Myelodysplastic Syndromes

Question 1

1. MDSs are most common in which age group?
   a. 2 to 10 years
   b. 15 to 20 years
   c. 25 to 40 years
   d. Older than 50 years

Answer 1

d. Older than 50 years

Question 2

2. What is a major indication of MDS in the peripheral blood
   and bone marrow?
   a. Dyspoiesis
   b. Leukocytosis with left shift
   c. Normal bone marrow with abnormal peripheral blood
   features
   d. Thrombocytosis

Answer 2

a. Dyspoiesis

Question 3

3. An alert hematologist should recognize all of the following
   peripheral blood abnormalities as diagnostic clues in MDS
   except:
   a. Oval macrocytes
   b. Target cells
   c. Agranular neutrophils
   d. Circulating micromegakaryocytes

Answer 3

b. Target cells

Question 4

4. For an erythroid precursor to be considered a ring sideroblast, the iron-laden mitochondria must encircle how much
   of the nucleus?
   a. One quarter
   b. One third
   c. Two thirds
   d. Entire nucleus

Answer 4

b. One third

Question 5

5. According to the WHO classification of MDS, what percentage of blasts would constitute transformation to an acute
   leukemia?
   a. 5%
   b. 10%
   c. 20%
   d. 30%

Answer 5

c. 20%

Question 6

6. A patient has anemia, oval macrocytes, and hypersegmented
   neutrophils. Which of the following tests would be most
   efficient in differential diagnosis of this disorder?
   a. Serum iron and ferritin levels
   b. Erythropoietin level
   c. Vitamin B12 and folate levels
   d. Chromosome analysi

Answer 6

c. Vitamin B12 and folate levels

Question 7

7. A 60-year-old woman comes to the physician with fatigue
   and malaise. Her hemoglobin is 8 g/dL, hematocrit is 25%,
   RBC count is 2.00 3 1012/L, platelet count is 550 3 109/L,
   and WBC count is 3.8 3 109/L. Her WBC differential is
   unremarkable. Bone marrow shows erythroid hypoplasia
   and hypolobulated megakaryocytes; granulopoiesis appears
   normal. Ring sideroblasts are rare. Chromosome analysis
   reveals the deletion of 5q only. Based on the classification
   of this disorder, what therapy would be most appropriate?
   a. Supportive therapy; lenalidomide if the disease progresses
   b. Aggressive chemotherapy
   c. Bone marrow transplantation
   d. Low-dose cytosine arabinoside, accompanied by cis-retinoic
   acid

Answer 7

a. Supportive therapy; lenalidomide if the disease progresses

Question 8

8. Which of the following is least likely to contribute to the
   death of patients with MDS?
   a. Neutropenia
   b. Thrombocytopenia
   c. Organ failure
   d. Neuropathy

Answer 8

d. Neuropathy

Question 9

9. Into what other hematologic disease does MDS often convert?
   a. Megaloblastic anemia
   b. Aplastic anemia
   c. AML
   d. Myeloproliferative disease

Answer 9

c. AML

Question 10

10. Chronic myelomonocytic leukemia is classified in the
    WHO system as:
    a. A myeloproliferative neoplasm
    b. Myelodysplastic syndrome, unclassified
    c. MDS/MPN
    d. Acute leukemia

Answer 10

c. MDS/MPN