MD Hematology and Oncology 4

Question 1

A 35-year-old woman with sickle cell disease develops sudden chest pain, fever, hypoxia, and a new pulmonary infiltrate during a painful crisis. The most likely diagnosis is:

Accepted Answer

Acute chest syndrome

Answer

Acute chest syndrome (new pulmonary infiltrate + chest symptoms) is the leading cause of death in sickle cell disease and requires exchange transfusion in severe cases.

Question 2

Which gene mutation, found in >95% of polycythemia vera patients, is used as a diagnostic criterion?

Accepted Answer

JAK2 V617F

Answer

JAK2 V617F is present in >95% of PV patients and causes constitutive JAK-STAT signaling, driving erythrocytosis independent of EPO.

Question 3

A 50-year-old man receiving cisplatin-based chemotherapy develops fatigue with hemoglobin 7.5 g/dL, low reticulocytes, and inappropriately low erythropoietin. The mechanism of his anemia is:

Accepted Answer

Renal EPO suppression from cisplatin nephrotoxicity

Answer

Cisplatin causes nephrotoxicity that impairs renal EPO production, leading to anemia disproportionate to the degree of myelosuppression.

Question 4

A newborn develops jaundice within 24 hours of birth and hydrops fetalis. The Coombs test is positive. The mother is O-negative and the baby is O-positive. What is the mechanism?

Accepted Answer

Rh hemolytic disease of the newborn due to anti-D IgG

Answer

Rh incompatibility (Rh-negative mother sensitized to Rh-positive fetal cells) causes IgG anti-D to cross the placenta and destroy fetal RBCs, causing hemolytic disease of the newborn.

Question 5

A 65-year-old presents with back pain, a serum M-spike, and lytic bone lesions on X-ray. CRAB criteria are met. Which bisphosphonate reduces skeletal events in multiple myeloma?

Accepted Answer

Zoledronic acid

Answer

Zoledronic acid (IV) is preferred over other bisphosphonates for multiple myeloma bone disease due to superior efficacy in reducing skeletal-related events.

MD - Doctor of Medicine Practice Test

MD - Doctor of Medicine Practice Test

MD Hematology and Oncology 4