ITE Hematology and Oncology

Question 1

A 28-year-old woman presents with fatigue, pallor, and pica (ice craving). Labs show Hgb 8.5 g/dL, MCV 68 fL, low serum ferritin, and low serum iron. What is the most appropriate initial treatment?

Accepted Answer

Oral ferrous sulfate

Answer

Iron deficiency anemia confirmed by low ferritin and microcytosis is treated with oral iron supplementation as first-line therapy.

Question 2

A 65-year-old strict vegetarian presents with fatigue, paresthesias in hands and feet, and glossitis. Labs show Hgb 9.2 g/dL, MCV 112 fL, and hypersegmented neutrophils on smear. Which lab finding would best confirm the diagnosis?

Accepted Answer

Low serum vitamin B12 level

Answer

Macrocytic anemia with neurological symptoms in a long-term strict vegetarian strongly suggests B12 deficiency, confirmed by low serum B12.

Question 3

A 22-year-old African American man with known sickle cell disease presents with severe bilateral leg bone pain, fever of 38.4°C, and WBC 12,500/μL. His Hgb is 6.9 g/dL compared to a baseline of 7.1 g/dL. What is the most likely diagnosis?

Accepted Answer

Vaso-occlusive (pain) crisis

Answer

Severe bone pain with near-baseline hemoglobin and no respiratory symptoms is characteristic of a vaso-occlusive pain crisis.

Question 4

A 32-year-old healthy woman has incidental platelet count of 26,000/μL on routine CBC. She has no bleeding symptoms, is on no medications, and has normal-appearing platelets on peripheral smear. What is the most likely diagnosis?

Accepted Answer

Immune thrombocytopenic purpura (ITP)

Answer

Isolated thrombocytopenia with normal platelet morphology and no medications or systemic illness in a healthy young person is most consistent with ITP.

Question 5

A patient on warfarin for atrial fibrillation presents with INR of 8.4 but has no active bleeding. What is the most appropriate management?

Accepted Answer

Hold warfarin and administer oral vitamin K

Answer

For supratherapeutic INR without active bleeding, holding warfarin and giving oral vitamin K to gradually lower the INR is the appropriate management.

ITE - Internal Medicine In-Training Exam Practice Test

ITE - Internal Medicine In-Training Exam Practice Test

ITE Hematology and Oncology