Pediatric shift report. Which patient to assess first?

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: 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.

Correct Answer: D

Rationale: The correct answer is D: Vitamin K deficiency. Prolonged PT and aPTT indicate impaired coagulation factors, which are dependent on Vitamin K for synthesis. The normal blood test rules out hemophilia A, a genetic deficiency of factor VIII (choice A), thrombocytopenia, a low platelet count (choice B), and Von Willebrand disease, a deficiency in a blood protein that helps with clotting (choice C). Therefore, the most likely diagnosis is Vitamin K deficiency due to the abnormal coagulation factors.

Correct Answer: B

Rationale: The correct answer is B: Vitamin B12 deficiency. Anemia in a strict vegetarian is likely due to inadequate intake of Vitamin B12 found in animal products essential for red blood cell production. Iron deficiency (A) is common in vegetarians but not the primary cause of anemia in this case. Erythropoietin defect (C) is rare and not specific to vegetarianism. Calcium deficiency (D) does not directly cause anemia.

Correct Answer: B

Rationale: The correct answer is B: Absolute lymphocytosis. This is the most important diagnostic criterion for Chronic Lymphocytic Leukemia (CLL). CLL is characterized by a high number of mature-looking lymphocytes in the blood. The presence of absolute lymphocytosis (>5,000/microliter) is a key feature in diagnosing CLL. Hypogammaglobulinemia (choice A) can occur in CLL but is not the primary diagnostic criterion. Male predominance (choice C) and enlarged lymph nodes (choice D) are common features of CLL but do not serve as the primary diagnostic criterion.