Inflammatory markers in laboratory testing US Medical PG Practice Questions and MCQs
Practice US Medical PG questions for Inflammatory markers in laboratory testing. These multiple choice questions (MCQs) cover important concepts and help you prepare for your exams.
Inflammatory markers in laboratory testing US Medical PG Question 1: Myeloperoxidase (MPO) is a heme-containing molecule that is found in the azurophilic granules of neutrophils. Upon release, the enzyme catalyzes hypochlorous acid production during the phagocytic response. In the setting of pneumonia, which of the following clinical findings is most directly associated with myeloperoxidase activity?
- A. Shortness of breath
- B. Green color of sputum (Correct Answer)
- C. Rust-tinged sputum
- D. Cough
- E. Fever
Inflammatory markers in laboratory testing Explanation: ***Green color of sputum***
- Myeloperoxidase contributes to the **greenish color of sputum** due to its heme content and enzymatic activity, which involves the formation of a green pigment during the oxidation of chloride ions.
- In pneumonia, activated neutrophils release myeloperoxidase as part of the immune response, leading to the characteristic **greenish discoloration** often observed in a patient's sputum.
*Shortness of breath*
- Shortness of breath, or **dyspnea**, is a common symptom of pneumonia reflecting impaired gas exchange and increased work of breathing.
- It is a **physiological response** to lung inflammation and consolidation, not a direct end result of myeloperoxidase activity.
*Rust-tinged sputum*
- **Rust-tinged sputum** is classically associated with **Streptococcus pneumoniae** pneumonia and is due to the breakdown of red blood cells and the presence of hemoglobin metabolites.
- While it indicates an infection, it is not directly linked to the enzymatic action or color of myeloperoxidase itself.
*Cough*
- **Cough** is a vital **protective reflex** in pneumonia, aiming to clear respiratory secretions and foreign material from the airways.
- It is a symptom of airway irritation and inflammation, rather than a direct visual outcome of biochemical reactions involving myeloperoxidase.
*Fever*
- **Fever** is a systemic manifestation of the body's generalized **inflammatory response** to infection, mediated by pyrogens.
- It is a non-specific symptom indicating an active infection, not a direct consequence of myeloperoxidase activity or its visual manifestation.
Inflammatory markers in laboratory testing US Medical PG Question 2: A 27-year-old male presents to his primary care physician complaining of pain with urination and eye redness. He reports that he developed these symptoms approximately one week ago. He also has noticed left knee and right heel pain that started a few days ago. He denies any recent trauma. He had an episode of abdominal pain and diarrhea ten days ago that resolved. He has otherwise felt well. On exam, he walks with a limp and his conjunctivae are erythematous. Laboratory findings are notable for an elevated erythrocyte sedimentation rate (ESR) and elevated C-reactive protein (CRP). Which of the following is most likely associated with this patient’s condition?
- A. Anti-centromere antibody
- B. HLA-B27 haplotype (Correct Answer)
- C. Anti-cyclic citrullinated peptide (anti-CCP) antibody
- D. HLA-DR4 haplotype
- E. Rheumatoid factor
Inflammatory markers in laboratory testing Explanation: ***HLA-B27 haplotype***
- The patient presents with symptoms of **urethritis** (pain with urination), **conjunctivitis** (eye redness), and **arthritis** (knee and heel pain), which is the classic triad of **Reactive Arthritis**
- **Reactive arthritis** is strongly associated with the presence of the **HLA-B27 haplotype**, especially following gastrointestinal or genitourinary infections.
*Anti-centromere antibody*
- This antibody is associated with **limited cutaneous systemic sclerosis** (CREST syndrome) characterized by calcinosis, Raynaud's phenomenon, esophageal dysmotility, sclerodactyly, and telangiectasias.
- The patient's symptoms do not align with systemic sclerosis.
*Anti-cyclic citrullinated peptide (anti-CCP) antibody*
- **Anti-CCP antibodies** are highly specific for **rheumatoid arthritis**, which primarily affects the small joints of the hands and feet symmetrically and does not typically present with conjunctivitis or urethritis.
- The patient's presentation with an acute, asymmetric arthritis following an infection is not consistent with rheumatoid arthritis.
*HLA-DR4 haplotype*
- The **HLA-DR4 haplotype** is primarily associated with **rheumatoid arthritis**, a chronic inflammatory autoimmune disease that differs significantly in presentation from the patient's acute symptoms.
- This patient's symptoms are more indicative of a seronegative spondyloarthropathy, not rheumatoid arthritis.
*Rheumatoid factor*
- **Rheumatoid factor (RF)** is an autoantibody found in many patients with **rheumatoid arthritis**, but it is also present in other conditions and can be negative in some RA cases.
- While it indicates systemic inflammation, it is not specific to the patient's constellation of symptoms, which point more directly to a reactive process.
Inflammatory markers in laboratory testing US Medical PG Question 3: A medical examiner was called to investigate the death of a 75-year-old type 1 diabetic Caucasian male who was a retired physician. His caretaker discovered his body in the bedroom with an empty syringe and a small bottle of lispro lying on the nightstand. She explains that his wife of 50 years passed away six months ago and that he had no children or family. He had become extremely depressed and did not want to live anymore. Which of the following would be most consistent with his blood chemistry if a blood sample were taken?
- A. Glucose: 95 mg/dL, high insulin and C-peptide levels
- B. Glucose: 25 mg/dL, high insulin and absent C-peptide levels (Correct Answer)
- C. Glucose: 95 mg/dL, low insulin and low C-peptide levels
- D. Glucose: 25 mg/dL, high insulin and high C-peptide levels
- E. Glucose: 25 mg/dL, high insulin and normal C-peptide levels
Inflammatory markers in laboratory testing Explanation: **Glucose: 25 mg/dL, high insulin and absent C-peptide levels**
- The presence of an empty syringe and a bottle of **lispro**, a **rapid-acting insulin**, indicates a likely insulin overdose. This would lead to profound **hypoglycemia** (glucose: 25 mg/dL) and **high insulin levels**.
- As the patient has **Type 1 diabetes**, his pancreas does not produce insulin, resulting in **absent C-peptide levels**. Administered exogenous insulin (lispro) does not contain C-peptide, so C-peptide levels would remain absent even with high exogenous insulin.
*Glucose: 95 mg/dL, high insulin and C-peptide levels*
- A glucose level of 95 mg/dL is within the normal range and inconsistent with a fatal insulin overdose scenario, which typically causes severe **hypoglycemia**.
- High insulin with high C-peptide levels would typically suggest conditions like an **insulinoma** or an overdose of a sulfonylurea, which stimulates endogenous insulin production, not an overdose of exogenous insulin in a Type 1 diabetic.
*Glucose: 95 mg/dL, low insulin and low C-peptide levels*
- Glucose at 95 mg/dL is normal to low-normal, which would not typically be seen in a fatal insulin overdose.
- Low insulin and low C-peptide levels are characteristic of controlled or untreated **Type 1 diabetes** or other forms of insulin deficiency, not an acute insulin overdose.
*Glucose: 25 mg/dL, high insulin and high C-peptide levels*
- While a glucose level of 25 mg/dL and high insulin are consistent with an insulin overdose, **high C-peptide levels** in a Type 1 diabetic are contradictory. Type 1 diabetics produce little to no C-peptide.
- High C-peptide levels would suggest endogenous insulin production, which is absent in Type 1 diabetes and not introduced by exogenous lispro.
*Glucose: 25 mg/dL, high insulin and normal C-peptide levels*
- Although **hypoglycemia** and **high insulin** are consistent with an overdose, "normal" C-peptide levels are unlikely in a Type 1 diabetic who has received exogenous insulin.
- In Type 1 diabetes, C-peptide is typically very low or undetectable, reflecting minimal to no endogenous insulin production.
Inflammatory markers in laboratory testing US Medical PG Question 4: A 70-year-old woman is evaluated for muscle pain and neck stiffness that has been progressing for the past 3 weeks. She reports that the neck stiffness is worse in the morning and gradually improves throughout the day. She feels fatigued, although there have not been any changes in her daily routine. Her past medical history includes coronary artery disease for which she takes a daily aspirin. Both of her parents died in their 80s from cardiovascular disease. Her blood pressure is 140/90 mm Hg, heart rate is 88/min, respiratory rate is 15/min, and temperature is 37.9°C (100.2°F). On further examination, the patient has difficulty standing up from a seated position, although muscle strength is intact. What is the best next step in management?
- A. Electromyography
- B. Erythrocyte sedimentation rate (Correct Answer)
- C. Muscle biopsy
- D. Antinuclear antibody
- E. Lumbar puncture
Inflammatory markers in laboratory testing Explanation: ***Erythrocyte sedimentation rate***
- The patient's symptoms of **muscle pain**, **neck stiffness**, **morning stiffness** that improves with activity, **fatigue**, elevated body temperature, and difficulty standing from a seated position are highly suggestive of **polymyalgia rheumatica**.
- **Polymyalgia rheumatica** is an inflammatory condition characterized by elevated inflammatory markers like **erythrocyte sedimentation rate (ESR)** and **C-reactive protein (CRP)**. Assessing ESR is crucial for diagnosis and monitoring.
*Electromyography*
- **Electromyography (EMG)** measures muscle electrical activity and is primarily used to diagnose **neuropathic** or **myopathic** disorders, which are less likely given the clinical picture of polymyalgia rheumatica.
- While it could show subtle changes in inflammatory myopathies, it is not the initial diagnostic test for this presentation.
*Muscle biopsy*
- A **muscle biopsy** is used to diagnose specific muscle diseases like polymyositis or dermatomyositis, where there is direct muscle weakness and inflammation.
- In polymyalgia rheumatica, muscle strength is typically intact, and muscle biopsy findings are usually normal or non-specific.
*Antinuclear antibody*
- **Antinuclear antibody (ANA)** testing is used to screen for **autoimmune connective tissue diseases** like systemic lupus erythematosus, scleroderma, or Sjögren's syndrome.
- While other autoimmune conditions can cause muscle pain, the constellation of symptoms (especially morning stiffness improving with activity and age of onset) points more specifically to polymyalgia rheumatica, where ANA is typically negative.
*Lumbar puncture*
- A **lumbar puncture** (spinal tap) is performed to analyze **cerebrospinal fluid (CSF)** and is used to diagnose conditions affecting the central nervous system, such as meningitis, encephalitis, or multiple sclerosis.
- This procedure is not indicated for the evaluation of muscle pain and stiffness described by the patient.
Inflammatory markers in laboratory testing US Medical PG Question 5: You conduct a medical research study to determine the screening efficacy of a novel serum marker for colon cancer. The study is divided into 2 subsets. In the first, there are 500 patients with colon cancer, of which 450 are found positive for the novel serum marker. In the second arm, there are 500 patients who do not have colon cancer, and only 10 are found positive for the novel serum marker. What is the overall sensitivity of this novel test?
- A. 450 / (450 + 10)
- B. 490 / (10 + 490)
- C. 490 / (50 + 490)
- D. 450 / (450 + 50) (Correct Answer)
- E. 490 / (450 + 490)
Inflammatory markers in laboratory testing Explanation: ***450 / (450 + 50)***
- **Sensitivity** is defined as the proportion of actual positive cases that are correctly identified by the test.
- In this study, there are **500 patients with colon cancer** (actual positives), and **450 of them tested positive** for the marker, while **50 tested negative** (500 - 450 = 50). Therefore, sensitivity = 450 / (450 + 50) = 450/500 = 0.9 or 90%.
*450 / (450 + 10)*
- This formula represents **Positive Predictive Value (PPV)**, which is the probability that a person with a positive test result actually has the disease.
- It incorrectly uses the total number of **test positives** in the denominator (450 true positives + 10 false positives) instead of the total number of diseased individuals, which is needed for sensitivity.
*490 / (10 + 490)*
- This is actually the correct formula for **specificity**, not sensitivity.
- Specificity = TN / (FP + TN) = 490 / (10 + 490) = 490/500 = 0.98 or 98%, which measures the proportion of actual negative cases correctly identified.
- The question asks for sensitivity, not specificity.
*490 / (50 + 490)*
- This formula incorrectly mixes **true negatives (490)** with **false negatives (50)** in an attempt to calculate specificity.
- The correct specificity formula should use false positives (10), not false negatives (50), in the denominator: 490 / (10 + 490).
*490 / (450 + 490)*
- This calculation incorrectly combines **true negatives (490)** and **true positives (450)** in the denominator, which does not correspond to any standard epidemiological measure.
- Neither sensitivity nor specificity uses both true positives and true negatives in the denominator.
Inflammatory markers in laboratory testing US Medical PG Question 6: A father brings his 3-year-old son to the pediatrician because he is concerned about his health. He states that throughout his son's life he has had recurrent infections despite proper treatment and hygiene. Upon reviewing the patient's chart, the pediatrician notices that the child has been infected multiple times with S. aureus, Aspergillus, and E. coli. Which of the following would confirm the most likely cause of this patient's symptoms?
- A. Increased IgM, Decreased IgG, IgA, and IgE
- B. Negative nitroblue-tetrazolium test (Correct Answer)
- C. Positive nitroblue-tetrazolium test
- D. Normal dihydrorhodamine (DHR) flow cytometry test
- E. Increased IgE and IgA, Decreased IgM
Inflammatory markers in laboratory testing Explanation: ***Negative nitroblue-tetrazolium test***
- A **negative nitroblue-tetrazolium (NBT) test** indicates an inability of phagocytes to produce a respiratory burst, which is characteristic of **Chronic Granulomatous Disease (CGD)**.
- CGD patients suffer from recurrent infections with catalase-positive organisms such as *Staphylococcus aureus*, *Aspergillus*, and *E. coli*, consistent with the patient's history.
*Increased IgM, Decreased IgG, IgA, and IgE*
- This pattern of immunoglobulin levels is characteristic of **X-linked hyper-IgM syndrome**, where there is a defect in CD40L on T cells.
- While it also causes recurrent infections, the typical pathogens differ from those stated in the question, often including *Pneumocystis jirovecii*.
*Positive nitroblue-tetrazolium test*
- A **positive NBT test** indicates that phagocytes are capable of producing a respiratory burst and forming superoxide, thus ruling out CGD.
- This result would be expected in a healthy individual or someone with an immunodeficiency not affecting the phagocytic oxidative burst.
*Normal dihydrorhodamine (DHR) flow cytometry test*
- A **normal DHR flow cytometry test** indicates that neutrophils can produce reactive oxygen species (ROS) effectively, meaning the respiratory burst is intact.
- This result would rule out CGD, as CGD patients have an abnormal (decreased) DHR test.
*Increased IgE and IgA, Decreased IgM*
- This specific pattern of immunoglobulin abnormalities is not typically associated with a single, well-defined primary immunodeficiency that would present with the described infections.
- **Hyper-IgE syndrome (Job's syndrome)**, for example, features very high IgE levels but usually a normal IgM.
Inflammatory markers in laboratory testing US Medical PG Question 7: A 29-year-old woman comes to the clinic for complaints of fatigue and palpitations for the past 3 days. She reports that even standing up and walking around takes “a lot of energy.” She was forced to call in sick today to her work as a kindergarten teacher. She denies any previous episodes but does endorse symmetric joint pain of her hands, wrists, knees, and ankles that was worse in the morning over the past week that self-resolved. She also reports a runny nose and congestion. Past medical history is unremarkable. Physical examination demonstrates splenomegaly, pallor, and generalized weakness; there is no lymphadenopathy. What is the most likely explanation for this patient’s symptoms?
- A. Rheumatoid arthritis
- B. Substitution of glutamic acid with valine at the beta chain
- C. Anemia of chronic disease
- D. Mutation of ankyrin
- E. Infection with Epstein-Barr virus (Correct Answer)
Inflammatory markers in laboratory testing Explanation: **Infection with Ebstein-Barr virus**
- The patient's symptoms of **fatigue**, **palpitations**, **splenomegaly**, and recent **runny nose/congestion** are highly suggestive of **infectious mononucleosis**, which is caused by the Epstein-Barr virus (EBV).
- The transient, symmetric polyarthralgia followed by resolution is consistent with a viral prodrome, and the pallor and generalized weakness point towards **anemia**, a common complication of infectious mononucleosis.
*Rheumatoid arthritis*
- While **symmetric joint pain** is characteristic of rheumatoid arthritis, the rapid onset, transient nature, and association with a viral-like prodrome and splenomegaly make this diagnosis less likely.
- Rheumatoid arthritis typically causes chronic, progressive joint inflammation and destruction, not self-resolving symptoms followed by systemic signs like splenomegaly.
*Substitution of glutamic acid with valine at the beta chain*
- This describes the genetic mutation responsible for **sickle cell anemia**. The patient's symptoms are acute and associated with a viral illness, not chronic hemolytic anemia or sickle cell crisis.
- There is no mention of a history of anemia or family history to suggest a genetic hemoglobinopathy.
*Anemia of chronic disease*
- Anemia of chronic disease typically presents with more insidious onset and is associated with chronic inflammatory conditions, infections, or malignancies.
- While fatigue and pallor are present, the acute presentation, viral prodrome, and splenomegaly point towards a more acute infectious process rather than a chronic disease.
*Mutation of ankyrin*
- A mutation in ankyrin or spectrin is associated with **hereditary spherocytosis**, a genetic hemolytic anemia.
- This condition usually presents with chronic or episodic hemolysis, jaundice, and often a family history of anemia, which are not described in this patient's acute presentation.
Inflammatory markers in laboratory testing US Medical PG Question 8: A 36-year-old woman presents with thyroid swelling. She has been healthy until now and follows all the healthcare precautions except for missing a flu shot this year. On physical examination, the thyroid gland is diffusely enlarged and tender to palpation. Laboratory findings show a decreased serum TSH level and elevated erythrocyte sedimentation rate. Which of the following histopathologic findings would most likely be found in the thyroid gland of this patient?
- A. Extensive fibrosis of the stroma
- B. Mixed cellular infiltration with multinuclear giant cells (Correct Answer)
- C. Lymphocytic infiltration with germinal centers
- D. Orphan Annie nuclei with psammoma bodies
- E. Sheets of polygonal cells in amyloid stroma
Inflammatory markers in laboratory testing Explanation: ***Mixed cellular infiltration with multinuclear giant cells***
- The patient's symptoms of a **diffusely enlarged and tender thyroid**, suppressed **TSH**, elevated **ESR**, and a recent viral illness (missing flu shot) are classic for **subacute granulomatous (De Quervain's) thyroiditis**.
- Histopathologically, this condition is characterized by a **disruptive inflammatory infiltrate** with **multinucleated giant cells** engulfing colloid, surrounded by granulomatous inflammation.
*Extensive fibrosis of the stroma*
- This finding is characteristic of **Riedel's thyroiditis**, a rare form of chronic thyroiditis.
- Riedel's thyroiditis typically presents as a **hard, fixed, and painless goiter**, often leading to compressive symptoms, which does not match this patient's tender goiter.
*Lymphocytic infiltration with germinal centers*
- This pattern is typical of **Hashimoto's thyroiditis**, an **autoimmune thyroid disease**.
- Hashimoto's usually presents with a **painless goiter** and often leads to **hypothyroidism**, not the tender, hyperthyroid-like state seen here.
*Orphan Annie nuclei with psammoma bodies*
- These are hallmark features associated with **papillary thyroid carcinoma**.
- This patient's acute presentation with **tenderness, inflammation**, and temporary hyperthyroidism is inconsistent with a malignant thyroid neoplasm.
*Sheets of polygonal cells in amyloid stroma*
- This describes the histopathology of **medullary thyroid carcinoma**.
- Medullary thyroid carcinoma arises from parafollicular C-cells and is characterized by the production of **calcitonin** and often has a genetic predisposition, which is not suggested by the patient's presentation.
Inflammatory markers in laboratory testing US Medical PG Question 9: An otherwise healthy 42-year-old man undergoes routine investigations prior to blood donation. His complete blood count is shown:
Hemoglobin 9.3 g/dL
Mean corpuscular volume (MCV) 71 μm3
Mean corpuscular hemoglobin (MCH) 21 pg/cell
White blood cell count 8,200/mm3
Platelet count 317,000/mm3
Iron studies are shown:
Serum iron 210 μg/dL
Serum ferritin 310 ng/mL
Total iron binding capacity (TIBC) 290 μg/dL
Transferrin saturation 78%
He occasionally drinks alcohol and denies smoking or use of illicit drugs. There is a family history of anemia including his brother and maternal uncle. Examination shows conjunctival pallor, but is otherwise unremarkable. Which of the following is the most likely diagnosis?
- A. Hemochromatosis
- B. Anemia of chronic disease
- C. Acute myeloid leukemia
- D. Sideroblastic anemia (Correct Answer)
- E. Myelodysplastic syndrome
Inflammatory markers in laboratory testing Explanation: ***Sideroblastic anemia***
- The patient presents with **microcytic anemia** (Hb 9.3 g/dL, MCV 71, MCH 21) and evidence of **iron overload** (serum iron 210, ferritin 310, transferrin saturation 78%). These findings, along with a **family history of anemia affecting males** (brother and maternal uncle), are classic for **hereditary sideroblastic anemia**, typically X-linked.
- **Sideroblastic anemia** is characterized by the bone marrow producing ring sideroblasts (erythroblasts with iron-laden mitochondria), leading to ineffective erythropoiesis and iron accumulation.
- The hereditary form presents in younger patients with isolated anemia and strong family history, distinguishing it from acquired forms.
*Hemochromatosis*
- While **hemochromatosis** also presents with iron overload (high serum iron, ferritin, and transferrin saturation), it typically does **not cause microcytic anemia** or any significant anemia.
- The primary defect in hemochromatosis is increased iron absorption leading to tissue iron deposition (liver, heart, pancreas), without the erythropoietic dysfunction seen in sideroblastic anemia.
*Anemia of chronic disease*
- **Anemia of chronic disease (ACD)** typically presents with normal or slightly reduced MCV and MCH, and is characterized by **low serum iron** and **low TIBC**, with normal or elevated ferritin.
- In this case, the patient has **elevated serum iron** and **high transferrin saturation (78%)**, making ACD unlikely.
*Acute myeloid leukemia*
- **Acute myeloid leukemia (AML)** involves the proliferation of immature myeloid cells and usually presents with pancytopenia or symptoms related to bone marrow failure (e.g., fatigue, bleeding, infections).
- The blood counts here show **isolated anemia with normal WBC and platelet counts**, and the iron studies are not typical for AML.
*Myelodysplastic syndrome*
- **Myelodysplastic syndromes (MDS)** are clonal disorders of hematopoietic stem cells, often presenting with cytopenias and dysplastic features in the bone marrow.
- While **acquired sideroblastic anemia** is a subtype of MDS (refractory anemia with ring sideroblasts), it typically occurs in **older adults (>60 years)** without a family history.
- This patient's **young age (42 years)** and **strong family history** (brother and maternal uncle) point to **hereditary sideroblastic anemia** rather than MDS-associated acquired sideroblastic anemia.
Inflammatory markers in laboratory testing US Medical PG Question 10: A 55-year-old man comes to the physician for a routine health visit. He feels well except for occasional left-sided abdominal discomfort and left shoulder pain. He has smoked 1 pack of cigarettes daily for 20 years. He does not drink alcohol. His pulse is 85/min and his blood pressure is 130/70 mmHg. Examination shows a soft, nontender abdomen. The spleen is palpated 5 cm below the costal margin. There is no lymphadenopathy present. The remainder of the examination shows no abnormalities. Laboratory studies show:
Hemoglobin 12.2 g/dL
Hematocrit 36 %
Leukocyte count 34,000/mm3
Platelet count 450,000/mm3
Cytogenetic testing of his blood cells is pending. Further evaluation of this patient is most likely to show which of the following findings?
- A. Autoimmune hemolytic anemia
- B. Elevated serum β2 microglobulin
- C. Elevated serum calcium
- D. Decreased basophil count
- E. Low leukocyte alkaline phosphatase score (Correct Answer)
Inflammatory markers in laboratory testing Explanation: ***Low leukocyte alkaline phosphatase score***
- The patient's presentation with **splenomegaly**, **leukocytosis** (34,000/mm³), and a normal hemoglobin/platelet count, strongly suggests a **myeloproliferative neoplasm**, specifically **chronic myeloid leukemia (CML)**.
- A **low leukocyte alkaline phosphatase (LAP) score** is a classic diagnostic feature of CML, as the neutrophils in CML have decreased LAP activity.
*Autoimmune hemolytic anemia*
- This condition is characterized by **anemia** and signs of **hemolysis**, such as elevated reticulocytes and lactate dehydrogenase, which are not described.
- While anemia is present, the primary issue indicated by the high leukocyte count and splenomegaly is a myeloproliferative disorder, not solely autoimmune hemolysis.
*Elevated serum β2 microglobulin*
- Elevated **β2 microglobulin** is a marker of **lymphocytic proliferation** and is commonly seen in conditions like **multiple myeloma** or **lymphoma**.
- The patient's dominant features of **marked leukocytosis** and **splenomegaly** are more consistent with a myeloid disorder than a lymphoid one.
*Elevated serum calcium*
- **Hypercalcemia** is a common complication of **multiple myeloma** or certain **carcinomas** due to bone destruction or paraneoplastic syndromes.
- The patient's symptoms and lab findings (especially high leukocyte count and splenomegaly) do not point to these conditions.
*Decreased basophil count*
- In conditions like **CML**, an **elevated basophil count** is often observed, which contradicts the option of a decreased basophil count.
- Other myeloproliferative neoplasms can also have varying basophil counts, but a decrease is not a hallmark.
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