A 50-year-old woman with abdominal fullness, adnexal fullness, BMI 40. Most appropriate next step?

Correct Answer: A

Rationale: Rationale for Choice A (Pelvic ultrasound): - Pelvic ultrasound is the most appropriate initial step for evaluating a 50-year-old woman with abdominal and adnexal fullness to assess for gynecologic issues like ovarian cysts, fibroids, or tumors. - It is non-invasive, cost-effective, and can provide valuable information about the structures in the pelvis. - It helps to visualize the ovaries and uterus, guiding further management decisions based on the findings. Summary of other choices: - Choice B (CA-125 antigen levels): While CA-125 is a tumor marker often elevated in ovarian cancer, it is not specific and can be elevated in other conditions. It is not the initial step in this case. - Choice C (Surgery): Surgery should not be the first step without proper diagnostic evaluation with imaging studies. - Choice D (CT scan of abdomen): CT scan may provide detailed information but is not the initial diagnostic modality for evaluating adnexal full

Correct Answer: C

Rationale: The most important initial step in a 30-year-old woman on propylthiouracil with fever and sore throat is to perform a CBC. This is crucial to assess for potential agranulocytosis, a rare but serious side effect of propylthiouracil leading to severe neutropenia. A CBC will reveal any abnormalities in white blood cell counts, particularly neutrophils, guiding immediate management. Checking serum TSH or T3 levels is not necessary in this acute situation and won't provide immediate actionable information. A chest x-ray is not indicated unless there are specific respiratory symptoms or clinical signs suggesting a need for imaging.

Correct Answer: A

Rationale: The correct answer is A: Hypercalcemia. In lung cancer, paraneoplastic syndromes can occur due to tumor-secreted substances affecting distant organs. Hypercalcemia is commonly associated with lung cancer and can cause confusion. SIADH (B) is more common in small cell lung cancer. Hypoglycemia (C) is not a typical paraneoplastic syndrome in lung cancer. Migratory thrombophlebitis (D) is associated with pancreatic cancer, not lung cancer.

Correct Answer: C

Rationale: The correct answer is C because taking aspirin can worsen thrombocytopenia by further reducing platelet function, leading to increased risk of bleeding. Aspirin is a known blood thinner and can exacerbate the condition in a patient with low platelet count. Choices A, B, and D are not as concerning because bruising easily, soft dark bowel movements, and decreased appetite can be common side effects of chemotherapy and not directly related to worsening thrombocytopenia.

Correct Answer: A

Rationale: Correct Answer: A Rationale: 1. Administering oral cyclosporine is crucial for managing GVHD post-transplant. 2. Cyclosporine suppresses the immune response, reducing GVHD symptoms. 3. It is essential to maintain therapeutic drug levels for efficacy. 4. Assessing for infection signs (Choice B) and educating about infection prevention (Choice D) are important but not the immediate priority. 5. Infusing D5NS at 125 mL/hr (Choice C) is not indicated for GVHD management.