Unit 5 Review Flashcards
A definition of a leukemia could include:
*both A and C
- an overproduction of leukocytes
- malignant cells trespassing the blood brain barrier
Descriptive terms for most lymphomas can include:
A solid malignant tumor of the lymph nodes
An acute leukemia can be described as being
Of short duration with many immature leukocyte forms in the peripheral blood
A difference between the FAB and WHO staging systems is that:
WHO uses molecular information
The etiology Al agents of leukemia can include:
*all of the above
- ionizing radiation
- certain infectious agents
- chemical exposure to benzene
HIV is associated with
AIDS
Cancer-predisposing genes may act by:
- all of the above
- affecting the rate at which exogenous precarcinogens are metabolized to actively cargcinogenic forms
The incidence of leukemia in higher in:
Scandinavian versus Japanese populations
Which of the following are typical characteristics of an acute leukemia?
*all of the above
- replacement of normal marrow elements by leukocyte blasts and bleeding episodes
- blasts and immature leukocytes in the peripheral blood and anemia
- leukocytosis
Myeloid and monocytic acute leukemias are classified:
M4
Monocytic acute leukemia is classified as FAB:
M5
Myeloid without maturation acute leukemias is classified as FAB
A
Lymphoblastic (one-cell population) acute leukemias are classified as FAB
L1
Characteristics of FAB M1 include:
Leukocytosis without maturation of the myeloid cell line in the peripheral blood
The incidence of FAB M1 is:
*both A and C
- high in children younger than 18 months of age
- high in middled-aged adults
A mixture of myeloid and monocytic blasts predominant in:
FAB M4
Blasts of the monocytic type of predominate in:
FAB M5
Many coarsely granular Promyelocytes with dumbbell-shaped or bilobed nuclei predominate in:
FAB M3
Myeloblasts, promyelocytes and myelocytes predominate in:
FAB M2
Immature leukocytic and erythrocytic cell types predominate in:
FAB M6
Which cytochemical stain will demonstrate lysosomal enzyme activity in primary azurophilic granules?
Myeloperoxidase
Multinucleated (3-5) erythroid presurcsors are usually seen in
AML without maturation
The M:E ratio in acute erythroid leukemia is usually
Low
Auer rods are:
An aggregation of lysosomes or primary granules
One cytochemical stain that can differentiate most cases of precursor lymphoblastic leukemia from other forms of leukemia is
TdT terminal deoxynucleotidyla transferase
Which cellular series can be identified by a positive Sudan Black B reaction?
Myelocytic
Which type of cell demonstrates the most intense per oxidase reaction?
Neutrophil, expect blast forms
Which cytochemical stain is associated with selectively identifying lipoproteins in the cellular membranes of myelogenous cells and mitochondria?
Sudan Black B
Which cytochemical stain is associated with staining glycogen and related mucopolysaccharides?
Periodic acid Schiff stain (PAS)
Leukemia secondary to Burkitt’s lymphoma is classified as
FAB L3
Childhood lymphoblastic leukemia is classified as:
FAB L1
Older children and adults are typically classified with:
FAB L2
Chloromas are associated with:
FAB M1
A common characteristic of ALL is:
Bone and joint pain
Patients with AML have a good prognosis if:
Less than 45 years of age
Which of the following classification systems delineates each subtype of acute leukemia on Immunophenotyping and cytogenetic analysis as well as morphology?
WHO
A MLS is reviewing a patients peripheral blood smear and notices many eosinophils in addition to two different populations of blasts— myeloid and monocytic. Immunophenotyping revealed blasts were positive for CD14 and CD33. Which of the following cytogenetic abnormalities would be expected finding with this picture?
Inv (16)9p13q22
A 27 year old woman presents with acute bleeding to the emergency department and is found to have a white count of 25.7 x 10^9/L. She has a combination of 97% blasts and abnormal promyelocytes in her peripheral blood; some of these cells contain stacked Auer rods. What form of these cells contain stacked Auer rods. What form of leukemia does she most likely have?
Acute myeloid with t (15; 17) (q22:q12)
A confirmed ALL patient was also positive for the Philadelphia chromosome. What conclusions can you make from this?
The patient has a poorer prognosis
A diagnosis of an acute leukemia according to the World Health Organization is defined by:
> 20% non-erythroid blasts in the bone marrow
An unknown blast is positive for CD34, CD19, CD10 (CALLA), CD22, and TdT. Using WHO guidelines, this Immunophenotyping profile is consistent with which classification of ALL?
Common ALL
ALL prognosis is NOT dependent on which of the following?
Morphology of blasts
Patients with Down Syndrome are predisposed to developing ALL due to what genetic alteration?
GATA1 mutation
The most common form of chronic leukemia in Western countries is:
Lymphocytic
The median survival time of patients with CLL, compared with patients with chromic monocytic leukemia, is
Longer
CLL is classified a
B-cell disorder
CLL symptoms frequently include
Absolute lymphocytosis, malaise, and low-grade fever
Characteristics of malignant lymphoma typically include:
- both B and C
- overproliferation of lymphocytes
- lymph node involvement
Hodgkin disease
Is a lymphoma, characterized by Reed-Sternberg cells, and occurs more frequently in males than in females
Rare forms of lymphoma include
Sezary syndrome and mycosis fungocides
Multiple myeloma is a disorder of
Plasma cells
The abnormal Protein frequently found in the urine of persons with multiple myeloma is:
Bence Jones
WM is chatacterized by increased levels of:
IgM
Which cluster designations are positive in typical HCL?
CD25, CD22, CD19, CD20
If a 65-year old female with swollen lymph nodes has a CBC performed and many smudge cells were noted along with lymphocytosis, a probably diagnosis might be:
Chronic lymphocytic leukemia
The most common lymphoma is young adults is
Hodgkin’s disease
MGUS is characterized by __________
Monoclonal immunoglobulin in a patients serum with only a small percentage of infiltration of bone marrow with plasma cells
MPNs are characterized by all of the following except:
Initial increase of immature cells
In CMLs, the total leukocyte (WBC) count is:
Extremely increased
Primary myelofibrosis differs from other types of MPN in which of the following ways?
Marrow fibrosis is greatly increased
Which of the following is a remarkable characteristic of PRV compared with other types of MPNs?
Extremely increased erythrocyte mass
Which of the following is a predominant features of essential thrombocythemia compared with other types of MPNs?
Extremely increased number of platelets
In MPN, the test results of disorders of hemostasis and coagulation that are most likely to be abnormal are
Increased APTT, decreased factor V level, and increased concentration of antithrombin III in many
Interferon alpha has been shown to
Suppress proliferation of hematopoietic progenitor cells
A leukemia of long duration that affects the neutrophilic granulocytes is referred to as:
CML
The alkaline phosphatase cytochemical staining reaction is used to differentiate between
CML and severe bacterial infections
Patients with the initial phase of CML are prone to:
Low grade fevers, night sweats, and splenic infarction
The total leukocyte count in CML usually is _______ x 10^9/L
> 50
The Philadelphia chromosome is typically associated with:
CML
Patients with PRV suffer from
Hypervolemia
In PRV, cytogenetic results do not predict/provide
Evolution of the disease
Hyperviscosity can produce
Dizziness
The major criteria for diagnosis of PRV include all of the following except:
Splenomegaly
Increased blood viscosity in patients with PRV can cause a dangerous condition of:
Vascular occlusion
The level of erythropoietin in the urine is _______ in patients with PRV compared with other kinds of polycythemia
Decreased
Patients with PRV demonstrates a _________ of hemosiderin in the bone marrow
Absence
Treated patients with PRV have a _________ life expectancy after diagnosis
More than 10 years
The primary treatment for PRV is
Therapeutic phlebotomy
Primary myelofibrosis is also called
Agnogenic myeloid metaplasia
The incidence of primary myelofibrosis is known to increase after exposure to:
Benzene
The predominant clinical manifestation of primary myelofibrosis is
*all of the above
- anemia
- splenomegaly
- medullary fibrosis
The most constant feature of primary myelofibrosis is
Dysmegakaryocytopoeisis
A leukoerythroblastic picture includes all of the following except:
Immature lymphocytes
The median survival time for patients with primary myelofibrosis is approximately _______ year(s)
5
If a peripheral blood smear exhibit numerous teardrop-shaped RBCs and abnormal platelets, what is a likely diagnosis?
Myeloid metaplasia
The least common form of MPN is
Essential thrombocytothemia
A major criterion for the disorder in patients with essential thrombocythemia is:
Persistent increase of platelets in peripheral blood
The most common disorder in patients with essential thrombocytothemia is
Neurological manifestations
OR
Thrombotic or bleeding problems
The bone marrow architecture is essential thrombocythemia is similar to the architecture seen in:
Leukocyte hyperplasia
Patients with some type of MDS are at increased risk of developing
AML
Which of the following agents has not been supported by scientific research as being associated with the development of secondary MDSs?
*both B and C
- organic solvents
- insecticides
An increased incidence of MDSs in seen in:
Males older than 55 years of age
The most frequently involved chromosomes in adults with MDSs are:
5, 7, and 8
The most frequent chromosomal abnormalties in children with MDSs include all of the following except:
- all of the above
- trisomy 8
- monopsony 7
- deletion of long arm of chromosome 20
The incidence of chromosomal abnormality in adults with MDSs is
40-90%
The karyotype associated with a high probability of transforming to AML is:
- both A and B
- monosomy 5
- monosomy 7
Patients with MDSs commonly suffer from________ initially
Anemia
An appropriate description of refractory anemia (RA) is
Anemia with less than 1% blasts
In young patients, the therapy of choice for MDSs involves
Cytopenia, less than 5% blasts, no Auer rods
In young patients, the therapy of choice for MDSs involves
Allogeneic bone marrow transplantation
Heinz bodies are:
Denatured by crystal violet stain
Prussian blue stain procedures
Precipitates of free iron into blue or blue-green granules
Periodic acid-Schiff procedures
Intense cytoplasmic granular staining particles in erythroleukemia
Peroxidase stain produces
Non-staining in lymphocytes
The result for an leukocyte alkaline phosphatase (LAP) stain is:
Normal, if the result is 32-182 with fast blue RR dye
Leukocytes that demonstrate a positive reaction in tartaric acid-resistant phosphatase cytochemical staining ate the lymphocytes seen in:
Hairy cell leukemia
LAP blood smears should be stained with_______ of specimen collection
8 hours
TRUE or FALSE: Anemia, low platelet count, and low leukocyte count, usually with absolute neutropenia, are commonly present in myelodysplastic syndrome
True
The hallmark of laboratory studies is chronic myeloprolifertive disorders is:
Cytogenetic abnormalties
Chronic myeloproliferative disorders include which of the following
- A, B and C
- essential thrombocythemia
- chronic myelogenous leukemia
- polycythemia Vera
Periodic-acid Schiff (PAS) reaction is:
Negative in myelocytes
Periodic Acid Schiff reaction stains:
Glycogen
Which of the following statements is true of multiple myeloma?
1— the presence of the Reed-sternberg cell
2— presence of bence-jones protein
3— presence of “M” spike on electrophoresis
4— a plasma cell leukemia
2, 3, and 4 correctly
Sudan Black stain differentiates
- AML from ALL
The FAB classification of leukemia is a means of:
*both A and B
- classifying acute leukemias
- assessing prognosis
50-90% of myeloblasts in a peripheral blood is typical of which of the following:
Acute granulocytic leukemia (MI)
The most common consistent chromosomal abnormality in CLL is _______
Trisomy of chromosome 12
The type of acute leukemia most commonly seen in children is
Acute lymphocytic
The nature of MDS occurring in those older than 50 and include
- all of the above
- CMML and CLL
- CML and CLL
- RA, CMML and RARS
What FAB classification would match the following description: large and small megakaryoblasts with high N:C ratio; pale agranular cytoplasm?
M7
Oncogenes are:
*both B and C
- genetic targets of carcinogens
- altered versions of normal genes
AML is the ________ leukemia subtype
Most common
From the list below, which are the prominent hematological findings in MDS
*A and B only
- Sideroblastic and HJ bodies
- Giant platelets, hypogranulation
What FAB classification would match the following description: small cells predominate, nuclear shape is regular with occasional cleft?
L1
SHORT ANSWER: what is the cytochemical stain that best separates acute myelocytic from acute monocytic leukemia?
Naphthol Esterase stain
What FAB classification would match the following descriptions: both myelogenous and monocytic cells are present, at least 20% of total WBC?
M4
What FAB classification would match the following description: large cells with irregular nuclear shape: clefts in nucleus are common?
L2
The alpha-naphthalene acetate esterase cytochemical staining reaction is:
Strongly positive in monocytes
SHORT ANSWER: compare lymphoma vs. leukemia, give 2 ways they differ from each other
- lymphoma is a solid mass that presents as a tumor and leukemia is a neoplastic proliferative disease
- lymphoma are characterized by into 2 types (Hodgkins and Non Hodgkins) based on absence/presence of Reed-Sternberg cells. Leukemia are classified to the FAB or WHO classification systems
What FAB classification would match the following description: blasts and promyelocytes predominate without further maturation?
M1
What FAB classification would math the following description: Promyelocytes predominate in the bone marrow?
M3
What FAB classification would math the following description: known as DiGulielmo syndrome, abnormal proliferation of all cells?
M6
SHORT ANSWER: list 2 myelodysplastic syndrome
- refractory anemia (RA)
- refractory anemia with ringer Sideroblasts (RARS)
What FAB classification would match the following description: most cells are monocytic?
M5
SHORT ANSWERS: List 3 factors related to the occurrence of leukemia
- genetic & immunological factors ( oncogenes, translocations most common)
- occupational/environmental exposure (ionizing radiation, insect/herb/fungicides
- viral agents (EBV, HIV, HTLV-1)
What FAB classification would match the following description: cells are large and homogenous in size; nuclear shape is round with 1-3 prominent nucleoli
L3
Chronic lymphocytic leukemia is defined as :
Malignancy of the thymus
Very low levels of leukocyte alkaline phosphatase can be found in:
- all of the above
- viral hepatitis
- IM
- PCH
PB characteristics of which of the following diseases has the following presentation?
RBC x 10^12/L —> increasing significantly
WBC x 10^9/L —> increasing
Platelets x 10^9/L —> moderately increasing
Polycythemia
Patients with some variety of myelodysplastic syndrome are at increased risk of developing
Acute nonlymphocytic leukemia
What is the best indication of a bleeding disorder?
Bleeding time
