KUMSA's Blood Booklet Year Three PDF

YEAR THREE KUMSA’S BLOOD BOOKLET BY: AMNAH ALKANDIRI ABDULLAH ALQAHTANI ANATOMY: 1. Bone Marrow & hematopoiesis …………………………………………………. #6 BIOCHEMISTRY: 1. Heme Synthesis & its Associated Disorders …………………………….. #11 2. RBC Membrane & its Abnormalities ………………………………………… #14 3. Structure & Function of...

YEAR THREE KUMSA’S BLOOD BOOKLET BY: AMNAH ALKANDIRI ABDULLAH ALQAHTANI ANATOMY: 1. Bone Marrow & hematopoiesis …………………………………………………. #6 BIOCHEMISTRY: 1. Heme Synthesis & its Associated Disorders …………………………….. #11 2. RBC Membrane & its Abnormalities ………………………………………… #14 3. Structure & Function of Hb …………………………………………….…………#17 4. Glucose Metabolism……………………………………………………..…………..#22 LT: Molecular Diagnosis of CML …………………………………………………… #25 MICROBIOLOGY: 1. Hypersensitive Cytotoxic rxn to RBCs ………………………….…………. #28 2. Function of Granulocytes ……………………………………………………….. #31 3. Lymphopoiesis & their function ……………..……………………………….#35 LT: Viruses associated with blood system ……………………………………..#38 PHARMACOLOGY: 1. Drugs used in Thromboembolic Disorders ……………………………… #41 2. Treatment of Hematological Malignancies……………………………… #45 PHYSIOLOGY: 1. Role of Vit. B12, Folate, & Iron in Erythropoiesis ……………………….#50 NUCLEAR MEDICINE & RADIOLOGY: ……………. #53 -Nuclear Hematology -Radiological Imaging in Hematology 1 PATHOLOGY: Week 1: 1. Iron & Anemia of Chronic Inflammation ………………………………….. #56 2. Megaloblastic Anemia..…………….……………………………………………… #61 Week 2: 3. Classification of Hemolytic Anemias …………………………………………#65 4. Molecular Genetics of Hemoglobinopathies …………………………….#69 5. Inherited anemia …………………………………………………………………….. #75 6. Principles of Blood Transfusion ……….………………………………………. #80 Week 3: 7. Hemostatic System- An Integrated Approach ……………………………#85 8. Work up of hemostatic Disorders …………………………………………….#88 9. Microvascular thrombotic disorders ………………………………………….#90 10. Thrombophilia: Etiology & pathogenesis …..………………………….. #93 11. Arterial & Venous Thrombosis ………………..………………………………#98 12. Bleeding disorders …………………………………………………………………. #99 13. Genetics of Bleeding & Thrombotic Disorders ……………………….#103 SEMINAR: Hemostatic disorders practical & clinical aspect Week 4: 14. Acute Myeloid Leukemia …………………………………………………….. #108 15. Chronic Myeloid Leukemia …………………………………………………… #110 16. Myelodysplastic Syndromes ………………………………………………… #115 2 Week 5: 17. Acute & Chronic Lymphoid Leukemias ………………………………… #118 18. Lymphoma ……………………………………………………………………………#123 19. Paraproteins Detection & Significance …………………………………..#126 20. Plasma Cell Dyscrasias …………………………………………………………. #126 LT: #132 1. Non nutritional anemia 2. Indications & Complications of Blood Transfusion 3. Benign Myeloid Disorders 4. Granulopoiesis & its Regulation 5. Lab Investigations of Common Malignant Lymphoid Disorders **Note**: Lecture titles are hyperlinked 3 ANATOMY 4 Bone marrow & hemaptopoiesis 1- What is a characteristic of Hematopoietic stem cells?(19)(18) a. Produce all cells in the BM b. self-renewal c. Become committed to a certain lineage d. Major cell in the bone marrow Answer B 2- What cell expresses CD34+ on their surfaces?(19)(18)(14)(13) A) Pluripotent stem cells B) T lymphocytes C) Multipotent stem cells Answer A 3- Which of the following is the major blood-forming organ in the fetus during the second trimester?(19) (18) a. Bone marrow b. Liver c. Spleen d. Thymus e. Yolk sac Answer B (1st trimester = yolk sac, 2nd trimester = liver, 3rd trimester = bone marrow) 4- What cells of the bone marrow secrete IL-7?(17) A. Stromal cells B. T lymphocytes C. Dendritic cells D. B lymphocytes Answer A 5- What is the first cell in erythropoiesis to undergo ribosome synthesis?(17) A. Basophilic erythroblast B. Orthochromatophilic erythroblast C. Normoblast D. Late erythroblast Answer A 5 6- What is the characteristic of hematopoietic stem cells?(16)(14) a- Infrequent in adult bone marrow b- No mechanism of apoptosis c- Symmetric division of these cells Answer A 7- Which cells express CD34+ on their surface?(19)(18)(16) a- T-cells b- Multipotent stem cells c- Pluripotent stem cells Answer C 8- Which hematopoietic cells are likely to be decreased in a 35-year-old male presenting with hypoxia due to a kidney disease?(16) not sure about the note A) Megakaryocytes B) Monocytes C) Myelocytes D) Proerythroblasts Answer D (Kidney disease—> decreased Erythropoietin—>RBCs affected so Erythroblast) 9- Which of the above choices is orthochromatic?(16) - Normoblast 10- A patient underwent hypoxia while having an already-existing renal disease. Which hematopoietic cell decreases in this condition?(15) A) Proerythroblasts B) Lymphocytes C) Monocytes D) Neutrophils Answer A (Kidney disease—> decreased Erythropoietin—>RBCs affected so Proerythroblast) 11- A person with renal failure will suffer from a deficiency in which group of cells?(14) A) Leukocytes B) Proerythroblast C) Platelets D) Myeloblast Answer B (Kidney disease—> decreased Erythropoietin—>RBCs affected so Proerythroblast) 12- Blood islands are formed at which stage?(14) 6 A) Bone marrow phase B) Hepatic phase C) Yolk sac phase Answer C (Yolk sac phase, Begins in the third week of gestation & is Characterized by the formation of “blood islands” in the wall of yolk sac of embryo.) 13- What’s the first stage of hematopoiesis in the embryo? (13) a) yolk sac b) Bone marrow c) Liver d) spleen Answer A (1st trimester = yolk sac, 2nd trimester = liver, 3rd trimester = bone marrow) 14- Which of the following is orthochromatic(13) -Normoblast 15- What is the correct sequence of hematopoiesis in the fetus?(12) - Yolk sac, spleen, lymph nodes, bone marrow (Correct sequence from note —> yolk sac, liver, spleen, BM) 16- What is the first cell in erythropoiesis to undergo ribosome synthesis(19) a. Basophilic erythroblast b. Orthochromatophilc erythroblast c. Normoblast d. Late erythroblast Answer A 17- What is the major blood forming organ in second trimester?(19) a. liver b. yolk sac c. bone marrow d. Spleen Answer A (1st trimester = yolk sac, 2nd trimester = liver, 3rd trimester = bone marrow) 7 Main points: Bone marrow & hemaptopoiesis - Mesenchymal cells/ mesoderm gives rise to blood cells & endothelial cells. - Hematopoiesis occur at red bone marrow @medulla of long bones. - CD34 is marker of pluripotent stem cells (eg: HSC) - Stromal cells at BM secrete IL-7 - Phases of making blood cells: o Phase 1: At 1st trimester @yolk sac: blood islands o Phase 2: At 2nd trimester @liver: erythroid cells o Phase 3: At 3rd trimester @BM & Lymphatics: hemopoiesis & leukopoiesis - Phases of erythropoiesis: o Phase 1: ribosome synthesis = early erythroblast, late erythroblast o Phase 2: Hb accumulation = late erythroblast, normoblast o Phase 3: ejection of nucleus (ejected from normo —> reticulocyte) - What regulates erythropoiesis? EPO (erythropoietin) - Substrates of erythropoiesis? Fe, AA, B vitamins - Leukopoiesis: o Myeloid: eosinophils, neutrophils, basophils, monocytes o Lymphoid: T, B lymphocytes (regulated by IL & CSF secreted from macrophages & T cells) - Platelets: o Fragments of megakaryocytes o Stimulated by Thrombopoietin 8 Biochemistry 9 1-Heme Synthesis & its Associated Disorders 1- What molecular mechanism of anemia is caused by lead poisoning? (2019) a. Prevents binding of heme to globin b. Inhibition of porphobilinogen synthase c. Inhibition of ALA synthase d. Inhibition of urobilonogen synthase Answer B (PBG synthase is inhibited by lead/Pb) 2-.This diagram shows the sequence of steps in heme biosynthesis. What enzyme catalyzes the first step and what happens if this first step is bypassed?(19)(17) a. ALA Synthase; heme synthesis is suppressed b. ALA dehydratase: heme synthesis overproduction c. ALA Synthase; heme overproduction Answer C 3- The structure below has a therapeutic use for which condition?(18) a. Methemoglobinemia b. Sickle cell c. Porphyria d. Hemolytic anemia Answer C (The figure is hemin, which is used to treat porphyria) 4- Which enzyme is inhibited by lead (Pb2+) poisoning?(17) A. ALA synthase 10 B. Porphobilinogen synthase C. Hydroxymethylbilane synthase D. G6PD Answer B 5- What is the main cause of drug-induced acute hepatic porphyria?(17) A. Stimulate CYP450 activity and increase demand for heme B. Inhibits ALA Synthase Answer A (Drug taken —> Increased CYP —> increased heme demand) 6- what is the main cause of medication-induced acute hepatic porphyria?(16) a) it increases the demand of heme b) inhibit ALA synthase Answer A 7- what causes photosensitivity / light sensitivity? (answers were structures of the compounds and their names written under them)15 A) Portoporphyrin ix B) ALA Acid C) PBG D) Hydroxymethlbilane Answer A & D ((Check attached slide, what’s “photosensitive” ) 11 8- Schematically represented below is the mechanism of a drug used to relieve the symptoms of acute porphyria. What is the mechanism of the drug?(14) A) inhibits delta-ALA dehydratase B) inhibits hydroxymethylbilane synthase C) inhibits delta-ALA synthase D) inhibits feedback of ala synthase Answer C 9- Which enzyme is inhibited by lead toxicity?(14) A) ALA synthase B) hydroxymethylbilane synthase C) ALA dehydratase Answer C (Lead inhibits PBG synthase, which is also called ALA dehydratase) 10- What is the key regulator enzyme in heme synthesis? (13) -Ala synthase 11- What stimulates globin synthesis?(13) -Heme 12- Which malfunctioned protein is involved in x-linked sideroblastic anemia?(13) - Ala synthase 13- How can lead cause anemia?(12) - By inhibiting -aminolevulinic acid dehydrase 14- What is methemoglobin?(12) - Hemoglobin with Fe3+ in the heme 12 2. RBC Membrane & its Abnormalities 1- What happens to the RBC when intracellular Ca+2 increases?(2019) a. AE-1 activation b. Increases activity of flippase c. Increases activity of floppase d. Increases activity of scramblase Answer D 2- What is only found in the interior of the RBC?(2019) a. Phosphatidylcholine b. Sphingomyelin c. Phosphatidylserine d. Phosphatidylethanolamine Answer C (PS is found inside, if out of cell then that cell is damaged) 3- Phospholipase A2 from snake venom will cause damage to which of the following?(17) A. Cytoskeleton B. RBC plasma membrane C. Glycocalyx Answer B (PLA2 damages RBC membrane phospholipid) 4- Anchors spectrin dimers to RBC plasma membrane (17) A. AE1 B. 4.1 band C. 4.2 band D. Spectrin dimers E. GLUT-1 F. Flippase G. Scramblase H. Ankyrin 1 Answer A 5- ATP-dependent causing asymmetrical plasma membrane phospholipids (17) A. AE1 B. 4.1 band C. 4.2 band D. Spectrin dimers E. GLUT-1 F. Flippase G. Scramblase H. Ankyrin 1 Answer F 13 6- What is the most important thing for RBC to withstand mechanical sheer force when moving through small blood vessels?(16) a-Integral membrane protein noncovalent attachment to cytoskeleton 7- What membrane component helps bind red cell membrane to cytoskeleton?(16)(14) a- AE 1 b- nucleoside transporter c- glucose transporter d- glycophorin A Answer A 8- A characteristic component of “lipid raft” microdomain?(16)(15)(14) A-AE1 B-Glut1 C-ankyrin D-spectrin E-Sphingomyelin Answer E 9- an integral membrane protein that attaches the cytoskeleton to the RBC membrane?(16) A-AE1 B-Glut1 C-ankyrin D-spectrin Answer A 10- What is the most important thing for the RBCs to help withstand the mechanicalsheer force of moving through small blood vessels?(15) A) covalent linking between membrane lipids to integral proteins B) covalent linking of rafts to spectrin C) binding of cytoskeleton to hemoglobin D) binding of integral membrane proteins to cytoskeleton Answer D 11- What component if exposed on the outer aspect of the RBC will lead to the removal of the RBC from the circulation?(15) A) phosphatidylserine C) Ankyrin D) Spectrin E) Actin F) Phosphatidylcholine Answer A 14 12- What are rafts of lipid in red blood cells? What are lipid rafts?(14)(13)(12) A) Indication of cell death B) Areas of low lipid fluidity C) Lipid interactions with membrane proteins D) Lipid clusters with covalent bonds E) Area with excessive linking to carbohydrates Answer B (Characteristics of lipid rafts = sphingomyelin + low fluidity ) 13- Which of the following indicates that the cell is old or damaged when it is expressed?(14) A) Sphingomyelin B) Phosphatadylethanoamine C) Phophatadylserine Answer C 14- A dimerized molecule mainly responsible for cytoskeleton formation? (14) A) Ankyrin B) Spectrin C) Actin D) AE1 E) GLUT-1 Answer B 15- What is the most important thing for the RBC to withstand the mechanical sheer force of moving through small blood vessels? (What is present in the membrane in order to strengthen it?(14)(13)(12) A) Non-covalent bonds between integral membrane proteins and cytoskeleton 16- What’s forms the meshwork under the cytoplasmic face of the plasma membrane of the RBC?(13) -Spectrin 17- what moves phosphatidylserine from outside to inside face of membrane?(13) -Flippase 15 3. Structure & Function of Hb 1- The following figure demonstrates the reaction between hemoglobin and CO2, how does this affect hemoglobin? (19)(17) a. Decreases hemoglobin’s affinity to O2 b. Methemoglobin is produced c. CO2 binds to hemoglobin d. Hemoglobin tetramer dissociates Answer A 2- Which of the following is a positive homotropic allosteric effector to hemoglobin?(18) a. 2,3-bisphophoglycerate b. Carbon dioxide c. Oxygen d. NADH Answer C 3- Answer A 16 4- Histidine resides are substituted with serine in the gamma chain of fetal hemoglobin. What property of the hemoglobin is affected?(18) a. Binding to carbon dioxide b. Affinity to carbon monoxide c. Binding of 2,3-BPG Answer C 5- What causes the transition from R state to T state?(18) a. 3-phosphoglycerate b. Low PH c. High NAD+/NADH ratio d. H2O2 Answer B 6- Why are the oxygen saturation curve of hemoglobin and myoglobin different?(17) A. Cooperativity 7- What is true about o2 binding to hemoglobin?(15) A) Cooperativity is present, due to iron moving relative to the plane of heme 8- According to the figure below, what causes the shift of the hemoglobin curve to point A and point B? 17 Curve A Curve B A) Oxidation of Fe2+ to Fe+ Reduction of hemin toheme B) Low Ht Addition of 2.3BPG C) Binding of CO Dissociation of CO D) Increase in BPG Decrease in CO2 Answer B 9- Myoglobin and hemoglobin curve, why is it shaped the way it is?(15) A) Myoglobin has no cooperativity B) Myoglobin binds CO2 Hb doesn’t C) Myoglobin has Fe3+ iron but Hb doesn’t Answer A 10- Which of the following is the reason for the transport of oxygen from the maternal circulation to into the fetal circulation? (14)(2) A) because HbF doesn’t bind to 2,3BPG B) gamma chains bind oxygen more tightly than beta chains in acidic environment C) Gamma chains have a higher affinity to CO2 than beta chains Answer A 11- What shifts the hemoglobin curve to the right?(13) - A-High H+ and 2, 3-BPG 12- underneath a diagram of myoglobin and hemoglobin O2 saturation: What is the reason behind the difference in binding affinities for O2 in myoglobin and hemoglobin? (13) a) Myoglobin has Fe3+, hemoglobin has Fe2+ b) Myoglobin is a monomer, hemoglobin is tetramer c) Myoglobin carries co2, HB does not d) Myoglobin takes glucose, HB does not Answer B 18 13- What causes the shift of the hemoglobin saturation curve from 1 to 5?(12) - Acidification 14- Which molecule links glucose metabolism with hemoglobin affinity for oxygen?(12) - 2, 3-bisphosphoglycerate 15- What best describes the difference between these two figures?(12) A) A is Fe3+, B is Fe2+ B) A is deoxyhemoglobin, B is oxyhemoglobin C) A has higher affinity to oxygen, B has a lower affinity Answer B 16- What causes the release of O2 from Hb to peripheral tissue? a. Acidification b. Biconcave shape of RBCs Answer A 17- What is true about a child with mutation in in this hemoglobin that replaces all beta chains with gamma chains? a. higher affinity to 2,3-BPG 19  b. higher affinity to oxygen Answer B (fetal hemoglobin HbF has 2 gamma chains, and we know that fetal Hb has higher affinity to O2 bcz of theses gamma chains this is why O2 can be transported from the mothers circulation to the fetus) 18- What causes the iron to shift from position a to position b? a) increase in PH b) binding to O2 c) binding to CO2 d) oxidation of Fe2 to Fe3 e) reduction of methemoglobin Answer B 20 4. Glucose Metabolism 1- Mediterranean variant of glucose-6-phosphate dehydrogenase has < 5% of the activity of normal enzyme. What is the consequence of this defect? (2019) a. inability heme synthesis b. methemoglobinemia c. Erythropoietic protoporphyria d. shorter erythrocytic lifespan Answer D (Note: @mountain (above sea level): mutase activated & phosphatase inhibited Vs @ sea level: mutase inhibited & phoshatase activated ) 2- What enzyme activity in the diagram is required to restore oxygen affinity to haemoglobin to its normal levels if someone starts living on sea level after living in high altitudes in the mountain?(19) a. 2,3 Bisphosphoglycerate phosphatase b. 3-Phosphoglycerate kinase c. Bisphosphoglycerate mutase d. Pyruvate kinase Answer A 3- inability to produce which reaction leads to the formation of Heinz bodies in a patient with G6PD deficiency?(18) a. GSSG to 2GSH b. NAD to NADH c. Pyruvate to Lactate Answer A 4- Inavailability of LDH would inhibit the activity of what enzyme on the glycolysis process in erythrocytes? a. Aldolase b. Glyceraldehyde-3-phosphate c. Phosphoglycerate kinase d. Phosphoglycerate mutase Answer B 5- For what disorder is methylene blue medication used for and what enzyme is involved?(17) A. Methemoglobinemia ; NADPH-dependent methemoglobin reductase 6- Shown below the mechanism of detoxification of hydrogen peroxide in erythrocytes. What are X and Y, and what is the cause of favism?(16)(13) 21 a- X=ADP, Y=ATP; inhibition of G6PD b- X=GSH, Y= GSSG; GSH oxidation c- X= GSSG, Y=GSH; inhibition of GSH-peroxidase d- X=NADH, Y= NAD+; oxidation of NADH Answer B 7- Below shows u the pathway of glycolysis in Erythrocytes. If Someone is living on high altitudes on the mountains, which enzyme has to be activated to compensate his status?(16) a- 2,3 Biphosphoglycerate phosphatase b- 3-Phosphoglycerate kinase c- 2,3 Biphosphoglycerate mutase d- Pyruvate kinase Answer C 8- How does methylene blue reduce methemoglobin?(16)(15) a- by NADPH-dependent methemoglobin reductase b- by Cytochrome B5 NADH dependent methemoglobin reductase Answer A 9- High demand of these compounds the reason behind hemolytic crisis in patients with G6PD deficiency, when facing great oxidative stress?(14) A) Low amounts of GSH and NADPH 10- Presence of this in low concentrations helps in the protection against malaria/limiting malaria effect (14) A) NAD+ B) G6PD 22 C) NADPH Answer C 11- What is the importance of the presence of NADH generated from glycolysis in erythrocytes?(14) A) Reduction of methemoglobin B) To produce ATP through oxidative phosphorylation Answer A 12- A patient went to Africa and was given antimalarial prophylaxis. What problem would you expect in this patient?(14) A) RBC enzyme deficiency 13- Which cofactor will be affected if there is deficiency in lactase dehydrogenase? (13) check salman a) NAP+ b) NAD+ Answer B 14- What results from the inactivation of the pentose phosphate pathway?(12) - Oxidative damage 15-Methylene blue is used in the treatment of a blood disorder. What is the disorder and what is the enzyme involved?(19) a. Coptoprotoporphyrin, Uro III syntahse b. Methoglobinemia, NADPH dependent enzyme c. Sickle cell, HbS reductade d. Hemolytic anemia, G6PD Answer B (Methylene blue – NADPH dependent) Straight forward,this explanation for thoses who want to know why NADPH and not NADH. NADPH is correct bcz those who have methoglobinemia have defective NADH this is why they developed methoglobinemia so if we want to treat it we should give a drug that targets another enzyme which is NADPH 23 LT: Molecular Diagnosis of CML 1- Which of the following fusion protein will result in CML (19)(15) a. P190 b. P210 c. P230 Answer B 2- Which of the following has the lowest frequency of Philadelphia chromosome?(19)(15) A) child ALL B) adult ALL C) CML D) AML Answer D 3- What is the function of ABL gene?(14) A) Tumor suppressor gene B) protooncogene C) oncogene D) oncosuppressor gene Answer B 4- What is the pathogenicity of BCR-ABL fusion protein?(14) A) tyrosine kinase activation 5- What is the protein that result from the translocation of chromosomes (9:22) and mostly associated with CML?(14) A) P210 B) P190 C) P200 Answer A 6- What is the size of the t (9:22) chromosome in CML? (13) a) P190 b) P210 c) P200 Answer B 7- What type of mutation is expressed in the following picture? (13) a) Deletion b) Inversion c) Translocation 24 d) Duplication Answer C 8- What is the consequence of the BCR-ABL translocation?(12) - Makes the cells more sensitive to growth factors 25 MICROBIOLOGY 26 1- Hypersensitive Cytotoxic rxn to RBCs 1- An 18-year-old young man, following a car accident was brought to the emergency department. He received a blood transfusion of packed RBCs. Thirty minutes following the transfusion he starts having shivering, fever, loin pain. The nurse stops the transfusion and sends a new blood sample to the lab. In the lab, a direct anti globulin (coomb’s) test is done. What does this test detect?(2019) a. Sensitized RBC in patient blood b. HLA antibodies c. Autoimmune hemolysis d. Allo antibodies in patient serum e. Platelet antibodies Answer A 2- What is the characteristic of hemolytic anemia of a newborn?(18) a. The maternal RBCs are damaged due to the activation of the complement system b. The first 2 babies usually escape the hemolysis c. The first Rh- negative baby and Rh-negative father sensitize the mother d. Anti Rh antibody develop after 2 weeks Answer D 3- Drug-induced hemolytic anemia is caused by penicillin. What is the mechanism of action for this?(17) A. Production of IgE B. Production of IgM and IgG C. Activation of cytotoxic T cell D. Production of Th1 Answer B 4- What hypersensitivity reaction best describes RBC hemolysis?(17) A. Anaphylactic B. Cytotoxic C. Immune complex D. Delayed Answer B 5- Why is the fetus not affected in the first pregregnancy in terms of hemolytic disease of the newborn?(17) A. Mother predominantly produces anti-Rh IgM B. Rh D is not that immunogenic Answer A 6- What is the reason for the production of alloantibodies in hemolytic disease of the newborn?(17) A. Exposure to foreign Rh+ RBCs 27 7- Which of the following is responsible for hemolysis of RBCs in auto immune haemolytic anemia?(16) a) Cytotoxic T-cells b) Neutrophils c) TNF d) Perforins Answer B 8- What induces hypersensitivity cytotoxicity towards RBCs?(15) A) drugs adsorbed to rbcs 9- In hypersensitivity type II, which of these mechanisms results in RBCs destruction?(15) A) ADCC B) Major cationic proteins C) Perforin D) Phagocytosis Answer A 10- Which of the following immunoglobulins results in hemorrhagic disease of the newborn?(15) A) IgG B) IgA C) IgM D) IgE Answer A 11- Which of these can cause a hypersensitivity reaction?(14) A) Drugs absorbed onto cell membrane 12- Which of the following is responsible for hemolysis of RBCs in auto immune haemolytic anemia? (13) a) T cytotoxic cells b) Neutrophils c) TNF d) Perforins Answer B 13- What causes Type II hypersensitivity?(13) a) Drugs absorbed into RBC membrane b) Allergen Answer A 14- Which of the following will most likely result in an anaphylactic reaction?(17) A. Donor’s IgA antibodies 28 B. IgA deficient recipient Answer B ( this Q is form the Lt) 15- What Rh antibodies should be present for mother and fetus for it to be maybe lethal on the fetus? A. Mom: Rh positive, baby: Rh positive B. Mom: Rh Negative, baby: Rh negative C. Mom: Rh positive, baby: Rh negative D. Mom: Rh negative, baby: Rh positive Answer D 16- What factors are involved in a cytotoxic hypersensitivity reaction type II targeting RBCs? A. Antigens, cytokines, and complement B. Antigen-antibody complexes, neutrophils C. Antigens, CD8 T lymphocytes & macrophages D. Antigens, IgG and complement E. Antigens, macrophages & complement Answer E 17- When do you administer anti Rh immunoglobulins to a mother A. After 3 days B. After 1 day C. After 7 days D. after 30 days E. after 60 days Answer A 18- Function of Th17 A. inflammation 29 2- Function of Granulocytes 1- what receptor on the granulocytes facilitate the process of phagocytosis?(18) a. Fc receptor b. Lactoferrin receptor c. Complement receptor d. Cytotoxic receptor Answer A 2- What is involved in respiratory burst? (18) a. Reactive oxygen mediators 3- How does eosinophils kill bacteria?(18) a. Phagocytosis followed by digestion b. Opsonization by antibodies c. Granuloma formation d. Cytotoxicity Answer D 4- Which antibody stimulates mast cell degranulation?(17) A. IgM B. IgA C. IgE D. IgD Answer C 5- What toxic substances are released during respiratory burst?(17) A. H2O2 B. Defensins C. Lysozymes D. CO2 Answer A 6- Which of the following is released during degranulation of neutrophils?(17) A. Major basic protein B. Cationic protein C. Defensins D. Heparin Answer C 7- What chemotactically attracts neutrophils?(17) A. Lysozymes 30 B. Cationic protein C. Complement fragments D. Viral components Answer C 8- How do eosinophils kill worms?(17)(16) A. Cytotoxicity B. Phagocytosis C. Complements D. Opsonization Answer A A-IgE B-complement C- IFN gamma D-TNF alfa E-granzymes F- lysozyme G-Perforin H- cationic protein 9a) An antibacterial factor found in neutrophilic granules (16) 9b) An anti-bacterial factor present in eosinophilic granules (EMQ) Answer 9a) F 9b) H 10- An azurophilic cell that is involved in allergic reactions?(16) a- Basophils b- Eosinophils c- Neutrophils d- Macrophages e- T lymphocytes Answer B 11- which of the following is an anti-bacterial material present in eosinophils?(15) A) major basic protein and cationic protein B) lysozymes C) defensins D) granzymes E) perforins Answer A 12- which of the following is present in neutrophilic granules?(15) A) major basic protein and cationic protein B) lysozymes 31 C) defensins D) granzymes E) perforins Answer B & C 13- Which molecule chemotactically attracts neutrophils to sites of inflammation?(15) A) Complement fragments B) Immunoglobulins D) Fc receptors E) Defensins Answer A 14- What do eosinophils secrete during respiratory burst?(15) - reactive oxidative intermediates 15- Which of the following substances is present in the granules of eosinophils? (14) A) Lysozyme B) Major basic protein C) Defensins Answer B 16- Which of the following antibacterial substance is found in neutrophils granules? (14) A) Lysozymes B) Granzymes C) Perforin D) major basic protein Answer A 17- Which of the following is a professional cell with MHC II and antigen presentation?(14) A) Neutrophils B) Macrophages C) T helper cell D) T cytotoxic cell Answer B 18- A cell with abundant azurophillic granules and involved in allergies? (13) a) Eosinophils (both choices were in the exam & this one was counted correct) b) Basophils Answer A 19- What is used by granulocytes to opsonize bacteria?(13) Fc receptors 32 20- What is the mechanism of eosinophils in killing pathogens?(13) - Cytotoxicity 21- Which of the following is an antibacterial substance found in neutrophilic granules?(12) - Lactoferrin 22- Which of the following is an antibacterial substance found in eosinophilic granules?(12) A- Major basic protein and Cationic protein 23- What is an anti-bacterial peptide released by neutrophils?(12) - Defensins 24- What is used by granulocytes to opsonize bacteria?(12) - Fc receptors What are defensins? (20) A. Osponin B. Anti-microbial peptides C. Chemotxis produced by eosinophils Answer B (Defensins: Small anti-bacterial peptides) 33 3- Lymphopoiesis & their function 1- What causes apoptosis in viral-infected cells by cytotoxic cell?(18) a. T-cell receptor b. Complement c. Granzyme d. CD 8 molecule Answer C 2- what is the difference between Th1 & Th2 Lymphocytes?(18) a. Th1& Th2 Lymphocytes can be distinguished based on morphology & structure b. Th2 is cytotoxic, Th1 is not c. Th2 mainly in secondary lymphoid organ , Th1 in mucosal surface d. Th2 help in humoral immunity, Th1 in cell mediated immunity Answer D 3- what can produce a cell that induces ab production? (Something like that)(18) a. Th2 b. Th1 c. T reg cell d. hematopoiesis stem cell Answer A 4- What is the function of Treg cells?(17) A. Cytotoxic killing of tumor cells B. Activation of B cells C. Suppress immune reaction D. Recruit neutrophils to enhance inflammation Answer C 5- Where do T lymphoblasts mature?(17) A. Bone marrow B. Lymph nodes C. Thymus D. Blood Answer C 6- How Tc cells kill tumor cells?(17) A. Apoptosis 7- Which of the following molecules is used by granulocytes to opsonize pathogens?(16) A) Adhesion molecules 34 B) Fc receptors C) complement D) Defensins Answer B 8- Which of the following produce cytokines?(16) a-Eosinophils and neutrophils b- Basophils and neutrophils c- Megakaryocytes and B cells d- Macrophages and T cells Answer D 9- How do cytotoxic T cells identify viral antigens? (wrong format sorry) (16) a- With MHC class 1 molecules b- With MHC class 2 molecules c- CD8 d- CD4 Answer A 10- T-cells that recognize self-antigen presented on MHC are eliminated by a process called:(16) a) negative selection b) positive selection c) T Cell activation d) T cell suppression e) T cell differentiation) Answer A 11- Which of the following is responsible for T cell death upon its presentation to a self- antigen?(15) A) Negative selection B) Positive selection C) ADCC Answer A 12- Where does Maturation of T-cell lymphocytes occur?(14)(13) A) Bone marrow B) Thymus C) Spleen D) Lymph nodes Answer B 13- By which process are the T lymphocytes that bind to self-MHC eliminated? (14)(13) A) Positive selection 35 B) Negative selection C) T cell differentiation D) T cell suppression E) T cell activation Answer B 14- Which of the following expresses CD3 and either CD4 or CD 8?(14) A)T-Lymphocytes B) T-helper Lymphocytes C) T-Cytotoxic Lymphocytes D) B-Lymphocytes Answer A 15- Where are self-reactive B cells deleted?(17) A. Bone marrow B. Liver C. Spleen D. Lymph nodes Answer A 16- What is the progenitor of antibody producing cells A) promyeloblast B) prolymphoblast C) promegakarioblast D) promonoblast Answer: B 36 LT: Viruses associated with blood system 1- which target cells are mainly infected by HIV?(18) a. Erythrocyte b. Monocyte c. CD4+ T lymphocyte d. B lymphocyte Answer C 2- Parvovirus B19 infects which cells?(17) A. Erythroid precursors B. B lymphocytes C. Myeloblasts D. Neutrophils Answer A 3- What is the most common cause of Infectious Mononucleosis?(17) A. HTLV I B. EBV C. HIV D. Parvovirus B19 Answer B 4- Erythema infectiosum (17) A. Measles B. CMV C. HIV D. HTLV I E. EBV F. Parvovirus B19 Answer F 5- Tropical spastic paraparesis (17) A. Measles B. CMV C. HIV D. HTLV I E. EBV F. Parvovirus B19 Answer D 6- What virus is associated with tropical spastic paresis?(16) 37  a-HTLV-1 b-HTLV-2 c-CMV d-Parvovirus e-EBV Answer A 7- 21-year-old woman with low grade fever, sore throat, difficulty swallowing, general malaise and atypical mononuclear cell. What is the causative agent?(16) a) Hemophilus influenza b) Epstein Barr virus c) parvovirus B19 d) Adenovirus Answer B 8- A patient came to your presenting with bilateral lymphadenopathy in the neck, upon biopsy of the Lymph node binucleated cells were present surrounded by a polycellular environment, what organism most likely caused this disorder?(14) A) HIV B) Hepatitis C C) EBV D) HTLV-1 Answer C 9- An elderly patient with lymphoma (lymphadenopathy), cytogenetic tests found a translocation t(8:14). What is most likely the causative agent?(14) A) EBV 10- Which cell type is deficient in HIV?(14)(13) A) B-lymphocytes B) T cytotoxic cells C) T helper cells Answer C 11- A 23-year-old male presented with sore throat, fever, and atypical lymphocytes (mononucleosis). What’s the organism causing this condition?(14)(13) A) EBV 12- A Chinese baby with nasopharyngeal carcinoma?(14) A) EBV 13- A patient came to your clinic complaining of cervical lymphadenopathy, upon biopsy of the lymph node you found nodular pattern, what organism most likely caused this disorder?(13) 38 a) HIV b) Hepatitis C c) EBV d) HTLV-1 Answer C 14- Tropical spastic paraparesis is caused by? (14)(13) -HTLV-1 15- A 25 year old female presenting with weight loss and fever , radiological indications show mediastinal lymph node enlargement, lymph node biopsy shows nodular pattern , large binucleated cells what do you expect is expressed on these large cells (20) A. EBV antigen B. CD3 C. BCL2 D. CD20 E. Tdt Answer A 39 Pharmacology 40 1- Drugs used in Thromboembolic Disorders 1- What is the advantage of alteplase preferentially binding to fibrin bound plasminogen?(2019) a. decreased clearance b. increased renal clearance c. does not activate/reduces systemic fibrinolysis side effects Answer C 2- A male patient was on an oral anticoagulant, which resulted in bleeding but the bleeding couldn’t not be stopped with vitamin k or protamine sulphate, what was the anticoagulant that the patient was taking?(2019) a. Heparin b. Warfarin c. Dabigatran d. Enoxaparine Answer C 3- What is the mechanism of action of heparin?(18)(14)(13)(12) a. direct inhibitor of factor 10A b. increases activity of antithrombin III c. direct inhibitor of thrombin Answer B 4- Heparin acts on which molecule to carry out its effect?(17) A. Antithrombin III B. Topoisomerase II Answer A 5- Act on both free and fibrin-bound plasminogen (17) A. Alteplase B. Warfarin C. Heparin D. Enoxaparin E. Streptokinase F. Clopidogrel Answer E 6- Irreversibly inhibits ADP dependent pathway of platelets aggregation (17)(15)(14) A. Alteplase B. Warfarin C. Heparin D. Enoxaparin 41 E. Streptokinase F. Clopidogrel Answer E 7- which substances promote platelet aggregation? (16) A- serotonin and v factor B- Thromboxane a2 and ADP C- protein C and protein S D- Antithrombin and a2-antiplasmin E- vWF and growth factors Answer B 8- Why is tPA is less likely to cause systemic adverse effects when given as a drug? (16) a- it has a short half life b- it is an endogenous protease c- preferentially activates fibrin bound plasminogen d- selectively inhibits the conversion of fibrinogen to fibrin e- it is less potent than urokinase and streptokinase Answer C 9- Which inhibits ADP receptor?(16) a) Aspirin b) Warfarin c) Heparin d) Enoxaparin e) Ticlopidine Answer E 10- Which of the following is an oral anticoagulant with rapid action but short half-life?(15) A) Heparin B) Otamixaban Answer B 11- What is the mechanism of action of heparin?(15) A) direct inhibitor of factor 10A B) increases activity of antithrombin III C) direct inhibitor of thrombin Answer B 12- A patient was given an oral anticoagulant and had bleeding that was not stopped by the administration of protamine sulfate or vitamin k supplements, which drug was administered? (14) A) Rivaroxaban 42 B) Warfarin C) Heparin D) Enoxaparin E) Otamixaban Answer A 13- Which of the following is direct factor Xa inhibitor?(14) A) Otamixaban B) Dabigatran Answer A 14- Which of the following act as a direct inhibitor of thrombin?(14) A) otaxixaban B) dabigatran C) fondapirux Answer B 15- which drug is a specific, direct inhibitor of factor 10, has a rapid onset of action but has a short half- life?(13) A) amixaban 16- Aspirin is given in low doses to prevent thrombosis. What is the mechanism of action of aspirin?(12) A) Inhibits platelets cyclooxygenase 17- What substances are secreted from platelets to enhance aggregation? A) Thromboxane A2 and ADP B) von willbrand factor Answer A 18- What does the anticoagulant effect of heparin is dependent on? a. GpIIa/IIIb b. Factor Xa c. Fibrin d. Antithrombin III Answer D (Straight forward, heparin increases the activity of antithrombin III, which is responsible for inactivating clotting factors IX, X, XI, XII,XIII, as well as Thrombin lla) 43 2- Treatment of Hematological Malignancies 1- What is administered to a cancer patient that takes methotrexate to prevent myelosuppression and mucositis? (2019) a. Asparaginase b. Imatinib c. Leucovorin d. 5-flurouracil Answer C 2- which anticancer drug inhibits ribonucloetide reductase?(18) a. Hydroxyurea b. 5 flurouracil c. 6 mercaptopurine d. Methotrexate Answer A 3- Which sign will remain unchanged after folate supplementation?(18) a. Anemia b. Leukopenia c. Thromocytopenia d. Acidurea e. Homocysteinemia Answer D 4- Which of the following is true about alkylating antineoplastic drugs?(17) A. Directly damage DNA via crosslinking B. Cell cycle specific C. Does not cause myelosuppression D. Does not cause secondary cancers Answer A 5- What is the mechanism of action of hydroxyurea in treating sickle cell anemia?(17) A. Increases polymerization of Hb S B. Decreases amount of circulating Hb S Answer B 6- Drug used to prevent myelosuppression and mucositis during antimetabolite treatment (17)(15) A. Busulfan B. Imatinib C. Leucovorin 44 D. Doxorubicin E. Cyclophosphamide Answer C 7- Adverse effect is cardiotoxicity (17) A. Busulfan B. Imatinib C. Leucovorin D. Doxorubicin E. Cyclophosphamide Answer D 8- Tyrosine kinase inhibitor (17)(15)(13) A. Busulfan B. Imatinib C. Leucovorin D. Doxorubicin E. Cyclophosphamide Answer B 9- Which of the following anticancer drugs could cause pulmonary fibrosis as a side effect?(16) a- busulfan b- topotecan c- vincristine Answer A 10- What is a general characteristic of alkylating antineoplastic drug?(16)(15)(14) A) Cross link DNA B) Does not cause secondary cancer C) Does not cause bone marrow suppression D) Cell cycle specific Answer A 11- Cumulative dose of this drug causes cardiomyopathy? C (16) 48a) which drug is a tyrosine kinase inhibitor? a- imatinib b- cyclophosphamide c- doxorubicin d- mercaptopurine e- Methotrexate f- Fluorouracil Answer A 45 12- which drug causes neurotoxicity? a- imatinib b- cyclophosphamide c- doxorubicin d- mercaptopurine e- Methotrexate f- Fluorouracil Answer E 13- What is treated by tyrosine kinase inhibitor? (16) a- acute myeloid leukemia b- acute myeloid leukemia c- chronic myeloid leukemia d-Megaloblastic leukemia e-myelodysplastic syndrome f- acute lymphoblastic leukemia g- chronic lymphocytic leukemia Answer C 14- Which of the following is a folate antagonist?(15) A) Methotrexate B) leucovorin Answer A 15- Which drug may lead to hemorrhagic cystitis?(14) A) Cyclophosphamide 16- Which of the following anti-neoplastic drugs is an anti-folate agent? (13) a) amatinib b) 6-MP c) Methotrexate d) 5-flurouracil Answer C 17- What is the general characteristics of alkylating agents?(13) -Act on proliferating and non-proliferating cells 18- Which drug removes the mucositis and myelosuppression associated with antineoplastic antimetabolites toxicities? a) Otamixaban b) Aspirin c) Streptokinase d) Leuvocorin Answer D 46 19- What is the drug that prevents the secretion of thromboxanses? a) Otamixaban b) Aspirin c) Streptokinase d) Leuvocorin Answer B 20- Which drug causes hepatic fibrosis and pneumonitis? a. methotrexate b. cyclosporin a Answer A 21- Which of the following is a pyrimidine analogue? A. methotrexate B. 5-FU Answer B 22- What is the drug used to treat chronic granulocytic anemia and may cause fatal pulmonary fibrosis in high doses? A. Busulfan B. 5-flouracil C. 6-mercaptourine D. hydroxyurea E. methotrexate Answer A 47 Physiology 48 1- Role of Vit. B12, Folate, & Iron in Erythropoiesis 1- What does an increase in the expression of hepcidin in mice cause?(2019) a. iron overload b. stunted growth c. macrocytic anaemia d. polycythemia Answer B 2- Secretion of which hormone is elevated in a female who is 55 years old with microcytic anaemia after long term treatment with non-steroidal anti-inflammatory drugs?(2019) a. Aldosterone b. Cortisol c. Erythropoietin d. Hepcidin e. Thyroxin Answer C or DD 3- Which enzyme produces succinyl coA?(2019) a. Methionine b. Dihydrofolate reductase c. Thiopurine methyltransferase d. Methymalonyl coA mutase Answer D 4- increased plasma level of which protein causes iron overload?(18) a. Erythroferrone b. Erythrpoietin c. Hepcidn d. s-HJ Answer D 5- What inhibits hepcidin synthesis in response to renal hypoxia?(17) A. Erythroferrone B. Erythropoietin C. HJV D. BMP Answer A 6- What may result if hemojuvelin is mutated and nonfunctional? A. Anemia B. Hypoferremia 49 C. Hemochromatosis D. Hepcidin synthesis will increase Answer C 7- Which of the following protects cobalamin while in the stomach?(17) A. Transcobalamin I B. Cubilin C. Haptocorrin D. Intrinsic Factor Answer C 8- Which of the following transports iron into the blood?(17) A) Ferroportin 9- Iron storage molecule that stains with Prussian Blue stain (17) A. Ferroportin B. Transferrin C. Transcobalamin II D. Cubilin E. Hemosiderin Answer E 10- Transports iron out of duodenal enterocytes (17) A. Ferroportin B. Transferrin C. Transcobalamin II D. Cubilin E. Hemosiderin Answer A 11- what binds to Vitamin B12 in the duodenum?(15) A) haptorcorrin B) gastric intrinsic factor C) hepcidin D) food protein Answer B 12- what protects vitamin B12 from denaturation in the stomach?(15) A) haptocorrin B) gastric intrinsic factor D) hepcidin E) food protein 50 Answer A 13- What protects vitamin B12 from denaturation in the stomach? (20) a) Cubulin b) Gastric intrinsic factor c) Amnionless d) Corrin e) Transcobalamin II f) Haptocorrin Answer F 14- What binds to b12 in the duodenum? (20) a) Cubulin b) Gastric intrinsic factor c) Amnionless d) Corrin e) Transcobalamin II f) Haptocorrin Answer B 15- What protects vitamin B12 from degradation in stomach? (20) a. Haptocorrin b. IF c. Cubulin d. Transcobulamin Answer A (The answer is not IF bcz B12 bind to IF in the small intestine not stomach) 51 Nuclear Medicine 52 Nuclear 1- Which of the following indicates Pernicious anaemia in schilling test?(2019) a. Normal phase 1 abnormal phase 2 b. Abnormal phase 1 normal phase 2 c. Abnormal phase 1 and 2 d. Normal phase 1 and 2 Answer AA or B 2- What is the importance of 18F FDG in PET/CT?(2019) a. management of lymphoma b. bone marrow imaging c. erythrokinetcs Answer A 3- In Erythrocyte kinetics studies which guide decision of splenectomy?(2019) a. Pernicious anaemia b. Aplastic anaemia c. Haemolytic anaemia d. Sickle cell anaemia Answer C 4- What is the method that is used in measuring the blood mass ? A- dilution method B- uptake method C- clearance method Answer A 53  PATHOLOGY After each week there will be Qs labelled as “others” bcz they could be from more than 1 note 54 1- Iron & Anemia of Chronic Inflammation-week 1 1- a 13 y/o girl starts menstruating, her cycle is regular but her bleeding is increased. If her menorrhagia is uncontrolled, she is suspected to develop anaemia. What's the earliest sign of this anaemia?(2019) a. low serum iron b. low ferritin c. high TIBC d. low transferrin saturation Answer B 2- 70-year male with iron deficiency anaemia found fresh blood in his stool. What is the reason for his anaemia?(2019) a. malabsorption b. decrease intake c. peptic/ duodenum ulcer d. colon cancer Answer D (Blood @ stool = cancer,,,, dark stool = ulcers) 3- 40yr female presented w/pallor & fatigue(2018) Laboratory investigations: Hb= 79 (low) MCV= 70 (low) MHC= 22 (low) MCHC= 31.4 (low) RDW= 20 (high) WBC normal PLT normal Blood film: Pencil cell & target cell Serum iron (low) TIBC (high) Soluble transferrin receptor (increase) What is the diagnosis? a. Megaloblastic anemia b. Iron deficiency anemia c. Anemia of chronic disease d. Aplastic anemia Answer B 4- In the previous question (13) what would be the best test to confirm the diagnosis.(2018) a. Serum vit B12 b. Colonoscopy and gastroscopy c. Abdominal ultrasound d. Bone marrow examination Answer B [to check for bleeding from GI tract > leads to IDA] 55 5- Lab investigations show: Serum ferritin: increased Serum iron: increased TIBC: decreased Transferrin saturation %: increased What is the most probable diagnosis?(2018) a. Sideroblastic anemia b. Anemia of chronic disease c. Thalassemia d. Iron deficiency anemia Answer A 6- Which of the following is a feature of lead poisoning?(2018) a. Diarrhoea b. Macrocytic anemia c. RBC basophilic stippling d. Normocytic anemia Answer C (bcz lead poisoning can cause microcystic anemia remember causes of microcytic anaemia is TAILS: T - Thalassemia, A - Anaemia of chronic disease, I - Iron deficiency anaemia, L - Lead toxicity associated anaemia, S - Sideroblastic anaemia). 7- microcytic anemia was diagnosed in a patient with chronic kidney disease. what hormone secretion is elevated in this patient?(18) a. Cortisol b. Erythropoietin c. Erythroferrone d. Hepcidin e. Thyroxine Answer D 8- Patient present with worm infection that leads to blood loss. Also presents with low hemoglobin, low MCV, pencil cells, and target cells. What would most likely be seen in this patient’s iron profile?(17) A. Normal serum iron, normal serum ferritin, normal TIBC B. High serum iron, low serum ferritin, low TIBC C. Low serum iron, low serum ferritin, high TIBC D. Low serum iron, low serum ferritin, low TIBC Answer C 9- Patient has rheumatoid arthritis with lab tests of high serum ferritin, what is the diagnosis?(16) a- Anemia of chronic disease b- iron deficiency anemia c- thalassemia Answer A 56 10- The first sign of iron deficiency anemia:(16) A- increase TIBC B-decrease serum iron C-decrease serum ferritin D-decrease transferrin saturation E-microcytic hypo-chromic anemia Answer C 11- 35-year-old woman underwent gastric sleeve operation for morbid obesity one year ago. She was referred to you complaining of shortness of breath on exertion, easy fatiguability, and bleeding. What is the mechanism explanation of the complaints?(16) A) hemolysis B) autoantibodies against gastric intrinsic factors C) defect primary hemostasis D) distributed iron body cycle Answer D 12- Suppression of which hormone will help in the treatment of microcytic anemia in patents with rheumatoid arthritis?(15) A) Hepicidin B) Erythropoietin Answer ?? 13- what would be the strongest evidence to suggest iron deficiency anemia?(15) A) Low transferrin saturation B) Low hemosidren C) Low serum iron Answer A 14- There are few different markers that we use in the clinic to assist our differential to microcytic anemia. Which of the following types would have a reduced ferritin level? (15) A) Iron deficiency anemia B) Anemia of chronic disease C) Sideroblastic anemia D) Thalassemia E) Myelodysplasia Answer A 15- A 29-year-old female who suffers from easy fatigability and can't perform her daily tasks visited a clinic. Upon examination, her Hemoglobin level was found to be 50g/L and a hookworm infestation was positive in her stool. What is the best treatment method assuming we gave her the needed medication for her helminthic (parasitic) infection?(14) A) Two units of packed cells 57 B) intensive iron therapy C) vitamin b12 therapy D) vitamin k therapy Answer ?? 16- A 16-year-old girl was brought to the hospital by her mother saying that he daughter is suffering from fatigue and tiredness. Upon asking her the doctor discovered that the girl has been experiencing irregular periods and menorrhagia. What is the cause of her problem?(14) A) iron deficiency anemia 17- A girl passing dark urine diagnosed w/ occult blood in stool blood smear shows pencil cells and target cells, what are the expected results?(13) a) Serum iron ⬇ , Serum ferritin ⬇ , TIBC ⬆ b) Serum iron⬇ , Serum ferritin⬇ , TIBC ⬇ Answer A 18- Antibodies against which cytokine could be most likely helpful in anemia of chronic disease?(13) a) IL-1 b) IL-6 c) IL-10 d) Interferon Answer B 19- A female had gastric sleeve surgery experienced fatigue and weight loss. What is the cause?(13) a) BM suppression b) Disturbed iron cycle c) Auto-antibodies against intrinsic factors Answer B 20- Which of the following is an iron storage form found in all cells?(12) - Ferritin 21- A person had a car accident and started bleeding. His hemoglobin was 50g/l, then 2 packs of packed RBCs were transfused. what is his hemoglobin following the transfusion? A) 55 g/l B) 70, g/l C) 100 g/l D) 60 g/l Answer B (1 unit —> 10 g) 58 22- A girl stopped eating iron-containing food, what is the earliest sign seen in tests(20) A. low serum iron B. low ferritin C. high transferrin D. low transferrin saturation Answer B 23- laboratory tests of a patient shows low mcv, high ferritin, low transferrin sat(20) a. ida b. thalassemia c. hemoglobinopathies d. inflammation e. chronic blood loss Answer D When you see low MCV , thing about IDA, ACD, sidroblastic anemia, thalassemia, MDS Now they talk about ferritin , so think about only two things (IDA, ACD) As they said that ferritin is high , so ACD 24- Where is most non-heme iron found ? (20) a. Bound to transferrin b. Bound to RBCS c. Stored in liver d. Bound to IF e. Free in plasma Answer A 59 2- Megaloblastic Anemia-week 1 1- A patient with a history of gastrectomy had his CBC checked, MCV was high, while his platelets, wbc, and HB were low. What is the diagnosis?(2019) a. Aplastic Anemia b. Liver Disease c. Pernicious Anemia d. Hypothyroidism e. Megalobastic Anemia Answer E 2- Patient has low RBC count, high MCV, high homocysteine levels, and normal methylmalonic acid levels. There are no signs of neurological symptoms. What is the most likely diagnosis?(17) A. Vitamin B12 deficiency B. Folate deficiency C. Iron deficiency anemia D. Thalassemia Answer B 3- Folate deficiency during pregnancy can cause(16) a) Hemolytic anemia b) Neural tube defect c) Phocomelia d) Duodenal atresia e) Hemolytic disease of the new born Answer B 4- 30-year-old women experiences weakness and fatigue. Her CBC showed low hemoglobin, low platelet, low WBC, and low reticulocytes. Patient did not show hepatosplenomegaly nor lymphadenopathy. Peripheral blood smear examination showed macrocytic RBCs with hyper segmented neutrophils. What is the diagnosis?(16) a) aplastic anemia b) hyperthyroidism c) megaloblastic anemia d) MDS e) liver disease Answer C 5- Pernicious anemia is due to the production of antibodies that lead to the immune destruction of which of the following?(14) A) Parietal cells B) haptocorin C) cobulin 60 Answer A 6- What would be increased in a patient who developed megaloblastic anemia after gastrectomy?(13)(12) a) Methylmalonic acid Transcobalamin III (aka intrinsic factor) is secreted from stomach, i.e. gastrectomy —> decreased IF —> decreased absorption of B12 —> decreased methylmalonyl-CoA mutase rxn —> increased methylmalonyl-CoA & decreased succinyl-CoA 7- A patient with antibodies against parietal cells and intrinsic factor and macrocytic anemia, what condition does he have? (19) a. pernicious anemia 8- Folate deficiency during pregnancy may cause which of the following to the fetus? A. Hemolyticanemia B. Growthretardation C. Duodenalatresia D. Neuraltubedefects E. Achondroplasia Answer D (Straightforward< A maternal folate deficiency can lead to neural tube defects in infants.) 9- A patient with anemia low HB high mcv normal retic normal plt (20) A) liver cirrhosis B) Hypothyroidism C) Megaloblastic anemia Answer: C 61 OTHERS WEEK 1 1. Anemia due to defect of heme biosynthesis in erythroid precursors (17) A. Sideroblastic anemia B. Iron deficiency anemia C. Anemia of chronic disease D. Megaloblastic anemia E. Aplastic anemia Answer A 2. Pancytopenia and hypocellular bone marrow due to destruction of hematopoietic stem cells in the bone marrow A. Sideroblastic anemia B. Iron deficiency anemia C. Anemia of chronic disease D. Megaloblastic anemia E. Aplastic anemia Answer E 3. Oval macrocytic RBCs and hypersegmented neutrophils A. Sideroblastic anemia B. Iron deficiency anemia C. Anemia of chronic disease D. Megaloblastic anemia E. Aplastic anemia Answer D 4. Underproduction of RBCs due to impaired utilization of iron A. Sideroblastic anemia B. Iron deficiency anemia C. Anemia of chronic disease D. Megaloblastic anemia E. Aplastic anemia Answer C 5- Which of the following is a characteristic finding in aplastic anemia?(2018) a. Microcytic anemia b. Decreased reticulocytes c. Hypercellular bone marrow d. Thrombocytosis Answer B (bcz aplastic anemia is basically a bone marrow failure due to the destruction of the stem cells so no cells will be produced) 62 6- A 17-year old boy with sickle cell trait presents with gross hematuria and flank plain. CT scan of abdomen reveals a mass in left kidney. What is the probable diagnosis?(2018) a. Renal Carcinoma b. Renal medullary carcinoma Answer B [Question seems difficult but simply you only have to know that patients with sickle cell trait are at risk of renal medullary carcinoma] 7- An iron storage complex stained with Prussian blue (12) – Hemosiderin 63 3- Classification of Hemolytic Anemias-week 2 1- A 25-year-old male presented with fever and cough for one week, chest x-ray showed pneumonia, culture showed mycoplasma pneumonia, and after two days his haemoglobin dropped, had reticulocytosis, and indirect hyperbilirubinemia, what type of anaemia does the patient have?(2019) a. cold AIHI b. G6PD c. Sickle cell disease d. Iron deficiency anaemia Answer A 2- A 5 year old child has hemolytic anemia. What laboratory parameters would you expect?(18) Answer C (hemolytic anemia=destruction of RBCs—> so hemoglobin is low, as compensatory mechanism the body will try to increase the production of RBCs —> so increase reticulocyte #, bilirubin is high bcz it’s released form the destroyed RBCs, haptoglobin is low bcz it binds to free hemoglobin that is released from the destroyed RBCs) 3- What is a characteristic of G6PD deficiency?(17) A. High conjugated bilirubin B. High LDH C. High haptoglobin D. Low reticulocyte count Answer B 4- Hemolytic anemia is characterized by:(17) A. Low reticulocyte count B. Increased LDH C. Increased haptoglobin 64 D. Low unconjugated bilirubin E. High conjugated bilirubin Answer B 5- Present in extravascular hemolysis (17) A. Spherocytes B. Elliptocytes C. Howell Jolly bodies D. Heinz bodies E. RBC agglutination Answer A 6- Cold autoimmune hemolytic anemia (17) A. Spherocytes B. Elliptocytes C. Howell Jolly bodies D. Heinz bodies E. RBC agglutination Answer E 7- in direct coombs test is used to detect antibody in which compartment of blood?(16) a/ serum b/ surface RBCs c/ surface of platelet d/ inside WBCs Answer B 8- A 30-year-old female shows normocytic anemia and spherocytosis on a peripheral blood smear examination. Her DAT is positive. What is the diagnosis?(16) immune mediated hemolysis 9- What’s the appropriate Initial test in a case suspected with hemolytic anemia?(13)(12) A-Reticulocyte Count B- Osmotic fragility test C- G6PD enzyme levels D- Hemoglobin electrophoresis Answer A 10- Which of the following is most likely associated with intravascular hemolysis?(13) a) Immune-mediated hemolysis b) Hereditary spherocytosis c) Thrombotic thrombocytopenia purpura 65 d) Hereditary elliptocytosis Answer C 11- Which of the following is an intravascular hemolytic anemia?(12) A- Thrombotic thrombocytopenic purpura B- Beta-thalassemia major C- Autoimmune hemolytic anemia D- Hereditary elliptocytosis E- Hereditary spherocytosis Answer A 12- A 28-year old female presents with fatigue, dyspnea, and shortness of breath. Her CBC shows increased reticulocyte and low Hb. PBS shows spherocytic morphology. The direct antiglobulin test is positive. What is the most likely diagnosis?(12) - Immune mediated hemolysis (auto-immune hemolytic anemia). Spherocytes can be seen in hereditary spherocytosis (ankyrin mutation) and autoimmune hemolytic anemia, which occurs in CLL u will take it in week 5 13- Which of the following is a type of autoimmune hemolysis? a. warm and cold Answer A 14- a 20 year old male presented to the emergency department with anemia,..., accompanied with fever and diarrhea> Low hemoglobin with high: reticulocytosis, indirect bilirubin, and LDH. Blood smear shows fragmented RBCs. What is the infectious agent? (20) A. Staphylococcusaureus B. E.coliO157/H7 C. Staphylococcushaemolyticus D. Clostridium Answer B (The patient has low Hb level with high retics = exclude megaloblastic , aplastic anemia (not linked to this question but keep in mind) Low Hb , reticulocytosis, high indirect bilirubin, and LDH = hemolytic anemia There is fragmented cell = schistocyte = intravascular hemolysis> Patient with hemolytic anemia may have hemolytic uretic syndrom caused by E.Coli and manifest by dirrhea) Last slide in hemolytic anemia note (Dr. Rajaa) 66 15- paroxysmal nocturnal hemoglobinuria exhibits sensitivity of one population of red cells to which of the following? (20) A. Warm antibodies B. Cold antibodies C. Oxidant injury D. Complement E. High pH Answer D 67 4- Molecular Genetics of Hemoglobinopathies-week 2 1- A mile aged female came to your clinic for a blood check up for work and she was discovered to have microcytic anaemia, HBA: 95%, HBA2: 4.3% N=