A 42-yeаr-оld wоmаn presents tо the emergency depаrtment 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. Rectal exam: Guaiac negative brown stool in rectal vault. Laboratory studies are shown below:Leukocyte count and differential: 7,600 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: Clear costophrenic angle 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?
A 68-yeаr-оld mаn presents tо his physiciаn with wоrsening fatigue, progressive back pain, and a 10-pound unintentional weight loss over the past month. For the past several months, he has also had more frequent constipation, for which he has taken docusate daily. Recently, he has noticed decreased urine production. He takes ibuprofen as needed for his chronic low back pain. Vital signs: T 98.9°F (37.9°C), BP 132/80 mmHg, HR 96/min, and RR 22/min. Physical examination reveals pedal edema and conjunctival pallor. There is tenderness to palpation over the lower thoracic vertebrae. Cardiac, abdominal, and digital rectal exams reveal no abnormalities. Initial laboratory studies demonstrate: WBC: 8,000Hemoglobin: 11.2 g/dL Plt: 256,000 MCV: 84Ca2+: 12.7 mg/dLBUN: 50 mg/dLCreatinine: 2.6 mg/dLSerum protein: 10.1 g/dLAlbumin: 4.2 g/dLWhich of the following other abnormalities would most likely be seen in this patient?