Hematopathology Practice Questions

Question 1

A 45-year-old woman comes to the physician because of a 1-week history of fatigue and bruises on her elbows. Examination shows a soft, nontender abdomen with no organomegaly. Laboratory studies show a hemoglobin concentration of 7 g/dL, a leukocyte count of 2,000/mm3, a platelet count of 40,000/mm3, and a reticulocyte count of 0.2%. Serum electrolyte concentrations are within normal limits. A bone marrow biopsy is most likely to show which of the following findings?

Accepted Answer

Hypocellular bone marrow

Answer

Increased myeloblast count

Answer

Sheets of abnormal plasma cells

Answer

Wrinkled cells with a fibrillary cytoplasm

Answer

Dysplastic bone with ringed sideroblasts

Question 2

A 24-year-old woman complains of intermittent fever and joint pain. She says that these symptoms have been present for the past month. Before that, she had no signs or symptoms and was completely healthy. She has also lost her appetite and some weight. A complete blood count (CBC) showed severe pancytopenia. What is the next best step in evaluating this patient?

Accepted Answer

Bone marrow examination

Answer

Repeated CBCs for several weeks and reassess

Answer

Treatment with corticosteroids

Answer

Treatment with antibiotics

Answer

Treatment for acute leukemia

Question 3

A 63-year-old man comes to the physician because of increasing generalized fatigue for 3 months. He is having more difficulty with keeping up with his activities of daily living and has lost 2.5 kg (5.5 lb) over the past month. He has hypertension and hyperlipidemia. He does not smoke and drinks two to three beers on weekends. His medications include lisinopril, hydrochlorothiazide, and atorvastatin. His temperature is 37.1°C (98.8°F), pulse is 85/min, respirations are 15/min, and blood pressure is 125/73 mm Hg. Examination shows pale conjunctivae. The remainder of the examination shows no abnormalities. His hematocrit is 27.3%, leukocyte count is 4500/mm3, and platelet count is 102,000/mm3. A peripheral blood smear shows numerous blast cells that stain positive for myeloperoxidase, CD33, and CD34. Which of the following is the most likely diagnosis?

Accepted Answer

Acute myeloid leukemia

Answer

Non-Hodgkin lymphoma

Answer

Hairy cell leukemia

Answer

Chronic lymphocytic leukemia

Answer

Acute lymphoblastic leukemia

Question 4

A 64-year-old woman comes to the physician because of a 7-month history of abdominal discomfort, fatigue, and a 6.8-kg (15-lb) weight loss. Physical examination shows generalized pallor and splenomegaly. Laboratory studies show anemia with pronounced leukocytosis and thrombocytosis. Cytogenetic analysis shows a BCR-ABL fusion gene. A drug with which of the following mechanisms of action is most appropriate for this patient?

Accepted Answer

Tyrosine kinase inhibitor

Answer

Ribonucleotide reductase inhibitor

Answer

Monoclonal anti-HER-2 antibody

Answer

Topoisomerase II inhibitor

Answer

Monoclonal anti-CD20 antibody

Question 5

A 67-year-old man comes to the physician because of a 2-month history of generalized fatigue. On examination, he appears pale. He also has multiple pinpoint, red, nonblanching spots on his extremities. His spleen is significantly enlarged. Laboratory studies show a hemoglobin concentration of 8.3 g/dL, a leukocyte count of 81,000/mm3, and a platelet count of 35,600/mm3. A peripheral blood smear shows immature cells with large, prominent nucleoli and pink, elongated, needle-shaped cytoplasmic inclusions. Which of the following is the most likely diagnosis?

Accepted Answer

Acute myelogenous leukemia

Answer

Acute lymphoblastic leukemia

Answer

Myelodysplastic syndrome

Answer

Hairy cell leukemia

Answer

Chronic myelogenous leukemia

Question 6

A 5-year-old patient presents to the pediatrician's office with fatigue and swollen lymph nodes. Extensive work-up reveals a diagnosis of acute lymphoblastic leukemia. In an effort to better tailor the patient's treatments, thousands of genes are arranged on a chip and a probe is made from the patient's mRNA (converted to cDNA). This probe is then hybridized to the chip in order to measure the gene expression of thousands of genes. The technology used to investigate this patient's gene expression profile is best for detecting which of the following types of genetic abnormalities?

Accepted Answer

Chromosomal translocations

Answer

Trisomies

Answer

Large scale chromosomal deletions

Answer

Frame-shift mutations

Answer

Single nucleotide polymorphisms

Question 7

A 5-year-old male is brought to his pediatrician after recurrent, prolonged upper respiratory infections over a period of several months. Physical exam reveals petechiae on the patient's legs and arms. Laboratory studies show hemoglobin: 10 g/dL, platelet count: 35,000/mm^3, leukocyte count: 6,600/mm^3. A bone marrow aspiration shows an abundance of lymphoblasts indicative of acute lymphoblastic leukemia (ALL). Positive immunostaining for which of the following would support a diagnosis of precursor B-cell leukemia?

Accepted Answer

CD19, CD10

Answer

CD2, CD8

Answer

TdT, HER-2

Answer

CD4, CD5

Answer

CD30, CD15

Question 8

A 72-year-old man goes to his primary care provider for a checkup after some blood work showed lymphocytosis 3 months ago. He says he has been feeling a bit more tired lately but doesn’t complain of any other symptoms. Past medical history is significant for hypertension and hyperlipidemia. He takes lisinopril, hydrochlorothiazide, and atorvastatin. Additionally, his right hip was replaced three years ago due to osteoarthritis. Family history is noncontributory. He drinks socially and does not smoke. Today, he has a heart rate of 95/min, respiratory rate of 17/min, blood pressure of 135/85 mm Hg, and temperature of 36.8°C (98.2°F). On physical exam, he looks well. His heartbeat has a regular rate and rhythm and lungs that are clear to auscultation bilaterally. Additionally, he has mild lymphadenopathy of his cervical lymph nodes. A complete blood count with differential shows the following:
Leukocyte count 5,000/mm3
Red blood cell count 3.1 million/mm3
Hemoglobin 11.0 g/dL
MCV 95 um3
MCH 29 pg/cell
Platelet count 150,000/mm3
Neutrophils 40%
Lymphocytes 40%
Monocytes 5%
A specimen is sent for flow cytometry that shows a population that is CD 5, 19, 20, 23 positive. Which of the following is the most likely diagnosis?

Accepted Answer

Chronic lymphocytic leukemia

Answer

Immune thrombocytopenic purpura

Answer

Aplastic anemia

Answer

Acute lymphoblastic leukemia

Answer

Tuberculosis

Question 9

A 27-year-old woman presents to the emergency department complaining of a left-sided headache and right-sided blurry vision. She states that 2 weeks ago she developed dark urine and abdominal pain. She thought it was a urinary tract infection so she took trimethoprim-sulfamethoxazole that she had left over. She planned on going to her primary care physician today but then she developed headache and blurry vision so she came to the emergency department. The patient states she is otherwise healthy. Her family history is significant for a brother with sickle cell trait. On physical examination, there is mild abdominal tenderness, and the liver edge is felt 4 cm below the right costal margin. Labs are drawn as below:

Hemoglobin: 7.0 g/dL
Platelets: 149,000/mm^3
Reticulocyte count: 5.4%
Lactate dehydrogenase: 3128 U/L

Total bilirubin: 2.1 mg/dL
Indirect bilirubin: 1.4 mg/dL
Aspartate aminotransferase: 78 U/L
Alanine aminotransferase: 64 U/L

A peripheral smear shows polychromasia. A Doppler ultrasound of the liver shows decreased flow in the right hepatic vein. Magnetic resonance imaging of the brain is pending. Which of the following tests, if performed, would most likely identify the patient’s diagnosis?

Accepted Answer

Flow cytometry

Answer

Glucose-6-phosphate-dehydrogenase levels

Answer

Anti-histone antibodies

Answer

Bone marrow biopsy

Answer

Hemoglobin electrophoresis

Question 10

A 48-year-old man is being evaluated for an acquired defect of the myeloid stem cell line with a mutation in the PIG-A gene. His diagnosis was first suspected due to anemia and recurrent pink-tinged urine. Which of the markers will be negative in the flow cytometry test for his condition?

Accepted Answer

CD55

Answer

CD18

Answer

CD3

Answer

CD19

Answer

CD40L

Hematopathology

Study Resources

Lessons

Questions

Flashcards

Lessons

Red blood cell disorders

White blood cell disorders

Platelet disorders

Coagulation disorders

Acute leukemias

Chronic leukemias

Myeloproliferative neoplasms

Myelodysplastic syndromes

Hodgkin lymphoma

Non-Hodgkin lymphomas

Plasma cell disorders

Bone marrow failure syndromes

Splenic pathology

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