Hematopathology MCQs & Essays: MBChB Exam OmpathStudy

Haematology Past Paper: MCQs & Essay Answers (with Explanations) — MBChB Revision Guide Preparing for a haematology exam? This guide works through a full past-paper MCQ set plus two structured essay questions covering general haematology (haemolytic anaemia workup, PNH) and transfusion medicine (TTP management, plasma exchange). Each MCQ includes the correct answer and a short, high-yield explanation. Essay answers are in exam-ready point form. Useful for MBChB, BSc Nursing, and Medical Lab Science students revising haematology, clinical pathology, and transfusion medicine. --- MCQs 1–10 1. Which of the following is NOT associated with thrombotic thrombocytopenic purpura (TTP)? A. Thrombosis B. Thrombocytopenia C. Microangiopathic haemolytic anaemia D. Neurologic deficits E. Renal failure Answer: A — Thrombosis TTP's classic pentad: thrombocytopenia, MAHA, neurologic deficits, renal failure, fever. The pathology is microvascular platelet clumping (ADAMTS13 deficiency → unusually large vWF multimers), not large-vessel thrombosis. ★ ADAMTS13 deficiency is the key trigger. --- 2. Suspected acute viral haemorrhagic fever with a history of tick bite. Most likely causative agent? A. Hantavirus B. Rift Valley virus C. Crimean-Congo virus D. Marburg virus E. Ross River virus Answer: C — Crimean-Congo haemorrhagic fever virus The only tick-borne haemorrhagic fever virus on this list (Bunyaviridae). Hantavirus spreads via rodent excreta, Marburg via bats/primates, Rift Valley and Ross River via mosquitoes. --- 3. Which of the following is FALSE regarding heparin? A. Subcutaneous injection of heparin is avoided because of haematoma formation B. Heparin is usually stored in the mast cells C. Heparin binds to plasma antithrombin III and inhibits activated thrombin D. Protamine sulfate can be used to counteract heparin overdose E. Partial thromboplastin time is measured to monitor heparin use Answer: A — False SC heparin injection is actually a standard, safe route (e.g. prophylactic LMWH) — haematoma risk is minor and not why it's avoided; it isn't avoided. ★ Heparin: stored in mast cells, works via antithrombin III, monitored by aPTT, reversed by protamine sulfate. --- 4. Which of the following requires IL-2 and IL-4 in the conversion of a unilineage progenitor cell into a mature circulating cell? A. Neutrophil B. Eosinophil C. Basophil D. B lymphocyte E. T lymphocyte Answer: D — B lymphocyte IL-2 and IL-4 drive B-lymphocyte proliferation and differentiation. Neutrophils need G-CSF, eosinophils need IL-5, basophils need IL-3/IL-4 alone, T cells mainly need IL-2/IL-7. --- 5. MCV is 90 fL and reticulocyte production index is low. Most likely cause of anaemia? A. Thalassaemia B. Vitamin B12 deficiency C. Aplastic anaemia D. Sideroblastic anaemia E. Iron deficiency anaemia Answer: C — Aplastic anaemia Normal MCV (normocytic) + low retic production index = hypoproliferative marrow failure. Thalassaemia and iron deficiency are microcytic; B12 deficiency and sideroblastic anaemia are typically macrocytic. ★ Low RPI = bone marrow problem, not peripheral destruction. --- 6. Weakness of legs, arms, trunk, tingling, numbness, progressively worsening. Peripheral smear shows macrocytic anaemia. Which is NOT a cause? A. Chronic atrophic gastritis B. Ileal resection C. Tapeworm infestation D. Alcoholism E. Exposure to nitrous oxide Answer: C — Tapeworm infestation This is subacute combined degeneration from B12 deficiency. Atrophic gastritis and ileal resection impair B12 absorption; nitrous oxide inactivates B12; alcoholism causes folate deficiency. Tapeworm (Taenia) doesn't typically cause B12 deficiency — that's classically the fish tapeworm Diphyllobothrium latum , but generic "tapeworm" here is the odd one out per this question's intended answer. --- 7. Which is NOT a good prognostic factor in acute lymphoblastic leukaemia (ALL)? A. Immunophenotype – mature B cell B. Gender – female C. Chromosomal number – hyperploidy D. Age – 4 to 10 years old E. Expression of ZAP 70 Answer: A — Mature B-cell immunophenotype Mature B-cell (Burkitt-type) ALL is high-risk/poor prognosis. Good prognostic factors: female sex, hyperploidy, age 4–10, pre-B phenotype. ★ ZAP-70 expression is actually associated with CLL prognosis, not classically ALL — flagging this option is debatable, but mature B-cell ALL is the clear poor-prognosis answer. --- 8. Vitamin K deficiency — which coagulation factor is NOT affected? A. Factor II B. Factor VII C. Factor VIII D. Factor IX E. Factor X Answer: C — Factor VIII Vitamin K-dependent factors: II, VII, IX, X (plus proteins C and S). Factor VIII is not vitamin K-dependent — it's synthesized independently and is actually an acute-phase reactant. ★ Mnemonic: "1972" → 10, 9, 7, 2. --- 9. 30-year-old with fever and posterior cervical lymphadenopathy over 2 years. Most likely causative organism? A. Trypanosoma cruzi B. Trypanosoma brucei rhodesiense C. Trypanosoma brucei gambiense D. Leishmania donovani E. Onchocerca vo