Hematology Exam 2 Book Questions
which laboratory test(s) provide the most important prognostic information in multiple myeloma a) Hemoglobin b) albumin c) B2-microglobulin d) all of the above
d
which of the following is not a characteristic of a chronic MPD a) extramedullary hematopoiesis b) possible termination into acute leukemia c) cytogenetic abnormalities d) hypoplasia of bone marrow
d
what is the predominant abnormal erythrocyte morphology associated with idiopathic myelofibrosis a) schistocytes b) ovalocytes c) teardrop cells d) target cells
c
what is the safest and least expensive treatment for patients with PV a) high altitude b) decrease of iron levels c) therapeutic phlebotomy d) decrease of erythropoietin levels
c
which of the following is characteristic of the accelerated phase of CML a) persistent thrombocytosis or thrombocytopenia b) blasts greater than 5% in the peripheral blood or bone marrow c) basophilia greater than 20% d) all of the above
d
what does staging refer to a) bone marrow compatibility b) estimate of disease severity c) chemotherapy regimen d) determination of specific immunoglobulin in heavy-chain disease
c
A 42-year-old woman presents with an elevated white blood cell count, anemia and thrombocytopenia. The white blood cell count is 50 x 10^9/L with 80% blasts, 15% segmented neutrophils, and 5% lymphocytes. The bone marrow reveals sheets of immature cells. Cytochemical studies show MPO positive (20%) and the nonspecific esterase negative staining on the immature cells. Flow cytometry shows the blast population positive for CD13, CD33, dim CD45, CD34, and CD117. What is the diagnosis? a) AML, without maturation, FAB M1 type b) AML, with maturation, FAB M2 type c) AML, acute myelomonocytic leukemia, FAB M4 type d) AML, acute monoblastic leukemia, FAB M5 type
a
How many blast cells in the bone marrow aspirate smear are necessary for a diagnosis of acute leukemia using the WHO criteria? a) 20% b) 15% c) 25% d) 30%
a
Which chromosome abnormality occurs in the FAB M2 type of AML a) t(8;21) b) t(9;22) c) t(15;17) d) t(1;19)
a
a lymphoma expressing a monoclonal B-cell phenotype with coexpression of CD10 and rearrangement of the BCL2 gene is most likely derived from a) follicular center cells b) mantle cells c) marginal zone cells d) interfollicular cells
a
a mutated tumor suppressor gene found in a variety of human cancers, including CLL is a) p53 b) MDM2 c) HLA-DR d) CD4
a
an asymptomatic mediastinal mass affecting a young woman is a common form of presentation for which type of Hodgkin's lymphoma a) nodular sclerosing b) lymphocyte-predominant c) Mixed cellularity d) lymphocyte depletion
a
in chronic lymphocytic leukemia a) the absolute lymphocyte count is usually equal to or exceeds 50 x 10^9 cells/L b) hemoglobin level, platelet count, and absolute number of neutrophils may be normal or elevated c) the neoplastic lymphocytes in the blood or bone marrow are large with fine chromatin and prominent nucleoli
a
in female patients with RA and elevated platelet counts, which chromosome abnormality is most often found a) 5q b) t(8;21) c) 7q d) t(15;17)
a
what condition is defined by a platelet count greater than 600 x 10^9/L, megakaryocytic hyperplasia, absence of Ph chromosome, and hemoglobin of 13 g/dL or more (or normal red cell mass)? a) essential thrombocythemia b) May-Heggelin anomaly c) acute myelogenous leukemia d) PV
a
what defect is found in lipid storage diseases a) subcellular accumulation of unmetabolized material in lysosomes b) cellular accumulation of metabolites in cytoplasm c) protein accumulation in cellular mitochondria d) abnormal sequestration of minerals and trace elements in cellular nuclear organelles
a
what is the enzyme deficiency seen in Niemann Pick disease a) sphingomyelinase b) hexosaminidase A c) B-glucocerebrosidase d) B-galactosidase
a
which features help to distinguish secondary erythrocytosis and relative erythrocytosis from PV a) absence of splenomegaly, normal leukocyte, platelet, and LAP levels b) presence of splenomegaly, increased leukocyte, platelet, and LAP levels c) presence of hepatomegaly, decreased leukocyte, platelet, and LAP levels d) presence of both splenomegaly and hepatomegaly, increased leukocytes and platelets, decreased LAP score
a
which list would contain diagnostic criteria for multiple myeloma a) Biopsy-proven plasmacytoma and 10% and 30% plasma cells b) more than 30% plasma cells in bone marrow c) biopsy- proven plasmacytoma and M-spike present d) monoclonal protein and M-spike present
a
which of the following chronic MPDs is associated with the best prognosis a) CML b) IMF c) PV d) ET
a
which of the following clinical and laboratory manifestations would point to a diagnosis of hairy-cell leukemia 1) pancytopenia 2) splenomegaly 3) CD20+, CD103+, CD25+ 4) prominent generalized lymphadenopathy a) 1, 2, and 3 are correct b) 1 and 3 are correct c) 2 and 4 are correct d) 4 is correct e) 1, 2, 3, and 4 are correct
a
which of the following factors does not cause fibroblast proliferation a) CSF b) TGF-B c) bFGF d) PDGF
a
which of the following is true concerning the organelle zone? a) responsible for metabolic activities of the platelet b) contains dense granules, a granules, and glycocalyx c) contains the dense tubular system which is the site of prostaglandin synthesis, calcium release, and platelet relaxation d) contains the OCS to deliver stored products to the platelet surface
a
which of the following myeloproliferative disorders is characterized by a decreased LAP score a) CML b) IMF c) ET d) PV
a
A 21-year-old patient's bone marrow and peripheral blood has medium sized blasts with basophilic cytoplasm and numerous lipid vacuoles. Cytogenetic studies show t(8;14) involving MYC on chromosome 8 and the Ig heavy chain region on chromosome 14. Flow cytometry is most likely to show which of the following? a) CD3, CD7, CD10, CD45, and TdT b) CD10, CD19, CD20, CD45, and surface k light chain c) CD10, CD19, CD45, TdT, and surface k light chain d) CD10, CD19, CD34, and no surface light chain or TdT
b
A 49-year-old woman was admitted to the hospital for easy bruising and menorrhagia. She had evidence of disseminated intravascular coagulation (DIC). Her white blood cell count is 3 x 10^9/L with 95% large, atypical mononuclear cells and some packed with larger, purple-staining granules; some have multiple Auer rods; and all are strongly peroxidase-positive. What is the diagnosis? a) AML, FAB M2 b) AML, FAB M3 c) AML, FAB M4 d) AML, FAB M5
b
All follicular center lymphomas are composed of a mixture of: A) Small cleaved and small non-cleaved cells B) Centrocytes (small cleaved) and centroblasts (large non-cleaved) cells C) Large cleaved cells and immunoblasts D) Prolymphocytes and paraimmunoblasts
b
Most patients (85%) are diagnosed in which phase of CML? a) accelerated phase b) chronic phase c) blast phase d) all of the above
b
Reed-Strenberg cells usually express the following immunophenotype a) CD45+, CD30+, CD15+ b) CD45-, CD30+, CD15+ c) CD45+, CD30+, CD15- d) CD45-, CD30-, CD15+
b
What is the chromosomal abnormality in CML a) t(8;14) b) t(9;22) c) t(1;12) d) Trisomy 12
b
Which of the following is true about the prognostic implications of cytogenetic findings seen in precursor B-cell ALL? a) hypodiploidy as determined by flow cytometry DI is associated with favorable prognosis b) t(1;19) PBX-E2A is associated with unfavorable prognosis c) t(9;22) BCR-ABL is associated with a favorable prognosis d) Hyperdiploidy of greater than 50 chromosomes as determined by flow cytometry DI is associated with a poor prognosis
b
immunophenotypic study using flow cytometry shows negative T-cell markers. However, neoplastic cells express bright CD19, CD20, and weak CD5 and show monotypic k light-chain restriction. Cyclin D1 immunohistochemical stain is negative. These cells will also express: a) CD103 b) strong FMC7 c) CD23 d) dim surface immunoglobulin e) CD38
b
the cells of CLL are morphologically identical to those of: a) ALL b) small lymphocytic lymphoma c) infectious mononucleosis d) Sezary syndrome
b
the diffuse aggressive lymphomas are a) seldom curable b) rapidly fatal if untreated c) best treated with a combination of surgery and radiotherapy d) single-agent chemotherapy is the treatment of choice
b
the poorest prognosis for patients with CLL is associated with which of the following features a) anemia b) splenomegaly c) thrombocytopenia d) white cell count greater than 15,000 cells/uL a) 1, 2, and 3 are correct b) 1 and 3 are correct c) 2 and 4 are correct d) 4 is correct e) 1, 2, 3, and 4 are correct
b
what are the characteristics of Neimann-Pick cells a) Atypical lymphocytes with large vacuoles b) cytoplasm filled with lipid droplets, inconspicuous nucleus c) vacuolated histiocytes or foam cells d) lymphocytes with Alder-Reilly bodies
b
what are the clinical features of Tay-Sachs disease a) waxy jaundiced skin, retarded physical and mental development, cherry-red spot on macula of eye b) startle reflex, blindness, macrocephaly, no enlargement of liver, spleen, or lymph nodes c) abnormal facial features, deafness, increased body hair, mental retardation, heart damage, structural deformities d) splenomegaly, hepatomegaly, eye, skin, nervous system, and lung abnormalities
b
what are the laboratory findings in PV a) decreased hematocrit, increased RBCs and granulocytes, decreased platelets b) increased hematocrit, increased RBCs, granulocytes, and platelets c) normal hematocrit, normal RBCs, increased granulocytes and platelets d) increased hematocrit, increased RBCs, decreased granulocytes and platelets
b
what condition is not characteristically associated with reactive thrombocytosis a) acute hemorrhage b) aplastic anemia c) chronic inflammatory disorders d) iron-deficiency anemia
b
what is the enzyme deficiency seen in Tay-Sachs disease a) Sphingomyelinase b) Hexosaminidase A c) B-glucocerebrosidase d) B-galactosidase
b
what is the origin of MPDs (Myeloproliferative Disorders) a) fibroid infiltration of major organs b) neoplastic transformation of multipotential stem cells c) widespread deterioration of cellular function d) splenic sequestration of normal blood cells
b
when is myelosuppression advocated in patients with PV a) if the patient is less than 20 years old b) when thrombosis-associated risk factors are present c) if the patient shows signs of glossitis d) if the patient has failed iron therapy
b
which MDS scoring system is most often used today a) FAB b) IPSS c) Sanz d) Bournemouth
b
what cytochemical stain is best for differentiating AML from ALL? a) Alpha-naphthyl acetate b) nonspecific esterase c) Myeloperoxidase d) Periodic Acid-Schiff
c
what is the enzyme deficiency seen in Gaucher's disease a) Sphingomyelinase b) Hexosaminidase A c) B-glucocerebrosidase d) B-galactosidase
c
which description best characterizes type 1 Gaucher's disease a) found in any ethnic group, multiple neurologic signs, including difficulty in swallowing and manifestations involving brain stem; enlargement of liver and spleen b) found primarily in Ashkenazi Jews, enlargement of liver and spleen, anemia thrombocytopenia c) found in northern Sweden; neurologic disorders, bone disorders, skin pigment changes d) found in Mediterranean populations; hypermetabolic manifestations, fever, lethargy, poor musculature, bone deformities
b
which of the MDS subtypes is more closely related to the chronic myeloproliferative disorders a) RAEB b) CMML with WBC > 13 x 10^9/L c) CMML with WBC < 13 x 10^9/L d) RARS
b
which of the following agents may lead to secondary MDS (sMDS) a) hydrocortisone b) alkylating agents c) irradiated blood components d) folic acid
b
which of the following biologic or genetic abnormalities are important in the pathogenesis of MDS a) chromosomal translocations b) chromosomal deletions c) hemolysis d) increased intramedullary apoptosis
b
which of the following findings would point to a diagnosis of CLL? 1) clonal proliferations of B lymphocytes 2) CD19+/CD51+, CD23- 3) CD19+/CD51+, CD23+ 4) Ph chromosome positive a) 1, 2, and 3 are correct b) 1 and 3 are correct c) 2 and 4 are correct d) 4 is correct e) 1, 2, 3, and 4 are correct
b
which of the following is most likely to affect prognosis in MDS a) leukopenia b) increased bone marrow myeloblasts c) erythroid hyperplasia d) thrombocytosis
b
which of the following would be diagnostic criteria for Waldenstrom's macroglobulinemia a) IgM M-spike and hyperviscosity b) lytic bone lesions and rouleaux c) renal failure and more than 30% plasma cells d) M-spike of IgM, IgG, or IgA; low-normal levels of other immunoglobulins; inability to make light chains
b
which type of treatment may offer a cure in patients with MDS a) chemoradiotherapy b) allogeneic bone marrow transplantation c) autologous bone marrow transplantation d) growth factors such as G-CSF
b
A 4 year old boy presents with bruising, fever, and coughing. His white blood cell count is 15 x 10^9/L, hematocrit 23%, and platelets 53 x 10^9/L. A bone marrow aspirate is obtained that reveals sheets of immature cells. Cytochemical studies for peroxidase and NSE are negative, the TdT is positive, Surface markers studies are done that show the following phenotype: HLA-DR+, CD19+, CD10+, Cu-, sIg-, CD7-. A portion of the aspirate is sent for cytogenetics and molecular studies. What is the most likely diagnosis? a) AML b) Precursor-B-cell ALL with t(9:22) BCR-ABL c) Precursor-B-cell ALL with t(12:21) TEL-AML1 d) T- cell ALL
c
Cytochemical stains were performed on bone marrow smears from an acute leukemia patient. All blasts were TdT negative. The majority of the blasts showed varying amounts of Sudan black B positivity. Fifty percent of them stained positive for nonspecific esterase. What type of leukemia is indicated? a) Acute myeloblastic leukemia b) ALL c) Acute myelomonocytic leukemia d) Acute erythroleukemia
c
MALT lymphomas are characterized by all of the following except a) extranodal involvement b) associated follicular hyperplasia c) CD19+, CD5+, CD10+ phenotype d) t(1;18)
c
The thrombosis seen in patients with essential thrombocythemia is a result of which of the following? a) protein C deficiency b) marked fibroblast proliferation c) intravascular clumping of sludged hyperaggregable platelets d) splenic sequestration of platelets
c
What is the M:E ratio in patients with CML (chronic myelogenous leukemia) a) 1:10 b) 1:5 c) 10:1 d) 3:1
c
Which of the following is not consistent with leukemoid reaction a) High WBC count b) associated with bacterial infection c) presence of Philadelphia chromosome d) high LAP
c
Which phase of CML carries the worst prognosis and is generally unresponsive to treatment? a) chronic b) accelerated c) blast d) refractory
c
Which type of anemia is most common in MDS? a) microcytic, hypochromic b) normocytic, hypochromic c) macrocytic, normochromic d) dimorphic
c
a patients with Hodgkin's lymphoma that is localized to lymph nodes above and below the diaphragm and is associated with drenching night sweats would be classified as a) Stage IIIE b) Stage IIB c) Stage IIIB d) Stage IIIA
c
lymphoblastic lymphomas are associated with all of the following except a) high frequency of developing acute lymphoblastic leukemia b) mediastinal mass c) usually express B-cell phenotype d) potentially curable in young patients
c
lymphomatous polyposis is a type of a) small lymphocytic lymphoma b) large-cell lymphoma c) mantle cell lymphoma d) MALT lymphoma
c
surface immunoglobulin is the most reliable surface marker for a) T lymphocytes b) plasma cells c) B lymphocytes d) Histiocytes
c
the cell characteristic of all types of classic Hodgkin's lymphoma are: a) Lacunar cell b) L&H cell c) Reed-Sternberg cell d) Sezary cell
c
the immunophenotypic definition of B-cell monoclonality is a) clonal rearrangement of the IgH gene b) loss of B-cell antigens by the malignant cells c) expression of a single light-chain class d) expression of a single heavy-chain class
c
translocations involving the BCL1 and IgH genes are commonly associated with which low-grade B-cell lymphoma a) small lymphocytic b) lymphoplasmacytic c) mantle cell d) marginal zone
c
what is the expected erythropoietin value in PV a) normal b) increased c) decreased
c
which cell is found in Tay-Sachs disease, but is not considered diagnostic a) Atypical lymphocytes with large vacuoles b) cytoplasm filled with lipid droplets, inconspicuous nucleus c) vacuolated histiocytes or foam cells d) lymphocytes with Alder-Reilly bodies
c
which chromosome abnormality occurs in the FAB M3 type of AML? a) t(8;21) b) t(9;22) c) t(15;17) d) t(1;19)
c
which of the following criteria will differentiate RAEB-t from AML of the M2 type a) thrombocytopenia b) anemia c) the finding of t(8;21) d) blasts less than 5%
c
which of these cell surface antigens is of prognostic significance in MDS a) CD19 b) CD HLA-DR c) CD34 d) CD33
c
Bone marrow examination reveals a hypercellular marrow with 60% blasts. Flow cytometry shows the following blast immunophenotype: CD3, CD7, CD10, CD13, CD34, CD45, and TdT positive. Surface immunoglobulins are negative. The diagnosis is: a) Burkitt's leukemia b) AML c) ALL, precursor B-cell type d) ALL, precursor T-cell type
d
Burkitt's lymphoma is histologically characterized by which of the following a) uniform nuclei b) high mitotic rate c) "starry sky" pattern d) all of the above
d
How many blast cells in a bone marrow aspirate smear are necessary for a diagnosis of acute leukemia using FAB criteria? a) 20% b) 15% c) 25% d) 30%
d
The white blood cell count is 15 x 10^9/L with 90% blasts, 6% segmented neutrophils, and 4% monocytes. The blasts are relatively large and have abundant cytoplasm. More than 90% of them are positive with the nonspecific esterase stain, and an occasional blast is positive with Sudan black. What is the diagnosis? a) AML, with maturation, FAB M2 type b) AML, acute promyelocytic leukemia, FAB M3 type c) AML, acute myelomonocitic leukemia, FAB M4 type d) AML, acute monoblastic leukemia, FAB M5 type
d
What is the likely genetic abnormality referring to AML, FAB M3? a) t(8;21) AML1-ETO b) t(4;11) AF4-MLL c) t(9;22) BCR-ABL d) t(15;17) PML-RARa
d
Which cytochemical stain is useful in separating myeloblasts from monoblasts a) myeloperoxidase b) Sudan Black B c) specific esterase d) nonspecific esterase
d
a lymphoma associated with infection by a type C retrovirus is a) endemic to Japan b) associated with hypercalcemia c) usually rapidly fatal d) all of the above
d
all of the following are T-cell disorders except a) mycosis fungoides b) sezary syndrome c) Hepatosplenic gamma/delta lymphoma d) Burkitt's lymphoma
d
all of the following are characteristics of chronic leukemias except: a) insidious onset b) mature leukemia cells c) found in adults d) found in all ages
d
all of the following are true regarding the low-grade non-Hodgkin's lymphomas except a) survival without treatment averages more than 5 years b) disease is usually advanced at diagnosis c) multiagent chemotherapy can prolong survival d) cure is possible in more than 50% of cases
d
alternatives to karyotypic analysis for the demonstration of chromosomal translocations include a) southern blot b) PCR c) FISH d) all of the above
d
cells that demonstrate a positive reaction with the tartrate-resistant acid phosphatase (TRAP) stain are most likely a) T lymphoblasts of ALL b) atypical lymphocytes of a viral infection c) large granular lymphocytes of T-gamma lymphoproliferative disorder d) hairy cells of hairy-cell leukemia
d
environmental factors that are associated with an increased risk of developing leukemia include: a) ionizing radiation b) chemicals and drugs c) viruses d) all of the above
d
small lymphocytic lymphoma is characterized by all of the following except a) indolent but incurable b) usually CD19+, CD5+, CD23+, CD10- c) growth centers d) t(14;18)
d
the blast phase of CML is defined by what percent of blasts found in the peripheral blood or bone marrow a) 50% b) 10% c) 80% d) 20%
d
the immunophenotype that best describes mantle cell lymphoma is: a) CD5+, CD19+, CD23+, FMC7+, cyclin D1+ b) CD5+, CD19+, CD23+, FMC7+, cyclin D1- c) CD5+, CD19+, CD23+, FMC7-, cyclin D1+ d) CD5+, CD19+, CD23-, FMC7+, cyclin D1+ e) CD5-, CD19+, CD23+, FMC7+, cyclin D1+
d
the philadelphia chromosome involves: a) t(9;22) b) the BCR and c-ABL genes c) a 210 kD protein possessing increased tyrosine kinase activity d) all of the above
d
the staging system for Hodgkin's lymphoma and the non-Hodgkin's lymphomas are a) working formulation b) Duke's staging system c) Rye staging system d) Ann Arbor staging system
d
what are the characteristics of Gaucher cells a) atypical lymphocytes with foamy cytoplasm b) hypersegmented neutrophils with Auer's rods c) large, multilobed monocytes with prominent red granules d) histiocytes with blue, folded cytoplasm
d
what events are involved in the normal formation of a platelet plug a) adhesion, activation, fibrinolysis, secondary hemostasis b) aggregation, coagulation, release reaction, lupus anticoagulant c) release action, adhesion, lupus anticoagulant, secondary hemostasis d) activation, adhesion, aggregation, release reaction
d
what infectious agent is most commonly associated with the pathogenesis of Hodgkin's lymphoma a) Echovirus b) Herpesvirus c) Helicobacter pylori d) Epstein-Barr virus
d
which cell may be found in MPS disorders a) large, foamy histiocytes with blue or green granules b) neutrophils with toxic granulation c) neutrophils with Dohle bodies d) lymphocytes with Alder-Reilly bodies
d
which features of chronic myelogenous leukemia are the most important characteristics that distinguish it from myelofibrosis a) presence of increased platelets and fibroblasts b) decreased erythrocytes with abnormal morphology c) increased leukocytes with hypercellular bone marrow d) low LAP score and presence of Ph chromosome
d
which of the following morphological abnormalities are helpful in the diagnosis of MDS a) Pseudo-Pelger-Huet and hypogranulation b) ringed sideroblasts c) micromegakaryocytes, monolobular megakaryocytes d) all of the above
d
which of these MDS subgroups has the most favorable prognosis a) RAEB b) CMML c) RA d) RARS
d
cytochemical stains (myeloperoxidase, nonspecific esterase) and TdT performed on samples of bone marrow aspirate smear were negative. The most likely diagnosis is a) chronic myelocytic leukemia, accelerated phase b) typical chronic lymphocytic leukemia c) acute lymphoblastic leukemia d) chronic lymphocytic leukemia/prolymphocytic leukemia e) B-cell prolymphocytic leukemia
e
the workup step(s) include a) cytochemical staining, including myeloperoxidase and nonspecific esterase, and TdT b) immunohistochemical study of trephine biopsy sections c) immunophenotypic study of flow cytometry d) cytogenetic studies e) all of the above
e