Q-91. Best test for assessment of iron status is
c) Serum iron
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?
Hemoglobin electrophoresis in sickle cell anemia:
HbS: 86-98 %
HbF: 5-15 %
HbA2: 1-3 %
Hemoglobin electrophoresis in sickle cell trait:
HbS: 40 %
HbF: < 1 %
HbA2: 1-2 %
HbA: 60 %
Q-93. False statement regarding DIC is
b) Decreased fibrinogen
c) Decreased PTT
d) Increased PT
Answer: Decreased PTT
Disseminated intra-vascular coagulation:
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
d) Cavernous hemangioma
Answer: Henoch Schonlein purpura
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:
Heparin induced thrombocytopenia
Thrombotic micro-angiopathy/ Thrombotic thrombocytopenic purpura (TTP)
Post transfusion purpura
Mechanical- Aortic valvular dysfunction, extra-corporeal bypass
Increased sequestration of platelets:
Hypersplenism: Cirrhosis, Myelo-proliferative disorder and Lymphoma
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
b) Aplastic anemia
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
d) Polycythemia Rubra Vera
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
b) Pituitary adenoma
c) Cerebellar hemangio-blastoma
d) None of the above
Answer: Cerebellar hemangio-blastoma
Tumor associated with polycythemia Vera:
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
Answer: Hemolytic jaundice
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
Most common presentation: Hematemesis and melena
NSID may be contributing factor for hematemesis.
Q-100. Urinalysis shows RBC casts; likely source is
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