A+RATED MSN
MSN 621 Final Exam A+
VERRIFIED EXAM2024/2025
,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 answers-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? - correct answers-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 answers-observation and close follow up
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 answers-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 answers-hodgkin
lymphoma
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 - correct answers-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
answers-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 answers-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 -
correct answers-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 answers-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) -
correct answers-chronic lymphocytic leukemia
