A 25-year-old female with a recent history of systemic lupus erythematosus (SLE) for which she takes corticosteroids, presents to the emergency department complaining of shortness of breath and dizziness. On examination, she is found to be pale and tachycardic. Laboratory tests reveal the following: WBC: 9,600; Hemoglobin: 7.2 g/dL; Hematocrit: 23%; Platelet count: 530,000; MCV: 70; RDW: 18; Retic count: 2.5%; serum LDH and serum haptoglobin are normal. Which of the following is the most useful clinical intervention to determine the underlying cause of this patient’s anemia?

In a patient diagnosed with essential thrombocythemia and a high risk of thrombosis, which of the following is the most appropriate treatment?

A 61-year-old woman presents to your office complaining of mild fatigue and weight loss over the past 6 months. She states she has felt generally unwell and has had decreased appetite during this time frame. Her temperature is 98.1°F (36.7°C), blood pressure is 122/80 mmHg, pulse is 88/min, respirations are 16/min, and oxygen saturation is 98% on room air. Physical exam reveals splenomegaly and a nontender abdomen. A complete blood count with differential shows the following:Hemoglobin: 10 g/dLHematocrit: 30%Leukocyte count: 166,500Diff: WBC precursors at all stages of maturationPlatelet count: 92,000A bone marrow biopsy is performed. Which of the following translocations is likely to be seen in this patient?

Match each clinical finding with the correct diagnosis.

A 13-year-old female patient with known sickle cell disease presents to the primary pediatrician’s office with chest pain, tachypnea, and fever. This chest x-ray was obtained (see image). What is the most likely diagnosis?

A 54-year-old male presents with 1 month of low back pain, feeling tired easily, and constipation. He denies any fever, night sweats, cough, trauma, or tingling/weakness in the limbs. On examination, the vital signs are normal. Physical examination reveals tenderness along the L4/L5 area. Abdominal and chest exams are normal. X-ray of the lumbar spine shows lytic bone lesions. Laboratory results are a hemoglobin level of 9 g/dL, a serum calcium level of 12.5 mg/dL, and increased urea nitrogen and creatinine. Urine electrophoresis reveals Bence Jones protein. Which of the following is most likely present in the peripheral blood smear?

During your Emergency Medicine rotation, you are asked to evaluate a 5-year-old male child who presents after falling off a scooter.  The patient reports that he fell sideways off the scooter as he rounded a curve in the road, and he describes dull, aching pain along his left side where he hit the ground. The patient’s parents report that he has never had any previous serious injury, but the mother recalls that he had increased bleeding following circumcision during infancy.  There is no other history of surgery or trauma.  On physical exam, the patient has extensive bruising of the lateral left thigh and tenderness to palpation. Initial CBC is performed and reveals normal WBC, Hgb, and HCT. Additional laboratory results are as follows: (Normal ranges in parentheses; abnormal results are in bold type)   Initial Test Results PT 12.6 sec (11.0-13.5) PTT 50.0 sec (25.0-35.0) Plt 250,000 (150,000-400,000) Based on these findings, what clotting factor deficiency is most likely in this patient?

A 26-year-old male patient who completed treatment for Hodgkin lymphoma four years ago now presents for evaluation complaining of increased fatigue, dry skin, mild weight gain, cold intolerance, and constipation. The patient received mantle field radiation therapy during his treatment for Hodgkin lymphoma. Which of the following associated clinical findings would you expect to be present in this patient?

A 3-year-old boy with no significant PMH presents to his pediatrician with a two-month history of petechial rash and intermittent epistaxis. The parent reports that he has had a cough, rhinorrhea, and has been fussier than normal. No fevers, weight loss, or unusual fatigue were reported. He is tracking along his growth curves and is meeting his developmental milestones appropriately. Initial laboratory test results are as follows: How would you describe the patient’s CBC results in the table above?

A 54-year-old female comes into your office with concerns of falling. She states that over the last few months, she has a feeling of numbness and “tingling” in her feet. She denies any problems with her balance and denies vertigo, but does not feel “sure-footed.” She denies any neurological history. Past medical history is significant for hysterectomy 10 years ago for menorrhagia and a bowel resection for Crohn’s disease. On exam, the patient has decreased reflexes and sensation bilaterally in her lower extremities. CBC reveals a Hgb of 9.1 with an MCV of 114. The peripheral blood smear is shown (see image). The patient’s methylmalonic acid (MMA) level is elevated. What is the most likely cause of the patients current symptoms?