Question 1

Explain the International Prognostic Scoring System (IPSS) score system for prognosis and treatment of MDS.

Accepted Answer

The IPSS for MDS assigns a score based on the progression of the disease. The higher the number of immature cells present, the worse the prognosis and the lower the survival rate.

Question 2

Myelodysplastic syndromes are sometimes called preleukemias because:

Accepted Answer

A)  They have a progressive induction into acute leukemia 
B)  They frequently progress to aplastic anemia 
C)  Treatment for this disorder leads to leukemia 
D)  They always precede leukemia 
A)  They have a progressive induction into acute leukemia 
B)  They frequently progress to aplastic anemia 
C)  Treatment for this disorder leads to leukemia 
D)  They always precede leukemia A

Question 3

Which of the following laboratory tests would not be helpful in identifying MDS/MPN, U?

Accepted Answer

A)  Immunophenotyping 
B)  Bone marrow analysis 
C)  Cytogenetic analysis 
D)  Molecular-based testing 
A)  Immunophenotyping 
B)  Bone marrow analysis 
C)  Cytogenetic analysis 
D)  Molecular-based testing A

Question 4

All of the following are included in the MDS/MPN family except:

Accepted Answer

A)  MDS-RS 
B)  CMML 
C)  Atypical chronic myeloid leukemia, BCR/ALB1- 
D)  JMML 
A)  MDS-RS 
B)  CMML 
C)  Atypical chronic myeloid leukemia, BCR/ALB1- 
D)  JMML

Question 5

Which test or tests support the theory that the abnormal cells in MDS are clones derived from an abnormal pluripotent stem cell?

Accepted Answer

A)  Cytochemical studies 
B)  Peripheral blood smear examination 
C)  Bone marrow examination 
D)  Cytogenetic and molecular studies 
A)  Cytochemical studies 
B)  Peripheral blood smear examination 
C)  Bone marrow examination 
D)  Cytogenetic and molecular studies

Question 6

Which of the following does the World Health Organization's classification consider an MDS/MPN variant?

Accepted Answer

A)  Polycythemia vera 
B)  Refractory anemia with ringed sideroblasts 
C)  Chronic myelogenous leukemia 
D)  Atypical chronic myeloid leukemia, BCR/ALB1- 
A)  Polycythemia vera 
B)  Refractory anemia with ringed sideroblasts 
C)  Chronic myelogenous leukemia 
D)  Atypical chronic myeloid leukemia, BCR/ALB1-

Question 7

Which of the following MDS/MPN classifications includes the immunophenotype CD33, CD13 +, MPO +?

Accepted Answer

A)  Chronic myelomonocytic leukemia-1 
B)  Chronic myelomonocytic leukemia-2 
C)  Atypical chronic myeloid leukemia, BCR/ABL1- 
D)  Juvenile myelomonocytic leukemia 
A)  Chronic myelomonocytic leukemia-1 
B)  Chronic myelomonocytic leukemia-2 
C)  Atypical chronic myeloid leukemia, BCR/ABL1- 
D)  Juvenile myelomonocytic leukemia

Question 8

A 60-year-old patient visited his general practitioner because of fatigue and unexplained bruising. Physical examination revealed a frail, thin, pale man with widespread bruising. A CBC was ordered and revealed abnormal granularity of platelets and leukocytes. Red cells appeared dimorphic. Bone marrow analysis showed 20% ringed sideroblasts with dysplastic changes in RBC and WBC precursors. No cytogenetic abnormalities were detected. Based on this information, what is a probable diagnosis?

Accepted Answer

A)  Acute leukemia 
B)  Chronic lymphocytic leukemia 
C)  Myelodysplastic syndrome 
D)  Myeloproliferative syndrome 
A)  Acute leukemia 
B)  Chronic lymphocytic leukemia 
C)  Myelodysplastic syndrome 
D)  Myeloproliferative syndrome

Question 9

What must be seen in the bone marrow to confirm refractory anemia with ringed sideroblasts?

Accepted Answer

A)  A minimum of 30% ringed sideroblasts 
B)  A minimum of 5% ringed sideroblasts 
C)  A minimum of 5% monoblasts 
D)  A minimum of 15% ringed sideroblasts 
A)  A minimum of 30% ringed sideroblasts 
B)  A minimum of 5% ringed sideroblasts 
C)  A minimum of 5% monoblasts 
D)  A minimum of 15% ringed sideroblasts

Question 10

A 58-year-old male visits his physician for extreme fatigue. After conducting a standard investigation, the physician strongly suspects that the patient is suffering from CML. Which of the following lab results would confirm this picture?

Accepted Answer

A)  Hypercellular bone marrow 
B)  Hypercellular bone marrow with dysmyelopoiesis 
C)  Positive molecular analysis for BCR/ABL1 
D)  Increased WBC count 
A)  Hypercellular bone marrow 
B)  Hypercellular bone marrow with dysmyelopoiesis 
C)  Positive molecular analysis for BCR/ABL1 
D)  Increased WBC count

Question 11

A 61-year-old woman saw her primary care physician because of fatigue and dyspnea on exertion for the past 3 months. Past medical history noted that the patient had been treated 5 years earlier with the DNA alkylating agent cyclophosphamide, non-Hodgkin lymphoma. A CBC revealed the following:
WBC: 3.6 × 109/L
RBC: 2.8 × 1012/L
Hb: 9.1 g/dL
MCV: 104 fL
Reticulocyte count: 2.0%
Normal vitamin B12 and folic acid levels
PLT: 120 × 109/L
Differential: 6% blasts
A bone marrow biopsy revealed hypercellularity, and dyshematopoiesis of all three myeloid lineages.
Suggest an appropriate follow-up test and a likely diagnosis for this patient.

Accepted Answer

Cytogenetics would be an appropriate fol

Question 12

According to the WHO classification, what percent of blasts must be present in the bone marrow to classify a patient with acute leukemia?

Accepted Answer

A)  19 
B)  20 
C)  30 
D)  1 
A)  19 
B)  20 
C)  30 
D)  1

Question 13

Explain the pathophysiology of MDS.

Accepted Answer

MDS results from persistent gr

Question 14

Which of the following characteristics are associated with a poor prognosis for MDS?

Accepted Answer

A)  25% bone marrow blasts 
B)  Normal karyotypes 
C)  No cytopenias 
D)  <5% marrow blasts 
A)  25% bone marrow blasts 
B)  Normal karyotypes 
C)  No cytopenias 
D)  <5% marrow blasts

Question 15

On which characteristic is the WHO classification system for each subgroup of myelodysplastic syndrome based?

Accepted Answer

A)  Peripheral blood and bone marrow morphology 
B)  Cytogenetic abnormalities 
C)  Number of cytopenias 
D)  All of the above 
A)  Peripheral blood and bone marrow morphology 
B)  Cytogenetic abnormalities 
C)  Number of cytopenias 
D)  All of the above

Question 16

All of the following are considered morphologic evidence of dyserythropoiesis except:

Accepted Answer

A)  Abnormal degranulation 
B)  Dimorphic cell population 
C)  Oval macrocytes 
D)  Karyorrhexis 
A)  Abnormal degranulation 
B)  Dimorphic cell population 
C)  Oval macrocytes 
D)  Karyorrhexis

Question 17

Which World Health Organization (WHO) classification for MDS is best supported when the peripheral blood shows a general cytopenia, 5-19% blasts with Auer rods, and 9 /L monocytes?

Accepted Answer

A)  Refractory anemia 
B)  Refractory anemia with excess blasts 2 
C)  MDS associated with isolated del(5q) 
D)  Refractory cytopenia with multilineage dysplasia 
A)  Refractory anemia 
B)  Refractory anemia with excess blasts 2 
C)  MDS associated with isolated del(5q) 
D)  Refractory cytopenia with multilineage dysplasia

Question 18

Which of the following is a defining characteristic of myelodysplastic syndromes (MDS)?

Accepted Answer

A)  One or more peripheral blood cytopenias 
B)  The presence of BCR/ABL1 
C)  Overproliferation of all myeloid elements 
D)  Dyslymphopoiesis 
A)  One or more peripheral blood cytopenias 
B)  The presence of BCR/ABL1 
C)  Overproliferation of all myeloid elements 
D)  Dyslymphopoiesis

Question 19

A patient blood smear shows oval macrocytes, a dimorphic population, and basophilic stippling. The peripheral blood also has 6% blasts. What is the presumptive classification based on these findings?

Accepted Answer

A)  Refractory anemia (MDS-SL
D)  
B)  Refractory anemia with ringed sideroblasts (MDS-RS) 
C)  Refractory anemia with excess blasts -1 (MDS-EB-1) 
D)  Refractory anemia with excess blasts -2 (MDS-EB-2) 
A)  Refractory anemia (MDS-SL
D)  
B)  Refractory anemia with ringed sideroblasts (MDS-RS) 
C)  Refractory anemia with excess blasts -1 (MDS-EB-1) 
D)  Refractory anemia with excess blasts -2 (MDS-EB-2)

Question 20

Which of the following is a likely diagnosis in a 55-year-old male with a bone marrow cellularity of 22%?

Accepted Answer

A)  Therapy-related myelodysplasia 
B)  MDS with fibrosis 
C)  Myelodysplastic syndrome, unclassifiable 
D)  Hypoplastic MDS 
A)  Therapy-related myelodysplasia 
B)  MDS with fibrosis 
C)  Myelodysplastic syndrome, unclassifiable 
D)  Hypoplastic MDS

Exam 25: Myelodysplastic Syndromes

Explain the International Prognostic Scoring System (IPSS) score system for prognosis and treatment of MDS.

Myelodysplastic syndromes are sometimes called preleukemias because:

Which of the following laboratory tests would not be helpful in identifying MDS/MPN, U?

All of the following are included in the MDS/MPN family except:

Which test or tests support the theory that the abnormal cells in MDS are clones derived from an abnormal pluripotent stem cell?

Which of the following does the World Health Organization's classification consider an MDS/MPN variant?

Which of the following MDS/MPN classifications includes the immunophenotype CD33, CD13 +, MPO +?

What must be seen in the bone marrow to confirm refractory anemia with ringed sideroblasts?

A 58-year-old male visits his physician for extreme fatigue. After conducting a standard investigation, the physician strongly suspects that the patient is suffering from CML. Which of the following lab results would confirm this picture?

According to the WHO classification, what percent of blasts must be present in the bone marrow to classify a patient with acute leukemia?

Explain the pathophysiology of MDS.

Which of the following characteristics are associated with a poor prognosis for MDS?

On which characteristic is the WHO classification system for each subgroup of myelodysplastic syndrome based?

All of the following are considered morphologic evidence of dyserythropoiesis except:

Which World Health Organization (WHO) classification for MDS is best supported when the peripheral blood shows a general cytopenia, 5-19% blasts with Auer rods, and <1 × 109 /L monocytes?

Which of the following is a defining characteristic of myelodysplastic syndromes (MDS)?

A patient blood smear shows oval macrocytes, a dimorphic population, and basophilic stippling. The peripheral blood also has 6% blasts. What is the presumptive classification based on these findings?

Which of the following is a likely diagnosis in a 55-year-old male with a bone marrow cellularity of 22%?

Introduction

Cellular Homeostasis

Structure and Function of Hematopoietic Organs

Hematopoiesis

The Erythrocyte

Hemoglobin

Granulocytes and Monocytes

Lymphocytes

The Platelet

The Complete Blood Count and Peripheral Blood Smear Evaluation

Introduction to Anemia

Anemias of Disordered Iron Metabolism and Heme Synthesis

Hemoglobinopathies: Qualitative Defects

Thalassemia

Megaloblastic and Nonmegaloblastic Macrocytic Anemias

Hypoproliferative Anemias

Hemolytic Anemia: Membrane Defects

Hemolytic Anemia: Enzyme Deficiencies

Hemolytic Anemia: Immune Anemias

Hemolytic Anemia: Nonimmune Defects

Nonmalignant Disorders of Leukocytes: Granulocytes and Monocytes

Nonmalignant Lymphocyte Disorders

Introduction to Hematopoietic Neoplasms

Myeloproliferative Neoplasms

Acute Myeloid Leukemias

Precursor Lymphoid Neoplasms

Mature Lymphoid Neoplasms

Hematopoietic Stem Cell Transplantation

Morphologic Analysis of Body Fluids in the Hematology

Primary Hemostasis

Secondary Hemostasis and Fibrinolysis

Disorders of Primary Hemostasis

Disorders of Secondary Hemostasis

Thrombophilia

Hemostasis: Laboratory Testing and Instrumentation

Hematology Procedures

Bone Marrow Examination

Automation in Hematology

Flow Cytometry

Chromosome Analysis of Hematopoietic and Lymphoid Disorders

Molecular Analysis of Hematologic Diseases

Quality Assessment in the Hematology Laboratory

Filters

Which World Health Organization (WHO) classification for MDS is best supported when the peripheral blood shows a general cytopenia, 5-19% blasts with Auer rods, and <1 × 10⁹/L monocytes?