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Clin Med 3 > Hematology Oncology Pack Rat Questions > Flashcards

Hematology Oncology Pack Rat Questions Flashcards

1
Q

Which of the following is the treatment of choice for polycythemia vera?

A. Oral steroids
B. Phlebotomy
C. Antiplatelet agents

D. Iron supplementation

A

B. The treatment of choice is phlebotomy, removing one unit of blood weekly until the Hct is less than 45%.

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2
Q

A patient presents with a macrocytic anemia and paresthesia of the lower extremities. The treatment of choice is

A. phenytoin.

B. gabapentin.

C. cobalamin.

D. folate.

A

C. The patient presents with laboratory findings and symptoms of Vitamin B12 deficiency. The treatment of choice is cobalamin.

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3
Q

What is the most common hypercoagulable state?

A. Factor V Leiden
B. Protein C deficiency
C. Protein S deficiency
D. Antithrombin III Deficiency

A

A. Factor V Leiden is the most common inherited hypercoagulable states with about 2-5% of the population affected.

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4
Q

A patient presents to the office for routine examination. Initial labs reveal a Hgb of 8.5 mg/dL and Hct of 26%, MCV 66 fL, and RDW 12.1. Peripheral blood smear shows numerous target cells. Based upon these findings what would be the next laboratory test to order?

A. Hemoglobin electrophoresis

B. Serum ferritin
C. Serum vitamin B12
D. Serum lead level

A

A. The findings of target cells on the peripheral blood smear indicate that a hemoglobinopathy exists. To confirm what type of hemoglobinopathy exists an electrophoresis should be done.

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5
Q

A 6 year-old male presents with hemarthrosis of the left knee. Coagulation studies reveal the following results: PT 12.5 seconds (normal range 12-14 seconds), INR 1.0, aPTT 58 seconds (normal range 18-28 seconds), platelet count 430,000/microliter (normal range 150,000-450,000/microliter), and bleeding time 4 minutes (normal range 2-12 minutes). Which of the following is the best treatment option for this patient?

A. Desmopressin acetate

B. Corticosteroids
C. Vitamin K
D. Cryoprecipitate

A

D.Hemophilia A presents with a prolonged aPTT and normal platelet count and function. Hemophilia A is treated

with factor VIII concentrate or cryoprecipitate.

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6
Q

An 18 year-old woman presents to the clinic complaining of fatigue. She reports a past history of lifelong frequent nosebleeds and bleeding gums. She also has menorrhagia. Her mother and maternal grandfather have a similar bleeding history. Initial lab results are as follows: WBC 9,500/mm3, Hgb 10.9 g/dL, HCT 33%, MCV 69 fL, MCHC 26 pg and platelets 284,000/mm3. Which of the following tests should be ordered to evaluate this patient’s diagnosis?

A. Hemoglobin electrophoresis
B. Bleeding time and platelet aggregometry

C. Bone marrow aspiration
D. PT and aPTT

A

B. The patient’s presentation is consistent with a congential qualitative platelet disorder, most likely von

Willebrand’s Disease, necessitating a bleeding time and evaluation of platelet function.

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7
Q

Which of the following physical findings suggest pernicious anemia?

A. Splenomegaly and hepatomegaly
B. Petechiae and ecchymosis
C. Loss of position and vibratory sensation

D. Cheilosis and koilonychia

A

C. Loss of position and vibratory sensation are common neurologic findings in pernicious anemia.

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8
Q

Which of the following therapies is recommended for a 13 month-old child with sickle cell disease?

A. Folic acid and penicillin V
B. Ferrous sulfate and penicillin V
C. Folic acid and ferrous sulfate
D. Folic acid, ferrous sulfate and penicillin V

A

A. Patients with sickle cell disease should receive prophylactic penicillin V starting at 2 months of age and folic acid starting at 1 year of age. Ferrous sulfate is not globally recommended for patients with sickle cell disease.

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9
Q

A 29 year-old patient with idiopathic thrombocytopenia purpura (ITP) is treated with prednisone therapy. Despite therapy, platelet counts remain consistently below 20,000/microliter over the course of 6 weeks. Which of the following is the most appropriate intervention for this patient?

A. Aspirin
B. Intravenous immunoglobulin

C. Danazol (Danocrine)
D. Splenectomy

A

D. Persistently low platelet counts (< 20,000) require effective long-term treatment, and splenectomy is the treatment of choice.

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10
Q

A defect in which of the following physiologic processes can lead to the development of a microcytic, hypochromic anemia?

A. Hemoglobin production
B. IgG antibody formation
C. Red blood cell nuclear maturation

D. Red blood cell membrane defects

A

A. A deficiency in substances required for hemoglobin synthesis result in RBCs with a deficient mean corpuscular hemoglobin concentration and usually microcytosis.

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11
Q

Which of the following leukemias is most closely associated with the Philadelphia chromosome?

A. hairy cell
B. acute lymphocytic

C. acute myelocytic

D. chronic myelocytic

A

D. Philadelphia chromosome is noted most commonly in patients with chronic myelogenous leukemia.

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12
Q

A 35 year-old female presents with fatigue. CBC results reveal the following:

WBC: 6,300/microliter Hgb: 9.5 g/dl
Hct: 28%
MCV: 75 fL

MCHC: 32 g/dl
MCH: 24 pg Platelets: 550,000/mL

Which of the following is the best treatment option for this patient?

A. folic acid
B. vitamin B12

C. prednisone
D. ferrous sulfate

A

D. Iron deficiency anemia is a microcytic, hypochromic anemia and is treated with ferrous sulfate.

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13
Q

A 13 year-old male with sickle cell trait is interested in playing football for his school. Which of the following considerations should be reviewed with the patient and his parents?

A. avoid dehydration
B. avoid all contact sports
C. begin daily use of aspirin
D. begin hydroxyurea supplements

A

A. No restriction of sports activity is required of patients with sickle cell trait. Hydration is required in all sports activities.

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14
Q

A 26 year-old female required 12 units packed red blood cells during a trauma resuscitation and surgical repair of liver and splenic lacerations. The patient is now 6 hours postoperative and has blood oozing from the suture line and IV sites. There is bloody urine in the Foley bag. Laboratory evaluation demonstrates a platelet count of 10,000/microliter, prolonged prothrombin level, and the presence of fibrin split products. Which of the following is the most likely diagnosis?

A. acute ABO incompatibility reaction
B. disseminated intravascular coagulation
C. exacerbation of idiopathic thrombocytopenia

D. inadequate repair of the liver lacerations

A

B. Disseminated intravascular coagulation is characterized by bleeding from many sites as all coagulation factors are consumed and then broken down, leading to decreased fibrinogen level and platelet count, prolonged PT and PTT, and presence of fibrin split products.

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15
Q

A 26 year-old male presents with a four week history of fatigue, night sweats, and a painless mass in his neck. Physical examination confirms the presence of an enlarged right posterior cervical lymph node. What is the next best step in the evaluation of this patient?

A. bone marrow biopsy and aspiration

B. lymph node biopsy
C. chest CT scan
D. reexamine in 2-4 weeks

A

B. This patient presents with possible lymphoma. Diagnosis is made by lymph node biopsy. Bone marrow biopsy and CT scan of the chest are used for staging of the disease.

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16
Q

Absorption of vitamin B12 requires intrinsic factor that is secreted by which of the following?

A. parietal cells
B. chief cells
C. mucous cells
D. enteroendocrine cells

A

A. Parietal cells are responsible for acid secretion and intrinsic factor.

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17
Q

A 55 year-old non-smoking male presents with a hemoglobin of 18.5 g/dl and a hematocrit of 56%. Which of the following physical examination findings is the most likely to be noted with this patient?

A. splenomegaly
B. cheilosis
C. purpura
D. decreased vibratory sense

A

A. Patients with polycythemia vera present with elevated hemoglobin and hematocrit. On physical examination plethora, engorged retinal veins, and splenomegaly are common.

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18
Q

Normal hemoglobin A is made of what combination of heme and globin chains?

A. 2-alphas and 2-betas
B. 4-gammas
C. 2-alphas and 2-gammas

D. 4-betas

A

A. Hemoglobin A1 is composed of two alpha and two beta chains.

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19
Q

What examination finding would be expected in a patient with von Willebrand disease?

A. Gingival bleeding

B. Splenomegaly
C. Muscle weakness

D. Hemarthrosis

A

A. A patient with von Willebrand disease most commonly presents with mucosal bleeding seen in epistaxis, gingival bleeding, and menorrhagia.

20
Q

A 56 year-old male is noted to have a recent diagnosis of polycythemia vera. His current hemoglobin is 21 gms/dl. What treatment should be instituted for this patient at this time?

A. Phlebotomy
B. Iron chelation therapy
C. Bone marrow radiation therapy

D. Normal saline IV hydration

A

A. This patient has a diagnosis of polycythemia vera treatment begins with phlebotomy instituted on a weekly basis until the hematocrit is less than 45%. Maintainance of the hematocrit at 45% is achieved with repeated phlebotomy as necessary.

21
Q

A positive osmotic fragility test is seen in which of the following?

A. G6PD deficiency
B. Sickle cell anemia
C. Hereditiary spherocytosis
D. Autoimmune hemolytic anemia

A

C. Hereditary spherocytosis will have a positive osmotic fragility test secondary to a defective red blood cell membrane.

22
Q

An adult patient who has undergone a splenectomy secondary to idiopathic thrombocytopenic purpura should receive which prophylactic agent?

A. Bicillin 1.2 million units IM every month

B. Pneumococcal vaccine IM one time only

C. Gamma globulin IM every month
D. Hepatitis B vaccine IM series

A

B. Pneumococcal vaccine should routinely be given to all patients who undergo splenectomy for prophylaxis to Streptococcal pneumoniae.

23
Q

A 48 year-old male complains of weakness and general malaise for about 2 months. Patient denies any recent illness and does not take any medications. Physical examination reveals a pale looking male in no acute distress. His heart rate is 110 beats/minute without a murmur and his abdominal examination reveals hepatosplenomegaly. A CBC reveals the WBC to be 62,000/microliter, Hgb is 8.3 gms/dl, Hct is 24.6%. A differential reveals a predominance of monoblasts and promyelocytes with Auer rods present. What is the most likely diagnosis?

A. Acute lymphocytic leukemia
B. Acute myelogenous leukemia

C. Chronic lymphocytic leukemia

D. Chronic myelogenous leukemia

A
24
Q

B. Acute myelogenous leukemia (AML) is a leukemia that presents in adults with a cell lineage of the immature granulocytic cells seen in the peripheral blood e.g. myeloblasts, promyelocytes. Auer rods are commonly seen in this condition.

A
25
Q

A patient with a history of multiple trauma has received a combination of 12 units of packed red blood cells and whole blood while in the emergency department. Later that night it is noted that the patient is beginning to ooze blood from sites of injury and needle punctures. Which of the following is the most appropriate intervention?

A. Continue transfusions of packed red blood cells

B. Fresh frozen plasma
C. Albumin
D. Factor VIII concentrate

A

B. When a patient receives more than one total blood volume (10 units) without replacement of clotting factors, the patient will continue to bleed without administration of fresh frozen plasma.

26
Q

A positive direct Coombs’ test may be seen in which of the following conditions?

A. G6PD deficiency
B. Sickle cell anemia
C. Hereditary spherocytosis

D. Autoimmune hemolytic anemia

A

D. A positive direct Coombs’ test indicates that antibody has attached to an antigen on the RBC which causes agglutination. Autoimmune hemolytic anemia results when the patient has antibodies against their own RBCs. G6PD deficiency does result from an antibody antigen reaction. Sickle cell anemia is caused by a defective hemoglobin which detected by hemoglobin electrophoresis. Hereditary spherocytosis is detected utilizing the osmotic fragility test.

27
Q

A female patient presents with weakness and fatigue for the past three months. A CBC was ordered and revealed the following values:

RBC 3.8 X 10(6)mcL (4.7-6.1 x 10(6)mcL) HCT 27% (35-45%)
Hgb 9.2 gms/dL (12-15.5 gms/dL)
MCV 120 fL (80-100 fL)

MCH 35 pg (26-34 pg)

On physical examination which of the following would be a consistent finding for this type of anemia?

A. Paresthesia of the hands and feet
B. Hepatosplenomegaly
C. Tachycardia

D. Jaundice

A

A. Neurological manifestation is the earliest type most commonly seen with megaloblastic anemia most commonly from vitamin B12 deficiency.

28
Q

A 69 year-old female presents to the clinic complaining of fatigue. Physical examination reveals lymphadenopathy, splenomegaly and pale conjunctiva. The remainder of the examination is unremarkable. CBC reveals a normochromic normocytic anemia. White blood cell count is 45,000/mm3, with a differential of 77% mature lymphocytes, 3% eosinophils, 18% segmented neutrophils and 1% basophils and monocytes. Platelets appear adequate in number. What is the most likely diagnosis?

A. Acute myelocytic leukemia

B. Acute lymphocytic leukemia

C. Chronic lymphocytic leukemia

D. Chronic myelocytic leukemia

A

C. Chronic lymphocytic leukemia typically occurs after age 50 presenting with lymphocytosis with lymphocytes that appear small and mature.

29
Q

Adult patients with a compromised immune system should not receive which of the following immunizations?

A. Hepatitis A
B. Pneumococcal
C. Influenza

D. Varicella

A

D. Varicella vaccine is a live vaccine and is contraindicated in those individuals with a compromised immune system. Hepatitis A, pneumococcal and influenza are recommended for patients with a compromised immune system.

30
Q

A 21 year-old male with a diagnosis of type 1 von Willebrand disease undergoes dental extraction of his wisdom teeth. The patient comes to the clinic with continued oozing of the dental sockets despite packing. Treatment should begin with which of the following?

A. DDAVP
B. Factor VIII
C. vWF concentrate

D. FFP

A

A. DDAVP causes the release of vWF and factor VIII from storage sites significantly which is needed to complete hemostasis. Factor VIII is indicated for patients with Hemophilia A. Fresh frozen plasma is indicated in Coumadin overdosage and vWF concentrate is indicated in type 2 and 3 patients with von Willebrand disease.

31
Q

A patient receiving heparin therapy for 6 days for deep vein thrombosis develops thrombosis at the IV site. The INR is 1.1. The aPTT is 66 seconds and the platelet count is 47,000 down from 148,000 on admission. Which of the following is the most appropriate treatment?

A. Protamine sulfate administration
B. Platelet administration
C. Discontinue the heparin
D. Schedule the patient for plasmapheresis

A

C. Once the diagnosis of heparin induced thrombocytopenia is suspected treatment should include immediate discontinuation of all forms of heparin and treatment with a direct thrombin inhibitor should begin. Platelet administration is generally not indicated. Protamine sulfate is used for heparin overdosage and plasmapheresis would not be indicated as the platelet count will resume when the heparin is discontinued.

32
Q

Which of the following conditions is caused by a disorder in the red blood cell membrane?

A. G6PD deficiency
B. Folate deficiency
C. Sickle cell anemia

D. Hereditary spherocytosis

A

D. The cell membrane defect of spherocytosis leads to hemolysis due to trapping of the cells by the spleen.

33
Q

A 68 year-old male with a history of atrial fibrillation treated with warfarin (Coumadin) presents to the emergency department after vomiting large amounts of bright red blood. INR is 3. Which of the following is most appropriate to rapidly lower the patient’s INR?

A. Discontinue warfarin

B. Administer fresh frozen plasma

C. Administer protamine sulfate

D. Administer heparin sulphate

A

B. Fresh frozen plasma is the most rapid way to lower the patient’s INR.

34
Q

Which of the following Rh genotypes in a mother and father would represent a risk for hemolytic disease of the newborn?

A. Mother Rh-positive, father Rh-negative

B. Mother Rh-positive, father Rh-positive

C. Mother Rh-negative, father Rh-positive

D. Mother Rh-negative, father Rh-negative

A

C. If an Rh-negative woman carries an Rh-positive fetus, she may develop antibodies against Rh when fetal blood cells enter her circulation.

35
Q

Low molecular weight heparin (LMWH) dosage is based on which of the following?

A. Weight

B. International normalized ratio (INR)

C. Prothrombin time (PT)

D. Partial thromboplastin time (PTT)

A

A. LMWH is based on a patient’s weight in kilograms.

36
Q

An African American male is placed on hydroxychlorquine (Plaquenil) for travel to Africa. Within six weeks he presents complaining of fatigue. CBC shows anemia. Which of the following is the diagnostic study of choice in this patient?

A. Peripheral smear

B. G6PD assay

C. Total iron binding capacity

D. Hemoglobin electrophoresis

A

B. G6PD assay is the diagnostic study of choice for G6PD deficiency.

37
Q

A 52 year-old female is diagnosed with chronic myeloid leukemia (CML). Which of the following would you expect to find on physical examination of this patient?

A. Hepatomegaly
B. Splenomegaly
C. Posterior cervical lymphadenopathy

D. Inguinal lymphadenopathy.

A

B. CML patients present with an enlarged spleen.

38
Q

A 27 year-old male nonsmoker is diagnosed with upper extremity venous thrombosis. What is the most likely factor abnormality found in this patient?

A. Factor VIII

B. Factor V

C. Factor I

D. Factor X

A

B. In young adults with otherwise unexplained thrombosis, factor V Leiden is the most common associated abnormality.

39
Q

A mean corpuscular volume (MCV) of less than 80 cubic microns is a manifestation of which of the following diagnoses?

A. Iron deficiency

B. Vitamin B12 deficiency

C. Folate deficiency

D. G6PD deficiency

A

A. Iron deficiency is associated with microcytic anemia.

40
Q

A 4 year-old female presents with a headache and new onset confusion. She was diagnosed with a viral illness 2 weeks ago. Examination reveals petechiae and mild scant purpura on her legs bilaterally. The CBC demonstrates a platelet count of 8,000/uL. Which of the following is the most appropriate next step in the assessment of this patient?

A. Lumbar puncture
B. D-dimer
C. PT and PTT
D. CT scan of the head

A

D. The concern for this patient is low platelets and internal bleeding. In this scenario, the patient complaining of a headache would warrant a CT scan to evaluate for an intracranial bleed.

41
Q

Which of the following physical examination findings is most likely in a patient with anemia, low factor VIII and a prolonged PTT?

A. Glossitis

B. Arthropathy

C. Deep vein thrombosis

D. Purpura

A

B. Hemarthrosis is likely in Factor VIII deficiency (Hemophillia A).

42
Q

Which of the following types of hemoglobin is responsible for the development of sickle cell anemia?

A. A
B. AS
C. F

D. SS

A

D. SS is the dominant hemoglobin found in sickle cell anemia.

43
Q

A 35 year-old female presents with fatigue and dyspnea on exertion. She has a history of increasingly heavy menstrual periods for the last 8 months. She denies change in stool. Examination reveals HR 102 bpm, TEMP 97.6 F, RESP 20, BP 100/60 mmHg, pallor and cheilosis. Peripheral smear demonstrates a hypochromic microcytic anemia and few target cells. Which of the following is the most likely diagnosis?

A. Iron deficiency anemia

B. Vitamin B12 deficiency

C. Thalassemia
D. Sickle cell anemia

A

A. Iron deficiency anemia is characterized by pallor and cheilosis and is commonly associated with menorrhagia. The peripheral smear will demonstrate hypochromic microcytic anemia and few target cells.

44
Q

A 33 year-old female 2 years status-post gastric bypass surgery presents to the office with complaints of generalized fatigue and paresthesias in her hands. Examination reveals pallor, mild glossitis and decreased vibratory sense. Which of the following laboratory tests is most diagnostic for her condition?

A. Serum ferritin

B. Serum vitamin B12

C. RBC with indices

D. Reticulocyte count

A

B. Vitamin B12 deficiency leads to neurologic symptoms of paresthesias, glossitis, and pallor. Gastric bypass surgery aids in malabsorption.

45
Q

A 13 year-old male presents with a two day history of fatigue and fever. He also complains of recent epistaxis and bleeding gums. Examination demonstrates pale skin with palpable purpura. Laboratory evaluation demonstrates pancytopenia with 42% blasts and a positive D-dimer. Which of the following treatment regimens is most likely to bring remission?

A. Single agent chemotherapy

B. Combination chemotherapy

C. Radiation therapy

D. Chemotherapy and radiation therapy

A

B. Combination chemotherapy is key in the treatment of acute lymphocytic leukemia and produces remission in 90% of patients.

46
Q

During the evaluation of a post motor vehicle accident patient who incurred blunt abdominal trauma, you notice a Grey-Turner’s sign. He undergoes corrective surgery. Which of the following is an appropriate preventive strategy for this patient?

A. Aspirin therapy

B. Pancreatic enzymes

C. Pneumococcal vaccine

D. Tdap vaccine

A

C. For a patient who has functional or anatomic asplenia, pneumococcal vaccine should be administered as the spleen is specifically responsible for combating infection by streptococcus pneumoniae.

47
Q

A patient presents complaining of new onset of repeated mottled and numb fingers when exposed to previously tolerated cold weather. The patient denies color changes or itching. ANA is negative. CBC reveals a mild anemia and rouleaux. Which of the following is the most likely diagnosis?

A. Cold agglutinin disease

B. Raynaud’s phenomena

C. Chilblains
D. Frostbite

A

A. Cold agglutinin disease presents with mottled and numb fingers after repeated cold exposure. CBC reveals a mild anemia and rouleaux.

Clin Med 3 (1 decks)

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