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Hematology and Oncology Flashcards

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  1. A 72-year-old man with CLL has a rising lymphocyte count and new lymphadenopathy. Biopsy shows transformation to DLBCL with loss of CD5 expression and elevated LDH. What is this transformation called?

    Answer: Richter transformation

    Richter transformation refers to the development of aggressive lymphoma (most commonly DLBCL) in a patient with CLL, carrying a poor prognosis.

  2. A patient with AML achieves complete remission after induction chemotherapy. Cytogenetics show inv(16). Which post-remission strategy is preferred?

    Answer: High-dose cytarabine consolidation

    Inv(16) is a favorable-risk cytogenetic abnormality in AML; high-dose cytarabine consolidation achieves excellent outcomes without the added toxicity of transplant.

  3. A 50-year-old woman presents with venous thrombosis at an unusual site (portal vein). Testing reveals the JAK2 V617F mutation. What underlying condition is most likely?

    Answer: Myeloproliferative neoplasm (polycythemia vera)

    JAK2 V617F is found in ~95% of polycythemia vera cases and is the most common MPN associated with splanchnic vein thrombosis.

  4. A 25-year-old man presents with bilateral testicular germ cell tumor markers showing elevated AFP and beta-hCG. Staging CT shows retroperitoneal lymph nodes up to 3 cm but no visceral metastases. What is the first-line treatment?

    Answer: Orchiectomy followed by BEP chemotherapy

    For intermediate or high-risk nonseminomatous GCT with elevated markers and lymph node involvement, orchiectomy followed by BEP (bleomycin, etoposide, cisplatin) is standard.

  5. A patient receiving cisplatin-based chemotherapy develops a serum creatinine rise from 0.9 to 2.1 mg/dL. Urinalysis shows granular casts and low urine sodium. What is the mechanism of nephrotoxicity?

    Answer: Direct proximal tubular cell injury

    Cisplatin causes direct proximal tubular injury through accumulation of platinum-DNA adducts, leading to tubular necrosis.

  6. A 40-year-old woman with myelodysplastic syndrome has a del(5q) as the sole cytogenetic abnormality, transfusion-dependent anemia, and platelet count of 450,000/μL. Which agent is specifically indicated?

    Answer: Lenalidomide

    Lenalidomide is specifically approved for transfusion-dependent MDS with isolated del(5q) and produces high rates of transfusion independence.

  7. A 55-year-old man with metastatic renal cell carcinoma (clear cell histology) has good performance status and no prior therapy. Which combination is preferred first-line based on current evidence?

    Answer: Nivolumab plus ipilimumab or pembrolizumab plus axitinib

    Checkpoint inhibitor-based combinations (e.g., nivolumab/ipilimumab or pembrolizumab/axitinib) have demonstrated superior overall survival compared to sunitinib in first-line clear-cell RCC.