Oncology and Hematology multiple choice questions

Q 1. A 73-year-old male presents to the clinic with 3 months

of increasing back pain. He localizes the pain to the lumbar

spine and states that the pain is worst at night while he is lying

in bed. It is improved during the day with mobilization.

Past history is notable only for hypertension and remote cigarette

smoking. Physical examination is normal. Laboratory

studies are notable for an elevated alkaline phosphatase. A

lumbar radiogram shows a lytic lesion in the L3 vertebra.

Which of the following malignancies is most likely?

A. Gastric carcinoma

B. Non-small cell lung cancer

C. Osteosarcoma

D. Pancreatic carcinoma

E. Thyroid carcinoma

Answer   B

Q 2. Patients from which of the following regions need

not be screened for glucose-6-phosphate dehydrogenase

(G6PD) deficiency when starting a drug that carries a risk

for G6PD mediated hemolysis?

A. Brazil

B. Russia

C. Southeast Asia

D. Southern Europe

E. Sub-Saharan Africa

F. None of the above

Answer   B

Q 3. All the following are vitamin K–dependent coagulation

factors except

A. factor X

B. factor VII

C. protein C

D. protein S

E. factor VIII

Answer   E

Q 4. A 31-year-old male with hemophilia A is admitted

with persistent gross hematuria. He denies recent trauma

or any history of genitourinary pathology. The examination

is unremarkable. Hematocrit is 28%. All the following

are treatments for hemophilia A except

A. desmopressin (DDAVP)

B. fresh-frozen plasma (FFP)

C. cryoprecipitate

D. recombinant factor VIII

E. plasmapheresis

Answer    E

Q 5. Which of the following statements regarding incidence

of and risk factors for hepatocellular carcinoma is true?

A. A chemical toxin produced by Aspergillus species,

aflatoxin B has a strong association with development

of hepatocellular carcinoma and can be found

in stored grains in hot, humid places.

B. In the United States, the incidence of hepatocellular

carcinoma is decreasing.

C. Nonalcoholic steatohepatitis is not associated with

an increased risk for hepatocellular carcinogen.

D. Fewer than 5% of individuals diagnosed with hepatocellular

carcinoma in the United States do not

have underlying cirrhosis.

E. The risk of developing hepatocellular carcinoma in

individuals with hepatitis C infection is 50%.

Answer    A

Q 6.  You are asked to review the peripheral blood smear

from a patient with anemia. Serum lactate dehydrogenase

is elevated and there is hemoglobinuria. This patient is

likely to have which physical examination finding? (See

Figure III-6, Color Atlas.)

A. Goiter

B. Heme-positive stools

C. Mechanical second heart sound

D. Splenomegaly

E. Thickened calvarium

Answer     C

Q 7.  All of the enzyme deficiencies that lead to porphyrias are

inherited either as autosomal dominant (AD) or autosomal

recessive (AR) traits with one exception. Which of the following

most commonly occurs sporadically?

A. 5-ALA dehydratase-deficient porphyria

B. Acute intermittent porphyria

C. Erythropoietic porphyria

D. Porphyria cutanea tarda

E. Variegate porphyria

Answer    D

Q 8 . A 55-year-old female presents with progressive incoordination.

Physical examination is remarkable for nystagmus,

mild dysarthria, and past-pointing on finger-to-nose

testing. She also has an unsteady gait. MRI reveals atrophy

of both lobes of the cerebellum. Serologic evaluation reveals

the presence of anti-Yo antibody. Which of the following

is the most likely cause of this clinical syndrome?

A. Non-small cell cancer of the lung

B. Small-cell cancer of the lung

C. Breast cancer

D. Non-Hodgkin’s lymphoma

E. Colon cancer

Answer     C

Q 9. A 36-year-old African-American woman with systemic

lupus erythematosus presents with the acute onset of lethargy

and jaundice. On initial evaluation, she is tachycardic,

hypotensive, appears pale, is dyspneic, and is somewhat difficult

to arouse. Physical examination reveals splenomegaly.

Her initial hemoglobin is 6 g/dL, white blood cell count is

6300/μL, and platelets are 294,000/ μL. Her total bilirubin is

4 g/dL, reticulocyte count is 18%, and haptoglobin is not

detectable. Renal function is normal, as is urinalysis. What

would you expect on her peripheral blood smear?

A. Macrocytosis and PMN’s with hypersegmented nuclei

B. Microspherocytes

C. Schistocytes

D. Sickle cells

E. Target cells

Answer   B

Q 10  You are investigating the cause for a patient’s anemia.

He is a 50-year-old man who was found to have a

hematocrit of 25% on routine evaluation. His hematocrit

was 47% 1 year ago. Mean corpuscular volume is 80,

mean corpuscular hemoglobin concentration is 25, mean

corpuscular hemoglobin is 25. Reticulocyte count is 5%.

Review of the peripheral blood smear shows marked

numbers of polychromatophilic macrocytes. Ferritin is

340 μg/L. What is the cause of this patient’s anemia?

A. Defective erythroid marrow proliferation

B. Extravascular hemolysis

C. Intravascular hemolysis

D. Iron-deficiency anemia

E. Occult gastrointestinal bleeding

Answer    A