A 35-year-old woman with fatigue, shortness of breath, recent Mycoplasma pneumoniae, Hb 9.0 g/dL, MCV 110 fL, icteric. Best next diagnostic test?

Correct Answer: C

Rationale: The correct answer is C, peripheral blood smear. A peripheral blood smear is the best next diagnostic test in this case to evaluate the red blood cell morphology for signs of hemolysis, such as spherocytes or schistocytes, which could indicate hemolytic anemia. This is important given the patient's symptoms, anemia (Hb 9.0 g/dL), elevated MCV (110 fL), and icteric appearance, suggestive of hemolysis. Serum protein electrophoresis (choice A) is not indicated for the evaluation of anemia. Flow cytometry (choice B) is not typically used in the initial workup of hemolytic anemia. Glucose-6-PD level (choice D) may be useful in diagnosing certain types of hemolytic anemia but is not the best initial test in this case.

Correct Answer: B

Rationale: The correct answer is B: Obtain α-fetoprotein and CT scan. In a patient with hemochromatosis presenting with weight loss, liver pain, and other concerning symptoms, the best next step is to evaluate for possible hepatocellular carcinoma (HCC) due to the increased risk in patients with liver disease. Obtaining α-fetoprotein levels and performing a CT scan can help detect any potential liver malignancy. Increasing phlebotomy (Choice A) may exacerbate the symptoms without addressing the underlying issue. Checking serum ferritin (Choice D) is not sufficient to rule out HCC. Hepatitis B serology (Choice C) is not indicated based on the patient's presentation.

Correct Answer: A

Rationale: The correct answer is A: Refer to surgeon. Given the presence of a palpable breast mass in a woman over 30, further evaluation is necessary to rule out malignancy. Referring to a surgeon for a biopsy or excision is crucial for definitive diagnosis. Choice B delays necessary evaluation. Choice C is not indicated as oral contraceptives have no role in evaluating breast masses. Choice D is inappropriate without further assessment.

Correct Answer: B

Rationale: The correct answer is B: Iron deficiency anemia. This woman presents with fatigue, heavy periods, low iron, and ferritin levels, which are classic symptoms of iron deficiency anemia. Iron is essential for red blood cell production, and a deficiency leads to decreased oxygen-carrying capacity causing fatigue. Thalassemia (choice A) would show microcytic anemia with normal iron studies. Sideroblastic anemia (choice C) presents with ringed sideroblasts on bone marrow biopsy. Anemia of chronic disease (choice D) is typically normocytic or microcytic and occurs in chronic inflammatory conditions.

Correct Answer: A

Rationale: The correct answer is A because increasing intake of green salads and fruit will potentially increase the intake of Vitamin K, which can interfere with the effectiveness of warfarin. Warfarin works by inhibiting Vitamin K-dependent clotting factors, so a sudden increase in Vitamin K intake can reduce the medication's efficacy. Choice B is important as constipation can lead to unpredictable absorption of warfarin. Choice C is valid as warfarin should be taken with food to reduce nausea. Choice D is accurate as regular blood tests are necessary to monitor warfarin's effectiveness and adjust dosage accordingly.