A 70-year-old ICU patient with gram-negative sepsis, bleeding, low platelets, fragmented RBCs. Best therapy?

Correct Answer: B

Rationale: The correct answer is B: Treat underlying disease. In this scenario, the patient is presenting with signs of disseminated intravascular coagulation (DIC) due to gram-negative sepsis. The priority is to address the underlying cause, which is the sepsis, to help improve the patient's condition. Treating the sepsis will help reduce the systemic inflammatory response and subsequent coagulopathy. The other options are not appropriate in this context: A (Begin heparin) can worsen bleeding in a patient with DIC, C (Begin plasmapheresis) is not indicated for DIC in sepsis, and D (Give vitamin K) does not address the main issue of sepsis-induced DIC.

Correct Answer: B

Rationale: The correct answer is B because applying cold packs can worsen vaso-occlusive crisis by causing vasoconstriction and increasing pain. Cold can exacerbate sickling of red blood cells. Immediate intervention is necessary to prevent further harm. Option A is not urgent during a crisis. Option C may be appropriate for infection control but is not the most critical action. Option D is important but not as urgent as avoiding cold packs.

Correct Answer: C

Rationale: The correct answer is C: Abdominal pain with palpation. After a splenectomy, patients are at risk for splenic complications such as splenic infarction or abscess. Abdominal pain with palpation could indicate an emergency situation requiring immediate medical attention to rule out these complications. Unprotected sex (A) is not the most immediate concern in this scenario. Temp of 100°F (B) may not be directly related to post-splenectomy complications. Occasional marijuana use (D) is not an immediate concern post-splenectomy.

Correct Answer: C

Rationale: The correct answer is C: Hb-F. Hemoglobin F (Hb-F) does not predispose to sickling because it has a higher affinity for oxygen, inhibiting the polymerization of Hb-S molecules that leads to sickling. Hb-C (choice A) and Hb-S (choice D) both have structural abnormalities that can lead to sickling. Hb-E (choice B) is a beta-thalassemia variant that can also contribute to sickling under certain conditions.

Correct Answer: C

Rationale: The correct answer is C: Aspirin-induced platelet dysfunction. Aspirin inhibits platelet function, leading to easy bruising. Von Willebrand disease and Factor VIII deficiency are inherited bleeding disorders, not typically related to easy bruising. Grackelguber's disease is a fictional distractor.