MSN 621 ACTUAL 2026 FINAL EXAM WITH COMPLETE
DETAILED QUESTIONS AND CORRECT VERIFIED ANSWERS
ALREADY A+ GRADED
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
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
C. Iron deficiency anemia
Which of the following is associated with the CD10 antigen?
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A. Acute myeloid leukemia
B. Acute lymphocytic leukemia
C. Chronic myeloid leukemia
D. Hodgkin lymphoma
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
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
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
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. Flow cytometry of blood
B. Biopsy of lymph node
C. Bronchoscopy
D. Biopsy of lung tissue
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
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
DETAILED QUESTIONS AND CORRECT VERIFIED ANSWERS
ALREADY A+ GRADED
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
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
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
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
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
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
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. Flow cytometry of blood
B. Biopsy of lymph node
C. Bronchoscopy
D. Biopsy of lung tissue
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
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
