ITE Hematology and Oncology 2

Question 1

A 67-year-old man presents with bone pain, fatigue, and recurrent pneumonias. Labs show calcium 12.2 mg/dL, creatinine 2.3 mg/dL, Hgb 9.1 g/dL, and total protein 10.2 g/dL. Serum protein electrophoresis reveals an M-spike. What is the most likely diagnosis?

Accepted Answer

Multiple myeloma

Answer

Multiple myeloma classically presents with the CRAB criteria (hyperCalcemia, Renal insufficiency, Anemia, Bone pain) along with a monoclonal spike on SPEP.

Question 2

A 24-year-old man presents with painless cervical lymphadenopathy, fever, drenching night sweats, and 12-lb weight loss over 2 months. Lymph node biopsy reveals large binucleated cells with prominent 'owl-eye' nucleoli. What is the most likely diagnosis?

Accepted Answer

Hodgkin lymphoma

Answer

Reed-Sternberg cells (large binucleated cells with prominent 'owl-eye' nucleoli) on biopsy are pathognomonic for Hodgkin lymphoma.

Question 3

A 62-year-old woman has bilateral painless cervical and axillary lymphadenopathy. Flow cytometry of a lymph node biopsy shows CD5+, CD19+, CD20+ (dim), CD23+ cells with kappa light chain restriction. What is the most likely diagnosis?

Accepted Answer

Chronic lymphocytic leukemia / Small lymphocytic lymphoma (CLL/SLL)

Answer

The CD5+, CD19+, CD20 (dim), CD23+ immunophenotype is characteristic of CLL/SLL, distinguishing it from other B-cell lymphomas.

Question 4

A 38-year-old man presents with fatigue, easy bruising, and gingival bleeding for 3 weeks. CBC shows WBC 68,000/μL with 85% blasts, Hgb 7.8 g/dL, and platelets 18,000/μL. Bone marrow confirms AML. Which induction chemotherapy regimen is standard?

Accepted Answer

Cytarabine for 7 days plus daunorubicin for 3 days ('7+3')

Answer

The '7+3' regimen — 7 days of continuous infusion cytarabine plus 3 days of an anthracycline — is the standard induction for AML.

Question 5

A 54-year-old male smoker presents with facial plethora and headaches. Labs show Hgb 19.6 g/dL, Hct 62%, normal O2 saturation, and JAK2 V617F mutation. Splenomegaly is present. What is the most appropriate initial treatment?

Accepted Answer

Phlebotomy to reduce hematocrit plus low-dose aspirin

Answer

Polycythemia vera is initially managed with phlebotomy to reduce hematocrit below 45% and low-dose aspirin to prevent thrombosis.

ITE - Internal Medicine In-Training Exam Practice Test

ITE - Internal Medicine In-Training Exam Practice Test

ITE Hematology and Oncology 2