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BOC review-Harr 5th ed > Heme 1.6 Acute Leukemias > Flashcards

Heme 1.6 Acute Leukemias Flashcards

1
Q
  1. Auer rods may be seen in all of the following except:

A. Acute myelomonocytic leukemia (M4)
B. Acute lymphoblastic leukemia (ALL)
C. Acute myeloid leukemia without maturation (AML:M1)
D. Acute promyelocytic leukemia (PML; M3)

A

B. Acute lymphoblastic leukemia (ALL)

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2
Q
  1. Which type of anemia is usually present in a patient with acute leukemia?

A. Microcytic, hyperchromic
B. Microcytic, hypochromic
C. Normocytic, normochromic
D. Macrocytic, normochromic

A

C. Normocytic, normochromic

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3
Q
  1. In leukemia, which term describes the peripheral blood finding of leukocytosis with a shift to the left, accompanied by NRBCs?

A. Myelophthisis
B. Dysplasia
C. Leukoerythroblastosis
D. Megaloblastosis

A

C. Leukoerythroblastosis

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4
Q
  1. The basic pathophysiological mechanisms responsible for producing signs and symptoms in leukemia include all of the following except:

A. Replacement of normal marrow precursors by leukemic cells causing anemia
B. Decrease in functional leukocytes causing infection
C. Hemorrhage secondary to thrombocytopenia
D. Decreased erythropoietin production

A

D. Decreased erythropoietin production

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5
Q
  1. Which type of acute myeloid leukemia is called the true monocytic leukemia and follows an acute or subacute course characterized by monoblasts, promonocytes, and monocytes?

A. Acute myeloid leukemia, minimally differentiated
B. Acute myeloid leukemia, without maturation
C. Acute myelomonocytic leukemia
D. Acute monocytic leukemia

A

D. Acute monocytic leukemia

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6
Q
  1. In which age group does ALL occur with the highest frequency?

A. 1–15 years
B. 20–35 years
C. 45–60 years
D. 60–75 years

A

A. 1–15 years

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7
Q
  1. Disseminated intravascular coagulation (DIC) is most often associated with which of the following types of acute leukemia?

A. Acute myeloid leukemia, without maturation
B. Acute promyelocytic leukemia (PML)
C. Acute myelomonocytic leukemia
D. Acute monocytic leukemia

A

B. Acute promyelocytic leukemia (PML)

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8
Q
  1. An M:E ratio of 10:1 is most often seen in:

A. Thalassemia
B. Leukemia
C. Polycythemia vera (PV)
D. Myelofibrosis

A

B. Leukemia

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9
Q
  1. Which of the following is a characteristic of Auer rods?

A. They are composed of azurophilic granules
B. They stain positive on periodic acid–Schiff (PAS) staining
C. They are predominantly seen in chronic myelogenous leukemia (CML)
D. They are nonspecific esterase positive

A

A. They are composed of azurophilic granules

Auer rods are a linear projection of primary azurophilic granules and are present in the cytoplasm of myeloblasts and monoblasts in patients with acute leukemia.

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10
Q
  1. SITUATION: The following laboratory values are seen:
    WBC = 6.0 × 10^9/L
    Hgb = 6.0 g/dL
    RBC = 1.90 × 10^12/L
    Hct = 18.5%
    PLT = 130 × 10^9/L
    Serum vitamin B12 and folic acid: normal
    WBC Differential:
    6% PMNs
    40% lymphocytes
    4% monocytes
    50% blasts
    Bone Marrow:
    40% myeloblasts
    60% promegaloblasts
    40 megaloblastoid NRBCs/100 WBCs
    These results are most characteristic of:

A. Pernicious anemia
B. Acute myeloid leukemia, without maturation
C. Acute erythroid leukemia
D. Acute myelomonocytic leukemia

A

C. Acute erythroid leukemia

In acute erythroid leukemia, greater than 50% of nucleated bone marrow cells are erythroid and greater than 30% nonerythroid cells are blasts. Pernicious anemia results in pancytopenia and low vitamin B12 concentrations.

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11
Q
  1. A 24-year-old man with Down syndrome presents with fever, pallor, lymphadenopathy, and hepatosplenomegaly. His CBC results are as follows:
    WBC = 10.8 × 10^9/L
    RBC = 1.56 × 10^12/L
    8% PMNs
    25% lymphocytes
    67% PAS-positive blasts
    Hgb = 3.3 g/dL
    Hct = 11%
    PLT = 2.5 × 10^9/L
    These findings are suggestive of:

A. Hodgkin lymphoma
B. Myeloproliferative disorder
C. Leukemoid reaction
D. Acute lymphocytic leukemia

A

D. Acute lymphocytic leukemia

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12
Q
  1. SITUATION: A peripheral blood smear shows 75% blasts. These stain positive for both Sudan Black B (SBB) and peroxidase. Given these values, which of the following disorders is most likely?

A. Acute myelocytic leukemia (AML)
B. CML
C. Acute undifferentiated leukemia (AUL)
D. ALL

A

A. Acute myelocytic leukemia (AML)

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13
Q
  1. In myeloid cells, the stain that selectively identifies phospholipid in the membranes of both primary and secondary granules is:

A. PAS
B. Myeloperoxidase
C. SBB
D. Terminal deoxynucleotidyl transferase (TdT)

A

C. SBB

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14
Q
  1. Sodium fluoride may be added to the naphthyl ASD acetate (NASDA) esterase reaction. The fluoride is added to inhibit a positive reaction with:

A. Megakaryocytes
B. Monocytes
C. Erythrocytes
D. Granulocytes

A

B. Monocytes

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15
Q
  1. Leukemic lymphoblasts reacting with anti–common acute lymphoblastic leukemia antigen (anti-CALLA) are characteristically seen in:

A. B-cell ALL
B. T-cell ALL
C. Null-cell ALL
D. Common ALL

A

D. Common ALL

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16
Q
  1. Which of the following reactions are often positive in ALL but are negative in AML?

A. TdT and PAS
B. Chloroacetate esterase and nonspecific esterase
C. SBB and peroxidase
D. New methylene blue and acid phosphatase

A

A. TdT and PAS

17
Q
  1. A patient’s peripheral blood smear and bone marrow both show 70% blasts. These cells are negative on SBB staining. Given these data, which of the following is the most likely diagnosis?

A. AML
B. Chronic lymphocytic leukemia (CLL)
C. Acute PML
D. ALL

A

D. ALL

18
Q
  1. Which of the following leukemias are included in the 2008 World Health Organization classification of myeloproliferative neoplasms (MPN)?

A. CML
B. Chronic neutrophilic leukemia (CNL)
C. Chronic eosinophilic leukemia (CEL)
D. All of these options are classified as MPN

A

D. All of these options are classified as MPN

19
Q
  1. In addition to morphology, cytochemistry, and immunophenotyping, the WHO classification of myelo- and lymphoproliferative disorders is based on which characteristic?

A. Proteomics
B. Cytogenetic abnormalities
C. Carbohydrate-associated tumor antigen production
D. Cell signaling and adhesion markers

A

B. Cytogenetic abnormalities

20
Q
  1. The WHO classification requires what percentage for the blast count in blood or bone marrow for the diagnosis of AML?

A. At least 30%
B. At least 20%
C. At least 10%
D. Any percentage

A

B. At least 20%

21
Q
  1. What would be the most likely designation by the WHO for AML M2 by the FAB classification?

A. AML with t(15;17)
B. AML with mixed lineage
C. AML with t(8;21)
D. AML with inv(16)

A

C. AML with t(8;21)

AML with t(8;21) is classified under the category “AML with Recurrent Genetic Abnormalities” by the WHO. This translocation occurs in up to 15% of cases of AML and may be the most common translocation. The AML1–ETO translocation occurs
chiefly in younger patients and often in cases of acute myeloblastic leukemia with maturation, FAB M2. The translocation involves the fusion of the AML1 gene on chromosome 21 with the ETO gene on chromosome 8.

22
Q
  1. What would be the most likely designation by the WHO for AML M3 by the FAB classification?

A. AML with t(15;17)
B. AML with mixed lineage
C. AML with t(8;21)
D. AML with inv(16)

A

A. AML with t(15;17)

AML with t(15;17) is classified under the category “AML with Recurrent Genetic Abnormalities” by the WHO. Acute PML (known as M3 under the FAB system) is composed of abnormal promyelocytes with heavy granulation, sometimes obscuring the nucleus, and abundant cytoplasm. Acute PML contains a translocation that results in the fusion of a transcription factor called PML on chromosome 15 with the alpha (α)-retinoic acid receptor gene (RARα) on chromosome 17.

23
Q
  1. Which AML cytogenetic abnormality is associated with AML M4 with marrow eosinophilia under the WHO classification of AML with recurrent genetic abnormalities?

A. AML with t(15;17)
B. AML with mixed lineage
C. AML with t(8;21)
D. AML with inv(16)

A

D. AML with inv(16)

AML with inv(16) has pericentric inversion of chromosome 16 and is associated with M4 with marrow eosinophilia, M4eo under the FAB system. The inv(16) results in the fusion of the CBFβ gene on 16q22 with the MYH11 gene on 16p13.

24
Q
  1. What would be the most likely classification by the WHO for AML M7 by the FAB classification?

A. Acute myeloid leukemias with recurrent genetic abnormalities
B. Acute myeloid leukemia with multilineage dysplasia
C. Acute megakaryoblastic leukemia classified under AML (not otherwise categorized)
D. Acute leukemias of ambiguous lineage

A

C. Acute megakaryoblastic leukemia classified under AML (not otherwise categorized)

Acute megakaryoblastic leukemia, which is equivalent to FAB M7, is a relatively uncommon form of leukemia characterized by neoplastic proliferation of
megakaryoblasts and atypical megakaryocytes. Recognition of this entity was aided by the use of platelet peroxidase (PPO) ultrastructural studies. PPO is distinct from myeloperoxidase and is specific for the megakaryocytic cell line. Acute megakaryoblastic leukemia is defined as an acute leukemia in which 50% or greater of
the blasts are of megakaryocytic lineage. In the WHO 2016 revision, it is classified under “AML (not otherwise categorized).”

BOC review-Harr 5th ed (59 decks)

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