Discussion Questions Discuss other tests that could be performed to diagnose this type of anemia. (See Pernicious Anemia—Diagnostic Tests.)

A male college freshman is seen at the college health service complaining of general fatigue, a sore throat, and swollen lymph nodes in his neck. A throat culture is done, and blood is drawn for hematology studies and a rapid MonoSlide test. Hematology results show a normal hemoglobin value and a slight increase in the white cell count, with many large, reactive lymphocytes seen in the differential. A rapid strep test is negative, but a second swab is cultured on sheep blood and incubated, with the result to be read in 18 hours. Result from the MonoSlide test is positive. Questions What laboratory tests could exclude or include the possible diagnoses? Why did the patient have an increased white blood count with abnormal appearing lymphocytes?

You are an emergency room physician. Marcus, a 7-year-old boy, has just presented in the ER complaining that (1) his chest hurts, his heart feels funny, and his ankles and knees hurt. His mother says that he has had a fever for the past 24 hours. (2) Upon physical examination, you notice that his ankles and knees are red and swollen, and examination with a stethoscope reveals unusual palpitations (his heart is fluttering). (3) You immediately order an EKG to check for signs of a heart-attack, a CBC blood draw to check for signs of infection, a throat culture to check for presence of Streptococcus, an X-ray of his legs to check for bone fractures or lesions, and a urine sample to check for bacterial contamination. You are using the scientific method to diagnose Marcus. Which of the following statement(s) is your puzzling observation? A) Statement 1 B) Statement 2 and 3 C) Statement 2 D) Statement 3 E) Statement 1 and 2

Would a hemophiliac have an above or below normal coagulation time?