A 50-year-old woman with joint pain, morning stiffness, Hb 10.3 g/dL, MCV 80 fL, low serum iron, low iron-binding capacity. Most likely explanation for anemia?

Correct Answer: C

Rationale: Rationale: The correct answer is C, anemia of chronic disease. This type of anemia is characterized by low serum iron, low iron-binding capacity, and normocytic, normochromic red blood cells. In chronic inflammatory conditions like rheumatoid arthritis, the body’s response to inflammation leads to impaired iron metabolism and decreased erythropoiesis. This explains the low iron levels and anemia in this patient. Choices A, B, and D do not fit the clinical picture as occult blood loss, vitamin deficiency, and sideroblastic anemia would present with different laboratory findings and mechanisms of anemia.

Correct Answer: C

Rationale: Rationale: 1. Rifampin induces warfarin metabolism, reducing its efficacy. 2. Discontinuing rifampin causes a sudden increase in warfarin levels. 3. To avoid bleeding risk, reduce warfarin dosage. Summary: A: Increasing dosage can lead to over-anticoagulation. B: Continuing 15 mg/d without rifampin can cause overdose. D: Stopping warfarin abruptly can lead to thrombotic events.

Correct Answer: C

Rationale: The correct answer is C: Aggressive, may be cured with chemo. In large cell lymphoma, aggressive treatment with chemotherapy has shown potential for cure. This is supported by studies showing high response rates and long-term survival in patients receiving appropriate chemo regimens. Indolent lymphomas (choice A) are slow-growing and typically do not require aggressive treatment. Aggressive lymphomas with poor chemo response (choice B) have a worse prognosis compared to large cell lymphomas. Responding but relapsing (choice D) indicates a temporary response followed by disease recurrence, which is less favorable than potential cure with chemo.

Correct Answer: D

Rationale: The correct answer is D: Anemia of chronic disease. In this case, the patient's high ferritin levels and chronic inflammatory condition (rheumatoid arthritis) are indicative of anemia of chronic disease. This type of anemia is characterized by low iron utilization due to inflammation, leading to a state of functional iron deficiency despite high ferritin levels. Thalassemia (Choice A) typically presents with microcytic anemia but would not have high ferritin levels. Iron deficiency anemia (Choice B) would present with low ferritin levels. Sideroblastic anemia (Choice C) is characterized by ringed sideroblasts on bone marrow biopsy, which is not mentioned in the case.

Correct Answer: B

Rationale: The correct answer is B: Transfuse factor VIII concentrate. In hemophilia A, deficiency of factor VIII leads to impaired blood clotting. Therefore, administering factor VIII concentrate is crucial to control bleeding in this patient. This step takes priority over other options as it addresses the underlying issue of hemophilia A. Choice A is not the priority as stabilizing the patient's bleeding takes precedence over radiography. Choice C is unnecessary until the patient's bleeding is controlled. Choice D, infusing normal saline, does not address the primary concern of bleeding in a hemophiliac patient.