MCQ Book Questions

Q60722. A 55-year-old man presents with recurrent epigastric pain. Upper GI endoscopy and gastric biopsy reveal a neoplastic, lymphocytic infi ltrate invading glandular tissue. Giemsa stain- ing is positive for Helicobacter pylori. Which of the following is the most likely diagnosis?

Q60723. A 58-year-old man presents with a 2-month history of ery- thematous, scaly plaques over his trunk and upper extremi- ties. Biopsy of these lesions reveals an atypical lymphocytic infi ltrate in the dermis, which extends into the overlying epi- dermis. Immunohistochemical staining demonstrates positive staining for CD4. Which of the following is the most likely diagnosis?

Q60724. A 56-year-old man presents with enlarged lymph nodes. Phys- ical examination reveals mild hepatosplenomegaly. A lymph node biopsy shows small lymphocytes, as well as plasma- cytoid lymphocytes containing Dutcher and Russell bodies. Immunohistochemical studies demonstrate cytoplasmic accu- mulation of IgM. What is the appropriate diagnosis?

Q60725. A 9-year-old girl develops widespread pinpoint skin hemor- rhages. She recovered from a fl u-like illness 1 week earlier. Laboratory fi ndings reveal a platelet count of 20,000/mL but no other abnormalities. Her bone marrow shows an increased number of megakaryocytes. The platelet count is normal after 2 months. Which of the following is the appropriate diagnosis?

Q60726. A 45-year-old man suffers severe third-degree burns in an industrial accident. During his hospital stay, the patient devel- ops anemia, thrombocytopenia, and widespread purpura. Blood oozes from venipuncture sites. Laboratory studies show that fi brin split products are elevated. The peripheral blood smear is shown in the image. What is the appropriate diagnosis?

Q60727. A 25-year-old woman with a history of systemic lupus erythematosus presents with diffuse petechiae and fatigue. Physical examination demonstrates lymphadenopathy and splenomegaly. Laboratory fi ndings include normocytic anemia (hemoglobin = 6.1 g/dL) and thrombocytopenia (30,000/mL). Which of the following is the most likely underlying mecha- nism in the development of thrombocytopenia in this patient?

Q60728. For the patient described in Question 50, a peripheral blood smear shows polychromasia with 10% reticulocytes. This patient most likely has which of the following hematologic diseases?

Q60729. A 22-year-old man presents with a 6-day history of sore throat, fever, and general malaise. Physical examination reveals gen- eralized lymphadenopathy, which is most prominent in the cervical lymph nodes. A CBC demonstrates atypical lympho- cytes. The monospot test is positive. Two weeks later, the patient complains of intermittent pain and tingling in the tips of his fi ngers. A CBC discloses a mild, macrocytic anemia. The peripheral blood smear is shown in the image. Which of the following is the most likely cause of anemia in this patient?

Q60730. An 18-year-old man is rushed to the emergency room in shock following a motor vehicle accident. He is transfused with 5 U of blood. Following the transfusion the patient complains of fever, nausea, vomiting, and chest pain. Laboratory data show elevated indirect serum bilirubin, decreased serum hap- toglobin, and a positive Coombs test. Which of the following is the most likely diagnosis?

Q60731. A 60-year-old woman complains of weakness and hematuria. Physical examination shows marked pallor, hepatospleno- megaly, and numerous ecchymoses of the upper and lower extremities. A CBC reveals a normocytic normochromic ane- mia, thrombocytopenia, neutropenia, and a marked leukocy- tosis, which is composed mainly of myeloblasts. The major clinical problems associated with this patient’s condition are most directly related to which of the following?

Q60732. A 69-year-old man is scheduled for surgery, but the procedure is canceled because of abnormal fi ndings in the preoperative blood work. A CBC shows leukocytosis (WBC = 124,000/mL), consisting mainly of maturing neutrophils. Basophilia and

Q60733. A 14-year-old boy presents with acute onset of right fl ank pain, which developed after he helped his father paint the ceiling of his bedroom. Physical examination demonstrates an area of ecchymosis in the right fl ank that is tender to palpa- tion. The patient has a lifelong history of easy bruising. His brother shows the same tendency. The serum level of clotting factor VIII is less than 2% of normal. Which of the following is the most likely underlying mechanism for bleeding tendency in this patient?

Q60734. A 4-year-old boy develops severe bleeding into the knee joint. Laboratory studies show that serum levels of factor IX are reduced, but levels of factor VIII are normal. What is the appropriate diagnosis?

Q60735. A 39-year-old man reports seeing red-colored urine in the morning. The CBC reveals anemia, low serum iron, and an elevated reticulocyte count. Laboratory studies show increased lysis of erythrocytes when incubated with either sucrose or acidifi ed serum. Which of the following is the appropriate diagnosis?

Q60736. A 21-year-old woman complains of generalized weakness, blurred vision, and diffi culty swallowing. Physical exami- nation shows bilateral ptosis and facial muscle weakness. A CT scan of the chest reveals a mass in the anterior medi- astinum. The patient’s mass is surgically removed (shown in the image). A microscopic examination demonstrates epithelial cells and normal lymphocytes. What is the most likely diagnosis?

Q60737. A 47-year-old man with a history of a heart-lung transplant 3 years ago complains of fever, malaise, and abdominal pain. The patient has been taking cyclosporine for immu- nosuppression. Physical examination reveals an abdomi- nal mass. A CT-guided biopsy of the mass shows atypical lymphocytes that are positive for latent membrane pro- teins of Epstein-Barr virus (EBV). What is the most likely diagnosis?

Q60738. A 56-year-old man presents with a 2-week history of fatigue. The patient’s past medical history is signifi cant for aortic and mitral valve replacement 5 months ago. A CBC shows mod- erate anemia with an increased reticulocyte count. Which of the following best explains the pathogenesis of anemia in this patient?

Q60739. A 48-year-old alcoholic man presents with a 6-day history of productive cough and fever. The temperature is 38.7°C (103°F), respirations are 32 per minute, and blood pressure is 125/85 mm Hg. The patient’s cough worsens, and he begins expectorating large amounts of foul-smelling sputum. A chest X-ray shows a right upper and middle lobe infi ltrate. A CBC demonstrates leukocytosis (WBC = 38,000/mL), with 80% slightly immature neutrophils and toxic granulation. Labora- tory studies reveal elevated leukocyte alkaline phosphatase. Which of the following best describes this patient’s hemato- logic condition?

Q60740. A 20-year-old carpenter with a wound infection on his left thumb presents with an enlarged and tender lymph node in the axilla. A lymph node biopsy shows follicular enlargement and hyperemia. The sinuses are fi lled with neutrophils. Which of the following is the most likely diagnosis?

Q60741. A 14-year-old boy presents with 3 months of lethargy, headaches, and muscle weakness. His parents note that he drinks water excessively. His vital signs are normal. A 24-hour urine collection shows polyuria. The fasting blood sugar is normal. An X-ray fi lm of the brain reveals suprasellar calcifi - cation. An autopsy specimen of a similar case is shown in the image. Which of the following neoplasms is the most likely cause of polyuria in this patient?