A 58-Year-Old Woman Comes to the Physician Because of Progressive

question 686

Multiple Choice

A 58-year-old woman comes to the physician because of progressive generalized weakness over the last two months.  Two weeks ago, she woke up with a nosebleed that stopped after applying pressure to her nostril.  She has had no other bleeding events.  She was diagnosed with early stage breast cancer 6 years ago and underwent surgery and adjuvant combination chemotherapy with doxorubicin, cyclophosphamide, and paclitaxel.  She underwent gastric bypass surgery two years ago.  Her other medical problems include depression and gastroesophageal reflux disease.  She takes paroxetine, omeprazole, and calcium and vitamin D supplements.  She had smoked 1 pack of cigarettes daily for 12 years, but stopped after her diagnosis of breast cancer.
Her blood pressure is 112/70 mm Hg and pulse is 89/min.  Her BMI is 30 kg/m².  Cardiopulmonary examination is normal.  Breast examination shows a well-healed scar over the left breast.  The abdomen is soft and non-tender and there is no organomegaly.  There are no skin rashes.
Laboratory results are as follows:

The peripheral smear reveals no platelet clumping but does show polychromasia; occasional nucleated red blood cells; metamyelocytes; and cells with large nuclei, prominent nucleoli, and scant cytoplasm.  There are no schistocytes.
This patient's current condition is most likely related to which of the following?

• A)Anthracycline exposure
• B)Breast cancer metastasis
• C)Intestinal malabsorption
• D)Microangiopathic anemia
• E)Paraneoplastic syndrome

---

Definitions:

Discount Rate

The interest rate used to determine the present value of future cash flows in discounted cash flow analysis.

Projected Benefit Obligation

Projected Benefit Obligation is the present value of expected future payments required to fulfill pension or other post-employment benefit plans.

Funded Status

The financial metric used to evaluate the financial health of a pension plan, indicating the difference between the plan assets and liabilities.

Defined Benefit Plan

A type of pension plan where the employer guarantees a specified pension payment in retirement, based on factors like salary history and duration of employment.