Haematology & Oncology Prometric exam questions with answers

1. Question 1Haemoglobinopathies and Transfusion Medicinemedium

   A young adult with sickle cell disease admitted with a painful crisis develops fever, chest pain, falling oxygen saturation of 89% on air and a new infiltrate on chest radiograph. Besides oxygen and antibiotics, what is the key treatment?

   1. AHigh-dose opioids alone
   2. BBlood transfusion, simple or exchange
   3. CIntravenous furosemide
   4. DStart hydroxyurea immediately
   Show answer and explanation▾

   Answer: B. Blood transfusion, simple or exchange

   This is acute chest syndrome, a leading cause of death in sickle cell disease. Hypoxia or deterioration is an indication for transfusion, with exchange transfusion for severe disease, alongside oxygen, antibiotics covering atypical organisms, analgesia and incentive spirometry. Hydroxyurea prevents future episodes but does not treat the acute event.

2. Question 2Haemoglobinopathies and Transfusion Medicinehard

   Which patient most clearly needs irradiated cellular blood components to prevent transfusion-associated graft-versus-host disease?

   1. AA patient with Hodgkin lymphoma
   2. BA patient with iron deficiency anaemia
   3. CA patient with sickle cell trait
   4. DA patient receiving warfarin
   Show answer and explanation▾

   Answer: A. A patient with Hodgkin lymphoma

   Patients with Hodgkin lymphoma at any stage need irradiated components, as do those treated with purine analogues such as fludarabine and recipients of stem cell transplants. Irradiation inactivates donor lymphocytes that could cause fatal graft-versus-host disease. Iron deficiency, sickle trait and warfarin are not indications.

3. Question 3Lymphoid Malignancies and Plasma Cell Disordersmedium

   A 68-year-old has a lymphocyte count of 25 x 10^9/L with smudge cells. Flow cytometry shows CD5 and CD23 positive B cells. He has no symptoms, cytopenias or bulky nodes. What is the most appropriate management?

   1. AStart a BTK inhibitor now
   2. BStart chemoimmunotherapy now
   3. CRefer for allogeneic transplant
   4. DActive monitoring without treatment
   Show answer and explanation▾

   Answer: D. Active monitoring without treatment

   Early-stage asymptomatic chronic lymphocytic leukaemia is managed by watch and wait, as early treatment has not improved survival. Treatment is indicated for active disease such as progressive marrow failure, symptomatic nodes or spleen, constitutional symptoms or rapid lymphocyte doubling. Transplant is reserved for selected high-risk relapsed disease.

4. Question 4Myeloid Malignanciesmedium

   A 40-year-old has bleeding gums, a low fibrinogen, raised D-dimer and abnormal promyelocytes with multiple Auer rods on the blood film. What is the most important immediate step?

   1. AWait for genetic confirmation before any treatment
   2. BStart all-trans retinoic acid at once
   3. CGive heparin to treat the coagulopathy
   4. DPerform an urgent splenectomy
   Show answer and explanation▾

   Answer: B. Start all-trans retinoic acid at once

   Suspected acute promyelocytic leukaemia is an emergency because of life-threatening coagulopathy. All-trans retinoic acid should start as soon as the diagnosis is suspected, without waiting for PML-RARA confirmation, together with aggressive blood product support. Early deaths are mainly from haemorrhage.

5. Question 5Red Cell Disorders and Anaemiaseasy

   A 34-year-old woman with heavy periods has haemoglobin 92 g/L, MCV 71 fL and a normal CRP. Which single test best confirms iron deficiency?

   1. ASerum ferritin
   2. BSerum iron
   3. CHaemoglobin electrophoresis
   4. DReticulocyte count
   Show answer and explanation▾

   Answer: A. Serum ferritin

   A low serum ferritin is the most specific test for iron deficiency, especially when inflammation is absent. Serum iron fluctuates widely and is unreliable alone. Haemoglobin electrophoresis is used for suspected thalassaemia when ferritin is normal.

6. Question 6Myeloid Malignanciesmedium

   On day 8 of all-trans retinoic acid for acute promyelocytic leukaemia, a patient develops fever, weight gain, breathlessness and pulmonary infiltrates. What is the most appropriate treatment?

   1. ADexamethasone 10 mg twice daily
   2. BBroad-spectrum antibiotics only
   3. CDouble the dose of retinoic acid
   4. DIntravenous furosemide only
   Show answer and explanation▾

   Answer: A. Dexamethasone 10 mg twice daily

   These features suggest differentiation syndrome, which is treated promptly with dexamethasone 10 mg twice daily, with temporary interruption of the differentiating agent if severe. Antibiotics may be given if infection is possible but do not treat the syndrome. Increasing retinoic acid would worsen it.

7. Question 7Solid Tumour Oncologyhard

   A man has orchidectomy for a testicular mass, and histology reports pure seminoma. His serum AFP is clearly raised. How should this be interpreted?

   1. AIt is typical of pure seminoma
   2. BIt suggests a hepatoma unrelated to the testis
   3. CIt indicates non-seminomatous elements
   4. DIt is a laboratory error to be ignored
   Show answer and explanation▾

   Answer: C. It indicates non-seminomatous elements

   Pure seminoma does not produce AFP, so a raised AFP indicates non-seminomatous elements such as yolk sac tumour, and the patient should be managed as non-seminomatous germ cell tumour. Beta-hCG can be mildly raised in seminoma. Other causes of raised AFP should be excluded, but the result should not be ignored.

8. Question 8Systemic Anticancer Therapy and Supportive Careeasy

   Ten days after chemotherapy, a patient has a temperature of 38.5 degrees Celsius and a neutrophil count of 0.3 x 10^9/L. He is haemodynamically stable. What is the most important immediate action?

   1. AWait for blood culture results before treating
   2. BGive oral paracetamol and review in 4 hours
   3. CStart empirical IV broad-spectrum antibiotics within 1 hour
   4. DGive granulocyte colony-stimulating factor only
   Show answer and explanation▾

   Answer: C. Start empirical IV broad-spectrum antibiotics within 1 hour

   Neutropenic sepsis is a medical emergency, and empirical intravenous broad-spectrum antibiotics such as piperacillin-tazobactam should be given within 1 hour of presentation after cultures are taken. Delay increases mortality. G-CSF is not a substitute for antibiotics.

9. Question 9Red Cell Disorders and Anaemiasmedium

   A 70-year-old has macrocytic anaemia, numb feet and impaired vibration sense. Both serum B12 and folate are low. What is the correct order of replacement?

   1. AFolic acid first, then B12 after 2 weeks
   2. BFolic acid alone, as neuropathy is unrelated
   3. CStart B12 before or with folic acid
   4. DOral iron first, then both vitamins
   Show answer and explanation▾

   Answer: C. Start B12 before or with folic acid

   When both are deficient, B12 should be started before or together with folic acid, because folate alone can correct the anaemia while allowing neurological damage such as subacute combined degeneration to progress. Neurological signs indicate the need for intensive intramuscular B12. Iron is not indicated without iron deficiency.

10. Question 10Red Cell Disorders and Anaemiasmedium

    A patient with active rheumatoid arthritis has normocytic anaemia, ferritin 450 micrograms/L, low transferrin saturation and raised CRP. What mechanism mainly explains the anaemia?

    1. ARaised hepcidin restricting iron release
    2. BAutoimmune destruction of red cells
    3. CLoss of iron from the gut
    4. DDeficient erythropoietin from kidney failure
    Show answer and explanation▾

    Answer: A. Raised hepcidin restricting iron release

    In anaemia of inflammation, cytokines such as IL-6 increase hepcidin, which blocks iron release from macrophages and gut absorption, giving low transferrin saturation with normal or high ferritin. Gut iron loss would give a low ferritin. Haemolysis would raise reticulocytes and bilirubin.

11. Question 11Solid Tumour Oncologymedium

    A non-smoker has metastatic lung adenocarcinoma with an EGFR exon 19 deletion. What is the preferred first-line systemic treatment?

    1. APlatinum doublet chemotherapy
    2. BPembrolizumab monotherapy
    3. COsimertinib
    4. DCrizotinib
    Show answer and explanation▾

    Answer: C. Osimertinib

    Osimertinib, a third-generation EGFR tyrosine kinase inhibitor, improved survival over earlier EGFR inhibitors in first-line treatment of EGFR-mutant NSCLC. Immunotherapy alone is less effective in EGFR-mutant disease. Crizotinib targets ALK and ROS1 rearrangements.

12. Question 12Solid Tumour Oncologymedium

    A postmenopausal woman with ER-positive early breast cancer is starting adjuvant letrozole. Which baseline assessment is most important?

    1. ABone mineral density scan
    2. BRetinal examination
    3. CAudiometry
    4. DPulmonary function tests
    Show answer and explanation▾

    Answer: A. Bone mineral density scan

    Aromatase inhibitors lower oestrogen further and accelerate bone loss, so baseline bone density assessment, calcium and vitamin D, and bisphosphonates where indicated are recommended. Tamoxifen has different risks, including thromboembolism and endometrial cancer. Audiometry relates to platinum drugs.

13. Question 13Stem Cell Transplantation and Professional Practicemedium

    Three weeks after allogeneic stem cell transplant, a patient develops a rash on the palms and soles, diarrhoea and raised bilirubin. Which condition do these three organ systems most suggest?

    1. AAcute graft-versus-host disease
    2. BEngraftment failure
    3. CCytomegalovirus retinitis
    4. DVeno-occlusive disease alone
    Show answer and explanation▾

    Answer: A. Acute graft-versus-host disease

    Acute graft-versus-host disease classically affects the skin, gastrointestinal tract and liver, with rash often starting on the palms and soles. Veno-occlusive disease causes jaundice, painful hepatomegaly and fluid retention but not the rash and diarrhoea. Biopsy and exclusion of infection support the diagnosis before systemic steroids.

14. Question 14Systemic Anticancer Therapy and Supportive Caremedium

    Which chemotherapy drug is best known for cumulative dose-related cardiomyopathy, so that lifetime dose must be recorded?

    1. AVincristine
    2. BDoxorubicin
    3. CCisplatin
    4. DMethotrexate
    Show answer and explanation▾

    Answer: B. Doxorubicin

    Anthracyclines such as doxorubicin cause cardiomyopathy whose risk rises with cumulative dose, so lifetime exposure is tracked and cardiac function monitored. Vincristine causes neuropathy and cisplatin nephrotoxicity and ototoxicity. Methotrexate toxicity includes mucositis and myelosuppression.

15. Question 15Systemic Anticancer Therapy and Supportive Caremedium

    A patient is to receive high-dose cisplatin. Which antiemetic combination is recommended as prophylaxis for this highly emetogenic regimen?

    1. AMetoclopramide and domperidone as needed
    2. BOndansetron and dexamethasone only
    3. CDexamethasone and lorazepam only
    4. DNK1 and 5-HT3 antagonists, dexamethasone, olanzapine
    Show answer and explanation▾

    Answer: D. NK1 and 5-HT3 antagonists, dexamethasone, olanzapine

    For highly emetogenic chemotherapy such as cisplatin, guidelines recommend a four-drug regimen combining an NK1 receptor antagonist, a 5-HT3 antagonist, dexamethasone and olanzapine. Single agents give poor control of acute and delayed vomiting. Uncontrolled vomiting can cause dehydration and worsen cisplatin nephrotoxicity.

Last reviewed September 2026. Questions are original and written to the published exam blueprint; they are not taken from any real paper.