Le6 REVIEW HEMATOLOGY Flashcards

Question

7. What is the most common early-phase radiation-induced pulmonary complication? A. Pulmonary fibrosis B. Acute pneumonitis C. Pleural effusion D. Pneumonia

Answer 1

B. Acute pneumonitis Rationale: Acute pneumonitis occurs within 4 weeks post-radiation and can extend beyond the radiation field.

Answer 2

B. Pulmonary fibrosis Rationale: Pulmonary fibrosis is the most common late complication following chest radiation.

Answer 3

D. High BMI Rationale: Advanced age, smoking, high radiation dose, and preexisting lung conditions increase the risk, but high BMI is not a direct risk factor.

Answer 4

C. DLco (Diffusion capacity of the lungs for carbon monoxide) Rationale: DLco is the most sensitive test for early detection of radiation-induced pulmonary dysfunction.

Answer 5

A. B-cell non-Hodgkin lymphoma Rationale: Hodgkin’s lymphoma survivors are at higher risk for B-cell non-Hodgkin lymphoma.

Answer 6

B. Alkylating agents Rationale: Alkylating agents increase the risk of thyroid, lung, breast, bladder cancer, and sarcomas.

Answer 7

A. Tamoxifen Rationale: Tamoxifen carries a 1-2% risk of endometrial cancer.

Answer 8

B. Radiation to the head, neck, pelvis, and alkylating agents Rationale: These treatments pose the highest risk for infertility in both males and females.

Answer 9

B. Vinca alkaloids Rationale: Vinca alkaloids cause dose-related stocking-glove neuropathy, autonomic neuropathy, and cranial nerve palsies.

Answer 10

B. Cisplatin Rationale: Cisplatin is known to cause sensorimotor neuropathy and ototoxicity (hearing loss).

Answer 11

C. Electric shock sensation down the spine upon neck flexion Rationale: Lhermitte’s sign is a self-limiting condition occurring 6-12 weeks post-radiation and resolves over time.

Answer 12

C. Necrotizing encephalopathy Rationale: Necrotizing encephalopathy is the most severe form of radiation injury and is associated with methotrexate.

Answer 13

B. Malabsorption Rationale: Malabsorption is one of the most common late complications in cancer survivors, along with colitis and chronic diarrhea.

Answer 14

C. Cisplatin Rationale: Cisplatin is known to cause reversible kidney damage, primarily acute tubular necrosis.

Answer 15

B. Cyclophosphamide and Ifosfamide Rationale: Cyclophosphamide and Ifosfamide can cause hemorrhagic cystitis, a severe bladder toxicity.

Answer 16

C. Deferoxamine Rationale: Deferoxamine (Desferal) is the first-line IV iron chelator, given via slow IV or subcutaneous infusion.

Answer 17

B. Oral administration (better compliance) Rationale: Deferasirox is an oral iron chelator, making it easier to use and improving patient compliance, especially in older children and adults.

Answer 18

B. Hypoproliferative anemia Rationale: Hypoproliferative anemias (e.g., iron deficiency, anemia of chronic disease) are the most common type of anemia.

Answer 19

A. Blood loss Rationale: Acute anemia is most commonly due to blood loss, such as GI bleeding or trauma.

Answer 20

A. Iron deficiency Rationale: Iron deficiency anemia is the most common cause of chronic anemia, particularly in women and children.

Answer 21

C. Fatigue Rationale: Fatigue is the most common symptom of anemia due to reduced oxygen delivery to tissues.

Answer 22

C. Mucosal pallor Rationale: Pallor (seen in the mucosa, conjunctiva, and palmar creases) is the most common sign of severe anemia.

Answer 23

B. Thalassemia Rationale: Thalassemia is the most common genetic disorder worldwide, especially in Mediterranean, African, and Southeast Asian populations.

Answer 24

C. HbS (Sickle Cell Disease) Rationale: HbS (Sickle Cell Disease) is the most common structural hemoglobinopathy, resulting from a point mutation in the β-globin gene.

Answer 25

B. Painful vaso-occlusive crisis Rationale: Painful vaso-occlusive crisis is the most common and hallmark complication of Sickle Cell Disease, triggered by dehydration, infection, or hypoxia.

Answer 26

B. Von Willebrand Disease (VWD) Rationale: Von Willebrand Disease (VWD) is the most common inherited bleeding disorder, due to deficiency or dysfunction of von Willebrand factor (vWF).

Answer 27

C. Desmopressin (DDAVP) Rationale: Desmopressin (DDAVP) increases vWF release from endothelial cells, making it the first-line treatment for mild VWD.

Answer 28

D. Nose (Epistaxis) Rationale: Epistaxis (nosebleeds) is the most common site of bleeding in Hereditary Hemorrhagic Telangiectasia (HHT).

Answer 29

A. Drug-induced (Heparin, Vancomycin, Quinine, Sulfonamides) Rationale: Drug-induced thrombocytopenia is the most common cause of low platelet counts, especially due to heparin, vancomycin, quinine, and sulfonamides.

Answer 30

C. Thrombotic Thrombocytopenic Purpura (TTP) Rationale: TTP is the most common TMA in adults, caused by ↓ ADAMTS13, leading to widespread platelet aggregation and microvascular thrombosis. Plasma exchange is the treatment of choice.

Answer 31

A. Hemolytic Uremic Syndrome (HUS) Rationale: HUS is the most common TMA in children, often caused by E. coli O157:H7 infection. Supportive care is the main treatment.

Answer 32

A. Sepsis (Gram-negative bacteria) Rationale: Sepsis, especially from Gram-negative bacteria, is the most common cause of DIC, leading to widespread coagulation activation.

Answer 33

B. Acute Promyelocytic Leukemia (APL) Rationale: Acute Promyelocytic Leukemia (APL) is the most common hematologic malignancy causing DIC due to the release of pro-coagulant granules.

Answer 34

A. GpIb Rationale: GpIb binds vWF, mediating platelet adhesion to damaged endothelium. Bernard-Soulier Syndrome (GpIb defect, giant platelets)

Answer 35

B. GpIIb/IIIa Rationale: GpIIb/IIIa binds fibrinogen, facilitating platelet aggregation and clot formation. Glanzmann’s Thrombasthenia: Absence of Gp IIb/IIIa receptor, affecting platelet aggregation.

Answer 36

B. Erythropoietin therapy Rationale: Erythropoietin therapy stimulates red blood cell production, increasing the demand for iron.

Answer 37

B. Phlebotomy for polycythemia vera Rationale: Phlebotomy, used in polycythemia vera, removes blood regularly, leading to iron loss.

Answer 38

C. Gastrectomy Rationale: Gastrectomy and bariatric surgery can impair iron absorption, increasing the risk of iron deficiency anemia.

Answer 39

A. Iron deficiency anemia 🧠 High-Yield Rationale: Microcytic, hypochromic RBCs suggest a microcytic anemia. Low serum iron (<30 µg/dL) and ferritin (<15 µg/L) with high TIBC (>360 µg/dL) confirm iron deficiency anemia (IDA). Percent saturation <10% further supports IDA. Common causes: Chronic blood loss (e.g., heavy menstruation, GI bleeding), inadequate dietary intake, malabsorption.

Answer 40

C. Beta-thalassemia trait 🧠 High-Yield Rationale: Thalassemia presents with microcytic anemia but normal to high serum iron and ferritin levels. Target cells on smear are characteristic. Hemoglobin electrophoresis shows increased HbA2 (>3.5%), confirming beta-thalassemia trait. Key distinction: Unlike IDA, thalassemia does NOT have low ferritin or high TIBC.

Answer 41

A. Iron deficiency anemia 🧠 High-Yield Rationale: Microcytic anemia (MCV 60-90 fL) suggests a problem with iron availability. Low serum iron (<30 µg/dL) with high TIBC (>360 µg/dL) and very low ferritin (<15 µg/L) confirms iron deficiency anemia (IDA). Iron stores are absent (0+), further supporting IDA. Common causes: Chronic blood loss (menorrhagia, GI bleeding), poor diet, malabsorption (e.g., celiac disease).

Answer 42

C. Burkitt’s lymphoma Rationale: EBV is highly associated with Burkitt’s lymphoma, particularly in endemic African cases.

Answer 43

B. HTLV-1 Rationale: HTLV-1 (Human T-cell Lymphotropic Virus-1) is strongly linked to Adult T-cell leukemia/lymphoma, primarily in Japan and the Caribbean.

Answer 44

B. Diffuse large B-cell lymphoma Rationale: HIV-associated immunosuppression increases the risk of diffuse large B-cell lymphoma (DLBCL).

Answer 45

A. Lymphoplasmacytic lymphoma Rationale: HCV infection is linked to lymphoplasmacytic lymphoma, which can progress to Waldenström’s macroglobulinemia.

Answer 46

B. Gastric MALT lymphoma Rationale: Helicobacter pylori infection is a well-established cause of gastric MALT lymphoma, which may regress after antibiotic treatment.

Answer 47

B. Primary effusion lymphoma Rationale: HHV-8 is the primary cause of primary effusion lymphoma, often seen in HIV/AIDS patients.

Answer 48

B. Involvement of a single lymph node region or a single extranodal site Rationale: Stage I lymphoma is characterized by localized involvement of one lymph node region (I) or a single extranodal site (IE).

Answer 49

A. Two or more lymph node regions on the same side of the diaphragm Rationale: Stage II lymphoma involves two or more lymph node regions or lymphatic structures on the same side of the diaphragm, with possible extralymphatic organ involvement (IIE).

Answer 50

A. Involvement of lymph nodes on both sides of the diaphragm Rationale: Stage III lymphoma is defined by lymph node involvement on both sides of the diaphragm, with possible spleen (IIIS) or extranodal organ involvement (IIIE, IIIES).

Answer 51

B. Disseminated extranodal involvement with or without lymph node disease Rationale: Stage IV lymphoma is diffuse or disseminated with multiple extranodal organs involved, with or without lymph node disease.

Answer 52

B. A = No systemic symptoms, B = Presence of systemic symptoms Rationale: Ann Arbor stages are further categorized as "A" (no systemic symptoms) or "B" (presence of fevers, night sweats, and/or weight loss >10% over 6 months).

Answer 53

C. Weight loss >10% in 6 months Rationale: Systemic B symptoms include unexplained fever, night sweats, and weight loss >10% of body weight over 6 months.

Answer 54

B. Heparin Rationale: Heparin-Induced Thrombocytopenia (HIT) is a well-known cause of drug-induced thrombocytopenia, often leading to thrombosis rather than bleeding.

Answer 55

D. AOTA Rationale: Ibuprofen, Acetaminophen, and Naproxen have been reported to cause drug-induced thrombocytopenia. Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) Acetaminophen Ibuprofen Naproxen

Answer 56

A. Amiodarone Rationale: Amiodarone, a potent antiarrhythmic, has been linked to drug-induced thrombocytopenia. Cardiovascular Drugs Amiodarone (Antiarrhythmic) Amlodipine (Calcium channel blocker) Furosemide (Loop diuretic) Rosiglitazone (Thiazolidinedione - used for diabetes)

Answer 57

C. Leukemic cells not detectable by light microscopy (<5% blasts in bone marrow) Rationale: CHR is defined as <5% blast cells in the bone marrow (BM) by light microscopy, indicating no visible leukemia.

Answer 58

B. ≤0.01% leukemia cells (≤1 cell in 10,000 BM cells) Rationale: MRD negativity means leukemia cells are undetectable at a molecular level (≤0.01%), indicating a deep remission.

Answer 59

B. Molecular failure/MRD positivity Rationale: Molecular failure (MRD positivity) means the patient is in CHR but has detectable MRD >0.01%, indicating a higher risk of relapse.

Answer 60

C. Detectable leukemia cells in BM despite prior molecular remission Rationale: Molecular relapse means the patient had prior MRD negativity but now has detectable leukemia cells in the BM (<5%), suggesting early recurrence.

Answer 61

B. >5% blasts in BM or peripheral blood Rationale: Hematologic relapse is defined as >5% blasts in the bone marrow or blood, indicating active leukemia recurrence.