Hematology - Oncology

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Neutropenia Evaluation and Management

Which one of the following statements regarding febrile neutropenia is false?

  • Antibiotic and antifungal prophylaxis are recommended for patients at high risk.
  • In a patient with known malignancy, antibiotics should be initiated within 1 hour of diagnosing febrile neutropenia.
  • Granulocyte Colony-Stimulating Factor (G-CSF) treatment should be avoided in those with acute leukemia.
  • G-CSF treatment during febrile neutropenia has shown mortality benefit.
Volume 41.3 - Question 30

Apixaban for Extended Treatment of Provoked Venous Thromboembolism

In adults with venous thromboembolism (VTE) after the occurrence of a transient provoking factor, but who have at least one enduring risk factors (e.g., autoimmune disorders, chronic lung disease, or obesity), extending the initial 3-month treatment with apixaban an additional 12 months, 2.5 mg twice daily results in a lower risk of symptomatic recurrent VTE than placebo.

  • True
  • False
Volume 41.3 - Question 29

Deep Vein Thrombosis

In outpatients with a non-high pretest probability, age-adjusted D-Dimer levels can safely rule out leg DVT without the need for LEL compression ultrasonography.

  • True
  • False
Volume 41.3 - Question 22

Diagnosis and Management of Iron Deficiency in Females

If a patient experiences a “Fishbane” reaction with IV iron infusion (eg. flushing and acute chest or back tightness, without hypotension, wheezing, stridor, or periorbital edema), further IV iron infusion is contraindicated.

  • True
  • False
Volume 41.2 - Question 31

Superficial Vein Thrombosis

Which one of the following statements regarding the use of anticoagulants for the treatment of superficial vein thrombosis (SuVT) is false?

  • Systemic anticoagulation with fondaparinux for 45 days is typically considered for patients with SuVT greater than 5 cm in length and greater than 3 cm away from the deep vein junction.
  • Conservative treatments include topical NSAID creams.
  • If the SuVT is closer than 3 cm to the deep vein junctions, therapeutic anticoagulation with regimens similar to those used for management of deep vein thrombosis should be considered.
  • People with SuVT are not at increased risk of subsequent deep vein thrombosis.
Volume 41.1 - Question 36

Elevated Vitamin B12 Levels

Which one of the following statements about elevated Vitamin B12 levels is false?

  • Less than 5% of individuals have elevated vitamin B12
  • Persistently elevated levels have been associated with an increased incidence of solid cancer, specifically liver, kidney, lung, breast, and gastrointestinal cancers.
  • Patients are at increased risk of hematologic disorders such as chronic myeloid leukemia, polycythemia vera, and myeloproliferative syndromes.
  • A repeat test should be performed to confirm persistent elevation.
Volume 41.1 - Question 29

Antiplatelet Therapy after Drug Coated Balloon Angioplasty

Among participants with acute coronary syndrome who could be treated by drug coated balloon angioplasty exclusively, a stepwise dual antiplatelet therapy (DAPT) de-escalation is non-inferior to 12-month DAPT for net adverse clinical events.

  • True
  • False
Volume 40.6 - Question 34

Essential Thrombocythemia

Which one of the following statements about essential thrombocythemia is false?

  • Most cases of severe thrombocytosis are secondary to essential thrombocythemia.
  • The presence of cardiovascular risk factors substantially increases the risk of thrombosis.
  • Aspirin is often effective for pain in the hands and feet.
  • Patients with essential thrombocythemia who develop venous thrombosis are treated similarly to individuals with venous thrombosis without essential thrombocythemia.
Volume 40.6 - Question 31

Extended Anticoagulation for Cancer Patient

Extended anticoagulation with reduced-dose apixaban (2.5 mg twice daily) is noninferior to full-dose apixaban (5 mg twice daily) for the prevention of recurrent venous thromboembolism in patients with active cancer.

  • True
  • False
Volume 40.6 - Question 30

Testicular Cancer

Which one of the following statements about testicular cancer is false?

  • Scrotal ultrasound can distinguish malignant from benign testicular masses with a sensitivity and specificity greater than 90%.
  • Normal serum tumor markers rule out cancer.
  • Patients suspected to have testicular cancer should undergo radical inguinal orchiectomy.
  • Patients treated for stage I testicular cancer should undergo surveillance for at least 5 years.
Volume 40.5 - Question 33

Statin Use and Risk of Hepatocellular Carcinoma

In patients 40 years or older with chronic liver disease and a baseline Fibrosis-4 (FIB-4) score of 1.3 or higher, statin use is significantly associated with a reduced risk of incident hepatocellular carcinoma.

  • True
  • False
Volume 40.5 - Question 26

Anticoagulation in Dialysis Patients with Atrial Fibrillation

Which one of the following statements regarding the use of Factor Xa inhibitors, as compared to vitamin K antagonists, in atrial fibrillation patients on dialysis is false?

  • There is a reduced risk of major bleeding.
  • There is no difference in risk of stroke and systemic embolism.
  • There is no difference in risk of acute coronary syndrome.
  • There is increased mortality.
Volume 40.5 - Question 25

Haemophilia Treatment

Which one of the following statements about treatment of haemophilia is false?

  • Prophylactic treatment to prevent bleeds has become the standard of care for severe haemophilia.
  • Extended half-life Factor IX products have a median half-life three to five times higher than standard products.
  • For treatment of major bleeds, the aim is to increase factor activity levels to the lower end of normal.
  • For treatment after minor surgeries, 1–3 days of full factor coverage usually suffices.
Volume 40.5 - Question 24

Haemophilia

Which one of the following statements about haemophilia is false?

  • In severe cases, symptoms frequently appear between ages 6 to12 months.
  • Joint damage due to bleeding rarely affects small joints.
  • A coagulation screen usually shows an abnormal prothrombin time.
  • Female carriers of haemophilia A tend to have more bleeding episodes compared to non-carriers.
Volume 40.5 - Question 23

Amyloidosis

Which one of the following statements about systemic light chain amyloidosis is false?

  • It commonly causes nephrotic range proteinuria.
  • Cardiac involvement is the leading cause of death.
  • It is associated with multiple myeloma.
  • The five year survival rate is 20%.
Volume 40.4 - Question 29

Cancer and Development of Tuberculosis Disease

Which one of the following statements regarding individuals with cancer and the diagnosis of tuberculosis disease is false?

  • The likelihood of diagnosis is lower for those with haematologic malignancies than for individuals without cancer.
  • Most people will be diagnosed within 6 months of cancer diagnosis.
  • The median time to diagnosis for those with respiratory cancers is less than 2 months.
  • There is approximately a six-fold increase in the risk of diagnosis within 2 years of cancer diagnosis.
Volume 40.4 - Question 20

Lung Cancer Among First Nations, Inuit & Métis

Which one of the following statements regarding lung cancer among First Nations, Inuit and Métis peoples is false?

  • Over 50% of Inuit with small-cell lung cancer are diagnosed with advanced stage disease.
  • First Nations individuals are less likely to be seen at specialized cancer centres in Ontario than non-Indigenous Canadians.
  • The age standardised incidence rate of lung cancer is statistically higher in Métis people than non-Indigenous Canadians.
  • Incidence amongst Inuit women is 2-3 times higher compared to non-Indigenous Canadian women.
Volume 40.3 - Question 8

Perioperative Management of Antithrombotic Therapy

Which one of the following statements regarding perioperative management of antithrombotic therapy is false?

  • For patients taking aspirin, continuation for elective noncardiac surgery is suggested.
  • For patients with atrial fibrillation taking vitamin K antagonists (VKA) who are undergoing an elective procedure with low to moderate risk of thromboembolism heparin bridging is recommended.
  • For patients with a mechanical heart valve with low to moderate risk of thromboembolism who require VKA interruption for an elective surgery or procedure heparin bridging is not suggested.
  • For patients receiving a direct oral anticoagulant (DOAC) who will be undergoing an elective surgery or procedure, discontinuing DOAC therapy is suggested.
Volume 40.2 - Question 23

Melanoma

Which one of the following statements is false?

  • There is sufficient evidence to support the effectiveness of skin cancer screening in reducing melanoma mortality.
  • Consistent sunscreen use does not meaningfully compromise vitamin D levels.
  • Immunotherapy is now the standard of care for patients with stage IV melanoma.
  • Patients who have a history of melanoma have a 4% to 8% risk of developing subsequent primary melanomas.
Volume 39.6 - Question 41

Non-Erosive Gastro-Esophageal Reflux Disease

Patients with non-erosive gastro-esophageal reflux disease have a higher incidence of esophageal adenocarcinoma than the general population.

  • True
  • False
Volume 39.6 - Question 39

Colon Cancer

Which one of the following statements about colon cancer in primary care is false? 

  • Colon cancer develops over approximately 10-15 years. 
  • Right-sided tumours have poorer overall survival compared with left-sided ones. 
  • In the setting of limited metastatic disease, patients with Stage IV colon cancer can be considered for surgical resection of lung and liver metastases. 
  • Individuals diagnosed with metastatic disease have a median overall survival of about 12 months. 
Volume 39.5 - Question 41

Cancer-Related Lymphedema

Which one of the following statements about cancer-related lymphedema is false? 

  • It affects more than 300,000 individuals in Canada.   
  • It is incurable.   
  • The criterion standard of lymphedema management is decongestive lymphatic therapy.   
  • Diuretics are recommended.  
Volume 39.4 - Question 41

Vestibular Schwannoma

Which one of the following statements about vestibular schwannoma is false? 

  • They account for 8% of all intracranial tumors.   
  • Widespread access to sensitive neurodiagnostic imaging has led to a rise in detection.   
  • Hearing loss is often subtle initially.   
  • Symptoms of vertigo occur in most cases. 
Volume 36.6 - Question 37

Chemotherapy

A 35 year-old female patient informs you during her visit that she has breast cancer and will be starting chemotherapy next week. You discuss adjuvant and neoadjuvant treatment with her. According to her, it will be neoadjuvant.
Volume 37.6 - Question 41

Venous Thromboembolism Treatment

Patients with venous thromboembolism (VTE) who are initiated on apixaban have lower rates for recurrent VTE than those initiated on rivaroxaban.

  • True
  • False
Volume 37.6 - Question 34

Cancer Diagnosis

Which one of the following statements about cancer diagnosis in primary care is false? 

  • Urgency has a higher positive predictive value for prostate cancer compared to hematuria.   
  • Cough has a lower positive predictive value for lung cancer compared to hemoptysis.   
  • For clinically low risk and asymptomatic prostate cancer, no staging investigations is required.   
  • Abdominal pain with repeat presentations has a lower positive predictive value for cancer than abdominal pain with one presentation. 
Volume 36.6 - Question 7

Diffuse Large B-cell Lymphoma

Which one of the following statements about diffuse large B-cell lymphoma is false? 

  • It represents about 30% of all cases of non-Hodgkin’s Lymphoma.  
  • It can arise as a transformation from an underlying known or occult low-grade B-cell lymphoma.  
  • Central nervous system recurrence has a median overall survival of less than 6 months  
  • Outcomes remain good for patients in which frontline treatment fails.
Volume 36.5 - Question 35

Erythrocytosis

The preferred laboratory marker to differentiate between primary and secondary erythrocytosis in a primary care setting is the Janus kinase 2 mutation testing. 

  • True
  • False
Volume 36.4 - Question 44

Transfusion and MI

In patients with acute myocardial infarction and anemia, electing to transfuse patients with an 80g/L hemoglobin threshold is non-inferior to employing a 100g/L threshold.

  • True
  • False
Volume 37.2 - Question 13

Smoking Cessation and Lung Cancer Survival

Smoking cessation at the time of diagnosis of early stage non-small cell lung cancer improves survival time.

  • True
  • False
Volume 37.2 - Question 11

Chronic Myeloid Leukemia

Which one of the following statements about chronic myeloid leukemia (CML) is false?

  • Most patients are diagnosed while asymptomatic.
  • The hallmark of CML is the Philadelphia chromosome.
  • Tyrosine kinase inhibitors are the first line therapeutic option.
  • Lifelong treatment is necessary to maintain remission in all patients.
Volume 37.4 - Question 25

Drug-Induced Thrombocytopenia

In drug induced thrombocytopenia, the implicated medication usually causes thrombocytopenia within three to ten days of exposure. 

  • True
  • False
Volume 38.1 - Question 35

Immune Thrombocytopenia

Which one of the statements of immune thrombocytopenia (ITP) is false? 

  •  It is the most common cause of isolated thrombocytopenia. 
  • It is often a diagnosis of exclusion since there is no specific test.  
  • Patient with newly diagnosed ITP with platelet counts of 20 x 103 per ul or greater with minimal bleeding can be managed as outpatients. 
  • Initial therapy includes splenectomy.   
Volume 38.1 - Question 34

Thrombocytopenia

Which one of the following statements about thrombocytopenia is false? 

  • Patients with platelets counts less than 10 x 103 per uL are at high risk of spontaneous bleeding. 
  • Myelodysplastic syndrome commonly develops in patients with isolated thrombocytopenia.  
  • Patients with platelets counts from 20 to 50 x 103 per uL often experience easy bruising. 
  • Isolated mild thrombocytopenia has a favorable prognosis. 
Volume 38.1 - Question 33

Myelodysplastic Syndromes

Which one of the following statements about myelodysplastic syndromes is false? 

  • The median age of diagnosis is approximately 70 years. 
  • Anemia, neutropenia and thrombocytopenia must all be present for diagnosis. 
  • A bone marrow biopsy is required to make the diagnosis. 
  • There is an increased associated risk of acute myeloid leukemia. 
Volume 38.1 - Question 32

Neonatal Hyperbilirubinemia

Case 1 A 29-year-old primigravid African American female delivers a healthy-appearing term male in hospital. She does not have any significant past medical history but did not have any prenatal care.
Volume 38.2 - Question 35

Endocrine Therapies for Breast and Prostate Cancers

Which one of the following statements about endocrine therapies for breast cancer is false?

  • More than 75% of breast cancers are driven by either estrogen or progesterone.
  • In premenopausal patients at standard risk, adjuvant tamoxifen therapy for 5-10 years is associated with a statistically significant reduction in breast cancer mortality at 15 years.
  • In postmenopausal patients, aromatase inhibitor therapy for a minimum of 5 years is the endocrine therapy of choice.
  • Endocrine therapies are well tolerated and rarely discontinued.
Volume 38.2 - Question 33

Drugs for Treatment and Prevention of Venous Thromboembolism

Which one of the following statements about drugs for venous thromboembolism (VTE) is false?

  • In patients with severe renal failure (CrCl <30 ml/min), VTE can be appropriately treated with apixaban.
  • Direct oral anticoagulants are safe for use in pregnancy.
  • Aspirin can reduce the recurrence rate of VTE in patients who are no longer taking an anticoagulant.
  • Low-dose apixaban can reduce the recurrence rate of symptomatic VTE in patients having completed 6-12 months of anticoagulation therapy.
Volume 38.2 - Question 28

PPIs and Gastric Cancer

There is a clinically significant increase in the risk of gastric cancer in patients taking a proton pump inhibitor (PPI) compared with those taking H2 receptor antagonists.

  • True
  • False
Volume 38.2 - Question 22

Lesions of the Ovary and Fallopian Tube

Which one of the following statements about lesions of the ovary and fallopian tube is false?

  • Transvaginal ultrasound is the imaging modality of choice in the initial workup of adnexal lesions.
  • Biopsy of an adnexal lesion should almost always be avoided.
  • MRI is the test of choice for clinical staging of a known ovarian cancer.
  • Up to 20% of women with metastatic ovarian or tubal cancers have a normal CA-125 level.
Volume 38.2 - Question 4

Early-Onset Colorectal Cancer

Which one of the following statements regarding early-onset (<50 years of age) colorectal cancer is false?

  • It now accounts for approximately 10% of all new diagnoses of this cancer.
  • An increase in colorectal cancer-related mortality has been observed in the past decade among younger patients.
  • Most cases are due to a hereditary syndrome.
  • More than 70% are detected in the left colon at presentation.
Volume 37.5 - Question 22

Venous Thromboembolism in Patients with Cancer

Direct oral anticoagulants are inferior to low molecular weight heparin in preventing cancer related recurrent venous thromboembolism. 

  • True
  • False
Volume 39.1 - Question 32

Secondary Causes of Erythrocytosis

SGLT2 inhibitors may be a significant, underrecognized cause of drug induced erythrocytosis.

  • True
  • False
Volume 38.3 - Question 35

Primary Immune Thrombocytopenia (ITP) in Pregnancy

Which one of the following statements about thrombocytopenia in pregnancy is false? 

  • Gestational thrombocytopenia is the most common cause of low platelet counts in pregnancy. 
  • Gestational thrombocytopenia has not been found to be a cause of maternal bleeding. 
  • For treatment of Immune Thrombocytopenia (ITP), prednisone is more likely to affect the fetus than dexamethasone. 
  • Approximately 10 % of neonates born to mothers with ITP have marked thrombocytopenia at birth. 
Volume 39.1 - Question 15

Febrile Neutropenia

Which one of the following statements about the management of febrile neutropenia is false?

  • Granulocyte colony–stimulating factors are not typically recommended in the treatment of febrile neutropenia.
  • Routine rectal examination to rule out mucositis is advised.
  • About 20% to 30% of patients with febrile neutropenia will have an identifiable infectious cause.
  • Low risk patients may be treated with oral antibiotics.
Volume 38.3 - Question 14

Venous Thromboembolism Prophylaxis in Pregnancy

In women with a history of venous thromboembolism, weight-adjusted intermediate-dose low molecular-weight heparin during the combined antepartum and post-partum periods is associated with a lower risk of recurrence than fixed low-dose low-molecular-weight heparin.

  • True
  • False
Volume 38.4 - Question 9

Vaccination for Patients Receiving Cancer Therapy

Which one of the following statements about vaccinations in patients receiving cancer therapy is false?

  • Vaccination rates are low.
  • Live vaccines are contraindicated in immunosuppressed patients.
  • Non-live vaccines are contraindicated in patients receiving cancer treatment with immunotherapy.
  • Patients are no longer considered immunosuppressed 3 months after cessation of treatment for cancer.
Volume 38.4 - Question 4

Anthracycline Cardiomyopathy

Among patients with lymphoma treated with anthracycline-based chemotherapy, atorvastatin reduced the incidence of cardiac dysfunction.

  • True
  • False
Volume 39.2 - Question 36

Vaginal Estrogen in Breast Cancer Survivors

In women with a history of breast cancer, use of vaginal estrogen to treat genitourinary syndrome of menopause does not increase breast cancer recurrence within 5 years.

  • True
  • False
Volume 39.2 - Question 27

Lead Toxicity

Which one of the following statements about lead toxicity is false?

  • Lead is toxic to all organ systems.
  • Stripping of old paint is an important source of exposure.
  • Screening for blood lead is recommended for the routine work up of anemia.
  • Removal from exposure is the most important aspect of management of lead poisoning.
Volume 39.2 - Question 23

Prostate Cancer

Prostate cancer-specific mortality rates for localized prostate cancer are similar regardless of the treatment provided (active monitoring, prostatectomy or radiotherapy).

  • True
  • False
Volume 38.6 - Question 40

Factor Prothrombin Complex Concentrate in Patients with Trauma

Among patients with trauma at risk of massive transfusion, there is no significant reduction of 24-hour blood product consumption after administration of 4 factor prothrombin complex concentrate.

  • True
  • False
Volume 38.6 - Question 25

Endocrine Therapy and Attempted Pregnancy after Breast Cancer

Among select women with previous hormone receptor–positive early breast cancer, temporary interruption of endocrine therapy to attempt pregnancy does not confer a greater short-term risk of breast cancer events.

  • True
  • False
Volume 38.6 - Question 16

Spinal Cord Compression

Which one of the following statements about malignant spinal cord compression is false?

  • The most frequent site of cord compression is the lumbar spine.
  • Contrast-enhanced magnetic resonance imaging is the most sensitive imaging modality.
  • Initial management includes immediate administration of an intravenous bolus of dexamethasone.
  • Radiation therapy is the mainstay of treatment.
Volume 38.5 - Question 39

Cancer Risk After CT in Childhood

In people under 25, there is an increased cancer risk in those who have received 4 or more CT scans in childhood.

  • True
  • False
Volume 38.5 - Question 11

Long-term Health Risks of Childhood Cancer

Which one of the following statements about long-term health risks in adult survivors of childhood cancer is false?

  • All cause mortality is increased.
  • Risk of cardiovascular mortality is increased.
  • Risk of mortality from other cancers is similar to the general population
  • Absence of diabetes is associated with a significant reduction in health-related mortality.
Volume 38.5 - Question 6

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