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Hematology and Oncology Flashcards

7 cards from real ITE practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.

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  1. A 57-year-old man undergoes colonoscopy for a positive stool occult blood test. A 2 cm polyp is removed; pathology shows T2N0M0 invasive adenocarcinoma of the colon. What is the most appropriate next step?

    Answer: Surgical resection of the involved colon segment

    T2 colon cancer has invaded the muscularis propria and requires surgical resection; polypectomy alone is inadequate for disease that extends beyond the submucosa (T1).

  2. A 66-year-old man with 45 pack-year smoking history has a right upper lobe mass. Biopsy shows squamous cell carcinoma. He has serum calcium of 12.8 mg/dL with no bone metastases on imaging. What is the most likely cause of his hypercalcemia?

    Answer: Ectopic PTHrP secretion by the tumor

    Squamous cell carcinoma of the lung commonly secretes PTH-related protein (PTHrP), causing hypercalcemia of malignancy without bone metastases.

  3. A 48-year-old premenopausal woman undergoes lumpectomy for a 1.8 cm invasive ductal carcinoma; pathology shows ER+/PR+, HER2-, pT1cN0M0. Which systemic adjuvant therapy is most appropriate?

    Answer: Tamoxifen (hormone receptor blockade)

    ER+/PR+ breast cancer is treated with endocrine therapy such as tamoxifen in premenopausal women; HER2-targeted therapy is not indicated in HER2-negative tumors.

  4. A patient with Burkitt lymphoma develops oliguria, creatinine rising to 3.1 mg/dL, potassium of 6.8 mEq/L, phosphorus of 8.2 mg/dL, calcium of 7.1 mg/dL, and uric acid of 14 mg/dL 24 hours after starting chemotherapy. What is the most likely complication?

    Answer: Tumor lysis syndrome

    Tumor lysis syndrome occurs when massive tumor cell death releases intracellular contents, causing hyperkalemia, hyperphosphatemia, hypocalcemia, and hyperuricemia with acute kidney injury.

  5. A 68-year-old woman with extensive-stage small cell lung cancer presents with serum sodium of 116 mEq/L, serum osmolality of 250 mOsm/kg, urine osmolality of 620 mOsm/kg, and urine sodium of 50 mEq/L. She appears euvolemic. What is the most likely cause?

    Answer: Syndrome of inappropriate ADH secretion (SIADH)

    Small cell lung cancer commonly secretes ADH ectopically, causing SIADH with euvolemic hyponatremia and inappropriately concentrated urine with elevated urine sodium.

  6. A 58-year-old multiple myeloma patient on day +8 after autologous stem cell transplant develops fever of 39.2°C with ANC of 150 cells/μL and no identifiable infection source. What is the most appropriate immediate management?

    Answer: Broad-spectrum IV antibiotics with anti-Pseudomonal coverage (e.g., piperacillin-tazobactam)

    Febrile neutropenia requires prompt initiation of broad-spectrum intravenous antibiotics covering gram-negative organisms including Pseudomonas to prevent septic mortality.

  7. A 42-year-old woman is found to have a platelet count of 980,000/μL on routine CBC. She is asymptomatic with no prior thrombosis. Bone marrow biopsy confirms essential thrombocythemia with JAK2 V617F mutation. She has no cardiovascular risk factors. What is the appropriate management for this low-risk patient?

    Answer: Low-dose aspirin alone

    Low-risk essential thrombocythemia (age <60, no prior thrombosis, no high-risk features) is managed with low-dose aspirin alone without cytoreduction.