haem_MCQ_2012_student_feedback.pdf

of 16

SCMD 3000 GEMP 1 HAEMATOLOGY MCQ EXAM 8 November 2012 Session No.: ________ Seat No.: ________ Student No.: _________________ (on each page) _____________________________________________________________________________________

UNIVERSITY OF THE WITWATERSRAND,

JOHANNESBURG

Faculty of Health Sciences

MB BCh III / GEMP I

INTEGRATED BASIC MEDICAL

AND HUMAN SCIENCES

(SCMD 3000)

Haematology Examination MCQ

Venue: Multipurpose Path Lab (3N28)

Seat Number: ___________

Student Number: _________________________________

Time allowed: 90 minutes

Date: 8th

November 2012

of 16


GENERAL INSTRUCTIONS Please read the following carefully: 1. Write your session number, seat number, student number and surname & Initials clearly

on the front page of this question paper (top and middle of page). 2. Then write your initials and surname at the top of each page of this exam paper. 3. Please hand in all cell phones, calculators and removable drives prior to the start of the

examination. 4. You may not remove any question papers from the examination room. 5. This paper consists of 45 multiple choice questions 6. Answer all questions on the script provided AND THEN ON THE ANSWER CARDS

PROVIDED. A-TYPE QUESTIONS Select the single best answer to each question. (Note: several options may be correct

but only one is the best answer.) Answers must be entered on the question paper and on the answer card for A-type

questions. If you give more than one answer for a question, you will score zero for that question. There will be no penalty for incorrect answers. If you do not know an answer you may leave it blank, in which case you will neither earn

a mark nor be penalised. X-TYPE QUESTIONS There is at least one correct statement and at least one incorrect statement. Identify BOTH the correct and incorrect statements. Answers must be entered on the question paper and on the answer card for X-type

questions. If you are unsure of a statement you can leave the answer bubbles blank or you can

tick the Dont know box. In that case you will neither get a mark or be penalised. Negative marking will be applied to wrong answers but negative marks will not be

carried forward. This means the minimum mark for a question is zero. R-TYPE QUESTIONS Here you are offered a number of answers. This is followed by a set of questions. Select

the single best answer to each question. Note that each answer may be used more than once or not at all unless you are

specifically instructed otherwise. Fill in your answers in the spaces provided on the question paper and on the answer

card for R-type questions. If you do not know an answer you may leave it blank, in which case you will neither earn

a mark nor be penalised. Note: Each A-type, X-type and R-type question has the same mark value except where indicated otherwise.

of 16


A-TYPE QUESTIONS

A.1 James and Josh have Haemophilia A. Kate is 18 weeks pregnant with a male fetus. What is the chance, prior to any testing, that the fetus will be affected with Haemophilia A?

a. 1 in 2 (50%) b. 1 in 4 (25 %) c. 1 in 8 (12.5 %) d. 1 in 16 (6.25%) e. No chance that she will have an affected child

Answer: b Chance that Kate is a carrier x Chance that she passes it on = (very easy) A.2 Loss of tumor suppression in a cell usually results from one of the following. Which one?

a. Activation of a proto-oncogene by a virus b. A mutation of both copies of a tumor suppressor gene c. An inversion involving a copy of a tumor suppressor gene d. Cytokine activation of a tumor suppressor gene e. Over expression of a tumor suppressor gene due to a translocation

Answer: b A.3 Chronic granulomatous disease (CGD) is due to one of the following primary immune deficiency

conditions. Which one?

a. A defect in neutrophil function such as an absence of NADPH oxidase b. Hypocomplementaemia c. Neutrophil phagosome-lysosome fusion d. Reduced B cell function e. Reduced T cell numbers

Answer: a

of 16

SCMD 3000 GEMP 1 HAEMATOLOGY MCQ EXAM 8 November 2012 Session No.: ________ Seat No.: ________ Student No.: _________________ (on each page) _____________________________________________________________________________________ A.4 Transplantation of the thymus gland from an aborted foetus to an immune deficient neonate

has been beneficial in one of the following immune deficiency disorders. Which one?

a. Brutons agammaglobulinaemia (hypogammaglobulinaemia) b. Coeliac disease c. Di George syndrome d. Hepatosplenomegaly e. Hereditary angioedema

Answer: c

A.5 A 34 year old woman sustains severe burns over most of her body surface when her propane

stove exploded. What is disrupted most significantly in this patient?

a. Antibody production b. Complement c. First line defence d. Phagocytosis e. T cell function

Answer: c A.6 One of the following is a defects of phagocytes which prevents effective intracellular killing of

organisms. Which one?

a. Absence of complement factor C3 b. Deficiency of leucocyte adhesion molecules c. Deficiency of actin in phagocytes d. Failure of phagosome-lysosome fusion e. Lack of a chemotactic gradient

Answer: d A.7 A neonate is found to have mutations in the Fc receptor gene. Which immune function is likely

to be affected?

a. Antigen binding b. Lymphocyte adhesion c. Intracellular killing d. Complement fixation e. Phagocytosis

Answer: e

of 16

SCMD 3000 GEMP 1 HAEMATOLOGY MCQ EXAM 8 November 2012 Session No.: ________ Seat No.: ________ Student No.: _________________ (on each page) _____________________________________________________________________________________ A.8 Antigen presentation is an important aspect of immune function. Several types of cells are

capable of presenting antigen to immune cells. What cell type is least likely to be called a professional antigen presenting cell? a. B lymphocyte b. Dendritic cell c. Langerhans cell d. Macrophage e. T lymphocyte

Answer: e A.9 A 5 year old boy is found to have almost no levels of IgA in his saliva and bronchial secretions.

Apart from slightly higher than normal incidence of upper respiratory tract infections he seems normal, and serum immunoglobulins are all within normal range. If genetic locus testing were done to look for the deficient gene what would be the most likely defect?

a. Alpha heavy chain locus b. J/secretory piece locus c. Kappa chain locus d. Lambda chain locus e. Mu heavy chain locus

Answer: b A.10 What is the nature of genetic expression of MHC genes?

a. Co-dominant b. Dominant c. Mitochondria inheritance d. Pleiotropic e. Recessive

Answer: a A.11 Which of the following detects antigen or antibody by a colour change reaction?

a. Agglutination test b. Complement fixation c. ELISA d. Precipitation test e. Toxin neutralisation test

Answer: c

of 16

SCMD 3000 GEMP 1 HAEMATOLOGY MCQ EXAM 8 November 2012 Session No.: ________ Seat No.: ________ Student No.: _________________ (on each page) _____________________________________________________________________________________ A.12 Pam has been diagnosed with allergic asthma. Her total IgE level is 325 IU/ml (normal range: 3-

150). What other test would you do to identify the offending agent? a. IgG subclasses b. Lung function c. Patch test d. Skin prick test e. Specific IgE against latex

Answer: d A.13 Deep vein thrombosis (DVT) of the lower limb involves stasis or slowing of venous blood flow.

Which component of the deep venous system is the most likely site of early thrombosis?

a. Anterior tibial vein b. Greater saphenous vein c. Popliteal vein d. Sinusoids of the posterior leg e. Superficial femoral vein

Answer: d

of 16


X-TYPE QUESTIONS

X.1 A group of diseases is characterised by the presence of the cell in the image above. Which of the

following statements about these diseases are correct, and which are not?

a. Involvement of lymph nodes on both sides of the diaphragm constitutes Stage III disease b. Spread of the disease is contiguous and orderly from one lymph node group to the next c. The classification takes into account the number and type of NON-MALIGNANT cells present d. The presence of B symptoms indicates a better prognosis e. The prognosis is poor, even in early stage disease

Answer: a, b, c X.2 Which of the following pairs are correctly matched with respect to B lymphocyte development,

and which are not?

a. germinal centre centroblasts (large cells) AND undergoing somatic hypermutation b. germinal centre centrocytes (small cells) AND resistant to apoptosis c. initial rearrangement of heavy and light chain genes AND occurs in the bone marrow d. marginal zone lymphocytes AND unexposed to antigen (nave B cells) e. plasma cells AND surface expression of antibody

Answer: a, b, c X.3 Which of the following pairs are correctly matched with respect to Non-Hodgkins lymphomas,

and which are not?

a. Adult T cell lymphoma AND caused by the HTLV-1 retrovirus (HTLV-1: human T-lymphotropic virus)

b. Burkitts lymphoma AND t(8;14) involving myc and the immunoglobulin heavy chain gene c. Diffuse large B cell lymphoma AND slow growing lymph nodes d. Follicular lymphoma AND treated with antibodies to B cell antigens e. Mycosis fungoides AND B cell lymphoma involving skin

Answer: a, b, d

of 16


X.4 The above peripheral blood comes from a 68 year old patient with a white cell count of 75 x

109/l. Which of the following statements with respect to this disease are correct, and which are not? a. Cytogenetic markers have no prognostic significance b. Development of microcytic, hyperchromic anaemia is a well-known complication c. This patient is at increased risk for bacterial infections d. This patient is likely to have significant lymphadenopathy e. This patients age is unusual as this is a disease of young people

Answer: b, c, d

A. B. C.

of 16


D. E. X.5 Which of the following changes in the differential count are correctly matched with the cells

labelled A to E above, and which are not?

a. Cell A AND increased due to increased marrow production in corticosteroid therapy b. Cell B AND increased in chronic bacterial infections c. Cell A AND increased in acute viral infections d. Cell D AND decreased in corticosteroid therapy e. Cell C AND increased in pertussis (whooping cough)

Answer: b, d, e X.6 In chronic myeloid leukaemia (CML):

a. The cell of origin is more differentiated than the CFU-GEMM cells b. The BCR-ABL protein phosphorylates a number of different substrates in the cytoplasm c. Untreated people usually die of marrow failure caused by fibrosis of the marrow d. Imatinib resistance may develop after an initial good response e. The raised white count is due to maturation arrest of neutrophils

Answer: b, d X.7 Which of the following statements regarding the myeloproliferative neoplasms are correct, and

which are not?

a. Essential thrombocythemia may present with abnormal bleeding b. Expansion of haemopoiesis occurs in sites of fetal haemopoiesis c. Primary myelofibrosis has an initial proliferative phase with elevated neutrophil and/or

platelet counts. d. Proliferation of red cells in Polycythemia vera is dependant on erythropoietin e. Transformation to acute leukaemia is the usual terminal event for patients with Essential

thrombocythemia Answer: a, b, c

of 16

SCMD 3000 GEMP 1 HAEMATOLOGY MCQ EXAM 8 November 2012 Session No.: ________ Seat No.: ________ Student No.: _________________ (on each page) _____________________________________________________________________________________ X.8 With respect to acute myeloid leukaemias:

a. Defects in apoptosis may contribute to the accumulation of leukaemic cells. b. Patients are not at increased risk of bacterial infection c. The peripheral blood blast count may be very low despite the marrow being very

hypercellular d. The t(15;17) is associated with a low incidence of bleeding complications e. The WHO classification reflects the importance of genetic lesions

Answer: a, c, e

X.9 HIV positive individuals have an increased risk of deep vein thrombosis (DVT). Which of the

following are recognised risk factors for DVT in this population, and which are not?

a. Decreased synthesis of Protein S

b. Endothelial cell activation

c. Increased Factor VIII levels

d. Increased incidence of antiphospholipid antibodies

e. Increased levels of Factor VII

Answer: b, c, d

X.10 Which of the following statements regarding the management of venous thrombosis are

correct, and which are not?

a. Heparin therapy in DVT has the direct effect of shrinking the clot.

b. If the patient has a prolonged PTT and PT which do not correct, an antiphospholipid

antibody should be suspected.

c. Low molecular weight heparin (LMWH) has a higher incidence of bleeding complications

than unfractionated heparin.

d. The patient should be fully anticoagulated with heparin (unfractionated or LMWH) before

starting warfarin therapy.

e. When using unfractionated heparin, the aim is to increase the baseline PTT by a factor of 5

(5 x increase).

Answer: b, d

of 16

SCMD 3000 GEMP 1 HAEMATOLOGY MCQ EXAM 8 November 2012 Session No.: ________ Seat No.: ________ Student No.: _________________ (on each page) _____________________________________________________________________________________ X.11 Which of the following statements are correct, and which are not? In HIV positive individuals:

a. Autoimmune haemolysis is a frequent cause of anaemia

b. Bone marrow suppression is a cause of cytopaenias

c. Immune thrombocytopenia tends to occur only in the AIDS phase

d. Mildly hypochromic, microcytic anaemia with increased ferritin levels commonly occurs late

in the disease

e. Neutrophils may show dysplastic features e.g. abnormal nuclear morphology

Answer: b, d, e

X.12 Which of the following statements regarding vitamin B12 and folate are correct, and which are

not?

a. Folate deficiency can occur in cases of bacterial overgrowth of the small bowel

b. Treatment of pernicious anaemia requires lifelong oral vitamin B12

c. Vitamin B12 absorption requires initial binding to R proteins in the stomach

d. Vitamin B12 and folate deficiencies are morphologically identical

e. Vitamin B12 deficiency can be safely and effectively treated with folate

Answer: a, c, d

X.13 Which of the following statements regarding iron absorption, transport and storage are correct,

and which are not?

a. Hepcidin inhibits the release of iron by cells

b. Iron is absorbed in the intestinal lumen by the divalent metal transporter DMT1

c. Iron stores are regulated by the secretion of iron

d. Most of the iron in the body is in the form of hepatic enzymes

e. Transferrin bound to iron attaches to the transferrin receptor on the cell surface

Answer: a, b, e

X.14 Which of the following statements about iron deficiency are correct, and which are not?

a. It causes an increase in transferrin levels

b. It causes a reduction in red cell size before it leads to hypochromia

c. It characteristically leads to the presence of acanthocytes in the blood

d. It is best diagnosed biochemically by a low serum iron concentration

e. Without an obvious dietary cause or source of bleeding in an adult should lead to

investigation for occult GIT blood loss

Answer: a, b, e

of 16

SCMD 3000 GEMP 1 HAEMATOLOGY MCQ EXAM 8 November 2012 Session No.: ________ Seat No.: ________ Student No.: _________________ (on each page) _____________________________________________________________________________________ X.15 Which of the following are causes of a macrocytosis, and which are not?

a. AZT therapy

b. Combined vitamin B12 and iron deficiency

c. Hypothyroidism

d. Sickle cell trait

e. The neonatal period

Answer: a, c, e

X.16 Which of the following are correctly matched with respect to pancytopaenia, and which are not?

a. Acute lymphoblastic leukaemia AND more common in children than in adults

b. Aplastic anaemia AND underlying cause unknown in many cases

c. Hypersplenism AND reduced reticulocyte production index (RPI)

d. Marrow infiltration by carcinoma AND presence of teardrop red cells

e. Megaloblastic anaemia AND hypocellular bone marrow

Answer: a, b, d

X.17 Which of the following statements regarding sickle cell anaemia (homozygous) are correct, and

which are not?

a. Chronic organ damage results from repeated episodes of infarction

b. Hydroxyurea is used to increase the HbF concentration

c. Option Removed

d. It protects against severe malaria

e. The red cells sickle in hypoxic conditions

Answer: a, b, e

X.18 Which of the following statements regarding the thalassaemias is/are correct, and which

is/are not?

a. thalassaemia presents at birth

b. In thalassaemias involving deletions of the globin gene cluster on chromosome 11, there

may be loss of the and genes

c. Iron overload is a major cause of morbidity and mortality in thalassaemia major

d. Patients with 0 thalassaemia major are able to produce small quantities of globin chains

e. The chain precipitation leads to intramedullary haemolysis

Answer: b, c, e

of 16

SCMD 3000 GEMP 1 HAEMATOLOGY MCQ EXAM 8 November 2012 Session No.: ________ Seat No.: ________ Student No.: _________________ (on each page) _____________________________________________________________________________________ X.19 Which of the following statements regarding thalassaemia are correct, and which are not?

a. thalassaemia is more commonly due to point mutations than deletions of the genes

b. thalassaemia trait is a cause of a hypochromic, microcytic anaemia

c. Deletion of 4 genes results in intrauterine death

d. HbH disease is common in people of African origin

e. If 3 genes are affected, HbH is produced

Answer: b, c, e

X.20 Which of the following are correctly matched with respect to non-haemolytic transfusion

reactions, and which are not?

a. Graft versus host disease AND less common in related host-donor pairs

b. Febrile non-haemolytic transfusion reactions AND Antibodies to donor leucocytes

c. Post transfusion purpura AND destruction only of donor platelets

d. Recipient sensitised to protein in donor blood AND urticaria

e. Transfusion-related acute lung injury (TRALI) AND clinically indistinguishable from ARDS

(adult respiratory distress syndrome)

Answer: b, d, e

X.21 In which of the following settings does polycythaemia occur?

a. Chronic obstructive airways disease

b. Increased binding of carbon monoxide to Hb in smokers

c. Left to right shunts in congenital heart disease

d. Mutations of Hb leading to low O2 affinity

e. Secretion of erythropoietin in renal disorders such as hydronephrosis

Answer: a, b, e

X.22 Which of the following statements regarding platelet disorders are correct, and which are not?

a. Acute idiopathic thrombocytopenic purpura (ITP) is more common than chronic ITP in

adults

b. Alcohol suppresses megakaryocyte synthesis

c. In Bernard-Soulier syndrome there is a deficiency of Glycoprotein 1b (GPIb) d. In Glanzmans disease the activated platelets are unable to aggregate

e. The effect of aspirin on platelets has a half life of 8 hours

Answer: b, c, d

of 16

SCMD 3000 GEMP 1 HAEMATOLOGY MCQ EXAM 8 November 2012 Session No.: ________ Seat No.: ________ Student No.: _________________ (on each page) _____________________________________________________________________________________ X.23 Which of the following are directly activated by thrombin, and which are not?

a. Factor VIII

b. Factor IX

c. Factor XI

d. Factor XIII

e. Plasminogen

Answer: a, c, d

X.24 Which of the following statements regarding von Willebrands factor (vWF) and von

Willebrands disease (vWD) are correct, and which are not?

a. vWF is necessary for adhesion of the platelet via Glycoprotein IIb IIIa

b. vWF is necessary for the stabilization of factor VIII

c. vWF is produced in the endothelium

d. Type II vWD is usually due to gene deletion

e. Type IIb vWD is a cause of thrombocytopenia

Answer: b, c, e

X.25 With respect to anti-platelet drugs: which of the following are correctly paired, and which are

not?

a. Cyclooxygenase : Clopidogrel

b. P2Y12 receptor : Aspirin

c. Phosphodiesterase inhibition : Ridogrel

d. RGD sequence : Integrelin

e. Thromboxane synthetase : Dazoxiben

Answer: d, e

of 16

SCMD 3000 GEMP 1 HAEMATOLOGY MCQ EXAM 8 November 2012 Session No.: ________ Seat No.: ________ Student No.: _________________ (on each page) _____________________________________________________________________________________ X.26 Which of the following differences in health outcomes would be considered to be inequitable?

a. Under-five mortality rates between white and black children b. Alzheimer disease in men and women older than 85 years of age. c. Maternal mortality rates between urban and rural populations. d. Option Removed e. Rates of bipolar disorders between urban and rural populations.

Answer: a, c, X.27 Which of the following statements about drugs used in the treatment of leukaemia are correct,

and which are not?

a. Cladribine is used to treat chronic B cell lymphocytic leukaemia b. Concurrent use of rifampicin increases the plasma concentration of imatinib c. Dasatinib is used as an alternative in imatinib resistance d. Methotrexate inhibits thymidylate synthase e. Rituximab causes a selective depletion of T-cells

Answer: a, c, d b: Rifampicin induces metabolism of imatinib thus reduces plasma concentration c: Correct used in cases of imatinib resistance d: Mechanism of action of methotrexate

X.28 Which of the following statements bout anticoagulant and fibrinolytic agents are correct, and

which are not?

a. abciximab prevents the binding of fibrin to GPIIb/IIIa T b. enoxaparin is contraindicated in the treatment of deep vein thrombosis c. heparin increases the affinity of antithrombin III for thrombin T d. streptokinase is used to prevent clotting after major surgery e. warfarin-induced haemorrhage is rapidly reversed by withdrawing the drug

Answer: a, c b: enoxaparin is used to treat d: streptokinase is contraindicated e: freshly frozen plasma is used drug withdrawal too slow X.29 Which of the following statements regarding the immune system are correct, and which are

not?

a. Adhesion molecules such as ICAM1, LFA1 and LFA3 are present on all leukocytes b. Cytotoxic T cells express CD3 and CD4 molecules c. Iinterleukin 2 is produced by macrophages d. Th1 cells produce histamine e. The adaptive response is due to T and B cell memory

Answer: a, e

of 16

SCMD 3000 GEMP 1 HAEMATOLOGY MCQ EXAM 8 November 2012 Session No.: ________ Seat No.: ________ Student No.: _________________ (on each page) _____________________________________________________________________________________ X.30 Which of the following statements are true during antigen presentation, and which are not?

a. CD3+ CD4+ T lymphocytes have receptors for Class II antigens b. Erythrocytes express both Class I and Class II antigens c. Formation of a 'new' antigen receptor on helper T erythrocytes is due to 'remoulding'

mediated by CD3 and CD4 on T cell surfaces d. Macrophages present antigen to CD3+ CD8+ in conjunction with Class I antigens e. P-selectin binds to CD2

Answer: a, d

R-TYPE QUESTIONS

A. Liver failure B. Warfarin treatment C. Unfractionated heparin therapy D. Antiphospholipid syndrome E. Haemophilia A F. Disseninated intravascular coagulation (DIC) G. Haemophilia B H. Von Willebrands disease The following are coagulation screen results for hospitalised patients who are bleeding from their drip sites. Choose the correct diagnosis of causes of bleeding from the list above.

Parameter Normal range Patient 1 Patient 2 Patient 3

PT 12 16 seconds 25 24 80

Correction 14 13.5 14.2

PTT 23 39 seconds 83 75 119

Correction 32 33 38

Fibrinogen 2 - 4 1.5 1.8 3.8

D-dimers

of 16


A. B.

C.

D.

E. F.

of 16

SCMD 3000 GEMP 1 HAEMATOLOGY MCQ EXAM 8 November 2012 Session No.: ________ Seat No.: ________ Student No.: _________________ (on each page) _____________________________________________________________________________________ For each of the patient scenarios below, select the blood smear that is most appropriate to that patient. R.4 A 48 year old woman is brought to hospital with an impaired level of consciousness.

Her FBC is as follows:

Parameter Result Normal range

WCC 3.8 4.00 10.00 x109/l

RCC 2.8 4.13 5.67

Hb 6.5 12.1 16.3

Hct 0.2 0.37 0.49

MCV 71 79.1 98.9 fl

MCH 23 27 32 pg

MCHC 32 32 36 g/dl

RDW 28 11.6 14 %

Platelets 45 137 373 x109/l

Answer: E R.5 A 48 year old woman with pallor and mild jaundice is taking thyroxine for autoimmune

thyroiditis. Her FBC is as follows:

Parameter Result Normal range

WCC 2.2 4.00 10.00 x109/l

RCC 1.13 4.13 5.67

Hb 4.2 12.1 16.3

Hct 0.13 0.37 0.49

MCV 115 79.1 98.9 fl

MCH 37 27 32 pg

MCHC 32 32 36 g/dl

RDW 25 11.6 14 %

Platelets 36 137 373 x109/l

Answer: B

haem_MCQ_2012_student_feedback.pdf

Documents

rtype questions

xtype questions

answer cards

number of answers

question papers

single best answer

answer bubbles blank

student number