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Mahmoud Sewilam Clinical Pathology, X-Rays, ECG

Haematology MCQs
RED BLOOD CELLS
1. The earliest recognizable 2. The mature red cell is 3. The normal red cell life span
form of RBCs is : biconcave disc with a is approximately :
 Proerythroblast diameter of :  10 days
 Early normoblast  5.2 µm  120 weeks
 Intermediate normoblast  9.2 µm  120 days
 Late normoblast  7.2 µm  200 days
 Reticulocyte  10.3 µm  30 days
4. Target cells are found in : 5. Spherocytes are NOT found 6. Anisocytosis means :
 Thalassaemia in one of the following  Increased reticulocytes
 Haemoglobin C disease condition :  Presence of immature WBCs
 Iron deficiency anemia  Congenital spherocytosis  Variation in the shape of
 Liver disorders  Autoimmune hemolytic RBCs
 All of the above anemia  Presence of immature
 Hemolytic disease of the erythroid cells
newborn  Variation in size of RBCs
 Blood transfusion
 Iron deficiency anemia
7. Polychromasia corresponds 8. Reticulocytes are NOT 9. Reticulocytes can be seen in :
to increased : increased in one of the  Haemorrhage
 Red cells following conditions :  Haemolysis
 Reticulocytes  Haemorrhage  Hypoplastic anemia with
 Ovalocytes  Haemolysis hyperactive foci in the bone
 Lymphocytes  In response to specific marrow
 basophils hematinics used in treatment  In response to treatment of
of anemias anemias
 Aplastic anemia  All of the above
 Thalassemia
10. Reticulocytes count is 11. The normal RBC count for 12. The normal Hb level for an
decreased in : adult female is : adult male is :
 Iron deficiency anemia  2.8 – 3.8 x /L  13 – 19 g/dl
 Aplastic anemia  3.8 – 4.8 x /L  11 – 16 g/dl
 Megaloblastic anemias  2.8 – 3.8 x /L  12 – 16 g/dl
receiving proper treatment  3.8 – 4.8 x /L  15 – 18 g/dl
 Hereditary hemolytic  4.8 – 5.8 x /L  13 – 17 g/dl
anemia
13. In adults, the normal range 14. In adult males, the normal 15. In adult females, the normal
for mean corpuscular range for packed cell volume range for packed cell volume
volume is : is: is :
 68 – 88 fl  30 – 50 %  25 – 45 %
 78 – 98 fl  40 – 60 %  35 – 55 %
 88 – 108 fl  40 – 50 %  35 – 45 %
 58 – 98 fl  45 – 55 %  30 – 40 %
 78 – 99 fl  50 – 65 %  40 – 65 %

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16. In adults, the normal range
for mean corpuscular
hemoglobin is :
 22-32 pg
 27-37 pg
 27 – 32 pg
 29 – 42 pg
 27 – 39 pg
18. Microcytic hypochromic
anaemias is a feature of all
these except :
 Iron deficiency anemia
 Thalassaemias
 Sideroblastic anemias
 Acute blood loss
 Chronic blood loss
21. All these findings help in the
diagnosis of iron deficiency
anemia except:
 Decreased iron stores
 Decreased TIBC
 Decreased serum iron
 Decreased transferrin
saturation index
 Decreased serum ferritin
level
24. All of the following
investigate iron status except
 Serum iron
 TIBC
 RDW
 % saturation of transferrin
 Serum ferritin
27. in iron deficiency anemia ,
all of the following is true
except :
 decreased serum iron
 increased MCV
 decreased serum ferritin
 decreased transferrin
saturation index
 decreased BM iron stores
Clinical Pathology, X-Rays, ECG
17. RDW indicates :
 Hypochromia
 Microcytosis
 Poikilocytosis
 Anisocytosis
 Reticulocytosis
ANEMIA
19. Causes of microcytic
hypochromic anemias
include all of the following
except :
 Sideroblastic anemia
 Autoimmune hemolytic
anemia
 Iron deficiency anemia
 Anemia of chronic disorders
 Thalassemias
22. Regarding the iron status in
iron deficiency, which of the
following is false :
 Decreased serum iron
 Increased TIBC
 Decreased serum ferritin
 Increased transferrin
saturation index
 Decreased BM iron stores
25. Serum iron decreases in :
 ß thalassaemia major
 ß thalassaemia minor
 sidroblastic anemia
 anemia of chronic disorders
 all of the above
28. to detect the cause of the
iron deficiency anemia,
which of the following is
done ?
 stool analysis for parasites
 stool analysis for occult
blood
 urine analysis for hematuria
 all of the above
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20. Microcytic hypochromic
anaemias is NOT found in
one of the following
conditions :
 Thalassemia
 Sideroblastic anemia
 Iron deficiency anemia
 Anemia of chronic disorders
 Autoimmune hemolytic
anemia
23. Which of the following
parameters reflects iron
stores :
 Serum iron
 TIBC
 RDW
 % saturation of transferrin
 Serum ferritin
26. hypochromic anamia is
present in all of the following
except :
 thalassemia major
 anemia of chronic disorders
 sideroblastic anemia
 lead poising
 congenital spherocytosis
29. all these can be used for
diagnosis of ß thalassemia
major except :
 increased serum iron level
 increased TIBC
 increased transferrin
saturation index
 increased serum ferritin
level
 increased Hb F level
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30. ß thalassemia major is
characterized by all of the
following except :
 Severe anemia (microcytic
hypochromic)
 Leucocyte and platelet
counts are normal
 Effective erythropoiesis
 Shortened red cell life span
 Hb electrophoresis shows:
increased HbF , HbA2 is
normal or high
33. Sideroblastic anemia is NOT
characterized by :
 Ineffective erythropoiesis
 Ring sideroblasts
 Decreased serum ferritin
 Increased iron stores in bone
marrow
 Dimorphic red cells
36. All these can cause
macrocytic anemias except :
 Liver disease
 Aplastic anemia
 Thalassemias
 Acute hemolytic anemia
 Acute blood loss
39. causes of macrocytic
anaemias include :
 liver diseases
 aplastic anemia
 pernicious anemia
 autoimmune hemolytic
anemia
 all of the above
42. Laboratory findings in
aplastic anemia include all of
the following except :
 Low reticulocyte count
 Normocellular bone marrow
 High ESR
 Low neutrophil count
 Low Hb level
Clinical Pathology, X-Rays, ECG
31. α thalassemia is
characterized by which of
these phenotypic categories :
 silent carrier
 α thalassemia trait
 Hb H disease
 Hb Bart’s
 All of the above
34. Anemia of chronic disorders
is found in cases of :
 Lung abscess
 Rheumatoid arthritis
 Chronic renal failure
 Tuberculosis
 All of the above
37. Laboratory diagnosis of
megaloblastic anemia is by
all of the following except :
 Blood picture : pancytopenia
megaloblastic erythropoiesis
 Positive intrinsic factor
antibodies
 Positive antiparietal cell anti
bodies
 Increased serum vit.B12
40. which of the following in
NOT a cause of
normochromic normocytic
anemia :
 acute blood loss
 aplastic anemia
 anemia due to chronic
disorders
 hemolytic anemia
 thalassemia
43. Laboratory evidence of
hemolysis includes all of the
following except :
 Hyperbilirubinaemia
(indirect)
 Reticulocytosis
 Increased urine urobilinogen
 Increased haptoglobin
 Bone marrow show
erythroid hyperplasia
3
32. The peripheral blood smear
of a silent carrier of α
thalassemia typically
appears as :
 Normocytic , normochromic
 Macrocytic, normochromic
 Microcytic , hypochromic
 Macrocytic , hpochromic
35. Direct Coomb’s test is
negative in :
 Lymphoproliferative
disorders
 Collagen diseases
 Rh incompatibility
 Congenital spherocytosis
38. In megaloblastic anaemia
one of the following is not
true :
 Mild thrombocytopenia
 Mild leucopenia
 Hypochromia
 Decreased serum vitamin
B12 or folate
 macrocytosis
41. aplastic anemia is a
condition characterized by :
 B12 deficiency
 Increased reticulocyte count
 Pancytopenia
 Hypocellular BM
 Both C & D
44. Which of the following is
NOT true for congenital
spherocytosis :
 Increased serum bilirubin
 Increased osmotic fragility
 Positive direct Coomb’s test
 Increased reticulocytes
 Negative indirect Coomb’s
test
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45. Which of the following is
NOT found in G6PD
deficiency :
 Hemoglobinemia
 Hemoglobinuria
 Low enzyme level during the
hemolytic attacks
 Increased reticulocyte count
 Anemia
48. Causes of warm
autoimmune hemolytic
anemia include all of the
following except:
 Idiopathic
 Chronic lymphatic leukemia
 Viral infections
 Collagen disorders as SLE
 Hereditary
51. Laboratory diagnosis of cold
autoimmune hemolytic
anemia include :
 Evidence of chronic
hemolysis with
exacerbations especially
when the patient is chilled
 Normochromic normocytic
anemia with polychromasia
 Cold antibodies in serum
 Positive indirect Coomb’s
test
 All of the above
54. In ABO incompatibility disease of
the newborn, all of the following
are true except
 The disease is milder because A
and B antigens are week in the
fetus
 It can occur in the first pregnancy
without prior sensitization
 Anemia and mild jaundice
 Blood film shows spherocytes and
reticulocytes
 Coombs’ test is strongly positive
46. In G6PD deficiency
diagnosis is established by
estimation of the enzyme :
 In between attacks (6 weeks  It is inherited as an
after the attack)
 During the attack
 Immediately after the attack  Diagnosis is established by
 At any time irrespective of
the attack
 After ingestion of fava beans
49. Laboratory diagnosis of
warm autoimmune
hemolytic anemia includes
all of the following except :
 Mild normochromic
normocytic anemia
 Blood film shows nucleated
RBCs, polychromasia, and
spherocytes
 Laboratory evidence of
hemolysis
 Positive direct Coomb’s test
 Positive indirect Coomb’s
test
52. Haemolytic disease of the
newborn may be due to all of
the following except:
 Rh incompatibility (mostly
anti-D)
 ABO incompatibility
 Minor group incompatibility
 Rh incompatibility (mostly
anti-C)
 None of the above
55. Normal hemoglobin pattern 56. Sickle cell disease is
in adult life is all of the
following except :
 HbA : 96 – 98 %
 HbA2 : 2-3.4 %
 HbF : < 1 %
 HbS : < 1 %
 Hb electrophoresis shows AS
 Sickle cells in the stained film
4
47. In pyruvate kinase enzyme
deficiency all of the
following are true except :
autosomal recessive trait
 RBC morphology is normal
enzyme essay
 Resulting anemia is
normochromic normocytic
 Resulting anemia is
macrocytic
50. Causes of cold autoimmune
hemolytic anemia include all
of the following except :
 Idiopathic
 Mycoplasma pneumonia
 Viral infections as infectious
mononucleosis
 Lymphoproliferative
disorders as non-Hodgkin’s
lymphoma
 Bacterial infections
53. In Rh hemolytic disease of
the newborn, laboratory
features of cord blood
include all of the following
except :
 Anemia, reticulocytosis,
normoblastemia
 Jaundice
 Increased indirect serum
bilirubin
 Direct Coomb’s test is
positive
 Indirect Coomb’s test is
positive
characterized by all of the
following except :
 Results from a genetic
abnormality in Hb structure
 Marked normocytic
normochromic anemia
 Hb electrophoresis shows SS
pattern
pattern

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57. Normal hemoglobin
electrophoresis pattern
found in :
 Sickle cell disease
 Beta thalassemia intermedia
 Beta thalassemia trait
 Beta thalassemia major
 Alpha thalassemia trait
60. Polycythemia occurs in all of
the following conditions
except:
 Hypoxic lung disease
 Renal ischemia
 Polycythemia rubra vera
 Liver disease
62. Decreased ESR could be
found in all of the following
except :
 Polycythemia
 Hypofibrinogenemia
 Sickle cell anemia
 Aplastic anemia
 Disseminated intravascular
coagulation
65. ESR is high in the following
conditions except :
 Paraproteniemia
 Collagen diseases
 Active tuberculosis
 Tissue damage
 Afibrogenemia
68. ESR is considered a :
 Diagnostic test
 Specific test
 Crude test
 Monitoring test
 Non of the above
Clinical Pathology, X-Rays, ECG
58. Immune hemolytic anemia
can occur in all of the
following except :
 Lyphoproliferative disorders  Lymphoproliferative
 Viral infections
 Collagen disorders
 Iron deficiency anemia
Polycythemia
61. Laboratory features of
secondary polycythemia are
all of the following except :
 Erythrocytosis
 Normal leucocytes and
platelet counts
 Normal leucocyte alkaline
phosphatase
 Increased serum
erythropoietin
 Increased arterial oxygen
saturation
ESR
63. Low ESR could be found in
all except :
 Polycythemia
 Hypofibrinogenemia
 Pregnancy
 Old specimen
 Sickle cell anemia
66. ESR is high in all of the
following conditions except :
 Multiple myeloma
 Collagen disease
 Pyogenic infections
 Hypofibrinogenemia
 Active tuberculosis
69. Reference range of ESR in
an healthy adult male is :
 3 - 12 mm/ 1st hr
 Up to 20 mm/ 1st hr
 Up to 30 mm/ 1st hr
 1 – 10 mm/ 1st hr
 0 – 5 mm/ 1st hr
59. Alloimmune hemolytic
anemia can occur in all of
the following except :
disorders
 Rh incompatibility
 ABO incompatibility
 Minor group incompatibility
64. ESR is low in :
 Rheumatoid arthritis
 Polycythemia
 Malignancy
 Pregnancy
 Tuberculosis
67. ESR is a diagnostic specific
test in :
 Rheumatoid arthritis
 Myeloprolfirative disorders
 Infectious mononucleosis
 tuberculosis
 non of the above
70. Marked rise in ESR is seen
in all of the following except
 Myeloma
 Collagen disease
 Active tuberculosis
 Malignancy
 Acute leukemia
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71. Reference range for total
leucocytic count in healthy
adults is :
 10 – 26 x L  1-4 x
 5 – 13 x L  2-7 x
 4 - 10 x L  0.2-0.5 x
 2–6x L  4-11 x
74. The term that denotes total
leucocytic count below
4x L is :
 Leucopenia
 Leucocytosis
 Agranulocytosis
 Leukemoid reaction
77. Presence of immature
myeloid and erythroid cells
in peripheral blood is
termed :
 Leukemoid reaction
 Hemolytic reaction
 Leucoerythroblastic reaction
 Febrile reaction
 Drug induced reaction
80. neutrophilia is a feature of
all of the following disorders
except:
 acute hemorrhage
 acute pyogenic infections
 cortisone therapy
 infectious mononucleosis
 acute hemolysis
83. Neutropenia is likely to
occur in :
 Typhoid, brucella ,
tuberculosis
 Felty’s syndrome
 Intake of anti-bacterial
drugs
 Megaloblastic anemiathe
 All of the above
LEUCOCYTES
72. Reference range for
neutrophils absolute count in
healthy adult is :
L  Leucopenia
L  Leukocytosis
L  Agranulocytosis
L  Leukemoid reaction
75. Leucoerythroblastic reaction
means :
 Presence of immature
myeloid and erythroid cells
in peripheral blood
 Presence of immature
myeloid and erythroid cells
in bone marrow
 Presence of blasts in
peripheral blood
 Presence of blasts in bone
marrow
78. Neutrophilia is afeature of
all of the following disorders
except :
 acute pyogenic infections
 tissue damage or necrosis
e.g. infarction , trauma
 corticosteroid therapy
 pregnancy
 parasitic infections
81. neutophilia is a feature of all
of the following disorders
except:
 bacterial infection
 myocardial infarction
 metastatic carcinoma
 acute hemorrhage
 chronic lymphocytic
leukemia
84. Neutropenia is likely to
occur in :
 Post-splenectomy
 Megaloblastic anemia
 Burns
 Bacterial infections
 Acute hemorrhage
6
73. The term that denotes total
leucocytic count above
10 x L is :
76. A leucoerythroblastic
reaction is
 Left shift in peripheral blood
 Right shift in peripheral
blood
 Both right and left shift in
peripheral blood
 Left shift and nucleated
RBCs in peripheral blood
 Non of the above
79. neutrophilia is a feature of
all of the following disorders
except:
 malignancy of all types
 myeloproliferative disorders
e.g. polycythemia vera and
myelofibrosis
 metabolic disorders e.g.
uremia , eclampsia … etc.
 acute hemorrhage or
hemolysis
 antibiotic therapy
82. neutropenia is likely to occur
in :
 intake of anti-inflammatory
drugs
 viral infections e.g. hepatitis,
influenza, HIV
 SLE
 Part of a general
pancytopenia
 All of the above
85. Anticonvulsant therapy may
cause :
 Neutrophilia
 Neutropenia
 Lymphocytosis
 Lymphopenia
 Non of the above

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Mahmoud Sewilam Clinical Pathology, X-Rays, ECG

86. Lymphocytosis occurs in all 87. Absolute lymphocytosis 88. Absolute lymphocytosis
of the following disorders occurs in all of the following occurs in all of the following
except: disorders except : disorders except:
 Infectious mononucleosis  Infectious mononucleosis  Tissue necrosis
 Tuberculosis  Infectious lymphocytosis  Chronic lymphatic leukemia
 Chronic lymphatic leukemia  Cytomegalovirus infection  Pertussis
 Lymphoma  Lymphoma  Infectious mononucleosis
 Pregnancy  Acute pyogenic infection  Tuberculosis
89. The following conditions are 90. Lymphocytosis occurs in all 91. Lymphocytosis is observed
associated with of the following disorders in all of the following
lymphocytosis except : except: disorders except :
 Cytomegalovirus infection  Infectious mononucleosis  Lymphoma
 Lymphoma  Lymphoma  Tuberculosis
 Infectious mononucleosis  Cytomegalovirus infection  Cytomegalovirus infection
 Myocardial infarction  Protozoal infections  Corticosteroid therapy
 Chronic lymphocytic  Tuberculosis  Infectious mononucleosis
leukemia
92. Lymphopenia is prominent 93. Lymphopenia occurs in all 94. Eosinophilia is NOT present
in : of the following disorders in :
 Chronic lymphocytic except :  Allergic diseases
leukemia  Severe BM failure  Drug sensitivities
 AIDS  Corticosteroid and  Hodgkin disease
 Infectious mononucleosis immunosuppressive drugs  Myxedema
 Toxoplasmosis  Irradiation  Myeloproliferative disorders
 Non of the above  Hodgkin’s disease
 Parasitic diseases
95. Eosinophilia is present in : 96. Reactive eosinophilia occurs 97. Monocytosis is present in :
 Allergic disease in :  Bilharzial infestation
 Tuberculosis  Drug allergies  Protozoal infections
 Protozoal infections  Neoplasms  Skin diseases
 Chronic lymphocytic  Parasitic infections  Drugs
leukemia  All of the above  Non of the above
 Non of the above  None of the above
98. Absolute monocyte count 99. Monocytosis can be observed 100. Basophilia is found in all
>1000/cmm is found in all of in of the following disorders
the following disorders  Tuberculosis except :
except:  Malignancy  Polycythemia vera
 Tuberculosis  Chronic myelomonocytic  Myxedema
 Brucellosis leukemia  Xanthemata
 Subacute bacterial  All of the above  Chronic myeloid leukemia
endocarditis  Chronic lymphatic leukemia
 Protozoal infections
 Acute follicular tonsillitis
101. Agranulocytosis is 102. All of the following present 103. Pancytopenia can result
associated with : with pancytopenia except : from :
 Leucopenia  Hypersplenism  Systemic lupus erythematosus
 Neutrophil count < 2x /L  Systemic lupus erythematosus  Hairy cell leukemia
 Neutrophil count < 1x /L  Aleukemic leukemia  Paroxysmal nocturnal
 Neutrophil count < 0.5x /L  Malaria hemoglobinuria
 Non of the above  Aplastic anemia  Hypersplenism
 All of the above
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104. All of the following
present with pancytopenia
except:
 Splenomegaly
 Aplastic anemia
 Megaloblastic anemia
 Iron deficiency anemia
 Acute leukemia
107. Infectious mononucleosis
is associated with all of the
following except :
 EBV
 Fever , sore throat
 Atypical lymphocytes
 Absence of heterophil
antibodies
 Normal hemoglobin RBCs
108. Leukemoid reaction is
due to all of the following
except:
 Pyogenic infection
 Acute bleeding
 Acute hemolysis
 Gangrene
 Chronic myeloid leukemia
111. In Leukemoid reaction,
all are true except :
 Increased total leucocytic
count up to 50,000/cmm
 Occurs in severe infections
 Characterized by the
presence of immature WBCs
in peripheral blood
 Philadelphia chromosome
positive
 NAP score is high
113. FAB classification classifies
acute leukemia according to :
 Cytogenetic abnormalities
 Immunological characteristics
 Both cytogenetic and
immunological abnormalities
 Morphological characteristics
 Morphological, phenotypic and
cytogenetic characteristics
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Clinical Pathology, X-Rays, ECG
105. Pancytopenia is present 106. A patient with EBV
in all of the following except: infection may develop all of
 Acute leukemia the following except :
 Chronic granulocytic  Neutrophilia
leukemia  Lymphocytosis
 Hypersplenism  Autoimmune hemolytic
 SLE anemia
 None of the above  Lymph node enlargement
 Mild thrombocytopenia
LEUKEMIA
109. Leukemoid reaction is 110. Leukemoid reaction is
characterized by the characterized by :
following except :  Presence of Philadelphia
 Leucocytosis chromosome
 Increased band forms  Low NAP score
 Shift to the right  High basophilia
 Increased NAP score  Shift to the left
 Neurophilia  High eosinophilia
112. Leukemia is a malignant proliferation of hematopoietic cells
in the :
 Bone marrow then infiltrate peripheral blood and lymph nodes
 Lymph nodes then infiltrate peripheral blood and bone marrow
 Peripheral blood then infiltrate bone marrow and lymph nodes
 Bone marrow and doesn’t infiltrate lymph nodes
 Lymph nodes and doesn’t infiltrate bone marrow or peripheral
blood.
114. WHO classification for 115. The least number of bone
acute leukemia classifies it marrow blast cell required
according to : to diagnose acute leukemia is
 Morphological characteristics  Blast cells ≥ 30 %
 Cytogenetic abnormalities
 Normoblasts ≥ 25 %
 Both cytogenetic and
 Blast cells ≥ 20 %
immunophenotypic
 Blast cells and normoblasts
abnormalities
 Morphological, ≥ 30 %
immunophenotypic and  Blast cells ≥ 60 %
cytogenetic characteristics
 Morphological and
immunophenotypic characteristics
8
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116. Diagnosis and
classification of acute
leukemia needs :
 Complete blood picture
 Bone marrow examination
 Immunophenotyping
 Cytochemical stain
 All of the above
119. Presence of Auer rods in
the blast cells indicated that
they are :
 Lymphoblasts
 Myeloblasts
 Of no significance
 Bilineage
 Biphenotypic
122. In subacute leukemia, we
can find the following except
 Leucopenia
 Thrombocytopenia
 Absence of blast cells in
peripheral blood
 10 % blast cells in bone
marrow
125. Diagnosis of acute
leukemia requires the
presence of at least :
 20 % blast cells in
peripheral blood
 90 % blast cells in
peripheral blood
 20 % blast cells in bone M.
 90 % blast cells in bone M.
128. Neutrophil alkaline
phosphatase score is
diagnostic in :
 Chronic lymphocytic
leukemia
 Acute lymphoblastic
leukemia
 Acute myeloid leukemia
 Chronic myeloid leukemia
 All of the above
Clinical Pathology, X-Rays, ECG
117. In acute myeloid
leukemia, all of the following
can be found except :
 Myeloblasts
 Megakaryoblasts
 Lymphoblasts
 Erythroblasts
120. Peroxidase stain
positivity indicates :
 Myeloblastic leukemia
 T-Lymphocytic leukemia
 Common acute
lymphoblastic leukemia
 Megakaryoblastic leukemia
 B-lymphoblastic leukemia
123. In acute lymphoblastic
leukemia, all of the following
can be found except:
 Lymphoblast cells in
peripheral blood
 Hypercellular bone marrow
 Blasts are myeloperoxidase
positive
 Lymphadenopathy
126. Lymphoproliferative
disorders include all of the
following except:
 Hairy cell leukemia
 Chronic lymphocytic
leukemia
 Non Hodgkin’s lymphoma
 Chronic myeloid leukemia
129. Neutrophil alkaline
phosphatase score is elevated
in all of the following
disorders except :
 Pregnancy
 Severe infection
 Chronic myeloid leukemia
 Polycythemia rubra vera
 Severe aplastic anemia
118. All of the following are a
must to diagnose acute myeloid
leukemia except :
 More than 20 % blasts in Bone
marrow
 Blast cells in peripheral blood
 Myeloperoxidase positivity
 Presence of myeloid antigens
on blast cells
121. Acute lymphoblastic
leukemia can present with
all of the following except :
 Anemia
 Hypercellular bone marrow
 Increased promyelocytes in
peripheral blood
 Thrombocytopenia
124. All of the following is a
must to diagnose acute
lymphoblastic leukemia
except :
 More than 20 % blasts in
bone marrow
 Blast cells in peripheral
blood
 Myeloperoxidase negativity
 Presence of lymphoid
antigens on blast cells
127. Neutrophil alkaline
phosphatase in acute
leukemia :
 Constantly low
 Constantly high
 Variable
 Used mainly to diagnose
lymphoblastic leukemia
 Non of the above
130. Neutrophil alkaline
phosphatase score is low in:
 Pyogenic infection
 Polycythemia
 Chronic myeloid leukemia
 Acute myeloid leukemia
 Non of the above
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131. Chronic myeloid 132. Neutrophil alkaline
leukemia is characterized by phosphatase is enzyme
 Splenomegaly present in the granules of :
 Marked leukocytosis  Monocytes
 Myelocyte bulge  Neutrophilis
 Basophilia  Basophilis
 All of the above  Lymphocytes
 Eosinophilis
134. In chronic phase of 135. Diagnosis of chronic
chronic myeloid leukemia all myeloid leukemia is based
of the followings are present on all of the following except
except:  Complete blood picture
 Philadelphia chromosome  Bone marrow examination
 Splenomegaly  NAP score
 Blast cells are more than 20  Cytogenic anaylsis
% in bone marrow  Myeloperoxidase stain
 High total leucocytic count
 Thrombocytosis
137. The characteristic 138. persistent lymphocytosis 139. in chronic lymphocytic
cytogenetic abnormality in with presence of smear cells
chronic myeloid leukemia is: in peripheral blood is
 t (8,21) present in cases of :
 t (9.22)  chronic myeloid leukemia
 t (15,17)  acute lymphoblastic
 t (12,21) leukemia L1
 t (8,14)  chronic lymphocytic
leukemia
 acute lymphoblastic
leukemia L2
 all of the above
140. chronic lymphocytic 141. patients of chronic
leukemia is disease of: lymphocytic leukemia
 old age only commonly presents with:
 middle age female  DIC
 children only  Persistent lymphocytosis
 elder female  Autoimmune hemolytic
 middle and old age anemia
 Thrombocytopenia and
anemia
143. In chronic myeloid leukemia  Splenomegaly
(chronic phase) one criterion of
the following can be found :
 Thrombocytopenia
144. In chronic myeloid leukemia all of
 Leucopenia
the following are correct except:
 High neutrophil alkaline
 Marked shift to the left
phosphatase
 Thrombocytosis  Eosinophilia and basophilia
 Lymphocytosis
 Lymphocytosis  Philadelphia chromosome positive
 Low NAP score
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133. Classical chronic myeloid
leukemia is characterized by
all of the following except:
 Hypercellular BM
 Marked shift to the left
 Monocytosis
 Increased bone marrow
megakaryocytes
 Low Neutrophil alkaline
phosphatase (NAP) score
136. Myeloperoxidase
reaction is mostly diagnostic
in:
 Chronic myeloid leukemia
 Acute myeloid leukemia
 Chronic lymphocytic
leukemia
 Acute lymphoblastic
leukemia
 All of the above
leukemia, all of the following
can be found except :
 splenomegaly
 lymphocytosis
 lymphoblasts in peripheral
blood
 lymphadenopathy
142. Diagnosis of chronic
lymphocytic leukemia is
based on the presence of :
 Peripheral lymphocytosis
with normal marrow
 Lymphocytes > 30 % in
marrow with persistent
lymphocytosis in blood
 Leucopenia with relative
lymphocytosis
 Atypical lymphocytosis
 Non of the above
145. Which of the following is the most
helpful to differentiate between leukmoid
reaction and chronic myeloid leukemia
 WBCs count
 Immature cells
 Platelet count
 NAP score
 RDW
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146. Lymphocytosis is one of the
findings in :
 Acute myeloid leukemia
 Chronic myeloid leukemia
 Acute lymphoblastic leukemia
 Chronic lymphocytic leukemia
149. diagnose of chronic
lymphocytic leukemia is
essentially based on presence
of :
 lymph node enlargement
 anemia
 persistent lymphocytosis
with characteristic
immunophenotypic findings
 thrombocytopenia
 leucocytosis
152. Myeloproliferative
disorders include all of the
following except :
 Chronic myeloid leukemia
 Essential thrombocythaemia
 Prolymphocytic leukemia
 Polycythemia rubra vera
155. Regarding total proteins
in multiple myeloma :
 No change in their level
 Marked decrease in their
level
 Increase in their level
 Increase only in albumin
with decrease in others
 Decrease in albumin
158. All of the following can be
found in multiple myeloma
except :
 Osteolytic lesions
 Bone marrow infiltrations by
plasma cells
 High serum proteins with high
globulins
 Polyclonal Ig in blood or urine
or both
 High serum calcium
Clinical Pathology, X-Rays, ECG
147. All of the following can be found
in peripheral blood in chronic
lymphocytic leukemia except:
 90 % lymphocytes
 Smear cells
 Leukocytosis
 Stab cells (Band forms)
 anemia
150. in chronic lymphocytic
leukemia, which of the
following can be found :
 persistent lymphocytosis
 thrombocytopenia
 autoimmune hemolytic
anemia
 lymph node enlargement
 all of the above
153. Regarding the diagnostic
triad of multiple myeloma
all are correct except :
 Monoclonal gammopathy
 Malignant plasma cell
infiltration of peripheral
blood
 Osteolytic bone lesions
 Malignant plasma cell
infiltration in bone marrow
156. Regarding
immunoglobulins in multiple
myeloma :
 All immunoglobulins are
increased
 All immunoglobulins are
decreased
 Increase of IgG and IgM and
decreased other types
 Increase of IgM and
decreased all other types
 Increase of one type and
decreased all other types
159. Bone marrow
examination in all of the
following except :
 Aplastic anemia
 Megaloblastic anemia
 G6PD deficiency
 Lipid storage disease
 Hypersplenism
11
148. chronic lymphocytic
leukemia is characterized by
all of the following except :
 leukocytosis
 lymphocytosis
 marked shift to the left
 splenomegaly
151. Philadelphia
chromosome is present in :
 AML
 CML
 CLL
 Eosinophilic leukemia
154. Multiple myeloma is
characterized by :
 Osteolytic lesions
 Normal serum protein level
 No bone affection
 Lymphocyte cell infiltration
in bone marrow
 Polyclonal gammopathy
157. The following is mostly
present in multiple myeloma
:
 Polyclonal gammopathy
 Monoclonal gammopathy
 Polyclonal gammopathy
And Monoclonal
gammopathy
 Increase serum albumin
 Decreased serum calcium
160. All these conditions are
associated with
splenomegaly except :
 Infectious mononucleosis
 Leukemia
 Lymphoma
 Hairy cell leukemia
 Sickle cell anemia
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161. In hypersplenism, the
most likely finding in the
peripheral blood is :
 Normochromic normocytic
anemia
 Thrombocytosis
 Pancytopenia
 Lymphopenia
 All of the above
162. Prothrombin time is used
to monitor:
 Intravenous anticoagulant
therapy
 Oral anticoagulant therapy
 A and B
 Platelet function defect
165. Activated partial
thromboplastin time is
prolonged in :
 Hemophilia B
 Factor VIII deficiency
 Blood vessel disease
 Hemophilia B & factor VIII
deficiency
 None of the above
168. International normalized
ration is the best monitor for
 IV anticoagulant therapy
 Oral anticoagulant therapy
 Platelet replacement therapy
 Cryoglobulin therapy
 All of the above
171. Bleeding time is used
clinically to screen for a
significant defect in :
 Coagulation defect
 Platelet function
 Fibrinolytic pathway
 None of the above
 All of the above
Clinical Pathology, X-Rays, ECG
HAEMOSTASIS
163. Prothrombin time is
prolonged in :
 Hemophilia A
 Massive liver disease
 Idiopathic thrombocytopenic
purpura
 Bone marrow failure
 Thrombocytopenia purpura
166. Heparin anticoagulant
therapy is best monitored by
 Prothrombin time
 Activated partial
thromboplastin time
 Bleeding time
 Thrombin time
 None of the above
169. Bleeding time is
prolonged in the following
conditions except :
 Henoch Schonlein purpura
 Bernard Soulier syndrome
 Immature thrombocytopenic
purpura
 Disseminated intravascular
coagulation
 Hemophilia A
172. Thrombocytopenia is
seen in :
 Fanconi syndrome
 Glanzmann’s disease
 Von Willebrand disease
 Storage pool diseas
 None of the above
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164. Activated partial
thromboplastin time is used
to detect :
 Extrinsic pathway defect
 Intrinsic pathway defect
only
 Fibrinolytic pathway defect
 Platelet function defect
 Intrinsic & common
pathway defect
167. Thrombin time
measures :
 Conversion of prothrombin
to thrombin
 Conversion of fibrinogen to
fibrin
 Conversion of factor VII to
active factor VII
 Conversion of plasminogen
to plasmin
170. All of the following
conditions lead to prolonged
bleeding time except :
 Von Willebrand disease
 Thrombocytopenia
 Haemophilia A
 Henoch Schonlein purpura
 DIC
173. In immune
thrombocytopenic purpura
all of the following is correct
except :
 Normal PT
 Prolonged bleeding time
 Normal PTT
 Decreased bone marrow
megakaryocytes
 Decreased platelet life span
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Mahmoud Sewilam Clinical Pathology, X-Rays, ECG

174. Routine evaluation of
patients with bleeding
tendency necessitates :
 Through history and clinical
examination
 TLC
 Collagen markers assay
 Trephine biopsy
 All of the above
177. Platelet function study
with ristocetin shows
defective response in :
 Glanzmann’s disease
 Von Willebrand disease
 Bernard Soulier syndrome
 Bernard Soulier syndrome
And Von Willebrand disease
180. In massive liver disease
there is :
 Prolonged PT and PTT
 Thrombocytosis
 Thrombocytopenia
 Prolonged PT and PTT
 And Thrombocytopenia
 Prolonged PT and PTT
And Thrombocytosis
183. All the following findings
are present in DIC except :
 Thrombocytopenia
 Decreased serum FDPs level
 Decreased serum fibrinogen
level
 Prolonged PT
 Prolonged PTT
186. In hemophilia B there is :
 Prolonged PT
 Prolonged PTT
 Prolonged TT
 Bleeding time is prolonged
 None of the above
175. Causes of vascular 176. Platelet adhesion defect
prupura include : occurs in :
 ITP  Henoch Schonlein purpura
 Henoch Schonlein purpura  Glanzmann’s disease
 Glanzmann’s disease  Bernard Soulier syndrome
 Bernard Soulier syndrome  All of the above
 None of above
178. Platelet function study 179. In ITP there is :
with collagen shows  Prolonged PT
defective response in :  Prolonged PTT
 Glanzmann’s disease  Decreased platelet count
 Von Willebrand disease  Increased bone marrow
 Bernard Soulier syndrome megakaryocytes
 Bernard Soulier syndrome  Decreased platelet count
And Von Willebrand disease And Increased bone marrow
megakaryocytes
181. Thrombocytopenia is a 182. Normal platelet count
common finding in : ranges from:
 Aplastic anemia  150 – 400 x /L
 Massive liver disease  150 – 400 x /L
 ITP  150 – 400 x /L
 Hypersplenism  150 – 400 x /L
 All of the above  150 – 450 x /L
184. In DIC : 185. D-dimer assay is valuable
 PT and PTT are prolonged in :
 TT and BT are prolonged  ITP
 Platelet count and fibrinogen  DIC
are decreased  Hemophilia A
 All of the above  Factor VII deficiency
 Platelet function defect
187. In von Willebrand
disease :
 Prolonged PT
 Prolonged TT
 Bleeding time is prolonged
 PTT test is normal
 Prolonged PT & TT

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188. Whole blood transfusion
is indicated in :
 Anemia of congestive heart
failure
 Exchange blood transfusion
 Hemophilia A
 Acute blood loss with
hypovolemic shock
 Both Exchange blood
transfusion and Acute blood
loss with hypovolemic shock
191. Acute hemolytic
transfusion reaction occurs
due to :
 HLA alloimmunization
 ABO incompatibility
 Platelet specific antigen
 Transmission of viral
infection
 None of the above
194. Which of the following is
false concerning fresh frozen
plasma :
 Prepared with 6 hours of
blood donation
 Stored at 18 ºC
 Thawed at 37ºC
 Can be refrozen
 Used in hemorrhage due to
deficiency of clotting factors
Clinical Pathology, X-Rays, ECG
BLOOD TRANSFUSION
189. Advantages of packed
RBCs are all of the following
except
 Smaller volume
 Large oxygen carrying
capacity
 Less risk of transfusion of
virus infection
 Rich in factor VIII
 Less risk of transfusion of
WBCs
192. Febrile transfusion
reaction occurs due to :
 Rh incompatibility
 HLA class I antigens
 ABO incompatibility
 Platelet specific antigen
 None of the above
195. Which of the following is 196. Which of the following is
false concerning packed
RBCs:
 Before use the bag is heated  Occurs during the first 30
in very hot water
 Most helpful in anemia of
congestive heart failure
 Can be washed with saline to  Hemoglobinemia and
remove plasma proteins in
certain cases
 Used in cases of exchange
blood transfusion
 Before use the bag is heated
in very hot water and Used
in cases of exchange blood
transfusion
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190. Which of the following is
false regarding platelet
concentrate :
 Indicated in bleeding due to
thrombocytopenia
 Stored in refrigerator at 2 –
6º C
 Stored at room temperature
(20-24ºC) with continuous
gentle agitation
 Can be used up to 10 days
after preparation
 Stored in refrigerator at 2 –
6º C and Can be used up to
10 days after preparation
193. Regarding acute lung
injury following transfusion,
all of the following are true
except :
 Transfusion related
 Due to antibodies against
patient’s leucocytes
 Presents with fever and
chills
 Anti Rh D is the main cause
present in acute hemolytic
transfusion reaction :
minutes of transfusion
 Chills, pain in the back and
dyspnea
hemoglobinuria
 Hypotension and shock may
develop
 All of the above
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Mahmoud Sewilam Clinical Pathology, X-Rays, ECG

197. Prerenal uremia occurs
in :
 Congestive heart failure
 Renal tumours
 Chronic renal failure
 Glomerulonephritis
 Benign prostatic hyperplasia
200. Which of the following is
a test of glomerular function
: of :
 Measurement of urine
specific gravity
 Measurement of low
molecular weight proteins in
urine
 Urinary acidification test
 Measurement of non protein
nitrogenoeus compounds in
blood
 Vasopressin test
203. Concerning urine
specific gravity, which one of
the following statements is
false:
 It is measured by a
urinometer (hydrometer)
 It reflects the concentrating
power of the kidney
 It is increased in diabetes
insipidus
 It becomes low and fixed in
end stage renal diseases
 It increase after overnight
fluid restriction in healthy
subjects
206. Congestive heart failure
may lead to
 Increased serum urea
 Heavy proteinuria
 Hypernatremia
 Increased serum creatinine
 Hyperkalemia
209. Proteinuria in excess of 3
g/day is a typical feature of :
 Cardiac failure
 Nephrotic syndrome
 Acute renal failure
 Polycystic renal disease
 Chronic pyelonephritis
RENAL DISEASES MCQs
198. A serum urea value of 60 199. Polyuria with increased
mg/dl is equivalent to BUN
value of :
 15 mg/dl
 28 mg/dl
 35 mg/dl
201. Low fixed urine specific
gravity at 1010 is a feature
 Acute glomerulonephritis
 Diabetes insipidus
 Chronic renal failure
 D.M.
 Nephrotic syndrome
204. Which is diagnostic of
acute post streptocoocal
glomerulonephritis :
 Increased BUN and serum
creatinine
 Hypocomplementaemia
 Impaired renal tubular
function
 Oliguria and high urine
specific gravity
 Hematuria and red blood
cell casts
207. Oliguria is a feature of :
 DM
 DI
 Addison’s disease
 Hysterical polydipsia
 Acute glomerulonephritis
210. Which of the following laboratory
findings is expected in nephrotic
syndrome :
 Hypocholesterolaemia
 Hypoalbuminemia
 Decresed serum α2 macroglobulin
 Oliguria
 Presence of granular casts in urine
urine specific gravity is a
feature of :
 Pituitary diabetes insipidus
 Nephrogenic D.I.
 Chronic renal failure
 D.M.
202. Which of the following is
a glomerular function test :
 Serum creatinine
 Fluid deprivation test
 Urinary acidification test
 Urine specific gravity
 Urine pH
205. Creatinine clearance is
calculated from serum or
plasma creatinine (P in
mg/dl) , urine creatinine (U
in mg/dl) and urine volume
(V in mL/min) as follows :
 Clearance = UxV/ P
 Clearance = UxP / V
 Clearance = U / VxP
 Clearance = P / VxU
208. Proteinuria is considered
heavy if it is above :
 500 mg/day
 1 g / day
 2 g /day
 3 g/day
 4 g/day
211. Which of the following laboratory
findings is expected in nephritic
syndrome :
 Increased creatinine clearance
 Hypercholestolremia
 RBC casts
 Polyuria
 Decreased urine specific gravity

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212. One of the following in
NOT a feature of chronic
renal failure :
 Increased BUN
 Increased serum creatinine
 Increased serum potassium
 Decreased serum calcium
 Decreased serum inorganic
phosphate
215. Serum urea is NOT
increased in :
 Severe liver disease
 Congestive heart failure
 Acute glomerulonephritis
 Dehydration
 Chronic renal failure
218. Concerning urinary
casts, one of the following
statements is NOT true :
 Hyaline casts may be found
in the urine healthy subjects
 Lipoid casts are found in
nephritic syndrome
 Red blood cell casts are
pathognomonic of acute
glomerulonephritis
 White cell casts are found in
pyelonephritis
221. which of the following
conditions is accompanied
by increased urine specific
gravity :
 hysterical polydipsia
 DM
 Pituitary D.I.
 Nephrogenic D.I.
 Chronic renal failure
223. Hypocalcemia occurs in
cases of :
 Acute pancreatitis
 Multiple myeloma
 Sarcoidosis
 Milk – alkali syndrome
 Tertiary hyperparathyroidism
Clinical Pathology, X-Rays, ECG
213. Hyperuricemia is seen in 214. Increased serum urea
: with normal serum
 Leukemia
 Nephrotic syndrome
 D.I.
 High protein diet
 Advanced liver cirrhosis
216. Oliguria occurs in
 Hypercalcemia
 Acute glomerulonephritis
 Diuretic phase of Acute
renal failure
 Nephrogenic D.I.
 Acute tubular necrosis
219. The aspect of urine
remains clear in the
presence of increased
amount of :
 Epithelial cells
 WBCs
 RBCs
 Protein
 Amorphous urate
222. A patient is oliguric
when is urine volume is less
than :
 1000 mL/24 hours
 800 mL/24 hours
 700 mL/24 hours
 400 mL/24 hours
 100 mL/24 hours
Calcium and phosphorus
224. Hypercalcemia occurs in :
 Hypoalbuminemia
 Chronic renal failure
 Pseudohypoparathyrodism
 Anticonvulsant therapy
 Squamous cell carcinoma of
lung
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creatinine is seen in :
 GIT hemorrhage
 Acute glomerulonephritis
 Chronic renal failure
 Prostatic enlargement
 Renal artery stenosis
217. Concerning serum
creatinine, one of the
following statements is NOT
true
 It is the end product of
muscle creatine
 It is higher in children that
in adults
 It is higher in males than
females
 It is inversely related to GFR
 It is increased in acute and
chronic glomerulonephritis
220. Which of the following
laboratory findings is
pathognomonic of acute
glomerulonephritis :
 Oliguria
 Hematuria
 Red blood cell casts
 Pyuria
 albminuria
225. Which of the following conditions
is accompanied by hypocalcemia :
 Primary hyperparathyroidism
 Secondary hyperparathyroidism
 Tertiary hyperparathyroidism
 Multiple myeloma
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226. Which of the following is
accompanied by
hypercalcemia :
 Hypoalbuminmia
 Chronic renal failure
 Pseudohypoparathyrodism
 Anticonvulsant therapy
 Sarcoidosis
229. Which of the following
laboratory findings is
expected in primary
hyperparathyrodism :
 Hypercalcemia and
hypophosphatemia
 Hypocalcemia and
hyperphosphatemia
 Metabolic alkalosis
 Decreased urinary calcium
and phosphate
 Decreased urinary cyclic
AMP
231. Which of the following
statements is true about
serum sodium
 It is the main extracellular
anion
 It is increased in addison’s
disease
 It’s increased in renal
tubular acidosis
 It is low in the Syndrome of
inappropriate antidiuretic
hormone secretion
 It can be excluded from
calculation of the anion gap
234. Hypokalemia is expected
to occur in :
 Mineralocorticoid deficiency
 Hyperemesis gravidarum
 Crush injuries
 Acute renal failure
 DKA
Clinical Pathology, X-Rays, ECG
227. Hyperphosphatemia 228. Hypophosphatemia
occurs in : occurs in
 Vitamin D deficiency  Renal failure
 Fanconi syndrome  Primary hypoparathyrodism
 Respiratory alkalosis  Pseudohypoparathyrodism
 Primary  Fanconi syndrome
hyperparathyroidism  Metabolic acidosis
 Chronic renal failure
230. Which of the following
laboratory findings is
expected in primary
hypoparathyrodism :
 Hypercalcemia and
hypophosphatemia
 Hypocalcemia and
hyperphosphatemia
 Increased alkaline
phosphatase
 Increased urinary calcium
 Increased urinary cyclic
AMP
Sodium & Potassium
232. Which of the following 233. Hypernatremia is a
endocrinal disorders leads to feature of :
hypernatremia ?  Cushing’s syndrome
 Hyperthyroidism  Renal tubular acidosis
 Hypothyroidism  Chronic interstitial nephritis
 Hyperparathyroidism  Congestive heart failure
 Hypoparathyrodism  Paralytic ileus
 Conn’s syndrome
235. Hyperkalemia occurs in :
 Anorexia nervosa
 Cushing’s syndrome
 Burns
 Use of purgative
 Insulin therapy
17
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236. Respiratory acidosis
may be seen in cases of :
 Improperly controlled
mechanical ventilation
(hyperventilation)
 Pulmonary fibrosis
 Anxiety
 Salicylate poisoning
 Chronic renal failure
239. Which of the following
conditions leads to
metabolic alkalosis?
 Treatment with carbonic
anhydrase inhibitors
 Severe diarrhea
 Severe vomiting
 High intestinal fistulae
 Ethylene glycol poisoning
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Clinical Pathology, X-Rays, ECG
Acid base balance MCQs
237. Which of the following 238. Hyperchloremic
conditions is accompanied acidosis with normal anion
by metabolic alkalosis : gap occurs in :
 Chronic renal failure  Ureteric implantation into
 Methanol poisoning colon
 Aspirin overdose  DKA
 Ethylene glycol poisoning  Lactic acidosis
 Pyloric stenosis  Salicylate overdose
 Methanol poisoning
240. Vomiting may lead to :
 Increased arterial pH
 Increased arterial H+
concentration
 Hyperchloraemia
 Hypernatraemia
 Hyperkalemia
18
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Mahmoud Sewilam Clinical Pathology, X-Rays, ECG

241. Which of the following
is associated with
conjugated
hyperbilirubinmia ?
 Dubin-Johnson syndrome
 Gilbert’s Syndrome
 Crigler Najjar syndrome
 Neonatal Jaundice
 Hemolytic anemia
244. Which of the following
is associated with
monoclonal gammopathy ?
 Rheumatoid arthritis
 SLE
 Tuberculosis
 Liver Cirrhosis
 Multiple myelomatosis
247. One of the following is a
feature of hemolytic
jaundice :
 Pale stool
 Dark brown urine
 Conjugated
hyperbilirubinemia
 Increased serum ALP and
GGT
 Increased urine
urobilinogen
250. Which of these findings
is expected in cases of acute
viral hepatitis:
 Prolongation of
prothrombin time
 Serum albumin is low
 AST/ALT ratio more than
1  Lactate dehydrogenase (LDH)
 Serum IgA is usually
Hepatobiliary MCQs
242. Which is a cause of
unconjugated
hyperbilirubinemia ?
 Dubin-Johnson syndrome
 Rotor Syndrome
 Primary biliary cirrhosis
 Cancer head pancreas
 Gilbert’s syndrome
245. Of the following serum
results, which are the most
indicative of biliary tract
involvement (and not
parenchymal cell damage)?
 ALT = 1500 U/L (N:5-40)
 ALT=500 U/L, AST= 3000
U/L (N:5-40)
 LDH = 700 U/L (N:100-
500)
 ALP = 650 U/L (N:30-100),
GGT =130 U/L (N:10-50)
 Total bilirubin = 4 mg/dl ,
direct bilirubin= 1 mg/dl
248. Obstructive jaundice is
accompanied by :
 Increased excretion of
conjugated bilirubin in
urine
 Increased excretion of
unconjugated bilirubin in
urine
 Increased urinary
urobilinogen excretion
 Almost equally increased
serum conjugated and
unconjugated bilirubin
 Increased serum
unconjugated bilirubin
251. Which of these enzymes is
most valuable to confirm the
hepatic origin of an elevated
serum alkaline phosphatase in
a pregnant women:
 Aspartate aminotransferase
(AST)
 Creatine kinase (CK)
 5 nucleotidase
19
243. Which of the following
conditions is associated
with bilirbinuria ?
 Hemolytic anemia
Gilbert’s syndrome
 Rotor syndrome
 Crigler-Najjar syndrome
 Neonatal Jaundice
246. Which of these
statements is NOT true
about bilirubin?
 It is derived exclusively
from breakdown of
hemoglobin
 It is bounded in the
unconjugated from serum
albumin
 It’s reabsorbed in the small
intestine after bacterial
metabolism to urobilinogen
 It is normally undetectable
in urine
 Normally, most of bilirubin
in serum is unconjugated.
249. Urinary urobilinogen is
usually increased in case of
:
 Extrahepatic biliary
obstruction
 Primary biliary cirrhosis
 Acute hemolysis crisis
 Icteric stage of acute
hepatitis
 Women receiving oral
contraceptives
252. In follow up of acute
viral hepatitis , which
enzymes is the earliest
indicator of recovery ?
 ALT
 AST
 ALP
 GGT
 LDH

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increased
 ALT/AST ratio is more
than 1
253. Detection of low titer
HBcAb IgG and positive
HBsAb denotes :
 HBV past infection with
immunity to HBV
 HBV carrier status
 HBV vaccination
 HBV acute infection
 HBV chronic infection
256. Super infection of HDV
and HBV is diagnosed by :
 Positive HDV Ab IgM and
HBc Ab IgG and negative
HBsAg
 Positive HBs Ab and
positive HDV Ab IgG
 Negative HBs Ag and
positive HDV Ab IgM
 Positive HDV Ab IgG and
HBcAb IgG
 None of the above
259. As regards HBc Ab,
which of the following is
false:
 It is an important serologic
marker in the window gap
 High titer IgG despite
positive HBsAb indicates
persistent viral load
 Low titer IgG with positive
HBsAb indicates past
infection and immunity
 Negative HBcAb IgG with
positive HBsAb denotes
post vaccination
262. Carrier state in viral
infection means :
 The virus is hidden in the host
cell and can’t be detected
Clinical Pathology, X-Rays, ECG
 Alanine aminotransferase
(ALT)
Hepatitis markers
254. Co – infection of HDV
and HBV is diagnosed by :
 Positive HBsAg and HBcAb
IgG
 Positive HDV Ab IgM and
HBcAb IgM
 Positive HBsAb and
positive HDV Ab IgM
 Negative HBs Ab and
positive HDV Ab IgM
 None of the above
257. As regard hepatitis B
which of the following is
true :
 Persistence of HBsAg >6
months is an indicator of
chronicity
 Serum HBcAg indicates
viral replication
 It is transmitted through
feco-oral route
 Positive HBcAb and +ve
HBsAb denotes post
vaccination
 HBsAb indicated viral
replication
260. The most definitive
diagnostic test for HCV
infection is :
 HCV Ab IgG by ELIZA
 HCV Ab IgM by ELIZA
 Recombinant immunoblot
assay (RIBA)
 Viral RNA by PCR
263. PCR is used to detect :
 Viral antigen
 Viral particles
20
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255. Super infection of HDV
on HBV infection is
diagnosed by :
 Positive HDV Ab IgG and
HBcAb IgG
 Positive HBs Ab and HDV
Ab IgM
 Negative HBs Ag and
positive HDV Ab IgM
 Positive HDV Ab IgM and
HDV Ab IgG
 Positive HBc Ab IgG,HBs
Ag and HDV Ab IgM
258. As regard hepatitis B
which of the following is
not true :
 Persistence of HBsAg > 6
months is an indicator of
chronicity
 Positive HBeAg indicates
viral replication
 Positive HBsAB indicates
immunity
 Positive HBvAb and +ve
HBsAb denotes post
vaccination
 HBcAb is the only marker
in the window gap
261. Which of the following
tests is clinically significant
for HCV infection
 HCV Ab by ELIZA
 HCV Ab by RIBA
 HCV RNA BY PCR
 Serotyping and quantitation
of viral load
 All of the above
264. Primary biliary cirrhosis
could be differentiated from
primary sclerosing cholangitis
by :
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Mahmoud Sewilam
after recovery
 The virus is secreted by the
host after clinical recovery
 The virus does not remain in
the host after recovery
 None-of the above
 All of the above
265. The following is true for
hepatocellular carcinoma :
 Mall elevation of AFP
occurs in primary
hepatoma
 Mild elevation of AFP plus
elevation of CEA occurs in
secondary liver cancer
 Normal level of CEA with
increased levels of AFP
occur in colorectal cancer
without hepatic malignancy
 All of the above.
Clinical Pathology, X-Rays, ECG
 Viral genome  Increased ALP and GGT
 Viral envelope  Evidence of hepatic
 None of the above dysfunction
 Increased total IgM
 Frequently progresses to
chronic hepatitis
 Positive AMA
266. Tumor markers for
liver metastasis include :
 CEA
 ALP
 Transaminases
 All of the above
 None of the above.
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267. hyperglycemia occurs in
one of the following
conditions
 Addison’s syndrome
 Gilbert’s Syndrome
 Cretinism
 Pheochromocytoma
 Insulinoma
270. Alimentary glucosuria
occurs in one of the
following conditions :
 Renal failure
 Advanced liver disease
 Congenital heart disease
 Pregnancy
 Type I D.M.
273. One of the following
statements is true about
impaired glucose tolerance:
 An OGTT is not required to
assign a patient to this class
 Fasting plasma glucose level
is ≥ 126 mg/dl
 2 hour post load plasma
glucose level is ≥140 <200
mg/dl
 Patients never revert to
normal glucose tolerance or
develop overt DM
 Microvascular disease is
common, but there is
increased incidence of
atherosclerotic disease
276. Which one of the
following laboratory
findings is expected in DKA
:
 Hypokalemia
 Hypernatremia
 Hypophosphatemia
 Prerenal uremia
 High total co2
Clinical Pathology, X-Rays, ECG
DM MCQs
268. Hypoglycemia occurs in :
 Down syndrome
 Hemochromatosis
 Cerebrovascular accidents
 Cushing’s syndrome
 Insulinoma
271. Which of the following
leads to a lag storage curve
in the OGTT:
 Insulinoma
 Mal-absorption syndrome
 Thyrotoxicosis
 Prolactinoma
 Cretinism
274. One of the following
statements is true about
glycated hemoglobuin :
 HbA1 represents 5 – 8 % of
HbA
 Hb1Ac represents 15% of
HbA1
 It is minimal value in the
monitoring of DM
 It reflects glycemic control
over the previous 1-2 weeks
 It should be monitored
yearly
22
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269. Renal glucosuria is found
in:
 Pregnancy
 Thyrotoxicosis
 Mal-absorption
 Advanced liver disease
 Cretinism
272. Which of the following
leads to a flat response in the
OGTT :
 Mal-absorption syndrome
 Hyperpituitarism
 Acromegaly
 Thyrotoxicosis
 Hemochromatosis
275. Which of the following
leads to hyperglycemia :
 Glomerulonephritis
 Hemochromatosis
 Iron deficiency anemia
 Mediterranean fever
 Obstructive jaundice
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Mahmoud Sewilam Clinical Pathology, X-Rays, ECG

Thyroid MCQs
277. One of the following is 278. One of the following is a 279. One of the following is a
cause of elevated total and cause of elevated total and cause of low free T4 :
free T4: free T3 :  Androgen therapy
 Pregnancy  Pregnancy  Liver cirrhosis
 Viral hepatitis  Viral hepatitis  Mal-nutrition
 Grave’s diseases  Pituitary adenoma  Nephrotic syndrome
 Heroin addiction  Heroin addiction  Hashimoto thyroiditis
 Oestrogen therapy  Oestrogen therapy
280. In primary 281. The first trimester of 282. Which is a cause of
hyperthyroidism, which of pregnancy is accompanied depressed TSH in an
the following statements is by which changes in thyroid euthyroid patient
true : function tests :  Subclinical hyperthyroidism
 All patients have decreased  Decreased TBG  Subclinical hypothyroidism
total and free T4 and T3  Decreased total T4 and T3  Secondary hypothyrodism
level  Decreaqsed or undetectable  Grave’s disease
 T3 uptake is decreased TSH  Hashimoto’s thyroiditis
 FTI is decreased  Increased TSH
 All patients have increased  Positive antimicrosomal
TRH antibodies
 There is a blunted response
to TRH stimulation
283. Which of the following 284. Which of the following is 285. TSH is NOT a reliable
statements is true true in primary indicator of thyroid function
concerning TSH : hypothyroidism ? in case of :
 It is increased in primary  FT3 is the most sensitive  Primary hypothyroidism
hyperthyroidism indicator of thyroid function  Primary hyperthyroidism
 It is increased in secondary  TSH increase may precede  First 6 months of treatment
hyperthyroidism the decrease in the thyroid of primary hyperthyroidism
 It is decreased in primary hormone  Third trimester of
hypothyroidism  Reverse T3 is increased pregnancy
 It is increased in secondary  Positive thyroid stimulating  TBG excess
hypothyroidism immunoglobulins are
 It is decreased in severe diagnostic of the causative
cases of non thyroid illness disease
 With treatment, TSH
returns to normal prior to
T4
286. In the acute phase of non
–thyroid illness, which
statements is true :
 Total T3 is increased
 Free T3 is increased
 Reverse T3 is increased
 TSH is increased
 Thyroid replacement
therapy is indicated

23

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287. Epidemic cerebrospinal
meningitis is caused by :
 E.coli
 Pneumococci
 Hemophilius influenza
 Neisseria meningitides
 Mycobacterium tuberculosis
290. Group (B) β hemolytic
streptoccoi are most likely to
cause :
 Acute diarrhea
 Acute rheumatic fever
 Neonatal meningitis
 Acute glomerulonephritis
 Infective endocarditis
293. All are true for septic
meningitis except :
 Aspect of CSF is turbid
 Protein level in CSF increase
 Glucose level in CSF
decrease
 CSF could be bloody
 White cell count in CSF is
normal
Clinical Pathology, X-Rays, ECG
CSF MCQs
288. The most valuable test
for the diagnosis of
tuberculosis meningitis is :
 Positive tuberculin test
 Positive gram stained smear
of CSF
 Low CSF glucose level
 High CSF protein level
 Positive Ziehl – Neelsen
stained smear of CSF
291. Neonatal meningitis is
most likely caused by :
 Pnemoccoci
 Hemophilius influenza
 Mycobacterium tuberculosis
 E.coli
 Neisseria meningitis
24
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289. For septic meningitis all
of the following are correct
except :
 Aspect is clear
 Increase white cell count in
CSF
 Increase protein level in CSF
 Decreased glucose level in
CSF
 Positive culture
292. Swimming pool
meningitis occurs due to
infection by :
 E.coli
 Amoeba
 Babesia
 Pneumococci
 Neisseria meningitides
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Mahmoud Sewilam Clinical Pathology, X-Rays, ECG

Cardiac markers
294. The earliest marker for 295. Total CK activity is NOT 296. Which of the following
diagnosis of acute increased in : markers may show
myocardial infarction within  Duchene myopathy increased levels 12 days after
the first 2 hours of onset of  Hyperthyroidism an acute myocardial
chest pain is :  Diabetic ketoacidosis infarction:
 CK-MB  Severe muscle exercise  Total CK
 AST  Acute myocardial infarction  CK-MB
 Myoglobin  AST
 cTnT  LDH
 LDH  cTnI
297. to diagnose AMI , the 298. The most specific marker 299. A specific marker which
ration of CK – MB for diagnosis of AMI is : can be used to diagnose AMI
isoenzyme to total CK must  Myoglobin in a patient presenting 8
exceed :  CK-MB days after the onset of chest
 4%  AST pain
 6%  LDH  AST
 8%  Cardiac troponins  Total LDH
 10 %  Flipped LDH ration
 20 %  Cardiac troponin I
 Cardiac troponin T
300. One of the following
cardiac markers is most
useful in ruling out MI :
 CK – MB mass
 LDH isoenzymes
 c.Troponins (I or T)
 myoglobin
 CK-total

25

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301. As regard ANA testing in
SLE cases which of the
following is true ?
 Done by indirect
immunoflurosence
 It is a sensitive screening test
for the disease
 Its specificity can be
improved by detection of
high titres
 All of the above
304. Children with insulin
dependent DM have :
 Anti-IgG Fc antibodies
 Anti-microsomal antibodies
 Anti-parietal cells antibodies
 Antinuclear antibodies
 None of the above
307. Sero-negative
rheumatoid arthritis (RA)
includes the following :
 Early RA
 Juvenile RA
 Arthritis with certain
systemic diseases
 All of the above
 None of the above
310. Which of the following is
a non organ specific
autoimmune disease ?
 Myasthenia graves
 Insulin dependent diabetes
 Rheumatoid arthritis
 Hasimoto’s thyroiditis
 Pernicious anemia
Clinical Pathology, X-Rays, ECG
Serology MCQs
302. In cases of rheumatoid
arthritis which of the
following statements is false
:  Affect RBCs
 Negative RF by routine lab
procedures excludes
diagnosis
 RF by Rose Waaler is more
specific than latex fixation
test
 RFs are antiglobulins
against autologous IgG
 None of the above
305. An autoimmune disease
characterized by the over
production of thyroid
hormones :
 Lupus erythematosus
 Myasthenia graves
 DiGeorge disease
 Grave’s disease
 Hemolytic anemia
308. The pathogenic antibody
in Grave’s disease has
specific for :
 Nuclei
 Thyroid peroxidase
 Thyroglobulin
 TSH receptors
 TSH
311. Which of the following
statements about anti-
mitochondrial antibodies is
false :
 found in patients with primary
biliary cirrhosis (PBC)
 found in some patients of
chronic active hepatitis
 can’t differentiate PBC from
primary sclerosing cholangitis
 accompanied by a rise in
serum IgM in patients with
PBC
 none of the above
26
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303. Hasimoto’s disease and
Graves’s disease are similar
in that both :
 Affect the liver
 Are forms of cellular
immunity
 Affect the thyroid gland
 Are accompanied by
histamine release
306. Rheumatoid arthritis is
an autoimmune disorder in
which the body’s immune
system act against it’s own :
 Lymphocytes
 Neutrophils
 RBC
 IgG
 DNA
309. Direct immunofloresent
examination of renal biopsy
shows linear depositon along
the glomerular basement
membrane
 Minimal change
nephropathy
 Membranous nephropathy
 Membranoproliferative
glomerulonephritis
 Anti-GBM nephritis
 IgA nephropathy
312. patients with SLE show
the following findings
 normocytic normochromic
anemia
 high EST
 thrombocytopenia
 leucopenia
 all of the above
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313. specificity of ANA testing
by immunofluorence can be
increased by :
 determination of titre
 determination of pattern
 using more than on
substrate
 all of the above
 none of the above
316. all of the following is true
for IC glomerulonephritis
except
 diminished serum
complement levels
 detection of circulating
immune complexes
 patient’s serum may be
positive for ANA or anti-
DNA
 linear deposits of
immunoglobulins and
complement in the glomeruli
 all of the above
319. Anti-n DNA antibodies
are all of the following
except :
 Diagnostic for SLE
 Correlate with SLE activity
 Indicate kidney affection
 Cannot be used for follow up
 None of the above
322. For diagnosis and follow
up of SLE which is false :
 Serum ANA is used for
screening
 Anti-nDNA & Anti-Sm are
diagnostic
 For activity , ESR , C3 , C4
& CIC are done
 For follow up ANA titre is
done
 CBC , urine analysis &
kidney function are done in
follow up
Clinical Pathology, X-Rays, ECG
314. anti-n-DNA antibodies in 315. in rheumatoid arthritis,
SLE are :
 associated with kidney
affection
 used in diagnosis and follow  results in high incidence of
up
 detected by IIF technique
 all of the above
 none of the above
317. in individuals with IC
glomerulonephritis which of
the following tests should be  Glomerulonephritis
done :
 ANA
 Anti-DNA
 Serum complement level
 Detection of CIC
 All of the above
320. In SLE all of the
following indicate activity
except :
 Elevated ESR
 High C3 and C4
 High anti n –DNA titre
 High levels of circulating
immune complexes
 None of the above
323. In systemic lupus
erythematosus, all are true
except :
 Serum complement is
frequently reduced
 CICs levels donot correlate
with disease activity
 High titre ANAs by IIF is a
sensitive screening test
 High titre anti-ds-DNA is
associated with renal
affection
 Anti-Sm antibodies are
specific
27
detection of RF by latex
agglutination test is :
 sensitive but not specific
false negative
 both sensitive and specific
 none of the above
318. Anti-GBM antibodies
can cause
 Goodpastur’s syndrome
 Idiopathic pulmonary
hemosiderosis
 All of the above
 None of the above
321. In SLE all of the
following autoantibodies
support the diagnosis except
:
 ANA
 Anti-n DNA
 Anti-Smith
 Anti-smooth muscle
 Anti RNP
324. The following is true
about rheumatoid arthritis :
 RFs are antiglobulins
directed against the Fc
fragment of autologous IgG
 Rose Waaler test for
detection of RF is specific yet
not sensitive
 Serum complement levels
are usually normal
 A negative RF does not
exclude diagnosis of
rheumatoid arthritis
 All of the above .
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325. All are true concerning
immune hemolytic anamias
except :
 It may be drug induced such
as by penicillin and methyl
dopa
 Diagnosis is by anti-globulin
test (Coombs test)
 Rh incompatibility is not an
example of alloantibody –
induced hemolytic anemia
 Warm anti-body type is
either idiopathic or
secondary to SLE , leukemia
, etc….
 None of tha bove
328. ANA and rheumatoid
factor may be associated
with all of the following
conditions except :
 Rheumatoid arthritis
 Sjogren’s syndrome
 SLE
 ITP
 None of the above
331. Children with insulin
dependent D.M. usually have
serum antibodies to :
 Mitochondria
 Thyroid microsomes
 Gastric parietal cells
 Nuclear antigens
 None of the above
334. In Hashimoto’s thyroiditis
which of the following is true :
 Inflammatory disorder of
unknown etiology
 Euothyrodism is early in the
disease
 Late in the disease
hypothyroidism often occur
 Autoantibodies to
thyroglobulin and thyroid
microsomal antigens are found
 All of the above
Clinical Pathology, X-Rays, ECG
326. All of the following are
diagnostic importance in
autoimmune disease except :
 Lesions are detected by
biopsy
 Immune complexes are
found in serum
 Decreased levels of serum
complement
 Decreased serum gamma
globulin levels
 All of the above
329. Which of the antibodies
are most useful for the
diagnosis of pernicious
anemia :
 Anti-parietal cell
 Anti-thyroid peroxidase
 Anti- nuclear
 Anti-IgG Fc
 Anti – TSH receptor
332. Is SLE which of the
following is false :
 Circulating immune
complexes level correlates
with disease activity
 Serum complement is
frequently decreased
 Positive ANA is found in 95
% of active untreated cases
 Anti-DNA is associated with
kidney affection
 ANA titre correlate with
disease activity
335. In autoimmune chronic
hepatitis which of the following
is true :
 Non organ specific
autoimmune disease
 Positive anti –Ro and anti – La
antibodies
 Positive HBsAg
 Positive Anti-Sm antibodies
 Positive anti smooth antibodies
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327. Any of the following are
consistent with diagnosis of
autoimmune hepatitis except
:
 Positive ANA
 Positive ASMA
 Positive AMA
 Positive HBsAg
 None of the above
330. Which of the following
antibodies are most use for
diagnosis of Sjogren
syndrome:
 Anti-cardiolipin antibodies
 Anti-neutrophil cytoplasmic
antibodies (ANCA)
 Anti-ssA(RO), anti-ssB(La)
antibodies
 Anti-mitochondrial
antibodies
 Anti-glomerular basement
membrane antibodies
333. In autoimmune chronic
hepatitis which of the
following is true :
 Organ specific autoimmune
disease
 Positive anti-Ro anti-La
antibodies
 Positive HBsAg
 Positive anti-Sm antibodies
 Positive ANCA
336. In primary biliary cirrhosis
which of the following is false :
 Anti mitochondrial antibodies
are positive
 AMA can’t differentiate it from
primary sclerosing cholangitis
 Bilirubin is elevated
 IgM is increased
 Alkaline phosphatase is usually
elevated
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Mahmoud Sewilam
337. All of the following are
consistent with diagnosis of
autoimmune hepatitis except
:  RFs are antiglobulins
 HCV Ab positive
 Positive liver specific
antibodies
 Positive anti-LKM
antibodies
 Polyclonal
hypergammaglobulinemia
 Positive ANA
340. All of the following
organisms can produce
diarrhea except :
 Vibrio cholera
 Campylobacter
 Staphylococcus aureus
 Bifidibacterium
 Rota virus
343. All of the following
organism cause food poising
except :
 Staphylococcus aurues
 Clostridium botulinum
 Bacillius cereus
 Salmonella enteritidis
 Salmonella typhi
 Other Available Books By The Author:
 Internal Medicine : Clinical
 Dermatology
 ECG
 X-Rays Of Internal Medicine
 Clinical Pathology
 Psychiatry
Clinical Pathology, X-Rays, ECG
338. In rheumatoid arthritis 339. A positive ANA test can
which of the following is be found in all of the
false : following except :
 SLE
directed against the Fc  Sjogren’s syndrome
fragment of autologous IgG  Rheumatoid arthritis
 Rose Waaler test for  Scleroderma
detection of RF is specific yet  Multiple sclerosis
not sensitive
 Serum complement levels
are usually normal
 A negative RF by lab
procedure does exclude
diagnosis of rheumatoid
arthritis
 None of the above
Stool analysis
341. All of the following 342. Infantile diarrhea can be
organisms produce diarrhea used by :
except :  Enteropathogenic E.coli
 Salmonella enteritidis  Giardia
 Enteropathogenic E.coli  Yersinia enterocolitica
 Yersinia enterocolitica  Vibrio cholera
 Bacillus cereus  Salmonella enteritidis
 Clostridium botulinum
29
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