An alcoholic with pancreatitis, Hb 7.8 g/dL, MCV 114, hypersegmented neutrophils. Diagnosis?

Correct Answer: C

Rationale: The correct answer is C: Folate deficiency. In this case, the patient presents with macrocytic anemia (elevated MCV) and hypersegmented neutrophils, which are characteristic of folate deficiency. Folate is essential for DNA synthesis and red blood cell production. Alcoholism can lead to folate deficiency due to poor dietary intake and malabsorption. Sideroblastic anemia (A) presents with ringed sideroblasts in the bone marrow, thalassemia (B) shows microcytic anemia, and anemia of renal disease (D) is typically normocytic normochromic.

Correct Answer: C

Rationale: Step 1: Patient showing signs of transfusion reaction (flushed, tachypneic, chills). Step 2: Immediate concern for potential serious reaction. Step 3: Stop transfusion to prevent worsening of symptoms. Step 4: Safety first to prevent adverse outcomes. Summary: A: Obtaining a warm blanket does not address the serious reaction. B: Checking oral temperature is not a priority in this urgent situation. D: Administering oxygen may be needed, but stopping the transfusion is the first crucial step in managing the reaction.

Correct Answer: A

Rationale: The correct answer is A because a 1-year-old with hemophilia B and decreased responsiveness indicates a potentially life-threatening situation requiring immediate assessment. Hemophilia B can lead to severe bleeding, and decreased responsiveness suggests a critical condition. Choice B can wait as DDAVP is a scheduled medication. Choice C's thrombocytopenia in a 7-year-old with ALL is serious but not as urgent as a potentially unconscious child with hemophilia B. Choice D's RLQ pain in a 16-year-old with sickle cell is concerning but not as critical as decreased responsiveness in a young child with hemophilia B. Prioritizing based on urgency and potential severity is key in pediatric care.

Correct Answer: A

Rationale: The correct answer is A: PT (INR). The PT evaluates the extrinsic pathway by measuring the time it takes for blood to clot after adding tissue factor. This pathway involves factors outside the blood vessel. PTT (choice B) evaluates the intrinsic pathway, TT (choice C) evaluates the common pathway, and closure time (choice D) assesses platelet function, not the extrinsic pathway. Therefore, PT is the most appropriate choice for evaluating the extrinsic pathway.

Correct Answer: D

Rationale: The correct answer is D: Gastrointestinal blood loss. In the elderly, gastrointestinal blood loss is the most common cause of iron-deficiency anemia due to conditions like peptic ulcers, gastritis, and colorectal cancer. Blood loss leads to decreased iron levels, causing anemia. Malnutrition (A) can contribute but is less common in the elderly. Chronic kidney disease (B) typically leads to anemia of chronic disease, not iron-deficiency anemia. Medication side effects (C) may cause anemia, but gastrointestinal blood loss is more prevalent in the elderly population.