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  #1  
Old 09-16-2012
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Arrow Gyrus Daily Questions; Internal Medicine #4

A 76-year-old man is admitted to the hospital with complaints of fatigue for 4 months and fever for the past 1 week. His temperature has been as high as 38.3°C at home. During this time, he intermittently has had a 5.5- kg weight loss, severe bruising with minimal trauma, and an aching sensation in his bones. He last saw his primary care physician 2 months ago and was diagnosed with anemia of unclear etiology at that time. He has a history of a previous left middle cerebral artery cerebrovascular accident which has left him with decreased functional status. At baseline, he is able to ambulate in his home with the use of a walker and is dependent upon a caregiver for assistance with his activities of daily living. His vital signs are: blood pressure 158/86 mmHg, heart rate 98 beats/ min, respiratory rate 18 breaths/min, SaO2 95%, and temperature 38°C. He appears cachectic with temporal muscle wasting. He has petechiae on his hard palate. He has no lymph node enlargement. On cardiovascular examination, there is a II/VI systolic ejection murmur present. His lungs are clear. The liver is enlarged and palpable 6 cm below the right costal margin. In addition, the spleen is also enlarged, with a palpable spleen tip felt about 4 cm below the left costal margin. There are multiple hematomas and petechiae present in the extremities. Laboratory examination reveals the following: hemoglobin 5.1 g/dL, hematocrit 15%, platelets 12,000/μL, and white blood cell (WBC) count 168,000/μL with 45% blast forms, 30% neutrophils, 20% lymphocytes, and 5% monocytes. Re- view of the peripheral blood smear confirms acute myeloid leukemia (M1 subtype, myeloblastic leukemia without maturation) with complex chromosomal abnormalities on cytogenetics. All of the following confer a poor prognosis for this patient except

A. advanced age
B. complex chromosomal abnormalities on cytogenetics
C. hemoglobin <7 g/dL
D. prolonged interval between symptom onset and diagnosis
E. WBC count >100,000/μL
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  #2  
Old 09-16-2012
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B. complex chromosomal abnormalities on cytogenetics
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Old 09-16-2012
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Would go with B
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