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This is a 55 year old woman who has fatigue. Her only

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1 This is a 55 year old woman who has fatigue. Her only
other symptom is a craving for chewing ice cubes. Apart from being pale her examination is normal. Test results Hgb g/L MCV 66f/L RBC x1012/L WBC x106/L Plat x109/L Blood film

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3 Which one of the following tests would best define the type of anemia she has ?
A. Hgb electropheresis B. Serum iron and iron-binding capacity C. Serum ferritin D. Serum transferrin E. Bone marrow iron

4 This is a 55 year old woman who has fatigue. Her only
other symptom is a craving for chewing ice cubes. Apart from being pale her examination is normal. Test results Hgb g/L MCV 66fL RBC x1012/L WBC x106/L Plat x109/L Blood film microcytosis hypochromia ovals pencil thrombocytosis

5 A 44 year old executive is sent to you for an insurance
examination. He is fit, but on examination he has mild hypertension. Test results Hgb g/L MCV fL  RBC x1012/L WBC x106/L Plat x109/L Blood film

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7 Which test is likely to give a diagnosis in this case ?
A. Serum ferritin B. Serum transferrin C. Sickle Cell screen D. Hgb electropheresis E. Liver function tests

8 A 44 year old executive is sent to you for an insurance
examination. He is fit, but on examination he has mild hypertension. Test results Hgb g/L MCV 65 fL RBC x1012/L WBC 6.5 x106/L Plat x109/L Blood film microcytosis hypochromia target teardrop basophilic stippling

9 What would you tell this executive ?
A. You have Beta thalassemia minor B. You have alpha thalasemia minor C. You have Sickle cell trait D. You have hemoglobin C trait E. More tests are needed

10 This is an 18 year old boy who you are investigating for
Jaundice. He has this intermittently for some time. His family are Christian Scientists. Physical exam shows jaundice and splenomegaly bili 35 mol/L blood film Test results Hgb g/L MCV fL RBC x1012/L WBC x106/L Plat x109/L

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12 Which of the following would be most helpful in identifying this young man’s problem ?
A. Reticulocyte count B. Osmotic fragility test C. DAT (Coomb’s test) D. Bone marrow test E. Family studies

13 This is an 18 year old boy who you are investigating for
Jaundice. He has this intermittently for some time. His family are Christian Scientists. Physical exam shows jaundice and splenomegaly bili 35 mol/L blood film polychromasia spherocytes Test results Hgb g/L MCV fL RBC x1012/L WBC x106/L Plat x109/L

14 A 46 year old diplomat is referred to you because of
abnormal blood results. On review of these you suspect the cause and order appropriate blood tests. Test results Hgb g/L MCV fL RBC x1012/L WBC x106/L Plat x109/L Blood Film

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16 What tests would you order on receiving these results ?
A. Serum B12 and folate B. Bone marrow aspirate C. Serum lipid studies D. Liver function tests E. Thyroid function tests

17 A 46 year old diplomat is referred to you because of
abnormal blood results. On review of these you suspect the cause and order appropriate blood tests. Test results Hgb g/L MCV fL RBC x1012/L WBC x106/L Plat x109/L Blood Film Macrocytosis Target cells stomatocytes

18 A 65 year old woman is referred to you because of memory
loss. Her family physician had received tests which included bilirubin of 28  mol/L and an LDH of U/L. He was puzzled by these results. Test results Hgb g/L MCV fL RBC x1012/L WBC x106/L Plat x109/L Blood Film

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20 Which one of the following tests is most appropriate ?
A. Liver function B. Thyroid function C. RBC folate D. Serum B12 E. Bone marrow aspirate

21 A 65 year old woman is referred to you because of memory
loss. Her family physician had received tests which included bilirubin of 28  mol/L and an LDH of U/L. He was puzzled by these results. Test results Hgb g/L MCV fL RBC x1012/L WBC x106/L Plat x109/L Blood Film Macrocytosis oval macroytes hypersegmented neutrophils

22 A 65 year old woman complains of back pain. Her X-rays
show diffuse osteoporosis. She also complains of increased thirst and drowsiness. Test results Hgb g/L MCV fL RBC x1012/L WBC x106/L Plat x109/L Blood Film

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24 Which one of these tests would most likely lead to the diagnosis ?
A. Serum osmolarity B. Serum viscosity C. Serum protein electrophersis D. Serum TSH E. Serum PTH

25 A 65 year old woman complains of back pain. Her X-rays
show diffuse osteoporosis. She also complains of increased thirst and drowsiness. Test results Hgb g/L MCV fL RBC x1012/L WBC x106/L Plat x109/L Blood Film rouleaux background staining

26 You admit a 36 year old woman with pneumonia. She has
fever, shortness of breath and requires oxygen. She is also noted to be anemic. Test results Hgb g/L MCV fL RBC x1012/L WBC x106/L Plat x109/L Blood Film

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28 These test results would help you choose which one of these antibiotics ?
A. Cephalexin B. Penicillin G C. Erythromycin D. Sulfamethoxazole E. Ciprofloxacin

29 You admit a 36 year old woman with pneumonia. She has
fever, shortness of breath and requires oxygen. She is also noted to be anemic. Test results Hgb g/L MCV fL RBC x1012/L WBC x106/L Plat x109/L Blood Film RBC agglutination

30 An 18 year old woman has symptoms of cystitis. After urine
cultures are taken she is given Sulfamethoxazole. Her urinary symptoms improve but she becomes short of breath. A week later on follow-up her investigation shows. Test results Hgb g/L MCV 107fL RBC x1012/L WBC x106/L Plat x109/L Blood Film

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32 What type of anemia is causing this problem ?
A. An idiosyncratic drug reaction B. An allergic drug reaction C. Marrow suppressive effect D. Immune hemolysis E. Oxidative hemolysis

33 An 18 year old woman has symptoms of cystitis. After urine
cultures are taken she is given Sulfamethoxazole. Her urinary symptoms improve but she becomes short of breath. A week later on follow-up her investigation shows. Test results Hgb g/L MCV 107fL RBC x1012/L WBC x106/L Plat x109/L Blood Film ploychromasia blister bite cells

34 You are called to see this 29 year old primip in the case
room. The obstetrician is concerned about her platelet count. She is well but a bit hypertensive. Test results Hgb g/L MCV fL RBC x1012/L WBC x106/L Plat x109/L Blood Film

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36 What diagnosis is most likely ?
A. ITP ( immune thrombocytopenia ) B. TTP ( thrombotic thrombocytopenic purpura) C. PIH (pre-eclampsia) D. Benign thrombocytopenia of pregnancy E. DIC (disseminated intravascular coagopathy)

37 You are called to see this 29 year old primip in the case
room. The obstetrician is concerned about her platelet count. She is well but a bit hypertensive. Test results Hgb g/L MCV fL RBC x1012/L WBC x106/L Plat x109/L Blood Film polychromasia rbc fragments thrombocytopenia

38 This 35 year old man is sent to you because of unusual
blood results. His complaints are of fatigue and an episodic itchy rash. Test results Hgb g/L MCV fL RBC x1012/L WBC x106/L Plat x109/L Blood Film

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40 What condition do you think is responsible for these results ?
A. Pernicious anemia B. Sickle cell anemia C. Hyposplenism D. Leaky prosthetic valve E. Liver cirrhosis

41 This 35 year old man is sent to you because of unusual
blood results. His complaints are of fatigue and an episodic itchy rash. Test results Hgb g/L MCV fL RBC x1012/L WBC x106/L Plat x109/L Blood Film targets acanthocytes fragments howell jolly bodies

42 What is the most likely cause ?
A. Blind loop syndrome B. Coeliac disease C. Ulcerative colitis D. Crohn’s disease E. Wilson’s disease

43 You are asked to asses a 72 year old woman for anemia
and splenomegaly. She has been losing weight for 1 year. She has had 2 episodes of gout. Test results Hgb g/L MCV fl RBC x1012/L WBC x106/L Plat x109/L Blood Film

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45 What test would give a definitive diagnosis ?
A. LAP score B. Osmotic fragility C. Hgb electropheresis D. Bone scan E. Bone marrow biopsy

46 You are asked to asses a 72 year old woman for anemia
and splenomegaly. She has been losing weight for 1 year. She has had 2 episodes of gout. Test results Hgb g/L MCV fl RBC x1012/L WBC x106/L Plat x109/L Blood Film thromboytosis tear drop cells leukoerythroblstic

47 This 24 year old man has acute abdominal pain. He has not
been feeling well for 5 days. After a baseball game he had acute upper abdominal pain and was quite tender in the upper abdomen. The surgeon asks you to see the patient. Test results Hgb g/L MCV fL RBC x1012/L WBC x106/L Plat x109/L Blood Film

48 What is the disorder most likely responsible for his condition ?
A. Acute leukemia B. Pancreatitis C. Malaria D. Infectious mononucleosis E. Liver abcess

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50 This 24 year old man has acute abdominal pain. He has not
been feeling well for 5 days. After a baseball game he had acute upper abdominal pain and was quite tender in the upper abdomen. The surgeon asks you to see the patient. Test results Hgb g/L MCV fL RBC x1012/L WBC x106/L Plat x109/L Blood Film variant lymphocytes atypical reactive

51 This 55 year old man is referred for unexplained elevated
White cell count. He feels well. Examination is normal. Test results Hgb g/L MCV fL RBC x1012/L WBC x106/L Plat x109/L Blood Film

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53 What test would confirm your diagnosis ?
A. Mono spot test B. LAP score C. Bone marrow biopsy D. Immunophenotyping E. Skeletal survey

54 This 55 year old man is referred for unexplained elevated
White cell count. He feels well. Examination is normal. Test results Hgb g/L MCV fL RBC x1012/L WBC x106/L Plat x109/L Blood Film Lymphocytosis Smudge cells

55 This 36 year old man is admitted to hospital with generalized
bruising and bleeding. He is febrile. There are many bruises and petichia present. Test results Hgb g/L MCV fL RBC x1012/L WBC 5.2 x106/L Plat x109/L Blood Film

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57 What disease is most responsible for his condition ?
A. Septicemia B. Drug reaction C. Infectious mononucleosis D. Chronic leukemia E. Acute leukemia

58 This 36 year old man is admitted to hospital with generalized
bruising and bleeding. He is febrile. There are many bruises and petichia present. Test results Hgb g/L MCV fL RBC x1012/L WBC 5.2 x106/L Plat x109/L Blood Film Cytopenias Blasts

59 This is a 65 year old male who at retirement has his last regular work medical checkup. He is a bit fatigued but otherwise well. Test Results Hgb g/L MCV fL RBC 4.3x1012/L WBC 5.2x106/L Plat x109/L Blood film

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61 What test would best establish the diagnosis ?
A. Serum iron and iron binding capacity B. Serum B12 C. Urine hemosiderin D. Bone marrow aspirate E. Serum transferrin

62 This is a 65 year old male who at retirement has his last regular work medical checkup. He is a bit fatigued but otherwise well. Test Results Hgb g/L MCV fL RBC 4.3x1012/L WBC 5.2x106/L Plat x109/L Blood film Normocytic Normochromic Microcytic Hypochromic Dimorphic population

63 This is a 35 year old male who is found to have persistent leukocytosis. His family physician wants you to rule out a Chronic leukemia. Test Results HGB g/L MCV fL RBC x1012/L WBC 25X106/L Plat x109/L Blood Film

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65 What test would be most cost effective in helping to establish a diagnosis ?
A. Immunophenotyping B. Leukocyte alkaline phosphatase C. Bone marrow aspirate D. Cytogenetics E. Blood cultures

66 This is a 35 year old male who is found to have persistent leukocytosis. His family physician wants you to rule out a Chronic leukemia. Test Results HGB g/L MCV fL RBC x1012/L WBC 25X106/L Plat x109/L Blood Film Normocytic Normochromic Neutrophilia Metamyelocyte

67 A 75 year old woman is admitted to hospital because of pneumonia
A 75 year old woman is admitted to hospital because of pneumonia. She has not been feeling well for some months. Test Results HGB 96 g/L MCV fL RBC x1012/L WBC 2.4x106/L Plat 74x109/L Blood Film

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69 A 75 year old woman is admitted to hospital because of pneumonia
A 75 year old woman is admitted to hospital because of pneumonia. She has not been feeling well for some months. Test Results HGB 96 g/L MCV fL RBC x1012/L WBC 2.4x106/L Plat 74x109/L Blood Film Macrocytes Mild pancytopenia

70 Which test would you do next ?
A. Reticulocyte count B. Serum B12 and Folate C. Thyroid function tests D. Liver function tests E. Bone marrow aspirate and biopsy

71 Which do you think is the most likely ?
A. RA - Refractory anemia B. RARS - Refractory anemia , ring sideroblasts C. RAEB - Refractory anemia excess blasts D. RAEBt - RAEB in transformation to Acute

72 A 25 year old female university student is found to have a very low hemoglobin. She in fact feels fairly well. Physical exam shows pallor only. Test Results HGB g/L MCV 80 fL RBC 2.7x1012/L WBC 6.3x106/L Plat x109/L Blood Film

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74 Which test do you think will give the diagnosis ?
A. Iron studies B. Reticulocyte count C. Endocrine studies D. Liver function E. Renal function

75 A 25 year old female university student is found to have a very low hemoglobin. She in fact feels fairly well. Physical exam shows pallor only. Test Results HGB g/L MCV 80 fL RBC 2.7x1012/L WBC 6.3x106/L Plat x109/L Blood Film Irreg contracted Burr cells

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