Hematology / Oncology

Question 1

Four causes of microcytic anemia

Answer 1

TICS: Thalassemia, Iron deficiency, anemia of Chronic disease, and Sideroblastic anemia

Question 2

An elderly man with hypochromic, microcytic anemia is asymptomatic. Diagnostic tests?

Answer 2

Fecal occult blood test and sigmoidoscopy; suspect colorectal cancer

Question 3

Precipitants of hemolytic crisis in patients with G6PD deficiency

Answer 3

Sulfonamides, antimalarial drugs, fava beans

Question 4

The most common inherited cause of hypercoagulability

Answer 4

Factor V Leiden mutation

Question 5

The most common inherited bleeding disorder

Answer 5

von Willebrand disease

Question 6

The most common inherited hemolytic anemia

Answer 6

Hereditary spherocytosis

Question 7

Diagnostic test for hereditary spherocytosis

Answer 7

Osmotic fragility test

Question 8

Pure RBC aplasia

Answer 8

Diamond-Blackfan amnesia

Question 9

Anemia associated with absent radii and thumbs, diffuse hyperpigmentation, cafe au lait spots, microcephaly, and pancytopenia

Answer 9

Fanconi anemia

Question 10

Medications that lead to aplastic anemia?

Viruses that do so?

Answer 10

Medications: Chloramphenicol, sulfonamides, chemotherapeutic agents, radiation
Viruses: HIV, Hepatitis, Parvovirus B19, EBV

Question 11

How to distinguish polycythemia vera from secondary polycythemia

Answer 11

Polycythemia vera should have normal O2 saturation and low EPO levels. (Both have increased hematocrit and RBC mass).

Question 12

Pentad of thrombotic thrombocytopenic purpura (TTP)? Treatment?

Answer 12

Pentad: FAT RN: Fever, Anemia, Thrombocytopenia, Renal dysfunction, Neurologic abnormalities

Treatment: Emergent large-volume plasmapheresis, corticosteroids, and antiplatelet drugs. Platelet transfusion is CONTRAindicated!

Question 13

Triad of hemolytic-uremic syndrome?

Answer 13

Anemia, thrombocytopenia, and acute renal failure

Question 14

Treatment for idiopathic thrombocytopenic purpura (ITP) in children?

Answer 14

Usually resolves spontaneously; may require IVIG and/or corticosteroids

Question 15

Which of the following are increased in DIC: fibrin split products, D-dimer, fibrinogen, platelets, and hematocrit?

Answer 15

Elevated: Fibrin split products and D-dimer
Decreased: Platelets, fibrinogen, and hematocrit

Question 16

An 8 year old boy presents with hemarthrosis and elevated PTT with normal PT and bleeding time. Diagnosis? Treatment?

Answer 16

Diagnosis: Hemophelia A or B
Treatment: Consider desmopressin (for hemophelia A) or factor VIII or IX supplements

Question 17

A 14 year old girl presents with prolonged bleeding after dental surgery and with menses, normal PT, normal or increased PTT, and increased bleeding time. Diagnosis? Treatment?

Answer 17

Diagnosis: von Willebrand disease
Treatment: Desmopressin, FFP, or cryoprecipitate

Question 18

A 60 year old African American man presents with bone pain. What might a workup for multiple myeloma reveal?

Answer 18

Monoclonal gammopathy, Bence Jones proteinuria, and “punched out” lesions on radiographs of the skull and long bones

Question 19

Condition associated with Reed-Sternberg cells

Answer 19

Hodgkin lymphoma

Question 20

A 10 year old boy presents with fever, weight loss, and night sweats. Examination shows an anterior mediastinal mass. Suspected diagnosis?

Answer 20

Non-Hodgkin lymphoma

Question 21

Microcytic anemia with decreased serum iron, decreased total iron binding capacity (TIBC), and normal or elevated ferritin?

Answer 21

Anemia of chronic disease

Question 22

Microcytic anemia with decreased serum iron, decreased ferritin, and increased TIBC?

Answer 22

Iron deficiency anemia

Question 23

An 80 year old man presents with fatigue, lymphadenopathy, splenomegaly, and isolated lymphocytosis. What is the suspected diagnosis?

Answer 23

Chronic lymphocytic leukemia (CLL)

Question 24

Patient with fatigue is found to have a decreased hemoglobin and increased mean corpuscular volume. What are the potential causes of this anemia?

Answer 24

Decreased B12 (pernicious anemia, vegetarian diet, Crohn ds/GI disorders), or decreased folate (e.g. in alcoholics)

Question 25

A late, life-threatening complication of chronic myelogenous leukemia (CML)

Answer 25

Blast crisis (fever, bone pain, splenomegaly, pancytopenia)

Question 26

Auer rods on blood smear

Answer 26

Acute myelogenous leukemia (AML)

Subtypes M2 (acute myeloid leukemia with granulocytic maturation) and M3 (acute promyelocytic leukemia

Question 27

AML subtype associated with DIC? Treatment?

Answer 27

Subtype: M3 (acute promyelocytic leukemia)
Treatment: Retinoic acid

Question 28

Electrolyte changes in tumor lysis syndrome

Answer 28

Elevated potassium, phosphate, and uric acid

Decreased calcium.

Question 29

A 50 year old man presents with early satiety, splenomegaly, and bleeding. Cytogenetics show t(9;22). Diagnosis?

Answer 29

CML

Question 30

A patient on chemotherapy service with an absolute neutrophil count (ANC) of 1,000 is noted to have a fever of 38.8 C (102.1 F). Next best step?

Answer 30

Neutropenic fever is a medical emergency. Start broad-spectrum antibiotics.

Question 31

Virus associated with aplastic anemia in patients with sickle cell anemia

Answer 31

Parvovirus B19

Question 32

A 25 year old African American man with sickle cell anemia has sudden onset of bone pain. Management of pain crisis?

Answer 32

Oxygen, analgesia, hydration, and if severe transfusion

Question 33

A significant cause of morbidity in thalassemia patients?

Treatment?

Answer 33

Cause: Iron overload
Treatment: Deferoxamine