BCPS Oncology & Hematology Pharmacotherapy 3

Question 1

Hydroxyurea reduces the frequency of vaso-occlusive crises in sickle cell disease primarily by:

Accepted Answer

Increasing fetal hemoglobin (HbF) production

Answer

Directly blocking HbS polymerization through steric inhibition

Answer

Improving red blood cell membrane flexibility via lipid modification

Answer

Reducing serum iron stores to limit HbS synthesis

Question 2

A patient on unfractionated heparin develops a platelet count drop from 240,000 to 85,000 on day 7 of therapy. Heparin-induced thrombocytopenia (HIT) is suspected. The most appropriate management is:

Accepted Answer

Discontinue all heparin products and start a non-heparin anticoagulant

Answer

Switch to low molecular weight heparin (LMWH)

Answer

Begin warfarin immediately while continuing heparin

Answer

Administer prophylactic platelet transfusion

Question 3

A patient with iron deficiency anemia has failed oral iron therapy due to GI intolerance. What is the most appropriate next step?

Accepted Answer

Initiate IV iron infusion

Answer

Double the oral iron dose and add a proton pump inhibitor

Answer

Start erythropoietin injections

Answer

Transfuse 2 units of packed red blood cells

Question 4

A patient with pernicious anemia requires vitamin B12 replacement. Which treatment approach is most appropriate?

Accepted Answer

High-dose oral cyanocobalamin (1000–2000 mcg/day) or IM cyanocobalamin injections

Answer

Standard-dose oral cyanocobalamin 100 mcg daily

Answer

Folic acid supplementation 1 mg daily

Answer

Dietary B12 fortification alone

Question 5

A patient with severe hemophilia A requires perioperative hemostasis for elective surgery. Which product is most appropriate?

Accepted Answer

Recombinant or plasma-derived factor VIII concentrate

Answer

Fresh frozen plasma (FFP)

Answer

Desmopressin (DDAVP) alone

Answer

Cryoprecipitate

Question 6

A patient on warfarin presents with an INR of 9.5 and active major bleeding. Which is the most appropriate management?

Accepted Answer

4-factor prothrombin complex concentrate (4F-PCC) plus IV vitamin K

Answer

Hold warfarin and monitor INR every 6 hours

Answer

IV vitamin K 10 mg alone

Answer

Fresh frozen plasma plus oral vitamin K

Question 7

A patient is diagnosed with immune thrombocytopenic purpura (ITP) with a platelet count of 22,000/mm³ but no active bleeding. What is the most appropriate initial therapy?

Accepted Answer

Corticosteroids (prednisone or dexamethasone)

Answer

Platelet transfusion to raise count above 50,000/mm³

Answer

Splenectomy

Answer

Rituximab