A 45-year-old woman comes to the physician because of a 1-week history of fatigue and bruises on her elbows. Examination shows a soft, nontender abdomen with no organomegaly. Laboratory studies show a hemoglobin concentration of 7 g/dL, a leukocyte count of 2,000/mm3, a platelet count of 40,000/mm3, and a reticulocyte count of 0.2%. Serum electrolyte concentrations are within normal limits. A bone marrow biopsy is most likely to show which of the following findings?
AIncreased myeloblast count
BSheets of abnormal plasma cells
CWrinkled cells with a fibrillary cytoplasm
DHypocellular bone marrow
EDysplastic bone with ringed sideroblasts
A 24-year-old woman complains of intermittent fever and joint pain. She says that these symptoms have been present for the past month. Before that, she had no signs or symptoms and was completely healthy. She has also lost her appetite and some weight. A complete blood count (CBC) showed severe pancytopenia. What is the next best step in evaluating this patient?
ARepeated CBCs for several weeks and reassess
BTreatment with corticosteroids
CTreatment with antibiotics
DTreatment for acute leukemia
EBone marrow examination
A 76-year-old woman presents to the physician for a follow-up examination. She had a hemoglobin level of 10.5 g/dL last month. She complains of mild dyspnea with exercise. She reports exercising daily for the past 30 years. She is relatively healthy without any significant past medical history. She occasionally takes ibuprofen for knee pain. She denies a prior history of alcohol or tobacco use. Her temperature is 37.1°C (98.8°F), the pulse is 65/min, the respiratory rate is 13/min, and the blood pressure is 115/65 mm Hg. The examination shows no abnormalities. Laboratory studies show: Laboratory test Hemoglobin 10.5 g/dL Mean corpuscular volume 75 μm3 Leukocyte count 6500/mm3 with a normal differential Platelet 400,000/mm3 Serum Iron 35 Total iron-binding capacity 450 μg/dL Ferritin 8 Ca+ 9.0 mg/dL Albumin 3.9 g/dL Urea nitrogen 10 mg/dL Creatinine 0.9 mg/dL Serum protein electrophoresis and immunofixation show a monoclonal protein of 20 g/L (non-IgM). Marrow plasmacytosis is 5%. A skeletal survey shows no abnormalities. In addition to the workup of iron deficiency anemia, which of the following is the most appropriate next step in management?
AReferral for radiation therapy
BCheck beta-2 microglobulin
CNo further steps are required at this time
DAnnual follow-up with laboratory tests
EReferral for induction therapy
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