Which of the following options represents a major difference between Hodgkin and Non-Hodgkin lymphoma?​

A 19-year-old woman comes for evaluation of persistently enlarged, nontender supraclavicular lymph nodes. She reports night sweats and a 4.5-kg (10-lb) weight loss over 3 months. She has no history of major medical illness. Three lymph nodes are palpable above her right clavicle. X-ray of the chest reveals mediastinal lymphadenopathy. Results of a lymph node biopsy are shown.​

A 65-year-old man presents with a rapidly enlarging, painless mass in his neck. He reports unintentional weight loss and night sweats over the past two months. Physical examination reveals a firm, non-tender lymph node in the cervical region. A biopsy of the lymph node shows large, atypical lymphoid cells with vesicular nuclei and prominent nucleoli. Immunohistochemistry confirms the diagnosis of diffuse large B-cell lymphoma (DLBCL).​

Which of the following cell surface markers is most likely to be expressed on the neoplastic cells in this patient?

A 67-year-old man presents with lymph node swelling and fevers for 3 months. Occasionally, the fevers wake him at night and he finds that he has sweated profusely. On physical examination, painless, enlarged lymph nodes are palpable in the cervical region, bilateral axillae, and left inguinal region. An excision lymph node biopsy is performed and reveals small- to medium-sized lymphocytes with irregular and notched nuclei. A karyotype shows an (11;14) chromosomal translocation.

Which of the following is this patient’s most likely diagnosis?​

A 9-year-old boy is brought to the pediatrician for evaluation of a soft tissue mass on his lower left jaw. The patient has had decreased appetite, significant weight loss, and has been experiencing drenching night sweats. Physical examination shows abdominal distension and numerous painless, firm, enlarged cervical lymph nodes. Results of biopsy of the spleen are shown in the image.​

Which of the following translocations is most likely present in the malignant cells shown?

Which translocation is most highly associated with follicular lymphoma?

A researcher is studying epigenetic regulation in mammalian cells. She observes that the addition of a methyl group to the 5' position of cytosine residues occurs predominantly at cytosine-phosphate-guanine (CpG) dinucleotides within gene promoter regions. Which of the following is the most likely consequence of this modification?

A 72-year-old man presents with progressive fatigue, easy bruising, and recurrent infections over several months. Laboratory studies reveal anemia, thrombocytopenia, and neutropenia. Bone marrow biopsy shows dysplastic changes in multiple cell lines and 8% myeloblasts. Which of the following diseases is this patient at risk of developing?

Azacitidine and Decitabine specifically target which phase of the cell cycle?

A 24-year-old woman presents with a 6-month history of a progressively enlarging mass on her right forearm. Physical examination shows a 4-cm firm, non-tender subcutaneous nodule. Biopsy reveals sheets of epithelioid cells with vesicular nuclei and prominent nucleoli. Immunohistochemistry shows complete loss of SMARCB1 (INI1) expression.The patient is started on a targeted therapy that selectively inhibits the methyltransferase activity of enhancer of zeste homolog 2 (EZH2). Which of the following best explains the mechanism underlying this therapeutic approach?

A 68-year-old man presents to his oncologist with intensely pruritic redness involving his entire body. He reports difficulty sleeping due to the itching and has noticed hair loss and thickening of his palms and soles. Physical examination reveals diffuse erythroderma covering >90% of his body surface area, palmoplantar keratoderma, alopecia, and bilateral cervical and axillary lymphadenopathy with nodes measuring 2 cm in diameter. Laboratory studies show: WBCs 18,000/µL (normal: 4,000-11,000/µL), absolute lymphocyte count: 8,000/µL, hemoglobin: 12.5 g/dL, and platelet count: 220,000/µL. Peripheral blood flow cytometry demonstrates an expanded population of CD4+ T cells with loss of CD7 and CD26 expression and a CD4/CD8 ratio of 12. He has previously failed treatment with extracorporeal photopheresis and interferon alfa. His oncologist recommends initiating vorinostat 400 mg orally once daily. Which of the following best describes the primary mechanism of action by which vorinostat exerts its therapeutic effect in this patient?

A 58-year-old woman presents to her primary care physician for a routine health maintenance visit. She has a 25 pack-year smoking history and quit smoking 12 years ago. She works as an accountant and has no occupational exposures. She has hypertension controlled with lisinopril and has no respiratory symptoms. Physical examination shows normal vital signs and clear lung fields. Which of the following is the most appropriate recommendation regarding lung cancer screening for this patient?

A 68-year-old man with a 50-pack-year smoking history comes to the physician because of a 3-month history of progressive dyspnea and hemoptysis. A chest CT scan shows a 4-cm mass in the right upper lobe with mediastinal lymphadenopathy. Biopsy of the mass confirms non-small cell lung cancer. Immunohistochemical analysis shows that 60% of tumor cells express programmed death-ligand 1 on their surface. The patient is started on pembrolizumab, a monoclonal antibody. Which of the following best describes the mechanism by which this patient's tumor cells evade immune destruction prior to treatment?

A 6-year-old boy is brought to his pediatrician because of fevers, weakness, and fatigue for the past week. Physical examination shows hepatosplenomegaly, generalized lymphadenopathy, and pale conjunctivae. Laboratory studies show a hemoglobin of 7.1 g/dL, leukocytes of 11,000/mm3, and a platelet count of 53,000/mm3. Peripheral blood smear is shown.Which of the following is the most likely diagnosis?

A 63-year-old woman comes to the clinic for evaluation because of a 6-month history of increasing fatigue, weakness, and anorexia. She states that she enjoyed playing tennis with her friends on weekends but has not played recently because of her inability to get through a set before “tiring out.” On physical examination, significant conjunctival pallor is noted. She also has petechiae scattered all over her body. An abdominal examination reveals splenomegaly. Laboratory studies show a hemoglobin level of 7.1 g/dL, platelet count of 590,000/mm3, and a WBC count of 64,000/mm3 with 70% neutrophils, 20% lymphocytes, 5% eosinophils, 3% bands, 2% promyelocytes, and 1% myelocytes. No blasts are seen. A blood smear is shown. Which of the following is the most appropriate next step in management?

A 73-year-old woman who resides in a nursing home is being examined for an infection on her foot and increasing fatigue. She has had similar infections in the past year, typically after small scrapes to her lower extremities. She takes atorvastatin and a daily multivitamin. Physical examination shows an erythematous lesion on her foot measuring 2 cm by 2 cm. Results of laboratory studies are below. This patient’s current disorder may progress into which of the following conditions?

A 69-year-old man is diagnosed with chronic myelogenous leukemia. Therapy with imatinib is started.Which of the following most accurately describes the cancer protein inhibited by this drug?

A 49-year-old man comes to the office because of bleeding gums and blood in his urine. He reports fatigue and a low-grade fever worsening over the past month. Physical examination reveals nonpalpable purpura over the extremities. Laboratory values are below. Which of the following is most likely to be seen on peripheral blood smear in this patient?

A 67-year-old man comes to the office with a 6-month history of increasing weakness and unintentional weight loss. Physical examination reveals a palpable spleen tip; an enlarged liver; and fixed and enlarged cervical, axillary, and inguinal lymph nodes. A peripheral blood smear is shown. Abnormal populations of which of the following cell types characterizes this patient’s most likely disease?

A 67-year-old man comes to the clinic because of increasing fatigue. Physical examination shows splenomegaly. Complete blood count shows normocytic anemia and leukocytosis. Genetic testing shows the presence of a t(9;22)(q34;q11.2) reciprocal translocation. Blood smear shows increased numbers of the cell shown in the center of the photograph. Which of the following functions is most likely performed by this cell type?

A 70-year-old woman is brought to the emergency department after falling in her house. She describes experiencing 3 to 4 months of worsening fatigue and low back pain. An x-ray of the right femur shows a fracture with surrounding lytic lesions. Laboratory studies are below. Which of the following findings is most likely in this patient’s peripheral blood smear?

Which lymphatic organ is this?

Where in the thymus does negative selection of T-cells occur?

What is the correct flow of lymph through a lymph node?

Where are plasma cells usually found?

Which is the correct order of venous blood flow through the spleen?

What is primarily found in the marked area of the spleen?

Which lymphatic tissue does not display lymphatic nodules?

For which type of lymphatic tissue are reticular fibers essential for structural maintenance? 

Which lymphatic tissues do not display a cortex/medulla pattern?

Which type of immune cell is found within the nodules of lymphatic tissues?

Which of these would be most likely to be included in the “subjective” of a SOAP note?

Which conditions are the least important to include in your differential?