Acute Myeloid Leukaemia (AML)

Question 1

When comparing leakaemia and lymphoma, which is a solid and which is a liquid tumour?

Answer 1

• leukaemia = liquid (blood)
• lymphoma = solid (lymph nodes)

Question 2

When comparing leukaemia and lymphoma, which cells are generally affected?

Answer 2

• leukaemia = myeloid and lymphoid cells (all bone marrow cells)
• lymphoma = lymphoid cells (B, T and NK cells)

Question 3

When looking at cell lines from the bone marrow we talk about haemopoietic stem cells, which are then able to differentiate into myeloid and lymphoid stem cells. Which of the following is NOT classed as a myeloid stem cell?

1 - erythrocyte
2 - thrombocyte (platelet)
3 - monocyte
4 - natural killer cell
5 - granulocyte

Answer 3

4 - natural killer cell
- these are classed as lymphoblasts

• granulocyte = eosinophil, neutrophil, basophil

Question 4

When looking at cell lines from the bone marrow we talk about haemopoietic stem cells, which are then able to differentiate into myeloid and lymphoid stem cells. Which of the following is NOT classed as a lymphoblast stem cell?

1 - pre-B cell
2 - thrombocyte (platelet)
3 - Pre-T cell
4 - natural killer cell

Answer 4

2 - thrombocyte (platelet)

Question 5

How common is acute myeloid leukaemia (AML)?

1 - 5000 per 100,000
2 - 500 per 100,000
3 - 50 per 100,000
4 - 5 per 100,000

Answer 5

4 - 5 per 100,000

Slighlty more common in men

1.3:1 ratio

Question 6

What age does the incidence of acute myeloid leukaemia (AML) peak at?

1 - >30
2 - >40
3 - >60
4 - >70

Answer 6

4 - >70

Question 7

Although not definitively known, which of the following has NOT be identified as a cause of Acute myeloid leukaemia (AML)?

1 - genetics
2 - environmental factors (smoking/radiation)
3 - viral exposure
4 - gender

Answer 7

4 - gender

Question 8

Although not definitively known, twin studies have shown that genetics is likely to be involved. Which of the following genetic disorders has the highest risk of developing acute myeloid leukaemia (AML)?

1 - Trisomy 21
2 - Klinefelter’s syndrome
3 - Bloom’s syndrome
4 - Fanconi anaemia

Answer 8

1 - Trisomy 21

Down syndrome patients are 10-20 x more likely to develop AML

All other genetic mutations can increase the risk of developing AML

Question 9

Which of the pre-existing haematologic disorders has been linked to an increased risk of developing acute myeloid leukaemia (AML)?

1 - Myelodysplastic syndromes
2 - Aplastic anaemia
3 - Myeloproliferative disorders
4 - Paroxysmal nocturnal haemoglobinuria
5 - Clonal haematopoiesis of indeterminate prognosis
6 - all of the above

Answer 9

6 - all of the above

Question 10

Which of the following is NOT true in Acute myeloid leukaemia (AML)?

1 - immature lymphoid cells affected
2 - grows rapidly
3 - common in older adults
4 - large amount of blast (immature cells) in the circulation)
5 - auer rods are present in histology

Answer 10

1 - immature lymphoid cells affected
- AML affects myeloid cells

Question 11

In acute myeloid leukaemia (AML), lymphoblasts do not mature but continue to grow in number (B, T and NK cells). This can lead to dysfunction of the bone marrow, causing which of the following to be affected?

1 - RBCs
2 - platelets
3 - WBCs
4 - all of the above

Answer 11

4 - all of the above

Can cause:
- anaemia = low RBcs
- leukopenia - low WBCs
- thrombocytopenai = low platelets
- pancytopenia = low everything

Question 12

There are lots of subcategories of acute myeloid leukaemia (AML). Which of the following is associated with a 9 and 22 chromsomal abnormality, also called the Philadelphia chromosome?

1 - AML without maturation
2 - acute myelomonocytic leukemia
3 - AML with minimal maturation
4 - acute promyelocytic leukemia

Answer 12

4 - acute promyelocytic leukemia

Can also cause bleeding secondary to disseminated intravascular coagulation

Question 13

Pancytopenia (low RBC, WBCs and platelets) can occur in acute myeloid leukaemia (AML). This can lead to a fever, is this always associated with an infection?

Answer 13

• no

Typically is associated with an infection in AML, but can also occur in isolation

Question 14

Pancytopenia (low RBC, WBCs and platelets) can occur in acute myeloid leukaemia (AML). Anaemia is a common problem due to low RBCs, but which of the following is NOT a symptom of anaemia?

1 - shortness of breath
2 - palpitations.
3 - weakness and fatigue
4 - sensory loss
5 - dizziness and pallor

Answer 14

4 - sensory loss

Common in peripheral neuropathies and B12 deficiency, but not common in anaemia

Question 15

Pancytopenia (low RBC, WBCs and platelets) can occur in acute myeloid leukaemia (AML). Which of the following can occur due to thrombocytopenia?

1 - ecchymoses (bruising)
2 - petechial rash
3 - gingival bleeding (bleeding gums)
4 - epistaxis
5 - menorrhagia
6 - all of the above

Answer 15

6 - all of the above

Petechial rash is a sign of low platelets and increased risk of bleeding

Question 16

Why do patients with acute myeloid leukaemia (AML) experience bone pain?

1 - acute bone marrow ischaemia
2 - increased lymphoblasts expand medullary cavity
3 - WBC begin attacking abnormal lymphoblasts
4 - increased leukemic process expands medullary cavity

Answer 16

4 - increased leukemic process expands medullary cavity

Question 17

Which 2 organs are typically associated with an increase in their size in patients with acute myeloid leukaemia (AML)?

1 - spleen
2 - kidneys
3 - heart
4 - liver

Answer 17

1 - spleen
4 - liver

Question 18

If you suspect a diagnosis of acute myeloid leukaemia (AML) a FBC should be performed. Would we expect to see a micro, normo or macrocytic anaemia?

Answer 18

• normocytic anaemia

Folate, B12 and iron are all present so myeloid cells should be normal size

Commonly see normocytic, normochromic anaemia

Question 19

If you suspect a diagnosis of acute myeloid leukaemia (AML) a FBC should be performed. Would we expect to see normal, hypo or hyperchromic RBCs?

Answer 19

• normochromic

Commonly see normocytic, normochromic anaemia

Question 20

If we suspect acute myeloid leukaemia (AML), we would perform a FBC. This would be followed by which of the following to confirm clinical diagnosis of AML?

1 - bone marrow biopsy
2 - Immunophenotyping
3 - genetic testings
4 - blood smear

Answer 20

4 - blood smear

Question 21

A blood smear is performed if we suspect a diagnosis of acute myeloid leukaemia (AML). We can use the mnemonic A.M.L to remember the 3 key things to diagnose a patient using a blood smear. Which of the following is NOT included?

1 - A = auer rods
2 - M = myeloperoxidase
3 - M = massive splenomegaly
4 - L = leukaemia in older patients

Answer 21

3 - M = massive splenomegaly
- not common in AML, but can occur

• myeloperoxidase = granules that stain for positive for Myeloperoxidase

Question 22

Typically the 1st test used to diagnose acute myeloid leukaemia (AML) is a FBC and blood smear that shows increased myeloblasts cells. The normal % of blast cells in the bone marrow of a healthy patient is around 2%. What is typically diagnostic in AML?

1 - >4%
2 - >12%
3 - >20%
4 - >65%

Answer 22

3 - >20%
- can be used for diagnosis purposes

Question 23

Which of the following is NOT commonly present in acute myeloid leukaemia (AML)?

1 - increased prothrombin time (intrinsic pathway)
2 - increased activated Partial Thromboplastin time (APTT)
3 - elevated d-dimer
4 - increased fibrinogen levels
5 - thrombocytopenia

Answer 23

4 - increased fibrinogen levels

This would be low because low platelets means low primary haemostasis

D-dimer may be increased due to haemolysis and breakdown of fibrin

Question 24

Disseminated intravascular coagulation (DIC) is an abnormal blood clotting throughout the body’s blood vessels. Is the risk of DIC increased or decreased in DIC?

Answer 24

• increased

Question 25

Leukostasis is a medical emergency causes by extremely elevated blast cell count. Which of the following symptoms can this cause? 1 - Chest pain 2 - Headache 3 - Altered mental status 4 - Priapism (constant erection) 5 - all of the above

Answer 25

5 - all of the above Leukocytes cause mechanical obstruction, especially in small capillaries leading to ischamia

Question 26

Tumour lysis syndrome is an oncologic emergency. It mostly occurs after initiating cytotoxic therapy, due to rapid destruction of tumour cells leads to a massive release of intracellular components (potassium, phosphate, and nucleic acid) into the circulation. Which of the following is NOT a common symptom associated with Tumour lysis syndrome? 1 - Nausea, vomiting, and diarrhoea, 2 - Vision loss 3 - Lethargy 4 - Hematuria 5 - Seizures, arrhythmias 6 - Tetany, muscle cramps, paresthesia 7 - renal toxicity and AKI

Answer 26

2 - Vision loss

Question 27

There is an increased risk of electrolyte imbalances in acute myeloid leukaemia (AML) due to the high levels of lysis. Which of the following is NOT typically observed in AML? 1 - Hyperphosphatemia 2 - hypercalcemia 3 - hyperkalemia 4 - hyperuricemia

Answer 27

2 - hypercalcemia Typically causes hypocalcaemia, which is likely to be due to renal dysfunction

Question 28

Tumour lysis is when there is a rapid cancer cell death (lysis) can be life threatening, causing acute nephropathy and acute renal failure. What is the treatment for this? 1 - Na+ infusion to balance electrolytes 2 - blood drain to dilute 3 - hyperdiuresis via excessive and often forced fluids 4 - all of the above

Answer 28

3 - hyperdiuresis via excessive and often forced fluids Given alongside allopurinol

Question 29

Patients with acute myeloid leukaemia (AML) may experience high hyperkalcaemia due to high lysis of cells, increasing the risk of tumour lysis syndrome (medical emergency). What medication is given to stabilise hyperkalcaemia? 1 - rifampicin 2 - cyclizine 3 - calcium gluconate 4 - allopurinol

Answer 29

3 - calcium gluconate Stabilises cardiac resting membrane potential

Question 30

Patients with acute myeloid leukaemia (AML) are often taking a medication to address the high levels of urate in the blood due to tumour lysis. What medication is typically given to patients? 1 - rifampicin 2 - cyclizine 3 - omalizumab 4 - allopurinol

Answer 30

4 - allopurinol

Question 31

Will lactate dehydrogenase be high or low in acute myeloid leukaemia (AML)?

Answer 31

- high Due to cell lysis and high turnover

Question 32

Patients with acute myeloid leukaemia (AML) can have an increased risk of infection due to pancytopenia. How can this be managed? 1 - admit the patient to hospital to protect them from infections and treat with antibiotics 2 - ensure they do not leave their house and provide antibiotics 3 - provide antibiotics, regardless of the location 4 - all of the above

Answer 32

4 - all of the above Really important in febrile neutropenia

Question 33

In patients with acute myeloid leukaemia (AML) and acute lymphoid leukaemia (ALL) the induction therapy (1st therapy given in an attempt to induce remission) is what? 1 - chemotherapy 2 - radiotherapy 3 - immunotherapy 4 - bone marrow transplantation

Answer 33

1 - chemotherapy - cytotoxic drugs are given that are able to kill cancer cells - can take months to years

Question 34

In patients with acute myeloid leukaemia (AML) and acute lymphoid leukaemia (ALL) the induction therapy (1st therapy given in an attempt to induce remission) is chemotherapy. What is the definition of remission in leukaemia? 1 - no symptoms for >12 months 2 - no signs of blast cells on blood smears 3 - immune cells are normal 4 - no detectable leukaemia on microscopy and <5% blast cells

Answer 34

4 - no detectable leukaemia on microscopy and <5% blast cells

Question 35

In patients with unfavourable looking prognosis, haematopoietic cell transplantation can be used. Which offers the best outcomes for patients? 1 - autologous bone marrow transplant. 2 - allogeneic bone marrow transplant 3 - umbilical cord blood transplant

Answer 35

2 - allogeneic stem‐cell transplantation Patients receives blood products from a healthy donor following whole body radiation to wipe out all immature blast cells before healthy cells from the donor are given