Question 1

Which of the following test results is most consistent with a diagnosis of multiple myeloma?

Accepted Answer

A) Increased plasma cell concentration in peripheral circulation 
B) Low calcium levels 
C) RBC aggregates on the peripheral blood smear 
D) Blasts in the peripheral blood 
A) Increased plasma cell concentration in peripheral circulation 
B) Low calcium levels 
C) RBC aggregates on the peripheral blood smear 
D) Blasts in the peripheral blood A

Question 2

Compare and contrast the lab features of the following disorders:
A)Plasmacytoma
B)Multiple myeloma
C)MGUS
D)Waldenström's macroglobulinemia

Accepted Answer

Plasmacytoma: Localized tumor collection of plasma cells; can lead to multiple myeloma.
Multiple myeloma: Proliferating cell line: plasma cell; immunoglobulin produced: IgG.
MGUS: low level of monoclonal protein produced without the presence of an underlying neoplasm.
Waldenström's macroglobulinemia: Proliferating cell lines: lymphocytes, plasma cells, and lymphoid cells; immunoglobulin produced: IgM.

Question 3

Explain how environmental factors contribute to the pathogenesis of lymphoid neoplasms.

Accepted Answer

The Epstein-Barr virus infects B lymphocytes, where it remains latent under the immune system's control.The EBV-infected cells can proliferate if the host becomes immunocompromised and/or the B lymphocytes acquire additional genetic abnormalities.
Helicobacter pylori leads to antigen-driven T lymphocyte stimulation and subsequent B lymphocyte activation.The B lymphocytes initially are polyclonal, and depend entirely on T cell stimulation.With time, the B cell population can proliferate autonomously.

Question 4

Which of the following laboratory tests would best help differentiate multiple myeloma and Waldenstrom's macroglobulinemia?

Accepted Answer

A) Peripheral blood smear 
B) Isoelectric focusing 
C) Bone marrow aspirate 
D) Total protein measurement 
A) Peripheral blood smear 
B) Isoelectric focusing 
C) Bone marrow aspirate 
D) Total protein measurement

Question 5

Hairy cell leukemia and chronic lymphocytic leukemia appear morphologically similar to the untrained eye.Which of the following tests would help differentiate between the two?

Accepted Answer

A) Immunophenotyping 
B) Cytogenetic analysis 
C) TRAP stain 
D) PAS staining 
A) Immunophenotyping 
B) Cytogenetic analysis 
C) TRAP stain 
D) PAS staining

Question 6

Which of the Hodgkin lymphoma histologic subtypes is composed of numerous reactive small lymphocytes and rare tumor cells that grow in loose nodular aggregates or popcorn cells-i.e., L&H cells?

Accepted Answer

A) Classic HL 
B) Nodular sclerosis 
C) Mixed cellularity 
D) Lymphocyte-predominant 
A) Classic HL 
B) Nodular sclerosis 
C) Mixed cellularity 
D) Lymphocyte-predominant

Question 7

A lymph node biopsy is performed in a patient with lymphadenopathy.Which of the following findings would support the diagnosis of a reactive proliferation rather than a malignant lymphoma?

Accepted Answer

A) A mixed population of cells varying in size, shape, and color 
B) Clonality 
C) Presence of large, bizarre cells 
D) Mitotic activity 
A) A mixed population of cells varying in size, shape, and color 
B) Clonality 
C) Presence of large, bizarre cells 
D) Mitotic activity

Question 8

Which of the following statements is correct regarding MGUS and multiple myeloma (MM)?

Accepted Answer

A) MGUS has a low level of monoclonal spike without an underlying neoplasm, whereas MM has a monoclonal spike along with an underlying neoplasm. 
B) MGUS has a monoclonal spike that is IgM in nature, whereas MM has a monoclonal spike that is IgG in nature. 
C) MGUS exhibits tumor localization, whereas MM exhibits tumor dissemination. 
D) MGUS and MM are the same. 
A) MGUS has a low level of monoclonal spike without an underlying neoplasm, whereas MM has a monoclonal spike along with an underlying neoplasm. 
B) MGUS has a monoclonal spike that is IgM in nature, whereas MM has a monoclonal spike that is IgG in nature. 
C) MGUS exhibits tumor localization, whereas MM exhibits tumor dissemination. 
D) MGUS and MM are the same.

Question 9

An increase in paraprotein concentration of a single isoform is defined as:

Accepted Answer

A) Immune response. 
B) Monoclonal gammopathy. 
C) Oligoclonal banding. 
D) Hyperparaproteinemia. 
A) Immune response. 
B) Monoclonal gammopathy. 
C) Oligoclonal banding. 
D) Hyperparaproteinemia.

Question 10

In the subgroups of chronic leukemic lymphoid malignancies, which are the key features of Sézary syndrome?

Accepted Answer

A) CD3+, CD2+, CD5+, CD4+, CD8± 
B) CD3+, CD2+, CD5+, CD4+, CD8±, CD7− 
C) CD19+, CD5−, CD20+ strong intensity 
D) CD22+, CD103+, CD11c+, CD25+ 
A) CD3+, CD2+, CD5+, CD4+, CD8± 
B) CD3+, CD2+, CD5+, CD4+, CD8±, CD7− 
C) CD19+, CD5−, CD20+ strong intensity 
D) CD22+, CD103+, CD11c+, CD25+

Question 11

Which subgroup of CLL reveals pancytopenia, TRAP+, CD19+, CD5−, CD20+ strong intensity, CD22+, CD103+, CD11c+, and CD25+ with circulating hairy cells?

Accepted Answer

A) B cell chronic lymphocytic leukemia 
B) T cell PLL 
C) Hairy cell leukemia 
D) Sézary syndrome 
A) B cell chronic lymphocytic leukemia 
B) T cell PLL 
C) Hairy cell leukemia 
D) Sézary syndrome

Question 12

A diagnosis of CLL requires morphologic and phenotypic findings of which of the following?

Accepted Answer

A) Variable absolute lymphocyte counts with few prolymphocytes and CD38+ 
B) Sustained absolute lymphocyte counts with mature lymphocytes, few prolymphocytes, smudge cells, CD20+, and ZAP-70+ 
C) Marked absolute lymphocytosis, anemia, and thrombocytopenia; prolymphocytes less than 10% 
D) Sustained absolute lymphocyte counts, mature lymphocytes; CD3−, CD2+, CD4−, CD8−, CD7+, CD16+, CD56+/CD57− 
A) Variable absolute lymphocyte counts with few prolymphocytes and CD38+ 
B) Sustained absolute lymphocyte counts with mature lymphocytes, few prolymphocytes, smudge cells, CD20+, and ZAP-70+ 
C) Marked absolute lymphocytosis, anemia, and thrombocytopenia; prolymphocytes less than 10% 
D) Sustained absolute lymphocyte counts, mature lymphocytes; CD3−, CD2+, CD4−, CD8−, CD7+, CD16+, CD56+/CD57−

Question 13

A technologist is reviewing a lymph node biopsy slide, and notices a prominent lymphocytosis as well as the presence of a few tumor cells with the following characteristics: large, multi-lobated nucleus with delicate nuclear membranes; finely granular chromatin; and small, indistinct nucleoli.Based on this information, from what stage and disease is the patient most likely suffering?

Accepted Answer

A) Anaplastic large cell lymphoma 
B) Lymphocyte predominant Hodgkin's lymphoma 
C) Monoclonal gammopathy of undetermined significance 
D) Lymphocyte depleted Hodgkin's lymphoma 
A) Anaplastic large cell lymphoma 
B) Lymphocyte predominant Hodgkin's lymphoma 
C) Monoclonal gammopathy of undetermined significance 
D) Lymphocyte depleted Hodgkin's lymphoma

Question 14

Which of the following agents promotes the development of non-Hodgkin's lymphoma through MALT infiltration?

Accepted Answer

A) BCL-2 translocation 
B) Helicobacter pylori 
C) Epstein-Barr virus 
D) Ataxia telangiectasia 
A) BCL-2 translocation 
B) Helicobacter pylori 
C) Epstein-Barr virus 
D) Ataxia telangiectasia

Question 15

In multiple myeloma the erythrocytes have a distinct abnormality in the peripheral blood.Which of the following is that abnormality?

Accepted Answer

A) Rouleaux formation 
B) Moth-eaten appearance 
C) Agglutinates 
D) Polychromasia 
A) Rouleaux formation 
B) Moth-eaten appearance 
C) Agglutinates 
D) Polychromasia

Question 16

Which of the following contributes to the pathogenesis of lymphoid neoplasms?

Accepted Answer

A) Genetic anomalies 
B) Inherited immunodeficiency syndromes 
C) Viral infections 
D) All of the above 
A) Genetic anomalies 
B) Inherited immunodeficiency syndromes 
C) Viral infections 
D) All of the above

Question 17

The presence of which of the following cells in peripheral circulation strongly indicates Sézary syndrome?

Accepted Answer

A) Lymphocytes with nuclear clefting 
B) Lymphocytes with cerebriform convoluted nuclei 
C) Normal lymphocytes 
D) Lymphocytes with bilobed nuclei 
A) Lymphocytes with nuclear clefting 
B) Lymphocytes with cerebriform convoluted nuclei 
C) Normal lymphocytes 
D) Lymphocytes with bilobed nuclei

Question 18

Which protein is identified as free light chains in the urine?

Accepted Answer

A) MGUS 
B) Heavy chains 
C) M spike 
D) Bence Jones 
A) MGUS 
B) Heavy chains 
C) M spike 
D) Bence Jones

Question 19

A technologist is reviewing a blood smear and notices 35% lymphocytes with azurophilic granules and nuclei with mature clumped chromatin.These cells are typical of those found in:

Accepted Answer

A) Hairy cell leukemia. 
B) Sézary syndrome. 
C) Large granular lymphocyte leukemia. 
D) Chronic prolymphocytic leukemia. 
A) Hairy cell leukemia. 
B) Sézary syndrome. 
C) Large granular lymphocyte leukemia. 
D) Chronic prolymphocytic leukemia.

Question 20

Which of the following detects clonality in an unknown cell population?

Accepted Answer

A) Absolute lymphocytosis using morphology 
B) CD4-positive T cells 
C) Kappa light chain only present on B cells 
D) Both kappa and lambda light chains present on B cells 
A) Absolute lymphocytosis using morphology 
B) CD4-positive T cells 
C) Kappa light chain only present on B cells 
D) Both kappa and lambda light chains present on B cells

Exam 25: Lymphoid Malignancies: Chronic Lymphoid Leukemias, Lymphomas, and Plasma Cell Neoplasms

Which of the following test results is most consistent with a diagnosis of multiple myeloma?

Compare and contrast the lab features of the following disorders: A)Plasmacytoma B)Multiple myeloma C)MGUS D)Waldenström's macroglobulinemia

Explain how environmental factors contribute to the pathogenesis of lymphoid neoplasms.

Which of the following laboratory tests would best help differentiate multiple myeloma and Waldenstrom's macroglobulinemia?

Hairy cell leukemia and chronic lymphocytic leukemia appear morphologically similar to the untrained eye.Which of the following tests would help differentiate between the two?

Which of the Hodgkin lymphoma histologic subtypes is composed of numerous reactive small lymphocytes and rare tumor cells that grow in loose nodular aggregates or popcorn cells-i.e., L&H cells?

A lymph node biopsy is performed in a patient with lymphadenopathy.Which of the following findings would support the diagnosis of a reactive proliferation rather than a malignant lymphoma?

Which of the following statements is correct regarding MGUS and multiple myeloma (MM)?

An increase in paraprotein concentration of a single isoform is defined as:

In the subgroups of chronic leukemic lymphoid malignancies, which are the key features of Sézary syndrome?

Which subgroup of CLL reveals pancytopenia, TRAP+, CD19+, CD5−, CD20+ strong intensity, CD22+, CD103+, CD11c+, and CD25+ with circulating hairy cells?

A diagnosis of CLL requires morphologic and phenotypic findings of which of the following?

Which of the following agents promotes the development of non-Hodgkin's lymphoma through MALT infiltration?

In multiple myeloma the erythrocytes have a distinct abnormality in the peripheral blood.Which of the following is that abnormality?

Which of the following contributes to the pathogenesis of lymphoid neoplasms?

The presence of which of the following cells in peripheral circulation strongly indicates Sézary syndrome?

Which protein is identified as free light chains in the urine?

A technologist is reviewing a blood smear and notices 35% lymphocytes with azurophilic granules and nuclei with mature clumped chromatin.These cells are typical of those found in:

Which of the following detects clonality in an unknown cell population?

Introduction

Cellular Homeostasis

Hematopoiesis

Structure and Function of Hematopoietic Organs

The Erythrocyte

Hemoglobin

The Leukocyte

Introduction to Anemia

Anemias of Disordered Iron Metabolism and Heme Synthesis

Hemoglobinopaties: Qualitative Defects

Thalassemia

Megaloblastic and Nonmegaloblastic Macrocytic Anemias

Introduction to Hemolytic Anemia

Hemolytic Anemia: Membrane Defects

Hemolytic Anemia: Enzyme Deficiencies

Hemolytic Anemia: Immune Anemias

Hemolytic Anemia: Nonimmune Defects

Nonmalignant Granulocyte and Monocyte Disorders

Nonmalignant Lymphocyte Disorders

Introduction to Hematopoietic Neoplasms

Myeloproliferative Disorders

Myelodysplastic Syndromes

Acute Myeloid Leukemias

Acute Lymphoblastic Leukemias

Hematopoietic Stem Cell Transplantation

Morphologic Analysis of Body Fluids in the Hematology Laboratory

Primary Hemostasis

Secondary Hemostasis and Fibrinolysis

Disorders of Primary Hemostasis

Disorders of Secondary Hemostasis

Thrombophilia

Hematology Procedures and Hemostasis

Bone Marrow Examination

Automation in Hematology and Hemostasis

Flow Cytometry

Chromosome Analysis of Hematopoietic and Lymphoid Disorders

Molecular Analysis of Hematologic Diseases

Laboratory Testing in Coagulation

Quality Assessment in the Hematology Laboratory

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