AOCNP Hematologic Malignancies 3

Question 1

The CRAB criteria are used to define symptomatic multiple myeloma requiring treatment. What do the letters C-R-A-B represent?

Accepted Answer

Hypercalcemia, Renal insufficiency, Anemia, Bone lesions

Answer

Cytopenia, Renal failure, Adenopathy, Bone pain

Answer

Coagulopathy, Rash, Azotemia, Blast cells

Answer

Cytopenia, Radiographic lesions, Abnormal protein, Bone marrow plasma cells >10%

Question 2

Which diagnostic test is most sensitive and specific for detecting and quantifying the monoclonal protein (M-protein) in multiple myeloma?

Accepted Answer

Serum protein electrophoresis (SPEP) combined with serum immunofixation electrophoresis (IFE)

Answer

Complete blood count with differential

Answer

Bone marrow biopsy alone

Answer

24-hour urine protein excretion

Question 3

A patient with multiple myeloma develops sudden onset of severe back pain, bilateral lower extremity weakness, and urinary retention. What is the most urgent nursing priority?

Accepted Answer

Recognize spinal cord compression and initiate urgent evaluation with MRI and notify the oncology team immediately

Answer

Administer IV bisphosphonate to address hypercalcemia

Answer

Begin hydration for suspected hyperviscosity syndrome

Answer

Assess for peripheral neuropathy from bortezomib

Question 4

Bortezomib is a key agent in multiple myeloma therapy. What is its mechanism of action?

Accepted Answer

Proteasome inhibitor that disrupts protein degradation and induces apoptosis in plasma cells

Answer

Anti-CD38 monoclonal antibody causing antibody-dependent cytotoxicity

Answer

Immunomodulatory drug that inhibits angiogenesis and stimulates T-cell immunity

Answer

Alkylating agent that causes DNA cross-linking

Question 5

Myelodysplastic syndrome (MDS) is best characterized by which of the following?

Accepted Answer

Peripheral cytopenias with dysplastic morphologic changes in bone marrow cells despite adequate or hypercellular marrow cellularity

Answer

Hypocellular bone marrow with absence of dysplasia and normal cytogenetics

Answer

Clonal proliferation of mature lymphocytes with hypogammaglobulinemia

Answer

Presence of >20% blasts in bone marrow meeting criteria for AML

Question 6

The Revised International Prognostic Scoring System (IPSS-R) for MDS incorporates which of the following factors to assign risk category?

Accepted Answer

Cytogenetic risk group, bone marrow blast percentage, hemoglobin, platelet count, and absolute neutrophil count

Answer

Age, comorbidity index, response to erythropoiesis-stimulating agents, and transfusion burden

Answer

Serum LDH, beta-2 microglobulin, albumin, renal function, and number of cytopenias

Answer

Number of mutations by next-generation sequencing, blast percentage, and transfusion history

Question 7

A patient with Waldenström macroglobulinemia (WM) presents with headache, blurred vision, dizziness, and epistaxis. Which pathophysiologic mechanism best explains these symptoms?

Accepted Answer

Hyperviscosity syndrome caused by high levels of circulating IgM monoclonal protein

Answer

Bone marrow failure causing severe thrombocytopenia and spontaneous bleeding

Answer

Leptomeningeal involvement by lymphoplasmacytic lymphoma

Answer

CRAB criteria-related renal insufficiency causing uremic encephalopathy