[MCQs] Acute and Chronic Myeloid Leukemia - Part 3

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Acute and Chronic Myeloid Leukemia

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Question 1

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

Question 1 Explanation:

Myeloid leukemias are characterized by infiltration of the blood, bone marrow, and other tissues by neoplastic cells of the hematopoietic system

Question 2

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

Question 2 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

Question 3

Disease associated with an increased incidence of AML is ?

A	Down syndrome
B	Fanconi anemia
C	Ataxia telangiectasia
D	All of the above

Question 3 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.

Question 4

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

Question 4 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

Question 5

Use of which of the following drugs may evolve into AML ?

A	Chloramphenicol
B	Phenylbutazone
C	Chloroquine
D	All of the above

Question 5 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.

Question 6

In WHO classification, the blast cutoff for a diagnosis of AML is ?

A	10 %
B	15 %
C	20 %
D	30 %

Question 7

In French-American-British (FAB) classification, the blast cutoff for a diagnosis of AML is ?

A	10 %
B	15 %
C	20 %
D	30 %

Question 7 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.

Question 8

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

Question 8 Explanation:

Minimally differentiated leukemia (M0 - 5%), Myeloblastic leukemia without maturation (M1 - 20%), Myeloblastic leukemia with maturation (M2 - 30%), Hypergranular promyelocytic leukemia (M3 - 10%)

Question 9

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

Question 9 Explanation:

Myelomonocytic leukemia (M4 - 20%), Monocytic leukemia (M5 - 10%), Erythroleukemia (DiGuglielmo’s disease) (M6 - 4%), Megakaryoblastic leukemia (M7 - 1%).

Question 10

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

Question 10 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.

Question 11

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

Question 11 Explanation:

AML associated with younger age are t(8;21) & t(l5;17), with older age are del(5q) and del(7q).

Question 12

Whar proportion of AML patients will have leukocyte count of more than 100,000 per µL ?

A	10 %
B	20 %
C	30 %
D	40 %

Question 12 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.

Question 13

Whar proportion of AML patients will have platelet count of less than 100,000 per µL ?

A	25 %
B	50 %
C	75 %
D	100 %

Question 13 Explanation:

100 %

Question 14

Auer rods are seen in ?

A	Acute myeloid leukemia
B	Myelodysplastic syndromes
C	Chronic myelomonocytic leukemia
D	All of the above

Question 14 Explanation:

Auer rods are a hallmark of acute myeloid leukemia but occasionally are seen in myelodysplastic syndromes (MDSs) or chronic myelomonocytic leukemia

Question 15

Rasburicase is used in ?

A	Contrast nephropathy
B	Salt-wasting nephropathy
C	Uric acid nephropathy
D	Diabetic nephropathy

Question 15 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.

Question 16

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

Question 16 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.

Question 17

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

Question 17 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.

Question 18

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

Question 18 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.

Question 19

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)

Question 19 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

Question 20

Antimetabolite Cytarabine interferes with which phase of cell cycle ?

A	M-phase
B	S-phase
C	G1-phase
D	G2-phase

Question 20 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.

Question 21

Which of the following drugs are of use in AML ?

A	Idarubicin
B	Cytarabine
C	Daunorubicin
D	All of the above

Question 21 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.

Question 22

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

Question 22 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

Question 23

Toxicity with high-dose cytarabine includes ?

A	Myelosuppression
B	Pulmonary toxicity
C	Irreversible cerebellar toxicity
D	All of the above

Question 23 Explanation:

Toxicity with high-dose cytarabine includes myelosuppression, pulmonary toxicity, and significant and occasionally irreversible cerebellar toxicity.

Question 24

Which of the following may protect heart against anthracycline toxicity ?

A	Ascorbic acid
B	Iron
C	Thiamine
D	Dexrazoxane

Question 24 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.

Question 25

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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See all quizzes of the Acute and Chronic Myeloid Leukemia at here:

Acute and Chronic Myeloid Leukemia Part 1 | Acute and Chronic Myeloid Leukemia Part 2 | Acute and Chronic Myeloid Leukemia Part 2

II. Preview all questions below

1. 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
.
2. 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

3. Disease associated with an increased incidence of AML is ?
A. Down syndrome
B. Fanconi anemia
C. Ataxia telangiectasia
D. All of the above

4. 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

5. Use of which of the following drugs may evolve into AML ?
A. Chloramphenicol
B. Phenylbutazone
C. Chloroquine
D. All of the above

6. In WHO classification, the blast cutoff for a diagnosis of AML is ?
A. 10 %
B. 15 %
C. 20 %
D. 30 %
7. In French-American-British (FAB) classification, the blast cutoff for a diagnosis of AML is ?
A. 10 %
B. 15 %
C. 20 %
D. 30 %

8. 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

9. 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

10. 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

11. 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

12. Whar proportion of AML patients will have leukocyte count of more than 100,000 per µL ?
A. 10 %
B. 20 %
C. 30 %
D. 40 %

13. Whar proportion of AML patients will have platelet count of less than 100,000 per µL ?
A. 25 %
B. 50 %
C. 75 %
D. 100 %

14. Auer rods are seen in ?
A. Acute myeloid leukemia
B. Myelodysplastic syndromes
C. Chronic myelomonocytic leukemia
D. All of the above

15. Rasburicase is used in ?
A. Contrast nephropathy
B. Salt-wasting nephropathy
C. Uric acid nephropathy
D. Diabetic nephropathy

16. 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

17. 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

18. 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

19. 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)

20. Antimetabolite Cytarabine interferes with which phase of cell cycle ?
A. M-phase
B. S-phase
C. G1-phase
D. G2-phase

21. Which of the following drugs are of use in AML ?
A. Idarubicin
B. Cytarabine
C. Daunorubicin
D. All of the above

22. 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

23. Toxicity with high-dose cytarabine includes ?
A. Myelosuppression
B. Pulmonary toxicity
C. Irreversible cerebellar toxicity
D. All of the above

24. Which of the following may protect heart against anthracycline toxicity ?
A. Ascorbic acid
B. Iron
C. Thiamine
D. Dexrazoxane

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

Chronic Myeloid Leukemia Chronic Myeloid Leukemia mcq

[MCQs] Acute and Chronic Myeloid Leukemia – Part 3

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Acute and Chronic Myeloid Leukemia

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[MCQs] Acute and Chronic Myeloid Leukemia – Part 2

[MCQs] Chronic Myeloid Leukemia (CML) – Part 1

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