MSN 621 Final Exam Questions and Verified
Correct Answers latest 2025–2026
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 denies smoking, caffeine
intake, tinnitus, vomiting, or coughing. He has been taking NSAIDs regularly for the past
year due to headaches that he attributes to "being stressed out from my new job." On
examination, BP: 120/81 mmHg, HR: 55 bpm, RR: 18/min, and O2: 99% on room air. Skin
examination: no rashes, abdominal examination: mild epigastric tenderness but no
organomegaly, chest examination: equal air entry bilaterally with no abnormal sounds.
ECG shows P waves and QRS complexes that are independent of each other. Blood tests
show antibodies to the organism in the picture. Which of the following is the most
appropriate treatment for this patient's case? (see photo) - answer>>>Hospitalization for
close monitoring with telemetry and IV ceftriaxone
Correct Answers latest 2025–2026
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 denies smoking, caffeine
intake, tinnitus, vomiting, or coughing. He has been taking NSAIDs regularly for the past
year due to headaches that he attributes to "being stressed out from my new job." On
examination, BP: 120/81 mmHg, HR: 55 bpm, RR: 18/min, and O2: 99% on room air. Skin
examination: no rashes, abdominal examination: mild epigastric tenderness but no
organomegaly, chest examination: equal air entry bilaterally with no abnormal sounds.
ECG shows P waves and QRS complexes that are independent of each other. Blood tests
show antibodies to the organism in the picture. Which of the following is the most
appropriate treatment for this patient's case? (see photo) - answer>>>Hospitalization for
close monitoring with telemetry and IV ceftriaxone
