A 66-year-old woman with 3-cm breast cancer, 4/13 nodes positive, ER/PR+. Next treatment?

Correct Answer: D

Rationale: The correct answer is D: Adjuvant hormonal therapy. For ER/PR+ breast cancer, hormonal therapy is the standard treatment to reduce the risk of recurrence. This patient has a high-risk tumor with positive lymph nodes, making hormonal therapy crucial to target any remaining cancer cells. No further treatment (A) is not appropriate given the high-risk features. Radiation to mammary nodes (B) is not the standard of care for ER/PR+ breast cancer. Platinum chemotherapy (C) is not indicated for ER/PR+ breast cancer and is reserved for other subtypes.

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.

Correct Answer: C

Rationale: Correct Answer: C (Tissue factor) Rationale: 1. Tissue factor initiates the extrinsic pathway of the coagulation cascade by forming a complex with Factor VII. 2. This complex activates Factor X to Xa, leading to the common pathway of coagulation. 3. Factor XII is part of the intrinsic pathway and is not the primary initiator in vivo. 4. Thrombin is generated downstream in the cascade and amplifies coagulation but does not initiate it. 5. Factor X is activated further downstream in the common pathway and is not the primary initiator.