A 38-year-old woman with sore throat, Hb 9.0 g/dL, WBC 2000/µL, platelets 30,000/µL. Best approach to diagnosis?

Correct Answer: C

Rationale: The correct approach is a bone marrow biopsy. The patient presents with pancytopenia (low Hb, WBC, platelets) which suggests a bone marrow issue. Bone marrow biopsy can reveal the cause of pancytopenia such as aplastic anemia, myelodysplastic syndrome, or leukemia. Erythropoietin level (A) is not indicated as low levels are expected in anemia. Serum B12 (B) is used for diagnosing B12 deficiency anemia, not pancytopenia. Liver spleen scan (D) is not helpful in this scenario. Bone marrow biopsy is the most direct and appropriate diagnostic test in this case.

Correct Answer: B

Rationale: The correct answer is B: Treat underlying disease. In this scenario, the patient is presenting with signs of disseminated intravascular coagulation (DIC) due to gram-negative sepsis. The priority is to address the underlying cause, which is the sepsis, to help improve the patient's condition. Treating the sepsis will help reduce the systemic inflammatory response and subsequent coagulopathy. The other options are not appropriate in this context: A (Begin heparin) can worsen bleeding in a patient with DIC, C (Begin plasmapheresis) is not indicated for DIC in sepsis, and D (Give vitamin K) does not address the main issue of sepsis-induced DIC.

Correct Answer: D

Rationale: The correct answer is D: Migratory thrombophlebitis. In a patient with a pancreatic mass and weight loss, migratory thrombophlebitis, also known as Trousseau syndrome, is a paraneoplastic syndrome commonly associated with pancreatic adenocarcinoma. This syndrome results from the release of procoagulant substances by the tumor, leading to migratory superficial thrombophlebitis. The other choices are not typically associated with pancreatic cancer. A: Hypercalcemia is more commonly seen in hyperparathyroidism or certain types of cancer. B: SIADH is commonly associated with small cell lung cancer. C: Hypoglycemia is seen in pancreatic insulinomas, not pancreatic adenocarcinoma.

Correct Answer: B

Rationale: The correct answer is B because applying cold packs can worsen vaso-occlusive crisis by causing vasoconstriction and increasing pain. Cold can exacerbate sickling of red blood cells. Immediate intervention is necessary to prevent further harm. Option A is not urgent during a crisis. Option C may be appropriate for infection control but is not the most critical action. Option D is important but not as urgent as avoiding cold packs.

Correct Answer: C

Rationale: The correct answer is C: Abdominal pain with palpation. After a splenectomy, patients are at risk for splenic complications such as splenic infarction or abscess. Abdominal pain with palpation could indicate an emergency situation requiring immediate medical attention to rule out these complications. Unprotected sex (A) is not the most immediate concern in this scenario. Temp of 100°F (B) may not be directly related to post-splenectomy complications. Occasional marijuana use (D) is not an immediate concern post-splenectomy.