hematology BCQs Part 1

1.       A 12 year boy presents to the OPD medicine department with swelling of knee after a trauma.  Family history reveals his maternal uncle also suffered from similar complaints. The boy is most likely suffering from

a)       Von willebrand disease

b)       Hemophilia

c)       Thrombocytopenic purpura

d)       Hereditary hemorrhagic telengiectasia

e)       Disseminated intravascular coagulation

2.       A 59 year old man with a history of coronary artery disease and a severe mitral regurgitation has surgery to replace his mitral valve. Post operatively there were no complications until 6 months after the surgery when he presented with increasing fatigue. Workup finds a normocytic normochromic  anemia that is due to fragmentation of RBCs by his artificial heart valves. Which of the following abnormality is indicative of intravascular hemolysis  and is most likely to be seen in peripheral blood film of this patient?

a)       Drepanocytes

b)       Heinz bodies

c)       Pappenheimer bodies

d)       Schistocytes

e)       Target cells

3.       Two days after receiving the anti malarial drug primaquine, a 27 year old man develops sudden intravascular hemolysis resulting in a decreased hematocrit,  hemoglobinemia  and hemoglobinuria. Examination of the peripheral blood reveals erythroctyes with a defect forming bite cells, when crystal violet stain is applied many Heinz bodies area also seen. Which of the following is the most likely diagnosis?

a)       Hereditary spherocytosis

b)       Glucose 6 phosphate dehydrogenase deficiecny

c)       Paroxysmal hemoglobinuria

d)       Autoimmune hemolytic anemia

e)       Micro angiopathic hemolytic anemia

4.       A  49 year old woman presents with signs of anemia and states that every morning her urine is dark. Investigations reveal that her RBC lyse in vitro with acid(positive HAMs tests). Which of the following Is the most likely diagnosis?

A)      Warm autoimmune hemolytic anemia

B)      Paroyxsmal nocturnal hemogolbinuria

C)      Paroxysmal cold hemogolbinuria

D)      Isoimmune hemolytic anemia

E)      Cold agglutinin autoimmune hemolytic anemia

5.       A  41 year  woman presents with increasing fatigue lethargy and muscle weakness. Her CBC reveals decreased number of erythrocytes, leukocytes and platelets along with an increase in the MCV of the erythrocytes.  Her blood smear shows hypersegmented neutrophils.  Which of the following substances is most likely to be deficient in this individual.

a)       Amino levulinic acis

b)       Ascorbic acid

c)       Folic acid

d)       Retinoic acid

e)       Vanillyl mandelic acid

6.       A 61 year old woman presents with inceasing fatigue and is found to have hypochromic microcytic RBC in her periopheral smear. Physical examination finds her heart rate and respiratory rate to be both increasd in frequency. Lab examination finds decreased serum ferritin, the levels of which are inversely propotional to the serum levels of which of the following substances.

A)      Bilirubin

B)      Haptoglobin

C)      Hemosiderin

D)      TIBC

E)      Transferring

7.       A 23 year old woman in her 25^th week of pregnancy has felt no fetal movement for the past 3 years. Three weeks later, she still has not given birth and suddenly develops dyspnea with cyanosis.  On physical examination, her  temperature  is 36.9 C, pulse 102/min, respiration 21/min and blood pressure 80/40 mm Hg. She has large ecchymoses over the skin of her entire body.  A stool sample is positive for her occult blood. Lab studies  show elevated prothrombin time and partial thromboplastin time. The platelet count is decreased, plasma fibrinogen is markedly decreased and fibrin split products are detected. A blood culture is negative. Which of the following is most likely cause of the bleeding diathesis?

a)       Increased vascular fragility

b)       Toxic  injury to the endothelium

c)       Reduced production of the platelets

d)       Increased consumption of clotting factors and platelets

e)       Defects in platelet adhesion and aggregation

8.       A 65 year old patient presents with generalized lymphadenopathy. Immunophenotype shows CD10+ BCL2+ mature B cells expressing surface immunoglobulin. Chromosomal studies show t(14:18). Which lymphoid neoplasms is most likely he suffering from:

a)       Mantle cell lymphoma

b)       Burkitt lymphoma

c)       Follicular lymphoma

d)       MALT lymphoma

e)       Plasmacytoma

9.       Lacunar cells, a variant of Reed Stenberg cells is seen in which of the following subtypes:

a)       Lymphocyte predominant

b)       Mixed cellularity

c)       Lymphocyte depleted

d)       Nodular sclerosis

e)       Lymphocyte rich

10.    A 3 year old boy in Japan presents with fever and rash that is desquamating. On examination he has enlarged cervical lymph nodes conjunctival and oral erythema and erosion. He also has edema of the hands and feet. The physician says the disease is classically self limited however if left untreated the important sequelae will be:

a)       Cerebral artery aneurysms

b)        Coronary artery aneurysms

c)       Cervical abscess

d)       Renal artery aneurysms

e)       Conjunctival hemorrhage

11.    A 72 year old man presents with increasing fatigue. Physical examination reveals multiple enlarged non tender lymph nodes with enlarged liver and spleen. Lab examination of his peripheral blood reveals a normocytic normochromic anemia and a slighty decreased platelet count and a leukocyte count of 72,000/microlitre. Examination of the peripheral smear reveals a marked increase in the number of mature looking lymphyocytes and many smudge cells. What is the most likely diagnosis:

a)       Acute lymphoblatic leukemia

b)       Atypical lymphocytosis

c)       Chronic lymophocytic leukemia

d)       Immunoblastic lymphoma

e)       Prolymphocytic leukemia

12.    A 22 year old woman presents with fever weight loss night sweats and painless enlargement of various supraclavicular lyphnodes. A biopsy from one of the enlarged lymph nodes shows binucleated giant cells with prominent acidophilic owl eye nucleoli. Wht is the most likely diagnosis:

a)       Anaplastic large cell lymphoma

b)       Diffuse non hodgkins lymphoma

c)       Hodgkins disease

d)       Reactive lymphnode hyperplasia

e)       Mantle cell lymphoma

13.    Administration of which one of the following substances would theoretically correct the abnormal bleeding lab tests in an individual who is deficient in factor V:

a)       Activated factor VIII

b)       Activated factor X

c)       Fibrinogen

d)       Plasmin

e)       Thrombin

14.    In which of the following conditions PT is prolonged and aPTT is normal:

a)       Von willibrand disease

b)       Factor IX deficeiny

c)       DIC

d)       Factor VII deficiency

e)       ASD

15.   A 30 year old female has splenomegaly and anemia with spherocytosis.The circulating RBCs demonstrate an increased osmotic fragility on laboratory testing. An inherited abnormality in which of the following RBC components best explains these findings:

a)      Glucose-6-phosphate dehydrogenase.

b)      A membrane cytoskeletal protein.  

c)       Α-globin chain

d)      Heme

e)      Β-globin chain

16.    one of the following statements about Hemangiomas is not true:

a)       They are benign tumors of blood vessels

b)       Capillary haemangioma commonly involves skin and mucosal tissue

c)       Cavernous haemangiomas involve deeper structures

d)       These tumors are encapsulated

e)       Strawbwerry haemangioma is a variant present at birth.   

1.       B
2.       D
3.       B
4.       B
5.       C
6.       D
7.       D
8.       C
9.       D
10.     B
11.     C
12.     C
13.     E
14.    D
15.    B
16.    D