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Specialty Medicine Area Haematology

Exam IMM Topic Oncology
Presenting Complaint Fatigue with
Sub-theme (Objective) Diagnosis
(Theme) progressive pallor
QUESTION STEM (Not more than 100 words)
Clinical Scenario:
A 58-year-old man presented to medical OPD with fatigue, progressive pallor and left upper
abdominal discomfort for 10 months. His blood CP shows Hemoglobin 9 gm/dL, platelet count of
457000, WBC count of 32000 with 73% neutrophils, 2% basophils, and occasional blast cells.
Bone marrow examination shows hypercellular marrow and grade 2 fibrosis, 3 % blasts with LAP
score of 3.
Lead-in: What is the most likely diagnosis?

OPTIONS (In alphabetical order)

A. Chronic Myeloid Leukemia
B. Essential Thrombocytosis
C. Myelodysplastic syndrome
D. Polycythemia Vera
E. Primary Myelofibrosis
KEY (Best/Correct option) ___A___ (A, B, C, D or E)
Cognition Level C2
Importance Essential / Important / Supplementary
Difficulty Hard / Moderate / Easy
REFERENCE: NCCN guidelines for Chronic Myeloid Leukemia v1.2019