[MCQs] Hemolytic Anemias and Anemia Due to Acute Blood Loss - Part 1

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Hemolytic Anemias and Anemia Due to Acute Blood Loss- Part 1

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Question 1

The main cytoskeletal protein is ?

A	Band 3
B	Band 4.1
C	Glycophorin
D	Spectrin

Question 1 Explanation:

RBC cell membrane (7 nm thick) is a lipid bilayer. Most abundant of the membrane proteins are glycophorins & band 3 (anion transporter). Main cytoskeletal protein is spectrin. Membrane is physically linked to cytoskeleton by proteins (ankyrin & band 4.1 / band 4.2). Spectrin, actin with Bands 4.1 & 4.2 together form a fibrillar, weblike network on inner surface of RBC membrane.

Question 2

Which is the largest component of RBC cell membrane ?

A	Protein
B	Lipid
C	Carbohydrate
D	Others

Question 2 Explanation:

RBC cell membrane contain ~52% protein, 40% lipid & 8% carbohydrate by weight

Question 3

Enzyme required for the production & utilization of ATP in RBC cell membrane is ?

A	Aldolase
B	Glyceraldehyde-3 phosphate dehydrogenase (G-3PD)
C	Phosphoglycerate kinase
D	All of the above

Question 3 Explanation:

A three-enzyme sequence concerned with ATP production is membrane bound - aldolase, glyceraldehyde-3 phosphate dehydrogenase (G-3PD) & phosphoglycerate kinase. Together, they convert fructose diphosphate to 3-phosphoglycerate with production of ATP

Question 4

Phospholipid of RBC membrane is ?

A	Phosphatidylcholine (lecithin)
B	Phosphatidylethanolamine
C	Sphingomyelin
D	All of the above

Question 4 Explanation:

Most of phospholipid of RBC membrane is phosphatidylcholine (lecithin), phosphatidylethanolamine, sphingomyelin & phosphatidylserine. Lecithin & sphingomyelin can substitute each other

Question 5

Which of the following gene mutation accounts for majority of autosomal dominant hereditary spherocytosis (HS) ?

A	ANK1
B	SPTA1
C	SLC4A1
D	EPB41

Question 5 Explanation:

Mutations in ANK1 gene on chromosome 8p11.2 producing ankyrin protein accounts for majority of autosomal dominant hereditary spherocytosis (HS).

Question 6

Mutation in which of the following gene is not a cause of hereditary spherocytosis ?

A	ANK1
B	SPTA1
C	SLC4A1
D	EPB42

Question 6 Explanation:

Mutations of SPTA1 gene account for ~65% of Hereditary elliptocytosis (HE)

Question 7

Which of the following is false about hereditary spherocytosis ?

A	Increased ratio of RBC surface area to volume
B	Splenomegaly is very common
C	Mean corpuscular volume usually normal
D	Mean corpuscular hemoglobin concentration increased

Question 7 Explanation:

Anemia in HS is normocytic. Increase in MCHC is a characteristic feature. HS is the only condition in which high MCHC is seen

Question 8

Which of the following is false about hereditary spherocytosis ?

A	Due to defect in ankyrin / protein 3 / spectrin / palladin
B	Pigmented gallstones are common
C	RBC survival after splenectomy is normal
D	None of the above

Question 8 Explanation:

Main clinical findings of HS are jaundice, an enlarged spleen, and gallstones. Splenectomy is regarded as an obligatory therapeutic measure in HS.

Question 9

Spherocytes are seen in ?

A	Cirrhosis liver
B	Clostridial infections
C	Snake envenomations
D	All of the above

Question 10

Pink test is a modified version of which of the following ?

A	RBC absolute values
B	Red cell survival study
C	Osmotic fragility test
D	Schilling test

Question 10 Explanation:

A modified version of osmotic fragility test is called the “pink test”

Question 11

Which of the following is false about pyruvate kinase deficiency ?

A	High reticulocytosis
B	Oxygen delivery to tissues is increased
C	Oral folic acid should be given constantly
D	None of the above

Question 11 Explanation:

Metabolic block at the last step in glycolysis increase bisphosphoglycerate (or DPG), a major effector of hemoglobin-oxygen dissociation curve. Thus, oxygen delivery to tissues is increased

Question 12

Which of the following protects RBC’s against oxidant stress ?

A	Glutathione
B	Glucose-6-phosphate dehydrogenase (G6PD)
C	Pyruvate
D	Erythropoietin (EPO)

Question 12 Explanation:

G6PD protects RBC’s proteins from oxidative damage by generating NADPH, which maintains high levels of reduced glutathione. Glutathione protects RBC’s against oxidant stress

Question 13

Glucose-6-phosphate dehydrogenase (G6PD) is related to which of the following pathways ?

A	Embden-Meyerhof pathway
B	Hexose monophosphate shunt
C	Purine salvage pathway
D	All of the above

Question 13 Explanation:

G6PD is a HMP shunt enzyme

Question 14

Which of the following reactions is releted to G6PD ?

A	ATP to ADP
B	ADP to ATP
C	NADP to NADPH
D	NADPH to NADP

Question 14 Explanation:

G6PD reduces NADP to NADPH while oxidizing glucose-6-phosphate (G6P) to 6-phosphogluconate (6PG). NADPH then provides the reducing power that converts oxidized glutathione (GSSG) to reduced glutathione (GSH). Reduced glutathione protects against oxidant injury by catalyzing breakdown of oxidant compounds like H2O2.

Question 15

Which of the following protects the patient from malaria ?

A	G6PD Deficiency
B	Hemoglobin S
C	Hereditary ovalocytosis
D	All of the above

Question 16

The G6PD gene is located on ?

A	X chromosome
B	Y chromosome
C	Autosome
D	Any of the above

Question 16 Explanation:

Gene for G6PD is located on X chromosome. Mode of transmission of G6PD deficiency is Xlinked recessive. It is the most common enzymatic disorder of RBC’s in humans. Defect is expressed in all erythrocytes of the affected male. In heterozygous female, two populations of red cells, some deficient, others normal, are present owing to random inactivation of the X chromosomes. It follows that males are more vulnerable to oxidant injury than females are

Question 17

The normal G6PD is designated as ?

A	Type A (+
B	Type A (-)
C	Type B
D	Any of the above

Question 17 Explanation:

Most common normal “wild type” G6PD enzyme is designated as G6PD-B. Two variants, designated G6PD A- ((10 - 60% of activity) and G6PD Mediterranean (<10% of normal activity), lead to clinically significant hemolysis. A- type is present in ~10% of American blacks, G6PD Mediterranean is found in Middle East, G6PD Vianchan & G6PD Mahidol in Southeast Asia, G6PD Canton in China, and G6PD Union worldwide.

Question 18

Which of the following ‘vitamins’ can cause hemolysis in G6PD deficient subjects?

A	Vitamin A
B	Vitamin D
C	Vitamin E
D	Vitamin K

Question 18 Explanation:

Vitamins that G6PD deficient persons should avoid include vitamin C & K. Vitamin E is protective.

Question 19

Which of the following ‘antimalarials’ can cause hemolysis in G6PD deficient subjects ?

A	Chloroquine
B	Quinine
C	Primaquine
D	Mefloquine

Question 19 Explanation:

Deficiency of G6PD protects against malaria due to Plasmodium falciparum

Question 20

Which of the following can precipitate an episode of hemolysis in G6PD deficient subjects ?

A	Viral & bacterial infections
B	Naphthalene
C	Metabolic acidosis
D	All of the above

Question 21

Which population of RBC is rapidly destroyed during hemolysis in G6PD deficient subjects ?

A	Immature
B	Mature
C	Older
D	All of the above

Question 21 Explanation:

G6PD enzyme activity is normal in reticulocytes, but older RBC’s are markedly deficient. Exposure to oxidants induces hemolysis of older red cells but not of younger ones.

Question 22

Which of the following is a peripheral blood finding of hemolysis in G6PD deficiency ?

A	Heinz bodies
B	Bite cells or blister cells
C	Spherocytes
D	All of the above

Question 22 Explanation:

Hemolysis in G6PD deficiency is both intravascular & extravascular. Exposure to oxidants causes oxidation of sulfhydryl groups of globin chains leading to denaturation of hemoglobin & formation of precipitates (Heinz bodies) which damage RBC membrane to cause intravascular hemolysis. Heinz bodies decrease RBC deformability, macrophages pluck out or bite Heinz bodies, giving rise to “bite cells”. Membrane damage induces formation of spherocytes. Bizarre poikilocytes with RBC’s having unevenly distributed hemoglobin are called hemighosts

Question 23

The enzymatically active form of G6PD is a ?

A	Monomer
B	Dimer
C	Trimer
D	All of the above

Question 23 Explanation:

Enzymatically active form of G6PD is either a dimer or a tetramer of a single protein subunit of 514 amino acids

Question 24

Which of the following is false about acute hemolytic anemia due to G6PD deficiency ?

A	Hemoglobinemia
B	Hemoglobinuria
C	Raised plasma haptoglobin
D	Raised LDH

Question 24 Explanation:

Acute hemolytic anemia due to G6PD deficiency leads to anisocytosis, poikilocytosis, polychromasia, spherocytes, reticulocytosis, unconjugated hyperbilirubinemia, hemoglobinemia, hemoglobinuria, low or absent plasma haptoglobin, raised LDH, gallstones, splenomegaly.

Question 25

Which of the following is false about CNSHA ?

A	Patient is always a male
B	History of neonatal jaundice (NNJ)
C	Chronic hemolysis
D	None of the above

Question 25 Explanation:

Chronic nonspherocytic hemolytic anemia (CNSHA) is a severe clinical phenotype of G6PD deficiency, always in a male, with history of NNJ

Question 26

Which of the following element is essential for the activity of glutathione peroxidase (GSHPx) ?

A	Cobalt
B	Zinc
C	Mercury
D	Selenium

Question 26 Explanation:

Infantile poikilocytosis is due to deficiency of glutathione peroxidase (GSHPx) due to nutritional deficiency of selenium which is an essential element for the activity of GSHPx

Question 27

Basophilic stippling is a highly distinctive feature of ?

A	Autoimmune Hemolytic Anemia (AIHA)
B	Familial Hemolytic Uremic Syndrome (HUS)
C	Pyrimidine 5'-Nucleotidase (P5N) Deficiency
D	All of the above

Question 27 Explanation:

P5N is a key enzyme in catabolism of nucleotides arising from degradation of nucleic acids that takes place in final stages of RBC maturation. Basophilic stippling is highly distinctive feature of P5N deficiency. HA caused by lead poisoning is also characterized by basophilic stippling.

Question 28

Drug that can cause hemolysis by depletion of ATP is ?

A	Dapsone
B	Ribavirin
C	Cisplatin
D	Methyldopa

Question 28 Explanation:

Ribavirin causes hemolysis by depletion of ATP. Hyperbaric oxygen, nitrates, chlorates, methylene blue, dapsone, cisplatin cause hemolysis by their oxidative potential. Penicillin acts as a hapten & induces antibody production leading to hemolysis. Methyldopa, through mimicry, produces of an antibody (Rhesus antibody anti-e) against RBC antigen causing hemolysis

Question 29

Which of the following about HUS due to Shiga toxin producing Escherichia coli O157:H7 is false ?

A	Nonimmune [Coombs test (–)] hemolytic anemia
B	Microangiopathic hemolytic anemia
C	Microangiopathic hemolytic anemia
D	Leucopenia

Question 29 Explanation:

Shiga toxin producing Escherichia coli O157:H7 is an etiologic agent of HUS, more common in children, developing several days after diarrhea. HUS is a nonimmune [Coombs test (–)] hemolytic anemia with classical triad - microangiopathic hemolytic anemia, thrombocytopenia & acute renal failure due to thrombosis of glomerular capillaries. Leucocytosis can cause in HUS.

Question 30

Direct Coombs test is also called ?

A	Direct antiglobulin test
B	Direct agglutination test
C	Direct antigen test
D	Direct antibody test

Question 30 Explanation:

Direct Coombs test is also called Direct antiglobulin test (DA

Question 31

Which of the following is false about direct antiglobulin test (DAT) ?

A	Reflects in-vivo antibody sensitization of RBC’s
B	Reflects in-vitro antibody sensitization of RBC’s
C	Erythrocytes are washed before the test
D	Anti-IgG antihuman globulin (AHG) reagent is used

Question 31 Explanation:

Anti-IgG antihuman globulin (AHG) reagent is used

Question 32

Which of the following is false about indirect antiglobulin test (IAT) ?

A	Used to detect IgG antibodies in serum
B	Reflects in-vitro antibody sensitization of RBC’s
C	Reagent RBC’s are incubated in with serum
D	nti-IgG antihuman globulin reagent is not used

Question 32 Explanation:

Indirect antiglobulin test (IAT) is used to detect the presence of IgG antibodies in serum (in-vitro sensitization). Reagent RBC’s are incubated with serum that potentially contains antibodies. If Ab’s are present, they bind to their target antigens on reagent RBC’s. After an incubation period, RBC’s are washed to remove unbound antibodies. Anti-IgG AHG reagent is then added and will cause IgG-coated RBC’s to agglutinate.

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See all quizzes of the Megaloblastic Anemias at here:

Hemolytic Anemias and Anemia Due to Acute Blood Loss – Part 1 | Hemolytic Anemias and Anemia Due to Acute Blood Loss – Part 2

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1.The main cytoskeletal protein is ?
A. Band 3
B. Band 4.1
C. Glycophorin
D. Spectrin

2. Which is the largest component of RBC cell membrane ?
A. Protein
B. Lipid
C. Carbohydrate
D. Others

3. Enzyme required for the production & utilization of ATP in RBC cell membrane is ?
A. Aldolase
B. Glyceraldehyde-3 phosphate dehydrogenase (G-3PD)
C. Phosphoglycerate kinase
D. All of the above

4. Phospholipid of RBC membrane is ?
A. Phosphatidylcholine (lecithin)
B. Phosphatidylethanolamine
C. Sphingomyelin
D. All of the above

5. Which of the following gene mutation accounts for majority of autosomal dominant hereditary spherocytosis (HS) ?
A. ANK1
B. SPTA1
C. SLC4A1
D. EPB41

6. Mutation in which of the following gene is not a cause of hereditary spherocytosis ?
A. ANK1
B. SPTA1
C. SLC4A1
D. EPB42

7. Which of the following is false about hereditary spherocytosis ?
A. Increased ratio of RBC surface area to volume
B. Splenomegaly is very common
C. Mean corpuscular volume usually normal
D. Mean corpuscular hemoglobin concentration increased

8. Which of the following is false about hereditary spherocytosis ?
A. Due to defect in ankyrin / protein 3 / spectrin / palladin
B. Pigmented gallstones are common
C. RBC survival after splenectomy is normal
D. None of the above

9. Spherocytes are seen in ?
A. Cirrhosis liver
B. Clostridial infections
C. Snake envenomations
D. All of the above
10. Pink test is a modified version of which of the following ?
A. RBC absolute values
B. Red cell survival study
C. Osmotic fragility test
D. Schilling test

11. Which of the following is false about pyruvate kinase deficiency ?
A. High reticulocytosis
B. Oxygen delivery to tissues is increased
C. Oral folic acid should be given constantly
D. None of the above

12. Which of the following protects RBC’s against oxidant stress ?
A. Glutathione
B. Glucose-6-phosphate dehydrogenase (G6PD)
C. Pyruvate
D. Erythropoietin (EPO)

13. Glucose-6-phosphate dehydrogenase (G6PD) is related to which of the following pathways ?
A. Embden-Meyerhof pathway
B. Hexose monophosphate shunt
C. Purine salvage pathway
D. All of the above

14. Which of the following reactions is releted to G6PD ?
A. ATP to ADP
B. ADP to ATP
C. NADP to NADPH
D. NADPH to NADP

15. Which of the following protects the patient from malaria ?
A. G6PD Deficiency

B. Hemoglobin S
C. Hereditary ovalocytosis
D. All of the above

16. The G6PD gene is located on ?
A. X chromosome
B. Y chromosome
C. Autosome
D. Any of the above

17. The normal G6PD is designated as ?
A. Type A (+)
B. Type A (-)
C. Type B
D. Any of the above

18. Which of the following ‘vitamins’ can cause hemolysis in G6PD deficient subjects ?
A. Vitamin A
B. Vitamin D
C. Vitamin E
D. Vitamin K

19. Which of the following ‘antimalarials’ can cause hemolysis in G6PD deficient subjects ?
A. Chloroquine
B. Quinine
C. Primaquine
D. Mefloquine

20. Which of the following can precipitate an episode of hemolysis in G6PD deficient subjects ?
A. Viral & bacterial infections
B. Naphthalene
C. Metabolic acidosis
D. All of the above

21. Which population of RBC is rapidly destroyed during hemolysis in G6PD deficient subjects ?
A. Immature

B. Mature
C. Older
D. All of the above

22. Which of the following is a peripheral blood finding of hemolysis in G6PD deficiency ?
A. Heinz bodies
B. Bite cells or blister cells
C. Spherocytes
D. All of the above

23. The enzymatically active form of G6PD is a ?
A. Monomer
B. Dimer
C. Trimer
D. All of the above

24. Which of the following is false about acute hemolytic anemia due to G6PD deficiency ?
A. Hemoglobinemia
B. Hemoglobinuria
C. Raised plasma haptoglobin
D. Raised LDH

25. Which of the following is false about CNSHA ?
A. Patient is always a male
B. History of neonatal jaundice (NNJ)
C. Chronic hemolysis
D. None of the above

26. Which of the following element is essential for the activity of glutathione peroxidase (GSHPx) ?
A. Cobalt
B. Zinc
C. Mercury
D. Selenium

27. Basophilic stippling is a highly distinctive feature of ?
A. Autoimmune Hemolytic Anemia (AIHA)
B. Familial Hemolytic Uremic Syndrome (HUS)
C. Pyrimidine 5′-Nucleotidase (P5N) Deficiency
D. All of the above

28. Drug that can cause hemolysis by depletion of ATP is ?
A. Dapsone
B. Ribavirin
C. Cisplatin
D. Methyldopa

29. Which of the following about HUS due to Shiga toxin producing Escherichia coli O157:H7 is false ?
A. Nonimmune [Coombs test (–)] hemolytic anemia
B. Microangiopathic hemolytic anemia
C. Thrombocytopenia
D. Leucopenia

30. Direct Coombs test is also called ?
A. Direct antiglobulin test
B. Direct agglutination test
C. Direct antigen test
D. Direct antibody test

31. Which of the following is false about direct antiglobulin test (DAT) ?
A. Reflects in-vivo antibody sensitization of RBC’s
B. Reflects in-vitro antibody sensitization of RBC’s
C. Erythrocytes are washed before the test
D. Anti-IgG antihuman globulin (AHG) reagent is used

32. Which of the following is false about indirect antiglobulin test (IAT) ?
A. Used to detect IgG antibodies in serum
B. Reflects in-vitro antibody sensitization of RBC’s
C. Reagent RBC’s are incubated in with serum

D. Anti-IgG antihuman globulin reagent is not used

[MCQs] Hemolytic Anemias and Anemia Due to Acute Blood Loss – Part 1

I. Start the exam by click the “Start” button

Hemolytic Anemias and Anemia Due to Acute Blood Loss- Part 1

See all quizzes of the Megaloblastic Anemias at here:

II. Preview all questions below

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