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A 60-year-old woman presents with complaints of fatigue and easy bruising. Her CBC showed anemia, thrombocytopenia, and an elevated white blood cell count of predominantly circulating myeloblasts. Flow cytometry confirmed an AML. While her bone marrow is being examined by cytogenetic testing, FISH testing, and gene mutation testing, a plan is made to start high intensity chemotherapy. Further peripheral blood testing revealed:    Patient Result Reference Interval Na (sodium) 140 mmol/L 132-141 mmol/L K (potassium) 4.9 mmol/L 2.7-4.9 mmol/L Cl (chloride) 96 mmol/L 94-102 mmol/L HCO3 (bicarbonate) 25 mmol/L 24-31 mmol/L BUN (blood urea nitrogen) 27 mg/dL 8-27 mg/dL SCr (serum creatinine) 1.2 mg/dL 0.6-1.8 mg/dL Alb (albumin) 4 g/dL 2.5-4.2 g/dL Ca (calcium) 10.7 mg/dL 10.7-13.4 mg/dL Phos (phosphate) 5.4 mg/dL 1.9-5.4 mg/dL UA (uric acid) 0.5 mg/dL < 0.5 mg/dL LDH (lactate dehydrogenase) 1620 mmol/L 520-1480 mmol/L  Which of the following do you order next?

A 36 year-old woman presents with a swollen left lower extremity. An ultrasound shows a left femoral vein deep vein thrombosis. You are consulted to discuss anticoagulation options with the patient who has heard about the direct oral anticoagulants (DOACs) on television. When comparing warfarin to the direct oral anticoagulants (DOACs), you should tell her:

Why is pain relief for sickle cell anemia patients often undertreated by practitioners?

A 60-year-old migrant worker from Honduras presents at the emergency room in Dallas with abdominal distension, abdominal pain, and fever. He migrated to the United States 20 years previously and had not returned home since that time. X-ray revealed a bloated colon that required surgical resection to prevent rupture. A Giemsa stain of the man’s blood is shown. How did the man acquire the infection shown in the image? 

A 3-year-old girl is taken to the pediatrician with complaints of increasing fatigue and lumps in the neck that have grown in size over the past couple of weeks. She has had a normal childhood with no past medical history. She denies catabolic symptoms (i.e., fevers, chills, night sweats, and weight loss). She is on no medications. On physical exam the girl appears tired, pale, and petechial hemorrhages are visible on the buccal mucosa. You draw a CBC which reveals a    Patient Result Reference Interval Hgb (female) 8.1 g/dl 12-14 g/dL WBC      24.3 K/uL 4.5-10.5 K/uL Platelet count    28,000 /uL 150,000-400,000/uL  Which one of the following tests would you use to confirm the diagnosis?

What is an indication for using leukocyte reduced blood products?

A 47 year old male presents with a history of loss of appetite, weight loss, fatigue and fever. You identifiy an abdominal mass and following biopsy made a diagnosis of Burkitt Lymphoma. You know Burkitt Lymphoma is caused by a virus that establishes a latent infection in:

A 30 year old man in New England presents with fever, chills, fatigue, and muscle pain. It is June. He has been hiking and camping in the forest, but has not been out of the country. He is anemic with an enlarged spleen and liver. A Giemsa stain of a blood smear is shown in the image. The man has no other major health problems. What is the most likely outcome of his illness? 

A 38 year old woman with a history of antiphospholipid syndrome currently at 34 weeks gestation presents for evaluation of acute onset shortness of breath. She has not been taking aspirin or prophylactic anticoagulation during her pregnancy. On exam her O2 saturations are noted to be 90%, her heart rate is 109 bpm. Your next step in her management should be:

A 33 year old female at 37 weeks gestation presents with fever, right upper quadrant pain, and elevated blood pressure. You are uncertain if she has HELLP syndrome or acute fatty liver of pregnancy. Which of the following lab values would best help you distinguish between these two diagnoses?