ITE Hematology and Oncology 4 — Questions and Answers
Question 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?
- Dasatinib
- Imatinib (Correct answer)
- Nilotinib
- Ponatinib
Correct 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.
Question 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?
- Hold warfarin and give IV vitamin K 10 mg
- Hold warfarin only and recheck INR in 24 hours (Correct answer)
- Give 4-factor PCC immediately
- Administer fresh frozen plasma
Correct 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.
Question 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?
- Oral prednisone
- IV zoledronic acid
- Subcutaneous calcitonin (Correct answer)
- Oral cinacalcet
Correct 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.
Question 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?
- Immune thrombocytopenic purpura
- Drug-induced TTP (Correct answer)
- Disseminated intravascular coagulation
- Heparin-induced thrombocytopenia
Correct 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.
Question 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?
- Waldenström macroglobulinemia
- Smoldering Waldenström macroglobulinemia
- IgM MGUS (Correct answer)
- Multiple myeloma
Correct answer: IgM MGUS
IgM MGUS is defined by IgM <3 g/dL with bone marrow lymphoplasmacytic infiltration <10% and no end-organ damage.
Question 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?
- Empiric antibiotics alone
- Exchange transfusion (Correct answer)
- Hydroxyurea initiation
- IV morphine and observation
Correct 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.
Question 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?
- CHOP alone
- R-CHOP (Correct answer)
- R-CVP
- Bendamustine-rituximab
Correct answer: R-CHOP
R-CHOP (rituximab plus cyclophosphamide, doxorubicin, vincristine, prednisone) is the standard first-line treatment for DLBCL regardless of stage.
ITE Hematology and Oncology 4
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?