ITE Hematology and Oncology 5

Question 1

A 72-year-old man with CLL has a rising lymphocyte count and new lymphadenopathy. Biopsy shows transformation to DLBCL with loss of CD5 expression and elevated LDH. What is this transformation called?

Accepted Answer

Richter transformation

Answer

Richter transformation refers to the development of aggressive lymphoma (most commonly DLBCL) in a patient with CLL, carrying a poor prognosis.

Question 2

A patient with AML achieves complete remission after induction chemotherapy. Cytogenetics show inv(16). Which post-remission strategy is preferred?

Accepted Answer

High-dose cytarabine consolidation

Answer

Inv(16) is a favorable-risk cytogenetic abnormality in AML; high-dose cytarabine consolidation achieves excellent outcomes without the added toxicity of transplant.

Question 3

A 50-year-old woman presents with venous thrombosis at an unusual site (portal vein). Testing reveals the JAK2 V617F mutation. What underlying condition is most likely?

Accepted Answer

Myeloproliferative neoplasm (polycythemia vera)

Answer

JAK2 V617F is found in ~95% of polycythemia vera cases and is the most common MPN associated with splanchnic vein thrombosis.

Question 4

A 25-year-old man presents with bilateral testicular germ cell tumor markers showing elevated AFP and beta-hCG. Staging CT shows retroperitoneal lymph nodes up to 3 cm but no visceral metastases. What is the first-line treatment?

Accepted Answer

Orchiectomy followed by BEP chemotherapy

Answer

For intermediate or high-risk nonseminomatous GCT with elevated markers and lymph node involvement, orchiectomy followed by BEP (bleomycin, etoposide, cisplatin) is standard.

Question 5

A patient receiving cisplatin-based chemotherapy develops a serum creatinine rise from 0.9 to 2.1 mg/dL. Urinalysis shows granular casts and low urine sodium. What is the mechanism of nephrotoxicity?

Accepted Answer

Direct proximal tubular cell injury

Answer

Cisplatin causes direct proximal tubular injury through accumulation of platinum-DNA adducts, leading to tubular necrosis.

ITE - Internal Medicine In-Training Exam Practice Test

ITE - Internal Medicine In-Training Exam Practice Test

ITE Hematology and Oncology 5