Hematopathology Practice Questions

Q: Which of the following is a poor prognostic factor in Acute Myeloid Leukemia (AML)?

Monosomy. ### Explanation In Acute Myeloid Leukemia (AML), cytogenetic and molecular abnormalities are the most significant predictors of clinical outcome and treatment response [1]. **1. Why Monosomy is the Correct Answer:** Monosomies (loss of an entire chromosome), particularly of **chromosomes 5 or 7**, or the presence of a **complex karyotype** (≥3 abnormalities), are classified as **adverse/poor prognostic factors**. These are often associated with therapy-related AML or AML evolving from Myelodysplastic Syndrome (MDS). They typically show poor response to standard induction chemotherapy and high relapse rates. **2. Analysis of Incorrect Options:** * **Deletion of X or Y chromosome:** These are considered **isolated secondary changes** and do not carry an adverse prognosis. In many cases, the loss of a sex chromosome is considered a "neutral" or "favorable" finding compared to complex karyotypes. * **t(8;21):** This translocation involves the *RUNX1-RUNX1T1* genes. It is a hallmark of **favorable prognosis** AML (specifically AML-M2 in the FAB classification) and generally responds well to cytarabine-based therapy [1]. * **Nucleophosmin (NPM1) mutation:** In the absence of *FLT3-ITD* mutations, an *NPM1* mutation is a **favorable prognostic marker** [1]. It is one of the most common genetic alterations in adult AML with a normal karyotype. **Clinical Pearls for NEET-PG:** * **Favorable Prognosis:** t(8;21), inv(16), t(15;17) [APML], and isolated *NPM1* or *CEBPA* mutations [1]. * **Poor Prognosis:** Monosomy 5/7, del(5q), 11q23 (MLL gene) rearrangements, and *FLT3-ITD* mutations [1]. * **APML (t15;17):** While it has a high risk of early mortality due to DIC, it has the **best long-term prognosis** with ATRA and Arsenic Trioxide therapy. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of White Blood Cells, Lymph Nodes, Spleen, and Thymus, pp. 620-621.

Question 1

Which of the following is a poor prognostic factor in Acute Myeloid Leukemia (AML)?

Accepted Answer

Monosomy

Answer

Deletion of X or Y chromosome

Answer

t (8; 21) translocation

Answer

Nucleophosphin mutation

Question 2

Which of the following is not a B cell neoplasm?

Accepted Answer

Mycosis fungoides

Answer

Hairy cell leukemia

Answer

Mantle cell lymphoma

Answer

Burkitt's lymphoma

Question 3

Which anticoagulant is the preferred choice for use in a blood bank?

Accepted Answer

Acid citrate dextrose solution

Answer

Calcium oxalate

Answer

Heparin solution

Answer

Sodium fluoride

Question 4

Which of the following statements is NOT true regarding Bernard-Soulier syndrome?

Accepted Answer

Ristocetin-induced platelet aggregation is normal.

Answer

Platelet aggregation with collagen and ADP is normal.

Answer

Platelets are large.

Answer

There is thrombocytopenia.

Question 5

Which of the following statements is not true regarding chronic myelogenous leukemia?

Accepted Answer

Bone marrow biopsy is essential for confirmation of diagnosis.

Answer

BCR-ABL fusion is involved in the oncogenesis.

Answer

Pseudo Gaucher cells may be present in the bone marrow examination.

Answer

Blast crisis in the disease may involve lymphoblasts.

Question 6

In the Ann Arbor staging system for Hodgkin's lymphoma, which stage is characterized by the involvement of lymph nodes on both sides of the diaphragm?

Accepted Answer

Stage III

Answer

Stage I

Answer

Stage II

Answer

Stage IV

Question 7

Chronic myeloid leukemia (CML) is characterized by all of the following except:

Accepted Answer

Increased Leukocyte alkaline phosphatase

Answer

Leukocytosis

Answer

Thrombocytosis

Answer

Increased serum Vitamin B12

Question 8

Which is the most common defectively produced antibody in multiple myeloma?

Accepted Answer

IgG

Answer

IgM

Answer

IgA

Answer

IgD

Question 9

All of the following are associated with Epstein-Barr virus (EBV), EXCEPT:

Accepted Answer

Lymphoplasmacytic lymphoma

Answer

Hodgkin's disease

Answer

Post-organ transplant lymphoma

Answer

Extranodal NK/T cell lymphoma, nasal type

Question 10

Prolonged prothrombin time (PT) and normal activated partial thromboplastin time (aPTT) may be seen in which of the following conditions?

Accepted Answer

Vitamin K deficiency

Answer

Thrombocytopenia

Answer

Disseminated Intravascular Coagulation (DIC)

Answer

Aspirin toxicity

Hematopathology — MCQs

Hematopathology — MCQs

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