ITE Hematology and Oncology 4

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?

Accepted Answer

Imatinib

Answer

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?

Accepted Answer

Hold warfarin only and recheck INR in 24 hours

Answer

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?

Accepted Answer

Subcutaneous calcitonin

Answer

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?

Accepted Answer

Drug-induced TTP

Answer

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?

Accepted Answer

IgM MGUS

Answer

IgM MGUS is defined by IgM <3 g/dL with bone marrow lymphoplasmacytic infiltration <10% and no end-organ damage.

ITE - Internal Medicine In-Training Exam Practice Test

ITE - Internal Medicine In-Training Exam Practice Test

ITE Hematology and Oncology 4