Which finding belongs in the Objective section of the SOAP note?

Choose the best one-line Chief Complaint (CC):

A 76-year-old male with a medical history significant for heart failure with reduced ejection fraction (HFrEF) of 30% to 35%, COPD, and iron deficiency anemia is admitted for acute dyspnea on exertion with wheezing. CBC reveals a hemoglobin of 6.2 g/dL and hematocrit of 20%. A packed red blood cell transfusion is initiated. Seven hours later, the patient developed worsening dyspnea with an oxygen saturation of 72% on room air. The temperature is 99.2 °F (37.3 °C). Lung sounds show rales bilaterally. The neck veins are distended, and the patient develops hypertension. CBC shows a WBC of 10,100 and a platelet count of 237,000. What is the most likely diagnosis?  

 A 7-year-old boy is brought to his pediatrician by his mother for recent fatigue and intermittent fevers over the past month. She also reports that her son has appeared much paler recently. Vital signs at today’s visit are within normal limits. Physical examination is significant for pallor, petechiae, lymphadenopathy, and hepatosplenomegaly. A complete blood count reveals anemia, thrombocytopenia, and neutropenia. A peripheral blood smear is shown (see image). Bone marrow aspiration reveals 47% lymphoblasts. You suspect that the patient has acute lymphoblastic leukemia (ALL). Which of the following genetic disorders is associated with increased risk of developing this condition?

A 30-year-old female presents to the primary care clinic complaining of a 2-week history of lower extremity bruising. She also reports a 1-month history of fatigue. Her medical history is significant for polycystic ovary syndrome. She had surgery last year for a fractured clavicle following a sports injury. She takes a combined oral contraceptive pill. Her family history is significant for “blood issues,” but she is not sure of the specifics. On physical examination, bilateral conjunctivae are pale and there are multiple ecchymoses on the patient’s lower extremities. Labs are drawn, with results shown below:Hemoglobin: 7.8 g/dLWBC count: 1,000 with normal differentialPlatelet count: 12,000Reticulocytes: 0.02%A bone marrow biopsy is obtained and reveals a markedly hypocellular, fat-filled bone marrow. Which of the following is the most likely cause of the patient’s presentation?

A 24-year-old female presents for evaluation and reports experiencing fevers, drenching night sweats, and weight loss for past month. Patient notices an area in the right side of her neck that develops a “dull ache” after drinking alcohol. The patient reports that fevers range from 101.3F to 104.0F and occur almost daily. She has lost 15 pounds in past month unintentionally and has had several episodes of generalized pruritus with no associated skin lesions. On exam, there is a 1 x 2.5 cm firm LN in right cervical area palpable on exam; no other palpable adenopathy; no organomegaly. Initial laboratory test results include: normal CBC with diff, elevated ESR, normal CMP, and negative HIV test. What is the most likely diagnosis for this patient?

A 52-year-old man arrives to the clinic for evaluation of arthritis and leg swelling. The patient reports that the joint pains began 8 months ago. He has tried acetaminophen and ibuprofen without significant improvement. He reports the leg swelling began within the past 2 months and has gotten progressively worse. The patient’s medical history is significant for diabetes. His medications include metformin and aspirin. The patient works as an accountant. He smokes cigars socially. The patient’s temperature is 99°F (37.2°C), blood pressure is 130/78 mmHg, pulse is 70/min, and respirations are 14/min with an oxygen saturation of 98% on room air. Physical examination notes a deeply tanned appearing, overweight male with 2+ edema of bilateral lower extremities. Which of the following tumor markers is associated with a known complication of this patient’s condition?

A 52-year-old patient is admitted to the hospital with a lower gastrointestinal bleed. He is given 2 units of packed red blood cells. Several hours later the patient develops a fever but has no other symptoms or changes in vital signs. Lab studies reveal no significant changes. 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%WBC count: 10,000Platelet count: 20,000 Prothrombin time (PT): 20 seconds (prolonged)Partial thromboplastin time (PTT): 60 seconds (prolonged)D-dimer: elevated Fibrinogen: decreased Direct 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 42-year-old woman presents to the emergency department with complaints of recurrent shortness of breath for the past 2 weeks. She reports shortness of breath whenever she goes on her morning run. The symptoms last for approximately 5-10 minutes and improve with rest. She denies chest pain, syncope, nausea, or abdominal pain during these episodes. Her medical history is significant for rheumatoid arthritis which is treated with hydroxychloroquine. She denies any recent surgeries, oral contraceptive/estrogen use, malignancy, or personal history of deep vein thrombosis (DVT) or pulmonary embolism (PE). She endorses some rhinorrhea and sore throat that has since resolved. Physical examination demonstrates some joint swelling at the proximal interphalangeal joints bilaterally but is otherwise unremarkable. Laboratory studies are shown below: WBC count and differential: 9,800 with normal differentialHemoglobin: 9.8 g/dLPlatelet count: 180,000Mean corpuscular volume (MCV): 83Reticulocyte count: 0.2%Ferritin: 268 ng/mL (Normal: 12-150 ng/mL)Serum iron: 38 mcg/dL (Normal: 60-170 mcg/dL)Total iron binding capacity (TIBC): 240 mcg/dL (Normal: 240-450 mcg/dL) CXR was obtained and reveals clear costophrenic angles and no signs of consolidation or interstitial infiltrate. Cardiac silhouette is clear, and there are no signs of cardiomegaly. What is the most likely explanation for this patient’s symptoms?