Hematopathology Practice Questions

Q: Which of the following is a poor prognostic factor in Acute Myeloid Leukemia (AML)?

Monosomy. ### Explanation In Acute Myeloid Leukemia (AML), cytogenetic and molecular abnormalities are the most significant predictors of clinical outcome and treatment response [1]. **1. Why Monosomy is the Correct Answer:** Monosomies (loss of an entire chromosome), particularly of **chromosomes 5 or 7**, or the presence of a **complex karyotype** (≥3 abnormalities), are classified as **adverse/poor prognostic factors**. These are often associated with therapy-related AML or AML evolving from Myelodysplastic Syndrome (MDS). They typically show poor response to standard induction chemotherapy and high relapse rates. **2. Analysis of Incorrect Options:** * **Deletion of X or Y chromosome:** These are considered **isolated secondary changes** and do not carry an adverse prognosis. In many cases, the loss of a sex chromosome is considered a "neutral" or "favorable" finding compared to complex karyotypes. * **t(8;21):** This translocation involves the *RUNX1-RUNX1T1* genes. It is a hallmark of **favorable prognosis** AML (specifically AML-M2 in the FAB classification) and generally responds well to cytarabine-based therapy [1]. * **Nucleophosmin (NPM1) mutation:** In the absence of *FLT3-ITD* mutations, an *NPM1* mutation is a **favorable prognostic marker** [1]. It is one of the most common genetic alterations in adult AML with a normal karyotype. **Clinical Pearls for NEET-PG:** * **Favorable Prognosis:** t(8;21), inv(16), t(15;17) [APML], and isolated *NPM1* or *CEBPA* mutations [1]. * **Poor Prognosis:** Monosomy 5/7, del(5q), 11q23 (MLL gene) rearrangements, and *FLT3-ITD* mutations [1]. * **APML (t15;17):** While it has a high risk of early mortality due to DIC, it has the **best long-term prognosis** with ATRA and Arsenic Trioxide therapy. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of White Blood Cells, Lymph Nodes, Spleen, and Thymus, pp. 620-621.

Question 1

A 62-year-old man reports early satiety, fatigue, and generally feeling unwell. The symptoms started gradually and are getting worse. He notes no chest discomfort, respiratory symptoms, or abdominal pain. On physical examination, he appears pale, the vital signs are normal, and the pertinent findings are a large spleen, absence of lymph nodes, and normal heart and lungs. His blood count is abnormal; the WBC is 50,000/mL with increased mature granulocytes, hemoglobin is 9.5 g/dL, and platelets are 450,000/mL. Which of the following cytogenetic changes is most characteristic of his condition?

Accepted Answer

Reciprocal translocation of 9 and 22 (Philadelphia chromosome)

Answer

Deletion of chromosome 14

Answer

Translocation of the renal artery stenosis (RAS) oncogene

Answer

Trisomy 21

Question 2

A child is diagnosed with Burkitt's Lymphoma. The presence of which of the following translocations confirms the diagnosis?

Accepted Answer

t (8:14)

Answer

t (11:22)

Answer

t (15:17)

Answer

t (9:22)

Question 3

Platelet dense granules contain all except?

Accepted Answer

vWF

Answer

ADP

Answer

5-HT

Answer

Calcium

Question 4

A patient presents with bone pain. X-ray reveals destructive lesions. Laboratory investigations show hypercalcemia. Serum electrophoresis shows M spike, while bone marrow shows 35% plasma cells. What is your diagnosis?

Accepted Answer

Multiple myeloma

Answer

Monoclonal gammopathy of undetermined significance (MGUS)

Answer

Smoldering multiple myeloma

Answer

Plasma cell leukemia

Question 5

Oxidative injury of the red blood cells leading to hemolysis is associated with which of the following clinical conditions?

Accepted Answer

G6PD deficiency

Answer

Hereditary spherocytosis

Answer

Sickle cell anemia

Answer

Hemophilia

Question 6

Which of the following is a poor prognostic factor in Acute Myeloid Leukemia (AML)?

Accepted Answer

Monosomy

Answer

Deletion of X or Y chromosome

Answer

t (8; 21) translocation

Answer

Nucleophosphin mutation

Question 7

Which of the following is not a B cell neoplasm?

Accepted Answer

Mycosis fungoides

Answer

Hairy cell leukemia

Answer

Mantle cell lymphoma

Answer

Burkitt's lymphoma

Question 8

Which anticoagulant is the preferred choice for use in a blood bank?

Accepted Answer

Acid citrate dextrose solution

Answer

Calcium oxalate

Answer

Heparin solution

Answer

Sodium fluoride

Question 9

Which of the following statements is NOT true regarding Bernard-Soulier syndrome?

Accepted Answer

Ristocetin-induced platelet aggregation is normal.

Answer

Platelet aggregation with collagen and ADP is normal.

Answer

Platelets are large.

Answer

There is thrombocytopenia.

Question 10

Which of the following statements is not true regarding chronic myelogenous leukemia?

Accepted Answer

Bone marrow biopsy is essential for confirmation of diagnosis.

Answer

BCR-ABL fusion is involved in the oncogenesis.

Answer

Pseudo Gaucher cells may be present in the bone marrow examination.

Answer

Blast crisis in the disease may involve lymphoblasts.

Hematopathology — MCQs

Hematopathology — MCQs

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