Hematology/Oncology UWorld UPDATED
ACTUAL Exam Questions and CORRECT
Answers
Evaluation of anemia - CORRECT ANSWER - Decreased MCV
- Iron def
- Lead intoxication
- Thalassemia
- Sideroblastic anemia
- Chronic disease
Increased MCV
- B12 def
- Folate def
- Liver disease
- Drugs
Normal MCV
Decreased reticulocyte count:
- Leukemia
- Aplastic anemia
- Infection
- Medication side effect
Increased reticulocyte count:
- Hemorrhage
- Hemolysis (intrinsic inherited defects of HgB, RBC membrane, or enzymes) (extrinsic =
autoimmune, paroxysmal nocturnal hemoglobinuria)
,Note: hemolysis = sickle cell, G6PD def, hereditary spherocytosis, AIHA, PNH
Common causes of macrocytic anemia - CORRECT ANSWER - Dx:
- Elevated MCV
- Elevated MCH
- Normal MCHC
- Folate deficiency
- Vitamin B12 deficiency
- Myelodysplastic syndromes
- Acute myeloid leukemias
- Drug induced (hydroxyurea, zidovudine, chemotherapy)
- Liver disease
- Alcohol abuse
- Hypothyroidism
Megaloblastic = impaired DNA synthesis 2/2 B12/folate def
- Low reticulocyte count
- Macroovulate RBCs
- Hypersegmented PMNs
- Anisocytosis
- Poikilocytosis
Non-megaloblastic = alcoholism, hypothyroid, drugs, liver disease
- Increased, normal, or decreased reticulocytes depending on etiology
Pernicious anemia - CORRECT ANSWER - Presence of autoantibodies against intrinsic
factor (required for B12 absorption)
,- Most common cause of vitamin B12 def in whites of northern European background
- Frequently have other associated autoimmune diseases (thyroid, vitiligo, etc)
- Shiny tongue (2/2 atrophic glossitis)
- Ataxia
- Neurologic abnormalities (loss of position and vibration sense)
- Exacerbated by vegan diet
Dx:
- Blood smear = macroovalocytes, megaloblasts, and hypersegmented neutrophils
- Thrombocytopenia/leukopenia
- Anti-intrinsic factor antibodies
Complications:
- Atrophic gastritis increases risk of intestinal-type gastric cancer and gastric carcinoid tumors
Lead poisoning - CORRECT ANSWER - Risks: occupational exposure (lead paint,
batteries, ammunition, construction, distillation of alcohol through parts w/ lead soldering)
p/w:
- GI (abdominal pain, constipation, anorexia)
- Neurologic (cognitive deficits, peripheral neuropathy--stocking glove)
- Hematologic (anemia)
Labs:
- Basophilic stippling (also caused by alcoholism and thalassemias)
- Microcytic anemia
- Elevated venous lead
, - Elevated serum zinc protoporphyrin level
Acute myeloid leukemia (AML) - CORRECT ANSWER - Clonal myeloproliferative d/o
characterized by the accumulation of blastic or immature myeloid cells in BM and peripheral
blood
- Most common adult leukemia
- Median age 65
p/w:
- Fatigue common (other B symptoms unusual)
- Often presents w/ symptoms from cytopenias
- Fatigue, weakness (anemia)
- Bleeding, bruising (thrombocytopenia)
- Infection (granulocytopenia)
- Hepatosplenomegaly/lymphadenopathy rrare
- DIC (if APML)
Labs:
- Cytopenias (leukocytes may be elevated, normal, or decreased)
- Elevated LDH
- Peripheral smear usually myeloblasts w/ Auer rods
Dx: BMBx usually hypercellular with myeloid blasts
Chronic myeloid leukemia (CML) - CORRECT ANSWER - Clonal myeloproliferative d/o
driven by abnormal fusion gene BCR-ABL (9;22). Results in leukemogenesis 2/2 to
constitutively active tyrosine kinase.
p/w:
ACTUAL Exam Questions and CORRECT
Answers
Evaluation of anemia - CORRECT ANSWER - Decreased MCV
- Iron def
- Lead intoxication
- Thalassemia
- Sideroblastic anemia
- Chronic disease
Increased MCV
- B12 def
- Folate def
- Liver disease
- Drugs
Normal MCV
Decreased reticulocyte count:
- Leukemia
- Aplastic anemia
- Infection
- Medication side effect
Increased reticulocyte count:
- Hemorrhage
- Hemolysis (intrinsic inherited defects of HgB, RBC membrane, or enzymes) (extrinsic =
autoimmune, paroxysmal nocturnal hemoglobinuria)
,Note: hemolysis = sickle cell, G6PD def, hereditary spherocytosis, AIHA, PNH
Common causes of macrocytic anemia - CORRECT ANSWER - Dx:
- Elevated MCV
- Elevated MCH
- Normal MCHC
- Folate deficiency
- Vitamin B12 deficiency
- Myelodysplastic syndromes
- Acute myeloid leukemias
- Drug induced (hydroxyurea, zidovudine, chemotherapy)
- Liver disease
- Alcohol abuse
- Hypothyroidism
Megaloblastic = impaired DNA synthesis 2/2 B12/folate def
- Low reticulocyte count
- Macroovulate RBCs
- Hypersegmented PMNs
- Anisocytosis
- Poikilocytosis
Non-megaloblastic = alcoholism, hypothyroid, drugs, liver disease
- Increased, normal, or decreased reticulocytes depending on etiology
Pernicious anemia - CORRECT ANSWER - Presence of autoantibodies against intrinsic
factor (required for B12 absorption)
,- Most common cause of vitamin B12 def in whites of northern European background
- Frequently have other associated autoimmune diseases (thyroid, vitiligo, etc)
- Shiny tongue (2/2 atrophic glossitis)
- Ataxia
- Neurologic abnormalities (loss of position and vibration sense)
- Exacerbated by vegan diet
Dx:
- Blood smear = macroovalocytes, megaloblasts, and hypersegmented neutrophils
- Thrombocytopenia/leukopenia
- Anti-intrinsic factor antibodies
Complications:
- Atrophic gastritis increases risk of intestinal-type gastric cancer and gastric carcinoid tumors
Lead poisoning - CORRECT ANSWER - Risks: occupational exposure (lead paint,
batteries, ammunition, construction, distillation of alcohol through parts w/ lead soldering)
p/w:
- GI (abdominal pain, constipation, anorexia)
- Neurologic (cognitive deficits, peripheral neuropathy--stocking glove)
- Hematologic (anemia)
Labs:
- Basophilic stippling (also caused by alcoholism and thalassemias)
- Microcytic anemia
- Elevated venous lead
, - Elevated serum zinc protoporphyrin level
Acute myeloid leukemia (AML) - CORRECT ANSWER - Clonal myeloproliferative d/o
characterized by the accumulation of blastic or immature myeloid cells in BM and peripheral
blood
- Most common adult leukemia
- Median age 65
p/w:
- Fatigue common (other B symptoms unusual)
- Often presents w/ symptoms from cytopenias
- Fatigue, weakness (anemia)
- Bleeding, bruising (thrombocytopenia)
- Infection (granulocytopenia)
- Hepatosplenomegaly/lymphadenopathy rrare
- DIC (if APML)
Labs:
- Cytopenias (leukocytes may be elevated, normal, or decreased)
- Elevated LDH
- Peripheral smear usually myeloblasts w/ Auer rods
Dx: BMBx usually hypercellular with myeloid blasts
Chronic myeloid leukemia (CML) - CORRECT ANSWER - Clonal myeloproliferative d/o
driven by abnormal fusion gene BCR-ABL (9;22). Results in leukemogenesis 2/2 to
constitutively active tyrosine kinase.
p/w:
