ITE Hematology and Oncology 1 — Questions and Answers
Question 1: A 28-year-old woman presents with fatigue, pallor, and pica (ice craving). Labs show Hgb 8.5 g/dL, MCV 68 fL, low serum ferritin, and low serum iron. What is the most appropriate initial treatment?
- Oral ferrous sulfate (Correct answer)
- Intramuscular vitamin B12
- Folic acid supplementation
- Blood transfusion
Correct answer: Oral ferrous sulfate
Iron deficiency anemia confirmed by low ferritin and microcytosis is treated with oral iron supplementation as first-line therapy.
Question 2: A 65-year-old strict vegetarian presents with fatigue, paresthesias in hands and feet, and glossitis. Labs show Hgb 9.2 g/dL, MCV 112 fL, and hypersegmented neutrophils on smear. Which lab finding would best confirm the diagnosis?
- Low serum vitamin B12 level (Correct answer)
- Low serum folate level
- Elevated serum ferritin
- Positive direct Coombs test
Correct answer: Low serum vitamin B12 level
Macrocytic anemia with neurological symptoms in a long-term strict vegetarian strongly suggests B12 deficiency, confirmed by low serum B12.
Question 3: A 22-year-old African American man with known sickle cell disease presents with severe bilateral leg bone pain, fever of 38.4°C, and WBC 12,500/μL. His Hgb is 6.9 g/dL compared to a baseline of 7.1 g/dL. What is the most likely diagnosis?
- Vaso-occlusive (pain) crisis (Correct answer)
- Acute chest syndrome
- Aplastic crisis
- Splenic sequestration crisis
Correct answer: Vaso-occlusive (pain) crisis
Severe bone pain with near-baseline hemoglobin and no respiratory symptoms is characteristic of a vaso-occlusive pain crisis.
Question 4: A 32-year-old healthy woman has incidental platelet count of 26,000/μL on routine CBC. She has no bleeding symptoms, is on no medications, and has normal-appearing platelets on peripheral smear. What is the most likely diagnosis?
- Immune thrombocytopenic purpura (ITP) (Correct answer)
- Thrombotic thrombocytopenic purpura (TTP)
- Heparin-induced thrombocytopenia (HIT)
- Disseminated intravascular coagulation (DIC)
Correct answer: Immune thrombocytopenic purpura (ITP)
Isolated thrombocytopenia with normal platelet morphology and no medications or systemic illness in a healthy young person is most consistent with ITP.
Question 5: A patient on warfarin for atrial fibrillation presents with INR of 8.4 but has no active bleeding. What is the most appropriate management?
- Hold warfarin and administer oral vitamin K (Correct answer)
- Hold warfarin and administer IV vitamin K plus fresh frozen plasma
- Continue warfarin and recheck INR in 24 hours
- Administer 4-factor prothrombin complex concentrate (PCC)
Correct answer: Hold warfarin and administer oral vitamin K
For supratherapeutic INR without active bleeding, holding warfarin and giving oral vitamin K to gradually lower the INR is the appropriate management.
Question 6: A 55-year-old man presents with left leg swelling and calf pain after a 12-hour flight. Doppler ultrasound confirms proximal DVT. He has no contraindications to anticoagulation and is otherwise healthy. What is the preferred initial treatment?
- Low molecular weight heparin (LMWH) or a DOAC (e.g., rivaroxaban) (Correct answer)
- Unfractionated heparin infusion with warfarin bridging
- Aspirin and graded compression stockings
- IVC filter placement without anticoagulation
Correct answer: Low molecular weight heparin (LMWH) or a DOAC (e.g., rivaroxaban)
LMWH or a DOAC such as rivaroxaban or apixaban are first-line outpatient treatments for uncomplicated acute DVT without contraindications.
Question 7: A 45-year-old man is found to have WBC 90,000/μL with predominantly mature neutrophils and myelocytes, low leukocyte alkaline phosphatase score, and splenomegaly. BCR-ABL fusion gene is detected on PCR. What is the first-line treatment?
- Imatinib (a BCR-ABL tyrosine kinase inhibitor) (Correct answer)
- Hydroxyurea alone
- Allogeneic stem cell transplant upfront
- Cytarabine and daunorubicin induction chemotherapy
Correct answer: Imatinib (a BCR-ABL tyrosine kinase inhibitor)
CML driven by the BCR-ABL fusion (Philadelphia chromosome) is treated with BCR-ABL tyrosine kinase inhibitors such as imatinib as first-line therapy.
