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Saturday, October 22, 2011

Special Pathology : CVS and Haematology MCQs

1.       A 12 year boy presents to the OPD medicine department with swelling of knee after a trauma.  Family history reveals his maternal uncle also suffered from similar complaints. The boy is most likely suffering from
a)       Von willebrand disease
b)       Hemophilia
c)       Thrombocytopenic purpura
d)       Hereditary hemorrhagic telengiectasia
e)       Disseminated intravascular coagulation

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

3.       Two days after receiving the anti malarial drug primaquine, a 27 year old man develops sudden intravascular hemolysis resulting in a decreased hematocrit,  hemoglobinemia  and hemoglobinuria. Examination of the peripheral blood reveals erythroctyes with a defect forming bite cells, when crystal violet stain is applied many Heinz bodies area also seen. Which of the following is the most likely diagnosis?
a)       Hereditary spherocytosis
b)       Glucose 6 phosphate dehydrogenase deficiecny
c)       Paroxysmal hemoglobinuria
d)       Autoimmune hemolytic anemia
e)       Micro angiopathic hemolytic anemia

4.       A  49 year old woman presents with signs of anemia and states that every morning her urine is dark. Investigations reveal that her RBC lyse in vitro with acid(positive HAMs tests). Which of the following Is the most likely diagnosis?
A)      Warm autoimmune hemolytic anemia
B)      Paroyxsmal nocturnal hemogolbinuria
C)      Paroxysmal cold hemogolbinuria
D)      Isoimmune hemolytic anemia
E)      Cold agglutinin autoimmune hemolytic anemia

5.       A  41 year  woman presents with increasing fatigue lethargy and muscle weakness. Her CBC reveals decreased number of erythrocytes, leukocytes and platelets along with an increase in the MCV of the erythrocytes.  Her blood smear shows hypersegmented neutrophils.  Which of the following substances is most likely to be deficient in this individual.
a)       Amino levulinic acis
b)       Ascorbic acid
c)       Folic acid
d)       Retinoic acid
e)       Vanillyl mandelic acid

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

7.       A 23 year old woman in her 25th week of pregnancy has felt no fetal movement for the past 3 years. Three weeks later, she still has not given birth and suddenly develops dyspnea with cyanosis.  On physical examination, her  temperature  is 36.9 C, pulse 102/min, respiration 21/min and blood pressure 80/40 mm Hg. She has large ecchymoses over the skin of her entire body.  A stool sample is positive for her occult blood. Lab studies  show elevated prothrombin time and partial thromboplastin time. The platelet count is decreased, plasma fibrinogen is markedly decreased and fibrin split products are detected. A blood culture is negative. Which of the following is most likely cause of the bleeding diathesis?
a)       Increased vascular fragility
b)       Toxic  injury to the endothelium
c)       Reduced production of the platelets
d)       Increased consumption of clotting factors and platelets
e)       Defects in platelet adhesion and aggregation
8.       A 65 year old patient presents with generalized lymphadenopathy. Immunophenotype shows CD10+ BCL2+ mature B cells expressing surface immunoglobulin. Chromosomal studies show t(14:18). Which lymphoid neoplasms is most likely he suffering from:
a)       Mantle cell lymphoma
b)       Burkitt lymphoma
c)       Follicular lymphoma
d)       MALT lymphoma
e)       Plasmacytoma
9.       Lacunar cells, a variant of Reed Stenberg cells is seen in which of the following subtypes:
a)       Lymphocyte predominant
b)       Mixed cellularity
c)       Lymphocyte depleted
d)       Nodular sclerosis
e)       Lymphocyte rich
10.    A 3 year old boy in Japan presents with fever and rash that is desquamating. On examination he has enlarged cervical lymph nodes conjunctival and oral erythema and erosion. He also has edema of the hands and feet. The physician says the disease is classically self limited however if left untreated the important sequelae will be:
a)       Cerebral artery aneurysms
b)        Coronary artery aneurysms
c)       Cervical abscess
d)       Renal artery aneurysms
e)       Conjunctival hemorrhage
11.    A 65 year old gentleman presents with headache which is most common along the course of superficial temporal artery. On palpation the temples are tender. The patient also complaints of transient visual loss. Biopsy of the temporal artery would show:
a)       Transmural inflammation demonstrating neutrophils, mononuclear cells with fibrinoid necrosis
b)       Necrotizing granulomas rimmed by lymphocytes, plasma cells macrophages and giant cells
c)       Granulomatous inflammation with lymphocyte and multinucleate giant cells with fragmentation of internal elastic lamina
d)       Onion skin, concentric, laminated thickening of the arterioles
e)       Homogeneous pink hyaline thickening with loss of underlying structural detail
12.    C-ANCA is seen in
a)       PAN
b)       Wegners granulomatosis
c)       Microscopic polyangiitis
d)       Churg strauss syndrome
e)       Takayasu arteritis
13.    Following component has a pro coagulant effect:
a)       Prostacyclin
b)       Plasminogen activator
c)       Plasminogen activator inhibitor
d)       Thrombomodulin
e)       Heparin like molecules
14.    Use of lipid lowering drugs (statins) and antiplatelet drugs in a patient suffering from ATH and coronary artey disease is and example of:
a)       Primary prevention
b)       Secondary prevention
c)       Tertiary prevention
d)       Both primary and secondary
e)       Both secondary and tertiary
15.    A 72 year old man presents with increasing fatigue. Physical examination reveals multiple enlarged non tender lymph nodes with enlarged liver and spleen. Lab examination of his peripheral blood reveals a normocytic normochromic anemia and a slighty decreased platelet count and a leukocyte count of 72,000/microlitre. Examination of the peripheral smear reveals a marked increase in the number of mature looking lymphyocytes and many smudge cells. What is the most likely diagnosis:
a)       Acute lymphoblatic leukemia
b)       Atypical lymphocytosis
c)       Chronic lymophocytic leukemia
d)       Immunoblastic lymphoma
e)       Prolymphocytic leukemia
16.    A 22 year old woman presents with fever weight loss night sweats and painless enlargement of various supraclavicular lyphnodes. A biopsy from one of the enlarged lymph nodes shows binucleated giant cells with prominent acidophilic owl eye nucleoli. Wht is the most likely diagnosis:
a)       Anaplastic large cell lymphoma
b)       Diffuse non hodgkins lymphoma
c)       Hodgkins disease
d)       Reactive lymphnode hyperplasia
e)       Mantle cell lymphoma
17.    A 28 year old man presents with vague muscle pain involving his right arm that developed several weeks after eating undercooked pork. Lab examination reveals increased serum activity of CPK. A biopsy from the affected muscle reveals rare encysted forms of Tricinella Spiralis. What type of WBC is most likely to be increased in peripheral blood of this individual:
a)       Basophil
b)       Eiosinophil
c)       Neutrophil
d)       Macrophage
e)       Lymophocyte
18.    Administration of which one of the following substances would theoretically correct the abnormal bleeding lab tests in an individual who is deficient in factor V:
a)       Activated factor VIII
b)       Activated factor X
c)       Fibrinogen
d)       Plasmin
e)       Thrombin
19.    The commonest vessel involved in myocardial infarction is:
a)       Right coronary artery
b)       Left circumflex artery
c)       Left anterior descending artery
d)       Posterior descending artery
e)       Left interventricular artery
20.    In which of the following conditions PT is prolonged and aPTT is normal:
a)       Von willibrand disease
b)       Factor IX deficeiny
c)       DIC
d)       Factor VII deficiency
e)       ASD
21.    A 60 year old man died secondary to coronary artery disease. At the time of autopsy marked atherosclerotic changes were present within his coronary arteries. Section from these abnormal areas revealed complicated atheroscelrotic plaques with calcification and hemorrhage. Within these plaques were cellular zones composed of smooth muscle cells and macrophages and a central core with foam cells and cholesterol clefts. Which one the following substances promotes atherosclerosis by stimulating smooth muscles cells to proliferate, phagocytize lipids and excrete extracellular matrix material.
a)       Alpha interferon
b)       Beta transforming growth factor
c)       Interleukin 1
d)       Platelet derived growth factor
e)       Tumor necrosis factor
22.     A 30 year old male smoker presents with gangrene of his extremities. Which one of the following histologic findings from the biopsy of blood vessels supplying this area would be most consistent with a diagnosis of Beurgers disease:
a)       Granulomatous inflammation with giant cells
b)       Fibriniod necrosis with overlying thrombosis
c)       Focal aneurysmal dilatation
d)       Fragmentation of neutrophils
e)       Thrombosis with micro abscesses
23.    During a routine physical examination a 67 year old man is found to have a 5 cm pulsatile mass in his abdomen. Angiography reveals a marked dilatation of his aorta distal to his renal arteries. Which of the following is the most likely cause of his aneurysm:
a)       Atherosclerosis
b)       A congential defect
c)       Hypertension
d)       Trauma
e)       A previous syphilitic infection
24.    A 56 year old man presents with a sudden onset of excrutiating pain. He describes the pain beginning in the anterior chest, radiatind to the back and then moving downwards to the abdomen. His blood pressure is found to b 160/115 mm Hg however no changes are seen on ECG. X ray abdomen shows a double barrel aorta. Which of the following is basiuc cause of his abnormality:
a)       A microbial infection
b)       Loss of elastic tissue in the media
c)       A congential defect in the wall of aorta
d)       Atherosclerosis of the aorta
e)       Abnormal collagen synthesis
25.    A known patient of Stable Angina visits his cardiologist with the complaints of breathlessness and tightness in chest at rest. He says these symptoms are progressively worsening. What is the likely mechanism underlying his new development?
a)       Dissolution of atherosclerotic plaque
b)       Fibrosis in plaque
c)       Vasoconstriction
d)       Acute plaque change
e)       Aneurysm development in plaque
26.    Foam cells are formed by phagocytosis of:
a)       Free fatty acids
b)       Triglycerides
c)       LDL
d)       HDL
e)       VLDL
27.    Plaque change includes all of following except one, which?
a)       Rupture
b)       Fibrinoid necrosis
c)       Thrombosis
d)       Haemorrhage
e)       Aneurysmal dilation
28.   A 30 year old female has splenomegaly and anemia with spherocytosis.The circulating RBCs demonstrate an increased osmotic fragility on laboratory testing. An inherited abnormality in which of the following RBC components best explains these findings:
a)      Glucose-6-phosphate dehydrogenase.
b)      A membrane cytoskeletal protein.  
c)       Α-globin chain
d)      Heme
e)      Β-globin chain
29.    “Tree barking” appearance of aorta is seen in:
a)       Atherosclerosis
b)       Inflammatory aortic aneurysms
c)       Syphilitic aortitis
d)       Mycotic aneurysms
e)       Aortic dissection
30.    one of the following statements about Hemangiomas is not true:
a)       They are benign tumors of blood vessels
b)       Capillary haemangioma commonly involves skin and mucosal tissue
c)       Cavernous haemangiomas involve deeper structures
d)       These tumors are encapsulated
e)       Strawbwerry haemangioma is a variant present at birth.
31.    A 48 year old woman presented with nodular thyroid gland swelling. Abdominal ultrasound examination shows adrenal gland tumor. The probable diagnosis is
a)       Anaplastic carcinoma of thyroid
b)       Medullary carcinoma of thyroid
c)       Follicular carcinoma of thyroid
d)       Papillary carcinoma of thyroid
e)       Lymphoma of thyroid
32.    A patient has presented in ER with severe chest pain for the last 4
days. On examination he is breathless with weak thready pulse. His ECG shows T wave inversion. Which of the following cardiac enzymes will be diagnostic of myocardial infarction at this stage.
a)       CPK
b)       CK-MB
c)       LDH
d)       Troponin I
e)       AST
33.    Injury after myocardial ischemia is reversible for:
a)       01 hour
b)       30 – 40 min
c)       10 – 20 min
d)       1 – 2 hrs
e)       01 day
34.     Granulation tissue appears after infarction on day:
a)       5 - 6
b)       1 - 3
c)       7 - 10
d)       12 - 15
e)       After 15 days
35.     Rheumatic fever is caused by:
a)       Streptococus pyogenes
b)       Streptococcus Viridans
c)       Staphylococcus aureus
d)       Streptococcus pneumonae
e)       Staphylococcus epidermidis
36.     A 17 year old girl came to OPD with complaint of swelling in middle of neck. FNAC was performed. It revealed cellular smears with nuclear grooving and intranuclear cytoplasmic inclusions. The diagnosis on cytological findings is:
a)       Papillary carcinoma of thyroid
b)       Medullary carcinoma of thyroid
c)       Follicular carcinoma of thyroid
d)       Anaplastic carcinoma of thyroid
e)       Lymphoma of thyroid
37.    A 30 years old heroin drug addict starts having fever with chills, weight loss and fatigue. On investigations he is diagnosed to be suffering from infective endocarditis. The most likely cause for his infection is:
a)                   Streptococus viridans
b)                   Streptococcus pyogenes
c)                   H Influenza
d)                   Streptococcus pneumonae
e)                   Staphylococcus aureus
38.    A 60 year old smoker and occasional drinker presents to the ER with severe pain in the epigastrium radiating to the back. He is feeling nauseated and has vomited twice. Lab shows markedly raised amylase and lipase and low serum calcium. What is the most likely diagnosis?
a)       Acute cholecystitis
b)       Acute pancreatitis
c)       Acute appendicitis
d)       Acute intestinal obstruction
e)       Perforated peptic ulcer
39.    The commonest site for myxoma is:
a)       Right atrium
b)       Inter ventricular septum
c)       Left atrium
d)       Left ventricle
e)       Inter ventricular septum
40.  A 10 year boy is brought to the physician for routine physical examination. The physician notes a 2 cm spongy dull red circumscribed lesion on the upper left arm. The parents state that this lesion has been present since infancy. On excision the lesion shows dilated endothelial lined spaces filled with RBCs. Which of the following is the likely diagnosis
a)       Kaposi sarcoma
b)       Angiosarcoma
c)       Lymphangioma
d)       Telengiectasia
e)       Hemangioma
41. A pharmaceutical company is developing an anti atherosclerotic agent. An experiment investigates mechanism of actions of several potential drugs to determine their efficacy in reducing atheroma formation. Which of the following mechanism of action is likely to have the most effective anti atherosclerotic effect:
a)       Inhibits the release of platelet derived growth factor(PDGF) and macrophage mediated lipoprotein oxidation
b)       Promotes the release of PDGF and inhibits macrophage mediated lipoprotein oxidation
c)       Inhibits the release of PGDF and promotes macrophage mediated lipoprotein oxidation
d)       Decreases the level of HDL and inhibits  macrophage mediated lipoprotein oxidation
e)       Increases the level of intercellular adhesion molecule 1 (ICAM-1) and VCAM-1
42. Lipoprotein fraction which contains the highest concentration of triacylglycerol is:
a)       Chylomicron
b)       Intermediate density lipoprotein
c)       High density lipoprotein
d)       Low density lipoprotein
e)       Very low density lipoprotein
43. Auer rods are characteristically seen in:
a)       ALL-L2
b)       AML-M1
c)       AML-M2
d)       AML-M3
e)       AML-M4
44. M spike in multiple myeloma is usually due to:
a)       IgG
b)       Light chains
c)       IgA
d)       Heavy chains
e)       Both light and heavy chains
45. A 60 years old sweeper presents with off & on diarrhea for the last 6 months which has led to weakness, pallor and numbness of hands & feet. On examination he is pale. His blood CP reveals Hb of 6.5 g/dl, TLC 3.0 x 10 3/ul and platelets count of 85,000/cmm. MCV is 110 fl with oval macrocytosis and hypersegmented neutrophils. What is the probable diagnosis?
a)  Iron deficiency anemia
b) Megaloblastic anemia
c) Aplastic anemia
d) Hemolytic anemia
e) Anemia of underlying disorder

46.  What investigation would you like to do next?
a) Serum Ferritin
b) Serum iron, TIBC
c) Bone Marrow examination
        d) Hb electrophoresis
                e) Coombs test.
47. The gene for beta globin chain of Hb is located on chromosome  
a) 11
b) 9
c) X
d) 16
e) 1
48. G6PD deficiency is:
a) Inherited as an autosomal dominant disorder
b) Associated with extravascular hemolysis only
c) X linked
d) Characterized by presence of target cells in blood
e) Associated with aggravation of symptoms in hypoxic conditions
49. Sickle cell anemia is
a) Because of a defect in the alpha globin chain of Hb
b) Associated with intravascular hemolysis
c) Diagnosed on bone marrow examination
d) Diagnosed on Hb electrophoresis
e) Associated with painful crisis resulting from acute severe vasoconstriction

50. What is the diagnostic test of choice for iron deficiency anaemia?
a) Peripheral blood film
b) Serum Ferritin levels
c) Serum iron, TIBC
d) Bone Marrow examination
e) Percent Transferrin saturation
51. A 45 year old smoker presents to the ER with history of recurrent pain in the epigastrium and diarrhea. He is taking H2 antagonists and proton pump inhibitors but his pain is not settling completely. He is giving analgesics and I.V fluids. After stabilizing his vitals upper endoscopy is done and multiple ulcers are seen in duodenum and jejunum. What is your most likely diagnosis
a) Pancreatic carcinoma
b) Zollinger Ellison syndrome
c) Glucagonoma
d) Insulinoma
e) Pheochromocytoma
52. A young otherwise healthy female presents with sudden onset of symptoms of anaemia after taking medicine for throat infection. She is very pale with mild splenomegaly. Her blood CP shows severe normocytic normochromic anaemia with normal TLC & platelet count. Spherocytes are also seen. What is the likely cause of her anemia?
a) Autoimmune hemolytic anemia
b) Megaloblastic anemia
c) Iron deficiency anemia
d) PNH
e) Cold haemagglutinin disease
53. What is the diagnostic test for your provisional diagnosis in above case?
a) Bone marrow examination
b) Urine for hemosidrin
c) Coombs test
d) Hb electrophoresis
e) Iron profile
54.   54.    You have diagnosed a child with beta thalassaemia major. How will you manage this child?
    1. Regular blood transfusions
    2. Regular blood transfusion with iron chelation.
    3. Haematinics therapy
    4. Give supportive care only
    5. Advise bone marrow transplant immediately
  1. A 35 year old male presents to the ER in confusional state. He is diaphoretic and having palpititions. Lab shows serum glucose of 35mg/dl. On further evaluation pro-insulin and C-reactive peptide is also raised. What is the most likely diagnosis:
a.        Factitious insulin
b.       Glucagonoma
c.        Insulinoma
d.       Pheochromocytoma
e.       Zollinger Ellison disease
  1. Parasite producing iron deficiency is:
    1. Ascaris Lumbricoides
    2. Entrobius vermicularis
    3. Shistosoma haematobium
    4. Entamoeba Histolytica
    5. Ankylostoma Duodenale
  1. Pernicious anaemia is produced due to:
a) Defective absorption of folic acid
b) Defective absorption of Vit B 12 resulting from deficient R  binder
c) Vit B 12 deficiency due to deficiency of Intrinsic Factor
d)Ileal resection
e) Deficiency of transcobalamine
       58.    Which one of the following is the one of the most common cause of death in young individual:
a.        Dilated cardiomyopathy
b.       Restrictive cardiomyopathy
c.        Hypertrophic cardiomyopathy
d.       Amyloidosis
e.       ASD
       59.    Which of the following can be used as a marker for endothelium:
a.        CD29
b.       CD30
c.        CD31
d.       CD32
e.       CD33
       60.    The best source of folic acid is
a.        Milk
b.       Eggs
c.        Vegetables
d.       Meat
e.       Animal liver
       61.    Bleeding does not become evident until platelet count is less than:
a.        1,00,000/ul
b.       75,000/ul
c.        50,000/ul
d.       20,000/ul
e.       10,000/ul
       62.     Individuals infected by Plasmodium Falciparum are protected against:
a.        Thalasemia
b.       Iron deficiency anemia
c.        Sickle cell anemia
d.       Megaloblastic anemia
e.       Anemia of chronic disease
    63.  A 2-year old child has had failure to thrive. The child is short, with coarse fascial features,a aprotuding tongue, and an umbilical hernia. Profound mental retardation is apparent as the child matures.These findings are best explained by a lack of
a)    Cortisol
b)    Norepinephrine
c)     Somatostatin
d)    Thyroxine (T4)
e)    Insulin
  64.  Nonbacterial thrombotic endocarditis is most frequently associated with which of the following conditions?
a)    Terminal neoplastic disease   
b)    Systemic Lupus erythematosus (SLE)
c)     Old rheumatic endocarditis
d)    Subdiaphragmatic abscess
e)    Congenital Heart disease.
      65.    Aplastic anaemia is diagnosed on:
a) Blood counts and reticulocyte count
b) Hb electrophoresis
c) Bone marrow aspirate alone
d) Bone marrow trephine alon
e) Both aspirate and trephine biopsy


mhmd usif said...

1------------b) hemophilia

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