A 56-year-old man, who undergoes haemodialysis 3 times a week due to kidney failure, presents

with dizziness, lethargy and shortness of breath. Laboratory results reveal a haematocrit of 20%
(normal range of 42%-54%).

Which is the most likely cause for this presenting condition?

Select one:

A. Iron deficiency

B. Vitamin B12 deficiency

C. Erythropoietin deficiency

D. Stem cell factor deficiency

A 20-year-old man is planned for a surgery and as part of the anesthesia workup, arterial oxygen
content was found to be below normal. The anesthetist explained to the patient that this low
arterial oxygen content is due to a rare enzyme deficiency, which causes the iron in his
haemoglobin to be in ferric state (Fe3+) rather than the normal ferrous (Fe2+) state.

Which enzyme deficiency is the anesthetist referring to?

Select one:

A. Glutathione reductase

B. Glucose-6-phosphate dehydrogenase

C. Methemoglobin reductase

D. Glutathione peroxidase

A 3-year-old child who had a respiratory infection, is noted to have small pinpoint haemorrhages
on the skin over the past 3 days. On examination, the child's vital signs are normal. There are
petechiae over skin of extremities and trunk. A complete blood count result is given below. This
condition resolves over the next month without treatment.

RBC indices Result Normal range

Haemoglobin 14.3 g/dL 11.5-15.5 g/dL

Haematocrit 43%, 34-45%

Mean corpuscular volume 90 fL 75-95 fL

Platelet count 19,300/uL 150,000-400,000/uL

White blood cells count 9370/uL 5500-15500/uL

What is the most likely diagnosis?
A. Aplastic anaemia
B. Immune thrombocytopenic purpura
C. Hereditary spherocytosis
D. Myeloproliferative disorder

A 40-year-old multiparous woman of Rhesus positive blood group A receives a blood transfusion
following a gastrointestinal bleed. Within 15 minutes of the start of the infusion, she complains of
pain at the infusion site, nausea, back pain and fever with chills. The infusion is stopped, and
blood samples are sent to the laboratory.

What is the most likely cause of patient’s symptoms?

Select one:

A. Acute haemolytic reaction

B. Allergic transfusion reaction

C. Non-immune haemolysis

D. Febrile non-haemolytic reaction

A 30-year-old man is evaluated for a possible haematological disorder. His peripheral blood
smear shows many blast cells with Auer rods.
What is the most likely diagnosis?
- AML

A 30-year-old man complains of swollen and painful joints of his hands. This is his first time
having these symptoms. He also has swelling in his ankles and patchy rashes all over his back.
Upon examination, he has mild-grade fever of 38.1ºC. His blood investigation shows elevated
erythrocyte sedimentation rate, elevated C-reactive proteins, positive for anti-dsDNA and
decreased levels of complements C3 and C4.

What is the most likely diagnosis of this patient?

Select one:

A. Multiple sclerosis

B. Goodpasture syndrome
 C. Systemic lupus erythematosus

D. Polyarteritis nodusa

A 17-year-oldattends clinic with the complaints of fever with chills, sore throat, headache and
vomiting for last one week. His room-mate was treated for tuberculosis last year. On
examination, he has morbilliform rash and his cervical lymph nodes are enlarged and tender.
Spleen is also palpable. Peripheral blood smear shows atypical lymphocytes. Antibodies to
Epstein Barr virus are increased.

What is the most likely diagnosis?

Select one:

A. Acute lymphoblastic leukemia

B. Infectious mononucleosis

C. Tuberculosis

D. Lymphoma

A 70-year-old patient who suffers from liver failure, presents with nausea, fatigue and bleeding
from the gums. Laboratory investigations reveal platelet counts of 25,000/µL (normal range:
150,000 to 450,000/µL).

Which factor most likely alleviates the patient’s condition?

Select one:

A. Erythropoietin

B. Stem cell factor

C. Colony stimulating factor

D. Thrombopoietin

A new-born is diagnosed with severe combined immunodeficiency disease. His bone marrow has
normal cellularity. Radioactive tracer studies reveal entry of T cell precursors into the thymus but
no mature T lymphocytes are found in his peripheral circulation.

Which process is severely affected under this condition?

Select one:

A. Irreversible inhibition of immunoglobulin heavy chain locus rearrangement

 B. Rearrangement of constant region genes of the heavy chain

C. Rearrangement of variable region genes of the light chain

D. Activation of the naïve mature B lymphocytes

A 35-year-old nurse presents to the emergency room complaining of fever and malaise. He
presents with severe generalised muscle pain, malaise, fatigue, and sore throat. He has recently
developed difficulty in breathing and a non-productive cough. On examination, a generalised
maculopapular rash and bilateral conjunctival injection are noted. Initial laboratory testing reveals
the presence of a virus belonging to the Filoviridae family.

Which pathogen is responsible for this patient’s symptoms?

Select one:

A. Lassa fever virus

B. Ebola virus

C. Hantavirus

D. Dengue virus

A 10-year-old boy living in a small town of southern Mexico is bitten by a triatomine bug and
subsequently develops fever, fatigue, body aches, headache, and rash.

Which complication is associated with this disease?

Select one:

A. Megacolon

B. Coma

C. Acute respiratory failure

D. Hemoglobinuria

A 30-year-old man presents with sore throat, fever and shortness of breath. Laboratory
investigations indicates a viral infection.

Which immune response will most likely eliminate the viral infection?

Select one:

A. Neutralisation of toxins

B. Antibody dependent cellular cytotoxicity

 C. Release of histamines

D. Production of antibodies

A 24-year-old woman was informed of her HIV positive status during her routine gynaecology
clinic visit. She has been sexually active with multiple partners in the last 6 months.

Which laboratory result is expected in this patient after several years with no treatment?

Select one:

A. CD138+ cells reduction

B. CD11c+ cells increment

C. CD8+ cells increment

D. CD4+ cells reduction

A 53-year-old man presents to the hospital with severe fever along with muscle and joint pains,
severe pain behind the eyes, headache and body pains. Physical examination reveals macular
rashes on the trunk and extremities, hepatomegaly and petechiae on the mucous membranes of
the mouth. The tourniquet test is found to be positive.

Which is the most likely causative organism of this patient's presentation?

Select one:

A. Coronavirus

B. Ebola virus

C. Norovirus

D. Dengue virus
A 10-year-old girl is noted to have increased facial distortion for the past 8 months from a lesion
involving her jaw. On physical examination, she has a right mandibular mass. Histopathological
examination of the lesion reveals a monotonous pattern of small non-cleaved lymphocytes.
Cytogenetic analysis of these cells shows t(8;14).

Which microorganism is most likely to be associated with development of this lesion?

Select one:

A. Epstein-Barr virus

B. Adenovirus

C. Human papillomavirus

D. Cytomegalovirus

A 60-year-old man is admitted to emergency department with complaints of severe chest pain for
the past 4 hours that radiated to left shoulder. ECG shows ST segment elevation and Troponin-T
is significantly elevated.

Which of the following is the best treatment option to quickly reverse the ECG changes?

Select one:

A. Heparin

B. Alteplase

C. Streptokinase
 D. Aspirin

A 40-year-old man from a remote village in Ivory Coast is bitten by a black fly and subsequently
presents with severe conjunctivitis and corneal opacification in his right eye.

What is the causative agent of this disease?

Select one:

A. Babesia microti

B. Brugia malayi

C. Trypanosoma cruzi

D. Onchocerca volvulus

A 35-year-old woman presents with chills, fever, splenomegaly and anaemia after returning from
a trip in East Africa. Microscopic examination of her blood film reveals the presence of a parasite
as shown in the figure below.
Select one:

A. Babesia microti

B. Brugia malayi

C. Plasmodium ovale

D. Trypanosoma cruzi

Residual spraying of insecticide is commonly employed to control the vector of which disease?
Select one:

A. Dengue

B. Japanese encephalitis

C. Plaque

D. Malaria

A 36-year-old man was diagnosed with tuberculosis (TB) co-infected with HIV. His CD4+ count is
more than 350 cells/uL.

What is the treatment plan for this patient?

Select one:

A. Start intensive TB treatment for 2 months and followed by antiretroviral therapy

B. Start antiretroviral therapy only to boost the immune system to clear TB infection

C. Start TB treatment immediately and once the TB treatment is tolerated within 2 weeks,
start antiretroviral therapy

D. Start TB treatment and delay antiretroviral therapy until needed

A 12-year-old boy is suffering from chronic fatigue. On physical examination, he was found to
have splenomegaly. Laboratory studies are shown below. Peripheral blood smear examination
shows hypochromia, microcytosis, target cells, basophilic stippling and many nucleated red blood
cells. A bone marrow biopsy shows a myeloid:erythroid ratio of 1:4, and there is 4+ stainable
iron.

RBC indices Result Normal range

Haemoglobin 8.8 g/dL 12-15 g/dL

Haematocrit 24.1%, 35-47%

Mean corpuscular volume 65 fL 80-100 fL

Platelet count 187,000/uL 150,000-400,000/uL

White blood cells count 7400/uL 4000-11000/uL

 Serum ferritin 3740 ng/mL 12-300 ng/mL

What is the most likely diagnosis?

Select one:

A. Hereditary spherocytosis

B. Beta-thalassemia major

C. Sickle cell anaemia

D. G6PD deficiency

A scientist claims to have synthesised an antibody that targets CD40L.

If administered, which process will be affected in a direct manner?

Select one:

A. Isotype switching in B cells

B. Differentiation of B cells to plasma cells

C. Expression of IL-4 by T cells

D. Inhibition of 2nd signal from B cells to T cells

BB is a 16-year-old boy who has been diagnosed with haemophilia. His parents often worry
about his health condition and strictly disallow him from participating in any physical activities as
they think it is too risky for him.

Which of the following is the most likely consequence of BB’s experience?

Select one:

A. His haemophilia may get worse by his overprotective parents.

B. BB may demonstrate better adherence to recommended treatment.

C. BB may engage in sports activities without his parents’ knowledge.

D. He may become more dependent on his overprotective parents.

A 30-year-old man is evaluated for a possible haematological disorder. His peripheral blood
smear shows many blast cells with Auer rods.

What is the most likely diagnosis?

Select one:

A. Leukaemoid reaction

B. Acute myelogenous leukaemia

C. Chronic lymphocytic leukaemia

D. Lymphoblastic leukaemia

A 72-year-old previously healthy man has noted increasing fatigue and shortness of breath with
minimal exertion for the past 4 months. On physical examination, he has non-tender cervical
lymphadenopathy and hepatosplenomegaly. A complete blood count report and peripheral blood
smear are shown below.

RBC indices Result Normal range

Haemoglobin 11.9 g/dL 13.2-16.6 g/dL

Haematocrit 36% 38.3-48.6%

Mean corpuscular volume 90 fL 80-100 fL

Platelet count 227,000/uL 150,000-400,000/uL

White blood cells count 23,000/uL 4000-11000/uL

Segmented 16% 50-70%

Bands 2% 2-5%

Lymphocytes 78% 20-40%

Monocytes 4% 3-10%
Select one:
A. Acute myelogenous leukaemia
B. Chronic myelogenous leukaemia
C. Acute lymphocytic leukaemia
D. Chronic lymphocytic leukaemia

A 7-year-old girl stepped on a rusty nail at the playground. Two hours later, she was taken to the
paediatrician as her foot appeared red, painful and swollen.

Which mechanism is most likely associated with her symptoms?

Select one:

A. The dead cells surrounding the wound is broken down.

B. There is an increased secretion of interleukin 10 (IL-10).

C. Circulating neutrophils migrating to the site of wound.

D. Infection has been cleared by antibodies and T cells.

A 38-year-old woman has become increasingly fatigued for the past 3 months. During the past
week, she has noted rashes on her skin. On physical examination, there are small haemorrhagic
spots on her trunk and extremities. She has no hepatosplenomegaly and no lymphadenopathy.
Laboratory studies show;

Hb 6.8 g/dL (12-15 g/dL),

HCT 20.7% (35-47%),

MCV 91 fL (80-100 fL),

platelet count 28,760/uL (150,000-400,000/uL), and

WBC count 1940/uL (4000-11000/uL).

Patient exhibited a dry tap on bone marrow aspiration.

What is the most likely diagnosis?

Select one:

A. Immune thrombocytopenic purpura

B. Myeloproliferative disorder

C. Aplastic anaemia

D. Hereditary spherocytosis

40-year-old man presents with acute onset fever with chills and rigor over the past 2 days. The
peripheral blood smear shows presence of Plasmodium vivax.

Which of the following is the most appropriate to provide a radical cure for this patient?

Select one:

A. Chloroquine + primaquine

B. Chloroquine + doxycycline

C. Chloroquine + atovaquone

D. Artesunate + chloroquine
A 35-year-old man experiences shortness of breath, rapid heart rate and breathing two hours
after visiting his friend’s farm. He is rushed to an emergency department and is then given
oxygen therapy.

Which antibody is most likely involved?

Select one:

A. IgE

B. IgG

C. IgA

D. IgM

Select one:
A. Trachea
B. Pulmonary artery
C. Ascending aorta
D. Oesophagus
A 53-year-old woman has complaints of fatigue and early satiety of 2 months’ duration. She has
had 10 kg weight loss during this period. On examination, her vital signs are normal. Liver and
spleen are palpable. Complete blood count is done and the values are as shown in the table.

Blood Parameter Patient values Normal Values

Total WBC count 55,000/mm3 4000 to 11,000/mm3

RBC count 4.1 million cells/mcL 3.9 to 5.03 million cells/mcL

Haemoglobin 9.8g/dL 12 to 15.5 g/dL

Platelet count 558,000/µL 150,000-450,000/µL

Manual leukocyte differential shows: segmented neutrophils 60%, bands 5%, metamyelocyte
3%, myelocyte 2%, lymphocytes 20%, monocytes 3%, eosinophils 2%, basophils 5% and blasts
1%.
Which cytogenetic abnormality is most likely associated with this condition?
Select one:
A. t(9;22)
B. Bcl-2 activation
C. t(8;14)
D. C-Myc activation

A 27-year-old woman is prescribed ferrous sulfate tablets as she is diagnosed of iron deficiency
anaemia, 4-months post-partum.

Which of the instructions is appropriate to ensure adequate iron absorption in this patient?

Select one:

A. It is better to take tablets along with antacids to avoid gastritis.

B. The tablets should preferably be taken with milk.

C. The tablets are better taken empty stomach.

D. The tablets should not be taken along with citrus drinks.

Select one:60-yea
A. Hypochromasia
B. Fragmentation
C. Nucleated red blood cells
D. Spherocytosis

A 60-year-old man has become increasingly fatigued for the past 6 months. On physical
examination, there are no abnormal findings. Laboratory studies show low haemoglobin and low
haematocrit levels, and high MCV. The platelet count and WBC count are within normal limits.

Which morphological finding is most likely to be present on examination of his peripheral blood
smear?

Select one:

A. Microcytosis

B. Hypersegmented neutrophils

C. Blast cells

D. Nucleated red blood cells

Select one:
A. X
B. Y
C. W
D. Z

A 7-month-old child with failure to thrive is found to have haemoglobin of 4.4 g/dL. The peripheral
smear shows very small red cells with marked pallor. Upon analysis, his red cells contain high
amounts of a haemoglobin which was composed of two alpha and two gamma globins.

Which is the haemoglobin that is increased in this child?

Select one:

A. Haemoglobin A2

B. Haemoglobin H

C. Haemoglobin S

D. Haemoglobin F
A 3-year-old child who had a respiratory infection, is noted to have small pinpoint haemorrhages
on the skin over the past 3 days. On examination, the child's vital signs are normal. There are
petechiae over skin of extremities and trunk. A complete blood count result is given below. This
condition resolves over the next month without treatment.

RBC indices Result Normal range

Haemoglobin 14.3 g/dL 11.5-15.5 g/dL

Haematocrit 43%, 34-45%

Mean corpuscular volume 90 fL 75-95 fL

Platelet count 19,300/uL 150,000-400,000/uL

White blood cells count 9370/uL 5500-15500/uL

What is the most likely diagnosis?

Select one:

A. Aplastic anaemia

B. Hereditary spherocytosis

C. Myeloproliferative disorder

D. Immune thrombocytopenic purpura

Which anatomical structure is best seen in a normal postero-anterior (frontal) chest radiograph?

Select one:

A. Alveolar sacs

B. Bronchioles

C. Pulmonary blood vessels

D. Pulmonary lymphatics
Select one:
A. Superior vena cava
B. Ascending aorta
C. Pulmonary trunk
D. Descending thoracic aorta

A woman is suffering from postpartum haemorrhage and was given blood transfusion. Almost
immediately, the patient developed fever, hypotension, nausea and vomiting along with pain in
the back and chest.

Which process contributes to her symptoms?

Select one:

A. Embolism
 B. Neutralisation

C. Coagulation

D. Agglutination

A 15-year-old girl has had mild fatigue for many years. Physical examination reveals just
palpable spleen. Laboratory studies are shown below. Her peripheral blood smear shows
numerous spherocytes.

RBC indices Result Normal range

Haemoglobin 11.1 g/dL 12-15 g/dL

Haematocrit 28.8% 35-47%

Mean corpuscular volume 77 fL 80-100 fL

Platelet count 229,000/uL 150,000-400,000/uL

White blood cells count 7340/uL 4000-11000/uL

Retic count 3.9% 1.5-2%

Which pattern of inheritance is most likely present with her disease?

Select one:

A. X-linked recessive

B. Sporadic occurrence

C. Autosomal dominant

D. Autosomal recessive
An 11-year-old boy presents with history of sustained fever with chills and rigor for 10 days. His
father remembered that the boy had been given chloroquine tablets earlier without improvement
of his condition. His peripheral blood smear shows presence of Plasmodium falciparum. He was
admitted and was given a combination of mefloquine and artesunate.

Which of the following is the most appropriate reason to combine mefloquine with artesunate in
this patient?

Select one:

A. To delay the excretion of artesunate

B. To protect against the emergence of resistance to mefloquine

C. To reduce the metabolic breakdown of artesunate

D. To reduce the adverse effects of mefloquine