A 7-year-old boy presents to the ER with progressive dysphagia over the course of 3 months and a new onset fever for the past 24 hours. The temperature in the ER was 39.5°C (103.1°F). There are white exudates present on enlarged tonsils (Grade 2). Routine blood work reveals a WBC count of 89,000/mm3, with the automatic differential yielding a high (> 90%) percentage of lymphocytes. A peripheral blood smear is ordered, demonstrating the findings in the accompanying image. The peripheral smear is submitted to pathology for review. After initial assessment, the following results are found on cytologic assessment of the cells: TdT: positive CALLA (CD 10): positive Which of the following cell markers are most likely to be positive as well?
ACD 2
BCD 19
CCD 7
DCD 8
ECD 5
A 66-year-old man comes to the physician for a 3-month history of fatigue. He has hypertension and hyperlipidemia. He had a transient ischemic attack 3 years ago. He drinks 3 beers a day, and sometimes a couple more on social occasions. He currently takes aspirin, simvastatin, hydrochlorothiazide, and metoprolol. His temperature is 37.1°C (98.8°F), pulse is 78, respirations are 19/min, and oxygen saturation on room air is 97%. He is in no distress but shows marked pallor and has multiple pinpoint, red, nonblanching spots on his extremities. On palpation, his spleen is significantly enlarged. Laboratory studies show a hemoglobin of 8.0 g/dL, a leukocyte count of 80,000/mm3, and a platelet count of 34,000/mm3. A blood smear shows immature cells with large, prominent nucleoli and pink, elongated, needle-shaped cytoplasmic inclusions. Which of the following is the most likely diagnosis?
ACirrhosis
BAcute lymphoblastic leukemia
CChronic lymphocytic leukemia
DMyelodysplastic syndrome
EAcute myelogenous leukemia
A 64-year-old woman comes to the physician for her routine health maintenance examination. She feels well. She had cervical cancer and received radiotherapy 8 years ago. Her vital signs are within normal limits. On percussion, the spleen size is 15 cm. Otherwise, the physical examination shows no abnormalities. The laboratory test results are as follows: Hemoglobin 10 g/dL Mean corpuscular volume 88 μm3 Leukocyte count 65,000/mm3 Platelet count 500,000/mm3 Two images of the peripheral blood smear are shown on the image. Which of the following is the most appropriate next step in management?
APhlebotomy
BRituximab
CWatchful waiting
DAllogeneic stem cell transplantation
EDasatinib
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