Deck 23: Introduction to Hematopoietic Neoplasms

Question 1

Which of the following disorders is characterized by signs of dyshematopoiesis?

A) Acute leukemias
B) Chronic leukemias
C) Myelodysplastic syndromes
D) Myeloproliferative disorders

Answer 1

Myelodysplastic syndromes

Question 2

Which of the following have the potential to progress into acute leukemia?

A) Myeloproliferative neoplasms
B) Acute neutrophilia
C) Megaloblastic anemias
D) Reactive leukocytosis

Answer 2

Myeloproliferative neoplasms

Question 3

A patient has a WBC count of 250 × 10⁹/L, and a peripheral blood smear contains many granulocytes and granulocytic precursors including 2% blasts. Pending further tests, which of the following neoplastic conditions is the most likely diagnosis?

A) Chronic myeloid leukemia
B) Lymphoblastic leukemia
C) Chronic lymphocytic leukemia
D) Acute myeloid leukemia

Answer 3

Chronic myeloid leukemia

Question 4

Leukemias are classified as:

A) Benign neoplasms
B) Malignant neoplasms
C) Neoplasms
D) Benign tumors

Question 5

How are oncogenes and proto-oncogenes different?

A) Proto-oncogenes are activated tumor genes, whereas oncogenes are inactivated tumor suppressor genes.
B) Oncogenes can lead to tumor formation, whereas proto-oncogenes prevent tumor formation.
C) Oncogenes can lead to tumor formation, whereas proto-oncogenes are inactivated forms of oncogenes.
D) Oncogenes are tumor suppressors, whereas proto-oncogenes cause tumor formation.

Question 6

A routine CBC from a 5-year-old boy shows 90% blasts in peripheral circulation. Cytochemical staining with SBB was negative and TdT was positive. Based on these findings, what is a probable diagnosis?

A) AML
B) ALL
C) CML
D) CLL

Question 7

Which of the following laboratory analyses can be used to diagnose hematopoietic neoplasms?

A) Cell morphology
B) Immunophenotyping
C) Cytogenetics
D) All of the above

Question 8

Which progenitor cells normally do not have the capacity for self-renewal?

A) CMP and CLP
B) HSC
C) Somatic cells
D) Primitive hematopoietic precursor cells

Question 9

Which laboratory test confirms the lineage of hematologic neoplasms?

A) Cytogenetic analysis
B) Immunophenotyping
C) Nuclear staining
D) Bone marrow differential

Question 10

In what age group does chronic leukemia usually occur?

A) All
B) Children
C) Adults
D) 15-20 years of age

Question 11

Which disease state has Auer bodies present on examination of the blood smear?

A) MDS
B) MPD
C) MDS/MPD
D) AML

Question 12

Which of the following cytochemical stains can help differentiate AML from ALL?

A) PAS stain
B) LAP stain
C) MPO stain
D) NSE stain

Question 13

All of the following have been proposed as being leukemogenic except:

A) Therapeutic radiation
B) Living in high altitude
C) Chromosome translocation
D) Benzene

Question 14

Which of the following combinations leads to tumor formation?

A) Activation of oncogenes and suppression of proto-oncogenes
B) Activation of proto-oncogenes with concurrent suppression of oncogenes
C) Activation of oncogenes and suppression of tumor-suppressor genes
D) Activation of tumor suppressor genes and suppression of proto-oncogenes

Question 15

The purpose of the induction phase in chemotherapy is to:

A) Eradicate normal cells
B) Eradicate tumor cells
C) Initiate an immune response against tumors
D) Help the patient tolerate the tumor

Question 16

Which of the following does the World Health Organization use to classify hematopoietic neoplasms?

A) Lineage morphology
B) Clinical presentation
C) HIV status
D) DNA profiling

Question 17

Which of the following is a complication of leukemia treatment?

A) Increased uric acid levels
B) Graft-versus-host disease
C) DIC
D) All of the above

Question 18

Which patient population is most affected by acute lymphoblastic leukemia?

A) Children
B) Adults
C) Geriatrics
D) Females

Question 19

A malignant neoplasm is best described as which of the following?

A) A clone of normal, proliferating cells
B) A clone of abnormal, anaplastic, proliferating cells that have the potential to metastasize
C) A clone of highly organized, differentiated cells that have the potential to metastasize
D) A clone of highly organized, differentiated cells that do not spread

Question 20

Which of the following has the best prognosis?

A) ALL in children
B) ALL in adults
C) AML in adults
D) AML in children

Question 21

What is the difference between the HSC and the cancer stem cell?

Question 22

TSG, or the tumor suppressor gene, plays a role in neoplastic transformation of cells by what mechanism?

A) Suppressing the cellular proliferation and neoplastic transformation
B) Initiating the cellular proliferation
C) Triggering the proto-oncogenes to activate to oncogenes
D) Initiating translocation of genes

Question 23

The HSC and the cancer stem cell are similar in:

A) Morphology
B) CD markers
C) Cytochemical staining
D) Replicating potential

Question 24

Cell lineage of leukemic blasts can be determined by:

A) Morphology, cytochemical stains, cell concentration
B) Cytochemical stains, immunophenotyping
C) Presence of Auer rods and Pappenheimer bodies
D) Immaturity of cytoplasm and presence of nuclear phi bodies

Question 25

Somatic cell chromosome mutations resulting in hematologic neoplasms are associated with:

A) Chemicals, drugs, bacterial infection
B) Drugs, chemicals, renal disease
C) Therapeutic radiation, drugs and chemicals
D) Viral and bacterial infections, autoantibodies

Question 26

Bleeding, infections, and anemia are common complications of chemotherapy because:

A) Drugs are used kill normal cells as well as leukemic cells
B) Normal cells are more susceptible to drug-induced apoptosis than leukemic cells
C) Drugs bind preferentially to normal cells
D) Drugs induce the formation of autoantibodies to normal cells

Question 27

Explain how proto-oncogenes contribute to tumor formation.

Question 28

What is(are) the common complication(s) of chemotherapy?

A) Bleeding, infection, and anemia
B) Bone marrow rejection
C) Thrombocytosis
D) Refractory anemia

Question 29

A bone marrow differential is performed on a patient suspected of having leukemia. Cytochemical stains are performed. MPO and SBB are negative. Blasts appear homogeneous and small in size. What would you expect to find when performing immunophenotyping?

A) Positive reactivity with immature B-cell or T-cell markers
B) Positive reactivity with immature myeloid markers
C) Positive reactivity with mature myeloid markers
D) Positive reactivity with plasma cell markers

Question 30

A gene involved in regulating the growth of myeloid cells is hypermethylated, resulting in a block in transcription. This is an example of malignancy as a result of:

A) Post-translational modification
B) DNA mutation
C) Epigenetic change
D) Genomic instability

Question 31

Which two stains are used to differentiate the myeloid from the lymphoid blasts?

A) MPO and SBB
B) PAS and LAP
C) Acid phosphatase and LAP
D) Toluidine blue and reticulin stain

Question 32

For the following cytochemical stains, indicate their expected results for (a) ALL and (b) AML.
a. MPO
b. SBB
c. PAS
d. TdT

Question 33

Name the two main classification systems that identify MDS and acute leukemia. Indicate how they are different.