PANRE Hematology 3

Question 1

A 68-year-old male presents with back pain, fatigue, and hypercalcemia. Serum protein electrophoresis shows an M-spike, urine contains Bence Jones proteins, and skeletal survey reveals multiple lytic lesions. Serum creatinine is elevated. What is the most likely diagnosis?

Accepted Answer

Multiple myeloma

Answer

Multiple myeloma presents with the CRAB criteria (hyperCalcemia, Renal failure, Anemia, Bone lytic lesions), M-protein spike, and Bence Jones proteinuria from clonal plasma cell proliferation.

Question 2

A 26-year-old male presents with painless cervical lymphadenopathy, night sweats, fever, and weight loss. Biopsy of a lymph node reveals Reed-Sternberg cells. CT shows mediastinal involvement. What is the most likely diagnosis?

Accepted Answer

Hodgkin lymphoma

Answer

Hodgkin lymphoma is characterized by Reed-Sternberg cells on biopsy, bimodal age distribution, B symptoms (fever, night sweats, weight loss), and frequent mediastinal involvement.

Question 3

A 45-year-old male presents with fatigue and splenomegaly. WBC is 85,000/μL with a left shift. Peripheral smear shows all stages of granulocyte maturation. Cytogenetics reveal the Philadelphia chromosome t(9;22). What is the first-line treatment?

Accepted Answer

Imatinib (tyrosine kinase inhibitor)

Answer

Chronic myelogenous leukemia (CML) driven by the BCR-ABL fusion from the Philadelphia chromosome is treated with tyrosine kinase inhibitors like imatinib as first-line therapy.

Question 4

A 55-year-old presents with fatigue, petechiae, and gingival hyperplasia. CBC shows WBC 40,000 with blasts, Hgb 7.8, platelets 18,000. Bone marrow biopsy shows >20% blasts with Auer rods. What is the most likely diagnosis?

Accepted Answer

Acute myeloid leukemia (AML)

Answer

AML presents with Auer rods on marrow biopsy (pathognomonic), gingival hyperplasia, and rapidly progressive pancytopenia; >20% myeloid blasts confirms the diagnosis.

Question 5

A 70-year-old man is found to have WBC 62,000 on routine labs with small, mature-appearing lymphocytes and smudge cells on peripheral smear. He is asymptomatic with no lymphadenopathy. CD19, CD5, and CD23 are positive on flow cytometry. What is the management for this patient?

Accepted Answer

Watchful waiting ('watch and wait')

Answer

Early-stage (Rai 0) chronic lymphocytic leukemia (CLL) in asymptomatic patients is managed with observation, as early treatment does not improve survival.

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PANRE Test Practice Test

PANRE Hematology 3