Hematology/Oncology

Question 1

An 18 year-old male patient presents with right upper quadrant abd pain. Ultrasound shows gall stones. On exam, you find the patient jaundiced and with mild splenomegaly. CBC shows a normocytic anemia with reticulocytosis. Coombs test is negative and heptaglobin is decreased. What is the likely cause for this patient’s anemia, and which test can confirm that suspicion?

Answer 1

Hereditary spherocytosis, osmotic fragility test

Question 2

A 6 month-old baby presents with anemia. The Hb is 6 and the MCV 60. TIBC, ferretin, and reticulocyte levels are normal. What is the most likely cause of this patient’s anemia?

Answer 2

Thalassemia

Question 3

A 45 year-old male presents with splenomegaly. The pt complains of pruritus that is associated with taking warm showers. Hb is 19, EPO is low. Which of the following is not indicated in managing this patient?

A) Aspirin
B) Recombinant erythropoietin
C) Phlebotomy
D) Hydroxyurea

Answer 3

B) Recombinant erythropoietin

Question 4

A previously healthy 28 year-old male with no known risk factors presents with acute ischemic stroke. Which genetic disorder is most likely to blame?

Answer 4

Factor V Leiden

Question 5

A six year-old patient presents with a three-week history of increasing lethargy and listlessness. The patient complains of pain in the left upper leg. On exam, you find petechiae and fever. CBC shows pancytopenia. What disorder do you suspect, and what do you expect to see on bone marrow smear?

Answer 5

Acute lymphocytic leukemia, >20% lymphoblasts

Question 6

A six year-old patient presents with a three-week history of increasing lethargy and listlessness. The patient complains of pain in the left upper leg. On exam, you find petechiae and fever. CBC shows pancytopenia. What is the preferred treatment for this patient’s condition?

Answer 6

Chemotherapy

Question 7

A patient is admitted to the hospital with high fever and hemolytic anemia. You examine the patient the next day and find a purpuric rash and altered mentation. CBC shows thrombocytopenia, and schistiocytes are apparent on blood smear. What is the best treatment for this patient?

Answer 7

Plasma exchange

Question 8

A patient presents with fatigue, weight loss, night sweats, and lymphadenopathy. Lymph node biopsy shows Reed-Sternberg cells. What is the most likely diagnosis?

Answer 8

Hodgkin’s Lymphoma