3.28.14* Formative Quiz

Question 1

FISH study with probe targets 17q and 15q (shows fusion gene). What is the likely clinical presentation?

a. WBC 150, 90% lymphoblasts
b. WBC 100, platelets 10 K
c. EBC 75, half of them are myelocytes
d. extensive lymphadenopathy and splenomegaly
e. WBC 100, 90% mature lymphocytes

Answer 1

B. (acute PML)
expect them to be thrombocytopenic

C. is AML (hard to distinguish this from aPML)

Question 2

A pancytopenic 68 year old man’s bone marrow biopsy shows 3% blasts and many cells like these: what is the diagnosis?

a. erythroleukemia
b. myelodysplasia
c. plasma cell myeloma
d. chronic lymphocytic leukemia
e. acute myeloblastic

Answer 2

B. (red cells with multiple nuclei) caused by myelodysplasia

Question 3

(see picture of myelodysplasia, multiple nucleated RBCs) Activating Jak2 mutations are seen in which of these conditions?

a. AML, ALL
b. CML, AML
c. P vera, primary myelofibrosis
d. CLL, DLBCL
e. mastocytosis, erythroleukemia

Answer 3

C.

Question 4

Portions of this patient’s bone marrow are replaced by these cells, and a molecular study detected a cKIT mutation. What clinical presentaiton would fit best?

a. flushing, tachycardia, extensive rash
b. pancytopenia
c. thrombocytopenia, AML
d. leukocytosis in a 6 year old
e. extensive lymphadenopathy

Answer 4

A. Mastocytosis

This disease is mostly for older people.

Question 5

THis anemic 12 year old female WBC count is 1.1 (normal 4.5-9.5) with 80% polymorphic lymphocytes. What diagnosis do you favor?

a. CL
b. ALL
c. primary myelofibrosis
d. aplastic anemia
e. mastocytosis

Answer 5

D. There are not many cells in the bone marrow. There are 80% polymorphic lymphoctes because these last longer in the PB compared to granulocytes.

Question 6

Her parents taker her to a famous referral center and they do a $100,000 workup. What is the most likely diagnosis?

a. fanconi’s anemia
b. myelodysplasia
c. parvovirus infection
d. idiosyncratic drug reaction
e. idiopathic

Answer 6

E.

parvovirus is possible but the bone marrow is usually not so hypocellular as this

Question 7

What is the most important reason to think of parvovirus infection?

Answer 7

sickle cell patient with sickle cell crisis. If reticulocytes are very low, they probably have parvovirus and need transfusion immediately.

Question 8

You patient has severe back pain and a monoclonal IgG kappa species in her plasma. You’ve gotten a BM biopsy, cytogenetics, UPEP, and B2M level. What is the most important next test?

a. MRI
b. IFE
c. check the bone marrow specimen for amyloid
d. serum viscosity
e. skeletal survey

Answer 8

E. Do skeletal survey quick with multiple myeloma to look for bone lesions.

Question 9

Big lymph node is biopsied. The alleged “follicles” show a high mitotic rate, tingbile body macrophages, and “centroblasts” off to one side. What is the diagnosis?

a. CLL
b. reactive follicular hyperplasia
c. follicular lymphoma
d. mantle cell lymphoma
e. diffuse large B-cell lymphoma

Answer 9

B. In a normal follicle, they are supposed to have a high mitotic rate. But lymphomas usually have low mitotic rates within the follicles.

Question 10

You biopsy one of the several large red rashes on a 78 year old man and find that there is an extensive dermal infiltrate of T-cells, almost all of which are CD4+. What else do you want to know?

a. the rest of their immunophenotype
b. conventional cytogenetic findings (karyotype)
c. t cell receptor gene rearrangement status
d. FISH results with probes for cyclin D1 and cKIT
e. A and C
f. B and D

Answer 10

E. Mycosis fungoides

Immunophenotype is abnormal.