A 67-year-old smoker with shortness of breath, bloody pleural effusion, bronchioalveolar adenocarcinoma. Best next step?

Correct Answer: C

Rationale: The correct answer is C: Refer for chemotherapy. Chemotherapy is the best next step for bronchioalveolar adenocarcinoma to target and shrink the tumor, control metastasis, and improve symptoms. It is a standard treatment for advanced-stage lung cancer. Option A (Refer to hospice) is premature as chemotherapy can improve quality of life and survival. Option B (Refer for lobectomy) is not suitable for advanced-stage cancer. Option D (Refer for radiation therapy) may be used in combination with chemotherapy but is not the initial treatment of choice.

Correct Answer: C

Rationale: The correct answer is C: Acute myeloid leukemia. The clinical presentation of fever, bone pain, ecchymoses, and presence of Auer rods on smear is highly suggestive of acute myeloid leukemia. AML is characterized by the rapid proliferation of abnormal myeloid cells in the bone marrow, leading to symptoms such as fever, bone pain, and easy bruising. The presence of Auer rods on smear is a hallmark finding in AML. Multiple myeloma (A) presents with lytic bone lesions, hypercalcemia, and monoclonal gammopathy. Myelofibrosis (B) is characterized by bone marrow fibrosis, splenomegaly, and teardrop-shaped red blood cells. Chronic myelogenous leukemia (D) typically presents with an elevated white blood cell count, splenomegaly, and the presence of the Philadelphia chromosome.

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: A

Rationale: The correct answer is A: Patient with digoxin toxicity. In this scenario, the patient with pancytopenia is at risk for bleeding due to low blood cell counts. Digoxin toxicity can cause an increased risk of bleeding, making it important to monitor for signs of bleeding in the roommate. Viral pneumonia, shingles, and cellulitis do not directly increase the risk of bleeding, making them less ideal roommates for a patient with pancytopenia. Selecting the patient with digoxin toxicity as the roommate ensures appropriate monitoring and management of potential bleeding complications.

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.