10 USMLE Hematology and Oncology Questions with Answers and Explanations (Set 1)

These 10 USMLE hematology and oncology practice questions cover high-yield blood and cancer topics: vitamin B12 deficiency, chronic lymphocytic leukemia, osteoblastic metastases, hemolysis, DIC, male breast cancer, Courvoisier sign, DiGeorge syndrome, G6PD deficiency and graft-versus-host disease. Each question includes the correct answer and an explanation.

Written by Dr. Ray Makar, MD, author of the Repeated USMLE Questions eBook series.

Prefer video? Watch daily USMLE case questions on MedFocus by Dr. Ray on YouTube.

How to use this page: read the question, pick your answer, then tap Show Answer and Explanation.

Questions

Question 1. A 42-year-old woman presents to the clinic with progressive fatigue and weakness for 6 months. She also complains of tingling and numbness in her arms and legs. Physical examination reveals decreased both superficial and deep sensations in her arms and legs. Blood count reveals decreased numbers of erythrocytes, leucocytes, and platelets along with increased mean red blood cell volume. The peripheral blood smear shows enlarged erythrocytes and hypersegmented neutrophils. Which one of these biochemical reactions is involved in this case?

A- Conversion of propionyl –CoA to methylmalonyl –CoA
B- Conversion of methylmalonyl-CoA to succinyl-CoA
C- Conversion of succinyl-CoA to fumarate
D- Conversion of malonyl-CoA to palmitate

CBC reveals megalocytosis and hypersegmented neutrophils which are the main characteristics of megaloblastic anemia. The most common causes of megaloblastic anemia are Folic acid deficiency and vitamin B12 deficiency. Vitamin B12 deficiency anemia is differentiated from folic acid deficiency anemia by neurological symptoms in the form of sensory loss. Vitamin B12 is involved in the conversion of methylmalonyl CoA into succinyl CoA. This is an important step in the formation of DNA. A deficiency of vitamin B12 leads to impaired DNA production and subsequently megaloblastic anemia. Other reactions are not involved in B12 deficiency.
The correct answer is B

 

Question 2. A 65-year-old man presents to the clinic complaining of weakness and recurrent infections for 6 months. He has no significant medical, surgical or family history. Physical examination reveals multiple enlarged lymph nodes. Histopathology reveals excessive mature B cells that mark strongly with CD5 and CD23 and weakly with CD22. They also have weak expression of kappa chains on the plasma membrane. Which of the following is the most likely diagnosis?

A- Acute lymphoblastic leukemia
B- Chronic lymphocytic leukemia
C- Chronic myeloid leukemia
D- Hairy cell leukemia
E- Sezary syndrome

Chronic lymphocytic leukemia usually affects older adults, like this 65-year-old man. His symptoms are weakness, infections, and swollen lymph nodes are common in CLL. CD5 and CD23 positive are key markers for CLL. Weak expression of kappa chains and CD22, also typical for CLL.
The correct answer is B

 

Question 3. A 65-year-old man presents with gradual low back pain increasing in intensity for the last six months. X-ray shows several osteoblastic lesions on lower vertebra and pelvic bones. Additional investigations reveal that those lesions are metastases. Which of these is most likely the primary cancer in this patient?

A- Chronic lymphocytic leukemia
B- Hodgkin’s lymphoma
C- Prostatic cancer
D- Renal cell carcinoma
E- Thyroid follicular carcinoma

Prostate cancer is the most common cause of osteoblastic metastases, particularly affecting the vertebrae and pelvis. Other cancers, like renal cell carcinoma and thyroid follicular carcinoma, tend to cause osteolytic rather than osteoblastic lesions. Chronic lymphocytic leukemia (CLL) and Hodgkin’s lymphoma do not commonly present with osteoblastic metastases.
The correct answer is C

 

Question 4. A 21 year-old college student complains of the appearance of yellowish coloration on her sclera. She mentions that she had been dizzy and weak for the last 3 days but did not feel any pain or fever and no change in stool color. Abdominal examination reveals normal bowel sounds and no tenderness or organomegaly. Laboratory tests show normal liver enzymes and elevated unconjugated (indirect) bilirubin. Which is the most likely initial diagnosis?

A- Hepatocellular disease
B- Hemolysis
C- Gallstones
D- Obstructive jaundice
E- Pancreatic cancer

This is a case of hemolysis which is characterized by jaundice without hepatic involvement or biliary obstruction. History, physical examination and laboratory tests confirm this etiology.
The correct answer is B

 

Question 5. A 62-year-old man complains of fever and diminished consciousness for 2 days. He has been healthy all his life and he doesn’t take any medications. On examination, he responds inconsistently to commands. His temperature is 103 F, pulse 110/min and blood pressure is 80/56 mmHg. There is no bleeding. Laboratory tests show hemoglobin 12 g/dL, leukocyte count 25,000/mm3 (80% neutrophils), platelet count 20,000/mm3, high D-dimer and low fibrinogen. What is the most likely diagnosis?

A- Idiopathic thrombocytopenic purpura
B- Thrombotic thrombocytopenic purpura
C- Disseminated intravascular coagulation
D- Hemophilia A
E- Hemophilia B

This patient most likely has sepsis leading to disseminated intravascular coagulation (DIC). It is confirmed by low platelets, increased D-dimer and a low fibrinogen level. ITP and TTP do not lower fibrinogen, and hemophilia presents earlier in life with bleeding.
The correct answer is C

 

Question 6. A 62-year-old man visits his physician with a complaint of a breast lump. On examination, there is no fever and vital signs are within normal limits. There is a hard lump in his right breast and nipple retraction. What is the most appropriate next step of action?

A- X-Ray of the chest
B- Ultrasound guided biopsy
C- Mammography
D- MRI of the chest
E- Whole body CT scan

This is most probably a case of ductal carcinoma. Ultrasound guided biopsy and pathology to find out more about the mass is mandatory to reach an early diagnosis. X-Ray of the chest, mammography and MRI do not add any information. Whole body CT scan would be appropriate if pathology confirm a breast cancer diagnosis.
The correct answer is B

 

Question 7. A 58-year-old woman comes to the emergency room complaining that her skin is turning yellow. The doctor performs a physical examination, which reveals that the woman is suffering from moderate jaundice. There is no abdominal pain and she also has a negative Murphy’s sign. The physician becomes concerned that he is able to feel the patient’s non-tender gallbladder. A CT scan is therefore ordered. What could be the most likely cause of the woman’s jaundice?

A- Acute hepatitis
B- Gall bladder stones
C- Hemolytic anemia
D- Pancreatic cancer

The patient is suffering from pancreatic cancer. This is proven during the physical exam, wherein the patient demonstrates Courvoisier’s sign, that is jaundice and a palpable, non-tender, and an enlarged gallbladder. This is a commonly found in patients having cancer of the head of the pancreas, which is blocking the gallbladder from emptying its contents.
The correct answer is D

 

Question 8. A 1-year-old boy is brought to the clinic by his mother due to recurrent upper respiratory tract infections and oral fungal infections. Physical examination reveals low set ears and fish-like mouth. Laboratory tests reveal hypocalcemia and chest x-ray shows no thymus shadow. What is the most likely etiology of hypocalcemia in this case?

A- Decreased secretion of parathyroid hormone
B- End-organ hyposensitivity to parathyroid hormone
C- End-organ hyposensitivity to calcitonin
D- Increased secretion of calcitonin
E- Increased secretion of parathyroid hormone

This case is most likely Di George syndrome. It is characterized by a defect in the third pharyngeal pouch which gives rise to inferior parathyroid and thymus. The fourth pharyngeal pouch gives rise to superior parathyroid.
The correct answer is A

 

Question 9. A 2-year-old boy originally from Egypt is diagnosed with anemia after he took antibiotics for the treatment of otitis media. He has two brothers and one sister. One of his brothers was diagnosed with anemia when he was two years old. His parents were given a list of food and drugs that could be associated with this type of anemia. What is the mode of inheritance of this condition?

A- Autosomal dominant
B- Autosomal recessive
C- X-linked recessive
D- Mitochondrial
E- Multifactorial

This is a case of glucose-6-phosphate dehydrogenase (G6PD) deficiency which is common in Africa and Mediterranean region. It is x-linked recessive disorder.
The correct answer is C

 

Question 10. A 29-year-old man underwent bone marrow transplantation two weeks ago. Yesterday he developed diarrhea with occult blood and rashes all over his face, hands and feet. Examination reveals jaundice and maculopapular rashes on his face, palms and soles. What are the most likely cells activated in this case?

A- Donor B-lymphocytes
B- Donor T-lymphocytes
C- Host B-lymphocytes
D- Host T-lymphocytes

About half of the patients that undergo bone marrow transplantation develop graft-versus-host disease. It is caused when donor T-lymphocytes recognize host antigens causing acute reaction which leads to appearance of maculopapular rashes on the face, palms and soles. It also leads to abnormal liver function tests and diarrhea with occult blood.
The correct answer is B

 

High-yield points from this set

  • Megaloblastic anemia with neurologic signs = vitamin B12 deficiency (methylmalonyl-CoA → succinyl-CoA).
  • Older adult with lymphadenopathy and CD5+/CD23+ B cells = CLL.
  • Osteoblastic bone metastases in an older man = prostate cancer.
  • Jaundice with normal liver enzymes and high indirect bilirubin = hemolysis.
  • Low platelets + high D-dimer + low fibrinogen in a septic patient = DIC.
  • A hard breast lump in a man needs a biopsy.
  • Painless jaundice with a palpable non-tender gallbladder (Courvoisier sign) = cancer of the pancreatic head.
  • Thymic aplasia, hypocalcemia and recurrent infections = DiGeorge syndrome (22q11 deletion).
  • Hemolysis after drugs or infection in a boy from the Mediterranean = G6PD deficiency (X-linked recessive).
  • Rash, diarrhea and jaundice after bone marrow transplant = GVHD caused by donor T cells.

Keep practicing

Leave a Comment