A 32-Year-Old Man Comes to the Emergency Department Due to a Persistent

question 847

Multiple Choice

A 32-year-old man comes to the emergency department due to a persistent nosebleed lasting an hour.  Over the past week, he has had several episodes of epistaxis that stopped after prolonged nose pinching.  The patient has also noticed more fatigue and skin bruising than usual over the past month.  He has not had any recent nasal trauma or upper respiratory tract infections and does not use any intranasal medications.  The patient does not use tobacco or alcohol and maintains a vegan diet.  Temperature is 37.2 C (99 F) , blood pressure is 130/80 mm Hg, pulse is 96/min, and respirations are 18/min.  Physical examination shows dried blood in the right nostril with no intranasal lesions.  No enlarged lymph nodes are present.  Lung fields are clear to auscultation and heart sounds are normal.  The abdomen is soft and nontender with no hepatosplenomegaly.  Scattered ecchymoses are present on the extremities.  Laboratory results are as follows: Which of the following is most likely associated with this patient's current condition?

• A)Atypical promyelocytes in the bone marrow
• B)Decreased plasma von Willebrand factor activity
• C)Decreased serum vitamin B₁₂ levels
• D)Diffuse blastic lesions on bone scan
• E)Mediastinal mass on chest imaging
• F)Monoclonal protein on serum electrophoresis

---

Definitions:

Retrieving

The process of getting information out of memory storage.

Core Knowledge Perspective

A theory in developmental psychology that suggests children are born with innate knowledge systems or core domains of thought.

Innate Knowledge Systems

Cognitive structures present at birth that allow individuals to acquire knowledge, often considered a part of the nature versus nurture debate.

Reflexive Behaviors

Automatic, instinctual actions that do not require conscious thought, often present from birth.