Hematology II MCQS

Final

Section B

1. Aplastic anemia

definition:

pancytopenia resulting from aplasia of bone marrow

reduction in blood count

failure or suppression of multipotent stem cells

characteristic:

MCV 80~100 fL

MCH 27~34 pg

normochromic normocytic

pancytopenia

hypocellular marrow

leukopenia, selective fall but not always <1.5 x 109/L

reduced platelet

low/absence reticulocyte count

BM shows hypoplasia

erythroid, granulocytic, megakaryocytic suppressed

largely empty marrow spaces fill with fat tissues

etiology secondary/acquired

drugs and environmental toxins, benzene
radiation, chemotherapy
chemicals, toluene
viruses, HBV, HIV, AIDS
paroxysmal nocturnal hemoglobinuria (PNH)
graft vs host ds
pregnancy
autoimmune ds, SLE

severe: BM cellularity <30%, ANC <500, platelet <20k

very severe: absolute neutrophil count <200/mm3

mild/moderate: pancytopenia, not fulfill criteria of severe

non severe: hypocellular BM

2. IDA

definition:

decreased availability of dietary iron + chronic blood loss from parasitic infection

not enough iron to produce Hb

smaller than usual, decreased red color

etiology:

increased demand of iron: pregnancy, iron depletion occurs more rapid

malabsorption: after gastrectomy, impaired iron absorption due to absence of gastric juice which helps to solubilize and reduce dietary iron into the more easily absorbed ferrous form

chronic blood loss: GIT, each ml blood loss, 0.5 mg iron loss, menorrhagia

hemodialysis: decreased EPO production, functional iron deficiency

treatment:

iron tablets with V C

clinical feature:

koilonychia

fatigue

restless leg syndrome

headaches

pagophagia

pallor

pica

angular stomatitis

lab:

hypochromic

microcytic

target cells, elliptocytes, teardrop

decreased iron stores in BM assay

hypercellular

erythroid hyperplasia

absence of stainable iron

Section C

megaloblastic

macrocytic
high MCV
normal MCHC
normal serum iron
normal ferritin
normal TIBC (total iron binding capacity)
low reticulocyte
normochromic

macrocytic

MCV >100f/L

large immature and dysfunctional RBC (megaloblast)

delayed nucleus maturation due to defective in DNA synthesis

etiology:

B12

nutritional: vegans, no meat, egg, cheese

inadequate secretion of intrinsic factor: pernicious anemia due to congenital lack of IF in stomach

total or partial gastrectomy

malabsorption: due to abnormalities in terminal ileum

folate

nutritional: poverty, special diet

malabsorption: tropical sprue, gluten-induced enteropathy

excess utilization: pregnancy and lactation

excess urinary folate loss: active liver ds, congenital heart failure

B12

pernicious, lack IF
malabsorption
veganism
Schilling test: oral-labelled V B12 57Co and 58Co
low serum B12
tx: hydroxocobalamin

folate

excess utilization: pregnancy, lactation
malabsorption
gluten induced enteropathy
excess urinary folate loss: active liver ds, congenital heart failure
low serum folate
tx: folic acid supplement

clinical feature

fatigue
dyspnea
glossitis
mild jaundice
vertigo
purpura
dyspepsia
early graying of hair

lab

PBF: anisocyte, poikilocyte, macrocyte, ovalocyte, teardrop, Howell-Jolly bodies, hypersegmented neutrophils, macropolycyte
high MCV
normal MCHC
low reticulocyte due to destruction to fragile and abnormal megaloblastic erythroid precursor
megaloblastic hyperplasia in BM
low serum B12
low serum folate

2. IDA

microcytic
low MCV
low MCHC
low serum iron
low ferritin
high TIBC
normal reticulocyte
hypochromic

CML

PBF: nucleated RBC, leukocytosis >100k /uL, absolute basophilia, thrombocytosis, NAP/LAP low or absent, increased granulocytes

BM: hypercellular, reticulin fibrosis, karyotyping analysis (fluorescent in situ hybridization, PCR: BCR-ABL 1 gene mapping), M:E 10:1

Cytogenetic: Ph chromosome

Molecular: BCR-ABL fusion gene

CLL

PBF: absolute lymphocytosis 10~105 x 10^9/L, smudge cells, markedly fragile leukocytes, neutropenia, thrombocytopenia, anemia

protein electrophoresis: hypogammaglobulinemia

immunophenotyping: CD5, 20, 23

lymph node biopsy: increased small round lymphocytes infiltration, proliferation centers (pathognomic)

August 2019

SECTION A: OBJECTIVE QUESTIONS (30 MARKS)

CHOOSE ONE BEST STATEMENT TO ANSWER THE QUESTIONS

1. When it comes to blood, why is the bone marrow so important?

(A) inhibits overgrowth of abnormal blood cells

(B) produces white blood cells, red blood cells and platelets*

(D) produces the activity centres through which blood circulates to all parts of the body.

2. What happens when a person has anemia?

(A) The blood becomes thick.

(B) The body produces too much iron.

(D) The blood does not have enough red blood cells.*

3. Anemia can contribute to which of these among older adults?

(A) diabetes

(B) more falls*

(D) diminished eyesight

https://www.urmc.rochester.edu/encyclopedia/content.aspx?ContentTypeID=40&ContentID=AnemiaQuiz&CustomAnswers_AnemiaQuiz=q2a3_c,q10a1_c

4. Which of the following is NOT a symptom of anaemia?

(A) fatigue

(B) light headedness

(D) warm hands and feet*

5. How does anemia affect the body?

(A) tissues retain fluids

(B) blood becomes thin

(D) the blood doesn't deliver enough oxygen to the body*

6. Which of these is the sign of anemia?

(A) bleeding

(B) pale gums*

(D) numbness in hands and feet

7. A lack of which of these will result in abnormally large red blood cells and a condition called megaloblastic anemia?

(A) oxygen

(B) vitamin C

(D) vitamin B-12 and folic acid*

8. The intrinsic factor is required for the absorption of

(A) zinc

(B) iron

(D) vitamin B12*

9. Which of the following is NOT etiology of iron deficiency anaemia?

(A) infection*

(B) malabsorption

(D) increased requirement--pregnancy, lactation (breastmilk production)

10. You are providing diet teaching to a patient with low iron levels. Which foods would you encourage the patient to eat regularly?

(A) egg yolks, beef, and legumes*

(B) chocolate, cornbread, and cabbage

(D) sweet potatoes, artichokes, and packaged meat

11. A patient has been prescribed ferrous sulfate 300mg per 8hr. What would not be suitable liquids for a patient to take with iron deficiency anemia?

(A) milk

(B) juice*--Vitamin C

(D) coffee

12. Which of the following terms is used to describe the destruction of red blood cells?

(A) homolysis

(B) hemolysis*

(D) heterogenesis

13. Choose the age range of the patient with acute lymphoblastic leukemia (ALL).

(A) 3-10 years*

(B) 45-55 years

(D) over 60 years

14. Which of the following BEST describes hemolytic anemia?

(A) Red blood cells stop being produced by the bone marrow.

(B) Red blood cells are replaced faster than they can be destroyed.

(D) Red blood cells are produced too rapidly from the bone marrow.

15. Which of the following BEST describes the characteristics of acute myelogenous leukaemia (AML)?

(A) leukocytes undergo increased differentiation

(B) mature leukocytes are transformed into immature cells

(D) examination of peripheral blood will show excessive myeloblasts*

16. Which of the following description is most consistent with chronic myelogenous leukemia (CML)?

(A) an increase in reticulocytes

(B) a translocation between two genes*--Philadelphia

(D) pronounced splenomegaly and lymphadenopathy

17. What are the two major types of thalassemia?

(A) beta and theta

(B) alpha and beta*

(D) beta and omega

18. Which of the following is NOT the symptom of Thalassemia disease?

(A) dark urine

(B) abdominal cramps*--swelling

(D) slow growth and Weakness

19. Which of the following statement is NOT correct about Thalassemia disease?

(A) in mild thalassemia you may not need treatment--mild anemia, minor thalassemia

(B) the type of thalassemia depends upon the number of mutations in genes

(D) Alpha thalassemia is a major disease which causes serious illness and is also known as Cooley's Anaemia*--Beta major

20. The term refer to less colour of red blood cells is

(A) microcytic

(B) macrocytic

(D) hyperchromic

21. How would the red blood cells appear if the patient had iron- deficiency anemia?

(A) hypochromic and microcytic*

(B) hypochromic and macrocytic

(D) hyperchromic and macrocytic

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

(A) decreased serum ferritin level

(B) decreased transferrin saturation

(D) decreased mean corpuscular hemoglobin concentration in red blood cells

23. In addition to measuring serum vitamin B12 and folate levels, the most useful ancillary tests for determining B12 deficiency as the cause for megaloblastic anaemia is

(A) lactate dehydrogenase and bilirubin

(B) a Schilling test and bone marrow exam*

(D) parietal cell antibodies and an anti-nuclear antibody (ANA) panel

24. The nurse is reviewing the laboratory report of a client who underwent a bone marrow biopsy. The finding that would most strongly support a diagnosis of acute leukaemia is the existence of a large number of immature

(A) leukocyte*

(B) reticulocytes

(D) thrombocytes

25. Morphologic features commonly seen in the peripheral blood of patients with megaloblastic anemia include

(A) macrocytes, polychromasia, and pseudo Pelger-Huet cells

(B) dimorphic RBC’s, basophilic stippling, and dysplastic WBCs

(D) oval macrocytes, teardrop cells, and hypersegmented neutrophils*

26. Which of these is NOT a diagnostic measure for Leukaemia?

(A) bone marrow biopsy

(B) swollen lymph nodes*

(D) high white blood cells count

27. When reviewing the laboratory results of a child with leukaemia, the healthcare provider notes that the child is also anaemic. Which statement provides the best rationale for this problem?

(A) the child has a poor appetite and has not been consuming adequate dietary iron

(B) the overproduction of immature white blood cells occurs at the expense of other cells*

(D) chemotherapy-induced osteoporosis has caused decreased erythropoiesis

https://quizlet.com/192725890/leukemia-nclex-flash-cards/

https://quizlet.com/397120886/peds-6-leukemia-flash-cards/

28. Which chromosomal abnormality is diagnostic in CML?

(A) Auer body

(B) Philadelphia chromosome*

(D) deletion of the short arm of chromosome 13

29. What is the screening test used to evaluate the function of platelets and small blood vessels?

(A) APTT*--MPV, PT, INR

(B) hemoglobin

(D) bleeding time

30. How would you expect leukemia to affect someone's blood test?

(A) cause a complete absence of platelets

(B) cause higher than expected numbers of red blood cells

(D) cause higher than expected numbers of white blood cells, red blood cells and platelets.

SECTION B: SHORT ANSWER QUESTIONS (30 MARKS)

ANSWER ALL QUESTIONS

1. a. Explain the characteristics of aplastic anaemia. (4 Marks)

MCV 80~100 fL

MCH 27~34 pg

normochromic normocytic

pancytopenia

hypocellular marrow

b. Discuss about laboratory findings of aplastic anaemia. (6 Marks)

normochromic normocytic

leukopenia, selective fall but not always <1.5 x 109/L

reduced platelet

low/absence reticulocyte count

BM shows hypoplasia

erythroid, granulocytic, megakaryocytic suppressed

largely empty marrow spaces fill with fat tissues

2. a. Define microcytic hypochromic red blood cell. (2 Marks)

smaller than usual, decreased red color

b. Discuss THREE (3) common causes of iron deficiency anaemia. (6 Marks)

increased demand of iron: pregnancy, iron depletion occurs more rapid

malabsorption: after gastrectomy, impaired iron absorption due to absence of gastric juice which helps to solubilize and reduce dietary iron into the more easily absorbed ferrous form

chronic blood loss: GIT, each ml blood loss, 0.5 mg iron loss, menorrhagia

hemodialysis: decreased EPO production, functional iron deficiency

c. Explain therapeutic strategies for the treatment of iron deficiency anaemia. (2 Marks)

iron tablets with V C

3. A patient has received a medication that has caused significant haemolysis. Laboratory analysis also showed increase number of reticulocyte.

a. Upon assessment, what is the expected colour of the patient’s urine sample? Explain. (8 Marks)

dark color

hemoglobinuria

intravascular hemolysis

bilirubin excreted thro kidneys

extravascular

b. Provide reasons why there is an increase number of reticulocyte count. (2 Marks)

increased RBC production

RBC destruction

blood loss

SECTION C: ESSAY QUESTIONS (40 MARKS)

ANSWER ALL QUESTIONS

Question 1

Discuss what are the differences between megaloblastic anaemia and iron deficiency anaemia. (20 Marks)

megaloblastic

macrocytic
high MCV
normal MCHC
normal serum iron
normal ferritin
normal TIBC (total iron binding capacity)
low reticulocyte
normochromic

IDA

microcytic
low MCV
low MCHC
low serum iron
low ferritin
high TIBC
normal reticulocyte
hypochromic

Question 2

Describe primary and ancillary laboratory test that are used to diagnose chronic leukemia. (20 Marks)

primary

ancillary

cytogenetics

April 2019

SECTION A: OBJECTIVE QUESTIONS (30 MARKS)

CHOOSE ONE BEST STATEMENT TO ANSWER THE QUESTIONS

1. What happens when a person has anemia?

(A) the blood becomes thick

(B) the body produces too much iron

(D) the blood does not have enough red blood cells*

2. Which of these is the sign of anemia?

(A) bleeding

(B) pale gums*

(D) numbness in hands and feet

3. What is the COMMON cause of anemia?

(A) too little sleep

(B) too much sugar

(D) exposure to X-ray radiation

4. Which of the following is NOT a symptom of anemia?

(A) fatigue

(B) light headedness

(D) warm hands and feet*

5. How does anemia affect the body?

(A) tissues retain fluids

(B) blood becomes thin

(D) the blood doesn't deliver enough oxygen to the body*

6. A lack of which of these will result in abnormally large red blood cells and a condition called megaloblastic anemia?

(A) oxygen

(B) vitamin C

(D) vitamin B-12 and folic acid*

7. The intrinsic factor is required for the absorption of

(A) zinc

(B) iron

(D) vitamin B12*

8. Which of the following is NOT an etiology of iron deficiency anemia?

(A) infection*

(B) malabsorption

(D) increased requirement

9. Which of the following terms is used to describe the destruction of red blood cells?

(A) homolysis

(B) hemolysis*

(D) heterogenesis

10. Sickle cell anemia refers to

(A) hemoglobin SC

(B) hemoglobin SS*

(D) hemoglobin SS and SC

11. Which of the following description is MOST consistent with chronic myelogenous leukemia (CML)?

(A) an increase in reticulocytes

(B) a translocation between two genes*

(D) pronounced splenomegaly and lymphadenopathy

12. Most common subtype of congenital AML is

(A) M0

(B) M2*

(D) M4

https://www.slideshare.net/magdisasi/leukemia-acute-myeloid-leukemia-magdi-sasi

13. Choose the age range of the patient with acute lymphoblastic leukemia (ALL).

(A) 3-10 years*

(B) 45-55 years

(D) over 60 years

14. You are providing diet teaching to a patient with low iron levels. Which foods would you encourage the patient to eat regularly?

(A) egg yolks, beef, and legumes*

(B) chocolate, cornbread, and cabbage

(D) sweet potatoes, artichokes, and packaged meat

15. A patient has been prescribed ferrous sulfate 300mg per 8hr. What would not be suitable liquids for a patient to take with iron deficiency anemia?

(A) milk

(B) juice*

(D) coffee

16. Which of the following BEST describes hemolytic anemia?

(A) red blood cells stop being produced by the bone marrow

(B) red blood cells are replaced faster than they can be destroyed

(D) red blood cells are produced too rapidly from the bone marrow

17. The healthcare provider is caring for a patient with acute myelogenous leukemia (AML). Which of the following BEST describes the characteristics of this type of leukaemia?

(A) leukocytes undergo increased differentiation

(B) mature leukocytes are transformed into immature cells

(D) examination of peripheral blood will show excessive myeloblasts*

18. When reviewing the laboratory results of a child with leukaemia, the healthcare provider notes that the child is also anaemic. Which statement provides the best rationale for this problem?

(A) the child has a poor appetite and has not been consuming adequate dietary iron

(B) the overproduction of immature white blood cells occurs at the expense of other cells*

(D) chemotherapy-induced osteoporosis has caused decreased erythropoiesis

19. What are the two major types of thalassemia?

(A) beta and theta

(B) alpha and beta*

(D) beta and omega

20. The term refer to less colour of RBC is

(A) microcytic

(B) macrocytic

(D) hyperchromic

21. Morphologic features commonly seen in the peripheral blood of patients with megaloblastic anemia include

(A) macrocytes, polychromasia, and pseudo Pelger-Huet cells

(B) dimorphic RBC’s, basophilic stippling, and dysplastic WBCs

(D) oval macrocytes, teardrop cells, and hypersegmented neutrophils*

22. The nurse is reviewing the laboratory report of a client who underwent a bone marrow biopsy. The finding that would most strongly support a diagnosis of acute leukaemia is the existence of a large number of immature

(A) leukocytes*

(B) lymphocytes

(D) thrombocytes

23. The physician orders a patient with suspected iron-deficiency anemia a blood smear test to assess the quality of the red blood cells. How would the red blood cells appear if the patient had iron- deficiency anemia?

(A) hypochromic and microcytic*

(B) hypochromic and macrocytic

(D) hyperchromic and macrocytic

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

(A) decreased serum ferritin level

(B) decreased transferrin saturation

(D) decreased mean corpuscular hemoglobin concentration in red blood cells

25. Choose the BEST statement about sickle cell anaemia.

(A) an autosomal dominant disease--recessive

(B) rarely due to the same mutation in unrelated individuals

(D) caused by mutations in either the alpha-globin gene or the beta-globin gene

26. In addition to measuring serum vitamin B12 and folate levels, the most useful ancillary tests for determining B12 deficiency as the cause for megaloblastic anaemia are

(A) lactate dehydrogenase and bilirubin

(B) a Schilling test and bone marrow exam*

(D) parietal cell antibodies and an anti-nuclear antibody (ANA) panel

27. If you are missing one of the four alpha chain genes, then you are which type of alpha thalassemia?

(A) silent carrier*

(B) haemoglobin H disease--3 gene, beta tetramers, microcytic, hypochromic, target cells, Heinz bodies, splenomegaly

(D) alpha thalassemia major--4 gene, hydrops fetalis, splenomegaly, fetus hydropic, predominant chain present is all tetrameric gamma

alpha thalassemia trait--2 gene, mild hypochromic, microcytic anemia, heterozygous/homozygous

28. The nurse is reviewing the laboratory report of a client who underwent a bone marrow biopsy. The finding that would most strongly support a diagnosis of acute leukemia is the existence of a large number of immature:

(A) leukocyte*

(B) reticulocytes

(D) thrombocytes

29. The MOST common translocation found in patients with chronic myelogenous leukemia is

(A) t(8;21)

(B) t(9;22)*

(D) t(15;17)

30. Which chromosomal abnormality is diagnostic in CML?

(A) Auer body

(B) Philadelphia chromosome*

(D) deletion of the short arm of chromosome 13

SECTION B: SHORT ANSWER QUESTIONS (30 MARKS)

ANSWER ALL QUESTIONS

1. a. List TWO (2) general classification of leukaemia based on cell type. (2 Marks)

acute, precursor

chronic, mature

b. State the classification of acute myeloid leukaemia based on FAB classification. (8 Marks)

M0 undifferentiated acute myeloblastic leukemia

M1 myeloblastic with minimal maturation

M2 with maturation

M3 promyelocytic

M4 myelomonocytic

M5 monoblastic monocytic

M6 erythro-

M7 megakaryoblastic

2. a. Define aplastic anaemia. (2 Marks)

pancytopenia resulting from aplasia of bone marrow

reduction in blood count

failure or suppression of multipotent stem cells

b. Describe the etiology of acquired/secondary aplastic anaemia. (8 Marks)

secondary

drugs and environmental toxins, benzene
radiation, chemotherapy
chemicals, toluene
viruses, HBV, HIV, AIDS
paroxysmal nocturnal hemoglobinuria (PNH)
graft vs host ds
pregnancy
autoimmune ds, SLE

3. a. Define megaloblastic anaemia. (2 Marks)

macrocytic

MCV >100f/L

b. State the causes of megaloblastic anaemia due to vitamin B12 deficiency. (4 Marks)

nutritional: vegans, no meat, egg, cheese

inadequate secretion of intrinsic factor: pernicious anemia due to congenital lack of IF in stomach

total or partial gastrectomy

malabsorption: due to abnormalities in terminal ileum

c. State the causes of megaloblastic anaemia due to folate deficiency. (4 Marks)

nutritional: poverty, special diet

malabsorption: tropical sprue, gluten-induced enteropathy

excess utilization: pregnancy and lactation

excess urinary folate loss: active liver ds, congenital heart failure

SECTION C: ESSAY QUESTIONS (40 MARKS)

ANSWER TWO (2) QUESTIONS ONLY

Question 1

Discuss in detail the clinical features and laboratory findings of iron deficiency anaemia. (20 Marks)

clinical features

fatigue
palpitations
breathlessness
dizziness
dyspnea
angular stomatitis
koilonychia--thin, spoon-shaped finger nails
pagophagia--craving ice
pica--craving non food
glossitis

lab

microcytic (55~74), hypochromic (22~31, MCH 14~26)
anisocytosis
poikilocyte: target cells (codocyte), elliptocyte, dacryocyte (tear drop)
low serum iron
high TIBC
low ferritin
low transferrin saturation
low reticulocyte
elevated RDW (>15)
elevated platelet

Question 2

Explain the causes, clinical features and laboratory findings of haemophilia A. (20 Marks)

causes

severity of ds depends on level of factor VIII in plasma
deficient synthesis of factor VIII
factor VIII <50%, bleeding
sex-linked recessive trait
mainly in males
abnormal in female when have abnormal gene on both X

clinical features

spontaneous bleeding into subcutaneous tissues, skeletal muscle joints, membranes
hemorrhage at muscle, joints
bleeding after dental surgery
bruising
GIT, UT hemorrhage

lab

normal bleeding time
normal prothrombin time
prolonged activated partial thromboplastin time
low serum factor VIII

treatment

fresh plasma
cryoprecipitate
factor VIII concentrate

Question 3

Discuss the clinical features and laboratory findings of chronic myeloid leukaemia. (20 Marks)

clinical features

30% asymptomatic
fatigue
malaise
anorexia
abdominal discomfort
weight loss
excessive sweating
night sweats, heat intolerance-mimicking hyperthyroidism, gouty arthritis, symptoms of leukostasis, splenic infartion, urticia (histamine release)
pallor
splenomegaly
sternal pain

lab

Hb concent. decrease
nucleated red cells
leukocyte >25000/ul
basophil increase
normal or increase platelet
neutrophilia alkaline phosphatase activity low or absent
hypercellular BM
reticulin fibrosis
cytogenetic--Ph chromosome
molecular--BCR-ABL fusion gene

September 2018

SECTION A: OBJECTIVE QUESTIONS (30 MARKS)

CHOOSE ONE BEST STATEMENT TO ANSWER THE QUESTIONS

1. Anemia is a common condition. What happens when a person has anemia?

(A) the blood becomes thick

(B) the body produces too much iron

(D) the blood does not have enough red blood cells*

2. What is the most common cause of anemia?

(A) too little sleep

(B) too much sugar

(D) exposure to X-ray radiation

3. Which of the following is NOT a symptom of anemia?

(A) fatigue

(B) light headedness

(D) warm hands and feet*

4. How does anemia affect the body?

(A) tissues retain fluids

(B) blood becomes thin

(D) the blood doesn't deliver enough oxygen to the body*

5. Which of these is the sign of anemia?

(A) bleeding

(B) pale gums*

(D) numbness in hands and feet

6. A lack of which of these will result in abnormally large red blood cells and a condition called megaloblastic anemia?

(A) oxygen

(B) vitamin C

(D) vitamin B-12 and folic acid*

7. The intrinsic factor is required for the absorption of

(A) zinc

(B) iron

(D) vitamin B12*

8. Which of the following is NOT an etiology of iron deficiency anemia?

(A) infection*

(B) malabsorption

(D) increased requirement

9. You are providing diet teaching to a patient with low iron levels. Which foods would you encourage the patient to eat regularly?

(A) egg yolks, beef, and legumes*

(B) chocolate, cornbread, and cabbage

(D) sweet potatoes, artichokes, and packaged meat

10. A patient has been prescribed ferrous sulfate 300mg per 8hr. What would not be suitable liquids for a patient to take with iron deficiency anemia?

(A) milk

(B) juice*

(D) coffee

11. Which of the following terms is used to describe the destruction of red blood cells?

(A) homolysis

(B) hemolysis*

(D) heterogenesis

12. Choose the age range of the patient with acute lymphoblastic leukemia (ALL).

(A) 3-10 years*

(B) 45-55 years

(D) over 60 years

13. Which of the following BEST describes hemolytic anemia?

(A) red blood cells stop being produced by the bone marrow

(B) red blood cells are replaced faster than they can be destroyed

(D) red blood cells are produced too rapidly from the bone marrow

14. The healthcare provider is caring for a patient with acute myelogenous leukemia (AML). Which of the following BEST describes the characteristics of this type of leukaemia?

(A) leukocytes undergo increased differentiation

(B) mature leukocytes are transformed into immature cells

(D) examination of peripheral blood will show excessive myeloblasts*

15. When reviewing the laboratory results of a child with leukaemia, the healthcare provider notes that the child is also anaemic. Which statement provides the best rationale for this problem?

(A) the child has a poor appetite and has not been consuming adequate dietary iron

(B) the overproduction of immature white blood cells occurs at the expense of other cells*

(D) chemotherapy-induced osteoporosis has caused decreased erythropoiesis

16. Which of the following description is most consistent with chronic myelogenous leukemia (CML)?

(A) an increase in reticulocytes

(B) a translocation between two genes*

(D) pronounced splenomegaly and lymphadenopathy

17. Most common subtype of congenital acute myelogenous leukemia (AML) is

(A) M0

(B) M2*

(D) M4

18. Sickle cell anemia refers to

(A) hemoglobin SC

(B) hemoglobin SS*

(D) hemoglobin SS and SC

19. Choose the BEST statement about sickle cell anaemia.

(A) an autosomal dominant disease

(B) rarely due to the same mutation in unrelated individuals

(D) caused by mutations in either the alpha-globin gene or the beta-globin gene

20. What are the two major types of thalassemia?

(A) beta and theta

(B) alpha and beta*

(D) beta and omega

21. The term refer to less colour of red blood cells is

(A) microcytic

(B) macrocytic

(D) hyperchromic

22. The physician orders a patient with suspected iron-deficiency anemia a blood smear test to assess the quality of the red blood cells. How would the red blood cells appear if the patient had iron- deficiency anemia?

(A) hypochromic and microcytic*

(B) hypochromic and macrocytic

(D) hyperchromic and macrocytic

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

(A) decreased serum ferritin level

(B) decreased transferrin saturation

(D) decreased mean corpuscular hemoglobin concentration in red blood cells

24. In addition to measuring serum vitamin B12 and folate levels, the most useful ancillary tests for determining B12 deficiency as the cause for megaloblastic anaemia are

(A) lactate dehydrogenase and bilirubin

(B) a Schilling test and bone marrow exam*

(D) parietal cell antibodies and an anti-nuclear antibody (ANA) panel

25. The nurse is reviewing the laboratory report of a client who underwent a bone marrow biopsy. The finding that would most strongly support a diagnosis of acute leukemia is the existence of a large number of immature:

(A) leukocyte*

(B) reticulocytes

(D) thrombocytes

26. Morphologic features commonly seen in the peripheral blood of patients with megaloblastic anemia include

(A) macrocytes, polychromasia, and pseudo Pelger-Huet cells

(B) dimorphic RBC’s, basophilic stippling, and dysplastic WBCs

(D) oval macrocytes, teardrop cells, and hypersegmented neutrophils*

27. The nurse is reviewing the laboratory report of a client who underwent a bone marrow biopsy. The finding that would most strongly support a diagnosis of acute leukaemia is the existence of a large number of immature

(A) leukocytes*

(B) lymphocytes

(D) thrombocytes

28. The most common translocation found in patients with chronic myelogenous leukemia is

(A) t(8;21)

(B) t(9;22)*

(D) t(15;17)

29. Which chromosomal abnormality is diagnostic in CML?

(A) Auer body

(B) Philadelphia chromosome*

(D) deletion of the short arm of chromosome 13

30. If you are missing one of the four alpha chain genes, then you are which type of alpha thalassemia?

(A) silent carrier*

(B) haemoglobin H disease

(D) alpha thalassemia major

SECTION B: SHORT ANSWER QUESTIONS (30 MARKS)

ANSWER ALL QUESTIONS

1. a. Explain characteristics of megaloblastic anaemia. (4 Marks)

macrocytic

MCV >100 fL

large immature and dysfunctional RBC (megaloblast)

delayed nucleus maturation due to defective in DNA synthesis

vitamin B12

folate

b. List THREE (3) causes of vitamin B12 and folic acid deficiencies. (6 Marks)

2. a. Define microcytic hypochromic red blood cell. (2 Marks)

b. Discuss THREE (3) common causes of iron deficiency anaemia. (6 Marks)

c. Explain therapeutic strategies for the treatment of iron deficiency anaemia. (2 Marks)

3. A patient has received a medication that has caused significant haemolysis. Laboratory analysis also showed increase number of reticulocyte.

a. Upon assessment, what is the expected colour of the patient’s urine sample? (1 Mark)

b. Justify your answer in question 3(a). (6 Marks)

c. Provide reason why there is an increase number of reticulocyte count. (3 Marks)

SECTION C: ESSAY QUESTIONS (40 MARKS)

ANSWER TWO (2) QUESTIONS ONLY

Question 1

Discuss what the differences between macrocytic anaemia and microcytic anaemia. (20 Marks)

macrocytic

MCV high
>100
B12 or folic acid deficiency
megaloblastic
non megablastic
alcoholism
liver ds
reticulocytosis
defective DNA synthesis

microcytic

MCV low
<80
Hb production deficiency
IDA
thalassemia
ACD
sideroblastic
defective Hb synthesis

Question 2

Describe primary and ancillary laboratory test that are used to diagnose acute leukemia. (20 Marks)

primary

ancillary

Question 3

By using a diagram, explain how alpha thalassemia is inherited. (20 Marks)

https://thalassaemia.org.cy/education/learn-about-thalassaemia/haemoglobin-disorders/alpha-thalassaemia/

February 2018

SECTION A: OBJECTIVE QUESTIONS (30 MARKS)

CHOOSE ONE BEST STATEMENT TO ANSWER THE QUESTION

1. Leukocytes that have a neutral blue or pink cytoplasm and a nucleus that has 2 – 5 lobes are

(A) basophils

(B) neutrophils*

(D) lymphocytes

2. Which of the following morphological classifications BEST describes the haemolytic anemia?

(A) microcytic, hypochromic

(B) normocytic, hypochromic

(D) normocytic, normochromic

https://quizlet.com/21427352/practice-questions-for-hematology-flash-cards/

3. Iron deficiency anemia is classified as

(A) microcytic, hypochromic*

(B) macrocytic, hypochromic

(D) normocytic, normochromic

4. The absorption of vitamin B12 needs the help of

(A) zinc

(B) vitamin C

(D) hydrogen chloride

5. Which of the following BEST indicates intravascular hemolysis?

(A) hemoglobinuria*

(B) increased reticulocytes

(D) increased serum bilirubin

6. Osmotic fragility test (OFT) is used for the diagnosis of

(A) thalassemia*

(B) sickle cell anemia

(D) hereditary spherocytosis*

7. Favism may be associated with

(A) iron deficiency anemia

(B) non-glycolythic enzyme deficiency

(D) glucose-6-phosphate-dehydrogenase deficiency*

8. Hemoglobinuria, hemosiderinuria and hemoglobinaemia are good indicators of

(A) intravascular hemolysis*

(B) intracorpuscular defects

(D) ineffective erythropoiesis

9. The primary cause of megaloblastic anemia is

(A) increased loss

(B) malabsorption*

(D) decreased dietary intake

10. Excess iron in the body is stored as

(A) transferrin

(B) hemoglobin

(D) transcobalamin

11. An osmotic fragility test shows initial hemolysis of the red cells at 0.70% NaCl. This is MOST consistent with

(A) hereditary ovalocytosis

(B) hereditary spherocytosis

(D) glucose-6-phosphate dehydrogenase deficiency

12. The laboratory test used for screening unstable haemoglobin is

(A) Coomb’s test

(B) heat instability test

(D) haemoglobin electrophoresis*

13. Which of the following haemolytic anemia is caused by membrane defect?

(A) thalassemia

(B) sickle cell anemia

(D) hereditary spherocytosis*

14. Hypersegmented neutrophils are frequently found in

(A) aplastic anemia

(B) sideroblastic anemia

(D) iron deficiency anemia

15. Which of these abnormal cells in the peripheral blood film show signs of haemolytic anemia?

(A) microcytes

(B) macrocytes

(D) polychromasis

16. The commonly used classification system for leukemia is the

(A) French American British*

(B) French Australian British

(D) French American Belgium

17. Following haemorrhage, coagulation is activated by

(A) endothelium

(B) vasoconstriction

(D) contact activation with collagen

18. What morphological leukocyte anomaly is shown by the arrow in Figure 1?

(A) dohle body

(B) toxic granule

(D) hypersegmented-->6 lobes

Figure 2

19. Which is the further confirmation test for Figure 2?

(A) Schilling test

(B) bleeding time

(D) Hb electrophoresis for Hb S*

20. Presence of “Gold-ball” appearance of red blood cells indicates

(A) aplastic anemia

(B) Hemoglobin F disease

(D) Bart’s hydrops fetalis syndrome

21. Non-functioning bone marrow can be described as

(A) aplastic anemia*

(B) hemolytic anemia

(D) megaloblastic anemia

22. Hemophilia A is a deficiency of factor

(A) X

(B) XI

(D) VII

23. The diagnosis of leukemia may be suspected when haematocrit test demonstrate or resulted in

(A) hemolysis

(B) heavy buffy coat

(D) high haematocrit value

24. The Philadelphia chromosome is MOST often associated with

(A) Acute Myeloid Leukemia (AML)

(B) Chronic Myeloid Leukemia (CML)*

(D) Chronic Lymphoblastic Leukemia (CLL)

25. Platelet adhesion requires the presence of

(A) calcium

(B) thrombin

(D) Von Willebrand factor

26. Which of the following test is MOST helpful in diagnosis of thalassemia?

(A) Coomb test

(B) bone marrow iron stain

(D) serum iron and iron binding capacity

27. How many blast cells in the bone marrow aspirate smear are necessary for a diagnosis of acute leukemia using the World Health Organization (WHO) criteria?

(A) 10%--ALL

(B) 20%*--AML

(D) 40%

28. Which of the following is NOT the response to vascular damage in normal hemostasis?

(A) circulating platelets

(B) the blood vessel wall

(D) blood coagulation factors

29. The following are common clinical symptoms for chronic myeloid leukemia EXCEPT

(A) fatigue

(B) weight gain*

(D) loss of appetite

30. All of the following stains can be used to differentiate acute myeloid leukemia (AML) EXCEPT

(A) Leishman*

(B) Sudan black B

(D) periodic acid Schiff--ALL

SECTION B: SHORT ANSWER QUESTIONS (30 MARKS)

ANSWER ALL QUESTIONS

1. a. State the action of glucose-6-phosphate dehydrogenase (G6PD). (4 Marks)

b. Define G6PD deficiency. (2 Marks)

c. List FOUR (4) agents that cause hemolytic anemia in G6PD deficiency. (4 Marks)

2. a. Define iron deficiency anemia (IDA). (2 Marks)

decreased availability of dietary iron + chronic blood loss from parasitic infection

not enough iron to produce Hb

b. Give THREE (3) etiology of iron deficiency anemia. (3 Marks)

increased demand of iron: pregnancy, iron depletion occurs more rapid

malabsorption: after gastrectomy, impaired iron absorption due to absence of gastric juice which helps to solubilize and reduce dietary iron into the more easily absorbed ferrous form

chronic blood loss: GIT, each ml blood loss, 0.5 mg iron loss

hemodialysis: decreased EPO production, functional iron deficiency

c. List FIVE (5) laboratory diagnosis of iron deficiency anemia. (5 Marks)

CBC

serum iron low

TIBC high

ferritin low

transferrin saturation low

reticulocyte low

elevated platelet

low Hct

low Hb

low MCV

3. a. Illustrate on the gene map, genotype and clinical syndrome of alpha thalassemia and beta thalassemia. (5 Marks)

b. Draw a simple chart to show how thalassemia is inherited from thalassemia carriers. (5 Marks)

SECTION C: ESSAY QUESTIONS (40 MARKS)

ANSWER TWO (2) QUESTIONS ONLY

Question 1

Differentiate the classification of acute leukemia and chronic leukemia based on clinical and laboratory manifestations. (20 Marks)

Acute

all ages
sudden onset
weeks to months (<6 months)
>20% blasts, some mature forms
mild to severe anemia
mild to severe thrombocytopenia
variable WBC
mild lymphadenopathy
mild splenomegaly
very aggressive

Chronic

adults
insidious onset
months to years (2~6 y)
mature forms
mild anemia
mild thrombocytopenia
increased WBC
present, often lymphadenopathy
present, often splenomegaly
less aggressive

Question 2

Explain the collection, handling and processing of samples for coagulation studies. (20 Marks)

Question 3

Illustrate and classify hemolytic anemia based on site of hemolysis. (20 Marks)

Intravascular hemolysis

activation of complement on RBC's membrane

physical or mechanical trauma to RBC

presence of soluble toxic substances in RBC's environment

hemoglobinemia, hemoglobinuria, hemosiderinuria, methamoglobinemia, decreased haptoglobin and hemopexin

Extravascular hemolysis

no hemoglobinemia, hemoglobinuria and hemosiderinuria

Hb degrade into heme, iron, globin

September 2017

SECTION A: OBJECTIVE QUESTIONS (30 MARKS)

CHOOSE ONE BEST STATEMENT TO ANSWER THE QUESTION

1. Anisopoikilocytosis indicates a change in erythrocytes in terms of

(A) size

(B) shape

(D) size and shape*

2. Which neutrophils are capable of chemotaxis?

(A) auer rod*

(B) avian heterophil

(D) segmented neutrophils

3. What is the normal daily requirement for folic acid?

(A) 10 mg/day

(B) 20 mg/day

(D) 0.2 mg/day

4. Which of the following is the lab finding of Iron Deficiency anemia?

(A) iron store increased

(B) hemoglobin normal--low

(D) reticulocyte increases--decreases

5. Which form of iron can be visualized in Prussian blue stain?

(A) heme

(B) ferritin

(D) hemosiderin*

https://quizlet.com/120536115/chapter-12-quiz-flash-cards/

6. The absorption of cobalamin acquire the help of

(A) folic acid

(B) vitamin C

(D) intrinsic factor*

7. Excessive denaturation of haemoglobin within the red blood cell is denoted by the presence of

(A) heinz bodies*

(B) dohle bodies

(D) siderocytic granules

8. Enzyme glucose-6-phosphate-dehydrogenase (G6PD) deficiency is a disease due to a/an

(A) acquired defect

(B) membrane defect

(D) sex-linked recessive gene

9. A bone marrow failure syndrome that results from damaged or defective stem cells is

(A) thalassemia

(B) aplastic anemia*

(D) liver enlargement

10. Presence of nucleated red cell indicates

(A) malnutrition

(B) malabsorption

(D) decreased red cell production

11. An absolute neutrophils count of <0.5X103/dL is useful in considering the diagnosis of

(A) liver enlargement

(B) malformed kidney

(D) bone marrow failure*

12. Condition in which red cell count, white cell count and platelet count lower than normal is known as

(A) anemia

(B) leukemia

(D) polycythaemia

13. Bite cells and polychromasia are seen in (hemolytic anemia)

(A) leukemia

(B) thalassemia

(D) bone marrow failure

14. All of the following are seen in Hereditary spherocytosis lab finding, EXCEPT

(A) Serum iron increased

(B) Stercobilinogen decreased

(D) Unconjugated bilirubin increased

15. Which of the following is a common feature of leukemia?

(A) anemia

(B) enlarged spleen

(D) excess white cells in the bone marrow*

16. Which of the following does NOT cause folate deficiency?

(A) veganism*--B12

(B) pregnancy

(D) gluten sensitivity

17. Hydrops fetalis is also known as

(A) beta thalassemia major

(B) beta thalassemia minor

(D) alpha thalassemia minor

18. “Shift to the left” in white cell differential count means

(A) presence of leukocytosis

(B) presence of erythrocytosis

(D) presence of immature white cells*

19. Which of the following cell morphology is shown by the arrow in Figure 1?

(A) elliptocyte

(B) spherocyte

(D) rouleaux formation*

Figure 2

20. Which of the following anemia demonstrated by the clinical feature shown in Figure 2?

(A) thalassemia

(B) hemolytic anemia

(D) iron deficiency anemia*

21. The bone marrow biopsy shown in Figure 3 can be seen in

(A) thalassemia

(B) aplastic anemia*

(D) glucose-6-phosphate dehydrogenase deficiency

Figure 4

22. Name the type of leukemia cells shown in Figure 4

(A) plasma cell leukemia

(B) Philadelphia chromosome*

(D) Large granular lymphocytic leukemia

23. In beta thalassemia major, which types of hemoglobin is reduced or absent?

(A) Hb F*

(B) Hb H--3 alpha gene deletion

(D) Hb A2--minor

24. Alpha thalassemia major is caused by deletion of which alpha globulin chains?

(A) 1

(B) 2

(D) 4*

25. Bleeding time test used to assess

(A) platelets*

(B) hemoglobin

(D) white blood cells

26. If a patient were deficient in Von Willebrand Factor, which test result would be abnormal?

(A) leukopenia

(B) iron ferritin

(D) bleeding time--prolonged

27. Chronic Myeloid Leukemia (CML) is associated with translocation of

(A) Chromosome 7-11

(B) Chromosome 9-22*

(D) Chromosome 20-22

28. Which type of acute leukemia shows the blast cells with peroxidase positive?

(A) Acute myeloid leukemia*

(B) Acute monocytic leukemia

(D) B lineage acute lymphotic leukemia

• PT – prolonged

• PTT – normal

29. Which coagulation factor deficiency MOST suitable with the criteria in Figure 5.

(A) V

(B) VI

(D) VIII

30. A patient serum has decreased vitamin B12. The Schilling test detects labeled B12 in the urine when it is given with intrinsic factor. What is the correct interpretation?

(A) leukemia

(B) malabsorption

(D) vitamin B12 deficiency*

SECTION B: SHORT ANSWER QUESTIONS (30 MARKS)

ANSWER ALL QUESTIONS

1. a. Briefly discuss THREE (3) classification of aplastic anemia. (6 Marks)

severe: BM cellularity <30%, ANC <500, platelet <20k

very severe: absolute neutrophil count <200/mm3

mild/moderate: pancytopenia, not fulfill criteria of severe

non severe: hypocellular BM

b. State FOUR (4) laboratory findings of aplastic anemia. (4 Marks)

2. a. Describe the genetic basic of Chronic Myeloid Leukemia. (2 Marks)

translocation of Ph chromosome t(9:22)

b. Give THREE (3) clinical features of Chronic Myeloid Leukemia. (3 Marks)

30% asymptomatic

fatigue

malaise

anorexia

weight loss

spenomegaly

c. List FIVE (5) laboratory diagnosis of Chronic Myeloid Leukemia. (5 Marks)

Hb concent. decrease

nucleated red cells

leukocyte count >25000/uL

basophil count increase

normal or increase platelet

NAP low or absent

3. a. State FOUR (4) mechanisms of haemostasis. (4 Marks)

vasoconstriction

platelet plug formation (primary hemostasis)

blood coagulation (secondary hemostasis)

fibrinolysis system

b. With the help of a diagram, show the blood coagulation pathway. (6 Marks)

SECTION C: ESSAY QUESTIONS (40 MARKS)

ANSWER TWO (2) QUESTIONS ONLY

Question 1

Discuss iron deficiency anemia (IDA) and the laboratory investigation. (20 Marks)

Question 2

Outline the pathophysiology and laboratory findings for both alpha thalassaemia and beta thalassaemia. (20 Marks)

Alpha thalassemia
Hydrops fetalis	--/--	Severe anemia Generalized edema Splenomegaly Death in utero
Hb H disease	-α/--	Moderate to severe microcytic anemia Hepatomegaly
Alpha thalassemia trait	-α/α- or --/αα	Asymptomatic Mild hypochromic microcytic anemia
Silent carrier	-α/αα	No sign
Beta thalassemia
Thalassemia major	Homozygous β⁰β⁰	Cooley’s anemia Hepatosplenomegaly Iron overload Prominent Hb F
Thalassemia intermedia	β⁺β⁺/β⁺β⁰ β^Eβ⁺/β^Eβ⁰	Mild to moderate anemia Possible extramedullary hematopoiesis Iron overload
Thalassemia minor	Heterozygous β⁰β⁺	Mild anemia Bone deformity Extramedullary erythropoiesis Hb A₂ level increases
Sickle cell anemia	Homozygous Hb SS and Hb SC	Leg ulcers Hemolytic anemia with jaundice Microvascular disruption of organs No Hb A is detected Prominent Hb S

alpha lab

low MCV, MCH
hypochromic
microcytic
anemia

beta lab

low MCV, MCH
hypochromic
microcytic
Hb electrophoresis:

major: HbF
minor: HbA2

Question 3

Describe Megaloblastic anemia in term of clinical feature and laboratory diagnosis. (20 Marks)

clinical feature

fatigue
dyspnea
glossitis
mild jaundice
vertigo
purpura
dyspepsia
early graying of hair

lab

PBF: anisocyte, poikilocyte, macrocyte, ovalocyte, teardrop, Howell-Jolly bodies, hypersegmented neutrophils, macropolycyte
high MCV
normal MCHC
low reticulocyte due to destruction to fragile and abnormal megaloblastic erythroid precursor
megaloblastic hyperplasia in BM
low serum B12
low serum folate

January 2017

SECTION A: OBJECTIVE QUESTIONS (30 MARKS)

CHOOSE ONE BEST STATEMENT TO ANSWER THE QUESTION

1. Blood for complete blood count (CBC) should normally be anticoagulated with

(A) EDTA*

(B) Citrate

(D) Fluoride

2. The measurement most likely to correlate with hypochromia observed on a blood film is

(A) pack cell volume (PCV)

(B) mean corpuscular volume (MCV)

(D) mean corpuscular hemoglobin concentration (MCHC)*

3. Which statement is TRUE about reticulocytes?

(A) raised after hemorrhage*

(B) contains DNA but no RNA--no nucleus

(D) count is increased in megaloblastic anemia--not increased

https://books.google.com.my/books?id=Qr5dEAAAQBAJ&lpg=PA16&ots=HC5kIvwQ2B&dq=Which%20statement%20is%20TRUE%20about%20reticulocytes%3F%20(A)%20raised%20after%20hemorrhage%20(B)%20contains%20DNA%20but%20no%20RNA%20(C)%20decreased%20after%20hemorrhage%20(D)%20count%20is%20increased%20in%20megaloblastic%20anemia&pg=PA20#v=onepage&q=Which%20statement%20is%20TRUE%20about%20reticulocytes?%20(A)%20raised%20after%20hemorrhage%20(B)%20contains%20DNA%20but%20no%20RNA%20(C)%20decreased%20after%20hemorrhage%20(D)%20count%20is%20increased%20in%20megaloblastic%20anemia&f=false

4. The commonly used classification system for leukemia is the ____________ system.

(A) Finland Australia Brazil (FAB)

(B) French American British (FAB)*

(D) French American Belgium (FAB)

5. In which of the following conditions iron absorption will be increased?

(A) pregnancy*

(B) phosphates

(D) chronic inflammation

6. Which of the following have decreased osmotic fragility?

(A) thalassemia*--B major

(B) megaloblastic anemia

(D) hereditary spherocytosis

7. What is the appearance of the bone marrow in aplastic anemia?

(A) fibrosis

(B) hypocellular*

(D) normocellular

8. Typical dominant hereditary spherocytosis is commonly caused by deficiency of

(A) Band 3

(B) Ankyrin

(D) Protein 4.2

9. Incubation increases the sensitivity of osmotic fragility test by

(A) increasing the MCV

(B) dehydration of the cell

(D) increasing the loss of surface area

10. Howell-Jolly bodies contain

(A) iron

(B) RNA

(D) protein

https://quizlet.com/575007040/erythrocyte-inclusions-flash-cards/

11. The least common type of white blood cell on a normal smear is

(A) basophil*

(B) monocyte

(D) lymphocyte

12. In iron deficiency anemia (IDA), there is an increase in

(A) serum iron

(B) hemoglobin

(D) total iron binding capacity*

13. The mean corpuscular hemoglobin for iron deficiency anemia is

(A) normal

(B) increased

(D) 27 to 32 μg

14. Polycythemia vera is characterized by

(A) a pancytopenia

(B) fluctuate of all cell lines

(D) an absolute increase in one cell line

15. Drabkin’s solution contains

(A) cyanide*

(B) sulfuric acid

(D) magnesium sulfate

16. The following indices are low in cases of thalassemia, EXCEPT

(A) MCH

(B) MCV

(D) MCHC

17. Which of the following is a microcytic hypochromic anemia?

(A) aplastic anemia--normocytic, normochromic

(B) sickle cell anemia--normocytic, normochromic

(D) thalassemia major*

IDA, ACD

18. Figure 1 arrows demonstrate which of the following cell morphology?

(A) elliptocyte*

(B) spherocyte

(D) acanthocyte

Figure 2

19. Figure 2 screening test usually used for

(A) thalassemia screening

(B) aplastic anemia screening

(D) glucose-6-phosphate dehydrogenase deficiency screening*

20. Name the type of leukemia cells shown in Figure 3?

(A) plasma cell leukemia

(B) B-Hairy cell leukemia*

(D) Large granular lymphocytic leukemia

Figure 4

21. What is the type of alpha thalassemia shown in Figure 4?

(A) Hb – H disease*

(B) Erythroblastosis fetalis

(D) Silent carrier of α thalassemia

22. Which of the following is TRUE about von Willebrand factor (VWF)?

(A) it carries factor IX

(B) it cross links platelet to each other

(D) it is functional in largest multimeric form

23. Which of the following is the strongest activator of platelet?

(A) thrombin*

(B) serotonin

(D) thromboxane A2

24. The diagnosis of leukemia may be suspected when hematocrit test demonstrate or result in

(A) hemolysis

(B) heavy buffy coat

(D) high hematocrit value

25. The inheritance pattern of von Willebrand disease (vWD) is usually

(A) X – linked

(B) non hereditary

(D) autosomal dominant

26. Patient with polycythemia vera has increased

(A) RBC*

(B) WBC

(D) All of the above

27. Which of the following is TRUE regarding polycythemia vera?

(A) bone marrow biopsy is not required

(B) males are more effected than females

(D) hematocrit should be kept below 0.45 in both males and females

28. The characteristic red cell indices in hereditary spherocytosis are:

(A) Low MCV, high MCHC, increased RDW

(B) Low MCV, increased MCHC, decreased RDW

(D) High MCV, increased MCHC, decreased RDW

Figure 5

• Hb = 7.8 gm/dL

• Reticulocyte = 0.8%

• Hb A2 = 2.4%

• Hb F = 1.3%

• Serum iron = 15 mg/dL

• TIBC = 420 mg/dL

• Blood smears = microcytic, hypochromic

29. Which of the following condition is potentially associated with results in Figure 5?

(A) Sideroblastic anemia

(B) Iron deficiency anemia*

(D) Anemia of chronic inflammation

30. The presence of hypersegmented neutrophil and Howell-Jolly bodies on the peripheral blood smear is most indicative of

(A) sideroblastic anemia

(B) megaloblastic anemia*

(D) anemia of chronic disorders

SECTION B: SHORT ANSWER QUESTIONS (30 MARKS)

ANSWER ALL QUESTIONS

1. a. Define iron deficiency anemia (IDA). (2 Marks)

b. State changes in the peripheral blood film of IDA. (4 Marks)

microcytic, hypochromic

poikilocytosis

c. Discuss the laboratory investigation for the case of iron deficiency anemia. (4 Marks)

2. a. Define extravascular and intravascular hemolysis (2 Marks)

EV spleen, liver, lymph nodes, RES mediated

IV RBC destruction in blood vessel

b. Give TWO (2) examples for each of the following:

i. Metabolic defects: G6PD, pyruvate kinase deficiency

ii. Membrane defects: hereditary spherocytosis, hereditary elliptocytosis

iii. Immune system disorder: autoimmune, drug induced

iv. Haemoglobin structure defects: sickle cell, thalassemia

enzyme ds

antagonistic plasma factors: intracellular parasites, infectious agents

traumatic physical cell injury: march hemoglobinuria, thermal injury

(8 Marks)

3. a. Differentiate between acute leukemia and chronic leukemia. (8 Marks)

Acute

all ages
sudden onset
weeks to months (<6 months)
>20% blasts, some mature forms
mild to severe anemia
mild to severe thrombocytopenia
variable WBC
mild lymphadenopathy
mild splenomegaly
very aggressive

Chronic

adults
insidious onset
months to years (2~6 y)
mature forms
mild anemia
mild thrombocytopenia
increased WBC
present, often lymphadenopathy
present, often splenomegaly
less aggressive

b. Describe the relation between leukemia and anemia. (2 Marks)

people with leukemia are more likely to develop anemia

anemia reduction in RBC

leukemia blood cancer

SECTION C: ESSAY QUESTIONS (40 MARKS)

ANSWER TWO (2) QUESTIONS ONLY

Question 1

Summarize the mechanism of hemostasis. (20 Marks)

Question 2

Outline both polycythemia vera and hyperviscosity. (20 Marks)

Question 3

Describe glucose-6-phosphatase deficiency in term of pathogenesis and clinical feature in laboratory diagnosis. (20 Marks)

August 2016

SECTION A: OBJECTIVE QUESTIONS (30 MARKS)

CHOOSE ONE BEST STATEMENT TO ANSWER THE QUESTION

1. Which of the following deficiency would most likely lead to megaloblastic anemia?

(A) iron deficiency

(B) folic acid deficiency*--V B12

(D) vitamin B6 deficiency

2. Which of the following features are related to an iron deficiency anemia patient?

(A) microcytic, hypochromic red cells*

(B) macrocytic, hypochromic red cells

(D) microcytic, normochromic red cells

3. With increased intravascular hemolysis, which of the following condition will likely to occur?

(A) urine hemosiderin will increased*

(B) the reticulocyte count will decrease

(D) unconjugated bilirubin levels will remain normal

4. In relative polycythemia, the red cell mass is

(A) normal

(B) elevated

(D) fluctuated

5. Mean corpuscular volume (MCV) in hemolytic anemia is

(A) 40 – 60 fL

(B) 60 – 80 fL

(D) 100 – 120 fL

6. Which of the following is characteristic of pernicious anemia?

(A) antibodies to gastric HCl

(B) decreased absorption of folate

(D) increased production of intrinsic factor

7. Abnormal red blood cell shapes typically seen in liver disease is

(A) teardrops--MPD

(B) target cells*

(D) schistocytes--HUS

elliptocyte--IDA, Hb S, Thalassemia

https://www.slideshare.net/Sajjan55/abnormal-red-blood-cell-morphologies

8. In sickle cell disease, which type of hemoglobin will be seen on hemoglobin electrophoresis?

(A) Hemoglobin A

(B) Hemoglobin H

(D) Hemoglobin Z

9. A patient’s peripheral blood smear shows hypochromic/microcytic red blood cell. Which of the following anemia he might have?

(A) polycythemia

(B) aplastic anemia

(D) megaloblastic anemia

10. Second stage in the development of iron deficiency anemia is

(A) TIBC decreases--high

(B) serum iron increases

(D) erythropoiesis in the bone marrow becomes affected--iron

11. Which of the following condition cause extrinsic red cell defects?

(A) sickle cell disease

(B) hereditary spherocytosis

(D) glucose 6 phosphate dehydrogenase deficiency

12. Which of the following statement about hereditary spherocytosis is correct?

(A) increased MCH

(B) hemolytic anemia

(D) decreased polychromasia

13. Macrocytosis is associated with

(A) thalassemia

(B) folate deficiency*

(D) anemia of chronic disease

14. Which of the following disorder is associated with microcytosis?

(A) thalassemia*

(B) B12 deficiency

(D) anemia of chronic disease

15. Why in acute leukemia the production of blood cells in the bone marrow decreased?

(A) there is a stem cell defect

(B) there is a growth factor deficiency*

(D) the malignant cells replace normal marrow

16. Factor II is also known as

(A) fibrinogen

(B) prothrombin

(D) antihemophilic factor

17. Which of the following causes Vitamin B12 deficiency?

(A) veganism*

(B) jejunal resection

(D) widespread carcinoma

18. Figure 1 is clinical features that demonstrate which of the following anemia?

(A) thalassemia

(B) hemolytic anemia

(D) iron deficiency anemia*

Figure 2

19. Figure 2 bone marrow biopsy can be seen in

(A) thalassemia

(B) aplastic anemia*

(D) glucose-6-phosphate dehydrogenase deficiency

20. Name the type of leukemia cells shown in Figure 3?

(A) plasma cell leukemia

(B) Philadelphia chromosome*

(D) Large granular lymphocytic leukemia

Figure 3

21. What is the further confirmation test for Figure 3?

(A) schilling test

(B) bleeding time

(D) Hb electrophoresis for HbA

22. Rise in platelet counts is associated with

(A) thalassemia

(B) corticosteroid

(D) systemic lupus erythematosus

23. Which of the following does NOT cause folate deficiency?

(A) veganism*

(B) pregnancy

(D) gluten sensitivity

24. Hemophilia A test result typically shows

(A) abnormal PT

(B) abnormal APTT

(D) abnormal von Willebrand factor levels

25. A patient has anemia, decreased RBC indices, and target on the peripheral smear. Serum iron is normal and electrophoresis shows increased HbF and HbA2.What is a possible diagnosis?

(A) beta thalassemia*

(B) alpha thalassemia

(D) anemia of chronic disease

26. Which of the following disorders can be found in the Philadelphia chromosome?

(A) acute lymphocytic leukemia

(B) acute myelogenous leukemia

(D) chronic myelogenous leukemia*

27. What kind of RBC destruction that is caused by the action of external agents such as an antibody against RBC antigens or a prosthetic heart valve?

(A) intrinsic

(B) extrinsic*--autoimmune

(D) extravascular

28. Which of the following clotting factor that can be inhibited by tissue?

(A) factor V and factor II

(B) factor VIIa and factor Xa

(D) factor XIa and factor XIIa

Figure 4

• MCV = 117 fL

• MCH = 37 pg

• MCHC = 320 g/L

• Blood smears = 3+ oval macrocytes, 1+ schistocytes, 1+ teardrops and hypersegmented neutrophils

29. Which of the following condition is potentially associated with results in Figure 4?

(A) thalassemia

(B) liver disease

(D) iron deficiency anemia

Figure 5

• Prothrombin time = 1.1 INR

• Activated partial thromboplastin time = 40 seconds

• Bleeding time = 11 minutes

• Platelet count = 160 X 109/L

30. Which of the following disorder may be indicated by results in Figure 5.

(A) Factor IX deficiency

(B) Factor VIII deficiency

(D) deficiency in extrinsic coagulation pathway

SECTION B: SHORT ANSWER QUESTIONS (30 MARKS)

ANSWER ALL QUESTIONS

1. a. Name THREE (3) causes of hereditary hemolytic anemia. (3 Marks)

b. List THREE (3) tests for hemolytic anemia study. (3 Marks)

c. Generalize the intravascular hemolysis. (4 Marks)

activation of complement on RBC membrane

physical or mechanical trauma to RBC

presence of toxic substances in RBC environment

hemoglobinemia, hemoglobinuria, hemosiderinuria, methamoglobinemia, decreased haptoglobin and hemopexin

2. a. Explain the pathological pathway of glucose-6-phosphate dehyrogenase deficiency. (2 Marks)

b. Enumerate FOUR (4) agents that cause hemolytic anemia in G6PD deficiency. (4 Marks)

c. Identify FOUR (4) laboratory finding for G6PD deficiency. (4 Marks)

3. a. Define prothrombin time (PT). (2 Marks)

measure extrinsic and common factor

b. State the reagent used to determine prothrombin time. (2 Marks)

thromboplastin

calcium chloride

c. Illustrate the overview mechanism of hemostasis. (6 Marks)

https://quizlet.com/298568273/haemostasis-steps-diagram/

SECTION C: ESSAY QUESTIONS (40 MARKS)

ANSWER TWO (2) QUESTIONS ONLY

Question 1

Compare both etiology of primary and secondary aplastic anemia, including the classification and laboratory finding of aplastic anemia. (20 Marks)

Question 2

Critically evaluate the classification of acute leukemia and the laboratory investigation. (20 Marks)

AML

myeloblasts
low RBC
Hb 610 g/dL
high RDW
howell-jolly bodies, Pappenheimer bodies, basophilic stippling (RBC inclusions)
macrocytic
thrombocytopenia
hypogranular platelets
giant platelets
Auer rods
hypercellular BM with decreased fat content

ALL

hyperleukocytosis >100.0*10^9/L), 11~23% patients, T cell ALL
neutropenia
lymphoblasts
normocytic normochromic anemia
thrombocytopenia
high N:C
slightly condensed chromatin
indistinct nucleoli
moderate amount of cytoplasm
finely dispersed chromatin
distinct nucleoli
no Auer rods
marrow densely populated with lymphoblasts >65%
hypercellular BM
>25% lymphoblasts

Question 3

Outline both alpha and beta thalassemia. (20 Marks)

January 2016

SECTION A: OBJECTIVE QUESTIONS (30 MARKS)

CHOOSE ONE BEST STATEMENT TO ANSWER THE QUESTION

1. How much iron is lost daily from body by excretion?

(A) 0.2 – 0.4 mg/day

(B) 0.4 – 0.8 mg/day

(D) 1.0 – 1.5 mg/day*

2. What is the cause of iron deficiency anemia in pregnant woman?

(A) blood loss

(B) malabsorption

(D) increase iron demand*

3. Total iron binding capacity in patient with iron deficiency anemia is

(A) absent

(B) normal

(D) decreased

4. What type of anemia is seen in patients with renal failure?

(A) microcytic, hypochromic

(B) macrocytic, hypochromic

(D) normocytic, normochromic*

5. Heinz bodies are

(A) nuclear-chromatin remnant*

(B) iron granules in red blood cells

(D) denatured globin chain in red blood cells

6. Mean corpuscular volume (MCV) in aplastic anemia is

(A) 40 – 60 fL

(B) 60 – 80 fL

(D) 100 – 120 fL

7. What is the primary change in peripheral blood film (PBF) in megalobastic anemia?

(A) microcytic

(B) macrocytic*

(D) hypochromic

8. What is the chemical name for vitamin B12?

(A) biotin

(B) folic acid

(D) cyanocobalamin*

9. Vitamin B12 is absorbed from which part of intestine?

(A) colon

(B) ileum

(D) duodenum

10. In hemolytic anemia serum haptoglobin is

(A) absent

(B) normal

(D) decreased*

11. Mediterranean anemia is also known as

(A) thalassemia

(B) aplastic anemia

(D) sideroblastic anemia

12. Deficiency of which membrane cytoskeleton causes hereditary spherocytosis?

(A) spectrin

(B) vimentin

(D) neurofilament

13. Which type of gall bladder stones occurs in patients of hereditary spherocytosis?

(A) calcium stones

(B) pigment stones

(D) cholesterol stones

14. Osmotic fragility is ___________ in hereditary spherocytosis.

(A) normal

(B) fluctuate

(D) decreased

15. Methaemalbuminaemia is seen in

(A) sickle cell anemia

(B) iron deficiency anemia

(D) extravascular hemolysis

16. Bite cells are seen commonly in which condition?

(A) thalassemia*

(B) acute leukemia

(D) glucose-6-phosphate dehydrogenase deficiency*

17. Which hemoglobin (Hb) is raised in beta-thalassemia major?

(A) Hb A

(B) Hb B

(D) Hb G

18. How long is the life span of red blood cells in hereditary spherocytosis?

(A) 10 – 20 days

(B) 30 – 40 days

(D) 110 – 120 days

19. Figure 1 bone marrow films demonstrate which of the following anemia?

(A) thalassemia

(B) hemolytic anemia

(D) iron deficiency anemia*

Figure 2

20. Name the type of alpha-thalassemia shown in Figure 2?

(A) Hb H disease 3

(B) Hydrops fetalis 4

(D) heterozygous alpha-thalassemia trait 2

21. Name the type of leukemia cells shown in Figure 3?

(A) plasma cell leukemia

(B) B-Hairy cell leukemia*

(D) Large granular lymphocytic leukemia

22. Hair-on-end appearance of skull in X-ray seen in which disease?

(A) thalassemia

(B) chronic leukemia

(D) hereditary spherocytosis

23. Inhalation of benzene vapours causes which type of anemia?

(A) thalassemia

(B) aplastic anemia*

(D) megaloblastic anemia

24. For diagnosis of acute leukemia, number of blast cells in the bone marrow should be

(A) less than 30% bone marrow cells

(B) less than 80% bone marrow cells

(D) more than 80% bone marrow cells

25. Person with sickle cell anemia is resistant to which malaria/parasite?

(A) plasmodium vivax

(B) plasmodium malariae

(D) plasmodium falciparum*

26. Increased number of basophils is seen in which type of leukemia?

(A) acute myeloid leukemia

(B) acute lymphoid leukemia

(D) chronic lymphoid leukemia

27. What type of hyperbilirubinemia is seen in beta-thalassemia major?

(A) free bilirubin

(B) direct hyperbilirubinemia

(D) unconjugated hyperbilirubinemia*

28. Which of the following test results is normal in a patients with classic von Willebrand’s disease?

(A) Factor VIII

(B) platelet count*

(D) activated partial thromboplastin time (APTT)--prolonged

Figure 4

• Bleeding time = prolonged

• Platelet count = normal

• Prothrombin time = normal

• Activated partial thromboplastin time = prolonged

29. Which of the following disorders is MOST consistent with result in Figure 4?

(A) Hemophilia A

(B) Hemophilia B

(D) von Williebrand’s disease*

• Prothrombin time = normal

• Activated partial thromboplastin time = prolonged

• Bleeding time = increased

• Platelet count = normal

• Platelet aggregation = abnormal

30. Which of the following disorders may be indicated by result in Figure 5.

(A) Hemophilia A

(B) Factor IX deficiency

(D) von Williebrand’s disease*

ANSWER ALL QUESTIONS

1. a. State FOUR (4) mechanisms of hemostasis. (4 Marks)

b. List FOUR (4) tests for blood coagulation study. (4 Marks)

c. With the help of diagram, show the blood coagulation pathway. (8 Marks)

2. a. Define Philadelphia chromosome. (2 Marks)

translocation of chromosome 9 and 22

b. Recall FOUR (4) laboratory diagnosis for chronic myeloid leukemia. (4 Marks)

PBF

cytogenetic

molecular

3. a. Draw gene map and give genotype:

i. alpha-thalassemia (4 Marks)

ii. beta-thalassemia (4 Marks)

SECTION C: ESSAY QUESTIONS (40 MARKS)

ANSWER TWO (2) QUESTIONS ONLY

Question 1

Create a standard operating procedure (SOP) for laboratory investigation of iron deficiency anemia. (20 Marks)

Question 2

Illustrate and classify hemolytic anemia. (20 Marks)

Question 3

Outline megaloblastic anemia in details including vitamin B12 and folate acid deficiency. (20 Marks)

fatigue, dyspnea, vertigo, purpura, glossitis, mild jaundice, dyspepsia, early graying of hair

B12

pernicious, lack IF
malabsorption
veganism
Schilling test: oral-labelled V B12 57Co and 58Co
low serum B12
tx: hydroxocobalamin

folate

excess utilization: pregnancy, lactation
malabsorption
gluten induced enteropathy
excess urinary folate loss: active liver ds, congenital heart failure
low serum folate
tx: folic acid supplement

August 2015

SECTION A: OBJECTIVE QUESTIONS (30 MARKS)

CHOOSE ONE BEST STATEMENT TO ANSWER THE QUESTION

1. Spherocytes in the blood film is a feature of

(A) reticulocytosis

(B) thalassaemia major

(D) Glucose-6-phosphate dehydrogenase (66PD) deficiency

2. Hereditary spherocytosis is

(A) more common in males

(B) caused by membrane defect*

(D) caused by an inherited defect in hemoglobin

3. Which of the following is a common feature of leukemia?

(A) anemia

(B) enlarged spleen*

(D) excess white cells in the bone marrow

4. Which of the following condition is present in intravascular hemolysis present in one of these conditions?

(A) jaundice

(B) absent haptoglobins*--decreased

(D) absent hemosiderin in urine

5. Which of the following does NOT cause folate deficiency?

(A) veganism*

(B) pregnancy

(D) gluten sensitivity

6. Non-functioning bone marrow can be described as

(A) aplastic anemia*

(B) hemolytic anemia

(D) megaloblastic anemia

7. Cyanocobalamin is also known as

(A) folic acid

(B) vitamin K

(D) vitamin B12*

8. Vitamin B12 deficiency can be detected by

(A) Coombs test

(B) schilling test*

(D) osmotic fragility test

9. Presence of “Golf-ball” appearance of red blood cells indicates

(A) aplastic anemia

(B) Hemoglobin F disease

(D) Bart’s hydrops fetalis syndrome

10. Hemolysis in patients deficiency in G-6PD deficiency occurs due to formation of

(A) Heinz bodies

(B) Dohle bodies

(D) Pappenheimer bodies

11. The molecular pathology in hereditary spherocytosis is due to

(A) gene deletions

(B) point mutation

(D) balanced chromosomal translocation

12. Which of the following BEST describe for Figure 1?

Figure 1

Decrease in the count of all or one granulocytic component

(A) leukopenia*

(B) leukocytosis

(D) agranulocytosis

13. Factor II is also known as

(A) fibrinogen

(B) prothrombin*

(D) antihemophilic factor

14. Which of the following causes Vitamin B12 deficiency?

(A) veganism*

(B) jejunal resection

(D) widespread carcinoma

15. Which of the following is known as formation of a blood clot?

(A) chemotaxis

(B) coagulation*

(D) erythropoiesis

16. Rise in platelet counts is associated with

(A) corticosteroid

(B) Evan’s syndrome

(D) systemic lupus erythematosus

17. Which of the following test is most helpful in diagnosis of thalassemia?

(A) Coomb test

(B) bone marrow iron stain

(D) serum iron and iron binding capacity

18. If a patient were deficiency of Factor VII, which of the following test result would be abnormal?

(A) clotting time

(B) bleeding time

(D) activated partial thromboplastin time

19. From these clinical features, choose the ones that are commonly suffered by patients with chronic myeloid leukemia.

(A) enlarged spleen*

(B) swelling of the gums

(D) bone marrow failure with reduced peripheral blood cell count

20. Acute myeloid leukemia is

(A) most common in children

(B) never caused by chemotherapy

(D) associated with more than 20% blast cells in the bone marrow*

21. Philadelphia chromosome is associated with translocation of

(A) Chromosome 7-11

(B) Chromosome 9-22*

(D) Chromosome 20-22

22. Bcl2 over expression is seen in

(A) Burkitts lymphoma

(B) lymphoblastic lymphoma

(D) small lymphocytic lymphoma

23. In beta thalassemia major, which types of the following hemoglobin is reduced or absent

(A) Hb F

(B) Hb H

(D) Hb A2

24. Alpha thalassemia is due to

(A) gene deletion*

(B) defects in transcription

(D) defects in processing or translation of beta-globin mRNA

25. Majority of non-Hodgkin’s lymphoma are

(A) T cell type

(B) B cell type*

(D) mixed cell type

26. The following are lab findings of hemophilia

(A) bleeding time is prolonged

(B) thrombin time is prolonged

(D) activated partial thromboplastin time (APTT) time is prolonged*

27. Von Willebrand’s disease is

(A) occur mainly in males

(B) deficiency of Factor XI

(D) predominantly causes deep muscle and joint haemorrhage

28. Which of the following is NOT the response to vascular damage in normal hemostatic?

(A) Circulating platelets

(B) The blood vessel wall*

(D) Blood coagulation factors

29. Which of the following is CORRECT interpreted of Figure 2.

Figure 2

A patient has menorrhagia and tendency to bleed from minor cuts and wounds. Partial thromboplastin time (PTT) and bleeding times are prolonged.

(A) Hemophilia A

(B) Factor XIII deficiency

(D) Von Williebrand’s disease*

30. Which diseases is the MOST suitable with the criteria in Figure 3.

Figure 3

• Hemoglobin = 14 g/dL--normal, F: 11.5~15.5, M: 13.5~17.5

• White blood cell = 27.109 /L--4.5~11

• Platelets = 10.109 /L--150~400

(A) Thrombocytopenia

(B) B-Hairy cell leukemia

(D) Chronic myeloid leukemia

SECTION B: SHORT ANSWER QUESTIONS (30 MARKS)

ANSWER ALL QUESTIONS

1. a. Classify types of hypochromic microcytic anemia. (2 Marks)

iron deficiency

thalassemia

b. Give expected hematology test results of iron deficiency anemia, including peripheral blood smear and bone marrow findings. (6 Marks)

hypochromic

microcytic

target cells, elliptocytes, teardrop

decreased iron stores in BM assay

hypercellular

erythroid hyperplasia

absence of stainable iron

2. a. Define polycythemia. (2 Marks)

b. State FOUR (4) pathophysiology of polycythemia. (4 Marks)

c. List FOUR (4) etiology of polycythemia. (4 Marks)

3. a. Define the acute leukemia. (2 Marks)

heterogenous grp of malignant ds

uncontrolled clonal

accumulation of blast cells

sudden onset

blast cell malignancy

b. Compare the result of acute leukemia by using cytogenetic and molecular genetic. (6 Marks)

AML: positive M2 in t (8, 21), positive M3 in t (15, 17)

ALL: positive T ALL in t (4, 11) and t (12, 21), positive B ALL in t (1, 19)

c. List FOUR (4) laboratory diagnosis of acute leukemia. (4 Marks)

hypercellular BM

Auer rods in AML

thrombocytopenia

nucleoli

myeloblast in AML >20%

lymphoblast in ALL >20%

SECTION C: ESSAY QUESTIONS (40 MARKS)

ANSWER TWO (2) QUESTIONS ONLY

Question 1

Discuss the pathophysiology and laboratory diagnosis that causes thalassemia. (20 Marks)

Question 2

Describe glucose-6-phosphate dehydrogenase deficiency (G6PD) in term of pathogenesis and clinical features in laboratory diagnosis. (20 Marks)

Question 3

Critically evaluate the mechanism of hemostasis. (20 Marks)

August 2015 (SPECIAL)

SECTION A: OBJECTIVE QUESTIONS (30 MARKS)

CHOOSE ONE BEST STATEMENT TO ANSWER THE QUESTION

1. In this kind of anemia, RBCs are smaller than normal and have an increased zone of central pallor.

(A) Chronic disease

(B) Hypochromic microcytic anemia*

(D) Normochromic Normocytic anemia

2. What is the most common cause of Hypochromic Microcytic anemia?

(A) Chronic disease

(B) Haemolytic anemia

(D) Iron deficiency anemia*

3. What kinds of people are most at risk for hypochromic microcytic anemia?

(A) Athlete

(B) Eldery

(D) Pregnant women*

4. How are anemia classified?

(A) Signs

(B) Treatment

(D) Morphological*

5. Differential diagnosis using MCV 80-96 fl?

(A) Chronic

(B) Microcytic--<80

(D) Normocytic*

6. Lack of ______________ inhibits thymidine (DNA) synthesis so RBC production does not occur or occurs abnormally.

(A) B12*

(B) Copper

(D) All of the above

7. To be absorbed into body, B12 must be absorbed with?

(A) Intrinsic Factor*

(B) Extrinsic Factor

(D) Phosphate Pathway

8. Which anemia is associated with alcoholism, liver and thyroid disorders?

(A) Hemolytic anemia

(B) Acute Hemolysis anemia

(D) Non-Megaloblastic Macrocytic anemia*

9. Plasma ferritin in iron deficiency will?

(A) Fluctuate

(B) Increases

(D) Remain normal

10. Serum transferrin receptor levels during iron deficiency will?

(A) Fluctuate

(B) Increases*

(D) Remain normal

11. What poikilocyte or RBC inclusion is commonly associated with G6PD deficiency?

(A) Echinocyte

(B) Stomatocyte

(D) Heinz bodies*

12. Which of the following tests is a good indicator of accelerated erythropoiesis?

(A) Schilling test

(B) Osmotic fragility

(D) Gel electropherosis

13. What characteristic red cell shape is associated with extravascular hemolysis?

(A) Echinocyte

(B) Spherocyte*--AIHA

(D) Heinz bodies

14. An appropriately increased reticulocyte production index (RPI) > 3% is associated with

(A) Hemolytic anemia*

(B) Megaloblastic anemia

(D) Folic acid deficiency anemia

15. Bite cells and polychromasia seen during a hemolytic episode patient with

(A) Hemolytic anemia

(B) Megaloblastic anemia

(D) Folic acid deficiency anemia

https://quizlet.com/306994166/hematology-ii-quiz-1-flash-cards/

16. Which of the following test used to distinguish malabsorption of Vitamin B12 resulting from pernicious anemia from other causes of malabsorption?

(A) Schilling test*

(B) Osmotic fragility

(D) Gel electropherosis

17. RBC destruction that caused by the action of external agents such as an antibody against RBC antigens or a prosthetic heart valve?

(A) Intrinsic

(B) Extrinsic

(D) Extravascular*

18. The majority of iron in adult is found as a constituent of

(A) DNA

(B) RNA

(D) Hemoglobin*

19. Which of the following is used for staining reticulocytes

(A) H & E

(B) Geimsa

(D) New Methylene Blue*--supravital stain

20. The presence of hemoglobinuria, hemosiderinuria, and hemoglobinemia indicate that hemolysis is

(A) Intrinsic

(B) Extrinsic

(D) Extravascular

21. Hydrops fetalis is also known as

(A) beta thalassemia major

(B) beta thalassemia minor

(D) alpha thalassemia minor

22. What neutrophils are capable of chemotaxis

(A) auer rod

(B) avian heterophil

(D) segmented neutrophils

23. What is the most common enzyme deficiency of the glycolytic pathway?

(A) pyruvate kinase*

(B) reduced glutathione

(D) pyrimidine 5’ nucleotidase

24. Which of the following haemoglobin characteristically resists alkali denaturations?

(A) Hemoglobin A

(B) Hemoglobin C

(D) Hemoglobin S

25. Which of the following conditions will usually result in leukopenia?

(A) measles

(B) tonsillitis

(D) appendicitis*

26. What is the normal daily requirement for folic acid?

(A) 10 mg/day

(B) 20 mg/day

(D) 0.2 mg/day*

27. Which of the following condition is NOT a cause of eosinophilia?

(A) asthma

(B) trichinosis

(D) appendicitis*

https://www.mayoclinic.org/symptoms/eosinophilia/basics/causes/sym-20050752

28. Excessive denaturation of haemoglobin within the red blood cell is denoted by the presence of

(A) heinz bodies

(B) dohle bodies

(D) siderocytic granules

29. A patient has decreased vitamin B12, the schilling test detects labeled B12 in the urine when it is given with intrinsic factor, what is the correct interpretation?

(A) leukemia

(B) malabsorption

(D) vitamin B12 deficiency*

30. Which coagulation factor deficiency MOST suitable with the criteria in Figure 1.

Figure 1

• PT – prolonged

• PTT – normal

(A) V--PT, PTT

(B) VI

(D) VIII--aPTT

SECTION B: SHORT ANSWER QUESTIONS (30 MARKS)

ANSWER ALL QUESTIONS

1. a. Classify types of normochromic normocytic anemia. (2 Marks)

b. Give expected hematology test results of aplastic anemia, including peripheral blood smear and bone marrow findings. (6 Marks)

normochromic

normocytic

reduced Hb

leukopenia

thrombocytopenia

BM shows hypoplasia

erythroid, granulocytic, megakaryocytic suppressed

largely empty marrow spaces fill with fat tissues

2. a. Define glucose-6-phosphate dehydrogenase deficiency (G6PD deficiency). (2 Marks)

b. State FOUR (4) agents that cause haemolytic anemia in G6PD deficiency. (4 Marks)

c. List FOUR (4) clinical features of G6PD deficiency. (4 Marks)

3. a. Define the acute leukemia. (2 Marks)

b. Compare the result of acute leukemia by using cytogenetic and molecular genetic. (6 Marks)

c. List FOUR (4) laboratory diagnosis of acute leukemia. (4 Marks)

SECTION C: ESSAY QUESTIONS (40 MARKS)

ANSWER TWO (2) QUESTIONS ONLY

Question 1

Discuss the pathophysiology and laboratory diagnosis that causes Iron Deficiency Anemia (IDA). (20 Marks)

Question 2

Describe polycythemia in term of pathogenesis and clinical features in laboratory diagnosis. (20 Marks)

Question 3

Critically evaluate the mechanism of hemostasis. (20 Marks)

August 2014

SECTION A: OBJECTIVE QUESTIONS (30 MARKS)

CHOOSE ONE BEST STATEMENT TO ANSWER THE QUESTIONS

1. ___________ deliver ‘food’ and ‘air’ towards all body tissues.

(A) Plasma

(B) Platelets

(D) Erythrocytes*

2. Fifty-five percent (55%) of the human blood is composed of

(A) plasma*

(B) platelets

(D) erythrocytes

3. Classification of anemia refers to

(A) morphological and initiation

(B) etiological and transportation

(D) morphological and transportation

4. The element involved in intrinsic disorder of red cell destruction is

(A) platelet

(B) antibody

(D) hemoglobin*--membrane defects, enzyme ds

5. The ability of red blood cell to squeeze through the blood vessel is called

(A) fluidity

(B) elasticity

(D) transformability

deformability

6. Which of the following is the CORRECT example of cell membrane defect?

(A) Hereditary elliptocytosis*--spherocytosis, pyropoikilocytosis, stomatocytosis, PNH

(B) Hemoglobin C defect

(D) Pyruvate kinase deficiency

7. ________ is an example of hypochromic microcytic anemia.

(A) Thalassemia*

(B) Aplastic anemia

(D) Megaloblastic anemia

8. Microcytic anemia shows

(A) low MCV*

(B) low MCH

(D) high MCH

9. Iron deficiency anemia belongs to

(A) aplastic anemia

(B) microcytic anemia*

(D) megaloblastic anemia

10. Which of the following is NOT TRUE about hemolytic anemia?

(A) It can only be inherited.*

(B) It can be caused by sickle cell disease.

(D) It can be caused by pyruvate kinase deficiency.

11. Hemolytic anemia patients show

(A) pallor, styes, pale urine

(B) jaundice, styes, dark urine

(D) jaundice, malaise, pale urine

12. Which flow is TRUE for haematopoiesis?

(A) Differentiation formation development

(B) Formation development differentiation*

(D) Formation differentiation development

13. Megaloblastic anemia is commonly due to

(A) iron deficiency

(B) G6PD deficiency

(D) pyruvate kinase deficiency

14. Which of the following is NOT the laboratory diagnosis for megaloblastic anemia?

(A) endoscopy

(B) diet history

(D) liver function test*

15. ___________ is smaller than other leukocytes, larger than red blood cells, transparent cytoplasm, round & large nucleus occupying most of cytoplasm.

(A) Monocytes

(B) Erythrocytes

(D) Thrombocytes

16. Megaloblastic anemia presents with reticulocyte count

(A) normal

(B) increased

(D) fluctuated

17. Which of the following describes red blood cells in aplastic anemia?

(A) Hyperchromic macrocytic

(B) Hyperchromic normocytic

(D) Normochromic normocytic*

18. Peripheral blood film of aplastic anemia shows red blood cells with

(A) hyperchromic macrocytic

(B) hyperchromic normocytic

(D) normochromic normocytic*

19. Aplastic anemia can be treated with

(A) blood transfusion

(B) hemopoietic growth factor

(D) all of the above*--graft rejection prevented by cyclosporine (neoral) therapy, platelet transfusion

20. Which of the following statement is FALSE for leukemia?

(A) Normal control mechanisms are disrupted.

(B) All affected cells are white blood cell types only.

(D) Uncontrolled multiplication and inability of bone marrow to compensate.

21. Myeloid leukemia generally involves

(A) monocytes and granulocytes*

(B) monocytes and agranulocytes

(D) lymphocytes and agranulocytes

22. Acute leukemia is classified based on

(A) morphological studies

(B) immunological point markers*

(D) cytochemistry compatibility studies

23. Chronic myeloid leukemia is known as

(A) Philadelphia disease

(B) Philadelphia disorder

(D) Chronic agranulocytic leukemia

24. Chronic myelocytic leukemia shows

(A) anemia

(B) leukopenia

(D) neutrophil alkaline phosphatase positive--negative

25. Chromosome studies in chronic myelocytic leukemia shows a translocation in chromosome

(A) 9 and 20

(B) 9 and 21

(D) 9 and 23

26. Hemoglobinopathies are categorized into

(A) quantitative and qualitative*

(B) qualitative and expressionative

(D) experimentative and expressionative

27. Alpha thalassemia is described as

I. A deletion disorder

II. An alpha globin chain affected

III. Comes from maternal and paternal origin

IV. Severity depends on numbers of affected allele

(A) I, II and II

(B) I, II and IV

(D) I, II, III and IV*

28. Which of the following describes beta thalassemia?

I. Deletion disorder

II. Beta globin chain affected

III. Loss of alpha globin chain

IV. Severity depends on the mutational changes

(A) I, II and II

(B) I, II and IV*

(D) I, II, III and IV

29. The mechanisms of hemostasis involves

I. fibrinoplasia--fibrinolysis

II. blood coagulation

III. vascular constriction

IV. platelet plug formation

(A) I, II and II

(B) I, II and IV

(D) I, II, III and IV

30. Which of the following describes hemophilia?

I. Has two types A and B

II. A type is mainly in males

III. B type is mainly in female

IV. Sex linked recessive disorder

(A) I, II and II

(B) I, II and IV*

(D) I, II, III and IV

SECTION B: SHORT ANSWER QUESTIONS (30 MARKS)

ANSWER ALL QUESTIONS

Question 1

1.a. State the functions of von Willebrand factor (5 Marks)

to stabilize factor VII and protect it from degradation

in absence of vWF, survival of factor VII in circulation is extremely short, 2 hrs

to serve and deliver factor VII to platelets adherent to a site of vascular injury

once factor VII cleared and activated by thrombin, it no longer bind to vWF

1.b. List FIVE (5) laboratory diagnosis for von Willebrand factor disease? (5 Marks)

prolonged bleeding time

prolonged activated partial thromboplastin time

prolonged clotting time

normal prothrombin time

low vWF

Question 2

2.a. List the characteristics for sickle cell disease. (4 Marks)

HA with jaundice

swelling of joints

leg ulcers and necrosis

stroke

2.b. Briefly describe the laboratory findings for sickle cell disease. (6 Marks)

low Hb 6~9 g/dL

PBF: sickle cell, target cell, Howell-jolly bodies

screening test for sickling is positive when blood is deoxygenated

Hb electrophoresis: Hb S detected

Question 3

3.a. Give SIX (6) clinical features for iron deficiency anemia. (6 Marks)

koilonychia

fatigue

restless leg syndrome

headaches

pagophagia

pallor

pica

angular stomatitis

3.b. State FOUR (4) types of hypochromic microcytic anemia. (4 Marks)

thalassemia

IDA

sideroblastic

ACD

SECTION C: ESSAY QUESTIONS (40 MARKS)

ANSWER TWO (2) QUESTIONS ONLY

Question1

In your own words, explain Thalassemia diseases in detail covering both alpha and beta types. (20 Marks)

Question 2

In your own words, categorize anemia based on the laboratory findings of red blood cell tests. (20 Marks)

Question 3

Illustrate and describe the mechanisms of hemostasis. (20 Marks)

January 2014

SECTION A: OBJECTIVE QUESTIONS (30 MARKS)

Choose ONE best statement to answer the questions.

1. Which of the following type of anemia can be morphologically classified as normochromic normocytic?

(A) Hemolytic*

(B) Sideroblastic

(D) Iron deficiency

2. Which of the following full blood count (FBC) parameter is abnormal for adult male?

(A) Hematocrit: 31%*--42~52

(B) Hemoglobin: 14.5 g/dL--13.5~17.5

(D) Mean cell hemoglobin: 32 pg--26~32

3. Majority of iron in human body are in the form of

(A) ferritin*

(B) hemoglobin

(D) transferrin

https://quizlet.com/220508641/clin-chem-2-exam-1-flash-cards/

4. In which group is the daily requirement of iron highest?

(A) Children

(B) Adult male

(D) Menstruating female

5. Which of the following laboratory finding is due to increased red cells production?

(A) Reticulocytosis*

(B) Microspherocytosis

(D) Increased fecal stercobilinogen--hemolytic anemia

6. Heinz bodies can be seen in the cases of

(A) aplastic anemia

(B) sickle cell anemia

(D) G6PD-deficiency anemia*

7. A clinical sign commonly associated with hemolytic diseases is

(A) gallstones*

(B) kidney stones

(D) gastrointestinal parasites

8. Megaloblastic anemia may be diagnosed using the following procedure EXCEPT

(A) endoscopy

(B) Schilling test

(D) peripheral blood film

9. Fanconi’s anemia is a hereditary form of aplastic anemia that can possibly develop into which type of leukemia?

(A) Acute myeloid

(B) Acute lymphoid

(D) Chronic lymphoid

10. Bone marrow hypoplasia is a common finding in the cases of

(A) Thalassemia

(B) Aplastic anemia*

(D) Hemolytic anemia

11. This type of anemia exhibits a ‘koilonychia’ symptom.

(A) Aplastic

(B) Hemolytic

(D) G6PD-deficiency

12. The deletion of three alpha globin genes on chromosome-16 will result in

(A) hydrops fetalis

(B) sickle cell disease

(D) beta thalassemia major

13. The appearance of Howell-Jolly bodies in peripheral blood film may be associated with

(A) Beta thalassemia*

(B) Acute myeloid leukemia

(D) Chronic lymphoid leukemia

14. Vitamin B12 and folate deficiency will result in an ineffective erythropoiesis because

(A) both are necessary for the uptake of iron into erythroid cells

(B) both are vital for the proper synthesis of erythropoietin by the kidneys

(D) both are necessary cofactors in the anabolic pathway that synthesizes DNA thymidine*

15. In French-American-British (FAB) classification of acute myeloid leukemia, M5 refers to

(A) erythroleukemia--M6

(B) monocytic leukemia*--monoblastic

(D) megakaryoblastic leukemia--M7

16. The French-American-British (FAB) classification of acute lymphoid leukemia consists of how many subtypes?

(A) 2

(B) 3*

(D) 5

17. Which of the following is an immunological marker used to classify acute leukemia?

(A) CD33*--CD13, 15, 1

(B) t(15:17)

(D) Sudan Black B*

18. Philadelphia chromosome may be associated with

(A) acute myeloid leukemia

(B) acute lymphoid leukemia

(D) megakaryoblastic leukemia

19. Which type of chronic lymphoid leukemia involves T-cells?

(A) Hairy cell leukemia

(B) Plasma cell leukemia

(D) Large granular lymphocytic leukemia*

20. Which of the following is NOT the purpose of vasoconstriction in damaged blood vessels?

(A) To initiate hemostasis process

(B) To enhance platelet aggregation

(D) To block oxygen supply to that area*

21.Which of the following acts as a “gum” to adhere platelets to endothelial cells of blood vessel?

(A) Fibrinogen

(B) Calcium ions

(D) van der Waals factor--von Willebrand*

22.What is the normal range of prothrombin time (PT)?

(A) 10-16 seconds*

(B) 14-19 seconds--TT

(D) 50-60 seconds

23.The severity of Hemophilia A disease depends on the level of which blood clotting factor?

(A) VI

(B) VII

(D) IX

24.Which of the following blood coagulation test will give abnormal value in the diagnosis of Hemophilia disease?

(A) PT

(B) APTT*

(D) Bleeding time

25.What is the normal percentage (%) of reticulocyte count in adult males?

(A) 0.5 – 1.5

(B) 1.5 – 2.5*--0.5~2.5

(D) 3.5 – 4.0

26. Which one of the following is a common feature of all leukemias?

(A) anemia

(B) enlarged spleen

(D) excess white cells in the bone marrow*

Figure 1

Normal

Afwan's result

27. Based on the normal Hb electrophoresis pattern in Figure 1, interpret Afwan’s result.

(A) Sickle cell disease

(B) Hemoglobin C disease

(D) Beta thalassemia major

28. All of the following coagulation factors can be evaluated in APTT test EXCEPT

(A) Factor XII

(B) Factor IX

(D) Factor VII*--PT

29. Christmas factor refers to which blood coagulation factor?

(A) Factor XI

(B) Factor X

(D) Factor XII

30.Which of the following may present in peripheral blood film of beta thalassemia major patients?

I. Target cells

II. Howell-Jolly bodies

III. Aeur rods

IV. Hairy cells

(A) I and II*

(B) II and III

(D) I, II, III and IV

SECTION B: SHORT ANSWER QUESTIONS (30 MARKS)

Answer ALL questions.

1. a. For each hereditary and acquired hemolytic anemia, provide THREE (3) examples. (6 Marks)

hereditary

G6PD
PK
hereditary spherocytosis

acquired

PNH
AIHA
drug-induced HA

b. State FOUR (4) causes of megaloblastic anemia due to vitamin B12 and folate deficiency. (4 Marks)

2. a. Define pancytopenia and acute leukemia. (4 Marks)

pancytopenia: reduced blood component

b. List THREE (3) clinical features and THREE (3) laboratory features of chronic lymphoid leukemia (CLL). (6 Marks)

clinical features

elderly >50 yr
lymphadenopathy
hepatosplenomegaly 50~60%
bruising

lab

absolute lymphocytosis 10~150 x 10^9/L
smudge cells
neutropenia
thrombocytopenia
hypogammaglobinemia

3. a. State THREE (3) blood components that can be used to treat Hemophilia A patients. (3 Marks)

fresh plasma

cryoprecipitate

factor VIII concentrate

b. List SEVEN (7) laboratory features of beta-thalassemia major. (7 Marks)

hypochromic

microcytic

target cells

Howell-Jolly bodies

low osmotic fragility test

low MCV

low MCH

absence of HbA

HbA2 is variable

HbF is prominent

SECTION C: ESSAY QUESTIONS (40 MARKS)

Answer TWO (2) questions only.

Question 1

Discuss the causes, symptoms and laboratory findings of iron deficiency anemia (IDA). (20 Marks)

Question 2

List all subtypes of acute myeloid leukemia (AML) under FAB classification and explain the characteristics of each. (20 Marks)

Question 3

Define hemostasis and using diagrams, explain the three coagulation pathways in hemostasis mechanism. (20 Marks)

April 2013

SECTION A: OBJECTIVE QUESTIONS (20 MARKS)

Choose ONE best statement to answer the questions.

1. The reason fixative is used in histology laboratory is

(A) to soften the tissue

(B) to minimize the staining reaction time

(D) to protect the lipid congestion of cellular matrix

2. The following statements describe Bouin’s fixative EXCEPT

(A) slow penetration

(B) good routine fixative

(D) perform cross-linking with proteins

3. The tissue is cut in the microtome at thicknesses varying from

(A) 2 to 25 μm*

(B) 30 to 75 μm

(D) 5 to 15 cm

4. Which of the following stains blue with Haematoxylin and Eosin (H&E) stain?

(A) nucleus*

(B) cytoplasm--pink

(D) collagen fibers

5. Which of the following is a description for pseudostratified columnar epithelium?

(A) It has no cilia.

(B) It does not have goblet cells.

(D) It does not stacked on each other.*

6. Microscopic image shown in Figure 1 is likely to be a/an

(A) elastic tissue

(B) areolar tissue

(D) dense irregular tissue

Figure 2

7. Which of the following is indicated by the arrows in Figure 2?

(A) I bands in skeletal muscle

(B) A bands in skeletal muscle

(D) intercalated disks in cardiac muscle

8. These are the layers of the blood vessel walls EXCEPT

(A) media

(B) intima

(D) adventitia

9. The following statement compares arteries to veins EXCEPT

(A) arteries has a higher wall to lumen ratio

(B) arteries does not have variable shape of the walls

(D) arteries does not contain any internal elastic membrane

10. Which of the following respiratory tract structure is also known as lobar bronchi?

(A) Bronchiole

(B) Tertiary bronchi

(D) Secondary bronchi

11. Parasympathetic nervous tissue that can be found in muscularis externa of the intestinal wall is called

(A) Peyer’s patches

(B) Brunner’s glands

(D) Meissener’s corpuscle

12. What is the main function of Paneth’s cell in the small intestine?

(A) produce secretin

(B) replace mucosal epithelial cells

(D) provide host defence against microbes

13. The following components are present in the renal cortex EXCEPT

(A) medullary ray

(B) renal corpuscle

(D) collecting duct tubules

14. Which of the following vessels are typically seen at the border between the renal cortex and medulla?

(A) vasa recta

(B) arcuate arteries and veins

(D) interlobular arteries and veins

15. Renal corpuscle consists of the following components EXCEPT

(A) glomerulus

(B) urinary pole

(D) loop of Henle

16. Which of the following is a permanent layer of an endometrium?

(A) stratum basale

(B) stratum lucidum

(D) stratum functionale

17. Which of the labels in Figure 3 corresponds to the rete testis?

(A) 2

(B) 4

(D) 6

18. Which of the following describe zymogenic cells of the gastric mucosa?

I. Basophilic cytoplasm

II. Predominate in basal layer

III. Smaller than the parietal cells

IV. Secrete pepsinogen and some lipase

(A) I, II and III

(B) I, II and IV

(D) I, II, III and IV

19. Which of the following describe the parietal cell of the gastric mucosa?

I. It has pale acidophilic cytoplasm.

II. It is located in between mucous neck cells in the neck.

III. It is large round to pyramidal with 1 or 2 central nuclei.

IV. It produces histamine and gastrin to enhance the gastric production.

(A) I, II and III

(B) I, II and IV

(D) I, II, III and IV

20. Which of the following describe the collecting tubule in renal system?

I. Its function is to form hypertonic urine.

II. The lining cells have distinct intercellular borders.

III. The cell cytoplasm stain very intense and appears as dark stains.

IV. The cells are cuboidal in smaller tubules and columnar in larger ducts.

(A) I, II and III

(B) I, II and IV

(D) I, II, III and IV

SECTION B: SHORT ANSWER QUESTIONS (40 MARKS)

Answer ALL questions.

1. a. Define fixation. (1 Mark)

b. Describe FOUR (4) aims of fixation. (4 Marks)

c. Provide FIVE (5) categories of fixative with an example each. (5 Marks)

2. a. Name and briefly describe the TWO (2) main elements of connective tissue. (5 Marks)

b. Provide ALL types and subtypes of connective tissue. (5 Marks)

3. a. Describe THREE (3) types of bronchiole of the respiratory system. (3 Marks)

b. Describe THREE (3) epithelial characteristics of alveolar ducts. (3 Marks)

c. Name THREE (3) types of cell lining the alveoli of the lungs and its function. (3 Marks)

d. Name the type of tissue most abundantly seen in C-ring of the trachea. (1 Mark)

4. a. Name TWO (2) layers of Bowman’s capsule . (2 Marks)

b. Briefly describe the characteristics of proximal and distal convoluted tubule. (8 Marks)

SECTION C: ESSAY QUESTIONS (40 MARKS)

Answer TWO (2) questions only.

Question 1

Tissue processing is one of the most critical stage in producing tissue slides for histology.

a. Discuss the advantages and disadvantages of different categories of fixative. (10 Marks)

b. Discuss the dehydration step in tissue processing procedure. (10 Marks)

Question 2

Discuss the histological characteristics of stomach in terms of its general structure, cell types and regional differences. (20 Marks)

Question 3

Discuss in detail the histology of seminiferous tubules of a testis. (20 Marks)

January 2013

PART A : OBJECTIVE QUESTIONS (20 MARKS)

Choose ONE best statement to answer the questions

1. The immediate precursor of metamyelocyte is

(A) Stab cells*

(B) Myelocyte

(D) Promyelocyte

2. The following results were obtained on analysis of an anemic patient :

MCV = 115 MCH = 50 MCHC = 34

Which of the following conditions would produce these results?

(A) Iron deficiency

(B) Aplastic anemia

(D) Megaloblastic anemia*

3. The term that indicates variation in the shape of red blood cells is

(A) anisocytosis

(B) macrocytosis

(D) poikilocytosis*

4. Which of the following hemoglobin is NOT found in normal adult blood?

(A) HbA

(B) HbF

(D) Hb barts*--hydrops fetalis

5. A negative myeloperoxidase reaction is seen in

(A) acute myeloid leukemia

(B) acute monocytic leukemia

(D) acute myelomonocytic leukemia

6. Which of the following would indicate macrocytic anemia?

(A) MCV = 80 fl

(B) MCV = 90 fl

(D) MCV = 110 fl*

7. Alkaline denaturation test giving Hb F = 10%. The result indicates

(A) Hb H disease

(B) α thalassemia trait

(D) β thalassemia major--prominent HbF

8. Normal Haemoglobin A is made up of which of the following?

(A) 2 alpha and 2 beta chains*

(B) 2 alpha and 2 delta chains--Hb A2

(D) 2 alpha and 2 epsilon chains

9. Which of the following hemoglobins is an abnormal haemoglobin composed of four beta globin chains?

(A) Hemoglobin F

(B) Hemoglobin G

(D) Hemoglobin S

10. Which of the following haemoglobin characteristically resists alkali denaturations?

(A) Hemoglobin A

(B) Hemoglobin F*

(D) Hemoglobin S

11. Chronic Myeloid Leukemia is differentiated from leukaemoid reaction by the following result

(A) Low LAP score*

(B) High LAP score

(D) High acid phosphatase score--low neutrophils alkaline phosphatase

12. An osmotic fragility test that shows a ‘shift to the right’ indicates

(A) sickle cell anemia

(B) hereditary spherocytosis*--AIHA

(D) paroxysmal nocturnal hemoglobinuria

13. Which of the following is the structure of Haemoglobin F, fetal haemoglobin?

(A) 4 Beta chains

(B) 2 alpha and 2 beta chains

(D) 2 alpha and 2 gamma chains*

14. The Philadelphia chromosome is associated with which of the following disorders?

(A) Acute granulocytic leukemia

(B) Acute lymphocytic leukemia

(D) Chronic lymphocytic leukemia

15. The Philadelphia chromosome is caused by

(A) t (8,11)

(B) t (9,22)*

(D) t (12,27)

16. The prothrombin time test will be prolonged in which of the following cases?

(A) Factor V deficiency

(B) Factor VII deficiency*

(D) Factor VIII deficiency

17. Schumm’s test is used to identify

(A) Methemoglobin

(B) Sulfhemoglobin

(D) Methemalbumin*

18. Which of the following is the average red blood cell survival time?

(A) 60 days

(B) 120 days*

(D) 9-10 days

19. Consider the following indices :

MCV = 60.6 cu microns MCH = 25μμg MCHC = 15.1%

Which of the following would you expect to find on the differential blood smear evaluation of red cell morphology?

(A) Macrocytic red blood cell

(B) Normochromic red blood cells

(D) Hypochromic, macrocytic red blood cells

20. Excessive denaturation of haemoglobin within the red blood cell is denoted by the presence of

(A) Heinz bodies*

(B) Dohle bodies

(D) Siderocytic granules

21. A positive peroxidase reaction indicates

(A) Acute myeloid leukemia*--SBB

(B) Acute monocytic leukemia

(D) Acute myelomonocytic leukemia

22. A positive Bence - Jones protein is present in the urine of

(A) Lymphoma

(B) Multiple myeloma*

(D) Chronic lymphocytic leukemia*

23. Auer rods are usually present in the cytoplasm of

(A) Monoblast

(B) Myeloblast*

(D) Erythroblast

24. Which of the following abnormal paraprotein is detected in the serum protein electrophoresis of multiple myeloma?

(A) IgD

(B) IgA

(D) IgG

25. The decrease or absence of iron store as demonstrated by the Perl’s stain indicates

(A) Aplastic anemia

(B) α thalassemia major

(D) Iron Deficiency anemia*

26. Which coagulation screening test will be prolonged in patients with hemophilia A?

(A) Thrombin time

(B) Prothrombin time

(D) Prothrombin time and Activated Partial Thromboplastin Time

27. Which of the following statements about multiple myeloma is FALSE ?

(A) Increased ESR

(B) Red blood cells show agglutination

(D) Rouleaux formation seen in the Peripheral Blood Film

https://labmedicineblog.com/2016/11/04/hematology-quiz-a-patient-with-multiple-myeloma/

28. A ‘shift to the left’ indicates the following condition, EXCEPT

(A) Acute bacterial infections

(B) Chronic myeloid leukemia

(D) Chronic lymphocytic leukemia*

29. Which of the following CD markers is indicative of acute monocytic leukemia?

(A) CD 13*--33, 41 M7, MPO M0, glycophorin M6

(B) CD 14

(D) CD 32

30. All these are characteristics of hemolytic anemia EXCEPT

(A) Schistocyte

(B) Microspherocytes

(D) Polychromatic red blood cells

PART B: Short Answer Questions (30 MARKS)

Answer ALL questions.

1. What is the significant of

a. Microcytes (2 Marks)

MCV low

b. Macrocytes (2 Marks)

MCV high

c. Nucleated red blood cells (2 Mark)

nucleus, immature

d. Sickle cells (2 Marks)

sickle or crescent

e. Metamyelocytes (2 Marks)

kidney nucleus/indented

pinkish blue cytoplasm with secondary granules

2. a. Define Hypochromic Microcytic Anemia (HMA) (2 Marks)

have decreased red color

smaller than usual cells

b. Name TWO (2) common type of HMA (2 Marks)

IDA, thalassemia

c. Describe the laboratory findings of HMA caused by nutritional deficiency. (6 Marks)

MCV low

MCHC low

serum iron low

TIBC high

ferritin low

reticulocyte low

normal EPO level

3. a. How are excess clots removed in the blood circulatory system. (2 Marks)

catheter directed thrombolysis

b. State the principle and application of Prothrombin Time. (4 Marks)

measures extrinsic and common factor

tissue thromboplastin in the presence of calcium activate extrinsic pathway

factor VII

normal clotting time for PT is 10~16 s

c. How do you use Prothrombin Time and APTT to differentiate factor VII and factor XIII deficiencies. (4 Marks)

PT VII

APTT VIII

PART C : ESSAY QUESTIONS (40 MARKS)

Answer TWO ( 2 ) questions only.

Question 1

Discuss the causes and laboratory findings of serum folate acid deficiency anemia. (20 Marks)

Question 2

Discuss the etiology and laboratory findings of β thalassemia major. (20 Marks)

Question 3

Discuss the genetic basis and laboratory diagnosis of Chronic Myeloid Leukemia (20 Marks)

July 2011

SECTION A: OBJECTIVES QESTIONS (30 marks)

Choose ONE best statement to answer the questions.

1. A cell with an MCV of 69 fL is called a

(A) anisocyte.

(B) normocyte.

(D) microcyte.*

Male: 80~98

Female: 96~108

2. Classify the cells with the following indices: MCV 106 fL, MCH 35, MCHC 33.

MCH: 27~32

MCHC: 32~36

(A) Macrocytic, hypochromic*

(B) Macrocytic, normochromic

(D) Microcytic, hypochromic

3. Which form of iron can be visualized by the Prussian blue stain?

(A) Transferrin

(B) Ferritin

(D) Hemosiderin*

https://quizlet.com/342519570/medt-405-final-exam-flash-cards/

4. Microcytic, hypochromic erythrocytes are most characteristic of which of the following anemias?

(A) Anemia of chronic disease

(B) Sideroblastic anemia

(D) Iron-deficiency anemia*

5. The morphological classification of anemias is based on the

(A) red cell count.

(B) cause of the anemia.

(D) reticulocyte count.

6. Which of the following is most closely associated with total iron binding capacity?

(A) Transferrin*

(B) Hemosiderin

(D) Hemoglobin

7. What is the transferrin saturation of a patient has a TIBC of 330 μg/dL and serum iron 50 μg/dL.

(A) 30%

(B) 50%

(D) 15%*=50/330

8. Which of these symptoms is specific for iron deficiency anemia?

(A) Fatigue

(B) Koilonychia*

(D) Dizziness

9. This clinical finding associated with hemolytic disease is

(A) kidney stones.

(B) gallstones.*

(D) gastrointestinal parasites.

10. The etiology of G6PD is

(A) autosomal recessive inheritance.

(B) acquired stem cell defect.

(D) sex-linked inheritance.*--recessive

11. Which of the following most commonly precipitates a hemolytic attack in individuals with G6PD deficiency?

(A) Drug oxidants*--infection

(B) Cancer

(D) High altitude

12. Enzymes in mature red cells act to

(A) break down hemoglobin.*

(B) destroy invading microorganisms.

(D) synthesize hemoglobin.

13. A deficiency in one of the following enzyme will lead to a loss of red cell energy in the form of ATP

(A) Pyruvate Kinase (PK)*

(B) Glucose 6-Phospahte Dehydrogenase (G6PD)

(D) glutathione synthetase

14. Favism is associated with a deficiency of enzyme

(A) PK.

(B) G6PD.*

(D) glutathione synthetase.

15. Bite cells are associated with a deficiency in

(A) PK

(B) G6PD*

(D) glutathione peroxidase

16. Which metabolic pathway is responsible for keeping erythrocyte oxidants in check?

(A) Hexose Monophosphate shunt*

(B) Embden Meyerhoff pathway

(D) 2,3-DPG

https://quizlet.com/122955731/chapter-18-quiz-flash-cards/

17. Pernicious anemia is megaloblastic anemia resulting from

(A) dietary deficiency of vitamin B12.

(B) folate deficiency.

(D) hepatic cirrhosis.

18. A deficiency in vitamin B12 or folic acid results in ineffective erythropoiesis because

(A) vitamin B12 and folic acid are necessary cofactors in the anabolic pathway that synthesizes DNA thymidine.*

(B) B12 is necessary to bind folic acid for transport to the erythroid marrow.

(D) B12 and folic acid are vital for the proper synthesis of erythropoietin by the kidneys.

19. The intrinsic factor receptor is also known as

(A) ferritin.

(B) cubulin.*

(D) transcobalamin.

20. The bone marrow in pure red cell aplasia can be best described as

(A) erythroid hypoplasia.*

(B) erythroid hyperplasia.

(D) hypercellular.

21. The development of aplastic anemia has been associated with exposure to

(A) radiation.*

(B) UV light from the sun.

(D) Parasites.

22. Erythrocyte morphology in aplastic anemia may be

(A) spherocytic, hyperchromic.

(B) normochromic, macrocytic.*

(D) hypochromic, macrocytic.

23. Hydrops fetalis is also known as

(A) beta thalassemia major

(B) alpha thalassemia minor

(D) beta thalassemia minor

18. A deficiency in vitamin B12 or folic acid results in ineffective erythropoiesis because

(A) vitamin B12 and folic acid are necessary cofactors in the anabolic pathway that synthesizes DNA thymidine.*

(B) B12 is necessary to bind folic acid for transport to the erythroid marrow.

(D) B12 and folic acid are vital for the proper synthesis of erythropoietin by the kidneys.

19. The intrinsic factor receptor is also known as

(A) ferritin.

(B) cubulin.*

(D) transcobalamin.

20. The bone marrow in pure red cell aplasia can be best described as

(A) erythroid hypoplasia.*

(B) erythroid hyperplasia.

(D) hypercellular.

21. The development of aplastic anemia has been associated with exposure to

(A) radiation.*

(B) UV light from the sun.

(D) Parasites.

22. Erythrocyte morphology in aplastic anemia may be

(A) spherocytic, hyperchromic.

(B) normochromic, macrocytic.*

(D) hypochromic, macrocytic.

23. Hydrops fetalis is also known as

(A) beta thalassemia major

(B) alpha thalassemia minor

(D) beta thalassemia minor

Normal/Positive control

Kim Lee's sample

24. Based on the normal Hb electrophoresis pattern below, interpret Kim Lee’s result.

(A) Hemoglobin SC disease.

(B) Hemoglobin F disease.

(D) Hemoglobin HF disease.

25. M4 acute leukaemia is also known as

(A) erythroleukaemia.--M6

(B) megakaryoblast leukaemia.--M7

(D) promyelocytic leukaemia.--M3

26. Cytogenetic marker of t(8:21) is positive for AML

(A) M1

(B) M2*

(D) M4

27. Which of the following AML is platelet antigen marker positive?

(A) M0

(B) M4

(D) M7*

28. The cytogenetic translocation between chromosome 9 and 22 that results in the Philadelphia chromosome is diagnostic of

(A) chronic lymphocytic leukemia

(B) polycythemia vera.

(D) chronic myeloid monocytic leukemia.

29. One of the following coagulation factor is detected in activated partial thromboplastin test (APTT) test EXCEPT

(A) Factor III*

(B) Factor IX

(D) Factor VIII

30. All the following are determined by the prothrombin time test EXCEPT

(A) Factor VII

(B) Factor II

(D) Factor VIII*

PART B- SHORT ANSWER QUESTIONS (30 MARKS)

Answer ALL questions.

Question 1

Explain the classification of acute lymphoid leukemia based on French American British (FAB) classification. (10 marks)

L1: small, uniform, homogenous blast with scant cytoplasm

L2: larger blast with prominent nucleoli and cytoplasm, more heterogeneity

L3: larger blast with prominent nucleoli, strongly basophilic with cytoplasmic vacuoles

Question 2

Discuss Sickling test procedure. (10 marks)

a drop of venous/capillary blood on slide

1~2 drop reducing agent, sodium metabisulphite

mix with applicator stick

induce sickling in susceptible cells

cover glass

avoid air bubbles

DPX mount

microscope after 20 min

40x

holly leaf form is positive

normal is negative

no sickling at the end 1 hr

allow preparation stand at room temp for 24 hr

examine that time

Question 3

Describe a procedure of Prothrombin time test. (10 marks)

water bath at 37

0.1 ml of plasma into respective tubes

stand for 3~5 min

0.1 ml thromboplastin

mix well incubate at 37 for 2 min

0.1 ml calcium chloride

start stopwatch

tube gently tilted

stop stopwatch when first fibrin strand is visible

record time in sec

repeat for 2~3 times and take the average

PART C: ESSAY (40 MARKS)

Answer TWO (2) questions ONLY.

Question 1

Describe alpha thalassemia in terms of;

a) Number of allele affected.

b) Clinical conditions and symptoms.

(20 marks)

Question 2

Explain on primary hemostasis and diagram the sequence of reaction in the coagulation cascade according to the concepts of intrinsic, extrinsic and common pathways. (20 marks)

Question 3

Explain the causes, clinical features, laboratory diagnosis and Choices of treatment in patients with Hemophilia A disorder. (20 marks)

January 2010

PART A: OBJECTIVE QUESTIONS (30 MARKS)

Choose the BEST option to answer the questions.

1. The morphological classification of anemias is based on the

A. Red cell count.

B. Cause of the anemia.

C. Red cell indices.*

D. Reticulocyte count.

2. Which of this symptom is specific for IDA?

A. Fatigue.

B. Koilonychia.*

C. Palpitations

D. Dizziness.

https://quizlet.com/439352109/ch-5-the-microcytic-anemias-flash-cards/

3. Which of the following hemoglobins has the chemical confirmation γ4?

A. Hemoglobin Barts.*

B. Hemoglobin Gower.

C. Hemoglobin H.

D. Hemoglobin Portland.

4. Which of the following substance is necessary for vitamin B12 to be absorbed?

A. Transferrin

B. Cubulin

C. Erythropoietin.

D. Intrinsic factor.*

5. Which of the following adequately describes the etiology of megaloblastic anemia?

A. Lack of DNA synthesis.*

B. Defect in globin synthesis.

C. Defect in iron metabolism.

D. Excessive iron loading.

6. In the osmotic fragility test, normal red cells hemolyze at which level?

A. 0.65%

B. 0.45%*

C. 0.20%

D. 0.30%

7. The red blood cell metabolic pathway for ATP is

A. Lueberig Rapaport.

B. Embden Meyerhoff.*

C. Methemoglobin reductase.

D. Hexose monophosphate shunt.

8. Which of the following metabolic pathway is regulates oxygen affinity of hemoglobin?

A. Lueberig Rapaport.*--2,3 BPG

B. Embden Meyerhoff.

C. Methemoglobin reductase.

D. Hexose monophosphate shunt.

9. The body iron distribution in humans are as follows EXCEPT

A. hemoglobin

B. myoglobin

C. fibrinogen*

D. cytochrome

10. The iron storage known as

A. Ferritin and transferrin.

B. Hemosiderin and ferritin.*

C. Transferrin and hemosiderin.

D. Hemoglobin and transferrin.

11. What is the amino acid substitution in sickle cell anemia patients?

A. Adenine for thymine

B. Lysine for valine

C. Valine for glutamic acid*

D. Cytosine for guanine

12. Which of the following factors contributes to the pathophysiology of sickling?

A. Increased iron concentration

B. Hypochromia

C. Fava beans

D. Dehydration*

https://quizlet.com/327320807/hematology-2-chapter-8-flash-cards/

13. The picture shows the

A. Dohle bodies.

B. Toxic granulation.*

C. Chediak Higashi.

D. Neutropenia.

14. The arrow shows the presence of

A. Heinz bodies.

B. Dohle bodies.*

C. Howell Jolly bodies.

D. Pappenheimer bodies.

15. What is Haemoglobin H disease?

A. Type of β-thalassaemia minor.

B. A tetramer of gamma globulin

C. A tetramer of beta globulin.*

D. Deletion of 2 alpha genes.

Normal/Positive control

16. The electrophoresis finding shows the normal and the blood’s result of Ahmad. The abnormality presence in Ahmad is

A. Sickle cell anemia.

B. Alpha thalassemia trait.

C. Beta thalassemia major.*

D. Beta thalassemia minor.

17. Based on the following normal and Aminah’s result. The abnormality presence in Aminah could be

A. Hemoglobin SC disease.

B. Hemoglobin F disease.

C. Hemoglobin H disease.*

D. Hemoglobin H F disease.

18. What is hereditary persistence of fetal haemoglobin?

A. Deletion of 4 alpha genes.

B. Increase of β globin chain*

C. Increase of δ globin chain

D. Increase of γ globin chain.

19. Which of the following is NOT a hereditary WBC disorder?

A. Gaucher’s anomaly--beta-glucocerebrosidase

B. Alder Reilly anomaly--mucopolysacchridosis

C. Chediak Highashi anomaly--fused granules that inhibits bactericidal functions

D. May-Hegglin anomaly--thrombocytopenia, giant platelets, Dohle body like inclusions

20. The type of chronic myeloid leukaemia is

A. Chronic plasma cell leukaemia.

B. Chronic Philadelphia negative.

C. Large granular leukaemia.*

D. Chronic sideroblastic leukaemia.

21. t (8:21) is positive marker for AML type

A. M1

B. M2*

C. M3

D. M4

22. M4 acute leukaemia also known as

A. erythroleukaemia.

B. megakaryoblast leukaemia.--M7

C. myelomonocytic leukaemia.*

D. promyelocytic leukaemia.

23. Myeloblastic leukemia with maturation is refer to

A. M0--undifferentiated

B. M1--minimal maturation

C. M2*

D. M3--promyelocytic

24. Monoblastic monocytic is identified as

A. M0

B. M1

C. M6--erythro

D. M5*

25. The positive cytochemistry staining for AML is

A. Myeloperoxidase*

B. Acid Phosphatase

C. Periodic acid Schiff

D. Alkaline phosphatase

26. Which of the following AML is specific positive for platelet antigen marker?

A. M0

B. M4

C. M6

D. M7*

27. The Glanzmann disease is a hemostasis disorder due to lack of

A. factor GPIIa/IIIb

B. factor GPIIa/Vb

C. factor GPIIb/IVa

D. factor GPIIb/IIIa

28. The thrombin time test is for

A. prolonged activated partial thromboplastin time

B. prolonged prothrombin time

C. normal levels of von Willebrand factor

D. normal clotting time*

29. The following are determined by prothrombin time test EXCEPT

A. Factor VII

B. Factor II

C. Factor III*

D. Factor VIII

30. The following coagulation factor is use in activated partial thromboplastin test (APTT) test EXCEPT

A. Factor III

B. Factor IX

C. Factor II

D. Factor VIII*

PART B: SHORT ANSWER QUESTIONS (40 MARKS)

Answer ALL questions.

Question 1

a. What is normochromic normocytic anemia? (2 marks)

normal size, normal color

b. Give TWO (2) examples of normochromic normocytic anemia disorders. (2 marks)

ACD

sickle cell

b. What is hydrops fetalis? (2 marks)

abnormal accumulation of fluid in 2 or more compartments of fetus

Question 2

a. Name the chromosome involves in beta thalassaemia cases. (1 mark)

11, Hb Beta gene

b. What could be the probability of the children if both of their parents are alpha-thalassaemia trait? (5 marks)

25% unaffected

50% silent/carrier

25% carrier/hydrops fetalis

Question 3

a. What is supravital stain? (2 marks)

b. What is the objective of this reticulocyte counting? (2 marks)

c. State the formula of getting a reticulocyte count. (3 marks)

Question 4

a. Illustrate the OFT graph and plot the normal range and thalassemia case. (4 marks)

c. State the normal range of total leukocyte in human body. (2 marks)

4,000 to 11,000/mm3

d. Define and state the condition that denotes the following terms;

i) basopenia

reduced basophils

CML, TB

ii) monocytopenia (6 marks)

reduced monocytes

aplastic anemia, SLE, HIV

Question 5

a. Give the classification and example of chronic lymphoid leukaemia. (4 marks)

B cell: hairy cell leukemia

T cell: T cell chronic lymphocytic leukemia

b. What is vasoconstriction process in haemostasis? (2 marks)

initial response reduce the blood flow to site of injury

damaged blood vessels lead to exposure of collagen and basement membrane

vasoconstriction enable platelets to come into and contact with damaged endothelium

c. State the THREE (3) products produce in vasoconstriction stage. (3 marks)

adenosine diphosphate -platelet adhesion and aggregation

fibrinogen -platelet aggregation

thromboxane A2 -vasoconstrictor

PART C: ESSAY (30 MARKS)

Answer THREE (3) questions ONLY.

Question 1

Outline and explain the classification of acute lymphoid leukemia based on FAB and immunological marker reaction. (10 marks)

Question 2

Based on your experiment session, describe the procedure and principle of G6PD test. (10 marks)

Question 3

Write a procedure on Prothrombin time test. (10 marks)

Question 4

With an aid of diagram, write the process of secondary hemostasis. (10 marks)

blood clot

coagulation pathway: intrinsic aPTT, extrinsic PT, common TT

a series of enzyme-mediated reactions that converts soluble fibrinogen to insoluble fibrin by activated coagulation factors specifically thrombin, reinforcing the platelet plug

https://quizlet.com/298570647/secondary-haemostasis-diagram/

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