PANCE PANCE Hematology 2 — Questions and Answers
Question 1: A patient with recurrent DVT has a prolonged aPTT that does not correct with a 1:1 mixing study. What is the most likely diagnosis?
- Antiphospholipid syndrome (Correct answer)
- Hemophilia A
- Factor VIII deficiency
- Heparin contamination
Correct answer: Antiphospholipid syndrome
Failure to correct on mixing study indicates an inhibitor; lupus anticoagulant in antiphospholipid syndrome is the most common cause.
Question 2: A 52-year-old has splenomegaly, WBC of 85,000 with basophilia, and a Philadelphia chromosome on cytogenetics. What is the diagnosis?
- Chronic myelogenous leukemia (Correct answer)
- Acute myeloid leukemia
- Polycythemia vera
- Myelofibrosis
Correct answer: Chronic myelogenous leukemia
CML is characterized by the BCR-ABL fusion gene (Philadelphia chromosome t(9;22)) and presents with leukocytosis, basophilia, and splenomegaly.
Question 3: A patient with multiple myeloma develops worsening renal function. Which renal complication is most directly caused by light chain deposition in tubules?
- Cast nephropathy (Correct answer)
- Renal artery stenosis
- Minimal change disease
- IgA nephropathy
Correct answer: Cast nephropathy
Bence-Jones proteins (free light chains) precipitate in renal tubules, causing tubular injury and cast nephropathy (myeloma kidney).
Question 4: What is the first-line treatment for newly diagnosed warm autoimmune hemolytic anemia?
- Corticosteroids (Correct answer)
- Splenectomy
- Rituximab
- Intravenous immunoglobulin
Correct answer: Corticosteroids
Corticosteroids suppress autoantibody production and are the initial treatment of choice for warm AIHA.
Question 5: Which finding on osmotic fragility testing is most characteristic of hereditary spherocytosis?
- Increased osmotic fragility (Correct answer)
- Decreased osmotic fragility
- Normal fragility with normal MCHC
- Target cells with low fragility
Correct answer: Increased osmotic fragility
Spherocytes lack the normal biconcave disc shape, causing increased osmotic fragility as they lyse more easily in hypotonic solutions.
Question 6: A patient on heparin for 7 days develops a platelet count drop from 240,000 to 55,000 and a new lower extremity DVT. What is the diagnosis?
- Heparin-induced thrombocytopenia (Correct answer)
- ITP
- DIC
- Drug-induced aplasia
Correct answer: Heparin-induced thrombocytopenia
HIT occurs when antibodies form against the heparin-PF4 complex, paradoxically causing platelet activation and thrombosis despite low platelet counts.
PANCE PANCE Hematology 2
A patient with recurrent DVT has a prolonged aPTT that does not correct with a 1:1 mixing study.
What is the most likely diagnosis?