Question 1

A patient has a very high white blood cell count with many blasts in the blood and bone marrow.Esterase stains using both naphthol AS-D chloroacetate and a-naphthyl acetate esterase as substrates are both positive.What condition is likely?

A)chronic myelogenous leukemia
B)acute lymphoblastic leukemia
C)acute myelomonocytic leukemia
D)hairy cell leukemia

acute myelomonocytic leukemia

Accepted Answer

Myelomonocytic leukemia will be positive for both naphthol AS-D chloroacetate and a-naphthyl acetate esterase stains.The others mentioned are either negative for both or positive for only one.The stain is not useful for the diagnosis of chronic myelogenous leukemia.

Question 2

A 27-year-old woman arrives at the emergency department with acute bleeding and is found to have a white count of 25.7 * 10⁹L with pancytopenia: hematocrit 27%,platelet count 35 * 10⁹/L,and absolute neutrophil count 0.8 * 10⁹/L.She has a combination of 97% blasts and abnormal promyelocytes in her peripheral blood;some of these cells contain Auer rods.What form of leukemia does she most likely have?

A)acute myeloid leukemia with t(15;17)(q22:q12)
B)chronic myeloid leukemia
C)acute monoblastic leukemia
D)acute myeloid leukemia with t(8;21)(q33:q22)

acute myeloid leukemia with t(15;17)(q22:q12)

Accepted Answer

Acute myeloid leukemia with t(15;17)(q22:q12)is characterized by abnormal promyelocytes,which may have Auer rods.Patients are most often young adults.

Question 3

What is the most common leukemia in children between the ages of 2 and 5 years?&#10;A)acute myeloid&#10;B)acute monocytic&#10;C)acute myelomonocytic&#10;D)acute lymphoblastic

Accepted Answer

The most common leukemia in this age group is acute lymphoblastic leukemia.

Question 4

What leukemia is most likely in a patient whose bone marrow is composed of predominantly large,multinucleated,vacuolated,dysplastic erythroid precursors?&#10;A)acute myelomonocytic leukemia&#10;B)acute megakaryocytic leukemia&#10;C)acute erythroleukemia&#10;D)acute myeloid leukemia with minimal maturation

Accepted Answer

The bone marrow erythroid precursors display significant dysplastic features,including multinucleation,megaloblastoid asynchrony,and vacuolization,in acute erythroleukemia.Abnormal megakaryocytes may also be present.

Question 5

An adult patient has a white blood count of 80 * 10&#8313;/L.The differential has 92% Sudan black B-positive blasts and 8% lymphocytes.Which of the following is most likely?&#10;A)acute myeloid leukemia, minimally differentiated&#10;B)acute myeloid leukemia without maturation&#10;C)immature B-cell acute lymphoblastic leukemia&#10;D)acute megakaryocytic leukemia

Accepted Answer

Positive staining with either or both the Sudan black B and peroxidase stain characterize acute myeloid leukemia without maturation.

Question 6

Which form of acute myeloid leukemia is most often associated with disseminated intravascular coagulation (DIC)?&#10;A)acute myeloid leukemia minimally differentiated&#10;B)acute myeloid leukemia with t(8;21)(q33:q22)&#10;C)acute myeloid leukemia with t(15;17)(q22:q12)&#10;D)acute myeloid leukemia with maturation

Accepted Answer

Acute myeloid leukemia with t(8;21)(q22:q12),also known as acute promyelocytic leukemia,is associated with DIC.Treatment of this disorder must therefore involve resolution of the DIC.

Question 7

Sudan Black is used to distinguish which types of leukemia?&#10;A)acute myeloid leukemia from acute lymphoblastic leukemia&#10;B)acute myeloid leukemia from chronic myelogenous leukemia&#10;C)acute myeloid leukemia from acute promyelocytic leukemia&#10;D)acute promyelocytic leukemia from acute monocytic leukemia

Accepted Answer

Lymphoid cells are generally negative,whereas myeloblasts are positive.Thus a positive result with this stain can be used to differentiate acute myeloid leukemia from acute lymphoblastic leukemia.The entire myeloid series through neutrophils is positive,so it is not useful in differentiating different types of myeloid leukemia.Monocytes are negative to weakly positive.

Question 8

Which of the following would stain most strongly for myeloperoxidase?&#10;A)lymphoblasts&#10;B)Auer rods&#10;C)monocytes&#10;D)normal myeloblasts

Accepted Answer

Auer rods are strongly positive for myeloperoxidase.Sometimes Auer rods that cannot be seen with Wright stain are visible after staining for myeloperoxidase.Monocytes are only very weakly positive for this enzyme,whereas normal myeloblasts and lymphoblasts (both normal and malignant)are negative.

Question 9

Acute myelomonocytic leukemia is positive for which of the following?&#10;A)CD10&#10;B)periodic acid-Schiff (PAS)&#10;C)HLA-DR1a&#10;D)CD13 and CD14

Accepted Answer

The cells in acute myelomonocytic leukemia are positive for CD13 (a myeloid antigen)and CD14 (a monocytic antigen).

Question 10

Which form of acute leukemia has megakaryoblasts and antibodies to platelet glycoprotein IIb/IIIa?&#10;A)acute myeloid leukemia with minimal differentiation&#10;B)acute monoblastic leukemia&#10;C)acute erythroleukemia&#10;D)acute megakaryoblastic leukemia

Accepted Answer

Acute megakaryoblastic leukemia has blasts that are positive for the platelet antigens glycoprotein IIb/IIIa.They may also be positive for glycoprotein Ib or factor VIII-related antigen.

Question 11

A 15-year-old boy is complaining of severe headaches;he has a white count of 76.0 * 10⁹/L,platelet count of 55 * 10⁹/L,and a hematocrit of 33%.When a white cell differential is performed,most of the nucleated cells are blasts.They are CD2,CD4,and CD8 positive.The TdT marker is expressed.What is the most likely diagnosis?

A)immature-B cell acute lymphoblastic leukemia
B)T-cell acute lymphoblastic leukemia
C)acute myeloid leukemia without maturation
D)acute myeloid leukemia with maturation

Accepted Answer

The answer of A 15-year-old boy is complaining of severe...

Question 12

A 47-year-old man has gingival hypertrophy and a white blood cell (WBC)count of 108 * 10⁹/L.He has a moderate anemia and is thrombocytopenic.The differential consists primarily of a combination of mature monocytes,promonocytes,and CD14-positive blasts.Which of the following forms of leukemia is most likely?

A)acute myeloid leukemia with maturation
B)acute myeloid leukemia with t(15;17)(q22:q12)
C)acute monoblastic leukemia
D)acute myeloid leukemia with minimal differentiation

Accepted Answer

The answer of A 47-year-old man has gingival hypertrophy and...

Deck 35: Acute Leukemias