1.

A 22-year-old woman comes to the physician because of painless cervical

lymphadenopathy, night sweats, and generalized pruritus. An enlarged cervical
lymph node is removed for diagnosis. On the cut surface, the lymph node
architecture is distorted by broads bands of brosis. Histologic evalua on shows a
mixture of cells, including lymphocytes, his ocytes, eosinophils, plasma cells, and
sca ered large cells with prominent nucleoli.

Which of the following is the most likely diagnosis?

A. Cat-scratch disease

B. Hodgkin disease

C. Infec ous mononucleosis

D. Non-Hodgkin lymphoma

E. Reac ve nonspeci c lymphadeni s

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 2. A 58-year-old man is brought to the emergency department because of crushing
substernal chest pain. A diagnosis of acute myocardial infarc on is made. The pa ent
has no known allergies. In addi on to metoprolol, nitroglycerine, and morphine
treatment is begun with a drug with an platelet e ects.
The second drug most likely exerts its an platelet e ect by decreasing the produc on of
which of the following?

A. Clo ng factors II, VII, IX, X

B. Cyclooxygenase

C. Prostaglandins

D. Thromboxane A2

E. Thrombin

3. A 69-year-old man comes to the physician because of a 2-month history of weight

loss, fa gue and night sweats. He has lost approximately 6.8 kg (15 lb). Physical
examina on shows mul ple, painless, palpable cervical and axillary lymph nodes. The

spleen is palpable 3 cm below the costal margin. Laboratory studies show leukocyte
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 count is 27,000/mm3, hemoglobin is 10.8 g/dL, and MCV is 80 μm3. A peripheral blood
smear is shown.
Which of the following is the most likely underlying condi on?

A. Acute lymphocy c leukemia

B. Acute myelogenous leukemia

C. Chronic lymphocy c leukemia

D. Hairy cell leukemia

E. Mul ple myeloma

4. A 72-year-old man comes to the physician because of fa gue and easy bruising.
Physical examina on shows hepatosplenomegaly. Laboratory studies show leukocyte
count is 4000/mm3, erythrocyte count is 3.8 million/mm3, blood hemoglobin is 9.6 g/
dL, and platelet count is 120,000/mm3. Abnormal-appearing lymphocytes are seen on
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 peripheral smear. The image shows a peripheral blood smear that has been processed
using a special stain to iden fy a substance within the lymphocytes.

Which of the following stains was most likely used?

A. An -Epstein Barr virus

B. Myeloperoxidase stain

C. Nitroblue tetrazolium

D. Periodic acid-Schi stain

E. Tartrate-resistant acid phosphatase

5. A 6-year-old boy is brought to the emergency department by his parents because of

severe lower extremity pain a er playing in the snow. He has had similar episodes of
hand and feet pain before. His height falls in the 40th percen le range. Physical
examina on shows cool and mildly cyano c extremi es and shortened digits on each
hand. A peripheral blood smear is shown.
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 Which of the following is the most likely underlying cause of these ndings?

A. Absent alpha-globin chain

B. Absent beta-globin chain

C. Beta-globin chain point muta on

D. Hexose monophosphate shunt enzyme defect

E. Spectrin de ciency

6. Low-molecular-weight heparins (LMWH) are dis nct from unfrac onated heparin in
several ways. Which of the following is the primary target of LMWH?
(A) An thrombin III
(B) Factor Ila
(C) Factor VIl
(D) Factor Xa
(E) Factors HI, IS, and X

7.A 7-year-old African-American boy is brought to see his pediatrician. His father says he
has no ced that the boy has been complaining of right knee pain for the past week. On
physical exam, mul ple ecchymoses are noted on both upper and lower extremi es. His
father claims that the boy has always bruised easily, and he has recently learned how to
ride a bicycle. Which of the following elements of the coagula on cascade is most likely
to be missing inthis child?
(A) An thrombin IlI
(B) Factor VII
(C) Factor VIII
(D) Factor IX
(E) Protein C
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1B
2D
3C
4E
5C
6D
7C