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Chronic lymphocytic leukemia — USMLE Step 2 CK MCQ

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ModerateInternal MedicineChronic lymphocytic leukemiaUSMLE Step 2 CK

A 49-year-old Asian American woman comes to the clinic because of a preventive health visit. History and focused examination are notable for asymptomatic lymphocytosis with smudge cells in an older adult. Temperature is 98.6°F (37.0°C), blood pressure is 126/78 mmHg, pulse is 84/min, respirations are 16/min, and oxygen saturation is 98% on room air. Physical examination confirms the key finding and shows no unrelated abnormality that would better explain the presentation. Focused laboratory studies and initial testing support the clinical pattern described in the stem. Which of the following is the most likely diagnosis?

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Correct answer: A — Chronic lymphocytic leukemia

The vignette describes Chronic lymphocytic leukemia, supported by asymptomatic lymphocytosis with smudge cells in an older adult. Chronic lymphocytic leukemia is the single best answer because it matches the diagnostic or management priority in this clinical setting. The other choices are plausible alternatives in related presentations, but they do not best fit the timing, findings, and guideline-directed approach described here.

Reference: https://www.ncbi.nlm.nih.gov/books/#stage-9-order-24