RBC Wbc Disorders

17 Questions | Total Attempts: 412

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RBC Wbc Disorders

When we think about the components that make up the blood, we’d be correct to think of red blood cells and white blood cells as two important factors to consider. What we may not know, however, is that there are a number of disorders an individual can suffer from that stem from those very cells. Let’s talk about RBC and WBC disorders, shall we?


Questions and Answers
  • 1. 
    A 61-year-old male gives a history of back pain for several months. A radiograph of the spine reveals several 1 to 2 cm lytic lesions of the vertebral bodies. He has no LN or splenomegaly. His serum BUN & creatinine are steadily rising. He recently developed a cough productive of yellowish sputum; sputum culture grew Streptococcus pneumoniae. BM  smear is shown here. Which of the following is the most likely diagnosis?
    • A. 

      DIC

    • B. 

      Primary myelofibrosis

    • C. 

      CML

    • D. 

      AIDS

    • E. 

      Multiple myeloma

  • 2. 
    A 61-year-old man has had dull, constant back pain for 3 months. He recently developed a cough productive of yellowish sputum. Physical examination reveals crackles at right lung base. A plain X-ray film of spine reveals several 1- 2 cm lytic lesions of vertebral bodies. Lab. studies show BUN 49 mg/dL, creatinine 5 mg/dL and Bence-Jones proteinuria. Sputum culture grows Strepto. pneumoniae. Which of the following pathologic findings is most likely to be seen in a BM 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 myeloblasts

  • 3. 
    A 55-year-old man presents with enlarged lymph nodes. Physical examination shows mild hepato-splenomegaly. Lymph node biopsy shows small lymphocytes, plasmocytoid lymphocytes with Russel bodies. Immunohisto-chemistry shows cytoplasmic IgM accumulation. What is your diagnosis?
    • A. 

      MGUS

    • B. 

      Solitary plasmacytoma

    • C. 

      Waldernstrom disease

    • D. 

      Multiple myeloma

    • E. 

      Burkitt lymphoma

  • 4. 
    A 62-year-old man has had increasing lethargy for the past 6 months. On physical examination there are no abnormal findings. Laboratory studies show his serum urea nitrogen is 42 mg/dL with creatinine 4.6 mg/dL. A urinalysis shows B-J proteins. Serum protein electrophoresis reveals a 4 gm monoclonal gamma spike. Which of the following laboratory test findings is this man most likely to have?
    • A. 

      Lymphocytosis

    • B. 

      Elevated erythrocyte sedimentation rate (ESR)

    • C. 

      Positive antinuclear antibody (ANA) test

    • D. 

      Hypocalcemia

    • E. 

      Macrocytic anemia

  • 5. 
    A 59-year-old man has experienced fevers and progressive weight loss of 6 kg over the past 7 months. O/E - Febrile. His spleen tip is palpable. There are enlarged non-tender right inguinal lymph nodes. An abdominal CT scan shows splenomegaly and para-aortic lymphadenopathy. An inguinal lymph node biopsy is performed and on microscopic examination there are small lymphocytes, plasma cells, eosinophils, neutrophils, macrophages, and multinucleated cells. The multinucleated cells mark with an immuno-histochemical stain for CD15 and CD30. Which of the following is the most likely diagnosis?
    • A. 

      Disseminated tuberculosis

    • B. 

      Hodgkin lymphoma

    • C. 

      Langerhans cell histiocytosis

    • D. 

      Mycosis fungoides

    • E. 

      Sarcoidosis

  • 6. 
    A 45-year-old man has noted a change in the appearance of his face over the past 7 months. On examination, his facial skin is thickened and reddened. A punch biopsy of skin shows infiltration by neoplastic T lymphocytes. Which of the following is the most likely diagnosis?
    • A. 

      Hodgkin disease

    • B. 

      Mycosis fungoides

    • C. 

      Burkitt lymphoma

    • D. 

      Acute lymphocytic leukemia

    • E. 

      Hairy cell leukemia

  • 7. 
    A 5-year-old girl is brought by her mother who states that the girl has been drinking too much water. On examination, eyes appear protruded. Radiology reveals multiple lytic lesions involving calvarium & base of skull. What is your diagnosis?
    • A. 

      Eosinophilic granuloma

    • B. 

      Hand-Schuller-Christian disease

    • C. 

      Letterer-Siwe disease

    • D. 

      Multiple myeloma

    • E. 

      Mycosis fungoides

  • 8. 
    A 2-year-old boy has had a seborrheic eruption over the scalp and trunk over the past month. He then develops a right ear ache. O/E right tympanic membrane is erythematous and bulging. He has hepato-splenomegaly and generalized LN. Hb 9.5 g/dL, Hct 28.7%, MCV 90 fL, platelet count 58,000/µL, WBC count 3540/µL. BM biopsy shows 100% cellularity with extensive infiltration by cells resembling macrophages that express CD1a antigen and, by EM, have prominent Birbeck granules. Which of the following conditions is most likely to produce this boy's findings?
    • A. 

      Myeloproliferative disorder

    • B. 

      Plasmodium vivax infection

    • C. 

      Hodgkin' disease, nodular sclerosis type

    • D. 

      Langerhan cell histiocytosis

  • 9. 
    A 21-yr-old woman complains of generalized weakness, blurred vision, difficulty swallowing. CT scan of the chest shows an anterior mediastinal mass. The mass is removed. Microscopy shows epithelial cells and normal lymphocytes. What is the most likely diagnosis? 
    • A. 

      Hodgkin’s lymphoma

    • B. 

      Burkitt lymphoma

    • C. 

      Thymoma

    • D. 

      Acute lymphoblastic leukemia

  • 10. 
    A 25-yr-old man presents with low grade fever and cough. Chest x-ray shows a 4cm left upper lobe nodule. CBC- Hb- 13.3 gm%, WBC- 15,000/cmm with 36% neutrophils, 55% lymphocytes. Which of the following is the most likely etiological agent responsible for this patients condition??
    • A. 

      Parasitic infestation

    • B. 

      Acute bacterial abscess

    • C. 

      Mycobacterium tuberculosis

    • D. 

      Acute appendicitis

  • 11. 
    A 15-year-old boy has a positive monospot test. He has a mild pharyngitis followed by generalized lymphadenopathy, malaise, and mild scleral icterus. His spleen tip is also palpable. He recovers in a month. Which of the following is the most likely finding on the peripheral smear
    • A. 

      Lymphocytopenia

    • B. 

      Atypical lymphocytes

    • C. 

      Neutrophilia

    • D. 

      Eosinophilia

  • 12. 
    A 7-year-old boy complains of groin pain since past few days. Painful, swollen lymph nodes in right inguinal region are noted. Lymph node biopsy shows follicular enlargement and hyperemia. Sinuses are filled with neutrophils.. What is the most likely cause of these histological changes?
    • A. 

      Acute lymphadenitis

    • B. 

      Lymphoma

    • C. 

      Leukemia

    • D. 

      Metastatic carcinoma

    • E. 

      Chronic lymphadenitis

  • 13. 
    A 12-year-old girl presents with fever and a swollen lymph node of 6 days duration. Biopsy of the lymph node reveals benign follicular hyperplasia. The pathologic finding is interpreted as which of the following?
    • A. 

      Proliferation in B-cell areas

    • B. 

      Proliferation in T-cell areas

    • C. 

      Proliferation of cancer cells

    • D. 

      Proliferation of plasma cells

  • 14. 
    A 30-year-old man gives a history of sore throat with fever followed by 6 weeks of malaise. O/E he has mildly tender generalized lymphadenopathy. A cervical lymph node biopsy shows a diffuse paracortical hyperplasia. Which of the following is the most likely diagnosis?
    • A. 

      Lymphoma

    • B. 

      Lymph node draining a cancer

    • C. 

      Infectious mononucleosis

    • D. 

      Acute lymphadenitis

  • 15. 
    A 17-year-old adolescent has had malaise for past 3 wks. Physical examination shows mild pharyngitis and tender axillary/inguinal lymphadenopathy. CBC shows Hb 14.0 g/dL, Hct 42.2%, MCV 90 fL, platelets 301,300/µL, WBC count 8120/µL with "atypical lymphocytes" on peripheral blood smear. Monospot test is positive. What is most likely to be seen on a lymph node biopsy? 
    • A. 

      Follicular hyperplasia due to proliferation of B cells

    • B. 

      Paracortical hyperplasia due to proliferation of activated T cells

    • C. 

      Sinus hyperplasia of histiocytes

    • D. 

      Necrotizing lymphadenitis

    • E. 

      Granulomatous lymphadenitis

  • 16. 
    A 5-year-old girl presents with a 2-3 day history of localized swelling in the right side of her neck. Physical examination shows very tender, firm, slightly enlarged lymph nodes in the right cervical region. CBC shows mild leukocytosis. Which of the following is the most likely diagnosis?
    • A. 

      Chronic lymphadenitis

    • B. 

      Acute bacterial lymphadenitis

    • C. 

      Lymphoma

    • D. 

      Metastatic cancer

  • 17. 
    A 10-yr-old boy presents with high fever since 10 days. O/E- Petechial hemorrhages on trunk and extremities. CBC shows normal Hb, normal platelet count; leukopenia with absolute neutropenia. BM biopsy does not show any abnormal cells. Which of the following is the most likely diagnosis?
    • A. 

      Viral infection

    • B. 

      Overwhelming bacterial infection

    • C. 

      Megaloblastic anemia

    • D. 

      Allergic reactions

    • E. 

      Parasitic infestation