Pathology Student

One Response to “Acute leukemia quiz”

• admin Says:
  November 20th, 2009 at 7:11 am

  1. Patients with which of the following leukemias may go into DIC if given routine chemotherapeutic agents?

  A. Acute promonocytic leukemia
  B. Acute promyelocytic leukemia *
  C. Acute lymphoblastic leukemia
  D. Chronic myeloid leukemia
  E. Chronic lymphocytic leukemia

  All those granules in the malignant promyelocytes have strongly pro-coagulant substances inside – so you can’t just bust open the cells and release all that stuff, or the patient will start clotting all over.

  2. All of the following terms are technically incorrect, EXCEPT:

  A. Acute lymphocytic leukemia
  B. Chronic myeloblastic leukemia
  C. Chronic lymphoid leukemia
  D. Leukemoid reaction
  E. Chronic myeloid leukemia*

  A. should be acute lymphoblastic leukemia
  B. should be chronic myeloid (or myelocytic) leukemia
  C. should be chronic lymphocytic leukemia
  D. should not be used at all. It means “a leukemia-like blood picture in the absence of leukemia.” So it could mean there is a high WBC, or an increase in blasts, or any of a number of things. Do not use. Just describe what you see.
  E. is correct!

  3. Which of the following leukemias is likely to show a panmyelosis:

  A. Acute lymphoblastic leukemia
  B. Acute monoblastic leukemia
  C. Acute erythroblastic leukemia
  D. Chronic lymphocytic leukemia
  E. Chronic myeloid leukemia*

  All the chronic myeloproliferative disorders have a panmyelosis. In most of them (except chronic myelofibrosis), one cell line predominates.

  4. A bone marrow biopsy shows 5% myeloblasts and some funny-looking neutrophils and precursors. The most likely diagnosis is:

  A. Acute myeloid leukemia
  B. Acute lymphoblastic leukemia
  C. Myelodysplastic syndrome*
  D. Bacterial infection
  E. Chronic myeloid leukemia

  Myelodysplastic syndromes are characterized by an increase in blasts (but not amounting to 20% or more of the nucleated cells – then you’d have to call it AML), and dysmyelopoiesis (funny looking red cells, neutrophils, and megakaryocytes).

  5. While looking around a blood smear, you notice a blast with an Auer rod in it. This patient has:

  A. A bacterial infection
  B. No disease, unless 20% of the nucleated cells have Auer rods
  C. A myelodysplastic syndrome
  D. Acute myeloid leukemia*
  E. Acute lymphoblastic leukemia

  Auer rods are ONLY present in cases of acute myeloid leukemia. They’re not present in every subtype of AML (for example, they are not present in the monoblasts in acute monoblastic leukemia), but when you do see them, it’s a diagnosis-clincher. They are NEVER present in any other condition (ALL, CML, benign things).

  6. Acute lymphoblastic leukemia:

  A. Often has a good prognosis*
  B. Never occurs in children
  C. Is classified according to morphologic appearance
  D. Is only diagnosed when 20% or more of the nucleated cells are lymphoblasts
  E. Is an indolent disease

  ALL often has a good prognosis (except when it occurs in adults, in which case the prognosis is poor). It is the most common type of leukemia in children. It is classified according to immunophenotype, not according to the way the cells look. There is no 20% cutoff for ALL. And it’s not indolent at all – quite the opposite.

  7. Which of the following is a GOOD prognostic indicator in acute lymphoblastic leukemia?

  A. Age less than 1
  B. A WBC >10,000
  C. B-lineage immunophenotype*
  D. Normal cytogenetics
  E. Age >10

  Good prognostic indicators:
  Age between 1 and 10.
  Low WBC (<10,000)
  Hyperdiploidy.
  A B-lineage immunophenotype (T-ALLs have a worse prognosis)

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