A 66-year-old woman comes to the office to have a lipoma removed from her elbow. The lipoma does not cause her pain, but she does not like the way it looks when she wears sleeveless dresses. Her other medical problems include hypertension and gastroesophageal reflux. Review of systems is positive for 8 months of general malaise and fatigue, which the patient attributes to having started a more difficult Pilates routine. Temperature is 37.2 C (98.6 F), blood pressure is 108/72 mm Hg, and pulse is 66/min. Physical examination shows mild pallor and mobile, firm lymphadenopathy in her cervical and supraclavicular chains. The jugular veins are not distended. Cardiopulmonary and abdominal examinations are normal. Her preoperative blood count is as follows: Flow cytometry confirms the diagnosis. Which of the following is correct about this patient?

Question

A 66-year-old woman comes to the office to have a lipoma removed from her elbow.  The lipoma does not cause her pain, but she does not like the way it looks when she wears sleeveless dresses.  Her other medical problems include hypertension and gastroesophageal reflux.  Review of systems is positive for 8 months of general malaise and fatigue, which the patient attributes to having started a more difficult Pilates routine.  Temperature is 37.2 C (98.6 F), blood pressure is 108/72 mm Hg, and pulse is 66/min.  Physical examination shows mild pallor and mobile, firm lymphadenopathy in her cervical and supraclavicular chains.  The jugular veins are not distended.  Cardiopulmonary and abdominal examinations are normal.  Her preoperative blood count is as follows:  Flow cytometry confirms the diagnosis.  Which of the following is correct about this patient?

Quizplus · Accepted Answer

Explanation: 11ec2b69_bf5a_ec0e_8f63_a7c2ba333027_MD0005_00 Chronic lymphocytic leukemia (CLL) is a lymphoproliferative disease of the elderly (median age at diagnosis is 70). It is often found on routine blood work in asymptomatic patients and is characterized by significant lymphocytosis (>5,000 cells/mm³). Staging systems (Rai, Binet) guide treatment and prognosis by taking into account: Physical examination findings: Organomegaly (spleen, liver), lymphadenopathy Complete blood count findings: Anemia, thrombocytopenia The presence of any of these abnormal findings, including thrombocytopenia, indicates a worse prognosis. (Choice A) CLL is confirmed by a combination of peripheral smear (smudge cells) and flow cytometry; lymph node and bone marrow biopsies are not generally needed. (Choice B) Patients with CLL have a median survival of 10 years. Patients are often asymptomatic for several years before reaching an accelerated, terminal phase. (Choice C) Infection and secondary malignancy (not renal failure) are the principal causes of death in patients with CLL. (Choice E) CLL is a monoclonal B-cell, not T-cell, disease. Educational objective: Chronic lymphocytic leukemia is a monoclonal B-cell leukemia that can cause lymphadenopathy, organomegaly, and anemia/thrombocytopenia, all of which are associated with a worse prognosis.

A 66-Year-Old Woman Comes to the Office to Have a Lipoma