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A 35 year old woman presents with increasing fatigue, lethargy, and muscle weakness. Her CBC reveals decreased numbers of erythrocytes, leukocytes, and.

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Presentation on theme: "A 35 year old woman presents with increasing fatigue, lethargy, and muscle weakness. Her CBC reveals decreased numbers of erythrocytes, leukocytes, and."— Presentation transcript:

1 A 35 year old woman presents with increasing fatigue, lethargy, and muscle weakness. Her CBC reveals decreased numbers of erythrocytes, leukocytes, and platelets. The peripheral blood smear is shown. What is the most likely diagnosis? Iron deficiency Anemia Hereditary spherocytosis Megaloblastic anemia Thalassemia minor Sideroblastic anemia

2 An anemic patient is found to have hypochromic, microcytic red cells. Additional tests reveal the serum iron levels, the total iron- binding capacity, and the transferrin saturation to be reduced. A bone marrow biopsy reveals the iron to be present mainly within macrophages. Which of the following is the most likely diagnosis? Iron deficiency Thalassemia trait Anemia of chronic disease Sideroblastic anemia Pernicious anemia

3 A 3 year old boy is being evaluated for sudden onset of bleeding episodes. The total WBC count is 68,000, 77% of which are homogeneous cells with nuclei having immature chromatin. Further testing of the immature cells show: T dT: positive PAS: positive Acid phosphatase: positive Myeloperoxidase: negative Based on these findings, which of the following is the cell of origin of these immature cells? Myeloblasts Monoblasts Megakaryoblasts Lymphoblasts Erythroblasts

4 A 65 year old man with enlarged axillary lymph nodes. Biopsy reveals effacement of the normal lymph node architecture by a diffuse proliferation of small, normal-appearing lymphocytes. These same cells are present in the peripheral blood. A bone marrow biopsy reveals a diffuse proliferation of these small lymphocytes. Special stains reveal these cells to be positive for CD5 and CD23. Which of the following is the best classification for this lymphoma? Burkitt lymphoma Follicular non-Hodgkin lymphoma Nodular sclerosis Hodgkin lymphoma Mixed cellularity Hodgkin lymphoma Small-lymphocytic non-Hodgkin lymphoma

5 A 23-year-old female presented with painless swelling on the right side of the neck: she also complained of dyspnea following moderate exercise in the few weeks prior to her visit. Her past and recent medical histories were fine and no other remarkable co-morbidities were reported. She had a 3-year-old daughter and was employed in a grocery store. The patient did not report any systemic symptoms including night sweats, weight loss or fever. The physical examination confirmed the presence of bilateral fixed lymph nodes of hard consistency in the latero-cervical and supraclavicular area with an estimated size of 1.5 cm and without the evidence of any other superficial lymphadenopathy or organomegaly.

6 Her biopsy findings are provided. Which of the following is most characteristic of this disorder ? (A)Benign neoplasm (B) Frequent association with EBV (C) Mostly a complication of HIV (D) Peak incidence in early childhood (E) Relatively favorable clinical course

7 An 18 year old African American man is brought to the emergency department with pain in the back and legs. His past medical history is indicative of similar episodes in the past that required hospitalization. On physical examination his sclera is yellow. His hemoglobin is 5.2 g/dL. Which of the following is most likely to happen to the spleen? Enlarged with congestion Enlarged with malignant cell infiltration Enlarged with white pulp hyperplasia Normal Atrophic

8 A 4 year old girl develops jaundice and pallor. Laboratory studies show anemia, reticulocytosis and increase indirect bilirubin. The peripheral blood smear is shown. Which additional finding is most likely to be present in this case? Decreased LDH Increased Haptoglobin Increased MCHC Increased MCV RBC inclusions

9 33 year old man with fever for 2 weeks Hb 12.2 g/dL, Hct 37.1%, MCV 92 fL, Platelet count 243,000/uL WBC count 25,000/uL WBC differential - 82 segmented neutrophils, 8 band forms, 3 metamyelocytes, 1 myelocyte, 4 lymphocytes, and 1 monocyte LAP score: 170 Which of the following additional laboratory test findings is most likely to be present in this man? Bone marrow karyotype of 46, XY, t(9;22) Serologic titer of 1:1024 for anti-double stranded DNA Serum vitamin B 12 level of 100 pg/mL (normal 200 -900pg/mL) 4+ ketonuria and 4+ proteinuria Blood culture positive for Streptococcus

10 80 year old woman with increasing fatigue for the past year Laboratory studies Hb : 9.1 gm/dL, Hct 27.9%, MCV 96 fL, WBC count 7000/microL, platelet count 125,000/microL WBC differential - 53 segmented neutrophils, 5 band forms, 2 metamyelocytes, 1 myelocyte, 32 lymphs, 7 monos, and 5 nucleated RBCs/100 WBCs Negative direct and indirect Coombs test Which of the following diseases is most likely? Metastatic carcinoma Chronic alcoholism Malabsorption Hemoglobinopathy Chronic blood loss


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