1.

Choose the laboratory result that is not characteristic for iron deficiency anemia:

A. decreased transferrin saturation

B. decreased serum iron level

C. decreased serum ferritin level

D. decreased total iron-binding capacity

2.A 26-year-old female is 36 weeks pregnant and presents with easy tiredness and nail brittleness.
Her Haemoglobin is 6.9 g/dl with a MCV of 63 fl. Select the most appropriate treatment for the
following cases with anaemia:

A. Parenteral Iron
B. Vitamin B12 injection
C. Blood Transfusion
D. Folate tablets

3.Oral Iron
A 44-year-old man presents with recurrent respiratory tract infection and haematuria over the past
6 months. On examination he is pale and has multiple mouth ulcers present. Full blood count shows
a pancytopenia.
Select the most appropriate treatment for the following cases with anaemia:

A. Oral Iron
B. Antithymocyte globulin
C. Vitamin B12 injection
D. Erythropoietin
E. Folate tablets

4.A 26-year-old female is 36 weeks pregnant and presents with easy tiredness and nail brittleness.
Her Haemoglobin is 6.9 g/dl with a MCV of 63 fl. Select the most appropriate treatment for the
following cases with anaemia:

E. Parenteral Iron
F. Vitamin B12 injection
G. Blood Transfusion
H. Folate tablets
I. Oral Iron

5.A 80-year-old male presents with tiredness, weakness and deteriorating confusion. On
examination he is pale and confused, has ataxia on standing with loss of vibration sensation and
 exaggerated leg reflexes. A full blood count reveals a pancytopaenia. Select the most appropriate
treatment for the following cases with anaemia:

A. Parenteral Iron

B. Vitamin B12 injection

C. Blood Transfusion

D. Folate tablets

E. Oral Iron

6. Enumerate food from which iron is readily absorbed:oo

A. meat

B. cereals

C. fish

D. vegetables

E. fruits

7. Iron supplementations are prescribed: 1) for 1-2 weeks; 2) for 3-6 month, 3) for 2-3 weeks; 4) for 1
month

8.A 60-year-old male has moderate anemia, with a suggestion of hemolysis on a peripheral blood smear.
Which one of the following patterns would be consistent with the presence of hemolysis?

a) Elevated LDH, decreased haptoglobin, elevated indirect bilirubin

b) Elevated LDH, elevated haptoglobin, decreased indirect bilirubin

c) Decreased LDH, elevated haptoglobin, elevated indirect bilirubin

d) Decreased LDH, decreased haptoglobin, elevated indirect bilirubin

9. Which of the following is not seen on hemoglobin electrophoresis in sickle

cell anemia:
A. HbA
B. HbA2
C. HbF
D. HbS
10. Diagnosis of beta thalassemia is established
by:
A. NESTROFT test.
B. HbA1c estimation.
C. Hb electrophoresis.
D. Target cells in peripheral smear.
11.A 19-year-old Nigerian presents with painful haemolytic crises following a chest infection.
She is noted to have fingers of varying lengths.
A. hereditary spherocytosis
B. sickle cell anaemia
C. b-thalassaemia major
D. malaria

12. A 6-year-old boy has had severe anaemia since he was 6 months old. He has bossing of his skull with
enlarged maxilla, and prominent frontal and parietal bones. Choose the SINGLE most likely cause

A. hereditary spherocytosis
B. sickle cell anaemia
C. b-thalassaemia major
D. malaria

13. A 50-year-old woman presents with lethargy and dysphagia. Oral examination showed a smooth
tongue, angular stomatitis and koilonychia. Her haemoglobin concentration is 8g/dL with an MCV of
60fL (80-96). Choose the SINGLE most likely cause

A. hereditary spherocytosis
B. sickle cell anaemia
C. iron deficiency anaemia
D. malaria
14. A 60-year-old lady complains of tiredness, sore tongue, and numb/tingling feet. Full blood count
reveals a haemoglobin concentration of 7g/dL (11.5-16.5) and an MCV of 115 fL (80-96).

Choose the SINGLE most likely cause

A. hereditary spherocytosis
B. pernicious anaemia
C. disseminated intravascular coagulation
D. haemolytic anaemia

15. A 55-year-old male presents with a month history of tiredness and lethargy. He has been
hypertensive for 5 years and recently started alpha-methyldopa. Full blood count reveals a
haemoglobin of 8.5 g/dL (13-18) with an MCV of 92 fL (80-96) and an increased reticulocyte
count. Choose the SINGLE most likely cause

A. hereditary spherocytosis
B. pernicious anaemia
C. disseminated intravascular coagulation
D. haemolytic anaemia
 16.A 24 year old woman with a seizure disorder treated with phenytoin is noted to have
the following findings at 15 weeks of pregnancy:

Hemoglobin (Hgb) 93 g/L (Normal 123-157 g/L)

Hematocrit (HCT) 29% (Normal 37-46%)
Mean corpuscular volume (MCV) 105 fL (Normal 80-100)

Which one of the following is the most likely cause for these findings?
a) Sickle cell trait
b) Iron deficiency
c) Physiologic anemia
d) Folate deficiency
e) Thalassemia

17.A 30 year old female presents to her physician's office for an increase in fatigue over the
last 2 months. On physical examination, the physician notes delayed capillary refill in the
nailbeds and a pale appearance of the inner lining of the eyelids. A peripheral smear
reveals hypochromic erythrocytes. Which one of the following tests would be most useful
in confirming the probable diagnosis?

a) Serum ferritin and total iron-binding capacity (TIBC)

b) Schilling's test
d) Hemoglobin electrophoresis
e) Serum folate and cobalamin (vitamin B12)

18. Pica chlorotica is characterized by:

A. B. altered taste
C. D. dry, hyperemic or “geographic” tongue
E. F. loss of hair
G. H. concave nails (koilonychias)
I. J. loss of proprioception
19.Peripheral blood smear: RBC 3.0х 1012/L, Hb 48 g/L, Ht 30 %, Colour index 0.5, MCV 59 fl, Reticulocyte Count 2.0 %, Pl 432 х 109/L, WBC 7.0 х 109
Segmented Neutrophils 60 %, Band Neutrophils 4 %, Monocytes 5 %, Eosinophils 3 %, Basophils 2 %, Lymphocytes 27 %, ESR 38 mm/h, Anisocytosis,
Hypochromia +. What is the most likely diagnosis?

A. Iron-deficiency anemia
B. Acute leukemia
C. Aplastic anema
D. Vitamin B12 deficiency anemia

20. A 64-year-old female patient presents with breathlessness on minimal exertion. She has a
symmetrical deforming arthropathy affecting the small joints of her hands and subcutaneous nodules on
her elbows. She is currently on Non steroidal anti- inflammatory drugs. Faecal occult blood tests are
negative. Choose the SINGLE most likely cause

A. pernicious anaemia
B. anaemia of chronic diseases
C. haemolytic anaemia
D. paroxysmal nocturnal haemoglobinuria
21. A 30-year-old woman presents to the gynaecology clinic with menorrhagia of two years
duration and also complains of tiredness and lethargy. Hemogramm:
Hemoglobin 6.8 g/l , Erythrocytes 3,2х1012/l , CI-0.7
Choose the SINGLE most likely cause

A. hereditary spherocytosis
B. sickle cell anaemia
C. iron deficiency anaemia
D. malaria
22.A 56-year-old woman had terminal ileum resection due to Crohn’s disease and was lost to
follow up. She presents on this occasion with difficulty walking. She is anaemic and has lost
position sense bilaterally.
A. hereditary spherocytosis
B. sickle cell anaemia
C. iron deficiency anaemia
D. vitamin B12 deficiency anaemia

23.A 50-year-old woman with a long history of alcohol abuse is prescribed Phenytoin for
epilepsy. Her full blood count reveals:
Haemoglobin10.0 g/dL, MCV-122 fL, White cell count-2.2 x109/L, Platelet count-85 x109/L
What is the most likely explanation for these results?
A. Alcoholic liver disease
B. Aplastic anaemia
C. Folic acid deficiency
D. Hypothyroidism
24. A 6-year-old girl presents with pallor and bruising. Haemoglobin 7.3 g/dl, White cell count
2.3x109/l, Platelets 84x109/l. Blood film: No blasts seen. Reticulocytes 0.4%. Bone marrow is
hypocellular. What is the most likely diagnosis?
A. aplastic anaemia
B. multiple myeloma
C. agranulocytosis
D. chronic lymphatic leukaemia

25. A 50-year-old woman presents with lethargy and dysphagia. Oral examination showed a smooth
tongue, angular stomatitis and koilonychia. Her haemoglobin concentration is 8g/dL (11.5-16.5) with an
MCV of 60fL (80-96). Choose the SINGLE most likely cause

A. hereditary spherocytosis
B. sickle cell anaemia
C. iron deficiency anaemia
D. malaria
26. A B-12 -deficiency anaemia developed in a patient following the stomach
resection. What colour index of blood is typical for this pathology?

A. 1.4

B. 1.0

C. 0.8

D. 0.5

27. A 38-year-old patient with an uterine haemorrhage lasting for 2 days was
delivered to the admission ward. Which of the following will be revealed in the
patient's blood?

A. Leukocytosis

B. Increase in the colour index

C. Decrease in the haematocrite index

D. Deceleration in ESR

28. A 58-year-old woman complains of fatigability, sleepiness, dyspnea when walking

fast. The analysis of the blood is as follows: erythrocytes — 3.5x1012/l, hemoglobin
— 9.2 g/1, Colour Index - 0.6, plenty of microcytes. What anemia is it?

A. Thalassemia.

B. Iron deficiency.

C. Hemolytic.

D. Pernicious.

29. A woman complains of headache, dyspnea during physical activity. For the last
3 years she has been having extensive menstrual bleedings. The patient has
normal body type, the skin is pale and dry. The analysis of the blood is as follows:
hemoglobin — 9.0 g/1, erythrocytes-3.4-10 12/l, Colour Index - 0.7, ESR - 20
mm/h, significant hypochromia of erythrocytes, anisocytosis, poikilocytosis. What
type of anemia is it?
 A. Chronic posthemorrhagic

B. Hemolytic

C. Acute posthemorrhagic

D.B12 and folic deficiency

30. After the resection of the stomach a patient developed B)2 deficiency anemia.
What color index is characteristic of this anemia?

A. 0.4.

B. 0.5.

C. 0.8.
D. 1.0.

E. 1.4

31.Limits of differences of content of absolute amount of neutrophils bands in blood of healthy people
are:
1. 0–5%

2. 0,8 - 3,6

3. 2,2 - 6,3

4. 0,05 - 1,2

32.Limits of differences of content of absolute amount ofsegmented neutrophils in blood of healthy

people are:
1. 54–65%

2. 0,8 - 3,6

3. 0,8- 1,8

4. 1,2 - 3,2
33.Limits of differences of content of absolute amount of eosinophils(109/l) in blood of healthy people
are:
1. 1 – 5%

2. 0,8 - 3%

3. 1 – 7 %

4. 5 - 8%

34. Limits of differences of content of absolute amount of basophils (109/l) in blood of healthy
people are:

1. 0- 0,05

2. 1,2 - 1,5

3. 2,3- 4,6

4. 0,08 - 1,2

35.Limits of differences of content of absolute amount of monocytesin blood of healthy people are:

1. 2–8%

2. 0,12 - 1,5

3. 2,3- 4,6

4. 0,15 - 1,2

36.Limits of differences of content of absolute amount of lymphocytesin blood of healthy people are:

1. 25–40%

2. 15 - 25%

3. 20- 46%

4. 12 - 18%

37.Limits of normal differences of ESR(erythrocyte sedimentation rate)of healthy men are:

 1. 1- 10

2. 5 – 20

3. 1 – 5

4. 15-20

38.Limits of normal differences of ESR(erythrocyte sedimentation rate)of healthy women are:

1. 2 - 15

2. 5 – 15

3. 2- 10

4. 10 – 15

39.The earliest sign of iron deficiency anaemia-

а) Increase in iron binding capacity

b) Decrease in serum ferritin level

c) Decreaseinserumironlevel

d) Alltheabove

40.Most sensitive and specific test for diagnosis of iron deficiency is -

a) Serumironlevels

b) Serum ferritin levels

c) Serumtransferrinreceptorpopulation

d) Transferrinsaturation

41.Best test for assessment of iron status is-

а)Transferrin b) Ferritin

c) Serumiron d) Hemoglobin

42.Which is not seen in iron deficiency anaemia -

a) Hyper-segmented neutrophils
 b) Microcytosis preceeds hypochromia .

c) MCHC<50%

43.Which of the following findings is diagnostic of iron deficiency anemia -

a) Increased TIBC, decreased serumferritin

b) Decreased TIBC, decreasedserumferritin

c) Increased TIBC, increasedserumferritin

d) Decreased TIBC, increasedsermferritin

44.True about iron deficiency anemia -

a) Microcytichypochromicanemia

b) Decreased TIBC

c) Increasedferritin

d) Bone marrow iron decreased earlier than serum iron

45.Anemia in chronic renal failure (CRF) is due to -

a) Decreased erythropoietin production, Iron deficiency

b) Hypoplastic bone marrow, increased serum ferritin

c) Decreased Vit-B12, Decreased TIBC,

46.All are true regarding Anaemia of Chronic Diseases, except -

a) DecreasedserumFe

b) Decreased Ferritin

c) DecreasedTotalFeBindingCapacity

d) IncreasedBoneMarrowFe

47.Anemia of chronic disease is characterized by all, except - )

a) Decreased serum iron

b) Increased total iron binding capacity (TIBC)

c) Increased serum ferritin

d) Increased macrophage iron in bone marrow

 48. Patient I. 40 years old, 5 years ago was undergone the resection of stomach because of peptic
ulcer complication. The expressed general weakness, shortness of breath, appeared lately. Blood
test: er. 3,1x1012/l, Hb 60 gr/l, colorindex 0,6, leukocytes 4,5x109/l, eosynophiles 2%, stub 3%,
segm. neutr. 55%, lymph. 32%, mon. 8%, ESR 5 mm/hour. What laboratory test will help in
clarification of diagnosis?

a. levelofilirubin

b. level of glucose

c. level of serumiron

d. levelofcreatinine

e. levelofamylase

49. Which one of the following is the most appropriate clinical tests to confirm the iron-deficiency
anaemia?

a) Redbloodcellindices

b) Serumferritinlevel

a) Bone-marrowexamination

d) Urinaryironclearance

50. All are conditions causing macrocytic anaemia EXCEPT

A. Pernicious anaemia

B. Chronic liver disease

C. Post hemorrhagic state

51. A 58 year old female has a decreased serum iron and total iron binding capacity (TIBC. in association
with an increased serum ferritin. These findings are most indicative of

A. Malabsorption

B. Anemia of chronic disease

C. Auto immune hemolytic anemia

D. Vit B 12 deficiency

E. Chronic blood loss

52. Reticulocytosis is not seen with

A. Hereditary spherocytosis

B. Following acute bleeding

C. Paroxysmal nocturnal Hbnuria

D. Anaemia of CRF

53. RBC production is initiated by the hormone:

A. Luteinizing (LH)

B. Interstitial cell stimulating (ICSH)

C. Parathyroid Hormone

D. Erythropoietin

54. Limits of normal differences of MCV [mean corpuscularVolume -Volume of Hgb in each RBC]are:

1. 70 to 100 m3
2. 80 to 100 m3
3. 80 to100 m3
4. 60 to90 m3
55.A patient, 60yrs old, complains of general weakness, fatigue, parestesia in limbs. He had resection of
stomach 3years ago because of peptic ulcer. Data of examination: the tongue is of raspberry colour and
smooth, the patient is not stable in Romberg’s position. Data of CBC: erythrocytes-2,5.1012/l, Hb-88g/l ,
CI-1,3, macrocytosis. What disease is present?

a. vitamin B12 deficiencyanemia

b. iron-deficiencyanemia

c. hemolyticanemia

d. hypochromicanemia

e. hyperchromicanemia

56.A patient, 60yrs old, complains of general weakness, fatigue, parestesia in limbs. He had resection of
stomach 3years ago because of peptic ulcer. Data of examination: the tongue is of raspberry colour and
smooth, the patient is not stable in Romberg’s position. The patient is diagnosed vitamin B12 deficiency
anemia. How do you explain parestesia?

a. affectionofcentralnervoussystem

b. affectionofperipheralnervoussystem

c. dystensionofskin

d. affectionofsubcutaneousfat

e. allmentioned

57.A patient,35yrs old, who suffers of autoimmune gastritis and vitamin B12-deficiency anemia,
presents signs of funicular myelosis. Data of CBC: erythrocyte-2,2.1012/l, Hb-80g/l, LC-2,4.109/l, ESR-
40mm/hr, direct bilirubin-4,6micmol/l, indirect bilirubin-27micmol/l. What is funicular myelosis?
 a. demyelinization of posteriolateral columns of spinal cord

b. demyelinization of anterior columns of spinal cord

c. affectionofbraincortex

d. demyelinization of peripheral nerves of lower limbs

e. nocorrectanswer

58. A patient,35yrs old, who suffers of autoimmune gastritis and vitamin B12-deficiency
anemia, presents signs of funicular myelosis. Data of CBC: erythrocyte-2,2.1012 /l, Hb-
80g/l, LC-2,4.109/l, ESR-40mm/hr, direct bilirubin-4,6micmol/l, indirect bilirubin-
27micmol/l. Which substance is not produced with patient’s gastric mucosa responsible
for vitamin B12 absorption in intestine?

a. fullhydrochloricacid

b. combinedhydrochloricacid

c. pepsin

d. gastromucoprotein

e. lacticacid

59. A patient,35yrs old, who suffers of autoimmune gastritis and vitamin B12-deficiency
anemia, presents signs of funicular myelosis. Data of CBC: erythrocyte-2,2.1012 /l, Hb-
80g/l, LC-2,4.109/l, ESR-40mm/hr, direct bilirubin-4,6micmol/l, indirect bilirubin-
27micmol/l. What is probable reason of funicular myelosis?

a. prolongedhypoxiaofnervoussystem

b. increased bilirubin content in blood serum

c. accumulation of propionic and methylmalonic acids in blood serum

d. infectioncontaminationduetoleukaemia

e. malnutritionduetogastritis

60. A patient presents with macroglossia and loss of tongue papilla. His Hb is 11.5 and MCV
is 100. What should be the next step in investigating this patient?

a) B12 estimation

b) Brushbiopsyofthelesion

c) Fluconazoletreatment

d) Incisionbiopsy
 61. A patient has Hb 6 gm% folic acid 82g/ml, vitamin BI2 60 pg/ml, serum iron 180g/dl, and
MCV-104. The diagnosis is-

a) Irondeficiencyanaemia

b) Vitamin ВI2deficiency

c) Folicaciddeficiency

62. In the blood of patient, 36 years, who treated the respiratory viral infection
by the sulfanilamides, there is hyporegenerative normochromic anemia,
leukopenia, thrombocytopenia. In the bone marrow - reducing of
myelokariocytes. What is the kind of anemia?

A. Aplastic

B. Hemolytic

C. Posthemorrhagic

D. B12 - deficiency

E. Iron - deficiency

63. The five types of leukocytes found in normal peripheral blood are:

A. Lymphocytes, monocytes, neutrophils, basophils, and

lymphoblast

B. Lymphocytes, neutrophils, monocytes, myeloblasts, and

eosinophils

C. Lymphocytes, neutrophils, monocites, eosinophils and

basophils

64. Pernicious anemia and folic acid deficiencies are example of:

A. Microcytic anemias

b. Megaloblasticanemias

C. Normochromic, normocytic anemias

D. Aplastic anemias
65. Hypersegmented, macrocytic neutrophils are often noted in the following condition:

A. IDA

B. Pernicious anemia

C. Acute myelogenuos leukemia

66. In pernicious anemia, as a rule, there is:

A. Hypochromasia

B. Leukocytosis

C. Leukopenia

D. Thrombocytosis

E. Spherocytosis

67.A man who had undergone total gastrectomy remains well for five years. Then he develops
anaemia. What is the most likely cause of this anaemia ?

a) Proteindeficiency b) Zincdeficiency

С)Folic acid deficiency d) Vitamin В12 deficiency

68. A person who has had a large portion of his stomach surgically removed is most likely to
suffer from,

a) Iron deficiency aneamia

b) Pernicious anaemia
c) Haemolyticanaemia
d) Vit K deficiency

69. Primery site of folate absorption is:A. Proximal jejunum; B. Duodenum; C. Both;
D. neither

70. A 77-year-old woman is admitted to the hospital because of difficulty walking. She has had
progressive pain and paresthesia of both feet over the past 3 weeks. Her pulse is 80/min,
respirations are 16/min, and blood pressure is 130/80 mm Hg. Neurologic examination shows
decreased ankle jerk reflexes bilaterally and decreased vibratory sense and proprioception in the
lower extremities. Laboratory studies show:Hemoglobin 8 g/dL, Leukocyte count -2,4.109/l,
platelet count 90,0Х109/l.Mean corpuscular volume 106 μm3

Which of the following is the most likely diagnosis?

(A) Diabetic neuropathy

(B) Hypothyroidism
(C) Pulmonary osteoarthropathy

(D) Spinal stenosis

(E) Vitamin B12 (cobalamin) deficiency

71. A 21-year-old woman comes to the physician for counseling prior to conception. She
delivered a female newborn with anencephaly 1 year ago. The newborn died at the age of 4 days.
She asks the physician if she can take any vitamins to decrease her risk for conceiving a fetus
with anencephaly. It is most appropriate for the physician to recommend which of the following
vitamins?

(A) Vitamin B12 (cyanocobalamin

(B) Folic acid

(C) Vitamin B1 (thiamine)

(D) Vitamin B2 (riboflavin)

(E) Vitamin B6 (pyridoxine)

72. Hemolytic anemia may be characterized by all of the following except-

a) Hyperbilirubinemia

b) Reticulocytosis

c) Hemoglobinuria

d) Increased Factor XII

73. All are features of hemolytic anaemia except -

a) Thrombocytopenia

b) Hemosiderinuria

c) Decreasedhaptoglobin

d) Raisedindirectbilirubin

74. A 23 year old female presenting with anemia, jaundice, for 2 years, peripheral smear
showing spherocytes, the best investigation to be done -

a)Reticulocyte count , b)Osmotic fragility test, c)Coombs test, d)Bone marrow aspiration
 75. A 21 year old male presents with anemia and mild hepatosplenomegaly. His Laboratory
studies show: Hemoglobin 8 g/dL, Color index – 1,0, Reticulocytes- 4%, Leukocyte count
-4,4.109/l, platelet count 200,0 Х109/l. , history of single blood transfusion is present till
date. Most probable diagnosis is-

a) Thalassemia major

b) Thalassemia minor

c) Thalassemia intermedia

d) Autoimmune hemolytic anemia

76. Hemolytic anemia may be characterized by all of the following except -

a) Hyperbilirubinemia

b) Reticulocytosis

c) Hemoglobinuria

d) Increased plasma iron level

77. Which of the following is not true about hereditary spherocytosis?

a)Splenomegaly, b) Increased RBC life span, c)Pigment gall stones, d) Effective splenectomy

78. Which of the following is associated with an ыpectrin deficiency in the RBC membrane?

a) Autoimmune hemolytic anemia

b) Hereditary spherocytosis

e) Thalassemia major

c) Thalassemia minor

79. The molecular pathology in hereditary spherocytosis is due to

A. Spectrin deficiency

B. Point mutation
C. Gene deletions

D. Balanced chromosomal translocation

80. Two days after receiving 3 units of packed red blood cells for postpartum hemorrhage, a 24-
year-old woman has fatigue and slight jaundice. Laboratory studies show: Hemoglobin 8.8 g/dL.
Serum total bilirubin 5 mg/dL.Liver tests are otherwise within normal limits. Which of the
following is the most appropriate next step in diagnosis?

(A) Cytomegalovirus antibody titer

(B) Direct and indirect antiglobulin (Coombs) tests

(C) Factor XII

(D) Serology for hepatitis B markers

(E) Ultrasonography of the gallbladder

81. The normal number of thrombocytes is:

A. 5,000 - 10,000

B. 125,000 - 150,000

C. 150,000 - 450,000

D. 500,000 - 1,000,000

82. The cell that functions as a plug at the site of bleeding is the:

A. Eosinophil

B. Red cell

C. Platelet

D. Neutrophil

83. Limits of differences of content of absolute amount of segmented neutrophils (109/l) in blood of
healthy people are:

a) 54- 65 *

b) 10 - 20

c) 12-24

d) 25 -70

84.Limits of differences of content of absolute amount of lymphocytes (109/l) in blood of healthy people
are:
 a) 20- 40

b) 10 - 30

c) 23- 50

d) 12 - 18

85. The normal level of iron in the serum of an adultthe body is:
1. 2 to 10 μmol / l
2. 12 to 30 μmol / L
3. 15-45 μmol / l
4. 26-50 μmol / l

86. In what situation is iron deficiency anemia apply blood transfusion:

1. women with profuse menstruation
2. Pregnant with a Hb content of more than 80 g / L
3. donors who developed anemia
4. with not abundant hemorrhoidal bleeding
5. with preanemic coma

87. Complications of hemorrhagic vasculitis

1. chronic glomerulonephritis
2. urolithiasis
3. cardiovascular failure
4. Depression of hematopoiesis

88. Normal iron content in the human body:

1. 1-2 g
2. 6-8 g
3. 10-12 grams
4. 2-3 grams
5. 4-5 g

89. For the treatment of autoimmune hemolytic anemia, the following is used:
1. Ascorbic acid
2. Vitamin B12
3. Preparations of iron
4. glucocorticoids

90. In the treatment of thalassemia, the following applies:

1. Desferal
2. Cyanocobalamin
3. Ginotardiferon
4. Nicotinic acid

91. For iron deficiency anemia is characterized by:

1. Megaloblastic type of hematopoiesis
2. Decreased serum iron
3. Hyperchromia
 4. Normochromia
5. Pancytopenia

92. Hemorrhagic syndrome in aplastic anemia

is due to:
1. abnormal structure of the wall vessels
2. increased destruction of platelets in the blood
3. Deficiency of coagulation factors
4. increased platelet consumption
5. Inadequate formation of megakaryocytes

93. Treatment of B12 deficiency anemia includes:

1. Cyanocobolamine
2. Prednisolone
3. Retabolil
4. tardiferon
5. Recormon

94. Your actions in anemic coma in a patient with B12 deficiency anemia:
1. Whole blood transfusion
2. Transfusion of red blood cells + vitamin B12
3. hydrocortisone in / in, polyglucin
4. Prednisolone IV, transfusion of red blood cells

95. The method of treatment of hereditary microspherocytosis is:

1. Anabolic steroids
2. corticosteroids
3. vitamin therapy
4. Splenectomy

96`. A 42-year-old patient complains of back pain, dark urine, general weakness, dizziness occurred after treating a flu with aspirin
and ampicillin. Physical examination: the patient is pale, with subecteric sclerae. HR - 98 bpm. Liver - +2 cm, spleen - +3 cm.
Peripheral blood smear: RBCs - 2,6 x 1012/l, Hb - 60 g/l, CI - 0,9, WBCs - 9,4 x 109/l, basophils - 0,5%, eosinophils - 3%, band
neutrophils - 6%, segmented neutrophils - 58%, lymphocytes - 25%, monocytes - 7%, ESR - 38 mm/hour, reticulocytes - 24%.
Total bilirubin - 38 millimole/l. What complication occurred in the patient?

A. Acquired hemolytic anemia

B. Toxic hepatitis

C. Cholelithiasis

D. Agranulocytosis

E. Paroxysmal nocturnal hemoglobinuria

97. The most common cause of aplastic anemia is:

A. Idiopathic

B. Chloramphenicol

C. Phenylbutazone
D. Petroleum products

E. Prednisolone

98. Treatment of choice for aplastic anemia is:

A. Methotrexat

B. ampicillini

C. chloramphenicol

D. Bone marrow transplantation

E. plasmaphoresis

99. Most sensitive and specific test for diagnosis of iron deficiency is:

A. Serum ferritin levels

B. Serum iron levels

C. Serum transferrin receptor population

D. Transferrin saturation

E. Hb, Ht

100. Laboratory finding in anemia of chronic disease is

A. TIBC decreased

B. Serum iron decreased

C. Ferritin decreased

D. Macrocytic anemia

101. Reduced serum iron and iron binding capacity is seen in:

A. Sideroblastic anemia

B. Thalassemia

C. Iron deficiency anemia

D. anemia of chronic disease

102. Following features may be present in patients of paroxysmal nocturnal haemoglobinuria except

A. Raised lactate dehydrogenasе

B. Reticulocytjsis

C. High leucocyte alkaline phosphatase

D. Hemosiderinuria
E. Decreased RBC

103. Mucosal transfer of iron in GIT by

A. Transferrin

B. Apoferritin

C. Apotransferrin

D. Ferritin

104. Pernicious anemia is due to:

A. Iron deficiency

B. Chronic liver disease

C. Bleeding

D. Atrophic gastritis

E. Hemolysis

105. A 77-year-old woman is admitted to the hospital because of difficulty walking. She has had
progressive pain and paresthesia of bothfeet over the past 3 weeks. She has a history of mild
hypertension treated with hydrochlorothiazide and hypothyroidism treated withthyroid replacement
therapy. Her pulse is 80/min, respirations are 16/min, and blood pressure is 150/80 mm Hg. Neurologic

examination shows decreased ankle jerk reflexes bilaterally and decreased vibratory sense and
proprioception in the lowerextremities. Laboratory studies show:

Hemoglobin 10 g/dL.Leukocyte count 11,000/mm3 with a normal differential.Mean corpuscular volume

106 μm3

Which of the following is the most likely diagnosis?

(A) Diabetic neuropathy

(B) Hypothyroidism

(C) Pulmonary osteoarthropathy

(D) Spinal stenosis

(E) Vitamin B12 (cobalamin) deficiency

194. Spherocytosis is best diagnosed by:

A. Splenic puncture

B. BM aspiration

C. Plasma

D. Peripheral blood smear

 E. Phenotyping

E. Idiopathic thrombocytopenic purpura

106. Treatment of hemorrhagic syndrome in aplastic аnemia includes:

1. Тransfusion of platelets

2. Ampicillin

3. quarantil

4. Heparin

5. penicillin

107. Iron is stored in the liver was

A. red blood cells.

B. hemosiderin.

C. apoferritin.

D. ferritin.

E. hemosiderin and ferritin.

108. Which is not seen in Iron deficiency anaemia:

A. Hyper-segmented neutrophils
B. MCHC<35 g/dL
C. Microcytosis
D. hypochromia
E. MCV< 80 fL

109. Most iron is stored in combination with:

A. Sulphate

B. Folic acid

C. Transferrin

D. * Ferritin
E. Ascorbic acid

110. Low serum iron and elevated TIBC are seen in :

A. * Iron deficiency anemia
B. Sideroblastic anemia

C. Thalassemia major

D. Sickle cell anemia

E. Megaloblastic anemia
111. The most common cause of aplastic anemia is:
A. Idiopathic
B. Chloramphenicol
C. Phenylbutazone
D. Petroleum products
 E. Prednisolone
112. A 37-year-old woman sees her physician because of gum bleeding, menorrhagia. Physical examination reveals petechiae,
bruises on her legs. CBC: RBC 2.5 х 1012/L, Hemoglobin 67 g/L, MCV 64 fl, CI – 0,7, Pl 41 х 109/L, Giant platelets +, WBС
7.9 х 109/L, Segmented Neutrophils 60%, Band Neutrophils 4%, Monocytes 5 %, Eosinophils 3 %, Basophils 2 %, Lymphocytes
27 %, ESR 7 mm/h, lactate dehydrogenase (LDH), indirect bilirubin levels, blood urea nitrogen (BUN) and creatinine
measurements are normal. Bleeding time 13 min. What is the most probably diagnosis?
A. Idiopathic thrombocytopenic purpura
* Henoch–Schonlein purpura
B.
C. Haemolytic uremic syndrom
D. Chronic myelogenous leukemia
E. Macrocytic hyperchromic anemia

113Cause of ITP is -
a) Vasculitis

b) Antibodytovascularepithelium

c) Antibodytoplatelets

d) Antibodytoclottingfactors

114.A Pt. has ecchymoses and petechiae all over the body with no hepatosplenomegaly. All are true
except -

a) Increased megakaryocytes in bone narrow.

b) Bleedingintothejoints

c) Decreasedplateletinblood

d) Disease resolves itslef in 80% of Pt. in 2-6 weeks.

115.The following laboratory determinants is abnormally prolonged in ITP -

a) APTT b) Prothrombintime

c) Bleeding time d) Clotting time

116. Not true about Immune Thrombocytopenic purpura (ITP)-

a) Autoimmunemediated

b) Massivesplenomegaly

c) T Megakaryocytesinbonemarrow

d) I.V immunoglobulinisgiven

117.Platelet transfusion is not indicated in -

a) DilutionalThrombocytopenia

b) ImmunogenicThrombocytopenia
c) AplasticAnemia

d) DIC

118. Which one of the following platelet counts is usually associated with increased incidence
of spontaneous bleeding - )

a) Greatertha 80,000/mm3 b) 40,000/mm3

c) 20,000mm3 d) Lessthan 20,000mm3

119. The typical clinical sighs of Schönlein-Henoch purpura are:

(A) Anemia and jaundice, splenomegaly;

(B) Acute onset with appearance of multiple ecchymoses, petechiae on the lips
and buccal mucosa, epistaxis

(C)Intermittent fevers; bone pain; pallor, petechiae, and purpura; hepatomegaly or splenomegaly;
generalized lymphadenopathy.

(D) Purpuric skin rash, migratory polyarthritis or polyarthralgia, colicky abdominal pain, nephritis.

(E) Hemarthroses, massive bleeding after traumas, operations, and teeth extraction.

120. The boy, 4 years old, is hospitalized in clinic with nasal bleeding, which had appeared in 1 hour after
trauma. From anamhesis: often hemarthroses, from 1 year of life. In the general blood analysis: er.
3.1х1012/l, Hb 89 г/л, thrombocytes 165х10 9/l, duration of the bleeding is 2 minutes, coagulation time
is 15 minutes. What disease is possible in this child?

(А) Werlgof's disease

(B) Hemophilia

(C) Hemorrhagic vasculitis

(D) Willebrand's disease

(E) DIC-syndrome

121. The girl, 7 years old, is hospitalized in clinic with complains of acute abdominal pain, sickness,
vomiting, hemorrhagic rashes on skin. Hemorrhagic vasculitis is suspected. What therapy is necessary to
prescribe this child?

(А) Anticoagulants

(B) Spleenectomy

(C) Cytostatics

(D) E-aminocapronic acid

 (E) Cryoplasm

122. All are true about hemophilia, except -

a) Increased Bleeding time (ВТ)

b) Decreasedfactor VIII

c) Decreasedfactor IX

123. In a patient of Hemophilia to be taken for dental extraction true is all, EXCEPT-

a) All patients should be screened for HIV

b) Extraction should be done under general anaesthesia and skilled anaesthetic care

c) Factor VIII or cryoprecipitate can be needed

d) Dose of Lignocaine required for anaesthesia is same as that for normal individuals

124. Haemophilia A is characterrised by the presence of following features, except -

a) Bleeding into soft tissues, muscles & joints

b) Lossof VIII levels

c) Prolongedpartialthromboplastintime

d) Prolongedprothrombintime

125. Which of the following is the best source of factor VIII -a) Fresh food b) Fresh
frozen plasma c) Cryoprecipitate d) Platelet concentrate

126. Increased bleeding due to impaired primary hemostasis is characteristic

for:
1. Hemophilia
2. Secondary coagulopathy
3. Thrombocytopenic purpura
4. Willebrand disease
5. congenital coagulopathy

127. CBC: RBC 2.25 х 1012/L, Hemoglobin 60 g/L, Hematocrit 29 %, MCV 64 fl, Reticulocyte Count 3.0 %, Pl 241 х 109/L, WBC 7.9 х 109/L,
Segmented Neutrophils 60 %, Band Neutrophils 4 %, Monocytes 5 %, Eosinophils 3 %, Basophils 2 %, Lymphocytes 27 %, ESR 7 mm/h,
Anisocytosis, hypochromia +, Bleeding time 5 min, Prothtombin time 12 seconds, Partial thromboplstin time 45 seconds,Factor VIII 3 %. What is t
most likely diagnosis?

A. Hemophilia A
B. Idiopathic thrombocytopenic purpura

C. Thrombotic thrombocytopenic purpura

D. Henoch–Schonlein purpura

128. Which of the laboratory indicators is characteristic for hemophilia?

1. Prolonged bleeding time
2. Decrease in the number of platelets
3. Prolongation of clotting time
4. Impaired platelet function
5. Decrease in the number of megakaryocytes

129. At what disease in patients are observed intermuscular, subcutaneous, retroperitoneal

hematomas?
1. Hemorrhagic vasculitis
2. Thrombocytopenic purpura
3. Hemophilia
4. Willebrand disease

130. Thrombocyte precursors are:

1. Reticulocytes
2. Megakaryocytes
3. Myelokaryocytes
4. Oxyphilic normocytes
5. Polychromatophilic normocytes

131. At what disease develop chronic hemorrhagic destructive osteoarthritis?

1. Hemorrhagic vasculitis
2. Thrombocytopenic purpura
3. Rundu-Osler disease
4. Нemophilia

132. Characteristic for hemophilia A laboratory test:

1. Deficiency of the VIII coagulation factor
2. Coagulation factor II deficiency
3. Deficiency IX factor of coagulation
4. Deficiency of the XII factor of coagulation

133. At what disease plasmapheresis is one of the components of the basic therapy?
1. Hemorrhagic vasculitis
2. Thrombocytopenic purpura
3. Hemophilia
4. Rundu-Osler disease

134. Why is fresh frozen plasma used for hemorrhagic vasculitis?

1. For replenishment of coagulation factors
2. For stimulation of immunity
3. To improve microcirculation
4. For activation of fibrinolysis
5. For replenishment of antithrombin III
 135. Increased adhesion and aggregation of plateletsis typical for:
1. Hemophilia
2. hemorrhagic vasculitis
3. Willebrand disease
4. Thrombocytopenic purpura

135.Peripheral blood smear: RBC 3.0х 1012/L, Hb 48 g/L, Ht 30 %, Colour index 0.5, MCV 59 fl, Reticulocyte Count 2.0 %, Pl
432 х 109/L, WBC 7.0 х 109/L, Segmented Neutrophils 60 %, Band Neutrophils 4 %, Monocytes 5 %, Eosinophils 3 %,
Basophils 2 %, Lymphocytes 27 %, ESR 38 mm/h, Anisocytosis, Hypochromia +. What is the most likely diagnosis?
A. Iron-deficiency anemia

B. Acute leukemia

C. Aplastic anema

D. Vitamin B12 deficiency anemia

E. Chronic hemolytic anemia

136. Which of following isn’t seen in haemophilia A

A. Hematomas

B. Hemarthritis

C. Increased aPTT

D. Petechia

E. Family history
137. Which of following is the sign of idiopathic thrombocytopenic purpura?
A. Hematomas
B. Hemarthritis
C. Increased aPTT
D. Petechia
E. Family history

138. Which of following is seen in haemophilia A

A. menorrhagia,

B. easy bruising (purpura),

C. extravasation of blood from capillaries into skin

D. hematomas

E. extravasation of blood from capillaries into mucous membranes (petechiae).

139. Which of following is seen in haemophilia A

A. menorrhagia,
B. easy bruising (purpura),
C. extravasation of blood from capillaries into skin
D. hemarthritis

140. Which of following is seen in haemophilia A

A. menorrhagia,

B. easy bruising (purpura),

C. extravasation of blood from capillaries into skin

D. family history

141. A 7-year-old girl presents with a 3 day history of rash and ankle swelling. She had a cold 4
weeks previously. On examination she has palpable non-blanching purple spots 1-4 mm in
diameter especially over the lower extremities and buttocks. Her left ankle is swollen, warm and
tender, with restricted movement.
What is the most likely diagnosis?
A. Acute lymphoblastic leukaemia
B. Henoch Schonlein purpura
C. Idiopathic Thrombocytopaenic Purpura
D. Pneumococcal septicaemia

142. Patients with immune thrombocytopenic purpura (ITP) have

A. Normal-to-increased number of megakaryocytes
B. Elevated blasts
C. Elevated lymphocytes
D. Elevated plasmocytes
E. Decreased precursors of RBC

143. Thrombocytopenia occurs in all except:

A. Henoch Schonlein purpura
B. TTP
C. DIC
D. Leukemia
144. A 7-year-old boy is admitted with haemarthrosis of his left knee. These episodes have
been recurrent since his early years. His Activated partial thromboplastin time is significantly
prolonged but bleeding time is normal. Choose the SINGLE most appropriate treatment.
A. Desmopressin
B. Factor VIII concentrate
C. Heparin
D. Vitamin K

145. A 7-year-old boy with a family history of a haemophilia presents with haemorrhage into
the left knee joint.
Choose the SINGLE most appropriate treatment.
A. Desmopressin
B. Recombinant factor VIII concentrate
C. Heparin
D. Vitamin K
E. Warfarin

146. A 73-year-old woman present with bruising on extremely minor trauma

and widespread purpura. Her platelet count is 14x10 9\ L and a bone
 marrow shows megakaryocytes suggestive of immune thrombocytopenia
purpura.
Choose the SINGLE most appropriate treatment.
A. Desmopressin
B. Recombinant factor VIII concentrate
C. Heparin
D. Prednisolone
E. Warfarin

147. True about haemophilia A are all except:

A. PTT increased
B. PT increased
C. Clotting time is increased
D. Serum levels of factor VIII are decreased
148.A 4-year-old child presents to ER with spontaneous bleeding into both knee
joints. He has had a number of admissions relating to bleeds previously. Lab. test:
A normal PT and platelet count but prolonged APTT
What is the most likely diagnosis?
A. haemophilia
B. multiple myeloma
C. agranulocytosis
D. chronic lymphatic leukaemia

149. The most common leukocytoclastic vasculitis affecting children is:

A. Takayasu disease.
B. Mucocutaneous lymph node syndrome (Kawasaki disease)
C. Henoch Schonlein purpura
D. Polyarteritis nodosa.

150. Bone marrow transplant is the treatment of choice in all, except:

A. Aplastic anemia

B. AML in 1st remission

C. ALL in second remission

D. ITP
 151. A patient with an Hb of 6 g%, WBC count of 2000/cmm, has a
normal different count
except for having 6% blasts, platelets are reduced to 80,000/cmm; moderate
splenomegaly
is present. Possible diagnosis is:
A. Leukemia
B. Aplastic anemia
C. HEMOLYSIS
D. lTP

152.A 3-year-old girl presents with pallor and marked gland enlargement. She has been unwell
for the past 3 weeks. On examination the temperature is 37.6°C, and she looks pale. She has a
few petechiae on the neck and palate, with moderate generalised lymphadenopathy and an 3 cm
spleen. What is the most likely diagnosis?
A. aplastic anaemia
B. multiple myeloma
C. Folic acid deficiency
D. acute leukaemia

153 A 20 year old university student comes to the student health center because of marked fatigue.
Temperature is 38.3°C (101.0°F). Physical examination shows striking pallor of skin, nail beds and
conjunctivae. There are petechial hemorrhages in the skin of his legs. A soft, blowing systolic murmur is
present over the precordium. No other abnormalities are present. The most appropriate study at this
time is:

a) Complete blood count

b) Determination of bleeding and clotting time

c) Examination of bone marrow aspirate

d) Hemoglobin electrophoresis

e) Serological testing for infectious mononucleosis

154.A 23-year-old male with Down syndrome is brought to your office by his parents. The patient has
had a fever for 12 days. The fever is not associated with rhinorrhea, sore throat, cough. The parents
note that their son has complained of aches in various places, and has not been eating well for several
weeks. The physical examination is remarkable painless lumps in the neck, pale conjunctivae, petechiae
on lower extremities and an 5 kg weight loss since his last visit 1 month ago.

Which one of the following is most consistent with this patient’s symptoms?

a) Acute myeloid leukemia

b) Atypical pneumonia
c) Hodgkin’s lymphomai

d) Myocarditis

e) Urinary tract infection

155.A 54-year-old woman complains of increasing fatigue and easy bruising of 3 weeks’ duration.
Physical findings included pale, scattered ecchymoses and petechiae and mild hepatosplenomegaly. CBC:
RBC – 2.5x1012/L; Hb – 73 g/L; HCT 20%; PLT – 23.000/mcL; and WBC – 162x109/L with 82% of blasts.
Whatisthemostprobablediagnosis?
a. Acuteleukemia

b. Chronicleukemia

c. Thrombocytopenia

d. Hemolyticanemia

e. Megaloblasticanemia

156. A patient complains of gingival bleedings,incraesed body temperature till 38`C,marked

general weakness.He feels himself sick for the recent 2weeks.Data of objective
examination,petectnia on the skin,by palpation enlarged submandibular axillary and femoral
lymph nodes.Data of CBC: erythrocythes-2,1.10 9/l,Hb-80g/l, thrombocytes-120000/l, Le-
18,6 .10`9/l, l%,stub-2%,segm-9%, lymph-5%, mon-3%, blast cels-80%, ESR-36mm/hr.Which
data of CBC directly proves diagnosis of acute leukaemia?

a. erythocytes 2,1.10`12/l

b. thrombocytes-120000/l

c. leukocytes 18,6.10`9/l

d. ESR-36mm/hr

e. Blast cells 80%

157. A patient complains of gingival bleedings,incraesed body temperature till 38`C,marked

general weakness.He feels himself sick for the recent 2weeks.Data of objective
examination,petectnia on the skin,by palpation enlarged submandibular axillary and femoral
lymph nodes.Data of CBC: erythrocythes-2,1.10 9/l,Hb-80g/l, thrombocytes-120000/l, Le-
18,6 .10`9/l, l%,stub-2%,segm-9%, lymph-5%, mon-3%, blast cels-80%, ESR-36mm/hr.Which
disease has developed in the patient:

a. acuteleukaemia

b. chronicleukaemia

c. hemolyticanaemia

d. vitamin B12-deficiency anaemia

 e. symptomofdysseminatedhypercoagulation

158. Patient, 62yrs old, is hospitalized with complaints of enlargement of neck, subclavian
and axillary lymph nodes, general weakness, increased sweating, subfebrile body temperature
within the last 3months. Data of CBC:WBC-64.109/l, lymphocytes-72%. Which examination
method is necessary for diagnosis?

a. computertomography

b. myelogram

c. Lymphography

d. Lymphosintigraphy

e. X-ray

159. Patient, 62yrs old, is hospitalized with complaints of enlargement of neck, subclavian
and axillary lymph nodes, general weakness, increased sweating, subfebrile body temperature
within the last 3months. Data of CBC: WBC-64.109/l, lymphocytes-72%. Blast cells 1-2%. Which
disease is possible to suspect?

a. vitamin B12-deficiency anemia

b. plasmacellmyeloma

c. acutreleukaemia

d. chronicleukaemia

e. mononucleosis

160. A patient complains of gingival bleedings, incraesed body temperature till 38`C,marked
general weakness.He feels himself sick for the recent 2weeks.Data of objective examination:
petechnia on the skin,by palpation enlarged submandibular axillary and femoral lymph
nodes.Data of CBC: thrombocytes-120000/l, Le-18,6 .10`9/l, blast cels-80%, ESR-36 mm/hr.
Acute leukaemia is diagnosed. Which symptom indicate an intoxication syndrome?

a. petechnia, gingival bleeding, low account of thrombocytes

b. generalweakness,fever

c. enlarged lymph nodes,decreased amount of RBC, thrombocytes,blast cells in CBC

d. allmentioned

e. nocorrectanswer.

161. A pt with an Hb of 6, WBC count of 2000, has a normal Different count except for having
6% blasts; platelets are reduced to 80,000; moderate splenomegaly is present; possible
diagnosis is -
a) Leukemia b) Aplasticanemia

c) Hemolysis d)ITP

162. A 5 year old child presents with history of fever off - and-on for past 2 weeks and
petechial spots all over the body and increasing pallor for past 1 month. Examination reveals
splenomegaly of 2 cms below costal margin. Data of CBC: thrombocytes-60000/l, Le-28,6
.10`9/l, blast cels-30%, ESR-46 mm/hr. The most likely diagnosis is -

a) Acuteleukemia

b) Idiopathicthrombocytopenicpurpura

c) Hypersplenism

d) Aplasticanemia

163. A four year old boy was admitted with a history of abdominal pain and fever for two
months maculopapular rash for ten days, and dry cough, dyspnea and wheezing for three days.
On examination liver and spleen were enlarged 4 cm and 3 cm respectively below the costal
margins. Jjps hemoglobin was 10.0 g/dl, platelet count 37 x 10 FL and total leukocyte count 70 x
109/l, Bone marrow examination revealed a cellular marrow comprising of 45% blasts and. The
blasts stained negative for myeloperoxidase and non-specific esterase and were positive for
CD19, CD10, CD22 and CD20. Which one of the following is the most likely diagnosis?

a) Biphenotypic acute leukemia (lymphoid and eosinophil lineage)

b) Acuteeosinophilicleukemia

c) Acute lymphoblastic leukemia

d) Acute myeloid leukemia with eosinophilia

164. L-asparaginase is partcularly used in which type of leukemia -

a) AML b)CML

c) ALL d)CLL

165. Treatment of choice of intracranial ALL is -

A) Intrathecalmethotrexate,Prednisolone,

B) Vincristineandpredinisolone
c)Intrathecalvincristine

d)Prednisolone

166. In which of the following types of leukemia is methotrexate administered for CNS
prophylaxis -

a) ALL b) CML

c)CLL

167. Treatmentof ALL-

a) Hydroxyurea, Prednisolone b) All trans retinoic acid

c)Prednisodone , L-asparginase, Vincristine

168. A 22 year old man presents with history of bleeding from gums for the last 6 months. On
investigation the Hb was found to be 8.2 gm% TLC 4400/mm, DLC N 64%, L 27%, E 3%, M 6%
and platelet count of 20,000 /cu mm. Which one of the following investigation would be most
useful in establishing the diagnosis -

a) Bleedingtimeandclottingtime

b) Prothrombintime

c) Partialthromboplastintime

d) Bone marrow examination

169. A 55 year old male presents with enlarged glands over the left side of neck. On
examination, Spleen is enlarged 4 cm below the costal margin and liver is enlarged 2 cm below
costal margin. Blood examination show a total leucocyte count of 80,000/ cumm. Mostly
lymphocytes and a few prematurecells the mostly likely diagnosis is -

a) Infectiveadenopathy

b) Acuteleukaemoidreaction

c) Lymphatic leukaemia

d) Hodgkin’sdisease
170. Lymphadenopathy in combination with hepatosplenomegaly
and a fever occurs when:
1. Acute leukemia
2. Aplastic anemia
3. Myeloma disease
4. Hemorrhagic vasculitis

171. Chronic myelogenous leukemia is characterized by the followingbone marrow picture:

1. Irritation of the red sprout
2. Plasma cells 10%
3. Lymphocytes 70%, the shadows of Botkin-Humprecht
4. Complete fat replacement by predominantly granulocyte cells

172. The patient has anemia, pancytopenia. What kind of examination is needed:
1. Determination of iron
2. Direct Coombs test
3. Coagulation time
4. Sternal puncture

173. Suddenly enlarging painful lymph nodes in a patient with chronic myeloid leukemia
indicate:
1. Lymphogranulomatosis
2. Lymph node tuberculosis
3. Viral infection
4. Transformation into acute leukemia

174. Chronic myelogenous leukemia is characterized by the following patternbone marrow:

1. diffuse proliferation by granulocyte cells
2. fatty bone marrow
3. lymphoid proliferation
4. hyperplasia of red sprout

175. Splenectomy in chronic myelogenous leukemia is indicated when:

1. Splenomegaly
2. The presence of hemorrhagic syndrome
3. Isolated localization of blasts in the spleen
4. Spleen infarction

176. Chronic lymphatic leukemia may be associated with:

1. hemolytic anemia
2. osteolytic foci
3. relative lymphocytosis
4. hypercalcemia
5. Dysproteinemia
177. Pathological bone fractures are most common
with the following disease:
1. chronic myelogenous leukemia
2. hemophilia
3. multiple myeloma
4. myelodysplastic syndrome
178. For acute leukaemia the blast cells should be morethan -
a) 10% c)20%

b) 30% d)40%

179. Enzyme used in Leukemia-

a) Asparginase b) Lipase

c) Amylase d) Transminase

180. The test most likely to be useful in the diagnosis of AML on a blood smear is staining by

A. Non specific esterase

B. PAS

C. Sudan black

D. TRAP

181. The minimum number of blasts present in Bone marrow, for “acute leukemia” diagnosis is

A. 10%

B. 20%

C. 30%

D. 35%

182. The characteristic cell of ALL is:

A. Myeloblast

B. Myelocyte

C. Lymphoblast

D. Lymphocyte

183. The first-line drug therapy in chronic myeloid leukemia is -

a) Hydroxycarbamide b) Alpha-interferon

c) Busulphan d)Imatinib

184. A 40 year old male patient is hospitalised with huge splenomegaly, marked sternal
tenderness, and a total leucocyte count of85,000 per cubic millimetre with large percentage of
myelocytes and meta myelocytes, which one of the following drugs is best indicated for his
disease ? a) Cyclophosphamide b) Chlorambucil

c) Melphation d) Hydroxyure
185.Which ONE of these is the most typical blood count in a patient presenting with chronic myeloid
leukaemia?

Hb 3 g/dL; WBC 10х109/L; platelets 500х109/L

a. Hb 9 g/dL; WBC 90х109/L; platelets 400х109/L

b. Hb 6 g/dL; WBC 12х109/L; platelets 50х109/L

c. Hb 16 g/dL; WBC 10х109/L; platelets 500х109/L

186.Which ONE of these is the most accurate definition of the mode of action of imatinib?

It is a specific inhibitor of the BCR‐ABL fusion protein and blocks phosphatase activity by interaction
with the enzyme site

a. It is a specific inhibitor of the BCR‐ABL fusion protein and blocks phosphatase activity by
competing with adenosine triphosphate (ATP) binding

b. It is a specific inhibitor of the BCR‐ABL fusion protein and blocks tyrosine kinase activity by
interaction with the enzyme site

c. It is a specific inhibitor of the BCR‐ABL fusion protein and blocks tyrosine kinase activity by
competing with adenosine triphosphate (ATP) binding

187.Which ONE of these is considered as an optimal response to imatinib treatment for chronic myeloid
leukaemia?

blood count that returns to normal after 6 months of treatment

a. Failure to find any Philadelphia‐positive chromosomes in bone marrow samples after 12

months

b. Failure to detect any mutations within the BCR‐ABL gene after 12 months

c. Noneoftheabove

188.Which ONE of these treatments is unlikely to be considered as appropriate treatment for a patient
with failure to respond to imatinib for treatment of chronic myeloid leukaemia?

Dasatinib

a. Autologousstemcelltransplantation

b. Allogeneicstemcelltransplantation

c. Increasethedoseofimatinib
 189.Splenomegaly is the characteristic of which of the following conditions?
a. Idiopathicthrombocytopenicpurpura

b. ChronicMyeloidleukemia

c. MultipleMyeloma

d. Hairycellleukemia

190.Within the last year, a patient complained of weakness, fatigue, sweating, dry cough. 1month ago,
he had severe herpes infection. Data of present examination:enlarged lymph nodes in the neck, in
axillary region. The lymph nodes are slightly dense and painless. Data of CBC: leukocytes-4,0х109/l,
lymphocytes-80%. Whichexaminationshouldbeperformedinfirstline?

a. Biochemicalbloodstudy

b. Biopsyofenlargedlymphnodes

c. Bloodimmunogram

d. chest x-ray

e. sternal puncture

191. Autoimmune hemolytic anaemia is commonly seen in:

A. CLL

B. AML

C. ALL

D. CML

192.Which ONE of these is TRUE concerning the translocation that leads to the Philadelphia
chromosome?

It leads to increased expression of the c‐ABL gene as it brings a strong gene promoter close to the c‐
ABL gene

a. It is present in around 60% of cases of CML

c. It is detected on a karyotype as the t(8;21) translocation

D. It leads to generation of a bcr‐abl fusion protein

193.Which ONE of these clinical features is commonly seen in patients who present with chronic
myeloid leukaemia?
Swollencervicallymphnodes
 a. Enlargedspleen

b. Bone marrow failure with reduced peripheral blood cell count

c. Swelling of the gums

194. What is seen in multiple myeloma?

A. Increased Alkaline phosphatase

B. Decreased IgA

C. Hypercalcemia

D. Hypouricemia

E. Fat bone marrow

195. Melphalan is used in:

A. Wilm'stumor

B. Retinoblastoma

C. Multiple myeloma

D. Nephroblastoma

E. ALL

196. Bence Jones proteins are excreted in the urine in

A. Chronic lymphocytic leukemia

B. Waldenstroms macroglobulinemia

C. Rheumatic fever

D. Multiple myeloma

E. AML

197. The main diagnostic criteria of multiple myeloma include

A. Lytic bone marrow lesions

B. Decreased B2 microglobulin

C. Bence Jones proteinuria

D. Plasmacytosis >10%

E. Rouleaux formation on peripheral smear

198. Which is not a feature of multiple myeloma?

 A. Cutaneous nodules

B. Bony lesions

C. Renal failure

D. 'M' Spike

E. Hypercalciemia

199. A 63-year-old patient complains of pain in spine, head, fever, fatigue, weakness, weight loss.
Physical and laboratory examinations find out tender bones, normocytic and normochromic anemia,
granulocytopenia and thrombocytopenia. Bone x-ray examination of ribs shows lytic bone lesions. What
is the possible diagnosis?

A. Polycytemiarubravera

B. AML

C. Multiple myeloma.

D. CML

E. CLL

200. A 64-year-old patient complains of weight loss, night sweating, general weakness, fatigue, sensation of fullness in left
hypochondrium. CBC reveals: RBC 3.9х 1012/L, Hb 1118g/L, Ht 41%, MCV 78fl, Pl 845 х 109/L, WBC 109,4х 109/L, Segmented
Neutrophils 62%, Band Neutrophils 10%, Metamyelocytes 3%, Myelocytes 5%, Monocytes 4%, Eosinophils 8%, Basophils 6%,
Lymphocytes 2%, ESR 27mm/h. What is the most likely diagnosis?

A. Acute leukemia
B. Chronic lymphocytic leukemia III st
C. Chronic myeloid leukemia, accelerated phase
D. Chronic myeloid leukemia, chronic phase
E. Chronic lymphocytic leukemia IV st

201.A 64-year-old patient complains of weight loss, night sweating, general weakness, fatigue, sensation of fullness in left
hypochondrium. CBC reveals: RBC 4.0х 1012/L, Hb 128g/L, Hematocrit 41%, MCV 78fl, Pl 98х 109/L, WBC 125,4х 109/L,
Segmented Neutrophils 35%, Band Neutrophils 8%, Metamyelocytes 6%, Myelocytes 5%, Myeloblasts 10%, Monocytes
4%,Eosinophils 8% Basophils 22%, Lymphocytes 2%, ESR mm/h 27mm/h. What is the most likely diagnosis?

A. Acute leukemia
B. Chronic lymphocytic leukemia III st
C. Chronic myeloid leukemia, accelerated phase
D. Chronic myeloid leukemia, chronic phase
E. Chronic lymphocytic leukemia IV st
202. A 64-year-old patient complains of weight loss, night sweating, general weakness, fatigue, sensation of fullness in left
hypochondrium, easy bruising. CBC reveals: RBC 3.4 х 1012/L, Hb 102 g/L, Ht 41 %, MCV 78 fl, Reticulocyte Count 1.0 %, Pl
 75 х 109/L, WBC 125,4 х 109/L, Segmented Neutrophils 33 %, Band Neutrophils 8 %, Metamyelocytes 3 %, Myelocytes 5 %,
Myeloblasts 23 %, Monocytes 3 %, Eosinophils 6 %, Basophils 18 %, Lymphocytes 1 %, ESR 33 mm/h. What is the most likely
diagnosis?

A. Acute leukemia

B. Chronic myeloid leukemia, accelerated phase

C. Chronic lymphocytic leukemia

D. Chronic myeloid leukemia, blast crises

E. Multiple myeloma

203. A 32 -year-old patient complains of weakness and fever. His illness started as tonsillitis a month before. On exam, BT of 38.9°C, RR of 24/min,
HR of 100/min, BP of 100/70 mm Hg, hemorrhages on the legs, enlargement of the lymph nodes. CBC shows RBC 2.0х 1012/L, Hemoglobin
65 g/L, Hematocrit 41 %, MCV 84 fl, Reticulocyte Count 1.0 %, Pl 67 х 109/L, WBC 124,2 х 109/L, Segmented Neutrophils 15 %, Band
Neutrophils 5 %, Blasts 65 %, Monocytes 10 %, Lymphocytes 5 %, ESR 38 mm/h. What is the cause of anemia?

A. Chronic lympholeukemia

B. Acute leukemia

C. Aplastic anema

D. Vitamin B12 deficiency anemia

E. Chronic hemolytic anemia

204. Following changes were discovered in peripheral blood of patient: erhytrocytes - 3,0x1012/l Hb-80g/l, leukocytes - 1,0x109/l. Leukocyte
formula: basophyles - 0%, eosinophyles - 0%, myeloblasts - 64%, stab - 1%, segmentonuclear - 8%, lymphocytes - 24%, monocytes- 3%. Make the
diagnosis due to blood picture.
A. Chronic myeloid leukemia.
B. Erythremia.
C. Neutrophyle leukocytosis.
D. Acute myeloid leukemia

205. For what disease is characterized hyperproteinemia?

A lymphosarcoma.

B. Мyeloma.

B. Chronic lymphocytic leukemia.

D. Non-Hodgkin's lymphoma.

206. For what disease is characterized detection in urine Bence-Jones?

A multiple myeloma.

B. Hodgkin's disease.

B. chronic glomerulonephritis.

G. acute leukemia.

D. autoimmune hemolytic anemia.

207. What are the chief laboratory findings in patient with chronic lymphatic leukemia?

A. Thrombocytosis

B. Thrombocytosis and lymphocytosis

C. Lymphocytosis

D. No specific findings

E. Philadelphia chromosome in abnormal cells

208. Which drug is mostly used for the treatment of chronic lymphatic leukemia?

A. Prednisone

B. Chlorambucil

C. Methotrexate

D. Myleran

E. Ampicilin

209. What genetic sign indicates on chronic myelogenousleukemia

A. No sings

B. XXX or XXY combination

C. Philadelphia chromosome in abnormal cells

D. chromosomes in the 19-st pare

E. Lack of chromosome 13 pare

210. A 70-year-old male complains of 2 months of low back pain and fatigue. He has developed fever
with purulent sputum production. On physical exam, he has pain over several vertebrae and rales at the
left base.

Laboratory results are as follows: Hemoglobin: 70 g/L ,WBC: 12×109/L ,BUN: 44 mg/dL,Hypercalcemia

Creatinine: 3.2 mg/dL,

The most likely diagnosis is

a. Multiple myeloma

b. Lymphoma

c. Metastatic bronchogenic carcinoma

d. Primary hyperparathyroidism

211. Haemophilia A is treated by

a) F.F. blood
b) F.F. plasma
c) Cryoprecipitate
d) Steroids
e) Vincristine
212. Development of agranulocytosis in acute leukemia is associated?

1. immunodeficiency state

2. Neuroleukemia

3. polychemotherapy

4. administration of antibiotics

5. infection

213. Increasing basophil, blast count in an already diagnosed CML patient is suggestive of

A. Severe infection

B. Good prognostic indicator

C. Going for accelerated phase

D. Bleeding diathesis

214. The normal myeloid erythroid ratio is

A. 1:1

B. 2:1

C. 3:1

D. 10:1
215.A 35 -year-old patient complains on severe weakness and fever. Disease started with pain in the throat and fever. Physical
examination: skin and mucous are pale, ecchymosis, purpura of skin and subcutaneous tissue. Peripheral blood smear: RBC - 1,5х 1012
/L, Нв - 50 g/L. Blast – 90 %,. What is the most likely diagnosis?

A. Acute leukemia
B. Thrombocytopenic Purpura
C. Hypoplastic Anemia
D. AIDS
E. Leukemoid reaction

216.A patient, 55yrs old, complains of pain in sternal bone and in ribs. 6 months ago he had pathological
fracture of the left shin. Data of lab tests: protein-110g/l, positive M-gradient. The patient is suspected
plasma cell myeloma. Which test is necessary to prescribe?

a. CBC

b. Biochemicalbloodstudy

c. Determination of Bence Jones protein in urine

d. X-rayofribs

e. CT ofthechest

217. Drug of choice in multple myeloma is -

a)Mechlorethamine b) Vincristine

c) Vinblastine d) Melphalan

218. Which of the following is least likely to be found in multiple myeloma

A. Hypercalcemia

B. Eosinophilia

C. Plasma cell leukemia

D. High ESR

219. Which ONE of the following drugs is NOT useful in the treatment of chronic lymphocytic
leukaemia?

A Cytosine arabinoside
B Fludarabine

C Rituximab (anti‐CD20)

D Chlorambucil

220. Which ONE of the following is a feature of chronic lymphocytic leukaemia?

A Herpes zoster infection

B Meningeal involvement

C Increased blasts in the bone marrow

D Bone lesions

221. Which ONE of these is the most common presentation of B-CLL at the time of initial diagnosis?

a. Anaemia caused by autoimmune haemolysis

b. Patient is asymptomatic but has increased white cell count
c. Enlarged lymph nodes
d. Severe and prolonged infection

222. A 65 year old man presents with low back pain. His labs show anemia and hypercalcemia. You
suspect multiple myeloma. What is the most appropriate test to confirm the diagnosis?

a) WBC count

b) Bone marrow aspiration

c) Platelet count

d) X-rays Decreased LDH, decreased haptoglobin, decreased indirect bilirubin

223. A 65-year-old male is found to have a raised lymphocyte count of 70 on full blood count.
Choose the SINGLE most likely cause
A. pernicious anaemia
B. disseminated intravascular coagulation
C. haemolytic anaemia
D. Chronic lymphocytic leucaemia

224. Which of the following is a pan-T lymphocyte marker-

a) CD2, b)CD3,

c) CD19, d) CD25
225. Note the characteristic for erythremia laboratory sign:
1. Erythrocytosis
2. Lymphocytosis
3. Thrombocytopenia
4. Blast crisis
5. Myeloid metaplasia

226. The following symptom is characteristic for chronic lymphocytic leukemia:

1. Diffuse bone marrow proliferation by mature lymphocytes
2. Presence of lymphoblasts in the bone marrow
3. Reticulocytosis
4. Bone marrow plasmacytosis

227. Shadows of Botkin-Humprecht are:

1. Destroyed lymphocytes
2. Blast cells
3. Hemolyzed erythrocytes
4. Polysegmented neutrophils

228. Philadelphia (Ph) chromosome is the most common find in patients with:

A. Chronic lymphoid leukaemia

B. Polycythaemia rubra vera

C. Chronic myeloid leukaemia

D. Myelofibrosis

E. Mulpiple myeloma
229. Signs of chronic lymphocytic leukemia may include all of the following, except:
A. Splenomegaly
B. asymptomatic lymphadenopathy
C. autoimmune hemolytic anemia
D. plethora
E. leukocytosis

230. Multiple myeloma (MM) is a malignant proliferation of:

A. functionally competent B-lymphocytes

B. atypical megakaryocytes

C. atypical plasma cells that produce monoclonal immunoglobulin

D. typical plasma cells that produce polyclonal immunoglobulin

E. plateletes

231. What is the most common nonspecific hallmark of multiple myeloma?

A. Low RBC

B. High WBC

C. High platelet counts

D. Elevated ESR

E. Elevated CRP
232. CBC reveals: RBC 3.75 х 1012/L, Hb 125 g/L, Ht 42 %, MCV 91 fl, -Reticulocyte Count 1.0 %, Pl 280 х 109/L, WBC 47.9 х 109/L, Segmented
Neutrophils 3 %, Band Neutrophils 1 %, Monocytes 2 %, Eosinophils 1 %, Basophils 0 %, Lymphocytes 93 %, ESR 7 mm/h, Smudge cells +. W
is the most likely diagnosis?

A. Acute leukemia
B. Chronic lymphocytic leukemia III st
C. Chronic lymphocytic leukemia I st
D. Chronic myeloid leukemia
233. CBC reveals: RBC 3.9х 1012/L, Hb 128g/L, Ht 41%, MCV 78fl, Reticulocyte Count 1.0 %, Pl 945 х 109/L, WBC 125,4х 109/L, Segmented
Neutrophils 62%, Band Neutrophils 10%, Metamyelocytes 3%, Myelocytes 5%, Monocytes 4%, Eosinophils 8%, Basophils 6%, Lymphocytes 2%, ESR
27mm/h. What is the most likely diagnosis?

A. Acute leukemia
B. Chronic lymphocytic leukemia III st
C. Chronic myeloid leukemia, accelerated phase
D. Chronic myeloid leukemia, chronic phase
E. Chronic lymphocytic leukemia IV st

234. A 67year-old man is found to have hepatosplenomegaly, with widespread

lymphadenopathy. His full blood count revealed anaemia, thrombocytopenia and leucocytosis,
with lymphocytosis. What is the most likely diagnosis?
A. chronic lymphatic leukaemia
B. multiple myeloma
C. agranulocytosis
D. tuberculosis

235. A 65 year old man presents with low back pain. His labs show anemia and hypercalcemia. You
suspect multiple myeloma. What is the most appropriate test to confirm the diagnosis?

a) WBC count

b) Bone marrow aspiration

c) Platelet count

d) X-rays Decreased LDH, decreased haptoglobin, decreased indirect bilirubin

236. A 72yo man is receiving chemotherapy for acute leukemia 8 days ago.He
has a cough with some green sputum but feels well. Temp=37.6C. Chest
exam =
few coarse crepitations in the right base. HR=92bpm. CBC: Hgb=9.5g/dL,
WBC=1.1, Neutrophils=0.6, Plt=89. Sputum, urine and blood culture sent to
microbiology. What is the most appropriate management?
a. Broad spectrum antibiotics IV
b. Broad spectrum antibiotics PO
c. GCSF (in myeoproliferative dirorders, when everything low)
d. Postpone tx until bacteriology results available
e. Reassure and send home

237. A 50yo man presents with itching after hot shower with dizziness,
chest pain after exercise. Exam: splenomegaly. Hb-19.2g/dl What is the single most likely

causative factor?

k. ALL

l. Lymphoma

m. Polycythemia

n. Eczema

238. A 51-year-old female with a history of treatment for thyroid dysfunction-carbimazole

therapy, presents with a sore throat, fever 39.00c. Examination reveals swollen and painful
fauces. Hemogramm: leukocytes 0,9x109/l Choose the SINGLE most likely cause
A. pernicious anaemia
B. agranulocytosis
C. haemolytic anaemia
D. paroxysmal nocturnal haemoglobinuria

239.All of the following are poor prognostic factors for acute myeloid
leukemias, except:
A. Age more than 60 years.
B. Leucocyte count more than 1,00,000/μl.
C. Presence of t(9;22).
D. Presence of t(8;21).

240.A 70-year-old man presents with low back pain, tiredness and headaches. A skull x-ray
reveals numerous punched out lesions. What is the most likely diagnosis?
A. multiple myeloma
B. agranulocytosis
C. haemolytic anaemia
D. paroxysmal nocturnal haemoglobinuria
241.A 70-year-old man presents with low back pain, tiredness and headaches. A skull x-ray
reveals numerous punched out lesions. What is the most likely diagnosis?
E. multiple myeloma
F. agranulocytosis
G. haemolytic anaemia
H. paroxysmal nocturnal haemoglobinuria

242. What violation of general volume of blood does arise up in case of absolute
erythrocytosis?
 А. Simple hypervolemia.

В. Oligocythemic hypervolemia.

С. Oligocythemic normovolemiya.

D. Policythemic hypervolemia.

Е. Simple hypovolemia.

243. A 17-year-old man presents with fever, neck stiffness and photophobia. On examination he is
hypotensive and peripherally shut down, with purpura over his legs. There is persistent oozing from his
venepuncture sites. His blood film contains many red cell fragments.

Choose the SINGLE most likely cause

A. hereditary spherocytosis
B. sickle cell anaemia
C. b-thalassaemia major
D. disseminated intravascular coagulation

244.Coagulopaty consumption at DIC-syndrome is characterized by such phenomena:

A. Hypercoagulation
B. Infarctions
C. Lysis of blood microthrombus
D. Hypocoagulation

245. Generalized coagulation of blood with violation of micricirculation and following

exhaustion of hemostasis mechanisms and haemorrhage is named:

a. Infarction
b. Haemophilia
c. Thrombosis
d. DIC-syndrome

246.The initial phase of DIC-syndrome is characterized by:

a. The dystrophic changes in organs

b. Hypocoagulation
c. Formation of stable fibrin
d. Hypercoagulation

247.Following stage of DIC-syndrome:

e. Chronic inflammation
f. Consumption coagulopathy
g. Activating of fibrinolysis
 h. Hypercoagulation

248. Most specific investigation in disseminated intravascular coagulation is -

a) D - dimer assay b) Bleeding time

c) Clotting time d) Fibrinegen level