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MSN 621 FINAL EXAM
EXAM WITH CORRECT SOLUTIONS.
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? - correct 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) - correct 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 - correct answer- L- asparaginase 1 / 4
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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? - correct 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? - correct 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 2 / 4
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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- 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? - correct 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? - correct answer- Iron deficiency anemia 3 / 4
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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 - correct 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? - correct answer- 17p deletion
A 60-year-old asymptomatic man is found to have leukocytosis on a preoperative CBC. Physical examination shows the spleen
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