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A 24-year-old male presents to his primary care physician for evaluation of recurrent fever, night sweats, and weight loss. The patient reports that he has been experiencing these symptoms for the past several weeks. After a complete physical exam and a series of laboratory and diagnostic tests, the patient undergoes an excisional lymph node biopsy (see image). He is determined to have Stage IIB disease. Which of the following clinical findings would be an adverse prognostic factor in this patient?  

A 13-year-old female patient with known sickle cell disease presents to the primary pediatrician’s office with chest pain, tachypnea, and fever. This chest x-ray was obtained (see image). What is the most likely diagnosis?

A 3-year-old boy with no significant PMH presents to his pediatrician with a two-month history of petechial rash and intermittent epistaxis. The parent reports that he has had a cough, rhinorrhea, and has been fussier than normal. No fevers, weight loss, or unusual fatigue were reported. He is tracking along his growth curves and is meeting his developmental milestones appropriately. Initial laboratory test results are as follows: How would you describe the patient’s CBC results in the table above?

A 42-year-old woman presents to the emergency department with complaints of recurrent shortness of breath for the past 2 weeks. She reports shortness of breath whenever she goes on her morning run. The symptoms last for approximately 5-10 minutes and improve with rest. She denies chest pain, syncope, nausea, or abdominal pain during these episodes. Her medical history is significant for rheumatoid arthritis which is treated with hydroxychloroquine. She denies any recent surgeries, oral contraceptive/estrogen use, malignancy, or personal history of deep vein thrombosis (DVT) or pulmonary embolism (PE). She endorses some rhinorrhea and sore throat that has since resolved. Physical examination demonstrates some joint swelling at the proximal interphalangeal joints bilaterally but is otherwise unremarkable. Laboratory studies are shown below:Leukocyte count and differential: 9,800 with normal differentialHemoglobin: 9.8 g/dLPlatelet count: 180,000Mean corpuscular volume (MCV): 83Reticulocyte count: 0.2%Ferritin: 268 ng/mL (Normal: 12-150 ng/mL)Serum iron: 38 mcg/dL (Normal: 60-170 mcg/dL)Total iron binding capacity (TIBC): 240 mcg/dL (Normal: 240-450 mcg/dL) CXR was obtained and reveals clear costophrenic angles and no signs of consolidation or interstitial infiltrate. Cardiac silhouette is clear, and there are no signs of cardiomegaly. What is the most likely explanation for this patient’s symptoms?

You are asked to evaluate a 46-year-old female who presents to the Emergency Department (ED) with complaint of right occipital headache and left upper extremity numbness and weakness for the past four days, accompanied by T: 100.4°F.  The patient denies blurry vision, nausea, vomiting, fever, or chills, and is without other complaints.  Initial lab results are as follows: (Normal ranges in parentheses; abnormal results are in bold type):             WBC 10,000 (4,000-11,000), Hb 8.0g/dL (↓) (11.5-15.5 g/dL), and Platelets 30,000 (↓) (150,000-400,000)             Serum creatinine 1.8 mg/dL (↑) (0.6-1.3 mg/dL), and BUN 24 mg/dL (10-26 mg/dL)             PT and PTT are both normal. Peripheral blood smear: red blood cell fragments and decreased number of platelets Which of the following clinical findings would you expect to find in this patient?    

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?