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Question 1 of 20
Dr. Anderson was overseeing the ICU when he was urgently paged to a patient’s room. Mr. Williams, a 63-year-old man with a history of chronic anaemia, was undergoing a packed red blood cell transfusion. Within minutes of starting the transfusion, the nurse observed that Mr. Williams appeared extremely anxious and began to complain of a sharp pain at the transfusion site. The nurse also noticed a rapid spike in his temperature. On further assessment, Dr. Anderson noted Mr. Williams’ blood pressure had dropped significantly. He suspected an Acute Haemolytic Transfusion Reaction (AHTR).
What is the most appropriate initial management step for Mr. Williams?CorrectIncorrect
Question 2 of 20
A 45-year-old male presents to the clinic with a 3-month history of fatigue, unexplained weight loss, and increasing abdominal fullness. On physical examination, there’s a noticeable enlargement of the spleen extending to the right iliac fossa. Laboratory investigations reveal a white blood cell count of 120 x 10^9/L. A differential count shows granulocytes at all stages of development without the presence of blast cells.
Based on the clinical and laboratory findings, which of the following investigations would be the most definitive to confirm the diagnosis?CorrectIncorrect
Question 3 of 20
Mrs. Gallagher, a 68-year-old woman, presents to her primary care physician with complaints of feeling more fatigued than usual for the past few weeks. She has also noticed some painless swelling in her neck and armpits. On examination, she has bilateral cervical and axillary lymphadenopathy. She also mentions that she’s been having occasional night sweats and has experienced unintentional weight loss. Her labs show an elevated white blood cell count, predominantly lymphocytes. Furthermore, a peripheral blood smear reveals the presence of smudge cells.
Based on Mrs. Gallagher’s clinical features, which of the following conditions is she most likely suffering from?CorrectIncorrect
Question 4 of 20
A 6-year-old boy is brought to the paediatrician by his parents. They report that he has been increasingly tired over the past few weeks and often prefers to rest rather than play. He also has had multiple nosebleeds and developed a few large, unexplained bruises on his legs. On examination, the paediatrician notes pallor, multiple ecchymoses on the extremities, and palpable lymph nodes in the cervical and axillary regions. An enlarged spleen is also detected on abdominal palpation. A blood test is ordered immediately.
Which of the following conditions is most likely given the child’s clinical presentation?CorrectIncorrect
Question 5 of 20
A 28-year-old female presents to the emergency department with a 3-week history of fatigue, easy bruising, and swollen gums. On examination, her gums are inflamed and bleed easily upon probing. Blood tests reveal anaemia and a high white cell count. A peripheral blood smear shows the presence of blast cells with characteristic Auer rods.
What is the most likely diagnosis?CorrectIncorrect
Question 6 of 20
A 28-year-old woman presents to her primary care physician with a 3-month history of painless swelling on the left side of her neck. She denies any trauma or infections in the area. On further inquiry, she mentions unintentional weight loss of about 15 pounds over the last 2 months, occasional fevers, and drenching night sweats. Physical examination reveals rubbery, non-tender cervical and supraclavicular lymphadenopathy. There’s also a palpable spleen on abdominal examination.
Given her clinical presentation, which of the following is the most likely diagnosis?CorrectIncorrect
Question 7 of 20
A 45-year-old female patient was admitted to the hospital with severe sepsis secondary to pneumonia. Her condition deteriorated over the past 48 hours, and she developed spontaneous bruising on her limbs, bleeding from her venepuncture sites, and haematuria. Concerned about an underlying coagulopathy, her physician ordered a series of blood tests to evaluate her coagulation profile.
Which combination of blood test findings is most consistent with a diagnosis of Disseminated Intravascular Coagulation (DIC)?CorrectIncorrect
Question 8 of 20
Dr. Martinez is evaluating a 50-year-old male who presents with complaints of fatigue, itching following hot baths, and occasional headaches. On physical examination, she notices facial redness and an enlarged spleen. Suspecting Polycythaemia Rubra Vera (PRV) based on the clinical presentation, she plans to order a diagnostic test that is considered the investigation of choice for confirming PRV.
Which test should Dr. Martinez order to confirm the diagnosis of PRV?CorrectIncorrect
Question 9 of 20
A 24-year-old Mediterranean male presents to the emergency department complaining of sudden onset fatigue, dark urine, and jaundice. He reveals that two days ago, he consumed a large meal of fava beans and soon after developed a high-grade fever. Given his symptoms and recent history, a peripheral blood smear is ordered.
What is the most likely finding on the blood smear suggestive of his underlying condition?CorrectIncorrect
Question 10 of 20
Dr. Martin, a 68-year-old retired schoolteacher, presents to the clinic with complaints of persistent back pain that has been bothering him for the past 3 months. The pain is especially prominent in the lower back region and tends to worsen with movement. He also mentions increased fatigue and that he feels breathless at times, even when performing simple activities. When asked about any other symptoms, Dr. Martin reports increased thirst and frequent urination. He denies any weight loss, fever, or night sweats. On physical examination, pallor is noted. Blood tests were ordered.
Based on the clinical presentation, which of the following is the most likely diagnosis?CorrectIncorrect
Question 11 of 20
Sarah, a 28-year-old female, visits her primary care physician complaining of persistent fatigue over the last few months. She also mentions that she feels short of breath when climbing stairs, which was not an issue for her earlier. On further questioning, she reveals she has an unusual craving to chew ice and has been experiencing restless sensations in her legs, especially at night. Physical examination reveals pallor, spoon-shaped nails, and redness at the corners of her mouth.
Which of the following conditions is the most likely diagnosis for Sarah?CorrectIncorrect
Question 12 of 20
Mr. Harris, a 72-year-old male with a history of rheumatoid arthritis, presents to the clinic with complaints of persistent fatigue, pallor, and breathlessness on exertion for the past three months. On examination, he appears pale, and there is evidence of swollen joints consistent with his rheumatoid arthritis. His blood tests reveal a haemoglobin level of 7.2 g/dL. The rest of his blood work shows decreased serum iron level, decreased total iron-binding capacity (TIBC), and elevated ferritin. Given his haemoglobin level of less than 8 g/dL in the setting of chronic inflammation from his rheumatoid arthritis, you suspect Anaemia of Chronic Disease (ACD).
Which of the following would be the most appropriate next step in management?CorrectIncorrect
Question 13 of 20
A 68-year-old woman presents to the clinic complaining of a 6-month history of fatigue and shortness of breath on exertion. She also reports experiencing numbness and tingling in her hands and feet. Upon examination, her tongue appears “beefy” red and sore. She mentions that she’s a strict vegan and hasn’t taken any supplements. A blood test shows macrocytic anaemia.
Which of the following clinical features is most consistent with her likely diagnosis?CorrectIncorrect
Question 14 of 20
Samantha, a 38-year-old woman with a history of rheumatoid arthritis, presents to her primary care physician complaining of fatigue, weakness, and pallor. On further questioning, she mentions that she has been on methotrexate therapy for the past year to manage her arthritis. A blood test reveals macrocytic anaemia. Her doctor suspects her anaemia may be related to her ongoing medication.
Which of the following is the most likely cause of Samantha’s anaemia?CorrectIncorrect
Question 15 of 20
A 17-year-old male presents to the clinic with complaints of increasing fatigue over the past 3 months. He also reports episodes of shortness of breath on exertion and frequent nosebleeds. On examination, he appears pale, and there are multiple petechiae on his lower legs. His oral mucosa shows several small ulcerations. He also mentions that he has been having recurrent gum bleeding while brushing his teeth. On further questioning, he denies any significant weight loss, night sweats, or enlarged lymph nodes. The spleen is not palpable on abdominal examination. A bone marrow biopsy was performed, which revealed a grossly reduced hematopoietic tissue replaced by fat tissue.
Which of the following is the most likely diagnosis based on the clinical presentation and bone marrow findings?CorrectIncorrect
Question 16 of 20
A 6-year-old boy is brought to the paediatric clinic by his parents. They are concerned as he appears more pale than usual and has been increasingly fatigued. He has no significant past medical history, but the parents mention that several family members on both sides have had some form of anaemia. On examination, the child has pallor, mild jaundice, and an enlarged spleen. The physician suspects thalassemia. The doctor orders a test to confirm the diagnosis.
Which of the following is the most definitive test to diagnose thalassemia?CorrectIncorrect
Question 17 of 20
A 32-year-old woman presents to the clinic with a 2-week history of spontaneous bruising on her arms and legs. She mentions that these bruises appear without any trauma and are increasing in number. Over the past week, she’s also noticed frequent nosebleeds that are hard to control and bleeding gums when she brushes her teeth. She denies any history of joint pain, fevers, weight loss, or other bleeding episodes in the past. She has no significant medical history and isn’t on any medications. She hasn’t had any recent illnesses or infections. Her blood reports just came in, and they show only a marked decrease in platelet count with all other blood parameters within the normal range.
What is your diagnosis?CorrectIncorrect
Question 18 of 20
A 26-year-old female presents to the clinic with a history of recurrent nosebleeds and unusually prolonged bleeding after a recent dental extraction. Her menstrual periods have always been heavy and prolonged. There’s no significant family history. She has not started on any new medications and denies taking any over the counter NSAIDs or supplements. Given these clinical features, the physician decides to run some haematological tests to pinpoint the cause of her bleeding tendency.
Which combination of investigation findings would be most consistent with a suspected diagnosis of von Willebrand disease?CorrectIncorrect
Question 19 of 20
A 9-year-old boy is brought to the paediatric clinic by his mother. She reports that over the past year, her son has had several episodes of painful, swollen knees and ankles without any apparent injury. The swelling would last for several days and then gradually resolve. The boy denies any significant trauma or injury to these joints. His mother also notes that he often develops large bruises on his body even from minor bumps. On examination, the boy’s right knee is swollen, warm to touch, and he has difficulty flexing it. The range of motion is limited due to pain. No signs of external injury or wounds are present. The remainder of the examination is unremarkable.
Which of the following is the most likely diagnosis?CorrectIncorrect
Question 20 of 20
A 6-year-old boy is brought to the emergency department by his parents. They report that he had diarrhoea that started 5 days ago, which became bloody in the last 2 days. The parents also noticed that he seems more fatigued than usual, and they spotted unusual bruises on his legs and arms. On examination, the boy appears pale and lethargic. Initial laboratory studies show signs of anaemia, elevated urea and creatinine levels, and a decreased platelet count.
Based on the clinical presentation and laboratory findings, which of the following conditions is the most likely diagnosis?CorrectIncorrect