A 48-year-old man presents to the emergency department with a 6-week history of progressively worsening abdominal pain and night sweats. Physical examination findings were significant for palpable bilateral 2-cm axillary lymph nodes and diffuse abdominal tenderness with no rebound or guarding. Computed tomography of the abdomen and pelvis showed retroperitoneal and mesenteric lymphadenopathy. Excisional biopsy of an axillary node was positive for diffuse, large B-cell lymphoma. Positron emission tomography showed fluorodeoxyglucose-avidity in the axillary, mesenteric, and retroperitoneal lymph nodes. Results of the bone marrow examination were normal. Which of the following is the best next step?

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Hematology Final Exam Questions Pdf Questions

Question 1 of 5

A 48-year-old man presents to the emergency department with a 6-week history of progressively worsening abdominal pain and night sweats. Physical examination findings were significant for palpable bilateral 2-cm axillary lymph nodes and diffuse abdominal tenderness with no rebound or guarding. Computed tomography of the abdomen and pelvis showed retroperitoneal and mesenteric lymphadenopathy. Excisional biopsy of an axillary node was positive for diffuse, large B-cell lymphoma. Positron emission tomography showed fluorodeoxyglucose-avidity in the axillary, mesenteric, and retroperitoneal lymph nodes. Results of the bone marrow examination were normal. Which of the following is the best next step?

Correct Answer: A

Rationale: Advanced-stage diffuse large B-cell lymphoma requires R-CHOP, improving survival over CHOP alone (C). Observation (B) is for indolent lymphomas. Transplant (D) is for relapse. Radiotherapy (E) suits early-stage disease, not advanced.

Question 2 of 5

Matching: Hemolytic anemia - Spectrin deficiency

Correct Answer: A

Rationale: Spectrin deficiency is a hallmark of hereditary spherocytosis (A), leading to membrane instability.

Question 3 of 5

Matching: Anemia - Aplastic anemia

Correct Answer: B

Rationale: Aplastic anemia (B) is normocytic due to marrow failure without RBC size alteration.

Question 4 of 5

Matching: Anemia - Hypothyroidism

Correct Answer: B

Rationale: Hypothyroidism (B) typically causes normocytic anemia due to reduced erythropoiesis.

Question 5 of 5

Matching: Red blood cell aplasia - Elevated hemoglobin F

Correct Answer: A

Rationale: Diamond-Blackfan anemia (A) features elevated HbF as a compensatory mechanism.

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