A 32-year-old woman presented with weakness, abdominal fullness, and difficulty maintaining energy levels despite dietary changes. Upon examination, her spleen was enlarged. Chronic lymphocytic leukemia (CLL) is most likely the cause, given her symptoms and enlarged spleen.

1. lymphatic system
lymphatic system1.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.A)
MyeloblastB) PromyelocyteC) Myeloid stem cellD) MetamyelocyteE) Neutrophil2.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

2. 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
myelomaD)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 feverB)Decreased oxygen
partial pressure and weight lossC)Increased serum potassium and sodium
levelsD)Increased blood urea nitrogen (BUN) and bone pain11.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 elevatedB)A 68-
year-old former coal miner who has white cell levels exponentially higher than normal
rangesC)An 81-year-old male resident of a long-term care home who has an uncommon
bacterial pneumonia and is unable to produce a feverD)A 70-year-old woman whose blood
work reveals large numbers of immature granulocytes13.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?A)AMLB)Multiple
myelomaC)ALLD)Hodgkin lymphoma14.A 32-year-old woman presents at her

3. 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
additional iron, she added 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 CMLB)Stage A Hodgkin diseaseC)Infectious mononucleosisD)CLL