In a patient diagnosed with essential thrombocythemia and a high risk of thrombosis, which of the following is the most appropriate treatment?

A 55-year-old male presents to his primary care physician for fatigue. He states he has not felt like himself recently and had to take a few days off of work secondary to fatigue. He has lost 10 pounds over the past month. Vital signs: T: 99.0°F (37.2°C), BP:128/65 mmHg, HR: 100/min, RR: 12/min, and oxygen saturation is 98% on room air. Laboratory values are ordered as seen below.Hemoglobin: 9 g/dLHematocrit: 27%Leukocyte count: 2,500 with normal differentialPlatelet count: 93,000A biopsy of the bone marrow is performed which demonstrates hypocellular and fibrotic bone marrow and a peripheral smear is performed (see image). Which of the following is the most likely diagnosis?

During your Emergency Medicine rotation, you are asked to evaluate a 5-year-old male child who presents after falling off a scooter.  The patient reports that he fell sideways off the scooter as he rounded a curve in the road, and he describes dull, aching pain along his left side where he hit the ground. The patient’s parents report that he has never had any previous serious injury, but the mother recalls that he had increased bleeding following circumcision during infancy.  There is no other history of surgery or trauma.  On physical exam, the patient has extensive bruising of the lateral left thigh and tenderness to palpation. Initial CBC is performed and reveals normal WBC, Hgb, and HCT. Additional laboratory results are as follows: (Normal ranges in parentheses; abnormal results are in bold type)   Initial Test Results PT 12.6 sec (11.0-13.5) PTT 50.0 sec (25.0-35.0) Plt 250,000 (150,000-400,000) Based on these findings, what clotting factor deficiency is most likely in this patient?

A 76-year-old male with a medical history significant for heart failure with reduced ejection fraction (HFrEF) of 30% to 35%, COPD, and iron deficiency anemia is admitted for acute dyspnea on exertion with wheezing. CBC reveals a hemoglobin of 6.2 g/dL and hematocrit of 20%. A packed red blood cell transfusion is initiated. Seven hours later, the patient developed worsening dyspnea with an oxygen saturation of 72% on room air. The temperature is 99.2 °F (37.3 °C). Lung sounds show rales bilaterally. The neck veins are distended, and the patient develops hypertension. CBC shows a WBC of 10,100 and a platelet count of 237,000. What is the most likely diagnosis?

A 17-year-old African American female presents to the emergency room complaining of severe chest pain, cough, and shortness of breath. She has had many of painful episodes before but has never sought medical attention. Her vital signs are: T 102 deg F, HR 105 bpm,            BP 130/95 mmHg, RR 16, pulse ox (RA) 85%. EKG and troponins are within normal limits. CXR shows an infiltrate in the right middle lobe. Which of the following would you expect to find on peripheral blood smear?

A 65-year-old man presents to the hospital with complaints of fatigue, nausea, vomiting, and diarrhea for the past five days. He also states numbness and tingling of the legs, joint pain, and decreased urination that developed around the same time. He was recently diagnosed with non-Hodgkin lymphoma and started on chemotherapy two weeks ago. Vital signs show a blood pressure of 95/65 mm Hg, a pulse of 98/min, a respiratory rate of 19/min, and a temperature of 100˚F. Physical examination reveals a pale and cachectic man. Laboratory investigations reveal serum potassium 6.0 mEq/L (normal: 3.5-5.0 mEq/L), serum creatinine 3.2 mg/dL (normal: 0.6-1.2 mg/dL), serum calcium 7.0 mg/dL (normal: 8.6-10.2 mg/dL), and serum uric acid 9 mg/dL (normal: 2.4-6.5 mg/dL). What could have been done to prevent this condition?

A 7-month old boy, born to immigrant parents from Greece, presents to the hospital with pallor and abdominal distention. His temperature is 98.7°F (37°C), blood pressure is 98/61 mmHg, pulse is 111/min, respirations are 28/min, and oxygen saturation is 98% on room air. On physical exam, the patient is found to have hepatosplenomegaly and frontal skull bossing. Hemoglobin electrophoresis reveals markedly increased HbF and HbA2 levels. What would be the most likely findings on a peripheral blood smear?

A 45-year-old woman presents to the emergency department with hematemesis. Her son said that the patient had complained of gnawing abdominal pain that worsened before and improved after meals for the past 3 weeks. She frequently travels for work and is often stressed. She drinks alcohol socially and does not smoke tobacco or marijuana. She has not had anything to eat or drink for the past 24 hours due to the pain, but coughed up “several cups” of frank red blood before arrival. Her temperature is 98°F (37°C), blood pressure is 80/50 mmHg, pulse is 140/min, respirations are 24/min, and oxygen saturation is 96% on room air. The patient is empirically started on 3 units of uncrossmatched O-negative blood transfusion and pantoprazole. In the meantime, the patient’s initial laboratory data results reveal the following:Hemoglobin: 6 g/dLHematocrit: 18 %Leukocyte count: 8,000 with normal differentialPlatelet count: 400,000Serum:Na+: 140 mEq/LCl-: 115 mEq/LK+: 3.2 mEq/LHCO3-: 26 mEq/LBUN: 60 mg/dLGlucose: 104 mg/dLCreatinine: 1.1 mg/dLBlood type: ABRh status: negativeAfter bedside upper endoscopy with stapling of several peptic ulcers, repeat labs are obtained in 2 hours. The patient now complains of “feeling hot” with intermittent shivering. She denies any other symptoms. Her temperature is 101°F (38.3°C), blood pressure is 100/55 mmHg, pulse is 100/min, respirations are 20/min, and oxygen saturation is 99% on room air. Her lungs are clear to auscultation bilaterally, and no accessory respiratory muscle use is observed. No rash is seen. What 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 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