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Hematology MCQ’s ( Acute and Chronic Myeloid Leukemia ) part-11

Hematology MCQ’s ( Acute and Chronic Myeloid Leukemia ) part-11

629 In myeloid leukemias, neoplastic cells of hematopoietic system infiltrate which of the following ?
A. Blood
B. Bone marrow
C. Other tissues
D. All of the above
Explanation:- Myeloid leukemias are characterized by infiltration of the blood, bone marrow, and other tissues by neoplastic cells of the hematopoietic system.

630 Incidence of acute myeloid leukemia (AML) is ?
A. 1.5 per 100,000 people per year
B. 2.5 per 100,000 people per year
C. 3.5 per 100,000 people per year
D. 4.5 per 100,000 people per year
Explanation:- Incidence of acute myeloid leukemia (AML) is 3.5 per 100,000 people per year, higher in men than in women. AML incidence increases with age, and median age at diagnosis is 67 years.

631 Disease associated with an increased incidence of AML is ?
A. Down syndrome
B. Fanconi anemia
C. Ataxia telangiectasia
D. All of the above
Explanation:- Down syndrome, Fanconi anemia, Bloom syndrome, Ataxia telangiectasia, Kostmann syndrome, myeloproliferative syndromes, germ-line mutations of CCAAT/enhancer-binding protein (CEBPA), runt-related transcription factor 1 (RUNX1), and tumor protein p53 (TP53) are associated with an increased incidence of AML.

632 Increase in the risk of myeloid leukemias peak how many years after radiation exposure ?
A. 2 – 3 years
B. 5 – 7 years
C. 10 – 15 years
D. 20 – 25 years
Explanation:- High-dose radiation increase the risk of myeloid leukemias that peak 5 – 7 years after exposure. Therapeutic radiation alone adds little risk of AML.

633 Use of which of the following drugs may evolve into AML ?
A. Chloramphenicol
B. Phenylbutazone
C. Chloroquine
D. All of the above
Explanation:- Anticancer drugs are the leading cause of therapy-associated AML occuring 4-6 years after exposure. Chloramphenicol, phenylbutazone, chloroquine & methoxypsoralen can result in bone marrow failure that may evolve into AML.

634 In WHO classification, the blast cutoff for a diagnosis of AML is ?
A. 10 %
B. 15 %
C. 20 %
D. 30 %

635 In French-American-British (FAB) classification, the blast cutoff for a diagnosis of AML is ?
A. 10 %
B. 15 %
C. 20 %
D. 30 %
Explanation:- Difference between WHO and FAB systems for a diagnosis of AML is the blast cutoff. It is 20% in WHO classification and 30% in FAB.

636 Out of the following, which acute myeloid leukemia is most common ?
A. M0 – Minimally differentiated leukemia
B. M1- Myeloblastic leukemia without maturation
C. M2 – Myeloblastic leukemia with maturation
D. M3 – Hypergranular promyelocytic leukemia
Explanation:- Minimally differentiated leukemia (M0 – 5%), Myeloblastic leukemia without maturation (M1 – 20%), Myeloblastic leukemia with maturation (M2 – 30%), Hypergranular promyelocytic leukemia (M3 – 10%).

637 Out of the following, which acute myeloid leukemia is most common ?
A. M4 – Myelomonocytic leukemia
B. M5 – Monocytic leukemia
C. M6 – Erythroleukemia (DiGuglielmo’s disease)
D. M7 – Megakaryoblastic leukemia
Explanation:- Myelomonocytic leukemia (M4 – 20%), Monocytic leukemia (M5 – 10%), Erythroleukemia (DiGuglielmo’s disease) (M6 – 4%), Megakaryoblastic leukemia (M7 – 1%).

638 Which of the following is false about AML with t(15;17) cytogenetic rearrangement ?
A. Juxtaposes PML with RAR
B. Encodes a chimeric protein
C. Associated with disseminated intravascular coagulation
D. Have a very poor prognosis
Explanation:- AML FAB M3 is called acute promyelocytic leukemia (APL) based on presence of either t(15;17)(q22;q12) cytogenetic rearrangement or PML/RAR product of translocation. They have a very good prognosis. DIC is associated with t(15;17). Patients with complex karyotype, t(6;9), inv(3) or 7 have a very poor prognosis.

639 Which of the following is false about AML with t(8;21) cytogenetic rearrangement ?
A. Older age
B. Associated with myeloid sarcomas
C. Granulocytic sarcoma or chloroma common
D. Back pain, lower extremity weakness common
Explanation:- AML associated with younger age are t(8;21) & t(l5;17), with older age are del(5q) and del(7q).

640 Whar proportion of AML patients will have leukocyte count of more than 100,000 per μL ?
A. 10 %
B. 20 %
C. 30 %
D. 40 %
Explanation:- Median presenting leukocyte count is about 15,000/μL. 25 & 40% of patients have counts <5000/μL, & 20% have counts >100,000/μL. <5% have no detectable leukemic cells in the blood.

641 Whar proportion of AML patients will have platelet count of less than 100,000 per μL ?
A. 25 %
B. 50 %
C. 75 %
D. 100 %
Explanation:- Platelet counts <100,000/μL are found at diagnosis in 75% of patients, and about 25% have counts <25,000/μL.

642 Auer rods are seen in ?
A. Acute myeloid leukemia
B. Myelodysplastic syndromes
C. Chronic myelomonocytic leukemia
D. All of the above
Explanation:- Auer rods are a hallmark of acute myeloid leukemia but occasionally are seen in myelodysplastic syndromes (MDSs) or chronic myelomonocytic leukemia.

643 Rasburicase is used in ?
A. Contrast nephropathy
B. Salt-wasting nephropathy
C. Uric acid nephropathy
D. Diabetic nephropathy
Explanation:- Rasburicase, a recombinant uric-oxidase enzyme, catalyzes enzymatic oxidation of uric acid into a soluble metabolite, allantoin. Rasburicase is contraindicated in G6PD deficiency. It is used in uric acid nephropathy, & tumor lysis syndrome.

644 In determining complete remission (CR) in AML, which of the following is not included ?
A. Neutrophil count
B. Platelet count
C. Hemoglobin concentration
D. Circulating blasts
Explanation:- In determining CR, blood neutrophil count must be >=1000/μL & platelet count >=100,000/μL & circulating blasts should be absent. Hemoglobin level is not considered in determining CR.

645 In determining complete remission (CR) in AML, which of the following is included ?
A. Bone marrow cellularity >20% with trilineage maturation
B. <5% blasts in bone marrow
C. Absent Auer rods
D. All of the above
Explanation:- In determining CR, bone marrow cellularity should be >20% with trilineage maturation with <5% blasts, and Auer rods should be absent. Extramedullary leukemia should not be present.

646 In AML, which of the following predict poor outcome with initial therapy ?
A. Advancing age
B. Hyperleukocytosis (>100,000/μL) at presentation
C. Secondary AML after cytotoxic agents
D. All of the above
Explanation:- Advancing age is associated with a poorer prognosis because AML in older patients differs biologically (multidrug resistance 1 (MDR1) efflux pump). Prolonged symptomatic interval with cytopenias (anemia, leukopenia, &/or thrombocytopenia for >3 months) preceding diagnosis of AML is associated with lower CR rate & shorter survival time. Secondary AML due to cytotoxic agents is difficult to treat successfully. Hyperleukocytosis (>100,000/μL), early CNS bleeding & pulmonary leukostasis contribute to poor outcome with initial therapy. Patients who achieve CR after one induction cycle have longer CR durations than those requiring multiple cycles.

647 Which of the following chromosome findings in AML have a very good prognosis ?
A. t(15;17)
B. t(8;21)
C. t(6;9)
D. inv(3)
Explanation:- AML patients with t(15;17) have a very good prognosis (~85% cured), those with t(8;21) and inv(16) a good prognosis (~55% cured), those with no cytogenetic abnormality have a moderately favorable outcome (~40% cured). AML patients with a complex karyotype, t(6;9), inv(3), or -7 have a very poor prognosis.

648 Antimetabolite Cytarabine interferes with which phase of cell cycle ?
A. M-phase
B. S-phase
C. G1-phase
D. G2-phase
Explanation:- Cytarabine is a cell cycle S-phase–specific antimetabolite that becomes phosphorylated intracellularly to an active triphosphate form (1--D-arabinofuranylcytosine-triphosphate) that interferes with DNA synthesis.

649 Which of the following drugs are of use in AML ?
A. Idarubicin
B. Cytarabine
C. Daunorubicin
D. All of the above
Explanation:- Most commonly used CR induction regimens in AML (other than acute promyelocytic leukemia – APL) is a combination chemotherapy with cytarabine and Daunorubicin or Idarubicin. Addition of etoposide may improve the CR duration.

650 After how many induction courses, AML patients who fail to attain CR should proceed to allogeneic stem cell transplant ?
A. 1
B. 2
C. 3
D. 4
Explanation:- Patients who fail to attain CR after two induction courses should immediately proceed to an allogeneic hematopoietic stem cell transplant (HSCT) if an appropriate donor exists.

651 Toxicity with high-dose cytarabine includes ?
A. Myelosuppression
B. Pulmonary toxicity
C. Irreversible cerebellar toxicity
D. All of the above
Explanation:- Toxicity with high-dose cytarabine includes myelosuppression, pulmonary toxicity, and significant and occasionally irreversible cerebellar toxicity.

652 Which of the following may protect heart against anthracycline toxicity ?
A. Ascorbic acid
B. Iron
C. Thiamine
D. Dexrazoxane
Explanation:- Dexrazoxane is an antidote to doxorubicin-induced extravasation. It’s an intracellular Fe chelator, protects heart against anthracycline toxicity by preventing Fe-dependent freeradical generation.

653 Which of the following drugs is used in the treatment of acute promyelocytic leukemia (APL) ?
A. Gemcitabine
B. Etoposide
C. Asparginase
D. Tretinoin

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