Multiple Choice Questions (MCQ)

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Category: Medicine--->Hematology and Oncology
Page: 2

Question 6# Print Question

A 38-year-old woman presents with a 3-day history of fever and confusion. She was previously healthy and is taking no medications. She has not had diarrhea or rectal bleeding. She has a temperature of 38°C (100.4°F) and a blood pressure of 145/85. Splenomegaly is absent. She has no petechiae but does have evidence of early digital gangrene of the right second finger. Except for confusion the neurological examination is normal. Her laboratory studies reveal the following:

  • Hemoglobin: 8.7 g/dL
  • Platelet count: 25,000/µL
  • Peripheral smear: numerous fragmented RBCs, few platelets
  • LDH 562 IU/L (normal < 180)
  • Creatinine: 2.7 mg/dL
  • Liver enzymes: normal
  • Prothrombin time/PTT/fibrinogen levels: normal

What is the most likely pathogenesis of her condition? 

A. Disseminated intravascular coagulation
B. Antiplatelet antibodies
C. Failure to cleave von Willebrand factor multimers
D. Verotoxin-induced endothelial damage
E. Cirrhosis with sequestration of erythrocytes and platelets in the spleen

Question 7# Print Question

A 60-year-old man develops numbness of the feet. On physical examination he has lost proprioception in the lower extremities and is noticed to have a wide based gait with a positive Romberg sign. His past medical history includes hypertension, hypothyroidism, and previous gastrectomy for gastric cancer. The peripheral blood smear is shown below.

What is the most likely cause of his symptoms? 

A. Folic acid deficiency
B. Vitamin B12 deficiency
C. Vitamin K deficiency
D. Iron deficiency
E. Thiamine deficiency

Question 8# Print Question

A 60-year-old man presents with vague left upper quadrant abdominal fullness. He also has fatigue, malaise, and weight loss described as loosening of his pants. CBC shows:

  • Hgb: 12 g/dL (normal 14-18)
  • Leukocytes: 40,000/µL (normal 4300-10,800)
  • Platelet count: 500,000/µL (normal 150,000-400,000)

Bone marrow biopsy shows hypercellular marrow. Chromosomal study is shown: 

Which of the following is the most likely diagnosis? 

A. Acute myeloid leukemia
B. Chronic myelogenous leukemia
C. Chronic lymphocytic leukemia
D. Acute lymphocytic leukemia
E. Myelodysplastic syndrome

Question 9# Print Question

A 25-year-old woman complains of persistent bleeding for 5 days after a dental extraction. She has noticed easy bruisability since childhood, and was given a blood transfusion at age 17 because of prolonged bleeding after an apparently minor cut. She denies ecchymoses or bleeding into joints. Her father has noticed similar symptoms but has not sought medical care. Physical examination is normal except for mild oozing from the dental site. She does not have splenomegaly or enlarged lymph nodes. Her CBC is normal, with a platelet count of 230,000. Her prothrombin time is normal, but the partial thromboplastin time is mildly prolonged. The bleeding time is 12 minutes (normal 3-9 minutes).

What is most appropriate way to control her bleeding? 

A. Factor VIII concentrate
B. Fresh frozen plasma
C. Desmopressin (DDAVP)
D. Whole blood transfusion
E. Single donor platelets

Question 10# Print Question

A 67-year-old man complains of progressive shortness of breath. He has a history of smoking 2 packs of cigarettes per day for 50 years and has been unable to quit despite nicotine replacement and bupropion. He has mild chronic obstructive lung disease for which he is using ipratropium. He is still able to work as a part-time store manager and play golf with his friends. Chest x-ray shows a moderate-sized left-sided effusion. Thoracentesis reveals bloody pleural fluid. Cytologic examination is consistent with bronchioalveolar adenocarcinoma.

What is the best next step in management? 

A. Refer to hospice
B. Refer to a surgeon for lobectomy
C. Refer to an oncologist for chemotherapy
D. Refer to a radiation oncologist for radiation therapy
E. Place a chest tube and observe

Category: Medicine--->Hematology and Oncology
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