Leukocyte Disorders Ciulla 4thEd - Hema 2 EE

Question 1

In patients with infectious mononucleosis, which blood cells are infected by the causative agent?
A. Monocytes
B. Tlymphocytes
C. B lymphocytes
D. Histiocytes

Answer 1

C. B lymphocytes

Question 2

Which of the following statements about hairy cell leukemia is true?
A. It is an acute disease, primarily affecting young adults.
B. Splenomegaly is an unusual finding.
C. Hairy cells contain tartrate-resistant acid phosphatase.
D. Hairy cells are abnormal T lymphocytes.

Answer 2

C. Hairy cells contain tartrate-resistant acid phosphatase.

Question 3

Based on the WHO classification system, B cell ALL (FAB type L3) and represent different clinical presentations of the same disease entity.
A. Burkitt lymphoma
B. Hodgkin lymphoma
C. Mycosis fungoides
D. Small lymphocytic lymphoma

Answer 3

A. Burkitt lymphoma

Question 4

The presence of both immature neutrophils and nucleated erythrocytes in the peripheral blood is most accurately called a
A. Neutrophilic left shift
B. Regenerative left shift
C. Neutrophilic leukemoid reaction
D. Leukoerythroblastic reaction

Answer 4

D. Leukoerythroblastic reaction

Question 5

In which anomaly is a failure of granulocytes to divide beyond the band or two-lobed stage observed?
A. Pelger-Huet
B. May-Hegglin
C. Alder-Reilly
D. Chediak-Higashi

Answer 5

A. Pelger-Huet

Question 6

In which of the following are eosinophils not increased?
A. Cushing syndrome
B. Allergic disorders
C. Skin disorders
D. Parasitic infection

Answer 6

A. Cushing syndrome

Question 7

Which of the following represents the principal defect in chronic granulomatous disease (CGD)?
A. Chemotactic migration
B. Phagocytosis
C. Lysosomal formation and function
D. Oxidative respiratory burst

Answer 7

D. Oxidative respiratory burst

Question 8

The blood shown in Color Plate 11• is from a leukemia patient following treatment. These findings are most suggestive of therapy with
A. Corticosteroids (e.g., prednisone)
B. A folate antagonist (e.g.,methotrexate)
C. Recombinant erythropoietin
D. Chloramphenicol

Answer 8

B. A folate antagonist (e.g.,methotrexate)

Question 9

A patient with normal hemoglobin and WBC count values, a persistently elevated platelet count (over 1000 X 109/L), increased marrow megakaryocytes, and a history of frequent bleeding and clotting episodes most likely has
A. Polycythemia vera
B. Chronic myelofibrosis
C. Essential thrombocythemia
D. Chronic myelogenous leukemia

Answer 9

C. Essential thrombocythemia

Question 10

An adult patient with massive splenomegaly has mild anemia, a slightly elevated WBC count, and an LAP score of 170. The blood smear shows teardrop erythrocytes and leukoerythroblastosis. These findings are most consistent with
A. Chronic myelogenous leukemia
B. Idiopathic myelofibrosis
C. Primary polycythemia
D. Primary thrombocythemia

Answer 10

B. Idiopathic myelofibrosis

Question 11

Which of the following infections does not reveal a blood picture as seen in Color Plate 12B?
A. Epstein-Barrvirus(EBV)
B. Bordetella pertussis (whooping cough)
C. Cytomegalovirus (CMV)
D. Toxoplasma gondii (toxoplasmosis)

Answer 11

B. Bordetella pertussis (whooping cough)

Question 12

The most common type of chronic lymphocytic leukemia (CLL) in the United States involves the
A. B cell
B. NK cell
C. T cell
D. Plasma cell

Answer 12

A. B cell

Question 13

Which of the following are characteristic findings in Waldenstrom disease?
A. Increased IgA and hepatosplenomegaly
B. Increased IgE and renal failure
C. Increased IgG and hypercalcemia
D. Increased IgM and blood hyperviscosity

Answer 13

D. Increased IgM and blood hyperviscosity

Question 14

Which of the following would not cause a total WBC count of 62.2 X 109/L (62.2 X 103/jjLL) and the blood findings seen in Color Plate 13B?
A. Treatment with myeloid growth factors
B. Gram-negative septicemia
C. Human immunodeficiency virus (HIV)
D. Systemic fungal infection

Answer 14

C. Human immunodeficiency virus (HIV)

Question 15

The peripheral blood shown in Color Plate 14B is from a 69-year-old female. Her WBC count was 83.0 X 109 cells/L (83.0 X 103/(xL) and her platelet count was normal. Based on the cell morphology and this information, what is the most likely diagnosis?
A. Acute lymphoblastic leukemia
B. Chronic lymphocytic leukemia
C. Waldenstrom macroglobulinemia
D. Viral infection

Answer 15

B. Chronic lymphocytic leukemia

Question 16

In which of the following is progression to acute leukemia least likely?
A. Chronic myelogenous leukemia (CML)
B. Refractory anemia with excess blasts (RAEB)
C. Refractoryanemiawithringed sideroblasts (RARS)
D. Chronic lymphocytic leukemia (CLL)

Answer 16

D. Chronic lymphocytic leukemia (CLL)

Question 17

A Gaucher cell is best described as a macrophage with
A. “Wrinkled” cytoplasm due to an accumulation of glucocerebroside
B. “Foamy” cytoplasm filled with unmetabolized sphingomyelin
C. Pronounced vacuolization and deposits of cholesterol
D. Abundantcytoplasmcontaining storage iron and cellular remnants

Answer 17

A. “Wrinkled” cytoplasm due to an accumulation of glucocerebroside

Question 18

Which of the following suggests a diagnosis of Hodgkin disease rather than other lymphoproliferative disorders?
A. Presence of a monoclonal population of large lymphoid cells
B. Predominance of immature B cells with irregular nuclear clefts
C. Circulating T cells with a convoluted, cerebriform nucleus
D. Presence of giant binucleated Reed-Sternberg cells with prominent nucleoli

Answer 18

D. Presence of giant binucleated Reed-Sternberg cells with prominent nucleoli

Question 19

In a patient with fever of unknown origin, which of the following findings is not consistent with an inflammatory process?
A. Increased C-reactive protein
B. Increased albumin level
C. Increased fibrinogen level
D. Increased erythrocyte sedimentation rate

Answer 19

B. Increased albumin level

Question 20

The presence of the chromosomal abnormality t(15;17) and a high incidence of disseminated intravascular coagulation (DIG) is diagnostic of
A. Acute myeloblastic leukemia without maturation (FAB type Ml)
B. Acute myeloblastic leukemia with maturation (FAB type M2)
C. Acute promyelocytic leukemia (FAB type M3)
D. Acute myelomonocytic leukemia (FAB type M4)

Answer 20

C. Acute promyelocytic leukemia (FAB type M3)

Question 21

Which of the following is not commonly found in acute myelogenous leukemias?
A. Neutropenia
B. Thrombocytopenia
C. Hepatosplenomegaly
D. Lymphadenopathy

Answer 21

D. Lymphadenopathy

Question 22

The child whose blast cells are shown in Color Plate 15> has acute lymphoblastic leukemia that is precursor B cell type and CALLA positive. Analysis by flow cytometry would likely show cells that immunophenotype for
A. CD2,CD7
B. CD10,CD19
C. CD13,CD33
D. CD14,CD34

Answer 22

B. CD10,CD19

Question 23

The patient whose bone marrow is shown in Color Plate 16 • most likely has a(n)
A. Acute leukemia
B. Chronic leukemia
C. Myelodysplastic syndrome
D. Aplastic anemia

Answer 23

A. Acute leukemia

Question 24

Multiple myeloma is characterized by the presence in urine of large amounts of
A. Cryoglobulins
B. IgG heavy chains
C. IgG light chains
D. Beta microglobulins

Answer 24

C. IgG light chains

Question 25

Which of the following is not classified as a myeloproliferative disorder?
A. Polycythemia vera
B. Essential thrombocythemia
C. Multiple myeloma
D. Chronic myelogenous leukemia

Answer 25

C. Multiple myeloma

Question 26

Which of the following gene mutations correlates with the t(9;22) that is present in Philadelphia chromosome positive chronic myelogenous leukemia?
A. MYC/IGH
B. BCR/ABL
C. PML/RARA
D. JAK2

Answer 26

B. BCR/ABL

Question 27

Which of the following statements does not correctly describe the WHO (World Health Organization)classificationof hematopoietic neoplasms?
A. Acute leukemia is defined as the presence of at least 20% bone marrow blasts.
B. Diagnosis is based on cellular morphology and cytochemistry.
C. It groups lymphoid disorders into B cell, T/NK cell, and Hodgkin lymphoma.
D. Diagnostic criteria include morpho- logic, cytochemical, immunologic, cytogenetic, and molecular features.

Answer 27

B. Diagnosis is based on cellular morphology and cytochemistry.

Question 28

Which of the following would be least helpful in distinguishing chronic myelogenous leukemia (CML) from a neutrophilic leukemoid reaction?
A. An extreme leukocytosis with increased neutrophilic bands, metamyelocytes, and myelocytes
B. Leukocyte alkaline phosphatase score
C. Presence of marked splenomegaly
D. Neutrophils with Dohle bodies and
toxic granulation

Answer 28

A. An extreme leukocytosis with increased neutrophilic bands, metamyelocytes, and myelocytes

Question 29

The cytoplasmic inclusion present in the cell shown in Color Plate 17•
A. Excludes a diagnosis of acute myelogenous leukemia
B. Stains positive with leukocyte alkaline phosphatase (LAP)
C. Stains positive with myeloperoxidase (MPO)
D. Identifiesthecellasamalignant lymphoblast

Answer 29

C. Stains positive with myeloperoxidase (MPO)

Question 30

Which of the following is a typical finding in chronic leukemias at onset?
A. Symptoms of infection and bleeding
B. Significant thrombocytopenia
C. Severe anemia
D. Elevated leukocyte count

Answer 30

D. Elevated leukocyte count

Question 31

In what condition would an LAP score of 10 most likely be found?
A. Bacterial septicemia
B. Latepregnancy
C. Polycythemia vera
D. Chronic myelogenous leukemia

Answer 31

D. Chronic myelogenous leukemia

Question 32

Which of the following is not associated with neutrophilia?
A. Staphylococcal pneumonia
B. Crushing injury
C. Infectious hepatitis
D. Neoplasms (tumors)

Answer 32

C. Infectious hepatitis

Question 33

In which of the following would an absolute monocytosis not be seen?
A. Tuberculosis
B. Recovery stage of acute bacterial infection
C. Collagen disorders
D. Infectious mononucleosis

Answer 33

D. Infectious mononucleosis

Question 34

Coarse PAS positivity may be found in the leukemic cells of
A. Acute myeloblastic leukemia (FAB type Ml)
B. Acute lymphoblastic leukemia (FAB type LI)
C. Acute myelomonocytic leukemia (FAB type M4)
D. Acute monocytic leukemia (FAB type M5)

Answer 34

B. Acute lymphoblastic leukemia (FAB type LI)

Question 35

Which of the following is not among the diagnostic criteria used for classifying the myelodysplastic syndromes?
A. Unexplained anemia refractory to treatment
B. Hypogranular and hyposegmented neutrophils
C. Abnormal platelet size and granulation
D. Hypocellular bone marrow with 25% blasts

Answer 35

D. Hypocellular bone marrow with 25% blasts

Question 36

Naphthol AS-D chloroacetate esterase (specific) is usually positive in cells, and alpha- naphthyl acetate esterase (nonspecific) is useful for identifying blast cells of lineage.
A. Granulocytic; monocytic
B. Monocytic; granulocytic
C. Granulocytic; lymphocytic
D. Monocytic; lymphocytic

Answer 36

A. Granulocytic; monocytic

Question 37

The familial disorder featuring pseudo- Dohle bodies, thrombocytopenia, and large platelets is called
A. May-Hegglin anomaly
B. Chediak-Higashi syndrome
C. Pelger-Huet anomaly
D. Alder-Reilly anomaly

Answer 37

A. May-Hegglin anomaly

Question 38

Alder-Reilly anomaly is an abnormality of
A. Lysosomal fusion
B. Nuclearmaturation
C. Oxidative metabolism
D. Mucopolysaccharide metabolism

Answer 38

D. Mucopolysaccharide metabolism

Question 39

What is the initial laboratory technique for the diagnosis of monoclonal gammopathies?
A. Immunologic markers of marrow biopsy cells
B. Cytochemical staining of marrow and peripheral blood cells
C. Serum and urine protein electrophoresis
D. Cytogenetic analysis of marrow cells

Answer 39

C. Serum and urine protein electrophoresis

Question 40

Which of the following statements about Hodgkin disease is false?
A. Peak incidence occurs in young adults.
B. Staging determines extent of disease and treatment course.
C. Stage IV has the best prognosis.
D. Almost a 2:1 male predominance over females is characteristic.

Answer 40

C. Stage IV has the best prognosis.

Question 41

Theblast cells shown in Color Plate 18 • are CD14 and CD33 positive, Sudan black B positive, specific esterase positive, and nonspecific esterase positive. Which type of acute leukemia is most consistent with the immunophenotyping and cytochemical staining results?
A. Acute lymphoblastic leukemia, T cell type
B. Acute erythroleukemia
C. Acute myelomonocytic leukemia
D. Acute monocytic leukemia

Answer 41

C. Acute myelomonocytic leukemia

Question 42

Which type of leukemia is associated with the best prognosis for a cure?
A. Chronic lymphocytic leukemia in the elderly
B. Acute lymphoblastic leukemia in children
C. Acute myelogenous leukemia in children
D. Chronic myelogenous leukemia in young adults

Answer 42

B. Acute lymphoblastic leukemia in children

Question 43

What is the key diagnostic test for Hodgkin lymphoma?
A. Bone marrow biopsy
B. Lymph node biopsy
C. Spinal tap
D. Skinbiopsy

Answer 43

B. Lymph node biopsy

Question 44

A bone marrow with 90% cellularity and myeloid:erythroid (M:E) ratio of 10:1 is most characteristic of
A. Chronic myelogenous leukemia
B. Primary polycythemia
C. Beta-thalassemia major
D. Aplastic anemia

Answer 44

A. Chronic myelogenous leukemia

Question 45

A 60-year-old patient presents with extreme fatigue. Her blood and bone marrow findings are as follows: severe anemia with a dual RBC population, 3% marrow blasts, and numerous ringed sideroblasts.This information is most consistent with
A. Refractory anemia (RA)
B. Refractory anemia with ringed sideroblasts (RARS)
C. Refractory anemia with excess blasts (RAEB)
D. Chronicmyelomonocyticleukemia (CMML)

Answer 45

B. Refractory anemia with ringed sideroblasts (RARS)

Question 46

Which of the following is not a mechanism by which neutropenia may be produced?
A. Hypersplenism
B. Marrow injury or replacement
C. Recent strenuous exercise
D. Drug-induced antibodies

Answer 46

C. Recent strenuous exercise

Question 47

Which of the following is not a characteristic finding in polycythemia vera?
A. Blood pancytosis
B. Increased red cell mass
C. Increased erythropoietin level
D. Increased blood viscosity

Answer 47

C. Increased erythropoietin level

Question 48

In what disorder is significant basophilia most commonly seen?
A. Hairy cell leukemia
B. Plasma cell leukemia
C. Acute lymphoblastic leukemia
D. Chronic myelogenous leukemia

Answer 48

D. Chronic myelogenous leukemia

Question 49

Acute erythroleukemia (FAB type M6) is characterized by increased
A. Promyelocytes and lysozyme activity
B. Marrow megakaryocytes and thrombocytosis
C. Marrow erythroblasts and multinucleated red cells
D. Marrow monoblasts and immature monocytes

Answer 49

C. Marrow erythroblasts and multinucleated red cells

Question 50

The blood findings present in Color Plate 20• arefrom a patient with complaintsof fatigue and severe lower back pain. Which of the following would not be typical of this disease?
A. Bone tumors of plasma cells
B. Hypercalcemia
C. Progressive renal impairment
D. Normal sedimentation rate

Answer 50

D. Normal sedimentation rate

Question 51

Myeloid metaplasia refers to
A. Displacement of normal marrow cells by fibrous tissue
B. Hematopoietic failure
C. Extramedullary hematopoiesis
D. Tumors (neoplasms) of the bone marrow

Answer 51

C. Extramedullary hematopoiesis

Question 52

Which of the following statements about non-Hodgkin types of lymphoma is true?
A. Lymphadenopathy is the most common presenting symptom.
B. Initially, they present as a systemic disease rather than a localized tumor.
C. They are often associated with multiple bone lesions.
D. They are characterized by proliferation of malignant cells primarily involving the bone marrow.

Answer 52

A. Lymphadenopathy is the most common presenting symptom.