A patient is presented with pallor, fatigue and dyspnea. Physical examination shows koilonychias and angular cheilitis. Which of the following is not expected in the laboratory finding of this patient?

Correct Answer: A

Rationale: Step 1: The patient presents with symptoms of iron deficiency anemia. Step 2: Koilonychias and angular cheilitis are characteristic of iron deficiency anemia. Step 3: Low total iron binding capacity (TIBC) is expected in iron deficiency anemia due to decreased iron stores. Step 4: High serum transferrin and low iron:TIBC ratio are also expected in iron deficiency anemia. Step 5: Therefore, the correct answer is A, as low TIBC is expected in iron deficiency anemia. Summary: B: High serum transferrin and C: Low iron:TIBC ratio are expected in iron deficiency anemia. D: Low serum ferritin is expected in iron deficiency anemia as it is a marker of decreased iron stores.

Correct Answer: D

Rationale: The correct answer is D: RA with excess blasts in transformation. This type has the poorest prognosis as it represents a progression to acute myeloid leukemia, which is associated with a high mortality rate. In the FAB system, this category indicates a higher blast count than RA with excess blasts (choice C), leading to a worse outcome. Choices A and B are associated with a lower risk of progression to AML compared to choices C and D. Therefore, D is the correct answer due to its direct association with the most aggressive form of the disease.

Correct Answer: C

Rationale: The correct answer is C: Chronic myelocytic leukemia. This is suggested by the presence of increased numbers of neutrophils, band cells, metamyelocytes, and myelocytes in the peripheral blood smear, which are characteristic of chronic myeloid leukemia. Basophils and eosinophils are also increased in CML. Platelets may be increased due to reactive thrombocytosis. Acute myeloid leukemia (A) typically presents with more blasts in the peripheral blood. Acute lymphoid leukemia (B) would show lymphoblasts instead of myeloid cells. Chronic lymphocytic leukemia (D) is characterized by an increase in mature lymphocytes, not myeloid cells.

Correct Answer: A

Rationale: The correct answer is A: Phlebotomus species. Phlebotomus species are the main vectors of visceral leishmaniasis in the Asian region. These sandfly species are known to transmit the Leishmania parasite, which causes the disease. Phlebotomus species are prevalent in the Asian region and have been identified through various studies as the primary vector for visceral leishmaniasis transmission. Summary of why other choices are incorrect: B: Lutzomyia species are primarily found in the Americas and are the main vectors for leishmaniasis in that region. C: Anopheles species are known to transmit malaria, not visceral leishmaniasis. D: Mansonia species are primarily associated with transmitting diseases such as filariasis and dengue fever, not visceral leishmaniasis in the Asian region.

Correct Answer: A

Rationale: The correct answer is A: vasculitis. Thalassemia major is a genetic blood disorder that causes anemia. Vasculitis, inflammation of blood vessels, is not a common cause of abdominal pain in thalassemia. Splenic infarction, dragging pain at huge splenomegaly, and pigment stones in the gall bladder are associated with thalassemia major due to complications such as splenomegaly and increased bilirubin levels, leading to abdominal pain. Vasculitis is not typically seen in thalassemia major patients, making it the exception among the choices.