A 50-year-old man with fever, bone pain, ecchymoses, Auer rods on smear. Most likely diagnosis?

Correct Answer: C

Rationale: The correct answer is C: Acute myeloid leukemia. The clinical presentation of fever, bone pain, ecchymoses, and presence of Auer rods on smear is highly suggestive of acute myeloid leukemia. AML is characterized by the rapid proliferation of abnormal myeloid cells in the bone marrow, leading to symptoms such as fever, bone pain, and easy bruising. The presence of Auer rods on smear is a hallmark finding in AML. Multiple myeloma (A) presents with lytic bone lesions, hypercalcemia, and monoclonal gammopathy. Myelofibrosis (B) is characterized by bone marrow fibrosis, splenomegaly, and teardrop-shaped red blood cells. Chronic myelogenous leukemia (D) typically presents with an elevated white blood cell count, splenomegaly, and the presence of the Philadelphia chromosome.

Correct Answer: A

Rationale: The correct answer is A: Patient with digoxin toxicity. In this scenario, the patient with pancytopenia is at risk for bleeding due to low blood cell counts. Digoxin toxicity can cause an increased risk of bleeding, making it important to monitor for signs of bleeding in the roommate. Viral pneumonia, shingles, and cellulitis do not directly increase the risk of bleeding, making them less ideal roommates for a patient with pancytopenia. Selecting the patient with digoxin toxicity as the roommate ensures appropriate monitoring and management of potential bleeding complications.

Correct Answer: D

Rationale: The correct answer is D: New-onset leg numbness. This finding has immediate implications as it could indicate spinal cord compression, a medical emergency in multiple myeloma. Chronic bone pain (A) is common in multiple myeloma but not an immediate concern. Very elevated blood uric acid (B) may indicate tumor lysis syndrome but is not as urgent. Bence Jones proteins in urine (C) are a hallmark of multiple myeloma but do not require immediate action.

Correct Answer: C

Rationale: The correct answer is C, Methotrexate 10 mg PO. In pediatric ALL treatment, Methotrexate is a critical chemotherapy drug with a narrow therapeutic index. Double-checking the dose is crucial to prevent under or overdosing. Prednisone and Amoxicillin are common medications in ALL treatment, but they have a wider therapeutic range. Filgrastim is a supportive medication used for neutropenia, not as critical as Methotrexate in ALL treatment.

Correct Answer: D

Rationale: The correct answer is D: Factor VII level. The patient presents with a prolonged PT, indicating a deficiency in the extrinsic pathway of the coagulation cascade, which is primarily mediated by Factor VII. Normal aPTT rules out von Willebrand factor deficiency (choice A). Platelet count (choice B) is not directly related to the PT results. The statement about X chromosomes (choice C) is irrelevant to the patient's condition. Choice D directly addresses the specific factor deficiency leading to the prolonged PT in this case.