MSN 621 Final Exam questions and
answers
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? - ANSWER>>Decreased platelet count
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? (see photo) - ANSWER>>Hodgkin lymphoma
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 - ANSWER>>L-asparaginase
A 57-year-old patient with lymphoma complains of nausea after starting
morphine. Which of the following is most accurate regarding nausea and vomiting
due to opioids? - ANSWER>>After starting opioids, nausea, often improves within
a few days
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? - ANSWER>>Observation and close follow up
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 - ANSWER>>Autoimmune hemolytic anemia
A 67-year-old female with a performance status of 0, is brought to the clinic with
symptomatic anemia and has required several transfusions over the past 2 to 3
months. Currently, her hemoglobin is 7.5 g/dL, absolute neutrophil count
1500/microL and platelet count is 119,000/microL. She had a bone marrow biopsy
performed that reveals myelodysplastic syndrome (MDS) with 6% blasts and
cytogenetics positive for 5q deletion. She did not have any mutations or other
cytogenetic abnormalities. Which of the following is the best initial course of
treatment? - ANSWER>>A thalidomide derivative
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? - ANSWER>>Iron deficiency anemia
A 59-year-old male patient with a history of non-Hodgkins lymphoma treated with
cyclophosphamide, adriamycin, vincristine, and prednisone eight years ago
presents with a new diagnosis of myelodysplastic syndrome. Bone marrow biopsy
reveals 12% blasts and greater than 10% dysplasia in the erythroid and
granulocytic lineages. Fluorescence in situ hybridization (FISH) revealed
monosomy 7. He asks you about the risk of transformation into acute myeloid
leukemia (AML). What is the risk of treatment-related myelodysplastic syndrome
transforming into AML - ANSWER>>50% of patients will transform into AML
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? - ANSWER>>17p deletion
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? (see photo) - ANSWER>>Chronic lymphocytic leukemia
A 65-year-old female with renal cancer presents with dyspnea, fatigue, and
dizziness. She is on warfarin to treat 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? - ANSWER>>Transfuse packed red blood cells
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? - ANSWER>>Flow cytometry of blood
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 - ANSWER>>Acute lymphoblastic leukemia
Which of the following is associated with the CD10 antigen? - ANSWER>>Acute
lymphocytic leukemia
A 16-year-old patient presents because she believes she was bitten by a tick while
hiking in the woods a few days ago. She mentions swelling in her right ear and
general malaise. On exam, she has a 1 x 2 cm bluish-red nodule on the right ear
lobe. What is the next best step in management for this patient? -
ANSWER>>lyme serology
A 26-year-old male comes to the emergency department complaining of fatigue,
dyspnea, chest pain, and syncope, especially when playing soccer. This has been
going on for the past 2 weeks. He has no significant past medical history. He
answers
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? - ANSWER>>Decreased platelet count
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? (see photo) - ANSWER>>Hodgkin lymphoma
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 - ANSWER>>L-asparaginase
A 57-year-old patient with lymphoma complains of nausea after starting
morphine. Which of the following is most accurate regarding nausea and vomiting
due to opioids? - ANSWER>>After starting opioids, nausea, often improves within
a few days
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? - ANSWER>>Observation and close follow up
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 - ANSWER>>Autoimmune hemolytic anemia
A 67-year-old female with a performance status of 0, is brought to the clinic with
symptomatic anemia and has required several transfusions over the past 2 to 3
months. Currently, her hemoglobin is 7.5 g/dL, absolute neutrophil count
1500/microL and platelet count is 119,000/microL. She had a bone marrow biopsy
performed that reveals myelodysplastic syndrome (MDS) with 6% blasts and
cytogenetics positive for 5q deletion. She did not have any mutations or other
cytogenetic abnormalities. Which of the following is the best initial course of
treatment? - ANSWER>>A thalidomide derivative
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? - ANSWER>>Iron deficiency anemia
A 59-year-old male patient with a history of non-Hodgkins lymphoma treated with
cyclophosphamide, adriamycin, vincristine, and prednisone eight years ago
presents with a new diagnosis of myelodysplastic syndrome. Bone marrow biopsy
reveals 12% blasts and greater than 10% dysplasia in the erythroid and
granulocytic lineages. Fluorescence in situ hybridization (FISH) revealed
monosomy 7. He asks you about the risk of transformation into acute myeloid
leukemia (AML). What is the risk of treatment-related myelodysplastic syndrome
transforming into AML - ANSWER>>50% of patients will transform into AML
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? - ANSWER>>17p deletion
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? (see photo) - ANSWER>>Chronic lymphocytic leukemia
A 65-year-old female with renal cancer presents with dyspnea, fatigue, and
dizziness. She is on warfarin to treat 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? - ANSWER>>Transfuse packed red blood cells
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? - ANSWER>>Flow cytometry of blood
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 - ANSWER>>Acute lymphoblastic leukemia
Which of the following is associated with the CD10 antigen? - ANSWER>>Acute
lymphocytic leukemia
A 16-year-old patient presents because she believes she was bitten by a tick while
hiking in the woods a few days ago. She mentions swelling in her right ear and
general malaise. On exam, she has a 1 x 2 cm bluish-red nodule on the right ear
lobe. What is the next best step in management for this patient? -
ANSWER>>lyme serology
A 26-year-old male comes to the emergency department complaining of fatigue,
dyspnea, chest pain, and syncope, especially when playing soccer. This has been
going on for the past 2 weeks. He has no significant past medical history. He
