Acute leukemias — MCQs

A 15-year-old male presents to the emergency department with fever, malaise, and shortness of breath for 1 week. Further history reveals that the patient experiences swelling in his face in the morning that disappears as the day progresses. Physical exam reveals hepatosplenomegaly. A complete blood count shows WBC 84,000 cells/mL. Most of this patient's leukocytes are likely to express which of the following cell surface markers?

A 5-year-old boy presents to his pediatrician with weakness. His father observed that his son seemed less energetic at daycare and kindergarten classes. He was becoming easily fatigued from mild play. His temperature is 98°F (37°C), blood pressure is 90/60 mmHg, pulse is 100/min, and respirations are 20/min. Physical exam reveals pale conjunctiva, poor skin turgor and capillary refill, and cervical and axillary lymphadenopathy with assorted bruises throughout his body. A complete blood count reveals the following: Leukocyte count: 3,000/mm^3 Segmented neutrophils: 30% Bands: 5% Eosinophils: 5% Basophils: 10% Lymphocytes: 40% Monocytes: 10% Hemoglobin: 7.1 g/dL Hematocrit: 22% Platelet count: 50,000/mm^3 The most specific diagnostic assessment would most likely show which of the following?

A 47-year-old woman comes to the physician because of easy bruising and fatigue. She appears pale. Her temperature is 38°C (100.4°F). Examination shows a palm-sized hematoma on her left leg. Abdominal examination shows an enlarged liver and spleen. Her hemoglobin concentration is 9.5 g/dL, leukocyte count is 12,300/mm3, platelet count is 55,000/mm3, and fibrinogen concentration is 120 mg/dL (N = 150–400). Cytogenetic analysis of leukocytes shows a reciprocal translocation of chromosomes 15 and 17. Which of the following is the most appropriate treatment for this patient at this time?

A 35-year-old male presents to his physician with the complaint of fatigue and weakness for six months. His physician orders a CBC which demonstrates anemia and thrombocytopenia. During the subsequent work up, a bone marrow biopsy is performed which ultimately leads to the diagnosis of acute promyelocytic leukemia. Which of the following translocations and fusion genes would be present in this patient?

A pathologist receives a patient sample for analysis. Cells in the sample are first labeled with fluorescent antibodies and then passed across a laser beam in a single file of particles. The light scatter and fluorescent intensity of the particles are plotted on a graph; this information is used to characterize the sample. This laboratory method would be most useful to establish the diagnosis of a patient with which of the following?

A 70-year-old retired police officer is being evaluated for fatigue. A peripheral smear shows extremely elevated numbers of immature myeloid cells, which are positive for myeloperoxidase and a translocation t(15,17). Which of the following statements is true regarding his condition?

A 59-year-old man presents to his primary care physician for fatigue. In general, he has been in good health; however, he recently has experienced some weight loss, abdominal pain, and general fatigue. He has a past medical history of anxiety, diabetes, a fracture of his foot sustained when he tripped, and a recent cold that caused him to miss work for a week. His current medications include metformin, insulin, buspirone, vitamin D, calcium, and sodium docusate. His temperature is 99.5°F (37.5°C), blood pressure is 150/100 mmHg, pulse is 90/min, respirations are 18/min, and oxygen saturation is 98% on room air. Physical exam reveals a calm gentleman. A mild systolic murmur is heard in the left upper sternal region. The rest of the physical exam is within normal limits. Laboratory values are ordered as seen below. Hemoglobin: 12 g/dL Hematocrit: 36% Leukocyte count: 66,500/mm^3 with normal differential Platelet count: 177,000/mm^3 Leukocyte alkaline phosphatase: elevated Serum: Na+: 139 mEq/L Cl-: 100 mEq/L K+: 4.3 mEq/L BUN: 20 mg/dL Glucose: 120 mg/dL Creatinine: 1.1 mg/dL Ca2+: 10.9 mEq/L AST: 12 U/L ALT: 10 U/L Which of the following is the most likely diagnosis?

A 3-year-old boy is brought to the physician by his mother because of a 2-week history of generalized fatigue, intermittent fever, and occasional bleeding from his nose. His temperature is 38.3°C (100.9°F). He appears pale. Physical examination shows cervical lymphadenopathy and multiple petechiae on his trunk. The spleen is palpated 3 cm below the left costal margin. His hemoglobin concentration is 9.3 g/dL, leukocyte count is 63,000/mm3, and platelet count is 30,000/mm3. A bone marrow aspirate predominantly shows immature leukocytes that stain positive for CD10, CD19, and terminal deoxynucleotidyl transferase (TdT), and negative for myeloperoxidase. Which of the following is the most likely diagnosis?

A 7-year-old boy presents to his primary care physician for a general checkup. The patient has been feeling poorly for the past several weeks and has been losing weight. He states that he often feels weak and too tired to play with his friends. He is no longer interested in many recreational activities he used to be interested in. The patient's parents state that a few of their child's friends have been sick lately. His temperature is 102°F (38.9°C), blood pressure is 77/48 mmHg, pulse is 110/min, respirations are 24/min, and oxygen saturation is 98% on room air. On exam, you note a fatigued appearing child who has lost 10 pounds since his last appointment. Left upper quadrant tenderness and a mass is noted on abdominal exam. Which of the following best describes the most likely diagnosis?

A 6-year-old boy is brought to the emergency department with a mild fever for the past week. He has also had generalized weakness and fatigue for the past month. He has been complaining of diffuse pain in his legs and arms. He has a history of Down syndrome with surgical repair of a congenital atrial septal defect as an infant. His temperature is 38.0° C (100.4° F), pulse is 85/min, respirations are 16/min, and blood pressure is 90/60 mm Hg. He has enlarged cervical lymph nodes bilaterally that are nontender to palpation. He is uncooperative for the rest of the examination. Laboratory studies show: Hemoglobin 10.2 g/dL Hematocrit 30.0% Leukocyte count 50,000/mm3 Platelet count 20,000/mm3 Serum Sodium 136 mEq/L Potassium 4.7 mEq/L Chloride 102 mEq/L Bicarbonate 25 mEq/L Urea nitrogen 18 mg/dL Creatinine 1.1 mg/dL Total bilirubin 0.9 mg/dL AST 30 U/L ALT 46 U/L Which of the following is most likely to confirm the diagnosis?