MKSAP HemeOnc II

Question 1

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

Answer 1

age-appropriate screening; addition of a comprehensive CT of the abdomen-pelvis for the screening of occult cancer in patients with unprovoked VTE is not cost effective

Question 2

Acute promyelocytic leukemia may present with a reduced total leukocyte count and features of ____.

Answer 2

disseminated intravascular coagulation
APML is a subset of acute myeloid leukemia that often presents with bleeding and coagulopathy; this coagulopathy contributes to early mortality and morbidity.

Question 3

In patients with IgG monoclonal gammopathy of undetermined significance, an M spike of less than ___ g/dL, and normal findings on serum free light chain assay and urine protein electrophoresis, the risk of progression is low (5% over 20 years), so extensive evaluation is not recommended.

Answer 3

1.5; you just monitor in 6mo to 1 year with repeat serum protein electrophoresis, Hgb, Ca, Cr and if still stable can reduce monitoring.

MGUS is seen in 3% of the population older than 50 years, and most of them do not progress,

Question 4

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

Answer 4

intravenous immune globulin

Question 5

delayed hemolytic transfusion reaction (DHTR), which is an anamnestic antibody response to previous erythrocyte antigen (non-ABO) sensitization that typically occurs ___ after the index transfusion. The primary alloimmunization event is usually a remote transfusion or pregnancy. At the time of the index transfusion, the antibody level is usually lower than the detectable threshold determined by routine blood bank screening. A DHTR is associated with jaundice, low-grade fever, and an otherwise unexplained decrease in the hemoglobin concentration; it is sometimes accompanied by hemoglobinuria.

Answer 5

7 to 14 days

Question 6

___ infection preferentially affects erythrocyte precursors in the bone marrow, causing transient pure red cell aplasia (low retic count) in patients with sickle cell anemia.

Answer 6

Parvovirus B19

Question 7

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

Answer 7

aspirin and hydroxyurea

Question 8

Causes of secondary thrombocytosis (4)

Answer 8

Chronic infection, collagen vascular disease, malignancy, ongoing bleeding, and iron deficiency

Question 9

When is plateletpheresis indicated?

Answer 9

emergent management of patients with ET with plts > 1000 and acute hemorrhage

Question 10

____ typically appears as an isolated, mild neutropenia (1000-1500/µL [1-1.5 × 109/L]) found on routine testing in asymptomatic Black persons or certain other ethnic groups.

Answer 10

Benign ethnic neutropenia

ANC of <500 is less likely to be normal and more likely to be increased risk for bacterial and fungal infections

Question 11

Testing for ____ is reliable in men who are not experiencing an acute hemolytic episode but is less useful during acute episodes because reticulocytes produce higher levels of enzyme, resulting in a falsely normal test result.

Answer 11

glucose-6-phosphate dehydrogenase activity

Question 12

What does ADAMTS13 activity test for?

Answer 12

thrombotic thrombocytopenic purpura

Question 13

Normocytic anemia with a low reticulocyte count and normal erythrocyte morphology in a patient with underlying chronic kidney disease is usually caused by ___ and will respond to therapy with an erythropoiesis-stimulating agent; however, normalization of the blood count is not advised.

Answer 13

erythropoietin deficiency

Question 14

hepatosplenomegaly, anemia, and night sweats along with an IgM spike on laboratory testing

Answer 14

Waldenström macroglobulinemia (WM) 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.

Question 15

____ presents with symptoms such as altered vision, headache, hearing loss, tinnitus, dizziness, nystagmus, altered mental status, and nasal and oropharyngeal bleeding. Funduscopic evaluation with dilated retinal veins, papilledema, and flame hemorrhages. M protein level greater than ____.

Answer 15

Hyperviscosity; 400mg/dL

Question 16

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

Answer 16

hemochromatosis