BLOCK 3.

7 HAEMATOLOGY

1. What is the common clinical presentation of hemophilia in affected individuals?

a. Prolong bleeding time
b. Petechial haemorrhages
c. Bleeding gum
d. Hemarthrosis

2. Peripheral blood film from a 78year old woman diagnosed of adenocarcinoma of the colon will
show all of the following except?
a. Anisocytosis
b. Poikilocytosis
c. Normochromic normocytic red blood cells
d. Microcytic normochromic red blood cells
e. Microcytic hypochromic red blood cells

3. Which of the following ratio is true of Tcells in bone marrow of a 12 year old male?
a. CD4+ : CD8+ = 2:1
b. CD4+ : CD8+ =1:2
c. CD4+ : CD8+ = :1
d. CD4+ : CD8+ = 2:2

4. Which of the following is an immune-related cause of neutropenia?

a. Chédiak-Higashi syndrome
b. Lazy leukocyte syndrome
c. Chronic granulomatous disease of childhood
d. Felty's syndrome

5. The purpose of a major cross-match in transfusion medicine is to?

a. To identify the donor blood group
b. To identify the patient's blood group
c. To give safe blood
d. To detect atypical antibodies that are directed against foreign antigens on donor RBCs

6. In transfusion medicine, forward blood grouping involves?

a. Patient RBCs are added to test tubes that contain either anti A or anti-B test serum.
b. Patient RBCs are added to test tubes that contain exogenous antigens
c. No agglutination reaction
d. Patient serum is added to test tubes containing either A or B test RBCs

7. Neural tube is associated with which nutritional anaemia

a. Iron
b. vitamin B12
c. B9
d. vitamin B6

8. The concentration of HbA2 in a neonate is?

a. 24%
b. 2.5℅
c. 0.5%
d. 97%
e. 12%

9. Which of the following transport proteins is synthesized in the stomach?

a. Transcobalamines
b. Intrinsic factor
c. Cobalamines
d. Cobalophilines

10. What percentage of oral iron is absorbed in the gastrointestinal tract?

a. 5-10%
b. 1-3%
c. 35-40%
d. 15-25%

11. The first organ of haematopoiesis in a foetus is?

a. Bone marrow
b. Thymus
c. Yolk sac
d. Kidney

12. The hormone that acts as a sensor in hematopoiesis in humans is?

a. Oxygen
b. Haemoglobin
c. Erythropoietin
d. Severe anaemia

13. In a 34 yr old healthy adult, what is the rate of hemopoiesis?

a. 1011 new cells replaced daily
b. 1013 new cells replaced daily
c. 1012 new cells replaced daily
d. 1014 new cells replaced daily

14. The commonest Haemoglobin found in cord blood of a baby born with Down syndrome is?
a. 2alpha/2beta globin chains
b. 2alpha/2delta globin chains
c. 2alpha/2gamma globin chains
d. 2gamma/2beta globin chains

15. Which of the following percentages of blast in the bone marrow defines acute myeloid leukemia?
a. 30.0%
b. 2.0%
c. 10%
d. 15%

16. The clinical features of multiple myeloma include?

a. Bronchiectasis
b. Restrictive cardiomyopathy
c. Nephrotic syndrome
d. All of the above

17. The following are true of blood group O except?

a. Can be transfused into any patient
b. Blood group O RBC lack A and B antibodies
c. Can receive only O blood
d. Can be given to a neonate

18. The components of a standard cross-match does not include

a. ABO group
b. Rh type
c. Antibody screen for atypical
antibodies
d. Indirect Coombs test
19. The following are common causes of haemolytic disease of the newborn
a. Kell
b. Rh
c. I
d. MN

20. The following pairings are incorrect except?

a. Blood group A patient--- Duodenal ulcer
b. Blood group A patient--- agglutination reaction with AB donor
c. Blood group B donor---anti B in the serum
d. Blood group O---less common

21. Infectious causes of lymphocytosis does not include?

a. Pertussis
b. Measles
c. Malaria
d. Hepatitis

22. The following are true of T helper cells. They are

a. CD4-
b. CD4+CD8-
c. CD4-CD8+
d. CD4-

23. The following are true of mature lymphocytes except?

a. Scanty sky blue cytoplasm
b. Granular cytoplasm
c. Nucleus may be indented
d. Very motile

24. The following are secondary lymphoid organs except?

a. Spleen
b. Thymus
c. Lymph nodes
d. Peyer’s patches

25. Enlargement of which of the following organs or in a disease

condition tissue may lead to anaemia without blood lost externally?
a. Kidney
b. Liver
c. Spleen
d. Heart

26. The following are true of hereditary spherocytosis except?

a. It is caused by intrinsic defects in the protein involved in the vertical interaction between the red
cell membrane skeleton and lipid bilayer of the red blood cell
b. It is caused by intrinsic defects in the protein involved in the horizontal interaction between the red
cell membrane skeleton and lipid bilayer of the red blood cell
c. An autosomal dominant inheritance pattern is seen in about 75% of cases.
d. The remaining 25% of the patients have compound heterozygosity

27. The following are known examples of qualitative haemoglobinopathies except?

a. Hb C disease
b. Hb E disease
c. Hb C- thal disease
d. Hb F disease
28. The following may complicate hereditary spherocytosis except?
a. Severe haemolytic anaemia
b. Mild jaundice
c. Cholelithiasis
d. Moderate splenic enlargement

29. The following are associated clinical features of Cooley’s anaemia except?
a. It is a disease adulthood
b. It is associated with extravascular haemolysis
c. Thinning of the cortical bone
d. Growth retardation is a common feature

30. An Hb electrophoresis of a child with Cooley’s anaemia will show the following except?
a. Elevated HbF
b. Elevated HbA2
c. Deceased HbF
d. Decreased HbA

31. Which variant of the acute myeloid leukaemia is associated with DIC?
a. AML7
b. AML3
c. AML4e
d. AML6b

32. Which variant of the acute myeloid leukaemia is associated with Down syndrome?
a. AML7
b. AML3
c. AML4e
d. AML6b

33. Which of the following chemotherapeutic agents is BCR-ABL inhibitor?

a. Cyclosphosphamide
b. Hydroxyurea
c. Imatinib
d. Interferon

34. Which of the following percentages of blasts in the bone marrow defines acute myeloid
leukaemia?
a. 30.0%
b. 2.0%
c. 10%
d. 15%

35. The peak age for acute myeloid leukaemia is?

a. 70 years
b. 60 years
c. 3 years
d. 7 years

36. In chronic myeloid leukaemia, the abnormal chromosome is

a. T(9,22)
b. 22
c. 9
d. T(9,24)

37. The bony lesion that is commonly seen in multiple myeloma is?
a. Osteoblastic
b. Osteoporotic
c. Osteolytic
d. Osteomalacia

38. Which of the following finding is pathognomic feature of Mycosis fungoides?

a. Sezary cells
b. Starry sky appearance
c. Pautrier microabscesses
d. Skin rashes

39. Lymphocytes constitutes what percentage of the body’s weight of an adult male?
a. 45%
b. 24%
c. 5%
d. 0.5%

40. Which of the following is the easiest way to diagnose multiple myeloma at the primary health care
centre?
a. Electrophoresis
b. Clinical history
c. X-ray of the bone
d. Heating urine collection form the patient

41. Pel-Ebstein fever is most likely a clinical feature in which of the following haematological
malignancy?
a. Burkitt’s lymphoma
b. Nodular sclerosing HL
c. ALL
d. NHL

A 12 year old girl from Nandom was referred to the paediatric

surgeon with a rapidly growing mandibular swelling. The surgeon
made a working diagnosis of NHL, most likely Burkitt’s. Use this to
answer questions 42-46.

42. What histological variant is the most likely?

a. Organ transplanted
b. HIV associated
c. Endemic
d. Sporadic

43. The most likely oral presentation will be?

a. Bleeding gums
b. Dental anargic
c. Ulcers
d. Dental cysts

44. The best investigation to confirm the diagnosis is?

a. CT scan of the head
b. MRI of the head
c. Core needle biopsy
d. Bone marrow aspirate

45. What is the cure rate for Burkitt’s lymphoma?

a. 90%
b. 75%
c. 67%
d. 60%

46. The EBV is implicated in what proportion of sporadic Burkitt’s lymphoma?

a. 25%
b. 30%
c. 45%
d. 35%

Mr. Kofi a farmer from Kumasi had children with Madam Hawa
from Nandom. The elder daughter Christiana wants to marry Mr.
Edmund, the son of her maternal uncle. During the marriage
counselling process, Edmund was told that Christiana’s paternal
grandmother died of a bleeding disorder called haemophilia A. By
further interaction with Christiana’s mother, Edmund got know his
grandfather (Mad Hawa’s father) also died of haemophlia A. Mr
Kofi was the only surviving twin male child of his parents, the
other twin died at birth. Christiana is however asymptomatic. This
kept Edmund thinking for he had already had four children with
Christiana while in school. Use this to answer questions 47-51.

47. What id the probability that Mr. Kofi would have haemophilia A?
a. ½
b. ¼
c. 1
d. 1/8

48. What percentage of Mr. Kofi’s sisters had clinical disease?

a. 50%
b. 25%
c. 75%
d. None of the above

49. What percentage of Mr. Kofi and Mad Hawa’s children will express the disease?
a. 50%
b. 25%
c. 75%
d. None of the above

50. Karyotyping of Edmund mother’s chromosome revealed trisomy 21 and no other abnormality.
What is the probability that Edmund’s sons will have the disease?
a. ½
b. ¼
c. 1/8
d. None of the above

51. What is the probability that Edmund’s daughter will be normal?

a. ½
b. ¼
c. 2/3
d. None of the above

52. How is Haemophilia A diagnosed?

a. PTT
b. PT
c. Factor assay
d. Clinical history
53. Which of the following viruses is implicated in the aetiology of aplastic anaemia in human?
a. HIV
b. HBV
c. Parvovirus B19
d. HPV

54. Which of the following defines sickle cell disease?

a. Genotype AS
b. Genotype SS
c. Genotype SC
d. Genotype SB-thal

55. The protein from food which first binds and transport vitamin B12 in the upper gastrointestinal
tract is?
a. Transcobalamines
b. Intrinsic factor
c. Cobalamines
d. Cobalaphilines

56. Oral iron absorption maximally occurs in the?

a. Stomach
b. Jejunum
c. First part of the duodenum
d. Ileum

57. Which of the following red blood cell indices is commonly used
in morphological classification of anaemia in humans?
a. Hb
b. MCH
c. MCHC
d. MCV

58. The following are cofactors in erythropoiesis except?

a. Folate
b. Manganese
c. Cobalt
d. Calcium

59. In a 72.0 kg male, what percentage of haemopoiesis activity takes place in the bone marrow?
a. 25%
b. 50%
c. 75%
d. 100%

60. Which of the following growth factors act on pluripotent cells?

a. IL-1
b. TNF
c. SCF
d. IL-3

61. Weibel-Palade bodies are synthesized in which of the following cells?

a. Magakaryocytes
b. Platelets
c. Liver cells
d. Endothelial cells

62. What is the normal life span of platelets in peripheral blood?

a. 100-120 days
b. 90-100 days
c. 9-10 days
d. 1-5 days

The figure above is a bone marrow aspiratefrom a 12-year-old boy. Use it to answer questions 63-66.

63. The picture shows which type of acute leukaemia in the FAB
stage?
a. ALL2
b. AML1
c. AML2
d. AML3

64. This condition is commoner in which age group?

a. Children
b. Young adults
c. Adults
d. Extremes of age

65. The common cell types in this condition is?

a. B lymphocytes
b. T lymphocytes
c. Marginal cells
d. Mantle cells

66. The prognosis of this condition is?

a. Good
b. Very good
c. Bad
d. Excellent

The Table shows the peripheral blood film of a 23-year-old pregnant woman. Use it to answer
questions 67-69.
Parameter Value Normal
Platelets 1153/ul 100-300/ul
MPV 5.9 6.5-12.0
PDW 9.0 9.0-17.0

67. The most likely haematological abnormality in this peripheral

blood film is?
a. Hypochromic normocytic anaemia
b. Thrombophilia
c. Spherocytosis
d. Megaloblastic anaemia

68. This patient may present with the following?

a. DIC
b. Thrombosis
c. Bleeding diathesis
d. Epistasis

69. The most appropriate test to request for this patient is?
a. PTT
b. PT
c. Bleeding time
d. Factor assay
70. Blood and or products given to congestive heart failure due to
severe anemia is?
a. Whole blood
b. Packed red blood cells
c. FFP
d. Platelet concentrate

71. Hereditary causes of haemolytic anaemia include except?

a. Pyruvate kinase deficiency
b. HbS
c. HbC
d. Autograft rejection

72. The following causes of anaemia are due to membrane defects

a. HbS
b. Elliptocytosis
c. HbC
d. G6PD deficiency

73. Which of the following factors is an enzyme?

a. Prothrombin
b. Fibrinogen
c. Thrombin
d. Factor X

74. Factor X is activated by the following except?

a. VIII
b. V
c. Calcium
d. PF3/PL

75. Factor XII is activated by

a. V
b. III
c. II
d. VIII
e. None of the above

76. The following coagulation factors are neutralized by serine

protease except?
a. XII
b. II
c. VIII
d. IX

A woman aged 65 years had palpitations, easy fatigability, exertional dyspnoea, dizziness and early
satiety. The Hb checked was 9g/gl, reticulocyte count was 20%. Use it to answer 77-81.

77. How much blood product should be given to raise the Hb to 12

g/dl
a. 450 ml
b. 900 ml
c. 3 units
d. 4 units

78. What type of blood products should be given?

a. Whole blood
b. Platelet concentrate
c. Packed red blood cells
d. Cryoprecipitate

79. What is the Haematocrit?

a. 12%
b. 27%
c. 36%
d. 3%

80. What is the corrected reticulocyte count?

a. 12%
b. 27%
c. 36%
d. 3%

81. What condition accounted for the corrected reticulocyte?

a. Aplastic anaemia
b. Sepsis
c. Adenocarcinoma
d. All of the above

82. Which step of haemostasis is affected in Glanzmann’s disease?

a. Re-establishment of blood flow
b. Dissolution of platelet plug
c. Platelet plug formation
d. Platelet synthesis

83. The following factors are synthesized by an intact endothelial

cell except?
a. vWF
b. Prostacyclin
c. NO
d. Thromboxane A2

84. What acts on fibrinogen to produce fibrin monomers plus

fibrinopeptides A and B?
a. Thrombin
b. Prothrombin
c. Factor XIII
d. Factor III

85. Factor VII is activated by

a. III
b. XIII
c. VII
d. IX

86. The commonest variant of Hodgkin’s lymphoma?

a. Lymphocyte depleted
b. Lymphocyte predominant
c. Nodular sclerosing
d. Mixed cellularity

87. The clinical features of extravascular haemolysis include the following except?
a. Jaundice
b. Splenomegaly
c. Hepatomegaly
d. Haemoglobinaemia

88. The following cross-matching are true except?

a. Normal bleeding time---4 minutes
b. Abnormal bleeding time—8 minutes
c. Platelet aggregation agent --- epinephrine
d. Ristocetin ---evaluate platelet function