In myelodysplastic syndromes, the primary indications for splenectomy include

Correct Answer: C

Rationale: The correct answer is C. In myelodysplastic syndromes, splenectomy is indicated for sustained leukocyte elevation above 30,000 cells/µL to manage symptomatic splenomegaly and cytopenias. This is because an enlarged spleen can sequester and destroy blood cells, leading to low blood cell counts. Choices A, B, and D are incorrect as splenectomy is not typically indicated for major hemolysis unresponsive to medical management, severe symptoms of massive splenomegaly, or portal hypertension in the context of myelodysplastic syndromes.

Correct Answer: A

Rationale: The correct answer is A: Hypogastrinemia and acid hyposecretion. Gastrinoma is a tumor that secretes excessive gastrin, leading to hypergastrinemia and increased acid secretion. However, due to a negative feedback mechanism, chronic exposure to high gastrin levels can cause downregulation of gastrin receptors on parietal cells, leading to decreased acid secretion. Therefore, in gastrinoma, despite high gastrin levels, acid secretion may be reduced due to this negative feedback loop. Choices B, C, and D are incorrect because they do not align with the expected relationship between gastrin levels and acid secretion in gastrinoma.

Correct Answer: D

Rationale: The correct diagnostic test for the patient is a barium enema. This test is commonly used to evaluate the colon and rectum for conditions such as colonic obstruction, inflammatory bowel disease, or colorectal cancer. In this case, the patient's presentation of left lower quadrant pain with a history of constipation and variable bowel habits suggests a possible colonic obstruction, which can be visualized through a barium enema. A CT scan with contrast may be helpful in some cases but may not provide as clear a view of the colon as a barium enema. CBC with WBC differential is a general blood test and would not directly aid in diagnosing colonic issues. Colonoscopy, while a valuable tool for evaluating the colon, may not be suitable for this patient initially due to the acute nature of the presentation and the need to first rule out a potential obstruction.

Correct Answer: D

Rationale: The correct answer is D because in the context of neoadjuvant chemotherapy, a partial response means converting an unresectable tumor to a resectable one. This is crucial as it allows for successful surgical removal of the tumor. Choices A, B, and C do not accurately define partial response in the context of cancer therapy. A, stating 50% of patients demonstrating remission, is not specific to the change in resectability. B, mentioning 50% survival at 5 years, is more related to overall survival rather than the response to treatment. C, stating a reduction in tumor mass by >50%, does not necessarily imply a change in resectability status. Therefore, option D is the most appropriate definition of partial response in the given scenario.

Correct Answer: A

Rationale: The correct answer is A: Peritoneal bleeding. In a patient with a serious motor vehicle accident, a physical examination that includes rectovaginal examination, inspection of the urethral meatus, and palpation of pelvic landmarks is aimed at assessing for signs of internal bleeding, particularly peritoneal bleeding. Rectovaginal examination can detect blood in the rectouterine pouch, inspection of the urethral meatus can reveal blood at the urethral opening, and palpation of pelvic landmarks can identify tenderness or instability associated with internal bleeding. These findings would be indicative of potential peritoneal bleeding requiring urgent evaluation and management. Summary of other choices: B: Retroperitoneal bleeding - While physical examination findings may include signs such as flank ecchymosis or tenderness, the specific examinations mentioned are not typically performed to assess retroperitoneal bleeding. C: Paresthesia - Paresthesia refers to abnormal sensations like tingling or numbness and