TABLE 1-149 Physiologic Characteristics of the Various Forms of Shock 5 page

D. If detected early, the 5-year survival is up to 20%.

E. The 5-year survival rates for pancreatic cancer have improved substantially in the past decade.

III-38. A 65-year-old man is evaluated in clinic for 1 month of progressive painless jaundice and 10 lb of unintentional weight loss. His physical examination is unremarkable. A dual-phase contrast CT shows a suspicious mass in the head of the pancreas with biliary ductal dilation. Which of the following is the best diagnostic test to evaluate for suspected pancreatic cancer?

A. CT-guided percutaneous needle biopsy

B. Endoscopic ultrasound-guided needle biopsy

C. ERCP with pancreatic juice sampling for cytopathology

D. FDG-PET imaging

E. Serum CA 19-9

III-39. A 63-year-old man complains of notable pink-tinged urine for the past month. At first he thought it was caused by eating beets, but has not cleared. His medical history is notable for hypertension and cigarette smoking. He does report some worsening urinary frequency and hesitancy over the past 2 years. Physical examination is unremarkable. Urinalysis is notable for gross hematuria with no white blood cells or casts. Renal function is normal. Which of the following statements regarding this patient is true?

A. Cigarette smoking is not a risk for bladder cancer.

B. Gross hematuria makes prostate cancer more likely than bladder cancer.

C. If invasive bladder cancer with nodal involvement but no distant metastases is found, the 5-year
survival is 20%.

D. If superficial bladder cancer is found, intravesicular BCG may be used as adjuvant therapy.

E. Radical cystectomy is generally recommended for invasive bladder cancer.

III-40. A 68-year-old man comes to his physician complaining of 2 months of increasing right flank pain with 1 month of worsening hematuria. He was treated for cystitis at a walk-in clinic 3 weeks ago with no improvement. He also reports poor appetite and 5 lb of weight loss. His physical examination is notable for a palpable mass in the right flank measuring greater than 5 cm. His renal function is normal. All of the following are true about this patient’s likely diagnosis EXCEPT:

A. Anemia is more common than erythrocytosis.

B. Cigarette smoking increased his risk.

C. If his disease has metastasized, with best therapy 5-year survival is greater than 50%.

D. If his disease is confined to the kidney, 5-year survival is greater than 80%.

E. The most likely pathology is clear cell carcinoma.

III-41. In the patient described above, imaging shows a 10-cm solid mass in the right kidney and multiple nodules in the lungs consistent with metastatic disease. Needle biopsy of a lung lesion confirms the diagnosis of renal cell carcinoma. Which of the following is recommended therapy?

A. Gemcitabine

B. Interferon-gamma

C. Interleukin-2

D. Radical nephrectomy

E. Sunitinib

III-42. Which of the following has been shown in randomized trials to reduce the future risk of pancreatic cancer diagnosis?

A. Finasteride

B. Selenium

C. Testosterone

D. Vitamin C

E. Vitamin E

III-43. A 54-year-old man is evaluated in an executive health program. On physical examination, he is noted to have an enlarged prostate with a right lobe nodule. He does not recall his last digital rectal examination and has never had prostate-specific antigen (PSA) tested. Based on this evaluation, which of the following is next recommended?

A. Bone scan to evaluate for metastasis

B. PSA

C. PSA now and in 3 months to measure PSA velocity

D. Repeat digital rectal examination in 3 months

E. Transrectal ultrasound-guided biopsy

III-44. Which of the following statements describes the relationship between testicular tumors and serum markers?

A. Pure seminomas produce α-fetoprotein (AFP) or beta human chorionic gonadotropin (β-hCG) in
more than 90% of cases.

B. More than 40% of nonseminomatous germ cell tumors produce no cell markers.

C. Both β-hCG and AFP should be measured in following the progress of a tumor.

D. Measurement of tumor markers the day after surgery for localized disease is useful in
determining the completeness of the resection.

E. β-hCG is limited in its usefulness as a marker because it is identical to human luteinizing
hormone.

III-45. A 32-year-old man presents complaining of a testicular mass. On examination, you palpate a 1 cm × 2 cm painless mass on the surface of the left testicle. A chest x-ray shows no lesions, and a CT scan of the abdomen and pelvis shows no evidence of retroperitoneal adenopathy. The α-fetoprotein (AFP) level is elevated at 400 ng/mL. Beta human chorionic gonadotropin (β-hCG) is normal, as is lactate dehydrogenase (LDH). You send the patient for an orchiectomy. The pathology comes back as seminoma limited to the testis alone. The AFP level declines to normal at an appropriate interval. What is the appropriate management at this point?

A. Radiation to the retroperitoneal lymph nodes

B. Adjuvant chemotherapy

C. Hormonal therapy

D. Retroperitoneal lymph node dissection (RPLND)

E. Positron emission tomography (PET) scan

III-46. Which of the following statements regarding the relationship between ovarian cancer and BRCA gene mutations is true?

A. Most women with BRCA mutations have a family history that is strongly positive for breast or
ovarian cancer (or both).

B. More than 30% of women with ovarian cancer have a somatic mutation in either BRCA1 or
BRCA2.

C. Prophylactic oophorectomy in patients with BRCA mutations does not protect against the
development of breast cancer.

D. Screening studies with serial ultrasound and serum CA-125 tumor marker studies are effective
in detecting early stage disease.

E. Women with known mutations in a single BRCA1 or BRCA2 allele have a 75% lifetime risk of
developing ovarian cancer.

III-47. All of the following statements regarding the diagnosis of uterine cancer are true EXCEPT:

A. Five-year survival after surgery in disease confined to the corpus is approximately 90%.

B. Endometrial carcinoma is the most common gynecologic malignancy in the United States.

C. Most women present with amenorrhea.

D. Tamoxifen is associated with an increased risk of endometrial carcinoma.

E. Unopposed estrogen exposure is a risk factor for developing endometrial carcinoma.

III-48. A 73-year-old man presents to the clinic with 3 months of increasing back pain. He localizes the pain to the lumbar spine and states that the pain is worst at night while he is lying in bed. It is improved during the day with mobilization. Past history is notable only for hypertension and remote cigarette smoking. Physical examination is normal. Laboratory studies are notable for an elevated alkaline phosphatase. A lumbar radiogram shows a lytic lesion in the L3 vertebra. Which of the following malignancies is most likely?

A. Gastric carcinoma

B. Non–small cell lung cancer

C. Osteosarcoma

D. Pancreatic carcinoma

E. Thyroid carcinoma

III-49. A primary tumor of which of these organs is the least likely to metastasize to bone?

A. Breast

B. Colon

C. Kidney

D. Lung

E. Prostate

III-50. A 22-year-old man comes into clinic because of a swollen leg. He does not remember any trauma to the leg, but the pain and swelling began 3 weeks ago in the anterior shin area of his left foot. He is a college student and is active in sports daily. A radiograph of the right leg shows a destructive lesion with a “moth-eaten” appearance extending into the soft tissue and a spiculated periosteal reaction. Codman’s triangle (a cuff of periosteal bone formation at the margin of the bone and soft tissue mass) is present. Which of the following are the most likely diagnosis and optimal therapy for this lesion?

A. Chondrosarcoma; chemotherapy alone is curative

B. Chondrosarcoma; radiation with limited surgical resection

C. Osteosarcoma; preoperative chemotherapy followed by limb-sparing surgery

D. Osteosarcoma; radiation therapy

E. Plasma cell tumor; chemotherapy

III-51. A 42-year-old man presented to the hospital with right upper quadrant pain. He was found to have multiple masses in the liver that were found to be malignant on H&E staining of a biopsy sample. Your initial history, physical examination, and laboratory tests, including prostate-specific antigen, are unrevealing. Lung, abdominal, and pelvic CT scans are unremarkable. He is an otherwise healthy individual with no chronic medical problems. Which immunohistochemical markers should be obtained from the biopsy tissue?

A. α-Fetoprotein

B. Cytokeratin

C. Leukocyte common antigen

D. Thyroglobulin

E. Thyroid transcription factor 1

III-52. A 52-year-old woman is evaluated for abdominal swelling with a computed tomogram that shows ascites and likely peritoneal studding of tumor but no other abnormality. Paracentesis shows adenocarcinoma but cannot be further differentiated by the pathologist. A thorough physical examination, including breast and pelvic examination, shows no abnormality. CA-125 levels are elevated. Pelvic ultrasonography and mammography findings are normal. Which of the following statements is true?

A. Compared with other women with known ovarian cancer at a similar stage, this patient can be
expected to have a less than average survival.

B. Debulking surgery is indicated.

C. Surgical debulking plus cisplatin and paclitaxel is indicated.

D. Bilateral mastectomy and bilateral oophorectomy will improve survival.

E. Fewer than 1% of patients with this disorder will remain disease free 2 years after treatment.

III-53. A 29-year-old man is found on routine chest radiography for life insurance to have left hilar adenopathy. CT scanning confirms enlarged left hilar and paraaortic nodes. He is otherwise healthy. Besides biopsy of the lymph nodes, which of the following is indicated?

A. Angiotensin-converting enzyme (ACE) level

B. β-hCG

C. Thyroid-stimulating hormone (TSH)

D. PSA

E. C-reactive protein

III-54. An 81-year-old man is admitted to the hospital for altered mental status. He was found at home, confused and lethargic, by his son. His medical history is significant for metastatic prostate cancer. The patient’s medications include periodic intramuscular goserelin injections. On examination, he is afebrile. Blood pressure is 110/50 mm Hg, and the pulse rate is 110 beats/min. He is lethargic and minimally responsive to sternal rub. He has bitemporal wasting, and his mucous membranes are dry. On neurologic examination, he is obtunded. The patient has an intact gag reflex and withdraws to pain in all four extremities. Rectal tone is normal. Laboratory values are significant for a creatinine of 4.2 mg/dL, a calcium level of 14.4 meq/L, and an albumin of 2.6 g/dL. All the following are appropriate initial management steps EXCEPT:

A. Normal saline

B. Pamidronate

C. Furosemide when the patient is euvolemic

D. Calcitonin

E. Dexamethasone

III-55. A 55-year-old man is found to have a serum calcium of 13.0 mg/dL after coming to clinic complaining of fatigue and thirst for the past month. A chest radiograph demonstrates a 4-cm mass in the right lower lobe. Which of the following serum tests is most likely to reveal the cause of his hypercalcemia?

A. Adrenocorticotropic hormone (ACTH)

B. Antidiuretic hormone (ADH)

C. Insulin-like growth factor

D. Parathyroid hormone (PTH)

E. Parathyroid hormone related protein (PTH-rp)

III-56. A 55-year-old woman presents with progressive incoordination. Physical examination is remarkable for nystagmus, mild dysarthria, and past pointing on finger-to-nose testing. She also has an unsteady gait. MRI reveals atrophy of both lobes of the cerebellum. Sero-logic evaluation reveals the presence of anti-Yo antibody. Which of the following is the most likely cause of this clinical syndrome?

A. Non–small cell cancer of the lung

B. Small cell cancer of the lung

C. Breast cancer

D. Non-Hodgkin’s lymphoma

E. Colon cancer

III-57. All of the following conditions may be associated with a thymoma EXCEPT:

A. Erythrocytosis

B. Hypogammaglobulinemia

C. Myasthenia gravis

D. Polymyositis

E. Pure red blood cell aplasia

III-58. A 52-year-old woman has been having worsening cough for the past month. She is a nonsmoker and has no known health problems. The cough is nonproductive and present throughout the day and night. It worsens when lying on her back. She has also noticed some upper chest pain and dyspnea on exertion for the past week. A chest radiograph shows a large mass (>5 cm) confined to the anterior mediastinum. Which of the following diagnoses is most likely?

A. Hodgkin’s lymphoma

B. Non-Hodgkin’s lymphoma

C. Teratoma

D. Thymoma

E. Thyroid carcinoma

III-59. All the following are suggestive of iron-deficiency anemia EXCEPT:

A. Koilonychia

B. Pica

C. Decreased serum ferritin

D. Decreased total iron-binding capacity (TIBC)

E. Low reticulocyte response

III-60. A 24-year-old man with a history of poorly treated chronic ulcerative colitis is found to have anemia with a hemoglobin of 9 g/dL and a reduced mean corpuscular volume. His ferritin is 250 μg/L. Which of the following is the most likely cause of his anemia?

A. Folate deficiency

B. Hemoglobinopathy

C. Inflammation

D. Iron deficiency

E. Sideroblastic anemia

III-61. All of the following statements regarding the anemia of chronic kidney disease are true EXCEPT:

A. The degree of anemia correlates with the stage of chronic kidney disease.

B. Erythropoietin levels are reduced.

C. Ferritin is reduced.

D. It is typically normocytic and normochromic.

E. Reticulocytes are decreased.

III-62. All of the following statements regarding the utility of hydroxyurea in patients with sickle cell disease are true EXCEPT:

A. It is effective in reducing painful crises.

B. It produces a chimeric state with partial production of hemoglobin A by the bone marrow.

C. It should be considered in patients with repeated acute chest syndrome episodes.

D. Its mechanism involves increasing production of fetal hemoglobin.

E. The major adverse effect is a reduction in white blood cell count.

III-63. Which of the following is the most cost-effective test to evaluate a patient for suspected cobalamin (vitamin B₁₂) deficiency?

A. Red blood cell folate

B. Serum cobalamin

C. Serum homocysteine

D. Serum methylmalonate

E. Serum pepsinogen

FIGURE III-64 (see Color Atlas)

A. Acute lymphocytic leukemia

B. Autoantibodies to ADAMTS-13

C. Cobalamin deficiency

D. Epstein-Barr virus infection

E. Iron deficiency

III-65. Patients from which of the following regions need not be screened for glucose-6-phosphate dehydrogenase (G6PD) deficiency when starting a drug that carries a risk for G6PD-mediated hemolysis?

A. Brazil

B. Russia

C. Southeast Asia

D. Southern Europe

E. Sub-Saharan Africa

F. None of the above

III-66. A 36-year-old African American woman with systemic lupus erythematosus presents with the acute onset of lethargy and jaundice. On initial evaluation, she is tachycardic and hypotensive, appears pale, is dyspneic, and is somewhat difficult to arouse. Physical examination reveals splenomegaly. Her initial hemoglobin is 6 g/dL, white blood cell count is 6300/μL, and platelets are 294,000/μL. Her total bilirubin is 4 g/dL, reticulocyte count is 18%, and haptoglobin is not detectable. Renal function is normal, as is urinalysis. What would you expect on her peripheral blood smear?

A. Macrocytosis and polymorphonuclear leukocytes with hypersegmented nuclei

B. Microspherocytes

C. Schistocytes

D. Sickle cells

E. Target cells

III-67. A 22-year-old pregnant woman of northern European descent presents 3 months into her first pregnancy with extreme fatigue, pallor, and icterus. She reports being previously healthy. On evaluation her hemoglobin is 8 g/dL with a normal mean corpuscular volume and an elevated mean corpuscular hemoglobin concentration, reticulocyte count is 9%, indirect bilirubin is 4.9 mg/dL, and serum haptoglobin is not detectable. Her peripheral smear is shown in Figure III-67. Her physical examination is notable for splenomegaly and a normal 3-month uterus. What is the most likely diagnosis?

FIGURE III-67 (see Color Atlas)

A. Colonic polyp

B. G6PD deficiency

C. Hereditary spherocytosis

D. Parvovirus B19 infection

E. Thrombotic thrombocytopenic purpura

III-68. The triad of portal vein thrombosis, hemolysis, and pancytopenia suggests which of the following diagnoses?

A. Acute promyelocytic leukemia

B. Hemolytic uremic syndrome (HUS)

C. Leptospirosis

D. Paroxysmal nocturnal hemoglobinuria (PNH)

E. Thrombotic thrombocytopenic purpura (TTP)

III-69. All of the following laboratory values are consistent with an intravascular hemolytic anemia EXCEPT:

A. Increased haptoglobin

B. Increased lactate dehydrogenase (LDH)

C. Increased reticulocyte count

D. Increased unconjugated bilirubin

E. Increased urine hemosiderin

III-70. Which of the following hemolytic anemias can be classified as extracorpuscular?

A. Elliptocytosis

B. Paroxysmal nocturnal hemoglobinuria

C. Pyruvate kinase deficiency

D. Sickle cell anemia

E. Thrombotic thrombocytopenic purpura

III-71. A 34-year-old woman with a medical history of sickle cell anemia presents with a 5-day history of fatigue, lethargy, and shortness of breath. She denies chest pain and bone pain. She has had no recent travel. Of note, the patient’s 4-year-old daughter had a “cold” 2 weeks before the presentation. On examination, the woman has pale conjunctiva, is anicteric, and is mildly tachycardic. Abdominal examination is unremarkable. Laboratory studies show a hemoglobin of 3 g/dL; her baseline is 8 g/dL. The white blood cell count and platelets are normal. Reticulocyte count is undetectable. Total bilirubin is 1.4 mg/dL. Lactic dehydrogenase is at the upper limits of the normal range. Peripheral blood smear shows a few sickled cells but a total absence of reticulocytes. The patient is given a transfusion of 2 units of packed red blood cells and admitted to the hospital. A bone marrow biopsy shows a normal myeloid series but an absence of erythroid precursors. Cytogenetics are normal. What is the most appropriate next management step?

A. Make arrangements for exchange transfusion.

B. Tissue type her siblings for a possible bone marrow transplant.

C. Check parvovirus titers.

D. Start prednisone and cyclosporine.

E. Start broad-spectrum antibiotics.

III-72. Aplastic anemia has been associated with all of the following EXCEPT:

A. Carbamazepine therapy

B. Methimazole therapy

C. Nonsteroidal anti-inflammatory drugs

D. Parvovirus B19 infection

E. Seronegative hepatitis

III-73. A 23-year-old man presents with diffuse bruising. He otherwise feels well. He takes no medications, does not use dietary supplements, and does not use illicit drugs. His medical history is negative for any prior illnesses. He is a college student and works as a barista in a coffee shop. A blood count reveals an absolute neutrophil count of 780/μL, hematocrit of 18%, and platelet count of 21,000/μL. Bone marrow biopsy reveals hypocellularity with a fatty marrow. Chromosome studies of peripheral blood and bone marrow cells are performed that exclude Fanconi’s anemia and myelodysplastic syndrome. The patient has a fully histocompatible brother. Which of the following is the best therapy?

A. Antithymocyte globulin plus cyclosporine

B. Glucocorticoids

C. Growth factors

D. Hematopoietic stem cell transplant

E. Red blood cell and platelet transfusion

III-74. A 73-year-old man has complained of fatigue and worsening dyspnea on exertion for the past 2 to 3 months. His medical history is only notable for hypertension and hypercholesterolemia. He is an active golfer who notes that lately he has difficulty walking 18 holes. His handicap has increased by 5 strokes over this time period. Physical examination reveals normal vital signs and is unremarkable except for pallor. His laboratory examination is remarkable for a hematocrit of 25% with a platelet count of 185,000/μL and low normal white cell count. There are no circulating blasts. These abnormalities were not present 1 year ago. Bone marrow reveals a hypercellular marrow with fewer than 5% blasts and the 5q-cytogenetic abnormality. All of the following statements regarding this patient’s condition are true EXCEPT:

A. He has myelofibrosis.

B. He is most likely to die as a result of leukemic transformation.

C. His median survival is more than 12 months.

D. Lenalidomide is effective in reversing the anemia.

E. Only stem cell transplantation offers a cure.

III-75. All of the following are considered myeloproliferative disorders in the WHO classification system EXCEPT:

A. Chronic myelogenous leukemia (bcr-abl positive)

B. Essential thrombocytosis

C. Mastocytosis

D. Polycythemia vera

E. Primary effusion lymphoma

III-76. Which of the following statements regarding polycythemia vera is correct?

A. An elevated plasma erythropoietin level excludes the diagnosis.

B. Transformation to acute leukemia is common.

C. Thrombocytosis correlates strongly with thrombotic risk.

D. Aspirin should be prescribed to all of these patients to reduce thrombotic risk.

E. Phlebotomy is used only after hydroxyurea and inter-feron have been tried.

III-77. A 68-year-old man seeks evaluation for fatigue, weight loss, and early satiety that have been present for about 4 months. On physical examination, his spleen is noted to be markedly enlarged. It is firm to touch and crosses the midline. The lower edge of the spleen reaches to the pelvis. His hemoglobin is 11.1 g/dL and hematocrit is 33.7%. The leukocyte count is 6200/μL and platelet count is 220,000/μL. The white cell count differential is 75% polymorphonuclear leukocytes, 8% myelocytes, 4% metamyelocytes, 8% lymphocytes, 3% monocytes, and 2% eosinophils. The peripheral blood smear

shows teardrop cells, nucleated red blood cells, and immature granulocytes. Rheumatoid factor is positive. A bone marrow biopsy is attempted, but no cells are able to be aspirated. No evidence of leukemia or lymphoma is found. What is the most likely cause of the splenomegaly?

A. Chronic primary myelofibrosis

B. Chronic myelogenous leukemia

C. Rheumatoid arthritis

D. Systemic lupus erythematosus

E. Tuberculosis

III-78. A 50-year-old woman presents to your clinic for evaluation of an elevated platelet count. The latest complete blood count is white blood cells (WBC), 7000/μL; hematocrit, 34%; and platelets, 600,000/μL. All the following are common causes of thrombocytosis EXCEPT:

A. Iron-deficiency anemia

B. Essential thrombocytosis

C. Chronic myeloid leukemia

D. Myelodysplasia

E. Pernicious anemia

III-79. A 38-year-old woman is referred for evaluation of an elevated hemoglobin and hematocrit that was discovered during an evaluation of recurrent headaches. Until about 8 months previously, she was in good health, but she developed increasingly persistent headaches with intermittent vertigo and tinnitus. She was originally prescribed sumatriptan for presumed migraine headaches but did not experience relief of her symptoms. A CT scan of the brain showed no evidence of mass lesion. During evaluation of her headaches, she was found to have a hemoglobin of 17.3 g/dL and a hematocrit of 52%. Her only other symptom is diffuse itching after hot showers. She is a nonsmoker. She has no history pulmonary or cardiac disease. On physical examination, she appears well. Her body mass index is 22.3 kg/m². Vitals signs are blood pressure of 148/84 mm Hg, heart rate of 86 beats/min, respiratory rate of 12 breaths/min, and SaO₂ of 99% on room air. She is afebrile. The physical examination, including full

neurologic examination, is normal. There are no heart murmurs. There is no splenomegaly. Peripheral pulses are normal. Laboratory studies confirm elevated hemoglobin and hematocrit. She also has a platelet count of 650,000/μL. Leukocyte count is 12,600/μL with a normal differential. Which of the following tests should be performed next in the evaluation of this patient?

A. Bone marrow biopsy

B. Erythropoietin level

C. Genetic testing for JAK2 V617F mutation

D. Leukocyte alkaline phosphatase

E. Red blood cell mass and plasma volume determination

III-80. A 45-year-old man is evaluated by his primary care physician for complaints of early satiety and weight loss. On physical examination, his spleen is palpable 10 cm below the left costal margin and is mildly tender to palpation. His laboratory studies show a leukocyte count of 125,000/μL with a differential of 80% neutrophils, 9% bands, 3% myelocytes, 3% metamyelocytes, 1% blasts, 1% lymphocytes, 1% eosinophils, and 1% basophils. Hemoglobin is 8.4 g/dL, hematocrit is 26.8%, and

platelet count is 668,000/μL. A bone marrow biopsy demonstrates increased cellularity with an increased myeloid to erythroid ratio. Which of the following cytogenetic abnormalities is most likely to be found in this patient?

A. Deletion of a portion of the long arm of chromosome 5, del(5q)

B. Inversion of chromosome 16, inv(16)

C. Reciprocal translocation between chromosomes 9 and 22 (Philadelphia chromosome)

D. Translocations of the long arms of chromosomes 15 and 17

E. Trisomy 12

III-81. All of the following statements regarding the epidemiology of and risk factors for acute myeloid leukemias are true EXCEPT:

A. Anticancer drugs such as alkylating agents and topoisomerase II inhibitors are the leading cause
of drug-associated myeloid leukemias.

B. Individuals exposed to high-dose radiation are at risk for acute myeloid leukemia, but
individuals treated with therapeutic radiation are not unless they are also treated with alkylating
agents.

C. Men have a higher incidence of acute myeloid leukemia than women.

D. The incidence of acute myeloid leukemia is greatest in individuals younger than 20 years of age.

E. Trisomy 21 (Down syndrome) is associated with an increased risk of acute myeloid leukemia.

III-82. A 56-year-old woman is diagnosed with chronic myelogenous leukemia, Philadelphia chromosome positive. Her presenting leukocyte count was 127,000/μL, and her differential shows less than 2% circulating blasts. Her hematocrit is 21.1% at diagnosis. She is asymptomatic except for fatigue. She has no siblings. What is the best initial therapy for this patient?

A. Allogeneic bone marrow transplant

B. Autologous stem cell transplant

C. Imatinib mesylate

D. Interferon-α

E. Leukapheresis

III-83. A 48-year-old woman is admitted to the hospital with anemia and thrombocytopenia after complaining of profound fatigue. Her initial hemoglobin is 8.5 g/dL, hematocrit is 25.7%, and platelet count is 42,000/μL. Her leukocyte count is 9540/μL, but 8% blast forms are noted on peripheral smear. A chromosomal analysis shows a reciprocal translocation of the long arms of chromosomes 15 and 17, t(15;17), and a diagnosis of acute promyelocytic leukemia is made. The induction regimen of this patient should include which of the following drugs?

A. Arsenic

Date: 2016-04-22; view: 734