Multiple Choice Questions (MCQ)

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Category: Q&A Medicine--->Hematology and Oncology
Page: 4

Question 16#Print Question

A 22-year-old woman with a history of epilepsy presents for follow-up. Other than mild fatigue, which she attributes to stress, she has no complaints. The patient has been seizure-free since initiating phenytoin therapy 3 years ago. Of note, the patient was noted to have latent tuberculosis infection after a positive PPD and has been taking isoniazid for the past 5 months. Physical examination is unremarkable. Laboratory results reveal the following:

  • Leukocyte count   9,100/mm3
  • Hemoglobin   10.5 g/dL
  • Mean corpuscular volume   104 fL
  • Platelets   210,000/mm3

Which of the following underlying mechanisms likely explains the laboratory findings?

a. Impaired absorption of folic acid
b. Intrinsic factor depletion due to autoimmune destruction of parietal cells
c. Excessive bleeding during menstrual cycle
d. Isoniazid depletion of vitamin B6

Question 17#Print Question

A 41-year-old woman with an insignificant past medical history presents for her annual check-up. The patient is very anxious because she has had a vague abdominal pain for the past 3 months. She reports that this mild abdominal pain started after she read online about ovarian cancer. She was researching the disease since her best friend’s mother was diagnosed with stage IV ovarian cancer. The patient is very concerned because she was informed that her paternal aunt passed away from ovarian cancer. The patient denies fevers, chills, weight loss, fatigue, or any other systemic symptom. Her Pap smear 2 years ago was normal.

Which of the following screening options should be recommended for this patient?

a. Annual serum CA 125 levels
b. Annual transvaginal ultrasound
c. Annual pelvic examination
d. No specific screening measures recommended

Question 18#Print Question

A 31-year-old man presents with progressive dyspnea with exertion, dry cough, and fatigue. He started chemotherapy 2 months previously for advanced testicular cancer. The patient reports that his symptoms have worsened since starting chemotherapy. Physical examination reveals fine inspiratory crackles at the lung bases on auscultation. A high-resolution CT is ordered which shows extensive fibrosis.

Which chemotherapeutic agent is the likely cause of this patient’s symptoms?

a. Cyclophosphamide
b. Bleomycin
c. Cisplatin
d. Vincristine

Question 19#Print Question

A 62-year-old woman presents with abdominal pain and bloating for the past 18 hours. The patient also endorses nausea and diarrhea. On physical examination, she has a temperature of 38.5°C, blood pressure of 80/52 mmHg, heart rate of 75 beats per minute, and respiratory rate of 16 breaths per minute. Abdominal distention and diffuse abdominal tenderness to palpation are present and fecal occult blood test is positive. The patient is started on IV normal saline and IV antibiotics. Further laboratory values reveal the following:

  • Leukocyte count   42,100/mm3
  • Hemoglobin   13.5 g/dL
  • Mean corpuscular volume   88 fL
  • Platelets   320,000/mm3
  • Sodium   138 mEq/L
  • Potassium   3.7 mEq/L
  • Bicarbonate   17 mEq/L
  • Creatinine   1.2 mg/dL

Leukocyte alkaline phosphatase score is elevated.

Which of the following is the most likely diagnosis in this patient?

a. Chronic lymphocytic leukemia
b. Chronic myelogenous leukemia
c. Leukemoid reaction
d. Myelodysplastic syndrome

Question 20#Print Question

A 22-year-old man presents with bloody and tarry stools for the last month. The patient denies any associated symptoms and reports that he does not know his family history since he is adopted. Fecal occult blood test is positive and the patient has a hemoglobin level of 8.9 g/dL. Colonoscopy is performed and hundreds of colonic polyps are appreciated. Biopsy confirms that they are adenomatous polyps.

What is the best next step in management for this patient’s condition?

a. Reassurance as the polyps are benign
b. Repeat colonoscopy and biopsy in 1 year
c. Monthly FOBT and CEA levels
d. Elective proctocolectomy

Category: Q&A Medicine--->Hematology and Oncology
Page: 4 of 4