HUS vs TTP (1487/1700)

A middle aged lady presented with fever, altered sensorium, bleeding gums and jaundice. Labs: deranged renal function tests, normal PT/APTT, fragmented RBCs and low plts. What’s the most likely dx?

a. Cholesterol emboli
b. HUS
c. TTP
d. Hepatorenal syndrome
e. Sepsis

Night sweats, lymphadenopathy, splenomegaly (1335/1700)

A 26yo man has returned from NY to the UK and noticed weight loss, night sweats, temp=37.5C and cervical lymphadenopathy. He also has splenomegaly. What is the dx?
a. TB
b. Lymphoma
c. Bronchial carcinoma
d. Bronchitis

Peripheral blood smear (1210/1700)

A 51yo man has become increasingly fatigued for the past 10m. PE: no abnormal findings. Labs:
Hgb=9.2, Hct=27.9%, MCV=132fl, plt=242, WBC=7.59. Which of the following morphologic
findings is most likely to be present on examination of his peripheral blood smear?
a. Hypersegmented neutrophils
b. Nucleated RBC
c. Blasts
d. Hypochromic, microcytic RBC
e. Schistocytes

Philadelphia chromosome (532/1700)

A 65yo man presents with back pain. Exam: splenomegaly and anemia. Blood: WBC=22,
Hgb=10.9, Plt=100, ESR=25. He has been found to have Philadelphia chromosome. What is the
single most likely dx?
a. ALL
b. AML
c. CML
d. CLL
e. Lymphoma

5 year old, bleeding gums, hepatosplenomegaly (531/1700)

A 5yo child was admitted with hx of feeling tired and lethargic all the time, bleeding gums and
sore throat since the last 3months. Exam: hepatosplenomegaly. What is the most probable dx?
a. ALL
b. AML
c. CML
d. CLL
e. Lymphoma

Epistaxis (513/1700)

A 30yo lady has epistaxis for 30mins. Her Hgb is normal, MCV normal, WBC normal,
PT/APTT/Bleeding time are normal. Where is the defect?
a. Plts
b. Coagulation factor
c. Sepsis
d. Anatomical
e. RBC

Hepatomegaly and Spleenomegaly (467/1700)

467. A 32yo pt presents with cervical lymphadenopathy and splenomegaly. What is the single most
appropriate option?

a. Hemophilus
b. Streptococcus
c. Toxoplasmosis
d. NHL
e. Pneumocystis jerovcii

High MCV, jaundice, weight loss, diarrhea (456/1700)

A 35yo lady is admitted with pyrexia, weight loss, diarrhea and her skin is lemon yellow in color.
CBC = high MCV. What is the most probably dx?
a. Aplastic anemia
b. Pernicious anemia
c. Leukemia
d. ITP
e. Lymphoma

Bleeding disorders (1684/1700)

INR:Normal, APTT: Elevated, Thrombin time: Elevated, Plt count: Normal, Bleeding time: Normal.
A likely aetiology is?

a. Waldenström's macroglobulinaemia
b. Heparin
c. Sézary cell leukaemia
d. Pelger-Hüet anomaly
e. von Willebrand's disease
f. Haemophilia
g. HIV infection
h. DIC
i. Acanthocytosis
j. Vit K deficiency

Blood donor passed out (1675/1700)

A 35yo 1st time donor suddenly passes out as she is donating blood. Which of the following steps would be least useful in managing this adverse event?

a. Ensure donor is adequately hydrated and has not skipped a meal
b. Elevating the donor's legs as this is usually due to a vasovagal syncope
c. Haemoglobin of the donor meets the minimum requirement for donation
d. The donation is usually continued along with simultaneous normal saline infusion
e. The donor should be encouraged to mobilise after they have recovered

Reccurent swollen tender joints (1356/1700)

A boy with a hx of recurrent swollen tender joints on both knees and elbows and not able to
participate in sports. What is the inv of choice to dx?
a. RF/ASO titre
b. Clotting factor
c. ESR

Philadelphia chromosone positive (318/1700)

A 53yo man presents complaining of weight loss, lethargy, increasing abdominal discomfort and
gout for the pat yr. Exam: spleen palpated 5cm below left costal margin, no fluid wave. CBC:
Hgb=10.5g/dL, WBC=200 – 85% neutrophils, plts=100, Na+=140mmol/L, K+ 4mmol/L,
create=151umol/L, urea=7mmol/L. Serum B12 increased. Philadelphia chromosome +ve. What
is the most likely dx?

a. CML
b. CLL
c. AML
d. ALL
e. Lymphoma

Pernicious anemia (280/1700)

A woman has pernicious anemia. She has been prescribed parenteral vitamin B12 tx but she is
needle phobic. Why is oral tx not preferred for this pt?
a. IM B12 is absorbed more
b. Intrinsic factor deficiency affects oral B12 utilization
c. IM B12 acts faster
d. IM B12 needs lower dosage
e. Pernicious anemia has swallowing difficulties

Headache, visual problems, tinnitus, splenomegaly (265/1700)

A 65yo woman presents with headache. She also complains of dizziness and tinnitus. She has
recently realized she has visual problems. There is hx of burning sensation in fingers and toes.
On exam: splenomegaly, itchy after hot bath. Labs: RBC=87, Hgb=31.9, Plt=796. What is the dx?
a. CML
b. CLL
c. Polycythemia vera
d. Myelofibrosis
e. NHL

Splenomegaly , fever, anemia (260/1700)

A 57yo man presents with weight loss, tiredness, fever and abdominal discomfort. Exam: spleen
palpable up to the umbilicus. Labs: WBC=127, Hgb=8.7, Plt=138. What is the most likely dx?

a. CML
b. AML
c. CLL
d. AML
e. Polycythemia

Macrocytic anemia following ileal resection (250/1700)

A 61yo man underwent a surgery in which ileal resection had been done. He complains of
fatigue, headache, and heart racing. Labs: MCV=108fL, Hgb=8.9g/dL. What is the most likely dx?

a. Vit B12 def
b. Iron def
c. Folate def
d. Hemolytic anemia
e. Anemia of chronic disease

Pernicious anemia (243/1700)

A 56yo woman is known case of pernicious anemia. She refuses to take hydroxycobalamin IM as
she is needle shy. She asks for oral medication. Why will oral meds be not effective?

a. Intrinsic factor def
b. Malabsorption
c. Irritated gastric mucosa
d. Lack of gastric acidity

Pathological fracture, hypercalcemia (236/1700)

60 yo man has a pathological rib fx. He also complains of recurrent infection. BMA is done.
Labs: Ca2+ = 3.9mmol/L and ALP = 127u/L. what type of cell would be found in abdundance in
the marrow smear?

a. Plasma cell
b. Myeloid cell
c. Bence-jones protein
d. Megakaryocytes
e. Reticulocytes

Anemic 5year old with splenomegaly (202/1700)

A 5yo child presents with fever. He looks pale. His parents say he always feels tired. On exam:
orchidomegaly & splenomegaly. Labs: WBC=1.7, Hgb=7.1, Plt=44. What is the dx?
a. ALL
b. CLL
c. AML
d. CML
e. Hodgkins

Hodgkin's lymphoma (194/1700)

The dx cells of Hodgkin disease are:
a. T-cells
b. R-S cells
c. B-cells
d. Macrophages
e. Auer rods