A patient shows prolonged prothrombin time and activated partial thromboplastin time. Blood test otherwise is normal. Which of the following is the most probably diagnosis for this patient's condition?

Correct Answer: D

Rationale: The correct answer is D) Vitamin K deficiency. Prothrombin time (PT) and activated partial thromboplastin time (aPTT) are both tests used to assess the clotting function of the blood. Prolonged PT and aPTT indicate an impairment in the clotting cascade, which involves factors that require vitamin K for their synthesis. Vitamin K is crucial for the synthesis of clotting factors II, VII, IX, and X. Therefore, a deficiency in vitamin K can lead to impaired clotting function, resulting in prolonged PT and aPTT. Now let's analyze why the other options are incorrect: A) Hemophilia A is a genetic disorder caused by a deficiency in factor VIII, which results in prolonged aPTT but not PT. Since both PT and aPTT are prolonged in this case, hemophilia A is not the likely diagnosis. B) Thrombocytopenia is a condition characterized by a low platelet count, which can lead to bleeding disorders. However, it typically does not affect clotting factors measured by PT and aPTT, so it is not the most probable diagnosis in this case. C) Von Willebrand disease is a genetic disorder that affects the von Willebrand factor and platelet function. It can lead to bleeding disorders, but it does not typically cause prolonged PT and aPTT, making it an unlikely diagnosis in this scenario. Educational context: Understanding the interpretation of clotting tests like PT and aPTT is essential for healthcare professionals, especially those working in hematology or coagulation clinics. Recognizing the specific patterns of abnormalities in these tests can help in diagnosing underlying conditions accurately and guiding appropriate treatment strategies. Knowledge of vitamin K deficiency as a cause of prolonged PT and aPTT is crucial in clinical practice to ensure prompt intervention and management.

Correct Answer: A

Rationale: In this case, the correct answer is A) Associated with translocation of c-myc gene on chromosome 18. Burkitt's lymphoma is indeed associated with a translocation involving the c-myc gene on chromosome 8, not chromosome 18. This genetic abnormality plays a crucial role in the pathogenesis of Burkitt's lymphoma by leading to the dysregulation of cell growth and division. Option B is incorrect because Burkitt's lymphoma typically presents with jaw and facial bone involvement, rather than abdominal involvement in HIV patients. Option C is incorrect as the development of Burkitt's lymphoma in African children is primarily linked to Epstein Barr virus infection, with malaria exposure not being a significant factor. Option D is incorrect because Burkitt's lymphoma is histologically characterized by a "starry sky" appearance, where macrophages phagocytose apoptotic tumor cells, giving the background a starry appearance. Educationally, understanding the genetic basis, clinical presentation, and histological features of Burkitt's lymphoma is crucial for healthcare professionals, especially hematologists and oncologists. This knowledge is essential for accurate diagnosis, appropriate treatment selection, and better patient outcomes. By differentiating between the true and false statements related to Burkitt's lymphoma, learners can deepen their understanding of this specific type of lymphoma and improve their clinical decision-making skills.

Correct Answer: B

Rationale: In a patient infected with hookworms, anemia can occur due to blood loss from the parasites feeding on the host's blood. Basophilic stippling is seen in the peripheral blood smear of a patient with lead poisoning or thalassemia, conditions that can result in anemia. Basophilic stippling indicates abnormal RNA in red blood cells and is not specific to hookworm infection but can be present due to other underlying conditions causing anemia. Howell-Jolly bodies are remnants of the nucleus found in red blood cells. They are typically seen in conditions affecting erythropoiesis, such as megaloblastic anemias or after splenectomy, and are not directly related to hookworm infection-induced anemia. Target cells are seen in conditions like liver disease or hemoglobinopathies, where the red blood cells have an excess of cell membrane relative to the amount of hemoglobin. They are not specific to hookworm infection-induced anemia. Spherocytes are seen in conditions like autoimmune hemolytic anemia or hereditary spherocytosis, where red blood cells have a spherical shape due to loss of membrane surface area. This morphology is not typically associated with hookworm infection-induced anemia. Educationally, understanding the different morphological changes in red blood cells seen in various conditions helps in diagnosing and managing patients with anemia. Recognizing basophilic stippling in the context of hookworm infection-induced anemia can guide appropriate treatment strategies for the patient.

Correct Answer: D

Rationale: Koilonychias, also known as spoon nails, is a specific feature associated with iron deficiency anemia (Option D). This condition causes the nails to become brittle, thin, and concave in shape, resembling a spoon. The rationale behind why iron deficiency anemia is the correct answer lies in understanding the role of iron in the body. Iron is essential for the production of hemoglobin, the protein in red blood cells that carries oxygen to tissues. When there is a deficiency of iron, the body is unable to produce an adequate amount of healthy red blood cells, leading to anemia and characteristic symptoms like koilonychias. Looking at the other options: - Haemolytic anemia (Option A) is characterized by the premature destruction of red blood cells, but it is not typically associated with koilonychias. - Sickle cell disease (Option B) is a genetic disorder affecting hemoglobin structure, leading to sickle-shaped red blood cells. While nail changes can occur in sickle cell disease, koilonychias are not a typical feature. - Thalassemia major (Option C) is a genetic disorder affecting hemoglobin production, but it is not commonly associated with koilonychias. In an educational context, understanding the specific clinical manifestations associated with different types of anemia is crucial for healthcare providers to make accurate diagnoses and provide appropriate treatment. Recognizing koilonychias as a key indicator of iron deficiency anemia can prompt healthcare professionals to further investigate the patient's iron status and implement necessary interventions to address the underlying cause of the anemia.

Correct Answer: D

Rationale: The correct answer is D) Aplastic anaemia. Aplastic anemia is characterized by a decrease in all three blood cell types (red blood cells, white blood cells, and platelets) due to failure of the bone marrow to produce these cells. In the case presented, the patient's symptoms of frequent infections, subcutaneous petechiae, low hemoglobin, and dry tap marrow are indicative of aplastic anemia. Option A) Iron deficiency anemia is characterized by low hemoglobin due to inadequate iron levels, but it typically does not present with frequent infections or a dry tap marrow. Option B) Megaloblastic anemia is usually caused by vitamin B12 or folate deficiency, leading to large, immature red blood cells. It does not typically present with the symptoms described in the scenario. Option C) Hemolytic anemia is characterized by the premature destruction of red blood cells, leading to anemia. It is unlikely to manifest with the combination of symptoms seen in the patient in this case. Educationally, understanding the different types of anemia and their characteristic features is crucial for healthcare providers to make accurate diagnoses and provide appropriate treatment. Recognizing the specific signs and symptoms of aplastic anemia, such as pancytopenia and dry tap marrow, helps in differentiating it from other types of anemia and guiding management strategies for the patient.