Audio Qbank – Q256 – A 52M with a painful hand

 

A 52-year-old man presents to the GP because of pain and numbness in his left hand for the past week. Vitals are within normal limits. Peripheral pulses are equal and full bilaterally. Cardiac exam shows a mid-systolic click. Photographs of his left hand are shown.

Serum studies show:

Hb 14.4 g/dL
Hct 43.2%
MCV 90 fL
Platelets 1,600,000/μL
WBCs 7,000/μL
Neutrophils 68%
Eosinophils 4%
Basophils 2%
Monocytes 2%
Lymphocytes 24%

What’s the most likely diagnosis?

Acute myelogenous leukemia
Chronic myelogenous leukemia
Essential thrombocytosis
Secondary thrombocytosis
Waldenstrom macroglobulinemia