Free practice quiz
ABIM Hematology & Oncology Prep Course (Hem/Onc): free quiz
10 questions from the program. See your score right away, then unlock the explanation of every answer.
- Question 1 of 10
A 68-year-old woman presents with 3 months of fatigue and numbness in both feet. She eats a strict vegan diet and has glossitis. Hemoglobin is 7.9 g/dL, MCV 116 fL, RDW 19%, leukocytes 2.4 × 109/L, platelets 78 × 109/L, and reticulocytes 0.2%. Peripheral smear shows macro-ovalocytes and hypersegmented neutrophils without schistocytes. Which diagnosis best explains this CBC pattern?
CBC indices and production failure
Vitamin B12 deficiency impairs DNA synthesis, causing macro-ovalocytes, hypersegmented neutrophils, high RDW, low reticulocytes, and sometimes pancytopenia from ineffective hematopoiesis; neuropathy and vegan diet confirm option D. C is tempting because anemia is severe, but hemolysis should raise reticulocytes and often shows spherocytes, not megaloblastosis. A can cause macrocytic pancytopenia in older adults, but neurologic findings and classic smear favor B12 deficiency. A causes low reticulocytes and pancytopenia, but MCV is usually normal or mildly high and smear lacks hypersegmented neutrophils.
Diagnose megaloblastic B12 deficiency; order B12, methylmalonic acid, and intrinsic factor antibodies; treat with B12 replacement and escalate urgently for severe cytopenias or neurologic progression. - Question 2 of 10
A 49-year-old patient has marrow and flow cytometry findings suspicious for a hematologic malignancy associated with a recurrent chromosomal rearrangement. A sequencing panel designed to identify selected gene sequence variants returns negative results, but the suspected rearrangement has not been directly assessed. Which additional testing strategy is most appropriate?
A: Incorrect. A negative test for selected sequence variants cannot exclude a chromosomal rearrangement that the assay was not designed to detect.
B: Correct. Cytogenetic and molecular investigations should match the alteration being evaluated. A rearrangement-directed assay can establish whether the suspected recurrent translocation is present and clarify its diagnostic significance.
C: Incorrect. Molecular remission is a treatment-response concept. A negative diagnostic sequencing panel does not establish remission, particularly when the relevant alteration was not assessed.
D: Incorrect. Prognostic interpretation requires established risk-associated findings. An unrelated negative panel does not independently justify favorable-risk classification.
- Question 3 of 10
A 67-year-old woman with a mechanical aortic valve develops progressively worsening anemia. Laboratory studies reveal elevated lactate dehydrogenase, decreased haptoglobin, elevated indirect bilirubin, and reticulocytosis. Her direct antiglobulin test is negative, and peripheral blood smear demonstrates fragmented erythrocytes. Which finding is most useful in distinguishing her anemia from warm autoimmune hemolytic anemia?
A: Incorrect. Reticulocytosis indicates a compensatory marrow response and can occur in both mechanical and autoimmune hemolysis. It does not reliably distinguish the mechanism.
B: Correct. Mechanical hemolysis associated with a prosthetic heart valve produces erythrocyte fragmentation, often reflected by schistocytes, without antibody coating. The combination of a negative direct antiglobulin test and schistocytes supports nonimmune mechanical destruction over warm autoimmune hemolysis.
C: Incorrect. Elevated indirect bilirubin reflects increased heme breakdown and is common to multiple hemolytic mechanisms, including mechanical and immune processes.
D: Incorrect. Haptoglobin decreases when it binds released hemoglobin and may be reduced in either mechanical or autoimmune hemolysis. It establishes evidence of destruction more effectively than its cause.
- Question 4 of 10
A 67-year-old man is admitted with septic shock secondary to pneumonia. He develops diffuse oozing from intravenous catheter sites and extensive ecchymoses. Laboratory testing reveals thrombocytopenia, prolonged PT and aPTT, markedly elevated D-dimer, and reduced fibrinogen. In addition to appropriate blood product support when clinically indicated, which intervention is most important for controlling the underlying hematologic process?
A: Correct. Thrombocytopenia with prolonged coagulation times, elevated D-dimer, and reduced fibrinogen during severe infection is characteristic of disseminated intravascular coagulation. Definitive management requires treating the precipitating condition, while transfusion support is guided by bleeding and clinical circumstances.
B: Thrombopoietin receptor agonists are used in selected patients with immune thrombocytopenia. They do not address the acute consumption of platelets and coagulation factors in disseminated intravascular coagulation.
C: Glucocorticoids are a treatment for immune thrombocytopenia, which generally does not cause the coagulation abnormalities described. The findings instead indicate consumptive coagulopathy.
D: Platelet transfusions may be necessary for significant bleeding or selected procedures, but they provide supportive rather than definitive treatment. Ongoing coagulation activation will persist unless the underlying trigger is controlled.
- Question 5 of 10
A 63-year-old man with malignancy-associated disseminated intravascular coagulation receives treatment directed at his cancer and supportive care for active bleeding. Twenty-four hours later, visible bleeding has decreased, but his platelet count has fallen from 96,000/µL to 54,000/µL, PT has become more prolonged, fibrinogen has declined from 190 to 95 mg/dL, and D-dimer has increased. Which conclusion is most appropriate?
A. Reduced visible bleeding does not establish resolution of DIC when platelet and coagulation studies continue to deteriorate.
B. Correct. Falling platelets and fibrinogen, increasing PT, and rising D-dimer are concerning for continuing consumptive coagulopathy. DIC assessment requires integration of clinical findings with serial laboratory trends, even after treatment has begun.
C. Decreasing fibrinogen in this context indicates worsening depletion rather than recovery of coagulation resources.
D. Treatment of the underlying malignancy is essential, but ongoing monitoring is necessary to evaluate the response and identify continuing consumption or supportive care needs.
- Question 6 of 10
A 58-year-old man undergoes major abdominal surgery and develops thrombocytopenia consistent with HIT during postoperative heparin prophylaxis. The clinical team discontinues systemic heparin and begins therapeutic nonheparin anticoagulation. During medication reconciliation, a nurse identifies an active order for heparin flushes to maintain central venous catheter patency. What is the most appropriate action?
A: Correct. When HIT is clinically likely, all sources of heparin exposure should be avoided, including heparin-containing catheter flushes. A nonheparin strategy should be used for catheter maintenance.
B: Incorrect. Small quantities of heparin can still represent clinically relevant exposure in HIT. Systemic heparin discontinuation alone is insufficient.
C: Incorrect. High clinical probability warrants avoidance of heparin before laboratory confirmation. Continuing exposure while waiting for results is inappropriate.
D: Incorrect. Low-molecular-weight heparin is not a safe substitute when HIT is suspected because it remains a heparin product.
- Question 7 of 10
A 64-year-old man who initially had chronic-phase CML is reassessed after a concerning rise in BCR-ABL1 transcripts during TKI therapy. Repeat hematologic evaluation also identifies an increasing proportion of immature myeloid cells, raising concern about disease-phase progression. He has several chronic comorbidities that may influence the safety of available TKIs. Which management approach best integrates the major considerations relevant to his current disease?
A: Incorrect. Symptoms alone cannot establish molecular control or exclude progression to a more advanced CML phase. The concerning objective changes require assessment.
B: Incorrect. CML management depends on recognizing disease phase and incorporating mutation profile and comorbidity context into TKI selection. A uniform strategy disregards these factors.
C: Correct. Appropriate CML management integrates phase recognition, BCR-ABL1 molecular monitoring, and individualized TKI selection. The combination of increasing molecular burden, possible phase progression, and relevant comorbidities warrants a comprehensive reassessment.
D: Incorrect. Complete blood counts cannot replace BCR-ABL1 molecular monitoring. Discontinuing molecular assessment would remove information important for evaluating disease control and guiding treatment.
- Question 8 of 10
A 67-year-old man has been followed for MDS with an initially favorable prognostic profile. Over the past year, his cytopenias have deepened and transfusion requirements have increased; repeat marrow assessment also demonstrates a rising blast percentage. His hematologist is reconsidering long-term management. Which of the following is the most appropriate guiding principle?
A: Incorrect. MDS risk and clinical burden can change over time. Treatment planning should respond to meaningful changes in disease features rather than remain anchored to the initial assessment.
B: Incorrect. Transfusion burden is relevant but does not replace the prognostic information provided by changing marrow blasts and cytopenia severity.
C: Correct. Longitudinal MDS planning requires assessment of both progression risk and transfusion burden. Rising blasts, deepening cytopenias, and increasing transfusion requirements justify updating the patient's prognostic assessment and management priorities.
D: Incorrect. Previously favorable cytogenetics do not eliminate the need to consider worsening cytopenias and other evolving risk features.
- Question 9 of 10
A 63-year-old woman with aggressive B-cell lymphoma has persistent active disease despite initial systemic treatment. Repeat evaluation confirms refractory lymphoma, and the treating team is considering advanced therapeutic approaches rather than continuing the original treatment plan unchanged. Which option is most appropriate to include in the next management discussion?
A: Incorrect. Persistent active disease requires reassessment of the treatment strategy rather than indefinite continuation of an ineffective approach.
B: Correct. CAR-T therapy is an important treatment consideration in selected patients with relapsed or refractory aggressive B-cell lymphoma. Referral for eligibility assessment allows evaluation of this option alongside other appropriate salvage strategies.
C: Incorrect. Refractory aggressive lymphoma remains a clinically significant malignancy and should not be presumed to convert spontaneously into an indolent condition.
D: Incorrect. Advanced treatment options, including CAR-T therapy and transplant-based approaches, are relevant to management discussions in selected patients with relapsed or refractory aggressive B-cell lymphoma.
- Question 10 of 10
A 69-year-old woman with established smoldering multiple myeloma presents for routine follow-up. She has no symptoms suggesting end-organ injury, and previous assessments have demonstrated neither CRAB manifestations nor qualifying myeloma-defining biomarkers. She asks why continued monitoring is recommended instead of immediate treatment. Which explanation best reflects the goal of surveillance?
A: Incorrect. Surveillance does not eliminate the possibility of progression from smoldering to active myeloma.
B: Incorrect. Asymptomatic precursor conditions can progress, making continued reassessment clinically important.
C: Correct. Monitoring is intended to identify new myeloma-defining events while avoiding unnecessary therapy before active disease develops. Assessment focuses on CRAB manifestations and qualifying biomarkers.
D: Incorrect. Surveillance evaluates changes in disease status rather than simply documenting the passage of time.
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