Haematology MCQS
A 69-year old woman was admitted to hospital because of easily fatigued over the past several
months. She claimed that she had been healthy her entire life. Her current problems began about 3
months ago when she began to notice a decreased appetite and fatigue which was progressive. She
denies bleeding from any orifice. Physical examination revealed pallor of mucous membranes, tongue
is glazed and nails are flat. Blood picture showed HB 6.0 g/dl, HCT 18.2% (normal 41%-53%), MCV 69
FL, platelets 400 x103 %/dl, WBC 3.6 x103 /dl (normal differential count).
1. What is the most probable diagnosis?
2. What would be your first diagnostic steps in evaluating this patient's anemia?
3. What are the major morphologic classifications of anemia based on RBC volume
? Give three examples of each.
An 18-year-old boy was referred to hospital presented with vomiting and cramp right upper abdominal
pain for two days. These were associated with dark-colored urine and pallor. The condition was
recurrent infrequently since age of 4 years mainly after infection. He had received his first blood
transfusion at that time. On admission, physical examination revealed pallor, jaundice and
splenomegaly. Results of laboratory investigations showed a hemoglobin level of 7.8 g/dl, WBC 6 x
103 /dl, RBC 2.9 x 106 /dl, and platelets 342 x 103 /dl, reticulocytosis of 10% and Heinz bodies in
peripheral blood. 1. What is most likely type of hemolytic anemia?
2. What are trigger factors for this anemia?
3. What are the investigations needed?
4. What is the treatment?
A 55 y. old male presented with gradually increasing easy fatigability, shortness of breath an effort &
numbness of both hands & feet for the last few months. He gave a history of subtotal gastrectomy for
gastric carcinoma many years ago. General examination revealed only pallor. Chest examination was
unremarkable while cardiac examination revealed ejection systolic murmur over the base. Apart from
the scar of the previous surgery, abdominal examination revealed no abnormality.
1. What is the most probable diagnosis?
2. What investigations would you order to reach the final diagnosis?
3. How would you treat this pt?
A 50-year-old man is seen complaining of dyspnea on exertion. He was in a car accident 5 years ago with
multiple abdominal injuries, resulting in a splenectomy and resection of several feet of his terminal
ileum. After a prolonged recovery, he returned to work and his normal activities. For the last 4-6 months
he has had trouble climbing the stairs to his flat without stopping to catch his breath. He is on no
medications, has not lost weight, and has a well-balanced diet. The CBC revealed hemoglobin 5.6 g/dl,
platelets 70,000, hematocrit 17%, bilirubin 2.3 mg/dl, RBC count 1.4 million, blood smear showed
hypersegmented white blood cell count 3,500 decreased platelets.
1. What is your initial diagnosis?
2. What is the mean corpuscular volume (MCV) in this case?
3. What are the metabolic complications of resection of terminal ileum?
4. there any other cause which causes the same type of anemia and what is this?
5. How can you manage this case?
A 46-year-old man presents to the hospital with a history of fever, and a feeling of fullness in his left
side. On examination there was enlarged spleen. A blood count shows: Hb 14.0 g/dL, WBC 65.8 x
10³/dl with myeloblasts, myelocytes, metamyelocytes and nucleated red cells. His platelet count is
elevated at 600x 10³/dl.
1. What is the most likely diagnosis?
2. What investigations would you perform and why?
3. Is there any cause known for this disease
A 36-year-old woman developed progressive fatigue over a period of ten days, exertional dyspnea,
dark urine and jaundice. On examination, there was splenomegaly. Laboratory studies showed a drop
in hemoglobin from 14.7 to 6.6 g/dl over 4 days, markedly elevated lactate dehydrogenase, indirect
bilirubin and reticulocyte count, and a low haptoglobin level.
1. What is most likely diagnosis and mention its causes?
2. How can you confirm the type of anemia?
3. What is the treatment
Administration of pneumococcal and H.influenza vaccine is considered to be of great help for patient
suffering from:
a- G6PD deficiency.
b- Hereditary spherocytosis.
c- Sickle cell anemia.
d- Beta thalassemia anemia.
e- Alpha thalassemia anemia
Anemia of liver cell failure is
a- microcytic hypochromic anemia
b- b- normocytic normochromic anemia
c- c- macrocytic
d- d- All of the above
e- Haemolytic anemia
Auto-immune hemolytic anemia is not characterized by all the following :
a.positive comb's test (direct-indirect)
b- abnormal hemoglobin electrophoresis
c- splenomegaly
d- increased retics
e.G6PD defeciency
Iron deficiency anemia may be not caused by all the following :
a- decrease intake
b- b- chronic blood loss
c- c- decrease folate
d- Pregnancy
e- H.pylori
Causes of bleeding include:
a- Hemolytic anemia.
b- Pernicious anemia.
c- Polycythemia.
d- Aplastic anemia.
e- All of the above
Which of the following is associated with prolonged PT:
a- Factor XI deficiency.
b- b- Factor IX deficiency
c- c- Factor VIII deficiency.
d- d- Factor VIl deficiency.
e- - Factor XIl deficiency
which one of the following about low molecular weight heparin is not true :
a- Testing of coagulation file profile is not necessary.
b- Less risk of osteoporosis is compared to unfunctionated heparin
c- Higher bioavailability and longer half-life as compared to unfractionated heparin.
d- Higher risk of heparin included thrombocytopenia is compared to unfunctionated heparin.
e- Clearance is dose dependent.
Which of the following statements about heparin is not true :
a- Used prophylaxis against DVT
b- Used in treatment of pulmonary embolism.
c- Anti-thrombin 3 required for its action.
d- It's antidote is vitamin K
e- Long term use may cause thrombocytopenia.
. Treatment with heparin is best monitored by:
a- Prothrombin time
b- Bleeding time
c- Activated partial thromboplastin time
d.Fibrin degradation product
e.fibrinogen
A 31 years old woman with history of easy bruising and epistaxis. O/E, there purpuric eruptions, was
CBC showed, Hb 13g/dl, WBCs 6500 /dl. with normal differential count,platelets 45000/dl, what is the
most likely first line of treatment:
a- Cryoprecipitate
b- Prednisolone.
c- Vasopressin.
d- Recombinant factor 9.
e- Factor8
One of the following is not considered a feature of thalassemia:
a- Jaundice
b- Mongoloid features.
c- Auto splenectomy
d.Hepatosplenomegaly
e.positive coombs test
1. Anemia of liver cell failure is
microcytic hypochromic anemia
b- normocytic normochromic anemia
c- macrocytic
d- All of the above
2. Auto-immune hemolytic anemia is characterized by all the following except
a- positive comb's test (direct-indirect)
b- abnormal hemoglobin electrophoresis
c- splenomegaly
d- increased retics
3. Iron deficiency anemia may be caused by all the following except
a- decrease intake
b- chronic blood loss
c- decrease folate
d- pregnancy
4. Iron transport protein:
a- Haptoglobin
b- Ferritin
c- Transcobalamine2
d- Transferrin
5. Which of the following is not a cause of folic acid deficiency?
a- Vegetarian diet.
b- Gluten enteropathy.
c- Pregnancy.
d- Hemolytic anemia
6. Causes of bleeding include:
a- Hemolytic anemia.
b- Pernicious anemia.
c- Polycythemia.
d- Aplastic anemia.
e- All of the above
7. In chronic iron deficiency anemia there is
a- reticulocytosis
b- high serum ferritin
c- high total iron binding capacity
d- macrocytic anemia
e- normocytic anemia
8. Which of the following is X- linked disease
a- G6PD deficiency
b.pyruvate kinase deficiency
c.sickle cell anemia
d. spherocytosis
e.thalassemia
9. Aplastic anemia is characterized by all except
a- microcytic hypochromic anemia
b- low reticulocyte count
c- thrombocytopenia
d- leukopenia
13. In intravascular hemolysis all the following are present except
a- Increased urobilinogen.
b- Reticulocytosis.
c- Increased urinary hemosiderin.
d- Increased plasma hemopexin
14. Splenectomy is indicated in the following except
a.spherocytosis
b.sickle cell anemia
c.immune thrombocytopenic purpura
d.thalassemia
e. G6BD deficiency
15. All of the following is pancytopenia causes except
a- megaloblastic
a.aplastic
b.hypersplenism
c.sideroblastic anemia
d.iron deficiency anemia
16. Serum ferritin is low in
a. Thalassemia.
B.Sideroblastic anemia
C.Iron deficiency anemia.
D. Renal diseases
17. Which of the following is true. concerning treatment of iron. deficiency anemia?
a- Folic acid should also be given if the anemia is severe
b.Treatment is stopped as soon as hemoglobin normalizes,
c- Hemoglobin should rise by 1g/L every 7days
d.Healthy diet is sufficiently for treatment
e- oral iron is effective as parenteral iron
18. Heinz bodies in red blood cells in hemolytic anemia is present :
a- Paroxysmal nocturnal hemoglobinuria.
B.Glucose-6-phosphate-dehydrogenase deficiency.
e- Post splenectomy.
f- Cold agglutinin disease.
e- Clostridium welchii septicemia.
19. All of the following produce microcytic anemia except
a- Sideroblastic anemia.
g- Thalassemia.
c- Pernicious anemia.
d- Lead poisoning
A 22 year old woman has had four episodes of deep venous thrombosis. Laboratory studies should
include each of the following except:
a- Protein S
b- Protein C
c- A2 macroglobulin
d- Anti-thrombin
b- 3 Lupus anticoagulant
A 25-year-old female patient presented with left brachial artery thrombus and she gave past history of
recurrent DVT that used to respond poorly to heparin therapy she is mostly likely to suffer from:
a.Anti-thrombin 3 deficiency
b- Protein C and S deficiency.
c- Factor 2 Leiden disease.
d- Factor 5 Leiden disease.
e-Hidden malignancy.
A 62-year-old male attends a general practitioner's clinic with a 4-week history of back pain, tiredness
and lethargy. His physical examination showed pale conjunctiva and tenderness to deep palpation
over T4-T6. Initial investigations revealed normochromic normocytic anemia with Hb 8.4g/dl, raised
ESR (>140 mm/hr), total serum protein level was elevated and serum creatinine was 1.8mg/dl.
Thoracic spine films showed lytic lesions in T4 and TS.
1. What is the probable diagnosis?
2. What further investigations would be indicated for the diagnosis?
3. What is the most likely metabolic abnormality present?
4. Mention the possible causes of raised serum creatinine in this patient.
A 28-year-old girl presented with a two months history of weakness, chills, fever, anorexia, and weight
loss. Her medical history was not remarkable. Physical examinations showed marked pallor, generalized
lymphadenopathy and hepatosplenomegaly. Laboratory findings included anemia with moderate
anisopoikilocytosis, hemoglobin level of 8.2 g/dl, ESR 90 mm/hr, and positive C-reactive protein.
Polymerase chain reaction for tuberculosis, blood culture, urine culture, hydatid antibody, direct
Coombs test, bone marrow culture, and blood smear for malaria were all negative.
1. What is the most likely diagnosis?
2. What are the investigations needed?
3.what are expected in pathology of lymph nodes ?
4. causes of lymph node enlkargment?
