconazole.
Q436. Low Molecular weight Heparins are favored on unfractionated heparin because:
(A). Higher bioavailability.
(B). No need for monitoring the anticoagulant effect with clotting tests.
(C). Much lower incidence of Heparin Induced Thrombocytopenia (HIT).
(D). No effect on function of the platelets.
(E). Much cheaper
Q437. The following clinical features indicate a more aggressive disease state in
patients with Hodgkin's Disease ("B" symptoms):
(A). Fever of 390 C.
(B). Drenching nocturnal sweats.
(C). Weight loss of more than 10 Kg in a 50 Kg body weight patient.
(D). Extensive pruritis.
(E). Alcohol-induced lymph node pain
Q438. The following criteria is more common in Hodgkin's disease than in NonHodgkin's Lymphoma:
(A). Bone marrow involvement
(B). Extra-nodal disease
(C). Usually affects young adults, especially in the developed countries.
(D). Unifocal in origin with a predictable contagious lymphatic spread.
(E). Most cases present with advanced stage
Q439. The following features relate to Immuno-proliferative Small Intestinal Disease:
(A).
Most cases are reported from the Middle East.
(B).
Patients usually present with malabsorption.
(C).
Also known as Mediterranean lymphoma.
(D).
Alpha heavy chain might be detected in the serum.
(E).
Small intestinal biopsy reveals diffuse infiltration of the lamina propria with
plasma cells and lympho-plasmacytoid cells.
Q440. Acute Graft versus Host Disease (GvHD) basically affects the following organs:
(A). Skin.
(B). Gut.
(C). Heart
(D). Liver.
(E). Brain
Q441. Allogeneic bone marrow transplantation could be done in the following diseases:
(A). Acute myeloid leukemia.
(B). Chronic myeloid leukemia.
(C). Aplastic anemia.
(D). Hemophilia
(E). Wiscott-Aldrich syndrome.
159
Q442. Bone marrow fibrosis could be increased in the following diseases:
(A). Tuberculosis involving the marrow.
(B). Lymphocyte depleted Hodgkin’s disease.
(C). Myelofibrosis.
(D). Acute megakaryoblastic leukemia.
(E). Thalassemia
Q443. Busulphan has been effective in the treatment of the following diseases:
(A). Pre-conditioning for bone marrow transplantation.
(B). Chronic myeloid leukemia.
(C). Myeloproliferative disorders.
(D). Burkitt’s leukemia
(E). Burkitt’s lymphoma
Q444. Hydroxyurea is used with great success in the following blood diseases:
(A). Sickle cell disease.
(B). Thalassemia
(C). Chronic myeloid leukemia.
(D). Polycythemia rubra vera.
(E). Secondary polycythemia
Q445. Prednisolone is an important part of the treatment in the following diseases:
(A). Immune thrombocytopenic purpura.
(B). Chronic lymphocytic leukemia.
(C). Autoimmune hemolytic anemia.
(D). Lymphomas.
(E). Acute lymphoblastic leukemia.
Q446. Chlorambucil is effective in the management of the following blood diseases:
(A). Lymphomas.
(B). Chronic lymphocytic leukemia.
(C). Acute myeloid leukemia
(D). Severe refractory cold hemagglutinin disease.
(E). Essential thrombocythemia
Q447. Melphalan is the Gold standard in the management of the following diseases:
(A). Burkitt’s lymphoma
(B). M-GUS “Monoclonal Gammopathy of Undetermined significance”
(C). Multiple myeloma.
(D). IPSID “Immunoproliferative Small Intestinal Disease”
(E). Acute leukemias
Q448. Aspirin should be considered in the prophylaxis of thrombotic tendency in:
(A). Polycythemia rubra vera.
(B). Essential thrombocythemia.
(C). Antiphospholipid antibody syndrome.
(D). Ischemic heart disease.
(E). Behcet’s syndrome.
Q449. “Wait and watch” policy is warranted in managing the following malignancies:
(A). Stage I Hodgkin’s disease
(B). Stage III low grade non-Hodgkin’s lymphoma.
(C). Stage I low grade non-Hodgkin’s lymphoma
(D). Stage III high grade non-Hodgkin’s lymphoma
(E). Stage I high grade non-Hodgkin’s lymphoma
160
Q450. The following relate to the half-life of different coagulation factors:
(A). Half-life of Factor VII is less than 5 hours.
(B). Half-life of Factor V is around 15 hours.
(C). Half-life of Factor VIII is around 10 hours.
(D). Half-life of Factor IX is around 25 hours.
(E). Half-life of Factor XI is around 45 hours.
Select the most appropriate answer:
Q451. All, but one, of the following relate to Homocystinuria :
(A). Predisposes to venous thromboembolism
(B). Could also predispose to arterial thrombosis
(C). The disease could manifest itself in childhood or even early in infancy
(D). Inborn error of metabolism due to deficiency of cystathionine synthase
(E). Marfan- features, ectopia lentis and mental retardation are not seen.
Q452. All, except one, of the following features relate to Factor V Leiden :
(A). It has been found to be strongly associated with venous thromboembolism
(B). Usually there is resistance to Active Protein C
(C). First described by Dahlback from Sweden
(D). Up to 40% of thrombotic anticoagulant clinic patients have this deficiency
(E). The incidence is much lower than all of AT III, Protein C & S deficiency.
Q453. All, but one, of the following could contribute to venous thromboembolism :
(A). Immobility, surgery & myocardial infarction
(B). Pregnancy and puerperium
(C). von Willebrand disease.
(D). Obesity
(E). Previous attacks of deep vein thrombosis
Q454. All, except one, of the following could contribute to venous thromboembolism :
(A). PNH “Paroxysmal Nocturnal Hemoglobinuria”
(B). PRV “Polycythemia Rubra Vera”
(C). Behcet’s syndrome
(D). Myeloma.
(E). Contraceptive pills
Q455 All, but one, of the following could contribute to thrombophilia :
(A). Statin group of cholesterol lowering drugs.
(B). Malignancy
(C). Homocystinuria
(D). Nephrotic syndrome
(E). Factor XII deficiency
Q456. Venous thromboembolism could result from any of the following genetic defects
EXCEPT :
(A). Protein C Deficiency
(B). Protein S Deficiency
(C). AT III Deficiency
(D). Factor XII Deficiency
(E). Factor V Deficiency.
161
Q457. End-stage chronic renal failure patients bleed because of :
(A). Burr red cells
(B). Inhibitors to coagulation factors
(C). Marked coagulation factor deficiency
(D). Marked thrombocytopenia
(E). Platelet dysfunction.
Q458. All, but one, of the following statements are true about Factor XIII Deficiency :
(A). It is an autosomal dominant disease.
(B). It is associated with poor wound healing
(C). Bleeding could be severe and protracted
(D). Weekly cryoprecipitate or factor XIII concentrate are effective treatments
(E). It is a rare disease
Q459. All, but one, of the following statements are true about Factor XI Deficiency :
(A). It is basically a disease of the Ashkenazi Jews
(B). There is a strong association between Factor XI level & severity of bleeding.
(C). APTT is prolonged but PT is normal
(D). The half life of Factor XI is 60 hours
(E). Factor XI concentrate treatment could be associated with thrombosis
Q460 All, but one, of the following statements are true about Factor VII Deficiency :
(A). It is a rare autosomal recessive bleeding disorder
(B). Bleeding manifestations is like what is seen in hemophiliacs
(C). Clotting screen shows prolonged PT and APTT.
(D). Severe bleeding only follows absent or very low level of Factor VII
(E). Factor VII half-life is very short at 3 hours, so surgery needs frequent doses
Q461. All, but one, of the following are true about True homozygous female
hemophilia A :
(A). It is exceedingly rare
(B). It usually results from marriage of a hemophiliac to a carrier female cousin
(C). Menorrhagia is never a problem in these patients.
(D). It must be differentiated from extreme unfavorable lyonization in a career
(E). It has been described in a female with Turner’s syndrome
Q462. One of the following is important in the diagnosis of Iron deficiency anemia :
(A). Coomb’s test
(B). Serum ferritin.
(C). Ring sideroblasts in the marrow
(D). Hemoglobin electrophoresis
(E). Empty bone marrow trephine biopsy
Q463. One of the following is important in the diagnosis of - thalassemia major :
(A). Coomb’s test
(B). Serum ferritin
(C). Ring sideroblasts in the marrow
(D). Hemoglobin electrophoresis.
(E). Empty bone marrow trephine biopsy
Q464. One of the following is important in the diagnosis of sideroblastic anemia :
(A). Coomb’s test
(B). Serum ferritin
(C). Ring sideroblasts in the marrow.
(D). Hemoglobin electrophoresis
(E). Empty bone marrow trephine biopsy
162
Q465. One of these is important in the diagnosis of autoimmune hemolytic anemia:
(A). Coomb’s test.
(B). Serum ferritin
(C). Ring sideroblasts in the marrow
(D). Hemoglobin electrophoresis
(E). Empty bone marrow trephine biopsy
Q466. One of the following is important in the diagnosis of aplastic anemia:
(A). Coomb’s test
(B). Serum ferritin
(C). Ring sideroblasts in the marrow
(D). Hemoglobin electrophoresis
(E). Empty bone marrow trephine biopsy.
Q467. Fragmented red cells could be seen in all of the following diseases EXCEPT:
(A). Thrombotic Thrombocytopenic Purpura/ Hemolytic Uremic Syndrome
(B). Malignant Hypertension
(C). Hereditary spherocytosis.
(D). MAHA “Micro-Angiopathic Hemolytic Anemia”
(E). March Hemoglobinuria
Q468. Sickle cells could be seen in the blood smear of one of the following diseases:
(A). Thalassemia
(B). Sickle cell disease.
(C). Sickle cell trait
(D). Anemia of chronic disorders
(E). Megaloblastic anemias
Q469. Spherocytes is not seen in which one of the following blood diseases:
(A). Hereditary spherocytosis
(B). Warm autoimmune hemolytic anemia
(C). Evans’ syndrome
(D). Incompatible blood transfusion
(E). Megaloblastic anemia.
Q470. One of these is more specific to sickle cell disease than - thalassemia major :
(A). Massive splenomegaly
(B). Very high Hemoglobin F
(C). Hypochromic microcytic red cells
(D). Splenic atrophy.
(E). Need for regular blood transfusions
Q471. All, but one, of the following features are more in favor of - thalassemia major
than sickle cell disease:
(A). Massive splenomegaly
(B). Very high Hemoglobin F
(C). Hypochromic microcytic red cells
(D). Splenic atrophy.
(E). Need for regular blood transfusions
Q472. One of the following Hemoglobin electrophoresis patterns is NOT true:
(A). Very high Hb F is in favor of the diagnosis of - thalassemia major
(B). Hemoglobin C migrates in the same position as Hemoglobin A2
(C). Hemoglobin E migrates in the same position as Hemoglobin A2
(D). Hemoglobin S in sickle cell trait could reach 100%.
(E). Hb A2 of ~ 5% is in favor of the diagnosis of - thalassemia minor
163
Q473. All, but one, of the following disorders can cause Anemia of Chronic Disorders:
(A). Pulmonary Tuberculosis
(B). Disseminated malignancy
(C). End stage renal disease
(D). Traffic accident with massive blood loss.
(E). Connective tissue diseases
Q474. All, but one, of the following are true about - thalassemias:
(A). Loss of four -chains is not compatible with life
(B). Loss of three -chains cause Hemoglobin H disease
(C). Loss of two -chains cause - thalassemia minor
(D). Loss of one -chain might not cause any clinical problem
(E). -thalassemias are extremely rare in Saudi Arabia.
Q475. Working formulation for clinical usage WAS a classification of:
(A). Hodgkin's Disease
(B). Chronic lymphocytic leukemia
(C). Myelodysplastic syndromes
(D). Malignant Non-Hodgkin's lymphoma.
(E). Acute non-lymphocytic leukemia
Q476. Rai and Binet systems are used for staging:
(A). Hodgkin's Disease
(B). Chronic lymphocytic leukemia.
(C). Myelodysplastic syndromes
(D). Non-Hodgkin's malignant lymphoma
(E). Acute non-lymphocytic leukemia
Q477. Ann Arbor system is basically used for staging :
(A). Hodgkin's Disease.
(B). Chronic lymphocytic leukemia
(C). Myelodysplastic syndromes
(D). Non-Hodgkin's malignant lymphoma
(E). Acute myeloid leukemia
Q478. The new W.H.O. & before that REAL classification is used for:
(A). Hodgkin's Disease
(B). Chronic lymphocytic leukemia
(C). Myelodysplastic syndromes
(D). Non-Hodgkin's malignant lymphoma.
(E). All lymphomas.
Q479. All, but one, of the following could cause Secondary Polycythemia:
(A). Cyanotic congenital heart disease
(B). Smoking
(C). Alcoholism.
(D). Chronic Obstructive Airway Disease (COAD)
(E). High altitude
Q480. All, but one, of the following conditions is said to predispose to acute leukemia:
(A). Down’s syndrome
(B). Ataxia telangiectasia
(C). Myelodysplastic syndromes
(D). Aplastic anemia
(E). Pure red cell aplasia.
164
Q481. Reticulocyte count of 3% could be seen in one of the following anemias:
(A). pernicious anemia.
(B). Aplastic anemia
(C). Pure red cell aplasia
(D). Fanconi’s anemia
(E). Diamond Blackfan syndrome
Q482. Gaucher’s disease is due to :
(A). β Glucocerebrocidase deficiency.
(B). Sphingomyelinase deficiency
(C). Hexosaminidase A deficiency
(D). Cystathione synthase deficiency
(E). Glucose-6-Phosphate Dehydrogenase deficiency
Q483. Niemann-Pick disease is due to :
(A). β Glucocerebrocidase deficiency
(B). Sphingomyelinase deficiency.
(C). Hexosaminidase A deficiency
(D). Cystathione synthase deficiency
(E). Glucose-6-Phosphate Dehydrogenase deficiency
Q484. Tay-Sachs disease is due to :
(A). β Glucocerebrocidase deficiency
(B). Sphingomyelinase deficiency
(C). Hexosaminidase A deficiency.
(D). Cystathione synthase deficiency
(E). Glucose-6-Phosphate Dehydrogenase deficiency
Q485. Favism is due to :
(A). β Glucocerebrocidase deficiency
(B). Sphingomyelinase deficiency
(C). Hexosaminidase A deficiency
(D). Cystathione synthase deficiency
(E). Glucose-6-Phosphate Dehydrogenase deficiency.
Q486. Homocystinuria is due to :
(A). β Glucocerebrocidase deficiency
(B). Sphingomyelinase deficiency
(C). Hexosaminidase A deficiency
(D). Cystathione synthase deficiency.
(E). Glucose-6-Phosphate Dehydrogenase deficiency
Q487. All, but one, of the following features are true about Pelger-Huet anomaly:
(A). It is autosomal dominant trait
(B). Neutrophil function is intact & it does not have adverse effect on health
(C). The acquired form could be seen in Myelodysplastic syndromes
(D). Neutrophils are usually multi-segmented with toxic granulation.
(E). Usually indicates poorer prognosis if seen in myelodysplastic syndromes
Q488. Malarial anemia could be from any, but one, of the following causes:
(A). Hypersplenism especially in tropical splenomegaly syndrome
(B). Bone marrow suppression
(C). Extravascular destruction of parasitized red cells
(D). Blackwater fever from intravascular destruction of parasitized red cell
(E). Dysplasia of the blood cell precursors in the bone marrow.
165
Q489. All, but one, of the following cancers can produce erythropoietin and cause
secondary polycythemia:
(A). Hypernephroma
(B). Hepatoma
(C). Leukemia.
(D). Bronchial carcinoma
(E). Pheochromocytoma
Q490. Basophilic stippling is a characteristic feature of one of the following red cell
enzymopathies:
(A). Glucose 6 Phosphate Dehydrogenase deficiency
(B). Pyruvate Kinase deficiency
(C). Phosphofructokinase deficiency
(D). Triose Phosphate isomerase
(E). Pyrimidine 5 nucleotidase deficiency.
Q491. Type II CDA “Congenital Dyserythropoietic Anemia” has all, but one, of the
following features:
(A). It is the least common of the three types of CDA.
(B). It is transmitted as an autosomal recessive disease
(C). Red cells could be hemolysed by acidified serum, hence called HEMPAS
(D). Smear shows aniso-poikilocytosis, and marrow erythroid multinuclearity
(E). Patients have anemia, mild jaundice and evidence of iron overload
Q492. A child from Tihama admitted with fever and organomegaly should have all of
the following initial investigations EXCEPT:
(A). Full Blood Count and smear
(B). Bone marrow examination to rule out visceral Leishmaniasis
(C). Mediastinoscopy.
(D). Full blood biochemistry
(E). Blood culture
Q493. Osmotic fragility test is helpful in identifying one of the following types of
hemolytic anemia:
(A). Glucose-6-Phosphate Dehydrogenase deficiency
(B). Sickle cell disease
(C). Hereditary spherocytosis.
(D). Aplastic anemia
(E). Diamond Blackfan syndrome
Q494 Patients with CHAD “Cold Hemagglutinin Disease” might have all, but one,
of the following features:.
(A). Acrocyanosis in cold weather due to red cell agglutination
(B). It is usually a benign chronic elderly disease, though could be distressing
(C). The machine could record a very high red cell MCV
(D). It is never associated with lymphoma.
(E). It could follow infection with Mycoplasma pneumoniae
Q495.
All, but one, of the following features should raise the possibility of PNH
“Paroxysmal Nocturnal Hemoglobinuria”:
(A). Intravascular hemolysis with negative direct Coomb’s test
(B). Hemolysis with low platelet and/or white blood cell count
(C). Hemoglobinuria, Budd-Chiari syndrome or recurrent abdominal pain
(D). Pancytopenia with marrow failure
(E). Marked splenomegaly and hypersplenism.
166
Q496. Match the following hematological data & clinical features with the corresponding
blood disease:
Biodata:
Presentation:
CBC:
Differential:
Blood Smear:
Marrow aspiration:
Others:
(A).
(B).
(C).
(D).
(E).
Age: 44 years
Sex: Male
Two years history of anemia not responding to treatment
Hb: 8.0 gm/dL
WBC: 8,000 /uL
Platelet: 200,000 /uL
Normal
Mildly macrocytic anemia
Active trilineage hemopoiesis
No evidence of megaloblastic anemia
Acute lymphoblastic leukemia
Fanconi’s anemia
Refractory anemia with excessive blasts
Chronic myelomonocytic leukemia
Refractory anemia.
Q497. Match the following hematological data & clinical features with the corresponding
blood disease:
Biodata:
Presentation:
CBC:
Differential:
Age: 80 years
Sex: Male
Splenomegaly
Hb: 10.0 gm/dL WBC: 80,000/uL
Platelet: 200,000 /uL
Neutrophils = 60% Monocytes= 10% Myelocytes: 10%
Blasts= 4%
Blood Smear:
Neutrophilia and monocytosis
Marrow aspiration: Hypercellular with some dysplastic features
Others:
Marked splenomegaly
(A).
(B).
(C).
(D).
(E).
Acute lymphoblastic leukemia
Fanconi’s anemia
Refractory anemia with excessive blasts
Chronic myelomonocytic leukemia.
Refractory anemia
Q498. Match the following hematological data & clinical features with the corresponding
blood disease:
Biodata:
Presentation:
CBC:
Differential:
Blood Smear:
Marrow aspiration:
Others:
(A).
(B).
(C).
(D).
(E).
Age: 8 years
Sex: Male
Anemia, infections & bruising
Hb: 8.0 gm/dL
WBC: 1,000 /uL
Platelet: 25,000 /uL
Neutrophils = 80%
Oligopenic
Nearly empty
Horse- shoe shaped kidney; extra thumb; café-au-lait spots.
Acute lymphoblastic leukemia
Fanconi’s anemia.
Refractory anemia with excessive blasts
Chronic myelomonocytic leukemia
Refractory anemia
167
Q499. Match the following hematological data & clinical features with the corresponding
blood diseases:
Biodata:
Presentation:
CBC:
Differential:
Blood Smear:
Marrow aspiration:
Others:
(A).
(B).
(C).
(D).
(E).
Age: 76 years
Sex: Male
Anemia, infection and bleeding
Hb: 6.0 gm/dL
WBC: 2,000 /uL
Platelet: 60,000 /uL
Blasts = 12%
Neutrophils = 44%
Hypogranular neutrophils; macrocytosis
Trilineage dysplasia; marrow blasts = 18%
Patient died six months later from an intracranial bleed.
Blasts were still 12%
Acute lymphoblastic leukemia
Fanconi’s anemia
Refractory anemia with excessive blasts.
Chronic myelomonocytic leukemia
Refractory anemia
Q500. Match the following hematological data & clinical features with the corresponding
blood diseases:
Biodata:
Presentation:
CBC:
Differential:
Blood Smear:
Marrow aspiration:
Others:
(A).
(B).
(C).
(D).
(E).
Age: 6 years
Sex: Male
Anemia, infection and bleeding
Hb: 6.0 gm/dL
WBC: 60,000 /uL Platelet: 60,000 /uL
Blasts = 44%
Neutrophils = 44%
Blast cells with high nuclear/cytoplasmic ratio
Solidly cellular with blast cells constituting majority of the cells
Blast cells were positive for CD10; TdT & HLA-DR
Acute lymphoblastic leukemia.
Fanconi’s anemia
Refractory anemia with excessive blasts
Chronic myelomonocytic leukemia
Refractory anemia
168
Q. FILL OUT THE FOLLOWING
NORMAL HEMATOLOGICAL VALUES
All the blanks and the ones signed with the question mark (?)
MEN
------
WOMEN
------------
INFANT(Cord)
-------------------
CHILD (3 months)
-----------------------
Red cell Count
(+/- 1.0 x 1012/L)
Hemoglobin
(gm/dL)
Hematocrit (PCV)
MCV (fL)
---------------------------------------------------------------------------------------------------------------?
0.45 x 1015 (fL)
450
Mean Cell Volume (MCV) = ----------= -------------------- = ------- = 90 fL
?
5.0 x 1012
5
Adult = ?
-----------------------------------------------------------------------------------------------------------------?
15 gm/dL
150 gm/L
150 x 1012 (pcg)/L
Mean Cell Hemoglobin = ---------- = --------------- = ------------- == ----------------------= 30
(MCH)
?
5.0 x 1012/L
5.0 x 1012
5 x 1012 /L
pcg
Adult = ?
---------------------------------------------------------------------------------------------------------------Hb
150 gm/L
Mean Cell Hemoglobin Concentration (MCHC) = -------- = ------------ = 333 g/L = 33 g/dL
Adult and children = ?
PCV
0.45 L/L
-----------------------------------------------------------------------------------------------------------------Reticulocyte =
? - ? % = 10 000 - 100 000 / uL (Adults and children)
2.0 - 6.0% Mean = 150 000 / uL (Infant = cord blood)
----------------------------------------------------------------------------------------------------------------BLOOD VOLUME : Red Cell Volume
MEN ...………….
?
ml/Kg
WOMEN .………
?
ml/Kg
Plasma Volume ...........…………………
?
ml/Kg
Total Blood Volume ------------------------ ?
ml/Kg
___________________________________________________________________________
LEUKOCYTE COUNT: 4.0-11.0x109/L
Red cell life span = ?
days
= 4 000 - 11 000/uL
Platelet life span = ?
days
Neutrophils = ?
/uL
Neutrophil half life = 7 hours
Lymphocyte = ?
/uL
Monocyte = 200 - 800/uL
Serum Iron = 13-32 umol/L (100)
Eosinophil =
40 - 440/uL
TIBC = 45-70 umol/L(300 ug/dL)
Basophil =
1 - 100/uL
Serum Ferritin =
15-300 ug/L
Platelet count = ?
/uL
Male = 30-300 ug/L
ESR = < ?
mm/hr
Female = 15-200 ug/L
169
ANSWER
Red cell Count
MEN
5.5
WOMEN
4.8
INFANT(Cord)
5.0
CHILD (3 months)
4.0
13.0-18.0
11.5-16.5
13.5-19.5
9.5-13.5
40%-54%
76-96
37%- 47%
76-96
44%-64%
106
32%-44%
96
(+/- 1.0 x 1012/L)
Hemoglobin
(gm/dL)
Hematocrit (PCV)
MCV (fL)
PCV
0.45 x 1015 (fL)
Mean Cell Volume (MCV) = ------- = ---------------------RCC
5.0 x 1012
Adult = 76 – 96 fL
450
= ---------- = 90 fL
5
Hb
15 gm/dL
150 gm/L
150 x 1012 (pcg)/L
Mean Cell Hemoglobin = ------- = --------------- = ------------- == ----------------------= 30 pcg
(MCH)
RCC
5.0 x 1012/L
5.0 x 1012
5 x 1012 /L
Adult = 27-32 pcg
-----------------------------------------------------------------------------------------------------------------Hb
150 gm/L
Mean Cell Hemoglobin Concentration (MCHC) = -------- = ------------- = 333 g/L = 33 g/dL
Adult and children = 32-36 g/dL
PCV
0.45 L/L
-----------------------------------------------------------------------------------------------------------------Reticulocyte = 0.2 - 2.0%
= 10 000 - 100 000 / uL (Adults and children)
2.0 - 6.0%
Mean = 150 000 / uL (Infant = cord blood)
-----------------------------------------------------------------------------------------------------------------BLOOD VOLUME : Red Cell Volume
MEN ...………….
25 - 35 ml/Kg
WOMEN .………
20 - 30 ml/Kg
Plasma Volume ...........…………………
40 - 50 ml/Kg
Total Blood Volume ------------------------ 60 - 80 ml/Kg
_____________________________________________________________________________
LEUKOCYTE COUNT: 4.0-11.0x109/L
= 4 000 - 11 000/uL
Neutrophils =
2 000 - 7 500/uL
Lymphocyte = 1 500 - 4 000/uL
Monocyte =
200 - 800/uL
Eosinophil =
40 - 440/uL
Basophil =
1 - 100/uL
Platelet count = 150 000 - 400 000/uL
ESR = < 20 mm/hr
Red cell life span = 120 days
Platelet life span = ~ 10 days
Neutrophil half life = 7 hours
Serum Iron = 13-32 umol/L (100)
TIBC = 45-70 umol/L(300 ug/dL)
Serum Ferritin =
15-300 ug/L
Male = 30-300 ug/L
Female = 15-200 ug/L
170
ANSWERS
TO
500 EXAM BANK
The answers to most of the multiple choice questions could be found in the
attached five pages.
The answers to questions that cannot follow the rules of ABCDE is
provided here:
Q33.
Q34.
Q35.
Q36.
Q37.
Q38.
Q39.
Q40.
Q41.
Q42.
BDCAE
BCDAE
EACDB
DCABE
DABCE
CBADE
CADBE
ABCDE
AEBCD
EDCBA
Q51.
Q52.
Q53.
Q54.
Q55.
Q56.
Q57.
Q58.
Q59.
Q60
G
E
A
D
B
C
F
I
J
H
Q61.
Q62.
Q63.
Q64
Q65.
O
K
L
N
M
Q141.
Q142.
Q143.
Q144.
Q145.
Q146.
Q147.
Q148.
Q149 .
Q150.
E
F
G
I
J
H
D
C
B
A
::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::
Q271.
Q271.
Q273.
Q274.
Q275.
Q276.
Q277.
Q278.
Q279.
Q280.
I
F
A
H
E
J
G
D
C
B
Q291.
Q292.
Q293.
Q294.
Q295.
Q296.
Q297.
Q298.
Q299.
Q300.
P
Q
L
M
N
J
K
R
T
S
Q281.
Q282.
Q283.
Q284.
Q285.
Q286.
Q287.
Q288.
Q289.
Q290.
I
H
C
B
D
E
A
F
G
O
Q301.
Q302.
Q303.
Q304.
Q305.
Y
X
W
V
U
171
Match the following diseases with the most appropriate features:
Each feature should be used once only; Put the right letter in the ANSWER BOX.
No
101
102
103
104
105
106
107
108
109
110
111
112
113
114
115
116
117
118
DISEASE
Hodgkin’s Disease
Myelofibrosis
Multiple Myeloma
Polycythemia
Rubra Vera
Nodular sclerosis HD
Burkitt’s Lymphoma
Essential
Thrombocythemia
Amyloidosis
Tropical
splenomegaly syndrome
T.T.P.
Glanzman’s Disease
ITP (Immune Thrombocytopenic Purpura)
Mycosis Fungoides
ANSWER
von Willebrand Disease
Waldenstrom’s macroglobulinemia
Hemophilia A
AML (M3)
Centrocytic lymphoma
A
C
E
L
B
G
J
R
O
P
M
I
K
D
N
H
Q
F
FEATURES
Prolonged APTT and bleeding time
Osteolytic lesions
IgM Gammopathy
Bleeding with low platelets &
marrow megakaryocytosis
Reed Sternberg cells
Follicular lymphoma
High Hb, Hct. & Red cell count.
Splenomegaly
Factor VIII:c Deficiency
Thrombosis, thrombocytopenia,
CNS symptoms, fever & MAHA.
Lacunar cells
Platelet GP IIb & IIIa deficiency
Tear drop red cells &
extramedullary hemopoiesis
Marked Malarial splenomegaly
plus high polyclonal IgM
Cutaneous T Cell Lymphoma
Thrombocytosis with splenic
atrophy
Macroglossia
Associated with D.I.C.
EBV & starry sky histology
A
B
C
D
E
F
G
H
I
J
K
L
M
N
O
P
Q
R
Q337.
DISEASE OR FACTOR
DEFICIENCY
PT
APTT
TT
HEMOPHILIA
(N)
N
(P)
N or P
N
N
(P)
N
VII
(P)
(N)
N
X, V & II
(P)
P
(N)
FIBRINOGEN
(P)
P
LIVER FAILURE
(P)
DIC
ITP
vWD
XII & XI
N
B.T.
(N)
(P)
N
(N)
N
N
P
(P)
P
(P)
(P)
(P)
(P)
(N)
(N)
(N)
(P)
N
172
BLOOD DISEASE
351
352
353
354
355
356
357
358
UREMIA
HEREDITARY SPHEROCYTOSIS
G6P DEHYDROGENASE DEFICIENCY
HEREDITARY ELLIPTOCYTOSIS
MAHA “Microangiopathic Hemolytic Anemia”
MYELOFIBROSIS
SICKLE CELL ANEMIA
IRON DEFICIENCY ANEMIA
359 LEAD POISONING
360 MEGALOBLASTIC ANEMIA
ALL
TdT
CD10
Cyt. 
POSSIBLE
RED CELL ABNORMALITY
J. BURR CELLS
I. SPHEROCYTES
H. HEINZ BODIES
G. ELLIPTOCYTES
A. SHISTOCYTES
B. TEAR DROP RED CELLS
C. SICKLE CELLS
F. HYPOCHROMIC
MICROCYTIC RBC
E. BASOPHILIC STIPPLING
D. HOWELL-JOLLY BODIES
SmIg CD19-22
(B-Lineage)
Q371
Q372
Q373
Q374
Q375
Pro-B
cALL
Pre-B
B-ALL
T-ALL
+
+
+
+
+
+
+/-
+
+
-
+
-
+
+
+
+
-
CD 2-8
(T-Lineage)
+
Answers to the rest of the exercise will be found in the attached papers.
173