Internal Medicine Exam Hematology 3

Question 1

A 70-year-old man has a WBC of 45,000/µL with small mature lymphocytes on smear. Flow cytometry shows CD5+/CD19+/CD23+. What is the most likely diagnosis?

Accepted Answer

Chronic lymphocytic leukemia (CLL)

Answer

CLL is characterized by clonal expansion of mature B-lymphocytes co-expressing CD5 and CD23 (CD5+/CD19+/CD23+), distinguishing it from mantle cell lymphoma (CD23-).

Question 2

Reed-Sternberg cells on lymph node biopsy are pathognomonic for which hematologic malignancy?

Accepted Answer

Hodgkin lymphoma

Answer

Reed-Sternberg cells—large binucleated cells with prominent nucleoli giving an 'owl-eye' appearance—are the hallmark pathologic finding of Hodgkin lymphoma.

Question 3

Which set of clinical features best describes the CRAB criteria used to diagnose symptomatic multiple myeloma?

Accepted Answer

HyperCalcemia, Renal failure, Anemia, and Bone lesions

Answer

CRAB criteria for multiple myeloma are: hyperCalcemia, Renal failure, Anemia, and Bone lytic lesions—end-organ damage that indicates symptomatic disease requiring treatment.

Question 4

Which finding on serum protein electrophoresis (SPEP) is characteristic of multiple myeloma?

Accepted Answer

M-spike representing a monoclonal protein

Answer

Multiple myeloma produces a single clone of plasma cells secreting identical immunoglobulin, creating a sharp M-spike (monoclonal protein) on SPEP.

Question 5

A patient develops fever, chills, flank pain, and hemoglobinuria 30 minutes into a blood transfusion. What is the most likely cause?

Accepted Answer

Acute hemolytic transfusion reaction due to ABO incompatibility

Answer

Acute hemolytic transfusion reactions from ABO incompatibility cause intravascular hemolysis, presenting with fever, chills, flank/back pain, and hemoglobinuria within minutes of transfusion.

Internal Medicine Exam Practice Test

Internal Medicine Exam Practice Test

Internal Medicine Exam Hematology 3