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Hematology and Oncology Flashcards

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  1. A 55-year-old man presents with fatigue and splenomegaly. Labs show WBC 85,000/μL with a predominance of mature granulocytes, hemoglobin 10 g/dL, platelets 600,000/μL, and Philadelphia chromosome positive. Which tyrosine kinase inhibitor is first-line therapy?

    Answer: Imatinib

    Imatinib (Gleevec) was the first BCR-ABL tyrosine kinase inhibitor approved for CML and remains a standard first-line option alongside second-generation agents.

  2. A 70-year-old woman on warfarin for atrial fibrillation presents with a supratherapeutic INR of 9.2 but no active bleeding. What is the most appropriate management?

    Answer: Hold warfarin only and recheck INR in 24 hours

    For supratherapeutic INR without bleeding, holding warfarin and rechecking INR is appropriate; vitamin K is added for INR >10 or high bleeding risk.

  3. A patient with multiple myeloma develops severe hypercalcemia (calcium 13.5 mg/dL) and acute kidney injury. After IV fluids, which agent should be added to lower calcium?

    Answer: Subcutaneous calcitonin

    Calcitonin provides the fastest onset of calcium-lowering effect (hours) and is used acutely alongside bisphosphonates, which have a delayed onset of days.

  4. A 45-year-old woman with breast cancer develops a platelet count of 12,000/μL and microangiopathic hemolytic anemia 3 weeks after starting gemcitabine. ADAMTS13 activity is normal. What is the diagnosis?

    Answer: Drug-induced TTP

    Gemcitabine is a well-known cause of drug-induced thrombotic microangiopathy (TTP-like syndrome) with normal ADAMTS13, distinguishing it from idiopathic TTP.

  5. A 68-year-old man is found to have an IgM paraprotein of 1.8 g/dL with bone marrow showing 12% lymphoplasmacytic cells. He is asymptomatic. What is the diagnosis?

    Answer: IgM MGUS

    IgM MGUS is defined by IgM <3 g/dL with bone marrow lymphoplasmacytic infiltration <10% and no end-organ damage.

  6. A 35-year-old woman with sickle cell disease presents with sudden onset severe chest pain, fever, new pulmonary infiltrates, and oxygen saturation of 88%. Which intervention is most critical?

    Answer: Exchange transfusion

    Acute chest syndrome with hypoxia is life-threatening; exchange transfusion rapidly reduces HbS percentage and is the key intervention when oxygenation is compromised.

  7. A 60-year-old man is diagnosed with diffuse large B-cell lymphoma (DLBCL), Ann Arbor stage II, IPI score 2. What is the standard first-line chemotherapy regimen?

    Answer: R-CHOP

    R-CHOP (rituximab plus cyclophosphamide, doxorubicin, vincristine, prednisone) is the standard first-line treatment for DLBCL regardless of stage.