A 72-year-old male with enlargement of superficial lymph nodes and mild hepatosplenomegaly is diagnosed as having chronic lymphatic leukemia (CLL). The most important criteria for diagnosis of this disease is the

Correct Answer: B

Rationale: The correct answer is B: Absolute lymphocytes. In CLL, the most important diagnostic criteria is an absolute lymphocyte count greater than 5,000/microliter. This is crucial for distinguishing CLL from other lymphoproliferative disorders. The presence of hypogammaglobulinemia (choice A) is not specific to CLL and can be seen in other conditions. Male predominance (choice C) is an epidemiological feature and not a diagnostic criterion. Enlarged lymph nodes (choice D) are a common clinical finding but do not solely confirm the diagnosis of CLL.

Correct Answer: D

Rationale: The correct answer is D, as the Philadelphia chromosome is typically found in myeloid cells, not lymphocytes. This is because the Philadelphia chromosome results from a translocation between chromosomes 9 and 22, leading to the formation of the BCR-ABL fusion gene, which is associated with chronic myeloid leukemia (CML). Choice A is correct as the Philadelphia chromosome results from the shortening of the long arm of chromosome 22. Choice B is incorrect as Philadelphia positivity in CML patients is associated with a worse prognosis. Choice C is correct as the presence of the Philadelphia chromosome is a diagnostic hallmark of CML.

Correct Answer: C

Rationale: The correct answer is C, pernicious anemia. Pernicious anemia is a macrocytic anemia caused by vitamin B12 deficiency affecting red blood cell production. Sideroblastic anemia (A), thalassemia (B), and lead poisoning (D) can all lead to microcytic anemia due to different mechanisms such as impaired hemoglobin synthesis or red blood cell destruction. Pernicious anemia, on the other hand, is not associated with microcytosis.

Correct Answer: C

Rationale: In understanding why option C is not associated with hypersplenism, it is crucial to grasp the pathophysiology of hypersplenism. Hypersplenism is a condition where the spleen removes blood cells excessively, leading to cytopenias. Option C, hypercellular bone marrow, is not typically associated with hypersplenism. In hypersplenism, the spleen sequesters and destroys blood cells, leading to cytopenias, but it does not directly affect bone marrow cellularity. Splenomegaly (option A) is commonly seen in hypersplenism due to the increased workload of the spleen. Pancytopenia (option B) is a hallmark of hypersplenism as the spleen destroys red blood cells, white blood cells, and platelets. Reversibility by splenectomy (option D) is also correct as removing the spleen can help alleviate the cytopenias associated with hypersplenism. Educationally, understanding the manifestations of hypersplenism is vital for healthcare providers, especially in diagnosing and managing hematologic disorders. Recognizing the relationship between the spleen, blood cell destruction, and resultant cytopenias is crucial in providing effective patient care.

Correct Answer: B

Rationale: The correct answer is B: gum bleeding. In Immune Thrombocytopenic Purpura (ITP), the hallmark feature is thrombocytopenia leading to mucocutaneous bleeding, including gum bleeding. Fever (choice A) is not a typical feature of ITP. Splenomegaly (choice C) can be present in chronic ITP but is not a defining feature. Sterna tenderness (choice D) is not specific to ITP and is not considered a characteristic feature. Thus, gum bleeding is the outstanding feature of ITP due to the primary pathophysiology of decreased platelet count leading to bleeding manifestations.