A 30-year-old primigravid woman at 16 weeks' gestation presents with vaginal bleeding. She has had spotting for the last 2 days. A viable uterine pregnancy was confirmed on ultrasonography during a prenatal care visit 2 weeks ago. She reports recurrent episodes of pain in her right wrist and both knees. Pelvic examination shows an open cervical os and blood within the vaginal vault. Laboratory studies show: Hemoglobin 9.6 g/dL Leukocyte count 8200/mm³ ,Platelet count 140,000/mm³ ,Prothrombin time 14 seconds ,Partial thromboplastin time 46 seconds Ultrasonography shows an intrauterine pregnancy and no fetal cardiac activity. Which of the following is the most likely explanation for this patient's examination findings?

A 34-year-old woman, gravida 4, para 0, at 8 weeks' gestation comes for a prenatal visit. The previous pregnancies ended in spontaneous abortion between the 8^th and 10^th week of gestation. She feels well but is worried about having another miscarriage. Examination shows a violaceous, reticular rash on the lower extremities. Her lab tests revealed low haemoglobin, low platelet , normal PT and prolonged PPT. Anti-beta 2 glycoprotein-1 antibody positive

Which of the following is the most appropriate next step in management?

A 24-year-old woman with presents pain and swelling of her left leg diagnosed as DVT. Seven months ago, she was diagnosed with a pulmonary embolism and was started on warfarin which was discontinued 1 month ago. Her sister has systemic lupus erythematosus. She currently takes no medications. Examination was normal apart from DVT. Laboratory studies show an elevated serum concentration of D-dimer and insensitivity to activated protein C. Further examination is most likely to show which of the following?

Elevated levels of homocysteine

Deficiency of protein

A 62-year-old man comes to his primary care physician for evaluation of daily headaches and blurry vision. These symptoms started two months ago. In addition, the patient reports feeling itchy over his body after bathing or visiting the sauna. Past medical history is notable for hypertension and asymptomatic gallstones were discovered on a recent ultrasound. The patient is a former smoker with a 20-pack-year smoking history. On the physical exam, the patient is observed to have facial plethora and a spleen palpated 2 cm below the left costal margin. Laboratory testing is ordered and the results are as follows:

Laboratory Results

Hemoglobin 18.1 g/dL

Hematocrit 54%

Erythrocytes 7.2 million/mm3

Leukocytes 12,500/mm3

Platelets 470,000/mm3

Uric Acid 7.9 mg/dL

Which of the following best describes the pathophysiology of this patient’s presentation?

A 55-year-old woman with a history of peptic ulcer disease comes to her primary care physician because of generalized itchiness. She says these symptoms started a few months ago, and she noticed that it tends to get worse when she takes warm showers. She recently began experiencing sudden severe burning pains in her hands, after which they turn a reddish color. Physical examination shows a well-developed female with diffuse ruddy cyanosis, elevated blood pressure, and splenomegaly. Laboratory studies show elevated erythrocyte count with increased mass, elevated platelet count, and decreased erythropoietin. Which of the following is the most likely diagnosis?

A 52-year-old woman, para 4 gravida 2 aborta 2, comes to the clinic for a follow-up appointment after a hospitalization. Two weeks ago, she had an incident of acute, severe abdominal pain and bloody stools. She was diagnosed with portal vein thrombosis. She denies similar episodes in the past. She does not smoke, drink excessive alcohol, or use illicit drugs. She had 2 spontaneous abortions in the first trimester, following 2 successful pregnancies. Family history is remarkable for DVT in her maternal uncle and colon cancer in her father. The physician suspects an inherited condition. Which of the following will prompt further evaluation in this patient?

A 30-year-old woman, gravida 1, para 0, comes to the office for follow up of a stillbirth 3 months ago. The pregnancy was at 22 weeks when the stillbirth occurred, and during the event she experienced painful contractions. There is no personal or family history of thrombotic or other blood disorders. Her temperature is 37.0°C (98.6°F), pulse is 72/min, respirations are 16/min, and blood pressure is 110/75 mm Hg. Her initial basic laboratory results are within normal limits, except for a prolonged activated partial thromboplastin time (APTT) of 50s. Which of the following is the next best step in this patient’s management?

A 22-year-old woman comes to the office because of fatigue and facial rash. The symptoms began several weeks ago and have been gradually worsening. The patient states that she gets a rash when she is exposed to sunlight for any significant period of time. Physical examination shows a round 4 cm (1.57 in), scaly rash on her left cheek. The patient is also found to have tender, boggy metacarpophalangeal joints of her right hand and her left knee. She is found to have a positive antinuclear antibody titer. What complication is this patient most likely to experience?

A 40-year-old man comes to the emergency department because of cough, shortness of breath, and pleuritic chest pain for the past 10 days. He has had a cerebrovascular accident in the past year. He believes he is allergic to contrast dye. His temperature is 37.2°C (99°F), pulse is 80/min, respirations are 16/min, and blood pressure is 120/80 mm Hg. Physical examination shows residual hemiparesis. A complete blood count shows:

His prothrombin time is 12s and partial thromboplastin time is 40s. An ECG is within normal limits. A chest X-ray shows left-sided pleural effusion. Which of the following is the most appropriate next step in management?