In addition to x-radiation, list other causes of changes to the genetic material of cells

Which of the following best defines an established problem, worsening?

a. When performing physician orders specific laboratory, pathology, or diagnostic tests for the purpose of identifying the differential diagnosis of the undiagnosed new presenting problem b. A patient's presenting problem that has already been diagnosed by the performing physician and has become worse c. A patient's presenting problem that has already been diagnosed by the performing physician and has remained stable or shows improvement d. A patient's presenting problem that has already been diagnosed by the performing physician

A 61-year-old woman saw her primary care physician because of fatigue and dyspnea on exertion for the past 3 months

Past medical history noted that the patient had been treated 5 years earlier with the DNA alkylating agent cyclophosphamide, non-Hodgkin lymphoma. A CBC revealed the following: WBC: 3.6 x 109/L RBC: 2.8 x 1012/L Hb: 9.1 g/dL MCV: 104 fL Reticulocyte count: 2.0% Normal vitamin B12 and folic acid levels PLT: 120 x 109/L Differential: 6% blasts A bone marrow biopsy revealed hypercellularity, and dyshematopoiesis of all three myeloid lineages. Suggest an appropriate follow-up test and a likely diagnosis for this patient. What will be an ideal response?