PA H7 | Benign Leukocytosis & Leukemias — Practice Quiz

A 28-year-old medical intern develops fever, severe sore throat, and cervical lymphadenopathy. CBC shows WBC 14,000/µL with 40% atypical lymphocytes. The peripheral smear shows large lymphocytes with abundant pale-blue cytoplasm, irregular nuclei, and prominent nucleoli. Monospot test is positive. Which of the following BEST describes the atypical lymphocytes seen in this condition?

A 35-year-old man presents with progressively increasing abdominal girth and early satiety for 6 months. Examination reveals massive splenomegaly. CBC: WBC 180,000/µL with a full myeloid spectrum (blasts 2%, myelocytes, metamyelocytes, bands, neutrophils), basophilia, and eosinophilia. Platelets 600,000/µL. Leukocyte alkaline phosphatase (LAP) score is 8. Which investigation would MOST directly confirm the diagnosis?

A 25-year-old woman is evaluated for a WBC of 28,000/µL discovered incidentally during antenatal workup at 32 weeks gestation. She is afebrile and asymptomatic. Differential: 85% neutrophils, 10% bands, 5% metamyelocytes. No toxic granules. No blasts. LAP score is 140. Which is the MOST likely diagnosis?

A 4-year-old boy is brought with pallor, easy bruising, and bone pain for 3 weeks. CBC: Hb 7 g/dL, WBC 60,000/µL with 80% blasts, platelets 30,000/µL. Bone marrow shows lymphoblasts. Cytochemistry: MPO negative, TdT positive. Cytogenetics shows t(12;21) ETV6-RUNX1. Which statement about this patient's disease is MOST accurate?

A 42-year-old man presents with acute onset fever, gum bleeding, and diffuse petechiae. CBC: Hb 9 g/dL, WBC 20,000/µL with blasts, platelets 15,000/µL. PT and aPTT are prolonged; fibrinogen is critically low; D-dimers are markedly elevated. Bone marrow shows promyelocytes with abundant azurophilic granules and Auer rod bundles (faggot cells). Which genetic abnormality BEST explains the DIC in this patient?

A 70-year-old retired farmer is found to have lymphocytosis of 35,000/µL on routine CBC. He is asymptomatic. Peripheral smear shows small, mature-looking lymphocytes with scant cytoplasm and many smudge (basket) cells. Flow cytometry: CD19+, CD5+, CD23+, CD20 dim, surface Ig dim. Which is the MOST likely diagnosis?

A 65-year-old man with known CLL (on watchful waiting) presents with worsening fatigue, new autoimmune haemolytic anaemia (positive direct Coombs), and recurrent chest infections. His CLL lymphocyte count has increased from 18,000 to 72,000/µL over 6 months. Which of the following BEST explains the recurrent infections in this patient?

During a hematology tutorial, students compare CML and CLL. Which of the following CORRECTLY pairs a distinguishing feature with the right diagnosis?

A medical student reviewing a peripheral blood smear identifies cells with blue-staining granules on a Leishman-stained smear in a patient with an eosinophil count of 3,200/µL. The patient also has post-nasal drip, itchy eyes, and seasonal exacerbations. Which of the following is the MOST LIKELY cause of this eosinophilia?

A 17-year-old girl presents with fever, fatigue, and generalised lymphadenopathy for 4 weeks. CBC: WBC 3,800/µL with neutrophils 42%, lymphocytes 50% (absolute count 1,900/µL). She is started on amoxicillin-clavulanate empirically for pharyngitis, after which she develops a widespread maculopapular rash. Monospot is later confirmed positive. Which is the MOST important reason to AVOID amoxicillin in this patient?

A 55-year-old male smoker has a WBC of 22,000/µL with 90% neutrophils on a routine health check. He has no fever, no focal infection, and no splenomegaly. LAP score is 180. Which of the following is the MOST likely explanation?

A 3rd-year MBBS student is reviewing a bone marrow report of a 60-year-old man with pancytopenia. The report states: '30% of nucleated cells are myeloblasts; MPO-positive by cytochemistry; cytogenetics show normal karyotype; FLT3-ITD mutation detected.' The student concludes this is AML. Which clinical feature at presentation would MOST strongly support this diagnosis over ALL in an adult?