Post-Resource Quiz

A textbook describes a leukaemia as 'Uncontrolled proliferation of lymphoid progenitors leads to these cells replacing normal haematopoietic cells of bone marrow and infiltrating other organs' 

 

Which leukaemia subtype is being described?

• CLL

• AML

• ALL

• CML

What is the definitive diagnosis for ALL?

• FBC with differentiation which shows anaemia, thrombocytopenia, neutropenia and leukocytosis

• Bone marrow biopsy containing >20% lymphoblasts

• Peripheral blood smear containing ≥1 x 10⁹/L leukaemic lymphoblasts

• Karyotyping which reveals a Philadelphia chromosome

ALL can be treated with chemotherapy followed by allogeneic stem cell transplantation.

 

What is the mechanism of this therapy?

• A. The transplanted immune cells replace the immune cells that were destroyed during chemotherapy.

• B. Transplanted immune cells are lysed with sodium dodecyl sulfate to release healthy genetic material into the bone marrow. Residual cells take up this material and proliferate using it. 

• C. Aggressive chemotherapy virtually eradicates the host immune system. Transplanted immune cells replace the host's immune system. These cells recognise leukaemia cells as abnormal and destroy them.

• Host stem cells enter the bone marrow and proliferate healthy cells. Over time, these replace leukaemia cells. 

You review the notes of a 79 year old man who is suspected of having AML. the history and examination findings are listed below. 

 

Which of the following is least associated with an acute leukaemia?

• Hepatosplenomegaly

• Lymphadenopathy

• Enlarged testes

• Bone pain

• Venous thromboembolism

A 72 year old lady has been given a peripheral blood smear as part of investigations querying AML. 

 

What is the definitive diagnosis for AML?

• A. Peripheral blood smear showing ≥20% myeloblast cells.

• B. Bone marrow biopsy showing ≥20% myeloblast cells.

• C. Peripheral blood smear showing auer rods.

• D. ≥20% myeloblast cells in a peripheral blood smear or bone marrow biopsy.

If a patient is symptomatic with CLL, what is the most common presentation?

• Lymphadenopathy and hepatosplenomegaly

• Low lymphocyte count

• Bone pain

• Gingivitis

A gentleman is 57. He is asymptomatic but he has been diagnosed with CLL after a persistently raised lymphocyte count.

 

What should the management be for this patient?

• Conservative management and monitoring

• Chemotherapy (fludarabine and cyclophosphamide)

• Targeted therapy e.g. Rituximab or Ibrutinib

• Allogeneic stem cell transplant

An otherwise asymptomatic 58 year old male patient has a raised neutrophil count. He has a recent diagnosis of CML. Their blood film is repeated.

 

Which type of cells would you expect to see on their blood smear?

• Mature myeloid cells

• Lymphoblasts

• Myeloblasts

• Mature lymphocytes

A 55 year old man with B symptoms and abdominal discomfort has been diagnosed with CML. 

 

What is the first line therapy? 

• Fludarabine

• Rituximab

• Cyclophosphamide

• Ibrutinib

A 56 year old man has a raised lymphocyte count.

 

For how long must the lymphocyte count be peristently raised to diagnose CLL?

• 2 weeks

• 3 weeks

• 6 weeks

• 3 months