Hema

Question 1

A patient was admitted to the ER after a vehicular crash. He complained of abdominal pain while being assessed at the ER. PE showed BP 110/60 (90/50 on standing), HR 100, RR 22, O2 saturation 99%, with abdominal hematoma. How much intravascular blood volume would be expected to be lost in this case?

a.10%

b.20%

c.30%

d.40%

Answer 1

30%

Question 2

For Questions 2-4: An 80/M presented for workup of fatigue at the OPD. He had no history of bleeding. Tests showed Hb 90, Hct 25%, MCV 110 fL, MCH 32 pg, MCHC 33 g/dL, reticulocyte count 6.7%, platelet 140, WBC 6.0. What is the patient’s reticulocyte production index?

a.1.5

b.2.0

c. 2.5

d. 3.0

Answer 2

2.0

Question 3

Which of the following diagnostic tests would be most appropriate to request next to narrow the differentials?

a.Bone marrow biopsy

b.Peripheral blood smear

c.Serum iron and total iron-binding capacity

d. Serum ferritin

Answer 3

Peripheral blood smear

Question 4

Which among the following is the most likely diagnosis?

a.Iron-deficiency anemia

b.Sideroblastic anemia

c.Thalassemia

d.Vitamin B12 deficiency

Answer 4

Vitamin B12 deficiency

Question 5

Which of the following conditions would present with an elevated reticulocyte production index?

a.Acute blood loss

b.Cardiopulmonary bypass

c.Hypothyroidism

d.Myelodysplasia

Answer 5

Cardiopulmonary bypass

Question 6

A 75 year old patient presented with easy fatigability, palmar pallor and occasional gum bleeding. Workup showed WBC 1.0, platelet 50, RPI of 1.5, serum iron 100 µg/dL, TIBC 320 µg/dL and ferritin 100 µg/L. Peripheral blood smear shows normocytic, normochromic erythrocytes. Which bone marrow finding is consistent with the patient’s condition?

a.Hypocellular with several fat globules

b.Myeloid:erythroid ratio of 1:1

c.Erythroid hyperplasia

d.Plasmacytosis of 20%

Answer 6

Hypocellular with several fat globules

Question 7

What is the most important predictor of bleeding risk?

a. Aspirin use

b.History of bleeding

c.Liver disease

d.Platelet count <150

Answer 7

History of bleeding

Question 8

A male patient with a history of lower gastrointestinal bleeding and treatment 1 month ago was referred for anemia with hemoglobin 9.0 with MCV 75 fL, MCH 20 pg, ferritin 80 mcg/L. He is currently asymptomatic with no signs of recurrence of bleeding. Which is the most appropriate treatment?

a. Erythropoietin 4000 units subcutaneously three or four times a week until 3 months after anemia correction

b.Erythropoietin 1000 units subcutaneously three or four times per day until 6 months after anemia correction

c. Oral elemental iron 200 mg three or four times per day until 3 months after anemia correction

d. Oral elemental iron 60 mg three or four times per day until 6 months after anemia correction

Answer 8

Oral elemental iron 60 mg three or four times per day until 6 months after anemia correction

Question 9

For Questions 9 and 10: An 18/M presented at the OPD for a 3-day history of a painful and swollen right knee after accidentally hitting it hard against the kitchen counter. He recalls that this happened 4 years ago, after a fall on the same knee. It was resolved after one week so work-up was not done. Laboratory results showed normal CBC and isolated prolonged aPTT. Which of the following diagnostics will confirm the diagnosis?

a. Factor VIII assay

b. Factor VII assay

c. Prothrombin assay

d. Bethesda assay

Answer 9

Factor VIII assay

Question 10

Which of the following is least appropriate for treatment of this condition?

a. Cryoprecipitate

b. Factor replacement therapy

c. Prothrombin complex concentrate

d. Tranexamic acid

Answer 10

Prothrombin complex concentrate

Question 11

Which set of iron studies is characteristic of iron-deficient erythropoiesis?

a.Low ferritin, low total iron-binding capacity, normal serum iron, normal transferrin saturation

b.Low ferritin, high total iron-binding capacity, normal serum iron, normal transferrin saturation

c.Low ferritin, low total iron-binding capacity, low serum iron, low transferrin saturation

d. Low ferritin, high total iron-binding capacity, low serum iron, low transferrin saturation

Answer 11

Low ferritin, high total iron-binding capacity, low serum iron, low transferrin saturation

Question 12

In which of the following patients is bone marrow examination most useful?

a. 65 year old with fatigue and thrombocytopenia

b. 65 year old presented with pneumonia, anemia, and thrombocytopenia

c. 65 year old smoker with leukocytosis

d. 65 year old UGIB patient with leukocytosis and anemia

Answer 12

65 year old with fatigue and thrombocytopenia

Question 13

What is the most common cause of non-iatrogenic thrombocytopenia?

a. Cancer

b.Infection

c. Immune

d. Blood loss

Answer 13

Infection

Question 14

A 30/F presented with recurrent episodes of gum bleeding and heavy menstrual flow. Blood count showed isolated thrombocytopenia of 3. Which of the following is appropriate to include in the succeeding work-up?

a. Antibody testing

b. Bone marrow biopsy

c. Bleeding time

d. Peripheral blood smear

Answer 14

Peripheral blood smear

Question 15

Which of the following patients with immune thrombocytopenic purpura can be treated on an outpatient basis?

a.Patient with platelet count of 40 with no bleeding

b. Patient with platelet count of 20 with no bleeding

c. Patient with platelet count of 3 and recurrent epistaxis

d. Patient with platelet count of 3 and retinal hemorrhages

Answer 15

Patient with platelet count of 3 and retinal hemorrhages

Question 16

Which of the following is consistent with thrombotic thrombocytopenic purpura (TTP)?

a. Decreased haptoglobin

b. Decreased lactate dehydrogenase

c. Decreased reticulocyte count

d. Decreased unconjugated bilirubin

Answer 16

Decreased haptoglobin

Question 17

A patient presented with decreasing urine output. She had a bout of gastroenteritis that was treated with ciprofloxacin 1 week ago. Workup showed creatinine 4.0 mg/dL, Hb 85, WBC 5.2, platelet 90. Peripheral blood smear showed fragmented red blood cells. Which of the following is the most appropriate treatment for their condition?

a. IV immunoglobulin

b. Plasma exchange

c. Rituximab

d. Supportive treatment

Answer 17

Supportive treatment

Question 18

What is the central mechanism of disseminated intravascular coagulation (DIC)?

a. Intravascular fibrin deposition

b. Uncontrolled thrombin generation

c. Red blood cell damage and hemolysis

d. Consumption of platelets and coagulation factors

Answer 18

Uncontrolled thrombin generation

Question 19

For Questions 19 and 20: A pregnant patient in the 3rd trimester presented to the ER with severe abdominal pain and bloody vaginal discharge. During her admission, she was noted to have bleeding from venipuncture sites and ecchymoses all over her body. She was also referred for an episode of tarry black stools. On work-up, her hemoglobin was 85 with platelet count of 20 and prolonged PT and PTT. Which of the following laboratory tests is the most sensitive for the most likely diagnosis?

a. D-dimer

b. Fibrinogen

c. Thrombin time

d. Peripheral blood smear

Answer 19

D-dimer

Question 20

Which of the following blood products is NOT appropriate for the patient’s condition?

a. Clotting factor concentrate

b. Cryoprecipitate

c. Fresh frozen plasma

d. Platelet concentrate

Answer 20

Clotting factor concentrate

Question 21

Which of the following patients with pancytopenia is most likely to present with bone marrow hypocellularity on biopsy?

a. 21 year old presenting with sepsis from anorectal infection

b. 21 year old presenting with gum bleeding

c. 72 year old presenting with fever and weight loss

d. 72 year old presenting with fatigue, weakness and pallor

Answer 21

21 year old presenting with gum bleeding

Question 22

Which of the following patients with pancytopenia is most likely to present with bone marrow hypocellularity on biopsy?

a. 21 year old presenting with sepsis from anorectal infection

b. 21 year old presenting with gum bleeding

c. 72 year old presenting with fever and weight loss

d. 72 year old presenting with fatigue, weakness and pallor

Answer 22

21 year old presenting with gum bleeding

Question 23

Which of the following patients with pancytopenia is most likely to present with bone marrow hypercellularity, dyserythropoietic changes, and hyposegmented granulocytes?

a. 21 year old presenting with sepsis from anorectal infection

b. 21 year old presenting with gum bleeding

c. 72 year old presenting with fever and weight loss

d. 72 year old presenting with fatigue, weakness, and pallor

Answer 23

72 year old presenting with fatigue, weakness, and pallor

Question 24

Which of the following is a proven component of supportive care for patients with pancytopenia from aplastic anemia?

a. Gut decontamination

b. Iron chelation

c. Low-dose glucocorticoids

d. Reverse isolation

Answer 24

Iron chelation

Question 25

In the work-up for polycythemia, which of the following laboratory findings and etiologies are correctly paired?

a. Low EPO levels: polycythemia vera

b. Low arterial oxygen saturation: smoker’s polycythemia

c. High hemoglobin oxygen affinity: renal neoplasm

d. High carboxyhemoglobin levels: hemoglobinopathy

Answer 25

Low EPO levels: polycythemia vera

Question 26

In general, the serum cobalamin level below which megaloblastic anemia develops is:
a. 164 pmol/L
b. 148 pmol/L
c. 74 pmol/L
d. 58 pmol/L

Answer 26

d. 58 pmol/L

Question 27

A 25-year-old woman is seen at the outpatient clinic with jaundice and dark-colored urine. 3 days earlier, she was diagnosed with UTI and was given Nitrofurantoin. 6 hours after her first dose of Nitrofurantoin, she complained of body malaise, weakness, and lumbar pain. She looked pale and icteric. CBC done showed normocytic normochromic anemia. PBS showed bizzare poikilocytes and Heinz bodies. What underlying condition can explain the patient’s clinical course?

a. Beta thalassemia
b. G6PD deficiency
c. Atypical HUS
d. Pyruvate kinase deficiency

Answer 27

b. G6PD deficiency

Question 28

A 26/F was admitted due to jaundice since 3 weeks ago. Physical examination shows pallor, icteric sclerae, and splenomegaly. Abdominal ultrasound confirmed the presence of splenomegaly with an incidental finding of gallstones. Further workup showed normocytic anemia with elevated mean corpuscular hemoglobin concentration. Her peripheral blood smear is shown below. What is the main diagnostic test to clinch the diagnosis for this case?
a. Electrophoresis
b. Osmotic fragility test
c. Reticulocyte count
d. Western blot

Answer 28

b. Osmotic fragility test

Question 29

A 23-year-old female flight attendant with no known comorbidities came in for a feeling of lassitude, weakness, shortness of breath and a pounding sensation in the ears. Yesterday, she noted a difficult-to-control bout of epistaxis. On physical examination, she was visibly pale, with crops of petechiae on her arms. Complete blood counts were taken which revealed pancytopenia, elevated MCV with very few reticulocytes. She was advised to have a bone marrow biopsy. The bone marrow biopsy will likely reveal:
a. Dry tap
b. 10-30% cellularity
c. 10-20% blasts
d. Predominantly fat

Answer 29

d. Predominantly fat

Question 30

Which of the following cytogenetic abnormalities confers a “good risk” feature in MDS?

a. del(20q)
b. -7
c. +8
d. +13/del(13q)

Answer 30

a. del(20q)

Question 31

Which of the following genetic changes characterizes Primary Myelofibrosis (PMF)?

a. t(15;19) translocation
b. JAK2 activating mutation
c. PDGFRa deletion or translocation
d. t(9;22)(q34:11) translocation

Answer 31

b. JAK2 activating mutation

Question 32

Which of the following myeloproliferative neoplasms has high risk of leukemic transformation?

a. Polycythemia vera
b. Primary myelofibrosis
c. Chronic myelogenous leukemia
d. Essential thrombocytosis

Answer 32

c. Chronic myelogenous leukemia

Question 33

DJ, 42/M was referred to you for a history of excessive bleeding after accidentally nicking himself during shaving. The patient denies any other symptoms nor any other previous bleeding episodes or easy bruisability. He denies intake of any medications nor any food supplements. Family history is unremarkable. PE is also unremarkable. Review of laboratory results showed normal CBC, prolonged PT but normal aPTT. Which of the following is the most likely differential for the patient’s case?

a. Factor VII deficiency
b. von Willebrand disease
c. Factor XI deficiency
d. Factor V

Answer 33

a. Factor VII deficiency

Question 34

A 50-year-old man, otherwise asymptomatic, shows you a CBC with the following findings: Hb 140mg/dL, Hct 0.38, WBC 4,500/uL, Platelet count 100,000/uL. What will you do next?

a. Assure patient that the values are normal
b. Repeat CBC in 24 hours
c. Request for peripheral blood smear
d. Refer for bone marrow biopsy

Answer 34

c. Request for peripheral blood smear

Question 35

Which treatment for ITP require monitoring for 8 hours post infusion due to the rare complication of severe intravascular hemolysis?

a. Prednisone
b. Rho (D) immune globulin
c. IVIg
d. Rituximab

Answer 35

b. Rho (D) immune globulin

Question 36

What is the central mechanism of DIC?

a. Increase in physiologic anticoagulant mechanism
b. Uncontrolled thrombin generation
c. Normal fibrinolysis
d. Systemic fibrin deposition in large vessels

Answer 36

b. Uncontrolled thrombin generation

Question 37

A 45-year-old man has an enlarged non-tender left cervical lymph node. He has been having late afternoon fever, night sweats, weight loss for the last 2 months. On PE, there we enlarged lymph nodes palpated post-auricular and left axillary. Excision biopsy of the left cervical lymph node showed diffuse proliferation of large atypical lymphocytes that are heterogenous with vesicular chromatin and prominent nucleoli, with no identified RS cells. IHCs done showed: CD20 (+), CD19 (+), CD10 (+), CD30 (-), BCL2 (-) What is the most likely diagnosis of this patient?

a. Hodgkin’s lymphoma
b. Follicular Lymphoma
c. Diffuse Large B-cell Lymphoma
d. Marginal Zone Lymphoma

Answer 37

c. Diffuse Large B-cell Lymphoma

Question 38

A 58-year-old female was newly diagnosed with AML. She has no known comorbids and has an ECOG performance score of 1. What is the best induction regimen for this patient?

a. Cytarabine and Anthracyclines
b. Hemopoietic Stem Cell Transplantation
c. Azacitidine and Decitabine
d. Investigational Therapy

Answer 38

a. Cytarabine and Anthracyclines

Question 39

A 48-year-old male diagnosed with ALL completed his induction therapy. He was advised to undergo maintenance therapy which usually consists of 6-mercaptopurine and methotrexate. For this patient, how long would you give the treatment?

a. 1 – 2 years
b. 1.5 – 2 years
c. 2 – 2.5 years
d. 2.5 – 3 years

Answer 39

c. 2 – 2.5 years

Question 40

A 34-year-old male underwent a pre-employment check-up. He is asymptomatic and has no known co-morbids. However, his results showed absolute lymphocytosis with 6425 B-lymphocytes/µL. What would be the next best diagnostic work-up?

a. Bone marrow aspiratory
b. Chest CT scan
c. Flow cytometry on the peripheral blood
d. Whole abdominal CT scan

Answer 40

c. Flow cytometry on the peripheral blood

Question 41

A 24-year-old athlete was diagnosed with iron deficiency anemia. Although she has a hemoglobin of 9 g/dL, she has no symptoms and can carry out her usual rigorous training. She asks you what is the best management for her anemia. You would tell her:

a. Oral treatment with ferrous fumarate would be best.
b. IV iron is the treatment of choice for her condition.
c. She would need a blood transfusion immediately.
d. Weekly subcutaneous erythropoietin injections would be better for her anemia.

Answer 41

a. Oral treatment with ferrous fumarate would be best.

Question 42

A 48-year-old male with anemia was noted with low serum iron, low percent transferrin saturation, normal ferritin and low TIBC. Which key iron regulator is responsible for these distinctive iron values?
a. Gamma interferon
b. Interleukin-6
c. Hepcidin
d. Interleukin-1

Answer 42

c. Hepcidin

Question 43

A patient presented with the characteristic “chipmunk” facies, easy fatigability, dizziness, pale skin and requires intensive blood transfusion support to survive. What is the possible diagnosis?
a. β Thalassemia Major
b. β Thalassemia Intermedia
c. β Thalassemia Trait
d. β Thalassemia Minor

Answer 43

a. β Thalassemia Major

Question 44

A 26-year-old female was referred for gum bleeding accompanied by heavy menstrual bleeding for the last 6 days. CBC showed Hg 9.7g/dL, WBC 11,000, platelet 25,000 and peripheral blood smear showed large platelets, normocytic hypochromic anemia. Initial management given was Prednisone at 1mg/kg/day however there was persistence of bleeding and low platelet. The next management would be:
a. Belimumab therapy
b. Infliximab therapy
c. Intravenous immunoglobulin therapy
d. Methotrexate therapy

Answer 44

c. Intravenous immunoglobulin therapy

Question 45

This is the major cause of morbidity and the second leading cause of death in hemophilia patients receiving clotting factor concentrates:

a. Hepatitis B virus
b. Hepatitis C virus
c. HIV
d. Tuberculosis

Answer 45

b. Hepatitis C virus

Question 46

This is an important co-factor for the y-carboxyglutamic acid residues on coagulation proteins:
a. Carboxylase
b. Epoxide reductase
c. Glutamic acid
d. Vitamin K

Answer 46

d. Vitamin K

Question 47

A 69-year-old male came in due to body pains for the last 3 weeks prompting patient for NSAID use. On further examination he is febrile 38.9C, pale, clear breath sounds, tender hypogastric area; with tender upper and lower limbs, no arthritis. His Hg 8.5, WBC 5.4, platelet 102,000; creatinine 2.1mg/dL, Total calcium 11.2 and urinalysis showed proteinuria +2, WBC >50, RBC 0-2. The likely organism to cause his current infection associated with his condition is:
a. Campylobacter sp
b. Eschericia coli
c. Pseudomonas sp
d. Streptococcus pneumoniae

Answer 47

b. Eschericia coli

Question 48

Features responsible for high progression from smoldering multiple myeloma to multiple myeloma include bone marrow plasmacytosis >10%, abnormal kappa/lamda free light chain ratio, and ___:
a. < 20 g/L hemoglobin, below the lower limit of normal
b. > 177umol/L serum creatinine
c. >30g/L (3g/dL) serum M protein
d. ≥ 200mg per 24h urinary monoclonal protein

Answer 48

c. >30g/L (3g/dL) serum M protein

Question 49

Individuals with blood type O have:
a. A more severe malaria
b. Enhanced susceptibility to Helicobacter pylori
c. Higher procoagulation phenotype
d. Less susceptibility to cholera bacillus

Answer 49

b. Enhanced susceptibility to Helicobacter pylori

Question 50

A 65-year-old female came in due to non-productive cough, progressive shortness of breath, facial and right upper extremity swelling, visible collateral veins on anterior chest wall. Chest X-ray revealed a large mediastinal mass. Which of the following is correct about the case?

a. Symptoms decrease in severity when lying down
b. The presence of breast edema would point to the possibility of a breast primary
c. Right-sided pleural effusion is seen in majority of patients with effusions being mostly exudative and occasionally chylous
d. The occurrence of seizure should point to the possibility of brain metastases rather than cerebral edema from venous occlusion

Answer 50

d. The occurrence of seizure should point to the possibility of brain metastases rather than cerebral edema from venous occlusion

Question 51

A 54-year-old woman diagnosed with Stage IV breast cancer now complains of lower back pain with point tenderness at the level of T12. She mentions that the pain developed 2 weeks ago and becomes worse when coughing or sneezing, and when lying supine. What is your next step in the management of this patient? a. Refer patient for radiotherapy and start patient on glucocorticoids
b. Request for a thoracolumbar MRI
c. Request for a plain spine X-ray
d. In the absence of neurologic signs and symptoms, continue to observe patient and give pain relievers

Answer 51

b. Request for a thoracolumbar MRI

Question 52

Which of the following biochemical findings is expected with Tumor Lysis Syndrome? a. Hypophosphatemia
b. Hypokalemia
c. Hypocalcemia
d. Hypomagnesemia

Answer 52

c. Hypocalcemia

Question 53

A 54-year-old male, non-smoker, comes to your clinic asking about genetic predisposition to lung cancer as one of his maternal cousins was recently diagnosed with lung cancer. What will you tell him about his genetic predisposition for lung cancer?

a. He may be at two-fold increased risk of lung cancer
b. Suggest to him screening for established inherited gene mutations associated with lung cancer
c. Being a non-smoker, his susceptibility to lung cancer is increased presence of a germline mutation called T790Ma
d. His risk of inherited lung cancer can be determined using established molecular criteria

Answer 53

c. Being a non-smoker, his susceptibility to lung cancer is increased presence of a germline mutation called T790Ma

Question 54

A 50-year-old female, non-smoker patient diagnosed with NSCLC who underwent chemotherapy and radiation therapy the previous year presented with disease progression. The patient turned out to be positive with anaplastic lymphoma kinase translocation. Which of the following can be given to the patient?

a. Alectinib
b. Dabrafenib
c. Osimertinib
d. Erlotinib

Answer 54

a. Alectinib

Question 55

1. E.F. a 45 year old female is referred to you because of microcytic hypochromic anemia. On history, you note that she has a history of menses lasting 10 days per month, necessitating a change in pad every 2 hours during the first 4-5 days. Your consideration is iron deficiency anemia. Which of the following results are expected in a patient with iron deficiency anemia (p.685, Figure 93-2, Must know, Recall, Moderately difficult)

a. Serum ferritin 320µg/dL
b. Serum iron 62µg/dL
c. Total iron binding capacity 420µg/dL
d. Transferrin saturation 32%

Answer 55

c. Total iron binding capacity 420µg/dL

Question 56

You start E.F. on oral iron however she is unable to tolerate it. You decide to start parenteral iron therapy. Her hemoglobin is 8g/dL, she weighs 45kg, and you decide to add 1000mg for iron stores. What is the calculated amount of iron needed (p.687, Must know, Recall, Easy)

a. 2032.8mg
b. 1724.5mg
c. 1654.3mg
d. 1443.5mg

Answer 56

b. 1724.5mg

Question 57

Which of the following is an acquired hemolytic anemia with intracorpuscular defects (p. 709, Table 96-1, Must know, Recall, Moderately difficult)

a. Atypical hemolytic uremic syndrome
b. Autoimmune hemolytic anemia
c. Microangiopathic hemolytic anemia
d. Paroxysmal nocturnal hemoglobinuria

Answer 57

d. Paroxysmal nocturnal hemoglobinuria

Question 58

Which of the following drugs carry a definite risk of clinical hemolysis in persons with glucose 6-phosphate dehydrogenase deficiency (p. 716, Must know, Recall, Moderately difficult)

a. Cotrimoxazole
b. Quinine
c. Chloramphenicol
d. Ciprofloxacin

Answer 58

a. Cotrimoxazole

Question 59

L.M a 35 year old female presents with epistaxis and heavy menstrual bleeding. Work up reveals pancytopenia. Bone marrow biopsy reveals a hypocellular marrow with mainly fat, Hematopoietic cells occupy <5% of the marrow space. No cytogenetic abnormalities are noted on karyotyping. What is your treatment of choice (p.727, Must know, Problem-solving, Easy)

a. High dose glucocorticoids
b. Eltrombopag
c. Hematopoietic stem cell transplant
d. Antithymocyte globulin

Answer 59

c. Hematopoietic stem cell transplant

Question 60

A 20-year-old medical student came to the emergency room because of a 1-week history of easy bruisability and gum bleeding. He denied fever, joint pains, rashes, and weight loss. PE showed stable vital signs with essentially unremarkable examination except for oral mucosal hemorrhage and petechia over the upper and lower extremity. His laboratory results showed the following: CBC Hg 14.1 g/dL, Hct 42, WBC 7.8 , Neutrophils 72%, Lymphocytes 20%, monocytes 8%, platelets 21 x 10^9/L. Prothrombin time 12.1 seconds (range 12.2-15.3 seconds), PTT 36.3(23.6-34.8 seconds). Peripheral blood smear showed normocytic normochromic RBCs, adequate WBCs with predominance of neutrophils, platelets are decreased. Serum creatinine 0.5 mg/dL, ANA-IF negative, HIV screening nonreactive, Hepatitis profile unremarkable. Which of the following will be the best management for his case? (HPIM Chapter 115)

A. Transfuse 1 unit per 10kg body weight random platelets
B. Start Prednisone 1mg/kg PO
C. Start eltrombopag 50mg/tab 1 tab BID PO
D. Infuse IVIg 1-2g/day for 5 days

Answer 60

B. Start Prednisone 1mg/kg PO

Question 61

This medication is an antiVWF nanobody which decreases mortality and burden of care for patients with ADAMTS13 <10%. (HPIM Chap 115)

A. Caplacizumab
B. Emicizumab
C. Eculizumab
D. Pembrolizumab

Answer 61

A. Caplacizumab

Question 62

This new drug is effective in patients with severe hemophilia A with or without inhibitors. It is an asymmetric bispecific antibody with one immunoglobulin variable chain region that binds FIXa and another that binds FX bringing them in close contact resulting in activation of FX by FIXa. FXa subsequently cleaves prothrombin to thrombin without the need for FVIII (HPIM Chapter 116)

A. Caplacizumab
B. Emicizumab
C. Eculizumab
D. Pembrolizumab

Answer 62

B. Emicizumab

Question 63

This blood product contains ~80 IU of FVIII and should be used only in emergencies when factor concentrates are not available (HPIM Chapter 116)

A. Fresh frozen plasma
B. Random platelets
C. Cryoprecipitate
D. Cryosupernate

Answer 63

C. Cryoprecipitate

Question 64

AB is a 47-year-old male, diabetic kidney disease s/p kidney transplant, living-related donor (2018), was referred to hematology for evaluation of hematuria. The patient is currently Day 4 intubated because of high-risk pneumonia and has been noted to have decreasing urine output. The patient’s medications before admission were as follows: Prednisone 5mg 1 tab OD, tacrolimus 1mg 1 tab BID, mycophenolate mofetil 500mg 1 tab TID, carvedilol 6.25mg 1 tab BID, linagliptin 5mg 1 tab OD. His labs are as follows:

CBC: Hg 91 g/L, hct 31.1, MCV 93, WBC 16.7, N92, L8, platelets 42 x 10^9/L; PT 21.1 (Range 12.2-14.5 seconds), PTT 54 seconds (Range 32.4- 36.4 s), creatinine 2.1 mg/dL, Na 131, K 4.8, SGPT 51, serum fibrinogen 1.1 (NV 2-4 ug/L), fibrin degradation product 21 (NV < 10mg/L), D-dimer2.2 (NV < 0.5mg/L)

Whole abdominal ultrasound: liver,spleen, pancreas, kidneys unremarkable, note of cystitis
Peripheral blood smear reviewed: Mostly normocytic normochromic RBCS, with few schistocytes, 2+ burr cells and echinocytes, no nucleated RBCS. WBC are increased with neutrophilic predominance, with plenty of toxic granulations in neutrophilic cytoplasm, platelets are decreased.

What is your treatment of choice for AB’s case (Chapter 116)?

A. Start dexamethasone
B. Give supportive platelet transfusion and FFP transfusion
C. Start low-continuous infusion heparin
D. Start tranexamic acid

Answer 64

B. Give supportive platelet transfusion and FFP transfusion

Question 65

A 56/M was referred to you or pre-employment clearance due to an elevated hemoglobin of 170 g/L. A serum EPO level was done showing increased result. What is the appropriate next step (Chapter 59: Anemia and Polycythemia, Figure 59-18, Page 393)?

A. Request for JAK2 mutation assay
B. Measure arterial oxygen saturation
C. Do bone marrow aspirate and biopsy
D. Clear patient without further need for workup

Answer 65

B. Measure arterial oxygen saturation

Question 66

In which hematologic malignancy is prophylactic CNS-directed therapy essential? (Chap 102 p. 760)

A. Acute lymphoblastic leukemia
B. Chronic myeloid leukemia
C. Diffuse large B cell lymphoma
D. Multiple myeloma

Answer 66

A. Acute lymphoblastic leukemia

Question 67

A 63/M was referred due to jaundice and back pain. He has been admitted to the hospital 4 times in the past 3 months due to recurrent pneumonia. PE findings were multiple cervical lymphadenopathies and a palpable spleen. His labs showed hgb 62, hct 21, WBC 48, Ne 15, Lym 80, Mo 2, Eo 3, plt 40, retic count 8%. What is the most likely diagnosis? (pp 766-767)

A. Acute myeloid leukemia
B. Chronic myeloid leukemia
C. Chronic lymphocytic leukemia
D. Multiple myeloma

Answer 67

C. Chronic lymphocytic leukemia

Question 68

Which of the following substances is a critical initiator of angiogenesis in cancer cells? (Ch 68 p. 476)

A. P53
B. IL-6
C. RANKL
D. VEGF

Answer 68

D. VEGF

Question 69

Which of the following chemotherapeutic agents is an anti-mitotic drug known to cause neurologic side effects? (Ch 69 Table 69-4, pages 487-489)

A. Fludarabine
B. 5-fluorouracil
C. Vincristine
D. Mitoxantrone

Answer 69

C. Vincristine