WBC Textbook Q's

Which of the following inherited leukocyte disorders is caused by a mutation in the lamin B receptor?

1. Pelger-Huet Anomaly

2. Chediak-Higashi disease

3. Alder-Reilly anomaly

4. May-Hegglin anomaly

Pelger-Huet Anomaly

Which of the following inherited leukocyte disorders involves mutations in nonmuscle myosin heavy-chain IIA?

1. Pelger-Huet Anomaly

2. Chediak-Higashi disease

3. Alder-Reilly anomaly

4. May-Hegglin anomaly

May-Hegglin anomaly

Which of the following inherited leukocyte disorders might be seen in Hurler syndrome?

1. Pelger-Huet anomaly

2. Chediak-Higashi disease

3. Alder-Reilly anomaly

4. May-Hegglin anomaly

Alder-Reilly anomaly

Which of the following lysosomal storage diseases is characterized by macrophages with striated cytoplasm and storage of glucocerebroside?

1. Sanfilippo syndrome

2. Gaucher disease

3. Fabry disease

4. Niemann-Pick disease

Gaucher disease

The neutrophils in chronic granulomatous disease are incapable of producing:

1. Hydrogen peroxide

2. Hypochlorite

3. Superoxide

4. All of the above

All of the above

Individuals with X-linked SCID have a mutation that affects their ability to synthesize:

1. Deaminase

2. Oxidase

3. IL-2 receptor

4. IL-8 receptor

IL-2 receptor

An absolute lymphocytosis with reactive lymphocytes suggests which of the following conditions?

1. DiGeorge syndrome

2. Bacterial infection

3. Parasitic infection

4. Viral infection

Viral infection

What leukocyte cytoplasmic inclusion is composed of ribosomal RNA?

1. Primary granules

2. Toxic granules

3. Dohle bodies

4. Howell-Jolly bodies

Dohle bodies

The expected complete blood cell count (CBC) results for women in active labor would include:

1. High total white blood cell (WBC) count with increased lymphocytes

2. High total WBC count with a slight shift to the left in neutrophils

3. Normal WBC count with increased eosinophils

4. Low WBC count with increased monocytes

High total WBC count with a slight shift to the left in neutrophils

Which of the following is true of an absolute increase in lymphocytes with reactive morphology?

1. The population of lymphocytes appears morphologically homogenous

2. They are usually effector B cells

3. The reactive lymphocytes have increased cytoplasm with variable basophilia

4. They are most commonly seen in bacterial infections

The reactive lymphocytes have increased cytoplasm with variable basophilia

1. According to the WHO classification, except in leukemias with specific genetic anomalies, the minimal percentage of blasts necessary for a diagnosis of acute leukemia is:

   1. 10%

   2. 20%

   3. 30%

   4. 50%

20%

A 20-year-old patient has an elevated WBC count with 70% blasts, 4% neutrophils, 5% lymphocytes, and 21% monocytes in the peripheral blood. Eosinophils with dysplastic changes are seen in the bone marrow. AML with which of the following karyotypes would be most likely to be seen?

1. AML with t(8;21)(q22;q22)

2. AML with t(16;16)(p13;q22)

3. APL with PML-RARA

4. AML with t(9;11)(p22;q23)

AML with t(16;16)(p13;q22)

Which of the following would be considered a sign of potentially favorable prognosis in children with ALL?

1. Hyperdiploidy

2. Presence of CD19 and CD20

3. Absence of trisomy 8

4. Presence of BCR/ABL gene

Hyperdiploidy

Signs and symptoms of cerebral infiltration with blasts are more commonly seen in:

1. AML with recurrent cytogenetic abnormalities

2. Therapy-related myeloid neoplasms

3. AML with myelodysplasia-related changes

4. ALL

ALL

An oncology patient exhibiting signs of renal failure with seizures after initial chemotherapy may potentially develop:

1. Hyperleukocytosis

2. Tumor lysis syndrome

3. Acute leukemia secondary to chemotherapy

4. Myelodysplasia

Tumor lysis syndrome

Disseminated intravascular coagulation is more often seen in association with leukemia characterized by which of the following mutations?

1. t(12,21)(p13;q22)

2. t(9;22)(q34;q11.2)

3. inv(16)(p13;q22)

4. t(15;17)(q22;q12)

t(15;17)(q22;q12)

Which of the following leukemia affects primarily children, is characterized by an increase in monoblasts and monocytes, and often is associated with gingival and skin involvement?

1. Pre-B lymphoblastic leukemia

2. Pure erythroid leukemia

3. AML with t(9;11)(p22;q13)

4. APL with PML-RARA

AML with t(9;11)(p22;q13)

A 20-year-old patient present with fatigue, pallor, easy bruising, and swollen. Bone marrow examination reveals 82% cells with delicate chromatin and prominent nucleoli that are CD14+, CD4+, CD11b+, and CD36+.

1. Minimally differentiated leukemia

2. Leukemia of ambiguous lineage

3. Acute monoblastic/monocytic leukemia

4. Acute megakaryoblastic leukemia

Acute monoblastic/monocytic leukemia

Pure erythroid leukemia is a disorder involving:

1. Pronormoblasts only

2. Pronormoblasts and basophilic normoblasts

3. All  forms of developing RBC precursors

4. Equal number of pronormoblasts and myeloblasts

Pronormoblasts and basophilic normoblasts

A patient with normal chromosomes has a WBC count of 3.0 x 10⁹/L and dysplasia in all cell lines. There are 60% blasts of varying sizes. The blasts stain positive for CD61. The most likely type of leukemia is:

1. Acute lymphoblastic

2. Acute megakaryoblastic

3. Acute monoblastic

4. APL with PML-RARA

Acute megakaryoblastic

SBB stains which of the following component of cells?

1. Glycogen

2. Lipids

3. Structural proteins

4. Enzymes

Lipids

The cytochemical stain ɑ-napthyl butyrate is a nonspecific esterase stain that shows diffuse positivity in cells of which lineage?

1. Erythroid

2. Monocytic

3. Granulocytic

4. Lymphoid

Monocytic

A peripheral blood film that shows increased neutrophils, basophils, eosinophils, and platelets is highly suggestive of:

1. AML

2. CML

3. MDS

4. Multiple myeloma

CML

Which of the following chromosome abnormalities is associated with CML?

1. t(15;17)

2. t(8;14)

3. t(9;22)

4. Monosomy 7

t(9;22)

A patient has a WBC count of 30 x 10⁹/L and the following WBC differential:

• Segmented neutrophils – 38%

• Bands — 17%

• Metamyelocytes — 7%

• Myelocytes — 20%

• Promyelocytes — 10%

• Eosinophils — 3%

• Basophils — 5%

Which of the following test results would be helpful in determining whether the patient has CML?

1. Nitroblue tetrazolium reduction product increased

2. Myeloperoxidase increased

3. Periodic acid–Schiff staining decreased

4. FISH positive for BCR-ABL1 fusion

FISH positive for BCR-ABL1 fusion

A patient in whom CML has previously been diagnosed has circulating blasts and promyelocytes that total 30% of leukocytes. The disease is considered to be in what phase?

1. Chronic stable phase

2. Accelerated phase

3. Transformation to acute leukemia

4. Temporary remission

Transformation to acute leukemia

The most common mutation found in patients with primary PV is:

1. BCR-ABL1

2. Philadelphia chromosome

3. JAK2 V617F

4. t(15;17)

JAK2 V617F

The peripheral blood in PV typically manifests:

1. Erythrocytosis only

2. Erythrocytosis and thrombocytopenia

3. Erythrocytosis, thrombocytosis, and granulocytosis

4. Anemia and thrombocytopenia

Erythrocytosis, thrombocytosis, and granulocytosis

A patient has a platelet count of 700 x 10⁹/L with abnormalities in the size, shape, and granularity of platelets; a WBC count of 12 x 10⁹/L; and hemoglobin of 11 g/dL. The Philadelphia chromosome is not present. The most likely diagnosis is:

1. PV

2. ET

3. CML

4. Leukemoid reaction

ET

Complications of ET include all of the following except:

1. Thrombosis

2. Hemorrhage

3. Seizures

4. Infections

Infections

Which of the following patterns is characteristic of the peripheral blood in patients with PMF?

1. Teardrop-shaped erythrocytes, nucleated RBCs, immature granulocytes

2. Abnormal platelets only

3. Hypochromic erythrocytes, immature granulocytes, and normal platelets

4. Spherocytes, immature granulocytes, and increased numbers of platelets

Teardrop-shaped erythrocytes, nucleated RBCs, immature granulocytes

The myelofibrosis associated with PMF is a result of:

1. Apoptosis resistance in the fibroblasts of the bone marrow

2. Impaired production of normal collagenase by the mutated cells

3. Enhanced activity of fibroblasts as a result of increased stimulatory cytokines

4. Increased numbers of fibroblasts as a result of cytokine stimulation of the pluripotential stem cells

Enhanced activity of fibroblasts as a result of increased stimulatory cytokines

MDS are most common in which age group?

1. 2 to 10 years

2. 15 to 20 years

3. 25 to 40 years

4. Older than 50 years

Older than 50 years

What is a major indication of MDS in the peripheral blood and bone marrow?

1. Dyspoiesis

2. Leukocytosis with left shift

3. Normal bone marrow with abnormal peripheral blood features

4. Thrombocytosis

Dyspoiesis

An alert hematologist should recognize all of the following peripheral blood abnormalities as diagnostic clues in MDS EXCEPT:

1. Oval macrocytes

2. Target cells

3. Agranular neutrophils

4. Circulating micromegakaryocytes

Target cells

For an erythroid precursor to be considered a ring sideroblast, the iron-laden mitochondria must encircle how much of the nucleus?

1. One-quarter

2. One-third

3. Two-thirds

4. Entire nucleus

One-third

According to the WHO classification of MDS, what percentage of blasts would constitute transformation to an acute leukemia?

1. 5%

2. 10%

3. 20%

4. 30%

20%

A patient has anemia, oval macrocytes, and hypersegmented neutrophils. Which of the following tests would be most efficient in differential diagnosis of this disorder?

1. Serum iron and ferritin levels

2. Erythropoietin level

3. Vitamin B₁₂ and folate levels

4. Chromosome analysis

Vitamin B₁₂ and folate levels

Into what other hematologic disease does MDS often convert?

1. Megaloblastic anemia

2. Aplastic anemia

3. AML

4. Myeloproliferative disease

AML

Chronic myelomonocytic leukemia is classified in the WHO system as:

1. A myeloproliferative neoplasm

2. Myelodysplastic syndrome, unclassified

3. MDS/MPN

4. Acute leukemia

MDS/MPN

Non-Hodgkin lymphoma can be best differentiated from reactive disorders by:

1. Genetic testing

2. Immunophenotyping

3. Absolute lymphocyte count

4. Blood film review

Blood film review

Which laboratory test is most suggestive of autoimmune hemolytic anemia in a patient with CLL?

1. Direct antiglobulin test

2. Hemoglobin

3. Lymphocyte count

4. Platelet count

Lymphocyte count

What is the best test or method for determining if a clonal population of T cells is present in a specimen?

1. Molecular diagnostic testing

2. Flow cytometry for CD3, CD5, and CD7

3. Immunohistochemical stain

4. Karyotyping

Karyotyping

A rise in the lymphocyte count from 4.1 x 10⁹/L to 5.5 x 10⁹/L in a patient with monoclonal B lymphocytosis suggests:

1. Acute lymphocyte leukemia

2. Chronic lymphocytic leukemia

3. Acute myelocytic leukemia

4. A reactive condition

A reactive condition

Which test is often used to differentiate CLL from mantle cell lymphoma?

1. Annexin A staining

2. Lymph node biopsy

3. Immunohistochemistry

4. FISH for BCL2 translocation

Lymph node biopsy

If not treated, which of the following would generally be associated with the best outcome?

1. Peripheral T cell lymphoma

2. Burkitt lymphoma

3. Splenic marginal zone lymphoma

4. Sezary syndrome

Burkitt lymphoma

What do CLL and myeloma have in common?

1. Osteolytic lesions

2. Light chain restriction

3. Cell of origin

4. Immunophenotype

Light chain restriction