Question 1

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

Accepted Answer

Acute myelomonocytic leukemia is positive for CD13 and CD14, which are commonly used as markers for myelomonocytic cells. CALLa (CD10) is more commonly seen in lymphoblastic leukemias, PAS is a stain used to identify glycogen in cells, and HLA-DR1a is a genetic marker for the human leukocyte antigen system.

Question 2

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. 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

T-cell acute lymphoblastic leukemia

Accepted Answer

The patient's presentation of severe headaches, high white count with blasts, and positive CD2, CD4, and CD8 markers all suggest a diagnosis of T-cell acute lymphoblastic leukemia. Immature-B cell acute lymphoblastic leukemia would typically present with CD10, CD19, and CD20 positivity, while acute myeloid leukemia would have a myeloid lineage marker and may show maturation in the blasts. Without more information on the specific markers present, it is hard to distinguish between acute myeloid leukemia with or without maturation.

Question 3

Which of the following is true regarding the symptoms of acute leukemia?&#10;A) Lymphadenopathy is found more often in myeloid than lymphoid.&#10;B) Central nervous system involvement is the most common presenting symptom.&#10;C) Most symptoms are related to abnormal cell counts.&#10;D) Bone pain results from fractures related to calcium loss.

Accepted Answer

Most symptoms of acute leukemia are related to abnormal cell counts, such as anemia, infections, bleeding, and fatigue. Lymphadenopathy is more commonly found in lymphoid rather than myeloid leukemia. Central nervous system involvement is a possible complication but not the most common presenting symptom. Bone pain may occur due to infiltration of abnormal cells in the bone marrow, but fractures related to calcium loss are not a common symptom.

Question 4

The most useful classification system for acute lymphoblastic leukemia based is based on:&#10;A) Immunophenotyping&#10;B) Morphology&#10;C) PAS staining&#10;D) Sudan black B staining

Accepted Answer

Immunophenotyping is the most useful classification system for acute lymphoblastic leukemia as it is based on the identification of specific cell surface markers expressed by the leukemic cells. This allows for a more accurate diagnosis, classification, and prognosis of the disease. Morphology, PAS staining, and Sudan black B staining can also be used in conjunction with immunophenotyping to further characterize the leukemic cells.

Question 5

A child has monotonous blasts in the peripheral blood that have scant blue cytoplasm. They are cALLa (CD10) positive. Which form of acute lymphoblastic leukemia is most likely?&#10;A) Immature B cell&#10;B) Immature T cell&#10;C) Mature B cell&#10;D) Mature T cell

Accepted Answer

The fact that the blasts are cALLa (CD10) positive indicates that they are early B cell progenitors, making immature B cell acute lymphoblastic leukemia the most likely diagnosis.

Question 6

Which form of acute myeloid 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 megakaryocytic leukemia

Accepted Answer

Acute megakaryocytic leukemia is characterized by the proliferation of megakaryoblasts and often presents with antibodies to platelet glycoprotein IIb/IIIa, which is a marker for megakaryocytes and platelets.

Question 7

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 acute myeloid 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...

Question 8

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(15;17)(q22:q12), also known as acute promyelocytic leukemia (APL), is most often associated with disseminated intravascular coagulation (DIC). This is due to the release of procoagulant factors from the leukemic cells, which can lead to abnormal blood clotting throughout the body. It is important to recognize and treat DIC in patients with APL, as it can lead to life-threatening complications such as organ damage and bleeding.

Question 9

An adult patient has a white blood count of 80 * 10⁹/L. The differential has 92% Sudan black B-positive blasts and 8% lymphocytes. Which of the following is most likely? A) Acute myeloid leukemia, minimally differentiated B) Acute myeloid leukemia without maturation C) Immature B-cell acute lymphoblastic leukemia D) Acute megakaryocytic leukemia

Accepted Answer

A white blood count of 80 × 10^9/L with 92% blasts is characteristic of acute leukemia. The fact that the blasts are Sudan black B-positive indicates that they are of myeloid origin. Furthermore, the low percentage of lymphocytes (8%) suggests that this is not a lymphoid leukemia. The differential diagnosis would then be between acute myeloid leukemia without maturation (AML-M0) and acute myeloid leukemia with minimal differentiation (AML-M1). However, AML-M0 is a rare subtype and AML-M1 is more common, making it the more likely diagnosis. Immature B-cell acute lymphoblastic leukemia (ALL) and acute megakaryocytic leukemia would have a different immunophenotype, and the peripheral blood and bone marrow smear would appear different.

Question 10

What leukemia is most likely in a patient whose bone marrow is composed of predominantly large, multinucleated, 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

Acute erythroleukemia is characterized by a bone marrow composed primarily of large, multinucleated, dysplastic erythroid precursors. The other choices listed do not fit this description.

Question 11

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

Accepted Answer

The answer of What is the most common leukemia in...

Question 12

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 stacked 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)

Accepted Answer

The answer of A 27-year-old woman arrives at the emergency...

Question 13

Which of the following indicates a favorable prognosis in acute lymphoblastic leukemia?&#10;A) Chromosal translocations&#10;B) Low white count at diagnosis&#10;C) Patient older than 45 years old&#10;D) T-cell immunophenotype

Accepted Answer

The answer of Which of the following indicates a favorable...

Deck 36: Acute Leukemias