MEDICINE PAPER FOR FINAL PROF.

2014
Note:
The Bold Option is the Answer of the Question. i.e Question No 1 answer is b.

QUESTION NO1.

A 40 years old woman presents to medical OPD with a three months history of tiredness, weight
loss, and vague abdominal pains, polyuria and polydipsia. Systemic examination is normal except a
Area
small mass in front of the neck. Chest X ray normal, RBS 120mg%, / Topic:_____________________
RFTs & TFTs are normal, Serum
______
calcium 16mg/dl, serum phosphate decreased, alkaline phosphatase 500 IU/liter (normal 20-140).
Ultrasound abdomen shows right renal stones.What is the most likely diagnosis?

a. Primary hyperparathyroidism
b. Primary hyperthyroidism
c. Vitamin D intoxication
d. Chronic renal failure
e. Sarcoidosi

QUESTION NO2.

A 35 years old man presents with 7 months history of palpitations and intermittent diarrhea. He
feels restless and hungry and has lost 5 kilos of weight. His heart rate is 120/min and irregular: BP
is 150/70. Examination of the abdomen, nervous system and chest is normal. There is a swelling in
front of his neck. Full blood count, blood sugar and LFTs are normal. Further workup has confirmed
primary hyperthyroidism (increased T3, T4 and decreased TSH). What is the most common cause
of hyperthyroidism?

a. Multinodular goiter
b. Toxic adenoma
c. Graves disease
d. Thyroiditis

QUESTION NO3:

A 15 years old boy is brought to medical OPD by his mother in drowsy state. He is a known
case of type 1 Diabetes Mellitus. Three days ago he developed productive cough and fever and he
stopped insulin. O/E he is dehydrated, Pulse is 130/min, BP 100/70 mmHg, temperature 104°F. His
breathing is deep and rapid. Crepitations on the right side of the chest. Blood sugar is 500mg/dl,
TLC 16000 with 90% neutrophils, blood urea 60mg/dl and serum creatinine 1.4mg/dl. What is your
most likely diagnosis?

a. Hyperosmolar non ketotic coma

b. Hypoglycemic brain injury
c. Diabetic ketoacidosis
d. Acute renal failure

QUESTION NO4:
 A 45 years old lady has come to the medical OPD with a complaint of increasing fatigue,
somnolence, constipation and body aches. These symptoms have gradually increased over last
two years. Her weight has increased; the menstrual cycle is irregular and has difficulty in hearing.
She looks pale. The skin is dry and the voice is hoarse. The pulse is 59/min and regular. Blood
pressure is 130/80 mmHg. Thyroid function tests confirmed primary hypothyroidism. What is the
most sensitive test for thyroid function?

a. Thyroid stimulating hormone (TSH)

b. Radioactive iodine uptake
c. Antibodies screening test
d. Thyroid hormones T3, T4
e. Serum thyroglobulin

QUESTION NO5:

A 42 yrs old female presented with 6 months history of worsening headache with
deteriorating vision in both eyes and polyuria. She is taking treatment for carpel tunnel
syndrome. She has consulted her physician for menstrual irregularities and galactorrhea.
She admitted rapid increase in the size of shoes and tight finger rings. Her BP was 190/110
mmHg and pulse was 82/min. Investigations have confirmed Acromegaly. Which one of
the following is best treatment option for Acromegaly?
a. Trans-sphenoidal surgery
b. GH receptor antagonists
c. Somatostatin analogues
d. Dopamine antagonists
e. Dopamine agonists

QUESTION NO6:

28 years old married lady presented to the medical OPD with the complaints of weight
gain and depression. Examination revealed that she is overweight, BP is 190/100 mmHg. Her skin
is thin and there are bruises on the arms and legs. Recently she was examined by
ophthalmologist who found that she had bitemporal hemianopia. The random blood sugar is
250mg%.You are suspecting Cushing syndrome, which one of the following tests is the gold
standard for confirmation of Dx?

a. Low dose DM suppression

b. High dose DM suppression
c. 24 hours urinary cortisol
d. Serum cortisol levels
e. Serum ACTH levels

QUESTION NO7:

35 years young man presented with chronic fatigue, lethargy, depression, weight loss and
orthostatic hypotension. His blood pressure is 90/60. Random blood sugar is 90 mg/dl and Serum
sodium130mEq/l. you have managed this patient well & have confirmed hypocortisolism through
proper investigations. Which one of the following is most common cause of hypocortisolism
(Addison’s disease)?

a. Sudden withdrawal of steroids

b. Pituitary gland destruction
c. Adrenal gland destruction
d. Adrenal gland tuberculosis
QUESTION NO8:

28 years old married lady presented to the medical OPD with the complaints of
weight gain and depression. Examination revealed that she is overweight, BP is 190/100 mmHg.
Her skin is thin and there are bruises on the arms and legs. The random blood sugar is 250mg%.
You are suspecting hypercortisolism, which one of the following is most common cause of
hypercortisolism?

a. Autoimmune disease
b. Exogenous steroids
c. Pituitary adenoma
d. Ectopic ACTH focus
e. Adrenal neoplasm

QUESTION NO9:

A 22 years young man reports with progressive pallor, easy fatigability and lack of
energy for the last 6 months. Eight years ago he was operated after fire arm injury in the right side
of the abdomen, caecum and terminal ileum resected with ileocoloic anastomosis. On
examination, he looks pale; there is no purpura or bruising. Liver and spleen are not enlarged.
Investigations show Hb was 8gm%, MCV 114, RFTs and LFTs normal. Which one of the following is
most likely cause?

a. Autoimmune hemolytic anemia

b. Folate deficiency anemia
c. Iron deficiency anemia
d. Vitamin B12 deficiency

QUESTION NO10:

60 years male presented with fatigue, weight loss and pain in the left
hypochondrium for the last 6months. On examination there was no lymphadenopathy & he has
huge firm spleen palpable up to the umbilicus (massive splenomegaly). FBC reveals TLC 140000,
Neutrophils= 80%, Lymphocytes=15%, Basophils=5%. Urea, sugar, LFTs & LDH were normal.
Repeated slides for malarial parasites were negative and the portal vein diameter was normal.
What is the most likely diagnosis?

a. Chronic lymphocytic leukemia

b. Chronic myeloid leukemia
c. Iron deficiency anemia
d. Malignant lymphoma
e. Multiple myeloma

QUESTION NO11:

A 25 year male was admitted with severe pain all over the chest following
gastroenteritis. The pain was very severe and would response to narcotic analgesic injections. In
the past he had decompression for priapism at the age of ten, ischemic stroke at the age of fifteen
and a vascular necrosis of right femoral head at the age of 20. On examination his temperature is
normal, blood pressure 90/60mmHg, pulse 120, pale, uncomfortable and moaning with pain. His
hemoglobin was 6gm/dl, normal TLC, DLC and platelet count. The mode of inheritance for likely
cause is?

a. Autosomal dominant
b. Autosomal recessive
 c. X-linked recessive
d. X-linked dominant

QUESTION NO12:

A sixty years old female with history of auto immune hypothyroidism presented with
weakness. She is also complaining of tingling in her fingers & toes. On examination she is pale and
has loss of vibration and position sense in her feet. Her Hb is 9 gm/dl, TLC, DLC, platelet count,
serum folate, LFTs, RFTs and TFTs normal (taking thyroxin 200 microgram per day). There is no
history of diarrhea or any surgery in the past. Her MCV is 120. Most likely cause for her anemia is?

a. Autoimmune hemolytic anemia

b. Anemia of chronic disease
c. Folate deficiency anemia
d. Iron deficiency anemia
e. Pernicious anemia

QUESTION NO13:

A 25 year male was admitted with severe pain all over the chest
following gastroenteritis. The pain was very severe and would response to narcotic analgesic
injections. In the past he had decompression for priapism at the age of ten, ischemic stroke at the
age of fifteen and a vascular necrosis of right femoral head at the age of 20. On examination his
temperature is normal, blood pressure 90/60mmHg, pulse 120, pale, uncomfortable and moaning
with pain. His hemoglobin was 6gm/dl, normal TLC, DLC and platelet count. Which one of the
following tests is used to investigate the cause?

a. Osmotic fragility test

b. Metabisulfite test
c. Schillings test
d. Coombs test
e. Hams test

QUESTION NO14:

A 20 years old lady, recently married presents with high grade fever, easy
bruiseability, generalized aches and pains and sore throat. Mother-in-law reports that she had two
episodes of epistaxis and bleeding from gums. She looks pale and toxic. Skin shows purpura and
bruises shins. Pulse 110/min, BP110/80mmHg. Hb 8gm%, Platelets₌ 40,000/mm3 and TLC
₌1500/mm3. You have confirmed Aplastic anemia through bone marrow biopsy. What is the most
common cause of Aplastic anemia?

a. Cytotoxic drugs
b. Radiations
c. Infections
d. Idiopathic
e. Thymoma
QUESTION NO15:

A 30 years old lady presents with one year history of easy fatigability, recurrent weakness of limbs
with reversible diplopia, which is worse during the evening time and better on waking up in the
morning. On examination she is hemodynamically stable. On sustained upward gaze she has
decreased frowning of her forehead and develops ptosis. She also has weakness of her sustained
grip. Biochemistry, FBC normal and X-ray chest shows mediastinal widening. Which of the
following will confirm your diagnosis?

a. Nerve conduction studies

b. Serum vitamin B12 levels
c. Electromyography (EMG)
d. Brain imaging (CT scan)

QUESTION NO16:

A 30 years old lady presents with one year history of easy fatigability,
recurrent weakness of limbs with reversible diplopia, which is worse during the evening time and
better on waking up in the morning. On examination she is hemodynamically stable. On sustained
upward gaze she has decreased frowning of her forehead and develops ptosis. She also has
weakness of her sustained grip. Biochemistry, FBC are normal and X-ray chest shows mediastinal
widening. Which one of the following has strong association with underlying pathology?

a. Campylobacter jejuni infection

b. Thymic hyperplasia/Thymoma
c. Respiratory tract infection
d. Underlying malignancy

QUESTION NO17:

A 65 years old man presented to your clinic with 2 years history of productive cough of white
sputum and exertional dyspnea for last four months. He is chain smoker for last 35 years. His echo
is normal with ejection friction of 60%, spirometry reveals FEV1/FVC of 50% with minimal/NO
reversibility after 3weeks trial of steroids. Which one is the most likely diagnosis?

a. Bronchogenic carcinoma
b. Ischemic heart disease
c. Asthma exacerbation
d. Interstitial lung disease
e. Chronic obstructive pulmonary disease

QUESTION NO18:

A 30 years old lady presents with one year history of easy fatigability, recurrent weakness of limbs
with reversible diplopia, which is worse during the evening time and better on waking up in the
morning. On examination she is hemodynamically stable. On sustained upward gaze she has
decreased frowning of her forehead and develops ptosis. She also has weakness of her sustained
grip. Biochemistry, FBC normal and X-ray chest shows mediastinal widening. Which of the
following is the most your diagnosis?

a. Guillain-Barre syndrome
b. Cerebrovascular disease
c. Myasthenia gravis
d. Multiple sclerosis
e. Metastatic cancer
QUESTION NO19:

A 22 years girl had an upper respiratory infection/diarrheal illness about 10 days back.
Now she has developed tingling and weakness in her both lower limbs. Three days later she
developed bladder and bowel incontinence. On examination, the patient has bilateral lower limbs
weakness and loss of reflexes (her knee and ankle jerks are absent bilaterally). FBC, electrolytes,
RFTs and LFTs, X-ray chest and X-rays of lumbar and dorsal spine were normal. What is your most
likely diagnosis?

a. Guillain-Barre syndrome
b. Cerebrovascular disease
c. Myasthenia gravis
d. Multiple sclerosis
e. Metastatic cancer

QUESTION NO20:

A 22 years girl had an upper respiratory infection/diarrheal illness about 10 days

back. Now she has developed tingling and weakness in her both lower limbs. Three days later she
developed bladder and bowel incontinence. On examination, the patient has bilateral lower limbs
weakness and loss of reflexes (her knee and ankle jerks are absent bilaterally). FBC, electrolytes,
RFTs and LFTs, X-ray chest and X-rays of lumbar and dorsal spine were normal. Which is
confirmatory test for GBS?

a. Nerve conduction studies

b. Serum vitamin B12 levels
c. Electromyography (EMG)
d. Brain imaging (CT scan)
e. LP and CSF analysis

QUESTION NO21:

A 40 years old man brought to emergency department with two days history of high grade fever,
headache, nausea and vomiting. On examination febrile (101F), vitally stable and he is found to
have neck stiffness and photophobia. Rest of the systemic examination is normal. Investigations
showed normal biochemistry, chest x-ray and neutrophilic leukocytosis.What is your most likely
clinical diagnosis?

a. Subarachnoid hemorrhage
b. Tuberculous meningitis
c. Bacterial meningitis
d. Viral encephalitis

QUESTION NO22:

A 40 years old man brought to emergency department with two days history of
high grade fever, headache, nausea and vomiting. On examination febrile (101F), vitally stable and
he is found to have neck stiffness and photophobia. Rest of the systemic examination is normal.
Investigations showed normal biochemistry, chest x-ray and neutrophilic leukocytosis. Which one
of the following is the investigation of choice to confirm your clinical diagnosis?

a. Brain imaging
b. Blood culture
c. CSF analysis
d. Blood smear
QUESTION NO23:

A 40 years old man brought to emergency department with two days history of high grade fever,
headache, nausea and vomiting. On examination febrile (101F), vitally stable and he is found to
have neck stiffness and photophobia. Rest of the systemic examination is normal. Investigations
showed normal biochemistry, chest x-ray and neutrophilic leukocytosis.Which one of the following
is most common pathogen responsible for meningitis in adults?

a. Streptococcus pneumoniae
b. Neisseria Meningitidis
c. Staphylococcus aureus
d. Streptococcus pyogenes
e. Haemophilus influenza

QUESTION NO24:

A 40 years old man brought to emergency department with two days history of
high grade fever, headache, nausea and vomiting. On examination febrile (101F), vitally stable and
he is found to have neck stiffness and photophobia. Rest of the systemic examination is normal.
Investigations showed normal biochemistry, chest x-ray and neutrophilic leukocytosis.If patient
with meningitis develops a rash, which one of the following is most likely pathogen?

a. Streptococcus pneumoniae
b. Staphylococcus aureus
c. Streptococcus pyogenes
d. Haemophilus influenza
e. Neisseria Meningitidis

QUESTION NO25:

A 60 years old gentleman with poorly controlled hypertension presents with

sudden onset severe occipital headache, vomiting and photophobia followed by loss of
consciousness. On examination he is irritable with stiffness of neck with positive kerning’s sign.
Temperature is normal, blood pressure 200/120 and cell counts are normal. What is most likely
clinical diagnosis?

a. Subarachnoid hemorrhage
b. Tuberculous meningitis
c. Bacterial meningitis
d. Brain abscess/tumors

QUESTION NO26:

A 60 years old gentleman with poorly controlled hypertension presents with

sudden onset severe occipital headache, vomiting and photophobia followed by loss of
consciousness. On examination he is irritable with stiffness of neck with positive kerning’s sign.
Temperature is normal, blood pressure 200/120 and cell counts are normal. What is most likely
cause of this patient illness?

a. Mycobacterium tuberculosis
b. Streptococcus pneumoniae
c. Arteriovenous fistula
d. Berry aneurysms
QUESTION NO27:

A 40 years old man from poor family from Afghanistan presented with four weeks
history of low grade fever, weight loss, headaches, anorexia and intermittent vomiting. For last
few days he is confused & disoriented. O/E vitally stable, febrile 99F and mild neck stiffness. Rest
of the examination and baseline investigations within normal limits.CSF analysis showed increased
proteins (100mg/dl), decreased sugar (30mg/dl) and increased TLC (2000/mm3) with 90%
lymphocytes. What is your most likely diagnosis?

a. Subarachnoid hemorrhage
b. Tuberculous meningitis
c. Bacterial meningitis
d. Viral encephalitis
e. Viral meningitis

QUESTION NO28:

A 32years old woman comes to the emergency department complaining of numbness and
tingling in her right hand for last two days with progressive worsening of symptoms. Three years
back she had an episode of diplopia that lasted for more than 24hours and resolved
spontaneously. O/E increased spasticity in her both lower limbs and hyper-reactive reflexes. What
is your likely diagnosis?

a. Guillain-Barre syndrome
b. Cerebrovascular disease
c. Vitamin B12 deficiency
d. Myasthenia gravis
e. Multiple sclerosis

QUESTION NO29:

A 25 years old lady came to the medical OPD with a history of anorexia, low grade fever, cough
and night sweats for the last six months. She has lost five kg of weight. She looks pale. There is no
hepato-splenomegaly or palpable lymph nodes. There are crackles in the left upper chest.
Temperature is 101°F, BP 110/60mm Hg. ESR 95mm at the end of first hour, TLC 9000, neutrophils
70%, lymphocytes 30%. What is the most likely diagnosis?

a. Interstitial lung disease

b. Pulmonary tuberculosis
c. Cystic fibrosis
d. Bronchiectasis
e. Pneumonia

QUESTION NO30:

A 25 years old man comes to you with 3 years history of productive cough (greenish
and copious) and fouls smelling breath. For last three days he has hemoptysis, fever and chest
pain with cough. He is very thin, pale, with bilateral clubbing of the fingers and toes. He has coarse
crepitations at the right upper zone. He was successfully treated for pulmonary TB in the past. He
also gives you history of recurrent pneumonias and five times hospitalized for pneumonias. What
is the most likely underlying cause?

a. Interstitial lung disease

b. Pulmonary tuberculosis
 c. Bronchogenic carcinoma
d. Bronchiectasis

QUESTION NO31:

A 35 years old female returned from hajj, she had been taking pills to avoid menstruation. She
had a right swollen calf and had been complaining of dyspnea and chest pain. She collapsed at the
airport. At the hospital she was pale and clammy with tachycardia, blood pressure of 70/40. On
examination her JVP was raised, she had a loud P2 at the left sternal border. Clinical examination
revealed clear lung fields. What is the most likely diagnosis?

a. Pulmonary Thromboembolism
b. Acute myocardial infarction
c. Tension Pneumothorax
d. Left ventricular failure

QUESTION NO32:

A 35 years old female returned from hajj, she had been taking pills to avoid
menstruation. She had a right swollen calf and had been complaining of dyspnea and chest
pain. She collapsed at the airport. At the hospital she was pale and clammy with
tachycardia, blood pressure of 70/40. O/E her JVP was raised, she had a loud P2 at the left
sternal border and clear lung fields.What is the gold standard test to confirm Dx of
Pulmonary Thromboembolism?

a. Magnetic resonance Imaging

b. CT pulmonary angiogram
c. Ventilation perfusion scan
d. High resolution CT scan
e. D-dimers assay

QUESTION NO33:

A 25 years old man comes to you with 3 years history of productive cough
(greenish and copious) and fouls smelling breath. He is very thin, pale, with bilateral clubbing of
the fingers and toes. He has coarse crepitations at the right upper zone. He was successfully
treated for pulmonary TB in the past. You suspect bronchiectasis and you order for HRCT. Which of
the following is not a cause of bronchiectasis?

a. Recurrent pneumonias
b. Bronchogenic carcinoma
c. Left ventricular failure
d. Kartagener syndrome
e. Cystic fibrosis

QUESTION NO34:

A 25 years old man comes to you with 3 years history of productive cough (greenish and copious)
and fouls smelling breath. He is very thin, pale, with bilateral clubbing of the fingers and toes. He
has coarse crepitations at the right upper zone. He was successfully treated for pulmonary TB in
the past.Recalling causes of clubbing which of the following is not a cause of clubbing.

a. Malignant Mesothelioma
b. Bronchogenic carcinoma
c. Cystic fibrosis
 d. COPD/asthma
e. Empyema

QUESTION NO35:

A 19 years old man is brought to casualty department complaining of sudden onset of right
sided chest pain and rapidly progressive breathlessness for the last six hours for the first time in
his life. He is irritable and cyanosed. Pulse is 125/min regular. BP is 70/30. Trachea is displaced
towards left. Hyper-resonant to percussion and breath sounds are absent on the right side. What
is the most likely diagnosis?

a. Pulmonary thromboembolism
b. Right sided Pneumothorax
c. Right sided pleural effusion
d. Acute asthma exacerbation
e. Right sided pneumonia

QUESTION NO36:

A 19 years old man is brought to casualty department complaining of sudden

onset of right sided chest pain and rapidly progressive breathlessness for the last six hours for the
first time in his life. He is irritable and cyanosed. Pulse is 125/min regular. BP is 70/30. Trachea
displaced towards left, Hyper-resonant percussion and decreased breath sounds on the right side.
What is the most appropriate first step imaging modality?

a. Magnetic resonance Imaging

b. CT pulmonary angiogram
c. Ventilation perfusion scan
d. High resolution CT scan
e. Chest X-ray

QUESTION NO37:

A 66 years old man presented with ON/OFF retrosternal chest pain of 2years. Each attack
lasts for LESS THAN 5 minutes, triggered by stress/exertion and relieved by rest and
nitroglycerine. He is diabetic for last 22years, Hypertensive for last 20years and smokers
for last 18years. Examination and resting ECG normal. What is the most likely diagnosis?

a. Myocardial infarction
b. Unstable angina
c. Prinzmital angina
d. Stable angina

QUESTION NO38:

A 50 years old obese man with BMI>35 (otherwise asymptomatic) is referred to you by
general practitioner for his persistently raised BP. You are suspecting secondary hypertension in
this patient. Recalling causes of secondary hypertension,which one of the following list is not the
cause of secondary hypertension.

a. Polycystic kidney disease

b. Pheochromocytoma
c. Cushing syndrome
d. Addison’s disease
 e. Hyperthyroidism

QUESTION NO39:

26 years old unmarried man has returned from Hong Kong where he spent two months.
He is complaining of profuse pus from urethra. Systemic examination is normal. He confessed
sexual promiscuity. There is no lymphadenopathy or ulceration. What is the most likely diagnosis
in this case?

a. HSV-2 infection
b. Gonorrhea
c. HIV/AIDs
d. Syphilis

QUESTION NO40:

A 25 years college student, very fond of eating outside home, presents with a two weeks history of
high grade continuous fever and constipation. O/E he looks toxic, pale and febrile. Temperature
102°F, he looks moderately dehydrated with centrally coated tongue. Palpable Soft spleen and
rose spot skin rashes on his abdomen and chest. His pulse is 62/min regular, temperature 102°F,
BP 110/70. Neutropenia on FBC repeated MP smears negative. What is the most diagnostic test for
confirmation of Enteric fever?

a. Typhidot test
b. Blood culture
c. Blood smear
d. Widal test

QUESTION NO41:

A 23 year old man (recently married) presents with a week’s history of fever and sore
throat. He developed a macular rash after taking Ampicillin, prescribed by his general practitioner.
One examination he has enlarged posterior cervical nodes, palatal petechiae and splenomegaly.
What is your diagnosis?

a. Infectious mononucleosis
b. Streptococcal pharyngitis
c. Oral mucocandidiasis
d. Herpes simplex type2

QUESTION NO42:

A 40 years old woman presented with severe pain epigastrium that radiates to back is
accompanied by nausea and vomiting. Examination revealed Periumbilical bruising and tenderness
in epigastrium. Serum amylase elevated (10 times above the upper limit) which confirms acute
pancreatitis. What is the most common cause of acute pancreatitis in our country?

a. Abdominal trauma
b. Thiazide diuretics
c. Alcohol intake
d. hypercalcemia
e. Gall stones

QUESTION NO43:
 A 20 years old sexually promiscuous active man, who has frequently travelled
abroad, presents with severe weight loss and chronic watery diarrhea. He also complains of
productive cough and difficulty in swallowing. On examination he is pale and has generalized
painless lymph node enlargement and extensive oral ulcerations. His White cell count is
6000/mm3 with only 4% lymphocytes. What is the most likely diagnosis?

a. Infectious mononucleosis
b. Milliary Tuberculosis
c. Malignant lymphoma
d. Metastatic cancer
e. Acquired immuneDeficiency syndrome

QUESTION NO44:

A 30 yrs old obese, hypertensive person is admitted to medical ward with one day History of
severe pain and swelling at the base of right toe. O/E the involved joint is tender, swollen and has
overlying red & shiny skin. He has history of similar attacks in the past. This patient has gout and it
is secondary to an ANTIHYPERTENSIVE DRUG. Which one of the following drugs he is taking for
blood pressure control?

a. Calcium channel blockers

b. Thiazide diuretics
c. ACE inhibitors
d. Loop diuretics
e. Beta blockers

QUESTION NO45:

A 60 years male presented with fatigue weight loss and pain in the left
hypochondrium for 6months. On examination there was no lymphadenopathy & he has huge firm
spleen palpable up to the umbilicus (massive splenomegaly). Blood smears and bone marrow
biopsy results confirmed your clinical suspicion of CML. Which one of the following is the most
appropriate step in management?

a. Bone marrow transplantation

b. Tyrosine kinase inhibitor
c. Repeated transfusions
d. Hydroxycarbamide
e. Beta interferon