WHO Hematology 2017 Review -4 - thehematologist.org

This Part has 35 MCQs from chapter 8 (From Page 145),9,10 of WHO Hematology 2017 in form of MCQs and True/False

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Question 1 of 35

1. Multilineage dysplasia alone is insufficient for a diagnosis of AML-MRC ( Acute myeloid leukaemia with myelodysplasia-related changes) in a de novo case of AML with mutated NPM1 or biallelic mutation of CEBPA.

A. True

B. False

Question 1 of 35

Question 2 of 35

2. Acute myeloid leukaemia with myelodysplasia-related changes (AML-MRC) is an acute leukaemia with >/= 20% peripheral blood or bone marrow blasts with morphological features of myelodysplasia (defined as the presence of 50% or more dysplastic cells in at least 2 cell lines). Which of the following should be absent to classify in this group?

A. AML with mutated NPM1

B. AML with biallelic mutation of CEBPA

C. Cases with del(9q)

D. All of above

Question 2 of 35

Question 3 of 35

3. Which of the following non hematological malignancy treated patient account for the largest numbers of t-MDS/MPN/AML cases ?

A. Breast

B. Lung

C. Ovary

D. Prostate

Question 3 of 35

Question 4 of 35

4. Which of the following hematological malignancy treated patient account for the largest numbers of t-MDS/MPN/AML cases ?

A. NHL

B. HL

C. AML

D. ALL

Question 4 of 35

Question 5 of 35

5. t-MN (MDS/MPN/AML) risk associated with alkylating agents or radiation therapy generally increases with age, whereas the risk associated with topoisomerase II inhibitors is similar across all ages.

A. True

B. False

Question 5 of 35

Question 6 of 35

6. Read the description >> This type of t-MN (MDS/AML) accounts for 20- 30% of cases, has a shorter latent period (1- 5 years) and most cases in this subset do not have a myelodysplastic phase but present with overt acute leukaemia, often associated with a balanced chromosomal translocation. This description fits into t-MN resulting from ?

A. Exposure to alkylating agents

B. Exposure to ionizing radiation.

C. Exposure to DNA topoisomerase II inhibitors

D. All of the above

Question 6 of 35

Question 7 of 35

7. t-AML associated with unbalanced loss of genetic material, often involving chromosomes 5 and/or 7, as well as complex karyotypes and mutations or loss of TP53 most likely to be associated with ?

A. Exposure to alkylating agents

B. Exposure to ionizing radiation.

C. Exposure to DNA topoisomerase II inhibitors

D. Both A and B

Question 7 of 35

Question 8 of 35

8. Most patients with t-MN present with an MDS or acute leukaemia associated with multilineage dysplasia.

A. True

B. False

Question 8 of 35

Question 9 of 35

9. Alkylating agent related t-AML commonly have recurrent balanced chromosomal translocations, involving KMT2A or RUNX1.

A. True

B. False

Question 9 of 35

Question 10 of 35

10. Mutations of TP53 occur in what % of t-MN cases ?

A. 10

B. 20

C. 50

D. 90

Question 10 of 35

Question 11 of 35

11. Which of the following is true for Acute myelomonocytic leukaemia ?

A. Accounts for 20-25 % of AML cases.

B. Accounts for > 25 % of AML cases.

C. At least 3 % of the blasts should show MPO positivity

D. At least 5 % of the blasts should show MPO positivity

Question 11 of 35

Question 12 of 35

12. Coexpression of CD15, CD36, and strong CD64 in blasts is characteristic of monocytic differentiation.

A. True

B. False

Question 12 of 35

Question 13 of 35

13. Which of the following is TRUE for Acute monoblastic and monocytic leukaemia ?

A. Have >/= 20% blasts (including promonocytes)

B. More than 80% of the leukaemic cells are of monocytic lineage

C. In acute monoblastic leukaemia, >/= 80% of the monocytic cells are monoblasts.

D. All of these are true.

Question 13 of 35

Question 14 of 35

14. Haemophagocytosis (erythrophagocytosis) may be observed in case of Acute monoblastic and monocytic leukaemia and is often associated with ?

A. t(9:11)

B. t(8:16)

C. t(9:22)

D. Both A and B

Question 14 of 35

Question 15 of 35

15. Pure erythroid leukaemia is a neoplastic proliferation of immature cells (undifferentiated or proerythroblastic in appearance) committed exclusively to the erythroid lineage. True for it is ?

A. > 80% of the BM cells are erythroid, with >/= 30% proerythroblasts

B. > 80% of the BM cells are erythroid, with >/= 20% proerythroblasts

C. > 50% of the BM cells are erythroid, with >/= 30% proerythroblasts

D. > 50% of the BM cells are erythroid, with >/= 20% proerythroblasts

Question 15 of 35

Question 16 of 35

16. Which of the following cases will be diagnosed as AML, NOS, acute erythroid leukemia in presence of >/= 50% erythroid cells in bone marrow aspirate (Multiple answers can be selected)?

A. >/= 20% Myeloblasts in bone marrow

B. Myeloblasts <20% of all nucleated cells but >/= 20% of Nonerythroid cells

C. Myeloblasts <20% of all nucleated cells and < 20% of Nonerythroid cells

D. >80% immature erythroid precursors with >/=30% proerythroblasts

Question 16 of 35

Question 17 of 35

17. The boxed case will be diagnosed as ??

A. AML, NOS, acute erythroid leukemia (erythroid/ myeloid subtype)

B. AML, NOS, acute erythroid leukemia (pure erythroid type)

C. AML, NOS (non erythroid subtype)

D. MDS

Question 17 of 35

Question 18 of 35

18. Pure erythroid leukaemia is characterized by the presence of medium-sized to large erythroblasts, usually with round nuclei, fine chromatin, and one or more nucleoli (proerythroblasts); the cytoplasm is deeply basophilic and agranular and frequently contains vacuoles. The following combination of cytochemical stains are positive :-

A. PAS only

B. Sudan Black B and PAS

C. Acid phosphatase and PAS

D. MPO, Sudan Black B and PAS

Question 18 of 35

Question 19 of 35

19. E-cadherin, which stains early erythroid forms, is positive in the vast majority of cases of Pure erythroidleukaemia and is specific for erythroid differentiation in BM.

A. True

B. False

Question 19 of 35

Question 20 of 35

20. Which of the following in not true for lmmunophenotype of erythroblasts ?

A. Positive for glycophorin and haemoglobin A

B. CD 71 is less lineage-specific marker than CD235

C. E-cadherin stains early erythroid forms.

D. CD235 is less lineage-specific marker than CD71

Question 20 of 35

Question 21 of 35

21. Acute megakaryoblastic leukaemia is an acute leukaemia with ?

A. >/= 20% blasts of which >50% megakaryocyte lineage

B. >/= 20% blasts of which >80% megakaryocyte lineage

C. >/= 30% blasts of which >50% megakaryocyte lineage

D. >/= 30% blasts of which >80% megakaryocyte lineage

Question 21 of 35

Question 22 of 35

22. True for cytochemistry of Megakryoblasts ?

A. MPO +

B. PAS +

C. Sudan Black B +

D. Both B and C

Question 22 of 35

Question 23 of 35

23. True for lmmunophenotype of the megakaryoblasts ?

A. CD41+/CD61+/CD42b+/CD36+

B. CD41+/CD61+/CD42b+/CD36-

C. CD41+/CD61-/CD42b+/CD36+

D. CD41+/CD61-/CD42b+/CD36-

Question 23 of 35

Question 24 of 35

24. Which of the following is true for blasts in Acute basophilic leukaemia ?

A. Metachromatic staining with toluidine blue.

B. CAE ie chloroacetate esterase negative unlike mast cells

C. CD25 Negative

D. All of these

Question 24 of 35

Question 25 of 35

25. Which of the following is true for Myeloid proliferations associated with Down syndrome ?

A. Individuals with Down syndrome have an increased risk of leukaemia

B. 150-fold increase in AML in children aged < 5 years

C. Acute megakaryoblastic leukaemia accounts for 70% of cases of AML in children aged < 4 years

D. All of these

Question 25 of 35

Question 26 of 35

26. The incidence of TAM (transient abnormal myelopoiesis) in neonates with Down syndrome is roughly ?

A. <5%

B. 10%

C. 40-50%

D. >90%

Question 26 of 35

Question 27 of 35

27. The incidence of TAM (transient abnormal myelopoiesis) in neonates with Down syndrome progressing to AML is roughly ?

A. <5%

B. 10%

C. 20-30%

D. 40-50%

Question 27 of 35

Question 28 of 35

28. Which of the following is true for transient abnormal myelopoiesis (TAM) associated with down syndrome ?

A. Usually diagnosed at the age of 3-7 days

B. Thrombocytopenia is most common cytopenia

C. Blasts have megakaryoblastic immunophenotype

D. All of these

Question 28 of 35

Question 29 of 35

29. Most common site of involvement of Blastic plasmacytoid dendritic cell neoplasm ?

A. Liver

B. Lung

C. Skin

D. Bone marrow

Question 29 of 35

Question 30 of 35

30. Blastic plasmacytoid dendritic cell neoplasm (BPCDN) must be distinguished from mature plasmacytoid dendritic cell proliferation (MPDCP), in which plasmacytoid dendritic cells are morphologically mature and CD56-Positive.

A. True

B. False

Question 30 of 35

Question 31 of 35

31. BPDCN (Blastic plasmacytoid dendritic cell neoplasm) is characterized by a diffuse, monomorphous infiltrate of mediumsized blast cells resembling either lymphoblasts or myeloblasts. The immuniphenotypic markers for BPDCN is ?

A. CD56-/CD123-

B. CD56-/CD123+

C. CD56+/CD123-

D. CD56+/CD123+

Question 31 of 35

Question 32 of 35

32. The T-cell component of an MPAL (Mixed Phenotypic Acute Leukemia) is characterized by strong expression of cCD3, usually in the absence of surface CD3.

A. True

B. False

Question 32 of 35

Question 33 of 35

33. To Prove presence of B-Liniage in MPAL (Mixed Phenotypic Acute leukemia) which of the following is true ?

A. Strong positive CD19 alone is sufficient

B. Strong positive CD19 along with any one of CD79a, cytoplasmic CD22, CD10 is required.

C. Weak positive CD19 along with any one of CD79a, cytoplasmic CD22, CD10 is required.

D. Both A and B

Question 33 of 35

Question 34 of 35

34. The single most specific hallmark of the myeloid component of an MPAL is MPO in the blast cytoplasm.

A. True

B. False

Question 34 of 35

Question 35 of 35

35. The most common recurrent genetic abnormality seen in MPAL is ?

A. t(9:22)

B. KMT2A (MLL) rearranged

C. t(3:6)

D. t(6:9)

Question 35 of 35

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