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?

A 65-year-old male presents to his primary care physician with fatigue that has gradually been worsening over the past month. The patient rarely sees his physician and came in today as he is unable to go to his exercise classes anymore. He also endorses joint pain in his right knee and hip that has been gradually worsening. The patient’s vitals are notable only for hypertension. Physical exam reveals a fatigued appearing man. Laboratory tests are ordered as seen below: WBC: 1,500 (Diff: Segs 56%, Bands 2%, Lymphs 36%, Monos 4%, Eos 2%) ANC = 1,500 x 0.58 = 870 Hemoglobin: 8 g/dLHematocrit: 25% MCV: 106WBC: 1,500 Platelet count: 47,000A peripheral smear is performed (see image below). Which of the following is the most likely diagnosis?

A 65-year-old woman presents for evaluation of fatigue. She has a history of lung adenocarcinoma and has undergone 6 cycles of chemotherapy in the last 5 months. For the last 2 weeks, she has experienced exertional dyspnea and generalized malaise. Her temperature is 99.0°F (37.2°C), blood pressure is 97/64 mmHg, pulse is 105/min, and respirations are 18/min. On exam, she is pale appearing with diffuse petechiae and gingival bleeding. Laboratory evaluation reveals:Hemoglobin: 6.7 g/dLHematocrit: 20%Leukocyte count: 10,000Platelet count: 20,000Prothrombin time (PT): 20 secondsPartial thromboplastin time (PTT): 60 secondsD-dimer: 2,000 ng/mlDirect Coombs test: Negative A peripheral blood smear is performed (see image). Which of the following is the most likely etiology of the patient’s current presentation?

A 54-year-old male presents to his primary care physician. He has been feeling very tired lately and thinks that he looks more pale. The physician orders a complete blood count, which shows: Hgb 8.5; WBC 1,200; platelets 70,000. The patient is referred for bone marrow biopsy, which shows the findings (see image below). Which of the following is the most likely diagnosis?

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: 92,000 Which of the following translocations is likely to be seen in this patient?

A 45-year-old male is brought to the emergency room by his wife because he has been acting confused for the past day. He is febrile, with an oral temperature of 103.6 deg F; vital signs are otherwise stable. His physical exam is significant for the finding shown (see image below); he has never noticed lesions like these before. He also has subtle right-sided weakness affecting upper and lower extremities. Labs reveal: hemoglobin 7.0 g/dL, hematocrit 21%, white blood count of 10,200, and platelet count of 20,000. PT/INR and PTT are normal. A peripheral blood smear is shown (see image below). What is the most likely diagnosis?

In order to reduce production costs, Autoworks, an automobile manufacturer, decided to buy out a glass plant and begin manufacturing the glass for the windows of cars on its own. The corporate strategy adopted by the company is known as

“I am pleased to announce that we have acquired Fancy Fruit Juices, a premier producer of natural beverages,” said Louis Garcia, CEO of Granddad’s Root Beer. “This will allow us to take advantage of our strengths by applying them in a new business that is similar to our core business.” Louis is speaking of a(n) __________ strategy.

Bee Corp. has only a few layers of management between the CEO and entry-level employees, allowing for quicker decision-making and more employee autonomy. This describes a: