MSN 621 Final Exam 2025 COMPLETE EXAM SET (Questions and
Verified Answers) FREQUENTLY MOST TESTED QUESTIONS
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?
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)
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
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?
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
,MSN 621 Final Exam 2025 COMPLETE EXAM SET (Questions and
Verified Answers) FREQUENTLY MOST TESTED QUESTIONS
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?
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
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?
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
,MSN 621 Final Exam 2025 COMPLETE EXAM SET (Questions and
Verified Answers) FREQUENTLY MOST TESTED QUESTIONS
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?
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
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?
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)
, MSN 621 Final Exam 2025 COMPLETE EXAM SET (Questions and
Verified Answers) FREQUENTLY MOST TESTED QUESTIONS
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?
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?
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
Acute lymphoblastic leukemia
Which of the following is associated with the CD10 antigen?
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?
Verified Answers) FREQUENTLY MOST TESTED QUESTIONS
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?
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)
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
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?
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
,MSN 621 Final Exam 2025 COMPLETE EXAM SET (Questions and
Verified Answers) FREQUENTLY MOST TESTED QUESTIONS
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?
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
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?
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
,MSN 621 Final Exam 2025 COMPLETE EXAM SET (Questions and
Verified Answers) FREQUENTLY MOST TESTED QUESTIONS
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?
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
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?
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)
, MSN 621 Final Exam 2025 COMPLETE EXAM SET (Questions and
Verified Answers) FREQUENTLY MOST TESTED QUESTIONS
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?
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?
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
Acute lymphoblastic leukemia
Which of the following is associated with the CD10 antigen?
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?
