MSN 621 - Hem/Onc Quiz (Passed!!!)

A 67-year old female presents with a history of high fevers and productive cough with green sputum for the last 3 days. The patient recieved the influenza vaccine this year. Her PMH is unremarkable. She has a smoking history of 25 pack years. She does not drink alcohol or use illicit drugs. Temperature is 102F, BP is 15/70, pulse is 101, and RR is 23. Her O2 is 91 on RA. On examination, her anterior cervical lymph nodes are enlarged and nontender. Chest auscultation reveals crackles in the LLL. Hepatosplenomegaly is present. A CXR shows a developing LLL consolidation. Labs show a WBC of 45000, with lymphocytes being 85%. Emperical pharmacotherapy is initiated, and blood cultures are sent to the lab. Which of the following is the most appropriate next step? A. Flow cytometry of blood B. Biopsy of lymph node C. Bronchoscopy D. Biopsy of lung tissue correct answers 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 answers 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? A. Trisomy 12 B. 13q deletion C. 17p deletion D. 19p deletion correct answers 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