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GENESIS
(Post Graduation Medical orientation Centre)
Exam : Blood & Hematology (Basic Exam January'25)
Course: FCPS Part-1 Discipline: Surgery & Allied
Batch: Offline P-1 Surgery Foundation Batch-1 Jan'2025
Year: 2025 Session: January'25 P-1 Candidate
1. Formation of hemoglobin-
a) 2 succinyl-CoA + 2 glycine ------ pyrrole
b) 4 pyrrole---------------------------- protoporphyrin X
c) Protoporphyrin X + Fe++------- heme
d) Heme + dipeptide--------------- hemoglobin chain (_alpha OR beta )
e) 2 alpha chains + 2 beta chains------------- hemoglobin A
TFFFT
2 succinyl-CoA + 2 glycine ------ pyrrole
4 pyrrole---------------------------- protoporphyrin IX
Protoporphyrin IX + Fe++------- heme
Heme + polyipeptide--------------- hemoglobin chain (_alpha OR beta)
2 alpha chains + 2 beta chains------------- hemoglobin A
[Ref: Guyton and Hall/14th/P-443]
2. Plasma of a normal adult-
a) Is about 91-92% water
b) Accounts for 10% of body weight
c) Contains 8 mmol/L of K+
d) Contains about 140 mmol of Na+
e) Contain xanthine and hypoxanthine
TFFTT
b) 5% of body weight
c) 3.8-5 mmol/L
d) 138 -146 mmol/L
[Ref: Guyton & Hall/14th/P-306-308] [Ref: Ganong/26th/P-4]
[Ref: Chakrabarti/2nd/P-149] [Ref: Vision/9th/P-53]
[Ref: Guyton and Hall/14th/P-306] [Ref: Ganong's Physiology/26th/P-4]
3. Total count of RBC is reduced but MCV and MCHC are normal due to–
a) Acute hemorrhage
b) Renal failure
c) Iron deficiency
d) Chronic inflammation
e) Lack of intrinsic factor
TTFFF
b) In chronic renal failure, there is normochromic normocytic anaemia (MCV and MCHC
normal but ed RBC)
c) In Iron Deficiency, both MCV and MCHC decrease than normal
d) In chronic inflammation, reticulocyte response to anemia is impaired contributing
decreased RBC count
Normochromic and normocytic in chronic inflammation
e) In lack of intrinsic factor, MCV and MCHC increases
• Normal MCV suggests either acute blood loss or the Anaemia of chronic disease
[Ref: De Gruchy/6th/P-103] [Ref: Hoffbrand/7th/P-22]
[Ref: Hoffbrand's Essential Haematology/7th/P-22]
4. Megaloblastic anaemia–
a) MCV > 120fL
b) PBF – Hyperpigmented neutrophil
c) PBF – pencil cell
d) Reticulocyte count – low
e) Thrombocytosis
TTFTF
Pencil cell found in Iron def. Anaemia
Platelet count low or normal in megaloblastic increase
[Ref: Guyton and Hall/14th/P-440]
5. Target cells appear in peripheral blood film in
a) Thalassaemia
b) Sickle cell anemia
c) Aplastic anemia
d) Pernicious anemia
e) Iron deficiency anemia
TFFFT
Explanation:
Target cells found in-
Target cells found in-
Iron deficiency anemia
Thalassaemia
Liver disease
Post splenectomy
Hemoglobin disease
How to interpret red cell appearances
Microcytosis (reduced average cell Nucleated red blood cells (normoblasts) [F]
size, MCV < 76 fL) [A]
• Iron deficiency •Sideroblastic •Marrow infiltration •Myelofibrosis
•Thalassaemia anaemia •Severe haemolysis •Acute haemorrhage
Macrocytosis (increased average cell Howell-Jolly bodies (small round nuclear
size, MCV > 100 fL) [B] remnants) [G]
• Vitamin B12 or • Drugs (e.g. •Hyposplenism •Dyshaematopoiesis
folate deficiency zidovudine, • Post-splenectomy
•Hypothyroidism • Liver disease, Polychromasia (young red cells -
•Myelodysplastic alcohol trimethoprim, reticulocytes present) [H]
syndromes phenytoin, •Haemolysis, acute • Increased red cell
methotrexate, haemorrhage turnover
hydroxycarbamide)
Target cells (central area of Basophilic stippling (abnormal ribosomal
haemoglobinisation) [C] RNA appears as blue dots) [I]
• Liver disease • Post-splenectomy
•Thalassaemia •Haemoglobin C
•Dyshaematopoiesis • Lead poisoning
disease
Spherocytes (dense cells, no area of
central pallor) [D]
•Autoimmune • Post-splenectomy
haemolytic • Hereditary
anaemia spherocytosis
Red cell fragments (intravascular
haemolysis) [E]
• Microangiopathic haemolysis, e.g.
haemolytic uraemic syndrome (HUS),
thrombotic thrombocytopenic purpura
(TTP)
• Disseminated intravascular coagulation
(DIC)
[Ref: Davidson’s/23rd/P-921/Box-23.2]
[Ref: Khaleque Pathology/2021/P-185
[Ref. Davidson/23rd P-921 + Khaleque Pathology/P-218]
6. Features of hemolytic anemia include
a) Microcytic blood Picture
b) Increased reticulocyte count
c) Increased conjugated bilirubin
d) Reduced heptoglobin
e) Raised LDH
FTFTT
Explanation
a) Microcytic blood Picture due to reticulocytosis
b) compensatory rising
c) Increased unconjugated bilirabin
e) Due to hemoloysis
[Ref: Davidson's/23rd/Box-23.36/P-946]
7. Very high ESR is/are found in
a) Polycythemia
b) Multiple myeloma
c) Tuberculosis
d) Congenital cyanotic heart disease
e) Aplastic anemia
FTTFT
Explanation:
d. ESR normal
e. Not very high
[Ref: Vision/9th/P-76] [Ref: Guyton/14th/P-439]
[Ref: Guyton and Hall/14th/P-439]
8. True regarding the bleeding time-
a) Measures the rate of bleeding from a small puncture
b) Is significantly prolonged in haemophilia.
c) Normally averages about 2-3 minutes.
d) Is dependent of the platelet count.
e) Normally averages about 6-10 minutes
FTFTF
a) Measure the time of bleeding
a) Measure the time of bleeding
c + d) Normally averages 1-6 minutes
[Ref: Guyton and Hall/14th/P-487]
9. The plasma proteins:
a) Are essential for blood coagulation.
b) Can be separated by electrophoresis.
c) Are in a dynamic state.
d) Have buffering power
e) Have role in maintaining viscosity of blood
TFFTT
Properties of plasma protein:
• Essential for blood coagulation
• Fractional precipitation
• Precipitation by salt
• Sedimentation by ulfracentrifuge
• Electrophoretic mobility
• Isoelectric point
• Osmotic effect
• Viscosity, molecular weight
• Almost all plasma protein are glycoprotein.
• Exhibits polymorphism
• Has a characteristics half life. Eg: albumin 20-26 days.
• Has a buffering power
[Ref: Ganong's Physiology/26th/P-551]
10. Which statements are true regarding the platelets?
a) Are formed from the megakaryocytes.
b) Have large nuclei
c) Contain serotonin
d) Activated by ADP
e) Contain Calcium
TFTTT
b) Do not have nucleus
[Ref: Ganong's Physiology/26th/P-545]
11. Cells of the reticuloendothelial system are found in the:
a) Lungs
b) Liver
c) Bone marrow
d) Lymph nodes
e) Heart
TTTTF
The total combination of monocytes, mobile macrophages, fixed tissue macrophages, and a
few specialized endothelial cells in the bone marrow, spleen, and lymph nodes is called the
reticuloendothelial system. Tissue macrophages present in Liver, Lungs, skin, lymph nodes,
bone marrow, spleen, bone, CNS, kidney.
[Ref: Ganong's Physiology/26th/P-452]
12. The coagulation time is prolonged in:
a) Haemophilia.
b) Anaemia
c) Polycythaemia
d) Purpura
e) Von Willebrand’s disease
TFFFT
Coagulation time prolonged in-
A. Congenital Coagulation disorders
1. Haemophilias
a) Haemophilia A (Classical haemophilia)
b) Haemophilia B (Christmas disease)
2. Von Willebrand’s disease
3. Other congenital deficiency disorders:
(a) Fibrinogen (Factor I) deficiency
(b) Prothrombin (Factor II) deficiency
(c) Factor V, VIII, X, XI or XII (Hageman factor) deficiency
(d) Factor XIII (Fibrin stabilizing factor) deficiency.
B. Acquired Coagulation Disorders
(1) Vitamin K deficiency
(2) Liver disease
(3) DIC
(4) Massive blood transfusion of stored blood
(5) Anticoagulant drug.
[Ref: Guyton/14th/P-484-487]
[Ref: Guyton and Hall/14th/P-484]
13. Essential factors for coagulation-
13. Essential factors for coagulation-
a) Factor I
b) Factor II
c) Factor V
d) Factor VII
e) Factor IX
TTFFF
First for clotting factors are called the essential factors for coagulation as without them
coagulation will not occur.
[Ref: Guyton/14th/P-479-480]
[Ref: Guyton and Hall/14th/P-479]
14. Blood coagulation requires-
a) Inactivation of heparin
b) Inactivation of plasmin
c) Calcium ions
d) Vitamin K
e) Vitamin C
TFTTF
b) Although plasmin degrades fibrin clot, core of thrombus; for blood coagulation it’s
inactivation is not a requirement
e) Protein C helps in blood coagulation
Also:
b) Activation of plasmin is associated with lysis of clot formed by blood coagulation but for
coagulation inactivation is not required. It remains in blood as plasminogen; even in clot it
remains in this from along with other proteins
e) Protein C is required not vitamin C
[Ref: Guyton/14th/Fig-37.5, 37.6/P-481, 482]
[Ref: Davidson/23rd/P-918/Fig-23.6]
[Ref: Guyton and Hall/14th/P-481] [Ref: Davidson/23rd/P-981]
15. Complications of massive blood transfusion are
a) Hypocalcaemia
b) Hypokalemia
c) Coagulopathy
d) Hyperthermia
e) Hypervolemia
TTTFT
TTTFT
[Ref: Bailey and Love’s/28th /P-22]
Explanation:
Massive Blood Transfusion complications
• Fluid overload
• Thrombocytopnea
• Decreased oxygen release by transfused red cells due to 2,3-bisphosphoglycerate(2,3-
BPG) levels (left shift in Hg-02 Curve).
• Hypothermia
• Acid/base derangements
• Coagulopathy
• Citrate toxicity
• Electrolyte abnormalities
o Hypocalcemia
o Hypomagnesemia
o Hypokalemia
o Hyperkalemia
• Transfusion-associated acute lung injury
[Ref: Bailey & Love’s/28th/P-22]
16. Regarding RBC
a) Are biconcave disks having a mean diameter of about 7.8 cm
b) Thickness of 2.5 micrometers at the widest point
c) Average volume of the RBC is 90 to 95 cubic micrometers
d) Is a“bag” that can be deformed into almost any shape
e) Persons living at high altitudes have greater numbers of RBCs
FFTTT
Shape and Size of Red Blood Cells. Normal RBCs, shown in Figure 33-3, are biconcave disks
having a mean diameter of about 7.8 micrometers and a thickness of 2.5 micrometers at
the thickest point and 1 micrometer or less in the center. The average volume of the RBC is
90 to 95 cubic micrometers. The shapes of RBCs can change remarkably as the cells
squeeze through capillaries. Actually, the RBC is a“bag” that can be deformed into almost
any shape. Furthermore, because the normal cell has a great excess of cell membrane for
the quantity of material inside, deformation does not stretch the membrane greatly and,
consequently, does not rupture the cell, as would be the case with many other cells.
Concentration of Red Blood Cells in the Blood. In healthy men, the average number of RBCs
per cubic millimeter is 5,200,000 (±300,000); in women, it is 4,700,000 (±300,000).
Persons living at high altitudes have greater numbers of RBCs, as discussed later
[Ref: Guyton and Hall/14th/P-443]
17. Following are the effects of anemia on the circulatory systems are-
a) Raised blood viscosity
b) Increased resistance in the peripheral blood vessels
c) Increased quantities of blood returned to the heart
d) Increased workload on the heart
e) Decreased heart rate
FFTTF
a) Decreased blood viscosity
[Ref: Ganong/26th/P-564]
b) Decreased resistance in the peripheral blood vessels
c) Blood flow also increased due to decrease viscosity
e) Tachycardia
[Ref: Hoffbrand/7th/P-20]
Also:
a+b) Decreased blood viscosity causing hyperdynamic circulation and a systolic flow
murmur is heard at apex. SO resistance also decreases
[Ref: Kumar & Clark's/9th/P-521]
[Ref: Ganong's Physiology/26th/P-564]
18. Iron absorption from GIT depends on-
a) Loss of body iron
b) Availability of transferrin only
c) Storage of iron in the body
d) Chemical conversion of dietary iron
e) State of circulation in the intestinal wall
TFTTF
b) False. Amount of iron absorbed is regulated according to the levels of DMT -1 and
ferroprotein
d) Ferro reductase present at the apical surface converts iron from Fe3+ at the basal
surface prior to binding to transferrin
[Ref: Ganong's Physiology/26th/P-477]
19. Red blood cells remain separated from each other in the circulating blood by-
a) Constant movement of RBC
b) Negative electrostatic charge of RBC membrane
c) Attraction of vascular endothelium
c) Attraction of vascular endothelium
d) Distraction of protein Band 3
e) Its biconcave shape
TTFFF
Explanation:
c) It is not cause of RBC separation from each other.
d)Protein Band 3 for anion transport across RBC membrane
e) Being biconcave shape RBC easily squeeze through capillaries
[Ref: Davidson's Principle and Practice Medicine/24th/P-946] [Ref: Guyton and Hall/14th/P-
439]
20. Prolonged standing of whole blood after collection can
a) Decrease blood glucose level
b) Decrease serum K+ level
c) Increase intracellular enzyme in serum
d) Increase in blood urea concentration
e) Increase in serum Na+ concentration
TFTFT
[Ref: Principle and Practice of Transfusion Medicine/2nd/P-89 -90+ Professor
Mainuddin Undergraduate Haematology/P-119]
Explanation:
It means prolong storage of blood
21. The term hemostasis means prevention of blood loss. Whenever a vessel is
severed or ruptured, hemostasis is achieved by–
a) Vasoconstriction
b) Vasodilation
c) Formation of a platelet plug
d) Formation of a blood clot
e) Eventual growth of fibrous tissue
TFTTT
The term hemostasis means prevention of blood loss. Whenever a vessel is severed or
ruptured, hemostasis is achieved by several mechanisms:
(1) Vascular constriction;
(2) Formation of a platelet plug;
(3) Formation of a blood clot as a result of blood coagulation; and
(4) Eventual growth of fibrous tissue into the blood clot to close the hole in the vessel
permanently.
permanently.
[Ref: Guyton and Hall/14th/P-477]
22. Blood coagulation outside of the body is prevented by-
a) Heparin
b) Warfarin
c) Sodium citrate
d) Ammonium citrate
e) High conc. of ionized Ca2+
TFTTF
Blood coagulation outside of the body is prevented by heparin, soluble oxalate, sodium,
ammonium and potassium citrate.
[Ref: Guyton and Hall/14th/P-487]
23. Changes in DIC -
a) Decrease Platelets
b) Increase BT but decrease CT
c) Decrease FDP
d) Increase fibrinogen conc.
e) Decrease Factor 1,2,5,8,10
TFFFT
Changes in DIC-
• Platelet count
• Factor 1,2,5,8,10
• BT, CT, PT, APTT, Thrombin time, fibrinogen conc.
• +ve D-dimer
• Thromboplastin generation time
[Ref: Guyton and Hall/14th/P-486]
24. Factors used in extrinsic pathway of coagulation-
a) Factor III
b) Factor VII
c) Factor VIII
d) Factor IX
e) Factor XI
TTFFF
Extrinsic pathway factors are-
Extrinsic pathway factors are-
• Factor III
• Factor VII
[Ref: Guyton/14th/P- 481-482]
[Ref: Guyton and Hall/14th/P-481]
25. After splenectomy, which of the following will be present in PBF?
a) Target cells
b) Microcytic RBC
c) Howell-Jolly body
d) Pencil cell
e) Pappenheimer bodies
TFTFT
Explanation:
b+d- Found in iron deficiency anemia[ Ref: Hoffbrands/ 8th/P-23]
26. A 60 years old lady present with jaundice. Following a minor ward based
surgical procedure she develops troublesome and persistent bleeding.
Deficiency of which of vitamins listed below is responsible?
a) Vit-C
b) Vit-K
c) Vit-D
d) Vit-B
e) Vit-A
B
Jaundice patients have impaired absorption of Vit-K. This can result in loss of the Vit K
dependent clotting factors
dependent clotting factors
[Ref: Ganong's Physiology/26th/P-557]
27. A 60- year- old male came to you with LBP and weakness. On examination you
found Anaemia (+++), X-ray L/S show Lytic lesion, S. creatinine 5 mg/dl
.Which of the following is appropriate diagnosis?
a) CML
b) Multiple myeloma
c) DIC
d) CLL
e) Iron deficiency anaemia
B
This is a case of multiple myeloma
Explanation:
1. Bone pain (especially backache) resulting from vertebral collapse and pathological
fractures (Fig. 21.5a,b).
2. Features of anaemia, such as lethargy or weakness.
3. Recurrent infections: related to deficient antibody production, abnormal cell-mediated
immunity and neutropenia.
4. Features of renal failure and/or hypercalcaemia: polydipsia, polyuria, anorexia, vomiting,
constipation and mental disturbance.
5. Abnormal bleeding tendency: myeloma protein may interfere with platelet function and
coagulation factors; thrombocytopenia occurs in advanced disease.
6. Amyloidosis occurs in 5% with features such as macroglossia, carpal tunnel syndrome
and diarrhoea.
7. In approximately 2% of cases there is a hyperviscosity syndrome with purpura,
haemorrhages, visual failure, central nervous system (CNS) symptoms, neuropathies and
heart failure
[Ref: Davidson's Principle and Practice Medicine/24th/P-976]
28. Which is not correct regarding about temperature for Blood product–
a) Whole blood: 2-80C
b) RCC: 2-80C
c) FFP: -300C
d) Platelet: 2-80C
e) Cryoprecipitate: -300C
D
Platelet is kept at 220C for 5-days or in room temperature
[Ref: Davidson's Principle and Practice Medicine/24th/P-941]
29. Which of the following is seen in PBF of a patient who has underwent
splenectomy?
a) Howell jolly bodies
b) Eosinophilia
c) Microcytosis
d) Thrombocytopenia
e) Neutrophilia
A
After splenectomy, following inclusion bodies are found---howell jolly bodies, pappenheimer
bodies, HZ bodies
[Ref: Ganong's Physiology/26th/P-550] [Ref: Davidson's Principle and Practice
Medicine/24th/P-931]
30. A 36-year-old woman who was commenced on warfarin following mechanical
aortic valve replacement for a congenital bicuspid valve developed skin
necrosis. Deficiency of which of the following proteins could be responsible for
this disorder?
a) Heparin cofactor II
b) Plasmin
c) Protein C
d) Protein S
e) Protein Z
C
Explanation:
Protein C deficiency
Inheritance is autosomal dominant with variable penetrance. Protein C levels in
heterozygote individuals are approximately 50% of normal. Characteristically,
many patients develop skin necrosis as a result of dermal vessel occlusion when
treated with warfarin, thought to be caused by a further reduction of protein C
levels in the first day or two of warfarin therapy. Rarely, infants may be born with
homozygous deficiency and characteristically present with severe disseminated
intravascular coagulation (DIC) or purpura fulminans in infancy. Administration of
protein C was once thought to be beneficial in patients with sepsis but it is no
longer generally used.
(Ref: Hoffbrand 7th/Page-305)
31. A patient ē thalassemia with hypersplenism gone through splenectomy
31. A patient ē thalassemia with hypersplenism gone through splenectomy
operation. Which organism is not responsible for post –splenectomy
septicemia?
a) Streptococcus pneumonia
b) Neisseria meningitidis
c) Hemophilus influenzae
d) E.coli
e) Influenza virus
E
(a, b, c, d are responsible for post splenectomy septicemia)
Explanation:
After splenectomy, septicemia may occur by streptococcus pneumonia, Neisseria
meningitidis ,H. influenzae and E. coli. Influenza virus in not responsible.
[Ref: Hoffbrand’s/7th/10.4/P-121]
32. Plasma colloidal osmotic pressure is mainly maintained by-
a) Albumin
b) Globulin
c) Fibrinogen
d) Prothrombin
e) Transferrin
A
Explanation:
Plasma proteins exert the oncotic pressure. Albumin generates about 70% of oncotic
pressure . Since the albumin concentration is more then other plasma proteins it exerts
maximum pressure. It contributes about 70-80% b of2 osmotic pressure. Globulin is next
and fibrinogen exerts least pressure
[Ref: Vision Physiology/9th/P-55]
33. A 5-year-old baby-Bone marrow aspiration done from?
a) Anterior aspect of iliac crest
b) Upper end of tibia
c) Post iliac crest
d) Sternum
e) Femur
[Ref: Hoffbrands/6th/P-25]
Explanation:
Explanation:
Posterior iliac crest
Sternum if obese
Tibia in infants
34. Main precursor for erythropoesis-
a) Iron
b) Vit B12
c) Erythropoetin
d) Androgen
e) Thiamine
C
Erythropoesis is regulated by the hormone erthropoietin .Erthropoietin is a heavily
glycosylated polypep tide normal 90% of the hormone is produced in the kindney and 10 %
in the liver and elsewherer. There are no preformed stores and stimulus to erythropotin
production is the O2 tension the tissue kidney according to ganong 85% of erythro poietin
secreted from kidney and 15% from liver
[Ref: Vision Physiology/9th/P-59]
35. A 2 years old boy bruises easily and has previously had bleeding gums. The
maternal grandfather has a bleeding disorder. His physical examination shows
several small bruises on the legs. Of which coagulation factor would you
suspect this patient to be deficient?
a) Prothrombin activator
b) Factor II
c) Factor VIII
d) Factor X
e) Factor XIII
C
A young man with bleeding disorders and a history of bleeding disorders in the males of his
family would lead one to suspect hemophilia A, a deficiency of factor VIII.
[Ref: Guyton and Hall/14th/P-485]
36. Key factor for coagulation is-
a) Factor I
b) Factor II
c) Factor III
d) Factor IV
d) Factor IV
e) Factor VIII
B
Activated thrombin activates Platelets and converts fibrinogen into fibrin which are two
major step of coagulation, thus called key factor of coagulation.
[Ref: Guyton/14th/P-479-480]
[Ref: Guyton and Hall/14th/P-479]
37. Factor which is synthesized both in Platelets and endothelium-
a) Factor II
b) Factor I
c) Factor VII
d) Factor VIII
e) vWF
E
vWF is synthesized both in Platelets and endothelium.
[Ref: Guyton and Hall/14th/P-485]
38. The plasma globulins are synthesized mainly in the:
a) Liver.
b) Heart
c) Lungs
d) Reticuloendothelial system
e) Kidneys
D
All plasma protein produced in Liver except Globulin which comes from reticuloendothelial
system.
[Ref: Ganong's Physiology/26th/P-551]
39. Confirmatory diagnosis of hemophilia-
a) Raised APTT
b) Normal PT
c) Factor Assay
d) Normal BT
e) Normal Platelet
C
Confirmatory test for Hemophilia is Factor 8 assay
[Ref: Hoffbrand's Essential Haematology/7th/P-291] [Ref: Davidson's Principle and Practice
Medicine/24th/P-556]
40. Which parameter is most specific for diagnosing DIC?
a) Platelet count
b) FDP
c) D-dimer
d) APTT
e) Fibrinogen
C
In DIC, D- dimer is high level in serum and urine, platelet count, PT, APTT and fibrinogen
level may be altered in other causes too. In DIC, Test for hemostasis 1.The platelet count is
low
2. Fibrinogen conc is low
3.Thrombin time is prolonged
4. High levels of fibrin degradation Product such as D- dimers are found in serum and urine
5. The PT and APTT are prolonged in the acute syndrome Compensation by the liver may
render some of the coagulation tests normal
[Ref: Kumar & Clark/8th/P-421-422]
[Ref: Hoffbrand/7th/P-299]
41. A 10 years old boy was seen in orthopedic outdoor with recurrent spontaneous
joint hemorrhages. Which of the following lab findings are most likely to be
seen in this patient?
a) Factor V def
b) Factor VIII def
c) Platelet count of 100,000
d) Positive protamine sulphate test
e) PT twice normal control
B
In hemophilia A, factor VIII is less than 0.01U/ml
[Ref: Guyton and Hall/14th/P-488]
42. A patient come to you with the complain of weakness irritable restless and
fever. He also complaints of per rectal bleeding. On examination pt is severly
pallor and no organomegaly and no enlargement of lymph nodes. BM shows
pallor and no organomegaly and no enlargement of lymph nodes. BM shows
hypocellularity. What is the most likely diagnosis?
a) IDA
b) Megaloblastic anaemia
c) Pernicious anaemia
d) Hemolytic anaemia
e) Aplastic anaemia
E
BM shows hypocellularity in aplastic anaemia
[Ref: Guyton and Hall/14th/P-452]
43. A 40 years old man following inguinal hernia repair bled excessively.
Investigations that he had a defect of primary haemostasis. Deficiency of
which of the following is most likely to cause a defect of primary haemostasis?
a) Factor V
b) Factor VII
c) Factor IX
d) Platelet
e) Protein C
D
Initial formation of platelet plug also known as primary hemostasis may fail in
thrombocytopenia. VWD and also in platelet function disorder and disease affecting the
vessel wall.
[Ref: Guyton and Hall/14th/P-484]
44. A pregnant D-negative (Rh-negative) mother has just delivered a D-positive
child. Administration of which of the following substance would be indicated?
a) Anti-D IgG to child
b) Anti-D IgG to mother
c) D- positive red cells to child
d) D- positive red cells is mother
e) Nothing is
B
Administration of Anti-D antiserum to a D-negative mother at the time of delivery of a D-
positive child. Prevents maternal alloimmunization by removing fetal red cells from maternal
circulation.
[Ref: Guyton and Hall/14th/P-478]
[Ref: Guyton and Hall/14th/P-478]
45. A 46-year-old alcoholic with sepsis was admitted into the intensive care unit
for management of coagulopathy. Which of the following laboratory tests best
distinguishes the coagulopathy of liver disease from disseminated
intravascular coagulopathy (DIC)?
a) D-Dimer test
b) Factor XIII assay
c) Partial thromboplastin time
d) Platelet count
e) Prothrombin time
A
Explanation:
In , DIC , Fibrin degradation product such as D- dimers are high level in serum and urine
other s options cant differentiated
[Ref: Hoffbrand 7th, Page-299]
46. In erythroblastosis fetalis kernicterus may develop which is a neurological
syndrome caused deposition of unconjugated bilirubin in-
a) Thalamus
b) Hypothalamus
c) Internal Capsule
d) Basal Ganglia
e) Cerebellum
D
Hemolysis in the fetus is severe, the infant may die in utero or may develop anemia, severe
jaundice, and edema (hydrops fetalis). Kernicterus, a neurologic syndrome in which
unconjugated bilirubin is deposited in the basal ganglia,
[Ref: Ganong's Physiology/26th/P-554]
47. A 23-year-old man presents with blunt abdominal trauma and a splenic bleed
is suspected. He is commenced on an infusion of tranexamic acid. Which of the
following best describes its mechanism of action?
a) Inhibition of plasmin
b) Inhibition of thrombin
c) Inhibition of factor II
d) Inhibition of factor Xa
e) Activation of factor VIII
A
Tranexamic acid inhibits plasmin and this prevents fibrin degradation.
Tranexamic acid
Tranexamic acid is a synthetic derivative of lysine. Its primary mode of action is as an anti-
fibrinolytic that competitively inhibits the conversion of plasminogen to plasmin. Plasmin
degrades fibrin and therefore rendering plasmin inactive slows this process.
[Ref: Ganong/26th/P-557/ Fig-31.13]
48. A unit of blood is stored at 4 °C. After 72 hours which of the following clotting
factors will be most affected?
a) Factor II
b) Factor VI
c) Factor V
d) Factor IX
e) Factor XI
C
Factors V and VIII are sensitive to temperature which is the reason why FFP is frozen soon
after collection.
[Ref: Guyton and Hall/14th/P-479]
49. Congenital absence of which system is one cause of hereditary
methemoglobinemia?
a) FADH2- Oxidase
b) NADH - Oxidase
C) FAD - Reductase
d) NADH- Reductase
e) Niacin Per-oxidase Correct
D
Ref: Ganong/26th/P-1265]
Explanation:
Oxidation of hemoglobin to Methemoglobin occurs normally, but an enzyme system in
the red cells, the dihydronicotinamide adenine dinucleotide (NADH)-methemoglobin
reductase system, converts methemoglobin back to hemoglobin. Congenital absence of this
system is one cause of hereditary methemoglobinemia
[Ref: Ganong's Physiology/26th/P-1265]
50. A patient with 12 years age came to you with knee joint swelling. His mother
gave a history of excessive bleeding during circumcision. Your diagnosis is-
gave a history of excessive bleeding during circumcision. Your diagnosis is-
a) Hemophilia
b) DIC
c) Von Willbrand disease
d) Thrombocytopenia
e) Thalassemia
A
Explanation:
In Hemophilia deep joint swelling and excessive bleeding during circumcision common
feature
[Ref: Hoffbrand's Essential Haematology/7th/P-294]
