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Hemato Onology
Hemato Onology
Question 1
A 26-year-old woman comes to your clinic because of a constant dry cough, low grade
fevers, and night sweats for the last 4 weeks.
She denies shortness of breath or chest pain. Furthermore, she has lost 2.3 kg over the
past 4 weeks.
She denies any other medical problems and takes no medications except for over-the-
counter cough syrup.
She denies recent travel or sick contacts. She does not use tobacco, alcohol, or illicit
drugs.
Her temp 38.0 C, BP is 110/80 mm Hg, and PR 90/min.
Physical examination shows multiple, bilateral, firm, rubbery, 2 to 3 cm-sized lymph nodes
in the cervical, supraclavicular, and axillary region.
There is no hepatosplenomegaly.
Chest imaging shows a widened mediastinum, hilar fullness, and clear lungs. HIV and
heterophile antibody testing are negative.
Q1 Answer ( …….….)
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Question 2
A previously healthy 38-year-old woman is brought to the emergency department
because of left-sided weakness for the past 4 hours.
Her husband noticed that she was confused.
She has a 3-year history of diabetes mellitus, for which she takes metformin.
Q2 Answer ( …….….)
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Question 3
Match:
1. DIC-like presentation, Vitamin-A derivative is a life-saving drug.
2. Huge Splenomegaly, weight loss with a good appetite.
3. ADAMT13 deficiency
4. Auto-splenectomy.
5. AIHA IgG autoantibody, Positive Coomb's test.
6. A complication of Mycoplasma pneumonia
Q3 Answer ( …….….)
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Question 4
A 24-year-old man with sickle cell disease (Hb SS) comes to the emergency department
with chest pain and shortness of breath. He has felt unwell for the last several days with
increasing extremity, abdominal, and chest pain. The patient took extra doses of oral
morphine with little relief. He stopped taking hydroxyurea 4 months ago due to stomach
upset.
BP 122/72 mm Hg, PR 108/min, RR 22/min, and oxygen saturation is 84% on room air.
Bilateral crackles are heard on chest auscultation. A 2/6 mid-systolic murmur is heard at
the left upper sternal border.
Leukocytes 14,000/µL
Haemoglobin 8.5 g/dL
Platelets 435,000/µL
Creatinine 0.9 mg/dL
Q4 Answer ( …….….)
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Question 5
32-year-old male underwent an elective right knee surgery 1 day ago.
He initially sustained an injury to right knee 5 years ago while playing tennis.
Recently, his right knee was bothering him to a point where he underwent surgery. After
this surgery, his right leg starts to swell, and an ultrasound reveals an acute venous
thrombosis.
The patient is started on Rivaroxaban.
Q5 Answer ( …….….)
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Question 6
A 37-year-old woman with known SLE is evaluated for generalized weakness and dyspnea
on exertion. Her current medications include HCQ, naproxen, and low-dose
prednisone. She stopped taking azathioprine 4 weeks ago due to side effects.
Her BP is 142/90 mm Hg and Pulse is 82/min. The oropharynx is moist with no visible
lesions.
Small, mobile lymph nodes are palpable in the submandibular area.
Skin examination shows a scaly erythematous rash over the face, scalp, and upper trunk.
Cardiopulmonary examination is within normal limits. There is no splenomegaly.
Laboratory results are as follows:
Liver function studies
Total protein 8.0 g/dL
Albumin 3.7 g/dL
Total bilirubin 2.3
mg/dL
Direct bilirubin 0.4
mg/dL
ALP 20 U/L
AST 12 U/L
ALT 24 U/L
Which of the following is most likely responsible for this patient's symptoms?
A. Anemia of chronic disease
B. Autoimmune hemolytic anemia
C. Folic acid deficiency
D. Microangiopathic hemolytic anemia
E. Red cell aplasia
DR. MOHAMMED DWAIMA 12
HEMATO-ONCOLOGY CLASS AUG 26
Q6 Answer ( …….….)
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Question 7
A 35-year-old woman is hospitalized with severe SOB. She also has Right calf pain and
swelling.
US Doppler showed R popliteal DVT.
CTPA showed PE as well.
Which of the following drugs was initially used to treat this patient leg DVT?
A. Enoxaparin
B. Apixaban
C. Dabigatran
D. UFH
E. Fondaparinux
Q7 Answer ( …….….)
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Question 8
35-year-old lady presented with a 4-wk history of progressive weakness and feet
paranesthesia.
She is known to have Crohn’s disease that required bowel resection 3 years ago.
LE: Normal tone, power5/5, reflexes and all sensation modalities are normal.
CBC:
WBC 3.5, Hb 8.0, MCV 98, PLT 140.
U/E:
BUN 12.0, Cr 1.0, Ca 8.8, Gluc 98 mg.
Q8 Answer ( …….….)
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Question 9
A 33 y/o pregnant woman at 28 weeks, presented with sudden onset R chest pain and
SOB. She has no hemoptysis, syncope or a preceding reparatory symptom.
Temp 36.5 C, BP 110/70 mmHg, HR 110, RR 26.
She is diaphoretic and appears to be in distress.
Q9 Answer ( …….….)
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Question 10
A 30-year-old man was leading a healthy life before he experienced L Leg DVT with no
discernible provoking factor. No personal history of previous VTE. However, his younger
sister has had and unprovoked DVT 3 years back.
PT 13 s, APTT 30 s, D-Dimer 1200 ng, Hb 14 HCT 42%, WBC 6.5, PLT 250
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Question 11
A 22-year-old woman comes to the emergency department due to heavy vaginal
bleeding.
The patient has always had heavy menses, but this time the bleeding has not stopped
since it started 5 days ago.
Her medications include ibuprofen for headaches and iron supplementation for iron
deficiency anemia. She has no other significant medical history.
Her mother had heavy menstrual periods and frequent nosebleeds.
CBC
Hb 9.0 g/dL
MCV 76 fL
Platelets 210,000/mm3
Coagulation studies
INR 0.8
Activated PTT 23 sec
Which of the following is the best next step in management of this patient?
A. Factor IX levels
B. Fibrinogen levels
C. Mixing study
D. No further testing
E. Plasma von Willebrand factor antigen and activity
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Question 12
A 77-year-old man with AF on dabigatran presents with new right sided weakness.
Labs are notable for normal creatinine and a normal INR.
A head CT is shown.
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Question 13
A 70-year-old woman is brought to the ED after she tripped and fell at home while getting
out of a bathtub. She did not lose consciousness but does have headache and mild right
arm pain.
Her medical history is significant for advanced breast cancer treated with radical
mastectomy and chemotherapy a year ago.
CT of the head is unremarkable. Radiographs of the upper extremities show bone lesions
consistent with metastases, but no evidence of fracture. Her serum creatinine level is 1.4
mg/dL (creatinine clearance 30 mL/min), serum calcium level is 9.6 mg/dL, and alkaline
phosphatase level is 220 U/L.
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Question 14
A 56-year-old male patient presents to ED with worsening SOBOE and increased redness
of his face with difficulty laying down flat over the last 4- 5 days. He had a CXR done and
showed a new mass occupying the right side of the chest and appears to be compressing
on the mediastinal structures.
Physical Exam: See picture.
The patient was admitted, and he was started on dexamethasone with elevation of the
head of the bed. On further evaluation he states that he had weight loss of 8 kg, night
sweats, decreased appetite.
What is the best next approach in his case?
A. Staging CT C/A/P
B. PET-CT scan
C. Biopsy of the lesion
D. Percutaneous intravascular stent placement
E. Dexamethasone
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Question 15
This is a 59-year-old male patient who has a known hx of high-grade lymphoma (DLBCL)
who is receiving his 1st cycle of R-CHOP. He has a massive mediastinal mass which was Bx
proven to be DLBCL.
The ROD has called you because he noticed a metabolic derangement as following:
K 5.6 Ca 7.2 mg PO4 3.2 mg Cr 1.5 mg HCO3 20.0
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Question 16
In the previous question, given that, TLS is established, you decided to proceed with
aggressive hydration and Rasburicase along continuous cardiac & electrolytes monitoring.
30 minutes later, the patient became icteric and having SOB.
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Question 17
A 65-year-old man known to have Chronic Lymphocytic Leukemia Stage I, with baseline
Lymphocytes count 30,000.
He was entirely symptomatic until 3 days ago when he starts to experience shortness of
breath and marked fatigue.
He looks tired, No palpable LNs, No Hepatosplenomegaly.
Hb 8.0 ‘baseline 13.0 2 weeks back ‘MCV 95 PLT 400 WBC 35000 ‘Lymphocytes 95% ‘,
Reticulocytes count: 12%
LDH 600, Total Bilirubin 5.0 g, DB: 1.0 AST 40 ALT 25, Folate Normal, B12 Normal,
Ferritin 200 ng
Blood film is shown
A. Prednisolone
B. Ibrutinib
C. Venetoclax
D. Rituximab
E. Imatinib
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Question 18
A 75-year-old man with a history of CAD presents for follow-up after a recent diagnosis of
anemia. In addition to fatigue related to his anemia, he complains of a tingling sensation
and burning pain in the feet, extending up to the midcalf. He reports consistent headache,
occasional epistaxis, and on/off blurry vision!
This discomfort limits his mobility, and he has difficulty sleeping because of the pain.
Laboratory workup for his anemia is shown below:
Laboratory studies
SPEP with immunofixation IgM monoclonal spike 7 g/dL
UPEP Negative
IgM 4895 mg/dL (normal 40-230 mg/dL)
A bone marrow biopsy is performed and demonstrates 65% bone marrow involvement
with monoclonal plasmacytoid lymphocytes.
What is the diagnosis?
A. MM
B. WM
C. HCL
D. AL Amyloidosis
E. Polycythemia Vera.
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Question 19
A 24-year-old woman has a low platelet count on routine blood work.
She denies bleeding, fever, chills, weight loss, bone pain, or abdominal pain.
Her past medical history is unremarkable, and she does not take any medications.
Which of the following is the best next step in managing this patient?
A. ANA
B. HIV
C. Bone Marrow examination
D. H. Pylori
E. No further workup is required.
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Question 20
55 y/o M, lifelong non-smoker, comes to the office with headache, non-restorative sleep
and daytime fatigue and sleepiness. Alcohol 2-3 drinks/day.
Hx of HTN and hypercholesterolemia.
O/E;
Sub-Q20
62-year-old woman with moderate fatigue, routine CBC:
Hb 12.5 WBC 5.5 PLTs 900 K
ESR 25 Ferritin 60 ‘Normal ‘
No identifiable reactive etiology!
Likely Diagnosis is ………………………………………………..
Sub-Q20
The patient in previous question refused to be treated with ASA and HU.
She came in 2 years later with massive splenomegaly!
WBC 25 K ‘See blood film’
Rx: ………………………………………………..
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Question 21
A 26-year-old woman is hospitalized with a temperature of 38.5 °C 10 days after her first
cycle of chemotherapy with rituximab, cyclophosphamide, doxorubicin, vincristine and
prednisone (R-CHOP) for diffuse large B-cell lymphoma. Other than fever, she has no
symptoms of infection.
On physical examination, temperature is 38.5, BP 110/80 mm Hg.
The remainder of the vital signs and physical examination are normal.
LAB: CBC: WBC 0.7, 50% Neutrophils, Hb 11.0 g/dl PLT 144,000 Urine/Blood cultures
Pending.
CXR PA normal.
A junior resident asks you on G-CSF use in this patient, what shall you answer him?
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Question 22
42-year-old female is currently undergoing a pRBC transfusion for her known thalassemia
major. She develops marked onset SOB and tachycardia. She has hypoxemia and requires
a high FiO2 requirement.
BP 105/70 PR 120 RR 22 Spo2 88 % Temp 37.8 C
A CXR is done urgently and she has whiteout of her lungs.
The BNP is WNL.
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Question 23
A 57-year-old man is scheduled to undergo a laparoscopic left inguinal hernia repair. He
known to have NVAF for years, with no previous embolic or hemorrhagic events.
He takes Apixaban 5 mg bid.
His basic lab including renal functions is within normal.
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Question 24
Two weeks after undergoing allogeneic stem cell transplant for multiple myeloma, a 55-
year-old man develops a severely pruritic rash, abdominal cramps, and profuse diarrhea.
He appears lethargic.
Physical examination shows yellow sclerae.
There is a generalized maculopapular rash on his face, trunk, and lower extremities,
and desquamation of both soles.
His serum ALT is 115 U/L, serum AST is 97 U/L, and TB is 2.7 mg/dL.
Which of the following is the most likely underlying cause of this patient's
condition?
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Question 25
A 67-year-old very active and healthy man has a PSA checked, which returns at 6. On
repeat testing 3 months later, the PSA is 6.1. He meets with a urologist to discuss these
results.
On rectal examination, he has a smooth but enlarged prostate without any nodules or
abnormalities.
The patient is quite hesitant to have invasive testing.
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Question 26
A 46-year-old woman comes to the physician with complaints of exertional dyspnoea over
the last 6 months. She can barely walk a block without having to stop and catch her
breath. She was diagnosed with Hodgkin’s lymphoma 2 years ago and was treated with
doxorubicin, bleomycin, vinblastine, and dacarbazine. She does not use tobacco, alcohol,
or illicit drugs.
CXR as shown.
Which of the following conditions is the most likely cause of this patient’s presentation?
A. Anthracycline toxicity
B. Bleomycin Toxicity.
C. Pleural disease.
D. Disease recurrence.
E. COVID-19
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