NMS Q&A Family Medicine

Hematology 31915 A 45-year-old busy male attorney complains of headachesand generalized pruritus. He flew into an easternAmerican city from Denver, Colorado, to attend ahigh-level legal conference. He smokes 1 pack of cigarettesper day. He denies recent upper respiratorytract infection, foci of specific pain, and urinary andGI symptoms. On examination, he manifests a bloodpressure of 160/105, a temperature of 98.6 F, a ruddycomplexion, and splenomegaly and hepatomegaly.Blood gases are not immediately available. His CBCshowed the hemoglobin level to be 18 g/dL, the whiteblood cell count to be 14,000, and the platelet countto be 7,00,000. Red blood cells are normochromicand normocytic. The BUN level is 18 mg/dL and thecreatinine level is 1.1 mg/dL. Urinalysis is within normallimits with a specific gravity of 1.015. Which ofthe following is the diagnosis?(A) Polycythemia vera(B) Secondary polycythemia from altitudeaccommodation(C) Secondary polycythemia caused by chronicobstructive pulmonary disease(D) Spurious polycythemia from dehydrationcaused by air travel(E) Secondary polycythemia compensating forcarboxyhemoglobin in a heavy smoker16 A 65-year-old woman complains of pain in the backand chest with localized tenderness at the spine of T8and ribcage pain with tenderness at the right seventhrib. The patient appears to be quite pale and admitsto fatigue. These symptoms have come on graduallyover a period of several weeks, with the back painbecoming the reason for consulting the physician. Adip urinalysis shows proteinuria. Screening CBCreveals a normochromic, normocytic anemia with8 g/dL of hemoglobin and marked rouleau formationwith normal platelets and white cell counts and morphology.Serum chemistry results include calciumelevation to 12.2 mg/dL with normal alkaline phosphatase.Plain x-rays show a fracture of the right seventhrib, compression of the eighth vertebra. Of thefollowing, which is the most likely diagnosis?(A) Alcoholism(B) Metastatic carcinoma(C) Multiple myeloma(D) Waldenström macroglobulinemia(E) Severe osteoporosis17 A 26-year-old man has noted painless swelling in theleft side of his neck. Furthermore, he has noted afternoonchills and night sweats for several weeks. He hasstopped smoking because inhaling tobacco smokemakes him ill. Although he seldom drinks alcohol,during the past week, he took a glass of wine and onlythen noted pain in the swelling about the neck.Examination is unremarkable except for the neck,which exhibits a firm irregular mass measuringapproximately 3 cm 5 cm located in the left anteriorcervical region. The CBC and laboratory chemicalbattery are within normal limits. Which of thefollowing is the most likely significant cause of thesesymptoms?(A) Hodgkin disease(B) Sialoadenitis(C) Viral respiratory tract infection(D) Streptococcal pharyngitis(E) Carotid artery aneurysm