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MSN 621 FINAL EXAM 2025 UPDATED ACTUAL
EXAM WITH CORRECT SOLUTIONS.
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
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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
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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
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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
MSN 621 FINAL EXAM 2025 UPDATED ACTUAL
EXAM WITH CORRECT SOLUTIONS.
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
,2 | Page
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
,3 | Page
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
, 4 | Page
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
