Question 1

A 55-year-old male presents with symptoms that include weakness,loss of appetite,and anemia.Immunofixation electrophoresis reveals a heavy IgM band.Which of the following is the most likely diagnosis?&#10;A) SCID&#10;B) multiple myeloma&#10;C) Waldenstr&#246;m's macroglobulinemia&#10;D) DiGeorge syndrome

Accepted Answer

The symptoms (weakness, loss of appetite, anemia) and the heavy IgM band on immunofixation electrophoresis suggest a diagnosis of Waldenström's macroglobulinemia. This is a type of lymphoma that produces large amounts of IgM antibodies, leading to hyperviscosity syndrome and a variety of symptoms including anemia. SCID and DiGeorge syndrome are both genetic disorders that affect the immune system, and multiple myeloma is a cancer of plasma cells that produces abnormal Ig proteins, but none of these conditions would present with the specific symptomatology and laboratory findings described in this scenario.

Question 2

What is the main difference between leukemias and lymphomas?&#10;A) In leukemias,malignant cells are mainly located in the tissues.&#10;B) Lymphomas are present mainly in peripheral blood.&#10;C) Lymphomas arise due to a lack of response to stimulating antigens.&#10;D) Lymphomas arise mainly in lymph nodes,the spleen,or other lymphoid tissue.

Accepted Answer

The main difference between leukemias and lymphomas is the location of the malignant cells. Leukemias have malignant cells mainly located in the peripheral blood and bone marrow. On the other hand, lymphomas arise mainly in lymph nodes, the spleen, or other lymphoid tissue. In addition, lymphomas can arise due to a lack of response to stimulating antigens, but this is not the main difference between the two.

Question 3

What is the interpretation of the following patient results? (normal values)WBC = 90.0 th/uL (5.0-10.0 th/uL,),with 89% lymphs (20-40%); CD3 = 90% (60-80%); CD5 = 87% (60-80%); CD10 = 0% (< 1%); CD4 = 88% (30-65%); CD20 = 12% (5-20%); CD34 = 0% (< 1%); CD8 = 3% (10-40%); kappa = 10% (3-15%); lambda = 5% (2-10%); CD19 = 15% (5-20%).

A) normal
B) B-cell acute leukemia
C) T-cell acute leukemia
D) B-cell chronic leukemia
E) T-cell chronic leukemia

T-cell chronic leukemia

Accepted Answer

The results show a high WBC count with a high percentage of lymphocytes, predominantly T-cells (CD3, CD5, CD4), suggesting T-cell chronic leukemia.

Question 4

Which immunoproliferative disorder is a cancer of the plasma cells and results in secretion of light chains into the urine?&#10;A) multiple myeloma&#10;B) Waldenstr&#246;m's macroglobulinemia&#10;C) alpha heavy chain disease&#10;D) DiGeorge syndrome

Accepted Answer

Multiple myeloma is a cancer of the plasma cells, which secrete abnormal amounts of monoclonal immunoglobulin (or light chains) that can be detected in the urine, leading to a condition called Bence Jones proteinuria. Waldenström's macroglobulinemia is another immunoproliferative disorder that involves excessive production of a different type of immunoglobulin (IgM). Alpha heavy chain disease is a rare immunodeficiency disorder characterized by systemic infections and malabsorption due to a deficiency in the production of alpha-heavy chains. DiGeorge syndrome is a genetic disorder that affects the development of multiple organs and is not related to immunoproliferative disorders.

Question 5

What is the interpretation of the following patient results? (normal values)WBC = 90.0 th/uL (5.0-10.0 th/uL,),with 89% lymphs (20-40%); CD3 = 90% (60-80%); CD5 = 87% (60-80%); CD10 = 0% (< 1%); CD4 = 88% (30-65%); CD20 = 12% (5-20%); CD34 = 0% (< 1%); CD8 = 3% (10-40%); kappa = 10% (3-15%); lambda = 5% (2-10%); CD19 = 15% (5-20%).

A) normal
B) B-cell acute leukemia
C) T-cell acute leukemia
D) B-cell chronic leukemia
E) T-cell chronic leukemia

Accepted Answer

The high WBC count with 78% blasts suggests acute leukemia. The immunophenotype shows high CD3, CD5, CD4, and CD8, which are T-cell markers, indicating T-cell acute leukemia.

Question 6

Which best describes the difference between chronic and acute lymphocytic leukemias?&#10;A) Chronic lymphocytic leukemias are exclusive of T-cell origin.&#10;B) Acute lymphocytic leukemias have a high response rate to chemotherapy.&#10;C) Chronic lymphocytic leukemias have a shorter survival time.&#10;D) Acute lymphocytic leukemias progress more slowly.

Accepted Answer

Acute lymphocytic leukemias (ALL) typically have a high response rate to chemotherapy, whereas chronic lymphocytic leukemias (CLL) progress more slowly and are often of B-cell origin, not exclusive of T-cell origin.

Question 7

A CBC,differential,and flow cytometry were performed on a patient with the following results (normal values): WBC = 8.0 th/uL (5.0-10.0 th/uL),diff = 90% lymphs (20-40%),CD3 = 5% (60-80%),CD5 = 95% (60-80%),CD19 = 95% (5-20%),CD10 = 0% (0%),surface Ig = pos (positive),and cytoplasmic Ig = neg (negative).What disease does this patient have?

A) B-cell acute lymphocytic leukemia
B) B-cell chronic leukemia
C) T-cell acute lymphocytic leukemia
D) T-cell chronic leukemia
E) AIDS

Accepted Answer

The patient has an elevated WBC count and a differential showing 90% lymphocytes. The flow cytometry results show a B-cell phenotype with CD19 and surface Ig positivity, as well as CD5, which is associated with B-cell chronic lymphocytic leukemia (B-CLL). The absence of CD10 excludes the possibility of B-cell acute lymphocytic leukemia (B-ALL). The T-cell markers (CD3) are decreased, making T-cell lymphocytic leukemia an unlikely diagnosis. Lastly, there is no evidence of HIV/AIDS based on the given results.

Question 8

What is the interpretation of the following patient results? (normal values)WBC = 90.0 th/uL (5.0-10.0 th/uL,),with 89% lymphs (20-40%); CD3 = 90% (60-80%); CD5 = 87% (60-80%); CD10 = 0% (< 1%); CD4 = 88% (30-65%); CD20 = 12% (5-20%); CD34 = 0% (< 1%); CD8 = 3% (10-40%); kappa = 10% (3-15%); lambda = 5% (2-10%); CD19 = 15% (5-20%).

A) normal
B) B-cell acute leukemia
C) T-cell acute leukemia
D) B-cell chronic leukemia
E) T-cell chronic leukemia

Accepted Answer

The patient's WBC count is within the normal range, but the high percentage of blasts (immature white blood cells) indicates a pathology. The CD markers indicate a predominance of CD10 and CD19, which are usually found on B-cells. The CD34 marker is also significantly elevated, which is a common marker for acute leukemia. The absence of CD20, which is expressed on nearly all mature B-cells and most B-cell malignancies, further supports a diagnosis of B-cell acute leukemia.

Deck 15: Immunoproliferative Diseases