ITE Hematology and Oncology 3

Question 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?

Accepted Answer

Surgical resection of the involved colon segment

Answer

Surveillance colonoscopy in 1 year only

Answer

Radiation therapy alone

Answer

Systemic chemotherapy without surgery

Question 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?

Accepted Answer

Ectopic PTHrP secretion by the tumor

Answer

Ectopic authentic PTH secretion

Answer

Calcitonin secretion by the tumor

Answer

1,25-dihydroxyvitamin D overproduction

Question 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?

Accepted Answer

Tamoxifen (hormone receptor blockade)

Answer

Trastuzumab (HER2-targeted therapy)

Answer

Platinum-based cytotoxic chemotherapy

Answer

Rituximab (anti-CD20 therapy)

Question 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?

Accepted Answer

Tumor lysis syndrome

Answer

Cisplatin-induced nephrotoxicity

Answer

Contrast-induced nephropathy

Answer

Septic acute tubular necrosis

Question 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?

Accepted Answer

Syndrome of inappropriate ADH secretion (SIADH)

Answer

Primary adrenal insufficiency

Answer

Hypervolemic hyponatremia from nephrotic syndrome

Answer

Cerebral salt wasting

Question 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?

Accepted Answer

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

Answer

Oral ciprofloxacin with close outpatient monitoring

Answer

G-CSF (filgrastim) administration only

Answer

Empiric antifungal therapy alone

Question 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?

Accepted Answer

Low-dose aspirin alone

Answer

Cytoreductive therapy with hydroxyurea plus aspirin

Answer

Anagrelide as monotherapy

Answer

Phlebotomy to reduce platelet count