COMMON MCQ & CASES IN Hematology By

Dr.Abdulrauf
1- The following are recognized causes of microcytic blood picture except:

a. Anemia of chronic illness.

b. Anticonvulsant therapy.
c. Iron deficiency.
d. Sidroblastic anemia.
e. Thalassemia minor.

2- Recognized features of iron deficiency anemia include all except:

a. Dysphagia.
b. Ringed sideroblasts in the bone marrow examination.
c. Low serum ferritin.
d. Splenomegaly.
e. pica.

3- A 75 years old patient presented with 3 week history of tiredness, palpitation

and exertional dysypnea. He has no significant past medical history. He is not on
any medications. On examination, he was pale, pulse of 100/min, regular, B.P
130/60mmHg, there was no other abnormal physical findings. His complete blood
count (CBC) shows Haemoglobin 7g/dl, Hct/28%, WBC 8×10^9/l, MCH 19g/dl,
MCHC 25% Platelets 322×10^9/l. The following statements are correct regarding
this patient condition except:

a. The most likely underlying causes is chronic blood loss.

b. Serum ferritin level is expected to be high.
c. Upper GIT endoscopy should be performed.
d. Stool examination for cyst and ova should be performed.
e. Heart failure is a recognized complication.

4- A 32 year old female previously healthy, presented with a 2 month history of

fatigue, exertional dyspnea and palpitation which worsened in the last week so
that she gets dyspnic even after walking few steps out of bed. On examination, she
is pale regular pulse of 96/min, blood pressure 120/60mmHg. Chest cardiac and
abdominal examinations were unremarkable. Hgb 5.6g/dl, MCV 60 fl(N80-100),
MCH 16pg(N 26-34), WBC 7.3×10^9/l, Platelets 218×10^9/l. All the following are
true except :

a. A history of the following of NSAID intake is of significance.

b. You expect a low serum frerritin and high iron binding capacity.
c. Packed Red Cell transfusion is indicated in this patient.
d. Parenteral iron leads to faster improvement in haemoglobin level than
oral iron.
e. Vitamin C helps improve absorption of iron from animal sources.

5- An asymptomatic 82 year old male, who underwent a routine medical check up,
was found to have the following findings on his complete blood count; haemoglobin
of 8.5g/dl, MCV of60 fl MCHC of 24g/fl. Platelets of 230×10^9/l, WBC of
6.5×10^9/l. Which of the following statements regarding this patients cases is
false:

a. A history of the following of NSAID intake is of significance.

b. Rectal examination is an important step in the clinical significance.
c. Serum ferritin is the best single test to confirm iron deficiency.
d. Blood transfusion is the first line therapy in this patient.
e. Reticulocytosis and a raise in the haemoglobin level by 1g/week indicate a
satisfactory response to oral iron.

6- in anemia of chronic disease all are true except:-

a-the anemia is usually related to high hepcidin

b-serum iron is low
c-MCV is usually normal
d-high erythropoietin level
e-ferritin level is elevated

7- 40 years old female patient presented with headache, general weakness dyspnea
on exertion and palpitation. On examination she was pale; pulse was 110/min, B.P
120/75 mmHg. Her haemoglobin is 6.3gm%, WB 5.9/mm³ and platelets 210/mm³.
The following statements are true except:

a. Presence of Koilonychia indicates chronic iron deficiency anemia.

b. A normal MCV( Normocytic anemia) suggest either blood loss or anemia of
chronic disease.
c. Stool examination is mandatory.
d. History of joint pain is of diagnostic value.
e. In iron deficiency anemia iron supplements should be stopped on
normalization of haemoglobin.

8- recognized causes of hemolytic anemia except:-

a-microangiopatic
b-hereditary spherocytosis
c-Malaria
d-mitral valve incompetence
e-Thalassemia

9- haemolytic anemia can be caused by all except:-

a-artificial heart valves

b-burns
c-March haemoglobinuria
d-Aldomet
e-pernicioues anemia

10- The following are features of Hemolysis except:

a. Raised LDH.
b. Indirect hyper bilirubinemia.
c. Reticulocytosis.
d. High serum Haptogolbin.
e. Low haematocrit.

11- The following are findings in haemolytic anemia except:

 a. A positive direct Coombs test in warm autoimmune haemolytic anemia.
b. Erythroid hyperplasia in the bone marrow.
c. Elevated urinary urobilinogen.
d. High level of plasma haptoglobin.
e. Raised levels of serum lactic dehydrogenase(LDH).

12- regarding hemolytic anemia all are true except:-

a-hemolysis occurs only intravascular

b-hemosiderinuria always indicates intravascular hemolysis
c-absent of haptoprotein is a strong indicator of hemolysis
d-bone marrow shows erythroid hyperplasia
e-red cell membrane abnormalities is one of the congenital causes of
hemolytic anemia

13- in sickle cell anemia the following are true except:-

a-Hb-S is formed by the substitution of valine in place of glutamic acid in B-

chain of adult Hb
b-in Hb-S-thalassemia the presence of large amounts of Hb-F protects
against sickling
c-blood transfusion may be used
d-splenomegaly is always persistent finding
e-Priapism may occur

14- the following are recognized complications of sickle cell anaemia except:-

a-chronic leg ulcers

b-pneumococcal infections
c-Salmonella osteomylitis
d-increased renal stone formation
e-malignant change

15- Sickle cell disease which is false:

 a. Chest pain is a recognized manifestation.
b. Osmotic fragility test is the diagnostic test.
c. Hydroxyurea is considered in to reduce the frequency of crisis.
d. Rehydration is important in treating sequestration crisis.
e. Aplastic crisis is typically associated with decrease in reticulocvte count.

16- An 18 year old black girl presents with repeated attacks of chest pain and
anemia. Physical examination revealed an anemic girl who was underweight Hb 6.2
normochromic normocytic red cells. She mentioned that her cousin was also anemia
and that he was repeatedly transfused in the past. WBCs 13000, platelets 561,
LDH 1032, all of the following are true regarding patients case except:

a. Splenomegaly is expected on physical examination.

b. Hydration and analgesia are the mainstay of treatment of her pain.
c. Special care will be needed if she requires general anaesthesia.
d. Patient is prone to infections secondary to capsulated bacteria.
e. Aplastic crises are well recognized complication of her disease.

17- A 21 year old black female presented with a tow days history of sever chest
pain and fever, she is known to have similar attacks since childhood which usually
resolve with antibiotics, analgesia and hydration. On examination she was in pain
and jaundiced. Abdominal examination was unremarkable. Her haemoglobin was
6.3g/dl, WBC 12.4, Plt 322, Total bilirubin 2.4 mg/dl SGPT 23, SGOT 33, ALP 221,
reticulocyte count was 10%. Periphery blood film showed target cells, crescent
(sickle) shaped RBCs. The following is true about the management of this patient:

a. NSAID will precipitate her attacks.

b. Splenomegaly is expected to be present in this patient.
c. Haemoglobin electrophoresis is expected to show Hb A2 level of 98%.
d. Blood transfusion to raise the haemoglobin to above 12 grams is
mandatory.
e. Hydroxyurea increases Hb F and reduces painful crises episodes

18- 35years black Libyan male present to medical out patient department complain
from sever bone pain in the spine, ribs, and both arms also patient has sweating,
patient had previous history of admission to hospital due to same illness many
times .On examination patient looks ill, pale, and jaundice pulse 120beat/min,
temperature 38c. Investigation:- Hb 6.8g/dl, total bilirubin 5mg/dl, indirect
bilirubin 4.3mg/dl. Which of the following is wrong statement:-

a-folic acid replacement is essential

b-haemoglobin electrophoresis is the most specific diagnostic investigation
c-50% is died by age of 20 years.
d-blood film may give the accurate diagnosis

19- A 16 year old female, presented with an acute attack of bone aches and
chest pain. Her brother has a similar condition. Haemoglobin electrophoresis
shows:

• Hb A 0%(N 97-99)

• Hb A2 2%(N 1-2)

• Hb F 10%(N<1)

• Hb S 88%(N=0)

Based on these finding you will diagnose this patient as having:

a. β- thalassemia major.

b. Autoimmune haemolytic anemia.

c. Sickle cell anemia.

d. Sickle cell trait.

e. α- thalassemia.

20- In Autoimune haemolytic anaemia all are true except:

 a. Is idiopathic in the majority of cases.
b. Has a recognized associated with SLE
c. Usually associated with splenomegaly.
d. Response to corticosteroids takes weeks to months.
e. The bone marrow is replaced by fat cells and fibrosis.

21- A previously healthy 38 year old woman presented with 2 weeks history of
fatigue and malaise. Physical examination shows slight sclera icterus and a mildly
enlarged spleen. There is no lymphadenopathy. Laboratory studies: haemoglobin
7.2g/dl. Reticulocyte count 9.8% A peripheral blood smear shows polychromasia,
occasional spherocytosis, and a rare nucleated erythrocyte. All of the following are
true regarding patients case except:

a. The anaemia most probably is due to haemolysis.

b. Presence of spherocyte indicate hereditary bases in this case .
c. Iron supplementation rarely needed.
d. Higher LDH level in the blood is expected.
e. Prednisolone is the best initial therapy.

22- clinical feature of aplastic anemia includes one of the following :-

a-occurs usually at young age

b-the onset is sudden
c-hematuria and epistaxis are not common
d-infection is common complication
e-anemia is common presenting feature

23- In Aplastic anaemia all are true except:

a. Hepatitis is a recognize cause.

b. The common presentation is lymphadenopathy and hepatosplenomegaly.
c. On peripheral blood film there is reduce of reticulocytes.
d. Bone marrow biopsy is hypo cellular with lots of fat spaces.
e. Bone marrow transplantation is one of the treatment options.

24- A 50 year old radiographer presented with lethargy, breathlessness and

fatigability. On examination, he was pale with no lymph node enlargement.
Investigations showed haemoglobin of 7.2g/dl, WBC 1.3×10^9/l(70% lymphocytes)
and platelets 60×10^9/l. Bone marrow biopsy showed a uniform reduction in all
elements with fatty replacement. Which of the following is true regarding this
patient:

a. History of upper GIT bleeding will explain the bone marrow findings.
b. Hepatomegaly is a characteristic feature in this patient.
c. Raised reticulocyte count will be the predominant finding.
d. Corticosteroids are used in treating such patients.
e. Such patients usually have a good prognosis.

25- Hyperchromic macrocytic anaemia seen in all except :-

a-liver disease
B-alcoholic abuse
c-hypothyroidisim
d-thalassemia
e-folate deficenct

26- Macrocytic anemia may be due to all except :-

a-malabsorption syndrome
b-thalassemia
c-Phenytoin therapy
d-alcohol
e-pregnancy

27- the following are causes of VIT-B12 deficiency anemia except:-

a-pernicious anemia
b-Tropical sprue
c-Zollinger-Ellison syndrome
d-chronic pancreatitis
e-gasterectomy

28- causes of folate deficiency includes all except :-

 a-coeliac disease
b-fish tapeworm infection
c-contraceptive pill
d-liver chirosis
e-Methotrexate

29- In megaloblasticanemia all are true except:

a. Phenytoin is a recognized cause .

b. Optic atrophy is a recognized complication.
c. Serum lactate dehydrogenase(LDH) is usually elevated.
d. Pancytopenia is not a recognized feature.
e. Rise of reticulocyte count is an indication of response to treatment.

30- The following are true about vitamin B12 deficiency anemia except:

a. Can be as a result of blind loop syndrome.

b. Patient may present with signs of subacute combined degeneration of
spinal cord.
c. High MCV and MCH.
d. Bone marrow aspirate shows signs of ineffective erythropoiesis.
e. Hyperkalaemia is a common complication of vitamin B12 therapy.

31- The following are classical neurological manifestations of vit. B 12 except .

a. Glove and stocking paraesthesia.

b. Diminished vibration sense.
c. Rigidity.
d. Dementia.
e. Optic atrophy.

32- The following associations are true in anaemia except:

 a. Haemolytic anemia and darkening of urine(Tea colour)
b. Hepcidin and anemia of chronic diseases.
c. Macrocytosis and thalasemia.
d. Koilonychia and iron deficiency anemia.
e. Alcoholism and megaloblastic anemia.

33- The following is compatible with the diagnosis of a megalobasticanemia:

a. Mean corpuscular volume of 69 fl.

b. Low erythrocyte count.
c. Normal reticulocyte count.
d. High serum LDH.
e. Low serum ferittin .

34- diagnostic features of megaloblastic anaemia includes which of the following :-

a-heamoglobin is often increased

b-reticulocyte count is low
c-leucocyte count is high
d-serum iron is very low
e-plasma LDH is low

35- the following are diagnostic features of megaloblastic anaemia except:-

a-raised MCV
b-low reticulocyte count for degree of anemia
c-elevated serum iron
d-low serum ferritin
e-bone marrow shows neutrophil hyper segmentation

36- the following are diagnostic features of megaloblastic anemia except :-

a-elevated serum iron

b-decreased bone marrow cellularity
c-low reticulocyte count
d-raised mean cell volume
e-elevated plasma LDH
37- regarding megaloplastic anaemia :-

A- presence of neurologic signs is in favors of B12 deficiency

b- folate is not low in leafy vegetable
c- Methotraxate can produce folate deficiency
d- reticulocyte count will peak in 2nd day of treatment
e- presence of hypersigmented neutrophil is in favors of VIT B12 deficiency

38- an elderly man admitted to hospital as a case of pernicious anemia. The

following are consistent with the diagnosis except:-

a-normal serum gastrin level

b-positive anti parietal-cell antibodies
c-bone marrow erythroid hyperplasia
d-very low serum vitamin B12 level

39- A 58 year old lady presented with headache fatigability, dyspnea on moderate
exertion for the last 6 months. On examination, she looks pale, with smooth red
tongue, no koilonychias, no lymphadenopathy, and no splenomegaly, HB 6gm%, WBC
3.6/mm³, platelets 150.000/mm³, MCV 110fl. The following are true except:

a. Dietary history is of diagnostic value.

b. Peripheral neuropathy is likely to be presented.
c. Plasma LDH will be elevated.
d. Treatment should be with held till confirmatory tests results are
available.
e. Few days after treatments, bone marrow will show striking change to
normal.

40- In patients with idiopathic thrombocytopenic purpura all are false except:

a. Adult males are more affected.

b. Splenomegaly is a common feature.
c. Peripheral blood film is usually abnormal
d. Intravenous immunoglobulin should be given severe bleeding.
e. Pneumococcal vaccination is not advisable if Splenectomy is planned.
41- regarding idiopathic thrombocytopenic purpura all are true except :-

a-more common in young women

b-subdural haematoma may occur
c-splenomegaly always present
d-splenectomy has cure rate of 70%
e-in acute form spontaneous remission may occur

42- Recognized features of haemophilia include all except :

a. Hemarthrosis and hematomas.

b. Prolonged APT time.
c. Low platelet count.
d. Good response to DDAVP.
e. Prolonged bleeding after circumcision.

43- Typical features of Hemophilia include which of the following :

a. Purpura.
b. Onset of symptoms soon after birth.
c. Autosomal dominant inheritance.
d. Hemarthrosis is uncommon.
e. Bleeding few seconds after trauma.

44- The following laboratory results are classical findings in Hemophilia except:

a. Prolonged APTT.
b. Prolonged PT.
c. Normal fibrinogen level.
d. Reduced factor VIII.
e. Normal vWF.

45- Which of the following is a typical laboratory feature of haemophilia?

 a. Low platelet count.
b. Prolonged prothrombintime(PT).
c. Prolonged partial thromboplastin time (APTT).
d. Prolonged bleeding time.
e. Low fibrinogen level.

46- Typical features of von Willebrands disease include all except :

a. Autosomal inheritance.
b. Hemarthrosis.
c. Menorrhagia.
d. Prolonged bleeding time.
e. Increased factor VIII level in the blood.

47- A 24 years old female presented with 2 weeks history of skin petechia and
menorrhagia. She has no history of similar problem or any significant medical
history. She has no history of drug intake. On examination, she looks well, with
slight pallor and petechia all over her skin, cardiac, chest and abdominal
examination was within normal. Her investigations showed haemoglobin of 10g/dl,
WBC of 8×10^9/l, Platelets, 12×10^9/l, ESR was 7 mm/hr. Other routine
investigations were normal. Bone marrow aspiration showed a reactive bone marrow.
The following are true regarding her condition except:

a. The most likely cause of her illness is an autoimmune process.

b. Splenomegaly is presented in more than 80% of cases.
c. Steroids are the treatment of choice in her condition.
d. Intravenous immunoglobulin should be considered.
e. Cerebral bleeding is a rare complication.

48- A 34 year old lady, previously healthy, presented with a 4 day history of
petechia all over the body, her last menstrual period was heavier and longer than
usual. Her complete blood count showed; haemoglobin of 12g/dl, WBC of 9×10^9/l,
platelets of 41×10^9/l bone marrow examinations showed a reactive bone marrow
with excess of megakaryocytes. There is no evidence of chronic liver disease or
portal hypertension. Which of the following statements is true:
 a. History of upper respiratory tract infection 2 weeks ago is present in
80% of pateints.
b. Moderate splenomegaly is present in 90% of cases.
c. Positive antinuclear antibody test would alert that this patient could be
case of systemic lupus erythematosus.
d. Platelets transfusion should be commenced immediately and continued till
the platelets count is more than 50×10^9/l.
e. Haemophilus influenza vaccine is contraindicated in this cases.

49- A 35 year old female presented with a 5 day history of gum bleeding and
purpura she gave a history of sore throat a week earlier, physical examination
revealed petechial and bruises around vein-puncture sites. Concerning this patient
which of the following statements is correct:

a. A bone marrow examination should be done.

b. The presence of Splenomegaly makes I.T.P very unlikely.
c. Anti hepatitis-C antibodies should be checked.
d. Platelets transfusion is needed immediately.
e. Giant platelets on blood film are characteristics of peripheral platelets
destruction.

50- A 27 year old nurse gives history of heavy menstruation and purpuric rash for
few weeks. Her past medical and drug history is uneventful. Physical examination:
she looks healthy with petechiae all over the body CBC shows: Hb 11g/dl, WBC
5.6×10^9/l, platelets 33×10^9, ultrasound revealed normal sized liver and spleen.
The following are true except:

a. Generalized lymphadenopathy is an expected finding.

b. Bone marrow examination shows reactive increase in megakaryocytes.
c. Bleeding time is prolonged.
d. There is evidence of lgG-antibodies against thrombocytes.
e. Corticosteroids are used in the treatment.

51- A 25 year old female presents with prolonged epistaxis, she gave a history of
heavy periods and her sister has history of bleeding disorder. Physical examination
apart from pallor was normal. Haemoglobin was 9.5g/dl, WBC were 7000/cmm, with
a normal differential count and platelets were 300000/cmm. The following
statements are correct except:

a. The disease is likely to be sex linked.

b. Prothrombin time is likely to be normal.
c. She is likely to respond to factor VIII administration.
d. Factor VIII and Von Will Brand pro-coagulant activity should be
estimated.
e. Desmopressin is of value in reducing the bleeding in mild cases.

52- A 22 year old male presented with acute abdomen. Assessment revealed an
acute appendicitis. Appendectomy was performed but the patient developed
prolonged bleeding the wound afterwards. He did not have any previous history of
bleeding diathesis in the past. There was no history of any drug intake. The
following statements are true about his condition, except:

a. A similar history in his sister would support the diagnosis of factor VIII
deficiency.
b. Splenomegaly with prolonged prothrombin time suggests an underlying
liver disease.
c. Prolonged bleeding time, reduced factor VIII level and reduced vWF are
consistent with the diagnosis of von willebrands disease.
d. Cryoprecipetate is not effective in the treatment of haemophilia B.
e. Hemarthrosis is recognized complication.

53- A 44 year old woman presented with epistaxis, her CBC shows:

• Hgb 12.4g/dl

• WBC 8.1×10^9/l

• Platelets 24×10^9/l

All of the following may be used in the management of this cases except:

a. Platelets transfusion.
b. Pridnisolne.
c. Rituximab.
 d. Chlorambucil.
e. High dose immunoglobin.

54- In acute lymphoblastic leukaemia all are true except :

a. Reduction of uric acid level, with hydration and allopurinol is needed

before starting chemotherapy .
b. Auers rods are NOT common as in acute myeloid leukaemia(AML).
c. CNS involvement carries poor prognosis.
d. Febrile neutropenia should be treated immediately with a third
generation cephalosporin.
e. Bone marrow transplantation after remission is a curative option.

55- The following about acute leukaemia are correct except :

a. They are clonal bone marrow disorders.

b. Typically associated with the presence of large numbers of blast cell in
bone marrow.
c. Anthracyclines are the main drugs used in induction therapy.
d. Stem cell transplant is used for resistant cases only.
e. Acute pro-myelocyticleukemia{M3} carries the best prognosis.

56- in acute leukemia all are true except :-

a-there is a failure of cell maturation

b-in adult, acute lymphoblastic leukemia is more common than acute
myelblastic leukemia
c-bleeding tendency is one of the clinical features
d-in advanced cases hepatosplenomegaly is present
e-enlarged lymph nodes are common feature of the lymphoblastic form

57- the following are poor prognostic feature in acute leukemia except :-
 a-young age
b-male sex
c-high leukocytes levels at diagnosis
d-CNS involvement at the diagnosis
e-cytogenic abnormalities

58- In chronic lymphocytic leukaemia all are true except :

a. An absolute lymphocytosis is observed.

b. Thrombocytosis is observed.
c. Splenomegaly may be present.
d. The development of an acute blastic crisis is possible.
e. Coombs positivity is possible.

59- chronic lymphocytic leukaemia which is true :-

a-the onset is rapied

b-the diagnosis is based on the peripheral blood film and BM
c-in stage C there is no anaemia or thrombocytopenia
d-no specific treatment
e-90% of patient died by infection

60- regarding chronic lymphatic leukemia all are false except :-

a-more than 90% T-cells

b-huge spelnomegaly is an early sign
c-autoimmune haemolysis may occur
d-more common in female
e-the prognosis very good

61- The following are typical finding in patients with chronic myeloid leukaemia
except:

a. Splenomegaly.
b. Leucopenia.
c. Thrombocytosis.
 d. Anemia.
e. Philadelphia chromosome positive in blood cells.

62- In chronic myeloid leukaemia all are true except :

a. The peripheral blood film is diagnostic in the majority of cases.

b. Philadelphia chromosome is presented in 90% of patients.
c. Bone marrow transplantation should be carried out late in the course of
the disease.
d. Transformation is characterized by an increase in the number of blast
cells.
e. Imitinab mesylate is the treatment of choice.

63- chronic myeloid leukaemia characterized by all except :-

a-presence of Philadelphia chromosome

b-occurs in old people
c- massive lymphadenopathy
d-huge splenomegaly
c-Priapism may occur

64- Regarding leukaemia's which is false :

a. Chronic leukaemia occurs mainly in middle and old age.

b. Male sex is poor prognostic feature in acute leukaemia.
c. Philadelphia chromosome in approximately 90% of patients with CML.
d. Stage B in CLL is characterized by thrombocytopenia with 3 or more
involved areas of lymphoid enlargement.
e. No specific treatment is required in stage A in CLL

65- Regarding Leukaemia's all are true except :

a. Immune deficiency states(hypogammaglobulinemia) are a recognized risk

factor.
b. Huge splenomegaly is in favour of Chronic Myeloid Leukaemia.
c. Cytotoxic drug therapy may induce myeloid leukaemia after a latent
period of several years.
 d. Chronic Lymphocytic Leukaemia has poor prognosis.
e. Appearance of blast cells and other primitive cells in blood film is usually
diagnostic of chronic leukemias

66- A 54 year old lady suffering from chronic myeloid leukaemia on treatment for
5 years, presented this time with increasing fatigue, left abdominal discomfort.
Her WBC count is 80×10^9/l, which was normal 3 months ago, platelet count is
elevated compared to previous readings. Which of the following statements
regarding this patients case is true:

a. Pain over the sternum is expected.

b. Generalized lymphadenopathy is recognized.
c. Blast cells of 5% in the bone marrow suggest blast transformation.
d. Imitinab mesylate is recognized modality of treatment at this stage.
e. Hyperuricemia is an expected complication.

67- A 50 old lady presented with a six weeks history of tiredness and upper
abdominal discomfort. On examination she was pale and abdominal examination
revealed hepato-splenomegaly. Her haemoglobin was 7.1g/dl, WBC 71×109/l, with
neutrophilia , platelet count qf/770×109/l. The following are correct except:

a. The Philadelphia chromosome is likely to be positive.

b. Basophilia is indicative of poor prognosis.
c. Transformation into an acute phase could be heralded by
thrombocytopenia.
d. Imitinab mesylate is the treatment of choice.
e. Splenectomy will lead a haematological remission.

68- A 60 year old male presented with brusising and tiredness, examination
reveals 4 finger breadth splenomagely and his results reveal:

• Heamoglobin 11g/dl (11.5-16)

• White cell count 100×10^9/l

• Platelets 900×10^9/l
Blood film reaveals a neutrophilla, basophilla,numerous myelocytes and 4%
myeloblasts. Which of the following is likely to be presented in this patient?

a. Delection of chromosome 22.

b. Delection chromosome 13.
c. Delection 11q 13.
d. Normal chromosomal analysis.
e. Translocation 9:22.

69- an 80 year old man presets with early satiety and left hypochondrial
discomfort. O/E tenderness at left hypochondrial, splenomegaly of 10cm below
costal margin. CBC: Hb 11g/dl, WBC 86,000/ul, platelet 560,000/ul. Which of the
following is most likely diagnosis:-

a-chronic lymphocytic leukemia

b-infection mononucleosis
c-chronic myeloid leukemia
d-hereditary spherocytosis

70- In Hodgkin's disease all are true except :

a. The anemia is normochromic normocytic.

b. The nodular sclerosis type is the most common but carries the worst
prognosis.
c. The presence of Reed Stemberg cells clearly differentiates it from Non-
Hodgkin's Lymphoma.
d. Superior vena cava obstruction may occur.
e. Raises LDH has an adverse prognostic effect.

71- Hodgkin lymphoma all are true except :-

a-pain full rubbery lymphadenopathy

b-LDH level has prognostic factor
c-the most common is nodular sclerosing
d-CBC may be completely normal
e- main treatment is chemotherapy
72- In hodgkins disease which is true :

a. Delayed type hypersensitivity reaction .

b. The diagnosis can be made with a bone marrow smear in 50% of cases.
c. Eosinophilia is detected in approximately 10% of cases.
d. Absolute lymphocytosis is a typical finding.
e. Haemolytic anemia may occur.

73- Hodgkin lymphoma all of the following are true except:

a. It is a disease primary involving the lymph nodes.

b. Has a peak incidence in the seventh decade.
c. Weight loss and sweating are poor prognostic factors.
d. Chemotherapy is the standard treatment in most cases.
e. Involvement of lymph nodes above and below diaphragm denotes stage
III disease.

74- In patients Hodgkin's Lymphoma all are true except :

a. Involvement of the cervical and inguinal lymph nodes puts the patient into
stage III.
b. Presence of reed Stemberg Cells in the tissue biopsy confirms the
diagnosis.
c. Normal LDH does not excludes the diagnosis.
d. Infertility could complicate treatment.
e. Stage IV disease should be treated with radiotherapy alone.

75- In Non-Hodgkin's lymphoma all of the following are true except:

a. Is a malignant clonal neoplasia of B and T lymphoma.

b. Burkett's lymphoma is a subtype of B cell lymphoma.
c. High lactate dehydrogenase(LDH) is a good prognostic factor.
d. Helicobacter pylori is an aetiological factor of MALT lymphoma.
e. Chemotherapy can induce remission.
76- The following statements are true regarding lymphomas except:

a. Lymphadenopathy and splenomegaly are characteristic presenting

features.
b. When localized to the stomach have a very poor prognosis.
c. Most lymphomas are monoclonal B cell malignancies.
d. Chromosomal aberrations are very common.
e. Have a recognized association with HIV infection.

77- A 33 year old female patient presented to the medical OPD with generalized
weakness fever, night sweat and loss of weight for 6 weeks. On examination, she is
pale, no bruises but has non tender bilateral cervical lymphadenopathy . The
following are true except:

a. Lymph node biopsy is essential for diagnosis.

b. Presence of reed Sternberg cell indicates Non-Hodgkin lymphoma.
c. Chemotherapy is the treatment of choice.
d. CT sans of chest and abdomen are indicated.
e. The response rate to chemotherapy is 70%.

78- Regarding Multiple Myeloma all are false except :

a. 60% of patients present with back and rib pain.

b. Hypocalcaemia is recognized feature.
c. Alkaline phosphatase is high in the absence of fractures or bone repair.
d. 50% of patients with ESR>100mm/hr had multiple myeloma.
e. High levels of b2 micro globulins are associated with good prognosis.

79- The following are true regarding Multiple Myeloma except:

a. Is a clonal plasma cell disorder.

b. Is associated with the presence of monoclonal band on protein
electrophoresis.
c. Hypercalcemia and renal failure are recognized complications.
d. It effects mostly people at 6th to 7th decade.
e. Cure is usually achieved with 2 cycles of melphalan and prednisolone.
80- the following are manifestations of multiple myeloma except:-

a-pathological fractures
b-hyperviscosity syndrome
c-hypercalcaemia
d-normal ESR
e-Raynauds phenomena

81- Multiple myeloma is characterized by one of the following :

a. Raised levels of immunoglobulin IgA in the majority of cases.

b. Marked elevation of serum alkaline phosphatase.
c. Hypocalcemia.
d. Bone marrow aspirate showing reed Stemberg cells.
e. Recurrent respiratory tract infections..

82- 70 years old male patient presented with back pain constipation, generalized
fatigability and dyspnea on exertion. On examination he was febrile, pale
dehydrated, no lymphadenopathy and no organomegaly. CBC show Hb of 7.8gm%,
WBC 10.000/mm³,platlets 300000/mm³, ESR 98mm/hr, Urea 72 mg%, Creatinine
1.4mg%, serum Ca 11.9 mg/dl(elevated). The following are true except:

a. Bone marrow will show plasmacytosis.

b. X-ray of skull will show multiple osteoporetic lesions.
c. High fluid intake is advisable to treat renal impairment.
d. Bisphosphonates are not beneficial for hypercalcemia.
e. Melphalan and prednisolone are effective therapy.

83- A 64 year old man presented with back pain, fatigue and shortness of breath
on exertion. On physical examination, he has pallor but is otherwise normal. He
denies blood loss, and stool is negative for occult blood. He is anemic (haemoglobin
8.4g/dl) with normochromic, normocytic indicates, and his serum creatinine level is
2.9mg/dl(N up to 1.3mg/dl. All of the following are true regarding patients case
except:

a. His condition is duo to malignant proliferation of T cells.

b. Increase risk of infections is likely duo to immune dysfunction.
 c. His diagnosis is typically confirmed by bone marrow examination.
d. High calcium level at presentation caries poor prognosis.
e. Erythropoitin therapy is not indicated.

84- A 60 year old female presented with bone pain and pallor. The laboratory data
revealed:

• Hb 10.1g/dl (N12-16)

• Calcium 12.5mg/dl (N 8-10.5)

• Gamma globullin 40% (N 11-22%)

• ESR 120mm/1st hr (N<20)

The following investigations are commonly needed for further evaluation,

except:

a. Radiological skeletal survey.

b. Bone marrow aspiration.
c. 24hr urine colletion for Albumin.
d. Renal function test.
e. Immunoglobin electrophoresis.

85- A 60 year old farmer presented complaining of persistent low back pain of 3
months duration, he feels unwell with general malaise and recurrent chest
infections for the same duration, physical examination was unremarkable apart
from pallor and bony tenderness. Hb 7.8gm%, normocytic normochromic, ESR 110 in
1st hr. The following are true except:

a. History of numbness and weakness in the lower extremities support the

diagnosis.
b. Hepato-splenoemgaly is expected.
c. Bence jones proteins in urine are likely to be positive.
d. Melphalan with or without corticosteroids is the treatment of choice.
e. Autologus stem cell transplantation improves survival.
86- In polycythaemia rubravera which is true :

a. The reticulocyte count is typically elevated.

b. The wbc alkaline phosphatase activity is low.
c. ESR is high .
d. High hematocrite .
e. The serum total iron level is typically elevated.

87- The following are features of myeloproliferative disorders except:

a. It is a disease of hematopoietic stem cell.

b. Associated with increased incidence of thrombo-embolic complications.
c. Allopurinol is used in the supportive treatment.
d. Acute leukaemia is unlikely complication.
e. Philadelphia chromosome is positive in > 90% of CML patients.

88- Regarding Myloprolifirative disorders all are false except :

a. Raised Neutrophil alkaline phosphatase in Mylofibrosis.
b. Peptic ulcer is not a recognized feature of primary proliferative polycythaemia.
c. In essential thrombocytosis active treatment to reduce platelet count is
indicated regardless of symptoms and age of patient.
d. The median life span after diagnosis of primary proliferative polycythemia is
less than 5 years in treated patients. e.
Hydroxyurea can be used to reduce the spleen size in myelofibrosis.

89- A 50 year old women presented with a 6 months history of dragging left
hypochondrail pain and tiredness. Physical examination reveals pallor ad an enlarged
spleen that was felt below the umbilicus Hb 6.8g/dl, WBC 13×10^9/l, platelets
576×10^9/l. blood film: nucleated RBCs and teardrop shaped red cells were
seen,all of the following are true regarding pateints case except:
a. The most likely diagnosis is myelofibrosis.
b. The liver is likely to enlarge as the disease progresses.
c. Transformation on to acute leukaemia occurs.
d. The philadephia chromosome is likely to be positive.
e. Blood transfusion and allopurinol are useful supportive measures.