USMLE PRACTICE HEMATOLOGY EXAM | WITH 100% CORRECT ANSWERS | LATEST UPDATE | GRADED A+

Your patient is a 65-year-old man with progressive fatigue. His fatigue started -7 months ago, and it is worsening; sometimes, he feels "too tired even to get out of bed". Over the last month, he has started having bone pain, and he has stopped his usual evening walks because of a decreased exercise tolerance. He has also noticed that he is sweating at night. At the same time, he has started having a feeling of abdominal fullness and early satiety; it is accompanied by a constant sensation of bloating, even after a small sandwich or an apple. He has lost approximately 5 kg over the last 6 months. Physical examination reveals liver palpable about 4 cm below the right costal margin, and the spleen is palpable about 8 cm below the left costal margin; the rest of his physical examination is within normal limits. His laboratory analyses are below: Question: What will be your therapeutic approach? A. Watchful waiting B. I - G. Tyrosine kinase inhibitor (Ruxolitnib) A 45-year-old man is evaluated for bleeding gums. He notices easy bleeding with minor trauma, especially after brushing his teeth. He also bruises easily and has multiple ecchymoses. He is a non-smoker and drinks no alcohol. Physical examination shows BP 110/70; BMI 18; Pulse 70/min; Temp normal. Cardiovascular and respiratory exam appear normal. Abdominal exam shows an enlarged liver and spleen, with the spleen measuring more than 10 cm in diameter. Lab investigations are shown below: Hb: 7.2 WBC count: 76,000 Neutrophils: 55% Lymphocytes: 20% Eosinophils: 12% Basophils: 10% Monocytes: 3% Platelet count: 42,000 LAP: low Peripheral smear: numerous granulocytes, with immature myeloid cells (myelocytes and metamyelocytes), and occasional blasts. Bone marrow appears hypercellular, with increase of the myeloid cell line (neutrophils, eosinophils, basophils) and progenitor cells. Megakaryocytes are prominent and increased - Imatinib