A 9-month-old boy appears pale. Examination reveals a palpable liver $3 \mathrm{~cm}$ below the right costal margin and palpable spleen $4 \mathrm{~cm}$ below the left costal margin. Lab findings include: hemoglobin concentration, 6.4 g/dl; mean corpuscular volume (MCV), 67 fL; and WBC, 15,000/mm3. Of the following, The MOST valuable test to confirm the diagnosis is

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Question 1 of 5

A 9-month-old boy appears pale. Examination reveals a palpable liver $3 \mathrm{~cm}$ below the right costal margin and palpable spleen $4 \mathrm{~cm}$ below the left costal margin. Lab findings include: hemoglobin concentration, 6.4 g/dl; mean corpuscular volume (MCV), 67 fL; and WBC, 15,000/mm3. Of the following, The MOST valuable test to confirm the diagnosis is

Correct Answer: C

Rationale: Microcytic anemia (MCV 67 fL), hepatosplenomegaly, and severe anemia at 9 months suggest thalassemia major. Hemoglobin electrophoresis (C) confirms elevated Hb F and absent Hb A, more specific than smear (A), iron studies (B), marrow (D), or US (E).

Question 2 of 5

Of the following, the LEAST likely feature of acute immune thrombocytopenia (ITP) is

Correct Answer: D

Rationale: Acute ITP features viral trigger (A), thrombocytopenia (B), bleeding (C), and marrow megakaryocytes (E). Isolated splenomegaly (D) is rare, suggesting other causes like hypersplenism.

Question 3 of 5

Inherited thrombocytopenias include all the following EXCEPT

Correct Answer: C

Rationale: CAT (A), TAR (B), Bernard-Soulier (D), and WAS (E) are thrombocytopenias. Glanzmann’s (C) is a qualitative defect with normal counts.

Question 4 of 5

Constrictive pericarditis secondary to radiation exposure with sings of increase in pulmonary pressure. The child received a course of irradiation which leads to

Correct Answer: B

Rationale: Radiation (B) is a known cause of constrictive pericarditis, supported by Kussmaul sign and right-sided signs. TB (A) is rare, others (C, D) less likely given history.

Question 5 of 5

Which of the following symptoms/sings is a manifestation of anemia?

Correct Answer: D

Rationale: Fatigue (D) is a classic anemia symptom due to reduced oxygen delivery; others are less specific.

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