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178630 Pathology

A 56-year-old woman with a history of breast cancer that was treated 5 years ago with lumpectomy and radiation but with no chemotherapy returns with bone pain, fatigue, and weakness. A complete blood count reveals severe anemia, as well as decreased white blood cells and platelets. Examination of a peripheral blood smear reveals small numbers of nucleated red cells, as well as an occasional “blast” cell and myelocyte. A likely cause of the hematologic abnormalities is

Achloramphenicol.
BDiphyllobothrium latum infestation.
Cmegaloblastic anemia.
Dmyelophthisic anemia.
Pathology
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178632 Surgery

Kamli Rath 75 yrs old woman present with post-myocardial infarction after 6 weeks with mild CHF. There was past H/O neck surgery for parathyroid adenoma 5 years ago, EKG shows slow atrial fibrillation. Serum Ca+2 13.0 mg/L and urinary Ca2+ is 300 mg/ 24 hr. On examination, there is small mass in the Para tracheal position behind the right clavicle. Appropriate management at this time is –

ARepeat neck surgery
BTreatment with technetium - 99
CObservation and repeat serum Ca+2 in two months
DUltrasound-guided alcohol injection of the mass
Surgery
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