Hematopathology — Past Paper OmpathStudy

hematopathology — Questions and Answers Complete review bank: 45 questions recovered from all 31 source pages. 1. A 62-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 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 Answer: D. The findings suggest multiple myeloma. He has a markedly increased level of serum globulins. The renal failure from light chains deposited in the kidneys, and the increased risk for encapsulated bacterial infections is typical. The lytic bone lesions are collections of plasma cells. 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 CD15+ and CD30+ 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 Answer: B. Reed-Sternberg cells are multinucleated with large nucleoli. Variants of them called lacunar cells are also seen with some forms of Hodgkin lymphoma. Her 2 lymph node groups on one side of the diaphragm put this at stage II, but the prognosis is still good. 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. The spleen is palpable. 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. Congenital genetic abnormality B. From close contact on a date C. As a result of an insect bite D. Through an environmental exposure at work E. Without any known etiology Answer: B. Infectious mononucleosis with Epstein-Barr virus (EBV) infection is typically acquired with close personal contact. This self-limited viral infection resolves in weeks. 4. A 30-year-old woman has had mild fatigue for many years. Physical examination reveals a palpable spleen tip. Laboratory studies show Hgb 11.1 g/dL, Hct 28.8%, MCV 77 fL, platelet count 229,000/microliter, and WBC count 7340/microliter. Her reticulocyte count is 3.9%. Examination of her peripheral blood smear shows small RBCs that lack central pallor. Which of the following patterns of inheritance is most likely present with her disease? A. Autosomal dominant, European ancestry B. Autosomal recessive, Asian ancestry C. X-linked recessive, Middle Eastern ancestry D. Autosomal recessive, West African ancestry E. Sporadic occurrence Answer: A. Hereditary spherocytosis is the most common inherited hemolytic anemia in persons of northern European descent. It has a frequency in this population of 1 in 5000. An abnormality in the structural membrane proteins ankyrin or spectrin accounts for the abnormality. 5. A 3-year-old child is noted to have small pinpoint hemorrhages on the skin, appearing over the past 3 days. On examination the child's vital signs are normal. There are petechae over skin of extremities and trunk. A CBC shows Hgb 14.3 g/dL, Hct 43%, MCV 90 fL, platelet count 19,300/microliter, and WBC count 9370/microliter. This condition resolves over the next month without treatment. Which of the following is the most likely antecedent event for this child's illness? A. Acetylsalicylic acid (aspirin) ingestion B. Congenital HIV infection C. Dietary cobalamin deficiency D. Repetitive trauma E. Respiratory syncytial virus infection F. Sulfonamide ingestion Answer: E. This is acute immune thrombocytopenia in a child. It is usually self-limited. In most cases the predisposing event is a viral infection that sets off an immune response directed specifically at platelet production. 6. A 30-year-old man has had a sore throat with fever for 5 days. On physical examination he has mildly tender generalized cervical lymphadenopathy. Pharyngeal tonsils are enlarged and erythematous with overlying exudate. Laboratory findings include Hgb 13 g/dL, platelet count 277,000/microliter,