Acute Leukemia Flashcards

*Question: What is the peak incidence age for Acute Lymphoblastic Leukemia (ALL)?
A) 6 months to 1 year
B) 2–5 years old
C) 10–15 years old
D) 20–30 years old

*Answer: B) 2–5 years old

*Question: Which classification system for acute leukemia was devised in the 1970s based on morphology and cytochemical stains?
A) WHO Classification
B) EGIL Classification
C) French-American-British (FAB) Classification
D) REAL Classification

*Answer: C) French-American-British (FAB) Classification

*Question: According to WHO classification, what minimum percentage of blasts in the bone marrow is required for diagnosis of most acute leukemias?
A) 5%
B) 10%
C) 15%
D) 20%

*Answer: D) 20%

*Question: Which laboratory test for acute leukemia assesses the pattern of expression of surface and cytoplasmic antigens on immature blood cell populations?
A) Cytogenetics
B) Molecular diagnostics
C) Immunophenotyping by flow cytometry
D) Bone marrow examination

*Answer: C) Immunophenotyping by flow cytometry

*Question: Which of the following is the most reliable indicator of a cell's origin in ALL?
A) Cytochemical staining
B) Immunophenotyping
C) Morphologic examination
D) Cytogenetics

*Answer: B) Immunophenotyping

*Question: Lymphoblasts in ALL have which of the following morphologic characteristics?
A) Moderate gray cytoplasm and prominent nucleoli
B) Scant blue cytoplasm and indistinct nucleoli
C) Abundant cytoplasm with Auer rods
D) Bilobed nucleus with large granules

*Answer: B) Scant blue cytoplasm and indistinct nucleoli

*Question: What is the size of small lymphoblasts relative to a normal lymphocyte?
A) Same size as a normal lymphocyte
B) 1.0 to 2.5 times the size of a normal lymphocyte
C) 2 to 3 times the size of a normal lymphocyte
D) 3 to 5 times the size of a normal lymphocyte

*Answer: B) 1.0 to 2.5 times the size of a normal lymphocyte

*Question: Large lymphoblasts in ALL can be confused with blasts of which condition?
A) Chronic Myeloid Leukemia
B) Multiple Myeloma
C) Acute Myeloid Leukemia
D) Myelodysplastic Syndrome

*Answer: C) Acute Myeloid Leukemia

*Question: Which clinical feature is characteristic of B-cell ALL but NOT T-cell ALL?
A) Anemia and thrombocytopenia
B) Large mediastinal mass
C) Lymphoblasts found in the CSF
D) Bone pain

*Answer: C) Lymphoblasts found in the CSF

*Question: Which clinical feature is characteristic of T-cell ALL?
A) Decreased neutrophil count
B) Lymphoblasts in CSF
C) Large mass in the mediastinum
D) Mucocutaneous bleeding

*Answer: C) Large mass in the mediastinum

*Question: Which chromosomal translocation in B-ALL is associated with the WORST prognosis?
A) t(12;21); ETV6-RUNX1
B) t(9;22); BCR-ABL1
C) t(1;19); TCF3-PBX1
D) t(5;14); IGH/IL3

*Answer: B) t(9;22); BCR-ABL1

*Question: Philadelphia chromosome-positive ALL is more common in which age group?
A) Infants
B) Children aged 2–5
C) Adolescents
D) Adults

*Answer: D) Adults

*Question: KMT2A rearrangement in ALL is most common in which population?
A) Elderly adults
B) Very young infants; may occur in utero
C) Adolescents
D) Adults over 50

*Answer: B) Very young infants; may occur in utero

*Question: Hyperploidy in B-ALL carries which prognosis?
A) Very poor prognosis
B) Intermediate prognosis
C) Very favorable prognosis in children
D) Dismal prognosis

*Answer: C) Very favorable prognosis in children

*Question: Which genetic mutation is characteristic of T-ALL?
A) BCR-ABL1 fusion
B) ETV6-RUNX1 fusion
C) GAIN-OF-FUNCTION mutations in NOTCH1 gene
D) KMT2A rearrangement

*Answer: C) GAIN-OF-FUNCTION mutations in NOTCH1 gene

*Question: The NOTCH1 mutation in T-ALL affects which process?
A) B cell differentiation
B) Normal T cell development via Notch receptor signaling pathway
C) Erythropoiesis
D) Megakaryocyte maturation

*Answer: B) Normal T cell development via Notch receptor signaling pathway

*Question: Which immunophenotype is associated with Intermediate (common) B-ALL?
A) CD34, CD19, cytoplasmic CD22, TdT
B) CD34, CD19, CD10, cytoplasmic CD22, TdT
C) CD2, CD3, CD4, CD5, CD7, CD8, TdT
D) CD34, CD19, cytoplasmic µ, TdT

*Answer: B) CD34, CD19, CD10, cytoplasmic CD22, TdT

*Question: Which immunophenotype is associated with T-ALL?
A) CD34, CD19, cytoplasmic CD22, TdT
B) CD34, CD10, CD19, TdT
C) CD2, CD3, CD4, CD5, CD7, CD8, TdT
D) CD34, CD33, CD13, CD117

*Answer: C) CD2, CD3, CD4, CD5, CD7, CD8, TdT

*Question: TdT stands for which enzyme used as a lymphoid precursor marker?
A) Thymidine diphosphate transferase
B) Terminal deoxynucleotidyl transferase
C) Thymidine deoxynucleotide transferase
D) T-cell deoxynucleotide transporter

*Answer: B) Terminal deoxynucleotidyl transferase

*Question: Which of the following B-ALL subtypes has a VERY FAVORABLE prognosis according to 2022 WHO classification?
A) BCR::ABL1 fusion
B) KMT2A rearrangement
C) ETV6::RUNX1 fusion
D) TCF3::HLF fusion

*Answer: C) ETV6::RUNX1 fusion

*Question: Which B-ALL subtype carries a DISMAL prognosis?
A) ETV6::RUNX1 fusion
B) TCF3::PBX1 fusion
C) High hyperdiploidy
D) TCF3::HLF fusion

*Answer: D) TCF3::HLF fusion

*Question: In ALL, chromosomal translocations are considered the strongest predictor of which outcome?
A) Favorable treatment response
B) Adverse treatment outcomes
C) Complete remission
D) Central nervous system involvement

*Answer: B) Adverse treatment outcomes

*Question: Peripheral blood lymphoblast counts exceeding what level indicate worst outcomes in ALL?
A) 5–10 × 10⁹/L
B) 10–15 × 10⁹/L
C) 20–30 × 10⁹/L
D) 50–60 × 10⁹/L

*Answer: C) 20–30 × 10⁹/L

*Question: AML is most common in which population?
A) Infants
B) Children aged 2–10
C) Adults; incidence increases with age
D) Adolescents

*Answer: C) Adults; incidence increases with age

*Question: Which classification system for AML uses molecular characterization and cytogenetics?
A) FAB Classification
B) REAL Classification
C) WHO Classification
D) Rappaport Classification

*Answer: C) WHO Classification

*Question: Which FAB subtype of AML is Acute Promyelocytic Leukemia?
A) M1
B) M2
C) M3
D) M4

*Answer: C) M3

*Question: Which FAB subtype of AML is Acute Myelomonocytic Leukemia?
A) M3
B) M4
C) M5
D) M6

*Answer: B) M4

*Question: Which FAB subtype of AML represents Acute Erythroleukemia?
A) M4
B) M5
C) M6
D) M7

*Answer: C) M6

*Question: Which FAB subtype of AML is Acute Megakaryoblastic Leukemia?
A) M5b
B) M6
C) M7
D) M0

*Answer: C) M7

*Question: The WBC count in AML typically ranges between which values?
A) 1–50 × 10⁹/L
B) 5–30 × 10⁹/L (range 1–200 × 10⁹/L)
C) 10–40 × 10⁹/L
D) 20–60 × 10⁹/L

*Answer: B) 5–30 × 10⁹/L (range 1–200 × 10⁹/L)

*Question: Myeloblasts are present in what percentage of AML patients?
A) 50%
B) 70%
C) 80%
D) 90%

*Answer: D) 90%

*Question: Which of the following is NOT a typical laboratory abnormality seen in AML clinical presentation?
A) Hyperuricemia
B) Hyperphosphatemia
C) Hypercalcemia
D) Hypokalemia

*Answer: C) Hypercalcemia

*Question: Tumor lysis syndrome in AML is caused by what mechanism?
A) Autoimmune destruction of normal cells
B) Breakdown products of dying cancer cells
C) Overproduction of clotting factors
D) Release of lymphokines from T cells

*Answer: B) Breakdown products of dying cancer cells

*Question: Which electrolyte abnormality in tumor lysis syndrome is described as LIFE-THREATENING?
A) Hypocalcemia
B) Hyperphosphatemia
C) Hyperkalemia
D) Hyperuricemia

*Answer: C) Hyperkalemia

*Question: Which AML genetic abnormality is associated with FAVORABLE prognosis?
A) BCR::ABL1 fusion
B) MECOM rearrangements
C) RUNX1::RUNX1T1 fusion
D) DEK::NUP214 fusion

*Answer: C) RUNX1::RUNX1T1 fusion

*Question: Which AML genetic abnormality is associated with ADVERSE prognosis?
A) NPM1 mutation
B) CEBPA mutation
C) CBFB::MYH11 fusion
D) MECOM rearrangements and TP53

*Answer: D) MECOM rearrangements and TP53

*Question: AML with t(8;21) represents what percentage of all AML cases?
A) 1–5%
B) 5–8%
C) 10–15%
D) 20–25%

*Answer: A) 1–5%

*Question: AML with t(8;21) involves which gene fusion?
A) PML-RARA
B) CBFB-MYH11
C) RUNX1/RUNX1T1
D) KMT2A::MLLT3

*Answer: C) RUNX1/RUNX1T1

*Question: Morphology of AML with t(8;21) includes which distinctive feature?
A) Flower cells
B) Chediak-Higashi-like granules and single Auer rods
C) Reed-Sternberg cells
D) Pelgeroid neutrophils only

*Answer: B) Chediak-Higashi-like granules and single Auer rods

*Question: What neutrophil abnormality is associated with AML with t(8;21)?
A) Hypersegmentation
B) Toxic granulation
C) Pseudo-Pelger-Huët cells and hypogranulation
D) Döhle bodies

*Answer: C) Pseudo-Pelger-Huët cells and hypogranulation

*Question: APL (Acute Promyelocytic Leukemia) accounts for what percentage of AML cases?
A) 1–3%
B) 5–8%
C) 10–15%
D) 20–25%

*Answer: B) 5–8%

*Question: APL is associated with which chromosomal translocation?
A) t(8;21)
B) t(9;22)
C) t(15;17)
D) inv(16)

*Answer: C) t(15;17)

*Question: In APL, the t(15;17) translocation involves which gene fusion?
A) CBFB-MYH11
B) RUNX1/RUNX1T1
C) KMT2A::MLLT3
D) PML-RARA

*Answer: D) PML-RARA

*Question: In APL, t(15;17) detection is sufficient for diagnosis regardless of what?
A) Patient's age
B) Blast count
C) WBC count
D) Platelet count

*Answer: B) Blast count

*Question: In APL, the release of primary granule contents from promyelocytes initiates which dangerous complication?
A) Tumor lysis syndrome
B) Disseminated Intravascular Coagulation (DIC)
C) Hyperleukocytosis
D) Aplastic crisis

*Answer: B) Disseminated Intravascular Coagulation (DIC)

*Question: Which treatment is specifically used for APL?
A) Rituximab and cyclophosphamide
B) All-trans retinoic acid (ATRA) and arsenic trioxide
C) Imatinib and dasatinib
D) Methotrexate and vincristine

*Answer: B) All-trans retinoic acid (ATRA) and arsenic trioxide

*Question: Variant RARA translocations in APL have what treatment implication?
A) They respond well to ATRA therapy
B) They require higher doses of arsenic trioxide
C) They do NOT respond to ATRA therapy
D) They require bone marrow transplant only

*Answer: C) They do NOT respond to ATRA therapy

*Question: The microgranular variant of APL accounts for what percentage of APL cases?
A) 5–10%
B) 15–20%
C) 30–40%
D) 50–60%

*Answer: C) 30–40%

*Question: The microgranular variant of APL is characterized by which nuclear feature?
A) Hypersegmented nucleus
B) "Butterfly" or "coin-on-coin" nucleus
C) Bilobed nucleus
D) Ring-shaped nucleus

*Answer: B) "Butterfly" or "coin-on-coin" nucleus

*Question: AML with KMT2A::MLLT3 is the most common rearrangement in which population?
A) Infants
B) Children
C) Adults
D) Elderly patients

*Answer: C) Adults

*Question: AML with t(9;11); KMT2A::MLLT3 characteristically involves which extramedullary sites?
A) Spleen and liver
B) Gingiva and skin
C) Testes and ovaries
D) Lungs and kidneys

*Answer: B) Gingiva and skin

*Question: Morphology of AML with t(9;11) shows which features?
A) Hypergranular promyelocytes
B) Large blasts with abundant cytoplasm, fine nuclear chromatin, and pseudopodia
C) Small blasts with scant cytoplasm and coarse chromatin
D) Ringed sideroblasts and dysplastic erythrocytes

*Answer: B) Large blasts with abundant cytoplasm, fine nuclear chromatin, and pseudopodia

*Question: AML with inv(16) is associated with which unique morphologic finding?
A) Hypergranular promyelocytes with Auer rods
B) Marrow eosinophilia with abnormal eosinophils showing large dark-purple granules
C) Ringed sideroblasts with erythroid dysplasia
D) Megakaryoblasts with cytoplasmic blebs

*Answer: B) Marrow eosinophilia with abnormal eosinophils showing large dark-purple granules

*Question: AML with inv(16) demonstrates which type of differentiation?
A) Purely granulocytic
B) Purely monocytic
C) Myelomonocytic differentiation
D) Erythroid differentiation

*Answer: C) Myelomonocytic differentiation

*Question: What is the remission rate for AML with inv(16)?
A) 10–20% of patients are cured
B) 30–40% of patients are cured
C) About half (½) of patients are cured
D) Nearly all patients are cured

*Answer: C) About half (½) of patients are cured

*Question: Which site is the most common site of relapse in AML with inv(16)?
A) Bone marrow
B) Liver
C) Central nervous system (CNS)
D) Spleen

*Answer: C) Central nervous system (CNS)

*Question: AML with Myelodysplasia-Related Changes predominantly affects which population?
A) Infants
B) Children
C) Adolescents
D) Older adults with poor prognosis

*Answer: D) Older adults with poor prognosis

*Question: Which of the following is a dysplastic feature of erythrocyte precursors in AML with Myelodysplasia-Related Changes?
A) Hypersegmentation
B) Vacuoles, karyorrhexis, megaloblastoid features, ring sideroblasts
C) Toxic granulation
D) Pseudo-Pelger-Huët anomaly

*Answer: B) Vacuoles, karyorrhexis, megaloblastoid features, ring sideroblasts

*Question: AML with minimal differentiation (M0) is positive for which markers?
A) CD14, CD64, CD11b
B) CD13, CD33, CD34, CD117
C) CD19, CD10, CD22, TdT
D) CD2, CD3, CD7, CD5

*Answer: B) CD13, CD33, CD34, CD117

*Question: AML with minimal differentiation (M0) is NEGATIVE for which cytochemical stains?
A) PAS and TdT
B) Myeloperoxidase and Sudan Black B
C) Nonspecific esterase and specific esterase
D) Naphthol AS-D chloroacetate and alpha-naphthyl butyrate

*Answer: B) Myeloperoxidase and Sudan Black B

*Question: In AML without maturation (M1), what percentage of nonerythroid cells in the bone marrow are blasts?
A) 20%
B) 50%
C) 75%
D) 90%

*Answer: D) 90%

*Question: In AML without maturation (M1), what percentage of blasts show positive results for myeloperoxidase or Sudan Black B?
A) 1%
B) 3%
C) 5%
D) 10%

*Answer: B) 3%

*Question: AML with maturation (M2) requires what minimum percentage of maturing cells of neutrophil lineage?
A) 5%
B) 10%
C) 20%
D) 30%

*Answer: B) 10%

*Question: Which AML subtype is characterized by the presence of Auer rods along with >20% blasts and ≥10% maturing neutrophil lineage cells?
A) M0
B) M1
C) M2 (AML with maturation)
D) M3

*Answer: C) M2 (AML with maturation)

*Question: Acute Myelomonocytic Leukemia (M4) requires that what percentage of marrow cells be monocytic?
A) 5%
B) 10%
C) 20%
D) 30%

*Answer: C) 20%

*Question: In acute myelomonocytic leukemia (M4), monoblasts show which morphologic features?
A) Scant cytoplasm and indistinct nucleoli
B) Granules and pseudopodia
C) Bilobed nuclei with coarse chromatin
D) Hypersegmented nuclei

*Answer: B) Granules and pseudopodia

*Question: Which monocytic antigens are positive in Acute Myelomonocytic Leukemia (M4)?
A) CD13 and CD33
B) CD34 and CD117
C) CD14, CD4, CD11b, CD11c, and CD64
D) CD19, CD10, and CD22

*Answer: C) CD14, CD4, CD11b, CD11c, and CD64

*Question: Acute Monoblastic and Monocytic Leukemia (M5) requires that more than what percentage of marrow cells be of monocytic origin?
A) 20%
B) 50%
C) 80%
D) 90%

*Answer: C) 80%

*Question: In Acute Monoblastic and Monocytic Leukemia (M5), promonocytes are considered what in blast counting?
A) Not counted
B) Blast equivalents
C) Mature cells
D) Dysplastic cells only

*Answer: B) Blast equivalents

*Question: Acute Monoblastic and Monocytic Leukemia (M5) occurs predominantly in which population?
A) Elderly adults
B) Infants
C) Younger individuals; fewer than 5% of cases
D) Adolescents

*Answer: C) Younger individuals; fewer than 5% of cases

*Question: Extramedullary involvement in Acute Monocytic Leukemia (M5) typically affects which sites?
A) CNS and spleen
B) Liver and kidneys
C) Cutaneous and gingival infiltration with bleeding disorders
D) Lungs and lymph nodes

*Answer: C) Cutaneous and gingival infiltration with bleeding disorders

*Question: Pure Erythroid Leukemia (M6) requires what minimum percentage of erythroid cells in the bone marrow?
A) 30%
B) 50%
C) 60%
D) 80%

*Answer: D) 80%

*Question: Pure Erythroid Leukemia (M6) requires what minimum percentage of proerythroblasts?
A) 10%
B) 20%
C) 30%
D) 50%

*Answer: C) 30%

*Question: Which chromosomes are frequently affected in Pure Erythroid Leukemia (M6)?
A) Chromosomes 1 and 2
B) Chromosomes 5 and 7
C) Chromosomes 9 and 22
D) Chromosomes 15 and 17

*Answer: B) Chromosomes 5 and 7

*Question: Which tumor suppressor gene shows biallelic loss in Pure Erythroid Leukemia (M6)?
A) BRCA1
B) RB1
C) TP53
D) APC

*Answer: C) TP53

*Question: Which inclusions are characteristically found in Pure Erythroid Leukemia (M6)?
A) Auer rods and Döhle bodies
B) Ring sideroblasts and Howell-Jolly bodies
C) Toxic granules and vacuoles
D) Chédiak-Higashi granules

*Answer: B) Ring sideroblasts and Howell-Jolly bodies

*Question: Acute Megakaryoblastic Leukemia (M7) diagnosis requires at least what percentage of blasts of megakaryocyte origin?
A) 20%
B) 30%
C) 40%
D) 50%

*Answer: D) 50%

*Question: Which markers are used for immunostaining to confirm megakaryoblasts in M7?
A) CD13, CD33, CD34
B) CD19, CD10, CD22
C) CD41 (glycoprotein IIb), CD42b (glycoprotein Ib), CD61 (glycoprotein IIIa)
D) CD14, CD64, CD11b

*Answer: C) CD41 (glycoprotein IIb), CD42b (glycoprotein Ib), CD61 (glycoprotein IIIa)

*Question: Immature megakaryoblasts in M7 characteristically show which cytoplasmic feature?
A) Auer rods
B) Toxic granulation
C) Light blue cytoplasmic blebs
D) Dark purple granules

*Answer: C) Light blue cytoplasmic blebs

*Question: Myeloid Sarcoma is defined as extramedullary proliferation of blasts of which origin?
A) Lymphoid lineage
B) One or more myeloid lineages
C) Plasmacytoid dendritic cells
D) Natural killer cells

*Answer: B) One or more myeloid lineages

*Question: Which tissues are characteristically affected by Myeloid Sarcoma?
A) Liver, spleen, and kidneys
B) Skin, gastrointestinal tract, and lymph nodes
C) Lungs, heart, and brain
D) Testes, ovaries, and adrenal glands

*Answer: B) Skin, gastrointestinal tract, and lymph nodes

*Question: Myeloid neoplasm post cytotoxic therapy (MN-pCT) arises within how many years of the last treatment?
A) 2 years
B) 5 years
C) 10 years
D) 15 years

*Answer: C) 10 years

*Question: Myeloid leukemia associated with Down Syndrome involves mutations in which gene?
A) BCR-ABL1
B) TP53
C) GATA1 (exon 2 or 3)
D) NOTCH1

*Answer: C) GATA1 (exon 2 or 3)

*Question: Blastic Plasmacytoid Dendritic Cell Neoplasm is derived from precursors of which cell type?
A) Natural killer cells
B) Plasmacytoid dendritic cells
C) Mast cells
D) Basophils

*Answer: B) Plasmacytoid dendritic cells

*Question: Blastic Plasmacytoid Dendritic Cell Neoplasm typically presents with what initial finding?
A) Bone marrow failure
B) Skin lesions
C) Mediastinal mass
D) CNS involvement

*Answer: B) Skin lesions

*Question: Acute Leukemias of Ambiguous Lineage (ALALs) with NO clear evidence of differentiation along a single cell line are called what?
A) Mixed Phenotype Acute Leukemias (MPALs)
B) Acute Undifferentiated Leukemias (AULs)
C) Acute Leukemias Not Otherwise Specified
D) Bilineal Acute Leukemias

*Answer: B) Acute Undifferentiated Leukemias (AULs)

*Question: ALALs that demonstrate a multiplicity of antigens are called what?
A) Acute Undifferentiated Leukemias (AULs)
B) Biphenotypic Leukemias
C) Mixed Phenotype Acute Leukemias (MPALs)
D) Null-cell Leukemias

*Answer: C) Mixed Phenotype Acute Leukemias (MPALs)

*Question: Myeloperoxidase (MPO) is an enzyme found in which cellular structures?
A) Secondary granules of eosinophils
B) Primary granules of granulocytic cells (promyelocyte to maturation)
C) Lysosomes of monocytes
D) Azurophilic granules of lymphocytes

*Answer: B) Primary granules of granulocytic cells (promyelocyte to maturation)

*Question: MPO stain is primarily used to differentiate blasts of which conditions?
A) CML from CLL
B) AML from ALL
C) MDS from AML
D) APL from AML

*Answer: B) AML from ALL

*Question: In AMLs, more than what percentage of blasts show MPO activity?
A) 20%
B) 40%
C) 60%
D) 80%

*Answer: D) 80%

*Question: Auer rods are found only in which cell lineage?
A) Lymphoid cells
B) Myeloid cells (AML)
C) Erythroid cells
D) Megakaryocytes

*Answer: B) Myeloid cells (AML)

*Question: What is the MPO staining result for Auer rods?
A) Weakly positive
B) Negative
C) Strongly positive
D) Variable

*Answer: C) Strongly positive

*Question: Sudan Black B stain is described as being more sensitive than MPO for which cells?
A) Lymphoid cells
B) Mature erythrocytes
C) Early myeloid cells
D) Monocytes

*Answer: C) Early myeloid cells

*Question: Sudan Black B staining of granulocytes is described as what in relation to cellular maturity?
A) Constant regardless of maturity
B) Decreases with maturation
C) Intensifies as the cell matures
D) Only positive in immature cells

*Answer: C) Intensifies as the cell matures

*Question: What is the Sudan Black B staining result for lymphoid cells?
A) Strongly positive
B) Weakly positive
C) Negative
D) Focal positive

*Answer: C) Negative