1. Multiple choice questions Dr. Mohammad Harith

2. 1. All of the followings causing macrocytic anemia, EXCEPT : A. B12 deficiency B. Folic acid deficiency C. Myelodysplastic syndrome D. Thalassemia E. Methotrexate

3. 2. Koilonachia is most commonly associated with which of the followings ? A. Megaloblastic anemia B. Iron deficiency anemia C. Cold agglutinin hemolytic anemia D. Aplastic anemia E. Thalassemia

4. 3. All of the following laboratory findings are associated with iron deficiency anemia, EXCEPT : A. Low iron B. Low TIBC C. Low ferritin D. High transferrin saturation E. Low marrow iron

5. 4. Hypersigmented neutrophil can be seen in which of the followings? : A. Iron deficiency anemia B. Megaloblastic anemia C. Myelodysplastic syndrome D. Myelofibrosis E. sickle cell anemia

6. 5. 58 year old male presented with hx. Of fatigue, palpitation, headache & exertional dyspnoea, on examination there is only anemia. His Hb is 8 g/l, wbc 10 * 10^9/l. Platelets 400, 000, MCV is (60) fl, b.film show anisopoikilocytosis, ferritin is low, TIBC is high, his PMH is significant only for chronic dyspepsia & he noticed that the colour of his stool turned black recently. What is the best next step in the evaluation of this patient? A. Treat him with ferrous sulphate 300 mg for 6 months B. He need urgent blood transfusion with 3 units C. Sent him for bone marrow examination D. He need to be evaluated by OGD ( upper endoscopy) E. It is better to give him parentral iron replacement therapy

7. 6. 45 year old male is diagnosed with megaloblastic anemia, which one of the following drugs may be responsible for this type of anemia ?? A. Pencillin B. Tetracyclin C. Vitamin B12 D. Cefotaxim E. Methotrexate

8. 7. 46 year old male had remote hx. Of anemia but the doctor lost contact with the patient since the dx., in addition to his symptoms, he started to develop parasthesia of both hands & he feel unstedy while walking, on examination there is anemia, absent ankle reflex with extensor planter response, his MCV is 122, RBC folate is normal Based on this informations, what is the most appropriate management ? A. Give him folic acid 5 mg urgently, then maintainance therapy B. Give him B12 1000 ug im urgently, then continue maintainance therapy. C. Give him both folic acid & B12. D. Give him iron maltose. E. Bone marrow followed by CT scan of the head.

9. 8. Which one of the following is a common cause of cold autoimmune hemolytic anemia ? A. Mycoplasma pneumonia B. Methyldopa ( aldomate) C. Chronic lymphocytic leukemia ( CLL) D. Systemic lupus erythrimatosis ( SLE) E. Rheumatoid arthritis

10. 9. Which one of the following is most suggestive of intravascular hemolysis ? A. hemoglobinuria B. Increase indirect bilirubin C. Increased LDH D. Increased reticulocyte count E. Low Hb.

11. 10. All of the followings are causes of intravascular hemolysis, EXCEPT : A. DIC B. PNH ( paroxysmal nocturnal hemoglobinuria) C. Transfusion reaction D. Heriditary spherocytosis E. Microangiopathic hemolytic anemia ( MAHA).