Certain Hematologic Conditions

Chapter 64 Certain Hematologic Conditions




Clinical Case Problem 1 A 16-Year-Old Boy with a Supraclavicular Mass


A 16-year-old boy is brought to your office by his mother. He has noticed a significant swelling in the left supraclavicular area that has been present for approximately 4   months. He did not think it was important initially; but when it gradually increased in size, he became concerned. According to the patient, it has not been tender or warm to the touch. He has had no fever, chills, nausea, vomiting, fatigue or malaise, weight loss, or other symptoms.


On examination, vital signs are normal. A mass measuring 2.5 × 1.5   cm is palpated overlying the trapezius muscle superior to the left scapula. His thorax is otherwise normal to palpation, auscultation, and percussion. The abdomen is soft. There is no hepatomegaly or splenomegaly. The skin is benign. No significant lymph node enlargement is present in the cervical, axillary, or inguinal regions.



Select the best answer to the following questions




1. What is the most appropriate definitive diagnostic step for this patient?


a. a complete blood workup

b. a fine-needle biopsy

c. an excisional biopsy

d. a chest radiograph

e. none of the above

2. The evaluation produces a report that reads as follows: “Reed-Sternberg cells present.” What is the most likely diagnosis?


a. reactive lymph node enlargement

b. acquired immunodeficiency syndrome (AIDS)

c. metastatic carcinoma

d. Hodgkin disease

e. non-Hodgkin lymphoma

3. What is (are) the next step(s) in the investigation of this patient?


a. computed tomography (CT) scan of the abdomen

b. radiation therapy

c. combination chemotherapy

d. bone scan

e. a and d

4. In the staging of the disease from which this patient suffers, there are two distinct categories, A and B. To what do these two categories refer?


a. the presence or absence of metastases

b. the presence or absence of symptoms

c. the presence or absence of bone marrow involvement

d. the possibility or nonpossibility of cure

e. the presence or absence of intraabdominal disease

5. The patient’s disease is staged, and he is found to have disease throughout the mediastinum but not below the diaphragm. At this time, what kind of therapy is likely to be administered?


a. no therapy is indicated at this time; await the development of symptoms

b. combination chemotherapy

c. radiation therapy

d. combination chemotherapy plus radiotherapy

e. radical surgery

6. The patient’s mother asks you about his prognosis. Which of the following is not true regarding this patient’s illness?


a. most patients with this disease have an overall survival of between 80% and 90%

b. he may be at risk for premature cardiovascular disease as a result of treatment

c. he may be at increased risk for infertility

d. he may be at increased risk for secondary malignant neoplasms

e. once treated, he will have little risk of recurrence


Clinical Case Problem 2 A 62-Year-Old Man with Swellings in His Neck and Elbows and Chest Pains


A 62-year-old man comes to your office to reassure himself about “some swellings in my neck, elbows, as well as some chest pain.” The other presenting symptom is profound fatigue for 3   months. On examination, his vital signs are normal, but he looks pale. He has unintentionally lost 20 pounds since a visit 1   year ago. He has multiple enlarged cervical lymph nodes, and palpable bilateral epitrochlear nodes measure 1 to 2   cm in diameter. His liver edge is palpated approximately 3   cm below the left costal edge, and the tip of the spleen can be felt when he lies on his side.




7. If you could select only one test to perform on this patient, which of the following would you select?


a. enzyme-linked immunosorbent assay human immunodeficiency virus (HIV) screening test

b. immunoglobulin G viral capsid antigen (IgG VCA) antibody titer for cytomegalovirus

c. IgG VCA antibody titer for toxoplasmosis

d. CT scan of the chest

e. excisional lymph node biopsy

8. The test you ordered is performed. The result shows diffuse small cleaved cell (diffuse poorly differentiated lymphocytic) histology. Based on what you currently know, what is the most likely diagnosis?


a. non-Hodgkin lymphoma

b. Hodgkin disease

c. systemic toxoplasmosis: systemic immune deficiency

d. systemic cytomegalovirus: systemic immune deficiency

e. AIDS

9. The patient turns out to have an advanced (stage III) follicular form of non-Hodgkin lymphoma. The treatment of choice may include which of the following?


a. zidovudine (AZT)

b. intensive chemotherapy and bone marrow transplantation

c. interferon alfa and monoclonal antibodies

d. intensive chemotherapy and radiotherapy

e. c and d

10. Which of the following statements is true regarding the illness seen in this patient?


a. it is more common in younger individuals

b. patients usually have a normal life span without treatment

c. there appears to be a relationship with the Epstein-Barr virus in some forms of the disease

d. it is less common than the Hodgkin form of lymphoma

e. there is no relationship between the disease’s incidence and HIV disease


Clinical Case Problem 3 A 62-Year-Old Man with “Bone Pain” in His “Breast Bone” and Skull


A 62-year-old man comes to your office with a chief complaint of “bone pain” in “my breast bone and my skull, Doc.” He tells you that the pain first occurred a year ago. He was sure it was not serious, but “the wife kept bugging me until I gave in and made an appointment.” The patient appears pale and tells you that he has been feeling tired lately and a bit “weak, depressed, and maybe confused.”


He had a “touch of the flu” a few months ago. His wife tells you that this touch of the flu was actually bacterial pneumonia (organism Streptococcus pneumoniae). On examination, the patient has a tender sternum, tender occipital area of the skull, and pale conjunctivae.


You perform a series of laboratory tests. The results are as follows: hemoglobin, 8.5   g/dL; normochromic, normocytic anemia; erythrocyte sedimentation rate (ESR), 55   mm/hr; platelets, 15,000/mm3; serum calcium, 14   mg/dL; Na+, 151   mEq/L; and serum creatinine, 5.3   mmol/L.




11. Based on the information you now have for this case, what is the most likely diagnosis?


a. metastatic carcinoma: metastasized to bone

b. chronic lymphocytic leukemia

c. multiple myeloma

d. chronic renal failure: secondary to macroglobulinemia

e. chronic myelogenous leukemia

12. Further investigations substantiate your findings. What is the treatment of choice at this time?


a. bone marrow transplantation

b. total body radiotherapy

c. adjuvant combination chemotherapy: doxorubicin (Adriamycin), vincristine, bleomycin

d. melphalan plus prednisone

e. none of the above

13. The patient’s disease is the result of a proliferation of which of the following?


a. myeloblasts

b. lymphoblasts

c. metastatic cancer cells

d. plasma cells

e. none of the above


Matching questions


Match each numbered question in part B (questions 14 to 23) describing a hematologic disorder with the appropriate disease listed in part A. Each disease may be used once, twice, three times, or not at all.



Part A: Diseases




a. Aplastic anemia


b. Secondary polycythemia


c. Hemolytic anemia


d. Drug-induced thrombocytopenia


e. Idiopathic thrombocytopenic purpura


f. Sickle cell disease


g. Sickle cell trait


h. Preleukemia


i. Acute lymphocytic leukemia


j. Disseminated intravascular coagulation


k. Hemophilia


l. Multiple myeloma


m. Chronic lymphocytic leukemia


n. Hemochromatosis


o. Acute myelogenous leukemia


p. Chronic myelogenous leukemia


q. Cutaneous T-cell leukemia


r. Neutrophilia


s. von Willebrand disease


t. Thalassemia


u. Hairy cell leukemia


v. Acute intermittent porphyria


w. Polycythemia rubra vera


x. Secondary thrombocytopenia


y. Transfusion reaction


z. Myelofibrosis

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Oct 1, 2016 | Posted by in GENERAL SURGERY | Comments Off on Certain Hematologic Conditions

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