MSN 621 Final Exam QUESTIONS AND
CORRECT ANSWERS
A 65-year-old female with renal cancer presents with dyspnea, fatigue, and dizziness. She is
on warfarin for the treatment of a left leg deep vein thrombosis. Her hematocrit is 22%,
hemoglobin is 7.1 g/dL, platelets 109,000/mL, PT 1.3, PTT 36, INR 1.45, and WBC 12,000
mm3. What is the next step in the management of the patient?
Well done!You answered successfully
A. Transfuse packed red blood cells
B. Transfuse platelets
C. Transfuse fresh frozen plasma
D. Give vitamin K - CORRECT ANSWER A. Transfuse packed red blood cells
A 36-year-old woman with a past medical history significant for menorrhagia from uterine
fibroids presents with exertional dyspnea and fatigue. Examination shows conjunctival pallor.
Laboratory tests reveal a hemoglobin of 6.2 grams/dL, mean corpuscular volume (MCV) 60
fl (normal: 80-100 fl), and normal liver function tests. What is the most likely diagnosis?
Well done!You answered successfully
A. Anemia of chronic disease
B. Vitamin B12 deficiency
C. Iron deficiency anemia
D. Acute blood loss anemia - CORRECT ANSWER C. Iron deficiency anemia
Which of the following is associated with the CD10 antigen?
Well done!You answered successfully
A. Acute myeloid leukemia
B. Acute lymphocytic leukemia
C. Chronic myeloid leukemia
D. Hodgkin lymphoma - CORRECT ANSWER B. Acute lymphocytic leukemia
,A 49-year-old male with fatigue and easy bruising is found to have terminal deoxynucleotidyl
transferase (TdT) positive cells in the blood. He may have which of the following conditions?
Well done!You answered successfully
A. Acute myelogenous leukemia
B. Hodgkin lymphoma
C. Hairy cell leukemia
D. Acute lymphoblastic leukemia - CORRECT ANSWER D. Acute lymphoblastic
leukemia
A 16-year-old male presents with fatigue, easy bruisability, and weight loss. On examination,
hepatosplenomegaly is noted. After a detailed evaluation, the patient is diagnosed with acute
lymphocytic leukemia. Which of the following is used in the management of this patient's
condition?
Well done!You answered successfully
A. Dexrazoxane
B. L-asparaginase
C. Imatinib
D. Everolimus - CORRECT ANSWER B. L-asparaginase
A 16-year-old male presents with lethargy, fatigue, and occasional mucosal bleeding. The
patient also reports weight loss in the past 5 months. Laboratory analysis reveals a white
blood cell count of 32,000 cells/microL. On examination, hepatosplenomegaly is noted.
Further evaluation shows findings suggestive of acute lymphocytic leukemia. What is the
most likely cause of the patient's mucosal bleeding?
Well done!You answered successfully
A. Hepatosplenomegaly
B. Decreased platelet count
C. Factor V deficiency
D. Microthrombi formation - CORRECT ANSWER B. Decreased platelet count
A 67-year-old female presents with a history of high fevers and productive cough with green
sputum for the last three days. The patient received the influenza vaccine this year. Her past
,medical history is unremarkable. She has a smoking history of 25 pack years. She does not
drink alcohol or use illicit drugs. Temperature is 102F, blood pressure is 115/70mmHg, the
pulse is 101/min, and respirations are 23/min. Her oxygen saturation is 91% on room air. On
examination, her anterior cervical lymph nodes are enlarged and nontender. Chest
auscultation reveals crackles in the left lower lobe. Hepatosplenomegaly is present. A chest x-
ray shows a developing left lower lobe consolidation. Labs show a WBC count of 45000,
with lymphocytes being 85%. Empirical pharmacotherapy is initiated, and blood cultures are
sent to the lab. Which of the following is the most appropriate step next?
Well done!You answered successfully
A. Flo - CORRECT ANSWER A. Flow cytometry of blood
A 60-year-old asymptomatic man is found to have leukocytosis on a preoperative CBC.
Physical examination shows the spleen tip to be palpable 2 cm below the left costal margin.
Rubbery, nontender lymph nodes up to 1.5 cm in size are present in the axillae and inguinal
regions. Laboratory data include the following: Hgb: 13.3 g/dL (normal 14 to 18)
Leukocytes: 40,000/microL (normal 4300 to 10,800) Platelet count: 238,000 (normal 150,000
to 400,000) His peripheral blood smear is shown in the accompanying photo. Which of the
following is the most likely diagnosis?
A. Acute monocytic leukemia
B. Chronic myelogenous leukemia
C. Chronic lymphocytic leukemia
D. Tuberculosis - CORRECT ANSWER C. Chronic lymphocytic leukemia
A 45-year-old asymptomatic man is found to have leukocytosis on a preoperative complete
blood count. His physical examination is significant for the spleen tip being palpable 2 cm
below the left costal margin. Enlarged, rubbery, nontender lymph nodes up to 1.5 cm in size
are present in the axillae and inguinal regions. Laboratory workup reveals a hemoglobin of
13.3 g/dL, leukocytes 40,000/microliter, and platelets 238,000/microliter. His peripheral
blood smear shows mature lymphocytes with smudge cells. If he fails first-line therapy,
which of the following cytogenetic changes would be an indication for stem cell transplant in
this patient?
Well done!You answered successfully
A. Trisomy 12
B. 13q deletion
C. 17p deletion
, D. 19p deletion - CORRECT ANSWER C. 17p deletion
A 65-year-old woman presents with an 8-month history of recurrent low-grade fevers, a 3-
month history of abdominal fullness, and more recently, fatigue and moderately reduced
exercise tolerance. Before this, she was in good health with no major medical conditions.
Upon examination, she appeared to be stable and in no acute distress. She has a heart rate of
95 bpm and blood pressure of 128/60 mmHg. She had several palpable cervical and axillary
lymph nodes (1-2 cm) that were non-tender and freely mobile. She also had palpable
splenomegaly. No other abdominal masses/hepatomegaly appreciated on examination. Her
complete blood count showed a leukocyte count of 32,000/mm3, hemoglobin of 9.8 g/dL,
platelet count of 145,000/mm3, neutrophil count 1,900/mm3, lymphocyte count 30,000/mm3,
elevated LDH, and elevated reticulocyte count. Peripheral blood smear showed an increasing
number of mature lymphocytes, spherocytes, and pol - CORRECT ANSWER B.
Autoimmune hemolytic anemia
A 43-year-old man presents to the clinic for evaluation after abnormalities noted on a routine
set of labs. CBC with differential demonstrated hemoglobin 14 g/dL, WBC count
26,000/microL, lymphocytes 21,000/microL, neutrophils 4500/microL, and platelets
260,000/microL. The basic metabolic panel demonstrates normal electrolytes and renal
function. LFTs show total bilirubin 1.2 mg/dL and normal liver enzymes. On examination in
office, his examination is normal, with no palpable lymph nodes or hepatosplenomegaly. He
denies any B symptoms. Peripheral smear shows lymphocytosis with many small
lymphocytes and smudge cells. Which of the following is the next best step in the
management of this patient?
Well done!You answered successfully
A. Dexamethasone monotherapy
B. Initiate chemotherapy with CHOP (cyclophosphamide, doxorubicin, vincristine, and
prednisone)
C. Rituximab monotherapy
D. Observation and close follow up - CORRECT ANSWER D. Observation and close
follow up
A 16-year-old female presents with complaints of fever, lethargy, and night sweats. The
patient also reports a 6-kilogram (13.2 pound) weight loss in the past 3 months. On
examination, painless, enlarged cervical and supraclavicular lymph nodes are palpated. A
fine-needle aspiration biopsy of one of the lymph nodes is shown in the image. The patient's
findings are most suggestive of which of the following?
CORRECT ANSWERS
A 65-year-old female with renal cancer presents with dyspnea, fatigue, and dizziness. She is
on warfarin for the treatment of a left leg deep vein thrombosis. Her hematocrit is 22%,
hemoglobin is 7.1 g/dL, platelets 109,000/mL, PT 1.3, PTT 36, INR 1.45, and WBC 12,000
mm3. What is the next step in the management of the patient?
Well done!You answered successfully
A. Transfuse packed red blood cells
B. Transfuse platelets
C. Transfuse fresh frozen plasma
D. Give vitamin K - CORRECT ANSWER A. Transfuse packed red blood cells
A 36-year-old woman with a past medical history significant for menorrhagia from uterine
fibroids presents with exertional dyspnea and fatigue. Examination shows conjunctival pallor.
Laboratory tests reveal a hemoglobin of 6.2 grams/dL, mean corpuscular volume (MCV) 60
fl (normal: 80-100 fl), and normal liver function tests. What is the most likely diagnosis?
Well done!You answered successfully
A. Anemia of chronic disease
B. Vitamin B12 deficiency
C. Iron deficiency anemia
D. Acute blood loss anemia - CORRECT ANSWER C. Iron deficiency anemia
Which of the following is associated with the CD10 antigen?
Well done!You answered successfully
A. Acute myeloid leukemia
B. Acute lymphocytic leukemia
C. Chronic myeloid leukemia
D. Hodgkin lymphoma - CORRECT ANSWER B. Acute lymphocytic leukemia
,A 49-year-old male with fatigue and easy bruising is found to have terminal deoxynucleotidyl
transferase (TdT) positive cells in the blood. He may have which of the following conditions?
Well done!You answered successfully
A. Acute myelogenous leukemia
B. Hodgkin lymphoma
C. Hairy cell leukemia
D. Acute lymphoblastic leukemia - CORRECT ANSWER D. Acute lymphoblastic
leukemia
A 16-year-old male presents with fatigue, easy bruisability, and weight loss. On examination,
hepatosplenomegaly is noted. After a detailed evaluation, the patient is diagnosed with acute
lymphocytic leukemia. Which of the following is used in the management of this patient's
condition?
Well done!You answered successfully
A. Dexrazoxane
B. L-asparaginase
C. Imatinib
D. Everolimus - CORRECT ANSWER B. L-asparaginase
A 16-year-old male presents with lethargy, fatigue, and occasional mucosal bleeding. The
patient also reports weight loss in the past 5 months. Laboratory analysis reveals a white
blood cell count of 32,000 cells/microL. On examination, hepatosplenomegaly is noted.
Further evaluation shows findings suggestive of acute lymphocytic leukemia. What is the
most likely cause of the patient's mucosal bleeding?
Well done!You answered successfully
A. Hepatosplenomegaly
B. Decreased platelet count
C. Factor V deficiency
D. Microthrombi formation - CORRECT ANSWER B. Decreased platelet count
A 67-year-old female presents with a history of high fevers and productive cough with green
sputum for the last three days. The patient received the influenza vaccine this year. Her past
,medical history is unremarkable. She has a smoking history of 25 pack years. She does not
drink alcohol or use illicit drugs. Temperature is 102F, blood pressure is 115/70mmHg, the
pulse is 101/min, and respirations are 23/min. Her oxygen saturation is 91% on room air. On
examination, her anterior cervical lymph nodes are enlarged and nontender. Chest
auscultation reveals crackles in the left lower lobe. Hepatosplenomegaly is present. A chest x-
ray shows a developing left lower lobe consolidation. Labs show a WBC count of 45000,
with lymphocytes being 85%. Empirical pharmacotherapy is initiated, and blood cultures are
sent to the lab. Which of the following is the most appropriate step next?
Well done!You answered successfully
A. Flo - CORRECT ANSWER A. Flow cytometry of blood
A 60-year-old asymptomatic man is found to have leukocytosis on a preoperative CBC.
Physical examination shows the spleen tip to be palpable 2 cm below the left costal margin.
Rubbery, nontender lymph nodes up to 1.5 cm in size are present in the axillae and inguinal
regions. Laboratory data include the following: Hgb: 13.3 g/dL (normal 14 to 18)
Leukocytes: 40,000/microL (normal 4300 to 10,800) Platelet count: 238,000 (normal 150,000
to 400,000) His peripheral blood smear is shown in the accompanying photo. Which of the
following is the most likely diagnosis?
A. Acute monocytic leukemia
B. Chronic myelogenous leukemia
C. Chronic lymphocytic leukemia
D. Tuberculosis - CORRECT ANSWER C. Chronic lymphocytic leukemia
A 45-year-old asymptomatic man is found to have leukocytosis on a preoperative complete
blood count. His physical examination is significant for the spleen tip being palpable 2 cm
below the left costal margin. Enlarged, rubbery, nontender lymph nodes up to 1.5 cm in size
are present in the axillae and inguinal regions. Laboratory workup reveals a hemoglobin of
13.3 g/dL, leukocytes 40,000/microliter, and platelets 238,000/microliter. His peripheral
blood smear shows mature lymphocytes with smudge cells. If he fails first-line therapy,
which of the following cytogenetic changes would be an indication for stem cell transplant in
this patient?
Well done!You answered successfully
A. Trisomy 12
B. 13q deletion
C. 17p deletion
, D. 19p deletion - CORRECT ANSWER C. 17p deletion
A 65-year-old woman presents with an 8-month history of recurrent low-grade fevers, a 3-
month history of abdominal fullness, and more recently, fatigue and moderately reduced
exercise tolerance. Before this, she was in good health with no major medical conditions.
Upon examination, she appeared to be stable and in no acute distress. She has a heart rate of
95 bpm and blood pressure of 128/60 mmHg. She had several palpable cervical and axillary
lymph nodes (1-2 cm) that were non-tender and freely mobile. She also had palpable
splenomegaly. No other abdominal masses/hepatomegaly appreciated on examination. Her
complete blood count showed a leukocyte count of 32,000/mm3, hemoglobin of 9.8 g/dL,
platelet count of 145,000/mm3, neutrophil count 1,900/mm3, lymphocyte count 30,000/mm3,
elevated LDH, and elevated reticulocyte count. Peripheral blood smear showed an increasing
number of mature lymphocytes, spherocytes, and pol - CORRECT ANSWER B.
Autoimmune hemolytic anemia
A 43-year-old man presents to the clinic for evaluation after abnormalities noted on a routine
set of labs. CBC with differential demonstrated hemoglobin 14 g/dL, WBC count
26,000/microL, lymphocytes 21,000/microL, neutrophils 4500/microL, and platelets
260,000/microL. The basic metabolic panel demonstrates normal electrolytes and renal
function. LFTs show total bilirubin 1.2 mg/dL and normal liver enzymes. On examination in
office, his examination is normal, with no palpable lymph nodes or hepatosplenomegaly. He
denies any B symptoms. Peripheral smear shows lymphocytosis with many small
lymphocytes and smudge cells. Which of the following is the next best step in the
management of this patient?
Well done!You answered successfully
A. Dexamethasone monotherapy
B. Initiate chemotherapy with CHOP (cyclophosphamide, doxorubicin, vincristine, and
prednisone)
C. Rituximab monotherapy
D. Observation and close follow up - CORRECT ANSWER D. Observation and close
follow up
A 16-year-old female presents with complaints of fever, lethargy, and night sweats. The
patient also reports a 6-kilogram (13.2 pound) weight loss in the past 3 months. On
examination, painless, enlarged cervical and supraclavicular lymph nodes are palpated. A
fine-needle aspiration biopsy of one of the lymph nodes is shown in the image. The patient's
findings are most suggestive of which of the following?
