TEST 1

Question 1

What virus causes lymphoid malignancies in humans

Answer 1

Epstein-Bar virus

Question 2

Tumor suppresor genes causes cancers such as leukemia when mutations result in

Answer 2

Failure to prevent malignant process

Question 3

Oncogenes are said to act in a dominant fashion because

Answer 3

A mutation in a single allele is sufficient for malignancy to develop

Question 3

what is a cellular abnormality produced by oncogenes

Answer 3

Acceleration of DNA catabolism

Question 3

Compared with autologous bone marrow transplantation, allogeneic transplantation has

Answer 3

better long term succes

Question 3

Chemotherapeutic agents are divided into which two major subgroups

Answer 3

1. phase specific
2. phase non specific

Question 4

Qualitative and quantitative neutrophil hanges noted in response to infection include

Answer 4

1. neutropenia
2. toxic granulation
3. vacuolization

Question 4

The WHO classification requires what percentage for the blast count in the blood or bone

Answer 4

At least 20%

Question 4

In addition to morphology, cytochemistry, and immunophenotyping, the WHO
classification of
Myelo- and lymphoproliferative disorders is based upon which characteristic?

Answer 4

Cytogenetic abnormalities

Question 4

Which AML cytogenetic abnormality is associated with acute myelomonocytic leukemia
with marrow eosinophilia under the WHO classification of AML with recurrent genetic
abnormalities?

Answer 4

AML with inv

Question 4

neutropenia is present in patients with which absolute count

Answer 4

<1.5*10^9/L

Question 4

A m:e (myeloid:erythroid ration) of 10:1 is mostly seen in

Answer 4

Leukemia

Question 5

Which of the following leukemias are included in the 2008 World Health Organization
classification of myeloproliferative neoplasms?

Answer 5

Chronic myelogenous leukemia (CML)
Chronic neutrophilic leukemia (CNL)
Chronio eosinophilic leukemia (CEL)

Question 6

Repeated phlebotomy in patients with polycythemia vera (PV) may lead to the
development of:

Answer 6

Iron deficiency anaemia

Question 7

in essential thrombocytopenia the platelets are

Answer 7

increased in number and fuctionality abnormal

Question 8

Which of the following cells is considered pathognomonic for Hodgkin’s disease?

Answer 8

Reed- sternberg cells

Question 9

Which of the morphological findings are characteristics of reactive lymphocytes

Answer 9

1. high nuclear: cytoplsmic ration
2. prominent nucleoli
3. basophilic cytoplasm

Question 10

Auer rods may be seen in all of the following

Answer 10

1. acute myelomonocytic leukemia (M4)
2. acute myeloid leukemia leukemia without maturation (M1)
3. acute promyelocytic leukemia (M3)

Question 11

Which type of anaemia is ussually present in a patient with acute leukemia

Answer 11

Normocytic, Normochromic

Question 12

In leukemia which term decribes a peripheral blood finding of leukocytosis with a shift to the left, accompanied by nucleated red cells

Answer 12

Leukoerythroblastosis

Question 13

The basic pathophysiological mechanisms responsible for producing signs and symptoms in leukemia include all of the following except

Answer 13

Decreased erythropoietin production

Question 14

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

Answer 14

Acute monocytic anaemia

Question 15

In which age group does acute lymphoblastic leukemia occur with the highest frequency

Answer 15

1-15 years

Question 16

Disseminated intravascular coagulation (DIC) is mostly often associated with which of the following types of acute leukemia

Answer 16

Acute promyelocytic leukemia

Question 17

In Myelofibrosis, the characteristic abnormal red blood cell morphology is that of

Answer 17

Tear drop cell

Question 18

PV is characterized by

Answer 18

Absolute increase in total red cell mass

Question 19

Features of secondary polycynthemia incude all of the foloowing except

Answer 19

splenomegaly

Question 20

The erythrocytosis seen in relative polycythemia occurs because of

Answer 20

Decreased plasma volume of circulating blood

Question 21

In PV, what is characteristically seen in the peripheral blood?

Answer 21

Pancytosis

Question 22

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).

Answer 22

137

Question 23

CML is distinguished from leukemoid reaction by which of the following?

Answer 23

CML: low LAP; leukemoid: high LAP

Question 24

Which of the following occurs in idiopathic Myelofibrosis (IMF)?

Answer 24

All of these options

Question 25

What influence does the Philadelphia (Ph1) chromosome have on the prognosis of patients with chronic myelogenous leukemia?

Answer 25

The prognosis is better if Ph1 is present

Question 26

Which of the following is (are) commonly found in CML?

Answer 26

An increase in basophils

Question 27

In which of the following conditions does LAP show the least activity?

Answer 27

In leukomoid reactions

Question 28

A striking feature of the peripheral blood of a patient with CML is a:

Answer 28

Presence of granulocytes at different stages of development

Question 29

Which of the following is often associated with CML but not with AML?

Answer 29

Splenomegaly

Question 30

The JAK2(V617F) mutation may be positive in all of the following chronic myeloproliferative disorders Except

Answer 30

CML

Question 31

All of the following are major criteria for the 2008 WHO diagnostic criteria for essential thrombocythemia Except:

Answer 31

Sustained platelet count >600 x 109/L

Question 32

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?

Answer 32

Transformation to acute leukemia

Question 33

Normal ranges of WBC

Answer 33

4.5 -11.5 X 10^9/L

Question 34

Normal ranges of RBC

Answer 34

4 - 6 X 10^9/L

Question 35

Normal ranges of Hgb

Answer 35

14 - 18 g/dL

Question 36

Normal ranges of HCT

Answer 36

40 - 54 %

Question 37

Normal ranges of HCT

Answer 37

40 - 54 %

Question 38

Normal ranges of MCV

Answer 38

80 - 100 fL

Question 39

Normal ranges of MCHC

Answer 39

32 - 36 g/dL

Question 40

Normal ranges of MCH

Answer 40

26 - 32 pg

Question 41

Normal ranges of platelet

Answer 41

150 - 450 x 10^9/L

Question 42

Normal ranges of RDW

Answer 42

11.5 - 14.5 %

Question 43

Normal ranges of reticulocyte

Answer 43

25 - 75 x 10^9/L

Question 44

In a table differentiate CML and Leukomoid reaction

Answer 44

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

Question 45

The neoplastic cells in Nodular sclerosis morphological subtype of classical Hodgkin lymphoma (3)

Answer 45

1. Reed sternberg cells 2. Lacular cells 3. Hodkin cells

Question 46

The hallmark feature of Burkitt lymphoma is a high proliferation rate, a feature linked to constitutive expression of(1):

Answer 46

MYC gene

Question 47

The cell of origin for chronic lymphocytic leukemia/small lymphocytic lymphoma (2)

Answer 47

1. Naive B cell 2. Memory B cell

Question 48

WHO classification variant of Burkitt lymphoma common in Africa and its presentation(2)

Answer 48

endemic, presenting with jawbone

Question 49

The genetic feature that interconnect ET, PV and PMF and suggests a continuum of diseases(1)

Answer 49

JAK2 gene mutation

Question 50

Disintegrated lymphoid cells present on the PB film in CLL not seen in other types of malignant lymphoma (1)

Answer 50

smudge cells

Question 51

one important difference between chronic lymphocytic leukemia and small lymphocytic lymphoma

Answer 51

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

Question 52

one important difference between the Pre-germinal center CLL and post-germinal center CLL (2 marks)

Answer 52

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

Question 53

Whta is the important difference between Accelerated phase and Blastic phase of CML (2 marks)

Answer 53

Accelerated phase there is 10 - 19 of blast while in blastic phase there is greater than or equal to 20% of blast.

Question 54

one important difference between Small lymphoblast and large lymphoblast (2 marks)

Answer 54

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

Question 55

one important difference between Blast count in Blastic crisis and metamorphosis (acceleration) phase of CML (2 narks)

Answer 55

Blast count in blastic crisis os greater than or equal to 20% while in acceralation phase is 10-19

Question 56

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).

Answer 56

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

Question 57

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.

Answer 57

1. 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). 2. 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 3. 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

Question 58

Write a scientific reason for the occurrence, Clinical symptoms mimic those of acute leukemia in the Blastic phase of CML .

Answer 58

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.