All of the following are associated with the Pickwickian syndrome, except:

Correct Answer: D

Rationale: Pickwickian syndrome (obesity hypoventilation syndrome) features obesity (A), somnolence (B), and polycythemia high RBCs from chronic hypoxia (e.g., SpOâ‚‚ <90%). Excessive appetite (C) contributes to obesity but isn't a core association weight gain drives it. Anemia (D) contradicts hypoxia's erythropoietic stimulus; polycythemia is typical. This triad obesity restricts breathing, causing COâ‚‚ retention and daytime sleepiness defines the syndrome, distinct from sleep apnea alone. Anemia's absence (D) is the exception, key in recognizing this respiratory-metabolic overlap, guiding weight loss or ventilatory support in nursing care.

Correct Answer: C

Rationale: Thrombocytosis (platelets >450,000/μL) occurs in malignancy (A cytokines), myelofibrosis (B marrow dysfunction), splenectomy (D no clearance), and chronic granulomatous disease (E inflammation), but not acute myelocytic leukemia (C) thrombocytopenia dominates from marrow suppression. AML's blast crisis consumes platelets, key in nursing for transfusion readiness, contrasting reactive thrombocytosis.

Correct Answer: C

Rationale: The Schilling test (C) best diagnoses pernicious anemia measures B12 absorption with/without intrinsic factor (IF), confirming gastric IF loss (e.g., <5% excretion). Marrow (A) shows megaloblasts, nonspecific. Neurologic exam (B) detects neuropathy, late. Smear (D) and indices show macrocytosis (MCV >100 fL), not cause. Schilling's specificity is key in nursing for B12 vs. folate differentiation and lifelong therapy.

Correct Answer: D

Rationale: Cholelithiasis gallstones stems from hemolytic anemia (D), where excess bilirubin from RBC breakdown (e.g., sickle cell, Hb 8 g/dL) forms pigment stones. Malignancy (A) or cirrhosis (C) may obstruct, not form stones. High fat diet (B) risks cholesterol stones, less specific here. CHF causes congestion, not lithiasis. Hemolysis's bilirubin overload is key, guiding nursing for ultrasound and monitoring jaundice in anemia patients.

Correct Answer: B

Rationale: Chronic lymphocytic leukemia (CLL) lymph nodes show early enlargement (A), discrete (C), diffuse involvement (D), and mobility , but not tender/painful (B) painless growth (e.g., >1 cm) reflects slow B-cell accumulation. Tenderness fits infection or Hodgkin's. CLL's indolent lymphadenopathy is key, guiding nursing for staging and infection watch.