1. 3 years old boy develops pallor (pallor) and recurrent epitaxis. there is no spleenomegaly and lympnode enlargement is noted.

laboratory finding were hemoglobin 3g/dl , hematocrit 14%. red blood cell 2,500,000/mm3, white blood cell 11,000/mm3 and platelet 180,000/mm3. the most likely diagnosis of this patient is : A. Hemolytic Anemia B. Aplastic Anemia c. Post hemorrhage anemia d. Iron diffeciency anemia 2. 4 years old child came to the clinic with mild fever, pale and jaundice. There's also splenomegaly. Most likely diagnosis: A. Post-hemorrhagic anemia B. Deficiency anemia C. Aplastic anemia D. Lukemia E. Hemolytic anemia 3. Most important investigation for diagnosis of this patient (CASE --> HEMOLYTIC ANEMIA): a) Bone marrow aspiration b) Splenic puncture c) Red blood cell indices d) Blood smear e) Transferin saturation ANS : D. A peripheral smear may demonstrate spherocytes, suggesting congenital spherocytosis or autoimmune hemolytic anemia (AIHA) 4. A 3 years old boy develops pale(pallor),purpura on the skin and recurrent epistaxis.There is no hepatosplenomegaly or lymhnode enlargement is noted.Laboratory findings were hemoglobin level is 3g/dl,hematocrite 9.3%,red blood cell count 1500,000/mm3,white blood cells count 1500,000mm3 and platelet count is 55,000mm3.The mostly diagnosis of the patient is: a)Hemolytic anemia b)Aplastic anemia c)Post hemorrhagic anemia d)Leukemia e)Iron deficiency anemia 5. the most important investigation for diagnosis of this patient a. bone marrow aspiration b. blood smear c. red blood indices d. splenic puncture e. hemoglobin analysis

6. A 4 y.o child with petchial rash but otherwise well and no physical finding. lab examination found platelet : 20,000/miroliter, hb & wbc 12,4 g/dl & 7,200/microliter. diagnosis: a. hemoch-scholein (if there is purplish purpura) b. DIC c. Acute lymphoblastic leukemia d. ITP e. purpura due to uremia 7. Which of the following laboratory abnormalities is most commonly found in this case? a. prolonged bleeding time b. prolonged prothrombin time c. elevated FDP d prolonged APTT e. prolonged clotting time 8. Appropriate treatment for this child includes a. aspirin therapy b. platelet transfusion c.intravenous gammaglobulin d. chemotherapy e. antithrombine 3 9. the most important investigation for diagnosis of this patient a. bone marrow aspiration b. blood smear c. red blood indices d. splenic puncture e. factor assay (bone marrow aspiration for thrombocytopenia, HiV test for high risk HIV infection) 10. A 5 year-old boy came to a policlinic with hematoma all over arms and legs since aged one year-old. His platelet count is 200,000/L, Hb and WBC count is 11.1 g/dl and 5,500/L respectively. There are no hepatosplenomegaly and enlargement of lymph nodes noted. The bleeding time is 2 minutes. What is the possible diagnosis of the boy? a) Disturbance of thrombocytes function b) Disturbance of synthesis of vWF c) Disturbance of vascular d) Disturbance of fibrinolytic system e) Disturbance of coagulation system 11. the most important investigation for the diagnosis A.bone marrow aspiration B.prothrombin time(PT) c. RBC indices D.blood smear E.blood culture

12. A 3 years 5 months old child present to clinic with fever, gum bleeding, malena and purpura. Body temperature was 40 degree celcius, blood culture positive for pathogen microorganisms. Bloos presseure was 90/70mmHg and peripheral blood count revealed Hb 7gr/dL, wbc 22000/microliter, and platelet 30000/microliter. APTT and PTT prolonged. Which is likely to explain bleeding manifestation of this child? a. thrombocytopenia and leucocytosis b.septic condition and hyperthermia c. coagulation disorder and thrombocytopenia d.thrombocytopenia and hyperthermia e. coagulation disorder and leucocytosis 13. The most likely diagnosis for this cases a. Henoch-scholein purpura b.DIC c. ITP d. Hemophilia e, ALL 14. The features which can be detected in the radiograph of ab acute laukemia patient are as follows, except for a. areas of bone osteolytic lesions b. radioluscent metaphyseak band c. areas of bone sclerosis are always persist d. diffuse bone mineralization e. periostal reaction are rarely found 16. Wwhich are the combination of parents blood types, that place an infant at high risk of hemolytic anemia? a. maternal RH negative , paternal RH negative, first child b. maternal RH negative , paternal RH positive, second child c. Maternal type blood O , paternal type O, first child d. maternal type blood AB, paternal type B, second child e. maternal RH positive, paternal RH negative , second child 17. hemorrhagic disease of newborn is a. hemolysis disorder b. coagulation disorder c. caused by ABO incompatibility d. bone marrow failure e. vitamin A deficiency 18. The most important investigation for diagnosis of this patient A. Bone marrow aspiration B. Blood smear c. red blood indices D. PT and PTT assay

E. Hemoglobin analysis 19. The first of choices for treatment this disease is giving of: a. whole blood transfusion b. RBC transfusion c. vitamin K d. coagulation factor e. vitamin E 20. 3 years old boy - bruising, comma, joint bleeding. His brother history bleeding circumcision. Lab exam? A. Hemoglobin and erythrocyte index B. Hemoglobin electrophoresis C. Bone marrow biopsy D. Platelet count, PT, APTT E. Serum iron, ferritin 21. In all blood components, which one delivers oxygen to tissue's cell: C. Red Blood Cell 22)Basic concept fo hematopoiesis is related to the condition below: A)apoptosis B)angiogenesis C)angiogenesis & angiotensin D)proliferation & angiotensin E)anti angiogenesis 23. In normal condition, hematopoiesis in feotus 4 months happen in: A. Yolk sac B. Liver, Spleen C. Bone Marrow ( all bones ) D. Bone Marrow Vertebra, sternum E. Lymph nodes 24. Non lineage specific growth factor act on pluripotent stem cell and multipotent stem cell to intiate self renewal and differentiation. Non lineage specific growth factor substance is: A EPO B MCSF C Thrombopoietin D GCSF E IL-3 25. The function of cytokine is to regulate production of eosinophils and activates mature eosinophils A. IL-2 B. IL-3 C. IL-4 D. IL-5 E. IL-6

26. last stage in maturation of RBC where proliferation still occur A. reticulocyte B. orthochromatophilic normoblast C. polychromatophilic normoblast D. basophilic normoblast E. pronormoblast 27. Patient A referred to lab for CBC test. after CBC test complete, the patient realise that the same test performed at the lab 5 hours before. In normal condition (patient and lab procedure) most significant change can occur on A. neutrophil count B. lympocyte count C. monocyte count D. platelet count E. basophil count (The cells that will shed away first are the neutrophils. this is because neutrophil has this following characteristics: 1. It has the shortest lifespan of all the blood cells of roughly 2-5 days in the plasma. 2. It is the most metabolically active cell, participating in phagocytosis in acute immune (innate) response, which itself consumes a lot of energy. Since blood left to stand for 5 hours, perhaps there will be some changes in the plasma composition; decreased energy substrate for the neutrophils. consequently more neutrophils die in the process.) just an opinion from my friend. 28) The responsible cell in the formation of platelet plug and a stable fibrin clot. a) Platelet b) RBC c)Monocyte d) neutrophil e)WBC 29) In general, primary hemostatic plug is a. prothrombin convert to thrombin b. formation of fibrin from fibrinogen by presence of thrombin c. adhesion of endothelial cells with platelets d. formation of peptide bonds e. activation of plasma from plasminogen 30. Dense granules of platelets contain high concentration of A. ADP B.PDGF C. Thrombospondin D. PF 4 E. Fibrinogen

31. the mediator for the attachment between subendothelial tissue and GP ib during adhesion process is a) fibrinogen b) vWF c) factor V d) fibrin e) factor VIII 32) Quick test for screening of coagulation system is a) PT b) TT c) Fibrin lysis test d) APTT e) FDP ( mungkin la.. x sure. sorry) 33.Which of these are anti-platelet drug? A. Aspirin B.VITAMIN K C.warfarin D.heparin E.tranexamic acid 34. The most frequent side effect of oral iron preparations: a. Nausea b. Headache c. Dizziness d. Diarrhea e. Articaria 36.hemostatics that increase membrane permeability: A.Carbazochrome B.Aspirin C.Octreotide D.Streptokinase E.Warfarin 37. Dose of FeSO4 for severe iron deficiency patient: A. 3x30 mg/day B. 3x300 mg/day C.3x10 mg/day D.3x100 mg/day E.1x300 mg/day

38. factor that increase orally iron absorbtion A. vit. C 39. Factors that increase oral iron absorbtion a. vit.c b. ca.carbonat c. fosfat d. Mg(OH)2 e. Al(OH)3 40. Hemostatic usually used for bleeding gastro-esophageal varices cirrhosis patient a. tranexamic acid b. phytonedione c. aprotinin d. octreotide 41. Anti-platelet that inhibits ADP receptor on the thrombocytes membrane is? ticlopidine and clopidogrel 42. A 40 -y.o. woman present with fatigue, weakness, a sore tongue and numbness and parethesis of her arms and legs. The complete blood count (CBC) reveals decrease numbers of erythrocytes, leukocytes and platelets (pancytopenia) along with an increase in the mean cell volume (MCV) of the erythrocytes. Examination of peripheral smear reveals numerous enlarged, oval-shaped erythrocytes (macroovalocytes) and many of the neutrophils have more than five lobes(hypersegmented neutrophils) additional workup discovers a...hydra and chronic atrophic gastritis. What is the most likely biochemical mechanism for the disease causing the patients symptoms or physical examination finding? a. Oxidative stress due to infection b. Iron deficiency due to chronic malnutrition c. Chronic bleeding due to long periods (hyperrhenorrhea) d. Impaired heme synthesis due to ................ALA synthesis(sori x clear la dr past year 2009) e. Impaired reaction methylmalonyl CoA -> succinyl CoA due to Vitamin B12 absorption disorders. 43. A blood cell that lacks a nucleus is which of the following? a. monocyte b. leucocyte c. lymphocyte d. reticulocyte e. thrombocyte 44. G6PD normally participates directly in which one of the following biochemical reactions ? a. glucose 6 phosphate + ATP ----> fructosa 1,6 diphospate b. glucose 6 phosphate + NADP ----> ribulosa 5 phosphate + NADPH + H c. glucose 6 phosphate + NADP ----> 6 phosphogluconolactone + NADPH + H

d. 6 phosphogluconolactone + H2O + 6 phosphogluconolaconate + H e.6 phosphogluconate + NADP ---> ribulosa 5 phosphate + NADPH + H 45.which statement is incorrect about biochemical aspect of blood plasma a.all plasma protien are synthesized in the cell include immunoglobin proteochar... b.production of complement protein increase in acute phase response n synthesize of albumin decrease c.CRP is the main compenent of acute phase response and marker of bacterial infection d.several plasma protein shows polymorphism e.plasma protein are glycoprotein 46.refer soklan 65 2009 47. What is the difference between sickle cell anemia and thalassemia? A. Formation of HbF in sickle cell anemia; HbS in thalassemia B. In sickle cell anemia occur hemolytic anemia; In thalassemia occur anemia nonhemolytic C. There are blood clotting disorders in sickle cell anemia; blood clotting are not impaired in thalassemia D. Examination of the peripheral smear in sickle cell anemia reveals normocytic normochrom; In thalassemia reveals microcytic hypochrom E. The amino acid sequence of globin structure is abnormal in sickle cell anemia; production of one type of globin chain decline in thalassemia 48. which one of the following is most responsible for producing normal red colour of blood? a. albumin b.myoglobin c.hemoglobin d.haptoglobin e.immuniglobulin 49. The initial reaction of heme synthesis is to form -aminolevulinic acid ( by ALA synthase. What is molecule required for this reaction? a) succinyl CoA and valine b) succinyl CoA and glycine c) succinyl CoA and alanine d) matonyl CoA and glycine e) malonyl CoA and alanine 50. What is the peripheral protein of RBC membrane? a) Amyloid b) Band 3 c) Dystrophin d) Spectrin e) Fibrillin -ALA) that catalyze

51. The abnormal spherical shape of the erythrocyte as would most likely in A. decrease ability to transport lucarbonate ions b. decrease ability to transport chlorite ions c. decrease ability to transport oxygen d. increase red cell capillary to expand when place in hypotonic salt solution e. increase red cell lysis when placed in hypotonic solution. 52. Which of the following mature blood cell lacks of mitochondria: A. Platelets B. Monocytes C. Leucocytes D. Red Blood Cell E. White Blood Cell 53. One function of myeloperoxidase, an enzyme found in azurophilic granules of neutrophil is to convert: a) hydrogen peroxide into hydroxyl free radicals in presence of ferric iron b) hydrogen peroxide into hypochlorous acid in presence of chloride c) hydrogen peroxide into water d) molecular oxygen into superoxide in presence of NADPH e) superoxide into hydrogen peroxide 54.A pneumonia patient treated with trimethoprim and sulfa drug.After three days,the patient experience mild jaundice,red-brown urine due to prensence of hemoglobin in the urin and the hemoglobin reduced to 3 mg.After stop consuming the drug,jaundice disappear.The patient had acute hemolysis due to infection and drugs. The anemia experienced by the patient due to a)inhibition of glycosis pathway by the sulfa drug b)decreased level of NADH that act to convert meth hb to oxy hb c)decreased life span of the red blood cell due to deformity in the membrane d)decreased NADPH level that act to restored oxsidised state of glutathione (GSH) to reduced state GSSG. 55. child, excess fatigue, microcytic hypochromic anemia, live at 100th years apartment, ingesting paint chips, parents told that have healthy diet and vitamin supplement. so, what kind of anemia deficiency? a. iron b. vit.b12 c.folat d.heme e.vit b6 56. which one is correct? a. biliverdin oxidised become bilirubin by biliverdin oxidase b. bilirubin 1 binds to albumin, then transport to spleen c. conversion of bilirubin 1 to bilirubin II occurs in hepatic cell

d. urobilin excreted into feces & stercobilin in urine e. jaundice in patient with hemolytic anaemia caused by accumulation of iron in blood. 57. leucocytosis can be defined as an increased in: a. neutrofil, monocyte and macrophage b. netrofil, eosinofil, basofil, monocyte and lymphocyte c. netrofil, eusinofil, erythrocyte and basofil d. netrofil, eusinofil, erythrocyte, basofil and lymphocyte e. netrofil, eosinofil, basofil, monocyte, lymphocyte and megakaryocyte 58. The hallmark of differentiating myelocytes from promylocytes morphologically is the visual identification of what in the myelocyte a. primary granule b. secondary granule c. loss of mucleoli d. pink cytoplasm e. presence of golgi zone (tak paham soalan n tak tau jawapan. sapa2 yg tau tolong isikan please. thank you :) 59. 30 year old healthy man needed CBC as part as his physical examination for purchasing life insurance policy. he decided to combine his daily 5-mile run with his appointment to get his blood drawn. he ran 3-mile to laboratory, drawn the blood and turn back home. his wbc increase 15000/mm3. o, why the wbc increase? a. had viral/bacterial infections b. had leukemia with leukemic cell present c. nucleated RBCs entered the peripheral blood d. the marginating wbc entered to circulating pool e. - x ingat 60.A patient has immunosuppressed must likely have a)increase in CD4 lympohcytes b)lymphocytosis and eosinophilia c)decrease in CD4 lymphs d)increase in T helper to T suppresse ratio. e)decrease in CD 10 lymphs 61. An 80% lymphocytic count in a total WBC count of 4,400/l on an adult would indicate a A relative and absolute decrease in lymphocyte B. relative decrease in lymphocyte but an absolute number in reference range C. relative increase in lymphocyte but an absolute number in reference range D. relative increase in lymphocyte but decrease absolute number in reference range e. relative and absolute increase in lymphocyte 62. The radiologic features which can be found in radiograph of Thalassemia Major are mentioned below except: a. hepatomegaly

b. splenomegaly c. air filled dilated paranasal sinus d. paravertebral soft tissue mass in the region of thoracic spine e. hair on end appearance on calvaria bone 63. The organ which are involve in extramedullar hematopoiesis are mention below, except for a. Liver b. Spleen c. lymph nodes d. Kidney e thymus 64. what is the difference between suckle cell anaemia and thalassemia? a. formation oh HbF in sickle anaemia, HbS in thalassemia b. in sickle cell anaemia occur hemolytic anaemia,in thalssemia occuur anamia nonhemolytic c. there are blood clotting disorder in sickle cell anemia , blood clotting are not impaired in thalassemia d. examination of the peripheral smear in sickle anemia reveals normisitik normochrome, in thalassemia reveals microcytic hipochrome e. the amino sequence of globin structure is abnormal in sickle cell anemia, production of one type of globin chain decline in thalassemia 66. The following appearance will be seen in the radiograph of lymphoma maligna patient, except for: a. Hilar lymph node enlargement b. Mediatinal lymph node enlargement c. Prostatic hypertrophy d. Hepatomegaly e. Splenomegaly 67. The hand radiograph of a Thalessemia major patient will show: 1. heavy medullary hyperplasia 2. enlarged medullary space in metacarpal bones and fingers 3. coarsed trabeculation of the bone 4. thinning of the bone cortex ANS : E 69. The bone abnormality which often detected in the radiograph of multiple myeloma patient is located in: 1. calvarial bones 2. vertebral bones 3. pelvis bones 4. fingers and toes answer: A

68. Radiograph of a Thalassemia Major patient will show: 1. Disappearance of the paranasal sinus pneumatisation 2. Thickening of the rib bones 3. Bulbous expansion at the posterior end of the ribs 4. Normal size of the spleen

70. Radiograph hemophilic patients lesion will be seen in area of 1. ankle joint 2. knee joint 3. elbow joint 4. finger joints ANS: A (1,2,3) 71. Radiograph of a thalassemia major patients will show: 1. Dissapearance of the paranasal sinus pneumatism 2. Thickening of the rib bones 3. Bulbous expansion at the posterior end of ribs 4. Normal size of the spleen Ans: B 72)Vit K is involved in formation of prothrombin 7 blood coagulation for factor ii,ix,x A)i B)vii C)viii D)xiii E)vWF 73. Megaloblastic anemia happens in defeciency of minerals: A. Natrium B. Phosphorus C. Calcium D. Cobalt E. Copper 74. Recommended daily allowance (RDA 2004) folic acid in adult is: A 100 Ug B 200 Ug C 300 Ug D 400 Ug E 500 Ug 75. Recommended daily allowence (RDA 2004) ferum in adult is: A.10mg B.20mg C.30mg D.40mg E.50mg 76. iron deficiency anemia can be caused by:

1) GI Disease 2) Malignancy 3) Pregnancy 4) Liver disease 77. iron in body mostly 60% incorporated in form of A. ferritin B. hemosiderin C. red blood cell D. myoglobin e. Plasma iron 78. The following statement regarding iron are true EXCEPT a) Mostly found in food as non-heme iron* b) Heme-iron (15-35%) is more readily absorbed than non-heme iron (2-20%) c) Iron must be tightly bound to protein to prevent destructive defect.* d) Approximately 10% is recovered and reused extensively e) Animal protein increase Fe absorption 79. Iron absorbtion are hindered by a. vitamin C b. meat protein factor c. dietry fiber (phytate) d. acid in stomach e. vitamin A 80. Several factor facilitate iron absorption except 1. Vitamin C 2. Tannin in tea 3. Meat protein factor 4. Dietary fiber Ans: C. Slide nutritional anemia - dr Agussalim Bukhari 81. megaloblasts anemia caused by.... a) iron defiencincy b) excessive blood loss c) folat/iron d) deficiency folat/b12 e) b12/excessive blood loss 82. Megaloblastic anemia caused by a) iron def. b) excess bleeding c) folat and/or iron def. d) folat and/or vit. B12 def.

e) vit.B12 and excess bleeding 83. below these are true except... A.folic acid are affected by the lack of intrinsic factor B.vit b12 are affected by the lack of intrinsic factor c...x igt.. d.folic acid .... e.vit b12..... sumpah aku lupa...sorry guys..jgn risau..jwpn dia A...CONFIRM DAN PASTI.. 84. Below are nutrients that involved in erythropoeisis EXCEPT; a. Fe b. Folic acid c. Vitamin C d. Vitamin D e. Co 85. The man,48 years old, presents to the hospital with fatigue, palpitation, parasthesia, commonly epigastric pain, the patient is vegetarian. In the physical examination, we found anemia with no jaundice. Peripheral blood count revealed HT:18%, Leucocyte:7 000/mm3, Platelet:150 000/mm3, MCV:140fl,MCH:50. Endoscopy exam we found ephythel gastric atrophy. The most likely diagnosis of the patient is: 1. 2. 3. 4. 5. Iron deficiency anemia Anemia deficiency folate Hemolytic anemia Aplastic anemia E. Perniciosa anemia

86. Laboratory first have to identify which protein: A.Follic acid B.Cyanocobalamin C.Bilirubin D.Iron E.(lupa lg 1, kalo korg ingt tlg editkan) 87. supportive therapy for this patient: A. transfusion PRC B. concentrate thombocyte transfusion C. FFP transfusion D. Cryopresipitat transfusion E. whole blood transfusion

89. A woman 47 years old, present to the hospital with the red spot in skin. This patient was 2 years ago with diagnose brest cancer stage III. No history of bleedong. 5 month ago she has gangrena at the leg distal sinistra. Peripheral blod count revealed Hb:11%, Leukocyte:12,000/mm3, thrombocyte:46,000/mm3. Working diagnose for this patient is: a. ITP b. DIC c. AML d. CML e. PNH 90. A women 60 y.o present to the hospital with low back pain. That low back pain doesn t disappear even has consumed asam mefenamat natrium diclofenac, no fever. In lab, result HT: 21%, leucocyte: 100 000, thrombocytes: 500 000. At peripheral blood smear found plasma which increases, in radiology image found fracture compression in CV. LIV. The most important investigation for diagnosis of this patient a. ham test b. reticulocyte c. peripheral blood smear d. PT n PTT e. morphology RBC ans: C 91. What is the most likely diagnosis of this patient? A. AML B. CML C. MM D. PV E. CLL 92. Thrombocyte level in this case a. thrombocytopenia b.thrombocytosis essential c. thrombocytosis reactive d. normally thrombocyte e. thromboembolism 93. which of the following is the correct therapy a. metamyphnon b. peroxicam c. amoxiciline d.morfin e. ciprofloxacin 94. A pregnant women 26 years old pregnancy 20 weeks or about 2th trimester , oresent to policlinic to ANC. At physics examination , T : 140/80 mmHg, N.90x/mnt, S.36 0C, Lab Result HT: 27% , leucocytes : 4600/mm3, trombocytes : 300000/mm3.

Working diagnose for this patient is: a. anemia in pregnancy b. normal pregnancy c. trombocytosis in the pregnancy d. leucositosis in the pregnancy e. leucopenia in pregnancy 95.The most important investigation for diagnose a.peripheral blood smear b.pt n aptt c.d dimer d.diff count wbc e.ct n bt 96. A man 60 years old has a headache,pruritus hemypharise synistra,platelet 500 g/ml and WBC 13000g/ml.Diagnosis A.Chronic leukimia B.MM C.Polysitemia D.Acute Leukimia E.Myelofibrosis 97. The early therapy: A. Salicylic acid B. Leucogen C. Furosemide D. Amoxilline E. ciprofloxacin 98. Aiman, 64 years old, present with high fever since 5 days before enter the hospital. Since 1 year also complain about abdominal and enlargement in upper right stomach. At physical examination found : anemia, lien S.IV. Peripheral blood count revealed : HT 33%, Platelet : 66,000/mm3, WBC : 100,000 mm3 Working diagnosis for this patient is a. CML b. AML c. ALL d. MM e. PV 99. The result of bone marrow found blast cell about 20%, so most likely diagnosis for this patient is.. a) CML in the acceleration phase b) CML in the blast crisis c) CML in the chronic phase d) Good prognosis for this CML e) CML in the calm phase

100. Which does not constitute a plasma component? a) colloids b) electrolytes c) gases d) glucose e) platelets