LE6 Flashcards
75. A breast cancer patient scheduled for chemotherapy suddenly complained of difficulty breathing. She had been experiencing progressive shortness of breath for the past 5 days. She could not lie flat on the bed without experiencing difficulty breathing and preferred to sit up and slouch forward on a table to sleep.
Physical Examination & Diagnostics:
- Auscultation: Muffled heart sounds
- Chest X-ray: Enlarged cardiac shadow
- ECG: Low voltage complexes with electrical alternans
What does the ECG finding indicate?
(1 Point)
A. Hypokalemia
B. Pericarditis
C. Cardiac tamponade
D. Pleural effusion
C. Cardiac tamponade
ECG findings of low voltage complexes and electrical alternans suggest pericardial effusion with tamponade, causing impaired cardiac output.
- Beck’s triad includes the following EXCEPT:
(1 Point)
A. Hypotension
B. Reflex tachycardia
C. Muffled heart sounds
D. Neck vein distention
B. Reflex tachycardia
Beck’s triad: Hypotension, muffled heart sounds, and neck vein distention. Reflex tachycardia is not part of the classic triad.
- The most common causes of malignant pericardial effusion are:
(1 Point)
A. Lung CA, breast CA, leukemia, lymphoma
B. Thyroid CA, breast CA, prostatic CA
C. Lung CA, osteosarcoma, melanoma, breast CA
D. None of the above
A. Lung CA, breast CA, leukemia, lymphoma
These cancers commonly metastasize to the pericardium, leading to malignant pericardial effusion.
- Treatment of life-threatening tamponade with hemodynamic instability is:
(1 Point)
A. Cardiac irradiation
B. Pericardiocentesis
C. Pericardial stripping
D. Sclerotherapy
B. Pericardiocentesis
Life-threatening cardiac tamponade requires urgent pericardiocentesis to relieve pressure on the heart.
- A leukemia patient undergoing chemotherapy complained of abdominal pain with nausea and vomiting of previously ingested food. She had painful micturition midstream and complained of dark yellow urine.
The above symptoms are highly suggestive of:
(1 Point)
A. Tumor lysis syndrome
B. Acute pyelonephritis
C. Cystitis
D. Hepatitis
A. Tumor lysis syndrome
Rapid cell destruction from chemotherapy releases intracellular contents, leading to metabolic abnormalities and acute kidney injury.
A leukemia patient undergoing chemotherapy complained of abdominal pain with nausea and vomiting of previously ingested food. She had painful micturition midstream and complained of dark yellow urine.
- The expected abnormal laboratory findings are:
(1 Point)
A. Hyperuricemia, hyperkalemia, hyperphosphatemia, and hypocalcemia
B. Hyperuricemia, hypokalemia, hypophosphatemia, and hypercalcemia
C. Hyperuricemia, hyponatremia, hypercalcemia, and hypermagnesemia
D. Hyperuricemia, hyponatremia, hypokalemia, and hypercalcemia
A. Hyperuricemia, hyperkalemia, hyperphosphatemia, and hypocalcemia
Tumor lysis syndrome causes elevated uric acid, potassium, and phosphate due to massive cell lysis, leading to hypocalcemia (calcium binds to excess phosphate).
A leukemia patient undergoing chemotherapy complained of abdominal pain with nausea and vomiting of previously ingested food. She had painful micturition midstream and complained of dark yellow urine.
- The standard preventive approach to this treatment complication is:
(1 Point)
A. Allopurinol and hydration
B. Febuxostat and allopurinol
C. Febuxostat and hydration
D. Sodium bicarbonate
A. Allopurinol and hydration
Allopurinol reduces uric acid production, and aggressive hydration prevents uric acid crystallization and kidney damage.
- Allogeneic hematopoietic stem cell transplantation is performed for AML patients in complete remission but at risk for relapse.
A. True
B. False
A. True
Allogeneic hematopoietic stem cell transplantation is indicated for AML patients in complete remission but at high risk for relapse to improve long-term survival.
- Planning for the possibility of allogeneic hematopoietic stem cell transplantation for all eligible patients under 75 years is part of optimal initial AML care.
A. False
B. True
B. True
AML treatment planning includes consideration of allogeneic HSCT in eligible patients ≤75 years to maximize curative potential.
- Which drug can normalize serum uric acid levels within hours with a single dose?
A. None of the above
B. Allopurinol
C. All of the above
D. Rasburicase
E. Febuxostat
D. Rasburicase
Rasburicase rapidly lowers uric acid levels by converting uric acid to allantoin, making it the preferred treatment for tumor lysis syndrome.
- The most common cause of therapy-associated acute myeloid leukemia is:
A. Benzene exposure
B. Anticancer drugs
C. Phenylbutazone
D. Chloramphenicol
E. Ionizing radiation
B. Anticancer drugs
Therapy-associated AML often results from exposure to alkylating agents and topoisomerase inhibitors used in chemotherapy.
- The subtype of AML associated with Down syndrome is:
A. Myeloid sarcoma
B. AML with myelodysplasia
C. Acute promyelocytic leukemia
D. AML with recurrent genetic abnormalities
E. Acute megakaryocytic subtype
E. Acute megakaryocytic subtype
Down syndrome is associated with acute megakaryoblastic leukemia (AMKL), a unique AML subtype occurring in young children.
- An empiric antibiotic with gram-negative coverage should be started at the onset of fever in a neutropenic patient after evaluation and procurement of cultures.
A. True
B. False
A. True
Empiric broad-spectrum antibiotics (e.g., cefepime, meropenem) should be started immediately at the onset of febrile neutropenia after blood cultures are taken.
- The only type of leukemia NOT linked to radiation exposure is:
A. Chronic lymphocytic leukemia
B. Acute promyelocytic leukemia
C. Chronic myeloid leukemia
D. Acute myeloid leukemia
E. Acute lymphocytic leukemia
A. Chronic lymphocytic leukemia
CLL has no known link to radiation exposure, unlike AML, CML, and ALL, which have radiation-associated risk factors.
CLL is primarily associated with genetic predisposition and age-related immune dysregulation rather than environmental or radiation-related factors.
- True of Monoclonal B-cell lymphocytosis:
A. Presence of malignant B cells
B. Absent cytopenias
C. Precursor of chronic lymphocytic leukemia
D. Absence of nodal, splenic, and liver involvement
E. All of the above
E. All of the above
Monoclonal B-cell lymphocytosis (MBL) is a CLL precursor with clonal B cells, no cytopenias, and no organ involvement.
- Chronic lymphocytic leukemia commonly presents as:
A. Hemarthroses
B. Fever with or without a focus of infection
C. Ecchymoses
D. Weight loss
E. Incidental finding on routine CBC with evaluation for another cause
E. Incidental finding on routine CBC with evaluation for another cause
CLL is often asymptomatic and diagnosed incidentally on CBC showing lymphocytosis during routine checkups.
- The most common cause of non-cancer death among childhood survivors is:
A. Neurologic dysfunction
B. Cardiovascular dysfunction
C. Psychological dysfunction
D. Pulmonary dysfunction
B. Cardiovascular dysfunction
Cardiovascular disease (e.g., cardiomyopathy, heart failure, CAD) is the leading non-cancer cause of death in childhood cancer survivors due to prior chemotherapy (anthracyclines) and radiation therapy.
- Which drugs have received a black box warning from the FDA with a median of 4 years post-treatment for cardiovascular toxicity?
A. Immunotherapy agents
B. Monoclonal antibodies, trastuzumab
C. Daunorubicin, doxorubicin
D. Lapatinib and ponatinib
D. Lapatinib and ponatinib
Tyrosine Kinase Inhibitors (TKIs) such as Lapatinib and Ponatinib have received an FDA Black Box Warning for cardiovascular toxicity, including CHF, QT prolongation, and systemic & pulmonary hypertension, with a median onset of 4 years post-treatment.
- The most effective therapy for pulmonary fibrosis resulting from chemotherapy is:
A. Bronchodilators
B. Antibiotics
C. Prednisone
D. None of the above
D. None of the above**
Rationale:
- Pulmonary fibrosis resulting from chemotherapy has no effective therapy and is irreversible.
- The mainstay of management is supportive care:
- Low-dose oxygen (if hypoxic).
- Pulmonary rehabilitation.
- Lung transplantation (severe cases, if eligible).
Why Not the Other Options?
- A. Bronchodilators → Used for reactive airway disease or bronchospasm, but do not reverse fibrosis.
- B. Antibiotics → Only helpful if there is a superimposed infection but do not treat fibrosis.
- C. Prednisone → Steroids are useful for drug-induced pneumonitis (early stage), but NOT for established pulmonary fibrosis.
- Exception: Nitrosoureas (Carmustine, Lomustine)–induced fibrosis is unresponsive to steroids.
👉 Since there is no effective treatment for pulmonary fibrosis, the correct answer is “None of the above.” 🚀
- The most severe form of radiation-induced neurologic dysfunction is:
A. Necrotizing encephalopathy
B. Lhermitte’s sign
C. Global CNS dysfunction
D. Polyneuropathy
A. Necrotizing encephalopathy
Necrotizing encephalopathy is the most severe form of radiation-induced neurologic damage, leading to progressive, irreversible CNS dysfunction with white matter necrosis.
- The most common side effects of cancer treatment are:
A. Nausea and vomiting
B. Febrile neutropenia
C. Myelosuppression
D. All of the above
D. All of the above
Nausea, vomiting, febrile neutropenia, and myelosuppression are among the most common side effects of cancer treatments, particularly chemotherapy.
- Which statement is true regarding tumor markers?
A. Tumor markers are highly sensitive and specific, making them ideal for cancer screening and diagnosis.
B. Tumor markers can be used to assess tumor burden in all cancer types.
C. Tumor markers can be used to assess treatment response in patients who had elevated levels at diagnosis.
D. None of the above
C. Tumor markers can be used to assess treatment response in patients who had elevated levels at diagnosis.
Tumor markers lack specificity and sensitivity for diagnosis but are useful in monitoring treatment response when initially elevated.
- The earliest radiologic finding of a vertebral tumor is:
A. The winking owl sign
B. Erosion of the pedicles
C. Both A and B
D. None of the above
C. Both A and B
The “winking owl sign” and pedicle erosion are early radiologic findings of vertebral tumors due to cortical bone destruction.
- True of superior vena cava syndrome, except:
A. CT provides the most reliable view of the mediastinal anatomy.
B. The most significant radiographic finding is widening of the superior mediastinum.
C. In young adults, the most common cause of SVCS is tuberculous lymphadenopathy.
D. Lung cancer accounts for approximately 85% of malignant cases.
C. In young adults, the most common cause of SVCS is tuberculous lymphadenopathy.
Lung cancer (85%) and lymphoma are the most common causes of superior vena cava syndrome (SVCS), not tuberculosis.
- The most frequent causes of metastatic tumors involving the vertebral column are:
A. Lung, breast, and prostate cancer
B. Myxoma, cervical, and pancreatic cancer
C. Lymphoma, colonic, and gastric cancer
D. Myxoma, lung, and breast cancer
A. Lung, breast, and prostate cancer
These cancers frequently metastasize to the vertebral column due to their high bone marrow blood supply.
- True of anthracyclines’ myocardial toxicity, except:
A. Mortality rate is as high as 50%
B. 5% of patients receiving >450-550 mg/m² doxorubicin will develop congestive heart failure
C. It is dose-dependent
D. Trastuzumab is the most notorious anthracycline
D. Trastuzumab is the most notorious anthracycline
Trastuzumab is NOT an anthracycline but a monoclonal antibody; doxorubicin and daunorubicin are anthracyclines known for dose-dependent cardiotoxicity.
- True of trastuzumab-induced cardiotoxicity, except:
A. Cardiotoxicity is difficult to reverse and causes high mortality.
B. It is not associated with pathologic changes in cardiac myofibrils.
C. It is frequently used in adjuvant breast cancer therapy.
D. Cardiotoxicity is monitored every 3-4 doses.
A. Cardiotoxicity is difficult to reverse and causes high mortality.
Unlike anthracycline-induced toxicity, trastuzumab-induced cardiotoxicity is often reversible and does not cause permanent structural damage.
✅ Anthracyclines → IRREVERSIBLE CHF.
✅ Trastuzumab → REVERSIBLE CHF.
✅ Radiation → PERICARDIAL DISEASE & VALVULAR DISEASE.
✅ Tyrosine Kinase Inhibitors → BLACK BOX WARNING for CV toxicity.
✅ Surveillance should be done EVERY 5 YEARS post-exposure.
✅ Prevention is key (Dexrazoxane, Radiation shielding, Lifestyle).
- The best measure of pulmonary functional impairment after chemotherapy is:
A. Diffusing capacity of the lungs for carbon monoxide (DLCO)
B. Spirometry
C. Arterial blood gas analysis
D. Chest X-ray
A. Diffusing capacity of the lungs for carbon monoxide (DLCO)
DLCO is the best measure of pulmonary impairment after chemotherapy, particularly in bleomycin-induced lung toxicity.
DLco (Diffusion Capacity of Lungs for CO₂) is the most sensitive test for detecting early impairment.
✅ Radiation Pneumonitis → 4 weeks post-radiation
✅ Bleomycin Pneumonitis → Dose-related, Lower Lobes
✅ DLco = Most Sensitive Test for Early Detection
✅ Prednisone 1mg/kg/day → Main Treatment for Pneumonitis
✅ Fibrosis = Irreversible, No Effective Treatment
✅ Prevention is Key → Monitor DLco, Avoid Smoking & High Oxygen in Bleomycin Patients
- The chemotherapeutic drug associated with “stocking-glove” neuropathy with numbness and tingling advancing to loss of motor function is:
A. Cisplatin
B. Vinca alkaloids
C. Doxorubicin
D. Methotrexate
B. Vinca alkaloids
Vincristine and vinblastine cause “stocking-glove” peripheral neuropathy, starting with numbness and tingling and progressing to motor dysfunction.
Peripheral neuropathy:
Stocking-glove neuropathy (Vinca alkaloids, Cisplatin).
Hearing loss (Cisplatin).
Lhermitte’s Sign (Electric shock sensation down the spine on neck flexion).
- The chemotherapeutic drug associated with sensorimotor neuropathy and hearing loss is:
A. Cisplatin
B. Vincristine
C. Doxorubicin
D. Bleomycin
A. Cisplatin
Cisplatin-induced neurotoxicity causes sensorimotor neuropathy and ototoxicity (hearing loss) due to damage to the cochlear hair cells.
Peripheral neuropathy:
Stocking-glove neuropathy (Vinca alkaloids, Cisplatin).
Hearing loss (Cisplatin).
Lhermitte’s Sign (Electric shock sensation down the spine on neck flexion).
- True of radiation pneumonitis, except:
A. It occurs 1-6 months after radiation therapy.
B. It is dose-dependent.
C. It is frequently seen in adjuvant breast cancer therapy.
D. It is irreversible and always progresses to fibrosis.
D. It is irreversible and always progresses to fibrosis.
Radiation pneumonitis is often reversible and does not always lead to pulmonary fibrosis, which occurs in a subset of patients.
Acute Radiation Pneumonitis (4 weeks post-treatment).
Pulmonary Fibrosis (Late-stage complication).
- True of Lhermitte’s sign, except:
A. It is a transient, self-limiting condition.
B. It presents as an electric shock-like sensation down the spine with neck flexion.
C. It is a specific sign of radiation-induced myelopathy.
D. It occurs immediately after radiation therapy.
C. It is a specific sign of radiation-induced myelopathy.
Lhermitte’s sign is not specific to radiation-induced myelopathy; it is also seen in multiple sclerosis and cervical spondylosis.
Myelopathy (Radiation-Induced)
Lhermitte’s Sign → Electric shock sensation down the spine with neck flexion
Diffuse Radiation Injury → White matter changes on MRI, global dysfunction
Chronic Radiation Myelopathy → Occurs 9 months to 10 years post-treatment
- The earliest radiologic finding of a vertebral tumor is:
A. Vertebral body collapse
B. Lytic or sclerotic lesions
C. Increased intrapedicular distance
D. Erosion of the pedicles (“winking owl sign”)
D. Erosion of the pedicles (“winking owl sign”)
Earliest radiologic finding of vertebral tumors due to pedicle destruction, appearing as a missing or asymmetric pedicle on X-ray.
- True of superior vena cava syndrome, except:
A. CT provides the most reliable view of the mediastinal anatomy.
B. The most significant radiographic finding is widening of the superior mediastinum.
C. In young adults, the most common cause of SVCS is tuberculous lymphadenopathy.
D. Lung cancer, particularly small-cell and squamous cell carcinoma, accounts for ~85% of malignant cases.
C. In young adults, the most common cause of SVCS is tuberculous lymphadenopathy.
Lung cancer (85%) and lymphoma are the most common causes of superior vena cava syndrome (SVCS), not tuberculosis.
- The central mechanism of disseminated intravascular coagulation (DIC) is:
A. Hemolysis of abnormal RBCs due to abnormal cell walls
B. Uncontrolled generation of thrombin by blood exposure to pathologic tissue factors
C. Deficiency of factor VIII and factor IX
D. Decrease in platelet count and elevated levels of reticulocytes
B. Uncontrolled generation of thrombin by blood exposure to pathologic tissue factors
DIC is caused by excessive thrombin generation, leading to widespread clotting and secondary fibrinolysis, consuming platelets and clotting factors.
- The earliest and most common finding in vitamin K deficiency due to reduced levels of prothrombin, FVII, FIX, and FX is:
A. Prolongation of PT
B. Thrombocytopenia
C. Prolongation of APTT
D. Aplastic anemia
A. Prolongation of PT
Vitamin K deficiency leads to decreased clotting factor activity (II, VII, IX, X), prolonging PT (early finding) before APTT is affected.
- Low-grade compensated or chronic disseminated intravascular coagulation is associated with:
A. Dead fetus syndrome
B. Metastasis
C. All of the above
D. None of the above
C. All of the above
Chronic DIC is associated with dead fetus syndrome, malignancies (metastasis), and chronic inflammation leading to low-grade coagulation activation.
- Which coagulation factors are X-linked in transmission?
A. Factor XIII and IX
B. Factor IX and X
C. Fibrinogen and prothrombin
D. Factor VIII and IX
D. Factor VIII and IX
Hemophilia A (Factor VIII deficiency) and Hemophilia B (Factor IX deficiency) are X-linked disorders.
- Drugs that commonly cause disseminated intravascular coagulation (DIC), except:
A. Warfarin
B. Amphetamines
C. Fibrinolytic agents
D. None of the above
D. None of the above
Rationale:
All the listed drugs—Warfarin, Amphetamines, and Fibrinolytic agents—are associated with disseminated intravascular coagulation (DIC) as per the provided table.
- The glycoprotein responsible for platelet adhesion to the damaged blood vessel wall is:
A. von Willebrand factor
B. Immunoglobulin
C. Transferrin
D. Ceruloplasmin
A. Von Willebrand factor
vWF mediates platelet adhesion to the subendothelial matrix at sites of vascular injury.
- Which calcium channel blocker causes isolated thrombocytopenia?
A. Atorvastatin
B. Amlodipine
C. Verapamil
D. Nifedipine
B. Amlodipine
Rationale:
Amlodipine, a dihydropyridine calcium channel blocker (CCB), has been reported to cause immune-mediated thrombocytopenia.
The mechanism is likely drug-induced immune thrombocytopenia (DITP), where drug-dependent antibodies target platelets.
Verapamil (C) and Nifedipine (D) are also calcium channel blockers but are not commonly associated with isolated thrombocytopenia.
Atorvastatin (A) is a statin, which can cause drug-induced myopathy, but thrombocytopenia is rare.
- The most common structural hemoglobinopathy is:
A. Sickle cell disease
B. Thalassemia
C. Hemoglobin C disease
D. Methemoglobinemia
A. Sickle cell disease
Sickle cell disease (HbS mutation) is the most common structural hemoglobinopathy, while thalassemias are disorders of hemoglobin synthesis.
- Factors that can aggravate anemia in alpha thalassemia, except:
A. Infection
B. Puberty
C. Splenomegaly and hypersplenism
D. None of the above
D. None of the above
All listed factors (infection, puberty, hypersplenism) can aggravate anemia in alpha-thalassemia due to increased hemolysis and erythropoietic stress.
- Sickle cell syndromes include the following, except:
A. Acute chest syndrome
B. Chronic pulmonary crises leading to pulmonary hypertension and cor pulmonale
C. Aseptic necrosis of the femoral or humeral head
D. None of the above
D. All of the above
Sickle cell disease complications include:
Acute chest syndrome (leading cause of death)
Chronic pulmonary crises → pulmonary hypertension & cor pulmonale
Avascular necrosis of femoral/humeral head due to vaso-occlusion
- The treatment for transfusion hemosiderosis is:
A. Ferrous sulfate
B. Ferrous sulfate with folic acid
C. Deferoxamine
D. None of the above
C. Deferoxamine
Deferoxamine is an iron chelator used to treat transfusion hemosiderosis (iron overload from
repeated blood transfusions).
🔍 What is Transfusion Hemosiderosis?
Hemosiderosis is iron overload caused by repeated blood transfusions, where excess iron accumulates in organs, leading to severe complications.
🩸 How Does it Happen?
1 unit of PRBC (Packed Red Blood Cells) = 250-300 mg of iron (1 mg/mL).
2 units of PRBC provide the same iron as 1-2 years of dietary iron intake.
>100 units of PRBC transfusions → Leads to iron overload.
- Which of the following is NOT TRUE regarding chronic blood transfusions?
A. One unit of packed RBC contains 250-300 mg of iron.
B. Transfusion of two units at one time is equivalent to 1-2 years of oral iron intake.
C. Vitamin C can be given to augment iron absorption.
D. Do not give vitamin C as it generates free radicals.
C. Vitamin C can be given to augment iron absorption.
FALSE. Vitamin C is contraindicated in iron overload because it increases free radical formation and oxidative stress, worsening tissue damage.
- The rule of thumb is that if a male patient or post-menopausal female has anemia, the cause is gastrointestinal blood loss unless proven otherwise.
A. True
B. False
C. Maybe
A. True
Unexplained anemia in males or postmenopausal females should be assumed to be due to GI blood loss (e.g., ulcers, malignancies) until proven otherwise.
- Oral iron therapy should be taken with meals to enhance absorption.
A. True
B. False
C. Maybe
B. False
Oral iron should be taken on an empty stomach for better absorption; food reduces iron absorption, especially dairy, tea, and coffee.
- The following statements are correct about chronic lymphocytic leukemia, except:
A. It is the most common adult leukemia in the Western world.
B. Higher incidence among Asians.
C. Higher incidence among Ashkenazi Jews.
D. Predominantly affects older individuals, with more than 70% being 65 years and older.
B. Higher incidence among Asians.
Chronic lymphocytic leukemia (CLL) is most common in Western populations and rare in Asians, unlike some other leukemias.
- Some cases of chronic lymphocytic leukemia are asymptomatic and found incidentally.
A. True
B. False
A. True
Many cases of CLL are asymptomatic and diagnosed incidentally on CBC showing lymphocytosis.
- Based on the Binet staging system of chronic lymphocytic leukemia, a patient with hemoglobin ≤10 g/dL and/or platelets <100,000/μL is classified as:
A. Stage A
B. Stage B
C. Stage C
C. Stage C
Binet Stage C: Hemoglobin ≤10 g/dL and/or platelets <100,000/μL due to bone marrow involvement.
- Reed-Sternberg cell is:
A. The cancer cell of Non-Hodgkin’s lymphoma
B. The cancer cell of Hodgkin’s lymphoma
C. The cancer cell of chronic lymphocytic leukemia
D. The cancer cell of thalassemia
B. The cancer cell of Hodgkin’s lymphoma
Reed-Sternberg cells (large, multinucleated “owl-eye” cells) are pathognomonic for Hodgkin’s lymphoma.
- The most common lymphoid malignancy is:
A. Non-Hodgkin’s lymphoma
B. Hodgkin’s disease
C. Acute lymphoblastic leukemia (ALL)
D. Plasma cell disorders
A. Non-Hodgkin’s lymphoma
Non-Hodgkin’s lymphoma (NHL) is the most common lymphoid malignancy, with various B-cell, T-cell, and NK-cell subtypes.
- Infectious agents associated with Hodgkin’s lymphoma include:
A. Epstein-Barr virus
B. HTLV-1
C. Hepatitis C virus
D. Helicobacter pylori
A. Epstein-Barr virus
EBV is strongly linked to Hodgkin’s lymphoma, particularly mixed cellularity and lymphocyte-depleted subtypes.
- Non-Hodgkin’s lymphoma is a cancer of:
A. B cells
B. T cells
C. NK cells
D. All of the above
D. All of the above
Non-Hodgkin’s lymphoma (NHL) arises from B cells (most common), T cells, or NK cells, with varying clinical presentations.
- MALT lymphoma is associated with which infectious agent?
A. Epstein-Barr virus
B. HTLV-1
C. Helicobacter pylori
D. Hepatitis C virus
C. Helicobacter pylori
Mucosa-associated lymphoid tissue (MALT) lymphoma, especially in the stomach, is strongly associated with chronic infection by Helicobacter pylori. Eradication of H. pylori can lead to regression of early-stage gastric MALT lymphomas.
- Chemicals associated with the development of malignant lymphoma, except:
A. None of the above
B. Radiation and prior radiation therapy
C. Prior chemotherapy
D. Phenytoin
A. None of the above
This implies that the listed options (B, C, and D) are all associated with the development of lymphoma:
B. Radiation and prior radiation therapy – Prior therapeutic radiation can increase the risk of secondary malignancies, including lymphomas.
C. Prior chemotherapy – Certain chemotherapeutic agents are associated with an increased risk of secondary malignancies, including lymphomas.
D. Phenytoin – Though more famously linked to a “pseudolymphoma” syndrome, phenytoin has been reported in association with true lymphomas as well.
- Acquired immunodeficiency diseases associated with the development of malignant lymphoma include the following, except:
A. Chediak-Higashi syndrome
B. HIV-1 infection
C. Iatrogenic immunosuppression
D. Acquired hypogammaglobulinemia
A. Chediak-Higashi syndrome
Chediak–Higashi syndrome is a congenital (inherited) disorder, not an acquired one. The other conditions—HIV infection, iatrogenic immunosuppression (e.g., post-transplant), and acquired hypogammaglobulinemia—are all acquired immunodeficiencies that increase the risk of developing lymphoma.
- Using the Ann Arbor staging system for lymphoma, a patient with lymph node involvement on both sides of the diaphragm, which may include the spleen, belongs to which stage?
A. Stage I
B. Stage II
C. Stage III
D. Stage IV
C. Stage III
Briefly:
Stage I: Single lymph node region/lymphoid structure
Stage II: Two or more lymph node regions on the same side of the diaphragm
Stage III: Lymph node regions on both sides of the diaphragm (may include spleen)
Stage IV: Diffuse or disseminated involvement of one or more extralymphatic organs
- Hodgkin’s lymphoma is a malignancy of:
A. Mature B lymphocytes
B. Mature T lymphocytes
C. Mature natural killer (NK) cells
D. All of the above
A. Mature B lymphocytes
The Reed–Sternberg cells (characteristic of Hodgkin lymphoma) are derived almost invariably from B cells (even though they often have crippled or minimal typical B-cell surface markers).
- Using the Ann Arbor staging system for Hodgkin’s lymphoma, a patient with involvement of a single lymph node region or lymphoid structure and no symptoms belongs to which stage?
A. Stage IA
B. Stage IB
C. Stage IIB
D. Stage IE
A. Stage IA
“A” indicates absence of “B symptoms” (fever, night sweats, weight loss).
“I” indicates involvement of only one lymph node region (or lymphoid structure).
- B symptoms of Hodgkin’s lymphoma include the following, except:
A. Unexplained weight loss >10% during the 6 months prior to staging
B. Unexplained fever >38°C for 1 month
C. Unexplained night sweats for 1 month
D. Palpable lymph nodes in the neck and inguinals
D. Palpable lymph nodes in the neck and inguinals
“B” symptoms are specifically:
Unexplained fever >38°C
Unexplained weight loss >10% of body weight in the preceding 6 months
Drenching night sweats
Having palpable lymph nodes (neck, inguinal, etc.) is not a “B” symptom; it is simply a clinical finding of lymphadenopathy.
- Poor prognostic factors in Hodgkin’s lymphoma include the following, except:
A. Female sex
B. Age older than 45 years
C. Stage IV disease
D. Serum albumin <4 g/dL
A. Female sex
Poor prognostic factors in Hodgkin’s lymphoma (e.g., per the International Prognostic Score) include:
Prognostic Factors (International Prognostic Score - IPS)
Unfavorable features:
Male sex.
Age >45 years.
Stage IV disease.
Albumin <4 g/dL.
Hemoglobin <10.5 g/dL.
WBC ≥15,000/μL.
Lymphocytes <600/μL or <8% of WBC.
- The most common chemotherapy regimen to treat Hodgkin’s lymphoma includes the following, except:
A. Adriamycin
B. Bleomycin
C. Cisplatin
D. Vinblastine
C. Cisplatin
Rationale: The standard ABVD regimen for Hodgkin’s lymphoma includes Adriamycin, Bleomycin, Vinblastine, and Dacarbazine. Cisplatin is not part of this regimen.
- True or false: The most common chemotherapy regimen used for early-stage disease is the same chemotherapy regimen used for advanced-stage Hodgkin’s lymphoma for 6 cycles.
A. True
B. False
B. False
Rationale: Although ABVD is the chemotherapy regimen used for both early-stage and advanced-stage Hodgkin’s lymphoma, the number of cycles differs. Early-stage (low-risk) patients often receive 4 cycles of ABVD (sometimes with involved-field radiation therapy for unfavorable cases), rather than the standard 6 cycles used for advanced-stage disease.
- True or false: For patients with Hodgkin’s lymphoma who relapse after primary treatment, they can be given the same chemotherapy for the second time at standard doses.
A. True
B. False
B. False
Rationale: Patients with relapsed Hodgkin’s lymphoma are usually treated with salvage chemotherapy followed by high-dose chemotherapy with stem cell transplantation, rather than reusing the same standard-dose regimen.
- Salvage chemotherapy for Hodgkin’s lymphoma includes the following:
A. Ifosfamide, carboplatin, etoposide regimen
B. Gemcitabine, navelbine, doxorubicin.
C. All of the above
D. None of the above
C. All of the above
Rationale: Both the Ifosfamide, Carboplatin, and Etoposide regimen and the Gemcitabine, Navelbine, and Doxorubicin regimen are used as salvage chemotherapy options in relapsed Hodgkin’s lymphoma.
- True or false: Hodgkin’s lymphoma has a high cure rate.
A. True
B. False
True
Rationale: Hodgkin’s lymphoma has a high cure rate, particularly when diagnosed early.
- The following long-term complications can occur with treated Hodgkin’s lymphoma, except:
A. Hypothyroidism in patients who had thoracic radiotherapy
B. Breast tumors in patients who had thoracic radiotherapy
C. Lhermitte’s syndrome in patients who received thoracic radiotherapy
D. None of the above
D. None of the above
Rationale: Long-term complications following treatment for Hodgkin’s lymphoma can include hypothyroidism, breast tumors, and Lhermitte’s syndrome, all potentially related to thoracic radiotherapy.
- True or false: Acute lymphoid leukemia is a disease in children with an early peak at 3-4 years of age.
A. True
B. False
C. Maybe
True
Rationale: Acute lymphoid leukemia (ALL) most commonly occurs in children, with a notable incidence peak at ages 3–4 years.
- True or false: Down syndrome is associated with a twentyfold increase in the incidence of leukemia.
A. True
B. False
True
Rationale: Down syndrome is associated with a significantly increased risk of leukemia—up to a twentyfold increase compared to children without Down syndrome.
- The etiologic agent associated with the development of adult T-cell leukemia is:
A. HIV
B. HTLV-1
C. EBV
D. HepC
B. HTLV-1
Rationale: Adult T-cell leukemia is etiologically linked to infection with HTLV-1.
- The purpose of the bone marrow examination in ALL includes the following, except:
A. To distinguish between AML and ALL
B. To confirm the diagnosis of acute leukemia
C. For immunologic, cytogenetic, and genomic markers
D. None of the above
D. None of the above
Rationale: Bone marrow examination in ALL is used to differentiate between AML and ALL, confirm the diagnosis, and evaluate immunologic, cytogenetic, and genomic markers.
- True or false: Lumbar puncture is done after complete remission to avoid seeding the central nervous system by circulating leukemic blast cells from the peripheral blood.
A. True
B. False
False
Rationale: Lumbar puncture is performed early in the treatment of ALL as a prophylactic measure to prevent central nervous system involvement, rather than after complete remission.
- Hematologic relapse in ALL is defined as:
A. Patient in complete remission, MRD not detectable, <0.01% leukemic blast cells in 10,000
B. Patient in complete hematologic remission but not in molecular complete remission <0.01%
C. >5% ALL cells in bone marrow/blood
D. None of the above
C. >5% ALL cells in bone marrow/blood
Rationale: Hematologic relapse in ALL is defined by having more than 5% leukemic blasts in the bone marrow or peripheral blood.
- True or false: Chemotherapy for elderly patients with ALL was modified by removing anthracyclines and alkylating agents, thereby improving survival by 42%, achieving complete remission in 73%, and reducing mortality by 13%.
A. True
B. False
A. True
Rationale: Chemotherapy regimens for elderly ALL patients were modified to remove anthracyclines and alkylating agents, leading to an improved overall survival rate of 42%, an increased complete remission rate of 73%, and a reduction in early mortality to 13%.
- True or false: Allogeneic stem cell transplant is a curative modality in CML, but 10-15% die in the first to second decade from CML relapse.
A. True
B. False
A. True
Rationale: Allogeneic stem cell transplant is a curative option in CML, but 10–15% of patients die within 1–2 decades due to subtle long-term complications, including chronic graft-versus-host disease (GVHD), organ dysfunction, and the development of secondary cancers.
- Long-term complications of allogeneic stem cell transplant in CML include:
A. Chronic graft vs host disease
B. Organ dysfunction
C. Development of second cancers
D. All of the above
D. All of the above
Rationale: Long-term complications following allogeneic stem cell transplant in CML include chronic graft-versus-host disease, organ dysfunction, and an increased risk of second cancers.
- Prognostic factors for AML, except:
A. Advancing age is associated with a poor prognosis
B. Cytopenia – lower complete remission rate
C. High performance status
D. High presenting leukocyte count >100,000/uL is associated with poor prognosis
C. High performance status
Rationale: A high performance status is a favorable prognostic factor in AML, while the other factors listed are associated with a poorer prognosis.
- Signs and symptoms of AML, except:
A. Fatigue, anorexia, weight loss, fever, bleeding, easy bruisability, bone pain, headache
B. Anemia – normocytic normochromic
C. Leukocyte count of 15,000/uL
D. Presence of Auer rods
E. Weight gain and increased appetite
E. Weight gain and increased appetite
Rationale: AML typically presents with systemic symptoms like fatigue, weight loss, and anorexia, not weight gain or increased appetite.
- Complete remission in AML is defined as:
A. Blood neutrophil count ≥1000/uL and platelet count ≥100,000/uL
B. Blood neutrophil count ≥1500/uL and platelet count ≥80,000/uL
C. Hemoglobin level ≥12 g/dL
D. Blood neutrophil count ≥500/uL and platelet count ≥150,000/uL
A. Blood neutrophil count ≥1000/uL and platelet count ≥100,000/uL
Rationale: Complete remission in AML is defined by a blood neutrophil count of ≥1000/uL, a platelet count of ≥100,000/uL, the absence of circulating blasts, and bone marrow blasts <5%. Hemoglobin levels are not a primary criterion for defining remission.
- The leading cause of therapy-associated acute myeloid leukemia:
a. Alkylating agents
b. Radiation therapy
c. Chloramphenicol
d. Phenylbutazone
a. Alkylating agents
Rationale: Alkylating agents are the leading cause of therapy-associated AML, often occurring years after chemotherapy for other malignancies. These agents cause DNA damage and chromosomal abnormalities, increasing leukemia risk.
- Acute myeloid leukemia is not typically severe with microcytic hypochromic picture with increased reticulocyte count and red cell survival is decreased due to accelerated destruction.
a. True
b. False
b. False
Rationale: AML is typically associated with normocytic normochromic anemia, not a microcytic hypochromic picture. The anemia results from bone marrow infiltration by leukemic blasts, leading to decreased RBC production rather than increased RBC destruction.
- The most frequent symptoms among AML patients:
a. Fever and infection
b. Fatigue
c. Anorexia
d. Weight loss
b. Fatigue
Rationale: Fatigue is the most frequent symptom in AML due to anemia and marrow failure. Other common symptoms include fever, infection, bruising, and bleeding due to leukopenia and thrombocytopenia, but fatigue remains the most prominent.
- Which coagulation factor is deficient if the laboratory findings showed prolongation of both prothrombin time and activated partial thromboplastin time?
A. Factor V or Factor X
B. Factor II or Fibrinogen
C. All of the above
D. None of the above
C. All of the above
Prolongation of both PT and aPTT suggests a defect in the common pathway (Factors V, X, II, or fibrinogen).
Factor V or Factor X deficiency affects both pathways since they are part of the common pathway.
Factor II (Prothrombin) and Fibrinogen deficiency also lead to prolongation of both PT and aPTT because they are essential in the final clot formation.
Therefore, all of the above are correct.
- The most common acquired coagulation factor deficiencies are the following:
A. DIC
B. Vitamin K deficiency
C. Hemophilia
D. Bleeding diathesis due to liver disease
C. Hemophilia
The most common acquired coagulation factor deficiencies result from liver disease, DIC, and Vitamin K deficiency.
Hemophilia is an inherited disorder, not acquired.
Liver disease affects multiple clotting factors since the liver synthesizes most of them (II, VII, IX, X, fibrinogen, etc.).
- Drugs that commonly cause DIC, except:
A. Amphetamines
B. Fibrinolytic agents
C. Warfarin
D. None of the above
D. None of the above
All listed drugs can contribute to DIC:
Amphetamines → Can trigger vasoconstriction & endothelial damage.
Fibrinolytic agents → Can disrupt normal clot formation, leading to consumption of clotting factors.
Warfarin → Inhibits Vitamin K-dependent clotting factors (II, VII, IX, X), increasing bleeding risk.
Since all three drugs are associated with DIC or coagulopathy, the correct answer is none of the above.
- The glycoprotein responsible for platelet adhesion to the damaged vessel wall is:
A. vWF
B. Immunoglobulin
C. Transferrin
D. Ceruloplasmin
A. vWF (Von Willebrand Factor)
vWF is crucial for platelet adhesion to subendothelial collagen during vascular injury.
Other options are incorrect:
Immunoglobulin → Involved in immune response, not coagulation.
Transferrin → Iron transport protein.
Ceruloplasmin → Copper-carrying protein.
