MCQ Book Questions

Q60702. Which of the following best describes the pathogenesis of the hematologic disorder seen in the patient described in Ques- tion 23?

Q60703. A 32-year-old man presents with mild fever and increasing fatigue. He is an immigrant from Russia and worked in a ben- zene factory. Physical examination does not reveal lymphade- nopathy or splenomegaly, but petechial skin lesions are noted. A CBC demonstrates severe pancytopenia, with normocytic red cell indices. A bone marrow biopsy is shown in the image. Which of the following is the most likely underlying mecha- nism in the development of this patient’s anemia?

Q60704. A 36-year-old man from China presents with increasing fatigue. He has a 3-year history of tuberculosis, and CBC shows a mild microcytic anemia. Blood work-up demonstrates low serum iron, low iron-binding capacity, and increased serum ferri- tin. The pathogenesis of anemia in this patient is most likely caused by which of the following mechanisms?

Q60705. A 45-year-old chronic alcoholic man presents with mental confusion. The peripheral blood smear is shown in the image. The morphologic abnormalities demonstrated in this blood smear are most likely associated with which of the following conditions?

Q60706. Which oncogene is located at the t(9;22) chromosomal break- point in the patient described in Question 28?

Q60707. A 40-year-old woman complains of fatigue and nausea of 3 months in duration. Physical examination reveals numer- ous pustules on the face, as well as splenomegaly and hepato- megaly. Laboratory studies show hemoglobin of 6.3 g/dL and platelets of 50,000/mL. A peripheral smear shows malignant cells with Auer rods (arrow). The patient develops diffuse purpura, bleeding from the gums, and laboratory features of disseminated intravascular coagulation (DIC). Which of the following is the appropriate diagnosis?

Q60708. A patient with a history of chronic alcoholism presents with a macrocytic anemia and thrombocytopenia. Blood smear examination demonstrates numerous oval macrocytes and hypersegmented neutrophils (results shown in the image). A Schilling test is normal. Which of the following is the most likely diagnosis?

Q60709. A 23-year-old, previously healthy man of Italian origin develops moderate to severe hemolytic anemia. The previ- ous evening he had celebrated a Saint’s day with a feast of beans and pasta. Urinalysis shows free hemoglobin, and the direct Coombs test is negative. Supravital staining of the blood smear demonstrates numerous membrane-bound inclusions (Heinz bodies) within erythrocytes. Which of the following is the most likely diagnosis?

Q60710. A 27-year-old man presents with an 8-week history of fevers, chills, pruritis, and night sweats. Two months ago, he expe- rienced a fl u-like illness. A nagging cough with occasional hemoptysis persisted for several weeks following resolution of his other symptoms. Physical examination reveals moderately enlarged, fi rm, nontender lymph nodes located in the right supraclavicular region. A lymph node biopsy is shown in the image. What is the appropriate diagnosis?

Q60711. Which of the following is the most common histologic sub- type of the disease in the patient described in Question 34?

Q60712. A 55-year-old man complains of pain in his back, fatigue and occasional confusion. He admits to polyuria and poly- dipsia. An X-ray examination reveals numerous lytic lesions in the lumbar vertebral bodies. Laboratory studies disclose hypoalbuminemia, mild anemia, and thrombocytopenia. A monoclonal Igk peak is demonstrated by serum electropho- resis. Urinalysis shows 4+ proteinuria. A bone marrow biopsy discloses foci of plasma cells, which account for 18% of all hematopoietic cells. What is the appropriate diagnosis?

Q60713. Cytogenetic studies in malignant cells from the patient described in Question 30 demonstrate a chromosomal trans- location. Which of the following genes is most likely found at the translocation site?

Q60714. A 60-year-old man presents with a 3-week history of lymph node enlargement in his neck and axillae. A CBC reveals mild anemia, with a leukocytosis of 20,000/mL. The peripheral blood smear is shown in the image. More than 80% of WBCs are small lymphocytes, but there are also prominent “smudge cells.” Examination of a bone marrow biopsy shows nodular and interstitial infi ltrates of lymphocytes, which demonstrate clonal rearrangement of the IgG light-chain gene. Which of the following is the appropriate diagnosis?

Q60715. A 50-year-old man presents with fever and diffuse lymphade- nopathy. A lymph node biopsy reveals non-Hodgkin follicular lymphoma. Immunohistochemical staining of neoplastic lym- phoid cells within the nodular areas of the lymph node would be expected to stain positively for which of the following pro- tein markers?

Q60716. A 12-year-old girl presents with a fever of 38°C (101°F) and a swollen lymph node of 6 days in duration. The CBC is nor- mal. Biopsy of the swollen lymph node shows benign follicu- lar hyperplasia (shown in the image). This pathologic fi nding is best interpreted as which of the following?

Q60717. A 4-year-old boy from Kenya presents with a 3-week history of a rapidly expanding jaw. A biopsy of an enlarged cervical lymph node is shown in the image. Histologic examination reveals numerous mitotic fi gures and many macrophages con- taining nuclear and cytoplasmic debris. The cells express sur- face IgM and are positive for common B-cell antigens. Which of the following is the appropriate diagnosis?

Q60718. A 62-year-old man presents with a history of several months of vague abdominal pain and fatigue. Physical examination reveals marked splenomegaly but no evidence of lymphade- nopathy. The patient subsequently develops bacterial sepsis and expires. A bone marrow biopsy at autopsy shows numer- ous atypical megakaryocytes and marked marrow fi brosis (results shown in the image). Which of the following is the most likely diagnosis?

Q60719. A 24-year-old woman presents with an earache of 4 days in duration. She also reports increased urine production, a skin rash, and bone pain on her scalp. Physical examination reveals otitis media, dermatitis, and exophthalmos. An X-ray of the scalp shows calvarial bone defects. A fi ne-needle aspirate dis- plays numerous eosinophils. Which of the following is the most likely diagnosis?

Q60720. A 42-year-old woman presents with an enlarged supraclavicu- lar lymph node. The patient is HIV positive and takes antivi- ral medications. A lymph node biopsy is shown in the image. The tumor cells express B cell antigens and are positive for Epstein-Barr virus (EBV). Which of the following is the most likely diagnosis?

Q60721. A 55-year-old man presents with a 3-week history of abdominal discomfort. Physical examination demonstrates splenomegaly but no lymphadenopathy. A CBC shows pancytopenia. Exami- nation of a peripheral blood smear reveals atypical lymphoid cells that exhibit tartrate-resistant acid phosphatase activity. Which of the following is the appropriate diagnosis?