MSN 622 FINAL EXAM 2025|ACTUAL EXAM QUESTIONS AND ANSWERS|ALREADY
GRADED A+
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? - (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) - (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 -
(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? - (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? - (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.
,MSN 622 FINAL EXAM 2025|ACTUAL EXAM QUESTIONS AND ANSWERS|ALREADY
GRADED A+
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 - (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? - (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? - (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 - (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? - (ANSWER)17p deletion
, MSN 622 FINAL EXAM 2025|ACTUAL EXAM QUESTIONS AND ANSWERS|ALREADY
GRADED A+
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) -
(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? - (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? - (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 - (ANSWER)Acute
lymphoblastic leukemia
Which of the following is associated with the CD10 antigen? - (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? -
(ANSWER)lyme serology
GRADED A+
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? - (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) - (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 -
(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? - (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? - (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.
,MSN 622 FINAL EXAM 2025|ACTUAL EXAM QUESTIONS AND ANSWERS|ALREADY
GRADED A+
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 - (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? - (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? - (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 - (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? - (ANSWER)17p deletion
, MSN 622 FINAL EXAM 2025|ACTUAL EXAM QUESTIONS AND ANSWERS|ALREADY
GRADED A+
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) -
(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? - (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? - (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 - (ANSWER)Acute
lymphoblastic leukemia
Which of the following is associated with the CD10 antigen? - (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? -
(ANSWER)lyme serology
