A 75-year-old man with prostate cancer history, hip pain, osteoblastic lesions, PSA 83 µg/mL. Treatment of choice?

Correct Answer: D

Rationale: The correct answer is D: GnRH analogue. In a 75-year-old man with prostate cancer and elevated PSA levels, GnRH analogues are the treatment of choice to suppress testosterone production and inhibit tumor growth. Observation (A) is not recommended due to the aggressive nature of prostate cancer. Radiation therapy (B) may be used as adjuvant therapy but is not the primary treatment for advanced disease. Estrogen therapy (C) is not recommended in men due to its side effects. Choosing GnRH analogues (D) is supported by guidelines for advanced prostate cancer management.

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.

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.