1.

Which one of the following options is a true statement with regards to haemolytic disease of the
fetus and newborn, HDFN
a. Rh d HDFN is the most severe form of the disease
b. ABO HDFN is the most severe form of the disease
c. ABO HDFN is the commonest form the disease
d. Anti – K HDFN presents a milder disease than ABO HDFN
2. Concerning the pathophysiology of HDFN true statements are
a. Anti – K antibodies cause more haemolysis than anti – D antibodies
b. Maternal red cells leaking into fetal circulation triggers the disease
c. Antibodies generated in the fetus following entry of maternal red cells into the fetus cause
the pathology
d. Antibodies against antigens in almost all the blood group systems have been responsible for
HDFN
3. Which one of these is not a potentially sensitizing event for occurrence of Rh HDFN
a. Amniocentesis
b. Prior blood transfusion
c. Previous miscarriage
d. Use of Anti – D immunoglobulin (RhoGAM)
4. In the pathophysiology of HDFN
a. Maternal IgM antibody is transported across the placenta into fetal circulation where it
binds to the corresponding fetal red cell antigens
b. Maternal antibody coated cells are destroyed by macrophages in fetal spleen
c. Hydrops fetalis can lead to fetal death if not treated
d. Fetal bone marrow does not respond to the destruction of fetal red cells by maternal
antibodies
5. Which one of these factors does not affect the rate of haemolysis in HDFN
a. IgG subclass
b. Amount of IgG transported across the placenta
c. The amount of IgM produced in the maternal circulation
d. the number of antigenic sites on fetal red blood cells
6. Concerning blood selection for intrauterine fetal transfusion, all are correct except
a. It is best that donor blood should be more than 5-day old
b. It has to be CMV negative
c. Hemoglobin S negative to prevent sickling under low O2 tension
d. A haematocrit of 80% or greater is desirable to minimize the chance of volume overload in
the fetus
7. About ABO HDFN, the most appropriate option is
a. Usually restricted to group O mothers possessing IgG Anti-A, B
b. First baby usually affected
 c. In A and B subjects, the anti-B and anti-A are predominantly IgM and do not enter the fetal
circulation
d. All options are correct
8. Which of the following is not a true statement
a. The overall incidence of ABO HDN requiring treatment is extremely low so exchange
transfusion is not usually required
b. Fetal haemoglobin resists elution from red cells under acid conditions, whereas adult Hb is
eluted
c. In HDFN, resulting decrease in liver production of albumin leads to reduced plasma colloid
osmotic pressure, generalized oedema, ascites and effusions
d. The Kleihauer-Betke acid elution test is a test which counts the number of maternal cells in
the maternal circulation
9. Which of the following options is not a treatment option in the management of severe HDFN
a. Intrauterine transfusion
b. Termination of pregnancy
c. Continuation of pregnancy to term without intrauterine transfusion when Liley’s chart is in
zone III
d. Exchange transfusion
10. In the division of white cells, phagocytes include all of the following except
a. Basophils
b. Monocytes
c. Lymphocytes
d. Neutrophils
11. Which of the following statements is false concerning granulopioesis
a. Granulopoiesis is a well-orchestrated programme of differentiation and maturation
b. Drivers of the programme are the transcription factors, cytokines and growth factors,
vitamins & minerals etc
c. Granulopoiesis is a committed process in the generation of erythrocytes
d. Transcription factors which regulate granulopioesis could play role in other lineage
commitment processes
12. Which of the following is the earliest morphologically recognizable granulocytes precursor when
using the light microscope
a. Haemopoietic stem cell
b. CFU – GEMM
c. Myeloblast
d. Myelocyte
13. Concerning the granulocyte precursors
a. The myeloblasts is the largest cell in the series
b. The promyelocytes lack nucleoli
c. Cell division ceases at the metamyelocyte stage
d. The myeloblast has clumped and dense nuclear chromatin
14. Concerning G – CSF receptor and signaling
 a. The G – CSF receptor is a transmembrane protein
b. Ligand binding to the extracellular parts causes phosphorylation of the extracellular parts of
the receptor
c. Ligation of the extracellular domain causes phosphorylation of the ligand
d. The G –CSF receptor is an intra-nuclear receptor
15. Which of the following is not an indication for use of G – CSF therapy
a. Chemotherapy induced neutropaenia
b. Mobilization of stem cells for harvesting
c. Use in the treatment of iron deficiency anaemia
d. Neutropaenia from marrow failure
16. Concerning bone marrow failure syndromes
a. Involves one cell line
b. Involves two cell lines
c. Could involve one or more cell lines
d. Marrow failure is established only when all three cell lines are affected
17. Concerning bone marrow failure
a. May be seen in the setting of hypoplastic marrow
b. May be seen in the setting of proliferative marrow condition
c. Defined as peripheral cytopaenia(s) in the setting of deficient marrow function
d. All options represent the concept of marrow failure
18. Which one of the following is not a cause of congenital bone marrow failure
a. Thrombocytopaenia with absent radii
b. Fanconi anaemia
c. HIV
d. Diamond-Blackfan anaemia
19. In defining aplastic anaemia, which of the following combinations of criteria is correct
a. Hb < 100g/l, ANC > 1.5 x 109/l, platelet count < 50 x 109/l
b. Hb > 100g/l, ANC < 1.5 x 109/l, platelet count > 50 x 109/l
c. Hb < 10g/dl, ANC < 1.5 x 109/l, platelet count < 50 x 109/l
d. Options A and C are correct
20. Which of the following statements is correct of the pathogenesis of aplastic anaemia
a. Clonal expansion of cytotoxic T cells
b. Destruction of haemopoietic stem cells and progenitors
c. Increased susceptibility of haemopoietic stem cells to apoptosis
d. All of the options are correct
21. In the classification of aplastic anaemia, which one of the following parameters is consistent
with the criteria that defines severe AA
a. Marrow cellularity > 25% with ANC < 0.5 x 109/l
b. Marrow cellularity of < 25% with reticulocytes count of <60 x 109/l
c. Marrow cellularity 25% - 50% with < 30% residual haemopoietic cells and ANC = 1.5 x 10 9/l
d. Marrow cellularity >75% with ANC < 0.2 x 109/l
22. Concerning Paroxysmal Nocturnal Haemoglobinuria, PNH
 a. It is due to an inherited defect in phosphatidyl inositol glycan protein class A, PIGA gene
b. It is due to an acquired defect in the PIGA gene
c. The PNH clones in the marrow have an increased susceptibility to apoptosis
d. There is presence of CD55 and CD59 in the cells in the peripheral bood
23. All of the statements are not true except
a. The PIGA gene is located on the X chromosome
b. The PIGA gene is on chromosome 22
c. The PIGA gene is on chromosome 11
d. The PIGA gene is found the short arm of chromosome 9
24. The following are correct of the pathophysiology of PNH except
a. Reduced susceptibility to complement-mediated lysis
b. Nitric oxide scavenging with reduced nitric oxide in the circulation
c. Disrupted fibrinolytic and tissue factor pathway inhibitor mechanisms
d. Chronic haemolysis with release of haemoglobin
25. About the lymph nodes
a. They are large, bean-shaped organs
b. They play role in the acquired immunity processes in the body
c. They are usually palpable in healthy, steady-state conditions
d. Para-hilar nodes are never involved in pathologies
26. About the structure of the lymph nodes
a. Divided into an outer medulla and an inner cortex
b. The medulla has more secondary follicles than the cortex
c. The paracortex has more T lymphocytes than B cells
d. More lymphocytes enter the lymph nodes via the afferent lymphatics than via the high
endothelial venules
27. Which statement is correct concerning lymph nodes
a. B cell ontogeny occurs in the lymph nodes
b. T cell ontogeny occurs in the lymph nodes
c. Ontogeny and activation are same entity
d. Activation of B and T cells occurs more in the lymph nodes and lymphoid tissues
28. Concerning the structure of the lymph nodes, which of the following is true
a. The primary follicle shows T cells proliferation
b. The mantle zone represents the outer darker rim of the secondary follicle
c. The primary follicles are sites of B cell proliferation
d. The secondary follicles show T cells proliferation
29. False comment concerning von Willebrand factor
a. vWF coded for by gene on chromosome 12p13
b. Post-translation protein requires cleaving by vit K to be effective
c. It is the commonest of the inherited bleeding disorders worldwide
d. The form produced in endothelial cells makes up the most quantity in circulation
30. Concerning the biology of vWF
a. There is constitutive release and release following stimulation
 b. Binds to FVIII in circulation and enhances its proteolytic digestion
c. Binds to sub-endothelial matrix proteins and collagen thereby preventing the formation of
the primary plug
d. It is the commonest of the coagulation factors
31. Which of the following is not a likely manifestation of von Willebrand disease
a. Bruising
b. Epistaxis
c. Tendency to thrombosis
d. Prolonged menstrual flow
32. Concerning the classification of von Willebrand disease
a. Type 3 VWD presents the most severe disease
b. Type 1 VWD is further divided into A, B, M, N
c. Type 2 disease is a quantitative disorder
d. All options are correct
33. Concerning the biology of vWF, all of the following statements are false except
a. The form produced in the megarkaryocytes make up the most abundant component in the
circulation
b. Desmopressin acts by releasing previously stored vWF
c. The role of desmopressin in the treatment of VWD is in the stimulation of production of
vWF
d. vWF plays role in the intrinsic tenase enzyme complex in the cell based model of coagulation
34. About Haemophilia A
a. Haemophilia A is more common than von Willebrand disease
b. Accounts for 1 in 10,000 live births
c. Flip tip inversion presents a milder disease manifestation
d. Commoner in the female population
35. In the pathogenesis of Haemophilia A
a. Always a genetic disorder involving mutations in the X chromosome
b. It could be acquired spontaneously
c. It may be due to point mutations in the FVIII gene on the Y chromosome
d. It is rare in our part of the world
36. In the biology of FVIII
a. It is a vit K dependent coagulation factor
b. Has a B domain which is duplicated and is cleaved off following activation
c. Has a C domain which is triplicated
d. Has a triplicated A domain
37. Which of the following is a less likely manifestation in Haemophilia
a. Petechia and ecchymosis
b. Haemophilic pseudotumour and swelling
c. Haemarthrosis with attendant pains and limbs deformity
d. Haematuria
38. Which of the following is not a possible complication of recombinant-factor treatment naïve
Haemophilia patients
a. Limb deformity
b. Development of inhibitors to recombinant factor FVIII and FIX
c. Haemophilic pseudotumour
d. Intracranial haemorrhage
39. In the biology of FVIII protein
a. The B domain connects A1 to A2
b. The B domain connects A2 to A3
c. The B domain connect A2 to C1
d. The B domain is added to the final protein following thrombin activation of the FVIII protein
40. All of the following categories of female patients could manifest bleeding due to low levels of
FVIII except
a. Patients with VWD type 2B disease
b. Extreme lyonization of the normal FVIII, FIX gene in carriers of the disease
c. Hemizygousity of the X chromosome such as is seen in Turner syndrome
d. Acquired haemophilia
41. Concerning G6PD Deficiency
a. Divided into four (4) classes by the WHO
b. Class I presents the most severe disease
c. Class IV presents the most severe disease
d. It is a rare disease in Africa
42. In the pathogenesis of G6PD Deficiency, which of the following statements are correct
a. African variant is G6PD A
b. Inheritance of G6PD is X-linked
c. G6PD enzyme is expressed in all cells of the body
d. All options are correct
43. In G6PD Deficiency, the reducing power used for reduction and detoxification of toxins
produced by infections and other oxidant stressors is provided by
a. ATP
b. NADH
c. NADPH
d. Pyruvate kinase
44. Which is not correct concerning G6PD Deficiency pathophysiology
a. Favism is a possibility
b. Does not cause bossing of the facial bones in young children
c. Could cause a chronic non-spherocytic haemolytic anaemia
d. Jaundice is mostly extravascular but there is some intravascular component
45. Which of the following sickle cell disease haplotypes presents the most severe phenotype
a. Bantu
b. Senegal
c. Sudan
 d. Arab – Indian
46. Concerning blood haemostasis, all are true except
a. In vivo, the coagulation mechanism is also initiated by the contact system
b. The first barrier to blood coagulation is the anatomical separation of cells expressing
functional tissue factor from other coagulation components in the circulation
c. The endothelial cells play predominantly an anticoagulation role
d. The endothelial cells play a minor procoagulant role in haemostasis

47. Which one of these statements is correct

a. The intrinsic tenase enzyme complex plays role in the cascade model of coagulation
b. The TFPI is expressed on the surface of endothelial cells and it could be released from
activated platelets
c. The extrinsic tenase enzyme complex is described in the waterfall model of coagulation
d. The cascade model is deficient with regards to explaining the principles of clotting profile
tests
48. Which statement concerning tissue factor pathway inhibitor, TFPI is true
a. It rapidly inactivates the extrinsic tenase enzyme complex
b. It rapidly inactivates the intrinsic tenase enzyme complex
c. It is a potent procoagulation molecule
d. Only options A and C are correct
49. The anticoagulation effect of antithrombin is provided by all of the following mechanisms except
a. It activates vWF by cleaving the D1 fragment
b. Binds to and forms inactive complex with FXa
c. Binds and forms inactive complex with FXIa
d. Damps down the effect of thrombin
50. Concerning red cell indices, which is correct option
a. MCH is a measure of the average Hb mass in grams of the red cells in the blood
b. MCH is a measure of the average concentration of Hb in RBCs in blood
c. MCH is measured in femtolitres
d. MCH is not one of the red cell indices
51. Concerning MCV, correct option is
a. It is a measure of the average Hb mass in grams of the red cells
b. The unit of measurement is femtolitres
c. It is a measure of the average concentration of Hb in red cells
d. It is not used in the classification of anaemia
52. Concerning MCHC, all are true except
a. It measures the average concentration of Hb in the red cells
b. The unit of measurement is g/dl
c. It is a measure of the average size of red cells in the blood
d. The unit of measurement is grams
53. Which one of the following is not a cause of failure to respond to oral iron medication
a. Another cause for the anaemia
 b. Poor drug compliance
c. Malabsorption
d. Poor dietary oral iron intake
54. In B lymphocyte ontogeny
a. There is exposure of developing immature lymphocyte to foreign antigens
b. Negative selection occurs in the medulla
c. Positive selection occurs in the cortex
d. It leads to the production of mature naïve cells
55. Concerning B cell lymphopoiesis
a. The P55 protein is expressed on the surface of immature cells
b. The surrogate light chain is first expressed after rearrangement of the heavy chain gene
locus
c. Pre –BCR is a composite of heavy chain and surrogate light chain
d. Checkpoint 1 prevents against autoimmunity
56. In B cell ontogeny, the following are true except
a. The heavy chain gene locus is rearranged before that of the light chain locus
b. Checkpoint 1 serves to select cells which react with appropriate strength
c. The first receptor to be expressed is the composite of rearranged heavy and light chain loci
genes
d. B cell ontogeny is the process of development and maturation of naïve B cells
57. Concerning T cell ontogeny
a. The thymocytes are early T cell precursors in the bone marrow
b. Some of the thymocytes show expression of CD44 and CD25
c. The earliest recognizable thymocytes are positive for CD4 and CD8
d. The T cells also undergo rearrangement of the heavy and light chain genes
58. Concerning the development of T cells
a. The process of beta selection occurs at the DN3 stage
b. The DN3 stage thymocytes show positivity for CD4
c. The DN2 stage thymocytes are positive for CD8
d. Beta selection occurring at the DN3 stage sees the rearrangement of the alpha chain gene
locus
59. All of these processes occur at the DN3 stage of T cell ontogenesis except
a. Formation of pre-Tα receptor
b. The DN3 cells are the ones which circulate and mount immune response in the periphery
and secondary lymphoid organs
c. Beta selection
d. Cells which fail beta selection are killed via apoptosis
60. Concerning plasma cells and plasma cell development
a. They are terminally differentiated T lymphocytes
b. They home to the bone marrow
c. They could arise from DN3 thymocytes
d. They are commonly seen in the peripheral circulation
61. About plasma cells and their development, the following are true except
a. Produce immunoglobulins
b. They could arise from post-germinal centre B cells
c. Only plasma cells produce immunoglobulins in the body
d. Development begins in the lymph nodes
62. Which of the following is not a subset of the B lymphocytes
a. Marginal zone B cells
b. Cytotoxic B cells
c. Follicular B cells
d. B1 cells
63. Which one of these is true?
a. Largest quantity of body iron is found in the muscles
b. Largest iron pool is seen in ferritin and haemosiderin
c. Largest pool of iron is collected in haemoglobin
d. Transferrin bound iron makes up the largest pool of body iron
64. In the control of hepcidin expression
a. Diferric transferrin competes with HFE for binding to TfR1
b. HFE and TfR1 binding promotes hepcidin synthesis
c. HJV and HFE binding suppresses hepcidin production
d. Diferric transferrin and TfR2 competes for binding to BMP
65. Which of the following is true in ferronomics
a. Ferroportin plays role in iron absorption from GIT
b. DMT1 plays role in release of iron into plasma
c. Ferroportin is located on the apical membrane of enterocytes
d. IRP/IRE interactions control ferroportin levels
66. The following statements are true except?
a. Mutations in matriptase 2 gene could cause excess hepcidin production
b. Oral iron treatment is ineffective in iron refractory iron deficiency anaemia
c. Mutations in DMT1 gene have not been implicated in aetiology of IRIDA
d. Circulating HJV antagonizes the activation of BMP with resultant reduced hepcidin
production
67. Concerning treatment of iron deficiency
a. Ferrous sulphate contains 57mg iron in 200mg tablets
b. Ferrous sulphate is best given on empty stomach
c. Doses of ferrous sulphate should ideally be taken after every 12 hours
d. Ferrous gluconate contains 37mg iron in 200mg tablets
68. All of the following statements are true except
a. TIBC is decreased and percentage saturation of iron is increased in iron deficiency
anaemia
b. Percentage saturation of iron and serum iron are decreased in iron deficiency
c. Concentration of ferritin found in circulation is related to reticuloendothelial stores
d. Ferritin is an indicator of inflammation
69. In iron metabolism
a. Caeruloplasmin plays role in iron absorption from GIT
 b. Hephaestin plays role in iron recycled by macrophages
c. Hephaestin is a ferrioxidase
d. Hephaestin is found on apical surface of enterocytes
70. Which is true concerning transferrin
a. Each molecule can contain 2 atoms of Fe3+
b. Delivers iron to mature erythrocytes
c. A large proportion of plasma transferrin iron comes from diet
d. Regulated via hepcin production