MCQS ANEMIAS -HEMATOLOGY (c) Anemia in chronic disease.

(d) Sideroblastic anemia

(e) Megaloblastic anemia
PAPER A
6. Which is not true about iron deficiency
1. A 60-year old male patient with history of anemia is:
rheumatoid arthritis presents with the following: (a) Microcytic hypochromic anemia
Hb:4.5g/dL.platelet count is 2 lakh/mm3. TLC: (b) Decreased TIBC
6000/mL, serum ferritin is 200μg/dL, serum (c) Decreased ferritin
iron 30mg/dL and TIBC 280ng/L. Which of the (d) Bone marrow iron decreased earlier than
following is the most likely serum iron
diagnosis?
(a) Anaemia of chronic disease 7. The condition which does not cause
(b) Thalassemia minor microcytic hypochromic anemia is:
(c) Iron deficiency anemia (a) Iron deficiency
(d) Autoimmune haemolytic anemia (b) Hookworm infestation
(c) Absence of intrinsic factor
2. A 20 year old female presents with the (d) Prolonged bleeding episodes
following laboratory values: hemoglobin 9gm%,
MCV is 55%, 8. Lead poisoning is associated with:
RBC is 4.5 million/mm3. There is no history of (a) Microcytic hypochromic anemia
blood transfusion. What is the most likely (b) Macrocytic anemia
diagnosis out of the (c) Decreased levels of zinc protoporphyrin
following? (d) Howell-Jolly bodies
(a) Thalassemia major
(b) Thalassemia minor 9. Anemia of chronic disease is characterized
(c) Iron deficiency anemia by all except:
(d) Anemia of chronic disease (a) ↓ Serum iron level
(b) ↓ TIBC
3. A 30 years old female, RBC count 4.5 (c) ↓ Serum ferritin level
million, MCV 55fl, TLC 8000/mm3. There is no (d) Increased macrophages iron in marrow
history of blood transfusion.
What is the likely diagnosis? 10. A patient of anemia due to chronic
(a) Iron deficiency anemia inflammation, the
(b) Thalassemia major positive finding is
(c) Thalassemia minor (a) Serum iron is increased
(d) Megaloblastic anemia (b) S. ferritin is decreased
(c) TIBC is decreased
4. The pathogenesis of hypochromic anemia in (d) Presence of normal iron in blasts
lead poisoning is due to:
(a) Inhibition of enzymes involved in heme 11. A 23-year-old female presented with
biosynthesis jaundice and pallor for 2 months. Her
(b) Binding of lead to transferrin, inhibiting the peripheral blood smear
transport of iron shows the presence of spherocytes. The most
(c) Binding of lead to cell membrane of relevant investigation to arrive at a diagnosis is
erythroid precursors. which of the
(d) Binding of lead to ferritin inhibiting their following?
breakdown into hemosiderin (a) Tests for PNH
(b) Osmotic fragility test
5. Bone marrow iron is increased in all except: (c) Coombs test
(a) Thalassemia (d) Reticulocyte count
(b) Iron deficiency anemia
12. An abnormal Ham test is most likely (d) Malignant hypertension
associated with which of the following? (e) HELLP syndrome
(a) Spectrin
(b) Defect in complement activating proteins 19. In hereditary spherocytosis an inherited
(c) Defective GPI anchor abnormality is seen in which of the following
(d) Mannose-binding residue effect red blood cell component:
(a) a-globin chain
13. PNH associated with somatic mutation (b) b-globin chain
affecting: (c) Phosphatidyl inositol glycan A
(a) Decay accelerating factor (DAF) (d) Spectrin
(b) Membrane inhibitor of reactive lysis (MIRL)
(c) Glycosylphosphatidyl inositol (GPI) 20. Not seen in paroxysmal nocturnal
(d) C8 binding protein hemoglobinuria is:
(a) LDH levels are raised
14. Cold hemagglutinin is associated with: (b) Increased hemosiderin in urine
(a) Anti IgM (c) Decreased leukocyte alkaline phosphatase
(b) Anti IgG (d) Increased platelets
(c) Anti IgA
(d) Donath-Landsteiner antibody 21. A young male photographer is evaluated
for recurrent episodes of jaundice. Laboratory
15. Microangiopathic hemolytic anemia is seen studies show anemia, an elevated LDH,
in all of the following diseases except indirect bilirubinemia and positive osmotic
(a) Antiphospholipid antibody syndrome fragility test. This patient is at highest risk of
(b) Thrombotic thrombocytopenic purpura developing which of the following?
(c) Microscopic polyangiitis (a) Cirrhosis and hepatocellular carcinoma
(d) Metallic cardiac valves (b) Pigmented gallstones
(c) Avascular necrosis of the femur
16. An Rh -ve woman became pregnant with (d) Episodic venous thrombosis
Rh +ve fetus. Within few days after birth, the
infant developed jaundice, ascites, 22. An infant presents with mild anemia,
hepatomegaly and edema. The likely jaundice, and splenomegaly. A complete blood
substance(s) deposited in skin and sclera in count with differential reveals spherocytosis;
jaundice is/are given below. Which is the best with elevated reticulocyte count. The parents
possible answer? state that several relatives have also suffered
(a) Biliverdin from a similar illness. The infant’s condition
(b) Conjugated and unconjugated bilirubin is most likely caused by defective
(c) Unconjugated bilirubin (a) Clathrin (b) Connexon
(d) Conjugated bilirubin (c) Ankyrin (d) Spectrin
17. Microangiopathic hemolytic anemia is seen 23. Helmet cells are characteristic of anemia
in all except: of:
(a) HUS (a) Hemolytic uremic syndrome
(b) ITP (b) Polysplenia
(c) Malignant hypertension (c) Spherocytosis
(d) Prosthetic valves (d) Acanthocytosis
(e) TTP
24. The primary defect which leads to sickle
18. Cause of fragmented RBC in peripheral cell anemia is:
blood include all except: (a) An abnormality in porphyrin part of
(a) Microangiopathic hemolytic anemia hemoglobin
(b) DIC (b) Replacement of glutamate by valine in b-
(c) Hemophilia-A chain of HbA
(c) A nonsense mutation in the b-chain of HbA (e) Hypothyroidism
(d) Substitution of valine by glutamate in the a-
chain of HbA 30. An adult who develops pure red cell aplasia
should be explicitly evaluated for which of the
25. Which is untrue about beta-thalassemia following?
trait? (a) Gastric adenocarcinoma
(a) Increased HbF (b) Pancreatic adenocarcinoma
(b) Increased HbA2 (c) Papillary thyroid cancer
(c) Microcytosis (d) Thymoma
(d) Severe anemia
31. All are true about the diagnosis of
(e) Target cell
hemolytic anemia except-
26. Hemoglobin H disease is caused by a) Elevated unconjugated bilirubin in the
deletion of:
(a) A single a globin gene blood
(b) Two a globin genes b) Low LDH in the blood
(c) Three a globin genes c) Haptoglobin levels are decreased
(d) All four a globin genes d) Direct cooms test is positive

27. A 23-year-old male presents to the 32. All are true in megaloblastic anemia
medicine OPD with complaint of hematuria.
There is no burning sensation during urination. except?
He gives a history of two of his relatives a) Teardrop cells
suffering from ‘some blood disease’. His b) Reversal of myeloid to erythroid ratio
coagulation studies are within normal limits. c) Defective DNA synthesis in RBCs
The hemoglobin electrophoresis shows the d) The decrease in LDH level
following: Hb A 60% and Hb S 40%. Which of
the following is most likely true about this 33. A 63-year-old male is diagnosed with
patient? colonic adenocarcinoma. Laboratory testing
(a) Irreversible sickle cells are present on the reveals a hemoglobin of 10.3 g/dL and an MCV
peripheral smear. of 71 fL. Of the following, further testing would
(b) Reticulocyte count is elevated most likely reveal?
(c) He is protected from Plasmodium a) Decreased ferritin, decreased serum iron,
falciparum. decreased TIBC
(d) MCHC is decreased b) Increased ferritin, increased serum iron,
increased TIBC
28. Which of the following manifestations is c) Decreased ferritin, increased serum iron,
common to decreased TIBC
sickle cell anemia and thalassemia major? d) Increased ferritin, decreased serum iron,
(a) Autosplenectomy decreased TIBC
(b) Bone marrow expansion in the e) Decreased ferritin, decreased serum
calvarium iron, increased TIBC
(c) Ineffective erythropoiesis
(d) Predisposition to Hemophilus influenzae 34. Of the following tests, which is most useful
infections for distinguishing between the pure red cell
aplasia and a warm autoimmune hemolytic
29. Macrocytic anemia may be seen in all of anemia?
these except: a) MCV
(a) Liver disease b) RDW
(b) Copper deficiency c) Ferritin
(c) Thiamine deficiency d) Reticulocyte count
(d) Vitamin B12 deficiency e) Total iron-binding capacity
 e) CT abdomen with contrast
35. A medical technologist observes
spherocytes in a blood smear of a patient of 39. A 6-year-old girl is brought into the
systemic lupus erythematosus. A direct emergency room after an automobile accident.
Coombs test, is positive. Of the following, what Physical examination shows bleeding from
is the most likely diagnosis? multiple wounds, and a CBC reveals a
a) Warm autoimmune hemolytic anemia normocytic, normochromic anemia. Which of
b) Microangiopathic hemolytic anemia
the following indices is most helpful in defining
c) Hereditary spherocytosis
this patient’s anemia as normocytic?
d) G6PD deficiency
e) Iron deficiency anemia a) Hematocrit
b) Hemoglobin
36. A 47-year-old male is diagnosed with c) Mean corpuscular hemoglobin
megaloblastic anemia by his family physician
concentration
based on a complete blood count, peripheral
d) Mean corpuscular volume
blood smear, and
MCV. Of the following, which feature would e) Red blood cell count
favor B12 deficiency as the cause of his 40. A 36-year-old man presents with increasing
anemia versus folate deficiency? fatigue. He has a 3-year history of tuberculosis,
a) Hypersegmented neutrophils and CBC shows a mild microcytic anemia.
b) Elevated concentration of homocysteine
Blood work-up demonstrates low serum iron,
c) Elevated concentration of
methylmalonic acid low iron-binding capacity, and increased serum
d) Pencil cells on peripheral smear ferritin. The pathogenesis of anemia in this
e) Teardrop cells on peripheral smear patient is most likely caused by which of the
following mechanisms?
37. A complete blood cell count reveals a
a) Clonal stem cell defect
hemoglobin of 8.5 g/dL. The MCV is 86 fL.
Additional testing reveals an AST of 15 U/L, an b) Hypoxemia
ALT of 12 U/L, total bilirubin of 5.3 mg/dL, c) Impaired utilization of iron from storage
direct bilirubin of 0.2 mg/dL, and LDH of 210 sites
U/L. Urinalysis identifies hemoglobin in the d) Synthesis of structurally abnormal globin
urine. Of the following, what is the most likely chains
etiology for this low hemoglobin? e) Toxic damage to bone marrow stem cells
a) A remote cardiac valve replacement
b) A warm autoimmune hemolytic anemia 41. A 45-year-old chronic alcoholic man
c) Aplastic anemia presents with mental confusion. The peripheral
d) Folate deficiency blood smear demonstrate acanthocytosis. The
e) Iron deficiency morphologic abnormalities demonstrated in this
blood smear are most likely associated with
38. A 56-year-old man presents complaining of which of the following conditions?
fatigue and polyarthralgia. Laboratory testing a) Abnormal spectrin in red cell membranes
for rheumatoid factor and anti-nuclear b) Chronic liver disease
antibodies are normal. A complete blood count c) Chronic renal failure
is performed, which shows a Hb of 19.2 mg/dL. d) Microthrombi in capillaries
His transferrin saturation is 65% and his serum e) Vitamin B12 deficiency
ferritin is 1425 ng/mL. What
additional testing is indicated?
a) Erythropoietin level
b) Chest radiograph
c) Genetic testing for HFE gene mutation
d) Flow cytometry
 (b) Autoimmune acquired hemolytic anemia
PAPER B (c) Thalassemia
(d) All of the above
1. A 13 yr girl with fatigue and weakness was
found to be having reduced hemoglobin. Her 8. “Macropolycytes” in peripheral smear is a
MCV 70fl, MCH 22pg and RDW was 28. What feature of:
is her most likely diagnosis? (a) Hereditary spherocytosis
(a) Iron deficiency anemia (b) Iron deficiency anemia
(b) Thalassemia minor (c) Sickle cell anemia
(c) Sideroblastic anemia (d) Megaloblastic anemia
(d) Thalassemia major
9. A 68 year-old man presents with skin
2. Ringed sideroblasts are seen in: pigmentation, cirrhosis and diabetes mellitus.
(a) Iron deficiency anemia Which pattern for serum iron and total iron-
(b) Myelodysplastic syndrome binding capacity (TIBC) is most consistent with
(c) Thalassemia the familial illness suggested by these
(d) Anemia of chronic disease findings?
(a) Inc. Serum iron, Inc. TIBC
3. A patient presents with increased serum (b) Inc. Serum iron, Dec.TIBC
ferritin, decreased TIBC, increased serum iron, (c) Dec. Serum iron, Dec. TIBC
% saturation (d) Dec. Serum iron, Inc. TIBC
increased. Most probable diagnosis is:
(a) Anemia of chronic disease 10. Low iron and low TIBC is seen in
(b) Sideroblastic anemia (a) Anaemia of chronic disease
(c) Iron deficiency anemia (b) Sideroblasticanaemia
(d) Thalassemia minor (c) Iron deficiency anaemia
(d) Aplastic anemia
4. Anemia in CRF is due to:
11. A 5 year old male child presents with
(a) ↓ erythropoietin
episodic anemia and jaundice since birth. He is
(b) ↓RBC survival
least likely to have
(c) ↓ folate
which of the following?
(d) Iron deficiency
(a) Hereditary spherocytosis
(e) All of the above
(b) Sickle cell disease
(c) G6PD deficiency
5. In Anemia of chronic disease, what is seen?
(d) Paroxysmal nocturnal hemoglobinuria
(a) TIBC ↑
(b) S. Iron ↑
12. Thrombotic event is seen in all of following
(c) BM iron ↓
except:
(d) S. ferritin ↑
(a) Paroxysmal nocturnal hemogloninuria
(b) Disseminated intravascular coagulation
6. A 30 years old female asymptomatic not
(c) Idiopathic thrombocytopenic purpura
requiring blood transfusion has Hb-13 gm%,
(d) Heparin induced thrombocytopenia
HbF-95%, HbA2 1.5%. Which of the following
is the most likely diagnosis?
13. The following protein defects can cause
(a) Beta-Heterozygous thalassemia
hereditary spherocytosis except:
(b) Beta-Homozygous thalassemia
(a) Ankyrin (b) Palladin
(c) Intermediate thalassemia
(c) Glycophorin C
(d) Persistently raised HbF
(d) Anion transport protein
7. Microspherocytes in peripheral blood smear
14. Autoimmune hemolytic anemia is seen in:
are seen in:
(a) ALL (b) AML
(a) Congenital spherocytosis
(c) CLL (d) CML the following is the best explanation for the
observed findings?
15. Features seen in hemolytic anemia are all (a) Anti body-mediated erythrocyte destruction
except: (b) Hereditary erythrocyte membrane defect
(a) Teardrop and Burr cells (c) Hereditary erythrocyte enzyme
(b) ↓ Haptoglobin deficiency
(c) Reticulocytosis (d) Microangiopathic hemolytic anemia
(d) Hemoglobinuria
21. A 30-year-old woman with SLE and chronic
16. Intravascular hemolysis occurs in: renal failure manifest rapidly progressive
(a) Hereditary spherocytosis weakness. Blood tests reveal severe anemia
(b) Glucose-6 phosphate dehydrogenase- and mild, mostly unconjugated,
G6PD deficiency hyperbilirubinemia. Coombs test is positive at
(c) Sickle cell disease 37°C but negative at 0-4°C. This patient
(d) Thalassemia developed anemia because of
(e) Hemophilia (a) Bone marrow aplasia
(b) IgG directed against red blood cells
17. The peripheral smear of hereditary (c) IgM directed against red blood cells
spherocytosis will show all except: (d) Spleen sequestration
(a) Reticulocytosis seen
(b) Smaller size spherocytes
(d) Anemia is always negligible 22. Bite cells are seen in:
(e) Always associated with ↑ MCHC (a) G6PD deficiency
(b) Sickle cell anemia
18. Microangiopathic hemolytic anemia seen in (c) Hereditary spherocytosis
all except: (d) Trauma
(a) Thrombotic thrombocytopenic purpura 23. Sickle cell trait patient do not have
(b) Hemolytic uremic syndrome manifestations of sickle cell disease, because:
(c) Henoch-Schonlein purpura (a) 50% HbS is required for occurrence of
(d) DIC sickling
(b) HbA prevents sickling
19. A man visited an area which (c) 50% sickles
has high endemicity of malaria. So, his (d) HbA prevents polymerization of HbS
physician gives him primaquine
chemoprophylaxis for Plasmodium vivax 24. True about Sickle cell anemia are all
malaria. Several days after beginning such a except:
regimen, he develops anemia, (a) Commonly seen in blacks
hemoglobinemia, and hemoglobinuria. Special (b) RBC size is altered
studies will likely reveal an abnormality in (c) Valine is substituted for glutamic acid in
which of the following? beta chain of globin.
(a) Duffy antigen (d) Deletion of gene
(b) Glucose-6-phospate dehydrogenase (e) Target cell are present
(c) Intrinsic factor
(d) PIG-A 25. In sickle cell disease, the defect is in:
(a) a-chain
20. A 38-year-old male presents to his (b) b-chain
physician with the complaints of sudden onset (c) g-chain
of fever, chills and dysuria. He was started on (d) Hb formation
treatment with trimethoprim-sulfamethoxazole,
but subsequently developed dark urine and
anemia with a high reticulocyte count. Which of
26. A 14-year-old male is brought to the 31. A five-year-old child presents with
emergency room with high grade fever, chest oliguria. There is a history of bloody
pain, and dyspnea. diarrhea 2 weeks ago. Coagulation tests are
His past medical history is significant for two normal. The peripheral smear shows
prior hospitalizations for abdominal pain, which shistocytes and RBCs fragments.
resolved with analgesics and hydration. Diagnosis is;
Evaluation today reveals a hematocrit of 23%
and reticulocyte count of 9%. Several hours a) Thrombotic thrombocytopenic purpura
after being admitted, the patient dies in the b) Idiopathic thrombocytopenic purpura
hospital. At autopsy, the patient’s spleen is firm c) G6PD deficiency
and brown; this finding is most likely related to: d) Hemolytic uremic syndrome
(a) Work hypertrophy due to disease state.
(b) Follicular hyperplasia in systemic infection 32. A 64-year-old male presents to his family
(c) Vascular occlusion crises in sickle cell physician with fatigue and dizziness, which
anemia. started three
(d) Pressure atrophy due to tumor infiltrating months ago. Physical examination reveals a
the spleen temperature of 98.6°F, a pulse of 113 bpm,
and a respiratory rate of 22 breaths per minute.
27. The primary defect which lead to stickle cell Laboratory testing
anemia is? reveals a hemoglobin of 9.5 g/dL and an MCV
(a) An abnormality in porphyrin part of of 70 fL. Of the following, which test is most
haemoglobin likely to help identify the source of the
(b) Substitution of valine by glutamate in the β- laboratory results?
chain of HbA a) A Coombs test
(c) Replacement of glutamate by valine in β- b) Osmotic fragility test
chain of HbA c) Testing for vitamin B12
(d) A nonsense mutation in the β-chain of HbA d) Fecal occult blood test
e) Donath-Landsteiner antibody testing
28.A patient with Hb-6 gm%, TLC 1200,
platelet-60,000, MCV 12fl, what is the 33. A pathologist is examining the liver biopsy
diagnosis? of a 22-year-old male with cirrhosis. He had a
(a) Aplastic anemia history of repeated blood transfusions. A
(b) Megaloblastic anemia Prussian blue
(c) PNH stain reveals extensive positivity. Of the
(d) Myelofibrosis following, what is the most likely diagnosis?
a. α-thalassemia
29. Which of the does not indicate b. β-thalasssemia major
megaloblastic anemia? c. Severe iron deficiency anemia
(a) Raised bilirubin d. Sideroblastic anemia
(b) Mild splenomegaly e. β-thalassemia minor
(c) Increased reticulocyte count
(d) Nucleated red cells 34. A 36 yr old male after minor injury
underwent testing. He has no past
30. Reticulocytosis is not seen in which of the medical history. A complete blood count
following conditions? reveals a white blood cell count of 7,100
(a) Thalassemia cells/μL, hemoglobin of 11 g/dL, and Hct of
(b) Hereditary spherocytosis 34%. The MCV is 50 fL. Of the
(c) Chronic renal failure following, what is the most likely diagnosis?
(d) Sickle cell anemia a) Hereditary spherocytosis
b) β-thalassemia minor
c) Iron deficiency anemia
d) Anemia of chronic disease
e) Megaloblastic anemia blood smear are most likely associated with
which of the following conditions?
35. A 56-year-old man underwent routine a) Abnormal spectrin in red cell membranes
checkup. His complete blood b) Chronic liver disease
count, showed 7.5 × 109 cells/L leukocytes, a c) Chronic renal failure
hemoglobin of 9.1 g/dL, with a mean d) Microthrombi in capillaries
corpuscular volume of 76 fL and a platelet e) Vitamin B12 defi ciency
count of 425,000 cells/
μL. Which of the following tests is indicated 39. A patient with a history of chronic
next? alcoholism presents with a macrocytic anemia
a) Colonoscopy and thrombocytopenia. Blood smear
b) Ferritin examination demonstrates numerous oval
c) Barium contrast enema macrocytes and hypersegmented neutrophils.
d) Vitamin B12 level
A Schilling test is normal. Which of the
e) Flow cytometry
following is the most likely diagnosis?
36. A 65-year-old female presents to her a) Anemia of chronic disease
primary care physician with pallor and fatigue. b) Folic acid deficiency
A complete blood count reveals a hemoglobin c) G6PD defi ciency
of 8.2 g/dL. The Total bilirubin is 6.4 mg/dL,
d) Iron defi ciency anemia
and direct bilirubin is 0.2 mg/dL. Her lactate
e) Sickle cell anemia
dehydrogenase is elevated, and a
direct antibody test causes agglutination with 40. A 22-year-old woman from a large Italian
anti- IgG. Her peripheral smear reveals family is screened for a familial blood disorder.
spherocytes. What is the most likely diagnosis? The results of laboratory studies include a
a) Hereditary spherocytosis
hemoglobin of 9.5 g/dL and a smear displaying
b) Glucose-6-phosphate dehydrogenase
mild microcytosis, hypochromia, and a few
deficiency
c) Warm antibody hemolytic anemia target cells. Hemoglobin electrophoresis shows
d) Cold antibody hemolytic anemia a mild increase in hemoglobin A2 (7.5%). What
e) Paroxysmal cold hemoglobinuria is the appropriate diagnosis?
a) Anemia of chronic disease
37. A 36-year-old man presents with increasing
b) G6PD deficiency
fatigue. He has a 3-year history of tuberculosis,
and CBC shows a mild microcytic anemia. c) Heterozygous b-thalassemia
Blood work-up demonstrates low serum iron, d) Homozygous b-thalassemia
low iron-binding capacity, and increased serum e) Silent carrier a-thalassemia
ferritin. The pathogenesis of anemia in this 41. A 24-year-old woman with sickle cell
patient is most likely caused by which of the
disease is seen in the emergency room for an
following mechanisms?
a) Clonal stem cell defect acute upper respiratory tract infection.
b) Hypoxemia Laboratory findings include a severe,
c) Impaired utilization of iron from storage normocytic anemia. The patient develops a
sites rapid drop in the hemoglobin level. However,
d) Synthesis of structurally abnormal globin the reticulocyte count is very low (<0.01%).
chains This finding most likely reflects which of the
e) Toxic damage to bone marrow stem cells following conditions?
38. A 45-year-old chronic alcoholic man
presents with mental confusion. The peripheral a) Bone marrow failure due to repeated
blood smear demonstrate acanthocytosis. The infarction
morphologic abnormalities demonstrated in this b) Expected result for the patient’s underlying
anemia
c) Parvovirus B19 infection
d) Retroperitoneal hemorrhage
e) Vitamin B12 defi ciency