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Category: Q&A Medicine--->Hematology and Oncology
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Question 1# Print Question

A 71-year-old man with a history of hypertension and hyperlipidemia presents with fatigue, diffuse joint pain, decreased appetite, and a weight loss of 5.44 kg (12 lb) over the last 4 months. Physical examination reveals splenomegaly. Laboratory studies reveal the following:

  • Leukocyte count 29,000/mm3
  • Hemoglobin 9.1 g/dL
  • Mean corpuscular volume 85 fL
  • Platelets 122,000/mm3

Cytogenetic studies are performed and reveal an abnormal chromosome 22.

Which of the following is the appropriate treatment for this disease?

A. Methotrexate
B. All-trans-retinoic acid
C. Imatinib
D. Bone marrow transplant

Question 2# Print Question

A 61-year-old woman with a history of diabetes mellitus, hypertension, and mechanical aortic valve replacement presents with fatigue and periodic palpitations when running. The patient does not endorse shortness of breath or chest pain. Her medications consist of warfarin, metformin, glyburide, lisinopril, and fish oil. On physical examination, she has conjunctival pallor, mechanical click during S2, and a soft systolic flow murmur. Fecal occult blood test is negative. Laboratory results reveal a hemoglobin of 10.1 g/dL, hematocrit of 29%, and a significantly elevated serum LDH. The peripheral blood smear is shown in Figure below.

Which of the following is the underlying cause of this patient’s condition?

A. Autoimmune hemolysis
B. Iron deficiency
C. Traumatic hemolysis
D. Bone marrow infiltration

Question 3# Print Question

A 39-year-old man presents after tripping over his child’s toy and subsequently falling down the stairs. The patient reports landing on his chest and now complains of pain over certain regions of his right chest wall. He endorses some mild pain on deep inspiration. The patient is otherwise healthy and denies alcohol or smoking. Physical examination demonstrates pain on palpation over the sternum. A chest x-ray is ordered which confirms two right rib fractures. The radiologist notes an incidental 2.25-cm coin-shaped lesion on the left upper lung. There is no associated adenopathy or atelectasis noted.

Which of the following is the most appropriate next step with respect to the solitary lung lesion?

A. CT scan of the chest
B. Lung biopsy
C. Review of an old chest x-ray
D. Reassurance

Question 4# Print Question

A 69-year-old woman presents with a 2-month history of worsening lower back pain, confusion, mild abdominal pain, weight loss, and constipation. She takes hydrochlorothiazide for hypertension and simvastatin for hypercholesterolemia. Her routine preventative screening measures were all up to date and within normal limits at her previous visit 5 months ago. Physical examination is unremarkable and fecal occult blood test is negative. Laboratory results and a peripheral blood smear (Figure below) are shown below.

  • Leukocyte count 9,000/mm3
  • Hemoglobin 9.1 g/dL
  • Platelets 290,000/mm3
  • Blood urea nitrogen 32 mg/dL
  • Creatinine 2.1 mg/dL
  • Erythrocyte sedimentation rate 68 mm/h
  • Amylase 67 U/L

Which of the following additional findings do you expect with this patient’s condition?

A. Mechanical obstruction
B. Electrolyte abnormality
C. Hormone level abnormality
D. Arterial blood gas abnormality

Question 5# Print Question

A 9-year-old girl being treated with combination chemotherapy for acute lymphoblastic leukemia (ALL) is noted to have increased levels of blood urea nitrogen (BUN) and creatinine on day 4 of treatment. The patient is immediately started on intravenous normal saline. An ECG is ordered which demonstrates prolonged QT intervals. For confirmation of the diagnosis, several laboratory tests, including a complete metabolic profile, are ordered.

Which of the following laboratory abnormalities result from this patient’s condition?

A. Decreased calcium, increased phosphate, decreased uric acid, decreased potassium
B. Decreased calcium, increased phosphate, increased uric acid, increased potassium
C. Decreased calcium, decreased phosphate, increased uric acid, increased potassium
D. Increased calcium, increased phosphate, increased potassium, increased uric acid

Category: Q&A Medicine--->Hematology and Oncology
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