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A 48-year-old female presents with weakness, fatigue and pallor. The patient has a past medical history of hypertension and was recently started on lisinopril. She denies any other symptoms. Laboratory evaluation finds the patient with a white blood cell count of 1.1, a hemoglobin of 7.4g/dL and a platelet count of 14,000. Which of the following is the most likely diagnosis?
Which of the following statements regarding iron deficiency anemia and anemia of chronic disease is correct?
A 64-year-old patient presents for annual exam and is found to be anemic. You note during physical exam that the patient has a loss of vibratory sensation. Which of the following anemias does the patient most likely have?
Chemotherapy is to be initiated in a 58-year-old man in treatment of non-Hodgkin’s lymphoma. Which of the following medicines should be administered prophylactically before the chemotherapy?
Zostavax (varicella-zoster vaccine) is contraindicated in which of the following groups of patients?
Chemotherapy is initiated in a 59-year-old woman in treatment of non-Hodgkin’s lymphoma. Which of the following is the most likely complication of rapid cell death of the malignant cells?
A 32-year-old woman in her 3rd trimester of pregnancy has abruptio placenta. She now has severe vaginal bleeding, oozing around venipuncture sites, hypotension, and tachycardia. Prothrombin time, aPTT, and thrombin times are all prolonged. Which of the following is the most likely diagnosis?
A 14-year-old boy has sickle cell disease complicated by impaired splenic function. He is at increased risk of infection caused by which of the following organisms?
The presence of which of the following differentiates infectious mononucleosis from Hodgkin’s disease?
Heparin therapy is initiated in a 40-year-old woman in treatment of pulmonary embolism. Which of the following values should be obtained on the 5th day of therapy?
A patient who has intravascular hemolysis caused by glucose-6 phosphate dehydrogenase deficiency in erythrocytes is most likely to have which of the following?
You are asked to evaluate a 26-year-old female patient who presents complaining of a swollen gland on the left side of her neck. She recently noted this area of swelling, and became concerned when it did not resolve during the past several weeks. On examination, you palpate a 3×3 cm left cervical lymph node that is rubbery in consistency and non-tender. On careful examination of the lymph node regions in the head/neck, axillary, epitrochlear, and inguinal areas bilaterally, there is no evidence of other palpable lymphadenopathy. The abdominal examination does not reveal any hepatosplenomegaly, and the remainder of the physical examination is unremarkable. The patient describes periods of days when she is febrile, alternating with periods of days when she is not febrile. Based on this information, each of the following interventions would be appropriate to include in your diagnostic evaluation of this patient EXCEPT:
A 50-year-old patient presents with newly diagnosed Non-Hodgkin lymphoma (NHL). Staging evaluation reveals lymph node involvement of the right and left cervical regions only. There is no evidence of distant spread of disease to liver, bone marrow, or other extranodal sites. The patient denies any drenching night sweats, fevers > 38˚C, or unintentional weight loss. Based on this information, what is the stage of this patient’s Hodgkin’s lymphoma?
A 52-year-old male patient presents with recent onset bone pain involving multiple ribs, and complete metabolic profile reveals the presence of renal insufficiency and hypercalcemia. Additional test results include:
Serum β2-microglobulin level: 5.2 mg/L
Serum albumin level: 3.8 gm/dL
Using the International Staging System for Multiple Myeloma, what is the stage of this patient’s disease?
A 68-year-old male patient was recently diagnosed with multiple myeloma. He presents today complaining of recent onset nausea, polyuria, and constipation. A complete metabolic panel is ordered and the results are normal with the exception of a mildly elevated serum calcium level.
Serum calcium level: 11.4 mg/dL (normal: 8.5-10.5 mg/dL)
Serum albumin level: 2.0 mg/dL (normal: 3.5-5.0 mg/dL)
Calculate the corrected serum calcium level for this patient:
A 74-year-old male patient presents for evaluation of recent onset severe back pain. Plain films reveal multiple lytic lesions in the spine. Initial lab work reveals renal insufficiency, hypercalcemia, and normocytic anemia. All of the following additional diagnostic tests are indicated in the evaluation of this patient except?
A 20-year-old female presents with a complaint of a sudden onset of a ‘rash’ over the past 24-36 hours. On examination, she is noted to have many petechiae scattered over her trunk and extremities. She feels otherwise entirely well, and except for several episodes of epistaxis during the past several days and gum bleeding when brushing teeth, she reports no other recent symptoms. Which of the following clinical findings would support a diagnosis of idiopathic thrombocytopenia purpura (ITP) in this patient?
A 32-year-old female patient was referred by her dentist. The patient was noted to have an excessive amount of bleeding during a routine dental procedure. Initial coagulation evaluation reveals the following results:
PT: normal PTT: 34 seconds (normal: < 29 seconds)
Platelet count: 250,000 (normal 150,000-400,000)
Bleeding time: 12 minutes (normal: < 9 minutes)
Based on this information, which of the following results would you expect for this patient?
A 72-year-old male patient with end-stage liver disease presents to the ER with a history of four episodes of hematemesis in the past six hours. His wife reports that he passed “very dark, tar-like stool” immediately prior to leaving home to come to the hospital. Vital signs: BP: 92/60 HR: 120
RR: 20/min T: 98.2˚F. On abdominal examination, the patient is noted to have a large amount of ascites present. Rectal exam reveals soft, black, guaiac (+) stool in the rectal vault.
Initial coagulation test results reveal: ↑PT, ↑PTT. You realize that the patient is actively bleeding from an upper GI source, and consult GI for further emergent evaluation. A PT/PTT mixing study is ordered. Based on this information, what is the most appropriate management of the elevated PT and PTT in a setting of active bleeding?
A 34-year-old female presents to the ER accompanied by her husband. He reports that over the past several days, she has become quite ill. His wife initially complained of headache and abdominal pain. She has also had a fever (Tmax: 102.8˚F), and over the past several hours has became extremely confused and disoriented. Her husband states that she has never had prior similar symptoms.
On examination, you note scattered petechiae and purpura. Initial lab results are as follows (abnormal results are in bold type):
WBC: 9,200 BUN: 40 mg/dL
Hgb: 9.0 g/dL Creat: 2.4 mg/dL
HCT: 27% PT/PTT: normal
MCV: 92 [80-100]
Plt: 32, 000 [150,000-400,000]
Peripheral blood smear: RBC fragments (microangiopathic hemolysis)
Based on this information, which of the following conditions is the most likely diagnosis for this patient?
An 18-year-old male presents with a complaint of “a lump in my neck.” The patient states that the lump is not painful. He has also noted recurrent fevers over the past month and explains that, for several days in a row, he has a fever, which then goes away for “about a week,” only to recur again for several days. Examination reveals enlarged lymph nodes in the left cervical region only. Based on this information, what is the most likely diagnosis for this patient?
A 10-year-old boy presents for evaluation after falling down while playing. On examination, the left knee is tender and swollen, with evidence of effusion. His mother reports that it has been months since the most recent similar episode of hemarthrosis. She states that her son has been diagnosed with Hemophilia B. What is the underlying abnormality associated with this condition?
You are asked to evaluate a 57-year-old patient who presents with fatigue, abdominal discomfort, early satiety, and malaise. The patient is noted to have an enlarged spleen on examination, and the results of a CBC with differential are as follows:
WBC: 120,000
Hgb: 11 g/dL
HCT: 33%
MCV: 86
Plt: 420,000
Differential: 64% segs, 4% bands, 8% metamyelocytes, 6% myelocytes, 6% promyelocytes, 4% eosinophils, 5% basophils, and 3% blasts.
Cytogenetic analysis of subsequent bone marrow aspirate shows t(9;22). Based on the information, which of the following is the correct diagnosis?
You are evaluating a 62-year-old patient who was recently noted to have an elevated WBC, HCT, and Plt on recent CBC. On examination, you note the presence of mild splenomegaly. Additional test results include the following:
Total body RBC Mass: elevated
JAK2 mutation: (+)
Erythropoietin (EPO) level: decreased
Peripheral blood smear: No immature WBCs present
Based on this information, which of the following conditions is the most likely diagnosis for this patient?
Which of the following clinical findings would be consistent with a diagnosis of hereditary hemochromatosis?
A 42-year-old male presents for evaluation of progressive fatigue, loss of libido, and generalized weakness. On examination, bilateral rales are present on lung exam. There is moderate hepatosplenomegaly, and testicular atrophy. Skin has a metallic hue. Based on this information, which of the following conditions is the most likely diagnosis for this patient?
A 82-year-old female patient presents for routine physical and blood work. She feels entirely well and is without new complaints. On examination, patient is noted to have enlarged cervical adenopathy bilaterally. The patient has no organomegaly, and the exam is otherwise unremarkable. The CBC results are as follows (abnormal results are in bold type):
WBC: 14,000
Hgb: 14 g/dL
HCT: 42%
MCV: 86
Plt: 182,000
Differential: 43% segs, 2% bands, 52% lymphs, 1% monos, 1% eos, 1% basos
Absolute lymphocyte count: 7,280
Peripheral blood smear: ‘smudge’ cells present
Based on this information, what is the most likely diagnosis for this patient?
A 65-year-old man is brought to the emergency department with chest pain. The patient has had fatigue, chest heaviness, and a nonproductive cough for several weeks. Today, he developed severe chest pain at a party after he drank a beer. The patient has no chronic medical conditions or recent travel history. Temperature is 36.5 C (97.7 F). Cardiopulmonary examination is normal. Chest x-ray reveals a large, anterior mediastinal mass displacing the trachea. Complete blood count reveals normocytic anemia and eosinophilia. Serum lactate dehydrogenase is 820 U/L. Which of the following is the most likely diagnosis for this patient?
A 14-month-old boy is brought to the office by his father due to prolonged bleeding from his mouth after slipping and hitting his face on a coffee table. He was born at term, and his mother died shortly after his birth due to bleeding complications. Vital signs are normal. There is blood oozing from his gums and marked bruises along his trunk and thighs. The remainder of the physical examination is normal. Laboratory evaluation shows decreased von Willebrand Factor antigen levels and activity. Which of the following sets of laboratory values is most likely present in this patient?
A 28-year-old woman undergoes induction of labor for severe preeclampsia. The patient has a spontaneous vaginal delivery, and after delivery of the placenta, the patient begins to have heavy vaginal bleeding. She is administered a high-dose oxytocin infusion and multiple uterotonic agents but continues to bleed heavily. Ten minutes later, the patient suddenly develops shortness of breath and chest pain. Blood pressure is 70/40 mm Hg, pulse is 118/min, and respirations are 28/min. The lungs are clear to auscultation. The uterus is soft and distended above the umbilicus, and the patient continues to have profuse vaginal bleeding.
Laboratory results are as follows:
Complete blood count – Hemoglobin 6 g/dL – Platelets 80,000/mm3 – Leukocytes 8,200/mm3
Liver function studies – Total bilirubin 3.3 mg/dL (0.1-1.0 mg/dL) – Direct bilirubin 0.4 mg/dL (greater than 0.3 mg/dL)
Coagulation studies – Prothrombin time 17 sec (11-15 sec) – Activated PTT 53 sec (25-40 sec)
Which of the following is the most likely cause of this patient’s acute decompensation?