At her annual physical examination, an asymptomatic 68-year-old woman has lymphocytosis (32 × 10^9/L) with a normal hemoglobin level and platelet count. On examination, she has 1-cm lymphadenopathy in the cervical region and no palpable liver or spleen enlargement. A peripheral blood smear shows identically appearing mature lymphocytes with smudge cells. Flow cytometry of the peripheral blood lymphocytes shows a monoclonal B population with dim expression of λ light chain and CD20 that is positive for expression of CD5, CD19, and CD23. Which of the following is the best next step in her management?

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Question 1 of 5

At her annual physical examination, an asymptomatic 68-year-old woman has lymphocytosis (32 × 10^9/L) with a normal hemoglobin level and platelet count. On examination, she has 1-cm lymphadenopathy in the cervical region and no palpable liver or spleen enlargement. A peripheral blood smear shows identically appearing mature lymphocytes with smudge cells. Flow cytometry of the peripheral blood lymphocytes shows a monoclonal B population with dim expression of λ light chain and CD20 that is positive for expression of CD5, CD19, and CD23. Which of the following is the best next step in her management?

Correct Answer: D

Rationale: Chronic lymphocytic leukemia (CLL) with lymphocytosis >5 × 10^9/L, smudge cells, and CD5/CD23 positivity in an asymptomatic patient with early-stage disease warrants active monitoring, not immediate treatment (A-D), per standard practice.

Question 2 of 5

Appropriate long-term management of the disease described in Question 3 includes all of the following EXCEPT

Correct Answer: D

Rationale: Hemophilia A management includes A, B, C, and E (for mild cases), but splenectomy (D) is irrelevant as it doesn’t affect factor VIII levels.

Question 3 of 5

Matching: Hemolytic anemia - Oxidant stressors

Correct Answer: C

Rationale: Hereditary pyropoikilocytosis (C) is sensitive to oxidant stress, causing hemolysis, unlike sickle cell anemia (D).

Question 4 of 5

Matching: Anemia - Thalassemia

Correct Answer: A

Rationale: Thalassemia (A) is a classic microcytic anemia due to defective hemoglobin synthesis.

Question 5 of 5

Matching: Anemia - Iron deficiency

Correct Answer: A

Rationale: Iron deficiency (A) is the most common microcytic anemia.

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