Narrow in the marrow
Rotten Clot
The Emperor of All Maladies
Genius of Genes
Benign, but not so Benign
100
70 year old patient presents with a macrocytic anemia but Vitamin B12/folate levels are normal. Bone marrow biopsy shows a hyper cellular marrow with dyspoietic changes. He has the following condition.
What is myelodysplastic syndrome?
100
A patient is found to have a DVT and hypercoagulable workup reveals a protein C deficiency. His hematologist will be concerned about the following complication when starting him on vitamin K antagonist therapy.
What is warfarin necrosis?
100
The following cause of liver disease can sometimes cause liver cancer before it causes liver cirrhosis.
What is Hepatitis B?
100
A female presents to the hospital after taking an antibiotic for a UTI and is found to have Hgb= 9 with increased LDH/reticulocyte count/indirect bilirubin. She has a condition with this pattern of inheritance.
What is X linked recessive?
100
In the absence of bleeding, patients with ITP are typically treated when their platelet count is less than the following number:
What is 30000?
200
24 year old female presents with anemia as well as mild leukopenia/ thrombocytopenia. Workup reveals high LDH, high reticulocyte count and high bilirubin and also shows iron deficiency anemia and directs comb testing is negative. This intervention will be required before she can start on a disease modifying treatment.
What is vaccination for pneumoccocus/ meningococcus?
200
35 year old female presents with an acute encephalopathy and is also found to have acute renal failure, liver dysfunction and acute thrombocytopenia with platelets= 50K. Workup reveals strong titers of lupus anticoagulant, beta 2 glycoprotein and anticardiolipin. In addition to starting anticoagulation and steroids, patient will benefit from the following intervention.
What is plasma pheresis?
200
This type of cancer is treated completely differently depending on whether it is low, intermediate or high grade.
What is neuroendocrine cancer?
200
In 2022, a study out of MSKCC made headlines around the world when they reported a 100% remission rate for patients with rectal cancer. Although oncologists are also excited by this study, they are quick to point out that this only applies to patients with following characteristic.
What is mismatch repair deficiency?
200
This new oral medicine has been shown to improve anemia and reduce transfusion requirements for patients with sickle cell anemia.
What is voxelotor?
300
30 year old male presents to the hospital with the following physical exam finding without any associated trauma:
He is found to have anemia in the 6-7 range that persists despite blood transfusion. Workup for causes of anemia (B12/folate/iron/SPEP/hemolysis testing normal) and causes of coagulopathy is unrevealing. His hematologist finally decides to treat with the following which leads to improvement in both his bruising and his anemia.
What is Vitamin C?
300
These two cancers have the highest risk for thrombosis as per the Khorana criteria:
What is gastric and pancreatic cancer?
300
35 year old premenopausal female is found to have a 3 cm breast cancer with bulky lymphadenopathy. Breast biopsy reveals that she has triple negative breast cancer. Her oncologist is planning to start on neoadjuvant treatment and the following treatment is likely to improve her survival.
What is immunotherapy?
300
50 year old female has a history of stomach cancer and lobular breast cancer. She reports having multiple family members with stomach cancer. She most likely has the following genetic mutation.
What is CDH1?
300
The following form of extra-vascular form of hemolysis is direct coombs negative and does NOT respond to steroids or IVIG but does often respond to rituximab.
What is cold agglutinin hemolytic anemia?
400
80 year old female with a history of essential thrombocytosis has a recent blood test that now shows pancytopenia with a left shift and nucleated RBCs. Bone marrow aspirate cannot be obtained but the marrow will likely stain for the following:
What is Reticulin fibrosis?
400
30 year old female comes to a hematologist and reports a family history of thrombosis but no personal history. Hypercoagulable workup reveals both factor V leiden/ prothrombin gene mutation compound heterozygote state. She asks what treatment she should receive during her pregnancy and postpartum?
She should receive prophylactic low molecular weight heparin both during pregnancy and postpartum.
400
40 year old male is found to have a tongue tumor with extensive cervical lymphadenopathy. FNA of the lymph node reveals squamous cell cancer. You review the pathology report and inform him that his staging will differ depending on the results of the following stain result for the cancer.
What is P16 status/ HPV status?
400
A patient of northern European descent who has no history of cirrhosis or fatty liver disease is found to have liver cirrhosis. Further workup reveals the following mutation.
What is C282Y or H63D?
400
50 year old male has a known longstanding history of hemolytic anemia and exam reveals splenomegaly. He has testing with direct coombs, G6PD, cold agglutinins, PNH that are all normal. He reports that one of his relatives was advised to have a splenectomy for unknown reasons. His hematologist will order the following test to confirm his diagnosis.
What is EMA binding (osmotic fragility can also be accepted as an answer)? 500:
500
50 year old male presents with dyspnea and is found to have restrictive cardiomyopathy, proteinuria and a monoclonal protein. Your oral exam reveals the following:
What is macroglossia/enlarged tongue ?
500
30 year old female who previously had lab tests that showed +lupus anticoagulant and +beta2 glycoprotein on two checks and has had three pregnancy losses discovers that she is now pregnant again. Her hematologist should start her on the following treatment.
What is anti-platelet and prophylactic heparin during pregnancy?
500
50 year old female lifelong non-smoker of Japanese origin with stage IV lung cancer. She has testing for EGFR which is negative. She is most likely to have the following mutation.
What is ALK mutation?
500
This class of cancer medications have been shown to have activity for cancer patients with BRCA mutations.
What are PARP inhibitors?
500
50 year old female with no recent drug exposures presents to the hospital with a seizure and is found to have microangiopathic hemolytic anemia, thrombocytopenia as well as renal dysfunction. Workup reveals a low ADAMTS13 level. In addition to steroids, plasma exchange and rituximab, her hematologist starts her on the following medication.
What is caplacizumab?