Block 10 White Blood Cells MCQ's

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Block 10 White Blood Cells MCQs - Quiz


Questions and Answers
  • 1. 

    You are the physician for the local college football team, who is asked to examine a 21 year old senior with fever, sore throat, and generalized lymphadenitis. Physical exam reveals splenomegaly. Laboratory data shows a leukocytosis with a significant lymphocytosis. Atypical lymphocytes are seen on peripheral blood smear (see arrow).  Flow cytometry will most likely show these atypical lymphocytes to be:

    • A.

      CD 4 +

    • B.

      CD 8+

    • C.

      CD 19 +

    • D.

      CD 33+

    Correct Answer
    B. CD 8+
    Explanation
    The presence of atypical lymphocytes, along with the symptoms of fever, sore throat, and generalized lymphadenitis, suggests that the patient may have infectious mononucleosis. In infectious mononucleosis, the atypical lymphocytes are typically CD8+ T cells. Therefore, flow cytometry will most likely show these atypical lymphocytes to be CD8+. CD4+ T cells are typically decreased in infectious mononucleosis, while CD19+ B cells and CD33+ myeloid cells are not typically affected.

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  • 2. 

    A 75 year old man complains of difficulty urinating with increased urgency and frequency. Physical examination reveals an enlarged non-painful hard nodular prostate. Urine analysis shows >100,000 leukocytes per ml of urine. A prostatectomy and a lymph node biopsy were performed.  The obturator lymph node is shown below: What is the most likely diagnosis?

    • A.

      Follicular hyperplasia in a lymph node with prostate cancer

    • B.

      Sinus histiocytosis in a lymph node draining prostate cancer

    • C.

      Paracortical lymphoid hyperplasia in a lymph node draining prostate cancer

    • D.

      Metastatic prostate cancer in a lymph node

    Correct Answer
    B. Sinus histiocytosis in a lymph node draining prostate cancer
    Explanation
    The presence of an enlarged non-painful hard nodular prostate, along with symptoms of difficulty urinating, increased urgency, and frequency, suggests the possibility of prostate cancer. The finding of >100,000 leukocytes per ml of urine indicates a urinary tract infection, which can be a complication of prostate cancer. The lymph node biopsy showing sinus histiocytosis in a lymph node draining prostate cancer supports the diagnosis of metastatic prostate cancer in a lymph node. Sinus histiocytosis is a characteristic finding in metastatic prostate cancer, indicating the spread of cancer cells to the lymph nodes.

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  • 3. 

    You are asked to diagnose and explain the findings of a recent work-up to a 70 year old man who you suspect has a hematologic malignancy. The complete blood count shows a leukocytosis with a lymphocytosis. Smudge cells are seen on peripheral blood smear. His bone marrow biopsy is hypercellular with monotonous large hyperchromatic cells with an increased nuclear to cytoplasmic (?) ratio. His lymph node biopsy was within normal limits. This patient most likely has:

    • A.

      Small Lymphocytic Lymphoma (SLL) originating in the lymph node

    • B.

      Chronic Lymphocytic Leukemia (CLL) originating in bone marrow

    • C.

      Chronic Lymphocytic Leukemia (CLL) originating in the blood

    • D.

      Small Lymphocytic Lymphoma (SLL) originating in the bone marrow

    Correct Answer
    B. Chronic Lymphocytic Leukemia (CLL) originating in bone marrow
    Explanation
    smudge cells, are in CLL which arises from BM

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  • 4. 

    A 75-year-old woman presents with severe fatigue. Her spleen is palpable 17 cm below the left costal margin and the liver 8 cm below the right costal margin. Red blood cell count, hemoglobin, hematocrit are decreased. White blood cell and platelet count are elevated. Many teardrop erythrocytes are seen on peripheral blood smear. The most likely diagnosis is:

    • A.

      Chronic myelogenous leukemia

    • B.

      Essential thrombocythemia

    • C.

      Myeloid metaplasia with myelofibrosis

    • D.

      Polycythemia Vera

    Correct Answer
    C. Myeloid metaplasia with myelofibrosis
    Explanation
    platelets are increased so it is myeloid
    teardrops daCRocYtes are from RBC's squeezing out of fibrotic BM.

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  • 5. 

    What is the most likely translocation associated with the tumor shown below?

    • A.

      T(14;18

    • B.

      T(15;17)

    • C.

      T 11;14)

    • D.

      T(8;14)

    Correct Answer
    D. T(8;14)
    Explanation
    The most likely translocation associated with the tumor shown is t(8;14). This is because t(8;14) is commonly associated with Burkitt lymphoma, a type of cancer that primarily affects the lymph nodes. Translocations involving the chromosomes 8 and 14 are characteristic of Burkitt lymphoma, where the MYC gene on chromosome 8 is translocated and fused with the immunoglobulin heavy chain gene on chromosome 14. This fusion leads to uncontrolled cell growth and the development of the tumor.

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  • 6. 

    A biopsy of a cervical and supraclavicular  lymph node is shown below.  The most likely diagnosis is:

    • A.

      Hodgkins Disease, Nodular Sclerosing type stage 1

    • B.

      Non-Hodgkins Lymphoma, Nodular Sclerosis type

    • C.

      Hodgkins Disease, Nodular sclerosing type, stage II

    • D.

      Non-Hodgkins Lymphoma, stage 4

    Correct Answer
    C. Hodgkins Disease, Nodular sclerosing type, stage II
    Explanation
    The most likely diagnosis is Hodgkins Disease, Nodular sclerosing type, stage II because the image shows characteristic features of Hodgkin's lymphoma, including Reed-Sternberg cells and nodular sclerosis. Additionally, the presence of lymph node involvement suggests stage II disease. Non-Hodgkin's lymphoma, on the other hand, typically lacks Reed-Sternberg cells and nodular sclerosis.

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  • 7. 

    A 55-year-old man complains for “non-tender swollen glands in his neck and groin”. He experiences some discomfort in these swollen glands only when he drinks alcohol. Biopsies of the cervical and  inguinal lymph nodes  shows numerous  Reed-Sternberg cells with a reactive cellular infiltrate which includes small lymphocytes, esoinophils,  plasma cells, and benign histiocytes.  The bone marrow shows a similar infiltrate of reactive cells surrounding Reed-Sternberg cells.  Which of the following is the most likely diagnosis and stage of disease?

    • A.

      Nodular Sclerosing Hodgkin disease, stage III

    • B.

      Lymphocyte predomince Hodgkin disease, stage IV

    • C.

      Mixed Cellularity Hodgkin disease, stage IV

    • D.

      Lymphocyte depleted, Hodgkin disease, stage III

    Correct Answer
    C. Mixed Cellularity Hodgkin disease, stage IV
  • 8. 

    You are asked to review a lymph node biopsy from a 50 year old man, with fever, fatigue and infection.  Microscopic examination reveals a nodular pattern.  The patient is anxious and would like to know if he has cancer.  Which of the following would be most helpful in answering his question?

    • A.

      T(15;17)

    • B.

      T(8;14)

    • C.

      Plasma cells in various stages of differentiation

    • D.

      Monotous lymphocytes that express the BCL2 protein

    Correct Answer
    D. Monotous lymphocytes that express the BCL2 protein
    Explanation
    The presence of monotous lymphocytes that express the BCL2 protein would be most helpful in answering the patient's question about whether he has cancer. Monotonous lymphocytes refer to a population of lymphocytes that are similar in appearance, suggesting a neoplastic (cancerous) process. The expression of the BCL2 protein is commonly seen in certain types of lymphomas, particularly follicular lymphoma. Therefore, the presence of monotous lymphocytes that express the BCL2 protein suggests the possibility of lymphoma, which would be an answer to the patient's concern about cancer.

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  • 9. 

    A 65-year-old man comes to your office for his yearly physical exam and lab tests.  He reports feeling fatigue.  Physical exam reveals a pale thin man with mild lymphadenopathy and splenomegaly. His laboratory data is significant for a leukocytosis with a lymphocytosis as well as an anemia and positive direct Coombs test.  The peripheral blood smear shows predominately mature-appearing lymphocytes with some smudge cells and occasional prolymphocytes.  What is the most likely diagnosis?

    • A.

      Acute lymphoblastic leukemia

    • B.

      Acute Myeloblastic leukemia

    • C.

      Chronic Lymphocytic leukemia

    • D.

      Chronic Myelogenous leukemia

    Correct Answer
    C. Chronic Lymphocytic leukemia
    Explanation
    The patient's presentation of fatigue, lymphadenopathy, splenomegaly, leukocytosis with lymphocytosis, anemia, positive direct Coombs test, and the presence of mature-appearing lymphocytes with smudge cells and occasional prolymphocytes on peripheral blood smear are consistent with chronic lymphocytic leukemia (CLL). CLL is a type of leukemia characterized by the accumulation of mature-appearing lymphocytes in the blood, bone marrow, lymph nodes, and spleen. It is more common in older individuals and often presents with fatigue, lymphadenopathy, and splenomegaly. The presence of smudge cells on the peripheral blood smear is a characteristic finding in CLL.

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  • 10. 

    A 65-year-old woman presents complains of fatigue and shortness of breath.  Physical examination reveals a pale thin woman with dullness heard on percussion of Traube’s space and a liver span of 18 at the mid-clavicular line.   Laboratory data is significant for a hemoglobin is 10.3 g/dL, hematocrit 31%, platelet count 474,000/mm3, WBC 31,300/mm3 (61% segmented neutrophils, 5% bands, 3% metamyelocytes, 4% myelocytes, 1% promyelocyte, 4% myeloblasts, 3% eosinophils, 4% basophils, 5% monocytes, and 10% lymphocytes).  Ten normoblasts are seen per 100 leukocytes.  Many teardrop erythrocytes are identified.  The most likely diagnosis is

    • A.

      Myeloid metaplasia with myelofibrosis

    • B.

      Chronic lymphocytic leukemia.

    • C.

      Chronic myelogenous leukemia

    • D.

      Myelodysplastic syndrome

    Correct Answer
    A. Myeloid metaplasia with myelofibrosis
    Explanation
    The patient's presentation of fatigue, shortness of breath, and physical examination findings of dullness on percussion of Traube's space and an enlarged liver suggest a hematologic disorder. The laboratory data further supports this suspicion, with low hemoglobin and hematocrit levels, elevated white blood cell count with a left shift, and the presence of normoblasts and teardrop erythrocytes. These findings are consistent with myeloid metaplasia with myelofibrosis, a condition characterized by abnormal proliferation of myeloid cells in the bone marrow, leading to fibrosis and extramedullary hematopoiesis. Chronic lymphocytic leukemia, chronic myelogenous leukemia, and myelodysplastic syndrome are less likely based on the given information.

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  • 11. 

    A 2-year-old boy presents with polyuria, exophthalmos and radiolucent bone defects in the skull.  Physical examination reveals a positive splenic percussion sign and the liver tip is felt 3 cm below the right costal margin.  What would you expect biopsy of the bony defects to show?  Biopsy of one of the bony defects reveals accumulations of lipid-laden histiocytes.  Which of the following is the most likely diagnosis?

    • A.

      Neoplastic lymphoblasts

    • B.

      Reactive lymphocytes

    • C.

      Reactive histiocytes

    • D.

      Neoplastic histiocytes

    Correct Answer
    D. Neoplastic histiocytes
    Explanation
    The most likely diagnosis based on the presentation and the biopsy findings is the presence of neoplastic histiocytes. The symptoms of polyuria, exophthalmos, and radiolucent bone defects, along with the positive splenic percussion sign and the palpable liver tip, suggest a systemic disease. The presence of accumulations of lipid-laden histiocytes in the bony defects on biopsy is consistent with a neoplastic process involving histiocytes. This could indicate a condition such as Langerhans cell histiocytosis, which is characterized by the proliferation of abnormal histiocytes.

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  • 12. 

    A 35-year-old man complains of fever, cough, increasing weakness and fatigue.  He has recently noted abnormal bruising and nosebleeds. Percussion of Traube’s space reveals tympany.  The peripheral blood reveals a normocytic, normochromic anemia without reticulocytosis.  Abnormal-appearing, early cells are seen in the peripheral blood smear.  The abnormal cells are positive for CD markers 13, 14, & 15. The most likely diagnosis is

    • A.

      Chronic lymphocytic leukemia.

    • B.

      Acute lymphoblastic leukemia

    • C.

      Chronic myelogenous leukemia

    • D.

      Acute myelogenous leukemia

    Correct Answer
    D. Acute myelogenous leukemia
    Explanation
    The given clinical presentation of fever, cough, weakness, fatigue, abnormal bruising, and nosebleeds, along with the findings of tympany on percussion of Traube's space and normocytic, normochromic anemia without reticulocytosis, suggest a hematological malignancy. The presence of abnormal-appearing, early cells in the peripheral blood smear that are positive for CD markers 13, 14, and 15 indicates a myeloid lineage. These findings are consistent with acute myelogenous leukemia (AML), making it the most likely diagnosis. Chronic lymphocytic leukemia (CLL) is a B-cell malignancy and would not present with the myeloid markers seen in this case. Acute lymphoblastic leukemia (ALL) is more common in children, and chronic myelogenous leukemia (CML) typically presents with a leukocytosis and the Philadelphia chromosome.

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  • 13. 

    A 23-year-old man presents with bleeding. His prothrombin, partial thromboplastin and bleeding time are prolonged.  His hemoglobin, hematocrit, red blood cell and platelet count are decreased.  Fibrin split products are elevated.   A bone marrow aspiration specimen was sent to the cytogenetics laboratory.  Culture cells showed a karyotype with t(15;17) (q21; 21).  What is the most likely diagnosis?

    • A.

      Acute promyelocytic leukemia (APL)

    • B.

      Chronic lymphocytic leukemia (CLL)

    • C.

      Acute lymphoblastic leukemia (ALL)

    • D.

      Chronic myelogenous leukemia (CML)

    Correct Answer
    A. Acute promyelocytic leukemia (APL)
    Explanation
    The patient's presentation of bleeding, prolonged coagulation times, decreased blood counts, elevated fibrin split products, and the presence of t(15;17) (q21; 21) in the bone marrow aspiration specimen suggests a diagnosis of acute promyelocytic leukemia (APL). APL is a subtype of acute myeloid leukemia (AML) characterized by the fusion of the PML and RARA genes, resulting in the formation of the abnormal protein PML-RARA. This fusion protein disrupts normal hematopoiesis and coagulation, leading to the clinical features seen in this patient.

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  • 14. 

    Three days after lung resection for squamous cell carcinoma, a 55-year-old man develops fever and chills.  Physical exam reveals a febrile ill-appearing man with an erythematous raised surgical incision site.  You order a complete blood count with differential white blood cell count and a peripheral blood smear.  The results would most likely show:

    • A.

      An increase in neoplastic neutrophils.

    • B.

      An increase in reactive neutrophils with a shift to the left.

    • C.

      A neutropenia.

    • D.

      An increase in neoplastic neutrophils with a shift to the left.

    Correct Answer
    B. An increase in reactive neutrophils with a shift to the left.
    Explanation
    After lung resection for squamous cell carcinoma, the patient developing fever, chills, and an erythematous raised surgical incision site indicates an infection. The presence of an increase in reactive neutrophils with a shift to the left on the complete blood count and peripheral blood smear suggests an acute inflammatory response. A shift to the left refers to an increase in immature neutrophils (bands) in the blood, which is characteristic of an acute infection. Neoplastic neutrophils would not be expected in this scenario, as the patient had surgery to remove the cancerous cells.

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  • 15. 

    A patient with a history of mycosis fungoides develops Sezary cell leukemia.  Which of the following CD markers are most likely be found by immunophenotyping?

    • A.

      CD 34+

    • B.

      CD 19+

    • C.

      CD 8+

    • D.

      CD 4+

    Correct Answer
    D. CD 4+
    Explanation
    Mycosis fungoides is a type of T-cell lymphoma that primarily affects CD4+ T-cells. Sezary cell leukemia is a leukemic variant of mycosis fungoides, characterized by the presence of malignant CD4+ T-cells in the blood. Therefore, immunophenotyping of a patient with mycosis fungoides developing Sezary cell leukemia would most likely show the presence of CD4+ markers.

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  • 16. 

    A 5-year-old boy has been listless and eating poorly for a week.  Examination reveals marked pallor of mucous membranes, petechiae over arms and legs, and hepato-splenomegaly. What is the most likely diagnosis?

    • A.

      Acute lymphoblastic leukemia

    • B.

      Chronic lymphocytic leukemia

    • C.

      Acute myeloblastic leukemia

    • D.

      Chronic myelogenous leukemia

    Correct Answer
    A. Acute lymphoblastic leukemia
    Explanation
    The most likely diagnosis for a 5-year-old boy with symptoms of listlessness, poor appetite, marked pallor of mucous membranes, petechiae over arms and legs, and hepato-splenomegaly is acute lymphoblastic leukemia. This is because these symptoms are commonly seen in acute lymphoblastic leukemia, which is a type of cancer that affects the white blood cells and bone marrow. It is more common in children and often presents with symptoms such as fatigue, pale skin, easy bruising or bleeding, and enlarged liver or spleen.

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  • 17. 

    A 43-year-old man received radiation to his chest shortly after birth because of an enlarged thymus.  He comes to see you because of sore swollen gums.  His hemoglobin is 8 gm/dL, white blood cell count is 2,400/mm3 and his platelet count is 60,000/mm3.  You correctly suspect which of the following?

    • A.

      Myelodysplastic syndrome

    • B.

      Aplastic anemia secondary to radiation

    • C.

      Chronic leukemia

    • D.

      Acute leukemia

    Correct Answer
    D. Acute leukemia
    Explanation
    The correct answer is Acute leukemia. The patient's symptoms of sore swollen gums, along with low hemoglobin, low white blood cell count, and low platelet count, are indicative of acute leukemia. Radiation exposure, especially at a young age, is a known risk factor for developing leukemia. Myelodysplastic syndrome and aplastic anemia would typically present with different clinical findings, such as abnormal blood cell morphology or bone marrow failure. Chronic leukemia would typically have a more indolent course and would not present with such severe cytopenias.

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  • 18. 

    A 66-year-old Caucasian man’s peripheral blood smear shows a lymphocytosis of mature-appearing lymphocytes and occasional smudge cells.  Ninety-nine percent of the B lymphocytes express kappa light chain while only one percent of the B lymphocytes express lambda light chain.  What is the most likely diagnosis? 

    • A.

      Chronic lymphocytic leukemia

    • B.

      Multiple myeloma

    • C.

      Neoplastic lymphopenia

    • D.

      Reactive lymphocytosis

    Correct Answer
    B. Multiple myeloma
  • 19. 

    You are asked to follow a 55-year-old man admitted to the oncology service.  On admission his complete and differential blood count revealed an anemia and thrombocytosis.  His peripheral blood smear revealed numerous cells resembling mature neutrophils and an increase in platelets. Two days later, your patient suddenly begins to complain of headache, shortness of breath, blurred and double vision. A repeat CBC and differential counts reveals a worsening anemia and thrombocytopenia. His peripheral blood smear is shown below.  What is the most likely diagnosis?

    • A.

      Chronic myeloid leukemia in chronic phase

    • B.

      Acute myeloid leukemia

    • C.

      Chronic myeloid leukemia with blast crisis

    • D.

      Hairy cell leukemia

    Correct Answer
    C. Chronic myeloid leukemia with blast crisis
    Explanation
    The most likely diagnosis is Chronic myeloid leukemia with blast crisis. This is supported by the initial presentation of anemia and thrombocytosis, which are characteristic findings in chronic myeloid leukemia. The sudden onset of symptoms such as headache, shortness of breath, blurred and double vision, along with a worsening anemia and thrombocytopenia, suggests a blast crisis, which is a transformation of chronic myeloid leukemia into a more aggressive and acute form. The peripheral blood smear showing immature cells further supports this diagnosis.

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  • 20. 

    A 73-year-old man comes to your office complaining of fatigue and weight loss. He denies that he has changed his diet but reports early satiety.  Physical exam reveals a pale man with a spleen tip palpable 3 cm below the left costal margin.  A positive percussion sign is heard over Traubes space.  A CBC reveals pancytopenia.  What is the most likely diagnosis?

    • A.

      HTLV- I leukemia

    • B.

      Hairy cell leukemia

    • C.

      Mantle cell lymphoma

    • D.

      Large B cell lymphoma

    Correct Answer
    B. Hairy cell leukemia
    Explanation
    The most likely diagnosis in this case is hairy cell leukemia. The patient's symptoms of fatigue, weight loss, and early satiety are consistent with this condition. The physical exam findings of a palpable spleen tip and a positive percussion sign over Traube's space further support this diagnosis. Additionally, the presence of pancytopenia on the CBC is a common finding in hairy cell leukemia. HTLV-I leukemia, mantle cell lymphoma, and large B cell lymphoma are less likely diagnoses in this case.

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  • 21. 

    A 24-year-old male complained with symptoms of easy fatigability, weakness and gum hypertrophy. A complete blood count was performed. Hb      - 3.5 g/dL      (Normal 11.7-15.7 g/dL) Plt      - 100 x 109/L (Normal 150- 450 x 109/L) TLC     - 3.8 x 109/L  (Normal 4.5-11.0 x 109/L) The findings of the peripheral blood smear are illustrated in the image below: A bone marrow aspirate revealed a hypercellular marrow with 40% blasts. The blasts were positive for myeloperoxidase and Sudan Black B; and negative for PAS stain. Flow cytometry revealed positivity for CD13 and CD33.  What would be your diagnosis on the basis of all these findings?

    • A.

      Acute lymphoblastic leukemia/lymphoma

    • B.

      Chronic myeloid leukemia

    • C.

      Chronic lymphocytic leukemia

    • D.

      Lymphoma

    • E.

      Acute myeloid leukemia

    Correct Answer
    E. Acute myeloid leukemia
    Explanation
    Based on the given information, the diagnosis would be Acute Myeloid Leukemia (AML). This is supported by the findings of a hypercellular bone marrow aspirate with 40% blasts, which are positive for myeloperoxidase and Sudan Black B staining. Flow cytometry also revealed positivity for CD13 and CD33, which are markers commonly seen in AML. The low hemoglobin, platelet count, and total leukocyte count further support the diagnosis of AML.

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  • 22. 

    A 23-year-old woman has persistent, low-grade fever and occasional night sweats for the past month. She is unusually fatigued and has lost her appetite. Firm non-tender 1 cm enlarged lymph nodes are palpated in her lower anterior neck bilaterally and in her right axilla. A microscopic section of the lymph node is shown in the image below. What is the  patient’s most likely diagnosis?

    • A.

      Nodular sclerosing Hodgkin’s lymphoma, Stage II

    • B.

      Mixed cellularity Hodgkin’ss ymphoma, Stage III

    • C.

      Lymphocyte predominant Hodgkin’s ymphoma, Stage III

    • D.

      Nodular sclerosing Hodgkin’s lymphoma, Stage I

    Correct Answer
    A. Nodular sclerosing Hodgkin’s lymphoma, Stage II
    Explanation
    The patient's most likely diagnosis is nodular sclerosing Hodgkin's lymphoma, Stage II. This is supported by the presence of persistent low-grade fever, night sweats, fatigue, loss of appetite, and enlarged lymph nodes in the lower anterior neck bilaterally and in the right axilla. The microscopic section of the lymph node shown in the image is consistent with nodular sclerosing Hodgkin's lymphoma. Stage II indicates that the disease is limited to two or more lymph node regions on the same side of the diaphragm.

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  • 23. 

    A 65-year-old woman, recovering from abdominal surgery for resection of colonic adenocarcinoma, develops an elevated white blood cell count of 20,100/mm3 (65% neutrophils, 10% bands and metamyelocytes, 3% myelocytes, 1% promyelocytes, 1% blasts, 10% monocytes and 10% lymphocytes).  She also has circulating nucleated RBCs (2/100 WBCs).  Which of the following would be your first diagnostic consideration to be further evaluated?

    • A.

      Bone marrow metastasis

    • B.

      Chronic myeloid leukemia

    • C.

      Myelodysplastic syndrome

    • D.

      Sepsis

    Correct Answer
    D. Sepsis
    Explanation
    Given the patient's history of abdominal surgery and the presence of an elevated white blood cell count along with circulating nucleated RBCs, the first consideration for further evaluation would be sepsis. Sepsis is a systemic inflammatory response to infection, which can lead to an elevated white blood cell count. The presence of circulating nucleated RBCs may indicate a severe infection or sepsis. Therefore, sepsis should be the first diagnostic consideration in this case.

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  • 24. 

    A 26-year-old man presents with polyuria, exophthalmos and radiolucent bone defects in the skull.  His liver and spleen are enlarged.  Biopsy of one of the bony defects reveals accumulations of lipid-laden histiocytes.  Which of the following is the most likely diagnosis?

    • A.

      Eosinophilic granuloma

    • B.

      Hand-Schuller-Christian syndrome

    • C.

      Tay-Sachs disease

    • D.

      Gaucher disease

    Correct Answer
    B. Hand-Schuller-Christian syndrome
    Explanation
    Hand-Schuller-Christian syndrome is the most likely diagnosis based on the symptoms described. This syndrome is characterized by the presence of polyuria, exophthalmos, radiolucent bone defects in the skull, and enlarged liver and spleen. Biopsy findings of lipid-laden histiocytes further support this diagnosis. Eosinophilic granuloma is a type of Langerhans cell histiocytosis, but it typically presents with solitary bone lesions and does not involve other organs. Tay-Sachs disease is a genetic disorder that affects the nervous system, not the bones or other organs. Gaucher disease is a lysosomal storage disorder that can cause hepatosplenomegaly, but it does not typically involve the bones.

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