Hematologic Malignancies USMLE Step 1 Practice Question
A 65-year-old man with a 10-year history of hepatitis C infection presents to clinic with progressive fatigue and lower extremity purpura for 2 months. Physical examination reveals generalized lymphadenopathy, hepatosplenomegaly, and palpable purpura on the lower extremities and buttocks. Vital signs are stable with no fever. Laboratory studies show WBC 6,800/μL, hemoglobin 11.2 g/dL, platelets 145,000/μL, and serum creatinine 1.8 mg/dL (baseline 0.9). Serum protein electrophoresis demonstrates an IgM monoclonal spike. Serum cryoglobulins are positive. Urinalysis shows 2+ proteinuria and RBC casts. Lymph node biopsy shows small lymphocytic infiltration with plasma cell differentiation. Which of the following best explains this clinical presentation?
Answer choices
- AFollicular lymphoma
- BWaldenström macroglobulinemia
- CHepatitis C-associated mixed cryoglobulinemiaCorrect answer
- DLymphoplasmacytic lymphoma
- EDiffuse large B-cell lymphoma
- FChronic lymphocytic leukemia
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