SHELF / USMLE Step 2 Practice Questions - Heme / Onc

SHELF / USMLE Step 2 Practice Questions > Internal Medicine > Hematology / Oncology

Q1) A 72-year-old for a routine exam. She has hypertension for which she takes a daily aspirin and ramipril. Her medical history is otherwise noncontributory.
On physical examination, pulse rate is 80/min, and blood pressure is 140/80 mm Hg. There is no bony tenderness, splenomegaly, or lymphadenopathy. Laboratory studies indicate a hemoglobin of 13.6 g/dL , leukocyte count of 7200/μL, and a platelet count of 247,000/μL. Total serum protein level is elevated to 8.0 g/dL, and serum creatinine and calcium concentrations are normal. Serum protein electrophoresis reveals a 1.2-g/dL monoclonal protein spike, further identified as IgG-κ by immunofixation. Bone marrow aspirate smear shows 7% plasmacytosis. No lytic lesions are detected on bone survey. hich of the following is the most appropriate next step in the management of this patient?

a) Thalidomide and dexamethasone
b) positron emission tomography
b) bisphosphonates
d) repeated serum protein electrophoresis in 3 to 6 months

Q2) A previously healthy 45-year-old man presents for the 4th time in 6 months with URI symptoms complaining of a sore-throat and waxing and waining cervical lymhadenopathy? He has undergone several courses of antibiotics, but his symptoms never fully disappear. On exam he has a low grade fever and a bp of 105/70. A left cervical non-tender, non-mobile lymph node measuring 3x3cm is appreciated. No other lymphadenopathy is palpable. A lymph node biopsy is performed. Which of the following is the most likely diagnosis?

a) Burkitt lymphoma
b) diffuse large cell lymphoma
c) follicular mixed lymphoma
d) follicular small cleaved cell lymphoma
e) immunoblastic lymphoma

Q3) A 50-year-old man complains of recent onset of generalized pruritus. He has previously been in excellent health, eats a normal diet, has never smoked, and does not take any medications. On physical examination, he has ruddy facies and a palpable spleen tip. Results of fecal occult blood testing are negative. The oxygen saturation at rest is 99% on room air. Laboratory studies are notable for a hematocrit of 61.0% compared with a value of 44.5% documented 5 years ago, leukocyte count of 12,300/μL, mcv of 79 fL, and platelet count of 550,000/μL. Serum chemistries are normal except for a reduced serum iron saturation and serum ferritin concentration. Results of upper and lower endoscopy are normal. Which of the following is the most appropriate management of this patient?

a) Phlebotomy and anagrelide
b) oral iron supplementation and low-dose aspirin
c) hydroxyurea and aspirin, 325 mg/d
d) phlebotomy and low-dose aspirin

A1) d - repeated serum protein electrophoresis in 3 to 6 months (Monoclonal gammopathy of unknown significance (MGUS) is characterized by the presence of serum monoclonal gammaglobulin without the clinical features of multiple myeloma)
A2) d - follicular small cleaved cell lymphoma
A3) d - phlebotomy and low-dose aspirin (polycythemia vera - elevated red blood cell mass, a normal blood oxygen saturation, and the presence of splenomegaly)

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