Plasma proteins: 9.

Fluid exudation into the tissue in an acute

1. Which of the following is NOT found in plasma? inflammatory reaction is due to which of the
a) Albumin. following?
b) Sodium. a) Decreased blood pressure
c) Glucose. b) Decreased protein in the interstitium
d) Hemoglobin. c) Obstruction of the lymph vessels
e) Potassium. d) Increased clotting factors
2. The plasma globulins are synthesized mainly in the: e) Increased vascular permeability
a) Liver. 10. The most abundant protein in blood is
b) Lung. a) Albumin.
c) Heart. b) Hemoglobin.
d) Reticuloendothelial system. c) Fibrinogen.
e) Kidney. d) beta-1 globulin.
3. The normal A/G ratio in blood is: e) beta-2 globulin.
a) 2:1. 11. Concerning the origin of plasma proteins:
b) 1:3. a) All types are formed by liver only.
b) Albumin, fibrinogen, prothrombin and 50% of
c) 3:1.
globulin are synthesized in liver.
d) 2:3.
c) Gamma globulins are formed by mast cells in
4. Osmotic pressure of plasma is mainly maintained by:
the lymphoid tissue.
a) Albumin. d) Gamma globulins are released from activated T
b) Carbon dioxide.
lymphocytes.
c) Globulins. e) Proteins of muscles and viscera favor globulins
d) Fibrinogen.
formation.
e) Antigens.
5. Clinically significant changes in blood plasma RBCs:
viscosity occur with changes in: 12. Carbonic anhydrase is found at high concentration
a) Platelets count. in:
b) Plasma immunoglobulin level. a) plasma
c) Plasma sodium level. b) red blood cells
d) Total leucocytic count. c) intestinal cells
6. Which of the following plasma proteins is NOT d) salivary gland cells
synthesized primarily in the liver? e) cardiac muscle cells
a) Angiotensinogen. 13. Reaction between water and carbon dioxide within
b) Alpha 2-Macroglobulin. the RBCs is catalyzed by the enzyme:
a) Peroxidase.
c) Angiotensin II-converting enzyme.
b) Catalase.
d) Fibrinogen.
c) Collagenase.
e) Albumin.
d) Carbonic anhydrase.
7. Which of the following is NOT primarily a
14. In an individual with a blood Hb of 10 gm/dL and
function of blood plasma? hematocrit of 40, MCHC approximately is:
a) Transport of hormones. a) 15 gm/dL.
b) Exert osmotic pressure. b) 20 gm/dL.
c) Transport of chylomicrons. c) 25 gm/dL.
d) Transport of antibodies. d) 30 gm/dL.
e) Transport of oxygen. e) 10 gm/dL.
8. Serum does not contain: 15. Hemoglobin contains:
a) Prothrombin. a) one protoporphyrin ring and 4 ferrous ions
b) Ca. b) four protoporphyrin ring and one ferrous ion
c) Factor VIII. c) four protoporphyrin rings and four ferrous ions
d) Factor IX. d) one protoporphyrin ring and one ferrous ion
e) four protoporphyrin rings and four ferric ions
16. Red cells: 22. The amount of hemoglobin contained in
a) are present in smaller numbers per mm' of normocytes is approximately:
blood in men than in women. a) 15 pg.
b) average life span in the circulation is 130 days. b) 20 pg.
c) in an individual, have a mean Hb concentration c) 25 pg.
of 35% if the blood Hb level is 15 g%. d) 30 pg.
d) sediment at a rate which is related to their e) 35 pg.
tendency to come together in Rouleaux. 23. Macrocytes have a MCV greater than:
17. A lab technician determined the RBCS count by a) 65 Cuµ.
manual hemocytometry, blood hemoglobin by b) 70 Cuµ.
Sahli's acid hematin method and hematocrit by c) 80 Cuµ.
microcentrifuge. Which of the following RBCs d) 90 Cuµ.
indices is calculated from these measurements e) 100 Cuµ.
would be most important?
Erythropoiesis:
a) Mean corpuscular volume (MCV).
24. In embryonic life, the blood cell stage is first:
b) Mean corpuscular hemoglobin (MCH).
a) Hepatic stage
c) Mean corpuscular hemoglobin concentration
b) Mesoblastic stage
(MCHC).
c) Myeloid stage
d) Mean corpuscular diameter.
d) Mature stage
18. A hematocrit of 41% means that in the sample of
e) Splenic stage
blood analyzed:
25. Increased erythrocytes production will occur in
a) 41% of the hemoglobin is in the plasma.
persons who:
b) 41% of the total blood volume is made up of
a) Experience hemorrhage.
blood plasma.
b) Receive blood transfusion.
c) 41% of the total blood volume is made up of red
c) Have kidney disease.
and white blood cells and platelets.
d) Have liver disease.
d) 41% of the hemoglobin is in red blood cells.
e) Received irradiation therapy.
19. Hematocrit value is:
26. The need for vitamin B12 and folic acid in the
a) larger in venous than in arterial blood.
formation of red blood cells is related primarily to
b) higher in females than in males.
their effects on:
c) decreased one hour after hemorrhage. a) Absorption of iron from the gut.
d) increased in cases of dehydration. b) DNA synthesis in the bone marrow.
e) larger in smaller vessels than in larger ones. c) Hb formation in the red blood cell.
20. Erythrocytes: d) Synthesis of erythropoietin from kidney.
a) have no role in blood viscosity. e) Absorption of calcium from the gut.
b) lack carbonic anhydrase. 27. In the adult, most of circulating erythropoietin
c) do not use energy after originates from:
extrusion of the nucleus. a) Interstitial cells (fibroblasts) surrounding
d) swell up and burst if suspended peritubular capillaries in the renal cortex.
in hypertonic saline. b) Pervious hepatocytes.
e) integrity of its membrane needs glucose-6- c) Kupffer cells in the liver.
d) Bone marrow.
phosophate dehydrogenase enzyme.
e) Spleen.
21. The amount of hemoglobin contained in 100 ml of
28. Hemopoietic activity in the bone marrow is typically
RBCs is defined as:
increased:
a) Mean corpuscular hemoglobin (MCH).
a) Following injections of vitamin B12 into a
b) Mean corpuscular hemoglobin healthy individual on a normal diet.
concentration (MCHC). b) In a patient suffering from hemolytic anemia.
c) Hemoglobin index. c) If the reticulocytes count is low in the
d) Hematocrit value. peripheral blood.
e) RDW. d) A month after a large hemorrhage.
e) In men than in women.
29. Erythropoietin is a glycoprotein which: 36. Which of these groups is the most likely to have
a) Stimulates red and white cell production. anemia?
b) Is broken down in the kidney. a) Men.
c) Has a half-life of days. b) Women
d) Is released as a result of hypoxia. c) Teenagers.
e) Levels inversely proportional to hematocrit. d) older adults.
30. Erythropoietin: e) Children.
a) Is platelet maturation hormone. 37. A patient with long-standing indigestion has noticed
b) Is inactivated by Kupffer cells. increasing lack of energy and tiredness when
c) Is metabolized in kidney. walking. On questioning, he has noticed that the
d) Half-life is 5 minutes. bowel motions (stools) are unusually dark from
e) Is produced mainly by the kidney. time to time. Due to indigestion, the patient takes a
31. Erythropoietin is essential for: bland diet without much meat or vegetables. Select
a) Blood clotting. the most appropriate option?
b) Leucopoiesis. a) Iron deficiency anemia.
c) Formation of RBCs. b) Microcytic anemia.
d) Thrombopoiesis. c) Macrocytic anemia.
d) Normocytic anemia.
32. What function do vitamin B12 and folic acid
perform that is critical to hematopoiesis? 38. Indication for blood transfusion?
a) Support porphyrin production. a) COVID19 infection.
b) HB% 13.4
b) Serve as cofactors for iron uptake.
c) Common cold.
c) Support terminal differentiation of erythroid
d) Restoring blood volume.
and myeloid cells. e) Congenital heart diseases.
d) Support production of thymidine triphosphate 39. Anemia is a common condition. What happens
for DNA replication. when a person has anemia?
e) Stimulate erythropoietin production. a) The body produces too much iron.
33. During the second trimester of pregnancy, where is b) The blood doesn’t have enough red blood cells.
the predominant site of RBC production? c) The blood becomes thick.
a) Yolk sac. d) Too many white blood cells are produced.
b) Bone marrow. e) Increase in body weight.
c) Lymph nodes. 40. How does anemia affect the body?
d) Liver. a) The blood doesn’t deliver enough
e) Spleen. oxygen to the body.
34. The --------- produces red blood cells, which b) Blood becomes thin.
transports ----------- and some --------- c) Tissues retain fluids.
a) Liver, oxygen, mineral ions d) Increase of body weight.
b) Liver, oxygen, carbon dioxide e) The peripheral resistance is increased.
c) Bone marrow, oxygen, hormones 41. A lack of which of these will result in abnormally
d) Bone marrow, oxygen, carbon dioxide large red blood cells and a condition called
e) Spleen, Co2, mineral ions megaloblastic anemia?
a) Vitamin C.
Anemia: b) Vitamin B12 and folic acid.
35. Red cells: c) Thiamin.
a) start lysis when put in 0.9% NaCl solution and d) Vitamin D.
complete lysis when put in 0.5% NaCl solution. 42. In iron deficiency anemia:
b) from patients with sickle cell anemia contain Hb a) The hematocrit value increases.
with normal amino acid sequence. b) The hemoglobin percentage decreases.
c) are smaller in patients with folic acid deficiency. c) The MCV increases.
d) are normal in size in patients with anemia due d) The MCH increases.
to depression of bone marrow activity. e) RBCs count is normal.
e) are large in size in patients with iron deficiency.
43. What is the most common cause of anemia? d) AB negative blood.
a) Too little sleep. 49. Agglutinins:
b) Too much sugar. a) B-globulins, belonging to IgM and IgD.
c) Too little iron in the blood. b) Natural antibodies not requiring prior
d) Exposure to X-ray radiation. immunization with RBCs.
e) Exposure to sun rays. c) Present in the plasma of a person whose
blood group is AB.
44. Anemia is a common condition. What happens
d) Can pass the placenta easily.
when a person has anemia?
50. Dangerous blood transfusion reactions involve:
a) The body produces too much iron.
a) Agglutination of donor's RBCs caused by
b) The blood does not have enough red blood agglutinogens of recipient's plasma.
cells. b) Agglutination of recipient's RBCs caused by
c) The blood becomes thick. agglutinogens of donor's plasma.
d) Too many white blood cells are produced. c) Agglutination of donor's RBCs caused by
e) The blood contains more thrombocytes. agglutinins of recipient's plasma.
45. How does iron-deficiency anemia affect teenagers? d) Agglutination of recipient's RBCs caused by
a) More trouble with written expression. agglutinins of donor's plasma.
51. Which of the following is better indicator of need
b) Can't concentrate.
for transfusion?
c) Aggravates hyperactivity a) Urine output
d) A and B. b) Hematocrit
e) A and C. c) Color of skin
Blood groups: d) Clinical examination
46. In the context of blood transfusions, ABO e) Blood pressure
compatibility is important because: 52. The following transfusion will lead to
a) There are 3 antigens in this system agglutination:
b) The A and B antigens are present in all cells a) Donor O and Recipient B
c) when an individual's RBCs lacks the A or B b) Donor AB and Recipient A
antigen, the corresponding antibody is c) Donor B and Recipient AB
invariably present d) Donor O and Recipient AB
d) O is strong antigen e) Donor O and Recipient A
e) there are 4 antigens in this system 53. woman whose blood type is A positive and who has
47. Regarding the medicolegal importance of blood always been healthy just delivered her second child.
groups, if a baby's blood group is: The father's blood type is O negative. Because the
a) [B] and his mother's blood group is [A], his child's blood type is O negative (O, Rh negative),
father's blood group could not be [AB]. what would you expect to find in this child?
b) [A] and his mother's blood group is [AB], his a) Erythroblastosis fetalis due to Rh incompatibility.
father's blood group could not be [B]. b) Erythroblastosis fetalis due to ABO blood group
c) [AB] and his mother's blood group is [B], his incompatibility.
father's blood group could not be [A].
c) The child would not be expected to have hemolytic
d) [AB], his father's blood group could not be [O]
disease of the newborn (HDN).
whatever is his mother's blood group.
e) No importance for baby's blood group 54. A person with blood group B:
48. A 55 years old male accident victim in the ED a) cannot be a father of a child with O blood
urgently require transfusion. His blood group could group.
not be determined as his red cells group and plasma b) cannot be a father of a child with A blood group.
group did not match. Emergency transfusion should c) cannot be a father of a child with an AB blood
be done with: group if the mother belongs to O blood group.
a) RBC corresponding to his red cell group, colloids d) has the most common blood type.
and crystalloids. e) has ẞ agglutinin in his plasma.
b) Whole blood corresponding to
his plasma group.
c) O positive RBC, colloids and crystalloids.
55. The group A antigen: 61. The following is true about the ABO and Rh
a) is present on the red cells in 2nd month of fetal life. systems:
b) may occur in the saliva of a group A patient. a) A person of group O is a universal recipient.
c) is transmitted as an autosomal recessive b) A person who is group AB has anti-A and anti-B
characteristic. antibodies.
d) is more common than the group O antigen. c) The presence of D antigen means that the
56. If a woman's plasma agglutinates both A & B subject is Rh (+).
types of RBCs, we conclude that: d) Rh antibodies occur naturally.
a) her blood group is AB. e) The person of group A has anti-A antibodies.
b) her blood group is O.
c) her RBCs will be agglutinated by plasma from a
Hemostasis:
62. Vitamin K is required by the liver for normal
person with blood group A.
formation of:
d) her RBCs will be agglutinated by plasma from a
a) Fibrinogen
person with blood group B. b) Globulins
57. Red blood cell antigens A and B are present in: c) Platelets
a) saliva. d) Prothrombin
b) semen. e) Fibrin
c) amniotic fluid. 63. The conversion of fibrinogen into fibrin:
d) pancreas. a) Is promoted by prothrombin, a proteolytic
e) all of the above. enzyme.
58. In terms of the ABO blood groups, the b) Involves stabilization of certain peptide linkages
transfused cells are likely to be affected by an in fibrinogen.
c) Is followed by polymerization of the fibrin to
antigen-antibody reaction when:
form strands.
a) group A blood is transfused to group A person.
d) Is inhibited by Ca+2.
b) group O blood is transfused to a group AB person.
e) Is promoted by albumin.
c) group A blood is transfused to group O person. 64. The first important event in hemostasis following
d) group A blood is transfused to a group AB severe tissue injury is:
person. a) blood coagulation.
e) group B blood is transfused to a group AB b) formation of platelet plugs.
person. c) vascular spasm.
59. Which blood unit carries the least risks for d) formation of Thromboplastin.
inducing an immediate transfusion reaction e) formation of prothrombin activator.
into a B- Positive (B, rhesus positive) recipient? 65. Thrombin inhibits
a) Whole blood A positive. a) factor Xa
b) Whole blood O positive. b) tPA
c) protein C
c) Whole blood AB positive.
d) platelets
d) Packed red blood cells O positive.
e) none of the above
e) Packed red blood cells AB negative. 66. The initial thromboplastin for clotting comes from:
60. Mismatched blood transfusion: a) Platelets.
a) causes acute renal shutdown. b) Liver.
b) can give an immediate reaction with the first c) Mast cells.
time of Rh incompatibility. d) Damaged vessel wall and surrounding tissues.
c) can lead to increase in blood pressure. e) Lymphocytes.
d) produces severe hyperkalemia which is due to 67. Platelet activation will NOT occur without:
inactivation of Na-K pump in the RBCs a) Na+
membrane. b) vessel wall damage
e) causes severe back pain and tightness of chest. c) von Willebrand factor
d) fibrinogen
e) serotonin
68. The following statement about the formation of c) Prothrombin.
thrombin during normal hemostasis is correct: d) Platelets.
a) Formation of thrombin occurs primarily on the e) Factor VII.
surface of platelets. 75. The adhesion of platelets to subendothelial
b) Thrombin is formed by the effect of active collagen is impaired in absence of:
factor IX on prothrombin. a) von Willebrand factor.
c) Formation of thrombin requires Ca2+ and factor V. b) plasmin.
d) Deficiency of thrombin formation leads to c) heparin.
prolongation of bleeding time.
d) antithrombin III.
e) Formation of thrombin occurs primarily on the
76. Which of the following clotting factors is
surface of WBCs.
not vitamin K-dependent:
69. Which of the following decrease platelet
a) Factor II.
aggregation & cause vasodilatation?
a) PGE2 b) Factor V.
b) PGF2alpha c) Factor VII.
c) TBXA2 d) Factor IX.
d) PGD2 77. The intrinsic blood clotting requires all of
e) PGI2 the following EXCEPT:
70. The following are NOT true about platelets: a) Factor VIII.
a) They are formed in the bone marrow from b) Factor V.
megakaryocytes. c) Factor VII.
b) Their life span in circulation is about 30 days. d) Factor IX.
c) In a normal person, 20% of the platelets are
found in the spleen. Bleeding disorders:
d) They contain ADP and serotonin. 78. Normally, blood does not coagulate in vivo
e) They produce prostacyclin. because:
a) the body temperature is 37 c.
71. Platelet aggregation is stimulated by: b) of presence of heparin in circulating blood.
a) thromboxane A2 c) blood is circulating in the vessels under
b) fibrinogen. pressure.
c) thrombin. d) of the intact endothelial lining of the blood vessels.
e) the body mass index (BMI).
d) prostaglandin.
79. Fibrin degradation products are natural
e) serotonin. anticoagulants interfering with:
72. Which coagulation pathway begins with tissue a) Fibrinogen concentration.
thromboplastin? b) Platelet count.
a) Extrinsic pathway. c) Thrombin activity.
b) Intrinsic pathway. d) Serum calcium concentration.
c) Common pathway. e) Blood vessel elasticity.
d) Fibrin stabilization. 80. Antithrombin III inactivates which factor?
e) Clot retraction. a) XIIa
73. Primary hemostasis refers to cessation of b) Xa
bleeding due to: c) XIa
a) formation of a definitive blood clot. d) IXa
b) formation of a temporary platelet plug. e) All of the above
c) clot retraction. 81. What condition leads to a deficiency in factor IX
d) vascular reaction. that can be corrected by an IV vitamin K?
a) Classic hemophilia.
e) local axon reflex.
b) Hepatitis B.
74. The conversion of fibrinogen into fibrin is
c) Bile duct obstruction.
promoted by: d) Genetic deficiency in antithrombin III.
a) Factor X. e) Atrophic gastritis.
b) Thrombin.
82. The test that screens the extrinsic pathway is: maternal grandfather has a bleeding disorder. The
a) Prothrombin time (PT). child's physical examination shows slight
b) Activated partial thromboplastin time (aPTT). tenderness of his knee with fluid accumulation in
c) Thrombin time. the knee joint. You suspect this patient is deficient
d) Urea solubility test. in which coagulation factor?
e) Clot lysis time a) Prothrombin activator
83. The enzyme that ultimately lyses fibrin b) Factor II
is: c) Factor VIII
a) plasminogen. d) Factor X
b) TPA. e) Factor VII
c) urokinase. 90. A 15 years old child is admitted to hospital with
recent onset of widespread pinpoint skin
d) plasmin.
hemorrhage. Which abnormality the laboratory
84. Petechial hemorrhages are very common in:
investigation can reveal for the bleeding tendency?
a) Vitamin K deficiency.
select the most appropriate option from the
b) Hemophilia.
following list of options:
c) Purpura. a) Deficiency of vitamin K.
d) Heparin overdosage. b) Excessive heparin activity.
85. The process by which certain substance induces c) Massive blood transfusion.
platelet production by megakaryocytes. d) Platelet count 90 X109/L.
a) Thrombocytopeiosis e) Platelet count 20 X109/L.
b) Thrombocytopenia
c) Hemophilia
d) Purpura 91. Which of the following causes some malnourished
86. A reduction in the blood level of coagulation patients to bleed excessively when injured?
of factor VIII: a) Vitamin K deficiency.
a) Typically increases the bleeding time beyond b) Platelet sequestration by fatty liver.
the normal range. c) Serum bilirubin that raises neutralizing
b) Occurs as a hereditary disease due to an thrombin.
abnormal gene on the Y chromosome. d) Low serum protein levels that cause factor XIII
c) Causes parahemophilia disease. problems.
d) Is typically associated with small petechial e) Vitamin C deficiency.
hemorrhage into the skin. 92. A patient has a congenital deficiency in factor XIII
e) Causes hemophilia disease. (fibrin-stabilizing factor). What would analysis of his
87. Which of the following causes some malnourished blood reveal?
patients to bleed excessively when injured? a) Prolonged prothrombin time.
a) Vitamin K deficiency. b) Prolonged whole blood clotting time.
b) Platelet sequestration by fatty liver. c) Prolonged partial thromboplastin time.
c) Serum bilirubin that raises neutralizing d) Easily breakable clot.
thrombin. e) Abnormal prothrombin time.
93. The extrinsic pathway is triggered by the release of:
d) Low serum protein levels that cause factor XIII
a) factor VII.
problems.
b) tissue factor.
e) Iron deficiency. c) tissue factor pathway inhibitor
88. Which of the following would best explain a d) contact factor.
prolonged bleeding time test? e) factor XII.
a) Hemophilia A. 94. The extrinsic pathway is inhibited by:
b) Hemophilia B. a) tissue factor.
c) Thrombocytopenia. b) thromboplastin.
d) Jaundice. c) tissue factor pathway inhibitor (TFPI).
e) Obstruction of common bile duct. d) contact factor.
89. A 2-year-old boy bleeds excessively from minor e) HMWK.
injuries and previously had bleeding gums. The
95. Prolongation of prothrombin time does not occur
when there is a deficiency of only:
a) factor VIII.
b) factor IX.
c) factor X.
d) vitamin K.
e) factor XIII.
96. Mutations in which of the following have been
implicated in the pathogenesis of hypercoagulable
states?
a) Protein C.
b) Protein S.
c) Factor V.
d) Antithrombin III.
e) All of the above.
Enumerate:
Complete: 1) Five functions of Blood.
1) The test that screens the extrinsic pathway for 2) Five functions of Plasma proteins.
coagulation is -------------- 3) Five functions of RBCs.
2) The test that screens the intrinsic pathway for 4) Two functions of Hemoglobin.
coagulation is -------------- 5) Five factors necessary for erythropoiesis.
3) The function of von Willebrand factor is --------- 6) Etiological classification of anemia.
7) Effects of anemia.
Give an account on: 8) Types and characteristics of polycythemia.
4) Purpura. 9) Clinical importance of rh grouping.
5) Hemostasis (definition and stages). 10) Functions of Platelets.
6) Erythroblastosis fetalis. 11) Four natural anticoagulants.
Why intravascular clotting does not occur
Case study: under physiological conditions?
7) A 2-year-old boy bleeds excessively from minor 12) Types of hemophilia.
injuries and previously had bleeding gums. The 13) Causes of hypercoagulable state.
maternal grandfather has a bleeding disorder. The
14) Indications of blood transfusion.
child’s physical examination shows slight
tenderness of his knee with fluid accumulation in
15) Hazards of blood transfusion.
Incompatible blood transfusion reactions
the knee joint. Which coagulation factor is
(Major incompatible reactions)?
deficient in this case?

Answers: ‫ﺔ ﻓﻘﻂ‬ƒ‫{ﺔ اﺳ•~ﺷﺎد‬z‫ﻫﺬە اﻷﺟ‬

1. prothrombin time
2. clotting time
3. adhesion of platelets
7. factor VIII
Hemoglobin structure & metabolism: b) Occupying the same position of O2 in the
1. Porphyrins are hemoglobin
a) Heterocyclic compounds c) Removing iron form hemoglobin,
b) Metalloproteins forming hematin
c) Inorganic pigments d) Inhibiting oxidative phosphorylation
d) Modified proteins e) Slowing capillary circulation
e) Compound lipids 8. Thalassemia is an example of:
2. All the following proteins contain porphyrin ring a) Frame shift (deletion) mutation.
EXCEPT: b) Silent mutation.
a) Hemoglobin c) Missense mutation.
b) Myoglobin d) Nonsense mutation.
c) Cytochrome e) X-linked recessive disease.
d) Catalase 9. Erythrocytes of peoples with a homozygous
e) Glutathione peroxidase sickle cell anemia contain predominantly:
3. Which is not part of hemoglobin molecule? a) Hemoglobin A.
a) Histidine. b) Hemoglobin A2.
b) Vinyl group. c) Hemoglobin F.
c) Ferric ion d) Hemoglobin S.
d) Pyrrole rings. e) Methemoglobin
e) Protein. 10. In sickle cell hemoglobin, the position 6
4. All of the followings are normal hemoglobin glutamyl residue is replaced by:
EXCEPT: a) Aspartate.
a) Hemoglobin A. b) Threonine.
b) Hemoglobin A2. c) Lysine.
c) Hemoglobin A1c. d) Glutamine.
d) Hemoglobin S. e) Valine.
e) Hemoglobin F. 11. In hemoglobin C, the position 6 glutamyl
5. The type of hemoglobin which binds irreversibly residue is replaced by:
with oxygen is: a) Aspartate.
a) Hemoglobin A. b) Threonine.
b) Hemoglobin A2. c) Lysine.
c) Hemoglobin F. d) Glutamine.
d) Hemoglobin S. e) Valine
e) Methemoglobin. 12. Heme biosynthesis occurs in
6. The Bohr effect describes: a) Bone marrow
a) The effect of PCO2 on the dissociation of b) Liver for cytochrome P450
oxyhemoglobin. c) Intestinal macrophages
b) The effect of Zn2+ on the activity of carbonic d) Both a and b
anhydrase. e) Both b and c
c) The toxic effect of very high P02 on the 13. Which of the following amino acid is the
nervous system. precursor of delta-Aminolevulinate:
d) The buffering action of imidazole groups. a) Alanine.
e) All of the above. b) Proline.
7. Carbon monoxide produce hypoxia by: c) Glycine.
d) Leucine.
a) Forming met-hemoglobin
e) Histidine.
14. Porphyrins are synthesized from: 21. Metabolic degradation of hemoglobin takes
a) Proline and iron place mainly in:
b) Glycine and proline a) The reticuloendothelial system.
c) Glycine and succinyl CoA b) The erythrocytes.
d) Amino acids and folic acid c) The skeletal muscles.
15. The key enzyme of heme biosynthesis is: d) Kidney tubules.
a) Delta-aminolaevulinic acid (ALA) synthase e) All the above.
b) Uroporphyrinogen I synthase 22. The first step in the catabolism of hemoglobin
c) Uroporphyrinogen II cosynthase occurs when hemoglobin is:
d) Uroporphyrinogen II decarboxylase a) Converted to biliverdin in the liver.
16. In heme synthesis, the committed step is: b) Converted to bilirubin in the reticuloendothelial
a) Condensation of 2 PBG (porphobilinogen). cells.
b) Condensation of 2 ALA (Aminolevulinate). c) Conjugated with glucuronic acid in liver.
c) Condensation of glycine and succinyl CoA. d) Reduced in the liver.
d) Formation of uroporphyrinogen III. e) Reduced in the intestine.
e) Formation of coproporphyrinogen III. 23. Catabolism of hemoglobin involves:
17. All about delta-Aminolaevulinic acid a) The formation of bile pigments.
synthase activity is true EXCEPT. b) Oxidative cleavage of porphyrin ring.
a) Occurs in mitochondria. c) The formation of urobilin.
b) Catalyzing the rate limiting reaction in d) Results in liberation of carbon monoxide.
heme biosynthesis. e) All of the above.
c) Inhibited by lead poisoning. 24. Heme is catabolized by which enzyme of
d) Requires the coenzyme pyridoxal phosphate. the phagocytic cells?
e) Its substrates are acetyl CoA and glycine. a) Protease
18. Delta-Aminolaevulinic acid synthase activity: b) Heme oxygenase
a) Occurs in cytosol. c) Ferrochelatase
b) Requires the coenzyme biotin. d) Decarboxylase
c) Stimulated by heavy metals as lead. e) Deaminase
d) Repressed in individuals treated with drugs such 25. The normal brown-red color of feces
as phenobarbital. results from the presence of:
e) Catalyzing the rate limiting reaction in heme
a) Heme.
biosynthesis.
b) Biliverdin.
19. Deficiency of ALA synthase leads to: c) Stercobilin.
a) Red urine d) Bilirubin diglucuronide.
b) Photosensitivity e) Coproporphyrin III.
c) Anaemia 26. Plasma bilirubin results mainly from the
d) Jaundice
breakdown of:
e) Brown stool
a) Hemoglobin
20. The following disorders are inherited as b) Myoglobin
autosomal dominant disease EXCEPT: c) Cytochrome oxidase
a) Acute intermittent porphyria. d) Cytochrome P450
b) Hereditary coproporphyria. e) Catalase
c) Porphyria variegate. 27. Bile pigments (bilirubin) are derived from:
d) Congenital erythropoietic porphyria.
a) Cholic acid
e) Erythrohepatic porphyria
b) Heme
 c) Triacylglycerols d) Dubin Johnson Syndrome
d) Cholesterol. 34. The enzyme deficient in acute intermittent
e) Phospholipids porphyria:
28. The direct bilirubin consists of: a) ALA synthase
a) Bilirubin conjugated with glucuronic acid b) Uroporphyrinogen-III synthase
b) Bilirubin conjugated with gluconic acid c) δ-ALA dehydratase
c) Bilirubin conjugated with albumin d) Porphobilinogen deaminase
d) Bilirubin conjugated with globulin 35. Iron in hemoglobin binds with:
e) All of the above a) Alanine
29. Bilirubin diglucuronide is: b) Serine
a) Elevated in neonatal hyperbilirubinemia. c) Histidine
b) Elevated in hemolytic jaundice. d) Glycine
c) Lipid soluble 36. The enzyme responsible for conjugation of
d) Normally excreted in urine bilirubin is:
e) Usually found in bile duct a) Bilirubin esterase
30. Delta bilirubin (indirect) is that type of bilirubin b) Glutamyl-bilirubin esterase
which: c) Bilirubin conjugase
a) Present normally in blood. d) Glucuronyl transferase
b) Present normally in bile. 37. Heme isn’t synthesized in:
c) Present in trace amounts in urine. a) Liver cells
d) Binds noncovalently with albumin. b) Muscular tissue
e) Binds covalently with albumin. c) Erythropoietic precursor of bone marrow
31. All of the following statements are correct d) Brain tissue
EXCEPT: 38. The end product of catabolism of heme is:
a) In normal individuals, bilirubin is not detectable a) Bile pigment
in urine. b) Bile salts
b) Hemolysis elevates plasma unconjugated c) Bile acids
bilirubin. d) Uric acid
c) Direct bilirubin in Van den Bergh reaction 39. Heme can be described as
corresponds to conjugated bilirubin. a) An apoprotein
d) Hemolytic jaundice results in decreased b) Iron containing metalloprotein
excretion of urinary urobilinogen. c) Iron atom located in the center of
32. Crigler Najjar syndrome is a congenital protoporphyrin
bilirubinemia due to a defect in the conjugating d) An inorganic component of
system due to the lack of which enzyme: hemoglobin
a) UDP-glucose epimerase. 40. What causes the brown color of the stool?
b) Phosphogalactose-uridyl transferase. a) Stercobilinogen
c) UDP-glucuronyl transferase. b) Urobilinogen
d) Phosphoglucose-uridyl transferase. c) Stercobilin
e) UDP-galactose pyrophosphorylase d) Urobilin
33. All the followings arc typos of congenital 41. Pyrrole ring is:
hyperbilirubinemia EXCEPT: a) A heterocyclic five-membered ring
a) Gilbert's disease b) Found in porphyrins and proline
b) Von Gierke's disease c) Both a and b
c) Crigler Najjar Syndrome d) Neither a nor b
42. The following are the normal forms of c) Thalassemia
hemoglobin, except: d) Cooley Hb (17)
a) НbA1C Vitamins metabolism:
b) Hb F 50. All are fat-soluble vitamins EXCEPT:
c) НbA2 a) Vitamin A
d) Hb S b) Vitamin C
43. Hb F has high affinity for O2 than Hb A due to c) Vitamin D
presence of: d) Vitamin E
a) β-chain e) Vitamin K
b) γ-chain 51. Vitamin B12 contains:
c) α-chain a) Iron
d) δ-chain b) Copper
44. Iron in heme is linked to globin through: c) Zinc
a) Histidine d) Selenium
b) Arginine e) Cobalt
c) Glycine 52. Vitamin B12:
d) Cysteine a) is a fat-soluble vitamin.
45. Which of the following has a protective effect b) a vitamin not needed in diet because it is
against malaria? synthesized by intestinal bacteria.
a) Hb F c) is a zinc containing B vitamin.
b) Hb M d) needs intrinsic factor for absorption.
c) Hb S e) present in animal and plant sources.
d) Hb H 53. Absorption of vitamin B12 doesn’t require:
46. The binding of oxygen to hemoglobin can best a) Bile salts
described graphically as: b) Intrinsic factor
a) hyperbolic c) Intestinal receptors
b) linear d) Healthy gastric mucosa
c) sigmoidal e) Cobalophilin protein
d) reciprocal 54. Which one of the following statements
47. The binding of oxygen to myoglobin can best be concerning vitamin B12 is INCORRECT?
described graphically as: a) is red in color.
a) sigmoidal b) contains heme ring.
b) linear c) is a cofactor for conversion of
c) hyperbolic homocysteine into methionine.
d) reciprocal d) requires intrinsic factor for its absorption.
48. Hemoglobin is a: e) Restrict vegetarians develops deficiency.
a) Monomeric protein 55. Vitamin K:
b) Trimeric protein a) Water-soluble vitamin.
c) Tetrameric protein b) Vitamin K2 is synthetic.
d) Dimeric protein c) Essential for clot formation.
49. A point mutation in the beta-globin gene d) Present in the intestine of newborn infants.
changing the codon from glutamate to valine will e) Long use of dicumarol promotes its action.
likely cause what disease? 56. In the regeneration of methionine from
a) Sickle cell anemia homocysteine, which of the following vitamins
b) Methemoglobinemia are involved:
 a) Lipoic acid c) Calcium ions
b) Retinoic acid d) Heparan sulfate
c) Vitamins E and K e) Iron deficiency
d) Tetrahydrofolate and vitamin B12 64. Vitamin K plays a role in biosynthesis of:
57. A deficiency of vitamin B12 causes: a) collagen and elastin
a) Scurvy b) prothrombin and osteocalcin
b) Beriberi c) heparin and heparin sulfate
c) Spina bifida d) prostaglandins and Leukotrienes
d) Pernicious Anemia 65. Vitamin K is essential for:
e) Microcytic Anemia a) Synthesis of prothrombin
58. Cyanocobalamin is: b) Synthesis of calcitonin
a) The therapeutic form of vitamin B12 c) Synthesis of serotonin
b) An inhibitor of cobalamin function d) Synthesis of catecholamines
c) The coenzyme form of vitamin B12 e) Iron absorption
d) A fat-soluble compound 66. THFA is coenzyme for:
e) The active form of vitamin B6 a) Transport of amino group
59. Folic acid is important for: b) CO2 fixation
a) Carbon dioxide donor. c) Transport of methylene group
b) Treatment of rickets. d) Transport of oxygen
c) Carbon dioxide fixation. 67. All the following vitamins are fat soluble EXCEPT
d) Provide carbon 6 of purine nucleotides. a) Vitamin A
e) Providing of carbon 2 and 8 of purines. b) Vitamin C
c) Vitamin D
60. Which is true about folic acid activation?
d) Vitamin E
a) The active form is dihydrofolate.
e) Vitamin K
b) It is activated by dihydrofolate reductase.
c) Reduction of folic acid requires FDH2
68. Vitamin B12 deficiency may lead to
a) Scurvy
d) Both a and c are true
b) Pellagra
e) All of the above
c) Megaloblastic anemia
61. Folic acid deficiency may be seen:
d) Osteomalacia
a) In pregnant women, who need double the
e) Rickets
normal daily requirements
b) With vitamin B12 deficiency, which leads Minerals metabolism:
to the methyl trap of folic acid 69. Hemochromatosis is due to excessive
c) In adult healthy males deposition of:
d) Both a and b a) Selenium
e) Both a and c b) Copper
62. Neural tube defects occur in deficiency of: c) Zinc
a) Vitamin K d) Iron
b) Vitamin B12 70. Total iron binding capacity is:
c) Folic acid a) Plasma iron binding protein.
d) Pyridoxine b) Total amount of iron that can be stored in the
e) Vitamin C iron stores.
63. Vitamin K is competitively inhibited by: c) Maximum amount of plasma iron that can be
a) Heparin carried by transferrin,
b) Coumarone
 d) Minimum amount of plasma iron that can be 79. Which of the following minerals help
carried by transferrin. crystallization, storage and release of insulin
71. All the following proteins contain iron EXCEPT: a) Selenium.
a) Hemoglobin b) Chromium,
b) Myoglobin c) Potassium.
c) Cytochrome c d) Zinc
d) Ceruloplasmin 80. Transferrin is:
72. Iron containing protein is: a) Plasma iron binding protein.
a) Ferritin b) Storage form of iron.
b) Apoferritin c) Hemoprotein containing single heme ring.
c) Transferrin d) Intestinal carrier for iron absorption.
d) All of the above 81. Which finding about iron deficiency anomia is
73. For TIBC (Total Iron Binding Capacity) incorrect
one of the following is correct: a) Plasma iron is decreased.
a) Increased in iron deficiency anemia b) Plasma TIDC is decreased.
b) Increased in iron overload c) Plasma ferritin is decreased.
c) Decreased in iron deficiency anemia d) RBCs are hypochromic and microcytic.
d) Synthesis of transferrin is increased in liver disease 82. Zinc deficiency causes:
74. A trace element is: a) Rickets
a) Magnesium b) Scurvy
b) Chlorine c) Impaired spermatogenesis
c) Iron
d) Cataract
d) Sodium
83. Iron is transported in the circulation bound to
75. Copper is transported in plasma in the form of
a) Ferroprotein
a) Ferritin
b) Transferrin
b) Ceruloplasmin
c) Ceruloplasmin
c) Hepatocuprein
d) Ferric acid
d) Erythrocuprein
84. Iron absorption is inhibited by:
76. Zinc is a constituent of all the following EXCEPT:
a) Tannic acid
a) Ceruloplasmin
b) Phytate
b) RNA polymerase
c) Oxalate
c) Carbonic anhydrase
d) Steatorrhea
d) Carboxy peptidase
e) All of the above
77. A plasma protein carrying copper is:
85. Zinc deficiency causes mostly:
a) Transferrin.
a) Rickets
b) Transcortin.
b) Scurvy
c) Ceruloplasmin
c) Anemia
d) Pre-albumin
d) Hypogonadism
78. Wilson's disease results from deposition of:
86. Trace elements (micro minerals) include
In Wilson's disease there is a deficiency of
a) Iron, copper and zinc
a) Transferrin
b) Calcium
b) Copper c) Phosphorus
c) Ferritin
d) Magnesium
d) Zinc
87. Impaired spermatogenesis may be present in Answers:
deficiency of one of the following: 1. Oxygen carrier – oxygen store
2. Four oxygen molecules – one oxygen molecule
a) Iron
3. Carbon monoxide binds to hemoglobin.
b) Copper
4. CO2 and 2,3-DPG. 5. 20
c) Zinc 6. Bilirubin – albumin – glucuronic acid – UDP
d) Folic acid glucuronide transferase – liver – water soluble.
Complete: 7. 0.2-1.0 mg/dl; 0-0.2mg/dl
8. Iron 9. Upper duodenum 10. Transferrin
1. Hemoglobin acts as --- but myoglobin acts as ---
11. Ferritin. 12. Hemopexin 13. Haptoglobin
2. Hemoglobin binds ---- but myoglobin binds ----- 14. microcytic hypochromic 15.16. macrocytic hypochromic
3. Carboxyhemoglobin formed when -------- 17. ALA dehydratase and ferrochelatase
4. Affinity of Hb to oxygen is decreased by ------- 18. upper duodenum
5. 100 ml of blood can carry ----- ml oxygen 19. factor II, VII, IX and X
6. The end product of heme catabolism is -----, 20. trap - vitamin B12 - megaloblastic anemia - 5-MTHF
then carried in the blood by --------- and finally 21. male - ATP7A
conjugate with ------- by the enzyme ------------ 1. Decreased pH and increased pCO2 helps oxygen to
present in the ---------- to get ------------ dissociate from Hb at the tissues and bind at the
7. The normal level of total plasma bilirubin is ----- lungs.
and direct bilirubin constitutes ------------. 2. Binding of oxygen molecule to hemoglobin helps
more oxygen binding.
8. The trace element deficient in milk is -------
3.Bicarbonate ions diffuses outside RBCs in exchange
9. Iron is absorbed at ------------
with chloride ions.
10. The transporter protein of plasma iron is ------ 4. yellowish discoloration of skin and mucous
11. The storage form of iron is --------- membranes due to hyperbilirubinemia above 3 mg/dl.
12. The carrier of free heme is called --------- 5. elevated plasma bilirubin level above 1 mg/dl but still
13. The carrier of free hemoglobin is called --------- below 3 mg/dl which is insufficient to cause jaundice.
14. Type of iron deficiency anemia is ------------ 6. Elements required in amount less than 100 mg/day
15. Type of cobalamin deficiency anemia is -------- e.g. iron , copper and zinc.
16. Type of THF deficiency anemia is ------------ 7. The maximum amount of iron that can be carried by
17. Lead poisoning is the most common cause of transferrin.
acquired porphyria by inhibition of ------------ Open questions:
18. Iron is readily absorbed from ------------ 1. Enumerate iron containing proteins (hemoproteins).
19. Vitamin K dependent coagulation factors are 2. Describe the structure of Hb A1 molecule.
------------ 4 polypeptide chains (2 α units and 2 β units) and
20. Folate ------------ occurs due to ------------ 4 heme molecules.
deficiency in the condition ------------ and it is 3. Describe the structure of myoglobin molecule.
present in the form of ------------ 1 polypeptide chain and 1 heme molecules.
21. Menke's kinky hair syndrome is an x-linked 4. Enumerate normal forms of hemoglobin with
syndrome that affects only ----------------- their constituent polypeptide chains.
where cupper is absorbed from GIT but can’t 5. Discuss glycated hemoglobin and its significance.
be transported due to absence of --------------- 6. What is sickle hemoglobin?
Define: 7. Discuss HbF and its significance.
8. Enumerate factors affecting iron absorption.
1. Bohr’s effect.
9. Enumerate functions of iron.
2. Cooperative oxygen binding.
10. What are sites of ferritin?
3. Chloride shift. 11. Enumerate functions of copper.
4. Jaundice. 12. Enumerate copper containing enzymes.
5. Latent icterus (Hyperbilirubinemia). 13. Enumerate functions of zinc.
6. Trace elements. 14. Enumerate zinc containing enzymes.
7. TIBC. 15. Discuss Wilson’s disease.
Plasma proteins: 9. Fluid exudation into the tissue in an acute
1. Which of the following is NOT found in plasma? inflammatory reaction is due to which of the
a) Albumin. following?
b) Sodium. a) Decreased blood pressure
c) Glucose. b) Decreased protein in the interstitium
d) Hemoglobin. c) Obstruction of the lymph vessels
e) Potassium. d) Increased clotting factors
2. The plasma globulins are synthesized mainly in the: e) Increased vascular permeability
a) Liver. 10. The most abundant protein in blood is
b) Lung. a) Albumin.
c) Heart. b) Hemoglobin.
d) Reticuloendothelial system. c) Fibrinogen.
e) Kidney. d) beta-1 globulin.
3. The normal A/G ratio in blood is: e) beta-2 globulin.
a) 2:1. 11. Concerning the origin of plasma proteins:
b) 1:3. a) All types are formed by liver only.
b) Albumin, fibrinogen, prothrombin and 50% of
c) 3:1.
globulin are synthesized in liver.
d) 2:3.
c) Gamma globulins are formed by mast cells in
4. Osmotic pressure of plasma is mainly maintained by:
the lymphoid tissue.
a) Albumin. d) Gamma globulins are released from activated T
b) Carbon dioxide.
lymphocytes.
c) Globulins. e) Proteins of muscles and viscera favor globulins
d) Fibrinogen.
formation.
e) Antigens.
5. Clinically significant changes in blood plasma RBCs:
viscosity occur with changes in: 12. Carbonic anhydrase is found at high concentration
a) Platelets count. in:
b) Plasma immunoglobulin level. a) plasma
c) Plasma sodium level. b) red blood cells
d) Total leucocytic count. c) intestinal cells
6. Which of the following plasma proteins is NOT d) salivary gland cells
synthesized primarily in the liver? e) cardiac muscle cells
a) Angiotensinogen. 13. Reaction between water and carbon dioxide within
b) Alpha 2-Macroglobulin. the RBCs is catalyzed by the enzyme:
a) Peroxidase.
c) Angiotensin II-converting enzyme.
b) Catalase.
d) Fibrinogen.
c) Collagenase.
e) Albumin.
d) Carbonic anhydrase.
7. Which of the following is NOT primarily a
14. In an individual with a blood Hb of 10 gm/dL and
function of blood plasma? hematocrit of 40, MCHC approximately is:
a) Transport of hormones. a) 15 gm/dL.
b) Exert osmotic pressure. b) 20 gm/dL.
c) Transport of chylomicrons. c) 25 gm/dL.
d) Transport of antibodies. d) 30 gm/dL.
e) Transport of oxygen. e) 10 gm/dL.
8. Serum does not contain: 15. Hemoglobin contains:
a) Prothrombin. a) one protoporphyrin ring and 4 ferrous ions
b) Ca. b) four protoporphyrin ring and one ferrous ion
c) Factor VIII. c) four protoporphyrin rings and four ferrous ions
d) Factor IX. d) one protoporphyrin ring and one ferrous ion
e) four protoporphyrin rings and four ferric ions
16. Red cells: 22. The amount of hemoglobin contained in
a) are present in smaller numbers per mm' of normocytes is approximately:
blood in men than in women. a) 15 pg.
b) average life span in the circulation is 130 days. b) 20 pg.
c) in an individual, have a mean Hb concentration c) 25 pg.
of 35% if the blood Hb level is 15 g%. d) 30 pg.
d) sediment at a rate which is related to their e) 35 pg.
tendency to come together in Rouleaux. 23. Macrocytes have a MCV greater than:
17. A lab technician determined the RBCS count by a) 65 Cuµ.
manual hemocytometry, blood hemoglobin by b) 70 Cuµ.
Sahli's acid hematin method and hematocrit by c) 80 Cuµ.
microcentrifuge. Which of the following RBCs d) 90 Cuµ.
indices is calculated from these measurements e) 100 Cuµ.
would be most important?
Erythropoiesis:
a) Mean corpuscular volume (MCV).
24. In embryonic life, the blood cell stage is first:
b) Mean corpuscular hemoglobin (MCH).
a) Hepatic stage
c) Mean corpuscular hemoglobin concentration
b) Mesoblastic stage
(MCHC).
c) Myeloid stage
d) Mean corpuscular diameter.
d) Mature stage
18. A hematocrit of 41% means that in the sample of
e) Splenic stage
blood analyzed:
25. Increased erythrocytes production will occur in
a) 41% of the hemoglobin is in the plasma.
persons who:
b) 41% of the total blood volume is made up of
a) Experience hemorrhage.
blood plasma.
b) Receive blood transfusion.
c) 41% of the total blood volume is made up of red
c) Have kidney disease.
and white blood cells and platelets.
d) Have liver disease.
d) 41% of the hemoglobin is in red blood cells.
e) Received irradiation therapy.
19. Hematocrit value is:
26. The need for vitamin B12 and folic acid in the
a) larger in venous than in arterial blood.
formation of red blood cells is related primarily to
b) higher in females than in males.
their effects on:
c) decreased one hour after hemorrhage. a) Absorption of iron from the gut.
d) increased in cases of dehydration. b) DNA synthesis in the bone marrow.
e) larger in smaller vessels than in larger ones. c) Hb formation in the red blood cell.
20. Erythrocytes: d) Synthesis of erythropoietin from kidney.
a) have no role in blood viscosity. e) Absorption of calcium from the gut.
b) lack carbonic anhydrase. 27. In the adult, most of circulating erythropoietin
c) do not use energy after originates from:
extrusion of the nucleus. a) Interstitial cells (fibroblasts) surrounding
d) swell up and burst if suspended peritubular capillaries in the renal cortex.
in hypertonic saline. b) Pervious hepatocytes.
e) integrity of its membrane needs glucose-6- c) Kupffer cells in the liver.
d) Bone marrow.
phosophate dehydrogenase enzyme.
e) Spleen.
21. The amount of hemoglobin contained in 100 ml of
28. Hemopoietic activity in the bone marrow is typically
RBCs is defined as:
increased:
a) Mean corpuscular hemoglobin (MCH).
a) Following injections of vitamin B12 into a
b) Mean corpuscular hemoglobin healthy individual on a normal diet.
concentration (MCHC). b) In a patient suffering from hemolytic anemia.
c) Hemoglobin index. c) If the reticulocytes count is low in the
d) Hematocrit value. peripheral blood.
e) RDW. d) A month after a large hemorrhage.
e) In men than in women.
29. Erythropoietin is a glycoprotein which: 36. Which of these groups is the most likely to have
a) Stimulates red and white cell production. anemia?
b) Is broken down in the kidney. a) Men.
c) Has a half-life of days. b) Women
d) Is released as a result of hypoxia. c) Teenagers.
e) Levels inversely proportional to hematocrit. d) older adults.
30. Erythropoietin: e) Children.
a) Is platelet maturation hormone. 37. A patient with long-standing indigestion has noticed
b) Is inactivated by Kupffer cells. increasing lack of energy and tiredness when
c) Is metabolized in kidney. walking. On questioning, he has noticed that the
d) Half-life is 5 minutes. bowel motions (stools) are unusually dark from
e) Is produced mainly by the kidney. time to time. Due to indigestion, the patient takes a
31. Erythropoietin is essential for: bland diet without much meat or vegetables. Select
a) Blood clotting. the most appropriate option?
b) Leucopoiesis. a) Iron deficiency anemia.
c) Formation of RBCs. b) Microcytic anemia.
d) Thrombopoiesis. c) Macrocytic anemia.
d) Normocytic anemia.
32. What function do vitamin B12 and folic acid
perform that is critical to hematopoiesis? 38. Indication for blood transfusion?
a) Support porphyrin production. a) COVID19 infection.
b) HB% 13.4
b) Serve as cofactors for iron uptake.
c) Common cold.
c) Support terminal differentiation of erythroid
d) Restoring blood volume.
and myeloid cells. e) Congenital heart diseases.
d) Support production of thymidine triphosphate 39. Anemia is a common condition. What happens
for DNA replication. when a person has anemia?
e) Stimulate erythropoietin production. a) The body produces too much iron.
33. During the second trimester of pregnancy, where is b) The blood doesn’t have enough red blood cells.
the predominant site of RBC production? c) The blood becomes thick.
a) Yolk sac. d) Too many white blood cells are produced.
b) Bone marrow. e) Increase in body weight.
c) Lymph nodes. 40. How does anemia affect the body?
d) Liver. a) The blood doesn’t deliver enough
e) Spleen. oxygen to the body.
34. The --------- produces red blood cells, which b) Blood becomes thin.
transports ----------- and some --------- c) Tissues retain fluids.
a) Liver, oxygen, mineral ions d) Increase of body weight.
b) Liver, oxygen, carbon dioxide e) The peripheral resistance is increased.
c) Bone marrow, oxygen, hormones 41. A lack of which of these will result in abnormally
d) Bone marrow, oxygen, carbon dioxide large red blood cells and a condition called
e) Spleen, Co2, mineral ions megaloblastic anemia?
a) Vitamin C.
Anemia: b) Vitamin B12 and folic acid.
35. Red cells: c) Thiamin.
a) start lysis when put in 0.9% NaCl solution and d) Vitamin D.
complete lysis when put in 0.5% NaCl solution. 42. In iron deficiency anemia:
b) from patients with sickle cell anemia contain Hb a) The hematocrit value increases.
with normal amino acid sequence. b) The hemoglobin percentage decreases.
c) are smaller in patients with folic acid deficiency. c) The MCV increases.
d) are normal in size in patients with anemia due d) The MCH increases.
to depression of bone marrow activity. e) RBCs count is normal.
e) are large in size in patients with iron deficiency.
43. What is the most common cause of anemia? d) AB negative blood.
a) Too little sleep. 49. Agglutinins:
b) Too much sugar. a) B-globulins, belonging to IgM and IgD.
c) Too little iron in the blood. b) Natural antibodies not requiring prior
d) Exposure to X-ray radiation. immunization with RBCs.
e) Exposure to sun rays. c) Present in the plasma of a person whose
blood group is AB.
44. Anemia is a common condition. What happens
d) Can pass the placenta easily.
when a person has anemia?
50. Dangerous blood transfusion reactions involve:
a) The body produces too much iron.
a) Agglutination of donor's RBCs caused by
b) The blood does not have enough red blood agglutinogens of recipient's plasma.
cells. b) Agglutination of recipient's RBCs caused by
c) The blood becomes thick. agglutinogens of donor's plasma.
d) Too many white blood cells are produced. c) Agglutination of donor's RBCs caused by
e) The blood contains more thrombocytes. agglutinins of recipient's plasma.
45. How does iron-deficiency anemia affect teenagers? d) Agglutination of recipient's RBCs caused by
a) More trouble with written expression. agglutinins of donor's plasma.
51. Which of the following is better indicator of need
b) Can't concentrate.
for transfusion?
c) Aggravates hyperactivity a) Urine output
d) A and B. b) Hematocrit
e) A and C. c) Color of skin
Blood groups: d) Clinical examination
46. In the context of blood transfusions, ABO e) Blood pressure
compatibility is important because: 52. The following transfusion will lead to
a) There are 3 antigens in this system agglutination:
b) The A and B antigens are present in all cells a) Donor O and Recipient B
c) when an individual's RBCs lacks the A or B b) Donor AB and Recipient A
antigen, the corresponding antibody is c) Donor B and Recipient AB
invariably present d) Donor O and Recipient AB
d) O is strong antigen e) Donor O and Recipient A
e) there are 4 antigens in this system 53. woman whose blood type is A positive and who has
47. Regarding the medicolegal importance of blood always been healthy just delivered her second child.
groups, if a baby's blood group is: The father's blood type is O negative. Because the
a) [B] and his mother's blood group is [A], his child's blood type is O negative (O, Rh negative),
father's blood group could not be [AB]. what would you expect to find in this child?
b) [A] and his mother's blood group is [AB], his a) Erythroblastosis fetalis due to Rh incompatibility.
father's blood group could not be [B]. b) Erythroblastosis fetalis due to ABO blood group
c) [AB] and his mother's blood group is [B], his incompatibility.
father's blood group could not be [A].
c) The child would not be expected to have hemolytic
d) [AB], his father's blood group could not be [O]
disease of the newborn (HDN).
whatever is his mother's blood group.
e) No importance for baby's blood group 54. A person with blood group B:
48. A 55 years old male accident victim in the ED a) cannot be a father of a child with O blood
urgently require transfusion. His blood group could group.
not be determined as his red cells group and plasma b) cannot be a father of a child with A blood group.
group did not match. Emergency transfusion should c) cannot be a father of a child with an AB blood
be done with: group if the mother belongs to O blood group.
a) RBC corresponding to his red cell group, colloids d) has the most common blood type.
and crystalloids. e) has ẞ agglutinin in his plasma.
b) Whole blood corresponding to
his plasma group.
c) O positive RBC, colloids and crystalloids.
55. The group A antigen: 61. The following is true about the ABO and Rh
a) is present on the red cells in 2nd month of fetal life. systems:
b) may occur in the saliva of a group A patient. a) A person of group O is a universal recipient.
c) is transmitted as an autosomal recessive b) A person who is group AB has anti-A and anti-B
characteristic. antibodies.
d) is more common than the group O antigen. c) The presence of D antigen means that the
56. If a woman's plasma agglutinates both A & B subject is Rh (+).
types of RBCs, we conclude that: d) Rh antibodies occur naturally.
a) her blood group is AB. e) The person of group A has anti-A antibodies.
b) her blood group is O.
c) her RBCs will be agglutinated by plasma from a
Hemostasis:
62. Vitamin K is required by the liver for normal
person with blood group A.
formation of:
d) her RBCs will be agglutinated by plasma from a
a) Fibrinogen
person with blood group B. b) Globulins
57. Red blood cell antigens A and B are present in: c) Platelets
a) saliva. d) Prothrombin
b) semen. e) Fibrin
c) amniotic fluid. 63. The conversion of fibrinogen into fibrin:
d) pancreas. a) Is promoted by prothrombin, a proteolytic
e) all of the above. enzyme.
58. In terms of the ABO blood groups, the b) Involves stabilization of certain peptide linkages
transfused cells are likely to be affected by an in fibrinogen.
c) Is followed by polymerization of the fibrin to
antigen-antibody reaction when:
form strands.
a) group A blood is transfused to group A person.
d) Is inhibited by Ca+2.
b) group O blood is transfused to a group AB person.
e) Is promoted by albumin.
c) group A blood is transfused to group O person. 64. The first important event in hemostasis following
d) group A blood is transfused to a group AB severe tissue injury is:
person. a) blood coagulation.
e) group B blood is transfused to a group AB b) formation of platelet plugs.
person. c) vascular spasm.
59. Which blood unit carries the least risks for d) formation of Thromboplastin.
inducing an immediate transfusion reaction e) formation of prothrombin activator.
into a B- Positive (B, rhesus positive) recipient? 65. Thrombin inhibits
a) Whole blood A positive. a) factor Xa
b) Whole blood O positive. b) tPA
c) protein C
c) Whole blood AB positive.
d) platelets
d) Packed red blood cells O positive.
e) none of the above
e) Packed red blood cells AB negative. 66. The initial thromboplastin for clotting comes from:
60. Mismatched blood transfusion: a) Platelets.
a) causes acute renal shutdown. b) Liver.
b) can give an immediate reaction with the first c) Mast cells.
time of Rh incompatibility. d) Damaged vessel wall and surrounding tissues.
c) can lead to increase in blood pressure. e) Lymphocytes.
d) produces severe hyperkalemia which is due to 67. Platelet activation will NOT occur without:
inactivation of Na-K pump in the RBCs a) Na+
membrane. b) vessel wall damage
e) causes severe back pain and tightness of chest. c) von Willebrand factor
d) fibrinogen
e) serotonin
68. The following statement about the formation of c) Prothrombin.
thrombin during normal hemostasis is correct: d) Platelets.
a) Formation of thrombin occurs primarily on the e) Factor VII.
surface of platelets. 75. The adhesion of platelets to subendothelial
b) Thrombin is formed by the effect of active collagen is impaired in absence of:
factor IX on prothrombin. a) von Willebrand factor.
c) Formation of thrombin requires Ca2+ and factor V. b) plasmin.
d) Deficiency of thrombin formation leads to c) heparin.
prolongation of bleeding time.
d) antithrombin III.
e) Formation of thrombin occurs primarily on the
76. Which of the following clotting factors is
surface of WBCs.
not vitamin K-dependent:
69. Which of the following decrease platelet
a) Factor II.
aggregation & cause vasodilatation?
a) PGE2 b) Factor V.
b) PGF2alpha c) Factor VII.
c) TBXA2 d) Factor IX.
d) PGD2 77. The intrinsic blood clotting requires all of
e) PGI2 the following EXCEPT:
70. The following are NOT true about platelets: a) Factor VIII.
a) They are formed in the bone marrow from b) Factor V.
megakaryocytes. c) Factor VII.
b) Their life span in circulation is about 30 days. d) Factor IX.
c) In a normal person, 20% of the platelets are
found in the spleen. Bleeding disorders:
d) They contain ADP and serotonin. 78. Normally, blood does not coagulate in vivo
e) They produce prostacyclin. because:
a) the body temperature is 37 c.
71. Platelet aggregation is stimulated by: b) of presence of heparin in circulating blood.
a) thromboxane A2 c) blood is circulating in the vessels under
b) fibrinogen. pressure.
c) thrombin. d) of the intact endothelial lining of the blood vessels.
e) the body mass index (BMI).
d) prostaglandin.
79. Fibrin degradation products are natural
e) serotonin. anticoagulants interfering with:
72. Which coagulation pathway begins with tissue a) Fibrinogen concentration.
thromboplastin? b) Platelet count.
a) Extrinsic pathway. c) Thrombin activity.
b) Intrinsic pathway. d) Serum calcium concentration.
c) Common pathway. e) Blood vessel elasticity.
d) Fibrin stabilization. 80. Antithrombin III inactivates which factor?
e) Clot retraction. a) XIIa
73. Primary hemostasis refers to cessation of b) Xa
bleeding due to: c) XIa
a) formation of a definitive blood clot. d) IXa
b) formation of a temporary platelet plug. e) All of the above
c) clot retraction. 81. What condition leads to a deficiency in factor IX
d) vascular reaction. that can be corrected by an IV vitamin K?
a) Classic hemophilia.
e) local axon reflex.
b) Hepatitis B.
74. The conversion of fibrinogen into fibrin is
c) Bile duct obstruction.
promoted by: d) Genetic deficiency in antithrombin III.
a) Factor X. e) Atrophic gastritis.
b) Thrombin.
82. The test that screens the extrinsic pathway is: maternal grandfather has a bleeding disorder. The
a) Prothrombin time (PT). child's physical examination shows slight
b) Activated partial thromboplastin time (aPTT). tenderness of his knee with fluid accumulation in
c) Thrombin time. the knee joint. You suspect this patient is deficient
d) Urea solubility test. in which coagulation factor?
e) Clot lysis time a) Prothrombin activator
83. The enzyme that ultimately lyses fibrin b) Factor II
is: c) Factor VIII
a) plasminogen. d) Factor X
b) TPA. e) Factor VII
c) urokinase. 90. A 15 years old child is admitted to hospital with
recent onset of widespread pinpoint skin
d) plasmin.
hemorrhage. Which abnormality the laboratory
84. Petechial hemorrhages are very common in:
investigation can reveal for the bleeding tendency?
a) Vitamin K deficiency.
select the most appropriate option from the
b) Hemophilia.
following list of options:
c) Purpura. a) Deficiency of vitamin K.
d) Heparin overdosage. b) Excessive heparin activity.
85. The process by which certain substance induces c) Massive blood transfusion.
platelet production by megakaryocytes. d) Platelet count 90 X109/L.
a) Thrombocytopeiosis e) Platelet count 20 X109/L.
b) Thrombocytopenia
c) Hemophilia
d) Purpura 91. Which of the following causes some malnourished
86. A reduction in the blood level of coagulation patients to bleed excessively when injured?
of factor VIII: a) Vitamin K deficiency.
a) Typically increases the bleeding time beyond b) Platelet sequestration by fatty liver.
the normal range. c) Serum bilirubin that raises neutralizing
b) Occurs as a hereditary disease due to an thrombin.
abnormal gene on the Y chromosome. d) Low serum protein levels that cause factor XIII
c) Causes parahemophilia disease. problems.
d) Is typically associated with small petechial e) Vitamin C deficiency.
hemorrhage into the skin. 92. A patient has a congenital deficiency in factor XIII
e) Causes hemophilia disease. (fibrin-stabilizing factor). What would analysis of his
87. Which of the following causes some malnourished blood reveal?
patients to bleed excessively when injured? a) Prolonged prothrombin time.
a) Vitamin K deficiency. b) Prolonged whole blood clotting time.
b) Platelet sequestration by fatty liver. c) Prolonged partial thromboplastin time.
c) Serum bilirubin that raises neutralizing d) Easily breakable clot.
thrombin. e) Abnormal prothrombin time.
93. The extrinsic pathway is triggered by the release of:
d) Low serum protein levels that cause factor XIII
a) factor VII.
problems.
b) tissue factor.
e) Iron deficiency. c) tissue factor pathway inhibitor
88. Which of the following would best explain a d) contact factor.
prolonged bleeding time test? e) factor XII.
a) Hemophilia A. 94. The extrinsic pathway is inhibited by:
b) Hemophilia B. a) tissue factor.
c) Thrombocytopenia. b) thromboplastin.
d) Jaundice. c) tissue factor pathway inhibitor (TFPI).
e) Obstruction of common bile duct. d) contact factor.
89. A 2-year-old boy bleeds excessively from minor e) HMWK.
injuries and previously had bleeding gums. The
95. Prolongation of prothrombin time does not occur
when there is a deficiency of only:
a) factor VIII.
b) factor IX.
c) factor X.
d) vitamin K.
e) factor XIII.
96. Mutations in which of the following have been
implicated in the pathogenesis of hypercoagulable
states?
a) Protein C.
b) Protein S.
c) Factor V.
d) Antithrombin III.
e) All of the above.
Enumerate:
Complete: 1) Five functions of Blood.
1) The test that screens the extrinsic pathway for 2) Five functions of Plasma proteins.
coagulation is -------------- 3) Five functions of RBCs.
2) The test that screens the intrinsic pathway for 4) Two functions of Hemoglobin.
coagulation is -------------- 5) Five factors necessary for erythropoiesis.
3) The function of von Willebrand factor is --------- 6) Etiological classification of anemia.
7) Effects of anemia.
Give an account on: 8) Types and characteristics of polycythemia.
4) Purpura. 9) Clinical importance of rh grouping.
5) Hemostasis (definition and stages). 10) Functions of Platelets.
6) Erythroblastosis fetalis. 11) Four natural anticoagulants.
Why intravascular clotting does not occur
Case study: under physiological conditions?
7) A 2-year-old boy bleeds excessively from minor 12) Types of hemophilia.
injuries and previously had bleeding gums. The 13) Causes of hypercoagulable state.
maternal grandfather has a bleeding disorder. The
14) Indications of blood transfusion.
child’s physical examination shows slight
tenderness of his knee with fluid accumulation in
15) Hazards of blood transfusion.
Incompatible blood transfusion reactions
the knee joint. Which coagulation factor is
(Major incompatible reactions)?
deficient in this case?

Answers: ‫ﺔ ﻓﻘﻂ‬ƒ‫{ﺔ اﺳ•~ﺷﺎد‬z‫ﻫﺬە اﻷﺟ‬

1. prothrombin time
2. clotting time
3. adhesion of platelets
7. factor VIII
Hemoglobin structure & metabolism: b) Occupying the same position of O2 in the
1. Porphyrins are hemoglobin
a) Heterocyclic compounds c) Removing iron form hemoglobin,
b) Metalloproteins forming hematin
c) Inorganic pigments d) Inhibiting oxidative phosphorylation
d) Modified proteins e) Slowing capillary circulation
e) Compound lipids 8. Thalassemia is an example of:
2. All the following proteins contain porphyrin ring a) Frame shift (deletion) mutation.
EXCEPT: b) Silent mutation.
a) Hemoglobin c) Missense mutation.
b) Myoglobin d) Nonsense mutation.
c) Cytochrome e) X-linked recessive disease.
d) Catalase 9. Erythrocytes of peoples with a homozygous
e) Glutathione peroxidase sickle cell anemia contain predominantly:
3. Which is not part of hemoglobin molecule? a) Hemoglobin A.
a) Histidine. b) Hemoglobin A2.
b) Vinyl group. c) Hemoglobin F.
c) Ferric ion d) Hemoglobin S.
d) Pyrrole rings. e) Methemoglobin
e) Protein. 10. In sickle cell hemoglobin, the position 6
4. All of the followings are normal hemoglobin glutamyl residue is replaced by:
EXCEPT: a) Aspartate.
a) Hemoglobin A. b) Threonine.
b) Hemoglobin A2. c) Lysine.
c) Hemoglobin A1c. d) Glutamine.
d) Hemoglobin S. e) Valine.
e) Hemoglobin F. 11. In hemoglobin C, the position 6 glutamyl
5. The type of hemoglobin which binds irreversibly residue is replaced by:
with oxygen is: a) Aspartate.
a) Hemoglobin A. b) Threonine.
b) Hemoglobin A2. c) Lysine.
c) Hemoglobin F. d) Glutamine.
d) Hemoglobin S. e) Valine
e) Methemoglobin. 12. Heme biosynthesis occurs in
6. The Bohr effect describes: a) Bone marrow
a) The effect of PCO2 on the dissociation of b) Liver for cytochrome P450
oxyhemoglobin. c) Intestinal macrophages
b) The effect of Zn2+ on the activity of carbonic d) Both a and b
anhydrase. e) Both b and c
c) The toxic effect of very high P02 on the 13. Which of the following amino acid is the
nervous system. precursor of delta-Aminolevulinate:
d) The buffering action of imidazole groups. a) Alanine.
e) All of the above. b) Proline.
7. Carbon monoxide produce hypoxia by: c) Glycine.
d) Leucine.
a) Forming met-hemoglobin
e) Histidine.
14. Porphyrins are synthesized from: 21. Metabolic degradation of hemoglobin takes
a) Proline and iron place mainly in:
b) Glycine and proline a) The reticuloendothelial system.
c) Glycine and succinyl CoA b) The erythrocytes.
d) Amino acids and folic acid c) The skeletal muscles.
15. The key enzyme of heme biosynthesis is: d) Kidney tubules.
a) Delta-aminolaevulinic acid (ALA) synthase e) All the above.
b) Uroporphyrinogen I synthase 22. The first step in the catabolism of hemoglobin
c) Uroporphyrinogen II cosynthase occurs when hemoglobin is:
d) Uroporphyrinogen II decarboxylase a) Converted to biliverdin in the liver.
16. In heme synthesis, the committed step is: b) Converted to bilirubin in the reticuloendothelial
a) Condensation of 2 PBG (porphobilinogen). cells.
b) Condensation of 2 ALA (Aminolevulinate). c) Conjugated with glucuronic acid in liver.
c) Condensation of glycine and succinyl CoA. d) Reduced in the liver.
d) Formation of uroporphyrinogen III. e) Reduced in the intestine.
e) Formation of coproporphyrinogen III. 23. Catabolism of hemoglobin involves:
17. All about delta-Aminolaevulinic acid a) The formation of bile pigments.
synthase activity is true EXCEPT. b) Oxidative cleavage of porphyrin ring.
a) Occurs in mitochondria. c) The formation of urobilin.
b) Catalyzing the rate limiting reaction in d) Results in liberation of carbon monoxide.
heme biosynthesis. e) All of the above.
c) Inhibited by lead poisoning. 24. Heme is catabolized by which enzyme of
d) Requires the coenzyme pyridoxal phosphate. the phagocytic cells?
e) Its substrates are acetyl CoA and glycine. a) Protease
18. Delta-Aminolaevulinic acid synthase activity: b) Heme oxygenase
a) Occurs in cytosol. c) Ferrochelatase
b) Requires the coenzyme biotin. d) Decarboxylase
c) Stimulated by heavy metals as lead. e) Deaminase
d) Repressed in individuals treated with drugs such 25. The normal brown-red color of feces
as phenobarbital. results from the presence of:
e) Catalyzing the rate limiting reaction in heme
a) Heme.
biosynthesis.
b) Biliverdin.
19. Deficiency of ALA synthase leads to: c) Stercobilin.
a) Red urine d) Bilirubin diglucuronide.
b) Photosensitivity e) Coproporphyrin III.
c) Anaemia 26. Plasma bilirubin results mainly from the
d) Jaundice
breakdown of:
e) Brown stool
a) Hemoglobin
20. The following disorders are inherited as b) Myoglobin
autosomal dominant disease EXCEPT: c) Cytochrome oxidase
a) Acute intermittent porphyria. d) Cytochrome P450
b) Hereditary coproporphyria. e) Catalase
c) Porphyria variegate. 27. Bile pigments (bilirubin) are derived from:
d) Congenital erythropoietic porphyria.
a) Cholic acid
e) Erythrohepatic porphyria
b) Heme
 c) Triacylglycerols d) Dubin Johnson Syndrome
d) Cholesterol. 34. The enzyme deficient in acute intermittent
e) Phospholipids porphyria:
28. The direct bilirubin consists of: a) ALA synthase
a) Bilirubin conjugated with glucuronic acid b) Uroporphyrinogen-III synthase
b) Bilirubin conjugated with gluconic acid c) δ-ALA dehydratase
c) Bilirubin conjugated with albumin d) Porphobilinogen deaminase
d) Bilirubin conjugated with globulin 35. Iron in hemoglobin binds with:
e) All of the above a) Alanine
29. Bilirubin diglucuronide is: b) Serine
a) Elevated in neonatal hyperbilirubinemia. c) Histidine
b) Elevated in hemolytic jaundice. d) Glycine
c) Lipid soluble 36. The enzyme responsible for conjugation of
d) Normally excreted in urine bilirubin is:
e) Usually found in bile duct a) Bilirubin esterase
30. Delta bilirubin (indirect) is that type of bilirubin b) Glutamyl-bilirubin esterase
which: c) Bilirubin conjugase
a) Present normally in blood. d) Glucuronyl transferase
b) Present normally in bile. 37. Heme isn’t synthesized in:
c) Present in trace amounts in urine. a) Liver cells
d) Binds noncovalently with albumin. b) Muscular tissue
e) Binds covalently with albumin. c) Erythropoietic precursor of bone marrow
31. All of the following statements are correct d) Brain tissue
EXCEPT: 38. The end product of catabolism of heme is:
a) In normal individuals, bilirubin is not detectable a) Bile pigment
in urine. b) Bile salts
b) Hemolysis elevates plasma unconjugated c) Bile acids
bilirubin. d) Uric acid
c) Direct bilirubin in Van den Bergh reaction 39. Heme can be described as
corresponds to conjugated bilirubin. a) An apoprotein
d) Hemolytic jaundice results in decreased b) Iron containing metalloprotein
excretion of urinary urobilinogen. c) Iron atom located in the center of
32. Crigler Najjar syndrome is a congenital protoporphyrin
bilirubinemia due to a defect in the conjugating d) An inorganic component of
system due to the lack of which enzyme: hemoglobin
a) UDP-glucose epimerase. 40. What causes the brown color of the stool?
b) Phosphogalactose-uridyl transferase. a) Stercobilinogen
c) UDP-glucuronyl transferase. b) Urobilinogen
d) Phosphoglucose-uridyl transferase. c) Stercobilin
e) UDP-galactose pyrophosphorylase d) Urobilin
33. All the followings arc typos of congenital 41. Pyrrole ring is:
hyperbilirubinemia EXCEPT: a) A heterocyclic five-membered ring
a) Gilbert's disease b) Found in porphyrins and proline
b) Von Gierke's disease c) Both a and b
c) Crigler Najjar Syndrome d) Neither a nor b
42. The following are the normal forms of c) Thalassemia
hemoglobin, except: d) Cooley Hb (17)
a) НbA1C Vitamins metabolism:
b) Hb F 50. All are fat-soluble vitamins EXCEPT:
c) НbA2 a) Vitamin A
d) Hb S b) Vitamin C
43. Hb F has high affinity for O2 than Hb A due to c) Vitamin D
presence of: d) Vitamin E
a) β-chain e) Vitamin K
b) γ-chain 51. Vitamin B12 contains:
c) α-chain a) Iron
d) δ-chain b) Copper
44. Iron in heme is linked to globin through: c) Zinc
a) Histidine d) Selenium
b) Arginine e) Cobalt
c) Glycine 52. Vitamin B12:
d) Cysteine a) is a fat-soluble vitamin.
45. Which of the following has a protective effect b) a vitamin not needed in diet because it is
against malaria? synthesized by intestinal bacteria.
a) Hb F c) is a zinc containing B vitamin.
b) Hb M d) needs intrinsic factor for absorption.
c) Hb S e) present in animal and plant sources.
d) Hb H 53. Absorption of vitamin B12 doesn’t require:
46. The binding of oxygen to hemoglobin can best a) Bile salts
described graphically as: b) Intrinsic factor
a) hyperbolic c) Intestinal receptors
b) linear d) Healthy gastric mucosa
c) sigmoidal e) Cobalophilin protein
d) reciprocal 54. Which one of the following statements
47. The binding of oxygen to myoglobin can best be concerning vitamin B12 is INCORRECT?
described graphically as: a) is red in color.
a) sigmoidal b) contains heme ring.
b) linear c) is a cofactor for conversion of
c) hyperbolic homocysteine into methionine.
d) reciprocal d) requires intrinsic factor for its absorption.
48. Hemoglobin is a: e) Restrict vegetarians develops deficiency.
a) Monomeric protein 55. Vitamin K:
b) Trimeric protein a) Water-soluble vitamin.
c) Tetrameric protein b) Vitamin K2 is synthetic.
d) Dimeric protein c) Essential for clot formation.
49. A point mutation in the beta-globin gene d) Present in the intestine of newborn infants.
changing the codon from glutamate to valine will e) Long use of dicumarol promotes its action.
likely cause what disease? 56. In the regeneration of methionine from
a) Sickle cell anemia homocysteine, which of the following vitamins
b) Methemoglobinemia are involved:
 a) Lipoic acid c) Calcium ions
b) Retinoic acid d) Heparan sulfate
c) Vitamins E and K e) Iron deficiency
d) Tetrahydrofolate and vitamin B12 64. Vitamin K plays a role in biosynthesis of:
57. A deficiency of vitamin B12 causes: a) collagen and elastin
a) Scurvy b) prothrombin and osteocalcin
b) Beriberi c) heparin and heparin sulfate
c) Spina bifida d) prostaglandins and Leukotrienes
d) Pernicious Anemia 65. Vitamin K is essential for:
e) Microcytic Anemia a) Synthesis of prothrombin
58. Cyanocobalamin is: b) Synthesis of calcitonin
a) The therapeutic form of vitamin B12 c) Synthesis of serotonin
b) An inhibitor of cobalamin function d) Synthesis of catecholamines
c) The coenzyme form of vitamin B12 e) Iron absorption
d) A fat-soluble compound 66. THFA is coenzyme for:
e) The active form of vitamin B6 a) Transport of amino group
59. Folic acid is important for: b) CO2 fixation
a) Carbon dioxide donor. c) Transport of methylene group
b) Treatment of rickets. d) Transport of oxygen
c) Carbon dioxide fixation. 67. All the following vitamins are fat soluble EXCEPT
d) Provide carbon 6 of purine nucleotides. a) Vitamin A
e) Providing of carbon 2 and 8 of purines. b) Vitamin C
c) Vitamin D
60. Which is true about folic acid activation?
d) Vitamin E
a) The active form is dihydrofolate.
e) Vitamin K
b) It is activated by dihydrofolate reductase.
c) Reduction of folic acid requires FDH2
68. Vitamin B12 deficiency may lead to
a) Scurvy
d) Both a and c are true
b) Pellagra
e) All of the above
c) Megaloblastic anemia
61. Folic acid deficiency may be seen:
d) Osteomalacia
a) In pregnant women, who need double the
e) Rickets
normal daily requirements
b) With vitamin B12 deficiency, which leads Minerals metabolism:
to the methyl trap of folic acid 69. Hemochromatosis is due to excessive
c) In adult healthy males deposition of:
d) Both a and b a) Selenium
e) Both a and c b) Copper
62. Neural tube defects occur in deficiency of: c) Zinc
a) Vitamin K d) Iron
b) Vitamin B12 70. Total iron binding capacity is:
c) Folic acid a) Plasma iron binding protein.
d) Pyridoxine b) Total amount of iron that can be stored in the
e) Vitamin C iron stores.
63. Vitamin K is competitively inhibited by: c) Maximum amount of plasma iron that can be
a) Heparin carried by transferrin,
b) Coumarone
 d) Minimum amount of plasma iron that can be 79. Which of the following minerals help
carried by transferrin. crystallization, storage and release of insulin
71. All the following proteins contain iron EXCEPT: a) Selenium.
a) Hemoglobin b) Chromium,
b) Myoglobin c) Potassium.
c) Cytochrome c d) Zinc
d) Ceruloplasmin 80. Transferrin is:
72. Iron containing protein is: a) Plasma iron binding protein.
a) Ferritin b) Storage form of iron.
b) Apoferritin c) Hemoprotein containing single heme ring.
c) Transferrin d) Intestinal carrier for iron absorption.
d) All of the above 81. Which finding about iron deficiency anomia is
73. For TIBC (Total Iron Binding Capacity) incorrect
one of the following is correct: a) Plasma iron is decreased.
a) Increased in iron deficiency anemia b) Plasma TIDC is decreased.
b) Increased in iron overload c) Plasma ferritin is decreased.
c) Decreased in iron deficiency anemia d) RBCs are hypochromic and microcytic.
d) Synthesis of transferrin is increased in liver disease 82. Zinc deficiency causes:
74. A trace element is: a) Rickets
a) Magnesium b) Scurvy
b) Chlorine c) Impaired spermatogenesis
c) Iron
d) Cataract
d) Sodium
83. Iron is transported in the circulation bound to
75. Copper is transported in plasma in the form of
a) Ferroprotein
a) Ferritin
b) Transferrin
b) Ceruloplasmin
c) Ceruloplasmin
c) Hepatocuprein
d) Ferric acid
d) Erythrocuprein
84. Iron absorption is inhibited by:
76. Zinc is a constituent of all the following EXCEPT:
a) Tannic acid
a) Ceruloplasmin
b) Phytate
b) RNA polymerase
c) Oxalate
c) Carbonic anhydrase
d) Steatorrhea
d) Carboxy peptidase
e) All of the above
77. A plasma protein carrying copper is:
85. Zinc deficiency causes mostly:
a) Transferrin.
a) Rickets
b) Transcortin.
b) Scurvy
c) Ceruloplasmin
c) Anemia
d) Pre-albumin
d) Hypogonadism
78. Wilson's disease results from deposition of:
86. Trace elements (micro minerals) include
In Wilson's disease there is a deficiency of
a) Iron, copper and zinc
a) Transferrin
b) Calcium
b) Copper c) Phosphorus
c) Ferritin
d) Magnesium
d) Zinc
87. Impaired spermatogenesis may be present in Answers:
deficiency of one of the following: 1. Oxygen carrier – oxygen store
2. Four oxygen molecules – one oxygen molecule
a) Iron
3. Carbon monoxide binds to hemoglobin.
b) Copper
4. CO2 and 2,3-DPG. 5. 20
c) Zinc 6. Bilirubin – albumin – glucuronic acid – UDP
d) Folic acid glucuronide transferase – liver – water soluble.
Complete: 7. 0.2-1.0 mg/dl; 0-0.2mg/dl
8. Iron 9. Upper duodenum 10. Transferrin
1. Hemoglobin acts as --- but myoglobin acts as ---
11. Ferritin. 12. Hemopexin 13. Haptoglobin
2. Hemoglobin binds ---- but myoglobin binds ----- 14. microcytic hypochromic 15.16. macrocytic hypochromic
3. Carboxyhemoglobin formed when -------- 17. ALA dehydratase and ferrochelatase
4. Affinity of Hb to oxygen is decreased by ------- 18. upper duodenum
5. 100 ml of blood can carry ----- ml oxygen 19. factor II, VII, IX and X
6. The end product of heme catabolism is -----, 20. trap - vitamin B12 - megaloblastic anemia - 5-MTHF
then carried in the blood by --------- and finally 21. male - ATP7A
conjugate with ------- by the enzyme ------------ 1. Decreased pH and increased pCO2 helps oxygen to
present in the ---------- to get ------------ dissociate from Hb at the tissues and bind at the
7. The normal level of total plasma bilirubin is ----- lungs.
and direct bilirubin constitutes ------------. 2. Binding of oxygen molecule to hemoglobin helps
more oxygen binding.
8. The trace element deficient in milk is -------
3.Bicarbonate ions diffuses outside RBCs in exchange
9. Iron is absorbed at ------------
with chloride ions.
10. The transporter protein of plasma iron is ------ 4. yellowish discoloration of skin and mucous
11. The storage form of iron is --------- membranes due to hyperbilirubinemia above 3 mg/dl.
12. The carrier of free heme is called --------- 5. elevated plasma bilirubin level above 1 mg/dl but still
13. The carrier of free hemoglobin is called --------- below 3 mg/dl which is insufficient to cause jaundice.
14. Type of iron deficiency anemia is ------------ 6. Elements required in amount less than 100 mg/day
15. Type of cobalamin deficiency anemia is -------- e.g. iron , copper and zinc.
16. Type of THF deficiency anemia is ------------ 7. The maximum amount of iron that can be carried by
17. Lead poisoning is the most common cause of transferrin.
acquired porphyria by inhibition of ------------ Open questions:
18. Iron is readily absorbed from ------------ 1. Enumerate iron containing proteins (hemoproteins).
19. Vitamin K dependent coagulation factors are 2. Describe the structure of Hb A1 molecule.
------------ 4 polypeptide chains (2 α units and 2 β units) and
20. Folate ------------ occurs due to ------------ 4 heme molecules.
deficiency in the condition ------------ and it is 3. Describe the structure of myoglobin molecule.
present in the form of ------------ 1 polypeptide chain and 1 heme molecules.
21. Menke's kinky hair syndrome is an x-linked 4. Enumerate normal forms of hemoglobin with
syndrome that affects only ----------------- their constituent polypeptide chains.
where cupper is absorbed from GIT but can’t 5. Discuss glycated hemoglobin and its significance.
be transported due to absence of --------------- 6. What is sickle hemoglobin?
Define: 7. Discuss HbF and its significance.
8. Enumerate factors affecting iron absorption.
1. Bohr’s effect.
9. Enumerate functions of iron.
2. Cooperative oxygen binding.
10. What are sites of ferritin?
3. Chloride shift. 11. Enumerate functions of copper.
4. Jaundice. 12. Enumerate copper containing enzymes.
5. Latent icterus (Hyperbilirubinemia). 13. Enumerate functions of zinc.
6. Trace elements. 14. Enumerate zinc containing enzymes.
7. TIBC. 15. Discuss Wilson’s disease.