MSN 621 FINAL STUDY GUIDE 100%
ACCURATE
,Which of the following is associated with the CD10 antigen? - ANSWERSAcute
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? - ANSWERSAcute lymphoblastic leukemia
A 67-year-old woman presents with a history of high fevers and productive cough with
green sputum for the last 3 days. Her past medical history is unremarkable. The patient
received the influenza vaccine this year. She has a smoking history of 25 pack years.
She does not drink alcohol or use illicit drugs. Vital signs are temperature 102 °F (38.9
°C), blood pressure 115/70mm Hg, heart rate 101 bpm, respiratory rate 23 breaths/min,
and oxygen saturation 91% on room air. On physical 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 left lower lobe
consolidation. Laboratory tests show a WBC count of 45000/μL, 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? - ANSWERSFlow cytometry of
blood
A 65-year-old woman with renal cancer presents with dyspnea, fatigue, and dizziness.
She is taking warfarin to treat a left leg deep vein thrombosis, and lab results show a
hemoglobin of 7.1 g/dL, hematocrit of 22%, platelet count of 109,000 cells/microliter,
and INR of 1.45. What is the best next step in treatment? - ANSWERSTransfuse
packed red blood cells
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/microliter (normal 4,300 to 10,800); and platelet count 238,000
cells/microliter (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? -
ANSWERSChronic 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? - ANSWERS17p deletion
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? - ANSWERS50% of patients
will transform into AML
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? - ANSWERSIron deficiency anemia
A 67-year-old woman with a performance status of 0 presents with breathlessness and
fatigue. She says she has needed several blood transfusions over the past 3 months.
Her hemoglobin is 7.5 g/dL, absolute neutrophil count is 1500 cells/microliter, and
platelet count is 119,000 cells/microliter. A bone marrow biopsy reveals myelodysplastic
syndrome (MDS) with 6% blasts and cytogenetics positive for a 5q deletion. There are
no mutations or other cytogenetic abnormalities. What is the best initial treatment for
this patient? - ANSWERSA thalidomide derivative
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 - ANSWERSAutoimmune
hemolytic anemia
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
ACCURATE
,Which of the following is associated with the CD10 antigen? - ANSWERSAcute
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? - ANSWERSAcute lymphoblastic leukemia
A 67-year-old woman presents with a history of high fevers and productive cough with
green sputum for the last 3 days. Her past medical history is unremarkable. The patient
received the influenza vaccine this year. She has a smoking history of 25 pack years.
She does not drink alcohol or use illicit drugs. Vital signs are temperature 102 °F (38.9
°C), blood pressure 115/70mm Hg, heart rate 101 bpm, respiratory rate 23 breaths/min,
and oxygen saturation 91% on room air. On physical 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 left lower lobe
consolidation. Laboratory tests show a WBC count of 45000/μL, 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? - ANSWERSFlow cytometry of
blood
A 65-year-old woman with renal cancer presents with dyspnea, fatigue, and dizziness.
She is taking warfarin to treat a left leg deep vein thrombosis, and lab results show a
hemoglobin of 7.1 g/dL, hematocrit of 22%, platelet count of 109,000 cells/microliter,
and INR of 1.45. What is the best next step in treatment? - ANSWERSTransfuse
packed red blood cells
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/microliter (normal 4,300 to 10,800); and platelet count 238,000
cells/microliter (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? -
ANSWERSChronic 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? - ANSWERS17p deletion
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? - ANSWERS50% of patients
will transform into AML
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? - ANSWERSIron deficiency anemia
A 67-year-old woman with a performance status of 0 presents with breathlessness and
fatigue. She says she has needed several blood transfusions over the past 3 months.
Her hemoglobin is 7.5 g/dL, absolute neutrophil count is 1500 cells/microliter, and
platelet count is 119,000 cells/microliter. A bone marrow biopsy reveals myelodysplastic
syndrome (MDS) with 6% blasts and cytogenetics positive for a 5q deletion. There are
no mutations or other cytogenetic abnormalities. What is the best initial treatment for
this patient? - ANSWERSA thalidomide derivative
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 - ANSWERSAutoimmune
hemolytic anemia
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
