A 64-year-old woman on chemo for breast cancer, thoracic pain, leg weakness, incontinence. Most important study?

Correct Answer: D

Rationale: The correct answer is D: MRI scan of spine. For a patient with thoracic pain, leg weakness, and incontinence during chemo for breast cancer, an MRI of the spine is crucial to evaluate for spinal cord compression, a serious complication. This can present with the mentioned symptoms and requires urgent intervention. Serum calcium (A) is not the most important study as it is less likely to explain the patient's symptoms. A bone scan (B) and plain radiographs (C) may not provide detailed imaging of the spinal cord to assess for compression. An MRI scan of the spine (D) offers the best visualization to identify spinal cord compression and guide appropriate management.

Correct Answer: D

Rationale: The correct answer is D: No further testing. In this scenario, the patient has a clear risk factor for DVT (long flight) and is already on anticoagulation therapy. Further diagnostic tests are not necessary for the management of acute DVT in this case. Testing for Factor V Leiden or Protein C, S, antithrombin III levels would not change the management at this point. Antiphospholipid antibody test is not indicated as there are no signs or symptoms suggestive of antiphospholipid syndrome. The most appropriate action is to continue the current treatment and monitor the patient's response.

Correct Answer: A

Rationale: The correct answer is A: Thalassemia. Thalassemia is a genetic disorder characterized by reduced production of hemoglobin, leading to microcytic anemia. Normal iron studies in this case suggest that iron deficiency anemia (choice B) is unlikely. Sideroblastic anemia (choice C) is characterized by abnormal iron utilization, not normal iron studies. Anemia of chronic disease (choice D) typically presents with normocytic or mildly microcytic anemia and is associated with underlying chronic inflammatory conditions. Therefore, given the clinical presentation of microcytic anemia with normal iron studies in an 18-year-old man, thalassemia is the most likely diagnosis.

Correct Answer: A

Rationale: The correct answer is A because the absence of palpable radial/pedal pulses indicates poor perfusion, a critical concern in DIC. This finding suggests compromised blood flow, requiring urgent intervention to prevent tissue damage. Choices B, C, and D are not immediate concerns in DIC. Chest pain may indicate cardiac issues, but perfusion is the priority. Oxygen saturation at 87% is low but not as urgent as impaired perfusion. Mottling of hands and feet is a sign of poor perfusion but not as immediate as the absence of palpable pulses.

Correct Answer: A

Rationale: The correct answer is A: Serum potassium 7.8 mEq/L. A high serum potassium level (hyperkalemia) can lead to life-threatening cardiac arrhythmias. Rapid action is necessary to prevent cardiac complications. Urine output slightly less than intake (choice B), oral mucosa inflammation (choice C), and ecchymoses on trunk (choice D) are important but do not require immediate action to prevent fatal consequences like hyperkalemia.