Blog

Match each clinical finding with the correct diagnosis.

A 34-year-old African-American woman presents to the emergency department with sudden-onset dark urine and pallor. She also complains of back pain and fatigue. She has a history of celiac disease. Due to inconsistent adherence to a gluten-free diet, the patient has recently developed dermatitis herpetiformis. She was started on dapsone 2 days ago. Labs are drawn, as shown below:Leukocyte count: 11,000Hemoglobin: 8.0 g/dLPlatelets: 200,000 PT/PTT: normalSerum:Aspartate aminotransferase (AST, GOT): 15 U/LAlanine aminotransferase (ALT, GPT): 12 U/LTotal bilirubin: 3.8 mg/dLDirect bilirubin: 0.2 mg/dLHaptoglobin: 36 g/dL (normal range: 50-200 g/dL)Lactate dehydrogenase (LDH): 125 U/LGlucose-6-phosphate dehydrogenase (G6PD): 8.5 U/g (normal range: 5.5 to 20.5 U/g)A peripheral smear shows red blood cells with semicircular portions removed from the cells’ periphery. Inclusion bodies are seen with methylene blue staining. Which of the following is the most likely diagnosis?

A 29-year-old female with PMH significant for Hashimoto thyroiditis presents with shortness of breath, fatigue, and jaundice. Initial lab results reveal the following: WBC and PLT normal; Hgb 6.2; HCT19%; MCV 102 AST, ALT, Alk Phos, Serum iron, TIBC, Ferritin, B12, Folate: normal TBili 5.0, DBili 0.2, LDH 800; Retic count: 15%; Direct Coombs Test (DAT): positive Based on this information, what is the diagnosis for this patient?

A 25-year-old female with a recent history of systemic lupus erythematosus (SLE) for which she takes corticosteroids, presents to the emergency department complaining of shortness of breath and dizziness. On examination, she is found to be pale and tachycardic. Laboratory tests reveal the following: WBC: 9,600; Hemoglobin: 7.2 g/dL; Hematocrit: 23%; Platelet count: 530,000; MCV: 70; RDW: 18; Retic count: 2.5%; serum LDH and serum haptoglobin are normal. Which of the following is the most useful clinical intervention to determine the underlying cause of this patient’s anemia?

A 68-year-old man presents to the oncologist for a scheduled visit. Since his last visit, he has experienced symptoms of fatigue as well as recurrent bouts of pneumonia. On physical examination, he is found to have peripheral lymphadenopathy as well as an enlarged liver and spleen. Flow cytometry indicates that he has CD20+, CD23+, and CD5+ B-cells. Which of the following images displays characteristics that would most likely be found on this patient’s peripheral blood smear?

A 68-year-old male presents with fatigue, pallor, and easy bruising. Laboratory tests reveal macrocytic anemia, neutropenia, and thrombocytopenia. Bone marrow biopsy shows dysplastic changes in myeloid cells with

A 68-year-old male presents to his primary care physician with complaints of fatigue and pain in his lower back for the past 2 months. Physical examination reveals pallor and focal bony tenderness to palpation over the lumbar vertebrae. Laboratory evaluation reveals hemoglobin 9.8 g/dL, serum calcium of 9.4 mg/dL, serum creatinine of 1.4 mg/dL, albumin of 3.7 g/dL, and rouleaux formation on peripheral blood smear. Serum protein electrophoresis reveals an elevated monoclonal IgG protein spike (M-protein concentration = 5 g/dL). Which of the following clinical findings would most likely be associated with this patient’s condition?

A 45-year-old male is brought to the emergency room by his wife because he has been acting confused for the past day. He is febrile, with an oral temperature of 103.6 deg F; vital signs are otherwise stable. His physical exam is significant for the finding shown (see image below); he has never noticed lesions like these before. He also has subtle right-sided weakness affecting upper and lower extremities. Labs reveal: hemoglobin 7.0 g/dL, hematocrit 21%, white blood count of 10,200, and platelet count of 20,000. PT/INR and PTT are normal. A peripheral blood smear is shown (see image below). What is the most likely diagnosis?

A 7-year-old boy is brought to his pediatrician’s office by his mother with a new onset rash. His mother says that the rash appeared suddenly yesterday. He is otherwise well. His medical history is unremarkable except for a recent upper respiratory infection that resolved without intervention two weeks ago. His temperature is 98.2°F (36.8°C), blood pressure is 110/74 mmHg, pulse is 84/min, and respirations are 18/min. Physical exam shows a well appearing child with a diffuse petechial rash. Complete blood count shows the following:  Hemoglobin: 12.6 Hematocrit: 37% Leukocyte count: 5,100 Platelet count: 65,000 Which of the following is the best choice in treatment for this child?

A 52-year-old female comes into your office with concerns of falling. She states that over the last few months, she has a feeling of numbness and “tingling” in her feet. She denies any problems with her balance and denies vertigo, but does not feel “sure-footed.” She denies any neurological history. Past medical history is significant for hysterectomy 10 years ago for menorrhagia and a bowel resection for Crohn’s disease. On exam, the patient has decreased reflexes and sensation bilaterally in her lower extremities. CBC shows a Hgb of 9.1 with an MCV of 114. The peripheral blood smear (see image below). The patient’s methylmalonic acid (MMA) level is elevated. What is the most likely cause?