If a germ cell or somatic cell had the original mutation, then there's an increased risk for cancer in other parts of the body too. If only retinal cells in one eye is mutated, only that one eye is at risk for cancer.

Chorionic villi sampling is the taking of genetic material within in the chorionic villi of the placenta. Chorionic sampling is done when a patient is at high risk for chromosomal abnormalities (previous pos. tests, 35yo or older, family hx.) during the 10-13 weeks of pregnancy.

Confined placental mosaicism results when the C.V.S. testing comes back back showing a trisomy, but all subsequent testing (and the fetus itself) have normal chromosomal counts. This may be due to either a trophoblastic mutation, or by "trisomic rescue," in which trisomic cells that were supposed to be in the fetus are confined to the placenta to prevent an abnormal fetus.

So although Misoprostol DOES increase mucus production and is gastro-protective (and in FA does state that it decreases acid production), thereby decreasing symptoms and aiding in healing, omeprazole is the "more correct" choice. This is because omeprazole is a proton-pump inhibitor, which will act directly on the proton pumps of the stomach and decrease the offending agent more than the misoprostol will. Therefore, it is the first line drug for GERD.

So I hate this question because you can know what the diagnosis is and still miss it.

TL;DR: This is lead poisioning, so there is basophilic stippling in a peripheral blood smear [BUT ringed sideroblasts would also be found in the bone marrow]

Why this is lead poisoning: (FA2020 p425)

• Microcytic Anemia (caused by lead inhibition of ferrocheletase and ALA dehydratase)
• Environmental exposure (ammunition at the range, he is an officer)
• GI effects (crampy abdominal pain)
• Neurological effects (headache, irritability, distractability, forgetful, motor weakness)

Why it is NOT the other answers:

• Auer rods - characteristic of acute myelogenous leukemia which would present with pancytopenias (his WBCs are normal) along with circulating myeloblasts on peripheral smear; median age onset 65 years and he has no risk factors
• Oval Macrocytes - in macrocytic anemias (B12 or folate deficiency), this is microcytic as indicated by MCV
• Pleomorphic lymphocytes - occur in chronic lymphocytic leukemias and infectious mono, both which have different symptomotologies
• Ringed sideroblasts - are from lead poisoning but are in the bone marrow
• Scistocytes - characteristic RBC which has been through a clogged vessel and sheared off, found in microangiopathic hemolytic anemias (MAHAs) like thrombotic microangiopathies like TTP and HUS (typically normocytic anemia and different presentation; a question would likely give you more info on the thrombolytic pathway if they wanted you to choose this; we didn't even get a platelet count here)
• Target Cells: found in HbC disease (glutamic acid to lysine in hemoglobin, causes extravascular hemolysis), liver disease, asplenia, and Thalassemia (deletions in either alpha or beta chain of hemaglobin, causes anemia that would be present from childhood and would not have neuro symptoms)