heme exam 3 chapter questions

What is the typical M:E ratio in patients with CML (chronic myelogenous leukemia)?

a. 1:10

b. 1:5

c. 10:1

d. 3:1

c. 10:1

2. What is the chromosomal abnormality found in CML?

a. t(8;14)

b. t(9;22)

c. t(1;12)

d. Trisomy 12

b. t(9;22)

3. Which of the following is consistent with leukemoid reaction?

a. Low WBC count

b. Basophilia

c. Presence of Philadelphia chromosome

d. High LAP

d. High LAP

4. Which phase of CML carries the worst prognosis and is generally unresponsive to treatment?

a. Chronic

b. Accelerated

c. Blastic

d. Refractory

c. Blastic

5. Which of the following myeloproliferative disorders is characterized by a decreased LAP score?

a. CML

b. PMF

c. ET

d. PV

a. CML

6. Most patients (95%) are diagnosed in which phase of CML?

a. Accelerated phase

b. Chronic phase

c. Blastic phase

d. Fibrotic phase

b. Chronic phase

7. The blastic phase of CML is defined by what percent of blasts found in the peripheral blood or bone marrow?

a. 50%

b. 10%

c. 80%

d. 20%

d. 20%

8. At the molecular level, the aberrant conjoining of genetic material from chromosome 9 and chromosome 22 results in a fusion gene called:

a. BCR-ABL1 gene

b. JAK2 gene

c. p53

d. The blast transformation gene

a. BCR-ABL1 gene

9. Which of the following is a common risk factor for CML?

a. Smoking

b. Ionizing radiation

c. Family history

d. Sulfa drug therapy

b. Ionizing radiation

10. The Philadelphia chromosome is found in which MPN?

a. PV

b. CML

c. ET

d. PMF

b. CML

11. Characteristics of CML include which of the following?

a. Seen only in elderly patients

b. Leukopenia

c. Splenomegaly

d. Enlarged lymph nodes

c. Splenomegaly

12. Resistance to treatment is typically found in patients with:

a. Low amount of blast cells in peripheral blood

b. Multiple genetic alterations

c. Basophilia

d. Chronic phase CML diagnosis

b. Multiple genetic alterations

13. The BCR-ABL1 mutation is found in which MPN?

a. ET

b. PV

c. CML

d. PMF

c. CML

14. Confirmation of CML and other MPNs requires which analysis?

a. LAP Score

b. Cytogenetic analysis

c. Peripheral blood smear

d. Bone marrow analysis

b. Cytogenetic analysis

15. Which can be seen in CML?

a. Increased LAP score

b. The lack of Ph chromosome

c. Frequent Dohle bodies

d. Basophilia

d. Basophilia

1. What is the origin of myeloproliferative neoplasms?

a. Fibroid infiltration of major organs

b. Neoplastic transformation of multipotential stem cells

c. Widespread deterioration of cellular function

d. Splenic sequestration of normal blood cells

b. Neoplastic transformation of multipotential stem cells

2. Which myeloproliferative neoplasm is Ph(+)?

a. Polycythemia vera

b. Chronic myelogenous leukemia

c. Essential thrombocythemia

d. Primary myelofibrosis

b. Chronic myelogenous leukemia

3. Which condition would present with increased Hct values, but normal RBC? a. Polycythemia vera

b. Relative erythrocytosis

c. Secondary polycythemia

d. Essential thrombocythemia

b. Relative erythrocytosis

4. Increased EPO levels are seen in which of the following?

a. Polycythemia vera

b. Relative erythrocytosis

c. Secondary polycythemia

d. Absolute erythrocytosis

c. Secondary polycythemia

5. Which of the following is the most common complication in polycythemia vera?

a. Myocardial infarction

b. Itching

c. Gout

d. Thrombosis

d. Thrombosis

6. What are the laboratory findings in polycythemia vera?

a. Decreased hematocrit; increased RBCs and granulocytes; decreased platelets

b. Increased hematocrit; increased RBCs, granulocytes, and platelets

c. Normal hematocrit; normal RBCs; increased granulocytes and platelets

d. Increased hematocrit; increased RBCs; decreased granulocytes and platelets

b. Increased hematocrit; increased RBCs, granulocytes, and platelets

7. What is the expected erythropoietin value in polycythemia vera?

a. Normal

b. Increased

c. Decreased

d. Variable

c. Decreased

8. The most striking peripheral blood finding in polycythemia vera is

a. Increased RBCs

b. Increased basophils

c. Increased monocytes

d. Decreased RBCs

a. Increased RBCs

9. Which of the following findings align with a diagnosis of essential thrombocythemia?

a. Plt count less than or equal to 450 x 109/L

b. BM biopsy showing proliferation of myeloblasts

c. Presence of JAK2

d. Meeting WHO criteria for other myeloid neoplasms

c. Presence of JAK2

10. What is the safest and least expensive treatment for patients with polycythemia vera?

a. High altitude

b. Decrease of iron levels

c. Therapeutic phlebotomy

d. Decrease of erythropoietin levels

c. Therapeutic phlebotomy

11. Which is a complication of essential thrombocythemia?

a. Skin rash

b. Splenomegaly

c. Thrombosis

d. Neuropathy

c. Thrombosis

12. Which of the following is a laboratory finding consistent with the diagnosis of essential thrombocytosis? a. Thrombocytopenia

b. Thrombocytosis

c. Leukocytopenia

d. Decreased RBCs

b. Thrombocytosis

13. The hallmark clinical finding in primary myelofibrosis is which of the following?

a. Splenomegaly

b. Bruising

c. Weakness

d. Pallor

a. Splenomegaly

14. Which of the following abnormally shaped RBCs is found in primary myelofibrosis?

a. Helmet cells

b. Target cells

c. Schistocytes

d. Teardrop cells

d. Teardrop cells

1. Chronic lymphocytic leukemia is most commonly a neoplasm of which white blood cell?

a. T lymphocytes

b. Neutrophils

c. B lymphocytes

d. Monocytes

c. B lymphocytes

2. Which of the following statements is true of smudge cells?

a. They are larger than normal lymphocytes.

b. They are an artifact resulting from peripheral smear slide preparation.

c. They are soccer ball-appearing chromatin patterns.

d. They are actually monocytes.

b. They are an artifact resulting from peripheral smear slide preparation.

3. CLL cells typically present with features of activation, which include:

a. Lymphocytes smaller in size

b. Exaggerated chromatin patterns

c. Lobulated or deep nuclear folds

d. Little to no cytoplasm

c. Lobulated or deep nuclear folds

4. Altered immunity in CLL is caused by which of the following?

a. Neutophilia

b. Increased production of immunoglobulins

c. Common development of autoimmune disorders

d. Anemia

c. Common development of autoimmune disorders

5. Which of the following is a B-cell marker?

a. CD 19

b. CD 21

c. CD 8

d. CD 4

a. CD 19

6. How does CLL typically present?

a. Women under 50 years old

b. Acutely with aggressive symptoms

c. Clearly pinpointed beginning of disease

d. Men over 50 years old

d. Men over 50 years old

7. Which is a laboratory finding consistent with a CLL diagnosis?

a. Lymphocyte count of 2 × 109/L

b. Bone marrow lymphocyte count of 30%

c. High red blood cell count

d. Normal platelet count

b. Bone marrow lymphocyte count of 30%

8. Which is a common B-CLL chromosomal abnormality?

a. 13q14 deletions

b. Trisomy 12

c. 17q translocation

d. TP53 deletion

b. Trisomy 12

9. Prognosis is decreased in CLL patients that present:

a. With indolent disease with asymptomatic presentation

b. With minimal lymphocytosis

c. With aggressive progression of lymphocytosis. anemia, and autoimmune phenomenon

d. With no anemia

c. With aggressive progression of lymphocytosis. anemia, and autoimmune phenomenon

10. Which treatment works best in progressive disease unresponsive to other therapies?

a. Anti-CD20

b. BCL2 inhibitors

c. BTK inhibitors

d. P13K inhibitors

d. P13K inhibitors

11. Lymphocytosis in peripheral blood and bone marrow with CD 20 +, CD 19 +, CD 5 +, and CD 23 + indicates which of the following lymphoproliferative disorders?

a. ALL

b. PLL

c. CLL

d. SLL

c. CLL

12. Lymphoblasts are seen in which lymphoproliferative disorder?

a. ALL

b. PLL

c. CLL

d. SLL

a. ALL

13. The cells of chronic lymphocytic leukemia are morphologically identical to those of:

a. Acute lymphoblastic leukemia

b. Small lymphocytic lymphoma

c. Infectious mononucleosis

d. Sézary syndrome

b. Small lymphocytic lymphoma

14. Surface immunoglobulin is the most reliable surface marker for:

a. T lymphocytes

b. Plasma cells

c. B lymphocytes

d. Histiocytes

c. B lymphocytes

15. Cells that demonstrate a positive reaction with the tartrate-resistant acid phosphatase (TRAP) stain are most likely:

a. T lymphoblasts of acute lymphoblastic leukemia

b. Atypical lymphocytes of a viral infection

c. Large granular lymphocytes of T-gamma lymphoproliferative disorder

d. Hairy cells of hairy cell leukemia

d. Hairy cells of hairy cell leukemia

1. Lymphoma is different from leukemia in that it originates in the:

a. Bone marrow

b. Breast tissue

c. Lymphatic tissue

d. Circulating lymphocytes

c. Lymphatic tissue

2. What infectious agent is most commonly associated with the pathogenesis of Hodgkin's lymphoma? a. Echovirus

b. Herpes simplex virus

c. Helicobacter pylori

d. Epstein-Barr virus

d. Epstein-Barr virus

3. Which of the following is the cell characteristic of all types of classic Hodgkin lymphoma?

a. Lacunar cell

b. Popcorn cell

c. Reed-Sternberg cell

d. Sézary cell

c. Reed-Sternberg cell

4. Which describes the Reed-Sternberg cell?

a. Small cell size

b. No nucleoli

c. Polylobated nucleus

d. Very little cytoplasm

c. Polylobated nucleus

5. Popcorn cells are seen in which Hodgkin lymphoma?

a. Classic Hodgkin lymphoma

b. Nodular lymphocyte-predominant Hodgkin lymphoma

c. Nodular sclerosis classic Hodgkin lymphoma

d. Mixed cellularity classic Hodgkin lymphoma

b. Nodular lymphocyte-predominant Hodgkin lymphoma

6. Lacunar cells are seen in which Hodgkin lymphoma?

a. Classic Hodgkin lymphoma

b. Nodular lymphocyte-predominant Hodgkin lymphoma

c. Nodular sclerosis classic Hodgkin lymphoma

d. Mixed cellularity classic Hodgkin lymphoma

c. Nodular sclerosis classic Hodgkin lymphoma

7. Which Hodgkin lymphoma has a female predominance?

a. Nodular sclerosis classic Hodgkin lymphoma

b. Mixed cellularity classic Hodgkin lymphoma

c. Nodular lymphocyte-predominant Hodgkin lymphoma

d. Classic Hodgkin lymphoma

a. Nodular sclerosis classic Hodgkin lymphoma

8. Fibrous bands are seen by microscopy in a mediastinal mass affecting an asymptomatic young woman most likely to have which type of Hodgkin lymphoma?

a. Nodular sclerosis

b. Lymphocyte-predominant

c. Mixed cellularity

d. Lymphocyte depletion

a. Nodular sclerosis

9. Which type of chromosomal abnormality is seen in Burkitt lymphoma?

a. Deletion

b. Mutation

c. Translocation

d. Amplification

c. Translocation

10. Which is the most commonly diagnosed category of non-Hodgkin lymphoma?

a. Diffuse large B-cell lymphoma

b. Hairy cell leukemia

c. Lymphoplasmacytic lymphoma

d. Burkitt lymphoma

a. Diffuse large B-cell lymphoma

11. A starry sky pattern of tingible-body macrophages is found in tumor tissue of which non-Hodgkin lymphoma?

a. Diffuse large B-cell lymphoma

b. Hairy cell leukemia

c. Lymphoplasmacytic lymphoma

d. Burkitt lymphoma

d. Burkitt lymphoma

12. Which of the following characterizes small lymphocytic lymphoma?

a. Aggressive but still generally curable b. Usually CD25-, CD5+, CD23+, CD10

c. Concomitant chronic lymphocytic leukemia

d. t(14;18)

c. Concomitant chronic lymphocytic leukemia

13. Mycosis fungoides is commonly associated with which T-cell lymphoma? a. T-lymphoblastic lymphoma

b. Peripheral T-cell lymphoma

c. Primary cutaneous T-cell lymphoma d. Anaplastic large cell lymphoma

c. Primary cutaneous T-cell lymphoma

14. Translocations involving the CCND1 gene is commonly associated with which B-cell lymphoma?

a. Small lymphocytic

b. Lymphoplasmacytic

c. Mantle cell

d. Marginal zone

c. Mantle cell

15. MALT lymphomas are most likely to have which of the following characteristics?

a. Extranodal involvement

b. T-cell immunophenotype

c. Blasts with fine nuclear chromatin

d. Reed-Sternberg cells

a. Extranodal involvement

16. A lymphoma expressing a monoclonal B-cell phenotype with coexpression of CD10 and translocation of the BCL2 gene is most likely derived from which cells?

a. Follicular center cells

b. Mantle cells

c. Marginal zone cells

d. Interfollicular cells

a. Follicular center cells

17. Lymphoblastic lymphomas are most associated with which of the following: a. Concomitant acute lymphoblastic leukemia

b. Differentiation to plasma cells

c. Clumped nuclear chromatin

d. Epstein-Barr virus genome in tumor cells

a. Concomitant acute lymphoblastic leukemia

18. Reed-Sternberg cells of classic Hodgkin lymphoma usually express which of the following immunophenotypes?

a. CD45+, CD30+, CD15+

b. CD45-, CD30+, CD15+

c. CD45+, CD30+, CD15

d. CD45-, CD30-, CD15+

b. CD45-, CD30+, CD15+

19. Which of the following is a subtype of non-Hodgkin lymphoma?

a. Nodular sclerosis

b. Acute myeloid leukemia

c. Mantle cell

d. Infectious mononucleosis

c. Mantle cell

20. Mycosis fungoides is commonly associated with which T-cell lymphoma? a. T-lymphoblastic lymphoma

b. Peripheral T-cell lymphoma

c. Primary cutaneous T-cell lymphoma d. Anaplastic large cell lymphoma

c. Primary cutaneous T-cell lymphoma

21. Which diagnostic analysis can aid most in determination of benign versus malignant lymphoma?

a. Light microscopy

b. Karyotyping

c. Immunophenotyping

d. Peripheral smear evaluation

c. Immunophenotyping

22. The diffuse aggressive lymphomas are:

a. Incurable

b. Indolent

c. Treated with surgical resection

d. Responsive to chemotherapy

d. Responsive to chemotherapy

23. Which describes an indolent prognosis of non-Hodgkin lymphoma? a. Median survival of 6 to 12 months

b. Clinically slow growing and very curable

c. Clinically slow growing, but often incurable

d. Clear therapies exist

c. Clinically slow growing, but often incurable