Hematology/Oncology Question 18

A 68-year-old man is evaluated for a 3-year history of dyspnea on exertion. He experiences no headaches or blurred vision. Medical history is notable for a stroke 2 years ago. He is a smoker with an 80-pack-year smoking history. Medications are hydrochlorothiazide, lisinopril, aspirin, and simvastatin.

On physical examination temperature is 36.7 °C (98.0 °F), blood pressure is 145/84 mm Hg, pulse rate is 88/min, and respiration rate is 16/min. Oxygen saturation breathing ambient air is 88%. He has facial plethora. He has no carotid bruits. Cardiac sounds are distant. Pulmonary examination reveals distant breath sounds with scattered wheezing. No hepatosplenomegaly is palpated. No digital clubbing is observed.

Laboratory studies show a hemoglobin level of 18.2 g/dL (182 g/L), leukocyte count of 8000/µL (8 × 109/L) with a normal differential, and platelet count of 225,000/µL (225 × 109/L). Erythropoietin level is 30 mU/mL (30 U/L).

The patient is advised to quit smoking.

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

A  Bone marrow biopsy

B  JAK2 V617F testing

C  Phlebotomy

D  Supplemental oxygen

Choose an Answer Above

Have your answer...click Next Page to see if you're right.

Powered ByCareerCast