TEST 1 Flashcards
PAST PAPER
What virus causes lymphoid malignancies in humans
Epstein-Bar virus
Tumor suppresor genes causes cancers such as leukemia when mutations result in
Failure to prevent malignant process
Oncogenes are said to act in a dominant fashion because
A mutation in a single allele is sufficient for malignancy to develop
what is a cellular abnormality produced by oncogenes
Acceleration of DNA catabolism
Compared with autologous bone marrow transplantation, allogeneic transplantation has
better long term succes
Chemotherapeutic agents are divided into which two major subgroups
- phase specific
- phase non specific
Qualitative and quantitative neutrophil hanges noted in response to infection include
- neutropenia
- toxic granulation
- vacuolization
The WHO classification requires what percentage for the blast count in the blood or bone
At least 20%
In addition to morphology, cytochemistry, and immunophenotyping, the WHO
classification of
Myelo- and lymphoproliferative disorders is based upon which characteristic?
Cytogenetic abnormalities
Which AML cytogenetic abnormality is associated with acute myelomonocytic leukemia
with marrow eosinophilia under the WHO classification of AML with recurrent genetic
abnormalities?
AML with inv
neutropenia is present in patients with which absolute count
<1.5*10^9/L
A m:e (myeloid:erythroid ration) of 10:1 is mostly seen in
Leukemia
Which of the following leukemias are included in the 2008 World Health Organization
classification of myeloproliferative neoplasms?
Chronic myelogenous leukemia (CML)
Chronic neutrophilic leukemia (CNL)
Chronio eosinophilic leukemia (CEL)
Repeated phlebotomy in patients with polycythemia vera (PV) may lead to the
development of:
Iron deficiency anaemia
in essential thrombocytopenia the platelets are
increased in number and fuctionality abnormal
Which of the following cells is considered pathognomonic for Hodgkin’s disease?
Reed- sternberg cells
Which of the morphological findings are characteristics of reactive lymphocytes
- high nuclear: cytoplsmic ration
- prominent nucleoli
- basophilic cytoplasm
Auer rods may be seen in all of the following
- acute myelomonocytic leukemia (M4)
- acute myeloid leukemia leukemia without maturation (M1)
- acute promyelocytic leukemia (M3)
Which type of anaemia is ussually present in a patient with acute leukemia
Normocytic, Normochromic
In leukemia which term decribes a peripheral blood finding of leukocytosis with a shift to the left, accompanied by nucleated red cells
Leukoerythroblastosis
The basic pathophysiological mechanisms responsible for producing signs and symptoms in leukemia include all of the following except
Decreased erythropoietin production
Which type of acute myeloid leukemia is called the true monocytic leukemia and follows an acute or sub acute course charcterized by monoblasts, promonocytes and monocytes
Acute monocytic anaemia
In which age group does acute lymphoblastic leukemia occur with the highest frequency
1-15 years
Disseminated intravascular coagulation (DIC) is mostly often associated with which of the following types of acute leukemia
Acute promyelocytic leukemia
In Myelofibrosis, the characteristic abnormal red blood cell morphology is that of
Tear drop cell
PV is characterized by
Absolute increase in total red cell mass
Features of secondary polycynthemia incude all of the foloowing except
splenomegaly
The erythrocytosis seen in relative polycythemia occurs because of
Decreased plasma volume of circulating blood
In PV, what is characteristically seen in the peripheral blood?
Pancytosis
The leukocyte alkaline phosphatase (LAP) stain on a patient gives the following results:
10(0) 48(1+) 38(2+) 3(3+) 1(4+). Calculate the LAP score.
The LAP score is calculated as: (the number of 1+ cells x 1) + (2+ cells x 2) + (3+ cells>
3) + (4+ cells x 4).
137
CML is distinguished from leukemoid reaction by which of the following?
CML: low LAP; leukemoid: high LAP
Which of the following occurs in idiopathic Myelofibrosis (IMF)?
All of these options
What influence does the Philadelphia (Ph1) chromosome have on the prognosis of
patients with chronic myelogenous leukemia?
The prognosis is better if Ph1 is present
Which of the following is (are) commonly found in CML?
An increase in basophils
In which of the following conditions does LAP show the least activity?
In leukomoid reactions
A striking feature of the peripheral blood of a patient with CML is a:
Presence of granulocytes at different stages of development
Which of the following is often associated with CML but not with AML?
Splenomegaly
The JAK2(V617F) mutation may be positive in all of the following chronic
myeloproliferative disorders Except
CML
All of the following are major criteria for the 2008 WHO diagnostic criteria for essential
thrombocythemia Except:
Sustained platelet count >600 x 109/L
A patient in whom CML has previously been diagnosed has circulating blasts and
promyelocytes that total 30% of leukocytes. The disease is considered to be in what
phase?
Transformation to acute leukemia
Normal ranges of WBC
4.5 -11.5 X 10^9/L
Normal ranges of RBC
4 - 6 X 10^9/L
Normal ranges of Hgb
14 - 18 g/dL
Normal ranges of HCT
40 - 54 %
Normal ranges of HCT
40 - 54 %
Normal ranges of MCV
80 - 100 fL
Normal ranges of MCHC
32 - 36 g/dL
Normal ranges of MCH
26 - 32 pg
Normal ranges of platelet
150 - 450 x 10^9/L
Normal ranges of RDW
11.5 - 14.5 %
Normal ranges of reticulocyte
25 - 75 x 10^9/L
In a table differentiate CML and Leukomoid reaction
CML LEUKOMID REACTION
1. There is increase in 1. increase in
all granules neutrophils and
their immature forms
2. Precence of dyspoietic 2. Reactive
morphology morphology is
is present
but no dyspoietic
morphology
3. Platelet are involved; giant 3. No abnormal
and hypogranular forms platelet morphology
seen
4. Leukocyte alkaline 4. Leukocyte
phosphatase score is markedly phosphatase
decreased markedly
increased
The neoplastic cells in Nodular sclerosis morphological subtype of classical
Hodgkin lymphoma (3)
- Reed sternberg cells
- Lacular cells
- Hodkin cells
The hallmark feature of Burkitt lymphoma is a high proliferation rate, a feature linked
to constitutive expression of(1):
MYC gene
The cell of origin for chronic lymphocytic leukemia/small lymphocytic lymphoma (2)
- Naive B cell
- Memory B cell
WHO classification variant of Burkitt lymphoma common in Africa and its
presentation(2)
endemic, presenting with jawbone
The genetic feature that interconnect ET, PV and PMF and suggests a continuum of
diseases(1)
JAK2 gene mutation
Disintegrated lymphoid cells present on the PB film in CLL not seen in other types of
malignant lymphoma (1)
smudge cells
one important difference between
chronic lymphocytic leukemia and small lymphocytic lymphoma
Chronic lymphocycytic leukemia are present in a peripheral blood and bone marrow while small lymphocytic lymphoma is present in lymoh nodes and other lymphoid organs
one important difference between the Pre-germinal center CLL and post-germinal center CLL (2 marks)
Pregeminal center of CLL there is no mutation of VH gene and there is trisomy 12 while in post germinal center there is mutation of VH gene and deletion of chromosome 13q14
Whta is the important difference between Accelerated phase and Blastic phase of CML (2 marks)
Accelerated phase there is 10 - 19 of blast while in blastic phase there is greater than or equal to 20% of blast.
one important difference between Small lymphoblast and large lymphoblast (2 marks)
small lymphocytes are involved in antibody production while large lymphoblasts are involved in differentiation process to produce more specialized and functional cells such as mature lymphocytes
one important difference between Blast count in Blastic crisis and metamorphosis (acceleration) phase of CML (2
narks)
Blast count in blastic crisis os greater than or equal to 20% while in acceralation phase is 10-19
Write a scientific reason for the occurrence of the following:
1.12 Higher dosages of Imatinib will restore remission in most patients who acquire
additional BCR/ABL during treatment of CML (4 marks).
Normal dosage of imatinib will restore remission in patient who have a single mutation of chromosome which has came due to translocation ofchromosome 9 and 22
Write a scientific reason for the occurrence of When performing differential counts and encountering a lymphocytic cell that
looks like a blast is most likely a reactive lymphocyte if all other findings are normal.
- Chemical Exposure: Exposure to certain chemicals, such as benzene, can elevate the risk of lymphocytosis. While this link is stronger for acute myeloid leukemia (AML), it can also apply to acute lymphocytic leukemia (ALL).
- Viral Infections: Rarely, viral infections like the human T-cell lymphoma/leukemia virus-1 (HTLV-1) or Epstein-Barr virus (EBV) can lead to blast-like lymphocytes, especially in specific geographic regions
- Infection: Reactive lymphocytes can resemble blasts due to an immune response triggered by infections. These activated lymphocytes undergo rapid proliferation, leading to their blast-like appearance
Write a scientific reason for the occurrence, Clinical symptoms mimic those of acute leukemia in the Blastic phase of CML .
Neutrophil Deficits: Patients with acute myeloid leukemia (AML) exhibit qualitative and quantitative deficits in granulocytes, which predispose them to bacterial and fungal infections. These deficits arise from the underlying malignancy and are compounded by periods of neutropenia induced by chemotherapeutic agents1.
