A 42-year-old man with a history of tuberculosis presents to your office complaining of fatigue for two months. Serum laboratory studies reveal the following: WBC 7,000 cells/mm^3, Hb 9.0 g/dL, Hct 25%, MCV 88 fL, Platelet 450,000 cells/mm^3, Vitamin B12 500 pg/mL (200-800), and Folic acid 17 ng/mL (2.5-20). Which of the following is the most appropriate next step in the management of anemia in this patient?
AIron studies
BBone marrow biopsy
CObservation
DColonoscopy
EErythropoietin administration
A 55-year-old woman comes to the physician because of a 6-month history of worsening shortness of breath on exertion and fatigue. She has type 1 diabetes mellitus, hypertension, hypercholesterolemia, and chronic kidney disease. Her mother was diagnosed with colon cancer at the age of 65 years. Her blood pressure is 145/92 mm Hg. Examination shows conjunctival pallor. Laboratory studies show: Hemoglobin 9.2 g/dL Mean corpuscular volume 88 μm3 Reticulocyte count 0.6 % Serum Ferritin 145 ng/mL Creatinine 3.1 mg/dL Calcium 8.8 mg/dL A fecal occult blood test is pending. Which of the following is the most likely underlying cause of this patient's symptoms?
ADecreased erythropoietin production
BChronic occult blood loss
CDeficient vitamin B12 intake
DHematopoietic progenitor cell mutation
EAutoantibodies against the thyroid gland
A 57-year-old woman comes to the physician because of a 3-month history of easy fatigability and dyspnea on exertion. Menopause occurred 5 years ago. Her pulse is 105/min and blood pressure is 100/70 mm Hg. Physical examination shows pallor of the nail beds and conjunctivae. A peripheral blood smear shows small, pale red blood cells. Further evaluation is most likely to show which of the following findings?
AIncreased concentration of HbA2
BDecreased serum haptoglobin concentration
CPositive stool guaiac test
DDry bone marrow tap
EIncreased serum methylmalonic acid concentration
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