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a. Combination chemotherapy
b. Allogenic stem cell transplant
c. Empiric antibiotics
d. Imatinib
e. Hydroxyurea
6. After 3 years on the same drug and in haematologic and
cytogenetic remission review Showed mild splenomegaly and
Hb 9.4g/dl, WBC 20.5x109/l, platelets 88x109/l and blood film
shows predominant neutrophilia with left shift and 5% blasts.
What is the most probable diagnosis now?
a. Acute myeloid leukemia
b. Blastic phase
c. Accelerated phase
d. Sepsis
e. Richters transformation
7. What would be the most optimal treatment now
a. Combination chemotherapy
b. Increase doses of current therapy
c. Allogenic stem cell transplant
d. Intravenous antibiotics
e. Observation
Extended matching Questions:
For each clinical history, choose the most appropriate specific
answer. One answer only
List A
8. A 4year old boy is noted to have
extensive bruising on his legs and
forearms, his mother has noticed in
the past week he is listless and noted
bleeding of his gums on brushing his
teeth. She got worried when he
started limping. His paediatrician
finds on examination generalized
lymphadenopathy with generalized
petechiae and ecchymoses. Hb
5g/dl., WBC 47.8 6x109/l with 78%
blasts with high nuclear cytoplasmic
ratio, no cytoplasmic granules;
platelets 23x109/l
ACUTE LYMPHOBALSTIC
LEUKEMIA
9. A 47 year old woman has a history of
breast cancer and treated with
chemotherapy and radiation ten
years ago. She currently has a
history of epistaxis and gum bleed
with extensive ecchymoses. Hb
List B
a. Acute Myeloid
Leukaemia
b. Acute
pormelocytic
Leukemia
c. Chronic
Myelocytic
Leukemia
d. Acute
Lymphoblastic
Leukemia
e. Chronic
Lymphocytic
Leukemia
f. Viral infection
g. Bacterial sepsis
h. Reactive
lymphocytosis
i. Toxic
neutrophilia
j. Herpes Zoster
infection
CHRONIC
MYELOCYTIC
LEUKEMIA
12.
A 54 year old lady went to the
dentist and had a tooth extraction.
After 2 weeks she still had oozing
from the tooth bed. She also was now
having a fever and feeling unwell so
she visited her GP. Blood test done
showed Hb 9.8g/dl, WBC 23x109/l,
platelets16x109/l, peripheral film
showed 50% blasts which contained
Auer rods.
ACUTE MYELOID LEUKEMIA
13.
A 4 year old girl is brought to the ER due to fever. Lab
data:
WBC 15.2 x 109/l; Hgb 12.0 g/dL; PLT 200 x 109/l; Differential results:
58% neutrophils, 25% bands, 10% lymphs, 7% monos
The appearance of her WBCs are shown.
Bone Marrow
a. What is his most likely disorder and its cause? Leukomoid
reaction causing sepsis.
b. How did you rule out CML? The LAP is high
18.
This 53 year year old male had noticed the onset of easy
fatigability and bruising. He saw his doctor when hedeveloped
a boil in the perianal area. His CBC and subsequent bone
marrow exam (shown) were abnormal. Lab data: WBC 78.0
x109/l; Hgb 7.3 g/dL, PLT 59 x109/l.
Bone
Marrow
a. What
is the most likely diagnosis?
20.
This 72 year old male was discovered to have an
elevatedWBC count 4 years ago. He has never received
therapyfor his disorder. Physical examination showed no
palpable lymphadenopathy. Lab data: WBC 50.7 x109/l; Hgb
13.9 g/dL, PLT 223 K/uL. Diff:10% neytrophils, 89%
lymphocytes, 1% monocytes.
His blood smear is shown.