Medicine
Hematology
A patient with chronic myeloid leukemia most characteristically has which genetic abnormality?
A. BCR-ABL1 fusion
B. JAK2 V617F in every case
C. PML-RARA
D. MYC translocation only
Correct Answer: A
CML is defined by the Philadelphia chromosome resulting in the BCR-ABL1 tyrosine kinase fusion.
Medicine
Hematology
A patient with immune thrombocytopenia has platelets 8,000/µL and active mucosal bleeding. Which initial treatment is appropriate?
A. Corticosteroids with IVIG when rapid rise is needed
B. Warfarin
C. Aspirin
D. Iron chelation
Correct Answer: A
Severe ITP with bleeding requires treatment to raise platelet counts rapidly, commonly corticosteroids and IVIG depending on severity.
Medicine
Hematology
A young man has recurrent hemarthroses, prolonged aPTT and normal PT and platelet count. What is the most likely disorder?
A. Hemophilia
B. Vitamin K deficiency
C. DIC
D. Immune thrombocytopenia
Correct Answer: A
Hemophilia A or B causes intrinsic-pathway factor deficiency with prolonged aPTT and deep-tissue bleeding such as hemarthroses.
Medicine
Hematology
A patient on unfractionated heparin has a platelet fall of 60% and develops a new DVT on day 7. What is the next step?
A. Stop all heparin and start a non-heparin anticoagulant
B. Increase heparin dose
C. Give platelets routinely and continue heparin
D. Switch to aspirin only
Correct Answer: A
Heparin-induced thrombocytopenia is strongly suspected with a major platelet fall and new thrombosis; heparin should be stopped and alternative anticoagulation started.
Medicine
Hematology
Which laboratory pattern is most typical of disseminated intravascular coagulation?
A. Prolonged PT/aPTT, low fibrinogen, high D-dimer
B. Normal coagulation tests with isolated neutropenia
C. High fibrinogen with normal D-dimer
D. Isolated prolonged bleeding time only
Correct Answer: A
DIC consumes clotting factors and platelets, causing prolonged coagulation times, reduced fibrinogen and elevated fibrin degradation products.
Medicine
Hematology
A patient has thrombocytopenia, microangiopathic hemolytic anemia, neurologic symptoms, fever and renal dysfunction. Which treatment should be started urgently for suspected TTP?
A. Plasma exchange
B. Platelet transfusion alone
C. Oral iron
D. Warfarin
Correct Answer: A
TTP is a thrombotic microangiopathy and requires urgent plasma exchange; treatment should not await confirmatory ADAMTS13 results when suspicion is high.
Medicine
Hematology
A patient with sickle cell disease develops chest pain, fever, hypoxemia and a new pulmonary infiltrate. What is the diagnosis?
A. Acute chest syndrome
B. Simple vaso-occlusive pain crisis only
C. Pulmonary edema from nephrotic syndrome
D. Asthma only
Correct Answer: A
New pulmonary infiltrate with respiratory symptoms in sickle cell disease defines acute chest syndrome and requires urgent treatment.
Medicine
Hematology
A patient has macrocytic anemia, paresthesias and loss of vibration sense. Which deficiency is most likely?
A. Vitamin B12 deficiency
B. Iron deficiency
C. Vitamin K deficiency
D. Copper excess
Correct Answer: A
Vitamin B12 deficiency causes megaloblastic anemia and neurologic dysfunction involving posterior columns and peripheral nerves.
Medicine
Hematology
A woman has fatigue, pica, microcytosis and low ferritin. What is the most likely diagnosis?
A. Iron deficiency anemia
B. Anemia of chronic disease only
C. Vitamin B12 deficiency
D. Hereditary spherocytosis
Correct Answer: A
Low ferritin with microcytosis and pica strongly supports iron deficiency anemia.
Medicine
Infectious Disease
A patient with latent tuberculosis infection is about to start potent biologic immunosuppression. Why is screening and treatment important?
A. To reduce risk of TB reactivation
B. To prevent influenza
C. To cure bacterial pneumonia
D. Because biologics eliminate all vaccine responses
Correct Answer: A
Immunosuppression, especially certain biologic therapies, can reactivate latent tuberculosis, so risk assessment and treatment are important before therapy.
Medicine
Infectious Disease
A diabetic patient has rapidly progressive painful leg swelling, systemic toxicity and crepitus. What is the most appropriate management principle?
A. Urgent surgical exploration and broad-spectrum antibiotics
B. Topical antifungal cream only
C. Observe for 48 hours
D. Compression stockings only
Correct Answer: A
Necrotizing soft-tissue infection requires immediate surgical source control and broad empiric antimicrobial therapy.
Medicine
Infectious Disease
Which exposure is a major risk factor for brucellosis in the Gulf and Middle East?
A. Unpasteurized dairy products
B. Chlorinated drinking water
C. Cooked rice
D. Indoor air conditioning
Correct Answer: A
Brucellosis is associated with infected livestock and consumption of unpasteurized milk or dairy products.
Medicine
Infectious Disease
A patient with suspected dengue has fever, myalgia, thrombocytopenia and rising hematocrit. What does a rising hematocrit most strongly suggest?
A. Plasma leakage
B. Massive hemolysis only
C. Iron deficiency
D. Bacterial meningitis
Correct Answer: A
Hemoconcentration from capillary plasma leakage is a warning feature in dengue and can accompany progression toward shock.
Medicine
Infectious Disease
An immunocompromised patient has painful grouped vesicles in a dermatomal distribution. What is the diagnosis?
A. Herpes zoster
B. Impetigo
C. Molluscum contagiosum
D. Erysipelas
Correct Answer: A
Reactivation of varicella-zoster virus causes a painful unilateral vesicular eruption limited to a dermatome.
Medicine
Infectious Disease
A patient has fever, jaundice, renal failure and thrombocytopenia after freshwater exposure in a tropical area. Which infection should be considered?
A. Leptospirosis
B. Measles
C. Pertussis
D. Tinea corporis
Correct Answer: A
Severe leptospirosis can cause Weil disease with jaundice, renal failure and hemorrhagic manifestations after exposure to contaminated water.
Medicine
Infectious Disease
A patient with septic arthritis of the knee has fever, severe joint pain and a large effusion. What is the most important diagnostic procedure?
A. Urgent arthrocentesis for synovial analysis and culture
B. Serum uric acid only
C. Plain X-ray only
D. Wait for spontaneous improvement
Correct Answer: A
Septic arthritis is an emergency; synovial fluid analysis and culture are essential and should be obtained promptly.
Medicine
Infectious Disease
A patient presents after a dog bite from an animal suspected of rabies. What is the key principle of post-exposure prophylaxis in a previously unvaccinated person?
A. Wound cleansing, rabies vaccine and rabies immunoglobulin when indicated
B. Antibiotics alone
C. Tetanus vaccine alone
D. Observe for symptoms before any action
Correct Answer: A
Rabies PEP includes immediate wound care plus vaccine, with rabies immunoglobulin for category III exposures in previously unvaccinated patients when indicated.
Medicine
Infectious Disease
A patient has fever, severe headache and a petechial rash with hypotension. Which organism is a critical concern?
A. Neisseria meningitidis
B. Helicobacter pylori
C. Mycoplasma genitalium
D. Clostridium tetani
Correct Answer: A
Meningococcemia can progress rapidly with petechiae/purpura, shock and disseminated intravascular coagulation.
Medicine
Infectious Disease
A patient with tuberculosis is receiving rifampicin. Which counseling point is appropriate?
A. It may cause orange discoloration of body fluids
B. It never interacts with other drugs
C. It is safe to stop after symptoms improve
D. It causes universal deafness
Correct Answer: A
Rifampicin can discolor urine, tears and other secretions orange-red and is a potent enzyme inducer with important drug interactions.
Medicine
Infectious Disease
A patient with malaria has altered consciousness, severe anemia and renal impairment. What classification applies?
A. Severe malaria
B. Uncomplicated malaria
C. Latent malaria only
D. Malaria is excluded
Correct Answer: A
Neurologic dysfunction, severe anemia, kidney injury and other organ complications indicate severe malaria requiring urgent parenteral therapy.