HemeOnc

Question 1

heme

Answer 1

Immune thrombocytopenic purpura can be idiopathic, triggered by medications, or associated with other disorders, such as systemic lupus erythematosus, chronic lymphocytic leukemia, lymphoma, HIV, hepatitis C, or Helicobacter pylori infection

no diagnostic test is available for immune-mediated thrombocytopenia

Question 2

heme

Answer 2

Patients who present with symptoms of mucocutaneous bleeding and a normal platelet count should be evaluated for acquired platelet dysfunction using the Platelet Function Analyzer-100.

Question 3

heme

Answer 3

Patients with a Pulmonary Embolism Severity Index score of less than 65 are at low risk of death and may be managed in the outpatient setting with a non–vitamin K antagonist oral anticoagulant, such as apixaban or rivaroxaban.

Dabigatran and edoxaban require bridging with parenteral anticoagulation, whereas apixaban and rivaroxaban can be used as monotherapy in the treatment of VTE.

Question 4

heme

Answer 4

Dabigatran and edoxaban require bridging with parenteral anticoagulation, whereas apixaban and rivaroxaban can be used as monotherapy in the treatment of VTE.

Question 5

Heme

Answer 5

Inflammatory anemia is usually mild to moderate in severity, characterized by low serum iron levels and total iron-binding capacity and elevated serum ferritin level, and usually requires no specific therapy.

Question 6

heme

Answer 6

In patients with myelodysplastic syndrome requiring frequent transfusions, supplemental treatments to help decrease transfusion requirements, such as lenalidomide, should be used to improve quality of life and decrease transfusion-associated iron overload and alloimmunization.

Treatment of MDS has two goals. The first goal is to relieve transfusion dependence; the second is to prevent transformation to acute myeloid leukemia (AML).

Question 7

heme

Answer 7

vHypereosinophilic syndrome is characterized by moderate eosinophilia and end-organ damage commonly involving the skin, lungs, gastrointestinal tract, and heart; secondary causes of eosinophilia should be excluded.

Question 8

heme

Answer 8

Fat pad biopsy is performed during evaluation for systemic amyloidosis. Amyloidosis involving the heart can cause restrictive heart disease.

Question 9

heme

Answer 9

The most appropriate management for this patient is clinical observation. He has hereditary spherocytosis (HS) characterized by a mild lifelong anemia in association with symptomatic cholelithiasis at an early age. The presence of spherocytes is supported by an elevated mean corpuscular hemoglobin concentration frequently seen in this disorder. HS is caused by mutations in several scaffolding proteins that make these cells less distensible and more susceptible to osmotic stress and hemolysis. Patients with this disorder may have mild anemia, an elevated reticulocyte response, and few or no symptoms. The development of pigmented gallstones resulting from excess bilirubin production may result in symptomatic cholelithiasis. Symptoms of anemia may arise when the bone marrow is suppressed, most commonly by an acute infection. In this situation, the reticulocyte count falls, and the patient rapidly develops symptomatic anemia. Parvovirus is most classically linked with bone marrow suppression, but many other viral and infectious agents can have a similar effect. The bone marrow suppression following acute infections is self-limited, but some patients may become symptomatic to the point of requiring blood transfusion.

Question 10

heme

Answer 10

Prednisone would be indicated to treat warm antibody autoimmune hemolytic anemia (WAIHA). Spherocytes are also seen in patients with WAIHA, but the direct antiglobulin test result would be positive. WAIHA would not explain the lifelong anemia in this patient.

Question 11

heme

Answer 11

Low-molecular-weight heparin is the anticoagulant of choice for patients with active cancer and a venous thromboembolism.

Question 12

heme

Answer 12

In the presence of normal Doppler studies of the lower extremities, ventilation-perfusion lung scanning is the initial lung imaging study to evaluate for pulmonary embolism in pregnant patients; D-dimer testing has no diagnostic role.

CT angiography, the gold standard in the diagnosis of PE in most patients, should not be the initial study in pregnant patients because of radiation exposure to both the mother and the fetus.

Question 13

HEME

Answer 13

Patients scheduled for elective surgery who have anemia should be evaluated for iron deficiency; preoperative management of iron deficiency anemia includes oral iron replacement and evaluation to determine the source of blood loss.

Preoperative anemia is associated with increased perioperative mortality in patients with cardiovascular disease; it is also a significant predictor for perioperative blood transfusion, which itself is associated with postoperative morbidity.

Question 14

HEME

Answer 14

Four-factor prothrombin complex concentrate should be used to reverse the effects of warfarin anticoagulation in patients experiencing severe bleeding and those requiring urgent surgery.

Question 15

HEME

Answer 15

Cryoprecipitate would be indicated to treat severe hypofibrinogenemia, usually arising as a consequence of disseminated intravascular coagulation (DIC) or severe liver disease

Question 16

Heme

Answer 16

In approximately 10% of patients in whom an unprovoked venous thromboembolism is diagnosed, cancer will be found within 1 year, so an age-appropriate screening test should be performed.

Question 17

Heme

Answer 17

pancytopenia, immature leukocytes with morphologic features consistent with promyelocytes, and laboratory features of disseminated intravascular coagulation (DIC), all of which are consistent with acute promyelocytic leukemia (APML).

APML looks like DIC with a low WBC

Question 18

Heme

Answer 18

In patients with IgG monoclonal gammopathy of undetermined significance, an M spike of less than 1.5 g/dL, and normal findings on serum free light chain assay and urine protein electrophoresis, the risk of progression is low, so extensive evaluation is not recommended.

follow-up in 6 months to 1 year with repeat serum protein electrophoresis, hemoglobin and calcium levels, and kidney function is appropriate

Question 19

Heme

Answer 19

In patients with multiple myeloma, hypogammaglobulinemia, and recurrent infections, intravenous immune globulin should be given to provide passive immunity against causative organisms.

Question 20

heme

Answer 20

A positive direct antiglobulin (Coombs) test will confirm a delayed hemolytic transfusion reaction, a diagnosis that should be considered in a patient with low-grade fever and features of hemolytic anemia after recent transfusion.

Question 21

heme

Answer 21

Cryoprecipitate is the treatment of choice for patients with bleeding and hypofibrinogenemia secondary to disseminated intravascular coagulation.

Question 22

heme

Answer 22

Parvovirus B19 infection preferentially affects erythrocyte precursors in the bone marrow, causing transient pure red cell aplasia in patients with sickle cell anemia.

Parvo affects only the red cells

Question 23

heme

Answer 23

Patients with essential thrombocythemia who are older than 60 years or who have had previous thromboembolic complications should be treated with aspirin and hydroxyurea.

Question 24

HEME

Answer 24

The most appropriate management for this patient is to discontinue dapsone. He most likely has glucose-6-phosphate dehydrogenase (G6PD) deficiency as a result of his dapsone therapy. He developed an acute hemolytic anemia, indicated by an acute reduction in the hemoglobin and haptoglobin levels and reticulocytosis, and the bite cells seen on the peripheral blood smear also suggest G6PD deficiency. A drug reaction should always be suspected in such settings

Question 25

heme

Answer 25

Diagnosis of amyloidosis requires biopsy of the affected organ and demonstration of characteristic apple-green birefringence with Congo red staining; fat pad biopsy is sometimes performed because it is less invasive.

Question 26

Heme

Answer 26

Patients with inflammatory bowel disease have difficulty absorbing oral iron to balance their increased iron loss from bleeding, so parenteral iron is an appropriate alternative for restoring iron stores.

severe iron deficiency and inflammatory bowel disease, which impairs iron absorption in the duodenum and proximal jejunum and commonly leads to increased gastrointestinal blood loss.

Question 27

heme

Answer 27

Waldenström macroglobulinemia is an indolent B-cell lymphoma with clonal lymphoplasmacytic infiltration of the bone marrow that secretes IgM in the blood, and a bone marrow biopsy will confirm the diagnosis.

For patients suspected of having a lymphoma, excisional biopsy of a lymph node is preferred to needle biopsy because it provides better architectural detail for distinguishing malignant from benign causes and for classifying the nature of the malignancy.

Question 28

heme

Answer 28

Atypical presentations of rheumatoid arthritis and osteoarthritis, particularly with hook-like osteophytes of the second and third metacarpophalangeal joints, suggest the possibility of hemochromatosis; evaluating the transferrin saturation and serum ferritin level should be considered.

atients with hemochromatosis have rheumatic symptoms that typically involve the small joints of the hand, especially the second and third metacarpophalangeal (MCP) joints associated with characteristic radiographic findings, including hook-like osteophytes.

Question 29

heme

Answer 29

Thrombolysis should be considered as the initial therapy for patients with iliofemoral deep venous thrombosis with acute limb ischemia.

Rivaroxaban, a non–vitamin K antagonist oral anticoagulant, is an accepted monotherapy for DVT (heparin not required).

Question 30

heme

Answer 30

In patients with severe symptomatic autoimmune hemolytic anemia, the autoantibody typically reacts against all erythrocytes, and a completely crossmatch-compatible unit may be impossible to find; these patients should receive ABO and Rh-matched blood even if it is not crossmatch compatible.

Question 31

heme

Answer 31

The International Myeloma Working Group recommends that all patients with smoldering multiple myeloma undergo whole body MRI to assess for lytic lesions.

The International Myeloma Working Group recommends that all patients with smoldering MM undergo whole body MRI (or spine and pelvic MRI if whole body MRI is not available). Whole body MRI is considered the gold standard for imaging of the axial skeleton, for the evaluation of painful lesions, and for distinguishing benign versus malignant osteoporotic vertebral fractures.

Question 32

heme

Answer 32

In patients with INR elevation and bleeding associated with warfarin administration, urgent reversal of anticoagulation should be accomplished using vitamin K and prothrombin complex concentrates.

Question 33

Heme

Answer 33

Secondary iron overload from chronic transfusions can be effectively treated with oral chelation agents, such as deferasirox.

In most cases, secondary iron overload occurs in patients with severe anemia who require chronic transfusion therapy. Because iron excretion has no regulated mechanism, multiple transfusions (for anemias not stemming from blood loss or iron deficiency) lead to iron overload, with subsequent secondary organ damage

Question 34

Heme

Answer 34

Patients with symptomatic anemia of chronic kidney disease may be treated with erythropoiesis-stimulating agents to reduce transfusion requirements with a target hemoglobin level of 11 to 12 g/dL (110-120 g/L) to avoid increased risk of adverse cardiovascular events.

Question 35

heme

Answer 35

Minor bleeding in patients taking a non–vitamin K antagonist oral anticoagulant can be managed by discontinuation of the anticoagulant alone without additional therapy.

Fresh frozen plasma has been used in patients experiencing major bleeding while taking a non–vitamin K antagonist oral anticoagulant, but it is not typically adequate monotherapy in patients experiencing severe bleeding; it is often combined with four-factor prothrombin complex concentrate (4f-PCC). However, neither fresh frozen plasma nor 4f-PCC would be necessary in this patient because she is hemodynamically stable,

Question 36

Heme

Answer 36

persons with sickle cell disease (SCD) should not receive transfusions unless they have significant symptoms or signs of end-organ failure from their anemia or are preparing for surgery.

Simple transfusion to achieve a hemoglobin level of 10 g/dL (100 g/L) in patients having low- to moderate-risk surgery reduces surgical complications equivalent to exchange transfusion with less risk and cost.

Question 37

Heme

Answer 37

Protein C or S deficiency is associated with warfarin-associated skin necrosis.

A family history of pulmonary embolism suggests the possibility of inherited protein C deficiency.

Question 38

Heme

Answer 38

Patients identified as low risk and meeting the Pulmonary Embolism Rule-Out Criteria do not require D-dimer testing to eliminate the need for further diagnostic imaging.

Question 39

Heme

Answer 39

Tyrosine kinase inhibitors such as imatinib are effective for initial treatment of chronic myeloid leukemia in the chronic phase.

he has chronic myeloid leukemia (CML) presenting in the chronic phase and requires therapy targeting the BCR-ABL fusion gene. Translocation of the long arm of chromosomes 9 and 22 leads to the fusion gene of BCR-ABL,

Question 40

heme

Answer 40

Diagnosis of paroxysmal nocturnal hemoglobinuria is based on flow cytometry results, which can detect CD55 and CD59 deficiency on the surface of peripheral erythrocytes or leukocytes.

Flow cytometry is the most appropriate test to perform next. This patient has pancytopenia with significant intravascular hemolysis and hemoglobinuria, most likely caused by paroxysmal nocturnal hemoglobinuria (PNH).

Question 41

heme

Answer 41

Patients with coagulopathy of liver disease and low fibrinogen levels who are experiencing bleeding should receive immediate cryoprecipitate transfusion.

Four-factor prothrombin complex concentrate is used to treat patients with warfarin toxicity and life-threatening bleeding. It should not be used more routinely to treat patients with the coagulopathy of liver disease and bleeding until conventional component support proves ineffective.

Question 42

heme

Answer 42

In patients with cancer who are hospitalized, prophylactic anticoagulation with low-molecular-weight heparin should be provided to reduce the risk of venous thromboembolism.

Question 43

heme

Answer 43

Patients with sickle cell disease and uncomplicated pregnancy should be closely monitored and treatment withheld until symptoms appear or some measurable parameter changes.

Question 44

nc

Answer 44

If a patient with breast cx is ER or PR positive, they need an aromatiase inhibit r(like anasrtazoke) or an tamofixen,

tamoixifen is for pre-mwnopausal (younger)

Anastrazoke is for Poxt menopausal

Question 45

onc

Answer 45

give trastuzimab for HER 2 positiver

Question 46

onc

Answer 46

araomatase inhibotors can cause osteoporosis, screen with DEXA

Question 47

Cervical ocn

Answer 47

After an abnormal pap, next is colpscopy

Answer 48

male teste cancer

Seminoma dint have elevated AFP

Nonseminimas dONT haved elevated AFP

Question 49

ONC

Answer 49

Tetste cancer- if youmg male has painless scrotal mass, next step is ultrasound, then check tumir markers0 then asurgery

no need for biopsy

Question 50

onc

Answer 50

Squamous cell lung cancer will have a CAVITY’

They are also more likely to have herper calcemia

they also have PANCOOAST TU,MOR

Question 51

lunf cancer

Answer 51

Central lung cancer= Squamour or small cell

Periphera;- large and adenocarnoma

Adeno can cause pancpat-

Question 52

small cell paraneoplastic

Answer 52

Small cell lung cancers have SIADH, Lamber eaton, ACTH

Question 53

HEME

Answer 53

Patients with α-thalassemia trait have no increase in the minor hemoglobin components, hemoglobin A2 and hemoglobin F

Patients with β-thalassemia minor produce increased amounts of hemoglobin A2 and hemoglobin F, respectively.

Question 54

Heme

Answer 54

Patients with asymptomatic INR elevation between 4.5 and 10 are managed by simply withholding warfarin.

For patients with an INR greater than 10, oral vitamin K, 2.5 mg, should be given.

The American Society of Hematology recommends against administering plasma or prothrombin complex concentrates for nonemergent reversal of vitamin K antagonists

Question 55

heme

Answer 55

A history of mucosal or endometrial bleeding, normal prothrombin and activated partial thromboplastin times, and normal platelet count with evidence of a qualitative platelet defect suggest the diagnosis of von Willebrand disease.

A prolonged Platelet Function Analyzer-100 results is VWB

Question 56

heme

Answer 56

In patients with sickle cell disease, hydroxyurea therapy has been shown to decrease vaso-occlusive episodes and acute chest syndrome, to decrease transfusion requirements and hospitalizations, and to prolong overall survival.

Question 57

heme

Answer 57

JAK2 V617F mutation is present in 97% of patients with polycythemia vera, so testing should be performed in patients in whom the disease is suspected.

Polycythemia vera (PV) is a disorder of the myeloid and erythroid stem cells that causes erythropoietin-independent proliferation of erythrocytes. This older adult patient has an elevated hematocrit level, a low erythropoietin level, and splenomegaly, indicating a likely diagnosis of PV.

Question 58

heme

Answer 58

In the proper clinical setting, a peripheral blood smear showing schistocytes in a patient with thrombocytopenia and hemolytic anemia establishes a presumptive diagnosis of thrombotic thrombocytopenic purpura and confirms the need to initiate early, life-saving therapy.

Prompt diagnosis is critical because TTP is fatal in 90% of patients without therapy. Patients require emergent treatment with plasma exchange.

Question 59

heme

Answer 59

Signs of transfusion-associated circulatory overload include respiratory distress within 6 hours of transfusion, positive fluid balance, elevated central venous pressure, elevated B-type natriuretic peptide, and radiographic findings of pulmonary edema.

Prevention includes a slower infusion rate (1 mL/kg/hour) and diuretic therapy between transfusions to maintain euvolemia for those at risk.

Question 60

heme

Answer 60

Transfusion-related acute lung injury (TRALI) is the leading cause of transfusion-related mortality. It is characterized by the development of acute lung injury within 6 hours of transfusion of erythrocytes, platelets, or fresh frozen plasma. TRALI is mediated by initial priming of neutrophils in the recipient’s lung parenchyma followed by their activation by anti-HLA and antineutrophil antibodies present in donor plasma. Signs and symptoms escalate quickly and include dyspnea, hypoxia, fever, chills, and hypotension. The chest radiograph shows diffuse bilateral pulmonary infiltrates. The presence of circulatory overload is not consistent with TRALI. Management of TRALI is supportive.

Question 61

heme

Answer 61

Patients with sickle cell disease and acute chest syndrome with respiratory distress requiring mechanical ventilation should receive emergent exchange transfusion.

Question 62

heme

Answer 62

for patients with SCD, Mild episodes require no transfusion, moderate episodes are managed with simple or exchange transfusion, and severe episodes require exchange transfusion. The target hemoglobin level is 10 g/dL (100 g/L). Most experts agree that patients requiring mechanical ventilation or experiencing shock or other signs of multiorgan dysfunction should receive exchange transfusion.

Question 63

heme

Answer 63

Patients taking dabigatran and requiring urgent surgery should be given idarucizumab, a monoclonal antibody fragment that binds free and thrombin-bound dabigatran and neutralizes its activity.

Because idarucizumab is available as a reversal agent for dabigatran, its use would be first line in this setting.

Question 64

heme

Answer 64

Folate deficiency should be suspected in patients with macrocytic anemia, malnutrition, and alcohol dependence.

Cobalamin deficiency will also produce a macrocytic anemia with hematologic features identical to that seen in folate deficiency. Unlike folate, cobalamin is effectively stored, and dietary inadequacy is not a common cause of deficiency.

Question 65

heme

Answer 65

Patients with hypercalcemia, renal failure, anemia, and bone disease should have further testing with serum protein electrophoresis and serum free light chain assay to evaluate for multiple myeloma.

Bone scans are not obtained in MM because myeloma lesions are usually lytic and lack the associated increase in osteoblast activity that leads to positive bone scan findings typical of other forms of metastatic cancer. Plain radiography of the bones (skeletal surveys) is the most common imaging used to assess lytic lesions, but PET scan and MRI are more sensitive than skeletal survey at identifying MM bone lesions.

Question 66

heme

Answer 66

Patients with pancytopenia, macrocytic erythrocytes, hypersegmented neutrophils, and findings consistent with intramedullary hemolysis should have vitamin B12 and folate levels assessed to determine the cause of megaloblastic anemia.

This constellation of findings is consistent with cobalamin deficiency, which often occurs simultaneously with other autoimmune conditions, such as Hashimoto thyroiditis.

Question 66

heme

Answer 66

Patients with pancytopenia, macrocytic erythrocytes, hypersegmented neutrophils, and findings consistent with intramedullary hemolysis should have vitamin B12 and folate levels assessed to determine the cause of megaloblastic anemia.

This constellation of findings is consistent with cobalamin deficiency, which often occurs simultaneously with other autoimmune conditions, such as Hashimoto thyroiditis.

Question 67

heme

Answer 67

High sheer force seen in some patients with prosthetic heart valves, abnormal native valves, and left ventricular assist device placement may cause an acquired von Willebrand disease with clinical bleeding.

But the relatively abrupt onset of bleeding manifestations is associated with prolongation of the Platelet Function Analyzer-100 test, suggesting a new qualitative platelet defect.

Question 68

heme

Answer 68

Bone marrow biopsy can help confirm the diagnosis of myelodysplastic syndrome in patients with macrocytic anemia and other cytopenias and a peripheral blood smear showing dysplastic, hypogranular neutrophils and nucleated erythrocytes.

He has macrocytic anemia likely resulting from myelodysplastic syndrome (MDS), and a bone marrow biopsy will help confirm the diagnosis. The peripheral blood smear shows a dysplastic neutrophil with abnormal segmentation and hypogranularity and a nucleated erythrocyte, which are characteristic in patients with MDS. MDS is an acquired bone marrow failure syndrome with ineffective hematopoiesis and peripheral cytopenias. A bone marrow biopsy specimen showing hypercellular marrow with dysplastic myeloid progenitor cells and lack of orderly maturation is diagnostic.

Question 69

Heme

Answer 69

Polycythemia is a common adverse effect of testosterone injections, and testosterone supplementation should be interrupted if the hematocrit level exceeds 54%.

Polycythemia vera (PV) is a disorder of the myeloid and erythroid stem cells that causes erythropoietin-independent proliferation of erythrocytes and splenomegaly. PV should be considered in all patients with polycythemia; however, in this patient who is receiving testosterone supplementation, has an elevated erythropoietin level, and does not have splenomegaly, PV is unlikely. If PV is suspected, mutational analysis for JAK2 V617F should be performed.

Question 70

heme

Answer 70

Patients with a high probability of heparin-induced thrombocytopenia should have heparin stopped, and therapy with an immediately effective anticoagulant, such as argatroban, should be initiated.

Question 71

heme

Answer 71

Patients with a high probability of heparin-induced thrombocytopenia should have heparin stopped, and therapy with an immediately effective anticoagulant, such as argatroban, should be initiated.

Question 72

heme

Answer 72

Classic hemolytic uremic syndrome is a diarrhea-associated syndrome of microangiopathic hemolytic anemia, thrombocytopenia, and acute kidney injury caused by Shiga toxin–producing Escherichia coli and, less commonly, Shigella dysenteriae.

Question 73

heme

Answer 73

Patients with artificial valves or those with left ventricular assist devices can develop anemia resulting from erythrocyte fragmentation known as macroangiopathic hemolysis.

Question 73

heme

Answer 73

Patients with artificial valves or those with left ventricular assist devices can develop anemia resulting from erythrocyte fragmentation known as macroangiopathic hemolysis.

Question 74

heme

Answer 74

In provoked deep venous thrombosis with reversible risk factors, 3 to 6 months of anticoagulation is recommended.

Question 75

heme

Answer 75

Evaluation of the peripheral blood smear to assess platelet clumping should be done in patients with isolated thrombocytopenia; if clumping is detected, the platelet count should be repeated in a heparinized blood specimen.

Question 76

heme

Answer 76

Zoledronic acid has been shown to prevent new skeletal-related events and improve survival in patients with multiple myeloma requiring therapy.

Question 77

heme

Answer 77

Antithrombin deficiency is a cause of heparin resistance.

This patient’s clinical presentation is consistent with heparin resistance, which occurs when the activated partial thromboplastin time (aPTT) does not increase into the therapeutic range despite increasing doses of heparin

Question 77

heme

Answer 77

Antithrombin deficiency is a cause of heparin resistance.

This patient’s clinical presentation is consistent with heparin resistance, which occurs when the activated partial thromboplastin time (aPTT) does not increase into the therapeutic range despite increasing doses of heparin

Question 78

heme`\

Answer 78

A prolonged activated partial thromboplastin time that does not fully correct with a mixing study suggests the presence of a factor inhibitor and the diagnosis of acquired hemophilia A; treatment is with activated factor VII, activated prothrombin complex concentrate, or recombinant porcine factor VIII.

Question 79

heme

Answer 79

Desmopressin is used in the treatment of von Willebrand disease (vWD) and causes preformed stores of von Willebrand factor and factor VIII to be released from endothelial cells.

Fresh frozen plasma is used to treat patients with massive bleeding and dilutional coagulopathy and has been used in patients with warfarin toxicity.

Bleeding associated with a prolonged aPTT should raise concern for disseminated intravascular coagulation (DIC) with hypofibrinogenemia requiring cryoprecipitate

Question 80

heme

Answer 80

Vitamin K deficiency, which can be recognized by a normal activated partial thromboplastin time and an elevated prothrombin time, should be expected in patients who have poor oral intake and are taking prolonged courses of antibiotics.

This patient has developed vitamin K deficiency from poor oral intake and a prolonged course of antibiotics combined with diarrhea from concurrent Clostridium difficile infection

Question 81

heme

Answer 81

Diarrhea (from any cause) results in decreased absorption of vitamin K. Vitamin K is needed to activate certain factors (II, VII, IX, and X), and the prothrombin time (PT), which is most sensitive to a decrease in factor VII levels, will be elevated out of proportion to the activated partial thromboplastin time (aPTT), which will be normal or only mildly elevated.

Question 82

Heme

Answer 82

With the exception of testing for genetic mutations, thrombophilia testing should not be performed in the acute setting or while receiving anticoagulant therapy and should be delayed at least 2 weeks after discontinuation of anticoagulant therapy to minimize diagnostic error.

Question 83

Heme

Answer 83

Patients with abdominal thrombosis, splenomegaly, and portal hypertension should be evaluated for the presence of a myeloproliferative neoplasm, specifically the JAK2 V617F gene mutation, even in the absence of erythrocytosis or thrombocytosis.

Paroxysmal nocturnal hemoglobinuria is also associated with abdominal vein thrombosis, but her normal haptoglobin level and absence of indirect hyperbilirubinemia indicate no evidence of hemolysis. Performing flow cytometry to evaluate for loss of CD 55/59 would not be appropriate.

Question 84

Heme

Answer 84

An elevated lactate dehydrogenase level along with the positive direct antiglobulin test (DAT) and spherocytes on the peripheral blood smear should further raise suspicion for hemolysis from an IgG autoantibody.

Although warm antibody hemolysis can cause a hemolytic anemia that is DAT positive for IgG, cold agglutinin disease is DAT positive for C3. The peripheral blood smear would show agglutinated cells, and spherocytes would not be present. Furthermore, cold agglutinin disease is not associated with Lyme disease. Cold agglutinin disease can be primary or associated with lymphoproliferative disorders and certain infections, typically Mycoplasma pneumoniae or Epstein-Barr virus.

Question 85

Heme

Answer 85

Glucose-6-phosphate dehydrogenase (G6PD) deficiency can cause acute hemolysis with certain medications (for example, sulfonamides, some antimalarials, rasburicase)

Question 86

heme

Answer 86

Babesia microti is a transfusion-transmissible pathogen that can be responsible for malaria-like symptoms, hemolytic anemia, thrombocytopenia, and abnormal liver chemistry study results.

Question 87

Heme

Answer 87

Pregnant women with immune thrombocytopenic purpura can be safely monitored during their pregnancy without intervention as long as they are asymptomatic and the platelet count remains greater than 30,000/µL (30 × 109/L).

Question 88

ONC

Answer 88

For patients with small cell lung cancer who have large centrally located tumors that are not amenable to resection, standard management is combined chemotherapy and radiation, which can result in cure for about 20% to 30% of patients.

Question 89

Onc

Answer 89

Combination therapy with radiation and a gonadotropin-releasing hormone agonist for up to 2 to 3 years results in an improvement in 10-year disease-free and overall survival and is the standard care for patients with high-risk and very-high-risk prostate cancer.

Brachytherapy is typically only recommended for men with low-risk and limited-volume cancer.

Question 90

Onc

Answer 90

The standard treatment for locally advanced head and neck cancer is a combination of radiation with systemic therapy, most commonly cisplatin or cetuximab.

Question 91

Onc

Answer 91

In patients with low-risk, early-stage hormone receptor–positive breast cancer, use of tamoxifen for 10 years has been shown to decrease the risk for breast cancer recurrence and breast cancer mortality.

Question 92

Onc

Answer 92

All patients with classic Hodgkin lymphoma, regardless of stage, receive chemotherapy, usually the doxorubicin, bleomycin, vinblastine, and dacarbazine regimen, obviating the need for staging laparotomy and splenectomy.

In the United States, doxorubicin, bleomycin, vinblastine, and dacarbazine is the most commonly used chemotherapy regimen for classic Hodgkin lymphoma. The need for radiation after chemotherapy for early-stage disease depends on the initial bulk of disease, the response to treatment, and patient and institutional preference.

Question 93

Onc

Answer 93

Olaparib is FDA approved as monotherapy for patients with germline BRCA-mutated advanced ovarian cancer previously treated with three or more lines of chemotherapy.

Question 94

onc

Answer 94

In men with clinical metastatic prostate cancer that is castrate sensitive, docetaxel along with continuation of androgen deprivation therapy has been shown to improve survival and is accepted as standard care.