MSN 621 FINAL EXAM
2026|COMPLETE EXAM SET
(QUESTIONS AND VERIFIED
ANSWERS) FREQUENTLY MOST
TESTED QUESTIONS |ALREADY
GRADED A+|100% PASSED!!
Ab16-year-
oldbmalebpresentsbwithblethargy,bfatigue,bandboccasionalbmucosalbbleeding.bThebpatientbalsobrepo
rtsbweightblossbinbthebpastb5bmonths.bLaboratorybanalysisbrevealsbabwhitebbloodbcellbcountbofb32,0
00bcells/microL.bOnbexamination,bhepatosplenomegalybisbnoted.bFurtherbevaluationbshowsbfindin
gsbsuggestivebofbacuteblymphocyticbleukemia.bWhatbisbthebmostblikelybcausebofbthebpatient'sbmuco
salbbleeding?b-bbCORRECTbANSWERSDecreasedbplateletbcount
Ab16-year-
oldbfemalebpresentsbwithbcomplaintsbofbfever,blethargy,bandbnightbsweats.bThebpatientbalsobreport
sbab6-
kilogramb(13.2bpound)bweightblossbinbthebpastb3bmonths.bOnbexamination,bpainless,benlargedbcerv
icalbandbsupraclavicularblymphbnodesbarebpalpated.bAbfine-
needlebaspirationbbiopsybofbonebofbtheblymphbnodesbisbshownbinbthebimage.bThebpatient'sbfindings
barebmostbsuggestivebofbwhichbofbthebfollowing?b(seebphoto)b-
bbCORRECTbANSWERSHodgkinblymphoma
Ab16-year-
oldbmalebpresentsbwithbfatigue,beasybbruisability,bandbweightbloss.bOnbexamination,bhepatospleno
megalybisbnoted.bAfterbabdetailedbevaluation,bthebpatientbisbdiagnosedbwithbacuteblymphocyticbleu
kemia.bWhichbofbthebfollowingbisbusedbinbthebmanagementbofbthisbpatient'sbconditionb-
bbCORRECTbANSWERSL-asparaginase
Ab57-year-
oldbpatientbwithblymphomabcomplainsbofbnauseabafterbstartingbmorphine.bWhichbofbthebfollowingb
,isbmostbaccuratebregardingbnauseabandbvomitingbduebtobopioids?b-
bbCORRECTbANSWERSAfterbstartingbopioids,bnausea,boftenbimprovesbwithinbabfewbdays
Ab43-year-
oldbmanbpresentsbtobthebclinicbforbevaluationbafterbabnormalitiesbnotedbonbabroutinebsetbofblabs.bC
BCbwithbdifferentialbdemonstratedbhemoglobinb14bg/dL,bWBCbcountb26,000/microL,blymphocytes
b21,000/microL,bneutrophilsb4500/microL,bandbplateletsb260,000/microL.bThebbasicbmetabolicbpa
nelbdemonstratesbnormalbelectrolytesbandbrenalbfunction.bLFTsbshowbtotalbbilirubinb1.2bmg/dLban
dbnormalbliverbenzymes.bOnbexaminationbinboffice,bhisbexaminationbisbnormal,bwithbnobpalpablebly
mphbnodesborbhepatosplenomegaly.bHebdeniesbanybBbsymptoms.bPeripheralbsmearbshowsblympho
cytosisbwithbmanybsmallblymphocytesbandbsmudgebcells.bWhichbofbthebfollowingbisbthebnextbbestbs
tepbinbthebmanagementbofbthisbpatient?b-bbCORRECTbANSWERSObservationbandbclosebfollowbup
Ab65-year-oldbwomanbpresentsbwithbanb8-monthbhistorybofbrecurrentblow-gradebfevers,bab3-
monthbhistorybofbabdominalbfullness,bandbmorebrecently,bfatiguebandbmoderatelybreducedbexercis
ebtolerance.bBeforebthis,bshebwasbinbgoodbhealthbwithbnobmajorbmedicalbconditions.bUponbexamin
ation,bshebappearedbtobbebstablebandbinbnobacutebdistress.bShebhasbabheartbratebofb95bbpmbandbblo
odbpressurebofb128/60bmmHg.bShebhadbseveralbpalpablebcervicalbandbaxillaryblymphbnodesb(1-
2bcm)bthatbwerebnon-
tenderbandbfreelybmobile.bShebalsobhadbpalpablebsplenomegaly.bNobotherbabdominalbmasses/hep
atomegalybappreciatedbonbexamination.bHerbcompletebbloodbcountbshowedbableukocytebcountbofb
32,000/mm3,bhemoglobinbofb9.8bg/dL,bplateletbcountbofb145,000/mm3,bneutrophilbcountb1,900/
mm3,blymphocytebcountb30,000/mm3,belevatedbLDH,bandbelevatedbreticulocytebcount.bPeriphera
lbbloodbsmearbshowedbanbincreasingbnumberbofbmatureblymphocytes,bspherocytes,bandbpolb-
bbCORRECTbANSWERSAutoimmunebhemolyticbanemia
Ab67-year-
oldbfemalebwithbabperformancebstatusbofb0,bisbbroughtbtobthebclinicbwithbsymptomaticbanemiaband
bhasbrequiredbseveralbtransfusionsboverbthebpastb2btob3bmonths.bCurrently,bherbhemoglobinbisb7.5b
g/dL,babsolutebneutrophilbcountb1500/microLbandbplateletbcountbisb119,000/microL.bShebhadbabbo
nebmarrowbbiopsybperformedbthatbrevealsbmyelodysplasticbsyndromeb(MDS)bwithb6%bblastsbandbc
ytogeneticsbpositivebforb5qbdeletion.bShebdidbnotbhavebanybmutationsborbotherbcytogeneticbabnor
malities.bWhichbofbthebfollowingbisbthebbestbinitialbcoursebofbtreatment?b-
bbCORRECTbANSWERSAbthalidomidebderivative
,Ab36-year-
oldbwomanbwithbabpastbmedicalbhistorybsignificantbforbmenorrhagiabfrombuterinebfibroidsbpresent
sbwithbexertionalbdyspneabandbfatigue.bExaminationbshowsbconjunctivalbpallor.bLaboratorybtestsbre
vealbabhemoglobinbofb6.2bgrams/dL,bmeanbcorpuscularbvolumeb(MCV)b60bflb(normal:b80-
100bfl),bandbnormalbliverbfunctionbtests.bWhatbisbthebmostblikelybdiagnosis?b-
bbCORRECTbANSWERSIronbdeficiencybanemia
Ab59-year-oldbmalebpatientbwithbabhistorybofbnon-
Hodgkinsblymphomabtreatedbwithbcyclophosphamide,badriamycin,bvincristine,bandbprednisonebei
ghtbyearsbagobpresentsbwithbabnewbdiagnosisbofbmyelodysplasticbsyndrome.bBonebmarrowbbiopsyb
revealsb12%bblastsbandbgreaterbthanb10%bdysplasiabinbtheberythroidbandbgranulocyticblineages.bFlu
orescencebinbsitubhybridizationb(FISH)brevealedbmonosomyb7.bHebasksbyoubaboutbthebriskbofbtransf
ormationbintobacutebmyeloidbleukemiab(AML).bWhatbisbthebriskbofbtreatment-
relatedbmyelodysplasticbsyndromebtransformingbintobAMLb-
bbCORRECTbANSWERS50%bofbpatientsbwillbtransformbintobAML
Ab45-year-
oldbasymptomaticbmanbisbfoundbtobhavebleukocytosisbonbabpreoperativebcompletebbloodbcount.bHi
sbphysicalbexaminationbisbsignificantbforbthebspleenbtipbbeingbpalpableb2bcmbbelowbthebleftbcostalb
margin.bEnlarged,brubbery,bnontenderblymphbnodesbupbtob1.5bcmbinbsizebarebpresentbinbthebaxillae
bandbinguinalbregions.bLaboratorybworkupbrevealsbabhemoglobinbofb13.3bg/dL,bleukocytesb40,000/
microliter,bandbplateletsb238,000/microliter.bHisbperipheralbbloodbsmearbshowsbmatureblymphocy
tesbwithbsmudgebcells.bIfbhebfailsbfirst-
linebtherapy,bwhichbofbthebfollowingbcytogeneticbchangesbwouldbbebanbindicationbforbstembcellbtra
nsplantbinbthisbpatient?b-bbCORRECTbANSWERS17pbdeletion
Ab60-year-
oldbasymptomaticbmanbisbfoundbtobhavebleukocytosisbonbabpreoperativebCBC.bPhysicalbexaminatio
nbshowsbthebspleenbtipbtobbebpalpableb2bcmbbelowbthebleftbcostalbmargin.bRubbery,bnontenderblym
phbnodesbupbtob1.5bcmbinbsizebarebpresentbinbthebaxillaebandbinguinalbregions.bLaboratorybdatabincl
udebthebfollowing:bHgb:b13.3bg/dLb(normalb14btob18)bLeukocytes:b40,000/microLb(normalb4300btob
10,800)bPlateletbcount:b238,000b(normalb150,000btob400,000)bHisbperipheralbbloodbsmearbisbshow
nbinbthebaccompanyingbphoto.bWhichbofbthebfollowingbisbthebmostblikelybdiagnosis?b(seebphoto)b-
bbCORRECTbANSWERSChronicblymphocyticbleukemia
, Ab65-year-
oldbfemalebwithbrenalbcancerbpresentsbwithbdyspnea,bfatigue,bandbdizziness.bShebisbonbwarfarinbtob
treatbableftblegbdeepbveinbthrombosis.bHerbhematocritbisb22%,bhemoglobinbisb7.1bg/dL,bplateletsb10
9,000/mL,bPTb1.3,bPTTb36,bINRb1.45,bandbWBCb12,000bmm3.bWhatbisbthebnextbstepbinbthebmanage
mentbofbthebpatient?b-bbCORRECTbANSWERSTransfusebpackedbredbbloodbcells
Ab67-year-
oldbfemalebpresentsbwithbabhistorybofbhighbfeversbandbproductivebcoughbwithbgreenbsputumbforbth
eblastbthreebdays.bThebpatientbreceivedbthebinfluenzabvaccinebthisbyear.bHerbpastbmedicalbhistorybisb
unremarkable.bShebhasbabsmokingbhistorybofb25bpackbyears.bShebdoesbnotbdrinkbalcoholborbusebillic
itbdrugs.bTemperaturebisb102F,bbloodbpressurebisb115/70mmHg,bthebpulsebisb101/min,bandbrespirat
ionsbareb23/min.bHerboxygenbsaturationbisb91%bonbroombair.bOnbexamination,bherbanteriorbcervical
blymphbnodesbarebenlargedbandbnontender.bChestbauscultation brevealsbcracklesbinbthebleftblowerblo
be.bHepatosplenomegalybisbpresent.bAbchestbx-
raybshowsbabdevelopingbleftblowerblobebconsolidation.bLabsbshowbabWBCbcountbofb45000,bwithblym
phocytesbbeingb85%.bEmpiricalbpharmacotherapybisbinitiated,bandbbloodbculturesbarebsentbtobthebl
ab.bWhichbofbthebfollowingbisbthebmostbappropriatebstepbnext?b-
bbCORRECTbANSWERSFlowbcytometrybofbblood
Ab49-year-
oldbmalebwithbfatiguebandbeasybbruisingbisbfoundbtobhavebterminalbdeoxynucleotidylbtransferaseb(T
dT)bpositivebcellsbinbthebblood.bHebmaybhavebwhichbofbthebfollowingbconditionsb-
bbCORRECTbANSWERSAcuteblymphoblasticbleukemia
WhichbofbthebfollowingbisbassociatedbwithbthebCD10bantigen?b-
bbCORRECTbANSWERSAcuteblymphocyticbleukemia
Ab16-year-
oldbpatientbpresentsbbecausebshebbelievesbshebwasbbittenbbybabtickbwhilebhikingbinbthebwoodsbabfe
wbdaysbago.bShebmentionsbswellingbinbherbrightbearbandbgeneralbmalaise.bOnbexam,bshebhasbab1bxb2
bcmbbluish-
redbnodulebonbthebrightbearblobe.bWhatbisbthebnextbbestbstepbinbmanagementbforbthisbpatient?b-
bbCORRECTbANSWERSlymebserology
2026|COMPLETE EXAM SET
(QUESTIONS AND VERIFIED
ANSWERS) FREQUENTLY MOST
TESTED QUESTIONS |ALREADY
GRADED A+|100% PASSED!!
Ab16-year-
oldbmalebpresentsbwithblethargy,bfatigue,bandboccasionalbmucosalbbleeding.bThebpatientbalsobrepo
rtsbweightblossbinbthebpastb5bmonths.bLaboratorybanalysisbrevealsbabwhitebbloodbcellbcountbofb32,0
00bcells/microL.bOnbexamination,bhepatosplenomegalybisbnoted.bFurtherbevaluationbshowsbfindin
gsbsuggestivebofbacuteblymphocyticbleukemia.bWhatbisbthebmostblikelybcausebofbthebpatient'sbmuco
salbbleeding?b-bbCORRECTbANSWERSDecreasedbplateletbcount
Ab16-year-
oldbfemalebpresentsbwithbcomplaintsbofbfever,blethargy,bandbnightbsweats.bThebpatientbalsobreport
sbab6-
kilogramb(13.2bpound)bweightblossbinbthebpastb3bmonths.bOnbexamination,bpainless,benlargedbcerv
icalbandbsupraclavicularblymphbnodesbarebpalpated.bAbfine-
needlebaspirationbbiopsybofbonebofbtheblymphbnodesbisbshownbinbthebimage.bThebpatient'sbfindings
barebmostbsuggestivebofbwhichbofbthebfollowing?b(seebphoto)b-
bbCORRECTbANSWERSHodgkinblymphoma
Ab16-year-
oldbmalebpresentsbwithbfatigue,beasybbruisability,bandbweightbloss.bOnbexamination,bhepatospleno
megalybisbnoted.bAfterbabdetailedbevaluation,bthebpatientbisbdiagnosedbwithbacuteblymphocyticbleu
kemia.bWhichbofbthebfollowingbisbusedbinbthebmanagementbofbthisbpatient'sbconditionb-
bbCORRECTbANSWERSL-asparaginase
Ab57-year-
oldbpatientbwithblymphomabcomplainsbofbnauseabafterbstartingbmorphine.bWhichbofbthebfollowingb
,isbmostbaccuratebregardingbnauseabandbvomitingbduebtobopioids?b-
bbCORRECTbANSWERSAfterbstartingbopioids,bnausea,boftenbimprovesbwithinbabfewbdays
Ab43-year-
oldbmanbpresentsbtobthebclinicbforbevaluationbafterbabnormalitiesbnotedbonbabroutinebsetbofblabs.bC
BCbwithbdifferentialbdemonstratedbhemoglobinb14bg/dL,bWBCbcountb26,000/microL,blymphocytes
b21,000/microL,bneutrophilsb4500/microL,bandbplateletsb260,000/microL.bThebbasicbmetabolicbpa
nelbdemonstratesbnormalbelectrolytesbandbrenalbfunction.bLFTsbshowbtotalbbilirubinb1.2bmg/dLban
dbnormalbliverbenzymes.bOnbexaminationbinboffice,bhisbexaminationbisbnormal,bwithbnobpalpablebly
mphbnodesborbhepatosplenomegaly.bHebdeniesbanybBbsymptoms.bPeripheralbsmearbshowsblympho
cytosisbwithbmanybsmallblymphocytesbandbsmudgebcells.bWhichbofbthebfollowingbisbthebnextbbestbs
tepbinbthebmanagementbofbthisbpatient?b-bbCORRECTbANSWERSObservationbandbclosebfollowbup
Ab65-year-oldbwomanbpresentsbwithbanb8-monthbhistorybofbrecurrentblow-gradebfevers,bab3-
monthbhistorybofbabdominalbfullness,bandbmorebrecently,bfatiguebandbmoderatelybreducedbexercis
ebtolerance.bBeforebthis,bshebwasbinbgoodbhealthbwithbnobmajorbmedicalbconditions.bUponbexamin
ation,bshebappearedbtobbebstablebandbinbnobacutebdistress.bShebhasbabheartbratebofb95bbpmbandbblo
odbpressurebofb128/60bmmHg.bShebhadbseveralbpalpablebcervicalbandbaxillaryblymphbnodesb(1-
2bcm)bthatbwerebnon-
tenderbandbfreelybmobile.bShebalsobhadbpalpablebsplenomegaly.bNobotherbabdominalbmasses/hep
atomegalybappreciatedbonbexamination.bHerbcompletebbloodbcountbshowedbableukocytebcountbofb
32,000/mm3,bhemoglobinbofb9.8bg/dL,bplateletbcountbofb145,000/mm3,bneutrophilbcountb1,900/
mm3,blymphocytebcountb30,000/mm3,belevatedbLDH,bandbelevatedbreticulocytebcount.bPeriphera
lbbloodbsmearbshowedbanbincreasingbnumberbofbmatureblymphocytes,bspherocytes,bandbpolb-
bbCORRECTbANSWERSAutoimmunebhemolyticbanemia
Ab67-year-
oldbfemalebwithbabperformancebstatusbofb0,bisbbroughtbtobthebclinicbwithbsymptomaticbanemiaband
bhasbrequiredbseveralbtransfusionsboverbthebpastb2btob3bmonths.bCurrently,bherbhemoglobinbisb7.5b
g/dL,babsolutebneutrophilbcountb1500/microLbandbplateletbcountbisb119,000/microL.bShebhadbabbo
nebmarrowbbiopsybperformedbthatbrevealsbmyelodysplasticbsyndromeb(MDS)bwithb6%bblastsbandbc
ytogeneticsbpositivebforb5qbdeletion.bShebdidbnotbhavebanybmutationsborbotherbcytogeneticbabnor
malities.bWhichbofbthebfollowingbisbthebbestbinitialbcoursebofbtreatment?b-
bbCORRECTbANSWERSAbthalidomidebderivative
,Ab36-year-
oldbwomanbwithbabpastbmedicalbhistorybsignificantbforbmenorrhagiabfrombuterinebfibroidsbpresent
sbwithbexertionalbdyspneabandbfatigue.bExaminationbshowsbconjunctivalbpallor.bLaboratorybtestsbre
vealbabhemoglobinbofb6.2bgrams/dL,bmeanbcorpuscularbvolumeb(MCV)b60bflb(normal:b80-
100bfl),bandbnormalbliverbfunctionbtests.bWhatbisbthebmostblikelybdiagnosis?b-
bbCORRECTbANSWERSIronbdeficiencybanemia
Ab59-year-oldbmalebpatientbwithbabhistorybofbnon-
Hodgkinsblymphomabtreatedbwithbcyclophosphamide,badriamycin,bvincristine,bandbprednisonebei
ghtbyearsbagobpresentsbwithbabnewbdiagnosisbofbmyelodysplasticbsyndrome.bBonebmarrowbbiopsyb
revealsb12%bblastsbandbgreaterbthanb10%bdysplasiabinbtheberythroidbandbgranulocyticblineages.bFlu
orescencebinbsitubhybridizationb(FISH)brevealedbmonosomyb7.bHebasksbyoubaboutbthebriskbofbtransf
ormationbintobacutebmyeloidbleukemiab(AML).bWhatbisbthebriskbofbtreatment-
relatedbmyelodysplasticbsyndromebtransformingbintobAMLb-
bbCORRECTbANSWERS50%bofbpatientsbwillbtransformbintobAML
Ab45-year-
oldbasymptomaticbmanbisbfoundbtobhavebleukocytosisbonbabpreoperativebcompletebbloodbcount.bHi
sbphysicalbexaminationbisbsignificantbforbthebspleenbtipbbeingbpalpableb2bcmbbelowbthebleftbcostalb
margin.bEnlarged,brubbery,bnontenderblymphbnodesbupbtob1.5bcmbinbsizebarebpresentbinbthebaxillae
bandbinguinalbregions.bLaboratorybworkupbrevealsbabhemoglobinbofb13.3bg/dL,bleukocytesb40,000/
microliter,bandbplateletsb238,000/microliter.bHisbperipheralbbloodbsmearbshowsbmatureblymphocy
tesbwithbsmudgebcells.bIfbhebfailsbfirst-
linebtherapy,bwhichbofbthebfollowingbcytogeneticbchangesbwouldbbebanbindicationbforbstembcellbtra
nsplantbinbthisbpatient?b-bbCORRECTbANSWERS17pbdeletion
Ab60-year-
oldbasymptomaticbmanbisbfoundbtobhavebleukocytosisbonbabpreoperativebCBC.bPhysicalbexaminatio
nbshowsbthebspleenbtipbtobbebpalpableb2bcmbbelowbthebleftbcostalbmargin.bRubbery,bnontenderblym
phbnodesbupbtob1.5bcmbinbsizebarebpresentbinbthebaxillaebandbinguinalbregions.bLaboratorybdatabincl
udebthebfollowing:bHgb:b13.3bg/dLb(normalb14btob18)bLeukocytes:b40,000/microLb(normalb4300btob
10,800)bPlateletbcount:b238,000b(normalb150,000btob400,000)bHisbperipheralbbloodbsmearbisbshow
nbinbthebaccompanyingbphoto.bWhichbofbthebfollowingbisbthebmostblikelybdiagnosis?b(seebphoto)b-
bbCORRECTbANSWERSChronicblymphocyticbleukemia
, Ab65-year-
oldbfemalebwithbrenalbcancerbpresentsbwithbdyspnea,bfatigue,bandbdizziness.bShebisbonbwarfarinbtob
treatbableftblegbdeepbveinbthrombosis.bHerbhematocritbisb22%,bhemoglobinbisb7.1bg/dL,bplateletsb10
9,000/mL,bPTb1.3,bPTTb36,bINRb1.45,bandbWBCb12,000bmm3.bWhatbisbthebnextbstepbinbthebmanage
mentbofbthebpatient?b-bbCORRECTbANSWERSTransfusebpackedbredbbloodbcells
Ab67-year-
oldbfemalebpresentsbwithbabhistorybofbhighbfeversbandbproductivebcoughbwithbgreenbsputumbforbth
eblastbthreebdays.bThebpatientbreceivedbthebinfluenzabvaccinebthisbyear.bHerbpastbmedicalbhistorybisb
unremarkable.bShebhasbabsmokingbhistorybofb25bpackbyears.bShebdoesbnotbdrinkbalcoholborbusebillic
itbdrugs.bTemperaturebisb102F,bbloodbpressurebisb115/70mmHg,bthebpulsebisb101/min,bandbrespirat
ionsbareb23/min.bHerboxygenbsaturationbisb91%bonbroombair.bOnbexamination,bherbanteriorbcervical
blymphbnodesbarebenlargedbandbnontender.bChestbauscultation brevealsbcracklesbinbthebleftblowerblo
be.bHepatosplenomegalybisbpresent.bAbchestbx-
raybshowsbabdevelopingbleftblowerblobebconsolidation.bLabsbshowbabWBCbcountbofb45000,bwithblym
phocytesbbeingb85%.bEmpiricalbpharmacotherapybisbinitiated,bandbbloodbculturesbarebsentbtobthebl
ab.bWhichbofbthebfollowingbisbthebmostbappropriatebstepbnext?b-
bbCORRECTbANSWERSFlowbcytometrybofbblood
Ab49-year-
oldbmalebwithbfatiguebandbeasybbruisingbisbfoundbtobhavebterminalbdeoxynucleotidylbtransferaseb(T
dT)bpositivebcellsbinbthebblood.bHebmaybhavebwhichbofbthebfollowingbconditionsb-
bbCORRECTbANSWERSAcuteblymphoblasticbleukemia
WhichbofbthebfollowingbisbassociatedbwithbthebCD10bantigen?b-
bbCORRECTbANSWERSAcuteblymphocyticbleukemia
Ab16-year-
oldbpatientbpresentsbbecausebshebbelievesbshebwasbbittenbbybabtickbwhilebhikingbinbthebwoodsbabfe
wbdaysbago.bShebmentionsbswellingbinbherbrightbearbandbgeneralbmalaise.bOnbexam,bshebhasbab1bxb2
bcmbbluish-
redbnodulebonbthebrightbearblobe.bWhatbisbthebnextbbestbstepbinbmanagementbforbthisbpatient?b-
bbCORRECTbANSWERSlymebserology
