1. A 12-year-old boy has contracted a bacterial infection at school and his body has responded by increasing leukocyte production. Place the following components of white blood cell production in the correct chronological order. Use all the options.
C) Myeloid stem cell
2. Which of the following statements most accurately conveys an aspect of lymphatic system activity?
A) B and T lymphocyte development begins in the bone marrow and ends in the peripheral lymphoid structures.
B) B cells and macrophages are released from the bone marrow in their completed state.
C) Stem cells in the lymph nodes initiate and regulate the process of white cell synthesis.
D) Leukocytes bypass vascular circulation and are distributed instead by the lymphatic system.
3. A 44-year-old male hospital patient with a diagnosis of end-stage acquired immunodeficiency syndrome (AIDS) has been placed on neutropenic precautions that limit his interaction with visitors, staff, and other patients. What is the underlying rationale for these precautions?
A) His antibody-mediated immunity is compromised by his low production of neutrophils.
B) Neutropenia limits the ability of his CD4 helper cells to present antigens.
C) Insufficient levels of neutrophils make him particularly susceptible to bacterial and fungal infections.
D) Cyclic neutropenia limits his body’s ability to fight various infections.
4. A 16-year-old female has been brought to her primary care physician by her mother due to the girl’s persistent sore throat and malaise. Which of the following facts revealed in the girl’s history and examination would lead the physician to rule out infectious mononucleosis?
A) The girl has a temperature of 38.1°C (100.6°F) and has enlarged lymph nodes.
B) Her liver and spleen are both enlarged.
C) Blood work reveals an increased white blood cell count.
D) Chest auscultation reveals crackles in her lower lung fields bilaterally.
5. A 14-year-old boy has been diagnosed with infectious mononucleosis. Which of the following pathophysiological phenomena is most responsible for his symptoms?
A) The Epstein-Barr virus (EBV) is lysing many of the boy’s neutrophils.
B) Viruses are killing some of his B cells and becoming incorporated into the genomes of others.
C) The EBV inhibits the maturation of white cells within his peripheral lymph nodes.
D) The virus responsible for mononucleosis inhibits the maturation of myeloblasts into promyelocytes.
6. A 60-year-old woman is suspected of having non-Hodgkin lymphoma (NHL). Which of the following aspects of her condition would help to rule out Hodgkin lymphoma?
A) Her neoplasm originates in secondary lymphoid structures.
B) The lymph nodes involved are located in a large number of locations in the lymphatic system.
C) The presence of Reed-Sternberg cells has been confirmed.
D) The woman complains of recent debilitating fatigue.
7. A 40-year-old male patient is shocked to receive a diagnosis of mature B-cell lymphoma and is doing research on his diagnosis on the Internet. Which of the following statements that he reads on various Web sites is most reliable?
A) “Like most forms of Hodgkin lymphoma, mature B-cell lymphoma often requires radiation treatment.”
B) “Doctors are able to diagnose mature B-cell lymphoma by the presence of Reed-Sternberg cells.”
C) “Unlike many other lymphomas, mature B-cell lymphoma is often self-limiting and treatment is focused on symptoms.”
D) “The lymph nodes are usually affected, and often the spleen and bone marrow.”
8. Which of the following statements by a patient of a cancer center who has a new diagnosis of non-Hodgkin lymphoma (NHL) demonstrates a sound understanding of the diagnosis and treatment of the health problem?
A) “They confirmed my diagnosis with a lymph node biopsy and I’ll get radiation treatment soon because it’s in a fairly early stage.”
B) “They took a sample of my lymph nodes and I’ll be having surgery soon that will hopefully cure my lymphoma.”
C) “My blood work came back positive for NHL, and I’m meeting with my oncologist to discuss chemotherapy soon.”
D) “Since the tests show NHL, I’m going to pursue my options for palliative care because I’m committed to dying with dignity.”
9. Which of the following individuals would be most likely to possess normal plasma cell synthesis and fully differentiated myeloid and lymphoid cells?
A) A 7-year-old boy with a diagnosis of acute lymphocytic leukemia (ALL)
B) A 70-year-old male who has acute myelogeneous leukemia (AML)
C) A 58-year-old female with HIV and multiple myeloma
D) A 78-year-old male who has been diagnosed with chronic lymphocytic leukemia (CLL)
10. Which of the following assessment and laboratory findings would be most closely associated with acute leukemia?
A) High blast cell counts and fever
B) Decreased oxygen partial pressure and weight loss
C) Increased serum potassium and sodium levels
D) Increased blood urea nitrogen (BUN) and bone pain
11. A 70-year-old woman has received a diagnosis of chronic myelogenous leukemia (CML) after a clinical investigation sparked by the presence of leukocytosis in her routine blood work. What clinical course should her care provider tell her to expect?
A) “You can expect your blood results, fatigue, and susceptibility to infection to gradually worsen over a few years.”
B) “You could remain in the chronic stage of CML for several years before it accelerates and culminates in a crisis.”
C) “It’s likely that this will give you chronic fatigue and malaise for the rest of your life, but that will probably be the extent of your symptoms.”
D) “Unfortunately, your leukemia will likely enter a crisis mode within a few weeks if we don’t treat it immediately.”
12. In which of the following individuals would a clinician most suspect multiple myeloma as a diagnosis?
A) A 40-year-old man who has had three broken bones over the past 6 months and whose serum calcium and creatinine levels are elevated
B) A 68-year-old former coal miner who has white cell levels exponentially higher than normal ranges
C) An 81-year-old male resident of a long-term care home who has an uncommon bacterial pneumonia and is unable to produce a fever
D) A 70-year-old woman whose blood work reveals large numbers of immature granulocytes
13. A 30-year-old male’s blood work and biopsies indicate that he has proliferating osteoclasts that are producing large amounts of immunoglobulin G (IgG). What is the man’s most likely diagnosis?
B) Multiple myeloma
D) Hodgkin lymphoma
14. A 32-year-old woman presents at her neighborhood health clinic complaining of weakness and a feeling of abdominal fullness. She reports that 6 months earlier she noticed that she had difficulty maintaining the high level of energy she has relied on during her aerobic workouts over the past few years. Because she felt that she was in overall good health but knew that women often need aIDitional iron, she aIDed a multiple vitamin with iron and some meat and leafy greens to her diet. She followed her plan carefully but had no increase in energy. Upon examination her spleen is noted to be enlarged. Which of the following is most likely to be the cause?
A) Accelerated CML
B) Stage A Hodgkin disease
C) Infectious mononucleosis