April exam taker ----- Lets make a group - harrisonusmle

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Question 1
A 61-year-old man has had dull, constant back pain for 3 months. He recently developed a cough productive of yellowish sputum. On physical examination there are crackles at the right lung base. A plain film radiograph of the spine reveals several 1 to 2 cm lytic lesions of the vertebral bodies. Laboratory studies show sodium 140 mmol/L, potassium 4.4 mmol/L, chloride 101 mmol/L, CO2 26 mmol/L, glucose 78 mg/dL, urea nitrogen 49 mg/dL, creatinine 5 mg/dL, total protein 8.3 g/dL, albumin 3.7 g/dL, alkaline phosphatase 176 U/L, AST 45 U/L, ALT 22 U/L, and total bilirubin 1.2 mg/dL. A sputum culture grows Streptococcus pneumoniae. Which of the following pathologic findings is most likely to be seen in a bone marrow biopsy from this man?

A Scattered small granulomas

B Nodules of small mature lymphocytes

C Occasional Reed-Sternberg cells

D Numerous plasma cells

E Hypercellularity with many blasts

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Question 2
A 33-year-old woman has experienced low grade fevers, night sweats, and generalized malaise for the past 2 months. On physical examination she has non-tender cervical and supraclavicular lymphadenopathy. A cervical lymph node biopsy is performed. On microscopic examination at high magnification there are occasional Reed-Sternberg cells along with large and small lymphocytes and bands of fibrosis. Which of the following is the most likely diagnosis?

A Burkitt lymphoma

B Hodgkin lymphoma

C Cat scratch disease

D Mycosis fungoides

E Multiple myeloma

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Question 3
A 17-year-old adolescent has had malaise for the past 3 weeks. He has a mild pharyngitis on physical examination, as well as tender axillary and inguinal lymphadenopathy. A CBC shows Hgb 14.0 g/dL, Hct 42.2%, MCV 90 fL, platelet count 301,300/microliter, and WBC count 8120/microliter with "atypical lymphocytes" on the peripheral blood smear. His illness is most likely to be acquired via which of the following mechanisms?

A From a genetic abnormality

B While on a date

C As a result of an insect bite

D Through an environmental exposure at work

E Without any known etiology

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Question 4
A 42-year-old man has had fevers for the past 4 weeks. On physical examination his temperature is 37.8 C. Laboratory studies show a Hgb of 12.2 g/dL, Hct 37.1%, MCV 92 fL, platelet count 243,000/uL, and WBC count 75,000/uL. The WBC differential count shows 82 segs, 8 bands, 3 metamyelocytes, 1 myelocyte, 4 lymphocytes, and 1 monocyte. The leukocyte alkaline phosphatase (LAP) score is high at 130. Which of the following laboratory test findings is most likely to be present in this man?

A Bone marrow karyotype of 46, XY, t(9;22)

B Serologic titer of 1:1024 for anti-double stranded DNA

C Serum vitamin B12 level of 100 pg/mL

D 4+ ketonuria and 4+ proteinuria

E Blood culture positive for Streptococcus, viridans group

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Question 5
A clinical study is conducted involving adults from 18 to 80 years of age who underwent splenectomy for blunt force abdominal trauma. An age-matched control group of patients consists of patients who have congestive splenomegaly. The laboratory findings from these subjects are analyzed. Which of the following laboratory test findings is most likely to be observed in the study group following splenectomy?

A Thrombocytopenia

B RBC Howell-Jolly bodies

C Decreased RBC distribution width

D Leukopenia

E Nucleated RBCs

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Question 6
A 30-year-old man gives a history of a sore throat with fever followed by 6 weeks of malaise. On physical examination he has mildly tender generalized lymphadenopathy. A cervical lymph node biopsy is performed and on microscopic examination shows prominent germinal centers in follicles with a diffuse polyclonal hyperplasia composed of lymphocytes, plasma cells, and macrophages. Which of the following is the most likely diagnosis?

A Lymphocytic lymphoma

B Hodgkin lymphoma

C Infectious mononucleosis

D Human immunodeficiency virus infection

E Brucellosis

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Question 7
A 30-year-old man has had a progressively worsening productive cough for one month. On physical examination, a few small non-tender lymph nodes are palpable in the axillae, and the tip of the spleen is palpable. Laboratory studies show Hgb 10.2 g/dl, Hct 31.1%, MCV 90 fL, WBC count 67,000/microliter, and platelet count 36,000/microliter. Microscopic examination of his peripheral blood smear shows many blasts with Auer rods. Which of the following is the most likely diagnosis?

A Leukemoid reaction

B Acute myelogenous leukemia

C Chronic lymphocytic leukemia

D Acute lymphoblastic leukemia

E Leukoerythroblastosis

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Question 8
A 68-year-old man has had malaise for over a year. On physical examination, there are no abnormal findings. His Hgb is 10.5 g/dL, Hct 31.5%, MCV 88 fL, platelet count 211,000/microliter, and WBC count 6980/microliter. His total serum iron is 130 microgm/dL total iron binding capacity (TIBC) 230 microgm/dL, and soluble serum transferrin receptor is normal. A bone marrow biopsy is performed and microscopic examination shows that maturation is occurring in all cell lines and there are no abnormal cells seen. Stainable iron in the bone marrow is increased. Which of the following underlying diseases is he most likely to have?

A Diverticulosis

B Hepatitis C infection

C Systemic lupus erythematosus

D Atrophic gastritis

E Fanconi anemia

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Question 9
A 68-year-old man has noted the presence of several lumps on the right side of his neck for the past 5 months. On physical examination he has firm, non-tender, movable lymph nodes palpable in right posterior cervical region. He does not have splenomegaly or hepatomegaly. Laboratory studies show Hgb 11.3 g/dL, Hct 40%, MCV 88 fL, platelet count 256,000/microliter, and WBC count 7230/microliter. A cervical lymph node biopsy is performed and on microscopic examination shows numerous crowded follicles composed of small, monomorphic lymphocytes. Which of the following is the most likely diagnosis?

A Chronic lymphocytic leukemia

B Poorly differentiated lymphocytic lymphoma

C Infectious mononucleosis

D Hodgkin lymphoma, lymphocyte predominance type

E Reactive hyperplasia

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Question 10
A 45-year-old man has had increasing abdominal discomfort with abdominal enlargement for the past two years. On physical examination, the spleen can be felt below the left costal margin. There is no fluid wave. An abdominal CT scan reveals massive (estimated 3000 gm size) splenomegaly. Which of the following underlying conditions is he most likely to have?

A Myelofibrosis

B Sickle cell anemia

C Portal hypertension

D Infectious mononucleosis

E Hemochromatosis