AIIMS/ NEET-PG 2017: Medicine MCQs 91-100

Q-91. Best test for assessment of iron status is
a) Transferrin
b) Ferritin
c) Serum iron
d) Hemoglobin

Answer: Ferritin
Explanation:
Iron deficiency develops in stages. The first is depletion of iron stores.
At this point, there is anemia and no changes in RBS size.
A ferritin value < 12 mcg/L is a highly reliable indicator of depletion of iron stores.

Q-92. Which of the following is not seen on hemoglobin electrophoresis in sickle cell anemia?
a) HbA
b) HbA2
c) HbF
d) HbS

Answer: HbA
Explanation:
Hemoglobin electrophoresis in sickle cell anemia:
HbS: 86-98 %
HbF: 5-15 %
HbA2: 1-3 %
HbA: 0
Hemoglobin electrophoresis in sickle cell trait:
HbS: 40 %
HbF: < 1 %
HbA2: 1-2 %
HbA: 60 %

Q-93. False statement regarding DIC is
a) Thrombocytopenia
b) Decreased fibrinogen
c) Decreased PTT
d) Increased PT

Answer: Decreased PTT
Explanation:
Disseminated intra-vascular coagulation:
Progressive thrombocytopenia
Prolongation of activated partial thromboplastin time (aPTT) and prothrombin time (PT)
Low level of fibrinogen
Elevated D dimer

Q-94. Thrombocytopenia occurs in all except
a) Henoch Schonlein purpura
b) TTP
c) DIC
d) Cavernous hemangioma

Answer: Henoch Schonlein purpura
Explanation:
Causes of Thrombocytopenia:
Decreased production of platelets:
Congenital bone marrow failure- Fanconi anemia and Wiskott Aldrich syndrome
Acquired bone marrow failure- Aplastic anemia, myelo-dysplasia
Marrow infiltration- Neoplastic, infection
Nutritional- Deficiency of vitamin B12, folate, iron; alcohol
Increased destruction of platelets:
Immune thrombocytopenia
Heparin induced thrombocytopenia
Thrombotic micro-angiopathy/ Thrombotic thrombocytopenic purpura (TTP)
DIC
Post transfusion purpura
Mechanical- Aortic valvular dysfunction, extra-corporeal bypass
Hemo-phagocytosis
Increased sequestration of platelets:
Hypersplenism: Cirrhosis, Myelo-proliferative disorder and Lymphoma
Important points:
Henoch-Schönlein purpura (HSP) is an acute immunoglobulin A (IgA)–mediated disorder characterized by a generalized vasculitis involving the small vessels of the skin, the gastrointestinal (GI) tract, the kidneys, the joints, and, rarely, the lungs and the central nervous system (CNS).
Typical features- Palpable purpura, abdominal pain, arthritis, and hematuria.
A normal platelet count differentiates Henoch-Schönlein purpura from thrombocytopenic purpura.

Q-95. A pt with an Hb of 6, WBC count of 2000, has a normal different count except for having 6% blasts; platelets are reduced to 80,000, moderate splenomegaly is present. Possible diagnosis is
a) Leukemia
b) Aplastic anemia
c) Hemolysis
d) ITP

Answer: Leukemia
Explanation:
Hallmark of acute leukemia is the combination of pancytopenia with circulating blasts. However blasts may be absent in aleukemic leukemia.
The bone marrow is usually hyper-cellular with circulating blasts.

Q-96. A pt being investigated for anemia has a dry marrow tap; peripheral smear reveals tear drop cells; likely diagnosis is
a) Leukemia
b) Lymphoma
c) Myelo-fibrosis
d) Polycythemia Rubra Vera

Answer: Myelo-fibrosis
Explanation:
Myelo-fibrosis is a myelo-proliferative disorder characterized by fibrosis of the bone marrow (Dry tap), splenomegaly, giant abnormal platelets and a leuko-erythroblastic peripheral blood picture with tear drop poikilocytosis.
Fibrosis at early stage is detected by a silver stain demonstrating increased reticulin fibres.

Q-97. Tumor associated with polycythemia Vera is
a) Sarcoma
b) Pituitary adenoma
c) Cerebellar hemangio-blastoma
d) None of the above

Answer: Cerebellar hemangio-blastoma
Explanation:
Tumor associated with polycythemia Vera:
Cerebellar hemangio-blastoma
Meningioma
Hepatoma
Adrenal adenoma
Pheochromocytoma
Uterine fibromyoma

Q-98. A young male with gallbladder stones shows the following test results; serum bilirubin 2.5, Hb 6, urine test positive for urobilinogen. Diagnosis is
a) Hemolytic jaundice
b) Obstructive jaundice
c) Hepato-cellular jaundice
d) Protoporphyria

Answer: Hemolytic jaundice
Explanation:
Hemolytic jaundice:
Anemia
Raised total bilirubin (Raised indirect bilirubin)
Raised serum LDH
Bilirubinate crystals or stone in gall bladder
Presence of urobilinogen in urine

Q-99. An 18 yr old male present with massive hematemesis; he has history of fever for the past 14 days for which he was managed with drugs; moderate spleenomegaly is present; diagnosis is
a) NSAID induced duodenal ulcer
b) Drug induced gastritis
c) Esophageal varices
d) None of the above

Answer: Esophageal varices
Explanation:
Esophageal varices:
Most common presentation: Hematemesis and melena
NSID may be contributing factor for hematemesis.
Splenomegaly

Q-100. Urinalysis shows RBC casts; likely source is
a) Kidney
b) Ureter
c) Bladder
d) Urethra

Answer: Kidney
Explanation:
RBC cast: Glomerular injury
White cell casts: Interstitial injury of kidney
Pigmented muddy brown granular casts: Ischemic or nephro-toxic injury
Broad granular casts: Interstial fibrosis and dilatation of tubules