KMU Past Paper Practice

Question:

Two patients have a hemoglobin concentration of 8.5 g/dL. One developed anemia rapidly after recent blood loss, while the other developed anemia gradually over several months. The first patient has much greater dizziness and breathlessness. Which factor best explains the difference in symptoms?

Correct Answer: Less time for physiological compensation

Explanation: The clinical impact of anemia depends on both hemoglobin level and rate of onset. Rapid falls allow less time for cardiovascular and tissue adaptation.

Question:

A young woman has a microcytic anemia. Her CBC also shows marked variation in red-cell size. Which interpretation best fits this additional finding?

Correct Answer: It supports a nutritional deficiency pattern

Explanation: Increased red-cell size variation, reflected by a raised RDW, can support nutritional deficiency when interpreted with the rest of the blood picture.

Question:

A 5-year-old child is being evaluated for chronic anemia. The physician has already documented the presenting symptoms and previous illnesses. Which additional assessment is particularly important because this patient is a child?

Correct Answer: Feeding, growth and developmental assessment

Explanation: Pediatric anemia assessment must consider feeding, growth and development because both nutritional causes and chronic anemia can affect these domains.

Question:

A clinically well infant shows a gradual fall in hemoglobin after birth. There is no jaundice, bleeding, infection or other evidence of disease. Which interpretation is most appropriate?

Correct Answer: Physiological postnatal hemoglobin decline

Explanation: A physiological fall in hemoglobin occurs after birth. Absence of pathological clinical features supports a normal postnatal process rather than disease.

Question:

A young adult is diagnosed with severe aplastic anemia after appropriate marrow assessment. Supportive care has been initiated and hematology review arranged. Which definitive treatment category may be considered according to disease severity and patient factors?

Correct Answer: Immunosuppression or stem-cell transplantation

Explanation: Severe aplastic anemia may require specialist definitive treatment with immunosuppressive therapy or hematopoietic stem-cell transplantation.

Question:

A patient with known marrow failure develops fever, oral ulcers, spontaneous bruising and gum bleeding. Which management priority best addresses the immediate risks?

Correct Answer: Prompt management of infection and bleeding

Explanation: Neutropenia increases infection risk while thrombocytopenia increases bleeding risk. Both require urgent supportive management in marrow failure.

Question:

A patient being evaluated for anemia is found to have multiple petechiae and easy bruising. Which additional hematological abnormality should be specifically considered?

Correct Answer: Reduced platelet count

Explanation: Petechiae and spontaneous bruising suggest thrombocytopenia and raise concern that the problem involves more than the red-cell line alone.

Question:

An adult with anemia has generalized lymphadenopathy and hepatosplenomegaly. There is no obvious dietary deficiency. Which interpretation is most appropriate?

Correct Answer: A systemic or hematological disorder should be sought

Explanation: Lymphadenopathy and hepatosplenomegaly broaden the differential beyond isolated nutritional anemia and suggest systemic or hematological disease.

Question:

A child has long-standing anemia, previous transfusions, splenomegaly and characteristic chronic facial and bony changes. Which disease category is most strongly suggested by this pattern?

Correct Answer: Severe hereditary anemia such as thalassemia

Explanation: Chronic anemia beginning in childhood with transfusion history, splenomegaly and bony changes strongly suggests a severe inherited anemia.

Question:

A pregnant woman with confirmed nutritional anemia says she plans to stop prescribed replacement therapy and rely only on an improved diet. Which counselling response best reflects appropriate management?

Correct Answer: Continue prescribed replacement with dietary support and follow-up

Explanation: Diet supports treatment but may not correct established deficiency alone. Adherence to appropriate replacement and follow-up remains important.

Question:

A woman has persistent clinically significant anemia throughout pregnancy. Which fetal outcome is an important recognized concern in addition to impaired fetal growth?

Correct Answer: Prematurity

Explanation: Significant persistent maternal anemia is associated with adverse pregnancy outcomes including prematurity and increased perinatal risk.

Question:

A woman enters pregnancy with borderline iron stores and develops iron-deficiency anemia later in gestation despite no major bleeding. Which physiological change most contributes to this risk?

Correct Answer: Increased maternal iron requirement

Explanation: Pregnancy substantially increases iron requirements, making iron deficiency more likely when maternal stores are inadequate.

Question:

A hemodynamically stable adult has confirmed uncomplicated iron-deficiency anemia. Gastrointestinal absorption is intact and oral medication is well tolerated. Which replacement approach is most appropriate?

Correct Answer: Oral iron replacement

Explanation: Oral iron is appropriate when iron deficiency is uncomplicated, absorption is adequate and treatment is tolerated.

Question:

A patient with confirmed iron-deficiency anemia begins effective replacement therapy. Follow-up shows an increasing reticulocyte count before full correction of hemoglobin. What does this finding indicate?

Correct Answer: Recovery of marrow erythropoiesis

Explanation: In the treatment context, a reticulocyte rise reflects renewed red-cell production and supports an appropriate marrow response to replacement.

Question:

A newborn is pale soon after delivery. There is a history of significant perinatal blood loss. The infant has no jaundice, and subsequent marrow response is appropriate. Which mechanism best explains the anemia?

Correct Answer: Acute neonatal blood loss

Explanation: Pallor after documented perinatal bleeding without jaundice supports blood loss rather than hemolysis as the cause of neonatal anemia.

Question:

A toddler has confirmed nutritional iron-deficiency anemia related to poor complementary feeding. Which management plan best addresses both the hematological problem and its cause?

Correct Answer: Iron replacement with correction of feeding practices

Explanation: Pediatric nutritional iron deficiency requires both replacement of depleted iron and correction of the feeding pattern that caused the deficiency.

Question:

Parents of a child with thalassemia major ask whether the condition will disappear as the child grows older. Which counselling message is most appropriate?

Correct Answer: It is a chronic inherited disorder requiring continuing follow-up

Explanation: Thalassemia major is a lifelong inherited disorder requiring regular follow-up, treatment monitoring and surveillance of growth and complications.

Question:

A pregnant woman with confirmed deficiency anemia has little improvement after prescribed treatment. She remains clinically stable. Before changing to a more intensive therapy, which issue should be reviewed first?

Correct Answer: Treatment adherence and ongoing sources of blood loss

Explanation: Apparent treatment failure should prompt reassessment of adherence and continuing causes such as blood loss before unnecessarily escalating therapy.

Question:

A patient with chronic renal disease develops normocytic anemia with an inappropriately low reticulocyte response. Which mechanism best explains the hematological pattern?

Correct Answer: Reduced erythropoietic stimulation and red-cell production

Explanation: Renal-related anemia is a production problem; inadequate erythropoietic stimulation produces an inappropriately low reticulocyte response.

Question:

An adult has unexplained anemia with an increased reticulocyte response. Iron studies do not explain the abnormality. The clinician wants to directly assess red-cell morphology for clues such as abnormal shapes or fragmentation. Which investigation is most appropriate?

Correct Answer: Peripheral blood film examination

Explanation: The peripheral film directly demonstrates red-cell morphology and can reveal patterns that guide further investigation of anemia.