1.1 Which ONE of these statements is TRUE regarding normal adult bone marrow?

A It is composed of 90% haemopoietic cells, 10% fat

B It has a myeloid : erythroid ratio of 1 : 2

C It is present in adults in the skull

D It secretes erythropoietin

?Which ONE of these is NOT TRUE concerning the haemopoietic stem cell 1.2
A It is believed to represent approximately 1% of bone marrow cells

B It is thought to have a CD34+CD38- phenotype

C It resembles a small to medium sized lymphocyte

D It is effectively transferred during stem cell transplantation

Which ONE of the following is NOT a significant component of bone marrow 1.3
?stroma
A Endothelial cells

B Adipocytes

C Fibroblasts

D Epithelial cells

Which ONE of these is NOT a mechanism by which granulocyte colony- 1.4

?stimulating factor (G-CSF) can increase neutrophil production
A Increased differentiation from progenitor cells

B Reduction in the selfrenewal of haemopoietic stem cells

C Increased rate of maturation of immature myeloid cells

D Suppression of apoptosis of myeloid cells

Which ONE of these cytokines has an important role in normal early 1.5
?haemopoiesis
A IL1

B IL2

C IL3

D IL4

?Which ONE of these is NOT TRUE concerning the normal cell cycle 1.6

A DNA is replicated in G1 phase

B The cycle is divided into the M phase and the interphase

C Cyclin dependent protein kinases (Cdk) phophorylate protein targets

D Cyclin proteins are synthesized and degraded during the cell cycle

?Which ONE of the following statements is TRUE concerning apoptosis 1.7

A FAS and TNFR have an extracellular death domain

B A critical step is entry of cytochrome c into mitochondria

C BCL2 proteins potentiate apoptosis

D It results from action of intracellular cysteine proteases called caspases

?Which ONE of these statements is NOT TRUE concerning transcription factors 1.8
A They regulate gene expression by controlling the transcription of specific genes
or gene families
B They usually contain at least two domains the DNA binding domain and
activation domain
C The cabl gene, translocated in chronic myeloid leukaemia, is one example

D Helixloophelix is a DNAbinding domain

?Which ONE of these is NOT TRUE concerning adhesion molecules 1.9

A Chemokines are a major family

B They include the immunoglobulin superfamily

C They are important in the spread and localisation of tumour cells

D Integrins can bind cells to extracellular matrix

Which ONE of these molecules does NOT have a role in the transduction 1.10
?pathway of growth factors
A p53

B RAS

C STAT

D JAK

?Which ONE of these statements is TRUE about haemoglobin 2.1

A One molecule contains 1 atom of iron

B It is broken down in macrophages

C It is different in children and adults

D It has a low level in blood at birth compared with adult life

?Which ONE of these statements is TRUE about reticulocytes 2.2

A They contain DNA not RNA

B They are raised in megaloblastic anaemia

C They are raised 12 months after splenectomy

D They are raised after haemorrhage

?Which ONE of these statements is NOT TRUE concerning erythropoietin 2.3

A 90% of the hormone is made in the liver

B It contains a hypoxia response gene

C One stimulus to production is a low atmospheric oxygen level

D Levels in blood are high if a tumour secreting erythropoietin is causing

polycythaemia but are low in severe renal disease or polycythaemia vera
Which ONE of these statements is TRUE concerning the therapeutic use of 2.4
?erythropoietin
A Side effects include hypotension and bleeding disorders

B The main indication is in patients with leukaemia

C Oral or parenteral iron is often needed to optimise the response

D Oral administration reduces the frequency of treatment

Which ONE of these statements is NOT TRUE concerning the biochemistry of 2.5
?haemoglobin
A Hb is 70% saturated in arterial blood

B As the haemoglobin molecule loads and unloads O2 the individual globin chains
in the haemoglobin molecule move on each other
C When O2 is unloaded the chains are pulled apart, permitting entry of the
metabolite 2,3diphosphoglycerate (2,3DPG) and resulting in a lower affinity of the
molecule for O2
D The P50 (i.e. the partial pressure of O2 at which haemoglobin is half saturated
with O2) of normal blood is 26.6 mmHg

Which ONE of these conditions is described by this phrase? A clinical state in 2.6
which circulating haemoglobin is present with iron in the oxidized (Fe3+) instead of
.the usual Fe2+ state
A Methaemalbuminuria

B Methaemoglobinaemia

C Congenital dyserythropoietic anaemia

D Glucose6phosphate dehydrogenase deficiency

?Which ONE of these statements is NOT TRUE concerning the red cell 2.7
A Each cell travels an estimated 480 km in its lifetime

B It has a maximum diameter of 3.5 mol so that it can pass through vessels
of this size
C It generates energy as adenosine triphosphate (ATP) by the anaerobic glycolytic
(Embden-Meyerhof ) pathway
D It generates reducing power as NADH by the E-M pathway and as reduced
nicotinamide adenine dinucleotide phosphate (NADPH) by the hexose
monophosphate shunt
?Which ONE of these is TRUE concerning the red cell membrane 2.8
A 50% of the membrane is cholesterol

B Spectrin and ankyrin are extracellular proteins that reinforce the membrane

C Alterations in serum lipids do not influence the red cell membrane

D Inherited defects in membrane proteins can cause hereditary spherocytosis

and elliptocytosis
?Which of the following normally contains >10% of body iron 3.1
A Transferrin

B Heart

C Neutrophils

D Macrophages

?Which of the following is NOT TRUE about sideroblastic anaemia 3.2

A It may be inherited

B It is most frequently caused by myelodysplasia

C It may be caused by folate deficiency

D It may respond to erythropoietin

?Which of the following statements is NOT correct 3.3

A A unit of blood contains 200-250 mg iron

B A man needs to absorb about 1 mg of dietary iron daily

C A molecule of transferrin may transport 4 atoms of iron

D Haemorrhage is the major cause of iron deficiency in the UK

?Which ONE of the following may be used to treat iron deficiency 3.4
A Ferric sulphate

B Desferrioxamine

C Ferrous gluconate

D Erythropoietin

?Which ONE of the following statements regarding oral iron therapy is TRUE 3.5
A Slowrelease preparations are indicated for patients with gastrointestinal
disorders
B Treatment should be given with vitamin C

C The maximum dose is 200 mg ferrous sulphate three times daily

D It is best given at night

E It is routinely indicated in pregnancy

?Which ONE of these statements is TRUE about genetic haemochromatosis 4.1

A It is dominantly inherited

B It is usually caused by mutation of HFE

C It causes excess iron in the duodenal mucosa

D It is associated with reduced saturation of transferrin

Which ONE of the following organs is not damaged by transfusional iron 4.2
?overload
A Liver

B Kidneys

C Parathyroids

D Pituitary

E Heart

?Which ONE of the following is a feature of iron deficiency 4.3

A Raised serum hepcidin

B Raised serum transferrin

C Raised mean corpuscular volume (MCV)

D Hyperchromic red cells

?In which ONE of the following is iron absorption favoured 4.4

A Pregnancy

B Chronic inflammation

C Iron overload

D Phosphates

?Which ONE of the following is NOT TRUE about serum iron 4.5

A It is low in inflammatory diseases

B It is raised in iron overload

C It shows a diurnal rhythm

D It is transported in plasma by ferritin

?Which ONE of the following is used therapeutically 5.1

A Methylcobalamin

B Folate polyglutamate

C Hydroxocobalamin

D Methyltetrahydrofolate

?Which ONE of the following is associated with pernicious anaemia 5.2

A Ileal resection

B Thyroid antibodies in serum

C Systemic lupus erythematosus

D Malabsorption of B12-intrinsic factor complex

?Which ONE of these statements is TRUE concerning the reduction of folate 5.3
A It needs vitamin B12

B It is inhibited by sulphonamide

C It is inhibited by methotrexate

D It occurs during thymidylate synthesis

?Which ONE of the following does NOT cause folate deficiency 5.4
A Antiepileptic drugs

B Veganism

C Gluten sensitivity

D Inflammation

E Pregnancy

?Causes of microcytic red cells include which ONE of the following 5.5
A Alcohol

B Renal disease

C Thalassaemia

D Increased reticulocyte count

?Which ONE of the following is NOT TRUE about megaloblastic anaemia 5.6
A It is always caused by B12 or folate deficiency

B Bone marrow appearances are identical in B12 or folate deficiency

C It is caused by defective DNA synthesis

D It may be caused by nitrous oxide

E It is associated with jaundice

?Which ONE of the following is caused by folate deficiency 5.7

A Spinal cord damage

B Haemolytic anaemia

C Neural tube defect

D Duodenal atrophy

?Which ONE of the following causes vitamin B12 deficiency 5.8

A Haemolytic anaemia

B Veganism

C Widespread carcinoma

D Jejunal resection

?Which ONE of the following may be caused by vitamin B12 deficiency 5.9
A Vitiligo

B Microcytic anaemia

C Peripheral neuropathy

D Carcinoma of stomach

?Spherocytes in the blood film are a feature of which ONE of the following 6.1
A Thalassaemia major

B Autoimmune haemolytic anaemia

C Reticulocytosis

D Glucose6phosphate dehydrogenase (G6PD) deficiency

Which ONE of the following is a feature of a chronic extravascular haemolytic 6.2

?anaemia
A Raised serum conjugated bilirubin

B Low reticulocyte count

C Hypocellular bone marrow

D Gallstones

?Which ONE of the following is NOT a cause of intravascular haemolysis 6.3

A Rhesus incompatibility

B ABO incompatibility

C Glucose6phosphate dehydrogenase (G6PD) deficiency

D Red cell fragmentation syndrome

?Which ONE of the following is NOT a feature of intravascular haemolysis 6.4

A Jaundice

B Haemosiderin in urine

C Absent haptoglobins

D Haemoglobin in urine

?Which ONE of these statements is TRUE regarding hereditary spherocytosis 6.5

A It is caused by an inherited defect in haemoglobin

B It is more common in males

C It can be treated by splenectomy

D It is more frequent in southern Europe

Which ONE of the following is NOT TRUE about autoimmune haemolytic 6.6
?anaemia
A It may be due to drugs

B It is associated with pernicious anaemia

C It may be associated with IgM antibodies in serum

D It may complicate Bcell chronic lymphocytic leukaemia

E It is associated with a positive direct antiglobulin test

Which ONE of the following is NOT TRUE about glucose-6-phosphate 6.7

?dehydrogenase (G6PD) deficiency
A It commonly presents as a chronic haemolytic anaemia

B It leads to intravascular haemolysis after certain infections

C It protects against malaria

D Carrier females have approximately 50% G6PD levels

E It is a cause of neonatal jaundice

Which ONE of the following is NOT TRUE about glucose-6-phosphate 6.7

?dehydrogenase (G6PD) deficiency
A It commonly presents as a chronic haemolytic anaemia

B It leads to intravascular haemolysis after certain infections

C It protects against malaria

D Carrier females have approximately 50% G6PD levels

E It is a cause of neonatal jaundice

?Which ONE of the following is NOT a feature of thalassaemia intermedia 7.1

A It may be due to homozygous o thalassaemia

B It may be associated with extramedullary haemopoiesis

C It is usually associated with splenomegaly

D It may cause iron overload

?Which ONE of the following is used to monitor transfusion iron overload 7.2
A Bone marrow biopsy

B Serum ferritin

C Magnetic resonance imaging

D Lung function

?Which ONE of these statements is TRUE about thalassaemia major 7.3

A The major cause of death is liver failure

B It requires iron chelation at diagnosis

C It is usually caused by deletion of globin genes

D It may be diagnosed antenatally

?Which ONE of these statements is TRUE about thalassaemia major 7.4

A It presents at birth

B It is caused by a defect in globin synthesis

C It is associated with splenomegaly

D It is associated with an increased risk of bone infarction

?Which ONE of the following is NOT TRUE about a-thalassaemia 7.5

A It may cause haemoglobin H disease

B It causes a microcytic hypochromic blood picture

C It ameliorates thalassaemia

D It is a cause of hydrops fetalis

E It is rare except in the Far East

?Which ONE of the following statements is TRUE about thalassaemia trait 7.6
A It is associated with a raised haemoglobin A2 level

B It is associated with iron overload

C It is associated with a reticulocytosis

D It is associated with splenomegaly

?Which ONE of these statements is TRUE concerning sickle cell trait 7.7
A It is a cause of anaemia

B It protects against malaria

C It occurs mainly in females

D It is a cause of frequent sickle cells in the peripheral blood

?Which ONE of the following is NOT TRUE about sickle cell anaemia 7.8
A The oxygen dissociation curve is shifted to the right (i.e. the haemoglobin gives
up oxygen more easily than normal)

B It is associated with stunted growth

C It may cause ankle ulcers

D It is associated with stroke

E It is associated with atrophy of the spleen