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Hematology and Oncology Flashcards

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  1. A 28-year-old woman presents with fatigue, pallor, and pica (ice craving). Labs show Hgb 8.5 g/dL, MCV 68 fL, low serum ferritin, and low serum iron. What is the most appropriate initial treatment?

    Answer: Oral ferrous sulfate

    Iron deficiency anemia confirmed by low ferritin and microcytosis is treated with oral iron supplementation as first-line therapy.

  2. A 65-year-old strict vegetarian presents with fatigue, paresthesias in hands and feet, and glossitis. Labs show Hgb 9.2 g/dL, MCV 112 fL, and hypersegmented neutrophils on smear. Which lab finding would best confirm the diagnosis?

    Answer: Low serum vitamin B12 level

    Macrocytic anemia with neurological symptoms in a long-term strict vegetarian strongly suggests B12 deficiency, confirmed by low serum B12.

  3. A 22-year-old African American man with known sickle cell disease presents with severe bilateral leg bone pain, fever of 38.4°C, and WBC 12,500/μL. His Hgb is 6.9 g/dL compared to a baseline of 7.1 g/dL. What is the most likely diagnosis?

    Answer: Vaso-occlusive (pain) crisis

    Severe bone pain with near-baseline hemoglobin and no respiratory symptoms is characteristic of a vaso-occlusive pain crisis.

  4. A 32-year-old healthy woman has incidental platelet count of 26,000/μL on routine CBC. She has no bleeding symptoms, is on no medications, and has normal-appearing platelets on peripheral smear. What is the most likely diagnosis?

    Answer: Immune thrombocytopenic purpura (ITP)

    Isolated thrombocytopenia with normal platelet morphology and no medications or systemic illness in a healthy young person is most consistent with ITP.

  5. A patient on warfarin for atrial fibrillation presents with INR of 8.4 but has no active bleeding. What is the most appropriate management?

    Answer: Hold warfarin and administer oral vitamin K

    For supratherapeutic INR without active bleeding, holding warfarin and giving oral vitamin K to gradually lower the INR is the appropriate management.

  6. A 55-year-old man presents with left leg swelling and calf pain after a 12-hour flight. Doppler ultrasound confirms proximal DVT. He has no contraindications to anticoagulation and is otherwise healthy. What is the preferred initial treatment?

    Answer: Low molecular weight heparin (LMWH) or a DOAC (e.g., rivaroxaban)

    LMWH or a DOAC such as rivaroxaban or apixaban are first-line outpatient treatments for uncomplicated acute DVT without contraindications.

  7. A 45-year-old man is found to have WBC 90,000/μL with predominantly mature neutrophils and myelocytes, low leukocyte alkaline phosphatase score, and splenomegaly. BCR-ABL fusion gene is detected on PCR. What is the first-line treatment?

    Answer: Imatinib (a BCR-ABL tyrosine kinase inhibitor)

    CML driven by the BCR-ABL fusion (Philadelphia chromosome) is treated with BCR-ABL tyrosine kinase inhibitors such as imatinib as first-line therapy.