Questions 134-136: Hematopathology

Question 134

A 35-year-old male presents to his primary care physician. Over the past 4 months he has felt a lump in his neck. Palpation reveals a painlessly enlarged lymph node. He has no past medical history and and review of systems is negative. Biopsy of the lymph node reveals occasional large binucleated cells with prominent nucleoli in a background of mixed inflammatory cells including eosinophils. The large cells are CD15 positive. Of the following markers, which is most likely to also be positive in these large cells?

A. CD5
B. CD20
C. CD30
D. CD45
E. CD103

Question 135

A 56-year-old male presents to his primary care physician. Over the past 6 months, he has had frequent sweating at night, sometimes which drenches his bed clothes. Review of systems reveals occasional subjective fevers and a 15 lb. weight loss over the past several months. His past medical history includes diet-controlled diabetes mellitus and hypertension. A chest x-ray reveals enlarged mediastinal lymph nodes. A biopsy of one of the involved lymph nodes reveals scattered large binucleated cells in a background of mixed inflammatory cells. Infection with which of the following viruses is associated with the change in the lymph node?

A. CMV
B. EBV
C. HTLV
D. Hepatitis C
E. HIV
F. HSV

Question 136

Over the past two days, a 12-year-old boy has had episodes of diarrhea and abdominal cramping. At first, his parents attributed it to a virus that was going around town, but then decided to take him to the emergency room when his symptoms did not improve. At CT scan of his abdomen reveals a mass at the ileocecal junction. If the mass is determined to be malignant, which of the following is the most likely diagnosis?

A. Follicular lymphoma
B. Mantle cell lymphoma
C. Extranodal marginal zone lymphoma
D. Burkitt lymphoma
E. Mycoses fungoides

Questions 131-133: Hematopathology

Question 131

A 33-year-old female presents to her obstetrician and gynecologist for a yearly physical examination. She reports that over the past 6 months, her menstrual periods have been much heavier than normal. And, over the past 2 months, she has become fatigued more easily, and sometimes short of breath with relatively minimal physical exertion. Laboratory testing reveals a hemoglobin of 8.8 g/dL. In the following chart, which choice best indicates the physiologic changes her body will undergo?

Question 132

A 34-year-old female presents to her obstetrician/gynecologist. She reports that over the past 12 months, her menstrual periods have been heavier than normal. And, over the past 4 months, she has become fatigued more easily, and sometimes short of breath with relatively minimal physical exertion. Laboratory testing reveals a hemoglobin of 8.1 g/dL. Additional laboratory testing reveals a ferritin of 3 ng/mL (normal range: 20-200 ng/mL), a total iron binding capacity of 700 µg/dL (normal range of 255-450 µg/dL), and a reticulocyte production index of <2. Of the following, which term best describes her anemia?

A. Supramicrocytic
B. Microcytic
C. Normocytic
D. Macrocytic
E. Supramacrocytic

Question 133

A 48-year-old Caucasian female who uses aspirin to treat her rheumatoid arthritis presents to an acute care clinic with complaints of abdominal pain. A guaiac test was negative. A complete blood cell count revealed a hemoglobin of 11.2 g/dL, hematocrit of 33%, MCV of 83 fL, and a red blood cell distribution width of 14. The reticulocyte production index was <2. Additional laboratory testing revealed a low serum iron and elevated ferritin concentration. Of the following, what is the most likely diagnosis?

A. Iron deficiency anemia
B. α-thalassemia
C. Anemia of chronic disease
D. Autoimmune hemolytic anemia
E. Hereditary spherocytosis

Questions 128-130: Hematopathology

Question 128

A 39-year-old female presents to her family physician with complaints of fatigue that has increased over the past 6 months. She is a runner and has had to cut back on her morning runs because of increased shortness of breath. A complete blood cell count reveals a hemoglobin of 8.3 g/dL, hematocrit of 24%, white blood cell count of 5200 cells/mm3, and platelet count of 300,000/mm3. The MCV is 70 fl. The reticulocyte production index (RPI) is <2. Of the following, what is the most likely mechanism for her presenting symptoms?

A. Splenic sequestration of red blood cells
B. Marrow infiltration by a non-neoplastic process
C. Decreased production of red blood cells
D. Antibody-mediated destruction of red blood cells
E. Decreased lifespan of red blood cells

Question 129

A 37-year-old female presents to her family physician with complaints of fatigue that has developed and been increasing over the past year. A review of systems indicates that she has been having heavier than normal menstrual periods for a little over a year. A complete blood cell count reveals a hemoglobin of 8.2 g/dL (normal: 12-16 g/dL), hematocrit of 24% (normal: 37-47%), a white blood cell count of 7.3 x 103 cells/mm3 (normal range: 4.5-11 x 103 cells/mm3), mean corpuscular volume of 67 fL (normal range: 80-100 fL), and platelet count of 280,000 cells/mm3 (normal range: 150-400,000/mm3). Of the following, which set of test results would confirm iron deficiency anemia?

Question 130

A 43-year-old alcoholic male presents to an acute care clinic complaining of fatigue. A complete blood cell count is performed and reveals a hemoglobin of 8.3 g/dL and hematocrit of 24%. The white blood cell count and platelet count are also slightly lower than the reference range for the lab. The MCV is 120 fL. Additional laboratory testing reveals elevated concentrations of homocysteine and methylmalonic acid. A deficiency of which of the following nutrients would explain his condition?

A. Vitamin B12
B. Folate
C. Iron
D. Calcium
E. Copper

Questions 125-127: Hematopathology

Question 125

A 9-year-old male is brought to the emergency room by his parents because he has been sick for the past five days. He has not passed stool in two days. He has not wanted to eat, and has been vomiting anything his parents are able to get him to eat. Physical examination reveals abdominal tenderness associated with guarding and rebound tenderness. He is diagnosed with a perforation of the terminal ileum, and a resection is performed. Examining the pathologic specimen, the pathologist notes a mass. Genetic analysis of the mass would most likely reveal which of the following?

A. t(8;14)
B. t(2; 8)
C. t(15;17)
D. t(11;14)
E. t(8;21)
F. t(9;22)
G. t(14;18)

Question 126

A 61-year-old female presents to her family physician with complaints that over the past year she has developed several bumps at places around her body. Her sister died of metastatic breast cancer and she is concerned that the same thing may happen to her. Physical examination reveals palpable lymph nodes on the right side of her neck, both axillae, and her left femoral region. A biopsy of one of the lymph node is performed. The pathologist describes a nodular neoplastic proliferation in the lymph node. The neoplastic cells express CD20 and CD10, but do not express CD5. Of the following, which set of features best describes this neoplasm.

Question 127

A 37-year-old white female who works at a local factory presents to her family physician complaining that over the past 6 months she has been more tired than normal, and when she exerts herself she will get shorter of breath than normal. A complete blood cell count reveals a hemoglobin of 8.5 g/dL, hematocrit of 24%, white blood cells count of 7200 cells/mm3, and platelet count of 250,000/mm3. Examination of the blood smear reveals red blood cells with increased central pallor. Of the following, what is the most likely diagnosis?

A. Iron deficiency anemia
B. Sarcoidosis with involvement of the bone marrow
C. Aplastic anemia due to chemical exposure at work
D. Acute leukemia
E. Parasitic infection

Questions 122-124: Hematopathology

Question 122

During a yearly physical examination of a 19-year-old male, a family physician palpates cervical lymph nodes. One of the enlarged lymph nodes is biopsied. Large cells within the lymph node express CD15 and CD30. Of the following, what is the most likely diagnosis?

A. Burkitt lymphoma
B. Follicular lymphoma
C. Diffuse large B cell lymphoma
D. Lymphocyte predominant Hodgkin disease
E. Classical Hodgkin lymphoma

Question 123

A 55-year-old male presents to his family physician complaining of intermittent fevers and night sweats over the past 6 months. He also notes a 20 lb. weight loss in the same time frame. Physical examination reveals an enlarged spleen. A chest x-ray reveals enlarged mediastinal lymph nodes. Biopsy of a lymph node reveals large cells, some with bilobed nuclei and prominent nucleoli, surrounded by an infiltrate of lymphocytes, eosinophils, plasma cells, and macrophages. Of the following viruses, which one is most likely to be associated with his condition?

A. HTLV
B. Hepatitis B
C. CMV
D. Parvovirus
E. EBV

Question 124

A 53-year-old female with a history of Hashimoto’s thyroiditis diagnosed 10 years ago and treated with thyroid hormone replacement presents to her primary care physician because of painless enlargement of a mass on the right side of her neck, which has evolved over several months. Palpation of the mass during physical exam locates the mass to approximately the same location as the right lobe of the thyroid gland and to be about 1.5 cm in size. Of the following, what is the most likely diagnosis?

A. Lymphocyte predominant Hodgkin disease
B. Burkitt lymphoma
C. Extra-nodal marginal zone lymphoma
D. Metastatic breast carcinoma
E. Occult trauma

Questions 119-121: Hematopathology

Question 119

A 62-year-old male is scheduled for an elective cholecystectomy. Routine laboratory testing prior to the surgery reveals a hemoglobin concentration of 19.5 g/dL. Physical examination reveals an enlarged liver and an enlarged spleen. Additional laboratory testing reveals a low concentration of erythropoietin. Of the following, which is the most likely diagnosis?

A. Chronic myelogenous leukemia
B. Hairy cell leukemia
C. Epstein-Barr virus infection
D. Polycythemia rubra vera
E. Occult renal cell carcinoma

Question 120

A 61-year-old male presents to his family physician. Over the past six months, he has had numerous episodes of weakness, lightheadedness, and headache, and occasionally dyspnea when he is working at his ranch. He also notes that after a bath his skin is particularly itchy. Laboratory testing reveals a hemoglobin of 20.2 g/dL. Genetic testing would most likely reveal which of the following?

A. JAK2 mutation
B. PAK2 mutation
C. RB mutation
D. p53 mutation
E. t(15;17)
F. t(9;22)
G. t(8;21)
H. inv 16

Question 121

A 53-year-old male presents to his family physician with complaints of fatigue that has developed over the past 6 months. Physical examination reveals normal lung and heart sounds. Palpation of the abdomen reveals an enlarged spleen. Laboratory testing reveals a white blood cell count of 45,000/μL. The platelet count is normal and the hemoglobin is 11.1 g/dL. A peripheral smear of the blood reveals an increased number of both mature and immature white blood cells as well as an increased number of basophils. Genetic analysis would reveal which of the following?

A. t(8;21)
B. t(15;17)
C. t(9;22)
D. t(8;14)
E. t(8;22)