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: The correct answer is A: Low total iron binding capacity. In this case, the patient is showing signs of iron deficiency anemia. Low total iron binding capacity is not expected because in iron deficiency anemia, the total iron binding capacity is typically elevated as the body tries to increase its capacity to bind and transport iron. High serum transferrin and low iron: total iron binding capacity ratio are expected findings in iron deficiency anemia, as the body increases the production of transferrin to compensate for low iron levels. Low serum ferritin is also expected as it is a marker of decreased iron stores in the body. Therefore, choice A is the correct answer as it contradicts the typical laboratory findings seen in iron deficiency anemia.

Correct Answer: D

Rationale: The correct answer is D: RA with excess blasts in transformation. This choice has the poorest prognosis because it represents a progression of RA with excess blasts, indicating a higher percentage of blast cells in the bone marrow. This progression signifies a more aggressive form of the disease with a worse outcome. A: Refractory anemia (RA) is a milder form with a better prognosis compared to the other choices. B: RA with ring sideroblasts is a subtype of RA, and while it may have some adverse features, it generally has a better prognosis than RA with excess blasts. C: RA with excess blasts represents a higher risk group, but it is not as severe as RA with excess blasts in transformation, which indicates a further deterioration of the disease. In summary, D is the correct answer because it signifies the most advanced stage of the disease with the highest risk and poorest prognosis compared to the other choices.

Correct Answer: C

Rationale: The correct answer is C, chronic myelocytic leukemia. The presence of increased numbers of neutrophils at various stages of maturation, along with increased basophils, eosinophils, and platelets, is characteristic of chronic myelocytic leukemia. This condition is marked by a myeloproliferative disorder, leading to an overproduction of myeloid cells in the bone marrow. Acute myeloid leukemia (choice A) typically presents with a high number of blast cells rather than mature neutrophils. Acute lymphoid leukemia (choice B) primarily involves lymphoid cells, not myeloid cells. Chronic lymphocytic leukemia (choice D) is characterized by the accumulation of mature lymphocytes, not myeloid cells as seen in this case.

Correct Answer: A

Rationale: Step 1: Visceral leishmaniasis is transmitted by sand flies. Step 2: In the Asian region, the main vector of visceral leishmaniasis is Phlebotomus species. Step 3: Phlebotomus species are known to transmit the Leishmania parasite in Asia. Step 4: Lutzomyia species are the main vector in the Americas. Step 5: Anopheles species are vectors for malaria, not leishmaniasis. Step 6: Mansonia species are vectors for diseases like filariasis, not leishmaniasis. Summary: Choice A is correct because Phlebotomus species are the main vector of visceral leishmaniasis in the Asian region, while choices B, C, and D are incorrect as they are not the main vectors for this disease in that specific geographical area.

Correct Answer: A

Rationale: The correct answer is A: vasculitis. Thalassemia major primarily causes abdominal pain due to complications such as splenic infarction, dragging pain from splenomegaly, and pigment stones in the gall bladder. Vasculitis is not a common complication of thalassemia major, making it the exception. Vasculitis is inflammation of blood vessels, not typically associated with abdominal pain in thalassemia. Therefore, A is the correct answer.