Heme Exam 2 - Quizzes

Quiz 3, 4

Which of the following does NOT describe a ring sideroblast?

• They consist of iron granules.

• They are stained with Prussian Blue.

• They surround at least one third of the nucleus.

• They are consistent with dysmyelopoietic changes.

They are consistent with dysmyelopoietic changes.

What are the typical laboratory findings in polycythemia vera:

• Decreased Hb/hematocrit, increased RBCs and granulocytes, decreased platelets

• Increased Hb/hematocrit, increased RBCs and granulocytes and platelets

• Normal Hb/hematocrit, normal RBCs, increased granulocytes and platelets

• Increased Hb/hematocrit, increased RBCs, decreased granulocytes and platelets

Increased Hb/hematocrit, increased RBCs and granulocytes and platelets

In myelodysplastic syndromes/neoplasms (MDS or MDN), dyserythropoiesis often leads to which of the following laboratory findings?

• Microcytic, hypochromic anemia with hypersegmented and/or hypogranular neutrophils

• Macrocytic, normochromic anemia with increased ovalocytes

• Normocytic, Normochromic anemia with progressive leukopenia

• Macrocytic, normochromic anemia with increased polychromasia (representing reticulocytes)

• All of the options are consistent with dyserythropoiesis seen in MDS or MDN

Macrocytic, normochromic anemia with increased ovalocytes

In which form of polycythemia do we see increased EPO?

• Primary Polycythemia

• Secondary Polycythemia

• Relative Polycythemia

• We never see increased EPO with any form of Polycythemia

Secondary Polycythemia

Neutrophilia accompanied by immature granulocytes and nucleated red cells is what kind of reaction?

• leukoerythroblastic

• leukemoid

• myelophthisic

• myeloproliferative

leukoerythroblastic

Which of the following would be an unexpected finding in the chronic phase of CML?

• increased eosinophils and basophils in the peripheral blood

• hypercellular bone marrow with granulopoiesis

• white blood count of 100 x 10⁹/L

• 30% blasts in the peripheral blood

30% blasts in the peripheral blood

A patient with essential thrombocythemia has mononuclear cells that have a cytoplasmic tags or cytoplasmic blebs seen in the peripheral blood. What is the most likely identification of these cells?

• myeloblasts

• megakaryocytes

• micromegakaryocytes

• plasma cells

• Giant platelets

micromegakaryocytes

According to the WHO 2022 criteria for diagnosis of Polycythemia Vera (PV), the hemoglobin value must be greater than what value for men?

• 16.5 g/dL

• 18.0 g/dL

• 20.0 g/dL

• There is NO criteria for hemoglobin values in P. vera

16.5 g/dL

Essential thrombocythemia (ET) is typically diagnosed based on which combination of factors?

• Elevated platelet count, bone marrow biopsy findings, and exclusion of secondary causes

• Elevated hemoglobin, low platelet count, and cytogenetic abnormalities (e.g., JAK2 mutation)

• Elevated white blood cell count, splenomegaly, and anemia

• Megakaryocyte hyperplasia, elevated reticulocyte count, normal platelet count, and high plasma uric acid

Elevated platelet count, bone marrow biopsy findings, and exclusion of secondary causes

Which of the following is a function of the TP53 tumor suppressor gene?

• Promote cell proliferation

• Induce apoptosis and DNA repair

• Prevent cellular differentiation

• Stimulate angiogenesis

Induce apoptosis and DNA repair

Assuming that controls are within acceptable limits, a low leukocyte alkaline phosphatase (LAP) score (e.g., less than 10) would be consistent with a diagnosis of:

• Normal

• Chronic myelogenous leukemia

• Hairy cell leukemia

• Leukemoid reaction

Chronic myelogenous leukemia

What is the safest and least expensive treatment associated with a low risk for transformation to acute leukemia in patients with polycythemia vera:

• Myelosuppressive therapy

• Iron supplementation

• Therapeutic phlebotomy

• Recombinant EPO

Therapeutic phlebotomy

What are the most common life-threatening complications after chemotherapy?

• bacterial infection and bleeding

• heart attack and stroke

• anemia and gastrointestinal symptoms

• renal and liver failure

bacterial infection and bleeding

What are the important features of primary myelofibrosis?

• Leukoerythroblastosis, teardrop cells, extramedullary hematopoiesis

• Positive TRAP stain, interstitial bone marrow, fibrosis

• Toxic granulation, vacuolization, and Dohle bodies

• CD25 and CD103 positivity, pancytopenia, ring sideroblasts

Leukoerythroblastosis, teardrop cells, extramedullary hematopoiesis

As the neoplastic cell population in the bone marrow ______1________, the concentration of normal cells in the bone marrow _________2____________, causing inevitable ______3_________ in normal peripheral blood cells

• (1) decreases, (2) decreases, (3) polycythemias

• (1) increases, (2) increases, (3) polycythemias

• (1) decreases, (2) increases, (3) cytopenias

• (1) increases, (2) decreases, (3) cytopenias

(1) increases, (2) decreases, (3) cytopenias

What is a common cause of relative polycythemia?

• Dehydration

• Chronic pulmonary disease

• Stem cell disorders

• JAK2 mutations

Dehydration

A myeloperoxidase stain is performed on peripheral blood cells of a patient with acute leukemia and 85% blasts; the patient has an occasional mature neutrophil. When the stained slide is evaluated, the blasts are all negative but the mature neutrophils are strongly positive. What is the significance of this finding?

• the stain worked (internal positive control), the blasts are negative for MPO

• nothing until a negative control is also examined

• nothing, because mature neutrophils are always positive

• nothing, because only examination of the blasts is useful

the stain worked (internal positive control), the blasts are negative for MPO

Which of the following best describes Myelodysplastic Syndromes (MDN/MDS):

• Normal cells in a hypocellular bone marrow, with normal platelets 

• Dysplastic cells in a hypercellular bone marrow, often seen with cytopenias from ineffective hematopoiesis 

• Complete absence of RBC production (erythropoiesis) leading to a decrease in blood production

• Neoplastic cell is the megakaryocyte

Dysplastic cells in a hypercellular bone marrow, often seen with cytopenias from ineffective hematopoiesis

Which of the following is a typical feature of chronic leukemia compared to acute leukemia?

• Rapid progression with severe symptoms

• Gradual onset with fewer symptoms

• Accumulation of malignant blasts in the bone marrow

• Frequent occurrence in children

Gradual onset with fewer symptoms

What percentage of blasts is usually required to be considered an Acute Leukemia (WHO criteria)?

• ≥ 20%

• ≥ 30%

• ≥ 15%

• ≥ 10%

• All of the answers are consistent with an acute leukemia

≥ 20%

An elderly patient presents with a macrocytic anemia and hypersegmented neutrophils seen on a peripheral blood smear. The best course of action in this patient is:

• Order a bone marrow aspirate and biopsy as the patient may have MDN

• Treat the patient with iron supplements to resolve the anemia

• Rule in or rule out a deficiency in B12 or folate

• Treat the patient with granulocyte colony stimulating factor (G-CSF)

Rule in or rule out a deficiency in B12 or folate

Which targeted therapy is commonly used in the treatment of chronic myeloid leukemia (CML)?

• Hematopoietic stem cell transplant (HSCT)

• Imatinib (Gleevec)

• Chemotherapy and radiation

• Lenalidomide

• Transfusions and prophylactic antibiotics

Imatinib (Gleevec)

Which of the following cytogenetic abnormalities are most often seen in MDS?

• chromosomal translocations

• chromosomal deletions

• chromosomal inversions

• trisomy (chromosomal addition)

• chromosomal abnormalities are not frequently seen in MDS or MDN

chromosomal deletions

The formation of a new fusion gene in CML is called the:

• bcr-abl gene

• tyrosine kinase inhibitor (TKI) gene

• gleevec gene

• blasts crisis gene

• MPN gene

bcr-abl gene

Which of the following is a common finding in the blood smear of a patient with chronic myeloid leukemia (CML)?

• Numerous malignant myeloblasts

• Presence of increased basophils and eosinophils

• Decreased white blood cell count and increased risk of infection

• Frequent occurrence in children

• Presence of toxic changes in the granulocytes and granulocyte precursor

Presence of increased basophils and eosinophils

A patient has a platelet count of 1200 x 109/L. Many platelets are giant and have abnormal shapes. A mild anemia is present. The bone marrow has increased megakaryocytes in clusters; iron stores are present. Which of the following is most likely?

• essential thrombocythemia

• chronic myeloid leukemia

• thrombocytosis secondary to blood loss

• polycythemia vera (PV)

essential thrombocythemia

If a patient with a lymphoid malignancy has a starry sky appearance on lymph node biopsy and is BCL2 negative, which lymphoma is most likely?

• Mantle cell lymphoma

• Burkitt lymphoma

• Follicular lymphoma

• Hodgkin lymphoma

Burkitt lymphoma

A 27-year-old woman presents with acute bleeding to the emergency department and is found to have a white count of 25.7 x 109L, hematocrit 27%, platelet count 35 x 109/L, and absolute neutrophil count 0.8 x 109/L. She has a combination of 97% blasts and abnormal promyelocytes in her peripheral blood; some of these cells contain stacked Auer rods (“faggot cells”). What form of leukemia does she most likely have?

• acute myeloid with t(15;17)(q22:q12)

• chronic myeloid leukemia with t(9;22)

• acute monoblastic leukemia

• acute myeloid with t(8;21)(q33:q22)

acute myeloid with t(15;17)(q22:q12)

In performing surface marker analysis for FAB classification M4 and M5, monoclonal antibodies specific for __________ cells would be detected by flow cytometry.

• Lymphoid

• Monocytic

• Erythroid

• None of the answers are correct

Monocytic

A child has a homogeneous population of blasts in the peripheral blood that have scant (i.e., very little) blue cytoplasm. They are cytoplasmic µ (mu) positive and CD34 positive, and TdT negative. Which form of acute lymphoid leukemia (ALL) is most likely?

• Intermediate B cell ALL

• T cell ALL

• Pre B cell ALL

• Pro (Early) B cell ALL

Pre B cell ALL

Blasts infiltration of extra marrow sites and meningeal involvement is more commonly seen in:

• AML with recurrent cytogenetic abnormalities

• B-cell ALL

• AML with MDS

• T- cell ALL

T- cell ALL

Which AML chromosome mutation is associated with extramedullary hematopoiesis in the gums?

• t(8:21)

• inv(16)

• t(15:17)

• del(13q14)

inv(16)

Which of the following is true regarding the symptoms of acute leukemia?

• Lymphadenopathy is found more often in myeloid than lymphoid

• Central nervous system involvement is the most common presenting symptom

• Most symptoms are related to abnormal cell counts

• Bone pain results from fractures related to calcium loss

Most symptoms are related to abnormal cell counts

A 4-year-old boy has a 15.0 x 10³/μL WBC with increased immature cells in the bone marrow. Cytochemical studies for myeloperoxidase and non-specific esterase are negative and TdT is positive. CD 34 and CD 10 are positive, and cytoplasmic µ is negative.  What is the diagnosis?

• Pre B-cell ALL

• Pro (Early) B-cell ALL

• AML

• Intermediate B cell ALL

• T cell ALL

Intermediate B cell ALL

In what condition would you most likely see an increase in smudge cells (or "basket cells") when looking at a peripheral blood smear?

• AML 

• CLL

• CML

• ALL

CLL

A negative reaction with myeloperoxidase (MPO) would favor a diagnosis of:

• AML with maturation (AML – M2)

• Acute promyelocytic leukemia (AML – M3)

• Acute myelocytic leukemia, without maturation (AML – M1)

• Acute myeloid leukemia, minimally differentiated (AML – M0)

Acute myeloid leukemia, minimally differentiated (AML – M0)

What is the most common leukemia in children between the ages of 2 and 10 years?

• acute myeloid

• acute monocytic

• acute myelomonocytic

• acute lymphoid

acute lymphoid

What leukemia is most likely in a patient whose bone marrow is composed of predominantly large, multinucleated, dysplastic erythroid precursors?

• acute promyelocytic leukemia (AML – M3)

• acute megakaryocytic leukemia (AML – M7)

• acute erythroleukemia (AML – M6)

• acute myeloid leukemia, minimally differentiated (AML – M0)

acute erythroleukemia (AML – M6)

A 15-year-old male presents complaining of severe headaches; he has a white count of 76.0 x 109/L, platelet count of 55 x 109/L, and a hematocrit of 33%. When a white cell differential is performed, most of the nucleated cells are blasts. They are CD2, CD4, and CD8 positive. What is the most likely diagnosis?

• immature B cell acute lymphoid leukemia

• T cell acute lymphoid leukemia

• acute myeloid leukemia without maturation

• acute myeloid leukemia with maturation

T cell acute lymphoid leukemia

Which of the following is characterized by an increase in monoblasts/monocytes and often is associated with gingival and skin involvement?

• AML with t(9;11)

• B-cell ALL

• AML with MDS

• pure erythroid leukemia

AML with t(9;11)

What is one of the best therapeutic choices for treatment/cure in most patients with AML?

• Stem cell transplantation

• Chemotherapy

• Radiation therapy

• Surgery

Stem cell transplantation

A patient has a very high white blood count with many blasts in the blood and bone marrow. Esterase stains using both naphthol AS-D chloroacetate and alpha-naphthyl acetate esterase as substrates are positive. What condition is likely?

• chronic myeloid leukemia

• acute lymphoid leukemia

• acute myelomonocytic leukemia

• chronic myelomonocytic leukemia

acute myelomonocytic leukemia

Why is Burkitt lymphoma such an aggressive malignancy?

• Cells readily metastasize to bone marrow.

• Cells have a high proliferative rate.

• Cells fail to mature to functional immunophenotype.

• Cells destroy red cells.

Cells have a high proliferative rate.

A CBC performed on a 75 year old reveals a lymphocytosis. A bone marrow examination reveals replacement of the normal hematopoietic cells with mature lymphocytes. Which of the following is the most likely course of the disease?

• Cure following chemotherapy

• Rapid, aggressive progression

• Slow progression

• Spontaneous remission

Slow progression

50 – 90% myeloblasts in a peripheral blood is typical of which of the following:

• CML

• t(15;17)

• t(8;14)

• t(8;21)

t(8;21)

Circulating micromegakaryocytes are more frequently found in which of the following acute leukemias:

• T - cell ALL

• AML without maturation

• Acute monoblastic leukemia

• Acute megakaryocytic leukemia

Acute megakaryocytic leukemia

A bone marrow from a 70-year-old patient reveals 82% blast cells that are CD14, CD4, CD11b, CD36, CD64, and CD68 positive and negative for the recurrent t(9;11) genetic abnormality. Which of the following is most likely?

• undifferentiated leukemia

• leukemia of ambiguous lineage

• acute monoblastic leukemia

• acute megakaryocytic leukemia

acute monoblastic leukemia

The diagnosis of lymphoma relies most heavily on all of the following EXCEPT:

• microscopic examination of affected lymph node

• immunophenotyping or flow cytometry

• cytogenetic analysis

• peripheral blood findings in a CBC

peripheral blood findings in a CBC

Acute leukemias primarily affect:

• children, progress rapidly, have mature cells in the peripheral blood

• all ages, progress rapidly, have immature cells in the peripheral blood

• young adults, progress slowly, have immature cells in the peripheral blood

• adults, progress slowly, have mature cells in the peripheral blood

all ages, progress rapidly, have immature cells in the peripheral blood

Which of the following indicates a favorable prognosis in acute lymphoid leukemia (ALL)?

• presence of Philadelphia chromosome

• low white count at diagnosis

• patient over 45 years old

• T cell immunophenotype

low white count at diagnosis

The most useful classification system for acute lymphoid leukemia (ALL) is based on:

• immunophenotyping

• morphology

• periodic acid Schiff staining.

• Sudan Black B staining.

immunophenotyping

A common presenting characteristic of ALL is:

• bone and joint pain from infiltration of the leukemic cells

• increased blasts with Auer rods

• a markedly increased platelet count

• that it often affects individuals > 60 years

bone and joint pain from infiltration of the leukemic cells