ITE Hematology and Oncology

Question 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?

Accepted Answer

Oral ferrous sulfate

Answer

Intramuscular vitamin B12

Answer

Folic acid supplementation

Answer

Blood transfusion

Question 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?

Accepted Answer

Low serum vitamin B12 level

Answer

Low serum folate level

Answer

Elevated serum ferritin

Answer

Positive direct Coombs test

Question 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?

Accepted Answer

Vaso-occlusive (pain) crisis

Answer

Acute chest syndrome

Answer

Aplastic crisis

Answer

Splenic sequestration crisis

Question 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?

Accepted Answer

Immune thrombocytopenic purpura (ITP)

Answer

Thrombotic thrombocytopenic purpura (TTP)

Answer

Heparin-induced thrombocytopenia (HIT)

Answer

Disseminated intravascular coagulation (DIC)

Question 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?

Accepted Answer

Hold warfarin and administer oral vitamin K

Answer

Hold warfarin and administer IV vitamin K plus fresh frozen plasma

Answer

Continue warfarin and recheck INR in 24 hours

Answer

Administer 4-factor prothrombin complex concentrate (PCC)

Question 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?

Accepted Answer

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

Answer

Unfractionated heparin infusion with warfarin bridging

Answer

Aspirin and graded compression stockings

Answer

IVC filter placement without anticoagulation

Question 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?

Accepted Answer

Imatinib (a BCR-ABL tyrosine kinase inhibitor)

Answer

Hydroxyurea alone

Answer

Allogeneic stem cell transplant upfront

Answer

Cytarabine and daunorubicin induction chemotherapy