An 80-year-old woman is brought in by ambulance in the summer after being found in her home by her husband dazed and confused. Body temperature is 106 F.

Which of the following is the most likely explanation for this patient’s hematologic findings?

A) Asplenia
B) Coombs test-positive hemolytic anemia
C) Liver failure
D) Microangiopathic hemolytic anemia
E) Sepsis

A 16-year-old boy is brought to the physician for a follow-up appointment.

Which of the following is most likely to be seen in this patient?

A) Abnormal endoderm of foramen cecum
B) Decreased serum sodium
C) Galactorrhea
D) Remnant of primitive oral cavity
E) Upward gaze palsy

A 31-year-old woman comes to the physician for a health maintenance examination. She had a prior imaging modality performed, the results of which are shown below. “A” represents a healthy control individual; “B” is the patient’s imaging results.

Which of the following is most likely to be seen in this patient?

A) Anti-microsomal antibodies
B) Anti-thyrotropin receptor antibodies
C) Calcium of 7.9 mg/dL
D) Calcium of 11.0 mg/dL
E) Post-viral illness state

A 47-year-old man is evaluated in hospital following a 2-week history of darkening of his urine. He reports no recent illnesses.

Which of the following is most likely to be seen in this patient?

A) Anti-Hu antibodies
B) Insulin resistance
C) Serum calcium of 12 mg/dL
D) Serum sodium of 125 mEq/L
E) Urinary specific gravity of 1.030

A 31-year-old woman comes to the physician for a follow-up appointment. She has a history of recurrent flares of joint pain and low platelets. Today she presents with two small mouth ulcers. Her prior HLA-B27 screening was negative. Serum creatinine and BUN are mildly elevated. Which of the following is most likely to be seen in this patient?

A) Anti-cyclic citrullinated peptide antibodies
B) Anti-microsomal antibodies
C) Decreased serum C3
D) IgM targeting the Fc region of IgG
E) Type II hypersensitivity

A 9-year-old girl is brought to the physician by her mother for a 1-month history of skin changes to the right forehead and periorbital region. She has acute lymphoblastic leukemia in remission and received her last dose of chemotherapy 4 months ago. Which of the following is the most likely explanation for this patient’s findings?

A) Bacterium
B) DNA virus
C) Stevens-Johnson syndrome
D) RNA virus
E) Toxic epidermal necrolysis

A 29-year-old man is evaluated in hospital. His father had a history of “anemia” treated with splenectomy and cholecystectomy. MCV is 85 fL. Hemoglobin is 14 g/dL. MCHC is elevated. The patient has a diagnostic modality performed that is abnormal. Below is an imaging result using the same modality from a healthy individual.

Which of the following most likely explains the patient’s abnormal diagnostic result?

A) Coombs test positivity
B) Gallstone ileus
C) Gallstone pancreatitis
D) Increased erythrocyte turnover
E) Increased HbS

A 78-year-old woman is evaluated in hospital for yellow eyes and skin. She has no overt past medical history apart from a cholecystectomy at age 58. She’s a non-smoker. Laboratory studies show:

Total bilirubin                                        4.0 mg/dL
Conjugated bilirubin                         3.0 mg/dL
Pancreatic amylase                            Normal
Pancreatic lipase                                 Normal

Which of the following is the most likely explanation for this patient’s findings?

A) Choledocholithiasis
B) Cholelithiasis
C) Malignancy
D) Reduced activity of hepatic enzyme
E) Sphincter of Oddi dysfunction

A 53-year-old woman is evaluated in hospital for a 6-month history of fatigue, lymphadenopathy, and easy bruising. Leukocyte count is 80,000/μL, with 89% lymphocytes. Hemoglobin is 9 g/dL. A Coombs test is positive.

Which of the following is most likely to be seen in this patient?

A) CD5/23 positivity
B) CD10 + TdT positivity
C) Intravascular hemolysis
D) t(9;22)
E) t(15;17)

A 41-year-old woman comes to the physician for a 4-month history of increasing fatigue. She is an avid traveler and visited Honduras 6 months ago. Serum laboratory studies show:

Sodium                                             137 mEq/L
Potassium                                       5.6 mEq/L
Bicarbonate                                   22 mEq/L
Leukocytes                                     8,000/μL
Eosinophils                                    26%

Which of the following is the next best step in diagnosis?

A) ACTH stimulation test
B) Dexamethasone suppression test
C) Measure serum iron and ferritin
D) Stool nematode toxin test
E) Stool smear for ova and parasites