Patient on cyclosporine post-transplant. Most concerning symptom?

Correct Answer: B

Rationale: The most concerning symptom for a patient on cyclosporine post-transplant is nontender groin swelling (Choice B) due to the risk of developing nephrotoxicity from cyclosporine. Groin swelling may indicate lymphoproliferative disorder or nephrotic syndrome, both associated with cyclosporine use. Bleeding gums (Choice A) may be due to gum disease but are not directly related to cyclosporine. Occasional nausea (Choice C) is a common side effect of cyclosporine but is usually mild and not as concerning. Numbness and tingling of feet (Choice D) may indicate peripheral neuropathy, which can be a side effect of cyclosporine but is less concerning than the potential kidney damage indicated by groin swelling.

Correct Answer: C

Rationale: The correct answer is C: Reed-Sternberg cell. These large, abnormal cells are characteristic of Hodgkin lymphoma. They originate from B cells but have lost most B cell markers. They express CD30 and CD15. A is incorrect as Hodgkin lymphoma is not derived from cytotoxic T cells. B is incorrect as it is not a malignancy involving NK cells. D is incorrect as Hodgkin lymphoma does not involve CD33+ clonal B cells.

Correct Answer: C

Rationale: The correct answer is C, Factor VIII. Vitamin K deficiency primarily affects the synthesis of Factors II, VII, IX, and X. Factor VIII is not dependent on vitamin K for its synthesis since it is a co-factor for Factor IX. Therefore, Factor VIII levels remain unaffected in Vitamin K deficiency. Factors II, VII, and IX are all vitamin K-dependent factors, making them incorrect choices.

Correct Answer: A

Rationale: Correct Answer: A - Low TIBC Rationale: - Pallor, fatigue, koilonychias, and cheilosis are symptoms of iron deficiency anemia. - Low TIBC is not an expected lab finding in iron deficiency anemia. - TIBC measures the total amount of iron that can be carried in the blood by transferrin. In iron deficiency anemia, TIBC is typically elevated, not low. - High serum transferrin, low iron:TIBC ratio, and low serum ferritin are all expected lab findings in iron deficiency anemia indicating low iron stores and increased iron-binding capacity.

Correct Answer: A

Rationale: The correct answer is A: Acute myeloid leukemia. The key clues are the presence of 15% myeloblasts and reduced erythropoiesis. In AML, there is an abnormal increase in myeloblasts in the bone marrow, leading to reduced production of normal blood cells, including erythrocytes. Myelofibrosis (C) is characterized by fibrotic changes in the bone marrow, not an increase in blasts. ALL (B) primarily affects lymphoid cells, not myeloblasts. MDS (D) involves ineffective hematopoiesis and dysplastic changes, but not necessarily a high blast count.