Question 1

Which autoimmune conditions are most commonly associated with PA?

Accepted Answer

Thyroid disease, type 1 diabetes, and vitiligo

Answer

Antiphospholipid syndrome and myasthenia gravis

Answer

Multiple sclerosis and rheumatoid arthritis

Answer

Systemic lupus erythematosus and Sjögren’s syndrome

Answer

Hashimoto’s thyroiditis and Addison’s disease

Question 2

What is the primary genetic predisposition associated with PA?

Accepted Answer

HLA-DRB1*03, DRB1*04

Answer

MYH9 gene mutation

Answer

HLA-DRQ8, HLA-DRB52

Answer

HLA-B27

Answer

TET2 mutation

Question 3

Which autoantibody is most specific for diagnosing PA?

Accepted Answer

Intrinsic factor antibodies

Answer

Anti-dsDNA

Answer

Anti-parietal cell antibodies, IgA

Answer

Anti-centromere antibodies

Answer

Anti-basement membrane antibodies

Question 4

Which metabolic abnormality is characteristic of vitamin B12 deficiency in PA?

Accepted Answer

Elevated MMA and homocysteine levels

Answer

Decreased homocysteine levels

Answer

Decreased RBC folate

Answer

Increased ferritin levels

Answer

Decreased methylmalonic acid (MMA)

Question 5

Which of the following is an early neurological symptom of PA?

Accepted Answer

Peripheral neuropathy

Answer

Myoclonus

Answer

Ataxia

Answer

Hemiparesis

Answer

Ophthalmoplegia

Question 6

Which bone marrow finding is the hallmark of PA?

Accepted Answer

Hypercellularity with nuclear-cytoplasmic asynchrony

Answer

Polychromasia of erythroid precursors.

Answer

Erythroid nuclear abnormalities and multinuclearity.

Answer

Howell-Jolly bodies in erythroid precursors.

Answer

Hypocellularity with relative erythroid hyperplasia

Question 7

What is the first-line treatment for uncomplicated pernicious anemia?

Accepted Answer

Intramuscular hydroxocobalamin or cyanocobalamin

Answer

IV immunoglobulin

Answer

Oral folic acid, B12 and iron supplement.

Answer

Steroid therapy.

Answer

Oral cyanocobalamin

Question 8

Which hematological parameter improves first after starting vitamin B12 therapy in PA?

Accepted Answer

Reticulocyte count

Answer

Hemoglobin level

Answer

Reticulocyte hemoglobin

Answer

MCV

Answer

MCH

Question 9

What is the most common long-term complication of untreated PA?

Accepted Answer

Subacute combined degeneration of the spinal cord

Answer

Heart failure

Answer

Liver cirrhosis

Answer

Marrow fibrosis

Answer

Myelodysplasia

Question 10

A 68-year-old woman presents with fatigue, pallor, and tingling in her hands and feet. Labs show Hb 9.5 g/dL, MCV 110 fL. What is the most appropriate next step?

Accepted Answer

Serum B12, MMA, and homocysteine levels

Answer

Blood transfusion

Answer

Bone marrow biopsy

Answer

IV B12 therapy

Answer

IF antibodies test

Question 11

A 50-year-old man with known PA has been receiving monthly cyanocobalamin injections but continues to have neurological symptoms. What should be considered?

Accepted Answer

Delayed neurological response to therapy or irreversible damage

Answer

Hypothyroidism

Answer

Iron deficiency

Answer

Inadequate dose

Answer

Folate deficiency

Question 12

A 45-year-old patient presents with jaundice, pallor, and a lemon-yellow skin color. What is the underlying cause of jaundice in PA?

Accepted Answer

Ineffective erythropoiesis and hemolysis

Answer

Gilbert’s syndrome

Answer

Hepatitis infection

Answer

Enzymatic dysfunction

Answer

Hepatic dysfunction

Question 13

A 55-year-old man with PA develops progressive weakness and difficulty walking. MRI shows posterior column demyelination. What is the best treatment?

Accepted Answer

High-dose IM vitamin B12

Answer

Plasma exchange

Answer

Start with oral low dose B12 and folate, then gradually increase the dose.

Answer

IV folinic acid

Answer

IV steroids

Question 14

A 72-year-old woman with PA presents with pancytopenia, schistocytes, and high LDH. What is the most likely misdiagnosis?

Accepted Answer

Pseudo-TMA

Answer

Hemolytic uremic syndrome

Answer

Myelofibrosis

Answer

Hemolytic anemia

Answer

Aplastic anemia

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