21- Thrombophilia with a predisposition to recurrent venous thrombosis is associated with all of the following except: a.

Antiphospholipid antibody syndrome. b.Antithrombin deficiency. c.Factor V. d.Polycythemia rubra vera. e.Protein C defiency. 22- A previously healthy 46-year-old man presents with generalized lymphadenopathy and splenomegaly. His WBC count is 20,000/L, with numerous immature forms. The following is expected in his diagnostic work up: a.Hypocellular Bone marrow aspirate b.Pheladelphia chromosome. c.Malignant infilatration on lymph node biopsy. d.Thrombocytosis. e.Increased leucocyte neutrophil alkaline phosphatase score.

23- A 62-year-old woman with platelet count of >1 million /L repeatedly for the last 6 months. Causes of thrombocytosis include all of the following except:???? a. Acute leukemia b. Connective tissue disorders c. Malignancy d. Splenectomy e. Essential thrombocytosis

Whilst being investigated for infertility, a 30-year-old woman is noted to have some bruising on her limbs with a massive enlarged spleen on abdominal examination. Investigations reveal: Haemoglobin 10. 0 g/dL (11. 5 - 16.5), White cell count 110 x 109/L (4 - 11), Neutrophils 60 x 109/L (1.5 -7), Lymphocytes 2 x 109/L (1.5 - 4), Monocytes 0.8 x 109/L (0 - 0. 8), Eosinophils 0.3 x 109/L (0. 04 - 0.4), Basophils 0.7 x 109/L (0 - 0. 1), Myelocytes 40 x 109/L, Myeloblasts 4 x 109/L, Platelet count 900 x 109/L (150 - 400). What is the most likely diagnosis? a ) Acute myeloid le ukaemia b ) Acute promyelocytic leukaemia c ) Chronic myeloid leukaemia d) Essential thrombocythaemia e ) Myelofibrosis

In a 33 years old female patient with asymptomatic lymphadenopathy in the : left supraclavicular area. The best investigation is a- tubecrulin skin test b- Excision biopsy c- Ct Chest and Abdomen d- fine needle aspiration e- upper gastrointestinal endoscopy

An 64-year-old woman presented with tiredness. On examination, she was anemic but had no palpable splenomegaly. Otherwise no abnormalities detect by clinical examination. Investigations: Hb 9.1 g/dl, MCV 80fl (8096), serum ferritin 55 ug/l (15-300), vitamin B12 and RBC folate were normal. Blood film showed marked anisopoiklocytosis. Her urea is 14 mmol/l (3-8) and creatinine 155 micromol/l (60-100), serum albumin 4.1 gm/dl. She was commenced on oral iron therapy for one month and her Hb remained unchanged. What is most likely diagnosis? a- Aplastic anemia b- Anemia of chronic diseases c- Hypothyroidism d- Iron deficinicy anemixa e- Sideroplastic anemia

A 23-year-old male presented by generalized lymphadenopathy, splenomegaly and fever since 3 weeks. Consistency of lymph nodes was ruberry. Since 10 days; he complained from lowbackache. Investigations: Hb 12.2 gm/dl, WBC 12.000 mainly lymphocyte. What the most useful investigation to confirm the diagnosis? a- Bone marrow aspiration b- Lymph node biopsy c- CT scan of chest and abdomen d- Immunophenotyping of WBCs e- Sputum cytology and acid fasting bacilli ex.

A 42-year old woman had been working in radiology department of KFH. She suffered since 3 weeks from exertional dyspnea & fatigue, her Hb 7.3 g/dl, WBC 2.300, platelets 60. 000. There was no history of drug intake, apart from being pale there were no other abnormal clinical signs. What is the most likely diagnosis? a- Hypersplenism b- Aplastic anemia c- Paroxysmal nocturnal haemglobinuria d- Iron deficiency anemia e- Thalasemia minor A 31-year-old man, he suffered from progressive lethargy, easily tired in the last three months. He was diagnosed as Mongolism and Grand mal epilepsy for which he took phenobarbitone & phenytion. On ex, he was very pale, bad teeth, hyperplastic gums, no lymphadenopathy, and no splenomegaly. He had rales at lung bases, gallop and ankle edema. A Blood ex. showed: Hb 4 gm/dl, WBC 3.000 50% lymphocytes, 38% polymorphs, 6% monocytes & 6% eosinophils, platelets 40.000, MCV 108 ft, MCHC 20 gm/dl. All of the following are most likely diagnoses except:????????? a- Folate deficiency b- Pernicious anemia c- Acute myeloid leukemia d- Monoblastic leukemia e- Myelofibrosis

A 68 year old woman was admitted to hospital with evidence of biventricular cardiac failure. On examination her pulse was 100 beats per minute (sinus rhythm), and her blood pressure was 140/60 mmHg. She had haemorrhages in both fundi. Her condition improved after intravenous diuretics. Investigations revealed: Hb 5.6 g/dl (11.5 16.5) haematocrit 0.19 (0.36 0.47) MCV118 fl (80 96) MCH 33.0 pg (28 32) WCC3.4 x 109/L (4 11) platelet count 95 x 109/L (150 400). What is the most likely diagnosis? a- Macrocytosi b- Macrocytic megaloblastic anemia c- Idiopathic Thrombocytopenia d- Aplastic anemia e- Myleofibrosis

A 42-year-old female presents with tiredness since 3 months otherwise no history of any medical diseases. Her investigations reveal: Hemoglobin 7.8 g/dl (11. 5 - 16.5) MCV 72 fL (80 - 96) white cell count 7.6 x 109/L (4 - 11) platelet count 350 x 109/L (150 - 400) serum ferritin 8 g/L (15 - 300). What is the most likely diagnosis? a- sideroblastic anemia b- iron deficiency anemia c- thalassemia minor d- anemia of chronic diseases e- myleofibrosis

81- A 75-year-old woman is referred to the outpatient clinic for investigation of anaemia. She gives a six month history of fatigue and exertional dyspnea. She has a past history of rheumatoid arthritis and long therapy with large doses of NSAIDs. On examination she appears pale and dyspnoeic. She has flat pale nails. There is neither lymphadenopathy nor organomegaly. One of the followings is expected to be found in her blood picture: a. Microcytic Anemia due to iron deficiency b. Sideroblastic anemia. c. Normocytic Anemia. d. Nonmegaloblastic macrocytosis. e. Megaloblastic anemias. 82- An 18-year-old young girl with no recent complaints was found to have anemia during routine laboratory investigation. She has haemoglobin 9.4 g/dL, mean corpuscular volume (MCV) 72 fL and low reticulocytic count. All of the following causes are possible explanation for her anemia except: a. Iron deficiency. b. Thalassemia minor. c. Sideroblastic anemia. d. Folate deficiency. e. Lead poisoning. 83- A 65-year-old man presents with frequent loose stool and painful tongue. His family noticed that he starts to forget important events. On examination he has pale yellowish skin, glossitis and cheilosis. Neurologic examination reveals loss of vibration and position sense. All of the followings is expected to be found in his blood picture except one: a. Mean corpuscular volume MCV>110 fL. b. Pancytopenia. c. Large, oval red blood cells in peripheral smear with hypersegmented neurrophils, and large platelets. d. Hypocellular bone marrow. e. Low reticulocytic count.

84- A 30-year-old woman with recent generalized bonypains and easy fatigue. Complete blood picture is performed and her haemoglobin is 10 g/dL, mean corpuscular volume (MCV) 90 fL and low reticulocytic count. One of the following causes could not be the cause of her anemia:. a. Aplastic anemia. b. B12 deficiency. megalo c. Early iron deficiency. d. Endocrinopathies e. Anemia of chronic disease as Uremia. 85- A 39-year-old man with no recent complaints was found to have anemia during routine laboratory investigation. Initial laboratory evaluation of any case of anemia include all of the following investigations except a. Reticulocytic count. b. Peripheral blood smear. c. Bone marrow aspirate and biopsy. d. Hemoglobin electrophoresis. e. Erythrocyte indices. 50- A 40-year old patient was diagnosed with hemolytic anemia with positive Ham test lysis. This patient is liable to the following complications except: a. Acute intravascular hemolysis. b. Budd-Chiari syndrome. c. Leukemia. d. Aplastic anemia. e. Splenic sequestration crises.

51- A 12-year-old Saudi boy presents of dark urine, dyspnea, back pain and fatigue for 5 days. One week before presentation he received sulphonamides for urinary tract infection. His Investigations show a hemoglobin of 6.5 g/dl and high reticulocyte count. Blood smear shows many bite cells and red cells with Heinz bodies. One of the following mechanisms could best explain this drug reaction: a. Drug induced autoimmune hemolytic anemia. b. Glucose-6-phosphate dehydrogenase deficiency. c. Paroxysmal nocturnal hemoglobinuria. d. Thalassemia major. e. Sickle cell anemia. 52- A 14-year-old Saudi male student with family history of G6PD deficiency in his uncle. He presents with acute fever, yellowish discoloration of his eyes and skin, dark urine and fatigue. One day before presentation he has just started antibiotic therapy for recent sore-throat. If this boy has G6PD deficiency, all of the following findings except one will be present: a. Presence of Heinz bodies. b. Presence of bite cells. c. Low G6PD in reticulocytes normal after heamolytic episode d. Low G6PD in old red blood cells. e. Reticulocytosis.

53- A hypertensive 35-year-old lady has got pregnant for the first time and her physician changed her medication to alpha methyldopa. At time of presentation to antenatal care she was very pale with icterus and she clamed that she had normal colored urine. Her hemoglobin was 5 g/dl, MCV is 88 fL and there is reticulocytosis. Liver function is remarkable for high indirect bilirubin. One of the following causes is most probably the cause of her anemia: a. Dilutional anemia of normal pregnancy. b. Folic acid deficiency anemia. c. Drug induced autoimmune hemolysis d. Severe iron deficiency anemia. e. Acute hepatitis. 54- A 19-year-old Saudi female student was diagnosed with sickle cell anemia since childhood. She presents with acute chest pain. One of the following statements is incorrect concerning painful crises in this patient: a. Microvasculature occlusions are the main cause. b. The extremities, chest, abdomen, and back can be affected. c. The usual precipitations are infections, dehydration, rapid changes in temperature. d. Painful crises are rare during pregnancy. e. Theses painful crises are unique to sickle cell anemia 55- A middle age young man was diagnosed with chronic myelogenous leukemia 12 years ago and he received specific therapy with good response. At his last follow up visit his CBC was as follows: Hemoglobin 9.4 g/dl (11.7 - 15.5) 9 White cell count 18.4 x 10 /L (4-11) Platelet count 40 x 109/L (150-400) Blood film with excess myeloblasts and promyelocytes. What has happened to this patient? a. Transformation to acute leukemia. b. Recurrence of chronic myelogenous leukemia. c. Secondary leukemia. d. Development of aplastic anemia. e. Drug induced thrombocytopenia.

56- A 42-year-old man presented with tiredness, breathlessness, and nose bleeds for three weeks. On examination there were several bruises on his arms and legs, 2 cm splenomegaly and fundal hemorrhages. Investigations revealed: Hemoglobin 7.2 g/dL (11.5-16.5) White cell count 13.8 x 109/L (4-11) Platelet count 24 x 109/L (150-400) Blood film white cells predominantly myeloblasts and promyelocytes. One of the followings is the most likely diagnosis: a. Chronic leukemia. b. Non Hodgkin's lymphoma c. Hodgkin's lymphoma. d. Acute leukemia. e. Aplastic anemia. 57- A 7-year-old girl is diagnosed with acute leukemia according to her blood cell count. Which one of the followings is the best next investigation? a. Cerebrospinal fluid examination. b. Bone marrow trephine biopsy. c. Cytogenic studies. d. Hemoglobin electrophoresis. e. Schilling test. 58- A middle age lady has recently noticed easy fatigue. On examination she looks pale. Abdominal examination detects an enlarged spleen. Her CBC reveals: Hemoglobin 10.0 g/dL (11. 5 - 16.5) White cell count 80 x 109/L (4 - 11) Neutrophils 73 x 109/L (1.5 -7) Lymphocytes 4 x 109/L (1.5 - 4) Monocytes 0.8 x 109/L (0 - 0.8) Eosinophils 0.4 x 109/L (0. 04 - 0.4) Basophils 0.9 x 109/L (0 - 0.1)

Platelet count 700 x 109/L (150 - 400) One of the followings is the most likely diagnosis:

a. b. c. d. e.

Acute myeloid leukemia. Leukemoid reaction. Chronic myeloid leukemia. Essential thrombocythaemia. Myelofibrosis.

59- A 69-year-old male was diagnosed with chronic myeloid leukemia. Which one of the followings is the expected chromosomal abnormality? a. Philadelphia chromosome. b. Balanced translocation. c. Bcr-abl oncogen. d. All of the above. e. Non of the above. 60- A 20-year-old previously healthy college student is admitted with acute follicular tonsillitis. Examination reveals severe pallor and petechial rash on the lower legs. No history of drug intake could be elicited. Investigations reveal: Hemoglobin 4 g/dl (11. 5 - 16.5). White cell count 1x109/l (4 - 11). Platelets 20x109/l (150 - 400). Which one of the followings is the likely diagnosis? a. Acute myeloid leukemia. b. Acute lymphocytic leukemia. c. Aplastic anemia.pan cytopenia d. Hodgkin's lymphoma. e. Non Hodgkin's lymphoma. 61- A 17-year-old previous healthy boy presents with cervical painless lymphadenopathy for 4 months. Lymph node biopsy reveals Hodgkin's disease. One of the following statements is correct concerning Hodgkin's disease: a. Non-Hodgkin's disease is less common than Hodgkin's under the age of 5 years.

b. c.

Hodgkin's disease is more common in males than females. Lymphocyte-predominant Hodgkin's disease has the worse prognosis. d. The nodular sclerosing variety is the least common form of Hodgkin's disease. e. Lymphadenopathy is the least common presenting clinical sign. 62- A 17-year-old boy presented with persistent painless cervical lymphadenopathy for 4 months. He has experienced fever, sweat and unintended loss of weight. Chest x-ray reveals mediastinal lymphadenopathy. However, there are no other lymphadenopathy or extranodal sites could be detected by through investigations. Lymph node biopsy reveals non-Hodgkin's lymphoma. The stage of lymphoma in this patient is: a. Stage IA. b. Stage IIB. c. Stage III1. d. Stage III2. e. Stage IV. 63- A 37-year-old known AIDs patient under antiviral therapy presented with generalized painless lymphadenopathy for the last 2 months. Lymph node biopsy reveals non-Hodgkin's lymphoma. One of the following patients has no increased risk of developing non Hodgkin's lymphoma: a. Congenital immune deficiency syndrome. b. Acquired immune deficiency syndrome (AIDS). c. Autoimmune disorder. d. Patients with liver cirrhosis. e. Organ transplanted patients. 64- A 75-year-old previous healthy man noticed painless neck swellings that persisted for the last 3 months. These were proved by examination to be large non tender cervical lymphadenopathy. He had enlarged axillary lymphadenopathy as well. Lymph node biopsy reveals non-Hodgkin's lymphoma. One of the following possible link between infection and nonHodgkin's lymphoma are correct: a. Helicobacter pylori infection and gastric MALT lymphoma. b. Human T- lymphotropic virus 1 (HTLV-1) infection and T-cell lymphoma.

c. Herpes virus infection and Kaposi sarcoma in AIDS patients. d. EBV infection and Burkitt's lymphoma. e. All of the above.

65- A 75-year-old previous healthy man presents with recent tiredness. On examination he is pale with mild icterus. There are generalized painless lymphadenopathy. Investigations reveal: Hemoglobin 5.0 g/dL (11. 5 - 16.5) White cell count 100 x 109/L (4 - 11) Neutrophils 8 x 109/L (1.5 -7) Lymphocytes 90 x 109/L (1.5 - 4) Monocytes 0.7 x 109/L (0 - 0.8) Eosinophils 0.3 x 109/L (0. 04 - 0.4) Basophils 0.6 x 109/L (0 - 0.1) Platelet count 550 x 109/L (150 - 400) Serum Bilirubin 3.2 mg/dl (0.3-1.1). Direct bilirubin 0.1 mg/dl (0- 0.3). The most probable Cause of anemia in this patient is: a. Bone marrow infiltration. b. Occult GIT bleeding. c. Anemia of chronic illness. d. Autoimmune hemolytic anemia. e. Megaloblastic anemia due to B12 deficiency.

A 42 years old alcoholic man presents with hepatospleenomegally and ascitis. Spider angiomata and bilateral Gynecomastia . The neurologic and mental status examination are normal. Complete blood count exhibits a Hb 7.0gm/dl ,MCV 120 um3, leukocyte 2500 cells/uL and platelet counts is 75,000cells.uL. Peripheral smear shows hupersegmented neutrophils . The corrected reticulocyte is 1% The most likely diagnosis is : a. Anemia of chronic disease. b. Hemolytic anemia. c. Folate deficiency. d. B12 deficiency

e. Iron deficiency secondary to upper GI blee

Important points in Physical Examination in anemic patient:except a) Cardiovascular examination b) Examination of Lymph nodes c) Signs of chronic asthmatic bronchitis d) Check for hepatomegaly and splemomegaly e) Examine for occult blood in stool

All of the following statements regarding Hodgkin disease:except a) Nodular sclerosing type is the most common (80%of HD case) b) Lymphcyte-prodominant type tend to involve peripheral nodes c) The prognosis of Lymphcyte-depletion type is excellent d) severe and unexplaind itching is a common presentation e) Reed-Strenberg (RS) cell in involved lymphoid tissue is pathogonom

A 22-year-old student went to his doctor with three week history of low back ache, especially in the mornings. In addition, she had visited the outpatient clinic by recurrent abdominal discomfort and diarrhea and she received nonspecific treatment with no real success. On ex. He was pyrexial & anaemic and she had a tender palpable mass in right iliac fossa. She had tenderness on flexion of her lumbosacral spine. Rectal ex. and sigmoidoscopy was normal. Initial investigations: Hb 9 gm/dl, WBC 10.000, ?ESR 60 mm/h, stool culture negative. What is the most probable diagnosis a- ulcerative colitis b- Crohn disease

c- Ileocaecal tuberculosis d- Lymphoma with spine infiltration e- Caeceal tumor

1- A 30 years old woman with systemic lupus erythrematosus SLE presents with generalised weakness and malaise. Physical examination shows pale palmar creases , generalised lymphadenopathy and hepatospleenomegally. The CBC is repeated to have a Hb 5.0gm/dl, MCV 103, leukocyte count of 3000cells/uL and platelet count 120,000 cells/uL. Numerous spherocytosis are noted on the smear. The uncorrected reticulocyte count is 27%. The direct coombs test is positive. She is likely to have: a- Hemolytic anemia b- Anemia of chronic disease c- Thalassemia d- B12 Deficiency e- spherocytosis 2- A 23 years old patient known case of chronic hemolytic anemia (sickle cell anemia) will have all of the following complications except: a- recurrent infection with encapsulated organisms b- spleenomegally c- congestive heart failure d- cardiac arrhythmias e- emphysema