Deck 17: Chronic Myeloproliferative Disorders I: Chronic Myelogenous Leukemia

Question 1

The prominent laboratory feature representative of CML is:

A) Leukocytosis with left shift
B) Leukocytosis with megaloblastic anemia
C) Leukopenia with lymphocytosis
D) Leukopenia with reticulocytosis
E) None of the above

Answer 1

Leukocytosis with left shift

Question 2

How is CML differentiated from a leukemoid reaction?

A) WBC >100,000/µL
B) Decreased leukocyte alkaline phosphatase (LAP)
C) Shift to the left
D) Increased LAP
E) RBC indices

Answer 2

Decreased leukocyte alkaline phosphatase (LAP)

Question 3

In CML the term "maturation arrest" refers to the:

A) Presence of cellular differentiation beyond the blast stage
B) Absence of cellular differentiation beyond the blast or promyelocyte stage
C) Absence of cellular differentiation beyond the band stage
D) Absence of cellular differentiation beyond the metamyelocyte stage
E) None of the above

Answer 3

Absence of cellular differentiation beyond the blast or promyelocyte stage

Question 4

Which clinical signs are evident in CML?

A) Splenomegaly
B) Hepatomegaly
C) Pallor
D) Epistaxis
E) All of the above

Question 5

When CML is diagnosed in infants and toddlers, it is called __________ CML.

A) Young
B) Juvenile
C) Infant
D) Myelofibrosis
E) AML

Question 6

Philadelphia chromosome is present in __________ percent of patients with typical leukemia cells.

A) 90-95%
B) 40-50%
C) 40-60%
D) 30-40%
E) 65-75%

Question 7

Patients with CML in blast crisis most commonly die of:

A) Therapy related to marrow aplasia
B) Exsanguination
C) Infection
D) Aplasia with myelofibrosis
E) All of the above

Question 8

Chronic myelocytic leukemia (CML) is characterized by examining the production of __________ and their precursors.

A) Erythrocytes
B) Platelets
C) Granulocytes
D) Lymphocytes
E) None of the above

Question 9

In CML, transformation to a more critical phase is evident by the appearance of which cells?

A) Blasts
B) Promyelocytes
C) Myelocytes
D) Bands
E) Metamyelocytes

Question 10

Which chromosomal abnormality is associated with CML?

A) Deletion 7
B) Chromosome 5
C) Trisomy 12
D) Philadelphia chromosome
E) None of the above

Question 11

The usual objective of therapy for the chronic phase of CML is to:

A) Reduce the proliferating myeloid mass
B) Relieve symptoms of hyperleukocytosis
C) Relieve symptoms of thrombocytosis
D) Relieve symptoms of splenomegaly
E) All of the above

Question 12

What is the etiology of chronic myelogenous leukemia?

A) Increased maturation in the granulocytic series
B) Neoplastic transformation of the hematopoietic pluripotent stem cell
C) Virus mediated
D) Suppression of myelopoiesis by cytokine
E) None of the above

Question 13

Which cell types contain the Ph chromosome in patients with CML?

A) Neutrophil
B) Monocyte
C) Erythrocyte
D) Platelet
E) All of the above

Question 14

What is the M/E ratio in patients with CML?

A) 1:10
B) 1:5
C) 10:1
D) 3-4:1
E) 4:1

Question 15

Which of the following is not consistent with leukemoid reaction?

A) High WBC count
B) High LAP
C) Toxic granulation of neutrophils
D) Presence of Philadelphia chromosome
E) Associated with a bacterial infection

Question 16

What is the chromosomal abnormality in CML?

A) t(8;14)
B) t(9;22)
C) t(1;12)
D) Trisomy 12
E) t(15;17)

Question 17

What is characteristic of the bone marrow morphology in CML?

A) Myeloid hyperplasia
B) Normal M/E ratio
C) Myeloid hypoplasia
D) Hypocellularity
E) Erythroid hyperplasia

Question 18

The only curative treatment for CML is __________.

A) Steroids
B) Immunosuppressive drugs
C) Radiation therapy
D) Hematopoietic stem cell transplant (HSCT)
E) Tyrosine kinase

Question 19

CML can be differentiated from polycythemia vera, essential thrombocythemia, and agnogenic myeloid metaplasia by the presence of __________.

A) Leukocytosis
B) Ph chromosome
C) Splenomegaly
D) Erythrocytosis
E) Thrombocytosis

Question 20

Which phase of CML carries the worst prognosis and is generally unresponsive to treatment?

A) Chronic phase
B) Accelerated phase
C) Blast crisis
D) Chemotherapy-resistant phase
E) None of the above

Question 21

Which phase of CML carries the worst prognosis and is generally unresponsive to treatment?

A) Chronic
B) Accelerated
C) Blast
D) Remission
E) Refractory

Question 22

Most patients (85%) are diagnosed in which phase of CML?

A) Chronic
B) Accelerated
C) Blast
D) Remission
E) Refractory

Question 23

All of the following are characteristics of chronic leukemias except:

A) Insidious onset
B) Mature leukemia cells
C) Found in adults
D) Found primarily in children
E) Organomegaly

Question 24

Which of the following myeloproliferative disorders is characterized by a decreased LAP score?

A) PV
B) IMF
C) ET
D) AML
E) CML