Leukemias

Front 1

Which of the following hematologic diseases are considered to be Myeloproliferative disorders?

Back 1

1)Chronic Myelocytic leukemia
2) Polycythemia vera
3) Idiopathic myelofibrosis
4) Essential thrombocythemia
*5) All of the above

Front 2

Acute myeloproliferative disorders (MPD) include all of the following except

Back 2

1) Erythroleukemia
*2) Polycythemia vera
3) Acute myeloblastic leukemia
4) Acute Promyelocytic leukemia

Front 3

Leukemia is defined as

Back 3

A malignant disease of hematopoietic tissue, characterized by replacement of normal bone marrow elements with abnormal (neoplastic) blood cells

Front 4

Leukemia of the myeloid lineage may include

Back 4

1) Granulocytic leukemia
2) Monocytic leukemia
3) Megakaryocytic leukemia
*4) All of the above

Front 5

What is the ratio of development of leukemia in adults versus children?

Back 5

10:1

Front 6

What clinical features suggests a chronic leukemia?

Back 6

Insidious clinical onset

Front 7

Five to 10% of cases of AML (acute myeloblastic leukemia) are preceded by a recognizable "preleukemic" __________ syndrome.

Back 7

Myelodysplastic

Front 8

A 35-year-old man presents with anemia, neutropenia, thrombocytopenia, myeloblasts with the presence of Auer rods and 1-2 distinct nucleoli and promyelocytes. Cytochemistry examination demonstrates peroxidase and Sudan black positive and TdT negative. This hematologic picture is consistent with

Back 8

AML (acute myeloblastic leukemia)

Front 9

A 5-year-old girl presents with anemia, neutropenia, thrombocytopenia, lymphoblasts and prolymphocytes. Cytochemical examination shows peroxidase and Sudan black negative, and a positive for TdT. This hematologic picture is consistent with

Back 9

ALL (acute lymphoblastic leukemia)

Front 10

When a leukemia is suspected in a patient, what laboratory test should be required for the initial diagnosis?

Back 10

1) CBC, differential, platelet count
2) Cytochemical stains
3) Immunologic surface markers
*4) All of the above

Front 11

The presence of Auer rods in the cytoplasm of cells rules out __________.

Back 11

ALL (acute lymphoblastic leukemia)

Front 12

A positive myeloperoxidase or Sudan black B stain indicates __________ differentiation.

Back 12

Myeloid

Front 13

A positive nonspecific esterase stain indicates __________ differentiation.

Back 13

Monocytic

Front 14

The cytochemical reactions are performed by applying staining techniques to __________ smears.

Back 14

1) Peripheral blood
2) Bone marrow
3) Touch preparation
*4) All of the above

Front 15

The Sudan black B (SBB) stain is the most sensitive stain for granulocytic precursors with a staining pattern which parallels the __________ stain.

Back 15

Myeloperoxidase

Front 16

Which cytochemical stain more specific than sudan black B stain should be recommended for granulocytic differentiation?

Back 16

Myeloperoxidase

Front 17

The alpha-naphthyl butyrate stain is used to identify __________ cells.

Back 17

Monocytic

Front 18

A strong periodic acid-Schiff (PAS) reaction supports the diagnosis of __________.

Back 18

Erythroleukemia

Front 19

Which of cytochemical stain differentiates AML from ALL?

Back 19

Myeloperoxidase

Front 20

In immunologic surface marker studies, __________ are used to detect markers associated with cell lineage and maturation stage.

Back 20

Antibodies

Front 21

Cytoplasmic marker studies are useful in assessing cell linege in

Back 21

ALL

Front 22

During bacterial infection the granulocyte-to-erythroid ratio can increase due to __________ production.

Back 22

Increased granulocyte

Front 23

What should be suspected when the left shift is seen in the presence of low leukocyte counts with 70% neutrophils?

Back 23

Septicemia

Front 24

Morphological features that can be clinically sensitive to the presence of severe infections include:

Back 24

1) Toxic granulation
2) Vacuolated cytoplasm
3) Döhle bodies
*4) All of the above

Front 25

Döhle bodies consist of __________.

Back 25

Endoplastic reticulum

Front 26

Neutropenia is produced by:

Back 26

1) Decrease in production by the bone marrow
2) Impaired release from the marrow into the blood
3) Maldistribution resulting in pseudoneutropenia
*4) All of the above

Front 27

Newborns who are afflicted with a bacterial infection will develop severe neutropenia because of:

Back 27

The neutrophil storage pool being depleted in the bone marrow

Front 28

Acquired neutropenia as a component of pancytopenia occurs in patients who have bone marrow failure due to:

Back 28

1) Toxic injury
2) Malignant cell invasion
3) Aplastic anemia
*4) All of the above

Front 29

A rare autosomal recessive congenital disorder that features partial albinism, mild bleeding tendencies, and giant lysosomal granules in blood and tissue cell is known as ____________.

Back 29

Chédiak-Higashi disease

Front 30

Myeloperoxidase is present in the primary granules of __________.

Back 30

1) Neutrophils
2) Eosinophils
3) Monocytes/macrophages
*4) All of the above

Front 31

The susceptibility to infections in Chédiak-Higashi disease is due to:

Back 31

1) Abnormal distribution of lysosomal enzymes
2) Impaired chemotaxis
3) Neutropenia
*4) All of the above

Front 32

What X-linked recessive disease is characterized by a granuloma formation as a result of the inability of neutrophils, monocytes, and eosinophils to kill microorganisms following normal engulfment?

Back 32

Chronic granulomatous disease

Front 33

A patient with leukemia demonstrated bilobed neutrophils on a peripheral blood smear. These are often called:

Back 33

Pseudo-Pelger-Huet neutrophils

Front 34

__________, seen in association with mucopolysaccharidosis, has characteristic dark staining and coarse cytoplasmic granules in the cytoplasm of neutrophils, lymphocytes, and monocytes.

Back 34

Alder's anomaly

Front 35

Which qualitative WBC disorder demonstrates blue-staining cytoplasmic inclusions in neutrophils that resemble Döhle bodies?

Back 35

May-Hegglin anomaly

Front 36

Which of the following morphologies differentiates reactive lymphocyte from monocytes?

Back 36

Increased patchy basophilic cytoplasm

Front 37

Reactive lymphocytes in infectious mononucleosis represent:

Back 37

T lymphocytes responding to infection

Front 38

Additional serologic findings may be required to distringuish EBV infection from which other viral infections?

Back 38

1) Hepatitis
2) Cytomegalovirus
3) Rubella
*4) All of the above

Front 39

A patient presents with absolute lymphocytosis with 12% reactive lymphocytes on the peripheral blood smear. The heterophils antibody test is negative. What more specific antibody test should be performed?

Back 39

IgM-EBV (Epstein-Barr virus)

Front 40

What other laboratory tests have significant correlation with infectious mononucleosis?

Back 40

1) ALT (alanine transferase)
2) AST
3) Bilirubin
*4) All of the above

Front 41

TdT (terminal deoxynucleotidyl transferase) is found in 90% of acute __________ leukemia.

Back 41

Lymphoblastic

Front 42

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

Back 42

Monocytic

Front 43

Which FAB (French-American-British) classification demonstrates at least 3% positivity with peroxidase or Sudan black, < 20% positivity with nonspecific esterase, and contains primarily myeloblasts with distinct nucleoli?

Back 43

M1

Front 44

This acute leukemia contains primarily abnormal promyelocytes with heavy granulation, and the presence of Auer rods is abundant. The cells react near 100% with Sudan black and peroxidase; however, the reaction is negative for non-specific esterase. DIC is frequently associated with this disorder. What is the FAB (French-American-British) classification?

Back 44

M3

Front 45

The most common acute leukemia FAB classification diagnosed is __________.

Back 45

M2

Front 46

What definitive laboratory findings in acute myelomonocytic leukemia aid in the differentiation of M4 and M2?

Back 46

Increased serum lysozyme level

Front 47

Chronic lymphocytic leukemia (CLL) is included in a general category of conditions known as the __________ disorders.

Back 47

Lymphoproliferative

Front 48

In chronic lymphocytic leukemia (CLL) there is a malignant proliferation of which cell?

Back 48

B lymphocytes

Front 49

Suppression of all classes of immunoglobulin is evident in CLL (chronic lymphocytic leukemia) resulting in:

Back 49

Autoimmune disease

Front 50

The laboratory test for detecting minimal residual disease in patients who have previously been treated for CLL but currently lack histopathelogic evidence of relapse is the:

Back 50

PCR

Front 51

A cell that could suggest that lymphocytes in CLL are not normal is a:

Back 51

Smudge cell

Front 52

All of the following are features of CLL (chronic lymphocytic leukemia) except:

Back 52

1) Monoclonality
*2) Polyclonality
3) Hypogammaglobulinemia
4) Autoimmune disease

Front 53

The final diagnosis of any lymphoproliferative disorder encompasses clinical data obtained from __________ analysis.

Back 53

1) Morphologic
2) Histologic
3) Immunologic
*4) All of the above

Front 54

CLL (chronic lymphocytic leukemia) has been known to occur simultaneously with what hematologic disorder?

Back 54

Acute myeloblastic leukemia (AML)

Front 55

Clinical features of CLL (chronic lymphocytic leukemia) include all of the following except:

Back 55

Splenomegaly

Front 56

What definitive factors differentiate prolymphocytic leukemia (PL) from CLL?

Back 56

Extreme leukocytosis (>100 x 10 /L) and splenomegaly without lymphadenopathy

Front 57

What is characteristic morphology for Sézary cells?

Back 57

Dark-staining hyperchromatic nuclear chromatin with numerous folds

Front 58

Other names for chronic myelogenous leukemia include:

Back 58

Chronic granulocytic leukemia
and Chronic myeloid leukemia

Front 59

CML (chronic myelocytic leukemia) is characterized by examining the production of __________ and their precursors.

Back 59

Granulocytes

Front 60

Which phase of CML (chronic myelocytic leukemia) carries the worst prognosis and is generally unresponsive to treatment?

Back 60

Blast crisis

Front 61

Which cell types contain the Ph chromosome in patients with CML (chronic myelocytic leukemia)?

Back 61

1) Neutrophil
2) Monocyte
3) Erythrocyte
4) Platelet
*5) All of the above

Front 62

In CML (chronic myelocytic leukemia) the term maturation arrest refer to the:

Back 62

Absence of cellular differentiation beyond the blast or promyelocyte stage

Front 63

Which of the following hematologic diseases are considered to be chronic myeloproliferative disorders?

Back 63

1) Chronic myelocytic leukemia
2) Polycythemia vera
3) Idiopathic myelofibrosis
4) Essential thrombocythemia
*5) All of the above

Front 64

Which myeloproliferative disorder is characterized by fibrosis of the marrow, extramedullary hematopoiesis of the spleen or liver, leukoerythroblastosis, and teardrop poikilocytosis?

Back 64

Idiopathic myelofibrosis

Front 65

Factors that have been implicated in stimulating fibroblast proliferation in myelofibrosis include:

Back 65

Release of PDGF (platelet derived growth factor)

Front 66

What is/are the strongest differentiating feature(s) that distinguish CML (chronic myelocytic leukemia) from IMF (idiopathic myelofibrosis)?

Back 66

Decreased LAP (leukocyte alkaline phosphatase)
and Presence of Philadelphia chromosome

Front 67

What is the etiology of polycythemia vera?

Back 67

Clonal hematologic malignancy of bone marrow

Front 68

A patient presents with an HCT of 55%, elevated red cell mass, normal arterial oxygen saturation, elevated LAP (leukocyte alkaline phosphatase) score, and thrombocytosis. What is the most probable cause of these laboratory findings?

Back 68

Polycythemia vera

Front 69

The fundamental characteristic of MDS is:

Back 69

Peripheral blood cytopenia and bone marrow hypercellularity

Front 70

The following morphologies are characteristic of dyserythropoiesis in MDS (myelodysplastic syndrome):

Back 70

Basophilic stippling and Normochromic, normocytic red cells

Front 71

What specific features are characteristic of dysgranulopoiesis morphology in MDS (myelodysplastic syndrome)?

Back 71

Hypersegmentation in bone marrow

Front 72

What specific features are characteristic of dysmegakaryocytopoiesis morphology in MDS (myelodysplastic syndrome)?

Back 72

Micromegakaryocytes

Front 73

What type of MDS (myelodysplastic syndrome) demonstrates a mild decreased WBC (3.9 x 10/L), increased erythropoiesis and normal numbers of blast cells in the marrow, and < 15% sideroblasts?

Back 73

Refractory anemia (RA)

Front 74

Which of the following is the most significant prognostic indicator in MDS (myelodysplastic syndrome)

Back 74

Percentage of bone marrow blasts

Front 75

In calculating the percentage of myeloblasts in the bone marrow, the following data is given. Erythroid nuclear precursors (E) = 65%, myeloblasts = 14%, other cells = 21%. Based on these numbers, what is the percentage of myeloblasts by FAB classification?

Back 75

40%

Front 76

Wright's stains of peripheral blood smears from some patients with myeloma are bluish. This coloration is due to increased background staining of the high level of __________ in the plasma portion of the blood.

Back 76

Immunoglobulin

Front 77

Which laboratory test(s) should be ordered to evaluate a patient suspected of having plasma cell disorder?

Back 77

1) SPEP (serum protein electrophoresis)
2) Calcium
3) BUN (blood urea nitrogen)
4) ESR (erythrocyte sedimentation)
*5) All of the above

Front 78

A 63-year-old black man presents with an elevated ESR, 10-30% plasma cells in the bone marrow, M-spike by SPEP (serum protein electrophoresis), and 4.0 g/dl of serum IgG by radial diffusion. What plasma cell disorder is implicated?

Back 78

Multiple myeloma

Front 79

In multiple myeloma, a plasma cell will sometimes contain clumps of aggregated immunoglobulin that stain red with Wright-Giemsa stain. These aggregates are referred to as:

Back 79

Russell bodies

Front 80

How does osteoclast activating factor (OAF) produced by malignant plasma cells influence disease in multiple myeloma?

Back 80

1) Induces overactivity of osteoclasts
2) Induces bone reabsorption
3) Produces lytic bone lesion
4) Increases calcium
*5) All of the above

Front 81

What multiple myeloma manifestation describes the formation of abnormal proteins in organ systems due to deposition of immunoglobulin light chains leading to kidney and renal dysfunction?

Back 81

Amyloidosis

Front 82

Neurologic manifestations such as blurred vision, headaches, and episodes of consfusion occur in patients with Waldenstrom's macroglobulinemia due to __________.

Back 82

Hyperviscosity syndrome

Front 83

The morphologic hallmark of Hodgkin's lymphoma is a peculiar cell called the __________cell.

Back 83

Reed-Sternberg

Front 84

The most frequently occurring subtype of Hodgkin's lymphoma is:

Back 84

Nodular sclerosing Hodgkin's lymphoma

Front 85

What following cell types are commonly found in mixed cellularity Hodgkin's disease?

Back 85

1) Lymphocytes
2) Histiocytes
3) Plasma cells
4) Reed-Sternberg cells
*5) All of the above