Patient with multiple myeloma. Which finding has immediate implications?

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: D

Rationale: The correct answer is D: Factor VII level. The patient presents with a prolonged PT, indicating a deficiency in the extrinsic pathway of the coagulation cascade, which is primarily mediated by Factor VII. Normal aPTT rules out von Willebrand factor deficiency (choice A). Platelet count (choice B) is not directly related to the PT results. The statement about X chromosomes (choice C) is irrelevant to the patient's condition. Choice D directly addresses the specific factor deficiency leading to the prolonged PT in this case.

Correct Answer: C

Rationale: The correct answer is C: Crimean Congo virus. This virus is known to cause viral hemorrhagic fever and can be transmitted through tick bites. The other options, Hantavirus and Rift Valley virus, are not typically associated with tick bites. Marburg virus is also a viral hemorrhagic fever but is not commonly transmitted through tick bites. Therefore, based on the patient's presentation and potential exposure history, Crimean Congo virus is the most likely causative agent.

Correct Answer: A

Rationale: The correct answer is A: Nodular sclerosis subtype of Hodgkin's lymphoma is common in young women with a good prognosis due to its characteristic presentation of fibrotic bands dividing the lymph node into nodules. This subtype is associated with less aggressive behavior and better response to treatment compared to other subtypes. Incorrect choices: B: Mixed cellularity subtype is more common in older adults and associated with a worse prognosis. C: Lymphocyte predominance subtype is more common in males and has a unique histological appearance with lymphocytic and histiocytic cells. D: Lymphocyte depletion subtype is rare, aggressive, and associated with a poor prognosis.

Correct Answer: D

Rationale: The correct answer is D, G6PD deficiency. Sulfonamides can induce oxidative stress, leading to hemolysis in individuals with G6PD deficiency due to impaired red blood cell protection against oxidative damage. Sickle cell disease (A), thalassemia minor (B), and hereditary spherocytosis (C) do not predispose individuals to sulfonamide-induced hemolysis as they do not involve oxidative stress as a primary pathophysiological mechanism.