Hematologic Neoplasm Flashcards

*Question: What are hematologic neoplasms derived from?
A) Abnormal growth of cells of the lymphatic system
B) Abnormal growth of cells of the hematopoietic system
C) Abnormal growth of cells of the nervous system
D) Abnormal growth of cells of the gastrointestinal system

*Answer: B) Abnormal growth of cells of the hematopoietic system

*Question: Hematologic neoplasms were the first human cancers in which what was identified?
A) A consistent viral infection
B) A consistent environmental toxin
C) A consistent genetic defect
D) A consistent chromosomal deletion

*Answer: C) A consistent genetic defect

*Question: Which of the following is NOT one of the three main types of hematologic neoplasms?
A) Leukemias
B) Lymphomas
C) Carcinomas
D) Myelodysplastic syndromes

*Answer: C) Carcinomas

*Question: In 1960, Nowell and Hungerford described a shortened chromosome in patients with CML. What is this chromosome called?
A) Denver chromosome
B) Boston chromosome
C) Philadelphia chromosome
D) Chicago chromosome

*Answer: C) Philadelphia chromosome

*Question: Who reported the t(9;22) translocation in CML in 1973?
A) Nowell
B) Hungerford
C) Taub
D) Rowley

*Answer: D) Rowley

*Question: What translocation was reported by Taub and colleagues in 1982 in Burkitt lymphoma?
A) t(9;22)
B) t(8;14)
C) t(4;11)
D) t(14;18)

*Answer: B) t(8;14)

*Question: Where do leukemias originate?
A) Lymphatic system
B) Spleen
C) Bone marrow
D) Thymus

*Answer: C) Bone marrow

*Question: Lymphomas are best described as which of the following?
A) Liquid tumors of myeloid cells
B) Solid tumors of lymphoid cells
C) Precursor cell neoplasms of the bone marrow
D) Myeloid proliferations in the spleen

*Answer: B) Solid tumors of lymphoid cells

*Question: Which leukemia subtype involves a Mixed-Phenotype?
A) Lymphoma
B) Myelodysplastic syndrome
C) Leukemia
D) Myeloid proliferation

*Answer: C) Leukemia

*Question: Acute leukemia is characterized by accumulation of which type of cells?
A) Mature and maturing cells
B) Precursor hematopoietic cells
C) Plasma cells
D) Natural killer cells

*Answer: B) Precursor hematopoietic cells

*Question: What term describes the accumulation of precursor cells causing failure of maturation in acute leukemia?
A) Clonal expansion
B) Maturation arrest
C) Blast crisis
D) Dysplastic change

*Answer: B) Maturation arrest

*Question: How does chronic leukemia differ from acute leukemia in terms of WBC count?
A) WBC count is variable in chronic leukemia
B) WBC count is decreased in chronic leukemia
C) WBC count is usually elevated in chronic leukemia
D) WBC count is normal in chronic leukemia

*Answer: C) WBC count is usually elevated in chronic leukemia

*Question: What is the predominant cell type in chronic leukemia?
A) Blast cells
B) Precursor cells
C) Mature cells
D) Immature myeloid cells

*Answer: C) Mature cells

*Question: The onset of chronic leukemia is best described as:
A) Sudden
B) Explosive
C) Insidious
D) Acute

*Answer: C) Insidious

*Question: Without treatment, acute leukemia progresses in:
A) Days to weeks
B) Weeks to months
C) Months to years
D) Years to decades

*Answer: B) Weeks to months

*Question: In untreated leukemia, bleeding occurs as a result of which condition?
A) Neutropenia
B) Anemia
C) Thrombocytopenia
D) Lymphocytosis

*Answer: C) Thrombocytopenia

*Question: In untreated leukemia, fever is caused by:
A) Thrombocytopenia
B) Decreased hemoglobin
C) Neutropenia-induced infection
D) Blast cell accumulation

*Answer: C) Neutropenia-induced infection

*Question: In untreated leukemia, fatigue is caused by:
A) Thrombocytopenia
B) Neutropenia
C) Decreased hemoglobin concentration
D) Increased WBC count

*Answer: C) Decreased hemoglobin concentration

*Question: Which leukemia is most common in young children?
A) CML
B) CLL
C) ALL
D) AML

*Answer: C) ALL

*Question: Which conditions are most common in older adults?
A) ALL and AML
B) CLL and myelodysplastic syndrome
C) ALL and CML
D) AML and Burkitt lymphoma

*Answer: B) CLL and myelodysplastic syndrome

*Question: The etiology of most hematologic neoplasms is:
A) Viral
B) Hereditary
C) Mostly unknown
D) Environmental

*Answer: C) Mostly unknown

*Question: Which environmental toxin exposure leads to hematologic neoplasms?
A) Radiation and organic solvents
B) Alcohol and tobacco
C) Pesticides and heavy metals
D) Asbestos and silica

*Answer: A) Radiation and organic solvents

*Question: Alkylating agents used in chemotherapy can cause:
A) Viral infections in hematopoietic cells
B) DNA damage in hematopoietic cells
C) Telomere shortening in lymphoid cells
D) Chromosomal gain in myeloid cells

*Answer: B) DNA damage in hematopoietic cells

*Question: HTLV-1 causes leukemia/lymphoma by invading which cells?
A) B lymphocytes
B) NK cells
C) CD4+ lymphocytes
D) Monocytes

*Answer: C) CD4+ lymphocytes

*Question: What disease does HTLV-1 lead to?
A) Burkitt lymphoma
B) Classic Hodgkin lymphoma
C) Adult T cell leukemia/lymphoma
D) Non-Hodgkin B cell lymphoma

*Answer: C) Adult T cell leukemia/lymphoma

*Question: Epstein-Barr virus primarily invades which cells?
A) T lymphocytes
B) B lymphocytes
C) Neutrophils
D) Megakaryocytes

*Answer: B) B lymphocytes

*Question: EBV infection is associated with which lymphomas?
A) T cell lymphoma and CML
B) Burkitt and other non-Hodgkin lymphomas and a subset of classic Hodgkin lymphoma
C) AML and myelodysplastic syndrome
D) CLL and hairy cell leukemia

*Answer: B) Burkitt and other non-Hodgkin lymphomas and a subset of classic Hodgkin lymphoma

*Question: HIV-1 increases risk for which hematologic neoplasm?
A) AML
B) CML
C) Non-Hodgkin lymphoma
D) Hodgkin lymphoma

*Answer: C) Non-Hodgkin lymphoma

*Question: Fanconi anemia involves a mutation in which genes?
A) TP53 genes
B) ATM genes
C) FA genes needed for DNA repair
D) Telomere maintenance genes

*Answer: C) FA genes needed for DNA repair

*Question: Li-Fraumeni syndrome involves a mutation in which gene?
A) ATM
B) FA
C) RB1
D) TP53

*Answer: D) TP53

*Question: Ataxia telangiectasia involves mutations in which gene?
A) TP53
B) ATM
C) FA
D) BCL2

*Answer: B) ATM

*Question: TP53 is nicknamed the "molecular policeman" because it:
A) Activates oncogenes to promote cell division
B) Promotes cell cycle arrest and apoptosis
C) Repairs double-stranded DNA breaks
D) Inhibits viral insertion into host genomes

*Answer: B) Promotes cell cycle arrest and apoptosis

*Question: Which hereditary condition increases the risk for leukemia due to a chromosomal abnormality?
A) Fanconi anemia
B) Li-Fraumeni syndrome
C) Down Syndrome
D) Dyskeratosis congenita

*Answer: C) Down Syndrome

*Question: Dyskeratosis congenita is caused by a mutation in genes responsible for:
A) DNA repair
B) Telomere maintenance
C) Cell cycle regulation
D) Apoptosis

*Answer: B) Telomere maintenance

*Question: The FAB classification system was developed in which decades?
A) 1950s and 1960s
B) 1960s and 1970s
C) 1970s and 1980s
D) 1980s and 1990s

*Answer: C) 1970s and 1980s

*Question: The FAB classification is based largely on:
A) Molecular genetics
B) Immunophenotyping
C) Morphologic characteristics
D) Cytogenetics

*Answer: C) Morphologic characteristics

*Question: The WHO classification of hematologic neoplasms was first published in which year?
A) 1995
B) 1998
C) 2001
D) 2005

*Answer: C) 2001

*Question: The WHO classification uses all of the following EXCEPT:
A) Clinical features
B) Morphology
C) Patient age and sex
D) Cytogenetics

*Answer: C) Patient age and sex

*Question: In the FAB classification, AML M3 is described as:
A) Minimally differentiated
B) Myelomonocytic
C) Hypergranular promyelocytic
D) Without maturation

*Answer: C) Hypergranular promyelocytic

*Question: In the FAB classification, AML M7 is:
A) Erythroleukemia
B) Megakaryoblastic
C) Myelomonocytic
D) Monoblastic

*Answer: B) Megakaryoblastic

*Question: In the FAB classification of ALL, L3 is described as:
A) Small, monomorphic
B) Large, heterogeneous
C) Burkitt-cell type
D) Hypergranular type

*Answer: C) Burkitt-cell type

*Question: Which of the following is a type of mutation that dysregulates stimulatory and inhibitory pathways in hematologic neoplasms?
A) Protein folding error
B) Chromosomal rearrangement
C) Mitochondrial dysfunction
D) Ribosomal mutation

*Answer: B) Chromosomal rearrangement

*Question: Leukemogenesis is defined as:
A) The spread of leukemia to lymph nodes
B) The initiation and maintenance of leukemia
C) The maturation arrest of blast cells
D) The replacement of bone marrow by fibrous tissue

*Answer: B) The initiation and maintenance of leukemia

*Question: In leukemogenesis, a hematopoietic cell accumulates multiple independent mutations referred to as:
A) Single-hits
B) Mega-hits
C) Multi-hits
D) Super-hits

*Answer: C) Multi-hits

*Question: Which leukemia is an exception to the multi-hit rule, being caused by only one genetic mutation?
A) ALL
B) AML
C) CLL
D) CML

*Answer: D) CML

*Question: The single mutation responsible for CML is:
A) t(8;14) → MYC gene
B) t(9;22) → BCR-ABL1 genes
C) t(4;11) → MLL gene
D) t(14;18) → BCL2 gene

*Answer: B) t(9;22) → BCR-ABL1 genes

*Question: Which of the following proteins is NOT listed as a cell protein altered in hematologic neoplasms?
A) Cell cycle regulatory proteins
B) Hemoglobin synthesis proteins
C) DNA repair proteins
D) Signal transduction proteins

*Answer: B) Hemoglobin synthesis proteins

*Question: Uncontrolled proliferation in hematologic neoplasms results from mutation of:
A) DNA repair proteins
B) Nuclear transcription factors
C) Signal transduction proteins or growth factor receptors
D) Pro-apoptotic proteins

*Answer: C) Signal transduction proteins or growth factor receptors

*Question: Checkpoint control proteins function to:
A) Promote cell cycle progression
B) Arrest the cell cycle when DNA is damaged
C) Activate oncogenes during mitosis
D) Stimulate growth factor receptors

*Answer: B) Arrest the cell cycle when DNA is damaged

*Question: A block in differentiation in hematologic neoplasms results from mutation in:
A) Growth factor receptors
B) Signal transduction proteins
C) Nuclear transcription factors or aberrant epigenetic regulation
D) Checkpoint control proteins

*Answer: C) Nuclear transcription factors or aberrant epigenetic regulation

*Question: Apoptosis is essential in the hematopoietic system to:
A) Stimulate blast cell differentiation
B) Contain massive cell expansion during stress, infection, or hemorrhage
C) Activate proto-oncogenes during cell division
D) Promote chromosomal rearrangement

*Answer: B) Contain massive cell expansion during stress, infection, or hemorrhage

*Question: Persistence of leukemic stem cells with self-renewal properties is due to:
A) Overexpression of growth factor receptors
B) Mutation/deletion of proapoptotic genes
C) Constitutive activation of oncogenes
D) Hypomethylation of CpG islands

*Answer: B) Mutation/deletion of proapoptotic genes

*Question: DNA methylation prevents gene expression through:
A) Histone deacetylation
B) miRNA binding
C) Hypermethylation of CpG islands in gene promoters
D) Telomere shortening

*Answer: C) Hypermethylation of CpG islands in gene promoters

*Question: Histone deacetylases (HDACs) keep DNA chromatin in what configuration?
A) Open configuration — allowing transcription
B) Closed configuration — preventing transcription
C) Partially open — allowing limited transcription
D) Supercoiled — allowing rapid replication

*Answer: B) Closed configuration — preventing transcription

*Question: microRNAs (miRNAs) are small RNA segments of approximately how many nucleotides?
A) 10 nucleotides
B) 16 nucleotides
C) 22 nucleotides
D) 30 nucleotides

*Answer: C) 22 nucleotides

*Question: How do miRNAs inhibit gene expression?
A) By methylating CpG islands in promoters
B) By binding to targeted mRNA transcripts and blocking translation
C) By deacetylating histones
D) By directly deleting genes from chromosomes

*Answer: B) By binding to targeted mRNA transcripts and blocking translation

*Question: Oncogenes were originally identified in:
A) Bacteria
B) Tumor-forming retroviruses
C) Chromosomal translocations
D) Hereditary syndromes

*Answer: B) Tumor-forming retroviruses

*Question: Normal human cellular homologues of oncogenes are called:
A) Tumor suppressor genes
B) DNA repair genes
C) Protooncogenes
D) Checkpoint genes

*Answer: C) Protooncogenes

*Question: Protooncogenes are important in all of the following EXCEPT:
A) Signaling pathways
B) Cell proliferation
C) DNA methylation
D) Apoptosis

*Answer: C) DNA methylation

*Question: What type of mutation is associated with oncogene activation?
A) Loss-of-function mutation
B) Gain-of-function mutation
C) Silent mutation
D) Frameshift deletion

*Answer: B) Gain-of-function mutation

*Question: Oncogenes act in what genetic fashion?
A) Recessive — both alleles must be mutated
B) Co-dominant — both alleles contribute equally
C) Dominant — only one mutant allele is needed
D) X-linked — only expressed in males

*Answer: C) Dominant — only one mutant allele is needed

*Question: A qualitative mutation that activates a protooncogene involves:
A) Overexpression of a normal protein
B) Structural change to the protooncogene producing an abnormal protein product
C) Gene duplication causing excess normal protein
D) Hypomethylation causing increased transcription

*Answer: B) Structural change to the protooncogene producing an abnormal protein product

*Question: A quantitative mutation that activates a protooncogene involves:
A) Structural change producing an abnormal protein
B) Deletion of the protooncogene
C) Overexpression of a normal protooncogene
D) Inactivation of checkpoint proteins

*Answer: C) Overexpression of a normal protooncogene

*Question: The BCR-ABL1 fusion gene is formed by which translocation?
A) t(8;14)
B) t(4;11)
C) t(9;22)
D) t(14;18)

*Answer: C) t(9;22)

*Question: In B-lymphoid neoplasms, quantitative activation of protooncogenes occurs by translocation next to the promoter of:
A) Ig light chain on chromosome 2
B) Ig heavy chain (IGH) on chromosome 14
C) T cell receptor on chromosome 7
D) BCL2 gene on chromosome 18

*Answer: B) Ig heavy chain (IGH) on chromosome 14

*Question: Tumor suppressor genes protect cells from malignant transformation by:
A) Activating growth factor receptors
B) Slowing down cell division or promoting apoptosis
C) Producing oncoproteins
D) Methylating promoter regions of oncogenes

*Answer: B) Slowing down cell division or promoting apoptosis

*Question: What happens when tumor suppressor genes are inactivated or deleted?
A) They produce gain-of-function mutations
B) They promote malignant transformation
C) They activate protooncogenes
D) They increase DNA repair activity

*Answer: B) They promote malignant transformation

*Question: What type of mutation is associated with tumor suppressor genes?
A) Gain-of-function mutation
B) Dominant mutation
C) Loss-of-function mutation
D) Insertion mutation

*Answer: C) Loss-of-function mutation

*Question: Tumor suppressor genes act in what genetic fashion?
A) Dominant
B) Co-dominant
C) Recessive — deletion or inactivation of both alleles needed
D) X-linked recessive

*Answer: C) Recessive — deletion or inactivation of both alleles needed

*Question: Which of the following is NOT a mechanism for loss of tumor suppressor gene function?
A) Gene deletion
B) Inactivating mutation
C) Gene amplification
D) Epigenetic silencing

*Answer: C) Gene amplification

*Question: Which of the following are examples of tumor suppressor genes relevant to hematologic neoplasms?
A) ABL1, JAK2, BCL2
B) TP53, RB1, WT1
C) BCR, MYC, IGH
D) ATM, FA, HTLV

*Answer: B) TP53, RB1, WT1

*Question: Which of the following are examples of oncogenes relevant to hematologic neoplasms?
A) TP53, RB1, WT1
B) FA, ATM, TP53
C) ABL1, JAK2, BCL2
D) HDAC, miRNA, CpG

*Answer: C) ABL1, JAK2, BCL2

*Question: DNA repair genes in hematologic neoplasms contribute to malignant transformation through:
A) Overexpression of tumor suppressor genes
B) Genetic instability and increased mutation rates
C) Constitutive activation of oncogenes
D) Hypermethylation of protooncogenes

*Answer: B) Genetic instability and increased mutation rates

*Question: Which DNA repair gene is important for maintaining genomic stability in hematopoietic tissues?
A) TP53
B) BCL2
C) Fanconi anemia gene (FA)
D) ABL1

*Answer: C) Fanconi anemia gene (FA)

*Question: Chemotherapy is classified as phase specific when it:
A) Acts through a biochemical mechanism of action
B) Has effects on the cell cycle
C) Targets specific genetic mutations
D) Produces unstable ions that damage DNA

*Answer: B) Has effects on the cell cycle

*Question: What is the goal of the INDUCTION phase of chemotherapy?
A) Eradicate remaining cells
B) Further reduce the number of cells
C) Rapidly decrease tumor burden and achieve remission
D) Mobilize stem cells from bone marrow

*Answer: C) Rapidly decrease tumor burden and achieve remission

*Question: What is the goal of the CONSOLIDATION phase of chemotherapy?
A) Achieve initial remission
B) Further reduce the number of remaining leukemic cells
C) Eradicate all remaining cells
D) Stimulate bone marrow recovery

*Answer: B) Further reduce the number of remaining leukemic cells

*Question: What is the goal of the MAINTENANCE phase of chemotherapy?
A) Rapidly decrease tumor burden
B) Further reduce the number of cells
C) Eradicate remaining cells
D) Achieve cytogenetic remission

*Answer: C) Eradicate remaining cells

*Question: Hematologic remission is defined as:
A) Absence of the cytogenetic defect by karyotyping
B) Absence of leukemia cell nucleic acid sequences
C) Normocellular bone marrow, recovery of blood cell counts, no microscopic evidence of leukemia cells
D) Complete disappearance of all symptoms

*Answer: C) Normocellular bone marrow, recovery of blood cell counts, no microscopic evidence of leukemia cells

*Question: Cytogenetic remission is defined as:
A) Normocellular bone marrow with no leukemia cells
B) Absence of the cytogenetic defect determined by karyotyping methods
C) Absence of leukemia cell nucleic acid sequences
D) Recovery of peripheral blood cell counts

*Answer: B) Absence of the cytogenetic defect determined by karyotyping methods

*Question: Molecular remission is defined as:
A) Recovery of blood cell counts
B) Normocellular bone marrow
C) Absence of cytogenetic defect by karyotyping
D) Absence of leukemia cell nucleic acid sequences

*Answer: D) Absence of leukemia cell nucleic acid sequences

*Question: Radiation therapy kills cancer cells by:
A) Blocking signal transduction pathways
B) Producing unstable ions that damage DNA
C) Inhibiting DNA methylation
D) Activating tumor suppressor genes

*Answer: B) Producing unstable ions that damage DNA

*Question: Which of the following systems is affected during radiotherapy?
A) Cardiovascular system
B) Nervous system
C) Hematopoietic system
D) Musculoskeletal system

*Answer: C) Hematopoietic system

*Question: EPO (Erythropoietin) is used in supportive therapy to:
A) Expand mature neutrophils
B) Stimulate platelet production
C) Promote RBC formation in cancer patients with anemia
D) Mobilize stem cells from bone marrow

*Answer: C) Promote RBC formation in cancer patients with anemia

*Question: G-CSF and GM-CSF are used in supportive therapy to:
A) Promote RBC formation
B) Rapidly expand the number of mature neutrophils
C) Stimulate platelet production
D) Enhance B lymphocyte activity

*Answer: B) Rapidly expand the number of mature neutrophils

*Question: Imatinib is the first-line targeted therapy for which condition?
A) Acute lymphoblastic leukemia
B) Non-Hodgkin lymphoma
C) Chronic-phase CML
D) Myelodysplastic syndrome

*Answer: C) Chronic-phase CML

*Question: Epigenetic therapies in hematologic neoplasms work by:
A) Directly destroying malignant cells
B) Reversing epigenetic silencing of gene transcription
C) Activating oncogenes in tumor cells
D) Blocking signal transduction pathways

*Answer: B) Reversing epigenetic silencing of gene transcription

*Question: In HSCT, stem cells harvested from the posterior iliac crests under anesthesia come from which source?
A) Peripheral blood
B) Umbilical cord blood
C) Bone marrow
D) Lymph nodes

*Answer: C) Bone marrow

*Question: Peripheral blood stem cells for HSCT are harvested by which method?
A) Direct bone marrow aspiration
B) Pheresis after mobilization by cytokines and chemokines
C) Collection from umbilical vein
D) Lymph node biopsy

*Answer: B) Pheresis after mobilization by cytokines and chemokines

*Question: Umbilical cord blood (UCB) for HSCT is collected from:
A) The placenta before delivery
B) The umbilical vein after infant delivery once the cord is clamped and cut
C) The umbilical artery during cesarean section
D) Cord tissue during the third trimester

*Answer: B) The umbilical vein after infant delivery once the cord is clamped and cut

*Question: A syngeneic HSCT donor is:
A) An HLA-matched unrelated donor
B) An HLA-identical sibling
C) An identical twin
D) The patient themselves

*Answer: C) An identical twin

*Question: An allogeneic HSCT donor is:
A) The patient's own stem cells
B) An identical twin
C) An HLA-identical sibling or HLA-matched unrelated donor
D) Any willing blood type-compatible donor

*Answer: C) An HLA-identical sibling or HLA-matched unrelated donor

*Question: An autologous HSCT uses stem cells from:
A) An identical twin
B) An HLA-matched sibling
C) An unrelated matched donor
D) The patient's own marrow or peripheral blood stem cells

*Answer: D) The patient's own marrow or peripheral blood stem cells

*Question: Histone acetyltransferases keep DNA chromatin in what configuration?
A) Closed — preventing transcription
B) Open — allowing transcription to occur
C) Supercoiled — preventing replication
D) Methylated — silencing gene expression

*Answer: B) Open — allowing transcription to occur

*Question: Which of the following best describes a gain-of-function mutation in the context of hematologic neoplasms?
A) Deletion of both alleles of a tumor suppressor gene
B) Constitutive activation of an oncogene even in the presence of a normal allele
C) Inactivation of DNA repair genes
D) Epigenetic silencing of protooncogenes

*Answer: B) Constitutive activation of an oncogene even in the presence of a normal allel