Question 1

Which of the World Health Organization's MDS subgroups contains two or more cytopenias,rare or no blasts,<1 × 10⁹/L monocytes in the peripheral blood,<5% blasts,and <15% ringed sideroblasts in the bone marrow?

Accepted Answer

A)  Refractory anemia (R
A)  
B)  Refractory anemia with ringed sideroblasts (RARS) 
C)  Refractory cytopenia with multilineage dysplasia (RCM
D)  
D)  Refractory anemia with excess blasts 2 (RAEB-2)  C

Question 2

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

Question 3

Explain the relationship between myelodysplastic syndromes and acute leukemia.

Accepted Answer

Myelodysplastic syndromes eventually can progress into acute leukemia.Acute leukemia as defined by the WHO is classified with >20% blasts in the bone marrow.The MDS family is classified as <20% blasts proliferating in the marrow.

Question 4

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

Question 5

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

Question 6

The chromosomal abnormalities present in most cases of MDS are located on which of the following chromosomes?

Accepted Answer

A)  4,6,8
B)  3,7,12
C)  5,7,9
D)  5,7,8

Question 7

What is the major criterion for the diagnosis of acute leukemia?

Accepted Answer

A)  The cytoplasm of the blasts contains no granules.
B)  The nuclear cytoplasmic ratio in blasts is lower than that of type I blasts.
C)  The blast count is 
D)  The blast count is >20% in the bone marrow.

Question 8

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.

Question 9

Which of the following represents the granule pattern of a dysplastic cell in MDS?

Accepted Answer

A)  Agranular
B)  Hypogranular
C)  Clumped granular
D)  All of the above

Question 10

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-

Question 11

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

Question 12

A technologist is reviewing a blood smear and finds a rare blast.Bone marrow analysis shows dysplasia in 30% of the erythroblasts and the myeloid precursors and 4% blasts.What is a possible diagnosis based on these findings?

Accepted Answer

A)  RA
B)  RAEB-1
C)  RARS
D)  RCMD

Question 13

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

Question 14

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

The answer of A 61-year-old woman saw her primary care...

Question 15

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

Question 16

Explain the pathophysiology of MDS.

Accepted Answer

The answer of Explain the pathophysiology of MDS....

Question 17

A bone marrow specimen is received in the cytogenetics lab.FISH analysis has been ordered.The laboratician performs the assay and notices that 96% of the patient's cells contain both 5q- and 12q- deletions.These cytogenetic findings are characteristic of:

Accepted Answer

A)  CML
B)  AML
C)  MDS
D)  ALL

Question 18

An unknown cell possesses the following characteristics: blastlike with open chromatin pattern,prominent nucleoli,absence of granules,and a high N:C ratio.Based on this information,what is the cell's most probable identity?

Accepted Answer

A)  Agranular blast
B)  Granular blast
C)  Dysplastic promyelocyte
D)  Promyelocyte

Question 19

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

Accepted Answer

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

Question 20

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?

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

Exam 25: Myelodysplastic Syndromes