Each MCQ has 01 mark.

Q No.1 A 30-year woman who is eight months pregnant, presented with a 2-day history
of giddy spells. This was her first pregnancy. Her past medical history was
unremarkable. She was taking no medication. Her blood tests on booking were normal.
Clinical examination was unremarkable. Her full blood count showed Hb 10 g/dl, MCV
103 fl, WBC 15 x 109/l and platelet count 180 x 109/l.
a: B12 deficiency
b: Folate deficiency
c: Physiological anemia of pregnancy
d: Thalassaemia trait
e: Anemia of chronic disease

KEY: c

Q No.2. Q 91. A 28-year pregnant woman from Balochistan, has presented with
deep jaundice. She previously had abnormal liver function tests, which were not
investigated. She denies use of any drugs or chemicals. Her Hb is 7 g/dl, normal
platelets and a blood film shows irregularly contracted cell and some erythrocytes with
retraction of haemoglobin to one side of the cell. A Heinz body preparation is positive.
What is most likely diagnosis in the patient?
a: Glucose 6 phosphate hydrogenase deficiency
b: HELPP Syndrome
c: Thrombotic thrombocytopenic purpura
d: Sickle cell disease
e: Wilsons disease
KEY: A
Q No.3. A 75 year old man presented with palpitation, dyspnea and sweating for
the last few hours. His physical examination and ECG findings were suggestive of atrial
fibrillation. He is started with tab warfarin 5 mg daily. His dose monitoring should be
carried out using which of the following test?
a. Antithrombin deficiency
b. Activated partial thromboplastin time (aPTT) only
c. Both Prothrombin time and activated partial thromboplastin time
d. INR
e. Urea solubility test.
Key: d
Q No 4: A 45 years old female presented with pain right hypochondrium. On
examination she was pale, mildly jaundiced and have hepatosplenomegaly. Ultrasound
abdomen revealed multiple small pigment gall stones. Anaemia in such patient is due
to:
a. Haemolytic anaemia
b. Iron deficiency anaemia
c. Megaloblastic anaemia
d. Aplastic Anaemia
e. Sideroblastic anaemia
Key: a

Q No.5. A 5 year old child presented with history of anemia since birth. On
examination there was jaundice, painful digits and hepatomegaly. Spleen was not
palpable. There was a non-healing ulcer of lower leg. Peripheral film revealed sickle
cells, NRBs, target cells and Howell Jolly bodies. On basis of history, physical findings
and peripheral film findings he was diagnosed as a patient of sickle cell anaemia. All are
true of sickle cell anaemia except
a. Red blood cells have shortened life span
b. Autosomal dominant disorder
c. Haemolysis is extravascular
d. Is due to a defective point mutation
e. Red cell dehydration makes cell vulnerable to sickling
Key: b
Q No.6. A 10 months old baby girl presented with failure to thrive, progressive pallor
and abdominal distension. Her family history was positive for thalassemia. On
examination she was markedly pale, had hepatosplenomegaly and delayed
developmental milestones. She was transfused RCC two days back. Which of the
following test confirms the diagnosis when Hb electrophoresis is inconclusive?
a. HPLC
b. Isoelectric focusing
c. DNA analysis for thalassemia gene mutations
d. Citrate ager electrophoresis
e. Capillary electrophoresis
Key: c

Q No.7. A 25 year old female presented with mild pallor and moderate
hepatosplenomegaly. Her Hb is 9.2 g/dl. Her Hb electrophoresis shows HbF of 65%.
She has not received any blood transfusion till date. She is most likely suffering from:
a. Thalassemia major
b. Hereditary persistence of fetal haemoglobin
c. Hemoglobin D, homozygous state
d. Thalassemia intermedia
e. Thalassemia minor
Key: d

Q No.8. A 24 years old female was brought to ER with complaints of fever,

dyspnea, pain in chest and extremities. She had flu and sore throat 4 days back for
which she didn’t take any medicine. Her Hb was 6.2 g/dl, WBC count 14.6 x 10*9/l and
oxygen saturation of 77%. Her peripheral film examination showed numerous sickle
shaped red blood cells. What is the basic defect in this disease?
a. Substitution of glutamic acid for valine in beta globin chain
b. Substitution of valine for glutamic acid in beta globin chain
c. Substitution of valine for glutamic acid in alpha globin chain
d. Abnormality in porphyrin part of Hb
e. Base deletion in HbA
Key: b
Q No.9. A 5 year old male patient presented with history of gum bleeding and
epistaxis on and off since birth. CBC revealed thrombocytopenia. Bleeding time is more
than 15 mins. All of the following are true except?
a. von Willebrand disease.
b. Bernard – Soulier syndrome
c. Glanzmann thrombasthenia
d. Immune thrombocytopenia
e. Hemophilia A
Key: e

Q No.10. A 45 year old male presented with complaints of fatigue, shortness of

breath and progressive pallor for 2 months. Lab reports showed pancytopenia,
macrocytosis and hypersegmented neutrophils. Which of the following is not true
regarding macrocytic anemia?
a. It is always caused by vit B12 or folate deficiency
b. Bone marrow appearances are identical in vit B12 or folate deficiency
c. It is caused by defective DNA synthesis
d. It is associated with jaundice
e. Cobalamin deficiency may cause bilateral peripheral neuropathy
Key: a

Q No.11. A 45 year old male presented with shortness of breath, palpitations,

difficulty in walking and decreased touch sensations in lower limbs for the past two
months. Peripheral blood smear showed macrocytosis, anaemia and hypersegmented
neutrophils. Patient was diagnosed as megaloblastic anemia. If this patient is treated
with only folic acid, which of the following will aggravate after treatment
a. Anemia
b. Macrocytosis
c. Neuropathy
d. Atrophic tongue
e. Sterility
Key: c

Q No.12. A male patient 68 years of age was found to have generalized

lymphadenopathy and hepatosplenomegaly. His Peripheral blood film showed
lymphocytosis, with mature lymphocytes and smudge cells. The most likely diagnosis
is?
a. Acute lymphoblastic leukaemia
b. Acute myeloid leukaemia
c. Chronic lymphocytic leukaemia
d. Chronic myeloid leukaemia
e. Multiple myeloma
Key: c
Q No.13. A 33 years old female presented with fatigue and shortness of breath for
last 01 month. O/E she was pale. Systemic examination was unremarkable. Blood CP
was done which revealed Hb of 9.8 g/dl and MCV 72 fl. Peripheral blood film showed
microcytic hypochromic picture. Her Serum Ferritin is 15 ng/ml. The most likely
diagnosis in this case is
a. Megaloblastic anaemia
b. Iron deficiency anaemia
c. Hemolytic anaemia
d. Anaemia of chronic disease
e. Aplastic Anaemia
Key: b

Q No.14. 60 years old male presented with progressive pallor, easy fatigability and
breathlessness after climbing stairs for last three months. He is also patient of chronic
kidney disease for past 3 years. O/E pallor was only significant finding with systemic
examination being unremarkable. His Hb was 10 g/dl with an MCV of 75fl. Which of the
following laboratory findings will support diagnosis of iron deficiency anaemia instead of
anaemia of chronic disease.
a. Decreased serum TIBC
b. Increased serum iron
c. Decreased serum ferritin
d. Decreased serum transferrin receptor
e. Increased serum folate
Key: c
Q No.15. A 45year old man presented with shortness of breath and lethargy for last
five months. He was diagnosed as a case of iron deficiency anemia after examination
and investigations. The doctor prescribed oral iron supplements. In absorption of iron,
which one of the following is involved in transfer of iron from lumen of gut across
enterocyte microvilli.
a. Tranferrin
b. Divalent metal transporter- 1
c. Ferroportin
d. Transcobalamin II
e. Haptoglobulin
Key: b

Q No.16. A 25 years old female presented with lethargy, pallor & breathlessness
after climbing stairs for last four months. She also had poor dietary intake. She was
diagnosed as case of iron deficiency anaemia after investigations and prescribed oral
iron supplements which of the following factor favors absorption of iron.
a. Phytates
b. Vitamin C
c. Inflammation
d. Ferric form
e. Alkaline pH
Key: b

Q No.17. A 25 years male presented with H/O fatigue, upper abdominal pain and
progressive pallor for the last three months. He does not have any H/O diarrhea or
constipation. He was diagnosed as a case of iron deficiency anaemia after thorough
workup. The most likely cause of iron deficiency anaemia in this age group is
a. Inadequate diet
b. Worm infestation
c. Genitourinary blood loss
d. Malabsorption
e. Ca colon
Key: b

Q No.18. A 36 years old female presented with H/O lethargy and progressive pallor
for the last six months. She also had difficulty in taking solid diet she had past history of
taking NSAIDS for long time. O/E she was pale. Blood CP: Hb 8.9 g/dl, MCV 70fl. She
can be labeled as a case of Plummer Vinson syndrome. What other feature must be
present for labeling this syndrome.
a. Barret esophagus
b. Splenomegaly
c. Hepatomegaly
d. Esophageal webs
e. Atrophic gastritis
Key: d

Q No.19. An 8 years old boy presented with weakness, progressive pallor for last
three months, he was pale with no other significant findings on examination. His Hb was
9 g/dl with MCV of 72fl and RBC 4.1x 10 12/L. The most likely diagnosis is:
a. Thalassaemia trait
b. Lead poisoniong
c. Anemia of chronic disease
d. Iron deficiency anemia
e. Megaloblastic anemia
Key: d

Q No.20. A 55 years old male was diagnosed as case of iron deficiency anemia
when he presented with lethargy and palpitations on climbing stairs. Iron transport is
mediated by transferrin. Most of the iron bound to transferrin comes from
a. Iron absorbed by intestine
b. Ferritin
c. Reticulocyte
d. Myoglobin
e. Macrophages
Key: e
Q No.21. A 15 years of female presented with history of menorrhagia, since
menarche. Her lab investigations showed prolonged bleeding time and aPTT, PT was
normal. VWF levels were low. What is the most likely diagnosis?
a. Haemophilia A
b. Haemophilia B
c. Von Willebrand disease
d. Afibrinogenemia
e. Haemolytic anaemia
Key: c

Q No.22. A new born baby, delivered full term at home presented at 3rd day of life
with petechiae and bruises. He is exclusively breast fed. His lab investigations shows
prolong PT and aPTT. Most likely he is suffering from
a. Vitamin K deficiency
b. Haemophilia A
c. Haemophilia B
d. Sickle cell disease
e. Haemolytic anaemia
Key: a

Q No.23. A 60 years old patient had pulmonary embolism. He is given intravenous

Heparin. His lab investigations will show
a. Prolonged aPTT
b. Prolonged BT
c. Prolonged PT
d. Hess test positive
e. Decreased VWF level
Key: a
Q No.24 A 45 years old male presented with myocardial infarction in emergency
department. Which of the following is not a risk factor for arterial thrombosis?
a. Diabetes mellitus
b. Male sex
c. Hyperhomocysteinemia
d. Folic acid intake
e. Hypertension
Key: d

Q No.25. A 15 years old girl had heavy menstrual flow and occasional epistaxis.
Physical examination was unremarkable. Blood tests showed Hb 10.0 gm/dl, RBC 3.8 x
10 12/L, MCV 68 fl, MCH 22.6 pg, WBC 6.2 x 10 9 /L and platelets 220 x 10 9 /L. She is
suspected to have vWD. Which of the following would help in the diagnosis
a. Thrombin time
b. Bleeding time
c. Clotting time
d. Serum fibrinogen
e. Prothrombin time
Key: b