A 52-year-old diabetic on dialysis, Hb 9 g/dL, normal indices. Diagnosis?

Correct Answer: C

Rationale: The correct answer is C, Anemia of renal disease. In this case, the patient's chronic kidney disease is causing decreased erythropoietin production, leading to anemia. Dialysis can also contribute to anemia. Thalassemia (choice A) and iron deficiency (choice B) can be ruled out by normal indices. Anemia of chronic disease (choice D) is typically associated with chronic inflammatory conditions, not specifically renal disease.

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.

Correct Answer: C

Rationale: The correct answer is C: Crimean Congo virus. This virus is known to cause viral hemorrhagic fever and can be transmitted through tick bites. The other options, Hantavirus and Rift Valley virus, are not typically associated with tick bites. Marburg virus is also a viral hemorrhagic fever but is not commonly transmitted through tick bites. Therefore, based on the patient's presentation and potential exposure history, Crimean Congo virus is the most likely causative agent.