MSN 621 Final Exam Questions With
Correct 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? |- |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
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 |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
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 |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) |- |CORRECT |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? |- |CORRECT |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? |- |CORRECT |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 |- |
CORRECT |ANSWER✔✔-Acute |lymphoblastic |leukemia
Which |of |the |following |is |associated |with |the |CD10 |antigen? |- |CORRECT |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? |- |CORRECT |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) |- |CORRECT |ANSWER✔✔-Hospitalization |for |close |monitoring |with |
telemetry |and |IV |ceftriaxone
Correct 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? |- |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
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 |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
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 |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) |- |CORRECT |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? |- |CORRECT |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? |- |CORRECT |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 |- |
CORRECT |ANSWER✔✔-Acute |lymphoblastic |leukemia
Which |of |the |following |is |associated |with |the |CD10 |antigen? |- |CORRECT |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? |- |CORRECT |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) |- |CORRECT |ANSWER✔✔-Hospitalization |for |close |monitoring |with |
telemetry |and |IV |ceftriaxone
