Sample questions / Hematology & Oncology

Organ system

Hematology & Oncology questions for Step 1

Work through hematology & oncology vignettes that mix physiology, pathology and pharmacology, the way the exam does. Every explanation covers all five options.

PathologyMedium

Multiple myeloma marrow criterion

A 70-year-old man has bone pain and a pathologic femur fracture. X-rays show multiple lytic lesions in the skull and pelvis. Calcium is 12.5 mg/dL, creatinine 2.8 mg/dL, total protein 9.5 g/dL and albumin 3.5 g/dL. Serum electrophoresis shows an M-spike.

Which bone marrow finding would confirm the diagnosis?

1. >40% plasma cells
2. >10% plasma cells
3. >50% plasma cells
4. >30% plasma cells
5. >20% plasma cells

MicrobiologyEasy

EBV mononucleosis

A 30-year-old man has fever and pharyngitis with atypical lymphocytes and a positive Monospot test. A week later he has jaundice and lymphadenopathy, and a node biopsy shows large activated B cells with prominent nucleoli.

Which virus is most likely responsible?

1. HIV
2. Hepatitis C virus
3. HTLV-1
4. Human herpesvirus 8
5. Epstein-Barr virus

PharmacologyEasy

Low-dose aspirin GI balance

A woman with CAD on chronic aspirin 325 mg develops a bleeding gastric ulcer; aspirin is continued with a PPI at a reduced dose.

Which dose best balances cardiovascular benefit and GI safety?

1. Aspirin 650 mg once daily to ensure complete thromboxane suppression through higher peak drug levels
2. Aspirin 500 mg three times daily to achieve anti-inflammatory doses needed for optimal cardiovascular protection
3. Aspirin 325 mg every other day to maintain equivalent platelet inhibition while halving mucosal exposure
4. Aspirin 81 mg once daily providing full antiplatelet efficacy with reduced prostaglandin-mediated GI toxicity
5. Aspirin 162 mg twice daily to achieve maximum COX-2 inhibition for anti-inflammatory cardiovascular benefit

BiochemistryEasy

Lead and heme synthesis

A 4-year-old in an old apartment has abdominal pain, constipation, behavior change, a gingival lead line, microcytic anemia, basophilic stippling and high protoporphyrin.

Which enzymes are inhibited?

1. Cytochrome P450 oxidase
2. Ferrochelatase and ALA dehydratase
3. Glucose-6-phosphate dehydrogenase
4. Carbonic anhydrase
5. Pyruvate kinase

ImmunologyEasy

Acute GVHD

Three weeks after an HLA-matched sibling marrow transplant for SCID, a 7-year-old boy has a maculopapular rash, profuse diarrhea and bilirubin 6.8. Skin biopsy shows lymphocytes at the dermal-epidermal junction with dyskeratotic keratinocytes.

Which cells are responsible?

1. Recipient NK cells
2. Donor neutrophils
3. Donor B lymphocytes
4. Donor T lymphocytes
5. Recipient T lymphocytes

Other systems

Cardiovascular · Respiratory · Renal & Urinary · Gastrointestinal & Hepatobiliary · Nervous System · Endocrine · Reproductive · Musculoskeletal & Skin · Behavioral Health · Multisystem & General Principles ·