heme/onc 5

Question 1

What are associated with the highest risk?

Answer 1

Burdens

Question 2

What is oxidized from ferrous (Fe2+) to ferric state (Fe3+)?

Answer 2

Hemoglobin

Question 3

What becomes methemoglobin?

Answer 3

Hemoglobin when all four heme molecules are ferric instead of ferrous.

Question 4

What cannot bind oxygen?

Answer 4

Hemoglobin when all four heme molecules are ferric instead of ferrous.

Question 5

What happens to the affinity of remaining ferrous-bearing heme molecules for oxygen after other molecules have been oxidized to its ferric form?

Answer 5

It increases, shifting the hemoglobin–oxygen dissociation curve left.

Question 6

What is the effect of the left shift in the hemoglobin–oxygen dissociation curve in terms of oxygen delivery?

Answer 6

Diminishing oxygen delivery to the tissues.

Question 7

What is the most likely diagnosis in a person with HIV showing thrombocytopenia?

Answer 7

Immune thrombocytopenia.

Question 8

are most palpable testicular tumors in adults malignant?

Answer 8

Yes

Question 9

What should a patient with thymoma have for further diagnostics?

Answer 9

A chest radiograph.

Question 10

What condition is typically idiopathic but can occur in patients with hematologic malignancies?

Answer 10

Pure red cell aplasia.

Question 11

What viral illnesses can lead to pure red cell aplasia?

Answer 11

Parvovirus, HIV, or hepatitis C.

Question 12

What medications can cause pure red cell aplasia?

Answer 12

Phenytoin or trimethoprim–sulfamethoxazole.

Question 13

What is a febrile transfusion reaction?

Answer 13

A reaction that can occur during blood transfusion.

Question 14

What is a transfusion reaction?

Answer 14

A transfusion reaction is defined as fever >38°C or an increase of at least 1°C from baseline that occurs during or up to 4 hours after a blood transfusion.

Question 15

What is a lupus anticoagulant?

Answer 15

A lupus anticoagulant is an antibody that leads to a prolonged prothrombin time or partial-thromboplastin time, causing an increase in clotting, not bleeding.

Question 16

What test is most appropriate for a patient who becomes febrile after receiving a correctly matched unit of packed red cells?

Answer 16

A postreaction direct antiglobulin test to rule out a hemolytic transfusion reaction.

Question 17

What is the risk associated with men who have a history of cryptorchidism?

Answer 17

Men with a history of cryptorchidism have an increased risk for the development of cancer in either testicle.

Question 18

What condition is indicated by hemolytic anemia and a positive Coombs test for anti-C3 and negative for anti-immunoglobulin G?

Answer 18

This condition is cold agglutinin hemolytic anemia.

Question 19

What must be ruled out by measurement of ristocetin cofactor activity in essential thrombocythemia?

Answer 19

Acquired von Willebrand syndrome must first be ruled out.

Question 20

When can screening mammography be discontinued?

Answer 20

Screening mammography can also be discontinued in women with a life expectancy of less than 5 to 10 years.

Question 21

What hematologic effect is associated with treatment using methotrexate?

Answer 21

Macrocytosis is a hematologic effect of treatment with methotrexate.

Question 22

What is tumor lysis syndrome (TLS)?

Answer 22

Tumor lysis syndrome is caused by the release of the contents of malignant cells into the bloodstream, resulting in electrolyte abnormalities.

Question 23

What electrolyte abnormalities may occur in tumor lysis syndrome?

Answer 23

Electrolyte abnormalities may include hyperuricemia, hyperkalemia, hyperphosphatemia, and hypocalcemia.

Question 24

What should be evaluated for the diagnosis of multiple myeloma?

Answer 24

Evaluate for proteinuria, anemia, and kidney disease.

Question 25

What is the significance of G6PD deficiency?

Answer 25

G6PD deficiency leads to the destruction of erythrocytes.

Question 26

What causes the denaturation of globin chains in deficient erythrocytes?

Answer 26

High levels of oxidants cause a cross-linking of sulfhydryl groups on globin chains, leading to their denaturation and the formation of Heinz bodies.

Question 27

What INR level is associated with an increased risk for bleeding?

Answer 27

An INR greater than 4.0 has been associated with an increased risk for bleeding.

Question 28

How does the risk for intracranial hemorrhage change with INR levels?

Answer 28

The risk for intracranial hemorrhage increases approximately twofold for every one-unit increase in INR.

Question 29

When can pharmacologic thromboprophylaxis generally be started after major orthopedic surgery?

Answer 29

Pharmacologic thromboprophylaxis can generally be started 8 to 12 hours after surgery.

Question 30

What percentage of bladder cancers are urothelial carcinomas?

Answer 30

Ninety percent of bladder cancers are urothelial carcinomas.

Question 31

What percentage of bladder cancers are squamous-cell carcinomas?

Answer 31

Ten percent of bladder cancers are squamous-cell carcinomas.

Question 32

Where do osteosarcomas generally arise?

Answer 32

Osteosarcomas generally arise in the metaphysis of the bone.

Question 33

What is the recommended screening for people aged 50 to 80 years with a history of smoking?

Answer 33

Current guidelines recommend annual screening with low-dose chest CT for people age 50 to 80 years who have a history of at least 20 pack-years of cigarette smoking.

Question 34

Can Rh-negative blood be given to Rh-positive patients?

Answer 34

Yes, one can give Rh-negative blood to Rh-positive patients but not the other way around.

Question 35

Is complement depletion seen in both PAN and GPA?

Answer 35

Complement depletion is typically not seen in either PAN or GPA.

Question 36

What is characteristically seen in certain ethnicities regarding neutrophil counts?

Answer 36

Asymptomatic isolated absolute neutrophil counts below the laboratory reference range are characteristically seen in patients of certain ethnicities, including people of African descent who typically do not express the Duffy allele.

Question 37

What should be considered as a likely diagnosis in a patient with urticaria pigmentosa and anaphylaxis?

Answer 37

Systemic mastocytosis should be considered as a likely diagnosis in such patients.

Question 38

When should positron emission tomography and electron microscopy be used?

Answer 38

They should be used only if the diagnosis is unclear after light microscopy and IHC analysis.

Question 39

What is the haptoglobin level in autoimmune and microangiopathic hemolytic anemias?

Answer 39

The haptoglobin level is low in both autoimmune and microangiopathic hemolytic anemias.

Question 40

Is the haptoglobin level low in both autoimmune and microangiopathic hemolytic anemias?

Answer 40

True

Question 41

What do the National Comprehensive Cancer Network guidelines recommend monitoring after neck irradiation?

Answer 41

Thyroid-stimulating hormone levels every 6 to 12 months.

Question 42

What is the most likely diagnosis in a patient with pancytopenia without myeloid immaturity or leukoerythroblastosis?

Answer 42

Gaucher disease ## Footnote Massive hepatosplenomegaly without lymphadenopathy and bone pain.

Question 43

What are the characteristic imaging findings of HCC in chronic liver disease with elevated serum alpha-fetoprotein?

Answer 43

Sufficiently specific and obviate the need for tissue diagnosis.

Question 44

What can be typically used to treat excessive bleeding with likely factor 8 inhibition?

Answer 44

Prothrombin complex concentrate or recombinant human factor VIIa.

Question 45

What is the diagnosis for a patient presenting after an atypical lung infection with hemolytic anemia?

Answer 45

Cold agglutinin hemolytic anemia ## Footnote Positive Coombs test for anti-C3 and negative for anti-immunoglobulin G.

Question 46

What findings are consistent with a diagnosis of low-grade lymphoma in a patient with hepatitis C virus infection?

Answer 46

Splenomegaly and diffuse lymphadenopathy.

Question 47

What are the most common intracranial tumors in adults?

Answer 47

Brain metastases.

Question 48

What type of tumors are most common in cryptorchid testicles?

Answer 48

Pure seminomas.

Question 49

What happens in a mixing study if the prolonged aPTT is caused by a lack of clotting factors?

Answer 49

The factors contained in the normal plasma will normalize the aPTT.

Question 50

What is the treatment of choice for an advanced inoperable or metastatic gastrointestinal stromal tumor?

Answer 50

A tyrosine kinase inhibitor such as imatinib.

Question 51

What are the most common malignant tumors in males aged 15 to 35?

Answer 51

Testicular tumors.

Question 52

What condition is characterized by myeloid immaturity or leukoerythroblastosis?

Answer 52

Gaucher disease

Question 53

What is associated with massive hepatosplenomegaly without lymphadenopathy?

Answer 53

Gaucher disease

Question 54

What symptom is commonly present in Gaucher disease?

Answer 54

Bone pain

Question 55

What leukocyte count indicates the highest risk category for TLS?

Answer 55

>50,000 cells per mm3

Question 56

What is the risk of cervical cancer in people with HIV?

Answer 56

Much higher than in the general population

Question 57

What is the blast count in patients with accelerated-phase CML?

Answer 57

10% to 20%

Question 58

What is the blast percentage in patients with CML in blast crisis?

Answer 58

>20% blasts in peripheral blood or bone marrow

Question 59

What condition is classically associated with microangiopathy?

Answer 59

Thrombotic thrombocytopenic purpura

Question 60

What are common symptoms of thrombotic thrombocytopenic purpura?

Answer 60

Thrombocytopenia, renal insufficiency, mental status changes, and fever

Question 61

What is the most appropriate approach to managing intractable back pain in a patient with metastatic cancer?

Answer 61

Initiate bolus doses of intravenous opioids

Question 62

What should be monitored in patients receiving bevacizumab?

Answer 62

Urine protein

Question 63

What is the first-line treatment for severe cases of methemoglobinemia?

Answer 63

Administration of intravenous methylene blue

Question 64

What does methylene blue activate in the body?

Answer 64

The NADPH-dependent methemoglobin reductase system

Question 65

What is the role of the methemoglobin reductase system?

Answer 65

It rapidly reduces methemoglobin back to hemoglobin.

Question 66

What treatment may ITP patients who relapse or are unresponsive to dexamethasone respond to?

Answer 66

They may respond to intravenous immunoglobulin stimulation of platelet production with eltrombopag or romiplostim.

Question 67

What is splenectomy reserved for?

Answer 67

It is reserved for patients refractory to medical management.

Question 68

What causes Porphyria cutanea tarda (PCT)?

Answer 68

PCT is caused by an acquired deficiency of hepatic uroporphyrinogen decarboxylase.

Question 69

What is the most likely diagnosis in a patient with recurrent epistaxis, telangiectasia, and anemia?

Answer 69

Hereditary hemorrhagic telangiectasia.

Question 70

What characterizes TTP?

Answer 70

TTP is characterized by deficiency of ADAMTS13, a plasma protease that normally cleaves ultra-large von Willebrand-factor multimers.

Question 71

What should a patient with likely lymphoma presenting with progressive cervical adenopathy undergo?

Answer 71

They should be urgently evaluated with a chest radiograph.

Question 72

What imaging is needed for a patient with suspected malignant airway obstruction?

Answer 72

A chest radiograph is the best and safest immediate choice.

Question 73

What is acute promyelocytic leukemia sensitive to?

Answer 73

It is very sensitive to the vitamin A derivative all-trans retinoic acid and to arsenic.

Question 74

What are RCTs best designed to find out?

Answer 74

RCTs are best designed to find out whether a treatment has caused a specific measured effect in a select population.

Question 75

What are the most common primary tumors that metastasize to the brain?

Answer 75

The most common primary tumors that metastasize to the brain are lung cancer.