According to the American Academy of Pediatrics, at what age should all children need screening for iron-deficiency anemia?
A 36 year-old female presents to your office with fatigue, shortness of breath, headaches and palpitations that are progressively getting worse over the last few weeks. On physical examination, you find a woman in mild distress with pallor and tachycardia. Laboratory tests are significant for microcytic anemia, due to iron deficiency anemia. From the laboratory values listed under A,B,C,D and E below, which reflects the laboratory values in this patient with iron deficiency anemia?
A 40 year-old female presents to your office with fatigue, shortness of breath, headaches and palpitations that are progressively getting worse over the last few weeks. On physical examination, you find a woman in mild distress with pallor and tachycardia. Laboratory tests are significant for microcytic anemia, due to iron deficiency anemia. Which of the following explains the mechanism of iron deficiency anemia?
A 55 year-old male patient comes to your office to discuss some laboratory test results. He reports that because he is over 50 years-old he wanted to get some blood work done and went to a health camp organized in a public school near his home and had his complete blood cells counts and serum chemistry tests done. As you review his test results, you noticed an elevated total protein of 11 grams/dL. However, his serum calcium is normal. His renal function is normal. He reports he does not have any medical problems. He takes some multivitamin tablets bought over the counter. His physical examination is unremarkable. You order a serum and urine electrophoresis. He has a positive monoclonal spike of 2.9 grams/dL of IgG and a normal serum free light chain ratio on serum protein electrophoresis. A skeletal survey (radiographs) demonstrates no lytic lesions. His bone marrow aspirate and biopsy demonstrate 9% plasma cells (normal is 1 – 4%). What is the next step in the management of this patient?
A 57 year-old male patient comes to your office to discuss some laboratory test results. He reports that because he is over 50 years-old he wanted to get some blood work done and went to a health camp organized in a public school near his home and had his complete blood cells counts and serum chemistry tests done. As you review his test results, you noticed an elevated total protein of 11 grams/dL. However, his serum calcium is normal. His renal function is normal. He reports he does not have any medical problems. He takes some multivitamin tablets bought over the counter. His physical examination is unremarkable. You order a serum and urine electrophoresis. He has a positive monoclonal spike of 2.9 grams/dL of IgG and a normal serum free light chain ratio on serum protein electrophoresis. A skeletal survey (radiographs) demonstrates no lytic lesions. His bone marrow aspirate and biopsy demonstrate 9% plasma cells (normal is 1 – 4%). What is the most likely diagnosis in this patient?
A 79-year-old pastor presents to the emergency department complaining of pain in his neck. He feels like he is too weak to preach to his congregation. He can barely keep his strength for more than a minute. Upon further questioning, he also reveals that he has suffered from two episodes of pneumonia over the past three months. You ordered some investigative studies. A neck x-ray demonstrates punched-out lytic lesions in the posterior skull. When you saw his laboratory studies, you suspected multiple myeloma and wondered whether he developed a paraneoplastic effect of this tumor. Of the following, multiple myeloma is associated with which paraneoplastic and distant effect of tumor?
A 55 year-old man comes to your office because he is concerned about swollen lymph nodes in his axilla and inguinal regions. He reports, ‘they (swollen lymph nodes) don’t bother me but I am concerned about fever, weight loss and drenching night sweats’. Physical examination reveals painless cervical, axillary, inguinal lymphadenopathy and hepatosplenomegaly. Laboratory tests show elevated LDH levels. An excisional lymph node biopsy revealed back-to-back follicles of the same size, composed of small cells or large cells. Later flow cytometry and genetic tests confirmed the diagnosis as follicular lymphoma.
A 58 year-old man presents to your primary care office complaining of severe fatigue, night sweats and low-grade fevers for the last four weeks. In the review of systems, he says ‘yes’ to blurred vision and persistent and painful erections. On physical examination, you find tenderness over the sternum. You send him to the laboratory for tests, which reveal the following results: Test Result Normal range Leukocyte count (WBC) 115,000 /mm³ 4500-11,000/mm³ Platelets 640,000 /mm³ 150,000 – 400,000/mm³ Leukocyte Alkaline Phosphatase (LAP) 6 score 20 – 100 Bone marrow: hypercellular, left-shifted myelopoiesis Peripheral smear: multiple immature granulocytes The PCR testing of the peripheral blood and bone marrow detected BCR/ABL gene. Of the following, which is the most common physical finding in patients with this disorder?
