Hemato

Histo - Dr. Mahmoud Shbair

1. Regarding neutrophils (polymorphonuclear leukocytes), all of the following are true except

a) They are the most numerous peripheral blood leukocytes.

b) They contain both specific and azurophilic granules.
c) They have deeply acidophilic staining specific granules.
d) Their life span in blood is shorter than in connective tissue.
e) They have segmented nuclei with great variability in shape and number of segments.

2. Basophils are best differentiated from eosinophils by

a) being more numerous in peripheral blood.

b) anucleus that is divided into 2-5 irregular lobes.
c) increase in number in response to parasitic infestation.
d) large specific granules overlying the nucleus and usually obscuring its shape.
e) markedly larger size.

3. During erythropoiesis hemoglobinization of the cytoplasm is first noted in

a) proerythroblast
b) basophilic erythroblast.
c) orthochromatophilic erythroblast.
d) reticulocyte.
e) polychromatophilic erythroblast.

4. A normal megakaryocytes characterized by all of the following except

a) Multiple nuclei that have been yielded by endomitosis.

b) Huge size reaching 150 um in diameter.
c) Typically sited in the bone marrow close to sinusoidal capillaries.
d) Ability to produce few thousands of platelets.
e) Branching processes penetrating through the sinusoidal endothelium

5. Mature RBC

a) Is a denucleated cell
b) Is thinner at the center than the periphery
c) Has a pale staining center
d) All of the above

6. Which of the following is not agranulocyte?

a) Lymphocyte
b) Monocyte
c) Neutrophil
d) None of above

Hothifa Raed
 Hemato
7. Most frequent white blood cells are

a) Neutrophils
b) Basophils
c) Monocytes
d) Eosinophils

8. Most of stained granules in platelets under light microscopy are

a) Alpha granules
b) Delta granules
c) Both of above
d) None of above

9. The denucleated cell in erythropoiesis is

a) Proeryhtroblast
b) Reticulocyte
c) Orthochromatophilic erythroblast
d) Polychromatophilic eryhtroblast

10. Band cell is an intermediate stage that appears in the differentiation of

a) Neutrophils
b) Basophils
c) Eosinophils
d) Lymphocytes

11. In human body, neutrophils can exist in

a) Granulopoietic compartment
b) Storage compartment
c) Circulating compartment
d) Marginating compartment
e) All of above

12. The largest cell in the bone marrow is

a) Megakaryocyte
b) Band
c) Normoblast
d) Metamyelocyte

Hothifa Raed
 Hemato
Histo - Dr. Momen Zeineddin
1. Which statement is the best to describe the structure of the thymus?

a) It is divided by connective tissue septa into complete lobules.

b) It contains a well-developed cytoreticulum formed by reticular cells.
c) The thymic cortex contains T lymphocytes, macrophages & plasma cells.
d) No lymphoid nodules characterize the parenchyma.
e) Filled with huge amount of adipose tissue in infants.

2. Which structure is partially capsulated and covered by pseudo stratified ciliated colu epithelium?

a) Lingual tonsils
b) Palatine tonsils
c) Peyers patch
d) Hassal corpuscle
e) pharyngeal tonsils

3. In the lymph node, T-lymphocytes are found mainly in

a) The outer cortex

b) Paracortex
c) Lymphoid nodule
d) Germinal center
e) Cortical sinus

4. Which of the following is rich in blood sinusoids?

a) Spleen
b) Thymus
c) Lingual tonsils
d) Palatine tonsils
e) Peyer patch

Hothifa Raed
 Hemato
Patho - Dr. Mahmoud Shbair
1. A 30-year-old woman complains of recent easy fatigability, bruising, and recurrent throat infections.
Physical examination reveals numerous petechiae over her body and mouth. Abnormal laboratory
findings include hemoglobin of 6 g/dL, (normal 12-14), WBC of 1,500/mL (normal 4,000-11,000), and
platelets of 20,000/mL (normal 150,000-450,0000). The bone marrow is hypocellular and displays
increased fat. The pathogenesis of this woman's illness includes

a) impairment of heme synthesis

b) impairment of DNA synthesis
c) immune mediated suppression of bone marrow progenitors
d) mechanical destruction of red cells and consumptive thrombocytopenia
e) antibody mediated phagocytosis of red cells and platelets

2. A 27-year-old pregnant woman comes to the obstetrician for a prenatal check-up. The obstetrician
noticed jaundice and splenomegaly. Routine laboratory testing reveals a normocytic anemia and
hyperbilirubinemia. The peripheral blood smear reveals many small, round, dark-staining
(hyperchromic) red blood cells (RBCs) lacking central pallor. Which of the following best explains the
pathogenesis of anemia seen in this patient?

a) Abnormal membrane lipoprotein molecules

b) Abnormal polymerization of spectrin molecules
c) Decreased iron release in the bone marrow
d) Destabilization of the lipid bilayer of the RBC membrane
e) Oxidative denaturation of hemoglobin

3. Regarding Glucose 6 phosphate dehydrogenase (G6PD) deficiency, all of the following is true except

a) Can be associated with extravascular hemolysis

b) Younger red cells contain higher level of the enzyme than older ones
c) Can present as neonatal jaundice
d) Mediterranean variant is associated with more severe clinical phenotype
e) Hemolysis most commonly follows ingestion of fava beans

4. In patients with sickle cell disease, which of the following factors is expected to decrease the rate and
degree of sickling?

a) Increased transit time of red cells in tissue vascular bed

b) Concomitant inheritance of a thalassemia
c) Intracellular acidosis
d) Cellular dehydration
e) Hb SS genotype

Hothifa Raed
 Hemato
5. α-Thalassemia

a) is caused by inherited deletions of a globin genes on chromosome 11

b) with 3 gene deletions is associated with less ineffective erythropoiesis compared to p
thalassemia
c) with 2 gene deletions can be easily diagnosed by hemoglobin analysis (electrophoresis)
d) causes more skeletal complications compared to ẞ thalassemia
e) all of the above is true

6. Untreated β thalassemia major (transfusion dependent thalassemia) results in all of the following
except

a) Inadequate reticulocytes count in peripheral blood

b) High hepcidin level
c) Increased alimentary iron absorption
d) Cortical bone thinning
e) Extramedullary hematopoiesis

7. Regarding cold hemolysin disease, all of the following is true except

a) It is a rare form of antibody induced hemolytic anemia

b) Caused by cold reacting IgG antibody
c) hemolytic events are mixed intravascular and extravascular
d) Associated with low haptoglobin level

8. Which of the following best describes megaloblastic changes?

a) An erythroid precursor with maturing cytoplasm in the presence of immature nucleus

b) Increased size and polychromatophilia of peripheral red blood cells
c) A huge erythroid precursor with multiple nuclei and increased cytoplasmic basophilia
d) A large peripheral neutrophil with more than 5 segments in its nucleus
e) Giant metamyelocytes and band forms

9. A 62-year-old man presents with pallor, fatigue, and dyspnea on exertion for 1 month. A complete
blood count reveals microcytic hypochromic anemia. Blood film revealed anisocytosis, poikilocytosis,
markedly increased central pallor of RBCs and pencil cells. The most likely cause of these findings is

a) dietary deficiency of iron.

b) increased iron requirement.
c) hemodilution
d) sideroblastic anemia
e) gastrointestinal bleeding.

Hothifa Raed
 Hemato
10. A 23-year-old woman with epilepsy who is desirous of becoming pregnant is found to be anemic.
Examination of a peripheral blood smear reveals oval macrocytes and hypersegmented neutrophils.
Neurologic examination is entirely normal. Which of the following is not expected to be seen in this
patient?

a) An erythroid precursor in the bone marrow with nuclear to cytoplasmic asynchrony of

maturation.
b) Giant metamyelocytes and band cells.
c) Abnormally large megakaryocytes
d) Low reticulocyte count
e) High homocysteine and methylmalonate concentrations

11. Glanzmann thrombasthenia is characterized by all of the following except

a) Autosomal recessive mode of inheritance

b) Defect in platelet adhesion
c) Normal platelet morphology
d) Bleeding that starts early in life
e) Normal platelet count

12. A 55-year-old woman with chronic pancreatitis undergoes coagulation screening tests before
surgery. The PT and APTT are found to be prolonged. Given the following choices, which of the following
is the most likely reason for the abnormal coagulation test results?

a) Congenital inherited bleeding disorder

b) Vitamin K deficiency
c) Glutamate deficiency due to impaired digestion of dietary protein
d) Nutritional vitamin C deficiency

13. All A 7-year-old boy presents with palpable purpura on the buttocks and legs, fever, abdominal pain
and vomiting arthritis in his knees and ankles, melena, and hematuria. His mother states that he had an
upper respiratory illness approximately 1 week ago. Blood tests reveal mild renal insufficiency. The most
likely cause of the bleeding into the skin observed in this patient is

a) coagulation factor deficiency.

b) qualitative platelet dysfunction
c) quantitative platelet dysfunction.
d) immune complex mediated destruction of small vessels.
e) vitamin deficiency.

Hothifa Raed
 Hemato
14. 25-year-old previously healthy woman develops spontaneous vaginal bleeding. The following day,
she experiences a tonic-clonic seizure. On physical examination, she is febrile and jaundiced and has
widespread purpura. Laboratory findings include a hemoglobin of 5.3 g/dL (normal 12-14) with 8%
reticulocytes, a platelet count of 10,000/mL (normal 145,000-450,000) and urea of 48 mg/dL
prothrombin time 12 seconds (normal 11-15), partial thromboplastin time 28 seconds (normal 25-35).
The peripheral blood smear was remarkable for red blood cells fragments. The pathogenesis in this
woman is expected to include all of the following except

a) Excessive activation of platelets

b) Accumulation of very high molecular weight multimers of von Willebrand factor in peripheral
blood
c) Deposition of hyaline microthrombi in the small blood vessels of brain
d) Fibrin deposition in the small blood vessels of the kidney
e) Intravascular hemolysis

15. All of the following is suggestive of a diagnosis of primary immune thrombocytopenic purpura
except:

a) Normal or increased megakaryocytes in the bone marrow

b) Normal spleen size
c) Low platelets count in peripheral blood
d) Small size of the platelet in peripheral blood
e) Bleeding is predominantly mucocutaneous

16. Microcytic anemia can be caused by

a) B12 deficiency
b) Aplastic anemia
c) Myelofibrosis
d) Thalassemia
e) Glucose 6 phosphate dehydrogenase (G6PD) deficiency

17. manifestations of anemia include

a) Pallor
b) Fatty change in the liver
c) Heart failure
d) Faintness
e) All of above

18. Pure red cell aplasia is characterized by all of the following except

a) Moderate to severe anemia

b) Increased erythropoietin
c) Increased reticulocyte count
d) Selectively absent erythroid precursors in bone marrow

Hothifa Raed
 Hemato
19. Anemia of chronic renal insufficiency results from

a) Decreased erythropoietin production

b) A uremic toxin suppression of erythropoiesis
c) Malnutrition
d) Blood loss
e) All of above

20. Hemolytic anemia is characterized by

a) Normal RBC life span

b) Decreased erythropoiesis
c) Excess bilirubin and jaundice
d) All of above

21. Hereditary spherocytosis

a) Has autosomal recessive mode of inheritance in the majority of cases

b) Caused by absent hemoglobin chains
c) Characterized by hyperchromic RBCs in peripheral blood
d) All of above

22. Most common cause of hemolysis in G6PD deficiency patients is

a) Infections
b) Oxidant drugs
c) Fava bean ingestions
d) None of above

23. Autosplenectomy complicates

a) Hereditary spherocytosis
b) Thalassemia major
c) Sickle cell disease
d) Paroxysmal nocturnal hemoglobinuria

24. Heinz bodies are a feature of

a) Sickle cell disease

b) G6PD deficiency
c) Iron deficiency anemia
d) Thalassemia intermediate

25. Pathological Consequences of β-Thalassemia include

a) Massive erythroid hyperplasia

b) bony cortical thinning
c) Extramedullary hematopoiesis
d) Secondary hemochromatosis
e) All of above
Hothifa Raed
 Hemato
26. Morphological changes in β-Thalassemia include all of the following except

a) Anisocytosis
b) Poikilocytosis
c) Target cells
d) Microcytosis
e) Hyperchromia

27. A patient with severe anemia has a peripheral blood smear with oval macrocytes, hypersegmented
neutrophils, and decreased platelets. The most likely cause of the anemia is

a) a red cell membrane protein defect.

b) an amino acid substitution in the -globin chain.
c) iron deficiency.
d) marrow hypoplasia.
e) vitamin B12 or folate deficiency.

28. A 23-year-old man presented to his primary care physician 2 weeks ago with a nonproductive cough
and malaise. He was treated with the antibiotic azithromycin for “walking pneumonia” due to
Mycoplasma pneumoniae. He now returns with fatigue and pallor. Laboratory studies demonstrate a
decreased red blood cell count with polychromatophilia and an increase in indirect (unconjugated)
bilirubin.The laboratory findings are most likely due to

a) acute cold agglutinin disease.

b) aplastic anemia.
c) aplastic crisis.
d) paroxysmal nocturnal hemoglobinuria.
e) warm antibody autoimmune hemolytic anemia.

29. Paroxysmal nocturnal hemoglobinuria

a) May present with pancytopenia

b) May lead to venous thrombosis
c) Caused by defect in CD55 and CD59
d) Increase susceptibility to acute myeloid leukemia
e) All of above

30. A 35-year-old woman presents with fever, fatigue, mucocutaneous bleeding, and changing
neurologic signs. Laboratory examination reveals thrombocytopenia, anemia, and reticulocytosis, as well
as increased concentrations of creatinine and urea nitrogen. Examination of a peripheral blood smear
reveals many fragmented circulating red cells (helmet cells and schistocytes). The most likely diagnosis is

a) Bernard-Soulier disease.
b) DIC.
c) ITP.
d) TTP.
e) von Willebrand disease.

Hothifa Raed
 Hemato
31. A 25-year-old man has a lifelong hemorrhagic diathesis. The PT and bleeding time are normal, but
the APTT is prolonged. The most likely cause of the bleeding disorder is

a) a platelet functional disorder.

b) factor VII deficiency.
c) factor VIII deficiency.
d) factor IX deficiency.
e) von Willebrand disease.

32. which of the following is/are suggestive of a diagnosis of primary immune thrombocytopenic
purpura?

a) Normal or increased megakaryocytes in the bone marrow

b) Normal spleen size
c) Low platelets count in peripheral blood
d) Bleeding is predominantly mucocutaneous
e) All of above

33. Thrombotic Thrombocytopenic Purpura (TTP) results from

a) Deficiency in a plasma ADAMTS13 enzyme

b) IgG antiplatelets antibodies
c) Deficiency of platelets GP IIb-IIa receptors
d) Deficiency of platelets GP Ib IX receptors

Hothifa Raed
 Hemato
Patho - Dr. Momen Zeineddin
1. Bad prognostic markers of Acute lymphoblastic leukemia include all of the following except

a) Adolescent patient
b) t(12,21)
c) CNS positive
d) Infantile leukemia
e) T cell phenotype leukemia

2. which is not true about Hodgkin's lymphoma?

a) Localized nodal involvement is common

b) The contiguous spread is seen
c) Mesenteric nodes and Waldeyers ring are rarely involved
d) Extranodal involvement is common
e) No leukemic phase

3. Which is true about lymphocyte depleted Hodgkins lymphoma?

a) Not associated with EBV

b) Usually seen in old patients with HIV
c) Classified as non-classical Hodgkin lymphoma due to aggressive course.
d) Positive for CD 15 and CD 45
e) Carries a good prognosis

4. Which is not true about infectious mononucleosis?

a) Seen in adolescents and young adults

b) CMV can cause a similar clinical picture
c) CDS T-lymphocytes with atypical dysplastic features is the classical blood smear finding.
d) Splenomegaly due to hyperplasia in the periarteriolar lymphoid sheath.
e) May cause splenic rupture

5. A 60-year-old woman with CLL, Over the past few months, she noticed swellings in the neck and axilla
which was rapidly increasing in size. She complains of fever and experiences weight loss. The most likely
explanation is

a) Richter transformation
b) Autoimmune thrombocytopenia
c) EBV infection
d) Immunodeficient hemolytic anemia
e) CMV infection

Hothifa Raed
 Hemato
6. Which is suggestive of Laukomoid reaction rather than CML

a) FISH positive for BCR-ABL

b) Increased basophils
c) Highly Positive leukocyte alkaline phosphatase stain
d) Elevated serum vitamin B12
e) Absence of infection

7. A peripheral smear with increased neutrophils, basophils, eosinophils, and platelets is highly
suggestive of

a) Acute myeloid leukemia

b) Acute lymphoblastic leukemia
c) Chronic myelogenous leukemia
d) Myelodysplastic syndrome
e) Aplastic anemia

8. Not true regarding Waldenstrom's macroglobulinemia is

a) Lymphadenopathy is usually present

b) Blood viscosity increased
c) IMimmunoglobulin increased
d) Hypercalcemia
e) Baynaud phenomena can be seen

9. A 60-year-old male patient, on polycythemis rubra vera treatment for long time, recently get tired and
needs frequent transfusions, Examination is remarkable for massive splenomegaly. The most likely
explanation is

a) Chronic myeloid leukemia

b) Myelofibrosis
c) Polysythemia vera
d) Essential thromboestos
e) Myelodysn

10. Which is true about the morphology of Multiple myeloma

a) Roulex formation are seen in blood smear

b) Atypical plasma cells with multiple prominent nuclei
c) Characterized by increased number of plasma cell in the bone marrow
d) Russell bodies are large homogenous cytoplasmic inclusion bodies containing immunoglobulins
e) Dutcher bodies are Cytoplasmic inclusion bodies in plasma cells

Hothifa Raed
 Hemato
11. A 9-year-old boy living in Uganda has had increasing pain and swelling on the right side of his face
over the past 8 months. On physical examination, there is a large, nontender mass involving the
mandible, which deforms the right side of his face. There is no lymphadenopathy or splenomegaly, and
he is afebrile. A biopsy of the mass is performed and microscopic examination shows intermediate-sized
lymphocytes with a high mitotic rate. A chromosome analysis shows a 46,XY.t(8;14) karyotype in these
cells. The hemoglobin concentration is 13.2 g notin L , platelet count is 272,000 mm3, and WBC count is
5820 mm3. Infection with which of the following viruses is most likely to be causally related to the
development of these findings?

a) Cytomegalovirus
b) Epstein-Barr virus
c) Hepatitis B virus
d) HIV
e) Human papillomavirus

12. A 63-year-old man has noticed a lump in his neck for 2 months. Examination reveals a group of three
discrete nontender right posterior cervical lymph nodes, and a mass of enlarged right axillary lymph
nodes. Chest and abdominal CT scans show mediastinal lymphadenopathy and hepatosplenomegaly
Microscopic examination of a cervical lymph node biopsy reveals abundant large CD15+ and CD30-
binucleate cells with prominent acidophilic nucleoli, scattered within a sparse lymphocytic infiltrate.
What is molecular analysis of this lesion most likely to reveal?

a) Clonal EBV integration in the large cells

b) BCL6 gene rearrangements in the large cells
c) Deletions of 5q in all the cells
d) Helicobacter pylori infection in all the cells
e) JAK2 gene mutations in the lymphocytes

13. One of the following is not correctly matched:

a) t (9,22) >> Chronic myeloid leukemia

b) t(15.17)>>acute myelomonocytic leukemia
c) t(11,14) Mantle cell lymphoma
d) t(14.18)>>Follicular lymphoma
e) t(8,14)>>Burkitt lymphoma

Hothifa Raed
 Hemato
14. A 39-year-old woman felt a lump in her breast 1 week ago. On physical examination, she has a firm,
fixed, irregular 3-cm mass in the upper outer quadrant of the right breast and a firm, nontender lymph
node in the right axilla. A lumpectomy and axillary node dissection are performed, and microscopic
examination shows an infiltrating ductal carcinoma in the breast. Flow sytometric analysis of the node
shows a polyclonal population of CD3+, CD19-, CD20-, and CD6S-calls with no aneuploidy Microscopic
examination of the axillary lymph node is most likely to reveal changes characteristic of which of the
following conditions?

a) Acute lymphadenitis
b) Diffuse large B-cell lymphoma
c) Metastatic infiltrating ductal carcinoma
d) Necrotizing granulomas
e) Sinus histiocytosis

Hothifa Raed
 Hemato
Immuno
1. All the following are TRUE in Immune thrombocytopenic Purpura (ITP) EXCEPT

a) Acute ITP occurs equal in both genders

b) Prescence of schistocytes in the blood film
c) Prothrombin Time (PT) & Partial Thromboplastin Time (PTT) are normal
d) Increased megakaryocytes in the bone marrow

2. A 32-year-old woman presents with the recent onset of petechiae of her lower extremities. Physical
examination is remarkable for petechiae of both legs. There is no hepatosplenomegaly. The rest of
physical examination is normal. Platelets count is 8000/L. Hb and WBCs are normal. Peripheral smear
reveals reduced platelets and an occasional giant platelet.

a) Thrombocytopenic thrombotic purpura

b) Hemolytic Uremic Syndrome
c) Disseminated Intravascular Coagulopathy
d) Idiopathic thrombocytopenic purpura

3. In warm autoimmune hemolytic anemia, all true except:

a) In warm AIHA positive IgG direct coombs test

b) The IgG antibodies are the main cause of hemolysis in the warm AIHA
c) In drug induced warm AIHA the gold treatment is splenectomy
d) The blood film shows increased reticulocyte count and small spherocytes

4. All true cold autoimmune hemolytic anemia except

a) In cold AIHA there is positive direct C3coomb's test

b) The IgM antibodies with the aid of classical complement pathway is the main mechanism for
hemolysis in Cold AIHA
c) The main hemolysis type in cold AIHA is intravascular hemolysis with (+) CD59 and(+)CD55
d) Infections could be a secondary cause for cold AIHA

5.25-year-old male presented to the ER with persistent cough, dark urine and chest pain, CXR was done
and showed that there is atypical pneumonia. CBC was done to reveal the cause of dark urine and
showed a normocytic anemia. Urine analysis showed: hemoglobinuria. Also, there was hemoglobinemia
and a decrease in the level of haptoglobin, what do you think the cause of such condition?

a) Chlamydia pneumonia with cold AIHA

b) Chlamydia psittaci with warm AIHA
c) Chlamydia pneumonia with warm AIHA
d) Mycoplasma pneumonia with warm AIHA
e) Mycoplasma pneumonia with cold AIHA

Hothifa Raed
 Hemato
anatomy + physio
1. What lymphatic structure absorbs lipids in the intestine

a) collecting vessel
b) vein
c) lymph trunk
d) lacteal

2. Afferent vessels enter the side of the lymph node, and Efferent vessels exit the side of the lymph node

a) convex, concave
b) concave, convex
c) top, bottom
d) bottom, top

3. Thymosin is abermon that will cause to maturate

a) B. cell
b) T. cell
c) T and B cells
d) Macrophages

4. Which of the following characteristics of the Erythrocytes allow for the easy exchange of oxygen and
carbon dioxide

a) Lack of nucleus
b) Lack of organelles
c) Flattened shape
d) Small size

5. The life span of white blood cells is

a) seconds to minutes
b) months to even years
c) minutes to days
d) 7 days

6. Which of the following stimulates the release of erythropoietin?

a) Decreased amount of Vit B12

b) Excess amount of oxygen going to the kidneys
c) Decreased amount of oxygen going to the kidneys
d) vasodilatation of renal artery

Hothifa Raed
 Hemato
7. Which substance along with thromboxane A2 helps activate other platelets during platelet plug
formation?

a) serotonin
b) ADP
c) ATP
d) lysosomes

8. Which group of nodes form a line directly below the inguinal ligament?

a) Superficial inguinal nodes

b) Superficial sub-inguinal nodes
c) Deep sub-inguinal nodes
d) Popliteal nodes

9. How to distinguish eosinophils from basophils?

a) Eosinophils have a bilobed nucleus and basophils have a single round nucleus
b) Eosinophils are granulated while Basophils are non granulated
c) Eosinophils have a single nucleus and basophils have a silobed nucleus
d) Eosinophils stain blue while basophils stain pink

Hothifa Raed
 Hemato
In patients with Chronic Myeloid Leukemia

a) Splenomegaly is unusual
b) The fusion gene bcr-abl forms a protein with tyrosine kinase activity
c) Philadelphia chromosome-positive patients respond poorly to Imatinib
d) ABL gene on Chr.22 is trans-located to BCR gene on Chr.9

Regarding chronic immune thrombocytopenic purpura, all of the following is true EXCEPT

a) Caused by autoantibodies mostly of the IgG class

b) Associated with foamy histiocytes in the splenic red pulp
c) Autoantibodies don't affect megakaryocytes
d) Bone marrow reveals increased number of megakaryocytes

Children have the following peculiarities of leukocyte formula:

a) lymphocytes predominate at birth

b) neutrophils predominate on the 5th year
c) lymphocytes predominate at 2 years old
d) leukocyte formula is the same as in adults on the 5th day of life

In which part of the lymph node T cells are most abundant?

a) Medullary sinuses
b) Paracortex
c) Lymphoid nodules
d) Subcapsular sinus
e) Germinal center

A 25-year-old previously healthy woman develops spontaneous vaginal bleeding. The following day, she
experiences a tonic-clonic seizure. On physical exam, she is febrile and jaundiced and has widespread
purpura. Laboratory findings include a hgb of 5.3g/dL with 8% reticulocytes, a platelet count of 10,000,
and a BUN of 48mg/dL. The peripheral blood

smear is shown in this image. Which of the following is the appropriate diagnosis?

a) Drug-induced thrombocytopenia
b) Henoch-schonlein purpura
c) Idiopathic thrombocytopenic purpura
d) Thrombotic thrombocytopenic purpura
e) Von Willebrand disease

Hothifa Raed
 Hemato
Which of the following is NOT true regarding paroxysmal nocturnal hemoglobinuria (PNH)

a) Venous thrombosis is the leading cause of death

b) Susceptibility to acute myeloid leukemia
c) Acidosis causes episodes of hemolysis in affected patients
d) May manifest as pancytopenia
e) Inherited in an X linked pattern

Lymph nodes draining infected skin wound are swollen because

a) formation of germinal centers for B-cell proliferation in nodes cortex.

b) Enlargement and increased activity of the node's high endothelial venule
c) increased flow of lymph Through the nodes afferent lymphatic
d) increased thickness of each antigen-presenting cell in each nodes medulla

Highest LAP score is seen in?

a) Polycythemia Vera
b) Chronic myeloid leukemia
c) Acute Myeloid Leukemia
d) Paroxysmal Nocturnal Hemoglobinuria

Monocyte is the precursor of all the following cells EXCEPT

a) Non of above
b) Microglia
c) Macrophages
d) Osteoclasts
e) NK cells

A patient with sickle cell disease and multiple splenic infarcts that led to autosplenectomy, this puts him
at risk of

a) Cholelithiasis
b) Membranous nephropathy
c) Megaloblastic anemia
d) Autoimmune gastritis
e) Pneumococcal Pneumonia

Which of the following best describes erythroid megaloblastic changes in bone marrow?

a) Appropriate cytoplasmic maturation with poor nuclear maturation

b) Cytoplasmic basophilia is retained throughout maturation
c) Early nuclear chromatin clumping
d) Erythroid nuclear fragmentation

Hothifa Raed
 Hemato
Which of the following is not a feature of Disseminated Intravascular Coagulation?

a) Prolonged Prothrombin time

b) High fibrinogen
c) High fibrin degradation products
d) Low platelets
e) Prolonged partial thromboplastin time

Presence of schistocytes is a feature of

a) Immune hemolytic anemia

b) Macroangiopathic hemolytic anemia
c) All of above
d) Hereditary spherocytosis
e) Sickle cell disease

Regarding sickle cell disease, all of the following is true except

a) Caused by amino acid substitution in the beta globin chain

b) Affected hemoglobin undergoes polymerization when deoxygenated
c) Can present as neonatal hemolytic anemia and jaundice
d) Vascular occlusion cause most serious clinical sequelae
e) Inherited in an autosomal recessive pattern

A patient presenting with mediastinal mass with sheets of epithelial cells giving arborizing pattern of
reactivity along with interspersed lymphoid cells. The most probable diagnosis would be

a) Primary mediastinal lymphoma

b) Non-Hodgkin lymphoma
c) Thymoma
d) Thymic carcinoid

In B-thalassemia major, all of the following is true EXCEPT

a) Most common in north America and Europe

b) Caused by homozygous mutation in ẞ chain gene
c) The very low hemoglobin is composed mainly of Hb F
d) Sequelae of hemochromatosis are the main cause of death
e) Lead to severe anemia and death without transfusion

Regarding anemia of chronic disease, all of the following is true EXCEPT

a) Pathogenesis involves ineffective use of iron stored within bone marrow macrophages
b) Increased amount of iron stored in the bone marrow
c) Characterized by increased total iron binding capacity
d) Erythrocytes can be either normocytic or microcytic
e) Caused by chronic inflammatory conditions

Hothifa Raed
 Hemato
Lymph nodes are all EXCEPT

a) Delivery sites for phagocytized organisms

b) Located throughout the body
c) Peyer patches in the gastrointestinal tract
d) Location of T- and B-cell maturation

Which of the following describes the pathogenesis of megaloblastic anemia?

a) Defective heme synthesis

b) Clonal stem cell abnormality
c) Impaired DNA synthesis
d) Immune destruction of circulating erythrocytes
e) Bone marrow fibrosis

Leukocyte alkaline phosphate (LAP) score is increased in all except

a) Hodgkin's lymphoma
b) sickle cell anemia
c) obstructive jaundice
d) pregnancy

Which of the following best describes erythroid megaloblastic changes in bone marrow

a) Appropriate cytoplasmic maturation with poor nuclear maturation

b) Cytoplasmic basophilia is retained throughout maturation
c) Early nuclear chromatin clumping
d) Erythroid nuclear fragmentation

Mechanisms of redistributive leukopenia are

a) low rate of leukocytes released from the marrow storage pool

b) increased leukocyte destruction by the spleen
c) increased leukocyte destruction in the vascular bed

Which of the following best describes erythroid megaloblastic changes in bone marrow?

a) Appropriate cytoplasmic maturation with poor nuclear maturation

b) Erythroid nuclear fragmentation
c) Early nuclear chromatin clumping
d) Cytoplasmic basophilia is retained throughout maturation

Which of the following is a common consequence of TCR and CCR7 signaling?

a) positive selection
b) Th2 induction
c) T cell migration
d) Th1 induction

Direct Coomb's test is an evaluation for:

Hothifa Raed
 Hemato
a) Anti-white blood cells antibodies in the serum
b) Anti-platelet antibodies bound to the patients platelets
c) Anti-red blood cells antibodies in the serum
d) Anti-red blood cells antibodies bound to the red blood cell membrane

The tertiary lymphoid organs:

a) Coordinate the functions of primary and secondary lymphoid tissue

b) Is associated with autoimmune reaction
c) Is the place of contact between primary and secondary lymphoid systems
d) It is just an alternative name for the secondary lymphoid system during chronic inflammation.

Which of the following bleeding pattern is NOT seen in coagulation factor defects?

a) Hemarthrosis
b) Urinary tracts bleeding
c) The gastrointestinal bleeding
d) Deep muscular tissue bleeding
e) Pinpoint skin hemorrhages

A9-year-old girl develops widespread pinpoint skin hemorrhages She recovered from a flu-like illness. 1
week earlier Laboratory findings reveal a platelet count of 20000/mL. but no other abnormalites . Her
bone marrow shows an increased number of megakaryocytes. The platelet count is normal after 2
months. which of the folowing is the appropriate diagnosis?

a) Acute immune thrombocytopenic purpura

b) Hemolytic-uremic syndrome
c) Thrombotic thrombocytopenic purpura
d) Disseminated intravascular coagulation
e) Antiphospholipid syndrome

Raynaud's phenomenon more often presents with:

a) G6PD deficiency
b) Cold Agglutinin Type hemolytic anemia
c) Sickle cell disease
d) Warm Antibody Type hemolytic anemia

A patient with sickle cell disease and multiple splenic infarcts that led to autosplenectomy this puts him
at risk of:

a) Membranous nephropathy
b) Cholelithiasis
c) Pneumococcal Pneumonia
d) Autoimmune gastritis
e) Megaloblastic anemia

Hothifa Raed
 Hemato
Which of the following is a common consequence of TCR and CCR7 signaling?

a) T cell migration
b) Th1 Induction
c) Th2 induction
d) positive selection

All of the following are a function of T cells EXCEPT:

a) Mediation of cytolytic reaction

b) Mediation of delayed Hypersensitivity reactions
c) Regulation of the immune system
d) Synthesis of antibody

Lymphangiogenesis:

a) is a reversible process
b) Normal process during infection
c) Correlate with cancer poor prognosis
d) Correlate with cancer good prognosis

You would expect normal test of coagulation PT and aPTT in:

a) Hemophilia A
b) Hemophilia B
c) Thrombotic thrombocytopenic syndrome
d) Disseminated intravascular coagulation

All the followings are true about lymphatic system EXCEPT:

a) The flow of lymph in the lymphatic vessels a bidirectional

b) The flow of lymph in the lymphatic vessels a unidirectional
c) lymph return back to the blood
d) lymph is a filtrate of blood

Which of these all types aids the activation of T-lymphocytes by antigens?

a) Macrophages
b) Neutrophils
c) Mast cells
d) Natural killer cells

A 7 years old patient who has anemia, jaundice and splenomegaly. His blood smear showed many dark
staining red cells lacking central pallor. His RBCs showed increased……………. Fragility but coomb's test is
negative What additional abnormality you would expect in his peripheral blood smear ?

a) Marked increase in red cells distribution width (RDW)

b) Increased mean corpuscular hemoglobin concentration(MCHC)
c) Low reticulocyte count
d) Markedly low mean corpuscular volume (MCV)
Hothifa Raed
 Hemato
All of the following are causes of decreased PLT production EXCEPT:

a) Vitamin B12 deficiency

b) Heparin therapy
c) Cytotoxic drug therapy
d) Leukemia
e) Myelodysplastic syndromes

Which one of the following statements is NOT true regarding iron?

a) Its ferric state is more absorbable than ferrous state

b) The major compartment inside the body is functional
c) is transported in plasma by transferrin
d) Its absorption is strictly regulated by hepcidin
e) Stored in the form of either ferritin or hemosiderin

One of the followings is NOT involved in cancer:

a) Angiogenesis
b) Immune cell recruitment
c) MHC class1 upregulation
d) Lymphangiogenesis

Naive T lymphocytes enter the lymph nodes via:

a) Germinal centers
b) Afferent lymphatics
c) Efferent lymphatics
d) High endothelial venues

A 36-year-old man presents with increasing fatigue. He has a 3-year history of tuberculosis, and CBC
shows a mild microcytic anemia. Blood work-up demonstrates low serum iron, low iron-binding
capacity, and increased serum ferritin. The pathogenesis of anemia in this patient is most likely caused
by which of the following mechanisms?

a) Hypoxemia
b) Clonal stem cell defect
c) Synthesis of structurally abnormal globin chains
d) Toxic damage to bone marrow stem cells
e) Impaired utilization of iron from storage sites

Regarding the thymus, all of the following is true except:

a) Has a lightly stained outer cortex surrounding a dark basophilic medulla

b) The main organ for T cell development
c) Its connective tissue capsule sends septa that divides it into lobules
d) Bilobed structure in the mediastinum
e) Less functional with advancing age

Hothifa Raed
 Hemato
Hemolysis caused by G6PD deficiency is:

a) All of above
b) Extravascular
c) Intravascular
d) Non of above

An 18 months old child was brought to the clinic by his mother because of increasing pallor and easy
fatigability, a CBC revealed a microcytic hypochromic anemia, which of the following parameters is most
helpful in defining this patient's anemia as hypochromic?

a) Mean corpuscular volume

b) Red blood cell count
c) Mean corpuscular hemoglobin concentration
d) Hemoglobin
e) Hematocrit

A 20 year old thin fashion model complains that she cannot concentrate and is always tired. She has
heavy menstrual bleeding every month but is otherwise healthy. The peripheral blood smear is shown in
the image. Which of the following laboratory findings would be expected in this patient?

a) Increased serum ferritin

b) Vitamin B12 deficiency
c) Positive direct Coombs test

Intravascular hemolysis is best differentiated from extravascular hemolysis by the absence of:

a) Methemoglobinuria
b) Hemoglobinemia
c) Splenomegaly
d) Hemoglobinuria
e) Hyperbilirubinemia

The role of sphingosine-1-phosphate on endothelial cells:

a) is to activate T cells in lymph node

b) is to facilitate entrance of T cells to draining lymph node
c) is to presentation of antigen to T cells .
d) is to facilitate exit of T cells from lymph node d

Hothifa Raed
 Hemato
Lymph vessels of submandibular gland drain into

a) submental nodes
b) Jugulo digastric nodes
c) Submandibular nodes
d) Jugulo omohyooid nodes

Which of the following cells function in the formation of pus following soft tissue infection?

a) Cells with polymorphic multiply lobed nuclei.

b) Cells with bilobed nuclei and many acidophil cytoplasmic granules
c) Very small cell-like elements with no nuclear but many granules
d) Biconcave cells with no nuclei
e) Cells with spherical nude and scant cytoplasm

All of the following constituents are normally included in lymph except

a) Foreign invaders as bacteria and viruses

b) white blood cells and lymphocytes
c) Red blood cells
d) Excess interstitial fluid
e) Fats, proteins and minerals

What is the earliest stage at which specific granulocyte types can be distinguished from one another

a) Metamyelocyte
b) Reticulocyte
c) Myelocyte
d) Promyelocyte
e) Band form

Which process occurs during granulopoiesis but not during erythropoiesis?

a) Euchromatin content increases

b) Cells lose their capacity for mitosis
c) Overall cell diameter decreases
d) Nucleus becomes increasingly lobulated
e) Overall nuclear diameter decreases

The following is true regarding polycythemia vera?

a) Decrease LAP score

b) Thrombocytopenia
c) Raised ESR
d) Leukocytosis

Hothifa Raed
 Hemato
Which of the following is not a minor diagnostic criterion for multiple myeloma

a) Plasmacytosis greater than 20%

b) Lytic bones lesions
c) Monoclonal globulin spike on serum electrophoresis of ......
d) Plasmacytosis on biopsy

Lymph nodes draining an infected skin wound are swollen because

a) Formation of germinal centers for B-cell proliferation in each node

b) Enlargement and increased activity of the nodes high end verules
c) Increased flow of lymph through the nodes afferent
d) increased thickness of each node precortes
e) De Arrival of antigen-presenting lots in each nodes medula

In sickle cell anemia, all of the following conditions are associated with increased risk of sickling EXCEPT

a) increased mean call hemoglobin concentration MCHC

b) acidosis
c) Tissue inflammation
d) Higher Hb
e) Homozygouty for HbS (HbSS)

The spleen:

a) is supplied with parasympathetic fibers from coeliac plexus

b) has an identifiable notch on its posterior border
c) lymphatic drainage is to coeliac node
d) lies between the 8th and 11th ribs
e) weights 15 ounces

Hothifa Raed