WBCs Clinical

Question 1

CC: 2 week hx of sore throat and body pain, 1 week hx of abd. tenderness and mass over right jaw
Physical Exam: erythematous pharynx, posterior cervical lymphadenopathy, ascites, hepatosplenomegaly, hard mass over R mandible
Biopsy: uniform population of neoplastic, medium sized lymphocytes and scattered macrophages
Dx:________________
Translocation:_____________________

Answer 1

Dx: Burkitt Lymphoma s/p EBV infection
Translocation: t(8;14)

Question 2

CC:s severe fatigue, mild weight loss, mild periostitis, L quad tenderness, hepatosplenomegaly
Labs: Low Hb, How Ht, CD34+
PBS: Auer Rods

Answer 2

Acute Myelogenous Leukemia

Question 3

CC: worsening fatigue over 1 month, Low Hb, Low platelets
PBS: tear drops

Answer 3

Myelofibrosis

Question 4

CC: 2 y/o increasingly clumsy, runs into things (picture of retina)
Dx: ______________
At Risk for: ____________

Answer 4

Dx: Pt has retinoblastoma
At Risk for: osteosarcoma

Question 5

CC: 5 y/o boy w/ hx of decreased appetite and energy, increased irritability
Vitals: High Temp,
Physical Exam: petechiae on oral mucosa, splenomegaly
PBS: all blast cells, light nuclei
MPO (-)

Answer 5

Dx: Acute Lymphoblastic Leukemia (dramatic response to chemotherapy)

Question 6

CC: 6 month hx intermittent headaches, two episodes of vision loss
Physical Exam: normal
Labs: platelets over 1,000,000, Low WBC, Normal Hb
PBS: lots of platelets

Answer 6

Dx: Essential Thrombocytosis

Question 7

CC: soft tissue mass on left lower jaw, decreased appetite, significant weight loss, drenching night sweats
Physical Exam: abd. Distention, numerous enlarged cervical lymph notes,
Labs:
PBS: Starry Sky

Answer 7

Dx: Burkitt Lymphoma

Question 8

CC: 3 month hx lethargy, cough w/ brownish sputum, hx of mycoplasma infection,
Physical Exam: R sided pulmonary crackles, non-tender lymphadenopathy
Labs: Leukocytes 40,000 Hb 8.2g/dL, platelet 190,000 neutrophils 20%, lymphocytes 77%, eosinophils 1%, Monocytes 1.5% basophils 0.5%
PBS: darker monomorphic lymphocytes, smudge cells

Answer 8

Chronic Lymphocytic Leukemia

Question 9

CC: middle aged woman nosebleeds, easy bruising, and increased bleeding w/ menses for 4 months,
Physical Exam: scattered petechiae over distal extremities
Labs: Hb 12.3 Ht37% platelet 21,500/mm3 WBC 7300/mm3
PBS: Megakaryocytes

Answer 9

Dx: Immune thrombocytopenia

Question 10

CC: 6 y/o w/ Down Syndrome presents w/ fever, profound fatigue, “red rash”over arms and legs
Physical Exam: lethargy, diffuse petechia, hepatomegaly
Labs: Low Hb, RBC, platelet ; Leukocytes 75,000
TdT, CD10(CALLA), CD29, CD79a (+)
PBS: blast cells

Answer 10

Dx: Acute Lymphoblastic Leukemia
Bad: 7(9;22)
Good t(12;21)

Question 11

CC: 25 y/o man w/ abd pain and swelling, denies bowel movement for 1 week, abd CT = mass, biopsy
Labs: biopsy highly mitotic, basophiles surrounding lymphocytes surrounding clear zones of macrophages

Answer 11

Dx: Burkitt Lymphoma

Question 12

CC: 68 y/o woman w/ fatigue and weightless over 1 year. Increasing abdominal fullness
Physical Exam: Hepatosplenomegaly
Labs: WBC 65,000, Hb LOW, Ht 31%, platelets 540,000
PBS: segmented neutrophils, metamyelocytes, myelocytes, promyelocytes

Answer 12

Dx: Chronic Myeloid Leukemia

Question 13

CC: 55 y/o male w/ mild fatigue and weight loss over 5 months
Physical Exam: Splenomegaly
Labs: Hb 9.5, platelets 183,000, leukocytes 42,000, neutrophils 64%, lymphocytes 7%, monocytes 5%, basophils 8%, immature granulocytes 12%

Answer 13

Dx: Chronic Myeloid Leukemia

Question 14

CC: 60 y/o woman w/ few weeks of fatigue and vaginal bleeding
Physical Exam: bleeding from gums, bruising over legs
Labs: platelets 42,000/mm3. PTT 50 sec, Pt 21 sec, fibrin degradation product 32 mg/dL

Answer 14

Dx: APML
Drug: ATRA promotes differentiation of immature cells